Professor Marshall

LESSON 5: Sexual Anatomy, Dysfunction, Birth Control and Sexual Regulation

Sexual Anatomy

LESSON HANDOUT

Introduction

Beginning in the 19th century and moving through the early 20th century, sexologists worked to discover and categorize various types of sexual practices and identities. It's important for us to understand that during that timeframe heterosexuality was the sexual standard or the norm for appropriate sexual behavior; further, the early sexologists categorized any practices and identities that did not exemplify the heterosexual norm as pathologically deviant or fetishistic. At that time people who practiced non-heteronormative sex or who identified with nonheterosexual sexual identities were subject to "rehabilitation." Behavioral therapies and pharmaceuticals were often used in an attempt to change what was thought to be sexually deviant or abnormal.

We might not realize it but we probably think of sexual behavior as biological in origin. At the very least we probably think about sexuality in terms of some sort of internal drive or genetic wiring that dictates how we behave and think sexually. Thus you can see how early sexologists may have categorized nonheterosexual sexual behavior as abnormal.

Today, most sexologists agree that sexual practices (and body parts which are labeled in a sexual way) are defined through social context. Who we are, what we believe, our attitudes, and our feelings towards other social phenomena are influenced by the process of socialization and social contexts. We need look no further than the media to see the labeling of sexual body parts in action. Likewise, when the media tells us what parts of our bodies are sexual and then go on to explain to us exactly what those parts should look like, many of us attempt to mold or shape ourselves to meet that normative standard. Unfortunately, those standards are not based in any kind of reality and instead often tend to be airbrushed and Photoshopped representations—ideals that do not exist. As a result of this type of pressure to conform, non-normative bodies (the bodies that all of us who exist in reality actually have) can often be perceived by us as unattractive or flawed.

Rather than viewing men who are not "masculine and strong" as somehow failing and rather than viewing women who are not "curvy and smooth" as somehow failing, perhaps a more realistic way to see our physical, sexual selves is on a spectrum. Likewise, rather than giving people with normative embodiments power and legitimacy (which allows them to invalidate those of us who cannot live up to this unrealistic ideal), perhaps we should challenge these unrealistic standards. Challenging and redefining meanings of sexuality and our sexual selves allows us to begin to see each person as an individual who doesn't have any obligation to fall in line with the heterosexual norm.

It is important for us to have a general idea of female and male sexual anatomy for this course. Note that this course is not an anatomy and physiology course; nor is it a health sciences course. This is a social sciences course and thus, we won't be spending a lot of time on anatomy but a basic understanding of our basic sexual physical selves is important.

Historically, sexual anatomy has been limited to those parts of our bodies which are directly related to reproduction. Today, not only do we include reproductive organs and components of our bodies, we also include other erogenous zones. This speaks again to how we have socially constructed meanings of sexuality over time.

Sexual Differentiation

Sexual differentiation occurs prenatally when a developing embryo receives either two X sex chromosomes or an X sex chromosome with a Y sex chromosome. These two chromosomes determine a fetus' internal and external sex characteristics. Intersex conditions occur when a person is neither anatomically fully male nor fully female, but instead somewhere along a continuum of sexual development. Sexual differentiation (physcial markers of sex characteristics, or those X and Y chromosomes) also influence our gender identities. Gender identity refers to how a person experiences his or her gender within a particular culture. Of course we know that nature alone does not determine a person's gender, but it does play a role in developing it. The type of sexual anatomy a person is born with will have a great impact on how society relates to him or her.

Female Sexual Anatomy

Mostly, when people use the word "vagina" they are actually talking about the vulva. The vulva is the term for all of the visible part of the external female genital region. It includes outer and inner labia, the mons pubis, urethral opening, the clitoral hood, and the vaginal opening. There are tremendous variations in overall appearance of women's vulvas, including size, shape, and color. The mons pubis is also known as the pubic mound and this is the area of skin alive just above the pubic bone. Usually, there's a fatty pad of tissue under the skin and generally speaking, this is likely the least sensitive part of the vulva. Labia is the Latin word for lips and most women have two sets: the outer labia called the labia majora are clearly visible while the labia minora rest inside the labia majora. Again, taking into account variations, the inner labia sometimes stick out of the outer labia. Both sets of labia have nerve endings however the inner labia are more sensitive. The labia come together at the top and form a small hood which covers the clitoris, which is made up of erectile tissue (erectile tissue is a spongy body that can fill up with blood the causing it to become firmer and larger). The clitoris extends into the body, into two areas that go on either side of the vagina; these areas will swell when sexually stimulated.

The urethral opening is also part of a woman's sexual anatomy and can be seen if you pull back the folds of the labia. The urethral sponge area, which is commonly referred to as the G spot, is a series of glands which surround the urethra.

The vagina itself is a tube shaped organ and contrary to what the media would have you believe, there is no ideal size or shape to the vagina – realistically, the size of the vagina changes dramatically when a woman becomes aroused. Contemporarily, the anus is also considered a sexual organ. It's a potential site for sexual pleasure and so could be thought of as part of our sexual anatomy.

The fallopian tubes and ovaries are also part of the female sexual anatomy, along with the uterus. The fallopian tubes are a few inches long and they extend to the ovary on each side of the pelvis. When an egg is released from an ovary, it is swept into the fallopian tubes to travel to the uterus and the endometrium. If the egg is fertilized, it will embed in the endometrium. Unfertilized eggs will disintegrate and eventually be swept away during menstruation. About 400 eggs will be released during the course of a woman's menstrual cycle.

Female Anatomy

Male Sexual Anatomy

Just as for women, the diversity in male genitalia is profound. Male genitals can look and function vastly differently from one man to the next and also in the same man over the course of his lifetime. The penis, which is composed of spongy erectile tissue will fill with blood when a man is aroused. Pieces come in all sizes most often the size of the penis has nothing to do with how it works or how well it works. The scrotum is a pouch of skin which loosely falls beneath the penis and contains the testicles. Testicles must be And even body temperature in order to function properly, and the scrotum is a very important protector of the testicles. Testicles serve two main functions: producing sperm and producing testosterone. The prostate gland is also a part of the male sexual anatomy, and is responsible for producing some male ejaculate. The perineum is the area between the scrotum in the anus and during sexual arousal this area can become quite sensitive. Along with these areas, and as with our understandings of female sexual anatomy, the anus is now sometimes thought of as part of the male sexual anatomy — while it has no direct role in reproduction, it does play a part in the sexual lives of many.

Male Anatomy

Having a basic understanding of the male and female sexual anatomy will help us to understand not only ourselves but also our partners.

Male and Female Circumcision, MGM and FGM

Male Circumcision

The word circumcision means "cutting around" and it is a surgical procedure in which some or all of the foreskin is removed from the penis glans. This exposes the end of the penis. Rates of neonatal circumcision rise and fall however in the United States since the 1980s they have steadily declined. Just about 60% of all newborn males in the United States are routinely circumcised. Reasons for circumcision generally include a decreased risk of infections, cancer, STI, as well as reasons related to increasing hygiene. Some circumcisions are also performed for religious reasons. Circumcision is a practice which is greatly dependent upon religious, cultural, and social context. There are however risks to circumcision. About one in 1 million circumcision results in the penis being destroyed, and there is some research to support that neonatal male circumcision is linked to a wide range of negative emotions later in life.

With regard to sexual satisfaction and circumcision, there is conflicting evidence. Some women report a strong preference for circumcised men, however women also report feelings of increased vaginal discomfort with circumcised partners. Conflicting research on the sexual performance of circumcised and uncircumcised men shows that circumcised men tend to use less force in penetration and this may increase the comfort of their partners.

MGM

In recent years male circumcision has been called into question as to whether or not it truly is a health issue. There is far less research and understanding of male circumcision as problematic than there is regarding female circumcision (FGM, which follows below). However some people now view male circumcision as a human rights violation. Decisions to circumcise male infants can be very difficult on parents. Beginning in 2007 the Genital Mutilation Prohibition Act was proposed to the U.S. Congress. This act would protect boys from circumcision as well as protect intersex children who may be born with ambiguous or hermaphroditic genitalia from undergoing procedures at birth. The bill has been submitted to Congress 11 times but has not passed. At question with the bill is whether or not infant male circumcision is abusive. The bill would make circumcision a crime.

Female Circumcision (FGM)

There is no approved procedure for female circumcison (FGM). While many of the same reasons and rationalizations are cited for both male circumcision and FGM, essentially, FGM is viewed (and socially constructed) in a very different light.

FGM is an extremely controversial practice, and is considered to be by most a human rights violation. In those cultures where FGM has been commonly accepted, it remains somewhat unchallenged as an integral practice of cultural value and tradition. Physicians in core nations such as the United States (and other Western industrialized countries) consider this to be a practice that should be abolished.

FGM is primarily practiced in some African communities such as Ethiopia, Somalia, and Eritrea, where rates of FGM can reach 80% of the female population. Rural women in these populations are more prone to having the procedure; urban, more highly educated women tend to view it as less acceptable. It is also important to note that while we in the West consider this to be "mutilation," for some of those who live in cultures where FGM is a traditional cultural practice, the procedure is not considered to be mutilation; rather, it is viewed as an important female rite of passage. Use of the term "circumcision" is viewed as less inflammatory and judgmental, and some women who have undergone the procedure view it as a more accurate descriptor. Others use "ritual female genital surgery" as a descriptor. Use of the term "FGM" is also used by some women who have undergone the procedure and who view it as a practice which should be abolished. In some cases, women who have undergone the procedure do not view themselves as "mutilated," and thus struggle to label it as FGM.

While the reasons for this practice are as varied as the cultures and traditions in which we find it, one of the main reasons women undergo this procedure is to "prove" their fitness for marriage. Thus, many women want to have the procedure and often women are integral in arranging and assisting in the procedure for young females. The process ensures that the young girl is "chaste" (virginal) for marriage. In some cultures, the process also ensures that the young girl cannot be raped. Thus, two of the primary reasons for this procedure relate to a woman's status in relationship to the men in her society. In the West, this type of unequal gendered relationship is certainly problematic. For those who live in these cultures however this type of unequal gender relationship can be the norm. That is to say, these societies are often strictly patriarchal where men maintain the social and cultural power and control. Women have little power and control in these societies and thus must rely on their fitness for marriage as the main source of power and status that they will have in their lives.

Women who undergo circumcision processes experience a high rate of medical complications. Because many of these procedures are done in unsanitary environments by non-medically trained personnel, high rates of infection occur. Infibulation has the highest rate of medical complications, and once a woman becomes sexually active even more problems can occur. Paradoxically, there is increased risk of infertility that accompanies this procedure as well as an increased risk of complications during labor and birth.

While today in the West we consider this type of practice to be problematic, there is a history of female circumcision in the West to treat all kinds of "problematic" behaviors of women such as masturbation, hysteria, frigidity, and so forth. Well into the mid-20th century, physicians practiced clitoral excision, and even today there are some unconfirmed reports of these surgeries continuing in the United States, especially with young girls and women who come from countries where the practice is still somewhat common.

FGM involves a variety of forms of circumcision. As a group, FGM entails several different procedures. Depending on the cultural practice, age of circumcision can range from birth to eight years of age. Customs dictate these procedures, and they can be broadly grouped into two categories: excision and/or infibulation. Excision occurs when all or part of the clitoris is removed from the body. Infibulation, also called radical circumcision, includes excision of the clitoris along with suturing closed the labia while leaving a small passage for urine and menstrual blood.

International aid organizations and health care workers who work with these populations must set aside their own personal beliefs about the practice and instead strive to understand it in the context of the culture and tradition of the societies in which it is practiced. While it is surely obvious to those who grow up in cultures that don't practice female circumcision to see it as a form of female subjugation, this subjective point of view does not lend itself to helping those who live in practicing societies. Instead, workers use the sociological imagination and place themselves into the mindset of the societies in which they work. This allows them to see the process as those who undergo it see it: often times, a normal process in which the woman conforms to cultural tradition. While those of us on the outside likely see this process as barbaric and one which serves the patriarchal structure of many of these societies, both the women and men who live in these societies often view the practice as important and valuable. Cross-cultural communication is an important component for workers who come in contact with populations where this practice is common. Establishing a dialogue which allows for trust among healthcare workers and the communities that they serve may eventually help to eradicate this practice.

One controversial way that healthcare workers have chosen to face the issue is in assisting in the process of female circumcision. When healthcare workers can gain the trust of the community, they often can also assist non-medically trained community members. This increases sanitary conditions, and also increases the chances that the procedure is done in the least physically damaging way.

Commentary

While much more research has been done on female circumcision practices than male circumcision practices, what is apparent in our understanding of these phenomena is that there is benefit in our attempts to understand the practices from within the culture rather than outside of it. Sociology allows us to take a nonjudgmental approach to seeing issues which otherwise may be personally offensive to us. Doing sociological research into these types of practices and beliefs not only assists us in understanding the issue on a personal level, but also understanding issues from a cultural perspective. If, as a global community, we find a practice to be unacceptable sociology allows us to find common ground from which to begin the conversation which eventually can change the behavior.

Having a basic understanding of female and male anatomy gives us not only an understanding our sexual selves, but also an understanding of cultural traditions. It also helps us to define the values of others and of ourselves. This gives us a solid platform for understanding why certain practices continue to prevail. In addition, having this kind of understanding of who we are physically also helps us to understand who we are emotionally. 

STDs, Sexual Dysfunction and Birth Control

Introduction to STDs/STIs, Birth Control and Sexual Health

In this section, we discuss some of the physical and emotional factors associated with STDs and STIs (sexually-transmitted diseases; sexually-transmitted infections). We will also be discussing some of the major types of birth control. This lesson is not intended to be a lesson on anatomy; this is a lesson which attempts to focus on sexual health in the context of its impacts to society.

The wish or motivation to engage in sexual activity is known as "sexual desire." Anticipating sexual pleasure is an important part of having sex. It is important however to understand that sexual desire is not the same thing as the physical reactions we have when thinking about sex—sexual desire encompasses these physical feelings and reactions. Physically engaging in sex can often be quite easy for us even if we don't desire to have it. In addition, the absence of sexual activity doesn't necessarily mean we don't desire sex. So we should think of sexual desire as both physical and psychological – a psychosexual experience that encompasses all of our senses including both are cognitive and physical realms.

For men, several studies suggest that their sex drive may be higher than women's. In general, research suggests that this is related to the biology of reproduction of procreation. However it is also true, based on some research, that men think about sex more than women and report having more sexual fantasies than women.

Sexual desires change over time and our sexual responses change with our desires. We may find at times that "life gets in the way," and our sex lives take a hit. Sexual difficulties can have a negative impact on our relationship and they can be very difficult for us to experience. It is important for us to understand how our bodies work and this type of knowledge can help us experience our sexuality to its fullest. Sex is not perfect. Sometimes you'll feel like not having sex – and that's okay.

Issues which make Intercourse Difficult or Impossible

In general, women and men have different types of sexual dysfunction. In broad terms, sexual dysfunction is defined as "an inability to enjoy sex fully. Sexual dysfunction may begin early in a person's life or may gradually develop after a person has had pleasurable and satisfying sex in their life."

For both men and women, sexual dysfunction appears to be somewhat common. Many of us, at some point in our lives, will report having some sort of sexual dysfunction. In general, we can categorize sexual dysfunctions into two categories: arousal disorders and physical disorders.

Arousal Disorders

Arousal disorders include disorders which are characterized by reduced feelings of sexual enjoyment or sexual excitement. Problems with orgasm are also included in this category. Having too little sexual desire is the most common sexual issue that women face in this category, however at an extreme, sexual aversion disorders may be clinically diagnosed. Sexual aversion disorders are characterized not just by a lack of sexual desire but by revulsion at the thought of genital contact with another. These types of disorders may often be due to interpersonal conflicts, relationship dysfunctions, or posttraumatic stress due to past traumatic experiences.

Low sexual desire is one of the least researched sexual dysfunctions for men. This is perhaps because of our cultural beliefs that men are always supposed to be ready to have sex. Low sexual desire can be caused by a variety of reasons, and these reasons are similar to those that women experience: relationship problems, depression, and stress and anxiety. In addition to these issues, arousal disorders and men are also associated with the use of certain prescription drugs. It is important to note that as men age they naturally experience a decrease in testosterone and this also can contribute to arousal disorders such as erectile dysfunction and rapid ejaculation.

Physical Disorders

Physical disorders for women are those which cause pain during sex, and there are a number of physical causes associated with it. Scoring of the vagina due to infections, injury, surgery, or childbirth may trigger pain during sex for some women. In addition to these physical causes of painful sex for women, fear, anxiety, trauma, and other issues may contribute to painful sex.

Erectile dysfunctions (ED) can occur at any age in men and most men experience erectile dysfunction from time to time. ED does become increasingly prevalent with age, and by age 70 nearly 70% of men experience erectile dysfunction.

Rapid ejaculation is also known as premature ejaculation and is the most common sexual dysfunction among men. Rapid ejaculation occurs more frequently among heterosexual men than it does among gay men; it increases with age and is positively associated with anxiety.

There are ways for men and women to overcome both emotional and physical sexual disorders. The first line of defense is often with a general practitioner or medical doctor. Healthcare providers will outline specific treatment plans which will address the physiological aspects of the issue. Complementary to seeking traditional healthcare, sex therapy has become standard for individuals and couples who have experienced sexual concerns and difficulty. Certified sex therapists are able to provide advice and treatment plans while also assisting individuals and couples with clearly defining the issues that are causing the problems.

Alcohol, Illegal Drugs, and Sexual Function

Drinking, using illegal drugs, and having sex may be a recipe for disaster. Drugs and alcohol are considered to be significant risk factors with regard to unwanted sexual activity. For many people, sexual performance is diminished while drunk or after taking drugs. Alcohol decreases our level of coordination and acts as an anesthetic; this can make it more difficult to reach orgasm or to achieve an erection. Drinking makes you think less clearly. You may forget to practice safe sex and this could lead to unwanted pregnancy.

While some people take drugs because they think it will make them perform better, in most cases illicit drugs such as cocaine, amphetamines, MDMA, or ecstasy can actually cause significant sexual dysfunction. Stories and myths abound in our culture of people who have had sex for hours and hours while taking illegal drugs – this is likely because they can't reach orgasm and is not necessarily an indicator that they're having better sex.

Many people are sexually assaulted when they are drinking or on drugs. Likewise many perpetrators of sexual assault have been drinking or taking illegal drugs. Thus, alcohol and certain drugs are considered to be factors in sexual assault. We will be learning more later about sexual violence and sexual assault.

STDs and STIs

Sexually transmitted diseases (STD) and infections (STI) are diseases which are transmitted through sexual contact between partners. In the past, these types of infections were referred to only as "sexually transmitted diseases." Today however the term "sexually transmitted infection" is more common and preferred among healthcare providers. Either way, when you hear "STD" or "STI" generally, they are being used to refer to the same conditions. STDs are transmitted through genital or non-genital contact which may or may not include penetration. Two thirds of all STIs are found in young adults under the age of 25. More than 65 million people in the United States currently have some form of sexually transmitted infection, and certain STDs and STIs must be reported to state health departments and the CDC.

Sexually transmitted infections and HIV/AIDS pose major treats to public health, and the female physiology makes women more susceptible to severe consequences if their STIs go untreated. STIs can be transmitted through skin-to-skin contact and via the exchange of bodily fluids. Bacterial infections include gonorrhea, chlamydia, and syphilis, while viral infections include herpes, HPV, and viral hepatitis. There are also parasitic infections like scabies, public lice, and trichomoniasis.

While there are more than two dozen known sexually transmitted diseases we're going to concentrate on just a few of the primary ones in this lesson. Along with learning about the primary STDs from a physical perspective we're also going to attempt to understand this issue from a cultural and social perspective.

Chlamydia and Gonorrhea

Chlamydia and gonorrhea are both bacterial infections that can be cured with antibiotics. Even though 1 million new chlamydia cases and 400,000 new gonorrhea cases are diagnosed every year in the United States, it's likely that many more than that go undiagnosed and unreported. When left untreated, these infections can lead to pelvic inflammatory disease, ectopic pregnancy, infertility and chronic pain for women. If a pregnant woman has untreated gonorrhea or chlamydia, her child may be born with blindness or eye infections or pneumonia. Rates of stillbirth are also higher than normal when gonorrhea or chlamydia are present in the mother.

Men show more symptoms of gonorrhea than women but it can take up to a month for the symptoms to occur.

Rates of gonorrhea and chlamydia are heavily concentrated among young people aged 15 to 24. In addition, African-Americans are most heavily affected by these two infections. While routine screening for chlamydia has been recommended by the CDC and other major medical associations in the United States, many young women do not regularly see healthcare providers in order to be tested. This likely means that gonorrhea and chlamydia are highly concentrated among the young and the poor in our society.

HPV

Human papilloma virus is extremely common in the United States. Most cases of HPV infection resolve on their own without treatment and cause no clinical problems however due to the extraordinary commonness of this infection it is referred to as a virtual marker for having had sex. 20 million people are estimated to be currently infected with HPV according to the CDC and over 6 million Americans become infected every year. 50% of all sexually active people in our society will acquire an HPV infection at some point in their lives. HPV may cause genital warts and while an individual may have the warts burned off by a medical doctor, the virus must be completely cleared by individual's immune system or symptoms may reappear. Some HPV strains can result in chronic and persistent infections over time for some individuals.

There is a vaccine for HPV and it has been recommended by the US FDA for young women in our society since 2006. It may also be administered to young men.

Herpes

Herpes is caused when the herpes simplex virus (HSV) enters the body; it has the capacity to reproduce itself and cannot be destroyed by antibiotics. Once a person becomes infected with HSV he or she will have it for the rest of his or her life. There are two basic strains of herpes:

  • Oral herpes occurs around the mouth and face
  • Genital herpes occurs on or near the genitals

1 million people in our society are infected with genital herpes every year. Nationwide studies indicate that about 45 million people over the age of 12, or about 20% of our adult population, have been infected with genital herpes. Transmission generally occurs when an infected partner is not aware that he or she has the virus. Once infected, the individual will generally develop herpes sores which are blister-like and painful, and eventually will open, "weep," scab over, and heal. This process takes about four weeks. Over time, generally speaking, outbreaks tend to become less prevalent in individuals. For some, the sores will become less frequent and weaker gradually disappearing altogether. There are prescription antiviral medications that can help reduce the frequency and symptoms of the virus; these treatments are referred to as suppressive therapies because they don't cure the disease, they just alleviate symptoms.

HIV

HIV is the virus that causes AIDS, and it may be transmitted through blood, sexual fluid or breast milk. The first case of HIV identified in the United States was in 1981 and over a half a million people today have died of this disease. Approximately 60,000 new HIV infections occur every year in the United States and its estimated that over 1 million individuals today are living with HIV. In recent years about half of the newly diagnosed HIV infections have been among men who have had sex with men, while 31% of new cases have resulted from heterosexual contact. Slightly over 10% of new infections are from injected drugs. 4% of new cases are from a combination of drug use and sexual activity and when looking at just HIV infection the results from heterosexual contact women are a growing majority — 80% of women diagnosed with HIV in recent years have contracted the virus through heterosexual contact.

African-Americans have the highest rate of new infection; while blacks make up 13% of our population they account for almost half of the new diagnoses.

Close to 40% of people who test positive for HIV receive a full-blown AIDS diagnosis within one year. Those tested later in life generally do so because they are are ready ill. Current federal guidelines recommend that HIV testing become a standard part of medical care for every American adult. It is asserted by a AIDS researchers that in the United States up to 20% of those infected with HIV may be unaware of their status.

Race, Ethnicity, and STDs

In the field of sociology, issues related to health and health care outcomes have become increasingly interesting to study. The sociology of health and illness is a new field of study within the discipline of sociology, and many new sociologists decide to specialize in this very emerging academic field. Sociologists assert that there are social determinants of health which are systematically associated with health disparities. Using the social determinants of health theory (SDH) helps us to see that some groups are at greater risk for disease than others. Since this is a new field of study for sociology we don't yet fully understand all of the different social forces that work together to cause this disparity. For some population subgroups, primarily blacks and men who have sex with men, high prevalence of STIs within the community can be a risk factor in itself, since individuals are more likely to encounter an infected partner. High community prevalence of STIs can be a symptom of other problems in the community, such as a lack of access to health care, poverty, unemployment and other persistent social and economic discrimination.

When children are raised in economically disadvantaged homes and neighborhoods they are more likely to be drawn into behaviors which may contribute to putting them at a higher risk for sexually transmitted diseases and infections. In addition, when a child is raised in poverty there is a higher likelihood of dropping out of school. This not only prevents a young adult from gaining access to sex and health education programs in their school, it also exposes them to behaviors of others in their neighborhood, such as illegal drug use, which may also increase their risk for STIs and STDs. Compounding these issues, many poor people simply cannot afford to see a doctor. While the ACA (the Affordable Care Act) may ameliorate this problem over time, for now if you are poor this means you may not have access to sexually transmitted disease testing and treatment.

Sociologists assert that social inequalities are the beginning of health inequality in our society. Thus, sociologists who specialize in the study of health disparities focus on cultural forces which put people at higher risks for acquiring disease. This type of knowledge helps us to combat the disease. It also helps us to see that health is intimately connected to environment and that there are social determinants of health that need to be addressed on multiple structural, cultural, political, and individual levels.

Educating Yourself

Many of you have been exposed to this kind of content before and as a result have probably become complacent about the dangers associated with STDs and STIs in American society today. Being sexually active carries with it a high level of responsibility, and critical thinking skills, not only fpr yourself and your well-being, but also for your partner. It is your responsibility to safeguard your physical and emotional health. Doing so will allow you to have fulfilling and enjoyable sex throughout your whole life. Educating yourself about these issues helps you to be able to set boundaries as well as have honest and open discussions with your partners about your sexual histories and the ways that you can protect your own sexual health. While some STDs and STIs are easily treated, others are yours for life. Abstinence is the only 100% safe way to protect yourself from sexual disease and infection however abstinence is not always a practical or reasonable form of protection when we're considering when and with whom to have sex. If you do decide to be sexually active, frank and open discussion with your partner along with safe sex practices are an absolute necessity.

Although talking about STIs can be uncomfortable and embarrassing, these conversations are essential to protect your own sexual health and the sexual well-being of others. Honesty is the best policy, and preparing yourself for a difficult conversation is the best way to approach it.


Birth Control

When I was in the Army, we had a running joke about the glasses we were issued in basic training. Even if you came in with your own glasses, you were required to wear the glasses that the military issued to you (thank goodness I had contact lenses!). We referred to them as "Birth Control Glasses." Ask anyone who has been in the military and they will tell you, BCGs are very effective:

Birth Control Glasses

The Sexual Revolution

From the 1960s through the early 1980s is a period of time referred to in the US as the "Sexual Revolution. From the gains of the second wave of the feminist movement and from the relaxed sexual attitudes of the Hippie Movement, this was a time in the US which marked a rejection of traditional gender roles and challenged sexual norms. New contraceptives hit the market and gave women control over their own sexuality. Attitudes about sex outside of committed relationships became more common and less deviant.

By the mid-1960s, there was a marked shift in the way we viewed sex. No longer was sex thought of as a method of procreation; from this point forward, sex would be viewed as a pleasurable and natural act. Self-help sex books became all the rage. 1965 was the year that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Abortion was also an issue directly related to the second wave and sexual liberation. Prior to Roe v. Wade, women seeking abortions could be charged with murder, manslaughter, or other felonies.

Contraception

Contraceptive techniques have been known since the time of the Ancient Greeks, Romans and Egyptians. Modern birth control however was not a focus until the shift of rural communities to urban populations which came with the Industrial Revolution in the West. Thomas Malthus, a member of the English clergy and an aspiring demographer, sounded an alarm about the rapid growth of population at at the onset of the Industrial when he questioned whether food supplies could keep up with high growth population demands. Bieng a religious man, Malthus had difficulty in endorsing any forms of birth control as this went against the teachings of the church. But, as a demographer, he also had strong concerns about rapid population growth. So, his solution: abstinence. Since the church would not allow him to espouse the use of any forms of control over reproduction, his only recommendation would be for married couples (never mind non-marrieds!) to curb their sexual desires. Of course, as we all know today, abstinence IS a form of birth control, but not a very good one according to statistics, as most people do not remain abstinent for long.

Nonetheless, by the mid-1800s in Britain and the US, various forms of birth control were readily available in pharmacies. Condoms, diaphragms, sponges, suppositories and medicated tampons were sold and were readily available to the public in the US until the close of the 19th century, when a bill was passed which prohibited certain forms of delivery of birth control (the bill prohibited using the USPS for delivery of birth control and also made it illegal to transport birth control devices across state lines, essentially, shutting off manufacturers, distributors, and customers from one another).

Margaret Sanger organized the National Birth Control League in 1917 in the United States, which would eventually become the Planned Parenthood Association. By the early 1900s some contraceptive devices were being legally recognized as an effective form of sexual disease prevention, and provisions of the bill which prohibited distributing birth control across state lines were modified. By the 1940s and 1950s many legal cases were being brought by birth control advocates and this resulted in the final state law, from Connecticut, being struck down by the US Supreme Court in 1965. This Connecticut law had prohibited the use of contraceptives essentially making it illegal to do so. By the mid-to late 1960s the government began to get involved in issues related to reproductive health and birth control as they recognized the links between reproduction, health and welfare, and society. Some federal funding was set aside for family planning and by 1970 separate funds were being set aside for birth control and sex education in schools.

Sanger opened the first birth control clinic in the US in the early 1900s, and it was subsequently shut down by police. Sanger was arrested and jailed for 30 days, but after her release she tried again and was able to permanently establish a clinic in New York City in 1923.

Birth control methods are often viewed, from a social and cultural perspective, as the domain of women. Often, in heterosexual relationships women are charged with maintaining appropriate birth control. In recent years however male birth control, and in particularly condom use, has become popular again mainly because of its protection against sexually transmitted disease and infection. Still, when it comes to pregnancy, most often women within heterosexual relationships are the ones to take on responsibility.

We also tend not to label methods that men use to control fertility as "birth control." However the use of condoms is likely the oldest birth control technique. Another method of male birth control is withdrawal prior to ejaculation, however this method is not as reliable as others.

Likewise, women can use the "rhythm" method, which requires abstinence around the time of ovulation. This method also has a higher failure rate than others as its reliability depends on a woman's ability to predict when she'll ovulate.

Barrier methods include the use of the diaphragm or cervical caps which are inserted before penetration and work as barriers to the sperm reaching its goal of fertilization. Spermicides (chemicals) are also the type of barrier which prevent the sperm from reaching the cervix. Contraceptive sponges work in tandem with spermicides and also work as barriers. Each of the barrier methods is essentially a single use method which means that each time a person engages in sex the method must be enforced.

IUDs are small devices which are inserted by physicians and which create a hostile environment for impregnation. Essentially, IUDs set up conditions which are not favorable for either the sperm or the egg. Many women choose to use IUDs due to the ease-of-use. IUDs are not single use methods and thus take away the responsibility of having to think about birth control or contraception for each sexual encounter.

Birth control pills, commonly referred to as "the pill," are hormone pills which contain estrogens and/or progestins. They are taken on a cycle and the elevated level of hormones in the blood suppresses the ability of the woman to get pregnant. This is by far the most common form of birth control and has a very high success rate when used over time and to directions. A similar form of birth control is a contraceptive patch or the monthly use of a vaginal ring. Patches and rings are also hormonal forms of birth control which, through slow-release, deliver enough hormones to suppress a woman's ability to get pregnant.

The most "final" form of birth control for women, (and for men, for that matter) is sterilization. Fo women, this involves cutting or tying the Fallopian tubes, which essentially cuts off the egg's ability to get from the ovaries to the uterus. For men, sterilization involves a vasectomy, which cuts the vas deferens, which is the tube that carries the sperm from the testes to the penis. Neither of these methods involves any loss of sensation or capacity for sex. Neither of these methods involves any loss of desire or libido. Both however are usually procedures that are done for life. While they can reverse sterilization for both men and women, reverse sterilization is a difficult surgery and has a high rate of failure. A person should only chooses sterilization if they are fully aware of the consequences.

Every method of birth control has some drawback. Whether it's complicated to use, problematic for long-term health, irreversible, or expensive, all methods require motivation by their users. Using the pill is associated with higher risks of some types of cancer and lower risk of other types of cancer. IUDs can be problematic from a physical standpoint, sometimes causing uterine infections, septic abortions, and other health issues; in a small percentage of women, IUDs cannot be tolerated and they are expelled.

The final version of birth control is the morning-after pill or emergency contraception for when birth control fails or in other situations where pregnancy may be suspected but unwanted. For example, in cases of rape or if a condom breaks or any other form of contraception fails, morning-after pills may be used. Essentially, the morning-after pill is several large doses of oral contraceptives which inhibit the establishment of pregnancy when fertilization may have taken place. Even though these pills are referred to as "morning- after" pills in many cases they may be taken up to three days after intercourse. These pills are now made available over-the-counter in many pharmacies across the United States, however some pharmacists and pharmacies have refused to stock them due to religious or moral objections.


Conclusion

Congratulations! You are probably now much more educated about sexuality than any of your peers. This can only be positive for you as you move through your life. You are encouraged to continue to understand sexuality in an academic and reliable way.