Ectopic Pregnancy

Universidad de Costa Rica
Sede del Atlántico
Recinto de Guápiles

Oral communication v

Ectopic pregnancy
Teacher: Robertho Mesén Hidalgo

Work team:

Arce Campos Gabriela
Arias Varela Randall
Barrantes Hernández Verónica
Contreras Obando Tatiana


I semester, 2010

Contents
Abstract 3
Background of the problem 3
Justification 4
Problem 5
Terminal objective: 5
Enabling objectives: 6
THEORETICAL FRAMEWORK 6
Ectopic pregnancy: 6
Causes, symptoms, treatment and consequences 6
Terminologies 16
Conclusions 22
Recommendations: 23
Outline 24
References 26

Abstract

The following work is about ectopic pregnancies, the main factors to take into account in this study, are first of all, generalities about that kind of pregnancies, then we are going to talk about the principal causes for instance: smoking, medications with hormones, birth defects; symptoms for example abdominal pain, bleeding and possible options of treatments such as surgery, injections; another important aspect is the consequences for women that suffer ectopic pregnancies.
Also is important to mention that you can find some conclusions and recommendations about how can you prevent or minimize the risk of suffer an ectopic pregnancy.



Background of the problem

Ectopic pregnancy (EP) also called tubal pregnancies, because the 95% of ectopic pregnancies occur in the uterine tube, are terms used to describe pregnancies occurring outside of the uterus, and this fact is automatically a synonym of fetal loss.
The baby cannot be saved in a tubal ectopic pregnancy. However, with early diagnosis, the pregnancy can be safely ended using medication or surgery. It increases the possibilities of having a normal pregnancy at a later date. Even worst, if left untreated, an ectopic pregnancy can be fatal (it is the main cause of 1st trimester maternal death).
A quotation from Nora Ephron says “if pregnancy were a book they would cut the last two chapters”. We can add “it could be worst if this book ends in an ectopic pregnancy”. For that reason, according to prevent this kind of pregnancy complication, it is important to know more about the generalities, causes, symptoms, diagnosis and treatment.




Justification

This investigation was created in the Universidad de Costa Rica, Sede Del Atlántico, Recinto de Guápiles by a team work during the I semester of 2010, in oral communication V. To continue it is presented and developed the following research.
The team work is pleased to share relevant information to the students about ectopic pregnancy or pregnancy out of place, which it is a risky stage for the sake of many women who are waiting a baby without any knowledge of the abnormal pregnancy, if they are having. It is important to let the people know about the topic because it is a serious problem that women and their families have to confront with strength; the information is not only directed for students, but also for someone else who want to be informed about the case.
It should help to be alert to the signals which appears during this kind of gestation in order to be warned to any complication that could be presented in these period, besides that, to take at time the appropriate treatment in an institution for the sake of the mother’s life; maintaining them in the better conditions as well as possible.



Problem

Nowadays the infant mortality rate is decreasing in our country, but the number of cases of ectopic pregnancies is increasing affecting to the fetus life and causing different problems such as infertility and even death on many women that are in gestation stage within an ectopic. It is important to everybody to know what are the causes, symptoms, the treatment, consequences, and how to prevent it in order to take the appropriated procedure if it is necessary with the goal of save their lives, besides to inform the students of this estrange pregnancy.


Terminal objective:

To recognize the process in which the ectopic pregnancy works in a pregnant woman and some factors related to this phenomenon.

Enabling objectives:

• To distinguish some of the causes of an ectopic pregnancy
• To mention the possible consequences for a woman in a ectopic pregnancy
• To identify different kind of treatments and advices for woman who suffer an ectopic pregnancy

THEORETICAL FRAMEWORK

Ectopic pregnancy:
Causes, symptoms, treatment and consequences

An ectopic pregnancy is that is not in the uterus. The fertilized egg settles and grows in any location other than the inner lining of the uterus. The large majority (95%) of ectopic pregnancies occur in the Fallopian tube. However, they can occur in other locations, such as the ovary, cervix, and abdominal cavity. We have to remember that an ectopic pregnancy occurs in about 1 in 60 pregnancies. Most ectopic pregnancies occur in women 35 to 44 years of age and the major concern with an ectopic pregnancy is internal bleeding.
Before the 19th century, the mortality rate (the death rate) from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to five percent because of surgical intervention. With current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. Ectopic pregnancy remains the leading cause of pregnancy-related death in the first trimester of pregnancy.
It is really important that when a woman knows she is pregnant, make an appointment with her doctor for an examination. Occasionally, the doctor may feel a tender mass during the pelvic examination. If an ectopic pregnancy is suspected, the combination of blood hormone tests and pelvic ultrasound can usually help to establish the diagnosis. Transvaginal ultrasound is the most useful test to visualize an ectopic pregnancy. In this test, an ultrasound probe is inserted into the vagina, and pelvic images are visible on a monitor. Transvaginal ultrasound can reveal the gestational sac in either a normal (intrauterine) pregnancy or an ectopic pregnancy, but often the findings are not conclusive. Rather than a gestational sac containing a visible embryo, the examination may simply reveal a mass in the area of the Fallopian tubes or elsewhere that is suggestive of, but not conclusive for, an ectopic pregnancy. The ultrasound can also demonstrate the absence of pregnancy within the uterus.
The beta subunit of human chorionic gonadotrophin (beta HCG) blood levels are also used in the diagnosis of ectopic pregnancy. Beta HCG levels normally rise during pregnancy. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy. In rare cases, laparoscopy may be needed to ultimately confirm a diagnosis of ectopic pregnancy. During laparoscopy, viewing instruments are inserted through three or more small (5-10 mm) incisions that are made in the abdomen to allow access ports to be inserted. The surgeon then uses the laparoscope, which transmits a picture of the abdominal organs on a video monitor, allowing the operation to be performed.
One of the most important test to confirm the diagnosis of ectopic pregnancy is a pelvic exam that is a way for doctors to look for signs of illness in certain organs in a woman's body. The exam is used to look at a woman's: Vulva (external genital organs), Uterus (the womb), Cervix (opening from the vagina to the uterus), Fallopian tubes (tubes that carry eggs to the womb), Ovaries (organs that produce eggs) and the Bladder (the sac that holds urine).
An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.
It's important to remember that in most cases of ectopic pregnancy, the cause is unknown. However, several factors can raise your risk for an ectopic pregnancy such as scarring caused by: Past ectopic pregnancy, Past infection or inflammation in the fallopian tubes, Use of an intrauterine contraceptive device (IUD), Surgery of the fallopian tubes or in the pelvic area.
Some ectopic pregnancies can be due also to:
• Birth defects of the fallopian tubes
• Complications of a ruptured appendix
• Endometriosis: Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.
• Smoking: is also associated with up to a five times greater risk of ectopic pregnancy. The problem is the nicotine in cigarettes, because it stimulates contractions in the fallopian tubes. This can cause spasm, resulting in temporary blockage of the tube so the embryo cannot pass through.
• Medications: Several hormonal medications like Fertility drugs and Contraceptive hormonal medications that contain progesterone-like hormones have also been associated with ectopic pregnancies, that kind of medications may predispose women to tubal pregnancies by altering the ability of the fallopian tube to contract and squeeze the embryo through to the womb.
Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 - 3 years after tubal sterilization will be ectopic.
Taking hormones, especially estrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilized egg through the tubes and lead to ectopic pregnancy.
Women who have in vitro fertilization or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy.
The "morning after pill" (emergency contraception) has been linked to some cases of ectopic pregnancy.
What about the future? The chances of having a successful pregnancy after an ectopic pregnancy may be lower than normal, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.
Some women have difficulties to be pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage that was done.
The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.
A important question that the woman make after had an ectopic pregnancy is about the chance to have a normal pregnancy and a successful one and the answer is yes, the earlier you end an ectopic pregnancy, the less damage you'll have in that tube and even if you lost one of your tubes, you can still have a normal pregnancy as long as your other tube is normal.
But if you're unable to conceive because of ectopic pregnancies or damaged tubes, the good news is that you're likely to be an excellent candidate for fertility treatments such as in vitro fertilization (IVF), in which your healthy embryos are implanted directly in your uterus.
An important consequence of the ectopic pregnancy is the feeling of devastated by the experience. Also the recovering from major surgery is one of the main consequences, which can leave the person exhausted and numb, or suffering from hormonal ups and downs that can leave you feeling depressed and vulnerable.
The person need time to recuperate emotionally and physically before trying for another baby. Most caregivers will advise the person to wait at least three months after major abdominal surgery for your body to heal.
In the emotional part, is very important to say that the partner may also be feeling sad or helpless and may have trouble figuring out how to express those feelings or how to be supportive.
The options for treatment depend largely on how developed the embryo is when the woman goes in for treatment, as the size of the embryo is a main factor for determining the treatment-type. An ectopic pregnancy starts out in the unruptured state, which is when the mass is still small enough to fit in the fallopian tube. However, if left untreated for too long, the mass will continue to grow until it eventually gets so large that it will rupture the tube. All these treatments are forms of abortion. A woman's chances of survival if she does not abort are very, very slim.
If the pregnancy is discovered in the unruptured state and the patient is stable (no major bleeding problems), a drug called methotrexate can be used if the mass is less than 3.5 cm in diameter. This drug cannot be used if the embryo is too developed because it works by preventing the rapid division of cells in the early embryo; the embryo is then reabsorbed. Methotrexate can either be injected by means of a shot, IV, or transvaginally into the fallopian tube. Either single or multiple doses can be used. Side effects of methotrexate use are very minimal, including nausea and fatigue. Contraindications to the use of methotrexate include:
a) Active lung disease
b) Cardiac problems
c) Pelvic pain
d) Early indications of shock
e) White blood cell count less than 3,000
However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what’s going on inside of the body without making large incisions. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or removed.
If the mass is greater than 3.5 cm and the woman is experiencing signs of blood loss and shock, surgical treatment will be required, which takes 60 minutes on average (although it can range from 13-240 minutes). There are 2 different types that can be performed:
Salpingostomy: this conservative procedure involves removal of the part of the fallopian tube that contains the fetus. It is done to maximize the preservation of the tube for subsequent fertility. The 2 ends of the cut tube are rejoined after healing has taken place. The woman should be informed that rejoining the tubes results in a decreased fertility and thus a higher rate of recurrent ectopic pregnancy.
Salpingectomy: this procedure involves the removal of the whole fallopian tube on the side where the ectopic occurred. It is done if conservative surgery is not possible, like when the tube is damaged or deformed. This procedure decreases fertility even more than salpingostomy; there is the chance of subsequent ectopic pregnancy, but not as much as with salpingostomy. It is important to understand that this surgery itself does not cause more ectopics. It is simply that women who had an ectopic because of one abnormal tube are more likely to have the same abnormality in the other tube, and thus more chance of an ectopic.
If the pregnancy is further along, you'll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area. This might still be necessary in cases of emergency or extensive internal injury.
The goal of treatment is to use the least invasive method that has the highest success rate and will preserve the woman's subsequent fertility.
Here is a table that provides some useful information regarding the success rates and benefits of methotrexate versus laparoscopy.
Treatment Success Rate Post-op stay Time for HCG back to normal Subsequent pregnancy rates Fertility Differences
Methotrexate 88.2% 24 hours 29 days 50-79% Use of methotrexate results in lower rate of repeat ectopic pregnancy
Laparoscopy (salpingotomy 95.9% 46 hours 13 days 50-85%



There are other procedures to save the mother's life such as:
• Blood transfusion
• Fluids given through a vein
• Keeping warm
• Oxygen
• Raising the legs
Whatever the treatment will be, the doctor will want to see the patient regularly afterward to make sure your Human chorionic gonadotropin or Human chorionic gonadotrophin (hCG) levels return to zero,( it is a hormone produced in pregnancy that is made by the developing embryo after conception and later by the part of the placenta. Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans. It may have additional functions; for instance, it is thought that hCG affects the immune tolerance of the pregnancy. Early pregnancy testing, in general, is based on the detection or measurement of hCG. Because hCG is produced also by some kinds of tumor, hCG is an important tumor marker). This may take several weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.
After a woman has an ectopic pregnancy, her HCG (human chorionic gonadotropin) levels need to be monitored. She will need to have her levels checked 48 hours after her treatment and then once a week until they go back to being negative. The woman does not need to make a separate doctor's appointment for each of these tests; usually, she can simply walk into the doctor's office in the morning to get her blood tested. If these levels do not become negative, surgery or additional methotrexate treatment will be required. The woman will also need to use contraception for at least 3 months after her ectopic to allow the fallopian tubes time to heal (unless her tube was removed altogether). The next time she does miss a period, she needs to see a doctor right away to make sure it is not another ectopic. Her doctor will measure HCG levels and perform an ultrasound.




Terminologies


Pregnancy:
According to Dr. Ricardo Bula from the Emilia’s EBAIS. (consulted on March 11, 2010.)
“It is the carrying of one or more offspring, known as a fetus or embryo, inside the woman’s womb. Childbirth usually occurs about 38 weeks after conception; approximately 40 weeks from the last normal menstrual period in humans.”
It is when a woman has an embryo growing in her womb for a period of 38-42 weeks.
Embryo
“In humans, it is called an embryo until about eight weeks after fertilization (i.e. ten weeks LMP), and from then it is instead called a fetus.”
(According to Wikipedia, the free encyclopedia. 21 April 2010)
Uterus
According to the Virtual medical dictionary “The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is the corpus. The corpus is made up of two layers of tissue.”
In the womb is where the embryo is located.
Fertilized Egg
In the other hand, the free dictionary of medicine affirm that the fertilized egg in an animal organism in the early stages of growth and differentiation that in higher forms merge into fetal stages but in lower forms terminate in commencement of larval life.
This definition allows us to conclude that is the union of the spermatozoid and the egg.
Fallopian Tube
The virtual Medial dictionary says that “Fallopian tube is one of the two Fallopian tubes that transport the egg from the ovary to the uterus (the womb)”. In the diagram, the Fallopian tubes are not labeled but are well shown running between the uterus and ovaries.
Cervix
According to Doctor Marshall from Memorial Hospital South Bend, Michigan street; “the Cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in a woman's lower abdomen, between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.
Ovary
In the same way the Doctor Marshall from Memorial Hospital affirm that the ovary is consider as the female gonad, the ovary is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development of female body characteristics, such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.
Blood hormone tests
According to Cathy Wong from the medical bureau of Lancaster, this hormone blood test for women evaluates hormonal balance in both pre-and post-menopausal women, using a single blood sample. And looks at: three estrogens, the balance of estrone, estradiol, and estriol; progesterone, this hormone rises and falls during the menstrual cycle, influencing fertility and PMS, and after menopause it modulates the effects of estrogens; two androgens, both testosterone and DHEA affect sexual function, body composition, and cognition; estrogen metabolites, the "2" and "16a" forms of hydroxylated estrone that have different effects on genetic expression and rate of cell proliferation, their ratio may indicate a woman's risk for breast and endometrial cancer; and the sex hormone-binding globulin (SHBG) that influences the circulating levels of free testosterone and estradiol.
Using this blood test they can know if the woman is pregnant and if everything is working in the correct way with the baby.
Laparoscopy
According to Mastery of Endoscopic and Laparoscopic Surgery W. Stephen, M.D. Eubanks Laparoscopy is an operation performed in the abdomen or pelvis through small incisions (usually 0.5–1.5cm) with the aid of a camera. It can either be used to inspect and diagnose a condition or to perform surgery.
This kind of surgery is an easy one, is not dangerous and the recuperation is very fast.
Pelvic exam:
According to Doctor Morgan from university of Pennsylvania, a Pelvic exam is an examination of the organs of the female reproductive system. In a pelvic exam, a speculum (an instrument for opening and widening certain passages of the body) is used to open the vagina and aid in visualizing the uterine cervix. A sample of cells may be taken off the surface of the cervix for a Pap smear or a sample may be obtained for laboratory culture. The uterus womb and ovaries are felt with the fingers to detect swellings or other abnormalities.
Transvaginal ultrasound
According to the book named The Medical World, Steven Carson, Florida (2006) “the transvaginal sound is a imaging technique used to create a picture of the genital tract in women”. The hand-held device that produces the ultrasound waves is inserted directly into the vagina, close to the pelvic structures, thus often producing a clearer and less distorted image than obtained through transabdominal ultrasound technology, where the probe is located externally on the skin of the abdomen.
Hormone
The Virtual Medical Dictionary says that a Hormone is “A chemical substance produced in the body that controls and regulates the activity of certain cells or organs” Many hormones are secreted by specialized glands such as the thyroid gland. Hormones are essential for every activity of daily living, including the processes of digestion, metabolism, growth, reproduction, and mood control. Many hormones, such as the neurotransmitters, are active in more than one physical process.
Intrauterine contraceptive device (IUD)
“Intrauterine contraceptive device (IUD) is a device inserted into the uterus (womb) to prevent conception (pregnancy). The IUD can be a coil, loop, triangle, or T-shape. It can be plastic or metal”.
Is one of the safest contraceptive after you already had kids. It is commonly known as the “T”.
(1996-2010 MedicineNet.com)
Fertility Drugs
“Fertility drug is a drug used to increase a woman's fertility; there are clomiphene, clomiphene citrate - a fertility drug (trade name Clomid) that is used to stimulate ovulation and that has been associated with multiple births-.”
(1996-2010 MedicineNet.com)
Prognosis
Doctor Sawyer, from the university of Pennsylvania says that “a Prognosis is defined as a prediction of the course of a disease in a patient”.
Methotrexate
“Methotrexate is a drug that acts as an antimetabolite and specifically as a folic acid antagonist that inhibits the synthesis of DNA, RNA, and protein”
(1996-2010 MedicineNet.com)

Ectopic:
It is a pregnancy that occurs in an abnormal position or place.
HCG (human chorionic gonadotropin):
It is a hormone produced during the pregnancy that is made by the developing embryo after conception and later by the part of the placenta. It’s role is to prevent the disintegration of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.
Endometriosis: It’s the presence of uterine lining in other pelvic organs, characterized by a cyst formation, adhesions, and menstrual pains.

Estrogen: the major female sex hormones produced primarily by the ovarian, capable of inducing estrus, developing and maintaining secondary female sex characteristics, and preparing the uterus for the reception of a fertilized egg.

Progesterone: It is a hormone, which prepares the uterus for the fertilized ovum and maintains pregnancy.
Conclusions

• The first conclusion is related with the importance of take into account an unusual topic, and inform to the people about that kind of pregnancy.
• The second conclusion is about take care of yourself, when a woman fell that something is not normal with her organism, she have to look for a doctor and ask him for some exams in order to know what is wrong or what is happening with her body.
• Another conclusion is look for another way of contraceptive method because the uterine contraceptive device and the emergency contraception are factors that can risk the level or the probabilities to suffer for an ectopic pregnancy.
• The nicotine in cigarettes is bad for the human health and is important to say that it produce spasm in the womb on women.
• Also is very important to say that the procedure or the surgeries always comes to an abortion because there are not possible ways in which the fetus can be saved.
• The treatment with more success rate in those cases is the Laparoscopy (salpingotomy) so is important to know that.




Recommendations:

• Try to avoid use medications with hormones because is a factor that increase the risk for an ectopic pregnancy.
• If you suffer that kind of pregnancy is very important that you look for information and try to stay calm.
• Go to the doctor more often in order to make some control test to detect any complication at time.
• Try not to smock because nicotine is not good.
• After an ectopic pregnancy is important to visit the doctor periodically to determine and monitored the situation of the woman.
• A good option for women to suffer an ectopic pregnancy, and have problems to conceive in a normal way the doctors recommend the in vitro fertilization.






Outline

Topic: Ectopic pregnancy

I. Introduction (thesis): The ectopic pregnancy is an uncommon pregnancy with symptoms, consequences, treatments unknown for many people and this is very dangerous because this can cause dead.

II. Body paragraph
A. description of ectopic pregnancy
- How it is diagnosed
- Pelvic exam

III. Body paragraph
a. causes of an ectopic pregnancy

IV. Body paragraph
D. treatments for ectopic pregnancy
-methods

V. Body Paragraph
C. consequences

VI. Conclusion:
As you noticed, it is an unknown pregnancy for many people, it is important to take into account this information in order to be updated and paying special attention to those symptoms if something estrange happens during pregnancy.










References

- Breast Cancer Foundation (1999). Ectopic Pregnancy (On line) Retrived on 19/03/2010-10:29 pm. Address:
http://www.womenshealth.org/a/ectopic_pregnancy.htm

-Larissa Hirsch (2008). MD. Ectopic pregnancy, (on line) Retrived on 20/03/2010-02:38 pm. Address:
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/ectopic.html

-American Pregnancy Association (2007). Ectopic Pregnancy (on line). Retrived on 23/03/2010-07:46 pm. Address:
http://www.americanpregnancy.org/pregnancycomplications/ectopicpregnancy.html

-Peter Chen (2008). Ectopic Pregnancy (on line). Retrived on 23/03/2010-08:12 pm. Address:
http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000895.htm

Urban Tribes: The Subcultures of the Youth

UNIVERSIDAD DE COSTA RICA
SEDE DEL ATLÁNTICO
RECINTO DE GUÁPILES


Course: Oral Communication V
I – 2010

Teacher: Lic. Robertho Mesén Hidalgo


Urban Tribes Presentation: The Subcultures of the Youth


Students: Melanie Alvarado Bolaños
Alex Campos Benavides
Irving Chinchilla Salas
Natalia Fuentes Brenes

April, 2010

Abstract

In order to be clearly understood, it is really important to analyze the meanings or information related to urban tribes written and created by some authors in order to strengthen the content of this presentation during its development. Now, there are some important meanings collected that are developed in a continuant way, in order to be understood in a better sense and so connect them with this presentation.

1. Background of the Problem

In order to be clearly understood, it is really important to analyze the meanings or information related to urban tribes written and created by some authors in order to strengthen the content of this presentation during its development. Now, there are some important meanings collected that are developed in a continuant way, in order to be understood in a better sense and in this manner connecting them with the presentation.
The urban tribe neologism was first used in 2001 by Ethan Watters in The New York Times magazine. He also defined this term as a group of single people with common interests who enjoy the same group lifestyle. By this way, urban tribes are groups of people (mostly young) whose associations are based on a style of life and activities.
According to Balaguer (2009), an urban tribe is a group of people that share the same preferences. These ones are related to music, aesthetics, slangs, places and ideologies. Basically, these ones are the main pillars of each urban tribe based on the book from María José Hooft (w.d.).
XXX (2007), writes in his blog that urban tribes are groups of people (mostly young people) in which their associations are based on the same lifestyle or activities. Also, he agrees with Balaguer in giving the similar feature of urban tribes for example the same aesthetics into the group. Besides that, this author says they also share strong socio-political convictions or religious and mystic beliefs; of course it depends on the movement of the urban tribe. However, there are people called “Poseur” that use aesthetics and/or behavior of a determined urban tribe but forgetting their entire philosophy and the movements own ideologies.
Based on Álvarez (n.d.) an urban tribe is a group of people that behave according to the ideologies of a determined subculture that its origin and development occurs in a city environment. He also says that some critics say they just want to find an identity to be shaped in an urban tribe.
Moreover, The Free Encyclopedia (2010) has another meaning for urban tribes; it says that urban tribes are groups of people in urban areas who have some kind of closed association based upon similar lifestyles or activities (as it was mentioned before on the other meanings). Besides that, it also says that these subcultures are more common in larger cities where the enormous size and complexity of the society create a sense of alienation or isolation on the level of the individual.
Also, the word urban tribe is related to subculture. For example The Free Dictionary (2010) says “a subculture is a group of people with a culture (whether distinct or hidden) which differentiates them from the larger culture to which they belong. If a particular subculture is characterized by a systematic opposition to the dominant culture, it may be described as a counterculture.

2. Justification

The aim of this presentation is to show and explain the lifestyle of the most popular Urban Tribes. The social relevance of the topic lies on the stereotypes society itself has imposed to all these people, blaming some of them for criminal acts, social disorders, misbehavior, and so on. Most of them based only on appearances and speculations, the benefit of this research is developing a point of view established on facts and to avoid misunderstandings and a priori judgments. The utility is to make people know each group by elements such as clothing, slangs, and way of thinking, attitude, and musical preferences among others.

3. Objectives

3.1. Terminal objective:
• To know the main features of the most popular urban tribes.

3.2 Enabling objectives:
• To explain the pillars and its basis.
• To categorize the different groups according to their specific beliefs and lifestyles.

4. Theoretical Framework
First of all, it is really important to analyze how urban tribes are categorized or made. For example, this means which are the pillars for each urban tribe talking in general terms and it is also vital to know the basis of each one. So, the next information is based on the book from María José Hooft (n.d.).
Later on are mentioned and explained each pillar and its basis:

4.1. Pillar and Basis

4.1.1. Esthetics:
o It is the look that has the tribe.
o It is related to sexuality.
o Esthetics shapes the identity.
o Hair styles, dress shapes the image but they slave them.

4.1.2. Music:
o It is the worldwide language.
o There are virtually no young people who do not listen to music.
o Music is not only heard, it has.
o It is a great ideologies creator.
o Music influences behavior.

4.1.3. Slang:
o Words have power.
o Each tribe has its own slang code which requires a kind of ability to decode.
o For the tribes, the lyrics of their favorite music work as the Bible for the Christians (they memorize and live them).

4.1.4. Places:
o Everyone needs a virtual or physic place which can be own or being hers or his.
o Public places are appropriated for tribes.
o City and night are together.
o Shopping.
o Internet (Hi5, MySpace, MyFlog, Facebook, etc).
o Graffiti, stencil.

4.1.5. Ideologies:
o Groups of ideas which tend to preserve or change the current system (social, economic, religious, etc.) which characterize a group.
o This is the real root of the problem.
o Most of the urban tribe members are ignorant about what are their ideology from they belong because is hidden or covered.


4.2. Urban Tribes’ Characteristics

4.2.1. Essential elements:

• Identity search.
• Affectionateness search.
• Rebelliousness demonstration.

4.2.2. Urban tribes’ dangerous characteristics:

• Violence: Some of the urban tribes used to be violent with other groups. In most cases, the reasons are unchained because of the clash of ideologies or maybe by other factors such as places. This is one of the most important aspects for urban tribes, because most of them feel that are the owners or appropriated of some public places and they do not allow entering other people from other social groups into their place or area.

• Darkness: This is another feature for many urban tribes. For example, Goths people love to wear black dresses and some of them love to be similar to demons. For example when they used to put black with red make-up in their faces and putting red or white contact lenses; and in some cases to make tattoos on their bodies. So, if you want to see some information about Goth people, you are always going to find pictures related to Satan. Also taking into account the rest of urban tribes to explain, have some features related to demons for instance metalheads are related to music with a diabolical or just depressed lyric, skinheads are related to darkness because have the Nazi ideology which is the racialism and so are the other urban tribes that are going to be developed.

• Passionate attitude: It is related to have a stand out attitude, in order to be different from the rest urban tribes. Besides, the urban tribes are really passionate because they are extremely identified with their philosophies and preferences. By this way, they can make whatever thing in order to protect their ideologies, places, music or aesthetics in the case that someone attacks them.

• Self-destruction: In this aspect, some urban tribes make self-destruction. For example many of them make tattoos in their bodies, put big piercings in wherever they prefer and cut their bodies where they want to feel.

• Fashion slavers: As it was mentioned before, some of the urban tribes are fashion slavers, because they are truly identified with his/her tribe, so they make everything to be correctly shaped in that group. That is why they spend money in those dresses and jewelry in order to be always in fashion and accepted in his/her urban tribe.

4.3. Urban Tribes

Nowadays, people are rounded of other people with different preferences. Some characteristics are the clothes, make-up, music, ideologies, fashion and many other things that characterize each person. For each group of similar characteristics are a group called urban tribe; into this concept is a big world of features. As it was mentioned at the beginning, an urban tribe is a group of people that shares ideas, fashion, places, slangs and music. By this way, they are similar between themselves.
Now, these are some common urban tribes between the current societies most common in big cities.

4.3.1. Goth

Where it comes from?

Based on The Free Dictionary (2010), this subculture or urban tribe began in The United Kingdom during the 1980s in the gothic rock in the post-punk genre. This urban tribe has been surviving more than other subcultures of the same area and has continued to diversify. For example, people from many areas or professions, like to be an element in some subculture that has the characteristics they want or like. So, it has been growing this tribe because as the statistics says, most people prefer this group and that is why this is the group that has been surviving more than the other ones. In most of the cases, goths are confused with darks because they wear in the same way but have different ideologies; based on a dark subculture person opinion.
This urban tribe is characterized by the clothes styles related to deathrock, punk, androgynous, medieval, some Renaissance and Victorian or combinations of the above most often with black attire, make-up and hair.

History:

The history began when a post-punk band in 1980s became in a subgenre called gothic rock, and the followers of these bands started to come together as a distinctly, recognizable movement.
Moreover, this tribe was influenced by imagery of horror films and television. Besides that, the Byronic hero was a key precursor to male goth image as well Dracula was an iconic portrayal appealed powerfully to early goths. The Byronic and Dracula image were attracted by Lugosi’s aura of camp menace, elegance and mystique. Also, some musical groups or movements from that age influenced gothic fashion and style.
That is why some of the early gothic rock and death rock artists adopted traditional horror movie images. As it was mentioned before, the goth urban tribe is really identified with those features; by this way, they used to wear with those attires, make-up, looks among others.

How can people identify them?

Now, many people guess how they can identify or maybe how they can know if certain group or maybe this one is dangerous or not. The answer for this question is to know their ideologies, because some urban tribes wear in a similar way but not all of them are grouped in the same urban tribe, so it is really important to analyze their ideologies. For instance, goths ideologies are related to tolerance. Many people reject them because they feel or think they are going to damage or attack them because of their appearances. This is the main impression people have about them in most of the cases. Another aspect to take into account for identify goths is their cloths. For example they used to wear in a dark and mysterious way; and these clothes are related to Romanticism’s gothic novel. Besides, the goth urban tribe has no pronounced political messages or cries for social activism. This subculture is marked by its emphasis on individualism, tolerance for diversity, a strong emphasis on creativity, tendency toward intellectualism, a dislike of social conservatism a mild tendency towards cynicism, but even these ideas are not universal to all goths. Goth ideology is based far more on aesthetics than ethics or politics. And a mild tendency towards cynicism (It is a philosophy which seeks to achieve happiness through wisdom, the release of the spirit and the achievement of virtue), but even these ideas are not universal to all goths.

4.3.2. Hip-hoppers

Background:

According to The Free Dictionary (2010), the hip hop was originated in the late 1970 in the working class of New York; this culture is based on music as a lifestyle and expression of people’s desires. It has five main features Mcing, Djing, breaking, graffiti writing and knowledge, then from this time the way of life was widely known and practiced.
It was considered as a culture since the year 1982, calling the attention of several newspapers, fact that increased the popularity of this movement.
It is estimated that this term first appeared in 1978 in order to describe this new kind of music that included parts of poetry accompanied by rhythmical beats and vocal imitation of percussive instruments. This movement that represented a completely updated pattern of sound begun with very basic equipment and now it has become one of the most powerful industries of music. Besides the appearance of videos helped to diffuse and support the lifestyle of African- American dwellers of New York.
But the main concern of hip hop artists was to show critic points of view by means of songs and graffiti, which are two of their five pillars that will be developed later in this chapter.


Main Pillars:

Hip hop as a social and cultural movement is based in music and its ramifications, so the main pillars of hip hop are
Djs: In the beginning djs were the music stars; their work consists basically on combining two songs at the same time by means of speakers, turntables, and amplifiers in order to make the 2 songs sound like one. The influence of djs in hip hop has been definitely important, because with the pass of time they have become a sort of music producers, giving artists unique songs with the singular touch of turntablism (hip hop djs particular techniques).
Rapping: It refers specifically to the work of artist; it means the particular style of singing which is accompanied by strong, rhythmical beats and lyrics with a high content of rhymes and slangs.
Graffiti: Originally this was used by political activists to complain also to mark territory, but hip hoppers and rap fans consider it as an art expression and also expressing their ideas about life. It has been seen as the visual part of hip hop thus it’s common to see graffiti in places like subways bus stations and so on.
Breaking: It is also called b- boying or breakdancing. It begun in the early 30s and it was taken by hip hoppers once the movement was well known, and during the decade of 1980 it was very regular to see youngsters listening to music and dancing in coordination with the music beats in places like basket courts or just in the streets or in sidewalks.
Beatboxing: It has to do with the imitation of music, or making music using the mouth, and it turned quickly accepted in the 80s, though its popularity declined some years later, since the 90s it has gradually become popular.
Language: As any other urban tribe rappers and hip hoppers have slangs that are used in daily conversations, but this is because the slangs are part of the song so that people learn to use the term they listen in songs or any other mean that transmits, directly or not, this language.

Diversification:

It is estimated this genre has distributed all around the world in countries in which English is not spoken massive sells of Cds are reported even when they do not know what they are saying and also they follow the American trends and creating subgenres from hip hop. It is important to notice that the music messages vary from nation to nation according to the reality each one has to face in political or economic problems.
The beginning of this genre helped young people to keep away from addictions and criminal acts. This makes a good point, nevertheless what once was an alternative to escape from the problems, nowadays has become part of the problem in certain way it is by means of the lyrics that have a increasing content of violence, sex, drug doing and some others. For this reason, some songs are censored to avoid these bad messages. In despite of it, there are some artists that continue making good music to preserve the spirit of this culture.

4.3.3. Metalhead

History:

It is estimated in The Free Dictionary (2010) that this is a popular term for a devoted fan of heavy metal music and is often used interchangeably with the term headbanger which means a type of dance which involves violently shaking the head in time with music, most commonly rock music and heavy metal music.
One of the most dominant features of the metalhead culture is the "Corna" hand-signal formed by a fist with the pinkie and index fingers extended, known variously as the “devil’s horns”, the “metal fist” and other similar descriptors.

Fashion:

On the other hand, the metalhead urban tribe attires are composed by comprised tight blue jeans, motorcycle boots or hi-top sneakers and black t-shirts traditionally augmented with a sleeve-less jacket of denim or leather decorated with woven patches and button pins from heavy metal artists. Moreover, metalheads often wear t-shirts with the emblem of bands they are fans such as Iron Maiden, Black Sabbath, Led Zeppelin, Metallica, and Slayer.
Pursuing this, the jewelry they wear are accessories that include studded leather wrist and arm bands, bullet belts, chains and even rings depicting skulls and other death and horror inspired designs.

4.3.4. Skinheads

History:

They are named skinhead for their close-cropped or shaven heads, they were originated in the United Kingdom in the late 1960s; originally, the skinhead was primarily based on the elements, not politics or race. The Free Dictionary (2010)
At the beginning skinhead subculture were associated with xenophobia and violence which was decisive in making the culture synonymous with racism, violence and neo-Nazis. However, there had also been anti-racist and leftist skinheads.

Political categories:

There are several different political categories of skinheads; though, many skinheads do not fit into any of these categories. They are anti-racist left wing, right wing, apolitical and white power skinheads or neo-Nazi.
The anti-racist skinheads are aggressively opposed to neo- Nazism and racism. Some anti-racist skinheads have been involved with political groups such as Anti-Fascist Action or Anti-Racist Action.
Apolitical skinheads oppose all politics in general, are politically moderate, or keep their personal political views out of the skinhead subculture.
Left wing skinheads are anti-racist and anti-fascist, taking a militant pro-working class stance. This category includes redskins and anarchist skinheads. The most well-known organization in this category is Red and Anarchist Skinheads.
Right wing skinheads are conservative and patriotic, but not necessarily extreme or fascist. This type of skinhead seems to be common in the United States.
White power skinheads or neo-Nazi skinheads are racist, extremely nationalist and highly political. Many Nazi skinheads have no connection to the original 1960s skinhead culture in terms.

Fashion:

Besides to short hair, skinheads are identified by their specific clothing styles. The first aspect is the hair it is for men typically shaved closer, with no greater than a number 2 guard. Many female skinheads had feathercuts; it is short on the crown, with fringes at the front, back and sides. Some female skinheads have a shorter punk-style version of the hairstyle; almost entirely shaved, leaving only bangs and fringes at the front.
Usually skinhead men sometimes wear suits, usually including a three-button waist jacket, and often made out of two-tone tonic fabric, for women is the same as men, with addition of dress suits—composed of a ¾-length jacket and matching short skirt. Both use coats they could be black or green; blue-denim jackets (Levi's or Wrangler). Also men dress trousers or jeans, normally Levi’s, Lee or Wrangler, usually blue; sometimes splattered with bleach to resemble camouflage trousers. Girls wear jeans and trousers as men, or skirts and stockings. Some skingirls wear fishnet stockings and mini-skirts, a style introduced during the punk-influenced skinhead revival. And both wear boots and hats.
They characterize for their tattoos on their faces or foreheads, some tattoos are national or regional flags. The anti-racist skinheads tattoos include a Trojan helmet; anti- Nazi logo; skinhead smashing a racist symbol. The white-power skinheads common tattoos include Swastika or other World War II Nazi symbols, such as SS symbols or the iron cross.

Music:

The skinhead subculture was related with music genres such as soul, ska, rocksteady and early reggae.

4.3.5. Punks

This culture is based around rock punk. It emerged from the large rock music scene in the mid-to-late-1970s in the United Kingdom, United States, Canada and Australia.
Punk culture encompasses distinct styles of music, ideologies, fashion, visual art, dance, literature, and film. Punk also lays claim to a lifestyle and community
There some aspects referring this culture:

History:

The punk subculture emerged in the United States, United Kingdom, Australia and South Africa in the mid-to-late-1970s, and has since undergone several developments.
Punk rock has a variety of musical origins in the rock and roll genre. Previous youth subcultures also had major influences on punk.
The earliest form of punk, retroactively named protopunk arose in the north-eastern United States in the early-to-mid-1970s. The first ongoing music scene that was assigned the punk label appeared in New York City between 1974 and 1976. Around that same time, a punk scene developed in London. Soon after, Los Angeles became home to the third major punk scene.
The underground punk movement in the United States in the 1980s produced scenes that either evolved from punk or claimed to apply its spirit and DIY ethics to a completely different music, securing punk's legacy in the alternative rock and indie scenes. The commercial success of alternative rock gave way to another style that the mainstream media dubbed pop punk. A new movement in America became visible in the early and mid-1990s, claiming to be a revival of punk.

Music:

Music is the most important aspect of the punk subculture. Punk music is called punk rock, usually shortened to punk. Most punk rock is performed in a specific style of rock music, although punk musicians sometimes incorporate elements from other genres. Different punk subcultures often distinguish themselves by having a unique style of punk rock, although not every style of punk rock has its own associated subculture. Most punk rock songs are short, have simple and somewhat basic arrangements and feature lyrics that express punk values. Punk rock is usually played in bands instead of by solo artists.

Ideologies:

Punk-related ideologies are mostly concerned with individual freedom. Common punk views include the DIY ethic, non-conformity, direct action, and not selling out Punk politics cover the entire political spectrum, although most punks could be categorized as having left-wing or progressive views. Some punks participate in protests for local, national or global change. Some trends in punk politics include anarchism, socialism, anti-authoritarianism, anti-militarism, anti-capitalism, anti-racism, anti-sexism, anti-nationalism, anti-homophobia, environmentalism, vegetarianism, veganism, and animal rights. However, some individuals within the punk subculture hold right-hand views.

Fashion:

Punks search outrage propriety with the highly theatrical use of clothing, hairstyles, cosmetics, tattoos, jewelry and body modification. Early punk fashion adapted existing objects for aesthetic effect: ripped clothing is held together by safety pins or wrapped with tape; ordinary clothing is customized by embellishing it with marker or adorning it with paint; a black bin liner becomes a dress, shirt or skirt; safety pins and razor blades are used as jewelry. Leather, rubber, and vinyl clothing are also popular, possibly due in part to the fact that the general public associates it with transgressive sexual practices like bondage and S&M. Punks also sometimes wear tight "drainpipe" jeans, Plaid or Tartan pants, T-shirts with risqué images, rocker jackets(which are often decorated by painting on band logos, adorning the lapels and pocket flaps with pins and buttons, and covering sections of the jacket, especially the back and sleeves of the jacket, in large numbers of carefully placed studs or spikes), and footwear such as Converse sneakers, skate shoes, brothel creepers, or Dr. Martens boots.
Some punks style their hair to stand in spikes, cut it into Mohawks or other dramatic shapes, often coloring it with vibrant, unnatural hues. Punks tend to adorn their favorite jacket or vest with pin-back buttons and patches of bands they love and ideas they believe in, telling the world around them a little bit about who they are.

Lifestyle:

Punks can come from any and all walks of life and economic classes. The subculture is predominantly male, with the exception of the riot grrrl movement. Compared to some alternative cultures, punk is much closer to being gender equalist in terms of its ideology. Although the punk subculture is mostly anti-racist, it is vastly white (at least in predominantly-white countries). However, members of other groups (such as Blacks, Latinos, Asians and Cambodians) have also contributed to the development of the subculture. Substance abuse has sometimes been a part of the punk scene, with the notable exception of the straight edge movement. Violence has also sometimes appeared in the punk subculture, but has been opposed by some subsets of the subculture.


5. Out-line

Urban Tribes
I.
Introduction

A. Thesis Statement: Nowadays, people are rounded of urban tribes and so is part of them, of course depending on the context. Many people do not manage this concept at all so; this is an important and interesting topic to talk about. So, take a look and check on which urban tribe you think you are classified. Some of the urban tribes are goths, punks and others.

II.
Urban Tribe meaning

III.
Pillars
1. Esthetics
2. Music
3. Slang
4. Places
5. Ideologies

IV.
Urban tribe’s examples

A. Goths.
1. Where it comes from?
2. History.
3. How can people identify them?
B. Hip-hoppers.
1. The main aspects of hip hop culture.
2. The explanation of their main pillars.
3. Their language.
4. Diversification.
C. Metalheads.
1. History.
2. Fashion.
D. Skinheads.
1. History.
2. Political categories.
3. Fashion.
4. Music.
E. Punks.
1. History.
2. Music.
3. Ideologies.
4. Fashion.
5. Lifestyle

V.
Closure


6. Closure

With the information provided in this presentation, it is possible to infer the main features of each urban tribe and to know in a better way the lifestyle and the motivation that gives force to their behavior which is affected by the social context, but also they change it in a reciprocal way, giving society a meaning that changes constantly.

7. References

Álvarez, F. (n.d.). Tribus urbanas, los dueños del siglo XXI. Consulted in April 3rd, 2010 in http://www.idukay.edu.ar/dmdocuments/tribus.pdf.

Balaguer, M. (2009). Las Tribus Urbanas. Consulted in April 3rd, 2010 in http://www.educacion.es/exterior/uk/es/tecla/2009/05-09Cbis.pdf.
Biblioteca Virtual-CONACE (2008). Boletín Biblioteca Virtual - CONACE. Consulted in April 3rd, 2010 in http://bibliodrogas.cl/bibliodrogas/boletines/BOLETIN%20ENERO%202008.pdf.

Encyclopedia. The Free Dictionary (2010). subculture. Consulted in April 12th, 2010 in http://www.thefreedictionary.com/subculture.

Encyclopedia.The Free Dictionary (2010). Urban Tribe. Consulted in April 3rd, 2010 in http://encyclopedia.thefreedictionary.com/urban+tribes.

Google (2010). urban tribes pictures. Consulted in April 7th, 2010 in http://images.google.co.cr/images?client=firefox-a&rls=org.mozilla%3Aes- ES%3Aofficial&hl=es&source=hp&q=urban+tribes&gbv=2&aq=f&aqi=&aql=&oq=&gs_rfai=.

Hooft, M. (n.d.). Tribus Urbanas. Consulted in April 3rd, 2010 in http://www.encuentroja-ua.com.ar/Tribus%20urbanas.pdf.

Illanes, B. (n.d.). Siquiatra revela los riesgos de pertenecer a una tribu urbana. Consulted in April 3rd, 2010 in http://www.uss.cl/datos/docs/20080821111918/Siquiatra%20revela%20los%20riesgos%20de%20pertenecer%20a%20una%20tribu%20urbana.pdf.

Wikipedia Foundation (2010). cynicism. Consulted in April 12th, 2010 in http://en.wikipedia.org/wiki/Cynicism.

XXX (2007). Tribus Urbanas. Consulted in April 3rd, 2010 in http://tribusurban.obolog.com/tribus-urbanas-32790.

Hi! How are you? I’m Carmen!

Well, I’m a little impressed about the sub topics that the paraphilia’s topic includes.
I know about some of those estrange preferences that certain people have, but really some of them are really crazy and disgusting too. I think that is so important to be very careful about what people are surrounded us because we don’t know what kind of ideas are crossing in their heads, mainly we have to be very careful with our children because I think that pedophilia is one of the most common crimes in our country.

UNIVERSIDAD DE COSTA RICA

SEDE DEL ATLÁNTICO

RECINTO DE GUÁPILES

“Paraphilias: The six more common and the six more unknown in the world.”

Bermúdez Murillo Yorleny

Elizondo Torres Keren

León Rodríguez Catalina

Trejos Morales Jessie

Guápiles, Pococí

April, 2010

Introduction

This research is about sexual behaviors named Paraphilias, focused on the six more common and the six more unknown in the world. According to the president of the Psychiatric and Human Sexuality Section WPA, Hernandez, R. paraphilias have been present in the world since the XIV century. He mentions that the first man who talk about this topic was the German neurologist Richard Von Kraft Ebing (1840-1903), who developed an investigation named Sexual Psychopathies. This investigation is a good support for many other people who are studying about this topic around the world. Also, after Richard Von Kraft Ebing, some others researchers made their approaches about this subject, for example: Sigmund Freud, John Money and also the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association (APA). Moreover, Hernandez mentions that Brenda Love (1992) made an average list of 400 unusual sexual behaviors, as a result, it can notice that there are a lot of these sexual characteristics present in human beings.

The research “Paraphilias: the six more common and six more unknown in the world” was chosen in order to get knowledge about them, because as future teachers it is important to know which the different sexual behaviors are, and how can affect or not a student performance. Base on that, it can say that teachers should study and analyze the kind of behavior that a student can have, because in that way teachers could help him/her if a student needs it. For example, classmates could mock of a student practicing any paraphilia, which could affect in her/his academic performance.

Also, this topic is interesting because it is almost unknown for many people and in some cases it is a taboo, but the real issue is that it is so common.

Objectives

Terminal objective:

Ø To explain the details about the six more common and the six unknown Paraphilias in the world.

Enabling objectives:

Ø To explain the concept of paraphilia.

Ø To look for the causes of these behaviors.

Ø To prove the social repercussion that a person could have practicing these kinds of sexual behaviors.

Ø To determine which the treatments for these sexual behaviors are.

Abstract

The present project consists in the study of twelve paraphilias, the six more common (pedophilia, exhibitionism, frotteurism, masochism, sadism, and voyeurism) and the six more unknown (acrotomophilia, coprophilia, klismaphilia, menophilia, asphyxiophilia, and gerontophilia) in the world. It contains data about the concept of these sexual behaviors, the causes of why they are originated, and the social repercussions if a person has these disorders, and the treatments which are available for some of them.

Theoretical Framework

Understanding what paraphilias mean the following definition was taken from the DSM-IV (Kafka, 2006):

“Paraphilias are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors that are considered deviant with respect to cultural norms”.

Also, according to this source paraphilia is a term used to identify sexual deviations or perversions. The person who has a sexual disorder involves the preoccupation to practice these behaviors, to the point of dependency, as a means of releasing sexual energy.

Moreover, based on the Merck Manual of Medical Information (2007a) it is common in healthy adult, when the couple mutually agree, some degrees of fantasies in their sexual relationships, these non injurious sexual behaviors may be part of a loving and caring relationship. But, when this actions turn into a routine and are extreme, such sexual behaviors are paraphilias.

In a wide sense, the DSM-IV says that paraphilias will fall into one or more of the following aspects:

ü Sexual fantasies and behaviors with non-human objects.

ü Sexual behaviors involving humiliation, pain, or suffering of oneself or another person.

ü Adult sexual behavior involving children.

ü Non-consenting sexual behavior involving another adult.

ü Sexual intrusion on the privacy or personal space of an unsuspecting person without their knowledge or consent.

Most of the paraphilias according to Benuto, L. (2009), emerge during adolescence although there is usually a connection with events in early childhood. These events lead the person to associate sexual pleasure with that event, so the result develops a paraphilia. Also, she says that researchers have not identified a specific biological or biochemical reason, so psychological factors seem to be the cause.

On the other hand, supported by the psychologist Moelker, W. (2008), there are many theories that try to explain the origin of an unusual sexual fantasy, thought or behavior in people, but a final explanation is not known yet. She also assumes that causes of paraphilias are originated in puberty.

Due to paraphilias are behaviors present in the society and people think that these kind of sexual fantasies belong to unhealthy people, this research has the objective to inform about the six more common and the six unknown paraphilias and avoid prejudices.

Based on the psychiatrist and professor of the University of Toronto Stephen Hucker (2005), the six more common paraphilias are pedophilia, exhibitionism, frotteurism, masochism, sadism, and voyeurism.

The pedophilia is a preference for sexual activity of fantasies with children, younger than 13 by a person older than 16. Although several pedophiles are attracted only to children many of them are attracted to kids and adults. Also, these people could be attracted to young boys, girls, or both, but most of them prefer children of the opposite sex. In addition, it is more common in pedophiles looking or general touching than to caress the genitals or having sexual intercourse. Generally, the children know the adult because is a family member, stepparent, or a person with authority (such as a teacher). So, the methods used by the adult to commit pedophilia are force, and threats (for example, to harm the child or the child's pets).

The exhibitionism is another common paraphilia which is divided into two actions, one is to show the genitals to strangers in order to become sexually excited and the second is to have a strong desire to be observed by other people during sexual activity. The majority of the exhibitionists are males who need to surprise, shock, or impress the victim, however sexual contact is almost never sought, so they rarely commit rape. This practice usually begins when people are in their mid 20s.

On the other hand, when exhibitionists have the need to practice their sexual acts, such people want to be seen by a consenting audience, rather than to surprise people. Consequently, many of this kind of exhibitionists make pornographic films or become adult entertainers.

Another common paraphilia which begins in adolescence is known as frotteurism that consist in the intentional rubbing up against or touching an unsuspecting victim for the purpose of sexual arousal. Most of the people who live with this paraphilia are male and the most common parts to touch of the victim’s body are the breasts, legs and buttocks. Besides, the person touches the victim with his hands or rubs his genital area against the affected, this situation usually occurs in crowded settings where it can be interpreted as an accidental behavior.

The next paraphilia is the masochism that involves acts in which a person experiences sexual excitement from being humiliated, beaten, bound, or otherwise abused. Activities with a partner include bondage, spanking, simulated rape, cutting or piercing their skin, or burning themselves. In the majority of the cases the humiliation and abuse are acted in fantasy, the couple is aware that the behavior is a "game," and actual pain and injury is avoided.

The sadism is one of the more frequent sexual behaviors in which an individual person experience sexual excitement from inflicting physical or psychological suffering on a sexual person. This disorder is different from minor acts of aggression in normal sexual activity. However, in the most extreme cases involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement.

Besides, the last more common paraphilia is voyeurism which involves sexual aroused by watching someone who is disrobing, naked, or engaged in sexual activity and they do not seek sexual contact with the people being observed. The period when this behavior begins is during adolescence or early adulthood. Some degree of voyeurism is common, for instance, viewing sexually pictures on internet, but the problem starts when the person is keeping in secret that behavior and they spend a lot of time seeking out viewing opportunities.

As the objective of that investigation is to explain the details about the six more common and the six unknown paraphilias in the world, the following information is regarding to the more unknown sexual behaviors which are: acrotomophilia, coprophilia, klismaphilia, menophilia, asphyxiophilia and gerontophilia.

The first unknown sexual behavior is named as acrotomophilia which was recognized in 1990 in clinics as a rare behavior. It consists in the attraction to someone who is an amputee and also it occurs if the person fantasized that its partner is an amputee, this practice could assume bizarre forms when the person ask to his or her partner to wrap a bandage around a limb to simulate the amputation.

Another unknown paraphilia is named coprophilia or fecophilia that consists of the condition of feeling sexual excitement focused on feces, like the practice of brown showers that refers to defecate on a person to derive sexual pleasure. People who practice this kind of paraphilia has the risks of an infection with diseases such as hepatitis, due to they are eating feces of anyone or consuming one's own feces.

On the other hand, klismaphilia was coined by Dr. Joanne Denko in 1973 that is also an unknown paraphilia which involves sexual excitement from having an enema that consists in the internal wash out through water or other liquid; it is considered in some cases as a type of anal masturbation. This kind of paraphilia is frequently associated with fetish for spanking, anal play and diapers.

The menophilia is another weird sexual behavior which is regarding to feel sexually excited at the sight of a menstruating woman, people who are involve in that kind of paraphilia are attracted by the smell, image, taste or feel of the blood expelled during menstruation that provoke sexual excitement. Moreover, there is a connection between the blood from the vagina and a primitive instinct in human beings, but that connection is not clear yet.

In addition, asphyxiophilia is when the person gets sexually aroused as he or she is slowly deprived of oxygen by self-strangulation or from being strangulated or asphyxiated by a sexual partner that may or not be involved in the act, but not including the loss of consciousness. Some methods used to feel the satisfaction are the usage of plastic bags over the head or self-strangulation, typically by the use of a ligature (scarfing). This practice provokes a very dangerous sexual gratification because the state of asphyxia produces more endorphins increasing the level of pleasure. This paraphilia is extremely risky and the authorities have some data about cases that ended in accidental deaths.

Finally, the gerontophilia is also one of the unknown paraphilias in that research. There are a few studies of this kind of deviant behavior that describes a specific sexual inclination towards the elderly people and they are not interested in young women or men. In some cases elder women are raped resulting in murder or death, this paraphilia is more common in those cultures where grandparents or elder people play chief role.

These kind of sexual behaviors are more common each day, so it is important to know them and to realize that these practices carry out some repercussions in many aspects of human lives. But this research is focused on the social consequences and according to the Merck Manual of Medical Information (2007b) people with a paraphilia have difficulties to be affective and the partners of them could feel like an object or if they are unnecessary in relationship. Also, the manual shows that paraphilias cause significant sorrow from people's reactions or from the feeling of guilty about something that is unacceptable.

Even not all of these paraphilias have treatments, psychiatrist have founded some ways to help people with sexual disorders. Based on the data of Benuto, L. (2009), treatments depends on the nature of the paraphilia and they have different ways to be applied, for instance the biological component such as medications like medroxyprogesterone acetate, antidepressants, leuprolide, and goserelin, the psychological component for example psychotherapy, and the sociocultural component like family or group therapy. Although some paraphilias are crimes such as pedophilia and must be punish, the simple act to be in jail does not change the desire or fantasy of the person.

Terminologies

Acrotomophilia: The attraction to someone who is an amputee.

APA: American Psychiatric Association.

Asphyxiophilia: Self-strangulation or asphyxiated.

Coprophilia or fecophilia: Sexual excitement focused on feces.

DSM IV: Diagnostic and Statistical Manual of Mental Disorders.

Exhibitionism: Exposing oneself sexually to others

Frotteurism: Intentional rubbing or touching an unsuspecting victim.

Gerontophilia: Sexual inclination towards the elderly people.

Klismaphilia: Sexual excitement from having an enema.

Masochism: Sexual excitement from being humiliated, beaten, bound.

Menophilia. Sexual excitement at the sight of a menstruating woman.

Paraphilias: Sexual impulse disorders.

Pedophilia: Sexual activity of fantasies with children.

Sadism: Sexual excitement from inflicting physical or psychological suffering on a person.

Voyeurism: Sexual aroused by watching someone who is disrobing, naked, or engaged in sexual activity.

WPA: Psychiatric and Human Sexuality Section.

Outline

¨ Chapter I Introduction: This research is about sexual behaviors named Paraphilias, focused on the six more common and the six more unknown in the world.

¨ Chapter II Theoretical Framework:

ü The concept of paraphilia.

ü The causes of paraphilia.

ü The six more common paraphilias.

pedophilia

exhibitionism

frotteurism

masochism

sadism

voyeurism

ü The six more unknown paraphilias.

acrotomophilia

coprophilia

klismaphilia

menophilia

asphyxiophilia

gerontophilia

ü The social repercussions of paraphilias.

ü The treatments of paraphilia.

¨ Conclusion

Conclusion

During many time, paraphilias were not know, but through the history this concept have evolved and at the same time extended its critics about people who practice this sexual behavior. Thanks to investigations made, paraphilias are nowadays well known and people can understand and have knowledge what a paraphilia is and how can affect or not in the social performance of a person. Base on that, paraphilia is considered as a mental disorder, recurrent sexual fantasies, urges and behaviors that are considered deviant with respect to cultural norms.

In that way, it can conclude that there are a lot of paraphilias, but in this research were analyzed twelve; the six more common (pedophilia, exhibitionism, frotteurism, masochism, sadism, and voyeurism) and the six more unknown (acrotomophilia, coprophilia, klismaphilia, menophilia, asphyxiophilia and gerontophilia), which their causes according to specialists, emerge during adolescence with an usual connection of events in early childhood and psychological factors, but the origin is not proved yet for some psychologists.

Supporting the ideas above, paraphilias have social repercussions; for example difficulties to be affective, sorrow from people’s reaction, feelings of guilt and others. Due to these social repercussions, some of them have treatments like medication, psychotherapy and family or group therapy.

References

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