به نام خداوند جان و خرد کزین برتر اندیشه برنگذرد به نام خداوند جان و خرد کزین برتر اندیشه برنگذرد

SEXUAL RESPONCE 2016 spring

Sexual health Sexual health is a state of physical, mental and social well-being in relation to sexuality. It 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. بهداشت جنسی، حالت فیزیکی، روحی ​​و رفاه اجتماعی در رابطه جنسی است. نیاز به یک رویکرد مثبت و محترمانه به تمایلات جنسی و روابط جنسی دارد، و همچنین امکان داشتن تجربه جنسی لذت بخش و ایمن، فارغ از اجبار، تبعیض و خشونت.

Sexual Health Ethnicity and cultural issues Gender Age Economic status Physical and mental abilities Childhood experiences Mental and emotional health

پاسخ جنسی در یک فرد به چه عواملی بستگی دارد؟ تجربیات کسب شده وضعیت روانی-اج عوامل محیطی عوامل فیزیولوژیک (هورمونی، عروقی، عضلانی، عصبی) مصرف دارو طبی غیر طبی: الکل، مواد مخدر، رضایت درک شده فرد از زندگی با همسرش مشکلات جنسی همسر

Different Expectations Men and women often have different ideas about sex and love, and therefore often differ on why they have sex.

Sex for men is a stress reliever Sex for women requires stress relief

Sexual Response Response to sexual stimulation involves (Masters & Johnson, 1966): vasocongestion myotonia

Sexual Response Cycle Kaplan three-stage model (1974) sexual desire sexual excitement orgasm

Desire Phase تعریف: انگیزه و تمنا برای فعالیت جنسی احساس ارادی است. عامل ایجاد آن: تمایل جنسی تحت تاثیر عواملی نظیر ظاهر جنسی (جذابیت) افراد، تصورات ذهنی، وضعیت روحی- روانی و عوامل محیطی است. محرک داخلی: تصورات جنسی محرک خارجی: حضور شریک جنسی

Differences in Desire One of the most common types of problems that a couple might encounter is a difference in the frequency with which sex is desired. In many relationships, it does no good to point the finger and put the blame on one person or the other. People are generally only oversexed or undersexed relative to their partners’ desires. It is the couple that has the problem.

Sexual Response Cycle Masters and Johnson Four-Stage Model excitement plateau orgasm refractory period

Human Sexual response Cycle Desire Excitement Plateau Orgasm Resolution Divided Arousal We improved this somewhat in the 1980’s when Helen Singer Kaplan divided Excitement into 2 separate phases, desire and arousal. Then we became even more sophisticated by including satisfaction as a necessary component to fulfill the cycle. Masters WH, Johnson VE. Human Sexual Response. Boston, Mass: Little Brown;1966. Kaplan HS. The New Sex Therapy. New York: Brunner/Mazel,1974 .

Stage I: Excitement both men and women: muscle tension, increased heart rate/blood pressure engorgement sex flush

More Excitement Women: engorgement lubrication enlargement Men: erection enlargement/elevation

Stage II - Plateau The acceleration of processes begun in the excitement phase Females the orgasmic platform – the significantly engorged outer 1/3 of the vagina Lasts from a few seconds to a few minutes

Phase III - Orgasm Involuntary muscle spasms Blood pressure, respirations, heart rate peaks Males – emission then expulsion Males ejaculate approximately 5-10ml of semen

Sexual Response Cycle: Resolution The resolution stage occurs after orgasm and allows the muscles to relax, blood pressure to drop and the body to slow down from its excited state. Generally males experience a refractory period, meaning orgasm cannot be achieved again until time has passed. The penis meanwhile returns to a flaccid state. Females may not experience this refractory period and further stimulation may cause a return to the plateau stage. Otherwise, significant changes may also occur, such as the opening of the cervix and the reduction of blood flow to the genitals and nipples.

Sexual Function

Female Sexual Response Cycle Orgasm Plateau Resolution Excitement Resolution Resolution (B) Sex response is a natural phenomenon in which sensory stimulation leads to increased peripheral blood flow and vasocongestion. Genital tissues and breasts are most obviously affected. With continuing stimulation, there is a build-up of muscle tension and the development of a “plateau” phase that leads to orgasm. During orgasm, there is a brain discharge, widespread muscle contraction, and increased cardiac output. Resolution follows orgasm with return to the unstimulated state. The essential components of sex response depend upon adequate functioning of nerves, arteries, and muscles. A B C (C) (A) Adapted from Masters WH, Johnson VE. Human Sexual Inadequacy. Little Brown; 1970.

Female Sexual Response Cycle Emotional Intimacy Emotional and Physical Satisfaction Spontaneous Sexual Drive Sexual Stimuli Female Sexual Response Cycle And now Rosemary Basson offers an alternative model to understanding the sexual response cycle that suggests that for women, it is not so linear and that for many women, desire comes after arousal and that many women begin from a point of sexual neutrality. Arousal may come from a conscious decision or as a result of seduction or suggestion from a partner. This is extremely important to understand because you can then normalize this reality for your patients who have come to believe that because the initial drive has gone they are no longer sexual beings and to reassure their partners that it is not that they have lost desirability. (e.g analogy of going to the gym—) So, Sexual neutrality or being receptive to rather than initiating sexual activity is considered a normal variation of female sexual functioning. This is very important for you to keep in mind as I review the female sexual dysfunctions, particularly hypoactive sexual desire disorder. This slide graphically illustrates “normal” female sexual response. Women’s desire has a large responsive (receptive) component that is driven by intimacy and is circular in nature. When any one (or more than one) aspect or phase of the cycle is absent, the patient may experience one or more sexual dysfunctions. Satisfaction is an essential component of the sexual response cycle. Instead of a linear relationship with orgasm as the end point, a cyclic concept with satisfaction as the focus appears to be more appropriate in females. The cycle: A woman starts out desire-neutral. If the patient experiences adequate emotional intimacy with her partner, she may seek or be receptive to sexual stimuli. Receptivity to sexual stimuli allows the woman to move from sexual neutrality to arousal. If the mind continues to process the stimuli on to further arousal, sexual desire will encourage the woman to move forward to sexual satisfaction and orgasm. This positive outcome fosters intimacy and reinforces sexual motivation. Arousal and Sexual Desire Sexual Arousal Biologic Psychological Basson R. Med Aspects Hum Sex. 2001;1:41-42.

Biopsychosocial Model of Female Sexual Response (e.g., physical health, neurobiology, endocrine function) (e.g., performance anxiety, depression) Psychology (e.g., quality of current and past relationships, intervals of abstinence, life stressors, finances) (e.g., upbringing, cultural norms and expectations) Sociocultural Interpersonal Biology Unlike the other influential models, the biopsychosocial model of female sexual response takes into account multiple etiologic factors and determinants that include the interpersonal, psychological, physiological, or biological, as well as the sociocultural.1,2 Examples of biological factors include physical health, neurobiology, and endocrine function; the psychological include performance anxiety and depression; the sociocultural include upbringing, cultural norms, and expectations; and the interpersonal, quality of current and past relationships, intervals of abstinence, life stressors, and finances.1,2 Rosen RC, Barsky JL. Obstet Gynecol Clin North Am. 2006;334:515-526. Althof SE, Leiblum SR, Chevret-Measson M, et al. J Sex Med. 2005;26:793-800. References: Althof SE, Leiblum SR, Chevret-Measson M, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2005;26:793-800. Rosen RC, Barsky JL. Normal response in women. Obstet Gynecol Clin N Am. 2006;334:515-526. SD66098 (Previously used in SD64473, Slide#18) 24

Thank you for Attention

رفتار جنسی نابهنجار یعنی رفتار جنسی که: برای خود یا دیگران مخرب است، قابل هدایت به سوی یک شریک جنسی نیست، تحریک اعضای جنسی اولیه در آن وجود ندارد، به طور نامتناسبی همراه با احساس اضطراب و گناه است، حالت وسواسی دارد، روابط خارج از زناشویی؟ خود ارضایی؟

Sexual Behavior: What Is Normal? Common socio cultural standards: The heterosexual standard The coital standard The orgasmic standard The two-person standard The romantic standard The safer sex standard

Difficulties That Can Hinder Sexual Function Sexual desire disorders Sexual arousal disorders Orgasm disorders Sexual performance anxiety Sexual pain disorders

Figure 6.6 Prevalence of Sexual Problems in Men and Women

منابع تمایلات و رفتارهای جنسی انسان: دکتر بهنام اوحدی behnam_ohadi_md@yahoo.com درسنامه اختلالات جنسی: دکتر شایسته جهانفر- میترا مولایی نژاد، نشر سالمی احساسات و پاسخ های جنسی انسان: دکتر بهنام اوحدی انسان و سلامت جنسی: دکتر سید کاظم فروتن، دکتر فریدون خیام فر، نشر حیان درمان های غیر دارویی در درمان اختلالات جنسی 1: دکتر حمید رضا شیر محمدی، ناشر شکوه زبان پژوه درمان های دارویی در درمان اختلالات جنسی 2: دکتر حمید رضا شیر محمدی، ناشر شکوه زبان پژوه راهنمای کاربردی درمان اختلالات جنسی 1: دکتر ماهیار آذر، دکتر سیما نوحی، ناشر معین ناتوانی جنسی در آقایان، دکتر علیرضا منجمی، ناشر آزادمهر روانشناسی کاپلان

Thank you for Attention