SEXUAL HEALTH
Chapter 4
Sexual Health
“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.”
Perspectives on Sexual Health
and Sexuality
◦ Cultural and religious dimensions
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“Marriage” is universal theme in all cultures sanctioning sexual privileges
and obligations.
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Sexual behavior is often defined by cultural values.
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Normative sex roles
Acceptable types of sexual activity
Sanctions/prohibitions on sexual behavior
Sexual restraint for females
Same-sex relationships
Contraception decision making
Perspectives on Sexual Health
and Sexuality
◦ Economic dimensions
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Daughter in marriage = dowry
Value of bride = virginity
Sexual aggression = power and economic dynamics
Commercial sex industry/sex work
Perspectives on Sexual Health
and Sexuality
◦ Legal dimensions
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Laws prohibiting certain types of sexual behavior/intimacy—
cohabitation, fornication, sodomy
Same-sex partners
Marriage, annulment, separation, divorce, child custody, child support
Perspectives on Sexual Health
and Sexuality
◦ Political dimensions
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Sex education in schools
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Abstinence-only until marriage programs
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Comprehensive or abstinence-plus programs
Sexual Behavior among
Youth in the United States
Figure 4-1
Sex, Gender and Gender
Identity
◦ Sex
•
An individual’s biological status as male or female
◦ Gender
•
The economic, social, and cultural attributes and opportunities
associated with being masculine or feminine
◦ Gender identity
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An individual’s personal subjective sense of being male or female
Definitions
◦ Intersex
•
A person who is born with sex chromosomes,
external genitalia or internal reproductive organs
not considered “standard” as male or female
◦ Gender expression
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The way a person acts to communicate gender
within a given culture, such as clothing and
interests
◦ Androgyny
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Having characteristics of both sexes, but
appearing gender neutral
Definitions
◦ Transgender
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Umbrella term for anyone whose biological sex is not aligned with the
person’s sense of self or gender identity
◦ Transitioning
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Process in which transgender people work to change their appearance
and societal identity to match their gender identity
FEMALE
REPRODUCTIVE
ANATOMY AND
PHYSIOLOGY
Breasts
◦ Pectoralis (chest) muscle
◦ Stroma (fat and ligaments)
◦ Lobes of the mammary
glands (milk producing cells)
◦ Lactiferous duct (carries milk
from the lobes)
◦ Lactiferous sinus (milk
accumulates between
breastfeeding)
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 WellWoman Exam
Pelvic examination:
◦ External exam: visual exam to ensure that the
reproductive organs look normal in size, shape,
and location
◦ Speculum exam: internal exam to observe for
internal organ normalcy
◦ Bimanual exam: to feel for abnormalities in the
fallopian tubes, ovaries, and uterus
SEXUAL RESPONSE
CYCLE
Sexual Arousal and Sexual Response
Masters and Johnson: Female Sexual Response Cycle
Four Phases
◦ Excitement
◦ Plateau
◦ Orgasm
◦ Resolution
Figure 4-6
Sexual Response Cycle:
Excitement
◦ Vaginal lubrication begins within 10-15 seconds of stimulation
◦ Labia majora and minora darken
◦ Clitoris engorges with blood and increases in size and length
◦ Uterus and cervix pull away from the vagina
◦ Breasts swell and nipples become erect
◦ Sex flush (darkening of the skin) may occur
Sexual Response Cycle:
Plateau
◦ Vagina continues to expand
◦ Uterus elevates into the abdomen
◦ Secretions occur from the Bartholin’s glands
◦ Breasts continue to enlarge
◦ Sex flush may continue and spread
Sexual Response Cycle:
Orgasm
◦ Rhythmic contractions of the uterine walls (3-15)
◦ The first 3-6 are the most intense
◦ Involuntary muscle spasms
◦ Vasocongestion and myotonia (muscle tension) release
◦ Respiration and heart rate increase
◦ Blood pressure increases
Sexual Response Cycle:
Resolution
◦ Vasocongestion and myotonia dissipate rapidly
◦ Uterus returns to unaroused state
◦ Labia majora and minora return to their normal size and shape
◦ Swelling of breasts disappears
Sexual Dysfunction
• Prevalence
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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
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Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders
Class Discussion
How do definitions of terms like “virginity” or
“premarital” complicate sexual health
research?
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
• Knowledge of healthcare resources