Sexual Self Learning Guide PDF

Chapter 2: The Sexual Self 1.1 THE SEXUAL SELF One of the normative tasks of an adolescent is the development and consolidation of an understanding of one’s self as a sexual person (Hensel, D., Fortenberry, J.D, & Orr, D., 2010). As defined by O’Sullivan et al. (2006), sexu...

Chapter 2: The Sexual Self 1.1 THE SEXUAL SELF One of the normative tasks of an adolescent is the development and consolidation of an understanding of one’s self as a sexual person (Hensel, D., Fortenberry, J.D, & Orr, D., 2010). As defined by O’Sullivan et al. (2006), sexual self refers to an individual’s view of him- or herself as a sexual person. Researches about adolescent sexuality were mainly focused on problem behavior outcomes such as pregnancy and sexually transmitted infection among middle or late adolescent girls, which results to a narrow perspective regarding the sexual lives of adolescents (Niccolai et al., 2004; O’Sullivan et al., 2006). There are notable changes in the early adolescents’ lives that are important in the evaluation of sexual self, such as dramatic physical change during puberty, awareness of sexual drive and erotic feelings, and developing interest in others (O’Sullivan et al., 2006). In addition, the primary developmental task during early adolescence is to integrate into a sense of self or identity those experiences associated with moving away from childhood (Erikson, 1950). To further explain, let’s look through the different dimensions of sexual self. 1.1.1 DEVELOPMENT OF SECONDARY CHARACTERISTICS AND HUMAN REPRODUCTIVE SYSTEM o Puberty is the period during which the sexual organs mature, it begins when the children’s bodies begin producing the sex hormones, androgens and testosterone (male hormone) and estrogens and progesterone (female hormone) with the help of the brain signals from pituitary gland. Both sexes produce androgens and estrogens, but males have higher concentration of androgens and females a higher concentration of estrogens. These hormones stimulate the development of primary and secondary sex characteristics and sexual drive (Feldman, 2011). However, the progesterone specially stimulates growth of the female reproductive organs and prepares the uterus for pregnancy (Rathus, 2017; Go-Monilla, 2018). The master gland also signals the body to increase production of growth hormones that interact with the sex hormones to cause the growth spurt and puberty. Although there are wide variations among individuals, girls start puberty at around age 11 or 12, and boys begin at around 13 or 14 (Feldman, 2011). o The development of secondary sex characteristics are the visible signs of sexual maturity. In girls, it primarily includes the development of breasts, pubic hair, wider hips, and higher voice and eventually the onset of menstruation called menarche. On the other hand, the sexual maturation for boys follows a different course. First, pubic hair starts to grow approximately around the age of 12, followed by the growth of facial and underarm hair. Also, their voice deepens as the vocal cords become longer and the larynx larger. Their muscles become more pronounced, narrow hips, and less fat tissue overall. In addition, at around age 13, the boy experiences his first ejaculation called spermarche (Feldman, 2011) o The reproductive system is a collection of internal and external organs that work together for the purpose of procreating. The male reproductive system consists of two major parts: the testes, where sperm are produced, and the penis. The testes are carried in an external pouch known as the scrotum, it is important that its temperature is cooler to facilitate sperm production (Zimmermann, 2018). The vas deferens transports the sperm-containing fluid called semen. The epididymis is a set of coiled ducts connected to the vas deferens and which sperm cells are stored. The prostate gland and seminal vesicles produce semen and nourish the sperm cells. While the releasing of sperm cells from the penis is called ejaculation. Each ejaculation contains approximately 300 to 500 million of sperm cells and can live up to 48 hours inside the uterus (Go_Monilla, 2018). o The female reproductive system includes the clitoris, labia minora and labia majora. The major internal organs of the female reproductive system include the vagina and uterus – which serves as the vessel for semen – and the ovaries, which produce the female’s ova. The vagina is attached to the uterus through the cervix, while the fallopian tubes connect the uterus to the ovaries (Zimmerman, 2018). Egg cells are produced and stored in the ovaries and are released during ovulation. Ovulation period can occur in 14 days after the beginning of the menstrual period (Go-Monilla, 2018). One ovum, or egg is released and sent down the fallopian tube during ovulation. If not fertilized, this egg is eliminated during menstruation (Zimmerman, 2018).  Figure 1. Male and Female Reproductive System 1.1.2 SEXUAL AROUSAL AND EROGENOUS ZONES o Human sexual arousal is complex. Although visual and auditory cues may trigger human sexual arousal, it may also be produced by direct stimulation of the body’s erogenous zones. According to Freud, erogenous zones “are areas of the body that provide pleasure”. Erogenous zones include the genitals, mouth, breast, ears, anus, and to a lesser degree, the entire surface of the body (Go-Monilla et al., 2018). In a study conducted, the erogenous zone expands while having sex with a partner versus while masturbating and that affiliative touching and stimulation may maintain and establish long-term relationships (Dunbar, 2010; Nummenmaa, 2016). Furthermore, touching a partner triggers and maintains their partner’s sexual arousal, thus preparing them physically for copulation and promoting sexual behavior (Hurlbert, Apt, Hurlbert, & Pierce, 2000). Figure 2. Maps of human erogenous zones during masturbation and sex with a partner. Retrieved from the study of Nummenmaa, 2016  Other Factors Affecting Sexual Arousal Cognitive Factors Fantasizing and creating erotic scenarios or images can trigger arousal to some individuals. In fact, men tend to think of sex or have sexual fantasies frequently than women. Emotional Factors Female tend to give importance to their emotional feelings when engaging into sexual activities than men do. Cultural Factors In some cultures, masturbation and pre-marital sex are not encouraged. In other words, culture shapes people’s perspective about sex in accordance to what is socially acceptable. Sexual scripts influence how a person expresses his/her sexual desire. Sexual scripts are stereotyped patterns of how people should behave sexually. Source: Go-Monilla & Ramirez: Understanding the Self, 2018 1.1.3 THE PHASES OF SEXUAL RESPONSE o Sex is a physical activity and thus it is important to know and understand our physiological responses during a given sexual experience. Further, this may also help in understanding our partners and enhance the sexual experience. o The sequence of physical and emotional changes when a person becomes aroused sexually and/or participates in sexually stimulating activities is referred as the sexual response cycle, this also includes intercourse and masturbation. It has four phases: Phase 1: Excitement Can last from a few minutes to several hours and include the following: Increase in muscle tension Accelerated breathing and heart rate. Flushed skin (redness on chest and back may appear)  Nipples become hardened or erect. Woman’s labia minora and clitoris swells due to increase blood flow to the genitals, and man’s penis erects. Vagina starts producing clear fluid for lubrication. The woman’s breasts become fuller and the vaginal walls begin to swell. Man’s penis begins secreting liquid for lubrication, scrotum tightens and the testicles swell. Phase 2: Plateau This extends to the brink of orgasm and includes the following: The physiological changes during the phase 1 is intensified. Due to increased blood flow, the vagina continues to swell and the vaginal walls turn a dark purple. At this point the clitoris is very sensitive (highly sensitive that may be painful to touch) and it retracts under the clitoral hood so it may not have direct stimulation with the penis Tightened testicles for men. Continued increase of breathing, heart rate, and blood pressure. Muscle spasms may begin in the feet, face, and hands. Increased muscle tension. Phase 3: Orgasm Orgasm is the shortest among the phases and is the climax of the sexual response cycle. It generally lasts for only a few seconds. General characteristics of this phase include the following: Involuntary muscle contractions begin. The highest rate of blood pressure, heart rate, and breathing are at this point, with a rapid intake of oxygen. Muscle spasm in the feet. Release of sexual There is a sudden, forceful release of sexual tension. In women, the muscles of the vagina contract. The uterus also undergoes rhythmic contractions. In men, rhythmic contractions of the muscles at the base of the penis result in the ejaculation of semen. A rash or “sex flush” may appear over the entire body  Phase 4: Resolution During resolution, the body slowly returns to its normal level of functioning, and swelled and erect body parts return to their previous size and color. This phase is marked by a general sense of well-being, enhanced intimacy and, often, fatigue. Some women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms. Men need recovery time after orgasm, called a refractory period, during which they cannot reach orgasm again. The duration of the refractory period varies among men and usually lengthens with advancing age. Source: Webmd.com: Reviewed by Nivin Todd, MD on September 7, 2018. 1.2 CHEMISTRY OF ATTRACTION, LOVE, AND ATTACHMENT o You saw a boy walking towards you while studying at the corner of the library, and that boy is none other than your ultimate crush. You noticed your palms start to sweat, you felt your breath getting shorter and your heartbeat getting louder, thumping and thumping as he walks nearer. This common scenario made us believe that love arose from the heart, however, it turns out that love is all about the brain. o According to Dr. Helen Fisher, the complexity of love can be categorized into three: lust, attraction, and attachment. There are different hormones from the brain associated with each category (Fig. 3). 1.2.1 Lust ▪ Evolutionary theory suggests that one of the reasons why people engage in sex is to reproduce. We are driven by our desire for sexual gratification in order to fulfill the purpose as an organism – to perpetuate our specie (Wu, 2017) Figure 3. Hormones related to different categories of love From: Katherine Wu blog  ▪ The hormones testosterone and estrogen plays an important part in this category of love. Testosterone increases the libido which makes them desire the person more and some women attested that they are more sexually motivated when they ovulate in which the estrogen levels are highest (Greenberg, 2016; Wu, 2017) 1.2.2 Attraction ▪ Although most of the time we mistaken lust for attraction and vice versa, Dr. Fisher (2004) argued that attraction is different and distinct from lust, for one can happen without the other. Attraction is associated to the part of our brain which controls our “reward” behavior, which may explain why the first few months of relationships is all thrilling. ▪ Hypothalamus is seen to be activated when a person is attracted to someone or something, for this part of the brain produces dopamine which is why we feel good when our behavior is being rewarded (Feldman, 2010). ▪ Further, our brain releases another hormone related to dopamine, the norepinephrine is also released during attraction. This hormone makes us euphoric, energetic, and giddy – the emotions we feel when we are “in love” (Wu, 2017). Which explains why people seem to be tireless during courtship and flirting seem to come naturally. ▪ Lastly, serotonin is also associated in attraction. Apparently, this hormone combat stress, reduce depression, and regulate anxiety (Scaccia, 2017). 1.2.3 Attachment ▪ The last category of love. Attachment is not only exclusive in romantic relationship, but this bond is also seen in friendships, parent-child relationship, and other intimacies as well. Oxytocin is the hormone involved in attachment, like dopamine, this hormone is also produced in the hypothalamus (Feldman, 2010). Oxytocin is seen to be high in activities such as during sex, child birth, and breast feeding and these activities are precursors to bonding (Wu, 2017). 3.3. DIVERSITY OF SEXUAL BEHAVIOR Human sexuality refers to an individual’s sexual interest and attraction to others. It is different from biological sex, which refers to the physical characteristics including the anatomy of an individual’s reproductive system. Sexuality is experienced in several ways, including thoughts, behaviors, practices, and relationships. 3.3.1 Sexual Orientation (American Psychological Association, 2008) Sexual orientation is defined as an enduring pattern of emotional, romantic, and or sexual attractions to men, women, or both sexes. Research suggests that sexual orientation ranges along a continuum, from exclusive attraction to the other sex to exclusive attraction to the same sex. Usually, sexual orientation is categorize into the following: a. Heterosexual- sexual attraction is directed to the members of the opposite sex b. homosexual (gay or lesbian)- sexual attraction is directed to the members of the same sex c. bisexual- sexual attraction is directed to both sexes There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Hence, nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation. The phrase “coming out” is used to refer to several aspects of lesbian, gay, and bisexual persons’ experiences: self-awareness of same-sex attractions; the telling of one or a few people about these attractions; widespread disclosure of same-sex attractions; and identification with the lesbian, gay, and bisexual community. Many people hesitate to come out because of the risks of meeting prejudice and discrimination. Coming out is often an important psychological step for lesbian, gay, and bisexual people. Research has shown that feeling positively about one’s sexual orientation and integrating it into one’s life fosters greater well-being and mental health. 3.3.2 Sexual Behaviors Young people engage in a variety of sexual behaviors covering from fantasy and stimulation to various forms of intercourse (Crockett, Raffaelli, and Moilanen, 2003). Erotic fantasies serve several important functions for adolescents: along with creating pleasant sexual arousal and expressing sexual needs, they provide insight into sexual desires and preferences and are an opportunity to “rehearse” sexual encounters (Katchadourian, 1990). Similar to fantasy, masturbation allows teenagers to explore their sexuality in a safe and private way, and is generally regarded as a normative activity (Katchadourian, 1990). Making out is also practiced by some adolescents. It involves kissing, rubbing one’s body against another, and even genital touching. In the Philippines, based on YAFS (2013), beginning 1994, there has been a rise in the proportion of 18-24 old youth having sex before the age of 18. Urbanization could be accounted with early sexual initiations with the highest rate from the young people from the National Capita Region. 3.3.2.1 PROBLEMS ASSOCIATED WITH ADOLESCENT’S SEXUAL BEHAVIOR A. Teenage or Unwanted Pregnancy According to WHO (2020), teenage pregnancy is a global problem affecting 21 million girls aged 15-19 years in developing regions every year. Teenage pregnancies most likely occur in marginalized communities, usually driven by poverty, lack of employment opportunities, and lack of education. These adolescents would not want to be pregnant but may not be able to avoid due to the knowledge gap and misconceptions about some forms of contraception. In addition, they may lack the agency or control in order to use correct and consistent use of contraception. An additional cause of unintended pregnancy is sexual violence, which is widespread with more than a third of girls in some countries reporting that their first sexual encounter was coerced. The health consequences of early teenage pregnancy include pregnancy and childbirth complications which can cause maternal mortality, morbidity, and lasting problems. The newborn has a higher risks of low birth weight, preterm delivery, and severe neonate conditions. In some settings, when the mother is pregnant again, it presents further risks for both the mother and the child. Aside from the health consequences, these adolescents also face social and economic consequences. Unmarried pregnant teens may  experience stigma, rejection or violence by partners, parents and peers. There is also a greater change that they would drop from school thus, limiting their education and employment opportunities later on. B. Sexually Transmitted Diseases (STDs) Sexually transmitted diseases (STDs) are infections that pass from one person to another through sexual contact. They are also known as sexually transmitted infections (STIs) or venereal diseases (VD). Some STDs can spread through the use of unsterilized drug needles, from mother to infant during childbirth or breast-feeding, and blood transfusions. The genital areas are generally moist and warm environments, ideal for the growth of yeasts, viruses, and bacteria. People can transmit microorganisms that inhabit the skin or mucous membranes of the genitals. Infectious organisms can also move between people in semen, vaginal secretions, or blood during sexual intercourse. Individuals pass on STDs more easily when they are not using contraceptive devices, such as condoms, dams, and sanitizing sex toys. The World Health Organization (WHO) estimates that there are more than 1 million new STDs acquired each day globally. People between the ages of 15 and 24 years acquire half of all new STDs, and 1 in 4 sexually active adolescent females has an STD. However, STD rates among seniors are increasing. The following sections explain the most common STD's. B.1. Chlamydia It is an STD caused by Chlamydia trachomatis (C. trachomatis). This bacterium only infects humans. Chlamydia is the most common infectious cause of genital and eye diseases globally. It is also the most common bacterial STD. According to the Centers for Disease Control and Prevention (CDC), in 2015, nearly 3 percent of girls aged 15 to 19 years had chlamydia. Women with chlamydia do not usually show symptoms. Any symptoms are usually non-specific and may include: o bladder infection o a change in vaginal discharge o mild lower abdominal pain B.2. Crabs, or pubic lice Pubic lice manifestations are primarily spread through sexual contact. Pets do not play any part in the transmission of human lice.  ▪ The lice attach to the pubic hair, and may also be sometimes found in the armpits, mustache, beard, eyelashes, and eyebrows. They feed on human blood. ▪ The common term "crabs" comes from the crab-like appearance of the lice B.3 Genital herpes This STD is caused by the herpes simplex virus (HSV). The virus affects the skin, cervix, genitals, and some other parts of the body. There are two types: ▪ HSV-1, also known as herpes type 1 ▪ HSV-2, also known as herpes type 2 Herpes is a chronic condition. A significant number of individuals with herpes never show symptoms and do not know about their herpes status. HSV is easily transmissible from human to human through direct contact. Most commonly, transmission of type 2 HSV occurs through vaginal, oral, or anal sex. Type 1 is more commonly transmitted from shared straws, utensils, and surfaces. In most cases, the virus remains dormant after entering the human body and shows no symptoms. The symptoms associated with genital herpes, if they do occur, may include: ▪ blisters and ulceration on the cervix ▪ vaginal discharge pain on urinating ▪ fever ▪ generally feeling unwell ▪ cold sores around the mouth in type 1 HSV ▪ Also, red blisters may occur on the external genital area, rectum, thighs, and buttocks. These can be painful, especially if they burst and leave ulcers. B.4. Human papillomavirus (HPV) Human papillomavirus is a name for a group of viruses that affect the skin and mucous membranes, such as the throat, cervix, anus, and mouth. There are over 100 types of HPV, of which, about 40 can affect the genital areas. These types may also transmit to the mouth and throat. HPV infection can lead to: ▪ abnormal cell growth and alteration within the cervix, significantly increasing the risk of cervical cancer ▪ genital warts The majority of individuals with HPV have no symptoms and are unaware. HPV is most commonly transmitted through vaginal or anal sex, oral sex, and genital-to-genital contact. People with an HPV virus but no signs and symptoms can still infect others.  A woman who is pregnant and has HPV might transmit the virus to her baby during childbirth, although this is very rare. Vaccination is the best way to prevent HPV. B.5. Syphilis Syphilis is the result of Treponema pallidum, a bacterium. It is transmitted by sexual contact, and the person passing on the infection will have a syphilitic lesion. A woman who is pregnant and also has syphilis can pass on this STD to her baby, which can result in stillbirth or serious congenital deformities. There is an incubation period of between 9 and 90 days after initial infection before the symptoms of the disease occur, with an average incubation period of 21 days. Each stage of syphilis has characteristic signs and symptoms. Some people with syphilis show no symptoms, while others may experience more mild presentations. For some people with the condition, even if symptoms resolve, the bacterium is still in the body and can cause serious health problems later on. B.6. Gonorrhoea This sexually transmitted bacterial infection usually attacks the mucous membranes. It is also known as the clap or the drip. The bacterium, which is highly contagious, stays in the warmer and moister cavities of the body. The majority of women with gonorrhea show no signs or symptoms. If left untreated, females may develop pelvic inflammatory disease (PID). Males may develop inflammation of the prostate gland, urethra, or epididymis. The disease is caused by Neisseria gonorrhoeae. The bacteria can survive in the vagina, penis, mouth, rectum, or eye. They can be transmitted during sexual contact. As soon as a person contracts gonorrhea, they risk spreading the bacteria to other parts of the body. An individual may accidentally rub their eye and spread the infection. This prolongs the treatment period. A woman who is pregnant can pass the infection on to the infant during childbirth. B.7. HIV and AIDS Human immunodeficiency virus (HIV) attacks the immune system, leaving its host much more vulnerable to infections and diseases. If the virus is left untreated, the susceptibility to infection worsens. HIV can be found in semen, blood, breast milk, and vaginal and rectal fluids. HIV can be transmitted through blood-to-blood contact, sexual contact, breast- feeding, childbirth, the sharing of equipment to inject drugs, such as needles and syringes, and, in rare instances, blood transfusions. With treatment, the amount of the virus present within the body can be reduced to an undetectable level. This means the amount of HIV virus within the blood is at such low levels that it cannot be detected in blood tests. It also means  that HIV cannot be transmitted to other people. A person with undetectable HIV must continue to take their treatment as normal, as the virus is being managed, not cured. If HIV progresses without treatment and reaches stage 3, known as AIDS, it can be fatal. However, modern medicine means that HIV need not reduce life expectancy. C. Prevention of STDs Sex using a condom is the safest way to prevent the spread of STDs. Condoms are known as barrier. Avoid using an oil-based lubricant, such as petroleum jelly, when using a latex condom. Non-barrier forms of contraception, such as oral contraceptives or intrauterine devices, do nothing to protect people from sexually transmitted infections. Here are other steps you can take to reduce the risk of an STD: 1. Abstinence: Abstaining from any sexual act is the most effective way to avoid an STD. 2. Monogamy to one uninfected partner: A long-term, monogamous relationship with one person who is not infected can reduce the risk of contracting an STD. 3. Vaccinations: There are vaccinations that can protect an individual from eventually developing some types of cancer that are caused by HPV and hepatitis B. 4. Check for infections: Before sexual intercourse with a new partner, check that the partner and yourself have no STDs. 5. Drink alcohol in moderation: People who have consumed too much alcohol are more likely to engage in risky behavior. Avoid using recreational drugs, which may also affect judgment. 6. Explain you want safe sex: Before engaging in any sexual act with a new partner, communicate that you would only consider safe sex. 7. Education: Parents, schools, and society need to teach children about the importance of safe sex, and explain how to prevent becoming infected with an STD.