Human Sexuality

Human Sexuality Augusto “jojo” Cruz Jr, MD DPBP UERMMMC Department of Psychiatry

What is Normal Sexuality? … perception of being male or female and all those thoughts, feelings, behaviours, connected with sexual gratification and reproduction, including the attraction of one person to another

involves feelings of desire, behavior that brings pleasure to oneself and one’s partner…. Devoid of guilt or anxiety… and not compulsive

Human Sexuality • Expression of sexual sensation and intimacy between persons • Expression of identity through sex • Comprises a broad range of behavior and processes

Human Sexuality • Determined by anatomy, physiology, psychology, culture, relationship with others, and developmental experiences

SEXUALITY

PSYCHOSEXU AL

PERSONALITY

Physiological Aspects of Human Sexuality • Influenced by hormonal changes during pregnancy/ genetic predisposition • Sexual Dysfunction: – libido diminution – erectile dysfunction

Social Aspects of Human Sexuality • Governed by rules of behavior and status quo • Influenced by social norms and vice versa – Example: gender identity

Psychological Aspects of Human Sexuality Sexual Identity • Gender Identity • Orientation • Intention

Sexual Function • Sexual Desire • Sexual Arousal • Orgasm

Sexual Satisfaction

Gender Identity • Sense of self as masculine or feminine • Gender in which a person identifies • Gender that other people attribute to the individual on the basis of gender role • Is affected by a variety of social structures

Gender Identity and Sexual Identity • Majority it is congruent • Human beings are cisgendered based on their biological sex • Gender is social and sex is biological

Gender Role • Usually related to and derived from gender identity • Includes all disclosures of a person as having the status of a man or a woman

Sexual Orientation • Describes the direction of an individual’s sexuality • AKA: sexual preference • Markers: – – – –

Self-labelling Actual sexual behavior Sexual fantasy Erotic arousal pattern

Sexual Orientation • “dynamic and multi-variable process” Klein, 1985 “The Bisexual Option”

Sexual Orientation and Mental Illness • Psychiatric disorders were more prevalent among homosexually active people – Depression/ anxiety – Suicide – Substance abuse (alcohol/ smoking)

• Sense of alienation predisposes them to mental illness

Sexual Intention • What a person wants to do to his/ her partner during the sexual behavior and what is done to him or her

Sexual Desire • Interest that a person experiences – Drive – biological aspects – Motive – psychological aspects – Wish – social aspects

Sexual Arousal • The emotion of sexual excitement based on pelvic vasocongestion and autonomic arousal

Orgasm • Stimulated by high levels of arousal that results to brief, intense pleasure and release of pelvic congestion

Sexual Satisfaction • Private judgment that sexual behavior is pleasurable

Normal Sexual Behavior • Sexual response is a true psychophysiological experience • There is…. – Arousal – Experience of tension – Orgasm

• Four phase response cycle in relation to stimulation – – – –

Phase Phase Phase Phase

1: 2: 3: 4:

Desire Excitement Orgasm Resolution

Four Phase Response Cycle • Phase 1: Desire – Motivation, drives, and personality towards the love object – Sexual fantasies and desire to have sexual activity

Four Phase Response Cycle •Phase 2: Excitement –Subjective sense of pleasure from •Psychological stimulation (fantasy, presence of the love object) •Physiological stimulation (Stroking or kissing) •Combination of both

Male

Female

-Lasts several minutes to several hours -Lasts several minutes to several hours -Penile tumescence (increase in diameter/ length) -Vaginal lubrication, nipple erection -Tightening & lifting of the scrotal sac and elevation of the -Clitoral enlargement, thickening of the labia minora testes; 50% increase in the size of the testes -Increase in breast size (25%) -2-3 drops of mucoid fluid that contain viable sperm are -Vaginal color change to dark purple; vaginal transudate secreted at the height of excitement appears 10-30 secs after arousal -Increase in heartbeat and respiration rates -Labia minora changes color to bright and deep red -Heightened excitement lasts 30 secs to several minutes -Increase in the heartbeat and respiration rates -Heightened excitement lasts 30 secs to several hours

Four Phase Response Cycle •Phase 3: Orgasm –Peaking of sexual pleasure with subsequent release of sexual tension and rhythmic contraction of the perineal muscles and the pelvic organs

Male

Female

-3-15 seconds -3-15 seconds -Forceful emission of semen (ejaculation) (12-20 inches at -Breasts may become tremulous age 18, decreasing with age to seepage at 70) -Uterine contractions throughout orgasm -4-5 rhythmic spasms of the prostrate, seminal vesicles, -Contractions of the lower third of the vagina vas, and urethra -Loss of voluntary muscle control (carpopedal spasm; -Loss of voluntary muscle control (facial grimacing; facial grimacing) carpopedal spasm) -Hyperventilation and tachycardia -BP up to 40-100 mm systolic, 20-50 mm diastolic -HR up to 180 beats per minute -Respiration up to 40 respirations a minute

Four Phase Response Cycle • Phase 4: Resolution – Disgorgement of blood from the genitalia (detumescence) – With subjective feelings of well-being, general relaxation and muscle relaxation – If it does not occur, may take 2-6 hours associated with irritability and discomfort – Women do not have a refractory period

Masturbation

Masturbation •Nearly all men and three fourths of all women masturbate sometime during their lives •Moral taboos have generated myths that masturbation causes mental illness or a decrease in sexual potency

Masturbation • Form of release from excessive sexual tension • is probably a universal and inevitable aspect of psychosexual development, and in most cases…….. • ADAPTIVE • Becomes pathologic if it becomes a compulsion

Homosexuality •What would your reaction be if you found out that your best friend is homosexual? •Homosexuality is a disorder…..?

Homosexuality •Homosexuality is a disorder…..? •Not a disorder –In 1973, was eliminated as a diagnostic category by the APA –In 1980, was removed from the DSM –ICD

•If not a disorder, what?

Homosexuality •An alternative lifestyle •A variant of human sexuality •Definition: –A person’s overt behavior, sexual orientation, and a sense of personal or social identity. •Lesbian or gay men •Same sex or male female

Homosexuality • Prevalence – 1948 :

10% of men

5% of women 37% had a homosexual experience – – –

1988 : 1989 : 1993 :

2-3% of men < 1% of either sex 1% exclusively homosexual

Expression of Human Sexuality Adolescent age group

REVIEW: ERIK ERIKSON’S STAGES OF THE LIFE CYCLE STAGE 5: Identity vs. Role Diffusion – 11 years through end of adolescence – Struggle to develop ego identity – Danger of role confusion, doubts about sexual and vocational identity

Some of the expressions of human sexuality in adolescents are the following: • Dating Behavior • Pre-marital Sex

Definition: Dating Behavior • DATE- is defined as any activity that involved going out with someone of the opposite sex whether in a group or as a couple – Group date – Single date YOUNG ADULTS FERTILITY SURVEY – II (1994)

Proportions ever Dated • Most Filipino youth aged 15-24 years have dated • 60% or 3 out of 5 have experienced going out on a date • 49% of the teenagers claimed to have gone out on a date

Proportions ever Dated • Dating either in groups or alone with someone of the opposite sex occurs quite early 10-13 years for only a few youth • By the age 15 the propensity to date picks up • At 16, more than a third of boys and 2 out of 5 girls date

GROUP DATES OR SINGLE DATES • 3 out of five-group date • Girls more likely to start with group date • Boys immediately launched into a single date

TIMING OF THE FIRST DATE • First date can trigger a series of events that might change the subsequent life of a person • During teens, boys date twice as much as girls • Age 15, 1/5 of the girls have dated while only 1/10 in boys have dated

FIRST SINGLE DATE PARTNER • Irrespective of gender, the partner was a classmate or officemate introduced by a friend or a neighbor • At the time of the first date: • 46% already a boyfriend/girlfriend • 28% friend • 16% admirer or crush • 10% acquaintance

DATING WITH A STEADY PARTNER • Boys revealed that their partners became their girlfriends after only 3 months • Girls report the same after 6 months • Favorite dating places: movie houses, restaurants, parks and shopping malls

CHAPERONES • Traditional role: ensure that no untoward incident happens during a date • Nowadays: chosen to assuage and persuade the parents or partner to agree to the date and leaves the couple during the actual date

BEHAVIOR DURING first DATES • 36% Kissed • 3% sexual intercourse • *17 % of the girls confided intercourse happened without their consent

IN THE SUBSEQUENT DATES • the number of those engaging in very intimate behaviors (petting and intercourse) increased dramatically from 15-28%

Dating and related events • The urban youth have their first crushes at 14 • Admiring the opposite sex at 15 • Group date at 16 • Single dates with BF and GF at 1718

Differentials in dating behavior • Those who have had exposure to urban life were prone to date about a quarter more than those who have always remained in the rural setting. • Having lived in a dorm, studied in a private school and living away from parents increase tendency to date

Determinants of dating behavior • • • • • • •

Live away from parents Older age Lived in the city Attends private school Fathers are college graduates Less strict parents Unstable marriage of parents

Premarital Sex Committed Casual Commercial

COMMERCIAL PREMARITAL EXPERIENCE • one pays for sexual favors usually with a prostitute • Prevalence: • 1 in 14 single men • 1 in 8 married men

CASUAL PREMARITAL SEX • Sexual intercourse with acquaintance or friend • Most common first sexual experience of boys

COMMITTED PREMARITAL SEX • Sexual experience before a union is formed • Experienced more equally between males and females

INITIAL EXPERIENCE WITH PREMARITAL SEX • Occurs at 18 years old • 18% of today’s youth engage in premarital sex • Most popular venue for sexual encounters is the HOME • Majority of the youth did not use contraception because they did not expect to have sex at that time • In those who practiced contraception, withdrawal and condom were them most commonly used

• DESPITE THE ACCEPTANCE OF PREMARITAL SEX, VIRGINITY IS STILL GENERALLY VALUED. » ZABLAN, 1995:

• 91.5% CONSIDER VIRGINITY AS AN IMPORTANT VIRTUE

Conclusion • 49% HAVE GONE OUT ON A DATE DATING OCCURS AS EARLY AS 10 YRS OLD GIRLS MORE LIKELY TO GROUP DATE FIRST FIRST DATE CAN TRIGGER EVENTS THAT MAY CHANGE THE PERSON’S LIFE • INITIAL EXPERIENCE WITH PREMARITAL SEX OCCURS AT AGE 18 • MOST COMMON FIRST SEXUAL EXPERIENCE WITH BOYS IS CASUAL SEX

Conclusion • MAJORITY OF THE YOUTH DID NOT USE CONTRACEPTION BECAUSE THEY DID NOT EXPECT TO HAVE SEX AND DESPITE ACCEPTANCE OF SUCH PRACTICES, VIRGINITY IS STILL A HIGHLY REGARDED VIRTUE • SEXUALITY is at it’s peak in adolescence as expressed in dating behavior and premarital sex

THANK YOU AND GOOD DAY