A Holistic Social Work Approach to Providing Sexuality Education and Counseling for Persons with Severe Disabilities
Romel W. Mackelprang, Deborah Valentine in Sexuality and Disabilities: A Guide for Human Service Practitioners, 2013
Slides or pictures depicting internal and external male and female genitalia can be extremely valuable in presenting this material. The social worker can show and describe slides, using them to generate questions and to assess client knowledge. Frank, open discussion models a willingness to talk about sexuality, can help people develop adequate sexual understanding and vocabulary and desensitize clients to sexual conversations. The social worker, when educating about female sexual anatomy shows and explains each physical structure. These are briefly outlined below. For women, the vulva is the region of the external sex organs consisting of the mons veneris, clitoris, labia majora, labia minora and perineum. The mons veneris is the area of soft fatty tissue over the pubic bone with numerous sensory nerves that make sexual touch pleasurable and in adults, is covered with hair. The labia majora (outer lips) lie close together over the vagina, extending from the mons veneris to the perineum. The labia minora (inner lips) are thin folds of tissue which protect the urethral and vaginal openings. Normally closed over the vagina, during sexual arousal they engorge with blood and spread apart to allow vaginal penetration. The clitoris is a small sexual organ at the anterior part of the vulva. Homologous to the male penis, it has the same number of nerve endings as the penis and is extremely sensitive to touch. It is unique in that it's only purpose is for sexual pleasure. When women become intensely sexually aroused, the clitoris often retracts protectively under the clitoral hood, which normally sits above the clitoris. The urethral meatus which lies between the clitoris and vagina is the opening from the bladder and through the urethra for the excretion of urine. The vagina lies between the rectum and urethra and is a muscular tubular organ approximately four inches long but which lengthens and widens during sexual arousal and intercourse. It acts as a passageway to the uterus and is the passageway for childbirth and through which menses flow. The Bartholin's glands lie near the opening of the vagina and secrete lubricating fluid during sexual arousal. The uterus (womb) is a hollow muscular organ about the size and shape of a pear to which a fertilized egg attaches and in which fetus grows. The lining builds up vascular tissue which is expelled during menstruation when a woman is not pregnant. The cervix is the narrow, lower end of the uterus which extends into the top of the vagina and through which sperm and menstrual flow pass, and which dilates, allowing a child to pass during childbirth.
Genital surgery
James Barrett in Transsexual and Other Disorders of Gender Identity, 2017
Some report more than adequate lubrication during sexual arousal. This fluid presumably comes from the prostate and urethral glands in response to stimulation. Indeed, some patients report significant discharge of fluid at around the time of orgasm; because the bulbo-spongiosus muscle is removed, this fluid dribbles out, rather than being forcefully ejaculated. Lack of depth is a more common problem than inadequate width, although some patients, especially those of Afro-Caribbean descent, find that the width of the vagina is limited by the angle between the inferior pubic rami and the symphysis pubis. The majority of such patients cope by choosing sexual positions where penetration is not deep enough for the penis to hit the end of the skin tube and cause pain to both partners. Lesbian patients use either fingers or smaller dildos to avoid problems. Most report satisfaction with their neovaginas, although the author did have one patient who complained that her girlfriend was unable to insert a clenched fist. Some patients ask for lengthening procedures; currently colovaginoplasty is the only reliable way of achieving this. Even after colovaginoplasty, there are some patients who find the vagina of insufficient capacity for intercourse; the reasons for this are not well understood. Accepting that there are inaccuracies resulting from incomplete reporting of orgasmic function, a reasonable estimate is that some 85% of patients are able to attain orgasm after the operation. Whilst this is more common in patients in whom the clitoris is sensitive, it is by no means exclusive to that group. Patients who underwent surgery prior to the development of the sensate neoclitoris are not anorgasmic. Stimulation of the residual tissue of the corpus spongiosus around the urethral stump is usually reported as pleasurable. Some patients report orgasms from vaginal penetration alone, even when that penetration occurs during ‘routine’ dilations. As much seems to depend on the mood of the patient as the presence of a sensitive clitoris. Almost all patients report that their orgasms are different to before the operation. Some claim to be able to differentiate between ‘clitoral’ and ‘vaginal’ orgasms. Some report multiple orgasms which they did not experience before their surgery. Much of this increased satisfaction with their sexual function is presumably a result of their being able to have sex as women, freed from what they considered an unsatisfactory penis (most pre-operative transsexuals do not want anyone to see their genitalia, let alone stimulate them), but it seems improbable that their surgery has had no physical effects. Some patients find that intercourse is limited by length or width of the neovagina. Inadequate depth is usually the result of limitations brought about by limited skin at initial operation, and is very difficult to treat.
ENTRIES A–Z
Philip Winn in Dictionary of Biological Psychology, 2003
Increasingly versions of cognitive therapy are being used in the treatment of PSYCHOSIS or of particularly problematic behaviours in psychotic individuals, such as HALLUCINATION or DELUSION. It is held by some clinical psychologists that diagnostic categories such as schizophrenia are inappropriate and that progress will be made by concentrating psychological theory and treatment on specific disturbed behaviours. When working with children and adolescents clinical psychologists often use versions of cognitive therapy (say in the treatment of EATING DISORDERS) but the focus is often on the family and more family oriented approaches taken. In the elderly there is more emphasis on the possible organic basis of the patient's behaviour but the use of appropriately targeted cognitive therapy is widespread and helpful. Clinical psychologists also get involved in the assessment and rehabilitation of patients with brain injuries. This overlaps with aspects of NEUROPSYCHOLOGY. DEREK W.JOHNSTONclitorisA highly sensitive area of erectile tissue and nerve endings at the upper end of the vulva. It consists of the clitoral glans, which contains sensitive nerve endings, the clitoral shaft, which contains spongy erectile tissue, and the protective skin or clitoral hood which covers them. Sensitive to touch, pressure, and temperature, the clitoris becomes engorged with blood during sexual arousal in women, and it functions specifically to relay pleasurable somatosensory stimulation during masturbation or sexual intercourse. Although it is derived embryologically from the same primordial tissue as the glans penis, it does not serve any reproductive or urinary function. See also: sexual arousal; sexual differentiationJAMES G.PFAUSclomipramineAn antidepressant drug (one of the TRICYCLICS) that works by blocking the REUPTAKE of SEROTONIN from the SYNAPTIC CLEFT. See also: depressionclonazepamA benzodiazepine drug, used in the treatment of SOMNAMBULISM and of ANXIETY. Unlike some other benzodiazepines—alprazolam for example—it is of less value in treating PANIC attacks because it has a slow action: clonazepam has relatively low lipid solubility and so has a long-lasting effect, being slowly absorbed and metabolized. Panic attacks, being rapid, need a swifter treatment.
The Clitoris: Anatomical and Psychological Issues
Published in Studies in Gender and Sexuality, 2017
The anatomy of the clitoris is much larger than commonly believed. Besides the small tip of the clitoris known as the glans, which protrudes in the external genitalia, the crura (or legs) of the clitoris extend 9 cm inside the body, with erectile tissue adjacent to the vagina and urethra. This finding has significance for theories of female sexual responsiveness, including the differentiation of clitoral and vaginal orgasms. It also offers guidelines for preserving erotic response during pelvic surgery in women. The facts of clitoral anatomy, clarified with modern scanning procedures by surgeon Helen O’Connell and colleagues (2005), have been repeatedly discovered, forgotten, and rediscovered, at least since 1844, when the German anatomist Kobelt made accurate drawings. Psychological reasons for why the true anatomy of the clitoris has so often been repressed or misrepresented by anatomists, psychologists, and other scientists are proposed. That most anatomists have historically been men may have led to disregard for precise charting of the clitoris that might lead to greater preservation of female sexual response. Envy by male anatomists of female sexual response may also play a role. Correct anatomical knowledge may significantly alter psychoanalytic theory and practice.
Body Movement Is Associated With Orgasm During Vaginal Intercourse in Women
Published in The Journal of Sex Research, 2019
Annette Bischof-Campbell, Peter Hilpert, Andrea Burri, Karoline Bischof
Very few studies have investigated the relationship between women’s ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women’s orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.
The Gender Gap in Orgasms: Survey Data from a Mid-Sized Canadian City
Published in International Journal of Sexual Health, 2019
Objective: Previous research has established a gap in orgasm frequency between men and women. This study investigates explanations for the gender gap in orgasm. Methods: Crosstab analysis and logistic regression are used to examine the gender gap in orgasms from one Canadian city: Hamilton, Ontario (N = 194). Results: We find a strong association between women’s orgasms and the type of sexual behavior in which partners engage. Women who receive oral sex are more likely to reach orgasm. Conclusion: Sexual practices focused on clitoral stimulation are important to reducing the gender gap in orgasms.