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ICM - Sex Summaries

ICM - Sex Summaries

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Published by Roshni Mahapatra

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Published by: Roshni Mahapatra on Aug 29, 2009
Copyright:Attribution Non-commercial

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10/15/2012

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
 
Cross-cultural issues in sexuality
More sex on prime-time TV than other times (most sex on soap operas, movies, talk shows…)
Inis Baeg in Ireland – sex is totally taboo. Mangaians in South Pacific – lots of teen sex, not taboo
People are
not 
having a lot more sex now than before
Single 20 year olds do
not 
have more sex than married 30 year olds
Single women over 40 have the least sex of all Americans
Most Americans are overwhelmingly satisfied with their sex lives
83% of our sex partners are within 5 years of our age
90% are same race/ethnicity
68% are same religion (93% same/similar religion)
<2% of men with college degree choose women who have no high school diploma; but only 8% choosewomen with a graduate degree
59% of population has 0-4 sexual partners in lifetime
The greater the education, the greater the number of partners
80% women, 65-85% men remain faithful during marriage
Only vaginal intercourse has nearly universal appeal
In US, about ¾ of couples engage in oral sex, about ¼ engage in anal sex
4-7 times per month is average; 15-60 minutes each time
Age of first sexual activity seems to be inversely related to legal age of consent in many countries
US has highest teenage pregnancy rate of developed countries (& one of highest abortion rates)
60% marriages globally are arranged
50% US married couples are adulterous; 49% get divorced
Age at first marriage in US – 26.9 (men), 25.3 (women); age at first divorce – 30.5 (men), 29 (women)
People are sexually active well into 80s, 90s (i.e., 80% of 70-year-olds, 50-60% 80-year-olds)
 
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Similarities across countries – established minimum age of sexual consent; adult porn regulated by gov’t;child porn not tolerated; incest is taboo
Female sexual response, part 1
Prevalence of sexual problems
48% couples have difficulty getting excited, 46% have trouble reaching orgasm, 15% unable to have orgasm,14% say sexual relationship is not satisfying
60-80% people rate sex as important in their lives, their relationshipsFemale sexual response cycle1)
 
excitement2)
 
plateau3)
 
orgasm4)
 
resolution
intimacy-based model of sexual response
60% of women never initiate sex
some women have a rather linear passage through these stages; others reach plateau and stay there (neverorgasm); others reach plateau and then have multiple orgasms (Masters and Johnson, 1966)Responses to sexual stimulation
CV/pulm:
HR elevated by late plateau phase, possibly up to 180 bpm. Increased rate reflects increased orgasmicintensity; higher rates seen during masturbation than partner sex (not true for men – new/forbiddenpartner produces highest HR)
RR – tachypnea may not develop until late plateau phase, possibly up to 40/min. Clinically observabletachypnea may not occur with low intensity orgasm
BP elevated in late plateau phase by 30-80 mmHg (systolic), 20-40 mmHg (diastolic)
breasts:
plateau phase – areolae become markedly engorged, size increases up to 25% (less in women whohave previously nursed)
orgasm phase – no specific breast response to orgasm; vasocongestive responses are at peak 
resolution phase – flush disappears, areolae lose tumescence, “false” nipple erection (because breastcontracts); vasocongestion lost slowly, over 10 minutes
skin:
“sexual flush” – seen in ¾ of women; can act as indicator of sexual intensity; primarily due tovasocongestion; mottled skin, sensation of warmth; usually over epigastrium, breasts, chest
urethra, bladder:
involuntary distention of urethral meatus during orgasm
postcoital dysuria (should get up & pee after sex to flush out bacterial that can get from perineum tobladder with ‘thrusting’ – avoid ‘honeymoon cystitis’)
rectum:
voluntary contraction of external rectal sphincter, gluteal muscles during excitement, plateau (auto-erotic – pumps even more blood into genitals)
involuntary rectal sphincter contraction during orgasm (to avoid BM!)
MSK:
plateau phase – myotonia (generalized & specific), clutching reflex, carpopedal spasm (feet down, toespoint up), rectus abdominus & gluteus contract; may help maintain vasocongestion
brain:
frontal lobes – variable involvement
 
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occipital, parietal lobes – minimal involvement
temporal lobes – involved in emotional responses (limbic system)
cerebellum – considerable movement
hypothalamus – hormonal mediation (women most receptive to sex in pre-ovulatory phase & pre-menstrual phase)
Nulliparous women:
labia majora – thin out, flatten against perineum; elevate, move upward/outward, away from introitus(may be secondary to changes in vagina or labia minora); may persist for several hours
labia minora – by plateau, increased up to 3x normal diameter; may cause separation from labia majora;adds 1cm to length of ‘vaginal barrel;’ marked color change (red wine) always seen when orgasm isexperienced (fades 10-15 min. later) – pathognomonic of impending orgasm
Multiparous women:
labia majora – labial viscosities are more prevalent; become distended, engorged; may increase 2-3times in diameter (can be painful); slight lateral movement seen; labial vasocongestion may persist for 3hours after orgasm
labia minora – color changes more intense than in nulliparous women
Bartholin glands:
vestigial scent glands; produce small amount (1-3 drops) of mucoid secretion in late excitement/earlyplateau phase
multiparas > nulliparas
may serve as initial lubricant of introitus; more lube can be elicited
secretions reduce vaginal acidity (
sperm longevity)
clitoris:
anatomy – consists of 2 corpora cavernosa enclosed in dense fibrous capsule; each corpus is connectedto the rami of the pubis by a crus; suspensory ligament inserts into anterior surface; ischiocavernosusmuscles insert into crura (originate from ischial rami)
glans measures 4-5mm on average; clitoral shaft varies markedly in length (cm); size of clitoris isunrelated to sexual performance/enjoyment
innervated by dorsal nerve (from pudendal nerve); dorsal nerve terminates in a nerve plexus in glans,corpora cavernosa; myelinated & unmyelinated fibers; autonomic nervous system
blood supply from deep & dorsal clitoral arteries (branches of internal pudendal artery); similarvascular pattern to penis, with smaller volume vessels
excitement phase – swells, becomes ‘erect’ (observable or not); much less rapid than penile swelling;swelling causes friction against clitoral hood
plateau phase – retracts, turns upwards 180 degrees (hides!);
crura, suspensory ligaments,ischiocavernosus muscles
are responsible for this; completely withdraws under clitoral hood; 50%reduction in length; allows for friction from symphysis and hood
orgasm phase – nothing happens to the clitoris!
resolution phase – returns to normal ‘overhang’ position in 5-10 seconds after orgasm; detemuscenceof glans is slower (30 min.); may remain engorged for several hours if no orgasm is reached
vagina:
responds to penile penetration; receptacle for ejaculate; responses to both somatic & psychogenicstimuli
excitement phase – vaginal lubrication is first sign of sexual stimulation in women; begins 10-30 secafter stimulation is perceived; transudate from vaginal walls due to engorgement of venous plexuses; noglands; neural mediation via parasympathetic S2, 3, 4. Distensible potential space. Cervix & corpuselevate. Inner vaginal lumen expands (from 2-6cm); vaginal length increases (from 8-10cm); colorchanges (vasocongestion), rugae flatten.
plateau phase – outer 1/3 becomes markedly distended; outer lumen diameter decreases (up to 50%);orgasmic platform develops; further lengthening occurs; production of secretion slows

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