Human Sexuality

Augusto “jojo” Cruz Jr, MD DPBP

UERMMMC Department of Psychiatry
What is Normal Sexuality?
… perception of being male or
female and all those thoughts,
feelings, behaviours, connected
with sexual gratification and
reproduction, including the
attraction of one person to
another

involves feelings of
desire, behavior that
brings pleasure to
oneself and one’s
partner…. Devoid of guilt
or anxiety… and not
compulsive
 Human Sexuality

• Expression of sexual sensation and

intimacy between persons
• Expression of identity through sex
• Comprises a broad range of
behavior and processes
 Human Sexuality

• Determined by anatomy, physiology,

psychology, culture, relationship with
others, and developmental experiences

SEXUALITY PERSONALITY

PSYCHOSEXU
AL
Physiological Aspects of Human Sexuality

• Influenced by hormonal changes

during pregnancy/ genetic
predisposition
• Sexual Dysfunction:
– libido diminution
– erectile dysfunction
 Social Aspects of Human Sexuality

• Governed by rules of behavior and

status quo
• Influenced by social norms and vice
versa
– Example: gender identity
Psychological Aspects of Human Sexuality

Sexual Identity
• Gender Identity
• Orientation
• Intention
Sexual Function
• Sexual Desire
• Sexual Arousal
• Orgasm

Sexual Satisfaction
 Gender Identity

• Sense of self as masculine or

feminine
• Gender in which a person identifies
• Gender that other people attribute
to the individual on the basis of
gender role
• Is affected by a variety of social
structures
 Gender Identity and Sexual Identity

• Majority it is congruent
• Human beings are cisgendered
based on their biological sex
• Gender is social and sex is
biological
 Gender Role

• Usually related to and derived from

gender identity
• Includes all disclosures of a person
as having the status of a man or a
woman
 Sexual Orientation

• Describes the direction of an

individual’s sexuality
• AKA: sexual preference
• Markers:
– Self-labelling
– Actual sexual behavior
– Sexual fantasy
– Erotic arousal pattern
 Sexual Orientation

• “dynamic and multi-variable

process”
Klein, 1985 “The Bisexual
Option”
 Sexual Orientation and Mental Illness

• Psychiatric disorders were more

prevalent among homosexually
active people
– Depression/ anxiety
– Suicide
– Substance abuse (alcohol/ smoking)
• Sense of alienation predisposes
them to mental illness
 Sexual Intention

• What a person wants to do to his/ her

partner during the sexual behavior and what
is done to him or her

Sexual Desire
• Interest that a person experiences
– Drive – biological aspects
– Motive – psychological aspects
– Wish – social aspects
 Sexual Arousal

• The emotion of sexual excitement

based on pelvic vasocongestion and
autonomic arousal

Orgasm
• Stimulated by high levels of arousal that
results to brief, intense pleasure and
release of pelvic congestion
 Sexual Satisfaction

• Private judgment that sexual

behavior is pleasurable
 Normal Sexual Behavior

• Sexual response is a true

psychophysiological experience
• There is….
– Arousal
– Experience of tension
– Orgasm
• Four phase response cycle in relation to
stimulation
– Phase 1: Desire
– Phase 2: Excitement
– Phase 3: Orgasm
– Phase 4: Resolution
 Four Phase Response Cycle

• Phase 1: Desire
– Motivation, drives, and personality
towards the love object
– Sexual fantasies and desire to have
sexual activity
 Four Phase Response Cycle

•Phase 2: Excitement
–Subjective sense of pleasure from
•Psychological stimulation (fantasy, presence of the love
object)
•Physiological stimulation (Stroking or kissing)
•Combination of both

Male Female
-Lasts several minutes to several hours -Lasts several minutes to several hours
-Penile tumescence (increase in diameter/ length) -Vaginal lubrication, nipple erection
-Tightening & lifting of the scrotal sac and elevation of the -Clitoral enlargement, thickening of the labia minora
testes; 50% increase in the size of the testes -Increase in breast size (25%)
-2-3 drops of mucoid fluid that contain viable sperm are -Vaginal color change to dark purple; vaginal transudate
secreted at the height of excitement appears 10-30 secs after arousal
-Increase in heartbeat and respiration rates -Labia minora changes color to bright and deep red
-Heightened excitement lasts 30 secs to several minutes -Increase in the heartbeat and respiration rates
-Heightened excitement lasts 30 secs to several hours
 Four Phase Response Cycle

•Phase 3: Orgasm
–Peaking of sexual pleasure with subsequent
release of sexual tension and rhythmic
contraction of the perineal muscles and the
pelvic organs
Male Female
-3-15 seconds -3-15 seconds
-Forceful emission of semen (ejaculation) (12-20 inches at -Breasts may become tremulous
age 18, decreasing with age to seepage at 70) -Uterine contractions throughout orgasm
-4-5 rhythmic spasms of the prostrate, seminal vesicles, -Contractions of the lower third of the vagina
vas, and urethra -Loss of voluntary muscle control (carpopedal spasm;
-Loss of voluntary muscle control (facial grimacing; facial grimacing)
carpopedal spasm) -Hyperventilation and tachycardia
-BP up to 40-100 mm systolic, 20-50 mm diastolic
-HR up to 180 beats per minute
-Respiration up to 40 respirations a minute
 Four Phase Response Cycle

• Phase 4: Resolution
– Disgorgement of blood from the
genitalia (detumescence)
– With subjective feelings of well-being,
general relaxation and muscle
relaxation
– If it does not occur, may take 2-6 hours
associated with irritability and
discomfort
– Women do not have a refractory period
Masturbation
 Masturbation

•Nearly all men and

three fourths of all
women masturbate
sometime during
their lives

•Moral taboos have

generated myths
that masturbation
causes mental illness
or a decrease in
sexual potency
 Masturbation

• Form of release from excessive

sexual tension
• is probably a universal and
inevitable aspect of psychosexual
development, and in most
cases……..
• ADAPTIVE
• Becomes pathologic if it becomes a
compulsion
 Homosexuality

•What would your

reaction be if you
found out that your
best friend is
homosexual?
•Homosexuality is a
disorder…..?
 Homosexuality

•Homosexuality is a
disorder…..?
•Not a disorder
–In 1973, was
eliminated as a
diagnostic category by
the APA
–In 1980, was removed
from the DSM
–ICD
•If not a disorder,
what?
 Homosexuality

•An alternative
lifestyle
•A variant of human
sexuality
•Definition:
–A person’s overt
behavior, sexual
orientation, and a
sense of personal or
social identity.
•Lesbian or gay men
•Same sex or male female
 Homosexuality

• Prevalence
– 1948 : 10% of men
5% of women
37% had a homosexual
experience
– 1988 : 2-3% of men
– 1989 : < 1% of either sex
– 1993 : 1% exclusively homosexual
Expression of Human Sexuality
Adolescent age group
 REVIEW: ERIK ERIKSON’S STAGES OF THE
LIFE CYCLE
STAGE 5: Identity vs. Role Diffusion
– 11 years through end of adolescence
– Struggle to develop ego identity
– Danger of role confusion, doubts about
sexual and vocational identity
 Some of the expressions of human
sexuality in adolescents are the following:
• Dating Behavior
• Pre-marital Sex
 Definition: Dating Behavior

• DATE- is defined as any activity that

involved going out with someone of
the opposite sex whether in a group
or as a couple
– Group date
– Single date
YOUNG ADULTS FERTILITY SURVEY –
II
(1994)
 Proportions ever Dated

• Most Filipino youth aged 15-24

years have dated
• 60% or 3 out of 5 have experienced
going out on a date
• 49% of the teenagers claimed to
have gone out on a date
 Proportions ever Dated

• Dating either in groups or alone

with someone of the opposite sex
occurs quite early 10-13 years for
only a few youth
• By the age 15 the propensity to
date picks up
• At 16, more than a third of boys and
2 out of 5 girls date
 GROUP DATES OR SINGLE DATES

• 3 out of five-group date

• Girls more likely to start with group
date
• Boys immediately launched into a
single date
 TIMING OF THE FIRST DATE

• First date can trigger a series of

events that might change the
subsequent life of a person
• During teens, boys date twice as
much as girls
• Age 15, 1/5 of the girls have dated
while only 1/10 in boys have dated
 FIRST SINGLE DATE PARTNER

• Irrespective of gender, the partner

was a classmate or officemate
introduced by a friend or a neighbor
• At the time of the first date:
• 46% already a boyfriend/girlfriend
• 28% friend
• 16% admirer or crush
• 10% acquaintance
 DATING WITH A STEADY PARTNER

• Boys revealed that their partners

became their girlfriends after only 3
months
• Girls report the same after 6
months
• Favorite dating places: movie
houses, restaurants, parks and
shopping malls
 CHAPERONES

• Traditional role: ensure that no

untoward incident happens during a
date
• Nowadays: chosen to assuage and
persuade the parents or partner to
agree to the date and leaves the
couple during the actual date
 BEHAVIOR DURING first DATES

• 36% Kissed
• 3% sexual intercourse
• *17 % of the girls confided
intercourse happened without their
consent
 IN THE SUBSEQUENT DATES

• the number of those engaging in

very intimate behaviors (petting
and intercourse) increased
dramatically from 15-28%
 Dating and related events

• The urban youth have their first

crushes at 14
• Admiring the opposite sex at 15
• Group date at 16
• Single dates with BF and GF at 17-
18
 Differentials in dating behavior

• Those who have had exposure to

urban life were prone to date about
a quarter more than those who
have always remained in the rural
setting.
• Having lived in a dorm, studied in a
private school and living away from
parents increase tendency to date
 Determinants of dating behavior

• Live away from parents

• Older age
• Lived in the city
• Attends private school
• Fathers are college graduates
• Less strict parents
• Unstable marriage of parents
Premarital Sex
Committed
Casual
Commercial
 COMMERCIAL PREMARITAL
EXPERIENCE
• one pays for sexual favors usually
with a prostitute
• Prevalence:
• 1 in 14 single men
• 1 in 8 married men
 CASUAL PREMARITAL SEX

• Sexual intercourse with

acquaintance or friend
• Most common first sexual
experience of boys
 COMMITTED PREMARITAL SEX

• Sexual experience before a union is

formed
• Experienced more equally between
males and females
INITIAL EXPERIENCE WITH PREMARITAL
SEX
• Occurs at 18 years old
• 18% of today’s youth engage in
premarital sex
• Most popular venue for sexual
encounters is the HOME
• Majority of the youth did not use
contraception because they did not
expect to have sex at that time
• In those who practiced contraception,
withdrawal and condom were them most
commonly used
• DESPITE THE ACCEPTANCE OF
PREMARITAL SEX, VIRGINITY IS
STILL GENERALLY VALUED.
» ZABLAN, 1995:

• 91.5% CONSIDER VIRGINITY AS AN

IMPORTANT VIRTUE
 Conclusion

• 49% HAVE GONE OUT ON A DATE

DATING OCCURS AS EARLY AS 10 YRS OLD
GIRLS MORE LIKELY TO GROUP DATE FIRST
FIRST DATE CAN TRIGGER EVENTS THAT MAY
CHANGE THE PERSON’S LIFE
• INITIAL EXPERIENCE WITH PREMARITAL SEX
OCCURS AT AGE 18
• MOST COMMON FIRST SEXUAL EXPERIENCE
WITH BOYS IS CASUAL SEX
 Conclusion

• MAJORITY OF THE YOUTH DID NOT

USE CONTRACEPTION BECAUSE THEY
DID NOT EXPECT TO HAVE SEX AND
DESPITE ACCEPTANCE OF SUCH
PRACTICES, VIRGINITY IS STILL A
HIGHLY REGARDED VIRTUE
• SEXUALITY is at it’s peak in
adolescence as expressed in dating
behavior and premarital sex
THANK YOU AND GOOD DAY