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Sexually Transmitted Diseases
- Diseases spread through sexual contract:
- -Vaginal
- -Anal
- -Oral
- 65 Million in the U.S. have an STD
- 15 Million new cases per year
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Modes of Transmission
- Direct sexual contact or sexual contact with someone's infected semen, vaginal secretions, blood or body fluids.
- Maternal transfer
- Sharing contaminated needles through injectable drug use.
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Chalmydia
- Source
- -Bacterium
- Incubation Period
- -1-30 days
- Signs and Symptoms
- -Males: watery (milky, white) discharge, pain upon urination
- -Females: watery (mikly white) discharge, PID
- -50% of men and women do not have any symptoms.
- Diagnosis
- -Culture discharge
- Treatment
- -Antibiotics
- Epidemiology
- -Most prevealent sexually transmitted bacterial pathogen in the U.S.
- -3 million cases annually
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Gonorrhea
- Source
- -Bacterium
- Incubation Period
- -1-30 days
- Signs and Symptoms
- -Males: pus discharge, pain upon urination, can lead to sterility
- -Females: usually asymptomatice, PID, can lead to sterility.
- Diagnosis
- -Culture discharge
- Treatment
- -Antibiotics
- -Not curable in late stages
- Epidemiology
- -350,000 cases reported annually in U.S.
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Genital Herpes
- Source
- -Virus
- Incubation Period
- -2-12 days
- -Can be transmitted to newborn during delivery
- Signs and Symptoms
- -Vesicles
- -Vesicles break down, crust over and form painful ulcers.
- -Entire first episode takes 15-20 days
- -Flu-like symptoms
- Recurrence
- -5 to 8 times per year
- -10 days per episode
- -Frequency and severity diminish with time
- Treatment
- -No cure
- -Antiviral therapies
- Epidemiology
- -45 million in U.S. infected
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Nongonococcal Urethritis (NGU)
- Source:
- -Bacterium
- -infection in urethra of males caused by chlamydia bacteria
- Signs and Symptoms:
- -Discharge
- -Pain upon urination
- Treatment:
- -Antibiotics
- Epidemiology:
- -3 Million cases annually
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Venereal Warts (HPV)
- Source:
- -Virus
- Incubation Period:
- -3 Months
- Signs and Symptoms:
- -Cauliflower-like growths in genital and rectal areas
- -Some individuals do not have any symptoms
- Diagnosis:
- -Presence of lesions
- Cervical Cancer:
- -HPV is indicated in 80% of all cervical cancer cases
- Treatment:
- -Removal of lesions by laser surgery or chemical
- -Not curable
- Epidemiology:
- -20 million Americans
- -Routine testing at 4 locations yielded the following results:
- --9% of women seeking routine Pap smears at OB/GYN offices tested positive.
- --9-45% of women attending health services in a university health center had positive results
- --23% of women attending a family planning clinc were positive.
- --82% of street prostitues in a select study were positive.
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Syphilis
- Source:
- -Bacterium
- Incubation Period:
- -3 to 4 weeks
- Signs and Symptoms:
- -Primary
- --Chancre
- ---A painless indurated primary lesion of early syphilis
- ---Internal, vagina or anus
- ---Disappears within 1-5 weeks
- -Secondary
- --Rash, 6 weeks later
- --Appears on trunk, or mild on hands, or feet
- --Disappears without treatment 2-6 weeks
- -Latency
- --Damage to central nervous system
- --Can transmit by donating blood
- --Congenital syphilis
- Diagnosis:
- -Blood Test
- Treatment:
- -Penicillin or other antibiotic
- Epidemiology:
- -Reduced numbers due to penicillin
- -Mini epidemics in major metropolitan areas
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Chancroid
- Source:
- -Bacterium
- Incubation Period:
- -4-10 days
- Signs and Symptoms:
- -Chancre
- --Granular, painful erosions
- --Painful, swollen lymph glands in the groin
- Treatment:
- -Antibiotics
- Epidemiology:
- -Not common in U.S.
- -Epidemics in developing countries
- -Predominance in black and Hispanic males; prostitution
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HIV/AIDS
- Source:
- -Virus
- --Disease of the immune systems
- Transmission:
- -Person-to-person
- --Sexual contact-anal or vaginal
- --Sharing contaminated needles-IDU
- --Maternal-to-fetal transmission
- Diagnosis:
- -Incubation period (window period)
- --8 weeks to 6 months
- -Blood test- detect HIV antibodies
- --ELISA
- --Western Blot- confirmatory test
- -Oral test-detect HIV antibodies
- --Saliva
- Signs and Symptoms:
- -Asymptomatic at first
- -Early Symptoms
- --fatigue, diarrhea, fever, night sweats, skin rashes, sudden weight loss, dry cough, swollen lypmh glands, vaginal or oral yeast infections
- -Opportunistic Infections:
- --Infections that individuals get due to a weakened immune system
- Treatment- No Cure
- -Some medications available to lesson symptoms and opportunistic infections
- -AZT, other antiviral medication
- --Prevents and slow replication of HIV
- -Protease Inhibitors
- --Acts as an enzyme to prevent replication of HIV-infected cells
- -HAART (Highly Active Antiroviral Therapy)
- -Halts the spread of the virus
- -Reducing viral loads
- -HIV infected individuals living longer, better quality of life.
- Epidemiology:
- -AIDS is reportable by law in U.S.
- -Majority of cases among males
- -57% of AIDS patients have died
- -Since 1996, there has been dramatic decline in the number of AIDS caese
- -Slight increase among heterosexual contact from 1998-2001
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Hepatitis B Virus (HBV)
- Source:
- -Virus
- -Attacks the liver
- --Can cause extreme illness and death
- Diagnosis:
- -Blood test
- Signs and Symptoms:
- -Jaundice
- -Dark urine
- -Fever
- -Malaise
- -Moderate liver enlargement and tenderness
- Treatment:
- -No cure
- -Boost the immune system
- -Vaccine available
- Epidemiology:
- -5% of U.S. population has HBV
- --Risks
- ---Heterosexual males and gay men
- ---Sexual transmission most common
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Pubic Lice
- Transmission:
- -Sexually
- -Clothing, bedding, towels
- -Nits, eggs, attach to shaft of hair
- Signs and Symptoms:
- -Visual confirmation of lice
- -Intense itching
- -Skin irritation
- -Sore from scratching
- Treatment:
- -Shampoos to kill nits
- -Bedding and other clothing must be washed
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Scabies
- Diagnosis:
- -Infestation with mite
- -Burrow under skin
- Treatment
- -Special lotion that is left on skin 8-24 hours
- -May need more than one application
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STD/HIV Prevention and Risk Reduction Model
- Sexual Behavior
- Sexual Relationships
- Sexual/Medical History
- Demographic variables
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Demographic Variable: Age
- More cases among 15-25 year olds
- -earlier onset
- -mutliple partners
- -unprotected
- -cervical tissue more susceptible
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Demographic Variable: Gender
- Women are at a greater risk of acquiring STDs:
- -Heterosexual women are receptive sexually
- -Asymptomatic in women
- -Menstruation facilitates movement of pathogens
- -Transmission to fetus or newborns
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Demographic Variable: Sexual Orientation
- Heterosexual women
- Gay and bisexual men
- Heterosexual men least at risk
- Lesbians have lowest rates of infection
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Demographic Variable: Injectable Druge Use
- Use of pscyhoactive drugs impair ability to make good decisions
- --Sex and drug use
- Sharing needles
- --Crack cocaine, heroin
- --Steroid
- Infections remain in syringe
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Demographic Variable: Urban and Rural, Geographic Differences
STDs and HIV are higher in urban areas
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Demographic Variable: Socioeconomic Status (SES)
- People of lower SES tend to lack enabling factors related to prevention and treatment
- People of lower SES do not perceive themselves to be at risk for STD/HIV
- Poverty contributes to higher levels of drug use which is a risk factor for STD/HIV
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Demographic Variable: Race/Ethnicity
- African Americans and Hispanics have highest rates
- Social class and poverty contribute to risk
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Sexual/Medical History
- Lifetime number of sexual partners
- Contraceptive use
- History of injected drug use
- Prior STD history
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Familiarity Risk
Know the person before you have sex with them
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Exclusivity Risk
Both must agree that the relationship is monogamous
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Sexual Behavior: Lowest Risk
- Noninsertive
- No exchange of body fluids
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Sexual Behavior: Midlevel Risk
- Insertive and protected sex
- Insertive and not protected
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Sexual Behavior: Highest Risk
Insertive and not protected including ejaculation
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Latex Condoms
- More effective against: gonorrhea, chlamydia, trich, and HIV
- Prevents transmission from mucosal surfaces
- Not reliable for prevention of transmission by skin-to-skin contact
- -HPV, Herpes, Syphilis
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Women-Centered Barriers
- Sponge, diaphragm, spermicides:
- -Reduced STD infection rate among barrier users
- -Lower STD infection rate for women who attend STD clinics and use barrier methods
- -Up to 70% effective against gonorrhea when using barriers
- -Up to 40% effective against chlamydia when using barrriers
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Fertilization and Conception
Union of the sperm and ovum
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Ovulation
Release of ovum from on ovary
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Predicting Ovulation
- Cervical mucous
- Body Temperature
- Ovulation kits
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Fallopian Tubes
Fertilization occurs
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Sperm
- Ejaculation contains 250-500 million sperm
- Only a few hundred get close to ovum
- Fertilin
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Uterus
- Implantation
- -The attachment of a fertilized egg to lining of uterus
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Embryo
Fertilized egg up to 8 weeks
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Fetus
Fertilized egg from 8 weeks to birth
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Pregnancy Confirmation
- Human Chorionic Gonadotropin (HGC)
- Home pregnancy tests are 85-95% accurate
- Medical confirmation necessary
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Pregnancy: Gestation
- Averaging 40 weeks
- Premature delivery prior to 38 weeks
- Due Date: First day of last menstrual period, subtract 3 months, then add 7 days
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Pregnancy: First Trimester
- Amniotic Fluid
- -Transparent liquid contained in the amniotic sac
- Placenta
- -An organ that attachs to the uterine wall and serves as a conduit for oxygen and nutrients to pass to the developing fetus
- At the end of 3 months:
- -Fetus has arms, legs, feet, toes, fingers, and vital organs for body systems.
- -Most vulnerable time for fetal development
- --teratogenic effects
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Pregnancy: Second Trimester
- By the end of 5 months:
- -Fetal movement is active enough for mother to feel
- -Sex organs have developed
- -Eyebrows and eyelashes have developed
- Some babies can survive if delivered at the end of 6 months
- -NICUs
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Pregnancy: Third Trimester
- Respiratory system is last to develop
- -Could cause damage to fetus if delivered early
- --Medication available to help mature the lungs and also prevent bronchiospasms in preemies
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Effects of Pregnancy
- Physical: Prenatal Care
- Psychological: Mothers and Fathers
- Social: Families
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Lovemaking During Pregnancy
- May experience a progressive decline in sexual desire
- Personal reactions vary
- Sexual activities
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Prenatal Care: Nutrition
- Balanced Diet
- Prenatal Vitamins
- More folic acid
- Appropriate weight gain
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Prenatal Care: Exercise
- Association with fewer c-sections
- Do not begin a new, strenuous, exercise program
- 15 minute rule
- Body temperature at 100F or lower
- Heart rate at 140 or lower
- Myth: If you exercise too much, you can have a miscarriage
- Benefits
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Drug Use During Pregnancy
- Do not take any medication without consulting a physician
- NO cigarrette use
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Fetal Alcohol Syndrome
- Effects:
- -Facial abnormalities
- -Mental retardation
- -Nervous system damage
- Some states can terminate parental rights
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Prenatal Screenings
- Uterine measurement
- Blood pressure
- Weight check
- Chorionic villus sampling
- -screening for genetic abnormalities
- Ultrasound
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Alpha-fetoprotein
- Blood sample
- High level indicates neural tube defects
- -Anencephaly: brain is underdeveloped
- -Spina Bifida: spinal cord is exposed
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Urine Tests
Gestational diabetes
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Labor and Delivery
- Hospital Births (traditional delivery)
- Home births
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The Childbirth Process
- 12-14 hour process
- Beginning of Labor Signs
- -uterus begins to contract
- -mucous plug covering cervix is dislodged
- -rupture of amniotic membrane
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Childbirth: First Stage
- Longest Stage
- Dilation of cervix to 10 cm
- Effacement
- Pain management- epidural
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Childbirth: Second Stage
- Birth of baby
- -pushing stage
- Episiotomy
- -surgical cutting of the perineum to facilitate childbirth
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Childbirth: Third Stage
- Delivery of the Afterbirth
- -The placenta, umbilical cord, and membranes expelled after the birth of the child
- -Take approx. 15 minutes
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Indications for a Cesarean Delivery
- Breech Position
- Baby's head too large to pass through pelvic region
- Fetal distress
- Prolonged labor
- Problems with placenta
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Postpartum
- The time after birth
- Hormones
- Emotional Concerns
- Lack of Sleep
- Recovering from physcial aspects of pregnancy, labor, and delivery
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Breastfeeding
- Numerous health benefits
- -Immunity
- -Encourages better mouth and tooth development
- -Reduces chances of obesity in children
- Convenient and economical
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Infertility
Inability to conceive after one year of unprotected intercourse.
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Sterility
- Purposeful action-vasectomy or tubal ligation
- Disease
- Cancer treatments
- Removal of uterus or ovaries
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Infertility: Women
- Lack of ovulation
- Hormonal imbalances
- Scar tissues in uterus or fallopian tubes
- Habitual miscarriages
- Production of antisperm antibodies
- Advanced age
- Cigarette smoking
- Drug use
- Excessive dieting and exercising
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Infertility: Men
- Sperm productino
- Hormone deficiencies
- Drug use
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Infertility: Women Diagnosis
- Physical assessments
- Medical and sexual history
- Charting menstrual cycle
- Basal body temperature
- Blood work
- Endometrial biopsies
- Hysterosalpingogram
- Postcoital cervical mucous test
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Infertility: Men Diagnosis
- Physcial assessment
- Medical and sexual history
- Check sperm
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Infertility: Women Treatment
- Absence of ovulation
- --Hormones
- Pelvic Surgery
- --Removal of endometrial tissue
- --Myomectomy
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Infertility: Men Treatment
- Sperm production
- --Lifestyle changes
- --Hormone treatment
- --Surgery to remove varicocele
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Infertility: In Vitro Fertilization
- Ova are removed from the woman's body and fertilized with sperm in a lab
- The embryo is surgically implanted into her uterus
- Success rates decline as woman ages
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Choosing a Method
- Safe and effective
- Adverse health conditions
- Affect sexual lifestyle
- Religious considerations
- Cultural considerations
- The best method is one that is used consistently and correctly
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Methods that Prevent the Sperm from Reaching the Egg: Coitus Interruptus (Withdrawal)
- Actual-use effectiveness: 65-70%
- Causes pregnancy due to human error and sex during peak fertility
- No STD protection
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Methods that Prevent the Sperm from Reaching the Egg: Fertility Awareness or Natural Family Planning
- Avoiding unprotected intercourse during peak fertility
- Determine ovulation:
- -Calendar
- -Basal Body Temperature
- -Cervical mucous
- -Combination of all the above
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Calendar Method
- Estimate future ovulation
- Need to track menstrual cycle for at least 8 months to determine average ovulation time
- Deteremine the "safe zone"
- Avoid unprotected vaginal intercourse during unsafe days
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Cervical Mucous Method
- Changes in cervical mucous to determine ovulation
- Combine method with calendar for maximum effectiveness
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Basal Body Temperature
- Basal Body Thermometer
- Chart temperature for 3 months
- Record temperature on a grid
- Normally, 12 to 24 hours prior to ovulation, the BBT will drop
- Next subsequent rise in temperature will indicate ovulation
- Combine with mucous and calendar methods for maximum prediction of ovulation
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Barrier Methods
Mechanical, chemical, or combination barrier between sperm and egg
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Mechanical
- Condoms (male and female)
- Diaphragm
- Sponge
- Cervical Cap
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Chemical
Spermicidal barriers
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Male Condom
- Latex
- Polyurethane
- Natural lamb membrane
- How it works:
- Covers penis and trapping ejaculate
- Pregnancy prevention
- Some STD prevention
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Male Condom: Latex
- Variety of shapes, colors, and sizes
- Theroretical use: 98%
- Actual Use: 88%
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Male Condom: Natural Lamb Membrane
- Made from intestines of lambs
- Fit more loosely than latex
- With or without spermicides
- Effective for pregnancy prevention
- Not effective for STD prevention
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Female Condom
- Polyurethane
- Lose-fitting pouch, one size
- Pregnancy and STD protection
- Non-prescription
- Theoretical Use: 95%
- Actual Use: 79%
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Diaphragm
- Rubber dome inserted into the vagine and placed over the cervix
- Use with spermicide
- Limited protectoin against STDs
- Must be fitted by health care professional
- Theoretical Use: 94%
- Actual Use: 84%
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Cervical Cap
- Small, thimblle-shaped rubber cap
- Fits snugly on cervix by suction
- Must be fitted by health care professional
- Limited protection against STDs
- Different than diaphragm
- Theoretical Use: 94%
- Actual Use: 40%
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Rape
- Sexual intercourse without the consent of the man/woman and effected by force, duress, intimidation or deception as to the nature of the act.
- 95% of rapes are committed by men against women
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Facts About Rape
- Rape is about violence
- Women do not want to be raped
- Rapists are not mentally ill
- Everyone is responsible for preventing rape
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Posttraumatic Stress Disorder (PTSD)
- A syndrome developing after exposure to an extremely traumatic event
- Victim or the witness to the event
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Acquaintance Rape
- Date Rape
- -Forced sexual intercourse by a person whom the victim knows
- Most common and least reported of all forms of rape
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What to Do If You Have Been Raped
- Get to a safe place
- Call someone you trust to stay with you
- Go to a hospital emergency room immediately
- Call local police
- Write down as much as you can remember
- Talk with a counselor
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Sexual Coercion
Persuasive or forcing someone into something
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Sexual Aggression
Doing anything sexually aggressive to another person without their consent
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The Sexual Victimization of College Women
- The National College Women Sexual Victimization Study (NCWSV)
- -Estimate the incidence of sexual victimization of college women
- Comprehensive representative sample of college women in U.S.
- Questioned if subject had experienced a sexual victimization event
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NCWSV Results
- 2.8% had experienced a completed rape or attempted rape
- Some women were raped by definition but did not personally feel they were raped
- 9 out of 10 women knew the perpetrator
- Overall, 15% of the women had been sexually victimized
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Risk Factors Associated with Rape:
- Frequently drinking to get drunk
- Being unmarried
- Having a history of previous sexual assaults
- Living on campus
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Binge Drinking is Associated With:
- Unplanned and unsafe sexual activity
- Physical and sexual assault
- Criminal violations
- Physical injury
- Interpersonal problems
- Academic Perfromance
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Rohypnol
Depressant that cause a loss of memory and make women vulnerable to uninvited sexual intercourse
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GHB
Depressant that causes amnesia, euphoria, loss of consciousness making women vulnerable to sexual assault
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Stranger Rape
- Forced intercourse by a person who is unknown to the victim
- The assailant typically targets the victim
- Most likely to involve guns, knives, other weapons
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Reducing Risk for Stranger Rape
- Plan travel in advance
- Avoid dark and isolated areas
- Take a self-defense course
- Don't list your telephone name in the phone book or on mailbox
- Locks on all doors and windows
- Leave a light on near the entrance
- Get a dog
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Marital Rape
- 13% of married women have been raped by husbands
- 84% of husbands used force
- Peronality traits of husbands
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Statutory Rape
- Sexual intercourse between a person older than the legal age of consent with a partner who is younger than the legal age of consent.
- The legal age of consent varies by state between 12 to 21 years old.
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Incidence of Rape
- Statistics from FBI and Bureau of Justice's National Crime Victimization Survey
- -Definition of rape as a crime:
- --The carnal knowledge of a female forcibly and against her will.
- Rape is one of the least reportable crimes in the U.S.
- Rate is 32 per 100,000 women
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Reasons Related to Reporting a Rape:
- Relationship between victim and rapist
- How the two came together
- Threat of force
- Use of force
- Extent of injury
- Use of medical treatment
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Characteristics of Rapists
- Hostility toward women
- Hostile home environment
- History of delinquency
- Sexual promiscuity
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Sexual Harassment
- Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature in the workplace
- Men and women tend to interpret sexual harassment differently.
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Conditions of Sexual Harassment
- A powerful differential in the relationship
- Inappropriate approach
- Pressure after expression of disinterest
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When Do Rapes Occur?
- At parties
- After midnight
- At their residence
- At a frat house
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Child Sexual Abuse
- Any sexual contact between an adult and a child who is under 18 years of age
- Begins as normal behaviors
- Perpetrator tells child that they are doing nothing wrong and don't tell anyone
- Child Molestation
- Incest
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Child Molestation
Sexual abuse of a child by non-family members
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Incest
Sexual abuse involving genetically related family members
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Preconditions Related to Child Sexual Abuse
- Child Molesters-profile
- Movitation to Abuse
- Internal Inhibitions Against Abuse
- External Inhibitions Against Abuse
- Children's Resistance
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Influences to Abuse:
- Emotional congruence
- Sexual arousal
- Blockage of alternative forms of sexual arousal
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Children's Resistance
- Prey on weaknesses
- Use coercion, threats, punishment, and force
- Prime targets
- Education and support
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Risks fo Child Sexual Abuse
- Having a stepfather
- Ever lived with mother alone
- Not close to mother
- Mother never finishing high school
- Sex-punitive mother
- No physical affection from Father
- Income under $10,000 a year
- Two friends or fewer in childhood
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Incidence of Child Sexual Abuse
- Unreported
- Number of reported cases have declined 2-11% since 1998
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The Future Well-Being of the Child:
- Relationship between the victim and perpetrator
- Time span of abuse
- Violent contact
- Intrusive
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Victims of Sexual Abuse:
- Have difficulty forming intimate relationships
- Lack trust
- Have revulsion of being touched
- Often alcohol and drug abusers
- Some are characterized by a lack of emotion and sexual interest
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Megan's Law
- Registration and Community Notification Laws
- -Convicted sexual offenders must register with law enforcement authorities
- -Provide community notification
- --Registered letters
- --Posting of pictures
- --Mailings to families, community, groups, and organizations
- --National Sex Offender Registry
- --Arkansas Crime Information Center
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Prevention of Child Sexual Abuse
- Provide sex education
- Become an approachable parent
- Discuss inappropriate sexual behavior with your children
- Let your children know they can can decide how, when, and by whome they want to be touched
- Discuss refusal skills
- Discuss escape skills
- Discuss telling
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