**7. Sexual response cycle**

Sexual response cycle which consists of desire, excitement and orgasm, have been classified by various authors in different ways. One of the simplest classifications is given by Kaplan, which is called DEOR model. D stands for desire, E stands for excitement, O stands for orgasm and R stands for resolution. Desire phase has biological, social and psychological component. Biological component is the drive, sexual motivation is the psychological component and sexual wish is the social component. Excitement phase is characterized by penile tumescence in males and vaginal lubrication in female. Orgasm phase is characterized by heightening of sexual pleasure and resolution phase is characterized by disgorgement of blood from genital organs. Any impairment in any of these stages constitutes dysfunction [10].

## **8. Childhood sexuality**

A strong emotional response is expected socially, whenever this topic is raised. Discussion on sexual behavior in children is obviously going to raise many eyebrows. Sexuality forms part of the personality and is a normal aspect of growing up. On one hand we resist talking to children regarding sexuality and on the other they get exposed to various sexual behaviors through the media. This makes it difficult for children to make right decisions during their adolescence. It is important to understand that the concept of normal sexual behavior in children is likely to vary with change in society's attitude. Research in the area of childhood sexual knowledge and behavior is scarce. Methodical issues are important during research as many of these rely on parental interviews leading to inconsistent results [11]. Sexual behavior is related to the age of the child, maternal education, family sexuality, family stress and violence, and hours spent in day care. For the clinician to understand the relationship between sexual abuse and sexual behaviors, it is important to understand normative childhood sexual behavior [12].

Much important psychosexual development occurs during childhood. Sexual development starts from birth and as the child develops the knowledge of gender identity during the first 2 years of life, genital exploration begins. Sexual knowledge is a child's basic under-standing of sexual acts. It varies with the child's age and the education level of the parents [13]. A child learns labeling of body parts including genitals and experiences genital pleasure during this time. They may use slang labels and touch other children's genitals or take off clothes in public. The physiology related to sexual arousal and orgasm is present in children at birth or even before that. Fetuses suck fingers/toes and penile erection or vaginal lubrication is seen in new born males and females. Sexual arousal is associated with REM (Rapid Eye Movement) sleep in infants and young children similar to adults. However infants and young children lack cognitive capacity to understand this autoerotic behavior which is more of "pleasure seeking" and is a reflex behavior. Sexual development occurs throughout early years but except for during puberty none of these sexual development milestones have been clearly defined [13].

During 3–5 years of sexual development, gender is permanently established and gender differences are clearly understood. The child has only little information regarding pregnancy and delivery. The child may use slangs for sexual parts of the body. During the preschool years (2–6 years) many overt sexual behaviors are seen. The child may masturbate for pleasure and experience orgasm either in public or private. Nudity is enjoyed and removing clothes in public may be noticed. Sex play with peers (mimicking dating behavior, using naughty words even if they do not understand the meaning) self-genital exploration and that of others, attempted intercourse may be noticed. Sitting close to others, touching breasts of mother or other females (in males), trying to view peer or adult nudity may be noticed. Masturbation is likely the most commonly observed sexual behavior in children. It has been noted in infants as young as 7 months, which is initially based on curiosity about one's body but gradually the pleasure obtained becomes a decisive act. Friedrich et al. [15] has reported that some of the behaviors like inserting objects

**53**

*Healthy Sexuality*

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

into vagina/ anus, putting mouth on sex parts and masturbating with objects may rarely be seen in children aged 2–12 years. Many parents may react negatively to this and punish their children for this behavior. Caregiving and nurturing provide the first sensual and erotic encounters to the new born and these experiences of physi-

During 6–12 years the child understands genital basis of gender. The child is able to label sex parts but uses slang. The child is able to understand sexual aspects of pregnancy; with increasing knowledge of sexual behavior, children may masturbate in private. Sex games with peers (like girlfriend/ boyfriend, truth or dare, playing family) role plays and sexual fantasy may be seen. Developmentally appropriate behavior includes touching their own genitals, trying to view another person's genitals or breasts and standing too close to other persons. Young children, who are yet to learn culturally appropriate distance, may rub against people, or casually touch their mother's breasts or father's genitals [16]. Sexual behaviors become more covert after 5 years of age [18]. Gundersen reported in 1981 that among preschool children aged 3–7 years sexual play was common including body exploration, genital manipulation and attempts at sexual intercourse. Kissing is part of normal sexual development. Exhibitionistic behavior in children, showing body parts to other children or adults, may be part of "playing doctor" [17]. About 85% of college women recalled engaging in sexual games during childhood in a study done by Lamb and Coakley in 1993. Over 40% reported fantasy sexual play including sexual stimulation, intercourse, rape, prostitution and strip shows. Over one third of the games involved genital fondling. These games are due to curiosity, however some children find them a source of sexual excitement. Coercive childhood sexual games are considered to be "normal" especially as boys and girls usually play together. Children may develop anxiety when parents or adults show affection towards each other. The frequency of childhood sexual behaviors when retrospectively recalled by adults may differ from the frequency reported by parents; recollection bias and personal acceptance of sexual behaviors as normal, differs. Educated mothers are

cal affection are critical for healthy development of the child [14, 15].

likely to report more sexual behaviors in their children [18].

Sexual encounters between siblings are very similar to those seen with friends in terms of the activities occurring, motivations associated, age and perception of them being positive or negative. Finkelhor in 1981 reported that younger children are more likely to exhibit their genitals whereas older children are more likely to engage in attempted or actual intercourse. Younger children show a broad range of sexual behaviors which decrease with the growing age. Sex between siblings occurs much less frequently than between friends. Sexual encounters in siblings range from 9 to 13%. Lower reported rates of sexual encounters between siblings may be either due to age difference or biased retrospective reporting due to incest taboo. However frequency of coercive sexual encounters is almost similar to that with friends and girls are predominantly the victims. Young children are likely to explore their sexuality more at home than in structured and monitored settings among children. The results reported may not represent full range of sexual behaviors seen in children due to ethnic differences in subjects on which research is conducted. Women who have had sibling sexual experiences (positive or negative) are more likely to be sexually active as adults. Sexual sibling experiences before the age of 9 with large difference of age between siblings led to lower sexual self-esteem. Sexual experiences between friends or siblings suggest that normal sexual contact occurs on a continuum and

differentiation between sexual play and abuse is not always clear [19].

The child gains knowledge of physical aspects of puberty by age 10. The child shows modesty and embarrassment and tries to hide sex games as well as masturbation from adults. Masturbation most likely increases before puberty especially

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

*Quality of Life - Biopsychosocial Perspectives*

dysfunction [10].

**8. Childhood sexuality**

understand normative childhood sexual behavior [12].

development milestones have been clearly defined [13].

is the drive, sexual motivation is the psychological component and sexual wish is the social component. Excitement phase is characterized by penile tumescence in males and vaginal lubrication in female. Orgasm phase is characterized by heightening of sexual pleasure and resolution phase is characterized by disgorgement of blood from genital organs. Any impairment in any of these stages constitutes

A strong emotional response is expected socially, whenever this topic is raised. Discussion on sexual behavior in children is obviously going to raise many eyebrows. Sexuality forms part of the personality and is a normal aspect of growing up. On one hand we resist talking to children regarding sexuality and on the other they get exposed to various sexual behaviors through the media. This makes it difficult for children to make right decisions during their adolescence. It is important to understand that the concept of normal sexual behavior in children is likely to vary with change in society's attitude. Research in the area of childhood sexual knowledge and behavior is scarce. Methodical issues are important during research as many of these rely on parental interviews leading to inconsistent results [11]. Sexual behavior is related to the age of the child, maternal education, family sexuality, family stress and violence, and hours spent in day care. For the clinician to understand the relationship between sexual abuse and sexual behaviors, it is important to

Much important psychosexual development occurs during childhood. Sexual development starts from birth and as the child develops the knowledge of gender identity during the first 2 years of life, genital exploration begins. Sexual knowledge is a child's basic under-standing of sexual acts. It varies with the child's age and the education level of the parents [13]. A child learns labeling of body parts including genitals and experiences genital pleasure during this time. They may use slang labels and touch other children's genitals or take off clothes in public. The physiology related to sexual arousal and orgasm is present in children at birth or even before that. Fetuses suck fingers/toes and penile erection or vaginal lubrication is seen in new born males and females. Sexual arousal is associated with REM (Rapid Eye Movement) sleep in infants and young children similar to adults. However infants and young children lack cognitive capacity to understand this autoerotic behavior which is more of "pleasure seeking" and is a reflex behavior. Sexual development occurs throughout early years but except for during puberty none of these sexual

During 3–5 years of sexual development, gender is permanently established and gender differences are clearly understood. The child has only little information regarding pregnancy and delivery. The child may use slangs for sexual parts of the body. During the preschool years (2–6 years) many overt sexual behaviors are seen. The child may masturbate for pleasure and experience orgasm either in public or private. Nudity is enjoyed and removing clothes in public may be noticed. Sex play with peers (mimicking dating behavior, using naughty words even if they do not understand the meaning) self-genital exploration and that of others, attempted intercourse may be noticed. Sitting close to others, touching breasts of mother or other females (in males), trying to view peer or adult nudity may be noticed. Masturbation is likely the most commonly observed sexual behavior in children. It has been noted in infants as young as 7 months, which is initially based on curiosity about one's body but gradually the pleasure obtained becomes a decisive act. Friedrich et al. [15] has reported that some of the behaviors like inserting objects

**52**

into vagina/ anus, putting mouth on sex parts and masturbating with objects may rarely be seen in children aged 2–12 years. Many parents may react negatively to this and punish their children for this behavior. Caregiving and nurturing provide the first sensual and erotic encounters to the new born and these experiences of physical affection are critical for healthy development of the child [14, 15].

During 6–12 years the child understands genital basis of gender. The child is able to label sex parts but uses slang. The child is able to understand sexual aspects of pregnancy; with increasing knowledge of sexual behavior, children may masturbate in private. Sex games with peers (like girlfriend/ boyfriend, truth or dare, playing family) role plays and sexual fantasy may be seen. Developmentally appropriate behavior includes touching their own genitals, trying to view another person's genitals or breasts and standing too close to other persons. Young children, who are yet to learn culturally appropriate distance, may rub against people, or casually touch their mother's breasts or father's genitals [16]. Sexual behaviors become more covert after 5 years of age [18]. Gundersen reported in 1981 that among preschool children aged 3–7 years sexual play was common including body exploration, genital manipulation and attempts at sexual intercourse. Kissing is part of normal sexual development. Exhibitionistic behavior in children, showing body parts to other children or adults, may be part of "playing doctor" [17]. About 85% of college women recalled engaging in sexual games during childhood in a study done by Lamb and Coakley in 1993. Over 40% reported fantasy sexual play including sexual stimulation, intercourse, rape, prostitution and strip shows. Over one third of the games involved genital fondling. These games are due to curiosity, however some children find them a source of sexual excitement. Coercive childhood sexual games are considered to be "normal" especially as boys and girls usually play together. Children may develop anxiety when parents or adults show affection towards each other. The frequency of childhood sexual behaviors when retrospectively recalled by adults may differ from the frequency reported by parents; recollection bias and personal acceptance of sexual behaviors as normal, differs. Educated mothers are likely to report more sexual behaviors in their children [18].

Sexual encounters between siblings are very similar to those seen with friends in terms of the activities occurring, motivations associated, age and perception of them being positive or negative. Finkelhor in 1981 reported that younger children are more likely to exhibit their genitals whereas older children are more likely to engage in attempted or actual intercourse. Younger children show a broad range of sexual behaviors which decrease with the growing age. Sex between siblings occurs much less frequently than between friends. Sexual encounters in siblings range from 9 to 13%. Lower reported rates of sexual encounters between siblings may be either due to age difference or biased retrospective reporting due to incest taboo. However frequency of coercive sexual encounters is almost similar to that with friends and girls are predominantly the victims. Young children are likely to explore their sexuality more at home than in structured and monitored settings among children. The results reported may not represent full range of sexual behaviors seen in children due to ethnic differences in subjects on which research is conducted. Women who have had sibling sexual experiences (positive or negative) are more likely to be sexually active as adults. Sexual sibling experiences before the age of 9 with large difference of age between siblings led to lower sexual self-esteem. Sexual experiences between friends or siblings suggest that normal sexual contact occurs on a continuum and differentiation between sexual play and abuse is not always clear [19].

The child gains knowledge of physical aspects of puberty by age 10. The child shows modesty and embarrassment and tries to hide sex games as well as masturbation from adults. Masturbation most likely increases before puberty especially

among boys. There are few physical changes associated with sexual development before the onset of puberty. Just before the teenage years body changes begin, menstruation starts in females and boys may experience wet dreams; fantasizing about sex, interest in media sex, using sexual language with peers is observed [19].
