Midterm 2 (Ch 7, 8, 9, 13, 14)

Question 1

Ancient forms of birth control

Answer 1

• silphium was a plant used in ancient Greece
• deadly substances like mercury and arsenic used
• tampons and other things inserted before sex
• sent girls away when they reached sexual maturity
• infanticide

Question 2

History of birth control in Canada

Answer 2

• using, selling, disseminating used to be a crime
• by the 60’s after the baby boomers, concerns about overpopulation made contraception more acceptable
• birth control removed from criminal code in 69

Question 3

Modern methods of birth control

Answer 3

• contraceptives made a breakthrough in 16th century w Gabriello Fallopio’s invention of the condom
• into 20th century contraceptives were favoured again due to activists like Margaret Sanger
• limited knowledge of contraceptives beyond external and oral contraceptives in Canada

Question 4

what are contraceptives

Answer 4

• methods/ tools intended to reduce the likelihood of pregnancy
• may not protect against STIs
• ovulation, fertilization, implantation (or a combination) interference

Question 5

Abstinence

Answer 5

• only 100% effective form of birth control
• ppl have different definitions
• still has the risk of STIs (depending on what ppls definitions are)
• can also increase chances of risky behaviour in the future bc they haven’t received proper education
• AOE can actually contribute to higher teen pregnancy rates

Question 6

How hormonal contraceptives work

Answer 6

• reversible methods of birth control that protect against pregnancy but not STIs
• inhibit ovulation, alter endometrium, and/or alter cervical mucus
• requires a prescription
• physician administered are more long-term, self-administered requires less doctor attention but are more short-term
• must be taken regularly regardless of how sexually active
• Pros: reduce symptoms of period, regulate period, reduce acne
• Cons: spotting, decreased libido, nausea, headache, weight gain, risk of blood clots (estrogen)

Question 7

Types of hormonal contraceptives

Answer 7

• Combination (estrogen and progesterone): oral pill, transdermal patch, NuvaRing
• Progesterone only: mini-pill, injectable (depo-provera), levonogestrel-releasing intra-uterine system (LNG-IUS)

Question 8

Types of non-hormonal contraceptives

Answer 8

• copper IUD (CuIUD)
• cervical barrier methods/spermicides: contraceptive sponge, cervical cap, diaphragm, spermicidal jelly and condoms
• internal and external condom

Question 9

Surgical methods of contraceptive

Answer 9

• female sterilization: tubal ligation
• male sterilization: vasectomy

Question 10

Oral contraceptive pill (the pill)

Answer 10

• most common –> prevents ovulation
• 21 days w pill, and 7 days w out w a withdrawal bleed
• failure rate: perfect use = 0.3%, typical use = 9%
• pros: easy to use
• cons: remembering to take it daily

Question 11

Transdermal contraceptive patch

Answer 11

• patch applied every week for 3 weeks and then removed for a week w withdrawal bleed; new spot each time (prevents ovulation)
• failure rate: perfect use = 0.3%, typical use = 9%
• pros: need to remember only once per week
• cons: can cause skin irritation, might be visible

Question 12

NuvaRing

Answer 12

• ring inserted near cervix for 3 weeks and then removed for a week w withdrawal bleed (prevents ovulation)
• failure rate: perfect use = 0.3%, typical use = 9%
• pros: need to remember only once per month
• cons: possible increased risk of vaginitis, interference w intercourse sometimes reported

Question 13

Mini-pill

Answer 13

• 21 days of pill, and 7 days of placebo pill (no breaks for menstruation) –> thicken cervical mucus, thin endometrium
• failure rate: perfect use = 0.3%, typical use = 9%
• pros: easy to take
• cons: must be taken at the exact same time (within 3 hours) each day

Question 14

Depo-Provera

Answer 14

• intramuscular injection every 3 months –> thicken cervical mucus
• failure rate: perfect use = 0.2%, typical use = 6%
• not first-line of defence until after about 3 months, so want another hormone or barrier at the beginning
• delayed return to fertility after cessation
• pros: need to remember once every 3 months, reduced risk of endometrial cancer, endometriosis, chronic pelvic pain, and PMS
• cons: weight gain and mood changes, decreased bone mineral density, need to see health care worker

Question 15

LNG-IUS

Answer 15

• T-shaped device w slow-release hormone (progesterone) inserted into uterus by physician –> thins endometrium
• failure rate: perfect use and typical use = 0.2%
• pros: not having to think ab contraception for 5 years, lower dose of hormones than OC (localized), significantly reduced menstrual flow
• cons: benign ovarian cysts, rare risk of uterine perforation or infection during insertion, exposure to STIs is associated w pelvic inflammatory disease, possibility of expulsion

Question 16

Cu-IUD

Answer 16

• t-shaped device inserted into uterus by physician
• makes uterine environment inhospitable to sperm and inhibits implantation
• failure rate: perfect use = 0.8% (usually during first 3 months)
• pros: lasts for 5 years, reduced risk of endometrial cancer, no hormonal side effects
• cons: possible irregular bleeding, increase in blood loss during menstruation, exposure to STIs is associated w pelvic inflammatory disease, possibility of expulsion or uterine perforation

Question 17

Cervical barrier/spermicide MOA

Answer 17

• create barriers at the cervix so no sperm can get through
• spermicide used with these methods provides extra protection by killing some sperm
• do not provide STI protection
• pros: no hormonal side effects
• cons: increased risk of TSS, unsuitable for those w recurrent vaginal infections or UTIs, insertion difficult for some users

Question 18

Contraceptive sponge

Answer 18

• moisten w water and inserted; lasts 12-24 h and removed 6-8 hours after ejaculation
• failure rate: nulliparous: perfect = 9%, typical = 12%; parous: perfect: 20%, typical = 24%
• pros: no prescription needed, already contains spermicide
• cons: high failure rate w typical use

Question 19

Cervical cap

Answer 19

• held in place against cervix by suction
• failure rate: nulliparous = 13%, parous = 29%
• pros: made of silicon, can be left in for 72 h
• cons: can be dislodged during intercourse, may cause vaginal odour

Question 20

Diaphragm

Answer 20

• inserted up to 6 hours before intercourse and removed within 24 hours; replaced every 2 years
• failure rate: perfect use = 6%, typical use = 12%
• pros: reduced incidence of cervical dysplasia
• cons: not widely available, available w prescription only, body weight changes requires new sizing

Question 21

Spermicides

Answer 21

• paired w barrier methods to be more effective, and is only effective for one act of intercourse
• vaginal contraceptive film: inserted into vagina 15-60 mins before intercourse
• bioadhesive jelly: inserted w applicator and effective immediately and or 24 hours
• foam: inserted w applicator and effective immediately and for 1 hour
• suppositories: inserted 10-15 mins prior to intercourse and effective for an hour
• jellies/creams: primarily for use w diaphragm or cervical cap and effective for 8-8 hours
• failure rate: perfect use = 18%, typical use = 28%
• pros: can also function as lubricant, no prescription, can lower risk of PID
• cons: can be irritating and increase risk of STIs, can be messy, can take time to be effective and aren’t effective for long

Question 22

Internal condom

Answer 22

• creates physical barrier to trap sperm
• inserted into vagina up to 8 hours before intercourse
• failure rate: perfect use = 5%, typical use = 21%
• pros: protects against STIs, made form polyurethane, no prescription, can be used for anal, extra protection bc it rests against vulva
• cons: appears bulky, crinkly or suction noises, more expensive and less widely available

Question 23

External condom

Answer 23

• makes physical barrier to trap sperm
• rolled onto penis and used w a water-based lubricant
• failure rate: latex: perfect use = 2%, typical use = 18% –> polyurethane have higher frequency of breakage and slippage
• pros: no prescription, protects against STI, widely available and sometimes free, putting it on can be incorporated into sex play
• cons: effectiveness decreases if not stored correctly, can reduce sensitivity

Dental Dams- used for STI protection during non-penetrative activities (normal condoms can be turned into dental dams bc they aren’t that widely available and are pricier)

Question 24

Vasectomy

Answer 24

• vas deferens are cut and sealed to prevent sperm from entering ejaculate
• failure rate: 0.05% (sperm is in ejaculate for 10-30 ejaculations)
• pros: relatively simple w few complications, reversible surgery is available
• cons: does not protect against STIs, potential short-term and long-term complications associated w surgery

Question 25

Tubal ligation

Answer 25

• fallopian tubes are severed and sealed to prevent egg and sperm from ever meeting
• failure rate: depends on type of surgery, but 99% effective (0.5%)
• pros: not having to think about contraception again
• cons: does not protect against STI, possible increased risk of ectopic pregnancy

Question 26

Natural methods

Answer 26

• methods w no human made barriers or methods
• pros: can be used in conjunction w other barrier methods, are reversible, don’t introduce chemicals into body, and are supported by religious groups
• cons: don’t protect against STIs and intercourse must be avoided during ovulation periods
• include: fertility awareness methods (sympto-thermal approach), calendar-based methods (rhythm method, standard-days method), lactational amenorrhea, withdrawal method

Question 27

Fertility awareness methods of contraception

Answer 27

• used to conceive rather than to avoid conception
• disadvantage is women are limited to when they can have intercourse, lots of vigilance
• *Sympatothermal approach:**
• Chart basal body temperature (BBT), cervical position, and cervical mucus to gain insight into when one is fertile
• slight rise in temp following ovulation (most fertile 3 days after this)
• Cervix is furthest away from vaginal opening and mucus is clear and more elastic as ovulation approaches

Question 28

Calendar based methods of contraception

Answer 28

• not recommended as primary methods of contraception
• *Rhythm method:**
• Fertile time is calculated based on the length of the previous 12 cycles
• if shortest was 26 days (-20) and longest was 31 days (-10) then fertile time would last from day 6 to 21, meaning unprotected sex can occur on day 1-5 and 22-beginning of next cycle
• *Standard-days method:**
• more accurate variation that works for those with menstrual cycles between 26 and 32 days in length
• assumes days 8 through 19 are unsafe if pregnancy prevention is the goal

Question 29

Lactational amenorrhea

Answer 29

• causes hormonal suppression of ovulation
• 98% effective as a temporary postpartum method of birth control as long as menstruation has not returned, the baby is being nursed exclusively with breast milk, and the baby is less than six months

Question 30

The withdrawal method

Answer 30

• Requires the withdrawal of the penis from the vagina before ejaculation to prevent sperm from entering the cervix
• Perfect use estimates 96% effective and typical use 81%
• pros: neither chemicals nor barriers needed
• cons: intercourse is interrupted partway through, pregnancy can still occur from pre-ejaculate

Question 31

Birth control use around the world

Answer 31

• most common are female sterilization and IUD, followed by OC pills and condoms
• some countries where women have a lower status, they are prohibited form using contraceptives

Question 32

Birth control use in Canada

Answer 32

• most frequent method is condoms, then OCs then withdrawal (IUDs not widely used)

Question 33

Information-motivation-behavioural skills (IMB) model

Answer 33

• Contraceptive information needs to be easy to understand, and accessible in a timely manner and an individual needs motivation to avoid engaging in risky sexual behaviours
• Motivation can come from personal attitudes and/or social norms that discourage sexual risk-taking, as well as an individual’s perceived vulnerability to unwanted pregnancies or STI’s
• A person’s behavioural skills need to be developed so they are self-efficacious and confident when implementing a birth control
• One way to achieve these goals is through sex-ed, developing positive attitudes toward social norms of contraceptive use, and helping individuals build skills to make good choices –> the more open and comfortable, the more likely they will be safe and comply w birth control

Question 34

Emergency Contraceptive

Answer 34

• any contraceptive used after intercourse and before the time that the egg can implant into the uterine lining –> does not have an effect on established pregnancy
• *The emergency contraceptive pill:**
• morning after pill taken within 72 hours post-coitus –> Plan B = levongestrol (less nausea) and Yuzpe = levongestrel + estrogen + estrodiol
• *Post-coital IUD insertion:**
• effectiveness approaches 100%
• must be inserted within 7 days of the intercourse, and requires a doctor’s appointment and prescription

Question 35

Therapeutic vs elective abortion

Answer 35

• Therapeutic abortions are performed due to maternal health problems and fetal anomalies that threaten the health or survival of either the birthing parent or the fetus
• Elective abortion reasons include not feeling ready to care for a child, financial concerns, concerns that a child will interfere with the current responsibilities to others, avoidance of single parenthood, relationship issues, or too young or immature to raise a child

Question 36

History of abortion in Canada

Answer 36

• made illegal in 1869
• Dr. henry Morgentaler defied laws and performed abortions regardless of a woman’s health
• abortion became legal in 1988

Question 37

Medical Abortions:

Answer 37

• usually performed up to 7 weeks following the last menstrual period but can be done up until the 10th week of gestation
• One option: first injection of methotrexate to stop growth of fetus, and 5 days later at home, woman takes misoprostol (suppository or orally) to cause uterus to contract and expel contents
• another option: RU-486 (mifepristone) blocks progesterone which prepares the lining of the uterus for a fertilized egg and without progesterone the pregnancy cannot proceed –> lining of the uterus softens and breaks down and bleeding begins
• -> prostaglandin misoprostol causes the uterus to contract and completes the abortion process
• main advantage is is they are less invasive and avoid risks involving surgical instruments

Question 38

Types of Surgical Abortions

Answer 38

• manual vacuum aspiration
• vacuum suction curretage
• dilation and evacuation
• second- and third- trimester abortions

Question 39

Manual vacuum aspiration

Answer 39

• only surgical option available during the first 7 weeks
• Flexible tube is inserted into the cervix and a syringe attached to the tube remove the contents of the uterus by creating suction
• 10 mins and generally safe and effective

Question 40

Vacuum suction curettage

Answer 40

• usually performed from the 6th- 14th week of gestation
• in preparation, the cervix is gradually dilated, and then a tube is inserted through the opening of the uterus
• contents of uterus are suctioned out and curette used to ensure all tissue has been removed

Question 41

Dilation and evacuation

Answer 41

• used for abortions in the 13th-16th weeks of gestation
• Similar to vacuum suction curettage but it’s more complicated because of the increase size the fetus and must be done in the hospital under general and aesthetics
• Beyond the 16th week the fetus is removed with forceps

Question 42

Second- and third-trimester abortions

Answer 42

• Abortions that occur after the 20th week of gestation involve an injection of a substance stop the fetal heart and removal of the fetus with the assistance of forceps
• labour is sometimes induced, and c-section is performed as a last resort
• Late pregnancy abortions are rare and often most performed because of diagnosed fetal anomalies

Question 43

History of syphilis and herpes

Answer 43

• thought columbus brought syphilis to the new world from europe
• others thought it was what they already referred to as leprosy
• first treated w arsenic and then penicillin

Question 44

History of HIV/AIDs

Answer 44

• AIDs epidemic began in 81 and the probably source was a cross from primates to humans
• widespread in MSM and injection drug users –> healthcare personnel were apprehensive to help bc of the stigma of these groups
• leading cause of death of males under 50 in north america in the 80s and 90s
• everything changed w the intro of ART –> can prevent transmission by reducing viral load, turn AIDs into a manageable chronic condition, prevent infection in at risk uninfected indv

Question 45

Examples of Bacterial STIs

Answer 45

• chlamydia
• gonorrhea
• syphillis
• can be cured w antibiotics

Question 46

Chlamydia

Answer 46

• PREVALENCE: highest prevalence of any STI (most common bacterial infection), and highest in adults aged 20-24
• ROT: penile-anal, penile-vaginal most common, but oral also, sharing sex toys, and to child during childbirth
• SYMPTOMS: usually asymptomatic, but can have mild symptoms like discharge, urinary burning/itching, vaginal bleeding
• CONSEQUENCES: may cause PID which can lead to infertility and increased likelihood of ectopic pregnancy and chronic pelvic pain (CPP), can cause urethritis which can cause epididymitis
• DIAGNOSIS: swab from cervix, urethra, anus, pharynx, or urine sample
• TREATMENT: one-time dose of oral antibiotics
• PREVENTION: internal external condoms, and negative screening

Question 47

Gonorrhea

Answer 47

• PREVALENCE: highest among MSM and those who have sex while travelling
• ROT: penile-vaginal, penile-anal most common, but also oral, sharing toys, and to infant during childbirth
• SYMPTOMS: more frequently symptomatic than chlamydia, yellowish white discharge/pus, oral is asymptomatic
• CONSEQUENCES: can cause PID in women, rare cases can enter blood and affect joints, skin, and tissues around liver, heart and brain membranes
• DIAGNOSIS: swab from cervix, vagina, urethra, anus, or pharynx, or blood or urine sample
• TREATMENT: oral or injectable antibiotics, injection if in pharynx or PID or epididymitis occurs, also treat chlamydia bc comorbid (antibiotic resistance!!!!)
• PREVENTION: internal and external condoms

Question 48

Syphilis

Answer 48

• PREVALENCE: not common in general public but higher in MSM and those who have sex while travelling
• ROT: penile-vaginal and penile-anal intercourse and oral routes most common, but also during childbirth and pregnancy, injection drug use, and sharing sex toys
• SYMPTOMS: primary- swelling of lymph nodes (flu symptoms) and painless ulcers; secondary- after 3 weeks, rashes, lesions, erosions in mouth and genitals, fever, malaise, jaundice, muscle joint aches, patchy loss of hair; ocular syphilis that leads to blindness can also occur
• CONSEQUENCES: of untreated can lead to tertiary stage where it affects blood vessels, heart, and eyes, and sensory or brain damage may occur, growths on bones and organs that lead to death, and may increase HIV acquisition and transmission
• DIAGNOSIS: blood test for antibodies, and test repeated after 3 weeks to confirm
• TREATMENT: injectable benzathine penicillin (course of antibiotics)
• PREVENTION: external and internal condom use

Question 49

Examples of Viral STIs

Answer 49

• Herpes
• HPV
• HIV
• Viral hepatitis
• most cant be cured, but can be prevented (vaccines, safe practices), and managed

Question 50

Herpes (HSV)

Answer 50

• HSV-1: orolabial, HSV-2: anogenital
• PREVALENCE: not reportable so limited info; affects women more than men
• ROT: genital-genital, oral-genital, oral-anal, oral-oral contact (skin to skin contact), infants during childbirth, can still potentially be transmitted even if no visible sores
• SYMPTOMS: orolabial: lesions around lips; anogenital: lesions, regional swollen lymph nodes, blistery lesions when recurs, outbreak lasts a few days but virus remains latent for life
• CONSEQUENCES: blisters can cause scarring, may cause UTIs, heighten HIV transmission and acquisition, distress, infants infected can experience neurological and other impairments and death
• DIAGNOSIS: swabbing lesions, viral identification test (not 100%)
• TREATMENT: oral antivirals can limit strength of outbreaks, for those w frequent outbreaks, oral antivirals taken at prodromal stage can prevent/shorten outbreak, daily antivirals for those w severe frequent infections, local antivirals not as efficacious, keeping lesions dry and clean can lessen local symptoms
• PREVENTION: condoms help but not entirely, blood test for detection for symptomatic and high risk ppl (not routine bc false positives = bad)

Question 51

HPV

Answer 51

• HR = associated w cervical, anal, head, and neck cancer; LR = genital warts
• PREVALENCE: not reportable but estimated to be the most prevalent, up to 75% will be infected at some point, higher rates of incidence in uni-aged individuals, incidence decreased in countries w good vaccination programs
• ROT: skin-to-skin contact, usually during genital-genital, genital-anal, and oral-genital contact
• SYMPTOMS: asymptomatic in most, some develop warts, some will have abnormal Pap smears, and some will develop precancerous conditions
• CONSEQUENCES: most infections spontaneously clear, infection of LR can lead to low-grade disease of genitals, anus, mouth and respiratory tract
• DIAGNOSIS: genital warts diagnosed by visual exams, precancerous changes by Pap smear –> close examination and biopsy if suspicious
• TREATMENT: warts treated at home by immune stimulating drug, drug w antiviral effects, or drug that kills on surface of skin, can also be treated by more toxic drugs, ablative surgery or cryotherapy; precancerous lesions of cervix removed via cryotherapy or surgically –> body will usually spontaneously clear
• PREVENTION: vaccination covers most common LR, and 7 HR types (gardasil 9) –> 2 separate injections given in Canada for free; still get Pap smear even if vaccinated

Question 52

HIV

Answer 52

• PREVALENCE: more common in MSM, drug users, ppl in countries where it is endemic
• ROT: blood or bodily fluid coming in contact w oral, genital, or anal mucosa and bloodstream, penile-vaginal and penile-anal are high risk (bc more microtears), oral is lower risk, sharing sex toys, presence of lesions, needles
• SYMPTOMS: initial infection cause flu like symptoms w enlarged lymph nodes (don’t always occur), later will experience severe damage of immune system and opportunistic infections
• CONSEQUENCES: can progress to AIDs which involves severe damage of immune system, opportunistic infections, cancers, neurologic and cardiac diseases, physical wasting, and death
• DIAGNOSIS: blood test to detect antibodies (takes time to have sufficient antibodies, so need to wait a bit), diagnosis of infants is harder bc born w maternal antibodies (either wait till maternal have cleared, or more direct testing)
• TREATMENT: ARV combination therapy helps to stop replication of HIV, preserve lifespan and health of patient, lowering infectiousness so condom use can be stopped, requires lifetime compliance, also preventative
• PREVENTION: external and internal condom use, testing and treatment of HIV infected parents (if birthing), post-exposure prophylaxis (72h), ARV-containing vaginal gel, avoidance and careful cleaning of injection equipment, pre-exposure prophylaxis in drug users, screening tests

Question 53

HIV stages

Answer 53

• Acute inflammation: 1st 2-4 weeks, no symptoms, highest viral load
• Chronic inflammation: up to 10 years, might still be fairly asymptomatic
• AIDS: after 10 years, it qualifies for AIDs if a person has CD4 cell counts of <200/mm^3 (w out ART)

Question 54

Viral Hepatitis

Answer 54

• most common are A, B, and C, and all involve inflammation of liver
• PREVALENCE: Hep A is prevalent at epidemic levels in certain close communities, and MSM; Hep B is prevalent among MSM and injection drug users, where medical instruments aren’t cleaned, and blood isn’t screened; Hep C is prevalent among injection drug users, in countries where there is poor infection control and health care settings, countries where blood products are not screened, and HIV positive MSM
• ROT: Hep A mainly by fecal-oral route, including oral-anal sex and ingestion of food or water contaminated with feces; Hep B through sexual contact, the sharing of contaminated drug injection or prep equipment, or the sharing of sex toys; Hep C not readily transmissible through most sexual activities in immunocompetent people
• SYMPTOMS: jaundice, flu-like symptoms w abdominal pain
• CONSEQUENCES: most ppl clear Hep A after treatment, Hep B and C can remain in body and cause liver cirrhosis, and/or liver cancer
• DIAGNOSIS: blood test
• TREATMENT: Hep A requires symptom specific treatment, most Hep B and C can be cured w antivirals
• PREVENTION: Hep A and B have vaccine available w out cost for many ppl, safer drug practices for Hep B and C prevention, newborns given Hep B vaccine

Question 55

Other genital concerns

Answer 55

• trichomonoiasis
• pubic lice and scabies
• moniliasis
• bacterial vaginosis

Question 56

Trichomonoiasis

Answer 56

• PREVALENCE: uncommon in Canada
• ROT: protozoan spread most commonly through sexual contact, genital-genital, genital-anal
• SYMPTOMS: often asymptomatic, but can cause vaginal discharge, pain upon urination and itching of genital area
• CONSEQUENCES: can lead to infertility, increased risk of cervical cancer, inflammation of uterus, endometritis, and premature delivery, can increase susceptibility to HIV
• DIAGNOSIS: swab of vaginal or urethra, penile swab/urine
• TREATMENT: oral metronidazole (single dose antibiotics)
• PREVENTION: external and internal condom use

Question 57

Pubic Lice and Scabies

Answer 57

• infestations fo small parasites
• PREVALENCE: both uncommon
• ROT: direct or non-direct sexual contact, contaminated services like bedsheets and towels
• SYMPTOMS: cause itchiness esp at night, white eggs and adult lice may be visible, scabies can cause rash
• CONSEQUENCES: severe itchiness can lead to bacterial infection due to breakdown of skin from scratching
• DIAGNOSIS: visual inspection (magnifying glass) by patient or healthcare provider, scabies also found via skin biopsy
• TREATMENT: permethrin, pyrethrin-piperonyl, and lindane cream or shampoo
• PREVENTION: no definitive methods or screening, shaving

Question 58

Moniliasis

Answer 58

• aka candidiasis or thrust, and is caused by overgrowth of naturally occurring vaginal yeast
• not sexually transmitted but can be activated by sexual activities involving the vagina
• SYMPTOMS: pain during intercourse, vaginal itchiness, odour, and discharge
• CONSEQUENCES: can cause eczema-like reaction in genital area and pain during urination or intercourse
• DIAGNOSIS: visual inspection by healthcare provider, or confirmed by lab tests if frequent infections
• TREATMENT: oral or topical drugs; if recurrent, boric acid vaginal suppositories or capsules, or oral fluconazole
• PREVENTION: avoidance of widespread antibiotics, no screening bc on body already, most women w recurrent infections have poor immune response to yeast

Question 59

Bacterial Vaginosis

Answer 59

• PREVALENCE: overgrowth of bacteria that usually live in vagina and common in pregnant women; not really an STI, new partner can be a risk
• SYMPTOMS: fishy odour, vaginal discharge, itching, dyspareunia
• CONSEQUENCES: can cause pregnancy complications like preterm delivery, increase susceptibility to acquiring and transmitting HIV, and susceptibility to acquiring chlamydia, gonorrhea, herpes, and HPV
• DIAGNOSIS: higher than usual vaginal pH, and absence of lactobacilli in vaginal secretions
• TREATMENT: oral medication, nightly vaginal insertion of clindamycin cream, metronidaxole gel, long-lasting vit C tablets, or acidifying agent (boric acid capsule, lactic acid gel)
• PREVENTION: no definitive prevention; abstinence, avoidance of multiple partners, avoidance of douching, adherence to meds can help prevent recurrence, frequent infections can be reduced w weekly small doses of meds

Question 60

Which two common STIs cannot be detected via screeening?

Answer 60

• HPV and HSV

Question 61

Reportable STIs

Answer 61

• chlamydia
• gonorrhea
• hepatitis
• syphilis
• HIV/AIDs
• automatically reported to public health

Question 62

Condom use

Answer 62

• check expiry date
• check for air bubbles
• open packing w out teeth and nails
• blow into condom
• pinch tip of condom and place on tip
• unroll to base of penis
• lubricate and enjoy
• withdraw from penis immediately after ejaculation
• tie condom in knot
• throw away, and don’t flush

Question 63

First sexual experience

Answer 63

• most people report a a good experience
• men reported more pleasure than women, and women are more likely to experience pain
• more positive emotions when sex occurs under in the context of close rather than casual relationship

Question 64

Virginity

Answer 64

• small number past the age of 20
• religion, fear of STIs/pregnancy, insecurity/inadequacy related to sexual behaviour, not feeling loved
• reluctant virgins/ involuntary celibates are those who are unsatisfied w their virginity status

Question 65

Sexual consent

Answer 65

• clear understanding of what the person is consenting to
• consent is given freely and w out coercion
• consent is ongoing –> can be withdrawn at any point, and should be revisited
• 4 Pillars: willingly given, informed, enthusiastic, sober
• women may have a greater need for explicit verbal consent (bc of TSS and mens role to initiate sex)
• should be clear agreement such as non-verbal cues, ask open ended questions, and never assume

Question 66

Sexual compliance and Guilt Resilience (SHRC)

Answer 66

• refers to a person freely consenting to engaging in sexual activity even when they don’t truly want to participate based on their own desire/preferences
• more likely in women
• want to make partner happy, promote intimacy, avoid conflict, more common in committed relationships
• set boundaries and don’t feel bad saying no, practice
• recognize the difference between wanting, willing, and complying

Question 67

SHRC: Rejection and Rejection resilience

Answer 67

• rejection isn’t always an obvious no
• expect it
• recognize when it happens
• understand what it means –> not rejecting you as a person but the activity
• have an exit plan
• selfcare

Question 68

SHRC: Receiving disclosures of sexual violence

Answer 68

• believe them
• don’t take away their choice
• mirror their language
• avoid re-traumatizing
• active listening and reaffirming
• make it easy for them
• selfcare

Question 69

Solitary sexual behaviours

Answer 69

• *Fantasy:**
• part of healthy sex life and engaging in sexual fantasy is associated w more positive emotions, greater arousal, more masturbation, greater sexual partners, and greater satisfaction
• diverse and sometimes taboo; doesn’t mean they want to act it out in real life
• sometimes can be distressing and lead to sexual problems
• *Masturbation:**
• good way to learn ones own response and prepare for future relationships
• by adulthood, most men and women are able to masturbate to the point of orgasm
• sexual double standard

Question 70

Partnered sexual behaviours

Answer 70

• *Kissing:**
• can be platonic or extremely intimate bc it stimulates a number of senses simultaneously
• *Touching:**
• stimulating genital and non-genital areas w hands/body part/other object
• can be foreplay, and many ppl spend a lot ot time doing it before sex
• *Oral Sex:**
• cunnilingus = oral sex on vulva; women also find oral stimulation of inner thighs, labia, and vaginal opening satisfying
• fellatio = oral sex performed on penis and involves stimulation of penile shaft, glans, and coronal ridge; many find this oral stimulation w simultaneous stimulation of scrotum, perineum, and anal opening pleasurable
• anilingus = oral sex performed on anus, perineum and surrounding area
• *Intercourse and other partnered stimulation:**
• nonpenetrative: dry humping (frottage), scissoring (tribadism) and intercrural intercourse
• intercourse involves penetration of penis, dildo, or other toy into vaginal or anal opening

Question 71

Orgasm

Answer 71

• one element of the TSS that isn’t strictly a behaviour bc it is part of the sexual response and isn’t directly within our control
• appears to be an important part of ss as it is often viewed as the end goal and indicator of sexual satisfaction –> can be problematic esp if some ppl can’t reach orgasm

Question 72

Sexual satisfaction

Answer 72

• an affective response arising from one’s subjective evaluation of positive and negative dimension associated with one’s sexual relationship
• individual factors: younger, fewer sexual problems, greater frequency of orgasm
• relational factors: relationship satisfaction and effective communication
• lifestyle factors: partners working w the same shifts
• Positively correlated w sexual functioning but sexual satisfaction reflects the interpersonal and affective (experience of feeling, emotion, or mood) qualities of sex, whereas sexual functioning focuses on sexual responses such as arousal, orgasm, and lubrication
• According to the personal exchange model of sexual satisfaction (IEMSS), those in long term relationships are more sexually satisfied when both partners’ sexual preferences are incorporated into sexual activity in a matter that maximizes rewards and minimizes costs for both

Question 73

Sexual preferences

Answer 73

• SGD indv report a greater affinity for the use of sex toys
• men masturbate more often, use explicit material more often, and are more often in casual sexually relationships
• disclosing sexual preferences to a partner contributes to greater sexual satisfaction

Question 74

Use of sex toys

Answer 74

• use is becoming more mainstream
• therapeutic reasons, to enhance pleasure, to spice up sex life
• majority of bisexual men and women report using toys, and vibrator is associated w better sexual health and functioning in women
• all toys can be cleaned, but not all can be sterilized so think about barrier methods and STI transmission

Question 75

Types of Monogamous relationships:

Answer 75

• Dating
• Cohabitation and marriage

Question 76

Dating

Answer 76

• traditionally viewed as part of courtship stage and begins at 10-11 and average start date being 16 (in NA)
• dating in NA emerges approx at the same time developmentally as sexual attraction
• harder for SGD individuals and may hold off until they feel safer
• *Internet Dating:**
• follows similar developmental pattern to offline dating
• first stage = becoming aware of the other person
• second stage = communicate and share info w each other
• third stage = meeting in person and developing couple identity to develop interdependence (may not occur until they meet in person)
• internet dating is becoming more common and socially acceptable

Question 77

Cohabitation and marriage

Answer 77

• marriage declining due to staying single for longer and more couples cohabitiating
• sexual satisfaction can fluctuate w life circumstances but generally, couples who are relationally satisfied tend to stay sexually satisfied over decades, and vice versa
• decline in sex is likely due to aging rather than relationship correlates
• after divorce, sexual opportunities are similar to those a single/never married indv –> many ppl find it harder to adjust to life as there may be new impediments to sex (like kids)

Question 78

Non-monogamous relationships

Answer 78

• FWBR
• CNM (polyamory, swinging, polygamy)

Question 79

Friends w benefits relationship (FWBR)

Answer 79

• easy going, sexual, requires no sexual or emotional exclusivity
• relationship rarely discussed directly or revealed to others
• women more stigmatized
• men are more motivated by desire for sex and want relationship to remain the same overtime, and women motivated by emotional connection and hope it evolves into romantic relationship or friendship w out sex

Question 80

Consensual Nonmonogamy (CNM)

Answer 80

• includes polyamory, swinging, and polygamy
• all partners explicitly agree that each partner may have romantic or sexual relationship with other people
• more common in SGD indv

Question 81

Polyamory

Answer 81

• long-term romantic and/or sexual relationship w more than one person at the same time (sometimes only one partner is intimately involved w more than one person)
• diverse structure: two partners having primary relationship and others being secondary, or 3 or 4 partners (triad, quad)
• most are “exclusive”
• tend to have agreed on rules to manage safety, jealousy, and other complications

Question 82

Swinging

Answer 82

• both partners in an emotionally committed or married relationship agreeing to and participating in sex w other individuals, usually at the same time
• don’t usually emphasize feelings of love for ppl other than primary partners (unlike polyamory)
• Perceived benefits: long term friendships with like-minded couples, opportunities to explore and share sexual interests together, enhanced trust with a primary partner

Question 83

Polygamy

Answer 83

• type of polyamory where one person is married to more than one spouse simultaneously
• polygyny = one man, multiple women, polyandry = one woman, multiple men (less common)
• usually a hierarchy emerges –> women report psychological and financial distress, domestic violence and children tend to have more behavioural, emotional and academic difficulties
• younger more fertile women are hold a higher status

Question 84

Nonconsesual Nonmonogamy (NCNM)

Answer 84

• Any emotional or sexual behaviour with a person outside of a monogamous relationship without the agreement of ones partner
• NCNM less judgemental and more encompassing than infidelity
• might occur due to enhanced desire and arousal by partner novelty
• many report not being sexually dissatisfied in their primary relationship
• some believe it reflects a problem of intimacy or attachment in the relationship, and might not have anything to do with sexual dissatisfaction or opportunistic sex

Question 85

Theoretical Perspectives on how media influences sexuality

Answer 85

• *Agenda theory:**
• Proposes that media affect what we think is important by highlighting what we should pay attention to, i.e. media sets the agenda
• *Cultivation Theory:**
• we develop a shared set of values and expectations about reality based on depictions of reality in media –> media cultivate certain ideas about sex
• *Social Learning Theory:**
• individuals model their attitudes and behaviours on the fictional characters they see in media, especially when the models are rewarded for particular behaviours

Question 86

Positive and negative influences of media on sexuality

Answer 86

• Internet gives access to seemingly unlimited content with very little investment of financial or other resources
• 6 types of OSA: exchange of sexual information, dissemination and consumption of sexual entertainment, buying and selling of sexual products, participation in sexual contact online or to arrange offline contact, sexual minority communities, sex work
• MSM and bi men seem to make greater use of the internet

Question 87

The internet and sexual activity (OSA)

Answer 87

• *Negative:**
• Greater solitary OSA use in men was associated with lower relationship satisfaction and with lower sexual desire in women
• Over involvement in OSA may result in one partner neglecting the other
• A small number of cyber sex users describe compulsive online behaviour that interferes with their relationship and ability to function in everyday activities
• *Positive:**
• Moderate amounts of OSA was linked to an increased quality and frequency of sexual activity and increased intimacy with partners for both women and men
• Reported that engaging in OSA with their partner improved sexual satisfaction and sexual communication between men and women

Question 88

Sexually Explicit Content

Answer 88

• *Magazines:**
• Most known explicit magazines in North America are Playboy (soft-core) and hustler (hard-core)
• magazines became popular in the 70s but sales have declined due to availability of material on the Internet
• *Films and Videos:**
• 1972 film Deep Throat is often credited as being the first sexually explicit film to include a plot, character development, and a relatively high production value
• Amateur film makers create sexually explicit movies and have become increasingly easy to produce, especially with the advent of digital recording devices, and the Internet allows for fast, easy distribution and access

Question 89

Patterns of communication between partners (destructive patterns)

Answer 89

• John Grottman identified 4 negative communication behaviours that are particularly strong predictors of decline in a relationship:
• Criticism: involves attacking a person’s character or personality rather than addressing the issue at hand
• Contempt: involves putting someone down, being hostile, and disrespectful (insults, sarcasm, eye rolling, name-calling)
• Defensive Behaviour: occurs when one person feels attacked and must protect themselves by denying responsibility, making excuses or complaining
• Stonewalling: when a person refuses to engage in the discussion
• Belligerence: confrontational interaction characterized by long-term pattern of poor communication in which one person’s right to influence the relationship is diminished
• responsiveness to communication efforts (perceived partner responsiveness) is associated w greater relationship and sexual well-being

Question 90

Importance of sexual communication

Answer 90

• associated w relationship and sexual satisfaction
• ensures both partners have equal right to pleasure, and overcome incompatibilities
• leads to greater closeness and intimacy and opportunities to have a wider realm of sexual experiences

Question 91

Nonverbal sexual communication

Answer 91

• accounts for 60-65% of information exchanges
• flirting relies heavily on nonverbal behaviours (see example in notes)
• plays a role during sexual experience and initiation is often nonverbal
• MSM use nonverbal more than WSW
• communicates likes and dislikes during sexual activity
• *Main functions (from lec):**
• provides info about peoples moods and what they really mean when they say something
• regulated interactions –> know when an interaction is gonna end
• defines relationship

Question 92

Facial expressions

Answer 92

• emotions/facial expressions are informative when authentic
• can be faked but not very well by the average person
• faked facial expressions: intensified/exaggerated, minimized, neutralized (poker player, judge), masked
• genuine vs faked expressions differ from each other in subtle ways
• Microexpressions: authentic flashes of real emotion, hard to control even for trained actors

Question 93

Gazing Behaviour

Answer 93

• direction and amount of a person’s eye contact
• communicates interest (or lack thereof) –> stop eye contact if ur not interested
• helps define the relationship in terms of affection/intimacy for example

Question 94

Body Language

Answer 94

• can accompany and support verbal communication, or can occur on its own
• makes it easier to convey what we mean
• meanings vary from culture to culture, esp body language w hands
• facial expressions overall are easier to control than body language

Question 95

Technology based sexual communciation

Answer 95

• sexting: receiving or sending sexual texts or photos –> higher rates found in SGD
• also sexy phone calls and video based exchanges
• technology-based communication strengthens in-person communication between partners

Question 96

Verbal Communication

Answer 96

• mutual empathy should be the basis of verbal communication
• you should care for your partner and feel as though this is being reciprocated

Question 97

Talking during sex

Answer 97

• Individualistic Talk: self-focused talk relating to one’s own sexual experience and pleasure and is liked to greater sexual satisfaction
• Mutualistic Talk: other-focused talk relating to sharing the sexual experience w partner and is linked to greater sexual and relationship satisfaction
• women tend to use statements that build intimacy or emotional bonding, and more submissive statements
• sexual talk is beneficial only when your partner is into it

Question 98

Why talking about sex is hard

Answer 98

• anxiety, discomfort, embarrassment during talk, it is hard to be vulnerable, open and assertive, and to some sex is taboo
• high stakes conversation, and if it goes wrong it might impact the relationship
• people don’t know what language to use (clinical or colloquial?)
• *TIPS:**
• practice, exposure (not all conversations get easier overtime, such as when there are conflicts w sexual relationship)
• use course material, news articles –> bring it up in a neutral way and not a personal way that can lead to rejection, and then share something person once you’ve gauged where the other person is at

Question 99

Good sexual communication: Active listening

Answer 99

• listening is just as important as speaking
• expectations as well as actual response to a conversation plays an important role in how discussion will unfold
• Active listening includes:*
• active vs passive: conveying you are listening through eye contact, leaning in, reflective sounds, asking questions
• eye contact
• feedback (e.g. paraphrasing)
• support communication efforts
• unconditional positive regard –> that you will still like them regardless of what they have to say

Question 100

Good sexual communication: Asking questions

Answer 100

• part of both talking and active listening
• first start w open ended question: elicits a lot of info, but can be anxiety provoking bc person may not know where to start, so then
• prompt w yes/no question, or either/or question

Question 101

Good sexual communication: Eliciting information

Answer 101

• self-disclosure: share your own ideas, stories first –> when one person opens up, the other is also likely to
• discussing sexual preferences
• giving permission: encouragement and reassurance –> make it known that it is okay for the person to talk about the topic

Question 102

Good sexual communication: Making requests

Answer 102

• Be specific: issues can be more easily fixed when they are specific –> vague requests aren’t helpful and can be stress-inducing
• Use “I” language: speak for yourself and not your partner, and make sure it is known your request is coming from your own thoughts and desires and is not negative

Question 103

Good sexual communication: Constructive complaint strategies

Answer 103

• be aware of your motivation –> want the reason for bringing up the topic to come from a neutral space
• choose the right time and place
• one complaint at a time
• include positives –> express that your motivations are to improve something that is already good
• express negative emotions appropriately –> ways to delay convo to a different time appropriately
• expect baby steps

Question 104

Good sexual communication: How to react when on receiving end

Answer 104

• think before reacting
• empathize and paraphrase –> not necessarily agreeing w what they are saying, but expressing that you understand why they felt that way, reflecting back to them what you think they are saying
• acknowledge the complaint, and find something to agree w
• ask questions
• express feelings appropriately using “I” language
• focus on future changes

Question 105

Communication about sexual problems and challenges

Answer 105

• when issues are talked about both partners tend to be more satisfied w both sexual and romantic relationship
• still many ppl don’t disclose it
• frequent issue is discrepancy of sexual desire –> sexual rejection is a difficult topic

Question 106

Constructive communication patterns

Answer 106

• levelling and editing –> stating thoughts and feeling simply and clearly and being right on the point
• validating POV –> understanding where they are coming from
• complaints in “I” language
• arguing early on relationship correlated w much more satisfaction later on bc issues were aired out and resolved –> no arguing might mean that they are not asserting their needs

Question 107

Communication and breaking up

Answer 107

• ending relationship is one of the most distressing negative events
• Breakups are linked to a loss of self-esteem, lingering anger and sadness, increased substance use, academic failure, and even increased risk of depression and suicide
• many ppl resort to technology to break up to avoid negative emotions
• positive and open = more likely to end in friendship

Question 108

Sexuality in infancy and early childhood

Answer 108

• sexual development starts when fetus is growing in the womb
• derive physical pleasure from tactile contact w caregivers, and from self-stimulation like rubbing against stuff from as early as 2 months
• sex stimulation at around 2-3, but motivated by curiosity and exploration rather than sexual desire
• 1-2 y/o they notice physical differences btwn the two genders and may compare genitals w siblings
• play doctor and games that display affection at 2-5
• sex play at a young age is not indicative of sexual orientation
• parents reaction to child’s sexual behaviour can have consequences –> bad rxn can lead them to feeling guilty and affect future adjustment

Question 109

Sexuality education during childhood

Answer 109

• doesn’t just mean teaching about contraception and safer sex
• sexual healthy indv have higher self-esteem, are more respectful, make age-appropriate decisions, ask questions, and are more prepared for puberty changes
• parents should make SHE a priority, and take advantage of teachable moments/golden opportunities so they are askable
• educated children are more likely to recognize inappropriate touching and can make more informed sexual choices when they get older

Question 110

Sexuality in preadolescence

Answer 110

• sex interest commonly increases btwn 8-12 (esp at 10)
• masturbation is primary form of sexual expression
• tend to be segregated by sex/gender at this age and can teach what’s socially acceptable, or isolating if they don’t conform to norms
• issues of sexualization are increasing among young girls
• media and ppl around girls can convey the message that physical attractiveness and sexuality are highly valued, and results can be harmful

Question 111

Sexuality in adolescence

Answer 111

• marked by considerable physical, cognitive, and emotional changes, and contribute to an individuals sexual development
• primary sex characteristics change and secondary sex characteristics develop
• girls experience first menstruation
• males experience first ejaculation, increase in frequency of erections, increased sexual dreaming, and nocturnal emissions
• puberty begins around 10-11 for females and 12-13 for males and lasts 3-4 years (a little longer for males)

Question 112

Sexual activity during adolescence

Answer 112

• primary expression is masturbation, but more and more partnered activity begins as adolescence progresses (following TSS)
• TSS based on heterosexual norms, so SGD indv might struggle to figure out when and what to do
• sexual double standards when it comes to first sex –> males = rite of passage and manly, females = becoming less pure
• teen pregnancy rates decreasing w more effective contraception
• STI becoming larger issue bc “trust in partner”, and not knowing that STIs can be transmitted through oral routes

Question 113

Sexuality among SGD individuals (adolescence)

Answer 113

• time when many SGD youth begin to process and organize the implications of their sexuality
• dating can be difficult due to lack of opportunity and social disapproval
• SGD from racially ethnic minority backgrounds might also face difficulties depending on the dominant views of their culture
• bullying towards SGD is pervasive in Canada

Question 114

Sexuality in Adulthood

Answer 114

• different ppl experience different levels of interest in sex regardless of relationship status, and many defy the stereotype that men are more interested in sex than women
• most adults come to understand sex can be more than physical sensation, but also sensual and emotional, and can create intimacy
• can include: being single, dating, living together, getting married, extradyadic sex, and divorce

Question 115

Sexuality in Adulthood: Being single

Answer 115

• some choose to engage in casual sex, and others remain celibate
• casual sexual relationships are becoming increasngly common and more accepted, esp among younger indv
• 4 types of relationship: FWD, one night stand, booty call, f buddies,
• dating apps makes casual sexual relationships easier

Question 116

Sexuality in Adulthood: Dating

Answer 116

• ppl who wish to be in a more committed relationship will go through a period of dating where they meet and spend time w ppl to determine whether any might be suitable partners
• online dating gives ppl access to multiple partners
• social media allows ppl in long-distance relationships remain in contact

Question 117

Sexuality in Adulthood: Living together

Answer 117

• more ppl are cohabitating
• common law relationships are becoming more common –> same legal rights, but no guaranteed financial protection for lower income partner
• cohabitating can allow couples to get to know each other better before marriage but can also be problematic if there is a difference in desire for marriage
• have more frequent sex

Question 118

Sexuality in Adulthood: Getting married

Answer 118

• *Reasons for marriage occurring at a later age:**
• more ppl attending post-secondary = more financial debt
• more ppl cohabitating before marriage
• women less financially dependent on men, so can be pickier
• more acceptable for women to delay their child-bearing age
• sexual frequency and marital satisfaction tend to be high during beginning, decreases as they have kids, and then increases again when kids leave home
• sexual satisfaction is positively correlated w marital status
• quality of friendship is most important factor for marital satisfaction

Question 119

Sexuality in Adulthood: Extradyadic sex

Answer 119

• People who engage in NCNM tend to be male, more educated, less religious, and tend to have more sexual interest, more permissive sexual values, more opportunity for sex outside the relationship, and less satisfaction in their primary relationship
• Women are more likely to be upset if partner is involved in NCNM characterized by emotional attachment, and men more upset about those involving a sexual component –> goes back to sociobiological theory

Question 120

Sexuality in Adulthood: Divorce

Answer 120

• 38-41% of Canadian marriages end up in divorce
• Age (younger couples = more likely), religion (positive effect), and ppl who have been divorced already (= more likely for subsequent marriages to end in divorce)

Question 121

Sexuality in older adults

Answer 121

• People are living longer, and are entering the final third of their lives healthy, w a wide variety of interests and often more time to enjoy life
• Aging in men was clearly associated with problems with erections, reaching orgasm, and sexual interest, whereas in women only a decrease in vaginal lubrication is clearly associated
• For a woman the impact of physical changes associated with aging may be attenuated by the availability of a loving partner and pleasant environmental circumstances

Question 122

Physical and hormone-related changes in older women

Answer 122

• Perimenopause is when ovaries begin to produce less estrogen and progesterone, starting sometime in the mid to late 40s –> some might feel menopausal symptoms
• Around age 50, women in the western world tend to experience menopause (not having a menstrual period for 12 months)
• During post-menopause hormone levels continue to fluctuate until about five years at which point levels stabilize and most women no longer experience symptoms
• Overall, women in post-menopause experience less sexual desire and report self-stimulating less often with increasing age, and frequency of sex decreases

Question 123

Physical and Hormone-related changes in older men

Answer 123

• Relationship between the physical effects of aging and sexual impairment appears to be more linear than in women
• Erection takes longer because its less sensitive and requires more stimulation, and sometimes less firm and less reliable
• Testicles decrease in size, ejaculations become less forceful, which can sometimes lead to decrease subjective pleasure with orgasm, and refractory period increases
• increased erectile dysfunction, decreased sexual desire, and difficulty having orgasm –> can also be correlated with decrease in testosterone but also lifestyle factors such as smoking
• Pharmaceutical companies have placed a premium on enhancing erectile functions via medications that relax the penile blood vessels to allow blood flow to the penis thereby facilitating erection

Question 124

Sexual activity in older adults

Answer 124

• Sexual expression has been described as more quality than quantity focusing on kissing, caressing, and sexual touching, and take more time to enjoy each other (foreplay becomes mainplay)
• Being in a nursing home can also create boundaries as there is a lack of privacy and many nurses and care staff see sexuality as problem behaviour

Question 125

Safer sex among sexually active older adults

Answer 125

• Many are less vigilant about safer sex practices as they have sexually matured before the HIV/AIDS epidemic, and are no longer concerned with contraception

Alder adults experience additional vulnerabilities as a result of the physiological changes of aging:

• Vaginal lining becomes thinner making it more vulnerable to small tears that can increase risk of contracting an STI
• Lower immune system function also increases the likelihood of infection
• Ageism on the part of health care professionals and embarrassment may stand in the way of routine STI testing