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Chapter 6: Taking Care of the Sexual Body Learning Objectives Knowing Our Own Body • Understand what it means to be proactive in one’s own health care. • Identify gynecological and reproductive health concerns for both women and men. Sexually Transmitted Infections • Identify the risks and protective factors for STIs. • Understand the prevalence, symptoms, transmission, testing, and treatments for bacterial, parasitic, and viral STIs. • Understand how sexual risk among intimate partners in a couple can be reduced. • Be able to engage in sexual risk negotiation with partners. • Understand the biological, cultural, social, and historical factors associated with the HIV/AIDS pandemic in the United States and around the world. Sexual Well-Being and Innovation in STI Prevention • Understand why protecting oneself from STIs is considered by experts to be a human right. Chapter Outline Chapter 6: Taking Care of the Sexual Body Learning Objectives 6.1 Discussion Topic 6.1 Discussion Topic 6.2 Discussion Topic 6.3 Learning Objectives 6.2 Discussion Topic 6.4 Discussion Topic 6.5 Discussion Topic 6.6 Learning Objectives 6.3 Discussion Topic 6.7 I. Knowing Our Own Body • Taking care of our own sexual body always involves both pleasure and danger. These two terms define the extreme ends of what’s at stake during the sexual encounters we have in our lives. • Experts have long stated that pleasure and danger help explain the excitement and appeal of sex. Too often, however, the risks of sex are emphasized so much that we feel there is nothing we can do proactively to enjoy sex and still protect ourselves. • Preserving good health means knowing one’s body and understanding the real-world sexual risks involved. Looking at each part of our bodies on a regular basis and understanding how the parts typically feel and respond to touch not only helps maximize sexual pleasure, but also helps us to maintain our own sexual health. A. Taking Responsibility for Our Own Sexual Health a. 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. b. 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. B. Female Sexual Health a. A woman’s breasts, vagina, and surrounding tissue all play a role in both sexual health and pleasure. b. Breast Cancer—Every year, approximately 230,000 women are diagnosed with breast cancer and 40,000 women die from the disease (American Cancer Society, 2012). In the United States, breast cancer is the fifth leading cause of death for women. o Worldwide, breast cancer comprises 23% of all cancers (excluding nonmelanoma skin cancers) in women and has caused more than 458,000 deaths worldwide (GLOBOCAN, 2008). The older a woman is, the more likely she is to develop breast cancer. o Not counting skin cancer, breast cancer is the most common cancer in women in the United States. Non-Hispanic White women have the highest incidence of breast cancer. o The chances of dying from breast cancer increase as a woman ages, but dying from breast cancer is much less common than being diagnosed with it. A diagnosis of breast cancer is frightening, but if caught early, people with breast cancer now have a much better outlook than they did 20 to 30 years ago. o Some of the risks associated with the development of breast cancer, in women include (American Cancer Society, 2012): 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 o As numerous as these risk factors are, women can lessen the chances of getting breast cancer by maintaining a healthy weight, avoiding the use of hormone replacement therapy (HRT), and limiting alcohol consumption. Also, every woman should conduct a monthly breast self-exam. o Every woman should become familiar with her own breasts so she can readily notice even slight changes. Most women commonly experience lumpy breasts, particularly around their menstrual period. If a lump doesn’t disappear or if it feels abnormal, the woman should consult a physician. When breast cancer starts, it is often too small to feel and may not cause any noticeable signs or symptoms. o As the cancer grows, it can change how the breast appears or feels. Some symptoms include: A new lump in the breast or a change in a current breast lump A change in the size or shape of the breast Flaky, red, or swollen skin anywhere on the breast A dimpled appearance to the breast when the arm is raised over the head A nipple that is extremely tender or suddenly turns inward o Researchers are continuously assessing preventive measures for both women and men due to their potential negative side effects, cost, and effectiveness. At one time, women were advised to begin having yearly mammograms at age 20 to detect breast abnormalities that might be cancerous. A few years ago, however, the U.S. Preventive Services Task Force (2009) published new guidelines for preventive mammograms. The new guidelines have caused some controversy among health care professionals and women. o A mammogram is a low-dose X-ray of the breast used to detect growths and cancer in breast tissue. These X-rays allow physicians to look for early signs of breast cancer, which can sometimes be detected as early as 3 years before a breast cancer lump can be felt. Treatment depends largely on how advanced the cancer is at the time of detection and its location in the body. o Chemotherapy, radiation, lumpectomy, and mastectomy (single or double) are all possible treatments for breast cancer. A lumpectomy removes the cancerous tumor in the breast while leaving the breast intact. A mastectomy is the removal of one or both breasts, and possibly other tissue around the breast, to eradicate cancer from that area. c. Gynecologic exams—Although seeing a gynecologist for a pelvic exam is probably not on a woman’s list of desirable activities, it is one of the most important things that a woman can do to maintain positive sexual health. It is recommended that teenage girls begin to see a gynecologist between the ages of 13 and 15. o Currently, the American College of Obstetricians and Gynecologists (ACOG, 2011) recommends that Pap smears begin within 3 years of first engaging in sexual intercourse, or by age 21 if the woman has not yet had sexual intercourse. Women should have Pap smears every 2 years until age 30, when healthy women who have had at least three consecutive normal Pap smears may begin to have the test done every 3 years, or as often as their doctor recommends. o This does not mean that women should still not have yearly pelvic exams to check for changes or infections that may have occurred since the last exam. o The procedures for a pelvic exam and Pap smear are quite simple and the exam is usually quite short. After an initial consultation with a nurse, women will be directed to remove all of their clothing and put on a hospital gown. With a nurse present, the doctor will do a breast examination and then ask the woman to lie down on the table and put her feet into the stirrups. A speculum, an instrument used to open the vagina is inserted, so the physician is able to view the vagina, the vaginal walls, and the cervix. The physician will collect a small sample of cervical tissue for a Pap test. o The last part of the pelvic exam is called a bimanual exam. This exam requires that the doctor insert two fingers in the vagina while placing the other hand on top of the lower part of the abdomen. This allows a doctor to feel for any abnormalities and to check the size, shape, and mobility of the uterus. Ovarian changes, such as the growth of cysts, can also be detected during this exam. d. Urinary tract infections—A urinary tract infection (UTI) begins in the urinary system, which is composed of the kidneys, uterus, bladder, and urethra. Men also get urinary tract infections but women are more susceptible to developing them. o UTIs typically develop when bacteria enter the urinary tract through the urethra and multiply in the bladder. While the urinary system is designed to keep out these kinds of bacteria, sometimes the defenses fail or are compromised. o Steps to reduce the risk of getting a UTI include: Drink plenty of fluids, particularly water. Empty the bladder as soon as possible after intercourse. In addition, drink a full glass of water to help flush out bacteria. For women specifically: Wipe from front to back after going to the bathroom. Doing so after urinating and after a bowel movement helps to prevent bacteria from spreading from the anal region to the vagina and urethra. Avoid using irritating feminine products. o If you contract a UTI, you may experience these common symptoms: A strong, persistent urge to urinate A burning sensation while urinating Passing frequent but very small amounts of urine Detecting blood in the urine or cloudy, strong-smelling urine e. Vaginitis—Vaginitis is an inflammation of the vagina that can result in some unpleasant symptoms including discharge, itching, and pain. Women may experience vaginitis due to changes in the normal balance of bacteria in the vagina. The most common types of vaginitis are treatable and include: o Bacterial vaginosis—this type results from overgrowth of one or more of several organisms typically present in the vagina, upsetting the natural balance of vaginal bacteria. It is treated with an antibiotic and requires a prescription from a health care provider. o Yeast infection—a naturally occurring fungus changes the normal environment in the vagina. It is usually treated with an anti-yeast cream or suppository placed in the vagina. o Trichomoniasis—this is caused by a parasite that is spread during sex with someone who already has the infection. It is treated with an antibiotic and requires a prescription from a health care provider. o Antrophic vaginitis—this vaginitis is due to reduced estrogen levels resulting from menopause. Using water-based lubricants can prevent inflammation and help women to enjoy intercourse f. Cancers of the Female Reproductive System—Five main types of cancer affect a woman’s reproductive system: vaginal, vulvar, uterine, ovarian, and cervical cancers. As a group they are referred to as gynecologic cancer. Each year, approximately 20,000 women in the United States get ovarian cancer. Among U.S. women, ovarian cancer is the eighth most common cancer and the fifth leading cause of cancer. o Table 6.1 describes known risk factors, common symptoms, and prevention efforts that women can take to reduce the risk of contracting one of these gynecological cancers. o Cancer that originates in the vagina is called vaginal cancer. Cancer that first forms in the vulva is called vulvar cancer. o Uterine cancer begins in a woman’s uterus. The most common type of uterine cancer, endometrial cancer, often forms in the endometrial lining of the uterus. o Ovarian cancer usually begins in one of the two ovaries. Ovarian cancer is not common in younger women. o Cervical cancer begins in the cervix, and is the easiest female cancer to prevent with regular screening tests. When found and treated early, it is also the most curable. Cervical cancer occurs most often in women over the age of 30. The human papillomavirus (HPV) is the main cause of cervical cancer. Even though HPV is quite common, most women who get HPV will not develop cervical cancer. C. Male Sexual Health a. Penis Health Care—Some men routinely groom, trim, or wax their pubic hair. Some of the benefits of regular grooming are that it improves cleanliness and reduces moisture, it can be sexually stimulating, it may increase sensitivity during sex, and it can be an enjoyable partner experience. o It is not necessary to vigorously scrub the penis with powerful soaps or disinfectants. Simply washing with warm water and a mild soap will ensure cleanliness. o Taking care of the penis on a regular basis also helps men to notice any changes in their testicles that might raise health concerns. Testicular self-exams and testicular exams by a doctor are also practices that all men should engage in on a regular basis. b. Testicular cancer—Testicular cancer, in particular, tends to occur among younger men. It is most common in U.S. males between 15 and 34 years of age (Moynihan, 2009). It generally affects only one testicle. It occurs when healthy cells in the testicle become altered in some way. Nearly all testicular cancers are thought to begin in the germ cells, the cells in the testicles that produce sperm. o What exactly causes these germ cells to become abnormal and develop into cancer is still unknown, but some risk factors include: An undescended testicle—One or both testicle may not descend in infancy, a condition called cryptorchidism. Abnormal testicle development—Conditions that cause testicles to develop abnormally (e.g., Klinefelter’s syndrome, a genetic condition that results in anatomical variations) may increase the risk of contracting testicular cancer. Family history—As with many forms of cancer, having a family history of testicular cancer may put an individual at risk. Age—It is most common among younger men between the ages of 15 and 34, but it can occur at any age. Ethnicity—Testicular cancer is more common in Whites than in Blacks or Hispanics. o Some doctors recommend that men between the ages of 15 and 40 perform testicular self-exams monthly. Some signs and symptoms of testicular cancer include: A lump or enlargement in either testicle A feeling of heaviness in the scrotum A dull ache in the abdomen or groin A sudden collection of fluid in the scrotum Pain or discomfort in the testicle or scrotum o Treatment options for testicular cancer depend on several factors, including a man’s overall health and preferences. These options include surgery to remove the cancerous testicle, radiation therapy, and chemotherapy. c. Prostate cancer—Prostate cancer affects the prostate gland, which produces seminal fluid. Affecting approximately one in six men in the United States, prostate cancer is one of the most common types of cancer in men. One of the misconceptions about prostate cancer is that it is an old man’s disease. Prostate cancer does occur in young men, although about two thirds of all prostate cancer cases occur in men over age 65. o Blacks experience higher rates of prostate cancer than Whites, and the disease occurs less frequently among Asian/Pacific Islanders and American Indian/Alaska Natives. The incidence of prostate cancer in the United States significantly decreased in the early 1990s, but since 1995 it has remained level. o Knowing the risk factors of prostate cancer can help men determine when to begin regular prostate screening. The main risk factors include: Age—After 50, the chance of having prostate cancer increases. Family history—If an immediate family member (brother or father) has had prostate cancer, the risk increases. Race/ethnicity—Blacks have a higher risk of both developing and dying of prostate cancer. Diet—A high-fat diet may increase the risk because fat increases the production of testosterone, which may promote growth and development of prostate cancer cells. High testosterone levels—Testosterone naturally stimulates growth of the prostate gland. o Prostate cancer usually does not produce any noticeable symptoms in its early stages so many cases are not detected until the cancer has spread beyond the prostate. If symptoms do appear, they can include urinary problems caused by the tumor pressing on the bladder or the urethra. For most men, prostate cancer is first detected during a routine screening procedure called the prostate-specific antigen (PSA) test or during a digital rectal exam. o The PSA blood test can detect early-stage prostate cancer. It is known that treatment is more effective the earlier the condition is diagnosed. II. Sexually Transmitted Infections • 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). A. Risk and Protective Factors for STI’s d. Knowing some of the risk factors can help to avoid them and maximize pleasure in our sexuality. Consider the following as the risk factors: o Unprotected sex—For sexually active individuals, consistent condom use is the best protection against a possible STI. Consistent condom use means using a condom every single time an individual has sex with a partner. o Multiple partners—The more partners an individual has, the more likely he or she is to be exposed to an STI at some point. o Engaging in sex from an early age—Youths, particularly teenagers, are more likely to contract an STI than older people. Young people are more likely not to use condoms and to engage in sexual risk taking. o Alcohol and drug use—Using injectable drugs is a high-risk behavior for the transmission of HIV, hepatitis, and other viruses due to the high incidence of sharing needles. In addition, people who are intoxicated or in an altered state of mind may be less discriminating about whom they choose to have sex with. o Having an STI—A person with one STI is more susceptible to getting other STIs. o Using the pill as the sole form of contraception—When protected from pregnancy, many couples are reluctant to use condoms as part of their sexual routine. The combination of using birth control pills and condoms is a better option than the pill alone or a condom alone, particularly since the pill can reduce the risk of pelvic inflammatory disease (PID), a disease that commonly results from STIs. o Being female—The cells of the cervix constantly change in teenage girls and young women, and so their cervix is more vulnerable to certain sexually transmitted organisms. In addition, women at any age are more likely to have more severe complications from STIs than men, particularly infertility. e. Many public health agencies have devised routine self-assessments that enable people to determine their own risk for STIs. Smart individuals take positive actions to promote sexual health and protect themselves and their loved ones from STIs, including the following measures: o Talk about sex—Communication is key. Greater adult–child communication, particularly between parents and children, about sex and condoms or contraception should occur before a young person engages in sex. o Create a positive peer culture—Have a peer group that supports and uses condoms and contraception, and promotes STI protection. o Keep a positive attitude—Value partners who consistently use condoms, have a positive attitude toward condoms and contraception, and know the benefits of condoms and contraception use. o Consistently use effective protection—people who have previously used condoms or contraception often have greater motivation, intent, and confidence in using effective and protective means of contraception. o Be informed—Individuals who are older at the time of first voluntary sexual intercourse are more likely to use condoms and contraception and to use them correctly. B. Sexual Risk and Negotiation f. Whether people are in a heterosexual relationship or a gay relationship, the issue of trust, risk, and prevention of STIs is one that couple must negotiate today. g. Because many people in the United States are socialized to view sex as a taboo and to avoid the topic in all conversations, they lack the understanding that talk about sex contributes to positive and healthy relationships. Conversely, mistrust and lack of communication can place people at risk, including risk of infection. h. Sex partners must talk about STIs before having sex. If they wait until after having sex, it may be more difficult and they may have already exposed the other person to an STI. i. Sex partners need to have some knowledge about STIs. Books or a credible website provide the right language to speak about STIs, to ease the flow of conversation. j. Partners should also prepare themselves emotionally. One may be either defensive or uncomfortable with the discussion, so both need to express their feelings toward each other clearly, which is why the conversation is necessary. k. When sex partners start having sex and one notices a symptom of an STI, he or she must tell the other partner immediately. This will be an upsetting time, but by gently pointing out the symptom(s) and discussing their concerns about health and well-being, the partners are paving the way to a healthy and enjoyable sexual relationship. l. Research on both gay and straight couples has found that when people gain trust with their partners, their risk goes down. However, there may be other barriers to communication, such as culture, language, and power. m. Table 6.2 summarizes the different types of STIs, specifically bacterial, parasitic, and viral infections. C. Human Immunodeficiency Virus n. Globally, the risk of becoming infected with the human immunodeficiency virus (HIV) is one of the clearest dangers of unprotected sex. Untreated HIV leads to the destruction of the immune system through a variety of illnesses known as the acquired immunodeficiency syndrome (AIDS). o. What people once considered a mysterious and exotic disease that infected Haitian immigrants, sex workers, hemophiliacs, homosexuals, and sexual tourists has become a global pandemic, meaning there is no corner of the earth that HIV/AIDS has not reached. p. At the end of 2010, 34 million people worldwide were infected by and living with HIV (UNAIDS, 2011). Globally, an estimated 1.8 million AIDS-related deaths occurred in 2009 as a result of HIV infection. q. A cure remains illusive but more effective treatments have enabled millions, including children born with HIV, to look forward to the possibility of a long life living with HIV/AIDS as a chronic disease. Through a combination of better education, improved treatments, safer sex practices, and avoidance of HIV risk, the number of HIV infections worldwide seems to be slowing. r. There is a huge disparity between racial groups when it comes to who actually gets HIV. Though Caucasians outnumber African Americans in the population by a factor of 4.5 to 1 in many areas of the United States, in fact, both groups exhibit a similar number of new HIV infections (Sutton et al., 2009). s. Beginning in the early 1980s and through the mid-1990s, the lack of effective treatment for HIV basically meant that having AIDS was a death sentence. Today, with good medical interventions, people can expect to live out their lives. t. History of HIV/AIDS—The first documented cases of AIDS appeared in the United States in 1980, but research suggests that HIV may have been present in human beings for decades, perhaps even before 1900. Recent discoveries suggest that a virus in primates crossed to humans in the late 1800s. The virus did not sicken the primate population, but it converted to HIV. o The first recognized cases of AIDS in the United States occurred among gay men, hemophiliacs, sex workers, and Haitian immigrants in the early 1980s. The early cases in New York and California were mysterious and highly resistant to any kind of known treatment. o The medical community could not stop the progression of diseases that were quickly taking the lives of those who had them. Symptoms of AIDS at this time were unexplained weight loss, rare forms of pneumonia, and rare cancers and infections not found in healthy human populations. o At the beginning of the AIDS crisis in the United States, most of the illnesses and deaths were occurring among gay men—and so they were mistakenly referred to as the “gay cancer.” This early trend is primarily responsible for the stigma HIV and AIDS still have today, despite the fact that both occur in every community in the world. o In late 1983, American and French researchers discovered that the organism responsible for AIDS is a retrovirus, a virus that destroys the cells of the body’s immune system as it reproduces. o HIV/AIDS continues to affect people of all races, ethnicities, and communities in American society, including gay and bisexual men and injecting drug users. In addition, HIV/AIDS has become a serious problem among heterosexual women, especially in African American and Hispanic/Latino populations. o A new spike in HIV rates among older men suggests that people are not protecting themselves, and this may be related to the stigma associated with homosexuality and/or high-risk unprotected anal sex, which is known as bare-backing (anal sex without condoms). u. Transmission of HIV—HIV can be detected in several fluids and human body tissues. It is important to understand, however, that finding a small amount of HIV in a body fluid or tissue does not mean that HIV is transmitted by that body fluid or tissue. Only specific fluids (blood, semen, vaginal secretions, and breast milk) from an HIV-infected person can transmit HIV. o These specific fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream for transmission to possibly occur. o In the United States, HIV is most commonly transmitted through specific unprotected sexual behaviors (anal or vaginal sex) or sharing of needles with an infected person. It is less common for HIV to be transmitted through oral sex or for an HIV-infected woman to pass the virus to her baby before or during childbirth or after birth through breastfeeding her infant. o It is not possible to transmit HIV by hugging someone, or sharing food or eating utensils. In addition, close-mouthed kissing is considered to be completely safe. v. Symptoms of HIV—HIV infects cells in the immune system, called T-cells, and the central nervous system in the body. T-cells play a critical role in our immune systems by coordinating the actions of other immune system cells. When HIV infects and reduces the number of available T-cells, the immune system can become seriously threatened. Over time, usually years, HIV infection will lead to a significant decrease in these cells. HIV infection can be broken down into four distinct stages: o Stage 1: Primary HIV infection—This stage of infection lasts for a few weeks and is often accompanied by a short flulike illness. During this stage, there is a large amount of HIV in the bloodstream, and the immune system responds by producing HIV antibodies—substances that detect HIV particles and disable them. This process is known as seroconversion. o Stage 2: Clinically asymptomatic stage—This stage lasts on average about 10 years, though it is known that with some of the new advances of treatment, this stage can last up to 20 years or longer in individuals. This stage is often free of major symptoms. o Stage 3: Symptomatic HIV infection—Symptomatic HIV infection is mainly caused by the emergence of opportunistic infections and cancers that a normal immune system would fight off and prevent. This stage of HIV infection is characterized by multisystem disease and infections, which can occur in almost every bodily system. o Stage 4: Progression from HIV to AIDS— A diagnosis of AIDS is made after a positive test for HIV and after two criteria are met: The T-cell count must dip below 200 (half the normal amount), and the person must be infected with one or more of 20 opportunistic infections. In the United States, the most common AIDS-defining opportunistic infection is Pneumocystis carinii pneumonia (PCP). w. Testing and Treatment—There are simple, accurate, and minimally invasive techniques for HIV testing. The tests are all designed to detect antibodies that the body produces in response to HIV infection. Because a number of antibodies must be present in order to signal a positive result on a test for HIV, a conclusive negative result cannot usually be obtained until 3 to 6 months after the time of possible infection. o A person planning on being tested for HIV should refrain from all risky sexual activities for several months prior to the test. Testing method include taking a blood sample or saliva sample. o In the past decade, significant advances in the development of antiretroviral therapy (ART) made up of a combination of medications that work together to reduce the replication of the human immunodeficiency virus has been seen. The latest medications have successfully reduced the levels of the virus in the bloodstream of HIV-infected persons to undetectable levels, lengthening the time it takes for the virus to cause further symptoms and develop into AIDS. x. Prevention—Condoms can greatly reduce the risk of transmission of HIV. If HIV infection has already occurred, several medications available through health care practitioners can reduce the viral load in the human body and prevent HIV from escalating to AIDS. The medications can also aid in preventing HIV transmission. D. Bacterial STI’s y. Single-cell organisms called bacteria cause bacterial STIs. These organisms are found in various bodily fluids, including saliva, mucous membranes, semen, vaginal secretions, and blood. z. Bacteria that cause STIs are spread primarily via sexual contact, including oral, vaginal, and anal sex, or when contact with bodily fluids occurs. The good news about bacterial STIs is that they can be treated successfully with antibiotics, especially when they are detected early. aa. Once treatment has begun, it is important to let any sexual partners know that they may have been infected. bb. Gonorrhea—Gonorrhea is caused by the bacterium Neisseria gonorrhea, bacterium grows in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and in the urethra in both men and women. The bacteria grow in the anus, mouth, and throat. cc. Chlamydia—Chlamydia is a common STI caused by the bacterium chlamydia trachomatis. Even though symptoms of chlamydia are usually mild or nonexistent, serious complications can result that have the potential to cause permanent damage including infertility. dd. Syphilis—Syphilis is an STI caused by the bacterium Treponema pallidum. It has often been referred to as the “great imitator,” because so many of its symptoms are indistinguishable from those of other infections. o Contrary to myth, syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils. It is transmitted by direct contact with a syphilis sore or prenatal exposure through an infected mother. o Symptoms—Syphilis develops in stages, defined by the symptoms present, which range from the primary stage, to the secondary and then latent and late stages. Many people who are infected with syphilis remain symptom-free for many years. Primary Stage—The primary stage of syphilis is usually marked by the appearance of a single sore called a chancre. The chancre is usually firm, round, and small, but painless. Secondary stage—In this stage, common symptoms include a skin rash and mucous membrane lesions. The rash will appear on one or more areas of the body and can appear as the chancre is healing or several weeks after the chancre has healed. In addition to the rashes, symptoms of secondary syphilis may include: Fever Swollen lymph glands Sore throat Patchy hair loss Headaches Symptoms of the secondary stage will resolve without treatment. However, without treatment, the infection will progress to the latent and possibly the late stages of the disease. Latent and late stages—Syphilis has a hidden stage, called the latent stage, when the symptoms of the primary and secondary stages begin to disappear. Without treatment, an infected person will continue to have syphilis even though there are no signs or symptoms. Common symptoms of the late stage of syphilis are: Significant damage to internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints Difficulty coordinating muscle movements Paralysis Numbness Gradual blindness ee. Pelvic inflammatory disease—Pelvic Inflammatory Disease (PID) confuses many people because, although it is most always associated with STIs, it is really a general term that refers to infection of the uterus, fallopian tubes, and other female reproductive organs. In fact, PID is a common and serious complication of some STIs, particularly gonorrhea and Chlamydia. E. Parasitic STI’s ff. The two most common body infestations caused by parasites are scabies and pubic lice. gg. Scabies—Human scabies is caused by an infestation of the skin by the human itch mite. The microscopic scabies mire burrows into the upper layer of the skin where it lives and lays its eggs. It is transmitted through non-sexual and sexual contact. hh. Pubic Lice—Pubic lice or crabs, are parasitic insects that are found primarily in the pubic or genital area of individuals. Pubic lice have different forms including the egg, the nymph, and the adult. Lice eggs, or nits, are tiny and can be hard to see. They are found firmly attached to the hair shaft. They are oval and usually yellow to white in color. Pubic lice nits take about 6 to 10 days to hatch. F. Viral STI’s ii. Different viruses contracted through high-risk sexual behaviors, such as unprotected vaginal, anal, and oral intercourse, cause viral STIs. Viral STIs include the four Hs: HIV, HPV (genital warts), herpes, and hepatitis. o These viruses have no cure, but many of their symptoms can be alleviated with treatment. Safer sexual practices can assist in the prevention of every one of these STIs. jj. Herpes simplex virus—Herpes is a recurrent skin condition characterized by sores on the mouth or genitals. It is caused by herpes simplex viruses HSV-1 and HSV-2. While HSV-1 mostly causes cold sores or fever blisters on the mouth or face and HSV-2 mostly causes sores on the penis or vulva, the viruses are identical under a microscope and either type can infect the mouth or genital region. kk. Human Papilloma Virus—The human papilloma virus (HPV) is a condition contracted from one of a group of more than 100 related viruses. Thirty of these different types of HPV are known to be genital strains. Each type of HPV has the potential to cause an abnormal growth on a particular part of the body—genital warts and other lesions on or near the genitals or anus are the most common symptoms of genital HPV infections. The HPV is also the leading cause of cervical cancer in women, and is associated with anal cancer in men. o Nearly all cases of cervical cancers are caused by HPV infections. Worldwide, cervical cancer is very common due to the fact that many women lack access to Pap test screening. ll. Hepatitis—The word hepatitis means “inflammation of the liver.” A virus most often causes hepatitis. In the United States, the most common types are hepatitis A, hepatitis B, and hepatitis C, though there are now cases of hepatitis D and E. Hepatitis D requires an infection of hepatitis B. Hepatitis B is the hepatitis virus that is associated with sexual contact. It causes chronic infection, cirrhosis (scarring), and cancer of the liver. o The virus is present in blood, semen, vaginal secretions, and breast milk. A blood test is used to diagnose hepatitis. Table 6.3 gives a comparison of the prevalence, symptoms, transmission, and treatment of the most common forms of hepatitis. III. Sexual Well-Being and Innovation in STI Prevention • There appears to be a growing vulnerability among the poor in the United States and in Third World countries caused by the lack of access to health care and awareness about STIs and how to prevent them. There are many ways for societies to improve conditions and control the spread of STIs. o They might, for example, launch community campaigns to alert people to HIV risk, distribute condoms, and teach people how to talk with their intimate partners about sexual risk. More than anything, such measures would equip people with the knowledge, skills, and motivation to fight HIV in their own backyards. • Research shows that HIV infections are actually increasing in some populations globally and in the United States. This is the result of poverty, poor health care, and lack of education about HIV, as well as high-risk unprotected sexual behavior. Key Terms Mammogram—low-dose X-ray of the breast used to detect growths and cancer in breast tissue Lumpectomy—removal of the cancerous tumor in the breast while leaving the breast intact Mastectomy—removal of one or both breasts, and possibly other tissue around the breast, to eradicate cancer from that area Speculum—an instrument used to open the vagina during vaginal exams performed by a physician Bimanual exam—an exam in which the doctor inserts two fingers in the vagina while placing the other hand on top of the lower part of the abdomen in order to feel for any abnormalities and to check the size, shape, and mobility of the uterus Urinary tract infection (UTI)—an infection of the urethra, bladder, or other urinary structure, usually caused by bacteria Vaginitis—inflammation of the vagina that can result in some unpleasant symptoms including discharge, itching, and pain Bacterial vaginosis—a type of vaginitis that results from overgrowth of one or more of several organisms typically present in the vagina Yeast infection—a type of vaginitis that occurs when a naturally occurring fungus changes the normal environment in the vagina, mouth, skinfolds, or fingernail beds Trichomoniasis—a common sexually transmitted protozoan parasite causing symptoms in women, but typically not in infected men Atrophic vaginitis—this type of vaginitis is due to reduced estrogen levels resulting from menopause and can cause vaginal tissues to become thinner and drier Gynecologic cancer—a group of five different cancers affecting a woman’s reproductive system. Includes vaginal, vulvar, uterine, ovarian, and cervical cancers. Vaginal cancer—a gynecologic cancer that begins in the vagina Vulvar cancer—a gynecologic cancer that forms in the vulva Uterine cancer—a gynecologic cancer that begins in the uterus Ovarian cancer—a gynecologic cancer that begins in one of the two ovaries Cervical cancer—a gynecologic cancer that begins in the cervix Human papillomavirus (HPV)—a sexually transmitted infection; a primary cause of cervical cancer Testicular cancer—a cancer that begins in one of the testicles; tends to occur among younger men Germ cells—cells in the testicles that produce immature sperm Cryptorchidism—a condition that occurs in infancy in which one or both of the testicles do not descend Prostate-specific antigen (PSA) test—a routine screening used to detect prostate cancer Digital rectal exam—an exam during which the physician inserts the fingers into the rectum in order to feel the size of the prostate gland Pelvic inflammatory disease (PID)—a painful condition in women marked by inflammation of the uterus, fallopian tubes, and ovaries; typically caused by the presence of one or more untreated STIs Human immunodeficiency virus (HIV)—a virus that leads to the destruction of the immune system through a variety of illnesses known as AIDS Acquired immunodeficiency syndrome (AIDS)—a late-stage infection with HIV Global pandemic—worldwide epidemic Retrovirus—a virus that survives and multiplies by invading and destroying the DNA of normal body cells and then replicating its own DNA into the host cell’s chromosomes Opportunistic infections—a group of infections that establish themselves in the human body as a result of a weakened immune system due to HIV infection Gonorrhea—a common STI caused by the bacterium Neisseria gonorrhea Chlamydia—a common STI caused by the bacterium Chlamydia trachomatis Syphilis—an STI caused by a bacterium and characterized by a chancre, or sore, at the point of infection Chancre—a sore that typically appears at the site of infection with syphilis Scabies—a skin infestation caused by a microscopic mite that burrows under the skin and causes a very itchy rash Pubic lice (crabs)—very small parasitic insects that attach themselves to hair shafts and cause itching Herpes—a recurrent skin condition characterized by sores on the mouth or genitals; caused by the herpes simplex virus Hepatitis—a chronic viral infection of the liver Instructor Manual for Human Sexuality: Self, Society, and Culture Gilbert Herdt, Nicole Polen-Petit 9780073532165, 9780077817527
