**10.2 Intelligence and sexuality**

There is evidence for correlation between intelligence and the age at the first sexual contact. There is inverse correlation between intelligence quotient and the age at first sexual intercourse. Though there is evidence that more intelligent people have more sexual desire, but the frequency of intercourse is less. Emotional intelligence plays a key role in marital relationship. Knowledge, self-competence, secured attachment, emotional processing and self-compassion were few aspects which determined good marital satisfaction [25].

### **10.3 Job, vocation and sexuality**

Job stressors have significant impact on sexuality. It majorly depends upon the role the individual is having in the job. It depends on working ability of individual for that job. Work ability includes physiological and psychological ability of the individual to cope with the specific type of the job. The managerial and organizational support also played important role in job stress. Job stress significantly affected desire, arousal and orgasm phases of sexual response cycle [26].

## **10.4 Exercise and sexuality**

Exercise releases hormones called endorphins, which has a feel good component as well as analgesic effects. Exercise may be acute as well as chronic exercise. Acute exercise increases metabolic rate, causes muscle activation and increases blood flow. Chronic exercise causes long lasting adaptation and improves performance. Acute exercise improves physiological sexual arousal through increasing sympathetic nervous system activity and endocrine factors. Chronic exercise increases sexual satisfaction by maintaining autonomic flexibility. Autonomic flexibility helps in maintaining cardiovascular health as well mood. Chronic exercise also gives positive body image which in turn gives sexual wellbeing. A couple of small studies have shown the effectiveness of exercise as intervention for dysfunctions [27].

## **10.5 Sleep**

Adequate sleep is essential for normal sexual activity. Quality of sleep has significant impact on various phases of sexual response cycle. Desire is a motivational state which drives the individual to search for sexual activity, while arousal prepares individual physically and psychologically for sexual activity. Rapid eye

movement sleep (REM) deprivation increases unstimulated sexual arousal but does not have any effect on desire. Sleep deprivation can also have impact on endocrine factors [28].

#### **10.6 Fantasy**

Fantasy both during masturbation as well as sexual intercourse enhances sexual responsiveness dramatically. Sometimes it may be perplexing for some individuals while having sex with someone. Sexual fantasies indicate person's sexual values that may not be overt in their behavior. Source of fantasies is not always obvious, it may be something one has read or seen or may be totally imaginary. Sexual fantasies can arouse sexual excitation and vice versa is also true, sexual excitation arouses sexual fantasy. Women and men who fantasize are more likely to experience orgasm during intercourse. Individuals who report frequent sexual fantasies are less likely to develop sexual dysfunctions. Themes of sexual fantasies are varied, imagining of having sexual intercourse with someone whom you love, having sexual encounters with strangers, having multiple sexual partners simultaneously, forcing someone to have sex or you being forced, being found sexually irresistible by someone, having sex with someone famous and many more. There are gender differences in sexual fantasies, men have more sexual fantasies than women. Even the content also varies, men fantasize an active role in sexual encounter while women more a passive role. Women fantasies' have more of emotional or romantic theme, revolves around current or previous partner, thoughts and feelings about love and devotion. Men usually fantasize impersonal sexual behavior, implicit visual sexual imagery, specific parts of partner's body, group sexual activity and focus on specific sexual activity [29].

#### **10.7 Masturbation**

Masturbation is genital self-stimulation with some anticipation of rewarding erotic feelings, though it is not a necessity that to achieve orgasm genital stimulation is required, some women achieve orgasm even with breast stimulation. Autoeroticism conveys a different meaning, it involves self-stimulation which may or may not involve external physical stimulation. It refers to personal sexual perception and feelings.

There are lots of myths and misconceptions about masturbation. Lot of cultural and religious myths surrounds masturbation. There is a misconception that masturbation is a dismal alternative to sexual intercourse. Professor NN Wig, an Indian psychiatrist described a syndrome called "Dhat Syndrome" which is characterized by "undue concern about debilitating effects of passage of semen". It has been included in International classification of disease (ICD 10) both under neurotic disorder and culture specific disorder. There is cultural myth that semen is made up of "Dhat" (Elixir), when individual loses semen either through masturbation or wet dreams, they start feeling apprehensive about loss of vitality. Though this syndrome is prevalent worldwide, it is more common in Indian subcontinent.

There are gender differences in masturbation. The frequency of masturbation is more in men when compared to women. Studies show that individuals who report masturbating more frequently, are more open minded about sexuality and have more satisfactory sexual relationship with the partners.

People who believe masturbation as second best mode of sexual expression, get perplexed finding a place for masturbation in relationship. Age, illness, boredom and interpersonal issues influence frequency and intensity of sexual relationship among couples. Masturbation is not always problematic in relationship. Men and

**57**

*Healthy Sexuality*

**10.8 Marriage**

stimuli [31].

**10.9 Pregnancy**

premature labor [33].

*DOI: http://dx.doi.org/10.5772/intechopen.92375*

women view masturbation differently in a relationship. Men view it as a supplement to pent up sexual energy, while women view masturbation as a substitutive role. Vibrators and Dildos are not synonyms. Dildos are erect "penis-like" objects which may or may not vibrate. Though vibrators are not substitutes for nurturance, love and sexual attachment, it helps to explore oneself about their sexual response

Religious prohibitions prevalent in the society results in restrictive upbringing. Effect of mass media leads to unrealistic sexual expectations. This leads to a conflict, which in turn causes guilt. Lack of communication, exhaustion and unusual expectation can lead to sexual problems during honeymoon. Interaction patterns among couples play an important role in sexual relationship. Hostility, power struggle and conflicts are few of the destructive interaction patterns. Sex at times can be used as a weapon where one partner may forego sexual pleasure rather than give satisfaction to the other. Emotions like anger, anxiety can act as antierotic

Pregnancy and childbirth are both the part of woman's sexual life. Positive experiences of female sexual functioning (as measured by dimensions including sexual desire, arousal, and satisfaction) were negatively correlated with the experience of stress, anxiety, and depression, and positively correlated with general quality of life during pregnancy. Moreover, experiencing fulfilling sexual experiences during pregnancy has been shown to promote well-being and maintain partner-intimacy, while low sexual functioning during pregnancy has been linked to poor body image [32]. Changes occurring in every trimester of pregnancy have significant influence on the sexual behaviors. A number of physiological and psychological changes occur in pregnancy with surge of hormones like estrogen, progesterone and prolactin that ultimately affect not only the frequency but also the quality and the outcome of sexual intercourse. Duration of coitus decreases over the length of pregnancy due to unfounded fears that intercourse may hurt the health of mother or baby or cause

Sexual satisfaction correlates with the feeling of happiness resulting from being pregnant. Pregnant women prefer the following types of sexual activity: non-genital fondling, stimulation of the clitoris, vagina and breasts, oral and anal stimulation and masturbation. However females and their partners are under informed on sexual life in pregnancy [34]. Many authors emphasize, that the pregnancy is a stimulus for partners to search for ways to maintain mutual emotional bond, close physical affinity and satisfy sexual needs not necessarily finished with an intercourse. As the pregnancy progresses patients report frequent dyspareunia, decline in orgasm and poor self-image. Anatomical changes during pregnancy compel couples to attempt abnormal uncomfortable positions. For a number of couples, pregnancy becomes a stimulus to search for new ways of pleasing each other in love

Mode of delivery also impacts sexual functioning. Patients who delivered vaginally even after 6 months postpartum may experience dysfunction in all phases of sexual cycle compared to women who deliver by caesarian section. Women who deliver vaginally have weakened pelvic floor muscles and may also have discomfort due to rectocele and cystocele. Kegel exercises are advised early in postpartum

play, which does not necessarily culminates with intercourse.

cycle, remove inhibitions and enhance knowledge about themselves [30].

#### *Healthy Sexuality DOI: http://dx.doi.org/10.5772/intechopen.92375*

women view masturbation differently in a relationship. Men view it as a supplement to pent up sexual energy, while women view masturbation as a substitutive role.

Vibrators and Dildos are not synonyms. Dildos are erect "penis-like" objects which may or may not vibrate. Though vibrators are not substitutes for nurturance, love and sexual attachment, it helps to explore oneself about their sexual response cycle, remove inhibitions and enhance knowledge about themselves [30].

#### **10.8 Marriage**

*Quality of Life - Biopsychosocial Perspectives*

endocrine factors [28].

**10.6 Fantasy**

**10.7 Masturbation**

tion and feelings.

movement sleep (REM) deprivation increases unstimulated sexual arousal but does not have any effect on desire. Sleep deprivation can also have impact on

Fantasy both during masturbation as well as sexual intercourse enhances sexual responsiveness dramatically. Sometimes it may be perplexing for some individuals while having sex with someone. Sexual fantasies indicate person's sexual values that may not be overt in their behavior. Source of fantasies is not always obvious, it may be something one has read or seen or may be totally imaginary. Sexual fantasies can arouse sexual excitation and vice versa is also true, sexual excitation arouses sexual fantasy. Women and men who fantasize are more likely to experience orgasm during intercourse. Individuals who report frequent sexual fantasies are less likely to develop sexual dysfunctions. Themes of sexual fantasies are varied, imagining of having sexual intercourse with someone whom you love, having sexual encounters with strangers, having multiple sexual partners simultaneously, forcing someone to have sex or you being forced, being found sexually irresistible by someone, having sex with someone famous and many more. There are gender differences in sexual fantasies, men have more sexual fantasies than women. Even the content also varies, men fantasize an active role in sexual encounter while women more a passive role. Women fantasies' have more of emotional or romantic theme, revolves around current or previous partner, thoughts and feelings about love and devotion. Men usually fantasize impersonal sexual behavior, implicit visual sexual imagery, specific parts of partner's body, group sexual activity and focus on specific sexual activity [29].

Masturbation is genital self-stimulation with some anticipation of rewarding erotic feelings, though it is not a necessity that to achieve orgasm genital stimulation is required, some women achieve orgasm even with breast stimulation. Autoeroticism conveys a different meaning, it involves self-stimulation which may or may not involve external physical stimulation. It refers to personal sexual percep-

There are lots of myths and misconceptions about masturbation. Lot of cultural and religious myths surrounds masturbation. There is a misconception that masturbation is a dismal alternative to sexual intercourse. Professor NN Wig, an Indian psychiatrist described a syndrome called "Dhat Syndrome" which is characterized by "undue concern about debilitating effects of passage of semen". It has been included in International classification of disease (ICD 10) both under neurotic disorder and culture specific disorder. There is cultural myth that semen is made up of "Dhat" (Elixir), when individual loses semen either through masturbation or wet dreams, they start feeling apprehensive about loss of vitality. Though this syndrome

There are gender differences in masturbation. The frequency of masturbation is more in men when compared to women. Studies show that individuals who report masturbating more frequently, are more open minded about sexuality and have

People who believe masturbation as second best mode of sexual expression, get perplexed finding a place for masturbation in relationship. Age, illness, boredom and interpersonal issues influence frequency and intensity of sexual relationship among couples. Masturbation is not always problematic in relationship. Men and

is prevalent worldwide, it is more common in Indian subcontinent.

more satisfactory sexual relationship with the partners.

**56**

Religious prohibitions prevalent in the society results in restrictive upbringing. Effect of mass media leads to unrealistic sexual expectations. This leads to a conflict, which in turn causes guilt. Lack of communication, exhaustion and unusual expectation can lead to sexual problems during honeymoon. Interaction patterns among couples play an important role in sexual relationship. Hostility, power struggle and conflicts are few of the destructive interaction patterns. Sex at times can be used as a weapon where one partner may forego sexual pleasure rather than give satisfaction to the other. Emotions like anger, anxiety can act as antierotic stimuli [31].

#### **10.9 Pregnancy**

Pregnancy and childbirth are both the part of woman's sexual life. Positive experiences of female sexual functioning (as measured by dimensions including sexual desire, arousal, and satisfaction) were negatively correlated with the experience of stress, anxiety, and depression, and positively correlated with general quality of life during pregnancy. Moreover, experiencing fulfilling sexual experiences during pregnancy has been shown to promote well-being and maintain partner-intimacy, while low sexual functioning during pregnancy has been linked to poor body image [32].

Changes occurring in every trimester of pregnancy have significant influence on the sexual behaviors. A number of physiological and psychological changes occur in pregnancy with surge of hormones like estrogen, progesterone and prolactin that ultimately affect not only the frequency but also the quality and the outcome of sexual intercourse. Duration of coitus decreases over the length of pregnancy due to unfounded fears that intercourse may hurt the health of mother or baby or cause premature labor [33].

Sexual satisfaction correlates with the feeling of happiness resulting from being pregnant. Pregnant women prefer the following types of sexual activity: non-genital fondling, stimulation of the clitoris, vagina and breasts, oral and anal stimulation and masturbation. However females and their partners are under informed on sexual life in pregnancy [34]. Many authors emphasize, that the pregnancy is a stimulus for partners to search for ways to maintain mutual emotional bond, close physical affinity and satisfy sexual needs not necessarily finished with an intercourse. As the pregnancy progresses patients report frequent dyspareunia, decline in orgasm and poor self-image. Anatomical changes during pregnancy compel couples to attempt abnormal uncomfortable positions. For a number of couples, pregnancy becomes a stimulus to search for new ways of pleasing each other in love play, which does not necessarily culminates with intercourse.

Mode of delivery also impacts sexual functioning. Patients who delivered vaginally even after 6 months postpartum may experience dysfunction in all phases of sexual cycle compared to women who deliver by caesarian section. Women who deliver vaginally have weakened pelvic floor muscles and may also have discomfort due to rectocele and cystocele. Kegel exercises are advised early in postpartum

period to strengthen pelvic floor muscles. The eventual benefits of cesarean delivery on sexual function do not last longer than a few months after childbirth.

The research makes it evident, that experiencing sexual satisfaction by pregnant women improves their self-esteem, facilitates mutual relationship between partners and tightens the marital bond. There are various factors that may be influencing the lack of dialog initiated by prenatal health-care providers with their pregnant patients and partners regarding sexual activity during pregnancy. For one, our society at large often deemphasizes the sexuality of pregnant women, finding the discussion of sex during pregnancy to be a taboo. Moreover, Hinchcliff et al. noted that prenatal care providers may avoid discussing sexuality proactively as it is a complex issue and requires sensitivity [35].

### **11. Marriage after living together**

After marriage, couple's start taking one another for granted. At times when marriages happen due to social pressure, couple may start taking one another for granted after marriage. When marriage happens after a period of open relationship due to social pressure, they may feel trapped [36].

#### **11.1 Divorce**

The rates of divorce have increased in all age groups in the recent times. Life after divorce requires emotional, social and sexual adjustment. Individuals spending most of their lives in wedlock, finds it difficult to adjust to singlehood. Many people are so adjusted to think their adult life as couple, they take time to get used to singlehood. It is confusing and perplexing for people to learn divorced role. Divorce leads to decline in life style in some people while in others it may lead to sexual liberty. Spiritual values and Literacy levels determines the number and frequency of partners [36].

#### **11.2 Remarriage**

Multitude of factors influences the likelihood of remarriage. Younger the person, there is more probability of remarriage. About 89% who separate under the age of 25 remarry, it decreases to 31% after 40 years. Shorter the duration of first marriage, there are more chances of remarriage. Other factors are the age at first marriage, younger a person at first marriage, more probability of remarriage [36].

#### **11.3 Families**

The attitude of parents about sexuality has a significant impact on sexual wellbeing. Attitude of parents as well as siblings about nudity, masturbation, willingness to discuss about sex and homosexuality all contributes to the development of sexuality of an individual. Relationship of the parents with the individual as well as the partner also influences sexuality. Distorted intrafamilial relationship, lack of discipline, overcrowding, lack of warmth, unusual helplessness and withdrawal from society may lead to certain deviant sexual behavior [36].

#### **12. Sexuality in geriatric population**

Sexuality is an important aspect in Geriatric population. Elderly individuals look sexuality as a means of expression of passion, love, admiration and loyalty.

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*Healthy Sexuality*

*DOI: http://dx.doi.org/10.5772/intechopen.92375*

**12.1 Sexuality and spirituality**

**12.2 Medical illness and sexuality**

**12.3 Psychiatric illness and sexuality**

as well as lutenising hormone.

sexual behavior [39].

alterations in other phases of sexual response cycle [9].

ing it as an integrated energy for passionate living [37].

dominate the everyday life of patients with chronic illnesses [38].

Furthermore sexuality acts as a means of affirming physical functioning, sense of identity and self-confidence. Though desire may remain the same, there may be

The popular belief is that sexuality and spirituality exists in opposition, but in reality spirituality and sexuality go hand in hand. If we look at different geographical areas, there is lot of literature in Chinese Taoist tradition about practices bringing Yin (Feminine) and Yang (Masculine) in harmony. In Indian literature there is mention about energy generated in the pelvic region moving upwards through chakras to the crown, where one enters the cosmic orgasm generated eternally by union of Shakti and Shiva. In psychotherapeutic perspective, people believe that sexuality is something sin and it should be removed or cured. What spirituality should do is to help these people move from the belief that sexuality is sin to enjoy-

Looking at sexuality from the biological perspective, neurological, vascular and endocrine systems contribute significantly for normal sexual functioning. Neurological disorders like stroke, epilepsy, multiple sclerosis, traumatic brain injury and spinal cord disorders lead to sexual problems. Endocrine disorders like androgen deficiency, hyperprolactinemia, diabetes mellitus can produce sexual dysfunctions. Vascular disorders like hypertension and atherosclerosis, prostatic illness, carcinomas all can lead to sexual dysfunctions. Prevalence of sexual dysfunctions among these psychosomatic disorders is around 20–70%. Sex and intimacy are likely to be powerful providers of salutogenesis in both the chronically and critically ill patients. Sexual encounters can serve as a refuge in an otherwise chaotic and turbulent situation, and intimate relations might constitute engines of meaningfulness and coherence in a context of meaninglessness and incoherence that so often

Substance use disorders have varying effects on sexual functions. Alcohol at a smaller quantity may have some stimulatory effect, at higher quantity decreases both desire as well arousal through its effect on testosterone. Cannabis causes detrimental effect on initiation as well as maintenance of erection. Cannabis historically has aphrodisiac effect, but current evidence shows mixed results. Long term use of cannabis has detrimental effect on testosterone. Similarly opioids delay ejaculation in men and improve vaginismus in women, but long term use decreases testosterone

The rates of sexual dysfunction in people suffering from schizophrenia, mood disorders, personality disorders, anxiety disorders and eating disorders is very high. In these disorders illness itself can have effect various stages of sexual response cycle, and also medication used can have adverse effects on sexuality. One of the major psychiatric disorder schizophrenia has negative symptoms like blunted affect, anhedonia and avolition itself causes impedance in enjoying sexual life. Loss of libido is one of the symptoms in major depressive disorder. Anxiety disorders are usually associated with premature ejaculation. Mania is associated with increased libido during the episode, at times disinhibited sexual behavior leads to high risk

Furthermore sexuality acts as a means of affirming physical functioning, sense of identity and self-confidence. Though desire may remain the same, there may be alterations in other phases of sexual response cycle [9].
