Sexuality and Gender (CMPP)

What is required for female sexual response

estrogen

Need intact sensation

Need vaginal lubrication

When does sexual desire usually increase in the cycle

Preovulation

What mediates sexual arousal

Centeral and autonomic nerves

What does sympathetic stimulation effect in sexual arousal

increase desire

What does parasympathetic stimulation effect in sexual arousal

clitoral vasocongestion

vaginal lubrication

What causes clitoral engorgement

Cavernosal and arteriole smooth-muscle relaxation

What is needed for orgasm to acquire

intact sympathetic outflow tract

Stages of the Sexual Response Cycle

Stage 1: Desire

Stage 2: Excitemnet (Peak)

Stage 3: Orgasm (Release of tension)

Stage 4: Resolution

What occurs in Stage 1 of sexual response cycle

sexual fantasies and/or the desire to have sexual activity

What occurs in Stage 2 of sexual response cycle

Males – psychological arousal and penile erection, testicles increase

Females – psychological arousal, vaginal lubrication, nipple erection, and vasocongestion of the external genitalia,

Heartbeat and respirations increase,

blood pressure rises

What occurs in Stage 3 of sexual response cycle

Males – ejaculation, involuntary muscular contraction (pelvis), followed by a refractory period

Females – contraction of outer 1/3 of the vagina, some involuntary pelvic thrusting

men and women have involuntary contractions of the internal and external anal sphincters

What occurs in Stage 4 of sexual response cycle

Males – relaxation, detumescence, sense of well-being, refractory period of minutes to several hours

Females – relaxation, detumescence, sense of well-being, no refractory period, capable of multiple and successive orgasms

Sexual Behavior

Normal sequential response to sexual stimulation in males and females

When is Masturbation considered abnromal

only type of sexual activity performed when it is a compulsion

consistently preferred to have sex with a partner

Ambiguous genitalia

infant’s external genitals do not appear clearly male or female

Management of Ambigous Genitalia

Avoid designating gender/sex or naming the child prematurely

Expedite workup

Evaluation for Ambigois Genitalia

Genetic testing

Testosterone

LH

FSH

DHEA

HCG stimulation test

Ultrasound of pelvis or MRI

Who do we refer ambigious gentilia to

Endocrinology

Urology

Geneticist