HEP2500 Exam 1

Depression

Feelings of sadness and hopelessness ii. Loss of pleasure in usual activities iii. Poor appetite and weight loss, or overeating iv. Insomnia or disturbed sleep v. Restlessness or fatigue vi. Thoughts of worthlessness or guilt vii. Trouble concentrating or making decisions viii. Thoughts of death or suicide

Barrier methods of contraception

(diaphragm, condom, and others) block the sperm from reaching the egg

hormonal methods of contraception

(oral contraceptives) alter the biochemistry of a woman's body; intrauterine devices prevent the sperm from reaching the egg through hormonal changes.

Effectiveness of the Pill

. A typical first-year failure rate is 9%; the average continuation rate after 1 year of use is 67%.

Allostatic Load

. Although the GAS model is viewed as a key conceptual contribution to understanding stress, some aspects of it are outdated. The stress response itself now is believed to be the cause of disease over time. Researchers have termed the long-term wear and tear of the stress response the allostatic load. A high allostatic load is linked to a greater risk of disease.

Generalized Anxiety Disorder

. Generalized anxiety disorder (GAD) is a diagnosis given to people who worry about ordinary future threats, such as financial concerns or passing an upcoming exam. The end result is a persistent feeling of nervousness, often accompanied by depression.

Successful Families

1. A strong family copes successfully with stress and crisis. 2. Family routines and rituals such as dinnertime, a regular bedtime, household chores, Sunday activities, and birthday and holiday celebrations are highly beneficial for couples, children, and families. 3. Six major qualities appear in strong families: a. Commitment to one another b. Appreciation for one another c. Communication d. Time spent together e. Spiritual wellness f. Successful strategies for coping with stress, crisis, and conflict 4. Knowing when to get professional counseling is often a sign of a strong family.

Conflict and Conflict Resolution

1. Conflict is natural but must be handled in a constructive way so that it doesn't damage or destroy the relationship. 2. It is best to let anger dissipate before trying to resolve conflict. 3. Sources of conflict change but primarily resolve around issues of finance, sex, children, in-laws, and housework. 4. These basic strategies for negotiating with a partner can be helpful: a. Clarify the issue and listen carefully to each side. b. Find out what each partner wants. c. Determine how you both can get what you want. d. Negotiate changes and be willing to compromise. e. Solidify agreements verbally or in writing. f. Review and renegotiate plans and make adjustments. 5. Conflict resolution requires trust in each other. Establishing basic rules for arguments can help avoid destructive conflict.

Contraceptive Implants

1. Contraceptive implants are placed under the skin of the upper arm and deliver a small but steady dose of progestin (a synthetic progesterone) over a period of years. a. The progestins may inhibit ovulation, affect development of the uterine lining, CIG - 6 | 3 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. thicken cervical mucus, and inhibit movement of the sperm. b. Implanon/Nexplanon is a single implant and is effective for 3 years.

Time Management

1. Efficient time management may help to lower stress levels. Some suggestions for avoiding procrastination and managing time better include the following: a. Set priorities, focusing on essential and important tasks. b. Schedule tasks for times of peak efficiency. c. Set realistic goals and commit to achieving them by writing them down. d. Budget enough time to achieve goals by making a reasonable estimate and then adding another 10% to 15%, or even 25%, as a buffer. CIG - 2 | 7 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. e. Break up long-term goals into short-term ones. f. Visualize the achievement of goals; mentally rehearse the performance of tasks. g. Keep track of uncompleted tasks to analyze reasons for procrastinating. h. Tackle the least pleasurable tasks first. i. Consolidate tasks when possible. j. Identify quick transitional tasks. k. Delegate responsibility—asking for help as appropriate and necessary. l. Say "no" when necessary without feeling guilty. m. Take breaks and allow for real free time to enjoy other activities. n. Avoid your personal "time sinks" such as watching TV, surfing the Internet, and talking on the phone. o. Stop thinking about getting started—just do it!

Ending a Relationship

1. Ending a relationship is usually difficult and painful. 2. Give the relationship a fair chance before breaking up. 3. Be fair and honest, and avoid attempting to make your partner feel responsible. 4. Being compassionate can allow the relationship to end without damaging anyone's selfesteem. 5. If you are the rejected person, give yourself time to resolve your anger and pain. 6. Ending a relationship can offer valuable lessons about your needs, preferences, strengths, and weaknesses. Allow the recovery period to be a time of self-renewal.

Friendship

1. Friendships, the first relationships formed outside the family, teach us tolerance, sharing and trust. 2. Friendships include these characteristics: companionship, respect, acceptance, help, trust, loyalty, mutuality, and reciprocity. 3. Friendship is like an intimate partnership, without the sexual desire and demand for exclusiveness; it may therefore be longer lasting and more stable than a romantic relationship. 4. Friends provide emotional support and act as a buffer from stress.

Achieving Healthy Self-Esteem

1. Having a healthy self-esteem means regarding yourself as good, competent, and worthy of love. 2. Developing a Positive Self-Concept a. Self-esteem is grounded in the positive experiences of love received in childhood. Although children originally build their self-concepts on characteristics adopted from parents, a healthy self-concept is integrated—resulting in a new, individual personality. b. Those who do not have a stable self-concept have conflicting, polar views of themselves, which makes it impossible to see themselves and others realistically. 3. Meeting Challenges to Self-Esteem a. All adults encounter situations that challenge their self-concepts, and they can choose to react in several ways—from acknowledging that something went wrong and starting again, to denying that anything went wrong and blaming someone else (psychological defenses), to developing a lasting negative self-concept in which they feel demoralized. b. Notice Your Patterns of Thinking i. It is possible to fight demoralization by recognizing one's own negative thoughts or assumptions and noting exactly when unpleasant emotions occur, identifying their cause, and keeping a journal. CIG - 3 | 3 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. c. Avoid Focusing on the Negative i. Demoralized people tend to use all-or-nothing thinking and to overgeneralize from negative events. ii. Cognitive distortions are patterns of thinking that make events seem worse than they really are. d. Develop Realistic Self-Talk i. It is possible to change the behavior patterns of jumping to a negative conclusion by developing realistic self-talk. Thoughts should be as logical and accurate as possible. e. Demoralized people who are unable to use techniques to change may create a selffulfilling prophecy whereby they turn themselves into the unworthy person they imagine themselves to be.

Factors That Influence Wellness

1. Health Habits a. Scientific research is continuously revealing new connections between our habits and health. b. Unfortunately, poor health habits take hold before many Americans reach adulthood. CIG - 1 | 5 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 2. Heredity/Family History a. Your genome consists of the complete set of genetic material in your cells; it contains about 25,000 genes, half from each of your parents. b. The human genome varies slightly from person to person, and many differences do not affect health. c. However, some differences do have important implications for health; knowing your family health history can help you determine which conditions may be of special concern for you. d. Errors in our genes are responsible for about 3,500 clearly hereditary conditions. Altered genes also play a part in heart disease, cancer, stroke, diabetes, and many other common conditions. 3. Environment a. Our environment includes not only the air we breathe and water we drink, but also substances and conditions in our homes, workplaces, and communities. 4. Access to Health Care a. Access to adequate health care helps improve both quality and quantity of life through preventive care and the treatment of disease.

Separation and Divorce

1. High rates of divorce in the United States reflect high expectations for marriage and a lack of belief in the permanence of marriage. 2. Physical separation usually follows an emotional separation. 3. Recovery from separation and divorce can take from 1 to 3 years and involves construction of a postdivorce identity. a. Sometimes counseling is necessary to help children adjust to the changes in their lives. b. Recent research has found that children who spend substantial time with both parents are usually better adjusted than those in sole custody arrangements. 4. Divorce often is followed by remarriage, a new life, and the development of new aspects of self.

Unhealthy relationships

1. It is important to recognize when a relationship is unhealthy. 2. Extreme examples are those that are physically or emotionally abusive or that involve codependency. 3. Even relationships that are not abusive or codependent may be unhealthy. a. The relationship may be unhealthy if it lacks love and respect and places little value on time spent together. b. Relationships characterized by communication styles that include criticism, contempt, defensiveness, and withdrawal may not be salvageable. c. There are negative physical and mental consequences of being in unhappy relationships.

Same-Sex Partnerships

1. Like any intimate relationship, same-sex partnerships provide intimacy, passion, and security. 2. Partnerships tend to be more equal and less organized around traditional gender roles. CIG - 4 | 6 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 3. Societal hostility or ambivalence often means that bisexual individuals and same-sex partners may find community resources and support more important as a source of identity than for heterosexuals. 4. Studies suggest that gay women are more successful than gay men at maintaining intimacy and emotional compatibility.

Living Together

1. Living together is gaining acceptance as part of the normal mate-selection process, a dramatic change. 2. Factors in its acceptance include greater tolerance of premarital sex, increased availability of contraceptives, the growing tendency to marry at older ages, and a larger pool of single and unmarried people. 3. It provides many of the benefits of marriage—the opportunity to develop companionship, greater intimacy, and a satisfying sex life. 4. Cohabitation has certain advantages over marriage—greater autonomy, freedom from social expectations of marriage, a greater sense of independence, and fewer obligations. 5. The disadvantages of cohabitation are lack of legal protection and benefits and family pressure to get married. 6. Cohabitation does not necessarily lead to happier or longer-lasting marriages.

Love, Sex, and Intimacy

1. Love is one of the most basic and profound human emotions. In many kinds of relationships, love is entwined with sexuality. 2. Personal standards, not social norms, are the basis for decisions about sex today, resulting in an increased emphasis on sex over love. 3. Love, sex, and commitment are closely related. Love draws people together; sex provides passion, pleasure, and intensity; and commitment reflects responsibility, reliability, and faithfulness. 4. Other elements of love include euphoria, preoccupation, idealization, and devaluation. Love and commitment become central to enduring intimate relationships. 5. The triangular theory of love (Robert Sternberg) proposes that love has three dimensions: CIG - 4 | 2 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. intimacy, passion, and commitment. The amount of love one experiences depends on the strength of each dimension on its own and relative to each other. Different stages and types of love can be understood as different combinations of the three dimensions. a. Intimacy: feelings of attachment, closeness, connectedness, bondedness b. Passion: motivational drives and sexual attraction c. Commitment: decision to remain together with the ultimate goal of making long-term plans 6. Men and women view the relationship between love and sex differently. Men often can separate sex and affection more easily than women can.

Male Sex Organs

1. Males' external sex organs: a. The penis consists of the glans and the shaft, which is made of spongy tissue that becomes engorged with blood during sexual excitement. b. The scrotum is a pouch that contains the testes and maintains their temperature at approximately 93.6 degrees Fahrenheit to allow normal sperm production. 2. The urethra runs the entire length of the penis. Both semen and urine pass through the urethra, but never at the same time. a. The Cowper's glands flank the urethra and excrete preejaculatory fluid. 3. During a brief lifetime, sperm take the following route: CIG - 5 | 2 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. a. Sperm are produced inside a maze of tiny, tightly packed tubules within the testes. As they begin to mature, sperm flow into a single storage tube called the epididymis, which lies on the surface of each testis. b. Sperm move from each epididymis into another tube called the vas deferens. c. The two vasa deferentia eventually merge into a pair of seminal vesicles, whose secretions provide nutrients for the sperm. The sperm pass through the prostate gland and pick up a milky fluid and become semen. d. On the final stage of their journey, sperm flow into the ejaculatory ducts. 4. The glans, or tip of the penis, is partially covered by the foreskin, which is removed by circumcision in about 55 percent of newborn males in the United States. Circumcision is performed for cultural, religious, and hygienic reasons.

The Sexual Response Cycle

1. Men and women respond physiologically with a predictable set of reactions regardless of the stimulation. a. Vasocongestion (the accumulation of blood in tissues and organs) and increased muscular tension characterize most physiological reactions. 2. The sexual response cycle has four phases: a. In the excitement phase, the genitals grow engorged with blood, and lubrication begins. b. In the plateau phase, the engorgement and lubrication increase. c. During the orgasmic phase, involuntary muscular contractions occur in both men and women, leading to the ejaculation of semen in men. d. The resolution phase reverses changes initiated during the excitement phase. i. Men enter a refractory period after ejaculation; they cannot be restimulated to orgasm during this period. 3. General physical reactions accompany the genital changes in both men and women. The male pattern of response is more uniform than that of the female.

Oral Contraceptives: The Pill

1. Oral contraceptives (OCs), or birth control pills, are based on the hormonal changes that occur in women during pregnancy, when the corpus luteum secretes estrogen and progesterone to suppress ovulation. a. OCs also thicken cervical mucus, which inhibits the movement of sperm; alter the rate of ovum transport; and possibly inhibit implantation by changing the lining of the uterus.

Self-Concept, Self-Esteem, and Self-Acceptance

1. Positive self-concept and self-esteem and an affirmative self-acceptance help us to form healthy relationships. 2. These positive views of self develop in infancy and childhood.

Psychoneuroimmunology

1. Psychoneuroimmunology (PNI) studies the interactions among the nervous, endocrine, and immune systems. Hormones and other chemical messengers released during the stress response may inhibit or strengthen the immune system. 2. Acute stress can cause a rise in immune cells which enhances the immune response. 3. Chronic stress causes prolonged secretion of cortisol, which negatively affects the immune system and causes an acceleration of diseases associated with inflammation, including heart disease and type 2 diabetes.

Schizophrenia

1. Schizophrenia is a devastating mental disorder that affects a person's thinking and perceptions of reality. 2. Although we are uncertain about the exact causes, researchers have identified possible chemical and structural differences in the brain. Several genes appear to increase risk. 3. General characteristics of schizophrenia include: a. Disorganized thoughts, expressed in a vague or confusing way b. Inappropriate emotions or the absence of emotion c. Delusions, or firmly held false beliefs d. Auditory hallucinations—schizophrenic people may hear voices when no one is present. e. Deterioration of function at work or in social situations 4. Because schizophrenics are at risk for suicide, professional help and regular medication are necessary.

Vaginal Contraceptive Ring

1. The NuvaRing contains a mixture of estrogen and progestin which it slowly releases into the blood, keeping hormone levels comparable to those found with OC use. a. The ring is inserted during a woman's menstrual period, removed in the fourth week, and then a new ring is inserted 7 days later. 2. Advantages a. The ring offers a month of protection with no daily or weekly action needed. b. It does not require a fitting and exact placement is not critical. c. Other advantages: lighter, less painful menses, decreased risk of uterine and ovarian cancer, decreased anemia, ability to control your cycle 3. Disadvantages a. No protection against STIs b. Side effects and medical risks are roughly similar to those of oral contraceptives. 4. Effectiveness a. Perfect use failure rate is 0.3%. The typical failure rate is similar to the pill's.

Cervical Cap

1. The cervical cap is a small flexible cup that fits snugly over the cervix, is used with spermicide, and is held in place by suction. 2. Advantages a. Similar to the advantages of the diaphragm b. Can be used by women who cannot use a diaphragm for anatomical or medical reasons c. It can be left in place for up to 48 hours and does not require backup condom use with additional acts of intercourse. 3. Disadvantages a. Most of the same disadvantages encountered with the diaphragm b. Difficulty with insertion and removal c. Slightly increased risk of TSS with prolonged use 4. Effectiveness a. For women who have never given birth, the first-year failure rate is 16%. b. For women who have given birth, the failure rate is 32%.

Contraceptive Skin Patch

1. The contraceptive skin patch, Ortho Evra, can be worn in various locations on the body and slowly releases estrogen and progestin into the bloodstream. a. Worn continuously for one week and replaced on same day of week for three consecutive weeks; the fourth week is patch free b. Patches should be discarded according to the manufacturer's directions to avoid CIG - 6 | 5 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. leakage of hormones into the environment. 2. Advantages a. Compliance may be higher with the patch than with oral contraceptives, because action is required only once a week. b. Other advantages: lighter, less painful menses, decreased risk of uterine and ovarian cancer, decreased anemia, ability to control your cycle 3. Disadvantages a. Does not protect against STIs b. Side effects similar to OCs c. Because Ortho Evra exposes users to higher doses of estrogen than most OCs, patch use may further increase the risk of blood clots and other adverse effects. 4. Effectiveness a. With both perfect and typical use, the patch is as effective as OCs in preventing pregnancy. The typical failure rate is approximately 9%.

Contraceptive Sponge

1. The contraceptive sponge is a round, absorbent device about two inches in diameter with a polyester loop on one side. It is presaturated with spermicide and fits snugly over the cervix. 2. Advantages a. Advantages similar to those of the diaphragm and cervical cap CIG - 6 | 9 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. b. Can be obtained without a prescription or professional fitting c. Can be safely left in place for 24 hours 3. Disadvantages a. Difficulty with removal b. Possible allergic reactions or irritation; irritation of the vaginal lining increases the risk of yeast infections and STIs c. The sponge has been associated with toxic shock syndrome. 4. Effectiveness a. Same as that of the diaphragm for women who have never experienced childbirth (12% in the first year) b. For women who have had a child, the failure rate rises to 24%.

Diaphragm with Spermicide

1. The diaphragm is a dome-shaped cup of thin rubber stretched over a collapsible metal ring and used in conjunction with spermicidal cream or jelly. It covers the cervix, blocking sperm from entering the uterus. a. Diaphragms, which must be fitted for each woman, can be obtained only by prescription, and women should be refitted after childbirth, abortion, or a weight change of 10 or more pounds. b. Diaphragms should be carefully inserted after being spread with spermicidal jelly or cream, no more than 6 hours before intercourse, and additional cream or jelly should be inserted before each additional act of coitus. After intercourse, the diaphragm must be left in place for at least 6 hours for the spermicide to work. A condom should be used with repeated intercourse. c. After removal and cleaning, the diaphragm should be checked each time for CIG - 6 | 8 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. punctures, tears, or cracks, and then stored in its case. 2. Advantages a. Less intrusive than male condoms (because it can be inserted up to 6 hours before intercourse) b. Its use is limited to times of sexual activity only c. It is immediately reversible d. It has no medical side effects 3. Disadvantages a. Need to always use it with a spermicide, making it difficult to carry unobtrusively b. The need for extra care and cleaning c. The need for refitting d. Some women cannot use diaphragms because of their anatomy. e. Diaphragms may also cause bladder infections and increase the risk of toxic shock syndrome. 4. Effectiveness a. The typical first-year failure rate is 12%. i. Incorrect insertion ii. Inconsistent use iii. Inaccurate fitting

Female Sex Organs

1. The external female sex organs are called the vulva, which includes: a. The mons pubis i. Fatty tissue over pubic bone b. The labia majora (outer lips) c. The labia minora (inner lips) d. The clitoris i. Highly sensitive to touch and plays an important role in female sexual arousal ii. Prepuce, clitoral hood, covers the glans e. The urethral and vaginal openings i. Leads directly from the urinary tract to its external opening between the clitoris and vaginal opening. 2. The vagina leads to the internal reproductive organs. a. The Grafenberg- or G-spot is located 1-2 inches internally in the vagina. b. The cervix is the opening to the uterus, or womb. c. Fallopian tubes lead from the top of the uterus to surround the ovaries and provide a channel for the ova to reach the uterus.

Injectable Contraceptives

1. The first injectable contraceptive marketed in the United States was Depo-Provera. a. With Depo-Provera, progestin is injected into the arm or buttocks, usually every 12 weeks. It prevents pregnancy by inhibiting ovulation. 2. Advantages a. Highly effective b. Convenient c. Private d. No estrogen-related side effects 3. Disadvantages a. Lack of protection against STIs b. Need for regular health-care visits to receive injections CIG - 6 | 6 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. c. Menstrual irregularities d. Weight gain e. Temporary infertility d. Use of Depo-Provera is associated with decreased bone density. i. The FDA advises women to only use Depo-Provera as a long-term contraceptive (longer than two years, for example) if other methods are inadequate. ii. Many gynecologic associations believe the benefits outweigh the risks. 4. Effectiveness a. Perfect-use failure rate with Depo-Provera is 0.2%. With typical use, failure rates increase to 6% in the first year of use.

The General Adaptation Syndrome

1. The term general adaptation syndrome (GAS) describes what many believe is the universal and predictable response pattern to all stressors. 2. The three stages of GAS can be triggered by a pleasant stressor, eustress, or by an unpleasant stressor, distress. a. The alarm stage is the fight-or-flight reaction. This stage makes the body vulnerable by mobilizing it to cope with a crisis. i. The shock phase is when the body initially experiences a stressor. ii. The antishock phase is the complex series of events brought on by the fight-orflight response. b. The resistance stage occurs with continued stress, the body develops a new level of homeostasis to cope with the added stress. c. The exhaustion stage results in the depletion of resources that leave the body vulnerable to disease.

Vaginal Spermicides

1. These come in a variety of forms, including foams, creams, jellies, suppositories, and films. a. Foams, creams, and jellies must be placed deep in the vagina not more than 60 minutes before intercourse. Reapplications are required before each repeated act of intercourse. b. Suppositories must be inserted at least 15 minutes but not more than 1 hour before intercourse. c. Vaginal Contraceptive Film (VCF) is a 2-inch square of film that dissolves into a gel about 15 minutes after placement over the cervix and is spermicidal for up to 1 hour. 2. Advantages a. Easy to use and are limited to times of sexual activity b. Readily available and do not require examinations c. Completely and immediately reversible d. Have virtually no side effects 3. Disadvantages a. Timing immediately before intercourse b. Increased vaginal discharge after use c. Possible increase in yeast and urinary tract infections d. This method does not protect against gonorrhea, chlamydia, or HIV. e. Overuse of spermicides can irritate vaginal tissue, possibly increasing risk of HIV transmission. 4. Effectiveness a. The typical first-year failure rate for vaginal spermicides is about 28% during the first year. b. Spermicide use is generally recommended only in combination with other barrier methods or as a backup to other contraceptives. i. Emergency contraceptives provide a better backup than spermicides.

Communication Skills

1. Three keys to good communication in relationships are self-disclosure, listening, and feedback. a. Self-disclosure means revealing risky personal information and usually helps create greater intimacy. b. Listening involves trying to understand instead of judging, blaming, advising, or trying to control. c. Feedback is a constructive response to another's self-disclosure and usually involves reciprocal self-disclosure.

Issues and Trends in Marriage

1. Traditional assumptions about marital roles have changed in recent years. The trend is toward an equalization of duties and responsibilities. 2. The best predictors of a happy marriage are: a. Realistic expectations b. Acceptance of the other's personality c. Development of friendship with other couples d. Good communication skills e. Effective ways of resolving conflict f. Agreement on religious/ethical issues g. Egalitarian role relationships h. A good balance of individual and joint interests and leisure activities 3. Marital adjustment tasks include negotiating and establishing marital roles, setting CIG - 4 | 7 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. domestic and career priorities, managing finances, and making sexual adjustments.

Emergency Contraception

A. Emergency contraception (EC) refers to postcoital methods—those used after unprotected sexual intercourse—and is designed only for emergency use. It may be appropriate if a regularly used method has failed or unprotected sex has occurred. 1. Postcoital pills appear to work primarily by inhibiting or delaying ovulation and by CIG - 6 | 11 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. altering the transport of sperm and/or eggs. They are not an abortifacient because they do not affect a fertilized egg already implanted in the uterus. 2. Plan B One-Step contains a single progestin-only pill. a. Available as an over the counter drug for everyone 3. Next Choice One Dose has two pills that are taken. a. The first pill should be taken as soon as possible after inadequately protected sex. b. The second pill should be taken 12 hours after the first pill. c. Available as an over-the-counter drug (no prescription required) for persons 17 and older 4. If taken within 24 hours after intercourse, emergency contraceptives may prevent as many as 75-95% of expected pregnancies. a. Overall, they reduce pregnancy risk by about 89%. b. It is most effective if initiated in the first 12 hours but can be taken up to 120 hours after unprotected intercourse. 5. Emergency contraception should be kept on hand to reduce the risk of pregnancy. 6. Intrauterine devices inserted within 5 days of unprotected intercourse can also be used as an emergency contraception. The Copper T ParaGard IUD is even more effective than pills for emergency contraception.

Managing Stress

A. Social Support 1. Social support systems may be one tool people can use to buffer themselves against the damaging effects of stress. 2. People who have family and friends to help them through times of stress stay healthier and recover faster than those who do not. B. Volunteering 1. Consider volunteering to help build your social support system and enhance your spiritual wellness. C. Communication 1. Assertive communication skills that help people respect the rights of others while protecting one's own rights can help stressful situations from getting out of control. 2. Suppressing feelings or expressing feelings aggressively can lead to problems with relationships. 3. Improve listening skills to help reduce stress in interpersonal relationships. D. Exercise 1. Regular exercise can stimulate the birth of new brain cells. 2. Exercise can also reduce many of the negative effects of stress by allowing one to expend the nervous energy built up from daily stressors, and training the body to return to homeostasis more readily after stressful situations. CIG - 2 | 6 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. E. Nutrition 1. A healthy diet provides energy stores for use in stressful situations; eating wisely also improves feelings of self-control and self-esteem. 2. Limiting or avoiding caffeine may be helpful in stress management. 3 Many people overeat in response to stress. F. Sleep 1. Sleeping seven to nine hours every night helps people stay healthy, perform their best, improves mood, fosters self-worth, enhances mental functioning, and supports proper emotional functioning.

Sexual Anatomy

A. The sexual organs of males and females are similar in origin and function. 1. Gonads—ovaries in the female, testes in the male—produce germ cells and sex hormones. 2. Germ cells—ova in the female, sperm in the male—are the basic units of reproduction.

Gender Role and Communication

Gender roles, the activities society deems appropriate for men and women, are also learned in childhood and affect the way we relate to others.

Reaching Wellness through Lifestyle Management

Getting Serious about Your Health, Building Motivation to Change, Enhancing Your Readiness to Change, Dealing with Relapse, Developing Skills for Change: Creating a Personalized Plan, put your plan into action, stay with it

Challenges in Relationships

Honesty and openness, emotional intelligence, unequal or premature commitment, unrealistic expectations, competitiveness, Balancing your time together and apart, jealousy, supportiveness

Fertility Awareness-Based Methods

Ordinarily, the ovaries release only one egg per month, which can live unfertilized for only about 24 hours. Sperm in the vagina may fertilize an egg for up to 6 to 7 days, so fertility is theoretically possible for only about 8 days per month.

Social Phobia

Social phobias, the fear of humiliation or embarrassment while being watched by others, occur in interpersonal settings; very shy people may experience these fears in nearly any social situation.

Physiological response to stress

The adrenal glands release the hormones cortisol and epinephrine (adrenaline), which trigger physiological changes. i. Increased heart and respiration rates ii. Hearing and vision becomes more acute iii. Liver releases extra sugar into bloodstream to boost energy iv. Perspiration increases v. Brain releases endorphins

Hormones and the Reproductive Life Cycle

The sex hormones produced by the ovaries or testes have a major influence on the development and function of the reproductive system throughout life. 1. The testes produce androgens; testosterone is the most important of these. 2. The ovaries produce estrogens, progestogens, and a small amount of testosterone. 3. The adrenal glands produce sex hormones in both sexes. 4. The hypothalamus controls the hormones of the pituitary gland, which in turn regulate hormones produced by the ovaries, testes, and adrenal glands.

TYPE A

Type A individuals tended to be overcompetitive, controlling, impatient, and aggressive. The Type A pattern of anger, cynicism, and hostility increases the risk of heart disease.

Type B

Type B individuals are less hurried and frustrated by daily events, more contemplative, and more tolerant of others.

Type C

Type C personality is characterized by anger suppression, difficulty expressing emotions, feelings of hopelessness and despair, and an exaggerated response to minor stressors.

Attachment

a. Adult styles of loving may be based on childhood styles of attachment to a primary caregiver: secure and trusting, anxious/avoidant, and distant/aloof. b. Successful relationships can still be established and maintained if someone's childhood has been less than ideal, if the person is willing to learn and change.

Effectiveness of IUDs

a. Failure rate during the first year is typically 0.8% for ParaGard and 0.2% for Mirena. b. If pregnancy occurs with the device in place, it should be removed if the pregnancy is to continue.

Advantages of implants

a. High effectiveness rate b. Reversibility c. Convenience d. Lower risk of certain side effects

Advantages of the Pill

a. High rate of effectiveness c. Relative ease of use CIG - 6 | 4 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. c. Continued spontaneity of sexual activities d. Predictable and regular periods e. Decreased menstrual and premenstrual syndromes f. Reversibility g. Reduced incidence of benign breast disease, anemia, pelvic inflammatory disease (PID), ectopic pregnancy, ovarian cysts, and endometrial and ovarian cancers

Advantages of IUDs

a. High reliability b. Simplicity and convenience i. Do not require the anticipation or interruption of sexual intercourse c. Side effects are localized d. Decreased risk of endometrial cancer e. Mirena also greatly decreases menstrual blood flow and cramps.

Disadvantages of implants

a. Lack of protection against STIs b. Need for professional insertion and removal c. Side effects: longer menstrual periods and other menstrual irregularities, headaches, weight gain, breast tenderness, and nausea

Menstrual Problems

a. Many women experience dysmenorrhea, discomfort associated with menstruation, which can include a combination of the following symptoms: lower abdominal cramps, backache, vomiting, nausea, bloating, diarrhea, headache, fatigue. i. Many symptoms are caused by prostaglandins that cause uterine muscular contractions. ii. NSAIDs and oral contraceptives are effective in reducing symptoms. CIG - 5 | 4 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. b. Emotional symptoms prior to the onset of a women's menstrual flow are common and may be categorized as one of three related conditions: i. Premenstrual tension symptoms are mild and may include negative mood changes, abdominal cramping, and backache. ii. Premenstrual syndrome (PMS) is characterized by more severe symptoms. iii. Very severe symptoms that cause impairment in normal daily and social functioning are classified as premenstrual dysphoric disorder (PMDD). c. Although the cause of these conditions is unknown, most researchers believe that they are probably caused by a combination of hormonal, neurological, genetic, dietary, and psychological factors. d. Strategies that may provide relief: limit salt intake, exercise, avoid alcohol and tobacco, eat a nutritious diet, and reduce stress. e. If you are a female with persistent premenstrual symptoms, keep a diary of the symptoms and their severity. Take it to your physician, who may prescribe a selective serotonin reuptake inhibitor which is taken during the progestational phase or during the entire menstrual cycle. Other drugs include certain oral contraceptives, diuretics, NSAIDs, and calcium.

Disadvantages of IUDs

a. No protection against STIs b. Side effects vary based on which type of IUD is being used c. Heavy menstrual flow and increased menstrual cramping occurs with ParaGard; Mirena causes a reduction in bleeding and cramping and women may stop bleeding altogether after several months d. Spontaneous expulsion of the IUD may occur (in 3% of women within the first year after insertion). e. In rare cases, an IUD can puncture the uterine wall. f. A serious but rare complication is pelvic inflammatory disease (PID), occurring shortly after insertion, which can be successfully treated with antibiotics if recognized early or can lead to permanent scarring and infertility if not noticed or treated early.

Obsessive-Compulsive Disorder

a. Obsessive-compulsive disorder (OCD) is a diagnosis given to people with obsession or compulsion or both. b. Obsessions are recurrent, unwanted thoughts or impulses that are not ordinary concerns. c. Compulsions are repetitive, difficult-to-resist actions usually associated with obsessions, such as hand washing. d. Feeling anxious, out of control, and embarrassed are common emotions of people with OCD.

The Transformation of Love

a. Over time, in most relationships, passion decreases; intimacy may continue to grow or may diminish; commitment is maintained unless other aspects of the relationship deteriorate. b. Passion often disappears; the key to enduring relationships is transforming passion into an intimate love.

Panic Disorder

a. Panic disorders are characterized by sudden, unexpected surges in anxiety. Symptoms include rapid heartbeat, shortness of breath, loss of physical equilibrium, and a feeling of losing mental control. b. Agoraphobia occurs when fear and avoidance spread to a large variety of situations until a person is virtually housebound. c. A panic attack is an occasional attack of overwhelming anxiety that may have no obvious antecedent and usually resolves in an hour or less.

Dimensions of Wellness

a. Physical Wellness i. Body's overall condition; absence of disease ii. Fitness level iii. Ability to care for yourself b. Emotional Wellness i. Self-acceptance ii. Self-esteem iii. Self-confidence c. Intellectual Wellness i. Maintaining an active mind d. Interpersonal Wellness i. Satisfying and supportive relationships ii. Communication skills iii. Intimacy e. Cultural Wellness i. Valuing difference f. Spiritual Wellness i. Focus on the positive g. Environmental Wellness i. Livability of your surroundings h. Financial Wellness i. Living within your means i. Occupational Wellness i. Level of happiness and fulfillment derived from work

Abraham Maslow's hierarchy of needs:

a. Physiological needs b. Safety and security c. Love and belongingness d. Self-esteem e. Self-actualization

Posttraumatic Stress Disorder

a. Posttraumatic stress disorder (PTSD) is a physiological and emotional reaction to events that produce a sense of terror and hopelessness; these include assaults, military combat, and natural disaster. b. Symptoms include re-experiencing the trauma in dreams and in intrusive memories, trying to avoid anything associated with the trauma, and numbing of feelings. The symptoms must last at least a month for a diagnosis to be made. c. Acute stress disorder is the diagnosis of those who have similar symptoms but whose symptoms resolve in less than a month. d. Tragic events like terror attacks and mass shootings often deeply affect those with PTSD and other preexisting psychological conditions.

Determining the Need for Professional Help

a. Professional help is sometimes a matter of individual choice but is indicated when: i. Depression, anxiety, or other emotional problems seriously interfere with school, work, or relationships. ii. Suicide is attempted or seriously considered. iii. Hallucinations, delusions, memory loss, or incoherent speech occurs. iv. Alcohol or drugs impair normal functioning, or reducing the amount ingested leads to psychological withdrawal symptoms.

Maslow says people achieve self-actualization when they fulfill a good measure of their human potential. Self-actualized people all share certain qualities:

a. Realism: They deal with the world as it is and recognize what can be changed and what cannot. They do not dwell on the past. b. Acceptance: They have a positive self-concept and healthy self-esteem. c. Autonomy: They are inner-directed and act independently of their social environment. d. Authenticity: They are not afraid to be themselves. e. Capacity for intimacy: They share their feelings and thoughts without fear of rejection. f. Creative: They continually look at the world with renewed appreciation and curiosity.

Disadvantages of the pill

a. Remembering to take a pill every day b. Lack of protection against STIs c. Minor side effects, i.e. breakthrough bleeding d. Less common effects: depression; nervousness; changes in sex drive; dizziness, headaches, or migraines; bleeding between periods; increase in vaginal discharge

To reduce the risks associated with OC use, a woman should:

a. Request a low dosage pill. b. Stop smoking. c. Follow the directions carefully and consistently d. Be alert to preliminary danger signals--ACHES i. Abdominal pain (severe) ii. Chest pain (severe), cough, shortness of breath, or sharp pain on breathing in iii. Headaches (severe), dizziness, weakness or numbness, especially if one-sided iv. Eye problems (vision loss or blurring) and/or speech problems v. Severe leg pain (calf or thigh)

Specific Phobia

a. Specific phobias include fear of something definite like animals, high places, enclosed spaces, and air travel. Sometimes the fears originate in bad experiences with the feared object.

Intrauterine Devices (IUDs)

a. The Copper T-380A (ParaGard), which i. Contains a copper that is thought to cause biochemical changes in the uterus, affecting movement of sperm and eggs, and it may also interfere with implantation of fertilized eggs ii. Provides protection for up to 10 years b. Mirena and Skyla i. Release progestin that thickens cervical mucus and prevents fertilization ii. Effective up to three years.

Effectiveness of Implants

a. The overall failure rate for Nexplanon is estimated at about 0.05%. It is one of the most effective methods of contraception and also one of the most discreet.

The Menstrual Cycle

a. The timing of menarche varies with ethnicity, genetics, and nutritional status. i. The "normal" range for the onset of menstruation is between 9 and 17 years old. The current average age in the United States is around 12 ½ years of age. ii. Two hundred years ago, the average age was closer to 17 years. The earlier onset is probably due in large part to nutritional factors. iii. Menarche tends to come later to those females living in relative poverty with diets lacking in protein and calories. iv. Obesity is strongly correlated with earlier menarche. v. Some experts worry that exposure to estrogen-like chemicals may also be contributing to earlier menarche. b. The menstrual cycle is divided into four phases: i. Menses: Characterized by the onset of menstrual flow; blood levels of hormones are relatively low. This phase usually lasts from 1 to 5 days. ii. Estrogenic phase: Begins when the menstrual flow ceases. During this phase, the pituitary gland begins to increase amounts of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Under the influence of increased FSH, an ovarian follicle begins to mature, producing increased amounts of estrogen. The endometrium, or uterine lining, thickens with large numbers of blood vessels and uterine glands. iii. Ovulation: Occurs when the follicle releases a large surge of estradiol which causes the pituitary to release a large amount of LH and a smaller amount of FSH. Ovulation usually occurs about 14 days prior to the onset of menstrual flow. This is known as the most fertile time during the menstrual cycle and is useful in both fertility treatment and natural family planning methods (discussed in Chapter 6). iv. Progestational phase: The amount of progesterone secreted from the corpus luteum increases and remains high until the onset of the next menses. Estrogen and progesterone allow the endometrium to continue to develop, readying itself to receive and nourish a fertilized ovum. (1) When pregnancy occurs, the fertilized egg produces the hormone human chorionic gonadotropin (HCG) which maintains the corpus luteum. This causes the ovarian hormones to remain high, preventing menses. (2) If pregnancy does not occur, the corpus luteum degenerates, estrogen and progesterone levels gradually fall, the endometrium can no longer be maintained, and it begins to slough off, initiating menses; a new menstrual cycle begins.

Sober Sex

i. Alcohol and drugs impair judgment and should not be used in association with sexual activity. ii. Chronic overuse of alcohol reduces testosterone in men, and decreases sexual function in women. iii. Smoking decreases blood flow to the genitals.