Sexuality and sexual identity

SEXUALITY

- multidimensional phenomenon (feelings, attitudes and actions)

- w/ both biologic and cultural components
- encompasses and gives direction
BIOLOGIC GENDER - chromosomal sex (XX – male | XY – female)
GENDER / SEXUAL IDENTITY - inner sense of a person (maybe be same or different from biologic
gender)
GENDER ROLE - male / female behavior

DEVELOPMENT OF GENDER IDENTITY:

 Sex Typing - amount of testosterone secreted in utero may affect gender development
 Culturally Influenced
 NOTE! Children who suspect that their parents wanted a child of the opposite sex are more likely
to adopt roles of the opposite sex that if they are confident their parents are pleased with them as
they are
INFANCY
GIRLS: BOYS:
 dainty rattles  bigger rattles
 dresses w/ ruffles  sports-related jogging suits
 treated more gently  more innate aggression
 held and rocked more

PRESCHOOL PERIOD
- 2 YEARS OLD: can distinguish male vs female
- 3-4 YEARS OLD: can define sex
- Sex role modeling is reinforced through behavior
- Social contacts between the child and significant adults contribute to sexual identification and
should be encouraged
- Positive self-concept grows from parental love, effective relationships, success in activities,
gaining skills and self-control
- Oedipus Complex: strong emotional attachment of boy for mother / girl for father (phenomenon
by freud)

SCHOOL-AGE PERIOD
- play time imitating adult roles as a way of learning gender roles
- BEFORE: school promotes differences by separating activities by gender and expecting boys to
be poorer readers, less neat writing and rougher

ADOLESCENT
- Begins the process of establishing a sense of identity
- Problem of final gender role identification surfaces again
- Advent of menstruation as common bond for girls
 - Comfortable with their own sex before they reach out and interact with members of the opposite
sex
NOTE! During sexual history interview! Remember that this is a new and sensitive area for them
- 50% past age 15 are already sexually active therefore as early as possible there is a need of
guidelines for safe sex = sexual counseling
- Stressful time for those who realized that they are gay / lesbian (common reason for high suicide
rate among adolescence is due to being homosexual)

YOUNG ADULT
- Changes in body image
- Choose the way they will express their sexuality along with other life patterns
- Cohabitation as a means of learning
- Homosexuality / Bisexuality may be overtly expressed
- Many young couples begin childbearing

MIDDLE-AGE ADULT
- Sexuality achieved a degree of stability
- Sense of masculinity / femininity established
- Comfortable patterns of behavior
- Increased security in identity can promote greater intimacy
- More freedom in exploring and satisfying sexual needs
- Men changes:
o sperm production
o erectile power
o achievement of orgasm
o sex drive
o feel threatened in sexuality / maleness by responding negatively
o Acute Sexual Dysfunction may arise!
- Re-examining Life
- Some adapts while others experience stress / crisis
- Hysterectomy: uterus removal
- Oophorectomy: ovaries removal
- Women need sensitive caregivers

OLDER ADULT
- Enjoy active sexual relationships
- Men: less erectile firmness / ejaculatory force
- Women: less vaginal secretion and estrogen after menopause

PHYSICALLY CHALLENGED INDIVIDUALS:

 Males with upper spinal cord injury: difficulty with erection and ejaculation
o Solution: manual / psychological stimulation
 Women with spinal cord injuries: cannot experience orgasm but can conceive and have
children
 Colostomy = feeling of diminishing their partner’s satisfaction / enjoyment
 People with Chronic pain may feel uncomfortable
 Urinary Catheters hinders the ability to enjoy sexual intercourse with the catheter in place
 o Women: retention catheters don’t hinder
o Men: should learn how to replace their own catheter so that they can remove it whenever

HUMAN sexual RESPONSE CYCLE

HISTORY CHECK!

Masters and Johnson: 2 earliest researchers of sexual response

 1966 – published results: 10,000 episodes of sexual activity among more than 600 men and women
“human sexual response – a cycle w/ 4 discrete stages that may blend together much more into one smooth process of
DESIRE, AROUSAL and ORGAMS”

4 STAGES OF SEXUAL RESPONSE CYCLE:

1. EXCITEMENT
- Occurs w/ physical and psychological stimulation = parasympathetic nerve stimulation
- Nervous system stimulated (Sacral Parasympathetic Neurons)
- Arterial dilation and venous constriction in the genital area = increased blood supply =
vasocongestion & increased muscular tension
o WOMEN:
 clitoris increase in size and mucoid fluid appearance on vaginal walls as
lubrication
 nipple erection
o MEN:
 penis erection
 scrotal thickening
 testes elevation
- increased heart and respiratory rate
- increased blood pressure
2. PLATEAU – occurs just before orgams.
- WOMEN: nervous system stimulated Sacrospinous Reflex
o Clitoris drawn forward and retracts under the clitoral prepuce
o Lower vagina becomes extremely congested (formation of orgasmic platform)
o Increased nipple elevation
- MEN:
o Penis Distention
o HR: 100-175 bpm
o RR: 40 rpm
3. ORGASM
- Body suddenly discharges accumulated sexual tension (experienced pleasure affecting
the body)
- Vigorous contraction of pelvic muscles = expels / dissipates blood and fluid from area of
congestion
o WOMEN: 8-15 contraction at intervals of 1 every 0.8 seconds
 MEN: contraction surrounding seminal vessels and prostate project semen into
o
proximal urethra = 3-7 propulsive ejaculatory contraction = cumming
- SHORTEST stage
- Intense pleasure affects whole body and highly personal experience
4. RESOLUTION
- 30 minutes period which external and internal genital organs return to an unaroused state
- NOTE! Nervous stimulated Thoracolumbar Sympathetic Pathway
o MEN: refractory period occurs during which further orgasm is impossible
o WOMEN: do not go through refractory period!

CONTROVERSIES: FEMALE ORGASM

  Freud’s 2 Types of Female Orgasm
o Clitoral Orgasm – from masturbation / noncoital acts, immaturity
o Vaginal Orgasm – authentic, mature form
o NOTE! Neurotic if women could not achieve orgasm thru intercourse
 G Spot – 1950 by German Physician Grafenberg
o Location: inner vaginal wall, halfway between the pubic bone and cervix
o Area of heightened erotic sensitivity
o Not verified

INFLUENCES ON SEXUAL RESPONSE:

MENSTRUAL CYCLE
- 2ND HALF / LUTEAL PHASE: increased fluid retention and vasocongestion in lower
pelvis | reach plateau phase more quickly and achieve orgasm more readily during this
time
- May initiate sexual relations

PREGNANCY
- With vasocongestion on lower pelvis because of blood supply for rapidly growing fetus
- Experience a first orgasm during first pregnancy
- Increased breast engorgement results in extreme breast sensitivity during coitus

TYPES OF SEXUAL ORIENTATION:

1. HETEROSEXUALITY 3. BISEXUALITY
2. HOMOSEXUALITY 4. TRANSEXUALITY

TYPES OF SEXUAL EXPRESSION:

1. SEXUAL ABSTINENCE – separation from sexual activity (main point on high school sex
education), ability to concentrate on means of giving and receiving love (not through sexual
expression) and the most effective way to prevent pregnancy / STD
2. MASTURBATION – self stimulation | women do it more than men
a. Autoerotic Asphyxia – extreme practice of causing oxygen deficiency during
masturbation
3. EROTIC STIMULATION – use of visual stimulation
NOTE! Respect this type of material in patient’s room
4. FETISHISM – arousal from objects / situations
5. TRANSVESTITISM – dresses in clothing of opposite sex
6. VOYEURISM – sexual arousal by looking at another person’s body | almost everyone passes
this phase with more active sexual expressions (an element included in stalking)
7. SADOMASOCHISM – pain (sadism) / pain (masochism)
8. EXHIBITIONISM – revealing genitals in public
9. BESTIALITY – sexual relations with animals
10. PEDOPHILES / PEDOPHILIA– sexual encounters with children and registered as sex
offenders
11. CELIBACY – abstinence from sexual act

SEXUAL HARASSMENT:
- Unwanted and repeated sexual advances, remarks / behavior (offensive and interferes)
 - In school: Bullying
- 2 TYPES
o Quid Pro Quo (Equal Exchange) – “something in return”
o Hostile Work Environment – employee feels uncomfortable and exploited
- Distressing and leads to short / long term psychosocial consequences, interpersonal
conflict and impaired intimacy and sexual functioning

DISORDERS OF SEXUAL FUNCTIONING

INHIBITED SEXUAL DESIRE:
- Normal in some circumstances
- Side effects of Medicines / Drugs
- Chronic Disease: Peptic Ulcers / Chronic Pulmonary Disorders
- Obesity
- STI Infected
- During Menopause
o SOLUTION: Administration of Androgen (Testorerone)
FAILURE TO ACHIEVE ORGASM:
- Poor Sexual Technique
- Concentration TOO Hard
- Negative Attitude
ERECTILE DYSFUNCTION (ED): IMPOTENCE
- Inability to produce / maintain erection long enough for vaginal penetration / satisfaction
- Physical Aging
- Atherosclerosis
- Diabetes
- Side Effect of Drugs
- SOLUTION: Drugs that stimulate penile erection
o Sildenafil (Viagra)
o Tadalafil (Cialis)
o Vardenafil (Levitra)
PREMATURE EJACULATION:
- Ejaculation before penile-vaginal contact
- Unsatisfactory and frustrating
- Maybe be psychological
PERSISTENT SEXUAL AROUSAL SYNDROME:
- Excessive and unrelenting sexual arousal in the absence of desire
- Triggered by medications / psychological factors
PAIN DISORDERS:
 VAGINISMUS – involuntary contraction at the outlet of the vagina when coitus is attempted
(occur in women who have been raped)
 DYSPAREUNIA -pain during intercourse due to endometriosis (abnormal placement of
endometrial tissue)
 VESTIBULITIS – vestibule inflammation , vaginal infection / hormonal changes during
menopause and may cause vaginal drying | may include psychological component