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Chapter 8 lecture outline

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Chapter 8 – Sexual Health
8
Sexual Health
LectureOutline
I. Sexual Health
Sexuality is the quality of being sexual. Our se...
Chapter 8 – Sexual Health
3. The labia majora cover soft flaps of skin (inner lips) called the labia
minora.
4. The inner ...
Chapter 8 – Sexual Health
b. Once dismissed as a psychological problem, OMS has been recognized
as a very real physical di...
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Chapter 8 lecture outline

  1. 1. Chapter 8 – Sexual Health 8 Sexual Health LectureOutline I. Sexual Health Sexuality is the quality of being sexual. Our sex is our biological maleness or femaleness. Sexual intimacy is physical closeness. A. Sexuality and the Dimensions of Health 1. Our sexuality both affects and is affected by the various dimensions of health. 2. Aspects of health enhance our sexuality. Some examples are: a. Physical – safer sex practices reduce the risk of sexually transmitted infections. Also, when our bodies are healthy and well, we feel better about ourselves, which enhances both self-esteem and healthy sexuality b. Emotional – when our emotional health is high, we can better understand and cope with the complex feelings related to being sexual c. Social – from dating to mating, we express and fulfill our sexual identities in the context of families, friends, and society as a whole d. Intellectual – our most fulfilling relationships involve a meeting of minds as well as bodies e. Spiritual – at its deepest, most fulfilling level, sexuality uplifts the soul by allowing us to connect to something greater than ourselves f. Environmental – responsible sexuality makes people more aware of the impact of their decisions on others II. Women’s Sexual Health If you are a woman of childbearing age, you should undergo regular “health maintenance” exams to monitor your sexual and reproductive well-being. A. Female Sexual Anatomy 1. The mons pubis is the rounded, fleshy area over the junction of the pubic bones. 2. The folds of skin that form the outer lips of a woman’s genital area are called the labia majora.
  2. 2. Chapter 8 – Sexual Health 3. The labia majora cover soft flaps of skin (inner lips) called the labia minora. 4. The inner lips join at the top to form a hood over the clitoris, a small, elongated erectile organ and the most sensitive spot in the entire female genital area. 5. Below the clitoris is the urethral opening, the outer opening of the thin tube that carries urine from the bladder. 6. Below that is a larger opening, the mouth of the vagina, the canal that leads to the primary internal organs of reproduction. 7. The perineum is the area between the vagina and anus (the opening to the rectum and large intestine). 8. At the back of the vagina is the cervix, the opening to the womb, or uterus. 9. The uterine walls are lined by a layer of tissue called the endometrium. 10. The ovaries, about the size and shape of almonds, are located on either side of the uterus and contain egg cells called ova. 11. Extending outward and back from the upper uterus are the fallopian tubes, the canals that transport ova from the ovaries to the uterus. B. The Menstrual Cycle 1. The menstrual cycle begins in the brain with the production of gonadotropin-releasing hormone (GnHR). a. Ovulation is the release of the egg cell from the follicle at midcycle. b. Estrogen levels drop and the remaining cells of the follicle then enlarge, change character, and form the corpus luteum, or yellow body. c. In the second half of the menstrual cycle, the corpus luteum secretes estrogen and larger amounts of progesterone. d. The endometrium (uterine lining) is stimulated by progesterone to thicken and become more engorged with blood in preparation for nourishing an implanted, fertilized ovum. e. If the ovum is not fertilized, the corpus luteum disintegrates. f. As the level of progesterone drops, menstruation occurs: the uterine lining is shed during the course of a menstrual period. g. If the egg is fertilized and pregnancy occurs, the cells that eventually develop into the placenta secrete human chorionic gonadotropin, a messenger hormone that signals the pituitary not to start a new cycle. 2. Premenstrual Syndrome a. Women with premenstrual syndrome (PMS) experience bodily discomfort and emotional distress for up to two weeks, from ovulation until the onset of menstruation.
  3. 3. Chapter 8 – Sexual Health b. Once dismissed as a psychological problem, OMS has been recognized as a very real physical disorder that may be caused by various factors, including: i. A hormonal deficiency ii. Abnormal imbalance of estrogen and progesterone iii. An imbalance of estrogen and progesterone iv. Social and environmental factors, particularly stress v. The most common symptoms of PMS are: vi. Mood changes vii. Anxiety viii. Irritability ix. Difficulty concentrating x. Forgetfulness xi. Impaired judgment xii. Tearfulness xiii. Digestive symptoms (diarrhea, bloating, constipation) xiv. Hot flashes xv. Palpitations xvi. Dizziness xvii. Headache xviii. Fatigue xix. Changes in appetite xx. Cravings (usually for sweet or salt) xxi. Water retention xxii. Breast tenderness xxiii. Insomnia 3. Treatments a. Treatments for PMS depend on specific symptoms: i. Diuretics for water retention ii. Relaxation techniques for anxiety iii. Sleep deprivation and bright lights to adjust circadian or daily rhythm iv. Charting of cycles to identify vulnerable periods v. Medications for symptoms such as tension, depression, irritability, and mood swings vi. YAZ, a low-dose combination birth control pill, to treat emotional and physical premenstrual symptoms vii. A diet rich in calcium and vitamin D or supplements to decrease severity of symptoms viii. Cognitive-behavioral therapy
  4. 4. Chapter 8 – Sexual Health ix. Other treatments, including exercise; lower caffeine, alcohol, salt, and sugar; acupuncture; and stress management techniques 4. Premenstrual Dysphoric Disorder (PMDD) a. Premenstrual dysphoric disorder, which is not related to PMS, occurs in an estimated 3 to 5 percent of all menstruating women. b. It is characterized by regular symptoms of depression (depressed mood, anxiety, mood swings, diminished interest or pleasure) during the last week of the menstrual cycle. 5. Menstrual Cramps a. Dysmenorrhea is the medical name for the discomforts—abdominal cramps and pain, back and leg pain, diarrhea, tension, water retention, fatigue, and depression—that can occur during menstruation. 6. Amenorrhea a. Women may stop menstruating—a condition called amenorrhea—for a variety of reasons, including a hormonal disorder, drastic weight loss, strenuous exercise, or change in the environment. 7. Toxic Shock Syndrome a. This rare, potentially deadly bacterial infection primarily strikes menstruating women under the age of 30 who use tampons. b. Both Staphylococcus aureus and group A Streptococcus pyogenes can produce toxic shock syndrome. c. Symptoms include: i. A high fever; a rash that leads to peeling of the skin on the fingers, toes, palms, and soles; dizziness; dangerously low blood pressure; and abnormalities in several organ systems, and in the muscles and blood. III. Men’s Sexual Health Men should make regular self-exams as part of their routine. A. Men’s Sexual Anatomy 1. The visible parts of the male sexual anatomy are the penis and the scrotum, the pouch that contains the testes. 2. The testes manufacture testosterone, the hormone that stimulates the development of a male’s secondary sex characteristics, and sperm, the male reproductive cells. 3. Sperm is the male reproductive cell. 4. Immature sperm are stored in the epididymis, a collection of coiled tubes adjacent to each testis. 5. The penis contains three hollow cylinders loosely covered with skin.
  5. 5. Chapter 8 – Sexual Health a. The two major cylinders, the corpora cavernosa, extend side by side through the length of the penis. The third cylinder, the corpus spongiosum, surrounds the urethra. 6. The urethra is the channel for both seminal fluid and urine. 7. Semen is the liquid in which the sperm cells are carried out of the body during ejaculation. 8. The vas deferens are two tubes that carry sperm from the epididymis into the urethra. 9. The seminal vesicles, which make some of the seminal fluid, join with the vas deferens to form the ejaculatory ducts. 10. The prostate gland produces some of the seminal fluid, which it secretes into the urethra during ejaculation. 11. The Cowper’s glands are two pea-sized structures on either side of the urethra and are connected to it via tiny ducts. B. Circumcision 1. Circumcision is the surgical removal of the foreskin. 2. Some of the health benefits of circumcision: a. Reduces the risk of infection with human immunodeficiency virus (HIV), herpes simplex virus type 2, and human papillomavirus (HPV) b. Lowers the risk of cancer of the penis c. May lower a man’s risk of prostate cancer d. Helps female partners who are less likely to develop bacterial vaginosis and Trichomonas vaginalis e. Lessons the risk of urinary tract infections during the first year of life f. Helps prevent foreskin infections and retraction g. Makes hygiene easier 3. Complications of circumcision include: a. Bleeding b. Infection c. Improper healing d. Cutting the foreskin too long or too short e. Discomfort 4. There is little consensus on what impact the presence or absence of a foreskin has on sexual functioning or satisfaction. IV. Responsible Sexuality Most people grow up with a lot of myths and misconceptions about sex. Rather than rely on what peers say or what you’ve always thought was true, find out the facts. A. Creating a Sexually Healthy Relationship.
  6. 6. Chapter 8 – Sexual Health 1. A sexually healthy relationship is based on shared values and has five characteristics: a. Consensual, nonexploitive, honest, mutually pleasurable, and protected against unintended pregnancy and sexuality transmitted infections. b. All individuals also have sexual rights, which include the right to the information, education, skills, support, and services they need to make responsible decisions. c. Communication is vital. B. Making Sexual Decisions 1. Making responsible sexual decisions means considering all the possible consequences – including emotional consequences – of sexual behavior for you and your partner. 2. Prior to any sexual activity that involves the risk of sexually transmitted infection or pregnancy, both partners should talk about their prior sexual histories and other high-risk behavior, such as the use of injection drugs. 3. Partners should also discuss the issue of birth control and which methods might be best for them to use. 4. Both partners should ask each other questions. C. Saying No to Sex 1. The following strategies can help you assert yourself when saying no to sex: a. Recognize your own values and feelings. b. Be direct. c. Just say no. d. If you’re still at a loss for words, try responses such as: “I like you a lot, but I’m not ready to have sex.” e. If you are feeling pressured, let your date know that you are uncomfortable. f. If you are a woman, monitor your sexual signals. g. Communicate your feelings to your date sooner rather than later. h. Remember that if saying no to sex puts an end to a relationship, it was not much of a relationship in the first place. V. Sexual Behavior Our sexual identities emerge in adolescence and become clearer as we enter adulthood, but continue to change and evolve throughout our lives. A. Sex on Campus
  7. 7. Chapter 8 – Sexual Health 1. Today’s undergraduates are more likely to question potential partners about their past, use condoms with a new partner, and maintain fairly long-term monogamous relationships. 2. College students tend to overestimate how much sex their peers are having. 3. Only one third of college students report using condoms regularly. 4. College students who binge drink or participate in drinking games, increase their odds of sexually risky behavior. B. Hooking Up 1. Hooking up is characterized by a lack of any expectation of emotional intimacy or a romantic relationship. 2. Two thirds of those who had ever had a hookup experienced regrets. C. Friends with Benefits 1. Relationships between “friends with benefits” occur between two individuals who have a friendship extending beyond a one-time sexual encounter. 2. An estimated 45 to 50 percent of college students report engaging in a friends-with-benefits relationship in the preceding 12 months. 3. Men were more likely to desire no change in such a relationship, while women preferred either going back to being “just friends” or moving into a committed romantic relationship. D. Romantic Relationships 1. Most college students still engage in sex in the context of a romantic relationship. 2. The context of sexual activity can affect sexual enjoyment in both sexes. VI. Sex in America The average American adult reports having sex about once a week. One in five has been celibate for at least a year. One in twenty engage in sex at least every other day. A. Sexual Diversity 1. Human beings are diverse in all ways—including sexual preferences and practices. 2. Physiological, psychological, and social factors determine whether we are attracted to members of the same sex or the other sex. This attraction is our sexual orientation. B. Heterosexuality 1. Heterosexuality or “straight,” the most common sexual orientation, is the term used for individuals whose primary orientation is toward members of the other sex.
  8. 8. Chapter 8 – Sexual Health C. Bisexuality 1. Bisexuality is the term for individuals who are attracted to both sexes. 2. Serial bisexuals are sexually involved with the same-sex partner for a while and then with partners of the other sex, or vice versa. 3. Fear of HIV infection has sparked great concern about bisexuality. D. Homosexuality 1. Homosexuality—social, emotional, and sexual attraction to members of the same sex—exists in almost all cultures. Homophobia has led to gay bashing in many communities, including college campuses. 2. Roots of Homosexuality a. Sexual orientation probably emerges from a complex interaction that includes biological and environmental factors. 3. Coming Out a. Relatively few gay adolescents declare their homosexuality, or come out, while in a state of identity confusion. b. Most homosexual men and women progress through several stages: Stage 1: “I feel different from other kids …” Stage 2: “I think I might be gay, but I’m not sure, and if I am, I’m not sure that I want to be …” Stage 3: “I accept the fact that I’m gay, but what’s my family going to say?” Stage 4: “I finally told my parents I’m gay.” 4. Homosexuality on Campus a. Students most likely to be accepting of homosexuality were those who were women, had less traditional sex-role attitudes, were less religious, attended colleges that did not have Greek social clubs, and had gay, lesbian, and/or bisexual friends. E. The Gender Spectrum 1. Experts in human sexuality have created a multidimensional gender spectrum that includes biology, gender identity, and gender expression. 2. Transgender includes individuals whose behaviors do not conform to commonly understood gender norms. a. Transyouth – young people experiencing issues related to gender identity or expression. b. Transsexuals – those who identify with a gender other than the one they were given at birth. c. Transwomen – male to female transsexuals. d. Transmen – female to male transsexuals. 3. Queer and gender queer – refer to a range of sexual orientations, gender behaviors, or ideologies.
  9. 9. Chapter 8 – Sexual Health 4. LGBTQQI – Acronym for lesbian, gay, bisexual, transgendered, queer/questioning, and intersex individuals. 5. Transgender individuals may be happy with the biological sex they were born with but enjoy dressing up and behaving like the other sex. 6. Gender Dysphoria – transsexuals who feel trapped in the body of the wrong gender. VII. Sexual Activity A. Celibacy 1. Celibacy means that a person doesn’t engage in sexual activity. 2. Complete celibacy means that the person doesn’t masturbate or engage in sexual activity with a partner. 3. Partial celibacy means that a person masturbates but doesn’t have sexual activity with a partner. B. Abstinence 1. The CDC defines abstinence as “refraining from sexual activities which involve vaginal, anal, and oral intercourse.” 2. Increasing numbers of adolescents and young adults are choosing to remain virgins and abstain from sexual intercourse until they enter a permanent, committed, monogamous relationship. 3. Among the reasons for abstinence undergraduates have reported are: a. Wanting to remain a virgin until they meet someone they love and see as a life partner b. Being true to their religious and moral values c. Getting to know a partner better d. If they are heterosexual, avoiding the risk of pregnancy e. To be sure of safety from sexually transmitted infections C. Fantasy 1. The mind is the most powerful sex organ in the body, and erotic mental images can be sexually stimulating. 2. Fantasies generally enhance sexual arousal, reduce anxiety, and boost sexual drive. 3. Men and women have different types of sexy thoughts. D. Masturbation 1. Not everybody masturbates, but most people do. 2. Masturbation is often the primary sexual activity of individuals not involved in a sexual relationship. E. Nonpenetrative Sexual Activity (Outercourse) 1. Outercourse includes kissing and hugging but does not involve genital-to- genital, mouth-to-genital, or insertive anal sexual contact.
  10. 10. Chapter 8 – Sexual Health 2. Usually kissing is the first sexual activity that couples engage in. 3. Stimulating erogenous regions can lead to orgasm in both men and women – more couples are gaining an appreciation of these activities as primary sources of sexual fulfillment and as safer alternatives to intercourse. F. Intercourse 1. Vaginal intercourse, or coitus, refers to the penetration of the vagina by the penis. 2. Sexual activity, including intercourse, is possible throughout a woman’s menstrual cycle. 3. Vaginal intercourse, like other forms of sexual activity involving an exchange of bodily fluids, carries a risk of sexually transmitted infections, including HIV infection. G. Oral Sex 1. The formal terms for oral sex are cunnilingus, which refers to oral stimulation of the woman’s genitals, and fellatio, oral stimulation of the man’s genitals. H. Anal Stimulation and Intercourse 1. Because the anus has many nerve endings, it can produce intense erotic responses. 2. Anal sex involves important health risks, such as damage to sensitive tissue, and the transmission of various intestinal infections, hepatitis, and STIs, including HIV.. VIII. Sexual Response A. Excitement 1. In men, sexual stimuli set off a rush of blood to the genitals, filling the blood vessels in the penis, which becomes erect. 2. Women respond to stimulation with vaginal lubrication. B. Plateau 1. The penis further increases in both length and diameter. 2. The outer one-third of the vagina swells. 3. During intercourse, the vaginal muscles grasp the penis to increase stimulation for both partners. 4. The upper two-thirds of the vagina become wider as the uterus moves up; eventually its diameter is 2½ to 3 inches. C. Orgasm 1. Both men and women experience orgasm.
  11. 11. Chapter 8 – Sexual Health 2. During the process of ejaculation, the vas deferens, the seminal vesicles, the prostate, and upper portion of the urethra contract. Seconds later muscle contractions force semen out of the penis via the urethra. 3. Female orgasms are primarily triggered by stimulating the clitoris until the vagina responds by contracting. D. Resolution 1. The sexual organs return to their normal, nonexcited state. 2. After orgasm, men typically enter a refractory period, during which they are incapable of another orgasm. The duration of this period varies from minutes to days. E. Other Models of Sexual Response 1. Some researchers have argued that the Masters and Johnson’s model neglects the importance of desire and that the plateau stage is virtually indistinguishable from excitement. 2. Others note that arousal may come before desire, particularly for women who may not have spontaneous feelings of sexual desire. IX. Sexually Transmitted Infections and Diseases A. Overview 1. Sexually transmitted infection (STI) refers to the presence of an infectious agent that can be passed from one sexual partner to another. 2. STI replaces the term sexual transmitted disease (STD) because sexual infections can be an often are transmitted by people who do not have symptoms. 3. STIs can: a. Last a lifetime b. Put stress on relationships c. Cause serious medical complications d. Impair fertility e. Cause birth defects f. Lead to major illness and death 4. STIs are transmitted mainly through: a. Direct sexual contact with someone’s symptoms or sexual contact with someone’s infected semen, vaginal fluid, blood, and other body fluid b. Sharing contaminated needles through injectable drug use c. Maternal transfer 5. STI pathogens like dark, warm, moist body surfaces, particularly the mucous membranes that line the reproductive organs. 6. Many STIs, including early HIV infection and gonorrhea in women, may not cause any symptoms.
  12. 12. Chapter 8 – Sexual Health 7. More Americans are infected with STIs now than at any other time in history. 8. The odds of acquiring an STI during a lifetime are one in four. 9. The three most common STIs are chlamydia, gonorrhea, and trichomoniasis. B. STI Risk Factors and Risk Continuum 1. Various factors put young people at risk of STIs, including: a. A sexual partner who has an STI b. A history of STIs c. Feelings of invulnerability d. Multiple partners or a partner who has had more than one sexual partner e. Failure to use condoms f. Substance abuse g. Failure of a partner to be notified and treated h. Use of injection drugs or sexual partner who uses them X. The ABCs of Safer Sex A. A Is for Abstain 1. Abstinence from vaginal, anal, and oral sex, is: a. Free b. Available to everyone c. Extremely effective at preventing pregnancy and STIs 2. Ways to avoid STIs during oral sex: a. Use barrier methods b. Be aware of sores, discharge and/or unpleasant odors c. Don’t floss or brush teeth before oral sex d. Avoid aggressive and deep thrusting in oral sex e. Remember that oral sex can transmit STIs B. B Is for Be Faithful 1. Women and men in a committed relationship don’t need to worry about getting STIs if: a. Neither partner ever had sex with anyone else b. Neither partner ever shared needles c. Neither partner currently has or ever had an STI 2. A committed relationship remains safe only as long as both partners remain committed. C. Is for Condoms 1. Condoms are the only contraceptive that helps prevent both pregnancy and STIs when used properly and consistently.
  13. 13. Chapter 8 – Sexual Health 2. Here are some essential guidelines to keep in mind: a. Most physicians recommend American-made latex condoms. Check the packages for FDA approval. b. Check the expiration date. c. Make sure the package is in good condition. Also, make sure the package says the condom is meant to prevent disease. d. Make sure they are the right size. e. Condoms can deteriorate if not stored properly. D. STIs and Gender 1. Both men and women can develop STIs, but their risks are not the same. 2. If You Are a Woman a. Your risk of getting an infection is greater than a man’s. b. Symptoms of STIs tend to be more “silent” in women. c. Talk to your doctor about whether you should be tested for sexually transmitted infections. 3. If You Are a Man a. Involve your partner. b. After potential exposure to an STI, urinate and wash your genitals with antibacterial soap. c. Ask your doctor whether you should be tested for sexually transmitted infections. 4. Although it can be awkward to bring up the subject of condoms, don’t let your embarrassment put your health at risk. 5. Additional guidelines: a. Use a new condom each time. b. Do not open the wrapper of a condom with your teeth. c. Squeeze the air out of a condom before putting it on. d. Do not use spermicide containing nonxynol-9 (N-9). e. If a condom fails, remove it carefully and replace with a new condom. E. What College Students Don’t Know about STIs 1. Many undergraduates think that they know more than they actually do. 2. Many do not realize that STIs can exist without symptoms so they don’t take steps to protect themselves or to avoid risky sexual behaviors. XI. Common STIs A. Human Papilloma Virus 1. HPV is the most common sexually transmitted infection in the U.S. 2. There are 100 or more different strains, approximately 40 are sexually transmitted.
  14. 14. Chapter 8 – Sexual Health 3. There are higher infection rates in women as well as higher risk of oral cancer. 4. “High-risk” strains higher the risk of cervical, vulva, vagina, anus, or penis cancer. 5. “Lower-risk” may cause Pap test abnormalities and genital warts. 6. Genital warts are single or multiple growths or bumps that appear in the genital area. 7. Primary risk factors for oral HPV infection include: a. Number of sex partners. b. Smoking. c. Heavy drinking. d. Marijuana use. 8. Incidence a. Approximately 20 million people in the U.S. are currently infected. b. 6.2 million get a new HPV infection each year. c. College-age women are at greatest risk of infection. 9. HPV Vaccination a. There are two FDA approved vaccines for HPV. b. The vaccines are different in the types of HPV strains they prevent. c. Federal authorities and the American Academy of Pediatrics recommends HPV vaccination for: i. All girls and boys ages 11 or 12, with catch-up vaccinations for those ages 13 to 21. ii. Women ages 13 through 26 who were not previously vaccinated. iii. Men ages 13 through 21 who were not previously vaccinated; men ages 22 through 26 may also receive the vaccine. 10. HPV Vaccination on Campus a. Sexually active young adults are at the highest risk of HPV infection. 11. Signs and Symptoms a. HPV lives in the skin or mucous membranes and usually causes no symptoms. b. Some people get visible genital warts or have precancerous changes in the cervix, vulva, anus, or penis. c. After contact with an infected individual, genital warts may appear within three weeks to 18 months, with an average period of about 3 months. 12. Diagnosis and Treatment a. Most women are diagnosed with HPV after an abnormal Pap test or HPV DNA test.
  15. 15. Chapter 8 – Sexual Health b. No form of therapy has been shown to completely eradicate HPV, nor has any single treatment been uniformly effective in removing warts or preventing their reoccurrence. B. Genital Herpes 1. Herpes describes some of the most common viral infections in humans. 2. Herpes simplex causes blisters on the skin or mucous membranes. a. Herpes simplex virus (HSV-1) can be transmitted by kissing and generally causes cold sores and fever blisters around the mouth. b. Herpes simplex virus 2 (HSV-2) is sexually transmitted. 3. HSV transmission occurs through close contact with mucous membranes or abraded skin. 4. Past views saw herpes as an episodic disease with the greatest of risk during flare-ups, however “classis herpes” for most people, is a chronic nearly continuously active infection that may produce subtle, varied, and often overlooked symptoms. 5. Herpes can be spread even between flare-ups. 6. Incidence a. At least 50 million people in the United States have genital herpes b. Only a minority know they are affected. 7. Signs and Symptoms a. Most people with genital herpes have no symptoms or very mild symptoms that go unnoticed. b. The most common symptom is a cluster of blistery sores. c. Other symptoms include: blisters, burning feelings if urine flows over sores, inability to urinate if severe swelling of sores block the urethra and itching and pain in the infected area. d. Herpes never entirely goes away. 8. Diagnosis and Treatment a. There are several antiviral therapies that not only reduce symptoms and heal herpes lesions but also, if taken continuously, significantly reduce the risk of transmission of the virus to sexual partners. C. Chlamydia 1. Chlamydia trachomatis is the most widespread sexually transmitted bacterium in the United States. 2. Incidence a. One in 25 young Americans is infected with chlamydia. b. Women are at greater risk. 3. Signs and Symptoms a. As many as 75 percent of women and 50 percent of men have no symptoms or those that are so mild they don’t seek medical attention.
  16. 16. Chapter 8 – Sexual Health b. Without treatment up to 40 percent of cases of chlamydia can lead to pelvic inflammatory disease. c. Untreated women have three to five times the risk of getting infected with HIV if exposed. d. In women, symptoms include abdominal pain, abnormal vaginal discharge, bleeding between menstrual periods, cervical or rectal inflammation, low-grade fever, yellowish discharge from the cervix, vaginal bleeding after intercourse, painful intercourse, painful urination, and the urge to urinate more than usual. e. In men, symptoms include pain or burning while urinating, pus, watery, or milky discharge from the penis, swollen or tender testicles, and rectal inflammation. f. Epididymitis can also occur in men, which can cause sterility. 4. Diagnosis and Treatment a. Antibiotics are used to treat chlamydia. D. Pelvic Inflammatory Disease (PID) 1. Pelvic inflammatory disease is the infection of a woman’s fallopian tubes or uterus. 2. Not actually an STI, but a complication of STIs. 3. Initial episodes of PID lead to scarring and obstruction of the fallopian tubes severe enough to cause infertility. 4. Potential complications of PID infertility, ectopic pregnancy, and chronic pelvic pain. 5. Smoking may increase the likelihood of PID. 6. Incidence a. About one in seven women of reproductive age has PID: half of all women may have had it. 7. Signs and Symptoms a. Half of all cases produce no symptoms. b. Early symptoms include: i. Abdominal pain or tenderness ii. Fever iii. Vaginal discharge that may have a foul odor iv. Painful intercourse or urination v. Irregular menstrual bleeding vi. Rarely, pain in the right upper abdomen 8. Diagnosis and Treatment a. Detecting gonorrhea and chlamydia as well as pelvic ultrasound or MRI can prevent or diagnose PID. E. Gonorrhea
  17. 17. Chapter 8 – Sexual Health 1. Sometimes called “the clap,” gonorrhea is one of the most common STIs in the United States. 2. Incidence a. Some 330,000 new cases are reported annually. b. Rates are higher in women. 3. Signs and Symptoms a. Men: i. Have thick pus oozing from the penis and painful urination ii. Untreated it can spread to the prostate gland, testicles, bladder, and kidneys iii. Complications include urinary obstruction and sterility b. Women: i. May have a discharge and burning or no symptoms at all ii. Inflammation travels from the vagina and cervix, through the uterus, to the fallopian tubes and ovaries and cause pain and fever iii. Gonorrhea is the leading cause of sterility in women and can cause PID c. In both sexes, gonorrhea can develop into a serious, even fatal, blood borne infection that can cause arthritis in joints, attack the heart muscle and lining, cause meningitis, and attack the skin and other organs. 4. Diagnosis and Treatment a. The tried-and-true method of diagnosis is still a microscopic analysis of cultures from the male’s urethra, the female’s cervix, and the throat and anus of both sexes. b. Cephalosporin antibiotic plus azithromycin or doxycyline is now the recommended treatment. F. Nongonococcal Urethritis (NGU) 1. NGU refers to any inflammation of the urethra that is not caused by gonorrhea. 2. NGU is the most common STI in men. Symptoms in men are similar to those of gonorrhea. 3. Women frequently develop no symptoms or very mild itching, burning during urination, or discharge. 4. Treatment consists of doxycycline or azithromycin given to both partners. G. Syphilis 1. A corkscrew-shaped, spiral bacterium called Treponema pallidum causes syphilis. 2. Sexual contact, including oral sex or intercourse, is the primary means of transmission.
  18. 18. Chapter 8 – Sexual Health 3. Genital ulcers increase the risk of HIV, while those with HIV may be more likely to develop syphilis. 4. Incidence a. An estimated 300,000 cases are reported each year. 5. Signs and Symptoms a. Primary syphilis i. The first sign of syphilis is a lesion, or chancre, which appears exactly where the bacteria entered the body. b. Secondary syphilis i. Anywhere from 1 to 12 months after the chancres appear, secondary-stage symptoms may appear. ii. Some people have no symptoms. iii. Others develop a skin rash or small, flat rash in moist regions on the skin; whitish patches on the mucous membranes of the mouth or throat, temporary baldness, low-grade fever, headache, swollen glands, or large moist sores around the mouth and genitals. iv. Sores are loaded with bacteria and can transmit the infection. v. Symptoms may last for several days or several months. c. Late and latent syphilis i. Involves no signs and symptoms and no sores or rashes. ii. At this stage, the bacteria are invading various organs inside the body, including the heart and the brain. iii. For two to four years, there may be recurring infectious and highly contagious lesions of the skin or mucous membranes. iv. Syphilis loses its infectiousness as it progresses: After the first two years, a person rarely transmits syphilis through intercourse. d. Tertiary syphilis i. Ten to 20 years after the beginning of the latent stage, the most serious symptoms of syphilis emerge. ii. Victims rarely live this long, but if they do they may die of a ruptured aorta or other heart damage or may have progressive brain damage. 6. Diagnosis and Treatment a. Penicillin is the drug of choice for treating primary, secondary, and latent syphilis. H. Chancroid 1. Soft, painful sore or localized infection caused by the bacterium Haemophilus ducrevi and usually acquired through sexual contact. 2. Half of all cases heal by themselves. 3. Treated with antibiotics.
  19. 19. Chapter 8 – Sexual Health I. Pubic Lice and Scabies 1. These infections are sometimes, but not always transmitted sexually. 2. Pubic lice or “crabs:” a. Are usually found in the pubic hair, although they can migrate to other hairy parts of the body. b. Irritation from the lice may lead to intense itching, and scratching can lead to sores. 3. Scabies: a. Is caused by a mite that burrows under the skin, where it lays eggs. 4. Lice and scabies are treated with applications of permethrin cream and lindane shampoo. J. Trichomoniasis 1. An estimated 7.4 million new cases of this curable STI appear each year. 2. It is caused by a single-celled protozoan parasite Trichomonus vaginalis. 3. Most men have no signs or symptoms. 4. Some may have irritation inside the penis, mild discharge, or slight burning or irritation during urination. 5. Some women develop a frothy, yellow-green vaginal discharge. a. They may experience discomfort during intercourse or urination, and genital itching and irritation. This may increase susceptibility to HIV if exposed to the virus. K. HIV and AIDS 1. HIV stands for human immunodeficiency virus. 2. AIDS stands for acquired immune deficiency syndrome. 3. Incidence a. According to statistics, 34 million people are living with HIV/AIDS worldwide. b. Nearly 30 million people have died. c. An estimated 2.5 million become infected with HIV every year. d. About 1.1 million people in the U.S. are living with HIV/AIDS in the U.S. e. Those at highest risk are: i. Gay and bisexual men ii. Black Americans iii. Women iv. Young adults 4. Reducing the Risk of HIV Transmission a. The risk of HIV transmission depends on sexual behavior, not sexual orientation.
  20. 20. Chapter 8 – Sexual Health 5. Sexual Transmission a. Casual contact does not spread HIV infection. b. Compared to other viruses, HIV is extremely difficult to get. c. HIV can live in blood, semen, vaginal fluids, and breast milk. d. Many chemicals, including household bleach, alcohol, and hydrogen peroxide, can inactivate HIV. e. In studies of family members sharing dishes, food, clothing, and frequent hugs with people with HIV infection or AIDS, those who have contracted the virus have shared razor blades, toothbrushes, or had other means of blood contact. f. You cannot tell visually whether a potential sexual partner has HIV. g. HIV can be spread in semen and vaginal fluids during a single instance of anal, vaginal, or oral sexual contact between heterosexuals, bisexuals, or homosexuals. h. Teenage girls may be particularly vulnerable to HIV infection. i. Anal intercourse is an extremely high-risk behavior. j. Other behaviors that increase the risk of HIV infection include having multiple sexual partners, engaging in sex without condoms or virus- killing spermicides, sexual contact with persons known to be at high risk, and sharing injection equipment for drugs. k. Condom use significantly reduces the risk of HIV transmission. l. Individuals are at greater risk if they have an active sexual infection. m. No cases of HIV transmission by deep (French) kissing have been reported, but it could happen. n. Oral sex can lead to HIV transmission. o. HIV infection is not widespread among lesbians, although there have been documented cases of possible female-to-female HIV transmission. 6. Nonsexual Transmission a. Efforts to prevent nonsexual forms of HIV transmission have been very effective. These include: b. Screening the blood supply has reduced the rate of transfusion- associated HIV transmission by 99.9 percent. c. Treatment with antiretroviral drugs during pregnancy and birth reduced transmission to newborns by about 90 percent in optimal conditions. d. HIV infections among injection drug users have fallen by half in the past decade.
  21. 21. Chapter 8 – Sexual Health 7. Preventing HIV Infection a. Behavioral methods, such as safer sex practices, remain the primary means of preventing transmission. b. Biological approaches may provide additional protection. 8. Recognizing and Treating HIV/AIDS a. HIV infection refers to a wide spectrum of health problems that result from immunologic abnormities caused by the virus when it enters the bloodstream. b. HIV destroys the cell-mediated immune system, particularly the CD4+ T-lymphocytes. c. Shortly after becoming infected with HIV, individuals may experience a few days of flu-like symptoms, which most ignore or attribute to other viruses. d. Symptoms: swollen lymph nodes, fever chills, night sweats, diarrhea, weight loss, coughing and shortness of breath, persistent tiredness, skin sores, blurred vision and headaches, and development of other infections, such as certain kinds of pneumonia. e. HIV infection is associated with a variety of HIV-related diseases, including different cancers and dangerous infections including tuberculosis. f. Diminished mental function may appear before other symptoms. 9. HIV Testing a. One in five Americans infected with HIV don’t know it. b. All HIV tests measure antibodies, cells produced by the body to fight HIV infection. c. It can take three to six months for the body to produce the telltale antibodies, so a negative result may not be accurate, depending on the timing of the test. d. Testing can be confidential or anonymous. e. Home Access, the only home HIV test approved by the FDA, is available in drug stores or online for $40 to $50. f. New blood tests can determine how recently a person was infected with HIV. 10. Diagnosing AIDS a. A diagnosis of AIDS applies to anyone with HIV whose immune system is severely impaired, as indicated by a CD4+ count of less than 200 cells per cubic millimeter of blood. b. AIDS is diagnosed in persons with HIV infection who experience recurrent pneumonia, invasive cervical cancer, or pulmonary tuberculosis.
  22. 22. Chapter 8 – Sexual Health c. People with AIDS may experience persistent fever, diarrhea that persists for more than a month, or involuntary weight gain or loss of more than 10 percent of body weight. 11. Treatments a. New forms of therapy have been remarkably effective in boosting levels of protective T cells and reducing viral load – the amount of HIV in the bloodstream. b. Starting treatments early can dramatically improve survival. Key Terms abstinence acquired immune deficiency syndrome (AIDS) amenorrhea bisexual celibacy cervix chancroid chlamydia circumcision clitoris corpus luteum Cowper’s glands cunnilingus dysmenorrhea ejaculation ejaculatory ducts endometrium epididymis erogenous estrogen fallopian tubes fellatio gender gonorrhea herpes simplex heterosexual homosexual hormone human immunodeficiency virus (HIV) human papillomavirus (HPV) intercourse intimacy labia majora labia minora masturbation menstruation mons pubis nongonococcal urethritis (NGU) orgasm
  23. 23. Chapter 8 – Sexual Health 165 ovaries ovulation ovum (ova) pelvic inflammatory disease (PID) penis perineum premenstrual dysphoric disorder (PMDD) premenstrual syndrome (PMS) progesterone prostate gland refractory period scrotum semen seminal vesicles sex sexual health sexual orientation sexuality sexually transmitted disease (STD) sexually transmitted infection (STI) sperm syphilis testes toxic shock syndrome (TSS) transgender urethra urethral opening uterus vagina vas deferens

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