Handout 2 of 2 NURS 330 February 16, 2015

What is Sexuality? “The integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation. “-WHO

What factors influence Sexuality?

The Senses and Sexuality Touch Smell Sound Sight Ask – which is missing? Sight (visual) – cultural differences in standards of beauty .universal appeal of healthiness, clear skin Touch – primary erogenous zones Smell – overt odors/fragrances Hearing – voice, music Taste does not appear to play a significant role in sexual arousal. Tate buds may not be an important source of sensory input for arousal, touch receptors on the tongue may be.

Smell Smell Odors play a role in sexual arousal Pheremones Perfumes Colognes Debate about its existence i.e. menstrual synchrony Not all odors are conducive to sexual arousal Offensive odors

Sound Sound Auditory stimuli Your partner’s voice Romantic or sexy music Love-making sounds Not all sounds are conducive to sexual arousal

Sight Sight Allows us to experience many images that can trigger feelings of sexual arousal Viewing an “attractive” person Subject to social and cultural influences Erotic images Sometimes even parts of one’s genitals

Which sense is this? Taste Do not appear to play a significant role in sexual arousal

Female Ejaculation Does it exist? Yes, female ejaculation does exist but is NOT very common The fluid that is ejaculated is odorless and clear

Terms to know Erogenous zones Kegel Exercises Aphrodisiacs Pheremones

Definition Erogenous Zones Kegel Exercise parts of the body that, when stimulated, elicit sexual arousal Kegel Exercise Recommended to reduce urinary incontinence and possibly increase sexual pleasure Identify the muscle by stopping urination in midstream

Definition Aphrodisiacs Pheromones Agents that show any ability to enhance sexual functioning Pheromones Substances that when secreted have a particular smell found to be sexually arousing. Pheromones also play a role in menstrual synchrony.

Sex Hormone Testosterone “Male” hormone Found in small amounts in women Affects sexual response in men and women Men – produced by the seminiferous tubules Women - produced by the ovaries Increase energy, sex drive (libido), aggression, appetite, muscle mass Increases libido in both men and women

FACT A person’s emotional and mental states also help determine whether that person experiences arousal

Sexual Response Cycle

Models of Human Sexual Response Master’s and Johnson Proposed their four-stage model of human sexual response cycle Stage I - Excitement Stage II - Plateau Stage III - Orgasm Stage IV - Resolution

EXCITEMENT- 1ST STAGE: Response to stimuli Transudation Vasocongestion FEMALE MALE Transudation Vasocongestion Tenting Effect HR, BP, RR Myotonia Penile Erection Testis enlarge RR – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate

PLATEAU – 2ND STAGE Orgasmic Platform Tenting Effect Seminal Pool FEMALE MALE Orgasmic Platform Tenting Effect Seminal Pool Erection is maintained (if there is enough stimulation) Cowper’s Gland secretes fluid

ORGASM – 3RD STAGE Muscle spasms Involuntary FEMALE MALE Muscle spasms Involuntary Collection of semen in the urethral bulb Ejaculatory Invariability -bulbocavernosus muscle Expulsion of semen

RESOLUTION – 4TH STAGE Return to non-aroused state Refractory Period FEMALE MALE Return to non-aroused state Refractory Period

Comparing male and female sexual response Key difference Male has a refractory period There’s a potential for multiple orgasms in women Controversies in understanding the female orgasm Freud vaginal orgasm is true orgasm Master’s and Johnson only one kind no matter how achieved Let them know the Master’s and Johnson’s definition is the most widely accepted.

Sexual Dysfunctions

Sexual Dysfunctions Recurrent or persistent sexual problems that interfere with normal performance and cause distress Nine types of sexual disorders Four categories Sexual Desire Disorders Sexual Arousal Disorders Orgasmic Disorders Sexual Pain Disorders

Prevalence

Sexual Desire Disorders Hypoactive sexual desire disorder Persistent deficit in sexual fantasies and desire for sex Sexual aversion disorder Extreme aversion to any form of sexual contact with a partner

Sexual Arousal Disorders Female sexual arousal disorder Difficulties becoming sexually aroused Deficient vaginal lubrication Male erectile disorder Recurrent problems in achieving or sustaining penile erection in a sexual situation Aka Impotence

Orgasmic Disorders Female orgasmic disorder (anorgasmia) Recurrent problem with reaching orgasm despite adequate erotic stimulation Male orgasmic disorder Delay or inability to reach orgasm during sexual activity Premature ejaculation Persistent or recurrent ejaculation following minimal stimulation and before the person wishes it

Sexual Pain Disorders Dyspareunia Vaginismus Recurrent genital pain during sexual intercourse Vaginismus Persistent involuntary spasms of vaginal muscles, which interfere with sexual intercourse

Sexual Dysfunctions - Differences in Men and Women Female Male Sexual Aversion Disorder Dyspareunia Dyspareunia (rare in men) Vaginismus Premature Ejaculation Female Orgasmic Disorder Male Orgasmic Disorder Hypoactive Sexual Desire Disorder Female Sexual Arousal Disorder Male Erectile Disorder

General Causes Physiological/Biological Psychological/Emotional Medication and illicit drugs Psychological/Emotional Anxiety Negative beliefs Sexual trauma Interpersonal/Social Relationship problems Environmental Cultural factors

Treatment of Sexual Dysfunctions Medical treatment of sexual dysfunctions Sex therapy Treatments for erectile disorder Surgical implants Vascular surgery Vacuum constriction devices Penile injection therapies Oral medications for erectile disorder Principles of sex therapy Mutual responsibility is emphasized Information and education are integral components Attitudes, expectations, and sexual scripts usually must be modified

Medical Treatment Viagra FDA approval in March 1998 Prescription only Lasts about four hours Side effects Short duration

Sex Therapy Principles of sex therapy Mutual responsibility is emphasized Information and education are integral components Attitudes, expectations, and sexual scripts usually must be modified

Rape Drugs What is a Rape Drug? A rape drug is one that is used in a drug facilitated sexual assault.

Rape Drugs (cont) The most common rape drugs: Odorless, colorless Rohypnol GHB Other common rape drugs Ecstasy Ketamine Odorless, colorless Easily dissolved into drinks

Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia

INFERTILITY

Infertility Definition: number of couples who have unprotected intercourse for one year and do not experience a pregnancy 10-15% of American couples are infertile

Causes of infertility Both men and women contribute to infertility 90% of cases, cause will be known Each gender contributes 40% Both contribute 10% Remaining 10% of cases, cause remains unknown Males Usually due to sperm defect Females More complex

Risk Factors Some common risk factors Age Weight Lifestyle Occupational and Environmental risks Stress and Emotional factors Genetic conditions??

Age and Infertility Females Males As a woman gets older, her chances of fertility declines Menopause Higher risk of chromosomal abnormalities that occur in her eggs More likely to have health problems that may interfere with fertility However, if fertilization occurs, can carry to full term High risk of miscarriage Males Not very clear on its impact of age and fertility in men Age does not appear to impact fertility in males as it does in females.

Chances of Pregnancy by Age Fertility % Up until 34 90% By age 40 Declining to 67% By age 45 Declining to 15%

Causes of Female Infertility Common causes Blocked Fallopian Tubes Pelvic Inflammatory Disease Endometriosis Ovulation disorders Others

Pelvic Inflammatory Disease (PID) Pelvic Inflammatory Disease, or PID, is the major cause of infertility worldwide. It is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). Infection of one or both fallopian tubes is known as Salpingitis Symptoms Mostly asymptomatic Fever, chills, pelvic pain (indicating inflammation of the entire pelvic area).

PID (cont) Causes of PID Untreated/uncured bacterial infection Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea. Other Causes Non-sterile abortions Cervicitis (usually from genital herpes infection) Other vaginal infections (bacterial vaginosis, trich) Ruptured appendix Childbirth

Endometriosis Lining of the uterus, instead of being expelled into the vagina, is expelled out into the fallopian tubes and implanted in other areas of the pelvis. These implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle Eventually causes scarring and inflammation Symptoms Often causes no symptoms Painful periods, painful sex, painful bowel movements Cause is unknown Possible defects in immune system

Endometriosis and infertility Endometrial cysts in the fallopian tubes may cause blockage Scar tissue between uterus, ovaries and fallopian tubes Poor egg implantation

Female Infertility- Other possible causes Ovulation Disorders Hormone Disorders Hypothalamic-Pituitary Disorders Polycystic Ovarian Disease/Syndrome Thyroid Other Ovarian Cysts Benign Uterine Fibroids Ectopic pregnancies, medical conditions, medications

Male Infertility Over 90% of cases are due to: Low sperm count Poor sperm quality Motility Morphology Both 30 - 40% of cases have an unknown cause

What affects sperm count and quality? Environmental and Biologic Factors Lifestyle -Emotional -Smoking -Sexual Issues/Infection -Malnutrition -Substance Abuse -Obesity -Testicular Exposure to overheating Genetic Factors Varicocele

Varicocele Varicose vein in the cord that connects to the testicle. Found in 10-15% of all men Found in 25% - 40% of infertile men Only varicoceles large enough to be felt are reported to affect fertility

Other causes of sperm defect Testosterone Deficiencies Autoantibodies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications

Testing for Infertility - males Sperm evaluation Hormone tests Ultrasound

Testing for Infertility – females Ovulation Assessment Body temperature Cervical mucus assessment Hormone Analysis Laparascopy Check vagina for naturally occurring sperm antibodies

Infertility Treatment Artificial Insemination Drug therapy Clomid In Vitro Fertilization (IVF)

Infertility Treatment Gamete Intrafallopian Transfer (GIFT) Both egg and sperm inserted into Fallopian tube Zygote Intrafallopian Transfer (ZIFT) Fertilized outside body and inserted into Fallopian tube Intracytoplasmic Sperm Injection (ICSI) Direct injection of sperm into egg in lab

In-Class Assignment