Transcript FEMALE-SEXUAL-DYSFUNCTIONS

FEMALE SEXUAL
DYSFUNCTIONS
FSD
Prof. IHAB YOUNIS
About 40% of women are affected by sexual
problems, with a higher prevalence of 50% in
perimenopausal and post-menopausal women
A woman’s sexual responsiveness is not the same as a
man’s. Ignoring its complexity
can make difference look like
dysfunction
Types & Definitions
1.Hypoactive sexual desire
disorder 27-52%
Persistent or recurrent deficiency or
absence of sexual fantasies and
desire for sexual activity
2.Sexual arousal disorder
11%-30% (<60 y)
Persistent or recurrent Inability to
attain, or to maintain adequate
lubrication-swelling response of
sexual excitement until completion of
the sexual activity
3.Orgasmic disorder
20%(Eur) -29%(Am)
Persistent or recurrent delay in, or
absence of, orgasm following a
normal sexual
excitement phase
4.Sexual pain disorders:
Vaginismus 6%
Involuntary vaginal spasms that
interfere with penetration
Dyspareunia17%24%(PM)
Pain during intercourse
HYPOACTIVE SEXUAL
DESIRE DISORDER
HSDD
• HSDD is the most common FSD
• Prevalence
ranged from
26.7% among
premenopausal
women to 52.4%
among naturally
menopausal
women
PATHOPHYSIOLOGY
• Dopamine is the key neurotransmitter in
the modulation of sexual desire
• Steroid hormones increase available
dopamine,
-Testosterone potentiates the synthesis
of nitric oxide, which controls dopamine
release
- Estradiol facilitates dopamine release
• Increasing levels of serotonin (e.g. as with
the, SSRIs) can diminish the effects of
dopamine on sexual function
• Endogenous opioids (e.g. Endorphin),
which give the sense of pleasure and
reward, also modulate the perceived
intensity of sexual desire in humans
• Following the experience of orgasm,
desire decreases and requires a certain
time span to be regained
• Therefore, they may have an inhibitory
effect on sexual desire
causes
1- Low Testosterone
• Low testosterone does not only cause low
libido, but also causes decreased sexual
receptivity and pleasure, fatigue, lack of
motivation, and an overall reduced sense
of well being
• It is common in menopausal women or
after bilateral oophorectomy
• It is not uncommon for pre-menopausal
women to experience HSDD. This may be
due to the fact that testosterone
concentrations begin to decline as early as
the late 20s in women and continue to fall
at a constant rate of about 50% of their
peak level by menopause
2-Low Estrogen
• Menopause can cause vaginal dryness,
inability to lubricate, or dyspareunia
• In this case, oral estrogen replacement is
often prescribed for the relief of hot flashes,
mood changes, and sleep disturbances to
improve quality of life
• The reason for this is that oral estrogen
increases circulating levels of sex
hormone binding globulin (SHBG) which
lowers the level of free testosterone
• Oral estrogen also suppresses FSH and
LH, reducing ovarian synthesis and
lowering total testosterone levels
3-Indirect hormonal effects
• Hormone imbalances related to
pregnancy, the postpartum phase and
lactation
• Menopause: Natural or surgical
• The use of certain medications e.g. antidepressants
4-Psychosocial factors
• Women with HSDD were 2.5 times more
likely to feel dissatisfied with their marriage
or partner than normal women
• 80% of patients with mood
(e.g.depression) or anxiety disorders
reported reduced sexual desire. However,
patients with depression often do not
appear to be distressed by their lack of
interest in sex
5-Medications
• SSRIs
• Antihypertensive agents are proposed to
affect sexual function via central
adrenergic inhibition and blockade of
adrenergic receptors
• Antipsychotics are dopamine blockers,
and may increase prolactin levels
• Oral contraceptives may have negative
effects in a minority of women. But
because of the wide variety of hormonal
medications available the results of
studies are not conclusive
6-Medical conditions
• Chronic illnesses e.g. diabetes mellitus,
and cancer
• Painful intercourse due vaginal/pelvic floor
conditions, such as vestibulitis, vulvodynia,
or endometriosis; or bladder conditions,
such as interstitial cystitis or urinary
incontinence
EVALUATION
Female Decreased Sexual Desire
Screener
1. In the past was your level of sexual desire or
interest good and satisfying to you? y/n
2. Has there been a decrease in your level of
sexual desire or interest? y/n
3. Are you bothered by your decreased level of
sexual desire or interest? y/n
4. Would you like your level of sexual desire or
interest to increase? y/n
5. Do you feel any of the following has contributed
to your current decrease in sexual desire or
interest?
An operation, depression, injuries, or other
medical condition? y/n
6. Medication, drugs or alcohol you are currently
taking? y/n
7. Pregnancy, recent childbirth, menopausal
symptoms? y/n
8. Other sexual issues you may be having (pain,
decreased arousal or orgasm)? y/n
9. Your partner’s sexual problems? y/n
10. Dissatisfaction with your relationship or
partner? y/n
11. Stress or fatigue? y/n
• If the answer is "no" to any of questions 14: patient may not qualify for the
diagnosis of HSDD
• If the answer is "yes" to all of 1-4
questions: patient may qualify for the
diagnosis of HSDD
• If the answer to any question 5-8, or 11 is
"yes" add: You should also seek
consultation with your health care provider
to determine if a medical condition or
problem is contributing to your current
decrease in sexual desire or interest
• If the answer to question 9 is "yes" add:
Your partner may need to seek
consultation with his health care provider
• If the answer to question 10 is "yes" add:
You and your partner should consider
professional counseling
•
Screener is based on Validation of the DSDS, Clayton et al: J Sex Med
2009;6:730-738
TREATMENT
1-Testosterone
• Intrinsa skin patch
• Releases 300 µg/day
• It is worn just below
the umbilicus & changed
twice weekly
• Sexual activity increased by an average of
19% in placebo users, vs. a 73% increase
for Intrinsa patch postmenopausal users
Contraindications
• Breast cancer
• Pregnancy
• Breastfeeding
• Naturally menopausal women
Side effects
• FDA declined to approve it for lack of
information on long term side effects
• Irritation of skin at patch application site
• Acne
• Excessive facial hair growth
• Voice deepening
• Breast pain
• Weight gain
• Hair loss
2-Bupropion (Wellbutrin)
• It is an antidepressant and
smoking cessation aid
• Bupropion SR 150 mg daily is
given for 12 weeks
• The thoughts/desire score showed a
greater than twofold increase in patients
treated with bupropion compared to those
receiving a placebo
Contraindications
• Conditions that lower the seizure threshold
e.g. alcohol or benzodiazepine discontinuation, anorexia nervosa, bulimia, or
active brain tumors & individuals taking
MAO inhibitors
Side effects
• Seizure: It is highly dose-dependent
• Hypertension in less than 1% of patients
3-Flibanserin (Female Viagra)
• As with Viagra, the effects of
flibanserin were discovered
accidentally after it was trialed as an antidepressant
• The results of four Phase III studies
involving more than 2,000 pre-menopausal
women suffering from HSDD showed that:
• Women using the drug said that the
average number of times they had
"satisfying sexual experiences" rose from
2.8 to 4.5 times a month
• Women with the placebo said the number
of times rose to 3.7 times a month
• Flibanserin must be taken once a day and
takes up to 4 weeks to have an effect
Mechanism of action
• It may enhance dopamine actions and
reduce serotonin actions
• The FDA refused to license it
because the studies showing its
effectiveness were not enough
4- Bremelanotide
• A double blind, placebo-controlled,
randomized study of 80 married women
with FSAD demonstrated that
bremelanotide 20 mg nasal spray
increased sexual arousal and intercourse
satisfaction when compared with the
placebo group. The manufacturer cited
blood pressure elevation with intranasal
administration of bremelanotide as a
reason for not pursuing approval for
sexual dysfunction
5-Apomorphineh
• Oral apomorphine 3 mg daily was tried in
patients compared with placebo for arousal and
desire
• The orgasm, enjoyment, and “satisfied by
frequency” scores improved during treatment
with daily apomorphine compared with
baseline and placebo
(P <0.05)
ANORGASMIA
• Orgasm is a variable, transient peak sensation
of intense pleasure creating an altered state of
consciousness, usually accompanied by
involuntary, rhythmic contractions of the pelvic
striated circumvaginal musculature, often with
concomitant uterine and anal contractions and
myotonia that resolves the sexually-induced
vasocongestion (sometimes only partially),
usually with an induction of well-being and
contentment
• Orgasms vary in intensity, and women
vary in the frequency of their orgasms and
the amount of stimulation necessary to
trigger an orgasm
• Although the clitoris and vagina are the
most common sites of stimulation that
result in an orgasm, stimulation of other
body sites (eg, breast, nipple, or mons)
can trigger an orgasm, as can mental
imagery, fantasy
• The G-spot is:
- An ill-defined region, located on the
anterior vaginal wall, in its upper outer
third, suggested by Grafenberg
- This area is sensitive to tactile touch,
which, when applied, is claimed to result in
an intense female orgasm and female
ejaculation during orgasm
- Debate regarding the existence
of the G-spot and female
ejaculation as true clinical
entities is still ongoing
How frequent is anorgasmia in
Egypt? (My Work)
• In all women
- 17% do not have orgasm at all
- 5% rarely have orgasm
• In genitally cut women
- 2% do not have orgasm at all
- 32% have orgasm infrequently
• In Non genitally cut women
- 8.5% have orgasm infrequently
• 70-80% of women achieve orgasm only
through direct clitoral stimulation. Clitoral
orgasms are easier to achieve because
the tip or glans of the clitoris alone has
more than 8,000 sensory nerve
• Copulatory vocalizations were reported to
be made most often before and
simultaneously with male ejaculation
• These data clearly demonstrate a
dissociation of the timing of women
experiencing orgasm and making
copulatory vocalizations and indicate that
there is at least an element of these
responses that are under conscious
control, providing women with an
opportunity to manipulate male behavior to
their advantage
What do women do when they
do not reach orgasm ? (My Work)
• Fake it : 75%
(56 % in America)
• Tell my husband : 17 %
• Do nothing : 35 %
Reasons for faking an Orgasm
REASONS (MY
WORK)
Not to hurt husband's
feelings : 59%
To avoid husband’s
criticism : 35%
Guilt feelings :14%
Husband will find
another wife :12%
REASONS USA
Orgasm was unlikely or
taking too long : 71%
They wanted the sex to
end : 61%
Partner was unskilled :
25%
Not in the mood : 18%
Etiology
I- Biological Factors:
1.General medical conditions, such as heart
or kidney disease, can damage patients’
quality of life and are often associated with
depression
2. Atherosclerosis and its related risk factors
(smoking, diabetes, hypertension, and
peripheral vascular disease) affect genital
blood flow which is critical to the female
sexual response
3.Anorgasmia is often seen as a side
effect of using psychotropic medications:
- Anorgasmia is reported in at least onethird of patients who receive SSRI
- Also it is reported
with antipsychotics
and mood stabilizers
4. Heavy alcohol consumption and illicit
drugs can also interfere with orgasmic
ability
5.Hormonal changes due to menopause or
other disorders:
- Lower estrogen levels may cause a
weakening of the pelvic muscles, affect
the responsiveness of nerves that act as
receptors for external sexual stimuli, and
reduce vaginal lubrication
- Low testosterone has also been found to
be reduce arousal and experiences of
orgasm
6-Recently, studies investigating genetic
factors have been conducted. Dunn et al.
estimate the heritability for difficulty
reaching orgasm to be 34%. Furthermore,
a certain gene (GRIA1) has been found to
be associated with difficulty achieving
orgasm
II- Psychosocial Factors
1-Poor body image and genital image (the
way a woman feels about the size, shape,
odor, and function of her genitals) can
contribute to anorgasmia
2- Relationship problems and lack of proper
communication with the partner about
clitoral stimulation techniques
3- Anorgasmic women often demonstrate
negative attitudes toward sex and
masturbation, and tend to experience guilt
following sexual activities
4- The effect of past sexual abuse on
women’s orgasmic functioning is important
to examine
5-Additional psychosocial factors
associated with orgasm capacity include:
• Age: older women may experience
orgasm difficulty due to changes in their
body and the belief that, at an older age,
sexual desire and activity are improper
• Education: correlates with anorgasmia
• Social class: correlates with anorgasmia
• Shame about sexuality due to religious
beliefs or familial inhibitions:Increase
incidence of anorgasmia
TREATMENT
• There are no Food and Drug Administration
(FDA)-approved medications for this disorder
• First , treat the underlying medical conditions
e g in anorgasmia due to hormonal changes
associated with menopause, partial
androgen replacement (avoiding doses that
could cause masculinization) can restore
sexual responsiveness
• Tibolone, a selective tissue estrogenic
activity regulator with estrogenic,
progestogenic, and androgenic properties,
did improve orgasm domains in multiple
studies of postmenopausal women
• Trials are needed to assess whether
androgen therapy can treat disorders of
orgasm in women who are not
postmenopausal
• Changing medications that may be
causing anorgasmia(eg SSRI) can reverse
it eg the use of moclobemide(Aurorix)
instead of SSRI can improve anorgasmia
• Cabergoline(Cabergolobe tab), a
dopaminergic agent, was found helpful
when administered prior to intercourse
• Sildenafil showed mixed results and
appears to be effective in some
populations of women, but additional
large-scale studies are needed
• Oxytocin is another potential therapy for
anorgasmia that warrants further study
• Alprostadil(Prostaglandin E1), 400 mg
vaginal cream applied prior to intercourse
was found effective in a controlled trial
The use of medical devices :
1- The Eros-Clitoral Therapy Device($395)
• It is the only such treatment approved by the
FDA for FOD
• The device works by
applying a gentle vacuum
to the clitoris, which
increases its blood flow
• It increased lubrication in 70% and increased
ability to have orgasm in 60% of patients in a
small study
2-Slightest Touch(140$)
• It stimulates nerve pathways to the genital
area
• Electrode pads
are appllied above the
ankles
• It gently stimulates the
sexual nerve pathways taking the woman
to a pre-orgasmic plateau where she
swings on the edge of orgasm for as long
as she wants
PERSISTENT GENITAL
AROUSAL DISORDER
• First documented in 2001(it may be the
counterpart of priapism)
• It will be included in DSM-5 expected in
May, 2013
• Incidence:rare
SYMPTOMS
• Very intense arousal persists for days or weeks
at a time
• Arousal is sudden and unpredictable
• Orgasm can sometimes provide temporary
relief, but within hours the symptoms return.
• Failure or refusal to relieve the symptoms
often results in waves of spontaneous orgasms
• The symptoms can be debilitating, preventing
concentration on ordinary tasks
• Some situations, such as riding in a car or train,
vibrations from mobile phones, and even going
to the toilet can aggravate the syndrome
unbearably causing pain
• It is common for sufferers to lose some or all
sense of pleasure over the course of time
leading to avoidance of sexual relations
• The condition may last for many years and can
be so severe that it has been known to lead to
depression and even suicide
POSSIBLE CAUSES AND
TREATMENT
• There is not enough knowledge to define a cause
• It has a tendency to strike post-menopausal
women, or those who have undergone hormonal
treatment
• Additionally, the condition can sometimes start
only after the discontinuation of SSRIs
• In some cases, the syndrome was caused by
pelvic arterial-venous malformation with arterial
branches to the clitoris. surgical treatment was
effective in this case
• In other situations the symptoms can sometimes
be reduced by the use of antidepressants,
antiandrogens, and anesthetising gels
• Psychotherapy with cognitive reframing of the
arousal as a healthy response may also be used.
• The symptoms of the condition have also been
linked with pudendal nerve entrapment.
Regional nerve blocks demonstrated varying
degrees of success in most cases
• In one recent case, relief of symptoms was
noted from treatment with, varenicline, a
treatment for nicotine addiction
Vaginismus
• Involuntary muscle spasm of outer third of
the vagina
• In severe cases, the adductors of the
thighs, the rectus abdominis, and the
gluteus muscles may be involved
• It may be 1ry or 2 ry
PC = Pubococcygeus
Variations of vaginismus
• Some women are unable to insert anything
at all
• Some women are able to insert a tampon
and complete a gynecological exam, yet are
unable to insert a penis
• Others are able to partially insert a penis,
although the process is very painful
• Some are able to fully insert a penis, but
tightness interrupts the normal
progression from arousal to orgasm and
bring pain instead
• Some women are able to tolerate years of
uncomfortable intercourse with gradually
increasing pain and discomfort that
eventually interrupts the sexual experience
ETIOLOGY
I-Psychological causes
1-Misinformation & ignorance (90%)
2- Fears of:
• Pain
• Not being completely healed following pelvic
trauma
• Tissue damage (ie. "being torn")
• Getting pregnant
3-Anxiety or stress :performance pressures,
previous unpleasant sexual experiences, guilt
4-Partner issues:Abuse, emotional
detachment, fear of commitment, distrust
5-Traumatic events:Past emotional/sexual
abuse, witness of violence or abuse
6-Childhood experiences:Overly rigid
parenting, unbalanced religious teaching,
exposure to shocking sexual imagery
7-Idiopathic
II- Physical Causes
1-Medical conditions:Urinary tract infections
or urination problems, yeast infections,
STDs, endometriosis, genital or pelvic
tumors, cysts, cancer, vulvodynia /
vestibulodynia, pelvic inflammatory disease,
lichen planus, lichen sclerosus, eczema,
psoriasis, vaginal prolapse, pain from
normal deliveries or c-sections
2-Age-related changes:Menopause and
hormonal changes causing vaginal atrophy
and inadequate lubrication
TREATMENT
1- Sex therpy & dilatation
• Vaginismus is highly treatable with high
success rates (75-100%)
-Steps of therapy:
• Step 1: normal reproductive anatomy and
physiology of the sexual act are explained
• The patient is made comfortable with her
genitals by asking her to look at the area
in the mirror
• She is taught Kegel exercises (contraction
& relaxation of pubococcygeus muscle
several times a day) which help control the
pubococcygeus muscle that surrounds the
entrance to the vagina
• Step 2: she is advised to insert her fingers
into her vagina and move them around
initially one finger, later two fingers.
Penetrative sexual intercourse is
prohibited during the period
• Step 3: Dilators insertion(Diameter 2-4cm)
• Step 4: Vaginal containment with
lubrication and local anesthesia
(e.g. 5% lignocaine jelly) is advised
• Step 5:Vaginal containment involved the
patient in female superior position, guiding
penile penetration with her hands and the
couple remaining still, concentrating on the
pleasant sensations they experience
2-Botox
• An analgesic (e.g.Voltaren) is administered i.m.
30 minutes before the injection
• 25 IU BT diluted in 1 ml of saline, is injected into
the bulbospongiosus muscle
• Satisfactory intromission on the 2nd day after
injection was reported
• The toxin has a long-duration of action of up to 6
months
Advantages
• It is usually the treatment of choice for
refractory cases
• It helps the dilation treatment and
consequently allows for coitus by training
the muscles that it's not painful to insert
something in the vagina
• Patients can go through the treatments
under sedation (general or local
anesthesia) so it can be painless (but add
risks associated with anesthesia)
Disadvantages
• The idea of having an injection inside the
vagina can be very scary and intolerable for
women with primary vaginismus
• Its effects are not permanent so you may
have to repeat the injections after a while but
its side effects instead will be permanent
• Botox is not yet licensed for use in the
treatment of vaginismus in Egypt
Side Effects
• The most serious one being the paralysis of
the wrong muscle
• An allergic reaction
• Urinary stress incontinence
• Flatus, and fecal incontinence intermittently
THANK YOU
LESBIANISM
ETYMOLOGY
• Comes from the Greek island “Lesbos” home
of Sappho, a female poet whose erotic lyrics
embraced women
SOME IMPORTANT DEFINITIONS
• Sex: refers to a person’s biological status
(male, female, or intersex) i.e., combinations
of features that usually distinguish male from
female e.g. genitalia and sex chromosomes
• Gender: refers to the attitudes, feelings, and
behaviors that a given culture associates with a
person’s biological sex
• A “Lesbian” is a woman with sexual acts or
romantic desire towards females
• A “Gay” is a man with sexual acts or romantic
desire towards males
• Gender identity: refers to an individual's
internal sense of being male or female
- It develops early in childhood and normally
solidifies by age 2.5 years
- Most homosexual individuals have a firmly
established gender identity that is consistent
with their anatomy i.e. A male homosexual
understands himself to be a man, just as
does a heterosexual man
• Gender role: is defined as the outward
manifestations that reflect the gender identity,
e.g. if a person considers himself a male and is
most comfortable referring to his personal
gender in masculine terms, then
his gender identity is male.
However, his gender role is male
only if he demonstrates typically
male characteristics in behavior,
dress, and/or mannerisms
• Gender orientation: refers to an individual's
desires and preferences regarding the sex of
intimate partners.
- Like gender identity, gender orientation is
based on deeply held conscious and
unconscious psychological constructs
- Individuals tend to have a range of
preferences and desires rather than falling
into neat, mutually exclusive categories i.e.
a person can be exclusively heterosexual,
mainly heterosexual, bisexual, mainly
homosexual, exclusively homosexual
HISTORICAL BACKGROUND
• Throughout history, lesbian relationships have
often been regarded as harmless and
incomparable to heterosexual ones and they
were not met with the harsh punishment in
some societies as homosexual
‫علَى أَنَّهُ ال َحدَّ في‬
‫• الموسوعة الفقهية الكويتية‪ -:‬اتَّفَقَ ْالفُقَ َها ُء َ‬
‫ير ; ألَنَّهُ‬
‫ْس زنًى ‪َ .‬وإنَّ َما يَج ُ‬
‫ب فيه الت َّ ْعز ُ‬
‫الس َحاق ; ألَنَّهُ لَي َ‬
‫َم ْعصيَةٌ اهـ‬
‫• وقال ابن قدامة ‪َ -:‬وإ ْن تَدَالَ َك ْ‬
‫ت ْام َرأَتَان ‪ ,‬فَ ُه َما زَ انيَتَان‬
‫ْ‬
‫َ‬
‫ع ْن النَّبي صلى هللا عليه وسلم أَنَّهُ قَا َل ‪:‬‬
‫و‬
‫ر‬
‫ا‬
‫م‬
‫ل‬
‫;‬
‫ان‬
‫ت‬
‫َ‬
‫ن‬
‫و‬
‫ع‬
‫ل‬
‫َم‬
‫ُ‬
‫ُ‬
‫ي َ‬
‫َ‬
‫َ‬
‫( إذَا أَت َ ْ‬
‫علَ ْيه َما ألَنَّهُ‬
‫ت ْال َم ْرأَة ُ ْال َم ْرأَة َ ‪ ,‬فَ ُه َما زَ انيَتَان ) ‪َ .‬وال َحدَّ َ‬
‫ض َّم ُن إيال ًجا ( يعني الجماع ) ‪ ,‬فَأ َ ْشبَهَ ْال ُمبَاش ََرة َ دُو َن‬
‫ال يَت َ َ‬
‫ْالفَ ْرج‬
• As a result, little in history has been
documented to give an accurate description of
how female homosexuality has been expressed
• When early sexologists in the late 19th
century began to categorize and describe
homosexual behavior, they were hampered by
a lack of knowledge about , so they classified
lesbians as women who did not adhere to
female gender roles and designated them
mentally ill
PREVALENCE
How frequent is homosexuality •
In USA •
Sexual orientation
Men
Women
Bisexual
0.5 %
2.8 %
Mainly homosexual
0.7 %
0.6 %
Entirely homosexual
1.2 %
0.8 %
In Britain •
Sexual orientation
Men
women
Bisexual
0.6%
0.8%
Mainly homosexual
0.5%
0.1%
Entirely homosexual
0.7%
0.3%
ETIOLOGY
• There are two main theories as to what causes
homosexual attractions
1- The genetic theories
2- The biological theories
1- THE GENETIC THEORIES
• A study found 52% of monozygotic brothers
and 22% of the dizygotic twins were concordant
for homosexuality
• Another study found 20% concordance in the
male monozygotic twins and 24% concordance
for the female monozygotic twins
• A 2010 study of all adult twins in Sweden
showed that the choice of sexual partner was
influenced by the following factors:
• Environment shared by twins (including
familial and societal attitudes): 0 F –17 M%
• Genetic factors :19 F –39 M %
• Unique environment for each twin
(circumstances during pregnancy and childbirth,
physical and physical trauma, peer groups and
sexual experiences):61F –66 M%
2-THE BIOLOGIC THEORIES
1- Early fixation hypothesis
• Intrauterine hormone exposures(eg drug intake)
may determine sexual orientation by changing
the masculinization of the brain in homosexual
men
• This hypothesis is supported by both the
observed differences in brain structure and
cognitive processing between homosexual and
heterosexual men
2- Brain studies
• Some studies reported:
- A difference in the size of the supraciasmic
nucleus and anterior commissure between
homosexual and heterosexual men
- INAH3(an area of the hypothalamus )was
smaller in homosexual men than in heterosexuals
• These studies are of no real value because these
areas are not known to be related to sexual
activity, sample size was small, mostly made on
cadavers of AIDS patients, some of the researchers
were gay
Does childhood sexual abuse (CSA)
affect sexual orientation?
• No causal connection has been established
between a history of child sexual abuse and
homosexuality in women
• A woman who hates men because she was
molested by a man does not gain the capacity
to be aroused by women
• However, several studies have reported higher
percentages of CSA experiences for lesbian
women. For example, a study found that 17%
of the lesbian women and 7% of the
heterosexual women reported a history of CSA
• In another study of molested women 10 of 18
reported a lesbian sexual orientation and 8
reported a heterosexual orientation
• Another study found that 77% of lesbians /
bisexuals claimed sexual activity with an adult
as a child, compared to 15% of heterosexual
women
SEXUAL PRACTICES AMONG
LESBIANS
• A study conducted on 100 lesbians about the
techniques they used in their last 10 sexual
encounters, the following results were
obtained:
100% reported kissing, sucking on breasts, and
manual stimulation of the clitoris
More than 90% reported French kissing, oral
sex, and fingers inserted into the vagina
80% reported tribadism(rubbing vulva against
another woman’s body)
• In 2003, data based on a sample from the UK
of 803 lesbians reported that:
The most commonly cited sexual practices
between women were oral sex, digital vaginal
penetration, mutual masturbation, and
tribadism
Like older studies, the data also showed that
vaginal penetration with dildos are rare
• Lesbian couples typically express female
characteristics, including
Less emphasis on genital contact
More rapidly decreasing frequency of sexual
contact
More emphasis on emotional intimacy and
nurturance
More exclusivity in relationships
A greater inclination to long-term stability in
relationships
SEXUAL PREFERENCES
AMONG LESBIANS
• This study proposes that feminine lesbians
who primarily date masculine lesbians will be
more likely than masculine lesbians who
mainly date masculine lesbians to perceive
their partners as the masculine sex-role, both in
a global and sexual situational sense. It is
hoped that these findings may help shed light
and facilitate understanding of lesbian sexroles
TYPES OF LESBIANS
• Femme
A feminine lesbian who is attracted to
masculine, or butch lesbians
• Lipstick Lesbian
A femme that is attracted to other feminine
lesbians
• Butch
A woman who adopts what would be considered
masculine characteristics. Often the "dominant" partner
in a lesbian relationship, and especially of a
butch/femme lesbian relationship
Dressing masculinely does not make a woman into a
lesbian, contrary to popular belief
• Stone Butch
A lesbian who gets her pleasure from pleasing her
partner. She does not like to be touched sexually
• Pillow Queen
A lesbian who prefers to receive sexual
pleasure without returning the favor because
it's all about her
SEXUALITY TRANSITIONS IN
WOMEN (SEXUAL FLUIDITY)
• Many homosexual women have previous
heterosexual relationships, marriages, and children.
Some women return to heterosexual relationships
following dissolution of a lesbian relationship
• Data indicate that 36 % of women in their 40s
with same-sex partners previously had been
married to men. That percentage grew to more
than half for lesbians in their 50s, and 75 % for
those 60 and older
• In a 2004 study, the female subjects (both
Homo or heterosexual) became sexually
aroused when they viewed heterosexual as
well as lesbian erotic films. Among the male
subjects, however, the straight men were
turned on only by erotic films with women, the
gay ones by those with men
• The study concluded that women's sexual
desire is less rigidly directed toward a
particular sex, as compared with men's, and it's
more changeable over time
TREATMENT
Can lesbianism be treated?
• The Western view is that lesbianism is not a
disorder to be treated and cured; it is just a
sexual orientation. They claim that lesbians are
neither mentally, nor physically ill. Lesbianism
is a trait, may be, just as your liking for a
particular food item
• If somebody feels that she should be cured
from lesbianism, then it is a clear sign that she
is not a lesbian at all. This means that she has
misidentified her sexuality and became a
lesbian, then proper counseling could help to
regain the right path
OLD THERAPIES
1-Aversion therapy:
• Homosexuals had electrodes attached to
genitals and were then shown homosexual
pornography
• As the pornography played, the patients were
injected with emetic drugs and administered
electric shocks
• The shocks and emetics would then cease and
the homosexual imagery would be replaced by
heterosexual pornography, during which time
the patient would not be abused
• Since 1994, the American Psychological
Association (APA) has declared that it is a
dangerous practice that does not work. Since
2006, the use of aversion therapy to treat
homosexuality has been in violation of the
codes of conduct and professional guidelines
of the APA and American Psychiatric
Association
2-Psychoanalytic therapy
3-Spiritual interventions, such as "prayer and
group support and pressure"
THANK YOU