Sexuality Exam 4
Orgasm in Women: Psychological Factors
men and women have similar psychological changes & experiences during orgasm Psychological Experience of Orgasm: - general mood changes - subjective perception of physiological events (awareness that body is going through breathing, heart, rate changes) - altered state of consciousness (out of the body type of experience) - post-orgasm feelings include happiness, love, relaxation, satisfaction Oxytocin: plays huge role in pair bonding - released during orgasm in both men & women - the higher the level of oxytocin released, the greater the perceived intensity of orgasm - if blocked pharmacologically, pleasurable quality reduced
Female Orgasmic Disorder
presence of either of the following: - marked delay in, marked infrequency of, or absence of orgasm - markedly reduced intensity of orgasmic sensations - must be present for minimum of 6 months and experiencing distress Prevalence: ~10% of women report lifelong lack of orgasm (however, some have had orgasm its just they were expecting something better or weak orgasm) ~50% of women report situational problems - overall ~24% of women have had a problem w/ orgasm during past year Factors Related to Orgasmic Ability: - can be certain diseases like nerve damage, spinal cord injuries, severe diabetes. - some women can't have an orgasm b/c they haven't learned what sensations are arousing enough to attain an orgasm - sex guilt (guilty in engaging in sexual activity) - attitudes and personality (negative attitudes about sex) - sexual conservatism - partner variables - partner's sexual function (i.e. erectile ability) - duration/quality of foreplay - duration/quality of sexual stimulation - relationship factors - compatibility - contentment - communication Etiology (Causes): - disease - drugs - psychological and interpersonal factors
Treatment for Women with Sexual Arousal Dysfunction
- Activate the nervous system to start sexual arousal (ex: exercise) 1. topical lubricants (i.e. K-Y Jelly, Astroglide) - putting on genitals before sex; adds a replacement lubrication(not solving problem but makes sex more enjoyable) 2. estrogen creams replace estrogen 3. Eros-CTD (clitoral therapy device): pumps blood into the genital region What About Viagra for Women?: not very effective - Viagra will increase blood into the genitals in women; does NOT mean there is psychological arousal (in men it does work) - for women, genital arousal response does not play a huge role in their psychological experience of arousal - in men: 0.9 correlation between genital response and mental turn-on response - men have a visible genital response (erection) - in women: 0.2 (women have a more subtle genital response; not that noticeable) - huge placebo effect w/ Viagra in women: changes expectations (42% of women felt sexually aroused w/ the placebo)
Aging and Sexual Desire
- As ppl age, more health problems & medications that cause sexual side effects (higher incidents of depression, loss of sexual partner..) - longitudinal study of women pre-menopausal, during menopause, post-menopausal and found that some women showed decreases in sex drive while most stayed the same, and small minority increased in sexual desire - most predictive variable in older women who experienced an increase in sexual desire: obtaining a new sexual partner Testosterone Changes in Men: - T levels drop about 1% per year - men in committed relationships have 21% lower T levels - T-levels of married men and men in committed relationships did not differ - married men w/ kids have 42% lower T why this may occur?: - lower T could shift orientation toward parenting; no more competition, etc. (causes you to think about sex less & shifts orientation more towards parenting) - men who fantasize or engage in sex w/ other partners have T levels that stay high
Treatment for Low Sexual Desire
- Dr. Meston says sexual desire is one of the hardest sexual problems to treat 1. psychotherapy: individual going to a psychologist or psychiatrist - first thing physician tries to determine is if there are relationship issues - most sex therapies include increasing sexual communication to provide a safe environment for couples to talk about their sex experiences 2. Flibanserin (Addyi): 1st drug approved by FDA for sexual dysfunction in women - acts as 5-HT1A agonist; 5-HT2A antagonist; D4 partial agonist - must abstain from alcohol - Addyi has a long history; FDA approved the drug in 2015 - black box warning: must have black box on the drug says "warning" - CANNOT consume alcohol while on this drug
How Does Body Image Impact Sex?
- If worried about body image one is not going to focus on the sexual act, sexual sensations but focusing on worry thoughts. - 55% married and single U.S. women aged 15-74 reported dissatisfaction w/ their bodies - turn out lights during sex, self-conscious - spectatoring: instead of being a player in the sexual activity, you're more a spectator; removed from the sexual act (not engaging)
Does Sexual Anticipation Increase T in Women as it Does in Men?
- Long Distance monogamous relationship study (Hamilton & Meston, 2010) - monitoring T during isolation, week before partner returns, day before partner arrived, then right before sex, then again the day after, and 3 days later - 5 measures of T - these individuals were NOT allowed to masturbate - found that there was an anticipatory effect (so yes woman also increase T when anticipating sex) - just like the man w/ the beard who was having an affair
Grafenberg Spot and Female Ejaculation (G spot)
- anterior wall of a woman's vagina (upwards towards belly button) - high density nerve endings (sensitive area of 2/3 women that touch & pressure this area) - stimulation of that region leads to orgasm - small portion of women ejaculate during orgasm - fluid is released from urethra-what is it? - fluid is not urine, it has higher levels of tartrate-inhibited acid phosphatase and glucose - "female prostate?" (Skene's paraurethral gland) - presence of prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA) - evidence that in these women who ejaculate when their "G-spot" is stimulated, it may be that these women have the Skene's paraurethral gland - G-spot CANNOT be located for all women - among women who have located a G-spot, there is usually not ejaculation
Treatment of Erectile Disorder
- assess organic/psychological - PDE5 inhibitors: Sildenafil (Viagra), Tadalafil (Cialis); Vardenafil (Levitra) - increases nitric oxide which increases blood flow into penis. - does not work if there is damage to the nitric oxide system, nerve damage, arterial damage Treatment: - T treatment for abnormally low T - vacuum constriction device (sucks blood into penis, then ring is put at the base of penis to hold blood in) - penile implants - penile artery bypass (replacing vein or arteries in penis) - Flexible Rod Penile Implant Surgery: erection would be permanent if bent upward and flexible rod; bending penis downward to mimic flaccidness - Inflatable Penile Implant: more realistic - penile injections of alprostadil relaxes muscles that surround blood vessels in penis (causes erection) - can be administered in suppository form and absorbed through the urethra
What Triggers Orgasm in woman?
- clitoral stimulation (most common) - vaginal stimulation (~60% orgasmic women w/o clitoral stimulation) - no physiological difference between clitoral and vaginal orgasm - G-spot or cervical stimulation - pressure applied to mons pubis (fatty area of tissue in pubic bone) - breast/nipple stimulation - fantasy, imagery, hypnosis, sleep - easier via masturbation than w/ partner (due to knowing what areas are most pleasurable)
Hormonal Aspects of Desire: Men
- estrogen (E) and progesterone (P) have little effect - exception: high levels of E inhibit sexual desire (seen among sex offenders; suppressing testosterone) - androgens (testosterone) play important role in men - men need certain amount of T to experience sexual desire & to be able to attain erection, however, cant draw conclusions on persons sex drive by their level of T, unless low T, then yes they have low sex drive - anticipating sex increases T - castration (removal of testes) decreases sexual interest - when one testes is removed, the other testicle compensates and still produces the necessary amount of T needed - if both were removed; no T = no sex drive - in adult males, variability in circulating T not linked to levels of sexual desire
Hormonal Aspects of Desire: Women
- increase in sexual desire in woman happens during ovulation; this can be due to increase of estrogen & T. - E and P play minimal role in sexual desire - estrogen is required for vaginal lubrication in women - testosterone plays an important role in sexual desire - some evidence for increase in sexual activity mid-cycle when T levels are high - "normal" range free T women aged 18-46 is 1.3 to 6.8 picograms per milliliter - beginning at puberty, male testes produce between 300-1000 picograms per milliliter daily - oophorectomy (removal of ovaries) decreases desire; desire is restored w/ T - low sex drive does not always mean low T - a lot of women have low sex drive for reasons that have nothing to do w/ low levels of testosterone - psychological factors involved - Hypoactive Sexual desire disorder: low levels of desire - some oral contraceptives shown to decrease T and impair desire - increasing levels of estrogen and/or progesterone (inhibiting ovulation; flattening our E and P across the menstrual cycle) - some oral contraceptives also increase SHBG (sex hormone-binding globulin) - if SHBG is increased, more binding to testosterone so less T is used by the body - increasing SHBG = decreasing T levels - oral contraceptives that have desogestrel or norgestimate especially bad; highest amount of SHBG
Orgasm in Women: Physiological Factors
2 Types of Orgasm Gaps: 1. orgasm gap between men and women and sexual orientation - 95% of heterosexual men said yes to usually/always have an orgasm - 89% gay men - 88% bisexual men - 86% lesbian women - 66% bisexual women - 65% of heterosexual women 2. literal anatomical gap in women - gap between clitoris and urinary opening: if 2cm or less then orgasm can be achieved through penile-vaginal intercourse - if 3cm or more, then there was a lower probability
Female Orgasmic Disorder: Treatment
- its a matter of time & exploration to learn how to have an orgasm - a reason why women tend to peak sexually in their 30s is b/c it takes women longer to learn what's sexually pleasurable for them Treatment: 1. sensate focus: technique that is used to treat orgasm problems, desire problems, ED problems, etc. - trains the couples to learn about each other's bodies and take anxiety out of the sexual situation - banning intercourse for a period of time; automatically getting rid of performance pressure - exploring each other's bodies at non-sexual regions at first, then slowly moving to sexual regions, then eventual penetration - week 1-2: exploring body and face (non-sexual areas) - week 3-4: breast and genital stimulation - week 5-6: intercourse directed masturbation: education, self-exploration to feel comfortable and knowledgeable about anatomy - treatment for women who have never had an orgasm - 88-90% success rate "Becoming Orgasmic" by Helman guides woman through self-exploration Sex therapist: hmw exercises & guides you
Gender Differences in Sex Drive
- men of all ages report higher levels of sexual interest - women report more problems with disinterest in sex - men on average think about sex 18 times a day - women on average think about sex 8-9 times a day explanations for gender differences: - differences in socialization (men initiate sex more) - sex roles ("because I'm a male I should have more sex") - anatomical differences (from a young age, men are more comfortable or in tune w/ their body) Ideal Number of Sex Partners Desired: - men desire more, women less Sex Differences in Fantasies: - pornography industry: - aimed primarily at males; 80% of males consume pornography - visual - involves many different partners - no commitment romance novels: women consumers, mate selection, emotional bonding
Premature (early) Ejaculation (PE)
- most commonly seen in men - persistent or recurrent ejaculation during partnered sexual activity within approx. 1 min of vaginal penetration and before individual wishes it - sometimes even ejaculating before entering a vagina - a new highly sexual experience = more men ejaculate earlier than desired (does not mean they fulfill the DSM diagnosis) - young men or sexually inexperienced men also ejaculate earlier than desired (also most likely not a clinical problem) - higher prevalence among young men; the problem goes away as they age Causes of PE: - goal-focused masturbation - individuals who masturbate a lot train their body to ejaculate in a short period of time - lack of awareness of sensation before ejaculation - during high levels of arousal, the ejaculate goes into the bulb at the base of the penis (point of no return or ejaculatory inevitability) teaching men to learn those sensations of high levels of arousal and getting them to slow down so they can decrease sexual arousal and not ejaculate too early Treatment for PE: - drugs- antidepressants or clomipramine - behavioral techniques: 1. Stop-start technique: stopping and cooling down before returning to sexual activity 2. Squeeze technique: applying pressure on the penile arteries
Physiological Experience of Orgasm in Woman
- orgasmic platform contracts: outer third of the vagina swells during high levels of arousal; the muscle contracts during orgasm - rectal sphincter contracts - uterus/cervix contracts - pulse rate, blood pressure, breathing increase - muscles throughout the body (i.e., legs, thighs, back) contract Multiple Orgasms: series of independent orgasms that occur in close proximity - generally occur when women engage in self-stimulation - up to 20 sequential orgasms in woman - Masters & Johnson: women can have multiple orgasms b/c they do not have a refractory period (men have this) - minority of men are capable of multiple orgasms - refractory period in men is age related, as man age their refractory period increases, meaning it takes longer for man to be able to achieve subsequent erection (they have short refractory period) - the first orgasms is accompanied w/ ejaculation; the subsequent orgasms are "dry orgasms" (no ejaculate or semen is released)
Evolutionary Theory of Sexual Desire
- primary reproductive benefit: direct increase in number of offspring Adaptive Problems Men Must Solve: - partner variety - review: men's reproduction is constrained by how many sexual partners they have access to - high levels of desire = more sex with more women - on the other hand, women don't benefit from having multiple partners - more sex partners = higher risk of contracting STIs - chance of getting pregnant by a man low in mate value Sexual Regret: - men: regret missed sexual opportunities - women: regret sex or acts of commission (regret having sex w/ that man) Hooking Up and Friends With Benefits: - men hope hooking up will lead to more hooking up - women are likely to report that "ideal outcome" would be a romantic relationship
The Effect of Alcohol & Tobacco on Erectile Function
1. Acute Alcohol Effects: - increasing levels of alcohol, there's a decline in erectile response. - over time, alcohol use, especially higher levels it takes longer to attain an erection. 2. Prolonged Alcohol use: - affects endocrine system - decreases production/metabolism of T - may lead to testicular atrophy - problems can persist even after alcohol recovery 3. Tobacco: - ED is higher in current smokers versus those who have never smoked - higher pack years = more likely to have ED (pack years = number of cigs smoked per year times number of years) Erectile Response with Nicotine (equivalent to cigarette): - in study: one group getting nicotine gum, one group getting placebo gum - found that Nicotine has inhibitory effect on blood flow to the penis.
Relationship Factors that Influence Sexual Desire
1. communication: - in order for your sexual needs to be met, your partner needs to know how to meet them (through communication) - there is huge individual variability in the likes and dislikes of certain sexual behaviors within men and women - need to communicate what you like/don't like - sex therapy involves opening up to communication 2. anger 3. lack of trust 4. lack of connection 5. lack of emotional intimacy 6. Unrealistic Expectations: - addicted to "infatuation stage": beginning of relationship you're excited, hormones pumped up, sexual drive pumped up, but it doesn't last. - phenylethylamine (PEA): released when a person first falls in love 7. Loss of Attraction to Partner: - change in physical appearance - change in status/earning potential - bad hygiene 8. Lack of Sexual Skill (sex not enjoyable) - frustration - ungratifying - boring 9. Mismatched Desire (differences in desired amount of emotional intimacy and/or sex) - "fusion" or "merging" among lesbian couples - in lesbian couples, sex drive dropped greatly at the start of the relationship; significantly greater drop across the relationship - greater drop compared to hetero; even greater compared to gay couples - fusion or merging: in a lesbian relationship, both women lose the motivation to have sex (since women have sex mainly for the emotional connection) b/c they already have the emotional attachment 10. Social/Cultural/Religious Factors and Desire: - culture and religion strongly influence both the way we feel about our sexuality and the way we express it - different messages of sex before marriage (either being good or bad) based on one's culture, religion, parents, etc. - growing up w/ negative connotations about sex before marriage cause adults to feel guilty growing up
Loss of Desire: Changes in Sexuality
1. complaints about sexual withholding (men tend to complain more about this) 2. frequency of sexual intercourse - tends to decline w/ the length of a relationship - exception: new sexual partner = rate goes back up 3. sexual satisfaction - around age 20: 40% of couples both report being sexually satisfied - around age 60: 20% 4. arrival of a baby (don't have time to think about sex b/c you have to looks after the baby) - moderating effect of men's perceptions of spouse's attractiveness - if a man perceives his partner to be extremely attractive, then the frequency of sex stays the same. - the physical attractiveness of a woman does tend to matter in the initiation of a sexual relationship - also matters for the maintenance of sex frequency over time when couples are really in love, one partner does NOT notice the other partner's attractiveness decrease
Exercise and Sexual Arousal in Women
1. no exercise condition: hanging around and reading non-sexual material for 20 mins then inserts the vaginal probe - then watches non-sexual film followed by sexual film - then fills out self-report ratings of arousal 2. exercise condition: same sequence except the woman exercises for 20 minutes instead of reading - exercising the woman at 70% VO2max - Results: Exercise Increases Genital Arousal in Women - No difference however between exercise or no exercise on the amount of blood flow in genitals during neutral state (non-sexual film) - Exercise was preparing woman's body for sexual arousal; so when put in sexual situation her body responded more intensely. - at 30 mins post-exercise, effect is starting to decline - exercising showed to counteract the effects of antidepressants (not experiencing decreased sexual arousal)
Why Do Women Fake Orgasms?
1. to get it over with 2. Make the man feel good about himself 3. women who have difficulty having orgasms will fake an orgasm so their partner does not think they have a problem some fake an orgasm to try and attain an orgasm
Etiology of Erectile Disorder: Psychological Factors
Anxiety: - performance pressure (when trying hard to be good lover, erectile dysfunction may occur) - fear of failure - differential effect on functional/dysfunctional men Barlow's Cognitive Model of Sexual Function/Dysfunction: 1. Sexually functional man: positive mindframe - positive affect/expectations - attention to erotic cues - functional performance 2. sexually dysfunctional man: negative mindframe - negative affect/expectations ("what if I loose my erection?") - attention to lack of performance - dysfunctional performance
Drugs that Impact Sexual Desire
Aphrodisiacs? - oysters, clams, many herbs and ground animal parts in Chinese medicine (some herbs increase peripheral blood flow; therefore more sexual arousal) - most effective via placebo effect - rarer and more expensive = greater placebo - yams increase T ( have T in it) - some people doing things and experiencing irritation/burning at the genitals but associating it to be enhancing their arousal or desire Prescription Drugs and Desire: 1. many prescription drugs impair desire and performance 2. antidepressants but newer generation have few side effects - earliest generations of antidepressants gave a lot of serotonin w/ many side effects (weight gain, sexual problems) - many different serotonin receptors (sub-types); only some of these receptors have a role in sexual behavior - newer generation of antidepressants are made to not affect the receptors that are important in sexual desire 3. antihistamines for allergies dry out mucous membranes in vaginal tissue Alcohol and Desire: - Small amounts enhances sexual desire b/c it decreases inhabitations (takes away anxiety, concern about body, helps relax) - higher levels of alcohol impair performance
Psychological Factors that Impact Desire
Depression: - people who are depressed report lower levels of sexual drive - common to the point where lower sex drive is a hallmark of depression (included as one of the questionaries for assessing depression) - antidepressants are effective in alleviating many depressive symptoms - negative side effects of impairing sex drive - depression is a result of low levels of serotonin - first generation antidepressants only gave serotonin - many deleterious side effects: weight gain and lower sexual desire - newer antidepressants act on very selective serotonin receptors in the brain (avoid receptors that impar sexual function) - there are many different subtypes of serotonin receptors Stress: - sleep important, exhausted, no energy, "one more thing to do" - chronic, long-term stress often impairs sleep, energy, and sex drive - sex becoming one more thing they have to do; a "chore" Body Image and Self-Esteem: - unrealistic standards of beauty - study showed that short exposure to magazines can have the effect of making women feel less desirable - media influences and body image (i.e., photoshop, airbrush) - tendency to compare yourself to these images 1. Women: - vanity sizing: decreasing sizes in the U.S. constantly - measuring Marilyn Monroe's clothes - size 16 in U.S. clothing sizes - by today's standards, she's a size 8 - vanity sizing pushes the notion that women have to be "thinner" - think that man want someone who's thinner than average but not entirely true. 2. Men: - correlates of drive for muscularity - exercise dependence - supplement use - self-esteem
Linear Model of Sexual Response Cycle
Desire -> Sexual arousal -> arousal plateaus (intensified) -> orgasm -> resolution - most effective for males but not so much for women's experience - for some women; arousal precedes desire sexual arousal -> desire -> arousal plateaus (intensified) -> orgasm -> resolution (non-linear model) - some women do relate better to the linear model, some women relate to the non-linear/circular model - women who have sexual problems tend to relate more to the non-linear model
Male Erectile Disorder
Erectile Disorder (ED): DSM-5 Diagnosis: At least ONE of the following: - marked difficulty obtaining erection during sex - marked difficulty maintaining erection until completion of sexual act - marked decrease in erectile rigidity minimum 6 months causes significant distress ED Prevalence: - 35% men experience incidental erectile failure - transient (occasional) impotence in 50-60% of males - impotence: inability to get an erection - prevalence of ED: approx. 7% in males ages 18-29; 18% in men ages 30-59 ED: Physiological Factors > Disease: - low T - nerve damage - can occur from biking (overexposure b/c of the bike seat) - only takes 11% of a man's weight to cause compression of the penile arteries - recent research showing the same effect for women; possible irreparable damage in the nerves and arteries - clogged or narrow arteries - diabetes - multiple sclerosis - spinal cord injury - kidney disease - hypertension - high blood cholesterol - nitric oxide system damage (smoking, alcohol) - nitric oxide is needed to maintain an erection > Drugs: - antidepressants - antipsychotics - benzodiazepines - diuretics - antihypertensives - alcohol - tobacco - chemotherapy - many recreational drugs
What makes Women desire sexual activity?
McCall and Meston (2006): - asked 50 women (aged 18-67) - "sexual activity" defined as kissing, petting, oral sex, intercourse, masturbation - generated 125 independent cues - administered to 874 women (aged 17-72) - 4 factors Emotional Bonding Cues: - feeling a sense of love w/ a partner - feeling a sense of commitment from a partner - experiencing emotional closeness w/ a partner - your partner expresses interest in hearing about you Explicit/Erotic Cues: - watching an erotic movie - reading about sexual activity - talking about sexual activity or "talking dirty" - having a sexual fantasy Visual/Proximity Cues: - seeing someone who is well-dressed or "has class" - seeing someone act confidently - seeing/talking w/ someone intelligent - being on close proximity w/ attractive people - seeing/talking w/ someone powerful - these cues are related to the evolutionary cues that - result in attraction Romantic/Implicit Cues: - dancing closely - touching your partner's hair or face - having a romantic dinner w/ a partner - laughing w/ a romantic partner
How Women's Sexual Arousal is Measured
Two Components of Arousal in Women: 1. genital arousal: blood flowing into the genital tissue and vaginal lubrication - as more blood flows into women's genital tissue, it squeezes cells in the lining of the vagina that squeezes our vaginal lubrication - lubrication is the first observable sign of a genital sexual response in women - occurs within 20 seconds of arousal in the brain - Vaginal Photoplethysmography: measuring blood flow in genital tissue - emits a light into the woman's vagina and measures the amount of light reflected back; giving us an indirect indicator of how sexually aroused she is 2. psychological arousal: - desire & arousal are diff. things: sexual desire should be conceptualized as motivation to engage in sex (the desire to be sexual) - sexual arousal is how engaged and turned on you are in a sexual situation - psychological arousal is most often measured with questionnaires (asking how aroused they are after a non-sexual and sexual film) - "Arousometer": measuring sexual arousal continuously (highest peak, how long)
Hormones and Male Sexual Desire
androgens (testosterone) estrogen (estradiol, estriol, estrone) progesterone men: produced mainly by the testes, also by adrenal glands women: produced mainly by the ovaries, also by adrenal glands
What is Sexual Desire?
desire to have sex - sexual desire has many names: sexual desire, sexual interest, sexual drive, and libido - sexual desire is a hard construct to measure; no objective physiological indexes of sexual desire - reliant on self-report data; issues w/ self-report: biased recall, over-reporting, under-reporting - when measuring sexual desire, you must ask a variety of questions (asking questions about how often you have sex; not just including partner sex, but frequency of masturbation, sexual thoughts, fantasies, etc.) - also ask questions like how much time you spend seeking sexual material, plan sexual activities; - gender difference in the degree to which men and women think about sex - men think about sex more than women do (fantasize more about sex than women) - in women, sexual thoughts and fantasies occur at high levels at the beginning of a relationship, but tend to decline over the course of the relationship - women don't spend a lot of time seeking out sex, initiating sex (except for the earlier stages of the relationship) - for women, an index of sexual desire is whether or not they're receptive (accept or are open) to sex - women are often in a sexually neutral state
Evolutionary Hypothesis about Testosterone Results in Men
elevated T facilitates success in intrasexual competition and mating effort reduced T facilitates parental effort; already mated men do not need to incur (sustain) cost of high T - men who are in committed relationships but have sex outside the relationship maintain high levels of T