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Chapter 6: Taking Care of the Sexual Body Discussion Topics Discussion 6.1: Taking Responsibility for Our Own Sexual Health Many STIs have no apparent symptoms and for most STIs, you cannot tell by looking at your partner(s) that he or she might have. You can contract an STI from unprotected oral sex. Many people don’t protect themselves during oral sex with contraception because it is not possible to get pregnant by giving or receiving oral sex. However, the mouth often has small cuts and sores and those points of entry can allow for the passage of sexually transmitted viruses and bacteria to the bloodstream. It is important to choose a contraceptive method that will protect against STIs during oral sex. It is crucial to recognize that many sexually transmitted infections (STIs) can be asymptomatic, meaning they may not show any visible signs or symptoms. Therefore, it is not possible to determine whether a partner has an STI based solely on their appearance. Additionally, STIs can be transmitted through unprotected oral sex. While pregnancy is not a concern with oral sex, the mouth can have small cuts or sores that can serve as entry points for STI-causing viruses and bacteria into the bloodstream. To protect against STIs during oral sex, it is essential to choose a contraceptive method that provides protection. This may include the use of condoms or dental dams to create a barrier between the mouth and the genitals, reducing the risk of STI transmission. Regular testing for STIs and open communication with sexual partners about STI status are also important steps in taking responsibility for one's sexual health. Discussion 6.2: Breast Cancer Risk and Menarche In Chapter 4 we discussed how menstruation levels are declining steadily in the US. In the United States, menstruation usually begins around 12 years of age. This age has declined significantly throughout history. In Europe in the early 1800s, the average age of a girl’s first period was 17 (Steingraber, 2007). In 1900, the average age of a first period among girls in the U.S. was 14.2 and now, the average age for girls beginning menstruation is about 12.4 years. Reasons can include diet and nutrition, exposure to chemicals, and childhood obesity. According to the American Cancer Society (2012), Risks associated with the development of breast cancer, in women include: Not having children or having a first child later in life (i.e., 30s and 40s) Reaching menarche at an early age Beginning menopause at a late age Having a personal history of breast diseases Having close family relatives (mother, sister, father, daughter) who have had breast cancer Having a genetic condition or genetic mutations that can lead to breast cancer Having been treated with radiation therapy to the chest area or breasts Being overweight, particularly after menopause Using hormone replacement therapy for an extended time Using oral contraceptives recently Drinking alcohol Being age 65 or older If females are reaching menarche earlier, might we see an increase in breast cancer? If females are reaching menarche earlier, there is a potential concern for an increase in breast cancer cases. Early menarche is associated with an increased risk of breast cancer, as indicated by the American Cancer Society. This increased risk is thought to be related to the longer lifetime exposure to estrogen, which is a hormone that can promote the growth of some types of breast cancer cells. The declining age of menarche in the United States, from an average of 14.2 years in 1900 to about 12.4 years now, suggests that girls are entering puberty earlier. This trend may indeed contribute to an increase in breast cancer cases in the future, particularly if other risk factors such as diet and nutrition, exposure to chemicals, and childhood obesity also play a role. It is important for healthcare providers and public health officials to monitor these trends and take proactive measures to educate individuals about breast cancer risk factors and promote healthy lifestyle choices that may reduce the risk of developing breast cancer. Regular screening and early detection are also essential in managing breast cancer risk. Discussion 6.3: Controversies in Breast Cancer Screening Recommendations for breast cancer screening from the U.S. Preventive Services Task Force (2009) suggest that women begin routine screenings at age 50, as opposed to age 40—as long recommended by the American Cancer Society. Additionally, the group recommends that women between the ages of 50 and 74 get mammograms every 2 years, as opposed to annually, as previously recommended. In keeping with earlier research, which questioned the value of physical breast exams, the task force suggests that doctors should no longer encourage their patients to conduct breast self-exams, because the practice hasn’t been proven to significantly reduce breast cancer deaths, and may cause unnecessary alarm and anguish (O’Callaghan, 2009). These recommendations were intended to be for women who were at average risk for breast cancer rather than high risk. However, there was a large outcry against the change, especially from women who credit self-exams with saving their own lives. Women have been left confused and the only official response has been to “ask your doctor.” The question on many people’s minds then is, “Should we adopt these new guidelines for women’s breast health care?” The controversy surrounding breast cancer screening recommendations highlights the complex nature of balancing potential benefits and harms. The U.S. Preventive Services Task Force (USPSTF) recommended changes to breast cancer screening guidelines, suggesting that routine screenings begin at age 50 and occur every two years for women aged 50 to 74, diverging from the previous recommendations of starting at age 40 and screening annually by the American Cancer Society (ACS). The USPSTF also advised against routine breast self-exams, citing insufficient evidence of their effectiveness in reducing breast cancer deaths and potential for causing unnecessary anxiety. These recommendations were aimed at average-risk women, not those at high risk for breast cancer. However, the change sparked significant backlash, particularly from women who credit self-exams with detecting their breast cancer early. This has left many women feeling confused about the best approach to breast health care. Ultimately, the decision to adopt these new guidelines should be made on an individual basis, taking into account a woman's personal risk factors, preferences, and discussions with her healthcare provider. While the USPSTF guidelines are based on a review of scientific evidence, it's important to consider each woman's unique circumstances and values when making decisions about breast cancer screening. Regular communication with healthcare providers is crucial in navigating these complex issues and making informed choices regarding breast health care. Discussion 6.4: Negotiating Intimate Partner Risk There are many ways for people to reduce risk with their intimate partners in ongoing relationships. In addition to the tips provided in this chapter, couples can learn about better ways to recognize risk, commit themselves to change, and act on strategies of mutual love and respect by working with a professional facilitator. Using techniques from family therapy and problem solving, partners who are at least 18 years old and are committed to staying together each get to determine whether the sexual partnership is “safe” or “not safe.” The couple then attends five sessions together in a private office with the facilitator. The intervention serves to enhance the couple’s relationship by exploring their gender and power dynamics and focuses on the links between the couple’s communication skills, HIV/STI risk, intentions, and behaviors. They learn communication, problem-solving, and negotiation skills. Condom use skills are demonstrated, and condoms are given out at each session. The couple also identifies social supports to help them maintain safer sex behaviors, which could include having individuals or other couples who practice safe sex as friends, and sharing what they have learned with family, peers, and community. Each partner focuses on: Emphasizing the relationship as the target of change: redefining sexual risk reduction from individual protection to protecting and preserving the relationship between two intimate partners—that is, “protecting us.” Discussing ideas about relationship fidelity and the need to reduce HIV/STI risk among couples. Identifying how gender differences, stereotypes, and power imbalances influence safe-sex decision making and behaviors. Using video-based scenarios to model good communication and negotiation of safer sex to stimulate discussions and role-plays. Using modeling, role-play, and feedback to teach, practice, and promote mastery in communication, negotiation, and problem solving, and the increase of the couple’s social and community support, including attending events or social functions that feature protection and risk reduction. How would you feel about engaging in this kind of process with a partner? In what aspects of your relationship might this kind of process be beneficial to you and/or your partner? Engaging in a process like the one described, which focuses on enhancing communication, problem-solving, and negotiation skills within a relationship, can be a positive and empowering experience for both partners. It provides a structured and supportive environment for couples to explore and address issues related to sexual health and intimacy, ultimately strengthening their relationship. Participating in such a process could be beneficial for various aspects of a relationship. For example, it can help partners better understand and navigate gender differences, stereotypes, and power imbalances that may influence safe-sex decision making. It can also foster a deeper sense of commitment and mutual respect, as both partners work together to redefine sexual risk reduction as a way of protecting and preserving their relationship. Additionally, learning communication and negotiation skills can improve overall relationship dynamics, leading to more effective conflict resolution and a stronger sense of intimacy. By identifying social supports and sharing what they have learned with others, couples can also create a supportive network that encourages and reinforces safer sex behaviors. Overall, engaging in a process like this can be a proactive and empowering step towards building a healthier and more fulfilling relationship. Discussion 6.5: Safe Sex Sex is safer when you: Don’t have sex in any way that puts you and your partner in direct contact with each other’s blood, semen, or other body fluids. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Use a latex condom every time you have sex. Never use an oil-based lubricant with a latex condom. Oil-based lubricants break down the latex material and can lead to breakage. Don’t drink or do drugs and then have sex. Our inhibitions are lowered and decision-making is compromised when under the influence. Sobriety helps to ensure we are having consensual sex and that we are in a mind-frame to make good health decisions. To engage in safer sex practices, it's essential to follow these guidelines: 1. Avoid any sexual activities that involve direct contact with blood, semen, or other body fluids to reduce the risk of sexually transmitted infections (STIs). 2. Refrain from vaginal and anal intercourse with new partners until both partners have been tested for STIs to prevent transmission. 3. Use a latex condom every time you have sex to reduce the risk of STIs and unwanted pregnancies. 4. Never use an oil-based lubricant with a latex condom, as it can weaken the condom and increase the risk of breakage. 5. Avoid consuming alcohol or drugs before engaging in sexual activity, as they can impair judgment and decision-making, leading to potentially risky behavior. It's important to be sober to ensure that sex is consensual and that you are in a clear state of mind to make good health decisions. Discussion 6.6: The Tuskegee Study on Syphilis You may want to bring up the Tuskegee study where the US military had white and black soldiers that tested positive for syphilis and they treated whites but left the black males untreated to see what would happen. It is one of the most unethical studies in the past 100 years. The Tuskegee Study on Syphilis was a highly unethical study conducted by the U.S. Public Health Service between 1932 and 1972. In this study, researchers enrolled 600 African American men, 399 of whom had previously contracted syphilis, while 201 did not have the disease and served as a control group. The study was initially conducted to observe the natural progression of untreated syphilis in African American men. However, the participants were not informed of the true nature of the study, nor were they provided with adequate treatment for their condition. The most shocking aspect of the study was that even after penicillin was discovered as a successful treatment for syphilis in the 1940s, the researchers withheld this treatment from the participants. This decision was made to continue observing the progression of the disease, despite the fact that it was leading to serious health complications and even death among the participants. The Tuskegee Study on Syphilis is considered one of the most unethical studies in the history of medical research. It highlighted the importance of informed consent, ethical treatment of research subjects, and the need for oversight and regulation in medical research. The study led to significant changes in research ethics and regulations to ensure that such abuses do not occur in the future. Discussion 6.7: Poverty and STIs A powerful example of both the profound effect of poverty on STIs and the power that innovative thought can have on prevention can be found among women in South Africa. For almost 2 years, researchers conducted a study in South Africa that showed the dramatic effect of poverty on sexual choices. Funded by the World Bank, this important study asked what results might occur if someone is paid an allowance to delay having sex in their life. The study was conducted among 3,800 girls and women, ages 13 to 22, whose families were poor and who were quite vulnerable to HIV/AIDS (Karim et al., 2010). In the study, the researchers provided one group of girls with a very small cash allowance ($2 or $3 a day or less) to delay having sex. It worked. The girls who received the cash actually delayed having sex. When they did have sex, they had less of it, and they tended to have fewer sexual partners compared to girls who did not receive the allowance. Furthermore, the researchers found that the greater the allowance, the less likely the girls were to agree to have sex for money. Because they had less sex, they were also less likely to be infected with HIV or the herpes virus, compared to girls who did not receive the allowance. The prevalence of HIV was 60% lower among the girls receiving allowances in this study than among those who received no allowance. In short, it appears that money can make a difference in determining whether or not girls from poor families contract HIV and possibly die from AIDS. The girls also experienced less sexual and gender-related violence. Polling Questions Polling 6.1: How Comfortable Are You? Teens and young adults have a disproportionately higher rate of certain STIs than other age groups in our society. Because an STI sometimes leads to serious illness and costly treatment needs, it is essential for this group to take steps to maintain good health. Positive health means being our own best advocate and communicating effectively and honesty with health care professionals about our sexual body and needs. 1. How many of you are comfortable in discussing sex with your doctor? 2. How many of you are comfortable with examining your own genitals? 3. Do you and your sexual partner(s) discuss having sex and issues related to the risks of STIs? 1. Discussing sex with your doctor can be uncomfortable for some, but it's crucial for maintaining good sexual health. It's important to be open and honest with your healthcare provider to receive the best care possible. If you're not comfortable discussing sex with your doctor, consider finding a healthcare provider with whom you feel more at ease. 2. Examining your own genitals is an important part of maintaining good sexual health. It can help you become familiar with your body and notice any changes or abnormalities. If you're uncomfortable examining your own genitals, consider talking to a healthcare provider or a trusted individual who can provide guidance. 3. Discussing sex and STI risks with your sexual partner(s) is essential for practicing safe sex. Open communication can help ensure that both partners are aware of the risks and can take appropriate precautions. If you're uncomfortable discussing these topics with your partner(s), consider finding a way to broach the subject in a comfortable and respectful manner. Polling 6.2: Self-Exams for Cancer We are all aware of the dangers of breast cancer, but how many of you are aware that testicular cancer is most common in men ages 20 to 35? How many of you regularly (at least every other month) perform a self-exam of breast or testes? How many of you have never examined your breast or testes for cancer? "Testicular cancer is most common in men aged 20 to 35, yet awareness of this fact is often lower compared to breast cancer. Regular self-exams of the testes, at least every other month, are crucial for early detection. Despite this importance, many individuals have never performed a self-exam. It is essential to raise awareness about the importance of self-exams for both breast and testicular cancer to ensure early detection and better outcomes." Polling 6.3: Do You Know Your Status? The United States today is in the midst of an epidemic of sexually transmitted infections (STIs). Of all industrialized countries in the world, the United States has the highest rate of STIs. In fact, every year, approximately 19 million Americans contract an STI (CDC, 2011e). In addition, it is predicted that one in every two Americans will contract at least one STI in their lifetime (Guttmacher Institute, 2007). Research shows that among teens 14 to 18 who do get STIs, many don’t adopt safer sex practices later on (Hollander, 2003). In fact, of the 522 participants in one key study, 5% tested positive for having two or more STIs at the same time. How many of you have been tested in the past 6 months? How many of you would say you are tested for STIs regularly? "Considering the alarming rates of sexually transmitted infections (STIs) in the United States, it is crucial for individuals to prioritize regular testing. Despite the prevalence of STIs, research indicates that many Americans do not undergo testing regularly. To address this, it is recommended that individuals get tested at least once every six months, and ideally more frequently if sexually active with multiple partners or engaging in high-risk behaviors. By staying informed about their STI status and adopting safer sex practices, individuals can help reduce the spread of STIs and protect their sexual health." Activities Activity 6.1: How to Lower the STI Rate in the US The United States has the highest rates of certain STIs in the industrial world. Reasons include inadequate sex education and sexual health education, and the absence of honest dialogue about sexual pleasure and risk among young people today. Ask students, either individually or in groups, to design a program to reduce STI’s in teens. What kinds of techniques do they think could be useful? Have them either present to the class; write a short paper on their campaign or post as a discussion board topic. "To reduce STI rates among teens in the United States, a comprehensive and multi-faceted approach is necessary. One key aspect is improving sex education and sexual health education in schools. This includes providing accurate and age-appropriate information about STIs, safer sex practices, and contraception. Another important strategy is promoting open and honest dialogue about sexual health and pleasure among young people. This can help reduce stigma and encourage individuals to seek testing and treatment when needed. Additionally, access to affordable and confidential STI testing and treatment services should be increased. This can be done through school-based health centers, community clinics, and telemedicine options. Promoting the use of condoms and other barrier methods during sexual activity is also critical. This can be achieved through educational campaigns, distribution programs, and making condoms readily available in schools and communities. Lastly, addressing underlying factors such as poverty, lack of access to healthcare, and discrimination can also help reduce STI rates among teens. By implementing these strategies, we can work towards reducing STIs and promoting the sexual health and well-being of young people in the United States." Activity 6.2: Common Misconceptions about Sexually Transmitted Infections Good information about STIs is widely available, but there are also a lot of myths about this sensitive topic (STD Express, 2011). Are you aware of some of the most common myths and misconceptions regarding STIs? Take the true/false quiz below and find out. Consider sharing this questionnaire with your friends or intimate partner. 1. Heterosexual men can actually become infected with the human immunodeficiency virus (HIV) from other men. 2. Two condoms are better than one and provide double protection. 3. You can get some STIs from skin-to-skin contact. 4. Knowing your intimate partner and communicating about the need to protect your bodies against STIs can lower your risk of disease. 5. The birth control pill provides protection from STIs. 6. Chlamydia and gonorrhea will go away on their own without treatment. 7. If condoms aren’t available, you can use plastic wrap as a substitute. 8. If you have sex in a pool or hot tub, chlorine will kill everything so there is no need to wear a condom. 9. If your partner has herpes, you can contract it only when he or she is having an outbreak. 10. The greatest risk of STI transmission is from anal sex. 11. Deep French kissing can infect you with HIV/AIDS. Answers 1. True: HIV does not discriminate based on sexual orientation. Gay or straight men and women can contract the virus if they engage in unprotected sexual behavior with infected individuals regardless of sex. 2. False: Currently, it is considered a bad idea to use two condoms at one time. While there does not yet seem to be any scientific literature to support this stance, it comes from the advice of professionals (including the Centers for Disease Control, OB/GYN doctors and nurse practitioners, and condom manufacturers). Their explanation is that during sex, an excessive amount of friction will occur between the two condoms and increase the likelihood of either, or both, condoms breaking. 3. True: Some STIs, such as pubic lice and scabies, can be passed to a partner by engaging in skin-to-skin contact. It is important to be aware of the modes of transmission of STIs so you can best protect yourself. 4. True: We know that communicating with partners about sexual histories and risk can be an uncomfortable discussion, but research shows that when people take the time to communicate honestly about histories and potential risk, they tend to make positive sexual health decisions to protect themselves and enjoy a more fulfilling sexual relationship. 5. False: The birth control pill only protects against pregnancy. Because the birth control pill does not prevent the sharing of bodily fluids during intercourse, it does not protect against any form of STI. 6. False: Gonorrhea and chlamydia are bacterial STIs and need to be treated with antibiotic medications. 7. False: Plastic wrap, baggies, and other household materials are not good substitutes for a condom. They don’t fit well, can easily be torn, and can get displaced during sex. Condoms are specifically made to provide a good fit and good protection during sex and they are thoroughly tested for maximum effectiveness. When it comes to condoms, there’s no substitute for the real thing. 8. False: The idea behind this method of avoiding pregnancy is, if you and your partner have sex in chlorinated water, the chemical will kill the sperm. The truth is, while chlorine can act as a spermicide, its effectiveness depends on how heavily the water is chlorinated. More importantly, this chemical would have to reach deep inside a woman’s vagina and reproductive organs in order to kill the sperm, which have been ejaculated into it. 9. False: During inactive periods, the virus cannot be transmitted to another person. However, at some point, it often begins to multiply again without causing symptoms (called asymptomatic shedding). During shedding, the virus can infect other people through exchange of bodily fluids. 10. True: The CDC and many health professionals consider unprotected anal sex, to be among the highest risks for STI transmission. The reason is, the tissues around the anus are very fragile and small tears (called fissures) are common after engaging in anal intercourse or even using sexual toys and inserting them into the anus. The best way to proceed with caution is to always use condoms; and if you are using sex toys, be sure they are sanitized and not shared with others. 11. False: There is an extremely low chance (actually, the risk is considered to be nonexistent) of transmitting the virus by French kissing, although it is theoretically possible because of the potential for blood contact. Activity 6.3: Breast Self-Exam It’s important to be aware of the benefits and limitations of breast self-exams (BSE). Please take note: If you find a change in your breasts, it does not necessarily mean cancer is present. Check with your campus student health and wellness department to see if they can come to your class to discuss self breast exams. They often have STI lectures for classes but may either have, or be willing to develop, a breast exam presentation for you. "Breast self-exams (BSE) are an important tool in breast health awareness. While finding a change in your breasts does not automatically indicate cancer, it is essential to be proactive about your breast health. Conducting regular BSEs can help you become familiar with how your breasts normally look and feel, making it easier to detect any changes that may occur. It's advisable to check with your campus student health and wellness department to see if they offer presentations or resources on BSE. They may have information on how to perform BSE correctly and what to look for, as well as guidance on when to seek further evaluation by a healthcare professional. Remember, early detection is key in the successful treatment of breast cancer. By performing regular BSEs and seeking medical advice if you notice any changes, you can take an active role in maintaining your breast health." Activity 6.4: Controversies in Breast Cancer Screening Recommendations for breast cancer screening from the U.S. Preventive Services Task Force (2009) suggest that women begin routine screenings at age 50, as opposed to age 40—as long recommended by the American Cancer Society. Additionally, the group recommends that women between the ages of 50 and 74 get mammograms every 2 years, as opposed to annually, as previously recommended. In keeping with earlier research which questioned the value of physical breast exams, the task force suggests that doctors should no longer encourage their patients to conduct breast self-exams, because the practice hasn’t been proven to significantly reduce breast cancer deaths, and may cause unnecessary alarm and anguish (O’Callaghan, 2009). These recommendations were intended to be for women who were at average risk for breast cancer rather than high risk. However, there was a large outcry against the change, especially from women who credit self-exams with saving their own lives. Women have been left confused and the only official response has been to “ask your doctor.” The question on many people’s minds then is, “Should we adopt these new guidelines for women’s breast health care?” Place students in groups. Make some groups “yes” and some groups “no.” Provide the groups 20 minutes and then have them debate the topic. This could also be done on the discussion board easily. YES: The members of the professional panel suggest that women in their 40s do not need to be screened unless they are at high risk. They argue that the harm from mammograms outweighs the benefits, especially if a woman is not at risk. Mammograms can turn up many small abnormalities that are not cancerous or cancers that grow far too slowly to lead to death. The panel members also cited the stress and anxiety that many women experience when a mammogram shows these types of abnormalities and stated that it is unnecessary to put women through such anguish. NO: Opponents of these guidelines cite evidence that mammography has saved the lives of many women in their 40s. Without this routine screening, small lumps and abnormalities that women cannot feel during a self-exam would go undetected. These abnormalities could lead to an aggressive cancer, which could compromise a woman’s life. In fact, some analyses suggest that mammography reduces the risk of dying from breast cancer by 15% among women ages 39 to 49 years (O’Callaghan, 2009). In addition, opponents of the health care reform bills in the United States cite these recommendations as evidence that the government is seeking to put bureaucrats between women and their doctors or argue that these reforms would eventually ration this kind of care by denying coverage for mammograms that are now routinely covered. This issue highlights the importance of self-advocacy in health care. Women need to research and be in contact with their doctors, to be proactive with their health care, and to advocate for screenings and exams they feel are necessary. For more information about breast health care, visit “the breast site” at www.thebreastsite.com. You can then assign students to write a brief paragraph describing their perspective. 1. What is your opinion regarding the new guidelines on mammograms and breast self-exams? Do you believe that we should adopt these guidelines and end mammograms for women in their 40’s who are not at high risk? Why or why not? Based on the provided facts, my opinion regarding the new guidelines on mammograms and breast self-exams leans towards adopting these guidelines, particularly for women in their 40s who are not at high risk. Here's why: 1. Evidence-Based Approach: The recommendations are based on research that questions the efficacy of routine mammograms and breast self-exams for women at average risk. It's crucial to rely on scientific evidence when determining the best screening practices. 2. Potential Harms of Overdiagnosis: Mammograms can lead to the detection of abnormalities that are not cancerous or pose a low risk. This can result in unnecessary stress and anxiety for women, as well as unnecessary follow-up tests and treatments. 3. Focus on High-Risk Groups: By focusing resources on high-risk groups, such as women with a family history of breast cancer, we can potentially improve outcomes by detecting cancers that are more likely to be aggressive and require treatment. 4. Professional Consensus: While there has been controversy and outcry, it's important to consider the recommendations of the professional panel that developed these guidelines. They have likely weighed the evidence and considered the overall benefit-to-risk ratio. 5. Need for Clarity and Education: The confusion and lack of clear guidance for women highlight the need for better education and communication about breast cancer screening. Providing accurate information can empower women to make informed decisions about their health. Overall, while there are valid concerns and differing opinions, I believe that adopting these guidelines could lead to more effective and personalized breast health care for women. 2. Do you know someone who was diagnosed with breast cancer in her 40s or earlier due to a routine mammogram? If so, does this persuade your opinion of the new guidelines? Knowing someone who was diagnosed with breast cancer in her 40s or earlier due to a routine mammogram could potentially influence my opinion of the new guidelines. If the individual's early diagnosis and successful treatment were directly attributed to a routine mammogram, it might lead me to be more cautious about fully adopting the new guidelines, especially for women in their 40s. However, it's important to consider that anecdotal evidence, while compelling, is not the sole basis for making broad healthcare recommendations. The guidelines are based on large-scale studies and analyses that assess the overall benefit-to-risk ratio of routine mammograms for women at average risk. These studies aim to minimize harm from unnecessary treatments while maximizing the detection of cancers that are likely to be aggressive and benefit from early intervention. Therefore, while personal experiences can be impactful, they need to be considered alongside the broader scientific evidence and recommendations from healthcare experts. It's crucial to strike a balance between individual experiences and population-based guidelines to ensure that healthcare practices are evidence-based and effective for the general population. Activity 6.5: Testes Self-Exam Testicular cancer is most common in men ages 20 to 35, but it can occur at any age. In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. Over a man’s lifetime, he has approximately a 1 in 250 chance of developing testicular cancer. Check with your campus student health and wellness department to see if they can come to your class to discuss testicular exams. They often have STI lectures for classes but may either have, or be willing to develop, a testicular exam presentation for you. "Testicular cancer is a serious health concern, particularly for men between the ages of 20 and 35, although it can occur at any age. It's important for men to be aware of the risk factors and to perform regular testicular self-exams (TSE) to detect any abnormalities early. The statistics on testicular cancer highlight the importance of proactive health practices. Men should be encouraged to check with their campus student health and wellness department for resources or presentations on testicular exams. These departments often have educational materials available and may be willing to provide presentations to raise awareness about testicular cancer and the importance of TSE. By conducting regular TSEs and seeking medical attention if any abnormalities are detected, men can take an active role in their health and potentially detect testicular cancer early, when it is most treatable." Activity 6.6: Ten Myths about Prostate Cancer Have students answer the following as True or False 1. Prostate cancer is an old man’s disease. 2. If you don’t have any symptoms, you don’t have prostate cancer. 3. Prostate cancer is a slow-growing cancer I don’t need to worry about. 4. Prostate cancer doesn’t run in my family, so the odds aren’t great that I will get it. 5. The PSA test is a cancer test. 6. A high PSA level means that you have prostate cancer and a low PSA means you do not have prostate cancer. 7. Vasectomies cause prostate cancer. 8. Treatment for prostate cancer always causes impotence or incontinence. 9. Sexual activity increases the risk of developing prostate cancer. 10. You can pass prostate cancer on to others. Answers: Myth #1: Prostate cancer is an old man’s disease. Fact: Many men get prostate cancer. It is rarely fatal, and it can occur even in young men. Myth #2: If you don’t have any symptoms, you don’t have prostate cancer. Fact: Prostate cancer is one of the most asymptomatic cancers. Symptoms can be mistaken for or attributed to something else. Myth #3: Prostate cancer is a slow-growing cancer I don’t need to worry about. Fact: Sometimes this is true. Researchers have discovered 25 types of prostate cancer, some of which a man may die with but not of, while others are very aggressive. Myth #4: Prostate cancer doesn’t run in my family, so the odds aren’t great that I will get it. Fact: Although a family history of prostate cancer doubles a man’s odds of being diagnosed to one in three, the fact is that one of every six U.S. men will be diagnosed with prostate cancer in their lifetime. Myth #5: The PSA test is a cancer test. Fact: The PSA test measures levels of prostate-specific antigen in the prostate, not cancer. Experts believe the PSA test saves the lives of approximately 1 in every 39 men who are tested. Myth #6: A high PSA level means that you have prostate cancer and a low PSA means you do not have prostate cancer. Fact: Although prostate cancer is a common cause of elevated PSA levels, some men with prostate cancer may even have low levels of PSA. Myth #7: Vasectomies cause prostate cancer. Fact: Having a vasectomy (a surgical procedure that prevents the release of sperm during ejaculation) was once thought to increase a man’s risk, but careful research has not uncovered a link between vasectomy and a higher risk of prostate cancer. Myth #8: Treatment for prostate cancer always causes impotence or incontinence. Fact: Erectile dysfunction (ED) is a possibility following surgery or radiation therapy for prostate cancer, but it is not true that all men experience these effects. Myth #9: Sexual activity increases the risk of developing prostate cancer. Fact: Some studies show that men who reported more frequent ejaculations had a lower risk of developing prostate cancer. Myth #10: You can pass prostate cancer on to others. Fact: Prostate cancer is not infectious or communicable. There is no way to pass it on to someone else. Adapted from: Dan Zenka, Ten Myths and Misconceptions about Prostate Cancer. (2011). www.pcf.org/site/c.leJRIROrEpH/ b.7425707/k.7A02/10_Myths_and_Misconceptions_About_ Prostate_Cancer.htm Activity 6.7: No Shave November November has become synonymous with prostate cancer the same way that October has become breast cancer awareness month. Males can show their support by growing out facial hair. If you are teaching in the Fall semester, see if your students health and wellness group has any moustache events planned on campus. You can promote these events to students and also see if they will come to your class to briefly discuss men’s health and specifically prostate cancer. "November's 'No Shave November' has evolved into a meaningful movement to raise awareness about prostate cancer, similar to the significance of October for breast cancer awareness. Men can participate by growing out their facial hair, sparking conversations about men's health and encouraging proactive measures like regular check-ups. For educators teaching in the Fall semester, collaborating with student health and wellness groups can enhance awareness. These groups often organize events like moustache contests or discussions on men's health, including prostate cancer. Promoting these events can engage students and promote important health dialogues on campus. Participation in 'No Shave November' not only supports those affected by prostate cancer but also serves as a reminder for men to prioritize their health through regular screenings and check-ups. By encouraging participation and education, we can contribute to greater awareness and potentially save lives." Activity 6.8: Know Your Status Check with your campus student’s services or student health to enquire if they do free HIV testing on campus. Many universities offer this service via oral swab; since it is quick, easy and free students have no excuse but fear. Check with student health services to see if they will come to your class and allay such fears. "Knowing your HIV status is crucial for maintaining good sexual health. Many universities offer free HIV testing on campus, often using oral swabs for quick and easy testing. Despite the convenience and accessibility of these services, some students may still have fears or reservations about getting tested. To address these concerns, it's important to check with your campus student services or student health to inquire about their HIV testing programs. They may offer testing on campus and be willing to come to your class to provide information and allay fears about the testing process. By promoting and normalizing HIV testing, we can help students overcome any hesitations they may have and encourage them to take control of their sexual health. It's important to remind students that knowing their HIV status is empowering and allows them to make informed decisions about their health and well-being." Activity 6.9: What Is Your Personal STI Risk? Have you ever wondered what kinds of questions a health care practitioner asks when a person seeks testing for STIs? Naturally, people wonder and sometimes worry about the kind of information that is gathered on an STI risk assessment. To assess risks for STIs, health care providers commonly use the following questionnaire. Answers to questions of this type allow the health care providers to assist clients with STI testing and to provide information about contraceptive and sexual health decisions. Have you been seen in this STI clinic before? _____ Yes _____ No If yes, when? ___________________________________ 1. What is the reason for your visit? (Check all that apply.) _____ You think you could be at risk for an STI. _____ You think you could be at risk for HIV/AIDS. _____ Other: ___________________________________ 2. If you have symptoms, please check all that apply: _____ Bleeding _____ Pain _____ Rash _____ Warts _____ Itching _____ Problems with urination _____ Other: ___________________________________ 3. Have you had sexual interactions with anyone in the last 6 months? _____ Yes _____ No With how many people? 1 2 3 4 5 6 7 8 9 10 more than 10 4. How many people have you had sexual interactions with in your lifetime? 0 1 2 3 4 5 10 15 25 30 50 75 more than 100 5. When with new or non-steady partners, do you use a condom or barrier? _____ Always _____ Most of the time _____ Sometimes _____ Rarely _____ Never 6. Have you had sexual interactions with: _____ A man _____ A woman _____ Both _____ Other 7. Check all that apply: _____ Oral sex _____ Vaginal sex _____ Anal sex: _____ Top (Insertive) _____ Bottom (Receptive) _____ Both 8. Please list any medication(s) you are currently taking: ______________________________ ___________________________________________________________________________ 9. Please list any allergies to medication(s): ___________________________________ 10. Have you ever exchanged drugs or money for sex? _____ Yes _____ No 11. Have you had sex with someone you know injects drugs? _____ Yes _____ No 12. Have you ever used a needle to inject drugs? _____ Yes _____ No 13. Have you had sexual interactions with someone you know has HIV/AIDS? _____ Yes _____ No 14. Have you used meth, speed, crank, crystal, cocaine, or crack in the last year? _____ Yes _____ No 15. Do you smoke cigarettes? _____ Yes _____ No 16. Have you ever been in jail or prison? _____ Yes _____ No 17. Do you have any tattoos? _____ Yes _____ No 18. Have you had the hepatitis B vaccine? _____ Yes _____ No 19. How many HIV/AIDS tests have you had before today? _____ 20. Have you ever been diagnosed with an STI? (Check all that apply below and indicate when.) _____ Have symptoms _____ Have no symptoms—STI testing/screening only _____ Referred by another doctor or clinic _____ Discharge _________________________ Sores/Blisters _________________________ _____ Chlamydia _________________________ Gonorrhea _________________________ _____ Genital Warts _________________________ Herpes _________________________ _____ Syphilis _________________________ Trichomonas (trich) ____________________ _____ HIV _________________________ Other: ___________________________________ _____ Never been diagnosed with an STI 21. Do your female sex partners use birth control? _____ Yes _____ No _____ Not sure 22. If so, what birth control method(s) are used: ___________________________________ 23. Would you like more information on contraceptive methods? _____ Yes _____ No Source: Questionnaire adapted from: Marin County Department of Health and Human Services, STD Risk Self- Assessment Questionnaire 2010. It might feel a little personal and invasive to fill out a questionnaire such as this, but it is important that you have this information readily available, particularly for health care providers so they can work with you in making important sexual health decisions. Internet Resources http://www.womenshealth.gov/publications/our-publications/fact-sheet/sexually-transmitted-infections.cfm STI fact sheet. Has a PDF printable version that can be used as a handout. http://www.hhs.gov/opa/order-publications/ A variety of PDF downloads on contraception and STIs. http://www.cdc.gov/std/ The CDC STI website— includes an overview of STIs including fact sheets and videos. http://www.cdc.gov/nchs/ National Center for Health Statistics. http://hivinsite.ucsf.edu/ HIV In Site Gateway to HIV and AIDS Knowledge. http://www.mhhe.com/socscience/psychology/psychonline/general.html McGraw Hill Higher Education General Resources for Students and Faculty. http://www.apa.org/ The APA website. http://www.apa.org/topics/sexuality/index.aspx APA site for research on sexuality. The Ten-Minute Test Name: __________ Answer the questions below utilizing the following terms: PSA Breast cancer Testicular PAP Bacterial Vaginitis Parasitic Poverty Opportunistic Infections Viral 1. _____ is an inflammation of the vagina that can result in some unpleasant symptoms including discharge, itching and pain. 2. A routine screening test to detect prostate cancer is a _____ test. 3. A group of infections that establish themselves in the human body as a result of weakened immune system are known as _____. 4. One of the most serious health concerns for women is _____, the fifth leading cause of death for women in the United States. 5. Regular pelvic exams and _____ smears are important screening procedures for women when they turn 21 or begin to engage in sexual intercourse. 6. _____ cancer is a common cancer among younger men, typically affecting those between the ages of 15 and 34. 7. STIs like Syphilis, Chlamydia and Gonorerhea are generally thought of as _____ STIs and are transmitted through high-risk sexual behaviors, such as unprotected anal, oral, and vaginal intercourse. Using condoms reduces the risk of transmission. 8. _____ STIs are external infestations by parasites such as scabies and pubic lice and can be spread by sexual contact. Both can be effectively treated with prescription medication, or in the case of pubic lice, with a special over-the-counter shampoo. 9. _____ STIs, including the four Hs (HIV, HPV, herpes, and hepatitis), are contracted by high-risk sexual behaviors, such as unprotected intercourse. 10. One of the largest effects worldwide on STI risk and transmission, thus putting people at heightened risk, is _____. Answers to the Ten-Minute Test 1. Vaginitis 2. PSA Test 3. Opportunistic Infections 4. Breast cancer 5. Pap 6. Testicular 7. Bacterial 8. Parasitic 9. Viral 10. Poverty Solution Manual for Human Sexuality: Self, Society, and Culture Gilbert Herdt, Nicole Polen-Petit 9780073532165, 9780077817527
