Vail-SmithK HLTH 1000
 
 


 
 

Introduction to Sexuality


 
 
PART I:  Life's Greatest Miracle
For Part I you will be viewing the PBS Nova Series "Life's Greatest Miracle. 

+Warning:  There is a birth sequence at the end of this video which is really graphic (at about 54:00)
Click HERE to go to "Life's Greatest Miracle."   (Then click "Watch the Program.")

 
PART II: Introduction to Important Concepts

Click on the following topics to read more about it:

Defining Our Terms
  Sexual Practices & Health Implications
Sexual Orientation & Behavior
 Sexual Response Cycle
The Sociocultural Context
Sexual Dysfunction
Sexual Practices
References/Resources


*Note: Most of the information from Part II of this lesson comes from:  "Sexuality MiniCourse by Engender Health"   (As of 1-27-10...This minicourse is unavailable while it is being revised by the authors.)


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Defining Our Terms

 What Are “Sexuality” and “Sexual Health”?

SEXUALITY is reflected in the total expression of who we are as human beings. It is shaped by our values, attitudes, behaviors, physical appearance, beliefs, emotions, personality, likes and dislikes, and spiritual selves, as well as all the ways in which we have been socialized.

Sexuality begins before birth and lasts a lifetime, and it is influenced by ethical, spiritual, cultural, and moral factors. It involves giving and receiving sexual pleasure, as well as enabling reproduction. Sexuality is a total sensory experience, involving the whole mind and body—not just the genitals.

SEXUAL HEALTH is the ability to express one’s sexuality free from the risk of sexually transmitted infections (STIs), unwanted pregnancy, coercion, violence, and discrimination. It means being able to have an informed, enjoyable, and safe sex life, based on a positive approach to sexual expression and mutual respect in sexual relations. It is positively enriching, includes pleasure, and enhances self-determination, communication, and relationships.

Sexual health is defined by the World Health Organization (WHO) as follows:
 

The integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation.

 (WHO Technical Report Series #572)


Sex and Gender

Terms relating to sex and gender are at the core of any discussions relating to sexuality. These terms—which refer to biological or sociocultural definitions of “male,” “female,” “masculine,” and “feminine”—can cause considerable confusion and debate. 

One’s SEX refers to one’s biological characteristics—anatomical (breasts, vagina; penis, testicles), physiological (menstrual cycle; spermatogenesis), and genetic (XX; XY)—as a female or as a male.

GENDER refers to what a person, society, or legal system defines as “female” or “male.”

A GENDER ROLE describes the set of socially or culturally defined attitudes, behaviors, expectations, and responsibilities that is considered appropriate for women (feminine) and men (masculine).

Gender roles may vary according to culture, class, and ethnicity. For example, in some cultures, being a man means being strong, dominant, and unemotional, while being a woman means being sensitive, nurturing, and passive. 

One’s GENDER IDENTITY (also known as sexual identity) refers to the personal, private conviction each individual has about being “feminine” or “masculine.”
 

Our gender identity is at the core of how we feel about who we are. Some people are biologically male but internally feel female, and vice versa—these people may never feel comfortable living as defined by the sex they were born with.

Feeling locked into a gender role can limit one’s ability to express oneself: those who do not conform to their designated role may be subjected to criticism and attack. However, gender roles are not fixed—they can change over time as the society changes and as many individuals reject traditional roles. For example, rejection of traditional gender roles in some societies has resulted in: 

* Females having access to athletic, educational, & economic opportunities previously considered “male” fields
* Men taking a more active role in parenting and household work
* Men being more willing to express feelings (such as affection, grief, fear)
* Women taking a more active role in decision making within a relationship



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sexual Orientation and Behavior

SEXUAL ORIENTATION the erotic or romantic attraction (or “preference”) for sharing sexual expression with members of the opposite sex (heterosexuality), one’s own sex (homosexuality), or both sexes (bisexuality).
 

SEXUAL BEHAVIORS are actions (touching, kissing, and other stimulation of the body) related to the expression of one’s sexuality. Activities related to sexual expression that are performed habitually or repeatedly can be referred to as SEXUAL PRACTICES (although some use the terms “sexual behaviors” and “sexual practices” interchangeably). Sexual behaviors and practices are what people “do” sexually with others or with themselves.
  

Many people believe (and there is some scientific evidence to support the idea) that sexual orientation may be determined before birth, though orientation may also be influenced by social factors. It should be noted that a person’s sexual practices do not necessarily indicate sexual orientation or sexual identity. For example, one person may practice sexual behaviors with another person for reasons other than sexual orientation (for example, for survival, money, or power over another individual), or a person may practice sexual behaviors that conform to societal norms, even if the practice is not consistent with that person’s sexual orientation.



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Sociocultural Context of Sexuality

 Our values, experiences, families, peers, media, school, religion, law, and government all influence sexuality, gender roles, and sexual behaviors. Society determines what sexual information and behaviors are legally permitted or considered appropriate on the basis of:

* Tradition, customs, religion, values, and beliefs
* The history and experience of the culture
* Economic and political conditions

NORMS and VALUES
Every culture has norms related to sex and sexuality. These norms are reflected in gender roles, relationships, marriage, partnerships, friendships, and family. Societal norms often determine sexual practices, marriage customs, punishment for unapproved sexual behaviors, and attitudes toward prostitution, homosexuality, contraception, sexual taboos, and sexuality education.  For example, in the photo above, you see Utah's Tom Greene and his five wives and 21 children. 

All societies have values that guide private and public behavior. These values are formal—that is, defined by religions, governments, and other official entities shaping a society’s laws. However, informal values—those reflecting a person’s day-to-day behavior—may not be consistent with the culture’s formal values.

TABOO BEHAVIORS
For example, while some societies may have strict taboos on homosexual behavior and may deny the presence of homosexuality, there is evidence that homosexual identity or orientation exists in nearly all societies and cultures. Under these circumstances, homosexual practices in that society may be suppressed or kept within a private subculture. Equally, while a society may publicly prohibit sexual activity outside of marriage, many people may practice sex with a person who is not their spouse. In some cultures, it may be understood informally that this is common—even acceptable—while in other cultures, norms—and even laws based on these norms—may make these behaviors acceptable for one sex and not the other. For example, in some cultures it is acceptable for men to have multiple sexual partners or sex with a person who is not their spouse, whereas a woman in the same culture who has sexual relations outside of marriage may be stigmatized, punished, or socially ostracized—even if the woman has been raped.

Many other types of sexual taboos exist—some of these are nearly universal, while others are more rare. For example, many cultures have laws or taboos regarding sex or marriage with close family members (such as fathers with daughters or mothers with sons), but cultures vary in what they consider to be “too close” a relation (for example, some cultures allow first cousins to marry, while others do not). Many cultures have taboos regarding sex during menstruation, pregnancy, or lactation, while others do not.

Societal and cultural values influence the range of stimuli that provoke sexual desire, and ideals about the stimuli considered “sexual” or “attractive” can vary greatly between cultures and among subsets of a single culture. In addition, each individual reacts to sets of stimuli that are idiosyncratic—based on his or her own thoughts, feelings, and experiences. 

RELIGIOUS NORMS and VALUES
Religion shapes sexual values with “sacred” law that articulates a range of acceptable sexual behaviors and practices (whom an individual can marry, the types of sexual expression allowed, the use of contraception, etc.). In many countries, “sacred” laws continue to have a powerful impact on current secular law. For example, there are current laws in some countries against oral and anal sex—practices that were first outlawed in those countries by religious law in the Middle Ages.
 
 LAWS and Values
  Although some laws are designed to protect people against sexual abuse (e.g., rape, pedophilia, incest), some laws also regulate sexual conduct between consenting adults and may favor one gender or sexual orientation over another.

In some countries (e.g., Belarus, Cyprus, Romania), a homosexual or bisexual orientation is outlawed and discrimination is permitted. But laws can protect sexual practices as well. In some countries (e.g., Denmark, Holland, Sweden, and Ukraine), the legal rights of people with these sexual orientations are protected. 
 
 



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sexual Practices

 What People Do...
Sexual practices between consenting adults can include a wide variety of behaviors. Depending on the individual and his or her culture, each person may have different ideas about which practices they consider to be “sex.”

As an exercise, ask yourself how you feel about the following practices—and ask yourself which of the following practices you consider to be “sex”:

  • Hugging
  • Kissing
  • Masturbating
  • Manually stimulating your partner
  • Vaginal penetration
  • Anal penetration
  • Vaginal or anal penetration with objects
  • Oral-genital stimulation
  • Sexual excitement while looking at or reading pornography
  • Telephone, “cyber” sex or "sexting"
  • Dressing up in “sexy” clothes

Where and With Whom...

Besides their attitudes toward different sexual practices, all people have attitudes, biases, and values related to the circumstances under which people engage in sexual practices. For example, ask yourself if you feel differently about any of the above practices in the following situations:
  • When done by a man and a woman
  • When done by two people of the same sex
  • When done by groups of people of both sexes
  • When one partner is getting paid for it
  • When done in a public place
  • When done by two unmarried people
  • When done by a young married couple
  • When done by an old married couple
  • When one person is married, but the other is not
  • When one person has many partners
  • When one person is much older than the other 
    • When the people do not know each other




 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sexual Practices and Their Health Implications
We would be remiss indeed if in a health class we did not discuss health risks of some of the common sexual practices.
 
(For a complete glossary of health practices, CLICK HERE.)

Masturbation (manual or other non-penetrative stimulation of oneself or a partner for sexual pleasure)

  • Self-stimulation involves no risk of pregnancy or transmission of Sexually Transmitted Infections (STIs).
  • In partner or group masturbation, there is a possibility of disease transmission from one person to another because body fluids and infections can be transmitted by contact with the hands or objects used. To maintain general hygiene, partners should wash their hands and any objects used before and after masturbating themselves or each other.
  • Note: Masturbation should not be performed on a part of the body that has skin lesions, sores, or abnormal discharge, because there is a risk of spreading infection (e.g., herpes, syphilis) to other parts of the body.
Vaginal Penetration (penile-vaginal penetration, manual penetration of the vagina, or penetration of the vagina with objects)
  • Because semen, vaginal fluids, and other body fluids are transferred between partners, unprotected penile-vaginal sex can result in pregnancy or, if one partner is infected, in transmission of STIs. 
  • The best way to avoid transmission of HIV or other STIs is to engage in unprotected penile-vaginal sex only with an uninfected partner. Or, if the partner is known to be infected or the STI status is unknown, it is important to cover the penis with a new condom every time you engage in penile-vaginal sex with an infected partner or any partners whose STI status is unknown.
  • “Dry sex” (using herbs, cloths, or other materials to dry out the vagina and increase friction) can be a painful and harmful practice. Lubrication provides the vagina with moisture to facilitate penetration while allowing for pleasurable friction from thrusting. Dry sex increases a woman’s chances of experiencing tears, scrapes, or other damage to the vagina and may increase a woman’s risk of contracting HIV or other STIs.
  • Objects used to penetrate the vagina should be clean and nonbreakable, should have no sharp edges, and should not be shared with other people. Whenever possible, cover the object with a new, lubricated condom each time before it is used to penetrate the vagina. If a condom is not used, always wash the object immediately before and after any act of penetration.
  • If anal penetration precedes vaginal intercourse, change the condom on the penis or object after anal penetration and before inserting the penis or object into the vagina to avoid bacterial infection. If a condom is not used, wash the penis or object before insertion into the vagina.
Oral-Genital/Oral-Anal Sex (stimulation of the male or female sexual organs or anus by sucking or rubbing or licking with the lips, mouth, or tongue)
  • These practices involve no risk of pregnancy.
  • Since body fluids and infections can be transmitted by oral-genital contact, transmission of STIs is possible. To reduce the risk of infection, engage in unprotected oral-genital sex only with a partner who is not infected with an STI. Or, if a partner is infected or the STI status is unknown, with female partners, use a thin piece of rubber, latex dental dam, female condom, or cut-open, unlubricated male condom, placing it between the mouth and the vulva before any oral contact is made. With male partners, cover the penis with an unlubricated condom before any oral contact is made.
  • Avoid oral-genital sex with partners who have sores on their genitals or abnormal discharge from the vagina or penis.
  • During oral-anal contact, use a barrier (such as a thin piece of rubber, latex dental dam, or cut-open, unlubricated condom) between the mouth and the anus to avoid the transmission of infection.
Anal Penetration (penile-anal penetration, manual penetration of the rectum, penetration of the rectum with objects)
  • Most STIs can be transmitted by anal or rectal contact. Anal sex is especially risky for transmission of STIs such as HIV because inserting and thrusting the penis or other objects in the anus can cause tears and bleeding in the rectum, facilitating transfer of blood-borne germs. Intestinal infections and diarrheal diseases can also be transmitted by anal and rectal contact.
  • To reduce the risk of infection, engage in unprotected anal or rectal penetration or stimulation only with partners who are not infected with an STI. With all other partners, use latex or plastic gloves on hands that will come in contact with the anus or rectum, put a condom over the touching finger(s), or cover the penis or object with a condom. 
  • The anus and rectum do not have natural lubrication, so artificial lubricant should always be used before anal penetration. If using a condom, to avoid breakage use one with extra water-based lubricant and change the condom before inserting the penis or object into the vagina or mouth after rectal penetration. If a condom is not used, wash the penis or object before putting it into the vagina or mouth.
  • Always wash hands thoroughly before and after touching the anal or rectal area. Avoid inserting fingers into the rectum if open sores are present on the hands or fingers.

    •  Objects used to penetrate the rectum should be clean and nonbreakable, should have no sharp edges, and should not be shared with other people. Cover the object with a lubricated condom before it is used to penetrate the rectum. Do not insert the object too deeply into the rectum. Rarely, an object inserted in the rectum may break or may become lodged and cannot be retrieved. In these cases, medical help will be needed.




 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Sexual Response Cycle

 
If you're feeling a little rusty on human sexual anatomy, CLICK HERE for a quick refresher course.

There are FIVE MAIN STAGES of the sexual response cycle: 

Stage 1: DESIRE
Our minds and bodies can respond sexually to a variety of stimuli—including sight, sound, smell, touch, taste, movement, fantasy, and memory. These stimuli can create sexual desire—a strong wanting for sexual stimulation (either by oneself or with another person) or sexual intimacy that may cause one to seek sexual satisfaction. Societal and cultural values influence the range of stimuli that provoke sexual desire, and ideals about the stimuli considered “sexual” or “attractive” can vary greatly between cultures and among subsets of a single culture. In addition, each individual reacts to sets of stimuli that are idiosyncratic—based on his or her own thoughts, feelings, and experiences. 

Indications of Desire: Desire is a prelude to sexual excitement and sexual activity—it occurs in the mind rather than the body and may not progress to sexual excitement without further physical or mental stimulation. Desire may be communicated between potential sexual partners either verbally or through body language and behavior (for example, through “flirting”). This communication, which is shaped by sociocultural factors, may be subtle and easily misread. In different cultures, behaviors meant to communicate desire may vary greatly along gender lines; for example, in some cultures, women are expected not to express overt, verbal communication of their sexual desire, whereas such communication from men is expected.

Stage 2: EXCITEMENT (arousal)
Excitement is the body’s physical response to desire. (A person who manifests the physical indications of excitement is termed to be “aroused” or “excited.”) The progression from desire to excitement depends on a wide variety of factors—it may be brought on by sensory stimulation, thoughts, fantasy, or even the suggestion that desire may be reciprocated. For some persons (particularly for some adolescents), the excitement stage may be achieved with very little physical or mental stimulation, whereas for others, significant intimacy, physical stimulation, or fantasy may be required. It generally takes longer for women to achieve full arousal than for men to do so. Excitement may lead to intimacy and sexual activity, but this is not inevitable: for both sexes, initial physical excitement may be lost and regained many times without progression to the next stage.

Indications of Excitement: Excitement can be communicated between partners verbally, through body language, through behavior, or through any of the following body changes: 

* For both sexes: Heart rate and blood pressure increase, body muscles tense, sexual flush (reddening of the skin) occurs, nipples become erect, genital and pelvic blood vessels become engorged, and involuntary and voluntary muscles contract. The aroused person feels a sense of restlessness.
* For women: The vagina lengthens and widens, the clitoris swells and enlarges, breasts increase in size, the labia swell and separate, the vagina becomes lubricated and darkens, and the uterus rises slightly. Vaginal lubrication is the key indicator of sexual excitement.
* For men: The penis becomes erect, the scrotum thickens, and the testes rise closer to the body. Erection of the penis is the key indicator of sexual excitement.

Stage 3: PLATEAU
If physical or mental stimulation (especially stroking and rubbing of erogenous zones or sexual intercourse) continues during full arousal, the plateau stage may be achieved. This stage, the highest moment of sexual excitement before orgasm, may be achieved, lost, and regained several times without the occurrence of orgasm. 

Indications of the Plateau Stage: The plateau stage can be communicated between partners verbally, through body language, through behavior, or through any of the following physiological changes: 

* For both sexes: Breathing rate, heart rate, and blood pressure further increase, sexual flush deepens, and muscle tension increases. There is a sense of impending orgasm.
* For women: The clitoris withdraws, the Bartholin’s glands lubricate, the aureola around the nipples become larger, the labia continue to swell and deepen in color, the uterus tips to stand high in the abdomen, and the “orgasmic platform” develops (that is, the lower vagina swells, narrows, and tightens).
* For men: The erect penis darkens, the ridge of the glans penis becomes more prominent, the Cowper’s glands secrete pre-ejaculatory fluid, and the testes rise closer to the body.

Stage 4: ORGASM
Orgasm occurs at the peak of the plateau phase. At the moment of orgasm, the sexual tension that has been building throughout the body is released, and the body releases chemicals called endorphins, which cause a sense of well-being. Orgasm can be achieved through mental stimulation and fantasy alone, but more commonly is a result of direct physical stimulation or sexual intercourse (although many women report difficulty in achieving orgasm through vaginal intercourse alone). Women are capable of multiple orgasms (moving immediately from orgasm back into the plateau stage and to orgasm again), whereas men must pass through the resolution stage before another orgasm can be achieved.

Indications of Orgasm: The intensity of orgasm can vary among individuals and can vary for an individual from one sexual experience to another. Orgasm may involve intense spasm and loss of awareness, or it may be signaled by as little as a sigh or subtle relaxation. Orgasm can be communicated between partners verbally, through body language, through behavior, or through any of the following physiological changes: 

* For both sexes: Heart rate, breathing, and blood pressure reach their highest peak, sexual flush spreads over the body, and there is a loss of muscle control (spasms).
* For women: The uterus, vagina, anus, and muscles of the pelvic floor contract five to 12 times at 0.8-second intervals.
* For men: Ejaculation (contractions of the ejaculatory duct in the prostate gland cause semen to be ejected through the urethra and penis) occurs, and the urethra, anus, and muscles of the pelvic floor contract three to six times at 0.8-second intervals.

Stage 5: RESOLUTION
Resolution is the period following orgasm, during which muscles relax and the body begins to return to its pre-excitement state. Immediately following orgasm, men experience a refractory period, during which erection cannot be achieved (the duration of this period varies among individuals and increases with age). Women experience no refractory period—they can either enter the resolution stage or return to the excitement or plateau stage immediately following orgasm.

Indications of Resolution: Resolution can be communicated between partners verbally, through body language, through behavior, or through any of the following body changes: 

* For both sexes: Heart rate and blood pressure dip below normal, returning to normal soon afterward; the whole body (including the palms of hands and soles of feet) sweats; there is a loss of muscle tension, increased relaxation, and drowsiness.
* For women: Blood vessels dilate to drain the pelvic tissues and decrease engorgement; the breasts and areolae decrease in size; nipples lose their erection; the clitoris resumes its prearousal position and shrinks slightly; the labia return to normal size, position, and color; the vagina lightens in color and relaxes; the cervix opens to help semen travel up into the uterus (closing 20?30 minutes after orgasm); and the uterus lowers into the upper vagina (location of semen after male orgasm during penile-vaginal intercourse).
* For men: Nipples lose their erection; the penis lightens in color and becomes softer and smaller; the scrotum relaxes, and the testes drop farther away from the body. Depending on a number of factors (including age), the refractory period in men may last anywhere from five minutes to 24 hours or more.
erotic or romantic attraction (or “preference”) for sharing sexual expression with members of the opposite sex (heterosexuality), one’s own sex (homosexuality), or both sexes (bisexuality).

MALE Sexual Response



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sexual Dysfunction

 What is "Sexual Dysfunction"? 
Sexual dysfunction is the persistent or recurrent inability to react emotionally or physically to sexual stimulation in a way expected of the average healthy person or according to one’s own standards of acceptable sexual response. Sexual dysfunction can occur during the desire, excitement, plateau, or orgasm stage of the sexual response cycle. 

For example, one of the most common dysfunctions is inhibited arousal during the excitement stage. This presents as erectile dysfunction (impotence) in men or lack of lubrication in women. Occasional inhibited arousal is common and not dysfunctional; however, chronic inhibited arousal is a sexual dysfunction that can be caused by recreational drug use, certain medications, certain diseases, physical damage, or psychological factors. Any of the following factors can contribute to sexual dysfunction:

  • Psychological/emotional factors, including stress, negative body image, performance anxiety, expectation of failure, fear of pregnancy, memory of negative sexual experiences, and fear of acquiring or transmitting a sexually transmitted disease
  • Biological/physiological factors, including changes related to aging, certain medical conditions (arthritis, reproductive cancers, diabetes, cardiac disease, hypertension), physical injury (such as spinal cord injuries), the effects of hormonal contraceptive methods, pregnancy, and substance abuse
  • Interpersonal/social factors, including peer pressure, poor communication with a partner, sexual abuse, attitudes toward sexual orientation, uncertainty of how to behave, and conflicts with one’s partner

    •  Environmental factors, including cultural influences, gender dynamics, availability of partners (partner ratio), and physical setting (lack of privacy)

Common Sexual Dysfunctions

Inhibited sexual desire (ISD) 

Sexual desire changes over the course of our lives, and occasional loss of desire in either sex is not uncommon. In ISD, however, there is persistent loss of desire that disrupts sexual relationships. It is characterized by diminished sexual attraction, decreased sexual activity, few or no sexual dreams or fantasies, and diminished attention to erotic material by one or both partners. ISD is the most common presenting sexual dysfunction in women and is less commonly reported in men. Female sexual arousal disorder (FSAD) is the name for persistent or recurrent inability to achieve or maintain an adequate lubrication-swelling response. (A woman with FSAD may or may not find enjoyment in physical contact.)

Causes of ISD: 

  • Contributing factors to ISD include hormone deficiencies, depression, alcoholism, liver or kidney disease, and chronic illness, as well as the side effects of drugs (e.g., antihypertensives and antidepressants). Psychological contributing factors include stress, relationship problems, sexual trauma, major life changes, and the pairing of negative memories with sexual interactions.
  • In women. Testosterone plays a vital role in women’s sexual desire. Reduction in testosterone (e.g., due to removal of ovaries, chemotherapy, menopause) can be treated through supplementation of the hormone. Life events affecting hormonal patterns (though not fully understood) include premenstrual tension, childbirth, pregnancy, and menopause. 
  • In men. Sexual desire in men can be inhibited by many physical and psychological factors. In the presence of testosterone deficiency, signs and symptoms include loss of facial and body hair, decrease in lean muscle mass, fatigue, loss of energy or lethargy, and erectile dysfunction (ED). 

Dyspareunia

Dyspareunia is a condition in women characterized by recurrent genital pain with sexual activity. Pain usually occurs with penetration but can occur during non-penetrative genital stimulation as well. The pain can be superficial (at the vaginal opening) or deep inside the vagina. Repeated pain can create a negative cycle, leading to avoidance of sexual activity, lack of arousal, anorgasmia, and ISD. Symptoms may include burning, itching, stinging, or inflammation in any area of the perineum. 

Causes of dyspareunia: 

  • The main causes are vulvovaginitis, genital herpes, atrophic vulvitis, urethral problems, episiotomy, radiation vaginitis, and sexual trauma, as well as inadequate lubrication or topical irritants such as spermicides or latex. 
  • Deep pelvic pain is often associated with thrusting by the partner that hits an ovary during sexual intercourse, pelvic inflammatory disease (PID), pelvic or abdominal surgery, postoperative adhesions, endometriosis, genital or pelvic tumors, irritable bowel syndrome, urinary tract infection, and ovarian cysts. Dyspareunia can also have psychological causes.

Vaginismus 

Vaginismus is a condition in women characterized by difficulty in achieving penetration or discomfort during penetration due to involuntary contractions of vaginal muscles. Some women’s symptoms are so severe that they avoid any sexual contact; others may have satisfying sexual experiences through extensive foreplay leading to orgasm without penetration.

Causes of vaginismus:

  • Vaginismus is often the result of physical or sexual abuse that causes a phobic reaction at the prospect of vaginal penetration.
  • Other causes may include painful first intercourse, relationship problems, fear of pregnancy, rape, religious orthodoxy, or the woman’s belief that her vagina is too small. It has been suggested that a woman experiencing psychological conflict may indirectly express anger toward her partner by closing off her vagina.

Anorgasmia

Anorgasmia is a condition in women characterized by a persistent or recurrent delay in or absence of orgasm following a normal sexual excitement or plateau stage. Affected women may have strong sexual desire, adequate arousal during the excitement stage, and pleasure with vaginal penetration but are unable to experience orgasm, even with adequate stimulation. (Note: Women are often misdiagnosed as anorgasmic if they are not able to experience an orgasm through penile-vaginal intercourse. A woman is not anorgasmic if she can achieve orgasm through means other than penile-vaginal stimulation.)

Causes of anorgasmia:

  • These include anger and hostility toward one's partner, ineffective sexual technique, anxiety, familial or religious teachings that discourage sexual stimulation, and strong fear of loss of control over feelings and behavior. 
  • Anorgasmia can be experienced where communication between partners is poor and where the sexual or emotional needs of the anorgasmic partner are not satisfied.

Premature ejaculation (PE)

Premature ejaculation is a condition in men characterized by persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. PE occurs when a man is unable to exert reasonable voluntary control of his ejaculatory response and is unaware of erotic sensations leading to the “point of inevitability” and ejaculation. PE is most common among younger men and men with limited sexual experience. The condition is often associated with performance anxiety.

Causes of PE: 

  • Causes are rarely physical. Some infections of the urethra and prostate, neglected gonorrhea, and overly tight foreskin have been considered as possible physical causes. 
  • More commonly, the affected man has not learned to recognize the sensory feedback that indicates ejaculation is imminent. This is common among men who have taught themselves to ignore this sensory feedback and “think of other things” as a means of avoiding ejaculation before they are satisfied or before their partner is satisfied. 

Male orgasmic disorder

Male orgasmic disorder is persistent or recurrent involuntary delay in orgasm and ejaculation or the inability of the man to have orgasm. (Note: This is sometimes confused with retrograde ejaculation—a condition in which the man ejaculates into his bladder instead of out through the urethra. Retrograde ejaculation is common in gay men and may be related to fears of infection believed to be brought on by “safer sex” campaigns.) 

Causes and treatment of male orgasmic disorder:

  • The cause is rarely physical and rather is associated with a traumatic sexual experience, strict religious upbringing, hostility, overcontrol, or lack of trust. 
  • Psychological exploration and counseling is the indicated treatment.

Erectile dysfunction (ED)

ED (also known as impotence) is the persistent or recurrent inability in men to attain an erection or to maintain an erection until completion of sexual activity. (Note: Occasional inability to achieve erection may cause undue stress and result in performance anxiety, which affects future functioning and creates a cycle of impotence. Occasional impotence is common; this is usually situational and is not considered dysfunctional.) Erectile dysfunction, usually of an organic type, is being seen increasingly in those with late stage HIV. It is not yet clear whether ED is an effect of the virus or of the antiviral drugs used to treat infection.

Causes of ED:

  • Drugs, alcohol, diabetes, Parkinson’s disease, multiple sclerosis, HIV, other diseases, and spinal cord lesions can cause ED.
  • Approximately one-third of cases are psychological, one-third physical, and the remaining third have a mix of both causes.
  • Performance anxiety is often associated with ED.


 
 
Most of the information from this lesson comes from:
"Sexuality MiniCourse by Engender Health" 
For more information, Click Here to view the entire minicourse.