Comprehensive Study Notes on Pregnancy, Sexual Dysfunction, Paraphilias, STIs, Sexual Assault, and Sex Work

Signs and Testing of Pregnancy

• Signs of Pregnancy:
  • Missed period
  • Morning sickness
  • Enlarged and tender breasts
  • Frequent urination
  • Excessive fatigue
• Confirmation:
  • Laboratory tests and physical examination.
  • Pelvic examination around the 6th week of pregnancy if lab tests are positive.

Physical and Psychological Changes During Pregnancy

• First Trimester:
  • Nausea
  • Vomiting
  • Frequent Urination
  • Leg Cramps
  • Vaginal Discharge
  • Fatigue
  • Constipation
• Second Trimester:
  • Vaginal Discharge
  • Fatigue
  • Constipation
  • Swelling
  • Varicose Veins
  • Backache
  • Heartburn
  • Shortness of Breath
• Third Trimester:
  • Frequent Urination
  • Vaginal Discharge
  • Fatigue
  • Constipation
  • Swelling
  • Varicose Veins
  • Backache

Prenatal Care and Testing Options

• Ultrasound Scan:
  • Sound waves project an image of the developing fetus on a video screen.
• Amniocentesis:
  • Needle inserted into the uterus to withdraw fluid for analysis.
  • Checks for XX (female) or XY (male) chromosomes and chromosomal defects.
• Chorionic Villus Sampling (CVS):
  • Prenatal diagnostic test of cells from the chorion (membrane surrounding the fetus).
  • Performed at 10-12 weeks gestation to identify chromosomal abnormalities and other diseases.

Effects of Miscarriage

• Range of feelings.
• Loss can strengthen relationships or create tension.

Lamaze Method of Childbirth and Stages of Labor

• Lamaze Method:
  • 12 hours of instruction over 6-8 classes during the last trimester.
  • Aims to reduce anxiety and pain of childbirth.
• Labor: First Stage
  • Primigravida: woman giving birth to first baby.
  • Multigravida: state of having given birth before.
  • Effacement: cervix flattening out and getting longer.
  • Dilation: increased size of the opening of the cervix.
• Labor: Second Stage
  • Expulsive stage of labor.
  • Begins when the cervix is completely dilated.
  • Ends when the baby is born.
  • Head usually emerges first.
  • Breech birth: baby's feet or buttocks come out first.
  • Episiotomy: cutting the perineum.
• Labor: Third Stage
  • Delivery of the placenta (or afterbirth).
  • Usually within 5 minutes after the birth of the baby.
  • Birth attendant may manually remove if it does not separate itself.
  • Stitch the episiotomy incision.

Role of Doulas

• Doulas offer emotional support during pregnancy, childbirth, and the early postpartum period.
• They have no formal status as hospital employees and are not a regulated profession.

C-Sections and Episiotomies

• Cesarean Birth (C-Section)
  • Incision made in the abdomen and uterus, and the baby is manually removed.
  • Performed when vaginal delivery would be risky to the baby or mother.
  • Rates are considerably higher in the United States than in other developed countries.

Definition of Sexual Dysfunction

• Acquired dysfunction:
  • Currently experiencing but has not always experienced.
• Situational dysfunction:
  • Occurs with one partner or in one situation only.
• Generalized dysfunction:
  • Occurs with all partners, in all contexts and settings.

Causes of and Contributing Factors to Sexual Dysfunctions

• Organic Factors:
  • Interfere with physiological or anatomical mechanisms involved in sexual desire, arousal, or orgasm.
  • Chronic diseases.
  • COVID-19 linked to erectile dysfunction.
  • Neurological conditions or diseases.
  • Age, weight, alcohol, drugs, prescription medicine.
  • Biological and psychological factors
• Sociocultural Factors:
  • Restrictive upbringing and religious training.
  • Teaching children that sex is “dirty”.
  • Traditional gender role socialization.
  • Society’s emphasis on intercourse as the sexual act and orgasm as the event necessary for satisfaction.
• Psychological Factors:
  • Child sexual abuse.
  • Anxiety, fear, guilt.
  • Depression and low self-esteem.
  • Conflict concerning sexual orientation.
  • Stress.
  • Negative views of one’s genitals.
  • Spectatoring: overthinking and overanalyzing one’s performance during sex.
• Relationship Factors:
  • Not satisfied in the relationship.
  • Ineffective sexual communication.
  • Relationship problems (e.g. unresolved conflict).
  • Performance pressure (e.g. trying to get pregnant).
  • Therapists focus on the relationship between partners before addressing a specific sexual dysfunction.
• Cognitive Factors:
  • Positive association between mindfulness and the absence of sexual dysfunction.
  • Beliefs or myths (cognitions).
  • Inadequate sex education.

Interest and Arousal Dysfunctions

• Female Interest/Arousal Disorder:
  • DSM-5 requirements: At least three of the following must have persisted for a minimum of 6 months:
    • Absent/reduced interest in sexual activity
    • Absent/reduced sexual/erotic thoughts or fantasies
    • No initiation of sexual activity and unreceptive to partner’s attempts to initiate
    • Absent/reduced sexual excitement during sexual activity in 75% to 100% of sexual encounters
    • Absent/reduced interest/arousal in response to sexual/erotic cues
    • Absent/reduced genital and nongenital sensations during sexual activity

Major Male Sexual Dysfunctions

• Premature Ejaculation:
  • Persistent or recurrent pattern of ejaculation during partnered sexual activity within 1 to 2 minutes following vaginal penetration or before the individual wishes.
  • Must be persistent for at least 6 months and experienced 75% to 100% of the time.
  • Treatment:
    • Psychosexual education to explain possible organic or psychological causes
    • Medical intervention
    • Counseling focused on sex education and communication
    • Stop/start technique (“edging”)
• Erectile Disorder:
  • Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.
  • Must have persisted for at least 6 months in 75% to 100% of situations, cause significant distress to the male.
  • Most common in men after the age of 40
  • Treatment:
    • Kegel exercises can help
    • Oral therapies
    • Penile injections
    • Transurethral suppositories
    • Rod implants
    • The vacuum pump
    • Dealing with diminished self-esteem, lack of confidence, and perceived failures

Orgasm Dysfunctions

• Female Orgasmic Disorder
• Delayed Ejaculation

Genito-Pelvic Pain and Penetration Disorders

• Genito-Pelvic Pain Disorder
  • Persistent genito-pelvic pain/penetration disorder (GPPD): Recurrent difficulties accomplishing vaginal penetration during intercourse, pain during vaginal intercourse/penetration attempts, and fear/anxiety surrounding such attempts
  • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
  • Must have persisted for a minimum of 6 months and causes distress
  • May be a protective response to prevent pain.
• Vaginismus
  • Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration
  • May be a protective response to prevent pain.
  • Treatment
    • Gynecological examination to determine organic or physical cause
    • Teaching the woman to insert a dilator or objects of graduated size into her vagina while she is relaxed
    • Systematic desensitization
    • Kegel exercises
    • Therapy
• Dyspareunia
  • The recurrent or persistent genital pain associated with intercourse or attempts at sexual intercourse
  • Experienced by either women or men.
  • The most common cause of painful intercourse among postmenopausal women is lack of estrogen.
  • In men, inflammations of or lesions on the penis (often caused by herpes), Peyronie’s disease, and urethritis may cause pain.

Approaches Used in Sex Therapy

• Cognitive Behavioral Sex Therapy
  • Negative thoughts and attitudes about sex interfere with sexual interest, pleasure, and performance
• Mindfulness-Based Therapy
  • Origins in Buddhist meditation.
• PLISSIT Model Approach
  • Permission, limited information, specific suggestions, and intensive therapy
• Effectiveness of Sex Therapy
  • Difficult to provide data
  • Degree of effectiveness depends on the problem
  • Presence of restrictive religious beliefs, depression, or paraphilia

Defining "Normal" Sexual Behavior

• Prevalence
• Moral Correctness
• “Natural”ness (procreation)
• Sexual behaviors are usually considered normal if they are adaptive, comfortable, and have positive outcomes for the participants.
• Historical variations in definitions

Origins of Kink

• Identity
• Nurture
• Negation
• Nature
• Uncertainty

Legal and Illegal Paraphilias

• Based on the DSM-5
• Do not necessarily meet legal or other nonmedical criteria for mental disability
• Depends on the degree to which the rights of others are affected
• Varying levels of criminal acts

Types of Paraphilias

• Paraphilia: Overdependence on a culturally acceptable or unusual stimulus for sexual arousal and satisfaction
• Essential elements: recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors generally involving:
  • Nonhuman objects
  • The actual suffering or humiliation of self or partner
  • Children or other nonconsenting persons

Theories Explaining the Origins of Paraphilias

• Origins: Psychoanalytic Theory
• Origins: Feminist Theory
  • Paraphilias as expressions of aggression and status more than mere sexuality
  • Many more men than women with paraphilias
  • Cultural perpetuation of traditional gender roles that emphasize male dominance, entitlement, sexual aggression, and control
• Origins: Learning Theory
  • Paraphilias learned by means of both classical and operant conditioning
  • Rachman pairing women’s boots with erotic slides of nude women.
  • Operant conditioning: Learning theory that behavior is learned in reference to its consequences; a behavior that is punished will decrease in frequency, while a behavior that is reinforced will increase in frequency
• Origins: Biological Theory
  • People as biologically wired to respond erotically to atypical stimuli
  • Paraphilias are associated with having a mood disorder, major depression, bipolar disorder, anxiety disorder, impulse control disorder, or avoidant personality disorder.

Treatment Options for Paraphilias and Alternatives

• Legal involvement
• Some seek treatment voluntarily.
• Treatment begins with a thorough assessment.
• Therapist gathers law enforcement report, victim statement, presents investigation and summaries of previous placements and treatment.
• Interviews with the client and relevant other people
• Models for treatment view sex as a biological drive that can be disturbed in both intensity and direction.
• Usually focused on decreasing deviant sexual arousal, increasing nondeviant sexual arousal, teaching social skills, changing faulty cognitions, resolving sexual dysfunctions, managing substance/alcohol abuse, or a combination
• Chemical castration
  • Administration of Depo-Provera or other androgen-blocking drugs
• SSRIs
  • Serotonin may reduce arousal as well as compulsive urges
  • Difficult to get offenders to take such drugs voluntarily

Prevalence and Incidence of STIs in the United States

• 26 million new STI occurring each year
• 30,000 new cases of HIV each year

How Ignorance Promotes STI Infection

• Only 32 States mandate sexual HIV/AIDS Education
• Of those 32 states only 17 require the information to be medically accurate

Factors Associated with Contracting an STI

• Exposure: The rate of sexual contact between uninfected people and infected individuals
• Transmission: The probability of an exposed person acquiring the infection
• Duration: The length of time an infected person is contagious and able to spread the disease
• Level of Arousal: The length of time an infected person is contagious and able to spread the disease

Protection Against STIs

• There is no such thing as safe sex, only safer sex
• To minimize risk of infection:
  • Communicate honestly about sexual histories
  • Get regular STI tests
  • Use barriers during oral, vaginal, and anal sex
  • Avoid sharing sex toys
  • Lubricants can reduce risk of internal tears and make sex more pleasurable
  • Maintain personal cleanliness & hygiene, but avoid douching
  • Use common sense and exercise good judgment

Treatment Options for STIs

• Bacterial infections: chlamydia
  • Most prevalent bacterial STI
  • All bacterial infections can be transmitted via oral, anal, or vaginal sex
  • Can be cured by antibiotics, but symptoms are often minimal and people may not know they are infected
  • If left untreated, it can develop into pelvic inflammatory disease and potentially cause infertility
• Bacterial infections: Gonorrhea
  • Rates have dropped dramatically since the 1970s, but it remains one of the most common bacterial STIs
  • Symptoms are often minimal; untreated infections can cause infertility
  • Also treated with antibiotics, but many strains are developing resistance and are becoming harder to treat
• Bacterial infections: Syphilis
  • Rates have dropped dramatically over the years, but there has been a recent uptick in cases
  • Symptoms are more noticeable (e.g., chancre in primary stage, rash in secondary stage)
  • Effects can be devastating if left untreated
  • Penicillin remains the primary treatment
• Viral infections: HPV
  • Human papilloma virus (HPV)
  • Most common viral STI
  • Spread via sexual activity and skin-to-skin contact
  • Can be transmitted even if using condoms
  • Some strains cause genital warts; other strains linked to cancers of the cervix, anus, and throat
  • Vaccines can now protect against highest risk strains
• Viral infections: Herpes
  • Characterized by painful blisters on or around the mouth (cold sores, typically HSV- 1) or genitals (typically HSV-2)
  • Highly contagious and easily spread through sexual activity, skin-to-skin contact, & kissing
  • Condoms do not provide full protection
  • Symptom severity and frequency varies across persons
  • Antiviral medications can manage outbreaks
• Viral infections: Human immunodeficiency virus (HIV)
  • Retrovirus that targets the immune system
  • When one has HIV and a T4 count that drops dangerously low, it becomes the acquired immune deficiency syndrome (AIDS)
  • Spread via sexual activity or direct blood contact
  • Daily antiretrovirals can prolong transition from HIV to AIDS, but no cure exists
  • Taking daily antiretrovirals can potentially prevent against infection taking hold among persons at high risk (Grant et al., 2010)
  • Known as pre-exposure prophylaxis (PrEP)
  • Not a replacement for condoms, but rather an additional layer of protection

Script for Disclosing an STI to a New Potential Sex Partner

• I have something to say, and I want you to wait and hear all the information before reacting. This is difficult for me to talk about, and I know this is going to sound and feel scary for you. The reason I want to talk to you about this is because I like you, care about you, and want to be honest with you. I have (insert STI). I have spoken to doctors, therapists, nurses (insert desired professionals) and feel confident in my abilities to keep it under control and keep you from contracting it. I feel very aware of when I am having a flare/outbreak and know how to stop it. (Insert detailed information about pertinent treatments and safe sex practices relevant to the specific STI.) I want us to be able to have a continued open dialog about concerns as they arise
• Additional thoughts about disclosing:
  • The disclosing person might want to include sharing how they contracted the STI.
  • • The disclosing person might want to anticipate shock and initial fear from their partner until they hear the facts/learn more information from professionals or do their own internet research.
  • The disclosing person should set aside a few hours to reveal having an STI. (The script may be short in writing, but it takes a long time to process the emotions and questions.)
  • The disclosing person might want to include an escape clause to the disclosure script. For example, “I under - stand if you want to end the relationship.”

Prevalence of Rape and Sexual Assault

• Forcible rape: Sexual force involving three elements: sexual penetration; use of or threat of force; and nonconsent of the victim
• Statutory rape: Sexual intercourse without force with a person below the legal age of consent
  • Age of consent varies by state.
• Marital rape: Forcible rape by one’s spouse
  • Now illegal in all states
• Varied and restrictive legal definitions associated with rape
• Forced sex: Acts of sex (or attempted sex) in which one party is nonconsenting, regardless of age and whether or not the act meets criteria for what legally constitutes rape (also called rape)
• Prevalence of Rape
  • 29% of college men report engaging in sexual assault behavior.
  • 37% percent of women reported an “involuntary” sexual experience (Caron, 2021).
  • Alcohol and cannabis are associated with being raped.
  • Depression role in being sexually victimized

Theories of Rape

• Theories: Evolutionary and Biological
  • Anatomy, biologically based drives, and natural selection for reproductive success
  • Male’s greater physical strength
  • Strong biological sex drive in men
  • High level of sex hormones
  • Criticized
  • Societies differ in their rape rates.
• Theories: Psychopathological
  • Rapists viewed as having a mental disorder.
  • Criticisms
  • Subject populations used for studies on rapists have been made up of incarcerated rapists.
  • Not all rapists display the same symptomology or show marked deviation on standard psychological tests.
• Theories: Feminist
  • Emphasizes the unequal distribution of power between men and women in society.
  • Rape viewed as an act of power and dominance that employs sex as a method.
  • Support
  • Prevalence of rape in different societies varies according to the degree of inequality between men and women.
• Theories: Social Learning
  • Learning aggressive behavior toward women
  • The sex-violence linkage effect
  • The modeling effect
  • The desensitization effect
  • The rape myth effect

Consequences of Rape and Treatment for Rape Survivors

• Consequences of Rape
  • Outcomes negative and long-lasting
  • Greater anxiety, depression, stress, a lower mental health-related quality of life
  • Role of social support
  • Initial reactions
  • An acute period of negative emotions
  • Self-blaming
  • Rape trauma syndrome: Acute and long-term reorganization process
  • Post-traumatic stress disorder: Reactions following traumatic events
  • Abuse of alcohol
  • Associated with repeat victimization
  • Physical consequences of STI and HIV infection and pregnancy
• Treatment for Rape Survivors
  • Great variability among survivors and multiple recovery pathways.
  • Trauma (e.g., induced by sexual victimization) is a brain injury.
  • Primary goals of therapy:
    • Education about trauma
    • Revisiting the trauma event
    • Reprocessing irrational/unhealthy thinking patterns
    • Mastery of trauma reminders

Strategies for the Prevention of Rape

• Ending rape culture is a major cultural challenge.
• Addressing issues in all people
• Education in self-respect and speaking out
• Modeling from the home
• Expand Title IX
• Actively investigate and prosecute cases.
• Mandatory workshops in nonsexist behavior and identifying sexual harassment in the workplace for everyone

Intrafamilial and Extrafamilial Child Sexual Abuse

• Intrafamilial child sexual abuse:
  • Exploitative sexual contact or attempted or forced sex that occurs between related individuals when the victim is under the age of 18
  • Include biologically related individuals, stepparents, and stepsiblings
  • Regardless of demographics
  • Fathers as perpetrators
  • Blatant abuse of power and authority
  • Contributing factors
  • Extreme paternal dominance, maternal disability, and the imposition of the mothering role on the oldest daughter
  • Some fathers force themselves on their daughters.
  • May begin with affectionate cuddling
  • Brothers as perpetrators
    • More common than parental abuse
    • Victims more likely to endorse feeling like damaged goods, to endorse thinking that they had suffered psychological injury, and to have undergone psychological treatment for child sexual abuse.
  • Women as perpetrators
    • Specific data are lacking.
    • These women felt lonely with their “secret,” inauthentic, and stigmatized.
    • Lack of support, help, or resources
• Extrafamilial Abuse
  • Extrafamilial child sexual abuse: Attempted or completed forced sex, before a child reaches the age of 14, by a person who is unrelated to the child by blood or marriage
  • Strangers make up only 10%.

Consequences, Treatment, and Prevention of Child Sexual Abuse

• Consequences of Child Sexual Abuse
  • Emotional, psychological, and substance use issues
  • Suicide ideology
  • Gateway to mental illness, substance abuse, and incarceration
  • Sexual abuse by partner
  • Impact on family members
  • Buffering effect
• Treatment
  • Treatment for the abuser
    • Incest as a family problem
    • Counseling begins immediately.
    • Individuals are first seen alone, then as a family.
    • Focus is to open channels of communication.
    • Confrontation between the perpetrator and the victim
    • Apologizing and taking full responsibility
    • Mother’s responsibility for not having been more vigilant
    • Child to be absolved of any guilt
    • Focus should be on empowering the survivor to take control over their own life.
  • Treatment of Perpetrators
    • Convicted sex offenders are much more likely to recommit sex offenses than any other type of felon.
    • Sex offenders rarely seek treatment on their own volition.
    • Most in treatment are required to be there.
• Prevention
  • Megan’s Law: Federal law that requires that convicted sex offenders register with local police when they move into a community

Definition, Theories, and Consequences of Sexual Harassment

• Sexual harassment:
  • Unwelcome verbal or physical conduct of a sexual nature; unreasonably interferes with work or school performance and creates an intimidating, hostile, or offensive work, educational, or domestic environment.
  • Sexual terrorism
  • Definitions may vary, but there is agreement on two elements:
    • Inappropriate for the context
    • Unwanted by a participant or observer
  • May involve harassing anyone, but generally men targeting women.
  • Hostile environment
  • Quid pro quo
  • Some common behaviors
    • Touching, questions, comments, and graffiti
  • Victim can be anyone affected by the offensive conduct.
  • Street harassment
    • Obscenities, whistles and sexual gestures, following, threats
    • Also known as catcalling
    • Most common form of male-on-male harassment targets are thought to be homosexual.
    • GBQT men are 47% more likely to experience sexual violence than men who are heterosexual.
• Theories of Sexual Harassment
  • Natural/biological model
    • Natural consequence of men’s sex drive
  • Sociocultural model
    • Patriarchal oppression of women
  • Organizational model
    • Considers the power hierarchies, norms, and situations that may be conducive to sexual harassment
  • Gender-role spillover model
    • Hypothesizes that workers bring gender-biased behavior expectancies into the workplace, even if these beliefs are not appropriate for work.
• Consequences of Sexual Harassment
  • Can be devastating
  • Shattering the victims’ core assumptions about the world and themselves
  • Considerable psychological distress

Sex in Advertising and Internet Sexuality

• Sex is used to sell everyday products with skimpy attire, subtle sex ideas
• Advantages of sexuality on the internet: Sex information, anonymous STI testing resources, find a partner, find a sex partner, maintain a long distance relationship, experience cybersex, connect disenfranchised or marginalizes individuals, try out a new identity or sexual orientation, buy sex products online.
• Disadvantages: Cybersex crime or catfishing, online pornography sex addiction, online pedophiles
• Criminal Sexual Behavior Categories
  • Category I: Criminal acts that require enforcement to protect society (Rape and child molestation are examples.)
  • Category II: Sexual acts with potential victimization (Exhibitionism and voyeurism are examples. Although these behaviors may not be regarded as morally severe, they may create harm to the victims, who deserve protection.)
  • Category III: Sexual acts midway between those considered morally reprehensible and those creating victims (Sex work and adultery are examples. Both are said to reflect immorality, and both have the potential to produce victims—the sex workers, or the spouse or children of the adulterer.)
  • Category IV: Sex acts between consenting adults (In some states, for example, oral sex is still against the law.)
  • Category V: Behaviors that do not involve sexual contact but are either criminalized or considered to be sex crimes (Abortion in countries where it is illegal, and the sale and distribution of child pornography are examples.)
• Sex Businesses
  • Phone sex
  • Camming
  • Nude erotic dancing
  • Erotic massage parlors

Pornography And Its Effects

• Pornography has provided variety in sexual activities, enhanced sexual communication, and improved relationship intimacy.
• Analysis of nationally representative data of 3,750 individuals in committed romantic relationships revealed that frequency of pornography use, both alone and with the partner, was positively associated with the frequency of sexual intercourse, oral sex (both giving and receiving), anal sex, and the use of sex toys.
• Other findings said there was an increase in unrealistic expectations and masturbation.

Types of Sex Work and Demographics of "Johns"

• Streetwalker
• Window/Open door sex worker
• Erotic Massage Parlor worker
• House sex worker
• Call girl
• Sugar Baby
• Indirect sex workers
  • Sex for rent. A single parent, student, or unemployed individual may bargain with their landlord to “forgive the rent” in exchange for sex. This is an example of survival sex trading referred to earlier.
  • Beer girls. These are females hired by major beer distributors to flirt with customers at beer exhibitions. The side hustle is that they may bargain to meet patrons later for sex.
  • Bar girls. A male goes into a bar for a drink and discovers a woman sitting next to him who “chats him up.” Soon, she asks if he is interested in going to her place? Picking up guys for sex is her way of generating an income.
  • Lap dance. Stripping contexts, sometimes referred to as “Gentlemen’s Clubs,” feature women who sit with patrons and offer to dance in front of them for an “extra fee.” This may be followed by the offer for sex either on or off the property.
  • Beach boys/Gigolos. Some women go on Caribbean island vacations and hire male sex workers to service them.
  • Swinger clubs. Some swinging clubs provide extra females.
  • Elevator girls. A single unattached male may step into an elevator at a hotel to discover that a sex worker is also riding up and will get off at his floor, walk down the hall with him, and ask “Would you like a date?”
  • Truck stop girl. These sex workers may climb up into the cab at a truck stop and ask the driver for a date. Some may use a CD radio to alert a trucker headed in their direction that “I’ll be waiting for you at the truck stop at exit 69.”
  • Geisha girls. In large cities, some Geisha houses provide attentive women to take care of the needs of the patrons. While the public offering may be polite/submissive conversation, sex may be on the menu.

Definition of Sex Trafficking

• Recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act.