Human Sexuality: Diversity in Contemporary America 10e

13: The Sexual Body in Health and Illness

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 Main Topics

Living in our bodies: the quest for physical perfection.

Alcohol, drugs, and sexuality.

Sexuality and disability.

Sexuality and cancer.

Additional sexual health issues.

Sexual orientation and health.

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 Living in Our Bodies: The Quest for Physical
Perfection (1 of 2)
Definitions of sexual health acknowledge two broad
elements:
Sexuality or relationships with a sexual or romantic
component have intrinsic value as part of health.
Healthy sexual relationships require positive experiences for
individuals and their partners.

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 Living in Our Bodies: The Quest for Physical
Perfection (2 of 2)
Good health requires us to know and understand our
bodies, to feel comfortable with them.
Requires a woman to feel at ease with the sight, feel, and
smell of her vulva and to be comfortable with and aware of
her breasts.
Requires a man to accept his body, including his genitals and
to be aware of physical sensations such as lower back pain
or a feeling of congestion in his bladder.

Our general health affects our sexual functioning.

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 Eating Disorders

Eating disorders: serious and often fatal illnesses that cause

disturbances to a person’s eating behaviors.

Most people with eating disorders have certain traits.

Low self-esteem, perfectionism, difficulty dealing with emotions,
unreasonable demands for self-control, negative perceptions of
self in relation to others, and fear of being fat.

Contrary to common media depictions, higher body weight may

increase the likelihood of sexual activity during the young adult
years, but it decreases the likelihood in adults over age 25.

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 Alcohol, Drugs, and Sexuality (1 of 4)

Belief that alcohol and sex go together is reinforced by

popular culture.

Alcohol use and sexual behavior are significant risk behaviors

in adolescent development.
Combining the two is associated with acquiring STIs.

Alcohol use among college students is very common.

Drinking is associated with sexual risks.
Disinhibition: an affect of alcohol, activating behaviors that
would normally be suppressed.
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 Alcohol, Drugs, and Sexuality (2 of 4)

Alcohol affects the ability of both men and women to become

sexually aroused.
Men may have difficulty getting or maintaining an erection.
Women may not experience vaginal lubrication.
Physical sensations are likely to be dulled.

Alcohol use has been linked to an increased risk of engaging in

risky behaviors, including unprotected sex.
Associated with exposure to STIs, HIV, unwanted pregnancies,
and sexual violence and intimidation.
Significant predictor of sexual assault in college.
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 Alcohol, Drugs, and Sexuality (3 of 4)

Aphrodisiacs: substances that purport to increase sexual

desire or improve sexual function.
Most recreational drugs actually have the opposite effect.

Marijuana users frequently report it increases frequency and

enjoyment of sexual encounters; but contradictory reports
exist.

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 Alcohol, Drugs, and Sexuality (4 of 4)

Many other drugs have numerous adverse effects and

increase risk of STIs.
Amyl nitrate, also known as “poppers”.
LSD and other psychedelic drugs.
Cocaine.
MDMA (Ecstasy or Molly).
Methamphetamine, often referred to as “crystal,” “Christina,”
“Crank,” or “Tina”.
Yohimbine, maca, horney goat weed, Ginkgo biloba, and
lotions such as Zestra.
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 Sexuality and Disability

Disability or chronic condition does not inevitably mean the

end of a person’s sexual life.

Common myths persist, including these:

People with disabilities are less sexual.
Sex means sexual intercourse.
Among those with disabilities, talking about sex is unnatural.
Sex is for younger people who are able-bodied.
Sex should be spontaneous.
Firm penis and an orgasm are requirements for satisfying sex.
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 Physical Limitations and Changing
Expectations (1 of 2)
Many people are subject to sexually limiting conditions.
Conditions may be congenital, appearing at birth, such as
cerebral palsy and Down syndrome.

With spinal cord injuries, the effects on sexual response are

generally associated with the degree and location of the
injury.

To establish sexual health, people with disabilities must

overcome previous sexual function expectations and realign
them with their actual sexual capabilities.

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 Physical Limitations and Changing
Expectations (2 of 2)
Loss of sight and hearing can present difficulties in both the
theoretical and the practical understanding of sexuality.
Can often be overcome with education or counseling.

Chronic illness can require considerable adjustments.

Diabetes mellitus may lead to nerve damage or circulatory
problems that can cause sexual problems.
Cardiovascular disease may lead to heart attack or stroke, which
will affect important aspects of daily living.
Arthritis, a painful inflammation and swelling of the joints, can
make sexual intimacy difficult.

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 Developmental Disabilities

People with developmental disabilities most often have

problems with major life activities such as language, mobility,
learning, self-help, and independent living.
Capabilities vary widely.
Three times greater risk of being sexually abused than
nondisabled peers.
Sexuality education is extremely important.

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 The Sexual Rights of People With Disabilities

Sexual rights of persons with disabilities should be the same

as those for persons without disabilities.
Sexual expression.
Privacy.
Be informed about and have access to needed services.
Choose one’s marital status.
Whether to have or not have children.
Make one’s own decisions and develop to one’s full potential.

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 Sexuality and Cancer

Cancer is a collection of related diseases in which some of the

body’s cells continually divide and spread into surrounding tissues.
Benign tumors: slow growing and remain localized.
Malignant tumors: cancerous.
Metastasis: process by which the disease spreads from one part of
the body to another, unrelated part.

Cancer can have a devastating effect on a person’s sense of self,

including their sexuality.
Education, support, and compassion are necessary.

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 Women and Cancer (1 of 2)

Most lumps and bumps are benign conditions.

Uterine fibroids, ovarian cysts, fibroadenomas of the breast.

Excluding cancer of the skin, breast cancer is the most

common cancer in women.

Lesbian and bisexual women get less routine health care,

including cancer screening—and postponing such tests can
result in later diagnoses, when cancer may be less treatable.

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 Breast Cancer Risk Factors

Most significant risk factor is age, but many other factors present
increased risk.
Inherited changes in certain genes, such as BRCA1 and BRCA2.
Personal or family history of breast cancer.
Having dense breasts.
Menarche before age 12 or menopause after age 55.
Not being physically active.
After menopause, being overweight or obese, or using combination
hormone therapy for more than 5 years.
Taking certain forms of oral contraceptive pills.
Having taken the drug DES (diethylstilbestrol) or drinking alcohol.
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 Breast Cancer Detection

Early detection is an important part of preventive care.

Mammogram: X-ray of the breast; the best way to find breast
cancer early.
Breast magnetic resonance imaging (MRI): magnets and
radio waves used to take pictures of the breast.

Most breast lumps are not cancerous.

Many disappear on their own.
Most are related to fibrocystic disease, a common and
generally harmless conditions; or are firboadenomas, also
harmless.
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 Table 1 Screening Guidelines for Early
Detection of Breast Cancer
U.S. Preventive Services Health American Congress of Obstetricians and
Risk Category Task Force, 2016 American Cancer Society, 2017 Gynecologists, 2017
Clinical Breast Exam (all ages) Insufficient evidence to Does not recommend May be offered every 1 to 3 years for women
recommend for or against aged 25 to 39 and annually for women 40 and
older
Mammogram: Women aged 40 Individual decision before age Individual decision between ages 40 and Recommends screening every 1 to 2 years
to 54 with average risk 50 45; yearly after age 45 beginning at age 40 but no later than age 50 plus
clinical breast exam every year for women 40
years or older
Mammogram: Women aged 55 Every other year Every 1 to 2 years and continued as long Every 1 to 2 years until age 75
to 74 with average risk as a woman is in good health and
expected to live 10 more years or longer
Women 75-plus with average Insufficient evidence for any Screenings should stop when life Decision to discontinue screening
risk detection methods expectancy is less than 10 years mammography should be based on shared
decision-making informed by a woman’s health
status and longevity
Women with dense breasts Insufficient evidence Insufficient evidence Insufficient evidence

Women with higher than Women may benefit from Yearly screening with MRI and a Twice yearly clinical breast exams, annual
average risk beginning screenings in their mammogram should begin by age 30 mammography, annual MRI, and self-breast
40s exams

Sources: American Cancer Society, Recommendations for Early Breast Cancer Detection in Women Without Breast Symptoms, 2014.13f.
Available: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-
recs; American Congress of Obstetricians and Gynecologists, Mammography and Other Screening Tests for Breast Problems, 2017b.
Available: https://www.acog.org/Patients/FAQs/Mammography-and-Other-Screening-Tests-for-Breast-Problems; and U.S. Preventive
Services Task Force, Breast cancer Screening, 2009. Available:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening?ds=1&s=breast%20cancer
(Last visited 5/7/15).
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 Breast Cancer Treatment

Most women undergo some type of surgery to remove the

primary tumor.
Breast conserving surgery, or lumpectomy: removal of only the
breast lump and some normal tissue around it.
Mastectomy: removal of all the breast tissue.
May be combined with other treatments.

Following a mastectomy, many plastic surgeons and oncologists

suggest breast reconstruction.
Quality of life may not be affected.
Some women remain breastless, also called “going flat”.
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 Sexual Well-Being and Adjustment After
Treatment for Breast Cancer
Treatment often results in dramatic changes to a patient’s
self-image and as a result, sexual function.
There is also worry about physical limitations; and frequent
physical and vaginal pain associated with intercourse.

Female sexual satisfaction or quality of life may not be

addressed in follow-up doctor visits.

Being comfortable with one’s own sexuality, along with

partner support, can enhance self-esteem and make coping
with cancer somewhat easier.

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 Cervical Cancer and Cervical Dysplasia (1 of
2)
Cervical dysplasia, or cervical intraepithelial neoplasia (CIN):
abnormal growth on the surface of the cervix.
Considered precancerous and can become cancer and spread.

Cervical cancer, or invasive cancer of the cervix: the most

advanced and dangerous malignancy.
Risk factors include having had sexual intercourse before age 18,
giving birth before age 16, having had multiple sexual partners,
having another illness such as diabetes or HIV, using medications
that suppress the immune system, and smoking.

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 Cervical Cancer and Cervical Dysplasia (2 of
2)
Most reliable means of early detection of cervical cancer is
the Pap test (or Pap smear).
Usually done during a pelvic exam.
If abnormal cells are found, the Pap test is followed by a
colposcopy.
If an abnormal area is seen on the cervix, a biopsy—surgical
removal of the tissue for diagnosis—will be done.
Treatment involves removal of the abnormal area; rarely does
the cervix have to be removed.

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 Figure 1 Pap Test and Pelvic Exam

Pap test and pelvic exam are used to diagnose cervical cancer or other
reproductive problems.
The Pap test (a) involves inserting a speculum into the vagina to maintain an
opening, while an Ayre spatula is used to scrape a sample from the cervix.
During the pelvic exam (b), in addition to the Pap test, a manual exam is done to
evaluate the reproductive organs.

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 Women and Cancer (2 of 2)

Ovarian cancer, which typically begins in the fallopian tubes,

is more aggressive than others because it is difficult to
diagnose in early, more treatable stages.

Endometrial cancer starts when the inner lining of the uterus

begins to grow out of control.

Vaginal cancer is rare.

Hysterectomy: surgical removal of the uterus.

Effects on a woman’s sexuality can vary.

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 Men and Cancer

Men are generally less likely to get regular checkups and

seek help at the onset of symptoms.

Early detection can often mean the difference between life

and death.

Men should pay attention to what goes on in their genital

and urinary organs, as well as in the rest of their bodies.

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 Prostate Cancer

Among American men, prostate cancer is the most common form

of cancer, excluding skin cancer.
It is a slow-growing disease, and often there are no symptoms.
When symptoms do occur, they may include urine flow issues;
difficulty in getting an erection; blood in urine or semen;
continuing pain in the lower back, pelvis, hips, or other areas;
weakness or numbness in the legs or feet; or loss of bladder
control.
Risk factors include aging, a family history, being African American
or Caribbean of African ancestry, and gene changes.

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 Prostate Cancer Detection and Treatment

Prostate-specific antigen (PSA) test: a blood test.

Poses dilemmas because levels of PSA can be elevated in men
with a benign condition called prostatic hyperplasia.
Also, the PSA test cannot distinguish between aggressive and
mild forms of cancer.

Treatment may include surgery, hormone therapy, radiation,

chemotherapy, or a combination of these.
Because prostate tumors are small and slow growing, many
men elect active surveillance rather than treatments, several
of which have potentially negative effects.
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 Table 2 Screening Guidelines for Early
Detection of Prostate Cancer
American Cancer Society,
Age 2017
Age 40 Only for men at high risk
Age 50 Only for average men
expected to live 10-plus
years
Age 55 to 69 For men who wish to be
screened; digital rectal exam
may be done with PSA test;
future screenings depend on
PSA results
U.S. Preventive Services Health American Urological
Task Force, 2017 Association, 2015
Not recommended Not recommended
Not recommended Not recommended for men
aged 40 to 54; individual
decision for men younger
than 55 and at higher risk
Benefits and harms are balance; Shared decision making
decision for testing is an between doctor and patient
individual one

Sources: American Cancer Society Screening for Prostate Cancer, American Cancer Society Recommendations for
Prostate Cancer Early Detection, 2017g. Available: https://www.cancer.org/cancer/prostate-cancer/early-
detection/acs-recommendations.html (Last visited 12/1/17); American Urological Association, Early Detection of
Prostate Cancer, 2015. Available: http://www.auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-
reviewed-and-validity-confirmed-2015) (Last visited 12/2/17); and U.S. Preventive Services Health Task Force,
Screening for Prostate Cancer. Understanding Task Force Draft Recommendations, 2017. Available:
www.uspreventiveservicestaskforce.org/Home/GetFilesByID/3059 (Last visited 12/1/17).

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 Testicular Cancer

Chance of a man developing testicular cancer is 1 in about 263;

but treatment is very successful.
Most cases can be found at an early stage—usually discovered as
a painless lump or slight enlargement or swelling of the testicle.
Treatment options include surgery, radiation, chemotherapy and
chemotherapy with stem cell transplants.
Loss of a testicle may be felt as a threat to masculinity and can
therefore have an impact on the sexual and overall quality of life
for survivors.
Remaining testicle usually can make enough testosterone to keep
a man healthy and able to reproduce.

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 Penile Cancer

Cancer of the penis is very rare in North America and Europe.

Risk factors include HPV infection, smoking, not being
circumcised, having AIDS, being treated for psoriasis with
ultraviolet light and a drug called psoralen, and age.
Perhaps the most important factor in preventing penile
cancer in uncircumcised men is good genital hygiene.
Many cases can be detected early by being alert to growths
or other abnormalities.
Treatment options include surgery, radiation, and
chemotherapy; removal of all or part of the penis is rare.

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 Breast Cancer in Men

Breast cancer is about 100 times less common among men than
among women.
Most breast disorders are benign.
Risk factors include aging, family history of breast cancer, heavy
alcohol use, inherited gene mutation, and others.
Symptoms include a lump or swelling, skin dimpling or puckering,
nipple retraction, redness or scaling, and discharge.
Diagnoses involves clinical breast examination, mammography,
ultrasound, MRI, nipple discharge examination, and biopsy.
Treatments include surgery, radiation therapy, and chemotherapy.

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 Anal Cancer in Men and Women

Anal cancer is fairly uncommon, although the numbers have been

increasing for many years.
Most cases may be due to the prevalence of HPV infection.
Risk factors include a history of cervical or precervical cancer,
having numerous lifetime sex partners, history of receptive anal
intercourse particularly under age 30, HIV infection, lowered
immunity, and smoking.
Symptoms include rectal bleeding, pain in the anal area, change in
the diameter of the feces, abnormal discharge from the anus, and
swollen lymph glands in the anal or groin areas.
Surgery, radiation therapy, and chemotherapy are the major
treatments.
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 Additional Sexual Health Issues (1 of 2)

Toxic shock syndrome (TSS): a rare, life-threatening

complication of certain types of bacteria.
Most commonly Staphylococcus aureus.
Associated with recent surgery; use of contraceptive sponges,
diaphragms, or superabsorbent tampons; or having a viral
infection.

Vulvodynia: chronic vulvar pain or discomfort of or around

the vulva with no definable cause for 3 months.
Once diagnosed, a variety of treatment options are available.

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 Additional Sexual Health Issues (2 of 2)

Endometriosis: a disorder in which the endometrium (lining of

the uterus) grows outside the uterus.
One of the most common gynecological disorders.
Symptoms include pain, spotting or bleeding, and infertility; and
though there is no cure, symptoms can be minimized.

Prostatitis: painful swelling and inflammation of the prostate

gland.
May be chronic, bacterial, or asymptomatic and inflammatory.
Treatment can include anti-inflammatory agents, antibiotics,
and/or alpha blockers.

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 Sexual Orientation and Health

Lesbian, gay, bisexual, and transgender individuals experience

unique health disparities.
Stigma, discrimination, family disapproval, social rejection, and
violence place sexual minority youth at increased risk for certain
negative health outcomes.
Numerous assessments have shown transgender individuals
encounter a range of unique barriers to accessing health care.
Additionally, fear of discrimination causes many LGBT people to
avoid seeking medical care.
One goal of Healthy People 2020 improve the health, safety, and
well-being of gay, lesbian, bisexual, and transgender persons.

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 Final Thoughts?

Living in our bodies: the quest for physical perfection.

Alcohol, drugs, and sexuality.

Sexuality and disability.

Sexuality and cancer.

Additional sexual health issues.

Sexual orientation and health.

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