SEXUAL RESPONCE 2016 SPRING Sexual Health Ethnicity and

SEXUAL RESPONCE 2016 SPRING

Sexual Health • • Ethnicity and cultural issues Gender Age Economic status Physical and mental abilities Childhood experiences Mental and emotional health

Different Expectations • Men and women often have different ideas about sex and love, and therefore often differ on why they have sex.

Sex for men is a stress reliever Sex for women requires stress relief

Sexual Response to sexual stimulation involves (Masters & Johnson, 1966): – vasocongestion – myotonia

Sexual Response Cycle • Kaplan three-stage model (1974) – sexual desire – sexual excitement – orgasm

Differences in Desire • One of the most common types of problems that a couple might encounter is a difference in the frequency with which sex is desired. • In many relationships, it does no good to point the finger and put the blame on one person or the other. • People are generally only oversexed or undersexed relative to their partners’ desires. It is the couple that has the problem.

Sexual Response Cycle • Masters and Johnson Four-Stage Model – – excitement plateau orgasm refractory period

Human Sexual response Cycle • Excitement • Plateau • Orgasm • Resolution Divided Masters WH, Johnson VE. Human Sexual Response. Boston, Mass: Little Brown; 1966. Kaplan HS. The New Sex Therapy. New York: Brunner/Mazel, 1974. Desire Arousal

Stage I: Excitement • both men and women: muscle tension, increased heart rate/blood pressure engorgement sex flush

More Excitement • Women: engorgement lubrication enlargement • Men: erection enlargement/elevation

Stage II - Plateau • The acceleration of processes begun in the excitement phase • Females the orgasmic platform – the significantly engorged outer 1/3 of the vagina • Lasts from a few seconds to a few minutes

Phase III - Orgasm • Involuntary muscle spasms • Blood pressure, respirations, heart rate peaks • Males – emission then expulsion • Males ejaculate approximately 5 -10 ml of semen

Sexual Response Cycle: Resolution • The resolution stage occurs after orgasm and allows the muscles to relax, blood pressure to drop and the body to slow down from its excited state. • Generally males experience a refractory period, meaning orgasm cannot be achieved again until time has passed. The penis meanwhile returns to a flaccid state. Females may not experience this refractory period and further stimulation may cause a return to the plateau stage. Otherwise, significant changes may also occur, such as the opening of the cervix and the reduction of blood flow to the genitals and nipples.

Sexual Function

Female Sexual Response Cycle Orgasm Plateau Re so (C) tion n A BC u Resolutio Excitement (A) Adapted from Masters WH, Johnson VE. Human Sexual Inadequacy. Little Brown; 1970. lu tio n (B)

Female Sexual Response Cycle Emotional Intimacy Emotional and Physical Satisfaction Spontaneous Sexual Drive Sexual Stimuli Sexual Arousal Biologic Arousal and Sexual Desire Psychological Basson R. Med Aspects Hum Sex. 2001; 1: 41 -42.

Biopsychosocial Model of Female Sexual Response (e. g. , physical health, neurobiology, endocrine function) (e. g. , upbringing, cultural norms and expectations) Biology Psychology Sociocultural Interpersonal (e. g. , performance anxiety, depression) (e. g. , quality of current and past relationships, intervals of abstinence, life stressors, finances) Rosen RC, Barsky JL. Obstet Gynecol Clin North Am. 2006; 334: 515 -526 Althof SE, Leiblum SR, Chevret-Measson M, et al. J Sex Med. 2005; 26: 793 -800

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Sexual Behavior: What Is Normal? • • Common socio cultural standards: The heterosexual standard The coital standard The orgasmic standard The two-person standard The romantic standard The safer sex standard

Difficulties That Can Hinder Sexual Function • • • Sexual desire disorders Sexual arousal disorders Orgasm disorders Sexual performance anxiety Sexual pain disorders

Figure 6. 6 Prevalence of Sexual Problems in Men and Women Figure 6. 6

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