SEXUALITY
should be.
 Sexuality is a multidimensional
phenomenon that includes feelings,
attitudes, and actions.
 It encompasses and gives direction to a
person’s physical, emotional, social, and
intellectual responses throughout life.
 Biologic gender is the term used to
denote a person’s chromosomal sex: male
(XY) or female (XX). 
 Gender identity or sexual identity is the
inner sense a person has of being male or
female, which may be the same as or
different from biologic gender.  home, the change in their eating patterns
 Gender role is the male or female
behavior a person exhibits, which, again,
may or may not be the same as biologic
gender or gender identity
DEVELOPMENTAL GENDER IDENTITY
 Several theories exist regarding whether
gender identity arises from primarily a
biologic or a psychosocial focus.
 Gender identity is the personal sense of
one's own gender.
INFANCY
 From the day of birth, female and male
babies are treated differently by their
parents.
 EXAMPLE:  A girl might be told, “Don’t cry.
You don’t look pretty when you cry.” A boy
might be told, “You’ve got to learn to be
tougher than that if you’re going to make it in
this world.
PRESCHOOL PERIOD
 Children can distinguish between males and
females as early as 2 years of age. By age 3
or 4 years, they can say what sex they are,
and they have absorbed cultural
expectations of that sex role. Often, boys will
play rough-and-tumble games with other
boys, and girls will play.
SCHOOL-AGED CHILD
 Early school-age children typically spend
play time imitating adult roles as a way of
learning gender roles. They form strong
impressions of what a female or male role
ADOLESCENT
 At puberty, as the adolescent begins the
process of establishing a sense of identity,
the problem of final gender role identification
surfaces again. Most early adolescents
maintain strong ties to their gender group,
boys with boys and girls with girls. The
advent of menstruation may provide a
common bond for girls at this stage. Some
adolescents choose a child of their own
gender a few.
YOUNG ADULT
 When young adults move away from home
to attend college or establish their own
can increase or decrease their weight that
lead to changes in their body image. During
this time, they choose the way they will
express their sexuality along with other life
patterns.
GUIDELINES FOR SAFE SEX PRACTICE
1. Abstinence is the only 100% guarantee against not
contracting a sexually transmitted infection.
2. If you do have sex, be selective in choosing sexual
partners. 
3. Do not be reluctant to ask a sexual partner about
his or her sexual lifestyle before engaging in sexual
relations. If a partner has a history of casual contacts
or bisexual or unprotected sex, there is a greater
hazard of infection for you than if your partner is also
choosy about partners.
4. Avoid sexual relations with intravenous drug users
or prostitutes (male or female) or sexual partners who
have had sexual relations with such people, because
such people have a greater than usual chance of
carrying the human immunodeficiency virus (HIV) and
hepatitis B or C infection.
5. Inspect your sexual partner for any lesions or
abnormal drainage in the genital area. Do not engage
in sexual relations with anyone who exhibits these
signs.
6. The use of a condom is the best protection against
infection. Condoms should be latex; the chance of the
condom tearing is less if it is a prelubricated brand.
Use water-based lubricants such as KY Jelly on
condoms, because oil-based lubricants can weaken
the rubber.
7. Condoms should be protected from excessive heat
to avoid rubber deterioration and should be inspected
to be certain they are intact before use. Do not inflate
condoms before use to test for intactness, because
this weakens the rubber.
8. Condoms should be fitted over the erect penis with
a small space left at the end to accept semen. The
condom should be held against the sides of the penis
while the penis is withdrawn to prevent spillage of
semen.
9. Void immediately after sexual relations to help
wash away contaminants on the vulva or in the
urinary tract.
10. Anal intercourse carries a high risk for HIV and
hepatitis infection as well as infection from intestinal
organisms. Always use a condom. Use lubricants for
anal penetration to keep bleeding and condom
resistance to a minimum.
11. Do not engage in oral-penile sex unless the male
wears a condom, because even preejaculatory fluid
may contain viruses and bacteria.
12. Hand-to-genital contact may be hazardous if open
cuts are present on hands. Use a latex glove or finger
cot for protection.
13. To decrease the possibility of transferring germs,
do not share sexual aids such as vibrators.
14. If you think you have contracted a sexually
transmitted infection, do not engage in sexual
relations until you have contacted a health care
provider and are again infection free. Alert any recent
sexual partners that you might have an infection so
they also can receive treatment.
MIDDLE-AGED ADULT
For many women and men in midlife, sexuality has
achieved a degree of stability. A sense of masculinity or
femininity and comfortable patterns of behavior have been
established.
Although menopause alters reproductive functioning, it
does not physically inhibit sexual functioning. Generally, a
woman with a strong self-image, positive sexual and social
relationships, and knowledge regarding her body and
menopause is likely to progress through this natural
biologic stage without problems and remain sexually active
and satisfied.
OLDER ADULT
Both male and female older adults continue to enjoy
active sexual relationships. Some men experience
less erectile firmness or ejaculatory force than when
they were younger, but others discover that they are
able to maintain an erection longer. Older women may
have less vaginal secretions because they have less
estrogen after menopause.
THE INDIVIDUALS WHO ARE PHYSICALLY
CHALLENGED
Individuals who are physically challenged have sexual
desires and needs the same as all others. However,
they may have difficulty with sexual identity or sexual
fulfillment because of their condition.
HUMAN SEXUAL RESPONSES
Sexuality has always been a part of human life, but it is
only in the past few decades that it has been studied
scientifically. One common finding of researchers has been
that feelings and attitudes about sex vary widely: the sexual
experience is unique to each individual, but sexual
physiology (i.e., how the body responds to sexual arousal)
has common features
SEXUAL RESPONSE CYCLE
Two of the earliest researchers of sexual response
were Masters and Johnson. In 1966, they published
the results of a major study of sexual physiology
based on more than 10,000 episodes of sexual
activity among more than 600 men and women
(Masters, 1998). In this study, they described the
human sexual response as a cycle with four discrete
stages: excitement, plateau, orgasm, and resolution.
Stages may actually be more individualized than
Masters proposed; they may blend together much
more into one smooth process of desire, arousal, and
orgasm.
EXCITEMENT
Excitement occurs with physical and psychological
stimulation (i.e., sight, sound, emotion, or thought)
that causes parasympathetic nerve stimulation. This
leads to arterial dilation and venous constriction in the
genital area. The resulting increased blood supply
leads to vasocongestion and increasing muscular
tension. In women, this vasocongestion causes the
clitoris to increase in size and mucoid fluid to appear
on vaginal walls as lubrication. The vagina widens in
diameter and increases in length. The nipples become
erect. In men, penile erection occurs, as well as
scrotal thickening and elevation of the testes. In both
sexes, there is an increase in heart and respiratory
rates and blood pressure.
PLATEAU
The plateau stage is reached just before orgasm. In the
woman, the clitoris is drawn forward and retracts under the
clitoral prepuce; the lower part of the vagina becomes
extremely congested (formation of the orgasmic platform),
and there is increased nipple elevation.
In men, the vasocongestion leads to distention of the penis.
Heart rate increases to 100 to 175 beats per minute and
respiratory rate to approximately 40 respirations per
minute.
ORGASM
Orgasm occurs when stimulation proceeds through
the plateau stage to a point at which the body
suddenly discharges accumulated sexual tension. A
vigorous contraction of muscles in the pelvic area
expels or dissipates blood and fluid from the area of
congestion. The average number of contractions for a
woman is 8 to 15 contractions at intervals of 1 every
0.8 seconds. In men, muscle contractions surrounding
the seminal vessels and prostate project semen into
the proximal urethra. These contractions are followed
immediately by three to seven propulsive ejaculatory
contractions, occurring at the same time interval as in
the woman, which force semen from the penis.
RESOLUTION
Resolution is a 30-minute period during which the external
and internal genital organs return to an unaroused state. For
the male, a refractory period occurs during which further
orgasm is impossible. Women do not go through this
refractory period, so it is possible for women who are
interested and properly stimulated to have additional
orgasms immediately after the first.
TYPES OF SEXUAL ORIENTATION
A heterosexual is a person who finds sexual fulfillment
with a member of the opposite gender. Because interest in
the opposite sex and sexual relationships may begin as
early as the beginning of puberty, it is important to provide
information on safer sex practices and planning for their
use to children as young as 10 to 12 years of age.
Otherwise, this knowledge comes too late to be most
helpful.
A homosexual is a person who finds sexual
fulfillment with a member of his or her own sex. Many
homosexual men prefer to use the term “gay.”
“Lesbian” refers to a homosexual woman. More recent
terms are “men who have sex with men” (abbreviated
as “MWM”) and “women who have sex with women”
(WWW).
Bisexuality
People are said to be bisexual if they achieve sexual
satisfaction from both homosexual and heterosexual
relationships. Like men who have sex with men, bisexual
men may be at greater risk for HIV and STIs than are
others. Female partners of bisexual men need to be aware
that they are also at increased risk for HIV and other STIs.
Transsexuality
A transsexual or transgender person is an individual
who, although of one biologic gender, feels as if he or
she is of the opposite gender . Such people may have
sex change operations so that they appear
cosmetically as the gender they feel that they are.
Such operations do not change the person’s
chromosomal structure, however, so although capable
of sexual relations in this new role (a synthetic vagina
or penis is created), the person is incapable of
reproduction.
TYPES OF SEXUAL EXPRESSION
Sexual Abstinence
Sexual abstinence (celibacy) is separation from sexual
activity. It is the avowed state of certain religious orders. It
is also a way of life for many adults and one that is
becoming fashionable among a growing number of young
adults. It is the main point of many high school sex
education classes . The theoretical advantage of sexual
abstinence is the ability to concentrate on means of giving
and receiving love other than through sexual expression
and, of course, is the most effective way to prevent
pregnancy or an STI.
Masturbation
Masturbation is self-stimulation for erotic pleasure; it can
also be a mutually enjoyable activity for sexual partners. It
offers sexual release, which may be interpreted by the
person as overall tension or anxiety relief.
Masters (1998) reported that women may find masturbation
to orgasm the most satisfying sexual expression and use it
more commonly than men. Children between 2 and 6 years
of age discover masturbation as an enjoyable activity as
they explore their bodies. Children who are under a high
level of tension may become accustomed to using
masturbation as a means of falling asleep at night or at
naptime. They do this without any attempt at concealment
because they have not yet been affected by society’s view
that such activity should not be public.
Erotic Stimulation
Erotic stimulation is the use of visual materials such as
magazines or photographs for sexual arousal. Although this
is thought to be mostly a male phenomenon, there is
increasing interest in centerfold photographs in magazines
marketed primarily to women. Some parents of adolescents
may need to be assured that an interest in this type of
material is developmental and normal. 
Fetishism
Fetishism is sexual arousal resulting from the use of certain
objects or situations. Leather, rubber, shoes, and feet are
frequently perceived to have erotic qualities. The object of
stimulation does not just enhance the experience; rather, it
becomes a focus of arousal and a person may come to
require the object or situation for stimulation
Transvestism
A transvestite is an individual who dresses in the clothes
of the opposite sex. Transvestites can be heterosexual,
homosexual, or bisexual. Many are married. Some
transvestites, particularly married heterosexuals, may be
under a great deal of strain to keep their lifestyle a secret
from friends and neighbors.
Voyeurism
Voyeurism is obtaining sexual arousal by looking at
another person’s body. Almost all children and adolescents
pass through a stage when voyeurism is appealing; this
passes with more active sexual expressions. That some
voyeurism exists in almost everyone is illustrated by the
large number of Rrated movies shown on television and in
movie theaters and by the erotic descriptions in modern
novels. If voyeurism is practiced to the exclusion of other
sexual experiences, such an extreme probably reflects
insecurity or the inability to feel confident enough to relate
to others on more personal levels.  maintain an erection long enough for vaginal
Sadomasochism
Sadomasochism involves inflicting pain (sadism) or
receiving pain (masochism) to achieve sexual satisfaction.
It is a practice generally considered to be within the limits
of normal sexual expression as long as the pain involved is
minimal and the experience is satisfying to both sexual
partners.
Other Types of Sexual Expression
A multitude of other types of sexual expression exist (e.g.,
exhibitionism, making obscene telephone calls, bestiality,
and pedophilia). Exhibitionism is revealing one’s genitals
in public. Bestiality is sexual relations with animals.
Pedophiles are individuals who are interested in sexual
encounters with children.
SEXUAL HARASSMENT
Sexual harassment is unwanted and repeated sexual
advances, remarks, or behavior toward another that
(a) is offensive to the recipient and (b) interferes with
job or school performance. It can involve actions as
obvious as a job superior demanding sexual favors or
a job superior sending sexist jokes by e-mail to a
person supervised.
Two types exist. 
One is quid pro quo (an equal exchange), in which
an employer asks for something in return for sexual
favors, such as a hiring or promotion preference. 
The second is hostile work environment, in which
an employer creates an environment in which an
employee feels uncomfortable and exploited.
DISORDERS OF SEXUAL FUNCTIONING
Inhibited Sexual Desire
Lessened interest in sexual relations is normal in
some circumstances, such as after the death of a
family member, a divorce, or a stressful job change.
The support of a caring sexual partner or relief of the
tension causing the stress allows a return to sexual
interest.
Failure to Achieve Orgasm
The failure of a woman to achieve orgasm can be a
result of poor sexual technique, concentrating too
hard on achievement, or negative attitudes toward
sexual relationships.
Erectile Dysfunction
Erectile dysfunction (ED), formerly referred to as
impotence, is the inability of a man to produce or
penetration or partner satisfaction. Most causes of ED
are physical, such as aging, atherosclerosis, or
diabetes, which limit blood supply.
Premature Ejaculation
Premature ejaculation is ejaculation before penile–
vaginal contact . The term also is often used to mean
ejaculation before the sexual partner’s satisfaction
has been achieved. Premature ejaculation can be
unsatisfactory and frustrating for both partners.
Persistent Sexual Arousal Syndrome
Persistent sexual arousal syndrome (PSAS) is
excessive and unrelenting sexual arousal in the
absence of desire . It may be triggered by medications
or psychological factors. 
Pain Disorders
Because the reproductive system has a sensitive
nerve supply, when pain occurs in response to sexual
activities, it can be acute and severe and impair a
person’s ability to enjoy this segment of their life.
PAIN DISORDERS

Vaginismus

Vaginismus is involuntary contraction of the muscles at the

outlet of the vagina when coitus is attempted that prohibits
penile penetration.

Dyspareunia and Vestibulitis

Dyspareunia is pain during coitus. This can occur because

of endometriosis (abnormal placement of endometrial
tissue), vestibulitis (inflammation of the vestibule), vaginal
infection, or hormonal changes such as those that occur
with menopause and cause vaginal drying.