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Human Sexuality Final

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
● 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
○ 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
○ 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
■ 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
■ 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
● 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
○ Spectatoring: when the person behaves like a judge of his or her own sexual
○ 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
■ People are more interested in maintaining a long-term monogamous
■ 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
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
○ 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
■ 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
○ 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,
○ 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
■ 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
■ 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
○ 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
A pelvic exam should also be performed in women, 60-80% are
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
○ 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
○ 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