Human Sexuality

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nbennett
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Human Sexuality
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2011-04-29 12:45:57
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  1. Sexually Transmitted Diseases
    • Diseases spread through sexual contract:
    • -Vaginal
    • -Anal
    • -Oral
    • 65 Million in the U.S. have an STD
    • 15 Million new cases per year
  2. Modes of Transmission
    • Direct sexual contact or sexual contact with someone's infected semen, vaginal secretions, blood or body fluids.
    • Maternal transfer
    • Sharing contaminated needles through injectable drug use.
  3. Chalmydia
    • Source
    • -Bacterium
    • Incubation Period
    • -1-30 days
    • Signs and Symptoms
    • -Males: watery (milky, white) discharge, pain upon urination
    • -Females: watery (mikly white) discharge, PID
    • -50% of men and women do not have any symptoms.
    • Diagnosis
    • -Culture discharge
    • Treatment
    • -Antibiotics
    • Epidemiology
    • -Most prevealent sexually transmitted bacterial pathogen in the U.S.
    • -3 million cases annually
  4. Gonorrhea
    • Source
    • -Bacterium
    • Incubation Period
    • -1-30 days
    • Signs and Symptoms
    • -Males: pus discharge, pain upon urination, can lead to sterility
    • -Females: usually asymptomatice, PID, can lead to sterility.
    • Diagnosis
    • -Culture discharge
    • Treatment
    • -Antibiotics
    • -Not curable in late stages
    • Epidemiology
    • -350,000 cases reported annually in U.S.
  5. Genital Herpes
    • Source
    • -Virus
    • Incubation Period
    • -2-12 days
    • -Can be transmitted to newborn during delivery
    • Signs and Symptoms
    • -Vesicles
    • -Vesicles break down, crust over and form painful ulcers.
    • -Entire first episode takes 15-20 days
    • -Flu-like symptoms
    • Recurrence
    • -5 to 8 times per year
    • -10 days per episode
    • -Frequency and severity diminish with time
    • Treatment
    • -No cure
    • -Antiviral therapies
    • Epidemiology
    • -45 million in U.S. infected
  6. Nongonococcal Urethritis (NGU)
    • Source:
    • -Bacterium
    • -infection in urethra of males caused by chlamydia bacteria
    • Signs and Symptoms:
    • -Discharge
    • -Pain upon urination
    • Treatment:
    • -Antibiotics
    • Epidemiology:
    • -3 Million cases annually
  7. Venereal Warts (HPV)
    • Source:
    • -Virus
    • Incubation Period:
    • -3 Months
    • Signs and Symptoms:
    • -Cauliflower-like growths in genital and rectal areas
    • -Some individuals do not have any symptoms
    • Diagnosis:
    • -Presence of lesions
    • Cervical Cancer:
    • -HPV is indicated in 80% of all cervical cancer cases
    • Treatment:
    • -Removal of lesions by laser surgery or chemical
    • -Not curable
    • Epidemiology:
    • -20 million Americans
    • -Routine testing at 4 locations yielded the following results:
    • --9% of women seeking routine Pap smears at OB/GYN offices tested positive.
    • --9-45% of women attending health services in a university health center had positive results
    • --23% of women attending a family planning clinc were positive.
    • --82% of street prostitues in a select study were positive.
  8. Syphilis
    • Source:
    • -Bacterium
    • Incubation Period:
    • -3 to 4 weeks
    • Signs and Symptoms:
    • -Primary
    • --Chancre
    • ---A painless indurated primary lesion of early syphilis
    • ---Internal, vagina or anus
    • ---Disappears within 1-5 weeks
    • -Secondary
    • --Rash, 6 weeks later
    • --Appears on trunk, or mild on hands, or feet
    • --Disappears without treatment 2-6 weeks
    • -Latency
    • --Damage to central nervous system
    • --Can transmit by donating blood
    • --Congenital syphilis
    • Diagnosis:
    • -Blood Test
    • Treatment:
    • -Penicillin or other antibiotic
    • Epidemiology:
    • -Reduced numbers due to penicillin
    • -Mini epidemics in major metropolitan areas
  9. Chancroid
    • Source:
    • -Bacterium
    • Incubation Period:
    • -4-10 days
    • Signs and Symptoms:
    • -Chancre
    • --Granular, painful erosions
    • --Painful, swollen lymph glands in the groin
    • Treatment:
    • -Antibiotics
    • Epidemiology:
    • -Not common in U.S.
    • -Epidemics in developing countries
    • -Predominance in black and Hispanic males; prostitution
  10. HIV/AIDS
    • Source:
    • -Virus
    • --Disease of the immune systems
    • Transmission:
    • -Person-to-person
    • --Sexual contact-anal or vaginal
    • --Sharing contaminated needles-IDU
    • --Maternal-to-fetal transmission
    • Diagnosis:
    • -Incubation period (window period)
    • --8 weeks to 6 months
    • -Blood test- detect HIV antibodies
    • --ELISA
    • --Western Blot- confirmatory test
    • -Oral test-detect HIV antibodies
    • --Saliva
    • Signs and Symptoms:
    • -Asymptomatic at first
    • -Early Symptoms
    • --fatigue, diarrhea, fever, night sweats, skin rashes, sudden weight loss, dry cough, swollen lypmh glands, vaginal or oral yeast infections
    • -Opportunistic Infections:
    • --Infections that individuals get due to a weakened immune system
    • Treatment- No Cure
    • -Some medications available to lesson symptoms and opportunistic infections
    • -AZT, other antiviral medication
    • --Prevents and slow replication of HIV
    • -Protease Inhibitors
    • --Acts as an enzyme to prevent replication of HIV-infected cells
    • -HAART (Highly Active Antiroviral Therapy)
    • -Halts the spread of the virus
    • -Reducing viral loads
    • -HIV infected individuals living longer, better quality of life.
    • Epidemiology:
    • -AIDS is reportable by law in U.S.
    • -Majority of cases among males
    • -57% of AIDS patients have died
    • -Since 1996, there has been dramatic decline in the number of AIDS caese
    • -Slight increase among heterosexual contact from 1998-2001
  11. Hepatitis B Virus (HBV)
    • Source:
    • -Virus
    • -Attacks the liver
    • --Can cause extreme illness and death
    • Diagnosis:
    • -Blood test
    • Signs and Symptoms:
    • -Jaundice
    • -Dark urine
    • -Fever
    • -Malaise
    • -Moderate liver enlargement and tenderness
    • Treatment:
    • -No cure
    • -Boost the immune system
    • -Vaccine available
    • Epidemiology:
    • -5% of U.S. population has HBV
    • --Risks
    • ---Heterosexual males and gay men
    • ---Sexual transmission most common
  12. Pubic Lice
    • Transmission:
    • -Sexually
    • -Clothing, bedding, towels
    • -Nits, eggs, attach to shaft of hair
    • Signs and Symptoms:
    • -Visual confirmation of lice
    • -Intense itching
    • -Skin irritation
    • -Sore from scratching
    • Treatment:
    • -Shampoos to kill nits
    • -Bedding and other clothing must be washed
  13. Scabies
    • Diagnosis:
    • -Infestation with mite
    • -Burrow under skin
    • Treatment
    • -Special lotion that is left on skin 8-24 hours
    • -May need more than one application
  14. STD/HIV Prevention and Risk Reduction Model
    • Sexual Behavior
    • Sexual Relationships
    • Sexual/Medical History
    • Demographic variables
  15. Demographic Variable: Age
    • More cases among 15-25 year olds
    • -earlier onset
    • -mutliple partners
    • -unprotected
    • -cervical tissue more susceptible
  16. Demographic Variable: Gender
    • Women are at a greater risk of acquiring STDs:
    • -Heterosexual women are receptive sexually
    • -Asymptomatic in women
    • -Menstruation facilitates movement of pathogens
    • -Transmission to fetus or newborns
  17. Demographic Variable: Sexual Orientation
    • Heterosexual women
    • Gay and bisexual men
    • Heterosexual men least at risk
    • Lesbians have lowest rates of infection
  18. Demographic Variable: Injectable Druge Use
    • Use of pscyhoactive drugs impair ability to make good decisions
    • --Sex and drug use
    • Sharing needles
    • --Crack cocaine, heroin
    • --Steroid
    • Infections remain in syringe
  19. Demographic Variable: Urban and Rural, Geographic Differences
    STDs and HIV are higher in urban areas
  20. Demographic Variable: Socioeconomic Status (SES)
    • People of lower SES tend to lack enabling factors related to prevention and treatment
    • People of lower SES do not perceive themselves to be at risk for STD/HIV
    • Poverty contributes to higher levels of drug use which is a risk factor for STD/HIV
  21. Demographic Variable: Race/Ethnicity
    • African Americans and Hispanics have highest rates
    • Social class and poverty contribute to risk
  22. Sexual/Medical History
    • Lifetime number of sexual partners
    • Contraceptive use
    • History of injected drug use
    • Prior STD history
  23. Familiarity Risk
    Know the person before you have sex with them
  24. Exclusivity Risk
    Both must agree that the relationship is monogamous
  25. Sexual Behavior: Lowest Risk
    • Noninsertive
    • No exchange of body fluids
  26. Sexual Behavior: Midlevel Risk
    • Insertive and protected sex
    • Insertive and not protected
  27. Sexual Behavior: Highest Risk
    Insertive and not protected including ejaculation
  28. Latex Condoms
    • More effective against: gonorrhea, chlamydia, trich, and HIV
    • Prevents transmission from mucosal surfaces
    • Not reliable for prevention of transmission by skin-to-skin contact
    • -HPV, Herpes, Syphilis
  29. Women-Centered Barriers
    • Sponge, diaphragm, spermicides:
    • -Reduced STD infection rate among barrier users
    • -Lower STD infection rate for women who attend STD clinics and use barrier methods
    • -Up to 70% effective against gonorrhea when using barriers
    • -Up to 40% effective against chlamydia when using barrriers
  30. Fertilization and Conception
    Union of the sperm and ovum
  31. Ovulation
    Release of ovum from on ovary
  32. Predicting Ovulation
    • Cervical mucous
    • Body Temperature
    • Ovulation kits
  33. Ovary
    • Release of ovum
    • Allurin
  34. Fallopian Tubes
    Fertilization occurs
  35. Sperm
    • Ejaculation contains 250-500 million sperm
    • Only a few hundred get close to ovum
    • Fertilin
  36. Uterus
    • Implantation
    • -The attachment of a fertilized egg to lining of uterus
  37. Embryo
    Fertilized egg up to 8 weeks
  38. Fetus
    Fertilized egg from 8 weeks to birth
  39. Pregnancy Confirmation
    • Human Chorionic Gonadotropin (HGC)
    • Home pregnancy tests are 85-95% accurate
    • Medical confirmation necessary
  40. Pregnancy: Gestation
    • Averaging 40 weeks
    • Premature delivery prior to 38 weeks
    • Due Date: First day of last menstrual period, subtract 3 months, then add 7 days
  41. Pregnancy: First Trimester
    • Amniotic Fluid
    • -Transparent liquid contained in the amniotic sac
    • Placenta
    • -An organ that attachs to the uterine wall and serves as a conduit for oxygen and nutrients to pass to the developing fetus
    • At the end of 3 months:
    • -Fetus has arms, legs, feet, toes, fingers, and vital organs for body systems.
    • -Most vulnerable time for fetal development
    • --teratogenic effects
  42. Pregnancy: Second Trimester
    • By the end of 5 months:
    • -Fetal movement is active enough for mother to feel
    • -Sex organs have developed
    • -Eyebrows and eyelashes have developed
    • Some babies can survive if delivered at the end of 6 months
    • -NICUs
  43. Pregnancy: Third Trimester
    • Respiratory system is last to develop
    • -Could cause damage to fetus if delivered early
    • --Medication available to help mature the lungs and also prevent bronchiospasms in preemies
  44. Effects of Pregnancy
    • Physical: Prenatal Care
    • Psychological: Mothers and Fathers
    • Social: Families
  45. Lovemaking During Pregnancy
    • May experience a progressive decline in sexual desire
    • Personal reactions vary
    • Sexual activities
  46. Prenatal Care: Nutrition
    • Balanced Diet
    • Prenatal Vitamins
    • More folic acid
    • Appropriate weight gain
  47. Prenatal Care: Exercise
    • Association with fewer c-sections
    • Do not begin a new, strenuous, exercise program
    • 15 minute rule
    • Body temperature at 100F or lower
    • Heart rate at 140 or lower
    • Myth: If you exercise too much, you can have a miscarriage
    • Benefits
  48. Drug Use During Pregnancy
    • Do not take any medication without consulting a physician
    • NO cigarrette use
  49. Fetal Alcohol Syndrome
    • Effects:
    • -Facial abnormalities
    • -Mental retardation
    • -Nervous system damage
    • Some states can terminate parental rights
  50. Prenatal Screenings
    • Uterine measurement
    • Blood pressure
    • Weight check
    • Chorionic villus sampling
    • -screening for genetic abnormalities
    • Ultrasound
  51. Alpha-fetoprotein
    • Blood sample
    • High level indicates neural tube defects
    • -Anencephaly: brain is underdeveloped
    • -Spina Bifida: spinal cord is exposed
  52. Blood Screenings
    • HIV
    • CBC
  53. Urine Tests
    Gestational diabetes
  54. Labor and Delivery
    • Hospital Births (traditional delivery)
    • Home births
  55. The Childbirth Process
    • 12-14 hour process
    • Beginning of Labor Signs
    • -uterus begins to contract
    • -mucous plug covering cervix is dislodged
    • -rupture of amniotic membrane
  56. Childbirth: First Stage
    • Longest Stage
    • Dilation of cervix to 10 cm
    • Effacement
    • Pain management- epidural
  57. Childbirth: Second Stage
    • Birth of baby
    • -pushing stage
    • Episiotomy
    • -surgical cutting of the perineum to facilitate childbirth
  58. Childbirth: Third Stage
    • Delivery of the Afterbirth
    • -The placenta, umbilical cord, and membranes expelled after the birth of the child
    • -Take approx. 15 minutes
  59. Indications for a Cesarean Delivery
    • Breech Position
    • Baby's head too large to pass through pelvic region
    • Fetal distress
    • Prolonged labor
    • Problems with placenta
  60. Postpartum
    • The time after birth
    • Hormones
    • Emotional Concerns
    • Lack of Sleep
    • Recovering from physcial aspects of pregnancy, labor, and delivery
  61. Breastfeeding
    • Numerous health benefits
    • -Immunity
    • -Encourages better mouth and tooth development
    • -Reduces chances of obesity in children
    • Convenient and economical
  62. Infertility
    Inability to conceive after one year of unprotected intercourse.
  63. Sterility
    • Purposeful action-vasectomy or tubal ligation
    • Disease
    • Cancer treatments
    • Removal of uterus or ovaries
  64. Infertility: Women
    • Lack of ovulation
    • Hormonal imbalances
    • Scar tissues in uterus or fallopian tubes
    • Habitual miscarriages
    • Production of antisperm antibodies
    • Advanced age
    • Cigarette smoking
    • Drug use
    • Excessive dieting and exercising
  65. Infertility: Men
    • Sperm productino
    • Hormone deficiencies
    • Drug use
  66. Infertility: Women Diagnosis
    • Physical assessments
    • Medical and sexual history
    • Charting menstrual cycle
    • Basal body temperature
    • Blood work
    • Endometrial biopsies
    • Hysterosalpingogram
    • Postcoital cervical mucous test
  67. Infertility: Men Diagnosis
    • Physcial assessment
    • Medical and sexual history
    • Check sperm
  68. Infertility: Women Treatment
    • Absence of ovulation
    • --Hormones
    • Pelvic Surgery
    • --Removal of endometrial tissue
    • --Myomectomy
  69. Infertility: Men Treatment
    • Sperm production
    • --Lifestyle changes
    • --Hormone treatment
    • --Surgery to remove varicocele
  70. Infertility: In Vitro Fertilization
    • Ova are removed from the woman's body and fertilized with sperm in a lab
    • The embryo is surgically implanted into her uterus
    • Success rates decline as woman ages
  71. Choosing a Method
    • Safe and effective
    • Adverse health conditions
    • Affect sexual lifestyle
    • Religious considerations
    • Cultural considerations
    • The best method is one that is used consistently and correctly
  72. Methods that Prevent the Sperm from Reaching the Egg: Coitus Interruptus (Withdrawal)
    • Actual-use effectiveness: 65-70%
    • Causes pregnancy due to human error and sex during peak fertility
    • No STD protection
  73. Methods that Prevent the Sperm from Reaching the Egg: Fertility Awareness or Natural Family Planning
    • Avoiding unprotected intercourse during peak fertility
    • Determine ovulation:
    • -Calendar
    • -Basal Body Temperature
    • -Cervical mucous
    • -Combination of all the above
  74. Calendar Method
    • Estimate future ovulation
    • Need to track menstrual cycle for at least 8 months to determine average ovulation time
    • Deteremine the "safe zone"
    • Avoid unprotected vaginal intercourse during unsafe days
  75. Cervical Mucous Method
    • Changes in cervical mucous to determine ovulation
    • Combine method with calendar for maximum effectiveness
  76. Basal Body Temperature
    • Basal Body Thermometer
    • Chart temperature for 3 months
    • Record temperature on a grid
    • Normally, 12 to 24 hours prior to ovulation, the BBT will drop
    • Next subsequent rise in temperature will indicate ovulation
    • Combine with mucous and calendar methods for maximum prediction of ovulation
  77. Barrier Methods
    Mechanical, chemical, or combination barrier between sperm and egg
  78. Mechanical
    • Condoms (male and female)
    • Diaphragm
    • Sponge
    • Cervical Cap
  79. Chemical
    Spermicidal barriers
  80. Male Condom
    • Latex
    • Polyurethane
    • Natural lamb membrane

    • How it works:
    • Covers penis and trapping ejaculate
    • Pregnancy prevention
    • Some STD prevention
  81. Male Condom: Latex
    • Variety of shapes, colors, and sizes
    • Theroretical use: 98%
    • Actual Use: 88%
  82. Male Condom: Natural Lamb Membrane
    • Made from intestines of lambs
    • Fit more loosely than latex
    • With or without spermicides
    • Effective for pregnancy prevention
    • Not effective for STD prevention
  83. Female Condom
    • Polyurethane
    • Lose-fitting pouch, one size
    • Pregnancy and STD protection
    • Non-prescription
    • Theoretical Use: 95%
    • Actual Use: 79%
  84. Diaphragm
    • Rubber dome inserted into the vagine and placed over the cervix
    • Use with spermicide
    • Limited protectoin against STDs
    • Must be fitted by health care professional
    • Theoretical Use: 94%
    • Actual Use: 84%
  85. Cervical Cap
    • Small, thimblle-shaped rubber cap
    • Fits snugly on cervix by suction
    • Must be fitted by health care professional
    • Limited protection against STDs
    • Different than diaphragm
    • Theoretical Use: 94%
    • Actual Use: 40%
  86. Rape
    • Sexual intercourse without the consent of the man/woman and effected by force, duress, intimidation or deception as to the nature of the act.
    • 95% of rapes are committed by men against women
  87. Facts About Rape
    • Rape is about violence
    • Women do not want to be raped
    • Rapists are not mentally ill
    • Everyone is responsible for preventing rape
  88. Posttraumatic Stress Disorder (PTSD)
    • A syndrome developing after exposure to an extremely traumatic event
    • Victim or the witness to the event
  89. Acquaintance Rape
    • Date Rape
    • -Forced sexual intercourse by a person whom the victim knows
    • Most common and least reported of all forms of rape
  90. What to Do If You Have Been Raped
    • Get to a safe place
    • Call someone you trust to stay with you
    • Go to a hospital emergency room immediately
    • Call local police
    • Write down as much as you can remember
    • Talk with a counselor
  91. Sexual Coercion
    Persuasive or forcing someone into something
  92. Sexual Aggression
    Doing anything sexually aggressive to another person without their consent
  93. The Sexual Victimization of College Women
    • The National College Women Sexual Victimization Study (NCWSV)
    • -Estimate the incidence of sexual victimization of college women
    • Comprehensive representative sample of college women in U.S.
    • Questioned if subject had experienced a sexual victimization event
  94. NCWSV Results
    • 2.8% had experienced a completed rape or attempted rape
    • Some women were raped by definition but did not personally feel they were raped
    • 9 out of 10 women knew the perpetrator
    • Overall, 15% of the women had been sexually victimized
  95. Risk Factors Associated with Rape:
    • Frequently drinking to get drunk
    • Being unmarried
    • Having a history of previous sexual assaults
    • Living on campus
  96. Binge Drinking is Associated With:
    • Unplanned and unsafe sexual activity
    • Physical and sexual assault
    • Criminal violations
    • Physical injury
    • Interpersonal problems
    • Academic Perfromance
  97. Date Rape Drugs
    • Rohypnol
    • GHB
  98. Rohypnol
    Depressant that cause a loss of memory and make women vulnerable to uninvited sexual intercourse
  99. GHB
    Depressant that causes amnesia, euphoria, loss of consciousness making women vulnerable to sexual assault
  100. Stranger Rape
    • Forced intercourse by a person who is unknown to the victim
    • The assailant typically targets the victim
    • Most likely to involve guns, knives, other weapons
  101. Reducing Risk for Stranger Rape
    • Plan travel in advance
    • Avoid dark and isolated areas
    • Take a self-defense course
    • Don't list your telephone name in the phone book or on mailbox
    • Locks on all doors and windows
    • Leave a light on near the entrance
    • Get a dog
  102. Marital Rape
    • 13% of married women have been raped by husbands
    • 84% of husbands used force
    • Peronality traits of husbands
  103. Statutory Rape
    • Sexual intercourse between a person older than the legal age of consent with a partner who is younger than the legal age of consent.
    • The legal age of consent varies by state between 12 to 21 years old.
  104. Incidence of Rape
    • Statistics from FBI and Bureau of Justice's National Crime Victimization Survey
    • -Definition of rape as a crime:
    • --The carnal knowledge of a female forcibly and against her will.
    • Rape is one of the least reportable crimes in the U.S.
    • Rate is 32 per 100,000 women
  105. Reasons Related to Reporting a Rape:
    • Relationship between victim and rapist
    • How the two came together
    • Threat of force
    • Use of force
    • Extent of injury
    • Use of medical treatment
  106. Characteristics of Rapists
    • Hostility toward women
    • Hostile home environment
    • History of delinquency
    • Sexual promiscuity
  107. Sexual Harassment
    • Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature in the workplace
    • Men and women tend to interpret sexual harassment differently.
  108. Conditions of Sexual Harassment
    • A powerful differential in the relationship
    • Inappropriate approach
    • Pressure after expression of disinterest
  109. When Do Rapes Occur?
    • At parties
    • After midnight
    • At their residence
    • At a frat house
  110. Child Sexual Abuse
    • Any sexual contact between an adult and a child who is under 18 years of age
    • Begins as normal behaviors
    • Perpetrator tells child that they are doing nothing wrong and don't tell anyone
    • Child Molestation
    • Incest
  111. Child Molestation
    Sexual abuse of a child by non-family members
  112. Incest
    Sexual abuse involving genetically related family members
  113. Preconditions Related to Child Sexual Abuse
    • Child Molesters-profile
    • Movitation to Abuse
    • Internal Inhibitions Against Abuse
    • External Inhibitions Against Abuse
    • Children's Resistance
  114. Influences to Abuse:
    • Emotional congruence
    • Sexual arousal
    • Blockage of alternative forms of sexual arousal
  115. Children's Resistance
    • Prey on weaknesses
    • Use coercion, threats, punishment, and force
    • Prime targets
    • Education and support
  116. Risks fo Child Sexual Abuse
    • Having a stepfather
    • Ever lived with mother alone
    • Not close to mother
    • Mother never finishing high school
    • Sex-punitive mother
    • No physical affection from Father
    • Income under $10,000 a year
    • Two friends or fewer in childhood
  117. Incidence of Child Sexual Abuse
    • Unreported
    • Number of reported cases have declined 2-11% since 1998
  118. The Future Well-Being of the Child:
    • Relationship between the victim and perpetrator
    • Time span of abuse
    • Violent contact
    • Intrusive
  119. Victims of Sexual Abuse:
    • Have difficulty forming intimate relationships
    • Lack trust
    • Have revulsion of being touched
    • Often alcohol and drug abusers
    • Some are characterized by a lack of emotion and sexual interest
  120. Megan's Law
    • Registration and Community Notification Laws
    • -Convicted sexual offenders must register with law enforcement authorities
    • -Provide community notification
    • --Registered letters
    • --Posting of pictures
    • --Mailings to families, community, groups, and organizations
    • --National Sex Offender Registry
    • --Arkansas Crime Information Center
  121. Prevention of Child Sexual Abuse
    • Provide sex education
    • Become an approachable parent
    • Discuss inappropriate sexual behavior with your children
    • Let your children know they can can decide how, when, and by whome they want to be touched
    • Discuss refusal skills
    • Discuss escape skills
    • Discuss telling

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