Masters and johnson researched the aspects of human sexuality

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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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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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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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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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