1. Chapter 4 Sexual Health

2. Sexual health defined: “A state of physical, emotional, mental and social well- being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. “ World Health Organization [WHO]. (2006). Defining Sexual Health. Report of a technical consultation on sexual health 28–31 January 2002, Geneva, Switzerland: WHO. Available at: http://www.who.int/reproductivehealth/publications/en/

3. Perspectives on Sexual Health and Sexuality Cultural and religious dimensions “Marriage” is universal theme in all cultures sanctioning sexual privileges and obligations Sexual behavior is often defined by cultural values – Normative sex roles – Acceptable types of sexual activity – Sanctions/prohibitions on sexual behavior – Premarital sex – Sexual restraint for females – Same-sex relationships – Contraception decision making

4. Perspectives on Sexual Health and Sexuality Economic dimensions Daughter in marriage = dowry Value of bride = virginity Sexual aggression = power and economic dynamics Commercial sex industry/prostitution

5. Perspectives on Sexual Health and Sexuality Legal dimensions Laws prohibiting certain types of sexual behavior/intimacy—cohabitation, fornication, sodomy Same-sex partners Marriage, annulment, separation, divorce, child custody, child support

6. Perspectives on Sexual Health and Sexuality Political dimensions Sex education in schools – Abstinence-only programs – Comprehensive or abstinence-plus programs

7. Class Discussion What are some current international news events related to sexual health? What are some current national news items related to sexual health?

8. Sexual Behavior Among Youth in U.S.

9. Sex Research Well-known studies Kinsey Report (1948 and 1953) o Factors affecting sexual behavior in males/females Masters and Johnson (1966) o Sexual response cycle phases Redbook Survey (1977) o Sexual behavior and attitudes of American women Hite Report (1976) o Sexual practices of American women Blumstein and Schwartz (1983) o Sexual and nonsexual components of relationships ABC Primetime Poll (2004) o Found most Americans were monogamous and happy about it

10. Class Discussion How do definitions of terms like “virginity” or “pre-marital” complicate sexual health research?

11. Sex and Gender Gender The economic, social, and cultural attributes and opportunities associated with male or female Sex An individual’s biological status as male or female Gender identity An individual’s personal subjective sense of being male or female

12. Homologous Sex Structures

13. Definitions Gender role The public expression of one’s gender identity, as well as cultural expectations of male and female behaviors - Masculine vs. feminine Socialization The process whereby society conveys behavioral expectations to the individual Androgyny Having characteristics of both sexes

14. Definitions Transgender Umbrella term for anyone whose behaviors, thoughts, or traits differ from those traditionally ascribed to the person’s sex Transsexual A person whose gender identity is opposite to her or his biological sex Transvestite A person who dresses like the opposite sex

15. Definitions Gender dysphoria Overall term used to describe negative or conflicting feelings about one’s sex or gender roles Transitioning Process in which transsexuals work to change their appearance and social identity to match with their gender identity (MTF or FTM) Intersexuality Refers to the sexual physiology of an individual; a person who is intersexed is born with nonstandard sex chromosomes or genitalia

16. Sexual Stereotypes: Discussion Women are undersexed and men are oversexed Women are inexperienced and men are experts Women are recipients and men are initiators Women are controllers and men are movers Women are nurturing and supportive, and men are strong and unemotional Women are sensitive and men are insensitive Women are dependent and men are independent Women are passive and men are aggressive

17. Sexual Orientation Sexual orientation refers to one’s erotic, romantic, and affectional response to people of the same sex, opposite sex, or to both sexes Homosexual Heterosexual Bisexual Issues Homophobia Profiling Discrimination in medical care

18. External Female Sexual Anatomy

19. Internal Female Sexual Anatomy

20. Common Problems Related with Menstruation Dysmenorrhea Painful menstrual flow Premenstrual syndrome (PMS) Group of symptoms linked to menstrual cycle Premenstrual dysphoric disorder (PMDD) Severe form of PMS Amenorrhea Lack of menstrual flow

21. Physical Health and the Gynecological Exam Exam steps Medical history General physical examination – Breast examination and pelvic examination Pelvic examination – Phase I = external examination – Phase II = use of speculum; collection of specimens – Phase III = bimanual examination

22. Sexual Arousal and Sexual Response Masters and Johnson: Female Sexual Response Cycle Four Phases 1.Excitement 2.Plateau 3.Orgasm 4.Resolution

23. Forms of Sexual Expression Traditional heterosexual positions Masturbation Petting Oral-genital stimulation (cunnilingus, fellatio) Anal intercourse Use of sex toys and accessories

24. Sexual Dysfunction Prevalence – About 40% of U.S. women report sexual problems, but only 12% are distressed about it Historically called “frigidity” Areas of dysfunction – Sexual desire disorders – Sexual arousal disorders – Orgasmic disorders – Sexual pain disorders

25. Sexuality Through the Life Span Childhood Self-genital stimulation Engage in play that may be viewed as sexual in nature Curious about secondary sex characteristics

26. Sexuality Through the Life Span Adolescence Puberty – Menarche – Secondary sex characteristics – Hair growth, breast budding, vaginal walls thicken, uterus enlarges, vaginal pH increases in acidity First intercourse average = 17.4 years

27. Sexuality Through the Life Span Young to middle adulthood Increasing number of single sexually active adults Marriage at later age Increase in the number of women who never marry Placing career goals and advanced education before marriage Increased divorce rate Increase in cohabitating adults Increase in the number of women who no longer depend on marriage to ensure economic stability

28. Sexuality Through the Life Span Older adulthood Climacteric—physiological changes that occur during period from female fertility to infertility Menopause—cessation of menstruation – Vaginal dryness and thinning, delayed lubrication, hot flashes Decline in frequency and intensity of sexual activity Quality vs. quantity of sexual expression

29. Types of sexual violence Sexual assault and rape Female genital mutilation (FGM) Forced sterilization Sexual Violence as a Public Health Problem

30. Informed Decision Making Gynecological checkup Understanding personal feelings, thoughts about sexual well-being Understanding the medical language associated with sexual health Understanding responsible sexual behavior Understanding myth vs. fact Communication between parents and children Knowledge of health-care resources