Sexuality over the lifespan

Question 1

What are the 5 circles of sexuality

Answer 1

1. Sensuality
2. Intimacy
3. Sexual Identity
4. Sexual Health and Reproduction
5. Sexualization

Question 2

OBI model of sexual orientation

Answer 2

O = Orientation or attraction who gives you butterflies in your stomach

B = Behavior with whom do you do sexual things

I = Identity how do you publicly identify (which can be different than how you privately identify)

Question 3

Common normal and developmentally appropriate sexual behaviors in young children

Answer 3

Self-stimulation

Personal space intrusiveness

Interest in language or images of a sexual nature

Exhibitionism

Mutual curiosity in peers’ genitals- Tends to be transient and responsive to parental redirection or admonishment, Younger the age, the more normal this behavior

Question 4

Solitary sexual behaviors which are inappropriate in children

Answer 4

Repeated penetration of vagina or anus with an object or digit

Behaviors that are persistent, and child becomes angry if distracted

Behaviors associated with conduct disorders or aggression

A variety of sexual behaviors displayed frequently or on a daily basis

Question 5

Sexual behaviors involving other persons which are inappropriate in children

Answer 5

Sexual behaviors involving children four or more years apart in age

One child coercing another into participating

Explicit imitation of sexual intercourse

Oral-genital contact

Asking an adult to perform a specific sexual act

Question 6

Progression of puberty in girls

Answer 6

Question 7

Progression of puberty in boys

Answer 7

Question 8

What is the parent factor

Answer 8

The amount of warmth, love, affection, communication teens receive from their parents influences sexual behaviors

A higher Parent Factor is associated with older age of 1st intercourse and lower frequency of sex during adolescence

Lower amounts of perceived Parent Factor correlates with emotional distress, lower self esteem, school problems, drug use, and sexual risk behaviors

The level of parental involvement and communication affects sexual behaviors and activities.

Question 9

What social institutions influence sexuality

Answer 9

School

Sex education, implementation and supportive services at school affect sexual behaviors. Poor support and lack of sex ed can increase the risky sexual behaviors.

Laws

Laws regarding accessing healthcare services influence the likelihood teenagers access these services and barriers to accessing healthcare services increase risky sexual behaviors.

Religion

Teenagers who are more actively involved in religious activities tend to initiate sex later.

Question 10

Contraception use in adolecents

Answer 10

Only about 78% of adolescents use any sort of method of contraception. The most common method of contraception is condoms (68%), followed by OCPs (16%).

Question 11

STIs in young adults

Question 12

When to start taking a sexual history

Answer 12

Age 11

Question 13

What is the HEEADSSS model

Answer 13

tool for providers for taking a comprehensive psychosocial history for adolescent patients.

–H: Home

–E: Education/Employment

–E: Eating

–A: Activities

–D: Drugs

–S: Suicide/depression

–S: Sexuality

–S: Safety

–*Additional questions:

•Strengths, Spirituality

Question 14

Progression of gender development

Answer 14

From Birth to 1 year of age, babies typically discover their genitals.

Between Ages of 1 and 2 years, children become conscious of physical differences between genders.

By the Age of 3, children can typically label themselves as boy or girl.

At the Age of 4 years, Gender identity is generally stable and constant.

Question 15

Average age of coming out as transgender or nonbinary

Answer 15

14-15

Question 16

Requirements of KY sex ed

Answer 16

The state Law requires STDs and HIV/AIDS education.

Abstinence must be covered as the only completely effective protection against unplanned pregnancy, sexually transmitted diseases, and HIV/AIDS. Teaching about contraceptives, such as condoms, the Pill, or the Patch, is NOT required in KY sex education

Question 17

Age of consent KY

Answer 17

In Kentucky, a person can legally consent to sexual intercourse at 16 years old ( However, a minor is younger than 18 years).

Question 18

Parent involvement in sexual health

Answer 18

A teenager does not need permission from a parent or guardian to get tested for STDs and HIV or to consent to treatment. However, the Physician may (but is not required to) inform the parents.

All minors are allowed to get a prescription for birth control without a parent’s permission. Again, the Physician may (but is not required to) inform the parents.

If a person under 18 years old desires an abortion in Kentucky, only One parent must give permission. However, an individual can ask a judge for permission, or get special permission if it’s an emergency, called “judicial bypass’ without parental permission.

There is a 24-hour mandatory waiting period before a teen can get an abortion.

Question 19

Stats on sexuality of older adults

Answer 19

54% had sex 2-3 times per month

23% reported sex at least 1 time per week

70% of men > 65 remain interested in sex

50% of women > 65 express interest in sex

Greater than 50% of respondents report a sexual problem!

Question 20

Goal-directed sexual experience

Answer 20

In goal directed sexual experience, good sex includes penetration, ends in orgasm. Anything else is “preliminary stuff”. This can lead to feelings of failure if an orgasm does not occur as the finale.

Question 21

Non-Goal Directed Sexual Experience

Answer 21

In non-goal directed sexual experience, each act of intimacy is satisfying on its own. Penetration/orgasm is not necessary. This sexual experience can be more fulfilling for many individuals, including older adults.

Question 22

Basson’s Non-Linear Model of Sexual Response

Answer 22

Question 23

Hormonal Changes with Menopause

Answer 23

1. Perimenopausally, ovarian follicles decrease which causes ovarian estrogen production to decrease.
2. FSH increases greater than LH increases.

Etiology of increased FSH is due to loss of negative feedback by gonadal steroid and cessation of ovarian follicular production of inhibin

Ovarian production of androgens continues under increased LH

3. In most postmenopausal women, the majority of the estradiol results from peripheral aromatization of androgens.
4. Decreased ovarian androgen production as well as decreased adrenal androgens, especially DHEA.

Question 24

Female Sexual Response with Aging

Answer 24

1. Excitement: decreased vaginal blood flow, genital engorgement, and lubrication
2. Plateau phase: prolonged, decreased color change of labia
3. Orgasm: multi-orgasmic capacity is maintained but weaker and less frequent contractions occur
4. Resolution: associated with more rapid loss of vasocongestion than in younger years

Question 25

Menopausal Symptoms that Affect Sexual Function

Answer 25

Question 26

Causes and effects of urogenital atrophy in older women

Answer 26

The Cause of urogenital atrophy is th**e loss of subcutaneous fat in labia majora causes shrinkage. The clitoral glans atrophies and there is a loss of vaginal muscularity and lack of lubrication.** Dyspareunia and vaginal bleeding may occur as a result of this atrophy. The absence of estrogen due to menopause causes i**ncreased vaginal pH leading to increase in UTIs.** Thinning of urethral epithelium and u**rethral prolapse may occur with loss of collagen supporting endopelvic fasci**a. This can also lead to Stress and Urge incontinence. The **treatment is localized application of estrogen**

Question 27

Sexual changes in men with aging

Answer 27

There is a g**radual slowing of physical reaction time with aging.** Most men respond well to increased stimulation of penis and genital area Recommend increased foreplay; consider use of visual stimulation **Erections may become somewhat less firm** (maintain capacity for intercourse). L**ower production of semen and fertility may diminish with age.** Men \< 50 years produce 3-5 mL semen q24 hours Men \> 50 years produce 2-3 mL semen q24 hours **Ejaculations may be less forceful.**

Question 28

Male Sexual Response Changes with Aging

Answer 28

1. Excitement: delay in erection, tensing of scrotal sac decreases, testicular elevation may not occur 2. Plateau: prolonged duration, decreased preejaculatory secretion from Cowper's gland 3. Orgasm: decrease in duration, decreased prostatic contractions, decreased urethral contractions, decreased force of emission; orgasm less intense 4. Resolution: rapid detumescence and testicular descent 5. Refractory Period: Prolonged

Question 29

Does aging cause Erectile dysfunction?

Answer 29

**Aging does not produce ED.** The Diagnosis should not be made unless it occurs in \> 25% of sexual encounters with same partner. The Probability of ED increases from 40% at age 40 to 70% at age 70.

Question 30

Causes of ED

Answer 30

The Most common etiology of ED is **vascular disease.** Neurologic disease is the 2nd most common cause of ED. Other causes of ED include: diabetes (low NO), drug induced, psychogenic

Question 31

Drug info on PDE5 inhibitors:

Answer 31

Question 32

Drug info of topical agents for ED

Answer 32

Prostaglandin E1 (alprostadil)- transurethral ($20 per dose) or intracorporal ($3-10 per dose) Mechanism **Induces relaxation of smooth muscle within penile erectile bodies and blood engorges corpora cavernosa with sufficient pressure to compress emissary veins** Promotes erection by upregulating cyclic adenosine monophosphate levels within corpus cavernosum **Adverse effects** **Hypotension is concern**

Question 33

Non pharmacological tx for ED

Answer 33

**3. Vacuum Device** Cost is about $200-400 Efficacy is 67% (depends on proper use) **4. Surgical Implants** Cost is about $5,000 per implant This is an Invasive procedure Typically surgical implants are reserved for resistant refractory ED

Question 34

Problems with sexuality after MI and hypertension

Answer 34

**Myocardial Infarction (MI)** Most patients can safely resume sex after 8-14 weeks after a MI. In patients who had MI, chance of 2nd MI during sexual activity was 2 in 1 million. **Hypertension** No restrictions on sexual activity unless BP is very high. Up to 1/3 of men with uncontrolled HTN report ED

Question 35

What is pelvic steal syndrome

Answer 35

Pelvic Steal Syndrome In this condition**, Erectile dysfunction results from changes in circulation. Blood flow is redirected from penis to buttocks.** Because of this redirected blood flow, a male loses the erection with thrusting. The best management of this condition is Good position: man on back or side to prevent pelvic steal.

Question 36

HIV stats for older adults

Answer 36

In 2016, **35% of people 50 and older had late stage infection (AIDS) when received HIV diagnosis.** AIDS cases among people \> 50 have increased 22% since 1991, making **heterosexuals \> 50 the fasting growing AIDS population.** Sexual transmission accounts for \> 60% of diagnosed cases of HIV in elderly. More people are now living with HIV than ever before. This means more older people are living with HIV than ever before.

Question 37

Guidance on sex toys

Question 38

Differences in lube

Answer 38

Water based lubricants are safe to use with latex condoms and rubber toys. They are easy in cleaning, stain free and are nongreasy. Silicone based lubricants last a long time and do not dry out. Small amounts are effective but may be more difficult in cleaning. They can also damage to silicone toys and cause vaginal irritation. **Oil based** lubricants are difficult to clean. **They are Not recommended for vaginal use. DO NOT use with latex condoms.**