Sexuality and You: Another Look

Abayomi Waheed

The first in the 2009 series of faculty lectures of the University of Ibadan Medical College’s Faculty of Clinical Sciences was held a few weeks ago. It was a lecture for all seasons and various reasons. Aptly titled Sexuality In Reproductive Health: Emergence of A New Disease, it was beautifully delivered by the erudite scholar Dr Ayo Arowojolu of the Department of Obstetrics and Gynecology. But more bits later on this preeminent gynetrician [and Nigeria’s Masters and Johnson] who works where saints and sinners play NTBB. The lecturer raised some issues and was silent on others. Issues like the leeway given to tradomedical practitioners to advertise especially in the media, their roles in reproductive health, and the state of health today, the HIV/AIDS scourge, and the emergence of the multilevel marketers were highlighted. However the desired action by government, religious institutions and NGOs to achieve a better reproductive health, same sex marriage under the law, legal abortion in Nigeria law, the desirability or otherwise of sex education in our curriculum etc were scarcely mentioned.

Every discussion on human sexuality is often controversial as rightly observed by the learned Prof, yet he was able to successfully dissect the how, why, when, where, wherefore and what goes on in the minds, under the heavy make-up and purdah, and behind closed doors on Vono mattresses in homes, hotels and harems, the concealed sexual deficiencies and exaggerated libidos, the medical approach that works or temporizes, transsexuality and intersexuality among others. The audience largely of consultants, eggheads, doctors, medicos and educated minds made his delivery very easy; in some parts of the country, for daring to say it as it is a fatwa may be issued by the very men who and whose wives would benefit most [directly and indirectly] from the frank discourse.

Sexuality, defined as that complex which integrates a person’s attitudes, thoughts, feelings and sexual expression and relationships as well as the biology of the sexual expression system, is as old as man and it permeates virtually all aspects of health and

living. And just like the genetic code, human sexuality is universal. It is insensitive [it should be!] to gender, religion, creed and colour. Put differently, all and everything about life is involved. Little wonder Mark Twain opined that of the delights of this world man cares most for sexual intercourse. All religions and cultures recognize the important role sexuality plays in the society and has put in place values and systems. For example premarital sex was a cultural taboo among the Yorubas of the pre-colonial era while some cultures are indifferent. With the possible exception of the physicians’ physician, all other prophets were married to at least a spouse, and they showed the human angle of sexuality. The Bible detailed Solomon’s harem of wives and mistresses and hisbedmatics prowess while the Quran ordained marriage among moslems. Mohammad [pbuh] was the ideal polygamist, and ancient Sanskrit and Hindu literatures relate various aspects of sexuality. Hence of all sexual aberrations, chastity is the strangest, said Anatole France. Sexuality forms a very important pillar in reproductive and sexual health defined by the WHO as the integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are passively enriching and that enhance personality, communication and love.

 Sexuality here will be discussed in the context of sexual health, sex and gender, sexual orientation, sexual practices, sexual response, sexual dysfunction and contemporary sexuality issues. All the aspects are interwoven with sociology, psychology, psychiatry, medicine, law and religion.

Sexual health, as noted above, is total health. It means the ability to enjoy and express one’s sexuality free from the risk of STI, unwanted pregnancy, coercion, violence and discrimination. It is being able to have an informed, enjoyable and safe sexual relationship based on a positive approach to sexual expression and mutual respect in sexual relations. The Nigeria experience in sexual health especially in the prisms of the socioreligion is dampening. What we have is a swing between the crass erotica and restrictive credo, each harming sexual health in different ways. The incorporation of sexual health in primary health care and sex education in school curriculum will go a long way in improving on this deficit. This may be an uphill task especially in areas where even vaccines are rejected yet STI incidence is increasing.

Sex and gender are often used interchangeably in confusion even by the educated, and to a layman sex is you know. Properly put, sex is that biological and physical attribute that divide people according to the gender. It refers to the biological characteristics that identify a man or woman; for example the breasts, external genitalia, menstruation, spermatogenesis, the X and Y chromosomes etc. So a man, even with jerry curls and ear-ring would never menstruate (a female attribute) and a tomboy with stubble would not obey the Federman’s rule for the testes at birth. True hermaphroditism is a rarity. Gender however refers to when, how, why and what a person, the society and legal system define as male or female. Gender roles are a set of socially and culturally defined attitudes, behaviors and responsibility that is considered appropriate for the male and female. In societies sympathetic to same sex marriage, one of the two partners would assume the male role. Gender roles depend on culture, religion, socioeconomic class and ethnicity. For example, in patrilineal societies, it is not appropriate for the woman to be the bread-winner, and the father is the ‘owner’ of the child; but times are changing.

The way an individual perceives and carries himself in terms of maleness or femaleness is gender identity. A biological woman may identify himself as man either as a transsexual or transvestite. Sexual orientation is the erotic attraction for sharing sexual expression with members of the opposite sex (heterosexuals), one’s own sex (homosexuals) or both sexes (bisexuals). Cat walking, use of bleaching cream, night crawling, the macho man’s penchant etc are forms of sexual orientation. Heterosexuality is, by religion and culture, the rule in Nigeria but there are anecdotes of homosexuals and bisexuals even among the clergy and top people. Sexual intercourse is that physical act between sexes that is coordinated by the neurological, vascular and endocrine systems. Most readers would easily relate with this aspect because it is innate, and all are involved; it is the part with which the success or otherwise of most relationships are measured with. A marriage that has not been consummated after some time is, under the law, null and void; and having a satisfying sexual intercourse depends on age, health status, personal experience, background, love and affection. A normal sexual act involves an acceptable, close and loving interpersonal relationship that leads to a feeling of contentment and enjoyment in each other’s company. The average age of sexual debut is 18 years for females and 15 years in males, and the frequency of coitus ranges from zero to 15 times per week.

Human sexual practices are a complex interplay of activities. It is not limited to the physical act of intercourse but includes the physical and emotional interaction between individuals, sexual contact, strategies to attract and keep a sexual partner, erotic stimulation, hugging, wearing of sexy apparels, telephone or cyber sex, self or group masturbation, oral sex, strip tease etc. In fact sexual practices can be used for different ends: promotion at work, a method of warfare, in business transaction by young bank workers hoping to meet a target deposit, by students for good grades in schools, as a religious obligation etc. Sexual practices vary with individuals and cultures, and what may be seen as innocuous in one context may be termed sex in another. President Clinton’s famous assertion that he ‘did not have sex with that woman’ readily comes to mind. In Nigeria, he would be celebrated and damn right.

While there may be dysfunction with all the aspects of sexuality, disorders of sexual response are perhaps the commonest at least in this environment. Sexual dysfunction is a persistent or recurrent difficulty during any stage of sexual act that prevents the individual from enjoying sexual activity. It is common though subjective and can be covert. Women are at the receiving end of the bitter taste of sexual dysfunction whether they are the primary cause or not. The society frowns at the woman who, no matter how deprived of sexual satisfaction, seeks comfort outside the box; not so for the African man. Erectile dysfunction, premature ejaculation, anorgasmia are perhaps the commonest in this environment. Others would include dyspareunia, vaginismus, decreased libido, impotence, nymphomania and frigidity.

There are five main stages of human sexual response broken into the desire, arousal, plateau, orgasm and resolution phases. The stages are predictable and are expressed in different ways. Age, drugs, socioeconomic status, co-morbidity, the environment, religion etc can affect these stages in different ways. Causes of sexual dysfunction can be psychological, physiological, social and environmental. Psychological factors include but not limited to: post-traumatic stress disorder, anxiety neurosis, inferiority complex, ad hoc fallacy, fear of STI or pregnancy, sex abuse amongst others. Neurological diseases, cardiac diseases, diabetes, reproductive system cancers, pregnancy, vulvodynias, congenital abnormalities of the organs of reproduction, aging, etc are physiological. Social causes include marital disharmony, sex abuse, acculturation, peer group pressure, internal conflicts etc, while environmental factors include poor physical settings, availability of partners, poverty, gender dynamics, poor dwellings and so on.

Luckily most of these cases of sexual dysfunction are treatable but in most instances would involve a team work by the psychologist, gynecologist, physiotherapist, internist, endocrinologist, etc. Some medical approach includes the wonder drug Viagra, hormonal therapy, vacuum devices, serial dilation, surgical correction etc. A good understanding of human sexuality would enhance the overall health of all, especially women who are as usual the sacrificial lambs and guinea pigs.

Dr Ayo Arowojolu, MBBS, DA, FMCOG, FWACS, FRCOG, MFFP, the renowned gynecologist had his basic medical education in Nigeria and further training in UK. The big fish in a small pond is a Fellow of the Royal College of Obstetricians and Gynecologists, International College of Surgeons, National Postgraduate Medical College of Nigeria, and West African College of Surgeons, Research Fellow with numerous international bodies, among others. Married with children, the trainer of trainers is the secretary of the Faculty of O&G of the National Postgraduate Medical College of Nigeria. He has contributed greatly to the development of medical practice in Nigeria. He is a potential national honors awardee

Robot  # 1 | 07.04.2009 22:11

Sexuality and You: Another Look Abayomi Waheed The first in the 2009 series of faculty lectures of the University of Ibadan Medical College’s Faculty of Clinical Sciences was held a few weeks ago. It was a lecture for all seasons and various reasons. Aptly titled Sexuality In Reproductive Health: Emergence of A New Disease, it was beautifully delivered by the erudite scholar Dr Ayo Arowojolu of the Department of Obstetrics and Gynecology. But more bits later on this preeminentgynetrician who works where saints and sinners play NTBB. The lecturer raised some issues and was silent on others. Issues like the leeway given to tradomedical practitioners to advertise especially in the media, their roles in reproductive health, and the state of health today, the HIV/AIDS scourge, and the emergence of the multilevel marketers were highlighted. However the desired action by government, religious institutions a...Read the full article.