Positive Sexuality: A Presentation to - PowerPoint Presentation

Slide1

Positive Sexuality: A Presentation to Family Medicine Physicians

by Frederick “DocPete” Peterson

Sexual

Health Program, The Flexman Clinic, Dayton, Ohio

Department

of Specialty Medicine

Heritage College

of Osteopathic

Medicine, Ohio University

Health Promotion & Disease Prevention,

Department of Veterans Affairs

Slide2

Positive Sexuality   Overview: Problem Statement One: The Lack of Communication Problem Statement Two: Negative SexualityPositive News about Sexual Science Positive News about Female Sexuality

Positive News Male Sexuality

Sexual Satisfaction & WellnessSlide3

Positive Sexuality   Objectives:At the conclusion of this session, participants will be able to: Identify at least two components of the definition of sexual identity Identify at least two components of the definition of

sexual expression

List at least two measures of

sexual health & wellbeing Slide4

Positive Sexuality   Cautions:You may blow your mind!Participants are cautioned to remember that… The empirical study of the human sexuality is relatively new and therefore is in its infancy as a scienceThere is much more we don’t know about sexual identity, expression and function

than we do know and this is especially true for female sexuality

The model of the

Sexual Hypercube

as an explanation of sexual interaction is one among manySlide5

Positive Sexuality   Problem Statement OneThe Lack of CommunicationThe lack of communication about sex while growing up,especially the lack of positive communication, imposes a strong message that sex is not an appropriate

subject for discussion and creates discomfort within people

regarding most things sexual.

(a condition informally referred to as “

sexophrenia

”)Slide6

Positive Sexuality   Problem Statement TwoNegative SexualityAlong with the lack of exposure children have to positive models of communication about sex, for many people there is a sense of sex as a necessary negative (evil) in life .Sex education in schools is less than a few decades old, and when provided is usually abstinence-based and fear-based emphasizing prevention of pregnancy & STI Slide7

Before Sexual Science in AmericaHistorical “whole-sale pathologizing” of women, people of color, and people with disabilities which include, but are not limited to:

Eugenics

Movement

(Galton, Davenport, Goddard, Roosevelt)

Masturbation was a disease leading to disease till mid-20

th

century

Forced & legalized sterilizations of people of minority status

Mass institutionalization of all forms of “substandard” people

Pseudo-rationale for racial segregation and “miscegenation” laws

Repression

of sexual rights, especially sexual expressionSlide8

The Development of Sexual Science

Scientific study of sexuality is little more than 100 years old (

Iwan

Bloch

and Magnus Hirschfeld 1907).

American’s historical focus has been on defining sexuality based on straight abled-body male WASP identity and obsessively

pathologizing

all “others” via social institutions of law, education, medicine and religion.

- women

- members of

racial/ethnic

minorities

- members of the varied disability communities

- LGBT individuals, especially men changing sex status

Slide9

The Development of Sexual Science

Three publications that permanently changed American consciousness about sexuality:

Sexual Behavior of the American Male

(Kinsey, 1948)

Sexual Behavior of the American Female

(Kinsey, 1953)

Human Sexual Response

(Masters & Johnson, 1966)Slide10

Positivity SexualityMs. Jorgensen is the first& best known American who underwent sexualreassignment (1952).

George W. Jorgensen

was an U.S. Army

WWII veteran.

Slide11

The Development of Sexual Science

Sexual Health

A

state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and

violence.

WHO, 2004Slide12

1. Right to Sexual Expression. 2. The Right to privacy. 3. The right to be informed. 4. The right to access to needed sexual services such as contraceptive counseling, medical care, genetic counseling, and sex counseling.

5. The right to chose one’s marital status.

6. The right to have or not have children.

7. The right to make decisions that affect one’s life.

8. The right to develop to one’s fullest potential.

Sex & Disability Project of George Washington University (

Chipouras

, S. et al.

Who Cares? A Handbook on Sex Education & Counseling Services for Disabled People

(1979).

Positive Sexuality

Bill of Sexual RightsSlide13

Relationship Bill of Rights I have the right to be treated with dignity and respect.I have a right to follow my own values and standardsI have the right to say no and not feel guilty.I have the right to experience and express my feelings.I have the right to feel safe.I have the right to take time for myself.I have the right to change my mind.I have the right to ask for what I want.I have the right to ask for information.I have the right to make mistakes.I have the right to do less than I am humanly capable of doing.

I have the right to be me and feel good about myself.

I have the right to leave conversations with people who make me feel put down or humiliated

I have the right to act only in ways that will promote my dignity and self-respect.

I have the right to feel scared and say “I’m afraid”.

I have the right to end the relationship.

I have the right not to be responsible for others’ behavior, actions, feelings, or problems.

I have the right to expect honesty from others

I have the right to all of my feelings

I have the right to make decisions based on my feelings, my judgments, or any reason that I choose.

I have the right to change and grow.

I have the right to be happy.

I have the right to make friends and be myself around people.

I have the right to be angry at someone I love.

I have the right to both experience and let go of fear, guilt, and shame.Slide14

Introduction to Sexual IdentitySlide15

Introduction to Sexual Expression Slide16

Introduction to the Sexual Hypercube Slide17

The Search for a Definition:A Review of College Textbooks

Major college sexuality textbooks were reviewed (N=27)

Eighteen (66

percent) did not include sexual identity in the index and did not provide a definition of sexual identity in the body of the text.

Nine

texts

(33

percent)

did have a definition

of sexual identity.

Peterson & Carter, 2010Slide18

The Search for a Definition:A Review of College Textbooks

T

his

finding

was astounding

as society looks to college

textbooks as

authoritative sources on a given

topic.

What

we found was the majority of the textbooks did not define what

is considered

a core concept of sexuality (sexual identity).

On

the other hand, this is the state of the field as the scientific study of sexuality has

just pasted

its centennial. Slide19

Definition of Sexual IdentitySex Identity is the sense of who one is as a sexual being and is an overarching

sexual health concept comprised

of a person's sex

orientation (male/female continuum),

sexual orientation, and sex role orientation.

Sexual Identity is

inclusive

of a person’s

overall sexuality

over the entire

lifespan, a central part of their overall identity,

and is influenced by both social-cultural and biological factors.

Here’s a quick look at these three components……Slide20

Positive SexualitySex Orientation (male/female continuum sex status) – A person’s fundamental status on a male to female continuum, which is composed of eight factors, both biological and psychosocial. Slide21

Positive SexualitySexual Orientation (sexual attraction pattern) – This is a personal quality which determines to whom one’s sexual, affectionate, and/or love interests are directed.Slide22

Positive SexualitySex Role Orientation (gender role). This refers to personal qualities and responses to the role expectations that society associates with a person’s sex designation,

and is manifest in

a person’s

gender-role attitude and gender-role behavior. Slide23

Introduction to Sexual IdentitySlide24

Positive SexualitySex Orientation (male/female continuum sex status) A fundamental

status on a male to female continuum, which is composed of

eight

factors

, both biological and psychosocial.

How is a person’s sex status designated? Slide25

Sex Orientation Sex Orientation (male/female continuum) How is a person’s sex status designated? Estimated

Number of Typical and Variant Sexual

Development Paths

Biological

Psychosocial

Chromosoma

l

Gender

Identity

Hormonal

Sex

Assigned at Birth

prenatal

and

pubescent

Anatomical

Sex

Raised As

internal

or external

organs Slide26

Sex Orientation Estimated Number of Typical and Variant Sexual Development PathsBiological

Psychosocial

Chromosoma

l

= 3

Gender

Identity

= 3

(XX, XY, or variant) (male, female, variant)

Hormonal

(x2) = 6

Sex

Assigned at Birth

= 2

(

masculine, feminine, or variant

(male or female - variant infants

development at

prenatal

and

pubescent

)

are often

“reassigned”)

Anatomical

(x2) = 6

Sex

Raised As

= 3

(

masculinized, feminized, or variant

(

male or female, or variant

development of

internal

or

external

organs)

“combined” development)Slide27

Sex Orientation (male/female continuum) How is a person’s sex status designated?Estimated Permutations of Typical and Variant Sexual DevelopmentSeparated into “Biological” (5) and “Psychosocial” (3) Categories

Chromosomal

3

Hormonal

(Prenatal)

x3

(

Carry-over)

243

9

Gender

Identity

x3

Hormonal

(Pubescent)

x3

729

27

Sex Assigned at Birth

x2

Anatomical

(Internal

)

x3

1,458

81

Sex

Raised As

x3

Anatomical (External

)

x3

243 Estimated

Permutations

4,374Slide28

Should we re-run the numbers? Estimated Number of Typical and Variant Sexual Development Paths

Biological

Psychosocial

Chromosoma

l

= 10

Gender

Identity

= 3

(male, female, variant)

Hormonal

(x2) = 6

Sex

Assigned at Birth

= 2

(

masculine, feminine, or variant

(male or female - variant infants

development at

prenatal

and

pubescent

)

are often

“reassigned”)

Anatomical

(x2) = 6

Sex

Raised As

= 3

(

masculinized, feminized, or variant

(

male or female, or variant

development of

internal

or

external

organs)

“combined” development)Slide29

Sex OrientationChromosomal & Hormonal VariationsEstimated prevalence of 10 most frequent sexual development variations (Estimated frequencies per every 100 live births) XO (Turner Syndrome) 0.03690 XXY (Klinefelter

Syndrome)

0.09220

XY

(Androgen Insensitivity Syndrome -AIS Full) 0.00760

XY

(Androgen Insensitivity Syndrome -AIS Partial) 0.00076

XX

(Congenital Adrenal Hyperplasia - Classic CAH)

0.00779

XX (Congenital Adrenal Hyperplasia - Late Onset CAH) 1.50000 XX Vaginal Agenesis (females born without a vagina) 0.01690

True Hermaphroditism (both ovaries & testicles) 0.00120

Idiopathic Hermaphroditism

0.00090

Non-XX or non-XY (except for Turner &

Klinefelter

)

0.06390

Estimation of Frequency for All Causes

1.72815

(from

Fausto

-Sterling

, 2000

) - Not Included are other combinations

such as XYY (Jacobs 1:1500), Triple-X (XXX), Mosaic (XX/XXX or XY/XXY) Slide30

Sex Orientation (male/female continuum) How is a person’s sex status designated?Estimated Permutations of Typical and Variant Sexual DevelopmentSeparated into “Biological” (5) and “Psychosocial” (3) Categories

Chromosomal

10

Hormonal

(Prenatal)

x3

(

Carry-over)

810

30

Gender

Identity

x3

Hormonal

(Pubescent)

x3

2,430

90

Sex Assigned at Birth

x2

Anatomical

(Internal

)

x3

4,860

270

Sex

Raised As

x3

Anatomical (External

)

x3

810 Estimated

Permutations

14,580Slide31

Estimated Permutations across the eight dimensions of sex orientation (male-female designation) could be a few hundred or several thousand (4,374 to 14,580). The

Point:

We do not know

However

, evidence strongly suggests sex orientation (male/

f

emale designation)

naturally occurs across a

continuum

so it is more accurately represented as a gender

mosaic, certainly not by a binary dichotomy.Slide32

Introduction to Sexual IdentitySlide33

Positive SexualitySexual Orientation (sexual attraction pattern) – This is a personal quality which determines to whom one’s sexual, affectionate, and/or love interests are directed.

Sexual orientation is the most familiar of the three components of sexual identity yet is still commonly misunderstood.Slide34

Sexual OrientationHow does one determine and/or measure sexual orientation?It is more complicated than w

ith whom one chooses to sleep.

Behavioral (choice of sexual partner)

Fantasy (uncensored private attraction)

Physiologically (the

ummm

factor)

Emotional (being in-love factor) Slide35

Sexual Orientation The Kinsey Scale of Heterosexuality-HomosexualitySlide36

A More Inclusive View Sexual Orientation Two by Two Matrix of Sexual Attraction High

Attraction to Males

Low Attraction to Males

High Attraction

bisexual

attraction

You

could be

straight

if a man

to Females You could be

lesbian

if a woman

Low Attraction

You

could be

gay

if a man

asexuality

to Females

You could be

straight

if a

woman (Low

attraction to either

)Slide37

This is NOT your grandfather’s VA!We Serve ALL Veterans That Have Served Our Country

Slide38

Positive SexualitySex Role Orientation (gender role). This refers to personal qualities and responses to the role expectations that society associates with a person’s sex designation, and is manifest in a person’s gender-role attitude and gender-role behavior. Slide39

Sex Role Orientation (gender role)Two x Two Matrix of Sex Role Orientation (based on the work of Dr. Sandra Ruth Lipsitz Bem)Slide40

Sex Role Orientation (gender role)Is self-identifying as Gender Queer a sex orientation or something different?Slide41

Positive Sexualityas Part of Personal Growth & Overall HealthA Sexual Health ProgramFor WomenHypoactive sexual desire disorder (HSDD) Arousal DisordersOrgasmic Disorders

DyspareuniaSlide42

Positive Sexualityas Part of Personal Growth & Overall HealthA Sexual Health ProgramFor MenHypoactive sexual desire disorder (HSDD) Rapid EjaculationErectile Dysfunction

Delayed or Inhibited Orgasm Disorder

Sexual CompulsivitySlide43

Positive Sexualityas Part of Personal Growth & Overall HealthA Seven-Step Sexual Health Program for Expanding One’sPositive Sexual Self-EsteemIncreased Self-AcceptanceEnhanced Personal SatisfactionSlide44

Positive Sexualityas Part of Personal Growth & Overall HealthAlways Remember Rule # 1Slide45

Positive Sexualityas Part of Personal Growth & Overall HealthAlways Remember Rule # 1Never hurt the Doctor!Slide46

Positive Sexualityas Part of Personal Growth & Overall HealthStep # 1Learn key tenets of Sexual HealthIt is important to understand the cultural & historical influences on your sexual identity as well as current sexual scienceSlide47

Positive Sexualityas Part of Personal Growth & Overall HealthStep # 2Take a Baseline Measure of your satisfaction for your personal sexual health(see list of available measures)Slide48

Positive Sexualityas Part of Personal Growth & Overall HealthStep #3Sexual Self-Image Exercise This is an experiential self-assessment of how well one can appreciate and celebrate the positivity of the physical body.

Get NAKED in front of a mirror and look at (and feel) all parts of the body from the tip of your head to the tip of your toes noting

ONLY POSITIVE ATTRIBUTES

Record

a

list of positive attributes in order to measure one’s growth of positive self-image and acceptance.Slide49

Positive SexualitySexual Health & Sexual Identity as Part of Personal GrowthStep #4Sensual Exploration Exercise This is also an experiential exercise but instead of how well one can accept and appreciate the physical body – it is about how well one can explore the sensual capacities of the body.There is no goal or expectation of experiencing orgasm in this exercise

.

Get NAKED in a warm bath or warm bed, touching the skin from the tip of the head to the tip of the toes noting

ONLY POSITIVE feelings and thoughts that are generated.

Record the list of positive attributes to measure one’s growth

of positive self-image and acceptance.Slide50

Positive Sexualityas Part of Personal Growth and Overall HealthStep #5Sensual Fantasy Exploration Exercise This is also an experiential exercise but it is mostly inside the mind.

There is no goal or expectation of experiencing orgasm in this exercise.

When and wherever one has privacy, intentionally generate fantasy stories that bring pleasure.

Record list of positive sensual fantasies to measure one’s

growth and capacity for personal satisfaction.Slide51

Positive SexualitySexual Health & Sexual Identity as Part of Personal GrowthStep #6Personal Pleasuring Exercise This is another experiential exercise - not about appreciating one’s physicality but rather enjoying feelings of sensual & sexual pleasure.While there is no requirement of experiencing orgasm in this exercise, there is permission to feel sexual to one’s fullest capacity – enjoying any part of the body in which these feeling are created.

Get NAKED in a warm bath or warm bed, touching one’s skin in places previously noted that feel the most sensuous and sexual. Afterwards, record one’s growth of positive sensual celebration.Slide52

Positive SexualitySexual Health & Sexual Identity as Part of Personal GrowthStep #7Sharing Your Sensual Self This is the real-deal in terms of experiential sharing if and only if one choses to do so. All interpersonal interactions must follow the guidelines of consensual touch and the Relationship Bill of Rights as a guide in terms of negotiating the touching with a partner.

Again - there is no requirement of experiencing orgasm in this encounter but one can feel sexual to one’s fullest capacity – enjoying any part of the body in which these feeling are created.

Afterwards, record one’s growth of positive sensual celebration.Slide53

Positive Sexualityas Part of Personal Growth & Overall HealthScreening Tools for Measuring Sexual Health“Am I Normal?” Ten-item Screening Tool International Index of Erectile Function (IIEF)Female Sexual Function Index (FSFI)Slide54

Positive Sexualityas Part of Personal Growth & Overall Health“Am I Normal?” Screening Tool Have you ever felt guilty regarding any of your own sexual behavior?How satisfied are you with your level of accurate knowledge about human sexuality? 

How satisfied are you with your own physical

appearance (attractiveness

of your

body)?

Did you ever have questions about your own sexual orientation?

Have you questioned whether you were

masculine or feminine

enough?

Have you ever questioned yourself about being "good enough" as a lover

?

Were you ever physically abused as a child or assaulted as an adult?

Were you ever sexually abused as a child or sexually assault as an adult?

How satisfied are you with regards to your ability to prevent yourself from engaging in

sexually

compulsive behaviors

(sometimes

referred to as

“sex addiction”

behaviors)? Slide55

Positive Sexualityas Part of Personal Growth & Overall HealthAssessment Instruments for Measuring Sexual HealthFamily Support for Healthy Sexual Development Sexual Health and Wellness Satisfaction Scale (SHAWS)

Problematic Sexual Behavior InventorySlide56

Positive Sexualityas Part of Personal Growth & Overall HealthSexual Health and Wellness Satisfaction Scale (25 item self-assessment or structured interview)Measures personal satisfaction across four m

ajor

d

omains of sexual

h

ealth:

Self-Satisfaction

Relational Satisfaction

Medical Satisfaction

Sexual IdentitySlide57

Introduction to Sexual IdentitySlide58

Introduction to Sexual Expression Slide59

Introduction to Sexual Hypercube Slide60

Key Focus of Positive SexualityImproved Intrapersonal Satisfaction Resolution of sexual dysfunction and effects of sexual trauma.More personal satisfaction and greater sense of health.Greater self-acceptance through less internal conflict & negative self-image.Improved Interpersonal Relations

Greater sexual satisfaction with one’s partner.

Promote

greater understanding and acceptance of

others.

Less

fear, prejudice, and violence toward those we

perceive

as

different from us. Slide61

Personal Stories of Sexual Empowerment are featured and solicited for forthcomingThe Gender Revolution & the New Sexual Health:

The Sexual

HyperCube

,

Sexophrenia

, and BeyondSlide62

Reference NotesWhile specific references are provided to particular sources (listed on References slide); this work is based upon the work of many different sexologists as well as scholars who do not identify as sexologists:* Alfred Kinsey * William Masters & Virginia Johnson * John Money* Harry Benjamin * Carl Jung * John Bancroft * Eli Coleman * Sandra Lipsitz Bem * Daryl Bem * Beverly Whipple * Lisa Diamond

* Judy

Seifer

* Gerald Weeks * Cindy

Meston

* Greg

Herdt

* Gene Able * Barry McCarthy * Brian Sykes * Lawrence

Kurdek

These individuals influenced the creation of the sexual identity cube, sexual

expression cube and the sexual hypercube model

Positive SexualitySlide63

ReferencesBrown, G.R (1988). Transsexuals in the military: Flight into hypermasculinity. Archives of Sexual Behavior 17(6):527-537.Coleman, E. (2004). Promoting sexual health: A presentation to the World Health Organization, Geneva, Switzerland.Coleman, E. (2009). International Journal of Transgenderism (Volume 11, Number 1) Edwards, W. & Coleman, E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior 33(3):189-195.Evans, N. J., Forney, D. S., Guido, F. M., Patton, L. D., & Renn, K. A. (2010).

Student development in college: Theory,

research

, and practice

(2nd ed.). San Francisco, CA: John Wiley & Sons, Inc.

Fausto

-Sterling

, Anne (2000). Sexing the body: Gender Politics and the construction of sexuality. New York: Basic Books

.

Haffey

, B., Peterson, F.,

Bley

, J., &

Glaus

, K. (2007). Addressing the sexual health concerns of sexual minority clients. Found in L.

Vandercreek

, F. Peterson & J.

Bley

(Eds.), Innovations in Clinical Practice: Focus on Sexual

Health

. Sarasota,

FL

: Professional Resource Press

.

Peterson, F. (2007). The Complexity of Sexual Diversity: Sexual Identity Cube and Self-Awareness Exercise. Found in L.

Vandercreek

, F. Peterson & J.

Bley

(Eds.), Innovations in Clinical Practice: Focus on Sexual Health

. Sarasota,

FL

: Professional Resource Press

.

Peterson, F. & Carter, R. (2010). Re-conceptualizing

and Redefining Sexual Identity in Light of

Intersectionality

and

Lifespan Transitions. Annual Convention of the Ohio

Psychological

Association, November

,

2010..

McCammon

, S.,

Knoz

, D., & Schacht, C. (2004). Choices in Sexuality. Independence, KY: Atomic Dog

Publishing.

World Health Organization. (2004). Progress in Reproductive Health Research – A New Focus for WHO. Geneva.

Zucker

, K. & Lawrence, A.

(2009): Toward Version 7 of the World Professional Association for

Transgender

Health’s Standards

of

Care,

International

Journal of Transgenderism (Volume 11, Number 1)

Sexual

Identity, Expression, &

Hypercubes

Dr. Fred PetersonSlide64

Positive Sexuality Questions?Answers?Margaritas?Contact:937-479-0008Docpete1000@aol.comSlide65

Positive SexualityTwo of the three primary components of the sexual identity are:Sex Orientation (male/female continuum) and sexual

fantasty

Sex Orientation (male/female continuum) and sexual orientation

Sex role orientation and sexual

behavior

Sex role orientation and sexual

orientationSlide66

Positive Sexuality Two of the three primary components of sexual expression are:Sexual fantasy and sexual behavior

Sexual fantasy and sexual

orientation

Sex role orientation and sexual behavior

Sex role orientation and sexual orientation