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Sexuality

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by Jennifer Dever on 5 March 2014

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Transcript of Sexuality

Sexual Orientation
“It is a characteristic of the human mind that tries to dichotomize in its classification of phenomena….Sexual behavior is either normal or abnormal, socially acceptable or unacceptable, heterosexual or homosexual; and many persons do not want to believe that there are gradations in these matters from one to the other extreme.”
from:
Sexual Behavior of the Human Female
(1953) by A. Kinsey

Congition & Learning are also key factors
Physiological responses of the genitalia and other organ systems provide the physical template on which subjective interpretations and experiences are socially constructed

Is there a clear pattern of response during sex?
Masters & Johnson, 1966
Female Sexuality
Sexuality:
Human sexuality is the way in which we experience and express ourselves as sexual beings

Key biological factors contributing to sexuality
Hypothalamus &
Hormones
Masters & Johnson
sexual response divided into four phases: excitement, plateau, orgasm, and resolution.
Linear
Physiological
Alternative Models:
Kaplan (desire added)
http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf
Testosterone
Positive relationship between mid-cycle testosterone levels and intercourse frequency
Positive relationship between testosterone levels and masturbation but not intercourse frequency
Positive relationship between testosterone levels and sexual interest among adolescents, but found that peer relationships were a more important determinant of sexual behavior
Found significant relationship between adolescent females' testosterone levels and initiation of coitus.
Estrogen
Estrogens play only a minimal direct role in female sexual desire
Estrogen deficiency, as occurs with menopause, causes a decrease in genital vasocongestion and lubrication and atrophy of the vaginal epithelium

Progesterone
Certain oral contraceptives that increase progesterone levels throughout the female cycle have been associated with decreased sexual interest and desire
However, progesterone treatment does not have a substantial influence on the sexual desire in females… new research on effects in males suggests otherwise.
Prolactin
evidence for an inhibitory influence of prolactin on sexual desire in women comes from a limited number of studies that have found lactating women
Oxytocin
For multiorgasmic women, the amount of oxytocin level increase also correlated positively with subjective reports of orgasm intensity
Neurotransmitters
Nitric oxide
essential component in the production of penile, and clitoral vasocongestion and tumescence
Sexual stimulation leads to NO production that in turn stimulates the release of guanylate cyclase.
Guanylate cyclase converts guanosine triphosphate to cGMP and cGMP produces relaxation of the smooth muscles of the penile arteries and corpus cavernosum resulting in increased blood flow in the clitoris
Sildenafil, a drug designed to treat erectile difficulties, prolongs the action of cGMP by inhibiting the metabolism of cGMP
Gender Identity separate from sexuality
The term "gender identity," distinct from the term "sexual orientation," refers to a person's innate, deeply felt psychological identification as male or female, which may or may not correspond to the person's body or designated sex at birth (meaning what sex was originally listed on a person's birth certificate). -from HRC website
Sexual Dysfunction
higher levels of dysfunction reported among females (43%) as compared to males (31%)

Categories of FSD:
A) Sexual desire disorders- absence of or a decrease in sexual interest, desire, sexual thoughts, and fantasies and an absence of responsive desire.
B) Sexual arousal disorders - lack of subjective or genital arousal or both.
C) Orgasmic disorder - involves orgasm that is absent, markedly diminished in intensity, or markedly delayed in response to stimulation despite high levels of subjective arousal
D) Sexual pain disorders – Dyspareunia (painful intercourse)

Psychogenic
Relationship issues, depression, anxiety, self-esteem, body issues, personal loss, abuse, etc.
Latrogenic
Medications, gynecologic surgery
Vascular
Cardiovascular disease, diabetes, hypertension, smoking…
Neurogenic
Spinal cord injury, disease of CNS, neurotransmitter dysfunction
Hormonal
Hypothalamatic-pituitary axis dysfunction, premature ovarian failure, androgen deficiency
Musculogenic
Hypertonic pelvic floor muscles, hypotonic pelvic floor muscles

Mechanisms of dysfunction:
FSD Treatment Options
Nonphparmacologic
-Vibrator
-Arousal fluids
-Clitoral vacuum device
Pharmacologic
-Hormone therapy
-Antidepressants

Basson's Non-Linear Model
intimacy
desire can be reactive or spontaneous
may come either before or after arousal
orgasms aren't necessary for satisfaction
relationship factors
EXCITEMENT:
Heart rate and blood pressure increases
Vasocongestion – pooling of blood in the pelvic area
Vaginal walls darken
Labia majora and minora enlarge
Clitoris begins to swell - the corpora cavernosa of the clitoris consist of a fibroelastic network and bundles of smooth muscle. Pelvic nerve stimulation results in clitoral smooth muscle relaxation and arterial smooth muscle dilation.
With sexual arousal, there is an increase in clitoral cavernosal artery inflow and an increase in clitoral intracavernous pressure that leads to tumescence and extrusion of the clitoris.
Lubrication, alkaline fluid seeps from congested tissues to the inside of vaginal walls
Myotonia – neuromuscular tension builds up
Lengthening and distension of the vagina
Uterus pulled forward
Nipples become harder and erect
“sex flush”: Skin may darken around neck, breasts and abdomen

PLATEAU:
Outer third of the vagina wall becomes swollen with blood
Inner two thirds of vagina show slightly more lengthening and expansion
Labia minora also become engorged with blood
Clitoral glans retracts back under its foreskin
Breasts become somewhat engorged, nipple erection maintained
Sex flush spreads
Muscular tension continues to increase along w/heart rate, respiration rate and blood pressure

ORGASM
Intense physical and emotional experience
Immediately preceded by a sensation of suspension, at which time the pulse rate reaches its peak
Suffusion of warmth spreads from pelvis throughout the body
Muscular contractions in outer third of vagina and anal area
Initial contraction, followed by 3 or 4 rhythmic contractions
May have involuntary contractions of muscles throughout the body

RESOLUTION
Body gradually returns to its unexcited state following the orgasm
Vagina returns to its usual size and color
Labia return to pre-aroused state
Glans emerges from the foreskin and returns to its usual size within 15-30 minutes
Uterus lowers to its pre-aroused position
Nipples lose erection
Sex flush leaves the body
Respiration, pulse and blood pressure return to normal
Muscles relax

Women have many reasons for engaging in sexual activity other than simply sexual drive
Components: Sexual orientation, Sexual Behavior & Sexual Identity
Sexual Behavior
What influences behavior?
Great Apes & Humans use sexuality for reproduction and maintenance of social bonds.
refers to the sex and/or gender of people who are the focus of a person's physical and emotional attraction
Epinephrine
epinephrine and norepinephrine metabolite, vanillylmandelic acid, increases prior to intercourse and continues to be elevated over baseline up to 23 hours following sexual activity
Seratonin
decreased desire, delayed orgasm
Dopamine
"reward" associated with desire
People learn to be sexual!

Social standards much less permissive toward the sexual activity of females
"sexual desire is not valued because it is not necessary for a woman to have desire in order to participate in partnered sexual activity. And if sex can occur without desire, the thought that follows is that lack of desire must not be a serious problem" A. Clayton, Huff Post 2/7/14
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