HUMAN SEXUALITY Course Objectives Jan.

2010

Chapter 1 1. State the authors definition of human sexuality. p.3 Human sexuality- the ways in which we experience and express ourselves as sexual beings. Our awareness of ourselves as females or males is part of our sexuality, as is the capacity we have for erotic experiences and responses. Our sexuality is an essential part of ourselves, whether or not we engage in sexual intercourse or sexual fantasy or even if we lose sensation to our genitals because of injury. 2. Explain the foundations and recent history of sexuality as a legitimate area of scientific study. p.17 Against the backdrop of the sexual repression found in the Victorian Era, 19th century, scientists and scholars began to approach sexuality as a legitimate area of study. English physician Havelock Ellis published an encyclopedia of sexuality between 1897 and 1910 entitled Studies in the Psychology of Sex. His arguments: a. Sexual desires in women were natural and healthy b. Many sexual problems were psychological, not physical c. Gay male or lesbian sexual orientation was a natural variation- and he treated as inborn dispositions, not as character flaws Another influential sexologist- German psychiatrist Richard von Krafft-Ebing described case histories of people with sexual deviations in Psychopathia Sexualis in 1886. Cases included: sadomasochism, bestiality, and necrophilia. He view deviations as mental disorders that could be studied and perhaps treated by medical science Viennese physician, Sigmund Freud developed a theory of personality that greatly influenced culture. He believed that our sex drive was our principal motivating force. Zoologist Alfred Kinsey, conducted the first large scale studies of sexual behavior in the 1930s and 1940s. Wrote the first book to represent the scientific attempts to provide a comprehensive picture of sexual behavior in the US. His books were branded immoral and obscene. In 1950, a congressional committee claimed that his work undermined the moral fiber of the nation, rendering it more vulnerable to a Communist takeover. Books: Sexual Behavior in the Human Male and Sexual Behavior in the Human Female In general, the books were dry to read. They became best sellers, even though the public had not yet learned to discuss sex openly. Despite Kinseys criticism, he went on to make sex research a scientifically respectable field. 3. Identify the major focuses of biological sexual research and its contributions to the field. p.19 Biological research focuses on the roles of genes, hormones, the nervous system, and other biological factors in human sexuality. Study of the biology of sex informs us about the mechanisms of reproduction, sexual arousal and response. Additional contributions include assisting in overcoming sexual problems such as helping infertile couples to conceive. 4. Describe some of the cross-cultural variations in sexual behaviors and attitudes and discuss possible conclusions about the universality of human sexual behavior given the cross-cultural material presented. pp. 21-24. The cross-cultural perspective provides insight into the ways in which cultural beliefs affect sexual behavior and peoples sense of mortality.

In most cultures characterized by a gender division of labor, men typically go to business or to hunt, and war. Men are viewed as strong, active, independent, and logical. Women are viewed as passive, dependent, nurturing, and emotional. These stereotypes are not inherent in our genetic heritage, but are acquired through cultural expectations and socializations. Some Commonalities and Differences between cultures: Kissing was common, although not universal The frequency of sexual intercourse varies from culture to culture, although more frequent among young people everywhere Great variation in attitudes towards childhood masturbation- some ignore, condemn, or encourage it. 84% of the cultures studied practiced polygamy, hence monogamy was relatively uncommon i. The more common form of polygamy was polygyny- in which men can have more than one wife practiced by a great majority- 82% BUT MONOGAMY IS STILL MORE PREVALENT WORLDWIDE (above statistics for cultures studied by a group of scientists) Polyandry- where woman can have more than one husband- is even rarer i. Fraternal polyandry is the most common form- where 2 brothers share a wife and they all live in the same house The cross-cultural perspective illustrates the importance of learning human sexual behavior. Although the anatomy and biology is the same, the sexual practices and pleasure they reap or fail to attain may set different cultures apart. If human sexuality were mainly based on biology, we might not see such differences. 5. Explain the psychoanalytic theory and several learning theories of human sexual behavior. pp. 24-26. Psychological perspectives focus on the many psychological influences- perception, learning, motivation, emotion, personality, and so on- that affect our sexual behavior and our experience of ourselves as female or male. Sigmund Freud and the Psychoanalytic Theory: Formulated theory of psychoanalysis- the theory of personality originated by Sigmund Freud, which proposes that human behavior represents the outcome of clashing inner forces He believed that we are all born with biologically based sex drives that must be channeled through socially approved outlets if family and social life are to carry on without undue conflict Proposed that the mind operates on conscious and unconscious levels a. Conscious level- state of present awareness b. Unconscious- darker reaches of the mind that lie outside our direct awareness c. Ego- shields the conscious mind from awareness of our baser sexual and aggressive urges by using defense mechanisms such as repression, or motivated forgetting of traumatic events Many sexual ideas and impulses are banished to the unconscious although they come out in ways such as dreams Freud originated concept of erogenous zones- idea that many parts of the body, not just the genitals, are responsive to sexual stimulation Controversial idea of Freuds: Children normally harbor sexual interests. He believed that the suckling of an infant in the oral stage was an erotic act and that anal bodily experimentation in which children learn to experience pleasure in the control of their sphincter muscles and the process of elimination. a. Psychosocial development: children undergo five stages of development: oral, anal, phallic, latency, and genital (named for the dominant e rogenous zones of each stage) 3

b. Inadequate or excessive gratification can lead to fixation- arrested development, which includes attachment to objects of an earlier stage of psychosexual development c. Oedipus Complex- a conflict of the phallic stage in which the boy wishes to possess his mother sexually and perceives his father as a rival in love Learning Theories: Family and personal experience can shape unique sexual attitudes and behaviors. Learning theorists focus on environmental factors that shape behavior. Behaviorists: Watson and Skinner Emphasized the importance of rewards and punishments in the learning process Reinforcements- events that increase or decrease the frequency or likelihood of behavior Praise will encourage children to repeat behaviors Punishment will discourage children from repeating behaviors If, as young children, we re severely punished for sexual exploration, we may come to associate sexual stimulation in general with feelings of guilt or anxiety Early learning experiences can set the stage for sexual problems or dysfunctions in adulthood Social-Learning Theorists: Use the concepts of reward and punishment, but emphasize the importance of cognitive activity (anticipations, thoughts, plans, and so on) and learning by observation Modeling- observational learning- acquiring knowledge and skills by observing others Psychological theories shed light on the ways in which sexuality is influenced by rewards, punishments, and mental processes such as fantasy, thoughts, attitudes and expectations. 6. Describe the contributions that the sociocultural perspectives make to the study of human sexual behavior. pp.26-27. Sociocultural theorists focus on differences in sexuality among the subgroups of society. The sociocultural perspective informs us of the relationship between sexuality and ones social group within a society. They study the ways in which the values, beliefs, and norms of a group influence the sexual behavior of its members. Some factors: Age: the number of sexual partners increases as people reach 40 due to the opportunity of more life experiences Education- people who have completed college are more likely to have more sexual partners Religion- restraining factor- liberal Protestants and no religion have a higher number of partners than Catholics and conservative Protestants Ethnicity- European Americans and African Americans have the highest numbers of sex partners, while Asian Americans are the most restrained ethnic group (numbers for Latinos and Latina Americans are lower than European Americans and African Americans) Gender Rolesa. Western culture- men are the breadwinners, women have been expected to remain home and rear the children today, many traditions fallen to the wayside. Most women today are members of the workforce.

7. Explain the importance of including multiple perspectives to understand sexuality. pp. 27-29 4

Each perspective has something to teach us. Human sexuality appears to reflect a combination of biological, social, cultural, sociocultural, and psychological factors that interact in complex ways. There are a few universal patterns of sexual behavior, and views on what is right and wrong show great diversity. Although our own cultural values and beliefs may be deeply meaningful to us, they may not indicate what is normal, natural, or moral in terms of sexual behavior. 8. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter) Its not true that knowing enough about the biology of sex will enable you to make the right sexual decisions. Only you can determine which of your options are compatible with your own moral values. You cannot trust everything that finds its way into print. Carefully weigh the evidence in all literature. Its true that Greek men might take on an adolescent male as a lover and pupil All in all, the women of the ancient world- and more recent times- were treated as chattels; that is property Its NOT true that the production of illustrated sex manuals originated in modern times It is true that the graham cracker came into being as a means for helping young men control their sexual appetites. It is true that Trobriander (tribe in Africa) boys and girls were expected to engage in intercourse when they were biologically old enough. The male redback spider, seconds after inseminating a female, does a somersault into her mouth and becomes her postcoital meal; because matings followed by cannibalism last twice as long as those that dont- the sacrifice improves the chance that his own sperm were fertilize the eggs before some else can have her. To a psychoanalysts, dreams of airplanes, bullets, snakes, sticks and similar objects may indeed symbolize the male genitals. This is not necessarily supported by the research evidence.

9. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below.

Running Glossary Key Terms

Bestiality- sexual relations between a person and an animal Gender identity- ones personal experience of being male or female Polygyny- a form of marriage in which a man has two or more wives Bisexual- sexually responsive to either gender Gender roles- complex clusters of ways in which males and females are expected to behave within a given culture Psychosexual development- in psychoanalytic theory, the process by which sexual feelings shift from one erogenous zone to another Coitus- sexual intercourse Human sexuality- the ways in which we experience and express ourselves as sexual beings Sadism- the practice of achieving sexual gratification through hurting or humiliating others Copulation- sexual intercourse Incest taboo- the prohibition against intercourse and reproduction among close blood relatives Sexologist- a person who engages in the scientific study of sexual behavior Cunnilingus- a sexual activity involving oral contact with the female genitals Monogamy- the practice of having one spouse 5

Erogenous zones- parts of the body, including but not limited to the sex organs, that are responsive to sexual stimulation Oedipus complex- in psychoanalytic theory, a conflict of the phallic stage in which the boy wishes to possess his mother sexually and perceives his father as a rival in love Erotic Pederasty- sexual love of boys Fellatio- a sexual activity involving oral contact with the penis Phallic symbols- images of the penis Foreplay- mutual sexual stimulation that precedes intercourse Polyandry- a form of marriage in which a woman has two or more husbands Fornication- sexual intercourse between two people who are not married to one another Polygamy- the practice of having two or more spouses at the same time

Practice with the Online Quiz!

Practice Questions: 1. The term that describes the practice of having two or more spouses at the same time is: a. Polyandry b. Foreplay c. Fellatio d. Polygamy 2. The term that describes the sexual love of boys is: a. Oedipus complex b. Erotic Pederasty c. Fornication d. Polyandry

Answers: D, B

Chapter 2 ~ Research methods in Human Sexuality 1. List the four goals of the science of human sexuality. Pp. 35-36 a. Formulating a research question: questions are formed by scientist based on their observations of or about certain events or behaviors. Answers are sought after by doing empirical research. b. Framing the research question in the form of a hypothesis: a hypothesis in this case is, a precise prediction about behavior that is often derived from theory. Hypothesis are tested by research. c. Testing the hypothesis: tests are conducted through carefully controlled observations & experimentation. d. Drawing conclusions: conclusions are drawn based on the correctness of the scientist hypothesis and analyses of the results. If the studies dont have the predicted outcome then the scientist can then revise their theories. 2. Explain the true groundbreaking report provided by Kinsey. P.41 a. Kinsey and his colleagues interviewed 5,300 males and 5,940 females between 1938 & 1949. They asked questions on various sexual experiences, including masturbation, oral sex, & coitus that occurred before, during, & outside of marriage. He couldnt do a direct observation study and chose not to obtain a random sample. Instead, he used group sampling. His study did not represent the general population and some statisticians speculate that his sampling methods were biased. He did seem to find a correlation between the level of education and the participation in oral sex. His interviewers were trained to ask matter-of-fact questions, reassure participants they were not passing judgments, & not to show emotional reactions. All of the interviewers were male so some of the women in the study may not have been as honest with them as they would have been if a female interviewer had been present. Kinsey checked the reliability of his data by reexamining the interviewers 18 months later. Their incidence of sexual activities were consistent. However, their frequency of participation were less consistent. people seem to find it more difficult to estimate the frequencies of their activities than to answer whether or not they have ever engaged in them. Kinsey knew that consistency did not guarantee validity. He had no way of proving the reported acts had actually occurred or in the frequency the participants stated. He used indirect ways to validate the data like comparing the answers from the reports of husbands and wives, of which there was high consistency. 3. Explain the true groundbreaking report provided by Masters & Johnson. Pp. 48-51 a. William Masters and Virginia Johnson were the 1st two to report direct laboratory observations (monitored in the laboratory & not in their natural setting) of individuals & couples engaged in sexual acts. In all there were 694 people (312 men & 382 females). Women were between18-78 & men were between 21-80 years old. There were 276 married couples, 106 single women, & 36 single men. The married couples participate in studied that evolved intercourse & forms of mutual stimulation like manual/oral stimulation of the genitals. The unmarried did not participate in intercourse but they did participate in studies involving measurement of female sexual arousal in response to insertion of a penis-shaped probe & male ejaculation during masturbation. These 2 scientists were accused of immorality, voyeurism, & other things. However, they were the 1st to offer reliable data on what happens to the body during sexual response. Their instruments measured vasocongestion, myotonia, & other responses. The artificial penis allowed them to study the changes that occur in the womans internal sexual organs as they become sexually aroused. From the studies they were able to divide sexual response in to 4 stages: excitement, plateau, orgasm, & resolution. One problem with these studies is, the fact that the participants knew they were being watched and that their responses were being measured. People may not respond in public like they would in private. 4. Discuss the major ethical issues researchers encounter when conducting sex research and how they are resolved. Pp.56-57 8

Exposing participants to harm: people can be harmed if exposed to pain or placed in stressful situations. For this reason researchers do not expose children to erotic material or human fetuses to male/female sex hormones to learn whether they can predict gay/lesbian orientation b. Confidentiality: ensuring confidentiality can be done by making questionnaires anonymous, not telling the interviewers the identities of the interviewees. c. Informed consent: a principle that requires that people freely agree to participate after being given enough information about the procedures and purposes of the research, and its risks & benefits, to make an informed decision. Once the study has begun, the participants must be free to withdraw at anytime w/out penalty. d. The use of deception: sometimes you dont want the participants to know what the purpose of the study is because you are studying their results. 5. Differentiate the items in the chapter Truth? Fiction Section. p(throughout) a. It is true that you could study the sexual behavior of millions of Americans and still not obtain an accurate picture of the sexual behavior of the general American population. Researchers need to obtain samples that represent the target population. b. It is true that case studies have been carried out on people who are dead. Such case studies rely on historic records rather than interviews with the individuals themselves or their contemporaries. c. It is true that some sex researchers have engaged in swinging with the people they studied. d. It is true that Masters & Johnson created a transparent artificial penis containing photographic equipment to study female sexual response. It was perhaps their most controversial device. e. It is true that people who attend church regularly then to be more satisfied with their relationships. What are some possible explanations? f. There is no evidence that Viagra causes risky sexual behavior. It is more likely that the effort to enhance sexual response explains both the use of Viagra and risky sexual behavior. g. There is evidence that the victims of genital mutilation-the women what are circumcised-tend to internalize the beliefs of their culture. Not only do they generally support female circumcision, they also accept the right of husbands to beat their wives. h. It is NOT true that researchers publish the names of participants in sex research in professional journals. Sex research must keep the identities and responses of participants confidential to protect them from possible harm or embarrassment. 6. Complete the definitions of the items in the Running Glossary section listed in the Key terms list below. a. Anthropomorphism: The attributing of human characteristics to an animal b. Penile strain gauge: A device for measuring sexual arousal in men in terms of changes in the circumference of the penis. c. Vaginal plethysmograph: a tampon-shaped probe that is inserted in the vagina and suggest the level of vasocongestion by measuring the light reflected from the vaginal walls. d. Vasocongestion: congestion from the flow of blood TQ: 1. True or False? The deceased have been used in some cases studies involving human sexuality in the past? 2. What is the device called that can be inserted in to the vagina to take pictures and to measure the level of vasocongestion? a. Vaginalgraph b. Penile strain gauge c. Plethysmograph d. Sphygmomanometer 9

a.

Answers: 1. True 2. C Chapter 3 Female Sexual Anatomy and Physiology 1. Identify, describe and explain primary function of the female external sex organs, or vulva. pp.63-70 The external sex organs on the female are collectively termed vulva or pudendum. The parts of the vulva are the mons veris, the labia, majora, and minora, the clitoris, and the vaginal opening. The mons veris consists of the fatty tissue that covers the joint of the pubic bones in front of the body, below the abdomen and above the clitoris. Pubic hair covers this area, and it serves to cushion the pubic bone during sex. The labia majora are the large folds of skin that run downward from the mons, inner surface is hairless, and the outer surface near the thigh is covered in hair. Shield the inner female genitals and is covered in many nerve endings. The labia minora are two hairless light colored membranes located between the labia majora. At the top they join at the prepuce (hood) of the clitoris. Surround the urethral and vaginal openings. Many nerve endings and can be stimulated and engorge with blood. The clitoris is the only sex organ specifically used for purposes of pleasure. Derives its name from the Greek word kleitoris, meaning hill or slope. The body of the clitoris, or shaft is 1 inch long and inches wide. It consists of erectile tissue containing the spongy masses- copora cavernosa that fill with blood and become erect. The prepuce or hood, covers the clitoral shaft. The clitoral glans is a smooth round knob above the urethal opening and covered by the hood, highly sensitive to touch. Clitoris and penis are homologus to each other. Hood is removed in Moslems in the Near East and Africa. The vestibule is the area within the labia minora that contains the vaginal and urethral openings. The urethral opening is where the urine passes from the body to the outside. Lies below the clitoral glads and above the vaginal opening. The proximity of the urethral opening to the external sex organs can pose hygienic problems. The vaginal opening or introitus lies in between the labia minora. Lies below and is larger than the urethral opening and the shape resembles a hymen. The hymen is a fold of tissue across the vaginal opening that is present at birth and remains somewhat intacted until first coitus. Presence or absence used in virginity arguments. Found only in female horses and humans, seems to serve no apparent biologic function. The perineum incoporates the skin and underlying tissue between the vaginal opening and the anus. 2. Name the structures that underlie the vulva. p.69 Vestublar bulbs and Bartholin's glands, sphincters that constrict bodily openings such as the vaginal and anal openings found on both sides. Vestibular bulbs are attached at the clitoris at the top and extend downward along the sides of the vaginal opening. Bartholin's glands lie just inside the minor lips and secrete lubrication before orgasm, it is not essential or coitus, this fluid has no known purpose. Vaginal lubrication comes from the sweating of the vaginal wall when it becomes engorged in blood, it forces the moisture out. 3. Recognize that the clitoris is the only sexual organ whose sole known function is pleasure. pp.64-65 See definition under #1. 4. Describe ritual female genital mutilation, why it is practiced, name the types of mutilation and the medical complications associated with the practice. p.66-67 Female ritual mutilation medically known as a Clitoridectomy, takes place in parts of Africa and the Middle East predominantly amongst Islamic cultures. It entails the removal of the clitoris as a whole. It is practiced on the assumption that young women of these cultures will stay chaste if they no longer have a clitoris as now they will lack any sexual desires. In the Sudan and even more extreme version called Infibulation is performed where the clitoris, labia minora, and part of the labia major are removed and then the raw edges are sewn shut leaving only small openings for urine and menstruation. Complications of both procedures are infection, edema, bleeding, and especially future sexual dysfunction. 10

5. Explain why the condition of the hymen cannot be used to prove or disprove virginity. p.68 The condition of the hymen is essentially useless as proof of virginity as there is a high degree of anatomic variation in size, structure, and the amount of the vaginal opening that the hymen covers. In some cases it is torn away during normal childhood activities and therefore isnt present at all as an indicator of sexual intercourse taking place. 6. Identify, describe and explain the primary functions of the female internal sex organs, or reproductive system. pp. 70-75 Vagina: the tubular female sex organ which contains the penis during intercourse and through which the baby is born. Cervix: The lower end of the uterus and upper end of the vagina, its walls produce secretions which contribute to the chemical balance of the vagina. Os: The opening if the middle of the cervix leading to the uterus Uterus: The hollow, muscular, pear-shaped organ in which a fertilized ovum implants and develops until birth. Fallopian Tubes: tubes that extend from the ovaries to the uterus and connect the two allowing for the travel of the ovum from ovary to uterus. Ovaries: almond-shaped organs that produce the ova and the hormones estrogen and progesterone. 7. Describe common medical pathology / disease conditions that may occur with the female internal organs. pp.70-75 Vaginitis: vaginal inflammation, prevented with proper hygiene Cervical Cancer: cancer of the cervix, more prevalent amongst females with many sexual partners or those that start having sex earlier in life. Endometriosis: condition caused by the growth of endometrial tissue in the abdominal cavity or elsewhere. Characterized by menstrual pain. Ectopic Pregancy: Pregnancy where implantation takes place outside the uterus 8. Describe the pelvic exam procedure and explain the importance of routine pelvic exams. p.75 Standard pelvic exams entail an inspection of the external genitalia where the physician looks for swelling or irritation. Then the internal genitalia are examined with the aid of a speculum (a device for holding open the vagina). A pap smear may or may not be taken depending on when the last one was. Finally the physician may do a rectovaginal inspection by inserting a finger in the anus and another into the vagina, this procedure provides additional information about the condition of certain ligaments and muscles that form the pelvic floor. 9. Identify the menstrual cycle. pp. 84-86 The menstrual cycle is the sexually mature female cycle regulated by hormones that is divided into four phases, lasts ~28 days and culminates in menstruation (the shedding of the endometrium). 10. Identify the four phases of the menstrual cycle and discuss the hormonal and physical changes associated with each. pp. 87-91 1. Proliferative phase: Increased estrogen levels, egg develops to full maturity, and the endometrium (cells lining the uterus) proliferates. 2. Ovulatory Phase: egg is released from the ovary and into the fallopian tubes to travel to the uterus, all caused by estrogen reaching a peak level 3. Secretory Phase: Endometrium thickens, secretions and blood supply increase in the internal sex organs due to the increase in progesterone levels 4. Menstrual Phase: surface of endometrium is released and vaginal bleeding occurs. Physical symptoms 11

can include, cramps, bloating, nausea, and headaches. 11. Explain how menopause affects women. pp. 92-94 Menopause or the cessation of menstruation generally takes place in women ages 46-50 over a course of roughly two years, although there are variations both younger and older. Besides the obvious symptoms of cessation of menstruation, women also experience a variety of additional symptoms. These range from hot flashes and hot flushes, night sweats, and cold sweats. All of this is caused by the falling off of the production of the female hormones like estrogen and progesterone from the ovaries even though the pituitary gland continues release adequate levels of LH and FSH. Other symptoms such as headache, joint pain, tingling in the hands and feet, burning or itchy skin, and heart palpitations are also common. Long term estrogen deficiency has also been linked to osteoporosis. 12. Discuss coitus during menstruation, pp. 91-92 Coitus during menstruation tends to have a certain social-religious stigma as being dirty or unsafe. While possibly messy, it is certainly not unsafe by any means. It in fact may be helpful to the woman as the contractions of the uterus during orgasm may help relieve cramping by helping to clear out the lining and any clotted blood left inside the uterus. 13. Summarize the research regarding the cultural, social, psychological, and biological correlates of dysmenorrhea. p. 96 Dysmenorrhea, or pain during menstruation is very common in most women. Symptoms include cramps, bloating, nausea, and headaches. The cramping is generally caused by elevated levels of prostaglandins which can activate muscle contractions. There are two types, primary and secondary with the difference being that primary types have no organic problems that cause their discomfort while those with the secondary type do. The cultural and social aspects of this phenomenon are generally referred to as that time of the month and are either made light of or even ignored by the male sex. It was even once believed that this part of a womans cycle was just part of her natural hysterical nature and would pass. Psychologically women need recognize that there is nothing wrong with them, this a naturally occurring event and they are blameless for their physical discomfort. They must not think of it as a time of pollution, dirtiness, or illness, but rather should accept it as part of their natural cycle and seek physicians assistance if the discomfort gets out of hand. 14. Identify the common symptoms of PMS, cite the prevalence of women who experience symptoms and list the possible causes of PMS and its proposed treatments. Compare these to the symptoms and treatments for PMDD. pp. 97-103 Premenstrual Syndrome (PMS) is a combination of psychological and physical symptoms (anxiety, depression, irritability, weight gain from fluid retention, and abdominal discomfort) that affects most women in the 4-6 period before menstruation. Premenstrual dysphoric disorder, or PMDD is a diagnosis used by the American Psychiatric Association to describe cases of PMS that are characterized by severe mood swings, impairment of functioning at work, school, or in social relationships. The best wait to treat both is to maintain a healthy lifestyle leading up to these times of the menstrual cycle. Regular exercise and healthy diet are good preventative measures that can lower the severity of symptoms. In addition, Birth Control, is also used to regulate symptoms as well as certain pain killers. In the case of PMDD and sometimes even PMS, counseling is a good idea and occasionally antidepressants are prescribed. TQ: 1. Which one of the following is not a common symptom of menopause? a. night sweats b. joint pain c. hot flashes d. weight gain 12

2. What is the form of genital mutilation that involves cutting out the clitoris and labia and sewing together the remnants of the labia majora? a. prepucectomy b clitroidectomy c. infibulation d. vaginal self-destruction Ans: 1.d. 2.c.
Chapter 4: Male Sexual Anatomy and Physiology

1. Describe the penis and the internal structures and bodily systems that make the male sexual arousal cycle possible.
The penis is a sex organ used in sexual intercourse, that serves as a conduit for both semen that each pass out of the urethral meatus (opening) Rather than bones or muscles, the penis contains 3 cylinders of spongy material that run its length The larger two of these cylinders is the corpora cavernosa- these two lie side by side and function like the cavernous bodies of the clitoris- fill up with blood and stiffen during sexual arousal In addition, the corpus spongiosum (spongy body) runs along the bottom (ventral) surface of the penisContains the urethra, expands at the end to become the glans (head) of the penis All three cyclinders contain spongy tissue that swells (becomes engorged) during sexual arousal, resulting in erection The urethra is connect to the bladder (unrelated to reproduction) and to those parts of the reproductive system that transport semen The glans is extremely sensitive to sexual stimulation, and therefore it can become irritated if directly stimulated for too long- men generally prefer to masturbate by stroking the shaft of the penis rather than the glans (but not all) Other areas men find sensitive are the corona (coronal ridge) which separates the glans from the shaft, and the frenulum (an area on the underside of the penis; a thin strip of tissue that connects the underside of the glans to the shaft) The base of the penis is known as the root and extends into the pelvis- it is attached to the pelvis by root like structures called crura The body of the penis is known as the shaft and is free swinging so when engorged with blood erection is obvious The skin of the penis is hairless and fixed to the penis just behind the glans- some of it folds over to partially cover the glans- this is known as foreskin

2. Cite the reasons people give for having males circumcised and the research evidence on this topic.
Circumcision is the surgical removal of the prepuce (foreskin) There is some controversy regarding circumcision Advocates of the practice believe it to be hygienic because it eliminates a site where smegma may develop (a cheese-like, foul smelling secretion that may accumulate under the prepuce) and disease organisms may flourish Opponents believe circumcision is unnecessary because regular cleansing is sufficient to reduce the risk of the problem Long been a religious rite- Jews traditionally carry on male circumcision shortly after a baby is born as a sign of the covenant between God and Abraham, Muslims also have ritual circumcisions for religious reasons although normally within a few years of birth Circumcision rates vary widely within the U.S., from about 80% in the Midwest to about 40% in the west- circumcision is uncommon elsewhere except in the Muslim world The rate is approx. 17% in Canada and 5% in England Circumcision is most common among European American men (including Jewish American men) (87%) Circumcision became widespread in the U.S. because medical research suggests that it lessens the risk of infections from UTIs to HPV to HIV/AIDS.

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Critics of circumcision note that it is generally accepted that circumcision lessens sexual sensation, and even though there is a higher risk of cancer/STIs in patients who are not circumcised this is not sufficient to recommend that it is performed universally according to the American Academy of Pediatrics

3. Distinguish between myths and facts derived from research on the effects of penis size on sexual performance and a partner's sexual satisfaction.
In our culture, the size of the penis is sometimes seen as a measure of a mans masculinity and his ability to please his sex partner The average male penis ranges in length from 3.5-4 inches when flaccid and 5-7 inches while erect. Penises that are small in size when flaccid tend to gain more in size when they become erect, large soft penises generally gain less Size differences thus can be largely canceled out by erection Even when flaccid, the same penis can vary in size Factors such as cold air, water, or emotions such as fear and anxiety can cause the penis to draw closer to the body, reducing its size- conversely warm water and relaxation can cause it to expand

4. Describe the scrotum and its role in maintaining optimum temperature for sperm production.
The scrotum is a pouch of loose skin that becomes lightly covered with hair at puberty. It has two compartments that hold the testes. Each testicle is held in place by a spermatic cord, a structure that contains the vas deferens tube, blood vessels, nerves and the cremaster muscle (the cremaster muscle raises and lowers the testicle within the scrotum in response to temperature changes and sexual stimulation- sexual arousal draws them closer to the body) Sperm production is optimal at slightly below the normal body temp. of 98.6 degrees, and scrotal temperature tends to be approx. 5-6 degrees less than normal body temperature The scrotum is loose hanging and flexible- permits the testes and nearby structures to escape the higher body heat (especially in warm weather). The middle layer of the scrotum is the dartos muscle, similar to the Cremaster muscle, responds to changes in temperature reflexively (contracts in the cold, expands in the heat)- also allows the scrotum to change surface area in response to temperature (hence the wrinkled appearance of the scrotum in the cold) The scrotum is sensitive to sexual stimulation

5. Trace the route of the sperm as they leave the testes and combine with the several glandular fluids that form semen.
Sperm are made in the testes, then proceed through the seminiferous tubules to the epididymis. Each epididymis then empties into a Vas Deferens tube which joins with a seminal vesicle (that produces fluid that mixes with the sperm) to form a short ejaculatory duct. The ejaculatory duct runs through the prostate (which contributes fluid) and empties into the urethra, where fluid joins from the bulbourethral glands. This fluid now constitutes semen and is ejaculated from the urethral meatus. The fluid produced by the seminal vesicles is rich in fructose, which nourishes the sperm. The fluid from the prostate is milky and alkaline and contributes to the texture and odor of the seminal fluid. The bulbourethral glands secrete fluid that may help to buffer the acidity of the males urethra and lubricate the urethra passageway.

6. Discuss the incidence, symptoms, treatments and survival rates associated with testicular cancer.
Cancer of the testicles remains a relatively rare form of cancer, accounting for only about 1% of all new cancers in men, however it is the most common form of solid-tumor cancer to strike men between the ages of 20-34 and accounts for nearly 10% of all deaths from cancer in that age group. No evidence that masturbation or sexual overactivity results in cancer. Approx. 14% of men with testicular cancer had cryptorchidism as children (a condition when one or both testicles failed to descend)- family history also increases the risk The prognosis is favorable today, especially with early detection- the survival rate among cases detected early is >90% Treatments include surgical removal, radiation, and chemotherapy The early stages often produce no symptoms other than the mass itself, and because early detection is so crucial to survival men are advised to examine themselves once a month following puberty and to have regular check-ups.

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7. Describe the testicular self-examination procedure and the importance of self-exams and regular medical checkups for early detection of testicular and prostate cancer.
Best performed shortly after a shower or warm bath when the skin of the scrotum is most relaxed The man should examine the scrotum for evidence of pea sized lumps: Each testicle can be rolled gently between the thumb and the fingers- lumps are generally found on the side or front of the testicle. The presence of a lump is not necessarily a sign of cancer but it should be promptly reported to a physician for follow up. The American Cancer Society and National Cancer Institute issued these warnings 1) Slight enlargement of one of the testes 2) Change in the consistency of the testicle 3) Dull ache in the lower abdomen or groin 4) Sensation of dragging or heaviness in the testicle

8. Identify the disorders of the prostate and their symptoms and treatments.
The prostate gland is tiny at birth and grows rapidly at puberty- it may shrink during adulthood but usually becomes enlarged past 50 Benign Prostatic Hyperplasia (BPH): The prostate gland becomes enlarged in about of the men past the age of 50 and 80% of men by age 80. This is noncancerous enlargement of the prostate due to hormonal changes associated with aging rather than other causes, such as inflammation from STIs. This enlargement may constrict the urethra since the prostate surrounds the upper portion of the urethra causing urinary frequency, urgency, and difficulty starting the flow of urine Treatment: There are two types of drugs to help with BPH. 5ARIs inhibit the production of the hormone DHT (a form of testosterone) which causes enlargement of the prostate. These shrink the prostate, provide long term improvement of symptoms and reduce the risk of severe urinary retention and the need for surgery. The second type of drug is alpha blockers, which act by relaxing the muscles of the bladder to improve the flow of urine, providing symptom relief. Part of the prostate is sometimes removed. Cancer of the Prostate: Prostate cancer is a serious and life-threatening problem. 1 in 6 men in the U.S. will develop prostate cancer at some point in their life. Prostate cancer is the second most common form of cancer among men, after skin cancer, and the second leading cause of cancer death among men, after lung cancer. There are about 221,000 new cases a year and approx. 40,000 deaths. Prostate cancer involves the metastatic growth of malignant prostate tumors that can metastasize to bones and lymph nodes if not detected and treated early. African American men are 1/3 rd more likely than European American men to develop prostate cancer, and 2x as likely to die from it (as African American men generally have less access to health care than European American men). Intake of animal fat is a potential risk factor. Risk increases with age and there are apparent genetic factors involved. The early symptoms mimic those of BPH. Later symptoms may include blood in the urine, pain or burning on urination, and pain in the lower back, pelvis or thighs, however most cases occurs without symptoms in the later stages. The ACS recommends that men receive annual DREs beginning at age 50. Those at higher risk should begin at age 45. Early detection is important because treatment is most effective before the cancer has spread. 58% of prostate cancers are detected while they are still localized, the survival rate drops dramatically if the cancer has metastasized. The most widely used treatment is surgical removal of the prostate gland. Prostatitis Prostatitis is inflammation of the prostate which can be caused by various agents. The main symptoms are aching or pain between the scrotum and anal opening and painful ejaculation. Usually treated with antibiotics.

9. Describe the conditions under which erections can occur and explain why the process of erection is a spinal reflex.
Erection is caused by the engorgement of the penis with blood such that the penis grows in size and stiffens. The erect penis is a conduit for depositing sperm deep within the vagina Erection is a hydraulic event, the spongy cavernous masses of the penis are equipped to hold blood. Filling them with blood causes them to enlarge like a sponge swells as it absorbs water In a few moments (10-15 seconds) the penis can double in length, become firm, and shift from a funnel that passes urine to one that expels semen (the bladder is closed off when the male is aroused)

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The corpora cavernosa are surrounded by a tough fibrous coating known as the tunica albuginea- as the corpora cavernosa fill with blood, the tunica albuginea resist expansion thus the penis rigidifies. The male capacity for erection spans the life cycle. Erections are common in babies, even minutes after birth. Some men who are in their 80s and 90s continue to experience erections and engage in coitus. Erections are not limited to the conscious state. Men have nocturnal erections every 90 minutes or so while they sleep, generally during REM sleep. Morning erections are actually nocturnal erections that were occurring during REM sleep that was interrupted, such as by an alarm clock. Men do not need to try and become aroused, they only need to expose themselves to sexual stimulation and reflexes take over. Erectile responses to direct stimulation such as touching or licking involve a simple spinal reflex that does not require the direct participation of the brain- however they can be initiated in the brain such as when a man has a sexual fantasy. In this case, the brain stimulates the spinal cord which triggers the erectile reflex. Tactile stimulations of the penis or nearby areas cause sensory neurons to transmit nerve messages to the sacrum. The sacral erection center controls reflexive erections, or erections occurring in response to direct stimulation of the penis or nearby areas.

10. Explain the effect of spinal cord injuries on erection and ejaculation.
The sacral erection center makes it possible for men whose spinal cords have been injured or severed above the center to achieve erections (and ejaculate) in response to direct tactile stimulation of the penis. Because of the lack of communication between genital organs and the brain there are no sensations, but many spinal injured men report that sex remains psychologically pleasurable because they can observe the response of their parteners

11. Discuss the role of the brain and the autonomic nervous system in erection.
The brain plays an important role in regulating sexual responses. Tactile stimulation of the penis may trigger erection through the spinal cord but sexual sensations are then normally relayed to the brain, which generally results in pleasure and often in a decision to focus on erotic stimulation. This can result in messages being sent by the brain through the spinal cord to the arteries servicing the penis, thus maintaining or strengthening an erection. When the brain originates messages that trigger erectile reflex, it transmits nerve impulses to a second and higher erection center located in the upper back in the lumbar region of the spinal cord- a switch board between the brain and the penis. The brain can also stifle sexual responses (i.e. when a man is highly anxious) Erection is an unlearned, automatic response controlled by the autonomic nervous system The nerves that cause the penile arteries to dilate during erection are part of the parasympathetic nervous system. The parasympathetic system largely governs erection. Ejaculation, however, belongs to the sympathetic nervous system, thus can lead to premature ejaculation during periods of stress or anxiety.

12. Describe several erectile and ejaculatory abnormalities.

Peyronies Disease- excessive curvature of the erect penis that can make erections painful Caused by a buildup of fibrous tissue in the penile shaft- some clear up on their own but most require medical attention Pirapism- erections persisting for hours or days Often cause by leukemia, sickle cell anemia or diseases of the spinal cord, although sometimes the cause is unknown. Occurs when mechanisms that drain the blood from the penis are damaged so blood cannot return to the circulatory system can be a medical emergency because erection beyond six hours can lead to tissue deterioration due to oxygen deprivation. Retrograde ejaculation- ejaculate empties into the bladder rather than being expelled from the body During normal ejaculation, an external sphincter opens allowing seminal fluid to pass out of the body, while another sphincter, internally, closes off to prevent seminal fluid from backing up into the bladder. In retrograde ejaculation these processes are reversed.

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13. Describe the process of ejaculation, including the roles of the spinal cord and the autonomic nervous system.
Ejaculation is also a spinal reflex. It is triggered when sexual stimulation has reached a certain threshold. Generally occurs together with orgasm, the sudden muscle contractions that occur at the peak of sexual excitement and result in the abrupt release of sexual tension that has built up during sexual arousal. Ejaculation refers only to the expulsion of semen from the tip of the penis. Ejaculation occurs in two stages: 1) Emissions stage- involves contractions of the prostate, seminal vesicles, and the upper part of the Vas Deferens (ampulla)- the force of these contractions propels seminal fluid into the prostatic part of the urethral tract (the urethral bulb) which balloons as the muscle contracts at either end, trapping the penis inside- at this point ejaculation is imminent 2) Expulsion stage-involves propulsion of the seminal fluid through the urethra and out of the urethral meatus at the tip of the penis. Muscles at the base of the penis and elsewhere contract rhythmically, expelling semen. Often accompanied by sensations of orgasm. Like erection, ejaculation is regulated by two centers in the spinal cord, one in the sacral region and one higher in the lumbar region. The lumbar ejaculatory center triggers the emissions stage and the sacral ejaculatory center triggers the expulsion stage. Even though it is a reflex, men can control ejaculation by learning to recognize their sexual stimulation threshold and keeping below this point in order to prevent ejaculation from occurring before they want it to.

14. Differentiate the items in the chapter Truth?Fiction?

a) The penis contains bone and muscle (F) Theres no bone/muscle tissue in the penis despite slang terms b) The father determines a babys gender (T) Father determines babys gender thru the presence of an X or Y sex chromosome. If the fertilizing sperm has an X, the child will be a girl. If it has a Y, the child will be a boy. c) The sperm of the tiny fruit fly are longer than human sperm (T) Sperm of the tiny fruit fly are longer than human sperm. Incredibly, they are longer than the sperm of any mammal! d) Morning erections reflect the need to urinate (F) They dont reflect the need to urinate. Instead, they are a form of nocturnal erection e) Men can will themselves to have erections (F) Men cannot do this. They can only set the stage for erections by physical or cognitive sexual stimulation f) The penis has a mind of its own (F) The penis doesnt have a mind of its own. Though it may seem like the penis acts as a free agent, but it is actually governed by the autonomic nervous system g) Many men paralyzed below the waist can attain erection, engaged in intercourse and ejaculate (T) Men paralyzed below waist can do all these things if the spinal centers that control erection and ejaculation remain intact. h) Men can have orgasms w/o ejaculating (T) They can. Such orgasms are termed dry orgasms

15. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below.
1. 2. 3. 4. 5. 6. Phallic symbols images of the penis suggestive of generative power Testes male sex glands suspended in the scrotum that produce sperm cells and male sex hormones Testicles testes Penis male organ of sexual intercourse Cloaca the cavity in birds, reptiles and many fish into which the genitourinary and intestinal tracts empty Corpora cavernosa cylinders of spongy tissue in the penis that become filled with blood and stiffen during sexual arousal

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7. Corpus spongiosum the spongy body that runs along the bottom of the penis containing the penile urethra and enlarges at the tip of the penis to form the glans 8. Corona ridge that separates the glans from the body of the penis 9. Frenulum sensitive strip of tissue that connects the underside of the penile glans to the shaft 10. Root base of the penis which extends into the pelvis 11. Shaft body of the penis which expands as a result of vasocongestion 12. Foreskin loose skin that covers the glans penis. Aka the prepuce 13. Circumcision surgical removal of the foreskin of the penis 14. Phimosis abnormal condition in which the foreskin is so tight that it cannot be withdrawn from the glans 15. Scrotum pouch of loose skin that contains the testes 16. Spermatic cord cord that suspends a testicle w/in the scrotum and has a vas deferens, blood vessels, nerves and the cremaster 17. Vas deferens tube that conducts sperm from the testicle to the ejaculatory duct of the penis 18. Cremaster muscle muscle that raises and lowers the testicles in response to temperature changes and sexual stimulation 19. Dartos muscle muscle in the middle layer of the scotum that contracts and relaxes in response to temperature changes 20. Germ cell a cell from which a new organism develops 21. Sperm the male germ cell 22. Androgens male sex hormones 23. Testosterone a male steroid sex hormone 24. Interstitial cells (Leydig cells) cell that lie btw the seminiferous tubules and secrete testosterone 25. Secondary sex characteristics traits that distinguish genders but are not directly involved in reproduction 26. Seminiferous tubules tiny, winding, sperm-producing tubes that are located w/in the lobes of the testes 27. spermatogenesis the process by which sperm cells are produced and developed 28. spermatocyte an early stage in the development of sperm cells in which each parent cell has 46 chromosomes, including one X and one Y sex chromosome 29. Spermatids cells formed by the division of spermatocytes. Each spermatid has 23 chromosomes 30. Spermatozoa mature sperm cells 31. Epididymis tube that lies against the back wall of each testicle and serves as a storage facility for sperm 32. Vasectomy sterilization procedure in which the vas deferens is severed, preventing sperm from reach the ejaculatory duct 33. Seminal vesicles small glands that lie behind the bladder and secrete fluids that combine with sperm in the ejaculatory ducts 34. Ejaculatory duct formed by the convergence of a vas deferens w/ a seminal vesicle, thru which sperm pass thru the prostate gland and into the urethra 35. Cilia hairlike projections from cells which beat w/ rhythm giving locomotion or currents 36. Prostate gland lies behind bladder and secretes prostatic fluid which gives semen its odor and texture 37. Cowpers (Bulbourethral) glands lie below prostate and empty their secretions into the urethra during sexual arousal 38. Semen whitish fluid constituting the ejaculate consisting of sperm and secretions from seminal vesicles, prostate gland, and Cowpers glands 39. Urologist doc who specializes in the diagnosis/treatment of diseases of the urogenital system 40. Urethritis inflammation of bladder or urethra 41. Cryptorchidism one or both testicles fail to descend from the abdomen into the scrotum 42. Benign prostatic hyperplasia enlargement of the prostate gland due to hormonal changes assod w/ aging and characterized by symptoms like urinary freq, urgency, and difficulty starting the flow of urine

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43. Prostatitis inflammation of the prostate gland 44. Erection enlargement and stiffening of the penis from its engorgement w/ blood 45. Performance anxiety feelings of dread and foreboding experienced in connection w/ sexual activity (or any other activity judged by another person) 46. Reflex simple, unlearned response to a stimulus thats mediated by the spine, instead of the brain 47. Sacrum thick, triangular bone located near the bottom of the spinal column 48. Autonomic nervous system (ANS) regulates automatic bodily processes like heartbeat, pupil dilation, respiration, and digestion 49. Sympathetic branch of the ANS most active during emotional responses that draw on the bodys reserves of energy like fear and anxiety. This largely controls ejaculation 50. Parasympathetic branch of the ANS most active during processes that restore bodys energy reserves like digestion. Parasympathetic ANS largely controls erection 51. Premature ejaculation sexual dysfunction in which the male persistently ejaculates too early to afford the couple adequate sexual gratification. 52. Peyronies disease- abnormal condition characterized by excessive curvature of the penis that can make erection painful 53. Orgasm the climax of sexual excitement 54. Paraplegic person w/ sensory and motor paralysis of the lower half of the body 55. Emission phase 1st phase of ejaculation which involves contractions of the prostate gland, the seminal vesicles, and the upper part of the vas deferens 56. Ampulla sac or dilated part of a tube or canal 57. Urethral bulb small tube that makes up the prostatic part of urethral tract and that balloons out as muscles close at either end, trapping semen prior to ejaculation 58. Expulsion stage 2nd stage of ejaculation, during which muscles at the base of the penis and elsewhere contract rhythmically, forceibly expelling semen and providing pleasurable sensations 59. Retrograde ejaculation ejaculation in which the ejaculate empties into the bladder

16. Describe the main topics in the A Closer Look Sections within the chapter.
Big The tiny fruit fly (Drosophila bifurca) is a fraction of an inch long, but has the longest sperm known (1000X as long as human sperm) His sperm can stretch to 2 inches or 20X his body length How is this possible? 11% of his body weight devoted to his testes Fruit flies are no match for people though in terms of # of sperm produced Men ejaculate many hundred million sperm vs fruit fly which releases 50 Plus human sperm are better swimmers Options and Decisions for Men with Prostate Cancer Mayor Rudolph W. Guliani of New York decided on radioactive seed implants as an out-patient procedure treatment option for his prostate cancer in 2000. The disease progresses slowly so men can take some time with this difficult decision and carefully weigh all their options. Prostate cancer is usually detected with a series of tests including one for Prostate specific antigen (PSA) (recommended annually for men >50), Digital Rectal Exams (DRE), and other tests including CT scans, radionuclide bone scans and MRIs. Deciding on treatment can be a challenge because there are so many options. These include: improved surgery with nerve sparing to help reduce incontinence and impotence, external beam radiation in which beams are directed at the prostate, high targeted proton radiation in which protons are shaped into beams to match the shape of the tumor and eliminate damage to surrounding tissue; cryosurgery, radioactive seed implants in which rice sized pellets are injected into the prostate to kill cancer cells, new hormone treatments to block production of testosterone, combination therapies, and watchful waiting in which a patient chooses NO treatment and simply monitors themselves for changes.

17. Discuss the topic listed in A World of Diversity Section within the chapter. 19

Koro-Genital Retraction Syndrome Koro- a disorder otherwise known as Genital Retraction Syndrome, is a disorder found primarily in Malaysia, Indonesia and China in which men mistakenly believe that their penises will shrink and retract into their bodies. The anxiety they experience during an attack does cause the penis to somewhat shrink in size but it does not retract into the body, which is anatomically impossible. Most likely to occur when a man attempts to urinate or is cold, or perhaps due to guilt or anxiety. During an attack, a man will typically grab his genitals to keep them from retracting, and often uses things such as clamps, cords or weights to prevent this from occurring. Most men benefit from anatomical information and assurance that this is not physically possible, some are helped by antidepressant medications.

18. Discuss the topic in the Human Sexuality in the New Millennium Section within the chapter.
Andropause and chemistory: must testosterone be toxic? Men may fall prey to raging hormones, similar to women during fluctuations of hormonal cycles. The male sex hormone testosterone is related to tendencies to dominate other people. More research has been done on male health problems then on female health problems yet the problems associated with LOW levels of male hormone do not as of yet have an agreed upon name. Andropause suggests a fall off in androgens, viropause suggests a decline in virility which is not a scientific term and suggests a general loss of ability and menopause is a widely used unscientific knock off of the term menopause. In men, however, the decline in production of sex hormones and fertility is more gradual (hence why a man who is 70 may still father a child, however may have difficulty maintaining erection). Sexual performance is only one part of the equation. Other factors include weight loss, muscle mass, height (lost in inches), and bone mass. Research has also shown body fat grows as androgen production decreases. Prescription for testosterone replacement therapy has proven inconclusive at this point and much more research is necessary to be at the level we are with the knowledge of the female hormone estrogen.

PRACTICE QUESTIONS 1) Some symptoms of manopause" are a) Hot flashes, night sweats, mood swings b) Loss in muscle mass, decrease in sexual performance, loss in stature c) There is no such thing is manopause" d) Loss of sexual performance only 2) What groups are at the highest risk for prostate cancer? a) European American men with no family history b) European American men with family history c) African American men with family history d) African American men with no family history

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ANSWERS 1) B 2) C
Chapter 5- Sexual Arousal and Response Describe the role of vision in sexual arousal. Visual cues can be sexual turn-ons, in a variety of different ways and forms. Although both men and women can be sexually aroused by porn- men are more interested in them. Describe the role of smell in sexual arousal and discuss the research on the influence of pheromones on human and other animal behavior. Smell plays a lesser role in governing sexual arousal in human than in lower mammals, odors can be sexual turn-ons or turn-offs. Most Westerners, and the Egyptians, prefer their lovers to be clean and fresh smelling. The ancient Romans had similar tastes. Some cultures find underarm or genital as aphrodisiacs. Smell may also indicate preference of sexual partners. In one study it was found that gay men preferred the axillary odors of gay men over heterosexuals or lesbians. This same study found that lesbians and heterosexuals preferred the axillary odors of heterosexual men and lesbians to that of gay men. Define erogenous zones and identify their locations. Erogenous zones are parts of the body that are especially sensitive to tactile sexual stimulation (strokes or other caresses). Primary erogenous zones are erotically sensitive because they are richly endowed with nerve endings. Primary erogenous zones include the genitals, inner thighs, perineum, butt, anus, and breasts (esp nipples), ears (esp ear lobes), mouth, lips, tongue, navel, and armpits. Secondary erogenous zones are areas of the body that become eroticized through association with sexual stimulation, or experience. Ex: A woman may start to associate a shoulder massage with sex, because her lover always massages her shoulders before sex. The brain is sometimes referred to as the primary sexual organ because some have stated that they can reach orgasm through fantasy alone. The brain, however, is not an erogenous zone because it is not stimulated by touch. Compare and contrast the roles each of the five senses play in sexual arousal. Refer to last three examples for sight, smell, and touch. Taste seems to play a minor role in sexual arousal and response. Some people are aroused by the taste of genital secretions, and others arent. People may learn to become aroused by these tastes, if we associate them with sexual pleasure. Hearing- sounds can be turn-ons or turn-offs. For some people, key words or vocal intonations may become as arousing as direct stimulation of an erogenous zone. Many people are aroused by their lovers talking dirty to them. Music can also contribute to sexual arousal, or if the wrong music can be seen as a turn-off. Summarize the research on substances that have aphrodisiac properties. Aphrodisiacs are substances that arouse or increase the capacity for sexual pleasure or response. Spanish fly- taken from a Spanish beetle- has been found to toxic, not an aphrodisiac. Spanish Fly, though, may cure warts. Spanish fly inflames the urethra, producing a burning sensation that is sometimes misinterpreted as sexual feelings. Any sexual arousal from aphrodisiacs may be a result of the placebo effect.

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Foods that resemble male genitals, oysters, clams, bulls testicles, tomatoes, have been considered aphrodisiacs. As well as phallic items such as celery stalks and bananas. Even ground up rhino, reindeer, and elephant horns have been considered aphrodisiacs. But none of these have been shown to be sexually stimulating. Some drugs, though, have been found to be effective aphrodisiacs. Arginine, aa extracted from the African yohimbe tree, stimulates blood flow to the genitals. Amyl nitrate, in the form of poppers or snappers, have been used to heighten sensation of arousal and orgasm by dilating blood vessels in the brain and the genitals. This produces a sense of warmth in the pelvis and possibly facilitating erection and prolonging orgasm. This drug can also reduce heart pain (angina) in cardiac patients. Viagra was originally developed to treat angina, because it increases blood flow to the heart, but it also dilates blood vessels in the genital organs- vasocongestion and erection- and according to some reports- sexual response in women as well. Certain drugs appear to have direct aphrodisiacal effects, because they act on the brain mechanisms controlling the sex drive. Drugs that affect the NT dopamine (Wellbutrin, L-dopa) can increase sex drive. The most potent chemical aphrodisiac may be the naturally occurring substance testosterone. It is the basic fuel of sexual desire in males and females. Regular exercise can also increase sex drive. As well as proper diet. Identify the major psychoactive drugs and explain their psychological and physical effects on sexual arousal. Alcohol- sm amts are stimulating, but large amounts curb sexual response- due to the fact that alcohol reduces cns activity. Alcohol may be liberating, though, because people can blame the alcohol for their sexual actions. Binge drinking is associated with high-risk behavior- such as sexual assault and sexual promiscuity. Hallucinogenics- no evidence that pot or other hallucinogenic drugs dir stim sex response. Some users, though, report heightened sensation while high and this can lead to more sexual responsiveness. Stimulants- Amphetamines (speed, uppers, etc)- these drugs generally do not have an effect on sexual responsiveness- and in large doses can increase irritability, loss of appetite, restlessness, and hallucinations. Cocaine- there is evidence that cocaine enhances sexual arousal in both males and females by increasing levels of the neurotransmitter dopamine. Identify the parts of the cerebral cortex and the limbic system that play roles in sexual arousal and sexual behavior. Cells in the cerebral cortex fire when we experience sexual thoughts, etc, and then other cells in the cerebral cortex interpret these signals as sexual turn-ons or turn-offs. These cells in turn send messages through the spinal cord that send blood rushing to the genitals- causing erection or vaginal lubrication. The limbic system has been found in animals to play a very key part in sexual arousal. Some animals that had limbic system damage, experienced persistent sexual behaviors- such as masturbation. Electrical stimulation of the hippocampus and septum of the limbic system can produce erections in laboratory monkeys. Electrical stimulation of a pathway in the thalamus produced seminal discharge without erection. These areas may also induce ejaculation. Summarize the research on the role of sex hormones in sexual orientation and interest in men and women. Testosterone was found to be a governing factor in male rats in sexual desire. Those rates who had no testosterone did not experience sexual arousal, but when injected with testosterone they exhibited normal behavior. Male fetuses and newborns usually have more testosterone in their blood systems than female fetuses and newborns. This may lead to organizing the brain in the masculine or feminine direction. Prenatal sex hormones are known to play a role in the sexual differentiation of the genitalia and of the brain structures, such as the hypothalamus. But their role in patterning sexual behavior in adulthood remains unknown, however. Some researchers have speculated that the brains of transsexuals may have been prenatally sexually differentiated in one direction, while their genitals were being differentiated in the other. It has also been speculated that prenatal sexual differentiation of the brain may also be connected with sexual orientation. Testosterone has been shown to be the activating factor in the sex drives of both men and women.

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Declines in testorone have been linked in men to a decrease in sexual desire. This has been found in men who were castrated. They gradually tend to lose their capacity to attain erection and to ejaculate. But some continue to experience sexual desires and are able to function sexually for years, even decades. Those men who were castrated before they had any sexual experience seem to exhibit little or no interest in sex. Also, hypogonadal men (men who have abnormally low levels of testosterone production) generally show a loss of sexual desire and a decline in sexual activity. When these men receive testosterone injections, their sex drive, fantasies, and activity are often restored to former levels. One research also found that testosterone levels predicted sexual interest, masturbation rates, and the likelihood of engaging in sexual intercourse among teenage boys. Female sex hormones estrogen and progesterone play prominent roles in promoting the changes that occur during puberty and in regulating the menstrual cycle. But, female sex hormones do not seem to play a direct role in determining sexual motivation or response in human females. Women have shown to be more sensitive to smaller amounts of androgens as compared to men. Women who have ovariectomies- no longer produce Female hormones- but they usually cont to experience a sex drive and interest in sex as before. But, women whose adrenal glands and ovaries were removed, so they no longer produced androgens, gradually lost sexual desire. Name the four phases and describe the changes associated with each phase of sexual response cycle proposed by Masters and Johnson. The sequences of changes in the body that takes place as men and women become progressively more aroused is referred to as the sexual response cycle. Masters and Johnson divided the sexual response cycle into four phases: Excitement, Plateau, Orgasm, and Resolution Phases. Excitement Phase: In men, erection, scrotal skin thickening, testes increase in size, and the testes and the scrotum become elevated. In women: vaginal lubrication occurs, as well as vasocongestion of the clitoris and labia majora- and an increase in size of the labia minora. The vaginal walls thicken, and turn a deeper hue. The uterus also becomes engorged and elevated. Both sexes may experience a sex flush, but it is more pronounced in women. Both sexes show an increase in myotonia, HR, and blood pressure. Plateau Phase: Sexual arousal remains constant in this stage. Men show a slight increase in the circumference of the coronal ridge of the penis. The glans also turns a purplish hue. Cowpers gland may also secrete a few droplets of fluid that are found at the tip of the penis. IN women vasocongestion swells the tissue of the outer third of the vagina, contracting the vaginal opening and building the orgasmic platform. The inner part of the vagina expands fully. The clitoris also withdraws beneath he clitoral hood and shortens. Coloration of the labia majora also occurs- sex skin. Breathing becomes rapid, and HR continues to increase. Orgasmic Phase: IN men- this consists of two stages of muscular contraction. 1-contractions of vas deferens, the seminal vesicles, the ejaculatory duct, and the prostate gland cause seminal flue to accommodate the fluid. The collection of semen in the urethral bulb produces feelings of ejaculatory inevitability- the sensation that nothing will stop ejaculation. During the second stage- the external sphincter of the bladder relaxes, allowing the passage of semen. Contractions of the muscle surrounding the urethra and urethral bulb and the base of the penis propel the ejaculate through the urethra and out of the body. In women- it is manifested in 3-15 muscle contractions of the pelvic muscles that surround the vaginal barrel. The uterus and anal sphincter also contract rhythmically. Female ejaculation may or may not occur. Both sexes, muscles go into spasm through the body. BP, HR, and resp reach a peak. Resolution Phase: The body returns to its prearoused state. Man looses erection. Release of blood from engorged areas. During this time, men enter into a refractory period- a period in which they are physiologically incapable of gaining an erection. Women do not enter this period- and if stimulated can continue to have orgasms. Compare Kaplans three-stage model of sexual arousal with Masters and Johnsons four-phase model. Kaplans model is based mainly on sexual dysfunction. This three stage model is composed of desire, excitement, and orgasm. These stages do not have to be in a spec order, as Masters and Johnsons model has a very specific and unvarying order. Lack of excitement may consist of problems with erection, or probs with lubrication in the female. Summarize the research on the female and male capacity for multiple orgasms.

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Kinsey reported that 14 percent of female respondents regularly had multiple orgasms. Masters and Johnson found that most, if not all, women are capable of multiple orgasms. Men, though, due to the refractory period are not capable of multiple orgasms. The differential capacity for multiple orgasms is one of the major sex differences in sexual response. Evaluate the research concerning the types of orgasms women and men experience. Masters and Johnson found that men and women seem to have only one type of orgasm, regardless of how that orgasms is achieved (coitus, clitoral stimulation, breast stimulation, etc). Other researchers, though, say that there are different types of female orgasmsSinger and Singer propose that there are three types: vulval (sim to the ones that Masters and Johnson found), uterine (does not involve vulval contractions- it occurs only in response to deep penile thrusting against the cervix- this is also associated with the holding of breath), and blended (combines features of the previous two). Running Glossary Key Terms: Anaphrodisiacs- Drugs or other agents with effects that are antagonistic to sexual arousal or sexual desire. Examples includetranquilizers, cns depressants (barbiturates), nicotine. Antiandrogen- A substance that decreases the levels of androgens in the bloodstream. These drugs are often used in the treatment of deviant behavior patterns such as sexual violence and sexual interest in children- with promising results. Aphrodisiac- any drug or other agent that is sexually arousing or increases sexual desire. Grafenberg spot- the G spot. A bean shaped area in the anterior front wall of the vagina that may have special erotic significance. This spot also may induce ejaculation in a female. Hypogonadism- An abnormal condition marked by abnormally low levels of testosterone production. Hypothalamus Multiple Orgasms- One or more additional orgasms following the first, which occur within a short period of time and before the body has returned to a preplateau level of arousal. Myotonia- Muscle tension that causes voluntary and involuntary muscle contractions, which produce facial grimaces, spasms in the hands and the feet, and eventually the spasms of orgasm. Orgasmic platform- The thickening of the walls of the outer third of the vagina, resulting from vasocongestion, that occurs during the platua phase of the sexual response cycle. Ovariectomy- Surgical removal of the ovaries. Pheromones- Chemical substances secreted externally by certain animals that convey info to, or produce spec responses in, other members of the same species. Lower animals use pheromones to stim sex response, organize food gathering, maintain pecking orders, sound alarms, and mark territories. Pheromones induce mating behavior in insects (bees). Pheromones can also lead to the synchronization of female menstrual cycles who are exposed to each other on a regular basis. Infants use pheromones to recognize their mothers. Secondary sex characteristics- Physical traits that differentiate males from females but are not directly involved in reproduction. Sex flush- A reddish rash that appears on the chest or breasts late during the excitement phase of the sexual response cycle. Sex skin- Reddening of the labia minora that occurs during the platua phase. Sexual response cycle- Masters and Johnsons model of sexual response, which consists of four phases. Transsexual- A person who feels that he or she is really a member of the other sex and is trapped in the body of the wrong sex.

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Vasocongestion- the swelling of the genital tissues with blood, which causes erection of the penis and engorgement of the area surround the vaginal opening.

When does orgasmic platform occur? a- The excitement phase b-The platue phase c-The orgasmic phase d-The resolution phase When does sex skin occur? a- The excitement phase b- The plateau phase c- The orgasmic phase d- The resolution phase

25

B,B

26

Chapter 6 1. Trace the influences of sex chromosomes and hormones on prenatal sexual differentiation brain and body anatomy. pp. 171-175 The 23rd pair of chromosomes defines what the sex will be of the zygote. The ovum automatically is giving an X to the genome of the zygote. The father (sperm) is responsible for the sex of the zygote. If the sperm is carrying an X, the zygote will normally develop as a female. If the sperm is carrying a Y, the zygote will normally develop as a male. The chance of either happening is 50:50. SRY is also one of the molecules involved in sex determination in humans. It ds to DNA and distorts it. This distortment alters the properties of the DNA and leads to the formation of the testes. Testosterone, the most important androgen also has a big role in sex development. This androgen spurs differentiation of the male (Wolffian) duct system. Each Wolffian duct develops into an epididymis vas deferens, and seminal vesicle. 2. Define gender identity and gender dysphoria and discuss the research relevant to the genetic vs. socialized determination of gender identity. pp. 175-178 Gender identity is ones belief that one is male or female. Gender dysphoria is a sense of incongruity between ones anatomic sex and ones gender identity. There is a controversy that has been going on for an extended period of time whether the sex of an individual is neutral in pregnancy or is determined from there on. The few cases described in the text book are ones of boys who experience circumcision accidents when they were born, and then went under surgery to become females, and were raised as females. All of these studies pointed in the same direction. When the girls (XY) were in their twenties, they were interviewed and said that they didnt feel like they were girls. Most of them reverted back to being boys, most likely because of the testosterone. Researchers believe that the brain is influenced by the pre-natal exposure of testosterone. 3. Define hermaphroditism, intersexualism and transsexualism. Discuss the theoretical transsexualism and describe the techniques and limitations of gender-reassignment 175-183 A hermaphrodite is a person who possesses both ovarian and testicular tissue. An intersexual is a person who possesses the gonads of one sex but external genitalia that are ambiguous or typical of the other sex. A transsexual is a person who has a strong desire to be of the other sex and live as a person of the other sex. Many transsexuals undergo hormone treatments and surgery to create the appearance of the external genitals typical of the other sex. It can be done more precisely with male-to-female than female-to-male transsexuals. After surgery people can participate in sexual activity and even attain orgasm. The minus is that they cannot bear children. 4. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter) a. Without male sex hormones, or androgens, we would all develop female external reproductive organs. However, Mullerian inhibiting substance (MIS) prevents the formation of a number of female internal reproductive organs. b. 17 out of 18 boys who appeared to have female external sex organs suddenly developed male sex organs at puberty, when male sex hormones went to work. These boys were diagnosed with Dominican Republic syndrome, a genetic enzyme disorder that prevents testosterone form masculinizing the external genitals. c. The sex of the crocodile is determined by the temperature at which the eggs develop. Sex-reassignment surgery cannot implant the internal reproductive organs of the other gender. Therefore, it is not accurate to say that people have actually changed their sexes through sex-reassignment surgery. Instead, surgery creates the appearance of the external genitals typical of the other sex. d. Males tend to behave more aggressively than females do. In almost all cultures, it is the males who march off to war, and who battle for fame. 27

5. Complete the definitions of the items in the Running Glossary Section listed in the below. SEE BELOW 6. Describe the main topics in the A Closer Look Sections within the chapter. p. 180 The main gist of this article is that its about Dr. Jayne Thomas, who appears to be female but tells a story about how she lived a good portion of her life as a male. She says that the two sexes are seen always to be so dissimilar but also according to her, have many similarities. She saw a lot of the differences of being a male and a female because shes honestly lived two lives, and has experienced what its like to be a person who has GID. (Gender Identity Disorder) Vocabulary: Androgen insensitivity syndrome- another type of intersexualism. There are varieties of this. One involves genetic males who, due to a mutated gene, have lower than normal prenatal sensitivity to androgens. As a result, their genitals do not become normally masculinized. Partial androgen insensitivity syndrome happens with females. It occurs in girls with a single X sex chromosome and in girls with XX chromosomal structures who lose some X sex chromosome material. They develop typical external genital organs, but their internal reproductive organs do not develop or function normally. Gender identity- psychological awareness or sense of being a male or being a female. It is just obvious and important aspects of our self-concepts. Testosterone-the most important androgen which spurs differentiation of the male (Wolffian) duct system. Androgens-male sex hormones, that promote the growth of male genitalia. Autogynephilic- males who are sexually stimulated by fantasies of their own bodies as being female. Chromosome a piece of genetic material found inside the nucleus of the cell. 23 of these are inherited from each parent. Congenital adrenal hyperplasia- the most common form of female intersexualism. This happens when a genetic female has female internal sexual structures (ovaries), but masculinized external genitals. Cryptorchidism where one or both of the testes remain undescended in the male. They remain in the abdomen at birth. Dominican Republic syndrome- a form of intersexualism that was first documented in a group of 18 boys in two villages in the Dominican Republic. This is a genetic enzyme disorder that prevents testosterone from masculinizing the external genitalia. These boys are born with normal testes and internal male reproductive organs, but their external genitals are malformed. Embryo the unborn child at about 5-6 weeks of gestation. At this point it is only about to long, and has primitive gonads, ducts, and external genitals. Gender- the psychological state of being female or being male, as influenced by cultural concepts of gender-appropriate behavior. Gender dysphoria- an experience of incongruity between a persons genital anatomy and their gender identity or role. Hermaphrodites- named after the Greek myth, son of Hermes and Aphrodite, whose body became united with that of a nymph while he was bathing. True hermaphrodites may have one gonad of each sex ( a testicle and an ovary), or gonads that combine testicular and ovarian tissue. Sexual differentiation-the process by which males and females develop distinct reproductive anatomy. Klinefelter's syndrome- a condition that affects 1/500 males. It is caused by an extra X chromosome, so the man has an XXY rather than an XY pattern. These men fail to develop appropriate secondary sex characteristics. 28

Inguinal canal-a passageway where after four months after conception, the testes descend to the scrotal sack. Homosexual transsexuals- men who are extremely feminine gays and not fully satisfied by sexual activity with other males. Zygote- the beginning of a new human being. It only is about 1/175 inches long. At this stage, the organisms uniqueness is already determined. Intersexual- individuals who possess the gonads of one sex but external genitalia that are ambiguous or typical of the other sex. Identification-ones belief in being male or female. Transsexuals- transgendered people. Transsexualism is a condition in which the individual wishes to possess the anatomical features of people of the other sex and to live as a person of the other sex. Sex assignment- also called gender assignment, reflects the childs anatomic sex and usually occurs at birth. Phalloplasty- an operation done to female-to-male transsexuals. Usually this is to construct an artificial penis that doesnt work too well.

1. A document describes a genetic enzyme disorder that prevents testosterone from masculinizing the external genitalia. Boys with this disorder are born with normal testes and internal male reproductive organs, but their external genitals were malformed. What syndrome is this? a. Kleinfelters Syndrome b. Domincan Republic Syndrome c. Congenital adrenal hyperplasia d. Gynecomastia 2. It has been documented that transsexuals often experience a feeling that is described as a sense of incongruity between ones anatomic sex and ones gender identity. This is called what? a. Sexual identity b. Gender dysphoria c. Inconsistency d. Confusion

1. B, 2. B 29

Chapter 9: SEXUAL TECHNIQUES AND BEHAVIOR PATTERNS

1) Summarize historical-medical and religious views on masturbation . pp. 263-266 Religious In Latin masturbation means hand and to defile. Early Judeo-Christians strongly condemned masturbation as sinful and referred to it as onanism, which is taken from the biblical story of Onan. The moral of this story is that nonprocreative sexual acts are sinful. Other people of ancient times condemned non-procreative sexual practices because of the need for an increase in their population. Medical In the medical field in the 18th century Benjamin Rush believed that masturbation caused tuberculosis, nervous diseases, poor eyesight, memory loss, and epilepsy. In the 19th century clergy and medical authorities thought certain foods had a stimulating effect on sex organs. They advised parents to eliminate foods that were believed to excite sexual organs, such as meat, coffee, tea, and chocolate. Reverend Slyvester Graham developed a cracker, called the Graham Cracker to help people control their sexual impulses. A man introduced a bland diet that was intended to help people, especially youngsters, control sexual impulses. Dr. J.H. Kellogg, creator of the cereal, identified 39 signs of masturbation including acne, paleness, heart palpitations, rounded shoulders, weak back, and convulsions. Kellogg and Graham believed sexual desires could be controlled by simple foods like grain, hence Corn Flakes. In 19 th century many physicians advised parents to take measures to prevent their children from masturbating, it was suggested for parents to bandage or cage their childrens genitals or tie their hands. 19th century scholars, such as Richard von Krafft-Ebring and Havelock Ellis, condensed masturbation as psychologically dangerous. Krafft-Ebring linked masturbation to sexual orientation. Male masturbation was believed to arrest the development of normal erotic instincts and led to impotence with women. Impotence is the recurrent difficulty in achieving or sustaining an erection sufficient to engage in sexual intercourse successfully. Despite this history, there is no scientific evidence that masturbation is harmful. In Indian society it is believed that masturbation leads to sexual impotence. 2) Cite the incidence of masturbation and describe the techniques used by males and females. pp. 266-269 - Today it appears that people are starting to masturbate at younger ages. Generally, it is more common in males than females. - Married people are less likely to masturbate, though 57% of married men and 37% woman report having masturbated in the last year. - People with more education (both men and woman) masturbate more frequently. - African Americans are the least likely to masturbate than any other ethnicity. Traditional religious beliefs appear to restrain masturbation. Most men report that they masturbate by manual manipulation of the penis. Men tend to grip the penile shaft with one hand, jerking it up and down in a milking motion. Some men move two fingers, generally the thumb and index finger. Men usually shift from a gentler rubbing action during the semi-erect state of arousal to a more vigorous milking motion once full erection takes place. Their grip tightens and their motions speed up as orgasm nears. Some men use soap suds as lubricant which can be irritating. Other lubricants, like petroleum jelly or K-Y jelly are less irritating and reduce friction. A few men prefer to masturbate by rubbing their penis against clothing, inflatable dolls having artificial vaginas. Some men strap vibrators to the backs of their hands. Most men rely heavily on erotic photos or videos, but do not use sex-shop devices. Masters and Johnson reported never observing two women masturbate, in precisely the same way. Some general trends have been noted. Most women masturbate by massaging the mons, labia minora, and clitoral region with circular or back and forth motions. They may also straddle the clitoris with their fingers, stroking the shaft rather than the glans. The glans may be lightly touched early during arousal. Women typically achieve clitoral stimulation by rubbing or stroking the clitoral shaft or pulling or tugging on the vaginal lips. Some women massage their sensitive areas such as their breasts or nipples with the free hand. Kinsey and colleagues found that only one in five women inserted objects into the vagina during masturbation. Sex shops sell dildos, penis-shaped vibrators. Many women masturbate during baths, and some spray their genitals with shower heads. 3) Explain the function and prevalence of sexual fantasy in males and females and the role fantasy plays in arousal and masturbation. pp. 270-271 People use sexual fantasies when they are alone or to heighten sexual excitement with a partner. Masturbators often require sexual fantasy or other erotica to reach orgasm. One study showed that 84% of a University population has sexual fantasies while having sex. Research suggests that sexual fantasies are normal in that most people have them (at least within our culture), where men have more fantasies than women. Fantasies are more common among people in long lasting relationships. Women are more likely to fantasize about prior sex partners than men. And 52% of men vs.

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40% of women are more likely to think its acceptable to fantasize about someone besides their partner. A high 98% of men and 80% of women reported sexual fantasies about someone other than their sex partner. Males are more likely to fantasize about forcing women into sex and women are more likely to fantasize about being victimized. Some people have deviant sexual fantasies, such as sadistic rape fantasies. While this thought is troublesome, there is no connection between our fantasy lives and our actual lives. 4) Describe common foreplay techniques, such as kissing, breast and genital stimulation. pp. 272-276 Foreplay is described as any non-coital sex and includes kissing, touching, breast and genital stimulation. Kissing is almost universal in our culture, but will occur least often among other cultures of the world. There are many styles of kissing in different cultures. Kissing may be done for its own enjoyment, to show affection without erotic significance (kissing your mom) and as a prelude to sex, in which case it is foreplay. There are two kinds of kissing: simple, where the mouths remain closed and deep (French kissing). Other parts of the body are often kissed as a part of foreplay. Touching of erogenous zones can be highly arousing. Men typically prefer direct stroking of their genitals by their partners early in lovemaking, whereas women prefer that their partner caress their genitals after a period of general body contact of non-genital massage. Women also prefer cuddling and petting as foreplay more than men. Genital Stimulation: Both men and women prefer manual or oral stimulation of the genitals prior to intercourse. Women most often do not like direct stimulation of the highly sensitive clitoral glans and not all like to have men finger them as a form of foreplay. Women generally want their partner to approach genital stimulation gradually, following stimulation of other body parts. Stimulation may begin at the inner thigh, move to the labia and then on to the clitoral area. A dry clitoris quickly becomes irritable and it may be necessary for the partner to provide natural lube by inserting their finger into the vagina, and then apply it to the clitoris. To stimulate male genitalia, the partner may use one hand to stimulate his scrotum and the other to stroke the penis in an up and down fashion. Some men prefer dirty talk to heighten their arousal. Breast Stimulation: The breasts are erotically sensitive in both sexes, but men are more likely to stimulate womens breasts than vice versa. Most women enjoy having their breasts fondled. Gay men stimulate their partners nipples more than any other group. Hetero men do not enjoy it or are unaware that their breasts are sexually sensitive. Manual genital stimulation is the most common and frequent sexual activity among lesbian couples. Like gay males, lesbians spend a lot of time caressing before approaching the breasts and genitalia. And like hetero women, lesbians are less genitally oriented and less fixated on orgasm than men and prefer outer vaginal stimulation and less deep penetration. 5) Describe fellatio and cunnilingus techniques and state how widely they are practiced among specific populations. pp. 277-278 Oral-genital stimulation has increased significantly in popularity since Kinseys day (~1950). Kinsey found that the higher level of education a person had, the more likely they had engaged in oral sex (like masturbation). Also, European Americans were the most likely ethnic group to engage in oral sex and African Americans were the least likely to do so. Fellatio means to suck, but this is not always the most stimulating. Men prefer up and down movements of the mouth and licking of the frenulum or scrotum. The speed of motions can vary greatly. Manual stimulation near the base of the penis can also be stimulating. Teeth should never be used other than the most gentle scraping that has been previously approved by the male. Cunnilingus provides such intense stimulation that many women find it to be the best means for achieving orgasm. Unlike a dry finger, the tongue can never be used to harshly and its soft, warm, well lubricated surface make for a more desirable stimulation. The partner should start by licking the abdomen and working their way down to the vulva. Gentle tugging or sucking of the labia minora can be stimulating, but the partner should take care not to bite. 6) Summarize findings on the incidence of oral sex and sexual permissiveness by education and race/ethnicity. p. 277 Statistics from #5. The incidence of oral sex correlates with level of education. More highly educated individuals are more likely to have practiced oral sex. African American men and women were less likely to have engaged in oral sex than people from other racial/ethnic backgrounds. From a national survey of more than 3,000 sexually active men between the age of 20 and 39 conducted by the Battelle Human Affairs Research Center in Seattle are consistent with the NHSLS findings. 75% of men reported performing oral sex. 79% reported receiving oral sex. African American men in the Batelle survey were less likely than their European Americans to have performed or received oral sex. 7) Cite reasons people give for abstaining from oral sex. pp. 278-280 Some people view the genitals as dirty because of the proximity to the urinary and anal openings. These people object on the grounds of cleanliness. Others refrain because they are disturbed by the offensive odors. Some prefer not

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to taste or swallow semen because they find it to be dirty, sinful, or repulsive. Others are put off by taste and texture. A college survey found that the two most frequent reasons to refrain were shyness and embarrassment 8) List the four basic intercourse positions and the advantages and disadvantages of each. pp. 280-284 1. The Male-Superior (Man on Top or Missionary) Position: Advantages- The couple faces each other so that kissing is easier. The woman can stroke his buttocks and cup the scrotum to increase stimulation as he reaches orgasm. Disadvantages- It is difficult for the man to caress his partner while also supporting himself with his hands (bad for women who like clitoral stimulation too). It can be highly stimulating for a man leading to premature ejaculation. It also limits the control of the woman (angle, rate and depth of penetration), making it difficult for her to achieve orgasm. This position is not suitable for pregnant women as the distended abdomen forces the man to arch above her. 2. The Female-Superior (woman on top) Position: Advantages- Kissing is easy. The man can reach the womans clitoris, breasts and buttocks for manual stimulation. The woman is in control and can guarantee her adequate clitoral stimulation to reach orgasm. Because this is less stimulating for the man, it can help control ejaculation (this can also be a disadvantage). Disadvantages- None listed. 3. The Lateral-Entry Position: Advantages- Since the couple is lying down side by side, facing one another; both partners have relatively free movement and easy access to each other. The position is not physically taxing as both partners rest easy on the bedding. This is an useful position during pregnancy. Disadvantages- Inserting the penis may be awkward. An underlying arm may become numb from constricted blood supply. Women may not receive adequate clitoral stimulation from the penis. It may be difficult to achieve deep penetration of the penis. 4. The Rear-Entry (doggy-style) Position: Advantages- This can be highly stimulating for both partners. Men may enjoy viewing and pressing into the buttocks. The man can reach around and stimulate the breasts or clitoris. Women can reach back and stimulate the scrotum. Disadvantages- Some couples feel uncomfortable using a style associated with animal mating positions. The position is impersonal in that the partners dont face each other, creating emotional distance. It is a male dominant position. Physically, the penis does not adequately stimulate the clitoris. The penis tends to pop out of the vagina. Air tends to enter the vagina during this position and when it is expelled, it can be mistaken for flatulence and can be embarrassing (though harmless). 9) Describe the incidence and frequency of fantasy during coitus and the effects of fantasy on relationships. p. 284 As with masturbation, mental excursions into fantasy during coitus may be used to enhance sexual arousal and response. Most married people (men and women) engaged in coital fantasies and a great majority of staff and students at Vermont College reported fantasizing during sex. Coital fantasies are as diverse as masturbation fantasies. Coital fantasies allow couples to inject sexual variety without being unfaithful. There does not appear to be any connection between sexual dissatisfaction with ones relationship and coital fantasies. 10) Discuss who engages in anal intercourse and the necessary precautions to take. pp. 284-285 Anal sex is practiced by male-female and male-male couples. Like masturbation and oral sex, there is a higher incidence of anal sex among more highly educated people (perhaps education is a liberating influence of sexual experimentation). Those that reported being religious were less likely to engage in anal sex. Anal sex carries a serious health risk and thus precautions should be taken. During penetration, small tears in rectal tissues may allow microbes to enter the recipients blood stream. In class we learned that these microbes can also enter the vagina and cause similar problems. Rectal microorganisms can cause STDs such as gonorrhea, syphilis, hepatitis and HIV. Partners who are both infection-free have no risk of contracting STDs through any sexual act. We also learned in class that condoms are to be used to prevent any infectious spread. 11) Differentiate the items in the chapter truth? Fiction section. Truth or Fiction 1. FALSE: Married people rarely if ever masturbate. Majority of married men and minority of married women report masturbating at least occasionally.

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2. 3. 4. 5. 6. 7. 8. 9. 10.

TRUE: European American Men are more likely to masturbate than African American Men. Maybe African American men are more likely to adhere to traditional views concerning masturbation. FALSE: Women who masturbate during adolescence are less likely to find gratification in marital coitus than women who did not. they are more likely to find gratification TRUE: Women are more likely to reach orgasm through sexual intercourse than through masturbation. FALSE: Most women masturbate by inserting a finger or other object into the vagina. clitoral stimulation FALSE: Heterosexual people do not fantasize about sexual activity with people of their own gender. People do not express fantasies in their behavior necessarily. TRUE: Statistically speaking, oral sex is the norm for todays young married couples. FALSE: African Americans are more likely then European Americans to engage in oral sex. opposite is more than likely the case FALSE: When lovers fantasize about other people, their relationship is in trouble . FALSE: Anal sex is more common among less educated people. Less common among less educated people, maybe education is a liberating experience and influences sexual experimentation.

12) Complete the definitions of the items in the running glossary sections listed in the key terms list 1. 2. 3. 4. 5. 6. 7. 8. 9. masturbation: sexual self stimulation dildo: a penis shaped object used in sexual activity coitus interrupts: practice of withdrawing the penis prior to ejaculation during sexual intercourse impotence: recurrent difficulty in achieving or sustaining erection to engage successfully in sexual intercourse foreplay: physical interactions that are sexually stimulating and set the stage for intercourse fellatio: oral stimulation of male genitals cunnilingus: oral stimulation of female genitals missionary position: coital position in which man is on top (AKA male superior position) anilingus: oral stimulation of the anus

1) Describe the term Fellatio: A) Oral stimulation on men, by up and down movements of the mouth on the penis and licking the frenulum or scrotum B) Provides such intense stimulation that many women find it to be the best means for achieving orgasm C) Is initiated when the partner starts by licking the abdomen and working their way down to the vulva. D) Involves the gentle tugging or sucking of the labia minora can be stimulating, but the partner should take care not to bite. 2) Reasons why people abstaining from oral sex. A) B) C) D) Some people view the genitals as dirty because of the proximity to the urinary and anal openings. Because they are disturbed by the offensive odors. Because people are put off by taste and texture. All of the above

1) A

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2) D

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Chapter Number 10 ~ Sexual Orientation

1. Define sexual orientation and distinguish between sexual orientation and gender identity. pp. 292-294 Sexual Orientation is defined by o Ones erotic attraction to, and interest in developing romantic relationships with, members of ones own or the other sex. Distinguish between o Sexual orientation Not defined by sexual activity per se, but rather by the direction of ones romantic interests and erotic attractions

o Gender identity Majority of gay people have a gender identity that is consistent with their anatomic sex

2. Compare and contrast the Kinsey continuum and Storms two-dimensional model of sexual orientation, including the limitations of both as addressed by Lippa & Arad. Pp. 294-297 Kinsey continuum o Kinsey and his colleagues conceived of a 7-point heterosexual-homosexual continuum that classifies people according to their homosexual behavior and the magnitude of their attraction to members of their own gender. People in category 0, who accounted for most of Kinseys study participants, were considered exclusively heterosexual. People in category 6 were considered exclusively homosexual. o Bisexual individuals would be less responsive to stimulation by people of the other sex than heterosexual people are, but more responsive to stimulation by people of their own sex o Limitations as addressed by Lippa & Arad Men seemed largely to fit the Kinsey model in that they showed a bipolar sexual orientation That is, the more aroused they were by women, the less they were aroused by men, and vice versa

Storms two dimension model of sexual orientation o Separate dimensions of responsiveness to male-female sexual stimulation (heteroeroticism) and sexual stimulation that involves someone of the same sex (homoeroticism) 35

o Bisexuals are high on both dimensions, whereas people who are low on both are essential asexual o Limitations as addressed by Lippa & Arad May hold only for women Womens sexual orientations are more flexible than mens and apparently more intertwined with their social experience

3. Discuss the various definitions and societal views of bisexuality. Pp. 297-299 Definitions and Societal views of bisexuality o Bi-gay Some have a stronger leaning toward people of their own sex

o Bi-straight o Bi-bi Still others appear to be equally attracted to people of their own sex and of the other sex Some are more attracted to people of the other sex

o Some gays and some heterosexuals believe That claims to bisexuality are a copout that people use to deny being gay

o Biphobia Hatred of bisexuals, found in both homosexual and heterosexual populations

o Some gay people mask their sexual orientation by adopting a bisexual lifestyle. 4. Examine Western culture's historical and religious perspectives on gay male and lesbian sexual orientations. pp. 299-301 Western cultures historical and religious perspectives o Few sexual practices have met with such widespread censure as sexual activities with members of ones own sex. o Ancient Greece Men frequently formed sexual relationships with adolescent males

o Romans

36

Described highly feminine gay men who dressed flamboyantly, had showy hair styles and mannerisms, and cruised certain neighborhoods, searching for partners

o 15th Century Florence Reputed to house numerous sodomites (Jews and Christians have traditionally referred to male-male sexual activity as the sin of Sodom).

o The Book of Leviticus was also clear in its condemnation If a man lies with a man as with a women, both of them have committed an abomination; they shall be put to death, their blood is upon them

o Most civil statutes throughout Western Europe contained penalties for Nonprocreative sexual acts involving the discharge of semen, including oral or anal sex, masturbation, male-male sexual behavior, and bestiality

5. Describe the incidence of and societal reaction to gay male and lesbian sexual orientations and behaviors across cultures and ethnicities. pp. 301-302 Incidence of gay male and lesbian sexual orientations o 49 of 76 preliterate societies, male-male sexual interactions were viewed as normal and deemed socially acceptable for some members of the group o 27 of 76 preliterate societies, had sanctions against male-male sexual behavior Societal reaction to gay male and lesbian sexual orientations o In some societies, sexual activities are acceptable between older and younger males or between adolescents, but not between adult men. o Negative attitudes toward gay people have pervaded our society o 59% of American adults believe that homosexuality is morally wrong, compared to 35% who say it is not wrong. Behaviors across cultures and ethnicities o Among Sambian people of New Guinea, 7- to 10-year-old males leave their parents houses to undergo sexual rites of passage. Ingestion of semen is believed to give rise to puberty. In their late teens or early twenties, however, young men are expected to take brides and enter into exclusively male-female sexual relationships 6. Define and categorize forms and cultural expressions of homophobia. Pp. 305-306 Forms and cultural expressions of homophobia o Derives from root words meaning fear of homosexuals. 37

o Forms Use of derogatory names (such as queer, faggot, and dyke) Telling disparaging queer jokes Barring gay people from housing, employment, or social opportunities Taunting (verbal abuse) Gay bashing (physical abuse)

o People who have a strong stake in maintaining stereotypical gender roles may feel more readily threatened by the existence of the gay male or lesbian sexual orientation, because gay people appear to confuse or reverse those roles. 7. Describe legislative and gay activist initiatives to combat discrimination against the nonheterosexual community and to disseminate information about HIV infection. pp. 306-308 Legislative and gay activist initiatives to combat discrimination against the nonheterosexual community o Gay people have organized effective political groups to fight discrimination and to overturn the sodomy laws that have traditionally targeted them o A 1986 Supreme Court decision (Hardwick v. Bowers) let stand a Georgia sodomy law that makes oral-genital or anal-genital sexual contact crimes punishable by up to 20 years in prison, even when engaged in by consenting adults. However, in 2003, by a vote of 6 to 3, the Supreme Court reversed that decision by striking down a Texas law against deviate sexual intercourse with another individual of the same sex. Legislative and gay activist initiatives to disseminate information about HIV infection o Organizations combat the HIV/AIDS epidemic on several fronts They lobby for increased funding for HIV/AIDS research and treatment They educate the gay and wider communities about the dangers of high-risk sexual behavior They encourage gay men and others to adopt safer sex practices, including use of condoms They protect the civil rights of people with HIV/AIDS with respect to employment, housing, and medical and dental treatment They provide counseling and support services for people with HIV/AIDS

8. Evaluate contemporary research conclusions on the genetics, sex hormonal influences, prenatal hormonal effects and brain structure differences as they attempt to explain adult sexual orientation. Pp. 310-313 38

Research conclusions on the genetics to explain adult sexual orientation o In a carefully conducted twin study, about 52% of identical twin pairs were found to be concordant (in agreement) for a gay male sexual orientation, compared with 22% of fraternal twins and only 11% of adoptive brothers o Bear in mind that MZ twins are more likely than DZ twins to be dressed alike and treated alike. Thus, their greater concordance for a gay sexual orientation may at least in part reflect environmental factors o A chromosomal region on the X chromosome is suspected to hold a gene that predisposes men to a gay male sexual orientation

Research conclusions on the sex hormonal influences to explain adult sexual orientation o Research has failed to connect sexual orientation in either sex with differences in the levels of either male or female sex hormones in adulthood.

Research conclusions on prenatal hormonal effects to explain adult sexual orientation o The genitals of gay people differentiate prenatally in accord with their chromosomal sex. o However, it remains possible that imbalances in prenatal sex hormones may cause brain tissue to be sexually differentiated in one direction even though the genitals are differentiated in the other.

Research conclusions on brain structure differences to explain adult sexual orientation o A segment of the hypothalamus specifically, the third interstitial nucleus of the anterior hypothalamus in the brains of the gay men was less than half the size of the same segment in the heterosexual men However, we do not know if these structural differences are innate.

9. Evaluate and describe the perspectives of psychoanalytic and learning theories as they explain gay male and lesbian sexual orientations. Pp. 314-315 Perspectives of psychoanalytics and learning theories that explain gay male and lesbian sexual orientations o Sigmund Freud, the originator of psychoanalytic theory, believed that children are naturally open to all forms of sexual stimulation o In Freuds view, a gay male or lesbian sexual orientation results from failure to resolve the Oedipus complex successfully by identifying with the parent of the same sex. o Learning theories People generally repeat pleasurable activities and continue painful ones 39

The overwhelming majority of gay males and lesbians were aware of sexual interest in people of their own sex before they had sexual encounters with them, pleasurable or otherwise

10. Examine the link between early gender nonconformity and other familial influences on later gay male and lesbian sexual orientations. pp. 315-316 Link of early gender nonconformity and other familial influences on later gay male and lesbian sexual orientations o Gender nonconformity Failure to form the gender-role stereotype that is consistent with ones anatomic sex.

o Gender nonconformity begins in childhood. Gay males and lesbians are more likely than heterosexuals to report childhood behavior stereotypical of the other sex. o Lesbians as a group were more likely than heterosexual women to perceive themselves as having been tomboys. They were more likely to have preferred rough-and-tumble games than to play with dolls and enjoyed wearing boys clothing rather than cutesy dresses 11. Summarize the research about the adjustment of gay men and lesbians, the prevalence of those who wish to change their orientation and the relative success of these attempts. pp. 317-321 Adjustment of gay men and lesbians o Carefully controlled studies have found that gay males and lesbians are more likely than heterosexuals to experience feelings of anxiety and depression and that they are prone to suicide. o Gay males, moreover, are more likely to have eating disorders than heterosexual males o It is clear that gay males and lesbians do encounter stress from societal oppression and rejection. It is also clear that the adjustment of gays is connected with conflict over their sexual orientation. Prevalence of those who wish to change their orientation o Some people including some homosexuals still view a gay male or a lesbian sexual orientation as an illness. o The great majority of gay men and lesbians do not seek professional assistance to change their sexual orientations. o Bell and Weinberg (1978) found only a few gay people who were interested in changing their sexual orientation. For such reasons as religious beliefs or the desire to create a typical family life.

Relative success of these attempts 40

o Failure rates of 20% for gay men and 23% for the lesbians treated in a therapy program. o Regardless of peoples changes in sexual behavior, remember that sexual behavior is not the same as sexual orientation. 12. Explain the coming out process. Pp. 321-323 The coming out process o Coming out to oneself Recognizing ones gay male or lesbian sexual orientation The development of sexual identity in gay males and lesbians involves four steps Attraction to members of the same sex Self-labeling as gay or lesbian Sexual contact with members of the same sex Disclosure of ones sexual orientation toother people

o Coming out to others Declaring ones orientation to the world A person typically informs only one or a few select people.

13. Compare the sexual techniques of gay male, lesbian and heterosexual partners. pp. 325-327 Sexual techniques of gay male partners o 84% of gay males report having more than 50 partners in their lifetimes o 79% have sex with strangers o Permissive attitudes toward extracurricular sexual activity than lesbians do o Gay males were more likely than lesbians to cruise in public places, such as gay bars Sexual techniques of lesbian partners o 7% of lesbians report having more than 50 partners in their lifetimes. o 6% have sex with strangers o Lesbians were more likely to find partners among friends, at work, and at informal social gatherings. Sexual techniques of heterosexual partners 41

14. Examine the variations in the lifestyles of gay men and lesbians. p. 327 Lifestyles of gay men o More likely to engage in casual sex with many partners than lesbians o 10% - close couples Lifestyles of lesbians o Lesbians confine their sexual activity to a committed, affection relationship o 28% - close couples 15. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter)
1. T/F - Gay males and lesbians would prefer to be members of the other sex? a. It is not true that gay males and lesbians in general would prefer to be members of the other sex. The gender identity of most homosexuals is consistent with their anatomic sex.

2.

T/F Members of the ethnic minority groups in the United States are more tolerant of homosexuals than are European Americans? a. However, according to psychologist Beverly Greene (2000) of St. Johns University, members of ethnic minority groups in the United States are less tolerant of homosexuals than are European Americans.

3.

T/F Gay males unconsciously fear womens genitals because they associate them with castration? a. Therefore, the idea that castration anxiety in gay males is aroused by knowledge of male-female intercourse has not been scientifically demonstrated

4.

T/F Most Americans would prefer that gay people are allowed to get married to one another? a. The majority of Americans oppose gay marriages

5.

T/F Most Americans believe that gay people are born gay? a. A majority of Americans still believe that gay people choose to be gay

6.

T/F The American Psychiatric Association considers homosexuality to be a mental disorder? a. It is not true that the American Psychiatric Association considers homosexuality to be a mental disorder. The association has not considered a gay male or lesbian sexual orientation to be a mental disorder since 1973.

7.

T/F Many gay couples have lifestyles similar to those of committed heterosexual couples and are as well adjusted? a. It is true that many gay couples have lifestyles similar to those of married heterosexual couples and are as well adjusted. Bell and Weinberg refer to them as close couples.

16. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below.

Running Glossary Key Terms

42

Activating effects o Those effects of sex hormones that influence the level of the sex drive, but not sexual orientation

Dysfunctionals o Bell and Weinbergs term for gay people who live alone and have sexual, social, or psychological problems.

Lesbians o Females who are erotically attracted to, and desire to form romantic relationships with, other females (After Lesbos, the Greek island on which, legend has it, female-female sexual activity was idealized).

Asexuals o Bell and Weinbergs term for gay people who live alone and have few sexual contacts

Femme o A lesbian who assumes a traditional feminine gender role

Monozygotic twins o Twins who develop from the same fertilized ovum. Identical twins.

Biphobia o Negative attitudes and feelings toward bisexual people, including intolerance, hatred, and fear

Functional o Bell and Weinbergs term for gay people who live alone, have adapted well to a swinging lifestyle, and are sociable and well adjusted

Open couples o Bell and Weinbergs term for gay couples who live together but engage in secret affairs

Bisexuality o Erotic attraction to, and interest in developing romantic relationships with, males and females

Gay bashing o Violence against homosexuals

Sexual Orientation 43

o The direction of ones sexual interests- toward members of the same sex, the other sex, or both Butch o A lesbian who assumes a traditional masculine gender role Gay males o Males who are erotically attracted to, and desire to form romantic relationships with, other males Castration anxiety o In psychoanalytic theory, a mans fear that his genitals will be removed. Castration anxiety is an element of the Oedipus complex and, in Freuds view, is implicated in the directionality of erotic interests Heteroerotic o Of an erotic nature and involving members of the other sex Close couples o Bell and Weinbergs term for gay couples whose relationships resemble marriage in their depth of commitment and exclusiveness Heterosexual Orientation o Erotic attraction to, and preference for developing romantic relationships with, members of the other sex Concordance o Agreement Homoerotic o Of an erotic nature and involving members of ones own sex Cruising o The name homosexuals give to searching for a sex partner Homophobia o A cluster of negative attitudes and feelings toward gay people, including intolerance, hatred, and fear. (From Greek roots meaning fear [of members of the ] same [sex].) Dizygotic twins 44

o Twins who develop from different fertilized ova. Fraternal twins. Homosexual Orientation o Erotic attraction to, and preference for developing romantic relationships with, members of the same sex (From the Greek homos, which means same, not the Latin homo, which means man).

Questions

1. Bell and Weinbergs term for gay people who live alone, have adapted well to a swinging lifestyle, and are sociable and well adjusted. This is defined as? a. Close couples b. Open couples c. Functional d. Dysfunctionals e. Asexual
2. T/F Most Americans believe that gay people are born gay?

a. True b. False

45

Answers 1. C 2. A Chapter 11: Conception, Pregnancy, and Childbirth 1. Identify the various methods of optimizing the chances of conception and their success rates. pp 333-335 The ovum can be fertilized within 4-20 hours after ovulation. In order to increase the chances of conceiving there are several methods that can be used: Using the Basal Body Temperature chart - can provide a more reliable estimate as to when ovulation will occur. Early morning temperature is usually below 98.6 degrees, but just before ovulation basal temperature falls slightly. The day after ovulation temperature rises about 0.4 0.8 degrees. Electronic digital thermometers best detect a womans temperature change. Analyzing Urine and Saliva for Lutenizing Hormone - over the counter kits can be used to detect the lutenizing hormone level. A rise can be indicative of ovulation by about 12-24 hours. Tracking Vaginal Mucus mucus becomes thin, slippery and clear for a few days before ovulation. A day or so after the mucus thickens and becomes opaque. Additional considerations- Coitus in the male-superior position will allow sperm to get deposited deeper in the vagina. Women can improve chances of conception by lying on their back and drawing their knees to their chest after ejaculation. Women can also improve their odds by lying still for 30-60 minutes after ejaculation. Women who have retroverted or tipped uteruses may profit by having their partner enter from behind, again to prevent semen from dripping out. Man should penetrate as deeply as possible just prior to ejaculation, hold still during ejaculation and then withdraw slowly in a straight line to avoid disrupting the pool of sperm. 2. Describe the various offspring gender selection techniques and their success rates. pp. 335-339 Shettlers approach Based on the assumptions that: Y sex chromosomes are smaller and faster, while X chromosomes are more durable. Landrum Shettlers derived a number of strategies for choosing the sex of ones children. To increase the chances of conceiving a BOY the couple should engage in coitus on the day of ovulation and the man should penetrate deeply at the moment of ejaculation. To increase the chances of having a GIRL the couple should engage in coitus two days or more before ovulation and the man should ejaculate at a shallow depth of penetration. Research has not shown that these methods are effective. Sperm Separation Procedures separation of sperm either by differences in swimming rates, electrical charge and on the amount of DNA they contained. The DNA sorting method works better in cows and horses because they tend to have larger differences in the amount of DNA between male and female sex-chromosome bearing sperm. Preimplantation genetic Diagnosis The most reliable method of sex-selection. Originally developed to detect disorders. Using in vitro fertilization 6-8 embryos are conceived in this manner and after a few days of cell division a cell is extracted and analyzed to determine the sex. Once sex is determined the embryos of the desired sex are implanted. While fool proof in sex 46

selection, it is an invasive and expensive procedure plus success of implantation cannot be guaranteed. 3. Describe the cause of infertility in males and females pp 339-341 Male fertility problems can be due to: 1. Low sperm count The most common problem (normal 40-150 million sperm per milliliter). Can be a result of genetic factors, advanced age, hormonal problems, diabetes, injuries to testes, varicose veins in scrotum, drugs, blood pressure meds, environmental toxins, excess hear, and stress frequent ejaculation, increased testicular temperature 2. irregularly shaped sperm malformed heads or tails 3. low sperm motility 4. chronic diseases such as diabetes, as well as infectious diseases such as sexually transmitted disease 5. injury to the testes 6. and autoimmune response, where antibodies deactivate the sperm 7. a pituitary imbalance and or thyroid disease Female fertility problems can be due to: 1. irregular ovulation, including failure to ovulate due to many factors including hormonal irregularities, malnutrition (low levels of body fat), genetics, stress and chronic disease. 2. obstruction or malfunctions of the reproductive track, which is often caused by infections or diseases involving the reproductive track 3. endometriosis 1 in 6 cases due to this 4. declining hormone levels of estrogen and progesterone that occur with aging and my prevent the ovum from becoming fertilized or remaining implanted in the uterus. 4. list and describe contemporary methods for overcoming infertility pp. 341-344 Artificial insemination- the introduction of sperm into the reproductive track through means other than sexual intercourse. Sperm are usually injected into the uterus following ovulation. Fertility drugs clomiphene to stimulate the pituitary gland to secrete FSH and LH which can in turn stimulate the maturation of the ova. Pregonal contains high levels of FSH which will directly stimulate maturation of ovarian follicles linked to multiple births. In Vitro Fertilization- woman is given fertility drugs in order to get ova to mature and then they are surgically removed. Fertilization occurs in a laboratory dish and then the embryo is implanted into the uterus. GIFT gamete intrafallopian transfer gametes are implanted into fallopian tube fertilization occurs in the fallopian tube instead of a laboratory dish ZIFT zygote intrafallopian transfer a combination of in vetro and GIFT. Sperm and ova are combined in the laboratory dish then placed into the mothers fallopian tube to journey to the uterus for implantation. More advantageous than GIFT because its certain that fertilization has occurred. Donor In vitro fertilization- where ova are donated from another woman and then fertilized and implanted into the intended mother Embryonic transfer for women who do not produce ova of their own. A woman volunteer is artificially inseminated by the male partner of the infertile woman, and then five days later the 47

embryo is removed from the volunteer and inserted within the uterus of the mother to be, where hopefully it will implant. Intracytoplasmic sperm injection (ICSI) when a man has to few sperm for IVF and when IVF fails. Sperm are injected directly into the ovum. Method may be associated with increased birth defects. Surrogate motherhood is artificially inseminated by the husband of the infertile woman and carries the baby to term. Adoption 5. Discuss sex during pregnancy pp. 346-347 Most health professionals agree that coitus is safe throughout the pregnancy until the start of labor, provided everything is developing normally and the woman has no history of miscarriages. Many women show a decline in sexual interest during the first trimester because of fatigue, nausea and misguided concerns that coitus will harm the embryo. Pain during intercourse is commonly reported especially during the third trimester. 6. Discuss the resumption of sex after pregnancy pp. 374 Typically should abstain for at least six weeks - depends on couples level of sexual interest, healing of episiotomies and other injuries, fatigue and recommendations of obstetricians and tradition. Most women prefer to wait until coitus becomes physically comfortable and everything has healed. Women who breast feed may have less vaginal lubrication which may cause discomfort. Sexual interest depends more on psychological than physical factors. 7. Differentiate the items in the chapter Truth?Fiction Section. p. (start of chapter) T- Prolonged athletic activity may decrease fertility in the male F A test tube baby is grown in a laboratory dish throughout the 9 month gestation T There is an all-female species of lizard that lays unfertilized eggs that develop into identical females generation after generation T Morning sickness is a sign that a pregnancy is progressing normally T for the first week after conception, a fertilized egg cell is not attached to its mothers body F pregnant women can have one or two alcoholic beverages a day without harming their babies F the way that the umbilical cord is cut determines whether the baby with have an inny or an outy, T- In the US nearly 1 birth in 4 is by cesarean section T Couples should abstain from sexual activity for at least 6 weeks after childbirth. 8. Complete the definitions of the items in the Running Glossary Section throughout the chapter. Infertility inability to conceive a child In vitro fertilization (IVF)- a method of conception in which mature ova are surgically removed from an ovary and placed in the laboratory dish along with sperm. Gamete intrafallopian transfer (GIFT) a method of conception in which sperm and ova are inserted into the fallopian tube to encourage conception Zygoter intrafallopian transfer (ZIFT) a method of conception in which the ovum is fertilized in a laboratory dish and then placed in a fallopian tube Donor IVF a variation of in vitro fertilization in which the ovum is taken from one woman, fertilized, and then injected into the uterus or fallopian tube of another woman Intracytoplasmic sperm injection (ICSI) a method of conception in which a single sperm is injected directly into an ovum

48

TQ 1. Method of conception in which a single sperm is injected directly into an ovum. a. ICSI b. HCG c. Embryonic Transfer d. Donor IVF 2. Method of conception in which the ovum is fertilized in a laboratory dish and then placed in fallopian tube. a. ZIFT b. GIFT c. ICSI d. HCG Answers: A, A Chapter 12 1. Define contraception and trace the history of methods of contraception. p. 382 Techniques that prevent conception. The bible contains references to several methods of contraception, including coitus interruptus (withdrawal method), vaginal sponges and contraceptive concoctions. Ancient Egyptians douched with wine and garlic after sex, as well as soaking crocodile dung in sour milk and stuffing the mixture deep into the vagina; the dung soaked up sperm and prevented cervical entry. Greeks and Romans placed absorbent materials in the vagina to absorb sperm. Condoms were used throughout history, but were not referred to as condoms until the eighteenth century. At this time, they were made of animal intestine. In the nineteenth century, many forms of contraception were used in addition to condoms: vaginal sponges, withdrawal and douching. 2. Discuss the history of contraception law in the United States. pp. 382-384 1873 Comstock law passed, prohibiting the dissemination of birth-control information via mail. 1914 Margaret Sanger establishes the National Birth Control League, publishing a magazine The Woman Rebel that challenged the view that birth control information was obscene. As a result, Sanger fled to the Netherlands. Charges against Sanger were dropped in 1916. She returned to the states and opened a birth control clinic in Brooklyn. She was arrested for this and the clinic closed, though she successfully appealed her sentence. 1918 Courts rule that physicians must be allowed to disseminate information that may help in preventing disease. 1960 The Pill is marketed in the United States 1965 Supreme Court strikes down a law preventing sale of contraceptives in Connecticut. 1973 Abortion legalized by Roe v. Wade Present churches still oppose use of artificial contraceptives. 3. Describe how oral contraceptives work and discuss their effectiveness, reversibility, advantages and disadvantages. pp. 384-388 Birth control pills fool the brain into acting as if a woman is pregnant and suppresses maturation of egg follicles and ovulation. Combination pills contain a combination of synthetic estrogen and progesterone, while minipills only contain synthetic progesterone. Combination pills known as multiphasic pills vary dosage of hormones across the menstrual cycle to reduce dosages and potential side effects. Estrogen in combination pills decreases secretion of FSH, so follicles do not mature. Progesterone inhibits LH secretion, which halts ovulation. The pill is taken 21 days of a 28 day cycle, with placebo pills taken the rest of the time; after the last pill has been taken, menstruation follows 3-4 days later. Progesterone thickens the cervical mucus and makes it more acidic (and therefore sperm-resistant). The minipill does not halt ovulation, since it lacks estrogen. 49

Effectiveness: failure rate is .5% or less, depending on type of pill, with perfect use. In typical use, the failure rate increases to 3%. Reversibility: 9/10 women begin ovulating normally within 3 months of suspending use of the pill, though fertility issues may exist immediately after stopping use of the pill. Advantages: Very effective, does not interrupt sex. Reduces risk of pelvic inflammatory disease, benign ovarian cysts and fibrocystic breast growths. Regularizes menstrual cycles and reduces menstrual cramping and premenstrual discomfort. Helps treatment of iron-deficiency anemia and facial acne. Reduces risks of ovarian and endometrial cancer. Disadvantages: Increases risk of breast cancer among women with a family history of breast cancer. Confers no protection against (sexually transmitted infections) STIs, and reduces antibiotic effectiveness in treating STIs. Requires medical consultation. Caution should be exercised in women that have hypertension, diabetes, migraine headaches, fibrocystic breast tissue, uterine fibroids and elevated cholesterol levels. Side effects from estrogen include nausea, vomiting, fluid retention, weight gain, increased vaginal discharge, headaches, tenderness in breasts and dizziness, though many of these are temporary. Hormone withdrawal symptoms may occur when the pill is not taken, including headaches, pelvic pain, bloating and breast tenderness. Risk of blood clots in patients with history of stroke or circulatory problems also exists. Side effects from progesterone include male secondary sex characteristics acne, facial hair, thinning of scalp hair, reduction in breast size, vaginal dryness, missed / shorter periods, irregular bleeding. Chances of breast cancer increase with progesterone, and some (but not all) studies show a link between cervical cancer and progesterone pills. Contraindications: Women with the following problems should not take the pill: circulatory or blood clotting problems, stroke or heart attack patients, those with a history of coronary disease, breast or uterine cancer, undiagnosed genital bleeders, patients with liver tumors or sickle-cell anemia, women over 35 who smoke, nursing mothers. Morning-After pills: These pills contain high doses of estrogen and progestin and stop the egg from implanting in the uterus. This is usually successful but can damage the fetus if unsuccessful. 4. Describe how Norplant works and discuss its effectiveness, reversibility, advantages and disadvantages. p. 388 Tubes are implanted in the body that release small, steady doses of progestin into the bloodstream and provide protection for as long as five years. Progestin suppresses ovulation and thickens cervical mucus so sperm cannot pass. Effectiveness: Low failure rate (less than 1% / year over 5 years). Reversibility: fully reversible Advantages: Convenient Disadvantages: Abnormal menstrual bleeding 5. Describe how IUDs work and discuss their effectiveness, reversibility, advantages and disadvantages. pp. 388-391 Small objects of various shapes inserted into the uterus. Some IUDs secrete hormones, while others merely act as foreign bodies that irritate the uterine lining. This leads to production of antibodies that are hostile to sperm or fertilized ova. They may also prevent fertilized eggs from implanting. Inflammation also impairs endometrium proliferation. Effectiveness: Failure is about 2% with the progestin-releasing Progestasert T. Most failures are attributed to shifting position or expulsion, with most failures occurring in the first 3 months after insertion. Paragard (copper IUD) is most successful, with a failure rate of .8% in the first year. Anti-inflammatory drugs inhibit IUD success. Reversibility: IUDs may be removed by professionals. 9/10 of IUD users become pregnant within a year of its removal 50

Advantages: Highly effective, does not diminish sexual spontaneity or sensation, convenient if positioned correctly. Does not affect hormone production. Disadvantages: Painful insertion, excessive menstrual cramping, irregular bleeding between periods, heavy menstrual bleeding. Risk of uterine wall tearing and PID, as well as infection associated with insertion of the device. PID can produce scar tissue that blocks fallopian tubes, causing infertility. IUDs are best suited to women who have completed their families and are not advised to use oral contraceptives. 6. Describe the diaphragm, and discuss how it works, its effectiveness, reversibility, advantages and disadvantages. pp. 391-393 Inserted by the woman no more than 2 hours before coitus; placed over the cervical opening and forms a barrier against sperm. Should be used in conjunction with spermicidal jelly or cream. Main function of the diaphragm is to keep cream / jelly in place. Effectiveness: 6% if used consistently and correctly; up to 18% if used typically due to ill-fitting diaphragms, inconsistent use, holes or cracks in the diaphragm or insertion / removal too early or late. Reversibility: Fully reversible Advantages: Does not alter hormone production or reproductive cycle. Can be used as needed, and does not require a time commitment (like the pill). Virtually no side effects; made from many materials to help allergic patients. Disadvantages: Relatively high failure rate, need to insert diaphragm before sex, taste of spermicides unpleasant during oral sex. Vaginal or urinary infections due to pressure exerted by the diaphragm against the vaginal or cervical walls. 1/20 women may develop allergies to their brand of spermicide. 7. Identify the types of spermicides and discuss their use alone or with other methods, their effectiveness, reversibility, advantages and disadvantages. pp. 393-394 Coat the cervical opening, blocking passage of sperm and killing sperm by chemical action. Types: Spermicidal jellies and creams come in tubes with plastic applicators. Vaginal suppositories are inserted into the upper vagina, near the cervix. These must be inserted no less than 10-15 min. prior to coitus so they have time to dissolve. Spermicidal film consists of thin sheets that are saturated with spermicide. Dissolve into gel and release spermicide. Must be inserted at least 5 minutes before intercourse, and is effective for up to an hour. Effectiveness: First year failure rate of spermicide used alone is 21%. Used correctly and consistently, failure rate drops to 6%. All spermicides are more effective with other means of contraception, such as the condom. Reversibility: Completely reversible Advantage: Do not alter hormonal levels, do not require prescription, cheap. Disadvantages: High failure rate when used alone. Application errors can lead to not enough foam cream being used, misplacement, etc. May cause penile irritation. 8. Describe the contraceptive sponge and its survival. p. 394 The sponge is a soft, disposable device. Does not need to be fitted, and contains spermicide. Can be inserted into vagina several hours before intercourse and absorbs sperm. Remote chance of toxic shock syndrome and irritation due to spermicide. The sponge was taken off the market in 1994 due to production problems, including bacterial contamination. Available now from Canada or online. 9. Describe the cervical cap and discuss how it works, its effectiveness, reversibility, advantages and disadvantages. pp. 395-396 Similar to a diaphragm, covers the cervix and filled with spermicide. Must be fitted by a doctor. May be worn for up to 48 hours, and must be worn 8 hours after intercourse. Forms a barrier to the cervix and users spermicide to kill sperm. 51

Effectiveness: High failure rate (18% in non-child bearing women, up to 36% in women that have had children) due to changes to cervix during menstrual cycle or movement / dislodging of cap. Reversibility: No effect on fertility Advantages: Does not affect hormonal balance, alternative to diaphragm in women that do not have vaginal muscle tone to support the diaphragm. Disadvantages: High failure rate, uncomfortable, urinary tract infection, allergic reactions or sensitivity to rubber and/or spermicide. Expensive and inconvenient to have fitted by professional. 10. Describe how condoms are used, and discuss their effectiveness, reversibility, advantages and disadvantages. pp. 396-399 Cylindrical sheath that fits over the penis and acts as a barrier to sperm. Also helps prevent from disease-carrying microorganisms. Rolled over the penis after erection is achieved, but before entering the vagina. Must be removed while still erect, with care not to allow it to slip down the penis. Effectiveness: 12% failure when used alone. Condom and spermicide has a failure rate that rivals that of the birth control pill when used correctly and consistently. Reversibility: No effect on fertility Advantages: Readily available, cheap, effective when used with spermicide, do not affect hormonal production. Nearly free of side effects, barring allergic reactions. Disadvantages: Uncomfortable, reduces spontaneity of sex, chance of breakage or slipping. 11. Describe douching and withdrawal and explain why both are considered non-methods of contraception. pp. 399-400 Douching Spermicidal agent or water used to flush the vagina. Used post-coitus as a contraceptive by some. Ineffective because sperm may be propelled towards the uterus, with a 40% failure rate. Large numbers of sperm also move beyond range of douche just seconds after ejaculation. Withdrawal When the penis is removed from vagina prior to ejaculation. Failure rate of about 20% because the man may not withdraw in time, pre-ejaculatory fluid contains sperm, ejaculate may fall on vaginal lips. 12. Name and explain the four fertility awareness techniques and discuss their effectiveness, advantages and disadvantages. pp. 400-401 Calendar method: Assumes ovulation occurs 14 days prior to menstruation. The couple abstains from days 10-17 of the womans cycle. Tracking the menstrual cycle for up to a year is recommended. Disadvantages: women with irregular cycles may have problems tracking and assessing safe days. Some women may have large abstention periods. Basal Body Temperature (BBT) method: Body temperature tracked to detect small changes that occur directly before / after ovulation. Sometimes dips before ovulation and rises between .4 and .8 degrees F just before, during and after ovulation. Remains elevated until onset of menstruation. Women should not have sex during the unsafe preovulatory period (determined by calendar method), and 3 days when temperature rises and remains elevated. Some women use the calendar method to determine the number of safe days prior to ovulation and the BBT method to determine the number of unsafe days after ovulation. Disadvantages: rise in temperature may not be due to ovulation. Cervical Mucous (Ovulation) method: Tracks changes in viscosity of cervical mucous. After menstruation, the vagina feels dry; dry days are relatively safe. At the first sign of any mucous discharge, coitus should be avoided. As the cycle progresses, mucous discharge thins and becomes slippery and stringy, like raw egg white. These are peak days; ovulation occurs one day after the last peak day (four days after this ovulatory mucous first appears). Intercourse may resume four days after the last peak day. Disadvantages: Consistency in mucous discharge may be due to infection, medications, contraceptives or sexual arousal, making charting difficult. 52

Ovulation-Prediction kits: Urine is tested for presence of LH, which surges about 12-24 hours prior to ovulation. More accurate than the BBT method. Some couples use the kits to determine unsafe period following ovulation and calendar method to determine unsafe days preceding ovulation. Disadvantages: Expensive, and require urine to be tested every morning. Does not reveal full range of unsafe pre-ovulatory days during which sperm may remain viable in vagina. Effectiveness: 20% failure in first year. Fewer failure when more than one method applied conscientiously. Reversibility: No effect on fertility. Advantages: Natural form of birth control, so these methods are appealing to people who do not like artificial means. No devices or chemicals used, no loss of sensation, inexpensive. Disadvantage: Reliability is low in all methods. Requires abstention for several days, or even weeks. Require ample recording time and do not provide any protection against STDs. 13. Explain the procedures used in male and female sterilization and discuss the effectiveness, advantages and disadvantages of the procedures. pp. 402-410 Male (vasectomy) vas deferens cut, a small segment removed, ends tied off or cauterized. Done by a small incision to the scrotum. Effectiveness: Nearly 100% Advantages: Man can resume sex a few days after the operation, but contraceptives are advised until residual sperm count is zero. Does not diminish sex drive or result in loss of ejaculation / ejaculatory ability. Disadvantages: Slightly increased chance of prostate cancer, permanent. Body may produce antibodies that attack sperm, leading to infertility if procedure is reversed. Infection of epididymis may occur, as well as inflammation. Female (tubal ligation): Two methods: minilaparotomy and laparoscopy. In minilaparotomy, small incision made in abdomen and a laparoscope is used; fallopian tubes cut and tied back or clamped. In laparoscopy, incision is made just below navel; fallopian tubes cauterized, cut or clamped. In culpotomy, the fallopian tubes are approached from incision in back wall of vagina. Hysterectomy is a major operation performed because of cancer or disease of reproductive tract. Uterus is removed. Effectiveness: Very effective, but less so than male sterilization (.4%) Advantages: Does not affect sex drive or response. Highly effective. Permanent. Disadvantages: Medical complications abdominal infections, bleeding, puncture of nearby organs and scarring. Permanent. No protection against STIs 14. Describe the advantages and disadvantages of the female condom and Depo-Provera and discuss possible future developments in contraception. p. 408 Female condom advantages: Offers some protection against STIs Female condom disadvantages: Bulky, difficult to insert. Less effective than male latex condoms in preventing pregnancies, transmission of STIs. Pregnancy rate between 5% and 26% depending on usage. Depo-Prevara advantages: Long-acting, synthetic form of progesterone that inhibits ovulation. Effective, with less than 1% failure rate during first year of use. Depo-Prevara disadvantages: Weight gain, menstrual irregularity, spotting. May be links to osteoporosis. Developments are being made in the realms of chemical barrier and mechanical barrier methods of contraception, though no perfect method has been found yet. 15. Differentiate the items in the chapter Truth?Fiction Section. p. (start of chapter) Ancient Egyptians used crocodile dung as a contraceptive true There is an oral contraceptive that can be taken the morning after unprotected intercourse true Sterilization operations can be surgically reversed false only some may be reversed 53

Contraceptives not only prevent conception; they also prevent the spread of sexually transmitted infections false not all contraceptives provide protection against STIs Testosterone can be used as a male contraceptive true Abortions were legal in the newly founded United States true The D&C is the most widely used abortion method in the United States - false 16. Complete the definitions of the items in the Running Glossary Section throughout the chapter. Artificial contraception-A method of contraception that applies a human-made device Douche-to rinse or wash the vaginal canal by inserting a liquid and allowing it to drain out Minipill-A birth control pill that contains synthetic progesterone but no estrogen. Basal body temperature method-A fertility awareness method of contraception that relies on prediction of ovulation by tacking the womans temperature during the course of the menstrual period Oral contraceptive-A contraceptive, consisting of sex hormones, that is taken by mouth Calendar method-A fertility awareness (rhythm) method of contraception that relies on prediction of ovulation by tracking menstrual cycles, typically for a 10 to 12 month period and assuming that ovulation occurs 14 days prior to menstruation Hysterotomy-surgical removal of the uterus. Ovulation method-A fertility awareness method of contraception that relies on prediction of ovulation by tracking the viscosity of the cervical mucous. Coitus interruptus-A method of contraception in which the penis is withdrawns from the vagina prior to ejaculation. Also known as the withdrawl method. Induced abortion-the purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life Peak days-The days during the menstrual cycle during which a woman is most likely to be fertile. Combination pill-A birth control pill that contains synthetic estrogen and progesteron Intra-amniotic infusion Prophylactic-an agent that protects against disease Condom-a sheath make of animal membrane or latex that covers the penis during coitus and serves as a barrier to sperm after ejaculation Intrauterine device-a small object that is inserted into the uterus and left in place to prevent conception Sterilization-Surgical procedures that render people incapable of reproduction without affecting sexual activity. Culpotomy-a kind of tubal sterilization in which the fallopian tubes are approached through an inscision in the back wall of the vagina. Laparoscopy-tubal sterilization by means of a laproscope, which is inserted through a small incision just below the naval and used to cauterized, cut, or clamp the fallopian tubes, sometimes referred to as belly button surgery Tubal sterilization-the most common method of female sterilization in which the fallopian tubes are surgically blocked to prevent the meeting of sperm and ova, also called tubal ligation D&C- Dilation and curettage, an operation in which the cervix is dilated and uterine contents are then gently scraped away Microbicide- a chemical substance that kills viruses and bacteria Vacuum aspiration-removal of the uterine contents by suction. An abortion method used early in pregnancy D&E-Dilation and evacuation, an abortion method in which the cervix is dilated prior to vacuum aspiration 54

Vasectomy-the surgical method of male sterilization in which sperm are prevented from reaching the urethra by cutting each vas deferens and tying it back or cauterizing it. Diaphragm-a shallow rubber cup or dome fitted in the contour of a womans vagina that is coated with a spermicide and inserted prior to coitus to prevent conception Minilaparotomy-A kind of tubal sterilization in which a small incision is made in the abdomen to provide access to the fallopian tubes Vasovasotomy- the surgical method of reversing vasectomy in which the cut or cauterized ends of the vas deferens are sewn together Viscosity-stickiness, consistency

Practice Questions 1. Which birth control method will a woman abstain from coitus for 10 days? a. Condom b. IUD c. Calendar Method d. Birth control pill 2. In ancient Egypt what was commonly used as birth control? a. Wine b. Garlic c. Crocodile dung d. Penile sheaths

C, D Chapter 13 1. List three indicators of the capacity for sexual response in infancy and state at what age these responses generally appear. p. 427 Sexual curiosity such as watching their parents in the shower, or playing doctor and showing interest in sexual anatomy usually displays as early as 12 to 15 months of age. Genital play is also another indicator for capacity of sexual response. This usually occurs at the age of 2. Masturbation is the final indicator which presents as early as 6-12 months. 2. Indicate at what age humans typically begin to masturbate and describe what techniques young children generally use for masturbation. p. 428 Human infants typically begin masturbation between 6 and twelve months old. Infants often masturbate by rubbing the genitals against a soft object, such as a towel, bedding, or a doll. As they mature and become capable of more coordinated hand movements, infants may prefer manual stimulation of the genitals. 3. Recognize why some parents react negatively to their childrens masturbation, discuss the implications of such reactions, and recommend an alternative response for parents could utilize. p. 430 Parents are usually trying to present their children as little gentlemen and ladies by underreporting their sexual activity. Their biases may lead them not to perceive genital touching as masturbation. Some 55

parents even scold their children for exploring themselves sexually. The better alternative to yelling and ridiculing them, would be not to punish them for it, but teach them when is an appropriate time to do that. 4. Using Friedrichs study of childrens sexuality, list two common sexual behaviors for children ages 2 to 5 and children ages 6 to 9 years old. p. 431 Table 13.1 For children in the ages of 2 to 5, it is typical for them to try to touch their mothers or other womens breasts. Another will be to try to look at people when they are nude or undressing. As far as children between the ages of 6-9, they typically start touching their private parts when at home. They also try to look at people when they are nude or undressing. 5. Assess the relationship between same-sex sexual play in childhood and preadolescence on the development of sexual orientation in adulthood. pp. 431-433 Same sex sexual play in youth does not foreshadow adult sexual orientation. So the overbearing punishment from parents is not warranted. It may in fact, be more common than heterosexual play. It typically involves handling the other childs genitals, although it may include oral or anal contact. An example of this would be two boys who urinate together and see who can reach the farthest. As far as preadolescence goes, most sexual behavior among members of the same sex is simply exploration. These practices may be more common that heterosexual experiences. These activities are usually limited to touching of each others genitals or mutual masturbation. Most same-sex sexual experiences involve single episodes or short lived relationships and do not reflect the individuals sexual orientation. 6. Discuss the purpose of sex education in the school systems. pp. 433-437 Preadolescents and adolescents could be said to learn about sex through a combination of education and miseducation. In America, we tend to spread fear instead of knowledge of loving relationships. And it hasnt worked. The United States has a very high rate of teen pregnancy. The problem with most sex education modules in America is that it mainly focuses on biological aspects of puberty and reproduction, but rarely deals with abortion, masturbation, sexual orientation, or sexual pleasure. 7. Outline the five suggestions Calderone and Johnson offer parents for improving parent-child communication about sexuality. pp. 434-435 1. Be willing to answer questions about sex. 2. Use appropriate language. 3. Give advice in the form of information that the child can use to make sound decisions, not as an imperial edict. 4. Share information in small doses. 5. Encourage the child to talk about sex. 8. Cite one reason why the age at menarche has declined among girls in Western nations. p. 439 One reason why the age of menarche has decline among girls in Western nations is because of improvement in nutrition and health care. 9. Describe the four general stages of pubertal development in females by specifying several changes that occur at each stage and indicating the average age at which each change occurs. pp. 440 Table 13.4 Beginning between ages 8 and 11, pituitary hormones stimulate ovaries to increase production of estrogen and the internal reproductive organs begin to grow. Beginning sometime between ages 9 and 15, the areola and then the breasts increase in size and become more rounded. Pubic hair becomes darker and coarser. Between ages 10 and 16, the areola and nipples grow, often forming a second mound sticking out from the rounded breast mound. Pubic hair begins to grow in a triangular shape and to cover the center of the mons. Underarm hair appears, and menarche occurs. Beginning sometime between ages 12 and 19, the breasts are 56

near adult size and shape. The pubic hair fully covers the mons and spreads to the top of the thighs. And the voice may depend slightly. Also, the menstrual cycles gradually become more regular. 10. Describe the four general stages of pubertal development in males by specifying several changes that occur at each stage and indicating the average age at which each change occurs. pp. 441 Table 13.4 Beginning between ages 9 and 15, the testicles begin to grow, and the skin of the scrotum becomes redder and coarser. A few straight pubic hairs appear at the base of the penis. Between the ages of 11 and 16, the penis begins to grow longer. The testicles and scrotum continue to grow. The pubic hair becomes coarser and more curled and spreads to cover the area between the legs. Between ages 11 and 17, the penis begins to increase in circumference as well as in length. The testicles continue to increase in size. The texture of the pubic hair becomes more like an adults. Between the ages of 14 and 18, the body nears final adult height, and the genitals achieve adult shape and size, with pubic hair spreading to the thighs and slightly upward toward the belly. Hest hair appears, and facial hair reaches full growth. 11. Indicate the prevalence of petting, oral sex, and sexual intercourse among adolescents today, noting any variations in sexual activity by gender and ethnicity. pp. 445-446 Many adolescents engage in petting to express affection, to satisfy their curiosities, heighten their sexual arousal, and reach orgasm while avoiding pregnancy and maintaining virginity. Girls tend to engage in light petting earlier than boys do. Oral sex is another alternative to getting pregnant because of the lack of protection. It is said that European American and Latino American males are more likely to have engaged in cunnilingus than African American males. Adolescent sexual intercourse is increasing by the day. African American males are more likely than Latino American Males and European American males, to engage in premarital sexual intercourse. 12. Recognize the primary biological, social, and psychological reasons why adolescents report initiating sexual intercourse, and evaluate how gender influences feelings about sexual activity. pp. 446-447 The first biological reason for sex is hormones, which activate sexual arousal. Hormonal changes may also have indirect effects on sexual experimentation. Love, desire, conformity, peer seeking, and domination are many of the psychological factors that give reason for initiating sexual intercourse. According to some girls, sex is a reward for guys being loyal to them. Also it may be a means to punish their parents. 13. List three factors that decrease the likelihood that female adolescents will be sexually active. p. 448 Being younger and more career oriented. Children who live in a two-parent household. Family values and religion. 14. Identify the prevalence of same-sex sexual activity among adolescents, and evaluate the consequences of stigmatization for gay and lesbian teenagers. pp. 449-450 About five percent of adolescents report sexual experiences with people of their own sex. Seduction of adolescents by gay male and lesbian adults is relatively rare. Many gay males and lesbians develop a firm sense of being gay during adolescence. Coming to terms with this is a difficult struggle. Derogatory terms such as homos queers, and faggots are very stigmatizing. Many adolescent gays therefore feel isolate and lonely and decide to cloak their sexual orientation. 15. Provide an overview of the consequences of teenage childbearing for adolescent mothers, their children, and society at large. p. 451 About ten percent of American girls between the ages of 15 and 19 become pregnant each year. Nine out of ten pregnancies are unplanned. The consequences can be devastating. The recurrent themes for these mothers is poverty, joblessness, and a lack of hope for the future. Half of teenage mothers quit school and go on public assistance. And few of them ever receive any support from family and loved ones. 57

16. Identify at least three factors that contribute to the incidence of teenage pregnancy in the U.S. p. 452 a. Lossening of traditional taboos on adolescent sexuality in the mainstream culture b. impaired family relationships c. problems in school 17. Cite three factors correlated with adolescents use of contraceptives and list three reasons why sexually active adolescents report not using contraceptives. pp. 452-453 Teenage girls who engage in more frequent intercourse are more likely to use contraception and to use more effective methods. Teens whose peers use contraceptives are more likely to use them themselves. Older teenagers are more likely than younger ones to use contraception. Some reasons why adolescents dont report using contraceptives are that they think that not having intercourse often enough warrants that. Also, they dont want to disrupt sex by using them. 18. Evaluate the influences of good parental communication and school-based prevention programs on curtailing unplanned pregnancy and the spread of STIs among adolescents. pp. 453-454 Most adolescents admit that it would be easier for them to postpone sex and void pregnancy if they could have more open discussions with their parents. It is very underestimated what impact parents can have on teen pregnancy. Through sex education programs, and free contraceptive use, many professionals think that teen pregnancy can be eventually curtailed. 19. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter)
a. Many boys are born with erections. Erection is a reflex that begins to operate early in life. Infants often engage in pelvic thrusting at 8-10 months og age. However, thrusting may not mean the same thing in infants as adults. b. It is NOT true that most children learn the facts of life from parents or from school sex education programs. Most children learn about sex from peers. c. There is no evidence that sex education encourages sexual activity among children and adolescents. And it is true that the country of Iran is more explicit and detailed than the United States in its sex education programs. d. Despite the term wet dreams, nocturnal emissions need not accompany boys erotic dreams. e. It is true that petting is practically universal among adolescents in the United States. f. It is true that abou 800,000 adolescent girls in the United States become pregnant each year.

20. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below. SEE BELOW 21. Describe the main topics in the A Closer Look Sections within the chapter. pp. 434 & 448 Talking with your children about sex is mainly about communication. If you can communicate with your children on an even level, and respect them as a peer, you can get farther than you would initially believe. Adolescents are mainly looking for respect from their parents, and are afraid to ask questions because of embarrassment or fear of punishment. But in the end, communication about tender subjects such as sex, is the best method by far. The second article describes the act of having sex for the first time. It really goes to say that the first time can be very awkward, and that that is normal. Most boys are satisfied with their first sexual encounter, while most girls are not. 22. Discuss the topic listed in A World of Diversity Sections within the chapter. Because of a lack of education, young African Americans are paying a very steep price. The increase in sexual risk taking and lack of education leads to many STDs including HIV/AIDS. The other problem is that young people have a sense of the personal fable, where they feel they are invincible and nothing bad could ever happen to them. 23. Discuss the topic in the Human Sexuality in the New Millennium Section within the chapter. p. 443 58

This section of the chapter goes to say that parents in the new millennium are learning more things about the Internet. Even so, they are learning what kind of content children can get their hands on out there, and they are prepared to take measures to filter what their children are exposed to on the world wide web.

VOCABULARY Anovulatory-without ovulation. Critical fat hypothesis-the view that girls must reach a certain body weight to trigger pubertal changes such as menarche. Gynecomastia- overdevelopment of a males breasts. Menarche-the onset of menstruation; first menstruation. Nocturnal emission-involuntary ejaculation of seminal fluid while asleep. Also referred to as a wet dream, although the individual need not be dreaming about sex, or dreaming at all, at the time. Personal fable-the belief that ones feelings and ideas are special and that one is invulnerable. Primary sex characteristics- physical characteristics that differentiate males and females and are directly involved in reproduction such as the sex organs. Puberty-the stage of development during which reproduction first becomes possible. Puberty begins with the appearance o secondary sex characteristics and ends when the long bones make no further gains in length. Secondary sex characteristics- physical characteristics that differentiate males and females and that usually appear at puberty but are not directly involved in reproduction, such as the bodily distribution of hair and fat, development of the muscle mass, and deepening of the voice. 1. What is another term for the overdevelopment of breasts in males? a. Hyperdysplasia b. Gynecomastia c. Acute Achondroplasia d. Gynecoherpsia 2. True or False In order for one to have a nocturnal emission, one must be dreaming about sex at the time.

Answers: 59

1. B, 2. F

Chapter Number 14 ~ Sexuality in Adulthood

1. Define monogamy, polygyny, and polyandry; and note which type of marriage is most common, and which type is illegal, in the United States. pp. 466-467 Monogamy-A marriage to one person Polygyny-A form of marriage in which a man is married to more than one woman at the same time. Polyandry-A form of marriage in which a woman is married to more than one man at the same time. Monogamy is the only legal type in the USA and the most common. 2. Discuss the legal status of same-sex couples in the U.S. and other Western nations. pp. 466-467 In the U.S. some states allow civil unions between same sex partners. Polls on the unions differ across the country. Two trends are important to note: Young people, especially college students, are more supportive of gay marriage AND majorities in most areas polled would allow gays to enter into civil unions even if they themselves define the term marriage to exclude gays. The Netherlands, Belgium and Canada have extended full marriage rights to same sex couples. 3. Compare the patterns of marital sexuality typical of couples today to those of the married couples in Kinseys research from the 1930s and 1940s. pp. 468-471 Kinseys pre-sexual revolution samples were characterized as restrictive. Today married couples engage in coitus more frequently, with greater variety and for longer periods of time. They report greater sexual satisfaction. Also, the myth that sexual pleasure is meant for men and that it is the womans duty to satisfy the mans needs is not as prevalent. 4. Discuss why women and men tend to report different motivations for participating in extramarital affairs. p. 472 Women tend to justify affairs when they are for love, but men justify theirs as not being for love, but for play. 77% of women compared to 43% of men who have engaged in an affair site love as their justification. 5. Consider how changes in the composition of the U.S. population may affect cultural views about sexuality among older people. p. 479 The composition of the U.S. population is getting progressively older. Although older people tend to have a decrease in sexual daydreaming, sex drive and frequency of sexual activity, they do not lose their sexuality. Although the younger people of the country do not wish for this to occur/to think about it, being aware of sex in the elderly population is important to preventing problems that can arise. 6. Cite evidence to support the finding that older people are interested in, and capable of, having satisfying sex lives. p. 479 Older people still feel urges although other factors such as personal appearance and a general question of physiology come into play. Although this is the case, in elderly people enduring intimate relationships, feelings of love, intimacy and sharing a life together can outweigh these things. In terms of a sex life, older people can have fulfilling ones. If they fine tune their expectations they may find themselves leading some of the most sexually fulfilling years of their lives. 60

7. List the most common changes in sexual arousal associated with the biological process of aging. pp. 480-481. Changes in the female with age Reduced myotonia and elasticity Reduced vaginal lubrication and intensity of muscle spasm at orgasm Smaller increases in breast size during sexual arousal Changes in the male with age Longer amount of time to become erect and orgasm Less semen Softer erections Testicles may not elevate as high into the scrotum Less intense orgasmic contractions Longer refractory period Lessened feeling of the need to ejaculate during sex 8. Recognize which factor the text authors suggest is probably the most important determinant of sexual fulfillment for both older people and people with disabilities. pp. 483 & 488 The availability of a sexually interested and supportive partner may be the most important determinant of continued sexual activity. 9. Discuss the five factors Nosek identifies as central to sexual wellness among the disabled. pp. 484-485 1. Positive sexual self-concept-seeing oneself as valuable sexually and as a person 2. Knowledge about sexuality 3. Positive, productive relationships 4. Coping with barriers to sexuality (social, environmental, physical and emotional) 5. Maintaining the best possible general and sexual health

10. Identify three physical disabilities and the limitations those conditions may impose on sexual activities, and discuss the strategies people with disabilities can use to maintain sexual activity. pp. 484488 Cerebral palsy This does not impair sexual interest, capacity for orgasm or fertility, yet they tend to suffer social rejection in adolescence and see themselves as not worthy of intimate sexual relationships Disabled women The women may lose the ability for sensation or lubrication but many can still deliver vaginally 61

Spinal cord injury patients still sexually active and can even achieve orgasm Arthritis-results in a hard time bending joints during sexual activity, but these patients can use positions that decrease the amount of discomfort and apply moist heat to joints before sexual relations. Pre-planning involved. 11. Explain why people with physical, sensory, and psychological disabilities often lack the knowledge and skills necessary to participate in sexual relationships. pp. 484-488 It is really just a matter of developing a comfort zone that applies to the individual. Like anything else, these individuals learn about their sexuality with time and deal with them. Although this is the case, many have conditions that may make life difficult in general. 12. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter)
Singlehood has become a more common US lifestyle over the past few decades (T) More individuals have chosen to remain single into their twenties and thirties as compared to a few generations ago Divorced people are more likely than never married people to cohabit (T) After getting a divorce, people are more likely to share their lives than their money. See definition of cohabitation below In the ancient Hebrew and Greek civilizations, wives were viewed as their husbands property (T) Such oppressive practices had been going on for millennia but the womens movement has fought to against this Men are more romantic than women (T) This is true if romantic is defined as believing in love at first sight or believing that there is just one person who is right for oneself Most of todays sophisticated young people see nothing wrong with an occasional extramarital fling (F) The sexual revolution never really extended far enough to include extramarital affairs Men are more likely than women to commit acts of domestic violence (F) It is the case that women are just as likely to commit acts of domestic violence than their male partners. However, women are more likely to sustain serious injury Few women can reach orgasm after the age of 70 (F) Healthy women still possess the capacity to orgasm well into their advanced years People who are paralyzed as a result of spinal cord injuries cannot become sexually aroused or engaged in coitus (F) This is not the case. In fact, even most women w/ spinal cord injuries can become pregnant and give birth to healthy children

13. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below.

Running Glossary Key Terms

Arthritis- a progressive disease characterized by inflammation or pain in the joints Homogamy- the practice of marrying someone who is similar to oneself in social background and standing

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Celibacy - complete sexual abstinence Mating gradient- the tendency for women to marry-up, and for men to marry-down (referring to social and economic status) Cerebral Palsy- a muscular disorder that is caused by damage to the CNS and is characterized by spastic paralysis Monogamy- marriage to one person Cohabitation - living together as though married, but without legal sanction Open marriage- a marriage characterized by the personal privacy of the spouses and the agreed upon liberty of each spouse to form intimate relationships that may include sexual intimate relationships with people other than the spouse Comarital sex - swinging or mate-swapping Polyandry- form of marriage in which a woman is married to more than one man at the same time Consensual adultery- extramarital sex that is engaged in openly with the knowledge and consent from ones spouse Polygamy- simultaneous marriage to more than one person Conventional adultery - extramarital sex that is kept hidden from ones spouse Polygyny- a form of marriage in which a man is married to more than one woman at the same time Extramarital sex - sexual relations btw a married person and someone other than his/her spouse Serial monogamy- a pattern of becoming involved in one exclusive relationship after another, as opposed to engaging in multiple sexual relationships at the same time Gay marriage- marriage between two individuals of the same sex Swinging-(aka mate-swapping) a form of consensual adultery in which both spouses share extramarital sexual experiences Group marriage - a social arrangement in which three or more people share an intimate relationship. This form of marriage is illegal in the US PRACTICE QUESTIONS Polyandry is A)a form of marriage in which a woman is married to more than one man at the same time B)a form of consensual adultery in which both spouses share extramarital sexual experiences C)a social arrangement in which three or more people share an intimate relationship. This form of marriage is illegal in the US D)sexual relations btw a married person and someone other than his/her spouse E)a form of marriage in which a man is married to more than one woman at the same time Swinging is defined as

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A)a form of marriage in which a woman is married to more than one man at the same time B)a form of consensual adultery in which both spouses share extramarital sexual experiences C)Mate swapping D) A &B E)B&C

A, E Chapter 15-Sexual Dysnfunctions

1. Name and describe the four categories of sexual dysfunction identified in the DSM. P 494 Sexual desire Disorders- involve lack of interest in sex or aversion to sexual contact. Sexual arousal disorders-mainly characterized by erection in the male and vaginal lubrication and swelling of the external genitalia in the female. In men, sexual arousal disorders involve difficulty in obtaining or sustaining erections sufficient to engage in sexual intercourse. In women, they typically involve insufficient lubrication. Basically, in which people persistently or recurrently fail to become adequately sexually aroused to engage in or sustain sexual intercourse. Orgasmic disorders-men or women may have difficulty reaching orgasm or may reach orgasm more quickly than they would like. Women are more likely to encounter difficulties reaching orgasm. Men are more likely to reach orgasm too quickly (to experience premature ejaculation). Basically, in which people persistently or recurrently have difficulty reaching orgasm or reach orgasm more rapidly than they would like, despite attaining a level or sexual stimulation of sufficient intensity to normally result in orgasm. Sexual Pain Disorders-both men and women may suffer from Dyspareuia (painful intercourse). Women may experience vaginismus or involuntary contraction of muscles that surround the vaginal barrel, preventing penetration by the penis or making it painful.

2. List the disorders from each category of sexual dysfunction and identify the primary factors that contribute to the development of each disorder. Pp 494-502 Sexual desire disorders People with little or no sexual interest or desire are said to have hypoactive sexual desire disorder. It is one of the most commonly diagnosed sexual dysfunctions, yet there is not clear consensus among clinicians and researchers. Biological and psychosocial factors (hormonal deficiencies, depression, dissatisfaction with ones relationship and so on) contribute to lack of desire.

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Medical conditions that diminish sexual desire are testosterone deficiencies, thyroid overactivity or underactivity, and temporal lobe epilepsy. Testosterone is produced in male testes (hypogonadism-treated with testosterone) and in males and females the adrenal gland (if removed may lessen sexual desire). Psychological problems like anxiety most reported factor and depression is common cause of lack of desire. Also history of sexual assault and some medications (anxiety and hypertension) may reduce desire. Sexual aversion disorder is where people find sex disgusting or aversive and avoid genital contact. Also known as sexual phobia or sexual panic state with intense, irrational fears of sexual contact and a pressing desire to avoid sexual situations. This could be due to history of sexual trauma, such as rape or childhood sexual abuse or incest. Sexual arousal disorder Male erectile disorder or erectile dysfunction is characterized by persistent difficulty in achieving or maintaining an erection sufficient to allow the completion of sexual activity. It may be situational (failure is limited to sexual activity with partner or some partners and not others) and generalized (found during sexual activity including masturbation). It can also be related to performance anxiety that contributes to repeated failure, and a vicious cycle of anxiety and failure may develop. This is the most prominent cause of erectile disorder and other psychological factors such as depression, low self-esteem and problems in the relationship and biological factors play a causal role. Female Sexual Arousal Disorder is when women may encounter persistent difficulties becoming sexually excited or sufficiently lubricated in response to sexual stimulation. This may develop after period of normal functioning, or difficulties are pervasive and occur during both masturbation and sex with partner but more often they occur in certain situations. This may be caused by neurological, vascular or hormonal problems that interfere with the lubrication or swelling response of the vagina to sexual stimulation. Diabetes mellitus, reduced estrogen, psychological causes and sexual trauma are areas of concern with female sexual arousal disorder. Orgasmic Disorders Female Orgasmic Disorder is when a female is unable to reach orgasm or have difficulty reaching orgasm following what would usually be adequate amount of sexual stimulation. Women who have not achieved orgasm are described as anorgasmic or preorgasmic. A woman who reaches orgasm through masturbation or oral sex may not necessarily reach orgasm during coitus with her partner. Penile thrusting during coitus may not provide sufficient clitoral stimulation to facilitate orgasm. The woman may take the spectator role which may further decrease the likelihood of orgasm. Male Orgasmic Disorder has been termed delayed ejaculation, retarded ejaculation, or ejaculatory incompetence. The problem may be lifelong or acquired, generalized or situational. It may be caused by physical problems such as MS or neurological damage that interferes with neural control of ejaculation, side effects of drugs, psychological factors and emotional factors. Premature Ejaculation (2nd type of male disorder) is the most common dysfunction. Men with this disorder ejaculate too rapidly to permit their partners or themselves to enjoy sexual relations fully. The prematurity has various degrees from during foreplay, to seeing partner undress to just prior to or immediately upon penetration. Rapid Female Orgasm is rarely recognized as a problem and generally ignored by clincians. Sexual pain disorders Dysparenuia (painful coitus) affects both male and female. It may result from physical causes, emotional factors, or an interaction of the two. Most common cause of coital pain is lubrication. Vaginal infection, STDs, allergic

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reactions to condoms may be other contributors. Psychological factors such as guilt or anxiety may contribute. Painful intercourse more common among female and less among males but their contributing factors are genital infections that cause burning or painful ejaculation. Smegma under the penile foreskin of uncircumcised men may also irritate the penile glans during sexual contact. Vaginismus involves involuntary contraction of the pelvic muscles that surround the outer third of the vaginal barrel. It is in women who have a fear of penetration but do not realize that it is happening. It is mostly caused by a psychological fear of penetration, rather by injury or defect or they may have history of sexual trauma, rape or botched abortions that resulted in vaginal injuries.

3. Provide an overview of organic factors most often implicated in sexual dysfunction and give examples of hormonal, vascular, neurological and chemical causes of sexual dysfunction. Pp 503-505 Organic causes of erectile disorder affect the flow of blood to and through the penis (clogged or narrowing arteries leading to decrease oxygen) or damage the nerves involved in erection. Many diseases/health issues such as diabetes mellitus, high cholesterol, heart disease, hypertension, etc may cause erectile dysfunction. Nerve damage due to prostate surgery, MS or syphilis is also contributors. Women also develop vascular or nervous damage that impair genital blood flow, reducing lubrication and sexual excitement, rendering intercourse painful, and reducing their ability to reach orgasm. Prescription drugs and illicit drugs, antidepressants, antipsychotic and BP meds affect blood flow or nerve flow. CNS depressants such as alcohol, heroin, morphine and cocaine may decrease sexual desire.

4.

Demonstrate familiarity with the nine psychosocial factors associated with sexual disorders, and consider how these factors may interact with organic causes to foster sexual dysfunction. Pp 505-509

Cultural influences. Different families may be brought up differently in that sexually repressive cultural or home environments may learn to respond to sex with feelings of anxiety and shame, rather than anticipation and pleasure. In some cultures, males have been the superior bearing of sex while women are taught to suppress their sexual desires. This may affect female sexual arousal and affect the sexual relationship. Psychosexual trauma. This affects men or women who were sexually victimized in childhood. They have trouble becoming sexually aroused. Sexual orientation. Some gay males and lesbians test their sexual orientation by developing heterosexual relationships, even marrying and rearing children with partners of the other sex. Ineffective sexual techniques. One partner controls the timing and sequence of sexual techniques. The couple who fail to communicate their sexual preferences or to experiment with new techniques may find themselves losing interest. Emotional factors. Orgasm involves a sudden loss of voluntary control. Fear of losing control or letting go may block sexual arousal. Problems in the relationship. Problems in the relationship are not easily left at the bedroom door. Troubled relationships are usually characterized by poor communication. Partners who have difficulty communicating in general may be unlikely to communicate their sexual desires to each other.

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Lack of sexual skill. Sexual competency involves sexual knowledge and skills that are acquired through learning. Irrational Beliefs. Psychologist Albert Ellis points out that irrational beliefs and attitudes may contribute to sexual dysfunctions. Negative feelings such as anxiety and fear do not stem directly from the events we experience but rather from our interpretations of these events. Performance Anxiety. Anxiety, especially performance anxiety, plays an important role in sexual dysfunctions. It occurs when a person becomes overly concerned with how well he or she performs a certain act or task. In men, performance anxiety can inhibit erection while also triggering a premature ejaculation. In women, performance anxiety can reduce vaginal lubrication and contribute to orgasmic disorder.

5. State which models of treatment are collectively referred to as sex therapy and list the five main goals of sex therapist. P 509 Sex therapy aims to modify dysfunctional cognitions (beliefs and attitudes) and behavior as directly as possible. Sex therapists also recognize the roles of childhood conflicts and the quality of the partners relationship. Sex therapy usually involved both partners, although individual therapy is preferred in some cases. The five main goals are: 1. Change self-defeating beliefs and attitudes 2. Teach sexual skills 3. Enhance sexual knowledge 4. Improve sexual communication 5. Reduce performance anxiety 6. Describe the process the text authors suggest you use to find a qualified sex therapist. P 511 They must be a member of a recognized profession (such as psychology, social work, medicine or marriage and family counseling) who has training and supervision in sex therapy. Licensing in each state differs so must check them out. If uncertain how to locate a sex therapist, obtain names from university or colleges, health department, or counseling center, etc. American Association of Sex Educators, Counselors, and Therapists (AASECT) can help out also.

7. Identify the most common methods of treating sexual desire disorders and classify the methods according to the type of treatment they represent, e.g. biological or psychological. Pp 511-512 Hypoactive sexual desire is often a complex problem that requires more intensive treatment than do problems of the arousal or orgasm phases. In males, it could involve hormonal deficiencies especially in testosterone. Among women, as among men, lack of sexual desire can be connected with low levels of androgens, and testosterone shows promise in heightening desire. Treatment of sexual aversion disorder may involve a multifaceted approach, including biological treatments such as the use of medications to reduce anxiety and psychological treatments designed to help the individual overcome the underlying sexual phobia. Couple therapy and Sensate focus exercises may help overcome sexual aversion disorders.

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8. Identify the most common methods of treating sexual arousal disorders and classify the methods according to the type of treatment they represent, e.g. biological or psychological. P. 512-517 Erectile Disorder (male) As long as the males problems are psychologically and not organically based, they need only receive sexual stimulation under relaxed circumstances, so that anxiety does not inhibit natural reflexes. To overcome anxiety, partners engage in activities that are nondemanding sexual contacts and once this has been mastered they move onto more sexual contact activities. Biological approaches Vascular surgery: helps when blood vessels that supply the penis are blocked. Penile implants: may be used when other treatments fail because of biological problems Hormone therapy: helps men and women with abnormally low levels of male sex hormones. Injections: muscle relaxants such as Alprostadil and phentolamine are injected into the corpus cavernosum of the penis, relaxing the muscles that surround the arteries in the penis, allowing the vessels to dilate and blood to flow more freely. Suppository: Alprostadil is inserted into the tip of the penis in gel form. Oral medications: oral forms of several compounds sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)relax the muscles that surround the small blood vessels in theh penis, allowing them to dilate so that blood can flow into them more freely. Apomorphine (Uprima) increases brain levels of the neurotransmitter dopamine which the side effect of these increasing levels of dopamine is erection. Vacuum pump: creates a vacuum when it is held over the penis. The vacuum induces erection by increasing the flow of blood into the penis. Rubber bands around the base of the penis maintain the erection.

Female Sexual Arousal Disorder Psychological treatment involve sex education (labeling the parts, discussing their functions, and explaining how to arouse them), searching out and coping with possible cognitive interference 9such as negative sexual attitudes), creating nondemand situations in which sexual arousal may occur, and-when appropriate-working on problems in relationships. Women may need lubrication (K-Y jelly) and biological treatment for female sexual disorders are just emerging. Researchers have been working on a cream that works similar to Viagra for the women where it is inserted into the vagina to enhance blood flow. Hormone levels may be low so wearing a testosterone patch may enhance sexual arousal and a device called the Eros, parallels to the vacuum pump used by men, in which it is a clitoral device that creates gentle suction over the clitoris, increasing vasocongestion and sexual sensations.

9. Identify the most common methods of treating orgasmic disorders and classify the methods according to the type of treatment they represent, e.g biological or psychological. Pp 517-522

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Female orgasmic disorder: Women suffer from orgasmic disorder more than men. The recommendation for a woman is to address certain attitudes about sex then do a couples-oriented approach. They focus on sensate focus exercises then move on to more involved activities where the woman guides the man in the caressing and movements. After the couple has experienced genital play numerous times, the couple engages in coitus in the female-superior position, which puts the female in charge. This method helps the female reach orgasm since she is controlling thrusting. Once this position works, the couple may try different positions. Masturbation also helps women to learn about their own bodies. The following elements may be used to direct a female: 1. Education-the couple learns about female sexuality 2. Self-exploration-helps increase the womens sense of body awareness (the mirror looking at herself) 3. Self-massage-Women explore body by touching herself (genitals and breasts), finding what sensation best suits her. 4. Giving oneself permission-Letting go of guilt and anxiety about masturbation and telling oneself it is okay. 5. Use of fantasy- Arousal heightened through sexual images 6. Use of vibrator- can provide more intense stimulation 7. involvement of the partner-once female is able to obtain orgasm through masturbation it involves the steps above (couples-approach) Male orgasmic disorder: Treatment focuses on increasing sexual stimulation and reducing performance anxiety. Couple practices sensate focus exercises (males does not try to ejaculate), then couple tries to bring male to orgasm manually, then once male is able to ejaculate in front of partner, they bring him to the point of ejaculation and female gets into female-superior position to engage in coitus. Premature ejaculation-In cases where males ejaculate prematurely, a squeeze technique is used where the woman holds the penis between the thumb and first two fingers of the same hand, with thumb against the frenulum for 20 seconds. This method can be used during coitus where they use the female-superior position and when the male feels he is going to ejaculate, they pull out and squeeze technique is used. This stop-start method helps the problem of premature ejaculation. Biological treatment for premature ejaculation is taking meds such as clomipramine that helps the male from ejaculating too early and antidepressant drugs have also been helpful.

10. Identify the most common methods of treating sexual pain disorders and classify the methods according to the type of treatment they represent, e.g. biological or psychological. Pp522-524 Dyspareunia (painful intercourse): calls for medical intervention to assess for andtreat any underlying physical problems such as UTI that may cause pain. Vaginismus: usually treated with behavioral exercises in which plastic vaginal dilators of increasing size are inserted to help relax vaginal musculature. The size can be increased by patient or the patients partner may use fingers starting with smallest and working up to bigger sized fingers and from one finger to two until it is comfortable for patient to have penis inserted. Once the couple is able to have the penis inserted into the vagina, the woman should control the speed and depth.

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11. Explain why the development of treatments for sexual dysfunction in women has lagged behind the development of treatments for men, and identify at least two treatments originally designed for men that are currently being investigated as treatments for women. P 522 The development has lagged due to more understanding of the female sexual dysfunctions and it has been historically a male driven society for drugs of this nature to get attention. Two treatments that were originally designed for men that are currently being investigated are Viagra (shows in some women to increase lubrication, sex arousal) and hormone replacement therapy (testosterone).

12. Differentiate the items in the chapter Truth?Fiction Section. Sexual dysfunctions are rare. (False, actually quite common) Only men can reach orgasm too early. (false, but they are more likely premature ejaculation) The most common cause of painful intercourse in women is vaginal infection. (False, lack of adequate lubrication) Sex therapy teaches a man with erectile disorder how to will an erection. (False, men are actually taught that it is not possible to will an erection.) A doctor made a somewhat unusual presentation to a medical convention by dropping his pants to reveal an erection. (True) Many sex therapist recommend masturbation as the treatment for women who have never been able to reach orgasm. (true) A man can be prevented from ejaculating by squeezing his penis when he feels that he is about to ejaculate. (True)

13. Complete the definitions of the items in the Running glossary Section throughout the chapter. Sexual dysfunction: persistent or recurrent difficulties in becoming sexually aroused or reaching orgasm Sexual desire disorder: sexual dysfunction in which people have persistent or recurrent lack of sexual desire or aversion to sexual contact Sexual arousal disorder: sexual dysfunctions in which people persistently or recurrently fail to become adequately sexually aroused to engage in or sustain sexual intercourse. Orgasmic disorder: sexual dysfunction in which people persistently or recurrently have difficulty reaching orgasm or reach orgasm more rapidly than they would like, despite attaining a level of sexual stimulation of sufficient intensity to normally result in orgasm Sexual pain disorders: sexual dysfunctions in which people persistently or recurrently experience pain during coitus. Dyspareunia: a sexual dysfunction characterized by persistent or recurrent pain during sexual intercourse

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Vaginismus: a sexual dysfunction characterized by involuntary contraction of the muscles surrounding the vaginal barrel, preventing penile penetration or making penetration painful. Hypogonadism: an endocrine disorder that reduces the output of testosterone. Vasocongestion; engorgement of blood vessels with blood, which swells the genitals and breasts during sexual arousal. Male erectile disorder: persistent difficulty achieving or maintaining an erection sufficient to allow the man to engage in or complete sexual intercourse Performance anxiety: anxiety concerning ones ability to perform behaviors, especially behaviors that may be evaluated by other people Anorgasmic: never having reached orgasm Spectator role: a role, usually taken on because of performance anxiety, in which people observe rathr than fully participate in their sexual encounters Premature ejaculation: a sexual dysfunction in which ejaculation occurs with minimal sexual stimulation and before the man desires it Tumescence: swelling; erection Sex therapy: a collective term for short-term behavioral models for treatment of sexual dysfunctions Sensate focus exercise: exercises in which sex partners take turns giving and receiving pleasurable stimulation in nongenital areas of the body Squeeze technique: a method for treating premature ejaculation whereby the tip of the penis is squeezed temporarily to prevent ejaculation Neurotransmitters: a chemical that transmits messages from one brain cell to another 14. Reinforce the chapter objectives with the Review Section and the Recite section within the chapter. 15. Describe the main topics in the A Closer Look Section within the chapter. This dealt with the qualifications of a sex therapist. It has already been addressed in previous question. 16. Discuss the topic listed in A World of Diversity Sections within the chapter. This describes the two different cultures of Inis Beag and Mangia. In Inis Beag society, the male is the superior role player and premarital relations do not occur. They do not believe that there is not foreplay (basically faster you get it done, the better). In Mangia, they are educated at a very young age and the men are taught how to pleasure the female. Females are also taught coitus technique from their elders. This article shows how differing cultures expose sex to their society and how it is accepted. Koro syndrome is people believe that their genitals are shrinking and retracting into the body. More reportedly among young males with signs of acute anxiety, including profuse sweating, breathlessness and heart palpations. Reassurance by health professionals that fears that genitals wil retract inot the body are unfounded ofte put an end to Koro. Dhat Syndrome is found among young Asian males and involves excessive fears over the loss of seminal fluid during nocturnal emissions. They believe it is harmful because it depletes the body of physical and mental energy.

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17. Discuss the topic in the Human Sexuality in the New millennium sections within the chapter. Many males feel self-conscious about talking with their physician about their sexual dysfunctions. Some men are buying meds like Viagra on line which is not a good thing to do. It is important to talk to your physician because these drugs could have adverse side effects. Men and women are trying to find drugs to help with their dysfunctions. There are researchers trying to find different methods to help with this dysfunction. (this article was addressed about more male drugs before women drugs).

TQ's 1.) Which of the following is not a category of sexual dysfunction? A. Sexual arousal disorders B. Orgasmic Disorders C. Sexual Pain Disorders D. Nondisjunction 2.) Which of the following word/s describes a female who is unable to orgasm? A. anorgasmic B. preorgasmic C. Handicapped D. Both a and b

Answers-D, D

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Chapter 16 Objectives 1. Cite evidence to support the assertion that STIs are epidemic in the United States. Pp. 529-532 The World Health Organization estimates at least 333 million people around the world are stricken with curable STIs each year. The United States is believed to have the highest rate of sexually transmitted diseases (STIs) in the industrialized world. Statistical information to support this includes that there are about 40,000 new cases of HIV/AIDS each year, HPV is estimated to be present in 20% of Americans over the age of 12, and there are 4 million new cases of Chlamydia each year. The Center for Disease Control and Prevention (CDC) estimates that 1 million new cases of HPV occur each year, which is higher than those for syphilis, genital warts, herpes, and HIV/AIDS combined. The CDC notes approximately 10-15 new cases of STIs each year. They estimate that at least 1 in 4 Americans is likely to contract a STI at some point in their life. STIs account for 15-30% of infertility cases among women due to the spreading of STIS through their reproductive system. 2. Identify the cause of each major STI presented in this chapter using the bacterial-viralectoparasitic classification scheme and note which category includes the STIS that are incurable. (Table 16.1) (see chart below) 3. Distinguish between those STIs that are almost exclusively transmitted by sexual contact and these that can be transmitted by both sexual contact and contact with contaminated objects (Table 16.1) Scabies, Pediculosis (crabs), genital warts, oral herpes, candidiasis can be transmitted by contact with contaminated objects in addition to sexual contact. Others are by sexual contact (refer to chart below) 4. Keeping in mind that some infected people are symptom free, describe the most common symptom associated with each of these sexually transmitted infections: gonorrhea, syphilis, Chlamydia, bacterial vaginosis, candidiasis, trichomoniasis, oral herpes, genital herpes, viral hepatitis, AIDS, genital warts, pediculosis, and scabies. Table 16.1(see chart) 5. Recognize techniques for diagnosis (see chart)

STI Gonorrhea (Neisseria gonorrhoeae )

Type of Modes of infection transmission bacterial Vaginal, oral, or anal sex, or from mother to newborn during delivery bacterial Vaginal, oral, anal sex, or by touching an infectious chancre

symptoms Men: yellow, thick penile discharge, burning urination Women: increased vaginal discharge, burning urination, irregularly menstrual bleeding, most women show no early symptoms Primary stage: hard, round, painless chancre at site w/in 2-4 wks. May progress through second, latent, and tertiary stages if left untreated

diagnosis Clinical inspection; culture of sample discharge

treatment Use antibiotics ceftriaxone, ciprofloaxacin, cefixime, ofloxacin

Syphilis (Treponema pallidum)

Primary stage via clinical exam and by examination of fluid from a chancre in a dark-field test; secondary dx by blood test (VDRL)

Penicillin; or doxycyclin, tetracycline, or erythromycin for nonpregnant penicillin allergic patients

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6. Distinguish between those that are currently incurable and those that can be cured with appropriate treatment, and identify the primary treatment method used for each STI. 16.1 (see
below)

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Chlamydia and nongonnococcal arthritis (Chlamydia trochomatis bacterium, also caused by Ureaplasm Urealyticum in men)

bacteri a

Vaginal, oral, anal sexual activity; eyes after touching infected partners genitals; newborns via birth canal of infected mother

Bacterial vaginosis(Gardn erella vaginalisis bacterium and others)

Bacter ia (vagin al)

Overgrowth of organism in vagina, allergic reaction, sexual contact

Women:mostly asymptomatic; frequent, painful urination, lower abdominal pain and inflammation, vaginal discharge Men: similar to but milder than those of gonorrhea- painful urination, penile discharge- 25% no symptoms Sore throat could indicate infection from oral-genital contact Women: thin- foul smelling discharge, irritation of genitals, mild pain during urination Men: inflammation of penile foreskin and glans, urethritis, cystitis Both sexes can be asymptomatic

Abbott Testpack analysis of cervical smear in women, men fluid from penis is analyzed

Antibiotics: azithromycin,d oxycycline, ofloxacin, amoxicillin

Culture and examination of bacterium

Metronidazole, clindamycin

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Candidiasis( Candida albicans)

Fungus (vaginal )

Overgrowth of fungus in vagina, sexual contact or sharing wash cloth w/ infected person

Tricomonias is (Trichomona s vaginalis)

Protozoa sex (vaginal infection )

Women: vulva itching, foulsmelling discharge, soreness or swelling of vaginal and vulval tissue Men: itching and burning on urination, reddening of penis Women: foamy, yellowish, odorous vaginal discharge; itching, burning of vulva; Many are asymptomatic Men: usually asymptomatic, mild urethritis possible

By symptoms Sing dose of flucanazole or suppositories of miconazole, clotrimazole,or butaconazole; modification of use of other medicines and chemical agents; keep infected area dry

Microscopic examination of smear of vaginal secretion; or of culture of sample

metronidazole

Oral herpes(herp es simplex virus- type I)

Viral

Touching, kissing, contact with sores or blisters, sharing cups, towels, seats, toilet

Cold sores or fever Clinical blisters on the lips, inspection mouth, or throat; herpetic sores on the genitals

Over counter lip balms, cold-sore medication, check with physician

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Genital herpes: Herpes simplex virus-type 2

virus

Vaginal, oral, anal sex; most contagious during outbreaks

Viral hepatitis: A,B,C, D types

virus

Sexual contact, especially via anus (hep A); contact with infected fecal matter; transfusion of contaminated blood (especially hep B and C) Sex; infusion with contaminated blood; from mother to fetus during pregnancy or through breastfeeding

Painful, reddish bumps around genitals, thighs, buttocks Women can get in vagina/ cervix. Bumps become blisters that shed viral particles; other symptoms include: burning urination, fever, aches. Pains, swollen glands, vaginal discharge Asymptomatic to mild flu-like symptoms and more severe symptoms, including fever, abdominal pain, vomiting, jaundiced skin and eyes

Clinical inspection of sores; culture and examination of fluid drawn from the base of a genital sore

THERE IS NO CURE; antiviral like acyclovir, famciclovir, valacyclovir may provide relief and prompt healing over; counsel and group support

Examination of blood for hep antibodies; liver biopsy

Tx usually involves bed rest, intake of fluids, and antibiotics to ward off bacterial infections that might take hold because of lowered resistance. Alpha interferon is sometimes used in hep C tx.

Acquired immunodefi ciency syndrome(A IDS): Human immunodefi ciency virus(HIV)

virus

Initially asymptomatic or mild flu like which may disappear before full-blown AIDS. Full blown AIDS: fever, weight loss, fatigue, diarrhea, opportunistic infections such as rare forms of cancer (Kaposi) an pneumonia

blood, saliva, urine tests detect HIV antibodies; expensive tests confirm presence of HIV; dx of HIV/AIDS usually on basis of antibodies, low CD4 count, presence of indicator diseases

There is no cure for AIDS; treatment is through HAART which is a cocktail of antiviral drugs including a protease inhibitor and nucleoside analogues like Zidovudine. Newer Fusion inhibitors are also joining cocktail

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Genital warts (Human papilloma virus)

virus

Sexual contact and sharing infected towels or clothing

Painless warts, often Clinical resembling inspection cauliflowers, on penis, foreskin, scrotum, or internal urethra in men; vulva, labia, vagina, and cervix in women; may occur around rectum and anus in both genders

Methods include cryotherapy, podophyllin, trichoroacetic acid (TCA) or bichloroacetic acid (BCA), burning, surgical removal

7. List two serious reproductive health problems that may develop in men and women who have an STI (such as gonorrhea). P.536 When gonorrhea is not treated early, it can spread through the urogenital systems in both genders and strike the internal reproductive organs. In men it can lead to epididymitis, which causes swelling and Pediculosis crabs: Phthirus pubis (pubic lice) Scabies: Sarcoptes scabies Itching in pubic Clinical Lindane- a Rx area and other examinati shampoo; hairy regions to on nonprescription meds which lice can containing pyrethrins or attach pipreronal butoxide Intense itching, Clinical Lindane(Kwell) reddish lines on inspection skin where mites have burrowed in; welts and pusfilled blisters in affected areas feelings of tenderness or pain in scrotum and can lead to fertility problems. In females, the bacterium can spread through the cervix to the uterus, fallopian tubes, ovaries, and other parts of the abdominal cavity, causing pelvic inflammatory disease (PID). PID includes cramps, abdominal pain and tenderness, cervical tenderness and discharge, irregular menstruation cycle, coital pain, fever, nausea, and vomiting. PID can cause scarring that blocks the fallopian tubes which leads to infertility. 8. Provide an overview of the four stages involved in the development of syphilis. pp.538-539 Primary: painless chancre (hard, round, ulcer like lesion with raised edges) appears at site of infection 2-4 wks after contact. Usually on vaginal walls or cervix, or on external genitalia on labia in women. Men get a chancre on penile glans or may form on scrotum or penile shaft. If it is spread by anal sex, may find chancres in rectum. If oral sex, may show on lips or tongue. It will disappear in a few weeks but will continue to work within body if untreated. Secondary: wks. to months later. Skin rash of painless, reddish, raised bumps that darken and burst, oozing discharge. May also get swelling of joints, sores in mouth, sore throat, fever, headache. May feel like flu ectoparasit Sexual contact ic or contact with contaminated towel, sheet, toilet seat ectoparasit Sexual contact ic or by contact with infested clothing or bed linen, towels, other fabrics

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Latent: after secondary symptoms disappear this stage is the dormant stage that can last 1-40 yrs. Spirochetes multiply and burrow into circulatory system, CNS, and bones, May no longer be contagious to sex partners after several yrs. But pregnant women can still pass to newborns Tertiary or late stage: Large ulcer may form on skin, muscle tissue, digestive organs, lungs, liver, or serious damage as it attacks CNS or Cardiovascular system. Can get neurosyphilis which causes brain damage and results in paralysis or mental illness called general paresis. 9. Describe how the incidence of HIV/AIDS in the United States varies by age, gender, race-ethnicity, sexual orientation, and explain why subpopulation differences exist. pp. 545-547 In the United States, AIDS is predominantly found among men who engage in sexual activity with other men or share needles when injecting drugs. However, incidence of women through male to female contact is increasing rapidly among women and the rate of new cases is also increasing in people of color. The reason for differences is due to the modes of transmission. Sharing of infected needles has a high risk for contracting AIDS. Transmission can occur through breast milk and through vaginal intercourse with an infected male, since more of the virus is found in male ejaculate than female. Malefemale or male-male anal intercourse is especially risky because it often tears or abrades rectal tissue, facilitating entry of virus into the bloodstream. In the United States, many cases of male-female transmission occur among people who inject drugs and their sex partners. 10. Summarize the process by which the human immunodeficiency virus disables the immune system and promotes development of AIDS. 547-549 Spikes (gp120 spikes) on the surface of HIV allow it to bind to sites on cells in the immune system. HIV uses the cells it invades to spin off copies of itself. It uses reverse transcriptase to cause genes in the cells it attacks to make proteins to enable viral reproduction. HIV attacks the immune system by destroying the CD4 lymphocyte. CD4 is the quarterback of the immune system. It recognizes invading pathogens and signals B cells to produce antibodies that inactivate pathogens and mark them for destruction. The CD4 cell can also signal the killer T Cells to destroy infected cells. HIV cripples the bodys ability to fight off infections that it would normally be protected against through immune system. Ex. Cancer cells may proliferate. HIV can attack other white blood cells besides CD4. Over the course of HIV, as the number of CD4 cells decline, the symptoms will increase. People are most vulnerable to opportunistic infections when CD4 goes below 200 (normal is 10000 per cubic mm). AIDS is characterized by a variety of different symptoms such as swollen lymph, fatigue, fever, night sweats, diarrhea, weight lost, and diseases such as Pnuemocystis carinii pneumonia, Kaposis sarcoma, toxoplasmosis, or Herpes simplex that emerge due to the weakened immune system. 11. Define the factors that scientists think increase the risk of communicating HIV p. 550 HIV is transmitted through contaminated body fluids such as blood, semen, vaginal secretions, and breast milk. Therefore, activities such as unprotected vaginal, anal, oral genital intercourse will spread disease. Injection of drugs from an infected person can also transmit the disease. Shared needles for piercing, steroids, or tattoos can also spread disease. There are certain factors that will increase the likelihood of contracting the disease: - increased risk with increased sexual partners - anal intercourse increases risk - amount of HIV in semen- high right after initial infection and in full blown AIDS - STIS that produce genital ulcers, such as syphilis and genital herpes, may heighten vulnerability to HIV infection by allowing virus to enter circulatory system - Uncircumcised men have higher risk because genital ulcers are more common and HIV can accumulate under folds in foreskin. Additionally, the cells in foreskin are particularly susceptible to HIV infection. 79

Genetic factors may play a role- some people of western European (about 1%) descent have inherited from both parents a gene that prevents HIV from entering cells in the immune system, and are immune to HIV. There are also some prostitutes in Africa and Thailand who appear to be immune.

12. Indicate the ways that people commonly, but incorrectly believe HIV is transmitted. P. 551-552 HIV is not transmitted from donating blood- needles are discarded after single use HIV is not contracted through casual, everyday contact- ex. hugging, handshake, bumping into someone, money, drinking fountains, toilets, pools. It is also not transmitted through urine, feces, sputum, sweat, tears, or nasal secretions, unless blood is visible. HIV is not transmitted by insect bites- nor animals It is not transmitted by airborne germs or contact with contaminated food- cant get from eating food prepared by HIV infected person It is not transmitted through sharing work or home environments- not through any casual contact. As long as there is no exchange of blood or genital secretions, you cannot get through toilet, hugging, food, etc. NO cases of HIV transmission from nonsexual contact in schools or workplace have been reported.

13. Discuss three psychosocial factors underlying risky sexual behavior among young people. P. 563564. Perceived low risk of infection. Young heterosexuals think they have a low risk of contracting HIV. Therefore, they will not alter their sexual behavior. Even gay men subscribe to the Im not the type fallacy. Negative attitudes toward condom use. Some are embarrassed to buy. Risk of HIV seems to fly out of minds when opportunity for sex occurs. Some say it dampens the romantic mood in moments of passion to take time to apply condom. Many men say it deprives them of sexual pleasure. Myth of personal invulnerability. People who know about STIs think they are immune to AIDS. Many because they have remained uninfected in their risky behaviors are lulled into a false sense of security. 14. Differentiate the items in Truth? Fiction Section T/F Most women who contract gonorrhea do not develop symptoms- True but they may develop serious problems later on. T/F Christopher Columbus brought more than beads, blankets, and tobacco back to Europe from the New World: he also brought syphilis. False- refuted in 1990 T/F Gonorrhea and syphilis can be contracted from toilet seats in public rest rooms. False- Pubic lice can be contracted in this manner but not gonorrhea or syphilis T/F If a syphilitic sore goes away by itself, the infection does not require medical treatment? Falsethey can damage body when early symptoms have abated T/F Men can develop vaginal infections. Not literally true (No vaginas) but the microbes that cause vaginal infections can cause problems for men 80

T/F As you are reading this page, you are engaged in search and destroy missions against foreign agents w/in your body? True- those white blood cells are always seeking and destroying foreign pathogens within body T/F Most people who are infected with HIV remain asymptomatic and appear healthy for years? True T/F Genital herpes can be transmitted only during flare- ups of infection. False- they are more contagious during flare-ups but can still be transmitted when asymptomatic 15. Complete Running Glossary Section Bacteria-class of one celled microorganisms that have no chlorophyll and can give rise to many illnesses. Gonorrhea-STI caused by Neisseria gonorrhoeae bacterium characterized by discharge and burning urination. Can lead to PID and infertility if untreated. Pharyngeal gonorrhea- gonorrheal infection of the pharynx Opthalmia neonatorum-gonorrheal infection of the eyes of newborn children who contract disease by passing through an infected birth canal Cervicitis-inflammation of cervix Epididymitis- inflammation of the epididymis Pelvic inflammatory disease- inflammation of the pelvic region that can be caused by organisms like N. gonorrhea. Leads to infertility Syphilis-An STI that is caused by the Treponema palladium bacterium and may progress through several stages of development- from a chancre to skin rash to CNS or CV problems Chancre- sore or ulcer Congenital syphilis- present at birth Neurosyphilis- syphilis infection of CNS which can lead to brain damage and death General paresis- a progressive form of mental illness caused by neurosyphilis and characterized by gross confusion VDRL- test that is named after Venereal Disease Research Lab of US Public Health Service. Tests for treponema palladium in blood Antibodies- specialized proteins produced by the white blood cells of the immune system in response to disease organisms and other toxic substances. Antibodies recognize and attack the invading organisms substances Chancroid- An STI caused by Haemophilus ducreyi bacterium. Aka soft chancre Shigellosis. STI caused by Shigella bacterium Granuloma inguinale-tropical STI caused by Calymmatobacterium granulomatous bacterium Lympogranuloma venereum. A tropical STI caused by Chlamydia trochomatis Vaginitis- any type of vaginal infection or inflammation Bacterial vaginosis- a form of vaginitis usually caused by the Gardnerella vaginalis bacterium Candidiasis- form of vaginitis caused by yeastlike fungus, Candida albicans Trichomoniasis- a form of vaginitis caused by protozoan Trichomona vaginalis Human immuno deficiency virus- a sexually transmitted virus that destroys white blood cells in the immune system, leaving the body vulnerable to life-threatening diseases

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Acquired immuno-deficiency syndrome- a condition caused by human immunodeficiency virus and characterized by destruction of the immune system, which strips the body of its ability to fend off life-threatening diseases. Immune system- a term for the bodys complex of mechanisms for protecting itself from diseasecausing agents such as pathogens Pathogen-an agent. especially a microorganism that can cause a disease. Leukocytes-white blood cells Antigen- a protein, toxin, or other substance to which the body reacts by producing antibodies Inflammation-redness and warmth that develop at site of injury, reflecting the dilation of blood vessels that permits the expanded flow of leukocytes to the region. Opportunistic diseases- diseases that take hold only when the immune system has weakened and unable to fend off. Ex. PCP HAART- highly active antiretroviral therapy which refers to a combination, or cocktail, of drugs that is used to treat HIV/AIDS Seropositive- having a pathogen or antibodies to that pathogen in the bloodstream Seronegative-lacking a pathogen or antibodies to that pathogen in the bloodstream. HSV-1-virus that causes oral herpes, characterized by cold sores or fever blisters on lips or mouth Genital herpes- STI caused by HSV-2 and characterized by painful shallow sores and blisters on the genitals Ocular herpes- a herpes infection of the eye, usually caused by touching an infected area of the body and then touching the eye Prodromal symptoms- warning symptoms that signal the onset or flare- up of a disease Hepatitis-an inflammation of the liver Jaundice-yellowish discoloration of the skin and whites of the eyes Genital warts-an STI that is caused by HPV and takes form of warts that appear around genitals and anus Molluscum contagiosum-an STI caused by a pox virus that causes painless raised lesions to appear on genitals, buttocks, thighs, or lower abdomen Ectoparasites- parasites that live on the outside of the hosts body Pediculosis-a parasitic infestation by pubic lice that causes itching Scabies-a parasitic infestation caused by a tiny might that causes itching Outercourse-forms of sexual expression that do not involve the exchange of body fluids

16. Reinforce chapter objectives with recite and review. review on own 17. Describe the main topics in A Closer Look section A closer look discusses how to talk with your partner about STIs. It can be awkward to bring up but they stress that being infected with a fatal illness is more awkward. so they offer a few things to try: Ive brought something and Id like to use it (referring to condom) I know this is a bit clumsy but the world isnt as safe as it used to be, and I think we should talk about what we are going to do Your partner should be aware of STIS and ought to work with you to make sure things are safe and unpressured. If they dont want safe sex, reassess relationship. 18. Discuss the topic listed in a World of Diversity. Killer of Dreams discusses the topic of AIDS in Africa and why people do not take the precautions there. It follows the story of Ms. Tobela who was the first in her family to graduate from college but contracted HIV from her husband who died of AIDS. She is now poor and heartbroken because she cannot protect her 82

children from the same fate. The story emphasizes that it is not just promiscuity but poverty that is responsible for AIDS. It is high in women, especially teenage girls who prostitute themselves to make money. When women are infected so are babies. Ms. Tobelas daughter left home to have freedom to be sexually active. AIDS lives on because children whose parents are crippled by age and see family dying are left with no hope and no idea what to live for so AIDS insinuates into the next generation. TQs 1. Which of the following can be transmitted by contact from contaminated objects? a. Trichomoniasis (trich) b. Gonorrhea c. Syphilis d. Genital warts 2. Which stage of syphilis is characterized by a skin rash with reddish raised bumps that ooze and swelling of joints? a. Primary b. Secondary c. Latent d. Tertiary

Answers: 1. d. 2. b.

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Chapter 18 1. Discuss why rape by women is rare and indicate what role women tend to play when they do participate in rape. pp. 611-612 Rape by women is rare. When it does occur, it often involves aiding or abetting men who are attacking another woman. Rape by women may occur in gang rape, when women may follow male leaders to gain their approval. In some cases, a woman will lure another woman to a safe place for the rape. Or the woman may hold the other woman down while she is assaulted. 2. List the most common motives for male-to-male rape, describe the conditions under which most male rapes occur, and state why male rape victims are unlikely to report the assault. p. 611 The prevalence of male rape is unknown because most assaults arent reported. Its estimated that 1 in 10 rape survivors is a man. Most men who rape other men are heterosexual. Their motives include domination and control, revenge and retaliation, sadism and degradation, or status and affiliation (in a gang). Sexual motives are absent. Most male rapes occur in a prison. Men are more often attacked by multiple people and held captive longer. Men are expected to be strong and silent. 3. Using information derived primarily from studies of incarcerated rapists, identify some of the common psychological and behavioral traits found within this group. pp. 613-614 There is no single type of rapist. Most rapists are in control of their behavior and know it is illegal. Some feel socially inadequate and cannot find willing partners. Some rapists have long histories of violent behavior. For some rapists, violence and sex become intermeshed. It is not true that most rapists are mentally ill! 4. Repeat the five suggestions Powell provides for individuals who have been raped. p. 617 1. Dont change anything about your body- dont take a shower, comb your hair, or take off your clothes. 2. Consider reporting the incident to police. 3. Ask a friend or relative to take you to the hospital. 4. Seek help in an assertive way. Be your own advocate 5. Question health professionals. Ask about biological risks and what treatments are available. 5. Distinguish between child molesters and pedophiles, and use a sociocultural framework to explain why both child molesters and pedophiles are almost always male. p. 623 Pedophiles: is a paraphilia in which an adult finds children to be the preferred and sometimes exclusive objects of sexual desire. Involves recurrent sexual attraction to children. Child molesters: not recurrent. Molesters seek sexual contacts with children only when they are under stress or lack other sexual outlets. 6. Assess the importance of the incest taboo in promoting the survival of the human species and the stability of families and kinship groups. p. 624 One explanation of the incest taboo asserts that inbreeding would results in genetic defects or diseases. Other theorists explain the incest taboo in terms of the role it may play in maintaining stability in the family and establishing kinship ties within larger social groupings (cooperation theory: make ties between families for survival) 84

7. Compare the prevalence of, motivations for, and consequences of father-child incest to those of brother-sister incest. pp. 624-625 Brother-sister incest, not parent-child incest, is the most common type of incest. Brother-sister is also believed to be underreported because it tends to be transient and less harmful than parent-child incest. Father-daughter incest: being with affectionate cuddling. Force is not typically used to gain compliance. Father who commits incest is more religiously devout, fundamentalist and moralistic (they are less likely to sleep with extra-family people) Brother-sister incest: the brother usually initiates and assumes the dominant role. Those who report childhood incest with siblings did not reveal more evidence of sexual adjustment problems than other non-abused people. 8. Describe the family context in which incest typically occurs, and indicate how social factors such as poverty may further support the development of the sexual abuse of children. p. 625 Abusive fathers are usually dominant. There is also a history of troubled sexual relationships between the spouses. The wife often rejects the husband sexually. Often the father is under stress but cant find emotional and sexual support from his wife. He turns to his daughter for emotional and sexual support. Incest is often repeated from generation to generation Sibling incest may be encouraged by crowded living conditions and open sexuality that occurs among some economically disadvantaged families. 9. Provide a legal definition of sexual harassment and explain why this behavior is considered a form of sex discrimination when it occurs in schools and workplaces. pp. 631-632 Sexual harassment: deliberate or repeated unsolicited verbal comments, gestures, or physical contact of sexual nature that is considered to be unwelcomed by the recipient. In some cases, clients make unwelcome sexual advances to employees and these overtures are ignored or approved of by the boss. The company can get in big trouble for not acting on sexual harassment that they knew about. Employers could be held accountable if such behavior was deemed to create a hostile or abusive work environment or to interfere with an employees work performance. 10. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter) Truth: a woman is raped every 10 minutes Truth: rape if ten times greater in the US than Japan False: majority of rapes are committed by strangers. Actually, most women are raped by men they know. Truth: 10 times as many woman as men are raped in the US False: men who rape other men are gay. Most men who rape other men are heterosexual False: when women say no, they mean yes False: most rapists are mentally ill Unclear: whether women who engage a rapist should attempt to fight him off. False: father-daughter incest is the most common. Most common is brother-sister incest 11. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below. Acquaintance rape: rape by an acquaintance Sadistic rape: ritualized, savage rape in which the person who is attacked is subjected to painful and humiliating experiences, threats, or torture Anger rape: a vicious, unplanned rape that is triggered by feelings of intense anger and resentment toward women 85

Crisis: stressful situation that can involve shock, loss of self-esteem, and lessened capacity for making decisions PTSD: stress reaction brought on by a traumatic event and characterized by flashbacks, a sense of emotional numbing or restricted range of feelings, and heightened body arousal. Incest: marriage or sexual relations between people who are so closely related that sexual relations are prohibited and punishable by law Forcible rape: sexual intercourse with a non-consenting person affected by the use of force of threat of force Pedophilia: sexual attraction to children Power rape: rape that is motivated by the desire to control and dominate the person assaulted Rape: sexual intercourse that takes place as a result of force or threats of force, rather than consent Statutory rape: intercourse with a person who is below the age of consent. Stranger rape: rape committed by a stranger Sexual assault: any sexual activity that involves the use of force or the threat of force TQ: 1. What is the main kind of incest? a. Father-daughter b. Mother- son c. Brother- sister d. Grandfather- grandson 2. What is the defining characteristic of a rapist? a. Mental illness b. Anti-social personality disorder c. Socially inept d. There is no defining characteristic

Answers: C, D 86

Chapter Number 19 ~ Commercial Sex

1. Compare the background characteristics, motivations, and work conditions of the various types of prostitutes. pp. 646-647 Escort Services o Typically (but not always) fronts for prostitution and are found in every major American city o Background- come from middle class families and are well educated o Work conditions: many provide companionship for corporate functions, many provide only prostitution, however, clients of other escort services sometimes negotiate sexual services after form escort duties are completed- or in their stead Call Girls: o Occupy highest status on the social ladder of female prostitution o Background- most attractive and well educated- tend to charge more for their services; many come from middle class backgrounds o Work conditions- many work on their own so they dont have to split their income with an escort service or massage parlor; they can lead a luxurious lifestyle and be selective about customers; they incur expenses for answering services, laundry, and payoffs to landlords, to doormen, and sometimes to police May escort clients to dinner and social functions, providing not only sex but charming and gracious conversation Can give clients feeling that they are important and attractive May make incalls- in their apartment- or outcalls For protection- they review a clients business card or his home phone number before contact

2. Recognize the terms assigned to men who purchase services from prostitutes and list the six common motives men have for using prostitutes. pp. 648-649 Terms used to describe men who purchase services from prostitutes: John, trick, patron, meatball, sucker, and beefbuyer Motives for using prostitutes: 1. Sex without negotiation 2. Sex without commitment 3. Sex for eroticism and variety 4. Prostitution as sociability- a way to socialize 5. Sex away from home 6. Problematic sex 3. Differentiate the items in the chapter Truth?Fiction Section. p. (throughout the chapter) Its not true that prostitution is illegal throughout the US. It is legal in some counties in the state of Nevada, although it is restricted to regulated, state-licensed brothels Not all massage and escort services advertised in the Yellow Pages are fronts for prostitution. Legitimate masseuses and masseurs advertise that they are licensed by their state It appears that the majority of female prostitutes were in fact sexually abused as children.

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It is not true that typical customers of prostitutes have difficulty forming sexual relationships with other women. Many men often turn to prostitutes for sexual variety or because they seek sexual activity when they are away from home It is NOT true that only males are sexually aroused by pornography. Most men and women are sexually aroused by erotica, physiologically speaking. Their interested in and subjective responses to porn may differ considerably Relatively aggressive men react differently from nonviolent men to the same pornography. Its not so much that the porn makes men violent, It seems to be more likely that porn makes violent men more violent. of all internet surfing is devoted to the pursuit of porn, adult chat rooms, and the like.

4. Complete the definitions of the items in the Running Glossary Section listed in the Key Terms List below.

Running Glossary Key Terms

Call girls- prostitutes who arrange for their sexual contacts by phone. Call refers both to telephone and to being on call Whore-Madonna complex- a rigid stereotyping of women as either sinners or saints Hustlers- men who engage in prostitution with male customers Obscenity- that which offends peoples beliefs or goes beyond prevailing standards of decency or modesty Pimps- men who serve as agents for prostitutes and live off their earnings Pornography- written, visual, or audiotaped material that is sexually explicit and produced for purposes of eliciting or enhancing sexual arousal Post-traumatic stress disorder- a type of stress reaction brought on by a traumatic event and characterized by flashbacks of the experience in the form of disturbing dreams or intrusive recollections, a sense of emotional numbing or restricted range or feelings, and heightened body arousal Prostitution- the sale of sexual activity for money or goods of value, such as drugs Prurient- tending to excite lust; lewd Scores- customers of hustlers Streetwalkers- prostitutes who solicit customers on the streets

Practice with the Online Quiz!

Practice Questions: 1. What is the term that describes the customers of hustlers? a. Streetwalkers b. Johns c. Beefbuyers d. Score 2. What is a term that describes customers of female prostitutes? a. Streetwalkers b. Scores c. Johns d. Pimps

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Answers: D, C

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