There are also several formal definitions of what constitutes healthy sexuality. Firestone, Firestone, and Catlett (2006) 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 (Firestone, Firestone, & Catlett, 2006).
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. A discussion of these differences follows.
Catagorical Differences in Healthy Sexuality
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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. While the above serves as a brief overview, a more detailed description of gender differences in sexuality follows.
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 can 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 (Meana & Nunnink, 2006). 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? Recalling our discussion of healthy sexuality, the appreciation of one's own body was a part of the definition. 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. (See section on Sexual Orientation for further discussion). Clearly, there are many other gender differences in sexuality than those explained here, 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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