A female client tells the nurse that she has difficulty in sexual relations with her spouse since ...

2. Body image

Rationale:
Body image is constantly changing. How people feel about their bodies is related to sexuality. People who have a poor body image may respond negatively to sexual arousal. This is what the client is experiencing. Sexual self-concept determines with whom one will have sex, the gender and kinds of people one is attracted to, and the values about when, where, with whom, and how one expresses sexuality. Gender identity is one's self image as male or female. Gender-role behavior is the outward expression of a person's sense of maleness or femaleness as well as the expression of what is perceived as gender-appropriate behavior.