Biology of human sexuality valencia

THINGS YOU LEARNED IN A HUMAN SEXUALITY COURSE

Human Sexuality

Human Human

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Human Sexuality

HumanHu DIVERSITY IN CONTEMPORARY AMERICA

William L. Yarber INDIANA UNIVERSITY

Barbara W. Sayad CALIFORNIA STATE UNIVERSITY, MONTEREY BAY

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HUMAN SEXUALITY: DIVERSITY IN CONTEMPORARY AMERICA, EIGHTH EDITION

Published by McGraw-Hill, a business unit of Th e McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY, 10020. Copyright © 2013 by Th e McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Previous editions © 2010, 2008, 2005, 2002, 1999, 1997, and 1996. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of Th e McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

Th is book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 0 DOW/DOW 1 0 9 8 7 6 5 4 3 2

ISBN 978-0-07-803531-9 MHID 0-07-803531-7

TM

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Library of Congress Cataloging-in-Publication Data Yarber, William L. (William Lee), 1943- Human sexuality : diversity in contemporary America / William L. Yarber, Barbara W. Sayad, Bryan Strong.—8th ed. p. cm. ISBN 978-0-07-803531-9 (alk. paper)—ISBN 0-07-803531-7 (alk. paper) 1. Sex. 2. Sex customs. 3. Sexual health. I. Sayad, Barbara Werner. II. Strong, Bryan. III. Title.

HQ21.S8126 2013 306.7—dc23 2012027980

Th e Internet addresses listed in the text were accurate at the time of publication. Th e inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill, and McGraw-Hill does not guarantee the accuracy of the information presented at these sites.

www.mhhe.com

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www.mhhe.com
This book is dedicated with admiration to Herman B Wells,

president of Indiana University when Dr. Alfred Kinsey

conducted and published his research on the sexual

behavior of Americans. Wells was a courageous and

unwavering defender of Kinsey's research, despite pressure

on Wells to end Kinsey's studies. Wells’s support of Kinsey’s

research 60 years ago is considered a landmark and

defi ning victory for academic freedom, which paved the way

for future research on human sexuality at other universities.

—W. L. Y.

To my family—with all my love and gratitude.

—B. W. S

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entsBrief Contee tse Co te

1 Perspectives on Human Sexuality 1

2 Studying Human Sexuality 29

3 Female Sexual Anatomy, Physiology, and Response 68

4 Male Sexual Anatomy, Physiology, and Response 105

5 Gender and Gender Roles 125

6 Sexuality in Childhood and Adolescence 158

7 Sexuality in Adulthood 187

8 Love and Communication in Intimate Relationships 218

9 Sexual Expression 256

10 Variations in Sexual Behavior 298

11 Contraception, Birth Control, and Abortion 325

12 Conception, Pregnancy, and Childbirth 361

13 The Sexual Body in Health and Illness 396

14 Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy 437

15 Sexually Transmitted Infections 481

16 HIV and AIDS 518

17 Sexual Coercion: Harassment, Aggression, and Abuse 557

18 Sexually Explicit Materials, Prostitution, and Sex Laws 596

vii

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viii

1 Perspectives on Human Sexuality 1

STUDYING HUMAN SEXUALITY 2 ■ Practically Speaking ASSESSING SEXUAL SATISFACTION 4

SEXUALITY, POPULAR CULTURE, AND THE MEDIA 5 Media Portrayals of Sexuality 5 Television 8 Feature-Length Films 9 Gay Men, Lesbian Women, Bisexual and Transgender People in Film and

Television 10 Online Social Networks 11

■ Think About It BEFORE PRESSING “SEND”: TRENDS AND CONCERNS ABOUT TEXTING, SEXTING, AND DATING 12

SEXUALITY ACROSS CULTURES AND TIMES 14 Sexual Interests 14 Sexual Orientation 17 Gender 18

SOCIETAL NORMS AND SEXUALITY 19 ■ Think About It AM I NORMAL? 20

Natural Sexual Behavior 20 Normal Sexual Behavior 21

■ Think About It DECLARATION OF SEXUAL RIGHTS 23 Sexuality Behavior and Variations 24

■ Think About It “MY GENES MADE ME DO IT”: SOCIOBIOLOGY, EVOLUTIONARY PSYCHOLOGY, AND THE MYSTERIES OF LOVE 25

FINAL THOUGHTS 26 | SUMMARY 26 QUESTIONS FOR DISCUSSION 27 | SEX AND THE INTERNET 27 SUGGESTED WEBSITES 28 | SUGGESTED READING 28

ContentsContents VISUAL PREFACE xxvi | LETTER FROM THE AUTHORS xxxv

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Contents • ix

2 Studying Human Sexuality 29 SEX, ADVICE COLUMNISTS, AND POP PSYCHOLOGY 30 Information and Advice as Entertainment 31

■ Practically Speaking EVALUATING POP PSYCHOLOGY 32 The Use and Abuse of Research Findings 32

THINKING CRITICALLY ABOUT SEXUALITY 33 Value Judgments Versus Objectivity 34 Opinions, Biases, and Stereotypes 34 Common Fallacies: Egocentric and Ethnocentric Thinking 35

SEX RESEARCH METHODS 36 Research Concerns 37 Clinical Research 38 Survey Research 39

■ Practically Speaking ANSWERING A SEX RESEARCH QUESTIONNAIRE: MEASURE OF SEXUAL IDENTITY EXPLORATION AND COMMITMENT 40

Observational Research 42 Experimental Research 42

THE SEX RESEARCHERS 44 Richard von Kraff t-Ebing 44 Sigmund Freud 45 Havelock Ellis 46 Alfred Kinsey 46 William Masters and Virginia Johnson 48

CONTEMPORARY RESEARCH STUDIES 49 ■ Think About It SEX RESEARCH: A BENEFIT TO INDIVIDUALS

AND SOCIETY OR A THREAT TO MORALITY? 50

The National Health and Social Life Survey 50 The National Survey of Family Growth 52 The Youth Risk Behavior Survey 53 The National College Health Assessment 53 The National Survey of Sexual Health and Behavior 54

EMERGING RESEARCH PERSPECTIVES 55 Feminist Scholarship 56 Gay, Lesbian, Bisexual, and Transgender Research 57 Directions for Future Research 59

ETHNICITY AND SEXUALITY 59 African Americans 59 Latinos 61 Asian Americans and Pacifi c Islanders 62 Middle Eastern Americans 64

FINAL THOUGHTS 64 | SUMMARY 65 QUESTIONS FOR DISCUSSION 66 | SEX AND THE INTERNET 66 SUGGESTED WEBSITES 67 | SUGGESTED READING 67

6

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3 Female Sexual Anatomy, Physiology, and Response 68

FEMALE SEX ORGANS: WHAT ARE THEY FOR? 69 External Structures (the Vulva) 71 Internal Structures 73

■ Practically Speaking PERFORMING A GYNECOLOGICAL SELFEXAMINATION 75 Other Structures 78 The Breasts 78

FEMALE SEXUAL PHYSIOLOGY 81 Reproductive Hormones 81 The Ovarian Cycle 81 The Menstrual Cycle 84

■ Practically Speaking VAGINAL AND MENSTRUAL HEALTH CARE 89 FEMALE SEXUAL RESPONSE 90 Sexual Response Models 90

■ Think About It SEXUAL FLUIDITY: WOMEN’S VARIABLE SEXUAL ATTRACTIONS 91 Desire: Mind or Matter? 95

■ Think About It THE ROLE OF ORGASM 98 Experiencing Sexual Arousal 98

FINAL THOUGHTS 101 | SUMMARY 101 QUESTIONS FOR DISCUSSION 103 | SEX AND THE INTERNET 103 SUGGESTED WEBSITES 103 | SUGGESTED READING 104

4 Male Sexual Anatomy, Physiology, and Response 105

MALE SEX ORGANS: WHAT ARE THEY FOR? 106 External Structures 106

■ Think About It THE PENIS: MORE THAN MEETS THE EYE 108 Internal Structures 110 The Breasts and Anus 112

MALE SEXUAL PHYSIOLOGY 113 Sex Hormones 114

■ Practically Speaking SEXUAL HEALTH CARE: WHAT DO MEN NEED? 115 Spermatogenesis 116

■ Practically Speaking MALE BODY IMAGE SELFCONSCIOUSNESS SCALE 118 Semen Production 118 Homologous Organs 119

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Contents • xi

MALE SEXUAL RESPONSE 119 Erection 120 Ejaculation and Orgasm 120

■ Practically Speaking CAN AN ERECTION BE WILLED? 122 FINAL THOUGHTS 123 | SUMMARY 123

QUESTIONS FOR DISCUSSION 124 | SEX AND THE INTERNET 124

SUGGESTED WEBSITES 124 | SUGGESTED READING 124

5 Gender and Gender Roles 125 STUDYING GENDER AND GENDER ROLES 127 Sex, Gender, and Gender Roles: What’s the Diff erence? 127 Sex and Gender Identity 128 Masculinity and Femininity: Opposites or Similar? 130 Gender and Sexual Orientation 131

GENDERROLE LEARNING 131 Theories of Socialization 131 Gender-Role Learning in Childhood and Adolescence 133 Gender Schemas: Exaggerating Diff erences 136

CONTEMPORARY GENDER ROLES AND SCRIPTS 137 Traditional Gender Roles and Scripts 137

■ Think About It THE PURITY STANDARD: DEFINING WOMEN BY THEIR SEXUALITY 140

Changing Gender Roles and Scripts 141 Androgyny 142

GENDER VARIATIONS 143 The Transgender Phenomenon 144 Disorders of Sexual Development/Intersex 144

■ Think About It A NEW APPROACH TO ADDRESSING DISORDERS OF SEXUAL DEVELOPMENT OR INTERSEX 147

Unclassifi ed Form of Abnormal Development 151 Gender Identity Disorder 151 Transsexuality 152 Coming to Terms With Diff erences 153

■ Think About It SEX REASSIGNMENT 154 FINAL THOUGHTS 155 | SUMMARY 155

QUESTIONS FOR DISCUSSION 156

SEX AND THE INTERNET 156

SUGGESTED WEBSITES 157 | SUGGESTED READING 157

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xii • Contents

6 Sexuality in Childhood and Adolescence 158

SEXUALITY IN INFANCY AND CHILDHOOD AGES 0 TO 11 159 Infancy and Sexual Response (Ages 0 to 2) 160 Childhood Sexuality (Ages 3 to 11) 160 The Family Context 163

SEXUALITY IN ADOLESCENCE AGES 12 TO 19 164 Psychosexual Development 164 Adolescent Sexual Behavior 172

■ Think About It THE “ORIGINS” OF HOMOSEXUALITY 175 ■ Practically Speaking FIRST SEXUAL INTERCOURSE REACTION SCALE 177

Teenage Pregnancy 178 Sexuality Education 181

■ Think About It ABSTINENCEONLY VERSUS COMPREHENSIVE SEXUALITY PROGRAMS: IT’S A NEW DAY 182

FINAL THOUGHTS 184 | SUMMARY 184

QUESTIONS FOR DISCUSSION 185 | SEX AND THE INTERNET 185

SUGGESTED WEBSITES 185 | SUGGESTED READING 186

7 Sexuality in Adulthood 187 SEXUALITY IN EARLY ADULTHOOD 188 Developmental Concerns 188

■ Think About It LIFE BEHAVIORS OF A SEXUALLY HEALTHY ADULT 190 Establishing Sexual Orientation 191

■ Think About It BISEXUALITY: THE NATURE OF DUAL ATTRACTION 194 Being Single 196

■ Think About It WHY COLLEGE STUDENTS HAVE SEX: GENDER DIFFERENCES, OR NOT? 199

Cohabitation 201

SEXUALITY IN MIDDLE ADULTHOOD 203 Developmental Concerns 203 Sexuality in Established Relationships 204 Divorce and After 205

SEXUALITY IN LATE ADULTHOOD 208 Developmental Concerns 208 Stereotypes of Aging 208 Sexuality and Aging 209

FINAL THOUGHTS 215 | SUMMARY 216

QUESTIONS FOR DISCUSSION 216 | SEX AND THE INTERNET 216

SUGGESTED WEBSITES 217 | SUGGESTED READING 217

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Contents • xiii

8 Love and Communication in Intimate Relationships 218

FRIENDSHIP AND LOVE 220

LOVE AND SEXUALITY 221 Men, Women, Sex, and Love 223 Love Without Sex: Celibacy and Asexuality 224

■ Think About It ARE GAY/LESBIAN COUPLES AND FAMILIES ANY DIFFERENT FROM HETEROSEXUAL ONES? 225

HOW DO I LOVE THEE? APPROACHES AND ATTITUDES RELATED TO LOVE 225

Styles of Love 226 The Triangular Theory of Love 227 Love as Attachment 230

■ Think About It THE SCIENCE OF LOVE 232 Unrequited Love 233

JEALOUSY 233 Defi ning Jealousy 234

■ Think About It THE PASSIONATE LOVE SCALE 235 Managing Jealousy 236 Extradyadic Involvement 236

MAKING LOVE LAST: FROM PASSION TO INTIMACY 238

THE NATURE OF COMMUNICATION 239 The Cultural Context 239 The Social Context 240 The Psychological Context 241 Nonverbal Communication 241

SEXUAL COMMUNICATION 243 Sexual Communication in Beginning Relationships 243 Sexual Communication in Established Relationships 246 Initiating Sexual Activity 246

DEVELOPING COMMUNICATION SKILLS 247 Talking About Sex 247

■ Practically Speaking COMMUNICATION PATTERNS AND PARTNER SATISFACTION 248

CONFLICT AND INTIMACY 250 ■ Practically Speaking LESSONS FROM THE LOVE LAB 251

Sexual Confl icts 251 Confl ict Resolution 252

FINAL THOUGHTS 252 | SUMMARY 252

QUESTIONS FOR DISCUSSION 254 | SEX AND THE INTERNET 254

SUGGESTED WEBSITES 254 | SUGGESTED READING 255

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xiv • Contents

9 Sexual Expression 256 SEXUAL ATTRACTIVENESS 258 A Cross-Cultural Analysis 258 Evolutionary Mating Perspectives 260

■ Think About It “HOOKING UP” AMONG COLLEGE STUDENTS 262 Views of College Students 263 Sexual Desire 266

SEXUAL SCRIPTS 266 Cultural Scripting 267 Intrapersonal Scripting 267 Interpersonal Scripting 267

AUTOEROTICISM 268 Sexual Fantasies and Dreams 269 Masturbation 271

■ Practically Speaking ASSESSING YOUR ATTITUDE TOWARD MASTURBATION 274 SEXUAL BEHAVIOR WITH OTHERS 278 Most Recent Partnered Sex 278 Couple Sexual Styles 279

■ Think About It YOU WOULD SAY YOU “HAD SEX” IF YOU . . . 280 Touching 282 Kissing 284 Oral-Genital Sex 284

■ Think About It GIVING AND RECEIVING PLEASURABLE TOUCH: “GEARS OF CONNECTION” 285

■ Think About It THE FIRST KISS: A DEALBREAKER? 286 Sexual Intercourse 289 Anal Eroticism 291 Health Benefi ts of Sexual Activity 294

FINAL THOUGHTS 295 | SUMMARY 295

QUESTIONS FOR DISCUSSION 296 | SEX AND THE INTERNET 296

SUGGESTED WEBSITES 296 | SUGGESTED READING 297

10 Variations in Sexual Behavior 298 SEXUAL VARIATIONS AND PARAPHILIC BEHAVIOR 299 What Are Sexual Variations? 299 What Is Paraphilia? 300

■ Think About It “SEXUAL INTEREST DISORDER”: A VIABLE ALTERNATIVE TO PARAPHILIA OR A RADICAL DEPARTURE? 302

Sexual Variations Among College Students 303

SEXUAL VARIATION: DOMINATION AND SUBMISSION 304

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Contents • xv

NONCOERCIVE PARAPHILIAS 306 Fetishism 306 Transvestism 308

■ Practically Speaking SEXUAL SENSATION SEEKING SCALE 309 COERCIVE PARAPHILIAS 310 Zoophilia 311 Voyeurism 311

■ Think About It WOULD YOU WATCH? COLLEGE STUDENTS AND VOYEURISM 312 Exhibitionism 313 Telephone Scatologia 315 Frotteurism 315

■ Think About It “SEXUAL ADDICTION”: REPRESSIVE MORALITY IN A NEW GUISE? 316 Necrophilia 316 Pedophilia 317 Sexual Sadism and Sexual Masochism 318

ORIGINS AND TREATMENT OF PARAPHILIAS 321

FINAL THOUGHTS 322 | SUMMARY 322

QUESTIONS FOR DISCUSSION 323 | SEX AND THE INTERNET 323

SUGGESTED WEBSITES 323 | SUGGESTED READING 323

11 Contraception, Birth Control, and Abortion 325

RISK AND RESPONSIBILITY 326 Women, Men, and Birth Control: Who Is Responsible? 327 Family Planning Clinics 328

■ Think About It RISKY BUSINESS: WHY COUPLES FAIL TO USE CONTRACEPTION 329

METHODS OF CONTRACEPTION AND BIRTH CONTROL 330

Birth Control and Contraception: What’s the Diff erence? 330

Choosing a Method 331 Sexual Abstinence 331 Hormonal Methods 333 Barrier Methods 338

■ Practically Speaking TIPS FOR EFFECTIVE CONDOM USE 340

■ Practically Speaking CORRECT CONDOM USE SELFEFFICACY SCALE 341

Spermicides 344 The IUCs (Intrauterine Contraceptives) 346 Fertility Awareness–Based Methods 347 Lactational Amenorrhea Method (LAM) 348 Sterilization 349 Emergency Contraception (EC) 351

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ABORTION 352 Methods of Abortion 352 Safety of Abortion 353 Women and Abortion 354 Men and Abortion 355 The Abortion Debate 355

RESEARCH ISSUES 357

FINAL THOUGHTS 357 | SUMMARY 358

QUESTIONS FOR DISCUSSION 359 | SEX AND THE INTERNET 359

SUGGESTED WEBSITES 359 | SUGGESTED READING 360

12 Conception, Pregnancy, and Childbirth 361

FERTILIZATION AND FETAL DEVELOPMENT 362 The Fertilization Process 362 Development of the Conceptus 364

■ Think About It A MATTER OF CHOICE 367 BEING PREGNANT 367 Preconception Care 368 Pregnancy Detection 368 Changes in Women During Pregnancy 369

■ Think About It SEXUAL BEHAVIOR DURING PREGNANCY 372 Complications of Pregnancy and Dangers to the Fetus 372 Diagnosing Fetal Abnormalities 377 Pregnancy Loss 378

INFERTILITY 379 Female Infertility 379 Male Infertility 380 Emotional Responses to Infertility 380 Infertility Treatment 380

GIVING BIRTH 384 Labor and Delivery 384 Choices in Childbirth 386

■ Think About It THE QUESTION OF MALE CIRCUMCISION 387 ■ Practically Speaking MAKING A BIRTH PLAN 388

Breastfeeding 390 ■ Practically Speaking BREAST VERSUS BOTTLE: WHICH IS BETTER

FOR YOU AND YOUR CHILD? 391

BECOMING A PARENT 392

FINAL THOUGHTS 393 | SUMMARY 393

QUESTIONS FOR DISCUSSION 394 | SEX AND THE INTERNET 395

SUGGESTED WEBSITES 395 | SUGGESTED READING 395

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Contents • xvii

13 The Sexual Body in Health and Illness 396

LIVING IN OUR BODIES: THE QUEST FOR PHYSICAL PERFECTION 398 Eating Disorders 398

■ Think About It “OH TO BE BIGGER”: BREAST AND PENIS ENHANCEMENT 399 Body Image and Its Impact on Sexuality 402 Anabolic Steroids: A Dangerous Means to an End 403

ALCOHOL, DRUGS, AND SEXUALITY 403 Alcohol Use and Sexuality 403 Other Drug Use and Sexuality 405

SEXUALITY AND DISABILITY 408 Physical Limitations and Changing Expectations 408 Vision and Hearing Impairment 410 Chronic Illness 410 Developmental Disabilities 412 The Sexual Rights of People With Disabilities 412

SEXUALITY AND CANCER 413 Women and Cancer 413

■ Practically Speaking BREAST SELFEXAMINATION 416 Men and Cancer 424

■ Practically Speaking TESTICULAR SELFEXAMINATION 427 ■ Think About It FEMALE GENITAL CUTTING: MUTILATION OR

IMPORTANT CUSTOM? 429

Anal Cancer in Men and Women 430

ADDITIONAL SEXUAL HEALTH ISSUES 430 Toxic Shock Syndrome 430 Vulvodynia 431 Endometriosis 431 Lesbian Women’s Health Issues 432 Prostatitis 432

FINAL THOUGHTS 433 | SUMMARY 433

QUESTIONS FOR DISCUSSION 435 | SEX AND THE INTERNET 435

SUGGESTED WEBSITES 435 | SUGGESTED READING 436

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xviii • Contents

14 Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy 437

SEXUAL FUNCTION DIFFICULTIES: DEFINITIONS, TYPES, AND PREVALENCE 439

Defi ning Sexual Function Diffi culties: Diff erent Perspectives 439 Prevalence and Cofactors 443 Disorders of Sexual Desire 446

■ Practically Speaking SEXUAL DESIRE: WHEN APPETITES DIFFER 448 Sexual Arousal Disorders 450

■ Think About It IS INTERCOURSE ENOUGH? THE BIG “O” AND SEXUAL BEHAVIORS 452 Orgasmic Disorders 452 Sexual Pain Disorders 455 Other Disorders 456

PHYSICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 457

Physical Causes in Men 457 Physical Causes in Women 457

PSYCHOLOGICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 458

Immediate Causes 458 Confl ict Within the Self 459 Relationship Causes 460

SEXUAL FUNCTION ENHANCEMENT 461 Developing Self-Awareness 461

■ Think About It “GOOD ENOUGH SEX”: THE WAY TO LIFETIME COUPLE SATISFACTION 462

■ Think About It SEXUAL TURNONS AND TURNOFFS: WHAT COLLEGE STUDENTS REPORT 463

Intensifying Erotic Pleasure 465 Changing a Sexual Relationship 466

TREATING SEXUAL FUNCTION DIFFICULTIES 467 Masters and Johnson: A Cognitive-Behavioral Approach 467 Kaplan: Psychosexual Therapy 471 Other Nonmedical Approaches 471 Medical Approaches 472

■ Think About It THE MEDICALIZATION OF SEXUAL FUNCTION PROBLEMS 475 Gay, Lesbian, and Bisexual Sex Therapy 475

■ Practically Speaking SEEKING PROFESSIONAL ASSISTANCE 477 FINAL THOUGHTS 477 | SUMMARY 478

QUESTIONS FOR DISCUSSION 479 | SEX AND THE INTERNET 480

SUGGESTED WEBSITES 480 | SUGGESTED READING 480

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Contents • xix

15 Sexually Transmitted Infections 481

THE STI EPIDEMIC 483 STIs: The Most Common Reportable Infectious Diseases 483 Who Is Aff ected: Disparities Among Groups 483 Factors Contributing to the Spread of STIs 486

■ Practically Speaking PREVENTING STIs: THE ROLE OF MALE CONDOMS AND FEMALE CONDOMS 489

■ Practically Speaking STI ATTITUDE SCALE 492 Consequences of STIs 493

PRINCIPAL BACTERIAL STIs 493 Chlamydia 493 Gonorrhea 497 Urinary Tract Infections 498 Syphilis 498

■ Think About It THE TUSKEGEE SYPHILIS STUDY: A TRAGEDY OF RACE AND MEDICINE 500

PRINCIPAL VIRAL STIs 500 HIV and AIDS 501 Genital Human Papillomavirus Infection 502 Genital Herpes 504 Viral Hepatitis 505

VAGINAL INFECTIONS 506 Bacterial Vaginosis 506 Genital Candidiasis 507 Trichomoniasis 508

OTHER STIs 508

ECTOPARASITIC INFESTATIONS 509 Scabies 509 Pubic Lice 509

STI AND WOMEN 510 Pelvic Infl ammatory Disease (PID) 510 Cervicitis 510 Cystitis 511

PREVENTING STIs 511 Avoiding STIs 511 Treating STIs 513

■ Practically Speaking SAFER AND UNSAFE SEX PRACTICES 514 FINAL THOUGHTS 515 | SUMMARY 515

QUESTIONS FOR DISCUSSION 516 | SEX AND THE INTERNET 517

SUGGESTED WEBSITES 517 | SUGGESTED READING 517

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xx • Contents

16 HIV and AIDS 518 WHAT IS AIDS? 520 Conditions Associated With AIDS 520

■ Think About It THE STIGMATIZATION OF HIV AND OTHER STIs 521 Symptoms of HIV Infection and AIDS 522 Understanding AIDS: The Immune System and HIV 522 The Virus 523 AIDS Pathogenesis: How the Disease Progresses 524

THE EPIDEMIOLOGY AND TRANSMISSION OF HIV 526 The Epidemiology of HIV/AIDS in the United States 527 Myths and Modes of Transmission 530 Sexual Transmission 531 Injection Drug Use 532 Mother-to-Child Transmission 532 Factors Contributing to Infection 533

AIDS DEMOGRAPHICS 533 Minority Races/Ethnicities and HIV 533 The Gay Community 536 Women and HIV/AIDS 538 Children and HIV/AIDS 539 HIV/AIDS Among Youth 540 Older Adults and HIV/AIDS 541 Geographic Region and HIV 541

■ Practically Speaking HIV PREVENTION ATTITUDE SCALE 542 PREVENTION AND TREATMENT 542

■ Practically Speaking HEALTH PROTECTIVE SEXUAL COMMUNICATION SCALE 543

Protecting Ourselves 543 Saving Lives Through Prevention 544

■ Think About It “DO YOU KNOW WHAT YOU ARE DOING?” COMMON CONDOMUSE MISTAKES AMONG COLLEGE STUDENTS 545

HIV Testing 548 Treatments 550

LIVING WITH HIV OR AIDS 552 If You Are HIV-Positive 553

FINAL THOUGHTS 554 | SUMMARY 554

QUESTIONS FOR DISCUSSION 555 | SEX AND THE INTERNET 556

SUGGESTED WEBSITES 556 | SUGGESTED READING 556

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Contents • xxi

17 Sexual Coercion: Harassment, Aggression, and Abuse 557

SEXUAL HARASSMENT 558 What Is Sexual Harassment? 559 Flirtation Versus Harassment 561 Harassment in School and College 562 Harassment in the Workplace 564

HARASSMENT AND DISCRIMINATION AGAINST GAY, LESBIAN, BISEXUAL, AND TRANSGENDER PEOPLE 565

Heterosexual Bias 565 Prejudice, Discrimination, and Violence 566

■ Think About It PUBLIC OPINION ABOUT GAY AND LESBIAN ISSUES AND RIGHTS 569

Ending Anti-Gay Prejudice and Enactment of Antidiscrimination Laws 570

SEXUAL AGGRESSION 572 The Nature and Incidence of Rape 572 Myths About Rape 573

■ Practically Speaking PREVENTING SEXUAL ASSAULT 574 Forms of Rape 576

■ Think About It DATE/ACQUAINTANCE RAPE DRUGS: AN INCREASING THREAT 578

Motivations for Rape 583 The Aftermath of Rape 584

■ Practically Speaking HELPING SOMEONE WHO HAS BEEN RAPED 585

CHILD SEXUAL ABUSE 586 Forms of Intrafamilial Sexual Abuse 587 Children at Risk 588 Eff ects of Child Sexual Abuse 588 Treatment Programs 591 Preventing Child Sexual Abuse 592

FINAL THOUGHTS 593 | SUMMARY 593

QUESTIONS FOR DISCUSSION 594 | SEX AND THE INTERNET 594

SUGGESTED WEBSITES 595 | SUGGESTED READING 595

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xxii • Contents

18 Sexually Explicit Materials, Prostitution, and Sex Laws 596

SEXUALLY EXPLICIT MATERIAL IN CONTEMPORARY AMERICA 597 Pornography or Erotica: Which Is It? 598 Sexually Explicit Material and Popular Culture 598 Sexually Explicit Materials on the Internet 599

■ Think About It COLLEGE STUDENTS AND THE VIEWING OF SEXUALLY EXPLICIT MATERIALS 602

The Eff ects of Sexually Explicit Material 602 Censorship, Sexually Explicit Material, and the Law 606

PROSTITUTION 610 Females Working in Prostitution 611

■ Think About It HUMAN TRAFFICKING: INTERNATIONAL CHILD AND TEEN PROSTITUTION 612

Males Working in Prostitution 617 Prostitution and the Law 618 The Impact of HIV/AIDS and Other STIs 619

SEXUALITY AND THE LAW 620 Legalizing Private, Consensual Sexual Behavior 620 Same-Sex Marriage 621

■ Think About It AN EXPANDING DEFINITION OF “FAMILY”: A TREND LEADING TO FURTHER LEGALIZATION OF SAMESEX MARRIAGE? 623

Advocating Sexual Rights 623

FINAL THOUGHTS 624 | SUMMARY 624

QUESTIONS FOR DISCUSSION 625 | SEX AND THE INTERNET 626

SUGGESTED WEBSITES 626 | SUGGESTED READING 626

GLOSSARY G1

BIBLIOGRAPHY B1

CREDITS C1

NAME INDEX NI1

SUBJECT INDEX SI1

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WILLIAM L. YARBER is a senior research fellow at Th e Kinsey Institute for Research in Sex, Gender, and Reproduction and the senior director of the Rural Center for AIDS/STD Prevention at Indiana University, Bloomington. He is also professor of applied health science and professor of gender studies at IU. Dr. Yarber, who received his doctorate from Indiana University, has authored or co-authored numerous scientifi c reports on sexual risk behavior and AIDS/STD prevention in professional journals and has received several federal and state grants to support his research and AIDS/ STD prevention eff orts. He is a member of the Th e Kinsey Institute Condom Use Research Team (CURT) comprised of researchers from Indiana University, University of Kentucky, University of Guelph (Canada), and University of Southampton (United Kingdom). For over a decade, with federal and institutional research support, CURT has investigated male condom use, particularly use errors and problems, and has devel- oped behavioral interventions designed to improve correct condom use. At the request of the U.S. government, Dr. Yarber authored the country’s fi rst secondary school AIDS prevention education curriculum, AIDS: What Young People Should Know (1987). He also co-edited the Handbook of Sexuality-Related Measures, Th ird Edition (2011). Dr. Yarber chaired the National Guidelines Task Force, which developed the Guidelines for Comprehensive Sexuality Education: Kindergarten–12th Grade (1991, 1996, 2004), pub- lished by the Sexuality Information and Education Council of the United States (SIECUS). Dr. Yarber is past president of Th e Society for the Scientifi c Study of Sexuality (SSSS) and a past chair of the SIECUS board of directors. His awards include the SSSS Distinguished Scientifi c Achievement Award, the Professional Stan- dard of Excellence from the American Association of Sex Educators, Counselors, and Th erapists, the Indiana University President’s Award for Distinguished Teaching, and the inaugural Graduate Student Outstanding Faculty Mentor Award at Indiana Uni- versity. Dr. Yarber has been a consultant to the World Health Organization Global Program on AIDS. He regularly teaches undergraduate and graduate courses in human sexuality. He was previously a faculty member at Purdue University and the University of Minnesota, as well as a public high school health science and biology teacher. Dr. Yarber is married and is the father of two adult daughters.

About the AuthorsAbout the Authors

William L. Yarber

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xxiv • About the Authors

BARBARA W. SAYAD is a faculty member at California State University, Monterey Bay, where she teaches human sexuality, women’s health, behavior change, service learning, and health promotion in multicultural populations. Dr. Sayad holds a Ph.D. in Health and Human Behavior, an M.P.H. in Community Health Education, and a B.S. in Foods and Nutrition. Along with co-authoring six editions of Human Sexuality: Diversity in Contemporary America (McGraw-Hill), she has also co-authored Th e Marriage and Family Experience (Wadsworth) and has contributed to a number of other health-related texts, curricular guides, and pub- lications. In addition to her 30 years of teaching and mentoring in the university setting, Dr. Sayad has facilitated a number of training programs, presented at professional organizations, and worked as a training and curriculum consultant in nonprofi t and proprietary organizations. Dr. Sayad is married and with her hus- band, Bob, has three adult children.

Barbara W. Sayad

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A Guided Tour Through the Eighth Editionthe Eighth Edition

Since the fi rst edition, Human Sexuality: Diversity in Contemporary America has presented students with a nonjudgmental view of human sexuality while encouraging them to become proactive about their own sexual well-being. Th is sex-positive approach, combined with an integrated exploration of cultural diversity and contemporary research, continues today. Th e new edition emphasizes the importance of affi rming and supporting intimacy, pleasuring, and mutual satisfaction in human sexuality. Th is empha- sis can be found throughout the book but particularly in Chapter 8, Love and Communication in Intimate Relationships and Chapter 9, Sexual Expression. In addition, students are encouraged to critically assess their own values and modes of sexual expression. For instance, Th ink About It boxes prompt students to evaluate their knowledge of and opinions about high-interest topics in sex- uality such as sexting or the expanding defi nition of family.

• Expanding Students’ Knowledge of Human Sexuality How many students think they know everything about human sexuality but struggle on the fi rst exam? LearnSmart, McGraw-Hill’s adaptive learning sys- tem, helps students identify what they know—and, more importantly, what

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they don’t know. Based on Bloom’s Taxonomy, LearnSmart creates a customized study plan, unique to every student’s demonstrated needs. With virtually no administrative overhead, instructors using LearnSmart are reporting an increase in student performance by one letter grade or more.

• Assessing Student Progress McGraw-Hill’s Connect Human Sexuality off ers a wealth of assignable and assessable course materials. Videos, interactivities, and self-assessments engage students in human sexuality course concepts. Detailed reporting helps the stu- dent and instructor gauge comprehension and retention—without adding admin- istrative load.

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xxviii

• Chapter-by-Chapter Changes Th e amount of research in gender and gender and queer studies is ever increasing, media continues to have a signifi cant impact on sexuality, and the approaches and language used to describe these areas are perpetually evolving. Th e eighth edition of Human Sexuality: Diversity in Contemporary America addresses these and many other important changes:

Chapter 1: Perspectives on Human Sexuality ■ Expanded and updated material on media portrayals of sexuality ■ New material on teens “coming out” ■ New research on social networking ■ Added discussion on the sexual revolution and its impact on sexual

expression

Chapter 2: Studying Human Sexuality ■ Findings of the latest CDC Youth Risk Behavior Survey ■ Results of the latest National Survey of Family Growth study on several

measures of sexual behavior, sexual attraction, and sexual identity of men and women aged 15–44 years

■ Th e most recent fi ndings of the American College Health Association research on college student sexual behavior

■ Findings of the National Survey of Sexual Health and Behavior, the most expansive nationally representative study since 1994

■ New Th ink About It box: “Sex Research: A Benefi t to Individuals and Society or Th reat to Morality?”

Chapter 3: Female Sexual Anatomy, Physiology, and Response ■ Expanded discussion on the science behind the G-spot ■ Added theory and discussion around the dual control model ■ Discussion of the circular model of sexual desire and response ■ New research on the brain “in love”

PrefacePreface

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Preface • xxix

■ New research on “faking orgasm” ■ New Th ink About It box: “Sexual Fluidity: Women’s Variable Sexual

Attractions”

Chapter 4: Male Sexual Anatomy, Physiology, and Response ■ Expanded discussion on the sexual health of men ■ New Practically Speaking box: “Male Body Image Self-Consciousness Scale” ■ Updated discussion on low testosterone

Chapter 5: Gender and Gender Roles ■ Updated research and discussion on disorders of sexual development ■ Added discussion on gender bias and violence on college campus ■ Added discussion on nonmedical options for the transgender person ■ New Th ink About It box: “Th e Purity Standard: Defi ning Women by

Th eir Sexuality”

Chapter 6: Sexuality in Childhood and Adolescence ■ New table on childhood sexual behaviors witnessed by parents ■ New research on “precocious puberty” ■ Introduction to the Report of the APA Task Force on the Sexualization

of Girls ■ New research on and discussion of what constitutes having “had sex” ■ New research on physiological and psychological satisfaction of fi rst

vaginal intercourse ■ New Th ink About It box: “Abstinence-Only Versus Comprehensive Sexuality

Programs: It’s a New Day” ■ New Practically Speaking box: “First Intercourse Reaction Scale”

Chapter 7: Sexuality in Adulthood ■ Expanded discussion on an integrated GLBT identity ■ Updated data on and trends in cohabitation ■ New discussion about online dating ■ Updates on menopause and hormone replacement therapy ■ New research on sexuality among older adults

Chapter 8: Love and Communication in Intimate Relationships ■ New research on keeping love alive ■ Added discussion on gender, sexual orientation, and relationship

satisfaction ■ New research on the role of oxytocin and relationship satisfaction ■ New self-assessment: “Dyadic Sexual Communication Scale”

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xxx • Preface

■ New Th ink About It box: “Are Gay/Lesbian Couples and Families Any Diff erent from Heterosexual Ones?”

■ New research on jealousy ■ Updated data and discussion on infi delity among marital and nonmarital

couples

Chapter 9: Sexual Expression ■ Expanded discussion on physical characteristics and scent as related to

sexual attractiveness ■ Updated Th ink About It box: “‘Hooking Up’ Among College Students” ■ New research on “mate poaching” ■ Findings of the prevalence of nine sexual behaviors and contextual factors

and men and women from the National Survey of Sexual Health and Behavior

■ New discussion of couple sexual styles ■ New Th ink About It box: “Giving and Receiving Pleasurable Touch:

‘Gears of Connection’” ■ New discussion on health benefi ts of sexual activity ■ New and lifelike positional art

Chapter 10: Variations in Sexual Behavior ■ New Practically Speaking box: “Sexual Sensation Seeking Scale” ■ Expanded discussion of domination and submission ■ New research on noncoercive paraphilias ■ Recent data concerning coercive paraphilias

Chapter 11: Contraception, Birth Control, and Abortion ■ New Practically Speaking box: “Correct Condom Use Self-Effi cacy

Scale” ■ New data on unintended pregnancies and outcomes ■ Latest research and updates on all birth control devices ■ Updated discussion of emergency contraception ■ New data on the prevalence and legal status of abortion ■ Updated research on and discussion of the role and impact of abortion

on males

Chapter 12: Conception, Pregnancy, and Childbirth ■ New discussion of pre-conception care ■ New research on the role of physical activity and obesity in pregnancy

outcomes ■ New research on Sudden Infant Death Syndrome (SIDS)

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Preface • xxxi

■ Update on policies and procedures for pregnancy, delivery, and new mothers and families

■ Updated Th ink About It box: “Th e Question of Male Circumcision”

Chapter 13: The Sexual Body in Health and Illness ■ Updates on male cosmetic surgery, including a critical look at penis

enhancement ■ New research on eating disorders among gay, lesbian, and transgender

individuals ■ New research on the sexual consequences of eating disorders ■ New research on and discussion of the role of binge drinking and sexual

risk-taking ■ Updated and expanded discussion about recreational drugs and sexual

behaviors ■ Updated discussion of “natural substances” and sexual performance ■ Updates and recommendations for men’s and women’s sexual health care,

including use of mammograms and prostate screening

Chapter 14: Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy ■ New research on the prevalence of sexual function diffi culties ■ New research on changes in sexual desire among men and women from

12 age groups and intercourse prevalence among long-term couples ■ New Th ink About It box: “Sexual Desire: When Sexual Appetites Diff er” ■ Expanded discussion of the role of varied sexual behaviors as related to

experiencing orgasm ■ Added Th ink About It box: “ ‘Good Enough Sex’: Th e Way to Lifetime

Couple Satisfaction” ■ New discussion of developing and maintaining sexual desire ■ Added discussion of ways to deal with discrepancies in sexual desire

among couples

Chapter 15: Sexually Transmitted Infections ■ Updated information on the prevalence and incidence of major STIs ■ Updated medical information on the major STIs ■ New discussion of concurrent sexual relationships as an STI risk ■ Expanded discussion of the factors contributing to the spread of STIs ■ New information on circumcision and STI prevention ■ Updated information on the HPV vaccination

Chapter 16: HIV and AIDS ■ Updated information on the prevalence and incidence of HIV/AIDS in

the United States and worldwide

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■ Updated biological information on HIV/AIDS ■ Expanded discussion of the disproportionate impact of HIV/AIDS on

African Americans, Latinos, and men who have sex with men ■ Updated information on antiretroviral therapy ■ New material on the success of HIV prevention eff orts

Chapter 17: Sexual Coercion: Harassment, Aggression, and Abuse ■ New material on stalking ■ Updated information on the prevalence and outcomes of sexual harassment,

aggression, rape, and child sexual abuse ■ Expanded discussion of the outcomes of anti-gay prejudice and discrimination ■ New public opinion polls on gay and lesbian rights ■ Expanded discussion of antidiscrimination laws

Chapter 18: Sexually Explicit Materials, Prostitution, and Sex Laws ■ New material on Internet sex site use by college students and other

populations ■ Expanded and new information on the eff ects of sexually explicit materials ■ Added Th ink About It box: “Human Traffi cking: International Child

and Teen Prostitution” ■ New material on the nature and outcomes of prostitution ■ Updated discussion of same-sex marriage ■ New Th ink About It box: “An Expanding Defi nition of ‘Family’? A Trend

Leading to Further Legalization of Same-Sex Marriage?” ■ Update on recent milestone rulings affi rming gay rights in the

United States

• Human Sexuality Teaching and Learning Resources Program Human Sexuality is the centerpiece of a complete resource program for both students and instructors. Th e following materials have been carefully developed by a team of experienced human sexuality instructors to support a variety of teaching and learning styles.

Online Learning Center for Instructors Th is password-protected website con- tains the Test Bank, Instructor’s Manual, PowerPoint presentations, and image gallery, as well as access to the entire student side of the website. To access these resources, please go to www.mhhe.com/yarber8e.

Instructor’s Manual prepared by ANSR, a leading academic supplements development company. Th is guide begins with general concepts and strategies for teaching human sexuality. Th e Instructor’s Manual contains a chapter

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Preface • xxxiii

outline, learning objectives, discussion questions, activities, a list of videos, a bibliography, worksheets, handouts, and internet activities for each chapter. Th e Instructor’s Manual can be accessed on the Online Learning Center.

Test Bank prepared by Tori Bovard, American River College. Th e Test Bank has been revised and updated by the author of the previous edition’s Test Bank. Updated and revised for the new edition, each chapter off ers over 100 ques- tions, including multiple choice and short answer questions. Th ese test items are available on the instructors’ Online Learning Center as Word fi les and in EZ Test, an easy-to-use electronic test bank that allows instructors to easily edit and add their own questions.

PowerPoint Presentations prepared by ANSR, a leading academic supplements development company. Available on the Online Learning Center, these presen- tations cover the key points of each chapter. Th ey can be used as-is or modifi ed to support an individual instructors’ lectures and style. Digital version of many images and fi gures are also available in the Image Gallery.

Online Learning Center for Students includes multiple choice, true/false, and fi ll-in the blank practice quizzes to help students prepare for exams. To access these resources, go to www.mhhe.com/yarber8e.

McGraw-Hill publishes Annual Editions: Human Sexuality, a collection of articles on topics related to the latest research and thinking in human sexuality from over 300 public press sources. Th ese editions are updated annually and contain helpful features, including a topic guide, an annotated table of con- tents, unit overviews, and a topical index. An instructor’s guide containing testing material is also available. ISBN: 0078051177.

For information on any component of the teaching and learning package, instructors should contact their McGraw-Hill representative.

• Acknowledgments Many people contributed to the creation and development of this book. First and foremost, we wish to thank the many students whose voices appear in the introductions of each chapter. The majority of these excepts come from Bobbi Mitzenmacher’s, Barbara Sayad’s, and William L. Yarber’s undergraduate human sexuality students (California State University, Long Beach and Monterey Bay, and Indiana University), who have courageously agreed to share their experi- ences. All of these students have given permission to use their experiences and quotations so that others might share and learn from their reflections. A number of reviewers and adopters were instrumental in directing the authors to needed changes, updates, and resources, and we are most grateful for their insights and contributions. Whenever possible, we have taken their suggestions and integrated them into the text. Special thanks are owed to the following reviewers of the sixth edition:

Michael W. Agopian, Los Angeles Harbor College Glenn Carter, Austin Peay State University Ellen Cole, Alaska Pacifi c University Sara L. Crawley, University of South Florida Linda De Villers, Pepperdine University

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xxxiv • Preface

Bety Dorr, Fort Lewis College Amanda Emo, University of Cincinnati Jean Hoth, Rochester Community and Technical College Mary Meiners, Miramar College William O’Donohue, University of Nevada Carlos Sandoval, Cypress College Mary Ann Watson, Metro State College at Denver Laurie M. Wagner, Kent State University

Th anks also to the reviewers of the seventh edition:

Stephanie Coday, Sierra College Jodi Martin deCamilo, St. Louis Community College, Meramec-Kirkwood Dale Doty, Monroe Community College Duane Dowd, Central Washington University, Ellensburg Edward Fliss, St. Louis Community College, Florissant Valley Richard Hardy, Indiana University at Bloomington Lynne M. Kemen, Hunter College Nancy King, Western Michigan University, Kalamazoo Kris Koehne, University of Tennessee, Knoxville Jennifer Musick, Long Beach City College Diane Pisacreta, St. Louis Community College, Meramec-Kirkwood Grace Pokorny, Long Beach City College Michael Rahilly, University of California at Davis Sally Raskoff , Los Angeles Valley College Daniel Rubin, Valencia Community College, West Campus Regine Rucker, University of Illinois, Champaign Catherine Sherwood-Puzzello, Indiana University at Bloomington Peggy Skinner, South Plains College

And most recently, thanks to the reviewers of the eighth edition:

Janell Campbell, California State University, Chico Susan Horton, Mesa Community College Eileen Johnston, Glendale Community College Amanda LeBlanc, University of South Florida Richard McWhorter, Prairie View A&M University Grace Pokorny, Long Beach City College Tina Timm, Michigan State University

Publishing a textbook is similar to producing a stage show in that even with a clear concept and great writing, there are individuals without whom the production (in this case, of the textbook) would not be possible. Our thanks go to Brand Managers Mark Georgiev and Nancy Welcher, and Directors Mike Sugarman and Krista Bettino, whose vision and energy helped guide the pub- lication of this book. Additional kudos and gratitude go to Barbara A. Heinssen, Director of Development, and Cheri Dellelo, Developmental Editor, who were intimately involved with all aspects of this publication. Production Editor Catherine Morris was a constant in assisting us in finding answers to questions and guiding us through the production process. A special thanks to Manuscript Editor Margaret Moore, Design Manager Matt Diamond, Photo Researchers Keri Johnson and Allison Grimes, and Sarah Colwell, Digital Development Editor. Our combined efforts have contributed to a book which we can all be proud of.