The relationship between a word and its meanings can be complex, and in studies of language, is known as semantics (Megginson, 1996). Communication involving sexuality-related words can encounter significant roadblocks. The mere articulation or description of certain words, objects, actions, and even people can generate two types of meaning for individuals -- denotative (referential) and connotative (representational). A person may find it easy to state the denotative meaning or dictionary definition of a word, but simultaneously have considerably more difficulty in successfully articulating its connotative meaning, due to an association (emotional or otherwise) that the word evokes (Megginson, 1996). In the theoretical framework of the meaning assigned to language discussed by Osgood, Suci, and Tannenbaum (1957), connotative meanings of specific constructs can vary depending on factors such as personal experience, age, gender, culture, language, ethnicity, religiosity, time, and setting.

In the health fields a large pool of sexuality-related terms is used by health care providers, including health educators, nurses, therapists, counselors, physicians, and other health professionals to convey meaning about sexual health, functions, relationships, behaviors, lifestyles, and consequences of sexual practices. The selection of terms by health professionals and the connotative translations of these terms by patients may not always produce optimal communication in the health care setting. Previous research supports the notion that an independent rating or evaluation can be applied to determine the connotative meanings assigned to various forms of birth control (McDermott & Gold, 1986-87) and to sexuality-related terms in general (McDermott, Drolet, & Fetro, 1989).

Under certain circumstances language may lose its communicative value and even contribute to the creation of significant communication barriers. In fact, two individuals may assign entirely different connotative or representational meanings to the same constructs due to differences in their previous experiences and sets of beliefs.

An example is the connotative or inferred meaning of the word drugs. Few people would argue against a denotative or referential meaning as "substances, other than food and water, that have a direct effect on the structure or

function of an individual" (Mullen, McDermott, Gold, & Belcastro, 1996, p.458). However, the representational meaning to each person may be unique. To some individuals, drugs may be defined in terms of their positive and therapeutic effects on the body systems to combat disease, correct metabolic disorders, or restore well-being. To other persons, drugs may represent social deviance and call to mind the negative consequences of substance abuse and lawlessness. The meaning of drug clearly is not limited to the relative simplicity of the material substance itself.

Berg (1995) reminds historiographers that the connotative meanings of words can change over time. For instance, a hundred years ago the word nurse gave rise to images of "hand maidens" and "clinical subservient helpers to physicians" (Berg, 1995, p.163). While these images may not have been shed universally even today, the connotation of nurse, at least in the U.S., is much less rigid, much more enlightened, and considerably more professionalized. Similarly, since the 1950s, words like "Negro" and "crippled" have acquired negative connotations, and according to Megginson (1996), have been replaced in the English language by either more "neutral" terms (e.g., "black" and "handicapped") or by words with a "positive" polarity (e.g., African-American" and "differently-abled").

Another example of connotative interpretation is the lack of a universally accepted sexual language and the dual meaning of words that make it difficult to discuss an area that already is laden with emotion and feeling. Connotative meanings assigned to sexuality-related constructs may present significant impediments to optimal sexual health and functioning. Such impediments may prevent individuals from being open to sexuality education, from obtaining sexual counseling and therapy, or from achieving favorable outcomes from such interventions. They also may limit a person's ability to provide a reliable medical and sexual history, to feel comfortable during a physical exam, or to describe symptoms related to sexual organs or sexual functioning. It cannot necessarily be assumed that the health professional has any greater comfort with sexual language than the patient she or he is trying to serve, since the practitioner is also a product of a complex belief and value system as well as cumulative experience.

In a somewhat different context, the problem of intended meaning and actual interpretation is augmented when language is used as a "power tool" between the sexes. To illustrate this point, Roffman (1991) refers us to the baseball vernacular used as sexual metaphors in some geographic regions of North America. Most people who are baseball literate understand the denotative meanings of the baseball terms: first base, striking out, and home run. However, the connotative meanings may be quite different. Whereas a male can speak of getting to "first base" or "striking out" with his date, one similarly expects scoring a "home run" to be nothing short of genital intercourse.

To represent this point in still another way, one need only look at the scientific definition of sexually transmissible infections. These disorders and their corresponding acronym (STIs) are part of everyday language. However, what thoughts, feelings, and visceral reactions come to mind when some of these words are spoken? The STIs get labeled by health professionals as a collection of disorders, but perhaps with only casual regard for the connotative meanings they create for the patient getting screened, diagnosed, educated, or counseled. Roffman (1991) notes that such words are anti-sexual in tone and lead one to believe that the diseases are linguistically blamed on sex. Quite unlike the STIs, problems such as the common cold, influenza, or tuberculosis do not get labeled as BTIs (breath transmitted infections).

Baudhim (1973) assessed the offensiveness of selected words and found that words with sexual connotations were judged to be the most offensive. Robinson, Balkwell, and Ward (1980) reported that males and females associated different meanings for the word intercourse. Moreover, among women who had experienced sexual intercourse, the word love was associated with intercourse, but among sexually inexperienced women, the word marriage was more likely to be associated. Kutner and Brogan (1974) showed that men had a larger slang vocabulary than women to describe sexual intercourse, a finding also demonstrated by Walsh and Leonard (1974). In general, in mainstream U.S. culture, males may have a larger vocabulary to represent and describe other aspects of sexual activity than their female counterparts (Sanders & Robinson, 1979). Other investigators refute these notions (Kramer, Thorne, & Henely, 1978; Rubenstein, Watson, Drolette, & Rubenstein, 1976).

Purpose of the Study

In the past, research often has focused either on the analyses of words synonymous with male and female genitalia and the act of sexual intercourse, or else the creation, use, or impact of other slang expressions (Sanders & Robinson, 1979; Simkins & Rinck, 1982). Although investigations of connotative meanings of sexual vocabulary have been reported previously on university students in the U.S. (McDermott & Gold, 1986-87; McDermott, Drolet, & Fetro, 1989) studies of a similar nature in non-English speaking countries are more difficult to find in the literature. The purpose of this study was to examine the attributes assigned to selected constructs representing sexuality-related events, objects/people, and abstract terms by nursing students at a university in the Dominican Republic. Nurses are included in the array of health care practitioners whose work necessitates their having sensitivity to, and understanding of, complex sexuality-related matters. This fact may be even more relevant in Latin American countries such as the Dominican Republic where nurses are confronted with unique sexuality-related issues that impact the educational and therapeutic aspects of patient care, including strong, culturally-ascribed gender roles, limited sexual dialogue, and a religious tradition predominated by Roman Catholicism. All of these factors may influence sexuality-related beliefs and potentially affect exchanges and interactions between nurses and patients. Unlike in the U.S. and a few other countries, where health educators are specially prepared, credentialed, and recognized as a health occupational group, it is nurses who conduct much of the formal, as well as the informal health education that takes place in the Dominican Republic. A study of nursing students at a university in the Dominican Republic is further warranted to examine their assigned meanings to the language of sexuality so that relevant educational experiences that reflect the role of language might be incorporated into their pre-professional experience and training.

This study used the Connotative Meanings of Sexuality-related Terms Survey developed by McDermott, et al. (1989) that employs three sets of scales representing events, objects/people, and abstract terms. McDermott, et al. (1989) reported Cronbach alphas of .93, .95, and .91 respectively for the three scales. Details concerning the identification of terms and the development and validation of these scales can be found in Gold, Regin, McDermott, and Drolet (1985). The three scales included 25 sexuality-related events, 15 sexuality-related objects or people, and 9 sexuality-related abstracts terms. Fifteen pairs of bipolar adjectives were arranged at opposite ends of a seven-point scale as described in Osgood, et al. (1957). Data from Gold, et al. (1985) indicated that these bipolar adjectives were not necessarily identical for the three categories of terms. The relevant adjectival pairs are shown in both English and Spanish in Table 1. In addition, demographic data related to gender, age, ethnicity, and religion were collected. The original English version of the survey was translated into Spanish by two bilingual professors, one from the United States and the other from the Dominican Republic. A panel of bilingual health professionals in the Dominican Republic reviewed the translated version. The survey was back-translated, and then pretested in the Dominican Republic, a process known as cultural decentering that helps assure item validity (Pasick, Sabogal, Bird, D'Onofrio, Jenkins, Lee, Engelstad & Hiatt, 1996).

Surveys were distributed in classroom settings by one of the researchers to students enrolled in nursing courses at a university in Santo Domingo. Nursing students were given written and verbal instruction "to rate each sexuality-related construct according to their initial impressions" and were encouraged "not to spend too long on any one item." The bipolar scales were scored from 1 (positive) to 7 (negative). Values were summed and overall means were calculated for each term as illustrated in previously published works (Gold, et al., 1985; McDermott & Gold, 1986-87; McDermott, et al., 1989).

Comparisons between the attributes assigned to sexuality-related terms by males and females were made through a series of t-tests with an initial alpha level of .05. The Bonferroni step-down correction, as recommended by Pedhazur (1982), was applied to the alpha level to account for multiple comparisons. This correction made the criterion for statistical significance more rigorous and decreased the probability of making a type I error. With these adjustments, the new criterion values for events, physical objects/people, and abstract terms were .002, .003, and .006 respectively. The research plan was reviewed and approved by the Institutional Review Board of the primary sponsoring university.

^*p<.002 (Bonferroni corrected) ns = nonsignificant