Monday, August 27, 2012

Healthy Sexuality in Men and Women

Before discussing the possible sexual problems, normally associated with male aging, we would like to touch basis on the point of reference. Problem represents the condition which is not normal for the particular individual, and causes physical and emotional distress. Therefore, we would like to review the important issue of what is the healthy sexuality as the condition all the sexual disorder should be validated against.

Experts in the study of sexuality have identified several characteristics of healthy sexuality. Healthy sexuality may include an ability to integrate sexuality into one's daily life, as opposed to it being some external event that occurs on its own. It may include components of affection, tenderness, and companionship between two people. In an ongoing sexual relationship, both partners should be aware of the important role that sex plays in their lives. While it is important not to make sex an exaggerated area of focus, it is certainly important to recognize sexuality as a natural part of being human. Humans are naturally, sexual creatures. Healthy and natural sexuality should also include an acceptance of our animal nature and a positive attitude toward our bodies, our nudity, and our sexual urges. Some theorists have described healthy sexuality as including a component of being able to attach emotions and meaning to sexual experiences.

So, in general framework for your sexuality includes:
  • Your body, including your sexual and reproductive anatomy. 
  • Your biological sex — male, female, or intersex.  
  • Your gender — being a girl, boy, woman, man, or transgender. 
  • Your gender identities — personal sense of “I am a man, I am a woman” (which may or may not be the same as biological sex).
  • Your gender role – what roles do men and women take on? What’s different? What’s the same?
  • Your sexual orientation — to whom are you sexually and emotionally attracted? 
  • Your sex drive.
  • Your sexual identity — the way you feel about your sex, gender, and sexual orientation.

There are also several formal definitions of what constitutes healthy sexuality. Firestone, Firestone, and Catlett reviewed several definitions and outlined the following: One definition reviewed by them included having appreciation for one's own body, seeking out knowledge regarding reproduction, understanding that human development includes sexual development (i.e., reproduction, genital sexual experiences), interacting with both genders respectfully and appropriately, understanding and respecting sexual orientation, appropriately expressing love and intimacy, and developing and maintaining meaningful relationships while avoiding exploitative or manipulative ones. Healthy sexuality has also been suggested to include components of communication and acceptance of love, expressing emotion and giving and receiving pleasure, having the ability to enjoy and control sexual and reproductive behavior without feelings of guilt, fear, or shame.

In addition to the tremendous variance among people's sexual behaviors, determining, what is normal or healthy is further complicated by several types of categorical variables that also impact sexuality (i.e., gender, age, health). Thus, from person-to-person what constitutes healthy sexuality may be very different. Sexuality, specifically sexual function, is impacted by many things. When one considers health from a holistic perspective, we begin to recognize that both mental and physical health factors significantly impact healthy, sexual functioning. Anxiety, depression, and other mental health conditions can greatly determine one's sexual health. For example, reduced interest in sex is commonly reported by individuals who are depressed. Also, physical conditions can heavily impact sexual function. Therefore, what might be considered abnormal for one physically healthy individual, might very well be considered normal (or average) for an individual who has a condition that affects the circulatory system (i.e., diabetes, heart-related conditions, high blood pressure, obesity, etc.) Lifestyle choices (smoking, alcohol consumption etc.) can also impact sexual function. It is important to note that this is not an exhaustive list of the things that can impact sexuality: there are also many categorical variables that influence how we define what is normal and healthy.

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The “CERTS” model of healthy sexuality

Wendy Maltz developed the CERTS model for healthy sexuality; this model requires that the following conditions be met for a person to enjoy healthy & satisfying sex: Consent, Equality, Respect, Trust, and Safety.
  • CONSENT means you can freely and comfortably choose whether or not to engage in sexual activity. You are able to stop the activity at any time during the sexual contact. It  also means that you respect when someone else does not want to engage in a particular activity, for any reason.
  • EQUALITY means your sense of personal power is on an equal level with your partner. Neither of you dominates the other.
  • RESPECT means you have positive regard for yourself and for your partner. You feel respected by your partner and you respect them.
  • TRUST means you trust your partner on both a physical and emotional level. You have mutual acceptance of vulnerability and an ability to respond to it with sensitivity.
  • SAFETY means you feel secure and safe within the sexual setting. You are comfortable with and assertive about where, when and how the sexual activity takes place. You feel safe from the possibility of harm, such as unwanted pregnancy, sexually transmitted infection, and physical injury.

It takes spending time together and engaging in lots of honest, open communication to make sure that the CERTS conditions are operating in your relationship. That's why it is helpful to allow all aspects of a relationship to grow and develop at a consistent pace with physical intimacy.

Meeting the CERTS conditions does not ensure yet without reasonable doubts that you'll have amazing sex, but it can help you feel more secure in your relationship and increase your level of self-esteem.

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Categorical Differences in Healthy Sexuality

When it comes to sexuality, it is important to consider there are many well established gender differences, and differences across the lifespan. Starting with sexual desire, it is a well-established fact that men have a stronger sex drive than women. In 2001, Baumeister and colleagues conducted an extensive review of the research and found that generally speaking, men want sex more than women. In fact, men think and fantasize about sex more than women. Conversely, women are willing to wait longer to begin sexual activity in new relationships and are less likely to masturbate than men. In terms of sexual arousal, on average it takes women longer to get turned on than men. Finally, gender differences in orgasm exist as well. Not only do men and women reach orgasm at different rates, but men can reach orgasm through penetration alone, while a large number of women cannot.

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Gender Differences in Sexuality

Often, very simple things can have a great deal of impact on sexual health. One such example is the mere act of thinking. During sexual activity, thoughts may not always be on sex. This lack of attention to the present moment of sexual activity is defined as general cognitive distraction. In fact, it is quite common for an individual to experience general cognitive distraction as the mind wanders to the grind of everyday life (i.e., balancing checkbooks, paying bills, shuttling children to extracurricular activities). While general cognitive distraction may certainly impact sexuality, there are other specific types of cognitive distraction that can also impact sexuality.

Because thoughts and concerns about performance are common during the act of sex, the term performance anxiety has been used to describe this phenomenon. Performance anxiety can wreak havoc on sexual function as well as make the sexual experience quite unpleasant. When we are anxious, we receive a surge of adrenaline and a large quantity of adrenaline is sexual arousal's worst enemy. Another type of cognitive distraction that can impact the sexual experience is appearance-based cognitive distraction. Appearance-based cognitive distraction is defined as having thoughts/concerns about one's body during sexual activity (i.e., Does my body look ok?).

So when it comes to the way cognitive distractions can effect sexual functioning, there are well-established gender differences. Research has shown that while men and women experience an equal amount of performance-based cognitive distraction during sex, women tend to experience more appearance-based cognitive distractions than men. What does this mean? Well, simply put, it seems that both men and women are preoccupied with thoughts about their sexual performance during sex, but women are more concerned than men about how their bodies appear while they are engaging in sexual activity.

So, how does this greater concern about body image impact women's sexuality? Despite recent concerns about the increase of body image problems among men; women continue to be more impacted than men by body image disturbances. Yamamiya, Cash, and Thompson (2006) reviewed the literature and identified that body dissatisfaction is related to sexual dissatisfaction, avoidance of sexual activities, sexual distress, and feeling sexually unskilled.

In addition to gender differences in cognitive distractions, the research also identifies sexual fluidity or erotic plasticity as another gender difference. The term, erotic plasticity, refers to the ability and willingness to adapt sexual attitudes and behavior to present circumstances and influencing forces. In other words, erotic plasticity refers to the ability to be flexible in sexual attitudes and behaviors. The scientific literature has identified that women are more sexually fluid than men when it comes to engaging in same-sex behaviors.

The theory of Female Erotic Plasticity was first proposed by Baumeister (2000). His review of the literature on gender differences in sexuality revealed that women are more flexible when it comes to sexuality than men. It seems that female sexual responses and behaviors are largely shaped by cultural, social, and situational factors. In contrast, male sexuality seems to be formed early in childhood (or before) and is less prone to change throughout the lifespan. Baumeister identified research studies that demonstrated that women tend to change their sexual attitudes and behaviors more throughout their life than men. For example, men tend to engage in a consistent amount of sexual activity (with a partner or alone) over the course of their lifetime whereas women may go through periods of time when they are extremely sexual, and then go through periods of time where they are not sexual at all. Baumeister also found research that suggested that female sexuality tends to be more affected by religion, parental attitudes, peer attitudes, and cultural than male sexuality. Finally, he found research that suggested that women tend to display greater attitude-behavior inconsistency than men. This simply means that women are more likely than men to say one thing (attitude) and then do another (behavior). For example, a woman is more likely to say she is against premarital sex, but then have sex outside of marriage.

Recently, researchers have found that it seems that even female sexual orientation is more flexible than male sexual orientation. It was concluded that for men in general, their experience is strongly related to physiological arousal whereas for women it is less so. A study reported in 2003 showed men's arousal clearly tracks sexual orientation, with gay men getting turned on by images of men, and straight guys by images of women. In contrast, that study showed both heterosexual and lesbian women were sexually aroused by male and female erotica, regardless of their sexual orientation.

Clearly, there are many other gender differences in sexuality, but the above is intended to simply illustrate that male and female sexuality are quite variable. Thus, what is considered "normal" or "healthy" for a man might not be for a woman.

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Age and Sex

There are still people who consider their male and female menopause as the sign of sexual aging, greatly decreasing, if not closing completely the sexual life benefits they have experienced in younger years. This perception is absolutely wrong, as you may have a great sex through your aging process. Definitely, you should take care of your psychological, emotional well-being as it is linked with your sexual performance.

The results, based on the National Health and Sexuality Survey in Spain, in 2009, showed that 62.3% of men and 37.4% of women after 65 years old are still sexually active. It is interesting that the most common practices are kisses, caressing and vaginal penetration. On the other hand, the least practiced are masturbation and oral sex. There are however some particular factors that limit sexual activity in both sexes: being older than 75, not having a partner, having a low level of education, a poor perception of their own health and sexuality, suffering from two or more chronic illnesses and taking two or more types of medication. Another 2003 study results are mostly correlated (while with no segregation by the gender): 60% of people over the age of 65 said they had sex on average four times a month. And the most important, the majority of respondents said that although their sexual intercourse had changed as a result of age, they were not less satisfying, than in younger years.

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