Health & Medical Sexual Development & Reproductive Health Discussion

”Do you think that “traditional” gender roles are appropriate in American society today? If you think that some are appropriate and some are not, pick one example from each category and explain your feelings about their appropriateness or inappropriateness.”

Chapter 5
Reproductive
Health
Male Reproductive System
Male Reproductive System
• The male reproductive system is structured for the
development and maturation of sperm and for
delivering sperm to the vagina.
• Internal organs of sexual reproduction
– Sperm development
– Testes contain seminiferous tubules where
sperm are made.
– Sperm mature in the epididymis on the back of
each testis.
Male Reproductive System
• Internal organs of sexual reproduction
– Semen formation
– When mature, sperm move through the
epididymis to the vas deferens via rhythmic
muscular contractions.
– Sperm are stored in the vas deferens until
released during ejaculation.
– If not ejaculated, sperm die and are ingested by
the body’s white blood cells.
Male Reproductive System
• Internal organs of sexual reproduction
– Semen formation
• Nutrients for sperm and compounds that protect
sperm
• Pre-ejaculate
Male Reproductive System
• External organs of sexual reproduction
– Scrotum
– Penis
• Three columns of spongy tissue
• Reduction of blood flow out of the penis
Female Reproductive System
Female Reproductive System
• Structured to receive sperm, develop and mature ova
(eggs), provide an environment for a fertilized ovum
(egg) to mature, and give birth to the developed fetus.
Female Reproductive System
• Internal organs of sexual reproduction
– Egg development
• Ova are produced in the ovaries.
• All female sex cells begin to develop before
birth.
• Each month after the onset of puberty and before
menopause, one ovum usually matures to the
extent that it bursts from the ovary in the process
of ovulation.
Female Reproductive System
• Internal organs of sexual reproduction
– Egg fertilization and development
• Uterine tubes transport ovum from pelvic cavity
toward uterus.
• If sperm are present, the tube is the site of
fertilization.
• The fertilized egg implants in the wall of the
uterus. The uterus opens into the vagina at the
cervix.
Female Reproductive System
• Internal organs of sexual reproduction
– Egg fertilization and development
• Cervix: mucus output varies throughout a
woman’s cycle
• Vagina—tube that receives the penis during
sexual intercourse, passes menstrual flow, and is
the birth canal
Female Reproductive System
• External organs of sexual reproduction
– Vulva: female genitals
– Urethra: no reproductive or sexual function
– Clitoris: contains numerous sensory nerves and
becomes engorged with blood during sexual
excitement
– Labia minora
– Labia majora/mons pubis
– Breasts/nipples
The Menstrual Cycle
• Levels of female hormones estrogen and progesterone
change during the menstrual cycle.
• The cycle averages 28 days in length.
• The cycle begins on the first day of the menses
(menstrual bleeding).
• The inner lining of the uterus, the endometrium,
develops gradually during the first half of the cycle,
preparing for implantation of a fertilized egg.
The Menstrual Cycle
• Ovulation usually occurs mid-cycle.
• If the ovum is not fertilized, a decline in female
hormones causes the endometrium to be shed.
• If the ovum is fertilized, female hormone production
continues, maintaining the uterine lining.
The Menstrual Cycle
• Premenstrual syndrome
– 70% to 90% of women report mild to moderate
discomfort during the week prior to menstruation.
– 20% of these women report that premenstrual
symptoms interfere with daily life.
– PMS symptoms include depression, anxiety,
irritability, mood swings, headaches, and bloating.
– Approximately 5% to 8% of women report severe
PMS, referred to as premenstrual dysphoric disorder
(PMDD).
The Menstrual Cycle
• Premenstrual syndrome
– Most women are helped by:
• Counseling
• Lifestyle modification including daily exercise
• Medications to reduce symptoms of depression
and anxiety
• Low-dose oral contraceptives
– Nutritional treatments, including calcium
supplements and diets low in salt, fat, caffeine, and
sugar.
The Menstrual Cycle
• Toxic shock syndrome
– Staphylococcal bacteria
– Can occur with the use of contraceptive diaphragms
and sponges, but this is rare.
– Signs and symptoms of TSS include fever, muscle
pain, headache, dizziness, diarrhea, vomiting, and a
sunburn-like rash.
– Reduce the risk of TSS by changing tampons often
and alternating use of tampons with pads.
Pregnancy and Human Development
• Pregnancy is the gestational process, the developmental
process of a new individual from fertilization until
birth.
• Prepregnancy and prenatal care
– Have blood tests for:
• Antibodies against rubella
• Sexually transmitted infections, including HIV
infection
– Eat a nutritious diet.
– Avoid drinking alcohol, smoking cigarettes, or
taking any drugs, unless prescribed.
Pregnancy and Human Development
• Determining if you or your partner is pregnant
– Missed menstrual period
– Sore and swollen breasts
– Nausea, tiredness, and mood changes
– If pregnancy is suspected, see a physician for
testing.
– A home pregnancy test is generally valid and
reliable when used correctly.
Pregnancy and Human Development
• Pregnancy and fetal development
– 38 weeks/9 months
– 40 weeks from first day of last menstrual period
– Weeks 1–2 = pre-embryo
– Weeks 3–8 = embryo
– Weeks 9–38 = fetus
Pregnancy and Human Development
• Birth process
– Labor
• Stage1: cervical dilation
• Stage 2: baby born
• Stage 3: placenta delivered
Pregnancy and Human Development
• Birth process
– Stage 1
• Rhythmic uterine contractions cause the cervix to
soften, dilate (widen), and efface (thin out).
• The fluid-containing amniotic sac that surrounds
fetus usually breaks during this stage (“water
breaks”).
• During transition into the second stage,
contractions occur every 1 to 2 minutes.
Pregnancy and Human Development
• Birth process
– Stage 2
• Contractions continue until baby is born.
• Usually lasts 30 to 60 minutes
• Normally, the baby is delivered “head first.”
• Breech birth (feet or buttocks first)
– Surgery (cesarean section) may be needed to
deliver the baby.
• Episiotomy—cut made by physician in tissue
surrounding the vaginal opening to prevent it from
tearing
Pregnancy and Human Development
• Birth process
– Stage 3
• Occurs 15 to 30 minutes after delivery of baby.
• Placenta separates from uterine wall and is
expelled from the uterus.
Pregnancy and Human Development
• Circumcision
– Circumcision is a surgical procedure to remove the
foreskin of the penis from a male infant’s penis.
– Has potential medical benefits:
• Reduces risk of urinary tract infections during
infancy
• Reduces risk of certain sexually transmitted
infections
– Complications are rare.
Pregnancy and Human Development
• The postpartum period
– The 6-week period after childbirth during which
mother’s body returns to pre-pregnant state
– Many women (40% to 85%) experience mild
postpartum depression (“baby blues”), especially in
the week after delivery.
– 10%–15% have more severe depression symptoms.
Infertility
• Infertility is the inability of a couple to conceive a child
after 1 year of unprotected sex.
– Affects 10.9% of women aged 15 to 44 in the United
States.
Infertility
• Factors that affect fertility
– Male infertility
• Low sperm count (below 80–120 mil/ml)
• High percentage of abnormally shaped sperm
(40%)
• Sperm transport issues
• Environmental factors:
– Smoking
– Chronic alcoholism
– Medications
– Infections
– Erectile dysfunction
Infertility
• Factors that affect fertility
– Female infertility
• Inability to penetrate the vagina with the penis
• Abnormal properties of cervical mucus
• Scarring of the fallopian tubes
• Endometriosis (the growth of abnormal tissue in
the abdomen)
• Hormonal imbalances that interfere with
ovulation
• Infections, radiation/chemotherapy, age, smoking,
obesity
Infertility
• Treating infertility
– Surgical procedures
– Hormone therapy
– Medication
– Lifestyle changes
– In vitro fertilization and assisted reproductive
technology
Contraception
• Methods to avoid pregnancy
• Abstinence and natural methods
– Refraining from sexual intercourse
• 100% effective
Contraception
• Abstinence and natural methods
– Natural family planning methods
• Couple abstains from vaginal intercourse
during the woman’s most fertile time of the
month.
– Theoretical effectiveness: 91%–99%
– Actual effectiveness: 75%
– If using two indicators of fertility it is
98% effective.
Contraception
• Abstinence and natural methods
– Natural family planning methods
• Basal body temperature method
• Mucothermal method
• Calendar method
• Coitus interruptus or withdrawal
– Theoretical effectiveness: 96%
– Actual effectiveness: 78%
Contraception
• Abstinence and natural methods
– Natural family planning methods
• None of these methods provides protection
against sexually transmitted infections
(STIs).
Contraception
• Chemical and barrier methods
– Spermicides—chemicals that kill sperm
• Nonoxynol-9
– Shortly before vaginal sex, foams,
creams, and jellies, are placed high in the
vagina, near the cervix using an
applicator.
• Correct placement and timing are critical to
effectiveness (72% actual; 82% theoretical).
Contraception
• Chemical and barrier methods
– Spermicides
• Advantages
– Easy to obtain (over-the-counter)
– Side effects are minimal
• Disadvantages
– Low rates of effectiveness
– Nonoxynol-9 can cause genital sores that
increase risk of contracting sexually
transmitted infections.
Contraception
• Chemical and barrier methods
– Douching
• Not an effective method of birth control
Contraception
• Chemical and barrier methods
– Barrier methods
• Block the path of sperm
• Correct use is critical to effectiveness.
Contraception
• Chemical and barrier methods
– Barrier methods:
• Diaphragm
– Actual effectiveness: 88%
• Lea’s shield
– Actual effectiveness: 85%
• Cervical cap
– Actual effectiveness: 86%
Contraception
• Chemical and barrier methods
– Barrier methods:
• Male condoms
– Theoretical effectiveness: 98%
– Actual effectiveness: 82%
• Female condoms
– Theoretical effectiveness: 95%
– Actual effectiveness: 79%
Contraception
• Hormonal methods
– Prevent pregnancy by suppressing ovulation
– Combined oral contraceptives (COCs)
– Combination of two hormones—estrogen and
progestin
– Available in pill, patch, vaginal ring, or
monthly injection form
– Highly effective, but comes with some risks
Contraception
• Hormonal methods
– Progestin-only contraception
• Use progestin to suppress ovulation.
• Implanon is a matchstick-sized contraceptive
implant that has to be surgically inserted under
the skin of the upper arm—lasts 3 years.
• Depo-Provera is an injection—lasts 3 months.
Contraception
• Hormonal methods
– Highly effective
– Reversible
– Decreases menstrual cramps
– Decreases length of menses and amount of blood
loss
– Protects against pelvic inflammatory disease
– Reduces risk of ovarian and endometrial cancers
– Reduces risk of benign breast disease
– Helps prevent osteoporosis
Contraception
• Hormonal methods
– Disadvantages of combination hormonal methods:
• Increased risk of cardiovascular disease,
especially in women over 50 or those over 35
who smoke cigarettes
• Increased risk of cervical cancer
Contraception
• Hormonal methods
– Disadvantages of progestin-only contraceptive:
• Changes in menstrual cycle
• Amenorrhea
• Break-through bleeding
• Thinning of the bones
Contraception
• Intrauterine device
– A small device inserted into uterus where it remains
in place
• Inhibits the ability of sperm to reach and fertilize
egg
• May thin the uterine lining and prevent
implantation
– Active ingredient in the IUD is either copper or
progestin.
– Among the safest, most effective, and least
expensive reversible contraceptives available
Contraception
• Emergency contraception (EC)
– EC helps prevent pregnancy after sexual intercourse.
– It can be taken up to 3 to 5 days after sex.
– Three types of emergency contraception are
available in the United States: Plan B One-Step®
(progestin-only pill), various brands of combined
oral contraceptives, and copper IUD.
– Emergency contraception is about 75% effective.
Contraception
• Sterilization
– Permanent form of birth control
– Highly effective
– Female sterilization
• Tubal ligation (surgical method)
• Essure (nonsurgical method)
– Male sterilization
• Vasectomy
– Surgical procedures can be reversed, but pregnancy
rates vary depending on several factors.
Abortion
• Removal of the embryo or fetus from the uterus
before it is able to survive on its own
• Spontaneous abortion
– Also known as miscarriage
– Body expels the embryo
– Generally occurs during first trimester of
pregnancy
– 10%–20% of pregnancies end in spontaneous
abortion.
– Cause may be serious genetic defects to the
embryo or other causes.
Abortion
• Induced abortion
– Caused by the taking of certain drugs or via
surgical procedure
– Method used will depend on stage of pregnancy.
• Medical abortion
– Conducted between weeks 7–9 of pregnancy
– Involves use of medications that cause changes in
the pregnant woman’s body so that it cannot
sustain the pregnancy, followed by expulsion of
the contents of the uterus
Abortion
• Surgical abortion
– Removal of the contents of the uterus through
surgical procedures
• Vacuum aspiration (suction curettage)
• Dilation and evacuation (D&E)
• Induction
• Intact dilation and evacuation
Across the Life Span:
Sexual Development
• Gender is determined at fertilization
• Puberty
– Stage of development during which the endocrine
and reproductive systems mature
– On average, puberty begins at age 10 or 11; girls
usually begin 2 years earlier than boys.
– Puberty ends about 5 or 6 years later.
– Average age of first menstruation is about 12
(range is 8 to 15 years of age).
Across the Life Span:
Sexual Development
• Menopause
– Most ova have matured, and remainder are old.
– Normal cyclic secretion of estrogen and
progesterone does not occur.
– Menses become irregular, then stop.
– Physicians may prescribe menopause hormone
replacement therapy and recommend lifestyle
modifications to reduce symptoms.
Across the Life Span:
Sexual Development
• Men
– Middle-aged men remain fertile but experience a
decline in testosterone and number of healthy,
active sperm.
– Ejaculation has less force and volume.
– Regaining an erection after orgasm takes longer
than at a younger age.
– Prostate gland usually enlarges.
Chapter 6
Romantic
Relationships and
Sexuality
Relationships and Sexuality
• Sexuality encompasses an individual’s sexual
thoughts, feelings, attitudes, and actions.
• It is influenced by biological, psychological, social,
and cultural forces.
• It is woven into every aspect of human life and affects
a person’s identity, self-esteem, emotions, personality,
relationships, lifestyle, and overall health.
Human Sexual Behavior
• Unlike other animals, humans exhibit a variety of
complex sexual behaviors that do not necessarily result
in reproduction.
• Biology of sexual behavior
– Libido is the motivation to pursue sexual activity (sex
drive).
– The glands of the endocrine system produce
hormones (chemical messengers).
– Testes and ovaries produce hormones that affect
sexual functioning.
– Testosterone
– Estrogen and progesterone
Human Sexual Behavior
• Psychology of sexual behavior
– In addition to sex hormones, certain thoughts,
sensations, and emotions modulate sexual
behavior.
– Sexual responsiveness is influenced by
– Satisfaction with one’s body
– Physical and emotional health
– Beliefs
– Previous sexual experiences
– Self-esteem
The Sexual Response
• The sexual response is governed primarily by the
nervous system.
• Testosterone maintains the libido in males and females.
• Two major physical changes during sexual arousal are:
– Vasocongestion—when the spongy tissue of the
penis and clitoris expand with blood during sexual
arousal
– Myotonia—an increase in muscle tension during
sexual arousal
The Sexual Response
• Masters and Johnson model (Figure 6.3)
– Excitement phase
• Heightened sexual awareness to thoughts, sights,
touches, sounds, and odors
• Blood rushes into penis, clitoris, and vaginal
opening.
• Erection occurs in males.
• Labia (female) swell; vagina becomes lubricated.
• Breasts swell, nipples become erect.
The Sexual Response
• Masters and Johnson model (Figure 6.3)
– Plateau phase
• HR, BP, respiration, and muscle tension increase.
The Sexual Response
• Masters and Johnson model (Figure 6.3)
– Orgasmic phase
• Ejaculation occurs (males)
• Orgasm in females involves rhythmic contractions
of the pelvic muscles and vaginal walls.
• Both sexes experience peak of sexual pleasure.
The Sexual Response
• Masters and Johnson model (Figure 6.3)
– Resolution phase
• The body returns to pre-arousal state.
• Refractory period for males
• Females have capacity for quickly reaching
orgasmic stage again (multiple orgasm).
The Sexual Response
• Other sexual response models
• Masters and Johnson model is a biological and
linear model of sexual response.
• Whipple and Brash-McGreer developed a circular
model of female sexual response using ideas from
Masters and Johnson but recognizing that the
pleasure and emotional satisfaction derived from
one sexual experience can lead to desire for the next
sexual experience.
The Sexual Response
• Other sexual response models
• Basson also developed a cyclical model of the
female sexual response, which heavily
incorporates emotional and psychosocial
aspects.
Sexual Response Models
• The Masters and Johnson model
Sexual Dysfunctions
• Erectile dysfunction (ED or impotence)
– Often caused by a physical problem, such as blood
vessel disease, nerve damage, alcohol consumption,
or certain medications
– Incidence of ED rises as men age.
• Premature (rapid) ejaculation
– The most common male sexual dysfunction
– Affects from 20%–30% of men of all ages
– Cause is still controversial; over the past decade,
biological factors have been the focus rather than
psychological factors.
– A variety of therapies may be helpful, including
medication and talk therapy.
Sexual Dysfunctions
• Hypoactive sexual desire disorder
– Refers to a persistent low interest in sex
– Occurs in both sexes and has physical and
psychological causes including:
• Restrictive views about sex
• History of sexual abuse
• Relationship problems
• Certain chronic diseases
• Fatigue, stress, and illness
• Abnormal hormone levels
Sexual Dysfunctions
• Female sexual arousal disorder
– Inability to obtain sexual pleasure from sexual
stimulation and the inability to maintain arousal and
vaginal lubrication during intercourse.
• Vaginismus
– Affects females
– The lower portion of the vagina contracts
involuntarily at anticipation of penetration. It has
physiological and psychological causes.
Culture and Sexuality
• A value is a belief that an idea, object, or action has
worth.
• A value system is a collection of beliefs that helps a
person identify things as good or bad, or neither good
or bad.
• Members of the culturally diverse U.S. population
adhere to a variety of sexual values.
– There is no universally accepted set of sexual values
that applies to all Americans.
Culture and Sexuality
• Gender identity and roles
– Gender identity—an individual’s perception of
himself or herself as male or female
– Gender role—patterns of behavior, attitudes, and
personality attributes that are traditionally
considered in a particular culture to be masculine or
feminine
– Sexual (gender) stereotype—the widespread
association of certain perceptions with one gender
Transgender
• Transgender—an umbrella term for various groups of
people who do not conform to traditional gender roles
and includes transsexuals, crossdressers, intersex persons,
drag performers, and androgynes.
• Intersex persons have disorders of sex development
(DSD) resulting in some combination of male and female
internal and external sexual organs.
• Androgynous persons, or androgynes, have traits with no
gender value; they do not fit easily into male or female
categories; or they have traits attributed to the opposite
sex.
Sexual Orientation
• The direction of a person’s romantic thoughts, feelings,
and attractions
– Heterosexual: opposite sex
– Homosexual (gay and lesbian): same sex
– Bisexual: both sexes
• According to sexologist Alfred Kinsey, sexual orientation
is a continuum.
Sexual Orientation
• Nurture or nature
– Mental health experts generally agree that
homosexuals do not decide their sexual orientation nor
can gay persons alter their sexual preferences easily.
• Sexual orientation and society
– Homophobia—the intense fear of or hostility towards
homosexuals
– Many heterosexuals do not accept homosexuality
because they think it is unnatural or it contradicts
religious beliefs.
Diversity in Sexual Behavior
• Common sexual practices between partners
– Sexual intercourse or coitus (vaginal sex)
– Petting: includes kissing, fondling, rubbing genitals
– Oral sex
• Cunnilingus—oral stimulation of the female’s
genitals
• Fellatio—oral stimulation of the male’s genitals
– Anal sex
Diversity in Sexual Behavior
• Solitary sexual behavior
– Solitary sex (masturbation)
• Celibacy or sexual abstinence
– Celibacy or sexual abstinence is refrainment from
sexual intercourse.
Romantic Relationships
• Defining love
– Love is difficult to define because it has different
meanings for different people.
– One definition: Love is a collection of behaviors,
thoughts, and emotions that are associated with a
psychological attraction toward other individuals.
– All forms of love involve the element of caring.
Romantic Relationships
• Defining love
– Intimacy—disclosure of personal thoughts and
emotions to a trusted individual
– Attachment—desire to spend time with someone to
give and receive support
– Commitment—determination to maintain the
relationship
– Affection—feeling of fondness
– Respect—feeling that a person has value and
deserves attention
Romantic Relationships
• Defining love
– Loving has characteristics of intimacy, attachment,
caring, and commitment.
– Liking has characteristics of affection and respect.
– Love that is fulfilling
• Is reciprocal
• Allows partners to achieve self-actualization
• Fosters mutual independence
• Fosters emotional, social, and spiritual growth
Romantic Relationships
• Psychologists’ theories about love
– More recently, social psychologists explore
questions about love by examining the idea that
humans are social beings with distinctive
personalities.
– In 1956, Eric Fromm suggested that loving is an art
that must be learned and practiced.
– In 1973, John Alan Lee theorized that six styles of
loving exist.
Romantic Relationships
• Psychologists’ theories about love
– In 1986, psychologist Robert Sternberg created a
triangular model that incorporates three components
of love: intimacy, commitment, and passion. The
balance of the three components affects the shape of
the triangle, and the amount of love affects the area
of the triangle.
– Couples with similar love triangles are more likely
to be satisfied with their relationships.
Romantic Relationships
• Love attachments
– Attachment—biological drive in which a child seeks
nearness or contact with a specific person when
under stress.
– Children with emotionally distant and neglectful
parents may mature into anxious lovers.
– Children who have poor attachments to their adult
caretakers may avoid becoming emotionally close
to people in adulthood.
– Those whose caretakers met their emotional needs
are more likely to display affection and mature into
secure lovers.
Romantic Relationships
• Love changes over time
– Early in a relationship, passion is high.
• Infatuation is a passionate but unrealistic
attraction.
• An infatuated person exaggerates positive
characteristics of his/her partner and ignores
faults.
Romantic Relationships
• Love changes over time
– After initial phase:
• Intense sexual attraction subsides.
• Companionship deepens.
• Although conflicts occur, committed partners
work to resolve problems.
– In the course of romantic relationships, phases of
growth and change occur.
Romantic Relationships
• Establishing romantic commitments
– Physical attraction—studies have shown that physical
attraction is the most important factor that determines
whether two people become romantically interested in
one another
– Compatibility—ability to exist together in harmony
– In general, important compatibility factors are:
• Closeness in age
• Similar racial, ethnic, religious, and educational
backgrounds
• Sexual satisfaction
Romantic Relationships
• Types of romantic commitments
– Cohabitation—unmarried people living together
• Becoming more common amongst heterosexual
couples
• Research results present conflicting results
regarding cohabitation.
Romantic Relationships
• Types of romantic commitments
– Marriage—legally binding commitment between an
adult man and adult woman in all U.S. states and also
between two individuals of the same sex in select U.S.
states
• More successful with:
– Positive problem-solving and communication
skills
– Open discussion of feelings
– Willingness to negotiate and compromise
– Shared values
– Mutual concerns
– High degrees of physical intimacy
Romantic Relationships
• Types of romantic commitments
– Marriage
• Common causes of separation
– Extramarital sexual activity
– Emotional immaturity
– Alcoholism
– Failure to communicate with or understand
one’s spouse
– Gender role disagreements
– Personality, interest, and value differences
– Desire for more personal freedom
Romantic Relationships
• Types of romantic commitments
– Extrarelational sex
• Persons engaging in extrarelational sexual activity
have sexual relationships with individuals who are
not their spouses or primary sex partners.
Communication in Relationships
• Effective communication is the cornerstone of
interpersonal and sexual relationships.
– Say exactly what you mean.
– Make statements specific, not vague.
– Avoid sending mixed messages.
– Use “I” statements to describe feelings.
– Listen with attentiveness, openness, patience.
– Observe nonverbal forms of communication.
Across the Life Span: Sexuality
• Most preschoolers masturbate and act out adult gender
roles.
• Elementary school children may engage in mutual sex
play. Such play is normal when it is playful, occurs
infrequently, and does not involve coercion.
• Peers, media, and older persons exert pressure on teens to
engage in sex.
– Despite efforts to promote abstinence, only about 1 in
4 teens refrains from having sex.
Across the Life Span: Sexuality
• By age 13, 5.6% of adolescents in the United States have
had sexual intercourse.
• Approximately 47% of American high school students
have engaged in sexual intercourse.
• Gender, age of puberty, and ethnic group are associated
with virginity loss.
• Religious affiliation, sex education, grade average, and
self-esteem are not associated with virginity.
Across the Life Span: Sexuality
• Sexuality does not end because a person is older.
• Sexual inactivity in later life is usually due to medical
disabilities or lack of a partner rather than lack of desire.
• Older adults experience a gradual decline in sexual
functioning.
• It takes longer to become adequately sexually stimulated.
• Antihypertensive and antidepressant medications can
impair sexual functioning.