Male and female sexual function Flashcards
1
Q
Discuss sex and gender
A
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Biological Sex:
- Male XY, female XX, variations in genotype and phenotype.
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Gender:
- Social and personal construct of identity including male, female, cis, trans, nonbinary identities, questioning and many others
- Fluidity of Identity:
- Identity may change over time.
- May also be non-gendered
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Stereotypes:
- Influence of societal expectations on masculinity and femininity, as a reference for sexual and other behaviours
2
Q
Discuss intersex and transgender
A
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Transgender:
- Identity differing from biological sex,or gender assigned at birth
- dysphoria to body and strong desire to change
- 1/11-30000 in men, 1/30-150,000 in women
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Intersex:
- Conditions where sex characteristics (sex chromosomes, gonads, genitalia, physiology) are not exclusively male or female.
- Occurs at conception or foetal development
3
Q
Describe the impact of being intersex on sexual function
A
- Variable influence
- Depends on initial individual intersex situation and if subsequent medical intervention
- Hormonal
- Surgical
- Age at which this occurs
- Independent of sexual orientation/attraction
Note that there is a general trend towards delaying surgical development until individual is old enough to have a say, unless acute problem.
4
Q
Discuss sexual orientation
A
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Attraction:
- Heterosexual, homosexual, bisexual, asexual, situational etc.
Note that sexual orientation is also fluid.
-
Independence from Gender:
- Sexual orientation not linked to gender identity.
5
Q
Describe the functions of sexual activity
A
- Reproduction
- Recreation: pleasure/fun, intimacy/relationship enhancing, stress relief
- Commerical, other gains
- Exploitative: issues of power imbalance, and consent
6
Q
Discuss some historical perspectives and discoveries regarding sexual function
A
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Alfred Kinsey:
- Contributions to understanding sexual behavior: women can have orgasms, and that people engage in sex for pleasure, not just for procreation
- Around this time: drug yohimbine (a poor aphrodisiac), penile reconstruction surgery and penile implant surgery
-
Masters & Johnson:
- Exploration of the sexual response cycle and physiological changes: elucidated the sexual cycle
- At this time:
- ads for penile vacuum pumps
- serotonin and inhibition of sexual response in rats
- Clomipramine and delayed ejaculation
7
Q
List the phases of the sexual cycle
A
- Desire
- Excitement
- Plateau
- Orgasm
- Resolution
8
Q
Describe desire
A
- desire: also known as lust or libido
- how often one thinks about or wants sex
- there is intra-personal variation: over time or in different situations, or with health issues
- inter-personal variation
- Desire is influenced by
- oestrogen and progesterone: menstrual cycle, thought to be higher mid-cycle ^[contraception could impact libido]
- testosterone increases libido, and affected by frequency of sexual activity
- frequency of sexual engagement and satisfaction
- dopamine – enhances motivation and arousal
- adrenaline
- mood (can decrease)
- recreational drugs (can decrease)
- limerence: passionate love, obsessional high desire at start of a relationship
9
Q
Discuss some issues with desire
A
- limbic inhibition may cause reduced desire
- mental health: mood disorders and psychosis
- androgen deficiency (in both men and women) and menopause
- medication
- recreational drugs
- poor health and chronic disease
- reaction to long standing sexual function problem
- relationship: hostility, ‘sparks gone out’
- beliefs
- mismatch in desire or desire discrepancy (which widens if not addressed)
Note that it is difficult to distinguish between normal and myths due to individual variation.
10
Q
Describe excitement
A
- Sexual arousal
-
Sensory Inputs:
- The importance of touch, sight, smell, hearing, and taste.
- Pornography, fetishes, paraphilias
- The importance of touch, sight, smell, hearing, and taste.
- Negative effect of cognition: personal beliefs, societal influences, situational influences, previous experiences
- Increased tactile sensitivity
- Sense of urgency
- Vaginal transudate forms; bulbo-urethral gland secretion (pre-ejaculate)
- Vaginal ‘tenting’
- Flushing of skin
- Increased HR, RR, BP, muscular tension
- Increased blood flow to erectile tissue of female and male genitals
11
Q
Discuss the changes during erection
A
- when flaccid, the penis is under sympathetic control or adrenergic tone
- sinusoids, arterioles and arterial smooth muscle is constricted
- arteriolar inflow is minimal
- no venous obstruction
- n.b. intracavernous pressure is same as venous pressure
Tumescence: Filling of Erectile Tissue
-
Parasympathetic NS Stimulation:
- Loss of adrenergic tone leading to vascular smooth muscle relaxation.
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Vascular Changes:
- Arteriolar dilation, trabecular relaxation, sinusoids filling and expanding.
= erectile tissue expansion
- Arteriolar dilation, trabecular relaxation, sinusoids filling and expanding.
- Compression of venules in sinusoidal space and subtunical venous plexuses obstructing outflow.
- Ischiocavernosus muscle contraction squeezing crura.
12
Q
Describe management of erectile dysfunction
A
-
1970-90s Approaches:
- Vascular surgery, inflatable implants, injectable vasodilator drugs.
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NO’s Role:
- Understanding the role of nitric oxide in vasodilation of erectile tissue.
- action of sildenafil, initially developed for angina – much more effective at vasodilation in penis
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Risk Factors:
- Hypertension, diabetes, high lipids, smoking. ^[CVS/PVS]
-
Cavernous Nerve releases neurotransmitters
- this leads to the production of NO which diffuses into and enters smooth muscle cells
- NO stimulates the conversion of GTP to cGMP
- cGMP induces a chemical cascade
- results in reduced intracellular calcium and smooth muscle relaxation
- note: PDE5 coverts cGMP to GMP, switches off this effect
- sildenafil inhibits this enzyme to prolong relaxation/vasodilation
13
Q
Discuss erectile dysfunction
A
- **Importance to All Genders
- Note: Orgasm and ejaculation possible with partial erections.
-
Causes of Dysfunction:
- Age-related, reduced arterial flow (in large and small vessels, atherosclerosis, diabetes), veins leaking, nerve damage, Peyronne’s disease (fibrous plaques impinge on erectile tissue of penis)
-
PDE5 Inhibitors:
- Only males benefit
14
Q
Discuss the plateau and changes in males and females
A
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Short Phase:
- Disputed
-
Men’s Changes:
- Maximum penile and testicular engorgement, increased pre-ejaculate from bulbo-urethral/Cowper’s glands
- Erection may vary in firmness
From excitement to plateau:
- full erection of penis
- testes elevate towards perineum to increasing in size and becoming fully elevated
- skin of scrotum tenses, thickens and elevates to scrotum thickening
- colour of glans penis deepens
- Cowper’s gland secretion
- Prostate enlarges
-
Women’s Changes:
- Increased blood flow to labia, vaginal expansion and elevation, elevated uterus, orgasm becomes inevitable
- From the excitement to plateau phase:
- uterus elevates up and away from vagina to being fully elevated
- vaginal lubrication appears
- inner labia swell, to increase in size and turn bright red
- outer third of vagina forms orgasmic platform
- clitoris enlarges and retracts under hood
15
Q
Discuss changes in males and females at plateau
A
- From the excitement to plateau phase:
- uterus elevates up and away from vagina to being fully elevated
- vaginal lubrication appears
- inner labia swell, to increase in size and turn bright red
- outer third of vagina forms orgasmic platform
- clitoris enlarges and retracts under hood
From excitement to plateau:
- full erection of penis
- testes elevate towards perineum to increasing in size and becoming fully elevated
- skin of scrotum tenses, thickens and elevates to scrotum thickening
- colour of glans penis deepens
- Cowper’s gland secretion
- Prostate enlarges
