human sexuality exam (COMPLETED)

comstock laws

published in 1873. information could not be proliferated via mail (considered “obscene”); only support for abstinence

what was margaret sangers influence on the distribution of contraceptives?

in 1915, she opened an illegal clinic to provide diaphragms shipped from europe and she published information about birth control in her magazine, the rebel woman

how do oral contraceptives work?

• combination, triphasic and extended-cycle: inhibit ovulation (estrogen); progestin inhibits ovulation

• progestin-only: alter cervical mucus to prevent implantation

what do oral contraceptives do?

• can help with painful or irregular periods, acne, PMS, some medical problems with uterus or ovaries

• contraindicated with history of blood clots, strokes, cancer, and heart problems

vaginal ring and transdermal patch

• release embedded hormones (synthetic estrogen and progestin) through the vaginal lining or skin into the blood stream

• fewer side effects than pill; dont have to remember to take daily

injected contraceptives

(progestin or both) inhibit secretion of gonadotropins and prevent follicular maturation and ovulation; endometrial lining of uterus thins; every 12 weeks

contraceptive implant

(1.5 inches; 3 years)

• releases a slow, steady dose of progestin

• prevents pregnancy like progestin-only minipill

condoms

(i.e. prophylactics and rubbers)

• thin latex, polyurethane, or natural membrane

female condom

worn internally by a female

male condom

sheath fits over erect penis

vagina spermicides

• contains a chemical that kills sperm

  • foams, creams, jellies, suppositories and films

  • less effective in preventing pregnancy than most other methods

cervical barrier devices

combine a physical barrier that covers the cervix and a vaginal spermicide to protect it from sperm contact

diaphragm

individually fitted by a health-care practitioner

femcap cervical cap

does not have to be fitted

intrauterine devices

• small, plastic device that is inserted into the uterus for contraception

  • disrupt ovulatory patterns

  • thicken cervical mucous

  • alter endometrial lining

  • impair tubal motility

emergency contraception

hormone pills or an IUD that can be used after unprotected intercourse to prevent pregnancy

hormone pills

birth control pills taken up to five days after unprotected intercourse

paragard IUD

inserted up to five days after unprotected intercourse and is more than 99% effective in preventing pregnancy

fertility awareness

birth control methods that use the signs of cyclical fertility to prevent conception

• low cost and side effects

• aka “family planning” method

• requires extensive training and motivation for perfect use

what are the methods that can be used for fertility awareness?

• calendar (chart menstrual cycle; 75% effective)

• standard days (avoid days 8-19)

• mucus (vaginal discharge)

• basal body temp (drops before and rises after ovulation — but only .2 degrees)

• symptothermal (mucus and temperature)

sterilization

most effective birth control method for sexually active people

female sterilization

• tubal: ligation or implant

• transcervical

male sterilization

vasectomy

how is pulling out an unreliable method for preventing pregnancy?

• removing penis from the vagina before ejaculation

• pre-cum fluid can fertilize an egg

how is lactational amenorrhea method unreliable for preventing pregnancy?

• amenorrhea common for brief period when nursing

• 80% ovulate before first period

how is douching an unreliable method for preventing pregnancy

sperm can reach uterus in a minute

advantages of remaining childfree

• more time for self and partner

• more spontaneity and less stressful marriages (e.g. time, energey for childcare)

• more financial resources and devotion to career

advantages of having children

• children give and receive love

• enhanced love between couples with shared experiences of child rearing

• builds self-esteem and a sense of accomplishment

• greater meaning and life satisfaction

female infertility

• failure to ovulate regularly

  • increases with age

  • impacted by many conditions (underweight, hormone imbalances, severe vitamin deficiencies, poor nutrition, genetics, medical conditions, stress)

  • infections and abnormalities of female sex organs (e.g. cervix, vagina, uterus, ovaries); may result from scar tissue from old infections such as STIs

  • medications can stimulate ovulation

male infertility

• too few sperm or abnormal sperm shape or motility

  • major cause is damaged or enlarged vein in testis or vas deferens

  • blood pools in scrotum → elevates temperature → impairs sperm production

  • infectious diseases (e.g. mumps, STIs)

  • alcohol, coke, or weed use and environmental toxins

artificial insemination

semen introduced into vagina or cervix

surrogacy

artificial insemination or embryo implanted in surrogate

in vitro fertilization (IVF)

ovaries stimulated, eggs removed and fertilized by sperm in lab; several implanted into uterus

assisted reproductive technology (ART)

egg removed and mixed with sperm

what are some concerns regarding assisted reproductive technology?

• financial and health costs (e.g., with multiple fetuses, high BP)

• legal, ethical, and personal dilemmas

  • extra embryos, divorces, donate to others or for research

  • genetic diagnoses: genetics can be altered before fertilization

• removal of embryos during pregnancy (cf., AL ruling about embryos? usually olny keep 1-2'; 18% twins, 1% triplets

when does miscarriage occur?

before 20 weeks

when does stillbirth occur?

after 20 weeks

what are causes of stillbirth and miscarriages

• most are due to random fetal chromosomal abnormalities

• possible causes: age > 35, smoking, alcohol (5+/wk), caffeine, coke, rejectionof abnormal fetus, damaged cervix, kidney inflammation, autoimmune reaction, diabetes, obesity

elective abortion

medical procedure performed to terminate pregnancy

medical abortion

use pills, can be done up to 10 weeks, blocks progesterone so cervix softens, uterus contracts, expels embryonic sac

suction curettage

7-12 weeks, tube attached to vacuum aspirator to draw the placenta, uterine lining, and fetal tissue from uterus

dilation and evacuation

13-21 weeks, most frequent, suction equipment, forceps, and curette for uterine walls

prostaglandin induction

hormones that cause uterine contractions

late term abortion

(intact dilation and evacuation): 20-24 weeks (illegal)

zygote

united sperm cell and ovum (in fallopian tubes)

blastocyst

multiple cells that implant (~1 week after fertilization)

when can the heartbeat be heard after the last menstrual period?

10 weeks

what happens during the second month of fetal development?

spinal canal, arms, and legs form (.5-1 inch)

what happens during the third month of fetal development?

internal organs form (3 inches)

what happens during the second-trimester development?

• begins with fourth month of pregnancy

• sex of fetus can be distinguished

• external body parts develop

• skin is covered by fine down-like hair

• growth in size and feature refinement occurs

• fetal movements felt by the end of fourth month

• weight is about 1 lb

• by the trimester end, the fetus has opened its eyes

what happens during third-trimester development?

• size and strength continues to develop

• increases from 4 to 7 lbs (on average

• down-like hair disappears

• skins becomes smoother

• protective, creamy, waxy substance (vernix caseosa) covers the fetus

what does prenatal care include?

• health assessment before pregnancy (e.g., HIV, rubella)

• folic acid during childbearing years prevents brain and spinal cord defects

• good nutrition, adequate rest, and moderate exercise

• routine health care

• prenatal education

what are some concerns about prenatal care?

substandard health care, poverty, lack of education, underlying, health conditions, gender-related factors, other factors contributing to health disparities

what are the risks of fetal development?

• fetus is dependent on the placenta

  • disk-shaped organ attached to the uterine wall and connected to the fetus by the umbilical

  • nutrients, oxygen and waste products pass between mother and fetus through the cell walls

contemporary childbirth/prepared childbirth

birth following an education process (e.g. lamaze)

first stage of childbirth

effacement or thinning of cervix (10-16 hours 1st birth)

second stage of childbirth

full dilation until delivery

third stage of childbirth

baby delivery until placenta delivery

c(esarean)-section

• child is removed through incision (~1 in 3 births)

• fetal head too large, mother is ill, fetal distress breech position

postpartum period

first several weeks after childbirth

postpartum depression (PPD)

• range of feelings

• “baby blues” affect 75% - tearfulness, mood swings

• sleep deprivation heightens stress

colostrum

yellowish liquid with antibodies and protein

when does lactation begin?

1-3 days after birth, stimulated by pituitary hormones and suckling

what are some advantages of breastfeeding?

• digestible food with antibodies

• helps uterus return to pre-pregnancy size (induces contractions)

• emotional experience that promote bonding

what are some disadvantages of breastfeeding?

• vaginal dryness due to decreased estrogen

• temporary breast tenderness and leaking milk

• harder to share feeding duties

infant sexuality

• capacity for sexual response likely present at birth

• sexual behavior is normal part of development

• infants engage in self-pleasuring activity

  • unable to differentiate sexual from sensual pleasure

what are some common behaviors at varying ages?

• 2-3 years old: masturbation often begins

• 4-7 years old: sex play begins (e.g. “doctor”)

• 5-7 years old: marriage script enactment begins

• 8-9 years old: girls and boys play separately

• 10-11 years old: interested in bodily changes

puberty

reproductive organ mature

when does puberty start?

onset: 8 to 14 years old; 2 years earlier in girls

• earlier puberty linked to earlier sexual activity and sexual risk behaviors

how does gonadotropins influence hormone production in males?

• males: testes increase testosterone production

• female: ovaries produce elevated estrogen levels

what are some primary sex characteristics of females?

• thicker vaginal walls and larger uterus

• vaginal secretions

• menarche: average age 12 or 13

what are some primary sex characteristics of males?

• larger prostate and seminal vesicles

• first ejaculation around 13 (orgasm possible before but need testosterone to act on seminal vesicle)

is masturbation more frequent during adolescence?

yes, it is more common than partnered sexual activity

what are the benefits of masturbation?

• can serve as an important avenue for sexual expression

  • an always-available outlet

  • a way to learn about one’s body and increase self-knowledge

  • no risk of STIs or pregnancy

adolescent sexting

sending or receiving sexually suggestive photos or text message via the internet, cell phones, or other electronic

• it is considering a criminal offense in some states

what are the predisposing factors of early intercourse

• poverty, family, and/or caregiver conflict, single caregiver status

• parental lack of education, supervisions or substance abuse

• poor academic performance, high consumption of sexual media content, antisocial behavior, hx of sexual victimization

what are the predisposing factors of late intercourse?

• strong religious belieges

• good school performance

• higher socioeconomic status

• high quality parent-child relationship and communication

what are the negative consequences of teenage pregnancy?

• more likely to have physical complications

• higher prenatal and infant mortality rates

• especially high risk for STIs

• impact on finances and education

• lower parenting quality

what are the effects of incorrect/inconsistent use of contraceptives?

• lack of adequate knowledge

• misconceptions about contraceptive risks

• confidentiality concerns

• fear of pelvic exam

• embarrassment

• infrequent intercourse

• difficulty communicating with partner

what are some strategies to reduce teen pregnancy?

• free, confidential contraceptive services (and disseminate info about availability)

• required evidence-based national sex education curriculum for all grades

• focus on shared responsibility (each partner) for birth control

• readily available condoms in middle schools and high schools

• increased adolescent-caregiver communication about sex

comprehensive sex education

• treats abstinence as one option

• provides broad-based, factual information

abstinence-only sex education programs

does not delay first intercourse or affect attitudes about sex

at what age is lack of sexual interest more prevalent in women?

18-39 (18-29 and 30-39) and people who are in high school or lower

in what age is lack of sexual interest more prevalent in men?

50-59 and people who are in high school or lower

at what age is failure to achieve an orgasm more prevalent in women?

30-39 and people who are in high school or lower

at what age is failure to achieve an orgasm more prevalent in men?

40-59 (40-49 and 50-59) and people who are in high school or lower

at what age is erectile dysfunction more prevalent?

50-59 and people who are in high school or lower

at what age is pain during sex more prevalent in women?

18-29 and people who are in high school or lower

at what age is premature ejaculation more prevalent in men?

30-39 and people who are in high school or lower

what are some specific sexual problems people encounter?

• DSM criteria: 75%-100% of time for at least 6 months

  • desire, excitement or orgasm-related

  • pain during intercourse

  • lifelong or acquired (at a specific time)

  • generalized (with all partners) or situational (specific situation, partner)

female sexual interest/arousal disorder

lack of or reduced sexual interest or arousal

male hypoactive sexual desire disorder

minimal experience of sexual thoughts, fantasies or interest prior to or during sexual activity

erectile disorder

consistent or recurring lack of erection sufficient for penetrative sex lasting at least 3 months

desire discrepancy

• discrepancies in preferences for frequency, type, and timing of sexual activities

• may be polarizing and contribute to relationship distress

persistent genital arousal disorder

• spontaneous, intrusive and unwanted genital arousal (e.g. tingling, throbbing, pulsating) in absence of sexual interest

• not alleviated by orgasm

• primarily affect women

female orgasmic disorder

• absence, marked delay, or diminished intensity of orgasm

• occurs despite high subjective arousal from stimulation

• situational: can orgasm with masturbation but not with partner stimulation

male orgasmic disorder (aka delayed ejaculation)

inability to ejaculate during sexual stimulation

premature ejaculation

• pattern of ejaculations within 1 minute and inability to delay ejaculation

• most commonly reported disorder among people < 40 years old

• also accompanied by distress or avoidance of intimacy to meet criteria

is (dyspareunia) painful intercourse more common in men or women?

women

genito-pelvic pain/penetration disorder

experience of pain with partial vaginal entry, during and after vaginal intercourse