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Psychology 2075 December Midterm Notes.docx

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Psychology 2075
William Fisher

Chapter 9: Sexual Responses The Sexual Response Cycle  Sexual response typically progresses in 3 stages: o Excitement: male erection, female vag lubrication (vasocongestion) o Orgasm: intense sensation that occurs at peak of sexual arousal o Resolution: body returns to unaroused state  Vasocongestion: accumulation of blood in the blood vessels in the genitals in which a swelling or erection results  Myotonia: muscle contractions not only in genitals but throughout body  Erection: result of vasocongestion, requires arteries to dilate (vasodilation), allowing strong flow of blood into corpora, while veins carrying blood away from penis compress to restrict outgoing blood flow o Nitric oxide (NO) is especially involved in this process o Viagra acts on the NO system o Vasoconstriction: make erection go away (usually following orgasm)  Vaginal lubrication: result of vasocongestion, capillaries in vaginal walls dilate and blood flow increases, fluids seep through semipermeable membranes of vaginal walls  Orgasmic platform: tightening of the entrance to vagina caused by contractions of bullbospongiosus muscle that occur late in the arousal stage of sexual response o Estrogen helps the vasodilation o Upper 2/3rds of vagina expands in a ‘ballooning’ response  Sex flush: resembles a measles rash often beginning on upper abdomen and spreads over chest o Appears on the skin of both males and females, but usually females  Male orgasm occurs in 2 stages: o Preliminary stage: vas, seminal vesicles, prostate contract forcing ejaculate to base of urethra  Ejaculatory inevitability (‘cumming’): sensation that ejaculation is just about to happen (Masters & Johnson) o Second stage: urethral bulb and urethra contract rhythmically forcing semen through urethra and out of penis o Study: feelings of pleasure and satisfaction from orgasm were more strongly related to psychological and social factors than physical o Sensations of male and female orgasms are very similar  Resolution in females: reduction of breasts, clit returns to normal position in 5- 10 seconds but takes longer to decrease in size, orgasmic platform shrinks  Resolution in males: detumescenceloss of erection first occurring rapidly but leaving penis enlarged, second occurs slowly emptying corpus of blood o Refractory period: following orgasm during which man cannot be sexually aroused length varies for people, gets longer with age  Female orgasm: according to Freud (refuted my Masters and Johnson) o Clitoral orgasm: Freud’s term for orgasm in females resulting from stimulation of clitoris those who could only have clitoral orgasms considered ‘vaginally frigid’ o Vaginal orgasm: resulting from stimulation of vagina in heterosexual intercourse Freud considered it more mature than clitoral  Female orgasm: according to Masters and Johnson o No difference between vaginal and clitoral orgasm all female orgasms are physiologically the same, regardless of site of stimulation o Clitoral stimulation is almost always involved in producing orgasm o Multiple orgasms: series of orgasms occurring within a short period of timeM & J discovered women do not enter a refractory period o Some women capable of having 50 orgasms in row, more typically for multiple orgasms is 5-20 o In some men, detumescence does not always follow orgasm and so men are sometimes able to have multiple orgasms o Criticized for ignoring the cognitive and subjective aspects of sexual response Other Models  Kaplan’s Triphasic Model: sexual response has 3 independent components o Sexual desire (psychological) o Vasocongestion (physiological) controlled by parasympathetic system o Muscular contractions (physiological) controlled by sympathetic one o Male capacity to orgasm decreased with age, but capacity for erection remains unimpaired o Reflex of ejaculation cannot be voluntarily controlled but erection reflex generally can o Erection problems: vasocongestion problems; ejaculation problems: orgasm/muscle contractions problems  Intimacy model: people may not be motivated to engage in sexual activity due to sexual desire but instead to enhance intimacy with partner o Once sexual activity begins does the person feel aroused o Emotional intimacysexual neutralitysexual stimulisexual arousalsexual desire and arousalemotional/physical satisfaction  Dual control model: sexual response is controlled by 2 basic processes o Sexual excitation: people high on excitation and low on inhibition may engage in high risk sexual behaviour o Sexual inhibition: people high on inhibition and low on excitation more likely to develop sexual disorders (erectile dysfunction, low desire, etc.) o Individuals vary in their tendencies toward excitation or inhibition o While both excitation and inhibition have biological bases, both are influenced by social and cultural learning o Inhibition is important because sexual activity may be dangerous, the environment may not be conducive to reproduction, and excessive sexual behaviour in men reduces fertility due to several ejaculations  Emotion and arousal: o Kaplan’s triphasic model includes cognitive processes to sexual desire o Intimacy model includes motivation and relationship factors o Dual control model includes culture and early learning in sexual stimuli/processes o Study: diary method daily questionnaire asking about people’s emotions and sexual behaviours to be filled out separately from one’s partner  Positive emotions (i.e. happiness) showed strong positive association with reports of sexual arousal  Negative emotions (i.e. anger) were also positively correlated with reports of sexual arousal likely because negative emotions involve generalized arousal, intensifies arousal to sexual stimuli Hormonal and Neural Bases of Sexual Behaviour  Spinal reflexes: components of sexual behaviour (i.e. ejaculation) controlled by these reflexes—3 components o Receptors: sensory neurons that detect stimuli and transmit message to spinal cord o Transmitters: centres in the spinal cord receive message, interpret it, send out message to product appropriate response o Effectors: neurons or muscles that respond to the stimulation  Mechanism of erection: can be produced by spinal reflexes or cognitive factors o Erection centre: tactile stimulation of penis or nearby regions sends neural signal to this centre in the lowest part of spinal cord  Then sends out message via effectors in parasympathetic system o Existence of this reflex proven by men who have had spinal cord severed right above erection centre cannot feel anything, have no brain effects, but can still produce erection from tactile stimulation o Can also be produced by fantasy or other purely psychological factors  Mechanism of ejaculation: similar to erection reflex but 2 ejaculation centres higher up, both parasympathetic and sympathetic systems involved, response is muscular not vasocongestion o Ejaculation centre: penis sends message in response to stimulation, then sent out via sympathetic system, triggering muscle contractions o Retrograde ejaculation: condition in which orgasm in the mal is not accompanied by external ejaculation—instead ejaculate goes to bladder  Mechanisms in women: o Sympathetic and parasympathetic systems supply clit and vagina nerves o Female ejaculation: only some women emit fluid from the G-spot o Grafenberg spot (g-spot): produces PSA and deeper uterine contractions  Limbic system: structures in brain including amygdala, hippocampus, fornix o Believed to be important for sexual behaviour in both animals and humans o Medial preoptic area (MPOA): in hypothalamus, implicated in male sexual desire o Paraventricular nucleus (PVN): in hypothalamus, when genitals are stroked cells in PVN fire  Organizing effects of hormones: effects of sex hormones early in development, resulting in permanent change in brain or reproductive system o Female rats given testosterone prenatally were incapable of displaying female sexual behaviour (in particular, lordosis) because testosterone ‘organized’ the brain tissue in a male fashion  Activating effects of hormones: effects of sex hormones in adulthood, resulting in activation of behaviours, especially sexual and aggressive behaviours o I.e. castrated rats no longer produce testosterone, results in cessation of sexual activity and aggressive behaviours—when given testosterone these behaviours are reactivated o Female rats given testosterone in adulthood showed about as much mounting (male sexual behaviour) as males because the testosterone ‘activated’ male patterns of sexual behaviour Pheromones:  Biochemical secreted outside the body that are important in communication between animals and that may serve as sex attractants o Often contained in animal’s urine  Vomeronasal organ (VNO) chemoreceptor in the olfactory bulb in which removal dramatically decreases sexual behaviour in rats and guinea pigs o Different neurons fire when in contact with male vs. with female  Nerve zero: cranial nerve that releases GnRH into blood o May sense pheromones even if they don’t have an odour  Perfume industry has eagerly tried to capitalize on pheromone research  Androstenol (odorous steroid found in pigs) and short-chain fatty acids (sex- attractants in male rhesus monkey) have been found in humans o Thus, humans do secrete pheromones  Study: women’s perfume was laced with synthesized female pheromone in one group, in control group perfume was laced with a placebo o Pheromone-treated women showed significantly greater frequency of intercourse, dates, sexual fondling and kissing o Did not show difference in frequency of masturbation o Concluded that pheromones increased women’s attraction to men  Menstrual synchrony: convergence over several months of the dates of onset of menstrual periods among women in close contact with one another o Odorless secretions from underarms collected in late follicular phase o Women exposed to these secretions showed accelerated appearance of LH that triggers ovulation o Secretions collected later in the menstrual cycle had the opposite effect delayed LH surge and lengthened time of period  Preferences for human body odours and brain responses to pheromones differ as a function of sexual orientation o Gay men found smell secreted from heterosexual men least pleasant o Heterosexual men found smell secreted from gay men least pleasant Sexual Techniques  Erogenous zones important in sexual pleasure genitals and breasts o Lips, neck, thighs; back, ears, stomach, feet o Zones differ from one person to the next  Autoeroticism: sexual self-stimulation i.e. masturbation, fantasy  Masturbation: stimulation of one’s own genitals with the hand or some object  Sexual fantasy: sexual thoughts or images that alter the person’s emotions or physiological state o Men’s fantasies revolved around themes of anonymous or impersonal sex o Women’s fantasies about role playing during sex and romance o Gays tend to fantasize about same sex while heterosexuals tend to fantasize about opposite or same sex o Involve places, people or animals with no real world connection to o People who engage in sexual fantasy more better adjusted sexually  Spicy sex: change from the usual sex script  Vanilla sex: the usual sex script  Dildo: rubber/plastic cylinder, often shaped like penis  Vibrator: handheld device that vibrates, used for massage or held against body to provide sexual stimulation o Sold as medical device to women in 1880s shunned after 1920s porn o Women and men who had used a vibrator engaged in more health- promoting behaviour and had better sexual functioning  Tribadism: when two women dry hump………  Interfemoral intercourse: when a man moves his penis between partner’s thighs  According to NHSLS, watching partner undress is one of most appealing sexual activities  Coitus: sexual intercourse involving insertion of penis into vagina o Man-on-top/missionary position doesn’t work with pregnant belly or obese people, most advantageous for ensuring conception o Woman-on-top position best to delay ejaculation o Rear-entry position doggie position or side-to-side position o Side-to-side position either face-to-face or rear entry, good for the pregnant or obese  Cunnilingus: mouth stimulation of female genitals (generally focus on clit) o Dental dam: small plastic sheet placed over vulva to practice safer sex o Some women enjoy partner blowing air into vagina, BUT unsafe for pregnant women—can result in death, damage to placenta, embolism  Fellatio: mouth stimulation of male genitals  Sixty-nining: simultaneous mouth-genital stimulation of both partners  Anal intercourse: insertion of penis into partner’s rectum sometimes referred to as ‘Greek style’ and sodomy but this also refers to having sex with animals o Do not have vaginal intercourse after anal—leads to vaginitis  Anilingus: mouth stimulation of partner’s anus ‘feuille de rose’ or ‘rimming’  Masters and Johnson: o Gay and heterosexual individuals don’t differ in masturbation techniques o Gay and heterosexuals differ in couple interactions  Gay men and lesbians took their time  Heterosexual couples seemed to be performance-oriented, striving for the goal of orgasm  Gay men more likely to stimulate nipples and frenulum (lower side of penis below the corona), also use ‘teasing technique’  Cyberspace created a new sexual space between fantasy and action—becoming more frequent and common  Aphrodisiac: substance that increases sexual desire (i.e. a food, drug, perfume) o No known substance that works best as aphrodisiac o Number of foods thought to be because they resemble sex organs (i.e. oysters, powdered rhino horn, bananas, asparagus, etc.) o ‘Natural’ aphrodisiacs: yohimbe, cayenne, arginine, avena sativa, damiana o No scientific proof but people claim weed acts as sex stimulant o Amyl nitrite (‘poppers’): popular among some because it relaxes muscle of anus, reportedly produces heightened sensations during orgasm  Can be dangerous  Chemical relative: Butyl nitrite—used to highten sex pleasure  Anaphrodisiac: substance that decreases sexual desire (i.e. a cold shower) o Research on drug cyproterone acetate—an antiandrogen  Foreplay: implies that activities like hand stimulation of genitals, kissing, etc. are only preliminaries to intercourse, which is ‘real sex’ o But in reality all these activities can result in sexual pleasure o Sex has become work—we must work hard and become successful o Must achieve orgasm Viagra encourages people to reduce sexuality to an orgasm o 21% men and 24% women said their partner spent too little time foreplay Characteristics of Exceptional sex:  Being fully present and focused  Sense of connection, merger, being in sync  Deep intimacy  Extraordinary communication  Authenticity, being genuine  Exploration, interpersonal risk-taking, fun  Letting go and being vulnerable  Moments of transcendence and awe Sexual Orientation and Identity: Gay, Lesbian, Bi, Straight, and Asexual Key Terms:  Sexual identity: one’s self-identity as gay, hetero, bi, or asexual o Different from sexual orientation as a woman may identify herself as a lesbian but still have sex with men thus having sexual orientation of bi o Tearoom trade: successful, heterosexual, married men stop off at public restroom to engage in oral sex with another man  Sexual orientation: a person’s emotional, romantic and erotic orientation/attraction to other members of the same or different genders  Homosexual/gay: sexual orientation toward members of same gender o Lesbian: woman’s sexual orientation toward other women  Heterosexual/straight: sexual orientation toward opposite gender  Bisexual: sexual orientation toward both men and women  Asexual: not attracted to men or women, does not refer to behaviour  Pansexual: open to relationships with people of any sex, gender, or gender identity (men, women, trans, intersex) How Many People Are Gay, Lesbian, Bi, Straight, Asexual:  Canadian Community Health Survey (CCHS) in 2003 and 2005 o Men: 1.4% considered themselves homosexual, 0.7% bisexual o Women: 0.8% considered themselves homosexual, 0.9% bisexual  People’s sexual identity changes throughout the years o Women more likely to report changes than men o Attractions can change in all directions  National Survey of Family Growth (NSFG): o 2% men, 1% women exclusively engage in same-sex sexual behaviour and have gay sexual identity o 10% men and women have had at least 1 same-sex sexual encounter in adulthood o 4% of men and women experience sexual attraction to same sex  Typological conceptualization: defining homo and heterosexual as separate and distinct categories  Kinsey: conceptualized opposite and same sex behaviour not as separate categories but as variations on a continuum o Scale running from 0 (exclusively hetero) to 6 (exclusively homo) o Problem with scale is that it refers only to behaviour, not attraction o Solution to Kinsey’s scale: create 2 scales measuring degree of hetero- eroticism on one scale and homoeroticism on the other Attitudes:  Attitudes of Canadians toward gay men and lesbians: o Most are in favour of equal rights for homosexuals o More than half, but less than ^ are in favour of same-sex marriage o Less than half are in favour of adoption by same-sex couples o More than half thought being homophobic was as bad as or worse than being racist/anti-Semitic o Canadians more accepting of homosexuality than Americans/British  Homophobia: strong, irrational fear of gay men and lesbians negative attitudes and reactions to gay men and lesbians  Homonegativity: negative attitudes and behaviours toward gay men and lesbians, without a fear of them anti-gay/sexual prejudice, heterocentrism o Traditional: based on moral and religious views that homosexuality is ‘not normal’ o Modern: based on beliefs that gays and lesbians exaggerate the importance of their sexual orientation, demands for social change o Internalized homonegativity: some LGB youth adopt the negative attitudes around them toward homosexuality  Heterosexism: belief that everyone is heterosexual and heterosexuality is the only legitimate, acceptable and healthy way for people to be o Homosexuality is denigrated  Hate crimes: violence against LGBs o Case of Matthew Shepard: 2 young men lured him out of a bar pretending to be gay themselves and repeatedly beat him, tied him to a fence and left him for dead at University of Wyoming o Case of Aaron Webster: photographer beaten to death in Vancouver by 4 men with baseball bats, a golf club and pool cue after finding him naked in an area known for gays looking for casual sex  Studies show that Canadians over the age 15 who identify as gay/lesbian are 2.5 times more likely to be victims of violent assault than heterosexuals o More likely to be verbally and physically assaulted o LGB youth are less likely to feel safe at school  Media representations of gays and lesbians: o Some argue that representations reinforce stereotypes, leading to negative attitudes toward gays and lesbians o Others argue that shows like Glee or Modern Family challenge stereotypes o Reading popular magazines associated with positive attitudes toward LGBS, whereas teen magazines is less positive, more conservative  Attitudes toward bisexuals: o Many negative stereotypes o Thought of as internally conflicted, psychologically immature, non- monogamous to satisfy both homo and hetero sexual needs o BUT research found bisexuals rarely have male and female partners at the same time and that they don’t differ from gays or lesbians in relationship status or length o Few bisexuals believe they ‘need’ both male and female partners to consider themselves bi  LGBs experience job and wage discrimination (regardless of legality of it) o In the US, gay men more educated than straight men but are paid less  1969: homosexual behaviour made legal by Trudeau under Criminal Code o Made anal sex illegal if it involves children (under 18—unlike vaginal sex which is age 16) or is not done in private (if more than 2 people are present—no restriction on number of partners with vaginal intercourse) thus, still discriminates against gays  Before the Charter of Rights and Freedoms, no human rights complaints made by LGBs were successful but the Charter prohibited discrimination o Police continued to lay ‘indecent act’ and ‘bawdy-house’ charges against men having consensual sex with other men after 1969 o Gays and lesbians were not legally protected from discrimination o Homosexuality was grounds for dishonorable release from military  The US still does not have any laws protecting LGBs from discrimination o Fewer Americans support equal rights for gays and lesbians  2003: courts in Ontario and BC were the first to legalize same-sex marriage until 2005 House of Commons legalized it for all Canadians o 4 country in the world to legalize gay marriage  Hiding one’s identity (sexual, disabled, illiteracy, etc.) exacts a psychological and physical toll o Gays who hid their identity had significantly higher incidence of cancer/infectious diseases than those who did not conceal identity Life Experiences of LGB Individuals:  Covert homosexual: ‘in the closet’—keeps sexual orientation a secret  Overt homosexual: ‘out of the closet’—open about sexual orientation  Coming out: process of acknowledging to oneself and then to others that one is gay or lesbian o Stage of exploration o Stage of forming first relationships o Integration stage  Identity development proceeds in 6 stages: o Identity confusion: begin assuming heterosexual identity because it is normative, but confusion sparks when same-sex attraction occurs o Identity comparison: may be feelings of alienation because the comfortable heterosexual identity has been lost o Identity tolerance: seeks out gays/lesbians to make contact with, hoping for affirmation o Identity acceptance: accepts rather than tolerates gay/lesbian identity o Identity pride: strong identification with the gay community, dichotomizing world into gays/lesbians vs. heterosexuals o Identity synthesis: no longer holds ‘us vs. them’ view, recognizing there are some good/supportive heterosexuals and some bad LGBs  A woman’s sexual orientation is more fluid and may be capable of change over time more so than a man’s  Bisexual women are more likely to have opposite-sex attractions and experiences before their same-sex attractions and experiences WHEREAS bisexual men are more likely to have same-sex experiences first  Bisexuals tend to base sexual identity on feelings of sexual attraction or capacity to fall in love with either a man or woman regardless of gender  Symbols representing LGB pride: o Upside-down pink triangle was used by Nazis to label gay men but has been reappropriated by gay community o Lowercase Greek letter lambda o Rainbow flag used since 1978, representing diversity o Pink, purple, blue striped flag used to symbolize bisexual pride  Pink: attraction to same-sex  Blue: attraction to opposite sex  Purple: attraction to both sexes  Gay bars: gay-friendly bar or club frequented by lesbians and gays  Gay baths: clubs where gay men can socialize features swimming pool/whirlpool and access to casual sex o Controversialsome see it as a hindrance to gay community, spreading HIV, others see it as an essential part to gay life  Gay liberation movement: encouraged LGBs to be more overt and feel less guilty about their behaviour given rise to organizations aimed at stopping discrimination against LGBs o EGALE (Equality for Gays and Lesbians Everywhere): organization committed to advancing equality and justice for LGBTs  Study: gay, lesbian and heterosexual couples told to discuss a problem no differences among any type of couple in their interaction measures  Research on children growing up in gay/lesbian families: o Adjustment and mental health of children are no different o They fare about as well in terms of social skills and popularity o The majority of children growing up in these households have a heterosexual orientation LGB Sexual Orientation and Mental Health:  Medical model: theoretical model in psychiatry in which mental problems are thought of as sickness or mental illness problems thought to be due to biological factors rather than viewed as a sin like in the past  Study: gays, lesbians and heterosexuals are equally well adjusted  1973: American Psychiatric Association (APA) removed homosexuality as a disorder removed by the World Health Organization only in 1993  Conversion/reparative therapy: any one of a number of treatments designed to turn LGBs into heterosexuals o Early techniques: electrical shocks to gay men while viewing slides of nude men, surgeries ranging from castration to brain surgery o Can create mental health problems o By 2000, APA issued official position statement opposing this therapy What Determines Sexual Orientation  Biological theories: more than half Canadians agree people are born with it  Genetic factors: has most supporting evidence of all biological theories o Study: gay men with an identical twin brother, 52% of their co-twins were gay too; gay men with fraternal twin, 22% of co-twins were gay  Statistics for lesbians were very similar o If genetic factors fully determined sexual orientation, concordance would be 100% for identical twins o Study: genome scan for sexual orientation in men comparing them to their heterosexual family members found possible influence by 3 genes found of chromosomes 7, 8, 10  Prenatal factors: o Theory: homosexuality caused by a variation in prenatal development  Study: severe stress to a mother during pregnancy tends to produce homosexual offspring—decrease testosterone in fetus  Mixed results when this research applied to humans o Study: gay men more likely to have late birth order, have more older brothers but not more older sisters only found in right-handed men  No birth order or sibling effects on lesbians o Mother’s antibodies against H-Y antigen produced by gene on Y chromosome may affect sexual differentiation in the developing fetal brain and subsequent sexual attraction o Gay men and lesbians more likely to be left-handed  Brain factors: o Study: Simon LeVay found significant differences between gay and straight men in certain cells in the anterior portion of hypothalamus  Other scientists found no differences in this region o No well documented brain differences between homosexuals and heterosexuals  Hormonal factors: no hormonal differences (testosterone levels) between gay and straight men yet clinicians still try to treat homosexuality with testosterone therapy, which fails but sometimes makes people more gay  Learning theory: rewards and punishments shape individual’s behaviour into predominantly homosexual or predominantly heterosexual o Assumes that humans have a relatively amorphous, undifferentiated sex drive which can be channeled in any direction o Example: if one has a bad heterosexual experience early in life (i.e. a girl gets sexually assaulted by a man), will turn to homosexuality—if one has a good homosexual experience early, turn to homosexuality, etc. o Recognizes that homosexuality and heterosexuality are not necessarily inborn but learned, sees both as normal behaviour  Interactionist theory: interaction of biological factors and experiences with the environment o Daryl Bem’s theory of development of sexual orientation:  Biological variables (i.e. genes, prenatal hormones)  Childhood temperaments (i.e. aggression, activity level)  Sex-typical/atypical activity and playmate preferences (gender conformity/non-conformity)  Feeling different from opposite/same-sex peers  Non-specific autonomic arousal to opposite/same-sex peers  Erotic/romantic attraction to opposite/same-sex peers sexual orientation o For heterosexuals, exotic describes members of opposite gender who have become eroticized—for gays and lesbians it is members of the same gender, who they felt different from during childhood thus becoming eroticized o Gay men and lesbians more likely to have history of non-conformity  Study: trained raters unaware of a person’s sexuality when watching home videos rated ‘pre-homosexual’ children as less conforming than ‘pre-heterosexual’ children o Criticism: evidence not discussed by Ben contradicts central propositions of his theory the theory reflects male experience and neglects female experience  Sociological theory: study the effects of labeling in explaining homosexuality o Label ‘homosexual’ often has derogatory connotations o Reiss’s theory: male-dominant societies with a great rigidity of gender roles produce the highest incidence of homosexuality young boys learn from mothers more than fathers, so become feminized (negative pathway to homosexuality)  In less gender-rigid societies, individuals freer to experiment Differences Between Gay Men and Lesbians  Women more likely than men to be bisexual  Sexual fluidity in women more so than men  Men are specific in their sexual arousal whereas females are not o Heterosexual men will be aroused by female stimuli, gay men aroused by male stimuli o Hetero and homosexual women aroused by male and female stimuli  Birth order effect applies to men but not women gay men more likely to be of late birth order, no effect of lesbians’ birth order Sexual Orientation in Multicultural Perspective  Different cultures hold different views of same-sex behaviour  Melanesians of southwest Pacific: same-sex behaviour is ritualized, boys expected to engage in exclusively same-sex activity for about 10 years and then marry women and become exclusively heterosexual  Sambia of Papua New Guinea: 11-12 year old boy gets set up with older man chosen by father to engage in same-sex sexual activity for several months  Members of Canadian ethnocultural communities have less tolerance for homosexuality than members of Canadian majority culture do o Members from ethnocultural minorities were less likely to identify themselves as homosexuals as members of majority culture  Caribbean and Latin American communities more likely to engage in extensive same-sex sexual behaviour but still identify with heterosexuality o Study: men who take the ‘inserting’ role of anal intercourse considered masculine and not labeled homosexual, but men taking the ‘receptive’ role are considered feminine and homosexual o Differs from the gay Canadian majority where men commonly switch roles  In Latin American and Caribbean cultures, lesbians are considered outsiders  Asian communities’ views shape attitudes toward homosexuality: o Strong distinction between what may be expressed publicly and what should be kept private o Stronger value placed on loyalty to one’s family and on performance of family roles than on expression of one’s own desires o Thus, sexual identity is something that should not be had, let alone shared publicly  Definition of homosexuality is set by culture, many ethnocultural communities are more disproving of homosexuality than the majority of Canadian culture  Deprivation homosexuality: same-sex sexual activity that occurs in certain situations when people are deprived of their regular mixed-sex activity (i.e. in prison)  Sexual orientation for some may be determined by genetic factors or early experiences, for others may be determined in adulthood or continue to be fluid  According to Freud, learning theorists and sociological theorists, bisexuality is the natural state Chapter 7: Contraception and Abortion  1969 contraception legalized, 1988 abortion legalized  Babies and mothers are healthier if pregnancies are spaces 3-5 years apart  Physicians don’t need permission from parents to prescribe contraceptives to teenagers  Canadian women under 30 who are single are more likely than older women and women who are married to use oral contraceptives/condoms Hormonal Methods  Combination birth control pills (oral contraceptives): contain a combination of estrogen and progestin (synthetic progesterone) i.e. Alesse, Yasmin o Take for 21 days, then take sugar pills for 7 days o Seasonale: provides 84 days of hormones, 7 days placebo  Period only once in 3 months o Loestrin24: 24 active pills, 4 inactive pills (not available in Canada) o QuickStart: start taking the pill first day she gets prescription regardless of the day of menstrual cycle o Works by preventing ovulation and thickening cervical mucus high levels of estrogen inhibit FSH, high levels of progesterone inhibit LH production o Side effects:  Blood clotting (thrombi) severe headaches, leg or chest pains, shortness of breath  High blood pressure  Prone to breast cancer, but protects against endometrial and ovarian cancer  Taken for over 5 years, risk of benign liver tumours increases  Increases vaginal discharge and susceptibility to vaginitis  Increased susceptibility chlamydia and gonorrhea  Increases appetite or water retention, causes weight gain  Changes sexual desire, vaginal lubrication and arousal o Anti-tuberculosis drugs and antibiotics decrease pill effectiveness o Pill increase metabolism of some drugs, making them more potent  Failure rate: pregnancy rate occurring using a particular contraceptive method percentage of women who get pregnant after a year of using method o Effectiveness calculation: 100 minus the failure rate o Perfect-user failure rate: studies of the best possible use of method  Combination BC pills: 0.3% perfect-user failure rate o Failure rate for typical users: failure rate when people use the method, perhaps imperfectly  Combination BC pills: 8% typical user failure rate  Triphasic pill: birth control pill containing steady level of estrogen and 3 phases of progesterone, intended to mimic more closely women’s natural hormonal cycle (i.e. Ortho 7/7/7)  Progestin-only pills/mini pills (i.e. Micronor): low dose of progestin, no estrogen changes cervical mucus so sperm can’t get through o Typical user failure rate: 5% o Side effects: produce irregular menstrual cycles o Useful for women who are breast feeding and can’t take estrogen  The patch (Evra): same hormones as combination pills but administered transdermally o Thin, beige, size of band aid o Lasts 7 days, new one on once a week for 3 weeks, patch-free 1 week o Available in Canada since 2004 o Actual-user failure rate: less than 1% (more effective than the pill) o Less effective in women weighing more than 200 pounds o May get more estrogen than from the pill  Vaginal ring (NuvaRing): flexible, transparent ring made of plastic, filled with same hormones as combination pill at slightly lower doses o Placed high in vagina and stays there for 21 days, removed for 7 days o Side effects should be same as combination pill o Actual-user pregnancy rate: less than 1%, half the pregnancies resulting from misuse of the ring  Emergency contraception (EC): Plan B contains levonorgestrel (progestin), which is also found in regular BC pills, but at a higher dose o Most effective 12-24 hrs. after sex, can’t delay over 120 hrs./5 days o Side effects: nausea, irregular vaginal bleeding, fatigue, headache, dizziness, breast tenderness o Will not cause abortion if woman is already pregnant o 75-89% effective during most fertile part of cycle  Actual pregnancy rates between 0.5-2% o Making it available without prescription more than doubled its use  Has no effect on whether or not teens have unprotected sex o Alternative: insertion of a copper IUD up to 7 days after sex more than 98% effective  Implants (i.e. Implanon in US, not in Canada): thin rods or tubes containing progestin inserted in woman’s arm and effective up to 3 years  Depo-Provera (DMPA) Injections: progestin injection every 3 months approved in Canada in 1997 o Inhibits ovulation, thickens cervical mucus, inhibits growth of endometrium o Typical-user failure rate: 3%, more effective than pill o Available for women who cannot use pill (over 35, smoking, etc.) o Side effects: amenorrhea (no period), sometimes spotting  Irreversible bone loss after only 2 years on drug o Can relieve anemia and treat endometriosis The IUD and IUS  Intrauterine device (IUD): plastic device sometimes containing metal or a hormone that is inserted into uterus for contraceptive purposes o 1909: Burton Richter reported on IUD made of silkworm gut o 1920s: Ernst Grafenberg reported 2000 insertions of silk or silver wire rings o 1950s: plastic and stainless steel devices triggered its popularity o 1970s-80s: use dropped by numerous lawsuits claiming damage by this device, specifically Dalkon Shield (taken off market) o Nova-T/Flexi-T: only one available in Canada, T-shaped with copper  Intra-uterine system (IUS): same as IUD but with hormones o Minera: available in Canada, T-shaped with progesterone o Reduce endometrium, resulting in reduced menstruation o Thickens cervical mucus, disrupts ovulation, changes endometrium  Prevents fertilization, copper T is also thought to have additional contraceptive effect by altering functioning of enzymes involved in implantation  Used as emergency contraceptive st  Pregnancy rate for copper t: 0.7% for 1 year of use, even lower failure rate after that  Copper T IUD effective for 12 years, Minera effective for 5 years  Most failures occur in first 3 months because IUD/S is expelled most likely in women who have never been pregnant, younger women, during period st o Expulsion rate: 1-7% during 1 year  Side effects of copper T: increased menstrual cramps, irregular bleeding, increased flow  Side effects of Minera: reduces flow, 20% users stop bleeding, weight gain, depression, decreased sexual interest  Inserted by physician, therefore $80-350 to purchase device  Typical user failure rate: 0.8%, more effective than pill, same effectiveness as Depo-Provera  No effect on tampon use or intercourse Cervical Caps and the Sponge  FemCap: sailor hat-shaped rubber cap that fits snugly over the cervix, 3 sizes: o Smallest size for women who have never been pregnant o Medium size for women who have been pregnant but not had vaginal delivery o Largest size for women who have had vaginal delivery o Lasts up to 2 years  Lea’s Shield: soft, pliable barrier contraceptive device prevents sperm from entering cervix  Mechanical function that blocks entrance of uterus so sperm can’t enter  Typical-user failure rate: 20%, mainly from improper use may not use it every time, not fit well, not leave it in long enough, not use contraceptive cream—still a 9% failure rate with perfect use  Side effects: possible irritation of vagina or penis due to cream/jelly o Few other side effects  Contraceptive sponge: vaginal barrier method made of polyurethane that contains a spermicide and is placed over cervix o Effective for 24 hours, should not be left in for longer than 24 hours otherwise risk TSS Condoms:  Male condom: contraceptive sheath placed over penis o Latex, polyurethane (i.e. Avanti, Trojan Supra), intestinal tissue of lambs (“skin”) st o Casanova (1725-1798): one of 1 to popularize condoms for its contraceptive ability and protective value o Protect against STIs including HIV, must be put on before penetration o 2 shapes:  Plain ends, must leave air-free space to catch semen  Protruding tip to catch semen o Perfect-user failure rate: 2% o Typical user failure rate: 18% o Only contraceptive method available for men besides sterilization o Dental dam: unlubricated condoms used during oral-genital activity  Female condom: made of polyurethane, resembles clear balloon with 2 rings o One ring into the vagina one ring spread over the entrance o Typical-user failure rate: 21%, perfect-user failure rate: 5% o Alternatives: FC2 synthetic latex, less expensive and quieter  VA feminine condom (Reddy/V-Armour): sponge to hold it in place rather than internal ring  PATH: urethane foam on condom pouch Spermicides:  Spermicide: a substance that kills sperm—foams, creams, jellies  Inserted much as a tampon is  Work in 2 ways: o Chemical: substance that kill sperm o Mechanical: inert base blocks entrance to cervix  Failure rates: as high as 25%  Foams more effective than creams or jellies  Allergic reaction may cause irritation to vagina or penis  Only effective when used with other contraceptive method (i.e. condoms) Douching  Douching: flushing out inside of vagina with a liquid  Rumour among teens that douching with Coca-Cola after sex prevents pregnancy  Not effective as contraceptive Withdrawal:  Withdrawal (coitus interruptus/’pulling out’): man withdraws his penis from partner’s vagina before orgasm  Most ancient form of birth control  Failure rate: 27%  May be psychologically stressful for man, must constantly be conscious of ejaculating may lead to sexual dysfunctions Fertility Awareness (Rhythm) Methods:  Fertility awareness methods: involves abstaining from intercourse around most fertile time, only form of natural birth control women’s fertile period determined differently  Calendar method: woman determines when she ovulates by keeping a calendar record of the length of her menstrual cycles o Based on assumption that ovulation occurs 14 days before period o 8 days of abstinence requires o Sperm can live up to 5 days in reproductive tract o For women without perfect cycles, must record periods for 6 months-1 year and record length of shortest and longest cycles, longer period of abstinence required  Basal body temperature (BBT) method: woman determines when she ovulates by keeping track of her temperature o Preovulatory phase: temperature fairly constant, low level o Ovulation: temperature drops o After ovulation: rises sharply, staying at high level for rest of cycle o Intercourse would be safe 3 days after ovulation o Only determines safe days after ovulation, no safe days before o Best used alongside calendar or cervical mucus methods  Cervical mucus method: woman determines when she ovulates by checking cervical mucus and its variations throughout cycle o Relatively safe period: few days after period when no mucus produced, vaginal dryness o Number of days of mucus discharge around mid-cycle  First day, mucus is white and cloudy  Mucus becomes clearer throughout  1-2 peak days mucus is raw egg-likeovulation occurs within a day after o Abstinence from first day of mucus discharge to 4 days after peak days  Sympto-thermal method: combination of cervical mucus method with BBT  Home ovulation tests predominantly for couples wanting to conceive (i.e. Clear Blue), some designed for contraception (PG53, PC2000, Maybe Baby)  Vatican roulette: not very effective with typical users  Ideal-user failure rates: o Calendar method: 5% o BBT: 2% o Cervical mucus method: 3% Sterilization:  Sterilization/voluntary surgical contraception (VSC): surgical procedure in which individual is made sterile, incapable of producing o Common method of BC for fertile, aged long-term couples in Canada  Vasectomy: surgical procedure severing the vas deferens o Performed in physician’s office under general anesthesia in 20 min. o Small incision on one side of upper part of scrotum, vas is separate from surrounding tissue, tied off and cut off, repeated on other side o No-scalpel vasectomy: tiny pierce in scrotum, has lower rate of complications than standard vasectomy o Should not rely on it as contraceptive until 3 months after surgery o Prevents sperm from entering ejaculate o Failure rate: 0.1% only during first months after or if physician did not completely sever vas, or ends of vas have grown back together o Vasovasectomy: reversal method, pregnancy rates following reversal between 38-89%  not very reliable, man should assume permanent o Only 5% of men regret the surgery  Laparoscopy: magnifying instrument inserted in abdomen to identify fallopian tubes and block them with clips o Mini-laparotomy: variation of this, used immediately after woman given birth o Takes 10-20 minutes  Trans-cervical approach: instruments enter through cervix and uterus, blockage device placed in each fallopian tube o Device used involves inserting micro-coil called Essure o Scar tissue forms around it blocking the tubes o Not to be confused with hysterectomy or oophorectomy do produce sterilization, but usually performed for other reasons o Failure rate: 0.5% due to occasional rejoining of fallopian tube ends o Impossible to reverse in some cases o Only 7% have regretted the procedure o Free! New Advances in Contraception:  Male hormonal methods: aim to suppress LH and FSH production so sperm wouldn’t be produced successful at shutting down sperm production but also shut down sex drive therefore not accepted by most men  Immunocontraceptives: contraceptive vaccine in the making that would induce immune system to interrupt one of the steps in fertility system (i.e. stages in production/maturation of sperm)  Male contraceptive implant: Health Canada approved clinical trial for intra-vas device (IVD)—2 plugs block sperm inserted into vas, can be removed  Microbicides: substances that kill microbes and preferably sperm o First hoped that foams and gels containing nonoxynol-9 (N-9) would be effective but N-9 is not and may cause infection o To be used with condom or on its own  Spray-on contraception: Nesterone Metered Dose Transdermal System a progestin being developed, spray on skin once a day, diffuses in bloodstream  New IUDs: GyneFix—similar to copper T but without the T (it is frameless)  Implant inhibition: selective modulators of progesterone receptors (SPRMS) o Anti-progestins as promising as post-coital methods like Plan B o Prevent LH surge that triggers ovulation  Reversible, non-surgical sterilization: injecting silicone into fallopian tubes or vas that hardens, forming a plug that could later be removed Psychological Attitudes toward Contraception  53% of teen pregnancies terminated by abortion, 45% result in live births, 2% end in miscarriages o Of the teens who give birth, 81% keep the baby  Canada Youth Sexual Health and HIV/AIDS Study: o 5-10% of grade 9-11s used no contraceptive method last time had sex o Reasons for not using contraception:  Weren’t expecting to have sex  Used another method of birth control  Too much alcohol or drugs, don’t want to spoil moment  Research on Western countries found that teens from low income households are most likely to become pregnant  Information-Motivation-Behavioural Skills (IMB) model: William Fisher o Information: people who lack info on contraceptives can scarcely use them effectively, must also need specific/practical info on where/how o Motivation: people motivated to use contraception if they have positive attitudes toward it, believe it’s socially acceptable, fear of pregnancy, etc.  Erotophobes: negative orientation to sexuality, guilt and fear of social disapproval less likely to engage in necessary steps for contraception  Erotophiles: positive orientation to sexuality, comfortable with sex o Behaviour: behavioural skills to engage in actions needed for effective contraception—skills to acquire, discuss contraception and refuse sex  Must set preventing pregnancy as a goal  Steps essential for effective contraception (Fisher): o Obtaining contraceptive information o Acknowledging that sex may occur o Obtaining contraceptives o Communicating with partner o Using contraceptive every time  Fantasy: important role in contraceptive behaviour—media shape our fantasies and do not reflect sex with use of contraceptives o Study: in media popular among adolescents, on the rare occasion that contraception was presented, it was portrayed as embarrassing o 25% of TV programs that show or imply sex also include reference to safer sex Abortion:  Abortion: termination of a pregnancy  Pro-life: opposition to abortion  Pro-choice: those seeking to reserve the right of women to legal abortions  Most Canadians take a middle position—belief that abortion should be available under certain circumstances o When their health is endangered o When pregnancy is due to rape o When baby is likely to have severe defect o When family has low income  More available in urban areas that rural ones—no services in PEI  In some provinces, all abortions are fully funded by medicare, but in others only hospital abortions covered not clinical ones  Japan, Russia, eastern/central Europe, South America: abortion is legal and widely practiced  World Health Organization (WHO) estimates 19 million unsafe abortions each year  Vacuum aspiration method: performed during first trimester and involves suctioning out the contents of uterus—takes only 10 minutes, woman stays in clinic for a few hours after most widely used, 97% of Canadian abortions o Risks: uterine perforation, infection, hemorrhaging, failure to remove all fetal tissue  Dilation and evacuation: especially for later abortions for 14-24 weeks gestation—similar to vacuum aspiration  Induced labour: saline-induced abortiontube inserted through abdomen injecting saline solution that causes labour to begin within few hours o Prostaglandins abortion: prostaglandins injected, cause labour o Accounts for only 1% of abortions in Canada o More hazardous, more costly, only on women late in 2 trimester  Mifepristone: RU-486—‘abortion pill’ induces very early abortion o Anti-progesterone effect causing endometrium to shed, bringing about an abortion o Administered as tablet followed 2 days later by small dose of prostaglandin (misoprostol), increasing uterine contractions to help expel the embryo o During the first 7-9 weeks of pregnancy, most effective when pregnant less than 49 days o Not available in Canada  Methotrexate: drug that is toxic to the embryo combined with misoprostol which causes uterine contractions that expel dead embryo o Also used to treat ectopic pregnancy—a life-threatening condition  Most women do not experience severe negative psychological responses  Women who had repeat abortions significantly more likely to have experienced sexual or physical violence or child abuse  Study in Czechoslovakia: followed up on 220 children born to women denied an abortion and control group of 220 children born to women who did not want an abortion by age 14, more children from study group had been referred to counseling o No differences in intelligence but children from study group did less well in school and were more likely to drop out o Study group children described as less sociable, more hyperactive o By 16, boys but not girls reported feeling neglected by mother o By early 20s, study group reported less job satisfaction, more conflicts, fewer relationships/friendships o Results point to the serious long-term consequences on some children of mothers denied an abortion  Main reasons why men want their partners to get abortions: o Family planning o Feeling unable to offer child caring environment o Socioeconomic reasons o Relationship with woman wasn’t stable enough o More than half of men report both positive and negative reactions Chapter 6: Conception, Pregnancy and Childbirth Conception  Egg has no means of moving itself, propelled by the cilia lining fallopian tubes  Sperm: one of tiniest cells in human body, consist of head, mid-piece, tail o Acrosome: chemical reservoir in head of sperm o Mitochondria: tiny structures in mid-piece fostering chemical reactions that provide energy o Flagellation: lashing action in tail that propels sperm forward using energy produced by mitochondria o Ejaculate: about a tsp. full containing about 200 million sperm o Swim 1-3 cm (1 inch) per hour, but can arrive at egg within an hour and a half after ejaculation muscle contractions of uterus may help o Live in woman’s body for up to 5 days  Conception typically occurs in the outer third of fallopian tube o Only about 2000 sperm reach the tube containing the egg  Zona pellucida: thin, gelatinous layer surrounding egg  Hyaluronidase: enzyme secreted by acrosome of sperm that dissolves the zona pellucida, allowing the sperm to penetrate the egg  Zygote: the developing organism from the fertilization of egg to the 2 week of gestation (5-7 days after conception)  Embryo: the developing organism between 2 -8 weeks of gestation  Fetus: from week 8 until birth  To conceive, intercourse every 24-48 hours/4 times a week is most effective o Prolonged abstinence may lead to lower sperm quality o Best position is man-on-top missionary Development of the Conceptus:  Gestational diabetes: woman has high blood sugar because body is unable to make and use all the insulin it needs  Pre-eclampsia: occurs during 3 trimester involves sharp rise in blood pressure, presence of protein in urine, swelling of hands/feet/face  Trimesters: 9 months/38 weeks of pregnancy divided into 3 equal periods of 3 months  1 trimester most remarkable in development  3 layers of embryo develop: o Endoderm: forms the digestive system pharynx, stomach, intestines, rectum—and the respiratory system o Ectoderm: form the entire nervous system and skin o Mesoderm: form the muscles, skeleton, reproductive and circulatory systems  Cephalocaudal order: head develops first, lower body last  Tophoblast: important functions in maintaining the embryo, eventually developing into the placenta  Placenta: organ formed on wall of uterus through which fetus receives oxygen and nutrients and gets rid of waste o Fetus’ blood passes out through umbilical cord to placenta, circulates in villi while mother’s blood circulates outside these villi—membrane barrier between the 2 blood systems where some nutrients can pass o Some drugs can pass the placental barrier o Produces large quantities of estrogen and progesterone o Human chorionic gonadotropin (hCG): hormone secreted by placenta that is detected in pregnancy tests th  Umbilical cord: tube that connects the fetus to the placenta formed during 5 week of development 20 inches long  Amnion: innermost membrane surrounding fetus o Amniotic fluid: watery fluid surrounding a developing fetus, maintaining it at constant temperature and cushioning it against possible injury the original waterbed o Amniocentesis  During 7 month, fetus turns in uterus to assume a head-down position o Breech presentation: women assume various positions to try and aid the fetus’ turning  Infants of European descent weigh more than those of Chinese or South Asian descent Pregnancy  1 trimester: weeks 1-12 o Missed menstrual period, spiked basal body temperature that lasts after ovulation, tender breasts, morning sickness (but not just in morning) o Pregnancy test: commonly an immunologic test based on detecting presence of hCG in urine OR lab tests that are 98-99% accurate  False negative: test says woman not pregnant when she is  Beta-hCG radio-immunoassay: assesses presence of beta-hCG in blood sample—more expensive and accurate than urine test  Claim accuracy the first day of a missed period, but over-the- counter brands not so accurate (16% false positives, high rate of false negatives) o Presumptive signs: amenorrhea, tender breasts, nausea, etc. o Probable signs: pregnancy tests th o Positive signs: definite indications of pregnancy detected in 4 month  Beating of fetal heart  Active fetal movement  Detection of fetal skeleton by ultrasound (in 1 trimester) o EDC: Expected Date of Confinement—expected delivery date  Nagele’s rule: 1 day of your last period, subtract 3 months, add 7 days, add one year  Use ultrasounds to predict date more than this rule o Large increase in estrogen and progesterone levels o Morning sickness: theorized that pregnant women vomit to expel and avoid food containing toxic chemicals o Low income associated with depression during pregnancy o Still birth: delivery of dead fetus brought on by high stress after 28th week  2 trimester: weeks 13-26 th o Woman becomes aware of fetal movement by 4 month—‘kicking’ o Most physical symptoms of 1 trimester disappear o Constipation and nosebleeds (caused by increased blood volume) o Edema: water retention/swelling in face, hands, wrists, ankles, feet o Colostrum: thin, yellow watery substance secreted by breasts at end of pregnancy and during first few days after delivery—no milk yet o Women who have had a baby before are typically more distressed than those who haven’t during this time o Maternal responsiveness to fetus increases  3 trimester: weeks 27-38 o Uterus becomes large and hard o Pressure on other organs such as lungs that cause discomfort (i.e. shortness of breath) o Amount of weight gained should be 15-40 pounds thin women should gain relatively more than bigger women o Woman is placed off balance with weight—compensate by ‘waddling’ o Braxton-Hicks contractions: contractions of uterus not part of actual labour—may help strengthen uterine muscles to prepare for labour o Lightening/dropping/engagement: at 2-4 weeks before delivery, baby’s head drops into pelvis o Women who reported more anxiety, stress, daily hassles during pregnancy had more complications  Father’s experience: o Couvade syndrome: pregnancy symptoms in men—indigestion, gastritis, nausea, change in appetite, headaches may be from hormonal changes  Associated with higher levels of prolactin prenatally  Couvade ritual: husband retires to bed and suffers all same pains of delivery as wife is in labour—practiced in parts of Asia, South America and Oceania o Lower levels of testosterone postnatally may enable paternal behaviour  Sex during pregnancy given a normal, healthy pregnancy, intercourse can occur until 4 weeks before delivery is due o No evidence that sex/orgasm is related to preterm labour, but may actually be associated with decreasing risk of preterm labour st nd o Declinrd frequency in 1 trimester, no change in 2 , even greater decline in 3 trimester o Side-to-side position most suitable, missionary becomes more awkward  Overweight and obese women increase risk for both them and baby o Risks to mother: hypertension, gestational diabetes, Caesarian delivery o Risks to baby: congenital abnormalities such as spina bifida, clef palate, hydrocephaly o Important to get enough protein, folic acid, calcium, magnesium, vitamin A during pregnancy  Teratogens: substance/drug that produces deformities in fetus o Alcohol: transfers through placental barrier, can affect fetal development o Fetal alcohol spectrum disorder: all outcomes associated with any amount of alcohol exposure during pregnancy  Dose dependent—the more alcohol, the more severe the defects o Fetal alcohol syndrome: serious prenatal and postnatal growth deficiency and malformations in child of mother who abused alcohol in pregnancy  Small brain, eye openings, joint/limb/heart defects, cognitive impairment  Risk drinking: 7+ drinks per week or 5+ drinks on occasion o Tobacco: maternal smoking associated with prematurity o Drug use in men: marijuana associated with decreased sperm count, damaged sperm, reduced fertility  Viral illness during pregnancy: o Rubella: if woman gets it in 1 month of pregnancy, 50% chance infant born deaf, have cognitive deficits, cataracts, congenital heart defects  By 3 month of pregnancy, that chance is only 10% o Herpes simplex when baby comes in contact with a sore o HIV can be passed on to baby during pregnancy, delivery, breast feeding  AZT: antiretrovirus drug to decrease likelihood of transmission  Amniocentesis: test to determine whether a fetus has birth defects—inserting a fine tube into woman’s abdomen to obtain sample of amniotic fluid o Provides early diagnosis of chromosomal and genetic defects, sex-linked diseases o Performed between 13-16 weeks of pregnancy  Chorionic villus sampling (CVS): technique for prenatal diagnosis of defects— sample of cells from chorionic villus is analyzed o Performed in 1 trimester usually weeks 9-11 o Transcervically—catheter inserted into uterus through cervix o Transabdominally—needle inserted through abdomen o Fetal loss rate (also for amniocentesis) 1-1.5% or as low as 0.04% Birth:  Labour begins within 24 hours of water breaking amniotic fluid rupture o More commonly, this rupture does not occur until 1 stage of labour  Progesterone-withdrawal theory: progesterone inhibits uterine contractions, proposed that some mechanism inhibits effect of progesterone allowing for contractions and labour to begin  Parturition: whole process of childbirth divided into 3 stages st o 1 -stage labour: regular contractions of uterus responsible for producing 2 changes in cervix, lasts until cervix is dilated 8 cm  Effacement: thinning out of cervix during labour  Dilation: opening up of cervix during labour st  Early 1 stagespaced out contractions lasting 45 seconds-1 min.  Late 1 stage contractions are quicker and more intense  Transition: most difficult part of labour at end of 1 stage where cervix dilates to 8-10 cm painful and exhausting  Lasts 2-24 hours, averaging 12-15 hours for 1 pregnancy nd o 2 -stage labour: during which baby moves out through vagina  Lasts a few minutes to a few hours, generally shorter than 1 st  Crowning: when baby’s head is visible at vaginal entrance  Episiotomy: incision made in skin just behind vagina, allowing baby to be delivered more easily  Baby’s body begins functioning drastically differently o 3 -stage labour: during which the afterbirth is expelled  Placenta detaches from uterus walls and is expelled with the fetal membranes  Lasts a few minutes to an hour  Caesarean section (C-Section): surgical procedure to deliver baby by an incision in abdomen when normal vaginal birth is impossible or undesirable o Placenta previa: placenta attached to uterus walls but covers cervix o Vaginal births after Caesareans (VBAC) are possible o Rate of C-sections in Canada is higher than most western European countries highest in NS, PEI, BC; lowest in Nunavut o Women who have C-sections are 3 times more likely than those who don’t to experience severe illness after delivery  Prepared childbirth: strive to reduce fear in mother to reduce pain during labour o Lamaze method: involves 2 basic techniques of relaxation and controlled breathing  Effleurage: light, circular stroking of abdomen with fingertips  Coach: woman’s hubby or other partner present during labour and delivery, timing contractions, checking mother’s status, etc. o Doula: “woman’s servant” present during childbirth to provide support o Misconception that prepared birth prohibits use of anesthetics—tries to teach woman techniques so she wont need it, but is fully allowed it o Primipara: woman having her first baby  Anesthesia: opposition to its use during childbirth dissipated when Queen Victoria gave birth under chloroform in 1853 o Tranquilizers (i.e. Valium) when labour becomes intense o Barbiturates (i.e. Nembutal/Seconal) to put woman to sleep o Scopolamine: makes woman forget what happened o Regional/local anesthetics: numb only specific regions of body most commonly used  Pudendal block: injection numbs only external genitals  Spinal: injection in spinal cord numbs entire birth area  Caudal block/epidural: injection in back to numb belly to thighs  Midwives: only 6% of Canadian women received prenatal care from midwife o Legal profession in BC, AB, SK, MA, ON, QC, NS, NWT and publicly funded o Provide care from early pregnancy to 6 weeks after birth o Women who give birth with midwife most satisfied with birth experience After Birth: The Postpartum Period  Postpartum period characterized by low levels of estrogen and progesterone  Canadian women typically remain in hospital 2-3 days after delivery; with C- section, 4-5 days  Postpartum blues: mildest ‘baby blues’ in which woman experiences mood swings, depressed, irritable, alternating with positive moods—experienced by majority of women, last until 2 week after delivery  Postpartum depression: mild to moderate depression, insomnia, tearfulness, feelings of inadequacy, fatigue—begins 2-3 weeks postpartum lasting 6-8 weeks  Postpartum psychosis: severe mood disturbance, restlessness, irritability, hallucinations—onset can be dramatic, within 72 hours of delivery, rare  Women experiencing multiple births more likely to experience depression 9 months postpartum than mothers of single babies  Couple must wait at least 2 weeks before resuming intercourse o With an episiotomy, may experience vaginal discomfort o With C-section, may experience abdominal discomfort o By 1 month, only few couples had re-engaged in intercourse, by 4 months almost all had—similar results for cunnilingus, but no decline in fellatio o Breastfeeding women reported less sexual activity and satisfaction Breastfeeding:  2 hormones involved in lactation: o Prolactin: stimulates breasts to produce milk o Oxytocin: stimulates breasts to eject milk  Produced reflexively in response to infant’s sucking—nerves in nipple signal to brain, which signals to pituitary, etc.  For first few days after birth, milk is not produced but colostrum—high in protein and gives baby temporary immunity to infection  Recommended that baby be fed breast milk exclusively for first 6 months and continue after introduction of solid food until 2 years of age  Associated with reduced risk of obesity at age 5-6 and boosts immune system  Mothers who are younger, lower income, lower education, single are less likely  Immigrants are more likely than non-immigrants to breastfeed  Advantages of breastfeeding: o Quicker shrinking of uterus to normal size o Reduced postpartum bleeding o More rapid weight loss o Reduced risk of breast cancer  Inhibits ovulation—delays but does not prevent it Pregnancy Related Problems  Ectopic pregnancy: fertilized egg implants somewhere other than uterus—most commonly in the fallopian tube (tubal pregnancy), rarely in abdominal cavity, ovary or cervix o Tubal pregnancy may occur if egg is prevents from moving down tube to uterus—i.e. result of scarring from chlamydia o Embryo may spontaneously abort and be released into abdominal cavity o Embryo and placenta may continue to grow, stretching tube until rupture  Sharp abdominal pain, cramping, shoulder pain, vaginal bleeding  Hemorrhaging occurs, woman may go into shock and could die o May be due to increased rates of STIs (esp. chlamydia) AND/OR increased use of contraceptives such as IUDs and progestin-only methods  Molar pregnancy: mass of abnormal tissue inside uterus hydatidiform mole o Caused by fertilization of ovum with no genetic information OR when 2 sperm fertilize same egg o Woman experiences all same pregnancy symptoms during 1 trimester o Diagnosed with blood test assessing hCG levels or with ultrasound o Women over 35, low in vitamin A, or with history of miscarriage more prone it molar pregnancy  Pseudocyesis: false pregnancy, woman displays signs of pregnancy but isn’t  Pregnancy-induced hypertension: includes 3 conditions o Hypertension: elevated blood pressure o Pre-eclampsia: serious disease of pregnancy marked by high blood pressure, sever edema (water retention), proteinuria (protein in urine)  May result in fetal death  Silent struggle between mother and baby for nutrients  Teens and overweight women more susceptible o Eclampsia: woman has convulsions, may go into a coma, may die  D (RH) antigen incompatibility: genetically transmitted substance in blood D+ dominant over D- o Majority of whites, blacks, aboriginals are D+ o When D- woman has a D+ baby, mother’s blood forms antibodies that can attack red blood cells in a subsequent pregnancy typically only harmful st after 1 pregnancy o D immunoglobulin: injection prevents woman’s blood from producing antibodies D- women should receive it at 28-29 weeks gestation, within 72 hours after delivery, and after induced abortion/amniocentesis  Miscarriage: termination of pregnancy before fetus viable, due to natural causes st o Most spontaneous abortions occur during 1 trimester o Women who experience miscarriage in first 24 weeks are at higher risk of pre-eclampsia, pre-term birth, assisted delivery in next pregnancy o Mostly occur
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