FNP

Sexual Development Across the Lifespan

Sexual development begins in utero with differentiation of the internal and external genitalia. Genetic sex determined at conception initiates hormonal cascades that produce phenotypic sex characteristics; variations result in differences of sex development that require specialized evaluation. Childhood sexuality involves curiosity about bodies and reproduction: self-touching, looking at others' bodies, and asking questions are developmentally appropriate. Behaviors involving coercion, a significant age difference between children, or adult-like sexual acts require further assessment.

Pubertaldevelopment(Tannerstaging)

Sex	TypicalOnset	Sequence
Female	Ages8–13	Breast budding (thelarche) pubic hair (pubarche) growth spurt menarche → → →
		(averageage125) .
Male	Ages9–14	Testicular enlargement penile enlargement pubic hair growth spurt → → →

Pubertal changes before age 8 in girls or 9 in boys. Central:

No breast development by 13 in girls or no testicular

early activation of the hypothalamic-pituitary-gonadal axis.

enlargement by 14 in boys. Constitutional delay is most

Peripheral: sex steroid production independent of central

common, but exclude hypogonadotropic hypogonadism and

activation. Evaluate with bone age, gonadotropins, and imaging

primary gonadal failure.

as indicated.

Sexual History Assessment

Approach sexual health assessment in a nonjudgmental, inclusive manner. Open by asking permission and normalizing the discussion ("I ask all my patients these questions"), and address confidentiality, particularly with adolescents.

Partners					Practi ces					Protecti on
Gender number , ,					Typesofsexualcontact					Barriermethods PrEP ,
concurrency

The 5 P's framework ends with pregnancy prevention and intentions. Adolescents need confidential time without caregivers; many states allow minors to consent independently to contraception, STI testing and treatment, and prenatal care, so know your jurisdiction's rules. In older adults, sexual activity continues into later life; assess for treatable barriers such as vaginal atrophy, erectile dysfunction, chronic disease, and medication effects.

Contraception

Method	KeyFacts
Combinedhormonal(pill ,	Estrogenplusprogestin:suppressesovulation thickenscervicalmucus thinstheendometrium , , .
patch ring) ,	Contraindicatedwithmigrainewithaura hypertension historyofVTE breastcancer andsmokingat , , , ,
	age35orolder
Progestin-only (pill DMPA ,	Appropriate when estrogen is contraindicated Progestin-only pills require consistent daily timing .
injection implant) ,
Intrauterinedevices	Copper IUD: non-hormonal effective for 10–12 years Levonorgestrel IUDs come in several doses and , .
	durations Appropriatefornulliparouspatientsandadolescents;insertatanypointinthecyclewhen .
	pregnancyisreasonablyexcluded
Barriermethods	Maleandfemalecondoms diaphragm cervicalcap spermicide Malecondomsaretheonlymethodthat , , , .
	alsoprotectsagainstSTIs
Fertilityawareness	Basalbodytemperature cervicalmucus orcalendarmethods(StandardDays TwoDay);requirehigh , , ,
	motivationandtraining

Option	WindowandNotes
Levonorgestrel(oral) Ulipristalacetate CopperIUD	1 Mosteffectivewithin72hours;maybeusedupto120hours Maintainsefficacythrough120hours Themosteffectiveemergencycontraceptive;insertupto5daysafterunprotectedintercourse . Thelevonorgestrel52mgIUDisalsoaneffectiveoption

Sexually Transmitted Infections

Infection	PresentationandDiagnosis	Treatment
Chlamydia	MostcommonlyreportedbacterialSTI;usually	Doxycycline100mgtwicedailyfor7days(preferred);
	asymptomatic Cervicitis urethritis orproctitis; . , ,	azithromycin1gsingledoseasanalternative ,
	complicationsincludePID ectopicpregnancy and , ,	includinginpregnancy Treatpartnersfromthe .
	infertility Screensexuallyactivewomenunder25 .	preceding60days
	annually andolderwomenwithriskfactors ,
Gonorrhea	Urethritis cervicitis orpharyngitis;disseminated , ,	Ceftriaxone500mgIMsingledose Ifchlamydiahas .
	infection causes arthritis-dermatitis syndrome .	notbeenexcluded adddoxycycline100mgtwice ,
	Antimicrobialresistanceisincreasing	dailyfor7days
Syphilis	Primary:painlesschancre Secondary:diffuserash .	BenzathinepenicillinG;doseanddurationdependon
	includingpalmsandsoles mucouspatches , ,	stage
	condylomatalata Latent:positiveserologyonly . .
	Tertiary:cardiovascularandgummatousdisease .
	Neurosyphilis can occur at any stage Reverse- .
	sequencescreeningstartswithatreponemaltest
Herpessimplex	Recurrentpainfulgenitalulcers;HSV-2moreoften	Acyclovir valacyclovir orfamciclovirshortens , ,
	genital HSV-1 increasingly identified Primary outbreak , .	outbreaks;suppressivetherapyreducesrecurrences
	ismostsevere ConfirmbyPCRorviralcultureofactive .	andtransmission
	lesions;serologydistinguishesHSV-1fromHSV-2
HPV	Genital warts; high -risk types cause cervical anal , ,	Vaccinationpreventscoveredtypes;wartstreatedwith
	penile andoropharyngealcancers Mostinfections , .	patient-applied or provider-administered therapy
	clearwithin1–2years
HIV	Acute retroviral syndrome (mononucleosis-like illness)	Lifelong antiretroviral therapy PrEP with oral tenofovir- .
	2–4 weeks after infection Fourth -generation .	emtricitabine or long-acting injectable cabotegravir or
	antigen/antibodytestsdetectinfectionearliest	lenacapavirgreatlyreducesacquisition
Trichomoniasis	Malodorousfrothydischarge vulvarirritation , ,	Metronidazoleortinidazole;treatpartners
	"strawberry"cervix;menoftenasymptomatic Diagnose .	concurrently
	bymicroscopy rapidantigen orNAAT , ,

Sexual Dysfunction

Condition	AssessmentandManagement
Femalesexualdysfunction	Desire arousal orgasm andpaindisorders Hypoactivesexualdesiredisorderispersistentlylow , , , .
	interestcausingdistress Assessrelationship psychological medical andmedicationfactors;treat . , , ,
	withpsychotherapy relationshipcounseling andpharmacotherapy , ,
Dyspareuniaand	Atrophyiscommonaftermenopauseandtreatedwithvaginalestrogenorospemifene Vulvodynia .
vulvovaginalatrophy	needsmultidisciplinarycare(topicalagents pelvicfloorphysicaltherapy CBT) , ,
Erectiledysfunction	Considervascular neurologic hormonal andpsychogeniccauses;evaluatecardiovascularrisk , , , ,
	testosterone and fasting glucose PDE-5 inhibitors are first line; alternatives include intraurethral , .
	alprostadil penileinjections vacuumdevices andprosthesis , , ,
Prematureejaculation	Behavioral stop-start and squeeze techniques; topical anesthetics and SSRIs (on-demand dapo1xetine isavailableinsomecountries)