HLTH 251: HEALTHY SEXUALITY

Sexuality in perspective
Definitions:

 Sex: genetic and biological characteristics

 Gender: psychological and sociocultural characteristics associated with sex
- Socially constructed, created by groups of people/society
 Sexual behaviour: behaviour defined as sexual by individuals and/or groups
 Sexuality: complex, socially, and individually determined sexual thoughts, feelings,
attractions, preferences and identify.
Sexual Right promoted by Health Canada

 Right to reproductive self-determination

 Right to sexual self-expression
 Freedom from sexual abuse/violence

Determinants of sexuality

 Social institutions that influence sexuality

 Religion
- Influences sexuality through moral codes
- Acts as a governing body teaching views of sex
- Varying views on sex depending on religion
- Limited and dogmatic views of sex
 Culture: what we do
- Differing norms between cultures
 Monogamy vs polyamory
 Sex education
 Gender
 Views on sex for pleasure
 Homosexuality etc.
 Media
- Affects social norms and perceptions surrounding sexuality
- Media influences sexual behaviour and perceptions in 3 main ways:
 Cultivation: creating a mainstream
 Agenda setting: determining value
  Social learning: providing role models
 Research
 Science/medicine
- Influenced by religion and cultural norms, important to consider the lens and
limitations of practices
- Most research has been done more recently due to cultural views, vilification and
taboo nature of sex in the past
 Egocentrism and ethnocentrism
- Belief that the way you or “your group” does things is the normal and right way
History of sexuality research

Sexual health and rights

 Sexual agency and self-determination

 Womens rights

Theoretical perspectives of human sexuality

Relational orientation vs non-relational orientation towards sex

 More likely to be sexual with someone who they have a relationship with
Socio-biological theories

 Organisms adapt through nature selecting the most favourable traits to ensure survival
of species
- Environmentally driven
 Darwins sexual selection (slide 5)
- Focused on animals
- Males compete for females attention
- Sex is for reproduction and heterosexual
 Evolutionary psychology
- Identifies different things men and women value and look for in a partner
 Critiques of sociobiology
- Biological deterministic
- Assumes every sexual characteristic must have some adaptive significance
 Paradox of flashy colours or traits to attract females but that also attracts
predators
- Focused on individuals not populations
- Central focus of sex is reproduction
 - Doesn’t recognize same sex reproduction
Psychological theories

 Freud’s theory
- Libido: sexual instinct and desires that drive us
 Exists in the subconscious
 Reveals itself through our actions and thoughts
 Wants to relieve our tension
 Id, ego, super-ego
- Psychosexual developments occurs in stages
 Disturbances at any stage freud claimed could cause fixation and deviant
behaviour later in life
 Oral
 Anal
 Phallic
 Oedipal (understanding that parents also have genitals, penis envy by boys
and girls, hate for parents)
 Latent
 Genital
- Critiques for freud
 Male bias: belief that women become sexually mature when they reach
penetrative orgasm
Learning theories

 Sexual arousal and behaviour is learned

 Classical conditioning: sexual behaviour is learned through stimulus paired with
response
 Operant conditioning: sexual behaviour is learned through reward and punishment
- Timing is important, punishment or reward must usually directly follow
- Social learning is based on operant conditioning, imitation, identification
- Upbringing and social rules and norms shape behaviour
Social exchange theory

 People look for relationships that maximize rewards and minimize costs
- Also assessing partners level of satisfaction/dissatisfaction
- Energy, time, other relationships, resources, happiness, freedom
Cognitive theories

 Perception and labeling of events/behaviour that you deem sexual in nature

- Use of schemas, frameworks of ideas
  Using schemas in situations has 3 steps
1. Perception
2. Labeling
3. evaluation
Critical theories

 Social constructionism: societies construct hierarchies and social categories that affect
people
- Race, gender, orientation
Feminist theory

 Womens sexuality is repressed and shamed

 Slut shaming
- Different standards for men vs women
Queer Theory

 Concerned with marginalized sexual orientations and gender identities

Sexual anatomy
Female sexual anatomy

 Important to remember that this is the typical anatomy of a cis-gendered female

- Not all women have this anatomy (transgender etc)
 Clitoral hood is made up of skin from labia minora, same cells that cover the head of the
penis
 Vagina and penis are homologous
- Come from same embryonic material
 Labia
- Labia majora: outer lips
 Rounded pads of fatty tissue, larger outer lips that encompass the vaginal
opening
- Labia minora: inner lips
- Diversity is the norm
- Pornography has created an unrealistic view of the “perfect vagina”
 Clitoris
- Sole purpose is sexual pleasure
- Glans clitoris: connected to crura of clitoris deep inside body
 Hymen
- Source of stereotypes, myths surrounding women and virginity
- Not everyone is born with a hymen
- Not a sign of virginity, hymen can be torn in many ways, not normal for bleeding to
happen during penetrative sex
- Imperforate hymen is atypical, person will need surgery in order for menstruation to
work
***Know anatomy diagrams from side view***

- Fundus is the top of the uterus, hump on top of the cervix in between the fallopian
tubes
 Bartholin glands
- Small pair of glands that lie to the right and left of the vagina
- Provide a small amount of lubricant prior to orgasm
 Skene’s gland
- Female “prostate”
- Para-urethral gland
 Fallopian tubes
- Create pathway from ovaries to uterus
 Ovaries
- Function is to produce eggs and sex hormones
- Progesterone and estrogen are not exclusively female sex hormones
 Everyone has these hormones, women have testosterone
 Breasts
- Consist of 15-20 mammary glands
- Feels like boobs are going to sneeze lmao when they fill with milk
Typical Male Anatomy

Important note

 The word typical is used because not all biological males have this exact genitalia and
other people such as trans men may not have this anatomy

***KNOW THIS DIAGRAM FOR EXAM***

- Know where structures are in relation to each other
- Will ask to identify structures from forward view and front to back
- Know position of structures
- 55 multiple choice

Corona and frenulum

  Sensitivity of glans of penis can be affected of several factors
- Environment
- Circumcision
- Arousal
Internal structure of the penis

 Vascular structures allow for blood flow

 Internal structure is remarkably similar to internal female anatomy because they
develop from the same original embryonic structures

 2 seminal vesicles
 Corpora cavernosa
-
Know seminiferous tubules and epididymis and other structures

 Seminiferous tubules
- Where sperm is created
 Epididymis
- Structure of vas deferens that leads to testicles
- Where sperm is stored and matured
- When sperm is ready it travels along epididymis to vas deferens
 Interstitial cells
- Where testosterone is produced
- Located in space between seminiferous tubules
 Prostate
- Helps to create a more alkaline environment for sperm
- Helps protect sperm from acidic environment of vagina
 Cowpers glands
- Secretes fluid for pre-ejaculate into urethra
Sexual response
Consists of two main physiological processes

 Vasocongestion
- Erection of tissues, genitals, surrounding areas
- Blood vessles carrying blood to erectile tissue dilate to allow more blood flow
- Blood vessels carrying blood away constrict to limit blood leaving area
 Myotonia
- Contraction of muscles, including the genitals and other muscles in the body during
orgasm
Masters and johnson study: four phase model

 Participants pleasured themselves and several metrics were measured

- Engorgement of genitals
- Breathing
- Heart rate
- Time to orgasm
 First phase: excitement phase
- Muscle contraction occurs throughout the whole body
- Biologically female bodies:
 Upper 2/3 of vagina swells during arousal, bottom 1/3 contracts
 Second phase: Plateau phase
- In women during late arousal the orgasmic platform forms causing the vaginal
entrance to tighten, this is caused by contractions of the bulbospongiosus muscle
 Third phase: orgasm phase
- Ejaculation: men can “train” to reach point right before orgasm and then pull back
(edging)
 Preliminary stage: vas deferens, seminal vesicles, and prostate contract to
force ejaculate into urethral bulb, Ejaculatory inevitability (cant be stopped)
 Secondary stage: bulb urethra and penis contract to force semen through the
urethra
 Myotonia: carpopedal spasms and general msucles contractions occur at
intervals of 0.8 seconds
 Fourth phase: resolution
- Repeated arousal without orgasm can cause some chronic pain problems because
the part of the body is swollen with blood repeatedly with no release
- Women generally do not have a refractory period
- Allows women to commonly have multiple orgasms
 Critiques of masters and johnson model
- Ignores cognitive and subjective aspects of arousal
 - Overly clinical physiological approach to arousal
- Research selection bias, participant pool might have not been representative of
larger population
Kaplans 3 stage model

 Desire (cognitive/subjective)
 Vasocongestion
 Muscle contraction
Basson’s model

 Emotional intimacy is the foundation of sexual activity/arousal

 More is needed for arousal than physical stimulation

Spinal reflexes

 Arousal, stimulation, and sensation can be affected by the type and placement of a
spinal cord injury
  Pudendal nerve innervates the area around the labia majora/minora for women, in men
the pudendal nerve innervates the testes
Female ejaculation

 G-spot on frontal wall of vagina

- Spongy tissue containing nerve endings
 Mutually exclusive from orgasm for females
Sex is not a competition; people are not machines who if you push the right buttons will
orgasm. Each experience is unique, each person is unique.

Chapter 9: Sexual Arousal notes

Excitement phase

 Biological men:
- For men the cowpers gland may secrete lubrication (precum)
 May contain active sperm
- Neurotransmitter nitric oxide (NO) is primarily involved in this process for men
 Biological women:
- Vasocongestion causes lubrication to seep through the semipermeable membrane
of the vagina
- Clitoris stiffens and becomes erect
- Late in the excitement phase clitoris may also elevate and retract up into the body
- Estrogen is the key neurotransmitter/hormone for vasodilation/erection in women
- Ballooning response: inner two thirds of the vagina expand to accommodate arousal
 Sex flush: arousal response that occurs in both men and women, resembles measles
rash
Orgasm phase

 Carpopedal contractions: muscles of feet and hands contracting during orgasm

 Research shows men feel responsible for their female partner to orgasm
 Biological women:
- Sharp increase in pulse rate for women is an indicator of orgasm
- Vaginal penetration without direct stimulation of the clitoris can still indirectly result
in clitoral stimulation because of the crura extending deep into the womans body
around the inner structure of the vagina
- Shorter distance from clitoris to urethral meatus distance were correlated with
increased likelihood of orgasm
- Women can have multiple orgasms with little to no time between them
Resolution phase

 Biological men:
- Epinephrine and norepinephrine are involved in the reduction of an erection
- Refractory period can last as little as a couple minutes and up to a full day
 Biological women
- Breasts reverse swelling and return to normal size
- Time for resolution to occur can take 15-30 minutes or as long as an hour if a woman
didn’t reach orgasm
 More prolactin is released after orgasm from penetration than from masturbation
Criticism of Masters and Johnson model

 It focuses solely on the physiological component of arousal and ignores the cognitive
and subjective elements
- Women tend to emphasize psychological arousal more than the physical
 Participants in the M&J study had a history of frequent orgasms and an active sex life
- Might not be a representative sample
Two dimensions of arousal

 Physiological
 Cognitive-affective
- Emotional connection
- Intimacy
- Setting
Kaplans triphasic model

 Desire comes before arousal

 Independent phases rather than successive stages (2 physiological, 1
social/psychological)
- Sexual desire
 Desire causes arousal
- Vasocongestion
 Produces erection in men and lubrication for women
 Controlled by the parasympathetic nervous system
 Involves dilation of blood vessels
- Orgasm
 Controlled by the sympathetic nervous system
 Muscular contractions
Basson’s intimacy model

 Arousal creates desire

 - People can and will begin sexual activity in order to create intimacy and desire
- Begin activity in a sexually neutral state
Equal numbers of women chose each of the 3 models as the one that described them in a study
Dual control model

 Two basic processes

- Excitation
 Responding to sexual stimuli with arousal
- Inhibition
 Reducing arousal
 Argues that other theories focus too much on excitation and inhibiting sexual arousal is
just as important
 People can lean more towards excitation or inhibition
- People high on excitation and low on inhibition might engage in risky sex
behaviours
- People high on inhibition might develop sexual disorders like erectile dysfunction
or low sex drive
 Partially culturally driven because the media and society influences what is supposed to
excite/inhibit people
 Argument that while excitation is necessary for reproduction inhibition is equally
evolutionarily advantageous to reduce arousal in potentially dangerous situations
- Predator nearby
- Drought or famine season
The role of emotion in arousal

 Study found that thoughts of arousal increased when people experienced both positive
and negative emotions
- Negative emotions cause general sympathetic system arousal

Sex Hormones and Sexual Differentiation

Sex hormones

 Post menopause ovaries don’t produce progesterone or any sex hormones

- Post menopause the adrenal glands in a biological female will increase production of
these hormones
 FSH
 Luteinizing hormone
 Inhibin
- Released to suppress FSH
 - Negative feedback loop
- Can be diagnosed by abnormally high levels of FSH, the body is trying to stimulate
follicles to be released but the ovaries are like “no”
 Prolactin
- Stimulates production of milk
- Men can produce milk under the right circumstances
 Oxytocin
- Promotes bonding
- Produced during affectionate physical touching
- Helps strengthen caring and bond between parents and their children
Prenatal sexual differentiation

 Mullerian and wolffian duct systems

Genital tubercle is the undifferentiated tissue
**Know which sex organs are homologous**
Brain differentiation

 Female and male brains are mostly similar in the vast majority of regions
 The brain is very plasticine, it can change and adapt to experiences
Assumptions

 We categorize and create norms for genders and then judge people based on these
classifications
Congenital Adrenal Hyperplasia
Androgen Insensitivity syndrome

 Chromosomally XY males but the cells do not respond to testosterone

Sex Hormones and Sexual Differentiation Part 2
Should children be given sexual education?

 If so at what age?
 Taboo of sex in a lot of cultures especially in regards to children
- Want to “protect” kids
 Will kids be encouraged to do sexual activities with knowledge?
 Kids being ignorant about sex can cause its own problems
Hormonal influences on development
**Slide 6 correction: Follicular stage that varies, luteal stage is 14 days**
As the recruited follicle is maturing it is pumping out estrogen
Hypothalamus produces gonadotropin hormone which stimulates the pituitary which causes LH
and FSH to be produced
We want to keep the environment in the vagina hostile to bacteria and toxins

 If not you can get infections in the uterus which can be very dangerous

***Exam 2 will not cover sex techniques, oral sex and penetrative techniques,
information about communication from attraction intimacy and love will also
not be on the exam, no more anatomy questions, will not cover textbook pages
248-266 and 354-365***

Attraction Intimacy and Love

Explaining our preferences

 We tend to like people who reinforce and reward us and dislike people who give us
punishments
Mere exposure effect

 Repeated exposure leads to greater attraction

Homophily

 We are attracted to people who are similar to us (not always)

- Religious views
- Ethnicity
 - Political views
Matching phenomenon

 We tend to choose people whose “social value” matches out own perceived worth
Characteristics of initial attraction

 Most important was agreeableness

- Provides evidence for reinforcement theory
 Least important was status
 No gender differences were found between the ratings of importance these qualities
How do dating apps affect attraction?

 Throwaway culture, easy to move onto the next person

 Reinforces gender roles of men being the chasers
LOVE
Triangular theory of love

 Sternberg (theorist)
 3 parts
- Passion
 Physical excitement, motivation and attraction
- Commitment
 Short term or long term
 Commitment to person
- Intimacy
 Emotional component
 Bonding
 Vulnerability and closeness to person
 Having 2/3 components creates different kinds of love, having all 3 is consummate love
Bowlby’s attachment theory

 Adult attachment style is very affected by childhood experiences

- Relationship with caregivers (most important) and friendships
- Mistreatment from parents/friends can damage our self worth
- Two main axes of whether you seek others out or avoid intimacy and whether you
are self confident or self anxious
Love as a story

 Sternberg examined common love stories throughout history and media (novels,
movies)
Passionate and companionate love
The biology of love

 Dopamine
- Reward system
Two-component theory of love

 Physiological arousal can be triggered by other things

 Study had men do physiologically arousing activities like running on a treadmill or doing
something scary that raised their heart rate, these men on average found women more
attractive when compared to a control group that did not do physiologically arousing
activities
Cross-cultural values and meanings of love

 Collectivist cultures
- Seek people that fit into our larger lives, family, society
- Our individual likes and needs do not always match with what benefits and fits with
our communities

***EXAM WILL COVER CHAPTER 9, 5, 12, 13***

LECTURE SLIDES: SEXUAL RESPONSE, SEX HORMONES AND SEXUAL
DIFFERENTIATION, ATTRACTION INTIMACY AND LOVE, GENDER AND SEXUALITY.

Gender and Sexuality

Gender expression is fluid
 Cultural and societal norms change over time
- Used to be very common for men to wear makeup, wear heels
Gender binary
 Most of society is based around a rigid two gender system, man and
woman
Transgender
 The term transgender applies to people who no longer identify with the
gender that they were assigned at birth
- Can also technically apply to non-binary people
Gender affirming modalities
 Include:
- Cosmetics
- Binders
- Surgery
- Hormone therapy
Someones gender expression is not always an indication of their gender
 Humans like to categorize people, helps us to understand and learn how to
treat them
Traditional female sexual script
 Womens role of being a “gatekeeper”
- Idea that when a women says no she just wants you to try harder
- Perpetuated by media of guy that doesn’t take no for an answer getting
the girl
Traditional male sexual script
 Men are more experienced with sex
 Men should be more sexually confident
 Men are the initiators
The problem with gender research
 Has mostly focused on cis-gendered heterosexual people
Binary gender differences
 Cis-men tend to be more aggressive
- Testosterone plays a role
Arousal to erotica study (heterosexual)
 Showed men and women graphic and romantic sexual material
- In both cases cis-gendered men and women found erotica where the
women initiated and was women centred more arousing
 Men reported higher levels of arousal compared to women
- However women were more physiologically aroused than they self-
reported
Why don’t women have consistent orgasms when with a partner
 Biopsychosocial view/intersectionality
 Peen is larger can be easier to stimulate
 View that female orgasm doesn’t matter as much
 Ignorance about female anatomy/techniques
Sexual Variation
How do we define “normal/abnormal” behaviour?
 Statistical approach
- Does rare mean wrong
 Sociological approach
- Does it violate social norms
 Psychological behaviour
- Is the behaviour harmful, uncomfortable, bizarre, and inefficient
 Medical approach
- DSM classification
- Homosexuality used to be listed as a mental illness
Determinants of paraphhilias
 Learning theory
- Classical conditioning, learned association
 Childhood abuse
- Sexual and/or non-sexual
 Cognitive theories
 Addiction model
Medical treatments for sexual variation
 Most paraphilic crimes are performed by men
 Surgical castration
- Can affect testosterone levels in men, possibly reducing sexual drive
 Hormone treatment
- Depression medications can lower sex drive

HIV/AIDS
What is HIV/AIDS?
 HIV is a retrovirus that is made of RNA and uses the DNA of a host to
replicate itself
- When it infects cells it eventually bursts from them causing them to die
  Attacks cells in the immune system
- CD4 and T cells, when enough of these die you become
immunocompromised, become susceptible to many diseases and
infections
 4 stages of HIV/AIDS
- Initial infection
- Asymptomatic carrier state
- Symptoms develop
- AIDS
 Occurs when people become immunocompromised and
vulnerable to other infections/diseases

 Important to look at other life factors such as nutrition, weight, healthcare

to gauge life expectancy
 Anti-retrovirals have bad side effects
Modes of transmission
 Blood, semen, vaginal fluid, pre-ejaculate, or breast milk
- Can be passed from mother to baby during pregnancy and after birth
through breast milk
Prevalence in Canada
 1/5 people that have HIV are unaware that they have it
  Within the general population of people living with HIV
- Over half are gay men (53%)
- 19% are intravenous drug users
- 31% are heterosexual
- 1% are other exposures
 20-24% of new diagnoses are between the ages of 15-29
HIV/AIDS: women, children, and ethnic minorities
 Disproportionately affects indigenous people in Canada, especially
indigenous women
Treatment
 Antiretroviral drugs (ART)
 Highly active retroviral therapy (HAART): interferes with the copying of HIV
- AZT – a nucleoside – interferes with RT
- Protease inhibitors – interferes with protease

Sex work
Commercial sex work
 Sex workers is umbrella term
- Prostitutes
- Pornographic models and actors
- Escorts
- Phone sex operators
 Provide sexual services in return for money or other compensation
Is sex work legal? Its complicated
 Bill C-36 made purchasing sex illegal but decriminalized selling sex
- Idea is that this discourages buyers and people seeking out sexual
activities for money but protects and destigmatizes vulnerable sex
workers
Venues for sex workers
 Call girl
- Most expensive, worker usually has more control over the work they do
and who they work with
 Brothel
- House of sex work, used to be more numerous but they declined after
WWII
 In call
- A residence where a sex worker or several sex workers offer services,
clients come to them
 Out call
- Sex worker goes to client, carries greater risk
 Massage parlours
- Can offer erotic massages, or happy endings, usually more expensive
  Streetwalker (street level prostitute)
- Lowest level of sex work, usually in lower income areas, walk the streets
offering sexual services, higher risk of STI’s and danger for worker, prices
are usually much lower
third parties
 What are the wider societal implications of legalizing and normalizing sex
work?
- What is considered obscene and appropriate changes over time with
social norms
 Pimp
- Provides protection or other valuable services like companionship,
transportation, sex, bail, food, shelter, drugs. Usually gets a cut of the
earnings of the sex worker
- Can be abusive and exploitative and also egalitarian and respectful
 Madam
- A woman who manages a brothel or escort service
 Other people who are involved in the facilitation of sex work, could be:
- Secretaries
- Camera people
- Fluffer
- Makeup artist
 Sex trafficking
- Recruiting, controlling, exploiting sex workers by threat/deception/force
- Tens of thousands of young women, men, boys, and girls are trafficked
each year, half of them are children
The career of a sex worker (not consistent for every person)
 Entry – first step in a sex workers career
 Reasons why people enter sex work
- Economics: financial difficulties, lack of qualifications, ease of access
- Drug addiction
- Force or coercion: by partner or family member
 Apprenticeship period: learn skills of the profession
- Fellatio lessons, negotiation, seduction, control, safety
  Mid career
- May transition to managing other sex workers or move in and out of
venues
 Leaving the profession
Sex workers well being
 Risk associated with sex work include
- Physical assault, murder
- Sexual assault
- STI’s
- Arrest
- Stealing, defrauding, non-payment
- Abduction
- Risk of mistreatment by law enforcement
 Most incidents occur indoors (car, clients residence, motel, sex
workers residence)
 Risks are especially high for women who are trafficked
 History of victimization and trauma before entering sex work is
associated with worse well being outcomes
 Not representative for all sex workers necessarily so these cannot
be generalized to every individual but rates are higher

 According to 1994 Netherlands study (who were these people? Prostitutes?

Escorts? Streetwalkers, what would the breakdown of experience across
these professions be)
- ¼ of 100 sex workers reported doing well one year after entering the
profession of sex worker
- ¼ had few physical and psychosocial complaints
- ¼ had many physical and psychological complaints
 People working at lower levels of sex work (streetwalker
compared to escort) the greater the workload, pace, burnout,
violence, coercion, and lack of control
Customers
 Use of sex workers has dramatically declined in the past 50 years
 - From 69% to 17%
- Popularization and ease of access of online porn
 “John” (client)
- Mean age of 42
- 39% single
- Mostly middle class and heterosexual
- Most have purchased sex around 100 times
- 50% are occasional clients, 50% are repeat customers
 Reasons
- Want more frequent sex
- Fellatio
- Exotic needs/kinks
- Proof of manhood
- Discreet homosexual activity
- Time constraints
- No emotional attachment
Male sex workers
 Gigolo
- A male who provides companionship/sexual services to women in
exchange for money
 Hustler
- Male sex worker who provides sexual services to men
- 23% do not have a “gay” identity
- Is this distinction between hustlers and gigolo’s as common as it used to
be?
 Reasons
- Men usually aren’t coerced as much as women
- Money, financial difficulties
- Pleasure
- Enhanced sense of self
- drugs
Transgender sex workers (is the assumption MTF?)
 usually male customers
  similar to female sex workers they on average spend less time with clients
and have regular hours
 similar to male sex workers few report never enjoying the sexual activities
 more than half never told their customer theyre trans
- engaged in oral sex, manual stimulation, anal
- different strategies to hide penis
- higher risk of assault and mistreatment
sex tourism
 purpose of travel is to procure sex in other countries
- often in countries that are less developed
- less expensive
- different laws

- usually more exotic tastes, younger people ☹

 made possible by
- migration from less developed nations, migration from rural to urban
areas, searching for jobs
- commodification of sexual intimacy
- increased travel for recreational purposes
 estimates suggest it is a 20 billion dollar industry
pornography
 sexually arousing media art, literature, films. Three main categories:
- explicit sex with violence (obscene, obscenity laws)
- explicit sex without violence but people are treated in a way that is
degrading or dehumanizing
- explicit sex that is neither degrading or dehumanizing (erotica)
 obscenity
- any publication where a dominant characteristic is the undue
exploitation of sex
 types of pornography
- online porn: adult websites, chat rooms, sex games, cams, forums
- DVD’s, videos, films
- Magazines
 - Live entertainment
 New Brunswick study showed 89% of males and 39% of females admitted
to looking at porn in the last month
 Salmon (2012) says women are less attracted to porn because of its focus
on impersonal sex and sexual variety
- She argues that women are more aroused by relationships
- Prefer erotica/romance novels, accounts for 13% of paperback sales in
the US (29 million) compared to estimated 40 million internet porn users
- Debate over the accuracy of this claim
Child pornography
 Photos or films of minors engaged in sexual acts (under 18)
 1993 criminal code of Canada made it illegal to process, distribute, or make
pornography involving anyone under 18
 Displaying or offering to sell pornography to persons under 16 is a criminal
offence regardless of whether its obscene
Issues related to porn
 Hard core porn mixes sex and violence and can portray it as normal
 Objectifies and debases men and women
- Oftentimes reinforces traditional gender roles
- Women in porn are more commonly objectified and degraded
 Glamorizes the unequal power relationships depicted in porn
Effects of porn
 Male focused porn is more arousing to men than women. Difference
becomes larger with increasing age
- Surprising?
 Viewing large quantities of videos can lead to more tolerance of “restricted
behaviour” including sexual assault
- Men who are already predisposed towards violence/sexual aggression
against women are more likely to be affected
- But there is no clear evidence that exposure to porn causes sexually
aggressive behaviour in men who are not already predisposed to sexual
violence
 Research has found that women who are exposed to violent pornography
have reported negative effects
What is the solution?
 Censorship would likely not be effective, ease of access of internet sites
- Would also turn porn into a more dangerous profession threatening the
lives and wellbeing of the people who make porn, particularly women
- Better solution is probably education to debunk myths of porn, paint a
more realistic picture of healthy sex
 Controversy of sex education, when should people be taught this?
Grade 7? 8? 9?
Sexual challenges lecture
Degree and Duration
 Sexual disorder
- Not able to respond sexually
 Masters and Johnson model
 Can be subjective
 People who are asexual, are they disordered?
- Not able to feel sexual pleasure
 Issues with arousal and orgasm
- Experience distress
 Primary sexual disorder
- Generalized, lifelong
 Happens regardless of circumstance
 Secondary sexual disorder
- Acquired after previous function
 Sexual challenges are caused by event, sometimes traumatic
 Sexual assault/rape
 Could occur from surgery, new medication
 Situational
- Occurs only under certain circumstances
 A lot of women usually have no problem achieving orgasm when
masturbating but can struggle with partners
Categories
 Desire
- Hypoactive or aversion
 Kaplans model
 Usually have issues with low desire, excess of desire does occur
(nymphomania) but people are less likely to seek help or have
issues from it
 Can be affected by perception of what is the right amount of
desire, affected by culture, media, partners
  Arousal
- Erectile or subjective
 Masters and johnson physiological arousal
 Physiological arousal can occur without mental arousal and vice
versa
 This and challenges with orgasm are the two most common issues
 Orgasm
- “Premature”, difficulty, or absence
 Technically premature ejaculation isn’t a thing just “fast
ejaculation”
 Sexual pain
- Dyspareunia or vaginismus
 Pain is not a disorder by itself, it is a symptom
 Dyspareunia (symptom): pain with genital contact, pain with
intercourse
 Vaginismus: painful muscle spasm around walls of vagina
Hypoactive sexual desire
 Lack of interest initiating or having sex
- May be general or situational
- Can be with oneself or others (masturbation versus with another
person)
- 6% of young men and 41% of men over 65
 Due in part to decreasing testosterone as men age
 Usually doesn’t affect young people for men and women
- 8% of women up to 49, 10% of women between ages 50-59
- Difficult to define because there isn’t really criteria or a standard
- May relate to discrepancy of desire between partners
 Can lead to resentment
Arousal challenges
 Male erectile difficulties
- Difficulty obtaining and/or sustaining erection in most circumstances
- Less than 10% of men under 40, 30% of men over 60
 Popularity of Viagra among older men
 - Most common challenge among men who seek sexual therapy
 Part of sexual script surrounding sexual activity for men,
perpetuates idea that the man has to have an erection
 Not being able to get an erection is a threat to masculinity
 Female arousal difficulties
- Lack of response (or awareness of response) to stimulation
Male orgasmic challenges
 “premature” (rapid) ejaculation
- Defined as absence of voluntary control over orgasm
- Most common complaint (24% of Canadian men)
 How are we defining and measuring sexual success
- Canadian average is 8 minutes (7% of men = 1 minute, 17% = 2 minutes)
- There is sometimes the expectation that the man will get erect fast, stay
erect, and will take a long time to ejaculate
 This creates a lot of pressure for men to perform and can create
shame and embarrassment
 Women who orgasm quickly are not considered dysfunctional
 In order to have penetrative sex the man has to be aroused the
woman technically doesnt
- People can have fun sexual activity without a male erection
Female orgasm
 Absence of orgasm (primary, secondary, situational)
 10% of women never orgasm (yikes), 21% of Canadian women report
seldom orgasming
 Orgasm through what stimulation?
- Penetrative? Oral from a partner? Masturbation?
 Orgasmic capacity increases with age
 Once gained- ability to orgasm is often not lost outside situational factors
- Getting to know your body better and what arouses you
 Psychological issues
- Anxiety and depression
- Cognitive interference can be used on purpose to prevent orgasm or it
can happen randomly
Vaginismus
 Involuntary contraction of muscles around the outer third of the vagina
upon attempted penetration
- Can be caused by stress/anxiety, trauma
 Responds well to relaxation techniques and gradual insertion of dilators
Dyspareunia (symptom)
 Typically pain during sexual intercourse
 Affects 15% of women and 3% of men
 Represents a symptom rather than a disorder
 Leads to avoidance or reduced arousal
What causes sexual challenges?
 Divided into 3 main categories
- Physical
- Personal psychological
- interpersonal
 Research was primarily begun by Masters and Johnson who were
physicians that wanted to study what caused sexual challenges after they
received complaints from patients about these issues
- Focused on the physiological component of sex only, ignored emotional
and psychological component
 Focused mainly on penetrative heterosexual sex
 Erectile challenges
- Anything that interferes with blood flow (vasodilation)
 Medical conditions that affect blood flow, heart disease, diabetes
 One of the first signs of early diabetes in men is erectile
dysfunction
 Can also occur from medications, diet, other factors
 Rapid ejaculation
- Often psychological factors
 - Physical hyper/hyposensitivity
- Inflammation of the prostate
 Male orgasm
- Often psychological factors
- Spinal injury, MS, prostate surgery
 Arousal and orgasm involves both the circulatory system and the
nervous system
 Female orgasm
- Often psychological issues
 Not necessarily serious mental disorders
- Severe illness, poor health
 Pain during intercourse
- Challenges to entrance of vagina such as painful scarring from
episiotomy, infection of Bartholin glands
- Vaginal infections
- Pelvic disorders such as PID, tumours, cysts, endometriosis
 Vaginismus
- Organic or psychological factors
Effects of alcohol
 At low dosage may reduce inhibition
 High dosages acts as a depressant and can suppress arousal
 Alcoholism
- Over time can disrupt sex hormones and impair desire
- Damage testes and liver
Nicotine
 Causes erectile dysfunction after extensive use
Effects of illicit drugs
 Occasional use of some of these drugs can enhance sexual experience,
excitement, and sensation
 Cocaine
- Chronic use results in loss of arousal and erectile challenges
 Amphetamines
 - Injection causes feeling of intense euphoria
- Can delay or make orgasm impossible
 Crystal methamphetamines
- Tendency to engage in riskier sex, confidence and reduced inhibition
- Hallucinations and violent behaviour
 Opiates
- Long term use leads to low testosterone levels in males
Psychological causes
 Predisposing factors
- Negative childhood experiences (including abuse, physical or sexual)
- Sex negative family
 Sex is dirty and taboo and not to be discussed openly
 State of societal and cultural views on sex
- Heteronormative views
- Women enjoying and expressing sexual desire is shameful
- Stigmatization of certain sexualities creates shame and anxiety
 Combined cognitive and physiological factors
- Some people equate sexual arousal with anxiety
 Maintaining factors
- Myths or misinformation
- Negative attitudes
- Anxieties such as fear of failure
 Pressure to perform, erectile dysfunction, finishing quickly
 Can become a self-fulfilling prophecy
- Cognitive interference
 Phenomenon of “spectating” – watching rather than experiencing
- Behavioural and lifestyle factors
 Diet, exercise, stress, drug use, alcohol consumption, etc
- Failure of the partners to communicate, expect partner to read your
mind
- Failure to engage in effective, sexually stimulating behaviour
- Relationship distress
Therapies for sexual challenges
  Behavioural therapy
- Sensate focus (eliminates goal focus)
 Works to refocus the person on their own sensuality and pleasure
of the overall experience instead of making penetration and
orgasm the goal
 Giving and receiving touch, communication and learning partners
preferences, foreplay
 Can help with feelings of rejection
 Cognitive behavioural therapy
- Works to restructure negative thoughts and negative behaviour patterns
 Couples therapy
Treatment
 Stop start technique (edging)
- Used to prolong male ejaculation
 Directed masturbation
- Vibrators are effective
- Help people (especially women) who struggle to achieve orgasm
 Kegel exercises
- Used to strengthen pubic muscles (muscles used to stop peeing) to
enhance arousal and orgasm
- Can help men last longer
 Bibliotherapy (reading)
- Self-help books
Biomedical therapies
 Drug treatments
- Viagra, Cialis treat erectile dysfunction
 Vasodilators
 Intravernosal injection
- Treats erectile difficulties, injection of a vasodilator drug into the corpus
cavernosa of the penis
 Vacuum devices (penis pump)
- Treat erectile challenges
 Surgical therapy
 - Prosthesis, can be used if there is damage to the penis
- Also used in gender affirming surgery
No Viagra for women
 Women typically don’t have vasocongestion issues, male vasocongestion is
required for penetrative sex
 Most women who have orgasm difficulties have trouble with low desire
and/or psychological difficulties
 Can be related to age
- As ovaries reduce testosterone production
 Testosterone patch for postmenopausal women was rejected by the FDA
- Testosterone supplements can cause aggression

Sexuality Education
Purposes of sexuality education
 promotes healthy sexuality
 the Sex Education and Information Council of Canada (SIECCAN) actively
promotes high quality sex education in Canada
- developed Canadas guidelines for sexual health education
- importance of diverse education that represents the multifaceted
nature of sexuality that includes diverse genders and orientations and
balances the well-being and desires of the individual with the needs and
rights of others and society
in the home, school, or somewhere else?
 Many children are given no sexuality education at home
 Many people/parents are embarrassed to discuss sexuality, taboo
 Many adults lack knowledge about sexuality
 Most adults (95%) favour sex education in schools
What to teach at different ages?
 What information is appropriate to teach at what age?
 Childrens knowledge varies with age, culture, social status etc.
Childrens knowledge of sex
 Early age: concept off pregnancy
 Age 7-8: more complex understanding of reproduction
 Age 10-11: understand parents want to be alone to have sex
Attitudes towards school based sexual education

The curriculum
HIV/AIDS risk education
 In the 1990’s the focus was on disease (STI) prevention, supporting condom
use and delaying intercourse
 - Usually 1 or 2 classes
- Significantly improved knowledge and reported positive changes
regarding condom use
- 2002 study found that students then had less knowledge about
HIV/AIDS than students in 1989, about half of grade 9 students didn’t
know there was no cure for AIDS
Abstinence only programs
 In the US and Canada not too long ago many programs taught that the only
way to prevent early pregnancy and STI’s was abstinence
- Problematic
- Stemmed from Christian views on sex
- heteronormative
- Well funded but theres no evidence they delayed pregnancy or stopped
the spread of STI’s
Comprehensive theoretically based programs
 New programs are more comprehensive and explicitly based on social
science theories of health promotion, including social inoculation theory,
social learning theory, the information-motivation behavioural skills
approach, and the health belief model
 Effective programs
- Focus on risk reducing behaviour
- Based on social theories of thinking
- Teach through experiential activities that personalize messages
- Address media and other social influences that encourage risk taking
behaviour
- Reinforce clear and appropriate values, enhance communication skills
Condom distribution
 Proven to be effective in reducing unwanted pregnancy and STI’s
- Ontario: pregnancy rates went down 21% and abortion rates went down
11% among teenagers 18 and younger
Sexual diversity
  Important to address homophobia, transphobia, and the discrimination on
the basis of sexual orientation
- Brent power
Home based sexuality education
 Most children get very little home based sex education
 Most parents are unsure and want guidance on how to talk to their kids
about sex

Sexual education in the community

Sex education by health professionals
 People need sex education throughout their lives not just when theyre
young
 Informed medical professionals
Sex education on the internet
 Becoming increasingly prevalent for a source of sex ed info
- Has pros and cons
 The source and reliability of the information cant always be
verified
 Can promote harmful views of sex, eg. Porn
Effective multicultural sex ed
 Must reflect or accept the culture(s) of the participants
- Sensitive to attitudes, beliefs, and values surrounding sexuality
 Should use communication styles and media common in the culture
Sexual education for people with disabilities
 Person with IQ’s below 70 are classified as developmentally delayed
 Important that sex educators and people realize that individuals with
disabilities still have normal sexual desires that require support and
education
- About their bodies
- Contraception
- Healthy relationships
- Setting safe boundaries