Why do I not find pleasure after masturbating?

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Care aims to look after people in need of care, [1] to alleviate illnesses and to promote health. This includes the holistic concern for well-being and thus - at least in theory - also includes sexual well-being as an important health factor and contribution to the quality of life. But what does the practice look like? This article describes the current state of research and development on dealing with sexuality in nursing and derives recommendations for action for politics.

Why is sexuality important?

Sexual wellbeing is a basic need for most people. Because sexuality fulfills four important functions. [2]

Pleasure function: Sexual activities of the most varied kinds allow physical and mental pleasure, sensuality, excitement and relaxation to be felt, and in an intensity and quality that other activities can hardly convey.

Relationship function: In partner sexuality, interpersonal closeness, intimacy, connectedness and security can literally be experienced first hand on an existential level.

Identity function: Sexuality conveys confirmation of one's own gender and sexual identity.

Fertility function: Sexuality enables biological reproduction and also includes other creative dimensions. Sexual activities can bring about and strengthen transcendent and spiritual experiences, for example a connection with all living things or with a divine principle.

People differ in which aspects of sexuality are particularly important to them and how they shape them in the course of their lives. A fulfilling sexuality is by no means only reserved for young, healthy, beautiful and fit people, even if it may often appear that way in the media. Empirical studies show that sexuality is important for most people over the entire lifespan and that this importance also applies to old and advanced ages and to short-term or long-term care needs. [3] In addition to masturbation and sexual intercourse, the desired sexual expression above all includes tenderness like caresses, kisses, hugs and massages, Ritualslike sleeping in a bed, holding hands, making yourself pretty, but also crushes, flirtations, compliments, sexual and romantic conversations, Books, films, memories and fantasies.

The great importance of self-determined sexuality is recognized not least by the World Health Organization by defining well-being as part of health and sexual well-being as an express part of sexual health. [4] Sexual health is therefore more than the absence of sexually transmitted infections, sexual dysfunction, unplanned pregnancies and sexual violence, but includes the highest possible degree of sexual well-being.

Why does care need to be concerned with sexual wellbeing?

People who are dependent on care for the short and especially long term have, against the background of internationally recognized human rights and the UN Convention on the Rights of Persons with Disabilities - just like everyone else - a right to sexual self-determination and participation. [5]Sexual human rights refer to both property rights and civil liberties. Nursing staff and nursing facilities are therefore required to provide sex-friendly framework conditions. In theory, this means that those in care must be given active opportunities to live out their sexualities in an individually self-determined manner - this should happen without impairing third parties, but also without devaluation, discrimination and moral sanctions by third parties.

Do not treat sex as a taboo, but consciously take care of it sex-friendly values Orientation is entirely compatible with ecclesiastical, charitable and humanistic values. Current care concepts and quality manuals from institutions for the disabled and elderly are increasingly integrating sex-friendly guidelines for dealing with sexuality. The "Quality Handbook of the Senior Citizens' Homes of the Oder-Spree District" (to be requested there) expressly records the rights of those in care to self-determined sexuality, specifically naming, among other things, masturbation, opposite and same-sex sexual contacts, pornography and sexual assistance. At the same time, it is stipulated in detail that and how the intimate and private sphere of those in care should be respected and how it should be dealt with if care activities trigger unplanned sexual arousal.

Nursing research is also strongly advancing the removal of taboos from sexuality. [6] In doing so, two sets of sex-related claims of people in need of care are identified. These coincide with the demands that are formulated in the political movement for the elderly and the disabled as well as in the corresponding research fields of Aging Studies and Disability Studies, all of which are formulated in a human rights-oriented framework.

Improving Sexual Education and Counseling: Even in a society that is apparently oversexualized by the media, it is still extremely difficult to address individual sexual experiences and needs in all areas of society. This also applies to medicine and nursing. Many people still do not receive the necessary sex-related education and advice in the course of short- or long-term care. Regardless of whether it is about cancer or neurodermatitis, depression or paraplegia, autism or high-risk pregnancy, high blood pressure, diabetes or dementia: what effects can be expected on sexuality and how these effects can be successfully dealt with individually, as a couple or as a family, which offers of help are available for specific sexual problems, all of this is discussed far too seldom and / or there is a lack of access to existing specialized sex advice centers. This creates avoidable burdens and risks and at the same time misses opportunities for sexual well-being.

Improvement of practical support for self-determined expression and living out of their sexualities: In particular, people with long-term care needs are severely restricted in their everyday autonomy. Your sexual self-determination and participation is essentially defined and often limited by the conditions of the care. Because even if they are well informed, they can usually only pursue sexual activities if they have active support available on request in care contexts, for example with access to aids, rooms and contacts, and if protection against sexual violence and transgressions is provided at the same time .

Sexuality in care as crossing borders

The human right to self-determined sexuality includes protective rights. In the context of care, there are two main aspects of protection: protection from sexual violence and protection of others from their own sexually inappropriate behavior.

Protection from sexual violence
Nursing and violence research has empirically proven that people in need of care are exposed to a significantly increased risk of sexual victimization. This is particularly true for Girls and women with physical and so-called mental disabilities: They are sexually victimized two to three times as often as women in the general population. [7] Older women are also often exposed to sexual violence. [8] The already increased sexual victimization increases in women in need of care, as they are often particularly difficult to defend themselves due to their impairments, since they are not always believed in the event of attacks, and since they are more often in dependency and vulnerable situations due to the need for care. The perpetrators are predominantly men, mostly from close social contact, such as family members, partners, roommates in the facility, work colleagues in the workshop and caregivers.

They are also particularly vulnerable Children and adolescents with care needs as well as presumably gender-diverse people. Even if men are sexually victimized significantly less often than women, report Menwith disabilities to a significant extent have experienced sexual violence. [9] Up-to-date and gender-sensitive protection concepts are therefore very important for all care facilities.

Protect others from their own sexually inappropriate behavior
People in need of care with developmental disorders and learning difficulties have often not learned "norm-compliant" sexual behavior and are therefore conspicuous for behaving inappropriately. People with dementia are also often perceived as sexually disinhibited: [10] They sexually touch roommates and carers against their will, move around in public without clothes, masturbate in the hallway or in the dining room. In terms of prevention, the aim here is to learn an appropriate closeness-distance regulation, to adopt and enforce common house rules, to train the nursing staff in appropriate interventions. A pharmacological treatment to suppress sexually inappropriate behavior is basically possible, but poorly researched, harbors health risks and ethical problems, which is why non-drug solutions how to prefer learning appropriate sexual expression. The specialist literature is relatively unanimous in the view that intervening in the case of sexually inappropriate behavior by people in need of care is urgent for their own protection and the protection of third parties, but must not result in the suppression of any sexual expression.