Human sexuality

1. Human sexuality

2. Normal sexuality • Difficult to define • Easier to define abnormal sexuality

3. Abnormal sexuality • Destructive • Compulsive • Cannot be directed to a partner • Excludes stimulation of the primary sex organs • Guilt feeling and anxiety

4. psychosexuality Sexuality and total personality are so entwined that to speak of sexuality as a separate entity is virtually impossible

5. Sexuality and psychosexual factors • Sexual identity • Gender identity • Sexual orientation • Sexual behavior

6. Sexual identity • All mammalian embryos are anatomically female during early stages of fetal life • Differentiation results from the action of fetal androgens • Actions begins at the age of six and ends at age of 12 weeks of gestational age

7. Gender identity • Psychological aspects of behavior related to masculinity and femininity • By the age of 2-3 almost everyone has a firm conviction that “I am male” or “I am female” • Most often congruent • May conflicting or even opposite way • Results from experiences with family members, teachers, friends, and coworkers and from cultural phenomena

8. Sexual orientation Describe the object of a person’s sexual impulse • heterosexual(opposite sex) • homosexual( same sex) • bisexual(both sex)

9. Sexual behaviorphysiological response • Desire phase • Excitement phase • Orgasm phase • Resolution phase

10. Desire phase • Or appetitive phase • Reflects motivation, drives, and personality • Characterized by sexual fantasies and the desire to have sexual activity

11. Excitement phase Brought on by • Psychological stimulation( fantasy or love object) • Physiological stimulation(stroking or kissing) • Combination of both

12. Excitement phase Male physiological changes • Penile erection • Nipple erection • Increased testes size Female physiological changes • Erection of clitoris then retracts • increased breast size • Labia minor becomes thick and deep red • Orgasmic plateform (constriction along the outer third)

13. Orgasm phase Male • Inevitable ejaculation • Forceful emission of semen • 4-5 rhythmic contraction of the prostate, seminal vesicles, vas and urethra Female • 3-15 contraction of the lower third of vagina • Strong sustained contraction of uterus

14. Orgasm phase • Facial grimacing • Carpopedal spasm • Increased blood pressure 20-40mm hg • Increased heart rate up to 160 • Cloudiness of consciousness • Lasts 3-25 seconds

15. Resolution phase If orgasm occur • Detumescence of genitalia • Subjective sense of well-being • General relaxation • Muscular relaxation If orgasm not occur • Prolonged resolution phase • Irritability and discomfort

16. Sexual disorders • Sexual desire disorder • Sexual arousal disorder • Orgasm disorder • Sexual pain disorder

17. Hypoactive sexual desire disorder • 20% of population • > • Unconscious fear • Unresolved oedipal conflict • Vagina dentata • Chronic stress, anxiety, depression • Abstinence from sex • Hostility to a partner

18. Female sexual arousal disorder • Generally under stimated • Often orgasm problem as well • 33% of women in happy married couple • Anxiety, guilt, fear • Usually with dyspareunia and lack of desire • Alteration in testosterone, estrogen, prolactin thyroxine

19. Male erectile disorder • Punitive superego • Inability to trust • Fear, anxiety, moral prohibition • 20-50% organic base

20. Male erectile disorder • Lifelong, acquired, situational • Acquired, 10-20% of all men • Lifelong, 1% of all men under age 35 • 75% of all men over 80 • Fear of impotence in all men over 40 • Psychological cause VS organic cause Morning erection  Erection without plan  Erection with masturbation

21. Female orgasmic disorder • Inhibited orgasm, anorgasmia • Masturbation or coitus • Prevalence: 30% • Fear of impregnation • Rejection by a sex partner • Damage to the vagina • Hostility toward men • Guilt feeling • Experince frustration or symptom free Pelvic complaints, lower abdominal pain, itching, vaginal discharge, Fatigue, irritability, tension

22. Male orgasmic disorder • Acquired male orgasmic disorder  Interpersonal difficulties  Greater demand of partner  Ambivalent for pregnancy  Unexpressed hostility  More common in OCD man

23. Male orgasmic disorder • Orgasmic anhedonia • Incidence of orgasm disorder • Life long orgasmic disorder Indicate severe psychopathology  Rigid, puritanical Back ground  Sex as sinful act  Conscious or unconscious incest wishes

24. Premature ejaculation • More common in college educated men • Chief complaint of 35-40% of men Treated for sexual disorder • Anxiety regarding the sex act • Unconscious fear of vagina • Negative cultural conditioning • Stressful marriage

25. Dyspareunia • > • Often with vaginismus • Unknown incidence • History of rape • History of childhood sexual abuse • Anxiety about the sex act • 30% of all genital area surgical procedure

26. Vaginismus • High educated women • High socioeconomic status • Sexual trauma (rape) • Psychosexual conflict • Strict religious upbringing • Protest in nonverbal fashion

27. paraphilia • Unusual fantasies or sexual urges or behaviors • Recurrent • Sexually arousing • Focus on a person’s humiliating himself or herself or a partner, on children or other nonconsenting people, or on nonhuman objects • 6 months duration • Clinically significant distress or impairment

28. classification • Exhibitionism • Fetishism • Frotteurism • Pedophilia • Sexual sadism • Sexual masochism • Voyeurism • Transvestic fetishism • Paraphilia not otherwise specified

29. Epidemiology • Practiced only by small percentage of the population • But large proportion of the population victimized due to repetitive nature of disorder • Pedophilia is most common • Fetishism almost always occur in men • Peak of incidence 15-25 • Usually 3-5 paraphilia in a person

30. Etiology • Psychological factors failure to resolve oedipal crisis early experiences • Biological factors abnormal hormone level, hard or soft neurological signs, chromosomal abnormalities, seizure, major mental disorder