1. Chapter 4
Sexual Health

2. Sexual Health Defined:
“A state of physical, emotional, mental and social well-
being related to sexuality; it is not merely the absence of
disease, dysfunction or infirmity. Sexual health requires a
positive and respectful approach to sexuality and sexual
relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of
coercion, discrimination, and violence. For sexual health
to be attained and maintained, the sexual rights of all
persons must be respected, protected, and fulfilled.”
World Health Organization [WHO]. (2006). Defining Sexual Health. Report of a technical consultation on sexual health 28–31 January
2002, Geneva, Switzerland: WHO. Available at: http://www.who.int/reproductivehealth/publications/en/

3. Perspectives on Sexual Health
and Sexuality (1 of 4)
Cultural and religious dimensions
• “Marriage” is universal theme in all cultures
sanctioning sexual privileges and obligations.
• Sexual behavior is often defined by cultural values.
– Normative sex roles
– Acceptable types of sexual activity
– Sanctions/prohibitions on sexual behavior
– Premarital sex
– Sexual restraint for females
– Same-sex relationships
– Contraception decision making

4. Perspectives on Sexual Health
and Sexuality (2 of 4)
Economic dimensions
• Daughter in marriage = dowry
• Value of bride = virginity
• Sexual aggression = power and economic
dynamics
• Commercial sex industry/prostitution

5. Perspectives on Sexual Health
and Sexuality (3 of 4)
Legal dimensions
• Laws prohibiting certain types of sexual
behavior/intimacy—cohabitation, fornication,
sodomy
• Same-sex partners
• Marriage, annulment, separation, divorce, child
custody, child support

6. Perspectives on Sexual Health
and Sexuality (4 of 4)
Political dimensions
• Sex education in schools
– Abstinence-only until marriage programs
– Comprehensive or abstinence-plus programs

7. Class Discussion
What are some current national or international
news items related to:
• The commercial sex industry or prostitution?
• Marriages between same-sex partners?
• Sex education curricula in schools?

8. Sexual Behavior among
Youth in the United States
Figure 4-1 Sexual behaviors among U.S. youth, 2017.
Data from Centers for Disease Control and Prevention. (2018). Youth risk behavior surveillance—United States 2017. Surveillance Summaries. Morbidity and Mortality
Weekly Report 67(SS-8):1–114

9. Sex, Gender, and Gender Identity
Sex: An individual’s biological status (male, female,
intersex): anatomy, chromosomes, and biological
characteristics
Gender: The economic, social, and cultural attributes
and opportunities associated with being masculine,
feminine, or a combination of both
Gender identity: An individual’s personal subjective
sense of being male, female, or somewhere in between

10. Homologous Sex Structures
Figure 4-3 External genital differentiation–male and female.

11. Definitions (1 of 2)
Intersex
• A person who is born with sex chromosomes, external
genitalia, or internal reproductive organs not
considered “standard” as male or female
Gender expression
• The way a person acts to communicate gender within
a given culture, such as clothing and interests
Androgyny
• Having characteristics of both sexes, but appearing
gender neutral

12. Definitions (2 of 2)
Transgender
• Umbrella term for anyone whose biological sex is not
aligned with the person’s sense of self or gender
identity
Gender dysphoria
• Psychological term used to describe a strong and
persistent cross-gender identification
Transitioning
• Process in which transgender people work to change
their appearance and societal identity to match their
gender identity

13. Class Discussion (1)
• What are some of the challenges faced by
transgender people? As individuals? In
school? In social situations? In various public
places?
• What are some possible solutions to these
challenges?

14. Sexual Stereotypes: Discussion
• Women are undersexed and men are oversexed.
• Women are inexperienced and men are experts.
• Women are recipients and men are initiators.
• Women are controllers and men are movers.
• Women are nurturing and supportive, and men are
strong and unemotional.
• Women are sensitive and men are insensitive.
• Women are dependent and men are independent.
• Women are passive and men are aggressive.

15. Sexual Orientation
Sexual orientation refers to one’s sexual and
romantic attraction to other people, whether the
attraction is to members of the opposite sex, the
same sex, or both sexes.
• Opposite sex = heterosexual
• Same sex = gay, lesbian, homosexual
• Both sexes = bisexual
Issues
• Homophobia
• Profiling
• Discrimination in medical care

16. External Female Sexual Anatomy
Figure 4-4 External female sexual anatomy.

17. Internal Female Sexual Anatomy
Figure 4-6 Internal female sexual anatomy.

18. Common Problems Related with
Menstruation
• Dysmenorrhea
– Painful menstrual flow
• Premenstrual syndrome (PMS)
– Group of symptoms linked to menstrual cycle
• Premenstrual dysphoric disorder (PMDD)
– Severe form of PMS
• Amenorrhea
– Lack of menstrual flow

19. Physical Health and the Well-
Woman Exam
Exam steps
• Medical history
• General physical examination
– Breast examination and pelvic examination
• Pelvic examination
– Phase I = external examination
– Phase II = use of speculum; collection of
specimens
– Phase III = bimanual examination

20. Sexual Arousal
and Sexual Response
Masters and Johnson: Female Sexual
Response Cycle
Four Phases
1. Excitement
2. Plateau
3. Orgasm
4. Resolution
Figure 4-7 Masters and Johnson’s model lists three
variations among women in the sexual response cycle.

21. Forms of Sexual Expression
• Traditional heterosexual positions
• Masturbation
• Petting
• Oral-genital stimulation (cunnilingus, fellatio)
• Anal intercourse
• Use of sex toys and accessories

22. Sexuality Through the Life Span
(1 of 4)
Childhood
• Self-genital
stimulation
• Engage in play that
may be viewed as
sexual in nature
• Curious about
secondary sex
characteristics
Children are innately interested in their bodies.
© Asiaselects/Getty Images

23. Sexuality Through the Life Span
(2 of 4)
Adolescence
• Puberty
– Secondary sex characteristics
o Hair growth, breast budding, vaginal walls
thicken, uterus enlarges, vaginal pH
increases in acidity
– Menarche
o About 2 years after breasts start to develop
and by the age of 15

24. Sexuality Through the Life Span
(3 of 4)
Young to middle adulthood
• Increasing number of single, sexually active adults
• Marriage at later age
• Increase in the number of women who never marry
• Placing career goals and advanced education
before marriage
• Increased divorce rate
• Increase in cohabitating adults
• Increase in the number of women who no longer
depend on marriage to ensure economic stability

25. Sexuality Through the Life Span
(4 of 4)
Older adulthood
• Climacteric—physiological changes that occur
during period from female fertility to infertility
• Menopause—cessation of menstruation
– Vaginal dryness and thinning, delayed
lubrication, hot flashes
• Decline in frequency and intensity of sexual
activity
• Quality vs. quantity of sexual expression

26. Sexual Dysfunction
• Prevalence
– About 44% of U.S. women report sexual problems,
with low desire being the most commons sexual
problem (38.7%).
• Historically called “frigidity”
• Areas of dysfunction
– Sexual desire disorders
– Sexual arousal disorders
– Orgasmic disorders
– Sexual pain disorders

27. Sex Research
Well-known studies
•Kinsey Report (1948 and 1953)
– Factors affecting sexual behavior in males/females
•Masters and Johnson (1966)
– Sexual response cycle phases
•Redbook Survey (1977)
– Sexual behavior and attitudes of American women
•Hite Report (1976)
– Sexual practices of American women
•Blumstein and Schwartz (1983)
– Sexual and nonsexual components of relationships
•ABC Primetime Poll (2004)
– Found most Americans were monogamous and happy about it

28. Class Discussion (2)
How do definitions of terms like “virginity” or “premarital”
complicate sexual health research?
Communication contributes
greatly to the satisfaction of
an intimate relationship.
© Iofoto/Dreamstime.com

29. Sexual Violence as a
Public Health Problem
Types of sexual violence
• Sexual assault and rape
• Female genital mutilation (FGM)
• Forced sterilization

30. Informed Decision Making
• Gynecological checkup
• Understanding personal feelings, thoughts
about sexual well-being
• Understanding the medical language
associated with sexual health
• Understanding responsible sexual behavior
• Understanding myth vs. fact
• Communication between parents and children
• Knowledge of healthcare resources