Human Sexuality in a World of Diversity, 6e Canada Version By Spencer A. Rathus Solution Manual

Type:

Solution Manual

Resource:

Human Sexuality in a World of Diversity

Edition:

6th Edition

Author(s):

Spencer A. Rathus Alex McKay Lois Fichner-Rathus Robin Milhausen

INSTRUCTOR’S MANUAL Heather L. Armstrong University of British Columbia

Human Sexuality in a World of Diversity Sixth Canadian Edition Spencer A. Rathus The College of New Jersey

Jeffrey S. Nevid St. John’s University

Lois Fichner-Rathus The College of New Jersey

Alexander McKay Ryerson University

Contents Chapter 1

Studying Human Sexuality: An Introduction

Chapter 2

Using Theory and Research to Understand Human Sexuality

Chapter 3

Female and Male Anatomy and Physiology

Chapter 4

Sexual Arousal and Response

Chapter 5

Gender Identity and Gender Roles

Chapter 6

Attraction and Love

Chapter 7

Relationships, Intimacy, and Communication

Chapter 8

Sexual Behaviours and Fantasies

Chapter 9

Sexual Orientation

Chapter 10

Conception, Pregnancy, and Childbirth

Chapter 11

Contraception and Abortion

Chapter 12

Sexuality Across the Life Span

Chapter 13

Sexual Problems and Dysfunctions

Chapter 14

Sexually Transmitted Infections

Chapter 15

Sexual Health Education

Chapter 16

Sexual Variations

Chapter 17

Sexual Coercion

Chapter 18

Sex Work and Sexually Explicit Material

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Chapter 1

CHAPTER 1 Studying Human Sexuality: An Introduction CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

What Is Human Sexuality?

Learning Objective 1

The Diversity of Human Sexuality

Learning Objective 2

Canadian Society and Sexuality

Learning Objective 3

Global Diversity in Attitudes Toward Sexuality

Learning Objective 4

Sexuality and Values

Learning Objective 5

Discussion Question 1

Supplemental Materials IM Activity: Introductory Topics Activity & Creating a Good Learning Space

Discussion Question 2

Discussion Question 3 Thinking Critically About Human Sexuality

Learning Objective 6

Perspectives on Human Sexuality

Learning Objective 7

Teaching Tip 1

Discussion Question 4 Teaching Tip 2

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IM Activity: Critical Thinking Activity IM Activity: Human Sexuality and the Internet IM Activity: Small Group Discussion Questions: Changing Gender Roles 1-1

Chapter 1

CHAPTER SUMMARY The chapter begins by defining human sexuality and discussing the many ways that sexuality is characterized by diversity. The different ways of defining “sex” are discussed – biological, physical, and psychological, and the authors distinguish between biological or anatomical “sex” and “gender”, referring to social or cultural categories. Human sexuality is defined as the ways we experience and express ourselves as sexual beings.

The authors then examine ethnocultural diversity related to sexuality within Canada and compare Canada to other countries with respect to attitudes toward sexuality. The authors describe the sexual beliefs, norms, and practices of Inis Beag and Mangaia, two very different island cultures, to highlight the importance of culture and diversity in human sexual expression. The authors suggest that making choices is a critical part of our development sexually and propose that scientific information as well as morals and values can inform sexual decision making.

The diversity of Canadian society is discussed with particular emphasis on sexual attitudes and behaviours. Political, social, and religious differences between Canada and other countries are highlighted, with particular emphasis on sexual scripts in Kenya.

Comparisons between Canada and the United States are drawn. The exploration of sex related behaviours and beliefs worldwide is introduced.

The authors then look at values and sexuality and the importance of using critical thinking to examine sexuality. Ethical issues related to sexuality are raised, and the World Association for Sexual Health’s (WAS) principles of sexual rights are introduced.

Readers are informed of the importance of critical thinking about sexual information and suggestions for critical thinking are given.

The chapter concludes with an overview of the many different ways of looking at human sexuality. The authors present historical, biological, cross-species, sociological, and anthropological perspectives on human sexuality. The historical approach contextualizes sexuality by examining the cultural norms and ethics of a particular time and place. The authors give a brief overview of various societies throughout history. Issues such as bisexuality, homosexuality, pederasty, sadomasochism, and gender roles are described in light of the social and political context of each society. The section ends with a brief introduction to the scientific study of human sexuality and recent trends and advances in the study of human sexuality.

The biological perspective focuses on the roles that genetics, the nervous system, and other biological factors play in human sexuality. The cross-species perspective provides an introduction to analogues of human sexual behaviour in other animals. It also points to the fact that as we climb the “evolutionary ladder,” psychosocial factors start acquiring a greater relevance in determining the occurrence and "quality" of the sexual response. The sociological and anthropological perspectives emphasize the ways that cultural context and social factors shape sexual values, beliefs, and behaviour.

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Finally, the authors suggest that considering multiple approaches is the most effective way to understand the complexity and range of human sexual behaviour.

LEARNING OBJECTIVES 1. Define human sexuality.

2. Identify ways in which human sexuality is characterized by diversity.

3. Describe the interaction between ethnocultural diversity and attitudes toward sexuality in Canada.

4. Compare and contrast attitudes toward sexuality in different countries.

5. Define the value perspectives that people use to evaluate sexual behaviours.

6. Identify and describe the key elements of critical thinking.

7. Discuss the various ways of looking at human sexuality.

TEACHING TIPS 1. Clip a recent newspaper article on a sexuality issue. Distribute copies to students. Have the class examine and discuss the article, keeping in mind the features of critical thinking.

2. Suggest a topic to the students, for example, desired characteristics in a dating or marital partner. Have them break into small discussion groups and assign each group a different approach to guide their discussion. Or have pairs of students discuss the topic from each perspective and then discuss as a class. How would someone who subscribes to the biological perspective explain partner choice? What about the anthropological perspective? The sociological perspective?

DISCUSSION QUESTIONS 1. What modern beliefs, myths or practices can you trace to the influences of earlier eras?

2. How can ethnocentrism interfere with one’s willingness to learn about and accept cultural differences?

3. Is it possible to apply a single “code” of sexual rights to all cultures?

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4. This chapter covers several different perspectives on human sexuality. Do you think some of these perspectives can explain our sexuality better than others? Which of the perspectives make(s) the most sense to you?

ADDITIONAL RESOURCES Web Sites http://sexualityandu.ca A Canadian site providing the latest news and updates related to sexual health. http://www.siecus.org The site of an American non-profit organization devoted to sex education. http://www.sieccan.org The site of a Canadian non-profit organization dedicated to informing the public and professionals about human sexuality. http://www.kinseyinstitute.org The site of the institute founded by Alfred Kinsey at Indiana University. It is devoted to research in sex, gender, and reproduction. Provides information on the Kinsey Institute’s latest research as well as numerous links to other sites. http://www.guttmacher.org The Alan Guttmacher Institute (AGI) is a non-profit organization focused on reproductive health research, policy analysis, and public education. https://www.actioncanadashr.org Canadian non-profit organization advocating access to sexual and reproductive health services and providing education on sexual health issues, abortion, and contraception. http://www.canadiansexresearchforum.com The site of the Canadian Sex Research Forum, a multidisciplinary academic organization of sexual health researchers and professionals.

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ACTIVITIES Activity I: Introductory Topics Activity & Creating a Good Learning Space Ask students to get a piece of paper and pen/pencil and make a list of sexual topics that they think might be covered during the entire course. Each student makes their own list.

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Ask them to shout out their topics. You can list each topic on the board or have students write them up. Note the degree to which students use the word “sex” or “sexual” (e.g., do they say “dysfunctions” or “sexual dysfunctions”). Note any topics that students might be forgetting—or topics/words that they might be avoiding.

There might be laughter in the beginning of this activity, although this will taper off and by the end there shouldn’t be much laughter.

After you have a good list, ask students to openly indicate what emotions might arise when discussing these topics. List these emotions on the board in a new color.

Consider having students tie each emotion to a topic (e.g., “A person might experience anxiety when discussing which topic?”).

As a group, analyze the emotions listed. Some common themes are that most of the feelings are “negative.” Discuss the meaning behind this. Also, note that two people can have different emotional responses to the same topic.

Explain to the class how this can make teaching a class in human sexuality challenging. Ask them to make a list of rules that everyone in class can follow to create a good learning space (e.g., what can be done to make the class a safe place where people can make comments and ask questions openly).

Activity II: Critical Thinking Activity Have your students use their critical thinking skills to evaluate the following statements.

Have students break up into pairs or small groups to start and then discuss as a group: • • • •

“Rap music causes adolescents to engage in sexual activity.”

“Young adults are having sex more often today than 10 years ago.”

“Having a threesome is a common sexual fantasy among males.”

“You can have oral sex without losing your virginity.”

Questions to ask: • • • • • • • • ..

What value assumptions held by the author underlie this argument?

What fallacies in reasoning have you found?

Who is making this statement?

What assumptions are being made in each statement?

What evidence would be needed to support this statement?

How is “sex” being defined?

What ambiguous terms do you find? What terms need to be further defined?

Does each statement reflect an oversimplification or overgeneralization?

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Activity III: Human Sexuality and the Internet This activity can be done in pairs, small groups, or outside the classroom. Students should take an inventory of what they have learned about sexuality from the Internet.

Have they used the Internet as a source of information about any sexual topics? Have they used the Internet to explore sexuality? How many hours does each student spend on the Internet for sex-related purposes? What messages about sexuality does the Internet give them? How does it shape their knowledge or values? What are the advantages and disadvantages of using the Internet for sexual information or experiences? What are some guidelines that should be used to evaluate the content of information found on the Internet about sexuality? What are some of the particular hazards that the Internet poses related to sexuality? How has the Internet impacted sexual norms and values? A representative from each group can then present a summary of the discussion to the entire class. Rules of confidentiality should be reviewed for this activity.

Activity IV: Small Group Discussion Questions Changing Gender Roles After finishing the chapters, have students break up into mixed-gender groups of three to four students to discuss the following questions and ideas. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. How might the evolution of gender roles in Western cultures represent an adaptation to changing conditions? Does this reflect an adaptation to increasing economic burdens?

2. Might we return to more traditional gender roles if economic conditions permitted women to quit their jobs and return to domestic roles? Would women want to leave the work force if they could? Would men?

3. Have employment equity policies affected gender roles?

4. When the term “family values” is used by politicians and social commentators, what definitions of gender roles are generally implied? How might different segments of society define “family values?” (i.e., consider culture/ethnicity, religion, sexual orientation)

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Chapter 2

CHAPTER 2 Using Theory and Research to Understand Human Sexuality CHAPTER-AT-A-GLANCE Chapter Outline Theoretical Approaches to Understanding Human Sexuality

Instructional Ideas

Supplemental Materials

Learning Objective 1 Learning Objective 2 Discussion Question 1

A Scientific Approach to Human Sexuality

Learning Objective 3 Learning Objective 4

IM Activity: Small Group Discussion Questions: Sex Research

Teaching Tip 1 Teaching Tip 2 Quantitative Research Methods

Learning Objective 5 Learning Objective 6

IM Activity: Thinking About the Limitations of Sex Surveys

Learning Objective 7 Discussion Question 2 Discussion Question 3 Qualitative Research Methods

Learning Objective 8

Research Approaches That Use Quantitative and Qualitative Methods

Learning Objective 9

IM Activity: Designing an Experiment

Ethics in Sexuality Research

Learning Objective 10

IM Activity: Limitations of Research Methods

Teaching Tip 3 Teaching Tip 4

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Chapter 2

Chapter Outline

Instructional Ideas

Supplemental Materials

Discussion Question 4

CHAPTER SUMMARY Chapter 2 starts with an overview of the major theoretical approaches to the study of human sexuality, including evolutionary, psychological, and sociological theories. From the evolutionary perspective, sexual behaviour is interwoven with reproductive success.

Sociobiology suggests that humans today carry traits that helped our ancestors survive and reproduce. Because of different levels of parental investment (i.e., males produce sperm while females carry the pregnancy, breast feed, and tend to take a larger role in raising children), men and women have evolved different strategies for mating and successful reproduction. As such, males have evolved a greater preference for short-term mating with multiple partners because it enables them to potentially father a higher number of children, which increases the likelihood that their genetic material will be passed on. Females, however, have evolved a preference for long-term mating which provides them with a partner who can contribute resources to offspring and with whom, parental responsibilities can be shared; this increases the likelihood that offspring will survive and their genetic material will live on.

Psychological perspectives on sexuality include psychoanalytic theory which focuses on the hypothesized inner conflicts between sexual drives and social constraints, and learning theories that emphasize the role that experience and cognition, as well as social, familial, and relationship factors, play in shaping behaviour. Learning theories discussed include: behaviourism, classical conditioning, operant conditioning, social learning theory, social-cognitive theory, and sexual script theory. Sociological perspectives discussed are social exchange theory, which suggests that individuals try to maximize their rewards and minimize their costs in relationships, and critical theories, including feminist, queer, and intersectionality theories.

The chapter then discusses the importance of an empirical approach for studying human sexuality and describes the steps in the scientific method: formulating a research question, formulating a hypothesis, testing the hypothesis, and drawing conclusions. Quantitative, qualitative, and mixed methods research designs are introduced and a historical introduction to the work of Alfred Kinsey is presented.

Quantitative research methods are then discussed in more detail. Key concepts for research are introduced including populations, samples, and generalizability. Because of the impracticality of studying all the members of a population of interest (target population), researchers try to select a representative sample. Probability sampling (random and stratified random) and convenience samples are the methods most frequently used. The issue of volunteer bias is also discussed.

After determining the sample, researchers then need to select the specific constructs or variables to study. Variables commonly used to explain sexual behaviour include biological, psychological, and demographic or sociological constructs. Quantitative research methods allow researchers to draw conclusions about relationships between variables. Correlational designs, ..

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which describe the association between variables but do not provide proof of casual relationships, are briefly discussed.

The survey method and the laboratory observation method, including their advantages and limitations, are then described. Survey methods are commonly used in sexuality research and can employ interviews or questionnaires to gather data. Since they often rely on validated scales and measures, this increases their validity and reliability. Surveys can also be administered to a large group of people (e.g., online) and are often anonymous which may help respondents feel more comfortable disclosing information about sexuality. Limitations of survey methods include sampling bias, non-representative samples, and social desirability bias. The laboratory observation method is illustrated referring to the work of Masters and Johnson who observed participants as they engaged in different sexual activities. The amount of control in a laboratory study is identified as a strength; however, it is noted that lab research is limited as it takes place in an artificial environment.

The experimental method is described as the best method for studying cause-and-effect relationships, although it is not always feasible, The different aspects of the experimental method, including independent and dependent variables, and experimental and control groups, are presented. Like other laboratory methods, experimental studies may not generalize perfectly to the real word and extraneous variables can influence the results.

Qualitative research methods, including the interview method and the focus group method, are then discussed. The interview method involves asking a set of questions to an individual in order to better understand their thoughts, feelings, attitudes, or experiences. Interviews can either be structured or semi-structured and allow for a more nuanced understanding of the research topic compared to quantitative methods. Focus groups are similar to interviews; however, the questions of interest are asked to a group of people together, rather than one-on-one.

Mixed methods research approaches use both quantitative and qualitative methods to study human sexuality. These approaches include case studies, naturalistic observation, ethnographic observation, and participant observation. The case study method, an in-depth observation of individuals or small groups, is frequently used in the report of innovative treatment approaches.

Naturalistic observations, or field studies, involve researchers directly observing behaviour where it happens. The ethnographic observation method provides data about sexual behaviours and customs within various ethnic or cultural groups and is common among anthropologists who immerse themselves in the environment they are studying. The participant observation method requires a direct interaction between the researchers and the participants of the study. As an example, the work of a graduate student who was employed as an exotic dancer while investigating female objectification and body image is described.

The chapter concludes with a discussion of ethical issues in sexuality research; exposing participants to harm, confidentiality, informed consent, and the use of deception are discussed.

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LEARNING OBJECTIVES 1. Describe the role that theory plays in the research process.

2. Compare and contrast key features of evolutionary theory, psychoanalytic theory, learning theories, social exchange theory, and critical theories.

3. Explain how the steps in the scientific method can be applied in sexuality research.

4. Compare quantitative and qualitative approaches to research.

5. Explain what is meant by populations and samples.

6. Describe quantitative methods, including the survey method and laboratory observation.

7. Explain how experiments seek to determine cause and effect.

8. Describe common approaches to qualitative research, including the interview and the focus group.

9. Describe research approaches that can utilize qualitative and quantitative methods (i.e., case studies, naturalistic observation, ethnographic observation, and participant observation).

10. Describe the ethical concerns that govern the ways in which researchers interact with research participants.

TEACHING TIPS 1. Have students describe a time they witnessed two people displaying affection in public. What inferences did they make about the partners? How would they label or classify the behaviours they observed?

2. As examples of the goals of the science of human sexuality, use research on HIV transmission.

Researchers have identified and described the virus, explained the process by which the virus attacks the body’s immune system, and attempted to predict the number of people who will contract the virus. Research findings have been used to control the spread of the virus through the establishment of infection control guidelines by the Public Health Agency of Canada.

3. Use the following example to discuss the limitations of the case-study method. In 1995, doctors transfused bone marrow cells from a baboon into a man who had been HIV-positive for 15 years. Because baboons do not get HIV, researchers hoped that the bone marrow cells would strengthen the man’s immune system.

4. To help students better understand the experimental method, have them plan a “real” study (e.g., testing a new treatment for HIV.) Discuss the ethical considerations involved, choosing ..

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subjects to participate, assigning subjects to the control and experimental groups, and the variables to consider.

DISCUSSION QUESTIONS 1. How would a Freudian psychologist explain why a five-year-old girl likes to play with dolls?

How would this be explained by a behaviourist?

2. How many of you would volunteer to complete a lengthy questionnaire about your sexual behaviours and attitudes? What differences in attitudes might there be between those of you who would volunteer and those who would not?

3. Have any of you ever completed and returned a sex questionnaire published in a magazine?

Did you (or would you) answer the questions as honestly as possible? On what topics would you refuse to answer questions?

4. What are some of the obvious limitations of sex research?

ADDITIONAL RESOURCES Web Sites http://www.canadiansexresearchforum.com The website of the Canadian Sex Research Forum, Canada's leading organization dedicated to interdisciplinary, theoretical, and applied research in the field of sexuality. http://www.sexscience.org This is the home page of the Society for the Scientific Study of Sexuality (SSSS). It also provides links to The Journal of Sex Research. http://www.kinseyinstitute.org The site of the institute founded by Alfred Kinsey at Indiana University. It is devoted to research in sex, gender, and reproduction. Provides information on the Kinsey Institute’s latest research as well as numerous links to other sites. http://www.sstarnet.org The website for the Society for Sexual Therapy and Research (SSTAR). SSTAR is a professional organization for sexual health professionals who treat and/or research problems of sexual function, sexual identity, and reproductive life.

ACTIVITIES Activity I: Small Group Discussion Questions Sex Research ..

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When you are discussing the various research methods, distribute copies of the Small Group Discussion Questions. This activity asks students to get into small groups of three or four to discuss the impact of sex research and speculate about their willingness to participate in various types of sex research. In groups of three to four students each, discuss the following questions and ideas. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Some legislators have argued against funding for any sex research because more knowledge would remove the mystery and romance from sexual relationships. How do you respond to this argument?

2. Have you ever completed and returned a sex questionnaire published in a magazine? Did you (or would you) answer the questions as honestly as possible? On what topics would you refuse to answer questions?

3. Would you volunteer to complete a lengthy questionnaire about your sexual behaviours and attitudes? Why or why not? What differences in attitudes might there be between students who would volunteer and those who would not?

4. Would you agree to participate in a direct laboratory observation study similar to Masters and Johnson’s study? Under what circumstances? Why or why not?

Activity II: Thinking About the Limitations of Sex Surveys Thinking about the Limitations of Sex Surveys asks students to apply their general knowledge about the limitations of sex surveys to their possible responses to survey questions. Give your students the following scenario: Imagine you are asked to participate in a sex survey. You know the investigator is a respected professor at your college/university and you are assured that the results will be kept confidential.

A code will be attached to your responses—no names, please! The questionnaire contains hundreds of items surveying everything from the age at which you had your first romantic kiss to whether you have had intercourse, sexual fantasies with members of the same-sex, and so on.

How valid do you think your responses would be? Based on your knowledge of the text, list some of the factors that might account for invalid results.

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6.

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Answer key: Factors that limit the validity of survey data include faulty memories; difficulties estimating the incidence of sexual behaviours; denial, distortion or concealment of information; tendencies to present socially desirable answers; differences in meanings of particular terms; use of biased, haphazard or nonrepresentative samples; and volunteer bias.

Activity III: Designing an Experiment When you are discussing the experimental method, distribute copies of this activity, Designing an Experiment, to students, either individually or in small groups. This activity asks students to apply what they have learned to design an experiment to test a new treatment for HIV. Directions: You are a medical researcher who has just “discovered” a new treatment for HIV. Now you need to design an experiment to test its effectiveness. Using the following questions as guidelines, plan your experiment.

1. What groups will you have in your study? How will you assign subjects to the group(s)? What problems do you anticipate?

2. What is your independent variable(s)? What is your dependent variable(s)?

3. How will you assign your subjects to the experimental and control groups?

4. What extraneous variables will you need to consider?

5. What ethical issues will you need to consider?

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Activity IV: Limitations of Research Methods When you have completed your discussion of all of the research methods, distribute copies of this activity, Limitations of Research Methods, to students, either individually or in small groups.

This activity asks students to think of a research topic that would be appropriate for each type of research, identify the precautions researchers must take, and list the limitation of each research method.

Directions: For each of the research methods listed below, think of a topic that would be appropriate for this method of research. Then, keeping this topic in mind, identify the precautions researchers should take and the limitations of that method.

Method and Topic

Precautions

Limitations

Case Study

Survey

Naturalistic Observation

Ethnographic Observation

Participant Observation

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Method and Topic

Precautions

Limitations

Laboratory Observation

Focus Groups

Correlational Approaches

Experiment

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CHAPTER 3 Female and Male Anatomy and Physiology CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

The External Female Sex Organs

Learning Objective 1

The Internal Female Sex Organs

Learning Objective 2

Supplemental Materials

Discussion Question 1

Teaching Tip 1

IM Activity: Small Group Discussion Questions: Women’s Issues IM Activity: Writing and Acting a Script

The Female Breasts

Learning Objective 3 Learning Objective 4 Discussion Question 2 Discussion Question 3

The Menstrual Cycle

Learning Objective 5 Learning Objective 6

IM Activity: Letters to a Friend

Teaching Tip 2 Discussion Question 4 Menstrual Difficulties

Learning Objective 7

The External Male Sex Organs

Learning Objective 8 Learning Objective 9

IM Activity: How Many Different Names Does the Penis Have?

Teaching Tip 3 Discussion Question 5 ..

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Chapter Outline The Internal Male Sex Organs

Instructional Ideas Learning Objective 10

Supplemental Materials IM Activity: Small Group Discussion Questions IM Activity: Letters to a Friend

Health Problems of the Male Urogenital System

Learning Objective 11 Learning Objective 12 Learning Objective 13 Learning Objective 14 Discussion Question 6 Discussion Question 7

Male Sexual Functions

Learning Objective 15 Learning Objective 16

IM Activity: Thinking, About Whether the Penis Has a Mind of Its Own

CHAPTER SUMMARY This chapter begins with a description of the vulva, the external female sex organs. These include the mons veneris, the labia majora, the labia majora, the clitoris, and the vaginal opening.

The role of the clitoris in sexual pleasure is noted, and its similarity to and difference from the penis is mentioned. The structure of the clitoris includes the glans and the shaft, which are external to the body and typically covered with a flap of skin known as the hood. Additionally, the clitoris comprises two branches (crura) which extend beside either side of the vagina, inside the body. The vestibule is briefly mentioned, as is the urethral opening. Because of its proximity to the external sex organs, the urethral opening may come in contact with bacteria from hands or from the vagina or rectum; bacteria may also be transmitted from a partner. Strategies to avoid infection as a result of this bacteria are discussed. The vaginal opening, or introitus, is the entrance to the vagina. The myth about the presence or absence of the hymen as proof of virginity is discussed and various hymen shapes are illustrated. Structures that underline the external sex organs include the vestibular bulbs, the Bartholin’s glands, and the pelvic floor muscles. The procedures, medical complications, and cultural issues related to the practice of ritual, genital mutilation/cutting are discussed.

The structure and function of the female internal sex organs are then described. These include the vagina, the cervix, the uterus, the ovaries, and the fallopian tubes. The G spot and female ejaculation are discussed, including a summary of recent research and controversies. Conditions which may affect the internal sex organs include vaginitis and cervical, uterine/endometrial, and ovarian cancers; health information, including prevention strategies, is provided.

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Female breast development and appearance is described, and the incidence and treatment of breast cancer is discussed. Recommendations on attention to specific risk factors and early detection of cancer are given.

The phases of the menstrual cycle are discussed and the role of the hypothalamus and the pituitary gland are explained. The risk of toxic shock syndrome as a result of tampon use and sex during menstruation are also discussed. The changes associated with menopause are outlined and the controversy surrounding the use of hormone replacement therapy is presented. Menstrual difficulties, including dysmenorrhea, amenorrhea, and premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are described. Tips on how to handle menstrual discomfort are included.

The external male sex organs include the penis and the scrotum. The structure and functions of the penis are explained. Circumcision is described, including possible cultural, religious, and health reasons for its practice. Reasons opposing male circumcision are also presented.

Debunking the myths about the connection between penis size and “manliness” or sexual performance is emphasized. A description of the scrotum and its role in maintaining optimal temperature for sperm production is presented.

The internal male sex organs consist of the testes, the system of tubes and ducts that conduct sperm, and the organs that help nourish, activate, and enable the sperm to survive in the acidic conditions of the vagina. The functions of the testes (analogous to the ovaries) are explained.

Among them, the secretion of testosterone is described. The process of sperm production is described as is the passage of sperm from the testes through the penis. The seminal vesicles, two small glands that lie behind the bladder, secrete fluid which combines with sperm to form part of the ejaculate. A discussion of andropause is included, focusing on potential outcomes of declining testosterone in men after age 40-50, as well as tips to slow some of the processes.

Notably, the gradual decline in men’s testosterone levels is unlike the drastic drop of estrogen among women at menopause. The structures and functions of the Cowper’s glands and the prostate gland are discussed. Both secrete fluids which combine with sperm and the fluids of the seminal vesicles to make up semen, the fluid that is expelled from the body during ejaculation.

Health problems of the male urogenital system are presented. The symptoms, preventative measures, and treatments for urethritis and testicular cancer are described. Instructions for testicular self-examinations are given. Prostate disorders include benign prostatic hyperplasia and prostatitis; treatments are discussed. Risk factors, symptoms, and treatments of prostate cancer are also presented and regular medical checkups to detect prostate cancer are encouraged.

The chapter concludes with a discussion of male sexual functions. Erection and ejaculation are examined and their reflexive nature explained. The roles of the spinal cord, the brain, and the autonomic nervous system in these functions are described. Erectile abnormalities are noted. The difference between ejaculation and orgasm is pointed out. Retrograde ejaculation is also discussed briefly.

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LEARNING OBJECTIVES 1. Describe the external female sex organs and their functions.

2. Describe the internal female sex organs, their functions, and health problems that may affect them.

3. Describe the composition and functions of the breasts.

4. Discuss risk factors for and detection and treatment of breast cancer.

5. Describe the regulation and the phases of the menstrual cycle.

6. Define and discuss menopause, perimenopause, and the climacteric.

7. Define menstrual difficulties and discuss what can be done about them.

8. Describe the external male sex organs and their functions.

9. Assess reasons why some parents choose to have their male infants circumcised and other parents choose not to.

10. Describe the internal male sex organs and their functions.

11. Discuss urethritis.

12. Discuss testicular cancer.

13. Discuss benign prostatic hyperplasia.

14. Discuss prostate cancer.

15. Explain how erection occurs.

16. Explain how ejaculation occurs.

TEACHING TIPS 1. Reduce fears about pelvic examinations by showing students a speculum and a spatula used to take a Pap smear. Emphasize the need to choose a different physician if the physician does not explain the procedure, is not sensitive to the woman’s possible embarrassment, or is not receptive to questions. Urge students to encourage all the women they know and love to get regular pelvic exams.

2. Distribute index cards. Without putting their names on the cards, students should write down the messages about menstruation they heard from peers, parents, school, and so on. Collect the ..

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cards and read each aloud in class. Analyze the messages for their accuracy and the negative or positive attitudes they convey.

3. Set up two columns on the blackboard, one labeled, “Arguments For Circumcision,” and the other labelled, “Arguments Against Circumcision.” Have students suggest items for each column. Then have students identify which items would influence their decision about circumcising a baby boy. Does social pressure or research evidence exert greater influence on their decisions?

DISCUSSION QUESTIONS 1. At what age did you become aware of the word clitoris and the sex organ to which it refers?

Why are girls not taught this term at the age boys are taught the term penis? What cultural or religious factors influence this?

2. Do you think most women are concerned with the size or appearance of their breasts or vulva?

Do you think most men are concerned with the size or appearance of their penis? Do you think these concerns have increased in recent years? If so, what do you think can account for this?

3. How do you think you would react if you received a diagnosis of breast cancer? If your mother received this diagnosis? If your girlfriend or wife did? What could you do to support a woman going through this crisis?

4. Did you know that there are birth control options that can prevent or reduce menstruation for months at a time? Why do you think such methods are slow to gain popularity among women? In general, do you think women like getting a period?

5. What is the link between the Cowper’s glands and the possible failure of the withdrawal method as a means of birth control? (Many young people choose withdrawal as a means of birth control because they believe that this method will be effective if they are careful to withdraw the penis before ejaculation.)

6. How would you react if you received a diagnosis of testicular cancer? If your brother, boyfriend, or husband received this diagnosis? How could you be supportive to a man who has had a testicle removed? (Remember that testicular cancer is the most common solid-tumour cancer in men ages 20 to 34.)

7. What role might male and female stereotypes play in health care seeking behaviour? Are men as likely as women to do self-examinations and get regular medical exams of their reproductive organs?

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ADDITIONAL RESOURCES Web Sites http://www.cwhn.ca The Canadian Women’s Health Network is a national organization dedicated to improving the health of women and girls across Canada. It acts as a forum for information sharing, advocacy, research, and support for women’s health issues. http://www.fwhc.org Established in 1980, Feminist Women’s Health Center (FWHC) is a nonprofit organization that promotes and protects a woman's right to choose and receive reproductive health care. http://www.menopause.org The North American Menopause Society (NAMS) is devoted to promoting understanding of menopause and midlife issues. http://www.womenshealthmatters.ca This website provides information about women's health issues including research news, articles, and access to the Women's Health Matters Resource Database (a searchable bilingual database of resources for consumers and health professionals). http://www.malehealthcenter.com A great source of information on sexual health and sexual functioning from a male’s perspective. http://www.cirp.org This site provides information related to all aspects of circumcision.

Contains technical material, medical and historical articles and statistics, as well as information suitable for parents and educators. http://www.cancer.ca The website for the Canadian Cancer Society which provides information on all varieties of cancer including breast, testicular, and prostate cancers.

ACTIVITIES Activity I: Small Group Discussion Questions Distribute copies of the Small Group Discussion Questions to mixed-gender groups. The first set of questions asks students to discuss some “women’s issues” and to decide whether these are women’s issues or societal issues. The second set of questions asks students to discuss if there are gender differences in knowledge about sex organs and health practices.

Women’s Issues?

In mixed-gender groups of three or four students each, discuss the following questions and ideas.

Discuss whether these are women’s issues or societal issues. After 20 minutes, one student from each group should summarize the small group discussion to the class.

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1. Were you aware of the practice of ritual female genital cutting? Do you have any factual information on this issue? Do you think western countries or the United Nations should intervene in any way?

2. When (how) did you become aware of the existence of the clitoris? Did you realize that its only function is to provide sexual pleasure? Compare the way males are taught about their penis as opposed to the way females are taught (or not taught) about the clitoris.

3. What messages did peers give you about the hymen and virginity? Which terms were used?

What were you told to expect when you had intercourse for the first time?

4. Jokes are made about women who are perceived as being in bad moods. We often call them “premenstrual” or say they probably just have PMS. Is there any validity to these jokes? Do we make similar characterizations of men who are in bad moods?

Gender Differences in Knowledge about Sex Organs In mixed-gender groups of three to four students each, discuss the following questions and ideas.

Discuss whether the males and females in your groups answer the questions differently. After 20 minutes, one student from each group should summarize the small group discussion to the class.

5. Were you as aware of the disorders of the male reproductive system as you were of the disorders of the female reproductive system? How do you account for the difference?

6. Are men as likely as women to do self-exams and get regular medical exams of their reproductive organs? Why? What roles do stereotypes about males and females play?

7. Why are men seemingly more concerned about penis size than their female sex partners? Why are they concerned?

8. Males: Estimate the percentages of men you know who are circumcised and uncircumcised.

Females: Do the same. If the estimates differ, how do you account for this? Discuss some of the characteristics attributed to circumcised and uncircumcised men. Check the text for the facts.

Activity II: Writing and Acting a Script Ask mixed gender groups of six to eight students to write a script of how a couple would talk to their daughter about sexual anatomy, menstruation, or behaviour. You can choose a particular age or let the groups decide to set the age according to their own experience. Once the script has been written and you review it, you might ask them to read it. Alternatively, you might provide students some different options, such as producing a short video or radio program.

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Activity III: E-mails to a Friend This activity asks students to think carefully about when girls and boys should be told various information about their bodies. Distribute the table about “girls” to half of the class and the table about “boys” to the other half. This activity asks students to make an outline of a letter to a friend expressing their opinions about when to convey specific information. Provide the following instructions to your students and after they have completed the activities, discuss their responses as a class. Are there any differences in what is considered appropriate for male or female children?

A friend who has a two-year-old daughter emails you and asks your opinion about what girls should be told about their bodies, at what age they should be told, and how much detail they should be given. To sort out your thoughts, you decide to make an outline before you write your response to the email. Consider each of the topics carefully and then complete the outline below.

Topic

Appropriate Age

Amount of Detail

Names for Body Parts

Answers to Questions About Pregnant Women and Babies

Menstrual Periods

Health Practices

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Topic

Appropriate Age

Amount of Detail

Avoiding Pregnancy and Sexually Transmitted Infections

A friend who has a two-year-old son emails you and asks your opinion about what boys should be told about their bodies, at what age they should be told, and how much detail they should be given. To sort out your thoughts, you decide to make an outline before you write your response to the email. Consider each of the topics carefully and then complete the outline below.

Topic

Appropriate Age

Amount of Detail

Names for Body Parts

Answers to Questions About Pregnant Women and Babies

Nocturnal Emissions (“Wet Dreams”)

Health Practices

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Topic

Appropriate Age

Amount of Detail

Avoiding Pregnancy and Sexually Transmitted Infections

Erections

Activity IV: How Many Different Names Does the Penis/Vagina Have?

Ask students to come up with as many as different words as they can that are used to refer to the penis and vagina. Write them on the board and group them according to the myths and beliefs implicated. If there is a relaxed atmosphere, this activity should serve as springboard for the discussion of different misconceptions with respect to penis size and female anatomy, as well as a reflection of some cultural beliefs.

This activity can also be used as an icebreaker in the introductory sessions.

Activity V: Thinking About Whether the Penis Has a Mind of its Own There is a common perception among men that the penis has a “mind” of its own. It sometimes becomes erect when the man would prefer that it would not (such as when noticing a scantily clad person at a public beach). At other times it may remain flaccid when the man would prefer it to become erect. How would you explain this curious perception that the penis seems to have an intelligence of its own? How do spontaneous erections come about? Draw upon your knowledge of the divisions of the nervous system to explain the lack of voluntary control over erection. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ..

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____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Of course the penis does not possess its own guiding intelligence. It consists of spongy masses of erectile tissue, not the lovely dense, gray matter that renders your thought processes so incisive.

While it may seem that the penis is following its own mind at times, it really is governed by the autonomic (automatic) nervous system, which explains how it functions outside the man’s direct conscious control. As you read in the accompanying text, tactile stimulation of the penis can cause a spontaneous erection to occur by means of a simple spinal reflex without the direct involvement of the brain.

Stimulation arising from the brain may also trigger an unplanned erection without any conscious intent, as when a man finds his penis “spontaneously” becoming erect as he watches a steamy love scene in a movie, or even when daydreaming about someone who caught his attention in his calculus class.

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CHAPTER 4 Sexual Arousal and Response CHAPTER-AT-A-GLANCE Chapter Outline Sexual Response

Instructional Ideas Learning Objective 1 Learning Objective 2 Learning Objective 3

Supplemental Materials IM Activity: Small Group Discussion Questions: Sexual Arousal and Response

Teaching Tip 1 Discussion Question 1 Discussion Question 2 Discussion Question 3 Discussion Question 4 Discussion Question 5 Effects of Drugs on Sexual Response

Learning Objective 4 Teaching Tip 2

IM Activity: Challenging Aphrodisiacs

Discussion Question 6 Erogenous Zones and the Brain

Learning Objective 5 Learning Objective 6 Teaching Tip 3

Sexuality and Disability

Learning Objective 7 Discussion Question 7

CHAPTER SUMMARY This chapter looks at factors that contribute to sexual arousal and the processes related to sexual response. The sequence of changes in the body that take place as males and females become progressively more aroused is referred to as the sexual response cycle. Three models of sexual ..

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response are presented. First, Masters and Johnson’s four-phase sexual response cycle identifies the physiological changes associated with sexual arousal and response; the similarities between the physiological responses of men and women are emphasized. The four phases consist of excitement, plateau, orgasm, and resolution. Second, Kaplan’s three stages of sexual response, which consists of desire, excitement, and orgasm, is mentioned. Lastly, Basson’s intimacy model of female sexual response is presented. This model is notable as it acknowledges the importance of intimacy in sexual response and suggests that people may begin a sexual encounter with a nonsexual or neutral state of mind and that sexual desire results in response to sexual stimulation and physical arousal. A text box presents the complexities of physical and psychological arousal, specifically focusing on gender differences in the perception of physiological response.

The authors then present research evidence that addresses the orgasm controversies: the question of multiple orgasms in women and men, and the debate over whether or not there are different types of orgasms in women.

The effects of drugs on sexual response are then discussed. The myth about the existence of aphrodisiacs is debunked—the scientific literature suggests that they have little actual effect on sexual desire or performance, and that some may pose health risks. The effects of poppers, erectile dysfunction drugs, a female sexual dysfunction drug, and other pharmaceuticals that affect dopamine are described. Anaphrodisiacs, substances which have been considered inhibitors of sexual response, are considered, as are other psychoactive drugs like alcohol, cannabis, and stimulants.

The following section in the text describes erogenous zones and the brain. Erogenous zones, areas of the body that are especially sensitive to touch, are categorized as primary erogenous zones and secondary erogenous zones. The brain’s central role in sexual functioning, specifically the influence of the cerebral cortex and the limbic system is discussed. Factors which inhibit and enhance sexual arousal (e.g., partner characteristics, type of sexual activity, characteristics of the sexual encounter, and worries and anxieties) are also mentioned. The organizing and activating influence of female and male sex hormones in sexual behaviour is explored. The role of testosterone in female and male sexual behaviour is emphasized. The impact of hormones might decrease with age when psychosocial factors acquire more relevance.

The chapter concludes with a discussion about sexuality and disability. People with disabilities are often seen as sexless, an incorrect view based on misconception. Although disabilities may require adjustments by both partners, people living with physical or intellectual disabilities have the same needs, feelings, and desires as people living without disabilities. Physical disabilities like multiple sclerosis, cerebral palsy, spinal cord injuries, and sensory disabilities are presented and their impact of sexual functioning is discussed. Some people living with developmental disabilities are vulnerable to sexual abuse and may not be able to consent to sexual activity with others. However, some have stronger-than-normal sexual desires. One of the biggest challenges among people with disabilities is finding a loving and supportive sexual partner. People living with disabilities and their partners may explore a wide variety of creative sexual expressions and may use their imaginations to expand their sexual horizons.

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LEARNING OBJECTIVES 1. Describe Masters and Johnson’s four-phase sexual response model.

2. Describe the Kaplan and Basson models of sexual response.

3. Identify common questions and controversies concerning female orgasm.

4. Evaluate the effects of drugs on sexual response.

5. Describe the role of the brain in sexual response.

6. Discuss the organizing and activating influences of sex hormones.

7. Assess the impact of physical and developmental disabilities on sexuality.

TEACHING TIPS 1. Remind students that STIs can be transmitted during oral-genital contact. Unless both partners are HIV-negative, free of other STIs, and monogamous, they should use condoms during fellatio and dental dams during cunnilingus.

2. Point out that the studies cited in the text address the issue of regretted or unwise, yet voluntary, sexual behaviour. By reducing inhibitions and impairing the ability to weigh information and foresee consequences, alcohol consumption can lead people to make choices about their sexuality that they would otherwise not make.

3. A model of the brain that can be disassembled is helpful when explaining the locations of various parts of the cerebral cortex and the limbic system that are involved in sexual functioning.

DISCUSSION QUESTIONS 1. Which sense do you think is most important to your own sexual arousal? Why? 2. Do you think that pheromones play a role in human sexual behaviour?

3. The text presents a series of factors which are said to inhibit and enhance sexual arousal.

However, these findings are based on a heterosexual university student sample. How do you think the results would be different among older people? Married people? Gay, lesbian, and bisexual persons?

4. Does desire always precede arousal as it is presented in Kaplan’s model? Does arousal always occur prior to sex? Can you think of times when the sequence of these phases might be different, even in consensual sexual relationships? ..

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5. Of the various models of female sexual response (Masters and Johnson, Kaplan, and Basson), which do you think best captures the female experience? Does one model better describe your subjective experience than the others?

6. Why do you think the idea of aphrodisiacs is so powerful? Why do ideas about chocolate, oysters, and other foods as enhancers of desire and arousal persist?

7. If you had a sibling with a physical or psychological disability, would you support them in having a safe and pleasurable sexual relationship? What factors would you consider in making your decision?

ADDITIONAL RESOURCES Web Sites http://www.arhp.org Click on ‘Reproductive Health Topics’ for a variety of sexuality-related news and other research from the Association of Reproductive Health Professionals. http://health.howstuffworks.com Click on ‘Sexual Health’ for a variety of resources and information on the functions and dysfunctions of the reproductive system.

ACTIVITIES Activity I: Small Group Discussion Questions Sexual Arousal and Response Distribute copies of the Small Group Discussion Questions. In mixed-gender groups of three to four students each, discuss the following questions and ideas. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Female students: Have you experienced the menstrual synchrony phenomenon? How long did you live with other women before menstrual synchrony occurred? Did the amount of time you spent together seem to influence the synchrony? Male students: Were you as aware of menstrual synchrony as the women were?

2. Colognes claiming to have synthetic human pheromones are now being marketed. What do you think their effects will be?

3. What substances have you heard referred to as aphrodisiacs? After reading the text, what do you conclude about their effectiveness?

4. Because some women may experience multiple orgasms if stimulation continues, some couples use the “ladies first” approach to orgasm. What do you think of this approach? ..

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5. Were you surprised at the similarities in the male and female sexual response cycles? What effects might male-female differences in the response cycle have on couples’ sexual behaviours?

Activity II: Challenging Aphrodisiacs Discuss with the class the questions outlined in the activity, or use these questions as a starting point for a class discussion. You could have students discuss the questions in small groups before having a discussion as a class.

Do aphrodisiacs exist?

• • •

Ask the students for a list of substances they think of as aphrodisiacs.

Ascertain why these substances are thought to be aphrodisiacs.

Discuss the effect different substances (drugs, alcohol, Viagra) have on sexual performance or enjoyment.

Do humans really need aphrodisiacs? Are we too focused on forcing sexual desire within ourselves? Why do not we not merely have sex when we want it? Students might explore whether the need for aphrodisiacs are for the personal use of the individual or for the potential partner (e.g., to please a sex partner). To what degree do our personal expectations regarding sexual activity and response influence our desire or need for aphrodisiacs? Are societal messages about sexual activity influencing our desire for aphrodisiacs? Would we need aphrodisiacs less if we changed how we think about sex or how we live our lives (e.g., working less to create more time for relaxation)?

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Chapter 5

CHAPTER 5 Gender Identity and Gender Roles CHAPTER-AT-A-GLANCE Chapter Outline Prenatal Sexual Differentiation

Instructional Ideas

Supplemental Materials

Learning Objective 1 Learning Objective 2 Learning Objective 3 Discussion Question 1

Gender Identity

Learning Objective 4

IM Activity: Thinking About Gender and Reality

Learning Objective 5 Discussion Question 2 Gender Roles and Stereotypes

Learning Objective 6 Learning Objective 7 Learning Objective 8 Teaching Tip 1

IM Activity: Small Group Discussion Questions: How Does Gender Affect Our Behaviour?

IM Activity: Gender Similarities

Teaching Tip 2 Discussion Question 3 Discussion Question 4 Discussion Question 5 Discussion Question 6

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Chapter Outline Psychological Androgyny

Instructional Ideas

Supplemental Materials

Learning Objective 9

CHAPTER SUMMARY This chapter discusses the biological, psychological, and sociocultural aspects of gender. Gender is a complex concept, based partly on anatomy, partly on an individual’s psychology, and partly on culture. It is distinct from biological, anatomical sex. The processes of sex and gender begin with prenatal sexual differentiation in vitro and continues throughout an individual’s life.

The chapter begins with a description of prenatal sexual differentiation, which starts at about the seventh week of gestation. Without male sex hormones, we would all develop female external reproductive organs. Male sex hormones, or their absence, also contribute to prenatal sexual differentiation of the brain. The development of the testes and ovaries, and the descent of the testes into the scrotal sac, are described.

In the next section, a discussion of intersexuality occurs. Intersex is a general term used for a variety of conditions in which a person is born with reproductive or sexual anatomy that is not typically male or female. Intersex conditions may occur in as many as 2% of people. The most common intersex condition among people with two X chromosomes (XX) is congenital adrenal hyperplasia in which the person experiences elevated levels of androgens in utero which leads to masculinized external genitals such as an enlarged clitoris which may resemble a small penis.

Among XY individuals, people with androgen-insensitivity syndrome experience lower than normal prenatal sensitivity to androgens as the result of a genetic mutation. As a result, these individuals may have undescended testes and feminized external genitals, including small vaginas. Additional intersex conditions (i.e., Klinefelter’s syndrome, Turner’s syndrome, and Dominican Republic syndrome) and their impact on sexual characteristics, physical health, and psychological development are presented.

Gender identity is defined as the psychological awareness or sense of being a boy or a man, a girl or a woman, or another gender. Gender identity is usually consistent with chromosomal sex; however, this is not true for all people. People for whom their gender identity matches their sex assigned at birth are cisgender. People for whom their gender identity is different than their sex assigned at birth may identify as transgender or trans. Not all cultures enforce the gender binary (i.e., males and females) and cultures that recognize more than two genders are discussed.

Gender dysphoria involves a sense of incongruity between assigned sex and gender identity such that individuals have thoughts and feelings consistent with the other gender, would like to be treated as the other gender, and want to change their sex characteristics to be consistent with the other gender. The diagnosis of gender dysphoria is dependent on the presence of clinically ..

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significant distress leading to functional impairment. Gender nonconformity alone is not sufficient to be diagnosed with gender dysphoria.

Transgender and trans are defined, as are other identities which may be used by gender diverse individuals (i.e., agender, gender fluid, genderqueer, and Two Spirit). It is noted that some trans people recall preference for other-gender play and dress, and report feeling as though they were the other gender, for as long as they can remember. Some trans people may begin to live as the gender with which they identify, a process called transitioning. This process may include changing their name, their dress, and possibly having medical treatments such as hormone therapy, gender reassignment surgery, or other procedures. Most reports of trans peoples’ postoperative adjustments are positive, although not all trans people wish to pursue medical interventions. Because of stigma and discrimination, trans people report more mental health concerns than cisgender people. The controversy about how best to support gender nonconforming children is discussed.

Gender role stereotypes are examined. Sexism is defined and its implications are discussed. The relationship between gender and aggression is presented; although typically men have been found to behave more aggressively than women, the rate of aggression among girls seems to have increased in recent years.

The biological, evolutionary, prenatal brain, and psychological perspectives for gender typing are presented. Biological perspectives focus on genetics and prenatal influences. The evolutionary perspective emphasizes that men’s and women’s traditional roles are the result of ancestral genetic predispositions which led to successful reproduction. Researchers studying prenatal brain organization suggest that gender-typed behaviour is the result of sex hormones in utero.

Psychological perspectives introduced include: psychoanalytic, social-cognitive, and cognitivedevelopmental. The concepts of socialization, gender stability, and gender constancy are described. The role of a gender schema, as an organizing and guiding construct in the formation of a self-concept, is explained.

The influence of gender roles on sexual behaviour is explored and the traditional sexual script is explained. Men typically initiate sex while women play the “gatekeeper” role. Traditional gender roles constrain both men and women and can negatively influence sexual relationships. A common assumption is that men and women are very different when it comes to sexual attitudes and behaviours. However, research shows that any gender differences are small and decreasing.

Further, there are usually greater differences within each gender than between them. The sexual double standard is also introduced and relevant research is discussed. Finally, the issue of psychological androgyny is presented.

LEARNING OBJECTIVES 1. Describe the processes of prenatal sexual differentiation.

2. Describe the role of sex hormones in sexual differentiation.

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3. Define intersexuality and compare and contrast various intersex conditions.

4. Define gender identity.

5. List and define current terms used to reflect gender diversity.

6. Discuss gender roles and stereotypes.

7. Differentiate between biological and psychological perspectives on gender typing.

8. Explain the relationship between gender roles and sexual behaviour.

9. Define psychological androgyny and assess its possible advantages.

TEACHING TIPS 1. Set up two columns on the blackboard: one labelled “Sexist Remarks About Women” and the other labelled “Sexist Remarks about Men.” Have students suggest remarks they’ve heard.

Examine the intent behind the remarks. Was it to force or shame people into conforming to stereotypical gender roles?

2. Have students give examples of famous people or people they know who excel in fields stereotypically associated with the other gender. Use the examples to emphasize that differences within a gender are much larger than (small) differences between the “average” male and the “average” female.

DISCUSSION QUESTIONS 1. Much controversy has surrounded surgeries performed on intersex babies in infancy and childhood to make genitals less ambiguous and assign sex. Many in the intersex movement say surgery should be delayed until children can consent. What would you do if you gave birth to a child with ambiguous genitalia?

2. What do you think has shaped your sense of self as masculine or feminine? Would you want to raise your children with a strong sense of one or the other, or a mix of both? What are the consequences for feminine boys and masculine girls growing up?

3. Recalling from your childhood, do you think you were socialized in a stereotyped masculine or feminine way? What impact do you think those socialization experiences have had on your current sexual attitudes and behaviours?

4. Do you think you conform to traditional gender roles? Do you think most people do? ..

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5. Do you perceive a sexual double standard around you? Or do you think Canada is becoming more egalitarian in terms of the sexual freedom afforded women and men? Why do you think research has found women are harsher judges of other women’s behaviour than are men?

6. Who has a higher sex drive, men or women? Or do men and women have similar sex drives?

Some have suggested that women feel desire for sex as intensely as men, but just experience it less frequently. What do you think of that?

ADDITIONAL RESOURCES Web Sites http://www.isna.org The Intersex Society of North America is dedicated to ending shame, secrecy, and fear for people born with an anatomy that may not be typically male or female. The organization offers support, advice, and educational resources for those seeking information about intersexuality. http://www.ipdx.org Website of the Intersex Initiative of the Pacific Northwest, SF Bay Area, and Japan. Click on ‘Intersex FAQ’ for frequently asked questions about intersex conditions. http://www.ok2bme.ca An information source for kids and teens to visit regarding LGBTQ issues such as understanding terms, religion, coming out, harassment, programs, from K-W Counselling Services of Kitchener-Waterloo. http://www.transcarebc.ca A website from the British Columbia Provincial Health Services Authority providing information and support for the delivery of accessible physical and mental health care for trans people.

ACTIVITIES Activity I: Thinking About Gender and Reality Use this activity, Thinking About Gender and Reality, to have students think and write about what they think really determines whether a person is male or female.

Teachers of human sexuality find that students now and then become confused, even frustrated, when discussing intersexuality. In discussing intersexuality, teachers may hear the question, “Well, was he/she really a boy or a girl?” Consider the word “really.” What does it mean to you to really be male or female? What do you say?

• Is reality, for you, defined in terms of chromosomal gender? That is, if an individual with masculinized sex organs and the gender identity of a male has an XX sex chromosomal structure, do you see him/her as really male or really female?

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• Consider transgender individuals. When a person has the gender identity of a person of the opposite chromosomal gender and undergoes gender reassignment to live life as a member of the opposite chromosomal gender, has his or her gender really changed?

• What, for you, is the ultimate definition of gender, something biological, something psychological, or a bit of each?

Activity II: Small Group Discussion Questions How Does Gender Affect Our Behaviour?

Distribute the Small Group Discussion Quetions. This activity asks students in mixed-gender groups of three to four students each to discuss the following questions and ideas about the effect of gender on behaviour. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. How would you react if one of your classmates told you he or she had gender-reassignment surgery? If a friend told you? If your date told you? What questions would you want to ask?

2. Generate a list of common stereotypes about males and females. Discuss the evidence for the “truth” of these stereotypes. How might the stereotypes we believe influence our relationships?

3. Do your experiences confirm the research finding that boys often dominate classroom discussions and discussions in mixed-gender groups? Do your experiences confirm that men interrupt others more? What effects do these patterns have on conversations? On intimate relationships?

4. Can you think of examples of boys and girls teasing their playmates into making more “gender appropriate” choices of activities and toys? In what ways might this pressure affect children?

5. Several recent best sellers seem to emphasize differences between rather than similarities in males and females. What effect do you think this has on the “War Between the Sexes”?

6. What is the impact of using the term “opposite sex”? Are men and women really opposites?

Activity III: Gender Similarities In mixed-gender groups of three to four students each, discuss the following questions. Have students read Hyde, J. (2005) The gender similarities hypothesis. American Psychologist, 60, 581–92 prior to class, so that they are prepared to discuss the following questions: 1.

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What do the overall meta-analytical findings about gender personality and abilities suggest about the relative differences and/or similarities between the sexes? Are they more alike or more different?

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2.

Why do gender differences appear to be so popular?

3.

What would you tell someone about the scientific data on gender differences?

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Chapter 6

CHAPTER 6 Attraction and Love CHAPTER-AT-A-GLANCE Chapter Outline Attraction

Instructional Ideas Learning Objective 1 Learning Objective 2 Learning Objective 3 Learning Objective 4 Learning Objective 5 Learning Objective 6 Teaching Tip 1

Supplemental Materials IM Activity: Analyzing Ads for Messages About Ideal Physical Characteristics IM Activity: Small Group Discussion Questions: Attraction, Love, and Relationships IM Activity: Testing the Attractiveness-Similarity Hypothesis

Teaching Tip 2 Discussion Question 1 Discussion Question 2 Discussion Question 3 Love

Learning Objective 7

IM Activity: All Those Love Songs

Learning Objective 8 Learning Objective 9 Teaching Tip 3 Teaching Tip 4

IM Activity: Thinking About Love and Gladiator Contests, or “Why I Took My Date to See ‘Rocky 10’”

Discussion Question 4

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Chapter 6

Chapter Outline

Instructional Ideas Discussion Question 5 Discussion Question 6

Contemporary Models and Theories of Love

Supplemental Materials IM Activity: Thinking About Whether All You Need Is Love

Learning Objective 10

CHAPTER SUMMARY The chapter begins with a discussion of attraction. According to the attraction-similarity hypothesis, people tend to develop romantic relationships with people who are similar to themselves in attractiveness, cultural background, personality traits, and interests. Interestingly, perceived similarity may be more important than actual similarity. Contrary to popular belief, opposites do not typically attract. As we tend to live among and come into contact with people whose backgrounds are similar to us, proximity, also known as propinquity, can contribute to our attraction to others. Reciprocation of positive words and actions is also a potent contributor to feelings of attraction.

Physical attractiveness is a major determinant of interpersonal and sexual attraction. Some cultural differences and similarities regarding ideals of physical attractiveness are described.

Other physical traits, such as voice and pitch, and scents and pheromones, also play a role in attraction.

Non-physical traits, such as familiarity, liking, respect, and shared values also contribute to attraction, as do gender-role expectations. Further, while physical traits may be important for initial attraction, as the relationship progresses, other personality traits and attributes become increasingly important.

Some evolutionary psychologists believe that evolutionary forces favour the continuation of gender differences in preferred traits because certain preferred traits provide reproductive advantages. Some traits (e.g., cleanliness, good complexion, firm muscle tone) may be indicators of reproductive potential for everyone. However, a woman’s appeal may be enhanced by indicators of youth and health as this may be associated with her reproductive capacity. A man’s reproductive value may depend more on how well he can provide for his family than on his age or physical appeal.

An interesting cross-cultural study conducted by Buss is described. Across 37 cultures, men tended to prefer younger mates while women preferred for older mates. Although there are differences (men tended to prefer physical attractiveness while women tended to prefer earning potential), both genders placed greater emphasize on kindness, understanding, and intelligence than on looks or income potential.

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Like other aspects of human sexuality, love must be understood within a culture context. The Greeks had four concepts related to the modern meanings of love: storge, agape, philia, and eros. Western culture has a long tradition of idealizing the concept of romantic love. A vast majority of people in Canada see romantic love as a prerequisite for marriage and over half of Canadian men and women report believing in love at first sight. Early in a relationship, infatuation and more enduring forms of romantic love may be indistinguishable. As time goes on, partners begin to view one another more realistically and if the relationship continues, deeper attachment and caring develop.

Researchers are now applying the scientific method to the study of love. Love is seen as a complex concept involving behavioural, emotional, cognitive, and motivational experiences.

Biological researchers have focused on bodily changes that occur when we experience love whereas social psychologists have defined romantic love in terms of physiological arousal and associated cognitive appraisal. Hendrick and Hendrick suggest that there are six styles of love: eros (romantic love), ludus (game-playing love), storge (friendship), pragma (logical love), mania (possessive love), and agape (selfless love). Sternberg’s triangular theory of love proposes three distinct components of love: intimacy, passion, and commitment. According to this model, love can be conceptualized in terms of a triangle, with each vertex representing one of the basic components. The triangle changes shape depending on how much of each component is present and the combination of these different components results in different types of love. For example, romantic love is characterized by the combination of passion and intimacy, but lacks commitment. Companionate love, characterized by intimacy and commitment, but lacking passion, is typical of long-term friendships and some long-term marriages. A balance of all three components represents consummate love. Relationships tend to fair better when partners are matched on corresponding levels of passion, intimacy, and commitment. Importantly, the balance among Sternberg’s three aspects of love is likely to shift throughout the course of a relationship and understanding that love changes over time can help people have more realistic expectations of what to expect during the course of their relationships.

LEARNING OBJECTIVES 1. Explain the role of similarity in the formation of romantic relationships.

2. Describe cultural standards for physical attractiveness.

3. Describe the role of voice and pitch in attraction.

4. Explain how pheromones function to influence attraction.

5. Appraise the role of non-physical traits in influencing perceptions of attractiveness.

6. Describe the evolutionary perspective on mate preference.

7. Discuss the historical concepts that provide the foundation for the modern meanings of love.

8. Discuss the meaning of romantic love. ..

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9. Compare and contrast infatuation and lasting love.

10. Compare and contrast models and theories of love.

TEACHING TIPS 1. Clip and bring in advertisements featuring photos of women and men from several generalcirculation magazines. Have students in small groups analyze these for messages about desirable physical appearance.

2. Review the studies by Maybach and Gold, Riggio, and Wolland Sadalla, et al. Have students discuss how males and females might be perceived in the following situations, in light of the conclusions of these studies: a) A student assertively questions an instructor’s grading policy b) A patient assertively asks a doctor for more information on a diagnosis and proposed treatment c) A buyer bargains assertively with a car dealer for a new car 3. Have students generate a list of expressions about love or the way we talk about love (falling in love, moonstruck, struck by Cupid’s arrow, swept off my feet, bewitched, smitten, lost my heart to, fell for, lovesick, etc.). Write these on the blackboard. Examine them for evidence of the underlying assumption that we have little or no control over whom we love.

4. Instead of thinking of “Sleeping Beauty,” “Cinderella,” and “Snow White” as tales of romantic love, have students think about them as tales of men’s and women’s sexual roles. In “Sleeping Beauty,” the woman is passive/she’s “asleep” forever. She needs only the kiss of a prince to “awaken” her. In “Cinderella,” a woman with a horrible family, great beauty, and small feet is “rescued” by her prince. Snow White is envied and poisoned because of her beauty and also “awakened” from the sleep of death by a prince. One message of these tales is that women have no sexuality of their own and need men to “awaken” them. The high value our society places on physical beauty should also be obvious from these tales.

DISCUSSION QUESTIONS 1. What are some things women often do to make themselves more attractive to others despite the fact that these actions may be highly painful or uncomfortable? Are men under the same pressure to conform to societal standards of physical attractiveness?

2. Think of the couples you know. Did opposites attract? Or are members of couples you know highly similar? What works best in relationships?

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3. What are the most important characteristics in a dating partner for you? How would these change if you were looking for a potential spouse? What characteristics would be “dealbreakers”?

4. What theory best explains who and why you love?

5. Think of your most fulfilling romantic relationship. Which of Sternberg’s or Hendrick and Hendrick’s types of love best describes that relationship? What kind of love do you aspire to?

6. Does the best love start as friendship? Or is passion/infatuation a more important ingredient for love?

ADDITIONAL RESOURCES Web Sites http://www.elainehatfield.com A link to Elaine Hatfield’s (prominent love researcher) website, where you can find the Passionate Love Scale. Take the test to see how passionate you are about your partner! http://teenadvice.about.com Advice for teens to help navigate and understand love, lust, and relationships.

ACTIVITIES Activity I: Analyzing Ads for Messages About Ideal Physical Characteristics When you discuss physical attractivenes, distribute copies of Analyzing Ads for Messages About Ideal Characteristics. It asks students to list the ideal physical characteristics of males and females displayed in advertisements for various products. Provide the following instructions for your students: From popular magazines, clip ten or more advertisements for products such as colas, liquors, cars, toothpastes, diet aids, sports and exercise equipment, etc. Now, pretend you know very little about this culture and you are using the ads to figure out what the people of this culture view as ideal physical characteristics. After examining at least ten ads, describe what they portray as the ideal physical characteristics of men and women. Consider height, weight, muscular build, shape, make-up, hairstyles, facial expressions, etc. List your findings in the columns below.

Females

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Males

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Activity II: Small Group Discussion Questions Attraction, Love, and Relationships Have students pair up or get into small, mixed-sex groups to discuss the following questions and ideas. These questions centre on what men and women are attracted to, value in relationships, and how they conceptualize love. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. What do women do to make themselves more physically attractive? What do women do to “dress up?” (Discuss make-up, hairstyle, jewellery, high heels, clothing and nylons, etc.) Do we have similar “guidelines” men can or must follow to be more physically attractive?

2. What do men you know say they want in a long-term relationship? Women? Does this match the research in this area?

3. How do we perceive couples in which the woman is significantly older, maybe ten years or more? How do we perceive couples in which the man is significantly older? Why do our perceptions differ? What about couples who seem “unbalanced” in terms of physical attractiveness?

4. Name some of the many meanings we give to the word “love,” besides affection for or romantic interest in. Obviously, the meaning of the word is vague and imprecise. What purposes might this vagueness serve?

Activity III: Testing the Attractiveness-Similarity Hypothesis When discussing the attraction-similarity hypothesis, ask students to rate the level of attractiveness of different people. From your newspaper section announcing engagements or some other sources of pictures of couples, randomly select ten photos of couples. It is interesting to use different ethnic groups as well as same-sex and mixed-sex couples. Make slides of the couple together and then of each partner separately. Randomly present the slides where the individual is by himself or herself and ask students to rate the level of attractiveness of the individuals in the photos from 1 (very unattractive) to 10 (very attractive.) Then let them know that these are couples and that this is a test of the matching hypothesis, so you want to see how many matches are there. Defining a match as a difference in ranking of two or less results in a great demonstration. Once the scores are obtained and the students realize how powerful the hypothesis is, show them the slides of the couples together, usually this gives the opportunity for a good discussion on how the hypothesis is not limited only to physical appeal.

Activity IV: All Those Love Songs In the session before discussing love, ask students to bring the lyrics of three of their favourite love songs. In small groups, let them share these lyrics with the other students and ask them to ..

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try to see what definition of love (if any) is being purported, what type of love they represent and whether the theories or approaches to the study of love discussed in the book are applicable to them.

Activity V: Thinking About Love and Gladiator Contests, or “Why I Took My Date to See Rocky 10” When you discuss the model of love as an appraisal of arousal, use this activity, to encourage students to think critically about the connection between love and physiology.

Ovid, the Roman poet, suggested that young men might open their ladies’ hearts by taking them to the gory gladiator contests (his interests were admittedly sexist). Based upon what you’ve read of the information on the physiology of love, explain why Ovid’s suggestions may have been right on the mark. Could going to a “horror movie” be a good first date? Research shows couples are more likely to bond in intense emotional experiences, or when physiological responses (e.g., increased heart rate) are intensified.

Activity VI: Thinking About Whether All You Need Is Love When you discuss Sternberg’s theory of love, use this activity to encourage students to examine whether passion is all that is needed for an enduring, successful relationship.

According to the Beatles song, “All you need is love.” Is it so? Is love all you need to have a lasting relationship (that is, as they say in the fairy tales, to “live happily ever after”)?

This is a situation in which everything depends on definitions. What, in other words, is meant by love in this song? Alternatively, what kind of love do you think of when you hear “All you need is love”?

Let us offer the not-too-risky conjecture that you don’t conjure up an image of compassionate love. Do you even think of romantic love, which combines passion and intimacy? Probably not.

The song is most suggestive of passion—of trusting and going with your feelings.

Is passion all you need to make an enduring, successful relationship? What other aspects of love relationships may be needed for a relationship to deepen and endure? If we stick to passionate love as our definition, then need we fly by the seats of our pants to arrive at an answer, or is there actual evidence on the matter? Yes, there really is some evidence and it is reported in Chapter 6.

Any conclusions?

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Chapter 7

CHAPTER 7 Relationships, Intimacy, and Communication CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

Supplemental Materials

Stages of Relationship Development

Learning Objective 1

IM Activity: Small Group Discussion Questions: Relationships

Beginning Relationships

Learning Objective 2

IM Activity: Opening Lines

Teaching Tip 1 Discussion Question 1 Discussion Question 2 Hooking Up

Learning Objective 3 Discussion Question 3

Developing Relationships

Learning Objective 4 Learning Objective 5 Learning Objective 6

Intimacy and Commitment

Learning Objective 7 Learning Objective 8 Learning Objective 9 Learning Objective 10

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Chapter Outline Breaking Up

Instructional Ideas

Supplemental Materials

Learning Objective 11 Discussion Question 4 Discussion Question 5

Communication

Learning Objective 12 Learning Objective 13 Learning Objective 14 Learning Objective 15

IM Activity: What Did You Say? Giving and Taking Criticism IM Activity: Using Nonverbal Communication

Learning Objective 16 Teaching Tip 2 Discussion Question 6 Discussion Question 7

CHAPTER SUMMARY In this chapter, concepts relating to relationships, intimacy, and communication are introduced.

The five-stage ABCDE model of romantic relationships is presented which includes: attraction, building, continuation, deterioration, and ending.

In order for relationships to begin, couples need to meet. Many couples meet by being in the same place at the same time. Others meet through friends or families while many others meet online. Research pertaining to online vs. offline meetings is discussed.

Because of cultural changes in timing of marriage, more and more people are engaging in casual sex and hooking up. Consequently, attitudes toward premarital sex have also shifted more favourably. In one study, half of first year university women reported having hook up sex during the year. Hook ups can include a wide variety of behaviours and partners. Potential positive and negative consequences of hook ups are discussed.

The ways we communicate and the personal information we share are critical to relationship development. In the early stages of a relationship, we tend to look for common ground in terms of overlapping attitudes and interests. At this point, communication may be based on small talk.

The role of new technologies in facilitating relationship communication is discussed. The role of self-disclosure in building an intimate relationship is also emphasized.

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Intimacy involves feelings of emotional closeness with another person and the desire to share each other’s innermost thoughts and feelings. Intimacy is one of the most valued components of long-term relationships. Intimate relationships are characterized by trust, caring, and acceptance.

People need not be sexually intimate to be emotionally intimate, nor does sexual intimacy automatically create emotional intimacy. Intimacy is an important component of relationships but also contributes to health and well-being. Research suggests there are few differences between same-sex and mixed-sex couples, although same-sex couples may face issues related to stigma and discrimination. Other relationship challenges that all couples may face are presented.

Jealousy has been found in different degrees of intensity in all cultures and can lead to loss of affection, feelings of insecurity and rejection, anxiety, loss of self-esteem, and mistrust.

Technological, evolutionary, and cognitive perspectives on jealously are presented.

Evolutionary theory predicts sex differences in jealousy such that men should be more upset by a partner’s sexual infidelity while women should be more upset by a partner’s emotional transgression; research supports these predictions. Communication strategies in response to jealously, both positive and negative, are presented.

Relationship break ups are among the most stressful life events experienced. Recent research about the process of breaking up is discussed.

The chapter concludes with a discussion about the importance of communication within relationships. While talking about sex can be difficult, sexual communication is associated with higher sexual satisfaction. There is considerable variation among people with regard to how comfortable they are in communicating with a partner about sexual matters; however, sexual communication skills can be learned. Sexual communication is important for sexual selfdisclosure and sexual initiation. Obstacles to sexual communication and strategies for improving communication including how to start a conversation about sex, communicating sexual needs, and listening effectively are presented.

LEARNING OBJECTIVES 1. Describe the stages of relationship development using the ABCDE model.

2. Discuss the various ways couples meet today and how this has changed over time.

3. List factors contributing to the rise in hookup behaviours and describe the benefits and negative consequences of casual sexual relationships.

4. Describe successful communication strategies to use during early exchanges with a new partner.

5. Explain ways in which technology has influenced dating and relationships.

6. Demonstrate effective ways to use self-disclosure in developing relationships.

7. Define intimacy and discuss how it is developed in relationships.

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8. Discuss ways in which heterosexual, gay, lesbian, and bisexual couples are similar and different in relationships.

9. Describe factors that support and challenge commitment in relationships.

10. Discuss factors associated with jealousy in relationships.

11. Describe factors associated with distress and factors associated with growth after a breakup.

12. Discuss benefits of sexual communication in relationships.

13. Summarize the research on sexual self-disclosure in relationships.

14. Compare men’s and women’s approaches to sexual initiation and discuss why gender differences in sexual initiation might exist.

15. Discuss reasons why sexual communication can be difficult in relationships.

16. Demonstrate some strategies for communicating sexual needs and listening effectively.

TEACHING TIPS 1. Have students list differences that may arise in a relationship. Have them discuss which ones they think could be resolved and which ones they think are intolerable. (Possible differences include opinions about family members, where you spend holidays, political party affiliations, religion, child discipline strategies, etc.)

2. Have students discuss the following questions in pairs and then discuss as a class, highlighting the importance of communication to relationships. To what degree do poor conflict-resolution skills lead to the ending of a relationship unnecessarily? Is poor conflict resolution related to anger management problems? Is it related to harassment, stalking, or violence in relationships?

What makes it hard to engage in conflict resolution? Do we lack adequate models? Are we taught that we have to agree with a partner or always be in the right?

DISCUSSION QUESTIONS 1. What are the pros and cons of meeting someone to date online? Do you think it is possible to develop intimacy with someone you’ve only talked with online?

2. How important is making a good first impression? What types of small talk would be most effective? How much information do you disclose about yourself at first meeting?

3. There is the stereotype that men do a lot of “locker-room” talking about women. Which gender do you think spends more time talking about potential partners with friends? What might Copyright © 2020 Pearson Canada In

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some differences be in the ways men and women approach these conversations? Who gives more detailed information?

4. Muise’s study found that more time on Facebook was associated with higher levels of jealousy. Do you think people who use Facebook are more likely to be jealous people, or that using Facebook creates more jealousy?

5. What is the best way to break up with someone? To get over a breakup?

6. How do you think college or university students best like to communicate sexual consent?

What are the dangers of relying on nonverbal communication to determine consent?

7. What types of sexual messages are the most difficult to communicate? Why?

ADDITIONAL RESOURCES Web Sites http://marriage.about.com This is an About.com expert guide on marriage. It provides a variety of links about various aspects of marital communication. http://www.bccf.ca Website of the British Columbia Council for Families; includes articles and other resources for couples. http://www.scienceofrelationships.com This website provides a wealth of articles and resources on the science of relationships, written by relationship researchers.

ACTIVITIES Activity I: Small Group Discussion Questions In mixed-gender groups of three to four students each, discuss the following questions related to dating, jealousy, breaking up, and intimate relationships. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. If men and women use the same date-seeking skills, will they be perceived differently? Give examples.

2. Describe some of your experiences with jealous partners. What were the effects on the relationship? Under what circumstances do you get jealous?

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3. Why don't people end relationships that have a deteriorated beyond repair? Fear of loneliness?

Fear of not being part of a couple? Fear of not finding another partner? Not wanting to be the one to take responsibility for ending the relationship?

4. Think about the intimate relationships you've had in which you cared deeply about another person and you felt comfortable sharing your inmost feelings. How many of these were with friends of the same sex? How many were with friends of the other sex? With how many were you also romantically intimate?

Activity II: Opening Lines Ask students to think of as many “opening lines” as they can remember having used or experienced. Select some of them to be role-played and then ask them which lines they believe would be effective and why. Are there gender differences?

Activity III: What Did You Say? Delivering and Receiving Criticism When you discuss the issue of criticism, ask students to write out situations (meaningful to them) they have experienced in which they have received or deliver criticism. Share some of these with the entire classroom or divide the class in small groups. Ask students to suggest what was appropriate and/or inappropriate and to provide suggestions on how to do it better.

Activity IV: Non-verbal Communication Divide the classrooms in dyads and ask them to use non-verbal skills to communicate different emotions. You can provide them with a list. The non-acting student should have 20 seconds to guess each emotion.

Anger

Eroticism

Disappointment

Boredom

Happiness

Inviting

Disbelief

Comforting

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Chapter 8

CHAPTER 8 Sexual Behaviours and Fantasies CHAPTER-AT-A-GLANCE Chapter Outline Solitary Sexual Behaviour

Instructional Ideas Learning Objective 1 Learning Objective 2

Supplemental Materials IM Activity: Asking People about Their Sexual Fantasies

Learning Objective 3 Discussion Question 1 Masturbation

Learning Objective 4 Learning Objective 5 Teaching Tip 1 Discussion Question 2 Discussion Question 3

Sexual Behaviour with Others

Learning Objective 6 Teaching Tip 2 Discussion Question 4

IM Activity: Small Group

Discussion Question 5

Discussion Questions: Sexual Behaviours

Vaginal Penetration

Learning Objective 7

Anal Stimulation and Penetration

Learning Objective 8

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IM Activity: Class Discussion: Foreplay

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CHAPTER SUMMARY This chapter explores different techniques and behaviours people engage in alone and with partners in order to fulfill their sexual desires. While there are some gender differences, engaging in sexual fantasy is one of the most common solitary sexual behaviours, though people may use sexual fantasy to heighten sexual excitement with a partner as well. Common fantasies are discussed. Women in same-sex relationships who were most happy with their relationships fantasized more often about their current partners; women who were less happy were more likely to fantasize about past partners. One study found gay men were open to a wider range of fantasies than were heterosexual men. Sexual dreams are common and most often are evaluated positively. The most common sexual dreams featured kissing and sexual intercourse.

Masturbation can be a solitary sexual behaviour or it can be shared with sexual partners.

Historically, masturbation was thought to be physically and mentally harmful, although no evidence of this has ever been reported. A more contemporary view is that masturbation can be empowering, an important part of healthy sexual development, and a way for people to learn about their own sexual responses. Surveys indicate that most people masturbate and that men masturbate earlier and more often than women. Recent research on factors associated with masturbation is presented. Further, people who use vibrators for sexual stimulation are also more likely to engage in sexually healthy behaviours, such as genital exams, and report more sexual desire, arousal, and orgasm.

Noncoital and precoital partnered sexual activities are described. In the past, these behaviours may have been considered “foreplay”, or sexual behaviour that occurs before coitus. However, noncoital behaviour can be enjoying and satisfying on its own and does not necessarily need to lead to anything else; further, it can occur at any time during a sexual encounter. Noncoital and precoital behaviour varies widely within and across cultures. Tantric sex is presented as a type of sexual activity that emphasizes prolonged noncoital activity.

Kissing is almost universal in the Western world but is not practiced in some societies.

Variations in types of kissing and their meaning is described. Touching or caressing erogenous zones can be highly arousing and is common during sexual activity. Variations in manual sexual stimulation are discussed. Most women enjoy breast stimulation and some women report being able to reach orgasm through stimulation of the breasts alone. Gay men stimulate their partner’s nipples more than heterosexual women do. The popularity of oral-genital stimulation has increased dramatically in the last 50-60 years. From being considered a taboo subject, oral sex has come to be viewed as a normal sexual activity and research indicates that many people engage in both giving and receiving oral sex. Techniques for fellatio and cunnilingus are presented.

Couples today use a great variety of coital positions for both vaginal and anal penetration. Faceto-face, side entry, and rear-entry positions are described. Each position has advantages and disadvantages for a couple. Anal stimulation and penetration are also described and both partners may have an orgasm during anal stimulation. Stimulation can occur with hands, penises, toys, or the mouth and is common among couples of all genders and orientations. Because the rectum ..

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produces no natural lubrication, people engaging in anal sex are advised to use plenty of lubricant. Additional research on anal sexual practices is discussed.

LEARNING OBJECTIVES 1. Explain why and how sexual fantasies might be used.

2. Compare the content in men’s and women’s sexual fantasies.

3. Summarize findings on gender and sexual dreaming.

4. Discuss historical attitudes toward masturbation.

5. Compare male and female approaches to masturbation.

6. Discuss purposes and methods of noncoital and precoital partnered sexual activity.

7. Identify and describe common positions for vaginal penetration.

8. Identify and describe common positions for anal stimulation and penetration

TEACHING TIPS 1. Set up two columns on the blackboard, one labelled “Positives About Masturbation” and the other labelled “Negatives About Masturbation.” Have students suggest items for each column: myths they’ve heard, facts they know, ideas that were once believed. Use this activity as a method of teaching the material on masturbation instead of lecturing on the myths and research.

2. (Conduct the following activity only if your institution’s ethics rules permit. Obviously, student participation must be voluntary.) Distribute index cards to all students. Ask them to write only “Male” or “Female” on their cards but to give no other identifying information. Then ask them to comment on foreplay preferences: time spent, behaviours, etc. Collect the cards and read them aloud to the class. Ask students to identify similarities and differences between males and females.

DISCUSSION QUESTIONS 1. Can you think of any reasons why women, in particular, might be prone to having forcedsex fantasies?

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2. Why do you think masturbation is more common among middle aged and older women than young women? Would you encourage your daughter to masturbate?

3. If you could design any sex toy, what would it do, and why? What would it look like?

4. Which is more taboo, fellatio or cunnilingus? Why? Which is more intimate?

5. If you were having sex with your partner and were not able to reach orgasm, do you think it would be okay to fake orgasm just once? Why or why not?

ADDITIONAL RESOURCES Web Sites http://www.goodvibes.com The “Sex Info” section provides a wealth of information, books, discussion, and links related to healthy sexuality. http://www.comeasyouare.com Website of a co-operatively run sex toy, book, and video store in Toronto; includes sexual health information and sex and disability resources. http://www.goodforher.com A woman-centred sex toy store in Toronto that also offers workshops and hosts an online advice column. http://www.ourbodiesourselves.org The companion website for Our Bodies, Ourselves includes a list of resources and links on sexuality. http://www.sexualityandu.ca Website from The Society of Obstetricians and Gynecologists of Canada on an array of sexual health topics, including masturbation, sexual behaviours, and other information. http://www.sexualpositionsfree.com Over 100 illustrated sexual positions with the use of mannequins, animated sequences, and explanations for each position.

ACTIVITIES Activity I: Asking People About Their Sexual Fantasies A week before talking about sexual fantasies, ask students to ask two males and two females to answer the following questions anonymously: 1. What are your sexual fantasies when you are alone?

2. What are your sexual fantasies when you are with a partner? ..

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Ask students to read them aloud in class, discuss similarities and differences.

Activity II: Class Discussion: Foreplay Ask students to list behaviours that are involved in foreplay. Share as a class. Ask students to identify similarities and differences between males and females. Have students consider how differences in foreplay preferences can affect sexual interactions between individuals. Does foreplay have a connotation that suggests it is less important than other forms of sexual activity, such as penile-vaginal intercourse or oral sex? Can foreplay be the main form of behaviour during sexual activity between two partners? How long does foreplay last? Many people find that the amount of time spent engaging in foreplay decreases over the duration of a relationship. Do students agree? Why does this happen? What are the advantages and disadvantages of this potential change? Finally, how can problems with foreplay be addressed?

Activity III: Small Group Discussion Questions: Sexual Behaviours Distribute copies of the Small Group Discussion Questions, and in groups of three to four students each, asks students to discuss the following questions related to sexual behaviours and to speculate on why some sexual behaviours are much less likely to be discussed among peers.

After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. What myths were you told about masturbation? What views do various religious groups hold? What effects do these myths and religious beliefs have on behaviour?

2. Research shows that the majority of men and women report having erotic fantasies, mostly during masturbation and coitus. Does this reflect your experience with what friends and acquaintances have told you? If your peers have not discussed this topic, speculate on why they haven’t.

3. Research findings from both Canadian and Kinsey studies indicate that people with higher levels of education are more likely to have engaged in oral genital sex than those who did not complete high school. How do you account for this difference?

4. The NHSLS study found that 26% of the men and 20% of the women surveyed had engaged in anal sex at some time in their lives. A survey of university students in British Columbia found similar results. Yet, somehow we continue to associate anal sex mostly with gay males. How do you explain this?

5. How can you communicate your position and stimulation preferences to a partner? Be specific. When, where, and what do you say and do?

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Chapter 9

CHAPTER 9 Sexual Orientation CHAPTER-AT-A-GLANCE

Chapter Outline Getting Oriented to Sexual Orientation

Instructional Ideas

Supplemental Materials

Learning Objective 1 Teaching Tip 1

Perspectives on Sexual Orientation

Learning Objective 2

Current Attitudes Toward Gay and Lesbian Sexuality

Learning Objective 3

IM Activity: Formulating Questions About Sexual Orientation

Discussion Question 1 Discussion Question 2

The Coming-Out Process

Learning Objective 4 Discussion Question 3

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IM Activity: Small Group Discussion Questions: Reaction to Sexual Orientation Issues

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Chapter 9

Chapter Outline

Instructional Ideas

Building Resilience Among Gay, Lesbian, and Bisexual Youth and Adults

Learning Objective 5

Gay and Lesbian Parenting

Learning Objective 6

Supplemental Materials

Discussion Question 4

Teaching Tip 2

CHAPTER SUMMARY This chapter presents an overview of sexual orientation: how it has been viewed historically, scientifically, and current societal attitudes. Sexual orientation is defined as a person’s erotic attraction to and romantic interest towards people of the same-gender, another gender, or both.

The terms heterosexual, gay or lesbian, and bisexual orientations are defined. Some object to the use of the term homosexual since it emphasizes sexual behaviour and carries a social stigma. Sexual identity is defined as one’s sense of who one is in terms of one’s sexual anatomy, cultural stereotypes of masculinity and femininity, one’s place in a given cultural setting as a man, woman, or somewhere in between, and the gender of those to whom one is sexually attracted.

Classifying sexual orientation can be complicated. Sometimes people’s sexual behaviours do not exactly match their stated sexual orientation. Some straight people have sexual experiences with people of their own gender and some gay and lesbian people have sexual experiences with people of the other gender. Sexual orientation might not be expressed in sexual behaviour and sexual behaviour per se does not define sexual orientation. People’s erotic interests and fantasies may also shift over time and some research suggests women’s sexual orientations are more flexible than men’s. The Kinsey Continuum is explained and challenges to it are discussed, such as Storm’s model which suggests that same-gender and other-gender orientations are independent dimensions and that a person might be high or low in both of them.

By this model, bisexual people are high in both heteroeroticism and homoeroticism, while asexual people are low in both. Prevalence estimates about the number of people who identify as gay, lesbian, bisexual, or something else other than heterosexual are discussed.

Bisexuality, sexual attraction for both genders, is described. Negative attitudes (bi-negativity) towards bisexuality are prevalent among gay and heterosexual communities and bisexual people face prejudice and discrimination.

Asexuality is defined as a lack of sexual attraction or interest in others. Some asexual people may still wish to form romantic relationships with others. Approximately 1% of the population may identify as asexual. Asexual individuals report low sexual response levels but do not experience this lack of response as distressing. There is also considerable diversity among the ..

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asexual community and future research is needed. Additional sexual identities introduced include queer, pansexual, questioning, and Two-Spirit.

Historical, cross-cultural, cross-species, biological, and psychological perspectives on gay and lesbian sexual orientations are presented. Historically, same-gender behaviour has been heavily punished; however, in ancient Greece, older men frequently formed sexual relationships with adolescent males. With the influence of Christianity, sexual behaviour between men was seen as sinful and ultimately this view was adopted into many secular laws. Cross-culturally, male-male sexuality has been practiced and, in some societies, viewed as normal and socially acceptable. In some societies, same-gender sexual activities are considered rites to mark a young male’s initiation to manhood. Sexual identity also varies by culture and so people may engage in samegender behaviour but may not share the Western concept of a gay identity. Male-male and female–female sexual behaviour has been observed in at least 450 different animal species in every part of the world.

Biological perspectives that may shape sexual orientation include evolutionary processes, genetics, hormonal influences, and brain structure. The evolutionary perspective suggests that gay and lesbian sexual orientations may have evolutionary benefits for the species. Research related to genetic influences on sexual orientation is presented; twin studies and the potential role of the X chromosome are discussed. The role of hormones is also described; however, no connection between sexual orientation and hormone levels in either males or females has yet been found. Some evidence suggests there might be structural differences between the brains of heterosexual and gay and lesbian people. Psychological perspectives are presented, analyzed and critiqued (i.e., psychoanalytic views, social learning, and gender nonconformity). Many gay and lesbian people report gender nonconformity from an early age.

Although negative attitudes towards gay and lesbian people still exist in our society, there is far greater acceptance in Canadian society now than in years past. Most Canadians accept samesex marriage. Homonegativity is defined and appears to be more common in heterosexual males than females. Some studies have found an association between homonegativity and homoerotic impulses. Harassment of LGBTQ youth in Canada is described. The fight for legal equality for gay and lesbian people has lasted for decades. In Canada, same-sex sexual behaviour was decriminalized in 1969. A timeline of other significant legal events is presented.

The challenges of coming out to one's self and others are presented. Because gay, lesbian, and bisexual people live in a society characterized by heteronormativity and homonegativity, they are the targets of violence and discrimination because of their sexual orientation. As such, they are more likely to experience psychological difficulties like depression and thoughts of suicide.

Compared to heterosexual youth, LGBTQ youth are more likely to have experienced a host of social and emotional difficulties. The concept of resilience is introduced. In relationships, gay, lesbian, and heterosexual couples report similar levels of satisfaction, love, attachment, closeness, caring, and intimacy. Further, three decades of research have clearly demonstrated that having gay or lesbian parents does not harm children in any way.

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LEARNING OBJECTIVES 1. Describe the various sexual orientations and define the different terms people use to selfidentify their sexual orientation.

2. Discuss the different ways sexual orientation has been viewed historically and scientifically.

3. Describe current attitudes toward gay and lesbian sexuality and summarize the evolution of Canadian law related to sexual orientation.

4. Describe the key features of the coming-out process for gay, lesbian, and bisexual people.

5. Identify factors associated with resilience among gay and lesbian people.

6. Evaluated the evidence concerning the effects of gay and lesbian parenting on children.

TEACHING TIPS 1. Even if you have discussed these terms earlier, stress again the definitions of heterosexual, gay, lesbian, bisexual, transgender, and transvestite. Differentiate between sexual orientation, gender identity, and the practice of cross-dressing.

2. Gay men and lesbian women may choose to live together as a family and rear children.

Various books at a primary school reading level address this family type: Heather Has Two Mommies, by Leslea Newman (1991), Daddy’s Roommate, by Michael Willhoite (1990), Asha's Mums (1990) by Rosamund Elwin and Michele Paulse, Mom and Mum are Getting Married (2004) by Ken Setterington. Acquire these books and have students examine them and discuss their possible use in schools. Should these books be available to students? At what age? Should teachers read these to students? In what grade?

DISCUSSION QUESTIONS 1. Same-sex marriage is a hotly debated topic in many countries worldwide. Why do you think people are so opposed to same-sex marriage? What are the major issues?

2. Do you think there is more negative prejudice toward gay men than toward lesbians? For example, is it considered more acceptable for two women to dance together in a bar or hold hands than for two men? Why might this be the case?

3. Many television sitcoms and dramas now have gay and lesbian characters. Various public personalities (i.e., politicians, athletes, entertainers) have disclosed their gay male or lesbian sexual orientation. How might the teenage years be easier for gay and lesbian teens if they have openly gay role models? ..

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4. How can teachers and school counsellors make the teenage years easier for gay and lesbian teens? Suggestions may include adopting a school policy guaranteeing equal treatment, not allowing derogatory comments, posting a pink triangle or rainbow symbol on their office doors indicating that they are “safe” people with whom to discuss this issue (assuming that some teens in their classes are gay), and using inclusive rather than heterosexist language in the classroom.

ADDITIONAL RESOURCES Web Sites http://www.biresource.org A non-profit, educational organization that promotes research and education about bisexuality. http://www.hrc.org The Human Rights Campaign features updated information on issues related to gay rights in the United States and suggests courses of action to change government policies. http://www.egale.ca Egale advances equality and justice for lesbian, gay, bisexual, and transgender people and their families across Canada. http://www.clga.ca The web site of the Canadian Lesbian and Gay Archives provides access to directories, inventories, essays, and articles relating to lesbian and gay life in Canada.

ACTIVITIES Activity I: Formulating Questions About Sexual Orientation You may choose to arrange a panel discussion on gay sexual orientation. If you do so, this activity asks students to first formulate guidelines for the panel discussion and then to formulate a list of questions to be given to panel members.

Few topics in a human sexuality course arouse more interest and emotion than sexual orientation.

One way to address this topic is to invite speakers from a local gay and lesbian resource centre or gay rights organization to serve as members of a panel discussion group. If you do so, this activity asks students to first formulate guidelines for the panel discussion and then to formulate a list of questions to be given to panel members.

To organize your task, complete the following: 1. What guidelines for this session would best serve students in getting answers to their questions while making the best use of time with the fewest arguments and interruptions?

2. Formulate a list of questions you’d like to see given to panel members (write these on 3×5 note cards). David M. McCord and Harold A Herzog of Western Carolina University ..

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compiled 280 questions about gay sexual orientations from 230 introductory psychology undergraduates. They grouped the questions into 13 categories. Consider the following categories as you formulate your questions: (1) family-of-origin relationships and reactions, (2) developmental issues, (3) discrimination, (4) experiential issues, (5) etiology (cause or origin), (6) sexual strategies or techniques, (7) experience with and feelings about heterosexuality, (8) religion, (9) raising children in a gay or lesbian household, (10) AIDS, (11) past experiences and influences, (12) same-sex marriage, (13) self-satisfaction.1 1McCord, D. M. and Herzog, H. A. (1991, December) "What undergraduates want to know about homosexuality."

Teaching of Psychology, 18(4), 243–244.

Activity II: Small Group Discussion Questions Reaction to Sexual Orientation Issues Distribute copies of the Small Group Discussion Questions and in mixed-gender groups of three to four students each, discuss the following questions and ideas. This activity asks students to discuss their reactions and societal reactions to several issues involving sexual orientation. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Why do you think men are generally more homophobic than women? Why are men more often than women associated with gay bashing?

2. The changing legal status of same-sex marriage in Canada has created a lot of controversy in recent years. What is your opinion of same-sex marriage?

3. If researchers find solid evidence for biological "causes" for adult sexual orientation, how do you think this will affect people’s attitudes toward gay men and lesbians?

4. Examine the idea that one of the biggest insults to boys is to be called a "sissy" and to men is to be called "effeminate." Calling a girl a "tomboy" or a woman "masculine" does not carry the same sting. Are males who "act like" females seen as less valuable? In what way does this reflect the sexism in our culture?

5. How would you react if a friend came out to you? A classmate? A fellow employee at work?

A professor? Your child’s teacher? Your doctor?

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CHAPTER 10 Conception, Pregnancy, and Childbirth CHAPTER-AT-A-GLANCE

Chapter Outline

Instructional Ideas

Conception

Learning Objective 1

Infertility and Assisted Reproductive Technologies

Learning Objective 2

Supplemental Materials

Teaching Tip1 Discussion Question 1 Discussion Question 2 Discussion Question 3 Discussion Question 4

Pregnancy

Learning Objective 3 Discussion Question 5

IM Activity: What Pregnant Women Should Know

Discussion Question 6 Prenatal Development

Learning Objective 4 Learning Objective 5 Learning Objective 6

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Chapter Outline Childbirth

Instructional Ideas Learning Objective 7 Learning Objective 8

Supplemental Materials IM Activity: Small Group Discussion Questions

Learning Objective 9 The Postpartum Period

Learning Objective 10

Canadian Birth Rates and Teen Pregnancy

Learning Objective 11

Teaching Tip 2

IM Activity: Postpartum Depression: Nature or Nurture?

CHAPTER SUMMARY Conception is the union of a sperm cell and an ovum. Ova carry X sex chromosomes; sperm carry either X or Y sex chromosomes. The journey of sperm is briefly described. Fertilization normally occurs in a fallopian tube. The chances of conception can be increased by engaging in coitus around the time of ovulation. Methods of predicting ovulation and techniques for optimizing conception are described in a text box.

About one couple in six or seven has fertility problems and about half of these eventually succeed in conceiving a child. The term infertility is usually not applied until a couple has been unable to conceive for more than a year. The most frequent causes of infertility in males and females are explained in conjunction with many of the treatment options available and the alternative ways of becoming parents, including adoption. Canadian legislation regulating reproductive technologies is discussed.

The biological and psychological aspects of pregnancy are described. Pregnancy entails physical changes and psychological effects that may vary according to the desire of being pregnant and the attitude toward the physical changes. Some early signs and effects of pregnancy are described, and the possible causes of miscarriage are discussed. Generally, coitus during a normal pregnancy is safe until the start of labour. A woman’s psychological response to pregnancy reflects her desire to be pregnant, her physical changes, and her attitudes toward these changes. The mother’s partner, if there is one, also responds to pregnancy according to the degree to which he or she wants the child.

Naegele’s rule for calculating a baby’s delivery date is presented. Prenatal development can be divided into three periods. The germinal stage is the period from conception to implantation and corresponds to about the first two weeks. The embryonic stage begins with implantation and ..

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extends to about the eighth week of development; it is characterized by differentiation of major organ systems. The fetal stage, characterized by continued maturation of the organ systems and dramatic increases in size, begins by the ninth week and continues until birth. There are many factors that can affect prenatal development such as maternal diet, maternal diseases and disorders, and exposure to different kinds of teratogens. Medications, vitamins, narcotics, marijuana, alcohol, and tobacco can all impact the developing fetus. Chromosomal and genetic abnormalities can also lead to particular defects and syndromes.

Childbirth begins with the onset of labour and progresses through three stages. In the first stage, uterine contractions efface and dilate the cervix. The second stage begins when the baby first appears at the opening of the birth canal and ends with the birth of the baby. During the third stage, the placenta is expelled. Contemporary methods of childbirth are described. Today, women in Canada typically give birth in hospitals, attended by physicians. However, some women may choose to deliver with the help of a midwife at home. Preterm delivery and low birth weight are some common birth problems.

The weeks after delivery are called the postpartum period. About 70% of mothers experience the “baby blues”, periods of tearfulness, sadness, and irritability in the first few days following the birth. They last for about ten days and are not severe enough to impair the mother’s functioning.

For up to one in seven women, postpartum depression begins within four weeks after delivery and can linger for weeks or months. The cause of this is likely largely biological. Other considerations related to the postpartum period are decisions about breast-feeding, resumption of ovulation and menstruation, and resumption of sexual activity.

Canadian birth rates and teen pregnancy are described and both have been declining in Canada since the 1970s. Pregnancy rates are higher among sexually active gay, lesbian, and bisexual teenagers than among heterosexual teenagers.

LEARNING OBJECTIVES 1. Describe the process of conception.

2. Discuss fertility problems and ways people with such problems can become parents.

3. Discuss signs of pregnancy and sexual activity during pregnancy.

4. Describe the key events of the stages of prenatal development.

5. Describe the effects of environmental hazards on the fetus.

6. Discuss the effects of genetic abnormalities on the child.

7. Describe the stages of childbirth.

8. Discuss the various methods of childbirth.

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9. Discuss various birth problems.

10. Discuss events of the postpartum period, including mood changes and breastfeeding versus bottle-feeding.

11. Discuss trends in birth rates and teen pregnancy rates.

TEACHING TIPS 1. Instead of lecturing about the alternative methods of becoming a parent, have students suggest and describe them. Then discuss how many “parents” each resulting infant would have. Discuss the moral and legal issues surrounding each method.

2. Ask students to search for information regarding the position of international health organizations with respect to breast-feeding. List advantages and disadvantages for the infant and mother. Compare norms and beliefs in different countries.

DISCUSSION QUESTIONS 1. If an absolutely reliable gender-selection method was developed, would you use it? What considerations determine your answer? Should this technology be available to anyone who desires it? To those who can afford it? Only to those who have a “good reason” for using it?

2. How far would you go to “design” your child if such options were available? If you could select genes for intelligence? Athletic ability? Personality characteristics? Hair colour?

3. Would you sell your sperm or eggs if it were legal to do so in Canada? Why or why not? How do you think you would feel about the possibility of there being a child out there with your DNA? 4. In what situation would you be a surrogate mother? Would it be easier or more difficult if you were a surrogate for a family member? In what situations would you consider using a surrogate to carry your baby? If you are a man, what would you consider before having a surrogate carry your baby?

5. What would you do if you saw an obviously pregnant woman smoking or drinking in a bar?

Would it be appropriate to do anything?

6. With advances in medicine and technology, women are able to get pregnant increasingly later in life. Should there be an age limit for women to seek medical assistance to get pregnant? Why or why not?

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ADDITIONAL RESOURCES Web Sites http://www.plannedparenthood.org Founded in 1916, Planned Parenthood is the world's largest and oldest voluntary family planning organization. Planned Parenthood is dedicated to the principles that every individual has a fundamental right to decide when or whether to have a child, and that every child should be wanted and loved. http://www.resolve.org The mission of RESOLVE, a nonprofit organization founded in 1974

by Barbara Eck Menning, is to provide timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy. http://www.marchofdimes.com Website of the March of Dimes, an organization dedicated to improving the health of babies by preventing birth defects, premature births, and infant mortality. http://www.infertilitynetwork.org The Infertility Network is a Canadian, non-profit organization that provides information on all aspects of infertility, such as medical treatments, adoption, current legislation, and psychological impact. http://fertilitymatters.ca Fertility Matters Canada is a nationwide network of support groups that provides information for couples experiencing infertility. http://www.babycenter.com This site provides information for parents from conception to birth and childhood.

ACTIVITIES Activity I: What Pregnant Women Should Know This activity asks students to use the information in the text to plan a brief question-and-answer brochure for women who are pregnant or planning a pregnancy.

Instructions for students: You have been given the assignment of making up a brief brochure to distribute to women who are pregnant or are planning a pregnancy. You have also been told to use a question-and-answer format. Using your text as a source of information, use the following list of topics (add others if you choose) to write a series of questions and answers.

Topic

Question

Answer

Health Before Conception

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Topic

Question

Answer

Pregnancy Tests

Figuring Due Dates

Weight Gain

Signs and Symptoms of Pregnancy

Substances to Avoid

Testing for Abnormalities

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Topic

Question

Answer

Signs and Symptoms of Labour

Breast-feeding

Postpartum Period

Activity II: Small Group Discussion Questions Conception, Pregnancy and Childbirth Distribute copies of the Small Group Discussion Questions, and in groups of three to four students each, discuss the following questions related to gender selection, infertility, and childbirth. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. If a gender-selection method that was absolutely accurate were developed, would you use it?

What considerations determine your answer? Should this technology be available to anyone who desires it? To those who can afford it? Only to those who have a “good reason” for using it?

What do you think about the fact that conception can occur in the absence of sexual intercourse?

2. The definition of infertility has been changing. Infertility used to be defined as failure of a couple to conceive on their own for five years. This length of time was first lowered to two years and later lowered to one year. What forces may have played a role in these changes? What effects might the changes in definition have had? ..

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3. Should provincial health insurance pay for infertility treatments? If your answer is yes, should it limit the choices of infertility treatments based on factors such as cost per attempt, success rates, or age of prospective mother?

4. Think about the ways we talk about the birth process. If, as we often say, doctors “deliver” babies, then what does the mother do? If pregnancy and birth are not disease states, why do we speak of pregnant women as “patients”? And why do many articles in women’s or parenting magazines refer to “medical management” of childbirth, instead of providing information to assist women during pregnancy, labour, and birth? What purposes do various language choices serve?

5. Do you think that cultural beliefs or expectations influence the experience of pain during delivery?

Activity III: Postpartum Depression: Nature or Nurture?

Before class, distribute the article by Dr. Laura Miller, Postpartum depression1. Have students come prepared to discuss the article. The following questions could be discussed in teams or in the context of the entire lecture: According to the article: What can most women expect to experience after giving birth? Is it inevitable that women will experience postpartum depression? What biological factors related to postpartum depression are discussed? What socio-cultural factors related to postpartum depression are discussed? What evidence is presented for each?

Have students share their opinions about the major tenets of the article.

1

Miller, L. J. (2002). Postpartum depression. JAMA, 287, 762–765.

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Chapter 11

CHAPTER 11 Contraception and Abortion CHAPTER-AT-A-GLANCE

Chapter Outline Contraception in Canada

Instructional Ideas Learning Objective 1

Supplemental Materials IM Activity: Small Group Discussion Questions

Discussion Question 1 Hormonal Methods of Contraception

Learning Objective 2 Teaching Tip 1

Barrier Methods of Contraception

Learning Objective 3 Teaching Tip 2 Discussion Question 2

Fertility-Awareness Methods of Contraception

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Learning Objective 4

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Chapter Outline

Instructional Ideas

Permanent Methods of Contraception

Learning Objective 5

Douching

Learning Objective 6

Abortion

Learning Objective 7 Learning Objective 8 Learning Objective 9

Supplemental Materials IM Activity: Deciding on a Birth Control Method

IM Activity: Controversial Issues in Contraception and Abortion

Learning Objective 10 Learning Objective 11 Discussion Question 3

CHAPTER SUMMARY Contraception has existed since the relationship between penile-vaginal intercourse and conception was recognized. A brief historical account of early forms of contraception is presented. Contraceptive use among Canadians is described. Most Canadians rely on male condoms and oral contraceptives for birth control. Before the 19th century, abortion and contraception were illegal in Canada. The movement to legalize contraception was started in the 1920s by female activists in Vancouver. The first Canadian birth control clinic was established in Hamilton, Ontario in the early 1930s. In 1969, the government of Pierre Trudeau legalized contraception and abortion was allowed under certain conditions.

Various methods of contraception and how they work are presented. The effectiveness, reversibility, and advantages and disadvantages of each method are discussed. Hormonal

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methods of contraception include oral contraceptives, emergency contraception, the contraceptive patch, the vaginal ring, injectable contraception, and intrauterine devices (IUDs).

Oral contraceptives, or birth-control pills, include combination pills and minipills. When used properly oral contraception is nearly 100% effective; however, failure rates increase if people forget to take the pill, or take them incorrectly. The main drawbacks are potential side effects and potential health risks, including no protection against STIs. Emergency contraception should be taken as soon as possible after unprotected intercourse or when other contraception fails (e.g., a condom breaks). It’s most effective when taken with 24 hours of unprotected sex but can be taken up to 72 hours after the event. In 2005, Health Canada allowed pharmacists to provide Plan B (the most recommended emergency contraceptive pill) without a prescription; however, it had to be kept behind the counter. In 2008, Health Canada permitted Plan B to be available on pharmacy shelves instead of behind the counter. Nausea is a common side effect of the drug, due to its high hormone content.

The contraceptive patch also delivers estrogen and progestin to prevent ovulation and implantation; when used correctly, it is also more than 99% effective. However, the typical failure rate is 9%. A new patch is worn every week for three weeks; the fourth week is patch-free to allow for menstrual bleeding. Its effects and potential hazards are similar to those of the pill.

The vaginal ring is inserted into the vagina and delivers hormones through the skin. If used perfectly, it is also more than 99% effective; however, the typical failure rate is 9%. Potential side-effects are comparable to the patch and the pill and, like the patch, it is worn for three consecutive weeks, with one ring-free week to allow for menstruation. Depo-Provera is an injectable hormone solution available by prescription. Depo-Provera prevents ovulation and is 99.7% effective. It is administered in the muscle of the arm or buttocks every 12 weeks. Its side effects are similar to other types of hormonal contraception, but in addition, prolonged use may lead to loss of bone density.

The IUDs (intrauterine devices) are highly effective and can be used for long periods (three to 10 years depending on the type). IUDs are small objects of various shapes that are inserted into the uterus by a physician or nurse practitioner; fine threads or strings hang down from the IUD into the vagina. Two main IUD systems are available in Canada: copper IUD devices and levonorgestrel-releasing IUD systems (Mirena and Jaydess). Though relatively maintenance-free, there are some possible side effects.

Barrier methods of contraception include condoms (insertive and receptive), the diaphragm, the cervical cap, spermicides, and the contraceptive sponge.

Latex condoms are safe, effective, inexpensive, and the most common barrier method of contraception. The condom is placed over the penis prior to sexual activity. They are effective in preventing pregnancy and reducing the risk of STIs. While perfect use efficacy is 98%, typical use failure rate is around 15%. Advantages and disadvantages are discussed. Textboxes provide information on using condoms effectively as well as common errors.

“Female” condoms, polyurethane sheathes which are inserted into the vagina prior to intercourse, may be less effective at preventing pregnancy than “male” condoms. Typical use failure rates have been reported between 21% and 26%. ..

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The diaphragm is a shallow cup made of thin latex or silicone and nylon that covers the cervix to prevent sperm from entering. It should be used with spermicide gel. It must be fitted to the contours of the vagina by a health care professional and if used correctly, the failure rate is estimated to be 6% during the first year of use. In typical use, however, the failure rate is believed to be three times as high: 18%. The cervical cap is similar to the diaphragm but is a somewhat smaller option.

Spermicides coat the cervical opening, block the passage of sperm, and kill sperm by chemical action. They should be used with another method of contraception as they are not highly effective when used alone (failure rates vary from 18-28%). Spermicides occasionally cause vaginal or penile irritation.

The contraceptive sponge is a soft, disposable device which can be inserted into the vagina several hours before coitus. It holds spermicide and absorbs sperm, although some people report irritation with use. The failure rate is between 12 and 24%.

Fertility-awareness methods of contraception rely on awareness of the fertile segments of a woman’s menstrual cycle. Essentially, intercourse is avoided (or another conceptive method is used) on days when conception is most likely. As no devices or chemicals are used, there are no side effects. The estimated first-year failure rate for typical use of fertility-awareness methods is 20%. Fertility-awareness methods include the calendar method, basal-body-temperature method, the cervical-mucus method, and withdrawal. Ovulation prediction kits enable women to predict ovulation; new smart-phone apps have also been developed for this purpose.

Permanent methods of contraception (also known as sterilization) are the most effective form of contraception. They are intended to be irreversible, although may be reversed in some cases. The permanent method of contraception used by men is the vasectomy, usually carried out under local anesthesia in a doctor’s office. The most common method of female sterilization is the tubal sterilization or tubal ligation which prevents ova and sperm from passing through the fallopian tubes.

Attitudes toward abortion have varied across culture and time. Abortion was illegal in Canada until 1969 when it was legalized under restricted conditions. At that time, abortions were only performed in accredited hospitals if the health or life of the mother was considered to be in danger. The Supreme Court of Canada overturned the abortion law in 1988 and there have been no federal restrictions on abortion since. Attitudes toward abortion in Canada are discussed.

Although legal, only a minority of hospitals perform abortions and provinces may set restrictions so access to abortion is difficult for many women. Methods of abortion include vacuum aspiration, D & E (dilation and evacuation), and abortion drugs. Although choosing to have an abortion is typically a difficult decision, the majority of women report being satisfied with their decision two years post-abortion.

LEARNING OBJECTIVES 1. Discuss trends in contraceptive use among Canadian women and adolescents. ..

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2. List types of hormonal contraception, explain how they work, and discuss their advantages and disadvantages.

3. List types of barrier contraceptives, explain how they work, and discuss their advantages and disadvantages.

4. List types of fertility-awareness methods of contraception, explain how they work, and discuss their advantages and disadvantages.

5. Describe methods of permanent contraception, and discuss the prospects of reversibility.

6. Explain why douching is not an effective contraceptive method.

7. Discuss historical and legal perspectives concerning abortion.

8. Discuss attitudes toward abortion among Canadians.

9. Summarize data on abortion rates and accessibility in Canada.

10. Discuss methods of abortion.

16. Discuss research on the psychological consequences of abortion.

TEACHING TIPS 1. Obtain samples of as many contraceptives as possible. Spermicides and male and female condoms can be purchased easily. Contact family planning clinics or physicians for samples of prescription and nonprescription contraceptives. Try to obtain the printed inserts for each. Put each contraceptive device in a small brown bag. Distribute one bag to each small group of three to five students. After small-group discussion, have one person from each group explain the contraceptive method to the class. After all the devices have been described, pass the devices around until all students have seen each one.

2. Have students list the many advantages of using condoms and spermicides together. Then ask students: Given the many advantages, why don’t more people choose condoms and spermicides?

Should the information about the advantages be more widely available? To whom? Via what media? If their answer is no, have them state why not. If their answer is yes, have them suggest a program to make this possible.

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DISCUSSION QUESTIONS 1. Why do you think so many college and university students are so inconsistent in their use of contraceptives? How do you think you could successfully encourage students to increase their use of contraceptives?

2. What method of birth control is best for college or university students today?

3. A news commentator once said, in describing the polls regarding abortion attitudes, that the problem is that many people are both pro-life and pro-choice. Analyze this idea. Do you consider yourself to be both pro-life and pro-choice?

ADDITIONAL RESOURCES Web Sites http://www.actioncanadashr.org Action Canada for Sexual Health and Rights is a non-profit, pro-choice organization that promotes sexual and reproductive health and rights in Canada and globally. http://www.morgentaler.ca An informative website from the Morgentaler Clinic that provides information about abortion and procedures, as well as the history of abortion and freedom of choice. http://www.plannedparenthood.org Founded in 1916, Planned Parenthood is the world's largest and oldest voluntary family planning organization. Planned Parenthood is dedicated to the principles that every individual has a fundamental right to decide when or whether to have a child. It also provides contraceptive and STI information. http://www.sexualityandu.ca Website from The Society of Obstetricians and Gynecologists of Canada on an array of sexual health topics, including contraception, sexual behaviours, and other information.

ACTIVITIES Activity I: Small Group Discussion Questions Contraception and Abortion Distribute copies of the Small Group Discussion Questions, and in mixed-gender groups of three to four students, discuss the following questions related to contraception and abortion. After 20 minutes, one student from each group should summarize the small group discussion to the class. ..

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1. Try to imagine what life would be like if both contraception and abortion were illegal. Would you break the law and try to obtain condoms or a diaphragm? How would you feel about a person being charged with the crime of possessing a condom or diaphragm? Would you break the law and help teach women how to prevent pregnancy?

2. Trying to talk about contraception with a partner may be embarrassing. When would you say is the right time to do it? What problems, if any, would you anticipate in trying to raise the topic?

Which of the factors in selecting a method of contraception are the most important to you?

3. Are some of the methods of contraception morally and ethically unacceptable to you? Do you believe that your views on contraception are consistent with those from your sociocultural background? Explain.

4. Describe the personal characteristics and the type of relationship that would make a couple good candidates for using fertility awareness methods of contraception.

5. Female sterilization, as compared to male sterilization, is costlier, sometimes requires the use of a general anaesthetic, and more often results in medical complications. Although recent Canadian research indicates that the rate of male sterilization is increasing while the rate of female sterilization is decreasing, it is still true that more Canadian women than men are sterilized each year. Why do you think this is the case?

Activity II: Deciding on a Birth Control Method Distribute copies of Deciding on a Birth Control Method and ask students to decide, in small mixed-gender groups, which method of birth control would be most appropriate for each couple’s situation. Afterwards, distribute answer sheet and discuss.

1. Karla has been with David for 3 years. They are monogamous and consider their relationship to be serious; however, they have no plans to get pregnant in the next few years. Karla is wondering what type of birth control is appropriate for her. She tried using an intrauterine device (IUD) and experienced excessive menstrual cramping during her periods. Karla is very diligent about taking medications and ensures that she always takes her medications on time. David has also stated that he does not like to use condoms, given that they decrease sensation during sex.

What form of birth control would best suit them?

2. Elizabeth is married to Daniel and they have 2 children. At the moment they are not ready to have a third child but both feel that it is morally unacceptable to use condoms or any other type of contraceptives. They may want to have more children in the future. What type of birth control would you recommend they use?

3. Merissa is not currently in a relationship. She has had multiple partners over the last year and is not interested in a committed relationship. She has a history of heart problems and periodically gets migraines. Her main concern regarding birth control is that she would like to be protected against STIs. What birth control method would be appropriate for her? ..

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4. Caitlyn had sex with her new boyfriend last night and during intercourse the condom tore.

Caitlyn is very concerned that this may result in an unwanted pregnancy. What contraceptive method would you suggest?

5. Christopher is 45 years old and is married to Michelle. They have 3 children and have decided that they do not want to have any more. Until recently, Michelle had been on the pill, but due to health concerns, her doctor recommended that she no longer use hormonal birth control methods.

Christopher has decided that he would like to take on the responsibility of birth control.

However, Christopher has an allergy to latex and is not able to use condoms. What birth control options would you recommend to Christopher?

Answers: 1. Karla’s best bet would be to use oral contraceptives. She is in a monogamous relationship and given that David has stated that he does not like using condoms, it is probably safe to say that they would not use condoms as consistently as they should if it were their primary birth control method. Since Karla is serious about taking her medications she would be a good candidate for the pill since the effectiveness of the pill depends on it being taken every day. However, the use of condoms would still be recommended if this couple had not yet been tested for STIs. 2. Given their beliefs, this couple may want to try some of the fertility-awareness methods. They may want to try the Calendar Method, where the couple abstains from intercourse during ovulation. These methods are a natural form of birth control and are in tune with the couple’s beliefs. However, the reliability of these methods is low and does not offer any protection against STIs. 3. Merissa would benefit greatly from using condoms as her primary method of birth control.

Condoms offer protection against STIs and also in preventing pregnancy. Since Merissa has a history of heart problems she is not a good candidate for oral contraceptives. Research has shown that the pill may increase the risk of heart attack in women who have had heart problems.

4. Caitlyn should look into taking an emergency contraceptive, such as Plan B. This type of contraception is to be used in emergency situations such as when a condom breaks during intercourse, and is not meant to be used as a primary method of birth control. This is due to the strength of the hormones used in the pill which is significantly higher than the levels found in regular oral contraceptives. In the future, Caitlyn may want to look into having a secondary method of birth control, such as a birth control pill in case she comes across this problem again.

However, the use of condoms is still important in a new relationship if the partners have not yet been tested for STIs or have not agreed to become monogamous.

5. Christopher may consider having a vasectomy. As a couple, they have decided that they do not want to have any more children and a vasectomy is nearly 100% effective in preventing pregnancy. While it is great that Christopher wants to take responsibility for the birth control in his partnership, the couple may also want to consider non-hormonal birth control options for Michelle (such as an IUD or spermicides) as a vasectomy is permanent. Although it can be reversed (vasovasectomy), it can be a complicated procedure and there may be side effects to doing so. ..

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Activity III: Controversial Issues in Contraception and Abortion This activity asks students to try to think critically about eight emotionally charged issues. In small groups of three to four students each, have students use their knowledge of critical thinking skills to consider the following emotionally charged issues. Keep in mind that critical thinking involves being skeptical of “common knowledge” and conventional wisdom. It requires thoughtful analysis—scrutinizing the definitions of terms, evaluating the premises and assumptions behind others’ arguments, and examining the logic of their arguments. If students find themselves interrupting others and not listening to their arguments, try having them taking turn presenting the arguments.

1. Contraception is considered by many to be the responsibility of women, and women are often blamed for and must cope with unintended pregnancies. What could be done by parents, schools, or health care professionals to change this?

2. Should anyone, male or female, ever be sterilized against his or her will? If so, who? Under what conditions?

3. Imagine that an oral contraceptive for males is perfected and its side effects are no more problematic than the oral contraceptives for women. How will men and women react? How many men do you think would be willing to take responsibility for contraception?

4. Many people think only of teenagers when they think about who has abortions, however, the Canadian abortion rate is highest in the 20–24 age group. What purposes does this misperception serve?

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CHAPTER 12 Sexuality Across the Life Span CHAPTER-AT-A-GLANCE

Chapter Outline The Development of Sexuality in Childhood

Instructional Ideas

Supplemental Materials

Learning Objective 1 Learning Objective 2 Teaching Tip 1 Discussion Question 1

Adolescent Sexuality

Learning Objective 3 Teaching Tip 2 Teaching Tip 3 Discussion Question 2

IM Activity: Thinking About Messages About Menstruation IM Activity: Small Group Discussion Questions: Sexuality in Childhood and Adolescence IM Activity: Sexual Knowledge and Experience Survey

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Chapter Outline Adult Sexuality

Instructional Ideas Learning Objective 4 Learning Objective 5 Learning Objective 6 Learning Objective 7 Teaching Tip 4

Supplemental Materials IM Activity: Issues to Consider Before Marriage or Cohabitation IM Activity: Small Group Discussion Questions: Sexuality in Adulthood

Teaching Tip 5 Discussion Question 3 Discussion Question 4 Discussion Question 5

Sexuality in Later Life

Learning Objective 8 Teaching Tip 6

CHAPTER SUMMARY This chapter explores sexual behaviour from infancy through late adulthood.

Many people assume the development of sexuality begins at puberty; however, development begins before birth and continues throughout life. Imaging techniques have shown that male fetuses have erections and most infant boys have erections in the first few weeks of life. Sexual arousal in infant girls is not as readily detected but does occur. These responses, however, should be viewed more as “reflexive” and not “sexual” in nature. Masturbation is typical for infants and young children and may start as early as 5 months, but an orgasmic response is uncommon before the age of 2.

During early childhood, children commonly show interest in examining each other bodies or in physical contact such as hugging, cuddling, or kissing. During this phase of development, children should begin to learn the basic rules of privacy, that they have basic autonomy over their own bodes, and that there’s a distinction between good touch and bad touch. ..

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During middle childhood (5 to 8 years), children may experience their first “crushes” and may have relationships with special friends that resemble an early form of dating. Curiosity about the genitals increases during this stages and sex games like show and playing doctor are common.

Same-gender play may be more common than other-gender behaviour at this time.

During preadolescence (9 to 13 years), individuals tend to socialize in same-gender groups. They typically begin to grow more self-conscious about their bodies and feel social pressure to conform. Masturbation is common and may be more common among males than females.

Preadolescent sex play often involves mutual display of the genitals, with or without touching.

Less than 10% of individuals report sexual intercourse during this phase.

The four major developmental tasks of adolescent sexuality are presented. During puberty, secondary sex characteristics appear and toward its end, reproduction is possible. Menarche occurs in girls and the first ejaculation occurs in boys. The age of menarche has declined sharply since the mid-1800s, probably because of better nutrition and health care. The role of estrogen and androgens in female sexual development is explored. In males, the role of testosterone is explained. Developing sexual self-acceptance is important during this phase. First romantic and sexual relationships are likely to occur and many fall in love for the first time. Research on first sexual intercourse is presented.

During adolescence, masturbation is very common for both genders. Research discussing the prevalence of oral sex and penile-vaginal sex is presented. Data for LGBTQ youth is also presented. Sexting and casual sexual relationship types are also discussed. Protecting sexual health during adolescence is important, including preventing unintended pregnancy and STIs. Adulthood has its own set of developmental tasks for sexuality and relationships including the integration of passion, friendship, communication, and sexual health. Singlehood is the most common lifestyle among people in their 20s and possible reasons for this are described. Some singles may experience loneliness and lack of meaningful relationships, although most report feeling well adjusted and content. Single people differ in their sexual interests and lifestyles.

Most are sexually active and practice serial monogamy while others might choose celibacy. New technology is changing the way single people meet and interact with each other.

Some couples choose to live together before marriage and attitudes toward cohabitation have become much more positive over the last few decades. There is some evidence that couples who cohabitate before marriage are more likely to divorce if they marry later on.

Marriage is found in all human societies and most people in every known society will get married at least once. The development of legalized same-sex marriage in Canada is traced and the prevalence of same-sex common-law and married couples is presented. People may marry to meet personal and cultural needs, to legitimize sexual relations, to maintain a home life, and to provide an institution for rearing children, as well as for love, companionship, and intimacy. The two major types of marriage are monogamy and polygamy. Arranged marriage is common in some cultures. In Western cultures, people tend to marry with people from their same race/ethnic background, educational level, and religion. They also tend to “match” in physical attractiveness and attitudes.

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Patterns of marital sexuality vary across cultures. Research on frequency of sex in marriage is presented. Sexual satisfaction and marital satisfaction are positively correlated; research and theory are discussed.

People engage in extramarital sex for a variety of reasons and research suggests that infidelity occurs in 20% - 25% of all marriages. The discovery of infidelity can evoke a range of emotional responses. The harm an affair does to a marriage depends on the meaning the affair has for each marriage partner. In some case, it may hasten the end of the marriage, for others, it may stimulate the couple to work to improve their relationship. Some married couples may engage in swinging, or mate swapping. Polyamorous relationships refer to open relationships that allow for consensual sexual and/or emotional interactions with more than one partner.

Myths about sexuality among older people abound. Most older people report that they like sex and that orgasm is still important to their sexual fulfillment. Although physical changes can impair sexual activity, potential problems can usually be averted or minimized. Psychological and social factors may be at least as important as physical factors in determining sexual behaviour and satisfaction among older people. Physical changes in older men and women are discussed. Older adults still need to protect their sexual health and be aware of sexual health risks like STIs.

LEARNING OBJECTIVES 1. Describe the development of sexuality during infancy and early childhood.

2. Describe the development of sexuality during middle childhood and preadolescence.

3. Discuss the developmental tasks of adolescent sexuality.

4. Discuss the developmental tasks of adult sexuality.

5. Describe different relationship statuses in adulthood.

6. Discuss sexuality within marriage.

7. Discuss extramarital sex.

8. Discuss the changes associated with aging that can affect sexuality and how older people can adapt to them.

TEACHING TIPS 1. If you discovered two children you know (e.g., siblings, nieces and nephews, children you are babysitting) “playing doctor,” how would you handle the situation? Have students discuss this in pairs and then role-play what they would say and do. ..

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2. Instead of lecturing about the physical and psychological changes associated with puberty, have students suggest what they would tell children in Grades 5 and 6. Encourage students to consider including information on specific body changes, average age of these changes, feelings, the wide range of “normal” development, and the problems experienced by early-and latematuring boys and girls. Have students discuss what information they would not teach children in Grades 5 and 6 3. Acquire at least five or six books about the physical changes associated with puberty that have a reading level appropriate for children ages eight to twelve. Pass these around the class. Ask students if they knew what to expect at puberty. Ask those who didn’t if they wish they had known.

4. Set up three columns on the blackboard labelled “Single,” “Cohabiting”, and “Married.” Write the advantages and disadvantages of each as students suggest them. Students will probably disagree about whether an item such as “making decisions without consulting another person” is an advantage or a disadvantage. Also, have students discuss the motives people have for making one of these lifestyle choices.

5. Set up three columns on the blackboard labelled “More people remaining single longer,” “More cohabitation”, and “More divorces.” First, have students discuss the possible causes of each trend. Second, discuss the societal impact of each trend. Third, if students view any of these trends negatively, have them suggest changes they think might halt or reverse these trends.

6. Instead of lecturing about sexual behaviour in later years, pose the following questions to students. Allow discussion to proceed on each until the major points have been discussed.

1) What myths do we believe about the sex lives of people over 50, 60, or 70 years of age?

2) What physiological changes occur in females? In males?

3) What effects do these changes have on sexual behaviour?

4) Which sexual behaviours, in what frequency, are typical of older adults?

5) What unique challenges do gay, lesbian, and bisexual people face as they age?

DISCUSSION QUESTIONS 1. What would you do if you walked in on your child masturbating? What if he/she was “playing doctor” with another child and his/her pants were off? Do you think your response would be different for a son vs. a daughter?

2. What were you told about sexuality before puberty? What information or advice would/should you give to your child or younger sibling about sexuality if he/she were beginning puberty?

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3. What expectations do you have about marriage? About a spouse’s behaviour? How important is it to discuss your expectations prior to marriage? (Topics to discuss prior to marriage can include religion, where you will spend holidays, how decisions about having children will be made, whether one spouse will stay home full-time with young children, who will do which household tasks, how money decisions will be made, how often the couple will visit extended family members, etc.)

4. What explanations would you suggest for why married women report somewhat less satisfaction than men on the subject of marital sex?

5. What reasons have you heard people give for engaging in extramarital sex? What effects did extramarital sex have on relationships you’ve observed?

ADDITIONAL RESOURCES Web Sites www.teenpregnancy.org Educational information from the National Campaign to Prevent Teen Pregnancy is provided to help adolescents prevent unwanted pregnancies. http://www.cfsh.ca The Canadian Federation of Sexual Health is a non-profit organization that provides information and promotes sexual and reproductive health rights. http://recapp.etr.org/recapp The Resource Center for Adolescent Pregnancy Prevention provides practical suggestions and information on reducing risk-taking behaviours among teens. http://www.goaskalice.columbia.edu A health question-and-answer Internet service for all ages and interests from Columbia University’s Health Education Program. The site posts questions and answers about relationships, sexuality, sexual health, emotional health, drugs, and general health. http://www.positive.org Coalition for Positive Sexuality is aimed mostly at teens and intends to offer sex-affirmative information concerning decisions about sexual activity. http://www.lgbtagingproject.org A guide to creating welcoming environments for lesbian, gay, bisexual and transgender elders from the LGBT Aging Project of Massachusetts.

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ACTIVITIES Activity I: Thinking About Messages About Menstruation Use this activity to stimulate discussion on this topic within small groups or as an entire class.

Historically in Canada, menarche has received a mixed response. The menstrual flow itself has generally been seen, erroneously, as polluting, and menstruating women have been stereotyped as irrational. Menarche has generally been perceived as the event in which a girl suddenly develops into a woman, but because of taboos and the unjustified prejudice against menstruating women, girls all too often matured in ignorance of menarche. However, things appear to be changing. In Canada today, most of the negative stereotypes about menstruation are diminishing.

Think about the messages you received about menarche and more generally, about menstruation.

1. From whom did you receive your first information about menarche? A parent? The school?

Friends? What did they tell you? Was the information accurate?

2. How did your family react when you had your first menstrual period? Was it a time of celebration? Was it kept secret from other family members? Did you tell your friends? How did they react?

3. Did anyone give you euphemisms to label your menstrual period (“the curse,” “a friend,” etc.)?

4. Did anyone tell you there were certain activities you could not engage in during your period?

5. How would you characterize the current attitudes toward menstruating women?

Activity II: Small Group Discussion Questions Sexuality in Childhood and Adolescence Distribute copies of the Small Group Discussion Questions, and in mixed-gender groups of three to four students each, discuss the following questions related to sexuality in childhood and adolescence. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Some daycare centres have one bathroom with several toilets which are used by boys and girls. How do you think daycare workers should handle this situation? At nap time in a daycare centre, a worker may find that a child masturbates himself or herself to sleep. How should a daycare worker approach this situation?

2. Female students: How did you learn about what to expect with your first menstrual period?

Did your family react in a positive or negative manner to this event? What, if any, “taboos” were taught in your family? Male students: When and from whom did you learn about menstruation? ..

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3. Do statistics about the age of first intercourse match your perceptions of your peers' behaviour? At what age did your peers begin having intercourse? Do you believe your peers were usually truthful about their sexual experiences?

4. Is there a double standard about premarital sex among your friends? Was there a double standard when you were in high school? What evidence can you cite for your answer? How have attitudes changed since you were sixteen?

Activity III: Sexual Knowledge and Experience Survey A week before lecturing on this chapter, ask students to answer anonymously the questions in the survey. Tabulate and use throughout the lecture.

Student instructions: The purpose of this survey is to explore the ways in which we acquire knowledge about human sexual behaviour, our own experiences, and the reaction to them. Please try to answer all questions as honestly as you can. Remember that this is anonymous. For purposes of data analysis, however, please indicate gender and age.

Gender: ____

Age: ____

1. At what age do you recall having your first sexual interest?

2. How old were you when you first masturbated to orgasm?

3. Do you recall having participated in same gender sexual play? If yes, how old were you? What kind of game?

4. When did you learn about masturbation? From whom?

5. When did you learn about sexual intercourse? From whom?

6. What was your reaction when you learned about sexual intercourse?

7. At what age did you engage in intercourse for the first time?

8. What was your reaction? ..

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9. What was your partner's reaction?

10. Did you use contraceptives that time? Which kind?

11. If you are sexually active, do you use contraception now? Which kind?

Activity IV: Issues to Consider Before Marriage or Cohabitation When you discuss cohabitation and marriage, distribute copies of Issues to Consider Before Marriage or Cohabitation. This activity asks students to discuss issues that can cause conflicts in relationships and identify those about which they feel strongly.

Student instructions: Consider the following issues that often cause conflicts in relationships.

Identify the issues about which you feel strongly. Would strongly held differences between you and a partner on any of these issues cause you to decide against marrying or cohabiting with that person?

1.

Money—Will you combine your incomes into one bank account? Who will decide on expenditures? Who will be responsible for paying the bills? What are your expectations about new clothes, furniture, cars, etc.? What are your expectations about saving money and acquiring debts?

2.

Household Chores—Who will do which chores? Cooking, cleaning, lawn care, taking out garbage, laundry, car maintenance? What are your expectations about how clean and neat your apartment or house will be? Never a dirty dish in the sink? Cluttered, except when you have company?

3.

Religion—Should partners have the same religious background? Does either partner expect the other to attend religious worship regularly with him or her? Does either partner expect the other to convert to a different religion? If you decide to have children, will religion become an issue?

4.

Children—Should both partners agree on whether they want to have children? On when to have children? On whom the responsibilities for child care will fall? On whether one will stay home full-time or part-time when the children are young?

5.

Socializing—How and where will you spend holidays and vacations? With extended family members? How often will you visit family members? Will you travel during vacations or holidays? With whose friends or acquaintances will you socialize? How often? What will you do?

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Activity V: Small Group Discussion Questions Sexuality in Adulthood Distribute copies of the Small Group Discussion Questions and in mixed-gender groups of three to four students each, discuss the following questions about adult sexuality. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. What do you see as the advantages and disadvantages of remaining single versus marrying or cohabiting?

2. What are the advantages and disadvantages of cohabiting versus marrying? Consider social and legal factors, as well as personal beliefs.

3. What explanations would you suggest for why married women of all ages report somewhat less satisfaction than men with marital sex?

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CHAPTER 13 Sexual Problems and Dysfunctions CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

Prevalence and Types of Sexual Problems and Dysfunctions

Learning Objective 1

Origins of Sexual Problems and Dysfunctions

Learning Objective 2 Learning Objective 3 Teaching Tip 1

Supplemental Materials

IM Lecture Material: Does Anxiety Always Interfere with Sexual Performance?

Discussion Question 1 Discussion Question 2 Solutions for Sexual Problems and Dysfunctions

Learning Objective 4 Learning Objective 5 Teaching Tip 2 Discussion Question 3

IM Activity: Small Group Discussion Questions: Sexual Dysfunctions and Sex Therapy IM Lecture Material: The Use of Sexual Surrogates

CHAPTER SUMMARY Many people experience some type of sexual problem from time to time. Some problems are temporary or only happen occasionally. If a problem persists over time and causes the person distress, it may qualify as a sexual dysfunction. Sexual problems and dysfunctions are common at all ages and some research is presented to describe prevalence and trends. The DSM-5 categorizes sexual dysfunctions into four groups: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. Conditions can be categorized as lifelong or acquired, and generalized or situational. ..

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Sexual desire-related disorders involve lack of sexual desire and can affect men or women.

People with these conditions often report an absence of sexual thoughts or fantasies. However, it should be noted that not everyone has the same level of sexual desire as other people and so a person with a lower level of desire doesn’t necessarily have a sexual dysfunction. It is only classified as a dysfunction if the person finds their lack of desire distressing.

Sexual arousal-related disorders are related to an inability to have or sustain lubrication or erection necessary to facilitate sexual activity, or to the lack of subjective feelings of sexual pleasure or excitement that typically accompany sexual arousal.

Orgasmic disorders include female orgasmic disorder, delayed ejaculation, and premature ejaculation. In female orgasmic disorder and delayed ejaculation, the individual is persistently delayed in reaching orgasm or does not reach orgasm at all, despite sufficient stimulation.

Premature ejaculation may be diagnosed if ejaculation occurs with minimal sexual stimulation and before the person desires it.

Distressing sexual disorders among women have been grouped into a single diagnostic category in DSM-5: genito-pelvic pain/penetration disorder. Broadly, this may be referred to as dyspareunia. Pain during sexual activity is particularly common among women. Other female sexual pain problems, vulvodynia and vaginismus, are discussed.

Because sexual problems and dysfunctions are complex, researchers often take a biopsychosocial approach to their understanding. Some biological causes for the development of sexual problems and dysfunctions include: testosterone deficiency, thyroid overactivity or underactivity, temporal lobe epilepsy, fatigue, health problems (e.g., cardiovascular disorders, hypertension, diabetes, multiple sclerosis, spinal cord injury, hormonal problems), and underlying infections. Various medications and other drugs may also impair sexual functioning. A special warning about SSRIs and sexual response is given. Aging also plays a role in the development of some sexual difficulties.

Psychosocial factors connected with sexual dysfunctions include cultural influences, economic problems, psychosexual trauma, dissatisfaction with relationships, lack of sexual skills, irrational beliefs, and performance anxiety.

The most common approaches to sex therapy are cognitive and behavioural. Cognitivebehavioural sex therapy aims to modify dysfunctional cognitions and behaviours as directly and as quickly as possible. Some medications may also be helpful, depending on the underlying issue. The PLISSIT model and the Masters and Johnson approach (e.g., sensate-focus) are discussed in more detail.

Sexual desire-related disorders are treated using self-stimulation exercises, sensate-focus exercises, and exercises to enhance communication and sexual skills. If low sexual desire is ..

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associated with hormonal deficiencies, hormone replacement therapy may be prescribed. When lack of desire is connected with depression, sexual interest may rebound when the depression lifts. Likewise, if problems with the relationship contribute to low desire, if the relationship problems are solved, desire may return.

Arousal-related disorders are treated by reducing performance anxiety, as long as problems are psychologically and not organically based. Biological treatments for erectile dysfunction include oral medications, hormone treatments, penile implants, vascular surgery, penile injections, and using a vacuum device. Female sexual interest/arousal disorder is commonly treated with sensate-focus exercises and/or mindfulness-based cognitive therapy. If the problem is associated with lack of lubrication, using a commercial lubricant may alleviate symptoms. Sex therapy (e.g., the PLISSIT model or the Masters and Johnson's approach) may be used to treating female orgasmic disorder and delayed ejaculation. Premature ejaculation is usually treated with the squeeze technique or the stop-start technique; biological treatments may also be used. Sexual pain disorders may be treated with medical intervention, cognitive-behavioural therapy, and physical therapy including biofeedback.

LEARNING OBJECTIVES 1. Describe the prevalence and types of common sexual problems and dysfunctions.

2. Discuss biological factors in the development of sexual problems and dysfunctions.

3. Discuss psychosocial factors in the development of sexual problems and dysfunctions.

4. Describe the PLISSIT and Masters and Johnson approaches to addressing sexual problems and dysfunctions.

5. Outline the treatment of specific sexual problems and dysfunctions.

TEACHING TIPS 1. Instead of lecturing about each sexual dysfunction in the order in which the text presents them, first review Kaplan’s sexual response cycle. Then on the blackboard, set up a column for each phase of the sexual response cycle and, as students suggest them, write the names of sexual dysfunctions in the appropriate column. For each dysfunction, identify the diagnostic criteria, possible contributing factors, and the possible effects on the individual and on the ..

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couple.

2. Write a list of the sexual dysfunctions on the chalkboard. Have individual students describe the techniques used to treat each dysfunction.

DISCUSSION QUESTIONS 1. When/if you are having sex with a partner, do you feel anxiety or pressure to perform? Does this affect your sexual behaviour or your satisfaction? What could you do to reduce this anxiety?

2. Do you think that sexual messages in the media (e.g., television, movies, magazines) affect people’s sexuality? If so, are the effects more often helpful or harmful?

3. Your best friend Jamie knows you are taking a human sexuality class and comes to you for advice about difficulty reaching orgasm during sex. What information or advice would you offer?

ADDITIONAL RESOURCES

Web Sites http://www.bestco.info Website of the Board of Examiners in Sex Therapy and Counselling in Ontario (BESTCO). It includes a directory of registered sex therapists in Ontario and FAQs regarding sex therapy and sex therapists. http://www.fsd-alert.org FSD-Alert (Female Sexual Dysfunction-Alert) is an educational campaign endorsed by researchers, therapists, and educators which challenges the myths of female sexual dysfunction and encourages research on the causes of women’s sexual problems.

The campaign rejects an uncritical reliance on pharmacological solutions to women’s sexual problems.

ACTIVITIES Activity I: Small-Group Discussion Questions Sexual Dysfunctions and Sex Therapy

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Distribute copies of the Small Group Discussion Questions and in mixed-gender groups of three to four students each, discuss the following questions on sexual dysfunctions and sex therapy.

After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. What if early sex education emphasized how common it is to have sexual problems occasionally? What if sex education emphasized mutual pleasure instead of goal-oriented sex to orgasm? Might fewer people experience shame, guilt, and anxiety about sexual performance?

2. Sexual desire disorders have been increasing in frequency. What societal changes might account for this? How much do our busy lifestyles contribute to lack of sexual desire?

3. Would you seek therapy if you developed a sexual dysfunction? Would you willingly agree to go to a sex therapist with a partner if he/she developed a sexual dysfunction? How would you feel about disclosing such intimate matters to a sex therapist?

4. Do you think the use of surrogate partners in sex therapy is a defensible practice? If your answer is no, state your reasons. If your answer is yes, do you believe that surrogates should be equally available to clients who do not have partners and those who do? Should they be equally available to men and women with sexual dysfunctions? Should they be available to persons with physical or intellectual disabilities?

5. Male students: Would you agree to any of the biomedical treatments for erectile dysfunction?

Why or why not? Male and female students: Would you encourage a male partner to agree to one of these treatments? (Remember, partners of men with erectile dysfunction could receive sexual satisfaction through stimulation other than penile penetration.)

ADDITIONAL LECTURE MATERIAL Lecture I: Does Anxiety Always Interfere with Sexual Performance?

Virtually all sex-therapy programs attempt to reduce or eliminate sexual anxieties to restore sexual response. However, evidence suggests that anxiety may increase sexual arousal under certain conditions. Researchers have found, for example, that exposing experimental subjects to an anxiety-inducing film, as compared to a neutral film, increases self-reported sexual response during a subsequent exposure to a sexually explicit film in both menl and women.2

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But what of the effects of performance anxiety? A study by David Barlow and his colleagues3 attempted to simulate conditions of performance anxiety under laboratory conditions. Sexually functional male volunteers were shown an explicit sexual film under one of three conditions: 1. A contingent threat condition in which the subjects were informed that there was a 60% chance that they would be shocked if they did not achieve an adequate level of sexual arousal.

2. A noncontingent threat condition in which subjects were informed that the likelihood of shock was unrelated to their level of sexual arousal or any other response.

3. A no-shock control condition in which a light signaled that no shock would be delivered.

Sexual arousal was measured by a penile strain gauge, which circles the penis and is worn unobtrusively under the man's clothing. Although no shocks were administered in any condition, the expectation of contingent shock was intended as an analogue of performance anxiety, since the likelihood of shock depended on achieving a certain level of arousal. The results showed that both threat conditions increased sexual arousal. Expectation of contingent threat actually produced the highest level of arousal.

A subsequent study by the Barlow group4 used the same method with sexually functional and sexually dysfunctional men. In contrast to sexually functional men, sexually dysfunctional men showed reduced levels of sexual arousal to both conditions of threat. Performance anxiety, as defined in these experiments, apparently plays a different role in sexually functional and dysfunctional men. It apparently facilitates sexual arousal in sexually functional men and impedes arousal in sexually dysfunctional men.

In other studies, subjects have been shown erotic films depicting women in various levels of sexual arousal. When she acts as though she is highly aroused and her male partner is not, sexually functional male viewers show higher levels of sexual arousal. Sexually dysfunctional men show lower levels of sexual arousal, presumably because the aroused woman is perceived as 5,6

being demanding of her partner. Watching a highly aroused partner may have evoked performance-related fears among the sexually dysfunctional men. By contrast, the sexually functional men may have construed the aroused woman as a sexual stimulus which heightened their own arousal.

Sexually dysfunctional men tend to report more negative emotions, principally depression, while viewing erotic films, whereas sexually functional men report more pleasurable experiences.7,8,9 The sexual context may evoke more unpleasant associations for men with sexual problems because it reminds them of their disappointments in the sexual arena. As compared with sexually functional men and men with organically based sexual dysfunctions, men with psychologically based sexual dysfunctions are also more likely to underestimate their level of sexual arousal while watching erotic films, as shown by comparing their self-reports of sexual arousal with their ..

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penile measurements.10,11 Sexually dysfunctional men may also see themselves as less able to control their sexual response, compared to sexually functional men.12 In another study, sexually dysfunctional males paid more attention to their own thoughts, sensations, and feelings when erotic stimuli were presented than did sexually functional males.13 The sexually functional men focused more of their attention on the erotic stimuli and less on their penile performance.

Barlow14 proposes a model of sexual dysfunction that focuses on the role of cognitive interference rather than anxiety per se. For sexually dysfunctional men, pressures to perform sexually lead to negative emotions (depression), to expectations of failure, to inaccurate underestimates of erectile response, and to perceived lack of control over sexual response.

Because they expect to fail, sexually dysfunctional men center on the anticipated consequences of failure—such as shame or embarrassment and the need to explain themselves and offer apologies—rather than on erotic cues. Their preoccupations heighten anxiety, impairing their performance, and distracting them from erotic stimuli. Sexual encounters are avoided because they are perceived as opportunities for repeated failure, frustration, and self-defeat.

When sexually functional men are stimulated by a responsive partner or by viewing an erotic film, they experience pleasurable emotions and positive expectations, perceive themselves to be in control, and accurately gauge their sexual response. Mild anxiety may actually enhance their sexual arousal. By centering on erotic cues, sexually functional men become more aroused, are able to successfully engage in sexual activity, and experience heightened expectations of their own competence and of a pleasant outcome—all of which increase their tendencies to approach opportunities for sexual encounters.

This model highlights the role of interfering cognitions (i.e., thoughts, expectancies, and beliefs) in sexual dysfunctions, such as the expectation of failure. They heighten anxiety to the point where it impairs sexual performance. In another vicious cycle, the more people focus on interfering cognitions, the more difficult it becomes for them to perform sexually—and the more likely they will be to focus on interfering cognitions in the future. Although the model was derived largely from research based on men, Barlow suggests that it may also apply to sexually dysfunctional women.

1 Wolchik, S. A., et al. (1980). The effects of emotional arousal on subsequent sexual arousal in men. Journal of Abnormal Psychology, 89, 595–598.

2 Hoon, P., Wincze, J., & Hoon, E. (1977). A test of reciprocal inhibition: Are anxiety and sexual arousal in women mutually inhibitory? Journal of Abnormal Psychology, 86, 65–74.

3 Barlow, D. H., Sakheim, D. K., & Beck, J. G. (1983). Anxiety increases sexual arousal. Journal of Abnormal Psychology, 92, 49–54.

4 Beck, J. G. (1984). The effect of performance demand and attentional focus on sexual responding in functional and dysfunctional men. Unpublished doctoral dissertation, State University of New York at Albany.

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5 Abrahamson, D. J., et al. (1985). The effects of attentional focus and partner responsiveness on sexual responding; Replication and extension. Archives of Sexual Behavior, 14, 361–371.

6 Beck, J. G., et al. (1983). The effects of attentional focus and partner arousal on sexual responding in functional and dysfunctional men. Behaviour Research and Therapy, 21, 1–8.

7Abrahamson, D. J., et al. (1985). The effects of attentional focus and partner responsiveness on sexual responding; Replication and extension. Archives of Sexual Behavior, 14, 361–371.

8 Beck, J. G. (1984). The effect of performance demand and attentional focus on sexual responding in functional and dysfunctional men. Unpublished doctoral dissertation, State University of New York at Albany.

9 Heiman, J. R., & Rowland, D. L. (1983). Affective and physiological sexual patterns: The effects of instructions on sexually functional and dysfunctional men. Journal of Psychosomatic Research, 27, 105–116.

10 Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54,140–148.

11 Sakheim D. K. (1984). Waking assessment of erectile potential: The validation of a laboratory procedure to aid in the differential diagnosis of psychogenic and organic impotence. Unpublished doctoral dissertation, State University of New York at Albany.

12 Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54,140–148.

13 Beck, J.G., & Barlow, D. H. (1986). The effects of anxiety and attentional focus on sexual responding: II. Cognitive and affective patterns in erectile dysfunction. Behaviour Research and Therapy, 24, 19–26.

14 Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140–148.

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Lecture II: The Use of Sexual Surrogates Masters and Johnson preferred to treat a sexually dysfunctional couple rather than an individual—but a sexually dysfunctional person may not have a partner, perhaps because of the dysfunction. In the cases of some dysfunctional men without partners, Masters and Johnson recruited surrogate partners (also called "sexual surrogates") for the two-week treatment program. The surrogates worked under the close guidance and direction of the therapists in following prescribed sexual exercises. Use of surrogates soon became more common at sex therapy clinics nationwide. Men have also been used as sexual surrogates to work with dysfunctional women who are without partners, but less commonly so.

The partner surrogates used by Masters and Johnson were not professional prostitutes. They recruited unpaid volunteers who showed personal qualities of warmth and patience. Of 13 women who served in this capacity over an 11-year period, many had college degrees and fulltime careers. A number had participated in earlier studies on sexual response. One was a physician. Some were motivated by a desire to widen their sexual experiences. Some wished to help dysfunctional men and were intrigued by the challenge.

The use of sexual surrogates raised a storm of public controversy. If the public raised an eyebrow when it learned that Masters and Johnson had used a "coition machine" to study certain aspects of female sexual response, the public almost fell off its collective seat over the practice of using partner surrogates to treat men with sexual dysfunctions. Some observers charged that "partner surrogate" was simply a polite term for prostitute. After all, many surrogates (but not those in the Masters and Johnson program) were paid for their services and they engaged in coitus and other sexual acts with strangers. Defenders of the use of surrogates have argued that there are important differences in the motives behind commercial prostitution and sexual surrogacy.

Sexual surrogates are trained to perform in a helping role and to follow therapeutic directions.

Prostitutes are engaged to perform sexual services for clients seeking sexual pleasure or release.

The partner surrogates at the Masters and Johnson institute helped thirty-two of forty-one clients reverse their sexual dysfunctions. The use of partner surrogates was as effective as the involvement of spouses in the treatment of men with sexual dysfunctions. Despite this high success rate, due to the adverse publicity, their institute no longer uses partner surrogates in its programs.

The use of sexual surrogates remains a controversial issue. Few studies have been conducted to examine the extent of its use of its efficacy.1 Although the number of therapists who use sexual surrogates today remains unknown, the practice has fallen off in recent years. Negative publicity and fears of prosecution for prostitution have taken their toll. But some sex therapists reject the idea of sexual surrogacy for other reasons. Sexual surrogates are generally trained not to become emotionally involved with their clients, so as not to encourage dependency or risk expanding the

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relationship beyond its therapeutic role. But critics maintain that sex is not a mechanical procedure that is detachable from the emotional aspects of a relationship.

Although the use of sexual surrogates has declined, questions concerning the efficacy and propriety of the practice continue to be debated.

1 Dauw, D. C. (1988). Evaluating the effectiveness of the SECS’ surrogate-assisted sex therapy model. Journal of Sex Research, 24, 269–275.

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Chapter 14

CHAPTER 14 Sexually Transmitted Infections CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

STIs in Canada

Learning Objective 1

Bacterial STIs

Learning Objective 2

Supplemental Materials IM Activity: STIs–Getting the Word Out

Learning Objective 3 Learning Objective 4 Teaching Tip 1 Vaginal Infections

Learning Objective 5

Viral STIs

Learning Objective 6 Learning Objective 7 Learning Objective 8 Learning Objective 9 Discussion Question 1 Teaching Tip 2 Teaching Tip 3 Teaching Tip 4

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Chapter Outline

Instructional Ideas

Ectoparasitic Infestations

Learning Objective 10

STI Epidemiology: Biological, Psychological, and Social Factors

Learning Objective 11 Teaching Tip 5 Teaching Tip 6 Discussion Question 2 Discussion Question 3 Discussion Question 4

Supplemental Materials

IM Activity: Small Group Discussion Questions: STIs and Social Issues IM Activity: Proposals to Reduce the Spread of HIV IM Lecture Material: Students: Knowledge and Risky Behaviour

Discussion Question 5

CHAPTER SUMMARY Sexually transmitted infections (STIs) are very common in Canada and the world. STIs can be transmitted through oral, vaginal, or anal sexual contact. In Canada, human papillomavirus (HPV) and genital herpes (HSV) are the most common STIs. Chlamydia, gonorrhea, and syphilis are also common and information relating to their prevalence in Canada is presented.

Bacterial STIs include chlamydia, gonorrhea, and syphilis. Chlamydia is the most common bacterial STI in Canada and gonorrhea is the second most common; transmission, symptoms, and treatment are discussed. While syphilis is not as common as it once was, left untreated it can cause serious health problems and even death. Transmission, symptoms, and treatment for syphilis are presented.

Vaginitis is any kind of vaginal infection or inflammation and is usually characterized by an odorous discharge, genital irritation, and burning during urination. Most vaginitis is caused by bacterial vaginosis, candidiasis (commonly called a yeast infection), or trichomoniasis. Bacterial vaginosis is caused by an overgrowth of the bacterium Gardnerella vaginalis. Candidiasis is caused by a yeast-like fungus and usually results from changes in the vaginal environment that allow the fungus to overgrow. Trichomoniasis is caused by a single-celled parasite.

Viral STIs include HIV, herpes (HSV), viral hepatitis, and human papillomavirus (HPV). The human immunodeficiency virus (HIV) attacks and disables the body’s immune system, making the person vulnerable to opportunistic diseases. If left untreated, it may progress to acquired immune deficiency syndrome (AIDS). Canadian trends, HIV’s effect on the immune system, the ..

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process of infection, disease progression, transmission, diagnosis, treatment, and prevention are discussed in detail. New prevention technologies such as combination antiretroviral treatments and pre-exposure prophylaxis have greatly reduced the burden of HIV. Genital herpes is caused by herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2). HSV-1 usually infects the mouth and is the cause of cold sores. HSV-1 is very common and affects about half the Canadian population. A person with HSV-1 can transmit the virus to another person’s genitals during oral sex. HSV-2 usually infects the genitals and is most often transmitted through genital-genital contact, although it can be spread to another person’s mouth during oral sex as well. Most people with HSV infection are asymptomatic. However, the virus remains present in the body even when there are no symptoms. Transmission, symptoms, and diagnosis and treatment are described.

Hepatitis is an inflammation of the liver. Several types of viral hepatitis (A, B, C, and D) are usually transmitted sexually or by contact with contaminated blood or fecal matter. A vaccine for hepatitis B (and D) is available.

HPV is the most common STI in Canada and around the world; it’s estimated that more than 70% of Canadians will have at least one HPV infection in their lifetime. Most HPV infections are asymptomatic and harmless. Some types of HPV cause genital warts. Several types of HPV can cause cancer (e.g., cervical, penile, anal, vulvar, vaginal, mouth, throat, and neck) if left untreated. Transmission, diagnosis, and treatment are discussed. A vaccine has been developed that protects against the HPV types that cause genital warts and the majority of HPV-related cancers. Vaccination is recommended for all males and females age 9-26, although older individuals may still benefit from immunization.

Pediculosis (“crabs”) is caused by pubic lice which attach themselves to pubic hair and cause itching. Scabies is caused by tiny mites that burrow into the skin and causes itching. Both are usually treated with medication.

Factors relevant to risk for STI infection are discussed. Biological factors include: multiple means of transmission, lifelong infections, asymptomatic cases, increased vulnerability, gender, and lack of vaccines and cures. Psychological factors include: perceived low risk of infection, lack of communication, negative attitudes or psychological obstacles toward condom use, and alcohol and drug abuse. Social factors include: socioeconomic status, social capital, gender inequality, sexual orientation, and ethnocultural factors.

A textbox provides multiple strategies to reduce the risk for STIs. Education and prevention is important to help reduce the spread of STIs.

LEARNING OBJECTIVES 1. Identify and discuss key features and recent trends in STIs in the Canadian population.

2. Describe the transmission, effects, and treatment of chlamydia. ..

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3. Describe the transmission, effects, and treatment of gonorrhea.

4. Describe the transmission, effects, and treatment of syphilis.

5. Describe the transmission, effects, and treatment of vaginal infections.

6. Describe the transmission, effects, and treatment of HIV and AIDS. 7. Describe the transmission, effects, and treatment of genital herpes.

8. Describe the transmission, effects, and treatment of viral hepatitis.

9. Describe the transmission, effects, and treatment of human papillomavirus.

10. Describe the transmission, effects, and treatment of ectoparasitic infestations.

11. Identify and assess the roles of different biological, psychological, and social factors in the epidemiology of STIs in Canada.

TEACHING TIPS 1. Set up four columns on the blackboard labelled “Bacterial STIs,” “Vaginal STIs,” “Viral STIs,” and “Ectoparasitic Infestations.” Define these categories. Have students name STIs and indicate the column in which to list each one. Discuss each STI: its incidence, symptoms, and treatment.

2. Have each student role-play telling a partner that he or she has an STI. Have the speaker tell the partner about the specific STI and explain that the partner needs to see a physician to be tested and treated.

3. Ask students to mention all the ways they have heard people say that HIV can be transmitted.

As they do so, write these on the blackboard. Then examine them one by one for accuracy. Cross out those that are not possible routes of transmission. When the exercise is complete, the verified routes of transmission should remain.

4. Too often, we blame those who acquire HIV and criticize them for “irresponsible” behaviour.

Discuss how gender inequality contributes to attitudes and behaviours that fuel the HIV epidemic.

5. Assign several students to research nearby clinics (if there are any) that test for and treat STIs. Have students look at the websites of the local public health department for information about the numbers of cases of each STI reported yearly.

6. Obtain information on the STI-reporting and partner-notification process. Inform students about the process and emphasize the importance of being truthful about their sexual contacts.

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DISCUSSION QUESTIONS 1. Discuss how people with herpes can approach partners with this information. Should they always inform all partners? Should they inform partners only during a flare-up? How can people with herpes protect their sexual partners from infection?

2. Should a person always be honest with a potential partner if they have had an STI? What if the STI is bacterial and has been treated?

3. How helpful is it, do you think, to have a conversation about STI and sexual history with a potential partner? Do you think people are generally honest about these things? How can a conversation about these topics be most effective?

4. Research suggests that many women have negative attitudes toward condom use. Why might that be? What can be done to improve men’s and women’s attitudes toward condom use?

5. Discuss what your campus could do to reduce the spread of STIs among students. What characteristics would be required for a program to be effective?

ADDITIONAL RESOURCES Web Sites http://www.afraidtoask.com Detailed photographs and education on sexually transmitted infections (STIs), including herpes, chlamydia, gonorrhea, trichomoniasis, vaginal warts (genital HPV), HIV and AIDS, and much more. http://www.caan.ca The Canadian Aboriginal AIDS Network is a non-profit organization that provides support and advocacy for Aboriginal people living with HIV/AIDS. http://www.cdnaids.ca The Canadian AIDS Society is a coalition of community-based AIDS organizations that facilitates program, service, and resource development for member groups. http://www.catie.ca CATIE provides information on HIV and hepatitis C prevention, care, and treatment for community organizations, health care professionals, educators etc. http://www.sexualityandu.ca Website from The Society of Obstetricians and Gynecologists of Canada on an array of sexual health topics, including STIs and other information.

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ACTIVITIES Activity I: STIs—Getting the Word Out This activity asks students to examine the possible roles of schools, colleges, health personnel, television, churches, and parents in reducing the spread of STIs. Instuctions for students: Your text includes the following information about STIs: • At least 340 million people worldwide contract curable STIs each year • STIs account for 15% to 30% of cases of female infertility • Some STIs may not produce noticeable symptoms • Chlamydia is Canada’s most common STI (other than HPV) • HPV is the world’s most common STI Education, treatment, and reducing the spread of STIs are essential to the control of this epidemic. The following questions ask you to think about the roles various social institutions could play. Remember, funding is always a problem, so try to utilize existing social structures.

1. What role could school systems play? Consider teachers, school boards, health teachers, school nurses, etc.

2. What role could universities and colleges play? How could they get information and treatment to students?

3. What role could existing health personnel play? Consider doctors, nurses, clinics, etc.

4. STIs in pregnant women can cause harm to fetuses and newborns. How can more pregnant women be encouraged to be tested and treated?

5. Can television play a role? How? Who would pay for the television time?

6. Can churches, synagogues, temples, and other religious institutions play a role? How? 7. If you are now a parent, or you plan to become a parent, what can you do to help protect your children?

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Activity II: Small Group Discussion Questions STIs and Social Issues Distribute copies of the Small Group Discussion Questions and in mixed-gender groups of three to four students each, discuss the following questions related to sexually transmitted infections.

After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Chlamydia (the "silent disease" or college student disease) is now the most common STI in Canada. Its possible effects include PID, infertility, eye infections, and pneumonia in babies born to women with chlamydia. Many men and women carrying this bacteria exhibit no symptoms.

How can we inform people about this STI? What should we tell them?

2. Recent studies implicate bacterial vaginosis in pregnant women with premature delivery and with low birth weight babies. Should there be mandatory testing of pregnant women during their pregnancies? What problems do you foresee?

3. What examples of discrimination against people who are living with HIV have you heard about? Consider the workplace, housing, school attendance, insurance company policies, etc.

Why do you think people discriminate?

4. Do you believe that all health care workers should be tested for HIV and be required to inform patients of their HIV status? Health care workers are much more likely to be infected by patients than patients are to be infected by health care workers. Should patients be required to be tested and to inform health care workers of their HIV status before receiving health care? Consider the impact of such a policy on emergency health care services.

5. Consider the statement, “I wouldn't wear a condom during sex; it’s like showering with a raincoat on.” Are you familiar with this attitude? What other reasons do men give for not using condoms? How can we change negative attitudes toward condom use?

6. HPV is very common among teenagers and young adults and HPV can cause cervical, anal, and oral cancers. Having regular check-ups and Pap smears could help reduce the spread of HPV and increase early detection of cervical and other cancers. Propose a program that would ensure more people got regular check-ups and Pap smears.

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Activity III: Proposals to Reduce the Spread of HIV In groups of three to four students each, consider the following proposals to reduce the spread of HIV. Evaluate arguments for and against by speculating on the possible effects of each proposal.

Think about costs, who would administer the proposals, who would benefit, how behaviour might change, etc.

1. Distribute free condoms in high schools.

2. Locate health clinics in high schools to provide STI screening and treatment as well as other health services.

3. Offer high school students free confidential HIV testing with no parental permission or notification requirement.

4. Set up needle-exchange programs (through which any person who injects drugs could exchange a dirty needle for a clean one) in areas where there is high injectable drug use.

5. Distribute bleach to injectable drug users and teach them to use it to sterilize any shared equipment.

ADDITIONAL LECTURE MATERIAL Lecture I: College Students: Knowledge and Risky Behaviour Since the beginning of the HIV epidemic, the media has often concentrated on the type of person who got HIV (“high risk groups”), not on the behaviours that made transmission from an infected to an uninfected person more likely. Many people mistakenly believe that because they are not members of any “high-risk groups,” they do not have to take any precautionary measures.

Many college students seem to believe they are not at risk. However, a 1989 national study conducted by the American College Health Association indicated that one of every 500 college students is HIV-positive.1 Other studies indicate that college students score high on HIV knowledge questionnaires, but have not altered their behaviour to conform with their knowledge. Consider the following findings from a study of 256 college students from southern Illinois:2 1. 87% were currently or had been recently sexually active.

2. 18% stated intentions to have anal intercourse.

3. The mean number of sexual partners in a month was one and the mean number of sexual partners for six months was three.

4. For subjects who reported having more than one sexual partner (183 students), 60% had never used condoms. ..

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5. 56% of white students and 36% of African American students who reported having more than one sexual partner had never used condoms.

6. 32% reported that their sexual partner was opposed to using a condom.

7. The mean score for the students completing a 28-item test of HIV-related facts was 23.5, demonstrating adequate basic knowledge of HIV/AIDS and HIV transmission. Do you think the statistics for your peers would be similar if they had participated in this study? How do you explain why many students who are knowledgeable about HIV and sexually active with multiple partners fail to use condoms? What type of program do you think would persuade college students to adopt safer sexual behaviours?

1

American College Health Association Survey. (1989). College health official sets priorities.

American Journal of Nursing, 89(8), 1030.

Strader, M. K., & Beaman, M. L. (1991). Comparison of selected college students’ and sexually transmitted disease clinic patients’ knowledge about AIDS, risk behaviors and beliefs about condom use. Journal of Advanced Nursing, 16, 584–590.

2

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Chapter 15

CHAPTER 15 Sexual Health Education CHAPTER-AT-A-GLANCE

Chapter Outline Sexual Health Education in the Schools: A Brief History

Instructional Ideas

Supplemental Materials

Learning Objective 1 Discussion Question 1 Teaching Tip 1

The Canadian Guidelines for Sexual Health Education

Learning Objective 2

IM Activity: Is There Something Wrong with the Content of Comprehensive Sex Education Curricula?

Using Theory and Research to Inform Sexual Health Education

Learning Objective 3

IM Activity: Should Sex Ed Teach about Abstinence?

Learning Objective 4 Learning Objective 5 Discussion Question 2

Attitudes Toward Sexual Health Education

Learning Objective 6 Discussion Question 3 Teaching Tip 2

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Chapter Outline

Instructional Ideas

Current Sources of Information about Sexuality

Learning Objective 7

Addressing Consent and Sexual Assault in Sexual Health Education

Learning Objective 8

Innovative Canadian Curricula and Resources

Learning Objective 9

Teaching Tip 3

Supplemental Materials IM Activity: Small Group Discussion Questions: Learning About Sexuality

Discussion Question 4

Meeting the Sexual Health Education Needs of Diverse Groups

Learning Objective 10

CHAPTER SUMMARY This chapter is about sexual health education. The purpose of sexual health education is to help people achieve positive outcomes (e.g., self-esteem, respect for self and others, non-exploitive sexual relations, rewarding human relationships, informed reproductive choices) and to avoid negative outcomes (e.g., STIs/HIV, sexual coercion, unintended pregnancy).

Early 20th-century sexuality education for youth often took the form of what was called “purity education” or “nature study.” During the 1960s and 1970s, sex education in Canadian schools was typically provided in “Family Life Education” classes which focused on reproduction, puberty, and in some cases, birth control. In the 1980s and 1990s, concerns about HIV/AIDS and other STIs prompted most secondary schools to introduce some form of sexuality education.

The Public Health Agency of Canada has published the Canadian Guidelines for Sexual Health Education to guide and unify professionals who provide sexual health education in Canada. The Guidelines suggest a basic three-step process of the development of sexual health education programs: assessment and planning, intervention, and evaluation. The Guidelines are based on the information–motivation–behavioural skills (IMB) model. The Sex Information and Education Council of Canada (SIECCAN) has identified 10 key ingredients for effective sexual health education. ..

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There has been much debate about whether sexual health education should take an abstinenceonly approach or if it should be more broadly based. Abstinence-only programs focus exclusively on persuading students not to be sexually active. These programs do not include information on birth-control methods or safer-sex practices, except to mention that they are not 100% effective. Many studies have shown that abstinence-only education does not work.

Further, abstinence-only programs have been criticized as unethical, because they don’t provide the information young people need to make their own choices about sexual behaviour and so violate young people’s human rights by withholding potentially lifesaving information. Broadly based sexual health education programs cover a wide range of topics and are structured so that students can exercise informed decision making. Broadly based sexual health education has been found to have a significant, positive impact on behaviour.

Surveys of parents in Canada indicate that the vast majority of them approve of sexual health education in the schools. Most parents approve of providing youth with information on a wide range of topics including puberty, reproduction, healthy relationships, STI/HIV prevention, birth control, abstinence, sexual orientation, and sexual abuse/coercion. Canadian youth also want sexual health education to be taught in school; unfortunately, many are disappointed with the quality of sexual health education they receive.

Canadian youth identify school as their primary source of information about sexuality, followed by friends, parents, and the media. In recent years, the Internet has become a key source of information about sexuality and sexual health. There are many advantages to the Internet for delivery of sexual health information; however, it can sometimes be very difficult to verify if the sexuality information presented is accurate and credible. Online porn may also be teaching unhealthy messages about sexuality.

Broadly based sexual health education can provide foundational knowledge and skill development opportunities regarding general concepts of respect of self and others, including learning verbal and nonverbal communication skills. It is important for sexual health education to provide students with a clear understanding of the meaning of consent as it applies to sexual activity. There are a large number of innovative Canadian curricula and resources available to guide and assist educators in providing sexual health education.

It is important that all Canadians have access to sexual health education that meets their needs.

Sexual-minority youth and youth with disabilities may not be provided with sufficient information in school based sexual health education. Adults have needs for sexuality education as well; however, many may be reluctant to ask their doctors about sexual concerns and physicians are often not adequately trained to meet those needs. Additionally, Canadian sexual health educators need to provide high-quality education in the context of a multicultural society.

LEARNING OBJECTIVES 1. Describe the history of sexual health education in Canada.

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2. Describe the assessment and planning, intervention, and evaluation components of sexual health education.

3. Discuss the Information-Motivation-Behavioural Skills (IMB) model approach to sexual health education.

4. List and discuss the key ingredients of effective sexual health education.

5. Describe the impact of abstinence-only and broadly based sexual health education.

6. Describe the attitudes of parents and youth toward sexual health education.

7. List and discuss current sources of information about sexuality among young people.

8. Discuss the importance of addressing consent and sexual assault in sexual health education.

9. Describe available curricula and resources for teaching sexual health education in Canada.

10. Discuss the sexual health education needs of diverse groups in Canada.

TEACHING TIPS 1. If a child you know (e.g., sibling, niece or nephew, child you are babysitting) asked you what sex is, how would you handle the situation? Have students discuss this in pairs, and then roleplay what they would say and do.

2. Instead of lecturing about the particulars of sexual health education curriculum, have students suggest what should be taught to children in Grades 5 and 6 (or in Grades 7 and 8, or in high school). Have students discuss what information they would not teach children in Grades 5 and 6 (or in Grades 7 and 8, etc.).

3. Acquire at least five or six books about sexuality that have a reading level and content appropriate for children of various ages. Pass these around the class. Ask students what they learned about sex during childhood. Ask them what they wish they had learned.

DISCUSSION QUESTIONS 1. What is a good way for parents to talk to children about sex? At what age should they start, what information should they include, and how should it be taught? What can parents do if they don’t know the answer to their child’s question?

2. What are the controversies regarding abstinence-only sex education programs? How does the effectiveness of such programs compare to that of broadly based programs? In other words, do abstinence-only approaches succeed in meeting their goals? Do other programs? ..

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3. Most Canadians are in favour of sexual health education in schools, but we sometimes get a different image from the media. What are the impressions sometimes conveyed by media reports of parents’ reactions to sex education curricula in schools? What conclusions do you draw from these media reports?

4. Assume that you are giving a sex education workshop to new Canadians. You realize that there are several different cultures represented in your group and they have different values about sex and sexuality. What will you do to make sure that your workshop is both culturally relevant and culturally appropriate?

ADDITIONAL RESOURCES Web Sites http://www.actioncanadashr.org Action Canada for Sexual Health and Rights is a non-profit, pro-choice organization that promotes sexual and reproductive health and rights in Canada and globally. http://recapp.etr.org/recapp Resource Center for Adolescent Pregnancy Prevention provides practical suggestions and information on reducing risk-taking behaviours among teens. http://www.goaskalice.columbia.edu A health question and answer internet service for all ages and interests from Columbia University’s Health Education Program. The site posts questions and answers about relationships, sexuality, sexual health, emotional health, drugs, and general health. http://www.sexualityandu.ca Website from The Society of Obstetricians and Gynecologists of Canada devoted to sexuality education on an array of sexual health topics. http://www.teachingsexualhealth.ca This sexual education site was developed by Alberta educators and offers sections for parents, teachers, and students. Information available on the site includes lesson plans, teaching tips, and general resources. http://www.sieccan.org Website for the Sex Information and Education Council of Canada, a not-for-profit charitable organization established in 1964 that works with health professionals, educators, community organizations, governments, and corporate partners to promote sexual and reproductive health.

ACTIVITIES Activity I: Debate Have students read the Taking Sides article and come to class prepared to debate the topic. ..

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Is There Something Wrong with the Content of Comprehensive Sex Education Curricula?

Divide the class in two and assign each group one side of the debate. Have each group first discuss among themselves the various issues and arguments on each side, then have the two groups debate their positions as a class.

From: Taking Sides: Clashing Views on Controversial Issues in Human Sexuality (11th ed.).

(William J. Taverner & Ryan W. McKee, Eds. McGraw-Hill, 2010.)

Activity II: Debate Have students read the Taking Sides article and come to class prepared to debate the topic.

Should Sex Ed Teach about Abstinence?

Divide the class in two and assign each group one side of the debate. Have each group first discuss among themselves the various issues and arguments on each side, then have the two groups debate their positions as a class.

From: Taking Sides: Clashing Views on Controversial Issues in Human Sexuality (11th ed.).

(William J. Taverner & Ryan W. McKee, Eds. McGraw-Hill, 2010.)

Activity III: Small Group Discussion Questions Learning about Sexuality Distribute copies of the Small Group Discussion Questions and in mixed-gender groups of three to four students each, discuss the following questions related to learning about sexuality. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. How did you learn about sexual intercourse? Did you learn about it from your family, friends, school, or somewhere else? What, if any, “taboos” about sex existed in your family?

2. Some people argue that sex education is a parent's responsibility and they do not want schools teaching about sex. How many of the parents of your peers provided sex education to their children? In your experience, where do young people get most of their information about sex?

3. School sex education programs rarely begin before Grades 5 or 6. At that time, usually what is taught is about body parts and their functions. What topics would you include in a sex education curriculum for Grade 6 children (about age 11)?

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Chapter 16

CHAPTER 16 Sexual Variations CHAPTER-AT-A-GLANCE Chapter Outline

Instructional Ideas

Normal Versus Deviant Sexual Behaviour

Learning Objective 1

The Paraphilias

Learning Objective 2 Teaching Tip 1

Supplemental Materials

IM Activity: Small Group Discussion Questions: Paraphilias

Teaching Tip 2 Discussion Question 1 Discussion Question 2 Discussion Question 3 Theoretical Perspectives

Learning Objective 3 Learning Objective 4 Learning Objective 5 Learning Objective 6 Learning Objective 7

Treatment of Paraphilic Disorders

Learning Objective 8 Learning Objective 9

IM Activity: Discussion on the Treatment of Paraphilic Disorders

Learning Objective 10

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Discussion Question 4 Sexual Addiction, Compulsive Sexual Behaviour, and Hypersexuality

Learning Objective 11

CHAPTER SUMMARY This chapter examines a number of sexual behaviours which deviate from the norm. It begins by clarifying what is meant when a sexual behaviour is considered abnormal or deviant. Behaviours can be considered abnormal or deviant based on statistical, sociocultural, or harm-based approaches. As such, the label of “atypical variations” is preferred. The term paraphilia refers to sexual interest and arousal in response to unusual stimuli such as children, other nonconsenting persons, nonhuman objects, or pain and humiliation. Paraphilic behaviours that involve mutually consenting adults or unharmful solitary sexual practices can be more simply be described as “kinky sex”. Patterns of atypical sexual arousal or behaviour that become problematic in the eyes of the individual and/or potentially cause harm to the self or others are labelled paraphilic disorders. Some paraphilias are generally harmless and victimless. Paraphilias also vary in severity. In general, most paraphilias are more common among men.

In fetishism, an inanimate object elicits sexual arousal and in partialism, people are excessively aroused by a particular body part. Transvestites become sexually aroused by wearing articles of clothing of the other gender. An exhibitionist experiences the compulsion to expose himself to unsuspecting strangers for the purpose of sexual arousal or gratification. Like exhibitionists, the obscene phone caller becomes sexually aroused by shocking his victim, and he typically masturbates during the phone call or shortly afterwards. People who practise chat scatologia are sexually aroused by sending obscene email, instant messages, and chatroom messages. Voyeurs become sexually aroused by watching unsuspecting others naked, disrobing, or engaged in sexual activity. He may masturbate while "peeping" or later, while engaging in voyeuristic fantasies.

As long as it occurs with mutual consent, it’s considered normal to enjoy some mild forms of pain during sexual activity (e.g., biting, hair pulling, minor scratches). People who prefer or need to have pain or humiliation inflicted on them by their sex partners are sexual masochists. Sexual masochism is the most common paraphilia among women. Sexual sadists become aroused by inflicting pain or humiliation on a sexual partner. Sado-masochism involves mutually gratifying sexual interactions involving power exchanges between consenting partners. A variation is bondage and discipline which involves restraining and punishing a submissive partner physically or verbally. The term BDSM is commonly used.

Other paraphilias discussed include: frotteurism (sexual arousal from the desire to rub against or touch nonconsenting persons), zoophilia, necrophilia, klismaphilia, coprophilia, and urophilia.

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Theoretical approaches that attempt to explain these behaviours are then discussed. The biological perspective looks at the involvement of factors such as the endocrine and nervous systems. Genetic factors may also be involved. Biological factors have yet to be fully understood and research is ongoing. Psychoanalytic theory suggests that paraphilias are psychological defenses, usually against unresolved castration anxiety. Cognitive-behavioural theorists argue that unusual stimuli acquire sexually arousing properties through association with sexual arousal and orgasm, or through incorporation in masturbatory fantasies. Sociological perspectives focus on the effects of the group and of society on individual and group behaviour. The erotic appeal of S&M rituals may result from the opportunity to reverse the customary power relationships that exist in society. It has also been suggested that paraphilias may be the result of “lovemaps” that become distorted by early traumatic experiences.

Interest in paraphilic behaviours is not considered a mental disorder requiring treatment unless it is destressing to the individual and/or causes harm to the self or others. If diagnosed as a paraphilic disorder, treatment may be sought. Challenges to providing treatment are discussed.

Psychoanalytic psychotherapy, cognitive-behavioural therapy (which employs techniques such as systematic desensitization, aversion therapy, covert sensitization, social skills training and orgasmic reconditioning), and medical approaches are discussed.

Three terms have been used to describe a psychological disorder in which a person is unable to control an excessively frequent sexual behaviour: sexual addiction, sexually compulsive behaviour, and hypersexuality. The authors discuss these three concepts and relevant treatments, as well as the controversy regarding the classification of hypersexuality as a mental disorder.

LEARNING OBJECTIVES 1. List and discuss different approaches to defining normal versus deviant sexual behaviour.

2. List and define the paraphilias.

3. Discuss biological perspectives on paraphilias.

4. Discuss the psychoanalytic perspectives on paraphilias.

5. Discuss cognitive-behavioural perspectives on paraphilias.

6. Discuss sociological perspectives on paraphilias.

7. Discuss the "lovemap".

8. Discuss the psychoanalytic treatment of paraphiliac disorders.

9. Discuss the cognitive-behavioural treatment of paraphiliac disorders.

10. Discuss the medical treatment of paraphiliac disorders.

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11. Discuss the concepts of sexual addiction, compulsive sexual behaviour, and hypersexuality.

TEACHING TIPS 1. One way to teach about paraphilias is to categorize them as either victimless paraphilias that do not involve other nonconsenting people, or paraphilias that violate the rights of others. Have students discuss which paraphilias should be placed in each category.

2. Play “Name that Paraphilia.” List all the paraphilias on the board and then read their definitions. Have students match each paraphilia with its appropriate description.

DISCUSSION QUESTIONS 1. Should paraphilias like fetishism and partialism be considered a disorder if all individuals involved are consenting adults?

2. What are some paraphilias that you consider harmful? What are some that you consider harmless? How would you feel if your partner revealed to you that he/she had one of these harmless paraphilias?

3. Does cybersex with an anonymous stranger qualify as cheating if the person is in a committed relationship? How would you respond if you discovered your partner masturbating to online pornography? Engaging in cybersex?

4. Do you agree with Moser and Kleinplatz that paraphilias should be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM)? Do you agree that the concept of Sexual Interest Disorder (SID) should be substituted for paraphilia?

ADDITIONAL RESOURCES Web Sites http://www.atsa.com Website for the Association for the Treatment of Sex Abusers, an international, multi-disciplinary organization dedicated to making society safer by preventing sexual abuse. http://www.dsm5.org Resources related to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) http://www.sexaddictionlondon.ca This website provides information and resources from a coalition of sex and relationship addiction 12-step recovery groups in London and Southwestern Ontario. ..

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ACTIVITIES Activity I: Small Group Discussion Questions Paraphilias Distribute copies of the Small Group Discussion Questions, which asks students in mixed-gender groups of three to four students each to discuss paraphilias, reactions to exhibitionists, and explanations for the paraphilias. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. Why do paraphilias occur almost exclusively among men? Is there gender bias regarding which behaviours we choose to label "deviant "?

2. Why are almost all transvestites male? Could our greater restrictions on what is acceptable male attire play a role?

3. Have you ever been a victim of an exhibitionist? How did you react? Would you react differently if this happened to you again?

4. Which of the five explanations for the development of paraphilias makes the most sense to you? Why?

Activity II: Discussion on the Treatment of Paraphilic Disorders Ask students to discuss questions regarding the treatment of paraphilias as a starting point for a discussion on the topic (e.g., laws, protection of privacy, protection of the public).

Fetishists often don’t feel that they have a problem or that they want to be treated. When (if ever) should treatment be required? Is it ethical to treat someone for a condition for which they don’t want to be treated? What makes it acceptable?

Are there different levels of appropriate treatment? For instance, should treatment be limited to psychological rather than biological approaches? Vice versa? Why or why not?

Megan’s Law is named after the 7-year-old girl who was raped and killed by a known child molester who had moved across the street from the family without their knowledge. This law requires states to make information on registered sex offenders available to the public.

1. What is your opinion on the registration of sex offenders? Should members of a community be informed of all crimes committed by their neighbours? If not, why are sex crimes given a different status? ..

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2. Should community members be informed if a neighbour is being treated for a paraphilic disorder? Some paraphilic disorders?? All paraphilic disorders? Why or why not?

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Chapter 17

CHAPTER 17 Sexual Coercion CHAPTER-AT-A-GLANCE Chapter Outline

Sexual Assault and the Law in Canada

Instructional Ideas

Supplemental Materials

Learning Objective 1 Learning Objective 2 Teaching Tip 1

Sexual Assault on Campus

Learning Objective 3

Types of Sexual Assault

Learning Objective 4 Learning Objective 5 Discussion Question 1

The Complexity of Consent

Learning Objective 6

IM Activity: Guest Lecture

Learning Objective 7 Discussion Question 2 Sexually Coercive Men

Learning Objective 8

Sexual Assault Survivors Learning Objective 9 Discussion Question 3 Preventing Sexual Assault

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Learning Objective 10

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Chapter Outline

Instructional Ideas

Supplemental Materials

Discussion Question 4 Coercive Verbal Pressure Tactics

Learning Objective 11

Sexual Abuse of Children

Learning Objective 12 Learning Objective 13 Learning Objective 14 Learning Objective 15 Learning Objective 16 Teaching Tip 2 Teaching Tip 3

Treatment of Perpetrators

Learning Objective 17

IM Activity: Debate

Sexual Harassment

Learning Objective 18

IM Activity: Small Group Discussion Questions: Sexual Coercion

Discussion Question 5 Discussion Question 6 Teaching Tip 4

CHAPTER SUMMARY This chapter is about sexual coercion, sexual assault, and sexual harassment. The chapter begins with a description of sexual assault and the law in Canada. The definitions for the three levels of sexual assault are presented. Data on the prevalence of sexual assault across Canada are presented. The majority (up to 95%) of sexual assaults are not reported to the police and most involve female victims and male perpetrators. There is a rising incidence of drug-facilitated sexual assault. Sexual assault on campus is discussed and research supports that one in five women are sexually assaulted during their college or university degree.

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Types of sexual assault are discussed including: stranger sexual assault, acquaintance sexual assault, date sexual assault, intimate partner sexual assault, group sexual assault, and sexual assault against males. Research on sexual consent is summarized. Several sexual assault myths that are born from social attitudes, such as gender-role stereotyping and the perception of sex as adversarial, create a social climate that legitimizes sexual assault and leads to blaming the victim.

Sexually coercive men vary considerably in their psychological characteristics. Studies that examine contributing factors to sexually violent behaviour are discussed. Sexual assault survivors often suffer physical injury, other physical symptoms, fear, anger, sadness, insomnia, anxiety, and depression. They may develop signs of post-traumatic stress disorder. Treatment typically involves helping them through the crisis period and fostering long-term adjustment.

Prevention of sexual assault, through educational programs offered at universities and colleges, and the changing of cultural attitudes that support sexual assault, is discussed. Coercive verbal pressure tactics range from coaxing to bullying and threats. Psychological pressure and manipulation are more common ways of acquiring sex in established relationships than physical force.

The authors discuss the issue of child sexual abuse and its social and emotional toll on the victims. Any form of sexual contact between an adult and a child is abusive. In many cases, the perpetrators are close to the victims: relatives, step-relatives, family friends, and neighbours.

Laws relate to sexual exploitation and the abuse of children and youth are presented. Touching, kissing, and being fondled in a sexual way are the most common type of abuse. Signs of abuse are sudden personality changes, developing fears, problems in school, and difficulty eating or sleeping.

Pedophilia refers to a pattern of sexual arousal in which children become the object of desire.

Pedophiles are almost exclusively male. However, not all child molesters are pedophiles and not all pedophiles molest children. Research on pedophilia is presented. Incest involves sexual relations between people who are related by blood; family factors associated with incest are presented.

The effects of sexual abuse are varied. Some emotional and health problems may develop.

Abused children often act out and display aggressive or antisocial behaviour; older children may turn to substance abuse. Psychotherapy may help adult survivors confront residual pain, anger, and misplaced guilt which may improve their self-esteem and their ability to develop intimate relationships.

Controversies on the success of “curing” child sex offenders is presented. Potential treatment options including psychological and medical therapies are discussed. The National Sex Offender Registry is also discussed.

Sexual harassment occurs everywhere and can be difficult to define. Sexual harassment in the workplace is usually defined as deliberate or repeated unwanted comments, gestures, or physical contact; it is forbidden by federal and provincial human rights legislation. Women are more likely to be harassed than men and minority women experience more sexual harassment than White women. Many workplaces have programs to educate workers about sexual harassment and mechanisms to deal with complaints. Sexual harassment on university and college campuses is ..

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common. Harassers are typically male and most forms of harassment involve unequal power relationships. A significant minority of adolescent boys and girls report experiencing sexual harassment in schools, though boys are more likely to report being perpetrators. Sexual harassment through cyberbullying is also discussed.

LEARNING OBJECTIVES 1. Describe the levels of sexual assault according to Canadian law.

2. Summarize key findings about sexual assault according to national Canadian surveys.

3. Discuss the prevalence of and factors associated with sexual assault on campus.

4. Compare and contrast the types of sexual assault.

5. Describe factors associated with sexual assault against males.

6. Discuss factors that make consent challenging to communication and discern.

7. Discuss attitudes that can facilitate sexual assault.

8. Describe factors that are associated with sexual coercion in men.

9. Discuss the effects of sexual assault on survivors and common treatment approaches.

10. Discuss ways of preventing rape, including campus prevention programs and Internet apps.

11. Describe verbal pressure tactics in sexual coercion.

12. Summarize findings on child sexual abuse in Canada.

13. Describe Canadian laws related to the sexual exploitation of children and youth.

14. Summarize current research on pedophiles.

15. Describe abusive sexual relationship that can occur in families.

16. Describe effects of sexual abuse in children and in later life.

17. Describe the treatment options for treating sexual offenders.

18. Discuss the various kinds of sexual harassment.

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TEACHING TIPS 1. Provide students with telephone numbers for the campus police, the city police, the local sexual assault crisis centre, the campus counselling service, and support groups for sexual assault victims.

2. Present information on local programs (if there are any) for incest perpetrators. In some programs, the perpetrator must live away from the family after charges are filed and attend counselling regularly. If the perpetrator fails to comply, a trial date is set. Explore students’ feelings about recent attempts to inform communities of the existence of child sexual abusers in their communities, and the implementation of the National Sex Offender Registry. Have students look at the rights of both sides.

3. Obtain a list of community services for survivors of child sexual abuse. Distribute copies to your students.

4. Inform your students about your institution’s procedure for filing sexual harassment complaints.

DISCUSSION QUESTIONS 1. What myths exist in our culture regarding sexual assault? Do you think these myths contribute to the incidence of sexual assault? What are some other possible effects of sexual assault myths?

2. Research suggests that university students are reluctant to give verbal consent to sex, preferring nonverbal strategies. What are some implications of this for sexual assault? Why is it so difficult and/or unappealing to discuss whether or not sex will occur directly?

3. Why is it that the sexual abuse of girls by men is often taken more seriously or considered more damaging than the sexual abuse of boys by women?

4. Careful examination of news reports of sexual abuse by the clergy indicates that charges have involved Catholics, Presbyterians, Jews, Buddhists, Methodists, Lutherans, and so on. What can members of religious groups do to help prevent such occurrences? (Many major religious groups have developed guidelines for handling cases of sexual harassment and abuse by clergy.)

5. Have you ever experienced behaviour that you think fits the definition of sexual harassment?

How did you react? If it happened again, would you react differently?

6. Do you think it is more difficult for men to report sexual harassment than it is for women? If so, why? What can we do to make it easier for both men and women to come forward when they have experienced sexual harassment?

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ADDITIONAL RESOURCES Web Sites https://rainn.org This website of the Rape Abuse and Incest National Network provides visitors with news, listing of crisis centres, and statistics on the incidence of rape and sexual abuse. http://www.whiteribbon.ca The White Ribbon Campaign is a non-profit organization founded by men and working to end men’s violence against women. The website includes information about international campaigns, downloadable posters, and documents. http://www.springtideresources.org Website of Springtide Resources, a Toronto based organization dedicated to educating the public about violence again women in order to decrease the incidence of physical, psychological, emotional, and sexual abuse against women. The site offers information on the following topics: custody issues, signs of abuse, same-sex abuse, FAQs, links, emotional abuse, and abuse of disabled women. http://www.rapereliefshelter.bc.ca Website for Vancouver rape relief and women’s shelter.

Includes information and resources on a variety of topics related to sexual assault. http://www.satcontario.com Website for the Ontario Network of Sexual Assault/Domestic Violence Treatment Centres which provides information and links to services. http://www.iatso.org The International Association for the Treatment of Sex Offenders is an international non-profit organization committed to the promotion of research of and treatment for sexual offenders.

ACTIVITIES Activity I: Guest Lecture Invite a guest speaker from the local rape crisis centre to address your class.

Activity II: Debate Have students read the Taking Sides article and come to class prepared to debate the topic.

Is chemical castration an acceptable punishment for sex offenders?

Divide the class in two and assign each group one side of the debate. Have each group first discuss among themselves the various issues and arguments on each side, then have the two groups debate their positions as a class.

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From: Taking Sides: Clashing Views on Controversial Issues in Human Sexuality (8th ed.).

(William J. Taverner, Ed., McGraw-Hill, 2002.)

Activity III: Small Group Discussion Questions Sexual Coercion Distribute copies of the Small Group Discussion Questions, and in mixed-gender groups of three to four students each, ask students to discuss the following questions on various aspects of sexual coercion. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. A popular saying for buttons and T-shirts reads, “What part of ‘No’ don’t you understand?”

Do you think that men really don’t understand that when women say no, they mean no? Are some women socialized to say no but mean yes?

2. Think about the immense contrast between our cultural views of “ideal” wedded bliss and the statistic that one wife in seven is likely to be sexually assaulted by her husband. What explanations can you offer for the contrast?

3. At some colleges and universities, women have begun posting the names of date sexual assailants on bulletin boards, often located in women’s restrooms. What do you think their motives are? Should the administration intervene in any way? Why or why not?

4. Have you been subjected to workplace behaviour that you think meets the definition of sexual harassment? How did you handle the situation? If this happens again, will you react differently?

How?

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Chapter 18

CHAPTER 18 Sex Work and Sexually Explicit Material CHAPTER-AT-A-GLANCE Chapter Outline

Sex Work

Instructional Ideas

Learning Objective 1 Learning Objective 2

Supplemental Materials IM Activity: Thinking Critically About Whether Sex Work Should Be Legal

Learning Objective 3 Learning Objective 4 Learning Objective 5 Learning Objective 6 Learning Objective 7 Learning Objective 8 Learning Objective 9 Learning Objective 10 Discussion Question 1 Discussion Question 2 Discussion Question 3

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Sexually Explicit Material Learning Objective 11 (SEM) Learning Objective 12 Learning Objective 13

IM Activity: Small Group Discussion Questions: Sex Work and Sexually Explicit Material

Learning Objective 14 Learning Objective 15 Learning Objective 16 Learning Objective 17 Learning Objective 18 Teaching Tip 1 Discussion Question 4

CHAPTER SUMMARY This chapter deals with commercial aspects of sexuality. Sex work is the exchange of sexual activity for money or goods of value. Historically, the term “prostitution” has been used; however, many people who sell sexual services, as well as advocacy groups and researchers, have adopted the term “sex work” which is less judgmental, more neutral, and less stigmatizing.

Sex work and the law in Canada are described and a historical timeline is presented. In Canada, selling sexual services is legal but buying sex is illegal. Challenges of this model are discussed.

Female sex workers are usually classified according to where they work. The major types of sex workers today are street-based sex workers, brothel workers, massage-parlour workers, escorts, and call girls. Less research has focused on male sex workers, who are sometimes called hustlers; a brief introduction is presented. Third-party managers, human trafficking, and entry into sex work are described. Human trafficking of sex workers is a major global enterprise.

Poverty and sexual and/or physical abuse figure prominently in the backgrounds of many sex workers, especially those who work on the street where many are homeless and runaway youth.

The majority of people who pay for sexual services are heterosexual men. Most patrons of female sex workers are “occasional johns” who also have regular sex partners. Motives for buying sex include: sex without negotiation, sex without emotional commitment, sex for eroticism and variety, sex away from home, and difficulty attracting a partner. John schools have been established for men who are charged with communicating for the purposes of prostitution.

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Among the most significant occupational hazards faced by sex workers is the threat of STIs and most sex workers report using a condom for vaginal and anal sex with clients, but are less likely to do so with people who are not clients. Exotic dancing, also known as stripping, is a type of sex work; people of all genders may be dancers. Positive and negative aspects of dancing are discussed.

The various approaches to the definition of sexually explicit materials (SEM) are discussed.

Pornography is defined as written, visual, or audiotaped material that’s produced to elicit or enhance sexual arousal. Perspectives on pornography are discussed. These include: the obscenity-based approach, the conservative position, the liberal position, the anti-pornography feminist approach, and the pro-pornography feminist approach.

Laws against obscenity provide the legal framework for regulating the dissemination of pornography. The Supreme Court of Canada considers material to be obscene if it is characterized by “undue” exploitation of sex. A “community-standard-of-tolerance” test is used to determine if undue exploitation exists. The Canadian Criminal Code strictly prohibits child pornography. The internet is by far the most common way that people access SEM and most first access SEM as adolescents. Research on the use of SEM is presented and some gender differences are noted. The subject of pornography addiction in introduced.

A discussion of sexual coercion and SEM is presented. Research evidence suggests there are little or no differences in terms of SEM viewed by incarcerated sex offenders and those incarcerated for nonsexual offenses. Also, it appears that it is the violence in violent SEM, not its sexual explicitness, that potentially reinforces the attitudes and behaviours of sex offenders.

Evidence that non-offending men are spurred to sexually assault women because of exposure to violent SEM is lacking and there is little evidence that exposure to nonviolent SEM causes sexual aggression. Rather, people who are predisposed to sexual aggression are more likely to view violent SEM. Some research suggests that men who used pornography had more genderegalitarian attitudes than men who did not. Pornography use may also be associated with greater acceptance of premarital sex, extramarital sex, and simultaneous sexual relationships with multiple partners. Prolonged exposure to SEM may also foster dissatisfaction with the physical appearance and performance of one’s intimate partners, and lead to unrealistic ideas about how people function sexually.

LEARNING OBJECTIVES 1. Describe why the term “sex work” has replaced the term “prostitution” to define the exchange of sexual services for money.

2. Describe past and current laws regulating sex work in Canada.

3. Summarize what we know about different categories of female sex work.

4. Summarize what we know about different categories of male sex work.

5. Identity the different types of third-party managers in the sex trade industry. ..

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6. Analyse the intersection of human trafficking and sex work.

7. Describe the reasons why people engage in sex work.

8. Describe the reasons why men use the services of sex workers.

9. Describe the relationship between sexually transmitted infections and sex work.

10. Discuss the positive and negative aspects of exotic dancing.

11. Define sexually explicit material and pornography.

12. Describe and discuss different perspectives on pornography.

13. Describe the legal regulation of pornography in Canada.

14. Describe legal efforts to combat child pornography in Canada.

15. Discuss the use of online SEM. 16. Assess reported gender differences in response to SEM. 17. Identify and evaluate different perspectives toward the pornography addiction model.

18. Discuss if there is a relationship between consumption of SEM and sexual coercion.

TEACHING TIPS 1. Invite a police officer from a local or nearby sex crimes unit to visit your class to discuss efforts to curb child pornography on the Internet.

DISCUSSION QUESTIONS 1. Can you think of a positive side to sex work? What could potential benefits could there be to this type of employment?

2. How would you react if your partner or close friend told you that he/she had had sex with a sex worker?

3. Should sex work be legal or illegal? What are the arguments for and against legal sex work?

4. Both research and public opinion on potential negative effects of pornography continue to be controversial. What is your opinion on the pornography debate? Do you think it can be harmful to viewers? Do you think there are possible benefits to viewing pornography? ..

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ADDITIONAL RESOURCES Web Sites http://www.steppingstonens.ca Stepping Stone is a charitable not-for-profit organization that offers supportive programs and outreach to current and former sex workers of all genders. http://www.spoc.ca Website of the Sex Professionals of Canada which includes legal information for sex workers, resources, and links. http://www.kidsintheknow.ca Kids in the Know is the Canadian Centre for Child Protection’s national safety education program. The program engages students with interactive activities to help build skills that increase their personal safety and reduce their risk of victimization online and in the real world.

ACTIVITIES Activity I: Thinking Critically about Whether Sex Work Should be Legalized This activity encourages students to weigh pros and cons of legalizing/decriminalizing prostitution.

Should all activities associated with sex work be legalized, decriminalized or criminalized?

Evaluate the pros and cons of each option. In decriminalization, criminal penalties would be removed, but the province would neither regulate nor license the activity.

In the case of legalization, sex work could be licensed and regulated by the province, which could provide the province with a source of taxable revenue and a means of ensuring that hygienic procedures are followed by operators of sex work businesses. Use of minors in sex work, however, would remain unlawful. In thinking critically about the issues, consider these questions: 1. Does society have a right to legislate morality? If so, why doesn't society treat other behaviours which are widely considered immoral, such as adultery, in the same way that it treats sex work?

2. Why keep laws on the books against sex work when they have clearly been ineffective in eliminating it?

3. Wouldn't sex work be a victimless crime since it involves consensual sexual activity between two parties, the sex worker and the client?

4. Or is sex work, by its very nature, degrading and demeaning to the person who sells her or his body to others? Since it is the sex worker who is usually the one arrested and punished, are legal penalties merely another way of victimizing the victim?

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5. Would legalizing or decriminalizing sex work send the wrong message to young people?

Activity II: Small Group Discussion Questions Sex Work and Sexually Explicit Material Distribute copies of the Small Group Discussion Questions which ask students to discuss aspects of prostitution and obscenity laws in mixed-gender groups of three to four students each. After 20 minutes, one student from each group should summarize the small group discussion to the class.

1. What social factors account for the large number of arrests of female sex workers and the small number of arrests of “johns,” when both are committing criminal offences?

2. Compare your views of street sex workers to your views of sex workers who are paid by a business to entertain out-of-town businessmen. How similar or different are your views of the men who have sex with these workers?

3. If the early family lives of so many sex workers are characterized by sexual abuse, why don’t people demand a massive program to eliminate child sexual abuse instead of periodically demanding that the police crack down on sex work? Does sex work serve such an important function in Canadian society that we are not really committed to its elimination?

4. What is the current status of legislative attempts to regulate the Internet? Are laws needed to protect minors from obscenity and indecency on the Internet? Are they enforceable? Programs are now available (often free from Internet services) that allow parents to block access to sites that they do not wish their children to see. Do these programs solve the problem of protecting minors from obscenity and indecency?

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 1 What Is Human Sexuality?

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Learning Objectives (1 of 2) 1. Define human sexuality.

2. Identify ways in which human sexuality is characterized by diversity.

3. Describe the interaction between ethnocultural diversity and attitudes toward sexuality in Canada.

4. Compare and contrast attitudes toward sexuality in different countries.

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Learning Objectives (2 of 2) 5. Define the value perspectives that people use to evaluate sexual behaviours.

6. Identify and describe the key elements of critical thinking.

7. Discuss the various ways of looking at human sexuality.

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What Is Human Sexuality? (1 of 12) • The word “sex” can refer to: – Whether we are anatomically male or female or something in between – Anatomical structures (sex organs) – Physical activities involving our sex organs – Erotic feelings, experiences, or desires

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What Is Human Sexuality? (2 of 12) • “Sex” refers to anatomical or biological categories, where as “gender” refers to social or cultural categories.

• “Human sexuality” refers to the ways we experience and express ourselves as sexual beings.

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What Is Human Sexuality? (3 of 12) • Sex can be conceptualized as a fun, healthy activity when: – It is voluntary – It is not seen as work – It serves a personal need

• Sex provides physical pleasure.

• Sexuality is an important part of identity.

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Choices, Information, and Decision Making • We choose how, where, and with whom to become sexually involved.

• Expression of sexuality is influenced by social context.

• We choose among courses of action.

• Gathering information helps us to predict outcomes of decisions we make.

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What Is Human Sexuality? (4 of 12) • The Study of Human Sexuality – Interdisciplinary – e.g., biology, medicine, psychology, sociology, anthropology – Promoted by leading Canadian organizations: ▪ The Sex Information and Education Council of Canada (SIECCAN) ▪ The Canadian Sex Research Forum (CSRF)

– International organizations include: ▪ Society of the Scientific Study of Sexuality (SSSS) ▪ World Association for Sexual Health (WAS)

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Innovative Canadian Research • Ethnocultural communities and sexuality – There is little research available on the sexuality of Canadian ethnic minority groups.

– Norms and roles differ by community, religion, and acculturation.

▪ May impact sexual attitudes and satisfaction

– Need for sexual health interventions tailored to socio-cultural contexts for adolescents

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Sexuality and Values • Canadian Society and Sexuality – Canada is culturally diverse, continually changed by immigration – Values of immigrants may conflict with those of people born in Canada ▪ Arranged marriage ▪ Female circumcision ▪ Sex-specific abortion

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What Is Human Sexuality? (5 of 12) • Canadian Society and Sexuality (Continued) – Comparing Canada with other countries ▪ Tremendous variation across countries of the world ▪ Western countries had highest sexual satisfaction (Laumann et al., 2006) ▪ Sexual scripts for adolescents different from Kenya – “Playing sex” at a young age is common – Girls provide sex to boys/men to obtain material goods

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What Is Human Sexuality? (6 of 12) • Canadian Society and Sexuality – Compared to the U.S., Canada’s population: ▪ Is more ethnically diverse ▪ Has a lower birth rate and teen pregnancy rate ▪ Is more geographically concentrated ▪ Open to multiculturalism

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What Is Human Sexuality? (7 of 12) • Canadian Society and Sexuality (Continued) – Compared to the U.S., Canadians: ▪ Are more likely to have some post-secondary education ▪ Consider religion to be less central ▪ Have more liberal sexual attitudes

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What Is Human Sexuality? (9 of 12) • Canadian Society and Sexuality – Politics and sex in Canada and the U.S. ▪ Christian fundamentalists have greater a presence in the U.S.; emphasize abstinence-only programs ▪ Canada has maintained separation between religion and state.

▪ Canadian governments have had more balanced approach to sex education.

▪ Canada is generally more liberal than the U.S.

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What Is Human Sexuality? (10 of 12) • Canadian Society and Sexuality (Continued) – Politics and sex in Canada and the U.S. ▪ Same-sex marriage differs between two countries ▪ Canada was 4th country to legalize same-sex marriage in 2005; U.S. legalized in 2015 under President Obama ▪ In 2006, Stephen Harper’s Conservative minority government introduced motion to overturn same-sex marriage; motion was defeated by other parties.

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What Is Human Sexuality? (11 of 12) • Canadian Society and Sexuality (Continued) – Politics and sex in Canada and the U.S. ▪ In 2017, Prime Minister Justine Trudeau’s Liberal government passed Bill C-16 to make discrimination based on gender identity and expression illegal under the Human Rights Act ▪ In the U.A., transgender rights vary state to state and remains a highly contentious issue in some parts of the country.

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What Is Human Sexuality? (12 of 12) • Sexuality and Values – Our society is pluralistic with respect to sexuality.

– The defining characteristic of Canada is acceptance of diversity.

– Sexual attitudes, experiences, and behaviours are shaped by culture.

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Sexuality and Ethics (1 of 5) • All societies have restrictions on certain sexrelated behaviours.

• Ethics of divinity (religious) – Based on belief in a divine right or wrong

• Ethics of community – Based on what is perceived as good for community

• Ethics of autonomy – Based on rights and freedoms of individuals

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Sexuality and Ethics (2 of 5) • Ethics and Sexual Rights (Continued) – The World Association for Sexual Health (WAS) has promoted sexual rights through a series of goals for the global community ▪ Goals are western-centric ▪ May be more successful if human-rights focused

– The concept of sexual rights is controversial.

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Sexuality and Ethics (3 of 5) • Ethics and Sexual Rights (Continued) – WAS goals for global community (1): ▪ Recognize, promote, ensure and protect sexual rights for all.

▪ Advance toward gender equality and equity.

▪ Condemn, combat, reduce sexuality-related violence.

▪ Provide universal access to sexuality education.

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Sexuality and Ethics (4 of 5) • Ethics and Sexual Rights (Continued) – WAS goals for global community (2): ▪ Ensure reproductive health programs recognize sexual health.

▪ Halt and reverse spread of sexually transmitted infections.

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Sexuality and Ethics (5 of 5) • Ethics and Sexual Rights (Continued) – WAS goals for global community (3): ▪ Identify, address and treat sexual concerns and dysfunctions.

▪ Recognize sexual pleasure as a component of holistic health and well-being.

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Thinking Critically About Human Sexuality (1 of 2) • Principles of Critical Thinking – Be skeptical.

– Examine definitions of terms.

– Examine the assumptions or premises of arguments.

– Be cautious in drawing conclusions from evidence, correlation does not imply causation.

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Thinking Critically About Human Sexuality (2 of 2) • Principles of Critical Thinking (Continued) – Consider alternative interpretations of research evidence.

– Consider the strengths and weaknesses of different perspectives, even ones you don’t agree with.

– Don’t oversimplify.

– Don’t overgeneralize.

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Perspectives on Human Sexuality (1 of 17) • The Historical Perspective – Sexuality and art in prehistory and antiquity ▪ Phallic worship ▪ Phallic symbols ▪ Incest taboo

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Perspectives on Human Sexuality (2 of 17) • Historical Perspective – Ancient Hebrews ▪ Hebrew Bible permitted polygamy, the practice of having two or more spouses at the same time ▪ Majority of Hebrews practised monogamy – For procreation, pleasure, and fulfillment – A wife was considered her husband’s property.

– Men who committed adultery with other men’s wives violated property rights.

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Perspectives on Human Sexuality (3 of 17) • Historical Perspective – Ancient Greeks ▪ Male–male adult sexual behaviour ▪ Bisexuality: sexually responsive to either gender ▪ Pederasty: sexual love between a man and a boy ▪ Courtesans: a mistress of a noble or wealthy man ▪ Concubines: a secondary wife ▪ Women had no more legal or political rights than slaves.

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Perspectives on Human Sexuality (4 of 17) • Historical Perspective – The Ancient Romans ▪ Sexual excesses and orgies in upper classes ▪ Male–male sexual contact was condemned.

▪ Women were considered their husband’s property.

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Perspectives on Human Sexuality (5 of 17) • Historical Perspective – The Early Christians ▪ Sexuality was associated with the original sin.

▪ Sought to restrict sex to marriage ▪ Celibacy was closer than marriage to Christian ideal ▪ Procreation should govern sexual behaviour.

▪ Masturbation, homosexuality, oral contact, anal intercourse, were viewed as abominations in the eyes of God.

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Perspectives on Human Sexuality (6 of 17) • Historical Perspective – Islam ▪ Treasures marriage and sexual fulfillment in marriage ▪ Men may have up to four wives; women may have one husband.

▪ Public interactions between men and women were restricted.

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Perspectives on Human Sexuality (7 of 17) • Historical Perspective – The Hindus ▪ Sexual pleasure as spiritual ideal ▪ The Kama Sutra ▪ Indian society has become more restricted since 1000 CE

– The Taoists ▪ First to produce a detailed sex manual ▪ Sperm not to be wasted

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Perspectives on Human Sexuality (8 of 17) • Historical Perspective – The Medieval Christians ▪ Perspectives on sex largely unchanged since Augustine ▪ Cult of the Virgin Mary elevated the status of women

– The Protestant Reformers ▪ Expanded and challenged Roman Catholic perspectives on sex and sexuality ▪ Luther claimed marriage was part of human nature.

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Perspectives on Human Sexuality (9 of 17) • Historical Perspective – The Victorians ▪ Prim and proper on the surface ▪ Believed that sex drained a man of his natural vitality ▪ Ejaculation wasted vital fluids ▪ The Graham cracker was invented to control sexual appetites (whole-grain flour-based diet) ▪ 1892 research describes behaviours were less repressed than the standard narrative suggests.

▪ Prostitution flourished.

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Perspectives on Human Sexuality (10 of 17) • Historical Perspective – The Scientific Study of Sexuality ▪ A sexologist is a scientist who studies sexual behaviour.

– Havelock Ellis (1859–1939) – Richard von Krafft-Ebing (1840–1902) – Sigmund Freud (1856–1939) – Alfred Kinsey (1894–1956)

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Perspectives on Human Sexuality (11 of 17) • Historical Perspective – The Sexual Revolution ▪ Mid-1960s to the mid-1970s ▪ Influenced by many factors, including the Vietnam war, fear of the nuclear bomb, the birth-control pill, and television ▪ Tied to social permissiveness and political liberalism ▪ Pierre Trudeau: “There is no place for the state in the bedrooms of the nation.” (1967)

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Perspectives on Human Sexuality (12 of 17) • Historical Perspective – Feminism ▪ The ‘70s was a period of advancement toward equal rights for women.

▪ Women were as entitled as men to sexual pleasure and satisfaction.

– Gay Activism ▪ Began in 1969 following Stonewall ▪ Developed in response to AIDS in 1980s.

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The Internet and Communication Technology (1 of 3) • The Internet has had the greatest impact on sexuality in the Western world.

– Some argue it resulted in a new sexual revolution.

• The Internet has made it easier to explore and express sexuality.

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The Internet and Communication Technology (2 of 3) • Positive implications of the Internet on sexuality: – Allows people to more easily find information that is relevant to their needs – Improves access to sexuality education, anatomy, and how to engage in various sexual behaviours

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The Internet and Communication Technology (3 of 3) • Negative implications of the Internet on sexuality: – Increased production and distribution of child pornography – Enables people who are not able to control their use of the web for porn or seeking anonymous partners

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Perspectives on Human Sexuality (13 of 17) • Biological Perspective – Roles of genes, hormones, nervous system, and other physiological factors – Anatomical structures and physiology make sexual behavior possible, and for most people, pleasurable.

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Perspectives on Human Sexuality (14 of 17) • Cross-species Perspective – A variety of sexual behaviours exist among animals – Analogues ▪ Something similar or comparable to something else – e.g., turtles massage their mates’ heads

– Copulation ▪ Sexual intercourse

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Perspectives on Human Sexuality (15 of 17) • Sociological and Anthropological Perspectives – Provides insight in to the ways cultural beliefs affect sexual behaviour and morality – Margaret Mead (1901–1978) ▪ Gender role stereotypes

– Bronislaw Malinowski (1884–1942) ▪ Sexual freedom results in less anxiety

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Perspectives on Human Sexuality (16 of 17) • Sociological and Anthropological Perspectives (Continued) – Ford and Beach (1951) studied 200 cultures: ▪ Kissing is not universal ▪ Frequency of sexual intercourse varied ▪ Differing attitudes toward nudity, childhood masturbation

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Perspectives on Human Sexuality (17 of 17) • Multiple Perspectives on Human Sexuality – Multiple perspectives are needed to understand sexuality.

– Human sexuality reflects a combination of biological, sociocultural, and psychological factors.

– There are few universal patterns of human sexuality.

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Gender and Sexual Orientation in Indigenous Cultures • Colonization influenced Christian perspective that valued heterosexuality • Prior to colonization, gender roles were fluid.

• Gender roles did not reflect sexual orientation.

• “Two-spirited” coined in 1990 – Also adopted to re-claim special status traditionally given to gender-variant identities

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End of Chapter 1

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 2 Using Theory and Research to Understand Human Sexuality

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2-1

Learning Objectives (1 of 3) 1. Describe the role that theory plays in the research process.

2. Compare and contrast key features of evolutionary theory, psychoanalytic theory, learning theories, social exchange theory, and critical theories.

3. Explain how the steps in the scientific method can be applied in sexuality research.

4. Compare quantitative and qualitative approaches to research. ..

2-2

Learning Objectives (2 of 3) 5. Explain what is meant by populations and samples.

6. Describe quantitative methods, including the survey method and laboratory observation.

7. Explain how experiments seek to determine cause and effect.

8. Describe common approaches to qualitative research, including the interview and the focus group. ..

2-3

Learning Objectives (3 of 3) 9. Describe research approaches that can utilize qualitative and quantitative methods (i.e., case studies, naturalistic observation, ethnographic observation, and participant observation).

10.Describe the ethical concerns that govern the ways in which researchers interact with research participants.

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2-4

Theoretical Approaches to Understanding Human Sexuality • Theory – Set of ideas/concepts used to explain a set of observed facts – Provides a conceptual framework for explaining/predicting sexual thoughts, attitudes, and behaviours

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2-5

Evolutionary Theory • Species have evolved physically and socially.

– Natural selection is a process where better-adapted members are more likely to survive, reproduce, and transmit traits

• Sociobiology – Social behavior results from evolution – Human today carry traits that helped ancestors survive and reproduce

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2-6

Evolutionary Theory (1 of 2) • Mating Strategies – Women and men have different biological roles ▪ Results in different mating strategies

– Men → short-term, attracted to cues of fertility – Women → long-term, attracted to cues of resources and commitment

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2-7

Evolutionary Theory (2 of 2) • Erotic Plasticity – Social and cultural forces shape levels/expression of sexual drive – Women are more responsive than men to cultural permissiveness/restraint.

– Men’s behaviours are more consistent with attitudes than women’s.

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2-8

Psychoanalytic Theory (1 of 3) • Psychoanalysis—Sigmund Freud – Theory of personality ▪ Human behaviour represents the outcome of clashing inner forces.

– We are born with biologically-based sex drives, channelled through socially approved outlets.

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2-9

Psychoanalytic Theory (2 of 3) • Psychoanalysis—Sigmund Freud – Originated concept of erogenous zones: ▪ Many parts of body are responsive to sexual stimulation ▪ Developmental progression from one erogenous zone to another (e.g., oral cavity → anal cavity)

– Proposed a theory of psychosexual development ▪ Normal erotic urges in childhood led to conflict with parent of same gender

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Psychoanalytic Theory (3 of 3) • Psychoanalysis—Sigmund Freud – Theory of children’s psychosexual development 1. Oral 2. Anal 3. Phallic 4. Latency 5. Genital

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Learning Theories (1 of 7) • Learning theories – Focus on experiences and degree to which society, family, and intimate relationships shape behaviours

• Behaviourism – Emphasizes rewards/punishments in learning process

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Learning Theories (2 of 7) • Classical conditioning – A process is an association formed between naturally occurring stimulus and a previously neutral one – Associations can be formed between seemingly innocuous places and things and sexual feelings (positive or negative)

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Learning Theories (3 of 7) • Operant conditioning – Reinforcements or punishments can be used to increase or decrease a behaviour ▪ Sexual exploration in childhood (masturbation) may feel good if it is connected to feelings of guilt and shame, the child may feel conflicted

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Learning Theories (4 of 7) • Social learning theory – Explains behavior as a cognitive process that exists within a social environment

• Social cognitive theory – Emphasizes importance of cognitive activity (e.g., problem solving, decision making, expectations) – Children acquire gender roles through reinforcement/observation of gender-appropriate behaviour

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Learning Theories (5 of 7) • Sexual Script Theory – We learn scripts from our social environment about how men and women should behave.

1. Cultural: general social rules for sexual interactions 2. Interpersonal: apply cultural scripts to own sexual interactions 3. Intrapsychic: internalize and personalize cultural scripts

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Learning Theories (6 of 7) • Sexual Script Theory – Traditional Sexual Script ▪ Western Culture ▪ Heterosexual script for men and women ▪ Men: assertive, initiators, higher sex drive, more interested in recreational sex ▪ Women: gatekeepers, passive, want commitment ▪ Evidence that it is still relevant today

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2 - 17

Learning Theories (7 of 7) • Social Exchange Theory 1. Social behaviour based on series of exchanges 2. Individuals try to maximize rewards/minimize costs 3. When we receive rewards, we feel obligated to reciprocate

• e.g. Interpersonal Exchange Model of Sexual Satisfaction

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2 - 18

Critical Theories (1 of 5) • Feminist theory – Explores inequalities in gender and gender relations – Analyzes relationships between sexism, heterosexism, racism and class oppression – Challenge femininity and masculinity as social constructs

• Variety of feminist theories/types of feminism

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2 - 19

Critical Theories (2 of 5) • Feminists – Share core assumptions: ▪ Distinctions between men/women, masculine/feminine ▪ These distinctions are socially constructed ▪ They function to make women subordinate to men in society ▪ This disadvantage can be addressed through changes to law, social policies, acceptance of gender equality, etc.

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Critical Theories (3 of 5) • Feminist theorists may focus on: – Sexual objectification – Potential of sexuality – Acceptance of lesbianism/bisexuality – Sexual pleasure

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2 - 21

Critical Theories (4 of 5) • Queer Theory – Challenges assumptions about gender and sexuality: ▪ Assumption that heterosexuality is superior to other sexual orientations ▪ Assumption of a binary sexual orientation (i.e., gay/lesbian OR heterosexual)

– States that concepts of heterosexuality and homosexuality are social constructs

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Critical Theories (5 of 5) • Intersectionality – Recognizes the interaction between gender, race, and other categories of difference in individual lives – Understands that systems of oppression, such as racism, patriarchy, capitalism, and heterosexuality are connected and impact social circumstances

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A Scientific Approach to Human Sexuality (1 of 5) • Empirical Approach – Derived from or based on observation and experimentation

• Critical Thinking – Question prevailing assumptions.

– “Truth” changes over the course of history.

– The search for “truth” is a continuous process.

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A Scientific Approach to Human Sexuality (2 of 5) • Goals of the Science of Human Sexuality – To describe, explain, predict, and control the events of interest – Variables ▪ Quantities or qualities that vary or may vary

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A Scientific Approach to Human Sexuality (3 of 5) • Goals of the Science of Human Sexuality – Theories provide frameworks for scientists – Explain and make predictions about what they observe – Goal of scientific study of sexuality is not to dictate ▪ Provide insight to help people better understand themselves and make decisions about their behaviour

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A Scientific Approach to Human Sexuality (4 of 5) • The Scientific Method – A systematic way of gathering scientific evidence and testing assumptions, by: 1. Formulating a research question 2. Framing the research question in the form of a hypothesis 3. Testing the hypothesis 4. Drawing conclusions

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A Scientific Approach to Human Sexuality (5 of 5) • Approaches to Research Methods – Quantitative research emphasizes systematic investigation and the use of objective measures – Qualitative research is conducted with the aim of understanding a phenomenon – Mixed methods combines quantitative and qualitative methods

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The Birth of Sexual Science (1 of 2) • The Kinsey Reports – Alfred Kinsey and his colleagues (1948, 1953) interviewed men and women in the U.S. – Asked questions about a wide array of sexual behaviours – Adopted a group sampling approach – Results likely not generalizable – Interviewers were trained to encourage honest responding

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The Birth of Sexual Science (2 of 2) • The Kinsey Reports – Reliability ▪ Consistency or accuracy of a measure

– Incidence ▪ A measure of an event’s occurrence

– Validity ▪ The degree to which a test measures what it purports to measure

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Quantitative Research Methods (1 of 6) • Quantitative Methodology – The collection of numerical data (e.g., percentages) to produce statistics – Focus may be on whole population or specific groups of people

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Quantitative Research Methods (2 of 6) • Populations and Samples – Populations ▪ Complete group of organisms or events

– Sample ▪ Part of a population selected for study

– Representative sample ▪ Research sample who accurately represent a population

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Quantitative Research Methods (3 of 6) • Populations and Samples – Generalize ▪ Use information from a particular case or sample to draw conclusions about a larger phenomenon or population

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Quantitative Research Methods (4 of 6) • Sampling Methods – Random sample ▪ Every member of a population has an equal chance of participating.

– Stratified Random Sample ▪ Known subgroups in a population are represented in proportion to their numbers in the population.

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Quantitative Research Methods (5 of 6) • Sampling Methods – Volunteer Bias ▪ Slanting of research data caused by the characteristics of the individuals who volunteer to participate

– Convenience Samples ▪ Consist of individuals who happen to be available to the researcher ▪ Often European-Canadian, middle-class university students

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Quantitative Research Methods (6 of 6) • Relationship between variables – Researchers select specific variables to study ▪ Demographic variables concern vital statistics such as gender, race, or age

– Correlation is a statistical measure of the relationship between two variables ▪ Correlation coefficient measures the strength and direction of that relationship

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Methods of Observation (1 of 4) • Survey Method – Detailed study of a sample obtained by interviews and questionnaires – Can be administered to many people at once – Increasingly conducted through the Internet, anonymity

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Methods of Observation (2 of 4) • Limitations of the Survey Method • Volunteer bias – Those who participate in sexuality research tend to be more sexually permissive, liberal

• Social desirability – Response bias caused by a person’s tendency to provide a socially acceptable answer to a questionnaire or interview question ▪ e.g., men may exaggerate levels of sexual activity, women may minimize in accordance with social expectations ..

2 - 38

Methods of Observation (3 of 4) • Laboratory Observation Method – Masters and Johnson were the first scientists to report direct laboratory observations of individuals and couples engaged in sexual acts – Treatment ▪ Experimental intervention that is administered so the effects may be observed

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2 - 39

Methods of Observation (4 of 4) • Limitations of the Laboratory Observation Method – External validity ▪ The artificial lab environment may not reflect the real world experience

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2 - 40

The Experimental Method (1 of 6) • Experiment – Scientific method that seeks to confirm causeand-effect relationships by manipulating independent variables and observing their effect on dependent variables

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2 - 41

The Experimental Method (2 of 6) • Aspects of the Experimental Method – Independent variable ▪ Condition that is manipulated so that its effects can be observed

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2 - 42

The Experimental Method (3 of 6) • Aspects of the Experimental Method – Dependent variable ▪ Believed to be affected by the independent variable(s) ▪ Results of the study are assessed by measuring changes in the dependent variable

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2 - 43

The Experimental Method (4 of 6) • Experimental and Control Groups – Experimental group ▪ Group of study participants who receive the experimental treatment

– Control group ▪ Group of study participants who do not receive the experimental treatment ▪ All other conditions are kept the same

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2 - 44

The Experimental Method (5 of 6) • Experimental and Control Groups – Selection factor ▪ Bias that may operate in research when people are allowed to determine whether they will receive an experimental treatment

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2 - 45

The Experimental Method (6 of 6) • Limitations of the Experimental Method • Within an experiment, not all variables such as mood, attention, and focus may be controlled for.

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2 - 46

A Closer Look/Innovative Canadian Research (1 of 3) • Measuring Sexual Arousal – Sexual arousal can be measured objectively using devices like the penile strain gauge, vaginal photoplethysmograph and thermographic cameras.

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2 - 47

A Closer Look/Innovative Canadian Research (2 of 3)

The penile strain gauge (left) and the vaginal photoplethysmograph (right) are used to measure physiological responses to sexual stimuli. ..

2 - 48

A Closer Look/Innovative Canadian Research (3 of 3) • Measuring Sexual Arousal – Research indicates that women are aroused by a wider range of stimuli than are men.

– Some researchers suggest this is because arousal is divided into two systems: physiological and subjective – Others suggest that women’s desire may be dictated more by the emotional connection , rather than the sex, of a partner.

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2 - 49

Qualitative Research Methods (1 of 6) • Qualitative Research Methods – The use of interviews, focus groups, diaries or other methods, to record people’s attitudes and experiences – Well-suited to revealing the way individuals or specific groups experience their sexuality in more detail than is possible using quantitative methods, nuanced understanding

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Qualitative Research Methods (2 of 6) • The Interview Method – Involves asking set of questions to elicit descriptions of their thoughts, feelings, attitudes, or experiences – May be structured or semi-structured

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Qualitative Research Methods (3 of 6) • Limitations of the Interview Method – Interviews may take a long time to transcribe prior to analysis – Time-consuming – Difficult to recruit participants

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Qualitative Research Methods (5 of 6) • The Focus Group Method – Involves bringing together a group of people to determine their attitudes about a specific topic – Online focus groups may yield more in-depth information

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Qualitative Research Methods (6 of 6) • Limitations of the Focus Group Method – As with all qualitative studies, it is difficult to generalize beyond the current sample – May be extensive and time consuming

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Research Approaches That Use (1 of 2) Quantitative and Qualitative Methods • Case Study Method – A carefully drawn, in-depth biography of an individual or small group of individuals – Researcher comes to know the person or group through interviews conducted over a prolonged period of time or through review of documents

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Research Approaches That Use (2 of 2) Quantitative and Qualitative Methods • Naturalistic Observation Method – Organisms are observed in their natural environments.

• Ethnographic Observation Method – Behaviours and customs are observed within a group’s native environment.

– Limited in the study of sexual behaviour, because sexual activities often performed away from others/visitors

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2 - 56

Methods of Observation • Participant Observation Method – Observers interact with their participants as they collect data.

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2 - 57

Ethics in Sex Research • Sex researchers are required to protect the people they study • Ethics Review Committees examine proposals in light of ethical guidelines – Exposing participants to harm – Confidentiality – Informed consent ▪ Agreement to participate in research after receiving adequate information

– Use of deception ..

2 - 58

Innovative Canadian Research • Do Research Consent Forms Affect Findings?

– Senn and Desmarais (2006) analyzed whether more stringent ethics requirements affect findings in sexuality research – Consent forms with information about explicit slides and potential harm evaluated the slides more negatively – More information about study was not associated with feeling more informed

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End of Chapter 2

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 3 Female and Male Anatomy and Physiology

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3-1

Learning Objectives (1 of 4) 1. Describe the external female sex organs and their functions.

2. Describe the internal female sex organs, their functions, and health problems that may affect them.

3. Describe the composition and functions of the breasts.

4. Discuss risk factors for and detection and treatment of breast cancer.

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3-2

Learning Objectives (2 of 4) 5. Describe the regulation and the phases of the menstrual cycle.

6. Define and discuss menopause, perimenopause, and the climacteric.

7. Define menstrual difficulties and discuss what can be done about them.

8. Describe the external male sex organs and their functions.

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3-3

Learning Objectives (3 of 4) 9. Assess reasons why some parents choose to have their male infants circumcised and other parents choose not to.

10.Describe the internal male sex organs and their functions.

11.Discuss urethritis.

12.Discuss testicular cancer.

13.Discuss benign prostatic hyperplasia.

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3-4

Learning Objectives (4 of 4) 14.Discuss prostate cancer.

15.Explain how erection occurs.

16.Explain how ejaculation occurs.

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3-5

External Sex Organs (1 of 24)

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3-6

External Sex Organs (2 of 24) • Vulva – External sexual structures of the female

• Mons Veneris – Fatty tissue covering the joint of pubic bones – Also known as the mons pubis or mons – At puberty becomes covered with pubic hair – Cushions a woman’s body during sexual intercourse

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3-7

External Sex Organs (3 of 24) • Labia Majora – Large folds of skin that run downward from the mons along the sides of the vulva – Shields the labia minora and the urethral and vaginal openings – Outer surfaces covered with pubic hair

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3-8

External Sex Organs (4 of 24) • Labia Minora – Hairless, light-coloured membranes located between labia majora – Surround the urethral and vaginal openings – Outer surfaces of the labia minora merge with the major lips – At the top they join at the hood of the clitoris

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3-9

External Sex Organs (5 of 24) • Clitoris – Female sex organ most sensitive to sexual sensation – Consists of a shaft and glans – Body, termed the clitoral shaft, is about 2.5 cm long and 0.5 cm wide – Consists of erectile tissue which stiffens when aroused.

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3 - 10

External Sex Organs (6 of 24) • Clitoris – Corpora cavernosa ▪ Spongy tissue in the clitoral shaft that becomes engorged with blood and stiffens in response to sexual stimulation

– Prepuce ▪ Fold of skin covering glans of clitoris

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3 - 11

External Sex Organs (7 of 24) • Clitoris – Clitoral glans is a smooth, round knob or lump of tissue – Situated about the urethral opening – Highly sensitive to touch

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3 - 12

External Sex Organs (8 of 24) • Clitoris – Homologous to the penis ▪ Similar in structure ▪ Developing from the same embryonic tissues

– Not analogous to the penis ▪ Not similar in function

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3 - 13

A World of Diversity (1 of 2) • Pubic hair removal – Historical evidence of women in ancient cultures who practised pubic hair removal

• Study of 2400 women under age 50 found that the majority practised some form of pubic hair removal (2010) • Study of men found that 82% of gay and 66% of heterosexual men removed some pubic hair (2008)

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3 - 14

A World of Diversity (2 of 2) • Female Genital Mutilation – Clitoridectomy ▪ Surgical removal of the clitoris

– Rite of initiation into womanhood in many predominantly Islamic cultures – Often performed as a puberty ritual in late childhood or early adolescence – The typical young woman does not see herself as a victim

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3 - 15

The Female Reproductive System

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3 - 16

External Sex Organs (9 of 24) • Vestibule – Area within the labia minora – Contains openings to vagina and urethra

• Urethral Opening – The opening through which urine passes from the female body – May become infected from bacteria (cystitis)

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3 - 17

External Sex Organs (10 of 24) • Vaginal Opening – Introitus – Hymen ▪ Fold of tissue across vaginal opening ▪ Usually present at birth ▪ Various types of hymens

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3 - 18

External Sex Organs (11 of 24) • Vaginal Opening – Perineum ▪ Skin and tissue that lies between vaginal opening and anus ▪ Rich in nerve endings

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3 - 19

External Sex Organs (12 of 24) • Vaginal Opening – Episiotomy ▪ Surgical incision in the perineum that may be made during childbirth ▪ Protects the vagina from tearing

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3 - 20

External Sex Organs (13 of 24) • Structures that Underlie External Sex Organs – Sphincters ▪ Ring-shaped muscles that constrict body openings

– Crura ▪ Attach clitoris to pubic bone

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3 - 21

External Sex Organs (14 of 24) • Structures that Underlie External Sex Organs – Vestibular bulbs ▪ Cavernous structures that extend downward along the sides of the introitus and swell during sexual arousal

– Bartholin’s glands ▪ Glands that lie just inside the minor lips and secrete fluid just before orgasm

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3 - 22

External Sex Organs (15 of 24) • Structures that Underlie External Sex Organs – Pubococcygeal muscle ▪ The muscle that encircles the entrance to the vagina ▪ Repeatedly contracting and relaxing this muscle (called Kegel exercises) is sometimes recommended

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3 - 23

Internal Sex Organs (1 of 29)

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3 - 24

Internal Sex Organs (2 of 29) • Vagina – The tubular female sex organ that contains the penis during sexual intercourse and through which a baby is born – Extends back and upward from vaginal opening – Vaginal walls have three layers – Inner two-thirds of vagina insensitive to touch – Vaginal walls secrete substances that help maintain the vagina’s normal acidity

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3 - 25

Internal Sex Organs (3 of 29) • Vagina – Douching may increase risk of vaginal infections – Vaginitis refers to any vaginal inflammation ▪ Infection, birth control pills, antibiotics, allergic reaction, chemical irritation, lowered resistance due to fatigue or poor diet ▪ Changes in body chemistry or lowered resistance may permit normal micro-organisms to multiply to dangerous levels

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Internal Sex Organs (4 of 29) • The G Spot and Female Ejaculation – The Grafenberg spot is theorized to be a part of the vagina—a bean-shaped area in the anterior (front) wall – It is believed to lie about 2.5–5 cm from the vaginal entrance and to consist of a soft mass of tissue that swells from the size of a dime to a loonie when stimulated.

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3 - 27

Internal Sex Organs (5 of 29) • The G Spot and Female Ejaculation – Stimulation may lead to female ejaculation.

– Some researchers challenge its existence.

– It is commonly agreed that: ▪ The anterior wall of the vagina has many nerve endings and may be sensitive to stimulation ▪ Many women may exude fluid through the urethra at the time of orgasm

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The G-Spot

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Internal Sex Organs (6 of 29) • Cervix – Lower end of the uterus – Contributes to the chemical balance of the vagina – The os is the opening in the middle of the cervix

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Internal Sex Organs (7 of 29) • Cervix (Continued) – Cervical cancer ▪ Incidence has declined since 1970s because women get regular Pap tests ▪ Greatest risk factor is HPV infection – Vaccine against HPV has been approved by Canadian government – If detected early, most cases can be treated

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Internal Sex Organs (8 of 29) • Cervix (Continued) – Cervical cancer ▪ If sexually active, women should get Pap test every one to three years ▪ Ethnocultural differences in rates of Pap testing in Canada

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Internal Sex Organs (10 of 29) • Uterus – Hollow, muscular, pear-shaped organ in which a fertilized ovum implants and develops until birth.

– Ovum ▪ Egg cell

– Endometrium ▪ The innermost layer of the uterus

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Internal Sex Organs (11 of 29) • Uterus – Endometriosis ▪ A condition in which endometrial tissues may also grow in the abdominal cavity or elsewhere in the reproductive system ▪ Most common symptom is menstrual pain ▪ Left untreated, it can lead to infertility.

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Internal Sex Organs (12 of 29) • Uterus – Uterine/Endometrial Cancer ▪ 4600 new cases of uterine cancer were diagnosed in Canada in 2013 ▪ One of the most common forms is cancer of the endometrial lining.

▪ Risk factors are high exposure to estrogen, late menopause, eostrogen replacement therapy, obesity, a high-fat diet, and diabetes.

▪ Symptomized by abnormal uterine staining or bleeding

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Internal Sex Organs (13 of 29) • Uterus – Hysterectomy ▪ Surgical removal of the uterus ▪ May be performed when women develop cancer of the uterus, ovaries or cervix ▪ Complete hysterectomy involves removal of ovaries, fallopian tubes, cervix and uterus ▪ Partial hysterectomy removes uterus, but not ovaries and fallopian tubes.

▪ Some women report sexual difficulties post surgery.

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Internal Sex Organs (14 of 29) • Fallopian Tubes – Uterine tubes 10 cm in length – Extend from upper uterus toward ovaries – Passageway for the ova to the uterus, providing nourishment along the way – Ectopic pregnancy ▪ Fertilized ovum implants outside the uterus, usually in the fallopian tube

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Internal Sex Organs (15 of 29) • Ovaries – Two almond shaped organs, 4 cm long – Lie on ether side of the uterus, attached by ligaments – Produce ova, estrogen, and progesterone – Estrogen ▪ Generic term for female sex hormones ▪ Promotes female sex characteristics ▪ Regulates menstrual cycle

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Internal Sex Organs (16 of 29) • Ovaries – Progesterone ▪ Secreted by the corpus luteum ▪ Steroid hormone that stimulates proliferation of the endometrium ▪ Regulates menstrual cycle

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Internal Sex Organs (17 of 29) • Ovaries – Follicle ▪ Capsule within an ovary that contains an ovum

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Internal Sex Organs (18 of 29) • Ovaries – Ovarian cancer ▪ 2600 cases of ovarian cancer in 2013; 1700 deaths ▪ Strikes women between the ages of 40 and 70 ▪ 4th leading cancer killer of women ▪ Early detection is key, but often there are no signs or symptoms.

▪ Surgery, radiation therapy and drug therapy are treatment options.

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Internal Sex Organs (19 of 29) • The Pelvic Examination – Woman examined externally for irritations, swellings, abnormal discharges, and clitoral adhesions – Speculum inserted to view cervix and vaginal walls – Sample of cells taken from cervix with a wooden spatula (Pap test) – Bimanual vaginal exam to examine internal sex organs

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Pelvic Examination

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The Female Breasts (1 of 8)

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The Female Breasts (2 of 8) • Secondary Sex Characteristics – Traits that distinguish women from men – Not directly involved in reproduction

• Mammary Glands – Each breast contains 15 to 20 milk-producing glands – Little variation between women in terms of glandular tissue – breast size does not determine the amount of milk produced

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The Female Breasts (3 of 8) • Areola – Dark ring that encircles the nipple – Darkens during pregnancy and remains darker after delivery

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The Female Breasts (4 of 8) • Breast Cancer – Most commonly diagnosed cancer in women and second-leading cause of cancer-related death – 27 500 new diagnosed cases in 2016; 4900 deaths – High survival rate if cancer has not spread

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The Female Breasts (5 of 8) • Breast Cancer – Risk factors ▪ Family history ▪ Genetics (inherited BRCA1 and BRCA2 mutations) ▪ Higher breast density ▪ Increased lifetime exposure to estrogen: First menstrual period before the age of 12, menopause after age 55, delayed or no childbearing ▪ Long-term use of hormone therapy ▪ Alcohol

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The Female Breasts (6 of 8) • Breast Cancer – Detection and treatment ▪ Cysts: Sac-like structures filled with fluid or diseased material ▪ Benign tumours: Doing little or no harm ▪ Malignant: Cancerous breast lumps ▪ Mammography allows the detection and treatment of tiny, highly curable cancers before they can be felt by touch.

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The Female Breasts (7 of 8) • Breast Cancer – Can be detected by self-examination, physical examination, mammography, MRI – Practice of breast self-exam is controversial – may not benefit women

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The Female Breasts (8 of 8) • Breast Cancer – Lumpectomy ▪ Surgical removal of a lump from the breast

– Mastectomy ▪ Surgical removal of all or part of a breast

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The Menstrual Cycle (1 of 10) • Menstruation – Cyclical bleeding that stems from the shedding of endometrium – Human menstrual cycle averages 28 days in length

• Ovulation – Second phase of the cycle – Release of an ovum from an ovary

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The Menstrual Cycle (2 of 10) • Secretory or Luteal Phase is third phase of the menstrual cycle, right after ovulation • Corpus luteum – Follicle that releases the ovum – Functions as an endocrine gland – Endocrine gland ▪ Ductless gland that secretes directly into the blood stream

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The Menstrual Cycle (3 of 10) • Menarche – First menstrual period

• Variations in menstrual cycle are common

• Psychological factors can influence secretion or hormones, impacting menstrual cycle

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The Menstrual Cycle (4 of 10) • Regulation of the Menstrual Cycle – Hypothalamus ▪ Regulates body temperature, motivation, and emotion

– Pituitary gland ▪ Secretes growth hormone, prolactin, oxytocin

– Hormone ▪ A substance secreted by an endocrine gland to regulate body functions

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The Menstrual Cycle (5 of 10) • Phases of the Menstrual Cycle – Proliferative phase ▪ Begins with the end of menstruation and lasts for 9 to 10 days ▪ Endometrium proliferates

– Ovulatory phase ▪ A follicle ruptures and releases a mature ovum

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The Menstrual Cycle (6 of 10) • Phases of the Menstrual Cycle (Continued) – Secretory (luteal) phase ▪ Corpus luteum secretes large amounts of progesterone and estrogen following ovulation

– Menstrual phase ▪ Endometrium is sloughed off

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The Menstrual Cycle (7 of 10) • Phases of the Menstrual Cycle – Menstrual phase (continued) ▪ Tampon

– Cylindrical plug of cotton inserted into the vagina to absorb menstrual fluid ▪ Toxic Shock Syndrome (TSS)

– Caused when bacteria overbreed when highly absorbent tampons are left in place for many hours

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The Menstrual Cycle (8 of 10) • Sex During Menstruation – There is no evidence that coitus during menstruation is harmful.

– Orgasm may help to relieve cramping.

– Desire for sex has been found to peak around the time of ovulation – Human coital patterns seem to reflect personal decisions, not hormone fluctuations.

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A World of Diversity • Historical and cross-cultural perspectives on menstruation: beliefs vary between cultures • Limited understanding by ancient (and some contemporary) societies of bodily processes

• Myth of being unclean causes anxiety, depression, and lowered self-esteem

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The Menstrual Cycle (9 of 10) • Menopause – Cessation of menstruation – Perimenopause is the beginning of menopause, 3 to 11 months of amenorrhea – Climacteric ▪ Gradual decline in the reproductive capacity of the ovaries

– Deficit of estrogen may lead to a number of unpleasant symptoms

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The Menstrual Cycle (10 of 10) • Menopause (Continued) – Hormone Replacement Therapy (HRT) ▪ Synthetic equivalents of estrogen and/or progesterone ▪ In 2002, controversy over HRT erupted in Canada because of increase in incidence of breast cancer in women taking HRT. ▪ Now HRT is recommended only for short-term use in women with severe symptoms.

▪ Alternatives are available.

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Menstrual Difficulties (1 of 3) • Dysmenorrhea – Pain or discomfort during menstruation ▪ Primary dysmenorrhea or secondary dysmenorrhea ▪ Prostaglandin

– Hormones that cause the muscle fibres in the uterine walls to contract – result in menstrual cramps ▪ Mastalgia

– Swelling of breasts causing premenstrual discomfort

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Menstrual Difficulties (2 of 3) • Amenorrhea – Absence of menstruation ▪ Primary amenorrhea ▪ Secondary amenorrhea

– Caused by abnormalities in structures of the reproductive system, hormonal abnormalities, growths, psychological problems (stress), and anorexia

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Menstrual Difficulties (3 of 3) • Premenstrual Syndrome (PMS) – Combination of physical and psychological symptoms that may affect a woman during a four- to six-day interval that precedes menses – Most often involves mild to moderate discomfort – Options to reduce effects include exercise, dietary control, hormone treatments, and other medications.

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Applied Knowledge (1 of 2) • How to Handle Menstrual Discomfort – See a doctor about your concerns – Develop nutritious eating habits – Eat several small meals throughout the day – Some women find vigorous exercise helpful

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Applied Knowledge (2 of 2) • How to Handle Menstrual Discomfort – Check with your doctor about vitamin and mineral supplements – Ibuprofen and other medicines may be helpful for cramping – Prescription medications and oral contraceptions may help

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Male Anatomy and Physiology • Phallic symbols – Images of the penis that are usually suggestive of generative power.

• Testes (testicles) – Male sex glands suspended in the scrotum – Produce sperm cells and male hormone

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External Sex Organs (16 of 29)

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External Sex Organs (17 of 29) • Penis – Male organ of sexual intercourse – Conduit for urine – Contains no bones or muscles – Corpora cavernosa ▪ Two cylinders of spongy tissue that become congested with blood and stiffen during sexual arousal

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External Sex Organs (18 of 29) • Penis (Continued) – Corpus spongiosum ▪ Spongy body that runs along the bottom of the penis ▪ Contains the urethra ▪ Enlarges at the tip of the penis to form the glans

– Corona ▪ The ridge that separates the glans from the body of the penis

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External Sex Organs (19 of 29) • Penis (Continued) – Frenulum ▪ Sensitive strip of tissue that connects the underside of the penile glans to the shaft

– Root ▪ Base of the penis which extends into the pelvis

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External Sex Organs (20 of 29) • Penis (Continued) – Shaft ▪ Body of the penis ▪ Expands as a result of vasocongestion

– Foreskin (prepuce) ▪ Loose skin that covers the penile glans

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External Sex Organs (21 of 29) • Penis (Continued) – Circumcision ▪ Surgical removal of the foreskin of the penis ▪ About 17% of Canadian male babies are circumcised ▪ 1996 report of the Canadian Paediatric Society concluded that the procedure is not medically necessary ▪ Lessens the risk of HPV, HIV, prostate cancer, genital herpes ▪ Montreal-based lobby group seeks to ban circumcision

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External Sex Organs (22 of 29) • Penis (Continued) – Phimosis ▪ An abnormal condition in which the foreskin is so tight that it cannot be withdrawn from the glans

– Penis size ▪ Most women report preference for average or slightly larger than average size ▪ Average flaccid penis 9 to 10 cm; erect 14 to 16 cm

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External Sex Organs (23 of 29) • Scrotum – Pouch of loose skin that contains the testes – Spermatic cord ▪ Cord that suspends the testicle within the scrotum and contains the vas deferens, blood vessels, nerves, and cremaster muscle

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External Sex Organs (24 of 29) • Scrotum (Continued) – Vas deferens ▪ Tube that conducts sperm from the testicle to the ejaculatory duct of the penis

– Cremaster muscle ▪ Muscle that raises and lowers the testicle in response to temperature changes and sexual stimulation

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Internal Sex Organs (20 of 29) • The Testes – Male sex glands, suspended in the scrotum – Secrete sex hormones (androgens) and produce mature germ cells ▪ A cell from which a new organism develops ▪ Germ cells produced by the testes are called sperm

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Internal Sex Organs (21 of 29) • The Testes (Continued) – Testosterone ▪ Most important androgen ▪ Stimulates prenatal differentiation of male sex organs

– Testes usually range between 2.5 and 4.5 cm in length – The left testicle usually hangs lower

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Internal Sex Organs (22 of 29) • The Testes (Continued) – Sperm ▪ Seminiferous tubules

– Tiny, winding, sperm-producing tubes in lobes of testicles ▪ Spermatogenesis

– Process by which sperm cells are produced and developed

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Internal Sex Organs (23 of 29) • The Testes (Continued) – Sperm ▪ Takes 72 days for testes to manufacture a mature sperm cell ▪ Each sperm cell is 0.0005 cm long.

▪ Epididymis

– Where seminiferous tubules converge – Tube that lies against the back wall of each testicle – Storage facility for sperm

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Internal Sex Organs (24 of 29) • Vas Deferentia – Each epididymis empties into a vas deferens.

– This cylindrical tube is about 40 cm long.

– Severed in a vasectomy ▪ Sterilization procedure

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Internal Sex Organs (25 of 29) • Seminal Vesicles – Small glands 5 cm long – Lie behind bladder and open into ejaculatory ducts – Secrete fluids that combine with sperm – Ejaculatory duct ▪ Duct formed by the convergence of a vas deferens with a

seminal vesicle

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Internal Sex Organs (26 of 29) • Is there a male menopause? Not certain.

– Also known as andropause – Men experience gradual declines in testosterone and human growth hormone as they age – Drop may be connected to a variety of age-related symptoms – Some experts believe that testosterone replacement can help avert problems

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Internal Sex Organs (27 of 29) • Prostate Gland – Lies beneath bladder, approximately the size and shape of a chestnut – Contains muscle fibres and glandular issue that secretes prostatic fluid – Gives semen its characteristic odour and texture – Stimulation can heighten arousal and pleasure – Alkalinity neutralizes some of the acidity of the vaginal tract

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Internal Sex Organs (28 of 29) • Cowper’s Glands – Lie below the prostate – Empty their secretions into the urethra during sexual arousal – Function of the fluid is not entirely understood

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Internal Sex Organs (29 of 29) • Semen – Whitish fluid that constitutes the ejaculate – Consists of sperm and secretions from the seminal vesicles, prostate gland, and Cowper’s glands – Contains water, mucus, sugar, acids and bases – Typical ejaculate contains 200 to 400 million sperm cells and ranges from 3 to 5 mL in volume

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Diseases of the Urogenital System (1 of 6) • Urologist – A physician who specializes in the diagnosis and treatment of diseases of the urogenital system

• Urethritis – Inflammation of the bladder or urethra ▪ Frequent urination, a strong need to urinate, burning during urination, and a penile discharge

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Diseases of the Urogenital System (2 of 6) • Testicular Cancer – 1100 diagnosed cases in 2016; 40 deaths (Canadian Cancer Society, 2017) – Cryptorchidism ▪ A condition in which at least one of the testicles fail to descend from the abdomen into the scrotum ▪ Individuals with this condition in childhood have 40 times greater chance of contracting testicular cancer.

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Applied Knowledge • Self-Examination of the Testes – Best performed after a warm shower or bath – Roll each testicle between thumb and fingers – Watch for these signs: ▪ A slight enlargement of one of the testicles ▪ A change in the consistency of a testicle ▪ A dull ache in the lower abdomen or groin ▪ Sensation of dragging and heaviness in a testicle ▪ A lump on the testicle

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Diseases of the Urogenital System (3 of 6) • Prostate Disorders – Benign prostatic hyperplasia ▪ Enlargement of the prostate gland due to hormonal changes associated with aging

– Cancer of the prostate ▪ 21,600 Canadian men were diagnosed with prostate cancer in 2016; and estimated 4000 men died from the disease ▪ Risk factors include age, family history, mutations in BRCA1 and BRCA2, and ethnicity

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Diseases of the Urogenital System (4 of 6) • Prostate Disorders – Cancer of the prostate (continued) ▪ Test involves a finger in the rectum followed by blood tests ▪ PSA blood test used for screening ▪ Most common treatment is surgical removal of the prostate gland ▪ This surgery may lead to problems with urinary and sexual functioning

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Diseases of the Urogenital System (5 of 6) • Prostate Disorders – Cancer of the prostate (continued) ▪ Other treatments include radiation, hormone treatment, anticancer drugs ▪ Some doctors recommend “watchful waiting” – many men die from other causes rather than prostate cancer

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Diseases of the Urogenital System (6 of 6) • Prostate Disorders – Prostatitis ▪ Inflammation of the prostate gland ▪ Usually treated with antibiotics

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Male Sexual Functions (1 of 11) • Erection – Enlargement and stiffening of the penis as a consequence of its engorgement with blood – In 10 to 15 seconds, the penis can double in length, become firm, and shift from a funnel for passing urine to one that expels semen.

– Loss of erection occurs when sexual stimulation ceases or when the body returns to a (sexual) resting state after orgasm

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Male Sexual Functions (2 of 11) • Erection (Continued) – Loss of erection can also occur in response to anxiety or perceived threats.

– Performance Anxiety ▪ Dread and foreboding experienced in connection with sexual activity (or any other activity which might be judged by another person)

– Men have nocturnal erections every 90 minutes or so as they sleep.

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Male Sexual Functions (3 of 11) • Spinal Reflex and Sexual Response – Regardless of the source of stimulation, men’s sexual responses occur by reflex.

– Reflexes governing erection and ejaculation are controlled by the spinal cord.

– Sacrum ▪ Thick, triangular bone near the bottom of the spinal column

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Male Sexual Functions (4 of 11) • Role of the Brain – Sexual sensations are related to the brain from the spinal cord – The sight of one’s partner, erotic fantasies, memories, can result in maintaining or strengthening the erection – The brain can also stifle sexual response.

– Erectile reflex is easily tripped in adolescents.

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Male Sexual Functions (5 of 11) • Role of the Autonomic Nervous System (ANS) – The division of the nervous system which regulates automatic body processes – Sympathetic ANS ▪ Governs general mobilization ▪ Controls ejaculation

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Male Sexual Functions (6 of 11) • Role of the Autonomic Nervous System (Continued) – Parasympathetic ▪ Controls erection

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Male Sexual Functions (7 of 11) • Erectile Abnormalities – Peyronie’s disease ▪ An abnormal condition characterized by excessive curvature of the penis

– Priapism ▪ Persistant and painful erection of the penis

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Male Sexual Functions (8 of 11) • Ejaculation – Orgasm ▪ The climax of sexual excitement ▪ Sudden muscle contractions which result in abrupt release of sexual tension ▪ Accompanied by subjective sensations which are generally pleasurable

– Usually occurs with orgasm, but not synonymous

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Male Sexual Functions (9 of 11) • Ejaculation (Continued) – Occurs in two stages ▪ Emission stage

– Contractions of the prostate gland, seminal vesicles, upper part of vas deferens (ampulla) – Force propels seminal fluid into the prostatic part of the urethral tract – At this point, male experiences “ejaculatory inevitability”

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Male Sexual Functions (10 of 11) • Ejaculation (Continued) – Occurs in two stages ▪ Expulsion stage

– Propulsion of the seminal fluid through the urethra and out of the urethral opening (30 cm+) – Muscles contract rhythmically (0.8 second intervals) – Accompanied by highly pleasurable sensations of orgasm

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Male Sexual Functions (11 of 11) • Retrograde Ejaculation – Ejaculate empties into the bladder – Usually harmless, but can result in infertility – May be some changes in sensation associated with orgasm

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End of Chapter 3

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 4 Sexual Arousal and Response

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4-1

Learning Objectives (1 of 4) 1. Describe Masters and Johnson’s fourphase sexual response model.

2. Describe the Kaplan and Basson models of sexual response.

3. Identify common questions and controversies concerning female orgasm.

4. Evaluate the effects of drugs on sexual response.

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4-2

Learning Objectives (2 of 4) 5. Describe the role of the brain in sexual response.

6. Discuss the organizing and activating influences of sex hormones.

7. Assess the impact of physical and developmental disabilities on sexuality.

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4-3

Sexual Response (1 of 22) • Masters and Johnson (1966) found that the physiological responses of men and women to sexual stimulation were quite alike.

• The sequence of changes that take place in the body is referred to as the sexual response cycle.

• Masters and Johnson divided the cycle into four phases.

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4-4

Sexual Response (2 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle – Both men and women experience vasocongestion and myotonia ▪ Vasocongestion – Swelling of the genital tissue with blood

▪ Myotonia – Muscle tension

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4-5

Sexual Response (3 of 22)

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4-6

Sexual Response (4 of 22)

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4-7

Sexual Response (5 of 22)

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4-8

Sexual Response (6 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Excitement Phase ▪ Erection in the male, scrotal skin thickens, testes increase in size, testes and scrotum become elevated ▪ Vaginal lubrication in the female, vasocongestion, uterus engorges, breasts enlarge ▪ Skin may take on rosy “sex flush”, more pronounced in women than men ▪ Increased myotonia, heart rate, and blood pressure

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4-9

Sexual Response (7 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Plateau phase ▪ Increases in vasocongestion, muscle tension, rapid breathing, heart rate, and blood pressure ▪ Myotonia may cause facial grimaces ▪ In men, coronal ridge increases in size, glans turns purplish hue, testes further elevate, Cowper’s glands excrete a few drops of fluid found at the tip of the penis

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Sexual Response (8 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Plateau phase ▪ In women, vasocongestion swells the tissues of the outer one-third of the vagina, contracting the vaginal opening ▪ Orgasmic platform – Thickening of the walls of the outer third of the vagina due to vasocongestion

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4 - 11

Sexual Response (9 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Plateau phase ▪ Uterus becomes fully elevated ▪ Clitoris shortens and withdraws beneath the clitorial hood ▪ Labia minora turns red, known as the “sex skin” ▪ Sex skin – The reddening of the labia minora

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Sexual Response (10 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Orgasmic Phase ▪ In the male, consists of two stages of muscular contraction ▪ Sensations of pleasure tend to be related to strength of contractions and amount of seminal fluid ▪ First 3 to 4 are most intense and occur at 0.8-second intervals; 2 to 4 more occur at a slower pace

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Sexual Response (11 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Orgasmic Phase ▪ In the female, orgasm is comprised of 3 to 15 contractions of the pelvic muscles that surround the vaginal barrel, first contractions occur at 0.8-second intervals ▪ Followed by another 3–6 weaker, slower contractions ▪ Spacing of contractions more variable in women.

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Sexual Response (12 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Orgasmic Phase ▪ In all individuals, muscles throughout the body spasm, blood pressure and heart rate peak, and respiration increases to 40 breaths per minute.

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Sexual Response (13 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Resolution phase ▪ Body gradually returns to its pre-aroused state ▪ Muscle tension dissipates within 5 minutes of orgasm.

▪ Blood pressure, heart rate, and respiration return to prearousal levels within a few minutes.

▪ Both men and women may feel relaxed and satiated.

▪ Myotonia and vasocongestion may take an hour to dissipate among those who did not have orgasm.

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4 - 16

Sexual Response (14 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Resolution phase ▪ Men lose erection in two stages ▪ Men enter refractory period where they are physiologically incapable of experiencing another orgasm or ejaculation ▪ In women, orgasm triggers release of blood from engorged areas.

▪ Clitoris, vaginal barrel, uterus, and labia gradually shrink to their pre-aroused states, sex flush lightens gradually

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4 - 17

Sexual Response (15 of 22) • Masters and Johnson’s Four-Phase Sexual Response Cycle (Continued) – Resolution phase ▪ Persistent pelvic vasocongestion in a man may cause “blue balls” (slang term for a throbbing ache) – Can be relieved through masturbation or partnered sex

▪ Women may also experience this sensation if they become highly aroused and don’t find release ▪ Not an excuse to pressure or coerce someone into sex

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Innovative Canadian Research (1 of 5) • Genital Versus Subjective Sexual Arousal – Sexual concordance refers to the degree to which actual genital response and self-reported sexual arousal correspond with each other.

– Male genital arousal is measured by the degree of penile erection.

– Female genital arousal measured by genital vasocongestation or vaginal blood flow.

– Subjective arousal is measured by questionnaires/interviews.

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4 - 19

Innovative Canadian Research (2 of 5) • Genital Versus Subjective Sexual Arousal (Continued) – Men tend to have a higher degree of sexual concordance than women.

– Suggested explanations: ▪ Women might underreport sexual arousal ▪ Women may not be aware of physical arousal.

▪ Women may be aware of physical sensations, but not label them as sexual.

▪ Women may interpret arousal as sexual, but not experience them as enjoyable.

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Sexual Response (16 of 22) • Kaplan’s Three Stages of Sexual Response – Helen Singer Kaplan was a prominent sex therapist and author.

– Based on her clinical work, she developed a threestage model noteworthy for designating desire as a separate phase of sexual response (1974, 1987): ▪ Desire ▪ Excitement ▪ Orgasm

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4 - 21

Sexual Response (17 of 22) • Basson’s Intimacy Model of Female Sexual Response – Rosemary Basson (2008) developed an intimacybased model of female sexual response, especially relevant for women in long-term relationships.

▪ Process may not always begin with desire.

▪ Women may feel aroused for intimacy reasons.

▪ Arousal may precede desire.

▪ Arousal may not lead to orgasm.

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4 - 22

Sexual Response (18 of 22) • Comparing Models of Female Sexual Response – Sand and Fisher (2007) conducted a study to see how closely women felt their own experiences fit the Masters and Johnson, Kaplan, and Basson models.

– Almost equal proportions of women selected each model.

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Innovative Canadian Research (3 of 5) • The Subjective Experience of Orgasm – Studies suggest that the orgasms of both genders may feel quite similar.

– Mah and Binik (2002) asked men and women to rate adjectives describing orgasms they had experienced during masturbation and sex with a partner.

– Two dimensions were found: sensory (e.g., flooding, throbbing) and emotional (e.g., relaxation, emotional intimacy).

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4 - 24

Innovative Canadian Research (4 of 5) • The Subjective Experience of Orgasm (Continued) – A subsequent analysis of the data found that women experienced differences in orgasms types, depending on partnered vs. solitary masturbation.

– Partnered Orgasms ▪ More flushing sensations, general spasms, pleasurable satisfaction, emotional intimacy, ecstasy

– Solitary Orgasms ▪ Greater feelings of relaxation

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Innovative Canadian Research (5 of 5) • The Subjective Experience of Orgasm (Continued) – Salisbury and Fisher (2013) explored the importance of female orgasm for men and women in a sexual relationship.

▪ Men believe women need regular orgasms to be satisfied; women felt pleasure was more important to their satisfaction.

▪ Women not having an orgasm was tied to feelings of inadequacy among men.

▪ Women reported faking orgasms in order to please their partner.

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Sexual Response (19 of 22) • Female Orgasm: Questions and Controversies – Multiple Orgasms ▪ One or more additional orgasms following the first ▪ Occurs before the body returns to a pre-plateau level of arousal ▪ Kinsey and colleagues thought a minority of women could experience multiple orgasm; Masters and Johnson thought most could ▪ Women can maintain a high level of arousal and experience orgasms in rapid succession because they do not have a refractory period.

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4 - 27

Sexual Response (20 of 22) • Female Orgasm: Questions and Controversies – Multiple Orgasms (Continued) ▪ In a study of 720 nurses, 435 reported experiencing multiple orgasms, often occurring with vibrator use applied to the clitoris.

▪ Women reported the orgasms experienced with vibrators to be more intense than other kinds.

▪ Some men report experiencing multiple orgasms without ejaculation (“dry orgasms”); do not follow a refractory period after initial dry orgasm

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Sexual Response (21 of 22) • Do female orgasms increase the likelihood of conception?

– Largely evolutionary perspective – Speculative

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4 - 29

Sexual Response (22 of 22) • How many kinds of orgasms do women have?

– Freud ▪ Suggested two types of orgasms: vaginal and clitoral ▪ Critiqued as heterosexist ▪ Most women report needing clitoral stimulation.

– Masters and Johnson ▪ Found only one kind of orgasm, regardless of whether stimulation was clitoral or vaginal.

..

4 - 30

Effects of Drugs on Sexual Response (1 of 8)

• Aphrodisiacs, Anaphrodisiacs, and Psychoactive drugs – Aphrodisiac ▪ A substance that arouses or increases one’s capacity for sexual pleasure or response ▪ Some are subject to the placebo effect ▪ Examples – Food – Drugs

..

4 - 31

Effects of Drugs on Sexual Response (2 of 8)

• Aphrodisiacs, Anaphrodisiacs, and Psychoactive drugs – Placebo Effect ▪ The perception that consumption of a substance (e.g., medication) results in an effect (e.g., relief), even though the substance does not contain properties (e.g., active ingredients) that cause the effect to occur.

..

4 - 32

Effects of Drugs on Sexual Response (3 of 8)

• Poppers – Amyl nitrate – Belief that it heightens sensations of arousal and orgasm

• Viagra, Cialis, and Levitra – Drugs facilitate vasocongestion and erection in the male

..

4 - 33

Effects of Drugs on Sexual Response (4 of 8)

• Addyi – Dubbed the “female Viagra” but it isn’t – Belief that it heightens sensations of arousal and orgasm

• Wellbutrin – Anti-depressant drug bupropion

..

4 - 34

Effects of Drugs on Sexual Response (5 of 8)

• Anaphrodisiac – A substance that is antagonistic to sexual arousal and desire – Anti-androgens may have anaphrodisiac effects; have been used in the treatment of deviant sexual behaviour patterns – Other examples: ▪ Tranquilizers ▪ Nicotine ▪ Antidepressants

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4 - 35

Effects of Drugs on Sexual Response (6 of 8)

• Psychoactive Drugs – Alcohol ▪ Small amounts can induce feelings of well-being, but large amounts can dampen sexual response ▪ Can lower sexual inhibitions and induce feelings of euphoria ▪ Expectations regarding alcohol may influence sexual responsiveness.

▪ Appears to impair ability to weigh information ▪ Leads us to ascribe our behaviour to the effects of alcohol rather than to ourselves

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4 - 36

Effects of Drugs on Sexual Response (7 of 8)

• Psychoactive Drugs – Marijuana ▪ Facilitates desire and heightens sexual pleasure among some women ▪ Can facilitate sexual desire and pleasure among men, but may hinder erectile functioning ▪ Effects on both men and women are dose-dependent

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4 - 37

Effects of Drugs on Sexual Response (8 of 8)

• Psychoactive Drugs (Continued) – Stimulants (e.g., amphetamines, cocaine, crystal methamphetamine)

▪ Reputed to heighten arousal and sensations of orgasm ▪ May increase levels of arousal in men and women by increasing levels of dopamine ▪ New users report enhanced sexual experiences → continued use often results in diminished sexual functioning (McKay, 2005)

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4 - 38

Erogenous Zones and the Brain (1 of 4) • Erogenous zones are parts of the body, including but not limited to the sex organs, that are responsive to sexual stimulation – Primary erogenous zones ▪ Areas richly endowed with nerve endings

– Secondary erogenous zones ▪ Parts of the body which become erotically sensitized through experience

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4 - 39

Erogenous Zones and the Brain (2 of 4) • The brain plays a central role in sexual functioning—the cerebral cortex and limbic system play key roles.

• Cerebral Cortex – The wrinkled surface area (grey matter) of the cerebrum (main part of the brain) – Cells fire when we experience sexual thoughts, images, wishes and fantasies.

• Limbic System – Active in memory, motivation, and emotion ..

4 - 40

Erogenous Zones and the Brain (3 of 4)

..

4 - 41

Erogenous Zones and the Brain (4 of 4) • Interpersonal Factors Influencing Sexual Arousal – Robert Milhausen (2004) at the University of Guelph analyzed factors that inhibit or enhance sexual arousal among university students – Sexual arousal enhanced by partners’ positive characteristics – Sexual arousal inhibited by partner’s selfconsciousness about his or her body, a feeling of giving more than receiving, and worries about other issues

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4 - 42

Sex Hormones and Sexual Response (1 of 6)

• Hormones – Chemical substances secreted by an endocrine gland – Regulate various body functions – Secondary sex characteristics ▪ Physical traits that differentiate males from females; not directly involved in reproduction

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4 - 43

Sex Hormones and Sexual Response (2 of 6)

• Organizing and Activating Influences – Organizing effects ▪ Influence the type of behaviour that is expressed – e.g., mating behaviours in lower animals

– Activating influences ▪ Influence the frequency or intensity of the drive that motivates the behaviour and ability to perform the behaviour – e.g., sexual response and sexual desire, testosterone

..

4 - 44

Sex Hormones and Sexual Response (3 of 6)

• Sex Hormones and Male Sexual Behaviour – Male sex hormones influence sex drive/response in men – Surgically/chemically castrated men exhibit a decrease in sexual fantasy, desire, capacity to attain erection, and to ejaculate.

▪ However, there is great variation in sexual interest and functioning → learning and motivation play a large role.

..

4 - 45

Sex Hormones and Sexual Response (4 of 6)

• Sex Hormones and Male Sexual Behaviour (Continued) – Evidence of the role of hormones is found among men whose testosterone levels have declined – Hypogonadism leads to loss of sexual desire and a decline in sexual activity – At puberty, hormonal variation plays a more direct role in stimulating sexual interest and activity in males.

..

4 - 46

Sex Hormones and Sexual Response (5 of 6)

• Sex Hormones and Female Sexual Behaviour – Female sex hormones do not appear to play a direct role in determining sexual motivation or response in human females.

– Unlike most mammals, human females are sexually responsive during all phases of menstrual cycle.

..

4 - 47

Sex Hormones and Sexual Response (6 of 6)

• Sex Hormones and Female Sexual Behaviour (Continued) – Women who have had ovariectomies (surgical removal of ovaries): ▪ Continue to have sex drive/interest ▪ May experience vaginal dryness

..

4 - 48

Sex Hormones and Sexual Behaviour • Sex Hormones and Female Sexual Behaviour (Continued) – Sexual responsiveness may be influenced by the presence of circulating androgens.

– Smaller amounts of androgens does not equal a weaker sex drive compared to men ▪ Adrenal gland removal associated with decreased sexual desire ▪ Androgen levels predict sexual interest among teenage women

..

4 - 49

Sexuality and Disability (1 of 7) • Millions of Canadians live with physical or intellectual disabilities and are often seen as sexless and childlike.

• These views are based on misconceptions.

• Some disabilities may call for adjustments to sexual activity.

• Most people with disabilities have the same sexual needs, feelings, and desires as those without. ..

4 - 50

Sexuality and Disability (2 of 7) • Research indicates that there is a stigma attached to the sexuality of people with disabilities (Esmail, Darby, Walter, & Knupp, 2010).

• Internalized stigma may impact the confidence and desire of people with disabilities.

• Sex education in schools typically does not include or acknowledge the information needs of people with disabilities.

• Community resources are improving.

..

4 - 51

Sexuality and Disability (3 of 7) • Their abilities to express their needs and feelings depend on the physical limitations imposed by their disabilities, how they adjust to their disabilities, and the availability of partners.

• Perhaps the biggest challenge to the sexuality of disabled people is that they must live in a society where myths, misconceptions, and negative stereotypes about sexuality and disability abound.

..

4 - 52

Sexuality and Disability (4 of 7) • Physical Disabilities – Sexual wellness for people with disabilities involves five factors: ▪ A positive self-concept ▪ Knowledge about sexuality ▪ Positive, productive relationships ▪ An ability to cope with social, environmental, physical, and emotional barriers to sexuality ▪ Maintenance of good general and sexual health, within personal limitations

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4 - 53

Sexuality and Disability (5 of 7) • Physical Disabilities (Continued) – Multiple sclerosis – Cerebral palsy – Spinal cord injuries – Sensory disabilities (blindness, deafness) – Other physical disabilities and impairments ▪ Arthritis

..

4 - 54

Innovative Canadian Research • Improving sexual function in men with spinal cord injuries – Experimental study in Quebec (2007) found that some vibrators may be more successful than others in helping men with spinal cord injuries ejaculate – Sensory substitution devices may be helpful in increasing levels of sexual pleasure

..

4 - 55

Sexuality and Disability (6 of 7) • Developmental Disabilities – People with intellectual disabilities are often stereotyped as incapable of understanding their sexual desires – Individuals with limited mental capacity are at higher risk of sexual abuse and exploitation – Autism spectrum disorder ▪ Important for youth and young adults with ASD to receive sexual health education specific to their unique learning needs

..

4 - 56

Sexuality and Disability (7 of 7) • Expanding Sexual Horizons – One of the greatest impediments to sexual fulfillment among people with disabilities is finding a loving and supportive partner.

– This barrier may decrease as stereotypes of disabled people as undesirable erode.

– Living with disabilities can prompt couples to explore creative avenues for sexual expression.

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4 - 57

End of Chapter 4

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4 - 58

Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 5 Gender Identity and Gender Roles

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5-1

Learning Objectives (1 of 2) 1. Describe the processes of prenatal sexual differentiation.

2. Describe the role of sex hormones in sexual differentiation.

3. Define intersexuality and compare and contrast various intersex conditions.

4. Define gender identity.

5. List and define current terms used to reflect gender diversity. ..

5-2

Learning Objectives (2 of 2) 6. Discuss gender roles and stereotypes.

7. Differentiate between biological and psychological perspectives on gender typing.

8. Explain the relationship between gender roles and sexual behaviour.

9. Define psychological androgyny and assess its possible advantages.

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5-3

Gender Identity and Gender Roles • Gender – The behavioural, cultural, or psychological traits typically associated with one sex.

– Gender is distinct from anatomic sex, which is based on the physical differences between females and males.

– Gender is a complex concept

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5-4

Prenatal Sexual Differentiation (1 of 11) • Sexual Differentiation – Males and females develop distinct reproductive anatomy.

– 23 chromosomes from male parent combine with 23 chromosomes from female parent – 23rd pair is the sex chromosomes – The ovum carries an X sex chromosome.

– Sperm can carry an X or Y sex chromosome.

..

5-5

Prenatal Sexual Differentiation (2 of 11) • Zygote – Fertilized ovum (egg cell)

• Embryo – Begins with implantation of a fertilized ovum and concludes with development of the major organ systems

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5-6

Prenatal Sexual Differentiation (3 of 11) • After fertilization, the zygote divides repeatedly.

– During the first six weeks, embryonic structures of both sexes develop along similar lines.

– At the seventh week, the genetic code (XX or XY) begins to assert itself.

– If a Y chromosome is absent, ovaries begin to differentiate.

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5-7

Prenatal Sexual Differentiation (4 of 11) • Sex Hormones and Sexual Differentiation – Androgens ▪ Male sex hormones ▪ Without androgens, we would all develop female external reproductive organs.

– Testosterone ▪ The male sex hormone that fosters the development of male sex characteristics and is connected with the sex drive

..

5-8

Prenatal Sexual Differentiation (5 of 11) • Descent of the Testes and Ovaries – By 10 weeks after conception, testes and ovaries have descended.

– Four months after conception, testes descend into the scrotal sac.

– Cryptorchidism ▪ A condition in which at least one of the testes fails to descend

..

5-9

Prenatal Sexual Differentiation (6 of 11) • Intersexuality – Someone born with reproductive or sexual anatomy that is not typical for males or females – Not always visible at birth – True hermaphroditism is rare and is someone who possesses both ovarian and testicular tissue

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5 - 10

Prenatal Sexual Differentiation (7 of 11) • Intersexuality (Continued) – Congenital adrenal hyperplasia (CAH) ▪ The most common female intersex condition ▪ Genetic (XX) female has female internal sexual structures and masculinized external genitals ▪ Majority who were assigned female sex at birth do not experience gender dysphoria in adulthood (a sense of incongruence between sex and gender)

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5 - 11

Prenatal Sexual Differentiation (8 of 11) • Intersexuality (Continued) – Androgen-insensitivity syndrome (AIS) ▪ Intersex condition in which a genetic male is prenatally insensitive to androgens ▪ Genitals do not become normally masculinized ▪ Individuals are typically assigned female sex at birth

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5 - 12

Prenatal Sexual Differentiation (9 of 11) • Intersexuality (Continued) – Klinefelter Syndrome ▪ Extra X chromosome ▪ Affects 1 in 500 males ▪ Men fail to develop appropriate secondary sex characteristics.

▪ Fail to produce sperm ▪ Tend to have learning disabilities, delayed speech and language difficulties

..

5 - 13

Prenatal Sexual Differentiation (10 of 11) • Intersexuality (Continued) – Turner Syndrome ▪ A disorder in which a female has just one X sex chromosome (X rather than XX) ▪ Affects 1 in 2500 females ▪ May not naturally undergo puberty ▪ Treated with hormones to spur development of secondary sex characteristics

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5 - 14

Prenatal Sexual Differentiation (11 of 11) • Intersexuality (Continued) – Dominican Republic Syndrome ▪ First documented in Dominican Republic in a group of 18 affected boys in two rural villages ▪ Enzyme disorder that prevents testosterone from masculinizing the external genitals ▪ Resembled girls at birth but at puberty, their testes descended, voices deepened, and musculature filled out, and their “clitorises” expanded into penises.

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5 - 15

Gender Identity (1 of 10) • Gender Identity – Internal/individual sense of being male, female or any other shade of gender

• Gender binary – A social system that insists that people assume a gender identity that is clearly defined as masculine or feminine – May not accurately reflect the diverse range of gender identities that actually exist

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5 - 16

Gender Identity (2 of 10) • Sex assigned at birth – Classification of anatomic sex assigned to an individual at birth as either male, female or intersex

• Cisgender – A gender identity that matches assigned sex

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5 - 17

Gender Identity (3 of 10) • Transgender/trans – A person whose gender identity is different from their assigned sex at birth

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5 - 18

Gender Identity (4 of 10) • Gender Dysphoria – Until recently, the DSM listed Gender Identity Disorder as a psychiatric diagnosis.

– The 2013 edition of DSM adopted a less pathologizing diagnosis of Gender Identity Disorder: ▪ A sense of incongruity between assigned sex and gender identity that causes significant distress ▪ The APA stresses that gender nonconformity is not a mental disorder, but the diagnosis is dependent upon distress.

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5 - 19

Gender Identity (5 of 10) • Transgender (“Trans”) – A person whose gender identity is different from their assigned sex at birth – Language related to transgender identities has changed over time.

– Language needs to reflect and be respectful of the transgender community.

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5 - 20

Gender Identity (6 of 10) • Transgender (“Trans”) (Continued) – Agender ▪ an umbrella term for people who do not have a gender or who described their gender as neutral

– Gender fluid ▪ refers to a changing or “fluid” gender identity

– Genderqueer ▪ an identity adopted by people who do not identify or express their gender within the gender binary

– Two-Spirit ▪ Indigenous term to describe interrelated aspects of their gender, sexual, community, culture and spiritual identities ..

5 - 21

Innovative Canadian Research • What can the Samoan Fa’Afafine teach us about western concepts of gender identity?

(Vasey & Bartlett, 2007) – Conducted a study in Samoa → high tolerance for men with feminine characteristics, cross-gender behaviour in children was seen as unproblematic – Interviewed males referred to as fa’afafine → feminine males who are attracted to masculine men ▪ Found no evidence that female-typical behaviours in childhood provoked distress ▪ Often recalled that they loved engaging in those activities

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5 - 22

Gender Identity (7 of 10) • Transitioning – The activities that some trans people may pursue to begin living as the gender with which they identify, rather than the gender they were assigned at birth – May include: changing one’s name, how one dresses, possibly undergoing medical treatments such as hormone therapy and gender-reassignment surgery

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5 - 23

Gender Identity (8 of 10) • Transitioning—Motivations – Incongruity between genital anatomy and gender identity – Some men fall into other categories: men who are extremely feminine, men who are sexually aroused by the idea of becoming women

• Autogynephilic – Transgender men who are sexually stimulated by fantasies that their own bodies are female

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5 - 24

Gender Identity—Transgender (1 of 4) • Transitioning—Motivations – Trans activists have contested the idea that some transgender people are motivated to seek gender reassignment by erotic interests.

– Often, transgender people show cross-gender preferences in play and dress in early childhood.

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5 - 25

Gender Identity—Transgender (2 of 4) • Gender Reassignment – Surgery is one element of gender reassignment.

– Health professionals conduct careful evaluations to determine that people seeking reassignments are competent to make such decisions and have thought through the consequences.

– Usually requires that people live openly as members of the other sex for extended trial periods before surgery.

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5 - 26

Gender Identity—Transgender (3 of 4) • Gender Reassignment (Continuted) – Involves a lifetime of hormone treatments – Surgery is largely cosmetic – cannot construct internal genitals or gonads

• Phalloplasty – Surgical creation of an artificial penis – Surgery is costly – The penises often don’t work very well

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5 - 27

Gender Identity—Transgender (4 of 4) • Surgical Outcomes ▪ Most reports of trans peoples’ postoperative adjustments are positive.

▪ Most are no longer gender-dysphoric.

▪ Most function well sexually, psychologically, and socially.

▪ Adjustment is most favourable for female-to-male transsexuals.

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5 - 28

Gender Identity (9 of 10) • Surgical Outcomes (Continued) – A Dutch study involving hundreds of Dutch trans people found 2/3 began hormone treatment whereas the rest did not – Research suggests that hearing directly from a trans person is the best way to learn about transgender issues, generating understanding and empathy.

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5 - 29

A World of Diversity • Third Gender/Third Sex – Refers to people who are considered neither women nor men – May represent ▪ An intermediate state between man and woman ▪ State of being both man and woman ▪ State of being neither man or woman

– Examples: ▪ The Ladyboys of Thailand ▪ The Hijras of South-Central Asia

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5 - 30

Innovative Canadian Research (1 of 5) • The Trans Pulse Project – Community-based research project that examines the impact of social exclusion and discrimination on the health of the trans community.

– Results in Ontario indicate: ▪ Split evenly between female to male (54%) and male to female (47%) ▪ Participants identified with a range of sexual orientations ▪ Broad range of cultural and ethno-racial groups

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5 - 31

Innovative Canadian Research (2 of 5) • The Trans Pulse Project (Continued) – 48% were living full-time in their felt gender, 30% part-time, 22% not living in felt gender at all – 59% became aware their gender did not match their bodies before age of 10 – Approximately 24% were in the process of a transition – Almost all had experiences of transphobia and discrimination.

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5 - 32

Gender Roles and Stereotypes (1 of 17) • Stereotype – Fixed, conventional idea about a group of people

• Gender Roles – Complex clusters of ways in which males and females are expected to behave

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5 - 33

Gender Identity (10 of 10) • Gender Non-conforming Children – Children who indicate that they prefer to be a gender different from their assigned sex.

– In the past, they were clinically diagnosed as having Gender Identity Disorder and given therapy aimed at conforming to societal standards.

– Some clinicians continue to offer similar interventions; however, this practice is increasingly opposed.

– Treatments designed to change gender identity/expression are no longer considered ethical.

– Supportive/affirming approaches are now more common.

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5 - 34

Gender Roles and Stereotypes (2 of 17) • Stereotypes are fixed, oversimplified, sometimes distorted ideas about a group of people • Gender roles are complex clusters of ways men and women are expected to behave

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5 - 35

Gender Roles and Stereotypes (3 of 17) • Sexism – Prejudgement that because of gender, a person will possess certain traits.

– May lead us to interpret the same behaviour in different ways – Children develop stereotypes about “men’s work” and “women’s work”.

– Psychologically damaging – Some progress has been made with respect to gender equality in Canadian society; the feminist movement in Canada has played a major role in this.

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5 - 36

Gender Roles and Stereotypes (4 of 17) • Gender Roles and Aggression – In most studies, males have been found to behave more aggressively than females.

– Aggression seems to have increased among girls in recent years.

– Bullying in both genders in elementary school is highly predictive of aggression in later dating relationships.

..

5 - 37

Gender Roles and Stereotypes (5 of 17) • Gender Typing – The process by which children acquire behaviour that is deemed appropriate to their gender

..

5 - 38

Gender Roles and Stereotypes (6 of 17) • Gender Typing (Continued) – Biological Perspectives ▪ Tend to focus on the roles of genetic and prenatal influences – The evolutionary perspective • Men’s role as hunters and warriors and women’s roles as caregivers and gatherers are carried forward in our genes.

• Has been criticized for rationalizing gender inequality and maintaining the status quo

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5 - 39

Gender Roles and Stereotypes (7 of 17) • Gender Typing (Continued) – Biological Perspectives ▪ Prenatal brain organization – Prenatal sex hormones may masculinize or feminize the brain by creating predispositions that are consistent with gender role stereotypes.

– One study found that sex differences in toy interest emerge earlier than self-awareness of one’s sex.

..

5 - 40

Gender Roles and Stereotypes (8 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Children become aware of gender-role stereotypes by age of two to three (Rathus 2017) ▪ By age three, most children have become aware of the stereotypical ways in which men and women dress and types of occupations considered appropriate for each

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5 - 41

Gender Roles and Stereotypes (9 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Psychoanalytic Theory (Freud) – Appropriate gender typing requires boys to come to identify with their fathers and girls with their mothers.

– Oedipus complex

..

5 - 42

Gender Roles and Stereotypes (10 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Social-Cognitive Theory – Explains gender-typed behaviour in terms of processes such as observational learning, identification, and socialization – Socialization • Process of guiding people into socially acceptable behaviour patterns using information, rewards, and punishment

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5 - 43

Gender Roles and Stereotypes (11 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Cognitive-Developmental Theory – Children play an active role in gender typing through the formation of schemas about gender – Schema • A concept or way of interpreting experience or processing information

– Gender stability • The concept that people retain their genders for a lifetime

..

5 - 44

Gender Roles and Stereotypes (12 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Cognitive-Developmental Theory – Gender constancy – Children are motivated to behave in gender appropriate ways once they’ve established the concepts of gender stability and gender constancy.

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5 - 45

Gender Roles and Stereotypes (13 of 17) • Gender Typing (Continued) – Psychological Perspectives ▪ Gender-Schema Theory – Children develop gender schemas as a means of organizing their perceptions of the world.

– Gender schema • A cluster of mental representations about male and female physical qualities, behaviours, and personality traits

– Gender gains prominence as an organizing construct because of society’s emphasis on it.

..

5 - 46

Gender Roles and Stereotypes (14 of 17) • Gender Roles and Sexual Behaviour – Traditional Sexual Script ▪ A sexual script based on stereotypical standards for sexual behaviour that dictates that males take an assertive and active role in heterosexual interaction while women take a receptive and passive role.

..

5 - 47

Gender Roles and Stereotypes (15 of 17) • Gender Roles and Sexual Behaviour (Continued) – Children learn at an early age that men usually approach women and initiate sexual encounters, whereas women serve as the gatekeepers in romantic relationships.

– Embedded in the larger stereotype that men are sexually aggressive and women are sexually passive – Men expected to have a higher number of sexual partners

..

5 - 48

Gender Roles and Stereotypes (16 of 17) • Attitude and Behaviour Differences – An assumption is that gender differences in sexual attitudes and behaviours are quite large – A meta-analysis (Petersen & Hyde, 2011) found differences in general sexual permissiveness were relatively small and decreasing over time ▪ Larger differences are related to masturbation and the use of sexually explicit materials

– There is greater variation within gender than between genders.

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5 - 49

Gender Roles and Stereotypes (17 of 17) • The Sexual Double Standard – Men and women are evaluated differently for the same behaviours.

– Many men and women perceive a sexual double standard.

– Women are judged more harshly than men for having many sexual partners.

..

5 - 50

A World of Diversity (1 of 3) • Are there universal differences in sexual strategies?

– Sexual Strategies Theory ▪ Men and women differ in long-term and short-term mating strategies.

▪ Qualities that men and women seek are believed to help solve adaptive problems humans have faced throughout evolutionary history.

..

5 - 51

A World of Diversity (2 of 3) • Are there universal differences in sexual strategies?

– Sexual Strategies Theory ▪ Men more interested in in short-term, sexual variety → place more value on signals of fertility ▪ Women more interested in long-term, commitment → place more value on signals of resources, commitment ▪ Men are more interested in one-night stands.

▪ Women have little to gain from casual encounters.

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5 - 52

A World of Diversity (3 of 3) • Are there universal differences in sexual strategies?

– Sexual Strategies Theory ▪ Evolutionary theory seeks human universal behaviours.

▪ Schmitt (2003) conducted a large cross-cultural study to examine sex differences in desire for sexual variety.

..

5 - 53

Table 5-1 Percentage of Men and Women Who Desire More Than One Sex Partner “In the Next Month” Across 10 World Regions

World Region

Percentage of Men Wanting More Than One Sexual Partner

Percentage of Women Wanting More Than One Sexual Partner

North America

23.1%

2.9%

South America

35.0

6.1

Western Europe

22.6

5.5

Eastern Europe

31.7

7.1

Southern Europe

31.0

6.0

Middle East

33.1

5.9

Africa

18.2

4.2

Oceania

25.3

5.8

South/Southeast Asia

32.4

6.4

East Asia

17.9

2.6

SOURCE: Data from Schmitt, D. P. (2003). Universal sex differences in the desire for sexual variety: Tests from 52 nations, 6 continents, and 13 islands. Journal of Personality and Social Psychology, 85(1), 85–104.

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5 - 54

Table 5-3 Mean Number of Sex Partners Desired by Men and Women “in the Next 30 Years,” Across 10 World Regions.

SOURCE: Data from Schmitt, D. P. (2003). Universal sex differences in the desire for sexual variety: Tests from 52 nations, 6 continents, and 13 islands.

Journal of Personality and Social Psychology, 85(1), 85–104. ..

5 - 55

Innovative Canadian Research (3 of 5) • Do young men really prefer sex over romance?

– Research and theory concludes that men are more sexually motivated than women, women are more romantically motivated than men – Explanations differ (e.g., Evolutionary Theory vs. Social Psychology theories) – Most research relies on self report

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5 - 56

Innovative Canadian Research (4 of 5) • Do young men really prefer sex over romance?

(Continued) – Researchers used an Implicit Association Test (IAT) to compensate for social desirability (Thompson & O’Sullivan, 2012)

– Assessed differences in students’ pleasant and unpleasant associations to romantic and sexual stimuli – Both men and women had a stronger automatic preference for romantic stimuli.

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5 - 57

Innovative Canadian Research (5 of 5) • Do young men really prefer sex over romance?

(Continued) – Explanations?

▪ Previous research has overstated actual gender differences ▪ Findings reflect changes in ways that men are socialized in Western culture

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5 - 58

Psychological Androgyny (1 of 2) • Psychological Androgyny – A state characterized by possession of both stereotypical masculine traits and stereotypical feminine traits – May lead to an individual being able to meet the demands of various situations and to better express their desires and talents

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5 - 59

Psychological Androgyny (2 of 2) • Psychological Androgyny (Continued) – May be perceived as a desirable goal for people who oppose constraints of traditional gender roles – Critics suggest that some benefits of psychological androgyny are confounded with masculinity.

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5 - 60

End of Chapter 5

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5 - 61

Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 6 Attraction and Love

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6-1

Learning Objectives (1 of 2) 1. Explain the role of similarity in the formation of romantic relationships.

2. Describe cultural standards for physical attractiveness.

3. Describe the role of voice and pitch in attraction.

4. Explain how pheromones function to influence attraction.

5. Appraise the role of non-physical traits in influencing perceptions of attractiveness. ..

6-2

Learning Objectives (2 of 2) 6. Describe the evolutionary perspective on mate preference.

7. Discuss the historical concepts that provide the foundation for the modern meanings of love.

8. Discuss the meaning of romantic love.

9. Compare and contrast infatuation and lasting love.

10.Compare and contrast models and theories of love. ..

6-3

Attraction (1 of 14) • The Attraction-Similarity Hypothesis – The concept that people tend to develop romantic relationships with those whose level of attractiveness and other traits are similar to their own – Our partners tend to resemble us in terms of race and ethnicity, age, level of education, and religion.

..

6-4

Attraction (2 of 14) • Do Opposites Attract?

– Opposites do not typically attract – Why do we have partners from our own backgrounds?

▪ Propinquity (proximity) – we live near people who are similar to ourselves.

▪ We’re drawn to people whose attitudes are similar to our own.

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6-5

Attraction (3 of 14) • Do Opposites Attract? (Continued) – Women place greater weight on similar attitudes, men on physical attractiveness.

– We tend to assume people we find attractive share our attitudes.

– Similarity may be important in determining initial attraction; compatibility appears to be a stronger predictor of maintaining an intimate relationship.

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6-6

Attraction (4 of 14) • Do Opposites Attract? (Continued) – When we feel admired and complimented, we tend to return those feelings and behaviours.

– Reciprocity ▪ Mutual exchange ▪ May enable many couples to become happy with one another.

▪ Can stoke neutral or mild feelings into robust, affirmative feelings of attraction.

..

6-7

Attraction (5 of 14) • Physical Attractiveness – Physical attractiveness is a major determinant of interpersonal and sexual attractiveness.

– Some contend it is the key factor in consideration of partners for dates, sex, and long-term relationships.

– Population dating apps (Grindr and Tinder) encourage users to rely heavily on photographs when selecting partners

..

6-8

Attraction (6 of 14) • Physical Attractiveness (Continued) – What is considered attractive varies by culture.

– In general, women consider taller men to be more attractive.

– Thinness is valued in North American culture.

– The hourglass figure is popular in Canada and in most other cultures (this varies by sexual orientation, however).

..

6-9

Attraction (7 of 14) • Physical Attractiveness (Continued) – What is considered attractive to women varies across the menstrual cycle.

– How attractive women are perceived to be is also influenced by where they are in the menstrual cycle.

– People who are attractive know it.

..

6 - 106- 10

Attraction (8 of 14) • Physical Attractiveness (Continued) – McMaster University researcher Jillian O’Connor and her colleagues found impact of the pitch of a man’s choice on a woman’s choice of short-term versus longterm romantic partners – Women who equated lower voices with infidelity showed a stronger preference for men with lowerpitched voices for short-term relationships

..

6 - 11

Attraction (9 of 14) • Physical Attractiveness (Continued) – Scents and Pheromones ▪ Pheromones are chemical substances that are secreted externally by certain animals and that convey information to, or produce specific responses in, other members of the same species

..

6 - 12

Innovative Canadian Research (1 of 3) • The powerful pull of attraction: Resisting infidelity in romantic relationships – Research from University of New Brunswick (Gibson, Thompson, & O’Sullivan, 2016) found: ▪ One in six participants reported at least one occasion of infidelity in their current romantic relationships ▪ Over one third reported experiencing emotional attraction to someone other than their partner ▪ Situational factors are more likely to lead to relationship transgressions than are personality traits

..

6 - 13

Attraction (10 of 14) • Non-physical traits and attractiveness – How beautiful we find a partner is likely to be enhanced by traits such as familiarity, liking, respect, and shared values and goals.

– Gender role orientation and expectations affect perceptions of attractiveness.

..

6 - 14

Attraction (11 of 14) • Desired Characteristics for Relationship Partners – In selecting a long-term partner: ▪ Men and Women: Rate responsibility as the most important skill, followed by physical attractiveness, sexual skill, and status/popularity ▪ Women: Place relatively greater emphasis on responsibility ▪ Men: Place relatively greater consideration on physical attractiveness

..

6 - 15

Attraction (12 of 14) • Desired Characteristics for Relationship Partners (Continued) – In selecting a short-term partner: ▪ Women rate physical attractiveness as more important than men.

..

6 - 16

Innovative Canadian Research (2 of 3) • What do Women Want?

– Researchers at Queens University and the University of Victoria tested the hypothesis that women who were more open to short-term sexual relationships would be more likely to prefer highly masculine male faces and bodies.

▪ Concluded that women associated higher levels of masculinity with healthier genes.

– Study at McMaster University found that women have a slight preference for men with lower-pitched voices for both short and long-term relationships ▪ Women also equated lower voices with infidelity.

..

6 - 17

Attraction (13 of 14) • An evolutionary perspective on mate preference – Some evolutionary psychologists believe evolutionary forces favour the continuation of gender differences in mate preference because these traits offer reproductive advantages.

– A woman’s reproductive value would be tied to youth and health – A man’s reproductive value might depend on his ability to provide for his family

..

6 - 18

Attraction (14 of 14) • An evolutionary perspective on mate preference (Continued) – Critics suggest that gender differences in mate preferences are maintained by male-dominated social structures.

– As cultures develop higher levels of gender equality, male and female standards of attractiveness will gradually change.

– Some of these changes are occurring already.

..

6 - 19

A World of Diversity • Sex Differences in Mate Preference Across 37 Cultures – Buss (1994) reviewed survey evidence for preferred age differences between individuals and their mates – In every culture: ▪ Men wanted mates to be younger and women preferred mates who were older.

▪ Men placed greater value on physical attractiveness.

▪ Both genders placed greater emphasis on other qualities such as being “kind”, “understanding” and “intelligent”— these all rated higher than characteristics emphasizing power or physical attractiveness. ..

6 - 20

Love (1 of 6) • Our culture idealizes the concept of romantic love.

• People who feel loved have better health than those who do not.

• The concept of love must be understood within a cultural context.

..

6 - 216- 21

Love (2 of 6) • A Greek Heritage – The concept of love can be traced back to the classical age of Greece.

– The Greeks distinguished four concepts of love: ▪ Storge – loving attachment and nonsexual affection, the type of emotion which bonds parents to children ▪ Agape – Selfless love, similar to generosity and charity ▪ Philia – Love between friends, based on liking and respect ▪ Eros – The kind of love that’s closest to passion

..

6 - 226- 22

Love (3 of 6) • Romantic Love – Romantic love, as represented by fairy tales, has been idealized in Western culture.

– In adolescence, strong sexual arousal and idealized images of the objects of our desire lead us to label our feelings “love”.

– Being “in love” ennobles sexual attraction and sexual arousal.

..

6 - 236- 23

Love (4 of 6) • Romantic Love (Continued) – Most people in Canada believe romantic love is a prerequisite for marriage.

– About one-half of Canadians believe in love at first sight.

– When fulfilled, romantic love is usually a source of deep fulfillment and ecstasy.

– When unrequited, it can lead to emptiness, anxiety, and despair.

..

6 - 246- 24

Love (5 of 6) • Infatuation versus “true love” – Infatuation ▪ A state of intense absorption in or focus on another person ▪ Usually accompanied by sexual desire, elation, general physiological arousal or excitement, passion – Difficult to distinguish between the two for the first month or two.

– As partners begin to view each other more realistically, they are better able to determine if a relationship should continue.

..

6 - 256- 25

Love (6 of 6) • Infatuation versus “true love” (Continued) – Infatuation is based on intense feelings of passion, not attachment and caring.

– Infatuation can lead to a more lasting love relationship, but it isn’t a necessary precursor.

– Sometimes, one partner experiences infatuation and the other does not.

..

6 - 266- 26

Contemporary Models and Theories of Love (1 of 8) • Biological Mechanisms – Some researchers focus on the bodily changes that occur when we experience feelings of romantic love ▪ E.g., neural pathways, brain chemistry, hormones

..

6 - 276- 27

Contemporary Models and Theories of Love (2 of 8) • Love as Appraisal of Arousal – Hatfield and Rapson define romantic love as the state of intense physiological arousal, and the cognitive appraisal of that arousal as love ▪ e.g., sweaty palms, racing heart attributed as love

– The perception of falling in love requires: state of arousal in connection with love object, cultural setting which idealizes romantic love, attribution of arousal to feelings of love

..

6 - 286- 28

Contemporary Models and Theories of Love (3 of 8) • Styles of Love – Hendrick and Hendrick (2003) developed Love Attitudes Scale which depicts 6 styles of love: ▪ Romantic Love (eros) ▪ Game-playing Love (ludus) ▪ Friendship (storge, philia) ▪ Logical Love (pragma) ▪ Possessive, Excited Love (mania) ▪ Selfless Love (agape)

..

6 - 296- 29

Contemporary Models and Theories of Love (4 of 8) • Sternberg’s Triangular Theory of Love – Organizes the relationships between different kinds of love discussed by many theorists – Three components of love: ▪ Intimacy ▪ Passion ▪ Commitment

..

6 - 306- 30

Contemporary Models and Theories of Love (5 of 8) • Sternberg’s Triangular Theory of Love (Continued) – Intimacy ▪ The experience of warmth toward another person that arises from feelings of closeness, bondedness, and connectedness ▪ Includes the desire to give and receive emotional support and to share one’s innermost thoughts

..

6 - 316- 31

Contemporary Models and Theories of Love (6 of 8) • Sternberg’s Triangular Theory of Love (Continued) – Passion ▪ An intense romantic or sexual desire for another person accompanied by physiological arousal

– Commitment ▪ Dedication to maintaining the relationship through good times and bad

..

6 - 326- 32

Contemporary Models and Theories of Love (7 of 8) • Sternberg’s Triangular Theory of Love (Continued) – Love can be conceptualized in terms of a triangle, with each vertex representing one of these basic elements of love.

▪ The way the components are balanced can be represented by the shape of the triangle.

▪ Couples are well-matched if their triangles are congruent.

..

6 - 336- 33

Contemporary Models and Theories of Love (8 of 8)

..

6 - 34

Love • Contemporary Models of Love: Sternberg’s Triangular Theory of Love – Various combinations of the three components of love characterize six different types of love relationships: ▪ Liking = Intimacy alone ▪ Empty love = Commitment alone ▪ Infatuation = Passion alone ▪ Romantic Love = Intimacy + Passion ▪ Companionate Love = Intimacy + Commitment ▪ Fatuous Love = Passion + Commitment ▪ Consummate Love = Intimacy + Commitment + Passion

..

6 - 356- 35

Innovative Canadian Research (3 of 3) • Obsessive versus harmonious passion – Two distinct kinds of romantic passion: ▪ Obsessive passion causes individuals to feel controlled by their passions – Usually leads to controlling and selfish behaviour

▪ Harmonious passion leads individuals to willingly establish relationships – Encourages partners to consider the needs and interests of each other

..

6 - 36

End of Chapter 6

..

6 - 37

Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 7 Relationships, Intimacy, and Communication

..

7-1

Learning Objectives (1 of 4) 1. Describe the stages of relationship development using the ABCDE model.

2. Discuss the various ways couples meet today and how this has changed over time.

3. List factors contributing to the rise in hookup behaviours and describe the benefits and negative consequences of casual sexual relationships.

4. Describe successful communication strategies to use during early exchanges with a new partner. ..

7-2

Learning Objectives (2 of 4) 5. Explain ways in which technology has influenced dating and relationships.

6. Demonstrate effective ways to use self disclosure in developing relationships.

7. Define intimacy and discuss how it is developed in relationships.

8. Discuss ways in which heterosexual, gay, lesbian, and bisexual couples are similar and different in relationships. ..

7-3

Learning Objectives (3 of 4) 9. Describe factors that support and challenge commitment in relationships.

10.Discuss factors associated wit jealousy in relationships.

11. Describe factors associated with distress and factors associated with growth after a breakup.

12. Discuss benefits of sexual communication in relationships.

..

7-4

Learning Objectives (4 of 4) 13. Summarize the research on sexual self disclosure in relationships.

14. Compare men’s and women’s approaches to sexual initiation and discuss why gender differences in sexual initiation might exist.

15. Discuss reasons why sexual communication can be difficult in relationships.

16. Demonstrate some strategies for communicating sexual needs and listening effectively. ..

7-5

Stages of Relationship Development (1 of 3) • Social-Exchange Theory – Development of a relationship reflects the unfolding of social exchanges.

– These involve the rewards and costs of maintaining a relationship compared with the rewards and costs of ending it.

..

7-6

Stages of Relationship Development (2 of 3) • ABCDE Model – Attraction ▪ Becoming aware of the other and finding them enticing

– Building ▪ A number of factors determine whether we will develop a relationship or not (e.g., level of attraction, similarity of attitudes)

– Continuation ▪ Established patterns of interacting remain stable

..

7-7

Stages of Relationship Development (3 of 3) • ABCDE Model – Deterioration ▪ Relationship becomes less rewarding

– Ending ▪ When partners find little satisfaction in the affiliation, when the barriers to leaving are low, and especially, when alternative partners are available ▪ Associated with distress, decrease in life satisfaction

..

7-8

Beginning Relationships (1 of 3) • Many couples meet each other by being in the same place at the same time • In the United States in 1940, 24% of heterosexual romantic couples met through family

• By the early 2000s, 22% of straight couples were meeting online

..

7-9

Beginning Relationships (2 of 3)

..

7 - 10

Beginning Relationships (3 of 3) • Beginning relationships – Research has examined pros and cons to online dating (Finkel et al., 2012) ▪ Provide access to other people also seeking potential dating partners ▪ Facilitate communication

▪ Make some attempt to match potential partners according to demographic variables ..

7 - 11

Hooking Up • Hooking up – Young people are delaying marriage to attend school, to establish careers, and often, to experiment in the

search for partners – Sexual revolution and the “pill” helped to divorce sex from the repercussions of unwanted pregnancy

– Hookups vary widely in the behaviours they involve

..

7 - 12

Developing Relationships (1 of 4) • Early Exchanges – One kind of small talk is the greeting, or opening line – This is usually preceded by nonverbal greetings – Some types of opening lines: ▪ Verbal salutes (“Good morning!”)

▪ Personal inquiries (“How are you doing?”)

▪ Compliments (“I like your outfit”)

▪ References to your mutual surroundings (“This is a nice apartment, isn’t it?” ..

7 - 13

Developing Relationships (2 of 4) • Technology and Communication in Developing Relationships – Most men and women find it acceptable to communicate with a potential date online or via texting – Good for getting to know someone in advance of a date – Newer technologies are accepted ways for potential dating partners to get to know each other – Emojis in messages may be important indicators when asking someone out on a date

..

7 - 14

Developing Relationships (3 of 4) • Self-Disclosure – The revelation of personal – perhaps intimate – information

– Central to building an intimate relationship – A careful balance of enough but not too much information

..

7 - 15

Developing Relationships (4 of 4) • Self-Disclosure – Rapid self-disclosure seems to be the norm in cyberspace.

– Cyberspace allows for anonymity and enables people to control what they want to reveal.

– Women are more likely to use higher privacy settings

on social networking sites than are men.

– Frank sexual self-disclosure is seen on many blog sites. ..

7 - 16

Intimacy and Commitment (1 of 9) • Intimacy – Feeling of emotional connectedness and the desire to share your innermost thoughts and feelings with another person – Along with sex, intimacy is one of the key ingredients in passionate relationships – Intimate relationships are also characterized by trust, caring,

and acceptance

..

7 - 17

Intimacy and Commitment (2 of 9) • Commitment – Studies show that men are more reluctant than women to make relationship commitments.

– Cohabitation (and having free access to sex) may be a disincentive to commit.

– In a healthy relationship, a strong sense of togetherness does not eradicate individuality.

– Boredom can deteriorate a relationship, but it may not end it, as people consider it a tradeoff for true love and companionship.

– Factors leading to endings include fighting, inequity, jealousy, and general dissatisfaction.

..

7 - 18

Intimacy and Commitment (3 of 9) • Sexual Orientation and Relationships – There are few differences between heterosexual and lesbian, gay, and bisexual couples – Gay and lesbian couples may distribute house-hold chores more evenly compared to straight couples – Stigma may be an important barrier for lesbian or gay

couples

..

7 - 19

Intimacy and Commitment (4 of 9) • Relationships Challenges – In a committed relationship, a delicate balance exists between individuality and mutuality

– Factors that contribute to a discontinuation of a relationship include evidence of negative evaluation, lack of fairness in the relationship, jealously and

general dissatisfaction

..

7 - 20

Intimacy and Commitment (5 of 9) • Jealousy – Jealousy is present in all cultures, but is more common in cultures: ▪ With stronger machismo traditions ▪ Where men view women’s infidelities as threats to their honour

– Is found in all genders and sexual orientations – Is aroused when we think our relationships are threatened by rivals ..

7 - 21

Intimacy and Commitment (6 of 9) • Jealousy – Can lead to loss of affection, feelings of insecurity and rejection, anxiety, loss of self-esteem, and mistrust of

our partners and potential rivals – Can lead to depression, abuse, suicide or murder – Milder forms not necessarily destructive – Prior experiences and personality variables impact levels of jealousy

..

7 - 22

Intimacy and Commitment (7 of 9) • Jealousy and Facebook – ¾ of participants in a University of Guelph study reported that they or their partners had former romantic

or sexual partners as Facebook friends; 92% said their partners had Facebook friends they didn’t know – Correspondence or seeing photos of these individuals

triggered feelings of jealousy, especially among those already jealous – Time spent on Facebook increased jealousy ..

7 - 23

Intimacy and Commitment (8 of 9) • Jealousy and Evolutionary Theory – Males are more upset by sexual infidelity ▪ Jealousy has been shaped by natural selection as a way of assuring males that their female partners’ offspring are their own

– Females are more upset by emotional infidelity ▪ Mates who stray may not continue to provide resources to facilitate child-rearing

– This gender difference disappears when our partners are unfaithful with members of the same sex… why would this be? ..

7 - 24

Intimacy and Commitment (9 of 9) • A Cognitive Perspective – Jealousy increases when individuals attribute their partners infidelity to internal causes (e.g., clear

personal choice).

– When infidelity is attributed to external causes (e.g., alcohol use, social pressures), less jealousy is

reported.

..

7 - 25

Breaking Up (1 of 2) • Breaking Up – Difficult for the person terminating the relationship and for the one being let go

– Anxious people experience more difficulty.

– Emotionally secure people seek social support.

– Insecure individuals more likely to turn to alcohol and drugs.

..

7 - 26

Breaking Up (2 of 2) • Breaking Up – Stalking ▪ Following or observing a person persistently ▪ Can occur online as well as in person ▪ Can follow a break up ▪ Jealousy, abusiveness, and physical violence in relationships are key predictors of this behaviour

..

7 - 27

Communication (1 of 8) • Clear communication can take the guesswork out of relationships.

• People may be uncomfortable discussing sexual topics, fearing they will offend their partners or incur negative reactions.

• Higher sexual self-esteem is associated with communicating sexual desires to a partner.

• Individuals who feel more positive about their sexuality and who have had more partners are more confident about bringing up a new activity. ..

7 - 28

Communication (2 of 8) • Sexual Self-Disclosure – University of New Brunswick psychology professor E. Sandra Byers (2011) has been conducting research on sexual communication of Canadians – Byers found that many men and women keep information about their sexual likes and dislikes from their partners – For men, there is a direct relationship between sexual disclosure and sexual satisfaction whereas for women, disclosing nonsexual issues seem more important

..

7 - 29

Communication (3 of 8) • Sexual Initiation – Predominant sexual scripts suggest “rules” for sexual behaviour and these are different for men and women – Sarah Vannier and Lucia O’Sullivan (2010) from the University of New Brunswick found that among 63 1– to 24-year-old men and women: ▪ 49% of instances of sexual activity were initiated by male partners ▪ 32% were initiated by female partners ▪ 19% were initiated equally by the male and female partners

..

7 - 30

Communication (4 of 8) • Obstacles to Sexual Communication – Is sex talk vulgar?

– Irrational beliefs – Are you sexually compatible?

• Getting Started

• Listening Effectively

..

7 - 31

Communication (5 of 8) • Obstacles to Sexual Communication – Considering sex talk to be vulgar or inappropriate – Harbouring irrational beliefs about relationships and sex

..

7 - 32

Communication (6 of 8) • Getting Started – Admit it’s difficult to talk about sex.

– Pick a time when you are rested and relaxed.

– Pick a place where you have privacy.

– Ask permission to raise an issue.

..

7 - 33

Innovative Canadian Research (1 of 2) • Keeping The Spark Alive in Romantic Relationships (1 of 2) – Sexual desire peaks at beginning of a relationship and declines over time.

– Communal Motivation ▪ Romantic partners are responsive to each others needs, without expecting reciprocation.

▪ Those high in communal strength are motivated to meet partner’s needs and trust their partner will meet theirs.

..

7 - 34

Innovative Canadian Research (2 of 2) • Keeping The Spark Alive in Romantic Relationships (2 of 2) – Muise et al.,’s (2013) study of long-term couples: ▪ People low in sexual communal strength – Desire declined over time ▪ People higher in sexual communal strength – Desire maintained over time – Had more enjoyable sexual experiences – Had partners who were more responsive to their needs – Were more satisfied in relationships over time

..

7 - 35

Communication (7 of 8) • Communicating Sexual Needs – Ask questions to draw the other person out.

– Use self-disclosure – it invites reciprocation.

– Grant the other person permission to say something that might upset you.

– Provide information.

– Accentuate the positive.

– Use verbal cues.

..

7 - 36

Communication (8 of 8) • Communicating Sexual Needs – Use nonverbal cues ▪ Take turns petting.

▪ Direct your partner’s hand.

▪ Signal pleasure using agreed-upon nonverbal cues.

..

7 - 37

Communication Skills • Listen Effectively – Active listening – Paraphrasing – Using reinforcement – Valuing your partner even when you disagree

..

7 - 38

End of Chapter 7

..

7 - 39

Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 8 Sexual Behaviours and Fantasies

..

8-1

Learning Objectives (1 of 2) 1. Explain why and how sexual fantasies might be used.

2. Compare the content in men’s and women’s sexual fantasies.

3. Summarize findings on gender and sexual dreaming.

4. Discuss historical attitudes toward masturbation.

..

8-2

Learning Objectives (2 of 2) 5. Compare male and female approaches to masturbation.

6. Discuss purposes and methods of noncoital and precoital partnered sexual activity.

7. Identify and describe common positions for vaginal penetration.

8. Identify and describe common techniques for anal stimulation and penetration.

..

8-3

Sexual Behaviours and Fantasy • There is significant variation in human sexual expression.

• Biology is not destiny.

• Cultural expectations, personal values, and

individual experience determine sexual behaviour.

..

8-4

Solitary Sexual Behaviour ( 1 of 6) • Sexual Fantasy – Mental imagery that’s sexually arousing or erotic – Can be purposeful or spontaneous, without conscious effort – Can be experienced as positive, negative, or both – Research indicates sexual fantasies are common; most consider it acceptable – Can heighten arousal during sexual activity with a partner

..

8-5

Solitary Sexual Behaviour (2 of 6) • Gendered Approaches to Sexual Fantasies – Men report engaging in more sexual fantasies compared to women, but women have them also.

– Fantasies more common in longer-term relationships.

– Women report more frequent and various fantasies during ovulation.

– Testosterone levels are related to the frequency of sexual fantasy.

– There is no connection between having fantasies during partnered sex and sexual dissatisfaction with one’s relationship.

..

8-6

Solitary Sexual Behaviour (3 of 6) • Gendered Approaches to Sexual Fantasies – Fantasies during partnered sex include a variety of activities/situations: ▪ Another partner ▪ Group sex ▪ Orgies ▪ Making love in interesting places ▪ Many others!

..

8-7

Solitary Sexual Behaviour (4 of 6) • Sexual Fantasy – Sadistic rape fantasies ▪ Men with these fantasies more likely to be socially isolated and emotionally unstable.

▪ The extent to which these fantasies contributes to crimes remains unclear.

▪ Professionals sometimes work with men to change these fantasies.

▪ However, fantasizing does not mean that the fantasizers want these events to occur.

..

8-8

Solitary Sexual Behaviour (5 of 6) • Theoretical Perspectives on Sexual Fantasy – Evolutionary theorists propose that men and women fantasize about partners and behaviours that would

enhance reproductive success ▪ Men – sex with many partners ▪ Women – close, protective partners

– Others say sexual fantasies are a reflection of traditional sexual scripts and gender roles. ..

8-9

Solitary Sexual Behaviour (6 of 6) • Sexual Dreams – Limited research, however one study conducted at Trent University and UBC: ▪ Sexual dreams appear to be common among university students.

▪ Most rated the dreams as pleasurable as having intercourse.

▪ Most common sexual dream activities were kissing and sexual intercourse.

▪ Most dreamed about behaviours they had engaged in with their partners.

..

8 - 10

Masturbation (1 of 6) • Historical Views of Masturbation – Within the Judeo-Christian tradition, self-stimulation has been strongly condemned as sinful.

– These views were carried into medicine in the 18th century ▪ Corn Flakes were invented by the Kellogg brothers to quell sexual urges

– During the mid-19th century, parents were encouraged to take steps to prevent children’s masturbation.

..

8 - 11

Masturbation (2 of 6) • Contemporary Views of Masturbation – Surveys indicate that most people masturbate at some time ▪ Population-based sexual health survey of men and women in the U.S. (Herbenick et al., 2010) suggests that masturbation occurs at least occasionally for 18- to 59year-olds ▪ Men masturbate more often than women; many women still report engaging in masturbation ▪ 40- to 59-year-old women masturbate more often than teenaged women.

..

8 - 12

Masturbation (3 of 6) • Contemporary Views of Masturbation – Surveys indicate that most people masturbate at some time ▪ Men who had more partnered sex → lower masturbation rates ▪ Women who had more partnered sex → higher masturbation rates ▪ Men and women with same-gender partners more likely to masturbate than men and women with other-gender partners.

▪ Frequency of masturbation increases with education.

..

8 - 13

Innovative Canadian Research (1 of 2) • The Depiction of Masturbation in North American Movies (Madanikia, Bartholomew, & Cytrnbaum, 2013) – Examined movies produced from 2005–2010, to identify common social norms associated with masturbation ▪ Characters were primarily single (84%); males (75%) ▪ Most were heterosexual (82%) ▪ In over half the scenes, the character was interrupted ▪ Most scenes were not depicted as pleasurable or satisfying ▪ Masturbation scenes with female characters were depicted more positively

..

8 - 14

Masturbation (4 of 6) • Male Masturbation Techniques – Most men masturbate with manual manipulation of the penis ▪ Gripping penile shaft with one hand, jerking it up and down in a milking motion ▪ Usually shift from a gentler rubbing action during the flaccid/semi-erect stage, moving to a more vigorous milking motion once fully erect ▪ Speeding up as orgasm approaches ▪ At orgasm, grasping shaft tightly, avoiding glans ▪ May use lubricant (soapsuds, lotion, etc.)

..

8 - 15

Masturbation (5 of 6) • Female Masturbation Techniques – Techniques vary widely, as do tempo and style ▪ Most masturbate by massaging the mons, labia minora,

and clitoral region with circular or back-and-forth motions ▪ May straddle the clitoris with their fingers, stroking shaft rather than glans

▪ May pull or tug on vaginal lips

..

8 - 16

Masturbation (6 of 6) • Female Masturbation Techniques – Techniques vary widely, as do tempo and style ▪ Many prefer stimulation of external parts of genitals, some prefer internal and external stimulation ▪ Some women massage other sensitive areas (e.g., breasts or nipples) ▪ Some use dildos or vibrators ▪ Some masturbate during baths

..

8 - 17

A World of Diversity • Good Vibes – Surveys with nationally representative samples reveal that half of U.S. residents use vibrators

– Vibrators can be used during solo and partnered sexual activities – Use of vibrators is connected with more healthful

behaviours and sexual desire

..

8 - 18

Noncoital and Precoital Partnered Sexual Activity (1 of 2) • Foreplay – Physical interactions that are sexually stimulating and set the stage for intercourse ▪ e.g., cuddling, kissing, petting, oral sex

– Pattern and duration varies widely – Sex therapists often encourage couples to consider foreplay activities as activities for their own sake, rather than as activities which must lead to penetration ..

8 - 19

Noncoital and Precoital Partnered Sexual Activity (2 of 2) • Foreplay – Tantric sex ▪ Type of lovemaking that emphasizes prolonged foreplay ▪ Based on Eastern spiritual philosophies that promote the integration of the mind and body ▪ Focuses on sexual union as spiritual connection which leads to heightened sexual pleasure and ecstasy ▪ Includes deep breathing, slowed sexual interactions, and delayed ejaculation ..

8 - 20

Innovative Canadian Research (2 of 2) • Desired Duration of Foreplay – A study of heterosexual couples at the University of New Brunswick found that heterosexual men and

women were similar in terms of how long they wanted foreplay to last.

– Women underestimated how much foreplay their partner wanted.

– Men were accurate in estimating how much time their partners, and the average woman, wanted to spend on foreplay. ..

8 - 21

Sexual Behaviour with Others (1 of 21) • Kissing – Almost universal in our culture, but unknown in some societies

– Simple kissing (mouth closed) – Deep kissing (also called French kissing) – May be an affectionate gesture without erotic significance

..

8 - 22

Sexual Behaviour with Others (2 of 21) • Manual Stimulation – Caressing erogenous zones with the hands or other parts of the body can be highly arousing.

– A common form of foreplay

– Women prefer stimulation around the clitoris rather than on the sensitive glans; often not manual penetration

– Men typically like their partners to directly stroke their genitals early in sexual interaction – Women prefer partners to caress genitals later. ..

8 - 23

Sexual Behaviour with Others (3 of 21) • Fisting – Insertion of all or most of a hand into the vagina or anus – Typically not a clenched fist, fingers are kept straight in

a beak-like shape – Little research documenting prevalence of this activity: ▪ One study reported 8% of MSM ▪ Less common among lesbians, bisexual women, and heterosexual men and women ..

8 - 24

Sexual Behaviour with Others (4 of 21) • Stimulation of the Breasts – Men are more likely to stimulate women’s breasts than to enjoy having their own breasts fondled.

– Many women enjoy breast stimulation; some can achieve orgasm from this alone.

– Can use hands and mouth to stimulate breasts – Generally women prefer several minutes of body contact and gentle caresses before intense breast stimulation. ..

8 - 25

Sexual Behaviour with Others (5 of 21) • Oral-Genital Sex – Fellatio ▪ Oral stimulation of the male genitals

– Cunnilingus ▪ Oral stimulation of the female genitals

– Popularity increased since the 1940s and 1950s – First seen as a way of arousing the couple, particularly the woman, prior to sex – Now an accepted means of pleasure on its own ..

8 - 26

Sexual Behaviour with Others (6 of 21) • Oral-Genital Sex – Survey Data ▪ Common assumption that women give oral sex to male partners more than they receive it – Women are only slightly less likely to report receiving than giving

▪ Assumed oral sex is practised mostly by younger people – A sizable percentage of people in their 40s, 50s and 60s engage in oral sex. ..

8 - 27

Sexual Behaviour with Others (7 of 21) • Oral-Genital Sex – Survey Data ▪ Oral sex experience is related to level of education ▪ Common activity among university women and gay and

bisexual men ▪ Majority of young adults’ oral sex experiences occur within committed relationships

▪ Desire and attraction to a partner are reported as the primary motivation to engage in oral sex ▪ 72% of lesbian and bisexual women reported often engaging in oral sex with a partner ..

8 - 28

Sexual Behaviour with Others (8 of 21) • Oral-Genital Sex – Not everyone likes oral sex ▪ Some choose to abstain.

▪ Some don’t enjoy giving or receiving.

▪ Some object on grounds of cleanliness.

▪ Some are concerned or embarrassed about direct views of “private” body parts.

▪ Some prefer not to taste or swallow semen.

▪ Some worry about whether oral sex is accepted by their religion or culture. ..

8 - 29

Sexual Behaviour with Others (9 of 21) • Oral Sex Techniques – Fellatio ▪ Though term means “to suck”, sucking is generally not highly arousing.

▪ Up-and-down movements of the penis in the partner’s mouth and licking of the penis are generally the most stimulating.

▪ Gentle licking of the scrotum may also be highly arousing ▪ Muscles of the mouth and jaw can create varied pressure and movements. ..

8 - 30

Sexual Behaviour with Others (10 of 21) • Oral Sex Techniques – Fellatio ▪ Be careful to never touch the penis with the teeth.

▪ Moving the penis in and out of mouth with varying speed and combined with manual stimulation can increase arousal.

▪ Gagging may be avoided: – By grasping the shaft of the penis with one hand and

controlling the depth of penetration – By having the receptive partner on top – By gradually deepening penetration ..

8 - 31

Sexual Behaviour with Others (11 of 21) • Oral Sex Techniques – Cunnilingus ▪ Partner may begin by kissing and licking the woman’s abdomen and inner thighs, gradually nearing the vulva.

▪ Gentle tugging or sucking of the labia minora can be stimulating (without biting).

▪ Many women enjoy licking or sucking of the clitoris.

▪ The tongue may be inserted in the vagina.

▪ Many women find cunnilingus the best means of achieving orgasm. ..

8 - 32

Sexual Behaviour with Others (12 of 21) • Oral Sex Techniques – “69” ▪ Mutual, simultaneous oral-genital stimulation ▪ May be practised side by side or with one partner on top of the other ▪ Partners often alternate positions ▪ Can be positive because both partners are stimulated at the same time, but may be challenging if partners are not the same size ▪ Also deprives each partner of focusing on receiving pleasure ..

8 - 33

Sexual Behaviour with Others (13 of 21) • Vaginal Penetration – Face-to-Face positions ▪ Also called the missionary position ▪ Partners face each other.

▪ Man lies above the woman, supporting himself on his hands and knees ▪ Movement is easier for man, so he largely directs the

activity ▪ May be pleasurable for the woman to guide the penis into the vagina ..

8 - 34

Sexual Behaviour with Others (14 of 21) • Vaginal Penetration – The Male-Superior (Man-on-Top) Position ▪ Because the couple faces each other, it is easier to kiss.

▪ Woman can stroke man’s body, buttocks, scrotum ▪ Makes it difficult for man to caress partner (clitoris in particular)

..

8 - 35

Sexual Behaviour with Others (15 of 21) • Vaginal Penetration – The Female-Superior (Woman-on-Top) Position ▪ Partners face each other

▪ Woman straddles man from above, controlling the angle of penile entry and the depth of thrusting ▪ Some women lie, some sit, most vary their positions

▪ Woman may feel “in charge” – can guarantee that she receives adequate clitoral stimulation, thus facilitating orgasm ..

8 - 36

Sexual Behaviour with Others (16 of 21) • Vaginal Penetration – Side-Entry Position ▪ Man and woman lie side-by-side, facing each other ▪ Allows each partner relatively free movement and easy access to each other ▪ Isn’t physically taxing ▪ An excellent position for prolonged coitus, older couples, couples who are fatigued, or with pregnant women ..

8 - 37

Sexual Behaviour with Others (17 of 21) • Vaginal Penetration – The Rear-Entry Position ▪ Man faces the woman’s back ▪ Man may enjoy viewing and pressing his abdomen against his partner’s buttocks

▪ Man can reach around to provide extra stimulation of the breasts or buttocks ▪ Woman can reach behind to stroke testicles

▪ Some couples feel uncomfortable with this position because of association with animal mating patterns, impersonality, or perceived male dominance. ..

8 - 38

Sexual Behaviour with Others (18 of 21) • Anal Stimulation and Penetration – Anal Sex ▪ Digital penetration can heighten sexual sensation ▪ The rectum is rich with nerve endings and highly sensitive to stimulation ▪ Both men and women may achieve orgasm through anal sex ▪ Penetrating partner is usually behind receiving partner ..

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Sexual Behaviour with Others (19 of 21) • Anal Stimulation and Penetration – Anal Sex ▪ The rectum produces no natural lubrication – artificial

lubricants are advised ▪ Approx. ¼ men and 1/5 women reported engaging in anal sex in their lifetimes (10% over the last year) ▪ More common among gay males than heterosexual couples ..

8 - 40

Sexual Behaviour with Others (20 of 21) • Anal Stimulation and Penetration – Anal Sex ▪ Not all gay men enjoy or practise anal sex.

▪ Those who do, often alternate between being the insertive and receptive partner.

▪ Many gay men who practise anal intercourse do not view sex as a power activity—viewed as sharing

..

8 - 41

Sexual Behaviour with Others (21 of 21) • Anal Stimulation and Penetration – Anal Sex ▪ Some couples kiss or lick the anus during foreplay (analingus) – Carries a serious health risk because

microorganisms which cause intestinal diseases and various STIs can be spread ▪ STIs and HIV are spread through anal sex when small

tears in the rectal tissues allow microbes to enter the recipient’s bloodstream.

▪ Couples having anal sex should use condoms. ..

8 - 42

Innovative Canadian Research • How to Have Great Sex: Advice in Popular Magazines (Menard & Kleinplatz, 2009) – Analyzed advice for having “great sex”; found five categories of advice: 1. Technical, mechanical and physical factors (e.g., sexual techniques) 2. Variety (e.g., porn, “mild kink”) 3. Relationship factors (e.g., improving communication) 4. Personal and psychological improvements (e.g., improve body image) 5. Preparation for sex (e.g., make settings more seductive) ..

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End of Chapter 8

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8 - 44

Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 9 Sexual Orientation

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9-1

Learning Objectives (1 of 2) 1. Describe the various sexual orientations and define the different terms people use to selfidentify their sexual orientation.

2. Discuss the different ways sexual orientation has been viewed historically and scientifically.

3. Describe current attitudes toward gay and lesbian sexuality and summarize the evolution of Canadian law related to sexual orientation.

..

9-2

Learning Objectives (2 of 2) 4. Describe the key features of the coming out process for gay, lesbian, and bisexual people.

5. Identify factors associated with resilience among gay and lesbian people.

6. Evaluate the evidence concerning the effects of gay and lesbian parenting on children.

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9-3

Getting Oriented Toward Sexual Orientation (1 of 23) • Sexual Orientation – A person’s erotic attraction to – and interest in developing romantic relationships with-people of the same gender, another gender, or both

• Heterosexual Orientation – Erotic attraction to people of the “other gender”; used to describe females who are attracted to males and males who are attracted to females

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9-4

Getting Oriented Toward Sexual Orientation (2 of 23) • Gay or lesbian orientation – Erotic attraction to, and preference for, developing romantic relationships with, members of the same gender

• Bisexual Orientation – Erotic attraction to, and preference for developing romantic relationships with, both men and women

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9-5

Getting Oriented Toward Sexual Orientation (3 of 23) • Coming to Terms with Terms – The term “homosexuality” and “heterosexuality” are somewhat controversial: ▪ Draws attention to sexual behaviour ▪ Has historical association with deviance and mental illness ▪ Often used only in reference to men, rendering lesbians invisible

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9-6

Getting Oriented Toward Sexual Orientation (4 of 23) • Coming to Terms with Terms – Sexual orientation refers to the direction of romantic interest and erotic attraction, not sexual activity.

– Attraction and desire may lead to sexual behaviour, but it’s not the same thing

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9-7

Getting Oriented Toward Sexual Orientation (5 of 23) • Coming to Terms with Terms – Sexual orientation should be conceptualized and measured as a combination of sexual attraction, sexual fantasies, sexual preference, sexual partners, tendency to fall in love romantically, and experience of falling in love romantically (Alderson, 2007, 2013) – Sexual identity refers to how one defines oneself sexually (Moser, 2016)

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9-8

Getting Oriented Toward Sexual Orientation (6 of 23) • Sexual Orientation, Gender Identity, and Heteronormativity – Like most heterosexuals, most gay males and lesbians have gender identities consistent with their anatomic sex.

– Heteronormativity ▪ The assumption that heterosexuality is normal ▪ One aspect of a history of prejudice against gay males and lesbians

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9-9

Getting Oriented Toward Sexual Orientation (7 of 23) • Classifying Sexual Orientation – Not clear cut – a significant percentage of people are neither exclusively heterosexual nor exclusively gay or lesbian ▪ It’s not unusual for heterosexuals to have sexual experiences with people of their own gender ▪ Gay males and lesbians may also engage in malefemale activity while maintaining a gay and lesbian sexual identities

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9 - 10

Getting Oriented Toward Sexual Orientation (8 of 23) • Classifying Sexual Orientation – Sexual orientation isn’t necessarily expressed in sexual behaviour.

▪ Many people see themselves as gay or heterosexual long before they engage in sex.

– People’s erotic interests may shift over time.

▪ Women’s sexual orientations are apparently somewhat more flexible than men’s.

..

9 - 11

Getting Oriented Toward Sexual Orientation (9 of 23) • Classifying Sexual Orientation – Chivers & Bailey (2005) ▪ Exposed men and women to visual male and female sexual stimuli and measured genital responses and selfreports of sexual arousal ▪ Male heterosexuals responded genitally to female stimuli; gay males showed the reverse pattern.

▪ Women, both heterosexual and lesbian, were more likely to be aroused by both male and female stimuli.

..

9 - 12

Getting Oriented Toward Sexual Orientation (10 of 23) • Classifying Sexual Orientation – People may have various degrees of sexual interest in, and sexual experience with, people of either gender – Attraction to people of the same and other sex may not be mutually exclusive.

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9 - 13

Kinsey Continuum

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9 - 14

Getting Oriented Toward Sexual Orientation (11 of 23) • The Kinsey Continuum – Kinsey and his colleagues (1948, 1953) found evidence of a continuum of sexual orientation.

– Bisexuality represented a midpoint (3) between exclusively heterosexual (0) and exclusively homosexual (6) orientation.

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9 - 15

Getting Oriented Toward Sexual Orientation (12 of 23) • The Kinsey Continuum – Kinsey data suggested that approximately 10% of Americans were either gay or predominantly gay.

– Half the people who reported male–male sexual activity in the Kinsey data limited it to the ages of 12 to 14, another one-third had experiences before age 18 and not again.

– The Kinsey research showed that sexual behaviour patterns can change.

..

9 - 16

Getting Oriented Toward Sexual Orientation (13 of 23) • Challenges to the Kinsey Continuum – Heterosexual and homosexual orientations may be separate dimensions, rather than polar opposites.

– Storm (1980) found evidence that there are separate dimensions of responsiveness to male-female sexual stimulation (heteroeroticism) and same sex stimulation (homoeroticism) – Bisexuals are high in both dimensions.

– Asexuals are low in both dimensions.

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9 - 17

Heterosexuality and Homosexuality as Separate Dimensions

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9 - 18

Getting Oriented Toward Sexual Orientation (14 of 23) • Estimates of Sexual Orientation – The controversy about how many people aren’t heterosexual continues: ▪ About 7% of women and men in the U.S. define themselves as “other than heterosexual”.

▪ However, 14% say they have had oral sex with person of same gender.

▪ According to 2014 data from Statistics Canada’s Canadian Community Health Survey – 1.7% of Canadians aged 18 to 59 reported that they were gay or lesbian and another 1/3% reported they were bisexual

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9 - 19

Getting Oriented Toward Sexual Orientation (15 of 23) • Estimates of Sexual Orientation – More recent 2012 Forum research poll found that younger people were more likely to identify as nonheterosexual ▪ 10% of 18-34 year olds identified as gay, lesbian, bisexual

– Clear trend for more recent surveys to find higher percentages of people reporting a gay, lesbian, or bisexual orientation than surveys conducted in the past

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9 - 20

A World of Diversity • Moving beyond the concept of sexual orientation: sexual configurations theory – Four parameters of partnered sexual activity included within SCT (van Anders, 2015) ▪ Gender/sex sexuality ▪ Partner number sexuality (number of partners a person is interested in having) ▪ Eroticism and nurturance ▪ Sexual parameter n sexuality

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9 - 21

Getting Oriented Toward Sexual Orientation (16 of 23) • Bisexuality – Sexual attraction to both males and females – Many have a somewhat stronger attraction to one gender over the other – Others view it as a form of experimentation.

– YouGov (2015) survey reported that as many as 29% of 18- to 29-year-olds show varying degrees of bisexuality

..

9 - 22

Getting Oriented Toward Sexual Orientation (17 of 23) • Bisexuality – Many bisexuals and researchers assert that bisexuality is an authentic sexual orientation.

▪ Bisexuals can maintain erotic interests in and romantic relationships with members of both genders ▪ Bisexuality has it’s own developmental patterns.

– Bi-negativity ▪ Negative attitudes and feelings toward bisexual people, including intolerance, hatred, and fear.

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9 - 23

Getting Oriented Toward Sexual Orientation (18 of 23) • Bisexuality – Some bisexual people live in ways that satisfy their dual inclinations.

– Others are pressured by heterosexual and gay people alike to commit themselves one way or another.

– Some gay and lesbian people mask their sexual orientations by adopting bisexual lifestyles (e.g., getting married but having sexual relationships with members of the same sex).

..

9 - 24

Innovative Canadian Research (1 of 3) • Bisexuality and intimate relationships – Lie et al (2013) found that : ▪ Rejection from potential partners because of bisexuality is common ▪ Heterosexual partners viewed bisexuals as promiscuous and unable to commit to monogamous relationships ▪ Participants also noted that bisexuality offered them more freedom and options for forming intimate relationships

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9 - 25

Getting Oriented Toward Sexual Orientation (19 of 23) • Asexuality – Anthony Bogaert (2012, 2015) argues that asexuality should be considered a sexual orientation.

▪ Low sexual attraction to both sexes ▪ Low interest in any kind of sexual stimulation, including masturbation ▪ May be romantically attracted to others

– In one study, 1% of respondents indicated they had never felt sexually attracted to anyone at all.

▪ One-third of these were currently in relationships

..

9 - 26

Getting Oriented Toward Sexual Orientation (20 of 23) • Asexuality – Many people who are asexual do not find the lack of sexual response distressing – Research that has been conducted suggests that asexuality isn’t pathological, shouldn’t be seen as a sexual dysfunction, and that asexual people can live happy lives.

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9 - 27

Getting Oriented Toward Sexual Orientation (21 of 23) • Queer, Pansexual, Questioning, and Two-Spirit – Queer ▪ A positive, self-affirming term for people who don’t see themselves fitting into standard classifications of sexual orientation ▪ Some lesbians are uncomfortable with the term because it may hide some of the issues they face.

– Questioning ▪ A term often used by youth when they are in the process of discovering their sexual identities.

..

9 - 28

Getting Oriented Toward Sexual Orientation (22 of 23) • Queer, Pansexual, Questioning, and Two-Spirit – Pansexual ▪ Sexual or emotional attraction to people, regardless of their gender identity or sexual orientation.

▪ Challenges the heterosexual/homosexual dichotomy and the male-female gender dichotomy

..

9 - 29

Getting Oriented Toward Sexual Orientation (23 of 23) • Queer, Pansexual, Questioning, and Two-Spirit – Two-Spirit ▪ Among Aboriginal communities, refers to gender or social identity and in many cases includes same-sex behaviour

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9 - 30

Perspectives on Gay and Lesbian Sexual Orientations (1 of 11) • Historical Perspectives – Jews and Christians have referred to male-male sexual activity as the sin of Sodom.

– Despite this, some churches marry gay couples.

– Some churches allow gay and lesbian clergy to be ordained, if they remain celibate.

– Struggles over gay rights occur internationally (i.e., at the United Nations).

..

9 - 31

Perspectives on Gay and Lesbian Sexual Orientations (2 of 11) • Cross-Cultural Perspectives – Male-male sexual behaviours have been engaged in across cultures and history.

▪ Viewed as normal in 49 of 76 preliterate societies studied

by Ford and Beach (1951), and occurred despite sanctions in the others ▪ Has been considered a rite that marks initiation into manhood

..

9 - 32

Perspectives on Gay and Lesbian Sexual Orientations (3 of 11) • Cross-Cultural Perspectives – Little is known about female-female sexual activity in non-Western cultures.

..

9 - 33

Perspectives on Gay and Lesbian Sexual Orientations (4 of 11) • Cross-Species Perspectives – Biologists have observed male-male and femalefemale sexual behaviour in at least 450 animal species, in every part of the world.

– Displays of dominance and submissiveness seem sexual, but it is difficult to infer sexual motivation.

– Bisexual orientation has been observed among female Japanese macaques.

..

9 - 34

Perspectives on Gay and Lesbian Sexual Orientations (5 of 11) • Biological Perspectives – Evolutionary Perspective ▪ Strong male-male and female-female alliances have advantages for group survival.

▪ Women related to gay males apparently bear more children, compensating for the lower likelihood that gay men will reproduce.

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9 - 35

Perspectives on Gay and Lesbian Sexual Orientations (6 of 11) • Biological Perspectives – Genetics and Sexual Orientation ▪ There is considerable evidence that gay and lesbian sexual orientations run in families (e.g., twin studies) ▪ Evidence suggests the marker is X-linked

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9 - 36

Perspectives on Gay and Lesbian Sexual Orientations (7 of 11) • Biological Perspectives – Hormonal Influences and Sexual Orientation ▪ Sex hormones strongly influence the mating behaviours of other species ▪ Testosterone appears to have activating effects in adulthood, influencing sex drive but not sexual orientation

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9 - 37

Perspectives on Gay and Lesbian Sexual Orientations (8 of 11) • Biological Perspectives – Brain Structure and Sexual Orientation ▪ Similarities have been found in the brains of lesbians and heterosexual men, and in gay men and heterosexual women.

▪ Preliminary research also suggests that a segment of the hypothalamus may be smaller in gay men.

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9 - 38

Innovative Canadian Research (2 of 3) • Birth Order and Sexual Orientation – Ray Blanchard and colleagues at the Centre for Addiction and Mental Health in Toronto have conducted several studies on birth order and sexual orientation.

– They concluded that a gay male with three or more older brothers can attribute most of the origin of his sexual orientation to this effect.

– Older brothers only increase the odds of being homosexual for right-handed males.

..

9 - 39

Perspectives on Gay and Lesbian Sexual Orientations (9 of 11) • Psychological Perspectives – Psychoanalytical Views ▪ Gay or lesbian sexual orientation results from failure to successfully resolve the Oedipus or Electra complex ▪ Castration Anxiety – Man’s fear that his genitals will be removed ▪ Penis Envy – A girl’s wish to have a penis

..

9 - 40

Perspectives on Gay and Lesbian Sexual Orientations (10 of 11) • Psychological Perspectives – Social Learning ▪ Early sexual behaviour patterns are reinforced ▪ Pleasurable sexual activity with members of the same gender don’t lead to adult gay or lesbian sexual orientations ▪ Learning theorists have not identified specific experiences that would lead to differing orientations.

▪ The majority of gays and lesbians were aware of sexual interest in people of their own gender before they had sexual encounters with them

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9 - 41

Perspectives on Gay and Lesbian Sexual Orientations (11 of 11) • Psychological Perspectives – Gender Nonconformity ▪ Not behaving in a way that is consistent with the genderrole stereotype associated with one’s anatomic sex in a given culture ▪ Gay men and lesbians are more likely to report childhood behaviours more typical of the other gender.

▪ Childhood gender nonconformity often leads to social rejection by parents and peers, leading many gay males to have a difficult time accepting their sexual orientation.

..

9 - 42

Current Attitudes Toward Gay and Lesbian Sexuality (1 of 6) • Current Attitudes – There is far greater acceptance of equal rights for gay people in Canada today than at other times in history.

▪ Can be attributed to exposure to gay individuals ▪ However, Canadian population remains segmented in attitudes towards moral acceptability of homosexuality (Langstaff, 2011) – Shift is result of people who were more or less neutral toward greater acceptance – People who oppose homosexuality have become more firm in their beliefs

– Most Canadians accept same-sex marriage.

..

9 - 43

Current Attitudes Toward Gay and Lesbian Sexuality (2 of 6) • Homonegativity – Takes many forms, including: ▪ Using derogatory names ▪ Telling disparaging “queer jokes” ▪ Barring gay people from housing, employment, and social opportunities ▪ Taunting (verbal abuse) ▪ Gay bashing (e.g., physical abuse, which is sometimes lethal)

..

9 - 44

Current Attitudes Toward Gay and Lesbian Sexuality (3 of 6) • Homonegativity – May stem from ▪ Fear of own gay identity ▪ Desire to maintain gender roles

– More common among conservative, traditional men, people who hold fundamentalist religious views, those who identify with Nazi beliefs – Some homophobic men may have homoerotic impulses they are unaware of: denial of impulses connected to fear and disapproval of gay men

..

9 - 45

Innovative Canadian Research (3 of 3) • Measures of homonegativity – Three measures of homonegativity ▪ Herek’s attitudes towards lesbian and gay men scale (ATLGS) ▪ Morrison and Morrison’s modern homonegativity scale (MHS) ▪ Hudson and Ricketts’ index of homophobia (IH)

– All three scales were found to be good measures of homonegativity – MHS had slightly stronger psychometrics

..

9 - 46

Current Attitudes Toward Gay and Lesbian Sexuality (4 of 6) • Harassment of LGBTQ Youth in Canada – Despite many strides, Canada still remains a hostile and damaging environment for many LGBTQ youth.

– Egale Canada’s national survey found 64% of LGBTQ students felt unsafe at school, 21% had been physically harassed .

– LGBTQ youth are more likely than heterosexual youth to be physically and sexually abused by people inside and outside the family.

..

9 - 47

Current Attitudes Toward Gay and Lesbian Sexuality (5 of 6) • Sexual Orientation and Canadian Law – Decriminalization of same-sex behaviour between consenting adults occurred in 1969.

▪ Since then, other pieces of legislation have benefited gay men and lesbians.

..

9 - 48

Current Attitudes Toward Gay and Lesbian Sexuality (6 of 6) • Stereotypes and Sexual Behaviour – Some people assume that in gay and lesbian couples, that one partner assumes the masculine role and that the other assumes the feminine role in sexual relations.

– This assumption is often mistaken.

..

9 - 49

The Coming-Out Process (1 of 4) • Due to the social condemnation and discrimination –gays and lesbians often struggle coming to terms with their sexual orientations – Referred to as “coming out” – Two-part process: 1. Coming out to oneself 2. Coming out to others (declaring sexual orientation)

– Can create a sense of pride and ability to form satisfying relationships

..

9 - 50

The Coming-Out Process (2 of 4) • Self-Acceptance and Coming Out – Given the stigma historically associated with homosexuality, it is not surprising that some gay, lesbian and bisexual people have a hard time recognizing and accepting their sexual orientation.

▪ Sexual minority youth growing up in hostile environments have extra challenges.

– There is often a 10-year gap between initial attraction to members of one’s own sex and disclosure of one’s orientation to others.

..

9 - 51

The Coming-Out Process (3 of 4) • Self-Acceptance and Coming Out – Males are more likely to become involved with samesex sexual activity before they label themselves as gay.

– Females are more likely to label themselves as lesbian before pursuing relationships with other females.

– Younger cohorts tend to come out earlier than older ones.

..

9 - 52

The Coming-Out Process (4 of 4) • Coming Out to Others – Many people are reluctant to come out.

– Disclosure is fraught with risks.

– Negative reactions are often anticipated from family members, but family reactions vary.

– Parents report initial reactions are highly emotional, involving shock, denial, guilt, and shame.

..

9 - 53

Applied Knowledge • Increasing resilience among LGBTQ youth – Kristopher Wells (2008) concluded that the following protective factors are crucial in providing a social environmental that results in greater resiliency: ▪ Positive representations of LGBTQ people in classrooms and the media ▪ Family acceptance and support ▪ School support programs ▪ School policies that prohibit discrimination ▪ Support networks ▪ Inclusive, nonjudgmental sexual-health education

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9 - 54

Building Resilience Among Gay, Lesbian, and Bisexual Youth and Adults (1 of 3) • Because gay, lesbian, and bisexual youth and adults must live in a social characterized by heteronormativity and homonegativity, and they are the targets of violence and discrimination, they are at increased risk of psychological difficulties • Those who accept their sexual orientations and, in particular, those who are openly gay or lesbian are more likely to have good mental health

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9 - 55

Building Resilience Among Gay, Lesbian, and Bisexual Youth and Adults (2 of 3) • Compared to heterosexual youth, LGBTQ youth were: ▪ More likely to have experienced physical and sexual abuse, harassment in school and discrimination in the community ▪ More likely to have run away from home ▪ More likely to have reported emotionally stress ▪ Less likely to participate in sports and physical activity ▪ More likely to spend time on the computer ▪ Felt less cared about my parents and less connected to their families ▪ Felt less connected to school (lesbian and bisexual females) ..

9 - 56

Building Resilience Among Gay, Lesbian, and Bisexual Youth and Adults (3 of 3) • Gay and Lesbian Relationships – All gay and lesbian people are not the same.

– Vander Laan & Vasey (2008) found variations in mate retention strategies of gay, lesbian, and heterosexual couples.

– Gays and lesbians in urban centres usually have support from gay communal structures/services (e.g., gay rights organizations, newspapers, bookstores etc.)

– Not all gays and lesbians feel a part of the gay community or participate in gay rights organizations .

..

9 - 57

Gay and Lesbian Parenting (1 of 2) • Gay and Lesbian Parenting – Foster’s (2005) analysis of research on lesbian families has found: ▪ Most lesbian families have formed as a result of birth mothers’ having children in heterosexual relationships ▪ Children in raised in lesbian families: – Develop typical gender identities and gender roles – Develop typical peer relationships – Exhibit normal emotional and behavioural development – Fewer issues regarding sexual identity compared to children raised in heterosexual families – No more likely to be gay or lesbian than children raised in heterosexual families ..

9 - 58

Gay and Lesbian Parenting (2 of 2) • Gay and Lesbian Parenting – Foster’s (2005) analysis of research on lesbian families has found: ▪ Key factor in the children’s development appears to be the equalitarian, nurturing and empathic nature of the families ▪ Children raised in lesbian families are at least as well adjusted as those raised in heterosexual families

– Similar findings have been reported for children raised by gay male parents.

– The APA has concluded that there is no scientific evidence that parenting effectiveness is related to parental sexual orientation. ..

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End of Chapter 9

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 10 Conception, Pregnancy, and Childbirth

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10 - 1

Learning Objectives (1 of 2) 1.

Describe the process of conception.

2.

Discuss fertility problems and ways people with such problems can become parents.

3.

Discuss signs of pregnancy and sexual activity during pregnancy.

4.

Describe the key events of the stages of prenatal development.

5.

Discuss the effects of environmental hazards on the fetus. ..

10 - 2

Learning Objectives (2 of 2) 6.

Discuss the effects of genetic abnormalities on the child.

7.

Describe the stages of childbirth.

8.

Discuss the various methods of childbirth.

9.

Discuss various birth problems.

10. Discuss events of the postpartum period, including mood changes and breastfeeding versus bottlefeeding.

11. Discuss trends in birth rates and teen pregnancy rates. ..

10 - 3

Conception (1 of 3) • Conception – The union of a sperm cell and ovum ▪ Ova carry X sex chromosomes.

▪ Sperm carry either X or Y sex chromosomes.

– Male conceptions outnumber female by 1.2–1.5:1, but are more likely to be spontaneously aborted.

– Of the 200–400 million sperm per ejaculation, only about 2000 find their way into the correct fallopian tube.

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10 - 4

Conception (2 of 3) • Conception – Of the 2000 sperm that find their way into the correct fallopian tube, fewer still swim the final 5 centimetres to meet the ovum.

– Ova secrete a chemical that attracts sperm.

– Fertilization normally occurs in a fallopian tube.

..

10 - 5

Conception (3 of 3) • Zona Pellucida – Gelatinous layer that surrounds the ovum; contains chromosomes, proteins, fats and nutritious fluid

• Hyaluronidase – Enzyme that briefly thins the zona pellucida, enabling one sperm to penetrate

..

10 - 6

Applied Knowledge • Optimizing the Chances of Conception – Engaging in coitus within a few hours of ovulation optimizes the chances of conception.

▪ Some ways to predict ovulation: – Use a basal body temperature chart.

– Analyze urine or saliva for luteinizing hormone.

– Track vaginal mucus.

▪ Other tips: – Woman: lie still on back for 60 minutes, with knees drawn close to your chest – Man: ejaculate deeply and withdraw in a straight line

..

10 - 7

Infertility and Assisted Reproductive Technologies (1 of 13) • Infertility – Inability to conceive a child – Can have significant psychological and emotional effects on individuals and couples – Likelihood of infertility increases with age – 15% of couples in North America have problems with fertility; about one-half succeed in conceiving – In vitro fertilization costs ~$15,000, and is covered by Quebec (2010) and Ontario (2014).

..

10 - 8

Infertility and Assisted Reproductive Technologies (2 of 13) • Male Fertility Issues – About 40% of fertility difficulties lie with men.

– Problems include: ▪ Low sperm counts ▪ Irregularly shaped sperm ▪ Low sperm motility (self-propulsion) ▪ Chronic diseases (e.g., diabetes) ▪ Injuries to the testes ▪ Autoimmune responses ▪ A pituitary imbalance and/or thyroid disease

..

10 - 9

Infertility and Assisted Reproductive Technologies (3 of 13) • Male Fertility Issues – Low sperm count is the most common problem.

▪ 40–150 million/mL of semen is normal; < 20 million is abnormally low

– Low sperm count can be caused by: ▪ Undescended testes uncorrected before puberty ▪ Frequent ejaculation ▪ Scrotal temperatures that are consistently 1–2 degrees above the normal temperature of 34oC to 35oC

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10 - 10

Infertility and Assisted Reproductive Technologies (4 of 13) • Male Fertility Issues – Autoimmune responses ▪ Antibodies attach naturally occurring substances that are recognized as foreign or harmful

– Motility ▪ Self-propulsion ▪ A measure of viability of sperm cells

..

10 - 11

Infertility and Assisted Reproductive Technologies (5 of 13) • Artificial Insemination – The introduction of sperm into the reproductive tract through means other than sexual intercourse.

– There are a variety of techniques.

..

10 - 12

Infertility and Assisted Reproductive Technologies (6 of 13) • Female Fertility Issues – Infertility in women has a variety of causes: ▪ Irregular ovulation and/or failure to ovulate ▪ Obstructions or malfunctions of the reproductive tract, often caused by infections or diseases (STIs) ▪ Endometriosis ▪ Declining hormone levels

– Many factors can play roles in failure to ovulate (e.g., stress, malnutrition).

– Ovulation can be induced by fertility drugs.

..

10 - 13

Infertility and Assisted Reproductive Technologies (7 of 13) • Female Fertility Issues – Endometriosis ▪ An abnormal condition in which endometrial tissue is sloughed off into the abdominal cavity, rather than out of the body, during menstruation ▪ This condition is characterized by abdominal pain and may cause infertility.

– Laparoscopy ▪ A medical procedure in which a long, narrow tube (a laparoscope) is inserted through an incision in the navel to inspect organs in the pelvic cavity

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10 - 14

Infertility and Assisted Reproductive Technologies (8 of 13) • Female Fertility Issues – In vitro fertilization (IVF) ▪ A method of conception in which mature ova are surgically removed from an ovary and placed in a laboratory dish with sperm for conception

– Gamete intrafallopian transfer (GIFT) ▪ A method of conception in which sperm and ova are inserted into a fallopian tube to encourage conception

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Infertility and Assisted Reproductive Technologies (9 of 13) • Female Fertility Issues – Zygote intrafallopian transfer (ZIFT) ▪ A method of conception in which an ovum is fertilized in a laboratory dish, then placed in a fallopian tube

– Donor IVF ▪ A variation of in vitro fertilization in which an ovum is taken from one woman, fertilized, and injected into the uterus or fallopian tube of another woman

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Infertility and Assisted Reproductive Technologies (10 of 13) • Female Fertility Issues – Embryonic Transfer ▪ A method of conception in which a female volunteer is artificially inseminated by the male partner of the intended mother, then the embryo is removed from the volunteer and inserted into the uterus of the intended mother

– Intracytoplasmic sperm injection ▪ A method of conception in which a single sperm is injected directly into an ovum

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Infertility and Assisted Reproductive Technologies (11 of 13) • Female Fertility Issues – Surrogate Mother ▪ A woman is impregnated with the sperm of a prospective father via artificial insemination, carries the embryo and fetus to term, and then gives the child to the prospective parents

– Adoption ▪ Most adopted children and adoptive parents fare well.

▪ Canada has become a world leader in facilitating adoption for gays and lesbians.

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A World of Diversity – LGBT Family Building • Assisted Parenthood for Gays and Lesbians – Many gays and lesbians use reproductive technologies to become parents.

– Options for lesbian couples include at-home insemination, intrauterine insemination, IVF, and reciprocal in vitro fertilization.

– Gay males need a surrogate mother to become impregnated by their sperm and carry the embryo and fetus to term.

▪ Sperm may be selected or mixed.

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Infertility and Assisted Reproductive Technologies (12 of 13) • Canadian Legislation and Reproductive Technologies – In 2004, Parliament passed legislation to regulate reproductive technologies.

– Main provisions of this legislation include bans on: ▪ Human cloning ▪ Selection of a baby’s sex for non-medical purposes ▪ Payment to a surrogate mother ▪ Payment to a sperm donor

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Infertility and Assisted Reproductive Technologies (13 of 13) • Canadian Legislation and Reproductive Technologies – One provision permits research using stem cells from embryos left over from infertility treatments.

– In 2010, the Supreme Court of Canada ruled that those aspects of the 2004 legislation pertaining to fertility clinic licensing and monitoring should be provincial rather than federal responsibilities.

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Pregnancy (1 of 7) • Early Signs of Pregnancy – Missed period (though this may also occur for other reasons) – Some women experience cyclic bleeding or spotting during pregnancy

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Pregnancy (2 of 7) • Pregnancy Tests – Tests to detect human chorionic gonadotropin (hCG) in the urine, as early as the third week of pregnancy – A blood test can detect hCG in the blood as early as the eighth day of pregnancy (5 days before expected pregnancy).

– Over-the-counter home pregnancy tests can be used as early as one day after a missed period; these are slightly less accurate than lab tests.

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Pregnancy (3 of 7) • Early Effects of Pregnancy – Breast tenderness – Morning sickness (nausea, aversions to specific foods, and vomiting) ▪ Usually subsides by the 12th week of pregnancy

– Greater-than-average fatigue, sleeping longer, and falling asleep more readily than usual – Frequent urination

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Pregnancy (4 of 7) • Miscarriage (spontaneous abortion) – In most cases, a specific cause is not identified.

– Known causes include chromosomal defects in the fetus and abnormalities of the placenta and uterus.

– ¾ occur in the first 16 weeks; the great majority in the first 7 weeks of pregnancy – Couples may feel a deep sense of loss and undergo a period of mourning.

– Most women who miscarry are able to carry subsequent pregnancies to term.

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Pregnancy (5 of 7) • Sexual Activity During Pregnancy – Sex is safe throughout the pregnancy, until the start of labour, as long as the pregnancy develops normally and the woman has no history of miscarriage.

– A study of 188 women showed a decline in sexual activity as the pregnancy progressed.

– 23.4% of women reported having a fear of sexual intercourse during pregnancy.

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Pregnancy (6 of 7) • Sexual Activity During Pregnancy – In another study, pregnant women reported an initial decline in sexual interest during the first trimester, increase in the second trimester, and another decline in the third trimester.

– 61% of women report having intercourse at least once a month during the third trimester ▪ 24% reported intercourse at least once a week

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Pregnancy (7 of 7) • Psychological Changes during Pregnancy – A woman’s psychological response to pregnancy reflects her desire to be pregnant, her physical changes, and her attitudes towards these changes.

– Financial, social, and psychological resources are an asset.

– The 1st trimester may be difficult for women who are ambivalent about pregnancy; 2nd trimester is smoother – Men respond to pregnancy according to the degree to which they want to become parents.

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Prenatal Development (1 of 13) • Normal gestation period is 280 days • Pregnancy can also be dated using an ultrasound scan in the first trimester.

• Naegele’s rule to calculate delivery date: – Write down the date of the first day of the last menstrual period – Add seven days – Subtract three months – Add one year

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Prenatal Development (2 of 13) • The Germinal Stage (Period of the Ovum) – The period from conception to implantation – Ovum takes 3–4 days to get to uterus, 3–4 days before beginning to implant; implantation takes about a week – Blastocyst ▪ An embryo that consists of a sphere of cells surrounding a cavity of fluid

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Prenatal Development (3 of 13) • The Embryonic Stage – The stage of prenatal development that lasts from implantation through the eighth week – Characterized by differentiation of the major organ systems – Growth of head and organs close to spinal cord occurs first.

– The embryo develops within the amniotic sac suspended in amniotic fluid, which suspends and protects the fetus

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Prenatal Development (4 of 13) • The Embryonic Stage – Placenta ▪ An organ connected to the fetus by the umbilical cord.

The placenta serves as a relay station between the mother and the fetus, allowing the exchange of nutrients and wastes ▪ Passes from the woman’s body after delivery (reason why it is also called afterbirth)

– Umbilical Cord ▪ A tube that connects the fetus to the placenta

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Prenatal Development (5 of 13) • The Fetal Stage – Begins at the 9th week and continues until birth – Fetus begins to respond to the outside world at this time – By the end of the first trimester, the major organ systems, fingers, toes, and external genitalia are formed, gender can be determined, and eyes are clearly distinguishable.

– Near the end of the second trimester, the fetus approaches the age of viability.

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Prenatal Development (6 of 13) • Environmental Influences – Maternal diet – Maternal diseases and disorders ▪ Pre-existing conditions ▪ Teratogens – environmental influences and agents that cause permanent, harmful, structural alterations of the embryo or fetus

– Critical periods of vulnerability ▪ A period when an embryo or fetus is vulnerable to the effects of a teratogen

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Prenatal Development (7 of 13) • Environmental Influences – Rubella (German Measles) ▪ A viral infection that can cause mental retardation and heart disease in an embryo

– Syphilis ▪ A sexually transmitted infection caused by a bacterial infection

– HIV/AIDS ▪ A blood-borne STI that is not typically transmitted during childbirth, but can be transmitted during breastfeeding

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Prenatal Development (8 of 13) • Environmental Influences – Pregnancy-induced hypertension ▪ A life-threatening condition characterized by high blood pressure ▪ Also called pre-eclampsia

– Ectopic pregnancy ▪ A pregnancy in which the fertilized ovum becomes implanted somewhere other than in the uterus

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Prenatal Development (9 of 13) • Environmental Influences – Rh incompatibility ▪ A condition in which antibodies produced by a pregnant woman are transmitted to the fetus where they may cause brain damage or death

– Maternal drug use ▪ Some widely used drugs, including nonprescription drugs, are linked to birth abnormalities.

▪ Antibiotics can also cause problems.

– Vitamins

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Prenatal Development (10 of 13) • Environmental Influences – Narcotics ▪ Can readily pass from mother to fetus ▪ At birth, babies can experience withdrawal.

– Marijuana ▪ Passes readily from mother to fetus ▪ May cause no impairment in the child’s global intellectual functioning ▪ May cause increased hyperactivity, impulsivity, anxiety, and depression later in life

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Prenatal Development (11 of 13) • Environmental Influences – Alcohol ▪ Leads to increased risk of birth defects, infant mortality, sensory and motor problems, and mental retardation ▪ 40% of children whose mothers drink during pregnancy develop fetal alcohol syndrome (FAS): – A cluster of symptoms typified by developmental lags, characteristic facial features, and smaller-than-average body and brain

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Prenatal Development (12 of 13) • Environmental Influences – Cigarette smoking ▪ Increases risks of spontaneous abortion, premature rupturing of the amniotic sac, stillbirth, low birth weight, and early infant mortality ▪ Risks increase with the amount smoked ▪ Combination of smoking cigarettes and drinking alcohol place the child at greater risk than either practice alone.

▪ Secondary smoke may be absorbed by mother and passed to fetus.

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Prenatal Development (13 of 13) • Chromosomal and Genetic Abnormalities – A genetic counsellor can help assess the risk of passing genetic defects to a child.

– Parental blood tests and fetal DNA tests can detect various disorders and diseases.

– The risk of giving birth to a child with Down’s syndrome increases with mother’s age ▪ Amniocentesis can detect Down’s syndrome before birth

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Childbirth (1 of 10) • “Dropping” or “lightening”— when the fetus’s head settles into the pelvis; occurs early in the 9th month of pregnancy • A day or so before labour begins, a woman may notice blood in her vaginal secretions and experience a rush of “water” from her vagina (the amniotic sac has burst).

• First contractions are called Braxton Hicks – False labour contractions; relatively painless

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Childbirth (2 of 10) • Stages of Childbirth – First stage ▪ Uterine contractions efface (cause to become thin) and dilate (open or widen) the cervix to about 10 cm in diameter ▪ 12 to 24 hours is average length for first stage ▪ Initial contractions are mild and widely spaced (at intervals of 10 to 20 minutes), lasting 20 to 40 seconds

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Childbirth (3 of 10) • Stages of Childbirth – First stage ▪ Transition – The process during which the cervix becomes almost fully dilated and the infant’s head begins to move into the birth canal – Contractions come quickly now.

– Transition lasts for up to 30 minutes.

– Accompanied by nausea, chills, and intense pain

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Childbirth (4 of 10) • Stages of Childbirth – Second Stage ▪ Begins after transition, when the cervix is fully dilated and the baby begins to move into the birth canal ▪ Crowning – when the baby’s head is visible at the vaginal opening ▪ Full emergence ends the second stage of childbirth, which lasts from a few minutes to a few hours.

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Childbirth (5 of 10) • Stages of Childbirth – Second Stage ▪ Episiotomy – A surgical incision in the perineum that widens the birth canal, preventing random tearing during childbirth – Incision can cause infection and pain, creating discomfort and itching as it heals – A controversial procedure – In Canada, the number of episiotomies is decreasing.

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Childbirth (6 of 10) • Stages of Childbirth – Third Stage ▪ Can last from a few minutes to an hour or more ▪ During this stage, the placenta is expelled and the uterus begins the process of contracting.

▪ The attending physician now sews up the episiotomy or any tears in the perineum.

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Childbirth (7 of 10) • Into the World – As the baby’s head emerges, the doctor may use suction aspiration to clear away mucus from its mouth.

– Doctor clamps and severs the umbilical cord.

– Caregiver places drops in infants eyes to prevent bacterial infections.

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Childbirth (8 of 10) • Methods of Childbirth – Until the 20th century, childbirth usually happened at home and involved the mother, a midwife, family, and friends – Today there are many options: ▪ Medicated childbirth ▪ Prepared childbirth (the Lamaze Method) ▪ Caesarean section – Rates of C-section are increasing – this is concerning because they are more dangerous and take more time to recover from

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Childbirth (9 of 10) • Methods of Childbirth – Midwives ▪ A health professional who provides primary care to a woman and her baby during pregnancy, labour, birth and the postpartum period ▪ Research from Ontario indicated that for healthy women with low-risk pregnancies, home births are just as safe as hospital births

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Childbirth (10 of 10) • Birth Difficulties – Preterm and Low-Birth-Weight Children ▪ Preterm if born before 37 weeks of gestation ▪ Low-birth-weight if weight is less than 2500 grams

– Stillbirth ▪ When a baby is born dead ▪ Can be connected with fetal abnormalities, infection, the mother’s medical condition, and pregnancy complications ▪ Majority of cases have no clear cause ▪ Can cause post-traumatic stress disorder in parents

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A World of Diversity – Maternal and Infant Morality Around the World • Maternal and infant mortality is connected with: – The percentage of births that are attended by trained people – Literacy rate of adult women (education) – Participation of women in national government

• Canada’s infant mortality rate is 5.6/1000 • Lowest rate was 2.8/1000 in Sweden

• Highest rate was in Nigeria (124.1/1000)

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The Postpartum Period (1 of 7) • The weeks after delivery are called the postpartum period.

• The first few days are usually happy ones.

• About 70% of new mothers experience periods of tearfulness, sadness, and irritability called the “baby blues” – Common – caused by hormone changes – Last for about 10 days

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The Postpartum Period (2 of 7) • Postpartum depression (PPD) – 1 in 5 women experience PPD – Begins within four weeks of delivery – May linger for weeks or months – Symptoms ▪ Serious sadness, feelings of hopelessness and helplessness, feelings of worthlessness, difficulty concentrating, major changes in appetite and sleep patterns

– May be caused by an interaction of psychological and hormonal factors

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The Postpartum Period (3 of 7) • Breastfeeding – Health Canada and the Canadian Paediatric Society recommend breastfeeding as the preferred method of feeding infants, because it provides optimal nutritional, immunological, and emotional benefits for the child’s growth and development.

– The percentage of Canadian women who breastfed their last babies increased from 81.5% in 2001 to 89.0% in 2011/12.

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The Postpartum Period (4 of 7) • Breastfeeding – Mothers who do not breastfeed typically give medical reasons ▪ May also find it unappealing, or may find bottle feeding easier

– Can also transmit HIV from mother to infant – Hormones prolactin and oxytocin are involved in breastfeeding.

– Uterine contractions that occur during breastfeeding help return the uterus to its typical size.

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The Postpartum Period (5 of 7) • Women who breastfeed are more likely than those who bottle-feed to experience decreased sexual desire.

• Resumption of Ovulation and Menstruation – For close to a month, women experience a reddish vaginal discharge called lochia.

– Non-nursing mothers resume menstrual cycles approximately two to three months postpartum.

– Ovulation precedes the first menstrual cycle.

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The Postpartum Period (6 of 7) • Resumption of Sexual Activity – Depends on a couple’s level of sexual interest, the healing of episiotomies and other injuries, fatigue, the recommendations of physicians, and tradition – Obstetricians usually advise a six-week waiting period for safety and comfort.

– Couples may enjoy other forms of sexual activity earlier.

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The Postpartum Period (7 of 7) • Resumption of Sexual Activity – Return of sexual interest and activity may take longer for some couples.

– Sexual interest depends more on psychological factors than physical ones.

– Satisfied couples prior to birth are likely to be satisfied after birth.

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Canadian Birth Rates and Teen Pregnancy (1 of 4) • Birth Rates – Birth rates in Canada have varied considerably over time ▪ High after World War II (3.6 children per woman) ▪ Lower after the introduction of the birth control pill – reaching an all-time low in 2000

– Canadian women today have an average of 1.61 children.

▪ This is below the replacement level of 2.1 children per woman

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Canadian Birth Rates and Teen Pregnancy (2 of 4) • Birth Rates – Why is the birth rate lower now than in past generations?

▪ Improved access to safe, effective contraception ▪ More women completing post-secondary education ▪ More women want to work full-time, so choose to limit their number of children ▪ Financial constraints ▪ It is becoming more socially acceptable in Western society to choose not to have children.

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Canadian Birth Rates and Teen Pregnancy (3 of 4) • Teen Pregnancy – Percentage of Canadian teens who become pregnant each year has declined sharply since the 1970s.

– Factors impacting teen pregnancy rates: ▪ Compositional factors (e.g., demographic aspects of the population, which province the teen lives in) ▪ Distal factors (e.g., economic inequality) ▪ Proximal factors (e.g., contraceptive use) – Teens have greater access to information and contraception, may feel more comfortable purchasing contraception, have more quality sex education

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Canadian Birth Rates and Teen Pregnancy (4 of 4) • Sexual Orientation and Teen Pregnancy – Pregnancy rates are higher among sexually active gay, lesbian, and bisexual teenagers than among heterosexual teenagers.

▪ Many gay and lesbian teenagers, fearing stigmatization because of their sexual orientations, engage in heterosexual sex to mask their preferences.

▪ Sexual assault can also lead to pregnancy among lesbian youth.

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End of Chapter 10

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 11 Contraception and Abortion

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11 - 1

Learning Objectives (1 of 3) 1.

Discuss trends in contraceptive use among Canadian women and adolescents.

2.

List types of hormonal contraception, explain how they work, and discuss their advantages and disadvantages.

3.

List types of barrier contraceptives, explain how they work, and discuss their advantages and disadvantages.

4.

List types of fertility-awareness methods of contraception, explain how they work, and discuss their advantages and disadvantages. ..

11 - 2

Learning Objectives (2 of 3) 5.

Describe methods of permanent contraception, and discuss the prospects of reversibility.

6.

Explain why douching is not an effective contraceptive method.

7.

Discuss historical and legal perspectives concerning abortion.

8.

Discuss attitudes toward abortion among Canadians.

9.

Summarize data on abortion rates and accessibility in Canada. ..

11 - 3

Learning Objectives (3 of 3) 10. Discuss methods of abortion.

11. Discuss research on the psychological consequences of abortion.

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11 - 4

Contraception • Sheaths or coverings for the penis have a long history.

• Condom: – Sheath of animal membrane or latex that covers the penis during coitus – Serves as a barrier to sperm

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11 - 5

Contraception in Canada (1 of 3) • Contraceptive Use Among Canadian Women – National survey of contraceptive practices of 2751 Canadian women of reproductive age who’d had penile-vaginal intercourse in the past six months: ▪ The vast majority of Canadian women rely on male condoms and oral contraceptives for birth control.

▪ 54.3% used condoms; 43.7% used oral contraceptives ▪ Withdrawal was the third most popular method of birth control, at 11.6%.

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11 - 6

Contraception in Canada (2 of 3) • Contraceptive Use Among Canadian Teens – Data from the Canadian Health Measures Survey (Rotermann et al, 2015) indicated that 30% of 15-24 year old females used oral contraceptives in the past month – Large-scale study of teenagers in British Columbia found: ▪ 65% used a condom ▪ 48% used birth control pill ▪ 35% withdrawal

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Contraception in Canada (3 of 3) • Contraceptive Use Among Canadian University Students (Milhausen et al, 2013) – 653 male and female university students who reported having penile-vaginal intercourse in the last 3 months, on reported contraception: ▪ Women: 63.0% oral contraception, 42.3% a condom, 17.7% another method, 7.8% no method ▪ Men: 55.4% a condom, 40.0% oral contraception, 15.1% another method, 11.7% no method

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A World of Diversity • The movement to legalize contraception in Canada began in the 1920s.

• First birth control clinic established in Hamilton, ON, in the early 1930s

• Contraceptive use (condom, the pill) in the 1960s was widespread, but still illegal.

• Trudeau government legalized contraceptives in 1969.

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Hormonal Methods of Contraception (1 of 16)

• Most common contraceptive methods used in Canada • Most effective (failure rate of all hormonal methods dropped to 6% in 2010)

• May be administered: – Orally – Insertion into the vagina – Injection – Transdermally

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Hormonal Methods of Contraception (2 of 16)

• Oral Contraceptives (The Pill) – Oral contraceptive ▪ A contraceptive that consists of sex hormones and is swallowed

– Combination pill ▪ A birth control pill that contains synthetic estrogen and progesterone

– Minipill ▪ A birth control pill that contains synthetic progesterone, but no estrogen

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11 - 11

Hormonal Methods of Contraception (3 of 16)

• Oral Contraceptives (The Pill) – How it works: ▪ Combination pill fools the brain into thinking the woman is already pregnant ▪ Cervical mucus thickens and becomes more acidic, becoming a barrier to sperm (in response to progesterone).

▪ Progesterone also inhibits the development of the endometrium, making implantation difficult.

▪ The minipill works via the last two ways.

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Hormonal Methods of Contraception (4 of 16)

• Oral Contraceptives (The Pill) – Effectiveness ▪ Used consistently and correctly, the failure rate is 0.5% or less ▪ With typical use – failure rate is about 3%

– Reversibility ▪ Ovulation resumes regularly within 3 months of stopping use of the pill.

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Hormonal Methods of Contraception (5 of 16)

• Oral Contraceptives (The Pill) Advantages

Disadvantages

• Nearly 100% effective when used properly • Doesn’t interfere with spontaneity or sensation • Reduces risk of PID, benign ovarian cysts, and breast growths • Regularizes menstrual cycles • Reduces premenstrual cramping and discomfort • May be helpful in treating irondeficiency anemia and facial acne • Reduces risk of some forms of cancer

• Confers no protection against STIs • May reduce the effectiveness of antibiotics • Must plan to use it several weeks before becoming sexually active • Not advised for women with various health concerns (e.g., hypertension, diabetes, migraine headaches, blood clots, etc.) or for smokers • May have side effects (e.g., nausea, weight gain, depression) ..

11 - 14

Hormonal Methods of Contraception (6 of 16)

• Emergency Contraception – The “morning after pill” can be taken after unprotected intercourse, or when contraception fails.

– In Canada – Plan B and Yuzpe regimen – Plan B has fewer side effects and is more effective ▪ Is not an abortion pill because it won’t end an established pregnancy ▪ Available without a prescription on customer-accessible shelves

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Hormonal Methods of Contraception (7 of 16)

• Emergency Contraception – How it works: ▪ Prevents the joining of the sperm and egg ▪ Prevents a fertilized egg from attaching to the uterine wall ▪ Most effective when taken within 72 hours (should be taken as soon as possible) ▪ Side effect is nausea that lasts a day or two

– Effectiveness ▪ Pregnancy rates of 1 to 3%

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11 - 16

Hormonal Methods of Contraception (8 of 16)

• The Contraceptive Patch – Delivers estrogen and progestin to prevent ovulation and implantation – Ortho Evra has been available in Canada since 2004.

– The patch is thin and measures about five cm across.

– Worn on the abdomen, buttocks, upper arm, or upper torso (not on the breasts).

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Hormonal Methods of Contraception (9 of 16)

• The Contraceptive Patch – When used correctly, more than 99% effective – Advantages ▪ Women who use it don’t need to think about contraception daily ▪ The patch doesn’t interrupt sex

– Disadvantages ▪ Side effects and potential hazards are similar to those of the pill.

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Hormonal Methods of Contraception (10 of 16)

• The Vaginal Ring – Doctor’s prescription is needed – Delivers estrogen and progestin through the skin – Inserted in the vagina and worn for three consecutive weeks, followed by one ring-free week ▪ At the end of this week, the woman inserts another ring.

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Hormonal Methods of Contraception (11 of 16)

• The Vaginal Ring – Ring is left in place during sex, can be reinserted if it slips out.

– Most men and women don’t notice it during sex – As effective as the birth control pill – May be helpful if the woman has a hard time remembering to take a pill every day – Research is needed to determine long-term side effects.

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Hormonal Methods of Contraception (12 of 16)

• Injectable Contraception – Depo-Provera is an injectable hormone solution available by prescription ▪ 99.7% effective

– Administered by a needle in the arm or buttocks every 12 weeks, preventing pregnancy for 12 weeks.

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Hormonal Methods of Contraception (13 of 16)

• Injectable Contraception Advantages

Disadvantages

• Highly effective • Permits spontaneous sex • Remains effective without taking it daily

• Similar side effects to other hormonal contraceptives (e.g., vaginal bleeding, headaches, weight gain, irregular menstrual cycles, etc.)

• Prolonged use is associated with bone loss • Ovulation may take a few months to return • Not recommended for women with health concerns (e.g., breast or uterine cancers, elevated blood pressure, etc.) ..

11 - 22

Hormonal Methods of Contraception (14 of 16)

• Intrauterine Devices (IUDs) – Small object inserted into the uterus by a doctor or nurse practitioner, and left in place – Used by less than 5% of sexually active women of reproductive age in Canada – Two main devices and systems available in Canada ▪ Copper IUDs (Flexi-T and Nova-T) ▪ Levonorgestrel-releasing IUD system (Mirena)

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Hormonal Methods of Contraception (15 of 16)

• Intrauterine Devices (IUDs) – How they work: ▪ Prevents sperm from fertilizing egg ▪ Prevents fertilized egg from implanting in the uterus

– Effectiveness ▪ About 99% for up to five years

– Reversibility ▪ About 9/10 former IUD users who wish to become pregnant do so within a year.

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Hormonal Methods of Contraception (16 of 16)

• Intrauterine Devices (IUDs) Advantages

Disadvantages

• Highly effective

• Side effects – most common are excessive menstrual cramping, irregular bleeding (spotting) between periods, and heavierthan-usual menstrual bleeding • Risk of pelvic inflammatory disease (PID) • Greater risk for ectopic pregnancy • Women with pelvic infections, or risk factors for PID, should not use IUDs.

• Relatively maintenance-free

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Barrier Methods of Contraception (1 of 15) • Barrier methods provide a mechanical or chemical barrier to prevent sperm from travelling to meet and fertilize an egg

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Barrier Methods of Contraception (2 of 15) • The Male Condom – Sheaths made of latex, polyurethane, or intestinal membranes of lambs (which do not provide protection against some STIs) – Many have nipples or reservoirs to catch semen and prevent bursting during ejaculation – Come in different sizes

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Barrier Methods of Contraception (3 of 15) • The Male Condom – How it works: ▪ Serves as a barrier, preventing the passage of sperm and disease-carrying micro-organisms from the man to his partner ▪ Helps to prevent infected vaginal fluids (and microorganisms) from entering the man’s urethral opening or penetrating through small cracks in the skin of the penis

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Barrier Methods of Contraception (4 of 15) • The Male Condom – How it’s used: ▪ The condom is rolled onto the penis once erection is achieved, before contact between the penis and the vagina (otherwise effectiveness is sharply reduced)

– Effectiveness: ▪ Typical use failure rate is estimated to be 15% ▪ Failure rate drops dramatically if condom is used correctly and consistently, and with a spermicide

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Barrier Methods of Contraception (5 of 15) • The Male Condom Advantages

Disadvantages

• Unparalleled protection against STIs

• Some people have allergic reactions to the spermicide

• Both partners can share in putting it on, making it an erotic part of lovemaking, rather than an intrusion

• Some people are allergic to latex

• Use of textured or ultra-thin condoms can increase sensitivity

• May make sex less spontaneous

• Condoms also sometimes slip off, break, or tear

• Some men experience erectile difficulties using condoms

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11 - 30

Innovative Canadian Research– Don’t like your condom? Try the “common buffet” • Negative attitudes about condoms are condom • Research from Canada suggests that men who are given a variety of condoms and lubricant options, may be able to find one they liked and would be more likely to use again • Testing out variety of condoms may reduce incidence of unprotected sex

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11 - 31

Applied Knowledge – Errors in Using Condoms • Condoms are highly effective when used properly, however couples can experience the following problems: – Breakage, slippage, leakage, late application, early removal, unrolling a condom before applying, no space at the tip, failing to remove air, inside-out application, failing to unroll completely, assuming the condom is not damaged, lack of lubrication, incorrect withdrawal, reuse, incorrect storage

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11 - 32

Barrier Methods of Contraception (6 of 15) • The Female Condom – A polyurethane sheath that is used to line the vagina during intercourse – Held in place by a flexible plastic ring – Provides a secure but flexible shield that barricades against sperm but allows the penis to move freely within the vagina during intercourse – Can be inserted up to 8 hours before sex, but should be removed immediately following

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Barrier Methods of Contraception (7 of 15) • The Female Condom – A new one must be used for each act of intercourse – During testing trials, pregnancy rate was estimated to range between 21% and 26%, though it is estimated to be as low as 5% among cautious users.

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11 - 34

Barrier Methods of Contraception (8 of 15) • The Diaphragm – Shallow cup or dome made of thin latex rubber – Rim is a flexible metal ring covered with rubber – Comes in different sizes for a precise fit – Available by prescription and must be fitted by a health-care practitioner

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11 - 35

Barrier Methods of Contraception (9 of 15) • The Diaphragm – How it works: ▪ Forms a barrier against sperm when placed over the cervical opening ▪ Unreliable when used alone – must be used with spermicidal cream or jelly ▪ Woman must insert and leave in place for at least 6 hours after intercourse

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11 - 36

Barrier Methods of Contraception (10 of 15) • The Diaphragm – Effectiveness ▪ If used correctly and consistently, failure rate is 6% ▪ In typical use, failure rate during the one year is 18%

– Advantages ▪ Fairly effective when used correctly ▪ Can use as needed, as opposed to taking every day

– Disadvantages ▪ High pregnancy rate associated with typical use ▪ Need to insert before intercourse – may be disruptive

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Barrier Methods of Contraception (11 of 15) • The Cervical Cap – Dome-shaped rubber cap which comes in different sizes – Must be fitted by a health-care professional – Smaller than a diaphragm (the size of a thimble) – Is meant to fit snugly over the cervix – Intended to be used with spermicide – Inserted by the woman before sex, left in for at least 8 hours

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Barrier Methods of Contraception (12 of 15) • The Cervical Cap – Effectiveness ▪ 18% of users who also use spermicide become pregnant during one year of use

– Disadvantages ▪ Some women find the cap uncomfortable.

▪ Side effects include urinary tract infections and allergic reactions or sensitivities to the rubber or the spermicide.

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Barrier Methods of Contraception (13 of 15) • Spermicides – Coat the cervical opening, blocking the passage of sperm and killing sperm by chemical action – Come in different forms: jellies, creams, suppositories, and aerosol foams – Should be left in the vagina for several hours after intercourse – Suppositories must be inserted 15 minutes before sex, to allow time to dissolve.

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Barrier Methods of Contraception (14 of 15) • Spermicides – Effectiveness ▪ Failure rates vary from 18% with perfect use to 28% with typical use ▪ Should be used with another method of contraception because they are not highly effective (e.g., the condom).

– Disadvantages ▪ May cause vaginal or penile irritation ▪ No STI protection, increases HIV susceptibility

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Barrier Methods of Contraception (15 of 15) • The Contraceptive Sponge – Soft, disposable device that is not fitted – Provides a barrier with built-in spermicide – Can be inserted in the vagina several hours before intercourse – High failure rate – 1/20 users is mildly irritated by the spermicide – Currently available in select Canadian pharmacies

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Fertility-Awareness Methods of Contraception (1 of 5) • Also called “natural birth control”, or “natural family planning”—rely on awareness of a woman’s menstrual cycle • Intercourse is avoided on days when conception is most likely • Estimated first-year failure rate of typical use of fertility-awareness methods is 20%

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Fertility-Awareness Methods of Contraception (2 of 5) • Effectiveness – Estimated first-year failure rate: 20%

• Advantages – Appeal to people who want to avoid artificial means – No side effects – Inexpensive (except for ovulation-prediction kits)

• Disadvantages – Low reliability – Abstaining from sexual intercourse

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Fertility-Awareness Methods of Contraception (3 of 5) • Calendar Method – Calendar method assumes ovulation occurs 14 days before menstruation ▪ The couple abstains from intercourse during the period that begins three days before day 13, and ends two days after day 15.

▪ Period of abstaining covers days 10 to 17 of the woman’s cycle.

– Basal-body-temperature method tracks body temperature changes to determine ovulation.

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Fertility-Awareness Methods of Contraception (4 of 5) • Cervical-mucus (ovulation) method ▪ Following menstruation, the vagina feels rather dry ▪ These dry days are relatively safe ▪ When a mucus discharge appears in the vagina that is thick, sticky, and white, unprotected sex should be avoided.

– As the cycle progresses, the mucus discharge thins and clears, becoming slippery – these are the peak days.

– Ovulation-prediction kits are the most accurate charting method.

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Fertility-Awareness Methods of Contraception (5 of 5) • Withdrawal – Man removes his penis before ejaculating – First-year failure rate among typical users: 27% – Several reasons for failure: ▪ Man may not withdraw in time ▪ A man may not be aware he has begun to ejaculate ▪ Active sperm may be present in pre-ejaculatory secretions

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Permanent Methods of Contraception (1 of 6)

• Many people decided to use a permanent method of contraception when they plan to have no children or no more children • Sterilization refers to surgical procedures that render people incapable of reproduction without affecting sexual activity • Most effective form of contraception, with the exception of abstinence • Prospect arouses strong feelings and often involves a profound change in self-concept ..

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Permanent Methods of Contraception (2 of 6)

• Vasectomy – Male sterilization – Surgically cutting each vas deferens and tying it back or cauterizing it to prevent sperm from reaching the urethra – Carried out in doctor’s office, under local anaesthesia, in about 15–20 minutes – Does not diminish sex drive, sensations, or function

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Permanent Methods of Contraception (3 of 6)

• Vasectomy – Few serious complications have been reported – Minor complications (e.g., inflammation, swelling) are not uncommon – Reversibility is a complicated practice (procedure called vasovasotomy) with success rates ranging from 16% to 79%

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Permanent Methods of Contraception (4 of 6)

• Tubal ligation (sterilization) – Fallopian tubes are surgically blocked to prevent meeting of sperm and ova – The most common method of female sterilization – Two main procedures: ▪ Minilaparotomy ▪ Laparoscopy

– Less common third method is a culpotomy

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Permanent Methods of Contraception (5 of 6)

• Female sterilization – These methods don’t disrupt sex drive or sexual response.

– Menstrual cycle is undisturbed – Unfertilized egg is reabsorbed by the body – Highly effective in preventing pregnancy (0.4% failure rate) – Should be considered irreversible (43% to 88% of reversals are successful) • Hysterectomy is the removal of the ovaries and uterus, and is inappropriate as a method of sterilization. ..

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Permanent Methods of Contraception (6 of 6)

• Female sterilization – Advantages ▪ Effectiveness ▪ Permanence

– Disadvantages ▪ Permanence – if couple changes their mind ▪ Greater risks of complications than with male sterilization ▪ No protection against STIs

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Applied Knowledge • Selecting a Method of Contraception – Consider the following factors: ▪ Convenience ▪ Moral acceptability ▪ Cost ▪ Ability to share responsibility ▪ Safety ▪ Reversibility ▪ Protection against STIs ▪ Effectiveness

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Abortion (1 of 10) • Induced Abortion – Purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life – Perhaps more divisive than any other social issue – Rarely used as a primary means of birth control – Reasons for abortion include psychological factors and external circumstances.

– Moral question of when life begins

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Abortion (2 of 10) • Historical and Legal Perspectives of Abortion – Attitudes have varied across cultures and eras.

– Right-to-life or Pro-life movements assert that human life begins at conception and views abortion as murder of an unborn child ▪ Some in the movement would permit abortion to save the mother’s life, or when a pregnancy results from rape or incest.

– Pro-choice movement contends that abortion is a matter of personal choice.

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Abortion (3 of 10) • Historical and Legal Perspectives of Abortion – Dr. Henry Morgentaler, the leader of the pro-choice movement in Canada, had challenged the law since 1969 by establishing private abortion clinics.

– Morgentaler was awarded the Order of Canada in 2008 for his commitment to increased health-care opportunities for women and his efforts to influence public policy.

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Abortion (4 of 10) • Abortion Attitudes in Canada – In a 2017 poll (Simpson, 2017), 77% of Canadians said abortion should be permitted ▪ 53% indicated abortion should be permitted whenever a woman decides she wants one

– Abortion was illegal in Canada until 1969.

– The struggle between pro-life groups and pro-choice groups has been contentious and sometimes violent.

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Abortion (5 of 10) • Abortion Attitudes in Canada – Liberal Party leader Justin Trudeau announced in 2014 that all new Liberal candidates running in the 2015 federal election had to be pro-choice – In early 2017, when US President Trump decided to reduce funding for global abortion services, Trudeau indicated he would fill the gap by pledging $650 million for global reproductive rights

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Abortion (6 of 10) • Canadian Abortion Statistics – It is estimated that about 30% of Canadian women will have at least one abortion in their lifetime.

– Current, reliable statistics are not available, because the majority of abortions conducted in Canada are performed in clinics that are not legally required to report the number of abortions they perform.

– From available statistics, it appears abortion rates are falling, most notably among teenage women.

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Abortion (7 of 10) • Methods of Abortion – Vacuum aspiration ▪ Removal of the uterine contents via suction ▪ Relatively painless and inexpensive ▪ Used during the first trimester

– Dilation and Evacuation (D & E) ▪ Removal of the uterine contents via a suction tube and forceps ▪ The uterine wall may be scraped to ensure that the lining has been fully removed ▪ Used most often in the second trimester

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Abortion (8 of 10) • Methods of Abortion – Abortion Drugs ▪ RU-486, or mifepristone, was developed and approved in France in the late 1980s ▪ Induces early abortion by blocking the effects of progesterone, the hormone that stimulates proliferation of the endometrium and allows implantation of the fertilized ovum ▪ Mifegysmio, as its known in Canada, has been available in select Canadian cities since early 2017.

– Can be prescribed in Canada up to 7 weeks gestation

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Abortion (9 of 10) • Psychological Consequences of Abortion – Women may experience a range of negative emotions, including fear, anger, guilt, and ambivalence.

– Reactions depend on various factors including the strength of social support and their relationship with their partners.

– The sooner the abortion occurs, the less stressful it is.

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Abortion (10 of 10) • Psychological Consequences of Abortion – In one survey of 882 women who had first-trimester abortions, the majority ▪ Were satisfied with their decision to have an abortion ▪ Would make the same decision again ▪ Experienced more benefits than harm

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End of Chapter 11

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 12 Sexuality Across the Life Span

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Learning Objectives (1 of 2) 1. Describe the development of sexuality during infancy and early childhood.

2. Describe the development of sexuality during middle childhood and preadolescence.

3. Discuss the developmental tasks of adolescent sexuality.

4. Discuss the developmental tasks of adult sexuality.

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Learning Objectives (2 of 2) 5. Describe different relationship statuses in adulthood.

6. Discuss sexuality within marriage.

7. Discuss extramarital sex.

8. Describe the changes associated with aging that can affect sexuality and how older people can adapt to them.

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The Development of Sexuality in Childhood (1 of 7) • We know far less about the development of sexuality in childhood than we do about sexuality in adolescence and adulthood.

– There is a cultural belief that children are innocent.

– There is reluctance to ask children about their sexual behaviour or their understanding of sexuality.

– We rely on (sometimes unreliable) reports of parents or caregivers.

– More attention is paid to child abuse than normal sexual development. ..

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The Development of Sexuality in Childhood (2 of 7) • Infancy (Birth to two years) – Infants engage in a variety of “sexual” behaviours: ▪ Boys have erections in the first few weeks of life.

▪ Evidence of lubrication and genital swelling has been reported in infant girls.

▪ Stimulation of the genitals can produce pleasure in infants.

– Masturbation is typical, and may start at five months.

▪ However, children’s reflexes should not be interpreted according to adult concepts of sexuality.

– Reflexes of lubrication and erection don’t signify an interest in sex

▪ Children should learn proper names for body parts.

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The Development of Sexuality in Childhood (3 of 7) • Early Childhood (two to five years) – Children may show curiosity about anatomy (e.g., play doctor) – Hugging, kissing, climbing on others is not a cause for concern.

– Rough-and-tumble play, including touching the genitals, is common.

– Children should be taught the basic rules of privacy, that they have autonomy over their own bodies, and distinctions between good and bad touch.

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The Development of Sexuality in Childhood (4 of 7) • Middle Childhood (five to eight years) – Crushes (our first romantic attachments) and relationships that resemble dating may occur.

– Curiosity about the genitals increases; playing doctor is common between ages 6 and 10.

– Exploratory same-sex play is more common than play with the other gender, may include handling the genitals and oral or anal contact – Same-sex play does not foreshadow adult sexual orientation.

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The Development of Sexuality in Childhood (5 of 7) • Middle Childhood (five to eight years) – Experiences aren’t overtly sexual in terms of desire or sexual gratification – more to satisfy curiosity – May ask, “Where do babies come from?”

– May have some awareness that not all people are heterosexual – Discuss these issues with factual information.

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The Development of Sexuality in Childhood (6 of 7) • Preadolescence (nine to twelve years) – Sex-segregated groups and friendships common – Increasing preoccupation and self-consciousness with their bodies – Feel pressure to conform with peers – Critical for children of this age to be educated about physical and emotional changes they’ll experience in puberty – if they are better informed, it means they’ll be better able to accept changes in a positive way.

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The Development of Sexuality in Childhood (7 of 7) • Preadolescence (nine to twelve years) – Masturbation is primary means of achieving orgasm ▪ 45% of males and 15% of females masturbated by age 13 (Kinsey and colleagues, 1948, 1953)

– Sex play with others is common and not harmful.

▪ Most activities are single episodes or short-lived experiences.

– Interest in the other sex develops in heterosexuals.

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Adolescent Sexuality (1 of 17) • Adolescent Sexuality – Though teens are biologically ready for sex, parents often see them as too cognitively, emotionally, and socially immature to be sexually active.

– These issues are complicated by a sex-saturated media.

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Adolescent Sexuality (2 of 17) • Adolescent Sexuality – Four main developmental tasks of adolescent sexuality: 1) Adapt to the physical and emotional changes of puberty.

2) Accept yourself as a sexual being.

3) Explore romantic and sexual relationships.

4) Learn to protect your sexual health.

– Parents, educators and society at large have focused on 1 and 4, but 2 and 3 are equally important.

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Adolescent Sexuality (3 of 17) • Puberty – The stage of development when reproduction first becomes possible – Begins with the appearance of secondary sex characteristics, and ends when the long bones make no further gains in length

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Adolescent Sexuality (4 of 17) • Puberty – Secondary Sex Characteristics ▪ Physical characteristics that differentiate males and females, appearing at puberty, not directly related to reproduction (e.g., body hair)

– Primary Sex Characteristics ▪ Physical characteristics that differentiate males and females and are directly involved in reproduction ▪ These are the sex organs

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Adolescent Sexuality (5 of 17) • Puberty: Female changes – Increased estrogen stimulates growth of breast tissue and onset of menarche – Menarche ▪ The onset of menstruation; first menstruation ▪ Commonly occurs between ages of 11–14, can occur as early as 9 or as late as 16 ▪ Puberty has been starting earlier over the past century ▪ Early menstrual cycles are typically anovulatory (without ovulation)

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A World of Diversity • The Many Meanings of Menarche – In some cultures, menarche is greeted with ceremony – In certain historical contexts, viewed as polluting, women viewed as irrational – Girls’ attitudes towards menarche related to education level and physical realities – In Canada, most girls receive information about menstruation

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Adolescent Sexuality (6 of 17) • Puberty: Male changes – Increased testosterone prompts growth of the testes, scrotum, and penis; fosters differentiation of the secondary sex characteristics – Testicle growth accelerates testosterone production and pubertal changes.

– The scrotal sac becomes larger and hangs loosely from the body; the penis widens and lengthens, pubic hair appears.

– By age 13 or 14, erections become frequent.

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Adolescent Sexuality (7 of 17) • Puberty: Male Changes – First ejaculations occur by age 13 or 14, most often through masturbation – After about a year, boys may begin to experience nocturnal emissions (wet dreams).

– Underarm hair begins to appear at 15, facial hair at 17 or 18 – Voice deepens at age 14 or 15 – Boys grow taller and increase in muscle mass – Estrogen causes nearly 1 in 2 boys to experience temporary enlargement of the breasts. ..

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Adolescent Sexuality (8 of 17) • Puberty: Sexual Self-Acceptance – Getting to know themselves as sexual beings; likes and dislikes; people they are attracted to – Body image can be a huge concern.

– Stereotypes can make it difficult for youth to accept who they are (if they don’t fit the mold).

– Developing self-acceptance can be particularly challenging for LGBTQ youth growing up in a heterosexist society.

– Exploring sexual identity can lead to sexual well-being.

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Adolescent Sexuality (9 of 17) • Puberty: Romantic and Sexual Relationships – During the teen years, most adolescents have their first romantic and sexual relationships.

– Many fall in love for the first time.

– Learning how to develop satisfying, mutually beneficial relationships is a process of trial and error.

– Communication about sex is related to greater relationship satisfaction.

– Open communication about sex was associated with greater relationship satisfaction for dating couples who were 14 to 21 years of age. ..

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Adolescent Sexuality (10 of 17) • Puberty: Romantic and Sexual Relationships – More females than males report being in love with their first sexual partner.

– Males find first sexual relationship more physically than emotionally satisfying; the reverse is true for females.

– Far more males than females report having orgasms.

– Females view virginity as a gift to give partners; males are more likely to perceive virginity as a stigma.

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Adolescent Sexuality (11 of 17) • Puberty: Romantic and Sexual Relationships – Although adolescents report a high degree of sexual desire, pleasure, and satisfaction: ▪ 81.4% of males and 75% of females reported that they’d felt anxious about “performing sexually” at some point

– 62% of men reported having an orgasm at the time of first intercourse, only 6% of women reported that they had an orgasm

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Adolescent Sexuality (12 of 17) • Adolescent Sexual Behaviour – Masturbation ▪ A major sexual outlet in adolescence ▪ Boys are more likely to masturbate than girls – Stronger sex drive or societal constraints?

▪ Cultural and religious norms impact frequency.

▪ There is considerable variation in both sexes – some masturbate frequently and some not at all.

▪ Researchers find no links between adolescent masturbation and sexual adjustment in adulthood.

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Adolescent Sexuality (13 of 17) • Adolescent Sexual Behaviour – Oral Sex ▪ Oral sex has captured the public’s attention recently.

▪ Media reports have led to a false assumption that oral sex among teens happens frequently and indiscriminately.

▪ Oral sex is about as common as intercourse and occurs at about the same age.

▪ Less then one-third of adolescents under age 18 regularly engage in oral sex.

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Adolescent Sexuality (14 of 17) • Adolescent Sexual Behaviour – Penile-Vaginal Intercourse ▪ Approx. one-third of youth experience intercourse before age 17.

▪ The proportion of younger adolescents who have had intercourse has remained stable in recent years.

▪ The proportion of older adolescents who have had intercourse declined over the years – Two-thirds have intercourse before age 20 ▪ Most sexually active youth aged 15 to 17 have only one intercourse partner at a time. ..

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Adolescent Sexuality (15 of 17) • Adolescent LGBT Sexual Behaviours – Previous research examining adolescent sexual health behaviours often either lumped sexual-minority youth in with other youth or measured sexual behaviours in a predominantly heterosexual context – LGBTQ youth continue to face discrimination and stigma

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Adolescent Sexuality (16 of 17) • Protecting Sexual Health in Adolescence – Unintended pregnancy and STI infection are threats to health and well-being.

▪ Teen pregnancy rates have declined over the past several decades.

– Adolescents use a number of strategies to protect their sexual health: ▪ Abstinence ▪ Engaging in lower risk activities ▪ Using condoms – most popular choice

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Adolescent Sexuality (17 of 17) • Protecting Sexual Health in Adolescence – Condom use has increased in recent years ▪ More common among younger than older teens.

▪ Older teens may have switched to hormonal birth control, believing that they are at low risk for STIs.

– Adolescent sexual health is improving in many respects; but challenges remain: ▪ STI rates remain high

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Adult Sexuality (1 of 26) • Developmental Tasks – Adults tend to seek more long-term, complete, relationships.

– Marriage has traditionally been, and is currently (though less so), the primary relationship for adult Canadians.

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Adult Sexuality (2 of 26) • Developmental Tasks – Passion ▪ Romantic relationships usually begin with some element of physical and emotional attraction.

▪ Once the novelty subsides, partners learn if they are compatible in other dimensions.

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Adult Sexuality (3 of 26) • Developmental Tasks – Friendship ▪ Is one of the most important dimensions of a strong, mutually satisfying relationship ▪ Over time, a couple’s sexual satisfaction becomes a function of their sense of shared intimacy.

– Communication ▪ More direct communication may be an important contributor to a mutually satisfying relationship.

▪ Better communication about likes and dislikes is associated with sexual satisfaction. ..

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Adult Sexuality (4 of 26) • Developmental Tasks – Sexual Health ▪ Protecting sexual health is no less important in adulthood.

▪ Commitment to condoms decreases with age, even though the health risks remain high.

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Adult Sexuality (5 of 26) • Being Single – Singlehood is now the most common lifestyle among people in their 20s (it used to be marriage).

▪ Many are postponing marriage to pursue educational and career goals ▪ Many decide to live together but not marry

– In 2008, the typical man in Canada got married for the first time at 30.0 years of age (women got married at 29.6)

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Adult Sexuality (6 of 26) • Being Single – Many view it as an alternative open-ended way of life, rather than a stage preceding marriage.

– Most are sexually active, some practice serial monogamy (being involved in one exclusive relationship at a time).

– Online dating and social networking sites provide new avenues for connecting with others.

– Celibacy ▪ Complete sexual abstinence ▪ For religious reasons, or to focus on other aspects of life ..

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Adult Sexuality (7 of 26) • Cohabitation – The state whereby two people live together as a couple but are not legally married – Socially acceptable

• Common-law Relationship – A relationship in which two people live together as a couple, but are not legally married ▪ May be same-sex or other-sex relationships ▪ Cultures differ in their acceptance of this practice.

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Adult Sexuality (8 of 26) • Cohabitation before Marriage – Many believe cohabitation will help them work out the kinks before marriage.

– However, Canadian couples who live together before marriage are twice as likely to get divorced.

▪ Cohabitators tend to be more committed to personal independence, are less traditional, and less religious.

▪ They tend to be less committed to the values and interests traditionally associated with the institution of marriage.

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Adult Sexuality (9 of 26) • Marriage – Found in all human societies – Marriage remains a common lifestyle in Canada ▪ According to Statistics Canada, in 2016 43.8% of Canadians aged 30 to 34 and over half of people aged 40 to 44 were married

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Adult Sexuality (10 of 26) • Marriage: Same-Sex Marriage – In July, 2002, the Ontario Superior Court of Justice ordered governments to redefine the term “marriage” to include same-sex couples.

– In 2005, Canadian Parliament passed legislation allowing same-sex couples to marry.

– Number of same-sex marriages jumped from 7465 in 2006 to 24 370 in 2016: ▪ 51.9% were male couples ▪ 48.1% were female couples

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Adult Sexuality (11 of 26) • Marriage: Same-Sex Marriage – Benefits of marriage for same-sex couples: ▪ Greater acceptance by family and friends ▪ Equality with heterosexuals in legal matters ▪ Greater relationship satisfaction ▪ Decreased feelings of internalized homophobia ▪ More openness to the idea of having children

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Adult Sexuality (12 of 26) • Why do People Marry?

▪ Meets personal and cultural needs ▪ Legitimizes sexual relationships ▪ Permits maintenance of a home life ▪ Provides an institution in which children can be supported and socialized ▪ Helps to assure paternity, in theory ▪ Leads to orderly transmission of wealth from one generation to the next

– Love is the most common reason for marriage: however, marrying for love is a relatively recent notion. ..

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Adult Sexuality (13 of 26) • Types of Marriage – Monogamy ▪ Marriage to one person

– Polygamy ▪ A person has more than one spouse and is permitted sexual access to all of them ▪ Polygyny – a form of marriage in which a man is married to more than one woman at the same time – is the most common form of polygamy ▪ Polyandry – a form of marriage in which a woman is married to more than one man at the same time – is practised rarely

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Adult Sexuality (14 of 26) • Arranged Marriage – Parents in Western cultures rarely arrange marriages.

– Among recent immigrants to Canada from the Middle East and Asia, arranged marriage is fairly common.

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Adult Sexuality (15 of 26) • Who We Marry – Not relatives – People who attract us – People who seem to meet our material, sexual, and psychological needs – People who are similar to us in social background and standing (homogamy) ▪ Ethnic background, educational level, religion, age

– Mixed-union couples are increasing in number in Canada.

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Adult Sexuality (16 of 26) • Marital Sexuality – Varies across cultures, but there are common threads: ▪ Privacy for sexual relations is valued ▪ Most cultures place restrictions on sex during menstruation, during some stages of pregnancy, and for a time after birth

– The sexual revolution led to a rising recognition of importance of sexual pleasure for women.

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Adult Sexuality (17 of 26) • Marital Sexuality – Among married sexually active Canadians, aged 18–49 ▪ 2% had sex every day ▪ 34% had sex a few times a week ▪ 46% had sex a few times a month ▪ 16% had sex once a month or less often

– Among unmarried relationships ▪ 20% had sex every day ▪ 43% had sex a few times a week

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Adult Sexuality (18 of 26) • Marital Satisfaction – Commitment – Adequate income – Sharing in housework – Generosity toward one’s spouse – Support of one’s family and friends – Agreement on attitudes toward having/raising children – Sexual satisfaction (closely linked) – For many couples, a belief in the religious or spiritual value of marriage ..

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Adult Sexuality (19 of 26) • Marital Satisfaction – Martial and sexual satisfaction are linked – The perception of rewards and costs is related to feelings of sexual satisfaction.

– Communication is also related to satisfaction.

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Adult Sexuality (20 of 26) Figure 12.2 Marital Satisfaction 18- to 46-Year-Old Married Mothers and Fathers, by Sexual Satisfaction.

SOURCE: W. Bradford Wilcox & Elizabeth Marquardt (Eds.). (2011). The State of Our Unions: Marriage in America 2011.

Reprinted by permission of the National Marriage Project at the University of Virginia and the Institute of American Values. marriage@virginia.edu, Figure 15, p. 37. ..

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Adult Sexuality (21 of 26) • Extramarital Sex – Sexual relations between a married person and someone other than his or her spouse – Some definitions: ▪ Conventional adultery – Extramarital sex that is kept hidden from one’s spouse

▪ Consensual adultery – Extramarital sex that is engaged in openly, with the knowledge and consent of one’s spouse

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Adult Sexuality (22 of 26) • Extramarital Sex – Some definitions: ▪ Swinging – A form of consensual adultery in which both spouses share extramarital sexual experiences

– Also referred to as mate-swapping

▪ Comarital sex – Swinging or mate-swapping

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Adult Sexuality (23 of 26) • Extramarital Sex – Patterns of Extramarital Sex ▪ Estimates from research in the United States suggest that Infidelity occurs in 20% to 25% of all marriages (Fincham & May, 2017): ▪ Research suggests reported rates of infidelity may be increasing.

▪ Surveys may result in under-reporting of affairs because of social desirability.

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Adult Sexuality (24 of 26) • Extramarital Sex – Effects of Extramarital Sex ▪ Cause emotions such as anger, jealousy, shame, feelings of inadequacy, insecurity ▪ Perceived breach of trust and intimacy ▪ May speed relationship dissolution or lead to renewed efforts and commitment

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Adult Sexuality (25 of 26) • Extramarital Sex – Swinging ▪ Most swingers seek to avoid emotional entanglements with their swinging partners.

▪ Emotional intimacy can be more threatening to the swingers’ primary relationship than sexual intimacy.

▪ In 2005, the Supreme Court of Canada ruled that swinging is not illegal, using the criteria of harm to society rather than community standards of morality.

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Adult Sexuality (26 of 26) • Polyamory – A form of open relationship that allows for consensual sexual and/or emotional interactions with more than one partner – Based on the view that people’s needs for intimacy are unlikely to be gratified through one relationship – Proponents argue that relationships can be strengthened if the partners have opportunities to develop emotionally intimate relationships with others.

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Sexuality in Later Life (1 of 9) • In the 20-year period from 1997 to 2016, the number of people in Canada aged 65 or older grew from 3,652,227 to 5,990,511 – This represents the fastest growing segment of the Canadian population

• Many people in our culture see sexual activity is only appropriate for the young.

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Sexuality in Later Life (2 of 9) • Research doesn’t support that individuals inevitably lose their sexuality as they age.

– Physical ability to function sexually diminishes somewhat.

– Psychological and social factors are as important as physical ones in determining sexual behaviour and satisfaction among older people.

– Having a partner affects sexual frequency.

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Sexuality in Later Life (3 of 9) • Sexuality-related Developmental Tasks of Later Life – Maintaining self-perception as a sexual being – Adapting to reduced frequency of sexual desire – Adapting to reduced intensity of genital sexual response – Adapting to the death of a partner – Adapting to entry into a long-term care facility – Using protection against STIs and HIV

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Sexuality in Later Life (4 of 9) • Physical Changes – Having accurate expectations can help older people to lead some of the most sexually fulfilling years of their lives.

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Sexuality in Later Life (5 of 9) Table 12.6 Changes in Sexual Function Often Associated With Aging Changes in the Female

Changes in the Male

Reduced myotonia (muscle tension)

Longer time to erection and orgasm

Reduced vaginal lubrication

Need for more direct stimulation for erection and orgasm

Reduced elasticity of the vaginal walls

Less semen emitted during ejaculation

Smaller increases in breast size during sexual arousal

Erections may be less firm

Reduced intensity of muscle spasms at orgasm

Testicles may not elevate as high into the scrotum Less intense orgasmic contractions Lessened feeling of a need to ejaculate during sex Longer refractory period

SOURCE: Data from The Kinsey Institute for Research in Sex, Gender, and Reproduction. From The Kinsey Institute New Report on Sex. 1990. New York: St. Martin’s Press.

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Sexuality in Later Life (6 of 9) • Changes in the female – Many of the physical changes in women stem from the decline in estrogen production around menopause – Women produce less vaginal lubrication after menopause – Vagina shrinks in size – Women can retain their ability to achieve orgasm well into their advanced years

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Sexuality in Later Life (7 of 9) • Changes in the male – Age-related changes tend to occur more gradually in men – After about age 50, men take progressively longer to achieve erections – Testosterone production gradually declines from about age 40 to age 60, then begins to level off

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Sexuality in Later Life (8 of 9) • Patterns of Sexual Activity – Sexuality is variable.

– Many older people engage in sexual activities at least as often as they did when they were younger.

– The availability of a sexually interested and supportive partner may be the most important determinant of continued sexual activity.

..

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Sexuality in Later Life (9 of 9) • Patterns of Sexual Activity – Peggy Kleinplatz (University of Ottawa researcher) studies optimal sexuality ▪ For many, “great sex” didn’t occur until midlife.

▪ Great sex was possible well into later years.

▪ Erotic intimacy, interpersonal exploration, authenticity, freedom to be themselves, and communication were ingredients for great sex.

– Couples may respond to physical changes of aging by broadening their sexual repertoires.

..

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Senior Sexuality • Protecting Sexual Health in Later Life – A number of factors have led to increased risks for STIs among older Canadians: ▪ It is more socially acceptable for older people to pursue active sex lives.

▪ Medical advances have made it possible for older people to live longer, and healthier.

▪ Increased divorce rates mean older people are back on the singles scene.

▪ Older adults may not be reached by sexual health prevention messages. ..

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End of Chapter 12

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 13 Sexual Problems and Dysfunctions

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13 - 1

Learning Objectives 1. Describe the prevalence and types of common sexual problems and dysfunctions.

2. Discuss biological factors in the development of sexual problems and dysfunctions.

3. Discuss psychosocial factors in the development of sexual problems and dysfunctions.

4. Describe the PLISSIT and Masters and Johnson approaches to addressing sexual problems and dysfunctions.

5. Outline the treatment of specific sexual problems and dysfunctions. ..

13 - 2

Sexual Dysfunction • Sexual Dysfunction – Persistent or recurring lack of sexual desire or difficulty becoming sexually aroused or reaching orgasm – Most people experience some type of sexual problem from time to time.

..

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Sexual Problems and Dysfunctions (1 of 2) • We don’t have precise figures on prevalence because people are reluctant to reveal their problems with sexual functioning to researchers • Quinn-Nilas, Milhausen, McKay, & Hotzapfel (2018) found that:

..

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Sexual Problems and Dysfunctions (2 of 2) Figure 13.1 Prevalence of sexual problem Among Canadian Males and Females 40 to 59 Years of Age Thinking back over the last six months, have you experienced any of the following problems on a regular basis?

Males

Yes

“My Interest in sex is lower than I would like it to be”

29.6%

“I have trouble getting and maintaining an erection”

23.9%

“I ejaculate more quickly than I would like”

24.7%

Females

Yes

“My interest in sex is lower than I would like it to be”

39.6%

“I am not able to have an orgasm”

13.3%

“I experience pain in the vaginal area during sex”

17.1%

SOURCE: Quinn-Nilas , Milhausen, Mckay, & Holzapfel (2018). Prevalence and predictors of sexual problem among midlife Canadian adults: Results from a national survey. The Journal of Sexual Medicine, 15(6), 873-879 ..

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Prevalence and Types of Sexual Problems and Dysfunctions (1 of 25) • Females are more likely than males to report having sexual problems.

• The occurrence of nearly every kind of sexual problem increases with age, with • premature (early) ejaculation being the exception.

• The most common sexual problems in women are related to a lack of interest in sex.

• The least common sexual problem, at least for males, is sexual pain.

• Despite the stereotype that males are “always ready” for sex, a sizable proportion of males actually report having little interest in sex. ..

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Prevalence and Types of Sexual Problems and Dysfunctions (2 of 25) Figure 13.2 Prevalence of Sexual Difficulties Among Sexually Active Males and females 15 to 24 Years of Age: France Males

Often/Sometimes

Lack of Sexual desire

10%

Erection problems

5%

Premature ejaculation

20%

Females Lack of sexual desire

24%

Difficulty reaching orgasm

28%

Pain during Intercourse

22%

SOURCE: Moreau, C, Kagesten,A,E, & Wn Blum, R (2016.) Sexual dysfunction among youth: An overlooked sexual health concern. BMC Public Health, 16. 1170 ..

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Prevalence and Types of Sexual Problems and Dysfunctions (3 of 25) • Types of Sexual Dysfunction – The most widely used system of classification is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (2013) ▪ Sexual-desire disorders ▪ Sexual-arousal disorders ▪ Orgasm disorders ▪ Sexual-pain disorders

..

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Prevalence and Types of Sexual Problems and Dysfunctions (4 of 25) • Types of Sexual Dysfunction – DSM-5 made several important changes: ▪ “Female hypoactive desire disorder” and “Female arousal disorder” – Merged into Female Sexual Interest/Arousal Disorder – Done because these sexual response phases overlap for many women

• A variety of female sexual-pain dysfunctions were merged into a singular category: Genito-pelvic pain/penetration disorder ..

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Prevalence and Types of Sexual Problems and Dysfunctions (5 of 25) • Types of Sexual Dysfunction – DSM-5 made several important changes ▪ In order for a sexual problem to be diagnosed as a dysfunction: – Must have occurred for 6 months or more – Must happen 75–100% of the time – Must cause the person significant distress

– Exceptions are problems caused by medications/substances

..

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Prevalence and Types of Sexual Problems and Dysfunctions (6 of 25) • Types of Sexual Dysfunction – Sexual dysfunctions are classified as: ▪ Lifelong or acquired (following periods of unproblematic functioning)

▪ Generalized (occur in all situations) or situational (occur only in some situations)

..

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Prevalence and Types of Sexual Problems and Dysfunctions (7 of 25) • Sexual Desire-Related Disorders – Men (male hypoactive desire disorder) – Women (female sexual interest/arousal disorder) ▪ Absence of sexual thoughts or fantasies

▪ Can become aroused and orgasm when adequately stimulated, many have no interest in genital stimulation

– Most common complaint related to sexual functioning – Differing sex drives between men and women may play a role – History of trauma impacts sexual aversion ..

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Prevalence and Types of Sexual Problems and Dysfunctions (8 of 25) • Sexual Arousal-Related Disorders – Failure to achieve or sustain the erections or lubrication necessary to facilitate sexual activity – Lack the subjective feelings of sexual pleasure and excitement that normally accompany sexual arousal

..

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Prevalence and Types of Sexual Problems and Dysfunctions (9 of 25) • Sexual Arousal-Related Disorders: Male Erectile Disorder – Persistent difficulty in achieving or maintaining an erection sufficient to allow completion of sexual activity

– In most cases, the failure is limited to sexual activity with partners or with some partners and not others (situational) – Some men can attain erections much not sustain them – Incidence increases with age

..

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Prevalence and Types of Sexual Problems and Dysfunctions (10 of 25) • Sexual Arousal Disorders: Male Erectile Disorder – Occasional problems are common; may be caused by fatigue, too much alcohol, impressing a new partner, etc.

– An isolated experience can become a persistent problem if the man fears it will happen again.

– Performance anxiety ▪ Anxiety concerning one’s ability to perform behaviours, especially behaviours that may be evaluated by other people

..

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Prevalence and Types of Sexual Problems and Dysfunctions (11 of 25) • Sexual Arousal Disorders: Male Erectile Disorder – Sexual arousal in men is also complex.

– Causes: ▪ Psychological factors (e.g. depression, lack of selfesteem, problems with the relationship) ▪ Biological factors (e.g. diabetes, heart disease)

..

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Prevalence and Types of Sexual Problems and Dysfunctions (12 of 25) • Sexual Arousal Disorders: Female Sexual Interest/Arousal Disorder – Desire and arousal phases are closely intertwined for many women.

– Women’s sexual response may not occur in a linear, step-by-step process (Basson, 2008).

– Some problems (e.g., lubrication) are lifelong, others develop after periods of normal functioning.

– Problems often occur in specific situations. ..

13 - 17

Prevalence and Types of Sexual Problems and Dysfunctions (13 of 25) • Sexual Arousal Disorders: Female Sexual Arousal Disorder – Basson (2004) suggests two types: ▪ Combined-arousal disorder – no subjective arousal and feel no genital response ▪ Subjective-arousal disorder – aware that genitals respond physically to stimulation, but feel no subjective arousal

– Genital-arousal disorder – become aroused by stimulation other than to the genitals ..

13 - 18

Prevalence and Types of Sexual Problems and Dysfunctions (14 of 25) • Sexual Arousal Disorders: Female Sexual Arousal Disorder – Causes: ▪ Physical factors (e.g., neurological, vascular, or hormonal problems, skin less sensitive to touch) ▪ Psychological factors (e.g., relationship issues, lack of attraction, childhood sexual abuse)

..

13 - 19

Prevalence and Types of Sexual Problems and Dysfunctions (15 of 25) • Orgasmic Disorders: Female Orgasmic Disorder – Unable to reach orgasm, or have difficulty reaching orgasm after what would usually be adequate sexual stimulation

– Anorgasmic – unable to reach orgasm through any means – A woman who has orgasms through masturbation but not intercourse does not have Female Orgasmic Disorder.

..

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Prevalence and Types of Sexual Problems and Dysfunctions (16 of 25) • Orgasmic Disorders: Delayed Ejaculation – Has been called male orgasmic disorder, retarded ejaculation, and ejaculatory incompetence – May be lifelong or acquired, generalized or situational – Can often ejaculate during masturbation or oral sex— delayed ejaculation is limited to intercourse

– Frustrating for both partners

..

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Prevalence and Types of Sexual Problems and Dysfunctions (17 of 25) • Orgasmic Disorders: Delayed Ejaculation – Causes: ▪ Physical factors (e.g., multiple sclerosis or neurological damage, side effect of drugs) ▪ Psychological factors (e.g., performance anxiety, sexual guilt, hostility toward partner)

..

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Prevalence and Types of Sexual Problems and Dysfunctions (18 of 25) • Orgasmic Disorders: Premature Ejaculation – Ejaculation occurs with minimal sexual stimulation, and before the man desires it.

– Also called rapid or early ejaculation

– After ED in elderly men, PE is the most common male sexual dysfunction.

– Degree of rapidity varies; most men ejaculate just before or after penetration.

– Prevalence varies, depending on how RE is defined – Some argue that the focus should be on whether the couple is satisfied with the duration, not timing. ..

13 - 23

Prevalence and Types of Sexual Problems and Dysfunctions (19 of 25) • Sexual Pain-Related Disorders – The DSM-5 combines all sexual pain disorders into the single diagnostic entity of genito-pelvic pain/penetration disorder (APA, 2013)

– This has broadly been referred to as dyspareunia ▪ Persistent or recurrent pain during sexual activity

..

13 - 24

Prevalence and Types of Sexual Problems and Dysfunctions (20 of 25) • Sexual Pain-Related Disorders – Painful sexual activity is particularly common among women, although about half of women with the problem do not seek professional help for it

– Painful sex is less common in men and is generally associated with genital infections

..

13 - 25

Prevalence and Types of Sexual Problems and Dysfunctions (21 of 25) • Sexual Pain-Related Disorders – Binik (2005) has found that women with dyspareunia have lower tolerance for pain in other areas of their bodies – suggests a generalized hypersensitivity to pain – Women who believe pain is due to psychological causes report higher levels of pain and more sexual problems than those who attribute pain to physical causes.

– For many women, pain cannot totally be eliminated but coping strategies can be taught. ..

13 - 26

Prevalence and Types of Sexual Problems and Dysfunctions (22 of 25) • Sexual Pain Disorders – Vulvodynia ▪ Gynecological condition characterized by vulval pain, particularly a chronic burning sensation, itching, irritation, and soreness ▪ Affects up to 16% of women

..

13 - 27

Prevalence and Types of Sexual Problems and Dysfunctions (23 of 25) • Sexual Pain Disorders: Vaginismus – Involuntary contraction of the pelvic muscles that surround the outer one-third of the vaginal barrel, resulting in pain

– Avoidance of penetration seems to be the key factor differentiating vaginismus from dyspareunia – Vaginismus occurs reflexively during attempts at vaginal penetration, making entry of the penis, fingers, dildo or any object (e.g., tampon) difficult or impossible.

..

13 - 28

Prevalence and Types of Sexual Problems and Dysfunctions (24 of 25) • Sexual Pain Disorders: Vaginismus – Causes: ▪ Some believe vaginismus is usually caused by a fear of penetration, rather than by physical injury or defect.

▪ Psychological factors (e.g., trauma or botched abortion resulting in fear of penetration) ▪ Physical factors (e.g., cause or effect of dyspareunia)

..

13 - 29

Prevalence and Types of Sexual Problems and Dysfunctions (25 of 25) • Sexual Pain Disorders: Vaginismus – Some propose that vaginismus be reconceptualized as either an aversion to vaginal penetration or a genital pain disorder.

– These distinctions are important in suggesting different courses of treatment.

..

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Origins of Sexual Problems and Dysfunction (1 of 6) • We need to consider possible biological, psychological, and social factors in sexual problems and dysfunctions, which can interact in a number of ways

..

13 - 31

Origins of Sexual Problems and Dysfunction (2 of 6) • Biological Factors – Medical conditions/health problems ▪ Thyroid overactivity or underactivity ▪ Temporal lobe epilepsy ▪ Hypogonadism ▪ Heart disease

▪ Diabetes mellitus ▪ Multiple sclerosis ▪ Spinal cord injury ..

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Origins of Sexual Problems and Dysfunction (3 of 6) • Biological Factors – Medical conditions/health problems ▪ Complications from surgery ▪ Use of some medicines ▪ Body composition ▪ Physical inactivity

▪ Alcohol consumption ▪ High cholesterol

..

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Origins of Sexual Problems and Dysfunction (4 of 6) • Biological Factors – Aging ▪ Physical changes to internal and external genitalia (e.g., thinning of the vaginal walls)

▪ Associated medical conditions and problems ▪ Stereotypes associated with aging and sexuality can create performance anxiety.

..

13 - 34

Origins of Sexual Problems and Dysfunction (5 of 6) • Biological Factors – Drugs ▪ Prescription drugs (e.g., blood pressure drugs) ▪ Illicit drugs (e.g., heroin, cocaine) ▪ Central nervous system depressants (e.g., alcohol)

– SSRIs ▪ Most anti-depressants impair sexual arousal, especially in older patients.

▪ Some medication can be prescribed along with SSRIs to prevent side effects. ..

13 - 35

Origins of Sexual Problems and Dysfunction (6 of 6) • Psychosocial Factors – Cultural influences – Psychosexual trauma – Emotional factors (e.g., depression, stress) – Myths and misinformation – Ineffective sexual techniques – Boredom and routine

– Lack of sexual communication – Relationship issues – Performance anxiety ..

13 - 36

Solutions for Sexual Problems and Dysfunctions (1 of 11) • Sex Therapy – Cognitive and behavioural – Aims to modify dysfunctional cognitions and behaviours, change self-defeating beliefs and attitudes, enhance knowledge, improve sexual communication, teach sexual skills, and reduce performance anxiety – Usually involves both partners – Gender-sensitive practice analyzes gender issues facing both men and women. ..

13 - 37

Solutions for Sexual Problems and Dysfunctions (2 of 11) • Biological Treatments – Viagra for erectile dysfunction – Treatments are also being developed for rapid ejaculation, female orgasmic dysfunction, and lack of sexual desire

• A combination of medical treatments and talk therapy is more effective than medicine alone.

..

13 - 38

Solutions for Sexual Problems and Dysfunctions (3 of 11) • The PLISSIT Model – Permission (P) – Limited Information (LI)

– Specific Suggestions (SS) – Intensive Therapy (IT)

..

13 - 39

Solutions for Sexual Problems and Dysfunctions (4 of 11) • The Masters and Johnson Approach – Pioneered the use of direct behavioural approaches to treating sexual dysfunction – Considered the couple to be dysfunctional, not the individual – Anxiety and resentments are aired, but the focus is on behavioural change.

..

13 - 40

Solutions for Sexual Problems and Dysfunctions (5 of 11) • The Masters and Johnson Approach – Daily homework exercises ▪ Sensate-focus exercises – exercises in which sexual partners take turns giving and receiving pleasurable stimulation in non-genital areas

..

13 - 41

Solutions for Sexual Problems and Dysfunctions (6 of 11) • Integrating Sex Therapy and Psychotherapy – Combining the two can be a powerful tool for enhancing relationships and sex lives.

– Many therapists use both to help couples: ▪ Learn how to share power ▪ Improve sexual communication ▪ Negotiate differences

..

13 - 42

Applied Knowledge (1 of 2) • How Do You Find a Qualified Sex Therapist?

– The provinces don’t regulate use of the term “sex therapist”, so it is important to find a sex therapist who is a member of a recognized profession (psychology, social work, medicine, or marriage and family counselling) and has training and supervision in sex therapy.

▪ Contact your university or college psychology department, health department, counselling centre, or a medical or psychological association, a marriage and family therapy association, or a family physician if you are stuck. ..

13 - 43

Solutions for Sexual Problems and Dysfunctions (7 of 11) • Treatments for low sexual desire – Self-stimulation exercises combined with erotic fantasies – Sensate focus exercises – Enhancing communication – Expanding couples’ repertoire of sexual skills – Testosterone – Treatment for depression – Counselling or psychotherapy ..

13 - 44

Solutions for Sexual Problems and Dysfunctions (8 of 11) • Treatments for low sexual desire – Treatment of Sexual Aversion ▪ Medication to reduce anxiety ▪ Therapy to overcome underlying sexual phobia ▪ Couples therapy ▪ Sensate-focus exercises

▪ Behavioural exercises

..

13 - 45

Solutions for Sexual Problems and Dysfunctions (9 of 11) • Treatments for Sexual-Arousal Disorders – Encouraging men and women to relax and receive stimulation without anxiety inhibiting their natural reflexes (as long as problem is psychologically and not organically based) – Nongenital sensate-focus exercises to remove demand

..

13 - 46

Solutions for Sexual Problems and Dysfunctions (10 of 11) • Biological Approaches for Sexual-Arousal Disorders: Erectile Disorder – Oral medications (e.g., Viagra, Cialis) – Hormone (testosterone) treatment – Vascular surgery – Penile implants – Vacuum pump

..

13 - 47

Solutions for Sexual Problems and Dysfunctions (11 of 11) • Treatments for Sexual-Arousal Disorders: Female Sexual Interest/Arousal Disorder – Sex education – Searching out and coping with possible cognitive interference – Working on relationship problems – Artificial lubricant – Testosterone skin patches – Eros clitoral suction device – Viagra ..

13 - 48

Applied Knowledge (2 of 2) • Promoting Eroticism In Sex Therapy – Ottawa-based sex therapist Peggy Kleinplatz, developed innovative approach to sex therapy ▪ Focus on personal growth ▪ Enhancing sexual relationships and erotic potential

..

13 - 49

Solutions for Sexual Problems and Dysfunctions (1 of 7) • Treatments for Orgasmic Disorders: Female Orgasmic Disorder – Address negative attitudes about sex – Masters and Johnson’s couples-oriented approach ▪ Sensate-focus exercises ▪ Training position and non-demanding genital play ▪ Intercourse with woman-on-top

..

13 - 50

Solutions for Sexual Problems and Dysfunctions (2 of 7) • Treatments for Orgasmic Disorders: Female Orgasmic Disorder – Individual masturbation approach – Education

– Self-exploration – Self-massage – Self-permission

– Fantasy – A vibrator – Partner involvement ..

13 - 51

Solutions for Sexual Problems and Dysfunctions (3 of 7) • Treatments for Orgasmic Disorders: Delayed Ejaculation – Increasing sexual stimulation – Reducing performance anxiety – Sensate-focus exercises

..

13 - 52

Solutions for Sexual Problems and Dysfunctions (4 of 7) • Treatments for Orgasmic Disorders: Premature Ejaculation – Sensate-focus exercises – Biological treatments (e.g., serotonin)

– Squeeze technique ▪ The tip of the penis is squeezed to temporarily prevent ejaculation

• Stop-start method ▪ Stimulate (manually or through intercourse) until the man is about to ejaculate, stop until arousal subsides, and then resume stimulation ..

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Solutions for Sexual Problems and Dysfunctions (5 of 7) • Treatments for Orgasmic Disorders: Premature Ejaculation – While the squeeze technique and the stop-start method are widely used, there is little research to demonstrate that they are effective, especially with severe cases.

– Emphasis is increasingly being placed on biological treatments (e.g., clomipramine, used to treat schizophrenia, because it impacts neurotransmitters, and SSRIs).

..

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Solutions for Sexual Problems and Dysfunctions (6 of 7) • Treatments for Sexual-Pain Disorders – Dyspareunia ▪ Medical intervention to identify and treat underlying physical problems which may cause pain

..

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Innovative Canadian Treatment (1 of 2) • Treatments for Provoked Vestibulodynia – Canadian and American researchers have conducted studies examining the effectiveness of three treatment programs (Bergeron et al., 2001): ▪ Cognitive-Behavioural Therapy ▪ Biofeedback ▪ Surgery

..

13 - 56

Innovative Canadian Treatment (2 of 2) • Treatments for Provoked Vestibulodynia – Results: ▪ Each resulted in pain reduction ▪ Equally successful in improving psychological adjustment

▪ Each successful at improving sexual functioning ▪ Some women assigned to surgery treatment refused to go ahead with the treatment.

▪ Follow-up study indicated that gains were still maintained for each intervention.

..

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Solutions for Sexual Problems and Dysfunctions (7 of 7) • Treatments for Sexual-Pain Disorders – Vaginismus ▪ Behavioural exercises in which plastic vaginal dilators of increasing size are inserted, to help relax the vaginal musculature ▪ Woman controls the pace of treatment ▪ After dilators, fingers and a penis or dildo can be used ▪ Psychological treatment for sexual trauma may be needed (if this was the root cause of vaginismus). ..

13 - 58

Innovative Canadian Research (1 of 2) • A Portrait of Great Sex – Peggy Kleinplatz and colleagues (2008) interviewed people who reported experiencing “great sex” ▪ Many were over 60, some had been in relationships for more than 25 years

..

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Innovative Canadian Research (2 of 2) • A Portrait of Great Sex – Eight components of great sex emerged: ▪ Being present, focused, and embodied ▪ Connection, or being in sync

▪ Deep sexual and erotic intimacy ▪ Extraordinary communication and heightened empathy ▪ Authenticity

▪ Transcendence and transformation ▪ Exploration and interpersonal risk-taking ▪ Vulnerability ..

13 - 60

A World of Diversity (1 of 3) • An Alternative Approach to Enhancing Female Sexuality – A significant minority of women do not find sex satisfying, even though the mechanics of sexual response are working.

▪ Some comment that sex is boring, dry, and unemotional.

• Eastern techniques, with their origins in the Kama Sutra, might provide some of the spiritual dimensions to sex that traditional Western approaches lack. ..

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A World of Diversity (2 of 3) • An Alternative Approach to Enhancing Female Sexuality – Mindful Meditation ▪ Nonjudgemental, present-moment awareness

▪ Has recently been incorporated into treatments for women with disorders of desire and arousal ▪ Treatment began with instructions about being mindful in their nonsexual lives.

▪ Heart of mindfulness is the body scan exercise – attending to sensations in specific parts of the body

..

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A World of Diversity (3 of 3) • An Alternative Approach to Enhancing Female Sexuality – Mindful Meditation ▪ Other body-focused mindfulness exercises – Focusing exercise – Self-observation exercise – Self-observation and touch exercise – Self-observation and touch exercise with a sexual goal

▪ Studies have found mindfulness-based sex therapy significantly improves sexual response and reduces sexual distress (Brotto, 2013). ..

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End of Chapter 13

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 14 Sexually Transmitted Infections

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14 - 1

Learning Objectives (1 of 2) 1.

Identify and discuss key features and recent trends in STIs in the Canadian population.

2.

Describe the transmission, effects, and treatment of chlamydia.

3.

Describe the transmission, effects, and treatment of gonorrhea.

4.

Describe the transmission, effects, and treatment of syphilis.

5.

Describe the transmission, effects, and treatment of vaginal infections.

6.

Describe the transmission, effects, and treatment of HIV and AIDS. ..

14 - 2

Learning Objectives (2 of 2) 7.

Describe the transmission, effects, and treatment of genital herpes.

8.

Describe the transmission, effects, and treatment of viral hepatitis.

9.

Describe the transmission, effects, and treatment of human papillomavirus.

10. Describe the transmission, effects, and treatment of ectoparasitic infestations.

11. Identify and assess the roles of different biological, psychological, and social factors in the epidemiology of STIs in Canada. ..

14 - 3

Sexually Transmitted Infections • Sexually Transmitted Infection (STI) – An infection that is passed from one person to another through sexual contact – Some STIs (like HIV) can also be transmitted other ways.

..

14 - 4

STIs in Canada (1 of 3) • Human papillomavirus (HPV) and genital herpes (herpes simplex virus, or HSV) are the most common (but not reportable) STIs. • Chlamydia is the most common reportable STI: – 116 499 reported cases of Chlamydia in 2015 (PHAC 2017) – Teens and young adults have the highest rates

..

14 - 5

STIs in Canada (2 of 3) • Gonorrhea is less common than chlamydia, but incidence has increased in the last decade.

– 16 289 cases reported in 2014

• Compared to gonorrhea and chlamydia, the number of syphilis cases is relatively small.

– 4551 cases were diagnosed in 2015 ▪ 87% among men

..

14 - 6

STIs in Canada (3 of 3) • STI rates are higher in young people under 30 • Even though the rate of chlamydia remains higher in young people, the reported rate increased more than twice as much among 40- to 59-year olds between 2006 and 2015

..

14 - 7

Bacterial Infections (1 of 20) • Chlamydia – Most common bacterial STI in Canada – Caused by the Chlamydia trachomatis bacterium – Causes several types of infection ▪ Non-gonoccocal urethritis (NGU) in women and men ▪ Epididymitis in men ▪ Cervicitis in women

▪ Endometritis in women ▪ Pelvic inflammatory disease (PID) in women

..

14 - 8

Bacterial Infections (2 of 20) • Chlamydia – Transmission ▪ Sexual intercourse – vaginal or anal ▪ Eye infection, if person touches eyes after handling genitals of infected partner ▪ Oral sex with infected partner can infect the throat

..

14 - 9

Bacterial Infections (3 of 20) • Chlamydia – Symptoms ▪ Men – Non-gonococcol urethritis (NGU; thin, whitish discharge from penis, burning or other pain during urination, soreness of the scrotum, feelings of heaviness in the testes)

▪ Women – Inflammation of the urethra or cervix (burning during urination, genital irritation, mild vaginal discharge)

..

14 - 10

Bacterial Infections (4 of 20) • Chlamydia – Symptoms ▪ Up to 90% of men and 70% of women have no symptoms

▪ If untreated, individuals can pass infection on to others.

▪ Untreated infections can damage the reproductive systems of women and men.

– In women, can lead to pelvic inflammatory disease (PID) and scarring of the fallopian tubes, resulting in infertility.

..

14 - 11

Bacterial Infections (5 of 20) • Chlamydia – Diagnosis and treatment ▪ Cervical or urethral smear for women ▪ Self-obtained urine samples and vaginal swabs for women ▪ If there is urethral or vaginal discharge, a swab may be taken

▪ Antibiotics other than penicillin are highly effective.

▪ Treatment of sex partners is essential to prevent reinfection. ..

14 - 12

Bacterial Infections (6 of 20) • Gonorrhea – Second-most common bacterial STI in Canada – Caused by the Neisseria gonorrhoeae bacterium

..

14 - 13

Bacterial Infections (7 of 20) • Gonorrhea – Transmission ▪ Requires a warm, moist environment; outside of the body the bacterium dies within a minute ▪ Can’t be picked up from toilet seats or dry objects ▪ Unprotected vaginal, oral, or anal sexual activity ▪ Rarely, from contact with a moist, warm towel or sheet immediately after it has been used by an infected person ▪ From mother to newborn during delivery

..

14 - 14

Bacterial Infections (8 of 20) • Gonorrhea – Transmission ▪ Pharyngeal gonorrhea – Gonorrheal infection of the pharynx

– Developed when a person performs fellatio on an infected partner

– Mouth-to-mouth kissing and cunnilingus are less likely to spread gonorrhea

– Highly contagious through vaginal sex, women have 50% chance of being infected after one exposure, men 25%. ..

14 - 15

Bacterial Infections (9 of 20) • Gonorrhea – Symptoms ▪ Men – Some men have symptoms within 2 to 5 days

– Discharge (clear, turns yellow and green, then thickens and turns pus-like) – Inflamed urethra, burning sensation while urinating – 30–40% of men have swelling and tenderness in lymph glands of groin – When left untreated, it may lead to inflammation of the epididymis ..

14 - 16

Bacterial Infections (10 of 20) • Gonorrhea – Symptoms ▪ Women – 80% of women have no symptoms in the early stages of the infection – Cervicitis (inflammation of the cervix) ➢ Discharge (yellow and green, pus-like)

– Burning during urination

..

14 - 17

Bacterial Infections (11 of 20) • Gonorrhea – Symptoms ▪ If untreated, can pass infection on to others ▪ Untreated infections can damage the reproductive systems of women (PID) and epididymitis in men; leading to infertility.

..

14 - 18

Bacterial Infections (12 of 20) • Gonorrhea – Pelvic Inflammatory Disease (PID) ▪ Inflammation of the pelvic region in women, possibly including the cervix, uterus, fallopian tubes, abdominal cavity, and ovaries ▪ Symptoms are abdominal pain, tenderness, nausea, fever, and irregular menstrual cycles

▪ Condition may lead to infertility

..

14 - 19

Bacterial Infections (13 of 20) • Gonorrhea – Diagnosis and treatment ▪ When diagnosed and treated early, infection clears up rapidly more than 90% of the time.

▪ Clinical inspection of the genitals by a physician ▪ Culturing and examination of the genital discharge ▪ Antibiotics (dual therapy with cephalosporin and azithromycin) ▪ Antibiotic-resistant strains are increasingly problematic

..

14 - 20

Bacterial Infections (14 of 20) • Syphilis – Caused by the Treponema pallidum bacterium – Not as widespread as it used to be, its effects can be extremely harmful

..

14 - 21

Bacterial Infections (15 of 20) • Syphilis – Transmission ▪ Vaginal or anal intercourse ▪ Oral-genital or oral-anal contact with infected person

▪ Usually transmitted when open lesions of an infected partner come into contact with mucus membrane of the other ▪ Can be contracted by touching an infectious chancre (sore or ulcer) ▪ From mother to fetus through placenta – Congenital syphilis is present at birth ..

14 - 22

Bacterial Infections (16 of 20) • Syphilis – Symptoms ▪ Primary stage – Two to four weeks after contact a painless chancre (hard, round, ulcer-like lesion with raised edges) appears at infection site – Women form a chancre on the vaginal walls or cervix, may also form on the external genitalia – Men form a chancre on the penile glans, may also form on the scrotum or penile shaft – If spread by anal sex, chancre may appear in the rectum.

..

14 - 23

Bacterial Infections (17 of 20) • Syphilis – Symptoms ▪ Secondary stage – A few weeks to a few months later skin rash develops (painless, reddish raised bumps) that eventually darkens and bursts, oozing a discharge.

– Sores in the mouth, swelling in the joints, sore throat, headaches, fever (may assume flu).

..

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Bacterial Infections (18 of 20) • Syphilis – Symptoms ▪ Latent stage – Symptoms disappear and infection lies dormant for 1 to 40 years – Spirochetes continue to multiply and burrow into the circulatory system, central nervous system, and bones.

– A person may no longer be contagious but a pregnant woman can still transmit infection to her newborn during delivery.

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Bacterial Infections (19 of 20) • Syphilis – Symptoms ▪ Tertiary stage – Large ulcers may form on the skin, muscle tissue, digestive organs, lungs, liver, and other organs.

– These can be treated.

– Serious damage can be done if the infection attacks the central nervous or cardiovascular system – can be fatal

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Bacterial Infections (20 of 20) • Syphilis – Diagnosis and treatment ▪ Primary stage is diagnosed by clinical examination.

▪ Spirochetes are quite visible in fluid draw from chancre.

▪ Blood tests are not definitive until the second stage.

▪ Penicillin is the treatment of choice.

▪ Sex partners of infected persons should be evaluated.

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Vaginal Infections (1 of 10) • Vaginitis – Any type of vaginal infection or inflammation – Genital irritation, itching or burning during urination, odorous discharge (most common)

– Majority of vaginal infections involve bacterial vaginosis, candidiasis, or trichomoniasis – The microbes that cause vaginal infections in women can also infect men’s urethral tracts.

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Vaginal Infections (2 of 10) • Vaginitis – Bacterial Vaginosis (BV) ▪ Usually caused by overgrowth of the Gardnerella vaginalis bacterium

▪ Transmitted through sexual contact ▪ Infected women often have no symptoms, but one symptom can be a thin, foul-smelling discharge ▪ Diagnosis requires culturing the bacterium

▪ Increases risk of other gynecological infections ▪ Oral and topical treatments are effective ..

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Vaginal Infections (3 of 10) • Vaginitis – Bacterial Vaginosis (BV) ▪ Recurrences are common ▪ Questions remain about whether or not partners should be treated – Bacterium can usually be found in the urethras of symptom-free males.

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Vaginal Infections (4 of 10) • Vaginitis – Candidiasis ▪ Caused by a yeast-like fungus ▪ Also known as moniliasis, thrush, or a yeast infection

▪ Produces soreness, inflammation, and intense itching around the vulva, accompanied by a thick, white, curdlike vaginal discharge.

▪ Yeast infections can occur in the mouths of men and women and in the penis of men.

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Vaginal Infections (5 of 10) • Vaginitis – Candidiasis ▪ Yeast produces no symptoms when the vaginal environment is normal.

▪ Infections arise when changes in the vaginal environment allow the fungus to overgrow.

– Can result from antibiotics, birth-control pill, IUDs, pregnancy and diabetes, nylon underwear, tight clothing

▪ Can be passed back and forth between partners, oral sex, anal sex, or by women sharing a washcloth.

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Vaginal Infections (6 of 10) • Vaginitis – Candidiasis ▪ Most men have no symptoms, but can develop NGU or genital thrush accompanied by itching and burning during urination, or reddening of the penis.

▪ About half of women will have at least one episode in their lives.

▪ 25% of women have recurrent infections.

▪ Treatments include vaginal suppositories or creams.

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Vaginal Infections (7 of 10) • Vaginitis – Trichomoniasis ▪ Caused by the protozoan Trichomonas vaginalis (a single-celled parasite)

▪ Most common parasitic STI ▪ Facilitates the transmission of HIV ▪ Linked to the development of tubal adhesions, which can result in infertility

▪ Almost always sexually transmitted

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Vaginal Infections (8 of 10) • Vaginitis – Trichomoniasis ▪ Can live for several hours on moist surfaces outside the body (e.g., towels, washcloths, bedclothes)

▪ Can be picked up from toilet seat, but penis or vulva has to directly touch it

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Vaginal Infections (9 of 10) • Vaginitis – Trichomoniasis ▪ Symptoms in women include burning or itching in the vulva, mild pain during urination or intercourse, and an odorous, foamy, whitish to yellow-ish green discharge – women can also have no symptoms.

▪ Symptoms worsen during or after menstrual periods.

▪ Can cause NGU in men, and a slight penile discharge noticeable before first urination in the morning, may be tingling or itching in the urethral tract – but most men are symptom-free

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Vaginal Infections (10 of 10) • Vaginitis – Trichomoniasis ▪ Symptoms in women include burning or itching in the Diagnosis is made by microscopic examination of a smear of vaginal fluid ▪ Examination of cultures grown from the vaginal smear is more reliable, however.

▪ When both partners are treated simultaneously, the success rate approaches 100%.

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Viral Infections (1 of 37) • Viruses are tiny particles of DNA surrounded by protein coatings.

• They are incapable of reproducing on their own, but when they invade a body cell, they can use the cell to spin off new viral particles that spread to other cells.

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Viral Infections (2 of 37) • HIV and AIDS – Human immunodeficiency virus (HIV) ▪ A sexually transmitted virus that destroys white blood cells in the immune system, leaving the body vulnerable to life-threatening diseases ▪ The virus that causes acquired immunodeficiency syndrome (AIDS)

– Acquired immunodeficiency syndrome (AIDS) ▪ A condition caused by HIV and characterized by destruction of the immune system, stripping the body of its ability to fend off life-threatening diseases ..

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Viral Infections (3 of 37) • HIV and AIDS – AIDS is considered fatal, though many people now live with HIV/AIDS for many years with the help of powerful antiviral medications.

▪ For people living in industrialized nations like Canada, HIV/AIDS may become a chronic but manageable condition, like diabetes.

▪ In other nations without access to medications, HIV/AIDS may remain a death sentence.

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Viral Infections (4 of 37) • HIV and AIDS – Globally, 35.3 million people were living with HIV in 2012, 2.3 million new infections occurred, and 1.6 million people died from AIDS-related causes.

– More than 90% of those with HIV live in low- or middleincome countries, particularly in sub-Saharan Africa.

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Viral Infections (5 of 37) • HIV and AIDS – Canadian HIV Trends ▪ From 1985 (when HIV testing began) through 2016, 84 409 people in Canada were diagnosed with HIV.

▪ There has been a steady decrease from 2008 to 2014.

▪ In 2016, there were 2344 newly diagnosed and reported cases

▪ It is estimated that 65 040 people were living with HIV in Canada at the end of 2014 (PHAC, 2016) – It is estimated that 12 820 (19.7%) were unaware they had HIV ..

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Viral Infections (6 of 37) • HIV and AIDS – Canadian HIV Trends

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Viral Infections (7 of 37) • HIV and AIDS – Canadian AIDS Trends ▪ Between 1979 until the end of 2016, a total of 24 179 cases of AIDS were reported in Canada.

▪ The number of new cases peaked in 1993 and since then has declined, due to introduction of antiretroviral therapy (ART) in 1996.

▪ In 2016, 114 AIDS cases were reported – The number of new cases has declined by 87% from 1993 to 2016

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Viral Infections (8 of 37) • HIV and AIDS – HIV and AIDS Terms ▪ The Immune System – The complex of mechanisms the body uses to protect itself from disease-causing agents such as pathogens

▪ Pathogens – An agent, especially a microorganism, that can cause disease

▪ Leukocytes – White blood cells that are essential to the body’s defenses against infection ..

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Viral Infections (9 of 37) • HIV and AIDS – HIV and AIDS Terms ▪ Antigen – Leukocytes recognize foreign agents by their surface fragments, which are called antigens

▪ Antibody – A specialized protein that attaches itself to a foreign body, inactivates it, and marks it for destruction

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Viral Infections (10 of 37) • HIV and AIDS – HIV Infection ▪ Spikes (technically known as gpl20 spikes) on the surface of HIV allow it to bind to sites on the cells in the immune system.

▪ HIV uses the cells it invades to spin off copies of itself.

▪ HIV directly attacks the immune system by invading a type of lymphocyte called the CD4 cell or helper T cell (the quarterback of the immune system).

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Viral Infections (11 of 37) • HIV and AIDS – HIV Infection ▪ By attacking and disabling CD4 cells, HIV disables the cells on which the body relies to fight infections.

▪ The blood normally contains about 1000 CD4 cells per millilitre.

▪ People remain healthy as long as this level is maintained.

▪ As the number of CD4 cells decrease with HIV infection, symptoms generally increase.

▪ A person is most vulnerable to opportunistic infection when their CD4 levels fall below 200. ..

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Viral Infections (12 of 37) • HIV and AIDS – HIV/AIDS Progression ▪ Shortly after infection, the person may experience mild, flu-like symptoms.

– These usually disappear in a few weeks.

▪ People generally look and act well and may unwittingly pass the virus on to others.

▪ Most people remain symptom-free for years.

▪ Some enter a symptomatic phase that is marked by chronically swollen lymph nodes, intermittent weight loss, fever, fatigue, and diarrhea. ..

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Viral Infections (13 of 37) • HIV and AIDS – HIV/AIDS Progression ▪ The beginning of full-blown AIDS is often marked by swollen lymph nodes, fatigue, fever, night sweats, diarrhea, and weight loss that can’t be attributed to diet or exercise.

▪ About 10% of people with AIDS have wasting syndrome, which is the unintentional loss of more than 10% of a person’s body weight ➢ connected with the appearance of opportunistic diseases like Kaposi’s sarcoma (a form of cancer)

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Viral Infections (14 of 37) • HIV and AIDS – HIV/AIDS Progression ▪ As AIDS progresses, the person grows thinner and more fatigued. She/he becomes unable to perform ordinary life functions, and falls prey to opportunistic infections.

▪ Left untreated, AIDS nearly always results in death within a few years.

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Viral Infections (15 of 37) • HIV and AIDS – Transmission ▪ Virus is transmitted by contaminated blood, semen, vaginal secretions, and breast milk

▪ HIV can enter the body through tiny cuts or sores in the mucosal lining of the vagina, the rectum, or even the mouth.

▪ HIV can also be spread – By sharing needles – From mother to fetus during pregnancy, childbirth or breastfeeding ..

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Viral Infections (16 of 37) • HIV and AIDS – Transmission ▪ ART therapy can reduce risk of transmission from mother to baby – Because ART is provided to HIV-positive mothers, the number of babies born with HIV has been dramatically reduced in Canada

▪ Male-to-female transmission through vaginal intercourse is twice as likely as female-to-male transmission.

▪ Male-female and male-male anal intercourse are especially risky because of easy tearing.

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Viral Infections (17 of 37) • HIV and AIDS – Diagnosis ▪ There are two main types of HIV testing in Canada – Standard HIV testing

– Rapid point-of-care testing

– In both types, a sample of blood is taken and either sent to a laboratory to be tested for HIV or, in rapid point-of-care testing, tested immediately at the location

– As of 2011, 49% of Canadians aged 16 and older reported that they had been tested for HIV at least once. ..

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Viral Infections (18 of 37) • HIV and AIDS – Treatment ▪ There is no safe, effective vaccine for HIV. ▪ A combination of antiviral drugs has become the standard for HIV and AIDS called antiretroviral therapy (ART) – Reduces the amount of virus in the body (viral load) to the point that is no longer detectable by blood tests

▪ In 2016, of people diagnosed with HIV in 2014, 76% were receiving ART, 89% had a suppressed HIV viral loads, and over 80% of people with HIV had no detectable virus ..

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Viral Infections (19 of 37) • HIV and AIDS – Prevention ▪ ART reduces the levels of the virus in the body and decreases the likelihood of transmission.

▪ Rodger et al (2016) study: – 1166 heterosexual and gay male couples in which one partner had HIV and was on ART and the other partner did not have HIV were followed for several years – Over the course of the study, there were 36 000 accounts of sex without condoms but not a single case of HIV transmission was reported

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Viral Infections (20 of 37) • HIV and AIDS – Prevention ▪ Pre-exposure prophylaxis (PrEP) – For HIV-negative individuals who are at high risk for HIV infection – Truvada medication for daily use

▪ Post-exposure prophylaxis (PEP) – PEP involves taking HIV antiviral medications within 72 hours after an HIV-negative person has been at moderate to high risk of exposure to HIV

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Viral Infections (21 of 37) • Herpes (Herpes Simplex Virus) – Herpes simplex virus type 1 (HSV-1) ▪ Common infection, affecting about half the population ▪ Causes oral herpes ▪ Cold sores or fever blisters on lips or in the mouth ▪ Can be transferred to the genitals via oral-genital contact

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Viral Infections (22 of 37) • Herpes – Herpes simplex virus type 2 (HSV-2) ▪ Causes genital herpes ▪ Painful, shallow sores and blisters on the genitals

▪ Most often transmitted by vaginal or penile-anal sex – Can be transferred to the mouth

▪ 13.6% of Canadians aged 14 to 59 have HSV-2 ▪ Most people with genital HSV-1 or HSV-2 infections are asymptomatic ▪ People with symptoms experience recurrent outbreaks at times of stress, due to immune system depression. ..

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Viral Infections (23 of 37) • Herpes – Transmission ▪ Oral, anal, vaginal sexual activity with an infected person ▪ Virus can survive for several hours on toilet seats and other objects where they can be picked up by direct contact ▪ Oral herpes is easily contracted by sharing a cup, kissing, or sharing towels.

▪ Genital herpes is generally spread sexually.

▪ Can be spread from one part of the body to another (e.g., ocular herpes—infection of the eye) ..

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Viral Infections (24 of 37) • Herpes – Transmission ▪ Many people don’t know that they are infected and can unknowingly transmit the virus.

▪ Virus is most contagious during active flare-ups, but can be spread at other times.

– Any intimate contact with an infected person carries some risk—even if they have never had or won’t ever have any more outbreaks.

– Condom effectiveness is limited

▪ Passage through the birth canals of infected mothers can harm or kill the babies (if prodromal symptoms). ..

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Viral Infections (25 of 37) • Herpes – Symptoms ▪ Most people don’t have any observable symptoms ▪ Genital lesions or sores appear six to eight days after infection (reddish, painful bumps or papules).

▪ Papules turn into groups of small blisters that are filled with fluid containing viral particles.

▪ These fill with pus, burst, and become extremely painful, shallow ulcers surrounded by red rings.

▪ Blisters crust over and heal within one to three weeks.

▪ Internal sores in the vagina or on the cervix may take 10 days longer than external sores to heal. ..

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Viral Infections (26 of 37) • Herpes – Symptoms ▪ Other symptoms may include headaches and muscle aches, swollen lymph glands, fever, burning urination, and vaginal discharge.

▪ Although symptoms disappear, the virus doesn’t.

▪ The virus burrows into the nerve cells at the base of the spine and may lie dormant for years, or a lifetime.

▪ Reoccurrences are related to infections, stress, fatigue, depression, exposure to the sun, hormonal changes.

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Viral Infections (27 of 37) • Herpes – Diagnosis and Treatment ▪ First diagnosed by clinical inspection of herpetic sores or ulcers in the mouth or on the genitals

▪ Fluid is cultured to detect growth of the virus.

▪ Antiviral drugs can relieve pain, speed healing, and reduce duration of viral shedding.

– Can reduce the severity of the initial episode and, if taken regularly, can reduce the frequency and duration of outbreaks

▪ Warm baths, loose clothing, aspirin and cold compresses may relieve pain during flare-ups. ..

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Viral Infections (28 of 37) • Herpes – Coping with Genital Herpes ▪ The psychological impact can be more distressing than physical effects.

▪ Most people learn to cope with the infection, and with adjustments, are able to establish and maintain satisfying intimate relationships.

▪ Some are helped by support groups.

▪ A caring, trusting partner is important.

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Viral Infections (29 of 37) • Viral Hepatitis – Hepatitis ▪ An inflammation of the liver ▪ Major types are A, B, C, and D

▪ Most have no symptoms ▪ When people have symptoms, they may have jaundice (a yellowish discoloration of the skin and whites of the eyes), loss of appetite, abdominal discomfort, whitish bowel movements, feelings of weakness and nausea, or tea-coloured urine – Symptoms of hepatitis B are more severe than A or C

▪ Hepatitis D only occurs in presence of B ..

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Viral Infections (30 of 37) • Viral Hepatitis – Hepatitis ▪ Hepatitis A is transmitted through contact with infected fecal matter in contaminated food or water, or by oral contact with fecal matter.

▪ Hepatitis B is transmitted through anal, vaginal or oral intercourse with an infected partner, transfusion with contaminated blood supplies, sharing of contaminated needles or syringes, and contact with contaminated saliva, menstrual blood, nasal mucus, or semen.

▪ Sharing razors, toothbrushes, and other personal articles with an infected person can also transmit hepatitis B. ..

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Viral Infections (31 of 37) • Viral Hepatitis – Hepatitis ▪ Hepatitis C and Hepatitis D can be transmitted sexually or through contact with contaminated blood.

▪ People can transmit the viruses even if they are unaware that they have the disease.

▪ Hepatitis is diagnosed by testing blood samples for the presence of hepatitis antigens and antibodies.

▪ Bed rest and fluids are generally recommended until the acute stage of the virus passes.

▪ A vaccine protects against hepatitis B and D. ..

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Innovative Canadian Research (1 of 2) • Living with STI: Resisting STI-associated Stigma – STIs are extremely common and can affect any person who is sexually active – Foster and Byers 92016) studied 188 individuals who had been living with genital herpes or HPV for an average of 7 years ▪ High levels of sexual satisfaction, sexual self-esteem and positive sexual self-schemas ▪ People who internalized the stigma associated with their STI reported the poorest sexual well-being

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Viral Infections (32 of 37) • Human Papilloma Virus (HPV) – The most common viral STI – approximately 70% of Canadians will have at least one HPV infection in their lifetimes.

– Most infections are asymptomatic and harmless.

– In 90% of cases, the body clears the infection within two years.

– There are many different strains.

▪ Types 6 and 11 cause genital warts ▪ Types 16 and 18 can lead to cervical cancer. ..

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Viral Infections (33 of 37) • Human Papilloma Virus (HPV) – Transmission ▪ Vaginal and anal intercourse are most common ways of transmitting HPV.

▪ Oral sex and other types of skin-to-skin contact can also transmit HPV. ▪ Virus is so common, it is difficult to prevent.

▪ Abstinence is the most effective way; condoms don’t eliminate risk entirely because the virus can be spread by skin-to-skin contact of areas not covered by the condom. ..

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Viral Infections (34 of 37) • Human Papilloma Virus (HPV) – Transmission ▪ Genital warts can be hard and yellow-grey when they form on dry skin, or they can take on a pink, soft, cauliflower-like appearance in moist areas.

▪ They can occur on external and internal genitalia.

▪ They can also occur outside the genital area – such as on lips, eyelids, or nipples, around the anus, and in the rectum.

▪ The incubation period for genital warts can be a few weeks to more than a year. ..

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Viral Infections (35 of 37) • Human Papilloma Virus (HPV) – Diagnosis and treatment ▪ Genital warts diagnosed through visual inspection ▪ Pap tests are used to detect precancerous changes to cervix ▪ DNA tests are also sometimes used

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Viral Infections (36 of 37) • Human Papilloma Virus (HPV) – Diagnosis and treatment ▪ Treatment for genital warts: – Cryotherapy (freezing the warts with liquid nitrogen)

– Alcohol-based podophyllin solution, gel, or cream – Burning of with electrodes – Removal with laser or conventional surgery ➢ Removal of the warts doesn’t rid the body of the virus.

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Viral Infections (37 of 37) • Human Papilloma Virus (HPV) – Vaccine ▪ Canada’s National Advisory Committee on Immunization (2016) recommended HPV vaccination for females and males from ages 9 to 26 ▪ All provinces and territories in Canada have implemented this publicly funded vaccine program ▪ Acceptance of the vaccine hasn’t been universal.

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Ectoparasitic Infestations (1 of 4) • Ectoparasites – Live on the outer surfaces of animals – Larger than the agents which cause other STIs

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Ectoparasitic Infestations (2 of 4) • Ectoparasites – Pediculosis (Pthirus pubis) ▪ Infestation by pubic lice ▪ Often called “crabs” because they look like crabs

▪ Spread sexually and via contact with infected objects ▪ Fingers may also transmit the lice from the genitals to other hair-covered parts of the body.

▪ Sexual contact should be avoided until the infestation is eradicated.

▪ Itching is the most prominent symptom. ..

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Ectoparasitic Infestations (3 of 4) • Ectoparasites – Scabies ▪ Infestation caused by tiny mites.

▪ May be transmitted through sexual contact or contact with infested fabrics.

▪ Mites burrow into the skin of the genital area causing itching and discomfort.

▪ Create reddish lines (from burrowing), sores, welts, and blisters on the skin.

▪ Diagnosis is made from scrapings of skin.

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Ectoparasitic Infestations (4 of 4) • Ectoparasites – Scabies ▪ Most often found on the hands and wrists; can also be found on the genitals, buttocks, armpits and feet.

▪ Can be effectively treated with medication.

▪ Sex partners and others in close bodily contact should also be treated.

▪ Clothing and bed linens should be dry-cleaned or washed and dried on hot cycle.

▪ Sexual contact should be avoided until the infestation is eliminated. ..

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STI Epidemiology: Biological, Psychological, and Social Factors (1 of 3) • Biological factors – Multiple means of transmission – Lifelong infections – Asymptomatic cases – Increased vulnerability from some STIs to contracting others – Gender

– Lack of vaccines and cures

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STI Epidemiology: Biological, Psychological, and Social Factors (2 of 3) • Psychological Factors – Perceived low risk – Lack of communication – Psychological obstacles to condom use ▪ e.g., love, trust, embarrassment about purchasing, decreased pleasure or spontaneity

– Alcohol and drug use

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STI Epidemiology: Biological, Psychological, and Social Factors (3 of 3) • Social Factors – Socio-economic status – Social capital – Gender inequality – Sexual orientation – Ethnocultural factors

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Applied Knowledge (1 of 2) • Reducing Your Risks for STIs and HIV – Some suggestions: ▪ Be knowledgeable.

▪ Be abstinent.

▪ Use latex condoms.

▪ Limit your number of sexual partners.

▪ Get tested for STIs and HIV.

▪ Avoid nonsexual risk behaviours.

▪ Get regular medical check-ups.

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Applied Knowledge (2 of 2) • Reducing Your Risks for STIs and HIV – Some suggestions: ▪ Engage in lower-risk sexual behaviours.

▪ Make your own sexual health plan.

▪ Talk to your partners about sexual health.

▪ Talk to your physician if you suspect you have been exposed.

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Innovative Canadian Research (2 of 2) • The male call Canada survey of men who have sex with men (MSM) – 1235 MSM from all of Canada, aged 16 to 89 years – 54.6% identified as gay, 35.6% as bisexual

– Number of sex partners in the last six months – 16.8% none, 22.3% one, 36.8% two–five, 24.0% six+ – 88.1% agreed that the benefits of using condoms outweighed the disadvantages – 75% had been tested for HIV; 6.6% were positive

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Education and Prevention (1 of 2) • A wide variety of groups provide STI- and HIVprevention education – Public Health Agency of Canada – Provincial ministries of health

– Universities – Schools – Community groups

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Education and Prevention (2 of 2) • Most effective programs go beyond providing information and try to motivate people to reduce their risks and acquire specific behavioural skills to enable them to put what they have learned into practice.

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End of Chapter 14

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 15 Sexual Health Education

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Learning Objectives (1 of 2) 1.

2.

3.

4.

5.

Describe the history of sexual health education in Canada.

Describe the assessment and planning, intervention, and evaluation components of sexual health education.

Discuss the Information–Motivation– Behavioural Skills (IMB) model approach to sexual health education.

List and discuss the key ingredients of effective sexual health education.

Describe the impact of abstinence only and broadly based sexual health education. ..

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Learning Objectives (2 of 2) 6.

Describe the attitudes of parents and youth toward sexual health education.

7.

List and discuss current sources of information about sexuality among young people.

8.

Discuss the importance of addressing consent and sexual assault in sexual health education.

9.

Describe available curricula and resources for teaching sexual health education in Canada.

10. Discuss the sexual health education needs of diverse groups in Canada. ..

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Sexual Health Education (1 of 4) • Distinction between “sex education” and “sexual health education” – School-based programs regarding sexuality were controversial.

– “Sexual health education” implied a more specific focus on the health-related aspects of sexuality.

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Sexual Health Education (2 of 4) • World Health Organization’s (2006) definition of sexual health: – State of physical, emotional, mental, and social wellbeing in relation to sexuality – Not merely the absence of disease, dysfunction, or infirmity – Requires a positive and respectful approach to sexuality/sexual relationships – Possibility of having safe sexual experiences, free of coercion, discrimination and violence – To be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. ..

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Sexual Health Education (3 of 4) • Sexuality-related education is often thought of as a mechanism to prevent problems (e.g., STIs).

• A broadly based conceptualization of sexual health education balances problem prevention with positive aspects of personal health/wellbeing.

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Sexual Health Education (4 of 4) • Canadian Guidelines for Sexual Health Education (PHAC, 2008) – Goals of sexual health education 1.

Help people achieve positive outcomes (e.g., self-esteem, rewarding human relationships)

2.

Help people avoid negative outcomes (e.g., STI/HIV, sexual coercion)

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Sexual Health Education in Schools (1 of 3)

• A Brief History – 20th Century: purity education, nature study – 1960s/1970s: little, if any, sexual health education

– 1980s/1990s: alarm over HIV/AIDS, prompted most secondary schools to introduce some form of sexuality education – By mid-1990s, every province/territory mandated or strongly recommended some form of sexuality health education be taught in schools.

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Sexual Health Education in Schools (2 of 3)

• A Brief History – Elementary grades ▪ Biological development ▪ Changes associated with puberty

– Secondary school ▪ Information on STIs

▪ Methods of prevention

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Sexual Health Education in Schools (3 of 3)

• A Brief History – Extent/quality of education varies from province to province, school board to school board, school to school, and classroom to classroom

– Sexual health education usually part of a broader heath curriculum—receives limited time and attention.

– The importance school administrators place on sexual health education and the sense of community support can greatly influence the quality of this education.

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Applied Knowledge • Educating Your Children About Sex – Most children are curious about where babies com from.

– Parents who avoid discussing these matters may teach children that sex is something they should be ashamed of.

– In answering children’s questions, think about the following: ▪ Be approachable and willing to answer questions.

▪ Use appropriate language.

▪ Give advice in the form of information the child can use to make decisions.

▪ Share information in small doses.

▪ Encourage the child to talk about sex.

▪ Respect the child’s privacy rights.

▪ As they get older, keep the conversation going, dispel myths they might come across on the Internet. ..

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Innovative Canadian Research • Sexual Health Education in Schools Across Canada – In 2010, a revised Canadian Guidelines for Sexual Health Education was withdrawn by the provincial government in response to political and media controversy.

– In response, Ophea, Healthy Schools, Healthy Communities (2013) reviewed provincial sexual health documents ▪ Almost all provinces recommended that children learn proper names for body parts by Grade 1 ▪ All provinces recommend that children be taught about physical changes of puberty by Grade 5, with many provinces including psychological, social, and interpersonal changes.

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The Canadian Guidelines for Sexual Health Education • Designed to guide and unify professionals who provide sexual health education in Canada – Basic guide for initiation, development, implementation and evaluation of sexual health education programs in schools and communities

• First edition published in 1994; most recent in 2008 • Three-step process development of sexual health education programs – Assessment and planning – Intervention – Evaluation ..

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Using Theory and Research to Inform Sexual Health Education (1 of 10) • In order for sexual health education programs to be effective, it is necessary that they incorporate an appropriate theoretical model.

• The PHAC (2008) guidelines were based on the Information-Motivation-Behavioural Skills (IMB) Model: – Teach information related to sexual health education – Address motivation factors – Teach specific behavioural skills

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Using Theory and Research to Inform Sexual Health Education (2 of 10)

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Using Theory and Research to Inform Sexual Health Education (3 of 10) • Effective Sexual-Health Education – The IMB Model just one of many key ingredients of effective sexual health education programming.

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Using Theory and Research to Inform Sexual Health Education (4 of 10) Table 15.1 The Key Ingredients of Effective Sexual Health Promotion Programming (1 of 2) The key ingredients of effective sexual health promotion programming include the following:

1. Setting aside a realistic and sufficient allocation of classroom time to achieve program objectives.

2. Providing teachers/educators with the necessary training and administrative support to deliver the program effectively.

3. Employing sound teaching methods, including the utilization of well-tested theoretical models to develop and implement programming (e.g., IMB model, social–cognitive theory, transtheoretical model).

4. Using elicitation research to identify student characteristics, needs, and optimal learning styles, including tailoring instruction to a student’s ethnocultural background, sexual orientation, and development stage.

5. Specifically targeting the behaviours that lead to negative sexual health outcomes such as STI/HIV infection and unintended pregnancy.

6. Delivering and consistently reinforcing the prevention messages related to sexual limit-setting (e.g., delaying first intercourse, choosing not to have intercourse), consistent condom use, and other forms of contraception. ..

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Using Theory and Research to Inform Sexual Health Education (5 of 10) Table 15.1 The Key Ingredients of Effective Sexual Health Promotion Programming (2 of 2) The key ingredients of effective sexual health promotion programming include the following:

7. Including program activities that address the individual’s environment and social context, including peer and partner pressures related to adolescent sexuality.

8. Incorporating the necessary information, motivation, and behavioural skills to effectively enact and maintain behaviours to promote sexual health.

9. Providing clear examples of and opportunities to practise (e.g., role plays) sexual limit-setting, condom use negotiation, and other communication skills so that students are active participants in the program, not passive recipients.

10. Incorporating appropriate and effective evaluation tools to assess program strengths and weaknesses in order to improve subsequent programming.

SOURCE: Used with permission from Sex Information and Education Council of Canada. (2015a0). Sexual health education in the schools: Questions and answers, updated Ontario editions (3rd ed.). Toronto: SIECCAN.

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Using Theory and Research to Inform Sexual Health Education (6 of 10) • Advanced Training in Sexuality for Professionals – Lack of specific training in the area of sexuality for educators/health professionals is a major limitation in the effectiveness of programs.

– Many Canadian universities offer undergraduate courses in sexuality.

– Some offer degree programs in human sexuality (e.g., University of Waterloo), others offer specializations.

– The Guelph Sexuality Conference is the largest annual conference on human sexuality in Canada. ..

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Using Theory and Research to Inform Sexual Health Education (7 of 10) • The Impact of Sexual Health Education: Abstinence-Only Versus Broadly Based Approaches – Abstinence-Only Approaches ▪ Motivate teens to not become sexually active until they are older or married ▪ Do not include information on birth control or safer sex practices ▪ Proponents of this approach suggest that abstinence allows teen to grow up without burden of potential of emotional turmoil that may be a part of sexual relationships. ..

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Using Theory and Research to Inform Sexual Health Education (8 of 10) • The Impact of Sexual Health Education: Abstinence-Only Versus Broadly Based Approaches (Continued) – Abstinence-Only ▪ When schools are associated with religious institutions, school administrators may feel obligated to instruct teachers to stress abstinence.

▪ The programs receive large amounts of funding in the U.S., are less popular in Canada ▪ Evaluations find that these programs are generally ineffective.

▪ They are criticized as being unethical for not providing critical information. ..

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Using Theory and Research to Inform Sexual Health Education (9 of 10) • The Impact of Sexual Health Education: Abstinence-Only Versus Broadly Based Approaches (Continued) – Broadly-Based Programs ▪ Incorporate a wide-range of objectives and ideas ▪ Go beyond biology, pregnancy, STI prevention ▪ Include information on mutually satisfying relationships, sexual orientation, gender-role stereotyping, gender identity ▪ Allow space for students to use the information they have learned to make decisions for themselves.

▪ Called “comprehensive sex education” in the U.S. ..

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Using Theory and Research to Inform Sexual Health Education (10 of 10) • The Impact of Sexual Health Education: Abstinence-Only Versus Broadly Based Approaches (Continued) – Broadly-Based Programs ▪ Research indicates that these programs do not encourage young people to become sexually active at an earlier age.

▪ These programs have a positive impact on behaviour – Delay first intercourse – Encourage use of condoms if sexually active – Encourage reduction of sexually risky behaviour ..

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Attitudes Towards Sexual Health Education (1 of 4) • Conflicts regarding sexual health education are often rooted in opposing ideological perspectives related to human sexuality.

– Restrictive sexual ideology ▪ Traditional moral standards for sexual behaviour ▪ Limited to procreative heterosexual intercourse within marriage

• Permissive sexual ideology – Sexual behaviour should be guided by honesty, equality, responsibility, and informed consent. ..

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Attitudes Towards Sexual Health Education (2 of 4) • Parental Attitudes – Research suggests that parents in several parts of Canada have favourable attitudes toward the provision of sexual health education in schools.

– Parents also agreed with providing youth with information on a range of topics.

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Attitudes Towards Sexual Health Education (3 of 4) • Youth Attitudes – Surveys indicate that youth want sexual health education in schools.

– Rate a range of topics as being very important (e.g., puberty, sexual coercion, STIs) – Many students are disappointed with the quality of sex education they received.

– Students report dissatisfaction because programs neglect the emotional and positive aspects of sex. ..

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Attitudes Towards Sexual Health Education (4 of 4) • Youth Attitudes – Toronto Teen Survey ▪ 92% reported receiving some form of sexual health education ▪ Most common topics: HIV/AIDs, STIs, pregnancy, and birth control options ▪ Fewer learned about communication (61%), relationships (61%), sexual assault (58%), sexual orientation (51%), and sexual pleasure (42%)

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Current Sources of Information About Sexuality (1 of 2) • Canadian youth identify range of sources of sexual health information: – School (80%) – Friends (76%) – Parents (63%) – Television (54%) – Books (52%) – Internet (44%) – Magazines (39%) – Doctors (37%) – Chat lines (20%) – Nurses (19%) ..

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Current Sources of Information About Sexuality (2 of 2) • Youth rank school and parents as the most useful and most valuable sources of information about sexuality.

• Recent study of young adults in the Ottawa region found that educational websites/news outlets and peers ranked ahead of schools/university courses as frequent sources of sexual health information • One quarter of boys in a Canadian survey said they could talk openly about sex with their fathers or mothers – For girls, 37% said they could talk with their mothers but far fewer (12%) said they could talk to their fathers ..

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Addressing Consent and Sexual Assault in Sexual Health Education • Educational programs can provide information on sexual consent to young people as they approach the ages at which a sizable proportion of young people become sexually active • Sexual health education should provide students with the information necessary to be able to identify when they have been sexually assaulted or abused (SIECCAN 2015)

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Innovative Canadian Curricula and Resources • Action Canada for Sexual Health and Rights (2017) has recently introduced an updated and completely revamped edition of Beyond the Basics: A Resource for Educators on Sexuality and Sexual Health.

• Beyond the Basics takes a sex-positive, rightsbased approach, and many of the activities are informed by the IMB model recommended by the Canadian Guidelines for Sexual Health Education.

• There are many examples of innovative curricula in various settings including online ..

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Meeting the Sexual Health Needs of Diverse Groups (1 of 2) • Sexual-Minority Youth – Many sex education programs do not address LBGTQ youth – The PHAC has created resources that provide teachers and school personnel with guidance on supporting sexual-minority youth.

– Sexual minority high-school students play important activist roles in challenging heterosexism and homophobia in schools.

– Teacher’s organizations in Canada have adopted policies that support LGBTQ youth (e.g., gay-straight alliances). ..

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Meeting the Sexual Health Needs of Diverse Groups (2 of 2) • Youth with Disabilities – The sexual health education needs of young people with disabilities are often ignored.

– Five principles of the Canadian Guidelines for Sexual Health Education can be applied to the education specific to the needs of people with physical and developmental disabilities

– There is a growing awareness of the need for sexual health education programs specific to needs of youth with autism spectrum disorders (ASD). ..

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Innovative Canadian Research (1 of 3) • Sexual Health Education for Youth with Physical Disabilities – East & Orchard (2013) interviewed youth with physical disabilities, parents, and health care providers regarding sexuality attitudes and sexuality education experiences ▪ Youth: highlighted need to discuss disability-related issues in general health classes to counteract myths around disabilities and sexuality – Expressed need for more sex-positive discussions, less emphasis on protection and prevention

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Innovative Canadian Research (2 of 3) • Sexual Health Education for Youth with Physical Disabilities – East & Orchard (2013) interviewed youth with physical disabilities, parents and health providers regarding sexuality attitudes and sexuality education experiences ▪ Parents: did not feel competent to deliver sexual health education to children, preferred to pass responsibility on to schools/health care providers

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Innovative Canadian Research (3 of 3) • Sexual Health Education for Youth with Physical Disabilities – East & Orchard (2013) interviewed youth with physical disabilities, parents and health providers regarding sexuality attitudes and sexuality education experiences ▪ Health care providers: sometimes lacked relevant information, sufficient time; privacy concerns; sensed parental and social disapproval related to provision of sexual health education to children with disabilities

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Meeting the Sexual Health Needs of Diverse Groups (1 of 3) • Adults – Often the most credible and accessible source for sex information for adults is their physician.

▪ But many patients are reluctant to ask their doctor about sexual concerns.

– Many doctors do not proactively bring up sexual health issues.

– Research indicates that physicians receive inadequate training in discussing sexuality with patients—this appears to be improving. ..

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Meeting the Sexual Health Needs of Diverse Groups (2 of 3) • Adults – Greater awareness of sexual function issues combined with greater emphasis on sexual issues in the medical community → resulted in literature growth advising physicians .

– Controversy regarding medicalization of sexuality – Accessing sexually relevant health care can be challenging for LGBT adults.

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Meeting the Sexual Health Needs of Diverse Groups (3 of 3) • Education and Services in a Multicultural Society – Canada’s ethnocultural diversity presents a challenge to sexual health educators/providers.

– An inclusive practice: ▪ Emphasizes the importance of self-determination ▪ Acknowledges cultural uniqueness ▪ Builds the capacity to advocate for and access sexual health services ▪ Includes First Nations, Inuit, and Métis cultures ..

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End of Chapter 15

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 16 Sexual Variations

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Learning Objectives (1 of 2) 1.

List and discuss different approaches to defining normal versus deviant sexual behaviour.

2.

List and define the paraphilias.

3.

Discuss biological perspectives on paraphilias.

4.

Discuss psychoanalytic perspectives on paraphilias.

5.

Discuss cognitive-behavioural perspectives on paraphilias. ..

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Learning Objectives (2 of 2) 6.

Discuss sociological perspectives on paraphilias.

7.

Discuss the “lovemap.”

8.

Discuss the psychoanalytic treatment of paraphilic disorders.

9.

Discuss the cognitive-behavioural treatment of paraphilic disorders.

10. Discuss medical treatment of paraphilic disorders. ..

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Normal Versus Deviant Sexual Behaviour (1 of 2) • What is normal?

– Western society tends to classify behaviour as “normal” or ‘abnormal”.

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Normal Versus Deviant Sexual Behaviour (2 of 2) • What is normal?

– Statistical – how much sexual behaviour deviates from the statistical norm – Social norm – how closely aligned sexual behaviour is with current accepted norms in society – Harm – sexual behaviour is abnormal if it causes stress, anxiety, or unhappiness for the individual or harms someone else

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The Paraphilias (1 of 28) • Paraphilias – A diagnostic category used by the American Psychiatric Association to describe atypical variations in sexual behaviour

– “Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (DSM-5, 2013)

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The Paraphilias (2 of 28) • Paraphilias – Involve sexual arousal in response to unusual stimuli, such as children or other non-consenting individuals (e.g., watching unsuspecting people), nonhuman objects (e.g., shoes, undergarments), or pain or humiliation – Behaviours that are consenting or unharmful are described as kinky sex.

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The Paraphilias (3 of 28) • Paraphilias – The DSM-5 distinguishes between a paraphilia and paraphilic disorder: – Paraphilic disorder: ▪ A paraphilia that causes distress or impairment to the individual, causes personal distress and/or harm to the individual or to others

▪ Atypical patterns of arousal or behaviour that become problematic in the eyes of the individual or potentially cause harm ..

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The Paraphilias (4 of 28) • Paraphilias – Some paraphilias are harmless and victimless (e.g., cross-dressing to achieve sexual arousal).

– Some experts believe that some paraphilias should not be considered psychiatric disorders (Moser 2016, Moser & Kleinplatz, 2005): ▪ Unusual sexual interests aren’t, in and of themselves, signs of pathology ▪ Paraphilias should be removed from the DSM ▪ Section in DSM on paraphilia is based on political values not scientific findings ..

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The Paraphilias (5 of 28) • Paraphilias – Perceived as persistent, demanding, compulsive, uncontrollable – Vary in severity – Often replayed in fantasy – More common among men than women (Bouchard, Dawson, & Lalumiere, 2017; Joyal & Carpentier, 2017)

– Prevalence is unknown

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The Paraphilias (6 of 28) • Fetishism – A paraphilia in which an inanimate object, such as an article of clothing or items made out of rubber, leather, or silk, elicit sexual arousal ▪ Leather boots and high-heeled shoes are popular

– The fetishist may act on urges while masturbating.

– Most fetishes are harmless and private.

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The Paraphilias (7 of 28) • Partialism – A fetishism-related paraphilia in which sexual arousal is exaggeratedly associated with a particular body part, such as feet, breasts, or buttocks

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The Paraphilias (8 of 28) • Transvestism – A paraphilia in which a person repeatedly crossdresses to achieve sexual arousal or gratification, or is troubled with persistent, recurrent urges to cross-dress.

– The clothing or object is only sexually alluring when the person is wearing it.

– Transvestites are mostly male (may be gay or heterosexual).

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The Paraphilias (9 of 28) • Transvestism – Different than transgenderism ▪ Many transvestites have masculine gender identities and do not seek to change their anatomic sex.

▪ Transgender people usually cross-dress because they are uncomfortable with the attire associated with members of their anatomic sex and wish to be members of the other gender.

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The Paraphilias (10 of 28) • Transvestism – Origins are largely unknown, but has been associated with separation from parents, same-sex sexual experiences, use of pornography, high rates of masturbation, and other paraphilias – The cross-dressing individual may use a single clothing item or a whole outfit.

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The Paraphilias (11 of 28) • Exhibitionism – A paraphilia characterized by persistent, powerful urges and sexual fantasies that involve exposing one’s genitals to unsuspecting strangers – The exhibitionist achieves sexual arousal or gratification from this behaviour.

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The Paraphilias (12 of 28) • Exhibitionism – Exhibitionists are more often men.

▪ In a survey of Quebec adults, 7.7% of men and 2.7% of women indicated that they had, at least once in their lifetimes, become sexually aroused by showing their genitals

– Behaviour usually begins before age 18 – Urge to “flash” usually occurs between the ages of 13 and 16 – Frequency declines after age 40 ..

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The Paraphilias (13 of 28) • Exhibitionism – Typical exhibitionist is thought to be male, young, lonely or in an unhappy male-female relationship, and sexually repressed ▪ Many are single, find it hard to relate to women ▪ May attempt to assert masculinity or express hostility towards women ▪ May be shy, passive, lack sexual and social skills

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The Paraphilias (14 of 28) • Exhibitionism – Flashing may be trivialized as a “nuisance crime” – Can have serious psychological consequences for victims – Ontario study of exhibitionists: ▪ 12% were convicted of other sexual offences ▪ 17% were convicted of violent crimes

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The Paraphilias (15 of 28) • Exhibitionism – Bring into focus boundaries of normal and abnormal behaviour ▪ For example: – Individuals displaying their body to a relationship partner – Exotic dancers exposing themselves to strangers

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The Paraphilias (16 of 28) • Obscene Phone Calling (Telephone Scatologia) – A paraphilia characterized by the making of obscene telephone calls – Usually males who become sexually aroused by shocking their victims – Women who do so are usually motivated by rage rather than sexual excitement – Many patterns of obscene phone calling

– The typical obscene phone caller is a socially inadequate heterosexual male who has difficulty forming relationships with women. ..

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Applied Knowledge • Responding to Exhibitionists and Obscene Phone Callers – How to respond to an exhibitionist ▪ Stay calm; do not display shock or fear

▪ Could advise that the individual seek professional help ▪ Report incident to the police

– How to respond to an obscene phone caller ▪ Remain calm; do not reveal shock or fright ▪ Hang up, or advise the caller to seek professional help ▪ Request an unlisted number or call trace ..

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The Paraphilias (17 of 28) • Voyeurism – A paraphilia characterized by strong, repetitive urges and sexual fantasies related to observing unsuspecting strangers who are naked, disrobing, or engaged in sexual relations – The voyeur becomes aroused by watching and does not seek to participate – More common among men – Usually begins before age 15 – May include masturbation during or afterwards ..

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Innovative Canadian Research (1 of 2) • Would you engage in voyeuristic behaviour?

– Rye and Meaney (2007) conducted a survey to determine if university students would, hypothetically, watch an attractive person undressing or two attractive people having sex ▪ Most said they would watch someone undress if they wouldn’t be caught.

▪ Fewer women (40%) than men (70%) said they would watch a couple have sex.

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The Paraphilias (18 of 28) • Sexual Masochism – A paraphilia characterized by the desire or need for pain or humiliation to enhance sexual arousal and attain gratification

– The most common paraphilia among women

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The Paraphilias (19 of 28) • Sexual Masochism – Sexual masochist is a person who becomes sexually aroused by experiencing pain or humiliation inflected by a sexual partner – Sexual masochists may derive pleasure from various types of punishing experiences, including being restrained, blindfolded, spanked, whipped, or made to perform humiliating acts

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The Paraphilias (20 of 28) • Sexual Masochism – The association of sexual arousal with mildly painful stimuli is actually quite common.

▪ Pain increases overall bodily arousal, which may enhance sexual excitement.

– When desire for pain for the purposes of sexual arousal overshadows other sources of sexual stimulation, or when masochistic experience causes physical or psychological harm, it is considered “abnormal”. ..

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The Paraphilias (21 of 28) • Sexual Masochism – Hypoxyphilia ▪ A practice in which a person seeks to enhance sexual arousal, usually during masturbation, by depriving themselves of oxygen ▪ Also known as auto-erotic asphyxia ▪ Miscalculations can result in death by suffocation or strangulation.

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The Paraphilias (22 of 28) • Sexual Sadism – A paraphilia characterized by the desire to inflict pain or humiliation on others to enhance sexual arousal and attain gratification – The sexual sadist acts on urges or finds them distressing.

– Some hurt or humiliate willing partners; a small minority stalk and attack non-consenting victims.

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The Paraphilias (23 of 28) • Sexual Sadism – Sado-masochism (S&M) – Mutually gratifying sexual interaction between consenting partners, in which sexual arousal is associated with inflicting and receiving pain and humiliation – A variation is bondage and discipline (B&D) ▪ Restraining and punishing a partner physically or verbally

– Small minority of relationships are 24/7 (attempts to live full time in owner-slave relationship) ..

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The Paraphilias (24 of 28) • Sexual Sadism – Sado-masochism (S&M) ▪ Sadomasochism becomes pathological when the fantasies are acted on in ways that become destructive, dangerous, or distressing to either partner.

▪ Some S&M practices can be dangerous.

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The Paraphilias (25 of 28) • Sexual Sadism – Sado-masochism (S&M) ▪ Sexual sadists and masochists form a subculture to inflict and receive pain and humiliation during sexual activity.

▪ Often involves highly elaborate rituals ▪ Psychological pain is as common as physical pain.

▪ Extreme forms of pain are rarely reported (e.g., torture, severe beatings).

▪ Participation varies in terms of gender, gender identity, and sexual orientation. ..

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The Paraphilias (26 of 28) • Sexual Sadism – Sado-masochism (S&M) ▪ There is a negative stereotype that people who engage in S&M behaviours are mentally disturbed.

– Research does not support this view – There is no evidence that people involved in S&M have greater difficulty than others in establishing intimate relationships.

– There is no evidence that engaging in S&M is distressing or dysfunctional.

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Innovative Canadian Research (2 of 2) • The Personality Characteristics of Dominant and Submissive BDSM Practitioners – Researchers in Nova Scotia (Hebert & Weaver, 2014) examined self-identified dominants and submissives: ▪ Dominants: higher on measures of desire for control, extraversion, self-esteem, life satisfaction ▪ Submissives: higher on measure of emotionality ▪ No difference: empathy, honesty-humility, conscientiousness, open to experience, altruism, agreeableness

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The Paraphilias (27 of 28) • Frotteurism – A paraphilia characterized by recurrent, powerful sexual urges and fantasies that involve rubbing against or touching a non-consenting person

– Also known as mashing or groping – Has been reported exclusively among males – Mostly takes place in crowded places

– Man fantasizes about a consenting relationship

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The Paraphilias (28 of 28) • Frotteurism – Often fleeting so goes unnoticed – Many men have difficulty forming relationships with women and are handicapped by fears of rejection.

– Toucherism ▪ A practice related to frotteurism, characterized by the persistent urge to fondle non-consenting strangers.

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Other Paraphilias (1 of 4) • Zoophilia – A paraphilia involving persistent or repeated sexual urges and fantasies that involve sexual contact with animals

– Actual contact with an animal is known as bestiality.

• Necrophilia – A paraphilia characterized by a desire for sexual activity with corpses

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Other Paraphilias (2 of 4) • Necrophilia – Regular necrophilia ▪ Individual has sex with a deceased person

– Necrophilic homicide ▪ Individual commits murder to obtain a corpse for sexual purposes

– Necrophilic fantasy ▪ Individual fantasizes about sex with a corpse

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Other Paraphilias (3 of 4) • Necrophilia – Some necrophiliacs get jobs where they can access corpses.

– The primary motivation appears to be desire to completely possess an unresisting and non-rejecting partner.

– Many necrophiliacs have other serious psychological disorders.

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Other Paraphilias (4 of 4) • Other Less Common Paraphilias – Klismaphilia ▪ A paraphilia in which sexual arousal is derived from the use of enemas

– Coprophilia ▪ A paraphilia in which sexual arousal is attained in connection with feces

– Urophilia ▪ A paraphilia in which sexual arousal is associated with urine ..

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Theoretical Perspectives (1 of 4) • Biological Perspectives – Influence of endocrine (hormonal) and nervous systems on paraphilic behaviour – Higher-than-normal sex drives – Brain differences

• Psychoanalytic Perspectives – Psychological defenses, usually against unresolved castration anxiety, repressed feelings of guilt and shame ..

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Theoretical Perspectives (2 of 4) • Cognitive-Behavioural Perspectives – Fetishes and other paraphilias are learned ▪ Association ▪ Punishment ▪ Observational learning

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Theoretical Perspectives (3 of 4) • Sociological Perspectives – Focus on the effects of the group and society on individual and group behaviour ▪ e.g., S&M provides the opportunity to reverse customary power relationships between males and females and social classes

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Theoretical Perspectives (4 of 4) • An Integrative Perspective: The ”Lovemap” – Paraphilias may have complex biopsychosocial origins.

▪ John Money (2003) traces paraphilias to ‘lovemaps’ which form in childhood.

▪ In the case of paraphilias, lovemaps become distorted by early traumatic experiences

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Treatment of Paraphilias (1 of 7) • Treatment for paraphilias raises a number of issues: – Many people don’t want to seek treatment – Health care providers may encounter ethical problems when asked to persuade sex offenders to change their behaviours – Health care providers realize they are generally unsuccessful in treating resistant clients.

– Sex offenders typically claim that they can’t control their impulses. ..

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Treatment of Paraphilias (2 of 7) • Psychoanalytic therapy – Focuses on resolving unconscious conflicts that are believed to originate in childhood – Has not been subjected to experimental analysis, so it is not known how effective this approach is in treating paraphilias.

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Treatment of Paraphilias (3 of 7) • Cognitive-Behaviour Therapy – Systematic application of the principles of learning in order to modify a problem behaviour – Systematic desensitization ▪ A method for terminating the connection between a stimulus and an inappropriate response ▪ The individual practices muscle relaxation in the presence of a series of increasingly arousing stimuli, until s/he learns to remain relaxed (and not sexually aroused) in their presence

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Treatment of Paraphilias (4 of 7) • Cognitive-Behaviour Therapy – Aversion therapy ▪ A method for terminating an undesirable sexual behaviour in which the behaviour is repeatedly paired with an aversive stimulus, such as an electric shock, until the person develops a conditioned aversion to the stimulus

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Treatment of Paraphilias (5 of 7) • Cognitive-Behaviour Therapy – Covert sensitization ▪ A form of aversion therapy in which thoughts of engaging in an undesirable behaviour are repeatedly paired with imagined aversive stimuli

– Pedophiles ▪ Persons with pedophilia, a paraphilia that involves sexual interest in children

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Treatment of Paraphilias (6 of 7) • Cognitive-Behaviour Therapy – Social skills training ▪ A method of behaviour therapy that relies upon coaching and practice to build social skills

– Orgasmic reconditioning ▪ A method for strengthening the connection between sexual arousal and appropriate sexual stimuli

▪ Involves repeatedly pairing the desired stimulus with orgasm

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Treatment of Paraphilias (7 of 7) • Medical Approaches – No drug or surgical technique eliminates paraphilic ideas while leaving other cognitive functions intact.

– Antidepressants – Anti-androgen drugs ▪ Substance that reduces sex drive by lowering the level of testosterone

▪ Chemical castration ▪ Surgical castration has sometimes been performed on convicted rapists and violent sex offenders. ..

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Sexual Addiction, Compulsive Sexual Behaviour and Hypersexuality (1 of 3) • Sex addiction – Conceptualized as similar to other addictions – A sex addict engages in sexual behaviour to relieve anxiety, but doesn’t feel a high level of sexual gratification.

– The addict experiences withdrawal symptoms.

– Treatment similar to that for other addictions.

– Some experts argue that excessively frequent, out-ofcontrol sexual behaviour is not an addiction ..

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Sexual Addiction, Compulsive Sexual Behaviour and Hypersexuality (2 of 3) • Compulsive Sexual Behaviour – Excessively frequent, out-of-control sexual behaviour is not an indication that an individual is addicted to sex.

– This behaviour is seen as being an obsessivecompulsive disorder.

– Treatment is similar to treatment for other obsessivecompulsive disorders, including medications.

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Sexual Addiction, Compulsive Sexual Behaviour and Hypersexuality (3 of 3) • Hypersexuality – Was being considered for inclusion in the DSM-5; but eventually not included – Proposed criteria were similar to those commonly described for sex addiction and compulsive sexual behaviour.

– The concept of hypersexuality as a mental disorder is highly controversial.

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End of Chapter 16

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 17 Sexual Coercion

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Learning Objectives (1 of 3) 1. Describe the levels of sexual assault according to Canadian law.

2. Summarize key findings about sexual assault according to national Canadian surveys.

3. Discuss the prevalence of and factors associated with sexual assault on campus.

4. Compare and contrast types of sexual assault.

5. Describe factors associated with sexual assault against males.

6. Discuss factors that make consent challenging to communicate and discern. ..

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Learning Objectives (2 of 3) 7. Discuss attitudes that can facilitate sexual assault.

8. Describe factors that are associated with sexual coercion in men.

9. Discuss the effects of sexual assault on survivors and common treatment approaches.

10. Discuss ways of preventing rape, including campus prevention programs and Internet apps.

11. Describe verbal pressure tactics in sexual coercion.

12. Summarize findings on child sexual abuse in Canada.

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Learning Objectives (3 of 3) 13. Describe Canadian laws related to the sexual exploitation of children and youth.

14. Summarize current research on pedophiles.

15. Describe abusive sexual relationships that can occur in families.

16. Describe effects of sexual abuse in children and in later life.

17. Discuss the treatment options for treating sexual offenders.

18. Discuss the various kinds of sexual harassment. ..

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Sexual Assault (1 of 38) • Sexual Assault – Any form of sexual activity forced on another person, or nonconsensual bodily contact for sexual purposes – Replaced “rape” as the term used in the Canadian legal system

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Sexual Assault (2 of 38) • Level 1 – Any form of sexual activity forced on another person, or non-consensual bodily contact for a sexual purpose – Touching, kissing, and oral, vaginal, and anal sex – Minor physical injury or no physical injury – Conviction is punishable by up to 10 years in prison

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Sexual Assault (3 of 38) • Level 2 – Sexual assault in which a perpetrator uses or threatens to use a weapon, threatens the victim’s friends or family members, causes bodily harm to a third party, or commits the assault with another person – Punishable by up to 14 years in prison

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Sexual Assault (4 of 38) • Level 3 – A sexual assault that wounds, maims, or disfigures the victim, or endangers the victim’s life – Conviction is punishable by up to life in prison

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Sexual Assault (5 of 38) • Sexual assault – There is no statute of limitations for persecution of sexual assault.

– A central issue is whether or not consent has been given.

▪ A person has to be capable of giving consent.

▪ Intoxication, fear of harm and age can make a person unable to give consent

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Sexual Assault (6 of 38) • Sexual assault: Canadian law – Considers sexual assault to be an act of power and dominance, rather than an act of sex – Is gender-neutral with regard to sexual assault – Allows for sexual assault to be committed against one’s spouse – Allows for consent to be given to some activities but not to others (i.e. “stealthing”) – People with HIV can be charged with sexual assault if they do not disclose their status to their partner. ..

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Sexual Assault (7 of 38) • Incidence in Canada – In Canada in 2015, the Uniform Crime Reporting Survey (UCR) indicated that: ▪ Over 21 000 sexual offences were reported to the police – The majority (98%) were Level 1 offences.

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Sexual Assault (8 of 38) • Incidence in Canada – In Canada in 2015, the Uniform Crime Reporting Survey (UCR) indicated that: ▪ Highest rates reported to police occurred in Nunavut, NWT, and Yukon ▪ Lowest reported rates in Ontario, B.C., PEI, and Quebec

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Sexual Assault (9 of 38) • Incidence of Sexual Assault – The General Social Survey (GSS) calculates selfreported crime rates with a representative sample of Canadians aged 15 and older: ▪ 635 000 incidents of sexual assault in Canada in 2014 ▪ Most (71%) involved unwanted sexual touching, grabbing, kissing, and fondling ▪ 20% involved more serious sexual attacks

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Sexual Assault (10 of 38) • Incidence of Sexual Assault – The General Social Survey (GSS) calculates selfreported crime rates with a representative sample of Canadians aged 15 and older: ▪ Assault rates much higher for those displaying other risk factors such as mental health conditions, a history of homelessness and childhood abuse ▪ Reported 35 incidents of sexual assault per 1000 women in Canada

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Sexual Assault (11 of 38) • Incidence of Sexual Assault – This data reveals a large difference between the number of sexual assaults reported to the police and those that actually take place.

– Researchers estimate that only 1/10 sexual assaults in Canada is reported to the police.

– False allegations are rare.

– There is a rising incidence of drug-facilitated sexual assaults.

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Sexual Assault on Campus • Frequency of harassment varies: – 1 in 5 women report some form of sexual assault – Rates increase for transgender and minority students, as well as first year students

• Criticism of current campus-based programs (“No means No”) • Assault prevention should focus on sociocultural determinants of sexual violence (Humphreys)

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A World of Diversity • Female Sexual Offenders – Researchers estimate that women are responsible for 4–5% of all sexual offences.

– Little is known about female sex offenders.

▪ They are less likely than males to use force.

▪ They are less likely than males to deny actions.

▪ Many have been physically or sexually abused as children.

▪ About one-third acted in tandem with male offenders.

▪ One sub-type is called the “teacher/lover”. ..

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Sexual Assault (12 of 38) • Types of Sexual Assault – Stranger sexual assault ▪ Sexual assault committed by an assailant previously unknown to the person

▪ The assailant selects a target who seems vulnerable and seeks out a safe time and place to attack.

▪ In 2014, 44% of reported incidents involved stranger sexual assault

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Sexual Assault (13 of 38) • Types of Sexual Assault – Acquaintance Sexual Assault ▪ A sexual assault committed by someone known to the victim

▪ These assaults are less likely to be reported to police than assaults by strangers.

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Sexual Assault (14 of 38) • Types of Sexual Assault – Date Sexual Assault ▪ Common form of acquaintance sexual assault ▪ More likely to occur after some other consensual sexual activity occurs.

▪ Alcohol is implicated in half of Date Sexual Assaults cases.

▪ Some men interpret resistance as being coy or gameplaying.

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Sexual Assault (15 of 38) • Types of Sexual Assault – Date Sexual Assault ▪ It can be more challenging for the courts to determine if consent was given in cases of established relationships.

▪ If a woman says no and a man forcibly violates her, then she has been assaulted.

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Sexual Assault (16 of 38) • Types of Sexual Assault – Intimate partner or marital sexual assault ▪ Probably more common than date rape, because a relationship has already been established.

▪ A “traditional” man may believe it is a woman’s duty to satisfy his sexual needs, even when she is not interested.

▪ This type of assault often goes unreported.

– May not be recognized by victims as assault – Victims may fear others won’t believe them.

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Sexual Assault (17 of 38) • Types of Sexual Assault – Intimate partner or marital sexual assault ▪ Motives include domination and degradation ▪ Often occurs within a pattern of violence and physical intimidation ▪ Victims may fear physical injury and death as much as victims stranger assault do.

▪ Long-term effects are similar to those of stranger assaults (fear, depression, sexual dysfunction).

▪ The woman usually has to live with her assailant, and may fear repeated attacks.

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Sexual Assault (18 of 38) • Types of Sexual Assault – Group sexual assault ▪ The exercise of power appears to be the major motive behind gang sexual assaults.

▪ Some attackers may be expressing anger against women.

▪ Sexual assaults involving groups of attackers tend to be more vicious than individual assaults.

▪ Relatively few survivors of gang assaults reported the attacks to police or sought support from rape-crisis centres.

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Sexual Assault (19 of 38) • Types of Sexual Assault – Sexual assault against males ▪ Rates are far lower than sexual assault rates against females, but more common than people assume

▪ According to GSS data, there were 204 000 incidents of sexual assault committed against men in 2009.

▪ 1 in 5 university men reported being coerced into sex in the previous year.

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Sexual Assault (20 of 38) • Types of Sexual Assault – Sexual assault against males ▪ Most sexual assaults against men are committed by other men – Most attackers are heterosexual.

– Motives include domination, control, revenge, retaliation, sadism, degradation, status/affiliation.

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Sexual Assault (21 of 38) • Types of Sexual Assault – Sexual assault against males ▪ Occurs often in prison, and outside of prison – Sports hazing rituals

– The media has recently reported many cases of men in positions of authority assaulting boys.

▪ Male survivors may experience traumatic effects similar to those suffered by female survivors.

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Sexual Assault (22 of 38) • Types of Sexual Assault – Sexual assault against gay and bisexual males ▪ One study found that 14% had been forced or coerced into having sex before the age of 14.

▪ Half of the reported incidents involved forced receptive anal intercourse.

▪ Men who’d been sexually coerced had lower rates of self-esteem and higher rates of depression; they were more likely to abuse alcohol and have attempted suicide.

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Sexual Assault (23 of 38) • The Complexity of Consent – The issue of sexual consent is central.

▪ Consent has been defined and conceptualized in many ways – Can it be given under duress?

– Must it be given verbally?

– How do people actually ask for and give consent?

– Is it a clear yes or no?

▪ Most men and women give consent indirectly.

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Sexual Assault (24 of 38) • The Complexity of Consent – Consent ▪ Some assume men are always willing to have sex, and that women seldom initiate.

▪ Sex education often does not provide women with strategies for saying yes to sex.

▪ Little research has been done on consent among gay men and lesbians.

▪ Most research has been conducted on violent encounters. ..

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Sexual Assault (25 of 38) • The Complexity of Consent – Consent ▪ Jozkoski and Humphreys (2014) provide suggestions for programs to reduce sexual assault on campus: – Focus attention away from idea that sex involves an initiator and recipient—promote a collaborative effort to ensure positive, consensual sex.

– Educational institutions should address gender inequality.

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Sexual Assault (26 of 38) • The Complexity of Consent – Consent ▪ Jozkoski and Humphreys (2014) provide suggestions for programs to reduce sexual assault on campus: – Educational programs at all levels should teach critical awareness of media messages that objectify women, promote violence, discrimination, and sexism.

– Sexual assault prevention education should focus on deconstructing sociocultural determinants of sexual violence.

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Sexual Assault (27 of 38) • Social Attitudes and Myths – e.g., women say no when they mean yes, women like men who are forceful and pushy, women dress in a way that invites assault, women want to be assaulted ▪ Myths create a climate which legitimizes sexual assault.

▪ Gender, gender roles, ethnicity, and endorsement of other social attitudes are associated with acceptance of these myths.

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Sexual Assault (28 of 38) • Social Attitudes and Myths – Many contend that our society encourages sexual assault by socializing males into socially and sexually dominant roles.

– Research supports the connection between stereotypical masculine identification and tendencies to sexually assault.

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Sexual Assault (29 of 38) • Social Attitudes and Myths – Young men may come to view dates not as chances to get to know their partners, but as opportunities for sexual conquest.

– Linking sexual behaviour and sports – Proposed to have roots in evolutionary history when men were forced to compete for limited sexual resources

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Sexual Assault (30 of 38) • Sexually Coercive Men – Not all men are equally likely to act in sexually aggressive ways.

– Researchers seek out factors that predict which men are more likely to be sexually coercive, e.g., ▪ Antisocial personalities ▪ Long histories of violent behaviour

▪ Violence and sexual arousal become connected

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Sexual Assault (31 of 38) • Sexually Coercive Men ▪ Other associated characteristics: ▪ More aroused by portrayals of rape ▪ More likely to come from families with alcohol problems ▪ More likely to abuse alcohol ▪ More likely to have experienced childhood sexual abuse, pornography during childhood, and deviant sexual fantasies during childhood and adolescence

– Research is biased because it usually only includes offenders. ..

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Sexual Assault (32 of 38) • Adjustment of Sexual Assault Survivors – Sexual assault is terrifying; victims may fear for their lives, and feel helpless.

– In the days and weeks following, many survivors are in crisis: ▪ Experience insomnia, crying, eating problems, menstrual irregularities ▪ Become withdrawn, sullen, mistrustful ▪ May experience guilt and shame

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Sexual Assault (33 of 38) • Adjustment of Sexual Assault Survivors – Emotional distress tends to peak about three weeks after the assault and tends to remain high for a month or two, before abating.

– Many survivors have more lasting problems ▪ Feeling powerless to affect their own fates ▪ Encountering problems at work

▪ Impaired relationships with partners ▪ Sexual problems ..

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Sexual Assault (34 of 38) • Adjustment of Sexual Assault Survivors – Many do not to report assaults to the police ▪ Fear retaliation ▪ Fear social stigma ▪ Worry others won’t believe them ▪ Feel it’s hopeless to bring charges against perpetrator

▪ Have concerns about negative publicity ▪ Fear emotional distress if the case goes to trial

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Applied Knowledge • If You’re Sexually Assaulted – Don’t change anything about your body.

– Strongly consider reporting the incident.

– Ask a relative or friend to take you to the hospital.

– Seek help in an assertive way.

– Question health care professionals about health risks and treatments.

– Consider calling a sexual-assault hotline.

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Sexual Assault (35 of 38) • Psychological Disorders Resulting from Sexual Assault – Anxiety disorders and depression – Alcohol and substance abuse

– Lower self-esteem – Post-traumatic stress disorder (PTSD) ▪ A type of stress reaction brought on by a traumatic event characterized by flashbacks of the experience in the form of dreams or intrusive recollections, a sense of emotional numbing or restricted range of feelings, and heightened body arousal ..

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Sexual Assault (36 of 38) • Treatment of Sexual Assault Survivors – Two-stage process – Helping the victim through the crisis after the attack – Fostering long-term adjustment

• Psychotherapy – To help deal with emotional consequences, avoid selfblame, improve self-esteem, validate experiences, establish or maintain loving relationships, mobilize social support

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Sexual Assault (37 of 38) • Preventing Sexual Assault – Total elimination would require massive changes in cultural attitudes and socialization practices.

– Education can reduce its incidence.

– Until basic cultural attitudes which support sexual assault change, women must take a number of precautions.

– This is not the same as blaming the victim – the assailant is always responsible for the assault.

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Sexual Assault (38 of 38) • Confronting the Attacker – Should you fight, flee, or plead?

▪ Some women have thwarted attacks by pleading or crying.

▪ Screaming may ward off some attacks.

▪ Self-defense training may help you fend off an assailant, however physical resistance may also spur some assailants to become more aggressive.

▪ No single strategy is likely to be helpful in all situations. ..

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Coercive Verbal Pressure Tactics (1 of 2) • Verbal sexual coercion – Persistent verbal pressure or the use of seduction lines to manipulate a person into sexual activity – A wide spectrum of persuasion, which not all would consider coercive – Used more often than physical coercion

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Coercive Verbal Pressure Tactics (2 of 2) • Verbal sexual coercion – Tactics include: ▪ Using alcohol and drugs to loosen a partner’s reluctance to have sex ▪ Using obligations, expectations, and guilt ▪ Exploiting emotional and economic vulnerabilities

– Continual arguments and verbal pressure are the most common tactics, followed by the use of alcohol or drugs – Women and individuals in same-sex relationships also use verbal coercion

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Sexual Abuse of Children (1 of 19) • Children who are sexually assaulted often suffer social and emotional problems that impair development and persist into adulthood.

• Data from 2008 UCR indicate that: – More than half of all victims that year were under the age of 18 – Most (82%) of those under 18 were female

• 2015 data: – 4532 reported incidents of sexual violations against children in Canada ..

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Sexual Abuse of Children (2 of 19) • In addition to sexual assaults (level 1, 2, 3), there are a number of sexual violations within the Criminal Code that apply only to victims under 18: – Luring a child via a computer

– Sexual exploitation – Sexual interference – Invitation to sexual touching – Making sexually explicit material available to a child

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Sexual Abuse of Children (3 of 19) • Sexual abuse of children ranges from exhibitionism, kissing, fondling, and sexual touching to oral, anal, and vaginal intercourse.

• Sexual contact between an adult and child is abusive even if the child is willing, because children are legally incapable of consenting to sexual activity.

• Voluntary contact between children of similar ages is not sexual abuse.

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Sexual Abuse of Children (4 of 19) • In Canada, it is against the law: – For any adult or a teenager to engage in any type of sexual activity with a child under the age of 14 ▪ Exception is activity between someone at least age 12 and someone who is less than two years older

– For a person in a position of trust or authority to have any sexual contact, consensual or not, with a person under 18.

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Sexual Abuse of Children (5 of 19) • In Canada, it is against the law: – For an adult to use the Internet to lure a person s/he believes is under age of 18 for the purpose of committing a sexual assault, or to entice a child believed to be under age 14 into sexual relations.

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Sexual Abuse of Children (6 of 19) • In 2008, the Canadian Parliament raised the legal age of consent from 14 to 16 to protect adolescents in that age group from adult sexual exploitation – Close-in-age provision – Challenged as discriminatory toward gay males, because it’s illegal to engage in anal sex with someone under 18 years of age

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Sexual Abuse of Children (7 of 19) • Patterns of Abuse – Children from stable, middle-class families appear to be at lower risk than children from poorer, less cohesive families.

– Most children know their attackers.

– The decision to report the abuse largely depends on the relationship between the abuser and the person who discovers the abuse.

– Typically, the child initially trusts the abuser; physical force is seldom necessary. ..

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Sexual Abuse of Children (8 of 19) • Patterns of Abuse – Most children are abused only once.

▪ Those abused by family members are more likely to suffer repeated acts of abuse.

– Genital fondling most common type of abuse.

– Abused children rarely report abuse: ▪ Because they fear retaliation or worry they will be blamed ▪ Adults may notice changes in child or doctor may see signs during physical exam ..

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Sexual Abuse of Children (9 of 19) • Patterns of Abuse – Abuser Types ▪ Overwhelming majority who abuse children are male ▪ Most are adults, some are adolescents ▪ Male adolescents are more likely to have been abused themselves ▪ The number of female abusers may be greater than it has been thought in the past.

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Sexual Abuse of Children (10 of 19) • Pedophilia – A paraphilia that features sexual attraction to children ▪ Involves sexually arousing fantasies, urges, or behaviours that involve sexual activity with a prepubescent child ▪ A clinical diagnosis is given when a person acts on or is distressed by these pedophilic urges ▪ It has been estimated that up to 5% of men have sexual fantasies or sexual contact with prepubescent children

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Sexual Abuse of Children (11 of 19) • Pedophilia – Pedophiles: ▪ Are almost exclusively male ▪ Are sometimes only attracted to children, sometimes not ▪ May never have any contact with children ▪ May only abuse children they are related to, or not

▪ Some may limit interest to looking at or undressing children, whereas others fondle them or masturbate in their presence, and others coerce them into oral, anal or vaginal sex. ..

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Sexual Abuse of Children (12 of 19) • Pedophilia – Pedophiles: ▪ Often have personality disorders ▪ Are often emotionally unstable, disagreeable, angry, impulsive, and mistrustful ▪ Often have grown up in families with insecure attachment experiences

▪ May lack social skills to develop relationships with adult women

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Sexual Abuse of Children (13 of 19) • Pedophilia – Pedophiles often: ▪ See children as sexual beings who want to have sex with adults

▪ Believe sex doesn’t harm children, and that it may be beneficial ▪ Think themselves so important that they are entitled to have sex with whoever they want

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Sexual Abuse of Children (14 of 19) • Pedophilia – Pedophilia is associated with: ▪ Having a head injury before the age of 6 ▪ Having older brothers ▪ School failure by one or more years and subsequent enrollment in special education ▪ Lower levels of intelligence ▪ Brain differences

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Sexual Abuse of Children (15 of 19) • Pedophilia – Research indicates that child pornography offences are stronger than child sexual offences in indicating pedophilia.

– Child-pornography offenders who had committed prior to or concurrent contact offences were most likely to offend again.

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Sexual Abuse of Children (16 of 19) • Incest – Sexual relations between individuals who are so closely related that sexual relations are prohibited and punishable by law

– Types of Incest ▪ Father-daughter incest ▪ Brother-sister incest

▪ Mother-son incest

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Sexual Abuse of Children (17 of 19) • Incest – Family factors ▪ General family disruption ▪ Spousal abuse

▪ Alcoholic or physically abusive parents ▪ Stressful events in the father’s life ▪ Uneven power relationships between spouses

▪ Generations of abuse history ▪ There is much research available on factors associated with fathers abusing daughters. ..

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Sexual Abuse of Children (18 of 19) • Effects of Sexual Abuse of Children – Short- and long-term psychological complaints ▪ e.g., anger, depression, anxiety, eating disorders

– Abused children often “act out”

– Many show signs of post-traumatic stress disorder – Sexual development may be adversely affected.

– Boys more likely to externalize, girls internalize.

– Late adolescence and early adulthood are difficult times

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Sexual Abuse of Children (19 of 19) • Treatment of Child Sexual Abuse Survivors – Psychotherapy in adulthood is often the first chance for survivors to confront pain, anger, and misplaced guilt.

– Group and individual therapy can be helpful ▪ Individual therapy for the mother, child, and father ▪ Group therapy for the younger child ▪ Marital therapy for the parents ▪ Family therapy for the entire family

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Treatment of Perpetrators (1 of 3) • What does treatment mean?

– Helping the individual or protecting society?

• Recidivism rates – Recent programs are more successful than those prior to 1980.

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Treatment of Perpetrators (2 of 3) • Programs can: – Encourage offenders to take responsibility for their actions.

– Teach more effective coping skills.

– Use reconditioning strategies to enhance appropriate sexual interests and reduce deviant ones.

– Integrate offenders into the community.

– Help offenders avoid reoffending by meeting their intimacy and relationship needs. ..

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Treatment of Perpetrators (3 of 3) • Other treatments: ▪ Surgical castration ▪ Anti-androgen drugs

– In 2004, the Canadian government established a sexoffender registry.

– Many do not register and the list is not up to date.

– Public notification programs have been criticized for increasing stress on the offender and thus the potential for reoffending.

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Sexual Harassment (1 of 9) • Sexual Harassment – Deliberate or repeated unsolicited and unwelcome comments, gestures, or physical contact of a sexual nature – Forbidden by federal and provincial human rights legislation – May include: verbal harassment, verbal abuse, leering or ogling, brushing against a persons body, etc.

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Sexual Harassment (2 of 9) • Sexual Harassment – Most common types of incidents include staring, jokes and remarks about women or about the respondents themselves – Affects a person’s job, leads to personal difficulties – May have more to do with abuse of power than sexual desire

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Sexual Harassment (3 of 9) • Experiences of Minority Groups – Ethnic minority women may feel less free to report harassment to the authorities.

– Minority women don’t perceive the term “sexual harassment” to fully capture the racial aspects of the behaviours.

– Minority women experience more harassment than white women – double jeopardy.

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Sexual Harassment (4 of 9) • Sexual harassment on campus – 2016 study: 2.8% of men and 8.2% of women have experienced stalking in the past year ▪ Inappropriate jokes or remarks are the most common form of harassment.

▪ Minority and transgender students are more likely to experience harassment.

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Sexual Harassment (5 of 9) • Sexual harassment in schools – In one study of 1213 students in Grades 6 to 8: ▪ Boys were more likely to report perpetration ▪ Both genders were equally likely to report victimization

▪ Three behaviours were the most experienced: – Homophobic name calling – Sexual comments or jokes – Flashing or mooning

▪ Boys perpetrated more same-sex harassment, girls more cross-sex harassment ..

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Sexual Harassment (6 of 9) • Sexual harassment in schools – Research on older adolescents suggests sexual taunts and advances have become an unwelcome ritual for many students.

▪ Girls are more likely to report becoming upset by sexual harassment behaviours than boys.

▪ Most students responded passively to the harassment; hardly anyone told a teacher or filed a complaint.

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Sexual Harassment (7 of 9) • Sexual harassment in schools – Large-scale studies suggest gay, lesbian and bisexual students experience more physical and sexual abuse than heterosexuals do.

▪ Attributed to the stigma attached to LGBT orientations

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Sexual Harassment (8 of 9) • Cyberbullying – There is considerable concern today about sexual harassment through cyberbullying.

▪ Posting nude photos of current or former partner without person’s consent – Repeated tormenting online, sharing videos/photos with nudity of people under 18 is illegal in Canada

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Sexual Harassment (9 of 9) • Cyberbullying – In 2014, the Protecting Canadians from Online Crime Act was introduced: ▪ If passed into law, will make it illegal to distribute intimate images without consent, no matter how old the person is.

▪ Act is designed to prevent “revenge porn”.

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End of Chapter 17

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Human Sexuality in a World of Diversity Sixth Canadian Edition

Chapter 18 Sex Work and Sexually Explicit Material

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18 - 1

Learning Objectives (1 of 4) 1. Describe why the term “sex work” has replaced the term “prostitution” to define the exchange of sexual services for money.

2. Describe past and current laws regulating sex work in Canada.

3. Summarize what we know about different categories of female sex work.

4. Summarize what we know about different categories of male sex work.

5. Identify the different types of third-party managers in the sex trade industry. ..

18 - 2

Learning Objectives (2 of 4) 6. Analyze the intersection of human trafficking and sex work.

7. Describe the reasons why people engage in sex work.

8. Describe the reasons why men use the services of sex workers.

9. Discuss the relationship between sexually transmitted infections and sex work.

10. Discuss the positive and negative aspects of exotic dancing. ..

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Learning Objectives (3 of 4) 11. Define sexually explicit material and pornography.

12. Describe and discuss different perspectives on pornography.

13. Describe the legal regulation of pornography in Canada.

14. Describe legal efforts to combat child pornography in Canada.

15. Discuss the use of online SEM.

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Learning Objectives (4 of 4) 16. Assess reported gender differences in response to SEM. 17. Identify and evaluate different perspectives toward the pornography addiction model.

18. Discuss if there is a relationship between consumption of SEM and sexual coercion.

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Sex Work (1 of 36) • Sex Work – The exchange of sexual activity for money or goods of value – Often called the world’s oldest profession – Includes everything from street-based sex work, adult magazines, to strip shows and sex toy shops.

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Sex Work (2 of 36) • “Prostitution” or “Sex Work”?

– “Sex work” is seen as less judgmental and more neutral.

– Coined by the sex workers themselves to redefine commercial sex.

– Underscores the economic and labour aspects of the work ▪ Need for worker protection

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Sex Work (3 of 36) • Sex Work and the Law in Canada – Until the government proposed a new set of laws in 2014, prostitution itself was legal but almost all of the activities involved with prostitution were illegal; specifically: ▪ Transporting or directing another person to a common bawdy house ▪ Keeping, being an inmate of, being found without lawful excuse in, or allowing a place to be used for the purposes of a common bawdy house ▪ Procuring and living off the avails of prostitution ▪ Communication in a public place for purposes of offering or obtaining sexual services ..

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Sex Work (4 of 36) • Sex Work and the Law in Canada – In 1983, a special committee appointed by the Canadian Minister of Justice recommended that prostitution offenses be removed from the Criminal Code.

▪ Instead, the federal government brought in more restrictive legislation; making it illegal to communicate with or stop a person in a public place from negotiating sexual services for payment.

▪ This was challenged under the Charter of Rights and Freedoms, but upheld by the Supreme Court.

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Sex Work (5 of 36) • Sex Work and the Law in Canada – Police and politicians have been particularly concerned about teen prostitution.

▪ Parliament has significantly increased penalties for clients who attempt to obtain sexual services from someone under the age of 18.

▪ Police in Canada often use the strategy of entrapment to obtain convictions against prostitutes and their clients.

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Sex Work (6 of 35) • Sex Work and the Law in Canada – Legal Challenges ▪ Attempts over the years to legalize prostitution have been resisted by government leaders.

▪ Additional challenges have related to mandating safer working conditions for sex workers.

▪ Sex work has been viewed as a degrading activity which no one would willingly engage in – leading to a focus on sexual exploitation of children and human trafficking.

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Sex Work (7 of 36) • Sex Work and the Law in Canada – Legal Challenges ▪ In 2007 a small group of lawyers and sex workers launched constitutional challenges to three sections of the prostitution laws: 1. The provision against communication for the purpose of prostitution, because it prevents sex workers from screening potentially violent clients 2. The provision against bawdy houses, because it prohibits sex workers from working in an indoor environment, which is safer than working on the streets

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Sex Work (8 of 36) • Sex Work and the Law in Canada – Legal Challenges 3. The provision against living off the avails of prostitution, because it’s too broad, and it prevents sex workers from hiring security personnel, such as escorts, who would in turn hire drivers for the prostitutes

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Sex Work (9 of 36) • Sex Work and the Law in Canada – Legal Challenges ▪ As a result, in 2010 the Ontario Superior Court and the British Columbia Court of Appeal issued rulings that struck down Canada’s prostitution laws.

▪ In 2013, the Supreme Court of Canada ruled the following unconstitutional, because they violated the charter rights of individuals to “security of person” and freedom of expression: – Communicating for the purposes of prostitution – Keeping a common bawdy house – Living off the avails of prostitution ..

18 - 14

Sex Work (10 of 36) • Sex Work and the Law in Canada – Legal Challenges ▪ The court stipulated that the existing laws would remain in effect for one year, after which time they would be invalid and would need to be replaced by new legislation.

▪ In response, the Conservative government has proposed Bill C-36.

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Sex Work (11 of 36) • Sex Work and the Law in Canada – Bill C-36 “Protection of Communities and Exploited Persons Act” ▪ Introduced by Conservative government in June 2014

▪ Treats prostitution as a form of sexual exploitation ▪ Buying of sex would be illegal: targets the customers (based on the Nordic model)

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Sex Work (12 of 36) • Sex Work and the Law in Canada – Bill C-36 “Protection of Communities and Exploited Persons Act” ▪ This bill has not been well received by sex workers or those who advocate for their rights ▪ Because clients of sex workers are highly motivated to avoid police, street-based sex workers are forced into hidden or remote locations ▪ Public opinion polls measuring attitudes about sex work revealed that Canadians are divided when it comes to legalizing sex work.

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18 - 17

Sex Work (13 of 36) • Female Sex Workers – Female sex workers are usually classified according to the settings in which they work.

▪ Street-based sex workers – Solicit customers in the street – Comprise about 20% of sex workers – Typically earn less and incur more risk – Research indicates that many have been physically and sexually assaulted while working.

– Work in the open, so are more likely to be arrested

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Sex Work (14 of 36) • Female Sex Workers – Street-based sex workers ▪ More likely than other types of sex workers to be socially, racially, or economically marginalized.

▪ Between 1991 and 2004, 171 female sex workers in Canada were murdered, and almost all were streetbased sex workers.

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Sex Work (15 of 36) • Female Sex Workers – Street-based sex workers ▪ Some sex workers support pimps, especially sex workers who are younger and have less than high school educations ▪ Many feel powerless to control their own fates.

▪ Many die young from drug abuse, disease, suicide, and physical abuse.

▪ Hotel workers have a slightly higher status and better working conditions.

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Sex Work (16 of 36) • Female Sex Workers – Brothel workers ▪ Occupy a middle position in the hierarchy of sex workers ▪ Work in brothels or massage parlours

– Massage parlour workers ▪ Many massage parlours serve as fronts for sex work.

▪ Clients pay fees for standard massages and tip the workers for sexual extras.

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18 - 21

Sex Work (17 of 36) • Female Sex Workers – Massage parlour workers ▪ To avoid massage-parlour regulations, some owners have obtained licenses claiming they were holistic health centres or aromatherapy centres.

▪ Most massage parlours that offer sexual services limit them to masturbation of the client.

▪ Most do not offer oral sex or penetration (in an attempt to avoid prosecution).

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18 - 22

Sex Work (18 of 36) • Female Sex Workers – Escorts ▪ Post ads in telephone directories and newspaper personals to attract conventioneers and businessmen.

▪ Services that provide outcalls send masseuses (or masseurs) to hotel rooms ▪ Escort services typically (but not always) offer sexual services.

▪ Sex workers who work for escort services usually come from middle-class backgrounds and are well-educated.

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Sex Work (19 of 36) • Female Sex Workers – Call girls ▪ Sex workers who arrange their sexual contacts by telephone

▪ “Call” refers to telephone calls and being on call ▪ Occupy the highest rung on the social ladder of female sex work ▪ Most attractive, best educated, charge the most money

▪ Work on their own (without pimps) ▪ Serve as companions and sex partners ..

18 - 24

Sex Work (20 of 36) • Female Sex Workers – Call girls ▪ May receive clients in their apartments (in-calls) or make outcalls to clients’ homes and hotels

▪ May insist on seeing a client’s business card or learning his home telephone number before making contact ▪ May investigate that the person is who he purports to be

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Sex Work (21 of 36) • Male Sex Workers – Male sex work includes male-male and male-female activities.

▪ Male sex workers who service female clients (gigolos) are rare.

▪ “Beach boys” in developing countries make money from their relations with women tourists.

▪ The overwhelming majority of male sex workers service gay men.

▪ Are sometimes called “hustlers” (a man who engages in sex work with male customers). ..

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Sex Work (22 of 35) • Male Sex Workers – Patrons of hustlers are sometimes called scores.

– Many male sex workers come from families troubled by conflict, alcoholism, and physical and sexual abuse.

– May be gay, bisexual, or heterosexual

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Sex Work (23 of 36) • Male Sex Workers – Major motivation is money – Running away from home typically serves as an entry point.

– Most hustlers are part-timers who continue some form of education or vocational activity.

– Drug dealing is also common.

– Hustlers aren’t typically attached to pimps.

▪ Generally, they make contact with clients in gay bars, social clubs, or by working the streets. ..

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Sex Work (24 of 36) • Male Sex Workers – Various kinds of male sex workers have been identified ▪ Strippers ▪ Kept boys

▪ Call boys ▪ Punks ▪ Bar hustlers and street hustlers

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Sex Work (25 of 36) • Third-Party Managers in the Sex Trade Industry – Pimp is a highly coercive man who often resorts to violence to control his stable of female sex workers – Managers, agency owners, security personnel, drivers, phone girls, booking agents, and website operators are also third-parties

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Sex Work (26 of 36) • Human Trafficking – Often involves coercing girls and women into prostitution and other sex-related work – Most work has focused on trafficking of girls and women into Canada, but trafficking also occurs within Canada.

– Trafficking in Canada is underreported.

– Few perpetrators are caught by police.

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Sex Work (27 of 36) • Human Trafficking – A major global enterprise – The trafficking of girls and women is the industry’s major component – Because it is illegal and occurs underground, it is difficult to obtain accurate information about the number of girl and women trafficked to Canada.

– Girls and women have been trafficked from Eastern Europe, Asia and Africa, usually by organized crime groups. ..

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Sex Work (28 of 36) • Human Trafficking – A woman is lured by the promise of a better life.

– She arrives in Canada after false promises of a legal job; then is coerced into sex work to repay the trafficker for travel costs.

– The trafficker keeps her working in the sex trade by withholding her passport, isolating her from the wider community, confining her with force, and threatening her with violence.

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Sex Work (29 of 36) • Entry into Sex Work – Many factors are associated with sex work ▪ Poverty and sexual and/or physical abuse are common in the backgrounds of many sex workers.

– Research in this area has focused on street workers, however, and may not accurately reflect characteristics of other categories of sex workers.

– Some voluntarily enter the business and don’t see themselves as victims.

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Sex Work (30 of 36) • Male Customers of Female Sex Workers – Referred to as johns or tricks – Represent all socioeconomic and racial groups

– One study found johns were similar to men who are not customers of sex workers ▪ Average age is 38 ▪ More than half were married or in serious relationships ▪ On average, they had used the services of a sex worker 19 times. ..

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Sex Work (31 of 36) • Male Customers of Female Sex Workers – Most Canadian studies of clients of sex workers have used samples from john schools ▪ These samples are biased, as they consist of men who were arrested for soliciting streetwalkers.

– Most patrons are occasional johns (e.g., travelling salesmen or military personnel).

– Habitual johns use sex workers as their primary or exclusive sexual outlet.

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Sex Work (32 of 36) • Male Customers of Female Sex Workers – Some johns use sex workers to meet psychological or sexual needs they are unable to meet otherwise.

– Others may have a madonna-whore complex ▪ A rigid stereotyping of women as either sinners or saints

– In Canada, there is stigma attached to paying for sex.

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Sex Work (33 of 36) • Male Customers of Female Sex Workers – Motives for buying sex: ▪ Sex without negotiation ▪ Sex without emotional commitment ▪ Sex for eroticism and variety ▪ Sex away from home

▪ Difficulty attracting a partner

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Sex Work (34 of 36) • Male Customers of Female Sex Workers – John schools ▪ In return for attending the day-long school, men with no previous criminal records who are charged with communicating for the purpose of prostitution can have their charges erased from the court record.

▪ Listen to streetwalkers talk about the negative effects of the sex trade, lectures on STIs, etc.

▪ Men are expected to provide donations to help support the programs.

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Sex Work (35 of 36) • Male Customers of Female Sex Workers – STIs and Sex Work ▪ One of main reasons for striking down existing prostitution laws in 2013 was that the laws reduced the ability of sex workers to protect themselves from violence, abuse, and STIs. ▪ In one study, 1/3 of both male and female sex workers reported that they had had STIs in the previous two years.

▪ Most sex workers report very high condom use with clients, less so with men who were not clients. ..

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Sex Work (36 of 36) • Exotic dancing – Exotic dancing, also called stripping, is a type of sex work, though men and women who work in strip clubs typically refer to themselves as dancers.

▪ Some limit their sexual activity to dancing and taking off their clothes.

▪ Others do lap or table dances, making contact with customers as they dance.

▪ Some strip clubs have private shows and VIP areas where strippers can be alone with clients.

▪ Most strippers do so on a part-time, temporary basis. ..

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Sexually Explicit Material (SEM) (1 of 23) • SEM is found nearly everywhere – Magazines, DVD rentals, Internet, cable/satellite, cellphones, and video mp3 players – Typically used to enhance sexual arousal, often as a masturbation aid – May also be used by couples during sex

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Sexually Explicit Material (SEM) (2 of 23) • What’s Pornographic?

– Pornography ▪ Written, visual, or audiotaped material that is sexually explicit and produced to elicit or enhance sexual arousal

▪ Has a negative connotation today ▪ Is typically associated with SEM that is violent and/or degrading

– Prurient ▪ Tending to excite lust; lewd

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Sexually Explicit Material (SEM) (3 of 23) • What’s Pornographic?

– Sexually explicit material (SEM) ▪ Written, visual, or audiotaped material that is graphic and produced to elicit or enhance sexual arousal

– Erotica ▪ SEM that doesn’t involve violence or degradation of women ▪ It may be as sexually explicit as pornography.

– Obscenity ▪ SEM that offends community standards ..

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Sexually Explicit Material (SEM) (4 of 23) • Perspectives on Pornography – Obscenity-based—offends community standards – Conservative—threat to the “traditional values” of society – Liberal—in the absence of clear harm, the government shouldn’t restrict access to SEM, violation of free speech

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Sexually Explicit Material (SEM) (5 of 23) • Perspectives on Pornography – Anti-pornography feminist approach—portrays women as objects intended to provide pleasure to men; presents women in dehumanized, degrading ways – Pro-pornography feminist approach—SEM can promote gender equality

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Sexually Explicit Material (SEM) (6 of 23) • Perspectives on Pornography: Canadian Law and SEM – Canadian obscenity laws provide the legal framework for outlawing the dissemination of pornography.

– Relies on offending people or violating community standards – The Supreme Court has been strongly influenced by the anti-pornography feminist approach.

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Sexually Explicit Material (SEM) (7 of 23) • Perspectives on Pornography: Canadian Law and SEM ▪ Community standard of tolerance test must be applied to determine whether undue exploitation has occurred

▪ Regina vs. Butler (1992): three categories of obscenity – Material that mixes sex and violence and/or includes children – Material that involves sex and degradation, encouraging violence or harm to women – Material that is nonviolent and not degrading to women, doesn’t involve children ..

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Sexually Explicit Material (SEM) (8 of 23) • Perspectives on Pornography: Canadian Law and SEM ▪ All materials that come into Canada can be confiscated by the Canadian Border Services Agency if they are deemed to violate Canada’s obscenity laws.

▪ Legal efforts to regulate SEM in Canada have been thwarted by easy access on the Internet.

▪ In recent years, Canadian law enforcement has focused on identifying and prosecuting Canadians who use the Internet to distribute or download child pornography.

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Sexually Explicit Material (SEM) (9 of 23) • Child Pornography – Canadians almost universally view child pornography as obscene and harmful.

– The law: ▪ It is illegal to sell child pornography, as well as possess anything that depicts people under the age of 18 engaging in real or simulated sexual behaviour.

▪ Visual representations (for sexual purposes) of sex organs of people who are under 18, and written materials and pictures that advocate having sex with underaged individuals, are also forbidden. ..

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Sexually Explicit Material (SEM) (10 of 23) • Child Pornography – The law: ▪ The law allows exemption from prosecution if the material has artistic merit or an educational, scientific, or medical purpose.

▪ In 2001, exceptions were made to include private materials and SEM created by children and adolescents that are meant to be kept strictly private and only for personal use.

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Sexually Explicit Material (SEM) (11 of 23) • The Internet and SEM – Canadians increasingly use the Internet to look at SEM. ▪ The internet is by far the most common way people access SEM ▪ In a study of young men, the reported average age of first exposure to pornography was 13.3 years old (Bischmann et al, 2017) ▪ Rates and frequency are typically higher among men than women.

▪ Repeated exposure to same pornographic materials progressively lessons the sexual response to them. ..

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Sexually Explicit Material (SEM) (12 of 23) • The Internet and SEM – Some evidence suggests excessive porn use can interfere with relationships – Many Canadians are exposed to unsolicited SEM through email messages and pop-ups ▪ Males are more likely to respond positively to these than females.

– On Secondlife.com, avatars (animated, cartoon-like figures) can engage in virtual sex with other avatars.

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Sexually Explicit Material (SEM) (13 of 23) • Gender Differences in Response to SEM – Researchers have found that both men and women are physiologically aroused by SEM. – Women tend to rate romantic scenes as more sexually arousing than sexually explicit scenes.

– Most erotic visual materials are produced by men, for men.

– Some women may find SEM a “turn-off” or disgusting, especially if it depicts women in unflattering roles.

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Sexually Explicit Material (SEM) (14 of 23) • Gender Differences in Response to SEM – Research from Sweden suggests that the majority of women in their study had been exposed to SEM ▪ Majority of which found that the experience was positive ▪ 27% reacted negatively (e.g., some felt their partners would want to make them engage in sexual behaviours they didn’t want to be involved with).

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Sexually Explicit Material (SEM) (15 of 23) • How does pornography affect romantic relationships?

– Growth of internet pornography has re-invigorated concerns about the harmful effects of pornography – Qualitative study of over 400 men and women showed that most people did not think that pornography use impacted themselves or their relationships negatively

– Negative effects reported included unrealistic expectations, decreased sexual desire, and personal insecurity. ..

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Sexually Explicit Material (SEM) (16 of 23) • Pornography Addiction – Controversy and disagreement surround the idea of whether a person can become addicted to watching pornography – Some people, mostly men, spend dozens of hours each week watching pornography online – Some may masturbate to pornography or – less oftenhave “online sex” with people they contact via chat rooms

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Sexually Explicit Material (SEM) (17 of 23) • Pornography Addiction – Conceptualizing high-frequency viewing of pornography as an addiction may be inaccurate for a number of reason ▪ Small number of people actually experience problems related to SEM ▪ Misapplication of the addiction model

▪ No published data on addiction treatment for SEM ▪ Unwarranted moralistic view applied to using SEM ..

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Sexually Explicit Material (SEM) (18 of 23) • Sexual Coercion and SEM – Is SEM a harmless diversion, or an inducement to commit sexual violence and other antisocial acts?

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Sexually Explicit Material (SEM) (19 of 23) • Sexual Coercion and SEM – SEM and Sex Offenders ▪ A research review found little or no difference in levels of SEM exposure between incarcerated sex offenders and felons incarcerated for nonsexual crimes.

▪ Sexually aggressive individuals are more likely than others to use pornography.

▪ Current studies are correlational.

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Sexually Explicit Material (SEM) (20 of 23) • Sexual Coercion and SEM – Violent SEM ▪ Research suggests it is the violence in violent SEM – not the explicit sex – that potentially affects or reinforces the attitudes and behaviours of sex offenders.

▪ There is little evidence to suggest that SEM causes aggression.

– Men who are predisposed to sexual aggression are more likely to view violent SEM, and are therefore likely to show the strongest effects. ..

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Sexually Explicit Material (SEM) (21 of 23) • Sexual Coercion and SEM – Nonviolent SEM ▪ Nonviolent SEM does not contain scenes of violence, but typically portrays women as sexually promiscuous, insatiable, and subservient.

▪ How might this affect people’s attitudes/behaviours toward women?

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Sexually Explicit Material (SEM) (22 of 23) • Sexual Coercion and SEM – Nonviolent SEM ▪ There is concern that prolonged exposure to SEM may foster dissatisfaction with the physical appearance and sexual performance of one’s intimate partners.

▪ It may also contribute to unrealistic expectations about sexual functioning.

▪ Research on effects of nonviolent SEM is inconclusive, may be more closely connected with whether women are portrayed in a dehumanizing ..

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Sexually Explicit Material (SEM) (23 of 23) • Sexual Coercion and SEM – Most research on SEM: ▪ Has come from harm-based approach

▪ Surveys only men ▪ Considers women as victims

– An increasing amount of SEM is produced by women, for women and couples.

▪ This indicates that many women are willing consumers. ..

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End of Chapter 18

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