Chapter 6 and Response Pop quiz: Which of the following is MOST responsible for sexual arousal?

• A) Physical attraction

• B) Secondary sex characteristics

• C) Primary sex characteristics

• D) Erotic play

• E) Thought processes The Brain and Sexual Arousal • Cerebral cortex (mental events) • Reasoning, language, and imagination • Thoughts • Memories • Cultural values • Limbic system and sexual behavior Cingulate = arousal Amygdala, hippo, cingulate =

• Hypothalamus • MPOA = medial preoptic area • Electrical stimulation of MPOA produces sexual arousal/orgasm • Larger in males, more active in males • Drugs/damage to this area inhibit sexual arousal The Brain and Sexual Arousal • Neurotransmitters • Dopamine facilitates sexual arousal at MPOA • Testosterone facilitates dopamine release • Possible reason for testosterone based increase • Serotonin inhibits sexual arousal • Released post in males • Blocks oxytocin release • SSRI’s used to treat depression • Side effect is often loss of libido The Senses and Sexual Arousal • All sensory systems can contribute to arousal • Touch is the dominant “sexual sense” • Primary erogenous zones • Genitals, butt, anus, , thighs, neck, ears, mouth, individual preferences are important • Secondary erogenous zones • Anything and everything else by preference

• Visual stimuli usually next in dominance • Men self-report higher arousal than women • Men’s mags, porn, pinups, calendars, etc. • Women and men have similar physiological responses • Vary in psychological responses • Women’s response is more complex • Visual, situational, evolutionary Other Senses and Sexual Arousal • Smell may arouse or offend depending on preference • Pheromones • Estratetraenol – EST, activates heterosexual male hypothalami • But not female • Androstadienone – AND, activates women, not men • Gay males = similar response to the female response • Genital secretions, response is variable • 6 “copulins” secreted by the

• Taste plays a minor role • Hearing plays a variable role • Chat • Direction • Noises • Dirty talk Aphrodisiacs • Substances believed to arouse sexual desire or increase capacity for sexual activity • Food • Oysters • Ginseng root • Horns (horny) • Tiger penis • Drugs • Alcohol, in moderation • Reduces inhibition • MDMA (ecstasy, X) • Yohimbine • Might actually work • Viagra, Levitra, Cialis • Increase ability, not true desire RHINO HORN IS MADE OF KERATIN REPUTED APHRODISIACS: VARIOUS ANIMAL PARTS

Rhino Horn

Oysters Tiger Penis

Mexican Ad Sea Turtle Eggs Aphrodisiacs • No clear evidence of genuine aphrodisiac qualities • Role of expectations Anaphrodisiacs • Inhibits sexual behavior • Drugs (e.g., opiates, tranquilizers) • Antihypertensives, antidepressants, and antipsychotics • pills • Nicotine • Constricts blood flow • Possibly reduces circulating testosterone

The Role of Hormones in Sexual Behavior Cholesterol

• Steroid hormones • Androgens (including testosterone) • Produced by testes, adrenal glands, and ovaries • Androgens converted to estrogens by aromatase

• Estrogens • Produced by ovaries and testes Testosterone • Women and men produce both types, different amounts 5α reductase • Neuropeptide hormones • Oxytocin Aromatase • Pair bonding Estriol DHT Cholesterol Sex Hormones in Male Sexual Behavior

• Testosterone • Linked to sexual desire and genital sensitivity • Castration leads to reduced sexual desire, less effect on sexual ability • Antiandrogen drugs • MPA = depo-provera, for sex offenders • Decline in desire, less effect on ability • Hypogonadism Testosterone • Reduced testosterone output • Typically associated with aging males 5α reductase

DHT Sex Hormones in Female Sexual Behavior • Estrogens • Overall link between estrogen and female sexual behavior is unclear • Appears to NOT increase desire, does help response • Estrogen therapy (ET) • No real change in sexual desire • Increases in lubrication • “Mood Mellowing” allows for better potential sexual interactions Testosterone • Testosterone • Role as major libido hormone in females • Supplementation shows increased desire, fantasy, orgasm, Aromatase

Estriol How Much Testosterone Is Necessary? • Two forms of testosterone (free and bound) • Free testosterone linked to libido, about 5% of “Total” • 300 – 1200 ng/dl males • Although women have less free testosterone, their cells are more sensitive to it than men’s • 20 - 50 ng/dl • Too much testosterone is linked to adverse effects • Males = Salt/fluid retention, hair loss, stimulate pre- existing prostate cancer • Females = hair growth, reduced breasts, enlarged clit • Testosterone levels decrease with age • Fairly rapid decrease for women at menopause; more gradual decline for men • Testosterone replacement therapy if below normal ranges

Oxytocin and Sexual Behavior • Secreted during cuddling and • Increased skin sensitivity • High levels associated with orgasmic release for women and men • Emotional and erotic bonding • For women, stimulates contractions of uterine wall during orgasm Sexual Response

A complex, highly individualized combination of physical, emotional and mental processes. Sexual Response, physiology only •’s four phases •Excitement

•Plateau • Poorly named, excitement continues • Prolong this phase to increase sexual arousal and orgasm intensity

•Orgasm

•Resolution • Males have a refractory period Female sexual response cycle. Pattern A) most closely resembles the male pattern, except that a woman can have one or more without dropping below the plateau level of sexual arousal. Variations of this response include an extended plateau with no orgasm (pattern B) and a rapid rise to orgasm with no definitive plateau and a quick resolution (pattern C). Male sexual response cycle. Only one male response pattern was identified by Masters and Johnson. However, men do report considerable variation in their response pattern. Note the refractory period; males do not have a second orgasm immediately after the first. Sexual Response, physiology only

• Two basic physiological processes • Vasocongestion • Blood engorgement of sexually excitable tissues • Arteries dilate, veins cannot drain the inflow • Penile , clitoral enlargement, Sexual Response, physiology only

• Two basic physiological processes • Vasocongestion

• Myotonia • Increased muscle tension, most evident at orgasm

Orgasm

• Shortest phase of sexual response cycle • Men and women’s subjective descriptions of orgasm are similar • Most female orgasms during partnered sex result from stimulation of the or

• Grafenberg spot • Area on lower front wall of vagina • Sensitive to pressure • Sometimes results in “ejaculation” MASTERS AND JOHNSON’S STAGES FEMALE SEXUAL RESPONSE CYCLE

Jenna Jameson Females experience characteristic changes in physiology during each phase of their sexual response cycle MASTERS AND JOHNSON’S STAGES FEMALE SEXUAL RESPONSE CYCLE

Females experience characteristic changes in physiology during each phase of their sexual response cycle MASTERS AND JOHNSON’S STAGES FEMALE SEXUAL RESPONSE CYCLE

Females experience characteristic changes in physiology during each phase of their sexual response cycle MASTERS AND JOHNSON’S STAGES

MALE SEXUAL RESPONSE CYCLE

Ron Jeremy Males experience characteristic changes in physiology during each phase of their sexual response cycle MASTERS AND JOHNSON’S STAGES

Males experience characteristic changes in physiology during each phase of their sexual response cycle MASTERS AND JOHNSON’S STAGES

MALE SEXUAL RESPONSE CYCLE

Males experience characteristic changes in physiology during each phase of their sexual response cycle “CLITORAL ORGASM” VS “VAGINAL ORGASM” Are there two kinds of orgasms? Does the G-spot exist?

Sigmund Freud mature orgasm = vaginal and preferable

Immature orgasm = clitoral stimulation, viewed the clitoris as a miniature penis = masculine and therefore not a feminine orgasm.

Actually, one type of orgasm regardless of how you get there. Locating the Grafenberg spot. Usually two fingers are used, and it is often necessary to press deeply into the anterior wall of the vagina to reach the spot. May lead to orgasm and possibly , maybe. Sex Differences in Sexual Response

• Greater variability in female response • Three patterns, A, B, C, or more, possible

• Male refractory period • Time following orgasm during which an erection and orgasm are not possible • Women can experience multiple orgasms Chapter 8 Sexual Behaviors “My sexuality has had many different dimensions during my life. My childhood masturbation was a secret desire and guilt that I never did admit to the priest in the confessional. “Playing doctor” was intriguing and exciting in its “naughtiness.” The hours of hot kissing and petting of my teenage and early college years developed my sexual awareness. My first intercourse experience was with a loved and trusted boyfriend. It was a profound physical and emotional experience; years later the memory still brings me deep pleasure. As a young adult my sexual expression alternated between periods of recreational sex and . Within the comforts and challenges of commitment; combining sex with an intense desire to become pregnant; the primal experience of , childbirth, and nursing greatly expanded the parameters of my sexuality. Now, balancing family, career, personal interests, my sexuality is a quiet hum in the background. I’m looking forward to retirement and time and energy for more than coffee and a kiss in the morning.” (Author’s files) Celibacy = physically mature person who does not engage in sexual behavior

• Types of celibacy • Complete celibacy • No sex, including no masturbation

• Partial celibacy • No sex, but does masturbate

• “Celibacy/ can be a viable option until the context for a sexual relationship is appropriate and positive for a given individual.” (Zafar, 2007) Reasons for or Benefits of Celibacy • Religious, moral beliefs “Vow of Celibacy” • Transform sexual energy into service to humanity • Obtain an education, in the middle ages nuns had access to libraries.

• “Pure Love Pledge”, etc. Before Your Vow of Purity Read What God Says In These Verses 1. Read Romans 12:1-2. It explains your promise. You're gifting yourself for the entire time you're • Waiting for the appropriate person: Mr./Ms. Right

• Learning about other aspects of self • Focus on school, work, friendships • Health considerations: pregnancy or disease fears

• During substance abuse recovery Erotic Dreams = while sleeping • Expression and exploration of desires taking place within the mind • 93% of men, 86% of women (Schredl, 2004) • Erection, lubrication, movements

• Nocturnal orgasm, • Males = “Wet Dream” = ejaculate • Women = little discernable evidence Erotic Fantasy = while awake • Can occur during daydreams, masturbation, or during sexual encounters

• 95% of women and men fantasize • Inverse correlation between strength of religion and amount of fantasy • Fantasy content among heterosexual, bisexual, and homosexual individuals are similar, except for sex of imagined partner • Function of sexual fantasies • Source of pleasure and arousal alone or accompanied • Overcome sexual anxiety leading to a sexual encounter • Acceptable expression of socially unacceptable behavior • Relive/imagine past or potential lovers • Consider cross orientation • One night stands • Give up control to the other partner • • 62% of women have fantasies about rape (Bivona, 2009) • > % of those had positive feelings about sex in general • Not an indication of past sexual force • Maybe an expression of sexual ambivalence • Not the same as wanting to be raped, the fantasy is controlled by the person and is “consensual” • Etc. all without actually doing that Bodice Ripper excerpts • “She sped up, racing further down the alley. Her eyes searched for a place to hide or barrier to protect her, anything to stop the man following her so persistently. But the space was vacant besides the brick wall looming before her, preventing her escape. There was no where she’d be able to hide from the man, no protection to be sought. Once he caught her, she’d be his, to do with as he pleased, regardless of her protests. Her stomach somersaulted at the idea, not entirely scared or displeased. But that can’t be true. I couldn’t want to be his captive.” • “She continued to fight against him, floundering and bucking across the bricks. But he maintained his steady movements, pumping his fingers in and out of her. Without ever realizing, she started to move with him, against him, for him. Her body shifted, pushing his fingers deeper inside her, finding just the right spot to have her wanting to scream to the sky.” In 2008, romantic fiction generated $1.37 billion in sales, with 7,311 novels published and making up 13.5% of the consumer book market. Sexual Fantasy • Gender similarities …. • Similar frequency during partnered sex • Wide range of content • ….and differences • Men • More often the initiator • Focus on women’s bodies and actions to such • Multiple partner/groups • Dominance • Women • More often passive • Focus on actions men would do to them • Focus on emotions and romance • Submission Sexual Fantasy • Fantasies: Help or hindrance? • Most research points to helpful • Sex therapists often recommend fantasy • Lower guilt about fantasy correlates to great sexual satisfaction • May assist with arousal and orgasm, and conversely, non-erotic thoughts contribute to a lack of arousal and orgasm • Some partners act out fantasies • Acceptable if all parties agree • May render the fantasy moot, sometimes reality is not as fun • On-line activities can reveal fantasies • Games • Chat rooms • Partner activities at a distance Sexual Fantasy Negative issues • Victims of may have unwanted fantasies • Therapy may help move those to positive fantasies • Fantasy in private may hinder partnered sex if the fantasies are not matching partnered sexual behavior • Fantasy during partnered sex can hinder intimacy • Double standard • It’s OK for me to fantasize about someone else…but.. • My partner better not…. • Especially if it’s about that neighbor, student, clerk • Movie stars, sports celebs, etc. might be OK Sexual Fantasy

Negative issues

• If dangerous fantasies move to reality • Violence • Rape • Child abuse

• Seek professional psychological assistance Masturbation Perspectives on Masturbation • Traditional condemnation • Bible has some odd euphemisms but no direct quote against it • Viewed as non-procreational • Erroneous health concerns • Samuel Tissot felt it was, “self abuse” and lead to debility • “Encyclopedia of Health”, 1918, “The health soon becomes noticeably impaired; There will be general debility… Next come sore eye, blindness, stupidity, consumption, spinal affliction, emaciation, involuntary seminal emissions, loss of all energy or spirit, insanity and idiocy, the hopeless ruin of both body and mind.” • 1800’s • Reverend Sylvester Graham (graham crackers), “Abstain from masturbation and marital intercourse to retain ‘vital fluids’”. • John Kellogg (Cereals), bland foods, like corn flakes, reduce sexual desire and masturbation Perspectives on Masturbation

• Preventions • Bandage genitals • Tying hands at night • FGC • devices • Freud considered it non-dangerous but a sign of immature development and an inability to form a healthy sexual relationship • Vatican • 1976 “Intrinsically and seriously disordered act” • 1993, “..morally unacceptable”

• Contemporary research has established that it is not harmful Ages 25-29 Men Women Ever 94% 85% (Herbenick, 2010) The highest rates of masturbation: Liberal, educated, cohabiting. White > African-American > Hispanic women

“Too much”? Maybe if it begins to interfere with some other life aspect. If you lose a BF/GF, grades drop, lose a job, become otherwise impotent, do it in public and get arrested, etc. Purposes for Masturbation • Relieves sexual tension • Means of self-exploration • Assist women to achieve orgasm • Men achieve ejaculatory control • Assists in physical relaxation • Aid with sleep at night • Form of “”, alone or mutual • Even out dissimilar partnered sexual desire • Those who masturbate tend to also have more partnered sex, (Laumann, 1994) • Women who masturbate have more partnered sexual satisfaction (Hurlbert, 1991) • But, it’s an option, not a mandate. Self-Pleasuring Technique • Follow your moral values • Set aside adequate time to relax • Experiment with different types of touch • Dry or lubricated • Direct stimulation +/- other erogenous zones • Pillows, mattress, water sprayer, tube sock? • Use of toys • 53% women, 45% men have used a • 79% of gay/bisexual men have used a • DON’T use anything damaging, light bulb, etc. This phallic shape was found at a Stone age settlement in Sweden. It is carved from a deer antler and is believed to be a 6,000 to 8,000 year old . Partnered Sex

“Sex can be motivated by excitement or boredom, physical need or affection, desire or duty, loneliness or complacency It can be a bid for power or an egalitarian exchange, a purely mechanical release of tension or a highly emotional fusion, a way to wear oneself out for sleep or a way to revitalize oneself. Sex can be granted as a reward or inducement, an altruistic offering or a favor; if can also be an act of selfishness, insecurity or a narcissism. Sex can express almost anything and mean almost anything.” (Fillion, 1996)

Online, not random, unreleased ages, Durex website, take the results as entertainment, not serious science. 113/52 weeks = U.S. = 2.17/wk Complete survey results on Canvas

Sexual acts in no particular order. The following is not a recipe, it’s a fluid environment, an alphabet soup, a continuum, a mosaic, a Mobius strip,,,, • Kissing Kissing and Touching • Cross-cultural practices and attitudes toward kissing • has 17 kinds of kisses • Some cultures consider kissing unhealthy and disgusting • Touching • Cornerstone of • Whole body is responsive • Personal preferences should be explored • Specific erogenous zones are individual • Tribadism • Rubbing genitals together or against another body part without intercourse • Hetero or homosexual play • Ie. Slick legging, frotting (males) • Ie. Scissoring, tribbing (females) Manual Stimulation of Genitals • Individual differences with regard to manual stimulation • Communication, cooperation, exploration, protection • Women • Lube, lube, lube • Direct clitoral stimulation may be uncomfortable • Above or sides may be more comfortable • Rubbing plus insertion of fingers into vagina at the G spot may help • Continue the rhythm, pressure through orgasm • Men • Lube, lube, lube • Gentle to firm stroking of the shaft and glans • Light tugging or rubbing of the • Stop after orgasm, the glans becomes very sensitive very fast Oral-Genital Stimulation

• Types: cunnilingus +/- fingers in vagina +/- stroking +/- swallowing • Watch the teeth, no biting, unless you’re both into that… • Or, both together = “69”

• Acceptance varies • Most common form of gay sexual expression • Protection can be a condom or “Swallowing” has no negative health effects. It’s something that should be agreed upon by consenting adults. Either the receiver can indicate coming is imminent, “I’m there”, etc., or the giver can recognize clues and finish with manual stimulation if swallowing is not an option.

More unmarried people engaging in oral sex now than reported in Kinsey’s survey However: Oral sex can spread HPV ABSTRACT Importance Prospective studies are needed to examine the temporal relationship between oral human papillomavirus (HPV) detection and risk. of head and neck squamous cell carcinoma

(HNSCC). Moreover, the oral cavity contains a wide spectrum of α-, β-, and γ-HPV types, but their association with risk of HNSCC is unknown. Objective To prospectively examine associations between α-, β-, and γ-HPV detection in the oral cavity and incident HNSCC. Design A nested case-control study was carried out among

96 650 participants, cancer free at baseline, with available mouthwash samples in 2 prospective cohort studies: (1) the American Cancer Society Cancer Prevention Study II Nutrition Cohort and (2) the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Incident cases of HNSCC (n = 132) were identified during an average 3.9 years of follow-up in both cohorts. Three controls per case (n = 396) were selected through incidence density sampling and matched on age, sex, race/ethnicity, and time since mouthwash collection. Methods Through a next-generation sequencing assay, DNA from α-, β-, and γ-HPV types were detected. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% CIs, adjusting for smoking history, alcohol consumption, and detection of HPV-16 for β- and γ-HPVs. Main Outcomes and Measures Incident HNSCC, which includes cancers of the oropharynx, oral cavity, and larynx. Results A total of 132 participants developed HNSCC during the follow-up period (103 men and 29 women; average age at baseline, 66.5 years). Oral HPV-16 detection was associated with incident HNSCC (OR, 7.1; 95% CI, 2.2-22.6), with positive association for oropharyngeal SCC (OR, 22.4; 95% CI, 1.8-276.7), but not for oral cavity (OR, 4.5; 95% CI, 0.6-34.7) or laryngeal SCCs (OR, 0.11; 95% CI, 0.01-834.80). Detection of β1-HPV-5 and β2-HPV-38 types, as well as γ-11 and γ-12 species, had ORs for HNSCC that ranged from 2.64 to 5.45 (P < .01 for all comparisons). Detection of β1-HPV-5 type was associated with oropharyngeal (OR, 7.42; 95% CI, 0.98-56.82; P = .054), oral cavity (OR, 5.34; 95% CI, 1.51-18.80; P = .01), and laryngeal SCCs (OR, 2.71; 95% CI, 1.00-7.43; P = .05), whereas γ11- and γ12-HPV species were associated with both oral cavity (OR, 7.47; 95% CI, 1.21-46.17; P = .03; and OR, 6.71; 95% CI, 1.47-30.75; P = .01, respectively) and laryngeal SCCs (OR, 7.49; 95% CI, 1.10-51.04; P = .04 and OR, 5.31; 95% CI, 1.13-24.95; P = .03, respectively). Conclusions and Relevance This study demonstrates that HPV-16 detection precedes the incidence of oropharyngeal SCC. Associations of other HPVs, including γ11- and γ12-HPV species and β1-HPV-5 type suggest a broader role for HPVs in HNSCC etiology.

Agalliu I, Gapstur S, Chen Z, et al. Associations of Oral α-, β-, and γ-Human Papillomavirus Types With Risk of Incident Head and Neck Cancer. JAMA Oncol.Published online January 21, 2016. doi:10.1001/jamaoncol.2015.5504 A little out of date. 20** numbers are probably higher in all categories. Who does what to whom? Older adults think oral sex is more intimate than intercourse. (Chambers, 2007) Teens and young adults think the opposite, oral is LESS intimate. (Gelperin, 2005) Of 15-19 year olds, 55% have had oral sex, 50% had intercourse. (Duberstein, 2008)

Is oral sex, “sex” for young people? “Would you say you ‘had sex’ if you engaged in………..?” “Yes”… for oral sex = 20%, intercourse = 98% , anal = 78% (Hans, 2010)

Can you catch diseases from oral sex? YES, you can, including HIV, HPV, Chlamydia, herpes……

Some suggestions for you……

Anal Stimulation • Prevalence is lower than other forms of sexual activity, but the number of people who have engaged in is increasing among heterosexuals. About 40% of men/women up to age 39 have had anal sex at least once. About 50% of women had to stop prior to full penetration due to discomfort. • HIV, other infection risks are HIGHER THAN any other form of sex. The tissues are delicate, tear easily and allow blood contact. Wear a raincoat or don’t go there. NEVER go from anus to vagina or mouth. • Lubricants and gentle insertion needed. Be very careful NOT to fully penetrate with objects. The anal sphincter can close and the object can become trapped. • /rimming • VERY risky, lots of infections transmitted this way. Two words: DENTAL DAM

Coitus and Coital Positions

• Position variations Lots…….

But, first….. A word…..

Man-above, face-to-face intercourse position, “Missionary”, and variations. The woman-above intercourse position, “cowgirl”, “ride the cowboy”, “reverse cowgirl”, and variations. “”, “Discovery Channel”, position and variations. Side-lying intercourse position and variations. The rear-entry intercourse position can be a comfortable option during pregnancy. Intromission: entry of the penis into the vagina. Variations in Sexual Arousal

Variation in sexual arousal due to both and culture Tantric Intercourse, Tantric sex, “Tantra”. • Ancient Eastern path to spiritual enlightenment, India, 5000 BCE. Tantric and/or erotic act between two gods created the world (depending on source). • Sexual expression considered a form of spiritual meditation • Involves control and delay of male orgasm with focus on harmony with partner • Minimal thrusting, maintain erection, small, gentle movements, muscle contractions, synchronize breathing, visualize energy rising through their bodies, create a “deep relaxation of the heart”.

End