Flashcards in Sexuality Deck (109):
Prenatal physical sexual development - The androgenic secretions of the fetal testes direct the ...?
Differentiation of MALE INTERNAL and EXTERNAL GENITALIA.
In the absence of androgens during prenatal life, internal and external genitalia are ...?
In androgen insensitivity syndrome (formerly testicular feminization), despite an XY genotype and testes that secrete androgen, a genetic defect prevents ...?
The body cells from responding to androgen, resulting in a female phenotype.
In androgen insensitivity syndrome - At puberty?
The descending testes may appear as labial or inguinal masses.
In the presence of excessive adrenal secretion prenatally (congenital virilizing adrenal hyperplasia, formerly adrenogenital syndrome), the genitalia of a genetic female are ...?
MASCULINIZED and the child may be visually identified initially as male.
Prenatal psychological sexual development - Differential exposure to gonadal hormones during prenatal life also results in ...?
GENDER DIFFERENCES IN CERTAIN BRAIN AREAS (eg the hypothalamus, anterior commissure, corpus callosum, and thalamus).
Gender identity, gender role, and sexual orientation - Gender identity - Definition:
Sense of self as being male or female.
Gender identity, gender role, and sexual orientation - Gender role - Definition:
Expression of one's gender identity in society.
Gender identity, gender role, and sexual orientation - Sexual orientation - Definition:
Persistent and unchanging preference for people of the same sex (homosexual) or the opposite sex (heterosexual) for love and sexual expression.
Gender identity, gender role, and sexual orientation - Gender identity - Presumed etiology:
Differential exposure to prenatal sex hormones.
Gender identity, gender role, and sexual orientation - Gender identity - Comments:
May not agree with physiological sex (ie gender identity disorder).
Gender identity, gender role, and sexual orientation - Gender role - Presumed etiology:
Societal pressure to conform to sexual norms.
Gender identity, gender role, and sexual orientation - Gender role - Comments:
May not agree with gender identity or physiological sex (eg, choice of opposite gender's clothing).
Gender identity, gender role, and sexual orientation - Sexual orientation - Presumed etiology:
1. Differential exposure to prenatal sex hormones.
2. Genetic influences.
Gender identity, gender role, and sexual orientation - Sexual orientation - Comments:
1. True bisexuality is uncommon.
2. Most people have a sexual preference.
3. Homosexuality is considered a normal variant of sexual expression.
Individuals with gender identity disorder (transsexual or transgender individuals) have a ...?
Pervasive psychological feeling of being born into the body of the wrong sex despit a body form typical of their physiological sex.
School-age children with gender identity disorder prefer to ...?
Dress like and have pleymates of the OPPOSITE sex.
--> Since gender identity is permanent, the most effective management of this situation is to help parents accept the child as he or she is.
In adulthood, individuals with gender identity disorder commonly ...?
Take the hormones of their preferred sex in order to better assume that gender role and may seek surgery to change their genital sex.
The biologic of sexuality in adults - Alterations in circulating levels of gonadal hormones (estrogen, progesterone, and testosterone) ...?
Can affect sexual interest and expression.
Hormones and behavior in women:
1. Because estrogen is only minimally involved in libido, menopause (ie cessation of ovarian estrogen production) and aging DO NOT REDUCE SEX DRIVE if woman's general health is good.
2. Testosterone is secreted by the ADRENAL GLANDS (as well as the ovaries and testes) throughout adult life and is believed to play an important role in SEX DRIVE IN BOTH MEN AND WOMEN.
Hormones and behavior in men?
1. Testo levels in men generally ARE HIGHER THAN NECESSARY to maintain normal sexual functioning. Low testo levels are LESS LIKELY THAN RELATIONSHIP PROBLEMS, age, alcohol use, or unidentified illness to cause sexual dysfunction.
2. Psychological and physical stress may decrease testo levels.
3. Medical treatment with estrogens, progesterone, or antiandrogens (eg to treat prostate cancer) can decrease testosterone availability via hypothalamic feedback mechanisms, resulting in decreased sexual interest and behavior.
Homosexuality - Etiology:
Believed to be related to ALTERATIONS IN LEVELS OF PRENATAL SEX HORMONES (eg increased androgens in females and decreased androgens in males) resulting in ANATOMIC CHANGES IN SOME HYPOTHALAMIC NUCLEI.
--> Sex hormone levels in adulthood are indistinguishable from those of heterosexual people of the same biological sex.
Homosexuality - Evidence for involvement of GENETIC factors includes markers on the ...?
X chromosome and higher concordance rate in monozygotic than in dizygotic twins.
Homosexuality - Etiology - Social factors, such as early sexual experiences, ...?
ARE NOT ASSOCIATED WITH THE ETIOLOGY of homosexuality.
Homosexuality is a ...?
NORMAL VARIANT OF SEXUAL EXPRESSION.
--> Because it is NOT a dysfunction, NO TREATMENT IS NEEDED.
People who are uncomfortable with their sexual orientation may benefit ...?
From psychological intervention to help them become more comfortable.
Occurence of homosexuality - By most estimates, at least ...?
5-10% of the population has an exclusively homosexual sexual orientation.
--> MANY MORE PEOPLE have had at least one sexual encounter leading to arousal with a person of the same sex.
Ethnic differences in the occurrence of homosexuality?
There are NO SIGNIFICANT ETHNIC DIFFERENCES.
Many people with gay and lesbian sexual orientations have experienced ...?
HETEROSEXUAL SEX and have had children.
The sexual response cycle:
Masters and Johnson devised a 4-stage model for sexual response in BOTH men and women.
Sexual dysfuncions involve ...?
Difficulty with one or more aspects of the sexual response cycle.
Characteristics of the stages of sexual response cycles in men and women - Excitement stage - Men:
Characteristics of the stages of sexual response cycles in men and women - Excitement stage - Women:
1. Clitoral erection.
2. Labial swelling.
3. Vaginal lubrication.
4. Tenting effect (rising of the uterus in the pelvic cavity).
Characteristics of the stages of sexual response cycles in men and women - Excitement stage - Bothe men and women:
1. Incr. pulse, BP, and respiration.
2. Nipple erection.
Characteristics of the stages of sexual response cycles in men and women - Plateau stage - Men:
1. Incr. size and upward movement of the testes.
2. Secretion of a few drops of sperm-containing fluid.
Characteristics of the stages of sexual response cycles in men and women - Plateau stage - Women:
Contraction of the outer 3rd of the vagina, forming the orgasmic platform (enlargement of the UPPER 3rd of the vagina).
Characteristics of the stages of sexual response cycles in men and women - Plateau stage - Both men and women:
1. Further increase in pulse, BP, respiration.
2. Flushing of the chest and face (the "sex flush").
Characteristics of the stages of sexual response cycles in men and women - Orgasm stage - Men:
Forcible expulsion of seminal fluid.
Characteristics of the stages of sexual response cycles in men and women - Orgasm stage - Women:
Contraction of the uterus and vagina.
Characteristics of the stages of sexual response cycles in men and women - Orgasm stage - Both men and women:
1. Contraction of the anal sphincter.
2. Further increase in pulse, BP, and respiration.
Characteristics of the stages of sexual response cycles in men and women - Resolution stage - Men:
Refractory, or resting, period (length varies by age and physical condition) when restimulation is NOT POSSIBLE.
Characteristics of the stages of sexual response cycles in men and women - Resolution stage - Women:
Little or no refractory period.
Characteristics of the stages of sexual response cycles in men and women - Resolution stage - Both men and women:
1. Muscle relaxation.
2. Return of the sexual, muscular, and cardiovascular systems to the prestimulated state over 10-15min.
Sexual dysfunction - Characteristics:
Sexual dysfunction can result from biological, psychological, or interpersonal causes, or from a combination of causes.
Sexual dysfunction - Biological causes:
1. Unidentified general medical condition (eg diabetes can cause erectile dysfunction, pelvic adhesions can cause dyspareunia).
2. Side effects of medication (eg SSRIs can cause delayed orgasm).
3. Substance abuse (eg alcohol use can cause erectile dysfunction).
4. Hormonal or neurotransmitter alterations.
Sexual dysfunction - Psychological causes:
1. Current relationship problems.
4. Anxiety (eg guilt, performance pressure).
5. In men with erectile disorder, the presence of morning erections, erections during masturbation, or erections during REM suggests psychological rather than physical cause.
DSM-IV-TR Classifications of sexual dysfunction:
1. The sexual desire disorders = HYPOACTIVE SEXUAL DESIRE disorder and SEXUAL AVERSION disorder (disorder of the excitement phase).
2. The sexual arousal disorders = Female sexual arousal disorder and male erectile disorder (disorders of the excitement and plateau phases).
3. The orgasmic disorders = Male orgasmic disorder, female orgasmic disorder, and premature ejaculation (disorders of the orgasm phase).
4. The sexual pain disorders = Dyspareunia + vaginismus (not caused by a general medical condition).
Hypoactive sexual desire disorder:
Decreased interest in sexual activity.
Sexual aversion disorder:
Aversion to and avoidance of sexual activity.
Female sexual arousal disorder:
Inability to maintain vaginal lubrication until the sex act is complete, despite adequate physical stimulation (reported in as many as 20% of women).
Male erectile disorder (commonly called "impotence"):
1. Lifelong or primary (rare): Has never had an erection sufficient for penetration.
2. Acquired or secondary (the MC male sexual disorder) - Currently unable to maintain erections despite normal erections in the past.
3. Situational (common) - Has difficulty maintaining erections in some sexual situations, but not in others.
Orgasmic disorder (male or female):
1. Lifelong: Has never had an orgasm.
2. Acquired: Is currently unable to achieve orgasm despite adequate genital stimulation and normal orgasms in the past.
3. Reported more often in women than in men.
1. Ejaculation before the man would like it to occur.
2. Plateau phase of the sexual response cycle is short or absent.
3. Is usually accompanied by anxiety.
4. Is the 2nd MC male sexual disorder.
Painful spasms occur in the outer 3rd of the vagina, which make intercourse or pelvic examination difficult without pelvic pathology.
1. Persistent pain occurs in association with sexual intercourse without pelvic pathology.
2. Can also be caused by pelvic pathology, eg PID caused by chlamydia infection (MC) or gonorrhea (most serious).
3. Occurs much more commonly in WOMEN. Can occur in men.
Management of sexual dysfunction - Basic principles:
1. Must understand the patient's sexual problem before proceeding with treatment (eg, clarify what a patient means when he says, "I have a problem with sex").
2. The physician should NOT ASSUME ANYTHING about a patient's sexuality (eg, a middle-aged married male patient may be having an extramarital homosexual relationship).
3. There is a growing tendency for physicians to manage the sexual problems of heterosexual and homosexual patients rather than to refer to these patients to sex therapists.
4. Management of sexual problems may be behavioral, medical, or surgical.
Behavioral management techniques:
1. Sensate-focus exercises.
2. Squeeze technique.
3. Relaxation techniques, hypnosis, and systematic desensitization.
Sensate-focus exercises - Used to ...?
Manage sexual desire, arousal, and orgasmic disorders.
Sensate-focus exercises - What happens?
The individual's awareness of touch, sight, smell, and sound stimuli are increased during sexual activity, and psychological pressure to achieve an erection or orgasm is decreased.
Squeeze technique - Used to ...?
Manage premature ejaculation.
Squeeze technique - What happens?
1. The man is taught to identify the sensation that occurs just before the emission of semen.
2. At this moment, the man asks his partner to exert pressure on the coronal ridge of the glans on both sides of the penis until the erection subsides, thereby delaying ejaculation.
Relaxation techniques, hypnosis, and systematic desensitization are used to ...?
Reduce anxiety associated with sexual performance.
Masturbation may be recommended to ...?
Help the person learn what stimuli are most effective for achieving arousal and orgasm.
Sexual dysfunction - Management - Medical and surgical management - SSRIs:
Because they delay orgasm, SSRIs (eg fluoxetine) are used to manage PREMATURE EJACULATION.
What has been used to manage erectile disorder?
Systemic administration of opioid antagonists (eg naltrexone) and vasodilators (yohimbine) have been used to manage erectile disorder.
Special side effect of Viagra?
The preferential use of UNUSUAL OBJECTS of sexual desire or engagement in unusual sexual activity.
Paraphilias - To fit DSM-IV-TR criteria, the behavior must continue over ...?
A period of at least 6 months and cause IMPAIRMENT in occupational or social functioning.
Occurence of paraphilias:
ALMOST EXCLUSIVELY IN MEN.
Paraphilias - Management:
2. Female sex hormones.
for paraphilias that are characterized by hypersexuality.
Sexual paraphilias - Mention some:
3. Transvestic fetishism.
7. Sexual masochism.
8. Sexual sadism.
9. Telephone scatologia.
Revealing one's genital to unsuspecting women so that they will be shocked.
Contact with inanimate objects (eg, women's shoes, rubber sheets).
Wearing women's clothing, particularly underclothing (exclusive to heterosexual men).
Rubbing the penis against a clothed woman who is not consenting and not aware (eg on a crowded train).
Engaging in fantasies or actual behaviors with children under age 14y, of the opposite or same sex; is the MC paraphilia.
Receiving physical pain or humiliation.
Giving physical pain or humiliation.
Enganging unsuspecting women in telephone conversations of a sexual nature (obscene phone calls).
Secretly watching other people (often by using binoculars or cameras) undressing or engaging in sexual activity.
Illness, injury, and sexuality - Heart disease and MI - Men who have a history of MI often have ...?
BOTH men and women who have a history of MI may have ...?
DECR. LIBIDO because of the side effects of cardiac medications and THE FEAR othat sexual activity will cause another heart attack.
When can sexual activity be resumed after a heart attack?
Generally, if exercise that raises the heart rate to 110-130 (eg exertion equal to climbing 2 flights of stairs) can be tolerated without severe shortness of breath or chest pain.
In people with history of MI, which sexual positions should be preferred?
Sexual positions that produce the least exertion in the patient (eg the PARTNER in the SUPERIOR position).
How many diabetics have erectile dysfunction?
1/4 to 1/2 (more commonly older patients).
Orgasm and ejaculation are affected in diabetics?
The major causes of erectile dysfunction in men with diabetes are ...?
1. Vascular changes.
2. Diabetic nephropathy.
Diabetic erectile dysfunction - Sildenafil citrate?
Spinal cord injuries in men:
1. Erectile + Orgasmic dysfunction.
2. Retrograde ejaculation (into the bladder).
3. Reduced testo.
4. Decr. fertility.
Spinal cord injuries in women?
1. Problems with vaginal lubrication.
2. Pelvic vasoconstriction.
--> Fertility is usually not adversely affected.
Aging and sexuality - Physical changes - Alterations in sexual functioning normally occurs with the aging process - In men?
1. Slower erection.
2. Diminished intensity of ejaculation.
3. Longer refractory period.
4. Need for more direct stimulation.
Aging and sexuality - Physical changes - Alterations in sexual functioning normally occurs with the aging process - In women?
1. Vaginal thinning.
2. Shortening of vaginal length.
3. Vaginal dryness.
Sexual interest and activity?
Sexual interest usually does NOT change significantly with increasing age.
Continued sexual activity is associated with ...?
Prolonged abstinence from sex leads to ...?
Faster physical atrophy of the genital organs in old age ("use it or lose it").
The effects of some prescription drugs on sexuality - Reduced libido:
1. Antidepressant (fluoxetine).
2. Antihypertensive (Propranolol).
3. Antihypertensive (methyldopa).
The effects of some prescription drugs on sexuality - Incr. libido:
The effects of some prescription drugs on sexuality - Erectile dysfunction:
1. Antihypertensive (propranolol).
2. Antihypertensive (methyldopa).
3. Antidepressant (fluoxetine).
4. Antipsychotic (thioridazine).
The effects of some prescription drugs on sexuality - Vaginal dryness:
1. Antihistamine (diphenhydramine).
2. Anticholinergic (atropine).
The effects of some prescription drugs on sexuality - Inhibited orgasm:
The effects of some prescription drugs on sexuality - Priapism:
The effects of some prescription drugs on sexuality - Inhibited ejaculation:
1. Antidepressant (fluoxetine).
2. Antipsychotic (thioridazine).
Drugs of abuse - Alcohol and marijuana?
Increase sexuality in the SHORT TERM by decreasing psychological inhibitions.
Alcohol - With long term use, may cause ...?
Liver dysfunction, resulting in increased O2 availability and sexual dysfunction in men.
Chronic use of marijuana?
1. May reduce testo levels IN MEN.
2. Pituitary gonadotropins IN WOMEN.
Amphetamines and cocaine?
INCREASE sexuality by stimulating dopaminergic systems.
Heroin, and to a lesser extent methadone?
Associated with SUPPRESSED LIBIDO, retarded ejaculation, and failure to ejaculate.
Is there a sex difference in the HIV viral load and the symptoms of AIDS?
YES - A woman with the same HIV viral load as a man is likely to develop AIDS sooner than the man.