SexualityReproduction

1
Sexuality/Reproduction
2
Definitions

• Sexuality - the condition of being characterized
  and distinguished by sex (Microsoft Encarta 97
  Encyclopedia).

3
Definitions

• We are sexual beings throughout our lifespan.
  Sex is an expression of love. It's not about
  sperm swimming up vaginas it's about tenderness,
  the desire to please someone we care about. It's
  about being completely at ease with another
  person-and feeling good about that (Cadoff 1997).

4
Sexual Health

• involves both promotion and prevention behaviors
  and the nurturing of healthy personal sexual
  lives.

5
Children

• It is important to raise confident,
  compassionate, and kind children, which will
  teach them more about how to behave in their
  adult relationships than any discussion of
  anatomy

6
Early Sexual Needs

• Teach infants them that people who care about
  them will respond to their needs
• When they cry you pick them up gently and speak
  softly
• You feed them when they're hungry,
• tuck an extra blanket around them when they're
  chilly.
• (Cadoff 1997).

7
Sexual Responses in Infants

• Boys have erections from infancy.
• Frequently explore their genitals
• by the age of ten months deliberately fondle
  themselves
• By age 3 understand the concept of public versus
  private behavior.
• One of the biggest jobs parents have is
  teaching children what's appropriate under what
  circumstances (Cadoff 1997).

8
Importance of Role Modeling

• Children learn how to form happy, loving
  relationships by growing up in a happy, loving
  home.
• From their parents' hugs, passing kisses, and
  friendly pats, a child sees love in operation.
• Many adults whose families never expressed
  affection just don't know how (Cadoff 1997).

9
Childhood Victimization Leads to

• Variety of negative health behavioral
  consequences
• prostitution,
• promiscuity
• teenage pregnancy

10
Adolescence

• Our sexuality, integration of gender sexual
  orientation with self-expression, takes center
  stage in adolescence (Brown 1994).
• The physical, emotional, cognitive growth
  hallmark of the period forms the basis of to
  develop maintain trusting and intimate
  relationships.

11
Antrhopological Findings

• Margaret Mead hypothesized that the crisis of
  adolescent sexuality in our society was a
  function of the complexities turbulence of the
  social system would not exist in a simpler
  culture.
• Her study of female adolescents in Samoa
  concluded that puberty, uninhibited sexual
  activity, and pregnancy did not disrupt the lives
  of these young women.
• Adolescent pregnancy and sexuality were accepted
  as natural lifecycle events.

12
Media Portrayal of Sexuality

• The media in the U.S. reflect the "Jekyll and
  Hyde" attitudes regarding sexuality
• We extol the excitement of sex, we condemn sex
  at a young age premarital sex (Tobias 1998).
• A reluctance to discuss or portray responsible
  sexual behavior instead offer mindless
  constant display of titillating sexuality.
• Our society bombards our adolescents with images
  glamorizing sexual activity.
• Historically, messages of sexual responsibility
  including contraception have been taboo.

13
Piaget's Model

• The completion of developmental tasks complements
  the gradual shift in adolescent cognitive styles.
  
• Adolescents move from concrete to formal
  operations, developing the ability to think
  abstractly.
• The rate of acquisition of these skills is highly
  variable,
• sometimes spanning 10-15 years, with only 35 of
  16- to 17-year-olds possessing the ability to
  move beyond concrete operations.

14
Concrete-thinking adolescents

• Lack the ability to understand consequences of
  high-risk behavior.
• Difficulty understanding cause effect.
• Explanations are based on past experience
  regardless of relevance.
• may leap to the assumption they cannot get
  pregnant fail to understand the need for
  contraception if unprotected intercourse on 1 or
  2 occasions without getting pregnant
• Wrongly assume that if no obvious symptoms they
  cannot be infected with a STD (Tobias 1998).

15
Adolescents are at elevated risk for HIV infection

• Disproportionate impact on minorities.
• More than half the adolescents in the US are
  sexually active,
• 86 of men are sexually active by age 19
• (Braverman 1993).

16
Age at first intercourse (Blum)

• Age Female Male
• 10-11 6.4 14.5
• 12-13 17.0 22.0
• 14-15 42.8 37.6
• 16-17 33.2 25.0

17
Gay Youth

• Feelings of homosexual attraction in a Minnesota
  study
• 5.2 of 12th -grade males and
• 8.5 of 11th -grade females reported (Braverman
  1993 p 66 1).
• Sexual orientation is believed to have a
  biological etiology since identical twins have
  similar sexual orientation
• (Braverman 1993 p 662).

18
Adults
19
Infertility Treatment

• Infertility is defined as having no pregnancy
  after a year of unprotected regular intercourse.

20
Current Options

• Couples with concerns about infertility currently
  have several options.
• medical help,
• adoption,
• becoming foster parents,
• using alternative therapies,
• focusing on other life goals.
• In one study of 131 infertile couples, the
  medical option was chosen in more than 80 of the
  cases. The most frequently mentioned motive was
  the desire to have a child
• (Van Balen 1997).

21
Infertility Treatment

• It has been nineteen years since the birth of the
  first baby via in vitro fertilization.
• New techniques that may soon become available
• intracytoplasmic sperm injection.
• preimplantation genetic diagnosis,
• use of fetal oocytes, and
• cryopreservation of ovarian tissue.
• genetic cloning.

22
Elderly

• Common myths / misinformation on sexuality
• intercourse and ejaculation of semen are
  debilitating will hasten the onset of old age
• older women who still enjoy sex were probably
  nymphomaniac when thy were younger.
• we are not sexually desirable, desirous, or
  capable at an older age.
• 54 of married seniors 65 of women over 70
  years old are sexually active
• How do you think Viagra may have changed these
  numbers in the past few years? (Loehr 1997).

23
Special Groups
24
Lesbian

• Lesbians est. 5 of the female population
• 12.5 of women have had incidental homosexual
  experiences.

25
Lesbian

• Risks for multiple psychosocial problems
• rejection by family, friends,
• poor school performance,
• a higher drop out rate,
• verbal and physical abuse (34),
• homelessness,
• substance abuse (39),
• childhood abuse (20),
• depression (49),
• suicide (27) (Lehmann 1998).

26
Gay Males

• 17 of males have been involved in a homosexual
  encounter by the age of 19.

27
Increased Medical Risk for Gays

• STDs
• HIV infection,
• Between Jan-June 1989 Jan-June 1994, AIDS among
  gay couples incr. 31 from 12.1 to 15.9 cases
  per 100,000 males 13 years old or older.
• Rate increased 51 in Midwest (MM WR Weekly,
  6-2-95).
• hepatitis,
• cytomegalovirus,
• enteric pathogens,
• genital trauma leading to hemorrhoids and
  fissures, and
• fecal incontinence (Braverman 1993).

28
Disabled

• Sexually functional but may be unable to perform
  intercourse without assistance.  

29
Prevalence

• In the news a variety of sexually related
  headlines
• President Clinton
• Robert Leroy Anderson
• Michael Jackson
• cloning of animals,
• many others.

30

• In the US there were an estimated 1 million
  pregnancies among women 15-19 years old,
• 95 of teenage pregnancies unintended.
• Average age of sexual initiation in one sample
  was 13.8 years.

31
STD'S

• The US has the highest rates of STDs in the
  industrialized world
• 50100 times gt than other industrialized nations.
  
• An estimated 12 million new cases of STDs occur
  in the US each year.
• gt 85 of the most common infectious diseases in
  the US are sexually transmitted. (CDC)
• half of all HIV infection in the US occurs gt
  age of 25.

32
US estimated

• 4,000,000/yr new cases of Chlamydia
• 800,000/yr new cases of Gonorrhea
• 500,000-1,000,00 /yr new cases of Human Papilloma
  virus (HPV) (high risk for cervical cancer)
• 200,000-500,000/yr new cases of Genital Herpes
• 101,000 /yr new cases of syphilis
• 40,000-80,000/yr new HIV infections

33
Teenagers

• Pregnancy rate
• One million US teenage women
• 12 of all 15-19 year-olds (CDC).
• gt 50 of all teenage pregnancies occur during the
  first 6 months of sexual activity gt 20 occur in
  the first month.
• Three million teenagers acquire a sexually
  transmitted infection,
• adolescents account for 25 of the new sexually
  transmitted infections in the US.

34
Costs to the Individual and Society

• STD's add 17 billion dollars to the nations
  health care costs each year.
• HIV infection is a leading cause of death among
  15-24-year-olds in the US. Three million cases
  of STDs annually in teens.

35
South Dakota Teen Pregnancy

• One million pregnant teens in the US ea. yr.
• In SD in 1990 1,425 pregnancies in women age
  15-19, (56.9/1,000)
• lower than the national average.
• abortion rates declined in SD from 1980 to 1990.

36
Costs of Teenage Pregnancies

• 1985 - 1990, the public costs (through AID to
  Families with dependent Children, Medicaid, and
  food stamps) related to teenage pregnancies
  120.3 billion dollars.
• Est. 48.1 billion dollars could have been saved
  if each birth had been postponed until the mother
  was at least 20 years old (Spitz 1993).

37
Gay Teens

• 110 adolescents struggle with sexual orientation
  issues.
• Study of involvement in a homosexual encounter by
  the age 19
• 6 of females
• 17 of males (Baverman 1993).

38
Risk Factors for Unsafe Sexual Activity (Beitz
1998)

• Recent loss or change
• Lower cognitive development
• School nonattendance
• History of sexual abuse
• Substance abuse
• Previous sexual behavior Early intercourse
• Low self-efficacy (especially for contraception)
• Stressed of depressed mental state

• Low internal health locus of control
• Male gender
• Poor communication with parents
• Low self-esteem
• Religious Noninvolvement
• Peer and sibling sexual activity
• Irresponsible media influences
• Scholastic underachieving

39
Interventions

• Abstinence is greatest sexual health promotion
  behavior available to Americans, but abstinence
  cannot be the sole focus in a sexual health
  curriculum because most Americans will ultimately
  become sexually active (Beitz 1998).
• Britain operates a national network of free,
  open-access STD clinics responsible for STD
  reporting.
• These clinics are thought to treat the majority
  of STDs and are known to be used by all sectors
  of the population (Michael 1998).

40
Interventions

• Former Surgeon General C. Everett Koop suggested
  that many of the serious problems of the US
  derive from its inadequate sex education
• (from Beitz 1998, p32).

41
Interventions for Parents

• gt comprehensive or broader messages encompassing
  a greater number of sex-related topics that were
  delivered by the mother were associated with less
  sexual risk behavior among adolescents.
• Mothers who were skilled communicators about
  sex-related topics were gt likely to discuss a
  broad range of sex-related topics with their
  adolescent, more likely to be heard by their
  adolescent during those discussions.

42
Sexual Violence

• Among women with disabilities
• 51 to 79 have had cases of reported sexual
  violence.
• 88 to 98 of perpetrators are male for these
  victims.
• Up to 30 of gay male teens attempt suicide.

43
Sexual Addiction

• Any driven-type of repetitive sexual behavior,
  characterized by extraordinary frequency of
  sexual activity as well as revolving partners
  (usually more than one encounter a day), all
  devoted to alleviating the underlying
  psychological pain (depression anxiety).

44
Classification Diagnoses for Addictive Sexual
Behavior

• satyriasis, nymphomania, paraphilias
  (perversions), obsessive-compulsive disorders,
  impulse control disorder, compulsive sexual
  behavior, and sexual addiction.
• What these people have in common is depression,
  anxiety, and low self-esteem that is
  self-medicated with hypersexual activity (Myers
  1995).

45
Compulsive Sexual Behavior

• Compulsive sexual behavior - has symptoms of a
  person preoccupied with sexual gratification
  leading to a disruption in daily life.
• This sexual behavior may be categorized as legal
  (multiple partners, compulsively cruising,
  pornography) or illegal (voyeurism, public
  masturbation, exhibitionism). In either case,
  the behavior is compulsive (Watter 1992).

46
Recognition DX of Sexual Addictions

• Ask the patient about relationships.
• Is he or she married?
• Are you in a steady relationship?
• How is it going?
• Is the sex satisfying?

47
Gender Issues in Sexual Addictions

• Much more is written about men and sexual
  addictive behavior than women
• Women, are not perceived as threatening
• Women engage in repetitive sexual behavior, but
  men tend not to report the behavior.
• A man who sees a woman exposing herself in public
  is more likely to appreciate the view than report
  it women are more likely to call the police when
  faced with similar circumstances

48
Hypersexual Activity likely Sign of a Sexual
Addiction

• C/O inability to find enough partners
• Differential DX 20 of the population suffers
  from a form of mental distress at some point
• 10 - 15 are affected by depression
• 6 - 8 by mood swings or low moods
• Hallmark low libido
• People with sexual addiction appear depressed,
  yet exhibit hypersexual behavior

49
Psychotherapist or Sex Therapist Referral

• Manage repetitive or compulsive sexual behavior
  must same as those addicted to alcohol or drugs
• Sexual addiction cuts across gender and sexual
  orientation fairly evenly.
• Presence of depression or a tendency to exhibit
  compulsive addictive behavior manifests itself as
  a sexual disorder