Chapter 16: Sex For Sale ● Pornography: sexually arousing art, literature, or films. ○ A $4 to $10 billion dollar industry ● Obscenity: something that is offensive according to accepted standards of decency; the legal term for pornography. ● Erotica: sexually arousing material that is not degrading or demeaning to women, men, or children. ● Types of Pornography: Magazines ○ Soft-core such as Playboy has reported a circulation of 3.2 million ○ Hard-core such as Hustler has reported a circulation of 1 million ○ Playgirl has reported a circulation of 575,000 ● Types of Pornography: Films, Videos, and DVDs ○ Hard-core film industry began to emerge in a big way in the 1970s: ■ I Am Curious, Yellow (1970) ■ Deep Throat (1973) ○ 24% of U.S. adults reported seeing an X-rated movie in 1999 ○ Development of home-video camera has enabled anybody to produce homemade porn ○ Human sexuality videos combine explicit portrayals of sexual activities with commentary by a psychologist or sex therapist ● Types of Pornography: Live Sex Shows ○ Strip shows have declined in popularity, but male strippers catering to female audiences have become common ○ In the sex districts of some cities, couples or groups engage in sex acts onstage ● Types of Pornography: Telephone Sex ○ Prerecorded messages include descriptions of: ■ Hugging and kissing ■ Masturbation ■ Vaginal intercourse ■ Oral sex ■ Female domination of male ○ There are also live phone sex services ● Types of Pornography: Electronic Porn ○ Types: ■ Chat rooms ■ Newsgroups ■ Commercial bulletin boards ■ Adult Web sites ○ No face-to-face social interaction ○ Can facilitate dependence or addition ● Types of Pornography: Kiddie Porn ○ Viewed as the most reprehensible part of the porn industry ■ Children cannot give truly informed consent to participate Great potential for psychological and physical damage to children An advertisement in Screw magazine offered $200 for little girls to appear in porn films; dozens of parents responded Sex in Advertising ○ Subtle and obvious sexual promises are used to sell a wide variety of products ○ 53% of ads portraying heterosexual couples showed them engaging in sexual contact ○ Exposure to gender-stereotyped ads was associated with dissatisfaction with one’s body, among both men and women Pornography: the customers ○ Typical customer in a pornographic bookstore: ■ Educated ■ Middle-class ■ Male ■ Ages 22-34 ○ 59% of white male college students and 36% of white female college students said they went to X-rated movies or read pornographic books Feminist Objections to Porn ○ Pornography: ■ Debases women ■ Associates sex with violence ■ Glamorizes unequal power relationships ○ Feminists do not object to erotica in which men and women are portrayed in equal, humanized relationships ○ Female empowered adult entertainment includes films, cable TV programs, sex toy stores, and Web sites The Effects of Pornography ○ In response to erotic portrayals of consenting heterosexual activity, both men and women may report an increase in: ■ Sexual thoughts and fantasies ■ Behaviors, such as masturbation and intercourse ○ Exposure to material that the viewer finds unacceptable does not produce arousal ○ Most people disapprove of: ■ Paraphilic behaviors ■ Rape ■ Sexual activity involving children ○ Most people react negatively to hard-core and kiddie pornography ○ Exposure to aggressive pornography does increase men’s aggression toward women ○ Using violent pornography may predispose men toward committing violent crimes against women The Solution ○ Education is a better solution than legal restrictions or censorship ■ ■ ● ● ● ● ● ■ ■ A typical prebriefing or debriefing consists of an audiotape or printed handout reminding participants that women do not enjoy forced sex and that rape is a serious crime In 60% of studies, there were no negative effects of exposure when accompanied by an educational briefing Chapter 17: Sexual Disorders and Sex Therapy ● Sexual disorder: a problem with sexual response that causes mental distress ○ Lifelong: present since the person became sexual ○ Acquired: the dysfunction appeared after a period of normal functioning ● Kinds of Sexual Disorders ○ Desire disorders: ■ Sexual desire (libido): an interest in sexual activity ■ Hypoactive sexual desire: when the person is not interested in sexual activity ■ Discrepancy of sexual desire: when one partner wants sex considerably less frequently than the other ○ Sexual Aversion Disorders: strong aversion to sexual interaction, involving ■ Anxiety ■ Fear ■ Disgust ● Avoids any kind of genital contact with partner ● Common in persons who have panic disorder ○ Female Arousal Disorder ■ Lack of response to sexual stimulation, including lack of lubrication ■ Involves psychological and physiological elements ■ Defined partly by a women’s sense that she does not feel aroused despite adequate stimulation ○ Erectile disorder ■ Lifelong erectile disorder: never been able to have an erection that is satisfactory for intercourse ■ Acquired erectile disorder: now has difficulty getting or maintaining an erection, but has had sufficient erections at other times ○ Orgasmic Disorder: for males ■ Unable to have an orgasm or it is greatly delayed, despite a solid erection and adequate stimulation ■ Far less common than premature ejaculation ○ Orgasmic Disorder: for females ■ Lifelong orgasmic disorder: never experienced an orgasm ■ Acquired orgasmic disorder: previously had orgasms at but no longer does so ■ Situational orgasmic disorder: orgasms in some situations but not others 24% of female respondents reported difficulty in the last 12 months with having orgasms ■ Female orgasmic disorder accounts for 25-35% of the cases of women seeking sex therapy ○ Painful intercourse ■ Dyspareunia: pain experienced during intercourse ■ Vaginismus: spastic contraction of the muscles surrounding the entrance to the vagina What causes sexual disorders? ○ Hypogonadism: an under-functioning of the testes, so that testosterone levels are very low ○ Hyperprolactinemia: excessive production of prolactin ○ Physical causes include organic factors such as disease and drugs ○ Diseases associated with the heart and circulatory system are likely to be associated with the condition ○ Premature ejaculation: caused by psychological than physical factors ■ Physical factors such as a local infection or a nervous system degeneration may be involved in cases of acquired disorder ○ Male orgasmic disorder: most commonly associated with psychological factors ■ May be associated with a variety of medical or surgical conditions such as: ● Multiple sclerosis ● Spinal cord injury ● Prostate surgery ○ Female orgasmic disorder: most cases are caused by psychological factors ■ May be caused by physical factors, such as: ● A severe illness ● General ill health ● Extreme fatigue ● Injury to the spinal cord ○ Dyspareunia ■ Painful intercourse in women is often caused by organic factors: ● Disorders of the vaginal entrance ● Disorders of the vagina ● Pelvic disorders ■ Painful intercourse in men can often be caused by a variety of organic factors: ● For an uncircumcised man, poor hygiene may be the cause ● Prostate problems may cause pain on ejaculation ○ Drugs and alcohol ■ Some drugs may have side effects that cause sexual disorders ■ Effects of alcohol vary considerably ○ Marijuana ■ Many respondents report that marijuana increases sexual desire ■ ● ● ■ Chronic users report decreased sexual desire ○ Cocaine ■ Said to increase sexual desire ■ Chronic use is associated with: ● Loss of desire ● Orgasmic disorders ● Erectile disorders ○ Stimulant drugs: drugs such as amphetamines are associated with increased sexual desire, but in some cases, orgasm becomes impossible or difficult ■ People high on crystal methamphetamine have a tendency to engage in risky sexual behaviors ○ Opiates: narcotics such as morphine, heroin, and methadone ■ Have strong suppression effects on sexual desire and response ■ Long-term use of heroin leads to decreased testosterone levels in males ○ Psychiatric drugs: alter functioning of the central nervous system which, in turn, affects sexual functioning ■ Some antidepressants are associated, in both men and women, with: ● Arousal problems ● Delayed orgasm problems ○ Immediate causes: various things that happen in the act of lovemaking itself that inhibit the sexual response ○ Prior learning: things people learned earlier (childhood, adolescence, earlier adulthood), which now inhibit their sexual response ○ Interpersonal factors ■ Disturbances in a couple’s relationship ■ Anger or resentment toward one’s partner ■ Fear of intimacy can cause a person to draw back from a sexual relationship before it becomes truly fulfilling ○ Cognitive interference: thoughts that distract the person from focusing on an erotic experience ○ Spectatoring: when the person behaves like a judge of his or her own sexual performance ○ Failure of the partners to communicate: one of the more important and immediate causes of sexual disorders ○ Emotional factors: such as depression, anger, sadness, and anxiety can interfere with sexual responding ○ Behavioral or lifestyle factors: such as smoking, alcohol consumption, and obesity are all associated with higher rates of sexual disorders Therapies for Sexual Disorders ○ Behavior therapy: eliminates goal-oriented sexual performance ■ Sensate focus exercises: gradually increase the sexual component as the couple successfully completes assignments ○ Couple therapy ● ● ● ● ■ Sexual and performance anxiety reduction ■ Education and cognitive intervention ■ Script assessment and modification ■ Conflict resolution and relationship enhancement ■ Relapse prevention training Specific Treatment for Specific Problems ○ Stop-start technique: used in the treatment of premature ejaculation ○ Kegel exercises: strengthen the pubococcygeal muscle (PC muscle) along the sides of the vagina ○ Bibliotherapy: using self-help books to treat a disorder Biomedical therapies: drug treatments ○ Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) ■ Treat erectile disorders ■ Do not seem to cause priapism (an erection that won‘t go away) ○ Intrinsa: a testosterone patch for postmenopausal women experiencing low sexual desire, is in clinical trials ○ Suction devices: ■ A tube is placed around the penis until a reasonably firm erection is present ■ Can be helpful in combination with cognitive-behavioral couple therapy ○ Surgical therapy ■ The inflatable penis involves implanting a prosthesis into the penis ■ This is a radical treatment that should be reserved for cases that have not been cured by sex or drug therapy Critiques of Sex Therapy ○ Masters and Johnson reported a failure rate of about 20%, which implied a success rate of 80% ○ There is a lack of carefully controlled studies that investigate the success of various therapies compared with other therapies ○ Disorders may be given a quick fix with drugs while the patient’s anxieties and relationship problems are ignored ○ We must be sensitive to the values expressed in labeling something as being, or someone has having, a “disorder” Sex Therapy in the AIDS Era ○ AIDS, herpes, and genital warts (HPV) put modern sex therapy into a new cultural context ■ People are more interested in maintaining a long-term monogamous relationship ■ Communication skills training has become increasingly important Chapter 18: Sexually Transmitted Diseases ● Chlamydia: a bacterium that is spread by sexual contact and infects the genital organs of males and females ■ 800,000 new cases are reported each year ■ ○ ● ● ● ● ● Adolescent girls have a high rate of infection Men symptoms: thin, usually clear discharge and mild discomfort on urination, appearing 7 to 14 days after infection ■ 50% of cases are asymptomatic ● Urine sample ○ Women: 75% of cases are asymptomatic ■ Can cause damage to the cervix and cause infertility ● Urine or sample from the cervix Treatment of Chlamydia ○ Curable with azithromycin or doxycycline; does not respond to penicillin ○ Poorly treated or undiagnosed cases may lead to: ■ Urethral damage ■ Epididymitis ■ Reiter’s syndrome ■ Proctitis in men who had anal intercourse ■ Pelvic inflammatory disease ● Possible infertility, due to scarring of the fallopian tubes ● Ectopic pregnancy ● Chronic pelvic pain ■ Problems with pregnancy and risks for newborn infants of infected mothers Prevention of Chlamydia ○ Many infected people are asymptomatic and spread the disease unknowingly ○ Screening programs can identify, treat, and cure asymptomatic carriers ○ The best method of prevention is the consistent use of a condom HPV (Human Papilloma Virus): causes genital warts around the urethral opening of the penis, on the shaft of the penis, scrotum, vulva, walls of the vagina, anus, and in the cervix ○ The majority of people infected with HPV are asymptomatic ○ Highly infectious, it tends to show up 3-8 months after intercourse ○ 14% college women are infected each year, and 43% every 3 years ○ HPV is the single most important risk factor for cervical cancer ■ Also associated with cancer of the penis and the anus ○ Individuals infected by oral sex have an increased risk of cancers of the mouth and throat Diagnosing and Treating HPV ○ Diagnosis is done by inspecting warts or analyzing DNA of the patient ○ Several treatments are available ■ Podophyllin acid or bichloroacetic acid - applied directly to the warts ■ Cryotherapy - warts are frozen off ■ Laser therapy can also be used to destroy the warts ● Several vaccines are currently being tested Genital Herpes ○ A disease of the genital organs caused by a herpes simplex virus (HSV-1 or HSV-2) ○ ● ● ● ● ● ● 22% of Americans 12 years or older (45 million people) are infected by genital herpes ○ Symptoms - small, painful bumps or blisters ■ Usually found on the vaginal lips, penis, or anus ○ Treatment ■ Drug acyclovir prevents or reduces recurring symptoms and their duration, but there is no cure ■ Valacyclovir and famciclovir are new drugs that are even more effective at shortening outbreaks and suppressing recurrences ■ Scientists are actively working to create an immunization against herpes Herpes: Possible Complications ○ Meningitis ○ Narrowing of the urethra due to scarring ○ Increased risk of becoming infected with HIV ○ Transfer of virus from mother to infant in childbirth Psychological Aspects: Coping with Herpes ○ Psychological consequences need to be taken as seriously as the medical consequences ■ In one study, 9% of women and 19% of men with herpes reported feelings of isolation and loneliness ○ One highly effective treatment program combines information on herpes, relaxation training, stress management training, and imagery technique AIDS: acquired immune deficiency syndrome HIV: human immune deficiency virus; the virus that causes AIDS ○ Opportunistic diseases make take over once HIV has damaged an individual’s immune system HIV and AIDS Epidemic ○ By the start of 2003, more than 886,000 persons in the U.S. had been diagnosed with AIDS; 500,000 had died from it ○ It is estimated that one million are infected with HIV ○ In the early years of the U.S. epidemic, gay male sex accounted for the majority of cases ○ Today, women are the fastest-growing group for new HIV infection HIV and AIDS Transmission ○ Exchange of body fluids ○ Contaminated blood and needles ○ From infected woman to baby during pregnancy, childbirth, or breastfeeding ○ Anal intercourse is the sexual behavior most likely to spread AIDS ○ Heterosexual, penis-in-vagina intercourse spreads HIV as well ○ The greater your number of sexual partners, the greater your risk of getting infected with HIV ○ Condoms are 87% effective in protecting against HIV transmission during heterosexual intercourse ● ● ● ● The HIV Virus ○ HIV is one of a group of retroviruses ■ Retroviruses reproduce only in living cells of the host species, in this case, humans ○ HIV invades a group of white blood cells (lymphocytes) called T-helper or T4 cells ■ These cells are critical to the body’s immune response in fighting off infections ■ When HIV reproduces, it destroys the infected T cell HIV Diagnosis ○ ELISA (enzyme-linked immunosorbent assay) - a blood test that detects the presence of antibodies to HIV ■ Produces a substantial number of false positives ■ A waiting period of more than a week before results are known ○ Western blot or immunoblot method ■ Highly accurate though more expensive and difficult to perform ○ OraQuick rapid HIV test for blood and OraQuick rapid HIV test for oral fluid both provide test results in 20 to 30 minutes ■ Both tests must be done in clinics HIV and AIDS: Treatment ○ No cure for AIDS ○ AZT (azidothymidine zidovudine, ZDV) stops the virus from multiplying ○ DDI (dideoxyinosine or didanosine) slows the progression of the disease ○ DDC (dideoxycytidine) stops the virus from replicating ○ Protease inhibitors - attack the viral enzyme protease, which is necessary for HIV to make copies of itself and multiply ○ HAART (highly active antiretroviral therapy) ■ Patients take a “drug cocktail” of protease inhibitor combined with AZT and another anti-HIV drug ■ Helping persons survive much longer ■ Concern about the emergence of restraint strains Women, Children, Ethnic Minorities, and AIDS ○ HIV/AIDS is now the fifth leading cause of death for U.S. women between the ages of 25 and 44 ■ The third leading cause of death for African American women ○ Intervention programs should include sexual assertiveness training, in which women are empowered to insist that their sex partners use condoms ○ Children become infected ■ From an infected mother at birth = 89% ■ Because of hemophilia = 4% ■ From transfusions of contaminated blood = 6% ○ African Americans ■ 12% of the population ■ 39% of AIDS cases ○ ● ● ● Hispanics ■ 13% of the population ■ 27% of AIDS cases ○ Asian Americans and Native Americans have less than 1% of cases ○ Culturally sensitive education and prevention programs that focus on the elimination of needle sharing an unsafe sexual practices should be developed HIV and AIDS: Psychological Considerations ○ Many patients experience a reaction that is a typical response to receiving a diagnosis of incurable disease ■ Denial of the reality ■ Anger ■ Repression ○ AIDS is a socially stigmatized disease ○ Cognitive-behavioral therapy combined with stress management therapy has been shown to be effective in improving quality of life and decreasing anxiety and infection in HIV-infected people ○ Social and psychological support is essential Recent Progress in AIDS Research ○ Vaccine: researchers are working to develop a vaccine, but this is more difficult than was expected ○ Research on Nonprogressors ■ HIV-infected people who go for 10 years or more without symptoms are being studied ■ They have high levels of chemokines (HIV-suppressor factors) which can block HIV from entering cells ○ Studying people who resist infection may also yield clues to a vaccine or a cure ○ Some researchers believe that HIV’s property of rapid mutation could be used against it by forcing it to mutate to a harmless form ○ Much effort going into developing effective microbicides that will attack HIV as well as other sexually transmitted viruses ○ In the last analysis, prevention is better than a cure Gonorrhea ○ Caused by a bacterium ○ Oldest of the sexual diseases ○ Symptoms: ■ Men: pus-like discharge and painful, burning urination ■ Women: asymptomatic ○ Treatment: ■ Men: sample of discharge is examined ● A urine test is also available; urination can be painful ■ Women: cervical discharge is taken and cultured, can be spread up to the uterus ● ● ● ● ● ● ● ● ● A pelvic exam should also be performed in women, 60-80% are asymptomatic Gonorrhea: Treatment ○ The traditional treatment was a large dose of penicillin or tetracycline ○ Ceftriaxone is a highly effective antibiotic even against resistant strains ■ The only STD that successfully can be treated with an antibiotic Syphilis: Caused by the treponema pallidum bacterium ○ Incidence is much less than that of gonorrhea or chlamydia ○ Can damage the nervous system and even cause death ○ Syphilis infection makes one more vulnerable to HIV Syphilis: Symptoms and Progress ○ Major early symptom - chancre ■ A round, ulcer-like lesion with a hard, raised edge, resembling a crater ○ Syphilis proceeds in stages: ■ Primary-stage syphilis ■ Secondary-stage syphilis ■ Latent syphilis ■ Late syphilis ○ Congenital syphilis - passed from mother to infant Syphilis: Diagnosis and Treatment ○ Diagnosis: physical exam; examination of fluid from a chancre ■ VDRL: fairly accurate blood test; cheap and easy to perform ○ Treatment: antibiotics ■ Penicillin, tetracycline, or doxycycline ○ Total elimination of syphilis seems to be a feasible goal Viral Hepatitis ○ There are 5 types of viral hepatitis but hepatitis B is of most interest in a discussion of STDS ○ People with long-term hepatitis B may develop serious liver disease involving cirrhosis or cancer ○ Treatment - rest, symptom relief, antiviral treatments ○ Prevention - a vaccine for hepatitis B Trichomoniasis: caused by Trichomonas vaginalis protozoan ○ Transmitted mainly through sexual intercourse ○ Occasionally transmitted nonsexually - the organism can survive on toilet seats and other objects ○ Can lead to pelvic inflammatory disease and problems with birth Pubic lice (Crabs) ○ Tiny lice - that attach to the base of pubic hairs and feed on blood from their human host ○ Symptom - itching ○ Treatment - Nix and Rid are both available without prescription Other genital infections ○ ○ ○ ○ ○ Vaginitis: vaginal inflammation or irritation Monilia (canidida) - yeast infection Bacterial vaginosis Cystitis: infection of the urinary tract or bladder in women Prostatitis: Inflammation of the prostate gland
