Exam 2 (4 sets)

Incidence

Estimated number of new cases of a disease per year

Prevalence

Estimated number of people currently infected with a given disease per year

Pubic lice (crabs)

• Small but visible insects (~1mm) that typically live in pubic hair but can spread to other hairy areas of the skin (move by clinging on to two strands of hair)

• Feed on the blood of the host

• Possible to acquire either through direct contact or by using an infested person’s bedding, clothing, etc.

• Mainly cause itching

• Typically treated with insecticidal lotion or removed by shaving

Scabies mites

• Infestation with a parasitic mite (Sarcoptes scabiei)

• Dig tunnels within the upper layers of the skin, commonly found in hairless areas such as wrists, elbows, between fingers, knees, penis, breasts

• Lay their eggs beneath the skin

• Cause severe itching and rash on skin

• Spreads easily between people

• Treated with medicated lotion

Trichomoniasis

• Infection of the vagina or male urethra and prostate gland with a single-celled protozoa

• In women, infection marked by foul-smelling, greenish, or frothy discharge from vagina, itching and redness, abdominal discomfort, and urge to urinate frequently

• Men are usually asymptomatic, though women may also be

• Transmission occurs through coitus

• Estimated 2 million women develop infection per year

• Cured with a single dose of metronidazole

Bacterial STDs

• Main examples in US are syphilis, gonorrhea, and chlamydia

• Can be fatal (syphilis), impair fertility (gonorrhea & chlamydia)), or facilitate HIV infection (all 3)

• All are curable when treated promptly, usually with antibiotics

Syphilis

• Spread via direct contact (usually sexual) with infected person in primary or secondary stage

  • Can be transmitted from mother to fetus

  • Spread via contact with fluid from sores (chancres) which appear at infection site within 10-90 days

• There are 4 stages: primary, secondary, latent, tertiary

• Can be diagnosed by clinical signs and symptoms (bacterial fluid in discharge from chancre or antibodies to T. pallidum in blood)

• Single large injection of penicillin is curative in first year of infection

• Epidemic among heterosexual African Americans in the south and gay/bi men in cities, as well as 13% of all new cases being reported in prisons

Primary syphilis

Chancre appears at infection site within 10-90 days and heals within 3-6 weeks. This is the stage in which the individual is most infectious.

Secondary syphilis

Painless rash following the chancre healing that disappears within a few weeks. Individual is still highly infectious.

Latent stage of syphilis

Bacteria continues to multiply in the body and invades the cardiovascular system, bones, liver, and nervous system. Less infectious during this stage.

Tertiary stage of syphilis

Large ulcers appear on skin or organs after having already covered internal organs. Usually too late to treat at this stage. No longer highly contagious.

Tuskegee Syphilis Study

• Significantly eroded minority groups’ trust in US medicine

• 1932 - study of effects of untreated syphilis began on hundreds of African American men in Tuskegee, Alabama (they were not told they had syphilis)

• 1947 - penicillin was recognized as standard of care for syphilis, but subjects in study were not informed or treated

• 1972 - CDC whistleblower told the media, at which point dozens of subjects had died and 22 wives, 17 children, 2 grandchildren had contracted syphilis

gonorrhea

• Symptoms develop within 2-10 days of infection

• Caused by Neisseria gonorrhoeae bacteria

• In women, infection site is cervix

  • Symptoms include yellow or bloody vaginal discharge, bleeding during coitus, burning sensation when urination

  • Infection can spread into the uterus and oviducts causing pelvic inflammatory disease (PID) and infertility

• In men, infection site is the urethra

  • Symptoms include discharge of pus from the urethra, pain during urination

  • Infection can spread to the epididymis or prostate gland (can potentially cause infertility in men)

• Used to be treated readily with standard antibiotics, but bacterium has developed drug resistance and CDC recommends all cases be treated with Cephalosporins (special class of antibiotics)

• ~700,000 new cases reported in US every year; must prevalent in the South

Chlamydia

• Most common of all reportable infectious diseases

• Usually spread by genital contact, but may be spread by insects in tropical countries (cause of blindness)

• Symptoms appear within days

  • Women - infection appears in the cervix or urethra causing discharge, painful urination

  • Men - infection appears in urethra causing discharge and burning pain during urination

  • 75% women and 50% men are asymptomatic

• Diagnosed from cell samples from penis or cervix, or urine samples

• Can be treated with a single dose of antibiotics

• Very common in young women - CDC recommends that all sexually active women under 25 be tested once per year

  • 1 in 10 of all adolescent girls is infected

Bacterial Vaginosis

• Status as an STD has been up for debate until recently

• Normal vaginal microorganisms are replaced by other bacteria

  • Vaginal pH becomes less acidic

  • Vagina develops fishy odor, may be itching, pain, and off-white discharge

  • Many women have no symptoms

• Very common among sexually active women (particularly WSW)

Viral STDs

• Extremely small infectious particles that enter a host cell

• Once in host cell, viral genes take over and either replicate immediately or after being inactive for a period of months to years

• NOT treatable with antibiotics, and antiviral drugs are rarely curative and extremely expensive with serious side effects

• 6 main classes: pox, herpes simplex, CMV, HPV, hepatitis, HIV

Molluscum contagiosum

• Skin condition caused by a pox virus

• Characterized by small, bump-like growths on the skin which are highly contagious

• Virus transmitted by skin-to-skin contact or by contact with infected clothing or towels

• Nonsexual transmission is common, especially among children

• Does not cause any serious health condition and usually disappears within a year

  • No serious long-term effects

Herpes

• Two herpes viruses (HSV-1 and HSV-2) may be transmitted sexually

• Lifelong infection, most common STD by prevalence

• 17% of Americans aged 14-49 are infected with HSV-2, and 90% are unaware that they’re infected (asymptomatic)

• Outbreaks typically preceded by tingling or itching at infection site, and first outbreak may include fever and swollen lymph nodes

  • Reddish bumps or cluster of spots appear, which turn into blisters within 24 hours, or cracks in the skin

  • Blisters break leaving sores or ulcers that leak clear discharge containing viral particles (may be painless or mildly itchy)

• Diagnosed via lab tests on samples from sores or blood

• Treated with acyclovir (Zovirax), available as a topical ointment and the more effective oral tablets

• Considered incurable with current therapy

HSV-1

• Commonly causes oral herpes, often in form of “fever blisters” or cold sores on lips

• May be spread by sexual or nonsexual contact, can be transmitted through touch

• Infections of this type have been increasing, possibly due to the popularity of oral sex

• Less severe version

HSV-2

• Common cause of the more serious genital herpes

• Usually transmitted by anogenital contact

• Initial symptoms occur within 2 weeks after exposure (outbreak of sores at infection site)

• Genitals are most frequently affected sites (penis, labia, clitoral hood, vaginal walls)

• Most serious outbreak occurs the first time an individual is exposed

HSV-2 recurrent outbreaks

• Primary herpes infection typically resolves within 2 weeks and the sores disappear

• Virus remains inert within nerve cell bodies

• Later outbreaks typically less severe and less frequent

• Virus mainly transmitted during outbreaks, but can also happen between them

Cytomegalovirus (CMV)

• DNA virus related to HSV

• Most people don’t show symptoms (estimated 50-80% of population infected with it at some point)

• Very easily transmitted in bodily fluids

  • Daycare and nursery school workers are at risk

  • Mother-to-fetus transmission is possible

Human papillomaviruses (HPV)

• 100 different types of DNA viruses, 30 of which are sexually transmitted

• Viruses infect cells lining urogenital tract or skin near genitalia, can remain inactive or trigger cell division leading to genital warts or sin lesions

  • Many infected people are asymptomatic

• Genital warts are highly infectious and usually painless, don’t cause serious health problems, 90% caused by types 6 and 11

• Infection with types 16 and 18 is the main cause of cervical cancer (70%), and linked to anal, mouth/throat, vulval cancer

• Not likely for mother to pass along to fetus

• Most common STD in the US by incidence (50-57% of sexually active individuals)

• Most infected individuals eventually clear the virus from their bodies and become noninfectious to others within 2 years of initial infection

• Gardasil - 1st vaccine against HPV types 6,11,16,18

Hepatitis viruses

• Viruses that attack the liver - Hep B, followed by Hep A, are the most likely to be sexually transmitted

• Vaccines available against both types:

  • Combined: 3 injections over 6 months

  • Costs $120 on average without insurance

Hepatitis B

• DNA virus that can be transmitted via sex or contaminated blood

• Symptoms include jaundice

• Most people recover, but some become “chronic” and remain infectious

• Treated via drugs taken for months (suppress symptoms but don’t get rid of the virus)

Hepatitis A

• RNA virus transmitted most often by fecal-oral route (sexual or nonsexual transmission)

• Similar symptoms to Hep B but milder

• Disease cannot progress to chronic state and individual does not remain infectious after recovery - no specific treatment

AIDS (Acquired Immune Deficiency Syndrome)

• First described in 1981, fatal if left untreated → now an epidemic across the world

• Caused by HIV (human immunodeficiency virus) - an RNA virus

  • Evolved from similar virus that infects chimps in west-central Africa, spread to humans around the 1950s, first major outbreak in gay communities in SF, LA, and NYC in late 1970s

• AIDS is the name of the syndrome acquired after the HIV virus becomes active - not everyone infected with HIV develops AIDS today

• When the level of CD4 cells in blood is at or below ~200/uL, the person is considered to have AIDS

• Symptoms: acute flu-like condition; after latent period, opportunistic infections, cervical cancer, lymphoma, wasting

• Diagnosed through blood test (antibodies to virus or DNA test)

• Treated through combination of several oral antiviral drugs (HAART) - not curable

  • Preventative care through PrEP has been highly effective

HIV

• Present in high concentrations in semen and vaginal fluid

• Transmission occurs more readily in penis-to-vagina or penis-to-anus directions, risk of transmission to receptive partner is 5x higher for anal sex than coitus due to micro-tears in anus being more likely

• Presence of existing STDs increases risk

• Virus mainly targets CD4 lymphocytes

• Seroconversion occurs 6 weeks - 6 months after infection

• Symptoms subside after antibodies form and person enters asymptomatic period for 7-10 years

• Level of CD4 cells in blood gradually decline from normal level of 1000/microlitier to ~200/uL, when the person is considered to have AIDS

• Disproportionately affects MSM and African American communities

childhood sexual expression

• Children are curious about sex

• Some children engage in solitary sexual activity (autoerotic exploration)

• Interpersonal sexual activity between youth

  • Most common is talking about sex, looking at porn, kissing and hugging, showing genitals

• Varying cultural attitudes

Adult-Child Sexual Contacts

• Sexual assaults against children have become less frequent because of greater awareness/resources

• 15% of women and 7% of men report at least one childhood sexual experience involving an adult

• 80-90% of adult-child contacts involve adult touching child’s genitals

  • Most likely age bracket for child to have contact with adult male is 7-10 years

  • Most likely to be relatives and family friends (stepfathers)

• Harmful consequences depend on:

  • cultural dependence (societally criminalized vs normalized)

  • one-off vs repeated

  • trusted individual vs stranger

  • framing - are you told there will be irreparable damage?

  • how intrusive/violence or threat involved?

Preadolescent sexual activity

• Period between 8-12/13 when puberty begins

• Most sexual information learned from peers (schools are variable)

• Most time is spent in same-sex groups

• 7% experience coitus before age 13 (red flag, more likely among Black kids)

Adolescent sexual activity

• Beginning of phase may correspond with onset of menarche or first ejaculation

• Marked by great increase in sexual feelings and behavior

• Testosterone levels are strong predictor of when individual will begin partner sex

• Lower education and SES level makes individuals more likely to engage in sex before age 15

• Coitus among teens increases over time, oral sex is common

• Kissing, fondling → noncoital orgasmic contacts → coitus (for some)

• Casual sex is becoming more common, and dating is replaced by group outings

Teen pregnancy

• 4 out of 5 are unintended, & 1/3 end in abortion

• For full-term pregnancies, babies are less likely to be breastfed, more likely to have health problems

• Father is often out of the picture

• Teen birth rates have decreased, though are still disproportionately high for the US compared to other developed nations

Young adult relationship stages

• Between puberty and marriage, most young adults spend a portion of time:

  • Without a sexual relationship

  • Dating (varying degrees of sexual intimacy)

  • Cohabiting with eventual marital partner (1yr)

Cohabitation

• Increasingly prevalent form of relationships in recent decades

• Influenced by demographic factors (age, religiosity, geographic location)

• 7% of the population (50% either break up or get married within a year)

• Marriages preceded by cohabitation end more quickly because those who are more likely to get married without cohabitation are also less likely to divorce (because religion)

• 40% of couples have children, and 20% last more than 5 years

Marriage

• Serves a variety of purposes:

  • Women viewed as men’s property

  • Environment for childrearing

  • Places obligation on others to respect couple’s sexual exclusivity

  • May bring extended families/clans closer together

• Polygamy is commonplace (84% of preindustrial societies)

• Over 90% of Americans marry at least once, but the marriage rate is decreasing overall

  • African American women in inner cities are less likely to be married or cohabiting due to the high incarceration rates of black men

• Married women have sex less frequently and have fewer orgasms; marital sex becomes less frequent with increasing age

• Emotional satisfaction increases with age for men and decreases for women

Polyamory

People who participate in non-monogamous relationships. Can be many different relationship configurations (triad, etc.)

Companionate Marriage

Form of marriage in which husband and wife are expected to be emotionally and sexually intimate, and engage in social activities together.

This implies some equivalence between husband and wife in distribution of breadwinning, household, & decision-making.

Contrast effects

Occurs in long-term relationships, where men who observe different sexual stimuli or act out different sexual behaviors may find their partner to be less attractive in comparison. This is different from the Coolidge effect, which is about mating and arousal.

Divorce

• 4 main contributing factors:

  • Passage of time

    • 1 in 5 first marriages end within 5 years, 1/3 in 10yrs

  • Woman’s age at marriage (<18)

  • Ethnicity (highest odds Black, lowest Asian)

  • Educational level (without degree more likely to divorce)

• Dissimilarity shortens marriages

• Divorced people suffer higher rates of psychological and physical ill health (less happy, less sexually active, more socially isolated, more prone to substance abuse)

• Women suffer severe income drop

• Children of divorce experience higher risk of depression, behavior problems, low academic performance, substance abuse, criminality, early sexual activity

Menopause

• Average age of menopause occurs at 51

• Early menopause can be caused by fewer pregnancies, short cycles, removal of an ovary, not using oral contraceptives, smoking, genetics

• Osteoporosis related to menopause (bone density drops with lowered estrogen)

• Post-menopausal hormone therapy may be used when women have severe symptoms

Women’s sexual problems

• Lack of interest in sex

• Inability to experience orgasm

• Problems with physiological arousal

• Pain during sex

Men’s sexual problems

• Premature ejaculation

• Anxiety about performance

• Pain during sex

Sexual dysfunctions

Impairment in either desire for sexual gratification or ability to achieve it. May be caused by psychological, interpersonal, or physical factors, or a combination. Can occur in any of the first 3 phases of the sexual response cycle (desire, excitement, orgasm).

Primary dysfunction

Lifelong sexual dysfunction, where the individual has never experienced normal functioning.

Secondary dysfunction

Appears after some period of normal sexual function

Situational dysfunction

Sexual dysfunction appears in some circumstances but not in others (eg. with some partners but not others, in partnered vs solitary situations)

Dysfunctions of sexual desire

Category of disruption during the first stage of the sexual response cycle. Only 3% of the general population meets criteria for a clinical disorder regarding lack of desire for sex. Includes:

• Hypoactive sexual desire disorder

• Sexual aversion disorder

• Discrepant sexual desire

• Hypersexuality (compulsive sexual behavior)

Hypoactive sexual desire disorder

Disorder where person shows little to no sex drive or interest. Most common female sexual dysfunction in both general and clinical population. Gonadal hormones play strong role in influencing sexual desire in both men and women.

• In men, may be treated with testosterone, though side effects can include prostate disease, liver and heart disease, mood problems, balding, lower fertility

• In women, low levels of androgens can cause decreased desire and testosterone patches may help

Sexual aversion disorder

Disorder where person shows extreme aversion to, and avoidance of, all genital sexual contact with a partner (usually penile-vaginal contact). More common in women, and is usually treated with psychotherapy.

Discrepant sexual desire

Different levels of sexual activity desired by partners.

Hypersexuality

Excessive sexual desire or behavior that can be caused by some medical conditions, or may be associated with paraphilic disorders. May be treated with psychotherapy and drug therapy (SSRIs, anti-androgens). Behaviors may be related to OCD.

Compulsive sexual behavior

Compulsive cycle related to OCD thought patterns:

craving for sex → ritualized search for sex → sexual behavior → guilt/despair after sexual behavior → …

Dysfunctions of sexual arousal

Category of disruption during the second stage of the sexual response cycle. Includes:

• Male erectile disorder (impotence)

• Female sexual arousal disorder

Male erectile disorder

Recurrent inability to achieve an adequate penile erection or to maintain it through the course of sexual behavior.

• May be partial or complete; primary, secondary, or situation, and becomes much more common as men age.

• Affects 50% of men over age 60, and majority of men age 70 or older

• Causes:

  • Behavioral or lifestyle (overweight, lack of exercise)

  • Medical condition (vascular disease)

  • Drugs (smoking, alcohol, weed, etc.)

  • Injuries (spinal chord damage)

  • Psychological factors (relationship stress, anxiety)

  • Developmental issues (paraphilias)

• Treatment:

  • Medications that increase responsiveness of erectile tissue to nitric oxide

  • Hormonal treatments if penile nerves are damaged - Prostaglandin E1

  • Vacuum constriction system or penile implants

  • Psychological treatments focus on reducing anxiety and providing reassurance, as well as addressing relationship problems

Prostaglandin E1

Hormonal treatment for men whose penile nerves have been damaged and who are experiencing erectile dysfunction. Can produce erections as long as erectile tissue is intact by heightening sensitivity to nitric oxide. This drug is delivered via self-injection and is very expensive, which results in 50% of men discontinuing treatment.

Vacuum constriction system

Non-drug method to help men with erectile dysfunction that involves placing a constricting cylinder over the penis and then drawing a partial vacuum to cause an erection, increasing bloodflow to the penis. It is among the least expensive forms of treatment and is popular among older men, but it may interrupt sex.

The Eros Clitoral Therapy device (ECTD) is meant to work similarly for women, but is largely ineffective.

Penile implants

Surgical intervention to assist with erectile dysfunction. Most invasive and expensive methods that are likely to damage the erectile tissue, and are usually the last resorts.

• Semi-rigid: Soft material implant is inserted in the shaft of the penis, can be bent downwards when not being used for sex

• Inflatable prosthesis: Expandable cylinders inserted into penis with saline solution, reservoir, and pump. Cylinders fill with solution to cause an erection. More expensive but more discrete than semi-rigid.

Dysfunctions of sexual orgasm

Category of disruption during the third stage of the sexual response cycle. Includes:

• Premature ejaculation

• Male orgasmic disorder

• Female orgasmic disorder

Premature ejaculation

Persistent and recurrent onset of ejaculation with minimal sexual stimulation. This is the leading form of sexual dysfunction among young and middle-aged men, and can be primary (lifelong), secondary, or situational.

Causes are not well-understood, but may include:

• Psychological (eg. early learning context from porn, anticipatory anxiety)

• Biological (eg. dysfunction in serotonin receptors)

Treatments:

• SSRI treatment

• Sex therapy, including CBT, sensate focus technique, stop-start technique, Kegel exercises

Sensate focus technique

A form of sex therapy that involves graduated touching exercises taking sex off the table and focusing on feeling more comfortable engaging in intimacy with one’s partner.

Stop-start method

A sex therapy technique for the treatment of premature ejaculation that involves alternating between stimulating and not stimulating the penis.

Kegel exercises

Exercises to strengthen pelvic floor muscles, with the aim of improving sexual function or alleviating urinary leakage.

Male orgasmic disorder (delayed ejaculation)

Persistent delayed or absent ejaculation during intercourse. This is a fairly uncommon problem that may be a side effect of several drugs (eg. antidepressants) or due to neurological damage. Psychological causes may be possible, but treatment has not been proven effective.

Female orgasmic disorder (anorgasmia)

Persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase.

• 10-15% of US women have never experienced an orgasm under any circumstances

• Estimated 2/3 of women don’t experience orgasm during coitus

  • Many women are satisfied with sex despite infrequent or absent orgasms

• Causes may include drugs (eg. antidepressants) or medical conditions (eg. diabetes or multiple sclerosis)

• Treatment is typically psychological (modify partnered sex, add clitoral stimulation, increase sexual activity, try different positions)

Dysfunctions involving sexual pain

Category of sexual disorders that includes:

• Vaginismus

• Dyspareunia

Vaginismus

An involuntary spasm of the muscles at the entrance of the vagina NOT due to a physical disorder prevents penetration and sexual intercourse by causing pain.

• Caused by the striated muscle of the outer portion of the vagina spasming

• Usually treated through both physical therapy involving vaginal dilators that increase in size and psychotherapy that addresses anxiety

Dyspareunia

Coitus causes persistent pain in either men or women (though more common in younger women), usually with a physical basis.

• Common causes include:

  • Developmental malformations

  • Scars from vaginal tearing

  • Vaginal atrophy

  • Acute or chronic vaginal infections (STDs)

  • Vulvar vestibulitis syndrome (vulval pain)

  • Endometriosis

  • Insufficient physiological arousal (especially with older women)

• Treatment varies considerably based on cause & diagnosis

  • infections usually treated with antibiotics, antiviral, or antifungal drugs

  • Vaginal dryness treated with lubricants or topical estrogen

  • Endometriosis treated with drugs or surgery

Paraphilias

• Group of persistent sexual behavior patterns in which unusual objects, rituals, or situations are required to fulfill sexual satisfaction

• Recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors that generally involve:

  • nonhuman objects

  • suffering or humiliation of self or partner

  • children or other nonconsenting persons

• Generally all held by men, and are rare conditions

• Most do not seek treatment

Comorbidity

The simultaneous presence of two or more medical conditions in a patient.

Fetishism

• Fetish is the most important source of sexual stimulation or is essential for satisfactory sexual response

• Fetish objects are not articles of clothing used in cross-dressing or devices designed for the purposes of tactile genital stimulation

• Generally nonliving objects (eg. shoes, rubber)

Partialism

A type of fetishism that involves typically nonsexual (not primary or secondary sexual characteristics) body parts as as sexually stimulating.

Transvestic fetishism

• Individual wears articles of clothing of the opposite sex in order to create the appearance & feeling of being a member of the opposite sex, primarily practiced by cis heterosexual men

• Cross-dressing closely correlated with sexual arousal

• Often a desire to remove clothing immediately after orgasm

• NOT related to being transgender or doing drag

Sadism & masochism

• There is a preference for sexual activity as the recipient or provider of pain, humiliation, and/or bondage

• In interactions, the infliction or reception of pain/humiliation is the most common source of stimulation or is necessary for sexual gratification

BDSM

Bondage, discipline/domination, sadism, & masochism that is highly scripted, usually consensual, and typically is done in a community with strong safety measures.

Autoerotic asphyxiation

Self-strangulation that produces erotic feelings for the individual, which is highly dangerous and often comorbid with other paraphilias.

Voyeurism

• Recurrent or persistent tendency to look at people engaging in sexual or intimate behavior such as undressing, which is associated with sexual excitement & masturbation

• No intention to reveal one’s presence or become sexually involved

• May not cause perpetrator distress but is a criminal activity

Exhibitionism

• Either a recurrent or persistent tendency to expose genitalia to unsuspecting strangers, which is almost invariably associated with sexual arousal & masturbation

• No intention or invitation to have sexual intercourse with the witness(es)

• May not cause perpetrator distress but is a criminal activity

Frotteurism

Recurrent or persistent preference for touching or rubbing against a nonconsenting person.

Pedophilia

• Persistent or predominant preference for sexual activity with a prepubescent child or children (defined by body maturity, not age of preferred partner)

• Individual must be at least 16 years old and at least 5 years older than the child or children

• Differs from hebephilia (adult attracted to pubescent kids)

• Nearly all male, victims usually female between 8-11 years old

• Those who act on it are more likely to have been sexually abused as children, and to believe children initiate sexual contact/will benefit from it

Paraphilia Not Otherwise Specified

• DSM-V category included for coding paraphilias that do not meet criteria for any of the specific categories

• Common examples: telephone scatologia, necrophilia, partialism, zoophilia, coprophilia (feces), urophilia (urine)

Conditioned arousal

• Potential mechanism for development of paraphilias

• Relies on classical conditioning, where an unconditioned stimulus is paired with physiological arousal and the individual is trained to associate it with arousal

• Conditioning experimentally that has been done was weak and easily extinguished

Recidivism

• Rate of returning to prison for the same crime after being released the first time

• Relatively low for sex offenders, except for those with strongest deviant sexual preferences

• Rate for rapists steadily decreases with age, but for child molesters only see decrease after age 50, when testosterone dips

Psychological therapies

• In treatment for sex offenders, may include:

  • Aversion therapy (electric shock therapy)

  • Covert sensitization/assisted covert sensitization

  • Cognitive restructuring

  • Relapse prevention

• Not very effective in reducing recidivism

Biological & surgical treatments

• In treatment for sex offenders, may include:

  • Physical castration - low recidivism rates

  • Chemical castration with anti-androgen drugs

• Many treatment programs use combination of hormone therapy and CBT

Autogynephilia

Natal male experiencing sexual arousal at the thought of being or becoming a woman, or having the sex characteristics of a natal female

Cycle of abuse

People with paraphilias who are sex offenders are more likely to have been sexually abused as children.

Seroconversion

Person does not test positive for HIV until antibodies appear in blood (usually 6 weeks - 6 months after infection), at which point they are considered to have HIV.

CD4 lymphocytes

White blood cells targeted by HIV. When level in blood drops to 200 cells/microliter, an individual is considered to have AIDS.

HPV Types 16 & 18

The most severe and concerning types of HPV, which are the main cause of cervical cancer (70%), and linked to anal, mouth/throat, vulval cancer