Chapter 4

Sexual Health

Homologous Sex Structures

Figure 4-2: External genital differentiation–male and female.

DefinitionsIntersex•A person who is born with sex chromosomes, external genitalia or internal reproductive organs not considered “standard” as male or female

Gender expression•The way a person acts to communicate gender within a given culture, such as clothing and interests

Androgyny•Having characteristics of both sexes, but appearing gender neutral

Definitions

Transgender• Umbrella term for anyone whose biological sex is

not aligned with the person’s sense of self or gender identity

Gender dysphoria• Psychological term used to describe a strong and

persistent cross-gender identification

Transitioning• Process in which transgender people work to

change their appearance and societal identity to match their gender identity

Class Discussion

• What are some of the challenges faced by transgender people? As individuals? In school? In social situations? In various public places?

• What are some possible solutions to these challenges?

Sexual Stereotypes: Discussion

• 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.

Sexual Orientation

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.

• Opposite sex = heterosexual• Same sex = gay, lesbian, homosexual• Both sexes = bisexual

Issues• Homophobia• Profiling• Discrimination in medical care

External Female Sexual Anatomy

Figure 4-3

Internal Female Sexual Anatomy

Figure 4-5

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

Physical Health and the Well-Woman Exam

Exam steps• Medical history• General physical examination

– Breast examination and pelvic examination• Pelvic examination

– Phase I = external examination– Phase II = use of speculum; collection of

specimens – Phase III = bimanual examination

Sexual Arousal and Sexual Response

Masters and Johnson: Female Sexual Response Cycle

Four Phases1. Excitement2. Plateau3. Orgasm4. Resolution

Figure 4-6

Forms of Sexual Expression

• Traditional heterosexual positions• Masturbation• Petting• Oral-genital stimulation (cunnilingus, fellatio)• Anal intercourse• Use of sex toys and accessories

Sexuality Through the Life Span

Childhood• Self-genital

stimulation• Engage in play that

may be viewed as sexual in nature

• Curious about secondary sex characteristics

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Sexuality Through the Life Span

Adolescence• Puberty

– Secondary sex characteristics o Hair growth, breast budding, vaginal walls

thicken, uterus enlarges, vaginal pH increases in acidity

– Menarcheo About 2 years after breasts start to develop and by

the age of 15

Sexuality Through the Life Span

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

Sexuality Through the Life Span

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

• Prevalence– About 44% of U.S. women report sexual problems,

with low desire being the most commons sexual problem (38.7%).

• Historically called “frigidity”• Areas of dysfunction

– Sexual desire disorders– Sexual arousal disorders– Orgasmic disorders– Sexual pain disorders

Sex Research

Well-known studies

•Kinsey Report (1948 and 1953)– Factors affecting sexual behavior in males/females

•Masters and Johnson (1966)– Sexual response cycle phases

•Redbook Survey (1977)– Sexual behavior and attitudes of American women

•Hite Report (1976)– Sexual practices of American women

•Blumstein and Schwartz (1983)– Sexual and nonsexual components of relationships

•ABC Primetime Poll (2004)– Found most Americans were monogamous and happy about it

Class Discussion

How do definitions of terms like “virginity” or “premarital” complicate sexual health research?

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Types of sexual violence• Sexual assault and rape• Female genital mutilation (FGM)• Forced sterilization

Sexual Violence as a Public Health Problem

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 healthcare resources