Repro test 3 combined* ppts 1-3

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Questions and Answers

What physiological process primarily drives the excitement phase in both men and women?

Increased heart rate

Vasocongestion (correct)

Oxytocin release

Myotonia

Which of the following describes a physiological change that occurs in males during the excitation phase?

Increased testicular size (correct)

Vasodilation of the scrotum

Vascular constriction in the penis

Decreased penile erection

What is the key characteristic of the plateau phase in both sexes?

Formation of the orgasmic platform in males

Immediate ejaculation in males

Maximum vasocongestion and muscle tension (correct)

Complete return to baseline physiological function

In females, which physiological change is critical for achieving orgasm during the orgasmic phase?

Contraction of the orgasmic platform Signup and view all the answers

During which phase does the body experience an increase in heart rate, respiration rate, and perspiration?

Plateau Signup and view all the answers

What role does oxytocin play during the female orgasmic phase?

It facilitates muscle contractions. Signup and view all the answers

What significant physiological change occurs during the resolution phase?

Blood flows away from the genital area. Signup and view all the answers

Which physiological process does not contribute to orgasm in males?

Tensing of the orgasmic platform Signup and view all the answers

What is indicated about the sexual response of males as they age?

They have longer refractory periods. Signup and view all the answers

Which health benefit is associated with having orgasms at least once or twice a week?

Enhanced immune system. Signup and view all the answers

What is retrograde ejaculation commonly associated with?

Semen flow into the bladder. Signup and view all the answers

How do women’s hormonal responses differ from men’s during sexual activity?

Women have lower levels of testosterone but are more sensitive to it. Signup and view all the answers

What physiological condition can prevent women from reaching orgasm?

Lack of orgasmic platform in plateau phase. Signup and view all the answers

Which statement correctly describes the connection between dopamine and sexual response?

Dopamine triggers a stress-reducing response. Signup and view all the answers

Which aspect of female sexual response is notably different from that of males?

Women can have multiple orgasms. Signup and view all the answers

What is the significance of oxytocin during orgasm?

Increases feelings of intimacy. Signup and view all the answers

What is a common misconception regarding female ejaculation?

It is definitively urine. Signup and view all the answers

What psychological factors significantly influence sexual response in humans?

Psycho-social context and culture. Signup and view all the answers

What is suggested as a significant predictor of sexual problems?

Sensitivity of the brake stimulation Signup and view all the answers

Which statement best distinguishes spontaneous and reactive sexual desire?

Spontaneous desire appears in anticipation of pleasure. Signup and view all the answers

What is a recommended strategy for those experiencing arousal non-concordance?

Use lubricants and communicate with partners. Signup and view all the answers

How does stress commonly affect sexual interest and pleasure?

Reduces sexual interest in 80-90% of people. Signup and view all the answers

What aspect of desire does NOT primarily influence low sexual desire according to research?

Hormone levels Signup and view all the answers

Which model introduced the concept of desire as a missing element in the sexual response cycle?

Triphasic Model Signup and view all the answers

What is considered a key feature of the Dual Control Model in understanding sexual response?

It emphasizes the role of environmental distractions in inhibiting arousal. Signup and view all the answers

In the context of the Dual Control Model, what does the 'brakes' refer to?

Neurological signals that reduce arousal Signup and view all the answers

Which assumption does the Dual Control Model NOT adhere to?

Sexual excitation is universally consistent across all individuals. Signup and view all the answers

What aspect of sexual behavior does the Dual Control Model emphasize as being influenced by context and culture?

The interplay of sexual arousal and context Signup and view all the answers

According to the Dual Control Model, which process is essential for achieving sexual arousal?

Activating the accelerator and deactivating the brakes Signup and view all the answers

What consequence does the Chronic Low-Level Inhibition type of sexual inhibition have?

Creates persistent apprehension regarding sexual performance Signup and view all the answers

What role does the Sexual Excitation System serve in the context of sexual arousal?

It delivers signals to activate sexual desire. Signup and view all the answers

What is a primary characteristic of Vulvar Vestibulitis Syndrome (VVS)?

Significant pain during normal activities Signup and view all the answers

What must be ruled out when assessing for vulvar vestibulitis specifically?

Endometriosis Signup and view all the answers

Which underlying condition is commonly associated with significant distress in women diagnosed with sexual dysfunctions?

Cystitis Signup and view all the answers

What treatment options are available for Vulvar Vestibulitis Syndrome?

Estrogen cream and vestibuloplasty Signup and view all the answers

Which of the following is NOT one of the criteria for diagnosing sexual dysfunction in women?

Complete absence of arousal Signup and view all the answers

What does the World Health Organization define as essential for sexual health?

A positive and respectful approach to sexuality and relationships Signup and view all the answers

In Kinsey's 7-point continuum, what does a score of '3' indicate?

Equal attraction to both sexes Signup and view all the answers

Which term describes a person's subjective sense of being male or female?

Gender Identity Signup and view all the answers

What is a significant characteristic of transgender individuals?

Their gender identity differs from their biological sex Signup and view all the answers

What does the term 'queer' represent in the context of sexuality?

An inclusive term for individuals with fluid sexuality or gender identity Signup and view all the answers

What is the primary focus of the DSM-5 regarding sexual dysfunction disorders?

It sets criteria for diagnosing sexual dysfunction based on multiple factors Signup and view all the answers

Which definition best describes sexual orientation?

The type of sexual attraction an individual feels towards others based on gender Signup and view all the answers

What does the term 'intersex' refer to?

Genetics or anatomical differences leading to ambiguous genitalia Signup and view all the answers

What is the prevalence of hypoactive sexual desire disorder in men?

8-15% Signup and view all the answers

Which of the following is NOT a contributor to sexual dysfunction?

Aging process Signup and view all the answers

What is the correct duration required for diagnosing sexual dysfunction?

At least 6 months Signup and view all the answers

Which of the following disorders is characterized by a significant delay or absence of orgasm?

Female Orgasmic Disorder Signup and view all the answers

What psychological factor is often associated with premature ejaculation?

Anxiety Signup and view all the answers

Which term was deleted from the revised terminology in sexual dysfunction diagnosis?

Sexual aversion Signup and view all the answers

What is the prevalence range for female orgasmic disorder?

10-40% Signup and view all the answers

Which of the following describes delayed ejaculation?

Inability to reach orgasm after sufficient stimulation Signup and view all the answers

In women, hypoactive sexual desire disorder can frequently be associated with which of the following?

Pain during sex Signup and view all the answers

What percentage of the population is estimated to be affected by male erectile disorders?

Up to 30% Signup and view all the answers

Which condition is characterized by pain during intercourse due to involuntary muscle contractions?

Vaginismus Signup and view all the answers

Which of the following is NOT typically associated with sexual dysfunction?

Overactive social life Signup and view all the answers

What accounts for a significant contributing factor to reduced sexual desire among individuals?

Cultural beliefs and attitudes Signup and view all the answers

What must not be present to diagnose primary sexual dysfunction?

Medical condition Signup and view all the answers

Study Notes

Human Sexual Response Phases

Masters and Johnson outlined four phases: Excitation, Plateau, Orgasm, Resolution
Two main processes drive response: Vasocongestion (blood flow increase) and Myotonia (muscle tension)

Excitation Phase

Vasocongestion is prominent, especially in the pelvis
Males: Penis becomes erect, scrotum thickens and elevates
Females: Lubrication, clitoral enlargement, nipple erection (myotonia), breast enlargement, labia minora swelling and darkening, vaginal ballooning, cervix and uterus tenting
Both Sexes: "Sexual flush" due to skin vasocongestion, increased heart rate, respiration, and generalized myotonia

Plateau Phase

Vasocongestion reaches maximum levels
Heart rate, respiration, and blood pressure continue to rise
Copious perspiration occurs
Myotonia intensifies
Males: Bulbourethral (Cowper's) glands secrete pre-ejaculate fluid (may contain sperm), scrotum elevates further, testicles enlarge
Females: Orgasmic platform forms (outer vaginal wall thickening and swelling, essential for orgasm), tenting is complete, clitoris remains erect

Orgasmic Phase

Males: Two stage process - contraction of seminal vesicles, vas deferens, prostate followed by urethral and penile contraction (ejaculation)
Females: Simultaneous contractions of the orgasmic platform and uterus. Multiple orgasms possible with continued stimulation
Both Sexes: Extremely high heart rate, blood pressure, respiration, and intense myotonia. Oxytocin plays a significant role in female orgasm

Resolution Phase

Return to normal physiology, muscle relaxation, blood returns from genitals to central circulation
Males: Have a refractory period (variable length, generally longer with age) before another response is possible
Females: Potentially no refractory period

Health Benefits of Orgasm

Potential immune system strengthening
Pain relief (menstrual cramps, general pain tolerance)
Lower prostate cancer risk (in men with frequent ejaculation)
Mood enhancement (estrogen and endorphin release)
Increased intimacy (oxytocin release)
Improved sleep (dopamine release)

Retrograde Ejaculation

Penile urethra has two sphincters: one for urine, one for semen. Normally, one is open while the other closes
In some cases, the urinary valve opens, causing semen to flow into the bladder instead of through the urethra
Most commonly related to MS, diabetes, or bladder/prostate surgery
No harmful effects other than potential infertility (sperm not reaching the egg)

Female Ejaculation

Anecdotal reports dating back centuries, but research is inconclusive
Chemical analyses have yielded mixed results: some similar to urine, others similar to prostatic fluid
Skene's glands (female equivalent of the prostate) may produce a fluid similar to prostatic fluid that is released during orgasm

Gender Differences in Sexual Response

Women's excitation phase is slower
Women must have an orgasmic platform to reach orgasm, or they may stay stuck in the plateau phase
Women can experience multiple orgasms, potentially due to longer lasting vasocongestion
Men have a refractory period after orgasm, while women theoretically do not

Hormones and Sexual Response

Testosterone is a key sex hormone, produced by testes, ovaries, and adrenal glands
It is crucial for sexual desire in both sexes. Free testosterone (unbound) is active
Women are significantly more sensitive to testosterone but only have 1/10th the amount
High testosterone levels do not necessarily increase desire or response beyond normal physiological levels

Forebrain Override

Unlike many animals, human sexual behavior is not solely determined by hormones
Psycho-social context and culture (forebrain) are the most important factors
Physiology helps explain how the body functions but is secondary to the forebrain in initiating sexual response

Human Sexual Response

Four-Phase Model: Excitement, Plateau, Orgasm, Resolution. This model was the first scientific description of the physiology of sexual response and became the basis for defining sexual health and sexual problems.
Triphasic Model: Desire, Arousal (combined excitement and plateau), Orgasm. This model was introduced by Helen Singer Kaplan in the 1970s as a response to the missing element of desire in the four-phase model.
Dual Control Model: Introduced by Dr. John Bancroft and Dr. Erick Janssen in the 1990s. This model emphasizes the balance between excitatory and inhibitory processes in sexual response.
- Neurobiological Inhibition is adaptive, preventing sexual arousal in disadvantageous or dangerous situations.
- Individual Variability exists in both sexual excitation and inhibition, and can be any combination of low/high excitation or low/high inhibition.
- Context and Cultural Meaning are crucial stimuli, influencing both excitatory and inhibitory processes.
Sexual Excitation System: Acts as an "accelerator," responding to sex-related stimuli and triggering genital arousal.
Sexual Inhibition System: Acts as "brakes," providing neurological "off" signals.
- Potential Threat Inhibition: Activated by environmental cues like sights, sounds, smells, touch, taste, or thoughts.
- Chronic Inhibition: Persistent low-level inhibition linked to fear of performance failure.
Sexual Arousal requires both activation of the accelerator and deactivation of the brakes.
Sexual Dysfunction can arise from insufficient accelerator stimulation or excessive brake stimulation.
High Brake Sensitivity is a strong predictor of various sexual problems, particularly low desire/low libido.
Context and Brain State: The circumstances of the moment and the brain's current state significantly influence sexual function. Key questions to consider for sexual difficulties:
- How sensitive is the accelerator?
- What activates the accelerator?
- How sensitive are the brakes?
- What activates the brakes?
Stress: During stressful times, the brain interprets everything as a threat, usually leading to reduced sexual interest and pleasure.
Arousal Non-Concordance: This describes a disconnect between the mind and body's response to desire and arousal.
- It can occur when the body responds to non-sexual stimuli with arousal or fails to respond to sexual stimuli.
- Suggestions for those experiencing non-concordance include reassurance of their health and functionality, encouragement to communicate with partners, and lubricant use.
Desire and Pleasure in Context:
- Spontaneous Sexual Desire arises in anticipation of pleasure.
- Reactive Sexual Desire emerges in response to pleasurable experiences.
- Both are normal and healthy responses.
- Research suggests that half of women may be categorized to either spontaneous or responsive desire.
- Desire is often context-dependent, emerging when the context is favorable, and stimulation is pleasurable.

The Range of Human Sexuality

The World Health Organization defines sexual health as physical, emotional, mental, and social well-being related to sexuality.

Sexual Terms and Definitions

Biological Sex: refers to genetic and anatomical characteristics.
Intersex: previously known as “hermaphrodite,” individuals with ambiguous genitalia.
Gender: a psychosocial concept of maleness and femaleness.
Gender Identity: a person's subjective sense of being male, female, or nonbinary.
Gender Expression: how an individual chooses to present themselves in public (behavior, clothing, etc.).
Sexual Orientation: describes an individual's sexual attraction to men, women, or both.
Transgender/Cisgender: refers to the relationship between a person's gender identity and their biological sex.
Queer: a term used to describe anyone with fluid sexuality or gender identity/expression, now embraced by the LGBTQIA community.
LGBTQIA: Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual.

Kinsey's 7-Point Continuum

A model that depicts a spectrum of sexuality, ranging from exclusively heterosexual to exclusively homosexual behavior.
Outdated, as it was developed in 1948.

DSM-5: Diagnostic and Statistical Manual of Mental Disorders

Sets criteria for mental disorders, including sexual dysfunctions.
Considers behavior, onset, duration, context, effects, and consequences.
Evolving changes in diagnosing sexual dysfunction include:
- Changes in terminology.
- More specific criteria for diagnosis.
- Duration of at least 6 months to differentiate from transient dysfunction.
- Causes distress.
- Some prior diagnoses have been deleted or revised into a single category.

Sexual Dysfunctions

Disorders affecting the sexual response cycle (excitement, plateau, orgasm, resolution).
Affects up to 30% of men and 50% of women at some point.
Lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems.
Often interrelated, with patients experiencing multiple dysfunctions.
Must meet specific criteria, have a duration of at least 6 months, cause distress, and not be due to a medical or non-sexual mental disorder for diagnosis.

Contributors to Sexual Dysfunction

Biological Causes:
- Hormonal interactions/deficiencies.
- Chronic illness.
- Medications/Drugs.
- Vascular problems.
- Genetic predisposition.
Psychological Causes:
- Anxiety, depression, anger, or other psychological disorders.
- Cultural beliefs, attitudes, and memories.
Sociocultural Causes:
- Situational pressures (divorce, death, job stress, infertility, relationship difficulties).
- Cultural standards.
- Trauma of sexual molestation or assault.

Basic Types of Sexual Dysfunction in DSM-5-TR

Hypoactive Sexual Desire Disorders:
- Lack of interest in sex and little sexual activity.
- Absent/reduced initiation of sexual activity.
- Absent/reduced response to erotic cues.
Male Erectile Disorders: Difficulty getting or maintaining an erection.
Male Ejaculatory Disorders:
- Premature Ejaculation: Reaching orgasm and ejaculating with little stimulation.
- Delayed Ejaculation: Difficulty reaching orgasm or delayed orgasm after normal sexual excitement.
Female Sexual Interest/Arousal Disorder: Difficulty with sufficient lubrication for sexual intercourse.
Female Orgasmic Disorder: Difficulty reaching orgasm.
Genito-Pelvic Pain/Penetration Disorder:
- Pain during intercourse.
- Tightening or tensing of pelvic floor muscles making sex difficult or impossible.
- May include Vaginismus and Vulvar Vestibulitis.
Substance/Medication-Induced Sexual Dysfunction: Be sure to obtain a full list of medications.

Disorders and Sexual/Physical Abuse

Not a sexual dysfunction diagnosis but may be a contributing factor.
Maintain a high index of suspicion, especially when symptoms don't fit the expected pattern.
May include:
- Coerced sex.
- Depression.
- Self-mutilation.
- Anxiety.
- Post-traumatic stress disorder (PTSD).
- Fear of intimacy.
- Sexual acting out.
- Sexual dysfunction.
Legal reporting obligations may apply depending on the state.

Sexual Desire

Determined by a combination of biological, psychological, and sociocultural factors.
Most cases of low sexual desire or sexual aversion are caused by sociocultural and psychological factors.
Biological conditions can significantly lower the sex drive.
Testosterone is helpful for sexual desire only if levels are sub-clinical.

Hypoactive Sexual Desire Disorder

Characterized by lack of interest in sex and little sexual activity.
Present at least 6 months.
Causes significant distress.
Not better explained by another non-sexual factor (stressors, major depression, drugs, etc.).

Premature Ejaculation

Characterized by reaching orgasm and ejaculation quickly with minimal stimulation.
Affects around 30% of men at some point.
Often associated with younger men early in sexual maturity.
May be related to anxiety, hurried masturbation experiences, or poor recognition of arousal.
Often associated with erectile disorder.
Criteria for diagnosis:
- Present for 6 months.
- Occurs > 75% of occasions.
- Causes significant distress.
- Not better explained by another diagnosis.

Delayed Ejaculation

Characterized by repeated inability to reach orgasm or delayed orgasm after normal sexual excitement.
Prevalence is uncertain, but less than 1% of the population experiences symptoms for over 6 months.
May cause psychological distress and contribute to delayed conception.
Criteria for diagnosis:
- Duration of 6 months.
- Causes significant distress.
- Not better explained by another diagnosis.

Female Orgasmic Disorder

Characterized by delayed, absent, or reduced intensity of orgasmic sensations.
Prevalence: 10-40% of population.
Ensure sufficient physiological stimulation is occurring.
Do not diagnose when significant relationship or context factors are present.
Criteria for diagnosis:
- Duration of 6 months.
- Causes significant distress.
- Not better explained by another diagnosis.

Genito-Pelvic Pain/Penetration Disorder

Represents a combination of Vaginismus and Dyspareunia.
Vaginismus: involuntary contractions of the muscles of the outer third of the vagina.
Dyspareunia: severe pain in the genitalia during sexual activity.
Significant overlap with prior physical/sexual abuse.
Criteria for diagnosis:
- Duration of 6 months.
- Causes significant distress.
- Not better explained by another diagnosis.
- Evaluate for underlying medical conditions (lichen sclerosis, PID, etc.).
- Frequently occurs with other sexual dysfunctions, relationship distress, or sexual assault.

Vulvar Vestibulitis Syndrome (VVS)

Likely caused by a "neuro-inflammatory" condition and can cause vaginismus.
Burning pain at the opening (vestibule) of the vagina.
Pain present during daily activities and sex in severe cases.
Treatment options include estrogen cream, lidocaine application, and vestibuloplasty.

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Ppt 1: The Physiology of Human Sexual Response ppt, ppt2:Human Sexual Response, ppt 3: the Range of Human Sexuality Clinical Human Sexuality ppt,