What is human sexuality?

It is an umbrella term generally referred to the expression of sexual sensation and related intimacy between human beings. It also includes expression of identity through sex (influenced by or based on sex).

Sexuality is an expression of who we are. It involves a person’s thoughts, feelings, sexual expression. It varies across the cultures and regions of the world and has continually changed throughout history.

 

What is Sexual Health?

Ability to enjoy and express one’s sexuality free from the risks of STIs, unwanted pregnancies, violence and discrimination.

One’s biological characteristics:

-Anatomical:    Breast, vagina(Female), penis, testicles(Male)

-Physiological:    menstrual cycle(Female), spermatogenesis(Male)

-Genetics:    XX(Female), XY(Male)

A person’s core sense of being male/female/a place in between. Erotic/romantic attraction for sharing sexual expression with members of the opposite  sex (heterosexual), one’s own sex (homosexual), or both sexes (bisexual).

Various activities related to the expression of one’s sexuality (what people do sexually with others and themselves) eg: touching, kissing, other stimulation of body and penetration. It represents a very complex integration between biology and psychology. In most societies and legal jurisdiction, there are legal bounds on what sexual behaviour is permitted.

It is a sequence of emotional and physical changes that occur as a person becomes sexually aroused and participates in sexual activity.

It has 4 phases.

  1. Excitement:
    It lasts from a few minutes to several hours and is brought on by sensory stimulation, thought and fantasy. This leads to intimacy and sexual activity, during which there is an increase in the heart rate, blood pressure and the respiratory rate. There is also an increase in the muscle tension and an increase in the blood flow to the genitals.
    In addition, there is erection of the nipples, the feeling of breast fullness and lubrication of vagina in the females.
    In the male, the testicles swell and tighten and penile erection occurs.
  2. Plateau
    If physical/mental stimulation continues, plateau stage is achieved, during which the above changes are intensified. Heart rate, blood pressure, respiratory rate increases further. In the male penile erection is maintained and the testes is raised further. In the female there is breast engorgement and areolar enlargement. The labia and the lower 1/3 of vagina swells.
  3. Orgasm (climax of the SRC)
    Sudden forceful release of the sexual tension, occurs at the peak of the plateau phase. It lasts only a few seconds. Sometimes, in certain females, a rash may sometimes appear over the entire body. In females, there may be accompanying tightening of the vagina whereas in the male rhythmic penile contractions and ejaculation occur.
  4. Resolution
    The body slowly returns to its normal level of functioning and due to the release of chemicals within the body, there is sense of well being.
    Males need recovery time after orgasm.
    Females gain rapid recovery, therefore can have multiple orgasms.

Common sexual problems:

Male:

Premature ejaculation

Erectile dysfunction

Female:

Vaginismus

Both (male and female):

Loss of sexual desire (Loss of Libido)

Orgasm problems

 

Premature Ejaculation

This is when ejaculation occurs more quickly than a man and his partner would wish, causing problems in a sexual relationship. Usually, the man experiences this during penetration itself or very soon afterwards.

It’s a relatively common problem – in fact, the most common sexual dysfunction in men. Lifetime prevalence is around 30%.

This is more common among the younger males, especially in the early sexual relationships.

 

It’s very rarely caused by a physical problem.The most common causes are:

  • Stress
  • Anxiety about sex (fear of failure)
  • Relationship difficulties
  • Guilt and anger
  • Inexperience in the early sexual relationships

Remember, this is a very common issue!! So you are not alone. There’s not much you can do, except find better ways of coping with stress and resolving difficulties with your partner. You should see a doctor, if the problem is persisting and causing you anxiety or affecting your relationship.

Behavioural treatment works well for premature ejaculation.

  1. Relaxation-
    Most of the time, it resolves on its own over time with simple relaxation techniques to overcome stress and tension.
  2. Sex Therapy- 2 techniques.
    Stop – Start method:
    *You stimulate your penis (or ask your partner to do it for you) until you’re near the point of ejaculation. Then stop and rest for 30–60 seconds before stimulating your penis again. You repeat this process five or six times in each  session.Squeeze technique:
    *You stimulate your penis (or ask your partner to do it for you) until you’re near the point of ejaculation. This time, you or your partner firmly squeeze around your penis just below the glans penis (head) – put your thumb on the underside of the penis in the indent where the head meets the shaft (the frenulum) and your first and second fingers on the other side of the penis, just above and below the ridge that separates the head from the shaft. The squeeze has the effect of preventing ejaculation.
  3. Medication:
    Doctors may sometimes prescribe short courses of antidepressants, as a treatment of overcoming stress. Remember, the decision of use of such drugs has to be strictly confined to the doctor due to the unpleasant side effects of these drugs. Short-term remedies such as wearing a condom with benzocaine, lubricants with benzocaine or use of anaesthetic sprays, to reduce the sensitivity of the penis can also be helpful.

Erectile dysfunction (Impotence):
It means the persistent inability to reach or maintain an erection, good enough to complete any sexual activity satisfactorily.
Prevalence rises with age, therefore commoner in older males.

 

It may either may be due to physical or psychological causes. The majority of cases are found to be due to physical causes. So, it’s better that you seek medical advice as soon as you notice this problem.The main physical causes are:

  • Diabetes:
  • Inadaquate blood flow to the penis:
    This is commonly resulted by a condition called atherosclerosis caused by smoking cigarettes etc.
  • Regular heavy drinking:
    Alcohol can damage the nerves leading to the penis, reduce testosterone levels and increase levels of the female hormone oestrogen.
  • The side-effects of certain drugs:
    Particularly, those used to treat high blood pressure, heart disease, depression, gastric ulcers and cancer can cause impotence.
  • Neurological causes
  • Pelvic surgery (eg: surgery in the prostate gland).

The main psychological causes are:

  • Relationship conflicts
  • Stress & Anxiety
  • Depression
  • Sexual boredom (Loss of interest in the sexual partner)

Have a healthy lifestyle. Quitting smoking and alcohol. Regular aerobic exercise and a low-fat diet will also reduce the risks of atherosclerosis.
If you have Diabetes, ensure it is properly controlled.

Remember, this is a very common issue!! So you are not alone. There’s not much you can do, except find better ways of coping with stress and resolving difficulties with your partner. You should see a doctor, if the problem  persists and is causing you anxiety or affecting your relationship.

  • Psychological Support:

Whatever the cause or treatment of their erectile dysfunction, many men could benefit from counselling or sex therapy. Sex therapy will be particularly necessary if the erectile dysfunction has psychological causes which can’t actually be “cured” with physical treatments.

  • Oral drugs:

There are now a number of oral treatments available, (Eg: Sildanafil,Tadelafil,vandenafil) and most work by helping to relax the blood vessels in the penis, allowing blood to flow in.

The most common side-effects are headaches and facial flushing.

*These oral treatments must not be taken by men using medicines containing nitrates (commonly prescribed for ischaemic heart disease).

  • Injection therapy:

This is an effective and reliable way of producing an erection with drugs, yet, the drug has to be injected every time they have sex. It relaxes the blood vessels and muscles, allowing increased blood flow and producing an erection within 15 minutes.

  • MUSE (medicated urethral system for erection):

It involves the insertion of  a small pellet, containing a drug increasing the blood flow to the penis, into the urethra through the opening to the penis.

  • Vacuum pumps:

The penis is inserted into a clear plastic cylinder and the air is pumped out, creating a vacuum,as a result the penis fills with blood,causing an erection.

  • Penile implants:
    A mechanical device is surgically inserted into the penis to create a rigidity in the penis.
  • Treatment of any underlying disease condition:
    Treatment and good control over Diabetes.

Vaginismus:
It is a condition in which there is involuntary tightening of the muscles surrounding the vagina, causing pain during intercourse. The tightness of the vagina may be so great that the opening of the vagina may be completely closed off, restricting the insertion of the penis at all.

Women with vaginismus are often unable to:

  • Tolerate vaginal penetration
  • Experience vaginal penetration without pain
  • Undergo a vaginal examination

This is commoner among the young women in their early sexual exposure.

Vaginismus does not have a single cause. It can occur due to a variety of physical and psychological causes.

Psychological causes include:

  • Anxiety and stress
  • Childhood experiences
  • Fear of pain
  • Pregnancy or tissue damage
  • Guilty feelings about sexuality
  • Relationship issues such as abuse, control, trust and vulnerability
  • Traumatic events such as rape or violence

Some of the physical causes of vaginismus are naturally occurring changes in a woman’s body.

  • Childbirth
  • Hormonal changes
  • Menopause .

Vaginismus can also be brought on by other medical conditions such as:

  • Pelvic inflammatory disease
  • Sexually transmitted diseases
  • Urinary tract infections
  • Vaginal prolapse
  • Fungal infections.

Pelvic trauma such as pelvic surgery (Eg: hysterectomy),trauma caused by rape.

In some cases, the cause of vaginismus remains unknown.

Treatment can be physical or psychological and is often individualized.
Counseling or therapy is aimed at resolving issues such as fears, strict religious upbringing and traumatic experiences

Therapy helps women with vaginismus deal with the problems of depression and low self-esteem that often accompany this condition.

Physical treatment of vaginismus is used to help relax pelvic floor muscles by alternative contraction and gradual dilatation using a finger or plastic dilators.

Loss of sexual desire
A condition in which you lack interest in sex, causing concern to you and/or your partner. This may sometimes lead to relationship problems.

 

There are a wide range of causes:

  • Relationship difficulties
  • Sexual boredom with a partner
  • Depression
  • Exhaustion
  • Stress
  • Low levels of testosterone
  • Lack of intimacy between partners
  • Communication problems
  • Not having enough time alone together
  • Strict upbringing concerning sex
  • Negative attitudes towards sex
  • Traumatic sexual experience
  • Illnesses & some medications
  • Lack of sleep
  • Hormonal imbalance

But, it’s possible that you simply have a naturally lower level of sexual desire than your partner and that your real problem is finding a way to negotiate some sort of compromise.

Have a healthy lifestyle. Quitting smoking and alcohol. Regular aerobic exercise and a low-fat diet will also reduce the risks of atherosclerosis.

If you have Diabetes, ensure it is properly controlled.

Remember, this is a very common issue!! So you are not alone. There’s not much you can do, except find better ways of coping with stress and resolving difficulties with your partner. You should see a doctor, if the problem is persisting and causing you anxiety or affecting your relationship.