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Summary Lectures Sexual Health
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Notes from the lectures of the course Sexual Health. Written in English. Gives a good summary of the exam material.
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Sexual HealthHC1 & 2: Fertility, infertility and pregnancy.
Sexuality: model
A model with 3 pillars of sexuality:
- sexual function fertility problems cause of sexual function disturbance.
- sexual identity loss of sexual interest cause of identity problems.
- sexual relationship the longer people try to get pregnant, sex loses its fun.
If you get a disease, what does it mean for these 3 pillars? What are the
consequences? a pro-active responsibility.
How does sexuality work
Three stages:
- Desire
- Excitement arousal
- Orgasm
When men get an orgasm they reach a black whole, where they lose interest in
sex for approximately 10 minutes. Women don’t have such a black whole.
In male first desire, then continuation (more or less a linear process). After
orgasm, black whole.
In female first contact and commitment, then eventually arousal, then desire
can develop and continuation to orgasm.
Needed for desire:
- Enough testosterone (men have much higher level than women).
- Good enough neurotransmitter balance: dopamine, prolactin etc.
Needed for the physical aspects of erection or lubrication:
- Good enough circulation.
- Good enough innervation (nerves).
- Enough physical stimulation.
Needed for the emotional aspects of excitement/arousal:
- Enough emotional stimulation.
- Not too much performance pressure.
- Enough ‘safety’ to perform.
- Enough ‘safety’ to enjoy (religion and cultural influences).
Male-female differences in orgasm:
Physically, the woman’s orgasm potential is much higher. She can have several
orgasms in a row. And she can orgasm from stimulation of various areas (due to a
lot of nerves). The male orgasm is easier to reach, but more difficult to control.
Average testosterone levels of young adults:
Women = 1 nmol/L. when falling in love, testosterone rises by 15%. The level
will eventually get back to the same level, or in some rare cases stay the same.
Men = 25 nmol/L. when falling in love, testosterone declines, because in that
period they are nicer until it changes back. The level will still be lower than before
the relationship. During pregnancy the testosterone is very low, which causes the
man to be more concentrated on the crying of the baby etc.
,If you have no testosterone you can’t fall in love disorder.
In longer standing relationship oxytocin goes up; causes you to relax or open up
to your partner.
Female – male differences
The differences of behavior start at the prenatal period.
XX Female: higher need for contact. Focus on relationship and ‘being nice’.
People and relation oriented.
XY Male: testosterone increases (male genital, male brain). High need for
autonomy, separate oneself and being opposed. Function or thing oriented.
Still the testosterone level is very low until puberty. Which means the differences
have much to do with education for example.
Both men and women have a vast amount of T receptors situated in the brains
and in the genital area.
Many differences between female and men are based on different T levels, like
sexual desires, mood etc. women usually think they don’t fit the body image
and men usually think they look great. This also leads to more women having a
depression in NL than men.
During sex: men are more oriented on genitals, orgasm and penetration (are
more assertive, no good antennae (don’t grab a lot of information)). Female are
more oriented on relationship, contact and sensuality (more submissive, more
sensitive, more feelings and guilt (provoked vestibule…)).
Babies: The fetus sleeps 90-95% of the day. During the REM sleep ultrasound
clearly shows fetal erections. Men have this during the night for all of their life.
Women also have this.
Why do people have sex
- Relation (love, intimacy etc.)
- Procreation (having children).
- Recreation (fun, adventure, lust etc.)
- Habit/custom.
- Emotionally it can relax, decrease tension in relationships, can restore
disturbed intimacy, comfort & console, important for self-respect, can diminish
depression (except when it’s a sin for a culture), way to deal with fierce
emotions.
- Physical muscle relaxation, stimulation increases the pain threshold, safest
‘sleep medication’, massage and orgasm increase oxytocin level (and as such
increase mutual trust).
- Pure health reasons regular sex will give in men less prostate cancer; is
accompanied by less vaginal atrophy; strongly diminishes in men the risk for
acute myocardial death.
Why we should discuss it
For many people it is important for the quality of life. Also it improves the
relationship with your patient.
Fertility
,(Preparations) to conception: having a baby results in less sex. But the decision
to start a pregnancy results in more sex. For men something changes in their
hormones (not clear why). If you don’t get conception, your sexuality goes down
very fast diminishing sense of self (I’m not a real woman/man), which
decreases the sexual desire. Also it starts getting to be obligatory sex
(conception based timing). This causes a decrease in coital frequency and the
lubrication goes down. When the lubrication goes down it diminishes the sperm
survival. No lubrication also mean you’ve got (female) dyspareunia, which means
pain, which means artificial lubricant en sperm survival diminished.
This al means a decreased ejaculation frequency, which causes a diminished
sperm quality. And diminished female orgasm.
Diminished conception chance causes poor sex, poor sex causes diminished
conception chance circle. All has to do with the sexual function, satisfaction
and relationship (model).
Pregnancy causes many changes
- Physical/physiology.
o Pregnancy & sex:
Desire: In the 1st trimester desire goes down, in the 2th trimester
goes up, 3th trimester goes down and stays down in the post-
partum.
Arousal: In the 1st trimester goes up and keeps going up until the
delivery. Post-partum it goes down very much. negative: pain
(breast/vulva). Positive: getting aroused is more easy, more
sexual dreams, reaching orgasms is more easy.
Orgasm itself changes. Usually women have clonic contractions
(contracts, relaxes, contracts, relaxes etc.) during pregnancy
they have tonic contractions which can be painful.
Males also have problems. Testosterone goes down, in part of the
men estrogen goes up, cortisol goes very high close to the
delivery.
Influence of culture! Also, every woman react differently to a
pregnancy.
- Psychological.
o Fears and worries (on spontaneous abortion and premature labour).
o Changes in (perception of) female attractivity. Causes problems when
perceptions don’t match.
o Existential change (adding a baby changes the 2-relationship to a 3-
relationship; transition to parenthood; changes in roles, responsibility,
division of tasks etc.).
- Relationship.
- Partner.
- Existential
- Long-term consequences.
Delivery
Sex will induce labour when the uterus is ready for delivery (approximately 38
weeks). After 38 weeks breast en nipple stimulation and orgasm will induce
oxytocin, which induces labour. Tapping the cervix or intravaginal- or oral
ejaculation stimulates prostaglandins, which also induces labour. The
contractions of orgasms can also be the beginning of labour.
, Labour can keep going on by sexual stimulation. This can be done by breast and
nipple stimulation (releases oxytocin), massage (oxytocin), orgasm (oxytocin
trust relaxation) and vulvo-vaginal stimulation during delivery (endorphin
release increases pain threshold keep labour going).
Lactation
Positive aspects: gives oxytocin uterine contractions orgasms, sexual
excitement, pleasurable contractions. When you get an orgasm during the period
of breastfeeding, milk will eject.
Negative aspect: lactation can decrease estrogen (vaginal atrophy), decrease
androgens (low arousability, low desire, fatigue) and high prolactin (low desire).
Stopping with lactating decreases the negative aspects.
A woman needs approximately 1 year to consolidate her identity as a mother and
to regain a grip on her body and life.
People who have a disturbed fertility have very low amount of sex during their
life as a couple, cause of fears and eventually get used to it. People who can’t get
children at all tend to have more sex to keep their relationship strong. People who
have normal pregnancies tend to have more sex before pregnancy, less during
pregnancy and then it builds up slowly as the baby gets older. They start coupling
when the kids enter puberty.
HC3: CSE programs and the World Starts With Me.
Comprehensive Sexuality Education:
- Understanding sexuality. rights, knowledge, attitude, skills etc.
- Bio-psycho-social approach. when discussing sexuality take all three aspect
in account.
- Age-appropriate.
Sexual revolution – end ‘60s.
People think that if you talk about sex with young people, it will trigger them to
have sex. But it’s the opposite. In an open culture, people decide at what point,
what steps they’ll take. In a closed culture, people think that sex means having
intercourse. That’s why they have intercourse at a very young age.
Different forms of sex education:
- Life Skills based Education. not talking about sex, but about e.g.
communication (saying no etc.).
- Abstinence-only & abstinence-only Plus Education. people are raised to wait
till marriage. (still premarital sex happens, +- 80%.
- Comprehensive Sexuality Education.
Different approaches in sexual education:
Public health-based:
Focus: preventing and reducing SRH problems.
Key message: abstinence, monogamy, safe sex (ABC – Abstinence, if you can’t be
abstinent then Be faithful, so stick to one partner, and if you can’t do that then
use Condoms.).
Morality based:
Focus: conveying dominant religious, moral values and norms.
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