Sexuality Defining sexuality Hormones involved in sexuality Women, men and sexual arousal The Female sexual response Sexual problems in women Drugs and sexuality

I. Defining Sexuality A. What does SEXUALITY mean? Sexuality involves – Sexual desire – (libido) the desire for sexual behavior

Anal sex BDSM Foreplay Frotteurism and Tribadism Fisting Masterbation Scrotism Oral sex (cunnilingus, fellatio, rimming,) Outercourse Petting Sexual fetishism Vaginal sex

B. social influences & social norms Growing up, family and friends Culture - media Stereotypes Religion Laws - - http://www.geocities.com/CapitolHill/2269/CApenal9.html IC 35-41-1-9 "Deviate sexual conduct" defined      Sec. 9. "Deviate sexual conduct" means an act involving:         (1) a sex organ of one person and the mouth or anus of another person; or         (2) the penetration of the sex organ or anus of a person by an object. As added by P.L.311-1983, SEC.10. Amended by P.L.183-1984, SEC.1.

C. Gender identity M F Transgender – “People who were assigned a gender, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves.” Transsexual – “Transsexual people are people who desire to have, or have achieved, a different physical sex from that which they were assigned at birth” FTM MTF Genderqueer – “A genderqueer person is part of a group of people who do not think that they fit into the traditional two-gender or gender-binary system.” http://encyclopedia.thefreedictionary.com/Genderqueer

D. Sexual orientation 0 1 2 3 4 5 6 Kinsey’s Scale

0 - exclusively heterosexual 1 – 2 - predominantly heterosexual, but more than incidentally homosexual 3 – 4 - predominantly homosexual, but more than incidentally heterosexual 5 - predominantly homosexual, incidentally heterosexual 6 -

II. Hormones and sexuality Hormones are directly involved in all aspects of sexuality: Desire, Excitement, Intimacy etc… Testosterone 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. Estrogen Estrogen deficiency, as occurs with menopause, causes a decrease in genital vasocongestion and lubrication and atrophy of the vaginal epithelium

Hormones continued: Progesterone Prolactin Oxytocin Pheromones Certain oral contraceptives that increase progesterone levels throughout the female cycle have been associated with decreased sexual interest and desire Prolactin Oxytocin Pheromones

Neurotransmitters also play integral part Nitric oxide Sexual stimulation leads to NO production that in turn stimulates the release of 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 Epinepherine epinephrine and norepinephrine metabolite, vanillylmandelic acid, increases prior to intercourse and continues to be elevated over baseline up to 23 hours following sexual activity

III. Women, men and sexual arousal A. Generalizations Women – Men –

B. People learn to be sexual

IV. The female sexual response

Overview of the female sexual response cycle: Physiological sexual arousal in women begins with increased clitoral length and diameter, and vasocongestion of the vagina, vulva, clitoris, uterus, and possibly the urethra. Engorgement of the genital vascular network increases pressure inside the vaginal capillaries and results in lubrication of the epithelial surface of the vaginal wall. Orgasm is characterized by a peak in sexual pleasure that is accompanied by rhythmic contractions of the genital and reproductive organs, cardiovascular and respiratory changes, and a release of sexual tension The body returns to its pre-aroused state

A. Excitement Phase Women are less likely than men to pick up on the physiological cues of their own sexual arousal… Heart rate Vasocongestion – 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. \

B. Plateau phase Outer third of the vagina wall becomes swollen with blood Labia minora also become engorged with blood Breasts become somewhat engorged, nipple erection maintained

C. Orgasm Orgasm – at which time the pulse rate reaches its peak Suffusion of warmth spreads from pelvis throughout the body Initial contraction, followed by 3 or 4 rhytmic contractions

D. Resolution Body gradually returns to its unexcited state following the orgasm Glans emerges from the foreskin and returns to its usual size within 15-30 minutes Respiration, pulse and blood pressure return to normal Muscles relax

Multiple orgasms in Women Most, if not all women have the potential for more than one orgasm May depend on the type of sexual stimulation involved

In 1997, Whipple and Brash-McGreer proposed a circular sexual response pattern for women. comprises four stages Seduction (encompassing desire), sensations (excitement and plateau), surrender (orgasm), and reflection (resolution). pleasant and satisfying sexual experiences may have a reinforcing effect on a woman, leading to the seduction phase of the next sexual experience.

V. Female Sexual Dysfunction 1) Sexual desire disorders, 2) sexual arousal disorders, 3) orgasmic disorder, 4) sexual pain disorders 1999 survey found that sexual dysfunction of some form was reported more commonly among females (43%) as compared to males (31%)

A. Mechanisms of sexual dysfunction Psychogenic Relationship issues, depression, anxiety, self-esteem, body issues, personal loss, abuse, etc. Iatrogenic 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

B. FSD Treatment Nonphparmacologic Pharmacologic Hormone therapy Antidepressants The Eros Therapy

VI. Effects of drugs on sexuality Dosage and timing important Limited information available Aphrodisiacs http://www.channel4.com/health/microsites/0-9/4health/drugs/dus_sex.html