Prof. K. Sivapalan.

1. Problems of Human Sexuality Prof. K. Sivapalan.

2. Sexual Orientation • It is the degree of emotional and physical attraction to members of the opposite sex, same sex, or both sexes. • Heterosexual people are attracted to the members of the opposite sex. • Homosexual people are attracted to people of the same sex. • Those who are bisexual are attracted to both men and women. • Bestiality- (sex with animals) Problems of sexuality

3. Unacceptable Practices • bestiality (sexual relations with animals) • incest (sexual relations within the immediate family structure) • fornication (sex outside marriage) • adultery (cheating on husband or wife) • rape, and • ? viewing pornography Problems of sexuality

4. Paraphilia • Exhibitionism- exhibiting body parts • Fetishism- arousal with certain objects, cloths • Frotteurism- rubbing on non-consenting person • Pedophilia- sexual attraction to prepubescent children • Sexual masochism- pain or humiliation to self • Sexual sadism- pain or humiliation to othres • Transvestic fetishism- cross dressing • Voyeurism- spying on people engaged in intimate behaviors Problems of sexuality

5. Superficial charm. Grandiose self-worth. Pathological lying. Manipulative and conning. Lack of remorse. Parasitic lifestyle. Poor behavior controls. Promiscuous sexual behavior. Impulsivity. Irresponsibility. Failure to accept responsibility for own actions. Criminal versatility. Psychopaths – ‘monsters’ of a society: Problems of sexuality

6. Authoritarian personality: • Tendency to hierarchy. • Sadistic – masochistic tendency. • Drive for power (and wealth). • One-sided scale of values favouring the one in power. • Hostility, hatred and prejudice • Superficial judgments of people and events. • Interpreting kindness as weakness. • Tendency to use people and see others as inferior. • Incapability of being ultimately satisfied. • Paranoia. • ? What about “strict teacher or monitor” Problems of sexuality

7. Sexual Perverts, Psychopaths etc. • They commit crimes. Punishment requires evidence. • They are sick. They benefit by treatment- counseling to inward treatment depending on the severity. • When such persons are identified, notify as early as possible. • They use vulnerable people to satisfy their urges- ragging freshers. Problems of sexuality

8. Protection from Dangerous Personalities[Advice given to American young girls] • Say “no” to any one who makes you feel embarrassed • If you feel uneasy by anyone looking at you or touching you, tell about this to someone • Never go out without telling your parents or guardian about where, with whom and the time of return Problems of sexuality

9. Protection from Dangerous Personalities- ctd • Encourage open discussion about instances of embarrassment to protect you and your friends • Avoid being alone with your superiors- always with someone else • Never agree to keep any relationship or body contact as secret • Learn self defense Problems of sexuality

10. Protection for whom? All vulnerable persons- • Children from elders • Patients from doctors and others in health team • Females from males • Fresh years from seniors • Students from teachers • Sports women from coaches Problems of sexuality

11. Sexual abuse- Individual • Exchange of reward or privilege for sexual favors • Rape • Forced sexual activity • Sexual assault • Physical or sexual violence • Feeling with hands • Indecent exposure • incest Problems of sexuality

12. Sexual Abuses All acts of violence against women sexual and other that are perpetrated by non family members. • Sex selective abortion, • Forced sex by dating partners, • Sexual assault by strangers, • Female genital mutilation, • Violence against women in conflict situations and among refugee populations and war victims, • Trafficking in women and forced prostitution. Problems of sexuality

13. Sexual Harassment • Written or verbal abuse or threats • Sexually oriented jokes, ill mannered comments, sexual hints • Insulting remarks about body, dress, marital situation or sexuality. • Ridiculing of performance • Sexual or homophobic drawing of scribbling on the wall • Practical jokes based on sex • Intimidating sexual remarks, propositions, invitations or familiarity Problems of sexuality

14. Sexual Harassment - ctd • Domination of meetings, play space or equipment • Condescending or patronizing behavior undermining self respect or work performance • Physical contact, fondling, pinching or kissing • Vandalism on the basis of sex • Offensive phone calls or photos • Bulling based on sex Problems of sexuality

15. Sexual Health Of Men And Women [Sexuality] • Mutually fulfilling sexual relationship is important for mental health of men and women. • When sexual act take place, the joy should be shared equally by both, the man and the woman • If it involves anger, violence, coercion, abuse or rape it can have serious consequences on the partner and the child conceived. • Sexuality can be affected by the environment, mental state, physical state and social state. • Sexuality is often surrounded by strict social, moral, and religious beliefs. Problems of sexuality

16. Defects in Sexuality. For Men, • Erection and Ejaculation: • Physical or psychological. For Women, • Relaxation of vaginal sphincter: • Physical or psychological. False beliefs and taboos about sex exist and therefore behavioral problems must exist. The effect of war and displacement on our people’s sexuality? Problems of sexuality

17. Genital Mutilation. • Females: • Circumcision- excision of clitoris. • Excision of genitalia leaving only the opening of the vagina. • [Cruel attempts to avoid promiscuity.] • Males: • Circumcision. • [reduced incidence of cervical cancer] • ? Infection, mental trauma. Problems of sexuality

18. Other Problems. • Adolescents: • Sexual feelings Vs delayed marriage. • Challenge to cultural norms. • Persons with excessive or diminished sexuality. • Mental, physical or other factors. Problems of sexuality

19. Reproductive tract infections • Neglect of personal, sexual and menstrual hygiene causes infections. • Sexually transmitted infections: direct contact of infected reproductive organs with that of the partners [rarely blood transfusion, indiscriminate use of injection needles]. • These include, bacterial infections like syphilis, gonorrhoea, and chlamydiosis, protozoal infection like tricomoniasis, and viral diseases like AIDS, genital herpes and genital warts. • Some diseases cause local discomfort, some serious consequences if not treated, AIDS kills [no treatment]. • CONCERN: People delay or fail to obtain appropriate treatment. Problems of sexuality

20. Prevention of Sexually Transmitted Diseases. • One man - one woman as sexual partner [family] will eliminate almost all possibilities of spread. • Use of condom prevents direct contact and avoids infection if intercourse with infected partner. • But lack of knowledge, discomfort, carelessness and several other factors lead to non use of condom. • Sex workers and casual sex seems to be the main causes of the spread of these diseases. • Educate all those indulge in sex about safe sex and the importance of prevention of STD- AIDS. • Early detection and treatment of STD. Problems of sexuality

21. Sexuality of Adolescents. • For adolescents in several countries, knowledge about reproduction and contraceptives were low or incorrect. • Knowledge does not translate automatically into practice of safe sex. • Lack of knowledge does not mean that young people will abstain from sexual intercourse • Large numbers of adolescents become sexually active before marriage. Problems of sexuality

22. Problems with Reproductive Health-1 • Expression of sexual urge of young people is often greeted with anxiety or anger by adults and • withfear, guilt and shame by the young people. • The sexual impulses are on one hand denounced as impure and • on the otherencouragedby commercial exploitation of eroticism [expression of sexual feeling] through the mass media. Problems of sexuality

23. Problems with Reproductive Health-2 • Anomalies in social attitudes may arise in relation to the awakening of sexuality in the adolescent, with its accompanying conflict of pleasure and guilt. • Conflicts in perception of sexuality drive sexual feeling and behavior of adolescents underground. • And make healthy development of sexuality within affectionate and responsible relationship more difficult. Problems of sexuality

24. Problems with Reproductive Health-3 • Premarital sex and childbearing at young age can have adverse consequences in educational and economic activities and maturity. • Adolescent fertility is high and marriage at young age increases family size. • Unwanted pregnancy and abortion are serious health problems for females. Problems of sexuality

25. Consequences of Adolescent Sexuality • Immature reproductive tract is easily infected. • Adolescent pregnancy, abortion and disease • As a result, a young woman may face: • interrupted education, • undesirable marriage, • social stigma, • health dangers, • infertility and • death. Problems of sexuality

26. A Mexican study on pregnant girls • Girls who choose abortion continued their studies and were assertive • Those who continued with pregnancy discontinued studies or stopped working. • They continued with pregnancy because they did not have enough money. • They tried self induced abortion by injection of different drugs, tea infusions, eating quinine tablets, engaging in heavy physical activity and so on. Problems of sexuality

27. Teenage Pregnancies And Marriages When women who had their first pregnancy at teen age and attended the teaching hospital were studied (in 2002): • 6% were unmarried; and • 7.9% conceived before marriage. • 56.2 % eloped but now have parental support. • 87.1 % had no idea of contraception before becoming pregnant. Problems of sexuality

28. Teenage Pregnancies And Marriages 47 females who married before the age of 20 in two villages near Jaffna (in 2002): • Only 24 were legally married. • 10.7 % proposed; and 89.3 % were love marriages. • 54.8 % met their partner on displacement, 23.8 % were school love, others started love while living in same place etc. • 38.5 % were involved in premarital sex and 19.3 % conceived before they were married. Problems of sexuality

29. Knowledge And Attitude About Sex Among Adolescents In Jaffna. • Boys knew more about contraceptives than girls even though inadequate. • 10 % of A/L students thought that woman can conceive by kissing, touching etc. • In the college of education 50 % of the females avoided talking about sex because shyness but 15.4 % males and 2.8% females had premarital sexual intercourse. • Most female undergraduates, including Medical, had inadequate knowledge. Problems of sexuality

30. Sexual Stimulation And Outlet. • 58 % of arts and 73% of medical students in the UOJ consider that story books and cinima are major sources of sexual stimulation. Problems of sexuality

31. Harassment Among GCE O/L Completed Students[150 males, 150 females]. Problems of sexuality

32. Sexual violence during adolescence It invokes, • a sense of vulnerability and powerlessness • shame, guilt, fear of sex, and • inability to distinguish affection from sexual exploitation Problems of sexuality

33. Domestic violence and Sexual abuse • The World Conference on women, held in 1995, advanced the idea of women’s fundamental human right to reproductive and sexual self-determination. • Violence against women is defined as “any act of gender based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women”. • Wife beating, rape and sexual abuse are increasingly recognized as major social and public health problem. Problems of sexuality

34. Domestic Violence. • Incidence ranges from 20 – 46 % all over the world with 37 % in Tamil Nadu and 28 % in USA. • 40% of the women in the Community Medicine project area, Jaffna are battered. • 25 % of emergency admissions due to injury in a Mumbai hospital were due to domestic violence • In many societies wife beating is accepted as part of married life – as social norm [including in Jaffna]. Problems of sexuality

35. Marital rape • Marital rape has been reported by women in: • Colombia- rural 7 %, urban 9 %, Mexico 6 %, Central America 12% and India10 % • These may be underestimates. • Sexual coercion and other forms of abuse exist in unknown quantities. • Prevalence of marital rape in our society? Problems of sexuality

36. Discriminatory laws and policies that affect reproductive health • Policies that deny adolescents access to reproductive health services. • Laws and practices related to female genital mutilation. • Lack of comprehensive laws dealing with rape and domestic abuse. • Policies that foster unnecessary use of obstetric practice such as episiotomy and caesarean section. • Laws that prohibit females owning property or access to education or to paid employment. Problems of sexuality