Human sexuality diversity in contemporary america 9th edition free pdf

HUMAN SEXUALITY Diversity in Contemporary America

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HUMAN SEXUALITY Diversity in Contemporary America

NINTH EDITION

William L. Yarber INDIANA UNIVERSITY

Barbara W. Sayad CALIFORNIA STATE UNIVERSITY, MONTEREY BAY

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HUMAN SEXUALITY: DIVERSITY IN CONTEMPORARY AMERICA, NINTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2016 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2013, 2010, and 2008. 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 McGraw-Hill Education, 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.

This book is printed on acid-free paper.

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Student Edition Instructor Review Edition ISBN 978-0-07-786194-0 978-1-259-68062-5 MHID 0-07-786194-9 1-259-68062-2

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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, Indiana University, Barbara W. Sayad, California State University, Monterey Bay.—Ninth edition. p. cm. Includes bibliographical references and index. ISBN 978-0-07-786194-0 (alk. paper) 1. Sex. 2. Sex customs. 3. Sexual health. I. Sayad, Barbara Werner. II. Title.

HQ21.S8126 2016 306.7—dc23

2015015172

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

mheducation.com/highered

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v

This book is dedicated to Ryan White, an Indiana native-son who died from AIDS on April 8, 1990.

During his illness Ryan experienced public scorn, harassment, and rejection, yet faced these difficulties with courage, dignity, and grace. He became the poster boy for the AIDS crisis, speaking out against the misconceptions about the disease and calling for persons with AIDS to be treated with compassion.

Ryan died at age 18, the spring before he planned to attend Indiana University (IU), Bloomington. To honor the legacy of Ryan, the Rural Center for AIDS/STD Prevention at IU established the Ryan White Distinguished Leadership Award for recognition of significant national/international leadership in HIV/AIDS prevention and the Ryan White Legacy Scholarship for IU Masters of Public Health students.

Sir Elton John said, “I have met a lot of people who were brave and courageous. . . . Ryan White gave a new meaning to these words. . . . He was a miracle of humanity.”

—W. L. Y.

Dedication

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vi Dedication

This book is dedicated to the students of human sexuality who quest for knowledge and understanding, to the instructors who diligently and compassionately support and inspire them, and to a system of governing that advocates for the sexual rights of all people.

I want my family to know that I cannot do this work without their love and support.

—B. W. S.

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1 Perspectives on Human Sexuality 1

2 Studying Human Sexuality 27

3 Female Sexual Anatomy, Physiology, and Response 65

4 Male Sexual Anatomy, Physiology, and Response 102

5 Gender and Gender Roles 122

6 Sexuality in Childhood and Adolescence 155

7 Sexuality in Adulthood 184

8 Love and Communication in Intimate Relationships 214

9 Sexual Expression 253

10 Variations in Sexual Behavior 296

11 Contraception and Abortion 322

12 Conception, Pregnancy, and Childbirth 359

13 The Sexual Body in Health and Illness 393

14 Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy 429

15 Sexually Transmitted Infections 479

16 HIV and AIDS 516

17 Sexual Coercion 557

18 Sexually Explicit Materials, Prostitution, and Sex Laws 601 ® McGraw-Hill Education Psychology’s APA Documentation Style Guide

Brief Contents

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PREFACE xxii | LETTER FROM THE AUTHORS xxxiii | ABOUT THE AUTHORS xxxv

1 Perspectives on Human Sexuality 1 STUDYING HUMAN SEXUALITY 2

SEXUALITY, POPULAR CULTURE, AND THE MEDIA 4 Media Portrayals of Sexuality 4 Television and Digital Media 7 Feature-Length Films 9 Gay Men, Lesbian Women, and Bisexual and Transgender People in Film

and Television 9 Online Social Networks 10

■ 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 16 Gender 18

SOCIETAL NORMS AND SEXUALITY 19 Natural Sexual Behavior 19

■ Think About It AM I NORMAL? 20 Normal Sexual Behavior 21 Sexuality Behavior and Variations 22

■ Think About It DECLARATION OF SEXUAL RIGHTS 23

FINAL THOUGHTS 24 | SUMMARY 25 | QUESTIONS FOR DISCUSSION 26 | SEX AND THE INTERNET 26 | SUGGESTED WEBSITES 26 | SUGGESTED READING 26

Contents

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2 Studying Human Sexuality 27 SEX, ADVICE COLUMNISTS, AND POP PSYCHOLOGY 29 Information and Advice as Entertainment 29

■ Think About It DOES SEX HAVE AN INHERENT MEANING? 30 The Use and Abuse of Research Findings 31

THINKING OBJECTIVELY ABOUT SEXUALITY 32 Value Judgments Versus Objectivity 32 Opinions, Biases, and Stereotypes 33 Common Fallacies: Egocentric and Ethnocentric Thinking 34

SEX RESEARCH METHODS 35 Research Concerns 35 Clinical Research 37 Survey Research 37 Observational Research 39 Experimental Research 39

THE SEX RESEARCHERS 40 Richard von Krafft-Ebing 41 Sigmund Freud 41 Havelock Ellis 42 Alfred Kinsey 43 William Masters and Virginia Johnson 45

CONTEMPORARY RESEARCH STUDIES 46 The National Health and Social Life Survey 46 The National Survey of Family Growth 47

■ Think About It SEX RESEARCH: A BENEFIT TO INDIVIDUALS AND SOCIETY OR A THREAT TO MORALITY? 48

The Youth Risk Behavior Survey 49 The National College Health Assessment 50 The National Survey of Sexual Health and Behavior 51

EMERGING RESEARCH PERSPECTIVES 52 Feminist Scholarship 53 Gay, Lesbian, Bisexual, and Transgender Research 54 Directions for Future Research 56

ETHNICITY AND SEXUALITY 56 African Americans 56 Latinos 58 Asian Americans and Pacific Islanders 59 Middle Eastern Americans 61

FINAL THOUGHTS 61 | SUMMARY 62 | QUESTIONS FOR DISCUSSION 63 | SEX AND THE INTERNET 64 | SUGGESTED WEBSITES 64 | SUGGESTED READING 64

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3 Female Sexual Anatomy, Physiology, and Response 65

FEMALE SEX ORGANS: WHAT ARE THEY FOR? 66 External Structures (the Vulva) 67 Internal Structures 70

■ Practically Speaking PERFORMING A GYNECOLOGICAL SELF-EXAMINATION 74 Other Structures 75 The Breasts 76

FEMALE SEXUAL PHYSIOLOGY 78 Reproductive Hormones 79 The Ovarian Cycle 79 The Menstrual Cycle 81

■ Practically Speaking VAGINAL AND MENSTRUAL HEALTH CARE 86

HUMAN SEXUAL RESPONSE 87 ■ Think About It SEXUAL FLUIDITY: WOMEN’S VARIABLE SEXUAL ATTRACTIONS 88

Sexual Response Models 89 Desire and Arousal: Mind or Matter? 92 Experiencing Sexual Arousal 95

FEMALE SEXUAL RESPONSE 95 Sexual Excitement 95

■ Think About It “DID YOU COME?” WHAT COLLEGE STUDENTS THINK ABOUT WOMEN’S ORGASMS DURING HETEROSEXUAL SEX 96

Orgasm 98

FINAL THOUGHTS 99 | SUMMARY 99 | QUESTIONS FOR DISCUSSION 100 | SEX AND THE INTERNET 101 | SUGGESTED WEBSITES 101 | SUGGESTED READING 101

4 Male Sexual Anatomy, Physiology, and Response 102

MALE SEX ORGANS: WHAT ARE THEY FOR? 103 External Structures 103 Internal Structures 106 Other Structures 108

MALE SEXUAL PHYSIOLOGY 110 Sex Hormones 110

■ Practically Speaking SEXUAL HEALTH CARE: WHAT DO MEN NEED? 111 Spermatogenesis 113

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Semen Production 113 Homologous Organs 115

MALE SEXUAL RESPONSE 115 ■ Think About It “OH, TO BE BIGGER”: BREAST AND PENIS ENHANCEMENT 116

Erection 117 Ejaculation and Orgasm 118

■ Practically Speaking CAN AN ERECTION BE WILLED? 119

FINAL THOUGHTS 120 | SUMMARY 120 | QUESTIONS FOR DISCUSSION 121 | SEX AND THE INTERNET 121 | SUGGESTED WEBSITES 121 | SUGGESTED READING 121

5 Gender and Gender Roles 122 STUDYING GENDER AND GENDER ROLES 124 Sex, Gender, and Gender Roles: What’s the Difference? 124 Sex and Gender Identity 125 Masculinity and Femininity: Opposites, Similar, or Blended? 127 Gender and Sexual Orientation 128

GENDER-ROLE LEARNING 128 Theories of Socialization 128 Gender-Role Learning in Childhood and Adolescence 130 Gender Schemas: Exaggerating Differences 133

CONTEMPORARY GENDER ROLES AND SCRIPTS 133 Traditional Gender Roles and Scripts 134

■ Think About It THE PURITY STANDARD: DEFINING WOMEN BY THEIR SEXUALITY 136

Changing Gender Roles and Scripts 137

GENDER VARIATIONS 138 The Transgender Phenomenon 139

■ Think About It PSYCHOLOGICAL AND MEDICAL TREATMENT OF GENDER DYSPHORIA 141

Gender Dysphoria 142 Transsexuality 143 Disorders of Sex Development (DSD) 144

■ Think About It A CAUTIOUS APPROACH TO ADDRESSING DISORDERS OF SEX DEVELOPMENT (DSD) IN CHILDREN 149

Unclassified Form of Abnormal Sexual Development 150 Coming to Terms With Differences 150

FINAL THOUGHTS 152 | SUMMARY 152 | QUESTIONS FOR DISCUSSION 153 | SEX AND THE INTERNET 153 | SUGGESTED WEBSITES 154 | SUGGESTED READING 154

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6 Sexuality in Childhood and Adolescence 155

SEXUALITY IN INFANCY AND CHILDHOOD (AGES 0 TO 11) 156 Infancy and Sexual Response (Ages 0 to 2) 157 Childhood Sexuality (Ages 3 to 11) 157 The Family Context 160

SEXUALITY IN ADOLESCENCE (AGES 12 TO 19) 161 Psychosexual Development 161

■ Think About It THE “ORIGINS” OF HOMOSEXUALITY 168 Adolescent Sexual Behavior 170 Teenage Pregnancy 174

■ Practically Speaking FIRST SEXUAL INTERCOURSE REACTION SCALE 175 Sexuality Education 178

■ Think About It HEALTHY TEEN SEXUALITY 180

FINAL THOUGHTS 181 | SUMMARY 181 | QUESTIONS FOR DISCUSSION 182 | SEX AND THE INTERNET 182 | SUGGESTED WEBSITES 182 | SUGGESTED READING 183

7 Sexuality in Adulthood 184 SEXUALITY IN EARLY ADULTHOOD 185 Developmental Concerns 186

■ Think About It LIFE BEHAVIORS OF A SEXUALLY HEALTHY ADULT 187 Establishing Sexual Orientation 188

■ Think About It BISEXUALITY: THE NATURE OF DUAL ATTRACTION 191 Being Single 193

■ Think About It WHY COLLEGE STUDENTS HAVE SEX 195 Cohabitation 198

SEXUALITY IN MIDDLE ADULTHOOD 199 Developmental Concerns 199 Sexuality in Marriage and Established Relationships 200 Divorce and After 202

SEXUALITY IN LATE ADULTHOOD 204 Developmental Concerns 204 Stereotypes of Aging 205 Sexuality and Aging 205

FINAL THOUGHTS 211 | SUMMARY 212 | QUESTIONS FOR DISCUSSION 212 | SEX AND THE INTERNET 213 | SUGGESTED WEBSITES 213 | SUGGESTED READING 213

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8 Love and Communication in Intimate Relationships 214

FRIENDSHIP AND LOVE 216

LOVE AND SEXUALITY 217 Men, Women, Sex, and Love 218 Love Without Sex: Celibacy and Asexuality 219

■ Think About It ARE GAY/LESBIAN COUPLES AND FAMILIES ANY DIFFERENT FROM HETEROSEXUAL ONES? 220

HOW DO I LOVE THEE? APPROACHES AND ATTITUDES RELATED TO LOVE 221

Styles of Love 221 The Triangular Theory of Love 222 Love as Attachment 225 Unrequited Love 227

■ Think About It THE SCIENCE OF LOVE 228

JEALOUSY 229 The Psychological Dimension 230 Managing Jealousy 230

■ Think About It THE PASSIONATE LOVE SCALE 231 Extradyadic Involvement 232 Rebound Sex 234

MAKING LOVE LAST: FROM PASSION TO INTIMACY 234

THE NATURE OF COMMUNICATION 235 The Cultural Context 235 The Social Context 236 The Psychological Context 237 Nonverbal Communication 237

SEXUAL COMMUNICATION 239 Sexual Communication in Beginning Relationships 239 Sexual Communication in Established Relationships 241

■ Think About It LET’S (NOT) TALK ABOUT SEX: AVOIDING THE DISCUSSION ABOUT PAST LOVERS 242

Initiating Sexual Activity 243

DEVELOPING COMMUNICATION SKILLS 243 Talking About Sex 244

■ Practically Speaking COMMUNICATION PATTERNS AND PARTNER SATISFACTION 245

CONFLICT AND INTIMACY 247 Sexual Conflicts 247

■ Practically Speaking LESSONS FROM THE LOVE LAB 248 Conflict Resolution 249

FINAL THOUGHTS 249 | SUMMARY 250 | QUESTIONS FOR DISCUSSION 251 | SEX AND THE INTERNET 251 | SUGGESTED WEBSITES 252 | SUGGESTED READING 252

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9 Sexual Expression 253 SEXUAL ATTRACTIVENESS 255 A Cross-Cultural Analysis 255 Evolutionary Mating Perspectives 258 Hooking Up and College Students 262 Sexual Desire 263

■ Think About It “HOOKING UP” AMONG COLLEGE STUDENTS: AS SIMPLE AS ONE MIGHT THINK? 264

SEXUAL SCRIPTS 266 Cultural Scripting 266 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 277 Most Recent Partnered Sex 277

■ Think About It YOU WOULD SAY YOU “HAD SEX” IF YOU . . . 278 Couple Sexual Styles 279 Touching 281 Kissing 282

■ Think About It GIVING AND RECEIVING PLEASURABLE TOUCH: “GEARS OF CONNECTION” 283

Oral-Genital Sex 284 ■ Think About It THE FIRST KISS: A DEAL-BREAKER? 285

Sexual Intercourse 288 Anal Eroticism 291 Health Benefits of Sexual Activity 293

FINAL THOUGHTS 293 | SUMMARY 293 | QUESTIONS FOR DISCUSSION 294 | SEX AND THE INTERNET 295 | SUGGESTED WEBSITES 295 | SUGGESTED READING 295

10 Variations in Sexual Behavior 296 SEXUAL VARIATIONS AND PARAPHILIC BEHAVIOR 297 What Are Sexual Variations? 297 What Is Paraphilia? 298

■ Think About It CLASSIFYING VARIANT SEXUAL BEHAVIORS AS PARAPHILIA: THE CHANGING VIEWS OF PSYCHOLOGY 300

TYPES OF PARAPHILIAS 301 Fetishism 301

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■ Think About It “SEXUAL ADDICTION”: REPRESSIVE MORALITY IN A NEW GUISE? 302 Transvestism 304 Zoophilia 306 Voyeurism 307

■ Think About It WOULD YOU WATCH? COLLEGE STUDENTS AND VOYEURISM 308 Exhibitionism 309 Telephone Scatologia 311 Frotteurism 311 Necrophilia 312 Pedophilia 313 BDSM, Sexual Masochism, and Sexual Sadism 314

ORIGINS AND TREATMENT OF PARAPHILIAS 318

FINAL THOUGHTS 319 | SUMMARY 319 | QUESTIONS FOR DISCUSSION 320 | SEX AND THE INTERNET 321 | SUGGESTED WEBSITES 321 | SUGGESTED READING 321

11 Contraception and Abortion 322 RISK AND RESPONSIBILITY 323 Women, Men, and Birth Control: Who Is Responsible? 324 Navigating Reproductive Health 325

■ Think About It RISKY BUSINESS: WHY COUPLES FAIL TO USE CONTRACEPTION 326

METHODS OF CONTRACEPTION 328 Choosing a Method 328 Sexual Abstinence 330 Hormonal Methods 331 Barrier Methods 336

■ Practically Speaking TIPS FOR EFFECTIVE CONDOM USE 338 ■ Practically Speaking CORRECT CONDOM USE SELF-EFFICACY SCALE 339

Spermicides 342 Intrauterine Devices (IUDs) 343 Fertility Awareness–Based Methods 344 Lactational Amenorrhea Method (LAM) 346 Sterilization 346 Emergency Contraception (EC) 349

ABORTION 349 Methods of Abortion 350 Safety of Abortion 351 Women and Abortion 351 Men and Abortion 352 The Abortion Debate 353

RESEARCH ISSUES 355

FINAL THOUGHTS 356 | SUMMARY 356 | QUESTIONS FOR DISCUSSION 357 | SEX AND THE INTERNET 357 | SUGGESTED WEBSITES 358 | SUGGESTED READING 358

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12 Conception, Pregnancy, and Childbirth 359

FERTILIZATION AND FETAL DEVELOPMENT 360 The Fertilization Process 360 Development of the Conceptus 362

■ Think About It CHILD-FREE: A MATTER OF CHOICE 365

PREGNANCY 365 Preconception Care 366 Pregnancy Detection 366 Changes in Women During Pregnancy 367

■ Think About It SEXUAL BEHAVIOR DURING PREGNANCY 369 Complications of Pregnancy and Dangers to the Fetus 369 Diagnosing Fetal Abnormalities 374 Pregnancy Loss 375

INFERTILITY 376 Female Infertility 376 Male Infertility 377 Emotional Responses to Infertility 377 Infertility Treatment 377

GIVING BIRTH 380 Labor and Delivery 380 Choices in Childbirth 382

■ Think About It THE QUESTION OF MALE CIRCUMCISION 383 ■ Practically Speaking MAKING A BIRTH PLAN 385

Breastfeeding 387

BECOMING A PARENT 387 ■ Practically Speaking BREAST VERSUS BOTTLE: WHICH IS BETTER FOR

YOU AND YOUR CHILD? 388

FINAL THOUGHTS 390 | SUMMARY 390 | QUESTIONS FOR DISCUSSION 391 | SEX AND THE INTERNET 391 | SUGGESTED WEBSITES 392 | SUGGESTED READING 392

13 The Sexual Body in Health and Illness 393

LIVING IN OUR BODIES: THE QUEST FOR PHYSICAL PERFECTION 395 Eating Disorders 395

■ Think About It BODY IMAGE AND SEXUALITY: ARE THEY ONE AND THE SAME? 396

ALCOHOL, DRUGS, AND SEXUALITY 398 Alcohol Use and Sexuality 398 Other Drug Use and Sexuality 399

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SEXUALITY AND DISABILITY 402 Physical Limitations and Changing Expectations 402 Vision and Hearing Impairment 404 Chronic Illness 404 Developmental Disabilities 405 The Sexual Rights of People With Disabilities 406

SEXUALITY AND CANCER 407 Women and Cancer 407

■ Think About It FEMALE GENITAL CUTTING: MUTILATION OR IMPORTANT CUSTOM? 414

Men and Cancer 416 ■ Practically Speaking TESTICULAR SELF-EXAMINATION 419

Anal Cancer in Men and Women 422

ADDITIONAL SEXUAL HEALTH ISSUES 422 Toxic Shock Syndrome 422 Vulvodynia 423 Endometriosis 423 Prostatitis 424

SEXUAL ORIENTATION AND HEALTH 424

FINAL THOUGHTS 425 | SUMMARY 426 | QUESTIONS FOR DISCUSSION 427 | SEX AND THE INTERNET 427 | SUGGESTED WEBSITES 428 | SUGGESTED READING 428

14 Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy 429

SEXUAL FUNCTION DIFFICULTIES: DEFINITIONS, TYPES, AND PREVALENCE 431

Defining Sexual Function Difficulties: Different Perspectives 431 Prevalence and Cofactors 434 Disorders of Sexual Desire 439

■ Practically Speaking SEXUAL DESIRE: WHEN APPETITES DIFFER 444 ■ Think About It IS INTERCOURSE ENOUGH? THE BIG “O”

AND SEXUAL BEHAVIORS 446

Orgasmic Disorders 447 Sexual Pain Disorders 450 Substance/Medication-Induced Sexual Dysfunction 452 Other Disorders 452

PHYSICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 452

Physical Causes in Men 453 Physical Causes in Women 453

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PSYCHOLOGICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 453

Immediate Causes 454 Conflict Within the Self 455 Relationship Causes 456

SEXUAL FUNCTION ENHANCEMENT 456 Developing Self-Awareness 456

■ Think About It “GOOD ENOUGH SEX”: THE WAY TO LIFETIME COUPLE SATISFACTION 458

Intensifying Erotic Pleasure 459 ■ Practically Speaking KEGEL EXERCISES FOR WOMEN AND MEN 460 ■ Think About It MY PARTNER COULD BE A BETTER LOVER IF . . . : WHAT MEN AND

WOMEN WANT FROM THEIR SEXUAL PARTNERS 462

Changing a Sexual Relationship and Managing Sexual Difficulties 463 ■ Think About It SEXUAL TURN-ONS AND TURN-OFFS: WHAT COLLEGE

STUDENTS REPORT 464

TREATING SEXUAL FUNCTION DIFFICULTIES 466 Masters and Johnson: A Cognitive-Behavioral Approach 466 Kaplan: Psychosexual Therapy 469 Other Nonmedical Approaches 469 Medical Approaches 470 Gay, Lesbian, and Bisexual Sex Therapy 472

■ Think About It THE MEDICALIZATION OF SEXUAL FUNCTION PROBLEMS 473 ■ Practically Speaking SEEKING PROFESSIONAL ASSISTANCE 474

FINAL THOUGHTS 475 | SUMMARY 476 | QUESTIONS FOR DISCUSSION 477 | SEX AND THE INTERNET 478 | SUGGESTED WEBSITES 478 | SUGGESTED READING 478

15 Sexually Transmitted Infections 479

THE STI EPIDEMIC 481 STIs: The Most Common Reportable Infectious Diseases 481 Who Is Affected: Disparities Among Groups 481 Factors Contributing to the Spread of STIs 483

■ Practically Speaking PREVENTING STIs: THE ROLE OF MALE CONDOMS AND FEMALE CONDOMS 487

■ Practically Speaking STI ATTITUDE SCALE 490 Consequences of STIs 491

PRINCIPAL BACTERIAL STIs 491 Chlamydia 491 Gonorrhea 494 Urinary Tract Infections 495 Syphilis 496

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PRINCIPAL VIRAL STIs 497 HIV and AIDS 497

■ Think About It THE TUSKEGEE SYPHILIS STUDY: A TRAGEDY OF RACE AND MEDICINE 498

Genital Herpes 499 Genital Human Papillomavirus Infection 500 Viral Hepatitis 503

VAGINAL INFECTIONS 504 Bacterial Vaginosis 504 Genital Candidiasis 505 Trichomoniasis 505

OTHER STIs 506

ECTOPARASITIC INFESTATIONS 506 Scabies 506 Pubic Lice 507

STIs AND WOMEN 507 Pelvic Inflammatory Disease (PID) 508 Cervicitis 508 Cystitis 509

PREVENTING STIs 509 Avoiding STIs 509 Treating STIs 511

■ Practically Speaking SAFER AND UNSAFE SEX PRACTICES 512

FINAL THOUGHTS 513 | SUMMARY 513 | QUESTIONS FOR DISCUSSION 514 | SEX AND THE INTERNET 515 | SUGGESTED WEBSITES 515 | SUGGESTED READING 515

16 HIV and AIDS 516 WHAT IS AIDS? 518 Conditions Associated With AIDS 518

■ Think About It THE STIGMATIZATION OF HIV AND OTHER STIs 519 Symptoms of HIV Infection and AIDS 520 Understanding AIDS: The Immune System and HIV 520 The Virus 521 AIDS Pathogenesis: How the Disease Progresses 522

THE EPIDEMIOLOGY AND TRANSMISSION OF HIV 524 The Epidemiology of HIV/AIDS in the United States 525 Myths and Modes of Transmission 528 Sexual Transmission 529 Injection Drug and Substance Use 530 Mother-to-Child Transmission 531 Factors Contributing to Infection 532

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AIDS DEMOGRAPHICS 532 Minority Races/Ethnicities and HIV 532 The Gay Community 535 Women and HIV/AIDS 537 Transgender People and HIV 538 Children and HIV/AIDS 539 HIV/AIDS Among Youth 539 Older Adults and HIV/AIDS 541 Geographic Region and HIV 541

■ Practically Speaking HEALTH PROTECTIVE SEXUAL COMMUNICATION SCALE 542

PREVENTION AND TREATMENT 543 Protecting Ourselves 543 Saving Lives Through Prevention 545

■ Think About It “DO YOU KNOW WHAT YOU ARE DOING?” COMMON CONDOM- USE MISTAKES AMONG COLLEGE STUDENTS 546

HIV Testing 547 Treatments 550

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

FINAL THOUGHTS 554 | SUMMARY 554 | QUESTIONS FOR DISCUSSION 555 | SEX AND THE INTERNET 556 | SUGGESTED WEBSITES 556 | SUGGESTED READING 556

17 Sexual Coercion 557 SEXUAL HARASSMENT 558 What Is Sexual Harassment? 559 Flirtation Versus Harassment 561 Harassment in School and College 563 Harassment in the Workplace 565 Harassment in Public Spaces 566

HARASSMENT AND DISCRIMINATION AGAINST GAY, LESBIAN, BISEXUAL, AND TRANSGENDER PEOPLE 568

Heterosexual Bias 568 Prejudice, Discrimination, and Violence 568 Ending Anti-Gay Prejudice and Enactment of Antidiscrimination Laws 570

SEXUAL VIOLENCE 572 Campus Sexual Violence 574 The Nature and Incidence of Rape 575 Myths About Rape 576

■ Practically Speaking PREVENTING SEXUAL ASSAULT 577

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Forms of Rape 579 ■ Think About It DATE/ACQUAINTANCE RAPE DRUGS: AN INCREASING THREAT 581 ■ Think About It CAN MEN AND WOMEN ACCURATELY JUDGE A PARTNER’S

WILLINGNESS TO HAVE CASUAL SEX? 583

■ Think About It HOW COLLEGE STUDENTS INDICATE AND INTERPRET CONSENT TO HAVE SEX 585

Motivations for Rape 589 The Aftermath of Rape 590

■ Practically Speaking SUPPORTING SOMEONE WHO HAS BEEN RAPED 592

CHILD SEXUAL ABUSE 593 Effects of Child Sexual Abuse 595 Treatment Programs 596 Preventing Child Sexual Abuse 596

FINAL THOUGHTS 598 | SUMMARY 598 | QUESTIONS FOR DISCUSSION 599 | SEX AND THE INTERNET 599 | SUGGESTED WEBSITES 600 | SUGGESTED READING 600

18 Sexually Explicit Materials, Prostitution, and Sex Laws 601

SEXUALLY EXPLICIT MATERIAL IN CONTEMPORARY AMERICA 602 Pornography or Erotica: Which Is It? 603 Sexually Explicit Material and Popular Culture 603 The Consumption of Sexually Explicit Materials 604 Themes, Content, and Actors of Sexually Explicit Videos 605

■ Think About It COLLEGE STUDENTS AND THE VIEWING OF SEXUALLY EXPLICIT MATERIALS 606

The Effects of Sexually Explicit Material 609 ■ Think About It SEXUALLY EXPLICIT MATERIAL USE IN ROMANTIC COUPLES:

BENEFICIAL OR HARMFUL? 612

Censorship, Sexually Explicit Material, and the Law 615

PROSTITUTION 618 Females Working in Prostitution 619

■ Think About It SEX TRAFFICKING: A MODERN-DAY SLAVERY 620 Males Working in Prostitution 625 Prostitution and the Law 627 The Impact of HIV/AIDS and Other STIs on Prostitution 628

SEXUALITY AND THE LAW 628 Legalizing Private, Consensual Sexual Behavior 629 Same-Sex Marriage 630 Advocating Sexual Rights 630

FINAL THOUGHTS 631 | SUMMARY 631 | QUESTIONS FOR DISCUSSION 632 | SEX AND THE INTERNET 633 | SUGGESTED WEBSITES 633 | SUGGESTED READING 633

GLOSSARY G-1

REFERENCES R-1

NAME INDEX NI-1

SUBJECT INDEX SI-1

® McGraw-Hill Education Psychology’s APA Documentation Style Guide

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xxii

Since the first 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 and identity. This sex-positive approach, combined with an integrated exploration of cultural diversity and contemporary research, continues today and includes an emphasis on the importance of affirming and supporting intimacy, pleasuring, and mutual satisfaction in sexual expression. Yarber and Sayad encourage stu- dents to critically assess their own values and modes of sexual expression while connecting them to research.

The new edition integrates SmartBook, a personalized learning program, offering students the insight they need to study smarter and improve classroom results.

Better Data, Smarter Revision, Improved Results Students helped inform the revision strategy:

STEP 1. Over the course of three years, data points showing concepts that caused students the most difficulty were anonymously collected from McGraw-Hill Education Connect for Human Sexuality’s LearnSmart® adaptive learning system.

STEP 2. The authors were provided with data from LearnSmart that graphically illustrated “hot spots” in the text impacting student learning (see following image).

STEP 3. The authors used the heat map data to refine content and reinforce student comprehension in the new edition. Additional quiz questions and assign- able activities were created for use in Connect for Human Sexuality to further support student success.

RESULT: With empirically based feedback at the paragraph and even sentence level, the authors developed the new edition using precise student data to pinpoint concepts that caused students to struggle.

Preface

Celebrating Sexual Diversity in Contemporary America

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Preface xxiii

LearnSmart is an adaptive learning program designed to help students learn faster, study smarter, and retain more knowledge for greater success. Distin- guishing what students know from what they don’t, and focusing on concepts they are most likely to forget, LearnSmart continuously adapts to each student’s needs by building an individual learning path. Millions of students have answered over a billion questions in LearnSmart since 2009, making it the most widely used and intelligent adaptive study tool that’s proven to strengthen memory recall, keep students in class, and boost grades.

Fueled by LearnSmart, SmartBook is the first and only adaptive reading experience currently available.

Make It Effective. SmartBook creates a personalized reading experience by highlighting the most impactful concepts a student needs to learn at that moment in time. This ensures that every minute spent with SmartBook is returned to the student as the most value-added minute possible.

Make It Informed. Real-time reports quickly identify the concepts that require more attention from individual students—or the entire class.

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xxiv Preface

Personalized Grading, on the Go, Made Easier Connect Insight® is a one-of-kind visual analytics dashboard—now available for both instructors and students—that provides at-a-glance information regarding student performance.

Designed for mobile devices, Connect Insight empowers students and helps instructors improve class performance.

■ Make it intuitive. Instructors receive instant, at-a-glance views of student per- formance matched with student activity. Students receive at-a-glance views of their own performance and how they are doing compared to the rest of the class.

■ Make it dynamic. Connect Insight puts real-time analytics in instructors’ and students’ hands, so they can take action early and keep struggling students from falling behind.

■ Make it mobile. Connect Insight is available on-demand wherever, and whenever, it’s needed.

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Preface xxv

Experience the Course You Want to Teach The Instructor Resources have been updated to reflect changes to the new edition; these can be accessed by faculty through Connect Psychology. Resources include the test bank, instructor’s manual, PowerPoint presentation, and image gallery.

Easily rearrange chapters, combine material, and quickly upload content you have written, such as your course syllabus or teaching notes, using McGraw- Hill Education Create. Find the content you need by searching through thou- sands of leading McGraw-Hill Education textbooks. Arrange your book to fit your teaching style. Create even allows you to personalize your book’s appear- ance by selecting the cover and adding your name, school, and course informa- tion. Order a Create book, and you will receive a complimentary print review copy in three to five business days or a complimentary electronic review copy via e-mail in about an hour. Experience how McGraw-Hill Education empowers you to teach your students your way: http://create.mheducation.com

Capture lessons and lectures in a searchable format for use in traditional, hybrid, “flipped classes” and online courses by using Tegrity (http://www .tegrity.com). Its personalized learning features make study time efficient, and its affordability brings this benefit to every student on campus. Patented search technology and real-time Learning Management System (LMS) integrations make Tegrity the market-leading solution and service.

McGraw-Hill Education Campus (www.mhcampus.com) provides faculty with true single sign-on access to all of McGraw-Hill Education’s course content, digital tools, and other high-quality learning resources from any LMS. This innovative offering allows for secure and deep integration, enabling seamless access for faculty and students to any of McGraw-Hill Education’s course solutions, such as McGraw-Hill Education Connect® (all-digital teaching and learning platform), McGraw-Hill Education Create (state-of-the-art custom-publishing platform), McGraw-Hill Education LearnSmart (online adaptive study tool), and Tegrity (fully searchable lecture-capture service).

McGraw-Hill Education Campus includes access to McGraw-Hill Educa- tion’s entire content library, including ebooks, assessment tools, presentation slides, multimedia content, and other resources. McGraw-Hill Education Cam- pus provides instructors with open, unlimited access to prepare for class, create tests/quizzes, develop lecture material, integrate interactive content, and more.

Annual Editions: Human Sexualities This volume offers diverse topics on sex and sexuality with regard to the human experience. Learning Outcomes, Critical Thinking questions, and Internet Refer- ences accompany each article to further enhance learning. Customize this title via McGraw-Hill Create at http://create.mheducation.com.

Taking Sides: Clashing Views in Human Sexuality This debate-style reader both reinforces and challenges students’ viewpoints on the most crucial issues in human sexuality today. Each topic offers current and lively pro and con essays that represent the arguments of leading scholars and commen- tators in their fields. Learning Outcomes, an Issue Summary, and an Issue Introduc- tion set the stage for each debate topic. Following each issue is the Exploring the Issue section with Critical Thinking and Reflection questions, Is There Common Ground? commentary, Additional Resources, and Internet References all designed to stimulate and challenge the student’s thinking and to further explore the topic. Customize this title via McGraw-Hill Create at http://create.mheducation.com.

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xxvi

Chapter-by-Chapter Changes

The research on sexuality is ever increasing, thereby providing the material to allow this new edition to be current and relevant. This new edition is based on the trends, data, and laws from 2012–2015, including the U.S. Supreme Court’s ruling that legalized same-sex marriage in all 50 states, the role of media in singlehood, dating, and partnerships, expanding definitions and meanings of gender and gender identity; increased focus on sexual desire, pleasure, and sat- isfaction; and how the DSM-5 has reframed paraphilic behavior and sexual func- tion difficulties. Human Sexuality: Diversity in Contemporary America addresses these and many other important changes in the field.

Chapter 1: Perspectives on Human Sexuality ■ Updated and expanded material on media use and its impact on teens ■ New data on social networking ■ New Think About It box: “Before Pressing ‘Send’: Trends and Concerns

About Texting, Sexting, and Dating” ■ New data on online dating sites ■ Updated language used to describe gender and gender identity ■ Updated Declaration of Sexual Rights

Chapter 2: Studying Human Sexuality ■ New Think About It box: “Does Sex Have an Inherent Meaning?” ■ Expanded discussion of computer-based technology and the Internet for the

collection of sexuality-related research data ■ Expanded presentation of the Kinsey Heterosexual-Homosexual Rating

Scale ■ Findings of the latest Centers for Disease Control Youth Risk Behavior Survey ■ Findings of the latest American College Health Association research on

college student sexual behavior ■ Expanded discussion of African American sexuality

Chapter 3: Female Sexual Anatomy, Physiology, and Response ■ Continued discussion and research on the G-spot ■ New research on sexual fluidity

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Chapter-by-Chapter Changes xxvii

■ Expanded discussion about the role of female desire ■ New Think About It box: “ ‘Did You Come?’ What College Students Think

About Women’s Orgasms During Heterosexual Sex”

Chapter 4: Male Sexual Anatomy, Physiology, and Response ■ Increased discussion about men’s hormone cycles ■ Updated and new to Chapter 4 Think About It box: “ ‘Oh to Be Bigger’:

Breast and Penis Enhancement” with added discussion on the significance of a man’s penis size

■ Discussion of the biological differences between men’s and women’s orgasms ■ Update on the sexual health of men

Chapter 5: Gender and Gender Roles ■ Changing terminology and laws related to gender ■ New steps that college campuses can take to address sexual violence ■ Added emphasis about the ways in which contemporary sexual scripts can

influence attitudes and behaviors ■ New “Tips for Allies of Transgender People” ■ New DSM-5 diagnosis and explanation of gender dysphoria ■ New material on disorders of sex development ■ Updated and re-titled Think About It box: “A Cautious Approach to

Addressing Disorders of Sexual Development (DSD) in Children” ■ Expanded discussion of transgender ■ Updated and re-titled Think About It box: “Psychological and Medical

Treatment of Gender Dysphoria”

Chapter 6: Sexuality in Childhood and Adolescence ■ Review of literature on early adolescence and precocious puberty and its

impact on boys and girls ■ Expanded discussion on the harassment of GLBT adolescents and its

impact on behavior ■ Updated data on teen sexuality and research about what predisposes teens

to sexual behavior ■ New discussion about first intercourse and the varied cultural and personal

meanings young people give to it ■ Introduction to the President’s Teen Pregnancy Prevention Initiative, which

replaces abstinence-only programs ■ New Think About It box: “Healthy Teen Sexuality”

Chapter 7: Sexuality in Adulthood ■ New discussion of Centers for Disease Control’s data related to sexual

orientation and its impact on government funding and research decisions ■ Expanded discussion about bisexuality ■ Updated discussion on the motivations for college students to have sex

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xxviii Chapter-by-Chapter Changes

■ New material on men having sex with men and racial and ethnic identity ■ New data on rates of cohabitation, same-sex marriage, and parenthood

Chapter 8: Love and Communication in Intimate Relationships ■ New Think About It box: “Let’s (Not) Talk About Sex: Avoiding the Dis-

cussion About Past Lovers” ■ Expanded discussion on the health of children raised by gay and lesbian

parents ■ Updates in the Think About It box: “The Science of Love” ■ New data on extradyadic relationships and the motivations for nonexclu-

siveness ■ Added discussion about and motivations for “rebound sex” ■ Expanded scale in the Practically Speaking box: “Communication Patterns

and Partner Satisfaction” ■ New discussion on argumentation and the resolution of conflicts

Chapter 9: Sexual Expression ■ Expanded discussion on factors that influence sexual attractiveness ■ New material on the similarities and differences in sexual desire and

desired traits of a potential sexual partner of same-sex and mixed-sex individuals

■ New summary of the results of studies related to the Sexual Strategies Theory

■ Expanded discussion and new research on the prevalence, sexual behaviors, and outcomes of hooking up among college students

■ Updated and re-titled Think About It box: “Hooking Up Among College Students: As Simple As One Might Think?”

■ New research on sexual scripts among college students ■ Expanded discussion of the sexual repertoires of same-sex and opposite-sex

couples ■ New research on the meaning of the first kiss with a possible new romantic

partner and the role of kissing in exclusive relationships ■ New data on college women’s attitudes toward and experiences with

cunnilingus

Chapter 10: Variations in Sexual Behavior ■ Updated discussion of sexual paraphilias based on the American Psychiatric

Association (APA) Diagnostic and Statistical Manual of Mental Disorders— 5th Edition (DSM-5)

■ New discussion of the distinction between APA paraphilias (relatively harmless variant sexual behavior) and APA paraphilic disorders (relatively harmful variant sexual behavior)

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■ Discussion of the changes in the DSM-5 description of paraphilias compared to DSM-IV-TR description

■ New Think About It box: “Classifying Variant Sexual Behaviors as Paraphilia: The Changing Medical Views of Psychology”

■ Expanded and updated discussion of sex addiction in the Think About It box: “ ‘Sexual Addiction’: Repressive Morality in a New Guise?”

Chapter 11: Contraception and Abortion ■ Updated material about navigating reproductive health, including a brief

history of contraception, Title X, and Affordable Health Care ■ Added discussion on long-acting reversible contraceptive methods (LARCs) ■ Complete review and update of contraceptive methods ■ New information about breastfeeding and hormonal methods of birth control ■ New data on the rates of abortion

Chapter 12: Conception, Pregnancy, and Childbirth ■ Updated data on pregnancies, by race and ethnicity, and marital status ■ Increased focus on preconception and prenatal care ■ Expanded discussion on maternal obesity ■ Updates on male and female infertility and assisted reproductive technologies ■ Revised Think About It box: “The Question of Male Circumcision” ■ Updated and expanded discussion on breastfeeding

Chapter 13: The Sexual Body in Health and Illness ■ New Think About It box: “Body Image and Sexuality: Are They One and

the Same?” ■ New focus on myths about disability and sexuality ■ Thorough revision of statistics, research, and new and controversial guide-

lines for the detection of breast cancer ■ Discussion of sexual adjustment following breast cancer treatment ■ New screening recommendations for cervical cancer and prostate cancer ■ New material on sexual orientation and health, especially as they relate to

disparities and discrimination

Chapter 14: Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy ■ Updated Think About It box: “Is Intercourse Enough? The Big ‘O’ and

Sexual Behaviors” ■ Updated discussion of sexual function difficulties based on the American

Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5)

■ Discussion of the changes in the DSM-5 description of sexual dysfunctions compared to the DSM-IV-TR description

Chapter-by-Chapter Changes xxix

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■ New data on sexual function difficulties among men and women with same-sex or opposite-sex partners and lesbian and heterosexual women

■ Discussion of a new DSM-5 category: substance/medication-induced sexual dysfunction

■ New discussion of the hierarchy of sexual behaviors ■ New Think About It box: “My Partner Could Be a Better Lover If . . . :

What Men and Women Want From Their Sexual Partners” ■ New material on strategies to cope with sexual difficulties ■ Updated Think About It box: “The Medicalization of Sexual Function

Problems”

Chapter 15: Sexually Transmitted Infections ■ Updated information on the prevalence and incidence of major STIs ■ Updated medical information on the major STIs ■ Expanded discussion on the role of male and female condoms in STI

prevention ■ New stances of the Centers for Disease Control and Prevention American

Academy of Pediatrics on the impact of male circumcision in stopping the spread of HIV infection and other STIs

■ Information on a new HPV vaccination ■ Expanded discussion of the impact of HPV vaccination on sexual behavior ■ Added discussion of the role of STI testing in preventing STIs

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

United States and worldwide ■ New discussion on the worldwide progress in reducing new HIV infections,

the recent decrease in annual HIV diagnoses, and stability of new HIV infections in the United States

■ Updated biological information on HIV/AIDS ■ Expanded discussion on the impact of HIV stigma ■ Expanded discussion of myths and modes of HIV transmission and esti-

mated lifetime risk for HIV diagnosis ■ Updated and expanded discussion of HIV/AIDS among minority races/

ethnicities and sexual minorities ■ New and expanded discussion of pre-exposure prophylaxis and new mate-

rial on post-exposure prophylaxis ■ Updated information on HIV testing and treatment

Chapter 17: Sexual Coercion ■ New and expanded information on stalking and sexual harassment in the

military and public places ■ Updated information on sexual harassment, discrimination, legal equality,

and rejection of GLBT persons

xxx Chapter-by-Chapter Changes

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■ New material on the lifetime prevalence of men and women who have experienced sexual violence

■ Updated and expanded information on preventing sexual assault ■ New material on campus sexual violence, including sexual coercion strate-

gies of both men and women ■ New Think About It box: “Can Men and Women Accurately Judge a Partner’s

Willingness to Have Casual Sex?” ■ New Think About It box: “How College Students Indicate and Interpret

Consent to Have Sex” ■ New material on strategies men and women employ to obtain sexual

contact with unwilling partners ■ New information on the mental health and sexual functioning of persons

who experience sexual violence

Chapter 18: Sexually Explicit Materials, Prostitution, and Sex Laws ■ New material on the 2015 U.S. Supreme Court’s ruling that legalized

same-sex marriage in all 50 states ■ New material on the consumption of sexually explicit materials, including

men’s and women’s preferences for various types of visual sexual stimuli ■ New research on the content of sexually explicit videos and the character-

istics of “porn stars” ■ New Think About It box: “Sexually Explicit Material Use in Romantic

Couples: Beneficial or Harmful?” ■ Expanded discussion on viewing sexually explicit videos and college stu-

dents, including its relationship with hooking up ■ New material on whether the label “porn addiction” is accepted among

mental health professionals ■ Expanded and updated discussion on research to determine any influence

of pornography consumption on sexual aggression ■ Expanded and updated information on female and male prostitution, why

individuals become prostitutes, and the characteristics of clients who pay for sex with male escorts

■ Updated and re-titled Think About It box: “Sex Trafficking: A Modern-Day Slavery”

Chapter-by-Chapter Changes xxxi

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• Acknowledgments In addition to student user feedback through McGraw-Hill Education’s Learn- Smart, feedback from instructor reviews were instrumental in guiding this revi- sion. Special thanks to the following:

Daria A. Bakina, SUNY Oswego Coreen Haym, University of Nevada at Las Vegas Nancy King, Western Michigan University Jennifer Mewes, Pima Community College Elizabeth Morgan, Springfield College Jonathan Moss, William Paterson University Helen J. Powell, Wayne State University Mary E. Ramey, University of Illinois at Urbana-Champaign Marie Wallace, Pima Community College, Northwest Campus Anthony D. Yankowski, Bergen Community College

We would also like to thank our team at McGraw-Hill Education: Nancy Welcher, Senior Brand Manager, Lead Product Developer Dawn Groundwater, Senior Product Developer Sarah Colwell, Product Developer Joni Fraser, Senior Marketing Managers AJ Laferrera, Ann Helgerson, and Christina Yu, Content Production Manager Sandy Wille, Content Licensing Specialists Beth Thole (text), Keri Johnson and Melissa Homer (photo), and Matt Diamond Designer. Additional thanks go out to: Alijah Marquez personal assistant and input editor, Angie Sigwarth and Christopher Greene, freelance proofreaders, and David Tietz, freelance photo researcher.

xxxii Chapter-by-Chapter Changes

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xxxiii

“Sex is like dynamite. . . . It can be the cement of a relationship, but it can be the level that breaks people apart.”

—Joseph Fletcher (1905–1991)

When students first enter a human sexuality class, they may feel excited, ner- vous, and uncomfortable, all at the same time. These feelings are common. This is because the more an area of life is judged “off limits” to public and private discussion the less likely it is to be understood and embraced. Yet, sex surrounds us and impacts our lives every day from the provocative billboard ad on the highway, to the steamy social media images of the body, to men’s and women’s fashions, and to prime-time television dramas. People want to learn about the role and meaning of human sexuality in their lives and how to live healthy psychologically and physically, yet they often do not know whom to ask or what sources to trust. In our quest for knowledge and understanding, we need to maintain an intellectual curiosity. Author William Arthur Ward observes, “Curi- osity is the wick in the candle of learning.”

Students begin studying sexuality for many reasons: to gain insights into their sexuality and relationships, to become more comfortable with their sexuality, to learn how to enhance sexual pleasure for themselves and their partners, to explore personal sexual issues, to dispel anxieties and doubts, to validate their sexual identity, to avoid and resolve traumatic sexual experiences, and to learn how to avoid STIs and unintended pregnancies. Many students find the study of human sexuality empowering; they develop the ability to make intelligent sexual choices based on reputable information and their own needs, desires, and values rather than on stereotypical, haphazard, unreliable, incomplete, or unre- alistic information; oppressive cultural dictums; or guilt, fear, or conformity. They learn to differentiate between what they have been told about their own sexuality and what they truly believe; that is, they begin to own their sexuality. Those studying this subject often report that they feel more appreciative and less apologetic, defensive, or shameful about their sexual feelings, attractions, and desires.

Particularly in a country as diverse as the United States, the study of human sexuality calls for us to be open-minded: to be receptive to new ideas and to various perspectives; to respect those with different experiences, values, orienta- tions, ages, abilities, and ethnicities; to seek to understand what we have not understood before; to reexamine old assumptions, ideas, and beliefs; and to embrace and accept the humanness and uniqueness in each of us.

Letter From the Authors

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Sexuality can be a source of great pleasure and, yes, the “cement” of a relationship. Through it, we can reveal ourselves, connect with others on the most intimate levels, create strong bonds, and bring new life into the world. Paradoxically, though, sexuality can also be a source of guilt and confusion, anger and disappointment, a pathway to infection, and a means of exploitation and aggression. We hope that by examining the multiple aspects of human sexuality presented in this book, you will come to understand, embrace, and appreciate your own sexuality and the unique individuality of sexuality among others, to learn how to make healthy sexual choices for yourself, to integrate and balance your sexuality into your life as a natural health-enhancing compo- nent, and to express your sexuality with partners in sharing, nonexploitive, and nurturing ways.

William L. Yarber Barbara W. Sayad

xxxiv Letter From the Authors

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xxxv

WILLIAM L. YARBER is professor of applied health science and affiliated faculty member in gender studies at Indiana University, Bloomington. He is also a senior research fellow at The Kinsey Institute for Research in Sex, Gender, and Reproduction and the senior director of the Rural Center for AIDS/STD Prevention at Indiana University.

Dr. Yarber, who received his doctorate from Indiana University, has authored or co-authored numerous scientific reports on sexual risk behavior and AIDS/STI pre- vention in professional journals and has received federal and state grants to support his research and prevention activities. He is a member of The 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 15 years, with federal and institutional research support, CURT has investigated male condom use errors and problems and has developed behav- ioral interventions designed to improve correct and consistent condom use.

At the request of the U.S. federal government, Dr. Yarber authored the country’s first secondary school AIDS prevention education curriculum, AIDS: What Young Peo- ple Should Know (1987). He also co-edited the Handbook of Sexuality-Related Mea- sures, third edition (2011). Dr. Yarber and Dr. Sayad’s textbook Human Sexuality: Diversity in Contemporary America (McGraw-Hill), which is used in colleges and uni- versities throughout the United States, was published in 2012 by the Beijing World Publishing Company as the most up-to-date text on human sexuality published in China in the past half century. Also in 2012, the text was published in Korea.

Dr. Yarber chaired the National Guidelines Task Force, which developed the Guide- lines for Comprehensive Sexuality Education: Kindergarten–12th Grade (1991, 1996, 2004), published by the Sexuality Information and Education Council of the United States (SIECUS) and adapted in six countries worldwide. Dr. Yarber is past president of The Society for the Scientific Study of Sexuality (SSSS) and a past chair of the SIECUS board of directors. His awards include the SSSS Distinguished Scientific Achievement Award; the Professional Standard of Excellence Award from the American Association of Sex Educators, Counselors, and Therapists; the Indiana University Pres- ident’s Award for Distinguished Teaching; and the inaugural Graduate Student Out- standing Faculty Mentor Award at Indiana University.

Dr. Yarber has been a consultant to the World Health Organization Global Program on AIDS as well as sexuality-related organizations in Brazil, China, Jamaica, Poland, Portugal, and Taiwan. 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 endowed at Indiana University, for perpetuity, the world’s first professorship in sexual health, the William L. Yarber Professorship in Sexual Health.

About the Authors

William L. Yarber

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xxxvi About the Authors

BARBARA WERNER SAYAD is a consummate teacher, trainer, writer, and consul- tant. As a recently retired faculty member from California State University, Monterey Bay, Dr. Sayad has taught a wide variety of courses, including human sexuality, women’s health, community health education, multi-cultural health education and promotion, and senior capstone. Her work in the classroom has earned her several nominations for outstanding faculty member and she has and continues to serve as a McNair Scholars mentor. Additionally, she has chaired a number of university committees, spoken at dozens of university-related events, and trained and collaborated with other faculty mem- bers in areas related to public health and personal well-being.

Dr. Sayad has presented her work at a variety of institutions, most significant of which is focused on comprehensive sexuality education programming. One that she is most proud of is her alliance with Aibai, the largest GLBT organization in China, where she traveled with her co-author, Dr. Yarber, to present to the Asian Conference on Sexual Education. There she also provided training for American delegates and Chinese scholars at the U.S. Embassy, U.S. State Department, and UNESCO and was invited to speak at Xixi, the equivalent of a TED Talk, in Shanghai.

The vast majority of Dr. Sayad’s 34-year career has been connected to issues of social justice: women’s reproductive rights, GLBT education and advocacy, and health access. As a result of this focus coupled with her global travels, she has contributed to a variety of health-related texts, curricular guides, and publications and has facili- tated a wide array of training programs, presented at professional conferences, and worked as a trainer and curriculum specialist.

Dr. Sayad holds a Bachelor of Science degree in Foods and Nutrition, a Masters degree in Public Health, and a PhD in health services.

Dr. Sayad is most proud of her three children, new grandchild, and extended family and is eternally grateful to be married for 33 years to Dr. Robert Sayad.

Barbara Werner Sayad

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1

1 Perspectives on Human Sexuality chapter

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C H A P T E R O U T L I N E Studying Human Sexuality

Sexuality, Popular Culture, and the Media

Sexuality Across Cultures and Times

Societal Norms and Sexuality

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2 Chapter 1 Perspectives on Human Sexuality

“The media, especially magazines and televi- sion, has had an influ- ence on shaping my sexual identity. Ever since I was a little girl, I have watched the

women on TV and hoped I would grow up to look sexy and beautiful like them. I feel that because of the constant bar- rage of images of beautiful women on TV and in magazines young girls like me grow up with unrealistic expectations of what beauty is and are doomed to feel they have not met this exaggerated standard.”

—21-year-old female

“The phone, television, and Internet became my best friends. I never missed an episode of any of the latest shows, and I knew all the words to every new song. And when Facebook entered my life, I finally felt connected. At school, we would talk about status updates: whom we thought was cute, relationship status, and outrageous pho- tos. All of the things we saw were all of the things we fanta- sized about. These are the things we would talk about.”

—23-year-old female

“Though I firmly believe that we are our own harshest critics, I also believe that the media have a large role in

influencing how we think of ourselves. I felt like ripping my hair out every time I saw a skinny model whose stom- ach was as hard and flat as a board, with their flawless skin and perfectly coifed hair. I cringed when I realized that my legs seemed to have an extra ‘wiggle-jiggle’ when I walked. All I could do was watch the television and feel abashed at the differences in their bodies com- pared to mine. When magazines and films tell me that for my age I should weigh no more than a hundred pounds, I feel like saying, ‘Well, gee, it’s no wonder I finally turned to laxatives with all these pressures to be thin surround- ing me.’ I ached to be model-thin and pretty. This fixation to be as beautiful and coveted as these models so preoc- cupied me that I had no time to even think about anyone or anything else.”

—18-year-old female

“I am aware that I may be lacking in certain areas of my sexual self-esteem, but I am cognizant of my shortcomings and am willing to work on them. A person’s sexual self- esteem isn’t something that is detached from his or her daily life. It is intertwined in every aspect of life and how one views his or her self: emotionally, physically, and men- tally. For my own sake, as well as my daughter’s, I feel it is important for me to develop and model a healthy sexual self-esteem.”

—28-year-old male

Sexuality was once hidden from view in our culture: Fig leaves covered the “private parts” of nudes; poultry breasts were renamed “white meat”; censors prohibited the publication of the works of D. H. Lawrence, James Joyce, and Henry Miller; and homosexuality was called “the love that dares not speak its name.” But over the past few generations, sexuality has become more open. In recent years, popular culture and the media have transformed what we “know” about sexuality. Not only is sexuality not hidden from view; it often seems to surround and embed itself into all aspects of our lives.

In this chapter, we discuss why we study human sexuality and examine pop- ular culture and the media to see how they shape our ideas about sexuality. Then we look at how sexuality has been conceptualized in different cultures and at different times in history. Finally, we examine how society defines various aspects of our sexuality as natural or normal.

• Studying Human Sexuality The study of human sexuality differs from the study of accounting, plant biol- ogy, and medieval history, for example, because human sexuality is surrounded by a vast array of taboos, fears, prejudices, and hypocrisy. For many, sexuality

Voices Student

Nature is to be reverenced, not blushed at.

—Tertullian (c. 155 ce–c. 220 ce)

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Studying Human Sexuality 3

creates ambivalent feelings. It is linked not only with intimacy and pleasure but also with shame, guilt, and discomfort. As a result, you may find yourself con- fronted with society’s mixed feelings about sexuality as you study it. You may find, for example, that others perceive you as somehow “unique” or “different” for taking this course. Some may feel threatened in a vague, undefined way. Parents, partners, or spouses (or your own children, if you are a parent) may wonder why you want to take a “sex class”; they may want to know why you don’t take something more “serious”—as if sexuality were not one of the most important issues we face as individuals and as a society. Sometimes this uneas- iness manifests itself in humor, one of the ways in which we deal with ambiv- alent feelings: “You mean you have to take a class on sex?” “Are there labs?” “Why don’t you let me show you?”

Ironically, despite societal ambivalence, you may quickly find that your human sexuality text or ebook becomes the most popular book in your dormi- tory or apartment. “I can never find my textbook when I need it,” one of our students complained. “My roommates are always reading it. And they’re not even taking the course!” Another student observed: “My friends used to kid me about taking the class, but now the first thing they ask when they see me is what we discussed in class.” “People borrow my book so often without asking,” writes one student, “that I hide it now.”

As you study human sexuality, you will find yourself exploring topics not ordinarily discussed in other classes. Sometimes they are rarely talked about even among friends. They may be prohibited by family, religious, or cultural teaching. For this reason, behaviors such as masturbation and sexual fantasizing are often the source of considerable guilt and shame. But in your human sexu- ality course, these topics will be examined objectively. You may be surprised to discover, in fact, that part of your learning involves unlearning myths, factual errors, distortions, biases, and prejudices you learned previously.

Sexuality may be the most taboo subject you study as an undergraduate, but your comfort level in class will probably increase as you recognize that you and your fellow students have a common purpose in learning about sexuality. Your sense of ease may also increase as you and your classmates get to know one another and discuss sexuality, both inside and outside the class. You may find that, as you become accustomed to using the accepted sexual vocabulary, you are more comfortable discussing various topics. For example, your communication with a partner may improve, which will strengthen your relationship and increase sexual satisfaction for both of you. You may never before have used the word masturbation, clitoris, or penis in a class setting or any kind of setting, for that matter. But after a while, using these and other terms may become second nature to you. You may discover that discussing sexuality academically becomes as easy as discussing computer science, astronomy, or literature. You may even find yourself, as many students do, discussing with your friends what you learned in class while on a bus or in a restaurant, as other passengers or diners gasp in surprise or lean toward you to hear better!

Studying sexuality requires respect for your fellow students. You’ll discover that the experiences and values of your classmates vary greatly. Some have little sexual experience, while others have a lot of experience; some students hold progressive sexual values, while others hold conservative ones. Some students are gay, lesbian, queer, bisexual, or asexual individuals, while the majority are heterosexual people. Most students are young, others middle-aged, some

Educating the mind without educating the heart is no

education at all.

—Aristotle (384 B.C.–322 B.C.)

Taking a course in human sexuality is like no other college experience. It requires that students examine their sexual beliefs and behaviors in the context of a wide variety of social and cultural factors and incorporate this new perspective into their sexual lives and well-being. © Andersen Ross/Getty Images

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4 Chapter 1 Perspectives on Human Sexuality

older—each in a different stage of life and with different developmental tasks before them. Furthermore, the presence of students from any of the numerous ethnic groups in the United States reminds us that there is no single behavior, attitude, value, or sexual norm that encompasses sexuality in contemporary America. Finally, as your sexuality evolves you will find that you will become more accepting of yourself as a sexual human being. From this, you will truly “own” your sexuality.

• Sexuality, Popular Culture, and the Media Much of sexuality is influenced and shaped by popular culture, especially the mass media. Popular culture presents us with myriad images of what it means to be sexual. But what kinds of sexuality do the media portray for our consumption?

Media Portrayals of Sexuality What messages do the media send about sexuality to children, adolescents, adults, and older people? To men and women and to those of varied races, ethnicities, and sexual orientations? Perhaps as important as what the media portray sexually is what is not portrayed—masturbation, condom use, and older adults’ sexuality, for example.

The media are among the most powerful forces in people’s lives today. Adults ages 18 and over spend more time engaging with the media than in any other activity—an average of 12 hours per day, 7 days per week (see Figure 1). Watch- ing TV, playing video games, texting, listening to music, and searching the Internet provide a constant stream of messages, images, expectations, and values about which few (if any) of us can resist. Whether and how this exposure is related to sexual outcomes is complex and debatable, depending on the popula- tion studied. However, the data that are available may provide an impetus for policymakers who are forming media policies, parents who are trying to support their children’s identity and learning, and educators and advocates who are con- cerned about the impact of media on youth and who wish to underscore the

One picture is worth more than a thousand words.

—Chinese proverb

© Robert Landau/Alamy

Images of sexuality permeate our society, sexualizing our environment. Think about the sexual images you see or hear in a 24-hour period. What messages do they communicate about sexuality?

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Sexuality, Popular Culture, and the Media 5

potential impact of media in individuals’ lives. For those concerned about pro- moting sexual health and well-being, understanding media’s prominence and role in people’s lives is essential.

Mass-media depictions of sexuality are meant to entertain and exploit, not to inform. As a result, the media do not present us with “real” depictions of sexu- ality. Sexual activities, for example, are usually not explicitly acted out or described in mainstream media, nor is interracial dating often portrayed. The social and cultural taboos that are still part of mainstream U.S. culture remain embedded in the media. Thus, the various media present the social context of sexuality; that is, the programs, plots, movies, stories, articles, newscasts, and vignettes tell us what behaviors are appropriate (e.g., kissing, sexual intercourse), with whom they are appropriate (e.g., girlfriend/boyfriend, partner, heterosexual), and why they are appropriate (e.g., attraction, love, to avoid loneliness).

Probably nothing has revolutionized sexuality the way that access to the Internet has. A click on a website link provides sex on demand. The Internet’s contributions to the availability and commercialization of sex include live images and chats, personalized pages and ads, and links to potential or virtual sex partners. The spread of the web has made it easy to obtain information, solidify social ties, and provide sexual gratification.

The music industry is awash with sexual images too. Contemporary pop music, from rock ’n’ roll to rap, is filled with lyrics about sexuality mixed with messages about love, rejection, violence, and loneliness. With the average young

12:05Total

Other 0:45

0:20Magazines

0:30Newspapers

Print** 0:32

Radio 1:26

TV 4:31

0:36Other

2:21Mobile (nonvoice)

2:19Online*

5:16Digital

0

Note: Ages 18+; time spent with each medium includes all time spent with that medium, regardless of multitasking; for example, 1 hour of multitasking online while watching TV is counted as 1 hour for TV and 1 hour for online; *includes all Internet activities on desktop and laptop computers; **ofine reading only.

1 2 3 4 5 6 7 8 9 10 11 12 13 Hr/Min

• FIGURE 1 Average Time Spent per Day in the United States with Media, Aged 18+ and Over, 2013. Includes all time spent with medium, regardless of multitasking.

(Source: www.eMarketer.com [July 2013].)

Would you like to come back to my place and do what I’m going to tell

my friends we did anyway?

—Spanky

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www.eMarketer.com
6 Chapter 1 Perspectives on Human Sexuality

person consuming approximately 2.5 hours of music each day (Roberts, Foehr, & Rideout, 2010), some research has found that increased exposure to sexualized music lyrics has the potential to negatively impact the development of healthy and equitable sexual attitudes of adolescent males and females (Hall, West, & Hill, 2011). Because of censorship issues, the most overtly sexual music is not played on the radio but can easily be streamed through the Internet, which we now recognize is available to nearly everyone.

Magazines, tabloids, and books contribute to the sexualization of our society as well. For example, popular romance novels and self-help books disseminate ideas and values about sexuality and body image. Men’s magazines have been singled out for their sexual emphasis. Playboy, Men’s Health, and Maxim, with their Playmates of the Month, sex tips, and other advice, are among the most popular magazines in the world. Sports Illustrated’s annual swimsuit edition, which is now a $1 billion empire, excites millions of readers who await the once-a-year feature (Spector, 2013). But it would be a mistake to think that only male-oriented magazines focus on sex.

Women’s magazines such as Cosmopolitan and Glamour have their own sexual content. These magazines feature romantic photographs of lovers to illustrate stories with such titles as “Sizzling Sex Secrets of the World’s Sexiest Women,” “Making Love Last: If Your Partner Is a Premature Ejacula- tor,” and “Turn on Your Man with Your Breasts (Even If They Are Small).” Preadolescents and young teens are not exempt from sexual images and arti- cles in magazines such as Seventeen and YM. In fact, of the top four teen magazines aimed at girls, 44% of the articles focused on dating and 37% on appearance ( American Academy of Pediatrics, 2014.1a). Given this heavy emphasis on looks, it’s not surprising that for those who read a lot of women- focused magazines, they are more likely to have internalized the thin ideal, have negative views of their appearance, and engage in restricted eating and bulimic behaviors (Northrup, 2013). Some of the men’s health magazines have followed the lead of women’s magazines, featuring sexuality-related issues as a way to sell more copies.

Advertising in all media uses the sexual sell, promising sex, romance, popularity, and fulfillment if the consumer will only purchase the right soap, perfume, cigarettes, alcohol, toothpaste, jeans, or automobile. In reality, not only does one not become “sexy” or popular by consuming a certain product, but the product may actually be detrimental to one’s sexual well-being, as in the case of cigarettes or alcohol.

Media images of sexuality permeate a variety of areas in people’s lives. They can produce sexual arousal and emotional reactions, provide social con- nection, entertain, increase sexual behaviors, and be a source of sex informa- tion. On the other hand, unmonitored Internet access among youth raises significant concerns about its risks (Federal Bureau of Investigation, 2014). Given the fact that 91% of 12- to 13-year-old girls have Internet access and 72% have mobile access via smartphones, tablets, and other devices, it’s clear that media consumption and exposure explode between the early and later tween years (Jones, 2014).

Studies examining the impact of exposure to sexual content in media have found a modest but significant association between adolescents’ sexual beliefs and early sexual initiation. When studies collectively examine adolescents’ online exposure to pornography, they suggest that youth may develop unrealis- tic sexual values and beliefs (Owens, Behun, Manning, & Reid, 2012).

Women’s magazines such as Cosmopolitan, Women’s Health, and Glamour use sex to sell their publications. How do these magazines differ from men’s magazines such as Men’s Health, Playboy, and Maxim in their treatment of sexuality? © Consumer Trends/Alamy

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Sexuality, Popular Culture, and the Media 7

Gender differences in self-concept have also been noted in adolescents’ use of pornography, with girls reporting feelings of physical inferiority, while boys fear they may not be as virile or able to perform compared to those in these media (Lofgren-Martenson & Mansson, 2010). As such, it isn’t surprising that self-objectification, choosing to evaluate ourselves based on appearance, has received some scrutiny from the American Psychological Association (2007), which warns that young people “may internalize an observer’s perspective on their physical selves and learn to treat themselves as objects to be looked at and evaluated for their appearance” (p. 18).

Television and Digital Media Among all types of media, television and digital (online and mobile) have been the most prevalent, pervasive, and vexing icons, saturating every corner of public and private space, shaping consciousness, defining reality, and enter- taining the masses. Between ages 12 and 17, the average youth spends over 100 hours a month watching TV and online videos (see Figure 2). By the time an American teenager finishes high school, he or she will have spent more time in front of a television or mobile device screen than in the class- room or sleeping. At the same time, most of the consumption of media leaves the majority of young people outside the purview of adult comment and with few messages or images that demonstrate the risks and responsibilities that accompany sexuality.

While the frequency of TV and digital viewing has been increasing, so has been the number of sexual references in programs. Television and digital video viewing are major sources of information about sex for teenagers, contributing to many aspects of young people’s sexual knowledge, beliefs, and behavior. Reporting on the health effects of media on children and adolescents, Stras- burger and colleagues (2010) state that “virtually every Western country makes birth control available to adolescents, including allowing birth control advertise- ments in the media, but the major U.S. television networks balk at airing ads for contraception” (p. 760).

In the accumulated volume of media research, media content does not reflect the realities of the social world; rather, the media images of women and men reflect and reproduce a set of stereotypical and unequal but changing gender roles. For example, women wearing skimpy clothing and expressing their sex- uality to attract attention underscores the objectification of women seen in

Reality shows, such as The Bachelorette, frequently highlight idealized and sexual themes. What are some of the most popular reality shows? Do they differ according to ethnicity? © Raymond Hall/GC Images/Getty Images

• FIGURE 2 Adolescents’ and Young Adults’ Monthly Video Viewing Time by Type of Device, 2012.

Source: The teen transition: Adolescents of today, adults of tomorrow (2013). New York: The Nielsen Company.

12- to 17-year-olds

8 mobile hours

5 online hours

99 TV hours

7 mobile hours

18- to 24-year-olds

15 online hours

111 TV hours

25- to 34-year-olds

5 mobile hours

11 online hours

136 TV hours

112 video hours per month

133 video hours per month

152 video hours per month

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8 Chapter 1 Perspectives on Human Sexuality

many genres of media. And men’s messages are equally unilateral, which is that they should accumulate sexual experience with women by any means pos- sible. Sexist advertising and stereotypical roles in comedy series and dramas may take subtle (or not so subtle) forms that, over time, may have an effect on the way some women and men view themselves. For example, studies exam- ining the effects of television have shown a positive connection between tele- vision viewing and poor self-image and self-esteem, particularly among girls and young women (Tiggemann, 2005). Girls who regularly watch reality tele- vision, for example, are significantly more likely to believe that a girl’s looks are the most important thing about her and are more likely to say they would rather people recognize them for their outer beauty than what’s inside (Girl Scout Research Institute, 2011). While it is apparent that exposure to television does not affect all people in the same way, it is clear that the sexual double standard that does exist taps into our national ambivalence about sex, equality, morality, and violence. In spite of this, television is making strides to educate teens and young adults about sexuality and parenting. Programs such as Teen Mom 2 and 3, Parenthood, East Los High, The Mindy Project, and The Fosters have consulted with organizations such as The National Campaign to Prevent Teen and Unplanned Pregnancy to help educate viewers. This type of alliance is good for all of us.