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PSY 370 Study Guide for Test 09/22

by: Jessica Garcia

PSY 370 Study Guide for Test 09/22 PSY370

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This study is a composite of the notes from the text book and the notes class and his power-points.
The Psychology of Human Sexuality
Dr. Foote
Study Guide
Psychology, humansexuality, contraception, Pregnancy, Hormones
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This 41 page Study Guide was uploaded by Jessica Garcia on Monday September 19, 2016. The Study Guide belongs to PSY370 at University of Miami taught by Dr. Foote in Fall 2016. Since its upload, it has received 5 views. For similar materials see The Psychology of Human Sexuality in Psychology at University of Miami.


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Date Created: 09/19/16
1 PSY 370--Human Sexuality First Test Study Guide Because the test will be computer scored, you must bring a number 2 pencil and eraser. There are 69 four or five choice multiple choice questions on the first test (and on the other two tests as well). Some of these questions will be based on anatomical diagrams. Even though most of the material can be found in both the textbook and lecture notes, some of the material comes only from the textbook and some comes only from lectures. Below is a list of topics that may be on the test. Anything not on the list will not be on the test. INTRODUCTION: SEXUALITY IN PERSPECTIVE 1. Definitions of coitus, gender, rape, sex, sexual behavior, and sexuality. Be able to recognize and explain from a description. Coitus: penile-vaginal intercourse Gender: The psychological state of being male or female; a person’s sense of being male/female. Rape: Any genital activity without affirmative confirmation, which must be ongoing throughout any sexual activity. Sex: (a) refers to sexual/ reproductive anatomy or (b) to the behavior that produces or is intended to produce an orgasm (i.e., sexual behavior) Sexual behavior: Behavior that produces arousal and increases the chance of orgasm. Sexuality: Patterns of sexual behavior, beliefs, attitudes, emotions and fantasies. 2. Sexual attitudes and practices of Victorians, Puritans, Muslims, and ancient Greeks Victorians: Extreme conservatism, women covered most of their bodies. Women were to carrie themselves in a formal and disciplined manner. Upon the 1800s, specifically 1837-1901, the strict beliefs of procreation only and gender roles returned. Women weren’t seen to have sexuality and their role was to service their husbands (Crooks & Baur, 2011). Women were viewed as not knowing much about sex and having very little desire for it (Platoni, 2010). These strict views on gender and sex became what we now think of as the Victorian stereotype. 2 Puritans: The Puritans were a group of 16th- and 17-century English Protestants who thought that the Reformation had not gone far enough in its rejection of the Catholic Church. They wanted a simpler, purer kind of worship and advocated a strict form of religious discipline. They were intolerant of any form of sexual activity outside marriage, and yet warmly encouraged it in the marital bed. The word puritan is often used today in a derogatory sense and is sometimes applied to those who appear to reject pleasure, especially of a sexual kind, or who are judged to have a too moralistic attitude towards sexuality in general. In fact, historically, Puritan attitudes towards sexuality were more tolerant than this, indeed celibacy wasn't viewed as a superior spiritual state and sex was approved of within certain contexts. ex within marriage was a gift from God and as much a rightful expression of love as it was a means to reproduction. The Puritans approved of the stabilizing influence of married life and believed it established conditions conducive to the worship of God. Muslims: Muslims have believed that sexual intercourse is one of the finest pleasures of life, reflecting the teachings of the great prophet Muhammad. However, the way that the laws of the Koran are carried out varies greatly from country to country. Ancient Greeks: Openly acknowledged both heterosexuality and homosexuality in their society and explained by the existence of the two in a myth in which the original humans were double creatures; some were double males, double females, and male/female. The gods split them in half, and forever after each one continued to search for its missing half. 3. What is true about sexual attitudes and behavior across cultures? Almost all societies have strong strong sexual norms.  Incest taboo is almost universal.  Adult exposure to genitals  Fairly similar rate of homosexuals to heterosexuals  Generally similar expressions of jealousy 4. Major differences and similarities in sexual behavior between species including how they compare to humans. What species has sex for emotional bonding more frequently than humans? Humans are not the only species that masturbate. Common among female and male primates. Same gender sex is commonly found; observations of other species indicate that our basic mammalian heritage is bisexual. Human uniqueness: For lower species, sexual behavior is regulated hormonally. Among higher species, this is controlled by the brain (influenced by learning and social contexts). This environmental influences are much 3 more important in shaping primate—esp human—sexual behavior than they are in shaping the sexual behavior of other species. In virtually all mammals, females do not engage in sexual behavior unless they are in heat, or estrus. In contrast, human females are capable of engaging in sexual behavior during any phase of their hormonal or menstrual cycle. Traditionally, it was thought that female orgasm is unique to humans; some studies found evidence of orgasm in rhesus macaques. 5. For what are Anthony Comstock, and Margret Sanger famous? Anthony Comstock: He was a U.S. Postal Inspector and politician dedicated to the ideas of Victorian morality. He underwent an extensive campaign to censor materials he considered indecent and obscene, such as birth control information. Margret Sanger (1879-1966): An American birth control activist, sex educator, writer, and nurse. She opened the first birth control clinic and established organizations that evolved into the Planned Parenthood Federation of America. 6. What is the major contribution to sexuality by Sigmund Freud and by Henry Havelock Ellis? The cultural context in which Sigmund Freud crafted his theories and writings was during the Victorian era, the late 1800s, both in the U.S. and in Europe. Norms about sexuality were extraordinarily rigid and oppressive. Freud’s psychoanalytic movement was his contribution; he stressed the importance of sexual drive, infantile sexuality, and sexual energy (i.e., libido). Henry Havelock Ellis was a physician in Victorian England, he compiled a vast collection of information in sexuality—including medical and anthropologic findings, as well as case histories—which was published in Studies of the Psychology is Sex (1896). He believed that men and women are sexual creatures. He believed that sexual deviations from the norm are often harmless, and he urged society to accept them. 7. What caused and what ended the two American sexual revolutions? About when did they occur? First American Sexual Revolution (1920s)  Influenced by the work of Sigmund Freud  New technologies  Women obtained the right to vote.  Stopped by the Great Depression (1930-40s) 4 Second American Sexual Revolution (1960s)  Second World War  Invention of birth control pills  Work of Masters and Johnson  Play boy!  Feminist movement  General disregard toward authority  Stopped by disillusionment caused by the surge in herpes and AIDS SEX RESEARCH 1. What does sampling mean and what difficulties occur when sampling? A sample is a portion of the population. A random sample or representative sample is a method of choosing participants, in which all members of the population have an equal chance of being included in the sample. Probability sampling is when each member of the population has a known probability of being included in the sample. Convenience sample: A sample chosen in a haphazard manner relative to the population of interest. Not a random or possibility sample. Problem of refusal or nonresponse: the problem that some people will refuse to participate in a sex survey, thus making it difficult to study a random sample. Volunteer bias: A bias in results of sex surveys that arises when some people refuse to participate, so that those who are in the sample are volunteers who may in some ways differ from those who refuse to participate. 2. Recognize and understand the limitations on the reliability of self-report on sexual behavior.  Purposeful distortion (enlargement vs. concealment)  Memory (difficulty to assess with accuracy)  Difficulties with estimates 3. What types of studies, especially observational studies, are done in sex research?  Web-based surveys  Qualitative research in which the results are conveyed not in numbers, but in words. Qualitative measures encompass a collection of methods that may involve the researcher’s participation in a setting direct 5 observation; or in depth, open-ended questionnaire. This method is naturalistic and holistic. It seeks to understand people in their natural environment.  Ethnography  Participant-observer technique: in this type of research, the scientist actually becomes part of the community, and he or she makes observation from inside the community.  Correlational research produces data that can tell us if certain factors are related to each other…not if one factor caused another.  Experiment: independent variable is manipulated and the dependent variable is observed. Casual inferences may be made if true experiment. 4. Recognize and understand the different ethical issues when doing sex research  Informed consent, protection of harm, justice 5. What are the assumptions, strengths, and limitations of the research by Kinsey, Masters and Johnson, and NHSLS?  Alfred C. Kinsey: interviewed a total of 5,300 males and 5,940 females (1938-1949) at Indiana University campus and large cities like Chicago. Excluded African Americans and those he interviewed where not published. Probability sample was used because of the problem of non- response. Face-to-face interview. Took precaution to ensure his participant’s privacy. Accuracy: some questions were very accurate while others contained serious problems (overestimation of sexual activity and homosexuality)  National Health and Social Life Survey: Probability sample of American households, 18-59 years of age. A sample of 3,432 people. The data were obtained in face-to-face interviews supplemented by brief written questionnaires, which were handed to the respondents for particularly sensitive topics (i.e., masturbation) and sealed in a privacy envelope. The NHSLS is one of the best sex surveys of the general population of the United States that we have today. Limitations: age of sample; did not include enough people from some statistically small minority groups (i.e., Native Americans).  Masters and Johnson: Masters had normal participants from the general population engage in sexual activity in the lab while he measured their behavior and physiological responses. Never before used approach. People who had history of emotional problems who where exhibitionist, where discarded from the study. A total of 694 people participated in the study; men ranged in age from 21-89; 6 women ranged from 18-79. The majority were well educated and white, with few minorities. o First participants engaged in sexual activity in privacy. Then, they were recoded during sexual intercourse, masturbation and “artificial coition”. In AC, female participants stimulate themselves with an artificial penis, powdered by an electric motor, capable of photographing the inside of the vagina. Measures as these avoid distortion. o Concerned about long-term effects, they made follow-up contacts every 5 years. SEXUAL ANATOMY 1. Recognize from verbal description or from diagrams the: areola, Bartholin gland, breast, cervix, clitoral crura, clitoral glans, clitoral prepuce, clitoral shaft, endometrium, fallopian tube, fimbriae, G-spot, inner labia, outer labia, mons, nipple, ovary, perineum, pubococcygeus muscle, Skene's gland, vagina, vaginal introitus, vestibular bulbs, vulva; corona, corpus cavernosum, corpus spongiosum, Cowper's gland, epididymis, frenulum, inguinal canal, interstitial cells (aka Leydig's cells), penile glans, penile prepuce, penile shaft, prostate gland, scrotum, seminal vesicle, seminiferous tubules, spermatic cord, testis, vas deferens 7 8 9 10 11 Know the sexual sensitivity and function of the above. 2. Generally, how often should women douche? Never. 3. What causes erections: both in the general sense and specific mechanisms? 12 13 An erection is a complex event that requires the interaction of the brain, nerves, hormones, and blood vessels. This process is separate from ejaculation and orgasms. The shaft of the normal penis consists of two erectile bodies each called the corpus cavernosum, which begins at the pelvic bone and extend to just below the head of the penis. They are spongy tissue made up of smooth muscle and blood vessels. The male hormone testosterone, which is secreted by the testes, controls the function of the penis and a man’s sex drive. The brain starts the changes that will produce an erection:  As a result of psychological or physical stimulation, the brain sends messages through the nervous system to the penis.  These messages relax the smooth muscles in the blood vessels, filling the corpus cavernosum.  At the same time, the veins that carry blood away from the penis shut down, causing an increase in blood pressure in the penis.  The blood that is trapped within the corpus cavernosa causes the penis to become erect. Peripheral Pathways  The innervation of the penis is both autonomic (sympathetic and parasympathetic) and somatic (sensory and motor). From the neurons in the spinal cord and peripheral ganglia, the sympathetic and parasympathetic nerves merge to form the cavernous nerves, which enter the corpora cavernosa and corpus spongiosum to affect the neurovascular events during erection and detumescence. The somatic nerves are primarily responsible for sensation and the contraction of the bulbocavernosus and ischiocavernosus muscles.  The sacral parasympathetic input is responsible for erections and the thoracolumbar sympathetic pathway is responsible for detumescence (lessening of tension, become flaccid) 4. What part of the nervous system maintains the penis in its flaccid state and what part creates and maintains erections? Flaccid: sympathetic nervous system Maintains erection: Parasympathetic nervous system 5. What is smegma? Smegma is a whitish substance that may be present on the genitalia. It is caused by the shedding of the skin cells and it is harmless, although it may become problematic if allowed to build up. 14 6. How does Viagra work? PDE5 inhibitors Viagra, a prescription medication used to treat erectile dysfunction, works by blocking a chemical in the body that is normally responsible for reversing an erection. As a result, more of the chemicals responsible for the erection remain, so the muscles in the penis do not constrict. This allows blood to stay in the penis longer, which allows the man to maintain an erection. Because Viagra has no effect on the chemicals that cause an erection, it does not work without stimulation. When a man is aroused, nerve signals are sent from the brain and around the penis. These nerve signals cause chemicals to be released. These chemicals relax muscles in the penis. Normally, these muscles are constricted so that blood cannot flow into the penis. When these muscles relax, large amounts of blood are able to enter the penis, causing an erection. An erection is reversed when another chemical (known as phosphodiesterase type 5 [PDE5]) breaks down the chemicals that caused the muscles to relax in the first place. This causes the muscles in the penis to constrict again, which results in blood leaving the penis. Viagra works by blocking PDE5. When PDE5 is blocked, more of the chemicals responsible for the erection remain, so the muscles in the penis do not constrict. This allows blood to stay in the penis longer, which allows the man to maintain an erection. 15 HORMONES, MENSTRUATION, & MENOPAUSE 1. What are the functions of estrogen, follicle-stimulating hormone (FSH), gonadal-releasing hormone (GnRH), luteinizing hormone (LH), oxytocin, progesterone, and testosterone? 2. What gender differences are there in the amount and function of the hormones listed above? Hormones: Chemical substances by the endocrine glands into the blood stream. Androgens: the group of male sex hormones. Testosterone: A hormone secreted by the testes in males and also present at lower levels in females.  The testes produce testosterone  Testosterone stimulates and maintains the secondary sex characteristics, maintaining the genitals and their sperm-producing capability, and stimulates the growth of bone and muscle. The ovaries produce two important hormones, estrogen and progesterone. Estrogens: The group of female sex hormones. Progesterone: A sex hormone secreted by the ovaries.  Estrogen brings about many of the changes of puberty (stimulating the growth of the uterus and vagina, enlarging the pelvis, and stimulating breast growth). Estrogen is also responsible for maintaining the mucous membranes of the vagina and stopping the growth of bone and muscle, which accounts for females being generally smaller than males.  In adult women the levels of estrogen and progesterone fluctuate according to the phases of the menstrual cycle and during various other stages (i.e., menopause and pregnancy). The pituitary gland produces Follicle-stimulating hormone and Luteinizing hormone. IN MEN: 16  Follicle-stimulating hormone: Affects the function of the testes by controlling sperm production.  Luteinizing hormone: controls testosterone production. IN WOMEN:  Follicle-stimulating hormone and Luteinizing hormone regulate the levels of estrogen and progesterone.  FSH stimulates follicles in the ovaries.  High levels of estrogen stimulate the hypothalamus to produce GnRH, which causes the pituitary to product LH.  LH triggers ovulation The levels of LH are regulated by Gonadotropin-releasing hormone (GnRH), which is secreted by the hypothalamus. Inhibin is another hormone produced by the testes and acts to regulate FSH levels. FSH controls sperm production. In women, inhibin is produced by the ovaries; it inhibits FSH production and participates in the feedback loop than controls the menstrual cycle. The pituitary produces two other hormones, prolactin and oxytocin.  Prolactin stimulates the production of milk by the mammary glands.  Oxytocin stimulates ejection of the milk from the nipples. Also stimulates contains of the uterus during child-birth. Lastly, this hormone is known as the “snuggle hormone” because it promotes affectionate bonding. (Males also produce oxytocin). 3. Know the four phases of the menstrual cycle in order. 17 18 First stage: Follicular phase  At the beginning of this phase, the pituitary secretes relatively high levels of FSH (follicular-stimulating hormone). As the name implies, its function is to stimulate follicles in the ovaries. At the beginning of the follicular phase, it signals one follicle in the ovaries to begin to bring an egg to the final stage of maturity. At the same time, the follicle secretes estrogen. Second stage: Ovulation  During ovulation, the follicle ruptures open and a mature egg is released. By this time, estrogen has risen to a high level, which inhibits FSH production (no more follicles are needed). The high levels of estrogen also stimulate the hypothalamus to produce GnRH, which causes the pituitary to begin production of LH (luteinizing hormone). A surge of LH triggers ovulation. Third stage: Luteal phase  After the egg has been released, the follicle, under stimulation of LH, turns into a glandular mass of cells called the corpus luteum (hence, 19 luteal phase). The corpus luteum manufactures progesterone. The high levels of progesterone inhibit the pituitary’s secretion of LH; and as LH declines, the corpus luteum degenerates. With the degeneration, comes a sharp decline in estrogen and progesterone levels at the end of the luteal phase. The falling levels of estrogen stimulate the pituitary to begin production of FSH, and the whole cycle begins again. Fourth stage: Menstruation  The fourth and final phase of the cycle is menstruation. Menstruation is the shedding of the lining of the uterus (the endometrium). During this level, estrogen and progesterone levels are low, and FSH levels are rising. Menstruation is triggered by the sharp decline in estrogen and progesterone at the end of the luteal phase. Follicular phase (day 1-13) This phase also begins on the first day of menstruation, but it lasts till the 13th day of the menstrual cycle. The following events occur during this phase:  The pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow.  One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13 days for the egg cell to reach maturity.  While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to develop a lining of blood vessels and soft tissue called endometrium. Ovulation phase (day 14) On the 14th day of the cycle, the pituitary gland secretes a hormone that causes the ovary to release the matured egg cell. The released egg cell is swept into the fallopian tube by the cilia of the fimbriae. Fimbriae are finger like projections located at the end of the fallopian tube close to the ovaries and cilia are slender hair like projections on each Fimbria. 20 Luteal phase (day 15-28) This phase begins on the 15th day and lasts till the end of the cycle. The following events occur during this phase:  The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.  If a sperm cell does not impregnate the egg cell within that time, the egg cell disintegrates.  The hormone that causes the uterus to retain its endometrium gets used up by the end of the menstrual cycle. This causes the menstrual phase of the next cycle to begin. Menstrual phase (day 1-5) Menstrual phase begins on the first day of menstruation and lasts till the 5th day of the menstrual cycle. The following events occur during this phase:  The uterus sheds its inner lining of soft tissue and blood vessels which exits the body from the vagina in the form of menstrual fluid.  Blood loss of 10 ml to 80 ml is considered normal.  You may experience abdominal cramps. These cramps are caused by the contraction of the uterine and the abdominal muscles to expel the menstrual fluid. 4. During each phase of the menstrual cycle, what's happening with the ovaries & oocytes, the endometrium, the cervix, the follicle & corpus luteum, and the relevant hormones?  During the first, or follicular phase, the high levels of estrogen stimulate the endometrium of the uterus to grow, thicken, and form glands that will eventually secrete substances to nourish the embryo. In other words, the endometrium proliferates. 21  Then, during the luteal phase, the progesterone secreted by the corpus luteum stimulates the glands of the endometrium to start secreting the nourishing substances.  If the egg is fertilized and the timing goes properly, about 6 days after ovulation the fertilized egg arrives in a uterus that is well prepared to cradle and nourish it.  The corpus luteum continues to produce estrogen and progesterone for about 10 to 12 days. If pregnancy has no occurred, it hormone output declines sharply at the phase. The uterine lining cannot be maintained and is shed, resulting in menstruation.  Immediately after, a new lining starts forming in the next proliferate phase. 5. What hormone signals the brain that a woman is pregnant? During menstruation, estrogen and progesterone sharply decease. I am assuming that the hormones signaling the brain that a woman is pregnant is high levels of estrogen and progesterone. 6. If a woman complains of PMS, in what phase of the menstrual cycle does it occur? Premenstrual syndrome or PMS refers to cases in which the woman has particularly severe combination of physical and psychological symptoms that occur premenstrually. The third phase of the cycle is called the luteal phase; this is the phase before menstruation occurs. 7. What is the average age of menopause for women? The most common age range at which women experience menopause is 48- 55 years. Premature menopause is defined as menopause occurring in women younger than 40 years of age. The average age is 51. 8. How does sexual and reproductive functioning change in men with age? Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like menopause). Instead, changes occur gradually during a process that some people call andropause. Aging changes in the male reproductive system occur primarily in the testes. Testicular tissue mass decreases. The level of the male sex hormone, testosterone stays the same or decreases gradually. There may be problems getting an erection. This is a general slowing, instead of a complete lack of function. Fertility: 22 The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells. But they continue to produce the fluid that helps carry sperm. Urinary function: The prostate gland enlarges with age as some of the prostate tissue is replaced with a scar-like tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. BPH may cause problems with slowed urination and ejaculation. In both men and women, reproductive system changes are closely related to changes in the urinary system. Effect of changes: Fertility varies from man to man. Age does not predict male fertility. Prostate function does not affect fertility. A man can father children, even if his prostate gland has been removed. Some fairly old men can (and do) father children. The volume of fluid ejaculated usually remains the same, but there are fewer living sperm in the fluid. Some men may have a lower sex drive (libido). Sexual responses may become slower and less intense. This may be related to decreased testosterone level. It may also result from psychological or social changes due to aging (such as the lack of a willing partner), illness, chronic conditions, or medications. Aging by itself does not prevent a man from being able to enjoy sexual relationships. 23 REPRODUCTION (ALL OF THIS MATERIAL IS ENTIRELY IN THE HYDE & DELAMATER TEXT, CHAPTER 6) 1. How many sperm in a typical single ejaculation? How long does it take a man to make that many sperm? 200 million. It takes at least 24 hours. 2. Where in a woman’s body does conception occur? Contrary to popular belief that conception occurs in the uterus, typically it occurs in the outer third (the part near the ovary) of the fallopian tube. Conception begins with a single fertilized egg cell which divides into many cells as it passed down the fallopian tube, finally arriving in the uterus and implanting itself in the uterine wall. 3. What are the parts of sperm, what part contains an enzyme to dissolve the zona pellucida? The sperm is one of the tiniest cells in the human body. It is composed of a head, mid-piece, and tail. The head of the sperm contains the nucleus, which contains the DNA. Sperm also contain RNA, carrying instruction for early embryonic development. The acrosome, a chemical reservoir is also in the head of the sperm. The mid-piece contains mitochondria, which provide energy that is used to propel the sperm forward (flagellation). As the sperm approaches the fallopian tubes, a chemical secreted by the egg attracts the sperm to the egg. The egg is surrounded by a thin, gelatinous later called the zona pellucida. Sperm swarm around the egg and secrete an enzyme called hyaluronidase (produced by the acrosome located in the head of the sperm); this enzyme dissolves the zona pellucida, permitting one sperm to penetrate the egg. Conception has occurred! 4. What surrounds the ovum that sperm have to get through in order to fertilize the ovum? zona pellucida 5. How long do sperm and ova live in a woman’s body? What is the optimum time for coitus with respect to ovulation if a couple desires to conceive a child? 24 Sperm live inside the woman’s body for up to five days. The egg is capable of being fertilized for about the first 12 to 24 hours after ovulation. Allowing the sperm some swimming time, this means that intercourse should be timed right at ovulation or one or two days before. 6. How accurate are home pregnancy tests? Home or over the counter pregnancy tests claim to be 99% accurate. Laboratory tests found that of 18 brands, only 1 detected low levels of hCG and only 8 detected high levels of hCG. This 10 out 18 brands would have produced a false negative result. The accuracy of the test depends on its sensitivity to the level of hCG in the urine. hCG: human chorionic gonadotropin, secreted by the placenta 7. What is the placenta? The placenta is the mass of tissues that surrounds the conceptus early in development and nurtures its growth. Later is moves to the side of the fetus. The placenta is responsible for serving as a site for the exchange of substances between the woman’s blood and the fetus’s blood. The placenta also secretes hormones (large quantities of estrogen, progesterone and human chorionic gonadotropin (hCG) (used to detect pregnancy). 8. What psychological changes occur in women during pregnancy? What factors seem to influence these changes? What differences exist by trimester and when comparing first-time mothers to women who had been pregnant previously? Situation matters: first, her attitude toward the pregnancy makes a difference; women who desire the pregnancy are less anxious than women who do not. Second, social class makes a difference; low income is associated with depression during pregnancy. Third, availability of support. Women with a supportive partner are less likely to be depressed. While the first semester can be relatively tempestuous, the second trimester is usually a period of relative calm and well-being. Depression is less likely during the second trimester if the pregnancy woman has a cohabiting partner. Interestingly, women who have had a previous pregnancy are more distressed during this time than women who have not. Perhaps because of the demands of caring for a child while also being pregnant. Third trimester: Psychological well-being is greater among women who have a social support system, have higher incomes, are middle class, and experience fewer recurrent stressful life events. A comparison of women pregnant for the first time with women who had previous pregnancies found that first time mothers reported a significant increase in dissatisfaction with their husbands from the second to the third trimester. 25 9. How long can women who have a normal, healthy pregnancy continue to have coitus? What major category of pregnant women is most likely to be advised not to have sex? What, if any, changes in frequency of coitus occur with pregnancy? Medical opinion is that—given a normal, healthy pregnancy, intercourse can continue safely. No evidence that intercourse or orgasm is associated with preterm labor. The only exception is a case where a miscarriage or preterm labor is threatened. Most women continue to have intercourse throughout the pregnancy. The man on top position is best abandoned. The side to side position is probably the most suitable one for intercourse during late stage of pregnancy. 10.What are Braxton-Hicks contractions? The uterus tightens occasionally in painless contractions called the Braxton- Hicks contractions. These are not part of labor. It is thought that they help to strengthen the uterine muscles, preparing for labor. 11.What sexual position is most frequently the best one during the last stages of pregnancy? Side-to-Side position. 12.Know the stages of labor and the major events that occur in each stage. First Trimester Weeks 3 and 4 Development of the head; Nervous system begins to form; Backbone is constructed Week 5 Formation of the umbilical cord Weeks 4 to 8 External body parts develop—eyes, ears, arms, hands, finders, legs, feet and toes Liver, lungs, pancreas, kidneys, and intestines form and being limited functioning Second Trimester Week 14 Fetal movement, or quickening Week 18 Fetal heartbeat detected Week 24 Fetus is sensitive to light and sound in utero Third Trimester Week 28 Fat deposits form—gains chubby baby appearance Weeks 29 to birth Rapid growth 13.What is an episiotomy? What does research say about its benefits? 26 An incision made in the skin just behind the vagina, allowing the baby to be delivered more easily. The reasons physicians give for performing an episiotomy are that it will prevent impaired sexual functioning in later life, reducing the severity of perineal lacerations, and reduce post-delivery pain and medication use. Research found no evidence of these benefits. Critics claim that it is unnecessary and done merely for the doctor’s convenience 14.How does the rate of Cesarean deliveries in the USA compare with other Western countries? Do Cesarean deliveries improve mortality? Does having one Cesarean delivery mean a woman will have a Caesarean for all subsequent deliveries?  It is not true that once a woman has had one delivery by cesarean, she must have all subsequent deliveries by the same method. Up to 60% of women with a prior C-section can have vaginal births.  C-sections did not lower the risk of mortality.  C-Section rates have been increasing steadily since 1996, reaching 32% of all births in 2007. This is the highest rate in U.S. history, and higher than most Western countries. Should only be performed when necessary! 15.What is the minimal waiting time after giving birth vaginally, without an episiotomy, to have coitus? According to Hyde et al’s (1996) data how long before about 90% of couples have resumed normal sexual activity? A couple should wait at least two weeks before resuming coitus. According to Hyde’s et al., data, in the month following birth, only 17% resumed intercourse; by the 4 month 9/10 couples had resumed intercourse. Note: Although sexual behavior was less frequent in the month following birth, satisfaction with the sexual relationship remained high. A major influence on when the couple resumed intercourse was whether the mother was breast-feeding. Women reported significantly less sexual activity and lower sexual satisfaction when breast-feeding. One year before 90% of couples have resumed normal sexual activity. 16.What recommendation is made about whether mothers should breast-feed their newborn infants? What effect does breastfeeding have on coital activity? Breast milk is the ideal food for a baby. It provides the baby with the right mixture of nutrients, it contains antibodies that protect the infant from some infections and diseases, it is free from bacteria, and is always the right temperature. Also associated with a reduced risk of obesity at ages 5 and 6; improved cognitive skills in children at ages 5, 7, 11, and 14. 27 Lactation suppresses estrogen production, which in turn results in decreased vaginal lubrication, making intercourse uncomfortable. 17.What is the most common cause of infertility in men today? In women today? Women: Pelvic inflammatory disease caused by a sexually transmitted infection, especially gonorrhea and chlamydia. Men: Infections in the reproductive system caused by sexually transmitted diseases. Another cause is low sperm count (often due to varicoceles). 18.Recognize artificial insemination, in vitro fertilization, gamete intrafallopian transfer (GIFT)  Artificial insemination: A procedure in which sperm are placed into the vagina by means other than sexual intercourse. There are two kinds of artificial insemination: by husband or by donor.  In vitro fertilization: A procedure in which an egg is fertilized by sperm in a laboratory dish. The fertilized egg or embryo can be implanted in the uterus of a woman and carried to term.  Gamete intrafallopian transfer (GIFT) is a procedure in which sperm and eggs are collected and then inserted together into the fallopian tube, where natural fertilization can take place, followed by natural implantation. CONTRACEPTION 1. What issues should be considered when choosing a form of contraception?  How well does it work?  Is it reversible? o Do I want to pregnant in the near or distant future?  What are the side-effects? Are they tolerable for me? o Abnormal periods, heavy periods, nausea, etc.  Does it fit your personality and lifestyle? o If you are forgetful, birth control may not be the right option. If condoms make sex awkward for you, then another form of birth control should be assessed. 28  Are you in a monogamous relationship? o Not all forms of birth control protect you from STDs  Do you have health conditions? o Are you a smoker and over 35? Do you have a history of blood clots?  Can you afford it? 2. What are erotophobes and erotophiles? People who are erotophobic feel guilty and fearful about sex. They are less likely to talk about sex, have more negative reactions to sexually explicit material, and have sex less frequently and with fewer partners over time. People who are erotophilic on the other hand experience less guilt about sex, talk about sex more openly, and hold more positive attitudes toward sexually explicit material. Erotophiles are more likely to use contraception. 3. Contraceptive myths  Douching  Hot tub/ Jacuzzi  Being a virgin  Man drinks Mountain Dew (or any other beverage)  Coitus standing up  Woman jumping up and down after sex 4. How men be helpful with birth control in general and if they have a girlfriend using birth control pills, patch, or ring. If couple does not want to be pregnancy, never pressure for coitus without contraception Genuinely consider methods with male responsibility:  Sperm banks now, and then obtain a vasectomy  If you engage in casual sex, always have condoms handy If woman is using rhythm, pills, IUD etc.  Emotional support with patience and without nagging 29  Instrumental support if asked  Financial contribution 5. What are the strengths, limitations, and risks for abstinence, combination pills, depo-provera injections, diaphragms, female condom, implants, IUDs, male condoms, mini-pills, patch, ring, spermicides, sterilization, rhythm method, and withdrawal? Combination Pills Birth control pills that contain a combination of estrogen and progestin. Strengths:  It is close to 100% effectiveness if used properly  It does not interfere with intercourse  Not messy  Some side-effects: reduces the amount of menstrual flow and thus helps reduce cramps  Iron-deficiency anemia is less likely  Can clear up acne  Protects against endometriosis, ovarian and endometrial cancer  Reduces risk of ectopic pregnancy  Reduces menstrual discomfort and PMS for some  Reduced vaginal dryness and painful intercourse related to menopause  Relatively inexpensive with insurance coverage  Does not interfere with sex; “spontaneity issue” Limitations:  Places all the responsibility on the woman  Taking them correctly may be complicated for some women  No protection against STDs  Blood clotting problems: higher risks of developing blood clots, thrombi. 30  Can cause high blood pressure  Increases the amount of vaginal discharge and the susceptibility to vaginitis  Increased susceptibility to chlamydia  May cause some nausea, weight gain (may easily be fixed with switching to another brand)  May cause depression and irritability  Decrease in vaginal lubrication  Certain medicines may make pill less effective  Potential interaction effects with other medicines Mini-pills (progestin only) Strengths:  Typical failure rate of 4-10%  Does not interfere with sex; “spontaneity issue”  Reduces risk of ovarian and endometrial cancer and pelvic inflammatory disease  Reduces menstrual discomfort (for some women)  Easy to us  reversible Limitations:  Slightly larger failure rate than combination pill  Irregular menstrual cycle and bleeding between periods may occur  Safer for older women and those with clotting problems  Requires remembrance and responsibility Patch The patch (Ortho Evra) contains the same hormones 31 as combination birth control pills but is administered transdermally —that is, through the skin. Strengths:  The patch lasts 7 days, so the woman places a new one every week for three weeks and has a week patch-free.  Women do not need to remember to take a pill daily at the same time.  With the patch the hormones enter the body through the skin rather than going to the stomach and needing to be digested  Possible side effects: irritation of the skin, headaches, depression, weight gain, change in libido, and mood swings. Nausea, breast tenderness and bleeding between periods are the most common side effect; these side effects usually clear up in less than 3 months  Does not interfere with sex; “spontaneity”  Reduces risk for acne, ovarian and endometrial cancer and for pelvic inflammatory disease  Makes menstrual cycle regular  Reduces discomfort and PMS symptoms (for some women)  Easily reversible Limitations:  Less effective for women who weight more than 200 pounds.  Also a concern that a woman gets more estrogen from the patch than she would with the combination pill.  Expect similar advantages and disadvantages to the pill  Possible side effects: irritation of the skin, headaches, depression, weight gain, change in libido, and mood swings. Also, nausea, breast tenderness, and bleeding between periods (these side effects usually clear up in less than three months).  May be seen by others Risks for abstinence:  The first time it is used it takes a couple of days for the hormones to reach effectiveness levels, so backup methods should be used. Ring 32 The vaginal ring (NuvaRing) is a flexible, transparent ring made of plastic and filled with the same hormones as those in the combination pill, at slightly lower doses Strengths:  The ring is placed high up in the vagina and remains in place for 21 days; 7 days ring-free  Requires even less remembering than the patch and the pill.  Easy to insert  Allows for spontaneity  Reduces risk of ovarian and endometrial cancer and pelvic inflammatory disease  Makes menstrual cycle regular  Reduces menstrual discomfort  Reversible Limitations:  Same hormones working as the pill; same expectations for limitations  Typical side effects: Acne, breast tenderness, depression, weight gain, nausea, lower libido, moods swings, vaginal irritation/ infection  Health risks: elevated blood pressure and/or blood sugar, changes in cervical cells  Does not protect against STDs  May be felt during coitus Depo-Provera injections DMPA is a progestin administered by injection, which must be repeated every 3 months for maximum effectiveness Strengths:  Highly effective 33  Does not interfere with lovemaking  Requires less reliance on memory than other methods.  Available for women who cannot use the combination pill because they are over 35 and smoke or/and have blood pressure problems  Most users experience no menstrual periods; occasional spotting  May relieve anemia due to menstrual periods  Can be used for treatment of endometriosis Limitations:  No known side effects  Cannot be reversed in the 3 months of use  Many women are infertile for 6 to 12 months after stopping its use; then become pregnant at normal rates.  Sometimes heavier and longer periods may occur  May increase appetite  May lower libido  Many first-time users do not repeat Diaphragms The diaphragm is a circular, dome- shaped piece of thin rubber with a rubber-covered rim of flexible metal. It is inserted up to 6 hours before intercourse and may be left in for as long as 24 hours. Strengths:  Readily available via physician  Can be inserted a few hours before use and used for several coital acts 34  Reversible Limitations:  Typical failure rate of 12%-16%  A woman must be fitted; if 15lb change, must be refitted  Wearing it for longer than 24 hours may increase toxic shock symptom  Allergies to nonoxynol-9  Vaginal soreness  Risk for urinary infections  May cause spontaneity problem  Must plan before use Implants Implants are thin rods or tubes containing progestin. They are inserted under the skin a woman’s arm and are effective for three years. Strengths:  Highly effective; except for abstinence, it is the most effective method of birth control!  There is no need to remember the pill, patch, etc for three years  Does not interfere with love making  Does not contain estrogen (so, no side effects associated with estrogen)  Reduces risk of endometrial cancer and pelvic inflammatory infection  Reduces menstrual discomfort  Reversible  May be used during breast feeding Limitations:  Changes in menstrual bleeding patterns; changes are unpredictable and may include unusually long bleeding, frequent bleeding, and amenorrhea.  No STD protection 35  May lower libido  Weight gain or being over 155 pounds may reduce effectiveness  Cost: $400 to $800 for insertion, if left for three years, the cost averages to $11-$22 per month IUDs The intrauterine device is a small piece of plastic; it is inserted into the uterus by a doctor or nurse and then remains in place until the woman wants to have it removed Strengths:  Extremely effective  Lasts 12 years!  Simple to use  Does not interfere with sex  Do not have to rely on memory  Reduced menstrual flow and reduced risk for anemia  Can be used safely by women after having a baby and while breast feeding  Woman can become immediately pregnant after removal  Does not disrupt menstrual cycle Limitations:  Common side effects include increased menstrual cramps, irregular bleeding and increased menstrual flow (these occur only in 10 to 20 percent of women and most likely immediately after insertion.  Initial costs, about $300  Copper T may greatly increase blood flow; although Mirena does not have copper Rhythm method Strengths:  Only method accepted by the Roman Catholic church 36  Easy to switch to attempting to become pregnant  Familiarity with body  Free! (except ovulation kit)  No health risks Limitations:  High typical failure rate; 25%  May be frustrating in periods of abstinence  Difficult and time consuming for some women Risks for abstinence:  Yes, must remain abstinent during ovulation and a couple days before/ after. Female condom Strengths:  Easily reversible  Provides protection against STDs Limitations:  High failure rate! 20% for typical users  Some may experience allergies to nonoxynol-9, although rare  More expensive than male condoms and not as readily available  Must plan for use and may interfere with spontaneity and sex  May cause vaginal irritation  Poor taste  Makes noise during seek Male condoms Strengths:  Readily available and cheap  Provides protection against STDs  Partner know it is being used  Gives the man more responsibility  Flavored condoms available  Easily reversible  May by effective if used properly 37 Limitations:  Must plan before use  Spontaneity problem  Some men claim they loss sensitivity and pleasure with condom on  Poor taste if used with spermicide  Some men may be allergic to latex condoms Spermicides Strengths:  Provides some lubrication Limitations:  Ineffective; 26-29 % failure rate  May cause vaginal irritation that may increase risk of HIV  Must plan for use  May disrupt spontaneity  Must plan ahead  Poor taste, which does not allow for oral sex Withdrawal Strengths:  Always available  Only last minute resort  Free!  No health risks (except potential psychological ones) Limitations:  Partner cooperation is required, limits ability to focus on pleasure  High failure rate, 26%; not effective!  May cause frustration and over time erectile dysfunction Sterilization is a surgical procedure whereby an individual is made permanently sterile, that is, unable to reproduce. Sterilization for men 38 The male sterilization operation is called a vasectomy, so named for the vas deferens, which is tied or cute. The vasectomy makes it impossible for sperm to pass beyond the cut in the vas deferens. Strengths:  Simply procedure, takes only 20 minutes to perform  Little recovery time  Creates no physical changes that interfere with having an erection or with the production of sex hormones. The testes continue to manufacture testosterone and secrete it to the bloodstream. The ejaculation is also completely normal, except it contains no sperm.  100% effective!  Minimal health risks  No need to plan ahead; does interfere with sex or spontaneity  Permanent method  Cheap over long term Limitations:  May be psychologically taxing  Non-reversible in most cases Risks for abstinence: Men should not assume they are sterile until three months have passed; back up methods needed. Sterilization for women Several surgical techniques are used to sterilize a woman (sometimes called tubal ligation or “having the tubes tide”), including minilaparotomy, laparoscopy, and the transcervical approach. Female sterilization procedure makes it impossible for the egg to move down the fallopian tube toward the uterus. With laparoscopy, a magnifying instrument is inserted into the abdomen. The doctors use it to identify the fallopian tubes and then blocks them with clips. A variation of this method is the 39 minilaparotomy, which is used immediately after a woman has given birth. Lastly, the transcervical approach, does not require and incision; instead the instruments enter through the cervix and uterus, and a blockage device is placed in each fallopian tube. Strengths:  Does not interfere with the ovaries; premature menopause does not occur.  100% effective  permanent method  cheap over long term Limitations:  Surgery requires anesthesia  Non-reversible (in most cases) 6. Know in detail, specifics of correct use of the male condom.  Be honest with yourself! If any possibility of otherwise unprotected sex, have condoms available.  Choose the right type for you.  Check the date (check again immediately before use).  Store properly, but have available.  Be assertive with yourself and your partner about their use.  Tear open carefully.  Put on while penis is erect and immediately before it touches vulva or any orifice.  Squeeze-hold by reservoir/tip.  If foreskin covers glans, roll back; place on top of glans of penis with roll-up outside.  Still holding reservoir/tip, unroll all the way to base of penis.  [Enjoy whatever activity you are engaging in] 40  As soon as wearer ejaculates, hold bottom of condom firmly on base of his penis.  When ready, remove away from wearer’s partner.  Tie condom and throw it away. 7. Why should most men and heterosexual women have two different types of condoms available?  The condom can break  Allergies to latex 8. Know the special care needed with contraceptive pills: i.e., take about the same time, reduced effectiveness with some medications (which ones?), etc. Certain medicines and supplements may make the pill less effective; these include:  The antibiotic rifampin (Most antibiotics do not interfere with the pill)  Some medicines that are taken by mouth for yeast infections  Some HIV medications  Some Anti-seizure medicines  St. John’s Wart  Vomiting and diarrhea may also keep the pill from working 9. What is emergency contraception? What does empirical evidence say about how Plan B works? What other types of emergency contraception are sometimes available? Emergency contraception is available in pill form. The treatment is most effective if begun within 12 to 24 hours and cannot be delayed longer than 5 days. Regular birth controls contained levonorgestrel (a progestin) are taken at higher doses. (plan B) Emergency contraception is between 75 and 89 percent effective. These statistics undermine its actual effectiveness because they refer to the effectiveness during the most fertile part of the cycle. Highly effective. An IUD can also be used for emergency contraception who wants continuing protection. The failure rate is less than 1 percent if inserted within 5 days of unprotected sex. 10.What impact does a vasectomy have on a man's functioning? Creates no physical changes that interfere with having an erection or with the production of sex hormones. The testes continue to manufacture testosterone and secrete it to the bloodstream. The ejaculation is also completely normal, except it contains no sperm. 41 11.What is tubal ligation? What other form of sterilization is available to women? Several surgical techniques are used to sterilize a woman (sometimes called tubal ligation or “having the tubes tide”), including minilaparotomy, laparoscopy, and the transcervical approach. Female sterilization procedure makes it impossible for the egg to move down the fallopian tube toward the uterus. With laparoscopy, a magnifying instrument is inserted into the abdomen. The doctors use it to identify the fallopian tubes and then blocks them with clips. A variation of this method is the minilaparotomy, which is used immediately after a woman has given birth. Lastly, the transcervical approach, does not require and incision; instead the instruments enter through the cervix and uterus, and a blockage device is placed in each fallopian tube. 12.How does RU 486 work? RU-486 or mifepristone, is a medication abortion because it involves only the administration of a drug. It can induce a very early abortion. It has a powerful antiprogesterone effect, causing the endometrium of the uterus to be sloughed off and thus bringing about an abortion. It is administered as a tablet followed 2 days later by a small does of prostaglandin (misoprostol), which increases contractions of the uterus, helping expel the embryo. It can be used the first 7 to 9 weeks of pregnancy. It is 92% effective. Early research has found little evidence of side effects.


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