Risk for Sexual Dysfunction | Nursing Care Plan for Fecal Diversions

Nursing diagnosis: risk for Sexual Dysfunction

Risk factors may include
Altered body structure and function, radical resection or treatment procedures
Vulnerability, psychological concern about response of significant other (SO)
Disruption of sexual response pattern, such as erectile difficulty

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Sexual Functioning
Verbalize understanding of relationship of physical condition to sexual problems.
Identify satisfying and acceptable sexual practices and explore alternative methods.
Resume sexual relationship as appropriate.

Nursing intervention with rationale:
1. Determine client’s and SO’s sexual relationship before the disease or surgery and whether they anticipate problems related to presence of ostomy.
Rationale: Identifies future expectations and desires. Mutilation and loss of privacy and control of a bodily function can affect client’s view of personal sexuality. When coupled with the fear of rejection by SO, the desired level of intimacy can be greatly impaired. Sexual needs are very basic, and client will be rehabilitated more successfully when a satisfying sexual relationship is continued or developed as desired.

2. Review with client and SO sexual functioning in relation to own situation.
Rationale: Understanding if nerve damage has altered normal sexual functioning (e.g., erection) helps client and SO to understand the need for exploring alternative methods of satisfaction.

3. Reinforce information given by the physician. Encourage questions. Provide additional information as needed.
Rationale: Reiteration of data previously given assists client and SO to hear and process the knowledge again, moving toward acceptance of individual limitations or restrictions and prognosis, such as that it may take up to 2 years to regain potency after a radical procedure or that a penile prosthesis may be necessary.

4. Discuss likelihood of resumption of sexual activity in approximately 6 weeks after discharge, beginning slowly and progressing, such as cuddling and caressing until both partners are comfortable with body image and function changes. Include alternative methods of stimulation, as appropriate.
Rationale: Knowing what to expect in progress of recovery helps client avoid performance anxiety and reduce risk of “failure.” If the couple is willing to try new ideas, this can assist with adjustment and may help to achieve sexual fulfillment.

5. Encourage dialogue between partners. Suggest wearing pouch cover, T-shirt, short nightgown, or special underwear designed for sexual contact.
Rationale: Disguising ostomy appliance may aid in reducing feelings of self-consciousness and embarrassment during sexual activity.

6. Stress awareness of factors that might be distracting— unpleasant odors and pouch leakage. Encourage use of sense of humor.
Rationale: Promotes resolution of solvable problems. Laughter can help individuals deal more effectively with difficult situation and promote positive sexual experience.

7. Problem-solve alternative positions for coitus.
Rationale: Minimizing awkwardness of appliance and physical discomfort can enhance satisfaction.

8. Discuss and role play possible interactions or approaches when dealing with new sexual partners.
Rationale: Rehearsal is helpful in dealing with actual situations when they arise, preventing self-consciousness about “different” body image.

9. Provide birth control information as appropriate and stress that impotence does not necessarily mean client is sterile.
Rationale: Confusion may exist that can lead to an unwanted pregnancy.

10. Arrange meeting with an ostomy visitor, if appropriate.
Rationale: Sharing of how these problems have been resolved by others can be helpful and reduce sense of isolation.