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This document contains chapters 10 to 12 Chapter 10 Reproduction, Reproductive Technology, and Birthing TOTAL TEACHING PACKAGE OUTLINE Lecture Outline Resources Reference Chapter 10: Reproduction, Reproductive Technology, and Birthing fERTILIZATION AND FETAL DEVELOPMENT Teaching Suggestions: 1(A), 1(B), 6(B) Learning Objectives: #1,2,3,4,5,6,7 REPRODUCTIVE AND FETAL TECHNOLOGY Teaching Suggestions: 1(A), 1(B), 1(C), 3(B), 4(B) Learning Objectives: #8,9,10,11,12,13,14,15,16 17,18,19,20,21, 22,23,24,25,26, 27 PREGNANCY AND BIRTHING Teaching Suggestions: 1(D), 2(A), 2(B), 3(A), 4(A), 5(A), 6(A), 6(C) Learning Objectives: #28,29, 30,31,32, 33,34,35,36,37,38, 39 LEARNING OBJECTIVES After reading this chapter, students should be able to: 1. Briefly describe the structures and chemicals associated with fertilization. 2. Briefly describe rates and causes of multiples. 3. List and describe two types of twins. 4. Describe risk and reduction methods associated with multiples. 5. Describe the structures and processes of embryo development and implementation and the extraembryonic structures associated with embryonic survival. 6. Define infertility and describe its potential affects on a couple. 7. Describe reasons for male and female infertility. 8. List and describe changes in the fetus and mother during pregnancy. 9. Briefly describe the status of reproductive and fetal technology. 10. Describe the benefits and risks of the available assisted reproductive technologies of today. 11. Briefly describe the importance of genes in humans. 12. Briefly describe genetic therapy and gene therapy. 13. Identify how genetic testing and gene therapy can help people. 14. Describe concerns regarding the science and use of genetic research. 15. Describe the process and legal consideration of artificial insemination. 16. Describe the general nature of, and legal issues associated with, the storage of gametes. 17. Describe the processes used in vitro fertilization (IVF). 18. Describe controversies and rates of success associated with IVF. 19. List and describe seven additional fertilization technologies. 20. Briefly describe how older women can use alternative methods of fertilization. 21. Describe the general considerations of choosing the sex of a fetus. 22. Describe concerns about, and ethical issues regarding fetal sex determination. 23. Describe two cloning techniques and the results of using these processes. 24. Describe ethical and physiological concerns associated with cloning. 25. Briefly describe the controversy and guidelines associated with embryo and stem cell research. 26. Describe the process of gestational surrogacy and controversies surrounding it. 27. List and describe five technologies used in monitoring fetal health. 28. Describe why prenatal care is important. 29. Briefly describe possible initial signs of pregnancy. 30. Briefly describe concerns regarding pregnancy tests as well as the hormone for which they test. 31. Briefly describe the influence of alcohol, drugs, and smoking on fetal development. 32. Describe reasons for refraining from or engaging in sex during and after pregnancy. 33. List and describe the stages of the birth process. 34. Describe concerns regarding caesarian sections. 35. List and describe six alternative birthing methods. 36. Briefly describe concerns associated with a newborn. 37. List and describe three pregnancy complications. 38. List and briefly describe three adjustments associated with post partum care. 39. Discuss relationship adjustments among new parents. CHAPTER OVERVIEW This chapter returns to some of the more biological foundations of human sexuality, since the processes of reproduction and birth represent one of the potential biological outcomes of heterosexual activity. Yet this subject matter can be applied to the broader contexts of sexuality in several ways. First, the primary physical aspects of maleness or femaleness are established during fetal development. It may be appropriate to remind students that some psychological aspects could also be established during prenatal stages of development, as discussed in Chapter 5. Second, having a baby is an intimate experience, and many couples find that it has a profound significance for their relationship. Third, infertility can interfere with individuals’ sexual lives. Finally, new advances in reproductive technology are, in a sense, ways of bypassing sex altogether in the reproductive process. One might wonder what the future of such developments will hold for us. This chapter provides thorough coverage of fertilization and early development, including some of the most recent findings. Multiple births, such as twinning, are discussed briefly, along with some discussion about the increase in multiples. Instructors may want to mention that, in addition to the types of twins discussed in the text, some scientists believe that a third type, half-identical twins, exists as well. These are said to be formed by the fertilization of two eggs that split from a single egg cell prior to fertilization by two separate sperm cells. Therefore, the two offspring each have half of their chromosomes identical. Risk rates for multiple pregnancies are outlined, along with the procedure of selective reduction in the number of fetuses in order to save or reduce risks for the other(s). This procedure presents students with an interesting ethical issue. The section on reproductive and fetal technology has been continually updated, incorporating the latest developments in gene therapy, intracytoplasmic sperm injection, immature oocyte collection, and cloning. The GIFT and ZIFT procedures are described. The successes that researchers formerly achieved with the cloning of embryos, and now with the cloning of adult mammals, is one of the reasons why the federal government has promulgated new guidelines for cloning and human embryo research. This section also cautions readers to keep the outcome statistics of techniques such as in vitro fertilization (IVF) in perspective. They are frequently unsuccessful, and students should realize that technology has a long way to go before such techniques represent truly reliable investments of one’s time, money, and emotional energy. On the other hand, research efforts at making these futuristic techniques more effective and more affordable are under way. As science has gained new understanding of reproductive processes and developed new technologies to facilitate them, reproduction has become more closely scrutinized by social policy, legislation, and court actions. When a sperm fertilizes an ovum to form a zygote within the fallopian tube, 23 chromosomes from both the sperm and the egg combine to form a total of 46. The DNA in these chromosomes establishes the genetic instructions for developing the new organism. The rate of multiple births has been increasing largely because of increased use of fertility drugs. Multiple births are associated with greater risks of birth defects and premature birth. Fraternal (dizygotic) twins result from the fertilization of two separate ova by two sperm. Identical (monozygotic) twins are formed when a single zygote divides into two cells that separate and develop into individual embryos. Because they have exactly the same chromosomes, these twins are identical in appearance. The zygote divides into increasing numbers of cells, eventually forming a spherical blastocyst. A few days after fertilization, the blastocyst implants itself in the inner lining (endometrium) of the uterus, where embryonic and fetal development continues. The embryo forms several extraembryonic membranes for its protection and nourishment. The amnion is a fluid-filled sac that is used to keep the embryo moist and cushioned. The yolk sac and allantois become partly incorporated into the umbilical cord, which connects the fetus with the placenta. The chorion is the outside membrane that helps form the placenta through which the blood systems of the fetus and the mother come close enough to permit exchange (by diffusion) of nutrients and wastes. Advances in reproductive technology, termed assisted reproductive technology (ART), are revolutionizing the processes of conception and gestation. Genetic engineering and gene therapy are opening the possibilities of early diagnosis and treatment of human genetic disorders, although they have yet to prove their worth. Gametes (sperm and eggs) and embryos may now be frozen and kept for long periods for later use in various reproductive technologies. Concerns are growing about the ethics involved with frozen embryos and the possible link of freezing with later problems of pregnancy and birth defects. There is a growing movement of people wanting to adopt donated frozen embryos. In vitro fertilization (IVF) allows for fertilization outside a woman’s body, with the developing embryo then being implanted into the uterus afterward. The success rate of IVF is still limited, and its associated costs are high. Gamete intrafallopian transfer (GIFT) is a process in which sperm and eggs are placed directly into the fallopian tubes. Intracytoplasmic sperm injection (ICSI), computerized sperm selection, and the transplantation of sperm-producing cells to infertile males all offer hope of increasing the likelihood of having viable sperm for reproduction. Immature oocyte collection permits immature eggs to be obtained, after which they are matured by cell-culturing methods. This technique could reduce the costs of IVF significantly. Choosing the sex of a fetus ahead of time has raised many ethical concerns. Sex selection is causing an imbalance in the number of males in China and some other countries. Cloning involves the creation of genetically identical organisms. New techniques have allowed the separation of early embryonic cells and thus the creation of genetic duplicates of an early human embryo. The prospect of human cloning raises ethical, social, and legal complications, and clones may be at risk for eventual defects. Embryo and stem cell research create complex ethical issues about which the government has decided to create policy and enter into the debate. Surrogate motherhood, or gestational surrogacy, is a controversial approach in which one woman agrees, for a fee, to carry a pregnancy and give the baby to another couple. Sometimes the surrogate is impregnated by the sperm of a man whose partner cannot become pregnant; and sometimes IVF is used to transfer an embryo produced from the egg and sperm of one couple into the surrogate’s uterus. Several methods are used to diagnose potential medical problems in a fetus. Amniocentesis withdraws fetal cells from the amniotic sac so that possible chromosome abnormalities may be discovered. Chorionic villasampling (CVS) also examines chromosomes but may be used as early as the eighth week in the pregnancy. Ultrasound pictures, or sonograms, are an alternative to X-rays for examining the features of the developing fetus. Ultrasound is not recommended for routine use. Embryoscopy and fetoscopy allow for visual examination of embryos and fetuses. Fetal surgery is a developing technology that can be used to treat some medical difficulties. Infertility can have many causes and often creates stress for couples who are anxious to have children. New reproductive technologies are offering more hope for infertile couples. Pregnancy may be signaled by many symptoms. Pregnancy tests detect a hormone produced by the embryo and placenta called human chorionic gonadotropin (HCG). It is best for the fetus if the mother practices good nutrition and avoids products such as alcohol, drugs, and cigarettes. Unless there is a problem with a pregnancy, there is no need to avoid sexual contact during pregnancy. To ensure healthy pregnancies, it is best that they be spaced at least one to two years apart. The birth process begins with contractions of the uterus, or labor. Gradually, the baby is moved through the birth canal and is born. The placenta, umbilical cord, and fetal membranes follow as the afterbirth. There are many approaches to birthing, including those that emphasize full awareness and participation on the mother’s part, such as the Lamaze method. Many women use some pain-relieving medications or anesthesia during labor and delivery. Mothers have choices as to where the baby can be born: home, hospital birthing room, or water. Newborns must be kept very warm, and eyedrops are used in their eyes to prevent infection by bacteria. Pregnancy-induced hypertension is a complication of pregnancy that involves a rise in the mother’s blood pressure and a buildup of fluids in her body, sometimes with life-threatening consequences. Prenatal blood tests are crucial, so any dangers of Rh incompatibility may be eliminated with medical treatment. RhoGAM is administered to the mother when Rh incompatibility exists. The post-partum period requires many adjustments and may be characterized by some level of post-partum depression for the new mother. TEACHING SUGGESTIONS 1. Discussion Topics A) Discuss some of the problems that can occur during pregnancy and how they are resolved. B) Describe the process of genetic engineering and how this science might impact future children. C) Ask students to search the internet for recent articles, news stories, and promotional material for stem cell research. Discuss the results of those searches. D) Show a video that depicts the many different birthing options. Discuss students’ reactions and responses. 2. Role-Plays A) Have two females play the role of a surrogate mother and adoptive mother who both want the child being born. Discuss the feelings both of them have and the legal rights of both. B) Have a male and female play the role of two parents trying to decide what gender they wish their child to be. Discuss with the class the consequence of having a boy or girl child. 3. Case Study A) Describe the case study of Jan and Charles (in the main text), who were unable to have children. What were their options (adoption, surrogate motherhood, in vitro fertilization)? What would various members of the class have done had they been Jan or Charles and why? This is a values question, and the reasons for selecting a particular option are more important than the actual choice. 4. Essays/Papers A) You are pregnant and expecting a child. Describe your pregnancy and the changes in your body over the nine-month gestation period. Students need to describe the effect of changing estrogen and progesterone levels on their body. Students need to realize the impact of pregnancy on a woman’s body image and physiological conditions such as nausea. B) You have an option of cloning yourself. Would you do it? Why or why not? This is a values question, and the reasons for the answer are far more important than the answer itself. 5. Speakers A. Invite a labor and delivery nurse, a midwife, and recent parents into the classroom to discuss medical techniques, support of the patients, and birthing stories. 6. SexSource Video Bank The SexSource video bank provides an excellent array of short videos that may serve as discussion starters. In order to elicit the best responses, it is advisable to pair students in groups of two for “pair sharing.” Give them the initial starter questions below, and then show the videos after some initial discussion. Instructors should preview videos for time and content. Additionally, you may want to download clips prior to class to ensure they are ready for viewing regardless of network connectivity. All video clips may be found at: http://www.mhhe.com/sexsource The Secret Club video clip – Ask paired students: Would you have an abortion? How many of your friends have had one, or do you think they would share that information with you? In this video a number of women discuss having abortions and their experiences in speaking with other women in the same situation. This video serves as a good opener for a discussion on abortions. Designer Babies video clip – Ask paired students: If possible, would you pick the eye color and hair color of your baby? What if you could pick your child’s body and intelligence, would you choose to genetically engineer your children to be beautiful, smart, and disease free? In this video an entrepreneur discusses the selling of sperm and eggs from models. The video serves as an excellent starting point for the discussion of genetic engineering. Baby Love video clip – Ask paired students: When did you first have sex? Was the experience enjoyable, painful, or frightening? Did you have sex for fun, to have a child, or for another reason. In this video a number of young women talk about having sex at a young age, many to have a baby. GLOSSARY afterbirth: the tissues expelled after childbirth, including the placenta, the remains of the umbilical cord, and fetal membranes. amniocentesis (am-nee-oh-sen-TEE-sis): a process whereby medical problems with a fetus can be determined while it is still in the womb; a needle is inserted into the amniotic sac, amniotic fluid is withdrawn, and fetal cells are examined. amnion (AM-nee-uhn): a thin membrane that forms a closed sac around the embryo; the sac is filled with amniotic fluid which protects and cushions the embryo. artificial embryonation: a process in which the developing embryo is flushed from the uterus of the donor woman 5 days after fertilization and placed in another woman’s uterus. artificial insemination: injection of the sperm cells of a male into a woman’s vagina with the intention of conceiving a child. assistive reproductive technology (ART): a collection of laboratory techniques that have been developed to help couples overcome infertility problems and have children, usually through bypassing one of the usual biological pathways to pregnancy or gestation. birth canal: term applied to the vagina during the birth process. birthing rooms: special areas in the hospital that are decorated and furnished in a nonhospital way and set aside for giving birth; the woman remains here to give birth rather than being taken to a separate delivery room. blastocyst: the ball of cells, after 5 days of cell division, that has developed a fluid-filled cavity in its interior; it has entered the uterine cavity. bond: the emotional link between parent and child created by cuddling, cooing, and physical and eye contact early in the newborn’s life. Cesarean section: a surgical method of childbirth in which delivery occurs through an incision in the abdominal wall and uterus. chorion (KAWR-ee-on): the outermost extraembryonic membrane which is essential in the formation of the placenta. chorionic villi sampling (CVS): a technique for diagnosing medical problems in the fetus as early as the eighth week of pregnancy; a sample of the chorionic membrane is removed through the cervix and studied. clone: the genetic-duplicate organism produced by the cloning process. cloning: a process by which a genetic duplicate of an organism is made either by substituting the chromosomes of a body cell into a donated ovum or by separation of cells in early embryonic development. computerized sperm selection: use of computer scanning to identify the most viable sperm which are then extracted to be used for fertilization of an ovum in the laboratory. deoxyribonucleic acid (DNA) (dee-AK-see-rye-bow-new-KLEE-ik): the chemical in each cell that carries the genetic code. dilation: the gradual widening of the cervical opening of the uterus prior to and during labor. ectopic pregnancy (ek-TOP-ik): the implantation of a blastocyst somewhere other than in the uterus, usually in the fallopian tube. effacement: the thinning of cervical tissue of the uterus prior to and during labor. embryo (EM-bree-oh): the term applied to the developing cells when, about one week after fertilization, the blastocyst implants itself in the uterine wall. episiotomy (uh-pee-zee-OT-uh-mee): a surgical incision in the vaginal opening made by the clinician or obstetrician to prevent the baby from tearing the opening in the process of being born. exocytosis (ek-soh-sahy-TOH-sis): the release of genetic material by the sperm cell permitting fertilization to occur. fertilin (fer-TILL-in): a chemical in the outer membrane of a sperm that assists in attachment to the egg cell and penetration of the egg’s outer membrane. fetal alcohol syndrome (FAS): a condition in a fetus characterized by abnormal growth, neurological damage, and facial distortion caused by the mother’s heavy alcohol consumption. fetal surgery: a surgical procedure performed on the fetus while it is still in the uterus or during a temporary period of removal from the uterus. fetus: the term given to the embryo after 2 months of development in the womb. fraternal twins: twins formed from two separate ova that were fertilized by two separate sperm. gamete intrafallopian transfer (GIFT): direct placement of ovum and concentrated sperm cells into the woman’s fallopian tube to increase the chances of fertilization. gene therapy: treatment of genetically caused disorders by substitution of healthy genes. genetic engineering: the modification of the gene structure of cells to change cellular functioning. gestational surrogacy: implantation of an embryo created by the sperm and ovum of one set of parents into the uterus of another woman who agrees to gestate the fetus and give birth to the child, which is then given to the original parents. human chorionic gonadotropin (HCG): a hormone detectable in the urine of a pregnant woman. identical twins: twins formed by a single ovum that was fertilized by a single sperm before the cell divided in two. immature oocyte collection: extraction of immature eggs from undeveloped follicles in an ovary, after which the oocytes are matured through cell-culturing methods to be prepared for fertilization. in vitro fertilization (IVF): a process whereby the union of the sperm and egg occurs outside the mother’s body. infertility: the inability to produce offspring. intracytoplasmic sperm injection (ICSI): a technique involving the injection of a single sperm cell directly into an ovum. It is useful in cases where the male has a low sperm count. labor: uterine contractions in a pregnant woman; an indication that the birth process is beginning. Lamaze method (la-MAHZ): a birthing process based on relaxation techniques practiced by the expectant mother; her partner coaches her throughout the birth. microscopic epididymal sperm aspiration (MESA): a procedure in which sperm are removed directly from the epididymis of the male testes. midwives: medical professionals, both women and men, who are trained to assist with the birthing process. morula (MAWR-oo-luh): a spherical, solid mass of cells formed after 3 days of embryonic cell division. natural childbirth: a birthing process that encourages the mother to take control, thus minimizing medical intervention. ovum donation: use of an egg from another woman for conception with the fertilized ovum then being implanted in the uterus of the woman wanting to become pregnant. oxytocin (ok-si-TOH-suhn): a pituitary hormone believed to play a role in initiating the birth process. placenta (pluh-SEN-tuh): the organ that unites the fetus to the mother by bringing their blood vessels closer together; it provides nourishment and removes waste for the developing baby. post-partum depression: a period of low energy and discouragement that is common for mothers following child-bearing. Longer-lasting or severe symptoms should receive medical treatment. pregnancy-induced hypertension: a disorder that can occur in the latter half of pregnancy marked by a swelling in the ankles and other parts of the body, high blood pressure, and protein in the urine; can progress to coma and death if not treated. preimplantation genetic diagnosis (PGD): examining the chromosomes of an embryo conceived by IVF prior to implantation in the uterus. premature birth: a birth that takes place prior to the 36th week of pregnancy. Rh incompatibility: condition in which a blood protein of the infant is not the same as the mother’s; antibodies formed in the mother can destroy red blood cells in the fetus. RhoGAM: medication administered to a mother to prevent formation of antibodies when the baby is Rh positive and its mother is Rh negative. selective reduction: the use of abortion techniques to reduce the number of fetuses when there are more than three in a pregnancy, thus increasing the chances of survival for the remaining fetuses. Also called selective termination. sonograms: ultrasonic rays used to project a picture of internal structures such as the fetus; often used in conjunction with amniocentesis or fetal surgery. umbilical cord: the tubelike tissues and blood vessels originating at the embryo’s navel that connect it to the placenta. villi: fingerlike projections of the chorion; they form a major part of the placenta. zona pellucida (ZOH-nuh puh-LOO-si-duh): the transparent, outer membrane of an ovum. zygote intrafallopian transfer (ZIFT): zygotes resulting from IVF are inserted directly into the fallopian tubes. zygote: an ovum that has been fertilized by a sperm. Chapter 11 Decision Making about Pregnancy and Parenthood TOTAL TEACHING PACKAGE OUTLINE Lecture Outline Resources Reference Chapter 11: Decision Making About Pregnancy and Parenthood HISTORICAL PERSPECTIVES Learning Objectives: #1,2,3,4,5,6 DECIDING ABOUT CONTRACEPTIVES Teaching Suggestions: 2(C), 8(A) Learning Objectives: #7,8,9,10,11,12 METHODS OF BIRTH CONTROL Teaching Suggestions: 1(A), 1(B), 2(A), 2(B), 2(D), 3(A), 4(A), 5(A), 6(A), 7(A), 8(A) Learning Objectives: #13,14,15,16,17, 18,19, 20,21,22,23,24,25,26,27,28,28,30,31,32,33,34,35 Unintended pregnancy: The Options Teaching Suggestions: 4(B), 5(B), 8(B) Learning Objectives: #36,37,38,39,40,41,42, 43,44 LEARNING OBJECTIVES After reading this chapter, students should be able to: 1. Describe the historical, medical, mechanical, and social efforts of birth control. 2. Describe the effect of Margaret Sanger on birth control. 3. Describe population projections and factors that influence population growth. 4. Describe considerations (economic, “wrong” reasons, and skills) for choosing to become a parent. 5. Briefly describe cultural comparisons regarding the use of birth control. 6. Briefly describe general considerations about the choice of birth control. 7. Briefly describe ethical and religious influences regarding the use of birth control. 8. Describe political factors that influence the availability of birth control. 9. Briefly describe health considerations and concerns with the selection and use of birth control. 10. Describe the influence of negative psychological factors regarding the use of birth control. 11. List and describe six factors to consider, and steps to take when choosing birth control. 12. List and describe four factors to consider when choosing a contraceptive. 13. Describe the concepts of theoretical and typical failure rates for contraceptive effectiveness. 14. Describe how each gender, as well as couples can share responsibility for the use of birth control. 15. Describe nonpenetrative and “interruptive” means of controlling births. 16. List and describe two types of oral contraceptives. 17. Identify a relatively new option for a birth control pill use that causes women to have a period four times a year. 18. Describe how oral contraceptives work. 19. Briefly describe noncontraceptive benefits of oral contraceptives. 20. Describe medical considerations for choosing and using oral contraceptives. 21. Describe the use and benefits of contraceptive implants. 22. Identify why contraceptive implants are not currently available. 23. Describe the two newest forms of hormonal birth control products. 24. Compare and contrast the use of 3-month injectable (Depo Provera) and 1-month injectable (Lunelle) birth control options. 25. List and describe three types of chemical methods for controlling births. 26. Describe what the latest research about spermicide has demonstrated. 27. List and describe two types of barrier methods of birth control used by women. 28. Describe the use, effectiveness, and controversies concerning male condoms. 29. Describe the use, effectiveness, and advantages of female condoms. 30. List and describe the types of intrauterine devices (IUDs). 31. Describe how IUDs work. 32. List and describe three types of fertility awareness methods used to control conception. 33. List and describe male and female types of voluntary surgical contraception. 34. Briefly describe a controversy regarding the use of emergency contraceptive methods. 35. List and describe one new male and one new female method for controlling conception. 36. Describe rates of, and cultural perceptions about unintended pregnancies. 37. List and describe three alternatives for dealing with an unintended pregnancy. 38. Identify concerns and issues that effect the decision to keep the baby. 39. Identify historical and current issues relating to adoption. 40. List and describe the means of terminating a pregnancy. 41. Describe the cultural and legal controversies regarding terminating pregnancies. 42. List and describe four abortion methods. 43. Briefly describe the benefits and controversies concerning the use of embryonic tissue. 44. Briefly describe the psychological effects of having an abortion. CHAPTER OVERVIEW This chapter is more than a litany of birth control methods. It offers a sound basis for understanding the issues to be weighed in personal decision making about contraception, placing them in the broader context of world overpopulation. It also surveys some issues, such as abortion and use of fetal tissue for research purposes, which continue to generate debate and controversy. The historical survey at the beginning of the chapter touches on some of the more ancient birth control methods, but instructors could add a great deal more, in the way of anecdotes and information during lectures, to spark student interest. The excerpt from Sanger’s autobiography provides poignant insight into her motivations and can be related to the dangers of illegal and self-induced abortions in modern times. Although most people do not realize it, there is a distinction between the terms “birth control” and “contraception”. People’s sense of well being contributes to their choices about having children. Human beings have sought to minimize the connections between sex and childbirth. In ancient times, botanical preparations may have provided contraceptive protection. Distribution of information about birth control was limited in the United States by the Comstock Laws, which were passed in the 1870s. Activist Margaret Sanger was influential in broadening the rights of women to learn about and use contraception in the early part of this century; although laws prohibiting the sale of contraceptives existed until the 1960s. Because of the earth’s burgeoning populations, some people believe that increased efforts to develop and promote contraception are necessary; others look toward redistribution of global wealth. Many children live in substandard conditions. It is believed that many global pregnancies are unwanted. Political and social factors may determine what kinds of birth control are accessible. In making a decision about contraceptive use, people are influenced by several factors, including ethical/moral and religious beliefs; possible effects on the woman’s health; and psychological and social factors. Guilt, fear, or anxiety may not always inhibit sexual behavior, but these feelings may inhibit preparing for it. Each person must sort through his or her personal values and concerns about birth control, understand his or her personal reactions to sexual feelings and activities, and learn how to communicate with a partner effectively in order to prepare fully for contraceptive decision making. There is no “best” method of birth control for all individuals. Each couple must consider several factors in making a choice: age and amount of protection needed, safety, what might hinder the method’s use, and cost. The theoretical or perfect use failure rate assumes that the birth control method is being used correctly and without technical failure. The typical use failure rate is the more realistic rating of the method, taking into account human error, carelessness, and technical failure. Even though most methods of contraception are designed for women, there are many ways for the responsibility to be shared by both partners, including cooperating in applying the method, communicating openly about birth control, and sharing the cost. Cultural imperatives sometimes interfere with the sharing of this responsibility. Abstinence, withdrawal (coitus interruptus), and outercourse are birth control methods that work with the user to avoid depositing sperm in the vagina. Withdrawal does not have an established history of effectiveness and can cause frustration for users. Hormones that prevent ovulation and change the consistency of cervical mucus can be administered in the form of combined oral contraceptive pills or progestin-only mini-pills. The newest form of the pill (Seasonale) allows a woman to menstruate every 3 months. The pill provides protection against ovarian and endometrial cancers, but it may also have some side effects. Hormonal implants consist of six capsules that are implanted under the skin, releasing a synthetic hormone that prevents ovulation for up to 5 years. They are currently unavailable for use in the United States due to prohibitive cost, unpleasant side effects, and availability of other hormonal method choices. The patch and the ring are now available and are getting a favorable response from users. Depo-Provera and Lunelle are injections of synthetic progesterone that prohibit ovulation and are effective for 12 weeks or 4 weeks respectively. Although they have high pregnancy prevention rates, women can experience undesirable side effects. The 4-week shot seems to produce less intense side effects and is becoming more popular than the 12 week shot. Spermicides kill sperm and are available without prescription as foams, film, jellies, creams, vaginal suppositories, and implanted on the contraceptive sponge. Recent research has determined that spermicide can cause vaginal irritation, which may in fact increase risks of HIV and other sexually transmitted diseases. Diaphragms, cervical caps, and male and female condoms are made from latex or polyurethane and are termed barrier methods. The intrauterine device (IUD) is inserted into the uterus and, because of the copper or hormone release depending on the type of IUD used, is effective by preventing the sperm to fertilize the egg. There is a slight risk of pelvic inflammatory disease (PID). Ectopic pregnancy was linked to IUD use but recent studies support no link. IUDs are an effective form of controlling fertility and most likely will become more popular in the years to come. Natural family planning/fertility awareness allows the woman to become more aware of her fertile period during the menstrual cycle by charting the length of her cycle, basal body temperature, and consistency of cervical mucus. Vasectomy involves cutting and tying the male vas deferens. Tubal ligation seals off the fallopian tubes. Studies are being done on more reversible forms of sterilization. The most accessible means of emergency contraception (aka Plan B) at present is to take extra doses of certain birth control pills. There are some opponents of emergency contraception that posit it an abortion method; proponents suggest that it prevents the need for abortion. New methods of birth control are under consideration. Scientists are especially interested in creating a method for men to use that suppresses sperm production or inhibits sperm from fertilizing an egg. When an unintended pregnancy occurs, one of several options must be chosen: keeping the baby, placing it up for adoption, or abortion. A woman’s choice is dependent on several factors. Some pregnancies terminate naturally, which is called miscarriage or spontaneous abortion. Induced abortion has been legal in the United States since 1973, but Supreme Court decisions have gradually allowed states to restrict its availability. There are several methods available to terminate a pregnancy. The method used is determined by the medical practitioner and how many weeks along the woman is in her pregnancy. The use of embryonic tissue transplants (stem cell research) in medical research has become part of the abortion controversy. The U.S. federal government has become involved with determining availability of stem cells for research. TEACHING SUGGESTIONS 1. Small Group Activities A) Contraceptive Methods Objective: To research, collect, and present information on birth control methods. Methods: Put students into groups of four. Instructor gives each group an envelope that contains a particular method of contraception (condom, spermicide, pills, etc.). The groups are to research, in class, the effectiveness rates, costs, side effects, health benefits, how to use the method, etc. The groups should use data gathered from research and design a commercial or advertising campaign for that method. Each campaign should be presented to the entire class and discussed. Upon completion: Students will gain important knowledge about contraception methods. B) Condom Strategy Response Objective: To examine refusal responses to condom use and develop strategies to counter. Method: Put students into groups of four. Ask students to write down refusal responses to the use of a condom (for example, “I am on the pill.” or “I can’t feel anything.”). Have students develop their own strategic response to the previous refusal lines. Have each group come up to the front of the class and act out two strategic responses to refusal lines. Upon completion: Students will have gained knowledge and experience in developing strategies to deal with condom refusal responses. 2. Large Group Activities A) Condom Demonstration in the Dark Objective: To demonstrate the difficulty of putting a condom on in the dark. Methods: Ask for a volunteer to come up front and sit in a chair. Blindfold the student so he or she cannot see, which simulates a completely dark room. Give the student a plastic or wooden penis model and a packaged condom. Instruct the student to put the condom on the penis model. As the person is opening the condom package, pressure them by saying, “What is taking so long? Hurry up!” Explain that their partner is impatiently waiting. After the person has put the condom on, cue in on what mistakes he or she made, such as the condom fell on the floor (dirt may cause a tear), trying to put it on inside out (pre-ejaculatory fluid may now be on the outside edge of the condom), air bubbles present (these could rupture the condom), and so forth. Instructor emphasizes proper instructions and the need for some light to avoid mistakes. In addition, the instructor could discuss the benefits of the partner putting the condom on the penis as a part of foreplay. What are safe and creative techniques for putting on a condom that enhance sexual pleasure? Upon completion: Students will understand the specifics of condom application techniques. B) Condom Cards Activity: Steps to Putting on a Condom Objective: To understand the sequence of events of using a condom. Method: Ask for 12 volunteers to come up front. Give each person a card that has the condom information already written on it. Students, either in the volunteer group or as a whole class, will then put the steps for using a condom in the correct order. Listed as follows is the information that the instructor is to write on cards. Steps are in the proper sequence with teaching points added: Communication about effective birth control and sexually transmitted disease (STD) risk reduction methods TEACHING POINT: Is this an easy conversation to have? When is the best time to have this discussion? Buy condoms. TEACHING POINT: The “s” is to make sure that more than one condom is available. A couple may decide to have more than one act of intercourse and/or the condom may fall on the floor, at which time it should be discarded. Mutual consent TEACHING POINT: If both parties are not in agreement that sex should occur, than it becomes illegal. Sexual arousal TEACHING POINT: Discuss stages of sexual arousal in detail. Erection Leave room at the tip Roll condom onto penis TEACHING POINT: Discuss condom breakage and how to reduce risk of method failing due to human mistakes. Intercourse Ejaculation Orgasm Hold on to the rim of the condom AND the base of the penis TEACHING POINT: Keeping in mind safer sex techniques, who should hold on to the outside of the condom? The partner, not the condom wearer, due to body fluids of partner on the outside of the condom. Withdraw penis Lose erection TEACHING POINT: Penis should still be at least partially erect while condom is on. Relaxation TEACHING POINT: This card can be placed at the beginning of the steps or at the end. Most agree that relaxation, not anxiety, should be a component of great sex. Lose erection (2nd card) TEACHING POINT: A second “lose erection” card can be put anywhere in the steps after “erection” to illustrate that men have no control over when they lose an erection. In fact, men who are not experienced condom users may spontaneously lose an erection when they are beginning to put a condom on. This presents two options for the couple: stop engaging in sex and move on to something else or engage in activities that will stimulate the penis for erection and continue with the “steps to putting on a condom”. Upon completion: Students will develop awareness of complex sexual interactions and the social approval for the need to use a condom. C) Sex or Not Sex Objectives: To gain personal insight to one’s definition of abstinence, which may or may not be based on behaviors that can cause pregnancy and/or sexually transmitted infection. To acknowledge that communication is a major piece in maintaining abstinence. Methods: Ask students to volunteer to take a card and place it on the continuum. Prepare cards with one phrase listed per card: sex not sex masturbation French kissing kissing anal intercourse vaginal intercourse oral intercourse hugging holding hands rubbing bodies together clothes on phone sex cyber sex rubbing bodies together clothes off sitting on the couch touching genitals beneath clothing touching breasts Tape the “sex” and “not sex” cards on the wall spaced far enough away from each other to create a continuum. Instruct students to proceed to the wall and tape the card in their hand where they think it belongs on the continuum. They are to use their own personal value system to determine placement. They are not to consult or look at any other person’s card to use as a guide to where theirs should be placed. They are simply to place their card under 100% “sex”, 100% “not sex” or at a percentage value on the continuum that meets their need. After cards are in place on the continuum, review individual cards placement with the entire class. As a group, are they satisfied with the placement of that card? Ask a volunteer to visibly draw a line where their definition of abstinence is represented. The line does not have to be vertical; indeed the line should loop around behaviors on the continuum that fall to the left (abstinence) or to the right (not abstinence). Ask a few more volunteers to do the same if the person previously does not represent their definition of abstinence. Ask for volunteers to draw a line where pregnancy can and cannot occur. Ask for a volunteer to draw a line where infections (STDs) can and cannot be transmitted. Discuss and process activity: Ask students to define the term “abstinence;” ask students to compare and contrast definitions. How do pregnancy and STDs fit into their personal definitions of abstinence? Discuss the sexual behaviors under abstinence. Why is this abstinence to some but not to others? Example: social/cultural influences (peers, parents, religion, etc.). What if their partner does not have the same definition? Upon completion: Students will know that abstinence is defined in a variety of ways. Students will have a better understanding of which sexual behaviors have a risk of disease transmission and how to protect themselves. 3. Role-Play A) Condom Use Convincing Ask four students to volunteer for role-plays. Take students into the hall to discuss the role-plays. Give each couple a card with the information on it, as in the situation one example that follows. The pairs are not restricted to male/female only. Let students improvise, and then follow up with a discussion. Situation one example: You have dated each other for about four months. Along the way in this relationship, you have shared your feelings and dreams, said “I love you,” but have not had sexual intercourse. You have engaged in heavy petting, but that is all. Both of you have talked and planned to have intercourse this Saturday night. Now, the male brings up the idea of using a condom; the female is surprised and resistant to the idea. Male must try to persuade her to accept the idea. Situation two example: Both of you have dated each other a few times. You are in her dorm apartment on the bed, getting really hot and heavy. Both consent to wanting sex (using various slang terminology and body motions). Female asks male if he has a condom; he says no and says he trusts her. She has a condom and now must persuade him to use it in contrast to his objections. 4. Case Study A) The case of Joanne and Arthur (in the main text) details a typical search that couples may go through to find a contraceptive method that best suits their relationship and needs. It is a story with which many couples could easily identify. Ask students what specific places they could get tested for HIV and other STDs (Health Dept., Student Health Services, etc.). Discuss the emotional aspects of getting tested (anxiety, fear of the unknown, etc.) and how these factors may influence the person. B) The case study of Rebecca, Christine, and Beth in the main text focuses on the very real problems associated with teen pregnancies. Readers of the text may well have their own stories to tell of young people they have known who have had to make difficult decisions about an early, unintended pregnancy. Ask students what they think about each of the situations. What would they do if they found themselves pregnant at this point in their lives? What rights do the fathers have in reference to abortion and adoption? 5. Guest Speakers A) Most family planning agencies, such as Planned Parenthood affiliates, have educators who are skilled in doing group presentations. They might be invited to present a program on contraceptive methods. Having samples of the various birth control methods for students to see and touch is worthwhile. B) Some agencies are willing to arrange panels of young women who have experienced unintended pregnancies. This can make a powerful classroom presentation. A discussion among representatives from organizations such as a pro-choice group, an anti-choice group such as a crisis pregnancy center, and an adoption agency that offer different options for unintended pregnancy can be informative. 6. Essays/Papers A) Ask students to investigate and write a paper about the newest methods of medical emergency contraception and the implications they have for the abortion controversy. Does your student health clinic offer emergency contraception to students? 7. Questionnaires A) Contraceptive Comfort and Confidence Scale (located at the end of the main text chapter) This scale may help students to evaluate their own level of knowledge and comfort in using a particular method of contraception. 8. SexSource Video Bank The SexSource video bank provides an excellent array of short videos that may serve as discussion starters. In order to elicit the best responses, it is advisable to pair students in groups of two for “pair sharing.” Give them the initial starter questions below, and then show the videos after some initial discussion. Instructors should preview videos for time and content. Additionally, you may want to download clips prior to class to ensure they are ready for viewing regardless of network connectivity. All video clips may be found at: http://www.mhhe.com/sexsource A) Baby Love video clip – Ask paired students: When did you first have sex? Was the experience enjoyable, painful, or frightening? Did you have sex for fun, to have a child, or for another reason? In this video a number of young women talk about having sex at a young age, many to have a baby. This video may be used for Chapter 10 or Chapter 11. B) The Secret Club video clip – Ask paired students: Would you have an abortion? How many of your friends have had one, or do you think they would share that information with you? In this video a number of women discuss having abortions and their experiences in speaking with other women in the same situation. This video serves as a good opener for a discussion on abortions. This video may be used for Chapter 10 or 11. GLOSSARY abortifacients: substances that cause termination of a pregnancy. cervical cap: a device that is shaped like a large thimble and fits over the cervix; not a particularly effective contraceptive method because it can dislodge easily during intercourse. coitus interruptus (KOH-I-tuhs): a method of birth control in which the penis is withdrawn from the vagina prior to ejaculation. Comstock Laws: enacted in the 1870s, this federal legislation prohibited the mailing of information about contraception. contraceptive implants: contraceptive method in which hormone-releasing rubber cylinders are surgically inserted under the skin. Depo-Provera: an injectable form of progestin that can prevent pregnancy for 3 months. diaphragm (DAY-uh-fram): a latex rubber cup filled with spermicide that is fitted to the cervix by a clinician; the woman must learn to insert it properly for full contraceptive effectiveness. dilation and curettage (D & C): a method of induced abortion in the second trimester of pregnancy that involves a scraping of the uterine wall. dilation and evacuation (D & E): a method of induced abortion in the second trimester of pregnancy; it combines suction with a scraping of the inner wall of the uterus. essure transcervical sterilization procedure: a less invasive alternative to tubal ligation, in which a small coil is implanted in the fallopian tube through a small abdominal incision. Tissue grows on the coil, eventually blocking the ovum. female condom: a lubricated polyurethane pouch that is inserted into the vagina before intercourse to collect semen and help prevent disease transmission. induced abortion: a termination of pregnancy by artificial means. intrauterine devices (IUDs): birth control method involving the insertion of a small plastic device into the uterus. laminaria (lam-uh-NAI-ee-uh): a dried seaweed sometimes used in dilating the cervical opening prior to vacuum curettage. laparoscopy (lap-uh-ROS-kuh-pee): simpler procedure for tubal ligation, involving the insertion of a small fiberoptic scope into the abdomen, through which the surgeon can see the fallopian tubes and close them off. laparotomy (lap-uh-ROT-uh-mee): operation to perform a tubal ligation, or female sterilization, involving an abdominal incision. male condom: a sheath worn over the penis during intercourse that collects semen and helps prevent disease transmission. mifepristone (RU 486): a progesterone antagonist used as a postcoital contraceptive. miscarriage: a natural termination of pregnancy. National Birth Control League: an organization founded in 1914 by Margaret Sanger to promote use of contraceptives. natural family planning/fertility awareness: a natural method of birth control that depends on an awareness of the woman’s menstrual/fertility cycle. pelvic inflammatory disease (PID): a chronic internal infection of the uterus and other organs. prostaglandin- or saline-induced abortion: used in the 16th to 24th weeks of pregnancy, prostaglandins, salt solutions, or urea are injected into the amniotic sac, administered intravenously, or inserted into the vagina in suppository form, to induce contractions and fetal delivery. spermicidal jelly (cream): sperm-killing chemical in a gel-base or cream which is used with other contraceptives such as diaphragms. spermicides: chemicals that kill sperm; available as foams, creams, jellies, or suppositories. sponge: a thick, polyurethane disk that holds a spermicide and fits over the cervix to prevent conception. spontaneous abortion: another term for miscarriage. suppositories: contraceptive devices designed to distribute their spermicide by melting or foaming in the vagina. theoretical failure rate: a measure of how often a birth control method can be expected to fail when used without error or technical problems, sometimes called perfect use failure rate. toxic shock syndrome (TSS): an acute disease characterized by fever and sore throat, and caused by normal bacteria in the vagina that are activated if tampons or contraceptive devices, such as diaphragms, are left in for long periods of time. tubal ligation (lahy-GeY-shuhn): a surgical cutting and tying of the fallopian tubes to induce permanent female sterilization. typical use failure rate: a measure of how often a birth control method can be expected to fail when human error and technical failure are considered. vacuum curettage (kyoo-i-TAHZH): a method of induced abortion performed with a suction pump. vasectomy (va-SEK-tuh-mee): a surgical cutting and tying of the vas deferens to induce permanent male sterilization. voluntary surgical contraception: sterilization; rendering a person incapable of conceiving with surgical procedures that interrupt the passage of the egg or sperm. zero population growth: the point at which the world’s population would stabilize, and there would be no further increase in the number of people on Earth. Birthrate and death rate become essentially equal. Chapter 12 Solitary Sex and Shared Sex TOTAL TEACHING PACKAGE OUTLINE Lecture Outline Resources Reference Chapter 12: Solitary Sex and Shared Sex SOLITARY SEX: THE PRIVATE WORLD Teaching Suggestions: 3(A), 7(A) Learning Objectives: #1,2,3,4,5,6,7,8,9,10 SHARED SEXUAL BEHAVIOR Teaching Suggestions: 1(A), 1(B), 2(A), 6(A) Learning Objectives: #11,12,13,14,15,16,17,18,19,20,21 SAME-GENDER SEXUAL SHARING Teaching Suggestions: 6(A) Learning Objectives: #22,23 HETEROSEXUAL INTERCOURSE Teaching Suggestions: 1(C), 4(A), 5(A), 6(A) Learning Objectives: #23,24,25,26,27,28,29,30,31, 32 LEARNING OBJECTIVES After reading this chapter, students should be able to: Briefly describe concerns regarding the use of research and sexual behaviors. Briefly describe what is meant by “the private world of sex”. Briefly describe an historical perceptive and attitudes about masturbation. Describe rates of masturbation. Describe methods of female masturbation. Describe methods of male masturbation Briefly describe how pictures and fantasy are used during masturbation. List and describe 10 facts about masturbation. Briefly describe the association of guilt with masturbation. Briefly describe the moral implications of masturbation. Describe the general dynamics of shared sexual behaviors. Briefly describe the intimate nature of nongenital oral stimulation. Describe the range of stimulation of erogenous zones. List and describe two types of oral sex, as well as rates of practice for each. Describe ways to reduce risks associated with oral sex. Briefly describe the process of mutual masturbation and perceptions about this behavior. Briefly describe forms of nonvaginal and penile intercourse. Describe the rates and concerns associated with anal intercourse. Briefly describe the relationship of vibrators, pornography, and fantasy with sexual behaviors. Describe the risks and benefits associated with using aphrodisiacs. Describe how the period directly following sexual activity can impact a relationship. Describe the range of male same-gender sexual behavior. Describe the range of female same-gender sexual behaviors. Briefly describe general perceptions about sexual intercourse. Briefly describe HIV risks associated with sexual intercourse. Describe the process of and concerns associated with intromission. Describe the process of intercourse, and ways in which couples can change and enhance the experience. List and describe three general position categories for intercourse. List and describe three reclining face-to-face positions for intercourse. List and describe three face-to-face variations for sexual intercourse. List and describe four rear vaginal entry positions for intercourse. Describe cross-cultural views of intercourse within marriage. CHAPTER OVERVIEW Chapter 12 discusses specific sexual behaviors in some detail. Although masturbation and coitus have been mentioned previously, they are examined here from various perspectives as human behaviors. The chapter begins with some fundamental information about the use of statistics on sexual behavior from the National Health and Social Life Survey (NHSLS), including some caveats concerning generalizability. The issue of normalcy and abnormalcy is revisited briefly in light of these statistics. NHSLS statistics are the most reliable we have on human sexual behavior in the United States and are supported by similar data coming from European research. Sexual behaviors are influenced by factors such as age, race, religious beliefs, and educational background. Solitary sex includes thoughts and fantasies, erotic materials and toys, and masturbation. Males think about sex and seek out erotic materials more frequently than do females. Solitary sex does not seem to be compensation for lack of availability of a sexual partner. The frequency with which people experience private sexual pleasure seems to be positively correlated with how frequently they seek shared sex. Masturbation, or self-stimulation of the genitals, is a sexual activity in which most people participate in at one time or another. Masturbation can occur at all stages of life. Medically speaking, there is no such thing as excessive masturbation; it does not produce physical weakness or illness. There are many myths and misconceptions about masturbation. It is important that these myths be addressed and dispelled. Negative attitudes persist concerning masturbation, and some people feel guilty about the practice. Guilt does not affect frequency of masturbation in males, but it does to some extent in females. Vaginal intercourse is the most popular of shared sexual behaviors, followed by watching a partner undress, and oral sex. Fellatio is oral stimulation of the penis, and cunnilingus is oral stimulation of the clitoris and other areas of the vulva. Oral sex has become more acceptable in recent years, but is more common among young, better-educated white people. The penis may be inserted between a partner’s legs, breasts, or buttocks, or into the anus (interfemoral intercourse). Anal intercourse is somewhat more appealing to males than females and is one of the high-risk behaviors for transmission of HIV. There are many myths about foods or chemicals leading to sexual arousal. Substances that create erotic stimulation are labeled aphrodisiacs, although they are believed to operate largely on suggestion and imagination. Following the end of shared sexual activity may be a quiet, warm, and comfortable time for communication between partners, or it may become a time of tension and further misunderstanding. Couples of the same gender share a range of sexual activities, depending on individual preferences and tastes. Male-to-male oral sex is more common than anal sex; female couples often prefer nonpenetrative activities. The techniques and timing of intercourse are variable, as are the positions in which a woman and man can share penile-vaginal penetration. Happier people seem more satisfied with their sexual lives. Satisfaction is not necessarily correlated with having orgasms. Intercourse is closely associated with marriage customs in most cultures. In North America, sex is considered to be a significant part of the marital relationship, with vaginal intercourse being the most preferred activity. TEACHING SUGGESTIONS 1. Small Group Activities A) Oral Sex Objective: To explore oral sex techniques. Method: Put students into groups. Have students create a list of techniques that make oral sex good and a list of what not to do when either performing or receiving fellatio and cunnilingus. Discuss the pros and cons of the techniques the students generate. Upon completion: Students will have real-life information and ideas about oral sex. B) Outercourse Objective: To create a list of specific sexual activities excluding penile penetration activities. Method: Place students into small groups. Instruct students to create a list of specific sexual activities excluding penile penetration (for example, putting ice in mouth and then performing fellatio, blindfolding your partner and stroking their body with different items like a feather, plastic wrap, ice, etc.). Emphasize to students to write specific activities. This encourages them to be creative. Have each group share several of their ideas with the rest of the class. Instructor keeps the information flowing and discusses ideas as necessary. Upon completion: The sharing of information gives them new ideas for sex, as well as seeing that many people have the same views on sex. C) Sexual Positions Objective: To discuss the advantages and disadvantages of various sexual positions. Method: Put students into small groups. Instructor calls out a sexual position, such as female-on-top, and then instructs the groups to create a list of advantages and disadvantages. Try to have enough time to explore several positions. Instructor has each group share their information and discusses it accordingly. Upon completion: Students will have gained valuable knowledge on what and how to have better sex. 2. Large Group Activities A) Kissing: The Good and the Bad Objective: To discuss techniques of good kisses and the horrors of bad kisses. Method: Within the large group setting, ask students to share their thoughts on what makes a good kiss and what makes a bad kiss (for example, bad breath, too much tongue action etc.). Students easily share stories of bad kissing experiences. This will help to create fun and bonding in the classroom. Upon completion: Students will gain knowledge and ideally apply the good kissing techniques. 3. Guest Speakers A) Invite members of the community (physician, clergy, sex therapist, etc.) for a panel discussion on the various views on masturbation. 4. Case Study A) The case study of Carlos and Sarah (in the main text) portrays a typical scenario for college students who are exploring sexual relationships. Residence hall living has its share of privacy issues, and residence life staff see many of the kinds of situations described in this case. In some ways, Carlos and Sarah were considerably more cooperative than many couples are with roommates. Your students may be interested in relating similar situations that they have observed while at college. 5. Essays/Papers A) Ask students to write brief, anonymous essays on “How I first learned about sexual intercourse,” and use the comments for discussion on attitudes and policies toward sexuality education. 6. Media A) Several sexuality education instructional videos explore various issues, such as oral sex, anal sex, massage, sex positions, etc. Explain what they are going to view ahead of time in order to deal with any student apprehension. 7. SexSource Video Bank The SexSource video bank provides an excellent array of short videos that may serve as discussion starters. In order to elicit the best responses, it is advisable to pair students in groups of two for “pair sharing.” Give them the initial starter questions below, and then show the videos after some initial discussion. Instructors should preview videos for time and content. Additionally, you may want to download clips prior to class to ensure they are ready for viewing regardless of network connectivity. All video clips may be found at: http://www.mhhe.com/sexsource Self-Awareness video clip – Ask paired students: When did you first touch your genitals? When did you first masturbate? This video, primarily for women, includes becoming familiar with their genitals, learning how the parts of the vulva function together, and learning how to control the pubococcygeus (PC) muscle. Self-knowledge also involves overcoming cultural taboos about the genitals, as the woman in this video clip describes. You will also see a mirror self-exam, as well as a demonstration of Kegel exercises. GLOSSARY anal intercourse: insertion of the penis into the rectum of a partner. aphrodisiac (af-roh-DEE-zee-ak): foods or chemicals purported to foster sexual arousal; they are believed to be more myth than fact. autofellatio (fuh-LEY-shee-oh): a male providing oral stimulation to his own penis; an act that most males do not have the physical agility to perform. cantharides (kan-THAR-i-deez): a chemical extracted from a beetle that, when taken internally, creates irritation of blood vessels in the genital region; it can cause physical harm. cunnilingus (kuhn-l-ING -guhs): oral stimulation of the clitoris, vaginal opening, or other parts of the vulva. fellatio: oral stimulation of the penis. onanism (OH-nuh-niz-uhm): a term sometimes used to describe masturbation, it comes from the biblical story of Onan, who practiced coitus interruptus and “spilled his seed on the ground.” rubber dam: a piece of rubber material, such as used in dental work, that is placed over the vulva during cunnilingus. Instructor Manual for Sexuality Today Gary Kelly 9780078035470

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