Nursing Interventions

The decision to have an operative procedure will result in varied reactions and response and its significance depends on a variety of factors. The impact of a surgical procedure that is experienced by the client is greatly influenced by:

1. Diagnosis or the reason for surgery
2. Significance of the loss of childbearing or fertility
3. Knowledge of anatomy and physiology
4. Meaning, assumptions, and values of sexual identity
5. Type and rationale of premorbid sex activity

Each of the above will be discussed briefly with emphasis on nursing assessment and interventions.

Diagnosis or the Reason for Surgery

Responses to surgery are influenced by the amount of choice that is perceived by the client in undergoing or not undergoing a recommended surgical intervention. Was the decision based on choice or was it forced on the client due to a disease process? Genital cancer, a dreaded disease, may also be a threat to independence, physical comfort, and survival. The surgical intervention may provide some hope for the relief of pain or bleeding urinary symptoms and still create feelings of anger, despair, and guilt, “What did is do to deserve this?” is a common concern.

“The possible link between genital herpes infections and cancer, as well as the association between prenatal stilbestrol exposure and malignancy are issues frequently brought to the clinician.”

However, if the client makes a decision after prolonged pelvic pain or excessive bleeding, there may be feelings of relief and hopes of improving health after the surgical procedure. Those with cancer of the colon or rectum may feel that they had no viable alternatives.

Understanding that the amount of choice, the time for preoperative or anticipatory planning, and how expectancies and past sexual experiences influence the acceptance of the surgical interventions is crucial for therapeutic nurse assessment and intervention.

Awareness of the Significance of the Loss of Childbearing or Fertility

Some women and men will need to mourn the loss of the childbearing function. The significance of the loss will often depend on the wishes and expectations of the woman and partner for future pregnancy. However, some women view themselves “desexed” without the capability of conceiving even though there is no plan or wish for future pregnancies. Other women will enjoy the freedom from concern of an unwanted pregnancy and the annoyance of routine menses. The significance of the loss cannot be judged from the values and expectations of the health personnel. For example, it is not uncommon to hear a nurse say, “I cannot understand why Mrs. S. is so upset about a hysterectomy since she has four children that she does not take care of.” The nurse who bases the significance of the loss of the childbearing function on the number of children without assessing what the hysterectomy means to the client and partner will have difficulty in being therapeutic. Suppose Mr. and Mrs. S. believe or presume that the capability of conceiving is necessary in order to be an adequate sex partner or to enjoy sex relations. In this instance, the number of children would not prove to be a valid measure for the significance of the loss.

In other situations the client may feel ambivalent and behaviors will not be consistent regarding the loss of childbearing. The nurse can be helpful in explaining and clarifying feelings and expectations of the loss. Mourning the loss of childbearing and fertility should be anticipated since this function is significant for many clients for a great variety of reasons. Again, the key to successful nursing intervention is awareness of one’s own feelings and values and an accurate assessment of client’s knowledge, attitudes, and perception of the loss.

Knowledge of Anatomy and Physiology

The understanding of the function of the organs that will be removed or damaged and what relevant complications might be expected is very important to most clients. Simple drawings or illustrations can be helpful in reviewing the structure of internal and external genital organs, their location in the body, and their function. Misconceptions and myths can be bothersome. Repeated sessions, alone and with partner, may be needed to increase understanding of the surgical intervention.

Meaning, Assumptions, and Values of Sexual identity

Four dimensions which include biological gender, sexual orientation, sex role, and femininity-masculinity characteristics are usually considered in sexual identity. These dimensions are interrelated and difficult to isolate for individuals or for groups of men and women in different societal subgroups. The value placed on sex organs by self, partner, and society are not static and seem to change as needs of the society change. For example, in an agricultural society with needs of a population increase, the uterus or childbearing function may have different values than when this same society moves into an industrial status with decreasing resources and a need to limit the population. Sex role, aspects of femininity-masculinity, and perhaps sexual orientation are certainly personalized but influenced by society’s needs, interpersonal relations, and past sexual experiences.

Type and rationale of Premorbid Sex Activity

Not all sex premobid activity is alike, nor does it always occur in a “healthy” heterosexual marital relationship that is blissful and satisfying. Premorbid sex activity may include extramarital, nonmartial, autosexual, and homosexual activities. How a vaginal surgical intervention will affect a woman with no interest in vaginal intercourse is very different from the women who believes her partner will abandon her if vaginal intercourse is not possible, even for a short period during recovery. An older woman with no partner will have less fear of abandonment but may have fears of mutilation that would interfere with autoeroticism or seeking new partners. Removal of the rectum may prove a very difficult decision for the male homosexual because of preferred anal sexual activity. There will be some clients who will be happy for a legitimate excuse not to have sexual relations. Partners may feel this is the time for extramarital relations. Determining what the client defines as sexual preference and problem solving to help maintain or find alternate methods requires that the nurse not be bound by a definite set of “appropriate or right ways” for sexual satisfaction.

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Category: Sex & Sexuality