Sexual Health

10.7 Sexual Health

Learning Objectives

Explain the importance of understanding your sexual values and making wise decisions regarding your sexuality.
Describe guidelines for sexually active college students to protect themselves against sexually transmitted infections and unwanted pregnancy.
List actions some can take to protect against sexual assault.

Sexuality is normal, natural human drive. As an adult, your sexuality is your own business. Like other dimensions of health, however, your sexual health depends on understanding many factors involving sexuality and your own values. Your choices and behavior may have consequences. Learning about sexuality and thinking through your values will help you make responsible decisions. Begin with the Sexual Health Self-Assessment.

Sexual Health Self-Assessment

Check the appropriate boxes.

	Often	Sometimes	Never
1. I think about issues related to sexuality.
2. I have experienced unwanted sexual advances from another.
3. If I am sexually active, I protect myself from the risk of sexually transmitted infections.
4. If I am sexually active, I protect myself from the risk of unwanted pregnancy.
5. I am proud of the choices I have made regarding sexual activity.
6. I am concerned about the possibility of sexual assault including date rape.
7. I have been in situations involving some risk of date rape.

Write your answers.

How comfortable are you with your past and present decisions related to sexual behavior?

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If you are not presently sexually active, do you feel prepared to make responsible decisions about sexual activity if you become active in the near future?

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If you are sexually active, how well protected are you against the risks of sexually transmitted infection? If you are not active now, how well do you understand protections needed if you become active?

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If you are sexually active, how well protected are you against the risk of unwanted pregnancy? If you are not active now, how well do you understand the different types of protection available if you become active?

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If you suddenly found yourself in a situation with a potential for sexual assault, including date rape, would you know what to do?

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Sexual Values and Decisions

It’s often difficult to talk about sexuality and sex. Not only is it a very private matter for most people, but the words themselves are often used loosely, resulting in misunderstandings. Surveys have shown, for example, that about three-fourths of college students say they are “sexually active”—but survey questions rarely specify exactly what that phrase means. To some, sexual activity includes passionate kissing and fondling, while to others the phrase means sexual intercourse. Manual and oral sexual stimulation may or may not be included in an individual’s own definition of being sexually active.

We should therefore begin by defining these terms. First, sexuality is not the same as sex. Human sexualityA general term for how people experience and express themselves as sexual beings, including feelings, thoughts, and actions. is a general term for how people experience and express themselves as sexual beings. Since all people are sexual beings, everyone has a dimension of human sexuality regardless of their behavior. Someone who practices complete abstinence from sexual behavior still has the human dimension of sexuality.

Sexuality involves gender identityA person’s sense of self in terms of being male or female., or how we see ourselves in terms of maleness and femaleness, as well as sexual orientationA sexual preference or choice that determines whether one chooses a member of the same or the opposite sex, or both, for sexual satisfaction., which refers to the gender qualities of those to whom we are attracted. The phrase sexual activityAny behavior involving genital stimulation, including vaginal, oral, and anal intercourse, that carries the risk of acquiring a sexually transmitted disease. is usually used to refer to behaviors between two (or more) people involving the genitals—but the term may also refer to solo practices such as masturbation or to partner activities that are sexually stimulating but may not involve the genitals. For the purposes of this chapter, with its focus on personal health, the term sexual activity refers to any behavior that carries a risk of acquiring a sexually transmitted disease. This includes vaginal, oral, and anal intercourseAn act of physical sexual contact between individuals that involves the genitalia of at least one person, typically with penetration of the vagina, mouth, or anus.. The term sexual intercourseAs used here, referring to heterosexual intercourse in which the penis penetrates the vagina. will be used to refer to vaginal intercourse, which also carries the risk of unwanted pregnancy. We’ll avoid the most confusing term, sex, which in strict biological terms refers to reproduction but is used loosely to refer to many different behaviors.

There is a stereotype that sexual activity is very prominent among college students. One survey found that most college students think that other students have had an average of three sexual partners in the past year, yet 80 percent of those answering said that they themselves had zero or one sexual partner. In other words, college students as a whole are not engaging in sexual activity nearly as much as they think they are. Another study revealed that about 20 percent of eighteen- to twenty-four-year-old college students had never been sexually active and about half had not been during the preceding month.

In sum, some college students are sexually active and some are not. Misperceptions of what others are doing may lead to unrealistic expectations or feelings. What’s important, however, is to be aware of your own values and to make responsible decisions that protect your sexual health.

Information and preparation are the focus of this section of the chapter. People who engage in sexual activity in the heat of the moment—often under the influence of alcohol—without having protection and information for making good decisions are at risk for disease, unwanted pregnancy, or abuse.

Alcohol and Sexual Activity

Figure 10.5

Drinking alcohol increases the likelihood of having unprotected sexual activity.

Almost all college students know the importance of protection against sexually transmitted infections and unwanted pregnancy. So why then do these problems occur so often? Part of the answer is that we don’t always do the right thing even when we know it—especially in the heat of the moment, particularly when drinking or using drugs. Some four hundred thousand eighteen- to twenty-four-year-old college students a year engage in unprotected sexual activity after drinking, and one hundred thousand report having been too intoxicated to know if they had consented to the sexual activity.

What’s “Safe Sex”?

It has been said that no sexual activity is safe because there is always some risk, even if very small, of protections failing. The phrase “safer sexThe use of protective actions or devices during sexual activity to minimize the risk of sexually transmitted infections and unwanted pregnancy.” better describes actions one can take to reduce the risk of sexually transmitted infections and unwanted pregnancy.

Sexually Transmitted Infections (STIs)

About two dozen different diseases can be transmitted through sexual activity. Sexually transmitted infections (STIs)Any infection predominantly transmitted through sexual activity between two individuals, usually through direct contact with the genitals or an exchange of body fluids. range from infections that can be easily treated with medications to diseases that may have permanent health effects to HIV (human immunodeficiency virus)Virus transmitted via body fluids during sexual activity and by other means such as drug needle sharing; the cause of AIDS, a fatal disease., the cause of AIDS, a fatal disease. Despite decades of public education campaigns and easy access to protection, STIs still affect many millions of people every year. Often a person feels no symptoms at first and does not realize he or she has the infection and thus passes it on unknowingly. Or a person may not use protection because of simple denial: “It can’t happen to me.”

Table 10.2 "Common Sexually Transmitted Infections" lists facts about common STIs for which college students are at risk. Although there are some differences, in most cases sexual transmission involves an exchange of body fluidsIn general, any fluid within the body, but more specifically used for those fluids that may carry a sexually transmitted disease: blood, semen, and vaginal secretions. between two people: semen, vaginal fluids, or blood (or other body fluids containing blood). Because of this similarity, the same precautions to prevent the transmission of HIV will prevent the transmission of other STIs as well.

Although many of these diseases may not cause dramatic symptoms, always see a health-care provider if you have the slightest suspicion of having acquired an STI. Not only should you receive treatment as soon as possible to prevent the risk of serious health problems, but you are also obligated to help not pass it on to others.

Table 10.2 Common Sexually Transmitted Infections

Infection	U.S. Incidence	Transmission	Symptoms	Risks
HIV (Human Immunodeficiency Virus) Causing AIDS	About 56,000 new HIV infections per year	Contact with infected person’s blood, semen, or vaginal secretions during any sexual act (and needle sharing)	Usually no symptoms for years or decades. Later symptoms include swollen glands, weight loss, and susceptibility to infections.	Because medical treatment can only slow but not cure AIDS, the disease is currently eventually fatal.
Chlamydia Bacteria	Over 1 million new cases reported annually, with many more not reported	Vaginal, anal, or oral sex with infected person	Often no symptoms. Symptoms may occur 1–3 weeks after exposure, including burning sensation when urinating and abnormal discharge from vagina or penis.	In women, pelvic inflammatory disease may result, with permanent damage to reproductive tissues, possibly sterility. In men, infection may spread and cause pain, fever, and rarely sterility.
Genital HPV (Human Papilloma Virus) Causing Genital Warts	6.2 million new cases a year (before vaccine)	Genital contact, most often during vaginal and anal sex	Most infected people have no symptoms at all and unknowingly pass on the virus. Warts may appear in weeks or months.	Of the 40 types of HPV, many cause no health problems. Some types cause genital warts; others can lead to cancer. Vaccine is now recommended for girls and young women and protects against cancer-causing HPV.
Genital Herpes Virus	An estimated 45 million Americans have had the infection	Genital-genital or oral-genital contact	Often no symptoms. First outbreak within 2 weeks of contact may cause sores and flu-like symptoms. Outbreaks occur less frequently over time.	Many adults experience recurrent painful genital sores and emotional distress. Genital herpes in a pregnant woman puts the infant at risk during childbirth.
Gonorrhea Bacteria	700,000 new cases each year	Direct contact with the penis, vagina, mouth, or anus; ejaculation does not have to occur	Often no recognized symptoms. Burning sensation when urinating. Abnormal discharge from vagina or penis. Rectal infection symptoms include itching, soreness, or bleeding.	If untreated, it may cause serious, permanent health problems, including pelvic inflammatory disease in women with permanent damage to reproductive tissues and possibly sterility in both men and women.
Trichomoniasis Protozoa	7.4 million new cases each year	Genital contact, most often during vaginal sex	Most men have no symptoms or may have slight burning after urination or mild discharge. Some women have vaginal discharge with strong odor and irritation or itching of genital area.	Trichomoniasis makes an infected woman more susceptible to HIV infection if exposed to the virus. Trichomoniasis is easily treated with medication.
Syphilis Bacteria	36,000 cases reported a year	Direct contact with a syphilis sore, which occurs mainly on the external genitals, vagina, anus, or in the rectum but can also occur on the lips and in the mouth; during vaginal, anal, or oral sex	Often no recognized symptoms for years. Primary stage symptom (a small painless sore) appears in 10–90 days but heals without treatment. Secondary stage symptoms (skin rashes, fever, headache, muscle aches) may also resolve without treatment. Late-stage symptoms occur after 10–20 years, including severe internal organ damage and nervous system effects.	Because the infected person may feel no symptoms, the risk of transmission is great. Syphilis is easy to treat in the early stages, but treatment in late stages cannot repair damage that has already occurred. Untreated, syphilis is often fatal.

The following are guidelines to protect yourself against STIs if you are sexually active:

Know that only abstinenceNot engaging in sexual activity. is 100 percent safe. Protective devices can fail even when used correctly, although the risk is small. Understand the risks of not always using protection.
Talk with your partner in advance about your sexual histories and health. Agree that regardless of how sure you both are about not having an STI, you will use protection because you cannot be certain even if you have no symptoms.
Avoid sexual activity with casual acquaintances whose sexual history you do not know and with whom you have not talked about health issues. Sexual activity is safest with a single partner in a long-term relationship.
Use a latex condom for all sexual activity. A male condom is about 98 percent effective when used correctly, and a female condom about 95 percent effective when used correctly. With both, incorrect use increases the risk. If you are unsure how to use a condom correctly and safely, do some private online reading. Good information can be found at http://www.emedicinehealth.com/how_to_use_a_condom/article_em.htm. You can watch a video demonstration of how to use condoms correctly at http://www.plannedparenthood.org/teen-talk/watch/how-use-condom-26797.htm.
If you are sexually active with multiple partners, see your health-care provider twice a year for an STI screening even if you are not experiencing symptoms.

Preventing Unwanted Pregnancy

Heterosexual couples who engage in vaginal intercourse are also at risk for an unwanted pregnancy. There are lots of myths about how a woman can’t get pregnant at a certain time in her menstrual cycle or under other conditions, but in fact, there’s a risk of pregnancy after vaginal intercourse at any time. All couples should talk about protection before reaching the stage of having intercourse and take appropriate steps.

While a male condom is about 98 percent effective, that 2 percent failure rate could lead to tens of thousands of unintended pregnancies among college students. When not used correctly, condoms are only 85 percent effective. In addition, a couple that has been healthy and monogamousA relationship involving a single mate for a significant period of time. in their relationship for a long time may be less faithful in their use of condoms if the threat of STIs seems diminished. Other methods of birth control should also therefore be considered. With the exception of the male vasectomyA surgical procedure that causes a man to be sterile and permanently incapable of reproducing unless the procedure is later reversed., at present most other methods are used by the woman. They include intrauterine devices (IUDs), implants, injected or oral contraceptivesA drug, device, or procedure used for the deliberate prevention of pregnancy. (the “pill”), hormone patches, vaginal rings, diaphragms, cervical caps, and sponges. Each has certain advantages and disadvantages.

Birth control methods vary widely in effectiveness as well as potential side effects. This is therefore a very personal decision. In addition, two methods can be used together, such as a condom along with a diaphragm or spermicide, which increases the effectiveness. (Note that a male and female condom should not be used together, however, because of the risk of either or both tearing because of friction between them.) Because this is such an important issue, you should talk it over with your health-care provider, or a professional at your student health center or an agency such as Planned Parenthood.

In cases of unprotected vaginal intercourse, or if a condom tears, emergency contraceptionContraceptive measures, such as a drug, used to prevent pregnancy after sexual intercourse has already occurred. is an option for up to five days after intercourse. Sometimes called the “morning after pill” or “plan B,” emergency contraception is an oral hormone that prevents pregnancy from occurring. It is not an “abortion pill.” Planned Parenthood offices around the country can provide more information and confidential contraceptive services including emergency contraception.

Sexual Assault and Date Rape

Sexual assault is a serious problem in America generally and among college students in particular:

About a third of all dating relationships involve some physical violence.
One in six women and one in ten men will be sexually assaulted in their lifetimes.
About a fourth of sexual assault victims are in the typical college age range of eighteen to twenty-four years old.
As many as one in four women experience unwanted sexual intercourse while attending college.
In more than three fourths of rape cases, the victim knows the perpetrator.

Sexual assaultAny form of coerced sexual contact or sexual activity without the other person’s voluntary consent. is any form of sexual contact without voluntary consent. RapeUnlawful sexual intercourse with or sexual penetration of another person without that person’s consent, typically with force or threat of force. is usually more narrowly legally defined as forced sexual intercourse, a specific type of sexual assault. Both are significant problems among college students. Although men can also be victims of sexual assault and rape, the problem usually involves women, so this section focuses primarily on the issue for women in college. Men must also understand what is involved in sexual assault and help build greater awareness of the problem and how to prevent it.

Sexual assault is so common in our society in part because many people believe in myths about certain kinds of male-female interaction. Common myths include “It’s not really rape if the woman was flirting first” and “It’s not rape unless the woman is seriously injured.” Both statements are not legally correct. Another myth or source of confusion is the idea that “Saying no is just playing hard to get, not really no.” Men who really believe these myths may not think that they are committing assault, especially if their judgment is impaired by alcohol. Other perpetrators of sexual assault and rape, however, know exactly what they’re doing and in fact may plan to overcome their victim by using alcohol or a date rape drug.

College administrators and educators have worked very hard to promote better awareness of sexual assault and to help students learn how to protect themselves. Yet colleges cannot prevent things that happen at parties and behind closed doors. Students must understand how to protect themselves.

Perpetrators of sexual assault fall into three categories:

Strangers
Acquaintances
Dating partners

Among college students, assault by a stranger is the least common because campus police departments take many measures to help keep students safe on campus. Nonetheless, use common sense to avoid situations where you might be alone in a vulnerable place. Walk with a friend if you must pass through a quiet place after dark. Don’t open your door to a stranger. Don’t take chances. For more information and ways to reduce your risk of sexual assault, see http://www.rainn.org/get-information/sexual-assault-prevention.

Most sexual assaults are perpetrated by acquaintances or date partners. Typically, an acquaintance assault begins at a party. Typically, both the man and the woman are drinking—although assault can happen to sober victims as well. The interaction may begin innocently, perhaps with dancing or flirting. The perpetrator may misinterpret the victim’s behavior as a willingness to share sexual activity, or a perpetrator intent on sexual activity may simply pick out a likely target. Either way, the situation may gradually or suddenly change and lead to sexual assault.

Prevention of acquaintance rape begins with the awareness of its likelihood and then taking deliberate steps to ensure you stay safe at and after the party:

Go with a friend and don’t let someone separate you from your friend. Agree to stick together and help each other if it looks like things are getting out of hand. If your friend has too much to drink, don’t leave her or him alone. Plan to leave together and stick to the plan.
Be especially alert if you become separated from your friend, even if you are only going off alone to look for the bathroom. You may be followed.
Be cautious if someone is pressuring you to drink heavily.
Trust your instincts if someone seems to be coming on too aggressively. Get back to your friends.
Know where you are and have a plan to get home if you have to leave abruptly.

These preventions can work well at a party or in other social situations, but they don’t apply to most dating situations when you are alone with another person. About half of sexual assaults on college students are date rapeThe rape of a person by someone whom the person is dating.. An assault may occur after the first date, when you feel you know the person better and perhaps are not concerned about the risk. This may actually make you more vulnerable, however. Until you really get to know the person well and have a trusting relationship, follow these guidelines to lower the risk of sexual assault:

Make it clear that you have limits on sexual activity. Take care that your body language or appearance does not send a message that you might be “easy.” If there is any question that your date may not understand your limits, talk about your values and limits.
If your date initiates unwanted sexual activity of any sort, do not resist passively. The other may misinterpret passive behavior as consent.
Be careful if your date is drinking heavily or using drugs. Avoid drinking yourself, or drink very moderately.
Stay in public places where there are other people. Do not invite your date to your home before your relationship is well established.
Trust your instincts if your date seems to be coming on too strong. End the date if necessary.
Pay attention for signs of an unhealthy relationship (described in Chapter 10 "Taking Control of Your Health", Section 10.6 "Emotional Health and Happiness").

If you are sexually assaulted, always talk to someone. Call a rape crisis center, your student health center, or the National Sexual Assault Hotline at 1-800-656-HOPE for a confidential conversation. Even if you do not report the assault to law enforcement, it’s important to talk through your feelings and seek help if needed to prevent an emotional crisis.

Date Rape Drugs

In addition to alcohol, sexual predators use certain commonly available drugs to sedate women for sexual assault. They are odorless and tasteless and may be added to a punch bowl or slipped into your drink when you’re not looking. These drugs include the sedatives GHB, sometimes called “liquid ecstasy,” and Rohypnol, also called “roofies.” Both cause sedation in small doses but can have serious medical effects in larger doses. Date rape drugs are typically used at parties. Use the following tips to protect yourself against date rape drugs:

Don’t put your drink down where someone else may get to it. If your drink is out of your sight for even a moment, don’t finish it.
Never accept an open drink. Don’t accept a mixed drink that you did not see mixed from pure ingredients.
Never drink anything from a punch bowl, even if it’s nonalcoholic. You can’t know what may have been added into the punch.
If you experience unexpected physical symptoms that may be the result of something you drank or ate, get to an emergency room and ask to be tested.

Key Takeaways

Sexual health is an important dimension of wellness and something we should all think about to affirm our values and make responsible decisions.
Your time in college and your overall health and well-being would be seriously impacted if you were to acquire a sexually transmitted infection or experience an unwanted pregnancy. You owe it to yourself—and anyone with whom you are in a relationship—to have the facts and know how to protect yourself.
The huge number of sexual assaults that occur every year is one of our society’s “dirty little secrets.” This problem is as rampant on college campuses as in society in general. You need to know what’s involved—and what to do to protect yourself from the pain of becoming a victim.

Checkpoint Exercises

For each of the following statements about sexual health, circle T for true or F for false:

T	F	As long as you always use a condom, you don’t have to worry about an STI from sexual activity.
T	F	You may have a very serious STI without feeling any symptoms at all.
T	F	Abstinence is the only 100 percent effective method of birth control.
T	F	It’s not rape if a man has sexual intercourse with a woman after she says no as long as he does not use force.

List at least three things a woman can do at a party to ensure she does not become a victim of sexual assault.

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Describe a first date scenario in which a woman is well protected from the risk of sexual assault. List at least three things she should make sure of.

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