Sexual Psychology – Sexual Behaviors – Due Wed 11/24

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The Psychology of Human Sexuality, Second Edition. Justin J. Lehmiller. © 2018 John Wiley & Sons, Ltd. Published 2018 by John Wiley & Sons, Ltd. Companion Website: www.wiley.com\go\lehmiller2e

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CHAPTER OUTLINE

Introduction, 265 Sexual Development From Infancy Through Adolescence, 267

Infancy and Childhood, 267 Puberty, 268 Adolescence, 270 Biopsychosocial Influences on Teenage Sexual Activity, 273 Implications of Early or Late Sexual Development, 274

Sexuality and Aging, 277 Biopsychosocial Influences on the Sexual Activities of Older Adults, 281

Lifespan Sexual Development

Introduction

Take a moment and think back to your very first sexual experience (if you have not had one yet, envision what that experience might be like). Next, imagine what your sex life will look like ten years from now—what kinds of things do you think you will desire, and which activities might

©JohnnyGreig/Getty Images

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you engage in? Finally, think about what your sex life will be like in the distant future, when you are much older and in your retirement years.

If you’re like most people, you have probably never stopped to seriously reflect on how your sex life has evolved over time, or how it is likely to change in the future. However, if you took the exercise in the opening paragraph seriously, chances are that you discovered just how dynamic human sexuality can be across the lifespan. It is precisely this insight that has led psychologists to begin looking at human sexuality as a developmental process. Psychology has long since abandoned the Freudian view that virtually all of our sexual development occurs in childhood as we advance through a series of psychosexual stages (perhaps getting “fixated” in one of them along the way). Instead, psychologists now view sexuality as something that continually evolves over the lifespan in response to biopsychosocial influences.

In this chapter, we are going to look at sexuality at various stages of the life cycle. Specifically, we will address the development of sexuality in childhood and adolescence, as well as the ways in which it changes in older age. This chapter will devote particular attention to biopsychoso- cial factors that trigger changes in sexual development at these different life stages. We will also consider the implications of becoming sexually active much earlier or later than one’s peers.

Before we begin, it is worth pointing out that we do not have as many data and as much information on lifespan sexual development as we would like. Most sex research has focused on young adults (as described in previous chapters), with children and seniors being largely neglected. There are a few reasons for this. Conducting research on sexuality in childhood is politically challenging. For example, in the United States, sex researchers cannot survey persons under age 18 about their sexual attitudes and behaviors unless they receive parental consent. Many parents are reluctant to provide their consent, either because they do not see their children as sexual beings or because they feel that it would be inappropriate or immoral for their kids to participate in sex research. As some evidence of this, recall from chapter  2 that when the initial wave of the National Survey of Sexual Health and Behavior (NSSHB) was undertaken, about 4 in 10 of the parents who were contacted refused to let their children aged 14–17 take part in the study (Herbenick et al., 2010). Due to such resistance, much of our data on sexuality in childhood and adolescence comes from retrospective self-reports of adults who try to recall what they can from the past, or from self-reports of parents who provide infor- mation about behaviors they have observed among their children. However, these are both imperfect methods that raise some concerns about the validity of the data, with the former being subject to memory distortions and the latter consisting of secondhand information from untrained observers (recall from chapter 2 that two people watching the same activity could categorize it very differently).

Our lack of information on the sex lives of older adults has been hampered by the fact that most sex research takes place on college and university campuses. The increasing move- ment toward online research has enhanced older adults’ representation in sex studies to some degree; however, there are limits to what online research can accomplish, given that seniors are less likely than the rest of the adult population to go online—indeed, 41% of US seniors age 65+ say they do not use the internet at all, a figure that is about three times higher than that of the overall adult population (Smith, 2014). In light of this, achieving representative samples of seniors tends to be quite labor intensive and expensive. Another reason older adults have been overlooked in most sex research probably stems from mistaken assumptions and stereotypes about sexuality and aging and, perhaps, discomfort with the topic. Just as many parents refuse to recognize their children as sexual beings, many people refuse to recognize seniors as sexual beings, too.

Thus, as we explore sexuality across the lifespan in this chapter, keep in mind that this is an area in which our empirical knowledge is limited in several ways.

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Sexual Development From Infancy Through Adolescence

Let us begin by taking a look at how sexuality develops and changes during childhood and adolescence, as well as some of the most significant biological, psychological, and social factors that contribute to early sexual development.

Infancy and Childhood

Sex researchers dating back to Alfred Kinsey have noted that sexuality has its roots in infancy. Indeed, both male and female infants are capable of sexual response from the moment of birth, if not before. For example, not only have erections been observed among male infants in the first hours of life, but ultrasound studies indicate that male fetuses experience erec- tions in the womb, too (Hitchcock, Sutphen, & Scholly, 1980). In addition to showing signs of physiological sexual response, infant self-stimulation has been documented; however, there is some debate about whether a behavior such as this that occurs so early in life is purposeful. Kinsey’s writings include references to both male and female infants engaging in various forms of self- stimulation, such as rubbing or thrusting their genitals against an object, followed by what appears to be orgasm (Kinsey, Pomeroy, & Martin,  1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953). The orgasms of male infants are different from those of adult men, though, in that they are dry orgasms, meaning no ejaculation occurs. What the psychological experience of these behaviors is like for infants, we do not know, although it does appear that they find these activities to be gratifying.

As motor development progresses, children begin to engage in genital manipulation that more closely resembles adult masturbation, something that may occur as early as two-and- a-half years of age (Martinson,  1994). Many children—both male and female—experiment with masturbation at this time and in the years leading up to puberty. In fact, retrospective self-report data indicates that approximately 4 in 10 adult men and women recall prepubertal

Figure 10.1 Ultrasound studies reveal that the human body’s capacity for sexual response begins in the womb. ©GagliardiImages 2016. Used under license from Shutterstock.com.

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masturbation and, further, about 1 in 8 recall having their first orgasm before puberty (Bancroft, Herbenick, & Reynolds, 2003). Parents who observe their children masturbating have a range of reactions. Some discourage them from engaging in self-stimulation completely, others encour- age them to do so only in private, and yet others ignore it, laugh at it, or punish the behavior. The messages that parents send about masturbation at this very early age can have a significant impact on how masturbation is viewed throughout one’s life.

As children grow older, sexuality is something that often expands from self-stimulation to sexual experience with peers. For many, this includes “playing doctor,” a game in which chil- dren inspect one another’s genitals. Which specific sexual behaviors are most common at this age? In a study that involved parental reports of their children’s sexual behaviors (ages 2–12) during the past six months, 34% were observed kissing other nonrelated children, 8% showed their genitals to other children, 7% rubbed their bodies against others, and 6% touched others’ genitals (Friedrich et al., 1992). Keep in mind that these numbers are probably underestimates, given that parents do not necessarily monitor their children’s activities at all times. Adults’ ret- rospective self-reports of their own childhood sexual behaviors suggest participation rates that are even higher than those obtained from studies that rely on parental reports. For instance, Kinsey found that almost half of the adult women and a majority of the adult men he sur- veyed remembered having a sexual experience by the age of 12 (Kinsey et al.,  1948; Kinsey et al.,  1953). Experiences of this nature can occur with peers of the same sex or the other sex; however, given the prevalence of sex-segregated play at this stage of life (i.e., boys playing primarily with boys and girls playing primarily with girls), same-sex experiences may actually be most common (Martinson, 1994). Keep in mind, though, that childhood same-sex experi- ences are not necessarily indicative of adult sexual orientation and, sometimes, simply reflect transitory behaviors.

All of the behaviors we have discussed here stem, in part, from an inherent curiosity children appear to have about sex and the human body. This curiosity, which only increases as children get older, is further reflected in the fact that it is not uncommon for parents to notice their children watching others undress or looking at nude photos (Friedrich et al., 1992). Many par- ents are reluctant to indulge their children’s curiosity by talking to them about sex or anatomy, which may lead children to seek out alternative sources of information, such as their peers or the Internet. This is particularly true in the United States, but less so in other countries such as the Netherlands, where sex is normalized, parents tend to have a more open dialogue with their children, and school-based sex education begins at a younger age (see chapter 11 for more on this).

It is important to note that, in the modern world, expressing curiosity about sex, masturbat- ing, and/or engaging in sexual activities with one’s peers are all generally regarded as normal and perfectly harmless by the medical and psychological communities. This is quite a depar- ture from the late 1800s and early 1900s, when childhood masturbation in particular was considered unhealthy and physicians developed a number of cruel and unusual methods to curb this behavior, as discussed in chapter 8.

Puberty

As the data reviewed in the previous section clearly reveal, sexual curiosity and behavior set in well before puberty begins; however, they tend to increase significantly afterwards. Puberty, of course, refers to a period of rapid physical changes that ultimately leads to sexual maturity. Puberty typically begins between ages 10 and 12 and lasts for several years. Girls tend to start puberty a little earlier than boys; however, there is significant variability in onset

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of puberty, with some beginning as early as ages 7 or 8 (known as precocious puberty) and others as late as 15 or 16 (known as delayed puberty). In addition to this gender difference in age of puberty onset, there are also racial and cultural differences. For instance, in the United States, 10% of White girls show signs of breast development by age 7, compared to 23% of African American girls (Biro et al., 2010), a finding that may reflect differences in diet and obesity rates (obesity is linked to earlier onset of puberty, and rates of obesity are higher among African American girls). This link between puberty and obesity also helps to explain why puberty tends to begin later in developing and underprivileged countries—where many children are starving or malnourished—than it does in the United States and other developed nations (Parent et al., 2011).

During puberty, the body experiences a surge of sex hormones that leads to the develop- ment of secondary sex characteristics, or physical features that indicate sexual maturity, such as growth of pubic hair. Many secondary sex characteristics are sexually dimorphic—meaning they are different across the sexes. This includes the development of breasts in girls, as well as the deepening of the voice and growth of facial hair that occurs in boys. These hormones also stimulate further development of the internal and external genital structures, ultimately leading to menarche, a girl’s first menstruation, and spermarche, when sperm production in the testes begins in boys. Thus, for both boys and girls, fertility is typically present by the end of puberty.

Figure 10.2 It is not uncommon for parents to observe their children engaging in behaviors of an intimate or sexual nature with their peers, such as kissing. Such behaviors are generally regarded as normal and harmless. ©bikeriderlondon 2016. Used under license from Shutterstock.com.

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Adolescence

Generally speaking, adolescence is the period of life between ages 10 and 19. Puberty usually begins and ends during adolescence, but (as noted in the preceding section) it sometimes begins in late childhood. Adolescence is a significant life stage because not only is it when most people develop feelings of sexual attraction for the first time, it is also when most people have their first experience with sexual intercourse and their first romantic relationship.

Sexual Attraction and Sexual Identity Development Research suggests that, regardless of sexual orientation, 10 is the average age at which both men and women recall their earliest feelings of sexual attraction (McClintock & Herdt, 1996). Thus, sexual attraction develops very early in life, and usually long before the gonads have fully matured. Those whose initial attractions are to persons of the same sex do not necessarily come to an immediate realization that they are gay or bisexual—in fact, there may be a period of years in between someone’s first same-sex attraction and when that person begins to question and, eventually, label their sexuality (Diamond, 1998).

The processes by which gay, lesbian, and bisexual individuals come to adopt sexual identity labels is itself another developmental process. This is something that often begins in ado- lescence and may extend well into adulthood for some. Numerous models of sexual identity development have been proposed, most of which are stage models, which argue that sexual identity develops according to a very distinct, orderly pattern. One example of this would be the Cass Model (Cass, 1979), which theorizes that a gay or lesbian identity develops after one passes through a series of six stages. Briefly, they are: confusion (initial awareness of same-sex attraction), comparison (consideration of the implications of being gay or lesbian), tolerance (recognizing that you are not the only one), acceptance (seeing one’s sexuality in a positive light), pride (coming out), and synthesis (integrating a gay identity with other aspects of the self ). Although popular, these models are limited in that they fail to capture the vast diversity that exists in the processes by which people come to form and integrate their sexual identities— not everyone develops their identity according to such a predictable, linear pattern (Rosario, Schrimshaw, & Hunter, 2011).

Sexual Exploration After the onset of sexual attraction, it is common for adolescents to further explore sexual behavior with their peers. Interestingly, those who start masturbating early seem to progress to peer sexual behaviors more quickly. As some evidence of this, in a study comparing adults who reported masturbating prepubertally to those who started masturbating after puberty, early masturbation was linked to engaging in partnered sexual behaviors at a younger age (Bancroft et al., 2003). This suggests that masturbation may be a marker for sexual development.

With respect to partnered sexual behaviors, there is usually a progression of sexual activities that takes place over three to four years, with the activities gradually leading up to intercourse. At least among American adolescents, kissing typically begins between ages 12 and 14, followed by petting and genital fondling between ages 15 and 16, and first intercourse between ages 16 and 18 (Reynolds, Herbenick, & Bancroft,  2003). Of course, as always, there is wide individual variation, not to mention substantial variation across race and culture. For instance, as discussed in chapter 9, African American adolescents tend to have their first kiss and first intercourse experiences at younger ages than Asian Americans (Regan, Durvasula, Howell, Ureno, & Rea, 2004). Despite this variability, what the available data suggest is that adolescent sexual behavior tends to follow a given culture’s sexual script for the order in which intimacy tends to be expressed in a dating relationship. For further information on the sexual activities

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practiced among adolescents and how they vary across age and sex, check out Table  10.1. This table focuses on data from the 14–17-year-old participants who took part in the NSSHB.

As you can see in this table, reports of both masturbation and partnered behaviors appear to increase throughout adolescence, regardless of gender. However, the overall number who have engaged in partnered activities is lower than you might expect based on the popular media narrative that teenagers today are hypersexual and having sex of all kinds at younger and younger ages. To the contrary, these data indicate that a majority of American adolescents aged 14–17 have not engaged in any partnered sexual behaviors in the past year. When you combine this with other research showing that the percentage of teens who report having ever had penile–vaginal intercourse has actually decreased since the 1980s (see Figure  10.3), we begin to see that the reality of adolescents’ sex lives is very different from the media spin.

On a side note, partnered sexual behavior in adolescence is often referred to in the media and on sex surveys as “premarital sex.” However, this is a problematic term because it implies that marriage is normative and something that everyone aspires to. It is also usually defined very narrowly as penile–vaginal intercourse. As such, I have avoided usage of that term in this section and throughout the rest of the book.

Romantic Relationship Initiation Coinciding with a rise in sexual attraction and behavior is the pursuit of romantic relation- ships. Contrary to popular belief, most adolescent sexual behaviors take place in the context of relationships, not sexual hookups. Indeed, NSSHB data reveal that the majority of adolescent boys and girls who engaged in partnered sexual behaviors in the last year did so with someone they considered a boyfriend or girlfriend (Fortenberry et al.,  2010). Certainly, many adoles- cents do engage in casual sex (e.g., one-night stands, friends with benefits)—it is just that most adolescent sex occurs with a romantic partner.

Adolescent romantic relationships serve multiple purposes and represent far more than simply a potential avenue to express and explore one’s newfound feelings of sexual attraction. For example, just as adults’ romantic relationships help to fulfill needs for belongingness and self-expansion (see chapter 8), adolescents’ relationships do just the same. Moreover, given that

Table 10.1 Male and female sexual behaviors among adolescents aged 14–17.

Age

14 15 16 17

Behavior M F M F M F M F

Solo masturbation 53% 42% 71% 38% 75% 42% 73% 48% Partnered masturbation 2% 10% 8% 5% 15% 15% 17% 24% Gave oral sex 4% 8% 11% 17% 9% 22% 28% 26% Received oral sex 4% 11% 18% 9% 27% 21% 36% 26% Vaginal intercourse 2% 12% 16% 9% 20% 28% 40% 31% Anal intercourse 1% 7% 5% 1% 6% 5% 5% 4% Any partnered sexual behavior 5% 16% 20% 21% 33% 35% 48% 39%

Note: M = male, F = female. Numbers represent the percentage of adolescents reporting each behavior in the past year. Adapted from the National Survey of Sexual Health and Behavior. Source: Fortenberry et al., 2010.

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adolescence is often a very tumultuous period of major life transitions, romantic relationships may offer some much-needed stability and emotional support. On another note, it is worth mentioning that the dynamics of adolescent relationships are strikingly similar to those of adult relationships in terms of the factors that promote love and commitment (Levesque, 1993).

Figure 10.4 Most people report their first feelings of sexual attraction in early adolescence. Subsequently, many begin pursuing sexual and/or romantic relationships. ©Dragon Images 2016. Used under license from Shutterstock.com.

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Figure 10.3 Note: This figure presents the percentage of never-married male and female teens aged 15–19 who report having engaged in penile–vaginal intercourse at least once. Data obtained from Martinez and Amba (2015).

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Biopsychosocial Influences on Teenage Sexual Activity

It should be clear by now that not all adolescents are sexually active and, further, among those who are, some become active much sooner than others. The reasons for this variability in sex- ual behavior are biopsychosocial in nature. In this section, we will consider some of the myriad factors that have been linked to timing of sexual debut (i.e., first sexual intercourse), number of partners, and risky sexual practices among adolescents.

With respect to biological factors, precocious puberty (i.e., going through puberty early) is linked to having sex prior to age 16 as well as a greater likelihood of having unprotected sex (Downing & Bellis,  2009). The link between early puberty and early sex might be explained by psychosocial factors, though, given that early puberty is confounded with lower parental socioeconomic status (SES). To the extent that lower SES translates to less adult supervision (e.g., by affecting parents’ ability to afford childcare), this could potentially account for the association. Beyond puberty, physical disabilities represent another biological factor that has the potential to impact age of sexual debut; however, different disabilities may have different effects. For instance, adolescents with physical disabilities that permanently affect function of their arms and/or legs have a sexual development trajectory that is quite similar to that of their able-bodied counterparts, although those with minimal disabilities are more likely to be sexually active than those with severe disabilities (Cheng & Udry, 2002). By contrast, persons with visual impairments tend to have a later age of sexual debut compared to sighted persons (Welbourne, Lifschitz, Selvin, & Green, 1983). One potential explanation for the differences between these studies is that, compared to disabilities affecting the limbs, visual impairments may make it more difficult to meet partners and/or to recognize many of the common social cues relevant to sex and dating. Differences in others’ attitudes toward specific disabilities could play a role as well.

Figure 10.5 Research suggests that the sexual development trajectory of adolescents with physical disabilities is not necessarily different from that of able-bodied adolescents; however, sexual development patterns may vary across different types of disabilities. ©iStockphoto.com/nullplus.

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Next, in terms of psychological factors linked to adolescent sexual activity, having an anxious attachment style is associated with having sex more often at a young age (Tracy, Shaver, Albino, & Cooper, 2003). Why? Perhaps because fear of abandonment and rejection makes anxiously attached teens more likely to agree to sex in the hope that their partner will stick around. In other words, adolescents’ feelings of relationship security/insecurity may influence whether and how often they have sex. In addition, adolescents with sensation-seeking personalities tend to have more partners, more casual sex, and more unprotected sex (Arnett, 1996). Regardless of where we are in the lifespan, sensation seekers tend to be more sexually active and engage in riskier activities. Furthermore, adolescents who hold positive beliefs and attitudes toward sex are more likely to have sex at an early age and to say they have had sex in the past year, whereas those with positive attitudes toward abstinence are more likely to delay sexual activity (Buhi & Goodson, 2007).

Finally, let us consider some of the many social and environmental factors that have been linked to adolescent sex. Parent–child relationships are particularly notable. Several studies have found that having a closer relationship with one’s parents, receiving more parental support, and having more parental supervision/monitoring are linked to delayed sexual activity (Buhi & Goodson,  2007). I should mention that several studies have found no association between parent–child relationship quality and adolescent sexual behavior; however, this may be a func- tion of the fact that researchers have not operationalized and measured relationship quality in a consistent manner across studies. In addition to relationships with parents, peer relationships also play an important role. Specifically, several studies have found that adolescents who believe that most of their peers are having sex and/or who believe that their peers have positive attitudes toward sex tend to have an earlier sexual debut (Buhi & Goodson, 2007).

The popular media and modern technology have also been identified as potential influences on adolescent sexual behavior. Longitudinal research has found that exposure to sexual content in movies is linked to having sex at a younger age, having more partners, and engaging in riskier sexual practices (O’Hara, Gibbons, Gerrard, Li, & Sargent, 2012). Although these data are often interpreted as evidence that kids simply imitate what they see on screen (“monkey see, mon- key do”), caution is warranted in drawing conclusions about cause-and-effect here because alternative explanations are possible. For instance, perhaps exposure to sexualized media is confounded with lower parental supervision. In addition to media influences, researchers have increasingly been exploring the role of the Internet in adolescent sexual behavior. In particular, much concern has been directed toward the issue of sexting, or the electronic transmission of sexual images or text messages, with some arguing that this is a “gateway” behavior that increases the odds of early and risky sex. For a closer look at what research on sexting has revealed, check out the Digging Deeper 10.1 box.

School-based sex education courses represent another social factor with the potential to shape the sexual behaviors of adolescents; however, we will consider this topic in more detail in the next chapter.

Implications of Early or Late Sexual Development

Clearly, there are numerous factors that can influence when and why adolescents decide to become sexually active. Ultimately, however, research suggests that most adolescents start having sex within a relatively narrow period of just a few years. For instance, in a national study of over 6,000 US men and women who were asked to report the age at which they first had sex (defined specifically in this study as penile–vaginal intercourse), the vast majority (60% of women and 56% of men) reported having done so between their 15th and 20th birth- days (Finer & Philbin, 2013). Of course, a sizeable minority fell outside of this window due to

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Digging Deeper 10.1 Teen Sexting is Linked to Having Sex, But Not to Having Risky Sex.

Many scientific studies have reported a link between sexting and sexual behavior among teenagers. However, this body of research is inherently limited because most studies on this topic have simply surveyed teens at one point in time and asked them about both sexting and sexual behavior, cre- ating the classic “chicken and egg” problem that exists in all correlational studies: which came first? Does sexting increase the odds of future sexual activity, or might being sexually active predispose teens to sexting? A longitudinal study by Temple and Choi (2014) offers some insight.

Temple and Choi studied 964 racially diverse adolescents (approximately one-third White, one-third Black, and one-third Hispanic) who were age 16 on average. Participants completed two surveys about one year apart in which they were asked whether they had ever sent or received a sext (defined as sending “naked pictures of yourself to another through text or e-mail”). They were also asked whether they had ever engaged in sexual intercourse (defined broadly so as to encom- pass both vaginal and anal intercourse with partners of any sex), whether they use condoms, how often they use alcohol or drugs before sexual activity, and how many partners they have had.

Results revealed that sexting was common. In the first survey, 60% said they had been asked for a sext, 31% had asked someone else for a sext, and 28% had actually sent a sext. In addition, most teens were sexually active: 53% reported having had intercourse on the first survey, while 64% reported it on the second survey.

So how was sexting at Time 1 related to sexual behavior one year later? Neither being asked for a sext nor asking someone else for a sext were linked to having intercourse at Time 2; however, sending a sext was. Specifically, compared to those who did not send sexts at Time 1, the odds of engaging in intercourse at Time 2 were 1.3 times greater for those who sent sexts.

Figure 10.6 Sexting, or the electronic transmission of sexual images or text messages, has become an increasingly common sexual behavior among adolescents. ©nito 2016. Used under license from Shutterstock.com.

(ContinueA)

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the biopsychosocial variables we considered in the preceding section (not to mention the fact that some adolescents are attracted to the same sex and others are asexual). This raises the interesting question of whether there are any implications of becoming sexually active much sooner or later than one’s peers. We will consider this in the paragraphs that follow; however, please bear in mind that research on age of sexual debut has primarily focused on age of first penile–vaginal intercourse. As a result, we do not know as much about the implications of age of debut for other sexual activities or for persons who are nonheterosexual.

With respect to early sexual debut, research suggests that this has implications for sexual health, given that the earlier adolescents begin having penile–vaginal intercourse, the less likely they are use contraception and the longer it takes them to start using birth control (Finer & Philbin,  2013). In light of this finding, it should not be surprising to learn that early sexual debut is linked to increased risk of contracting sexually transmitted infections (Epstein et al.,  2014) and teenage pregnancy (Baumgartner, Geary, Tucker, & Wedderburn,  2009). Beyond this, some researchers have suggested that early sexual debut has implications for subsequent nonsexual behaviors. Specifically, longitudinal research has found that adoles- cents who begin having intercourse early are more likely to engage in delinquent behavior one year later, such as committing minor theft or property damage (Armour & Haynie, 2007). One interpretation of this finding is that, because early sex is widely considered a taboo activ- ity, perhaps this opens the door to violating other taboos. However, an alternative explana- tion is that perhaps this association is explained by a third variable, such as sensation-seeking tendencies. Lastly, having sex at a younger age has long been argued to have psychological implications, such that it increases risk of depression and poor mental health—not just in ado- lescence, but carrying over into adulthood. In fact, this is one of the main arguments advanced by those who favor abstinence-only sex education. However, this claim appears to have been vastly over-stated. While a nationally representative longitudinal study of over 5,000 US ado- lescents revealed that early experiences with vaginal intercourse were linked to experiencing depressive symptoms, this was only true for girls and only those under age 16; beyond 16, age of first intercourse was unrelated to symptom reports (Spriggs & Halpern, 2008). Thus, early sexual debut may have some mental health implications, but they appear specific to one sex and seem to be quickly overcome.

Regarding delayed sexual debut, research has found that persons who do not begin having intercourse in adolescence and, instead, wait until early adulthood tend to report experiencing

However, while sending sexts predicted future intercourse experience, it did not predict risky sexual behavior, such as having sex without condoms, reporting multiple sexual partners, or combining alcohol/drugs with sex.

These results reveal that sexting does indeed predict subsequent experience with sexual inter- course among teenagers; however, the association is relatively small. At most, this means that sexting is just one of many potential factors that might shape adolescents’ sexual behavior. In other words, while sexting could potentially be a “gateway” to sex for some, it isn’t for everyone.

There are some important limitations of this research. For instance, it only considered experi- ences with intercourse, and not with other behaviors such as oral sex. In addition, the researchers did not consider whether the link between sexting and sexual behavior might vary across differ- ent groups of adolescents. That said, this study suggests that while sexting has a small link with initiation of sexual activity, it is not necessarily a sign of future sexual risk-taking.

Note: Reprinted with permission from Sex anA PscynToloucy (www.lehmiller.com).

Digging Deeper 10.1 (Continued)

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more sexual problems. This is particularly true for men, with later sexual debut being linked to issues becoming—and staying—aroused and reaching orgasm (Sandfort, Orr, Hirsch, & Santelli, 2008). One interpretation of these findings is that perhaps not having sex in adoles- cence negatively affects the development of emotional and interpersonal skills, which impairs later sexual functioning. However, an alternative explanation is that those who did not have sex in adolescence had sexual difficulties to begin with, or perhaps had more anxiety or other issues that can interfere with sexual function. In addition to increased reports of sexual difficulties, those who delay sexual activity into adulthood tend to be socially stigmatized, at least in the Western world. In many parts of Africa and the Middle East, virginity—especially female virginity—is a highly desired trait in a romantic partner. However, in the United States and other Western countries, virginity has largely gone from a coveted trait to a social liability. As some evidence of this, when researchers surveyed 5,000 heterosexual American adults about how likely they would be to begin a committed relationship with someone who was a virgin, most said that the odds were low (Gesselman, Webster, & Garcia, 2016). Moreover, men said they were less willing to date a virgin than were women, which suggests that female virginity is actu- ally more stigmatized than male virginity among US adults. It appears that there is an optimal amount of sexual experience that Westerners now desire, such that small numbers of partners boost one’s attractiveness relative to both being a virgin as well as having an extensive sexual history (Stewart-Williams, Butler, & Thomas, 2016).

Before we move on, it is important to note that there is wide individual variability with respect to all of the implications of early and late sexual debut considered above. For instance, whereas adult virgins may be stigmatized at a societal level, this stigma does not exist within all communities (e.g., among followers of religions that strongly disapprove of sex outside of mar- riage). Likewise, early sexual debut does not necessarily always precipitate delinquent behavior or have negative health implications—in fact, more often than not, it is likely that neither one of these things occurs. Keep in mind that how early or late sexual debut will affect a specific individual is the product of a unique interaction between that person and their environment.

Sexuality and Aging

Researchers and journalists alike who write about the topic of sexuality and aging have a ten- dency to focus on just one thing: sexual difficulties. Their articles paint a bleak portrait of the future, suggesting that the sex lives of older adults are either fraught with problems or nonex- istent. While it is certainly true that we tend to encounter more sexual difficulties as we age (more on this in chapter 13), sex can still be a very important and positive aspect of seniors’ lives. Sadly, few recognize this, and the repercussions for older adults’ health and happiness are immense.

For one thing, doctors tend to neglect the topic of sex entirely when dealing with elderly patients. For some physicians, this neglect stems from the fact that they stereotype seniors as being asexual or “post-sexual,” whereas for others, it stems from feeling under-trained in the area, concern about potentially offending older patients by talking about sex, or simply not being comfortable with the subject (Taylor & Gosney, 2011). Regardless of the reason, the end result is that seniors’ sexual health needs (e.g., treatment for sexual dysfunctions, getting tested for STIs) go unaddressed all too often. In addition, many seniors end up mov- ing to nursing homes or assisted living facilities, the vast majority of which discourage sen- iors from having sex lives. This is partially because these facilities tend to afford residents relatively little privacy, but it is also because many staff members and managers simply lack awareness of older adults’ sexual needs, they consider sex among residents to be taboo, or

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they worry that residents having sex might create liability issues (For example, can patients with diminished cognitive capacity consent to sex? We will explore this issue in more detail in just a moment.). No matter the reason, when seniors are denied the ability to meet their sexual needs, it has the potential to negatively impact their physical and psychological health and wellbeing.

In order to change this state of affairs, we must begin by recognizing and acknowledging that one’s sexuality does not suddenly shut off upon hitting retirement age. Indeed, research reveals that most men and women in their 60s are sexually active and, further, that many in their 70s and beyond are having sex as well. For a closer look at the numbers, check out Table  10.2, which reports findings from a nationally representative US study of more than 3,000 adults aged 57–85 (Lindau et al., 2007).

As you can see in this table, many older adults continue to masturbate and engage in part- nered sex, and some do so quite frequently. In fact, across all age groups included in this study, the majority of seniors who indicated having had partnered sex in the past year did so at least 2–3 times per month, with vaginal intercourse being the most common sexual activity. Many seniors also engage in oral sex, although that appeared to decline in frequency with advancing age more so than did vaginal intercourse. Other research on the sexual practices of older adults is consistent these trends (Schick et al., 2010).

It is important to note that the results reported in Table  10.2 come from a study in which less than one-half of one percent of participants in relationships had a same-sex partner. Thus, these findings do not necessarily reflect the sexual activity patterns of sexual minority seniors. Very little research has addressed the sex lives of gay, lesbian, and bisexual seniors; however, the few studies that do exist indicate that many of them continue to be sexually active, too (Orel, 2004). Such research also reveals that, just like their heterosexual counterparts, sexual minority seniors report that their physicians typically neglect to discuss sexual activity; how- ever, on the rare occasions it is addressed, they often encounter heterosexism, with their phy- sicians making presumptions of heterosexuality. Thus, while the sexuality of older adults in general tends to be invisible to the outside world, this issue is even more pronounced for gay, lesbian, and bisexual seniors.

Table 10.2 Male and female sexual behaviors among older adults aged 57–85.

Age

57–64 65–74 75–85

Behavior M F M F M F

Solo masturbation 63% 32% 53% 22% 28% 16% Any partnered sexual behavior 84% 62% 67% 40% 39% 17% Of those who had partnered sex in the last year, number who did so at least 2–3 times per month

68% 63% 65% 65% 54% 54%

Of those who had partnered sex in the last year, number who engaged in oral sex

62% 53% 48% 47% 28% 35%

Of those who had partnered sex in the last year, number who engaged in vaginal intercourse

91% 87% 79% 85% 83% 74%

Note: M = male, F = female. Numbers represent the percentage of older adults reporting each behavior in the past year. Adapted from Lindau et al. 2007.

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Regardless of sexual orientation, the single biggest factor that affects whether older adults maintain active sex lives is their health—and the health of their partners. A big part of the reason for this is because some of the most common chronic health conditions experienced by seniors (e.g., cardiovascular disease, arthritis, diabetes) have a deleterious impact on sexual functioning (see chapter 13). As a result, it should not be surprising to learn that seniors who rate their overall health status as fair or poor are only about half as likely to engage in partnered sex as seniors who indicate that their health is excellent (Lindau et al., 2007).

Seniors who remain in good physical health obviously have an easier time maintaining an active sex life. However, research suggests that maintaining an active sex life in older adulthood may also be good for seniors’ physical health and mental abilities. In other words, the associa- tion between sex and health is bidirectional. As some evidence of this, recall from chapter 9 that research has found frequent orgasms to be linked to enhanced immune system function (Haake et al., 2004) and a longer lifespan (Davey Smith, Frankel, & Yarnell, 1997). In addition, research on middle-aged and older adults (ages 50–89) has found that having more frequent sex is linked to higher levels of cognitive functioning (Wright & Jenks, 2016)—a finding that is theorized to stem from sexual activity stimulating neuron growth, something that has been shown to occur in rat studies (Leuner, Glasper, & Gould, 2010).

Maintaining an active sex life may also benefit seniors’ romantic relationships. Research reveals that the more frequently older adults engage in physically intimate behaviors such as kissing, cuddling, and sexual caressing, the happier they are with their relationships (Heiman et al.,  2011). Enhanced relationship happiness, in turn, has the potential to offer additional health benefits, given that being in a happy, high quality relationship has been linked to better health and longer life (Kiecolt-Glaser & Newton, 2001).

Before we round out this chapter by considering biopsychosocial influences on the sex lives of seniors, let us consider the topic of sexual satisfaction among older adults. How sexually satisfied are seniors, and what makes for satisfying sex later in life? For a look at what the research has found, check out the Digging Deeper 10.2 box.

Figure 10.7 Many older adults maintain active sex lives, including those who are gay, lesbian, or bisexual. However, research on the sex lives of older sexual minorities has received scant research attention. ©iStockphoto.com/DavidsAdventures.

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Digging Deeper 10.2 How Does Sexual Satisfaction Change in Older Age?

It’s a simple biological fact that, as we age, the odds of developing one or more sexual problems increases. But what exactly does this mean for the sexual satisfaction of older adults? Are they necessarily discontent with their sex lives? Study after study has found that there is a negative correlation between age and sexual satisfaction, such that the older people get, the less satisfied they tend to be (e.g., Forbes, Eaton, & Kruger, 2016; Laumann et al., 2006). However, if you dig a lit- tle deeper into the research, you will see that it would be a mistake to conclude that older adults are inherently unhappy in the bedroom.

For one thing, studies of middle-aged and older adults reveal that a majority of them actually report being sexually satisfied. For example, in a nationally representative US sample of 1,384 older adults (mean age of 60 for men and 61 for women), average sexual satisfaction scores ranged from 3.6–3.8 on a five-point scale (DeLamater & Moorman,  2007). Given that the aver- age was above the scale mid-point, this tells us that most participants were satisfied with their sex lives on balance. Similar results were obtained in a study of 1,009 heterosexual couples from five countries: Brazil, Germany, Japan, Spain, and the United States (Heiman et al., 2011). Overall, 64% of male participants (median age of 55) and 69% of female participants (median age of 52) reported being sexually satisfied.

More importantly, while studies find that average levels of sexual satisfaction tend to decrease as people get older, it appears that this is largely accounted for by the fact that what makes sex satisfying changes considerably as we age. Specifically, when we are younger, our sexual sat- isfaction depends more on how often we are having sex (i.e., more sex = better sex); however, when we get older, quantitcy matters less and qualitcy begins to matter more (Forbes et al., 2016). Put another way, older adults care more about the thought and effort that goes into sex than

Figure 10.8 What makes for a satisfying sex life in older adulthood has more to do with quality than it does with quantity. ©iStockphoto.com/KatarzynaBialasiewicz.

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Biopsychosocial Influences on the Sexual Activities of Older Adults

Just as the sexual activities of adolescents are subject to biopsychosocial influences, so are those of older adults. Regarding biological factors, health status is undoubtedly the most important, as previously mentioned. In chapter  13, we will go into much greater detail about the most common health issues experienced by seniors and consider how they affect sexual function- ing, as well as how they can be treated. Beyond changes in health and ability status, there are also hormonal changes associated with aging that can impact sexual functioning. Most signifi- cantly, when women go through menopause, their menstruation permanently ceases and there is a dramatic drop in the production of sex hormones by the ovaries. As mentioned in chap- ter 3, menopause occurs on average between ages 50 and 52, but some women experience it in their 30s and others in their 60s. Longitudinal research has found that the hormonal changes that occur during menopause can have several effects on women’s sexual functioning includ- ing low sexual desire, vaginal dryness, and difficulties with arousal and orgasm (Dennerstein, Dudley, & Burger, 2001). This same research also reveals that menopause is related to a decline in sexual frequency. As we will discuss in chapter  13, hormone replacement therapy is one potential treatment for these effects. On a side note, there is no true equivalent of menopause in men; instead, men experience a steady, gradual decline in the production of sex hormones as they age. Hormone replacement therapy is sometimes prescribed to aging men, too, as a treatment for sexual difficulties that stem from hormonal issues.

With respect to psychological factors, some older adults develop diminished cognitive capac- ity as a result of Alzheimer’s disease and other forms of dementia. This can have implications for seniors’ sex lives because many argue that diminished capacity impairs one’s ability to provide sexual consent. To learn more about this complex and controversial issue, check out the Your Sexuality 10.1 box. Another psychological factor that may affect seniors’ sex lives is the fact that, after menopause, pregnancy is no longer possible, which may create an illusion of safety. This, combined with research suggesting that most seniors do not perceive themselves to be at risk of contracting sexually transmitted infections (Syme, Cohn, & Barnack-Tavlaris, 2016), contributes to extremely low rates of condom use among seniors. In fact, according to the NSSHB, just 6% of men and women over age 60 reported using a condom the most recent time they had sexual intercourse (Schick et al., 2010)! This finding suggests that there is great need for sexual health education among older adults, just as there is among adolescents.

Finally, with respect to social and environmental influences on older adults’ sex lives, per- haps the most notable is relationship status. Indeed, beyond health, relationship status is the other major predictor of whether older adults remain sexually active, with partnered individu- als being more likely than singles to continue having sex (Schick et al., 2010). A big part of the reason for this is because many seniors who were married or in long-term relationships have

they do about how often they’re doing it. When researchers statistically account for this different emphasis placed on quantity vs. quality of sex, they see that the negative correlation between age and sexual satisfaction dissipates.

In short, these results suggest that it may be misguided to attempt simple, direct comparisons of sexual satisfaction scores for persons at different stages of the lifespan. Getting older doesn’t necessarily mean that your sex life is going to get worse. Instead, the more likely outcome is that your sexual priorities and preferences are likely to change.

Note: Reprinted with permission from Sex anA PscynToloucy (www.lehmiller.com).

Digging Deeper 10.2 (Continued)

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lost their partners to death. When the death of a spouse occurs, one enters a post-relationship state known as widowhood. Although some widowed persons remarry or begin new relation- ships, many do not, perhaps because they find the prospect of starting over to be daunting, they do not want to diminish the memory of their former spouse, or they find themselves

Your Sexuality 10.1 Can Older Adults with Diminished Capacity Consent to Sex?

“MoFe tTan 350 people attenAeA tTe weAAinu Feneption of Donna Lou Younu anA HenFcy V. RacyTons in Dunnan, owa on Den. 15, 2007. amilcy anA fFienAs ate poFk Foast anA AanneA polkas to nelebFate tTe union of a wiAow anA a wiAoweF, botT in tTeiF 70s, wTo TaA founA unexpenteA love afteF tTe AeatTs of tTeiF lonu-time spouses. oF tTe next six-anA-a-Talf cyeaFs, HenFcy anA Donna RacyTons weFe insepaFable. . . oAacy, Te’s awaitinu tFial on a feloncy nTaFue tTat Te FapeA Donna at a nuFsinu Tome wTeFe sTe was livinu. Te owa ttoFnecy GeneFal’s offine sacys RacyTons TaA inteFnouFse witT Tis wife wTen sTe lankeA tTe mental napanitcy to nonsent benause sTe TaA lzTeimeF’s. STe AieA on uu. 8, fouF Aacys sToFt of TeF 79tT biFtTAacy, of nomplinations fFom tTe Aisease. One week lateF, RacyTons, 78, was aFFesteA. He pleaAeA not uuiltcy. . .Bcy mancy announts, HenFcy anA Donna RacyTons weFe Aeeplcy in love. BotT tTeiF families embFaneA tTeiF maFFiaue. Te nase Tas pFoAuneA no eviAenne tTus faF tTat tTe nou- ple’s love faAeA, tTat Donna faileA to Fenounize TeF TusbanA oF tTat sTe askeA tTat Te not tounT TeF. . . BaseA on eviAenne ueneFateA so faF, state pFosenutoFs aFe likelcy to poFtFacy RacyTons as a sex-TunuFcy man wTo took aAvantaue of a sweet, nonfuseA woman wTo AiAn’t know wTat montT it was, foFuot Tow to eat a TambuFueF anA lost tFank of TeF Foom (GFulecy, 2014).”

The above excerpt comes from a news story about the 2014 sexual assault case against Henry Rayhons, who was charged with felony rape after having sex with his wife, Donna, a nursing home patient with Alzheimer’s disease. Donna’s roommate alerted nursing home staff that she heard noises coming from the other side of the privacy curtain in their room while Henry was vis- iting one evening. The staff informed Donna’s daughters, who asked that the police be called. The ensuing case made national news in the United States and spurred multiple discussions about the issue of sexual consent among older adults with diminished cognitive capacity. While Henry was later cleared of the charge in 2015 after a jury returned a not guilty verdict, the broader debate over this issue continues.

Take a few moments to consider your perspective by answering the following questions:

● When older adults develop dementia or Alzheimer’s disease, do they lose their ability to con- sent to sex? If so, at what point does that occur? As soon as the condition is diagnosed, or only when the condition becomes severe? If consent is lost only when the condition is severe, who determines when it becomes “severe?”

● Should nursing homes and assisted living facilities have blanket policies in place that prohibit patients with diminished cognitive capacity from having sexual contact with anyone, includ- ing their spouses?

● Suppose two nursing home patients with diminished capacity enter into a sexual relationship. Should staff intervene? What if one or both patients are married to someone who does not live at the facility?

● If a nursing home patient with diminished capacity engages in sexual activity and the patient’s family believes that it was coercive, should management be liable for damages?

● We have focused here on cognitive capacity and sexual consent in the context of chronic men- tal conditions like Alzheimer’s disease and dementia—but what about when people tempo- rarily experience reduced cognitive capacity due to the consumption of alcohol, marijuana, or other drugs? Do people lose the ability to consent to sex when they consume substances? How are these issues similar or different?

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under pressure from their children not to remarry. Regardless of the reason, the end result is that many seniors who would otherwise be sexually active are not because their partner has passed away. As previously mentioned, one other environmental factor that may affect seniors’ sex lives is their living arrangement. Specifically, those who reside in nursing homes or assisted living facilities may have limits that are implicit (e.g., lack of privacy) or explicit (e.g., formal rules and regulations) placed on their sexuality, which may affect whether and how often they are able to have sex.

Key Terms

puberty secondary sex

characteristics

menarche spermarche sexual debut

sexting menopause widowhood

Discussion Questions: What is Your Perspective on Sex?

● If a friend of yours asked for advice on how to respond after walking in on their 7-year-old child “playing doctor” with one of the neighbor’s kids, what action(s) would you advise, if any?

● When it comes to what Western adults want in a romantic partner, virginity has gone from a once-coveted trait to a stigmatized social status in the span of just a few decades. What cultural or other factors do you think account for this change in attitudes?

● Physicians report a number of barriers to speaking with elderly patients about sex during office visits (e.g., fear of offending the patient, discomfort with the subject). If you were asked to contribute to a medical school curriculum designed to enhance doctors’ sexual communi- cation skills with older patients, what recommendations would you offer?

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