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Normal Human Sexuality

Normal Human Sexuality . By: Maryam Sorayani,MD Psychiatry resident Roozbeh hospital maryam.sorayani@gmail.com 1392/9/28. To be noticed… . Normal sexual behavior brings pleasure to oneself and one's partner Involves stimulation of the primary sex organs including coitus

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Normal Human Sexuality

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  1. Normal Human Sexuality By: MaryamSorayani,MD Psychiatry resident Roozbeh hospital maryam.sorayani@gmail.com 1392/9/28

  2. To be noticed… • Normal sexual behavior brings pleasure to oneself and one's partner • Involves stimulation of the primary sex organs including coitus • It is devoid of inappropriate feelings of guilt or anxiety and is not compulsive

  3. Physiological Responses • The sequence of responses may not occur in a linear progression, but may overlap and fluctuate for example, many women in monogamous relationships find that, over time, desire follows arousal that results from sexual stimulation by a partner • A person's subjective experiences are as important to sexual satisfaction as the objective physiologic response

  4. Phase I: Desire • A psychological phase and doctors’ fundamental concern is with motivations, drives, and personality • Characterized by sexual fantasies and the conscious desire to have sexual activity

  5. Phase II: Excitement • Brought on by psychological stimulation (fantasy or the presence of a love object), physiological stimulation (stroking or kissing), or both • Consists of a subjective sense of pleasure and objective signs: - penile erectionin men - vaginal lubrication in women

  6. Phase III: Orgasm • Peaking sexual pleasure, with release of sexual tension • Rhythmic contractionof the perineal muscles and pelvic reproductive organs • Ejaculation in men

  7. Phase IV: Resolution • A subjective sense of well-being, general relaxation, and muscular relaxation • Men have a refractory period that may last from several minutes to many hours • No refractory period in women, who are capable of multiple and successive orgasms • If orgasm occurs, resolution is rapid; if it does not occur, resolution may take 2 to 6 hours and be associated with irritability and discomfort

  8. Taking a Sexual History

  9. Identifying data • Age • Sex • Occupation • Relationship status • Sexual orientation

  10. Current functioning • Unsatisfactory to highly satisfactory ...if unsatisfactory, why? Feelings about partner satisfaction • Dysfunctions? • Onset—lifelong or acquired • If acquired, when? • Did onset coincide with drug use , life stresses ? • Generalized—occurs in most situations or with most partners • Situational • Only with current partner • In any committed relationship • Only with masturbation • In socially proscribed circumstance (e.g., affair) • In definable circumstance (e.g., very late at night, in parental home, when partner initiated sex play)

  11. Current functioning • Frequency—partnered sex (coital and non coital sex play) • Desire/Excitement/Orgasm/Resolution • Description of typical sexual interaction • Manner of initiation or invitation (e.g., Verbal or physical? Does same person always initiate?) • Presence, type, and extent of foreplay (e.g., kissing, caressing, manual or oral genital stimulation) • Coitus? Positions used? • Verbalization during sex? If so, what kind? • After play? (whether sex act is completed or disrupted by dysfunction); typical activities (e.g., holding, talking, return to daily activities, sleeping) • Feeling after sex: Relaxed, tense, angry, loving • Sexual compulsivity

  12. Childhood sexuality • Parental attitudes about sex • Learning about sex • Childhood sex activities • Genital self-stimulation before adolescence • Sexual play or exploration with another child (playing doctor)

  13. Adolescence • Puberty • Sense of self as feminine or masculine • Sex activities • Masturbation • Homosexual activities • Dating • Experiences of kissing, necking, petting • Orgasm • First coitus…safe sex

  14. Adult sexual activities • Premarital sex • Sex play experienced • Safe sex • First coitus • Cohabitation • Engagement

  15. Adult sexual activities • Marriage (s) • Sexual interaction • First sexual experience with spouse • Honeymoon • Effect of pregnancies and children on marital sex • Extramarital • Postmarital masturbation • Group sex • Areas of conflict in marriage • Sex after widowhood, separation, divorce • orgasms in sleep,noncoital sex play

  16. Special issues • History of rape, incest, sexual or physical abuse • Spousal abuse (current) • Chronic illness (physical or psychiatric) • Substance abuse or dependency • History or presence of sexually transmitted diseases • Fertility problems • Abortions, miscarriages, or unwanted or illegitimate pregnancies • Gender identity conflict • Paraphilias

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