Chapter 4: Sexual Health

Intersex

a person who is born with sex chromosomes, external genitalia, or internal reproductive organs not considered "standard" as male or female. This condition can be manifested as a girl without ovaries, a boy without testes, or a child with genitalia that may appear as neither a vagina nor a penis. For intersex individuals, recent activism has drawn attention to medically unnecessary childhood surgeries performed to "assign" a sex to an infant.

Sex

an individual's biological status (male, female, intersex): anatomy, chromosomes, and biological characteristics.

Gender Identity

an individual's personal subjective sense of being male, female, or somewhere in between. Gender identity is clearly influenced by biological sex, which is determined by a complex set of variables; however, a person's gender identity is not necessarily consistent with his or her biological sex.

Transgender

an umbrella term for anyone whose biological sex is not aligned with the person's sense of self or gender identity.

Transitioning

process in which transgender people work to change their appearance and societal identity to match their gender identity. To acknowledge their transition, transgender people self-identify as male to female (MTF) or female to male (FTM). Changes are often medical, via surgery and hormones, as well as legal, through name and sex changes on legal documents and forms of identification.

Gender

the economic, social, and cultural attributes and opportunities associated with being masculine, or feminine.

Gender Expression

the way a person acts to communicate gender within a given culture, such as clothing and interests.

Sexual Health Defined

"A state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled."

Informed Decision Making

-Gynecological checkup. -Understanding personal feelings, thoughts about sexual well-being. -Understanding the medical language associated with sexual health. -Understanding responsible sexual behavior. -Understanding myth vs. fact. -Communication between parents and children. -Knowledge of health-care resources.

Sexuality Through the Lifespan: Young to middle adulthood

-increasing number of single, sexually active adults -marriage at later age -increase in the number of women who never marry -placing career goals and advanced education before marriage -increased divorce rate -increase in cohabitating adults -increase in the number of women who no longer depend on marriage to ensure economic stability.

Types of Sexual Violence

-sexual assault and rape -female genital mutilation (FGM) -forced sterilization

Transsexual

A transsexual is a person whose gender identity is opposite to her or his biological sex. A transsexual should not be confused with a transvestite, an individual who obtains sexual excitement from putting on clothes of the opposite sex. The American Psychiatric Association classifies transsexualism as a gender identity disorder (GID), a mental disorder characterized by strong and persistent cross-gender identification; however, significant controversy exists regarding the classification of transsexuality as a mental disorder.

Androgyny

Androgyny refers to having characteristics of both sexes, but appearing gender neutral (or not specifically male or female). Androgyny has physiological, behavioral, and psychological aspects. Physiological androgyny describes an individual whose appearance suggests gender ambiguity; behavioral androgyny refers to the manner in which people present themselves, such as a male who displays traditionally feminine behaviors; and psychological androgyny describes an individual whose gender identity may differ from his or her sex. Androgynous individuals of both sexes are more likely to engage in behavior typically ascribed to the other sex than are gender-typed individuals.

Physical Health and the Well-Woman Exam

Exam steps: Medical history General physician examination -breast examination and pelvic examination Pelvic Examination - Phase I = external examination - Phase II = use of speculum; collection of specimens - Phase III = bimanual examination A gynecological examination usually begins with a medical history and a general physical examination, including a breast examination, and is followed by a pelvic examination. The pelvic exam provides the woman and her clinician with essential basic information about her gynecological health. It should be timed to avoid the menstrual period. It is also advisable to avoid douching at least 24 hours before an examination; some clinicians recommend avoiding vaginal intercourse for at least 48 hours prior to the examination as well. These precautions ensure a more accurate visualization of the cervix and greater likelihood of diagnosing an infection if it is present. For the pelvic exam, the woman lies on her back with her bottom at the very end of the examining table and her legs supported in foot stirrups. The American College of Obstetricians and Gynecologists (ACOG) recommends pelvic exams for women 21 year of age or older. In 2014, the American College of Physicians published new evidence-based clinical practice guidelines recommending against performing routine pelvic exams, which includes the speculum and the bimanual exams, in women who are not pregnant and have no symptoms.

Sexual Arousal and Sexual Response

Four Phases: 1. Excitement 2. Plateau 3. Orgasm 4. Resolution In the excitement phase of the female sexual response cycle, the clitoris swells with blood engorgement. In addition to clitoral swelling, the labia majora flatten and separate during the excitement phase. The labia minora increase in size, and lubrication begins. During the plateau phase of the female sexual response cycle, the clitoris withdraws under its hood and shortens in length. The labia majora remain unchanged from the excitement phase, while the labia minora intensify in color. An orgasmic platform develops from further vasocongestion of the outer third of the vagina. Orgasm is the shortest phase of the sexual response cycle. Orgasmic experiences vary widely in terms of intensity, frequency, and duration among both men and women. The female orgasm includes an elevated blood pressure, heart rate, and breathing pattern. Orgasmic platform contractions are rhythmical, beginning at high intensity and then becoming weaker and slower. The uterus usually contracts at orgasm. During resolution, the sexual systems return to the nonexcited state. Skin coloration quickly subsides, and vital signs return to normal levels. The clitoris, labia majora, and labia minora return to their unaroused sizes and positions.

Historic facts on the economic dimensions of perspectives on sexual health and sexuality..

Historically, marriage represented the exchange of property between two families—usually in the form of a daughter. The daughter was either purchased from the maternal family through the exchange of goods, or, in some cultures, the father of the girl would offer a dowry to the groom's family to compensate for the financial burden of taking the girl into their house/clan. Throughout history, and even today in most of the world, the value of a bride often depends on her virginity. A girl who has lost her virginity prior to marriage, either willingly or unwillingly, can lose significant value to both her family and the groom's family she is entering. In the United States and other Western countries, it has become extremely common for young women to have sex prior to marriage. Sexuality can be viewed within a frame of power and economic dynamics. The less power a woman has, based on either cultural or individual factors, the less able she is to control a given sexual encounter. Significant power imbalances, like those seen between rich and poor, educated and noneducated, and young and old, are often strongly associated with sexual violence and abuse.

Internal Female Sexual Anatomy

Internal female sexual anatomy consists of the vagina, cervix, uterus, fallopian tubes, and ovaries. The vagina opens between the labia minora and extends upward into the body, angling toward the lower back. The vagina is approximately 3 to 5 inches in length when not aroused. The vagina consists of three layers of tissue—mucous, muscle, and fibrous tissue—all of which are richly endowed with blood vessels. The cervix, located at the back of the vagina, is the mouth of the uterus. The opening in the middle of the cervix, called the os, connects the vagina with the uterine cavity. During childbirth, the cervical canal is 50 or more times its normal width. The uterus, also known as the womb, is a thick, pear-shaped organ. The uterus is suspended within the pelvic cavity by a series of six ligaments. The uterine wall consists of three layers: the endometrium, the myometrium, and the perimetrium. The endometrium is the lining of the uterus, which, in preparation for fertilization, thickens in response to hormone changes during the monthly menstrual cycle. In addition, the endometrium is a source of hormone production. The myometrium, the middle layer, consists of the longitudinal and circular muscle fibers of the uterus. The muscle fibers are interwoven and enable the uterus to expand during pregnancy and contract during labor and childbirth. The myometrium is covered by a thin membrane known as the perimetrium. The perimetrium functions as the external surface of the uterus. The fallopian tubes are thin, pale, pink filaments. The outside end of each tube is like a funnel, with fingerlike projections called fimbriae that draw the egg from the ovary into the tube. The ovaries are located at the end of the fallopian tubes. The ovaries are endocrine glands that produce two classes of sex hormones: estrogens and progesterones. The estrogens influence the development of female physical sex characteristics and help regulate the menstrual cycle. The progesterones help regulate the menstrual cycle and stimulate development of the uterine lining in preparation for pregnancy.

What is a universal them in all cultures?

Marriage

Sexuality Through the Lifespan: older adulthood

Older Adulthood -climacteric: physiological changes that occur during period from female fertility to infertility. -Menopause: cessation of menstruation..vaginal dryness and thinning, delayed lubrication, hot flashes. -decline in frequency and intensity of sexual activity -quality vs. quantity of sexual expression

Sexual Dysfunction

Sexual dysfunction is defined as the inability of an individual to function adequately in terms of sexual arousal, orgasm, or in coital situations. The highest prevalence of sexual dysfunction is found in older women, but they experience less associated distress. The most distress occurs at midlife; younger women have the lowest prevalence of problems and associated distress.

Socialization

Socialization refers to the process whereby society conveys behavioral expectations to the individual. Parents, peer groups, schools, textbooks, and the media frequently help develop and reinforce traditional gender-role assumptions and behaviors. Gender-role conditioning has an impact on all facets of an individual's life, perhaps most importantly in influencing sexuality.

External Female Sexual Anatomy

The vulva encompasses all the female external genital structures, including the pubic hair, folds of skin, and urinary and vaginal openings. The mons veneris, or "mound of Venus," is the area covering the pubic bone. It consists of pads of fatty tissue between the bone and the skin. Numerous nerve endings in this area are responsible for the pleasure sensations from touch and pressure. The labia majora consist of the outer lips that extend downward from the mons and extend toward each side of the vulva. The color of the labia majora is usually darker than the color of the thighs. The labia minora, or inner lips, are located within the outer lips and often protrude between them. The clitoris consists of an external shaft and glans and the internal crura; its function is sexual arousal. The shaft and glans of the clitoris are located just below the mons area, where the inner lips converge. They are covered by the clitoral hood, or prepuce. The vestibule is the area of the vulva inside the labia minora. It is rich in blood vessels and nerve endings. Its tissues are also sensitive to touch. Both the urinary and the vaginal openings are located within the vestibule. The vaginal opening, known as the introitus, is located between the urinary opening and the anus. The hymen, a thin piece of tissue, partially covers the introitus. The perineum refers to the area of smooth skin between the vaginal opening and the anus. This tissue is rich with nerve endings and very sensitive to touch.

Homologous Sex Structures

Under normal conditions, the prenatal differentiation processes interact to determine biological sex, and later, gender identity. In early prenatal development, male and female external genitalia are undifferentiated and will remain so unless a specific gene on the Y chromosome involved in sex determination is present and is activated. This gene is necessary for the development of the testes, so it is involved in initiating the male sexing process. Through a series of complex interactions involving gonadal sex hormones, both the internal and the external sex structures differentiate into male or female genitalia. Because the external genitals, gonads, and some of the internal structures of males and females originate from the same embryonic tissues, it is not surprising that they have homologous, or corresponding, parts. Sex differentiation in human brains occurs largely during prenatal development, but takes place at a much later stage in development than sexual differentiation of the genitals.

What are the economic dimensions for perspectives on sexual health and sexuality?

daughter in marriage= dowry value of bride = virginity sexual aggression = power and economic dynamics commercial sex industry/prostitution.

Legal Dimensions of sexuality

laws prohibiting certain types of sexual behavior/intimacy--cohabitation, fornication, sodomy. same-sex partners marriage, annulment, separation, divorce, child custody, child support.

Sexual behavior is often defined by cultural values such as..

normative sex roles acceptable types of sexual activity sanctions/prohibitions on sexual behavior premarital sex sexual restraint for females same-sex relationships contraception decision making.

Gender Dysphoria

psychological term used to describe a strong and persistent cross-gender identification. This term replaces the use of gender identity disorder when referring to transgender and focuses on the fact that distress is not inherent in a transgender person.

Sexuality Through the Lifespan: Adolescence

puberty - secondary sex characteristics: hair growth, breast budding, vaginal walls thicken, uterus enlarges, vaginal pH increases in acidity. - menarche: about 2 years after breasts start to develop and by the age of 15. Adolescence, the period from about ages 12 to 19, is the most dramatic stage for physiological changes and social role development. The first few years of adolescence are known as puberty, and this is a time of dramatic physiological change including breast development, the growth of public hair, and the first menstrual period. Over the past 30 years, the average age of puberty has decreased, with some girls seeing physical changes as young as age seven. The onset of puberty generally occurs 2years earlier in girls than in boys. Secondary sex characteristics appear at this time in response to higher levels of hormones. In females, estrogen levels result in pubic hair growth and breast budding. African American females seem to experience puberty earlier than White adolescents. A number of environmental factors may contribute to the earlier age of puberty, including higher rates of childhood obesity; increased intake of animal protein and meat; high dairy and soft drink consumption; and exposure to endocrine-disrupting chemicals found in plastics, pesticides, and other chemicals.

Sexual Orientation

refers to one's sexual and romantic attraction to other people, whether the attraction is to members of the opposite sex, the same sex, or both sexes. People attracted to same-sex partners refer to themselves as gay, lesbian (for women who are gay), or homosexual. People attracted to members of the opposite sex refer to themselves as straight or heterosexual. A bisexual person is attracted to both sexes. Issues: homophobia, profiling, and discrimination in medical care.

Sexuality Through the Lifespan: Childhood

self-genital stimulation engage in play that may be viewed as sexual in nature curious about secondary sex characteristics

Political Dimensions of sexuality

sex education in schools..abstinence-only until marriage programs(AOUM) comprehensive or abstinence-plus programs. Controversy about sexual education programs has been intense for over a decade. In recent years the federal government has endorsed abstinence-only until marriage (AOUM) as the primary approach to sex education. Federally funded AOUM programs must promote abstinence from sexual activity and limit discussion of condoms and contraception. The AOUM programs exist despite evidence that comprehensive sexuality education effectively promotes sexual health and that parents support these programs in public schools. Although federal monetary support for AOUM programs has been over $175 million dollars annually in the past decade, no research has shown that they are effective at preventing teen pregnancies or STIs. Some analyses have shown many of the programs contain misleading and medically inaccurate information. In 2007, a congressionally mandated study found no statistically significant impact from Title V-funded programs on the sexual behavior of young people. Proponents of AOUM programs have argued that comprehensive sex education might lead to an increase in teens having sex; however, research shows that comprehensive sexual education programs either delay or have no effect on initiation of sexual activity. Studies have also shown that teaching about contraception was not associated with increased risk of adolescent sexual activity or STIs; in fact, adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education. Studies have shown that teaching about contraception is not associated with increased risk of adolescent sexual activity or STIs. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.

Forms of Sexual Expression

traditional heterosexual positions, masturbation, petting, oral-genital stimulation (cunnilingus, fellatio), anal intercourse, use of sex toys and accessories. One of the most traditional heterosexual positions is known as the "missionary" position (male on top of female.) Masturbation refers to erotic self-stimulation, usually to the point of orgasm. Historical records indicate that masturbation has been practiced since ancient times. Petting is defined as erotic stimulation of a person by a sexual partner, without actual sexual intercourse. Petting can include kisses, genital caresses, and oral-genital contact. Oral-genital stimulation, also known as oral sex, takes two basic forms. Cunnilingus is the act of sucking or licking the vulva, particularly the clitoris. Fellatio is the act of sucking or licking the penis and scrotum. A couple needs to be careful in performing anal intercourse, which increases the possibility of both pain and injury. A water-based lubricant (not petroleum-based products, which weaken condoms) should be used. Care should be taken to avoid contamination of the vaginal area once anal penetration has occurred. Oral, anal, and vaginal intercourse can all spread sexually transmitted infections; using a latex condom can greatly reduce this risk. Many women choose to use sex toys and accessories, either by themselves or with their partner.

Sexual Stereotypes for women

women are undersexed and men are oversexed. women are inexperienced and men are experts. women are recipients and men are initiators. women are controllers and men are movers. women are nurturing and supportive, and men are strong and unemotional. women are sensitive and men are insensitive. women are dependent and men are independent. women are passive and men are aggressive.

Common Problems related with menstruation

• Dysmenorrhea - painful menstrual flow • Premenstrual syndrome (PMS) - Group of symptoms linked to menstrual cycle • Premenstrual dysphoric disorder (PMDD) - severe form of PMS • Amenorrhea - Lack of menstrual flow