Learning the Facts about Sexual Coercion Most teen women who have had sex say that

they really didnt want to have sex the first time they did it. This is called sexual coercion. These young women say there are many reasons they felt they had to, ranging from physical force to feeling sex was expected of them. What is sexual coercion? Sexual coercion is when anyone persuades or coerces someone under the age of 18 into taking part in any kind of unwanted sexual activity. The person may be threatened with physical force or be manipulated emotionally. The person may feel pressured or belittled. The person may feel it is easier to say yes to sexual activity than to say no. There is often an imbalance of power in the relationship. The person being coerced may be a lot younger or more inexperienced. The person using coercion may threaten, humiliate, or use anger to get their way. This person may talk them into having sex. Who is most likely to be abused this way? Teens who have a history of sexual abuse are 5 times more likely to be coerced into sex than those who have not been abused in the past. Among students who had sex before age 15, 4 out of 10 girls and 1 out of 20 boys said they were forced to have sex. Teens who first had sex before age 15 were seven times more likely to state they were forced to have sex as teens who first had sex after that age. What are warning signs that a partner may be abusive? When there is a big age gap or other power differences, there is a greater chance of unwanted sex and unhealthy relationships. When a person constantly puts down the other person, judges people based on their gender, uses bad language about peoples sexuality, or views violent pornography this person is at higher risk of being abusive.

The Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM , is used by mental health professionals to diagnose specific mental disorders. In the 2000 edition of this manual (the Fourth Edition Text Revision also known as DSM-IV-TR ) sexual masochism is one of several paraphilias . Paraphilias are intense and recurrent sexually arousing urges, fantasies, or behaviors. Description In addition to the sexual pleasure or excitement derived from receiving pain and humiliation, an individual with sexual masochism often experiences significant impairment or distress in functioning due to masochistic behaviors or fantasies. With regard to actual masochistic behavior, the person may be receiving the pain, suffering, or humiliation at the hands of another person. This partner may have a diagnosis of sexual sadism but this is not necessarily the case. Such behavior involving a partner is sometimes referred to as sadomasochism. Masochistic acts include being physically restrained through the use of handcuffs, cages, chains, and ropes. Other acts and fantasies related to sexual masochism include receiving punishment or pain by means of paddling, spanking, whipping, burning, beating, electrical shocks, cutting, rape, and mutilation. Psychological humiliation and degradation can also be involved. Masochistic behavior can also occur in the context of a roleplaying fantasy. For example, a sadist can play the role of teacher or master and a masochist can play the role of student or slave. The person with sexual masochism may also be inflicting the pain or suffering on himself or herself. This can be done through self-mutilation, cutting, or burning. The masochistic acts experienced or fantasized by the person sometimes reflect a sexual or psychological submission on the part of the masochist. These acts can range from relatively safe behaviors to very physically and psychologically dangerous behavior. The DSM lists one particularly dangerous and deadly form of sexual masochism called hypoxyphilia. People with hypoxyphilia experience sexual arousal by being deprived of oxygen. The deprivation can be caused by chest compression, noose, plastic bag, mask, or other means and can be administered by another person or be self-inflicted. Causes and symptoms Causes There is no universally accepted cause or theory explaining the origin of sexual masochism, or sadomasochism in general. However, there are some theories that attempt to explain the presence of sexual paraphilias in general. One theory is based on learning theory that paraphilias originate because inappropriate sexual fantasies are suppressed. Because they are not acted upon initially, the urge to carry out the

Masochist Sex Definition The essential feature of sexual masochism is the feeling of sexual arousal or excitement resulting from receiving pain, suffering, or humiliation. The pain, suffering, or humiliation is real and not imagined and can be physical or psychological in nature. A person with a diagnosis of sexual masochism is sometimes called a masochist.

fantasies increases and when they are finally acted upon, a person is in a state of considerable distress and/or arousal. In the case of sexual masochism, masochistic behavior becomes associated with and inextricably linked to sexual behavior. There is also a belief that masochistic individuals truly want to be in the dominating role. This causes them to become conflicted and thus submissive to others. Another theory suggests that people seek out sadomasochistic behavior as a means of escape. They get to act out fantasies and become new and different people. Symptoms Individuals with sexual masochism experience sexual excitement from physically or psychologically receiving pain, suffering, and/or humiliation. They may be receiving the pain, suffering, or humiliation at the hands of another person, who may or may not be a sadist, or they may be administering the pain, suffering, or humiliation themselves. They experience distressed or impaired functioning because of the masochistic behaviors, urges, and fantasies. This distress or impairment can impact functioning in social, occupational, or other contexts. Demographics Although masochistic sexual fantasies often begin in childhood, the onset of sexual masochism typically occurs during early adulthood. When actual masochistic behavior begins, it will often continue on a chronic course for people with this disorder, especially when no treatment is sought. Sadomasochism involving consenting partners is not considered rare or unusual in the United States. It often occurs outside of the realm of a mental disorder. More people consider themselves masochistic than sadistic. Sexual masochism is slightly more prevalent in males than in females. Death due to hypoxyphilia is a relatively rare phenomenon. Data indicate that less than two people per million in the United States and other countries die from hypoxyphilia. Diagnosis The DSM criteria for sexual masochism include recurrent intense sexual fantasies, urges, or behaviors involving real acts in which the individual with the disorder is receiving psychological or physical suffering, pain, and humiliation. The suffering, pain, and humiliation cause the person with sexual masochism to be sexually aroused. The fantasies, urges, or behaviors must be present for at least six months. The diagnostic criteria also require that the person has experienced significant distress or impairment because of these behaviors, urges, or fantasies. The distress and impairment can be present in social, occupational, or other functioning. Sexual masochism must be differentiated from normal sexual arousal, behavior, and experimentation. It should also be

differentiated from sadomasochistic behavior involving mild pain and/or the simulation of more dangerous pain. When this is the case, a diagnosis of sexual masochism is not necessarily warranted. Sexual masochism must also be differentiated from selfdefeating or self-mutilating behavior that is performed for reasons other than sexual arousal. Individuals with sexual masochism often have other sexual disorders or paraphilias. Some individuals, especially males, have diagnoses of both sexual sadism and sexual masochism. Treatments Behavior therapy is often used to treat paraphilias. This can include management and conditioning of arousal patterns and masturbation. Therapies involving cognitive restructuring and social skills training are also utilized. Medication is also used to reduce fantasies and behavior relating to paraphilias. This is especially true of people who exhibit severely dangerous masochistic behaviors. Treatment can also be complicated by health problems relating to sexual behavior. Sexually transmitted diseases and other medical problems, especially when the sadomasochistic behavior involves the release of blood, can be present. Also, people participating in hypoxyphilia and other dangerous behaviors can suffer extreme pain and even death. Prognosis Because of the chronic course of sexual masochism and the uncertainty of its causes, treatment is often difficult. The fact that many masochistic fantasies are socially unacceptable or unusual leads some people who may have the disorder not to seek or continue treatment. Treating a paraphilia is often a sensitive subject for many mental health professionals. Severe or difficult cases of sexual masochism should be referred to professionals who have experience treating such cases. Prevention Because it is sometimes unclear whether sadomasochistic behavior is within the realm of normal experimentation or indicative of a diagnosis of sexual masochism, prevention is a tricky issue. Often, prevention refers to managing sadomasochistic behavior so it primarily involves only the simulation of severe pain and it always involves consenting partners familiar with each other's limitations. Also, because fantasies and urges originating in childhood or adolescence may form the basis for sadomasochistic behavior in adulthood, prevention is made difficult. People may be very unwilling to divulge their urges and discuss their sadistic fantasies as part of treatment.

REDUCING YOUR SEXUAL RISK

HIV can be spread by having unprotected sexual contact with an HIV-positive person. "Unprotected" means sex (anal, oral, or vaginal) without barrier protection, like a condom. Some of the ways to reduce your risk of getting HIV through sexual contact include: Don't have sex. Sex (anal, oral, or vaginal) is the main way that HIV is transmitted. If you aren't having sexual contact, you are 100% protected from getting HIV in that way. Be monogamous. Being monogamous means: 1) You are in a sexual relationship with only one person and 2) Both of you are having sex only with each other. Having only one sex partner reduces your risk of getting HIVbut monogamy won't protect you completely unless you know for sure that both you and your partner are not infected with HIV. Get tested and know your partner's status: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status can be difficult or uncomfortablebut it's important to start the discussion BEFORE you have sex. You need to ask your sexual partners: o Have you been tested for HIV? o When was the last time you had an HIV test? o What were the results of your HIV test? If you have more than one sex partner, the CDC recommends that you be tested for HIV and other sexually transmitted infections (STIs) every 3-6 months. Use condoms consistently and correctly. To reduce your risk of getting HIV or other STIs, you must use a new condom with every act of anal, oral, or vaginal sex. You also have to use condoms correctly, to keep them from slipping off or breaking. You have to use the right kind of condom too. Latex condoms are highly effective against HIV. (If you are allergic to latex, you can use polyurethane or polyisoprene condoms.) Lambskin condoms will NOT protect you from HIV, because the virus is small enough to slip through lambskin. You should always use a water-based lubricant when you use a condom for anal or vaginal sex. Lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (like petroleum jelly, hand lotion, or cooking oil). Oil-based lubricants can damage condoms and make them less effective. Both male condoms and female condoms will help protect you against HIV and other STIs. To learn more about how to use a condom correctly, see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams. Condoms do not provide 100% protection against all STIsbut you are ALWAYS safer using a condom! You can get certain STIs, like herpes or HPV, from contact with your partner's bare skin, even if one of you is wearing a condom. But condoms lessen the risk of infection even for those types of STIs. Condoms with the spermicide Nonoxynol-9 are NOT recommended for STI/HIV prevention. Nonoxynol-9 (N9)

irritates rectal and vaginal walls, which increases the chance of HIV infection if infected body fluids do come in contact with them. Roles of nurses in caring for children include providing direct care, patient education, patient advocacy, and case management, and minimizing the psychologic and physical distress experienced by children and their families. Nurses care for children in many different settings. Within the hospital, these settings include the emergency department, observation or short-stay unit, postanesthesia unit, intensive care unit, general pediatric inpatient unit, and various outpatient clinics. Other settings include schools, child care centers, physician offices, community health centers, rehabilitation centers, and the home. Family-centered care is a method designed to meet the emotional, social, and developmental needs of children and families needing health care. Nurses must identify culturally relevant facts about their patients to provide appropriate and competent care to an increasingly diverse population. Unintentional injury is the leading cause of death for children between 1 and 19 years of age. Efforts to provide all children with access to health care include the Child Health Insurance Program currently being implemented in all states. Documentation of nursing care is essential for risk management and quality improvement. Documentation must include the patient assessment, the nursing care plan, the child's responses to medical therapies and nursing care, and the regular evaluation of the child's progress toward nursing goals. Informed consent is the formal preauthorization for an invasive procedure or participation in research. Parents typically give informed consent for children under 18 years of age unless the child is an emancipated minor, a self-supporting adolescent not subject to parental control. Children need to become more actively involved in decisions about their care as their decision-making abilities develop. Even though they cannot provide informed consent, federal guidelines mandate that children as young as 7 years of age receive information about treatment procedures and research project participation and give their assent. Because adolescents fear disclosure of confidential information, they may avoid seeking health care. When the adolescents have a reportable disease, it is important to inform them that confidentiality cannot be maintained as a report must be made to a public health agency. Adolescents at a higher risk of death due to a serious acute or chronic condition should be encouraged to talk with their parents and jointly prepare advance directives. Federal regulations require a formalized ethical decision- making process to assist health care providers and families in making important decisions about withholding, withdrawing, or limiting a child's therapy.