1. Handout 2 of 2
NURS 330 February 16, 2015

2. What is Sexuality?
“The integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation. “-WHO

3. What factors influence Sexuality?

4. The Senses and Sexuality
Touch
Smell
Sound
Sight
Ask – which is missing?
Sight (visual) – cultural differences in standards of beauty .universal appeal of healthiness, clear skin
Touch – primary erogenous zones
Smell – overt odors/fragrances
Hearing – voice, music
Taste does not appear to play a significant role in sexual arousal. Tate buds may not be an important source of sensory input for arousal, touch receptors on the tongue may be.

5. Smell Smell Odors play a role in sexual arousal Pheremones
Perfumes
Colognes
Debate about its existence
i.e. menstrual synchrony
Not all odors are conducive to sexual arousal
Offensive odors

6. Sound Sound Auditory stimuli
Your partner’s voice
Romantic or sexy music
Love-making sounds
Not all sounds are conducive to sexual arousal

7. Sight
Sight
Allows us to experience many images that can trigger feelings of sexual arousal
Viewing an “attractive” person
Subject to social and cultural influences
Erotic images
Sometimes even parts of one’s genitals

8. Which sense is this? Taste
Do not appear to play a significant role in sexual arousal

9. Female Ejaculation Does it exist?
Yes, female ejaculation does exist but is NOT very common
The fluid that is ejaculated is odorless and clear

10. Terms to know
Erogenous zones
Kegel Exercises
Aphrodisiacs
Pheremones

11. Definition Erogenous Zones Kegel Exercise
parts of the body that, when stimulated, elicit sexual arousal
Kegel Exercise
Recommended to reduce urinary incontinence and possibly increase sexual pleasure
Identify the muscle by stopping urination in midstream

12. Definition Aphrodisiacs Pheromones
Agents that show any ability to enhance sexual functioning
Pheromones
Substances that when secreted have a particular smell found to be sexually arousing.
Pheromones also play a role in menstrual synchrony.

13. Sex Hormone Testosterone “Male” hormone
Found in small amounts in women
Affects sexual response in men and women
Men – produced by the seminiferous tubules
Women - produced by the ovaries
Increase energy, sex drive (libido), aggression, appetite, muscle mass Increases libido in both men and women

14. FACT
A person’s emotional and mental states also help determine whether that person experiences arousal

15. Sexual Response Cycle

16. Models of Human Sexual Response
Master’s and Johnson
Proposed their four-stage model of human sexual response cycle
Stage I - Excitement
Stage II - Plateau
Stage III - Orgasm
Stage IV - Resolution

17. EXCITEMENT- 1ST STAGE: Response to stimuli Transudation Vasocongestion
FEMALE
MALE
Transudation
Vasocongestion
Tenting Effect
HR, BP, RR
Myotonia
Penile Erection
Testis enlarge
RR – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate

18. PLATEAU – 2ND STAGE Orgasmic Platform Tenting Effect Seminal Pool
FEMALE
MALE
Orgasmic Platform
Tenting Effect
Seminal Pool
Erection is maintained (if there is enough stimulation)
Cowper’s Gland secretes fluid

19. ORGASM – 3RD STAGE Muscle spasms Involuntary
FEMALE
MALE
Muscle spasms
Involuntary
Collection of semen in the urethral bulb
Ejaculatory Invariability
-bulbocavernosus muscle
Expulsion of semen

20. RESOLUTION – 4TH STAGE Return to non-aroused state Refractory Period
FEMALE
MALE
Return to non-aroused state
Refractory Period

21. Comparing male and female sexual response
Key difference
Male has a refractory period
There’s a potential for multiple orgasms in women
Controversies in understanding the female orgasm
Freud
vaginal orgasm is true orgasm
Master’s and Johnson
only one kind no matter how achieved
Let them know the Master’s and Johnson’s definition is the most widely accepted.

22. Sexual Dysfunctions

23. Sexual Dysfunctions
Recurrent or persistent sexual problems that interfere with normal performance and cause distress
Nine types of sexual disorders
Four categories
Sexual Desire Disorders
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders

24. Prevalence

25. Sexual Desire Disorders
Hypoactive sexual desire disorder
Persistent deficit in sexual fantasies and desire for sex
Sexual aversion disorder
Extreme aversion to any form of sexual contact with a partner

26. Sexual Arousal Disorders
Female sexual arousal disorder
Difficulties becoming sexually aroused
Deficient vaginal lubrication
Male erectile disorder
Recurrent problems in achieving or sustaining penile erection in a sexual situation
Aka Impotence

27. Orgasmic Disorders Female orgasmic disorder (anorgasmia)
Recurrent problem with reaching orgasm despite adequate erotic stimulation
Male orgasmic disorder
Delay or inability to reach orgasm during sexual activity
Premature ejaculation
Persistent or recurrent ejaculation following minimal stimulation and before the person wishes it

28. Sexual Pain Disorders Dyspareunia Vaginismus
Recurrent genital pain during sexual intercourse
Vaginismus
Persistent involuntary spasms of vaginal muscles, which interfere with sexual intercourse

29. Sexual Dysfunctions - Differences in Men and Women
Female
Male
Sexual Aversion Disorder
Dyspareunia
Dyspareunia (rare in men)
Vaginismus
Premature Ejaculation
Female Orgasmic Disorder
Male Orgasmic Disorder
Hypoactive Sexual Desire Disorder
Female Sexual Arousal Disorder
Male Erectile Disorder

30. General Causes Physiological/Biological Psychological/Emotional
Medication and illicit drugs
Psychological/Emotional
Anxiety
Negative beliefs
Sexual trauma
Interpersonal/Social
Relationship problems
Environmental
Cultural factors

31. Treatment of Sexual Dysfunctions
Medical treatment of sexual dysfunctions
Sex therapy
Treatments for erectile disorder
Surgical implants
Vascular surgery
Vacuum constriction devices
Penile injection therapies
Oral medications for erectile disorder
Principles of sex therapy
Mutual responsibility is emphasized
Information and education are integral components
Attitudes, expectations, and sexual scripts usually must be modified

32. Medical Treatment Viagra FDA approval in March 1998 Prescription only
Lasts about four hours
Side effects
Short duration

33. Sex Therapy Principles of sex therapy
Mutual responsibility is emphasized
Information and education are integral components
Attitudes, expectations, and sexual scripts usually must be modified

34. Rape Drugs What is a Rape Drug?
A rape drug is one that is used in a drug
facilitated sexual assault.

35. Rape Drugs (cont) The most common rape drugs: Odorless, colorless
Rohypnol
GHB
Other common rape drugs
Ecstasy
Ketamine
Odorless, colorless
Easily dissolved into drinks

36. Effects of Rape Drugs
Drowsiness
Disorientation
Disinhibition
Amnesia

37. INFERTILITY

38. Infertility
Definition: number of couples who have unprotected intercourse for one year and do not experience a pregnancy
10-15% of American couples are infertile

39. Causes of infertility Both men and women contribute to infertility
90% of cases, cause will be known
Each gender contributes 40%
Both contribute 10%
Remaining 10% of cases, cause remains unknown
Males
Usually due to sperm defect
Females
More complex

40. Risk Factors Some common risk factors Age Weight Lifestyle
Occupational and Environmental risks
Stress and Emotional factors
Genetic conditions??

41. Age and Infertility Females Males
As a woman gets older, her chances of fertility declines
Menopause
Higher risk of chromosomal abnormalities that occur in her eggs
More likely to have health problems that may interfere with fertility
However, if fertilization occurs, can carry to full term
High risk of miscarriage
Males
Not very clear on its impact of age and fertility in men
Age does not appear to impact fertility in males as it does in females.

42. Chances of Pregnancy by Age
Fertility %
Up until 34
90%
By age 40
Declining to 67%
By age 45
Declining to 15%

43. Causes of Female Infertility
Common causes
Blocked Fallopian Tubes
Pelvic Inflammatory Disease
Endometriosis
Ovulation disorders
Others

44. Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease, or PID, is the major cause of infertility worldwide. It is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries).
Infection of one or both fallopian tubes is known as Salpingitis
Symptoms
Mostly asymptomatic
Fever, chills, pelvic pain (indicating inflammation of the entire pelvic area).

45. PID (cont) Causes of PID Untreated/uncured bacterial infection
Most common chlamydia (about 75% of cases)
Second most common cause is gonorrhea.
Other Causes
Non-sterile abortions
Cervicitis (usually from genital herpes infection)
Other vaginal infections (bacterial vaginosis, trich)
Ruptured appendix
Childbirth

46. Endometriosis
Lining of the uterus, instead of being expelled into the vagina, is expelled out into the fallopian tubes and implanted in other areas of the pelvis.
These implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle
Eventually causes scarring and inflammation
Symptoms
Often causes no symptoms
Painful periods, painful sex, painful bowel movements
Cause is unknown
Possible defects in immune system

47. Endometriosis and infertility
Endometrial cysts in the fallopian tubes may cause blockage
Scar tissue between uterus, ovaries and fallopian tubes
Poor egg implantation

48. Female Infertility- Other possible causes
Ovulation Disorders
Hormone Disorders
Hypothalamic-Pituitary Disorders
Polycystic Ovarian Disease/Syndrome
Thyroid
Other
Ovarian Cysts
Benign Uterine Fibroids
Ectopic pregnancies, medical conditions, medications

49. Male Infertility Over 90% of cases are due to:
Low sperm count
Poor sperm quality
Motility
Morphology
Both
% of cases have an unknown cause

50. What affects sperm count and quality?
Environmental and Biologic Factors
Lifestyle
-Emotional -Smoking
-Sexual Issues/Infection -Malnutrition
-Substance Abuse -Obesity
-Testicular Exposure to overheating
Genetic Factors
Varicocele

51. Varicocele Varicose vein in the cord that connects to the testicle.
Found in 10-15% of all men
Found in 25% - 40% of infertile men
Only varicoceles large enough to be felt are reported to affect fertility

52. Other causes of sperm defect
Testosterone Deficiencies
Autoantibodies
Retrograde Ejaculation
Physical and Structural abnormalities
Cancer and its treatments
Infections
Other medical conditions
Medications

53. Testing for Infertility - males
Sperm evaluation
Hormone tests
Ultrasound

54. Testing for Infertility – females
Ovulation Assessment
Body temperature
Cervical mucus assessment
Hormone Analysis
Laparascopy
Check vagina for naturally occurring sperm antibodies

55. Infertility Treatment
Artificial Insemination
Drug therapy
Clomid
In Vitro Fertilization (IVF)

56. Infertility Treatment
Gamete Intrafallopian Transfer (GIFT)
Both egg and sperm inserted into Fallopian tube
Zygote Intrafallopian Transfer (ZIFT)
Fertilized outside body and inserted into Fallopian tube
Intracytoplasmic Sperm Injection (ICSI)
Direct injection of sperm into egg in lab

57. In-Class Assignment