SEXUAL HEALTH & SEXUAL DISORDERS

SEXUAL HEALTH

In 1975, WHO defined sexual health as, “integration of the somatic, emotional,
intellectual and social aspects of sexual being, in ways that are positively enriching
and that enhance personality, communication and love.”

COMPONENTS OF SEXUAL HEALTH

Four critical components of sexual health are:

1. Self concept
2. Body image
3. Gender identity
4. Sexual orientation

FACTORS AFFECTING SEXUAL HEALTH

The factors affecting sexual health are:

 Biological factors
 Psychological factors
 Environmental factors
 Hormonal factors
 Medications
 Sexual health history
 Stress

BIOLOGICAL FACTORS

 Congenital abnormalities
 Old age and sickness
 Injuries(affecting nerves, physical or reproductive system etc.)
  Less secretions of hormones or reasons related to endocrine glands.
 Pain, fatigue etc

PSYCHOLOGICAL FACTORS

Predisposing factors

 Disturbance/ obstacles in family relationships

 Incomplete sexual knowledge
 Initial sexual experience being bitter
 Disinterest or disliking for partner

Assisting and maintaining factors

 Unnecessary hopes and expectations from the partner.

 Tension and pressure
 Sense of guilt regarding sexual relationship
 Death of beloved one
 Wrong notions and superstitions regarding sexual relationship.

ENVIRONMENTAL FACTORS

 Change in lifestyle
 Lack of poor place and privacy
 Incidents in life

HORMONE/GENETIC FACTORS

 Can affect sperm quality

 Ovulation disturbances (e.g. failure to ovulate regularly, or irregular menstrual
cycle, may be caused by problems with the hypothalamus and pituitary gland.)
 Congenital factors - inability to conceive(e.g. born without uterus)
 PHASES OF SEXUAL RESPONSE CYCLE


 The sexual response cycle has five phases: desire, excitement, plateau, orgasm,
and resolution. Both men and women experience these phases, although the
timing usually is different

Phase 1. Appetitive phase

This is a phase which occurs before the sexual response cycle. This consists of sexual
fantasies and a desire to have sexual activity.

Phase 2: Excitement

General characteristics of the excitement phase, which can last from a few minutes to
several hours, include the following:

 Muscle tension increases.

 Heart rate quickens and breathing is accelerated.
 Skin may become flushed (blotches of redness appear on the chest and back).
 Nipples become hardened or erect.
 Blood flow to the genitals increases, resulting in swelling of the woman's
clitoris and labia minora (inner lips), and erection of the man's penis.
 Vaginal lubrication begins.
 The woman's breasts become fuller and the vaginal walls begin to swell.
 The man's testicles swell, his scrotum tightens, and he begins secreting a
lubricating liquid.

Phase 3: Plateau

General characteristics of the plateau phase, which extends to the brink of orgasm,
include the following:

 The changes begun in phase 1 are intensified.

 The vagina continues to swell from increased blood flow, and the vaginal walls
turn a dark purple.
 The woman's clitoris becomes highly sensitive (may even be painful to touch)
and retracts under the clitoral hood to avoid direct stimulation from the penis.
 The man's testicles are withdrawn up into the scrotum.
 Breathing, heart rate, and blood pressure continue to increase.
 Muscle spasms may begin in the feet, face, and hands.
 Muscle tension increases.

Phase 4: Orgasm

The orgasm is the climax of the sexual response cycle. It is the shortest of the phases
and generally lasts only a few seconds. General characteristics of this phase include
the following:

 Involuntary muscle contractionsbegin.
 Blood pressure, heart rate, and breathing are at their highest rates, with a rapid
intake of oxygen.
 Muscles in the feet spasm.
 There is a sudden, forceful release of sexual tension.
 In women, the muscles of the vagina contract. The uterus also undergoes
rhythmic contractions
 In men, rhythmic contractions of the muscles at the base of the penis result in
the ejaculation of semen.
 A rash, or "sex flush" may appear over the entire body.

Phase 5: Resolution

During resolution, the body slowly returns to its normal level of functioning, and
swelled and erect body parts return to their previous size and color. This phase is
marked by a general sense of well-being, enhanced intimacy and, often, fatigue. Some
women are capable of a rapid return to the orgasm phase with further sexual
stimulation and may experience multiple orgasms. Men need recovery time after
orgasm, called a refractory period, during which they cannot reach orgasm again. The
duration of the refractory period varies among men and usually lengthens with
advancing age.

SEXUAL DISORDERS

In ICD10 gender identity disorders, disorders of sexual preference and sexual

development and orientation disorders are listed under disorders of adult personality
and behavior (f6), while sexual dysfunctions are listed under behavioral syndromes
associated with physiological disturbances and physical factors (f5).

DEFINITION

Any disorder involving sexual functioning, desire, or performance OR Sexual

disorder is difficulty experienced by an individual or a couple during any stage of a
normal sexual activity, including physical pleasure, desire, preference, arousal or
orgasm.
CLASSIFICATION

1. Gender identity disorders

2. Psychological and behavioral disorders associated with sexual development and

maturation

3. Disorders of sexual preference (paraphilias)

4. Sexual dysfunctions

1. Gender Identity Disorders

In these disorders, the sense of one's masculinity or femininity is disturbed. They

include;

a) Transsexualism

In this, there is a persistent and significant sense of discomfort regarding one's

anatomic sex and a feeling that it is inappropriate to one's perceived gender.The
person will be preoccupied with the wish to get rid of one's genitals and secondary sex
characteristics and to adopt the sex characteristics of the other sex.

Treatment  Counseling to help the individual reconcile with the anatomic sex.  Sex
change to the desired gender [sex reassignment surgery (SRS)] in selected cases.

b)Gender identity disorder of childhood - This is a disorder similar to

transsexualism, with a very early age of onset.

c)Dual-role transvestism - It is characterized by wearing clothes of the opposite sex

in order to enjoy the temporary experience of membership of the opposite sex but
without any desire for permanent sex change.

d) Intersexuality - The patients have gross anatomical or physiological features of the

other sex. For example, Turner's syndrome, congenital adrenal hypoplasia.
2. Psychological and Behavioral Disorders Associated with Sexual Development
and Maturation

a. Homosexuality - In this, sexual relationships are maintained between persons of the

same sex. Female homosexuals are called as 'lesbians' and male homosexuals are
called 'gay.'

Treatment:  Behavior therapy: Aversion therapy, covert sensitization, systematic

desensitization  Supportive psychotherapy • Psychoanalytic psychotherapy

3. Disorders of sexual preference (Paraphilias)

Paraphilia is used to identify repetitive or preferred sexual fantasies or behaviors that

involve any of the following:

 The preference for use of nonhuman object

 Repetitive sexual activity with humans that involves real or simulated suffering
or humiliation.
 Repetitive sexual activity with non- consenting partner.

These are the disorders of sexual preference in which sexual arousal occurs
persistently and significantly in response to objects which are not a part of normal
sexual arousal.

Types of paraphilias

Fetishism: sexual gratification from actual or fantasized inanimate objects.

Transvestic fetishism: cross dressing

Sexual sadism: sexual activity that hurts or humiliates the sexual partner

Exhibitionism: exposing genitals to a stranger

Frotteurism: fantasies of touching or rubbing others often with the genitals.

Voyeurism: looking at unsuspecting people who are naked, undressing or engaging in

sexual behavior.

Pedophilia: sexual activity with a prepubertal child.

Incest: sexual attraction to ones own children or blood relations.

Klismaphilia: sexual arousal linked to giving or receiving enemas.

Gerontophilia: becoming sexually aroused by elderly individuals.

Necrophilia: sexual activity with a dead person.

Somnophilia: fondling a person who is sleeping.

Urophilia: sexual arousal by watching someone urinate or by urinating on someone.

Zoophilia: aroused by sexual contact with animals.

4. Sexual dysfunction

It is a significant disturbance in the sexual response cycle, which is not due to an

underlying organic cause. • The common dysfunctions are:

 Frigidity: Absence of desire for sexual activity

 Impotence: This disorder is characterized by an inability to have or sustain penile

erection till the completion of satisfactory sexual activity.

 Premature ejaculation: Ejaculation before the completion of satisfactory sexual

activity for both partners.

 Non-organic vaginismus: An involuntary spasm of lower l/3rd of vagina,

interfering with coitus.
 Non-organic dyspareunia - Pain in the genital area of either male or female during
coitus.

Treatment  Psychoanalysis  Hypnosis  Group psychotherapy  Behavior therapy

CLASSIFICATION OF SEXUAL DISORDERS ACCORDING TO SEXUAL

RESPONSE CYCLE

Disorders of appetitive phase

 Hypoactive sexual desire

 Sexual aversion disorder

Disorders of excitement and plateau phase

 Male erectile disorder

 Female sexual arousal disorder

Disorders of orgasmic phase

 Male orgasmic disorder

 Female orgasmic disorder
 Premature ejaculation

Sexual pain disorders

 Vaginismus – involuntary contraction of muscles of vagina leading to painful

intercourse
 Dyspareunia – pain during coitus/ sexual intercourse

Hypoactive Sexual Desire Disorder - This disorder may be present when a person has
decreased sexual fantasies and a decreased or absent desire for sexual activity. In order
to be considered a sexual disorder the decreased desire must cause a problem for the
individual. In this situation the person usually does not initiate sexual activity and may
be slow to respond to his/her partner's sexual advances.
Sexual Aversion Disorder - A person who actively avoids and has a persistent or
recurrent extreme aversion (resistance) to genital sexual contact. In order to be
considered a disorder, the aversion to sex must be a cause of difficulty in the person's
sexual relationship. The individual with sexual aversion disorder usually reports
anxiety, fear, or disgust when given the opportunity to be involved sexually.

Female Sexual Arousal Disorder - Female sexual arousal disorder is described as the
inability of a woman to complete sexual activity with adequate lubrication. Swelling
of the external genitalia and vaginal lubrication are generally absent. These symptoms
must cause problems in the interpersonal relationship to be considered a disorder.

Male Erectile Disorder - If a male is unable to maintain an erection throughout sexual

activity, he may have male erectile disorder. This problem must be either persistent or
recurrent in nature. Also, the erectile disturbance must cause difficulty in the
relationship with the sexual partner to be defined as a disorder. Erectile disorders may
accompany a fear of failure.

Female Orgasmic Disorder - Female orgasmic disorder occurs when there is a

significant delay or total absence of orgasm associated with the sexual activity. This
condition must cause a problem in the relationship with the sexual partner in order to
be defined as a disorder.

Male Orgasmic Disorder - When a male experiences significant delay or total absence
of orgasm following sexual activity, he may have male orgasmic disorder. In order to
be qualified as a disorder, the symptoms must present a significant problem for the
individual.

Premature Ejaculation - When minimal sexual stimulation causes orgasm and

ejaculation on a persistent basis for the male, he is said to have premature ejaculation.
The timing of the ejaculation must cause a problem for the person or the relationship
in order to be qualified as a disorder.
Dyspareunia - Dyspareunia is a sexual pain disorder. Dyspareunia is genital pain that
accompanies sexual intercourse. Both males and females can experience this disorder,
but the disorder is more common in women. Dyspareunia tends to be chronic in
nature.