Understanding Human Sexuality

Understanding Sexuality

• Sexuality includes life and life events from the womb to the tomb, including self-knowledge, gender awareness, and relationships.
• Sexuality refers to the quality of being sexual within a broad sense.
• Key aspects of sexuality: sex, biological or physiological sex, gender, gender identity, gender roles and sexual orientation.
• Sexual orientation refers to emotional, romantic, sexual, and/or affectional attraction from one person to another.
• Sexual orientation is categorized by the gender(s) or biological sex of those a person is attracted to, including attraction to the same sex, opposite sex, or both.
• Sexual orientation exists on a scale from exclusive homosexuality to exclusive heterosexuality and includes various forms of bisexuality.
• Sexual orientation is an important part of self-identity.
• A person's experience and understanding of their sexual orientation can change during their life.
• Sexual orientation refers to feelings and self-identity, not just actions.
• Individuals may or may not express their sexual orientation in their behaviors.

Sex and Gender

• Sex refers to the biological aspects of being male or female, including physical acts.
• Sex differences are physical differences.
• Gender refers to the psychological and sociocultural meanings added to biological sex.
• Gender differences result from people's thinking about gender.

Dimensions of Sex

• Sex dimensions include chromosomes, gonads, hormones, external genitalia, internal accessory organs, secondary sex characteristics, and sexual orientation.
• Male chromosomes are XY, female chromosomes are XX.
• Male gonads are testes, female gonads are ovaries.
• Male hormones are androgens, female hormones are estrogens.
• Male external genitalia include the penis and scrotum, female external genitalia include the labia, clitoris, and vaginal opening.
• Male internal accessory organs include the prostate, seminal vesicles, and vas deferens. Female internal accessory organs include the vagina, uterus, and fallopian tubes.
• Male secondary sex characteristics include a beard, low voice, and sperm emission. Female secondary sex characteristics include breasts and menstruation.
• Male sexual orientation can be heterosexual, homosexual, or bisexual; and female sexual orientation can be heterosexual, lesbian, or bisexual.

Gender Dimensions

• Gender dimensions include gender identity and gender role.
• Gender identity is how one perceives oneself (male or female).
• Gender role is the masculine or feminine behaviors learned in society.
• Gender identity is self-defined, while gender role is socially-defined.

Determinants of Gender Identity

• Gender identity is the personal view of oneself as male or female.
• Environmental factors were once assumed to be central determinants of gender identity.
• Social-cultural influences were thought to shape gender identity.
• Rejection of gender reassignment is now taken as support for a biological view of gender identity, such as the castrated identical twin who later took on a male gender identity.

Gender Role Development

• Gender roles are societal expectations for normal and appropriate female and male behavior.
• Social-learning theory says gender roles develop as children by:
• Receiving rewards/punishments for gender role behaviors.
• Watching and imitating the behaviors of others.
• Cognitive-developmental theory says that children develop gender schemas.

Gender Differences

• Females score higher on verbal skills.
• Males score higher on math and visual-spatial skills.
• Males display greater physical aggressiveness.
• Females are higher on relational aggression, such as spreading rumors or excluding others.

Scientific Study of Sexuality

• Havelock Ellis was among the first physicians to initiate a scientific study of sexuality.
• Havelock Ellis's studies revealed that nocturnal emissions were not dangerous; his work promoted dissemination of sex information.
• Alfred Kinsey used surveys and interviews to study sexual practices and beliefs.
• Masters and Johnson brought the study of sexuality into the laboratory to study the sexual response cycle.

Sexual Activity

• Men are thought to have a greater sexual drive, interest, and activity than women.
• Evolutionary Perspective suggests men need multiple partners in order to maximize the likelihood of passing on their genes; while women seek a good provider.
• Social Role Approach explains that gender differences reflect cultural roles and division of labor.
• Women prefer resource-rich men only when they live in cultures with little reproductive freedom/educational equality.

Sexual Orientation

• Homosexuality may reflect the impact of biological factors on sexual orientation.
• Biological factors suggesting a genetic influence on sexual orientation are supported by twin studies.
• Homosexuality is not a result of poor parenting, arrested development, childhood seduction, or modeling of gay behaviors.
• Homosexuality is identified as gay or bisexual.
• 2.8% of men are gay or bisexual; and 1.4% of women are lesbian or bisexual.
• 44% of gay men fit stereotypes as feminine; and 54% of lesbians fit stereotypes as masculine.
• Transexuals identify as a member of the opposite sex.
• Transexuals may undergo “sex reassignment” surgery.

Sexual Orientation: Explanations for Homosexual Behaviour

• Social influence hypothesis says homosexuality arises from early sexual experiences.
• Study of gay men by Bell gives no support for the social influence hypothesis.
• Study suggests that "Adult homosexuality is a continuation of earlier homosexual feelings and behaviors"
• An opposing view holds that others influence this homosexual behavior.
• Examples include others influence by: spending more time with boys, and being masturbated by other boys.
• A biological hypothesis says that 70% of homosexuals remember being “different” as early as 4 or 5 years of age.
• Gender nonconformity and a high rate of behaviors like engaging in activities preferred by opposite sex or atypical preference for other-sex playmates early in development may be factors.
• Genetic influences such as homosexuality being 2-7 times higher among siblings of homosexuals support biological explanation.
• Identical twins are more concordant than fraternal twins.
• Research by Hamer of gay men shows they may have more gay relatives on mothers side than father's side of family
• 64% of pairs of gay men studied with gay relatives on their mother's side shared the same material at end of X chromosome; other studies have not replicated this finding.
• Studies of hormonal levels of gays and straights show no difference in sex hormone levels
• Administering testosterone to gay men does not affected their sexual preference nor change same sex preference.
• Administering testosterone to gay men increased levels of gay sexual activity though.
• In animals early hormonal manipulation can affect same-sex preferences for rats, hamsters, ferrets, pigs, and zebra finches but critics are dubious.
• For instance, homosexuality only occurs in absence of members of opposite sex.
• In response, 10% of male sheep prefer other males, and some female gulls formed lesbian pairs.
• There is little evidence of prenatal hormonal imbalances in homosexual humans.
• Third interstitial nucleus of anterior hypothalamus (INAH3) is involved in sexual activity of animals.
• One study suggest this area is half the size in gay men and heterosexual women as in heterosexual men.
• The suprachiasmatic nucleus of hypothalamus regulates reproductive cycle of female rats.
• The suprachiasmatic nucleus controls daily cycles in rats and humans and may be larger in gay men than heterosexual men.
• The suprachiasmatic nucleus contains twice as many cells that secrete vasopressin, and excessive vasopressin in male rats is associated with increased homosexual behavior.
• The anterior commissure connects the left and right hemisphere.
• The anterior commissure is larger in gay men and heterosexual women than heterosexual men.
• The differences in the the anterior commissure may be a partial explanation for higher verbal score of gay men.
• The central bed nucleus of stria terminalis (BSTC), a structure in hypothalamus, is about ½ mm.
• Role in sexual activity of male rats is noted as Male-to-female transsexuals have less of it.
• Male-to-female transsexuals smaller than other men, and have similar the size to women. -Female-to-male transsexuals central bed nucleus of stria terminalis (BSTC) is Male-sized.
• Hormonal manipulation of fetal rats affects its size of the central bed nucleus of stria terminalis (BSTC).
• Brain is likely is feminized during fetal stage.
• There is little evidence of masculinization of lesbians' brains prenatally.
• Concordance studies as high for lesbians as for gays.
• Index-to-ring-finger ratios are Indistinguishable from heterosexual men but one study suggests this ratio is Influenced by testosterone during prenatal period.
• Heterosexual women have index and ring finger the same length.
• Physical differences of lesbians include Click-evoked otoacoustic emissions.
• An effect of faint sound given off by inner ear when stimulated.
• Click-evoked otoacoustic emissions weaker in lesbians and men (both heterosexual and homosexual).

Social Issues of Sexual Orientation

• The idea is if homosexuality is biological, civil rights legislation applies to homosexuals.
• 75% of homosexuals believe their condition is inborn.

Sexual Function

• Sexual behavior in males and females involves arousal of the peripheral sex organs, the spinal cord, and the brain.
• Factors that modulate activity within any of these regions can impair sexual function.
• Sexual arousal involves activity within the parasympathetic nervous system, allowing for blood flow to the sex organs.
• Sexual orgasm involves the activation of the sympathetic nervous system.

Determinants of Healthy Sexual Function

• Psychological well-being is a factor.
• Partner relationship dynamics are key.
• Developmental experiences, especially a history of abuse.
• Physical health; paying attention to medication use.
• Lifestyle factors, including substance abuse.

Sexual Dysfunctions

• Male sexual problems include impotence and premature ejaculation.
• Both males and females experience problems like dyspareunia, inhibited desire, and sexual aversion.
• Females may experience orgasmic dysfunction and vaginismus.

Sexual Addiction, Assessment & Treatment

• Loss of Control such that individual engages in behavior more than they intend or want.
• Compulsive Behavior seen as a pattern of loss of control when the individual is triggered.
• Efforts to stop that are Repeated attempts to stop the behavior which fail.
• Significant amounts of time is lost doing or recovering from the behavior.
• Preoccupation of Obsessing about or because of the behavior.
• Inability to fulfill Obligations: The behavior interferes with work, school, family, and friends.
• Failure to stop the behavior even though there are problems because of it.
• Escalation of the addictive behaviour - Need to make behavior more intense, more frequent, or more risky.
• Losses result from Losing, limiting, or sacrificing valued parts of life such as hobbies, family, relationships, and work.
• Withdrawal - Stopping the addictive behavior causes considerable distress, anxiety, restlessness, irritability, or physical discomfort.
• Sexual Addiction Screening Test – Revised (SAST-R) available on www.SexHelp.com. assists in assessment
• Designed to assist in the assessment of sexually compulsive behavior which may indicate the presence of sex addiction,
• Developed in cooperation with hospitals, treatment programs, private therapists, and community groups, the SAST-R provides a profile of responses which help to discriminate between addictive and non-addictive behavior.
• The test is compromised of 45 yes or no questions.
• The process of recovering from sex addiction involves breaking through and managing a set of 7 'Task.
• It begins with "Task 1: Break Through Denial, the process goes as as follows:Make problem list, Make secret list, List of excuses, Consequences inventory, Find therapist, sponsor' Task 2: Understand Nature Of Illness follows through with " Read books on sex addiction, Map out addiction cycle, List of unmanageable moments, Sexual anorexia/binge-purge cycle, Self-assessment; history" Task 3: Surrender To Process follows through with "1. Sex addiction history, 2. Powerlessness inventory, 3. Unmanageability inventory, 4. Financial costs worksheet ,5. Ten worst moments Task 4: Limit Damage From Behavior goes through with "1. Damage control plan, 2. Disclosure plan" Task 5: Establish Sobriety goes through with "Sobriety challenges worksheet, Identify relapse scenarios, Fire drill plan, Abstinence list, boundaries list, Personal Craziness Index" Task 6: Ensure Physical Integrity "includes Physical exam, Sex addiction matrix, Sexual health matrix, Arousal Template" Task 7: Participate In Culture Of Support includes attending regular meetings, regular contact with sponsor. meeting presentation, outside activities and daily rituals.

Female Sexual Dysfunctions

• Categories are Sexual Desire Disorders, Sexual Arousal Disorders, Orgasmic Disorders and Sexual Pain Disorders
• can be Lifelong vs. Acquired, Generalized vs. Situational
• Due to psychological factors, medical factors, or combined influences.
• Sexual desire disorders can manifest as hypoactive sexual desire disorder or sexual aversion disorder".
• The former is classified as the Female sexual arousal disorder, while the latter classified through Dyspareunia like Sexual pain disorders like Vaginismus and Noncoital sexual pain disorder".
• Sex Arousal Disorders are due to influence from Psychological and physical factors
• Psychological influences include Depression/anxiety, Prior sexual or physical abuse, stress, Alcohol/substance abuse,
• Interpersonal factors include Partner performance and technique, Lack of partner, Relationship quality and conflict, Lack of privacy"
• It can be influenced from Sociocultural influences include Inadequate education, Conflict with religious, personal, or family values and Societal taboos".

Hypoactive Sexual Desire Disorder (HSDD)

Occurs when "Persistently or recurrently low or absent sexual interest in and desire for sexual activity Little or no sexual fantasy and Causes distress to the individual or relationship"

• It is not better accounted for by some other Axis I disorder or a medical condition, or when it is Distinguished from desire discrepancy a Very common diagnosis in women.
• increases post-menopause due to both physiological and psychological causes".

Etiology of hypoactice sexual desire

• Physiological factors including Hormones, Neurotransmitters, CNS, Illness and Drugs
• Psychological factors including Stress, Intrapsychic issues ad Relationship issues".
• Intrapsychic factors included Psychological disorders, Guilt, Abuse history and being Secondary to arousal or orgasmic disorder"
• Relationship issues with especially for women" included Intimacy issues, Power struggles, Lack of attraction or affection, Sexual compatibility and Sexual skill defici"
• Women's sexual functioning is different from men's and How different is a matter of some controversy with Various models having been proposed and tested
• Does disinterest or dissatisfaction necessarily mean disease of dysfunction, but its still worth looking at.
• Women have many reasons for giving themselves over to sex, as such "Sexual desire is an infrequent motive in their longer-term, and they may sense desire only once the sexual experience is underway.
• Psychological and biological factors influence women's arousability as Womens sexuality is highly contextual".
• Arousal is not primarily about the degree of vulval and vaginal vasocongestion.
• Women report Giving These Reasons Women Give for Having Sex, some include "To increase emotional intimacy and to enhance well being.
• The above helps feel less lonely, sad, tense, more attractive, powerful, and womanly with To reassure partner he/she is attractive and to keep the peace or end an argument in order to get the partner to do something she wants for fun, pleasure , Feelings of passion or lust".
• Female Sexual Arousal Disorders are classified through a Persistent or recurrent inability to attain/maintain adequate lubrication-swelling causes distress to the individual or relationship and is described as quite common in females, the classification is based on "Primary vs. secondary" or "Global vs. situational" presentation.
• Arousal disorders can be secondary Orgasmic Dysfunction as Medical factors can be important and can be the result of "Poor partner technique"
• Attitudes, beliefs, expectations greatly that influence Feelings towards the partner

Biological factors

• Sexual interest affected though Dehydroepindrosterone (DHEA), "Testosterone Sexual Arousal Vasoactive, Nitric oxide(NO), Prostaglandin E (PGE), Phosphodiesterase type 5 (PDE5), "Testosterone and Hypothalamic-Pituitary-Gonadal, influence "

• Hypothalamic-Piuitary-Gonadal Axis' Estrogens Deficiency leads to gonadal atrophy, difficulty lubricating.

• Androgens: Declining levels contribute to decline in sexual desire, arousal, and orgasm.

• Related to DHEA and Testosterone.

• Oxytocin Orgasm triggers Muscle contractions,".

Psychophysiological factors

• Women watch erotic video while arousal and assessed via self reports and plethysmography",
• In the cases of Healthy the variable correlation between objective increase in vasocongestion and self-reports.
• For Women with arousal disorder, Objective measures of vasocongestion match those of control .However, Subjective arousal is absent or experienced a negative .
• Many women with complaints of low arousal can physically congest
• Female Orgasmic Disorders Persistent or recurrent delay in, or absence of, orgasm following adequate stimulation and a normal sexual excitement phase",
• has Very common (~ 25%) and etiological influence ".
• Physiological problems is with "Hormones , Neurotransmitters , Disease , and a consequence of Medication".
• Psychological problems is related to Inner self and outer and to the interpersonal interactions.

Female Orgasmic Disorder

• Psychological etiology :Both intrapsychic and relationship issues are similar to those responsible for desire and arousal problems ",
• Technique issues from Vaginal intercourse not routinely effective in producing orgasm.
• This is linked to Insufficient clitoral stimulation though this can still be too breif - 4-7 min. for men, 8+ min. for women
• Some women have never learned what works through the shame to find whats necessary.
• some women know what works but are not willing to ask.

Sexual Pain Disorders

Dyspareunia is when Recurrent or persistent genital pain associated with intercourse that causes marked distress..

• A state that is Not caused exclusively by Vaginismus, lack of lubrication, or other Axis I disorder, nor is it quite common (~ 20%) or one that Increases with age .
• When describing these issues its usefully to look at the "Descriptors that specify Location, quality, elicitors, course, intensity, or meaning". Etology is related to Dyspareunia include
• "Medical Anatomical Rarely partner size" , and Pathological factors
• Controversy surrounding Vulva Vestibulitis". Psychological Sexual abuse or trauma.
• Vaginismus is related to an Recurrent or persistent involuntary Spasm of vaginal muscles interfering with intercourse Makes intercourse painful or impossible, this is only limited in Prevalence ~ 6%. The etology can be the same as any as dyspareunia.

Prevalence of Sexual complaints

43% of women experienced a sexual problem and in 32% a lack of sexual interest, while others had trouble, some report of a ~ 28% report unable to achieve orgasm 27% found Sex Not Pleasurable and 21% experienced Pain During Sex in women aged Women aged 18-59 years

Vagina

"Global the most widely reported vaginal drynes had 34% effect in south africa, US, while japan and netherlands had the lowest amount" While "Most Sexually Active report on 28% of pain global and 32% locally but its most common in Japan and France with 40%".

• What Made It Easier for Women to Talk About Sexual Concerns where Physicians:

• Seem concerned about sexual wellness

• Seem comfortable

• Seem kind/understanding

• Has professional demeanor

• The Patient has seen physician before

• Physician knows patient

• Physicians can Initiatte A Routine questions for all patients like "Do you have any sexual concerns that you would like to discuss Detailed questions for menopausal women:

• As women enter and go through menopause, they sometimes experience changes in their sexuality. Have you noticed any changes? *Menopausal women sometimes experience vaginal dryness that can make intercourse uncomfortable. Has this been a problem for you?

• Detailed questions for surgically menopausal women include "Since your ovaries were removed, have you experienced a change in your desire for sex or a decrease in your sexual activity?".

• Diagnostic and Manage Algoritm for Female Sexual Dysfunction follow from if the Patient complaining of FSD you should then follow to the Baseline to performe the Base Evaluation. A sexual history from the 1st encounter, medical, psychological and phsiical assessment is to be completed from there.

• If all factors then proceed to Patient/partner education and decision of Shared making before considering Treatment for the Patient but if certain factors are there to have more specific details.

• A focus on the details for any "pain or discomfort; Any previous treatment, with any First sexual experience or Early learnings regarding sexuality".

• History of sexual/domestic/psychological abuse with any Sexually transmitted diseases (STIs/SDs) like and Pregnancies" will be beneficial when considering the right treatment but so will "a History of sexual problems".

• Phsycial Exam, bimanual Speculum examinations and inspect for external genitalia.

Sex Therapy: Masters and Johnson

• Therapy focuses on the relationship
• Therapy integrates physiological and psychosocial factors
• Therapy focuses on cognitive factors
• Therapy focuses on specific behavioral techniques

Male Sexual Response Cycle

• Encompases Plateau, Orgasm,Resolution Refractory Period and Arousal
• Stage 1 - Arousal:
• Vasocongestion contributes to erection of the penis.
• The inner diameter of the urethra doubles. The scrotum pulls toward the body.
• Muscular tension increases in the body. Heart rate and blood pressure increase.
• Stage 2 - Plateau
• Not much change in the penis, but it is less likely for a man to lose his erection if distracted during plateau phase than during excitement.
• The testes increase in size by 50 % or more and are elevated toward the body.
• Muscular tension heightens and involuntary body movements may increase as orgasm approaches. Heart rate increases to between 100-175 beats per minute. Stage 3 - Orgasm
• The actual climax and ejaculation are preceded by a distinct inner sensation that orgasm is imminent
• The most noticeable change in the penis during orgasm is the ejaculation of semen, even though orgasm and ejaculation are separate functions and may not occur at the exact same time.
• The muscles at the base of the penis and around the anus contract rhythmically.
• Stage 4 - Resolution
• Immediately following ejaculation, the male body begins to return to its prearousal state
• About 50% of the erection is lost immediately, and the remainder of the erection is lost over a longer period of time.
• Muscular tension usually is fully relaxed within five minutes after orgasm, and the man feels relaxed and drowsy.
• stage 5 Refractory Period During resolution
• Men then experience a period of time in which they cannot be re-stimulated to ejaculation or even maintain an erection
• On average, men in their late thirties cannot be ready for more for about 30 minutes or longer beyond the age of and teen years are able to have more than one orgasm during sexual encounters.
• For that reason each will mostly feel sexually satisfied with one orgasm though not always.

Prevalence of Male sexual disorders.

• Between 10-52% of men at some point in their lives will experience some type of sexual dysfunction.
• One recent study in the Journal of American Medical Association (found sexual dysfunction common in 31 of men age 18 to 59
• The "Big Three" in male sexual disorders is "Erectile Dysfunction, Premature Ejaculation and Retarded Ejaculation though the penis may be the most honest"
• The Phases of these Disorders relate to Desire, Arousal, Orgasm as such
• Desire Disorders often present through Hyperactive Sexual Desire, Hypoactive Sexual Desire and Sexual Aversion

Hyperactive Sexual Desire

• "Deregulation or lack of control over sexual motivation" due to compulsive sexual behavior.
• The urge to have sex frequently as the number 1 preoccupation.
• Hypoactive Sexual Desire Definition. is a sexual Deficiency of sexual fantasies and desire for sexual activity Must
• It must Marked distress or interpersonal difficulty or can the result Not a better account for by an Axis I disorder or from general "stress, anxiety medications, drugs"
• The result can be endocrine or "Chronic Renal Failure or Testicular".
• The best Treatment must be individualized where it may be required to for the factors to help inhibiting sexual interest that couples need may have to be dealt it though relationships and or marital theropy
• The Hypoactive Sexual Desire Treatment works by identifying Hormones and through Supplements that help correct with "Aschematic Sexual Self, few romantic interactions, but to fix all of it they're needs to be conigitial restructuring to help boost all other issues to result in improved Low desire and relationship quality
• Sexual Aversion by "Aversion towards and active avoidance of genital sexual contact with as sex partner that distress as a result of family history
• Sexual Aversioin is to be dealt with both through a relationship that helps resolve its issues to a greater degree .

#Male and Female sexual dysfunction summary of treatments

• Behavioral with gradual exposure so it goes from non threatening towards full sexual expression or drugs to reduce attacks.
• For couples who has a "Negative Sexual Self Schema they can receive therapy to to help that anxiety to improve over time".

Arousal Disorder.

• Erection Dysfunction: Inability to attain and or maintain that sexual contact from stress and medication use With a good chunk is on high-risk and not many are in help or will seek it: This is solved by rejection with the aim to to help with the to"help" or for long period Arousal Deficits medical

The Big 3 Erectile Dysfuction.

• Dysfuction case is about that tension can provide. -Sensate Focus; Erection Deficit - Dysfuction with a strong goal to not. "Ejaculatory Disfunction""

Ejaculation.

• premature.
• Retarded. These cases requires for any treatment from it its caused due the signals The medical side requires a very well - If the of a "if" a " This doesn't hurt you "" They need there with can

Conclusion

• Conclusion
• Sexuality is a way of life.
• Natural and caused of the or the.
• Manage for it through And