Normal sexuality

Normal
Sexuality
By
Dr. Helal Uddin Ahmed
MD-Part-II Student
Department of Psychiatry
BSMMU

Introduction of Human sexuality
 It is the process by which people experience and
express themselves as sexual beings.
 Sexuality has been a consistent focus of curiosity,
interest, and analysis to humankind.

Contd.

 Sexuality is determined by anatomy, physiology, the
culture in which a person lives, relationships with
others, and developmental experiences throughout the
life cycle.
 It includes the perception of being male or female and
private thoughts and fantasies as well as behavior.
 Normal sexual behavior brings pleasure to oneself
and one's partner, involves stimulation of the primary
sex organs including coitus

Contd.

 Normal sexuality is devoid of inappropriate feelings
of guilt or anxiety and is not compulsive.
 Recreational VS Relational sex-
Masturbation,
Various forms of stimulation sex organs,
Getting sexual gratification by several ways etc.

Aspects of sexual behavior Cognitive
Learning

Anatomical Physiological Psychological

Sociological Philosophical
Moral
Cultural
Ethical
Political
Theological
Legal
Spiritual
Religious

Anatomical Perspective
 Primary sex organs- Reproductive organs
 Secondary sexual characteristics and organs
 Nervous system, Endocrine system

Physiological Perspective

 Action of Neurotransmitter
 Actions of Hormones
 Sexual drive

Cognitive Perspective
 How a stimulus or situation is interpreted
determines how the individual will respond to the
stimulus
 Perception includes at least three components:
detection, labeling, and attribution.
Detection is defined by an individual's ability to
note the presence of a stimulus or to discriminate it
from other stimuli.
Labeling is the descriptors that an individual uses to
categorize the stimulus event.
Attribution is an explanation for the perception

Cognitive Perspective
Contd.

 Another cognitive factor is
evaluation; when an individual
evaluation
evaluates a sexual stimulus as
good or positive, sexual arousal
may be enhanced. On the other
hand, when a stimulus is
evaluated negatively, sexuality
will be diminished

Learning Perspective
 Learning theory postulates the environmental
factors that shape sexual behavior
 When sexual activity is pleasurable - it reinforced
 If sexual activity is restricted, punishable or full of
shame then people may come to associate sexual
stimulation with feelings of guilt or anxiety
 Observational learning of sexual behavior.

“Human sexuality is not simply imposed by instinct or
stereotypical conducts, as it happens in animals, but it
is influenced both by superior mental activity and by
social, cultural, educational and normative
characteristics of those places where the subjects grow
up and their personality develops. Consequently, the
analysis of sexual sphere must be based on the
convergence of several lines of development such as
affectivity, emotions and relations .”

Boccadoro L., Carulli S.
Italian Mentors

Sigmund Freud

Three Essays on the Theory of Sexuality
 Psychosexual development
Oral stage, Anal Stage, Phallic Stage, Genital Stage
 Oedipus complex
 Sexual etiology of neuroses,
 Libido developed in individuals by changing its object,
a process codified by the concept of sublimation
 Generalization that all pleasurable impulses and
activities are originally sexual .

Michel Foucault
 Sexuality are the activities and
sensations determined historically,
regionally and culturally.
 The construction of sexual meanings, is
an instrument by which social
institutions (religion, marketing, the
educational system, psychiatry, etc.)
control and shape human relationship.

Sexual ethics and
legality
 Unlike some other sexual activities, vaginal
intercourse has rarely been made Taboo on religious
grounds or by law.

 Many of the cultures that had prohibited sexual
intercourse entirely –Shakers, Roman Catholic
Church, Mahayana Buddhist Monks.

Sexual ethics and legality
Contd.
 Masturbation (Auto-erotic sexuality)
 Fornication or Live-together
 Adultery or Extramarital sex
 Homosexuality- Gay, Lesbian
Forceful Sex
 Commercial sex or Prostitution
Rape
 Necrophilia (sex with dead body)
Sexual assault
 Incest Statutory Rape
 Child sexual abuse/Pedophilia
Lust Murder
 Bestiality
 Sexual intercourse during a woman's menstrual period,
as prohibited in Islam and Judaism
 Sex between members of different tribes / same cast
 Public decency (exhibitionism and voyeurism)

Benefits
of
SEX
beyond reproduction

Health benefit of sex

Relieves stress

Contd.

Boosts the immune
system by  Ig A

Contd.

Improves CVS
( Lower BP)

Contd.

 Self esteem

Contd.

Improves intimacy
with partner

Contd.

Reduce pain
(+) oxytocin

Contd.

 Risk of
prostate cancer

Contd.

Strengthens
pelvic muscles

Contd.

Promotes good
sleep

Contd.

Improves the
sense of smell

Contd.

Improves
urinary bladder
control

Sexual Identity and Gender Identity

 Sexual identity is the pattern of a person's biological
sexual characteristics: chromosomes, external
genitalia, internal genitalia, hormonal composition,
gonads, and secondary sex characteristics.

 Gender identity is a person's sense of maleness or
femaleness.

Sexual Orientation

 Sexual orientation describes the object of a person's
sexual impulses:
-Heterosexual (opposite sex),
-Homosexual (same sex),
-Bisexual (both sexes).
-Transexuality (desire to be a member of the
opposite sex)
 A group of people have defined themselves as
“asexual” and assert this as a positive identity. Some
asexual
researchers believe this lack of attraction to any
object is a manifestation of a desire disorder.

Sexual Behavior : Role of the
Central Nervous System

 Cortex :controlling sexual impulses and processing sexual
stimuli that may lead to sexual activity .
 Orbitofrontal cortex- emotions

 Left anterior cingulate cortex- hormone control and
sexual arousal
 Right caudate nucleus- sexual activity follows
arousal

Sexual Behavior : Role
of the Central Nervous
System

 Limbic System : Chemical or electrical stimulation of the
lower part of the septum and the contiguous preoptic area,
the fimbria of the hippocampus, the mammilary bodies, and
the anterior thalamic nuclei have all elicited penile
erections in male. In case of female those area are related
with orgasm.

 Brainstem : Exert inhibitory and
excitatory control over spinal sexual
reflexes.
The nucleus paragigantocellularis
projects directly to pelvic efferent
neurons in the lumbosacral spinal
cord, apparently causing them to
secrete serotonin, which is known to
inhibit orgasms


 Neurotransmitters : dopamine, epinephrine,
norepinephrine, and serotonin, are produced in the
brain and affect sexual function.
 An increase in dopamine is presumed to
increase libido.
 Serotonin, exerts an inhibitory effect on
sexual function.

Sexual Behavior : Role of the Central
Nervous System

 Spinal Cord: Sexual arousal and climax are
ultimately organized at the spinal level. Sensory
stimuli related to sexual function are conveyed via
afferents from the pudendal, pelvic, and hypogastric
nerves

Hormones and Sexual Behavior
 Testosterone increases libido in both men and women
 Estrogen is a key factor in the lubrication involved in
female arousal and may increase sensitivity in the
woman to stimulation.
 Progesterone mildly depresses desire in men and
women as do excessive prolactin and cortisol.
 Oxytocin is involved in pleasurable sensations during
sex and is found in higher levels in men and women
following orgasm. It reinforces pleasurable activities

Physiological Responses
 Sexual response is a true psychophysiological
experience.
 Arousal is triggered by both psychological and
physical stimuli;
 Levels of tension are experienced both physiologically
and emotionally

Contd.

 Psychosexual development
 Psychological attitudes toward sexuality
 Attitudes toward one's sexual partner
These 3 are
Directly involved with, and Affect, human
sexual response.

Contd.

 William Masters and Virginia
Johnson observed that the
physiological process involves
increasing levels of
vasocongestion and myotonia
(tumescence) and the subsequent
release of the vascular activity and
muscle tone as a result of orgasm
(detumescence).

Sexual Stimulation: Foreplay
 Psychological Stimulation -use of smell, taste,
hearing, sight or fantasy
 Physical Stimulation- use of touch pressure or
bodily contact

1. Erogenous zones
2. Kissing
3. Breast stimulation
4. Oral-genital stimulation
5. Anal stimulation
6. Manual stimulation of genitals

Four-phase cycle of Physiological Responses
Phase-1

Desire

Phase-4 Resolution Excitement Phase-2

Orgasm
Plateau phase

Phase-3

Four-phase cycle of

es
ns t e
po ua
es ct
o f r flu
ce and
en p
qu rla
se ve
he n o
T a
c

Phase 1: Desire

 The desire (or appetitive) phase, identified solely
through physiology, reflects the psychiatric concern
with motivations, drives, and personality.
 The phase is characterized by sexual fantasies and
the desire to have sexual activity.

Phase 2: Excitement

The excitement and arousal phase,
brought on by psychological stimulation
(fantasy or the presence of a love object)
or physiological stimulation ( Foreplays-
stroking or kissing) or a combination of
the two, consists of a subjective sense of
pleasure.

Phase 3: Orgasm
 Peaking of sexual pleasure,
 Release of sexual tension
 Rhythmic contraction of the perineal muscles and the
pelvic reproductive organs.
 A subjective sense of ejaculatory inevitability triggers
men's orgasms. The forceful emission of semen. 4 to 5
rhythmic spasms of the prostate, seminal vesicles, vas, and
urethra.
 In women, orgasm is characterized by 3 to 15 involuntary
contractions of the lower third of the vagina and by strong
sustained contractions of the uterus, flowing from the
fundus downward to the cervix.

Phase 4: Resolution
 Resolution consists of the disgorgement of
blood from the genitalia (detumescence). Body
back to its resting state.
 If orgasm occurs: resolution is rapid, a
subjective sense of well-being, general and
muscular relaxation.
 If orgasm does not occur : resolution may
take from 2 to 6 hours and may be associated
with irritability and discomfort.
 After orgasm, men have a refractory period
(several minutes to many hours) when they
cannot be stimulated to further orgasm.
Women do not have a refractory period and are
capable of multiple and successive orgasms.

Male sexual response
An individual man may experience any of these
three patterns (A, B, or C) during a particular sexual
experience.

Female sexual response
An individual woman may experience any of these
three patterns (A, B, or C) during a particular sexual
experience.

Sexual Response Cycle

Excitement Phase Orgasmic Resolution
Phase Phase
Male Lasts several minutes 3 to 15 10 to 15
& to several hours; seconds minutes;
Female heightened excitement if no orgasm,
before orgasm, 30 ½ to 1 day
seconds to 3 minutes

Male Sexual Response Cycle
Organ Excitement Phase Orgasmic Phase Resolution Phase
Skin Just before orgasm: Well-developed flush Flush disappears in reverse
sexual flush inconsistently order of appearance;
appears; maculopapular inconsistently appearing
rash originates on film of perspiration on
abdomen and spreads to soles of feet and palms of
anterior chest wall, face, hands
and neck and can include
shoulders and forearms
Penis Erection in 10 to 30 Ejaculation; emission Erection: partial
seconds caused by phase marked by three to involution in 5 to 10
vasocongestion of erectile four 0.8-second seconds with variable
bodies of corpus cavernosa contractions of vas, refractory period; full
of shaft; loss of erection seminal vesicles, prostate; detumescence in 5 to 30
may occur with ejaculation proper marked minutes
introduction of asexual by 0.8-second contractions
stimulus, loud noise; with of urethra and ejaculatory
heightened excitement, spurt of 12 to 20 inches at
size of glands and diameter age 18, decreasing with
of penile shaft increase age to seepage at 70
further

Male Sexual Response Cycle Contd

Scrotum Tightening and lifting of scrotal No change Decrease to
and testes sac and elevation of testes; with baseline size
heightened excitement, 50% because of loss of
increase in size of testes over vasocongestion;
unstimulated state and flattening testicular and
against perineum, signaling scrotal descent
impending ejaculation within 5 to 30
minutes after
orgasm;
involution may
take several hours
if no orgasmic
release takes
place
Cowper's 2 to 3 drops of mucoid fluid that No change No change
glands contain viable sperm are secreted
during heightened excitement

Male Sexual Response Cycle Contd

Other Breasts: inconsistent nipple Loss of voluntary
erection with heightened muscular control
excitement before orgasm Rectum: rhythmical
Myotonia: semispastic contractions of
contractions of facial, abdominal, sphincter
and intercostal muscles Heart rate: up to
Tachycardia: up to 175 beats a 180 beats a minute
minute Blood pressure: up
Blood pressure: rise in systolic to 40 to 100 mm
20 to 80 mm; in diastolic 10 to 40 systolic; 20 to 50 mm
mm diastolic
Respiration: increased Respiration: up to
40 respirations a
minute

Female Sexual Response Cycle

Orgasmic
Organ Excitement Phase Phase Resolution Phase
Skin Just before orgasm: sexual Well- Flush disappears in reverse
flush inconsistently appears; developed flush order of appearance;
maculopapular rash originates on inconsistently appearing film
abdomen and spreads to anterior of perspiration on soles of feet
chest wall, face, and neck; can and palms of hands
include shoulders and forearms
Breasts Nipple erection in two thirds of Breasts may Return to normal in about 30
women, venous congestion and become minutes
areolar enlargement; size increases tremulous
to one fourth over normal
Clitoris Enlargement in diameter of No change Shaft returns to normal
glands and shaft; just before position in 5 to 10
orgasm, shaft retracts into prepuce seconds; detumescence in 5 to
30 minutes; if no orgasm,
detumescence takes several
hours

Female Sexual Response Cycle Contd

Labia Nullipara: elevate and flatten No change Nullipara: decrease to
majora against perineum normal size in 1 to 2 minutes
Multipara: congestion and Multipara: decrease to
edema normal size in 10 to 15
minutes
Labia Size increased two to three Contractions of Return to normal within 5
minora times over normal; change to pink, proximal labia minutes
red, deep red before orgasm minora

Vagina Color change to dark purple; 3 to 15 Ejaculate forms seminal pool
vaginal transudate appears 10 to contractions of in upper two thirds of vagina;
30 seconds after arousal; lower third of congestion disappears in
elongation and ballooning of vagina at seconds or, if no orgasm, in 20
vagina; lower third of vagina intervals of 0.8 to 30 minutes
constricts before orgasm second

Female Sexual Response Cycle Contd

Uterus Ascends into false Contractions Contractions cease,
pelvis; labor-like throughout orgasm and uterus descends to
contractions begin in normal position
heightened excitement just
before orgasm
Other Myotonia: Loss of voluntary Return to baseline status
A few drops of mucoid muscular in seconds to minutes
secretion from Bartholin's Control Cervix color and
glands during heightened Rectum: rhythmical size return to
excitement contractions normal, and cervix
Cervix swells slightly of sphincter descends into seminal
and is passively elevated Hyperventilation and pool
with uterus tachycardia

SIX Points for SEX
1 Preparation

Position
2
3 Duration

4 Concentration

5 Relaxation

6 Frequency

Gender Differences in Desire and Erotic Stimuli

 Sexual impulses and desire exist both in men and
women but males generally possess a higher baseline
level of desire than do women
 Men respond sexually to visual stimuli of nude or
barely dressed women.
 Women report responding sexually to romantic
stories with a tender, demonstrative hero whose
passion for the heroine impels him toward a lifetime
commitment to her .

Gender Differences in Desire and Erotic Stimuli
Contd.

 Woman's subjective sense of arousal is not always
congruent with her physiological state of arousal.
 Women’s sense of excitement may reflect a readiness
to be aroused rather than physiological lubrication.
Conversely, she may experience the physical signs of
arousal without being aware of them.
 This situation rarely occurs in men.
men

Love and Intimacy
 Freud postulated that psychological health could be
determined by a person's ability to function well in
two spheres, work and love.
 A person able to give and receive love with a
minimum of fear and conflict has the capacity to
develop genuinely intimate relationships with others.
 Sex frequently acts as a catalyst in forming and
maintaining intimate relationships.

Frequency of sexual activity

 Zero (sexual abstinence) to 15-20 times/week
 The average frequency of sexual intercourse for
married couples in USA is 2 to 3 times /week
 It is generally recognized that postmenopausal
women experience declines in frequency of sexual
intercourse
 Average frequency of intercourse declines with age in
both men and women.

Frequency of sexual activity
Contd.
 According to the Kinsey Institute, average frequency
of sexual intercourse in USA :
112 times/ year (age 18-29),
86 times /year (age 30-39)
69 times /year (age 40-49)
52 times/ year (age 50-59)
35 times/year (age 60-69)
22 times/year (age 70-79)
?? times/year (age> 80)

Conclusion

 Human sexuality is a very complex and multi-
dimensional behavior that is affected by many facets
of our lives including anatomy, physiology,
cognition, and learning. As well as influenced by
culture, ethnicity and even economy and politics.

Conclusion
Contd.

 Sex Education is very much needed in every society-
specially in the school curriculum- otherwise faulty
learning about sex misguided one’s personal life and
may produce many sexual as well as psycho-social
problem.
 Accepted Sex-education from Scientific authority .

Why should we take advice on sex from
the pope? If he knows anything about it,
he shouldn't!
--George Bernard Shaw

Normal sexuality

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