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Soc 152A W14 Outline MT3.docx

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Molecular, Cellular & Develop. Biology
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MCDB 1A
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Feinstein

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Soc 152 Midterm 3 Review **We will not cover contraception in this review, so look over lecture notes, the book and the chart on Gauchospace** CHAPTER 14 – SEXUAL DISORDERS Sexual disorders are common • F: lack of interest in sex (most common), inability to reach orgasm, vaginal lub • M: climax too early (most common), anxiety about performance, little interest The Prevalence of Sexual Disorders is Controversial 1. M and W sexual problems differ a. Sexual problems affect RELATIONSHIPS 2. Amultidisciplinary approach to treatment is preferred i. sensate focus = sex therapy w graduated touching 1. Box 14.1: touch for comfort ▯ fades anxieties a. Discuss with partner how it made you feel b. Overcomes distractions ii. kegel exercises= strengthen PC muscles & improving sexual fxn 1. Box 14.2: strengthen muscles of pelvic floor a. Overcome urinary incontinence also b. Improve orgasmic function in M & W c. Locate ▯learn how to contract muscle for greater genital arousal & bladder control b. Primary disorder – lifelong; disorder not preceded by any period of healthy function. c. Secondary disorder – disorder that follows period of normal fxn d. Situational disorder – only in some circumstances Premature Ejaculation (PE) is Men’s Number One Sex Problem 1. PE – Ejac before man wishes, rapid & often immediately after P/V sex 2. There are different kinds of PE a. May be primary, secondary, or situational b. The causes of PE are not well understood i. Traditional view was that PE results from learning & conditioning to reach orgasm quickly ii. Psych. theories more plausible for situational PE, biological more plausible for lifelong 3. Drug treatment may be effective a. Mostly antidepressants aka SSRIs b. Topical anesthetics can reduce sensitivity but may also numb F 4. Sex Therapy may help men to regulate excitation a. Stop-start procedure – helpful but Ps can relapse i. Man masturbates alone & tries to avoid high levels of arousal until O; several x a week, several weeks ii. Px stimulation & squeeze to reduce arousal/ ejac iii.Coitus: penis in vagina with no movement get accustomed to sensation, gradual movement ▯ squeeze ▯ can ejac after some time ▯ man can defer ejac for longer period Delayed Ejaculation Can Be a Side Effect of Several Drugs 1. Delayed Ejaculation – difficulty or inability to achive orgasm/ejac (aka male orgasmic disorder) a. Opposite of premature ejac 2. Fairly uncommon 3. May result from neurological damage of certain drugs, or psychological causes. i. Viagra = a drug to treat the side effects (delayed ejac) of certain drugs (antidepressants, tranquilizers, antihypertensive) b. Psychological causes i. Conditioning to vigorous strokes; insensitivity to gentle stimulation Erectile Dysfunction (ED)Has Many Causes and Treatments 1. ED: recurrent inability to achieve adequate penile erection or maintain it thru desired sex beh a. Is much more common as men age 2. ED can have physical or psychological causes a. behavioral/ lifestyle factors i. smoking, alcohol abuse, obesity, lack of exercise b. medical conditions i. diabetes , hypertension, prostate surgery, atherosclerosis c. drugs i. tranquilizers, diuretics, antidepressants, some recreational d. injuries i. spinal cord injury, injury to nerves & blood vessels in penis, penis e. psychological factors i. performance anxiety, distraction, inadequate stim, relationship difficulties, stress, depression f. developmental issues g. childhood trauma, sexual orientation, religious taboos 3. Simple measures may alleviate the problem a. lifestyle changes (i.e. quitting smoking or losing weight) b. switching drugs to avoid side effect 4. Viagra & other drugs have become the leading treatments a. Simply swallowing a Viagra-like tablet does not produce an erection i. Drugs increase responsiveness to erectile tissue but does nothing unless nerves release some nitric oxide b. Must not be taken in conjunction with certain other substances (i.e. “poppers”) i. Life-threatening drop in blood presssure c. Can cause a variety of undesirable side effects (headache, facial flushing, visual disturbances) 5. Locally applied drugs a. Require only that the erectile tissue be intact b. Prostaglandin E – hormone injected into penis to produce erection i. Delivered by self-injection into corpora cavernosa or soft pellet pushed into urethra 6. ED can be treated with devices & implants (know advantages and disadvantages) a. Vacuum constriction system – device for treating ED that creates partial vacuum around penis & draws blood to erectile tissue b. Penile implants – implanted device for treatment of ED i. Semi- rigid implant ii. Inflatable prosthesis 7. Psychological treatments may be useful a. Sex therapy i. Goal is to reduce anxiety 1. Sensate focus exercises 2. Cognitive a. Overcome misperceptions ii. Efforts to resolve relationship problems iii.May be combined with drug treatment Sexual Pain is Uncommon in Men 1. Dyspareunia: pain during coitus 2. May be associated with infections or phimosis (problems with retracting of foreskin) 3. Prostatitis or epididymis Female SexualArousal Disorder 1. Female sexual arousal disorder – insufficient physiological arousal in W to make sex pleasurable or painful a. involves insufficient genital responses (i.e. the clitoris) b. insufficient lubrication common i. lubricants available or hormone treatment 2. W can also experience erectile dysfunction (lack of clitoral erection) i. EOS clitoral therapy devise = mini version of vacuum system used to treat male ED 3. Viagra helps counteract side effect of antidepressants in W too, otherwise ineffective 4. Persistent genital arousal disorder- frequent, unwanted or near- continuous physiological arousal (very rare) Dyspareunia- Pain During Coitus 1. Far more common in W than M 2. Many reasons for sexual pain in W (see list on pg. 453) a. Developmental malformations, intersexed conditions, persistent unruptured hymen b. Scars from vaginal tearing during labor or from episiotomy, hysterectomy, sexual assault, or female circumcision c. Vaginal atrophy (thinning of vaginal walls w aging) d. Acute or chronic infections or inflammation of vagina, internal productive tract, or urinary tract, including several STDs and pelvic inflammatory disease e. Vulvar vestibulitis syndrome; common vulvar pain from inflammation of vestibule & increased tension in PC muscle) f. Endometriosis g. Allergic reactions to foreign substances (latex, spermicides or soap) h. Insufficient genital arousal i. Vaginismus- inability to experience coitus due to spasm of muscles & pain or fear of pain 3. Treatment for dyspareunia depends on the diagnosis (antibiotics, antiviral or antifungal drugs, lub, forplay…) a. Vaginismus – inability to experience coitus due to spasm of muscles & pain or fear of pain i. May make intercourse impossible ii. Favored treatment – mix of psycho/sex therapy exercises iii.Vaginal dilators – inserted into vagina while doing relaxation exercises Box 14.3: Dyspareunia:Acase history VULVAR VESTIBULITIS SYNDROME • Similar histories: each one had parent who was depressive & absent from family life • Busy, active lives • Heather leaned on Steven for support & o He neglected his needs to focus on hers • Both felt inadequate for not engaging in sex more often • Opened up about feelings o By the end of sex therapy:  Sexual desire no longer major issue  Pain was negligible • placed high value on healthy marriage Difficulty in Reaching Orgasm (Anorgasmia) is Very CommonAmong Women 1. Psychotherapy and direct masturbation may be helpful a. May or may not have any obvious biological cause b. Clinician or therapist will suggest different strategies depending on the details of the problem. (i.e. directed masturbation. See pg. 457-458 for more techniques) c. Coital alignment technique (CAT)= variation of the man- above position of coitus that increases clitoral stimulation d. Direct masturbation = most successful at helping women reach orgasm during masturbation i. Works better for women w lifelong (primary) orgasmic disorder Too Much Interest in Sex Can Cause Problems 1. Especially with discrepant sexual desire 2. Hypersexuality= excessive sexual desire 3. Is excessive sexual behavior an addiction or a compulsion? a. May take over peoples lives b. Often associated with sexual addiction c. Sexual addiction – idea tat a person may be addicted to certain forms of sex beh by a mechanism similar to that of substance addiction (see stages on pg. 459) stages: 1. increasing craving for sex 2. ritualized search for sex 3. sex beh (mast or sex) 4. guilt or despair after bout of sex beh d. The use of the term addiction is controversial e. Some prefer to use the term compulsive sexual behavior i. Can often be treated with SSRIs (selective serotonin reuptake inhibitors) Hypoactive Sexual Desire Disorder - low or absent interest in sex – is Not Necessarily a Problem 1. 1 in 3 women and 1 in 6 men lack any interest in sex 2. Hormone treatment may restore sexual desire a. Psychological factors probably play a significant role in HSDD for M 3. Estrogen orAndrogen treatment may improve sexual desire in W 4. Sex therapy may be helpful for low sexual desire in W a. Therapists often use a combo of cognitive/behavioral approaches 5. Read about new views towards women’s response cycle on pages 463-464 Box 14.4: Sexual Minorities & Sexual Dysfunction • Some homosexual men are in heterosexual relationships & perform well • Gey men & lesbians may have sense of shame or self- hatred about homosexuality • Some gay men have unreasonable fear ofAIDs • Anal penetration can present performance diffucultuers • Trans Ps may have special concerns but may be dissatisfied with genitals • Lesbian couples may lose interest in sex over time 6. Sexual problems a. Due to sociocultural, political, or economic factors i. Lack of info about sex ii. Cultural anxiety about one’s attractiveness iii.Cultural shame about sex orientation iv. Conflicts between one’s cultural norms & of the dominant culture v. Lack of interest in sex due to family/ work obligations b. Relating to partner & relationship i. Sex inhibition ii. Different desires iii.Poor communication iv. Partner’s health or sexual problems c. Due to Psychological factors i. Include sexual aversion due to past trauma, attachment or depression, anxiety, fear of consequences of sex or refusing sex d. Due to medical factors i. Painful intercourse ii. Lack of physiological arousal PGS. 172.5 – 194.4 (CHAPTER 6) Attitudes Towards Kissing Vary (esp. in Non Western Societies) “Petting” and “Fondling” Refers to a Variety of Noncoital Behaviors 1. Foreplay/afterplay 2. Necking, petting, heavy petting (Fondling can be used to describe any of these behaviors) 3. Outercourse, “dry humping,” tribadism (rubbing vulvas) Oral Sex is Increasingly Popular 1. Fellatio – oral stimulation of the penis a. May run lips up & down the shaft or use the tongue to stimulate sensitive portions (corona & frenulum) b. Good communication is key (to avoid gagging and miscommunications about whether the receiver is okay with having ejaculate in the mouth) c. Men typically enjoy fellatio more than women d. Demographic differences (i.e. more educated people tend to enjoy it more) 2. Cunnilingus – oral stimulation of the vulva a. Explore vulva with lips & tongue b. For some women, this is the only way in which they can regularly achieve orgasm 3. 69 – mutual oral sex in a head to genitals fashion Anilingus – mouth anal contact Most Sexual Encounters Include Coitus 1. Wide variety of positions – different positions achieve different goals 2. Man-above position (traditional favorite) a. W lies on her back with her legs parted and the M places himself above her (“missionary position”) b. Know advantages and disadvantages i. e.g. may provide more erotic stimulation to the M than W ii. Pros: allows eye contact iii.Cons: M hands not free to roam; G spot not well stimulated 3. Women’s movement has encouraged alternative positions a. Woman above position i. Pros: Gives W greater control; W may receive more erotic stimulation ii. Cons: M have less stim (good if he suffers premature ejac); may injure penis b. Side by side position i. Pros: Relatively relaxed; prolongs sexual encounter ii. Cons: penis dislodged easily; limbs trapped under body & go numb c. Rear-entry coitus (“doggy-style”) i. Pros: W breast & clit free for stim ii. Cons: eye contact limited iii.No direct stimulation of clitoris but may be desirable for G spot stimulation Box 6.2: Progress in Coitus Research MRI of coitus Penis has boomerang shape & bends towards the W’s abdomen Anal Sex May be a Part of Either Heterosexual or Male Homosexual Behavior 1. Anal sex – penetration of the anus by the penis a. Sphincter: circular muscle around a tube or orifice whose contraction closes the orifice b. Rectum: final, straight portion of the large bowel; connects the exterior via anus 2. Not rare in heterosexual sex 3. Usually necessary to go slowly and learn to relax sphincter, as well as use lubricant 4. The anus can also be penetrated with objects other than a penis (i.e. a dildo, a finger, etc.) Inserting any large, hard or sharp object may be very dangerous Box 6.3: Crime of Sodomy Sodomy= obsolete term for anal sex or for any homosexual contact Legal term to refer to prohibited sex acts (anal & oral) In 2002- sodomy made legal in all states M and W May Have Different Preferences for Sexual Encounters 1. Ideal duration of foreplay is same in M and W, but the real duration is much shorter 2. Premature ejaculation: ejac before man wishes, often immediately on commencement of coitus 3. A man may delay ejaculation by a number of methods: going slowly, less stimulating positions, PE techniques (Ch. 14) 4. Woman-woman sex is marked by a greater duration as well as a greater variety of behaviors a. Gay & lesbian couples may find it easier to express sexual desires and needs b. Lessened mystery & tension in heterosexual relationships Sex Toys are used to Enhance Sexual Pleasure 1. Vibrators – electrically powered device used to provide sexual stimulation a. See lecture notes!! b. Both M and W can use vibrators (either during masturbation or as a variation in sexual activity) 2. Dildos – sex toys designed for penetration of the vagina or anus a. Strap on dildos are designed for sex between women b. Cleanliness is an important issue! c. Use gently & with lube 3. Others: anal beads, erotic dolls Box: 6.4 WHAT IS GREAT SEX? 1. Being present & focused 2. Connection 3. Intimacy 4. Communication (verbal & nonverbal) 5. Authenticity, transparency 6. Transcendence, bliss 7. Exploration, risk taking 8. Vulnerability Kama sutra: classic work on how to make love Describes sex positions & oral sex Includes M & F genital sizes (compatibility) Mindful of F interests Some Cultures Have Discussed Sexual Behavior More Openly than Others 1. Sex education in schools is a controversial topic 2. American culture is in a state of transition (websites & books cover mainstream sex & minority interests) 3. Kama Sutra – “love guide” the classic work on how to make love 4. The Aka people are an example of a sex positive society a. Engage in sex about 3x a week b. Attach no value to masturbation c. Seminal nurture (fetus needs repeated exposure to semen in order to grow) Box 6.5: Dry Sex • W place drying substances in vaginas before sex • Cause genital tissues to become swollen, hot & dry o Tighter more abrasive sensation that many S. African men prefer • Ms circumcised & don’t need as much lubrication • Can be painful for W o Small tears in mucosa & increases Many Disabled People Have Active Sex Lives 1. Disabilities do not generally interfere with sexual desire 2. Arthritis is the Number One Disability Affecting Sex (15% of US population) – planning can make lovemaking a much more positive experience 3. Spinal Cord Injuries Present a Major Challenge to Sexual Expression – use parts of the body whose movement & sensation are not impaired, unimpaired partner may have to do more of the work 4. Many intellectually disabled people are competent to make sexual choices Box 6.6: Man with disability has sexual experience Great, felt attractive, loved sexually, comfortable CHAPTER 17 – Sex as a Commodity Can Money buy you Love? 1. Prostitution – the practice of engaging in sex for pay a. Hustler: male prostitute b. Sex trader: person who exchanges sex for money, drugs or other incentive c. Sex worker: person who engages in prostitution, porn or other sex-related occupation 2. Historically prostitution viewed as a necessary evil a. “The oldest profession” b. Only way in which unattached women could support themselves c. Development of “red light districts”: where prostitution is tolerated or legal Box 17.1: Temple Prostitution • Devadasi: Indian temple prostitute • Parents sold her into a life of temple prostitution & dedicated to a God • Has sex for money with men everyday • Among the poorest in India • Trying to fight against this but many girls still stuck 3. Prostitution is on the decline a. High proportion of male and/or transgendered prostitutes in some cities b. Illegal everywhere in U.S., except parts of Nevada. There is a Hierarchy of Prostitution 1. Street prostitution or “street walking” a. Most visible and familiar part of the industry b. Lowest rank and charge lowest prices c. Lifetime of social degradation d. Dangerous physically & risk HIV/ other STDs e. Majority of female prostitutes are mothers Box 17.2: NYC: The Changing Face of
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