Unit 4Readings and ResourceseBookZastrow, C., Kirst-Ashma.docx

Unit 4
Readings and Resources
eBook:
Zastrow, C., Kirst-Ashman, K.K. & Hessenauer, S.L. (2019).
Empowerment series: Understanding human behavior
and the social environment (11th Ed.). Cengage Learning.
· Chapter 10: Biological Aspects of Young and Middle
Adulthood
· Chapter 11: Psychological Aspects of Young and Middle
Adulthood
· Chapter 12: Social Aspects of Young and Middle Adulthood
Articles, Websites, and Videos:
Determinants of health are those factors which can influence a
person’s health. They include the conditions under which we are
born, grow, live and advance in age and each is critically
important to determining not only the health of an individual,
but also a community.
https://youtu.be/zSguDQRjZv0
What questions should be asked while making the decision to
move in with your partner? In this easy to listen to video, 8
practical questions are asked and answered which should be
considered prior to making that decision. Do these seem logical
to be considered? They range from thinking about the long term
relationship you are considering with your partner to finances
and how responsibilities are to be shared. As you watch this,
what additional questions come to your mind?
https://youtu.be/FBc9Q1TSC-U
This video will explore how the toxic stress children experience
while growing up in poverty negatively affects their brains.

Furthermore, it explains how we all have a responsibility to
address poverty and the need to intervene within our
communities for those who are most vulnerable.
https://youtu.be/6HVsjpu4vQw
Chapter 10
Biological Aspects of Young and Middle AdulthoodChapter
Introduction
Roy Morsch/Corbis/Getty ImagesLearning Objectives
This chapter will help prepare students to
EP 6a
EP 7b
EP 8b
· LO 1 Recognize the contributions of physical development,
health status, and other factors to health during young
adulthood
· LO 2 Describe the physical changes in middle adulthood,
including those affecting physical appearance, sense organs,
physical strength and reaction time, and intellectual functioning
· LO 3 Describe the midlife crises associated with female
menopause and male climacteric
· LO 4 Summarize sexual functioning in middle age
· LO 5 Describe AIDS—its causes and effects; how it is
contracted; how its spread can be prevented; and understand
AIDS discrimination
Shannon Bailey, age 22, is a senior in college, majoring in
English. She is nearing graduation and is seeking a career focus.
She realizes that a degree in English will indicate to potential
employers that she probably writes well. Yet she also knows
that an English major is not linked to professional positions the
way a degree in engineering, for example, is linked to
engineering positions. She is confused about what kind of
career she wants, and also what kind of career she is qualified

for.
Shannon is nervous about finding a job as she knows she will
soon need to pay back student loans. Although her parents had
saved some money for her education, she still has $19,000 in
student loans. She is hoping to find a job that will provide her
enough money to afford the life style she wants while allowing
her to pay back her loans.
To add to her confusion, Eric Kim, whom she has been dating
for three years and who is two years older than she, proposed to
her a week ago. He wants to get married in a year or two.
At first, Shannon was flattered by the proposal and accepted the
ring. But now she is having second thoughts, as she does not
know if she wants to be in a committed relationship with Eric
for the rest of her life. Shannon realizes that the decisions she
makes in young adulthood will have a major impact on the rest
of her life-including her health, well-being, and happiness.
Shannon’s parents, Patrick and Laura Bailey, are in the middle
adulthood phase of their lives. They have been married for 23
years and have had relatively few serious conflicts. Shannon is
their only living child; another child died of sudden infant death
syndrome when he was 8 months old. This was very traumatic
for them for several years.
More recently, Patrick’s father died from a heart attack.
Although their three other parents are still living, they are
worried about Patrick’s mother living alone, their parents
declining health, and what the future will look like with aging
parents. Patrick, who is 50, has been employed as a construction
worker most of his adult life. Due to a recession that impacted
the housing industry, he was unemployed from 2009 to 2011,
creating a heavy financial burden on his family. Luckily, Laura,
age 48, has been a carrier for Federal Express for the past 13
years and had more stability in her income. They feel they are
just getting back on their feet and are grateful there home was
not foreclosed on, as had happened to several of their friends
and family members during this time. However, they do still

have some outstanding debts, mainly credit cards, and are
resuming contributions to their retirement accounts.
They are active in church activities and enjoy taking walks,
gardening, playing softball, and bowling. For the past five
summers, they have been spending their vacations traveling to
various places in the United States in their Buick Enclave
SUV.A Perspective
Young adulthood is both an exciting and a challenging time of
life. Growth and decline go on throughout life, in a balance that
differs for each individual. In young adulthood, human beings
build a foundation for much of their later development. This is
when young people typically leave their parents’ homes, start
careers, get married, start to raise children, and begin to
contribute to their communities.
Middle adulthood has been referred to as the prime time of life.
Patrick and Laura Bailey illustrate this. Most people at this age
are in fairly good health, both physically and psychologically.
They are also apt to be earning more money than at any other
age and have acquired considerable wisdom through experiences
in a variety of areas. However, middle adulthood also has
developmental tasks and life crises. This chapter will examine
human biological subsystems in young and middle adulthood
and discuss how they affect people’s lives.10-1Recognize the
Contributions of Physical Development, Health Status, and
Other Factors to Health during Young Adulthood
10-1aYoung Adulthood
It is difficult to pinpoint the exact time of life we are referring
to when we talk about young adulthood. The transition into
adulthood is not a clear-cut dividing line. People become voting
adults by age 18. However, in most states, they are not
considered adult enough to drink alcoholic beverages until 21.
A person cannot become a U.S. senator until age 30 or president
until age 35. All this presents a confusing picture of what we
mean by adulthood.
Various theorists have tried to define young adulthood. Buhler

(1933) clustered adolescence and young adulthood together to
include the ages from 15 to 25. During this time, people focus
on establishing their identities and on idealistically trying to
make their dreams come true. Buhler saw the next phase as
young and middle adulthood. This period lasts from
approximately age 23 to age 45 or 50. This group focuses on
attaining realistic, concrete goals and on setting up a work and
family structure for life.
Levinson, Darrow, Klein, Levinson, and McKee (1974) broke up
young adulthood into smaller slices. They believed that in the
process of developing a life structure, people go through stable
periods separated by shorter transitional periods. The stage from
ages 17 to 22 is characterized by leaving the family and
becoming independent. This is followed by a transitional phase
from ages 22 to 28, which involves entering the adult world.
The age-30 transition focuses on making a decision about how
to structure the remainder of life. A settling-down period then
occurs from about ages 32 to 40.
The current generation of young adults is called the millennials,
compared to past generations who held the titles of baby
boomers, Generation X, and upcoming (Generation Z).
Currently there are 50 million millennials who grew up in the
twenty-first century and the digital age. These young adults
have learned to navigate the ever-changing world of technology
and have faced traumas such as the terrorist attacks of
September 11, 2001, and the recession of 2008–2009
(Tanenhaus, 2014).
Ethical Question 10.1
EP 1
1. Are you taking good physical care of yourself?
For our purposes, we will consider young adulthood as
including the ages from 18 to 30. This is the time following the
achievement of full physical growth when people are
establishing themselves in the adult world. Specific aspects of
young adulthood addressed in this chapter include physical

development, health status, and the effects of lifestyle on
health.
10-1bPhysical Development
Young adults are in their physical prime. Maximum muscular
strength is attained between the ages of 25 and 30, and
generally begins a gradual decline after that. After age 30,
decreases in strength occur mostly in the leg and back muscles.
Some weakening also occurs in the arm muscles.
Top performance speed in terms of how fast tasks can be
accomplished is reached at about age 30. Young adulthood is
also characterized by the highest levels of manual agility. Hand
and finger dexterity decrease after the mid-30s.
Sight, hearing, and the other senses are their keenest during
young adulthood. Eyesight is the sharpest at about age 20. A
decline in visual acuity isn’t significant until age 40 or 45,
when there is some tendency toward presbyopia
(farsightedness). At that point, you start to see people read their
newspapers by holding them 3 feet in front of them.
Hearing is also sharpest at age 20. After this, there is a gradual
decline in auditory acuity, especially in sensitivity to higher
tones. This deficiency is referred to as
presbycusis. Most of the other senses—touch, smell,
and taste—tend to remain stable until approximately age 45 or
50.
10-1cHealth Status
Young adulthood can be considered the healthiest time of life.
Young adults are generally healthier than when they were
children, and they have not yet begun to suffer the illnesses and
health declines that develop in middle age. (Papalia &
Martorell, 2015)
Most young adults report they are in good to excellent health
(Papalia & Martorell, 2015). However, rates of injury,

homicide, and substance abuse peak at this time (Papalia &
Martorell, 2015). In the past, this age group has lacked access
to health care, often aging out if they did not go to college or if
there were age limits on their parents’ insurance, but with the
Affordable Care Act of 2010, most young adults can stay on
their parents’ insurance plan until the age of 26. This change
has resulted in 5.7 million young adults having health care
coverage (The White House, 2015) and allowing young adults
the health care they require to prevent or address health
concerns. However, the Trump administration has indicated it
plans to repeal/replace the Affordable Care Act, which could
impact the health care of young adults.
Many people in all socioeconomic classes show a significant
interest in measures that promote health. For example, running
and other forms of exercising, health foods, and weight control
have become very popular.
It has also been found that adults in the United States are using
more complementary medicine approaches, including dietary
supplements, yoga, chiropractors, meditation, acupuncture,
massage therapy, and/or osteopathic manipulation. In 2012, in
the National Health Interview Survey, it was found that 33.2
percent of adults used complementary health approaches
(NCCIH, 2016).
Even though young adulthood is generally a healthy time of life,
health differences can be seen between men and women. For
example, women of all ages tend to report more illnesses than
do men (Lefrancois, 1999). However, these health issues may be
related to gender (such as contraception, pregnancy, or an
annual Pap test), rather than more general health problems.
Perhaps women are also more conscientious about preventive
health care in general.
Of all the acute or temporary pressing health problems
occurring during young adulthood, approximately half are
caused by respiratory problems. An additional 20 percent are
due to injuries. The most frequent chronic health problems of
young adulthood are spinal or back difficulties, hearing

problems, arthritis, and hypertension. These chronic problems
occur even more frequently in families of lower socioeconomic
status. For example, young African Americans experience
hypertension more frequently than their white counterparts
(Papalia & Martorell, 2015).
Other health concerns are also on the rise for young adults.
Alarmingly, people ages 15–24 account for half of the 20
million newly diagnosed sexually transmitted infections yearly
in the United States (CDC, 2015). Obesity rates are of concern
with young adults, along with increases in stress levels, lack of
sleep, smoking, and alcohol use (Papalia & Martorell, 2015).
Men and Health
A 21-year-old male, who has been healthy his entire life, has a
pain in his groin area. As he is a student athlete, he assumes it
is a pulled muscle and ignores it. Despite the continued
discomfort it causes, he believes it is not healing properly due
to his continued training. By the time he seeks care, it is too
late. He has untreatable prostate cancer. The following year, his
family accepts his college diploma on his behalf as he died
several months prior to graduation.
This case highlights the need for males to seek medical care. In
2014, 83.2 percent of adults visited a physician; however, the
majority of these visits were made by females (CDC, 2015b).
Despite recommendations that men visit their primary physician
once every two years. (However, it is recommended they go
more routinely if they smoke, have high blood pressure, or have
high cholesterol.) Between the ages of 18 and 39, men do not
visit the physician as often as women, especially for preventive
care (CDC, 2015b). The leading causes of death for men are
heart disease, cancer, and accidents (CDC, 2015c). Of cancer,
the most frequent diagnoses are prostrate, lung, and colorectal;
however, lung cancer causes the most deaths (CDC, 2015a).
Many of the health issues faced only by men, such as prostate
cancer or low testosterone, can be prevented or treated

successfully if caught early (NIH, 2016b). It is critical that
young males be encouraged to seek routine, preventive health
care in order to live to their fullest potential.Women and Health
Although women do tend to visit the physician more than men,
as indicated above, women have unique needs, such as
pregnancy, conditions of female organs, and breast health that
need to be routinely monitored. Women also have a higher
incidence than men of certain health risks; for example, women
are more likely to die following a heart attack than men, are
more likely to show signs of depression, are affected more often
by osteoarthritis, and are more likely to have urinary tract
problems (NIH, 2016c). The leading causes of death for women
are heart disease, cancer, and chronic lower respiratory disease
(CDC, 2016b).
10-1dBreast Cancer
Within the context of health status, an extremely important
issue confronting women is the incidence of breast cancer.
According to the American Cancer Society (ACS, 2016b), breast
cancer is the most common form of cancer among women,
except for skin cancer. Approximately 1 out of 8 women will
get breast cancer during their lifetime, and about 40,450 women
will die from it in every year (ACS, 2016b). It is the second
leading cause of cancer death in women, second only to lung
cancer (ACS, 2016b). Although men can get breast cancer, the
numbers are significantly lower than those of women, with
2,600 cases diagnosed in men each year and 440 reported deaths
(ACS, 2016d).
Although older adult women are much more likely to get breast
cancer than their younger counterparts, because of its general
prevalence it will be discussed here.
Being knowledgeable about the issue of breast cancer is
especially important in helping your female clients become
aware of risks, prevention, and treatment. If you are a woman,
it’s important for your own health. If you are a man, it’s
important for the women who are close to you.Benign Lumps

To begin with, it’s important to note that 80 percent of all
breast lumps are benign (not cancerous) (Hyde & DeLamater,
2017). These usually take one of two forms (Crooks & Baur,
2014). First, there are
cysts, which are pouches of fluid. The other form of
lump is a
fibroadenoma, which is a more solid, rounded growth of
cells resembling scar tissue (Crooks & Baur, 2014, p. 81).
Symptoms
A number of symptoms other than identification of a lump or
tumor can indicate malignancy. Tumors can assume a number of
shapes and forms. Generally, any change in the external
appearance of the breasts should make one suspicious. For
instance, one breast becoming significantly larger or hanging
significantly lower than the other is a potential warning sign.
Discharges from the nipple or nipple discoloration are
additional indications, as is any pain in the breast. Dimpling or
puckering of the nipple or skin of the breast should be noted.
Nipple retraction (where the nipple turns inward) is also a
potential sign of cancer. Finally, any swelling of the upper arm
or lymph nodes under the arm should be investigated.Risk
Factors
Numerous factors are involved in getting breast cancer (ACS,
2016a). Some are variables that can’t be changed. We have
already established that being a woman and advancing age
increase risk. About two-thirds of women with breast cancer are
age 55 or older by the time the cancer is discovered.
Between 5 and 10 percent of breast cancers are related
to genetic mutations, most frequently in the genes labeled
BRCA1 and BRCA2 (ASC, 2016e). Women with mutations in
these specific genes may increase their likelihood of breast
cancer by as much as 80 percent. Note that mutations in other
genes may also be linked to increased risk.
Genetic testing can be done to determine if a female has BRCA1
or BRCA2 mutations, but women are encouraged to talk to a

genetic counselor or doctor to explain the results (ACS, 2016e).
Family history is another relevant variable in assessing breast
cancer risk. Having close female relatives on either side of the
family with breast cancer increases a woman’s chances. Risk
doubles for women who have a mother, sister, or daughter who
has breast cancer and triples for women with two such relatives.
(However, note that over 85 percent of all women with breast
cancer do not have it in their family history.) Having a prior
history of breast cancer increases the chances of developing a
new cancer in the same or the other breast.
Race affects risk. “White women are slightly more likely to get
breast cancer than are African American women but African
American women are more likely to die of this cancer.
However, in women under 45 years of age, breast cancer is
more common in African American women. Asian, Hispanic,
and American Indian women have a lower risk of developing
and dying from breast cancer” (ACS, 2016).
Women who have been exposed to radiation treatment in the
chest area at some earlier time have greater risk. Risk may also
be related to menstruation. It increases a bit for women who
started menstruating before age 12 or who went through
menopause (the normal change of life occurring in
middle age when a woman stops menstruating and can no longer
bear children) after age 55. Having dense breast tissue (the
fatty, fibrous, and glandular tissue making up breasts) increases
the risk of developing breast cancer. Additionally, having been
diagnosed with certain benign breast conditions (e.g., certain
benign breast tumors) also increases breast cancer risk, although
the level of risk varies with the particular condition.
Some risk factors for breast cancer are linked to lifestyle and
life choices. Risk increases slightly for childless women and for
women having their first child after age 30. Conversely, having
numerous pregnancies and bearing children at a young age
reduces a woman’s chance of getting breast cancer. The risk
posed by taking oral contraception (birth control pills) is not yet

understood. Studies have found that women now using birth
control pills have a slightly greater risk of breast cancer than
women who have never used them. Women who stopped using
the pill more than 10 years ago do not seem to have any
increased risk. Women should address issues such as this with a
physician. Long-term use of
combined hormone therapy (HT) with estrogen and
progesterone to diminish the negative symptoms of menopause
increases the risk of breast cancer and of dying from the
disease. The use and effects of hormone therapy are complex
and should be carefully discussed with a physician. Since
combined HT also “appears to increase the risk of heart disease,
blood clots, and strokes,” “there appear to be few strong reasons
to use post-menopausal hormone therapy” (ACS,
2016c). Alcohol consumption, especially in greater quantities
on a regular basis, increases risk, as does being overweight.
Several other factors that may contribute to the risk of breast
cancer are under investigation. However, research results aren’t
clear at this time. These factors include high-fat diets,
chemicals in the environment, tobacco smoke, and working at
night. In contrast, exercise appears to reduce risk, as does
having breast-fed a child, especially if the practice lasted for
one-and-a-half to two years.
Remember that the factors discussed here do not condemn a
woman to getting breast cancer. Such discussion should only
alert women to be careful and aware.Suspicion of Breast Cancer
In the event that a suspicious lump is detected, numerous
options can be pursued. First, a
mammogram (X-ray of the breast) can be used to detect
a tumor. (Note that mammograms are also used for regular
screenings, described later.) Improvements in mammogram
technology have resulted in decreased amounts of radiation, so
there is little if any risk of negative consequences.
Diagnostic mammograms “are used to diagnose breast
disease in women who have breast symptoms (like a lump or

nipple discharge) or an abnormal result on a screening
mammogram” (ACS, 2016a). They involve taking more images
depicting greater detail of the suspicious area in the breast.
Second,
magnetic resonance imaging (MRI) scans “use radio
waves and strong magnets instead of x-rays” (ACS, 2016a). A
dye is injected into the bloodstream to accentuate effects.
Healthy and diseased bodily tissues absorb the energy in
different ways so that a computer can interpret results and
discover abnormalities. Some research has found that MRIs can
discover more and smaller cancers than can mammograms.
However, MRIs are more expensive, may take up to an hour,
and involve being confined in a tube (which makes some people
quite uncomfortable). In current practice, MRIs are usually used
along with mammograms to screen women in high-risk groups,
to investigate suspicious tissue, to determine the mass of a
cancer that has already been detected, or to check for the
existence of cancer in the opposite breast. New imaging tests
are also being studied.
Third, an
ultrasound (picture of an internal area by the use of
sound waves) may also be employed. Ultrasound has become a
valuable tool to use along with mammography because it is
widely available and less expensive than other options such as
MRI. The use of ultrasound instead of mammograms for breast
cancer screening is not recommended. Usually, breast
ultrasound is used to target a specific area of concern found on
the mammogram. Ultrasound helps distinguish between cysts
(fluid-filled sacs) and solid masses and sometimes can help tell
the difference between benign and cancerous tumors.
Ultrasounds can be beneficial in assessing breasts with
exceptionally dense tissue, as tumors may be more difficult to
see in mammograms. Research is currently being done to

determine the value, pros, and cons “of adding breast ultrasound
to screening mammograms in women with dense breasts and a
higher risk of breast cancer” (ACS, 2013c).
Fourth, for women with nipple discharge, a
ductogram (or
galactogram) can be performed. This involves inserting
“a very thin plastic tube into the opening of the duct in the
nipple” producing the discharge and injecting a very small
quantity of a liquid into the duct (ACS, 2016a). This provides a
contrast between the injected liquid and breast tissue, thus
delineating the structure of the duct. An X-ray can then
determine if a mass exists within the duct.
Fifth, a
biopsy involves extracting some amount of tissue to
examine for cancerous cells. In a
fine needle aspiration biopsy (FNAB), an extremely fine
needle extracts fluid from the lump for evaluation. In a
core needle biopsy, a larger needle is used to remove
several cores of tissue from a potentially problematic area
discovered during an ultrasound or mammogram. “Because it
removes larger pieces of tissue, a core needle biopsy is more
likely than an FNAB to provide a clear diagnosis, although it
may still miss some cancers” (ACS, 2016c).
Vacuum-assisted biopsies such as Mammotome® or
ATEC® (Automated Tissue Excision and Collection) (trade
names) are outpatient procedures that involve the suctioning of
tissue using a hollow probe through a small incision. A
surgical biopsy entails a removal by incision of a larger
section of the identified mass or abnormal area in addition to
some of the surrounding tissue. This more complex procedure,
used because of the tissue’s location or because the results of a
core biopsy are unclear, is usually performed in a hospital’s
outpatient unit and requires anesthesia. The type of biopsy
selected depends on a woman’s specific circumstances. “Some
of the factors your doctor will consider include how suspicious

the lesion appears, how large it is, where in the breast it is
located, how many lesions are present, other medical problems
you may have, and your personal preferences” (ACS, 2016c).
Treatment of Breast Cancer
If it is established that the lesion is cancerous, several treatment
options are available (National Cancer Institute [NCI], 2016a).
The type of treatment depends on the complexity,
severity/progression of the cancer. Women with breast cancer
need to explore all of the options with their doctor to determine
their best course of action based on their individual situation.
The standard treatment options used are listed below.
1. Surgery: Surgery removes the cancer. During surgery lymph
nodes may be removed because they are the first structures to
receive drainage from the tumor (NCI, 2016c). The sentinel
lymph node is the lymph node to receive the drainage first. This
lymph node is evaluated for cancer cells and if no cancer cells
are found, removal of more lymph nodes may be unnecessary.
Different types of surgery include
· —
lumpectomy: only the tumor and surrounding tissue are removed
resulting in the least disruption in the breast’s external
appearance.
· —
partial mastectomy: removal of a portion of the breast
containing the tumor, tissue around the tumor, and possibly the
chest muscle below the cancer.
· —
simple or total mastectomy—the entire breast is removed and
possibly some lymph nodes under the arm.
· —
skin-sparing mastectomy: the same amount of internal breast
tissue is removed as a simple mastectomy, but the breast
remains intact in preparation for breast reconstruction surgery
(Mayo Clinic, 2016b).
· —

modified radical mastectomy: “many of the underarm lymph
nodes, the lining over the chest muscles, and sometimes part of
the chest wall muscles are removed” (NCI, 2016c).
2. Radiation: Radiation therapy involves using “high-powered
beams of energy, such as x-rays to destroy cancer cells” (Mayo,
2016a). Radiation can be administered externally (outside the
body with a machine) or internally (place radioactive substances
in the body). Treatment schedules vary depending on the stage
of the cancer treated (NCI, 2016c).
3. Chemotherapy: Chemotherapy involves administering cancer
fighting drugs either by injecting them into the vein or ingesting
them in liquid or pill form. They are intended to fight and
eliminate cancer cells that have split off from the tumor and
migrated to other parts of the body. The way chemotherapy is
given depends “on the type and stage of the cancer being
treated” (NCI, 2016c). Chemotherapy may be used before
surgery to shrink a tumor, thereby facilitating the tumor’s
removal.
4. Hormone therapy: Hormone therapy involves administration
of drugs that block or decrease the effects of the female
hormone estrogen in those women whom estrogen encourages
the development of breast cancer. One example of hormone
therapy is tamoxifen, a drug in pill form that is usually
administered for two to five years after breast cancer surgery.
5. Targeted drugs: Targeted drug treatments attack specific
cancer cells without harming normal cells (NCI, 2016c). These
drugs may kill the cancer cell or slow the cells’ growth.
6. Clinical trials: Some patients take part in a clinical trial to
determine if a new cancer treatment is safe and effective or
better than the standard treatments as identified above (NCI,
2016c).
All of the treatment options noted may have side effects,
ranging from tiredness, hair loss, and premature menopause to
greater vulnerability to infections and diseases because of
decreased supply of white blood cells. Additionally, when a
woman has surgery on her breast it can affect her self-esteem

due to tremendous significance placed on breasts in our society.
A women’s perception of herself, how others perceive her, and
of the effects on her sexual relationships can be severely
affected.
One option, for women who have had a mastectomy is
reconstructive surgery. Reconstructive surgery is done to make
the breast look as natural as possible. In 2015, 106,338 breast
reconstruction procedures were performed in the United States
(American Society of Plastic Surgeons, 2016). Reconstruction
surgery can be performed during the initial surgery (which must
be planned in advance) or at a later time. As a last resort, some
women turn to alternative or complementary medicine to help
fight their cancer. It should be noted, however, that no
alternative treatments have been found to cure breast cancer
(Mayo, 2016a). Some of these options are acupuncture, a special
diet, meditation, and/or yoga. It is believed these treatments can
help treat the patient’s mind, body, and spirit (NCI, 2016b).
Many procedures and therapies exist to combat breast cancer.
However, early detection is key to effective treatment.
Highlight 10.1 describes what women can do to
facilitate detection as soon as possible.
Highlight 10.1Early Detection of Breast Cancer
There are three primary recommendations for early detection of
breast cancer. First, the American Cancer Society strongly
recommends that women should have an annual mammogram
beginning at age 40. Women with a high risk of breast cancer
should discuss the issue of having mammograms or other
screening tests conducted at an earlier age. Some high-risk
women should consider having an annual MRI in addition to
their mammogram.
Second, beginning in their 20s or 30s, women should begin
having a clinical breast exam (CBE) performed by a health care
practitioner at least every three years. Note that many cancers
cannot currently be detected by mammography. CBE exams
involve the practitioner examining your breasts for

abnormalities or changes. The practitioner will also use the pads
of her fingers to search for lumps in the breast and under the
arms.
The third means of early detection involves conducting a breast
self-exam (BSE) beginning in your 20s. The idea is that getting
to know the contours and structure of your own breasts can help
you detect any changes of abnormalities. You can develop much
greater expertise in checking yourself than can a physician or
other health professional who checks you only once a year or
less. It has been suggested that women conduct a BSE monthly,
or at least occasionally. The following describes how to do a
BSE:
1. Lie down and put your left arm over your head (when
checking your left breast with your right hand). This position
spreads out the breast tissue more uniformly and allows you to
explore the breast more thoroughly.
2. Use the pads on your three middle fingers to feel for lumps
by using circular motions about the size of a dime.
3. Use three levels of pressure—mild, medium, and deep—in
order to explore the depth of the entire breast.
4. Move in an up-and-down pattern, illustrated in
Figure 10.1 (ACS, 2010a). You should start under your
arm and make certain you check all areas of the breast down to
the bottom of the lib cage and up to the collarbone.
5. Duplicate the procedure using the three middle fingers of
your left hand to check your right breast. Don’t forget to put
your right arm over your head.
6. Now get up and look at yourself in the mirror. Push your
hands down tightly on your hips, as this tends to emphasize any
changes in your breasts. Examine your breasts carefully for any
differences or abnormalities.
7. Either standing or sitting in a chair, elevate your left arm
slightly (do not raise it too high, as this tenses the muscles too
much and makes it more difficult to detect lumps or
abnormalities). Carefully inspect your left underarm with your

right hand’s three middle finger pads.
8. Using the same approach, examine your right underarm with
your left hand.
Figure 10.1Breast Self-Exam
A Final Note
Breast cancer is a critically important issue. In summary, there
are two important principles for women lo remember. First,
women should become experts on their own bodies. The earlier
a lump is found, the smaller it will probably be and the easier it
will be to treat. Second, in the event that a lump is found,
women should seek help immediately and become
knowledgeable about alternative remedies. They should
seriously consider the pros and cons of each available option.
10-1eLifestyle and Good Health
Good health doesn’t just happen. It is related to specific
practices and to a person’s individual lifestyle. People begin
developing either beneficial or harmful health habits at an early
age. Several simple, basic habits have been found to prolong
life. People who follow all of them tend to live longer than
people who follow only some of them. In fact, a clear
relationship exists between the number of the suggested habits
followed and the state of overall health.
These positive health habits include eating breakfast and other
meals regularly. Snacking on high-fat and high-sugar foods
should be avoided. Moderate eating in order to maintain a
normal, healthy weight is important. Smoking and heavy alcohol
consumption are dangerous to health and should be avoided.
Moderate exercise and adequate sleep also contribute to good
health.
Excessive consumption of alcohol has a very negative effect on
health. Alcoholics are people who have a continual and
compulsive need for alcohol. Physical dependence occurs when
body tissues become dependent on the continuous presence of
alcohol. Approximately three-quarters of all alcoholics show

some impaired liver function. About 8 percent of alcoholics
eventually develop cirrhosis of the liver. Cirrhosis involves
gradual deterioration of the liver tissue until it no longer can
adequately perform its normal functions. These functions
include converting food to usable energy. Other effects of
alcoholism include cancer; heart problems and heart failure; a
variety of gastrointestinal disorders including ulcers; damage to
the nervous system; and psychosis.
Stress is another factor that can affect health (NIMH, 2016).
Stress can be caused by positive events (such as marriage or a
job promotion) or negative events (death of a relative or
divorce). There are three different types of stress: routine stress
from a sudden change, or traumatic stress (major accident or
disaster). Everyone responds differently to these stressors;
however, with continued stress an individual may suffer serious
health problems such as digestive issues, weight gain, heart
disease, high blood pressure, depression, or other illnesses
(NIMH, 2016).
Poor people are likely to suffer stress related to their lack of
resources. They may be worrying about what to feed their kids
near the end of the month when money has run out. Maybe
they’re worried about having their phone disconnected or their
electricity turned off because they couldn’t pay the bills.
To cope with stress, it is important to obtain proper health care,
reach out to others, exercise regularly, seek help from a
counselor for any mental health issues, avoid alcohol and drug
use as a means of coping, and focus on the positives. Programs
such as yoga and meditation also help deal with stress (NIMH,
2016). (For additional material on stress management, see
Chapter 14.)
Diet also affects health. Being overweight increases the risk of
heart disease, high blood pressure, and other health problems.
On the other hand, choosing a well-balanced diet, limiting food
intake, and avoiding foods infused with salt and fat can promote

good health, especially in conjunction with exercise. For
instance, limiting cholesterol intake decreases the risk of heart
disease (Seaward, 2012). Cholesterol is “a soft, fat-like
substance found among the fats in the bloodstream” (American
Heart Association, 1984, p. 1). It can collect in arteries, thereby
stalling blood flow. Extreme blockages can arrest the blood
flow into the heart and ultimately cause a heart attack. Eating
foods low or lacking in cholesterol can significantly decrease
these risks.
Health is obviously related to the incidence of death.
Spotlight 10.1 discusses the differential death rates and
causes of death experienced by different groups.
Spotlight on Diversity 10.1Differential Incidence of Death
The leading causes of death among all young adults in the
United States ages 15 to 24 are accidents, homicide, suicide,
and cancer, respectively; among people 25 to 44, the leading
causes of death are accidents, cancer, heart disease, and suicide
(Papalia & Martorell, 2015).
When gender and racial groups are looked at separately, some
differences emerge. Death rates for men 15 to 24 are almost
three times higher than those for women (Papalia & Martorell,
2015).
As for racial differences, the death rate for African American
males 15 to 24 is almost double that of their white counterparts
(Papalia & Martorell, 2015). The incidence of violent death in
the two groups contributes to this difference. Murder is the
number one cause of death for young African American men.
Recent census data report that African American men ages 15 to
19 are seven times more likely to die from a homicide than are
their white peers, and those 20 to 24 are almost nine times more
likely. The U.S. homicide rate is six times the rate in Holland,
five times the rate in Canada, and eight times the overall rate in
Europe (Mooney, Knox, & Schacht, 2013). You might ask
yourself why you live in such a violent society.
The death rate for people of color between the ages of 15 and 44

is about twice as high as that for whites (Papalia & Martorell,
2015).
The difference in the death rates of people of color and whites
reflects a significant difference in environment. Of course, there
are people of virtually every ethnic and racial background who
are poor. However, in the United States, if you are African
American or a member of a number of other minority groups,
including Latinos/Latinas and Native Americans, you are more
likely to be poor than if you are white. This is a complicated
issue. However, much of the difference in circumstances is due
to a long history of prejudice and discrimination. If you’re poor,
you’re more likely to be living in the crowded urban center of a
city than in the suburbs. If you’re poor and live in the inner city
where the crime rate is higher, you are more likely to be a
homicide victim. Inner cities also have higher rates of air
pollution, which (similar to smoking cigarettes) causes lung and
heart disease.
If you are poor, you are also more likely not to have
employment that provides adequate health insurance. You’re
more likely to find yourself in a position where you can’t go to
a doctor when you’re sick because you have no money and no
insurance. Young adulthood is supposed to be the healthiest
time of life, and it is for most people. However, overall health
status varies drastically depending on environment and living
conditions. It’s important for social workers to be aware of the
impact that poor environments can have on people.
Poverty is often linked to minority status. Many minorities have
been physically abused, burdened by the abuse of others’ power,
and treated unfairly. The result is the likelihood of a poor
standard of living, including a poor health status with more
health problems. Instead of asking what people can do to get out
of poor environments, social workers need to ask how these
environments can be changed to improve the living conditions
of the oppressed people.10-2Describe the Physical Changes in
Middle Adulthood, including Those Affecting Physical
Appearance, Sense Organs, Physical Strength and Reaction

Time, and Intellectual Functioning
10-2aMiddle Adulthood
Middle age has no distinct biological markers. Different writers
identify the beginning of middle adulthood as ranging from 30
to 40 and the end of this age period as ranging from 60 to 70.
Somewhat arbitrarily, this text will view middle adulthood as
ranging from ages 30 to 65. This period indeed covers a large
number of years.
10-2bPhysical Changes in Middle AgeChanges in Physical
Functioning
Most middle-aged people are in good health and have
substantial energy. Small declines in physical functioning are
barely perceptible. At age 48, for example, Althea Lawrence,
who jogs, may notice it takes her a little longer to run the
course. These decreases in physical functioning may be
sufficient to make people feel they are aging.
People age at different rates, and the decline of the body
systems is gradual. A major change is a reduction in reserve
capacity, which serves as a backup in times of stress and during
a dysfunction of one of the body’s systems. Common
physiological changes in middle age include diminished ability
of the heart to pump blood. The gastrointestinal tract secretes
fewer enzymes, which increases the chances of constipation and
indigestion. The diaphragm weakens, which results in an
increase in the size of the chest. Kidney function is reduced. In
some males, the prostate gland (the organ surrounding the neck
of the urinary bladder) enlarges, which can cause urinary and
sexual problems.
Despite changes in physical functioning, it is important for
people to remain physically active as they age.
kali9/E+/Getty Images
In addition to gradual reductions in energy levels, middle-aged

adults also have less capacity to do physical work. A longer
time is needed to recoup strength after an extended period of
strenuous activity. Working full-time at a job and then
socializing into the wee hours of the morning is harder.
Recovering from colds and other common ailments generally
takes longer. It takes longer for pain in joints and muscles to
subside after extensive physical exercise. Middle-aged adults
are best at tasks that require endurance rather than rapid bursts
of energy; they need to make adjustments in their physical
activities to compensate for these changes in energy level.
Health Changes
In the early 40s, a general slowing down in metabolism usually
begins. Individuals who reach this age either begin to gain
weight or have to compensate by eating less and exercising
more.
Health problems are more apt to arise. Signs of diabetes may
occur, and the incidence of gallstones and kidney stones
increases. Hypertension, heart problems, and cancer also occur
at higher rates during the middle adult years than in the younger
years. Back problems, asthma, arthritis, and rheumatism are
also more common. Because nearly all these ailments can be
treated, middle-aged adults need to have periodic physical
examinations in order to detect and treat these illnesses in their
early stages.
One major health problem during middle age is hypertension, or
high blood pressure. The disorder predisposes people to heart
attacks and strokes. The disorder affects about 40 percent of
adults in the United States, and is more prevalent among
African Americans and poor people (Papalia & Martorell,
2015). Fortunately, the disorder is now often detected by blood
pressure screening, and can generally be effectively treated with
medication.
The typical middle-aged American is quite healthy. The three
leading causes of death for those between the ages of 35 and 54
are, in order, cancer, heart disease, and accidents. Between ages
55 and 64 the leading causes are cancer, heart disease, and

strokes (Papalia & Martorell, 2015).Changes in Physical
Appearance
Gradual changes in appearance take place. Some people become
alarmed when they discover these changes. Gray hairs begin to
appear. The hair may thin. Wrinkles gradually appear. The skin
may become dry and lose some of its elasticity. There is a
redistribution of fatty tissue; males are apt to develop a “tire”
around their waist, and the breasts of women may decrease in
size. Minor ailments develop that cause a variety of twinges.
Some studies with interesting results have been conducted on
personal appearance. Knapp and Hall (2010) reviewed studies in
which slides of both women and men were shown to subjects.
The studies found that those judged to be physically attractive
were also judged to be brighter, richer, and more successful in
their social lives and career.
Having a physically attractive body has become an obsession in
our society. Americans spend thousands of hours and millions
of dollars on grooming themselves, exercising, and dieting. The
“body beautiful” cult leads those who judge themselves to be
attractive to believe that they are superior to those they judge to
be less attractive.The Double Standard of Aging
Gray hair, coarsened skin, and crow’s feet are considered
attractive in men; they are viewed as signs of distinction,
experience, and mastery. Yet the same physical changes in
women are viewed as unattractive indicators that they are “over
the hill.” Many men in our society view older women as having
less value as sexual and romantic partners and even as business
associates or prospective employees (Knapp & Hall, 2010). For
example, some middle-aged television anchorwomen allege they
have been discharged from their positions because normal
changes in their physical features are considered unattractive.
Today, the double standard of aging is waning (Papalia et al.,
2012). Men too are suffering from the premium placed on youth.
Both men and women age 50 and older encounter age
discrimination (although it’s illegal) in looking for a job.
In the area of career advancement, men are more apt than

women to feel old before their time if they have not achieved
career or financial success. Our society places more pressure on
men than on women to have a successful career.
EP 1
1. If you were an employer, would you be reluctant to hire
someone who was 50 or older?
Changes in Sense Organs
A gradual deterioration occurs in the sense organs during
middle adulthood. Middle-aged adults are apt to develop
problems with their vision that may force them to wear bifocals,
reading glasses, or contact lenses. As the lens of the eye
becomes less elastic with age, its focus does not adjust as
readily. As a result, many people develop
presbyopia—which means they become farsighted. They
are unable to focus sharply for near vision and thus need
reading glasses. The psychological impact of having to wear
glasses may be minor or can be fairly serious if the person is
fearful about growing older.
During middle age, there is also a gradual hardening and
deterioration of the auditory nerve cells. The most common
deterioration in middle adulthood is
presbycusis, which is a reduction in hearing acuity for
high-frequency tones. Middle-aged men generally have
significantly greater losses of high-frequency tones than
middle-aged women. Sometimes the hearing loss is enough so
that a hearing aid is needed. There are generally some minor
changes in taste, touch, and smell as a person grows older. Most
of these changes are so gradual that a person makes adjustments
without recognizing that changes are occurring.
Changes in Physical Strength and Reaction Time
Physical strength and coordination are at their maximum in the

20s and then decline gradually in middle adulthood. Generally,
these declines are minor. Manual laborers and competitive
athletes (boxers, football players, weight lifters, wrestlers, ice
skaters) are most apt to be affected by these gradual declines.
As
Highlight 10.2 illustrates, some sports figures who have
been applauded and worshipped by fans may experience an
identity crisis in middle adulthood when they are no longer as
competitive. Their lifestyle and identity have been based on
excelling with athletic skills; as those skills fade, they need to
find new interests and another livelihood.
Highlight 10.2An Identity Crisis: When the Applause Stops
Chuck Walters excelled in sports in grade school and high
school. In high school, he lettered in basketball, football, and
baseball. In his senior year, he was tall and weighed about 220
pounds. He was a halfback on the football team and scored ten
touchdowns in eight games. He was an outfielder on the
baseball team and batted .467, hitting 13 home runs. Especially
good at basketball, he was quick and averaged 23.4 points a
game.
He was recruited by a number of universities for both his
football and basketball skills. He chose to accept a basketball
scholarship at a major midwestern university. As a bonus for
accepting a scholarship, an alumnus bought him a Hummer. The
purchase was hidden, as it violated NCAA rules for athletes.
Another alumnus gave him a summer job as a construction
worker, which paid well and didn’t require much work. Chuck
had concentrated on sports and partying in high school and
college. In college, he chose the easiest major he could find
(physical education) and only occasionally went to class. By
taking the minimum number of credits needed to maintain his
basketball eligibility and by having a tutor, be managed to make
his grades and play varsity basketball. He loved college. He had
plenty of money, a new vehicle, and many dates, and was
worshipped on campus as a hero. He thought this was the way to

live. In his junior year, he averaged 16.7 points as a guard, and
in his senior year, he was an all-conference selection and
averaged 22.3 points a game.
He also began experimenting with cocaine. He loved being
applauded and adulated. He thought the merry-go-round would
keep whirling around. To his surprise, he wasn’t drafted by the
pros. So he went to Europe to play basketball, hoping to excel
so that some professional team would give him a tryout. He
played in Europe for five years and was traded several times. At
age 30, he was finally cut.
This cut led to a major identity crisis. Chuck realized the
applause and adulation were now coming to a screeching halt.
He drank and used cocaine to excess to try to numb the pain of
his loss. He had failed to graduate from college, having only
junior standing when his scholarship eligibility ran out. He had
been carried in college by his tutor because his reading and
writing skills were at the 10th-grade level. He now fears he has
no saleable skills and is worried his money may soon run out.
He can no longer support his extravagant lifestyle. At the
present time, he is considering trying to get some fast money by
smuggling cocaine into the United States. His cocaine habit is
costing him $100 per day. What should he do? He doesn’t know,
but he’s dulling the pain with cocaine.
Simple reaction time reaches its optimum at around age 25 and
is maintained until around age 60, when the reflexes gradually
slow down. As people grow older, they learn more and are
generally better at a number of physical tasks in middle
adulthood than they were in their 20s. Such tasks include
driving ability, hunting, fishing, and golf. The improvement that
comes from experience outweighs minor declines in physical
abilities. The same is true in other areas. Skilled industrial
workers are most productive in their 40s and 50s, partly because
they are more careful and conscientious than younger workers.
Middle-aged workers are less likely to have disabling injuries
on the job—which is probably due to learning to be careful and
to use good judgment. Another factor in reduced accident rates

for this age group may be a reduction in the abuse of mind-
altering substances among middle-aged workers.
Changes in Intellectual Functioning
Contrary to the notion that you can’t teach an old dog new
tricks, mental functions are at a peak in middle age. Middle-
aged adults can continue to learn new skills, new facts, and can
remember those they already know well. Unfortunately, many
middle-aged people do not fully use their intellectual capacities.
Many settle into a job and family life and are less active in
using their intellectual capacities than they were in their
younger years, when they were attending school or when they
were learning their profession or trade. Some middle-aged
adults are unfortunately trapped by the erroneous belief that
they can’t learn anything new.
If a person is mentally active, that person will continue to learn
well into later adulthood. Practically all cognitive capacities
show no noticeable declines in middle adulthood. Adults who
mistakenly believe that they completed their education in their
20s are apt to show declines in their intellectual functioning in
middle adulthood. There is truth in the adage “What you do not
use, you will begin to lose.”
There are variations in regard to specific intellectual capacities.
People in middle adulthood who use their verbal abilities
regularly (either on the job or through some other mental
stimulation such as reading) further develop their vocabulary
and verbal abilities. There is some evidence that middle-aged
adults may be slightly less adept at tests of short-term memory,
but this is usually compensated by wisdom gained from a
variety of past experiences (Papalia & Martorell, 2015). If
middle-aged adults are mentally active, their IQ scores on tests
are apt to show slight increases.
Creative productivity is at its optimum point in middle age.
Scientists, scholars, and artists have their highest rate of output
generally in their 40s—and their productivity tends to level off
in the late 40s or 50s (Papalia & Martorell, 2015). There are
different age peaks for different types of creative production. In

general, the more unique, original, and inventive the
production, the more likely it is to have been created in a
person’s 20s or 30s rather than later in life. The more a creative
act depends on accumulated development, however, the more
likely it is to occur in the later years of life.
Middle-aged adults tend to think in an integrative way. That is,
they tend to interpret what they see, read, or hear in terms of its
personal and psychological meaning. For example, instead of
accepting what they read at face value (as younger people are
apt to do), middle-aged adults filter information through their
own learning and experience. This ability to interpret events in
an integrative way has a number of benefits. It enables a person
to better identify scams and “con games,” because an
integrative thinker is less naive. It enables many adults to come
to terms with childhood events that once disturbed them. It
enables middle-aged people to create inspirational legends and
myths by putting truths about the human condition into symbols
that younger generations can turn to for guidelines in leading
their lives. Papalia and Martorell (2015) note that people need
to be capable of integrative thought before they can become
spiritual and moral leaders.
Integrative thinking also enables people in their 40s and 50s to
be at the peak of their
practical problem-solving capacities. People in this age
group are best able to arrive at quality solutions for everyday
problems and crises, such as what is wrong with an automobile
that fails to start, how to repair a hole in drywall in a house, and
what types of injuries require medical attention.
In the past few decades, an increasing proportion of middle-
aged adults have been returning to college. Some want an
additional degree to move up a career ladder. Some seek
training that will help them to perform their present jobs better.
Some are preparing to seek a new career. Some are taking
courses to fill leisure time and to learn about subjects they find
challenging. Some want to expand their knowledge in special-

interest areas, such as photography or sculpting. Some want to
expand their interests in preparation for retirement years.
Professionals in rapidly expanding fields (such as computer
science, law, health care, gerontological social work,
engineering, and teaching) need to keep up with new
developments. Social work practitioners often take workshops
and continuing education courses to keep abreast of new
treatment techniques, new programs, and changes in social
welfare legislation. In our modern, complex society, it is
essential that learning continue throughout one’s lifespan.
Life is more meaningful if one’s intellectual capacities are
being challenged and used. College instructors are generally
delighted to have returning students in their classes, because
such students have a wealth of experiences to share and are
usually highly committed to learning. Compared to younger
students, they are less apt to major in “having a good time.”
When middle-aged adults return to college, they often need a
few weeks to get used to the routine of taking notes in classes,
writing papers, and studying for exams. A few courses, such as
mathematics and algebra, tend to be particularly difficult
because returning students have forgotten some of the basic
concepts they learned years ago. Because people at age 50 learn
at nearly the same rate and in the same way as they did at age
20, most returning students do well in their courses.
Colleges are not the only places that offer adult education
courses. Courses are also provided by vocational and technical
centers, businesses, labor unions, professional societies,
community organizations, and government agencies. The
concept of lifelong education has been a boon for many colleges
and universities.
In middle adulthood, there is generally only a small amount of
deterioration in physical capacities, and almost no deterioration
in potential for mental functioning. Cognitive functioning may
actually increase well into later adulthood (Lefrancois, 1999).
The sad fact is that many people are not sufficiently active,

either mentally or physically. As a result, their actual
performance, physical and mental, falls far short of their
potential performance.10-3Describe the Midlife Crises
Associated with Female Menopause and Male Climacteric
10-3aFemale Menopause
Menopause is the event in every woman’s life when she stops
menstruating and can no longer bear children. The median age
when menopause occurs is 51 years, although it may occur in
women as young as 36, or may not occur until a woman is in her
mid-50s. The time span ranging from two to five years during
which a woman’s body undergoes the physiological changes that
bring on menopause is called the
climacteric. There is some evidence of a hereditary
pattern for the onset of menopause, because daughters generally
begin and end menopause at about the same age and in the same
manner as their mothers.
Menopause is caused by a decrease in the production of
estrogen, which leads to a cessation of ovulation. Menopause
begins with a change in a woman’s menstrual pattern. This
pattern varies between women. Periods may be skipped and
become irregular. There may be a general slowing down of flow
of blood during menstruation. There may be irregularity in the
amount of blood flow and in the timing of periods. Or there may
be an abrupt cessation of menstruation. The usual pattern is
skipped periods, with the periods occurring further and further
apart.
During menopause, a number of biological changes occur. The
ovaries become smaller and no longer secrete eggs regularly.
The fallopian tubes, having no more eggs to transport, become
shorter and smaller. The vagina loses some of its elasticity and
becomes shorter. The uterus shrinks and hardens. The hormone
content of urine changes. All of these changes are biologically
related to cessation of functioning of the reproductive system.
The reduction of activity of the ovaries affects other glands and

may produce disturbing symptoms in some women. A majority
of women undergoing menopause encounter few, if any,
disturbing symptoms. As
Spotlight 10.2 indicates, the symptoms of menopause
may even vary among cultures.
Spotlight on Diversity 10.2Cultural Differences in Women’s
Experience of Menopause
The importance of doing cross-cultural research on widely held
beliefs is indicated in a study by Lock (1991) that compares
Japanese women’s experience of menopause to that of Canadian
women. Vast differences were found. Only 12.6 percent of
Japanese women who were beginning to experience irregular
menstruation reported experiencing hot flashes in a two-week
period compared to 47.4 percent of Canadian women. Fewer
than 20 percent of Japanese women had ever had a hot flash,
compared to almost 65 percent of Canadian women.
There is no specific Japanese word for a hot flash, which is
surprising, because the Japanese language makes many subtle
distinctions about all kinds of body states. This lack of a word
for a hot flash supports the finding of a low incidence of what
most Western women report as the most troubling symptom of
menopause.
Chornesky (1998) notes that Mayan women in Mexico do not
report having any symptoms related to menopause. Chornesky
also reports that symptoms of menopause are uncommon among
Native American women, interestingly, in Native American
cultures menopause is viewed as an important rite of passage,
signifying entrance into the highly respected state of elderhood
and opening up the opportunity to assume important new social
roles. For example, in the Lakota Sioux tribe, only after
menopause can a Lakota woman become a midwife or a
medicine woman and assume roles that are equal to those of
men in tribal affairs (Chornesky, 1998).
What does this research tell us? It emphasizes the importance of
conducting cross-cultural studies on biological phenomena. The

findings also mean that it would be a mistake to use a list of
menopausal symptoms drawn up in one country to assess women
in another country. The findings also suggest the possibility of
biological interpopulation variations in physical symptoms,
such as hot flashes. Finally, the research suggests that different
cultures view events (such as menopause) differently.
The most common symptom of menopause is the hot flash,
which affects approximately 50 percent of menopausal women
(Hyde & DeLamater, 2011). A hot flash generally occurs quite
rapidly, involves a feeling of warmth over the upper part of the
body (very similar to generalized blushing), and is usually
accompanied by perspiring, reddening, and perhaps dizziness.
Some women have hot flashes infrequently (once a week or
less), whereas others may have them every few hours. A hot
flash may last just a few seconds and be fairly mild, or it may
last for 15 minutes or more. It tends to occur more often during
sleep than during waking hours. A hot flash while sleeping
tends to awaken the woman, which contributes to insomnia.
Hot flashes appear to be due to a malfunction of temperature
control mechanisms in the hypothalamus (Hyde & DeLamater,
2017). Estrogen deficiency contributes to this malfunction. Hot
flashes generally disappear spontaneously after a few years.
Other changes may occur during menopause, most of which are
due to reduced estrogen. The hair on the scalp and external
genitalia may become thinner. The labia may lose their
firmness. The breasts may lose some of their firmness and
become smaller. There is a tendency to gain weight, and the
body contour may change, though some women lose weight.
Itchiness, particularly after showering, may occur. Headaches
may increase, and insomnia may occur. Some muscles,
particularly in the upper legs and arms, may lose some of their
elasticity and strength. Growth of hair on the upper lip and at
the corners of the mouth may appear. Many of these symptoms
can be minimized by regular exercise. In approximately one of
four women who are postmenopausal, the decrease in estrogen

leads to osteoporosis (see
Highlight 10.3).
Highlight 10.3Osteoporosis
Osteoporosis is a thinning and weakening of the bones. As a
result of a drop in blood calcium level, bones become thin and
brittle, with a consequent reduction in bone mass. Osteoporosis
is a major factor leading to broken bones in later life. Women
are much more susceptible to osteoporosis, particularly women
who are white, thin, and smokers, and those who do not get
enough exercise or calcium. Women who have had their ovaries
surgically removed in middle age are also more susceptible to
osteoporosis.
One of the dangers of osteoporosis is fractures of the vertebrae,
which can lead to those affected becoming stooped from the
waist up, with a height loss of 4 inches or more. Osteoporosis
also often leads to hip fractures in older women.
Osteoporosis is preventable. The most important preventive
measures include exercising, getting more calcium, and
avoiding smoking. Exercise appears to stimulate new bone
growth. It should become part of the daily routine early in life,
and continue at moderate levels throughout life. Weight-bearing
exercises (such as jogging, aerobic dancing, walking, bicycling,
and jumping rope) are particularly beneficial in increasing bone
density.
Most women in the United States drink too little milk and eat
few foods rich in calcium. It is recommended that women
should get between 1,000 and 1,500 milligrams (or more) of
calcium daily, beginning in their youth (Papalia et al., 2012).
Dairy foods are calcium rich. To avoid high-cholesterol dairy
products, low-fat milk and low-fat yogurt are recommended.
Other foods rich in calcium include canned sardines and salmon
(if eaten with the bones still present), oysters, and certain
vegetables, such as broccoli, turnips, and mustard greens. Also
useful is taking recommended daily amounts of vitamin D,
which helps the body absorb calcium.

An alternative treatment that used to be recommended is
hormone replacement therapy (HRT), which involves the
administration of estrogen to women at high risk for developing
osteoporosis, such as those who have had their ovaries removed
at a fairly young age. HRT is now seldom recommended for
preventing osteoporosis, as a major study in 2002 found that
women who received HRT, rather than a placebo, suffered more
strokes, more heart attacks, and more blood clots, and had
higher rates of invasive breast cancer (Spake, 2002).
A variety of psychological reactions also accompany
menopause, but certainly not every woman encounters
psychological difficulties at this time. If a woman is well
adjusted emotionally before menopause, she is unlikely to
experience psychological problems during it (Hyde &
DeLamater, 2017).
The psychological reactions a woman has to menopause are
partly determined by her interpretations of this life change. If a
woman sees this change as simply being one of many life
changes, she is not apt to have any adverse reactions. She may
even view menopause as a positive event, for she no longer has
to bother with menstruation or worry about getting pregnant.
On the other hand, if a woman views menopause negatively, she
is apt to develop such emotions as anxiety, depression, feelings
of low self-worth, and lack of fulfillment. Some women believe
menopause is a signal they are losing their physical
attractiveness, which they further erroneously interpret as
meaning the end of their sex life. Some no longer feel needed,
especially if their children have left the nest and they have a
low-paying, boring job—or no job at all. Some are widowed,
separated, or divorced, and regret still having to “scrimp and
save to make ends meet.” For many women, this is a time of
reexamining the past; if the past is interpreted as having been
something other than what they had desired, they feel
unfulfilled and cheated. Even worse, if they believe the chances
for a better life to be nil, they are apt to be depressed and have
a low sense of self-worth. If they viewed their main role in life

as being a mother and raising children, they now may feel a
sense of rolelessness; and if their children fall far short of
meeting their hopes and expectations, they are apt to view
themselves as a failure. Some women seek to relieve their
problems through alcohol. Others seek out understanding lovers.
Some isolate themselves, while others cry much of the time and
are depressed.
There is no clear-cut way to identify the exact time when
menopause ends. Most authorities agree that the climacteric can
be considered as ending when there has been no menstrual
period for one year. Physical symptoms of menopause usually
end when ovulation ceases.
Some doctors urge that some type of birth control be continued
for two years after the last period in order to prevent pregnancy.
“Change-of-life” babies are rare because conception, although
possible, is unlikely to occur. Middle-aged pregnancies do
present increased health risks. The child has a higher chance of
having a birth defect. For example, the risk of Down syndrome
is greatest with older parents; the chances rise from 1 in 2,000
among 25-year-old mothers to 1 in 40 for women over 45
(Papalia et al., 2012). Spontaneous abortions are more common
in women who become pregnant after the age of 40. In addition,
older women are more apt to have a prolonged labor due to the
loss of elasticity of the vagina and the cervix.
Since the most troublesome physical symptoms of menopause
are linked to reduced levels of estrogen, hormone replacement
therapy (HRT) in the form of artificial estrogen is sometimes
prescribed by physicians. Because estrogen taken alone
increases the risk of uterine cancer, women who still have a
uterus are usually given estrogen in combination with progestin,
a form of the female hormone progesterone. The use of HRT has
become highly controversial, as it has been found that HRT
increases the risk of strokes, heart attacks, invasive breast
cancer, and blood clots (Spake, 2002). The medical profession
is now studying using alternative approaches to treating

menopause.
10-3bMale Climacteric
In recent years, there has been considerable discussion about
“male menopause.” In a technical sense, the term is a misnomer,
as menopause means the cessation of the menses. The term
male climacteric is more accurate. It should be noted
that men who have gone through male climacteric still retain the
potential to reproduce.
Sometime between the ages of 35 and 60 men reach an uncertain
period in their lives that has been termed a
midlife crisis. It is a time of high risk for divorce, for
extramarital affairs, for career changes, for accidents, and even
for suicide attempts. All men experience it to some degree and
emerge a bit changed, for better or for worse. It is a time of
questions: “Is what I’m doing with my life really satisfying and
meaningful? Would I be better off if I had pursued a different
vocation or career? Do I really want to be married to my
partner?”
Male climacteric is a time when a man reevaluates his marriage
and his family life. This period of reassessment is often
characterized by nervousness, decrease in sexual activity,
depression, decreased memory and concentration, decreased
sexual interests, fatigue, sleep disturbances, irritability, loss of
interest or self-confidence, indecisiveness, numbness and
tingling, fear of impending danger, and/or excitability. Other
possible symptoms are headaches, vertigo, constipation, crying,
hot flashes, chilly sensations, itching, sweating, and/or cold
hands and feet.
A man going through male climacteric usually encounters some
event that forces him to examine who he is and what he wants
out of life. During this crisis, he looks back on his successes
and failures, his degree of dependency on others, the outcomes

of his dreams, and examines his capabilities for what lies ahead.
Depending on what he sees and how he deals with it, this
experience can be either exhilarating or demoralizing. He sees
the disparity between youth and age, between hope and reality.
Male climacteric is caused by a combination of biological and
psychological factors. As a male grows older, his hair thins and
begins to turn gray. He develops more wrinkles and tends to
develop a “tire” around his waist. His physical energy gradually
decreases, and he can no longer run as fast as he once did.
There are changes in his heart, his prostate, his sexual capacity,
his chest size, his kidneys, his hearing, and his gastrointestinal
tract.
The production of testosterone gradually decreases.
Testosterone is an androgen that is the most potent naturally
occurring male hormone. It stimulates the activity of male
secondary sex characteristics, such as hair growth and voice
depth, and helps to prevent deterioration in the sex organs in
later life. The male sex glands are essential for the vitality of
youth. These glands are the first glands to suffer when aging
occurs. Two of the subtler changes (as compared to hair loss,
wrinkles, slowing blood circulation, and more sluggish
digestion) are a decline in the number of sperm in an ejaculation
and a reduction of testosterone present in the plasma and urine.
The testes lose their earlier vigorous functioning and produce
decreasing amounts of hormones. Older men generally take a
longer time to achieve an erection. It also takes a longer time
before an erection can be regained after an orgasm.
Some men do have greater hormonal fluctuations at climacteric.
Hyde and DeLamater (2017) summarize studies that have found
evidence of monthly cycles in some men with hormonal
fluctuations in a 30-day rhythm.
While biological changes (including the diminishing production
of sex hormones) play an important part in male climacteric,
perhaps even more important is the problem of being middle-
aged in a culture that worships youth. Many of the problems
associated with male climacteric are due to psychological

factors.
There is the fear of aging, which is intensified by the awareness
that mental and physical capacities are declining, including
sexual capacities. Also involved is the fear of failure, either in a
job or in the man’s personal life. Fear of women may be a part
of this. A man may think that his sexual prowess is waning, and
then may fear women’s greater sexual capacities. He may also
have a fear of failing in his sexual activities. The man with self-
doubts is especially susceptible to the fear of rejection. He is
very sensitive to derogatory comments about his age,
his physique, or his thinning hah. A fear of death may be
apparent as he realizes he has probably lived at least half of his
life. All of these fears are apt to have an adverse impact on his
emotional and sexual functioning.
A significant part of male climacteric is due to depression,
which is often brought on when a man fears aging and
recognizes that His sexual powers are waning (Hyde &
DeLamater, 2011). He also realizes that he will never achieve
the successes that he envisioned for himself years earlier. His
bouts with depression may be so profound that he may
contemplate suicide. Depression during this midlife crisis may
also be triggered by a reevaluation of childhood dreams,
conflicts in need of resolution, new erotic longings and
fantasies, sadness over opportunities lost, and a new
questioning of values. All of this is coupled with a search for
new meaning in life. He realizes half of his life may be gone,
and time becomes more precious. He worries about things
undone, and there does not seem to be enough time for
everything. He has the feeling of missing out on a big chunk of
life. The man who is engaged in activities outside his daily job
is a less likely candidate for depression. It is unbalanced to be
so busy with getting ahead that the pleasures of life are missed.
To recapture some of his former enthusiasm and perhaps to
shake some of his unsettling doubts and fears, he may drive
himself to work harder, to exercise more, or to seek younger

women.
A man at midlife is also apt to experience a growing
dissatisfaction with his job. He feels a sense of entrapment as
the pressure to pay bills forces him to continue working at a job
that he finds increasingly boring and unfulfilling. At the same
time, his personal identity is deeply entwined with his work
roles. His job has provided him with an opportunity to further
develop his identity, to enter into a stable set of relationships
with colleagues and/or clients, and to explain his place in the
world. Now he questions that place. Occupational aspirations
may change several times during this period. The emphasis may
shift from measuring success in terms of achievement to
measuring it in terms of economic security. Also at this time,
movement up the occupational ladder is largely completed. If a
man has not achieved his work goals by age 40 or 50, he may
realize he may never achieve them; he may even be demoted one
or two steps down the occupational ladder.
10-3cMidlife Crisis: True or False?
The ease or panic with which a man faces his middle years will
depend on how he has accepted his faults and his strengths
throughout life. The man who has developed a strong affective
bond with his family will fare better than the man who has
followed a more isolated and career-oriented course. To age
gracefully is to realize that he has done the best he could with
his life.
Many physicians will prescribe antidepressant therapy and
counseling, and recommend the support and understanding of
family and close friends (Hyde & DeLamater, 2011). Men who
undergo a midlife crisis need to realize that there is still a great
deal of pleasure and satisfaction to be gotten out of life. This is
not the end; there are still things left for them to do.
Women go through similar psychological worries (for example,
the empty-nest syndrome). Recent research indicates that a
declining proportion of women are affected by the empty-nest
syndrome because more women are emphasizing careers.

Midlife is a time of reassessment for both sexes as people in
this age group look over their lives. It is a time of reprioritizing
one’s life. With the right attitude, this period can become a time
of reappraisal, renewed commitment, and growth.
But the realization of slow deterioration in one’s physical
capacities and of a disparity between one’s earlier dreams and
present reality is apt to be a crisis for many people.
Some health evidence shows that midlife is a time of crisis for
many people. Hypertension, peptic ulcers, and heart disease are
most often diagnosed in middle-aged patients. The rate of first
admissions for alcoholism treatment is higher for middle-aged
individuals than for younger adults (Papalia & Martorell, 2015).
These statistics suggest that middle adulthood can be a period
of stress and turmoil.
Thus, it appears that midlife is a time of transition and change.
It is a crisis for some, but not for others (Hyde & DeLamater,
2011). For some women, menopause is a precipitating factor
that sets off a midlife crisis; for other women, some of the
symptoms may be uncomfortable, but an identity crisis is not
precipitated. For some men and women, their children leaving
home precipitates an identity crisis; other men and women
delight in seeing their children grow and develop, and
experience a new sense of freedom in being able to travel
more and to pursue more vigorously special interests and
hobbies. Most men and women look forward to the departure of
the youngest child.
Men who undergo a midlife crisis are apt to have had
adjustment problems for a long time. Kaluger and Kaluger
(1984, p. 541) conclude, “Midlife crises may be the result of
unadjusted adolescents and young adults who grow up to be
unadjusted middle-aged adults rather than the result of a
universal crisis confined to midlife.”
Stage theorists (such as Daniel Levinson; see
Chapter 11) view midlife as a crisis, believing that the
middle-aged adult is suspended between the past and the future,

trying to cope with this gap that threatens life’s continuity.
Adult development experts are virtually unanimous in their
belief that midlife crises have been exaggerated (Santrock,
2013). There is often considerable variation in the way people
experience the stages of life.
In contrast to stage theories, the
contemporary life events approach asserts that such
events as divorce, remarriage, death of a spouse, and being
terminated from employment involve varying degrees of stress,
and therefore vary in their influence on an individual’s
development (Lorenz, Wickrama, Conger, & Elder, 2006). This
approach asserts that how life events influence an individual’s
development depends not only on the life event itself but also
on a variety of other factors, including physical health, family
supports, the individual’s coping skills, and the socio-historical
context. (For example, an individual may be better able to cope
more effectively with divorce today than in the 1960s because
divorce has become more commonplace and accepted in today’s
society.)
10-4Summarize Sexual Functioning in Middle Age
10-4aSexual Functioning in Middle Age
Sexual expression is an important part of life for practically all
age groups. In this section, we will focus on sexual functioning
during middle adulthood—in marriage, in extramarital
relationships, for those who are divorced or widowed, and for
people who have never married.Sex in Marriage
A close relationship exists between overall marital satisfaction
and sexual satisfaction, particularly for men (Hyde &
DeLamater, 2017). These two factors probably influence each
other. Marital satisfaction probably increases the pleasure
derived from sexual intercourse, and a satisfying sexual
relationship probably increases the satisfaction derived from a
marriage. Women are much more likely to be orgasmic in very
happy marriages than in less happy marriages (Hyde &

DeLamater, 2011).
Generally speaking, marriage partners report satisfaction with
marital sex. For men, satisfaction is highest in the 18–24 age
group and decreases slightly as men grow older. For women,
satisfaction is highest in the 35–44 age group. These findings
are consistent with studies that have found that a man’s sex
drive reaches its peak at a relatively young age, whereas a
woman’s tends to peak in her late 30s or early 40s (Hyde &
DeLamater, 2017).
The percentage of people engaging in sexual intercourse by age
groups is presented in
Table 10.1. The frequency of coitus is highest when the
individuals are in their 20s and 30s, and then gradually declines
as people grow older.
Table 10.1Percentage Engaging in Sexual Intercourse
Age Groups
Not At All
A Few Times Per Year
Few Times Per Month
2–3 Times a Week
4 OR More Times a Week
Men
18–24
15
21
24
28
12
25–29
7
15
31
36
11
30–39

8
15
37
23
6
40–49
9
18
40
27
6
50–59
11
22
43
20
3
Women
18–24
11
16
32
29
12
25–29
5
10
38
37
10
30–39
9
16
6
33
6

40–49
15
16
44
20
5
50–59
30
22
35
12
2
Source: Santrock (2016)
Hyde and DeLamater (2011) note that for women there is a
strong correlation between the frequency of intercourse and
satisfaction with marital sex. There is also a strong correlation
between a wife’s ability to communicate her sexual desires and
feelings to her husband and the quality of marital sex.
After the birth of their first child, couples report less sexual
satisfaction on average than do childless couples (Hyde &
DeLamater, 2011). The presence of children in a family
generally functions as an inhibition to sexual relations.
Contrary to popular belief, the highest frequency of sexual
intercourse occurs in childless couples. Many adjustments,
pressures, and problems can be associated with parenthood.
For some couples, the birth of the first child produces
difficulties, particularly if the pregnancy was unplanned. Wives
usually experience the most stress after the birth of the first
child. They are apt to be concerned about their physical
appearance, have increased responsibilities that lead to fatigue,
and sometimes feel neglected by their husbands as the husband–
wife interactions and social activities tend to decline. The
arrival of more children tends to further lessen sexual
satisfaction in the marriage.
The frequency of sexual intercourse appears to be negatively

related to the number of children in a family (Hyde &
DeLamater, 2011). To some extent, the reduction of sexual
activity and sexual gratification with parenthood is offset by the
increased gratifications that most parents receive from being
parents—watching and helping their children grow and develop,
and feeling pride in performing parental roles.
Married couples now use a greater variety of sexual techniques
than couples in earlier generations did. The female-on-top
position is increasingly being used, because it gives the female
greater control over stimulation of the clitoris than the man-on-
top position. Oral sex has also become more popular. Couples
today also spend a longer time making love than couples did
decades ago. Most couples now spend between 15 minutes and
an hour having sex (Hyde & DeLamater, 2011). This change
may reflect a greater awareness by married men and women that
women are more likely to enjoy sex more and to be orgasmic if
intercourse is unhurried.
Crooks and Baur (2011) summarize information on
masturbation:
Most men and women, both married and unmarried, masturbate
on occasion. Women tend to masturbate more after they reach
their 20s than they did in their teens. Kinsey hypothesized that
this was due to increased erotic responsiveness, opportunities
for learning about the possibility of self-stimulation through sex
play with a partner, and a reduction in sexual inhibitions.
Masturbation is often considered inappropriate when a person
has a sexual partner or is married. Some people believe that
they should not engage in a sexual activity that excludes their
partners, or that experiencing sexual pleasure by masturbation
deprives their partners of pleasure. Others mistakenly interpret
their partner’s desire to masturbate as a sign that something is
wrong with their relationship. But unless it interferes with
mutually enjoyable sexual intimacy in the relationship,
masturbation can be considered a normal part of each partner’s
sexual repertoire. It is common for people to continue

masturbation after they marry. In fact, individuals who engage
in sexual activity with their partners more frequently than other
individuals also masturbate more often. (p. 233)
See
Highlight 10.4—
Five languages of love.
Highlight 10.4Five Languages of Love
Some people mistakenly believe that being a great sex partner is
the best way to communicate love to one’s mate. A good sex
life is indeed important, but there are five other more important
ways to express love to one’s mate, according to Gary Chapman
(1992). These five emotional love languages are
· (1)
words of affirmation,
· (2)
quality time,
· (3)
gifts,
· (4)
acts of service, and
· (5)
physical touch.
We fall in love because of the way we feel about ourselves
when we are with that person. In a nutshell, if we want a certain
person to love us, we need to make that person feel special.
What is the secret to making someone feel special? Chapman
indicates it is through the above five emotional love languages.
It is important to recognize that there is considerable variation
in how each person prioritizes these love languages; for
example, one person may assign the highest value to physical
touch and the lowest to gifts, while another person may assign
the highest value to quality time and the lowest to words of
affirmation. If we want our mate to feel special, it is critical for
each of us to determine the values that our mate assigns to each
of these love languages. Before we discuss how we determine

our mate’s priorities about these five languages of love, each of
these love languages will be briefly described.
(1) Words of affirmation: Words of appreciation, or verbal
compliments, are powerful communicators of love. Examples
include the following: “You look great in that outfit”; “The
dinner you just made is the best I’ve eaten in a long time”; “I
truly appreciate you doing the laundry this evening”; and “I
love how you can talk with anyone.” Words of affirmation have
an additional benefit of building your mate’s self-image and
confidence. (The focus of love should not be on getting
something you want, but on doing something for the well-being
of the one you love.)
(2) Quality time: Some mates believe that doing things together,
being together, and focusing in on one another is the best way
to show love. “Quality time” involves giving your mate your
undivided attention. If your mate highly values quality time,
you need to turn off the TV and focus on attending to what your
mate is desiring. Quality time is not just being in close
proximity, but being together with focused attention. One way
to learn to better communicate focused attention with your mate
is to establish a daily sharing time in which each of you talks
about some significant things that happened to you that day and
how you feel about them.
(3) Gifts: In every culture, members give gifts to one another. A
gift is something your mate can hold in his or her hand and
conclude “Look! He is thinking of me,” or “She values me.” If
your mate’s primary love language is receiving gifts, you
should become a proficient gift giver. Giving gifts may be the
easiest love language to learn. Gifts do not necessarily have to
always be material in nature; for example, if your mate is
encountering a crisis, your most powerful gift may be physical
presence. Gifts also do not need to be expensive to send a
powerful message of love. Mates who forget a special day of
their mate’s (such as a birthday) will soon discover that their
mate feels neglected and unloved.
(4) Acts of service: There are an infinite number of acts of

service—vacuuming, cooking a meal, doing the dishes, washing
your mate’s car, painting a room, making the bed, taking out the
trash, fixing a broken appliance, going to the grocery store to
purchase products your mate wants, volunteering to visit your
mate’s parents, and so on. Discovering what your mate most
wants you to do in regard to acts of service requires observation
and trial and error. (You can let your mate know what you most
desire in regards to acts of service by highlighting what you
most cherish—while remembering that demands stop the flow of
love.)
(5) Physical touch: Physical touch is a way to communicate
emotional love. Everyone needs to be held and hugged.
Rene Spitz (1945) demonstrated that even young children need
physical contact, such as being cuddled and held. Without such
direct physical contact, the social, intellectual, emotional, and
physical development of children will be severely stunted.
Everyone needs to observe what their mate cherishes in regard
to physical touch: sometimes hugging your mate, stroking their
back, holding hands, or a kiss on the cheek will fulfill this need.
The right physical touch can improve a relationship, while the
wrong physical touch (such as hitting) can break a relationship.
If your mate’s primary love language is physical touch, holding
him or her when he or she is in crisis may be the most important
thing you can do. Physical touch includes learning and doing
what your mate cherishes in your sexual relationship.
Each of us has a primary love language—odds are that your
mate’s primary love language is not the same as yours. All of us
need to observe and learn (often through trial and error) what
our mate’s primary love language is. And then we need to seek
to fulfill our mate’s love language—if we want him or her to
feel special and be in love with us.
Interestingly, each person can learn his or her love language
preferences by taking a 30-question quiz
at www.5lovelanguages.com/profile/. If you want to know the
love language preferences of your mate, you can ask him or her
to take the quiz, and then share the results with you.

Extramarital Sexual Relationships
Different studies have found a wide variation in the percentage
of men and women who report having had an affair while they
were married: 5 to 26 percent of husbands, and 1 to 23 percent
of wives reported having affairs (Hyde & DeLamater, 2017).
For males, the frequency of extramarital coitus decreases with
age, whereas with females, there is a gradual increase up to
around age 40. These sex differences may reflect differences in
the peaking of the sex drive. Wives with full-time jobs outside
the home are more apt to have extramarital affairs than are
wives who do not have jobs. Wives with full-time jobs have an
increased opportunity to become acquainted with a variety of
men who are not known by the husband.
EP 1
1. Do you believe an extramarital affair is sometimes
justifiable? If you were married and your spouse had an
extramarital affair, would you seek a divorce?
Spouses become involved in extramarital coitus for a variety of
reasons. In some cases, marital sex may not be satisfying. The
spouse’s partner may have a long-term illness or a sexual
dysfunction, or the couple may be separated. The extramarital
affair may represent an attempt to obtain what is missing in the
marriage. Some seek extramarital involvements to obtain
affection, to satisfy curiosity, to find excitement, or to add to
their list of sexual conquests. Some become involved in
extramarital affairs to get revenge for feeling wronged by their
spouse. Some want to punish their spouse for not being more
affectionate or appreciative. In many cases, there is a
combination of reasons for an extramarital affair.
Some surveys have examined why a high percentage of married
couples do not have extramarital affairs. The most mentioned
reason is that it would be a betrayal of trust in the love
relationship. Other stated reasons are that it would damage the

marital relationship, that it would hurt the spouse, and that the
probable benefits of an affair are not worth the consequences
(Hyde & DeLamater, 2011).
In most cases, extramarital affairs are carried out in secret.
Sometimes the spouse later discovers the affair. Typical
reactions to the affair are summarized by Maier (1984) through
his experiences as a marriage counselor:
Among the most common feelings expressed by a spouse after
such a discovery are anger and a sense of being deceived and
betrayed. In addition, the affair is often seen as a symbolic
insult to the spouse’s affection and sexual adequacy. Certain
subcultures consider it appropriate to seek some type of revenge
or retribution.
Generally speaking, isolated sexual experiences are less
disturbing to spouses than prolonged extramarital affairs. Brief
sexual encounters can sometimes be written off as temporary
reactions to sexual frustration; however, longer affairs are seen
as greater threats to the marital love relationship, (p. 322)
In the new digital age, sexual relationships no longer need to
occur face to face. With the click of a mouse or an app on a
phone, individuals are able to connect with other individuals
from all over the world. It is easy to send a message to an old
girlfriend/boyfriend or meet someone new with similar
interests. Popular dating sites (Match.com, eHarmony, Tinder,
etc.) encourage singles to meet online as a way of screening
potential suitors. However, for committed couples, these types
of interactions can cause problems to relationships as what
starts as a simple get to know you can turn into a romantic or
sexual relationship, leading to a cyber affair (Hyde &
DeLamater, 2017). In other cases, individuals may seek out
online sexual interactions to satisfy some internal need or to
fulfill a fantasy. Representative Anthony Weiner agreed to step
down from office after it was found out that he was sexting,
tweeting sexual material, and having online relationships with
women other than his wife. In one study of 183 adults in a
relationship, 10 percent reported having an intimate online

relationship (Smith, 2011). Some individuals justify their
behavior by stating that online intimacy is not the same as an
affair as they are not physically having sexual relationships
with another person. Many other individuals disagree. Cyber
affairs have caused a partner to pull away from the other partner
and some even report less interest in sex with their committed
partner (AAMFT, 2016). Once found out, cyber affairs lead to a
lack of trust, feelings of inadequacy, and even divorce.
Marriages can survive cyber affairs; however, marriage
counseling is encouraged to address how to repair the marriage
and deal with any other problems that may exist in the marriage.
The discovery of an extramarital affair may lead to a divorce,
but not always. Sometimes the discovery of an affair is a crisis
that forces a couple to recognize that problems (sexual or
nonsexual) exist in their marriage, and the couple then seek to
work on these to improve the marriage. Some spouses
reluctantly accept and adjust to the affair without saying much.
They may be financially dependent on their partner, or they may
have a low sense of self-worth and have made adjustments to
being emotionally abused by their spouse in the past. Others
show little reaction because they realize a divorce is expensive,
socially degrading, and may result in loneliness. In such
marriages, the relationship may become devitalized, with the
partners having little emotional attachment to each other.
A few spouses react to an extramarital affair by gradually
entering into a consensual extramarital relationship. In such a
relationship, extramarital sexual relationships are permitted and
even encouraged by both partners. One type of consensual
extramarital sex arrangement is
mate swapping. In this arrangement, two or more
couples get together and exchange partners, either retiring to a
separate place to have sexual relations or having sex in the same
room with various combinations of partners.

Unit 4Readings and ResourceseBookZastrow, C., Kirst-Ashma.docx

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