Jill Norvilitis, Ph.D.

A few definitions to start us off…

 Gender-maleness or femaleness  Sex —biological distinction  Gender roles —how males and females are expected to behave  Gender identity —personal experience of being male or female

Historical perspectives

 Art from the Stone Age suggests worship of women’s fertility  Then, around 11,000 BC, ice age retreated, more agrarian    Phallic worship emerged around 9000 BC Incest taboo —earliest of taboos; universal, but varied Ancient Hebrews —polygamy permitted, monogamy preferred

History continued

 Ancient Greeks —viewed men and women as bisexual   Male-male sex was normal, but not relationships  Lots of prostitution Ancient Rome —sexual excess   Julius Caesar Caligula —orgies with bestiality and sadism  However, family was important social structure

History continued

  Early Christianity  Sexuality was associated with sin  Marriage bed only  Some ideas became more conservative over time Eastern Religions    Islam —marriage important and sexual fulfillment in marriage Tao —sex as sacred duty Hinduism —sexual pleasure as a spiritual ideal  Kama Sutra —3 rd to 5 th century AD

Middle Ages

 Eve vs. Mary  Roman Catholic church ○ Sex for procreation only  Reformers ○ Sex strengthens marriage, which is a part of worship

19

th

Century

 Science of Sex began in the 19 th century —Victorian era      Freud —next class Havelock Ellis —1859-1939—compiled information on sex; believed that deviations from the norm were not harmful Von Krafft-Ebing —200 cases of pathological individuals Hirschfeld (1868-1935) —sex survey of 10,000 people on 130 items; much of his work was destroyed by Nazis Kinsey —start of current sex research

Influences on sexual behavior

 Variety of behaviors  Culture  Peers and family ○ Larsson & Suedin, 2002 —269 high school students  70%--knowledge from friends   62% knowledge from television 51%--knowledge from parents  15 %--(mostly boys) pornography  Religion ○ Adolescents who are more religious are less likely to have sex in high school

Evolutionary psychology/sociobiology

   Application of evolutionary biology to understanding social behavior of animals, including humans. Heralded by EO Wilson Natural selection Parental investment    Women —one child. Men—many children Related to sexual selection  men promiscuous, women monogamous Rape as an extreme case  causes genes to be continued

Criticisms of evolutionary psychology

 No personal choice  Central function of sex is no longer reproduction  Wide variety of cultural behavior says genetics can’t be cause  Evolutionary psych looks at survival of individual, but modern biology looks at survival of species

Psychoanalytic theory

 Freud  Id —pleasure principle—seek pleasure/avoid pain  ○ ○ Need to get rid of anxieties/pain Instincts —hunger/sex/thirst/elimination/aggression Ego —reality principle  Superego-idealism/conscience  Develop sequentially  Mind is both conscious/unconscious  Ego shields our more base urges through defenses ○ ○ ○ Repression Rationalization Intellectualization ○ ○ Projection Reaction formation ○ Sublimation

Psychoanalytic theory continued

  We often banish sexual impulses to the unconscious, but they creep in through dreams Erogenous zones —libido is focused in different places —pt. of skin or mucus membrane sensitive to stimulation —lips/mouth, etc.

 Stages of psychosexual development ○ ○ ○ ○ ○ ○ Over vs. underindulged Oral —birth to 1 Anal —1 to 2 Phallic —3 to 5 or 6   Oedipal complex —castration anxiety Electra complex —penis envy Latency Genital stage —adolescence

Criticisms of psychoanalytic theory

 Lack of empirical testing  Focus on disturbances in personality  Overemphasis on biology

Learning theory

    Classical conditioning helps explain fetishes.

 UCS  UCR   UCS+CS  UCR CS  CR    Operant conditioning  Behavior followed by reward or punishment changes likelihood of behavior happening again Sex is a primary reinforcer Immediate vs. delayed reinforcement Punishments are less effective shapers Behavior modification   Used to modify sexual dysfunction Deal with problem  unconcerned with origins  Aversion therapy Social learning  Observational learning —peers, tv, parents, etc  Imitation  Identification

Social factors

     Every society regulates sexuality in some way Basic institutions of society (religion, family) affect the rules governing sexuality Appropriateness/inappropriateness is culture bound Sexual scripts  Sexual behavior is scripted —much learning!

 People can predict what will happen next and there is consensus about what the order should be Social levels of analysis   Macro or societal —religion, economy, family, medicine, laws Subcultural —social class, ethnic group  Interpersonal  Individual

Cross-cultural perspectives

        Ethnocentrism Kissing is common, but not universal Frequency of sex varies, US in the middle Masturbation —universally practiced, universally disapproved of Eastern Polynesia Incest —most common taboo; extramarital sex is second Wide variety of beliefs about homosexuality  4 rules emerge  It happens, regardless of social beliefs   More common in males Never predominant  Never >5% Attractiveness —what do we do to be attractive?

 Poor complexion always bad

Cross-species considerations

      Analogues beh.

—something that is comparable to something else. In this case, animal beh. that is like human See masturbation in many mammals, primarily primates Same gender beh in porpoises Polyandry in some sandpipers Sexual signaling —monkeys who parade Nonsexual uses of sexual behavior

Issues in sex research

  Sampling   Identify the population to be studied and choose a subset Random sample —each member of the population has = chance of being studied   Refusal/non-response Volunteer bias —the Hite report was based on a 3 % return rate  Convenience sample Reliability    Purposeful distortion ○ ○ Enlargement Concealment Memory Difficulty with estimates

Ethics in sex research

 Informed consent  Protection from harm  Confidentiality  Deception  Cost-benefit approach

Methods of research

     Case study  Limitation —generalizability Survey  Interview vs. questionnaire   Interviews can branch, literacy is not an issue, rapport harder on the phone Questionnaire —less costly, honesty?

○ People report riskier beh on questionnaires Direct observation  Observer effects--? Increased inhibition  One study showed that men who volunteered for observational research were less guilty, less sexually fearful, more sexually experienced Participant observer True experiments

Observational study example

    Study of flirting  Cross-species studies find importance of female in choosing mate    Naturalistic observation as mode of data collection Worked in bars with bar owners’ cooperation No personal info  Microcassettes, proper dress to be unobtrusive  Random selection Women indicated interest through… Comparison of locations Women in bar: 70 flirting acts per hour Student union: 19 Library: 10 Women’s center meetings: 5 Women who signal most are most likely to be approached by men

Major sex surveys

 Kinsey  Born 1894, biologist  Began to study sex after he became part of a faculty committee for a class on marriage. Dearth of information   He and colleagues studied 5300 males, 5940 females between 1938 and 1949 Sampling —not so great ○ 100% sampling —got permission from group, then interviewed all members  College, young, well-educated, city-living, white, Protestants, Indiana —all over-represented   Rapport well-established, non-judgmental, used vernacular, assured confidentiality ○ Even had plans to destroy data if necessary Critique ○ Good results for his sample ○ ○ Not representative Overestimates of many behaviors

National Health and Social Life Survey

   1990s Edward Laumann —National Opinion Research Center Probability sampling of households  excluded only 3 % of population 18-59   79 % participation rate  Originally targeted 20,000 individuals, reduced to 3432 because of blocking of federal funds One of the main findings —people will do sex research if they are convinced it has a scientific purpose

Other major surveys

   Playboy Foundation —Hunt Report  Selected people at random from 24 US cities  982 men, 1044 women   80% refusal rate Asked over 1000 questions —both small group and questionnaire Janus Report     2765 people 18 and up Questionnaires and in-depth interviews with subset Tried to construct a cross-sectional sample, but not randomly selected 61 % return rate Magazine surveys   McCall’s—20,000 responses but many more married than general population, more homemakers Redbook —mailed survey in magazine. 100,000 responded, but that was only 2 % of readership  The Hite Report ○ 3019 responses from women ○ ○ 7000 men 100,000 distributed, essay-type questions ○ Claimed women were unhappy with loving relationships, that >70% had affairs

Masters and Johnson

   Published 1966 Began by interviewing prostitutes. Then set up lab —EKG to measure heart, electromyography to measure muscle contractions, pH meter to measure acidity of vagina 694 people 18-89    276 couples 106 women, 36 men unmarried Carefully screened out anxious people, let them have practice session —collected data during intercourse and masturbation  Did follow up, no one reported harm

Female sexual anatomy—external anatomy

    Vulva —collective term for external genitals Mons pubis or mons veneris  Fatty tissue that covers the joint of the pubic bones  Covered with hair at puberty  Captures chemical secretions from vagina during sexual arousal —alluring to lovers Labia majora  Large folds of skin that run downward from the mons alongside of the vulva  When close together, conceal labia minora, urethral, and vaginal openings Labia minora  Hairless, light-colored membranes that surround urethral and vaginal openings  At top, join the hood of the clitoris

Clitoris

    Knob of tissue situated externally in front of vagina and urethral openings  Two parts ○ Shaft and glans or tip ○ Glans is visible but shaft is hidden by clitoral hood Homologous to penis  same embryonic tissue Varies in size Erectile ○ Internal corpora cavernosa that fills with blood, like penis   Many nerve endings No reproductive value, except arousal

Clitoridectomy

       Surgical removal of clitoris Predominantly occurs in Islamic cultures, but not required by Koran Generally done by women, no anesthesia, unsanitary conditions Complications common —infections, bleeding, scarring, painful menstruation, obstructed labor More radical version —infibulation ○ Also remove labia minora and inner layers of labia major.

○ Raw edges of labia majora are sewn together with only a tiny opening to ensure chastity ○ After marriage, opening is enlarged, but it may take 3 mos to allow penetration. 85-114 million women in 30 countries in Africa, Middle East, India-Pakistan subcontinent Illegal in US since 1996.

Urethral opening

 Below clitoral glans and above vaginal opening  Unrelated to reproduction,   Proximity can be a problem Cystitis —bladder inflammation ○ Symptoms are burning and frequent urination ○ Also pain, blood, pus ○ Precautions to avoid this  2 quarts water/day to flush system  Orange and cranberry juice help maintain acidic environment to prevent bacterial growth  Alcohol and caffeine can both irritate bladder  Wash before and after sex  Prevent objects that touch anus from then coming into contact with vulva

Perineum

 Skin from vaginal opening to anus  Nerve endings here, too  Area that is cut in episiotomy

Vaginal opening

  Hymen  Thin membrane partially covering vaginal opening   At time of first intercourse, hymen is torn or stretched Can be bleeding or pain —may be unnoticed in excitement    Generally remains intact until intercourse, though rough sports like horseback riding may tear it Taken through history as a sign of virginity Defloration ○ Destruction of the hymen —significance as a cultural ritual Vaginal opening itself is called introitus (from Latin for entrance)

Vagina

      Extends back and upward from vaginal opening Usually 3-5 in long at rest, expands in length and width during arousal AKA birth canal —so it expands quite a bit Vaginal walls have 3 layers    Vaginal mucosa ○ Inner lining ○ Made visible by opening labia minora ○ Similar to skin in your mouth Middle layer —muscular Outer layer —fibrous covering that connects vagina to other structures Outer 1/3 of vaginal barrel has many nerves, inner 2/3 doesn’t Vaginal walls —secrete substances to maintain normal acidity and contain pheromones

Vaginitis

 Vaginal inflammation  Many causes —infection, BCP, allergies  To avoid ○ ○ Wash with mild soap Don’t wear tight pants ○ Make sure sex partners are clean ○ Cotton panties ○ Avoid diets high in refined carbs and sugar as they alter vagina’s acidity

Cervix

    Lower end of the uterus Opening in the middle is the os   About the width of a straw Expands to permit passage of baby This is where sperm pass from vagina to uterus 500,000 cases of cervical CA/yr   95% are caused by HPV More common among women with many sex partners, sex at a young age, low SES, smokers   Pap test to ID 5 yr survival is 67%, 90% if localized  Can be prevented if precancerous cells are removed

Uterus

       Where fertilized ovum implants and develops 90% women antroverted, 10 % retroverted Suspended in pelvis by flexible ligaments Shaped like an upside-down pear In woman who hasn’t given birth, 3x3x1in thick at top 3 layers  Endometrium —innermost layer   ○ Supplied with blood vessels and glands ○ This tissue is discharged with menstruation ○ Endometriosis Myometrium —muscular Perimetrium —external cover Hysterectomy  2 nd most common surgery on women (c-section 1 st )  1/3 of women by age 60

Fallopian tubes

 AKA oviducts or uterine tubes   Lined with hairlike projections called cilia Path of egg —where sperm and egg meet  Ectopic pregnancy  Sx —missed period, abdominal pain, irregular bleeding  Can burst tubes and cause death

Ovaries

     Almond shaped, 1 ½ long Produce ova (egg cells), estrogen, and progesterone Each woman has about 2 million at birth  About 400,000 survive into puberty  Each is contained in a small capsule called a follicle Each year in US, 27,000 women are dx’d with ovarian cancer  Over ½ die from it  4 th leading cancer killer    90% survive with early detection Risk ○ Family history ○ Never having given birth ○ Prolonged use of talcum powder between anus and vagina ○ Infertility ○ Breast CA ○ Diet rich in meat and animal fact Most recent research suggests acetaminophen may cut risk Most common symptom is enlarged abdomen

Breasts

    Almond shaped, 1 ½ long Produce ova (egg cells), estrogen, and progesterone Each woman has about 2 million at birth  About 400,000 survive into puberty  Each is contained in a small capsule called a follicle Each year in US, 27,000 women are dx’d with ovarian cancer  4 th leading cancer killer  90% survive with early detection   Risk ○ Family history ○ Never having given birth ○ Prolonged use of talcum powder between anus and vagina ○ Infertility ○ Breast CA ○ Diet rich in meat and animal fact Most recent research suggests acetaminophen may cut risk

Menstrual cycle

 4 phases —each has changes in hormones, ovaries, and uterus Hormones and ovaries   1) Follicular, proliferative, preovulatory phase  Pituitary (master gland) secretes relatively high levels of FSH, thus stimulating the follicles in the ovaries  Although several follicles may be stimulated, usually only one matures.  Follicle secretes estrogen and moves toward the surface of the ovary 2) Ovulation  Follicle containing egg is released from ovary, follicle ruptures open  High level of estrogen inhibits FSH production  High level of estrogen stimulates hypothalamus to produce GnRH-gonadotropin-releasing hormone-which cases pituitary to produce LH (leutinizing hormone)

Stages 3 and 4

  3) Luteal or postovulatory phase  Follicle (having released egg) doesn’t just disappear. It turns into a mass of cells called the corpus luteum with the stimulation of LH  Corpus luteum produces progesterone which inhibits production of LH. As LH decreases, corpus luteum degenerates   Because CL declines, progesterone and estrogen production decline Falling levels of estrogen stimulate pituitary to begin production of FSH so the whole cycle can begin again 4) Menstruation  Inner lining of uterus is shed, then passed out through cervix and vagina   Estrogen and progesterone are now low and FSH is increasing Menstruation is triggered by low estrogen and progesterone

Meanwhile, back in the uterus

   1 & 2) High levels of estrogen stimulate the endometrium to grown, thicken, and form glands that will eventually secrete substances to nourish the embryo. 3) Progesterone secreted by corpus luteum stimulates glands of the endometrium to start secreting nourishing substances   If egg is fertilized, about 6 days after ovulation, the fertilized egg arrives in a uterus well-equipped to nourish and cradle it If no egg, CL continues to produce estrogen and progesterone for 10-12 days 4) If no pregnancy, hormone output of CL declines sharply at the end of the luteal phase. The uterine lining can’t be maintained and is shed. Immediately after, a new lining starts to form.

Length and timing

 20 to 36/40 normal; 28 avg  Menstruation begins day 1 of cycle   Ovulation is about day 14. Luteal phase is pretty constant at about 14 days, so it is phase 1 of a cycle that varies Anovulatory cycles —common if only 1 or 2x year  Slight dip in temperature on day of ovulation, sharp rise day after

Cultural views

   Orthodox Judaism  Old Testament (Leviticus 15:19-24) ○ ○ ○ ○ Menstruating women were separated for 7 days Anything that touches her is unclean Intercourse is forbidden At the end of 7 days, bathe in mikvah  As recently as 1972, chief rabbi of Israel called for punishment for married couples that violate Torah by having intercourse at this time Jamaica    Traditional rural Jamaicans believe that menstrual blood has + power Menstruation is a sign of health to get rid of toxins, esp toxins from semen Post menopausal women don’t need to menstruate because wombs are closed up and not susceptible to dangerous effects of semen Mescalero Apache  Pubertal rites that accompany menarche are a celebration of power and fertility  Each year, 4 day celebration for all young women who began menstruating that year

Menstrual problems

   Dysmennorhea  Pain or discomfort during menstruation    Cramping, headaches, backaches, nausea, pressure, bloating Prostaglandins —likely culprit—cause uterine muscles to contract Tx —aspirin, orgasm, naprosyn Endometriosis   When endometrium grows elsewhere Sx —painful periods that last a long time Amenorrhea   Primary if no menstruation by age 18 Secondary if it stops  Related to cysts or tumors, hormonal imbalance, disease, stress, strenuous exercise, anorexia

PMS—Is it real?

      ¾ women experience some premenstrual problems 4-6 days prior to menstruation Over 150 sx id’d as part of PMS—anxiety, irritability, depression, fatigue, headaches Could also be a + moods around ovulation  Some studies have found increased sex at ovulation  BDI ○ 6.84 Ovulation ○ 9.30 PMS ○ 16.03 Depressed One study of PMS —10% of women had sx of PMS, but ½ of 90% and ½ of the 10% said they had PMS Evidence suggests    Some fluctuation in mood No changes in intellectual or athletic performance ○ 31 % of athletes say they experience decline (Quadagno et al , 1991) Big range among women

Why the link?

    Some relationship between sex hormones and depression ○ Increase depression premenstrually, postpartum, menopause, with BCP ○ No one knows quite why  Absolute amount of estrogen     Estrogen/progesterone ratio Absolute amount of progesterone Hypersensitivity to estrogen Changes in estrogen or progesterone  Most data are correlational Cultural —ultra-orthodox religions experience more PMS Women led to believe they were premenstrual made premenstrual complaints McFarlane et al 1988 —longitudinal study of men and women on and off pill changes at PMS time —no diff in fluctuation of mood, but when retrospectively asked about sx, women reported

Menopause

    Climacteric lasts 15-20 years  Roughly age 45-60  Transition to not being able to reproduce marked by decline in function of ovaries Menopause refers to cessation of menstruation only — takes 2 years approximately, about age 50    As women age, pituitary continues to produce FSH and LH, but ovaries become less able to respond, therefore no eggs and low estrogen and progesterone Sx —hot flashes, headaches, dizziness, heart palpitations, joint pain Increased risk for osteoporosis due to estrogen deficiency Hot flashes-sudden waves of heat from the waist up Sexuality ○ Vagina less well lubricated, less acidic

Culture and controversy

  Cultural stereotype of empty nest syndrome and depression     May be brief increase in depression at menopause due to hormones —then relief Matthews et al 1990 —not connect to depression, anx, stress, anger or job sat Jackson et al 1991 —also no relation Jones, 1994 —reaction is related to what menopause means to woman HRT  Reduces sx, decreases osteoporosis  May help lower risk for colon cancer and dementia  Replaces estrogen, progesterone and sometimes testosterone   Related to increase in breast cancer and heart disease Number of women taking HRT dropped dramatically  Now women with normal menopause (not surgical) are recommended to take the lowest dose for the shortest time

Male anatomy

Penis   Arrived on evolutionary scene 100 million years ago in reptiles  Much more efficient than cloaca that preceded it Does not contain bones in humans —but other mammals have bones  No muscles except at base     Instead, 3 cylinders of spongy material  Larger 2 are side by side —corpora cavernosa ○ Fill up with blood and stiffen during sexual arousal  Corpus spongiosum ○ Runs along bottom side ○ Contains penile urethra Glans of penis —extremely sensitive Corona/coronal ridge —separates glans from shaft Base of penis —called the root  Attached to pelvic bones by crura

Foreskin

   Covers the penile glans Loose skin, but smegma can accumulate and not allow foreskin to retract Circumcision —surgical removal of foreskin ○ ○ Discuss —list on board—arguments for and against Masters and Johnson —no difference in excitability ○ UTI more common in uncircumcised ○ ○ ○ ○ Uncircumcised slightly more likely to contract HIV when exposed NHSLS —lower rates of sex dysfunction in circumcised Hygiene —big argument for, but opponents say regular cleaning is enough 1971 —American Academy of Pediatrics said did not recommend for health reasons  Currently about 75% in US  About 30% worldwide

Scrotum

   Pouch of loose skin that holds the testes (male sex glands--produce sperm cells and sex hormones) Each testicle is held in place by a spermatic cord  Cord contains the vas deferens (tube carrying sperm to ejaculatory duct of penis), blood vessels, nerves, and the cremaster muscle (raises and lowers testicle in response to room temp and sexual arousal —closer to body during arousal) Scrotum develops from same embryonic tissue that becomes labia majora in female

Testes

     Produce androgens and germ cells/sperm cells Most important androgen cells   testosterone which is secreted by interstitial cells known as Leydig’s release testosterone directly into bloodstream Testosterone —masculinizing hormone  Stimulates secondary sex characteristics  Maintains genitals and sperm production  Stimulates growth of bone and muscle  Level is kept constant by a feedback loop between testes and hypothalamus Pituitary also secretes FSH in males. Here it stimulates sperm production.  This is controlled by Inhibin —secreted by testes. This serves as a different feedback loop. Testes usually range between 1 and 1 3/4 “ in length

Sperm

         Each testicle is divided into many lobes that are filled with seminferous tubules.

Takes 72 days for testes to manufacture a mature sperm cell Mature sperm cells are called spermatozoa (1/5000 in long) Sperm cells actually have the same kind of receptors that nose uses to sense odors Men produce about 1000/second Sperm go from seminferous tubules through maze of ducts to a single tube called epididymus. Mature sperm move into vas deferens Seminal vesicles are small glands that lie behind bladder that produce a high fructose fluid to nourish sperm At base of bladder, each vas joins a seminal vesicle to form ejaculatory duct that goes through prostate gland where it then opens through urethra where it can be carried out through penis

Other structures

   Prostate gland    Secretes prostatic fluid Gives semen its odor and texture —milky alkaline fluid Combines with seminal fluid and sperm  The alkalinity neutralizes the acidity of the vagina to prolong life of the sperm Cowper’s gland  Below the prostate gland  Clear slippery secretion precedes ejaculate  But may contain sperm Semen   70% fluid from seminal vesicles 29 % Cowper’s gland and prostate gland fluids  1% sperm

Illnesses

  Testicular Cancer   7000 new cases/year Most common CA in men 20-34   Accounts for 10% of all cancer deaths in that age Usual 1 st sx is a painless lump, generally on side or front   Early detection 90% survival, 25 % when wait three months Should not affect sexual performance, enough testosterone will be produced by other testicle Enlarged prostate  Prostate is tiny at birth, grows at puberty, may shrink in adulthood   Usually becomes enlarged past age 50 About 1/8 men will dev prostate CA ○ 3 rd most common CA in men ○ About 37,000 men die from it annually ○ Spreads/grows slowly ○ ○ More than 80% of cases are in men over 65; 25 % of men over 90 have it Sx —frequent urination, especially at night, difficulty in urination, difficulty emptying bladder