Exam 2 Flashcards
The Pill general info
- combination est & progestin
- 21 days on, 7 off
- works by inhibiting ovulation, thickening cervical mucus, endometrium inhospitable for implantation
Quick Start
- with the pill… start pill as soon as prescribed, regardless of day in cycle
Health Risks of Pill
- no increased risks of cervical, uterine, or breast cancer
- protect against endometrial and ovarian cancer
- risk of thromboembolic disorders (blood clots)
- esp women over 35 who smoke - BP increase
- increased risk of STIs
Why increased risk of STIs with pill?
- more likely to not use a condom
- makes vagina more vulnerable to infection
Side effects of the pill
- increased vaginal discharge
- change in libido, up or down
- mood changes (20%)
- antibiotics can decrease effectiveness
- the pill can change dosage of antibiotic
Risk on pill 5+ years
- increased risk of benign hepatic tumors (liver)
The Patch
- Ortho evra
- 1 patch/week for 3 weeks
- estrogen & progestin
- lack of certainty about dosing, esp over 200lbs
- possibly higher or lower est levels
- slightly higher rates of blood clots
- more consistency with timing
Nuva Ring
- mainly works by stopping ovulation
- insert ring like diaphragm, leave in for 3 weeks
- failure rate comparable to pill
- est & progestin
Seasonale
- 84 days of pills, 7 off
- no additional side effects from normal
Other pills (2)
- Triphasic ( steady est levels, increasing progestin levels in phases)
- Progestin-only
Progestin-Only pills
- “mini pills”
- safest for breastfeeding mothers
- not to be used in first 6 weeks after birth
- not as effective)
Depo-Provera Injections
- Progestin only
- inhibits ovulation
- thickens cervical mucus
- inhibits growth of endometrium
- every 3 months
- works slightly better than pill (no memory needed)
- possible lag of 6-12 months of fertility
- most no problems after that
Emergency Contraception
- “morning after pill”
- 75-89% effective
- pregnancy rate .5-2%
- Plan-B one step
- Ella
- insertion of IUD within 5 days
- handful of BC pills
Plan B One-Step (next choice one dose)
- OTC
- effectiveness decreases longer you wait
- high dose of synthetic progesterone
- most effective within 24 hours after intercourse
- must be within 120 hours (5 days)
- mode of action depends on what time in cycle
- prevent ovulation, prevent fertilization, inhibit sperm function, inhibit endometrial growth - not abortion, egg not implanted
Ella
- non-hormonal (UPA) (Ulipristal acetate)
- by prescription only (antiprogestin)
LARC
- long acting reversible contraception
- preferred methods, dont rely on user, have very low failure rates
- implants, IUDs
- Implants
- Implanon/Nexplanon
- single rod, progestin-only
- lasts 3 years
- high cost
- effectiveness (99.95%)
- work like other progestin only birth controls
IUDs and side effects
- paraguard- copper
- mirena and skyla - progesterone
- changes uterine lining making it lethal to sperm and eggs
- side effects:
- increased menstrual cramping, flow
- usually not covered by insurance
- does not affect tampon use or intercourse
- can get pregnant immediately after
Copper T
- Paraguard
- changes enzymes in uterus so implantation unlikely
- up to 12 years
- more irregular bleeding
Progestin IUDs
- disrupts ovulation, reduces endometrium
- Mirena 5 years
- reduced flow
- Skyla 3 years
- smaller
Barrier Methods & Facts
- Diaphragm and Fem Cap
- metal rimmed, fits over cervix, place spermicide on rim and inner edge
- work by mechanical blockage of sperm, spermicide kills sperm
- may insert up to 6 hrs before intercourse
- needs to stay in 6 hours after, not more than 24
- one diaphragm can be used for ~2 yrs
- failure rate ~12%
- $75 + dr. visit + spermicide
Barrier Method: Sponge
- polyurethane and spermicide
- not very effective
External Condom
- Protection against STIs and pregnancy
- Latex - don’t use oil based lube
- lambskin - ineffective (STIs can get through)
- polyurethane- noisier
- leave 1/2 inch space at top
External Condom + Spermicide
- not more effective
- may increase risk for STIs b/c of irritation
Dental Dam
- type of external condom
- rectangle of latex
- placed over anus/vagina during oral sex
- some flavored (keep flavoring out of vagina, irritation)
Internal Condom
- polyurethane (noisy)
- lube inside & outside
- STIs can be transmitted if it malfunctions/slips
- two rings, one at each end
- typical failure rate 21% (perfect 5%)
Spermicides
- foam, vaginal film etc
- Nonoxynd 9 (N-9)
- use along with diaphragm
- 28% failure rate
- must leave in 6 hours
- increased risk of STIs b/c of irritation
Douching/Withdrawal
- DONT DO THIS
- flushing out vagina can push sperm in
- pre-ejaculate contains sperm
- failure rate 22%
Rhythm
- Roman Catholic Church approved
- fertility awareness methods (abstain during ovulation)
- sperm can survive 5 days
- eggs can be fertilized 12-24 hours after ovulation
- Calendar, Standard Days, BBT, Cervical Mucus, Sympto-thermal
Calendar Method
- Rhythm method
- abstain 3 days before and 2 days after ovulation
- assume ovulation occurs on days 13-15
- need 6 months-1 year data to be effective
Standard days method
- Rhythm
- assume most menstrual cycles 26-32 days
- abstain days 8-19
- failure rate 12%
BBT Method
- Rhythm
- only tracks temp rise AFTER ovulation
- determine safe days after
Cervical mucus method
- Rhythm
- right after menstruation: relatively little mucus
- white & tacky: follicular phase
- thin: days shortly before ovulation
- determine safe days before
Sympto-Thermal Method
- mucus + BBT
- best rhythm method
Irreversible Methods
- Sterilization
Irreversible Method: Men
- Vasectomy: cut vas deferens
- no effect on hormone production
- 20 mins local anesthetic
- use contraception 3 months after
Reconnecting Vas deferens
- vasovasectomy
Irreversible Methods: Women
- tubal ligation (laparotomy): cut and tie fallopian tubes
- minilaparotomy: small incision usually immediately after giving birth
Failure Rate Definition
- “if 100 women use this method for 1 year, the % of whom become pregnant”
Effectiveness rate
- 1-failure rate
Perfect vs Typical user
- perfect: perfect
- typical: human error involved
Best method for spacing of births
- rhythm
- don’t care as much
Psychological Aspects of BC
- 750,000 teen pregnancies in US/yr
- 29% abortion
- 57% live births
- 14% miscarriage
- often as a result of not using contraception
Medical Abortion
- RU-486 (mifepristone): antiprogesterone + prostaglandin (misopristol)
- within 7-9 wks of conception
- anti-progesterone sloughs off uterus, prostaglandin makes uterine contractions
- 92% effective
- 17% all abortions
- commonly done in physician’s office
- shown little negative psychological effects of woman
Methotrexate
- used in medical abortions
- also used as cancer treatment and ectopic pregnancies
New contraceptive methods for men (3)
- new condoms
- pill or injection to suppress sperm production
- “switch” on vas
New contraceptive methods for women (3)
- better microbicides: kill sperm and viruses and bacteria (bufferGel)
- vaginal ring with antiviral to protect against HIV
- SPRMs: selective progesterone receptor modulators
SPRMs
- selective progesterone receptor modulators (ella)
- useful for emergency contraception
- depending on time in cycle when used either prevent LH surge or prevent implantation
Surgical Abortion
- vacuum aspiration (suction and curretage)
- 1st trimester up to 14 weeks
- outpatient
- dilation of cervix and suction of fetus
- most common method early abortion
- 88% abortions (& in first 12 weeks)
- dilation and evacuation (D&E) 2nd trimester abortions
Ekiti Yoruba
- S.W. Nigeria
- 200,000-500,000 pregnancies aborted/yr
- 10,000 women die/yr
- believe “real child” isn’t formed until 4th month
Turnaway study
- 3 groups: 1st trimester abortions, near limit abortions, & turnaways
- found good adjustment and mood of those who had abortion to those who didn’t
How many partners knew about abortion?
- 82% knew
- 80% of those were supportive
Masters & Johnson
- Masters: father of human sexual response
- Johnson: recruited by Masters, later married
“Glass Penis”
- insertable EMG sensor
- measured blood flow, muscle contractions, took pictures
Basic Phys Processes of sexual response
- Vasocongestion
- Myotonia
Stages of Sexual Response
- excitement
- orgasm
- resolution
Male Excitement Phase
- testes elevated, penis elevates
Male Late Excitement Phase
- testes fully elevated, color of penis deepens, secretion of cowper’s gland
Male Orgasm: Stage 1
- internal sphincter of bladder closes
- prostate and seminal vesicle contracts
- rectal sphincter closes
Male Orgasm: Stage 2
- ejaculation
- urethral contractions
Male Resolution
- scrotum thins
- erection disappears
- testes descend
Refractory Period
- time after ejaculation where male cannot have another erection
- increases with age
Female Excitement Phase
- vaginal lubrication
- clitoris swells
- labia swell
- bladder shifts
Female Late Excitement
- expansion of upper 2/3 of vagina
- clitoris retracts
- color change in labia
- uterus elevates
- orgasmic platform forms (Front side of vagina)
Female Orgasm
- rhythmic contractions in uterus and orgasmic platform
- rectal sphincter contracts
Female Resolution
- uterus lowers
- vagina to normal size
- orgasmic platform disappears
- semen pools under cervix
- no refractory period (multiple orgasms possible)
____% of women never experience an orgasm
- 10%
- likely physiological problem
Breast Response (excitement, orgasm, resolution
- size increase
- nipples erect
* excitement - areolar enlargement
- sex flush
- veins visible
* orgasm - sex flush disappears v rapidly
* resolution
Extragenital Response; Excitement
- nipple erection
- sex flush (late excitement –> orgasm)
Extragenital Response; Orgams
- carpopedal spasm
- increased HR, BP
Extragenital Response; Resolution
- sweating, hyperventilation
Viagra
- 1998
- developed originally for prevention of heart attacks
Erection: Spinal Reflex
- Psychogenic Stimulation (visual, auditory..)
- Reflexogenic Stim (tactile stim)
Psychogenic Stim (Spinal Reflex)
- from brain through T11-L2
Reflexogenic Stim (Spinal Reflex)
- tactile stim of the genitals
- bowel or bladder stim
- sacral erection center (S2-S4)
Erection Mechanism
- smooth muscle relaxation lets blood flow in (parasymp), smooth muscle contraction at venules keeps blood there
- NO –> cGMP –> Muscle Relaxation
PDE5 and viagra
- viagra inhibits PDE5 which usually degrades cGMP… viagra keeps muscles relaxed to let blood flow in
If spinal cord is severed above S2 what can happen?
- can still get erection by tactile stim
Triphasic Model
- Kaplan
- Sexual Desire, Vasocongestion, Myotonia all need for sexual arousal
- “good sex needs good friction and good fantasy”
Sexual Excitation-Inhibiton Model
- “dual control model”
- need balance between the two models
High excitation, low inhibition
- risky behavior
Low excitation, high inhibition
- sexual disorders
Study with emotions and arousal
- both extremes of mood correlated with higher arousal
G-Spot
- Grafenberg’s Spot
- Skene’s gland (female prostate)
- female ejaculation
- uterine orgasms “Freudian mature orgasm”
What does some female ejaculation have in it?
- PSA (prostate specific antigen
Phermones
- biochems secreted outside the body
- McClintock and Stern
- menstrual synchrony and pads - mechanism: vomernasal cells have chemoreceptors
McClintock and Stern
- Menstrual Synchrony
- Pad experiment (underarms and necklaces)
Endocrine Influences
- Organizing Effects
- Activating Effects
Organizing Effects
- Prenatal Development hormones
- cause relatively permanent change of structures in nervous or repro systems
- critical period for these
Activating Effects
- Hormones that activate/deactivate certain behaviors
Sexual Behaviors influence _____, and _____ influences sexual behaviors
- testosterone levels
Antiandrogen drugs
- “chemical castration”
- tried on pedophiles, sexual assaulters
- should also have psychotherapy b/c sexual behavior of humans controlled by both hormones and brain
Women and Testosterone
- effects on desire
- adrenal-ectomy: decreased sexual desire.. take T injections to return libido levels to normal
Components of a reflex
- Receptors
- Transmitters
- Effectors
Receptors (Reflex)
- sensory neurons that detect stim & transmit messages to brain or spinal cord
Transmitters (Reflex)
- centers in spinal cord or brain that receive the messages, interpret, and send out a message to produce a response
Effectors (Reflex)
- neurons or muscles that respond to stim.
Ejaculation Reflex
- muscular response (not vasocongestion)
Retrograde Ejaculation
- ejaculate empties into bladder
- creates “dry orgasm”
- can be caused by illness, psychoses drugs, and prostate surgery
- external sphincter closes, internal opens (backwards)
Brain Control of Sexual Response
- 3 phases
- anticipatory
- consummatory
- post-orgasmic
Anticipatory Phase
- Brain Control of Sexual Response
- sexual interest, desire, beginnings of arousal
- limbic system activation
Consummatory Phase
- Brain Control of Sexual Response
- corresponds roughly to excitement and late excitement
- motor and somatosensory cortex
- orgasm
- decreased prefrontal cortex
Post Orgasmic Phase
- Brain Control of Sexual Response
- dearousal neural network
Anticipatory and Consummatory Phase of sexual response neurotransmitters
- dopamine, melanocortins, oxytocin, NE
Post Orgasmic Phase of sexual response neurotransmitters
- opioids, endocannabinoids, serotonin
Measuring Sex (4)
- Self-reports
- behavioral measures
- implicit measures
- biological measures
Self-Reports
- questionnaires
Behavioral Measures
- direct observation
- eye tracking
- police reports
Problem with police reports as behavioral measures
- have some wrongly accused, underreported
Implicit Measures
- measures nonconscious attitudes
- ex) slow rxn time between gay and good
Biological Measures
- genital measure
- plethsmograph
- MRI and fMRI
- pupil dilation
Plethsmograph
- measures arousal in women (tampon-like camera to view vagina during arousal) and men (penialgage)
fMRI function
- measures relative blood flow in brain
Population vs. Sample
- population: everyone of interest
- sample: small group of everyone of interest
Sampling: random vs probablity
- random: each member of population has an equal chance of being selected
- probability: target a group of people more than others.. known probability of being chosen
- both considered representative sample
Convenience sample
- when researchers fails to obtain a random or probability sample
- use who’s around
volunteer bias
- those who volunteer for study have something different about them that makes them want to volunteer vs those who don’t
Issues in sex research (3)
- accuracy of measurement of self reports
- accuracy w/ behavioral observations or biological measures
- ethics
Problems with Self Reports
- purposeful distortion
- memory
- ability to estimate
Ways to make self reports better
- increase anonymity
- computer assisted self interviews (CASI)
CASI
- computer assisted self interviews
- reads questions to participant
Ethics of sex research
- 3 pillars
- informed consent
- protection from harm
- justice
Ethics: Informed Consent
- participants need to be informed on what is expected and be able to give consent
Ethics: Protection from Harm
- minimize stress
- protect anonymity
Ethics: Justice
- cost of research should be born equally
- benefits of research should be born equally
- ex) BC tested on low-income puertorican women.. not same effects as other women - do costs outweigh risks?
Kinsey Report
- 1938-1949
- interviews with >11,000 people (over half interviewed by Kinsey himself)
- Indiana University
- Sampling: mostly well educated students, or people of interest to kinsey
- interviewing techniques: good
- nonjudgmental
Books By Kinsey
- 1948: Sexual behavior in the human male
- 1953: Sexual behavior in the human female
NHSLS
- 1994
- National Health & Social Life Survey
- Laumann**
- U of Chicago
- probability sample of households
- 79% response rates
- 3,500 participants
- mostly face to face interviews
NSSHB
- 2009
- National Survey of Sexual Health & Behavior
- Indiana University
- Probability sample: random digit dialing
- Ages 14-94
- 53% response rate
- n=5865
- answered survey on website
- 69% white, 14% hispanic, 11% black, 7% other
British and Australian Surveys
- similar to NSSHB and NHSLS
- better funding
- larger samples
Ethnicity in US surveys
- interviewer same sex & ethnicity as participant: better response rate/honesty of response
- can be profoundly different cultural conceptualizations of same ideas
Magazine Surveys
- can reach large population
- do not know who sample is.. hard to make conclusion
Web-Based Surveys (Strengths & Weaknesses)
- Strengths
- large samples at low cost
- access to hidden populations, recruited through specialty websites
- Weakness
- lose control of samplings
Snowball Sampling
- existing participants suggest names of future participants to recruit
Daily Diary Method of Sampling
- improved self reporting.. log every day
Media Content Analysis
- set of procedures to make valid interference about text
Intercoder Reliability
- multiple researchers measuring same thing, look @ their consistency
Masters and Johnson Experiment
- 1966
- Lab Study
- Biological Measures
- Behavioral Measures
- n=694
Quan vs. Qual Methods
- Quan: assign #s to attributes
- surveys, experiments
- Qual: “thick description” gain indepth understanding of behavior
- interviews, words, not #s
Participant-Observer Studies Examples
- Inis Beag, Mangaia
- Humphrey’s Tearoom Trade
- Moser = S&M parties
Humphrey’s Tearoom Trade
- 1970
- followed those who left bathroom after sex to see what their lives were like
Moser Participant-Observer Study
- S/M parties
Meta-Analysis
- quantitative lit review
- method for combining results of numerous studies on a given question
- Effect Size: d=Mn-Mw/Sw
What we learn from meta-analyses
- whether there is an effect
- how big the effect is
- whether it replicates across many studies
What is the gold standard for conclusions in medicine, ed, and psych?
- meta-analyses
Measures of discrimination
- formal: permission to interview
- informal: # words spoken
