CHP8 SEXUAL HEALTH

The Sexuality Information and Education Council of the United States (SIECUS)

has worked with nongovernmental organizations around the world to develop a consensus about the life behaviors of a sexually healthy and responsible adult.

In the past, gynecologists recommended annual pelvic exams for all women age 21 and older. However, some physicians question the need for pelvic exams in women who do not have symptoms such as pelvic pain, menstrual problems, or vaginal discharge. Other, less expensive and less invasive forms of testing can detect STIs, and a pelvic exam is usually not required before

initiation of many forms of birth control

Most homosexual individuals progress through several stages, although men may reach these milestones sooner:

coming out stage 1. stage 2, stage 3, and stage 4

Pornagraphy-a considerable amount of research suggests potentially negative impacts, including:

Increased viewing of women as sex objects. Increased aggression toward women. Greater acceptance of rape. Decreased sexual satisfaction within romantic relationships. Partner's feelings of betrayal. More infidelity among college students in committed relationships. Increased hooking up, with more risky behaviors (oral sex and intercourse rather than kissing and petting). Increased number of hookup partners.

Stage 2: HIV Inactivity or Latency

Individuals may not feel sick or develop any symptoms but the HIV continues to reproduce at low levels. With proper treatment, people can remain in this stage for a decade or even several decades. They can still transmit HIV to others during this stage. However, those who receive ART and have a very low level of virus in their blood are much less likely to infect a partner. As the amount of virus in the blood (the viral load) increases, individuals develop more symptoms and enter Stage 3.

If You Are a Woman

Keep in mind that your risk of getting an infection is greater than a man's. STIs can be transmitted through breaks in the mucous membranes, and women have more mucosal area exposed and experience more trauma to these tissues during sexual activity than men. Don't think you don't have to worry just because you have no symptoms. Symptoms of STIs also tend to be more "silent" in women, so they often go undetected and untreated, leading to potentially serious complications. For instance, pelvic inflammatory disease has no symptoms but puts you at risk of infertility and ectopic pregnancy. At your checkup, talk to your doctor about whether you should be tested for STIs. You may need to ask for these tests. Be aware that frequent Brazilian bikini waxing and similar forms of pubic grooming may increase the risk of STIs, including herpes, HPV, and syphilis. At highest risk are "extreme" groomers who remove all their pubic hair more than eleven times a year and "high frequency" groomers who trim their pubic hair daily or weekly.

Intellectual.

Our most fulfilling relationships involve a meeting of minds as well as bodies. High-level intellectual health enables us to acquire and understand sexual information, analyze it critically, and make healthy sexual decisions.

Clamydia Diagnosis and Treatment

Various antibiotics such as azithromycin and doxycycline kill Chlamydia bacteria. Some are taken in a single dose; others over several days. Both partners must be treated to avoid reinfections. The CDC recommends that all women with chlamydia be rescreened 3 to 4 months after treatment is completed. The reason is that reinfection, which often happens because a patient's sex partners were not treated, increases the risk of PID and other complications. Immediately treating the partners of people infected with gonorrhea or chlamydia can reduce rates of recurrence of these infections.

Here are some questions to consider as you think and talk about the significance of becoming sexually intimate with a partner:

What role do we want relationships and sex to have in our life at this time? What are my values and my potential partner's values as they pertain to sexual relationships? Does each of us believe that intercourse should be reserved for a permanent partnership or committed relationship? Will a decision to engage in sex enhance my positive feelings about myself or my partner? Does either of us have questions about sexual orientation or the kinds of people we are attracted to? Do my partner and I both want to have sex? Is my partner pressuring me in any way? Am I pressuring my partner? Am I making this decision for myself or for my partner? Have my partner and I discussed our sexual histories and risk factors? Have I spoken honestly about any STIs I've had in the past? Am I sure that neither my partner nor I have an STI? Have we taken precautions against unwanted pregnancy and STIs?

The key to a healthy, happy sexual relationship is open, honest communication—even when you and your partner have different points of view. t/f

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Coming out stage 3

"I accept the fact that I'm gay, but what's my family going to say?" Homosexual men and women often do not accept their sexual orientation until their late teens or their 20s. Even then, they often fear their family's rejection or disapproval. As societal prejudice against gays and lesbians abates, boys and girls may arrive at this point somewhat earlier.

Coming out Stage 1:

"I feel different from other kids ..." Many gay and lesbian teens say they sensed something "different" about themselves early in life, sometimes as far back as age 5. A boy may have liked to play house instead of sports, and vice versa for a girl. Patterns of social isolation from peers frequently start very young.

Coming out stage 4

"I finally told my parents I'm gay." In an online survey of nearly 2,000 gay and bisexual young people age 25 and under, the respondents were 16 the first time they revealed their sexuality to anyone, including their parents. Many homosexual teens don't begin to date until they're on their own—possibly on a campus or in a city with a sizable gay population. Only then do they begin having the experiences that straight kids encounter earlier in their sexual development.

Coming out Stage 2:

"I think I might be gay, but I'm not sure, and if I am, I'm not sure that I want to be ..." Many homosexual youngsters first realize that they are attracted to members of their own sex at puberty. A common response is to try to bury those feelings or to isolate themselves from other teens for fear of being exposed, or "outed."

All women of childbearing age should undergo regular "health maintenance" exams to monitor their sexual and reproductive well-being, detect infections and other medical problems, and prevent unwanted pregnancy. These should include:

- Counseling on contraception for women who do not want to get pregnant. - Counseling on pre-pregnancy health care for women who are attempting to conceive. - Counseling for all women who may become pregnant to take a daily folic acid supplement of 400 to 800 mcg. - Counseling on reducing the risks of STIs. - Screening of all women age 24 or younger for chlamydia. - Screening of all women at high risk for chlamydia, gonorrhea, and syphilis and of all women for HIV. - Screening for domestic violence and sexual or reproductive coercion.

Treatments for PMS symptoms include:

- Diuretics (drugs that speed up fluid elimination) for water retention and bloating. - Psychotherapy, including cognitive-behavioral therapy, to relieve symptoms of anxiety and depression. Relaxation and stress management techniques such as meditation and yoga. - Certain oral contraceptives to relieve mild to moderate physical symptoms. - Sleep deprivation or the use of bright light to adjust a woman's circadian or daily rhythm. - Certain oral contraceptives that effectively relieve physical but not psychological symptoms. - Charting of cycles to identify vulnerable periods. - Low doses of medications known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (marketed as Prozac and Sarafem and in generic forms), for symptoms such as tension, depression, irritability, and mood swings, taken only during the premenstrual phase or daily throughout the month. - Other treatments with some reported success include exercise; lower caffeine, alcohol, salt, and sugar intake; and acupuncture.

Approximately 1 in 4 new infections are transmitted by individuals who are unaware that they are HIV-positive. About 7 in 10 new infections are transmitted by individuals diagnosed with HIV infection but who are not receiving treatment. At highest risk are the following:

- Gay and bisexual men. - Women - young adults - Black Americans

Every menstrual cycle begins in the brain with the production of gonadotropin-releasing hormone (GnRH) and then proceeds through the following steps:

- GnRH sets into motion the sequence of steps that lead to ovulation, the potential for conception, and, if conception doesn't occur, menstruation. The hypothalamus monitors hormone levels in the blood and sends messages to the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). - As shown in Figure 8.2, in the ovaries, these hormones stimulate the growth of a few of the immature eggs, or ova, stored in follicles in every woman's body. Usually, only one ovum matures completely during each monthly cycle. As it does, it increases its production of the female sex hormone estrogen, which in turn triggers the release of a larger surge of LH. - At midcycle, the increased LH hormone levels trigger ovulation, the release of the egg cell, or ovum, from the follicle. Estrogen levels drop, and the remaining cells of the follicle then enlarge, change character, and form the corpus luteum, or yellow body. - In the second half of the menstrual cycle, the corpus luteum secretes estrogen and larger amounts of progesterone. The endometrium (uterine lining) is stimulated by progesterone to thicken and become more engorged with blood in preparation for nourishing an implanted, fertilized ovum. - If the ovum is not fertilized, the corpus luteum disintegrates. As the level of progesterone drops, menstruation occurs; the uterine lining is shed during the course of a menstrual period. - If the egg is fertilized and pregnancy occurs, the cells that eventually develop into the placenta secrete human chorionic gonadotropin (HCG), a messenger hormone that signals the pituitary not to start a new cycle. The corpus luteum then steps up its production of progesterone.

Women cannot get bacterial vaginosis from toilet seats, bedding, or swimming pools. The best ways to prevent BV are:

- Not having sex. - Limiting the number of sexual partners. -Not douching

Once dismissed as a psychological problem, PMS has been recognized as a very real physiological disorder that may be caused by various factors, including:

-A hormonal deficiency. - Abnormal levels of thyroid hormone. - An imbalance of estrogen and progesterone. - Social and environmental factors, particularly stress. - Vitamin D deficiency

Social

. From dating to mating, we express and fulfill our sexual identities in the context of families, friends, and society as a whole. Having strong friendships, intimate relationships, and caring partnerships enables us to explore our sexuality in safe and healthy ways.

According to a national survey of about 9,000 adults ages 18 to 44:

94.2 percent of women and 92.0 percent of men had vaginal intercourse. 86.2 percent of women and 87.4 percent of men had oral sex. 35.9 percent of women and 42.3 percent of men had anal sex. 92.3 percent of women and 95.1 percent of men said they were "heterosexual or straight." 17.4 percent of women and 6.2 percent of men reported any same-sex contact in their lifetime. 1.3 percent of women and 1.9 percent of men said they were "homosexual, gay, or lesbian." 5.5 percent of women and 2.0 percent of men said they were bisexual. 0.9 percent of women and 1 percent of men said "don't know" or did not report their sexual orientation. 81 percent of women and 92.1 percent of men reported feelings of attraction "only to the opposite sex."

Diagnosing AIDS

A diagnosis of AIDS applies to anyone with HIV whose immune system is severely impaired, as indicated by a CD4+ count of fewer than 200 cells per cubic millimeter of blood, compared to normal CD4+ cell counts in healthy people not infected with HIV of 800 to 1,200 per cubic millimeter of blood. In addition, AIDS is diagnosed in persons with HIV infection who experience recurrent pneumonia, invasive cervical cancer, or pulmonary tuberculosis. People with AIDS may also experience persistent fever, diarrhea that persists for more than a month, or involuntary weight loss of more than 10 percent of normal body weight. Neurological disease—including dementia (confusion and impaired thinking) and other problems with thinking, speaking, movement, or sensation—may occur. Secondary infectious diseases that may develop in people with AIDS include Pneumocystis carinii pneumonia, tuberculosis, or oral candidiasis (thrush). Secondary cancers associated with HIV infection include Kaposi's sarcoma and cancer of the cervix.

Various factors put young people at risk of STIs, including:

A sexual partner who has an STI. A history of STIs. Feelings of invulnerability, which lead to risk-taking behavior. Even when they are well informed of the risks, adolescents and young adults may remain unconvinced that anything bad can or will happen to them. Use of injection drugs or a sexual partner who uses them. Multiple partners or a partner who has had more than one sexual partner. Figure 8.7 illustrates how STI risks increase as relationships become less familiar and exclusive. In surveys of students, a significant number report having had four or more sexual partners during their lifetime. Individuals with more than one concurrent partner are also at greater risk. Meeting sex partners through the Internet. Individuals who find sex partners online are more likely to report unprotected sex, higher rates of drug use in the past 12 months, more sexual partners, and failure to discuss sexual histories—all behaviors that increase the risk of STIs. Failure to use condoms. Among students who reported having had sexual intercourse in the previous 3 months, fewer than half report condom use. Alcohol and substance abuse. Drinking in almost all contexts (Greek parties, off-campus parties, campus events, dorms, and bars) is associated with a greater number of sexual partners, unplanned sex, and unprotected sex. The more alcohol or substance use that students report, the more likely they are to engage in risky sexual behavior and to acquire an STI. Failure of a partner to be notified and treated. Although physicians and health officials urge infected individuals to notify all their sexual partners, only an estimated 40 to 60 percent are notified and seek treatment.

The three antiviral medications approved for the treatment of genital herpes are as follows:

Acyclovir. The oldest antiviral medication for herpes, acyclovir is sold as a generic drug and under the brand name Zovirax. Available as an ointment and pill, acyclovir has been shown to be safe in persons who have used it continuously (every day) for as long as 10 years. Valacyclovir. Sold as Valtrex, this medication delivers acyclovir more efficiently so that the body absorbs more of the drug and medication can be taken fewer times during the day. Famcyclovir. Sold as Famvir, this drug utilizes penciclovir as its active ingredient to stop HSV. Like valacyclovir, it is well absorbed, persists for a long time in the body, and can be taken less frequently than acyclovir.

When women have symptoms of chlamydia, they may experience:

Abdominal pain. Abnormal vaginal discharge. Bleeding between menstrual periods. Cervical or rectal inflammation. Low-grade fever. Yellowish discharge from the cervix that may have a foul odor. Vaginal bleeding after intercourse. Painful intercourse. Painful urination. The urge to urinate more than usual.

Pelvic Inflammatory Disease Inccidence

About one in every seven women of reproductive age has PID; half of all adult women may have had it. Each year, about 1 million new cases are reported. Most cases of PID occur among women under age 25 who are sexually active. Gonococcus-caused cases tend to affect poor women; those caused by Chlamydia range across all income levels. One-third to one-half of all cases are transmitted sexually, and others have been traced to some IUDs that are no longer on the market.

after 4 years if having syphilis

After 4 years, even congenital syphilis is rarely transmitted. Until this stage of the disease, however, a pregnant woman can pass syphilis to her unborn child. If the fetus is infected in its fourth month or earlier, it may be disfigured or even die. If infected late in pregnancy, the child may show no signs of infection for months or years after birth, but may then become disabled with the symptoms of tertiary syphilis.

HIV Testing

All HIV tests measure antibodies, cells produced by the body to fight HIV infection. A negative test indicates no exposure to HIV. It can take 3 to 6 months for the body to produce the telltale antibodies, however, so a negative result may not be accurate, depending on the timing of the test. Faster tests that can detect HIV earlier are under development. Electron micrograph of a white blood cell being attacked by HIV (light blue particles), the virus that causes AIDS.

Federal authorities and the American Academy of Pediatrics recommend HPV vaccination for:

All girls ages 11 or 12, with catch-up vaccinations for those through age 26. Males ages 11-12 years, with catch-up vaccinations through age 21. Gay, bisexual, and other men who have sex with men (collectively referred to as MSM) and persons who are immunocompromised (including those infected with HIV), through age 26.

Gonnorhea Diagnosis and Treatment

Although a blood test has been developed for detecting gonorrhea, the tried-and-true method of diagnosis is still a microscopic analysis of cultures from the male's urethra, the female's cervix, and the throat and anus of both sexes. Because gonorrhea often occurs along with chlamydia, practitioners often prescribe an agent effective against both, such as ofloxacin. Fluoroquinolones are no longer advised for use in its treatment. The CDC recommends a cephalosporin antibiotic plus azithromycin or doxycyline, but recommendations for treatment are rapidly evolving. A new strain of gonorrhea resistant to available antibiotics has emerged in North America. Antibiotics taken for other reasons may not affect or cure gonorrhea because of their dosage or type. The CDC estimates that at least 2 million Americans contract infections—including gonorrhea—that are resistant to at least one antibiotic. Symptoms of the infection are often absent. Undiagnosed and untreated gonorrhea may lead to pelvic inflammatory disease, infertility, ectopic pregnancy (a pregnancy that occurs outside of the uterus), and/or chronic pelvic pain. At risk older women and all sexually active women age 24 and younger should be routinely screened for the infection. The CDC advises medical professionals to treat gonorrhea with a combination that includes the injectable antibiotic ceftriaxone and the antibiotic pill azithromycin. However, there is concern about the growing threat of resistance to these drugs.

Late and latent syphilis.

Although there are no signs or symptoms and no sores or rashes at this stage, the bacteria are invading various organs inside the body, including the heart and brain. For 2 to 4 years, there may be recurring infectious and highly contagious lesions of the skin or mucous membranes. However, syphilis loses its infectiousness as it progresses: After the first 2 years, a person rarely transmits syphilis through intercourse.

Clamydia Incidence

An estimated 1.7 million cases of chlamydia were reported in 2017. Chlamydia is much more prevalent in young black adults than in young white adults. However, this may be because black and Hispanic women are much more likely to be screened. Women have three times the rate of chlamydia as men. Chlamydial infections are more common in younger than in older women, and they also occur more often in both men and women with gonorrhea. Those at greatest risk of chlamydial infection are individuals 25 years old or younger who engage in sex with more than one new partner within a 2-month period and women who use birth control pills or other nonbarrier contraceptive methods. The USPSTF recommends regular screening for chlamydia for all sexually active women under age 25. The incidence of chlamydia is lower in older women, and screening is recommended only for those with multiple sexual partners, a history of STIs, or inconsistent use of condoms.

Trichomoniasis

An estimated 7.4 million new cases of this common curable STI appear each year in men and women. The cause is a single-celled protozoan parasite Trichomonas vaginalis, transmitted by vaginal intercourse or vulva-to-vulva contact with an infected partner. Women can acquire this disease from male or female partners; men usually contract it only from infected women .Most men have no signs or symptoms; some experience irritation inside the penis, mild discharge, or slight burning on urination or ejaculation. Some women develop a frothy, yellow-green vaginal discharge with a strong odor and may experience discomfort during intercourse and urination as well as genital itching and irritation. Diagnosis is based on a physical examination and a laboratory test. Treatment consists of a single dose of oral medication, either metronidazole or tinidazole. If untreated, an infected man, even if he has never had symptoms or if his symptoms have gone away, can continue to infect or reinfect partners.

Secondary syphilis.

Anywhere from 1 to 12 months after the chancre's appearance, secondary-stage symptoms may appear. Some people have no symptoms. Others develop a skin rash or a small, flat rash in moist regions on the skin; whitish patches on the mucous membranes of the mouth or throat; temporary baldness; low-grade fever; headache; swollen glands; or large, moist sores around the mouth and genitals. These sores are loaded with bacteria; contact with them, through kissing or intercourse, may transmit the infection. Symptoms may last for several days or several months. Even without treatment, symptoms eventually disappear as the syphilis microbes go into hiding.

Clamydia Signs and Symptoms

As many as 75 percent of women and 50 percent of men with chlamydia have no symptoms or have symptoms so mild that they don't seek medical attention. Without treatment, up to 40 percent of cases of chlamydia can lead to pelvic inflammatory disease (PID), a serious infection of the woman's fallopian tubes that can also damage the ovaries and uterus. Also, women infected with chlamydia may have three to five times the risk of getting infected with HIV if exposed. Babies exposed to chlamydia in the birth canal during delivery can be born with pneumonia or with an eye infection called conjunctivitis, both of which can be dangerous unless treated early with antibiotics. Symptomless women who are screened and treated for chlamydial infection are almost 60 percent less likely than unscreened women to develop PID. Chlamydia may also be linked to cervical cancer.

Spiritual.

At its deepest, most fulfilling level, sexuality uplifts the soul by allowing us to connect to something greater than ourselves. Individuals who have developed their spirituality bring to their most intimate relationships an awareness and appreciation that lifts them beyond the physical.

Gential herpes incidence

At least 50 million people in the United States have genital herpes, including 21 percent of women. Only a minority know they are affected, and many believe they could tell if a sexual partner were infected. About 40 percent of new cases of genital herpes occur in young people ages 15 to 24.

Although each STI is distinct, they are all transmitted mainly through:

Direct sexual contact with someone's symptoms (e.g., genital ulcers) or sexual contact with someone's infected semen, vaginal fluids, blood, and other body fluids. Sharing contaminated needles through injectable drug use. Maternal transfer (mother to fetus during pregnancy or childbirth).

The students most likely to engage in hookups tend to:

Be white. Be attractive. Be outgoing. Be nonreligious. Have high-income and/or divorced parents. Have a history of middle and high school hookups. Use marijuana Engage in heavy or binge drinking. Be in a situation, such as studying abroad or spring break, that encourages hookups. More frequently view pornography. Belong to athletic or certain social groups.

Adverse effects, reported in about 6 percent of vaccinated patients, include:

Fainting. Itchiness. Headache. Nausea. Blood clots. Allergic reactions.

If you decide to abstain only from vaginal or anal penetration, remember that other sexual activity such as oral sex can also expose you to STIs. If you have oral sex, make it safer by using effective barrier methods such as condoms or latex dental dams. (A dental dam is a square piece of latex that can be stretched across the vulva or anus to prevent the transmission of STIs.) In the absence of barrier methods, men should avoid ejaculating in their partner's mouth. Also:

Be aware of sores and discharge or unpleasant odors from your partner's genitals. These are signs to avoid oral sex. Don't floss or brush teeth before oral sex. It might tear the lining of the mouth, increasing exposure to viruses. Avoid aggressive and deep thrusting in oral sex, which can damage throat tissues and increase susceptibility for throat-based gonorrhea, herpes, and abrasions. Remember that oral sex can transmit various STIs, including HPV, herpes, gonorrhea, syphilis, and HIV.

Men's Sexual Health

Because the male reproductive system is simpler in many ways than the female, it is often ignored—especially by healthy young men. However, men should make regular self-exams (including checking the penis and testes) part of their routine.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

Because their immune systems are so severely impaired, people with AIDS are susceptible to severe complications and opportunistic illnesses, with symptoms such as chills, fever, sweats, swollen lymph glands, weakness, and weight loss. Because they have such high levels of HIV in their blood, they are very infectious. Without treatment, people with AIDS may survive for about three years. Psychological problems, including depression, anxiety, and stress, occur "in epidemic proportions" in individuals with HIV, according to recent research, and can affect their behavior (such as taking steps to prevent transmitting the virus) and treatment outcome.

Prevention and Protection

Behavioral methods, such as safer sex practices, remain the primary means of preventing transmission of HIV (see Health on a Budget). Individuals at very high risk for HIV can lower their risk of becoming infected using preexposure prophylaxis (PrEP), which consists of daily HIV medicines. PrEP, which can stop HIV from spreading throughout the body, reduces the risk of sexual transmission by more than 90 percent if taken consistently and by even more if combined with condoms. Among people who inject drugs, PrEP reduces the risk of HIV infection by more than 70 percent. For those who have been exposed to HIV through sexual contact, sharing needles, or accidental exposure (as can happen for medical personnel), PEP (postexposure prophylaxis) consists of antiretroviral therapy (ART) to protect against infection. For use only in emergency situations, PEP must be started within 72 hours after a possible exposure to HIV.

Emotional.

By acknowledging and respecting the intimacy of a sexual relationship, responsible sexuality builds trust and commitment. When our emotional health is high, we can better understand and cope with the complex feelings related to being sexual.

Here is what you should know about sexual transmission of HIV:

Casual contact does not spread HIV infection. You cannot get HIV infection from drinking from a water fountain, contact with a toilet seat, or touching an infected person. Compared to other viruses, HIV is extremely difficult to get. HIV can live in blood, semen, vaginal fluids, and breast milk. Many chemicals, including household bleach, and hydrogen peroxide, can inactivate HIV. In studies of family members sharing dishes, food, clothing, and frequent hugs with people with HIV infection or AIDS, those who have contracted the virus have shared razor blades or toothbrushes or had other means of blood contact. You cannot tell visually whether a potential sexual partner has HIV. A blood test is needed to detect the antibodies that the body produces to fight HIV, thus indicating infection. As noted in Chapter 9, circumcision greatly reduces the risk for HIV infection. HIV can be spread in semen and vaginal fluids during a single instance of anal, vaginal, or oral sexual contact between heterosexuals, bisexuals, or homosexuals. The risk increases with the number of sexual encounters with an infected partner. Teenage girls may be particularly vulnerable to HIV infection because the immature cervix is easily infected. Anal intercourse is an extremely high-risk behavior because HIV can enter the bloodstream through tiny breaks in the lining of the rectum. HIV transmission is much more likely to occur during unprotected anal intercourse than vaginal intercourse. Other behaviors that increase the risk of HIV infection include having multiple sexual partners, engaging in sex without condoms or virus-killing spermicides, having sexual contact with persons known to be at high risk (e.g., prostitutes or injection drug users), and sharing injection equipment for drugs. Condom use significantly reduces the risk of HIV transmission (by as much as 78 percent). Individuals are at greater risk if they have an active sexual infection. STIs—such as herpes, gonorrhea, and syphilis—facilitate transmission of HIV during vaginal or anal intercourse. No cases of HIV transmission by deep (French) kissing have been reported, but it could happen. Studies have found blood in the saliva of healthy people after kissing; other lab studies have found HIV in saliva. Social (dry) kissing is safe. Oral sex can lead to HIV transmission. The virus in any semen that enters the mouth could make its way into the bloodstream through tiny nicks or sores in the mouth. A man's risk in performing oral sex on a woman is smaller because an infected woman's genital fluids have much lower concentrations of HIV than does semen. HIV infection is not widespread among lesbians, although there have been documented cases of possible female-to-female HIV trans-mission. However, in each instance, one partner had had sex with a bisexual man or male injection drug user or had injected drugs herself.

The U.S. Preventive Services Task Force (USPSTF) recommends that health-care providers routinely ask about the sexual history of adolescents and young adults in order to screen for specific STIs, including:

Chlamydia and gonorrhea in all sexually active and pregnant women younger than 25 and in older women at increased risk because of new or multiple sex partners. Human immunodeficiency virus (HIV) infection in all patients 15 to 65 years of age regardless of risk. Hepatitis B virus infection and syphilis in persons at increased risk. Hepatitis B virus infection, HIV infection, gonorrhea, chalmydia, and syphilis in pregnant women at risk. Testing for syphilis, gonorrhea, chlamydia, and HIV at least once a year for men having sex with men. Those with multiple partners are advised to seek testing more frequently, such as every three to six months.

A sexually healthy relationship, as defined by the Sexuality Information and Education Council of the United States (SIECUS), is based on shared values and has five characteristics:

Consensual. Nonexploitative. Honest. Mutually pleasurable. Protected against unintended pregnancy and STIs.

The U.S. Department of Health and Human Services (HHS) has proposed a new initiative with the goals of reducing new HIV infections by 75 percent within 5 years and by 90 percent within 10 years. Its fundamental strategies are:

Diagnose all individuals with HIV as early as possible after infection. Treat HIV infection rapidly and effectively to achieve sustained viral suppression. Prevent at-risk individuals from acquiring HIV infection, including the use of preexposure prophylaxis (PrEP) Rapidly detect and respond to emerging clusters of HIV infection to further reduce new transmissions.

Plateau

During this stage, the changes begun in the excitement stage continue and intensify. The penis further increases in both length and diameter. The outer one-third of the vagina swells. During intercourse, the vaginal muscles grasp the penis to increase stimulation for both partners. The upper two-thirds of the vagina become wider as the uterus moves up; eventually its diameter is 2.5 to 3 inches.

Stage 1: Acute HIV Infection

Flu-like symptoms develop within two to four weeks after infection and may last for a few weeks. During this stage, individuals often do not realize that they have been infected, yet they have high levels of virus in their blood and are extremely contagious.

Sexual orientation can indicate whether an individual:

Engages in sexual behavior with men, women, both, or neither. Feels sexual desire for men, women, both, or neither. Falls in love with men, women, both, or neither. Identifies with a specific sexual orientation: heterosexual, for individuals whose primary attraction is toward members of the other sex; homosexual, for those preferring partners of their own sex; bisexual, for those attracted to both men and women; and asexual, for those who do not feel a sexual attraction to either sex. Some individuals describe themselves as pansexual, polysexual, or omnisexual because they are attracted to individuals who identify themselves as men, women, transgender, or intersex—terms defined and discussed The Gender Spectrum. Asexual individuals, according to the Asexual Visibility and Education Network, do not experience sexual attraction.

Nonsexual Transmission

Efforts to prevent nonsexual forms of HIV transmission have been very effective. Screening the blood supply has reduced the rate of transfusion-associated HIV transmission by 99.9 percent. Treatment with antiretroviral drugs during pregnancy and birth has reduced transmission to newborns by about 90 percent in optimal conditions. Drug injection has become a more frequent cause of HIV transmission.

Although there are many specific steps to take to safeguard your sexual health, the three key fundamentals are as simple as A, B, C.

Following the ABCs of safer sex—Abstain, Be Faithful, use Condoms—doesn't mean you can't have an intimate, loving relationship.

Rather than the labels of male or female, individuals may identify as:

Gender-fluid (a person with a gender identity that shifts between masculine and feminine at varying times). Gender-neutral (a person who prefers not to be described by a specific gender). Gender nonbinary (a person who identifies as neither male nor female but as outside the gender binary, sometimes shortened to NB). Gender nonconforming, or GNC (a person who expresses gender outside the traditional norms associated with masculinity or femininity). Some, but not all, gender-nonconforming individuals are transgender. Genderqueer (a term often chosen by people who do not identify with the gender binary of male or female). Intersex (a person born with biological sex characteristics that aren't traditionally associated with male or female bodies). Intersexuality does not refer to gender identity. MAAB/FAAB/UAB (male assigned at birth, female assigned at birth, unassigned at birth). Trans* or trans+ (umbrella terms for non-cisgender identities).

Gay and bisexual men.

HIV infection rates have generally declined among gay and bisexual men, but new infections are on the rise among this group. An estimated 53 percent of new HIV infections occur in gay or bisexual men. Younger gay and bisexual men and those of color are at particularly high risk. One reason may be a misperception of risk. In a study of men engaging in behaviors such as unprotected anal sex, only 25 to 35 percent considered themselves at high risk of infection. Gay and bisexual Hispanic males—another population group at serious risk of HIV—have a one in four chance of contracting HIV, according to a CDC report. CDC researchers predict that one in six will be diagnosed with HIV in their lifetime. For gay or bisexual black males, the rate is one in two; for gay or bisexual Hispanic men, one in four; and for gay or bisexual white males, 1 in 11, according to the CDC.

Reducing the Risk of HIV Transmission

HIV/AIDS can be so frightening that some people have exaggerated its dangers, whereas others understate them. The fact is that although no one is immune to HIV, you can reduce the risk if you abstain from sexual activity or remain in a monogamous relationship with an uninfected partner and if you do not inject drugs. If you're not in a long-term monogamous relationship with a partner you're sure is safe and you're not willing to abstain from sex, there are things you can do to lower your risk of HIV infection. Remember that the risk of HIV transmission depends on sexual behavior, not sexual orientation. Among young men, the prevalence and frequency of sexual risk behaviors are similar regardless of sexual orientation, ethnicity, or age. Homosexual, heterosexual, and bisexual individuals all need to know about the kinds of sexual activity that increase their risk.

Syphilis Diagnosis and Treatment

Health experts urge screening with a blood test for syphilis for everyone who seeks treatment for an STI, especially adolescents; for anyone using illegal drugs; and for the partners of those in these two groups. They also recommend that anyone diagnosed with syphilis be screened for other STIs and be counseled about voluntary testing for HIV. Penicillin is the drug of choice for treating primary, secondary, and latent syphilis. The earlier the treatment begins, the more effective it is. Those allergic to penicillin may be treated with doxycycline, ceftriaxone, or erythromycin. An added danger of not getting treatment for syphilis is an increased risk of HIV transmission.

Women.

In 1985, women represented 8 percent of AIDS diagnoses; now they account for 25 percent. According to CDC estimates, almost 280,000 women in the United States are living with HIV or AIDS. Black women make up about two-thirds of women diagnosed with AIDS, but the rate of new infections among black women has dropped. Latinas account for 18 percent of new infections in women. Women are most likely to be infected through heterosexual sex, followed by injection drug use. Mother-to-child transmission of HIV has decreased dramatically because of the use of medicines that significantly reduce the risk of transmission from a woman to her baby. At least one case of woman-to-woman infection has been documented. Although the risk is low, female sex partners can transmit HIV when bodily fluids such as menstrual blood and vaginal fluids come into contact with a cut, an abrasion, or a mucous membrane (the tissue lining the mouth and vagina).

If You Are a Man

Involve your partner. Men are more likely to avoid common errors, such as removing condoms before sexual contact ends or slippage during withdrawal, when both partners mutually decide on their use. After potential exposure to an STI, give yourself a little extra protection by urinating and washing your genitals with an antibacterial soap. At your checkup, talk to your doctor about whether you should be tested for STIs. Although it can be awkward to bring up the subject of condoms, don't let your embarrassment put your health at risk. Discuss using a condom before having sex; don't wait until you're on the brink of a sexual encounter.

STIs can:

Last a lifetime. Put stress on relationships. Cause serious medical complications. Impair fertility. Cause birth defects. Lead to major illness and death.

e first federal guidelines affirmed that circumcision is a personal decision that may involve religious or cultural preferences. Based on the scientific evidence, circumcision provides numerous health benefits that outweigh its risks, including

Less risk of urinary tract infections during the first year of life. (An uncircumcised baby boy has a 1 in 100 chance of getting a urinary tract infection, compared with a 1 in 1,000 chance for a circumcised baby boy.) Prevention of foreskin infections and retraction. Easier genital hygiene. Reduced risk of acquiring an STI from an infected female partner. Less risk of cancer of the penis and possibly of the prostate gland. Less risk to female partners of human papillomavirus (HPV), cervical cancer, Trichomonas vaginalis infection, bacterial vaginosis, and possibly genital ulcer disease.

Coming Out

Many young people have questions about their sexuality, but relatively few gay adolescents declare their homosexuality, or come out, while in a state of identity confusion. Many lesbian and bisexual women report that their first sexual experience occurred with a man (at the median age of 18) and that sex with a woman followed a few years later (at median age 21).

Orgasm

Men and women have remarkably similar orgasm experiences. Both men and women typically have 3 to 12 pelvic muscle contractions approximately four-fifths of a second apart and lasting up to 60 seconds. Both undergo contractions and spasms of other muscles, as well as increases in breathing and pulse rates, and blood pressure. Both can sometimes have orgasms simply from kisses, stimulation of the breasts or other parts of the body, or fantasy alone. The process of ejaculation (the discharge of semen by a male) requires two separate events. First, the vas deferens, the seminal vesicles, the prostate, and the upper portion of the urethra contract. The man perceives these subtle contractions deep in his pelvis just before the point of no return—which therapists refer to as the point of "ejaculatory inevitability." Then, seconds later, muscle contractions force semen out of the penis via the urethra. Female orgasms follow several patterns. Some women experience a series of mini-orgasms—a response sometimes described as "skimming." Another pattern consists of rapid excitement and plateau stages, followed by a prolonged orgasm. This is the most frequent response to stimulation by a vibrator. Female orgasms are primarily triggered by stimulating the clitoris. When stimulation reaches an adequate level, the vagina responds by contracting. Although it sometimes seems that vaginal stimulation alone can set off an orgasm, the clitoris is usually involved—at least indirectly during full penile penetration. Some researchers have identified what they call the Grafenberg (or G) spot (or area) just behind the front wall of the vagina, between the cervix and the back of the pubic bone (see Figure 8.4). When this region is stimulated, women report various sensations, including slight discomfort, a brief feeling that they need to urinate, and increasing pleasure. Continued stimulation may result in an orgasm of great intensity, accompanied by ejaculation of fluid from the urethra. However, other researchers have failed to confirm the existence and importance of the G spot, and sex therapists disagree about its significance for a woman's sexual satisfaction. As part of their sexual response, some women experience female ejaculation, the expulsion from the urethra of a fluid that is different from urine. Hundreds of studies over more than 20 years have confirmed this phenomenon and identified the chemical composition of the ejaculated fluid. G spot stimulation, orgasm, and female ejaculation are not always related. Some women report experiencing ejaculation with orgasm from clitoral stimulation; others experience ejaculation without orgasm.

The most common symptoms of PMS are as follows:

Mood changes. Anxiety. Irritability. Difficulty concentrating. Forgetfulness. Impaired judgment. Tearfulness. Digestive symptoms (diarrhea, bloating, and constipation). Hot flashes. Palpitations. Dizziness. Headache. Fatigue. Changes in appetite. Cravings (usually for sweets or salt). Water retention. Breast tenderness. Insomnia.

Gonnorhea Incidence

More than 550,000 new cases of gonorrhea were reported to the CDC in 2017, an increase of 75 percent in the previous decade. Gonorrhea rates have increased among both men and women and across all racial and ethnic groups.

HIV and AIDS incidence

More than 700, 000 people in the United States have died as a result of HIV/AIDS since the disease was first recognized in 1981. An estimated 1.1 million people are currently living with HIV; about 15 percent are unaware of their HIV infection. Globally, about 35 million have died, and an estimated 36.9 million to 43.9 million people are living with HIV. Women comprise half of adults estimated to be living with HIV/AIDS worldwide. More than 1.1 million people in the United States are living with HIV; 1 in 7 do not realize they are infected. More than 38,000 people were diagnosed with HIV in the United States in 2017. The majority were young black/African American and Hispanic/Latino men who have sex with men (MSM). There is also a high incidence of HIV among transgender individuals, high-risk heterosexuals, and those who inject drugs. More than half of new HIV diagnoses have been reported in southern states and Washington, D.C.

In a recent study, college students were less embarrassed about obtaining free condoms distributed by their schools than purchasing condoms at a store.

More women than men reporting being embarrassed when purchasing condoms.

Gonnorhea Signs and Symptoms

Most men who have gonorrhea know it. Thick, yellow-white pus oozes from the penis, and urination causes a burning sensation. These symptoms usually develop 2 to 9 days after the sexual contact that infected them. Men have a good reason to seek help: It hurts too much not to. In men, untreated gonorrhea can spread to the prostate gland, testicles, bladder, and kidneys. Among the serious complications are urinary obstruction and sterility caused by blockage of the vas deferens (the excretory duct of the testis). Women may also experience discharge and burning on urination. However, as many as 8 in 10 infected women have no symptoms.

Gential herpes Signs and Symptoms

Most people with genital herpes have no symptoms or very mild symptoms that go unnoticed or are not recognized as a sign of infection. The most common is a cluster of blistery sores, usually on the vagina, vulva, cervix, penis, buttocks, or anus. They may last several weeks and go away. They may return in weeks, months, or years. Other symptoms include blisters, burning feelings if urine flows over sores, inability to urinate if severe swelling of sores blocks the urethra, and itching and pain in the infected area. Severe first episodes of herpes may also cause swollen, tender lymph glands in the groin, throat, and under the arms; fever; chills; headache; and achy flulike feelings.

For men and women who are sexually active, a mutually faithful sexual relationship with just one healthy partner is the safest option. Women and men in a committed relationship don't need to worry about getting STIs if:

Neither partner ever had sex with anyone else. Neither partner ever shared needles. Neither partner currently has or ever had an STI. If these criteria fail to apply, two partners should be sure that neither has an STI before giving up on safer sex practices. Some infections, such as HIV, may take years to develop symptoms. The only way to know is by being tested.

Condoms are the only contraceptive that helps prevent both pregnancy and STIs when used properly and consistently. Male condoms reduce the risk of transmission of an STI by 50 to 80 percent. They are more effective against STIs transmitted by bodily fluids (chlamydia, gonorrhea, HIV, etc.) than those transmitted by skin-to-skin contact (HPV, syphilis, herpes, and chancroid). Inexpensive and widely available in pharmacies, supermarkets, and convenience stores, condoms don't require a doctor visit or a prescription. Contrary to a common misconception, condoms do not interfere with sexual enjoyment. (See Chapter 10 for a comprehensive discussion of condoms.) Here are some essential guidelines to keep in mind:

Most physicians recommend American-made latex condoms. Check the package for FDA approval. Also check the expiration (Exp) or manufacture (MFG) date on the box or individual package to make sure the condom is still effective. Make sure the package and the condom appear in good condition. If the package does not state that the condoms are meant to prevent disease, they may not provide adequate protection, even if they are the most expensive ones on the shelf. Get the right size. Ill-fitting condoms lead to more problems with slippage and breakage, as well as diminished sexual pleasure. Men also may be more likely to remove a condom that doesn't fit well before ejaculation. Condoms can deteriorate if not stored properly, because they are affected by both heat and light. Don't use a condom that has been stored in your back pocket, your wallet, or the glove compartment of your car. If a condom feels sticky or very dry, don't use it; the packaging has probably been damaged.

Roots of Homosexuality

Nobody knows what causes a person's sexual orientation. Research has discredited theories tracing homosexuality to troubled childhoods or abnormal psychological development. Sexual orientation probably emerges from a complex interaction that includes biological and environmental factors.

The primary risk factors for oral HPV infection include:

Number of sex partners. Smoking. Heavy drinking. Marijuana use.

Pelvic Inflammatory Disease Signs and symptoms

PID is a silent disease that in half of all cases produces no noticeable symptoms as it progresses and causes scarring of the fallopian tubes. Early symptoms include: Abdominal pain or tenderness. Fever. Vaginal discharge that may have a foul odor. Painful intercourse or urination. Irregular menstrual bleeding. Rarely, pain in the right upper abdomen.

When men have symptoms of chlamydia, they may experience:

Pain or burning while urinating. Pus or watery or milky discharge from the penis. Swollen or tender testicles. Rectal inflammation.

Sexual activity

Part of learning about your own sexuality is having a clear understanding of human sexual behaviors. Understanding frees us from fear and anxiety so that we can accept ourselves and others as the natural sexual beings we all are.

The following strategies can help you assert yourself when saying no to sex:

Recognize your own values and feelings. If you believe that sex is something to be shared only by people who've already become close in other ways, be true to that belief. Be direct. Look the person in the eyes, keep your head up, and speak clearly and firmly. Just say no. Make it clear you're rejecting the offer, not the person. You don't owe anyone an explanation for what you want, but if you want to expand on your reasons, you might say, "I enjoy your company, and I'd like to do something together, but no," or "Thank you. I appreciate your interest, but no." If you're still at a loss for words, try these responses: "I like you a lot, but I'm not ready to have sex," "You're a great person, but sex isn't something I do to prove I like someone," or "I'd like to wait until I'm in a committed relationship to have sex." If you're feeling pressured, let your date know that you're uncomfortable. Be simple and direct. Watch out for emotional blackmail. If your date says, "If you really liked me, you'd want to make love," point out that if he or she really liked you, he or she wouldn't try to force you to do something you don't want to do. Communicate your feelings to your date sooner rather than later. It's far easier to say, "I don't want to go to your apartment" than to fight off unwelcome advances once you're there. Remember that if saying no to sex puts an end to a relationship, it wasn't much of a relationship in the first place.

Among the reasons students give for abstaining are:

Remaining a virgin until you meet someone you love and see as a life partner. Being true to your religious and moral values. Getting to know a partner better. Avoiding pregnancy. Ensuring you're safe from STIs.

Environmental.

Responsible sexuality makes people more aware of the impact of their decisions on others. Protecting yourself from sexual threats and creating a supportive environment in which to study and work are crucial to high-level health and to healthy sexuality.

Physical.

Safer sex practices reduce the risk of STIs that can threaten sexual health, physical health, and even survival. When our bodies are healthy and well, we feel better about ourselves, which enhances both self-esteem and healthy sexuality.

Culture can influence sexual attitudes and activities through the messages young people receive. In a recent study, Latino college students described four types of messages from parents and friends:

Sex is only for marriage (procreational). Sex is only appropriate in a loving relationship (relational). Sex is for pleasure (recreational). There is a gender-based double standard for male and female sexual behavior.

Other Models of Sexual Response

Since Masters and Johnson's pioneering work, other researchers have challenged and expanded their theories. Some argue that their model neglects the importance of desire in sexual response and that the plateau stage is virtually indistinguishable from excitement. Others note that arousal may come before desire, particularly for women who may not have spontaneous feelings of sexual desire. As many experts have concluded, physiology alone can never explain the complexity of human sexual response. Desire, arousal, pleasure, and satisfaction are highly subjective. Positive feelings like trust and happiness enhance them. Negative emotions such as anger and anxiety can undermine them. For women, sexual satisfaction cannot be defined, as it typically is for men, by whether or not they achieved orgasm.

A Cross-Sectional View of Sexual Intercourse

Sperm are formed in each of the testes and stored in the epididymis. When a man ejaculates, sperm carried in semen travel up the vas deferens. (The prostate gland and seminal vesicles contribute components of the semen.) The semen is expelled from the penis through the urethra and deposited in the vagina, near the cervix. During sexual excitement and orgasm in a woman, the upper end of the vagina enlarges and the uterus elevates. After orgasm, these organs return to their normal states, and the cervix descends into the pool of semen.

Without treatment, HIV infection typically progresses through three stages:

Stage 1: Acute HIV Infection Stage 2: HIV Inactivity or Latency Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

Excitement

Stimulation is the first step: a touch, a look, a fantasy. In men, sexual stimuli set off a rush of blood to the genitals, filling the blood vessels in the penis. Because these vessels are wrapped in a thick sheath of tissue, the penis becomes erect. The testes lift. Women respond to stimulation with vaginal lubrication within 10 to 20 seconds of exposure to sexual stimuli. The clitoris becomes larger, as do the vaginal lips (the labia), the nipples, and later the breasts. The vagina lengthens, and its inner two-thirds increase in size. The uterus lifts, further increasing the free space in the vagina.

Syphilis Signs and Symptoms

Syphilis has clearly identifiable stages: - Primary syphilis. - Secondary syphilis. - Late and latent syphilis. - after 4 years - Tertiary syphilis.

Young Adults

Teens and young adults under age 30 continue to be at risk. Those between ages 13 and 20 account for 34 percent of new HIV infections, the largest share of any age group. Most are infected sexually. As a result of the opioid crisis, drug injection has become a more frequent cause of HIV transmission. An estimated 50 percent of young Americans infected with the virus that causes AIDS don't know they have it. However, the HIV testing rate is lower among those ages 18 to 24 than for older people in the United States. In the National College Health Assessment, 28.8 percent of students report ever being tested for HIV.

Tertiary syphilis.

Ten to 20 years after the beginning of the latent stage, the most serious symptoms of syphilis emerge, generally in the organs in which the bacteria settled during latency. Syphilis that has progressed to this stage has become increasingly rare. Victims of tertiary syphilis may die of a ruptured aorta or of other heart damage, or may have progressive brain or spinal cord damage, eventually leading to blindness, insanity, or paralysis. About one-third of those who are not treated during the first three stages of syphilis enter the tertiary stage later in life.

Gential herpes Diagnosis and Treatment

Testing for the herpes virus has become much more accurate. Several highly effective antiviral therapies not only reduce symptoms and heal herpes lesions but also, if taken continuously, significantly reduce the risk of transmission of the virus to sexual partners.

Primary syphilis.

The first sign of syphilis is a lesion, or chancre (pronounced "shanker"), an open lump or crater the size of a dime or smaller, teeming with bacteria. The incubation period before its appearance ranges from 10 to 90 days; 3 to 4 weeks is average. The chancre appears exactly where the bacteria entered the body: in the mouth, throat, vagina, rectum, or penis. Any contact with the chancre is likely to result in infection.

Syphillis Incidence

The rates of syphilis, which was nearly eliminated more than a decade ago, have been increasing. Men account for almost 9 in 10 cases, with gay, bisexual, and other men having sex with men accounting for about two-thirds of these cases. Syphilis also has increased among injection drug users, women, and newborns infected before birth.

Resolution

The sexual organs of men and women return to their normal, nonexcited state during this final phase of sexual response. Heightened skin color quickly fades after orgasm, and the heart rate, blood pressure, and breathing rate soon return to normal. The clitoris also resumes its normal position and appearance very shortly thereafter, whereas the penis may remain somewhat erect for up to 30 minutes. After orgasm, men typically enter a refractory period during which they are incapable of another orgasm. The duration of this period varies from minutes to days, depending on age and the frequency of previous sexual activity. If either partner doesn't have an orgasm after becoming highly aroused, resolution may be much slower and may be accompanied by a sense of discomfort.

The transgender community includes:

Transyouth (young people experiencing issues related to gender identity or expression). Transsexuals (who identify with a gender other than the one they were given at birth). Transwomen (a term for male-to-female transsexuals to signify that they are female with a male history). Transmen (a term for female-to-male transsexuals to signify that they are male with a female history).

Pubic Lice and Scabies

These infections are sometimes, but not always, transmitted sexually. Pubic lice (or "crabs") are usually found in the pubic hair, although they can migrate to any hairy areas of the body. Lice lay eggs called nits that attach to the base of the hair shaft. Irritation from the lice may produce intense itching. Scratching to relieve the itching can produce sores. Scabies is caused by mites that burrow under the skin, where they lay eggs that hatch and undergo many changes in the course of their life cycle, producing great discomfort, including intense itching. Lice and scabies are treated with applications of permethrin cream and lindane shampoo to all the areas of the body where there are concentrations of body hair (genitals, armpits, scalp). Pubic lice or "crabs" usually are found in pubic hair but can migrate to other hairy parts of the body.

Black Americans.

Two percent of black Americans are HIV positive, higher than any other group. The AIDS diagnosis rate for blacks is more than nine times that for whites. If current HIV rates continue, about half of gay and bisexual black men in the United States will be diagnosed with the AIDS-causing virus in their lifetime, a new government analysis says. In general, black people have the greatest lifetime HIV risk—1 in 20 for men and 1 in 48 for women, the analysis showed. The overall lifetime HIV infection rate in white men is 1 in 132, while for white women, it's 1 in 880, according to the CDC. Blacks have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic. The reasons for this discrepancy are complex and include a higher rate of other STDs in black communities, disparities in health care, and poverty. While HIV diagnoses dropped significantly over the past decade in the United States, blacks with HIV are less likely than whites or Hispanics to receive routine, ongoing care, according to the CDC. Black women with HIV fared better than black men, the CDC noted. While 44 percent of black women benefited from routine care, just 35 percent of black men did the same. Most of the black HIV patients who received ongoing care were infected during heterosexual contact.

Pelvic Inflammatory Disease Diagnosis and Treatment

Urine testing is a cost-effective method of detecting gonorrhea and chlamydia in young women and can prevent development of PID. For women with symptoms, a pelvic ultrasound can show whether fallopian tubes are enlarged or an abscess is present. Magnetic resonance imaging (MRI) can also establish a diagnosis of PID and detect other diseases that may be responsible for the symptoms. Treatment consists of antibiotic therapy, usually with at least two antibiotics effective against a wide range of bacteria. A woman's sex partner(s) should also be treated to decrease the risk of reinfection, even if they have no symptoms. PID causes an estimated 15 to 30 percent of all cases of infertility every year and about half of all cases of ectopic pregnancy.

instructions on condom use. Here are some additional guidelines:

Use a new condom each and every time you engage in any form of intercourse. Do not open the wrapper of a condom with your teeth or fingernails since this can weaken or tear the condom. Squeeze the air out of a condom before putting it on. Do not use spermicide containing nonoxynol-9. Frequent use of nonoxynol-9 (N-9) may increase the risk of HIV by creating vaginal or rectal ulceration. N-9 does not offer protection from gonorrhea, chlamydia, or HIV. The FDA has required that products containing N-9 state that they do not protect against HIV and other STIs and may increase the risk of getting HIV from an infected partner. If a condom fails during vaginal or anal intercourse, remove it carefully. If you continue sexual activity, use a new condom.

Young people of traditional college ages acquire half of all new sexually transmitted infections One in four sexually active adolescent females has an STI, such as chlamydia or human papillomavirus (HPV). Why are young people at higher risk? Researchers have identified biological, cultural, and behavioral reasons:

Young women naturally have higher levels of certain cells particularly susceptible to infection on the outer surface of the cervix. Such "cervical ectopy" is normal but increases their risk of infections such as chlamydia. Inability to pay Lack of transportation Long waiting times Conflict with work and school schedules Embarrassment and stigma Concerns about confidentiality and privacy.

The sex lives of Americans born after 1980 are quite different from those of Americans born in preceding decades. Among the key changes:

Younger age for sexual initiation. The median age at first intercourse for today's "emerging adults" is 16.1 years for males and 16.2 years for females. The percentage of sexually active adolescents increases with age, from 13.1 percent of males and 12.5 percent of females at age 14 to more than 75 percent for both sexes at age 19. More sexual partners. The median number of lifetime partners has risen to 8.8 for males and 5.3 for females. More women with same-sex partners. Among women ages 20 to 24, 14.9 percent report having had sex with another woman. The percentage of men having sex with men did not change over recent decades. Less of a gender gap in sexual activity. Female respondents report initiating sexual activity at about the same age as males. Men report more lifetime partners than women, but the difference has narrowed over time.

Sexuality and the Dimensions of Health examples

physical, emotional, social, intellectual, spiritual, environmental

"At my age, I know everything already and believe that my classmates do, too." That's what an entering freshman said in a survey of undergraduates' sexual health knowledge. Many undergraduates would echo the same words, yet often they think that they know more than they actually do. This is particularly true of STIs. Although they often can name common STIs, such as HIV, genital herpes, gonorrhea, and chlamydia, undergraduates are less familiar with human papillomavirus (HPV) and syphilis, the symptoms associated with STIs, and the ways in which STIs are transmitted or diagnosed. Many do not realize that STIs can exist without symptoms, so they don't take steps to protect themselves or to avoid risky sexual behaviors. t/f

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"Casual" sex, defined as any sexual experience outside a committed relationship, is common on college campuses. However, students often define casual sex differently, depending on the nature of the sexual encounter (e.g., kissing vs. intercourse), perceived intimacy, commitment level, and length of the acquaintance or relationship. t/f

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A baby exposed to chlamydial infection in the birth canal during delivery may develop an eye infection. Symptoms include a bloody discharge and swollen eyelids. t/f

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A celibate person does not engage in sexual activity. Complete celibacy means that the person doesn't masturbate (stimulate him- or herself sexually) or engage in sexual activity with a partner. In partial celibacy, the person masturbates but doesn't have sexual contact with others. Many people decide to be celibate at certain times of their lives. Some don't have sex because of concerns about pregnancy or STIs; others haven't found a partner for a permanent, monogamous relationship. Many simply have other priorities, such as finishing school or starting a career, and realize that sex outside a committed relationship is a threat to their physical and psychological well-being. t/f

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A chancroid is a soft, painful sore or localized infection caused by the bacterium Haemophilus ducrevi and is usually acquired through sexual contact. Half of the cases heal by themselves. In other cases, the infection may spread to the lymph glands near the chancroid, where large amounts of pus can accumulate and destroy much of the local tissue. The incidence of this STI, widely prevalent in Africa and tropical and semitropical regions, is rapidly increasing in the United States, with outbreaks in several states, including Louisiana, Texas, and New York. Chancroids, which may increase susceptibility to HIV infection, are believed to be a major factor in the heterosexual spread of HIV. This infection is treated with antibiotics (ceftriaxone, azithromycin, or erythromycin) and can be prevented by keeping the genitals clean and washing them with soap and water in case of possible exposure. t/f

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A college hookup usually involves two people who have met online or previously, often at a bar, fraternity house, club, or party, and agree to engage in some sexual behavior for which there is little or no expectation of future commitment. There is often minimal communication, and the hookup ends when one partner leaves, falls asleep, or passes out. t/f

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A corkscrew-shaped, spiral bacterium called Treponema pallidum causes syphilis. This frail microbe dies in seconds if dried or chilled but grows quickly in the warm, moist tissues of the body, particularly in the mucous membranes of the genital tract. Entering the body through any tiny break in the skin, the germ burrows its way into the bloodstream. Sexual contact, including oral sex or intercourse, is a primary means of transmission. Genital ulcers caused by syphilis may increase the risk of HIV infection, while individuals with HIV may be more likely to develop syphilis. t/f

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A kiss can be just a kiss—a quick press of the lips—or it can lead to much more. Usually kissing is the first sexual activity that couples engage in, and even after years of sexual experimentation and sharing, it remains an enduring pleasure for partners. In a loving, committed relationship, every form of physical contact can serve as an intimate form of expressing deep emotion. t/f

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A newborn can be infected with genital herpes while passing through the birth canal, and the frequency of mother-to-infant transmission seems to be increasing. Most infected infants develop typical skin sores, which can be cultured to confirm a herpes diagnosis. Some physicians recommend treatment with acyclovir. Because of the risk to the infant of severe damage and possible death, caesarean delivery may be advised for a woman with active herpes lesions. t/f

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A women's reproductive lifespan begins at menarche, with her first menstrual period, and ends at menopause, when her periods end. Women with more than 40 reproductive years—who may begin menstruating at age 12 and continue to do so until their early 50s—are likely to outlive women who menstruate for less than 33 years. t/f

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About 60 percent of colleges with a student health center provide some STI testing and treatment. However, in various studies, fewer than a third of students report that they've been tested for HIV or other STIs. The reasons may include shame, stigma, fear, denial, concern about social consequences, inaccurate beliefs about STIs, privacy concerns, and inconveniences such as long waiting times. t/f

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About a third of students who've reported hooking up have described the experiences as "traumatic" or "very difficult to handle." The negative consequences include unprotected sex, unwanted sex, and emotional distress, including sexual regret, loss of self-respect, and embarrassment. t/f

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About one in five women and one in nine men have genital herpes. More than 80 percent do not realize they are infected. HSV transmission occurs through close contact with mucous membranes or abraded skin. Condoms help prevent infection but aren't foolproof. t/f

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About two-thirds of undergraduates report engaging in oral sex or vaginal or anal intercourse within the last year, but only about half (44.4 percent) used condoms most or all of the time they engaged in vaginal intercourse in the last 30 days. Fewer (26.6 percent) used condoms the last time they engaged in anal sex; only 5.1 percent used condoms for oral sex. t/f

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Abstinence education programs, which received federal support and became widespread in American schools, have had little, if any, impact on teen sexual behavior. t/f

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Abstinence from vaginal and anal intercourse and oral sex is free, available to everyone, extremely effective at preventing both pregnancy and STIs, and has no medical or hormonal side effects. t/f

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According to longitudinal studies, most people engage in vaginal intercourse for the first time between the ages of 15 and 17, with 70 to 90 percent engaging in sexual behavior by age 18. First-time sexual experiences can affect a variety of health outcomes. For instance, individuals who use condoms during first intercourse are more likely to continue to do so. t/f

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Acculturation—the process of adaptation that occurs when immigrants enter a new country—also affects sexual behavior. As Latina immigrants become more acculturated in the United States, some aspects of their sexual behavior become more Americanized; for instance, they become more likely to engage in nonmarital sexual activity and to have multiple partners. In a study of Cuban American college women, older, less religious, and U.S.-born Latinas were more likely to be sexually active and to engage in risky sexual behavior than other Latinas. t/f

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Affection and romance are significant for partners in same-sex as well as heterosexual relationships t/f

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All STI pathogens like dark, warm, moist body surfaces, particularly the mucous membranes that line the reproductive organs; they hate light, cold, and dryness. Figure 8.6 shows how STIs in body fluids spread from person to person and how a barrier can help prevent their entry. It is possible to catch or have more than one STI at a time. Curing one doesn't necessarily cure another, and treatments don't prevent another bout with the same STI. t/f

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Although college students see sexual activity as normal behavior for their peer group, they tend to overestimate how much sex their peers are having. According to the American College Health Association, a third of undergraduates report having had no sexual partners within the past 12 months. Among sexually active students, the mean number of partners is two. (See Snapshot: On Campus Now: The Sex Lives of College Students.) In a study that compared young adults (ages 18-24) attending 2-year colleges, attending 4-year colleges, and not in college, those not enrolled in school were more likely than full- or part-time students to have multiple lifetime sexual partners and to report never using a condom. Undergraduates at 2-year colleges reported more partners than their counterparts at 4-year schools. Men generally report more lifetime sex partners than women, but this difference has narrowed over time. t/f

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Although many people assume that Americans today have more sexual partners than in the past, this isn't necessarily the case. According to recent research, men and women born in the 1970s to 1990s report three lifetime other-sex partners, the same as those born in the 1940s—although this number may rise as this cohort of individuals grows older. Among Americans of all ages, both men and women report an average of one other-sex partner in the last year. t/f

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Although popular media have described a pervasive "hookup culture" on campuses, its true prevalence remains unknown. The average graduating senior reports hooking up eight times in the past 4 years. Almost one-third of college students never hook up at all. In one study, both college men and women reported twice as many hookups as first dates. t/f

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Although young women under age 25 are most likely to develop HPV, older women at risk for cervical cancer can also benefit from vaccination, according to initial tests of the HPV vaccine in various age groups. If you are age 26 or older and have not been vaccinated, talk to your health-care provider about the relative risks and benefits for you. t/f

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Among married people, husbands and wives report having sex 58 to 59 times a year. If other differences between men and women are statistically controlled (such as sexual preference, age, and educational attainment), married women report a slightly higher frequency than men. t/f

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Among men, more masculine gender identity and less spiritual meaning in life are associated with greater homophobia. Young black men who have sex with men report greater gender role strain arising from conflict between homosexuality and rigid, often antihomosexual expectations of masculinity from their families, peers, and communities. As a result, they may feel greater psychological distress, try to camouflage their homosexuality, or attempt to prove their masculinity in ways that damage their self-esteem and increase social isolation. Hispanic culture, with its emphasis on machismo, also has a very negative view of male homosexuality. Asian cultures, which tend to view an individual as a representative of his or her family, tend to view open declarations of sexual orientation as shaming the family and challenging their reputation and future. t/f

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Among the factors linked with premenstrual symptoms in college students are stress, sleep quality, and higher rates of psychological disorders. t/f

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An estimated 7 to 9 million men, about twice the number thought to be exclusively homosexual, could be described as bisexual during some extended period of their lives. Until relatively recently, many bisexual men were married and had secret sexual relationships with men. As HIV became more prevalent, an estimated 20 to 30 percent of cases of AIDS in women were attributed to bisexual partners. t/f

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Another negative effect of pornography is its seemingly addictive nature. Therapists debate whether some individuals, usually men, develop a specific compulsion for pornography or whether their behavior is a manifestation of sexual addiction. Yet those unable to curtail or limit their use of pornography can suffer intense psychological distress, including a deep sense of guilt and shame. t/f

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Approximately 20 million people in the United States—almost 7 percent of those between ages 14 and 69—are currently infected with HPV, and 6.2 million Americans get a new HPV infection each year. Worldwide, more than 440 million individuals are infected with HPV. t/f

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As illustrated in Figure 8.1a, the mons pubis is the rounded, fleshy area over the junction of the pubic bones. The folds of skin that form the outer lips of a woman's genital area are called the labia majora. They cover soft flaps of skin (inner lips) called the labia minora. The inner lips join at the top to form a hood over the clitoris, a small elongated erectile organ, and the most sensitive spot in the entire female genital area. Below the clitoris is the urethral opening, the outer opening of the thin tube that carries urine from the bladder. Below that is a larger opening, the mouth of the vagina, the canal that leads to the primary internal organs of reproduction. The perineum is the area between the vagina and the anus (the opening to the rectum and large intestine). t/f

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As many as 80 percent of sexually active women acquire HPV by age 50. However, 44 percent of women ages 20 to 24 have HPV. Approximately 70 percent of sexually active women contract HPV, most within 5 years of their first sexual encounter. t/f

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As with other aspects of health, cultural, religious, and personal values affect students' sexual behaviors. Researchers raised concern about young Latina women, who have the highest teen birth rate in the United States (twice the national rate) and are at greater risk of STIs. Although Latinas represent about 10 percent of women over age 21, they account for 20 percent of female AIDS cases. Among college students and other populations, Latinas are more likely to engage in unprotected intercourse than women from other ethnic groups. t/f

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At the back of the vagina is the cervix, the opening to the womb, or uterus (see Figure 8.1b). The uterine walls are lined with a layer of tissue called the endometrium. The ovaries, about the size and shape of almonds, are located on either side of the uterus and contain egg cells called ova (singular, ovum). Extending outward and back from the upper uterus are the fallopian tubes, the canals that transport ova from the ovaries to the uterus. When an egg is released from an ovary, the fingerlike ends of the adjacent fallopian tube "catch" the egg and direct it into the tube. t/f

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Bacterial vaginosis (BV), the most common vaginal infection in women ages 15 to 44, is caused by an imbalance of normal bacteria in the vagina. Having a new sex partner or multiple sex partners and douching can increase a woman's risk for getting BV. Although not considered an STD, BV increases vulnerability to STIs. t/f

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Because the anus has many nerve endings, it can produce intense erotic responses. Stimulation of the anus by the fingers or mouth can be a source of sexual arousal; anal intercourse involves penile penetration of the anus. An estimated 25 percent of adults have experienced anal intercourse at least once. However, anal sex involves important health risks, such as damage to sensitive rectal tissues and the transmission of various intestinal infections, hepatitis, and STIs, including HIV. t/f

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Before 1973, homosexuality was classified as a mental disorder, and research focused on its sources and associated psychological issues. Only in recent decades have we learned more about the development of lesbian, gay and bisexual identities and about the strengths and rewards of LGBTQ relationships. t/f

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Bisexuality can be viewed on the basis of behavior, attraction, or identity. An individual who has been erotically attracted to or who has had sexual experiences with persons of more than one gender can be described as bisexual, but may not identify as such. Other individuals may identify as bisexual, whether or not they've ever engaged in sexual behaviors with partners of more than one gender. Gender identities and expressions also are fluid and can change over time or in different contexts. t/f

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Bisexuality—sexual attraction to both males and females—can develop at any point in one's life. Individuals may identify themselves as bisexual even if they don't behave bisexually. Some individuals are sexually involved with same-sex partners for a while and then with partners of the other sex or vice versa. Individuals who experience emotional, physical, sexual, and/or romantic attraction for members of all gender identities/expressions may also be referred to as pansexual. t/f

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Both men and women can develop STIs, but their risks are not the same. Here is what you need to know about your risks. t/f

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College norms also have an effect. Women at an elite academic college and those at a state university reported different reasons for engaging in hookups. At "Ivy U," hook ups and long-distance relationships were seen as advantageous for time-crunched "preprofessional students." At a public school with a party reputation, women described hookups as part of the "fun of college life," while women seeking or involved in committed relationships negotiated the effects of a party culture in their partnerships. t/f

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College students often report never using a condom or using condoms inconsistently during sex. The reasons may have more to do with emotions and attitudes than with availability or cost. Some fear that bringing up condom use might jeopardize the relationship or cause embarrassment. Even if partners believe that condoms could help prevent an STI, those hoping for or seeing themselves as already in a long-term relationship may feel that condoms are not necessary because they and their partners know each other well. t/f

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College students reporting having the following number of sexual partners (oral sex, vaginal, or anal intercourse) within the past 12 months: t/f

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Communication is vital in a sexually healthy relationship, even though these discussions can be awkward. Yet if you have a need or a problem that relates to your partner, it is your responsibility to bring it up (see Health on a Budget in this chapter). t/f

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Condoms provide only limited protection. Most people who become infected with HPV do not have any symptoms, and the infection clears on its own. However, HPV infection can cause cervical cancer in women and genital warts and other types of cancers in both sexes. t/f

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Contracting an STI may increase the risk of being infected with HIV. Because college students have more opportunities to engage in sex with different partners and may use drugs and alcohol more often before sex, they are at greater risk for all STIs, including HIV. t/f

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Critics of circumcision emphasize the pain, bleeding, and risk of infections. In newborns, the estimated complication rate is 0.5 percent. Complications may include bleeding, infection, improper healing, or cutting the foreskin too long or too short. Analgesic creams or anesthetic shots are typically used to minimize discomfort. There is little consensus on what impact the presence or absence of a foreskin has on sexual function or satisfaction. t/f

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If left untreated in men or women, gonorrhea spreads through the urinary-genital tract. In women, the inflammation travels from the vagina and cervix, through the uterus, to the fallopian tubes and ovaries. The pain and fever are similar to those caused by stomach upset, so a woman may dismiss the symptoms. Eventually these symptoms diminish, even though the disease spreads to the entire pelvis. Pus may ooze from the fallopian tubes or ovaries into the peritoneum (the lining of the abdominal cavity), sometimes causing serious inflammation. However, this, too, can subside in a few weeks. t/f

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Cultural and childhood influences can affect our attitudes toward sex. Even though America's traditionally puritanical values have eased, our society continues to convey mixed messages about sex. Some children, repeatedly warned of the evils of sex, never accept the sexual dimensions of their identity. Others—especially young boys—may be exposed to macho attitudes toward sex and feel a need to prove their virility. Young girls may feel confused by media messages that encourage them to look and act provocatively and a double standard that blames them for leading boys on. In addition, virtually everyone has individual worries. A woman may feel self-conscious about the shape of her breasts; a man may worry about the size of his penis; both partners may fear not pleasing the other. t/f

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Decades ago no one knew about human immunodeficiency virus (HIV) or had ever heard of acquired immune deficiency syndrome (AIDS). Once seen as an epidemic affecting primarily gay men and injection drug users, AIDS has taken on very different forms. Thanks to medical advances, HIV has evolved into a chronic disease instead of a fatal one. But those who are infected must take medications for their entire lives and face higher risk of various health problems as they age. t/f

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Different ethnic groups respond to homosexuality in different ways. To a greater extent than white homosexuals, gays and lesbians from ethnic groups tend to stay in the closet longer rather than risk alienation from their families and communities. LGBTQ individuals develop and live in the context of other social identities. According to intersectionality theory, those who are also members of racial or ethnic minorities may confront additional challenges associated with being in two stigmatized minority groups. t/f

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Discharge and changes in odor normally occur in a healthy vagina. They typically fluctuate through the menstrual cycle, depending on hormone level. In the past, many women practiced douching, the introduction of a liquid into the vagina, to cleanse the vagina. However, particularly if done frequently, douching may increase the risk of pelvic inflammatory disease (discussed later in this chapter) and ectopic (out-of-uterus) pregnancy. As discussed in Chapter 14, physicians no longer recommend annual pelvic exams for all women, but some women continue to view them as reassuring or necessary to detect ovarian cancer or sexually transmitted infections. t/f

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Does penis size matter? In surveys of heterosexual men and women, 85 percent of women typically report satisfaction with their partner's penis size, but only about 55 percent of the men say they are satisfied. Some men's anxiety is so distressing that they develop what therapists term "small penis anxiety" or "small penis disorder." Among those who consult physicians, almost all learn that their penis is within the normal size range. Fewer than 2 percent of men have a "micropenis," measuring 2 inches or less in flaccid state and less than 3.3 inches when stretched. t/f

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Early ART has shown promise in treating newborns with HIV infection but also causes serious complications. HIV resistance to the antiretroviral drug tenofovir (Viread) is increasingly common, which is alarming because the drug plays a major role in treating and preventing infection with HIV, the virus that causes AIDS. Resistance often occurs when patients don't take their drugs as directed. To prevent resistance, people need to take the drugs correctly about 85 to 90 percent of the time. Tenofovir-resistant HIV strains could be passed on to other people and become more widespread, potentially weakening global efforts to control HIV. A significant number of people with HIV have strains of the AIDS-causing virus that are resistant to both older and newer drugs. Among the 40 million people living with HIV, there is only one confirmed cure: a patient who also developed cancer and underwent intensive chemotherapy, total body radiation, and bone marrow transplantation. A key challenge is that once HIV invades an individual's genome, it is extremely difficult to remove all HIV-infected cells, which—even with treatment—persist in the body for decades. t/f

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Fantasies generally enhance sexual arousal, reduce anxiety, and boost sexual desire. They're also a way to anticipate and rehearse new sexual experiences, as well as to bolster a person's self-image and feelings of desirability. Part of what makes fantasies exciting is that they provide an opportunity for expressing forbidden desires, such as sex with a different partner or with a past lover. t/f

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For a diagnosis to be made, women must report troubling premenstrual symptoms in the days before menstruation in at least two successive menstrual cycles. t/f

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From birth to death, we are sexual beings. Our sexual identities, needs, likes, and dislikes emerge in adolescence and become clearer as we enter adulthood, but we continue to change and evolve throughout our lives. In men, sexual interest is most intense at age 18; in women, it reaches a peak in the 30s. Although age brings changes in sexual responsiveness, we never outgrow our sexuality. t/f

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Gender expression, an outward presentation of gender, includes clothes, makeup, piercings, or hairstyles that may be perceived as feminine, masculine, or androgynous. Transgender individuals may be happy with the biological sex in which they are born but enjoy dressing up and behaving like the other sex. Most do so for psychological and social pleasure rather than sexual gratification. t/f

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Gonococcus, the bacterium that causes gonorrhea, can live in the vagina, cervix, and fallopian tubes for months, even years, and continue to infect the woman's sexual partners. Approximately 5 percent of sexually active American women have positive gonorrhea cultures but are unaware that they are silent carriers. t/f

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Gonorrhea (sometimes called "the clap"), the second most commonly reported STI in the United States, can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. t/f

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Gonorrhea, the leading cause of sterility in women, can cause PID. In pregnant women, gonorrhea becomes a threat to the newborn. It can infect the infant's external genitals and cause a serious form of conjunctivitis. As a preventive step, newborns may have penicillin dropped into their eyes at birth. In both sexes, gonorrhea can develop into a serious, even fatal, bloodborne infection that can cause arthritis in the joints, attack the heart muscle and lining, cause meningitis, and attack the skin and other organs. A cloudy discharge is symptomatic of gonorrhea. t/f

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Not everybody masturbates, but most people do. Kinsey estimated that 7 of 10 women and 19 of 20 men masturbate (and admit they do). Their reason is simple: It feels good. Masturbation produces the same physical responses as sexual activity with a partner and can be an enjoyable form of sexual release. t/f

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HIV infection refers to a spectrum of health problems that results from immunologic abnormalities caused by the virus when it enters the bloodstream. In theory, the body may be able to resist infection by HIV. In reality, in almost all cases, HIV destroys the cell-mediated immune system, particularly the CD41 T lymphocytes (also called T4 helper cells). The result is greatly increased susceptibility to various cancers and opportunistic infections (infections that take hold because of the reduced effectiveness of the immune system). HIV triggers a state of all-out war within the immune system. Almost immediately following infection with HIV, the immune system responds aggressively by manufacturing enormous numbers of CD4+ cells. It eventually is overwhelmed, however, as the viral particles continue to replicate, or multiply. The intense war between HIV and the immune system indicates that the virus itself, not a breakdown in the immune system, is responsible for disease progression. t/f

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HIV testing can be either confidential or anonymous. In confidential testing, a person's name is recorded along with the test results, which are made available to medical personnel and, in 32 states, the state health department. In anonymous testing, no name is associated with the test results. Anonymous testing is available in 39 states. The only home HIV test approved by the FDA, Home Access, is available in drugstores or online for $40 to $50. An individual draws a blood sample by pricking a finger and sends it to a laboratory, along with a personal identification number. Results are given over the phone by a trained counselor, usually within several days. Newly developed blood tests can determine how recently a person was infected with HIV and distinguish between long-standing infections and those contracted within the previous 4 to 6 months. t/f

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HPV infection may invade the urethra and cause urinary obstruction and bleeding. It greatly increases a woman's risk of developing a precancerous condition called cervical intraepithelial neoplasia, which can lead to cervical cancer. Adolescent girls infected with HPV appear to be particularly vulnerable to developing cervical cancer. t/f

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HPV lives on the skin or in mucous membranes and usually causes no symptoms. Some people get visible genital warts or have precancerous changes in the cervix, vulva, anus, or penis. After contact with an infected individual, genital warts may appear within 3 weeks to 18 months, with an average period of about 3 months. t/f

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Herpes (from the Greek word that means "to creep") collectively describes some of the most common viral infections in humans. Characteristically, herpes simplex causes blisters on the skin or mucous membranes. Herpes simplex exists in several varieties. Herpes simplex virus 1 (HSV-1) can be transmitted by kissing and generally causes cold sores and fever blisters around the mouth. Herpes simplex virus 2 (HSV-2) is sexually transmitted and may cause blisters on the penis, inside the vagina, on the cervix, in the pubic area, on the buttocks, on the thighs, or in the mouth and throat (transmitted via oral sex). In recent years HSV-1 infections of the genitals have increased among young adults, in part because of an increase in oral sex. t/f

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Heterosexuality, the most common sexual orientation, refers to sexual or romantic attraction between different sexes. The adjective heterosexual describes intimate relationships and/or sexual relations between a man and a woman. The term straight is used predominantly for self-identified heterosexuals of either sex. In his landmark research in the 1940s, Alfred Kinsey reported that while many men and women were exclusively heterosexual, a significant number (37 percent of men and 13 percent of women) had at least one adult sexual experience with a member of the same sex. t/f

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High school sexual norms have a strong influence on college sexual experiences. In a study that categorized female students as placing priority on religion, relationships, partying, or careers, these values influenced their behavior in college much as they did in high school. t/f

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Homosexuality threatens and upsets many people, perhaps because homosexuals are viewed as different, or perhaps because no one understands why some people are heterosexual and others homosexual. Homophobia has led to gay bashing (attacking homosexuals) in many communities, including college campuses. t/f

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Homosexuality—social, emotional, and sexual attraction to members of the same sex—exists in almost all cultures. Men and women attracted to same-sex partners are commonly referred to as gay; female homosexuals are also called lesbian. t/f

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Hooking up can be defined as an experience in which partners engage in physically intimate behaviors (such as kissing, oral sex, or sexual intercourse) without explicit expectation of future romantic commitment. Some students describe it more informally as "making out with no future" or "a one-time experience without any kind of responsibility to each other." t/f

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How do students choose partners (researchers sometimes use the term targets) for casual sex? Physical attraction may matter most. Men, according to numerous studies, are more likely to judge an attractive woman as less risky because she looks healthy. Even when men acknowledge that an attractive woman has probably had more sexual encounters, including one-night stands, they still say they would have sex with her. t/f

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Human beings are diverse in all ways, including sexual preferences and practices. Sexual orientation refers to the gender(s) to which someone feels sexually attracted. The acronym LGBTQIA is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual (or allied individuals). Transgender people, like their cisgender counterparts, might identify as gay, straight, queer, bisexual, or gender-fluid. t/f

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Human papillomavirus (HPV) is the most common STI in the world and a necessary cause of all cases of cervical cancer. Of the 100 or more different strains, or types, of HPV, approximately 40 are sexually transmitted, and 15 have been identified as "oncogenic," or cancer-causing. Some "high-risk" HPV strains may lead to cancer of the cervix, vulva, vagina, anus, or penis. If transmitted via oral sex, they significantly increase the risk of mouth and throat cancers. The risk to an individual increases along with the number of oral sex partners. t/f

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Human sexuality—the quality of being sexual—is as rich, varied, and complex as life itself. Along with our sex, or biological maleness or femaleness, it is an integral part of who we are, how we see ourselves, and how we relate to others. Of all of our involvements with others, sexual intimacy, or physical closeness, can be the most rewarding. But while sexual expression and experience can provide intense joy, they also can involve great emotional turmoil. t/f?

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In a recent study of sexually active first-year college students, oral sex led to fewer positive consequences (such as intimacy or physical satisfaction) than negative ones (such as guilt or worry about health) compared to vaginal sex. Female freshmen generally found vaginal sex more satisfying than oral sex, whereas males found them equally pleasurable. t/f

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In a recent survey of college students, nearly all learned about masturbation through the media or from peers rather than from parents or teachers. Most of the women reported struggling with feelings of stigma and taboo and enjoying this pleasurable act. Most of the men saw masturbation as part of healthy sexual development. t/f

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In its natural state, the tip of the penis is covered by a fold of skin called the foreskin. About 60 percent of baby boys in the United States undergo circumcision, the surgical removal of the foreskin, for reasons that vary from religious traditions to preventive health measures. t/f

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In medical terms, sexually transmitted infection (STI) refers to the presence of an infectious agent that can be passed from one sexual partner to another. In public health, this term is replacing sexually transmitted disease (STD) because sexual infections can be—and often are—transmitted by people who do not have symptoms. Again, the odds of acquiring an STI in the course of a lifetime are one in four. These diseases cannot be prevented in a laboratory. Only you, by your behavior, can prevent and control them. t/f

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In the American College Health Association (ACHA) survey, 28.8 percent of college students reported being tested for HIV. After testing, a committed relationship remains safe only as long as both partners remain committed. Most women who get HIV from having sex believe that they are their sex partner's only lover and never suspect that their partner's other lovers are men or women with HIV. t/f

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In the United States, NGU is more common in men than gonococcal urethritis. The symptoms in men are similar to those of gonorrhea, including discharge from the penis (usually less than with gonorrhea) and mild burning during urination. Women frequently develop no symptoms or very mild itching, burning during urination, or discharge. Symptoms usually disappear after 2 or 3 weeks, but the infection may persist and cause cervicitis or PID in women and, in men, may spread to the prostate, epididymis, or both. Treatment usually consists of doxycycline or azithromycin and should be given to both sexual partners. t/f

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In the past, physicians viewed herpes as an episodic disease with the greatest risk of transmission during a flare-up. But as newer research has documented, "classic herpes" that produces acute symptoms is not typical. For many people genital herpes is a chronic, nearly continuously active infection that may produce subtle, varied, and often-overlooked symptoms. Most cases are transmitted by sexual partners who are unaware of their infections or do not have symptoms at the time of transmission. t/f

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Increasing numbers of adolescents and young adults are choosing to remain virgins and abstain from sexual intercourse until they enter a permanent, committed, monogamous relationship. About 2.5 million teens have taken pledges to abstain from sex. t/f

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Infection of a woman's fallopian tubes or uterus, called pelvic inflammatory disease (PID), is not actually an STI but a complication of STIs involving the uterus, oviducts, and/or ovaries. Ten to 20 percent of initial episodes of PID lead to scarring and obstruction of the fallopian tubes severe enough to cause infertility. Other long-term complications are ectopic pregnancy and chronic pelvic pain. Smoking may also increase the likelihood of PID. t/f

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Initially, doctors had targeted girls because the vaccination is highly effective in preventing cervical cancer. However, other cancers linked to HPV, including anal cancer and some head and neck cancers, have been increasing, especially among men. t/f

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Inside the body are several structures involved in the production of seminal fluid, or semen, the liquid in which sperm cells are carried out of the body during ejaculation. The vas deferens are two tubes that carry sperm from the epididymis into the urethra. The seminal vesicles, which make some of the seminal fluid, join with the vas deferens to form the ejaculatory ducts. t/f

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It is not known if HPV itself causes cancer or acts in conjunction with cofactors (such as other infections, smoking, or suppressed immunity). A woman's risk of cervical cancer is strongly related to the number of her partner's current and lifetime female partners. Women are significantly more likely to get cervical cancer if their steady sex partner has had 20 or more previous partners. t/f

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Like hookups, relationships between "friends with benefits" include varied sexual behaviors but occur between two individuals who do not identify their relationship as romantic but engage in sexual interaction (ranging from kissing to sexual intercourse) on repeated occasions. About half of college students report having engaged in a friends-with-benefits relationship in the preceding 12 months. A significant number were also involved in other friends-with-benefits relationships simultaneously. t/f

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Like other aspects of human identity and experience, homosexuality is complex and diverse. Researchers have analyzed sexual orientation from many difference perspectives, including genetics, hormones, physiology, development, and behavior. "Interactional" theory proposes that homosexuality results from an interaction of biological, psychological, and social factors. t/f

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Many STIs, including early HIV infection, may not cause any symptoms. As a result, infected individuals may continue their usual sexual activity without realizing that they're jeopardizing another's well-being. Globally more than a million STIs are acquired every day. More Americans are infected with STIs now than at any other time in history. Almost half of STIs occur in young people ages 15 to 24. Within 2 years of having sex for the first time, half of teenage girls may acquire an STI. The three most common are chlamydia, gonorrhea, and trichomoniasis. t/f

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Many sexual concerns stem from myths and misinformation. There is no truth, for instance, behind these misconceptions: Men are always capable of erection, sex always involves intercourse, partners should experience simultaneous orgasms, or people who truly love each other always have satisfying sex lives. t/f

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Many women experience physical or psychological changes, or both, during their monthly cycles. Usually the changes are minor, but more serious problems can occur. t/f

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Many women with BV do not have symptoms. Others may notice a thin white or gray vaginal discharge and odor, pain, itching, or burning in the vagina. Some women detect a strong fishlike odor, especially after sex; burning when urinating; or itching around the outside of the vagina. Laboratory tests of vaginal fluid can determine if BV is present. Antibiotics can treat BV, although the infection may recur. Male sex partners of women diagnosed with BV generally do not need to be treated. Antibiotic treatment for sexual partners of women with BV does not increase the rate of clinical or symptomatic improvement or a lower recurrence rate. Without treatment, BV increases the risk of various STIs, including chlamydia, gonorrhea, and HIV, and, in pregnant women, the risk of having a premature or low-birth-weight baby. t/f

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Masturbation has been described as immature; unsocial; tiring; frustrating; and a cause of hairy palms, warts, blemishes, and blindness. None of these myths is true. Sex educators recommend masturbation to adolescents as a means of releasing tension and becoming familiar with their sexual organs. t/f

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Men and women have different types of sexy thoughts, with men's fantasies containing more explicit genital images and culminating in sexual acts more quickly than women's. For many women, fantasy helps in reaching orgasm during intercourse; a loss of fantasy is often a sign of low sexual desire. Fantasies lived out via the Internet are becoming more common but may also be harmful to psychological health. t/f

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Men of all ages may have concerns about the size of their penis. In a recent scholarly analysis titled "Am I Normal?" researchers analyzed 20 studies of the penis size of more than 15,000 men around the world—all measured by physicians in clinical settings. The mean length of a flaccid penis was 3.6 inches; of both a stretched flaccid penis or an erect penis, about 5.2 inches. Penile lengths varied by 1 to 1.5 inches, and the analysis found no indications of size variability based on race. t/f

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Men often don't take these symptoms seriously because the symptoms may appear only early in the day and can be very mild. Chlamydia, which can spread from a man's urethra to his testicles, can also cause a condition called epididymitis, which can cause sterility. Symptoms include fever, swelling, and extreme pain in the scrotum. Six percent of men with epididymitis develop reactive arthritis, which causes swelling and pain in the joints and can progress and become disabling. In women and men, chlamydia may cause the rectum to itch and bleed. It can also result in a discharge and diarrhea. If it infects the eyes, it may cause redness, itching, and a discharge. If it infects the throat, it may cause soreness. Babies exposed to chlamydia during birth may develop an eye infection that causes swollen eyelids and a bloody discharge. t/f

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Men who have sex with men and men who have sex with both men and women have the highest rates of HPV. Men who have had more than 16 sex partners have about three times the HPV risk of those with fewer sex partners and are nearly 10 times more likely to contract a potentially cancer-causing strain. Once infected, men who have been circumcised are more likely to have their immune systems "clear" the virus. Circumcised men are also less likely to transmit the virus to female partners. HPV has also been linked to penile cancer. t/f

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Most HPV infections are asymptomatic in men, who may unwittingly increase their partners' risk. Men who test positive for HPV typically report significantly more sex partners than those who do not. HPV may also cause genital warts in men and increase the risk of cancer of the penis. t/f

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Most college students assume that their classmates are more sexually active than they are. As the preceding data indicate, a significant percentage have never had sexual intercourse. Those who are sexually active report a median of two partners. Do these statistics change your perception of sexual activity on campus? Do they have any influence on your own intimate relationships? t/f

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Most college students still engage in sex in the context of a romantic relationship. In one study of first-year female undergraduates, romantic sexual encounters—including oral and vaginal sex—were approximately twice as common as hookup sex. t/f

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Most people grow up with a lot of myths and misconceptions about sex. Than rely on what peers say or what you've always thought was true, find out the facts. This textbook is a good place to start expanding your sexual literacy. The student health center and the library can provide additional materials on sexual identity, orientation, behavior, and health, as well as on options for reducing your risk of acquiring STIs or becoming pregnant. t/f

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Most women are diagnosed with HPV after an abnormal Pap test or HPV DNA test. The results of HPV DNA testing can help health-care providers decide whether treatment is necessary to prevent or treat cervical cancer. (See Chapter 12 for a discussion of cervical cancer.) Warning signs for cervical cancer include irregular bleeding and unusual vaginal discharge. Precancerous cervical cells can be destroyed by laser surgery or freezing during a visit to a doctor's office. t/f

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Neither sexual orientation nor attraction necessarily correlates with reported sexual behavior. Researchers use the terms heteroflexibility and homoflexibility to describe individuals who are primarily heterosexual or homosexual, yet report some sexual interest in or experience with both sexes. t/f

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New forms of therapy have been remarkably effective in boosting levels of protective T cells and reducing viral load—the amount of HIV in the bloodstream. Starting HIV treatment early, before a patient's immune system is badly weakened, can dramatically improve survival. People with high viral loads are more likely to progress rapidly to AIDS than people with low levels of the virus. ART dramatically reduces viral load but does not eradicate the virus. This complex regimen uses 1 of 250 different combinations of three or more antiretroviral drugs, often available in a single tablet. Treatment begins much earlier than in the past, even before moderate immune suppression. This benefits the individual patient and helps prevent HIV transmission to a sexual partner. t/f

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No form of therapy has been shown to completely eradicate HPV, nor has any single treatment been uniformly effective in removing warts or preventing their recurrence. CDC guidelines suggest treatments that focus on the removal of visible warts—laser therapy, cryotherapy (freezing), and topical applications of podofilox, podophyllin, or trichloroacetic acid—and then eradication of the virus. At least 20 to 30 percent of treated individuals experience recurrence. t/f

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Not related to PMS, premenstrual dysphoric disorder (PMDD) occurs in an estimated 3 to 5 percent of all menstruating women. It is characterized by regular symptoms of depression (depressed mood, anxiety, mood swings, and diminished interest or pleasure) as well as physical symptoms, such as changes in appetite, energy, weight, or sleep during the last week of the menstrual cycle. t/f

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Our sexuality both affects and is affected by the various dimensions of health. Responsible sexuality and high-level sexual health contribute to the fullest possible functioning of body, mind, spirit, and social relationships. In turn, other aspects of health enhance our sexuality. t/f?

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People who were sexually active in the past may choose abstinence because the risk of medical complications associated with STIs increases with the number of sexual partners a person has. Practicing abstinence is the safest, healthiest option for many. However, there is confusion about what it means to abstain, and individuals who think they are abstaining may still be engaging in behaviors that put them at risk for HIV and STIs. t/f

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Prior to any sexual activity that involves a risk of STI or pregnancy, both partners should talk about their prior sexual histories (including number of partners and exposure to STIs) and other high-risk behavior, such as the use of injection drugs. They should also discuss the issue of birth control and which methods might be best for them to use. If you know someone well enough to consider having sex with that person, you should be able to talk about such sensitive subjects. If a potential partner is unwilling to talk or hedges on crucial questions, you shouldn't be engaging in sex. t/f

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Rates of HPV vaccination remain lower than for other routinely recommended immunizations. Vaccination against HPV has lagged in part because of fear that it might encourage teenagers to initiate sexual activity at earlier ages or to engage in riskier sexual behaviors. However, several studies have confirmed that girls vaccinated against HPV are no more (and in some cases are less) likely than others to initiate sex or, if they are already sexually active, to have more partners or not use condoms during sex. t/f

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Researchers have concluded that the more sex a person has, the more likely he or she is to report having a happy life and marriage. This connection is stronger among women than among men. A second and more important predictor of sexual frequency is the feeling that one's life is exciting rather than routine or dull. As researchers have noted, "Increased sexual activity is one of the many benefits of having a positive attitude." t/f

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Researchers have found differences between platonic (nonsexual) friendships and those that mixed friendship and sex. In one study, those in casual-sex friendships did less to maintain the relationship as compared with platonic friends. Men are more likely to desire no change in a friends-with-benefits relationship, while women typically prefer either to go back to being "just friends" or to move into a committed romantic relationship. t/f

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Sexual activity, including intercourse, is possible throughout a woman's menstrual cycle. However, some women prefer to avoid sex while menstruating because of uncomfortable physical symptoms, such as cramps, or concern about bleeding or messiness. Others use a diaphragm or cervical cap (see Chapter 9) to hold back menstrual flow. Since different cultures have different views on intercourse during a woman's period, partners should discuss their own feelings and try to respect each other's views. If they choose not to have intercourse, there are other gratifying forms of sexual activity. t/f

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Sexual decision making should always take place within the context of an individual's values and perceptions of right and wrong behavior. Making responsible sexual decisions means considering all the possible consequences—including emotional consequences—of sexual behavior for both yourself and your partner. t/f

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Sexual frequency peaks among those with some college education, then decreases among 4-year college graduates, and declines even further among those with professional degrees. Americans who have attended graduate school are the least sexually active educational group in the population. These respondents may be more honest than others in reporting sexual activity, or they may be more precise in their definition of what counts as sex. t/f

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Sexual health refers, by simplest definition, to a state of optimal well-being related to sexuality throughout the lifespan. The World Health Organization (WHO) describes it more comprehensively as "a state of physical, emotional, mental, and social well-being related to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual responses, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence." t/f?

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Sexual orientation influences various risky behaviors among college students, including smoking and substance use. According to recent research, lesbian and bisexual females drink heavily more often than heterosexual women, while heterosexual men engage in heavy drinking more than gay men. Although there has been an increase in legal recognition, social acceptance, and visibility for LGBTQIA people, sexual prejudice and intolerance persist, particularly toward LGBTQIA individuals. Compared to heterosexuals, LGBTQIA youth experience higher rates of harassment, abuse, and violence. t/f

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Sexual orientation represents only one aspect of a person's life rather than a complete identity. The term "sexual fluidity" describes variability in same-sex and other-sex attraction and experiences throughout the life span. As longitudinal research has shown, sexual self-identity and the biological sex of preferred sexual partners vary over time. Generally more women than men experiment sexually with the same sex, while sexual fluidity among men is less common. t/f

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Sexuality involves every part of you: mind and body, muscles and skin, glands and genitals. The pioneers in finding out exactly how human beings respond to sex were William Masters and Virginia Johnson, who first studied more than 800 individuals in their laboratory in the 1950s. They discovered that sexual response is a well-ordered sequence of events, so predictable it could be divided into four phases: excitement, plateau, orgasm, and resolution (Figure 8.5). In real life, individuals don't necessarily follow this well-ordered pattern. But the responses for both sexes are remarkably similar. And sexual response always follows the same sequence, whatever the means of stimulation. t/f

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Sexuality may be timeless, but sexual behaviors change over time. Acceptance of nonmarital sex rose steadily between those born between 1901 to 1924 and baby boomers (born from 1946 to 1964), dipped slightly among early Generation X-ers (born from 1965 to 1981), and then rose again with Millennials (born 1982 to 1999) (Table 8.1). Generational shifts for men and for blacks are greater for men and black, as compared with whites and women. t/f

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Sexually active young adults are at the highest risk of HPV infection. More than half of college students—56 percent—report having been vaccinated against HPV. Many of those who remain unvaccinated describe themselves as not being in a committed relationship or not living with a romantic partner. t/f

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Since HPV vaccination began more than a decade ago, prevalence of the cancer-causing virus has significantly decreased in girls 14 to 19 years of age and in those 20 to 24—the age groups at highest risk for HPV. Health-insurance claims indicate lower rates of changes in cervical cells among women ages 25 to 29 years who've been vaccinated and in anogenital warts among vaccinated young women and men. t/f

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Some transsexuals feel trapped in the body of the wrong gender—a phenomenon called gender dysphoria. In general, more men than women have this experience. Gender transition is the process of shifting one's outward gender expression to match one's internal sense of gender—from masculine to feminine or from feminine to masculine. For transgender individuals, this may include gender-affirming hormones and surgical procedures. t/f

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Sperm are formed in each of the testes and stored in the epididymis. When a man ejaculates, sperm carried in semen travel up the vas deferens. (The prostate gland and seminal vesicles contribute components of the semen.) The semen is expelled from the penis through the urethra and deposited in the vagina, near the cervix. During sexual excitement and orgasm in a woman, the upper end of the vagina enlarges and the uterus elevates. After orgasm, these organs return to their normal states, and the cervix descends into the pool of semen. t/f

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Students may engage in or endorse casual, commitment-free sexual encounters for various reasons, including a belief that hooking up is harmless because it requires no emotional commitment, will enhance their status in a peer group, allows them to assert control over their sexuality, or reflects sexual freedom. t/f

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The "low-risk" types of HPV may trigger changes in cervical cells that cause Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps, sometimes shaped like cauliflower, that appear in the genital area. t/f

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The CDC currently recommends using two doses—instead of the previous three—for those who start the HPV vaccine series between ages 9 and 14. Older patients (ages 15 through 26 for women, and 15 through 21 for men) and immunocompromised patients should still receive three doses—the second dose 1 to 2 months after the first and the third dose 6 months after the first. t/f

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The CDC has endorsed "expedited partner therapy" (giving medications to the infected person to give to partners) for cases of gonorrhea, chlamydia, and trichomoniasis. This approach is permissible or potentially allowable in most states, but prohibited in Arkansas, Florida, Kentucky, Michigan, Ohio, Oklahoma, South Carolina, Vermont, and West Virginia. t/f

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The Centers for Disease Control and Prevention (CDC) defines abstinence as "refraining from sexual activities which involve vaginal, anal, and oral intercourse." The definition of abstinence remains a subject of debate and controversy, with some emphasizing positive choices and others avoidance of specific behaviors. In reality, abstinence means different things to different people, cultures, and religious groups. t/f

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The average American adult reports having sex about once a week. However, one in five Americans has been celibate for at least a year, and 1 in 20 engages in sex at least every other day. Men report more sexual frequency than women—probably because more older women are widowed or do not have healthy partners. t/f

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The circumstances of losing one's virginity also have psychological effects. According to research, women who did not lose their virginity with a steady dating or committed partner have greater feelings of guilt and remain less comfortable with their sexuality and less sexually satisfied. Men generally have higher levels of physical and emotional satisfaction with their initial sexual experience and less anxiety and negativity than do women. t/f

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The concept of sexual normalcy differs greatly in different times, cultures, or racial and ethnic groups. In certain times and places, only sex between a husband and wife has been deemed normal. In other circumstances, "normal" has been applied to any sexual behavior—alone or with others—that does not harm others or produce great anxiety and guilt. The following are some of the most common contemporary sexual concerns. t/f

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The context of sexual activity can affect sexual enjoyment in both sexes. In a recent study, young adults who saw themselves in more committed relationships reported enjoying their "partnered sex acts" more, on average, than those in less committed relationships. However, there was no consistent association between sexual enjoyment and formal relationship status. The reasons may be that people who feel a commitment experience fewer inhibitions and less anxiety, are more motivated to invest time and energy in learning to please each other sexually, and communicate more successfully, ultimately providing each other with greater sexual satisfaction. t/f

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The decision to go through a gender transition is usually made after months or years of weighing the risks, benefits, and impact on loved ones. The complex process remains controversial but can lead to greater emotional well-being and healthier post-operative functioning. t/f

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The explosive growth of the Internet has made pornography more available, affordable, and accessible almost anywhere on computers and mobile devices. Although, as researchers put it, "the effects of pornography are probably not uniformly negative," t/f

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The formal terms for oral sex are cunnilingus, which refers to oral stimulation of the woman's genitals, and fellatio, oral stimulation of the man's genitals. For many couples, oral sex is a regular part of their lovemaking. For others, it's an occasional experiment. Oral sex with a partner infected with herpes, HIV, or other pathogens can transmit an STI, so a condom should be used (with cunnilingus, a dental dam can be used). t/f

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The key to a healthy, happy sexual relationship is open, honest communication—even when you and your partner have different points of view. All individuals also have sexual rights, which include the right to the information, education, skills, support, and services they need to make responsible decisions about their sexuality, consistent with their own values, as well as the right to express their sexual orientation without violence or discrimination. t/f

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The medical name for menstrual cramps is dysmenorrhea, which may involve abdominal cramps and pain, back and leg pain, diarrhea, tension, water retention, fatigue, and depression during menstruation. About half of all menstruating women suffer from dysmenorrhea. The cause seems to be overproduction of bodily substances called prostaglandins, which typically rise during menstruation. Medications that inhibit prostaglandins can reduce menstrual pain, and exercise can also relieve cramps. t/f

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The mind is the most powerful sex organ in the body, and erotic mental images can be sexually stimulating. Sexual fantasies can accompany sexual activity or be pleasurable in themselves. t/f

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The most widespread sexually transmitted bacterium in the United States is Chlamydia trachomatis, which causes more than a million cases of chlamydia each year, a number that continues to rise. Almost half of reported cases occur among sexually active young adults between ages 15 and 24. The use of condoms with spermicide can reduce, but not eliminate, the risk of chlamydial infection. t/f

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The penis contains three hollow cylinders loosely covered with skin. The two major cylinders, the corpora cavernosa, extend side by side through the length of the penis. The third cylinder, the corpus spongiosum, surrounds the urethra, the channel for both seminal fluid and urine t/f

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The prostate gland produces some of the seminal fluid, which it secretes into the urethra during ejaculation. The Cowper's glands are two pea-sized structures on either side of the urethra (just below where it emerges from the prostate gland) and are connected to it via tiny ducts. When a man is sexually aroused, the Cowper's glands often secrete a fluid that appears as a droplet at the tip of the penis. This fluid is not semen, although it occasionally contains sperm. t/f

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The sexual health of college students, particularly those in the period termed "emerging adulthood" (ages 18-25), is at greater risk than that of the rest of the population. Less likely to use condoms or practice birth control, young adults in this age group face a greater likelihood of STIs and, if heterosexual, unwanted pregnancy. Older students also engage in a range of sexual experiences, depending on their gender identity, sexual orientation, and relationship status, but are more likely to protect against pregnancy and sexually transmitted infections. t/f?

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The students who received fewer procreational sex messages from parents and more recreational sex messages from friends reported higher levels of sexual exploration and assertiveness. t/f

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The term nongonococcal urethritis (NGU) refers to any inflammation of the urethra that is not caused by gonorrhea. NGU is the most common STI in men, accounting for 4 to 6 million visits to a physician every year. Three microorganisms—Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma genitalium—are the primary causes; the usual means of transmission is sexual intercourse. Other infectious agents, such as fungi or bacteria, allergic reactions to vaginal secretions, or irritation by soaps or contraceptive foams or gels may also lead to NGU. t/f

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The vast majority of people identify as cisgender, which means that their biological sex and gender identity match—for example, someone born with male genes and sex organs identifies as a man. Transgender individuals have a gender identity that does not match their assigned sex—for example, a birth-assigned female identifies as a male. t/f

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The virus that causes herpes never entirely goes away; it retreats to nerves near the lower spinal cord, where it remains for the life of the host. Herpes sores can return without warning weeks, months, or even years after their first occurrence, often during menstruation or times of stress, or with sudden changes in body temperature. Of those who experience HSV recurrence, 10 to 35 percent do so frequently—that is, about six or more times a year. In most people, attacks diminish in frequency and severity over time. t/f

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The visible parts of the male sexual anatomy are the penis and the scrotum, the pouch that contains the testes (Figure 8.3a). The testes manufacture testosterone, the hormone that stimulates the development of a male's secondary sex characteristics, and sperm, the male reproductive cells. Immature sperm are stored in the epididymis, a collection of coiled tubes adjacent to each testis. t/f

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The way we think and talk about gender continues to evolve beyond the binary (limited to two options) view of individuals as either male or female. Unlike biological sex, which is assigned at birth based on genes, anatomy, and reproductive organs, gender identity, an individual's internal sense of being male, female, both, or neither, is a product of both innate and external influences and can shift over time. t/f

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These antiviral medications are prescribed for initial and recurrent episodes of herpes. In episodic therapy, a person begins taking medication at the first sign of recurrence and continues for several days to hasten healing or prevent a full outbreak from occurring. In suppressive therapy, people with genital herpes take antiviral medication daily to prevent symptoms. For individuals who have frequent recurrences (six or more per year), suppressive therapy can reduce the number of outbreaks by at least 75 percent. Suppressive therapy may also reduce asymptomatic shedding of HSV. They may be less effective for a first episode of genital herpes. t/f

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This rare, potentially deadly bacterial infection primarily strikes menstruating women under age 30 who use tampons. Both Staphylococcus aureus and group A Streptococcus pyogenes can produce toxic shock syndrome (TSS). Symptoms include a high fever; a rash that leads to peeling of the skin on the fingers, toes, palms, and soles; dizziness; dangerously low blood pressure; and abnormalities in several organ systems (the digestive tract and the kidneys) and in the muscles and blood. Treatment usually consists of antibiotics and intense supportive care; intravenous administration of immunoglobulins that attack the toxins produced by these bacteria may also be beneficial. t/f

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This widely used term has different meanings to different people. In an online survey of more than 500 men and women, 97 percent defined "having sex" as "penile—vaginal intercourse." Far fewer use these words to indicate manual stimulation of genitals, oral sex, or anal sex. t/f

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Three FDA-approved vaccines—Gardasil, Gardasil 9, and Cervarix—are effective in preventing cervical cancer caused by the two types of high-risk HPVs that cause about 70 percent of cervical cancers. In addition, Gardasil 9 adds protection against five additional HPV types, which cause approximately 20 percent of cervical cancers and are not covered by previously FDA-approved HPV vaccines. The FDA has approved Gardasil and Gardasil 9 for use in females ages 9 to 26 to protect against cervical cancer and prevent genital warts, and for males ages 9 to 26 to prevent genital warts. Cervarix, which does not protect against genital warts, is approved for females ages 10 to 26 to help prevent cervical cancer. Cervarix has not been approved for use in boys or men. t/f

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Throughout adulthood, masturbation is often the primary sexual activity of individuals not involved in a sexual relationship and can be particularly useful when illness, absence, divorce, or death deprives a person of a partner. In a University of Chicago survey, about 25 percent of men and 9 percent of women said they masturbate at least once a week. t/f

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To be considered amenorrheic, a woman's menstrual cycle is typically absent for 3 or more consecutive months. Prolonged amenorrhea can have serious health consequences, including a loss of bone density that may lead to stress fractures or osteoporosis. Scientists have developed chemical mimics, or analogues, of GnRH—usually administered by nasal spray—that trigger ovulation in women who don't ovulate or menstruate normally. t/f

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Touching is a silent form of communication between friends and lovers. Although a touch to any part of the body can be thrilling, some areas, such as the breasts and genitals, are especially sensitive. Stimulating these erogenous regions can lead to orgasm in both men and women. Though such forms of stimulation often accompany intercourse, more couples are gaining an appreciation of these activities as primary sources of sexual fulfillment—and as safer alternatives to intercourse. t/f

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Transgender and gender-nonconforming individuals face varied health risks. They are more likely to use drugs and alcohol, smoke, be diagnosed with HIV or other sexually transmitted infections, experience depression, or attempt suicide. Recent research suggests that early recognition may lessen these risks. However, violence—including harassment, rape, sexual abuse, physical abuse, and suicide—remains a major threat. t/f

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Two bacteria—Gonococcus (the culprit in gonorrhea) and Chlamydia—are responsible for one-half to one-third of all cases of PID. Other organisms are responsible for the remaining cases. Several studies have shown that women with PID are more likely to have used douches than those without the disease. Consistent condom use may decrease PID risk. t/f

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Vaginal intercourse or coitus, refers to the penetration of the vagina by the penis (Figure 8.4). This is the preferred form of sexual intimacy for most heterosexual couples, who may use a wide variety of positions. The most familiar position for intercourse in our society is the so-called missionary position, with the man on top, facing the woman. An alternative is the woman on top, either lying down or sitting upright. Other positions include lying side by side (either face-to-face or with the man behind the woman, his penis entering her vagina from the rear); lying with the man on top of the woman in a rear-entry position; and kneeling or standing (again, in either a face-to-face or rear-entry position). Many couples move into several different positions for intercourse during a single episode of lovemaking; others may have a personal favorite or may choose different positions at different times. t/f

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Vaginal intercourse, like other forms of sexual activity involving an exchange of body fluids, carries a risk of STIs, including HIV infection. In many other parts of the world, heterosexual intercourse is the most common means of HIV transmission. t/f

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Various factors influence an individual's willingness to disclose an STI to a prospective sexual partner, including age, masculinity-related values, interpersonal violence, partner cell phone monitoring, alcohol and/or drug use, condom use, number and characteristics of sexual partners, and previous STIs. Among college-age men, type of sex partner and masculinity-related values are key determinants in predicting whether an individual is willing to reveal having an STI. t/f

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Various pleasurable behaviors can lead to orgasm with little risk of pregnancy or STI. The options for "outercourse" include kissing, hugging, and touching but do not involve genital-to-genital, mouth-to-genital, or insertive anal sexual contact. t/f

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Various treatments—compresses made with cold water, skim milk, or warm salt water; ice packs; or a mild anesthetic cream—can relieve discomfort. Herpes sufferers should avoid heat, hot baths, and nylon underwear. Some physicians have used laser therapy to vaporize the lesions. Clinical trials of an experimental vaccine to protect people from herpes infections are underway. t/f

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What have you done to protect yourself from STIs? Have you been vaccinated against HPV? Have you been tested for HIV? The incidence of diagnosed STIs on campuses is low, but many individuals are not aware that they have these infections. Write down your feelings about how getting an STI might affect your health and your life in your online journal. t/f

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When herpes sores are present, the infected person is highly contagious and should avoid bringing the lesions into contact with someone else's body through touching, sexual interaction, or kissing. However, the herpes virus is present in genital secretions even when patients do not notice any signs of the disease, and people infected with genital herpes can spread it even between flare-ups, when they have no symptoms. t/f

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Whether couples are on a first date or have been married for years, each partner always has the right not to have sex. Sometimes partners have differing intentions and can make incorrect assumptions that the other is willing to engage in sexual acts. t/f

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White men and women have a higher incidence of masturbation than African American men and women. Latina women have the lowest rate of masturbation, compared with Latino men, white men and women, and African American men and women. Individuals with a higher level of education are more likely to masturbate than those with less schooling, and people living with sexual partners masturbate more than those who live alone. t/f

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Women also see physically attractive men as more desirable short-term sexual partners than those who look less appealing. Some say they would be willing to have sex with a physically attractive man, even if he seemed more likely to have an STI and if the sexual encounter would be unprotected. The reasons, researchers theorize, may be that sexual arousal lowers inhibitions and impairs decision making or that "sociosexuality"—the willingness to engage in casual sexual encounters—decreases perception of risk. t/f

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Women may stop menstruating—a condition called amenorrhea—for a variety of reasons, including a hormonal disorder, drastic weight loss, strenuous exercise, or change in the environment. "Boarding-school amenorrhea" is common among young women who leave home for school. Distance running and strenuous exercise can also lead to amenorrhea. The reason may be a drop in body fat from the normal range of 18 to 22 percent to a range of 9 to 12 percent. t/f

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Women with PMDD cannot function as usual at work, school, or home. They feel better a few days after menstruation begins. Certain birth control pills can help by stopping ovulation and stabilizing hormone fluctuations. SSRIs, which are often used to treat PMS, are also effective in relieving symptoms of PMDD. Some women may benefit from exercise, relaxation, or cognitive-behavioral therapy. t/f

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Women with premenstrual syndrome (PMS) experience bodily discomfort and emotional distress for up to 2 weeks, from ovulation until the onset of menstruation. As many as 95 percent of menstruating women report one or more premenstrual symptoms; fewer than 10 percent experience disabling, incapacitating symptoms. t/f

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Women's attitudes toward menstruation may reflect how positively or negatively they view their own body in general. t/f

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Young women who engage in sexual intercourse at an early age are more likely than those with later sexual debuts to become infected with HPV. Their risk also increases if they are black, have multiple sexual partners or a history of an STI, use drugs, or have partners with multiple sexual partners. College-age women are among those at greatest risk of acquiring HPV infection. In various studies conducted in college health centers, 10 to 46 percent of female students (mean age, 20 to 22) had positive HPV tests. t/f

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