Sexual Health Workshop.
Part One.
3.5 hours.
Sexuality, Sexual Health in New
Zealand and the Role of the Nurse.
First: Ground Rules
Ground Rules for Discussion
 Absolute confidentiality.
 Respect: demonstrated by
 Active listening
 Allowing each person to talk for designated time
 Respecting differences in cultural and life
 Open to learning.
 May choose same or mixed sex group for
Group Discussion. In Groups of 5-6
• What is appropriate to discuss in my
family/culture about sex and
• What I leaned at home and at school
about sex and sexuality.
Relates to HEAL6012 Learning
Examine concepts of Primary Health Care and apply to community
nursing practice.
• Demonstrate understanding and application of basic epidemiological
concepts to community health.
Demonstrate understanding and application of recent research, including
population health statistics, health determinants and appropriate
literature in assessing and identifying health issues for individuals and
groups in the community.
Critically discuss the role of the nurse within the community, specifically
advocacy, enabling and mediation for individuals and groups.
1. Discuss in small groups the influence of own
cultural and of sexual health teaching in school
curricula regarding sex and sexual health
2. Outline the concept of sexuality.
3. Outline NZ Government priorities regarding key
directions for Sexual and Reproductive Health
Strategy (2002).
4. Discuss the Long Term personal and societal
outcomes of teenage pregnancies for both
mother and the children of teenage mothers.
5. Outline the effects of pornography as an
International Public Health Issue.
6. Outline the qualities of effective sexuality
7. Outline sexual health screening and barriers
to sexual health screening.
8. Discuss the nurses role in relations to stigma
and de-stigmatisation in sexual health.
9. Outline recent NZ epidemiology re STIs and
abortions. AND
10. Outline general signs and symptoms of STIs,
assessment and history taking.
11. Discuss the nurse’s role in health education
regarding STIs treatment and prevention.
12. Outline legal aspects and notifiable STI diseases
under the Health Act (and Regulations) 1956.
13. Outline the health professional’s role in
contact/partner tracing.
 Goldberg, S., Adapted by Rolley, J. (2008). Nursing
Management: Sexually transmitted infections. (pp.14631479). In: Lewis medical-surgical nursing. Assessment
and Management of Clinical Problems. Sydney: Mosby
• N.Z Family Planning Organisation has excellent teaching
kits you can borrow.
 Ministry of Health (2001): Sexual and Reproductive
Health Strategy. Wellington, NZ: Author.
 Perrin, P. C., Madanat, H.N., Barnes, M.D., Carolan, A.,
Clark, R. B., Ivins, N., Tuttle, H.A V., & Williams,.
P.N.(2008). Health Education’s role in framing
pornography as a public health issue: local and national
strategies with international implications. In IUHPEPromotion & Education. Vol. 15, (1) 11-18.
References cont.
• White, J. Mortensen, A. (2003). Counteracting
Stigma in Sexual Health Care Settings. In: The
Internet Journal of Advanced Nursing Practice. Vol 6.
No. 1. pp 1523-6064
Setting the scene from
Best Practice Advocacy Centre New Zealand
Professor Murray Tilyard BSc, MBChB, DipObst, MD (Otago), FRNZCGP (Dist)
Editor-in-Chief, Executive Director and CEO, bpacnz (Note his credentials).
BPAC NZ. (2013). Sexually transmitted infections
in New Zealand. Retrieved from
Obj. 2. Sexuality
• Sexuality is the totality of an individuals attitudes,
values, goals, and behaviours (both internal and
external) based on, or determined by , perceptions of
• It is so central to our identity that it permeates
nearly every aspect of self-knowledge, self
expression and self ideal.
• Expression of ones concept of sexuality, is closely
related to physical, cognitive and moral
• See last years notes on gender role, gender identity,
sex, gender orientation, masculinity and femininity.
(Review Nurs.5061).
Objective 3.Health Strategy. Phase
One (MOH 2001).
Positive sexuality and healthy sexual reproductive
health are Government priorities. As we are sexual
beings, positive sexual identity and sexuality are
fundamental to our sense of self, self-esteem and
ability to lead a fulfilling life.
• Govt. focus is on 2 key areas:
1. NZ’s increasing number of sexually transmitted
infections (STI’s), particularly chlamydia,
gonorrhoea and HIV/Aids.
2. The high level of unintended/unwanted
MOH (2002) Sexual/ Reproductive Health
Strategic Directions One, Two, and Three
pp. 7-10. (15-17 on computer counter)
See on-line Strategy at:
One: Societal attitudes, values and behaviour (Read).
Two: Personal knowledge, skills and behaviour (Read)
Three: Services (Read this for homework)
People with disabilities face specific problems:
1. Acquiring a positive sexual identity
2. In accessing mainstream sexual and
reproductive health services.
3. Parents may not see their disabled young
person as a sexual being.
4. Common problems in adulthood include
inadequate or poor access to information
(Braille), services not physically accessible,
and many are vulnerable to sexual abuse.
Obj. 4. Discuss the possible long term
consequences of
Sexual Health problems
HIV consequence may be death (much better management
Rates of chlamydia and gonorrhoea have increased over
past years, in NZ.
Rates disproportionately high for Maori and PI peoples.
Antibiotic resistance to standard treatment for gonorrhoea
is increasing.
STI’s may lead to infertility from pelvic inflammatory
disease, cancer, and other chronic diseases.
NZ has very high adolescent pregnancy rate. This leads to
social and economic problems for mum, and :
Increases the child’s risk of poor outcomes in education,
health, and welfare.
And outcomes of teenage pregnancy for
mother and children of teen mothers?
What does International Research tell us?
1. Babies at higher risk of low birth weight
2. Higher rates of infant mortality
3. More likely to grow up in homes that offer lower levels of
emotional support and cognitive stimulation.
Why?....add you own findings from Readings here.
1. Low levels of educational attainment, increased welfare
dependency, maternal depression and less competent
Why?.... add you own findings from Readings here
What does recent NZ Research tell
• Results:
• Early motherhood was associated with higher levels of
mental health disorders, lower levels of educational
achievement, higher levels of welfare dependence, lower
levels of workforce participation, and lower income. Boden
JM; Fergusson DM; John Horwood L
• Author's Address:
– Christchurch Health and Development Study, University of Otago,
Christchurch School of Medicine and Health Sciences, New Zealand.
• Source:
– Journal Of Child Psychology And Psychiatry, And Allied Disciplines [J
Child Psychol Psychiatry] 2008 Feb; Vol. 49 (2), pp. 151-60. Date of
Electronic Publication: 2007 Dec
What about teenage mothers in
• ]The Paediatric Society - Auckland District
Health Board
• Number of Teenage Births in the Auckland
DHB Region during 1990-2001. Table 3. ...
Teenage Birth Rates by Ethnicity, Auckland
DHB 1996-2003. Figure 11.
• (See pgs. 12-14 of report)
Obj. 5. Discuss Pornography as a Public
health Issue.
Potential adverse effects.
For the user:
• Sexual addiction
• Sexually acting out
• Deviant sexual behaviour
• Predisposes or intensifies the predisposition to rape
 See Reference. Perrin, P. C., Madanat, H.N., Barnes, M.D., Carolan, A., Clark,
R. B., Ivins, N., Tuttle, H.A V., & Williams,. P.N.(2008). Health Education’s role in
framing pornography as a public health issue: local and national strategies with
international implications. In IUHPE- Promotion & Education. Vol. 15, (1) 11-18.
Women and pornography
• Higher likelihood to be described in sexualized
• Forced to participate in violent sexual acts
such as rape
• More likely to be categorized in traditional
gender roles
• More likely to experience sex without
emotional involvement
• Broken marriages
Cartoon: Roast Busters' latest victim – The NZ Herald
Thursday Oct 30, 2014. Perpetrators are heavy
pornograpgy users.
Children and pornography
• Become victims of sexual interest
• Victims of sexual maltreatment and fantasies
• Accessibility increases use by child of
pornography as source of sex education,
which creates future unrealistic and harmful
attitudes towards sex and relationships.
Teenagers and Pornography
• This clip is useful for all teenagers, and
especially for young women and parents of
teenage girls
Obj. 6. Outline qualities of effective
sexuality education.
(Family Planning 20/9/2011).
• International evidence proves, good quality,
comprehensive sexuality ed. delays onset of
sexual activity, reduces number of partners,
frequency of intercourse, and increases
condom and contraceptive use.
• Programmes are effective when they begin
before the young person first has sex.
• More effective when home and school
• Parents are first sexuality educators. Values
are ‘taught, not caught’. Role models.
• Normalizing sexuality and sexual health
• Young people are maturing earlier, so ed.
should start earlier: include attitudes and
values, knowledge and skills, communication,
negotiation and resisting pressure.
• Plethora of overtly sexualised media messages
Obj. 7. Outline Sexual Health Screening,
and barriers to sexual health screening.
Why have a sexual health screen?
1. Start of a new relationship
2. Episode of risk
3. Regular check ups
4. Symptomatic-visible signs of infection
Why come to a sexual Health Clinic?
1. Confidentiality
2. Anonymity
3. Specialist Services
4. Free Service
Barriers to Sexual health
1. Stigma associated with STI’s
• Shame
• Embarrassment
2. Poor access to health care
• Poverty
• Cultural issues
• Marginalized groups
3. Bad sexual health consultation experience
• Clinician can often ensure a positive outcome
Obj. 8. Stigma and
• Historically people with STI have been
stigmatized through prejudice and negative
social attitudes.
• Some health professionals believe clients with
STI’s have deviated from the norms of
respectable illness.
• Polarized ‘them’ (indecent, diseased) and ‘us,’
the decent, clean and healthy. (E.g. women
with cervical cancer)
The process of destigmatisation.
Is…a conscious process of the reversal of the negative
cultural message about STI’s
Health care practitioners have a key role.
• Professional responsibility to change the secrecy,
stigma, and silence around sexuality.
• Begin with self: exploring and reflecting own
attitudes and values (see handout).
• Understand the relationship between poor socioeconomic and cultural conditions and poor patterns
of sexual and reproductive self-care.
• Nurse engages therapeutically with client
through, intense rapport building,
identification (how he she might feel in
same situation), personalization, respect
and dignity and client empowerment.
Obj.9. Define STIs , outline who gets it, and
recent NZ epidemiology of STIs and abortions.
• Who gets it?
1. Anyone who has had more than one sex
partner ever, or whose partner has had more
than one sex partner.
2. Young people between the ages of 15-25 are
highest risk.
3. If you don’t ask about sexual health issues,
they may not tell you.
4. Even when seeing a young person for
another health issue, do ask about their
sexual health
Obj. 9.a. Recent NZ Epidemiology.
Surveillance data from the ESR.
• Information from Sexual Health Clinics, (including
Student Health Clinics), Family Planning and
Laboratory data
• Chlamydia
• Gonorrhoea
• Syphilis
eillance/sti_surveillance.php (see Tables slides).Note,
Clinic and Laboratory data and Annual Reports that combine lab and
clinic data.
Increase of STIs in over 60s.
April 2014 WHO:"Antimicrobial resistance:
global report on surveillance"
• Treatment failure to the last resort of treatment for
gonorrhoea–third generation cephalosporins–has
been confirmed in Austria, Australia, Canada, France,
Japan, Norway, Slovenia, South Africa, Sweden and
the United Kingdom. More than 1 million people are
infected with gonorrhoea around the world every
Abortion Rates
Congenital syphilis
(note on ESR site the rise in cases of
• All pregnant women should be tested for syphilis in pregnancy.
• Penicillin is the only antibiotic proven to be effective in the management
of gestational syphilis.
• Children born to mothers treated with a nonpenicillin regimen should be
considered to have been treated inadequately.
• Syphilis and HIV coinfection is not uncommon.
• All children with clinical or serological evidence of congenital syphilis
should be treated with penicillin G for 10 to 14 days. Close clinical and
serological follow-up of all children potentially exposed to syphilis in utero
is required.
Obj. 10. Outline General Signs and
• Common general symptoms:
• in females include: purulent discharge,
dysuria( painful urination), abnormal bleeding,
or pain and bleeding with coitus, lower
abdominal pain and in genital warts…horny
papules on vulva, vagina, cervix, anal canal,
and urethra.
In Males
• Purulent urethral discharge, dysuria,
epididymitis, prostatitis, testicular pain, nonspecific urethritis.
• In addition, horny papules anal canal, urethra,
glans penis,
• For both sexes, flu like symptoms and inguinal
canal enlargement.
Nursing Management. Begin with
Assessment: History taking.
Set the scene
Be aware of your own anxieties (alternative clinician?)
Privacy. Other people can hear you.
Explain why you want to ask some questions
Confidentiality (check if want partner there).
Use plain language
Explain why you will ask questions specific to sexual
Indicates where to take swabs from
Indicates what to test for
Questions to ask: (some open
some closed).
Do you have a current partner?
Is your partner male or female?
How long have you been together?
For males, have you ever had sex with a male?
For females, pregnancy risk
Have you had any other partners in the last 3-6
• When was your last sexual contact? (incubation
period for STI check-2 weeks)
• Sexual abuse?
• Drug use?
Nursing Management
See Book of Readings. (pp….)
Assessment (see previous slides).
Nursing Diagnosis (take own brief notes)
Planning (take own brief notes)
Nursing Implementation: Focus: Health
• Read p. 1475-1476 (in Lewis) now. Note
in particular Table 52.10 Patient and
Family Teaching Guide.
Nursing Management must
1. Nurses first responsibility in STI control is
educate people in a non-judgemental
manner. Build trust and rapport.
2. R.N must confront own feelings and
attitudes (see stigmatisation slides).
3. Attend to holistic needs, emotions (guilt,
fear, shame), self esteem, physical treatment
(must complete medication and have
clearance), self care, knowledge of how is
spread, responsibilities (letting partner
know), hygiene, self examination…etc. (Read
pages as above).
• 1. To ensure clients understand the
medication given and the need for
follow-up to establish the success of
treatment I.e. cure.
• 2. To assess and refer on to other
agencies where appropriate. E.g.
counseling, Rape Crisis etc.
Obj.11. Evaluation of Client Education
See p. 1477-p. 201 of Book of Readings
• Expected Outcomes of effective client
education are that the client describes:
1. modes of transmission
2. and uses appropriate hygienic measures
3. states that he/she will have no reinfection
4. explains compliance behaviour with follow
up protocols.
Summary of Main Education Points
1. Acknowledge clients feelings about having
STI (most important)
2. To ensure clients have a full understanding
of the disease they have and the effects it
will/may have on themselves and their
3. To discuss with and educate clients about
prevention and ensure that learning has
Obj. 12. Legal Aspects of Sexual
Under Health Act 1956
• Section 88. Persons suffering from veneral disease MUST
undergo treatment:
• 1. Must be under a medical practitioner and attend for
• 2. Must attend for treatment until cured
• 3. Person will commit and offence if does not comply with
the above.
whole.html#DLM307283 (see 88 and 89)
Legal aspect continued.
Section 89 Duty of Medical Practitioner
• Venereal diseases: Section 89, requires medical practitioners
to educate their patients regarding STI’s about:
• 1. the infectious nature of the disease and the penalties under
the Act for infecting any other person with the disease.
• 2. Warn patient not to have sexual relations until cured of
that disease or is free from disease in communicable form
• 2. Give written information re treatment of disease and the
duties of person suffering from disease.
• Regulation 7 (1982)
• Any patient who is evading treatment to be referred to the
Medical Officer of Health (same with any sexual contacts of
this person).
Section 92. Infecting any person
with veneral disease.
• Every person who knowingly infects
another person with venereal disease
commits an offence and is liable to a fine
not exceeding 1,000 or to imprisonment
for a term not exceeding 1 year or to
Obj. 13. Contact Tracing/Partner
• Health Professional must:
1. Discuss with clients their sexual history, partners,
and practices, to ascertain who needs contacting.
2. Negotiate with clients as to who will contact/trace
their partners.
3. Advise no sex until partner (and client) has
completed treatment and partner tested
4. Stress that partner requires treatment even if tests
are negative.
5. Advise that casual contacts should be advised to
seek testing and treatment if contactable.
General MOH Resources re Sexual
Health in variety of Languages
NZ Family Planning Resources:
• See Resources
Your Teenager and Sexual Health
• (see Sexual health left side of screen)
Sexuality and Law – Sources of information
Rape Prevention Education - Legal Definitions of Rape and other Sexual
• Community Law Offices. See for:
• About Us: Sexual Orientation, Gender Identity and the Law in New
Zealand, Youth and the law, and Legal information for pregnant tenagers.
Community Law Centres:
• h
Critical thinking (for Revision)
• Discuss the current contributing factors
related to the current high STI and
unplanned pregnancies rates in New
• (See pg. 1464 in extract in Book of
View the DVD
• Sexually Transmitted infections: what we can’t
• Publisher. VEA (Video Education Australia)
Bendigo Vic. Classroom Video
• Available in the library: 616:951
For Interest Only.
Trans Gender DVD from:
The Guardian Newspaper:14 August 2014
• ‘There’s no such thing as a Sex Change’
Using vulgar language to teach sex
education to boys?
• From The New Zealand Herald
• Sex ed for boys needs to be 'vulgar' - expert
• 10:20 AM Thursday Oct 24, 2013.
Your Questions
• When is it appropriate to
engage in sexual practices?
For females and males?
• When can children come to
the clinic
• When can children/young
people be taught about sex
and sexuality?
• What is a transgendered person?
• (Transgendered =person born
with the physical characteristics
of one sex who emotionally and
psychologically feels that they
belong to the opposite sex. ∎ a
person who has undergone
surgery and hormone treatment
in order to acquire the physical
characteristics of the opposite
sex). (Oxford Dictionary).
Your Questions
• Is there a link between
(chromosome) xxy
people and the way
they identify? They
present as males, but
do they ‘feel’ female?
There are a number of theories, but
as yet, no scientific consensus.
Different cultural beliefs and norms
about gender (some cultures have
more than 2).
Biological theories include: XXY and
May be considered inter-sex but not
identify as transgender
Some speculate that hormones and
some that brain structure is involved.
Clear than some people are aware
they are transgender from earliest
Your Questions
•Sexual health issues for homosexual
•How can I talk to an adolescent
and transgendered persons
•Does sexual orientation contribute
to poor sexual health?
•What family support available for
families with a family member who is
gay, lesbian or transgendered.
about sexuality and sexual health?
•What are different cultures attitudes
•What education is given in school
and in universities?
•How can youth begin to explain to
their religious parents about being
sexually active?
to homosexuality and contraception?
•How can we protect ourselves (as
•Why are some youth more sexually
active than others? Is there a cultural
Your Questions
•What is safe sex?
•How do we solve sexual abuse?
•Who decides what is right for
someone sexually?
•What if it goes against our own
•Help for youth in incestuous
• What is the prevalence of STI’s
amongst hetero and homosexual
young people?
•Types of contraceptives/options
• Sexual health and chronic illness.
•How to use a condom.
•Sexual violation: what help is
E.g. CHF, Coronary heart disease,
chronic respiratory disease.
• What about contraception(See
part 2 Thursday).

2012 Sexual Health Workshop. Part One.