Sexual Disorders

1. Sexual Disorders Gabriel Asongwe

2. Normal Human Sexuality

3. Gender & Sex • Sex • genetic sex - chromosomes • anatomical sex - internal and external genitalia • sexual identity - one’s identity as male or female • Gender • social meaning attached to being male or female • gender identity - sense of being male or female • gender role - expectations about how a male or female should behave • Androgyny/hermaphrodism • sex: possessing both male and female reproductive organs • gender: possessing both male and female qualities

4. Sexual vs Gender Identity Sexual Identity Internal genitalia and hormones match external genitalia Determined in utero Gender Identity What you think you are Established by age 3. Disorder if you feel trapped in the wrong sex Gender Role Behavior reflecting a person’s inner sense of gender identity

5. We are sexual even before birth • Sexuality begins in the womb with reflexive displays of genital arousal (erection in boys); • both boys and girls continue to experience reflex-induced genital arousal throughout infancy. • Physical contact and emotional bonding with caretakers is essential for life and begins a child’s education about sexuality (the pleasure of touch and emotional intimacy).

6. Early Childhood (Ages 2 – 6) • Egocentrism before age 2; a lack of understanding others’ points of view. • Genital exploration is a natural part of learning about one’s own body. • Social play after age 2; genital exploration expands beyond their own bodies to include curiosity about others; peaks in ages 3-5. • Sexual exploration games, touching self and others, • talking about sex, • noticing differences between boys & girls, and between children & adults.

7. Responding to childhood sexuality • Aggressive sexual behaviors may be indicative of abuse and should be investigated. • Sexual exploration games (especially with same-sex playmates) are normal and only become harmful when a parent’s response frightens or shames the child. • Socialize children for privacy rather than punishing. To stop the behavior when it is inappropriate, distract the child rather than scolding or slapping their hands away.

8. School-Age Years (Ages 7 – 15) • By age 9, most social play is with same-sex friends; including sexual exploration games. • Girls tend to be treated more harshly than boys when “caught” engaging in sex play. • Puberty – reproductive and sexual maturation lasting several years. • Adrenarche(ages 6-8) – adrenal glands secrete androgen hormone DHEA > converts to testosterone and estrogen. • Gonadarche(several years later) – pituitary gland (FSH & LH), testes (sperm and testosterone) and ovaries (ova, estrogen and progesterone) mature. • Secondary sex characteristics appear

9. Puberty in Girls • Breast buds – 1st sign of puberty (avg. age 11.2) • Growth spurt begins – begins about age 12 and finishes about age 16 in most girls. • Fatty deposits at hips and buttocks • Pubic hair, & after a few years, underarm hair • Sweat and sebaceous glands > acne  • Menarche – First period (avg. age 12-13) • Attitudes about menarche  -- 

10. Puberty in Boys • Testicles/scrotum growth – 1st signof puberty • Testosterone then stimulates growth of the penis, prostate gland and seminal vesicles. • Genital growth (and pubic hair) begins around ages 11-12; finishes about age 15; • ejaculation possible about a year after penis begins growing. • Nocturnal emissions and voice deepening • Temporary gynecomastia • Underarm & facial hair, sweat & sebaceous glands appear later

11. Precocious or Delayed Puberty • Precocious – before age 11-12 in girls and before 8-9 in boys; • premature activation of pituitary hormones perhaps due to early weight gain, hormones in meat/milk, chemical pollutants. • Delayed – when secondary sex characteristics and physical growth do not begin in early adolescence. • Treatment with gonadatropin-releasing hormone or androgens.

12. Sexual behavior at or before puberty • Pubertal changes in the brain increase sexual desire, making sexual risk-taking behaviors more likely. • First sexual attractions occur at about age 10, after adrenarche but before gonadarche. • Masturbation to orgasm is not uncommon. • Sexual attraction > sexual fantasy > sexual exploration games. Have more erotic content than early childhood exploration games.

13. Adolescence (Ages 13 – 17) • In many non-industrialized countries, individuals become adults immediately following puberty. • Most important psychological challenge is development of a self-identity; • intense body awareness as the teen’s body becomes a symbol of self-worth. • Broader-based sense of self-esteem dependent upon accomplishments and quality of life develops later.

14. Masturbation in adolescence • Most teens masturbate (more boys than girls) but nearly half feel guilty about it. • When viewed positively, masturbation provides a way to gain sexual self-confidence as well as a way to control sexual impulses. • People who masturbated in adolescence generally engage in sex more frequently and with better sexual self-esteem in adulthood than those who did not.

15. Partnered sexual activity in teens • Petting/Necking – most have begun by age 14 and 80% have begun by age 18. • 2001 – 6.6% have had sexual intercourse by age 13; 60% of high school seniors have had sexual intercourse; 14% of high school students have had four or more partners. • Age at first intercourse (boys and girls) – younger for African-Americans and Whites; older for Latinos and Asian-Americans.

16. Attitudes about premarital sex • 1994 – 58% of those who say premarital sex is wrong have engaged in premarital sex. • Fewer young people today believe premarital sex is wrong than in the 1980s. • Less guilt and greater condom use has led to small decreases in teen pregnancy and birth rates during the 1990s. • For most teen girls (but much less so for boys), love and committed relationships are important before engaging in sex.

17. First sexual intercourse • Men/boys generally experience greater pleasure and less guilt than women/girls. • Males much more likely to experience orgasm • One-third of girls reported severe physical pain • Cultural and religious values instill fear and conflicts • Young women with positive experiences usually had extensive childhood and adolescent sexual experiences and 1st intercourse was with a caring partner in a safe place. • Confusing sexual and emotional intimacy

18. Peer pressure vs. abstinence • 1/4 to 1/3 of girls say they “went along” with it or that it was “voluntary but not wanted” – more so when her partner was much older. • Teens who believe that most of their friends are having sex will often feel intense pressure to conform. • Teens who postpone sexual intercourse • Waiting for marriage and fears of pregnancy/STDs • Positive parental involvement/communication and lack of drugs/alcohol use by the teens • Family, Cultural and Religious enforcement

19. Sex for the right reasons • Feeling guiltless and self-confident that your reputation will not be hurt by this choice. • Not trying to prove yourself or your love. • Not rebelling against parents or seeking attention. • Sex as expression of current feelings vs. attempt to improve a poor relationship. • Ability to discuss and agree about contraception, STDs, what to do if contraception fails.

20. Emerging Adulthood (Ages 18 – 25) • Today, “full” adulthood (economic self-sufficiency, marriage, parenthood, etc.) is later than in the past; median age of marriage for women is 25, and 27 for men. • 90% of emerging adults are sexually experienced, have sex regularly, and have had multiple partners. • Multiple partners are less common among the more religious and more educated women.

21. Sex among emerging adults • Emotional involvement – 86% of women and 71% of men say that sex is difficult without it. • Serial monogamy – a common pattern • Sexual self-schemas – cognitive views about the sexual aspects of ourselves • Erotophilia – positive emotions about one’s sexuality; these individuals tend to have a wider range of sexual experiences • Erotophobia – negative emotions about one’s sexuality

22. Young Adulthood (Ages 26 – 39) • Long-lasting monogamy is the norm for most adults aged 25 and older. • Adults who get and stay married have higher levels of psychological well-being than those who remain single. • Frequency of sexual intercourse in the first year of marriage is usually high; about 15 times per month. • For the entire population, frequency is highest for married couples in their 20s and 30s.

23. Sex in marriage • Married women are more likely than single women to have orgasms during intercourse. • Married couples use a greater variety of sexual techniques than in the past. • The majority of young people continue to masturbate after getting married. • A majority of men and women report marital sex to be more satisfying, than singles.

24. How do people select a mate? • Short-term relationships dominate human mating patterns worldwide, but in all cultures the idealistic goal is for a lasting relationship. • Manyof societies allow polygamy – men may have multiple wives or mistresses, but most do not. • Fewallow polyandry – women may have more than one mate. • Western cultures achieve the same thing through serial marriages or extramarital affairs. • Men may enjoy female promiscuity in short-term relationships but seek a chaste woman for a long-term relationship.

25. Extramarital sex • 36% of husbands and 25% of wives report at least one extramarital affair. Rates are just as high in cohabitating couples. • Men tend to be looking for sexual enjoyment whereas women are almost always looking for emotional connection as well as sex. • Men are most upset with their partner’s sexual infidelity; women with the emotional infidelity. • Opportunity for an affair and growing apart from one’s mate play important roles.

26. Consensual extramarital arrangements • Open marriage – both partners agree that it is okay to have sex with others (separately) • There are usually agreed-upon restrictions to serve to honor the primary status of the marriage. • Divorce rates equal to traditional marriages. • Swinging – extramarital sex (together) • Often sex between the wives while husbands watch • Some will “full swap” and some set limits • Tend to be white, non-religious, politically diverse

27. Middle Ages (Ages 40 – 59) • Many parents appear to be nonsexual because their behavior is private and they hesitate to discuss sexual topics with their children. • Decrease in sexual activity is very gradual between ages 30 and 60. • Many couples remain sexually active after 60 and report that their relationships are very satisfying sexually and emotionally. • Hugging and kissing become even more important than they were at younger ages.

28. Death and divorce – Losing one’s partner • Over half of all marriages end in divorce, with the greater risk being to 2nd, 3rd, 4th marriages. • 40% of Americans aged 45+ are single. • Because men die earlier than women, there are many more available single women than men as the population ages. • About ¾ of divorced people remarry; usually within 3 to 4 years. Half of these marriages end in divorce.

29. Female hormonal changes • Ovaries begin failing to respond to pituitary hormones; menstrual irregularities become common after age 35. • Climacteric (perimenopause) – the few years preceding and the year following menopause. • Menopause – cessation of ovulation and menstruation. • Four-fifths experience menopause between ages 44 and 55.

30. Physical changes of menopause (1) • Hot flashes – without ovarian estrogen and progesterone to inhibit them, LH and FSH are released in large amounts, causing blood vessels to dilate. • Sudden, intense heat spreads over upper body lasting from a few seconds to 15 minutes. • Pressure in heart or chest, nausea, feelings of suffocation can also be experienced. • Night sweats > fatigue, irritability and depression • 20% of women experience hot flashes for 5 years or longer.

31. Physical changes of menopause (2) • Osteoporosis – bones become brittle • Hip fractures are most common • Decrease in vaginal lubrication • Some couples mistakenly assume that this is a sign of decreased sexual desire. • Pick up a water-based lubricant at the drug store – KY jelly. • Uterine or vaginal prolapse – occurs in some women when severely weakened ligaments can no longer hold these organs in place. • Reconstructive surgery can correct the problem.

32. The medicalization of menopause • This normal process has become viewed as an illness to be treated medically with hormone replacement therapy (HRT). • The majority of women go through menopause without HRT and with no or few complaints. • HRT was believed to protect against heart disease and broken bones but recent research indicates that it does not decrease heart attack and it does increase risk of breast and ovarian cancer and strokes.

33. The good news • Post-menopausal women can throw away their contraceptives. • For most women, menopause causes no change in level of sexual desire. • For those who do experience lowered desire, medical treatment is available. • Women who have regular sexual activity throughout life experience less vaginal atrophy and loss of vaginal lubrication. • Yes, it’s true: Use it or lose it!

34. Male menopause? • There is no “sudden” loss of hormones in men as there is in women. • “Andropause” refers to emotional reactions some men have in response to changing family relationships, inability to achieve career goals and accepting their changing body. • A very gradual decline in testosterone begins in the late teens; • by age 55, 20-50% of men have testosterone levels that would be considered “low” for a young man.

35. Effects of lowered testosterone • Decreased sensitivity of the penis, longer time needed to achieve erection, less firm erection, less forceful ejaculation, testicle shrinkage, longer refractory period. • Taking longer to achieve erection pleases the female partner. • Sperm production continues but at a reduced rate after age 40. Sex-life satisfaction remains high • Testosterone replacement therapy can increase muscle mass and restore sexual desire in men who experience a hormonally related decline. • Reduction in bone density, sparser beard growth and slightly higher voice.

36. The Elderly Years (Ages 60+) • Our culture has viewed the elderly as sexually neutered; sex is seen as being for the young. • Among people in their 60s who have partners, over 70% have sex regularly. • 50% report having sex at least once a week • A study of men and women aged 80-102 found that ¾ still fantasized about sex and enjoyed touching and caressing their partners; • nearly ½ still engaged in sexual intercourse and 1/3 engaged in oral-genital sex.

37. Sex among the elderly • Sexual activity tends to be limited most by living arrangements (lack of privacy) or lack of an available partner rather than lack of interest. • Elderly people with physical disabilities who must depend on others for their care experience even less privacy, even to masturbate. • Sex after a heart attack – once you can engage in moderate exercise you’re okay. • Most other cultures view their elderly as sexual human beings; maturity improves sexual satisfaction. • There is more to sexuality than intercourse, oral-sex or masturbation; elderly people often report great sexual satisfaction with emotionally erotic experiences.

38. Varieties in Sexual Expression… • In our society, there exist a large variety of sexual behaviors and contraceptive methods. • 24.7% of men and 7.6% of women report masturbating at least once monthly. • 70% of people report experience with oral sex. • 26% of men and 20% of women have some experience with anal intercourse.

39. Hormones in male sexual behavior • Testosterone linked to male libido • Less linked to functioning; a man w/low testosterone level can be fully capable of erection and orgasm but might have little interest in sex. • Evidence 1) Castrated men shows reduction in desire and activity. 2) Androgen-blocking drugs (antiandrogens) • Have been used to try and treat sex offenders, and are used to treat some medical conditions, such as prostate cancer. 3) Hypogonadism: endocrine disorder causing testosterone deficiency in males; also causes major reduction in sexual desire that can be treated with testosterone replacement.

40. Hormones in female sexual behavior • Testosterone linked to female libido • Evidence 1) Testosterone-replacement therapy enhances sexual desire and arousal in post-menopausal women and other women with low levels of testosterone 2) In women with normal testosterone levels, supplemental testosterone caused a significant increase in genital responsiveness within hours. 3) Women with a history of low sex drive and inhibited arousal positively responded to testosterone administration. • Estrogens: role in female sexual behavior is still unclear. • Contribute to general sense of well-being • Help maintain thickness & elasticity of vaginal lining • Contribute to vaginal lubrication • No evidence to prove its effect on libido

41. How much testosterone is necessary for normal sexual functioning? • Levels of free testosterone are much lower in women than men. • This does not mean that women have lower or weaker sex drives. • Rather, women’s body cells are more sensitive to testosterone than a man’s body cells are. • Testosterone levels decline w/age in both sexes.

42. Oxytocin in male & female sexual behavior • Oxytocin:. • Stimulates release of milk during breast-feeding; thought to facilitate mother-child bonding • Released during physical intimacy/touch • Increases skin sensitivity to touch • High levels are associated w/orgasm • Levels remain high after orgasm; thought to contribute to emotional and erotic bonding of sexual partners • Breast feeding may result in orgasms • Research suggests oxytocin is important for facilitating social attachments and development of feelings of love. • Stress lowers oxytocin secretion.

43. Funny ad . . . oxytocin spray!

44. The brain and sexual arousal • Sexual arousal can occur w/o any sensory stimulation, through thoughts and fantasy alone. • Stimuli that people find arousing is greatly influenced by cultural conditioning. • Features that are considered attractive vary from one culture to another. • In many cultures, bare female breasts are not viewed as erotic stimuli, as they are in the U.S. • Foreplay leading to arousal varies considerably in different cultures. • Ex: in a survey of 190 cultures, mouth kissing was only practiced in 21.

45. Anatomical regions of the brain involved in sexual arousal & response cerebral cortex: thinking center of the brain Limbic system: associated w/emotion & motivation; also includes the “pleasure center”

46. Limbic system • Associated with emotion, motivation, and memory • Includes several brain structures • Hypothalamus, hippocampus, amygdala, cingulategyrus • 1950s study: rats implanted w/electrodes in regions of limbic system that could be activated by a lever. • Rats pressed lever over and over, in preference to eating or drinking, eventually dying of exhaustion. • Limbic stimulation in people (done for therapeutic purposes) : patients reported intense sexual pleasure. • Damage to certain parts of the hypothalamus seems to dramatically reduce sexual behavior of both males and females in several species.

47. Neurotransmitters and sexual arousal • Dopamine • Released in the “pleasure center” of the limbic system. • Facilitates sexual arousal and response. • Testosterone stimulates dopamine release in both males and females. • Oxytocin(already discussed) • Serotonin • Inhibits sexual activity • inhibits release of dopamine. • Antidepressants called SSRIs increase serotonin levels in the brain--side effects often include decreased libido and diminished sexual response.

48. Sexual arousal: the role of the senses • Touch is the dominant "sexual sense” • Primary erogenous zones: areas of the body that contain dense concentrations of nerve endings. • Includes genitals, buttocks, anus, perineum, breasts, inner thighs, armpits, navel, neck, ear lobes, mouth. • Varies from one person to another. • Secondary erogenous zones: areas of the body that have become erotically sensitive through learning and experience. • Virtually any other region of the body--depends on personal erotic experiences.

49. Sexual arousal: the role of the senses • Vision: usually next important sense in arousal. • Early research supported the idea that males are more aroused by visual stimuli than females. • Reflects many social influences: • Was considered culturally inappropriate for women to view pornography. • Most pornography was made to appeal exclusively to men; some women found themes/ideas offensive. • Today, pornography and erotica is available that appeals to many women. • Studies using physiological recording devices while subjects viewed pornography showed equal physiological signs of arousal in women and men. • When arousal was assessed by self-reporting, women are less inclined to report being sexually aroused by visual erotica.

50. Sexual arousal: the role of the senses • Smell: highly influenced by a person’s sexual history and social conditioning. • In some cultures, the smell of genital secretions are considered a sexual stimulant. • Use as a ‘perfume’ by some women in Europe. • U.S.: near obsession w/masking any natural body odor • Difficult to study effect of natural odors on desire when they are so heavily masked by frequent bathing, deodorants, perfumes, and antiperspirants. • Even so, many report being aroused by the smell of their partner, or by people to whom they are attracted. • Pheromones: odors produced by the body that relate to reproductive functions (e.g. fertility). • Very important in sexual response and arousal in many animals. • Research still not clear on how important they are in humans.