Science

HUMAN SEXUALITY Diversity in Contemporary America

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HUMAN SEXUALITY Diversity in Contemporary America

NINTH EDITION

William L. Yarber INDIANA UNIVERSITY

Barbara W. Sayad CALIFORNIA STATE UNIVERSITY, MONTEREY BAY

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HUMAN SEXUALITY: DIVERSITY IN CONTEMPORARY AMERICA, NINTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2016 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2013, 2010, and 2008. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

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Student Edition Instructor Review Edition ISBN 978-0-07-786194-0 978-1-259-68062-5 MHID 0-07-786194-9 1-259-68062-2

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Library of Congress Cataloging-in-Publication Data Yarber, William L. (William Lee), 1943- Human sexuality: diversity in contemporary America / William L. Yarber, Indiana University, Barbara W. Sayad, California State University, Monterey Bay.—Ninth edition. p. cm. Includes bibliographical references and index. ISBN 978-0-07-786194-0 (alk. paper) 1. Sex. 2. Sex customs. 3. Sexual health. I. Sayad, Barbara Werner. II. Title.

HQ21.S8126 2016 306.7—dc23

2015015172

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered

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v

This book is dedicated to Ryan White, an Indiana native-son who died from AIDS on April 8, 1990.

During his illness Ryan experienced public scorn, harassment, and rejection, yet faced these difficulties with courage, dignity, and grace. He became the poster boy for the AIDS crisis, speaking out against the misconceptions about the disease and calling for persons with AIDS to be treated with compassion.

Ryan died at age 18, the spring before he planned to attend Indiana University (IU), Bloomington. To honor the legacy of Ryan, the Rural Center for AIDS/STD Prevention at IU established the Ryan White Distinguished Leadership Award for recognition of significant national/international leadership in HIV/AIDS prevention and the Ryan White Legacy Scholarship for IU Masters of Public Health students.

Sir Elton John said, “I have met a lot of people who were brave and courageous. . . . Ryan White gave a new meaning to these words. . . . He was a miracle of humanity.”

—W. L. Y.

Dedication

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vi Dedication

This book is dedicated to the students of human sexuality who quest for knowledge and understanding, to the instructors who diligently and compassionately support and inspire them, and to a system of governing that advocates for the sexual rights of all people.

I want my family to know that I cannot do this work without their love and support.

—B. W. S.

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1 Perspectives on Human Sexuality 1

2 Studying Human Sexuality 27

3 Female Sexual Anatomy, Physiology, and Response 65

4 Male Sexual Anatomy, Physiology, and Response 102

5 Gender and Gender Roles 122

6 Sexuality in Childhood and Adolescence 155

7 Sexuality in Adulthood 184

8 Love and Communication in Intimate Relationships 214

9 Sexual Expression 253

10 Variations in Sexual Behavior 296

11 Contraception and Abortion 322

12 Conception, Pregnancy, and Childbirth 359

13 The Sexual Body in Health and Illness 393

14 Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy 429

15 Sexually Transmitted Infections 479

16 HIV and AIDS 516

17 Sexual Coercion 557

18 Sexually Explicit Materials, Prostitution, and Sex Laws 601 ® McGraw-Hill Education Psychology’s APA Documentation Style Guide

Brief Contents

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PREFACE xxii | LETTER FROM THE AUTHORS xxxiii | ABOUT THE AUTHORS xxxv

1 Perspectives on Human Sexuality 1 STUDYING HUMAN SEXUALITY 2

SEXUALITY, POPULAR CULTURE, AND THE MEDIA 4 Media Portrayals of Sexuality 4 Television and Digital Media 7 Feature-Length Films 9 Gay Men, Lesbian Women, and Bisexual and Transgender People in Film

and Television 9 Online Social Networks 10

■ Think About It BEFORE PRESSING “SEND”: TRENDS AND CONCERNS ABOUT TEXTING, SEXTING, AND DATING 12

SEXUALITY ACROSS CULTURES AND TIMES 14 Sexual Interests 14 Sexual Orientation 16 Gender 18

SOCIETAL NORMS AND SEXUALITY 19 Natural Sexual Behavior 19

■ Think About It AM I NORMAL? 20 Normal Sexual Behavior 21 Sexuality Behavior and Variations 22

■ Think About It DECLARATION OF SEXUAL RIGHTS 23

FINAL THOUGHTS 24 | SUMMARY 25 | QUESTIONS FOR DISCUSSION 26 | SEX AND THE INTERNET 26 | SUGGESTED WEBSITES 26 | SUGGESTED READING 26

Contents

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Contents ix

2 Studying Human Sexuality 27 SEX, ADVICE COLUMNISTS, AND POP PSYCHOLOGY 29 Information and Advice as Entertainment 29

■ Think About It DOES SEX HAVE AN INHERENT MEANING? 30 The Use and Abuse of Research Findings 31

THINKING OBJECTIVELY ABOUT SEXUALITY 32 Value Judgments Versus Objectivity 32 Opinions, Biases, and Stereotypes 33 Common Fallacies: Egocentric and Ethnocentric Thinking 34

SEX RESEARCH METHODS 35 Research Concerns 35 Clinical Research 37 Survey Research 37 Observational Research 39 Experimental Research 39

THE SEX RESEARCHERS 40 Richard von Krafft-Ebing 41 Sigmund Freud 41 Havelock Ellis 42 Alfred Kinsey 43 William Masters and Virginia Johnson 45

CONTEMPORARY RESEARCH STUDIES 46 The National Health and Social Life Survey 46 The National Survey of Family Growth 47

■ Think About It SEX RESEARCH: A BENEFIT TO INDIVIDUALS AND SOCIETY OR A THREAT TO MORALITY? 48

The Youth Risk Behavior Survey 49 The National College Health Assessment 50 The National Survey of Sexual Health and Behavior 51

EMERGING RESEARCH PERSPECTIVES 52 Feminist Scholarship 53 Gay, Lesbian, Bisexual, and Transgender Research 54 Directions for Future Research 56

ETHNICITY AND SEXUALITY 56 African Americans 56 Latinos 58 Asian Americans and Pacific Islanders 59 Middle Eastern Americans 61

FINAL THOUGHTS 61 | SUMMARY 62 | QUESTIONS FOR DISCUSSION 63 | SEX AND THE INTERNET 64 | SUGGESTED WEBSITES 64 | SUGGESTED READING 64

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3 Female Sexual Anatomy, Physiology, and Response 65

FEMALE SEX ORGANS: WHAT ARE THEY FOR? 66 External Structures (the Vulva) 67 Internal Structures 70

■ Practically Speaking PERFORMING A GYNECOLOGICAL SELF-EXAMINATION 74 Other Structures 75 The Breasts 76

FEMALE SEXUAL PHYSIOLOGY 78 Reproductive Hormones 79 The Ovarian Cycle 79 The Menstrual Cycle 81

■ Practically Speaking VAGINAL AND MENSTRUAL HEALTH CARE 86

HUMAN SEXUAL RESPONSE 87 ■ Think About It SEXUAL FLUIDITY: WOMEN’S VARIABLE SEXUAL ATTRACTIONS 88

Sexual Response Models 89 Desire and Arousal: Mind or Matter? 92 Experiencing Sexual Arousal 95

FEMALE SEXUAL RESPONSE 95 Sexual Excitement 95

■ Think About It “DID YOU COME?” WHAT COLLEGE STUDENTS THINK ABOUT WOMEN’S ORGASMS DURING HETEROSEXUAL SEX 96

Orgasm 98

FINAL THOUGHTS 99 | SUMMARY 99 | QUESTIONS FOR DISCUSSION 100 | SEX AND THE INTERNET 101 | SUGGESTED WEBSITES 101 | SUGGESTED READING 101

4 Male Sexual Anatomy, Physiology, and Response 102

MALE SEX ORGANS: WHAT ARE THEY FOR? 103 External Structures 103 Internal Structures 106 Other Structures 108

MALE SEXUAL PHYSIOLOGY 110 Sex Hormones 110

■ Practically Speaking SEXUAL HEALTH CARE: WHAT DO MEN NEED? 111 Spermatogenesis 113

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Semen Production 113 Homologous Organs 115

MALE SEXUAL RESPONSE 115 ■ Think About It “OH, TO BE BIGGER”: BREAST AND PENIS ENHANCEMENT 116

Erection 117 Ejaculation and Orgasm 118

■ Practically Speaking CAN AN ERECTION BE WILLED? 119

FINAL THOUGHTS 120 | SUMMARY 120 | QUESTIONS FOR DISCUSSION 121 | SEX AND THE INTERNET 121 | SUGGESTED WEBSITES 121 | SUGGESTED READING 121

5 Gender and Gender Roles 122 STUDYING GENDER AND GENDER ROLES 124 Sex, Gender, and Gender Roles: What’s the Difference? 124 Sex and Gender Identity 125 Masculinity and Femininity: Opposites, Similar, or Blended? 127 Gender and Sexual Orientation 128

GENDER-ROLE LEARNING 128 Theories of Socialization 128 Gender-Role Learning in Childhood and Adolescence 130 Gender Schemas: Exaggerating Differences 133

CONTEMPORARY GENDER ROLES AND SCRIPTS 133 Traditional Gender Roles and Scripts 134

■ Think About It THE PURITY STANDARD: DEFINING WOMEN BY THEIR SEXUALITY 136

Changing Gender Roles and Scripts 137

GENDER VARIATIONS 138 The Transgender Phenomenon 139

■ Think About It PSYCHOLOGICAL AND MEDICAL TREATMENT OF GENDER DYSPHORIA 141

Gender Dysphoria 142 Transsexuality 143 Disorders of Sex Development (DSD) 144

■ Think About It A CAUTIOUS APPROACH TO ADDRESSING DISORDERS OF SEX DEVELOPMENT (DSD) IN CHILDREN 149

Unclassified Form of Abnormal Sexual Development 150 Coming to Terms With Differences 150

FINAL THOUGHTS 152 | SUMMARY 152 | QUESTIONS FOR DISCUSSION 153 | SEX AND THE INTERNET 153 | SUGGESTED WEBSITES 154 | SUGGESTED READING 154

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6 Sexuality in Childhood and Adolescence 155

SEXUALITY IN INFANCY AND CHILDHOOD (AGES 0 TO 11) 156 Infancy and Sexual Response (Ages 0 to 2) 157 Childhood Sexuality (Ages 3 to 11) 157 The Family Context 160

SEXUALITY IN ADOLESCENCE (AGES 12 TO 19) 161 Psychosexual Development 161

■ Think About It THE “ORIGINS” OF HOMOSEXUALITY 168 Adolescent Sexual Behavior 170 Teenage Pregnancy 174

■ Practically Speaking FIRST SEXUAL INTERCOURSE REACTION SCALE 175 Sexuality Education 178

■ Think About It HEALTHY TEEN SEXUALITY 180

FINAL THOUGHTS 181 | SUMMARY 181 | QUESTIONS FOR DISCUSSION 182 | SEX AND THE INTERNET 182 | SUGGESTED WEBSITES 182 | SUGGESTED READING 183

7 Sexuality in Adulthood 184 SEXUALITY IN EARLY ADULTHOOD 185 Developmental Concerns 186

■ Think About It LIFE BEHAVIORS OF A SEXUALLY HEALTHY ADULT 187 Establishing Sexual Orientation 188

■ Think About It BISEXUALITY: THE NATURE OF DUAL ATTRACTION 191 Being Single 193

■ Think About It WHY COLLEGE STUDENTS HAVE SEX 195 Cohabitation 198

SEXUALITY IN MIDDLE ADULTHOOD 199 Developmental Concerns 199 Sexuality in Marriage and Established Relationships 200 Divorce and After 202

SEXUALITY IN LATE ADULTHOOD 204 Developmental Concerns 204 Stereotypes of Aging 205 Sexuality and Aging 205

FINAL THOUGHTS 211 | SUMMARY 212 | QUESTIONS FOR DISCUSSION 212 | SEX AND THE INTERNET 213 | SUGGESTED WEBSITES 213 | SUGGESTED READING 213

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8 Love and Communication in Intimate Relationships 214

FRIENDSHIP AND LOVE 216

LOVE AND SEXUALITY 217 Men, Women, Sex, and Love 218 Love Without Sex: Celibacy and Asexuality 219

■ Think About It ARE GAY/LESBIAN COUPLES AND FAMILIES ANY DIFFERENT FROM HETEROSEXUAL ONES? 220

HOW DO I LOVE THEE? APPROACHES AND ATTITUDES RELATED TO LOVE 221

Styles of Love 221 The Triangular Theory of Love 222 Love as Attachment 225 Unrequited Love 227

■ Think About It THE SCIENCE OF LOVE 228

JEALOUSY 229 The Psychological Dimension 230 Managing Jealousy 230

■ Think About It THE PASSIONATE LOVE SCALE 231 Extradyadic Involvement 232 Rebound Sex 234

MAKING LOVE LAST: FROM PASSION TO INTIMACY 234

THE NATURE OF COMMUNICATION 235 The Cultural Context 235 The Social Context 236 The Psychological Context 237 Nonverbal Communication 237

SEXUAL COMMUNICATION 239 Sexual Communication in Beginning Relationships 239 Sexual Communication in Established Relationships 241

■ Think About It LET’S (NOT) TALK ABOUT SEX: AVOIDING THE DISCUSSION ABOUT PAST LOVERS 242

Initiating Sexual Activity 243

DEVELOPING COMMUNICATION SKILLS 243 Talking About Sex 244

■ Practically Speaking COMMUNICATION PATTERNS AND PARTNER SATISFACTION 245

CONFLICT AND INTIMACY 247 Sexual Conflicts 247

■ Practically Speaking LESSONS FROM THE LOVE LAB 248 Conflict Resolution 249

FINAL THOUGHTS 249 | SUMMARY 250 | QUESTIONS FOR DISCUSSION 251 | SEX AND THE INTERNET 251 | SUGGESTED WEBSITES 252 | SUGGESTED READING 252

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9 Sexual Expression 253 SEXUAL ATTRACTIVENESS 255 A Cross-Cultural Analysis 255 Evolutionary Mating Perspectives 258 Hooking Up and College Students 262 Sexual Desire 263

■ Think About It “HOOKING UP” AMONG COLLEGE STUDENTS: AS SIMPLE AS ONE MIGHT THINK? 264

SEXUAL SCRIPTS 266 Cultural Scripting 266 Intrapersonal Scripting 267 Interpersonal Scripting 267

AUTOEROTICISM 268 Sexual Fantasies and Dreams 269 Masturbation 271

■ Practically Speaking ASSESSING YOUR ATTITUDE TOWARD MASTURBATION 274

SEXUAL BEHAVIOR WITH OTHERS 277 Most Recent Partnered Sex 277

■ Think About It YOU WOULD SAY YOU “HAD SEX” IF YOU . . . 278 Couple Sexual Styles 279 Touching 281 Kissing 282

■ Think About It GIVING AND RECEIVING PLEASURABLE TOUCH: “GEARS OF CONNECTION” 283

Oral-Genital Sex 284 ■ Think About It THE FIRST KISS: A DEAL-BREAKER? 285

Sexual Intercourse 288 Anal Eroticism 291 Health Benefits of Sexual Activity 293

FINAL THOUGHTS 293 | SUMMARY 293 | QUESTIONS FOR DISCUSSION 294 | SEX AND THE INTERNET 295 | SUGGESTED WEBSITES 295 | SUGGESTED READING 295

10 Variations in Sexual Behavior 296 SEXUAL VARIATIONS AND PARAPHILIC BEHAVIOR 297 What Are Sexual Variations? 297 What Is Paraphilia? 298

■ Think About It CLASSIFYING VARIANT SEXUAL BEHAVIORS AS PARAPHILIA: THE CHANGING VIEWS OF PSYCHOLOGY 300

TYPES OF PARAPHILIAS 301 Fetishism 301

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■ Think About It “SEXUAL ADDICTION”: REPRESSIVE MORALITY IN A NEW GUISE? 302 Transvestism 304 Zoophilia 306 Voyeurism 307

■ Think About It WOULD YOU WATCH? COLLEGE STUDENTS AND VOYEURISM 308 Exhibitionism 309 Telephone Scatologia 311 Frotteurism 311 Necrophilia 312 Pedophilia 313 BDSM, Sexual Masochism, and Sexual Sadism 314

ORIGINS AND TREATMENT OF PARAPHILIAS 318

FINAL THOUGHTS 319 | SUMMARY 319 | QUESTIONS FOR DISCUSSION 320 | SEX AND THE INTERNET 321 | SUGGESTED WEBSITES 321 | SUGGESTED READING 321

11 Contraception and Abortion 322 RISK AND RESPONSIBILITY 323 Women, Men, and Birth Control: Who Is Responsible? 324 Navigating Reproductive Health 325

■ Think About It RISKY BUSINESS: WHY COUPLES FAIL TO USE CONTRACEPTION 326

METHODS OF CONTRACEPTION 328 Choosing a Method 328 Sexual Abstinence 330 Hormonal Methods 331 Barrier Methods 336

■ Practically Speaking TIPS FOR EFFECTIVE CONDOM USE 338 ■ Practically Speaking CORRECT CONDOM USE SELF-EFFICACY SCALE 339

Spermicides 342 Intrauterine Devices (IUDs) 343 Fertility Awareness–Based Methods 344 Lactational Amenorrhea Method (LAM) 346 Sterilization 346 Emergency Contraception (EC) 349

ABORTION 349 Methods of Abortion 350 Safety of Abortion 351 Women and Abortion 351 Men and Abortion 352 The Abortion Debate 353

RESEARCH ISSUES 355

FINAL THOUGHTS 356 | SUMMARY 356 | QUESTIONS FOR DISCUSSION 357 | SEX AND THE INTERNET 357 | SUGGESTED WEBSITES 358 | SUGGESTED READING 358

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xvi Contents

12 Conception, Pregnancy, and Childbirth 359

FERTILIZATION AND FETAL DEVELOPMENT 360 The Fertilization Process 360 Development of the Conceptus 362

■ Think About It CHILD-FREE: A MATTER OF CHOICE 365

PREGNANCY 365 Preconception Care 366 Pregnancy Detection 366 Changes in Women During Pregnancy 367

■ Think About It SEXUAL BEHAVIOR DURING PREGNANCY 369 Complications of Pregnancy and Dangers to the Fetus 369 Diagnosing Fetal Abnormalities 374 Pregnancy Loss 375

INFERTILITY 376 Female Infertility 376 Male Infertility 377 Emotional Responses to Infertility 377 Infertility Treatment 377

GIVING BIRTH 380 Labor and Delivery 380 Choices in Childbirth 382

■ Think About It THE QUESTION OF MALE CIRCUMCISION 383 ■ Practically Speaking MAKING A BIRTH PLAN 385

Breastfeeding 387

BECOMING A PARENT 387 ■ Practically Speaking BREAST VERSUS BOTTLE: WHICH IS BETTER FOR

YOU AND YOUR CHILD? 388

FINAL THOUGHTS 390 | SUMMARY 390 | QUESTIONS FOR DISCUSSION 391 | SEX AND THE INTERNET 391 | SUGGESTED WEBSITES 392 | SUGGESTED READING 392

13 The Sexual Body in Health and Illness 393

LIVING IN OUR BODIES: THE QUEST FOR PHYSICAL PERFECTION 395 Eating Disorders 395

■ Think About It BODY IMAGE AND SEXUALITY: ARE THEY ONE AND THE SAME? 396

ALCOHOL, DRUGS, AND SEXUALITY 398 Alcohol Use and Sexuality 398 Other Drug Use and Sexuality 399

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SEXUALITY AND DISABILITY 402 Physical Limitations and Changing Expectations 402 Vision and Hearing Impairment 404 Chronic Illness 404 Developmental Disabilities 405 The Sexual Rights of People With Disabilities 406

SEXUALITY AND CANCER 407 Women and Cancer 407

■ Think About It FEMALE GENITAL CUTTING: MUTILATION OR IMPORTANT CUSTOM? 414

Men and Cancer 416 ■ Practically Speaking TESTICULAR SELF-EXAMINATION 419

Anal Cancer in Men and Women 422

ADDITIONAL SEXUAL HEALTH ISSUES 422 Toxic Shock Syndrome 422 Vulvodynia 423 Endometriosis 423 Prostatitis 424

SEXUAL ORIENTATION AND HEALTH 424

FINAL THOUGHTS 425 | SUMMARY 426 | QUESTIONS FOR DISCUSSION 427 | SEX AND THE INTERNET 427 | SUGGESTED WEBSITES 428 | SUGGESTED READING 428

14 Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy 429

SEXUAL FUNCTION DIFFICULTIES: DEFINITIONS, TYPES, AND PREVALENCE 431

Defining Sexual Function Difficulties: Different Perspectives 431 Prevalence and Cofactors 434 Disorders of Sexual Desire 439

■ Practically Speaking SEXUAL DESIRE: WHEN APPETITES DIFFER 444 ■ Think About It IS INTERCOURSE ENOUGH? THE BIG “O”

AND SEXUAL BEHAVIORS 446

Orgasmic Disorders 447 Sexual Pain Disorders 450 Substance/Medication-Induced Sexual Dysfunction 452 Other Disorders 452

PHYSICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 452

Physical Causes in Men 453 Physical Causes in Women 453

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PSYCHOLOGICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 453

Immediate Causes 454 Conflict Within the Self 455 Relationship Causes 456

SEXUAL FUNCTION ENHANCEMENT 456 Developing Self-Awareness 456

■ Think About It “GOOD ENOUGH SEX”: THE WAY TO LIFETIME COUPLE SATISFACTION 458

Intensifying Erotic Pleasure 459 ■ Practically Speaking KEGEL EXERCISES FOR WOMEN AND MEN 460 ■ Think About It MY PARTNER COULD BE A BETTER LOVER IF . . . : WHAT MEN AND

WOMEN WANT FROM THEIR SEXUAL PARTNERS 462

Changing a Sexual Relationship and Managing Sexual Difficulties 463 ■ Think About It SEXUAL TURN-ONS AND TURN-OFFS: WHAT COLLEGE

STUDENTS REPORT 464

TREATING SEXUAL FUNCTION DIFFICULTIES 466 Masters and Johnson: A Cognitive-Behavioral Approach 466 Kaplan: Psychosexual Therapy 469 Other Nonmedical Approaches 469 Medical Approaches 470 Gay, Lesbian, and Bisexual Sex Therapy 472

■ Think About It THE MEDICALIZATION OF SEXUAL FUNCTION PROBLEMS 473 ■ Practically Speaking SEEKING PROFESSIONAL ASSISTANCE 474

FINAL THOUGHTS 475 | SUMMARY 476 | QUESTIONS FOR DISCUSSION 477 | SEX AND THE INTERNET 478 | SUGGESTED WEBSITES 478 | SUGGESTED READING 478

15 Sexually Transmitted Infections 479

THE STI EPIDEMIC 481 STIs: The Most Common Reportable Infectious Diseases 481 Who Is Affected: Disparities Among Groups 481 Factors Contributing to the Spread of STIs 483

■ Practically Speaking PREVENTING STIs: THE ROLE OF MALE CONDOMS AND FEMALE CONDOMS 487

■ Practically Speaking STI ATTITUDE SCALE 490 Consequences of STIs 491

PRINCIPAL BACTERIAL STIs 491 Chlamydia 491 Gonorrhea 494 Urinary Tract Infections 495 Syphilis 496

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PRINCIPAL VIRAL STIs 497 HIV and AIDS 497

■ Think About It THE TUSKEGEE SYPHILIS STUDY: A TRAGEDY OF RACE AND MEDICINE 498

Genital Herpes 499 Genital Human Papillomavirus Infection 500 Viral Hepatitis 503

VAGINAL INFECTIONS 504 Bacterial Vaginosis 504 Genital Candidiasis 505 Trichomoniasis 505

OTHER STIs 506

ECTOPARASITIC INFESTATIONS 506 Scabies 506 Pubic Lice 507

STIs AND WOMEN 507 Pelvic Inflammatory Disease (PID) 508 Cervicitis 508 Cystitis 509

PREVENTING STIs 509 Avoiding STIs 509 Treating STIs 511

■ Practically Speaking SAFER AND UNSAFE SEX PRACTICES 512

FINAL THOUGHTS 513 | SUMMARY 513 | QUESTIONS FOR DISCUSSION 514 | SEX AND THE INTERNET 515 | SUGGESTED WEBSITES 515 | SUGGESTED READING 515

16 HIV and AIDS 516 WHAT IS AIDS? 518 Conditions Associated With AIDS 518

■ Think About It THE STIGMATIZATION OF HIV AND OTHER STIs 519 Symptoms of HIV Infection and AIDS 520 Understanding AIDS: The Immune System and HIV 520 The Virus 521 AIDS Pathogenesis: How the Disease Progresses 522

THE EPIDEMIOLOGY AND TRANSMISSION OF HIV 524 The Epidemiology of HIV/AIDS in the United States 525 Myths and Modes of Transmission 528 Sexual Transmission 529 Injection Drug and Substance Use 530 Mother-to-Child Transmission 531 Factors Contributing to Infection 532

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AIDS DEMOGRAPHICS 532 Minority Races/Ethnicities and HIV 532 The Gay Community 535 Women and HIV/AIDS 537 Transgender People and HIV 538 Children and HIV/AIDS 539 HIV/AIDS Among Youth 539 Older Adults and HIV/AIDS 541 Geographic Region and HIV 541

■ Practically Speaking HEALTH PROTECTIVE SEXUAL COMMUNICATION SCALE 542

PREVENTION AND TREATMENT 543 Protecting Ourselves 543 Saving Lives Through Prevention 545

■ Think About It “DO YOU KNOW WHAT YOU ARE DOING?” COMMON CONDOM- USE MISTAKES AMONG COLLEGE STUDENTS 546

HIV Testing 547 Treatments 550

LIVING WITH HIV OR AIDS 552 If You Are HIV-Positive 552

FINAL THOUGHTS 554 | SUMMARY 554 | QUESTIONS FOR DISCUSSION 555 | SEX AND THE INTERNET 556 | SUGGESTED WEBSITES 556 | SUGGESTED READING 556

17 Sexual Coercion 557 SEXUAL HARASSMENT 558 What Is Sexual Harassment? 559 Flirtation Versus Harassment 561 Harassment in School and College 563 Harassment in the Workplace 565 Harassment in Public Spaces 566

HARASSMENT AND DISCRIMINATION AGAINST GAY, LESBIAN, BISEXUAL, AND TRANSGENDER PEOPLE 568

Heterosexual Bias 568 Prejudice, Discrimination, and Violence 568 Ending Anti-Gay Prejudice and Enactment of Antidiscrimination Laws 570

SEXUAL VIOLENCE 572 Campus Sexual Violence 574 The Nature and Incidence of Rape 575 Myths About Rape 576

■ Practically Speaking PREVENTING SEXUAL ASSAULT 577

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Forms of Rape 579 ■ Think About It DATE/ACQUAINTANCE RAPE DRUGS: AN INCREASING THREAT 581 ■ Think About It CAN MEN AND WOMEN ACCURATELY JUDGE A PARTNER’S

WILLINGNESS TO HAVE CASUAL SEX? 583

■ Think About It HOW COLLEGE STUDENTS INDICATE AND INTERPRET CONSENT TO HAVE SEX 585

Motivations for Rape 589 The Aftermath of Rape 590

■ Practically Speaking SUPPORTING SOMEONE WHO HAS BEEN RAPED 592

CHILD SEXUAL ABUSE 593 Effects of Child Sexual Abuse 595 Treatment Programs 596 Preventing Child Sexual Abuse 596

FINAL THOUGHTS 598 | SUMMARY 598 | QUESTIONS FOR DISCUSSION 599 | SEX AND THE INTERNET 599 | SUGGESTED WEBSITES 600 | SUGGESTED READING 600

18 Sexually Explicit Materials, Prostitution, and Sex Laws 601

SEXUALLY EXPLICIT MATERIAL IN CONTEMPORARY AMERICA 602 Pornography or Erotica: Which Is It? 603 Sexually Explicit Material and Popular Culture 603 The Consumption of Sexually Explicit Materials 604 Themes, Content, and Actors of Sexually Explicit Videos 605

■ Think About It COLLEGE STUDENTS AND THE VIEWING OF SEXUALLY EXPLICIT MATERIALS 606

The Effects of Sexually Explicit Material 609 ■ Think About It SEXUALLY EXPLICIT MATERIAL USE IN ROMANTIC COUPLES:

BENEFICIAL OR HARMFUL? 612

Censorship, Sexually Explicit Material, and the Law 615

PROSTITUTION 618 Females Working in Prostitution 619

■ Think About It SEX TRAFFICKING: A MODERN-DAY SLAVERY 620 Males Working in Prostitution 625 Prostitution and the Law 627 The Impact of HIV/AIDS and Other STIs on Prostitution 628

SEXUALITY AND THE LAW 628 Legalizing Private, Consensual Sexual Behavior 629 Same-Sex Marriage 630 Advocating Sexual Rights 630

FINAL THOUGHTS 631 | SUMMARY 631 | QUESTIONS FOR DISCUSSION 632 | SEX AND THE INTERNET 633 | SUGGESTED WEBSITES 633 | SUGGESTED READING 633

GLOSSARY G-1

REFERENCES R-1

NAME INDEX NI-1

SUBJECT INDEX SI-1

® McGraw-Hill Education Psychology’s APA Documentation Style Guide

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xxii

Since the first edition, Human Sexuality: Diversity in Contemporary America has presented students with a nonjudgmental view of human sexuality while encouraging them to become proactive about their own sexual well-being and identity. This sex-positive approach, combined with an integrated exploration of cultural diversity and contemporary research, continues today and includes an emphasis on the importance of affirming and supporting intimacy, pleasuring, and mutual satisfaction in sexual expression. Yarber and Sayad encourage stu- dents to critically assess their own values and modes of sexual expression while connecting them to research.

The new edition integrates SmartBook, a personalized learning program, offering students the insight they need to study smarter and improve classroom results.

Better Data, Smarter Revision, Improved Results Students helped inform the revision strategy:

STEP 1. Over the course of three years, data points showing concepts that caused students the most difficulty were anonymously collected from McGraw-Hill Education Connect for Human Sexuality’s LearnSmart® adaptive learning system.

STEP 2. The authors were provided with data from LearnSmart that graphically illustrated “hot spots” in the text impacting student learning (see following image).

STEP 3. The authors used the heat map data to refine content and reinforce student comprehension in the new edition. Additional quiz questions and assign- able activities were created for use in Connect for Human Sexuality to further support student success.

RESULT: With empirically based feedback at the paragraph and even sentence level, the authors developed the new edition using precise student data to pinpoint concepts that caused students to struggle.

Preface

Celebrating Sexual Diversity in Contemporary America

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Preface xxiii

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