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KIN 140

Section 11 SEX

Dr Mike Walsh

I. Sexuality Ones sexuality is a product of their biology and the social conditioning they have received. Biology is used to determine if someone is male or female. Man and woman refer to the psychosocial roots of our sexuality. And masculinity and femininity refers to the resultant of ones biology and psychosocial experience.

A. Biological Basis of Sexuality 1. Genetic Basis The biological basis of our sexuality is determined by whether an X sperm cell or a Y sperm cell wins the race to the egg. The egg is haploid (one set of chromosomes) X if it is fertilized by a haploid X sperm cell, a biological female (diploid) is produced. If the haploid X egg is fertilized by a haploid Y sperm cell then a biological male is produced. 2. Gonadal Basis Development of gonads: testes for males and ovaries for females, occurs within the first trimester of pregnancy. Development of male reproductive organs will take place if there is a presence of the SRY gene (sex-determining region on the Y chromosome) is expressed to make the protein testis-determining factor (TDF). If the SRY gene is not present, then female gonads will develop.

3. Structural Basis

In general, there is slow growth through childhood. In puberty there is an increase in male and female hormone (testosterone and estrogen (both are also needed for gonadal basis) that stimulates the growth of secondary sexual characteristics. In females, menarche also occurs at this time and both genders become capable of sexual reproduction. In males, normally testosterone is converted to a more potent form, dihydrotestosterone, by the enzyme 5-alpha reductase. Males lacking this enzyme often have female appearance and genitals and behaviour until puberty then develop male sex organs and behavior.

In the Dominican Republic, the incidence of 5-alpha reductase deficiency can be 1-2 %. These male children are called 'guevedoces' (literally, penis at 12 years). In later life, they to do not have male pattern baldness

4. Aging Females are born with a full complement of eggs. At menopause they have an abrupt cessation of reproductive capacity. This usually occurs at the age of about 50. Males have a gradual reduction in spermatogenesis but can be still be reproductive past 70. While there is some debate about exact egg number, it is remarkable that one cell can last 50 yr.

B. Psychosocial Basis of Sexuality 1. Gender Identity By the age of about 18 months, the infant recognizes itself as male or female and is quite robust by 3 yr. It is your own personal feelings combined with what you think you have in common with others.

2. Gender Preference The infant and child are steered subtly and /or overtly toward behaviours considered appropriate for the gender. This is done primarily by the parents but also by many outside influences. Whether this gender preference stage is truly environmental or has some genetic basis is open for discussion. Either way, if you ask some 7 year old children if they would be happier changing gender, you will get some very definitive responses. Certainly most children are very comfortable with their bodies, except for perhaps obesity.

3. Gender Adoption Observing, watching, and practicing what adults do enables the child and adolescent to begin thinking, feeling, and acting like an adult of their gender. Obviously, television can play a large part in gender adoption. Also learning the psychological attributes of the opposite gender is important to the development of a balanced sexuality.

4. Adult Gender Identification The final development of an adult image of oneself is in a gender-specific context. Of course this image may differ substantially between people because of their differing genetics and experience. This final image may also be changing with time: male levels of testosterone and viable sperm are decreasing.

5. Androgyny (andro=male, gyny=female) Androgyny is having a self-image that incorporates aspects of both genders. This combination of masculine and feminine qualities is more prevalent today than in past decades and centuries. In general, people who demonstrate a less polarized sexual image and a more androgynous one have greater self-esteem, more social, psychologically more flexible, and have more motivation to achieve.

C. Sex Anatomy and Physiology 1. Female Sex Organs The female anatomy in their genital region, from anterior to posterior, is the clitoris, urinary opening, vaginal opening, and anus. The clitoris is very sensitive to touch, hence it plays an important part of sexual arousal and orgasm.

The vaginal opening leads to the internal reproductive organs. It is the orifice of choice for most heterosexual intercourse, and it is also the birth canal. The vaginal opening is initially partially covered by the hymen. The hymen is ruptured during a womans first intercourse. It can also be ruptured by athletic activity. This means the absence of a hymen is not necessarily an indication of lost virginity.

2. Male Sex Organs Male organs in the genital area going anterior to posterior are the penis, testicles, and anus. At the head of the penis is the opening for the urethra, which serves for both the voiding of urine and ejaculation of semen.

The testicles are, by design, located exterior to the body core to maintain sperm temperature about 2.5 C lower than core temperature. Small changes in temperature strongly affect the viability of the sperm. The scrotum can substantially decrease its size when temperature is lower.

3. Circumcision This is when a male cuts off another males (not anesthetized) foreskin when all the other males leave the room. The reasons for this are cultural and religious. There is very little medical evidence to support the prevalence of this procedure. However, lately it has been shown that circumcised males suffer less STDs. This can be important in Africa since circumcision may reduce the spread of AIDS.

4. Female Sexual Cycle (aka Menstrual Cycle) The menstrual cycle is a monthly ovarian (thus female) cycle in which an egg is made receptive to fertilization and if fertilization does not occur there is a loss of blood and the enriched tissue lining of the uterus. The average female cycle is about 28 days although the duration between women does vary from 20-45 days. The average females first menstrual cycle (aka menarche) occurs at 12.8 yr with a substantially large but normal range.

The menstrual cycle consists of 4 phases: menses, estrogenic phase, ovulation, and progestational phase. a. Menses The onset of menstrual bleeding indicates day 1. With low levels of estrogen and progesterone, the outer portions of the endometrial lining degenerate and separate from the endometrium. The loss of blood and epithelial lining normally lasts about 5 days. b. Estrogenic Phase (aka Follicular Phase: ~8 days) Begins when menstrual flow ceases. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) are released in greater amounts from the anterior pituitary gland. Follicle stimulating hormone stimulates the egg/follicle to make estrogen. The uterine lining (endometrium) begins to thicken and gets enriched with blood vessels and glands in response to the increasing estrogen produced by the follicle. Thus the endometrium is prepared for implantation by a fertilized egg.

During this phase 5-25 follicles are released. Of these, a single follicle increases in size from 25 um to 15 mm diameter in response to the combined effects of LH, FSH, and estrogen. Of course the egg inside the follicle is much smaller.

c. Ovulation (1 day) Rapid increase in estrogen stimulates an increase in LH which induces ovulation: the release of the ovum from the follicle. This occurs at about day 14. The remaining follicle becomes the corpus luteum. d. Progestational Phase (aka Luteal Phase: 7-13 days) The remaining follicle tissue becomes luteinized (made yellowish) into the corpus luteum (yellow body). The corpus luteum is a separate endocrine organ that generates progesterone secretion and estrogen secretion. These hormones (especially progesterone at this time) stimulate the continued growth and development of the endometrial lining. They also inhibit further secretion of LH and FSH from the pituitary gland. If the egg does not become fertilized in the next about 12 days, the corpus luteum is preprogrammed to degenerate. Estrogen and progesterone decrease and can no longer maintain the uterine lining which then becomes the start of menses. Women are more creative in this phase.

D. Responsible Sexual Behaviour 1. Communication It is difficult to express your intentions and determine your partners when the hormones are flowing. To practice responsible sexual behaviour, it is necessary to understand why the sexual activity is occurring. Sex can be to express love, make babies, or attain physical gratification. Most sexual acts involve the latter. Most high school-aged males that engage in sexual activity have a higher than normal self-esteem. For similar aged females, they have a lower than average self-esteem and lower than average mental health. One might recognize incompatibility here.

2. Agreed-on Sexual Activities Each sexual partner must engage in each sexual act willingly. Coercion is a very bad sexual act; whether it is done by drugs or physical dominance, coercion is unacceptable. 3. Sexual Privacy Not only do you respect the person during the act, you respect them afterwards and do not discuss you or your partners sexual activities with others. Lose lips sink ships

4. Using Contraception If you do not want a pregnancy then use contraception. Methods discussed later. 5. Safer Sex With the prevalence of STDs in our society Anyone who is not in a mutually monogamous relationship with an uninfected partner and who wishes to have sex should always use a condom p88

6. Sober Sex As mentioned in the alcohol section, the use of drugs increases the risk of unplanned and unsafe sex. 7. Taking Responsibility If you engage in the activity you must accept the consequences. Consequences include not only pregnancy but also STDs and emotional changes.

E. Contraception (Chapter 6) In the majority of sexual intercourse acts, pregnancy is not a desired outcome. There is a large variety of contraceptive methods. With this is a variety of advantages and disadvantages including contraceptive failure rate. The contraceptive failure rate is the percentage of how many women out of 100 users become pregnant within one year. This can be due to both the nature of the contraceptive method used and the improper implementation. Some methods require a certain degree of motor skill; they should be practiced before being used. Abstenincesafest?

1. Reversible Contraceptives Reversible contraceptive methods are ones in which conception is possible after discontinuation. a. Oral Contraceptive (The Pill) This is the most common form of contraception for young women. The most common pill contains estrogen and progestin (a progesterone mimicking molecule). The elevated levels of these hormones prevent ovulation. It also reduces sperm and egg motility. The pill must be taken every day for 21 or all 28 days of the ovarian cycle. The pill is a very effective birth control method when instructions are followed. As with all birth control methods, older women follow the instructions more closely than younger women. The hormones make the body think it is pregnant and thus there is no ovulation. The woman still has her period while taking the pill. Some women take the pill, not for the contraceptive effects, but rather for the reduced menstrual cramps.

b. Contraceptive Implants Capsule(s) filled with progestin are inserted under the skin (usually the medial upper arm). These implants can maintain effectiveness for up to 5 years. Periods may be absent or stronger.

c. Injectable Contraceptives Long-lasting progestins (sometimes with other hormones) are injected every 1-3 months. Period tends to have some minor and irregular bleeding. Periods maybe become absent after a year in about 70 % of users.

d. Emergency Contraception Emergency contraceptives are oral contraceptives that are taken when regular contraceptive methods failed (e.g., broken condom) or were not used. These must be taken within 72 hr of intercourse. They function by preventing ovulation and slowing egg and sperm transport. If the woman is pregnant, emergency contraception has no effect.

Two or four pills are taken: 1-2 right away and 1-2 four hours later. One may also require antinausea medication.

e. Intrauterine Device (IUD) These are small plastic devices containing progestin. The device is placed in the uterus and can provide 1-10 yr of contraception. There are two types: one that contains copper and one that releases progesterone. The copper type works by impairing sperm mobility and also causing some irritation of the uterus lining preventing embryo implantation. The progesterone acts similar to a localized pill, maintaining local levels of progesterone while systemic levels are low. Use a condom for the first 2-3 months. Be sure one is not pregnant before insertion.

f. Condoms Historically, penis sheaths have been found on cave paintings dating back 15,000 BC, although the nature of these sheaths maybe be debatable. Romans used linen and attached them with a ribbon In the mid 1700s, animal membranes were being used. They need some serious preparation, often still had holes in them and (yuk) they were reusable. Today (since the late 1800s) condoms are single-use latex (sometimes polyurethane) tubes placed over the penis. They prevent the sperm from entering the vagina. They must be put on before insertion because pre-ejaculation fluid can contain sperm. Condoms are not as effective as the above-mentioned methods and reduce male sensation. However, their frequency of use has increased in the last 10 years because they help prevent some STDs. Any lubricant used with a condom must be water based. Oil-based lubricants dissolve latex quite rapidly. Do not use a lubricant for oral sex. g. Female Condoms

These condoms are larger (loose-fitting) than the male counterparts. Reality was the first to be sold in BC. It is a 2-ring design with one ring located at the cervix and the other ring outside of the vagina. It should be inserted 20 min before intercourse and can be inserted up to 8 hr prior to intercourse. Like the male condom, it is a barricade contraceptive device that also prevents some STDs. h. Vaginal Spermicides Spermicides are compounds designed to kill sperm. They come in foam, jellies, and creams. They are most effective (relative term) when applied 5-30 min prior to intercourse. They actually have a high failure rate and therefore are usually used in combination with other methods of contraception (e.g., used with barrier methods such as a cervical cap).

i. Fertility Awareness Method (aka Rhythm Method) In this method, the woman only has intercourse when she is not fertile and practices abstinence when she is fertile. The trick is in determining which phase of the menstrual cycle the woman is in and which days of that cycle she is fertile/infertile. From the beginning of menstruation, there is 6-9 days when the woman is infertile depending on the regularity of her ovarian cycle. Then there are 8-14 possible fertile days centered around ovulation. The woman is considered infertile during the remainder of the ovarian cycle. Fertility awareness uses body temperature and cervical mucus to determine the timing of the ovarian cycle. Clear cervical mucus means the woman is more fertile and cloudy means less fertile. For a 26-32 day cycle, days 8-19 are considered fertile. What do you call a couple who practices the rhythm method?..................... Table 6-3: Contraceptive Effectiveness. Method Contraceptive Implant Vasectomy Injectable Contraceptive Female Sterilization Copper IUD Progestasert IUD Oral Contraceptives Combination Percent One Year Failure Rate Typical Use Perfect Use 0.05 % 0.15 0.30 0.50 0.8 2.0 0.05 % 0.10 0.30 0.50 0.6 1.5 0.1

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Progestin Only Male Condom Withdrawal Female Condom Fertility Awareness Spermicides Chance

14 19 21 25 26 85

0.5 3 4 5 9 6 85

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Table 6-1: Contraceptive Risks Contraceptive Method

Risk of Death in Any Given Year

Oral Contraceptives Non-smoker Age less than 35 Age 35-44 Heavy Smoker < 35 35-44 IUDs Barrier Methods, Spermicides Fertility awareness Tubal Ligation Vasectomy Abortion Before 9 weeks After 15 weeks Illegal Abortion Pregnancy and childbirth

1 in 66,700 1 in 200,000 1 in 28,600 1 in 1,700 1 in 5,300 1 in 700 1 in 10,000,000 None None 1 in 38,500 1 in 1,000,000 1 in 1 in 1 in 1 in 262,800 10,200 3,000 10,000