Human Sexuality as pertinent to the aspiring physician Ron Cowan, M.D., Ph.D. cowanlab

1. Human Sexuality as pertinent to the aspiring physician Ron Cowan, M.D., Ph.D. www.cowanlab.com

2. Sexual and Reproductive Health: A Matter of Life and Death • Unsafe sex is the #2 risk factor for death and disability in the world’s poorest countries • Unsafe sex is the #9 risk factor for death and disability in developed countries Glasier et al., Lancet 2006;368:1595-607

3. Top 5 Rules for the Good Physician • Inquire about sexual function (as casually as you inquire about eating habits) • Minimize assumptions (suspend stereotypes) • Don’t think in dichotomies (i.e. male/female, gay/straight, normal/abnormal) • Treat all types of sex as natural and morally neutral • Realize that your patients may have much shame and guilt regarding sexuality (and sex/gender roles)

4. Questions to Ask Yourself • Is heterosexuality a mental illness? • Is monogamy a virtue? • Are 6 parents better than 1? • Is cloning reproduction better than sexual reproduction? • Is anyone really a boy or a girl? • Does genital contact differ from tennis? • Is it possible to be hypersexual? • Is there an age of consent? • Should prostitution be legal? • Do perverts exist? • Should marriage be banned? • Should reproduction require a license?

5. Basic Screening For Sexual Function Source: Kingsberg 2006

6. Essential questions to include in a (detailed) sexual assessment • How does the patient see or describe the problem? • How long has the problem been present? (Also specify if life-long or occurred after a period of normal function) • Was the onset sudden or gradual? • Is the problem specific to a situation or partner or is it generalized? • Were there likely precipitating events (biologic or situational)? • Are there problems in the patient's primary sexual relationship (or any relationship in which the sexual problem is occurring)? • Are there current life stressors that might be contributing to sexual problems, and if so, how is stress perceived and managed? • Is there some underlying guilt, depression, or anger that is not being directly acknowledged? • Are there physical problems, such as pain? • Are there problems with desire, arousal, or orgasm, and can the patient determine the primary problem? • Is there a history of physical, emotional, or sexual abuse that may be contributing? • Does the partner have any sexual problems? Source: Kingsberg 2006

7. Harmful Attitudes About Human Sexuality are Linked to: Homophobia Xenophobia Misogyny Racism Obsessionality Guilt Control (Source: My opinion)

8. Sexual behavior is part of the brain’s reward system-- --therefore, controlling it is a formidable task.

9. The Reward System http://www.psy.plym.ac.uk/year3/psy337DrugAddiction/theorydrugaddiction.htm#drugsandbrainreinforcement

10. Parenting Exercise Smoking Gambling Religion Spirituality The Reward System Obesity Violence Sexual Behavior Overpopulation Sexually transmitted diseases Sexual addiction? Alcohol Abuse & Dependence Cocaine, opiates, benzodiazepines and other drug addictions

11. Sex and Gender

12. Boys and Girls and …. What causes biological sex? What causes sexual orientations? Does it matter?

13. Are there two genders? How can a male be feminine? How can a female be masculine? Is gender identity healthy? Should we emphasize or minimize sex/gender differences? Is one oriented to “male” or “female” or “androphilic” or “gynophilic” Does it matter?

14. Sexual Minorities

15. Moderately Unpopular Gender-Based Sexual Minorities Intersex Transgendered Lesbian Gay Bisexual

16. Very Unpopular Sexual Minorities • Pedophiles • Sadomasochists • Necrophiles • Sexual Cannibals • Prostitutes • Zoophiles • Polygamists • Fetishists (in general)

18. Sexual orientation is probably determined at birth • Sexual orientation can’t be changed • Unethical therapists try and fail

19. 90% of 18-44 year olds self-identify as heterosexual

20. Symbols of the Contemporary Gay Equality Movement Red for life,  Orange for healing,  Yellow for the sun,  Green for nature,  Blue for art,  Violet for spirit. The Rainbow Flag as we know it today was developed by San Francisco artist Gilbert Baker in 1978. The Greek symbol lambda4 was emblazoned on the shields of Trojan warriors in ancient Greece. While the city state is famous for its legendary battle prowess, it is also notable for its practice of pairing experienced soldiers with young new recruits for both training and sex. The lambda was co-opted by gay activists during the 1950s and 1960s. The pink triangle5 was originally used in Nazi Germany, starting in 1935, to designate homosexual men. Such men were typically put into labour camps, where almost all were beaten to death by prison guards or slowly starved. Source: BBC

21. 25% of patients in child and adolescent psychiatric practices are GLBT but their doctors often don’t know it. • AMERICAN ACADEMY OF PEDIATRICS • The psychosocial problems of gay and lesbian adolescents are primarily the result of societal stigma, hostility, hatred and isolation. • The gravity of these stresses is underscored by current data that document that gay youths account for up to 30 percent of all completed adolescent suicides. • Approximately 30 percent of a surveyed group of gay and bisexual males have attempted suicide at least once. • Adolescents struggling with issues of sexual preference should be reassured that they will gradually form their own identity and that there is no need for premature labeling of one’s sexual orientation.

22. Bisexual behavior, if not identity Men on the Down Low - What are the origins of this term down low and what does it refer to? The most generic definition of the term down low, or DL, is “to keep something private,” whether that refers to information or activity. The term is often used to describe the behavior of men who have sex with other men as well as women and who do not identify as gay or bisexual. …. Although the term originated in the African American community, the behaviors associated with the term are not new and not specific to black men who have sex with men. National Center for HIV, STD and TB PreventionDivisions of HIV/AIDS Prevention

23. Gender and Sex Roles Are Incongruent for Some Transformation Magazine is the nationally known magazine covering the Crossdressing/ Transgender Community. Trannyweb is one of the largest online communities in the world for transvestites, crossdressers, transsexuals and transgendered people.

24. Defeat Will Make Some Straight Men Crave Gay Sex“Non-homosexual men who experience defeat and failure may also experience homosexual fantasies or dreams.” (Dr. Joseph Nicolosi, National Association of Research and Therapy of Homosexuality) Gaining Weight Will Help Make You Hetero“My weight started to increase, and I found little desire to keep on a strict diet and stay fashionably slim. My very appearance was changing. I was looking less and less gay. And I was perfectly happy about it.”(John Paulk, Spokesperson, Focus on the Family) Dr. Nicolosi is the president and principal research investigator for the National Association of Research and Therapy of Homosexuality (NARTH).

28. Asexuals, new type of sexual minority, to conquer the world The young people were married for five years, but they never had sex with each other. They were not ashamed to talk about it: “Our relationship is purely platonic. We only kiss each other sometimes,” they said. Needless to mention that such a family arrangement seems to be more than just extremely strange to the majority of normal, healthy people. If someone stands up and says that he or she rejects the driving force of the basic instinct, such a person will inevitably be considered insane. The number of asexual people is growing in the world today. French designer Philippe Starck said once that sexual attraction would soon vanish from Earth. It appears that we are now witnessing the start of this process. Asexual individuals say that they are the people of the future.

29. Sex Addiction?

30. (Shadowy?) Sexual Addiction Addicted to SEX ? It Isn't Love … By Larry Axmaker EdD, PhD Most people have sexual feelings, sexual relationships, and the occasional sexual fantasy. For others, sex is the focus of their entire life. They may be addicts, sex junkies, or sex dependent.

31. State Regulation of Sexual Behavior • Rational? • Moral? • Healthy?

32. 10-year sentence without possibility of parole Once, he was the homecoming king at Douglas County High. Now he's Georgia inmate No. 1187055, convicted of aggravated child molestation. When he was a senior in high school, he received oral sex from a 10th grader. He was 17. She was 15. Everyone, including the girl and the prosecution, agreed she initiated the act. But because of an archaic Georgia law, it was a misdemeanor for teenagers less than three years apart to have sexual intercourse, but a felony for the same kids to have oral sex. http://sports.espn.go.com/espn/eticket/story?page=wilson

33. Suggestions for Further Learning • Read a lot about human sexuality • Listen to your patients, family, friends • Read about animal sexuality • Study the sexual effects of medication • Study the sexual effects of illness • Examine the diversity of human sexual expression • Watch movies • Surf the web • Take field trips

34. Top 5 Rules for the Good Physician • Inquire about sexual function (as casually as you inquire about eating habits) • Minimize assumptions (suspend stereotypes) • Don’t think in dichotomies (i.e. male/female, gay/straight, normal/abnormal) • Treat all types of sex as natural and morally neutral • Realize that your patients may have much shame and guilt regarding sexuality (and sex/gender roles)

35. REFERENCES