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Human Sexuality

Clinical Update
By Zur Institute

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With the aging of the Baby Boomers, greater attention has been paid to maintenance of sexual health than ever before. In order to have a comprehensive awareness and understanding of Human Sexuality in this New Millennium, clinicians must know far more than Basic Anatomy!

Our online course on Human Sexuality for 10 CE Credits fulfills CA pre-licensing requirement. The course reviews basic anatomy, sexual function and response, and challenges and disorders of sexual function. Diagnostic formulations and treatments for the disorders that clinicians are most likely to encounter in clinical practice are also presented. Finally, challenges and complexities of sexuality within special populations are reviewed.


Facts about STDS:

  • One out of five adolescents and adults, have had genital HSV (herpes) infection. Between the late 1970s and the early 1990s, the number of Americans with genital herpes infection increased 30 percent.
  • Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five).
  • An estimated 2.8 million Americans are infected with chlamydia each year.
  • Women are frequently re-infected with chlamydia if their sex partners are not treated.
  • CDC estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year.
  • In 2002, there were more than 32,000 cases of syphilis reported in the U.S.
  • Each year, about 6.2 million people in the U.S. become newly infected with HPV.
  • There are more than 100 different types of HPV.
  • The single most important factor associated with invasive cervical cancer is the factor of never or rarely being screened for cervical cancer.



Facts about Sexual Disorders and Dysfunction

  • Most males, at some point in their lives, will have difficulty getting or keeping an erection.
  • This occurs in males of all age groups, not just older men!
  • It is estimated that 20-30 million men in U.S. suffer from erectile problems.
  • More than 50% of diabetic men may experience this complication, but over 95% of cases are successfully treated.
  • Male fertility depends on three primary elements: there must be adequate spermatozoa production by the testes, the sperm must be able to travel unobstructed through the seminal duct and the sperm must reach the ovum without fail.
  • Low sperm count is defined as less than 20 million sperm per milliliter (the "normal" sperm count is 200 million per ejaculate).
  • Low sperm motility is defined as less than 50% of the sperm have purposeful forward movement towards the ovum.
  • Poor sperm morphology means that less than 30% of the sperm have normal form and shape.
  • A woman's sexual response cycle is strongly influenced by the quality of the relationship with her partner.
  • Initial desire for a woman typically lessens with age but increases with a new partner at any age.
  • There are 5 major categories of female sexual dysfunction: sexual desire/interest disorder, sexual arousal disorders, orgasmic disorder, vaginismus, and dyspareunia. Disorder is diagnosed when symptoms cause distress.
  • 30% of women have some PCOS symptoms.
  • The most common psychogenic causes for Erectile Dysfunction: Anxiety (work, school), stress, guilt about sex (from religion, family, culture), fatigue, sexual problems are often rooted in relationship problems (power, trust, intimacy), feelings about partner (can influence sexual response), depression, sexual situation: place, time, person...are they right? anxiety about performance, size, etc.
  • The most common physical causes for Erectile Dysfunction: Vascular conditions, Alcohol, Medications, Diabetes, Abnormal nerve function, Hormone deficiency, Removal of prostate gland for cancerr, Other surgical procedure, Peyronie's disease, Illicit drugs, Smoking and diet, as contributing factors.
  • The most common psychogenic causes for Sexual Dysfunction in Women: Past negative sexual experiences, Emotional, physical, or sexual abuse during childhood or adolescence, Low self-esteem, shame, or guilt, Anxiety, Depression and mood frequent mood fluctuation, Fatigue, Stressors or distractions (home, work, family), Concerns about privacy and Concerns about unwanted outcomes, Desire for control, Fear of negative evaluation, rejection, or abandonment by lover, Negative feelings or reduced attraction toward a sex partner, Confirmed infertility.
  • The most common physical causes for Sexual Dysfunction in Women: Medical conditions causing fatigue or debility, Chronic Pain Disorders, Hyperprolactinemia, Hypothyroidism, Atrophic vaginitis, Bilateral oophorectomy in younger women with consequent hormonal cha, Psychiatric disorders & psychotropic medications that may inhibit desire, Oral estrogen and oral contraceptives increase SHBG which decreases the amount of free androgen available for tissue receptor binding, and ultimately reduces sexual desire and arousal, Uterine and ovarian disorders (fibroids, endometriosis), Presence of STDS, Pregnancy-related concerns (pregnancy, history of miscarriage, previous abortion)



Myths about Male Sexuality and Sexual Function

  • MEN ARE ALWAYS CAPABLE OF HAVING SEX: Feeling tired of having concerns about schoolwork or family can affect the degree of a man's desire and sexual functioning. Men should not attempt intercourse if they are not in the mood.
  • MYTH: PLEASURABLE CONTACT MUST LEAD TO SEX: This myth can add to performance anxiety when, in fact, many men and women enjoy pleasurable touching that does not lead to intercourse. It may help men and women to realize that an erection or arousal does not have to equal sex.
  • MYTH: REAL SEX REQUIRES THAT A MAN HAVE A GOOD, HARD ERECTION: Many men feel that the sexual encounter must end if he starts to lose an erection. This can lead to further anxiety about erections and sexual situations. Pleasure for both partners comes in many forms and can be achieved in a variety of ways!
  • MYTH: IF THE MAN IS NORMAL, ERECTIONS SHOULD BE AUTOMATIC: Many men, like many women, need direct manual or oral stimulation for the peniss to become sufficiently erect for intercourse. Media images lead us to believe that men - at any moment, at any time - are ready for sex both physically and psychologically. This is not true in real-life situations.
  • MYTH: IF A MAN HAS AN ERECTION, HE IS READY FOR SEX: Men develop erections in non-sexual situations. Erections occur during normal, nightly sleeping patterns (REM sleep). These erections are not related to erotic dreams. In addition, if a man experiences fear, (while sleeping or awake), he may get an erection, which is not due to sexual arousal or pleasure. Men can also be with a partner and have an erection without thinking sexual thoughts.



Facts about Sex in Special Populations

  • Nationally, more than half of teenagers are virgins until they are at least 17 years of age.
  • In the U.S., 7 in 10 women who had sex before age 14, and 6 in 10 of those who had sex before age 15 report having had sex involuntarily.
  • Nationally, one-quarter of 15 year old females and less than 30% of 15 year old males have had sex, compared with 66% of 18 year old females, and 68% of 18 year old males who have had sexual intercourse.
  • The level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population.
  • A recent survey of married men and women showed that 87% of married men and 89% of married women in the 60-64 age range are sexually active. Those numbers drop with advancing years, but 29% of men and 25% of women over the age of 80 are still sexually active.
  • Sex and disability are rarely discussed in the same sentence. As a result more than 50% of disabled people do not have any form of a regular sex life.
  • A person with a disability of some kind may tend to feel unattractive, or even less worthy of sexual partnership or relations, because they think that they can't live up to the idealized image today's society has set. If the disability happened later on in their life, the person may recall how they used to look and feel very unattractive by comparison to who they once were.
  • Physical disability can most certainly prevent experimenting with many sex positions or cause problems with sexual arousal and reduce their general libido.
  • 90% of female-to-male transsexuals and 61% of male-to-female transsexuals are sexually satisfied. 70% of female-to-male transsexuals and 43% of male-to-female transsexuals retain close contact with their families. 57% of female-to-male transsexuals and 27% of male-to-female transsexuals form lasting romantic partnerships.



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