Essay

T H E S E X U A L I T Y A N D S O C I E T Y R E A D E R F I F T H   E D I T I O N

M I N DY S TO M B L E R

DAW N   M .   B AU N AC H

E L I S A B E T H   O .   B U R G E S S

W E N DY S I M O N D S

E L R O I   J .   W I N D S O R

W .   W .   N O R T O N & C O M P A N Y

New York • London

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Library of Congress Cataloging-in-Publication Data

Names: Stombler, Mindy. Title: Sex matters : the sexuality and society reader / [edited by] Mindy Stombler [and four others]. Description: Fifth edition. | New York : W.W. Norton & Company, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2018044515 | ISBN 9780393623581 (pbk.) Subjects: LCSH: Sex—Social aspects. | Sex—Social aspects—United States. | Sex in popular culture—United States. | Sex customs—United States. Classification: LCC HQ16 .S46 2019 | DDC 306.70973—dc23 LC record available at https://lccn.loc.gov/2018044515

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1 2 3 4 5 6 7 8 9 0

In honor of those resisting attacks on sex education, the rights of sexual

minorities, evidence- based research on sexuality, procreative justice,

and access to medical services, who strive for a sex- positive

environment for us all.

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Preface XIII About the Contributors XIX

CHAPTER 1 Categorizing Sex 1 Spotlight on ReSeaRch: An Interview with Marysol Asencio 1

1 Are We Having Sex Now or What? Greta Christina 5 box: How Do Heterosexual Undergraduate Students Define Having Sex? Kelsey K. Sewell and Donald S. Strassberg 9

2 “Bringing Intersexy Back”? Intersexuals and Sexual Satisfaction Georgiann Davis 14

3 The Perils and Pleasures of Sex for Trans People Harper Jean Tobin 25

4 I Am Gay— But I Wasn’t Born This Way Brandon Ambrosino 32 box: Queer: Identity and Praxis Maura Ryan 37

5 Bud- Sex: Constructing Normative Masculinity among Rural Straight Men That Have Sex with Men Tony Silva 41 box: Bisexuality and Bi Identity PJ McGann 49

6 “Straight Girls Kissing”? Understanding Same- Gender Sexuality beyond the Elite College Campus Jamie Budnick 52 box: Sexual Orientation versus Behavior— Different for Men and Women? Eliza Brown and Paula England 60

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CHAPTER 2 Investigating Sexuality 65 Spotlight on ReSeaRch: An Interview with Mignon R. Moore 65

7 Alfred Kinsey and the Kinsey Report Vern L. Bullough 68

8 Large- Scale Sex: Methods, Challenges, and Findings of Nationally Representative Sex Research Amanda M. Jungels and Stacy Gorman Harmon 75 box: Doing It Differently: Women’s and Men’s Estimates of Their Number of Lifetime Sexual Partners Mindy Stombler and Dawn M. Baunach 85

9 Racism and Research: The Case of the Tuskegee Syphilis Study Allan M. Brandt 87

10 Sexing Up the Subject: Methodological Nuances in Researching the Female Sex Industry Teela Sanders 99 box: Funding Sex Research Mindy Stombler and Amanda M. Jungels 107

CHAPTER 3 Representing Sex 111 Spotlight on ReSeaRch: An Interview with Joshua Gamson 111

11 Sexy Like a Girl and Horny Like a Boy: Contemporary Gay “Western” Narratives about Gay “Asian” Men C. Winter Han 115

12 What Teenagers Are Learning from Online Porn Maggie Jones 128 box: Virtual Reality Gets Naughty Alyson Krueger 139

13 Race and Masculinity in Gay Porn Desmond F. Goss 143

C O N T E N T S V I I

14 Out of Line: The Sexy Femmegimp Politics of Flaunting It! Loree Erickson 153

15 Constructing Victims: The Erasure of Women’s Resistance to Sexual Assault Jocelyn A. Hollander and Katie Rodgers 159

CHAPTER 4 Learning about Sex 169 Spotlight on ReSeaRch: An Interview with Jessica Fields 169

16 The Death of the Stork: Sex Education Resources for Children and Parents Wendy Simonds and Amanda M. Jungels 173 box: Sex- Positive Parenting, or We Don’t Touch Our Vulvas at the Table Lea Grover 190

17 Talking to Teens about Sex: Parent– Adolescent Communication about Sex and Sexuality Mona Malacane and Jonathon J. Beckmeyer 193 box: Let’s Talk about Sex: How Parents of Color Communicate with Teens Lauren Fannin 203

18 Conflicted Identification in the Sex Education Classroom Elizabeth A. Williams and Robin E. Jensen 207 box: The Case for Starting Sex Education in Kindergarten Saskia de Melker 218

19 LGBTQ Youth Need Inclusive Sex Education Human Rights Campaign, in collaboration with Advocates for Youth, Answer, GLSEN, Planned Parenthood Federation of America,

and the Sexuality Information and Education Council of the U.S. (SIECUS) 223 box: Disability and Sexuality Myth- Busting: Non- normative Sex Liberates Us All Bethany Stevens 230

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20 Sex, Love, and Autonomy in the Teenage Sleepover Amy T. Schalet 234

21 “Put Me In, Coach, I’m Ready to Play”: Sexuality Education for Adults at Good Vibrations Jessica A. Nodulman 240

CHAPTER 5 Sexual Bodies 253 Spotlight on ReSeaRch: An Interview with Leonore Tiefer 253

22 The G- Spot and Other Mysteries Elisabeth O. Burgess and Amy Palder 257

23 Female Genital Mutilation and Male Circumcision: Toward an Autonomy- Based Ethical Framework Brian D. Earp 262

24 The Politics of Acculturation: Female Genital Cutting Lisa Wade 277

25 “When There’s No Underbrush the Tree Looks Taller”: A Discourse Analysis of Men’s Online Groin Shaving Talk Matthew Hall 295

26 “Basically, It’s Sorcery for Your Vagina”: Unpacking Western Representations of Vaginal Steaming Tycho Vandenburg and Virginia Braun 307

27 Human Nature: On Fat Sexual Identity and Agency Cat Pausé 319

CHAPTER 6 Sexual Practices 327 Spotlight on ReSeaRch: An Interview with Michael Reece 327

28 The Pursuit of Sexual Pleasure B. J. Rye and Glenn J. Meaney 331 box: Teen Sex in the United States Chris M. Vidmar 342

29 God’s Case for Sex Orit Avishai and Kelsy Burke 346

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30 A Qualitative Exploration of the “Coming Out” Process for Asexual Individuals Nicolette Zangari, Kathryn Graff Low, and Anna N. Query 352

31 Adventures with the “Plastic Man”: Sex Toys, Compulsory Heterosexuality, and the Politics of Women’s Sexual Pleasure Breanne Fahs and Eric Swank 363 box: Grandma Does WHAT!?: Perceptions about Older Adults and Sex Christina Barmon, Alexis A. Bender, and Elisabeth O. Burgess 379

32 A Sexual Culture for Disabled People Tobin Siebers 383

33 Becoming a Practitioner: The Biopolitics of BDSM Margot Weiss 393

34 The Privilege of Perversities: Race, Class, and Education among Polyamorists and Kinksters Elisabeth Sheff and Corie J. Hammers 402

CHAPTER 7 Sexual Health 419 Spotlight on ReSeaRch: An Interview with Héctor Carrillo 419

35 Secondary Prevention of Sexually Transmitted Infections: Treating the Couple and Community Adam Sonfield 423 box: STDs at Record High Centers for Disease Control and Prevention 427

36 Venereal Disease: Sin versus Science Elizabeth Fee 430 box: HIV among People Aged 50 and Over Centers for Disease Control and Prevention 439

37 Damaged Goods: Women Managing the Stigma of STDs Adina Nack 441 box: HPV and Vaccines Evelina Sterling and Wendy Simonds 450

38 “Proper Sex without Annoying Things”: Anti- condom Discourse and the “Nature” of (Hetero)sex Virginia Braun 455

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39 PrEP for HIV Prevention: Community Controversy and Generational Sexualities Griff Tester and Jennifer Rosen 464

40 America’s Hidden HIV Epidemic Linda Villarosa 477

CHAPTER 8 Social Control 487 Spotlight on ReSeaRch: An Interview with Amin Ghaziani 487

41 The New Pariahs: Sex, Crime, and Punishment in America Roger N. Lancaster 491 box: Too Young to Consent? Elizabeth Cavalier and Elisabeth O. Burgess 500

42 Sick Sex Elroi J. Windsor 505

43 Birthright: A History of Planned Parenthood Jill Lepore 515 box: From Contraception to Abortion: A Moral Continuum Wendy Simonds 521 box: Choice or Coercion? Abortion and Black Women Zakiya Luna 524

44 No Brokeback for Black Men: Pathologizing Black Male (Homo)sexuality through Down Low Discourse C. Winter Han 529

45 Unequal Pleasures Lisa Wade 542

46 “How You Bully a Girl”: Sexual Drama and the Negotiation of Gendered Sexuality in High School Sarah A. Miller 548

47 Out in the Country Mary L. Gray 564 box: LGBTQ Politics in America: An Abbreviated History Marik Xavier- Brier and Chet Meeks 573

48 “How Could You Do This to Me?” How Lesbian, Bisexual, and Queer Latinas Negotiate Sexual Identity with Their Families Katie Acosta 577

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CHAPTER 9 Sexual Violence 585 Spotlight on ReSeaRch: An Interview with Kevin Swartout 585

49 “I Wasn’t Raped, but . . .”: Revisiting Definitional Problems in Sexual Victimization Nicola Gavey 590

50 Rampant or Rare? The Conundrum of Quantifying Rape and Sexual Assault on College Campuses and Beyond Megan M. Tesene 601 box: I Was Raped by a Woman Caroline Catlin 612

51 The Rape- Prone Culture of Academic Contexts: Fraternities and Athletics Patricia Yancey Martin 614 box: Sexual Coercion among Athletes Jake New 619

52 The Sexual Victimization of Men in America: New Data Challenge Old Assumptions Lara Stemple and Ilan H. Meyer 622

53 Everything You Need to Know about Consent That You Never Learned in Sex Ed Zhana Vrangalova 636 box: Sex Workers Don’t Deserve to Be Raped Jillian Keenan 639

54 Rape and War: Fighting Men and Comfort Women Joane Nagel 643

CHAPTER 10 Commercial Sex 653 Spotlight on ReSeaRch: An Interview with Kari Lerum 653

55 What Male- for- Male Internet Escorts Say about What They Do Kevin Walby 657

56 Can We “Cure” the Men Who Pay for Sex? Brooke Jarvis 665 box: Strip Clubs and Their Regulars Katherine Frank 671

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57 Overcome: The Money Shot in Pornography and Prostitution Lisa Jean Moore 674

58 Autonomy and Consent in Sex Work Kimberly Kay Hoang 685

59 Performing without a Net? Safer Sex in Porn Wendy Chapkis 693

Sex Matters: Future Visions for a Sex- Positive Society Elroi J. Windsor, Jasmine Suryawan, and Elisabeth O. Burgess 703

Index 713

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to worry about others’ reactions? Can you imagine how dating someone of the same sex might be beneficial to you?

• Imagine that an evening of partying ends in an unplanned “ one- night stand.” You or your partner becomes pregnant. Would you see the pregnancy as something to celebrate? To ignore? To hide? To terminate? Would your family and friends share your feelings? Would their reaction be the same if you were 15 or you were 45? What if your partner were much older or younger than you? Or of a dif- ferent race, ethnicity, or religion?

• Imagine that you’ve made a careful decision to refrain from sexual activity. Which cir- cumstances might compel such a decision? Would it be hard to maintain your resolve? Or imagine, by contrast, that you’ve sought out as much sexual activity as you can find. Either way, who would support your deci- sion to be celibate or sexually adventurous? Who might challenge it? How would these responses be different, depending on your age, gender, or social status?

SEXUALITY AND SOCIETY

If you vary the time, place, or cultural setting of the scenarios, you’ll find that your feelings, the decisions you would make, and the reactions of those around you will probably change. These variations occur because the social norms gov- erning sexual behavior are continually in flux. Other social factors, such as your religious beliefs, level of education, economic status, ethnicity, gender, and age, influence sexual activity and its meaning. All of the following are influenced by society: what counts as a sex

We live in a sex- saturated society. We hear of sex drive, sex toys, sex machines, sex slaves, sex scandals, sex gods, sex crimes, and sexaholics. Sex per- meates every aspect of our lives from advertis- ing to politics to our relationships with others. Yet we rarely consider the historical, legal, and sociocultural contexts of sexuality. Many people take the current state of sexual atti- tudes and practices in our society for granted, as if they are natural and thus unchangeable. Understanding contemporary sexual matters requires considering how sexuality varies across time and place and how it is modeled, molded, and even manipulated by those around us. Consider, for instance, the influence of social contexts as you read the following scenarios:

• Imagine that you’ve chosen to have sex for the first time. How would you know what to do? How would you plan on pleasing your partner? Yourself? Would you turn for guid- ance to books or magazines, pornography, websites on the internet, or the wall of the public bathroom? What makes you excited? Nervous? Would you practice safe sex?

• Imagine that you and your partner do things together that you’ve never heard about before but that make you feel transported, ecstatic, or orgasmic. Or imagine you feel nothing much during your encounters, or that you feel disgusted, or that you’re not even sure if you have “had sex.” Imagine that you want to stop but your partner won’t. What would you do? Whom would you tell?

• Imagine that you and your partner are the same sex. Would you feel comfortable show- ing affection in public? Can you imagine a cultural context in which you wouldn’t have

X I V P R E FAC E

all its forms, regardless of actors, can be ben- eficial. We have selected pieces that historicize and thus challenge the cultural stigmatization and marginalization of some sexualities and the valorization of others. To us, part of sex- positivity means, for example, promoting the pursuit of sexual pleasure and not centering sex education around danger and disease. To be sex- positive is to recognize that sex can be enriching and to affirm that sex matters.

Each of our chapters highlights the dual themes of social construction and social con- trol. In other words, society— composed of social institutions and the individuals within them— constructs our understanding of sexual- ity and influences our behaviors, attitudes, and sexual identities. The readings illustrate that some social institutions and some members of society have more power to control and define a society’s sexual agenda than others. At the same time, social control is usually met with social resistance, and we offer readings that feature examples of successful individual and cultural resistance to societal expectations and oppression.

Chapter 1, “Categorizing Sex,” explores how society constructs and socially controls sexual categories. We challenge readers to question what should count as having sex, a topic with wide- ranging legal and health implications. Readings on intersex and transgender sexuali- ties encourage us to consider the viability of our current categories of “male” and “female,” and “man” and “woman,” and how these con- structions affect sexual behaviors and sexual identities. Other readings question current methods of categorizing sexual orientation and sexual identity. What does it mean to be straight, gay, lesbian, queer, or bisexual? Is sex- ual identity a matter of behavior, erotic attrac- tion, or self- definition, and do these categories always align with one another? What role does community or politics play in the construction of our sexual identities? In what ways are sex

act, how often we have sex, what is considered erotic, where we have sex, the age when we begin having sex, with whom we have sex, what we do when we are having sex, how often we desire sex, our reasons for having or avoiding sex, whether we pay others or get paid for sex, and how we define consensual sex. Although often characterized as a purely biological and often uncontrollable phenomenon, sex is, in fact, social. The readings we have selected por- tray sex as a social issue influenced by culture, politics, economics, media, education, medi- cine, law, family, and friends.

SEX MATTERS

Our title reflects the content of the book in two ways. First, we have included research articles and essays on a variety of sexual matters. Sec- ond, the title supports our assertion that sex, and the study of sexuality, matters. There is much to learn about sexuality. Despite the prevalence of sexual matters in public life and the media, as well as their private significance, scholars researching sexuality often have dif- ficulty getting institutional and financial sup- port. Many funding agencies, politicians, and even academics do not take sexuality seriously.

Yet the study of sexuality is burgeoning, as evidenced by the proliferation of courses on sexuality in colleges and universities through- out the United States. This book applies social theory and methods to the study of sexuality. The Spotlight on Research feature, which pro- files the work of sex researchers, enhances the empirical focus in each chapter. Each of these interviews echoes the fact that sex really does matter.

THEMES OF THIS BOOK

This book is designed to promote sex- positivity and to provide an opportunity for students to reflect on the ways that contexts affect sexual meanings. We believe that consensual sex, in

and where we’re going. Cultural texts docu- ment how racism, misogyny, and homophobia circulate in public discourses on sexuality. The critical perspectives presented in the readings demonstrate the varieties of possible interpreta- tions of various representations.

Chapter 4, “Learning about Sex,” examines the messages about sexuality people receive and how they engage with the meanings of these messages. Youth (ranging from young children to older teenagers) confront a variety of sex information— and misinformation— that informs their sexual attitudes and behaviors. The readings in this chapter explore the differ- ent messages youth encounter in media, school, and family contexts. Across cultures, race groups, and genders, youth are taught rather differently about sex, based on assumptions about their capacities to act as autonomous sexual beings. Across the board, sex education in the United States, as reported by educa- tors, parents, and students, has room for much improvement, lacking sex- positive messaging, failing to be inclusive of LGBTQ and disabled sexual needs and experiences. As active con- sumers of messages, youth make sense of sexu- ality meanings in ways that vary across gender, race, class, and sexual identity. And as lifelong learners, adults continue to learn from formal sex education and less formal contexts across the life course.

Chapter  5, “Sexual Bodies,” addresses how we eroticize bodies, body parts, and bodily functions and explores how notions of the erotic can affect the way we feel about our bodies. Societal discourse both celebrates and stigmatizes the body and its functions. What is sexy about a person’s body? Most people can come up with distinct body types or features that are appealing or unappealing to them. Yet ideas about what is sexy and what is not are cul- turally constructed. For example, some people groom their genitals to craft “sexier” bodies using methods that are just recently becoming

and sexuality more fluid, and is this fluidity consistent across gender and other social cat- egories? Although existing categories can be helpful for understanding commonalities, they also collapse a wide variety of experiences and feelings into inflexible and essentialized divi- sions. As the readings show, sexual categories vary across societies, cultures, and time.

Chapter 2, “Investigating Sexuality,” presents historical and contemporary sex research and considers ethical, political, and method ological issues involved in conducting sex research. The readings introduce the unique challenges and rewards of conducting sex research. The associ- ation of sex with privacy creates a level of anxi- ety and reluctance among would- be research participants that is unmatched in other areas of research. For example, the cultural unwill- ingness to see adolescents as sexual beings discourages parents from allowing minors to participate in sex research, yet adolescents report benefiting from participating in sex research. Chapter  2 also illustrates the effect of researcher bias and how, for example, racist ideologies guiding research have resulted, his- torically, in serious harm to minority popula- tions. Differing religious teachings on sexuality add to the controversial nature of sex research. The protest efforts of fundamentalist religious groups have successfully limited governmental support of art, health, and research programs that involve sexuality.

Chapter  3, “Representing Sex,” presents a variety of interpretations of the ways that U.S.  culture depicts sexualities and sexual activities. For example, media (books, songs, magazines, videos, internet imagery, etc.) both reflect and create ideas about sexuality. Cul- tural representations of sexuality affect viewers or readers in a variety of ways by telling power- ful stories about appropriate sexual activity and what happens to individuals who deviate from cultural expectations. Cultural representations tell us about who we are, where we’ve been,

P R E FAC E X V

disease and received little attention. In spite of intense efforts by queer activists, AIDS was considered a national emergency in the United States only when it began infecting white, middle- class, heterosexual Americans. Regard- less of the manageability of sexually trans- mitted infections (as with the vaccine against many strains of HPV or the prophylactic use of PrEP to avoid HIV infection), fears associated with them continue to be a powerful tool in the control of sexuality.

Chapter 8, “Social Control,” illustrates how sexuality is managed and directed by forces both internal and external to individuals. Whereas much research on sexuality empha- sizes individual responsibility, in this section we explore the structural factors that influence sexual attitudes and behaviors. Social institu- tions such as family, law, and medicine control sexual behavior through systems of rewards and punishments. Interpersonal interactions further constrain sexual choices through means such as harassment and labeling. This chapter explores how the mechanisms of social control are often turned against certain groups and how the social control of sexuality is a powerful weapon of oppression. Some selections high- light how social control is a two- way street, with the forces of control and resistance in con- stant conflict.

Although people like to think of sex as an intimate— and ideally pleasant— activity, it can be used as a weapon of violence and control to humiliate, degrade, and hurt. The readings in Chapter  9, “Sexual Violence,” illustrate the complexities of defining rape and rape victim- ization. They deal with various types of sexual assault, rape of sex workers, date or acquain- tance rape, the rape of men, rape on campus, rape during war, and nuances of giving con- sent to sexual activities. The articles presented in this section also illustrate the diversity of sexual violence and the sociocultural contexts that support this violence. Although women

popular. Others have surgeries to change their bodies, challenging norms about bodily func- tion and sexuality. Cultural constructions of the sexual body also function as a form of social control— shaping how we feel about our own bodies, framing our interactions with others, and even forcing us to manipulate our bodies to meet cultural expectations. The articles in this chapter explore many traditional ideas about sexuality that emphasize the gendered nature of sexual bodies.

Chapter  6, “Sexual Practices,” examines how people behave sexually. As you read the articles in this section, think about how social norms, laws, religion, media, families, friends, and partners influence our sexuality and shape our behavior. From the absence of sexual desire to the interest in kink play, human sexuality is tremendously diverse. Although how we enact our sexuality varies immensely, these readings demonstrate what can happen when we vary from expected and accepted ways of acting sexually. Finally, these articles also remind us that the ways we enact sexual behaviors pro- foundly impact social relationships across the life course.

Chapter  7, “Sexual Health,” illustrates how society treats sexual health and sexually trans- mitted infections (STIs, also commonly called sexually transmitted diseases, or STDs) quite differently from other forms of health and dis- ease. STIs are the only major group of diseases categorized by their method of transmission, rather than by their symptoms or the parts of the body they affect. People infected with STIs are stigmatized, creating a shield of secrecy in which some people deny to themselves that they have an STI, fail to tell their partners, and avoid seeking treatment. The stigma and perceptions of risk surrounding STIs affect the resources that the government and medi- cal agencies opt to dedicate to public sexual health. For example, when AIDS was first discovered, it was seen as a “gay” or “African”

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staff has worked incredibly hard to publish this edition in record time with white- glove service. We love a publisher that works hard and plays hard (and we enjoy being included in both)!

We are grateful to the researchers and schol- ars who took time out of their busy schedules to be interviewed for the Spotlight on Research features. Their dedication to the field of sex research, their humor in the face of monetary and political challenges, and their willingness to share personal experiences make us opti- mistic about the future of sex research. We want to thank the authors who wrote original pieces for the fifth edition. Their contributions make the book bigger and better (not that size matters . . .).

We received crucial assistance from Leanna Greenwood, Samantha Howat, and Sierra Nicely at Georgia State University, and Jayme Mendez at Salem College. Special thanks to librarians extraordinaire Mandy Swygart- Hobaugh, who assisted with our obscure search requests, and Laura Carscaddon, who held books hostage on our behalf.

Thanks to our families and friends for their encouragement and support. In particu- lar, Mindy would like to thank her son, Moey Rojas, for his independence, allowing her to focus on book work; her parents, Lynne and Milton Stombler, for their seemingly unend- ing support; and her partner, Nate Steiner, for being a mensch in every way. Dawn thanks Jeff Mullis and their four cats. Wendy thanks Jake Simonds- Malamud, Ben Simonds- Malamud, Gregg Rice, Hinky Simonds (RIP), and Puff Simonds for their sweetness. Elroi thanks Aly, Avie, and Izzy Windsor for being a fantastic family. Elisabeth appreciates the support of Leila Burgess- Kattoula, Ehsan Kattoula, and the rest of her family and friends.

This book would not have been possible without our dedicated and discerning under- graduate and graduate students. We appreciate

are the primary targets of sexual violence, no group is exempt. Sexual violence cuts across all social categories. This chapter also questions assumptions about what counts as sexual vio- lence when consent is not clearly defined. The articles presented here contain graphic and sometimes upsetting or shocking information; it is our hope that readers will not simply be overwhelmed, but will learn how sexual vio- lence is prevalent in our culture as a form of social control and how it is “structured” into our society in a myriad of ways. With knowl- edge, we can work more effectively for change.

Chapter 10, “Commercial Sex,” explores the commodification of sexuality. Despite numer- ous laws regulating the sale of sexual services, commercial sex continues to be both a profit- able business and a source of abuse. We address the tensions between the freedom to express sexuality through commercial avenues and the exploitation and control of sexuality through its sale. The readings examine who profits finan- cially from the sex industry, who works in the sex industry and their working conditions, who consumes its products, and attempts to stem that consumption.

ACKNOWLEDGMENTS

Revising this book for the fifth  edition was a challenging yet rewarding experience. We would like to thank our editor, Sasha Levitt, for  her patience and unparalleled flexibility, as well as project editors Sujin Hong and Diane Cipollone and assistant editor Erika Nakagawa. Other wonderful Norton team members included Elizabeth Trammell, permissions manager; Stephen Sajdak, production man- ager; Rubina Yeh, design director; Julia Hall, marketing manager; Eileen Connell, media editor; Ariel Eaton, associate media editor; Travis Carr, photo editor; Harry Haskell, copyeditor; Carol Sawyer, proofreader; and Heather Dubnick, indexer. The W. W. Norton

as the team’s “dominatrix,” and the constant mutual support among all team members, cre- ating this book often felt more like fun than work. We hope you have as much fun reading this book as we had putting it together.

them for letting us know their favorite read- ings, for fearlessly voicing their opinions, and for asking tough questions.

This project is truly an example of collab- orative feminist work. With Mindy Stombler

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tion at Work: Ideology and Practice in a Feminist Clinic; Women and Self- Help Culture: Reading between the Lines; and co- author of Centuries of Solace: Expressions of Maternal Grief in Popu- lar Literature and Laboring On: Birth in Transi- tion in the U.S. She is currently doing research on affirmative action policies and programs on U.S. college and university campuses.

Elroi J. Windsor is an associate professor and chair of the Department of Sociology at the University of West Georgia. Windsor’s teaching and research interests include gender, sexual- ity, and embodiment. Windsor’s past research focused on the disparate regulation of transgen- der and cisgender consumers of surgical body modification. Currently, Windsor is writing a book about health care providers who work with body parts and dead bodies and co- editing Male Femininities with Dana  Berkowitz  and C. Winter Han (New York University Press).

CONTRIBUTORS

Katie Acosta is an associate professor of soci- ology at Georgia State University.

Brandon Ambrosino is a PhD student in theology and ethics at Villanova University.

Orit Avishai is an associate professor of soci- ology and the co- director of Women, Gender, and Sexuality Studies at Fordham University.

Christina Barmon is an assistant profes- sor of sociology at Central Connecticut State University.

Jonathon  J.  Beckmeyer is an assistant pro- fessor in the School of Public Health at Indiana University.

THE EDITORS

Mindy Stombler is a principal senior lecturer of sociology at Georgia State University. Her past research has focused on the production of sexual collective identities. For example, she explored how men in gay fraternities negoti- ated their dual identities of being gay and being Greek and how they reproduced hegemonic masculinity. Her current research focuses on power relations and oral sex as well as a vari- ety of pedagogical issues. She is also co- editor with Amanda  M.  Jungels of Focus on Social Problems: A Contemporary Reader (Oxford Uni- versity Press).

Dawn M. Baunach is the chair of the Depart- ment of Sociology and Criminal Justice and a professor of sociology at Kennesaw State Uni- versity. Her research interests include sexuality and gender inequalities, statistics and method- ologies, social demography, and the sociology of food. She is currently studying various sex- ual attitudes and behaviors, including same- sex marriage, sexual prejudices, sexual disclosure, and bullying.

Elisabeth  O.  Burgess is the director of the Gerontology Institute and a professor of geron- tology and sociology at Georgia State Univer- sity. Her research interests focus on changes in intimate relations over the life course, includ- ing involuntary celibacy, sexuality and aging, and intergenerational relationships. In addi- tion, she writes on theories of aging and atti- tudes toward older adults.

Wendy Simonds is a professor of sociology and gerontology at Georgia State Univer- sity. She is the author of Hospital Land USA: Sociological Adventures in Medicalization; Abor-

X X A B O U T T H E C O N T R I B U TO R S

Brian D. Earp is associate director of the Yale- Hastings Program in Ethics and Health Policy at Yale University and the Hastings Center, as well as a research fellow in the Uehiro Centre for Practical Ethics at the University of Oxford.

Paula England is a professor of sociology at New York University.

Loree Erickson is a community organizer and porn star academic in Toronto, Ontario.

Breanne Fahs is a professor of women and gender studies at Arizona State University.

Lauren Fannin is a doctoral student in sociol- ogy at Georgia State University.

Elizabeth Fee is a professor of health policy and management at the Johns Hopkins Univer- sity Bloomberg School of Public Health.

Katherine Frank is a faculty associate in anthropology at the College of the Atlantic and affiliate research faculty at the University of Nevada, Las Vegas.

Nicola Gavey is a professor of psychology at the University of Auckland, New Zealand.

Desmond F. Goss is a lecturer of sociology at Georgia State University.

Mary L. Gray is a senior researcher at Micro- soft Research, associate professor in the School of Informatics, Computing, and Engineering at Indiana University, and fellow at Harvard University’s Berkman Klein Center for Internet and Society.

Lea Grover is a blogger and public speaker.

Matthew Hall is a research associate at Ulster University.

Corie  J.  Hammers is an associate professor of women’s, gender, and sexuality studies at Macalester College.

Alexis A. Bender is an assistant professor of medicine in the Division of General Medicine and Geriatrics in the Emory University School of Medicine.

Allan  M.  Brandt is the Amalie Moses Kass Professor of the History of Medicine and a professor of the history of science at Harvard University.

Virginia Braun is a professor of psychology at the University of Auckland.

Eliza Brown is a doctoral student at New York University.

Jamie Budnick is a doctoral candidate at the University of Michigan.

Vern  L.  Bullough was, before his death, a distinguished scholar and professor emeritus in the History Department at California State University, Northridge.

Kelsy Burke is an assistant professor of sociol- ogy at the University of Nebraska, Lincoln.

Caroline Catlin is a storyteller and mental health worker in Seattle, Washington.

Elizabeth Cavalier is an associate professor of sociology at Georgia Gwinnett College.

Wendy Chapkis is a professor of women and gender studies and sociology at the University of Southern Maine.

Greta Christina is an author, editor, and pub- lic speaker in San Francisco.

Georgiann Davis is an assistant professor of sociology at the University of Nevada, Las Vegas.

Saskia de Melker is a Peabody award– winning broadcast and multimedia producer who works extensively for the public television program PBS NewsHour Weekend.

A B O U T T H E C O N T R I B U TO R S X X I

Zakiya Luna is an assistant professor of soci- ology at the University of California, Santa Barbara and faculty affiliate of the Center on Reproductive Rights and Justice at Berkeley Law.

Mona Malacane is an assistant instructor at the Media School at Indiana University.

Patricia Yancey Martin is a professor emeri- tus of sociology at Florida State University.

PJ McGann is a lecturer of sociology at the University of Michigan, Ann Arbor.

Glenn  J.  Meaney is a lecturer of psychology and sexuality, marriage, and family studies at St.  Jerome’s University at the University of Waterloo in Ontario, Canada.

Chet Meeks was, before his death, an assis- tant professor of sociology at Georgia State University.

Ilan  H.  Meyer is a Williams Distinguished Senior Scholar of Public Policy at the Williams Institute for Sexual Orientation Law and Pub- lic Policy at the UCLA School of Law.

Sarah  A.  Miller is a doctoral candidate in sociology at the University of Massachusetts, Amherst.

Lisa Jean Moore is a medical sociologist and professor of sociology and gender stud- ies at Purchase College, State University of New York.

Adina Nack is a professor of sociology at California Lutheran University.

Joane Nagel is chair of the Anthropology Department and University Distinguished Pro- fessor of Sociology at the University of Kansas.

Jake New is a reporter for Inside Higher Ed.

Jessica  A.  Nodulman is an assistant profes- sor of communication studies at Augustana College.

C. Winter Han is an associate professor of sociology at Middlebury College.

Stacy Gorman Harmon is a research scien- tist at the Centers for Disease Control (CDC) Foundation.

Kimberly Kay Hoang is an assistant profes- sor of sociology at the University of Chicago.

Jocelyn A. Hollander is a professor of sociol- ogy at the University of Oregon.

Brooke Jarvis is a contributing writer to the New  York Times Magazine and the California Sunday Magazine and a winner of the Livings- ton Award for National Reporting.

Robin E. Jensen is a professor of communica- tion at the University of Utah.

Maggie Jones is a contributing writer for the New  York Times Magazine and a visiting assis- tant professor of English at the University of Pittsburgh.

Amanda M. Jungels is an  assistant direc- tor of Faculty Programs and Services  in the Center for Teaching and Learning, Columbia University.

Jillian Keenan is a freelance writer in Dakar, Senegal.

Alyson Krueger is a freelance journalist writ- ing for the New York Times, the Washington Post, Elle, and Forbes, among other publications.

Roger N. Lancaster is a professor of anthro- pology and cultural studies at George Mason University.

Jill Lepore is the David Woods Kemper ’41 Professor of American History at Harvard University.

Kathryn Graff Low is the interim vice presi- dent for academic affairs and dean of the fac- ulty at Bates College.

Lara Stemple is the assistant dean for gradu- ate studies and international student programs and the director of the Health and Human Rights Law Project at the UCLA School of Law.

Evelina Sterling is an assistant professor of sociology at Kennesaw State University.

Bethany Stevens is a doctoral student in soci- ology at Georgia State University.

Donald S. Strassberg is a professor of clinical psychology at the University of Utah.

Jasmine Suryawan is a doctoral student in sociology at the University of Colorado, Boulder.

Eric Swank is an associate professor of prac- tice at Arizona State University (Social and Cultural Analysis at ASU West).

Megan M. Tesene is a doctoral candidate in sociology and adaptive learning program man- ager at the Center for Excellence in Teaching and Learning at Georgia State University.

Griff Tester is an assistant professor of sociol- ogy at Central Washington University.

Harper Jean Tobin is director of policy at the National Center for Transgender Equality.

Tycho Vandenburg is a doctoral candidate at the University of Auckland, New Zealand.

Chris M. Vidmar is a doctoral student in sociology at Georgia State University.

Linda Villarosa is a contributing writer to the New York Times Magazine. She is also the direc- tor of the journalism program at the City Col- lege of New  York in Harlem and an assistant professor of media and communication arts.

Zhana Vrangalova is an adjunct professor of psychology and sexuality at New  York University.

Amy Palder is the assistant dean of stu- dents and chief conduct officer at Oglethorpe University.

Cat Pausé is a senior lecturer at Massey Uni- versity in New Zealand.

Anna  N.  Query is a practicing child and family clinician in the field of early education.

Katie Rodgers is an assistant professor of sociology at Coe College.

Jennifer Rosen is an assistant professor of sociology at Ashford University.

Maura Ryan is a senior lecturer of sociology at Georgia State University.

B. J. Rye is an associate professor of psychol- ogy and sexuality, marriage, and family studies at St. Jerome’s University.

Teela Sanders is a professor of criminology at the University of Leicester.

Amy T. Schalet is an associate professor of sociology at the University of Massachusetts, Amherst.

Kelsey  K.  Sewell is a postdoctoral fellow in behavioral medicine/ psycho- oncology at the University of Kansas Medical Center.

Elisabeth Sheff is an expert witness, re - searcher, educator, and speaker.

Tobin Siebers was, before his death, co- chair of the university’s Initiative on Disability Stud- ies,  V.  L.  Parrington Collegiate Professor, and professor of English language and litera- ture, and art and design at the University of Michigan.

Tony Silva is a doctoral candidate in sociology at the University of Oregon.

Adam Sonfield is a senior policy manager at the Guttmacher Institute’s Washington, DC, office.

X X I I A B O U T T H E C O N T R I B U TO R S

Elizabeth A. Williams is an associate profes- sor of organizational communication at Colo- rado State University.

Marik Xavier- Brier is a civil rights analyst at the U.S. Commission on Civil Rights.

Nicolette Zangari is a doctoral student of clinical psychology at the University of Kansas.

Lisa Wade is an associate professor of sociol- ogy at Occidental College.

Kevin Walby is an associate professor and Chancellor’s Research Chair in the Depart- ment of Criminal Justice at the University of Winnipeg.

Margot Weiss is an associate professor of American studies and chair of the Anthropol- ogy Department at Wesleyan University.

A B O U T T H E C O N T R I B U TO R S X X I I I

1

CATEGORIZING SEX

A N I N T E R V I E W W I T H

M A R Y S O L A S E N C I O

Marysol Asencio, MPH, DrPH, is a full professor at the University of Connecticut with a joint appointment in sociology and El Instituto: The Institute of Latina/o, Caribbean, and Latin American Studies. Dr. Asencio focuses on the intersections of Latina/o sexualities and sexual health with gender, race/racialization, socioeconomic status, and migration. Dr. Asencio has authored, edited, and coedited a number of books and special issues of journals on Latinas/os and their sexualities, in addition to peer-reviewed articles, chapters, and other publications. Her research and projects have been supported by both internal and external grants, such as the Ford Founda- tion. Her edited volume, Latina/o Sexualities: Probing Powers, Passions, Practices, and Policies (Rutgers University Press, 2010), helped coalesce Latina/o sexualities research and scholarship as a field of study. She is currently working on a research project on Latina lesbian-queer visibility, which was funded through the UConn Collaborative to Advance Equity through Research on Women and Girls of Color.

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What led you to begin studying sexuality? I entered graduate school with a research interest in women’s reproductive health issues, which at the time ironically rarely dealt with issues of sexuality. It was mostly focused on family planning, contraceptive use, and maternal-child issues. However, this was also shortly after the medical community had identified AIDS when it was briefly referred to as GRID (Gay-Related Immune-Deficiency). It was a time when the lack of understanding of sexuality, as well as the biases about sexuality and certain racial/ethnic and sexual minorities, was exposed in a dramatic and deadly manner. The quickly advancing epidemic affected me per- sonally as well, with the loss of several friends and colleagues. It was a frightening and frustrating time. It not only influenced me to enter sex research but it also awakened me to the need for community-based research and social justice advo- cacy for marginalized populations in order to promote evidence-based health and social policy.

How do people react when you tell them you study sexuality? Over the course of my career, I have gotten the impression that for some col- leagues who do not do this type of research, sex research is not viewed as serious or important. This is a big concern in terms of having an academic career in sexuality research. Will you be hired because the work is seen as being in the margins of a particular discipline or in academia as a whole? When you tell the average person that you teach human sexuality, there is usually some laughter and a perception that it is a course that provides sexual entertainment rather than a forum for serious, rigorous, and challenging research and scholarship.

What ethical dilemmas have you faced as you’ve studied sexuality? Could you tell us about a particularly thorny dilemma and how you solved it? I was working on a research project on gay men and prostate health with a couple of colleagues. Given that at the time there were no published studies on gay men with prostate cancer, we decided to conduct focus groups with diverse populations of gay men (racial/ethnic and socioeconomic) to see what concerns they had around prostate screening, diagnosis, treatment and its after-effects (many of them being sexual in nature). We used standard procedures that were established for recruiting men into the study, including a $40 stipend for participation. Toward the end of the study, we were trying to move away from middle-class participants and reach out to poorer, marginalized, and in some cases homeless, gay men. What resulted was that our outreach efforts yielded potential participants who seemed as if they were claiming to be “gay” or “transgendered women” in order to receive the stipend. It was difficult to determine if someone was “gay” or “transgender” since we depend on reported self-identity.1 If we accepted their assertions that they were gay men or

3

transgendered women when there were signs that they may not be, we would bias our results. Also, given that they said they “matched” the criteria, there was very little rationale for turning them away other than none of the researchers believing this was the case based on other arguably unreliable cues. There was no way to know for sure.

We addressed this ethical dilemma2 by providing every participant with the stipend and then reiterating the fact that although they consented to participate, they could leave at any time without having to give back the stipend. We hoped that those who were questionable in terms of meeting the study criteria would not feel they needed to participate. We went from around 22 people who showed up for the focus group to seven who remained. All the participants we had seri- ous questions about left. It cost us some funds, but we had few options given our approved human subjects protocol and the volatility of the situation. This incident allowed us to consider ways to minimize this problem in future studies. However, it also demonstrates that the use and/or amount of stipends for research participa- tion as well as the self-identification of sexual orientation and gender can in some cases become problematic depending on the particular research population and research needs.

What do you think is most challenging about studying sexuality? While I think the field as a whole has become more accepted, the research is still “suspect.” It is assumed to be potentially harmful until proven not harmful, in par- ticular when dealing with the sexuality of those under the age of 18. There are sig- nificant barriers to getting detailed sexual histories of participants; discussing sexual acts; and attending locations that are designated as sexual such as strip clubs, broth- els, etc. Sex research often depends on non-sex researchers (institutional review boards [IRBs], funders, and communities) who may view this type of research as different from other forms of research or who believe that we ought not to ask about sex or that it is a voyeuristic enterprise.

Why is sex research important? Sexuality is central to understanding a great deal about humanity and society. As someone who researches Latinas/os and sexuality, I was once asked why I “waste” my time as a researcher on sexuality when I could be studying more important issues for the Latina/o community, such as poverty and racism. First of all, studying sexuality involves understanding all its intersections and connections with issues such as poverty and racism. Second, if you look at political debates in this country, sexuality plays a major role (e.g., contraception, abortion, same-sex marriage, teen pregnancy, etc.). Moreover, the outcomes of those debates many times affect racial/ ethnic and sexual minorities and low-income individuals and families in ways that disadvantage or minimize their experiences. Therefore, sex research furthers our understanding of power, marginalization, and other social issues.

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Of the projects you’ve done over the course of your academic career, which was most interesting and why? My first large independent qualitative research on adolescent sexuality was most interesting because I was still learning about sexuality research. It was eye-opening. I remember when I asked one of my female respondents about the first time she had sexual intercourse, she went on to explain how she was raped as a child by an uncle and she wanted to make it clear to me that she saw herself as a “virgin” and would like me to characterize her as such. She had still not had, at the age of 18, “consensual” first sexual intercourse. It was very important to her sense of dignity and control of her sexuality to be seen as a virgin. She also told me that what she did not like about questionnaires that asked her “if she had ever had sexual intercourse” was that they did not reflect her experience or her wish “not” to be characterized as a “sexually active” teen or not a “virgin.” I learned a great deal about the meanings attached to sexuality from those adolescents and I am very grateful that they shared their lives with me.

If you could teach people one thing about sexuality, what would it be? I would say that sexuality is not just about identity and behaviors; it is a portal to understand society and issues of power.

Is there anything else you’d like to add? One thing that I would like to add is that I hope as the field continues to grow it will attract researchers from many different backgrounds and experiences. I believe, as with any subject matter, that the more diverse the researchers are, in terms of demo- graphic backgrounds and life experiences, the more opportunity there is for various perspectives and insights to be brought into our understanding of sex and sexuality.

NOTES 1. It is important to note that many transgender women do maintain their prostate even if they have had hormonal and surgical alterations to their bodies.

2. For a full account, see Descartes, Lara, Marysol Asencio, and Thomas O. Blank. 2011. “Paying Project Participants: Dilemmas in Research with Poor, Marginalized Populations.” Advances in Social Work 12, no. 2: 218–25.

R E A D I N G 1

5

ing doubts about whether I’d been keeping score accurately or not. I’d lie awake at night thinking to myself, well, there was Brad, and there was that guy on my birthday, and there was David and . .  .  no, wait, I forgot that guy I got drunk with at the social my first week at college . . . so that’s seven, eight, nine . . . and by two in the morning I’d finally have it figured out. But there was always a nagging suspicion that maybe I’d missed someone, some dreadful tacky little scumball that I was trying to forget about having invited inside my body. And as much as I maybe wanted to forget about the sleazy little scumball, I wanted more to get that number right.

It kept getting harder, though. I began to question what counted as sex and what didn’t. There was that time with Gene, for instance. I was pissed off at my boyfriend, David, for cheating on me. It was a major crisis, and Gene and I were friends and he’d been try- ing to get at me for weeks and I hadn’t exactly been discouraging him. I went to see him that night to gripe about David. He was very sym- pathetic of course, and he gave me a back- rub, and we talked and touched and confided and hugged, and then we started kissing, and then we snuggled up a little closer, and then we started fondling each other, you know, and then all heck broke loose, and we rolled around on the bed groping and rubbing and grabbing and smooching and pushing and pressing and squeezing. He never did actually get it in. He

W hen I first started having sex with other people, I used to like to count them. I wanted to keep track of how many there had been. It was a source of some kind of pride, or identity anyway, to know how many people I’d had sex with in my lifetime. So, in my mind, Len was number one, Chris was number two, that slimy awful little heavy metal barbiturate addict whose name I can’t remember was number three, Alan was num- ber four, and so on. It got to the point where, when I’d start having sex with a new person for the first time, when he first entered my body (I was only having sex with men at the time), what would flash through my head wouldn’t be “Oh, baby, baby you feel so good inside me,” or “What the hell am I doing with this creep,” or “This is boring, I wonder what’s on TV.” What flashed through my head was “Seven!”

Doing this had some interesting results. I’d look for patterns in the numbers. I had a theory for a while that every fourth lover turned out to be really great in bed, and would ponder what the cosmic significance of the phenom- enon might be. Sometimes I’d try to determine what kind of person I was by how many peo- ple I’d had sex with. At eighteen, I’d had sex with ten different people. Did that make me normal, repressed, a total slut, a free-spirited bohemian, or what? Not that I compared my numbers with anyone else’s—I didn’t. It was my own exclusive structure, a game I played in the privacy of my own head.

Then the numbers started getting a little larger, as numbers tend to do, and keeping track became more difficult. I’d remember that the last one was seventeen and so this one must be eighteen, but then I’d start hav-

ARE WE HAVING SEX NOW OR WHAT ?

G R E TA C H R I S T I N A

From “Are We Having Sex Now or What?” by Greta Chris- tina; from The Erotic Impulse edited by David Steinberg, copyright © 1992 by David Steinberg. Used by permission of Tarcher, an imprint of Penguin Publishing Group, a divi- sion of Penguin Random House LLC. All rights reserved.

6 C AT EG O R I Z I N G S E X

all except human bodies. Of course, that’s true for sex between women and men as well. But between women, no one method has a centu- ries-old tradition of being the one that counts. Even when [cisgender women] do fuck each other, there’s no dick, so you don’t get that feel- ing of This Is What’s Important, We Are Now Having Sex, objectively speaking, and all that other stuff is just foreplay or afterplay. So when I started having sex with women, the binary system had to go, in favor of a more inclusive definition.

Which meant, of course, that my list of how many people I’d had sex with was completely trashed. In order to maintain it I would have had to go back and reconstruct the whole thing and include all those people I’d necked with and gone down on and dry-humped and played touchy-feely games with. Even the question of who filled the all-important Number One slot, something I’d never had any doubts about before, would have to be re-evaluated.

By this time I’d kind of lost interest in the list anyway. Reconstructing it would be more trouble than it was worth. But the crucial ques- tion remained: What counts as having sex with someone?

It was important for me to know. You have to know what qualifies as sex because when you have sex with someone your relationship changes. Right? Right? It’s not that sex itself has to change things all that much. But know- ing you’ve had sex, being conscious of a sexual connection, standing around making polite conversation with someone while thinking to yourself, “I’ve had sex with this person,” that’s what changes things. Or so I believed. And if having sex with a friend can confuse or change the friendship, think how bizarre things can get when you’re not sure whether you’ve had sex with them or not.

The problem was, as I kept doing more kinds of sexual things, the line between sex and

wanted to, and I wanted to too, but I had this thing about being faithful to my boyfriend, so I kept saying, “No, you can’t do that, Yes, that feels so good, No, wait that’s too much. Yes, yes, don’t stop. No, stop that’s enough.” We never even got our clothes off. Jesus Christ, though, it was some night. One of the best, really. But for a long time I didn’t count it as one of the times I’d had sex. He never got inside, so it didn’t count.

Later, months and years later, when I lay awake putting my list together, I’d start to wonder: Why doesn’t Gene count? Does he not count because he never got inside? Or does he not count because I had to preserve my moral edge over David, my status as the patient, ever- faithful, cheated-on, martyred girlfriend, and if what I did with Gene counts then I don’t get to feel wounded and superior?

Years later, I did end up fucking Gene and I felt a profound relief because, at last, he defi- nitely had a number, and I knew for sure that he did in fact count.

Then I started having sex with women, and, boy, howdy, did that ever shoot holes in the sys- tem. I’d always made my list of sex partners by defining sex as penile-vaginal intercourse—you know, screwing. It’s a pretty simple distinction, a straightforward binary system. Did it go in or didn’t it? Yes or no? One or zero? On or off? Granted, it’s a pretty arbitrary definition, but it’s the customary one, with an ancient and respected tradition behind it, and when I was just screwing men, there was no compelling reason to question it.

But with women, well, first of all there’s [generally] no penis, so right from the start the tracking system is defective. And then, there are so many ways women can have sex with each other, touching and licking and grind- ing and fingering and fisting—with dildoes or vibrators or vegetables or whatever happens to be lying around the house, or with nothing at

A R E W E H AV I N G S E X N OW O R W H AT ? 7

I have friends who say, if you thought of it as sex when you were doing it, then it was. That’s an interesting idea. It’s certainly helped me construct a coherent sexual history without being a revisionist swine: redefining my past according to current definitions. But it really just begs the question. It’s fine to say that sex is whatever I think it is; but then what do I think it is? What if, when I was doing it, I was wonder- ing whether it counted?

Perhaps having sex with someone is the conscious, consenting, mutually acknowledged pursuit of shared sexual pleasure. Not a bad definition. If you are turning each other on and you say so and you keep doing it, then it’s sex. It’s broad enough to encompass a lot of sexual behavior beyond genital contact/orgasm; it’s distinct enough not to include every instance of sexual awareness or arousal; and it contains the elements I feel are vital—acknowledgment, consent, reciprocity, and the pursuit of pleas- ure. But what about the situation where one person consents to sex without really enjoying it? Lots of people (myself included) have had sexual interactions that we didn’t find satisfy- ing or didn’t really want and, unless they were actually forced on us against our will, I think most of us would still classify them as sex.

Maybe if both of you (or all of you) think of it as sex, then it’s sex whether you’re having fun or not. That clears up the problem of sex that’s consented to but not wished-for or enjoyed. Unfortunately, it begs the question again, only worse: now you have to mesh different people’s vague and inarticulate notions of what is and isn’t sex and find the place where they overlap. Too messy.

How about sex as the conscious, con- senting, mutually acknowledged pursuit of sexual pleasure of at least one of the people involved. That’s better. It has all the key com- ponents, and it includes the situation where one person is doing it for a reason other than

not-sex kept getting more hazy and indistinct. As I brought more into my sexual experience, things were showing up on the dividing line demanding my attention. It wasn’t just that the territory I labeled sex was expanding. The line itself had swollen, dilated, been transformed into a vast gray region. It had become less like a border and more like a demilitarized zone.

Which is a strange place to live. Not a bad place, just strange. It’s like juggling, or watch- making, or playing the piano—anything that demands complete concentrated awareness and attention. It feels like cognitive dissonance, only pleasant. It feels like waking up from a compel- ling and realistic bad dream. It feels like the way you feel when you realize that everything you know is wrong, and a bloody good thing too, because it was painful and stupid and it really screwed you up.

But, for me, living in a question naturally leads to searching for an answer. I can’t simply shrug, throw up my hands, and say, “Damned if I know.” I have to explore the unknown fron- tiers, even if I don’t bring back any secret trea- sure. So even if it’s incomplete or provisional, I do want to find some sort of definition of what is and isn’t sex.

I know when I’m feeling sexual. I’m feeling sexual if my pussy’s wet, my nipples are hard, my palms are clammy, my brain is fogged, my skin is tingly and super-sensitive, my butt mus- cles clench, my heartbeat speeds up, I have an orgasm (that’s the real giveaway), and so on. But feeling sexual with someone isn’t the same as having sex with them. Good Lord, if I called it sex every time I was attracted to someone who returned the favor I’d be even more bewildered than I am now. Even being sexual with someone isn’t the same as having sex with them. I’ve danced and flirted with too many people, given and received too many sexy, would-be-seductive backrubs, to believe otherwise.

8 C AT EG O R I Z I N G S E X

ing about what we were going to do, what would and wouldn’t be okay, and she said she wasn’t sure she wanted to have sex. Now we’d been explicitly planning all kinds of fun and games—spanking, bondage, obedience— which I strongly identified as sexual activity. In her mind, though, sex meant direct genital contact, and she didn’t necessarily want to do that with me. Playing with her turned out to be a tremendously erotic experience, arousing and stimulating and almost unbearably satisfying. But we spent the whole evening without even touching each other’s genitals. And the fact that our definitions were so different made me wonder: Was it sex?

For instance, I worked for a few months as a nude dancer at a peep show. In case you’ve never been to a peep show, it works like this: the customer goes into a tiny, dingy black box, kind of like a phone booth, puts in quar- ters, and a metal plate goes up; the customer looks through a window at a little room/stage where naked women are dancing. One time, a guy came into one of the booths and started watching me and masturbating. I came over and squatted in front of him and started mas- turbating too, and we grinned at each other and watched each other and masturbated, and we both had a fabulous time. (I couldn’t believe I was being paid to masturbate—tough job, but somebody has to do it . . . . ) After he left I thought to myself: Did we just have sex? I mean, if it had been someone I knew, and if there had been no glass and no quarters, there’d be no question in my mind. Sitting two feet apart from someone, watching each other masturbate? Yup, I’d call that sex all right. But this was different, because it was a stranger, and because of the glass and the quarters. Was it sex?

I still don’t have an answer.

sexual pleasure—status, reassurance, money, the satisfaction and pleasure of someone they love, etc. But what if neither of you is enjoying it, if you’re both doing it because you think the other one wants to? Ugh.

I’m having trouble here. Even the conven- tional standby—sex equals intercourse—has a serious flaw: it includes rape, which is some- thing I emphatically refuse to accept. As far as I’m concerned, if there’s no consent, it ain’t sex. But I feel that’s about the only place in this whole quagmire where I have a grip. The longer I think about the subject, the more questions I come up with. At what point in an encounter does it become sexual? If an interac- tion that begins nonsexually turns into sex, was it sex all along? What about sex with someone who’s asleep? Can you have a situation where one person is having sex and the other isn’t? It seems that no matter what definition I come up with, I can think of some real-life experience that calls it into question.

For instance, a couple of years ago I attended (well, hosted) an all-girl sex party. Out of the twelve other women there, there were only a few with whom I got seriously physically nasty. The rest I kissed or hugged or talked dirty with or just smiled at, or watched while they did seri- ously physically nasty things with each other. If we’d been alone, I’d probably say that what I’d done with most of the women there didn’t count as having sex. But the experience, which was hot and sweet and silly and very, very spe- cial, had been created by all of us, and although I only really got down with a few, I felt that I’d been sexual with all of the women there. Now, when I meet one of the women from that party, I always ask myself: Have we had sex?

For instance, when I was first experi- menting with sadomasochism, I got together with a really hot woman. We were negotiat-

H OW D O H E T E RO S E X UA L U N D E RG R A D UAT E S T U D E N T S D E F I N E H AV I N G S E X ? 9

A number of studies have examined which physically intimate behaviors individuals con- sider to be “having sex” (e.g., Sanders & Rein- isch, 1999).  .  .  . Though there has been some disagreement among these studies regarding how often some behaviors were considered sex (e.g., for oral stimulation, 24% to 40% across studies), the list of behaviors from most to least likely to be considered sex has proven to be very consistent, being replicated both within (Gute, Eshbaugh, & Wiersma, 2008) and out- side (e.g., Pitts & Rahman, 2001) the United States, as well as across time (Sanders & Rein- isch, 1999; Horowitz & Spicer, 2013). Nearly all of these studies have been limited (or nearly so) to exclusively heterosexual participants, the sole exception being a study on gay men in the United States and United Kingdom (Hill et al., 2010). . . .

Several recent studies have explored the idea that definitions of sex may be flexible or ambiguous. Peterson and Muehlenhard (2007) suggested that underlying many studies is the implicit assumption that individuals have clear definitions of what behaviors do and do not constitute having sex. In contrast to this assumption, however, they found that almost everyone they surveyed could describe previ- ously experiencing an ambiguous sexual situa- tion (e.g., “not quite sex” or “unsure”). Further, they found that participants’ definitions of sex sometimes seemed to be motivated. That is, their decisions about whether to label an

ambiguous sexual encounter as “having sex” seemed to be influenced by their perception of the consequences of labeling it as such (e.g., negative self-evaluation). These authors called those circumstances in which participants considered the possible consequences of the label when choosing their definition “moti- vated definitions” (Peterson & Muehlenhard, 2007, p. 257). They suggested these motivated definitions may serve to protect an individual’s self-image but could also have the nega- tive consequence of justifying sexually risky behaviors. . . .

THE PRESENT STUDY

.  .  .  Utilizing a mixed-method design, par- ticipants rated their degree of confidence that each of a variety of behaviors constituted “having sex,” assuming (a) they and (b) their significant other (with someone else) were engaging in the behavior, with the order in which these judgments were made (i.e., for self or significant other first) systematically manipulated so that possible order effects could be evaluated.  .  .  . [T]he final sample consisted of 594 individuals, 267 men and 327 women. Participants ranged in age from 18 to 62 (M = 23.3, SD = 6.55). . . . None of the demographic variables (e.g., age, race, reli- gious importance) was significantly related to the variables of interest.

How Do Heterosexual Undergraduate Students Define Having Sex?

Kelsey K. Sewell and Donald S. Strassberg

10 C AT EG O R I Z I N G S E X

Note: SO = significant other; org = orgasm; NO = nobody orgasms; MO = male orgasms; FO = female orgasms; BO = both orgasm.

Quantitative Findings Descriptive Information for Intimate Behavior Rankings

definitely pRobably pRobably definitely intimate behavioRS not Sex (%) not Sex (%) Sex (%) Sex (%) Deep kissing 92.3 4.7 1.9 0.8 SO stimulates your nipples 73.2 16.8 6.1 3.5 You stimulate SO’s nipples 69.7 19.9 7.1 3.4 Self-stimulation on computer 64.6 21.5 9.8 3.9 Self-stimulation on phone 63.1 22.6 10.1 3.7 Mutual self-stimulation 59.3 23.4 10.8 6.2 SO manually stimulates you 49.3 26.1 15.0 9.4 You manually stimulate SO 47.6 28.3 15.2 8.9 SO manually stimulates you, org 41.2 25.9 18.5 14.1 You manually stimulate SO, org 40.7 26.8 18.2 14.0 SO orally stimulates you 28.8 23.1 23.4 24.6 You orally stimulate SO 27.4 25.1 22.9 24.6 SO orally stimulates you, org 23.1 23.6 22.2 31.0 You orally stimulate SO, org 21.7 24.2 22.9 31.0 69 position (mutual oral stimulation) 20.0 20.7 25.6 33.2 Anal intercourse, NO 3.5 4.5 21.5 70.0 Anal intercourse, org 3.7 3.7 18.4 74.1 Penile-vaginal intercourse, NO 2.0 0.5 8.4 88.9 Penile-vaginal intercourse, MO 0.8 0.2 3.5 95.3 Penile-vaginal intercourse, FO 0.7 0.2 3.7 94.9 Penile-vaginal intercourse, BO 0.7 0.2 0.3 98.7

SUPPORT AND IMPLICATIONS FOR UNCERTAINTY

In contrast to almost every published study in this area, our use of a four-point (rather than a Yes/No) scale allowed participants to express either absolute certainty (i.e., Definitely not sex or Definitely sex) or a degree of uncertainty (i.e., Probably not sex or Probably sex) in their judg- ments. The value in doing so is evident by the fact that our intermediate answer choices were frequently used, especially for those behaviors found in previous studies for which there was the

least participant agreement regarding whether the behavior counted as sex. In fact, some behav- iors we included received almost evenly distrib- uted responses across choices. For example, while Sanders and Reinisch (1999) found that 40% of those they surveyed checked Yes (and 60% checked No) when rating oral- genital stim- ulation, nearly half of our participants expressed some uncertainty by selecting an intermediate answer choice (25.1% picked Probably not sex and 22.9% chose Probably sex). Providing par- ticipants only a Yes/No option would have failed to capture this uncertainty. . . .

H OW D O H E T E RO S E X UA L U N D E RG R A D UAT E S T U D E N T S D E F I N E H AV I N G S E X ? 11

individuals try to use clear rules when navigat- ing their physically intimate experiences and negotiating acceptable boundaries with a new partner. For example, if an individual considers penile penetration to be a requisite for “having sex,” oral-genital stimulation may be a way to be intimate with a partner without having sex.

Some of our participants wrote that consid- ering the potential outcome of engaging in the behavior influenced their certainty regarding whether a particular behavior should be con- sidered as sex. Many such explanations referred to physical outcomes (e.g., 18.5% mentioned sexual arousal; 29.2% mentioned orgasm). Others wrote about situational outcomes, such as the potential for the act to result in preg- nancy, STIs, and virginity loss. Outcome-based definitions can easily impact the sexual choices people make. For example, if a person believes only behaviors that can result in pregnancy constitute having sex, they might feel quite comfortable (e.g., nonguilty) engaging in oral sex or anal intercourse, perhaps leaving them at risk for negative outcomes, such as STIs. This supports Peterson and Muehlenhard’s (2007) suggestion that some individuals use “moti- vated definitions” in their definitions of sex.

Our results suggest that there exists a very strong social norm that PVI [penile-vaginal intercourse] counts as “having sex.” Quantita- tive results in our study and every other pre- vious study in this area have indicated that almost 100% of people consider PVI (at least when orgasm occurs) to be sex. Further, our qualitative results found that almost half of the comments offered nothing more than “this is sex” in explanation for PVI, suggesting many people considered PVI to be so obviously and widely considered sex that they struggled to explain or felt an explanation was unnecessary. This idea of PVI as the “gold standard” of sex- ual encounters is not new. Research has sug- gested that many people tend to think about

Uncertainty about which behaviors are and are not sex may increase the likelihood of risky behavior. For example, someone’s experi- ence of uncertainty about the extent to which anal intercourse is “sex” could discourage the use of proper protection (e.g., condoms) when engaging in this behavior, increasing the risk of spreading or contracting sexually transmitted infections (STIs; e.g., “Why practice ‘safe sex’ if I don’t think the behavior is definitely hav- ing sex?”). Though this study was able to mea- sure uncertainty, it could not link uncertainty with behavioral outcomes. Future work should consider the potential relationship between certainty levels in categorizing a behavior as “sex” and the perceived health risks involved in engaging in this behavior.

QUALITATIVE FINDINGS

Qualitative follow-up encouraged participants to explain their answers, providing the oppor- tunity to begin to understand why people do and do not consider various behaviors as sex. It was clear from the responses that a number of factors can influence one’s definition of sex and that people differ in which of these factors play a role in their decisions.

The most popular themes mentioned were physical reasons, such as whether physical contact with the other person occurred (men- tioned by 50% of our sample), whether penetra- tion occurred (46.3%), and whether the genitals were involved, with 28.7% saying that at least one person’s genitals must be touched and 17.1% specifying that a person’s genitals must be touching the other person’s genitals to count as sex. Consistent with this, lack of physical contact was used most often to describe why a behavior did not count as sex (e.g., for phone/ computer sex: “no physical contact, no sex”). Using physical reasons to distinguish when a behavior counts as sex may represent a way

12 C AT EG O R I Z I N G S E X

having sex within a strictly heterosexual, patri- archal model of insertive sex (Maines, 1999), where a sex act does not fully occur unless PVI happens and is not over until the man orgasms (Jackson & Scott, 2001).

.  .  .  Among participants in our study, no consistent sex differences were found: Men and women were equally certain about whether the presented behaviors constituted sex. In con- trast, we did find gender differences in the qualitative findings. Specifically, when com- pared to men, women (1) offered significantly more reasons and (2) were significantly more likely to mention specific reasons for defining a behavior as sex (e.g., “virginity loss,” “foreplay,” “only penis in vagina is sex”), while men were significantly more likely to offer no reason or to compare a behavior to one previously rated (e.g., “nipple stimulation is closer to sex than kissing”). It is possible that women were simply more thoughtful and complete in their expla- nations than were men in this study. However, this finding might also suggest that though men and women may not differ in which behav- iors they consider as “having sex,” they may differ in why behaviors fit (or do not fit) their definitions of sex.

CONCLUSION

Our findings suggest that, at least within a research setting, the context in which physi- cally intimate behaviors are presented can sig- nificantly affect judgments regarding whether they constitute having sex (Gute, Eshbaugh, & Wiersma, 2008). This appears to include (but is certainly not limited to) (1) whether one is rating one’s own behavior or that of another, (2) whether the ratings for one’s own or another’s behavior are made before or after the other, and (3) various aspects of the inti- mate behavior (i.e., the presence or absence of an orgasm). However, there appear to be some

limits to these effects. Specifically, though context can influence the degree of certainty that a given behavior is considered sex, it does not appear to change the overall hierarchi- cal order of behaviors. That is, in all of these contextual conditions, the overall rank order- ings of the certainty ratings did not change. For example, while oral-genital stimulation was rated higher (i.e., greater certainty it was sex) when an orgasm did versus did not occur, it still received lower certainty ratings than anal intercourse and greater certainty ratings than manual-genital stimulation under both orgasm conditions. This supports the idea of a robust hierarchical structure of behaviors defined as sex (Horowitz & Spicer, 2013). In summary, though this study supported the idea of a widely agreed upon hierarchy of behaviors, it was clear that many individuals experienced varying degrees of uncertainty for some behaviors, especially when the con- text is varied. . . .

REFERENCES Gute, G., Eshbaugh, E., & Wiersma, J. (2008). Sex for

you, but not for me: Discontinuity in undergraduate emerging adults’ definitions of “having sex.” Journal of Sex Research, 45(4), 329–37.

Hall, J. H., & Fincham, F. D. (2006). Relationship dissolution following infidelity: The roles of attributions and forgiveness. Journal of Social and Clinical Psychology, 25(5), 508–22.

Hill, B. J., Rahman, Q., Bright, D. A., & Sanders, S. A. (2010). The semantics of sexual behavior and their implications for HIV/AIDS research and sexual health: U.S. and U.K. gay men’s definitions of having “had sex.” AIDS Care, 22(10), 1245–51.

Horowitz, A., & Spicer, L. (2013). “Having sex” as a graded and hierarchical construct: A comparison of sexual definitions among heterosexual and lesbian emerging adults in the U.K. Journal of Sex Research, 50(2), 139–50.

Jackson, S., & Scott, S. (2001). Embodying orgasm: Gendered power relations and sexual pleasure. Women and Therapy, 24, 99–110.

Maines, R. P. (1999). The technology of orgasm: “Hysteria,” the vibrator, and women’s sexual satisfaction. Baltimore, MD: Johns Hopkins University Press.

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Source: “How Do Heterosexual Undergraduate Students Define Having Sex? A New Approach to an Old Ques- tion,” The Journal of Sex Research Vol. 52, No. 5, pp. 507–16. Copyright © the Society for the Scientific Study of Sexu- ality (SSSS), http://www.sexscience.org/, reprinted by per- mission of Taylor & Francis Ltd, http://www.tandfonline .com on behalf of the Society for the Scientific Study of Sexuality (SSSS).

Peterson, Z., & Muehlenhard, C. (2007). What is sex and why does it matter? A motivational approach to exploring individuals’ definitions of sex. Journal of Sex Research, 44, 256–68.

Pitts, M., & Rahman, Q. (2001). Which behaviors constitute ‘‘having sex’’ among university students in the U.K.? Archives of Sexual Behavior, 30, 169–76.

Randall, H., & Byers, E. S. (2003). What is sex? Students’ definitions of having sex, sexual partners, and unfaithful sexual behavior. Canadian Journal of Human Sexuality, 12, 87–96.

Sanders, S. A., & Reinisch, J. M. (1999). Would you say you “had sex” if . . .? Journal of the American Medical Association, 281, 275–77.

14

the genital ambiguity of CAIS lies internally rather than externally, it is generally not diag- nosed until adolescence, when females are expected to begin menstruation. Rather than accept intersexuality as a naturally occurring disruption of the two-sex model,2 the medi- cal profession surgically removes or modifies intersex genitalia to fit into the sex binary, providing  evidence that sex is a socially con- structed phenomenon (Fausto-Sterling, 1993: 24; see also Dreger, 1998a, b; Fausto-Sterling, 2000a, b; Karkazis, 2008; Kessler, 1998, 1990; Preves, 2003, 2000).

Background Intersexuality makes the two-sex model that organizes our bodies visible, and it also chal- lenges any form of sex categorization. Although some scholars have argued that we should organize bodies into multiple sex categories, going beyond the two we currently recognize (e.g., Fausto-Sterling, 1993), plural sex catego- rization is neither truly possible nor entirely logical (Kessler, 1998). To categorize bodies by sex, regardless of the number of sex categories made available, is a difficult task because “few, if any, physical characteristics are exclusive to one sex” (Karkazis, 2008: 22–23). For example, testosterone is not found exclusively in male bodies; nor is estrogen. Instead of attempting to sex-categorize intersex bodies by biological markers, medical professionals need to shift their focus to “sexual variability,” embracing the diverse appearance of genitals without requiring categorization (Kessler, 1998).

rom as early as a prenatal ultrasound image, genitalia are classified into a sex binary—males have penises and

females have vaginas. However, for decades now, scholars have argued that this troubling two-sex model is socially constructed through processes that begin in the medical profession (e.g., Dreger, 1998a; Fausto-Sterling, 1993; Karkazis, 2008; Kessler, 1990; Preves, 2003). One of the very best examples of both the problem with the two-sex model and evidence that it is socially constructed is intersexuality,1 conditions where one is born with “ambiguous genitalia, sexual organs, or sex chromosomes” that deviate from the “norm” (Preves, 2003: 2). According to the Intersex Society of North America, over twenty different intersex condi- tions have been identified by the medical pro- fession (Consortium, 2006).

One example of intersexed bodies occurs among people with androgen insensitivity syn- drome (AIS). Individuals with AIS have XY sex chromosomes yet are unable to, during gesta- tion and beyond, partially (PAIS) or completely (CAIS) metabolize androgens, an umbrella term for male sex hormones, most notably tes- tosterone. Individuals with PAIS are usually diagnosed at birth because it results in ambigu- ous external genitalia (usually a larger clitoris that resembles a small penis) with either inter- nal or external testes. Individuals with CAIS also have XY sex chromosomes, but unlike those with PAIS, they do not have ambiguous external genitalia. Instead, they commonly have what appears to be a “normal”-looking vagina and internal undescended testes. Since

R E A D I N G 2

“BRINGING INTERSEXY BACK”? INTERSEXUALS AND SEXUAL SATISFACTION

G E O R G I A N N D AV I S

F

“ B R I N G I N G I N T E R S E X Y B AC K ” ? 15

A BRIEF HISTORY OF INTERSEX GENITAL SURGERY

Rather than accept intersexuality as a challenge to the sex binary and evidence of naturally occurring sexual variability, the medical profes- sion has historically approached it as an abnor- mality that can be surgically corrected. In the twentieth century, technological advancements provided the medical profession at large with the tools to surgically “shoehorn” individuals who deviated from the sex binary system to fit into a male or female body (Fausto-Sterling, 1993: 24; see also Dreger, 1998a, b; Fausto- Sterling, 2000a, b; Karkazis, 2008; Kessler, 1998, 1990; Preves, 2003, 2000). Doctors assumed that surgery would reduce the stigma and shame associated with not comfortably fit- ting into the narrow sex, gender, and sexuality categorization system (Dreger, 1998a; Fausto- Sterling, 2000a, 1996; Kessler, 1998, 1990; Preves, 2003, 2002). However, in many cases, intersex genital surgery isn’t medically neces- sary. For example, although intersexuals were often told that they were at a high risk for devel- oping gonadal cancer (e.g., Preves, 2003), there is minimal evidence to support this claim. The presumed strong correlation between intersex- uality and cancerous germ cell tumors is not consistently predicted (see Cools et al., 2006).

The surgical modification of genitalia impacts all aspects of intersexuals’ lives, espe- cially sexual pleasure, by disrupting genital sen- sation (Karkazis, 2008; Preves, 2003). Genital surgeries leave many intersexuals feeling muti- lated, unable to achieve sexual satisfaction, and in some instances, incontinent (Preves, 2003). A recent study documented that almost half of all intersexuals who underwent genital sur- gery were dissatisfied with surgical outcomes (Köhler et al., 2012). While such evidence raises awareness of intersexuals’ sexual dissat- isfaction, it also situates the problem narrowly onto scalpels and the medical providers who

use them. Some medical professionals who are experts on intersexuality have themselves advocated for the end of intersex genital sur- geries (Köhler et al., 2011; Lee et al., 2006).

Given that intersexuality is usually diag- nosed when one is a minor, it is up to the indi- vidual’s parent(s) to grant surgical consent. It might seem unusual for any parent to authorize a medical provider to perform a surgery that in many cases is cosmetic, medically unnecessary, or purely preventative (see Cools et al., 2006). However, parents of intersexual children, like many in our society, are uninformed about sex- ual variability and consequently follow medi- cal recommendations without hesitation. For this reason, the validity of parental consent has been questioned (Dreger, 1998b).

Feminist critiques of intersex genital sur- gery (e.g., Dreger, 1998b; Fausto-Sterling, 1993; Kessler, 1998) helped adult intersexuals orga- nize collectively together in the 1990s (Karkazis, 2008; Preves, 2003). The goal of the intersex rights movement was simple: to end the  surgi- cal modification of intersex genitalia (see e.g., Karkazis, 2008; Preves, 2003). Since the surger- ies are usually performed on minor children who do not have a legal voice of their own, intersex activists accused medical professionals of per- forming nonconsensual female genital cutting, which is an illegal practice in the United States among non-intersexed females (Chase, 2002).

FROM “INTERSEX” TO “DISORDERS OF SEX DEVELOPMENT”

By the year 2000, after a decade of protests by adult intersex activists, the American Academy of Pediatrics issued a consensus statement on the medical management of intersex conditions. The document had a number of recommenda- tions including that intersex infants should be referred to as “your baby” or “your child”—not “it,” “he,” or “she” (Committee, 2000: 138). How- ever, surgery was still an option. The guidelines

16 C AT EG O R I Z I N G S E X

a large clitoris that resembles a small penis, medical professionals will only define them as female.3 They ignore the possibility that this person might desire to penetrate using their phallus, so to them, surgery is only logical. In other words, medical professionals fail to see any possibilities beyond gender- and sexual- normative bodies when they make their gender and medical intervention recommendations.

In 2006, the American Academy of Pedi- atrics revised their policy regarding the treat- ment of intersexual infants due to “progress in diagnosis, surgical techniques, understand- ing psychosocial issues, and recognizing and accepting the place of patient advocacy” (Lee et al., 2006: 488). They offered new recommen- dations in this policy revision, including avoid- ing unnecessary surgical intervention. The consensus statement notes:

Because orgasmic function and erectile sensation may be disturbed by clitoral surgery, the surgical procedure should be anatomically based to preserve erectile function and the innervation of the clitoris. Emphasis is on functional outcome rather than a strictly cosmetic appearance. It is generally felt that surgery that is performed for cosmetic reasons in the first year of life relieves parental distress and improves attachment between the child and the par- ents; the systematic evidence for this belief is lack- ing. (Lee et al., 2006: 491)

The guidelines also recommend a nomenclature shift away from “intersex” and “sex reversal” ter- minology in favor of new “disorders of sex devel- opment (DSD)” language (Lee, 2006: 488).

Only five years after the consensus state- ment was published, current evidence suggests that intersexuality has become an outdated term in the medical profession (Davis, 2011). Medical terminology is a concern because his- tory has shown us that there are implications to naming and defining conditions as disor- ders (e.g., Brown, 2007, 1995, 1990; Conrad, 2007; Cooksey and Brown, 1998). Consider, for example, attention deficit hyperactivity disorder

advised doctors to inform parents that their baby’s “abnormal appearance can be corrected and the child raised as a boy or a girl as appro- priate” (Committee, 2000: 138). The guidelines also stated that a number of factors should be considered when determining which “gender assignment” should be recommended for a given intersex child. Most notably, these factors included “fertility potential” and “capacity for normal sexual function” (Committee, 2000: 141).

Many medical professionals hold cissex- ist and heteronormative ideologies, which are especially problematic in the case of the medi- cal management of intersexuality, because these ideologies are relied on during gender assignment and imposed on intersexuals and their bodies. Cissexism is the belief that gen- der is authentic only when it is neatly aligned with sex (Serano, 2007), and heteronormativity is “the suite of cultural, legal, and institutional practices that maintain normative assump- tions that there are two and only two genders, that gender reflects biological sex, and that only sexual attraction between these ‘oppo- site’ genders is natural or acceptable” (Schilt and Westbrook, 2009: 441; see also Kitzinger, 2005). For example, an intersexual’s gender assignment is recommended based on capac- ity for “normal [hetero]sexual function” and “fertility potential” (Committee, 2000: 141). Only women can become pregnant in the eyes of most medical professionals, and thus, many seem to think that all bodies capable of preg- nancy must then be “female.” The guidelines suggested that “[a]ll female infants virilized because of [congenital adrenal hyperplasia, or CAH] or maternal androgens are potentially fertile and should therefore be raised as girls” (Committee, 2000: 141). And assessments of prospects for “normal” sexual function pre- sume heterosexual partnering, which exem- plifies a heteronormative ideology. Because those born with CAH, a type of intersexual- ity, are capable of pregnancy despite having

“ B R I N G I N G I N T E R S E X Y B AC K ” ? 17

who are experts on such conditions, I studied how intersexuality is understood, contested, and experienced by those in the community. Most data were collected from October 2008 to August 2010. A few additional interviews took place in April 2011. As a feminist with an intersex condition, I collected the data from an informed standpoint.

Informants were initially recruited from four organizations: the Intersex Society of North America (ISNA), Accord Alliance, the Androgen Insensitivity Syndrome Support Group-USA4 (AISSG-USA), and Organisation Intersex International (OII). Participants were targeted from these four organizations because, based on my initial assessment of their web- sites, each organization appeared to be involved in the intersex rights movement in a different way. For instance, ISNA and OII are activist organizations, while AISSG-USA is a support group, and Accord Alliance is an organization that seeks to distribute educational resources to medical professionals. I also employed snowball sampling by asking initial informants to name others who might share different views from their own (Biernacki and Waldorf, 1981).

Findings Regardless of surgical history, all of the inter- sexuals I interviewed reported experiencing sexual struggles at some point in their lives. Everyone was also critical of surgical interven- tions when conducted on minor children who weren’t capable of refusing or legally allowed to refuse consent for medical treatment. The intersex rights movement was formed in the 1990s, united by this critique (e.g., Chase, 2002; Preves, 2003). However, intersexuality remains medicalized, most recently with the disorder of sex development (DSD) terminol- ogy (Davis, 2011). Support for the new DSD terminology was mixed5 among the 37 6 indi- viduals with intersex/DSD conditions whom

(ADHD). In the 1990s, Conrad (2007) argues, ADHD diagnosis expanded to include adults who weren’t previously diagnosed in ways that had lasting implications on how individuals, after diagnosis, understood and explained their behaviors.

Given what is known about the medicaliza- tion process, is it possible that the sexual strug- gles intersexuals experience are not only due to genital surgery? If surgery were the only cause of sexual dissatisfaction, there would be signifi- cant differences in sexual satisfaction between those who were surgically modified and those who were not. Yet, empirical studies do not sup- port such expectations (Köhler et al., 2012; van der Zwan et al., 2012). In a study of intersexuals that included those who had genital surgeries and those who had not, sexual dissatisfaction was still alarmingly high. Regardless of surgical history, 37.5 percent of intersexuals reported dissatisfaction with their sex life and 44.2 per- cent reported sexual anxieties. The majority of intersexuals (68.2%) reported that their sexual dissatisfaction was the result of their “abnormal- ity” (Köhler et al., 2012). In a different study, similar results were obtained, with 41 percent of intersex women reporting sexual distress, irre- spective of surgical status (van der Zwan et al., 2012). Would ending genital surgeries solve the dissatisfaction experienced by intersexuals? Is it possible that the sexual dissatisfaction reported by intersexuals is situated in a larger medicaliza- tion process and not just in the operating room? What can we learn from intersexuals who report more positive sexual experiences?

Methods Relying on extensive qualitative data includ- ing over 300 hours of informal observations in the public meeting spaces of intersex organi- zational meetings and 65 in-depth interviews with intersexuals, intersex activists, parents of intersex children, and medical professionals

18 C AT EG O R I Z I N G S E X

and that there was a risk of cancer and that they needed to be removed. And I had lots of examina- tions including of my genitals, but I was never made aware [prior to surgery] that anything was going to be taken away [from down] there. So it was a big shock to me [when I woke up after surgery]. And I really had some work to do when I was eventually ready to do it . . . from the trauma that I had from waking up from my surgery to realize that what was between my legs was gone.

Prior to the 2000 medical consensus statement that advised against such deception, intersexu- als like Ana were often lied to about their diag- nosis because doctors were concerned that the intersex diagnosis might disrupt a child’s gen- der identity formation. While this deception is far less common today, possibly reducing the emotional consequences of surgery, intersex genital surgeries continue (see Davis, 2011).

Intersex genital surgeries are also problem- atic because they can result in physical con- sequences. Pidgeon7 shared, “My clitoris is gone. . . . My vagina looks really fucked up. . . . There’s some scar tissue there and . . . penetra- tion hurts.” Only four of the 37 intersexuals interviewed were not surgically modified (11%). Given the physical consequences of surgery, it wasn’t a surprise that only one of the four unal- tered intersexuals interviewed desired surgical modification. Although Pidgeon indicated she would ultimately support any intersexual adult who chose to have genital surgery, she still would passionately advise against it:

[N]ever let them touch you in terms of surgery. That’s number one. If they ask about surgery or ask your opinion, don’t do that. Don’t do surgery, no matter what they say. . . . You’ll love your body somehow, some way, and you don’t need surgery to love your body and love yourself. . . . If you fuck with your body, you can never change that. But if you don’t fuck with your body, you can change your acceptance of your body.

Given that intersex genital surgeries result in a loss of sexual pleasure, the question that arises

I interviewed. While it is outside the scope of this reading to adequately explain why individ- uals with such conditions embraced the DSD nomenclature while others rejected it, the deci- sion can briefly be explained as resulting from DSD proponents desiring to work alongside medical professionals in a medical context with medical terms to promote social change. Here, I focus specifically on how the terminology— which is situated in a larger medicalization pro- cess—is connected to sexual dis/satisfaction rather than focus on why individuals chose the terminology that they did.

I begin my analysis by establishing that inter- sexuals who were surgically modified commonly reported emotional and physical struggles because of their genital surgery. I next highlight the differences between those who embrace the new DSD terminology that upholds the two-sex model and those who reject it. I then describe the sexual struggles that surfaced, regardless of sexual history, for many intersexuals who sought sexual pleasure. I end by reporting three differ- ent responses to sexual struggles that involved avoiding intimacy, seeking heterosexual encoun- ters, or rejecting medicalization and the disorder of sex development terminology that patholo- gizes bodies.

THE CONSEQUENCES OF INTERSEX GENITAL SURGERY

Consistent with previous research (e.g., Karka- zis, 2008; Preves, 2003), of the 37 intersexu- als I interviewed, 33 underwent genital surgery as children, leaving them emotionally and physically scarred (89%). The emotional con- sequences of surgery resulted from individuals being lied to by their parents and doctors who attempted to keep their diagnoses a secret (see also Karkazis, 2008; Preves, 2003). For exam- ple, Ana shared:

When I was 12 . . . I was told [by my parents and doctors] that my ovaries had not formed correctly

“ B R I N G I N G I N T E R S E X Y B AC K ” ? 19

with someone of the “opposite” gender. This might, in part, explain why many of the inter- sexuals I interviewed identified as “straight” or “heterosexual” (32%). However, almost as many intersexuals identified as lesbian, gay, or homosexual (30%). Fewer intersexuals identi- fied themselves as bisexual (11%), queer (11%), or asexual (8%), and several others (8%) either refused to identify themselves, reported that their sexuality was “complicated,” or noted that they were “unsure.”

DSD is medical terminology that upholds the two-sex system, while intersex language is an identity characteristic that challenges its existence. Given that medical professionals favor DSD terminology because it maintains ideologies that sex, gender, and sexuality are all neatly biologically correlated (Davis, 2011), it makes sense that those who preferred the DSD  nomenclature were also more likely to claim a “straight” or “heterosexual” sexuality and actively sought, or maintained, a romantic relationship with an individual of the “opposite” gender. More specifically, among the 32 percent of individuals with an intersex/DSD condition who identified as straight or heterosexual, 75 percent preferred the DSD nomenclature over intersex terminology. When I asked Vanessa what terminology she preferred, she shared, “disorder of sex development . . . I’m pretty comfortable with that. . . . Intersex [terminol- ogy] rubs me the wrong way.” Although Han- nah wasn’t as critical of intersex terminology as Vanessa, she still preferred DSD language: “I like ‘DSD’ . . . because if you say ‘DSD’ [sex is] kind of camouflaged. When you say ‘intersex,’ it has the word ‘sex’ right in it and it’s like, ‘what?’ It’s kind of a red flag for people.”

On the other hand, those who preferred intersex terminology over the DSD nomencla- ture more often than not identified as lesbian, gay, bisexual, asexual, or queer. To be exact, just over 86 percent of those who identified as LGBA or Q preferred intersex terminology while the

is, why do they continue? Many medical profes- sionals claim intersex genital surgeries promote health by minimizing cancer risks, despite minimal evidence for such claims (see Cools et al., 2006). Another, more plausible explana- tion for why intersex genital surgeries continue has to do with the two-sex binary model that medical professionals, like many throughout society, believe should neatly map onto gender and sexual binaries (Davis, 2011). For instance, Donna was told by her doctor, “you can go to college . . . have sex with any boy you want to.” She also shared that “he pushed [her] to be fem- inine, he pushed [her] to be heterosexual, [and] he pushed [her] to give in to boys.” Pidgeon had a similar experience. When she was 10 or 11 in the 1990s, a doctor asked her:

Wouldn’t you like to have normal sex with your husband when you’re older? We can just fix [your vagina], we can make it a little bit bigger for you. It’s just a little snip incision, and [your vagina] will just be a little bit bigger. And then you can feel like normal women and have normal sex.

Intersexuals like Donna and Pidgeon were pres- sured by medical professionals to undergo sur- gery in order to fit into the sex binary. Doctors assumed Donna and Pidgeon, surgically con- structed as females, would adopt a feminine iden- tity and partner with men. However, as I show in the sections that follow, the sex binary model isn’t enforced exclusively through surgery. Even those who were able to avoid surgical interven- tion reported emotional and physical insecurities at some point in their lives, which suggests that the sex binary is connected to a much broader medicalization process beyond surgery.

SEXUAL IDENTITIES AND MEDICAL TERMINOLOGY

Medical professionals frame intersex normalcy (especially after genital surgery) as something one can achieve by romantically partnering

20 C AT EG O R I Z I N G S E X

silencing of her experience affected her ability to relate to others:

So not only was I wounded physically through sur- gery . . . which I still am dealing with and may sur- gically revise at some point . . . I was wounded by the mantling of my very existence being something that should not be discussed . . . the whole notion of connecting with other people especially in intimate relationships.

The few individuals who were not surgically modified offer evidence that the sexual strug- gles common to intersexuality are not exclu- sively due to surgery. Kimberly, who has not had surgery, shared, “In relationships I have had, it’s always really bothered me that I feel I have to disclose that I’m intersex before I get physically intimate with anybody because it’s not like I could fake being normal. . . . I’ve always resented that.” Caitlyn, who also has not had surgery, echoed this sentiment: “Being in sexual relationships with people, that was really hard. I didn’t have a positive relationship with my sexuality when I wasn’t being honest with the people I was sleeping with.” As I describe in the following section, these sexual struggles are dealt with in differ- ent ways.

RESPONDING TO SEXUAL STRUGGLES

Intersexuals in this study often employed one of three strategies to handle their sexual struggles: 1) avoid sexual intimacy; 2) seek out heterosexual encounters; or 3) reject medical- ization. Intersexuals were not confined to a particular strategy, although most chose one and never shifted from it.

The first strategy involved avoiding sexual intimacy, and is perhaps the most disheart- ening. Emily explained, “I don’t do intimacy very well. . . . Somewhere around 30 [years old] or so I decided to screw it. I might just

others either welcomed DSD language (9%) or reported being indifferent about the termi- nology (5%). They were usually not concerned with fitting into a sex binary that medical pro- fessionals believed could neatly be mapped onto gender and sexuality binaries; instead, they typically rejected it. Kimberly shared, “I love the term ‘intersex.’ For me, it really truly describes me. I am somewhere in between. I believe there’s a continuum; it’s not a dichot- omy.” While most who favorably viewed intersex terminology were in same- gender relation- ships, not all were. Several were, in fact, living in one gender, usually as women, while part- nered with a person of the “opposite” gender, usually men. For example, Leigh, a woman who identified as queer, was in a long-term committed relationship with a man. Jeanne, a woman who identified as bisexual, was also involved with a man. Similarly, Chris, a man who identified as asexual, was also partnered with an individual of the “opposite” gender before her untimely death. By rejecting the DSD nomenclature, some intersexuals are able to avoid the medical profession’s attempt to force their bodies into sex, gender, and sexual- ity categories assumed to be neatly biologically correlated.

IN SEARCH OF SEXUAL SATISFACTION

Regardless of surgical history and position on DSD terminology, all of the intersexuals I interviewed indicated some form of sexual anxiety about their “abnormal” bodies. Aimee, who has had surgery, expressed that even the very thought of a romantic relationship resulted in a “crippling effect of fear.” Mariela, who also has had surgery, commented, “I’m worried about falling in love and when to dis- close. . . . What if . . . he decides he doesn’t want to be with me anymore?” Stevie, who had surgery as a young child, explained how the

“ B R I N G I N G I N T E R S E X Y B AC K ” ? 21

looked to heterosexual encounters to normal- ize her body  and feel appropriately gendered. She shared:

I still have issues with the fact that I have AIS. . . . It’s not a debilitating sort of thing . . . but . . . I think about it frequently. . . . I don’t feel like I’m less of a woman or anything . . . but one thing I have noticed about me like sexually is that . . . I have something to prove. . . . I’m like . . . I’m a woman, damn it! . . . And I’m going to take care of business and . . . you’re gonna be like: . . . “That’s the best I ever had!” . . . . It’s like on some sort of subconscious level . . . I want to prove that I’m a woman and I can take care of this man’s needs.

When I asked Jenna to elaborate, she provided an example:

Let’s say that your orgasm is a 100 on a scale of 0 to 100. . . . For me, having my partner reach climax, which obviously with a dude it’s ridicu- lously easy . . . but having my partner climax is 95 out of 100. . . . It doesn’t make me . . . but the satisfaction I get from that . . . is almost as much as me orgasming . . . ’cause I’m like: FUCK YEAH! I DID THAT!!! THIS XY!! BA BAM! I’m not joking that’s how I am! . . . I’m like THAT’S WHAT I’M TALKING ABOUT!

Tara, Leigh, and Jenna all sought out hetero- sexual activity in order to normalize their inter- sex conditions. By engaging in heterosexual activity, they were able to feel, in Leigh’s words, “feminine.”

The third strategy involved rejecting medi- calization by holding onto intersex as an identity characteristic in the face of the new DSD nomen- clature. Caitlin described what the term “intersex” meant to her: “I feel very emotionally connected to that word because it really did change my life for the better. So kind of moving away from that word does definitely bring up some emotional response of like no! [Intersex] really empowered me.” Those who chose to employ this third strat- egy reached liberation without relying on others, something they wished everyone with intersex

not even bother anymore. . . . I’ll just be sin- gle. . . . That’s worked out better.” Marilyn, a 50-year-old woman, expressed something simi- lar: “I still haven’t had sex. . . . I haven’t had a date in the last 20 years. Not a single date.” Aimee also avoided intimacy, which even her therapist could not help her overcome. Aimee reported her therapist would say, “I don’t really know how to help you with this, other than to tell you: you need to just get out there and get some experience and get over it.” Avoid- ing sexual intimacy was a reliable response to sexual struggles because it offered intersexuals the ability to escape their fears of abnormal- ity. However, this strategy was limited because it left the sexual struggles avoided rather than confronted.

The second strategy of dealing with the sexual struggles associated with intersexual- ity centered on heterosexual encounters that served to validate one’s assigned sex (pre- sumed to be neatly biologically correlated with gender and sexuality). This strategy was encouraged by medical professionals who (as described earlier) urge intersexuals to romanti- cally partner with individuals of the “opposite” gender. In the eyes of medical profession- als, heterosexuality is the desired outcome of medical intervention. Individuals with intersex conditions often worry that they are “freaks” or “abnormal” because of their atypical sex anatomies. One way to overcome these feel- ings was to engage in sexual encounters with the “opposite” gender. Tara said, “I slept with a decent amount of guys that I . . . don’t think I should have, but I think it was the whole fact that I wanted to feel like a . . . a woman.” Leigh had a similar experience: “When I was a young adult . . . like 16 through . . . 20, I went through this period where I was trying to prove to myself that I was feminine and I just engaged in some risky sexual behaviors [with men]. I think that really interfered with my life, and left some lasting marks.” Jenna also

22 C AT EG O R I Z I N G S E X

think about it anymore.” Kimberly had a simi- lar experience:

Growing up, and dealing with being intersexed and ashamed and the secrecy, I was very asexual. I simply didn’t allow myself to have an orientation. I didn’t allow myself to be attracted to anybody. Now I can be, and I’m really enjoying it. I think [my female partner’s right], I never wore dresses before because I never felt I could pull them off. Now I feel like I can. I’ve got enough ego to really enjoy the body [laughing].

Rejecting the medicalization of intersexuality by rejecting the language of “disorder” resulted in a very real form of liberation that was often enforced by supportive friendship networks. Leigh expressed: “My friends have been incred- ibly supportive and really love me for this. One of my friends actually made me a T-shirt for my birthday one year that said, ‘She’s bringing intersexy back.’”

CONCLUSION

The sexual struggles associated with intersexu- ality need to be understood as part of a broader medicalization process and not just in rela- tion to surgical history. The danger of focus- ing exclusively on surgery is that it reduces the medicalization process to the operating room. Intersex genital surgery poses real problems for intersexuals, but it is not the only piece in the medicalization puzzle. While sexual strug- gles are common to people’s experience of intersexuality, some intersexuals minimized them by enacting one or more of three strat- egies: avoiding intimacy; seeking out hetero- sexual encounters; or rejecting medicalization by “bringing intersexy back.” If we accept that sex is something that everyone should be able to experience if they so desire, the first strat- egy seems to fall short. Many intersexuals who adopt this strategy do not voluntarily choose it. Instead, they feel it is the only option, given their sexual insecurities. The second strategy

conditions could experience. Consequently, they were critical of those who supported DSD termi- nology. Millarca explained:

These girls [who favor DSD] are in relationships because they’re trying to be normal. They don’t want to be different, but they are different and they can’t accept that. We’re different. You’re different, and I’m different. That’s where the turmoil lies . . . in trying to be something you’re not. If you can accept who you are, like I have, like other people have, what other people say don’t mean shit. You’re not trying to switch into some other box where you know damn well you can’t fit into.

The first step in this strategy’s process of over- coming sexual struggles involved embracing intersexuality while rejecting the search for normalcy.

Although Millarca was critical of those “trying to be normal,” she was also sympa- thetic. She hoped they would eventually come around. Many of those who hold onto inter- sex terminology spoke of sexual satisfaction as a process that began with information about the condition. Irene shared, “I grew up being heterosexual, and . . . I think I evolved as I found out my condition. I felt more in touch with both sides of how I feel and so I feel I’m somewhere in between.” Leigh, who earlier in her life had used the strategy of seeking out heterosexual encounters to minimize feelings of abnormality (the second strategy), decided in her twenties to embrace her intersexuality and reject the two-sex model. Although she remained interested in men, she now identi- fies as queer. This strategy reduced the sexual struggles she experienced as a teenager. Simi- larly, as a teenager, Ana adopted the first strat- egy of avoiding intimacy by burying “any hint of sexuality at all.” Now, as a partnered woman in her late thirties, she embraces her sexual- ity, and a more fluid one at that. She revealed, “I probably could have gone either way. But I probably decided at one point that women are for me and I’ll put my energy there and I won’t

“ B R I N G I N G I N T E R S E X Y B AC K ” ? 23

similar, I find it misleading to use majority and minority terminology in this context.

6. One intersexed individual out of the 37 noted here is a medical professional with an intersex condition.

7. Participant has indicated preference for this spelling of the chosen pseudonym. In an earlier publication, the pseudonym was spelled “Pigeon” (see Davis, 2011).

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Sampling: Problems and Techniques of Chain Referral Sampling.” Sociological Methodology 10:141–63.

Blackless, Melanie, Anthony Charuvastra, Amanda Derryck, Anne Fausto-Sterling, Karl Lauzanne, and Ellen Lee. 2000. “How Sexually Dimorphic Are We? Review and Synthesis.” American Journal of Human Biology 12:151–66.

Brown, Phil. 2007. Toxic Exposures: Contested Illnesses and the Environmental Health Movement. New York: Columbia University Press.

———. 1995. “Naming and Framing: The Social Construction of Diagnosis and Illness.” Journal of Health and Social Behavior, 35: 34–52.

———. 1990. “The Name Game: Towards a Sociology of Diagnosis.” The Journal of Mind and Behavior 11(3/4): 385–406.

Chase, Cheryl. 2002. “‘Cultural Practice’ or ‘Reconstructive Surgery’? U.S. Genital Cutting, the Intersex Movement, and Medical Double Standards.” In Stanlie M. James and Claire C. Robertson, eds., Genital Cutting and Transnational Sisterhood: Disputing U.S. Polemics. Chicago: University of Illinois Press. 126–51.

Committee on Genetics: Section on Endocrinology and Section on Urology. 2000. “Evaluation of the Newborn with Developmental Anomalies of the External Genitalia.” Pediatrics 106:138–42.

Conrad, Peter. 2007. The Medicalization of Society: On the Transformation of Society. Baltimore, MD: Johns Hopkins University Press.

Consortium on the Management of Disorders of Sex Development. 2006. “Clinical Guidelines for the Management of Disorders of Sex Development in Childhood.” Retrieved January 13, 2012 from www .accordalliance.org/dsd-guidelines.html.

Cooksey, Elizabeth C., and Phil Brown. 1998. “Spinning on Its Axes: DSM and the Social Construction of Psychiatric Diagnosis.” International Journal of Health Services 28(3):525–54.

Cools, Martine, Stenvert L. S. Drop, Katja P. Wolffen buttel, J. Wolter Oosterhuis, and Leendert H. J. Looijenga. 2006. “Germ Cell Tumors in the Intersex Gonad: Old Paths, New Directions, Moving Frontiers.” Endocrine Reviews 27(5):468–84.

is also inadequate in that it involves engaging in heterosexual encounters not for one’s own sexual pleasure, but for validation that one is appropriately gendered. Rather than eliminate insecurities, this strategy tended to create new ones. The third strategy seems to be the most liberatory. By rejecting the medicalization of intersexuality, and the pathologizing disorder of sex development terminology that goes along with it, intersexuals can begin to overcome their sexual anxieties in the search for sexual pleasure. Kimberly says it best:

There is a lot of freedom in living outside the rules. If you can make that switch into seeing the freedom, it’s really fabulous. . . . You get to really, truly, have an authentic experience that’s all your own, and you start seeing how being “normal” is so limiting.

NOTES 1. I use the language of “intersex” and “intersexuality” throughout this paper as opposed to “disorders of sex development” for three reasons. First, due to the greater visibility such words have had in academic publications over the newer terminology “disorders of sex development,” I felt it was necessary to continue to reach a broader audience. Second, recent publications in the medical sciences have, for the most part, abandoned “intersex” language despite the fact that not all individuals with such conditions prefer “disorders of sex development” terminology. Third, and the main reason for my choice in terminology, as an individual with an intersex condition, I prefer intersex language over DSD nomenclature.

2. Although we don’t have any reliable estimates that capture the frequency of intersexuality in the population, attempts at estimating the intersexed population have been made. Blackless et al. (2000), for example, have estimated that intersexuality appears in 1 in 100 births. However, Fausto-Sterling (2000a) offers a different estimate that ranges from 1 in 1,000 to 1 in 2,000. These different estimates warrant skepticism of any attempts to estimate the prevalence of intersexuality.

3. It should be noted that infertile heterosexuals are still understood as appropriately gendered.

4. Androgen Insensitivity Syndrome Support Group- USA was recently renamed AIS-DSD Support Group for Women and Families.

5. Since the numbers of individuals who supported DSD terminology and those who were against it were

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Lee, Peter A., Christopher P. Houk, S. Faisal Ahmed, and Ieuan A. Hughes. 2006. “Consensus Statement on Management of Intersex Disorders.” Pediatrics 118(2):488–500.

Preves, Sharon E. 2003. Intersex and Identity: The Contested Self. New Brunswick, NJ: Rutgers University Press.

———. 2002. “Sexing the Intersexed: An Analysis of Sociocultural Responses to Intersexuality.” Signs 27(2):523–56.

———. 2000. “Negotiating the Constraints of Gender Binarism: Intersexuals Challenge Gender Categorization.” Current Sociology 48(3):27–50.

Schilt, Kristen, and Laurel Westbrook. 2009. “Doing Gender, Doing Heteronormativity: ‘Gender Normals,’ Transgender People, and the Social Maintenance of Heterosexuality.” Gender & Society 23(4):440–64.

Serano, Julia. 2007. Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Emeryville, CA: Seal Press.

van der Zwan, Yvonne G., Nina Callens, Stenvert Drop, Martine Cools, Catharina Beerendonk, Katja P. Wolffenbuttel, and Arianne Dessens 2012. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC3313564/. “Do Surgical Interventions Influence Psychosexual and Cosmetic Outcomes in Women with Disorders of Sex Development?” ISRN Endocrinology.

Davis, Georgiann. 2011. “‘DSD Is a Perfectly Fine Term’: Reasserting Medical Authority through a Shift in Intersex Terminology.” In P. J. McGann and D. J. Hutson, eds., Sociology of Diagnosis. United Kingdom: Emerald. 155–82.

Dreger, Alice Domurat. 1998a. Hermaphrodites and the Medical Intervention of Sex. Cambridge, MA: Harvard University Press.

———. 1998b. “Ambiguous Sex—or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality.” Hastings Center Report 28(3):24–35.

Fausto-Sterling, Anne. 2000a. Sexing the Body: Gender Politics and the Construction of Sexuality. New York, NY: Basic Books.

———. 2000b. “The Five Sexes, Revisited.” The Sciences 40(4):18–23.

———. 1996. “How to Build a Man.” In Science and Homosexualities, ed. Vernon A. Rosario. New York: Routledge. 219–25.

———. 1993. “The Five Sexes: Why Male and Female Are Not Enough.” The Sciences 33(2):20–25.

Karkazis, Katrina. 2008. Fixing Sex: Intersex, Medical Authority, and Lived Experience. Durham, NC: Duke University Press.

Kessler, Suzanne J. 1998. Lessons from the Intersexed. New Brunswick, NJ: Rutgers University Press.

———. 1990. “The Medical Construction of Gender: Case Management of Intersexed Infants.” Signs 16(1):3–26.

Kitzinger, Celia. 2005. “Heteronormativity in Action: Reproducing the Heterosexual Nuclear Family in After- hours Medical Calls.” Social Problems 52(4): 477–98.

Köhler, Birgit, Eva Kleinemeier, Anke Lux, Olaf Hiort, Annette Gruters, Ute Thyen, and the DSD Network Working Group. 2012. “Satisfaction with Genital Surgery and Sexual Life of Adults with XY Disorders of Sex Development: Results from the German Clinical Evaluation Study.” Journal of Clinical Endocrinology & Metabolism 97(2): 577–88.

25

R E A D I N G 3

WHO ARE TRANS PEOPLE?

Every person has a gender identity—an inter- nal sense of self that we are aware of from a young age, which usually corresponds to the gender we are assigned at birth. You’ve proba- bly most often encountered the word transgen- der in reference to people who are assigned one gender at birth but who strongly identify and eventually go through a gender transition to live their daily lives as members of the “opposite” gender. Such a person may be a transgender woman (such as myself) who was assigned male at birth but lives and identifies as a woman, or a transgender man, who was assigned female at birth but lives and identi- fies as a man. When used in this way, the term transgender is roughly synonymous with the older term transsexual.

But “transgender” can also refer to a wide variety of people whose identities and self- expressions vary from gender norms. Transgen- der (used interchangeably in this essay with the abbreviated trans) can encompass identities that don’t fit the narrative of male-to-female or female-to-male transition. Many people iden- tify as genderqueer, meaning that they identify and express themselves in ways that mix or defy categories of male and female, but which feel simply authentic to them. Genderqueer indi- viduals “describe their gender identity as being a combination of female and male; as neither female nor male but as a different gender alto- gether; or as somewhere ‘in between’ female and male.”3 Some genderqueer folks prefer to use gender-neutral pronouns such as ze and hir.

Whether we identify as male, female, gen- derqueer, or something else, trans people

In the popular imagination, people who cross gender boundaries are rarely seen as happy, healthy people in satisfying sexual relationships. We are typically slotted into ste- reotypes such as asexual confidante, freaky fetish object, lonely tragic hero(ine), or con- niving deceiver. Think of films like The Crying Game, Boys Don’t Cry, All About My Mother, Transamerica, or even Hedwig and the Angry Inch. In reality, transgender people are as sexually diverse as anyone else, just as we are diverse in race, class, gender, age, and geog- raphy. In recent surveys, one-quarter to one- third of trans people identified themselves as gay or lesbian (transgender men who love men and transgender women who love women), and another one-quarter to one-third identified as heterosexual. A similar number of transgen- der people identified as bisexual, and the rest identified as “queer” or something else.1 Fifty percent of transgender people are partnered or married, according to a recent national sur- vey,2 and many others are single and happily sexually active. Transgender people practice monogamy, polyamory, abstinence, recrea- tional sex, kinky sex, and conventional sex. We have the same range of desires for intimacy, power, vulnerability, security, intense sensa- tions, orgasms, creativity, playfulness, and more. And we face the same sexual challenges: inhibition, difficulty communicating effec- tively, difficulty getting aroused or reaching orgasm, sexual trauma, and anxieties about our performance and our bodies. This essay explores how these desires and challenges are impacted by having an identity, a life experi- ence, and in many cases a body that does not conform to cultural expectations about gender.

THE PERILS AND PLEASURES OF SEX FOR TRANS PEOPLE

H A R P E R J E A N T O B I N

26 C AT EG O R I Z I N G S E X

or may not refer to as breasts, and may or may not like to have touched. He may have a hor- monally and perhaps also surgically enhanced phallus, smaller than most cisgender (i.e., non- transgender) men’s phalluses, but much larger than a cisgender woman’s clitoris. And he may have an orifice he refers to as a pussy, a front hole, a manhole, or any other terms, or he may prefer not to talk about that body part in such explicit ways.

Being trans can present some dating chal- lenges. If you are genderqueer, it can be uncom- fortable to explain to a potential date that you aren’t the girl or boy they think you look like. If you’ve transitioned to living as a gender dif- ferent from the one you were assigned at birth, there is no perfect moment on a date to tell someone that certain things about your body or your history aren’t what they might expect. Coming out as trans to a potential partner car- ries risks: encountering reactions of shock and disdain; being rejected by way of mockery and humiliation; being reduced to a freaky fetish object; and possibly even experiencing a violent reaction. Dating or hooking up with a trans or genderqueer person can inspire insecurities for some people about their own identities. Jakob Hero, a gay trans man, relates the dilemma this can present when one is the catalyst for such anxieties: “From my first interactions with gay men I have had to hold, comfort, and reassure them while they go through total cri- ses about my body. For the first few years after transition I was very open to them and to their struggles [regarding my body and gender his- tory], but eventually it took its toll.”5 I’ve heard a lot of stories like that—about lovers, dates, tricks, gay and straight, men and women, freaking out that they’re attracted to someone with an unexpected identity or body part. But as the statistics previously cited would suggest, many trans folks of all sexualities are happy and successful in their romantic partnerships and dating adventures, such as Bryn Kelly, a

often reshape our bodies to better reflect our internal sense of self. This can involve daily steps such as binding one’s chest to present a flatter appearance, as well as more permanent steps such as hormone therapy or surgery. A common misconception is that gender tran- sition equals genital reconstruction surgery. While genital reconstruction is essential for some people, genitals are not the end-all and be-all of gender. Some of us have arrived at this truth because we accept that the bodily changes we might want are out of reach, for financial or medical reasons. Some of us, tak- ing into account the limitations of current surgical techniques and the stress, pain, and risk of complications that accompany any major surgery, have simply not felt the need to take every possible medical step. According to national survey data, only about 20 percent of transsexual women have had some sort of genital surgery, and only about 5 percent of transsexual men have. While “top” surgery to achieve a flatter chest is the most common gender surgery for trans men, not all of them have that either.4

That means that most (though not all) trans people have bodies that, to varying degrees, differ from the norm. A trans woman like myself may have breasts that are curvy or com- pletely flat. She may still have the genitals she was born with, their size and function perhaps altered by estrogen and testosterone blockers. She may call that part of her body her clit, her cock, her ladystick, her girldick, her strapless (as opposed to strap-on), or any other term, or she may prefer not to refer to it explicitly. These variations in language reflect the basic fact that every person’s genitals develop from the same fetal anatomical structures; the penis and clitoris, labia and scrotum, are basically the same body parts to begin with. A trans man may have a surgically flattened chest or a fleshier one that has not been surgically altered, which he may or may not bind, may

T H E P E R I L S A N D P L E A S U R E S O F S E X F O R T R A N S P EO P L E 27

being trapped in the wrong body. For some trans people, this disconnect manifests as discomfort or ambivalence about certain parts of our bod- ies. The prospect of letting other people see and touch certain parts of our bodies, and receiv- ing and giving pleasure through them, can be frightening. Sometimes we fear that particular sexual activities would contradict our deepest sense of self, or even invalidate it.

For some of us, our anxiety is not so much about our own relationship with our bodies, as about whether another person will see, under- stand, and accept our bodies, our identities, and our desires. Sometimes we fear that seeing and interacting with our bodies will cause our lovers, our health care providers, or others in our lives to doubt or reject our identities—and, perhaps, to either reject us or reduce us to a sexual fetish. Or, we fear that others will desire us, or will truly see us as we see ourselves, only so long as our own desires don’t include sexual activities that they might deem inconsistent with our identities. We might have been told in the past that our iden- tities or desires are not valid, and we may have struggled not to internalize those messages. We may struggle to find a language to communicate to our partners how we see our bodies and our desires in a way that honors who we are.

We all have the right to sexual pleasure, regardless of our gender identity, our anatomy, or the steps we have or have not taken to out- wardly affirm that identity. Even if we expect to make (further) changes to our bodies to make them better reflect our identity at some point in the future, we shouldn’t have to wait that long to have a sexual relationship, or just a sexual fling. We deserve to have intimacy and pleasure with the bodies we have, right here, right now. To do that, we have to ask ourselves questions that anyone might ask, such as: What is it that I value or need sexually? Physical close- ness? Emotional intimacy? The opportunity to be vulnerable, or to experience my partner’s vulner- ability? The opportunity to take or to surrender

trans woman who wrote in an essay about her boyfriend:

I love how I can drag his ass to trans [events] and he is totally nonplussed. I love how he can be the only non-trans person in a room and not think there’s anything all that unusual. . . . I know that some peo- ple who know about my trans history might have a few questions about his sexuality but one thing I  love  about him is how he really has no problems with it. When I ask him, “Are you ever worried that people might think you’re gay?” He says, “Nah. Besides, there’s nothing wrong with being gay.”6

NAVIGATING BODIES AND IDENTITIES

Once trans people connect with a sexual partner—for a night or a lifetime—we have to figure out what to do together, and that is my main subject here. Many of us, trans and cisgender, struggle with cultural ideals about male and female bodies and beauty that our own bodies and gender expressions may not match—worrying whether your body is thin enough, pretty enough, hairless enough, nor- mal enough, ad nauseam, can be a real obsta- cle to intimacy. Many of us have sometimes felt that, as S. Bear Bergman writes, “There’s no part of me able to trust that this complicated body with all its speed bumps and dead ends will remain a viable route once someone is seri- ously considering setting off on it, when all the limitations are so visible.”7

Trans people frequently experience a gap between our innate sense of identity and the meanings inscribed on specific parts of our bod- ies. Our culture assigns gendered names and meanings to body parts. This body part, says our culture, is a penis—it is a male part, and it makes you a man. And this, it says, is a vulva—it is a female part, and it makes you a woman.8 The dis- connect many people feel between their gender identity and these cultural definitions assigned to body parts has been crudely described as

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just be a hot thing that we embrace.” Wanting to control or limit how we are sexually viewed or touched doesn’t have to be viewed as a hang- up to get over. On the contrary, embracing the kinds of sex that work for you, and clearly iden- tifying and letting go of the kinds that don’t, can be incredibly freeing.

For some of us, it’s not so much about whether or not our bodies are touched and stimulated, but how. Certain kinds of touch can feel affirming and others discordant. A  man may like to have his chest stroked and his nip- ples played with, but dislike having his chest cupped or squeezed like a woman’s breasts. A trans woman may not like to have her geni- tals directly touched by a partner, but may get off from grinding against a lover’s body, wear- ing a strap-on dildo, or stimulating herself while being anally penetrated. A genderqueer person might enjoy receiving oral sex, but dislike hav- ing hir genitals licked in a way ze associates with going down on a woman. Instead, ze may want hir partner to wrap her lips around hir dicklet (hir term for the body part that cisgender women call the clitoris) and suck it, more in the manner we associate with a blow job.

Talking about the acts we’re sharing with our partners in a way that reflects our own conception of our bodies and identities can also be essential to feeling connected to our identities. A friend of mine, a gay trans man, relates struggling in one of his past relation- ships to navigate sex acts he physically enjoyed in a way that allowed him to feel affirmed in his male identity. Notice the ways he reimagines and renames his sexual body in this struggle:

[O]ne of the many reasons why it didn’t work was totally different assumptions we came to sex with. I rarely [fucked my partner], because there wasn’t room for the communication and logistics required for me to strap-on without completely derailing the sex for him. . . . After I got naked with him (which was after we’d had what I consider sex many times), we almost exclusively had coitus. Coitus is easy,

control? To have or to give a partner orgasms? To feel affirmed as a man, a woman, masculine, feminine, beautiful, strong, dominant, submissive, boy, girl, or something else?

To those questions trans people must add an understanding of what stands between us and our desires. What is it about sex, or the prospect of sex, that is uncomfortable for me in the body I have? It may be engaging in particular acts that we tend to think of as male or female, masculine or feminine. It may be being unable to engage in particular physical acts we long for. For some, it is having a partner see, touch, talk about, or think about certain parts of their body. Or, it may be seeing, touching, talking, or thinking about certain parts of one’s own body, certain ways of being touched that feel better or worse, more discordant or “just right.” The answers are different for every trans person. Together with our partners, we figure out how to move away from the feelings and associations that make good sex difficult, and toward being our truest and most satisfied sexual selves. That means not only identifying sexual acts that do and don’t work for us, but also finding ways to approach and contextualize specific acts so that they feel right for us.

Some trans people prefer to focus their sex- ual energy on their partner’s body instead of their own. Driving one’s partner wild can, for many, be the most exciting and satisfying part of sex. Butch queer activist Koja Adeyoha— who prefers to mix gendered pronouns—spoke at a recent sexuality conference about iden- tifying as a stone butch, which s/he explained means that “I limit access to myself sexually and emotionally . . . and I express my desire through other people.” Bastien said that s/he used to struggle with this and experience it as “a really pathologized identity for me,” feel- ing that somehow s/he ought to want and be comfortable with his body being the center of sexual attention. But, s/he reflected, s/he and her partner ultimately realized that “this can

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I usually don’t like being seen naked or talking about my genitals explicitly—but when we are playing, it’s different. When I am in control of her, whatever I desire is okay and she is eager to give it to me. Penetrating her with my body, any part of my body, makes sense.10

Erotic role-play can also provide, for some, a space to enact scenarios that allow us to explore or affirm our identities. Genderqueer and mixed-race writer A. P. Andre, for example, writes about experimenting with gender roles during sex as a key part of

trying to figure out what genders I am or might be and also figure out my personal relationship to black masculinity. That’s been, at times, a scary process for me. So, when we’re having sex and I’m able to use the space to play with the male parts of my identity and to play with being a boy, it feels very safe for me. I really appreciate that, because I feel like it’s not a very safe world for the expression of black mascu- linity in any body. But in bed, in a sexual context [with partners I trust], I can go there with myself and see what it means to be masculine—well, I’m not a very masculine boy!—but see what it means to be a very femme-y boy, and have it celebrated and eroticized.11

We all have the right to define our identi- ties, and to choose and define the meanings of our sexual practices, rather than having them assigned based on any cultural script. Queer communities have effectively modeled and affirmed myriad combinations of masculinity/ femininity, male/female, active/passive, and pen- etrating/receiving. Plenty of cisgender women enjoy penetrating their partners, and plenty of cisgender men love being penetrated. This is demonstrated by many heterosexual couples who enjoy strap-on “pegging” (i.e., a woman penetrating her male partner with a strap-on dildo). From these increasingly commonplace insights, it also follows that if (for example) you identify, as a man, no one can tell you that any part of your body, or anything you choose to do with it, is not male. In this way, trans and

[but challenged my ability to feel seen as a gay man because] gay men didn’t have coitus. But all the same, I love [coitus], and I love it best when my part- ner tells me how good it feels to have my cock in his vagina, even though the physical reality is the oppo- site [i.e., that my partner is penetrating me]. That kind of mental play and flexibility requires imagi- nation and talking dirty to show everyone else how you’re imagining things[.]9

The “mental play and flexibility” and dirty talk my friend describes can make all the difference in bridging the apparent gap between body and identity—and between ambivalent sex and good sex. It can allow him to collaborate with his partner to feel confident and sexy putting on a strap-on cock, rather than to feel that his lack of typical male genitals was highlighted by the need to pause to put on a harness. Similarly, it can allow him to feel seen and affirmed in his maleness while enjoying being penetrated in a body part associated with femaleness.

For some trans folks, less common sexual practices such as BDSM (short for bond- age/discipline, dominance/submission, and sadomasochism) can provide spaces of erotic empowerment—a space in which top and bottom, dominant and submissive, or other erotic roles can be much more salient than gender. In BDSM communities, explicit and detailed sexual negotiation, including discuss- ing specific language in an encounter, is also more normalized, which can make hooking up with someone new a less intimidating pros- pect. Moreover, BDSM practices can involve intense erotic experiences that aren’t focused on genital sex, such as flogging, spanking, or temporary piercing—providing intense physi- cal excitement and release without genitals or orgasms even being involved.

A trans woman in a BDSM relationship with another woman shared the following:

My girlfriend is also my submissive. I love making her suck my cock—and that is the way we talk about it. I’m embarrassed by my body in so many ways.

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you exactly what works and doesn’t for them— or they may be in the process of figuring that out, in which case your asking helps give them permission to be unsure and to explore and fig- ure it out with you. Third, ask what words they use for their body parts. The right words can be huge turn-ons and the wrong ones huge turn- offs, and which is which is different for every- one. Just ask, “What do you call this part of you?”—then you can talk dirty with confidence. Again, your partner may still be figuring out what works for them, and you can help them do that by being flexible and open to trying dif- ferent terms and seeing how each one feels for them. Fourth, communicate your own desires. It takes (at least) two to connect, and while what you have in mind may not be the same, you won’t know if you don’t express it. Fifth, respect your partner’s boundaries. This is the basic obli- gation we owe all our sexual partners. We all have different boundaries, and they may fluc- tuate. Respecting them makes hot, connected sex possible. Finally, and critically, make space for creativity. The ways people can connect sexu- ally are virtually unlimited, and they aren’t—or don’t need to be—determined or limited by our identities. It may take negotiation and prac- tice to discover the places where your partner’s desires and boundaries can match up with your own. Although our sexual needs and desires are infinitely varied, the fundamentals of good sex are similar for everyone. For trans people—and indeed for everyone—sex can and should be a safe place where we can connect with, explore, and affirm ourselves and one another.

NOTES 1. J. M. Grant, L. A. Mottet, J. Tanis et al. 2011. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 29. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; Genny Beemyn and Susan Rankin. 2011. The Lives of Transgender People. New York, NY: Columbia University Press. 33–34.

2. Grant et al., Injustice at Every Turn.

genderqueer people strive to claim ownership of our bodies, resisting dominant cultural scripts, and refusing to acknowledge any incongruity or reason for shame in our bodies or our desires—a fine aspiration for anyone and everyone.

HOW TO HAVE SEX WITH A (TRANS) PERSON

In hir essay “Made Real,” Sassafras Lowrey observes that for trans and genderqueer people, sex can be a minefield, riddled with dangers—the danger of feeling divorced from our bodies, of being misperceived, and of being unable to real- ize our true desires. “Our minds,” Lowrey writes, are “so indoctrinated by narrow definitions of sex, we come to think it’s an act which can never include us.” At the same time, ze observes, sex can affirm who we are, make us feel whole and at home in ourselves. To be seen and to connect with someone as just who you truly are—a sweet boy, a strong woman, a beautiful gender-fluid person—can heal and strengthen. “Sex,” Lowrey writes, “gave me my body back.”12

As previously noted, sex can be complicated for everyone, and trans and genderqueer peo- ple are not so different from cisgender people in that regard. We all would benefit from more and better communication with our partners about the kinds of sex we want to have. For that reason, this essay concludes with some specific suggestions for sexual communication that may be particularly salient if one’s partner is trans, but which are applicable to—and would probably make for better sex with—anyone.

First, avoid relying on assumptions about your partner. Try not to assume what a person’s iden- tity is, what their body is like, what words they like to use for it, or what they like to do with it. These assumptions can limit your ability to truly see and connect with each other. Sec- ond, ask where and how your partner wants to be touched. This is more effective—and more fun— than trial and error. They may be able to tell

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9. Personal communication, October 2009.

10. Personal communication, October 2009.

11. A. P. Andre and Luis Gutierrez-Mock, “In Our Skin.” 2010. In Kate Bornstein and S. Bear Bergman (eds.). Gender Outlaws: The Next Generation. Berkeley, CA: Seal Press. 157, 159.

12. Sassafras Lowrey, “Made Real.” 2011. In Morty Diamond, ed., Trans/love: Radical Sex, Love & Relationships Beyond the Gender Binary. San Francisco: Manic D. Press. 96–97.

3. Genny Beemyn and Susan Rankin. 2011. The Lives of Transgender People, 147. New York, NY: Columbia University Press.

4. J. M. Grant, L. A. Mottet, J. Tanis et al. 2011. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 79. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

5. Jakob Hero, “Out of the Darkness.” 2011. In Morty Diamond, ed. Trans/love: Radical Sex, Love & Relationships Beyond the Gender Binary, 26, 27–28. San Francisco: Manic D. Press.

6. Brynn Kelly, “Fifty Reasons I Love My Man.” 2011. In Morty Diamond, ed. Trans/love: Radical Sex, Love & Relationships Beyond the Gender Binary, 60, 62–63. San Francisco: Manic D. Press.

7. S. Bear Bergman, “Gay Men, Queer Men, and Me.” 2009. In The Nearest Exit May Be Behind You: Essays. Vancouver: Arsenal Pulp Press. 164, 168.

8. On the social construction of gendered bodies, see generally Suzanne J. Kessler and Wendy McKenna. 1978. Gender: An Ethnomethodological Approach. University of Chicago Press; Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality. 2000. New York, NY: Basic Books. The Australian Family Court succinctly summarized the issue when it concluded, after a review of current medical science, that “[a]ttributing some kind of primacy to [a particular] aspect of the person [in determining a person’s gender] is not a medical conclusion. It is a social or legal one.” Kevin v. Att’y Gen. (Re Kevin), (2001) 165 Fam. L.R. 404, 463 (Austl.).

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sexuality. Well, you must have been gay the whole time, some might think, and because of some religious shame, you decided to lie to yourself and experiment with a girl. But that was nothing more than a blip in the road. After all, most kids experi- ment with heterosexuality in college, don’t they? If so, that “blip in the road” has always been a thorn in my flesh. How do I explain that I was honestly in love with a woman? Some people might argue that I am innately bisexual, with the capacity to love both women and men. But that doesn’t feel like an accurate description of my sexual history, either. I’m only speaking for myself here. But what feels most accurate to say is that I’m gay—but I wasn’t born this way.

In 1977, just over 10% of Americans thought gayness was something you were born with, according to Gallup. That number has steadily risen over time and is currently somewhere between 42% and 50%, depending on the poll. Throughout the same period, the num- ber of Americans who believe homosexuality is “due to someone’s upbringing/environment” fell from just under 60% to 37%. These ideas reached critical mass in pop culture, first with Lady Gaga’s 2011 Born This Way and one year later with Macklemore’s Same Love, the chorus of which has a gay person singing, “I can’t change even if I tried, even if I wanted to.” Videos started circulating on the internet featuring gay people asking straight people “when they chose to be straight.” Around the same time, the Human Rights Campaign

“You can’t be gay.” She was on top of me.

It wasn’t a command—it was a challenge. You so obviously cannot be gay, was her implication, because this is good sex. It was 2006, a full five years before Lady

Gaga would set the Born This Way argument atop its unassailable cultural perch, but even then, the popular understanding of [sexual] ori- entation was that it was something you were born with, something you couldn’t change. If you happened to engage in activity that ran counter to your sexual identity, then you had two options: you were lying to yourself and everyone else, or you were just experiment- ing. The sexual categories were rigid. Fixed. They weren’t subject to human imagination or experimentation—to the frustration of many sociologists, and kids, like myself, who found themselves inexplicably in bed with a player from the other team.

My sexual journey through college was any- thing but run-of-the-mill. I came out at a con- servative Christian college in the U.S. and was in a gay relationship for around two years with a basketball player who ended up marrying a woman. During that time, we both pal’d around with girls on the side. I even went so far as to fall in love with one. To this day, she and I joke about how she was the only girl I was ever in love with, and how I would’ve been quite happy marrying her. As a writer, this kind of compli- cated story is incredibly interesting to me— mostly because it shows that my own personal history resists the kind of easy classifications that have come to dominate discussions of

I AM GAY—BUT I WASN’ T BORN THIS WAY

B R A N D O N A M B R O S I N O

From “I am Gay—But I Wasn’t Born this Way,” BBC Future, 28 June 2016. Reprinted by permission.

I A M G AY— B U T I WA S N ’ T B O R N T H I S WAY 33

shared similar levels of belief in a Born This Way ideology.

As Samantha Allen notes at The Daily Beast, the growing public support for gays and lesbi- ans has grown out of proportion with the rise in the number of people who believe homosexual- ity is fixed at birth; it would be unlikely that this small change in opinion could explain the spike in support for gay marriage, for instance. Instead, she suggests it hinges on the fact that far more people are now personally acquainted with someone who is gay. In 1985, only 24% of American respondents said they had a gay friend, relative or co-worker—in 2013, that number was at 75%. “It doesn’t seem to matter as much whether or not people believe that gay people are born that way as it does that they simply know someone who is currently gay,” Allen concludes. In spite of these studies, those who push against Born This Way narratives have been heavily criticized by gay activists. “They tell me my own homo-negativity is being mani- fested in my work,” says Grzanka. Similarly, Ward has received her own hate mail for push- ing against the ruling LGB narratives. . . . And when I published my essay on choosing to be gay, an irate American lesbian activist wrote me that it had “just been confirmed” to her that my writing was “directly responsible for four gay deaths in Russia.”

While I can understand why some con- temporary activists (and the journalists who seem beholden to their agendas) might chalk up recent gains in LGB acceptance to Born This Way’s cultural infiltration, activism must be founded upon facts and truths, or the whole program will eventually turn out to be a sham. Drowning out every voice that dares to ques- tion dominant cultural narratives is not the same thing as invalidating the arguments those voices are making. As Ward says, “Just because an argument is politically expedient doesn’t make it true.” So what does the science say about Born This Way?

declared unequivocally that “being gay is not a choice,” and to claim that it is “gives unwar- ranted credence to roundly disproven practices such as conversion or reparative therapy.”

As Jane Ward notes in Not Gay: Sex Between Straight White Men, what’s interesting about many of these claims is how transparent their speakers are with their political motivations. “Such statements,” she writes, “infuse bio- logical accounts with an obligatory and nearly coercive force, suggesting that anyone who describes homosexual desire as a choice or social construction is playing into the hands of the enemy.” People who challenge the Born This Way narrative are often cast as homo- phobic, and their thinking is considered back- ward—even if they are themselves gay. Take, for example, Cynthia Nixon of Sex and the City fame. In a 2012 interview with New York Times Magazine, the actress casually mentioned that homosexuality was, for her, a choice. “I under- stand that for many people it’s not, but for me it’s a choice, and you don’t get to define my gayness for me.” The blogger John Aravosis was one of many critics who pounced on Nixon. “Every religious right hatemonger is now going to quote this woman every single time they want to deny us our civil rights.” Aravosis lev- eled the same accusations against me in 2014 when I wrote a piece for The New Republic dis- cussing my own complicated sexual history. Calling me “idiotic” and “patently absurd,” Aravosis wrote, “The gay haters at the religious right couldn’t have written it any better.” For Aravosis, and many gay activists like him, the public will only accept and affirm gay people if they think they were born gay. And yet the available research does not support this view. Patrick Grzanka, assistant professor of psy- chology at the University of Tennessee, for instance, has shown that some people who believe that homosexuality is innate still hold negative views of gays. In fact, the homophobic and non-homophobic respondents he studied

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anterior hypothalamus (INAH-3), is smaller in homosexual men than it is in heterosexual men. You can spot the problem with this study a mile away: were the gay brains LeVay studied born that way, or did they become that way? LeVay himself pointed this out to Discover magazine in 1994: “Since I looked at adult brains, we  don’t know if the differences I found were there at birth or if they appeared later.” Further, the brains LeVay studied belonged to AIDS victims, so he couldn’t even be sure if what he was seeing had something to do with the disease.

Another landmark paper on the origins of homosexuality was published in 1993 by a geneticist named Dean Hamer, who was inter- ested to learn whether homosexuality could be inherited. Beginning from his observation that there are more gay relatives on a mother’s side than a father’s, Hamer turned his atten- tion to the X chromosome (which is passed on by the mother). He then recruited 40 pairs of gay brothers and got to work. What he found was that 33 of those brothers shared matching DNA in the Xq28, a region in the X chromo- some. Hamer’s conclusion? He believes there’s about “99.5% certainty that there is a gene (or genes) in this area of the X chromosome that predisposes a male to become a heterosexual.” A 2015 study sought to confirm Hamer’s find- ings, this time with a much larger sample: 409 pairs of gay brothers. Researchers were pleased with their findings, which they claimed “support the existence of genes on . . . Xq28 influencing development of male sexual orien- tation.” But not everyone finds the results con- vincing, according to  Science. For one thing, the study relied on a technique called genetic linkage, which has been widely replaced by genome-wide association studies. It’s also note- worthy that Sanders himself urged his study to be viewed with a certain caution. “We don’t think genetics is the whole story,” he said. “It’s not.” And as Allen points out, there have also been studies that found no “X-linked gene

Let’s first be clear that whatever the origins of our sexual orientation, there is a unanimous opinion that gay “conversion therapy” should be rejected. These efforts are potentially harm- ful, according to the APA, “because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.” Little wonder these therapies have been shown to provoke anxiety, depression and even suicide. In other words, the question of the efficacy of conversion thera- pies is a non-issue. We condemn these efforts not just because we don’t think they work— perhaps anyone could be tortured into liking or disliking anything?—but because they’re immoral. The question of what leads to homo- sexuality in the first place, however, is obscure, even to the experts. The APA, for example, while noting that most people experience little to no choice over their orientations, says this of  homosexuality’s origins: “Although much research has examined the possible genetic, hormonal, developmental, social and cultural influences on sexual orientation, no findings have emerged that permit scientists to con- clude that sexual orientation is determined by any particular factor or factors.” Similarly, the American Psychiatric Association writes in a 2013 statement that while the causes of het- erosexuality and homosexuality are currently unknown, they are likely “multifactorial includ- ing biological and behavioral roots which may vary between different individuals and may even vary over time.”

True, various eye-grabbing headlines over the years have claimed that some scientists have found something like The Gay Gene. In 1991, for example, neuroscientist Simon LeVay published findings that he claimed suggest that “sexual orientation has a biological substrate.” According to LeVay’s research, a specific part of the brain, the third interstitial nucleus of the

I A M G AY— B U T I WA S N ’ T B O R N T H I S WAY 35

idea is still that these desires are innate and immutable—but this runs counter to what we know about human taste, says Ward. “Our desires are oriented and re-oriented based on our experiences throughout our lives.” In fact, the straight-identified men Ward studied for her book sometimes found themselves in situations that sparked the desire for homosexual sex: fra- ternities, deployments, public restrooms, etc. But Ward doesn’t conclude these are somehow repressed or latent gay men. Rather, she argues that they—like all of us—have come to desire bodies and genitals within specific social con- texts pregnant with “significant cultural and erotically charged meanings.” In other words, what they want isn’t the “raw fact” of a man’s body, but what it represents in a certain con- text. Why might we be uncomfortable asking whether and how much control we each pos- sess over our “full range of erotic possibilities,” as Ward calls it? “What would it mean to think about people’s capacity to cultivate their own sexual desires, in the same way we might culti- vate a taste for food?” she asks. Ward thinks this question is the next frontier of queer thought.

When I first said I chose to be gay, a queer American journalist challenged me to name the time and date of my choice. But this is an absurd way to look at desire. You might as well ask someone to name the exact moment they began liking Chaucer or disliking Hemingway. When did I begin to prefer lilies to roses? What time did the clock read at the exact moment I fell in love with my partner? All of our desires are continually being shaped throughout our lives, in the very specific contexts in which we discover and rehearse them.

Thinking back to my college romances with women and men, I can begin to understand how my own experiences might have helped me to cultivate my desire for homosexuality. I want to be very clear: I’m not claiming I sim- ply began to “grow into” my homosexuality, or that as I became more comfortable with being

underlying male homosexuality.” Perhaps pre- dictably, these studies haven’t received as much media coverage. Besides the individual cri- tiques leveled against each new study announc- ing some gay gene discovery, there are major methodological criticisms to make about the entire enterprise in general, as Grzanka points out: “If we look at the ravenous pursuit, par- ticularly among American scientists, to find a gay gene, what we see is that the conclusion has already been arrived at. All science is doing is waiting to find the proof.”

The other problem with Born This Way sci- ence is summed up nicely by Simon Copland: “Scientists are asking whether homosexuality is natural when we can’t even agree exactly what homosexuality is.” Grzanka agrees. “If you know anything about social constructionism, then you know these sexual categories are very recent. How then could they be rooted in our genome?” Our desires may express themselves in many different ways that do not all conform to existing notions of “gay,” “straight” or “bisex- ual.” This is one of the best takeaways of Ward’s Not Gay, a penetrating analysis of sex between straight white men. Gay men make up only a fraction of the U.S. population—yet Ward says that there are many men not included in that number who engage in homosexual behavior. Why, then, do some men who have sex with men identify as gay, and others identify as het- erosexual? This question interests her far more than “how were they born?” Ward stresses that not all straight-identifying men who have sex with men are bisexual or closeted, and we do a disservice if we force those words on them. That’s because terms like “heterosexual” and “straight” and “bisexual” and “gay” come with all sorts of cultural baggage attached. Crucially, she argues, “whether or not this baggage is appealing is a separate matter altogether from the appeal of homosexual or heterosexual sex.” Even if you accept that sexual desire may exist on a kind of spectrum, the predominant

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brains? For that matter, why play their game and pretend the only forms of difference that deserve justice are those we were born with? “That’s a very narrow understanding of what justice looks like,” says Ward. What about the concern that homophobes will want to “encour- age” gay people to be straight if there’s no bio- logical basis for sexuality? Let’s turn it around. Is it not equally true that “finding a gay gene” might inspire the same homophobes to “find a cure” for homosexuals? It doesn’t take too much creativity to imagine a scenario in which homophobic parents, upon being informed their fetus has “the gay gene,” choose what to them may seem the lesser of two evils: abortion.

Finally, I would argue that the Born This Way narrative can actively damage our per- ceptions of ourselves. In my sophomore year of college, I attended a Gay Student Alliance event at a nearby campus. It was the last meet- ing before Thanksgiving break, and the theme was coming out to your families. The idea was that the students would rehearse the coming- out speech that they’d deliver while they were home. Student after student, while sobbing hysterically, said something like this: “Mom, you see how much pain this is causing me! Of course I’d want to be straight if it were up to me. This is just who I am! You have to accept that because I can’t change that.” I wanted to grab each of them and say, “Being gay is not a handicap. It’s OK to be queer even if you choose to be queer—and you should want to be queer! Because we are beautiful and fabulous.” Ward sees this as a self-hating narrative. “Could you imagine if the dominant narrative of people of color was, ‘Well, of course I’d want to be white if I could. Wouldn’t everyone want to be white?’ That’s so racist! We’d never accept that story.”

Perhaps it is time to look to the beginning of the gay rights movement. “Queer Nation and earlier movements in the U.S. were not fundamentally organized around Born This Way explanations,” says Grzanka. “They were

gay, I allowed myself the freedom to express what had always been latent within me. I’m claiming that at some point during college, my sexual and romantic desires became reori- ented toward men. These desires suggested to me a queer identity, which I at first reluctantly accepted and then passionately embraced. This new identity in turn helped reinforce and grow new gay desires within me. Granted, none of this means that there were no genetic or pre- natal factors that went into the construction of my or any other sexual orientation. It just means that even if those factors exist, many more factors do too. So why not encourage conversations about those other things?

Humans aren’t who and what we are because of one gene. We’re who and what we are for a variety of reasons, and some of it might have something to do with how our genes randomly interact with our environments. But that’s not the whole story, and to engage in discourse that pre- tends it is—regardless of the nobility of the inten- tions—could have “profound and very negative consequences” for the LGBT community, says Grzanka. “Limiting our understanding of any complex human experience is always going to be worse than allowing it to be complicated,” he says.

So what are we to do with the Born This Way rhetoric? I would suggest that it’s time to build a more nuanced argument—regardless of how good a pop song the current one makes. There are several reasons for this. Firstly, and most importantly, it’s just not the truth, as we currently understand it. The evidence to date offers no consensus that the Born This Way argument is the beginning and end of the story. We should stop pretending that it does.

Secondly, the entire search for a gay gene is predicated upon the assumption that homo- sexuality is not the natural or “default” state of a developing human. “Something had to hap- pen to make that man gay!” But why cede such enormous ground to those who believe some- thing has “gone wrong” inside gay bodies and

third chose a number between one and five. . . . [T]he Generation Z findings don’t signal some evolutionary shift over the last 15 years. Rather, they show that the times—the “nurture” part of the nature/nurture dichotomy—are changing. Homosexuality isn’t considered taboo. Hetero- sexuality isn’t (always) considered the compul- sory norm. And importantly, each isn’t always constructed in opposition to the other.

I’m thankful for a new generation that is capable of imagining sexuality in a way that transcends the gay/straight binary, that couldn’t care less about what happened to their bodies and minds to make them who they are today. I’m hopeful that for this gen- eration, sexual histories like mine and Cynthia Nixon’s aren’t seen as threatening, but liberat- ing. I don’t think I was born gay. I don’t think I was born straight. I was born the way all of us are born: as a human being with a seem- ingly infinite capacity to announce myself, to re-announce myself, to try on new identities like spring raincoats, to play with limiting cat- egories, to challenge them and topple them, to cultivate my tastes and preferences, and, most importantly, to love and to receive love.

organized around sexual liberation, and the radi- cal notion of challenging heteronormativity.” Gay and lesbian activists, says Ward, used to draw on religion parallels to argue for inclusion. “People aren’t born with their religions. They’re born into religious cultures, and they can convert if they’d like. But there are still legal protections for them.” Eventually activists decided that argument wasn’t working fast enough, particularly in the shadow of the AIDS epidemic. “Then there was a shift, and the leaders of the movement chose to jump on board with a less nuanced argument that peo- ple already understood: just like race, people are born with their homosexuality.”

Fortunately, we have now made enormous strides in understanding and affirming our queer sexualities. Some experts have even started using categories like “mostly straight” and “mostly gay” to try and expand our limited ways of viewing human sexuality. A recent UK poll from J. Walter Thompson Innovation group found that only 48% of Generation Z (ages 18–24) identify as “100% heterosexual.” Respon- dents were asked to rate themselves on a scale from zero (which signified “completely straight”) to six (“completely homosexual”). More than a

Queer: Identity and Praxis

Maura Ryan

You’re probably familiar with the word queer being used as a catchall term for all gender and sexual minorities (GSMs), and it is often used for brevity in place of listing various LGBT iden- tities. Certainly, some of its appeal is that it can be used as an umbrella term that simply identi- fies an individual as not heterosexual rather than

tying them to a particular identity. But in addi- tion to being an umbrella term, queer also has its own specific social history, its own unique meaning, and a particular political stance.

The word queer was once only a slur the domi- nant society used to mock nonnormative sexu- alities and genders, which is why some LGBT

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and our own self-hatred. (We have been carefully taught to hate ourselves.) And now, of course, it means fighting a virus as well, and all those homo- haters who are using AIDS to wipe us off the face of the earth. Being queer means leading a different sort of life. It’s not about the mainstream, profit- margins, patriotism, patriarchy or being assimilated. It’s not about executive directors, privilege and elitism. It’s  about being on the margins, defining ourselves; it’s about gender-fuck and secrets, what’s beneath the belt and deep inside the heart; it’s about the night. (Anonymous Queers, 1990: 2)

According to Berlant and Freeman (1993), Queer Nation “always refuse[d] closeting strat- egies of assimilation and [went] for the broadest and most explicit assertion of presence.” Their demand to be acknowledged as part of the cul- ture is expressed in their most recognizable protest chant, “We’re here! We’re Queer! Get used to it!” They reject a “politics of respectabil- ity” that would be a faster avenue to legislative change; actually, they often reject legislative change altogether. As opposed to the liberal “add and stir” approach of asking for entry into institutions that have previously excluded them (e.g., marriage, military service), they follow a radical approach that problematizes those very institutions. While gay and lesbian activists would call for same-sex couples to be included in the institution of marriage, a queer politics would assert that marriage is a patriarchal institution by which the state regulates sexual- ity, relationships, and families. Queer activists would call for the rights associated with mar- riage to flow through other channels, work- ing on national health care and immigration reform rather than marriage equality.

These different perspectives on social change, one for equality and one for liberation, flow from different perspectives on identity. The main- stream liberal agenda for civil rights is influenced by an identity politics: Gay and lesbian identities are neatly and objectively defined, homophobia is the problem, and gay people deserve the same access as heterosexuals to society’s institutions.

people are still offended by the term. However, for a segment of this community, it became formally reclaimed and redefined following the onset of the AIDS epidemic in the late 1980s. The government was hostile toward the margin- alized communities affected, perceived at first to be only gay men, IV drug users, and sex workers. President Ronald Reagan eschewed discussion of HIV/AIDS while in office and his successor, President George H. W. Bush, remarked that the government had no business helping people who are in their predicament because of their immoral behaviors (Gould, 2009). Politicians, media pun- dits, and religious figures were either completely silent on the matter or celebratory about the deaths of social “misfits.” In short, “AIDS offered the wish fulfillment of a homicidal culture that knows fags have always been, and must always be, already dead” (Stanley, 2012: 159). Rather than allowing the government to rationalize its negligence with the narrative that gay promiscu- ity caused the outbreak of the illness, a radical direct-action organization called ACT UP (AIDS Coalition to Unleash Power) reasoned that it was homophobia itself that was responsible for what they called a genocide of gay people, and that the proper way to fight their inaction was to flaunt their nonconformity unapologetically. They wanted a word that was gender neutral—that could be used to describe gay men or lesbians— and that made it clear they were no longer play- ing nice. By 1990, this word that had been used against them—queer—now meant “to be righ- teously angry about homophobia and the AIDS crisis, politically militant, free of shame about nonnormative sexualities, and unconcerned about social acceptance” (Gould, 2009: 191). In fact, in 1990 the first specifically queer organiza- tion formed: Queer Nation. In their manifesto, “Queers Read This,” they defined queer this way:

Being queer is not about a right to privacy; it is about the freedom to be public, to just be who we are. It means every day fighting oppression: homophobia, racism, misogyny, the bigotry of religious hypocrites,

warps their ability to be true to themselves; queer discourse seeks to disrupt the false con- sciousness that human sexuality or gender can be understood within a binary.

But not all oppressive structures were equally critiqued in the formation of queer identity and politics. Cohen (1997) has argued that the early manifestation of queer politics lacked an intersectional analysis. White queer people created an us/them logic that saw all queers as oppressed and all heterosexuals as oppressing, with no context for how white supremacy, class status, or male privilege may insulate someone from queer oppression. It is an astounding testament to the power of privi- lege that white queer people did not see the problem with their righteous anger over het- eronormativity and their silence around how whiteness advantaged them. This is perhaps why some lesbian, gay, and bi people of color still associate queer identity with whiteness and a flawed idealistic radicalism. However, it is also important to note that some people of color see queerness as an ideal conceptual space for POC sexual and gender minorities.

In Ferguson’s (2003) call for a “queer of color critique,” he argues that queer people of color are ideally positioned to dissolve the oppres- sive pillars of white supremacy, capitalism, het- erosexism, and patriarchy because their lived experiences give them special insight into how power operates. Muñoz (1999) also argues this through his concept of disidentifications, that queers of color exist as racial and sexual outsid- ers who are especially positioned to go against the currents of our oppressive culture. Although it may not have been true for everyone who sub- scribed to queer identity in the early years of its usage, it is now an obvious and unarguable tenet of queerness that if sexual liberation and bodily autonomy are going to be realized, white supremacy and patriarchy have to fall, too.

Queer stands as the underbelly of every- thing enforced as a norm; it understands that

The queer radical agenda for cultural transfor- mation is influenced by a deconstructivist poli- tics: gender and sexuality are fluid and believed to be socially constructed labels; heteronorma- tivity (the structuring of social life around het- erosexuality and its mores, such as monogamy and gender conformity) is the problem, and all people deserve the right to sexual freedom (Gamson, 1995). According to Shepard (2001), this division between those who believe it’s best to assimilate to the dominant culture (the group he calls “the suits”) and those who believe full sexual liberation is the only objective (the group he calls “the sluts”) has always been present in modern LGBT communities, which in the United States is traceable back to the 1940s, but it was the rise of queer identity and queer politics that cemented this divide.

The queer politics has a “deconstructivist” aim; queer activists want to deconstruct what they believe is a meaningless social construct— the divide between heterosexual and homo- sexual and between man and woman. Queer offers a new way to conceive of desire that does not conform to the binary of straight and gay; it offers ways of being a person, dressing, and acting that cannot be boxed within the limited framework of man and woman. In fact, queer activists believe that these either/or binaries were only created to control people.

The discourses which particularly oppress all of us, lesbians, women, and homosexual men, are those discourses which take for granted that what founds society, any society, is heterosexuality. . . . These dis- courses of heterosexuality oppress us in the sense that they prevent us from speaking unless we speak in their terms. . . . These discourses deny us every possibility of creating our own categories. (Wittig, 1990: 53)

In this view, homosexual is a label created by the dominant group to mark a subordinate group. The very language people are given to describe themselves is a social control mechanism that

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diversity; it’s ending white supremacy and capi- talist exploitation. Queerness is about finding value in what is not valued and working to undo the harm of social oppression. It is about the possibility of a completely different way of life. The real value of queerness is its openness, that it is not supposed to be defined. Because it is nothing in particular, it is everything. Because it is not one central identity, it can be anything an individual wants it to be.

REFERENCES Anonymous Queers 1990. “Queers Read This.” Leaflet.

Retrieved from http://www.qrd.org/qrd/misc/text/queers .read.this.

Berlant, L., and E. Freeman. 1993. Queer Nationality. In M. Warner, ed., Fear of a Queer Planet: Queer Politics and Social Theory. Minneapolis: University of Minnesota Press. 213–46.

Cohen, C. J. 1997. “Punks, Bulldaggers, and Welfare Queens: The Radical Potential of Queer Politics?” GLQ: A Journal of Lesbian and Gay Studies, 3(4): 437–65.

Ferguson, R. 2003. Aberrations in Black: Toward a Queer of Color Critique. Minneapolis: University of Minnesota Press.

Gamson, J. 1995. “Must Identity Movements Self- destruct?: A Queer Dilemma.” Social Problems, 42(3): 390–407.

Gould, D. B. 2009. Moving Politics: Emotion and ACT UP’s Fight against AIDS. Chicago: University of Chicago Press.

Malachi. 2017. “Don’t Tell Me You’re Queer.” Retrieved from https://monomaniacism.com/2017/04/16/dont -tell-me-youre-queer/.

Mary Nardini Gang. 2014. Toward the Queerest Insurrection. Zine. Retrieved from https://theanarchistlibrary.org /library/mary-nardini-gang-toward-the-queerest -insurrection.

Muñoz, J. E. 1999. Disidentifications: Queers of Color and the Performance of Politics. Vol. 2. Minneapolis: University of Minnesota Press.

Shepard, B. H. 2001. “The Queer/Gay Assimilationist Split: The Suits vs. the Sluts.” Monthly Review, 53(1): 49–62.

Spade, D. 2010. “It’s So Queer to Give Away Money.” Tikkun, 25(4): 63–74.

Stanley, E.A. 2012. “Slow Boil.” In M. B. Sycamore, ed., Why Are Faggots So Afraid of Faggots?: Flaming Challenges to Masculinity, Objectification, and the Desire to Conform. Oakland, CA: AK Press. 157–61.

Wittig, M. 1990. “Homo sum.” Gender Issues, 10(1): 3–11.

sexual liberation requires a cultural overhaul of every shame-inducing tenet of idealized social behavior. In their zine Toward the Queer- est Insurrection, the Mary Nardini Gang writes, “Queer is the cohesion of everything in conflict with the heterosexual capitalist world. Queer is a total rejection of the regime of the Normal” (2014: 3). Perhaps most straightforwardly, it could be said that queerness is about reverence for difference. As Dean Spade has said:

We have long critiqued powerful shame-inducing norms about sexual practices, family structures, appearance, and behavior. We have celebrated sexual desires, gender expressions, and relationships that are marked as abnormal, criminal, or pathological by our cultures. We have done this despite disapproval from our families, vulnerability, and significant loss of security. We have felt the excitement of entering a queer space where we can see ways of life that are hidden or despised played up and celebrated, where we can exist for a moment in an alternative world, in which the most beautiful people are those reach- ing most daringly away from norms, even mocking them. (Spade, 2010: Para. 8)

It is in this revolutionary valuing of differ- ence that queerness creates an alternative universe, one that encompasses new ways of loving and creating social networks. As Malachi (2017) said:

Queer is asking permission of our lovers, and not ask- ing forgiveness for the ways we don’t fit in. Queer- ness is thinking about the space we occupy and how we  move through it because we have had so little space in our own lives and refuse to contribute to minimizing the space of others. Queerness is assum- ing our friends and lovers have been hurt, because we have been hurt, and know what it feels like when people assume we haven’t. Queerness is wanting to know the wounds before we reach them, instead of apologizing after for reopening them. (Para. 4)

For many, queer identity has become synon- ymous with a radical political agenda. It is not just exploring the potential of sexual and gender

41

R E A D I N G 5

M ainstream understandings of hetero-sexuality emphasize that straight men’s attractions, behaviors, and desires should be oriented exclusively toward women, and yet research indicates that some straight- identified men have sex with other men. There are multiple reasons why some men who have sex with men (MSM) identify as straight, incl- uding internalized heterosexism, participation in other-sex marriage and child rearing, and enjoyment of straight privilege and culture (Ward 2015). Few interview-based studies of straight MSM exist, and previous studies focus on urban, military, or prison contexts. . . . Addi- tionally, there is a widespread urban focus in sexualities and gender literatures (Halberstam 2005), which obscures the role of geography in the construction, maintenance, perception, and experience of gender and sexuality. . . . [T]his study is one of the first to examine how straight MSM themselves understand their own gen- ders and sexualities, and how rurality affects these perceptions.

How do rural, white, straight MSM unde- rstand  their gender? Through complex inter- pretive processes, participants reworked non-normative sexual practices usually anti- thetical to rural masculinities to actually con- struct normative masculinity. Participants selected male sexual partners on the basis of masculinity, race, and sexual identity. Most chose other masculine, white, and straight or secretly bisexual men for secretive sex with- out romantic involvement. By choosing these partners and having this type of sex, the par- ticipants normalized and authenticated their

sexual encounters as straight and normatively masculine. The married men framed sex with men as less threatening to their marriages than extramarital sex with women, helping to pre- serve a part of their lives that most described as central to their straightness.

Rather than referring to participants as MSM, a public health term, I describe them as guys who engage in bud-sex. I use “bud-sex” when referring to the participants’ sexual activi- ties and “MSM” when referring to broader pop- ulations of straight men that have sex with men.1 Similar sexual practices carry different mean- ings across populations and contexts, including among different groups of MSM. Ward (2015) examines dude-sex, a type of male–male sex that white, masculine, straight men in urban or military contexts frame as a way to bond and build masculinity with other, similar “bros.” Carrillo and Hoffman (2016) refer to their pri- marily urban participants as heteroflexible, given that they were exclusively or primarily attracted to women. While the participants in this study share overlap with those groups, they also frame their same-sex sex in subtly different ways: not as an opportunity to bond with urban “bros,” and only sometimes—but not always—as a novel sexual pursuit, given that they had sexual attractions all across the spectrum. Instead, as Silva (forthcoming) explores, the participants reinforced their straightness through unconven- tional interpretations of same-sex sex: as “helpin’

BUD-SEX: CONSTRUCTING NORMATIVE MASCULINITY AMONG RURAL STRAIGHT MEN THAT HAVE SEX WITH MEN

T O N Y S I LVA

From “Bud-Sex: Constructing Normative Masculinity among Rural Straight Men That Have Sex with Men,” Gender & Society 31(1), pp. 51–73. Copyright © 2017 by the Author. Reprinted by permission of SAGE Publications, Ltd.

42 C AT EG O R I Z I N G S E X

tions (Adam 2000). In addition, stereotypical views of sexual identities (e.g., lesbian women are butch) may affect the one that individuals adopt (Kitzinger and Wilkinson 1995). Sexual identities reflect culture, time period, social structures, and personal interpretations.

Despite increasing acceptance of same-sex sexuality, hegemonic masculinity remains dis- tinctly heterosexual (Connell 1987). Homopho- bia is often a key aspect of normative masculinity (Kimmel 1994), and from a young age: Pas- coe (2011) explores how boys utilize a “fag discourse” to regulate the masculinity and heterosexuality of peers. Similarly, many mea- sures of normative masculinity—such as sup- port for all-male institutions—are related to homophobia (Britton 1990). The relationship between heterosexuality and normative mas- culinity remains, even as overt homophobia has lessened in many contexts (Anderson 2008; Bridges 2014; Connell 2005; Dean 2014; McCormack 2013). . . . “[N]ormative masculin- ity” in this [reading] refers to gender practices that eschew femininity and reinforce white, straight, male, and masculine (i.e., nonfemi- nine) dominance. Because rural spaces in dif- ferent regions (e.g., rural Alabama vs. rural Québec) are distinct and will consequently develop unique masculinities in those spaces, this [reading] specifically examines normative masculinity in U.S.-based rural regions in the Midwest and Pacific Northwest—areas that share social conservatism and demographic white majorities (Bump 2014; United States Census Bureau 2016).

INTERSECTIONS OF RURAL MASCULINITIES AND SEXUALITIES

. . . “Rural masculinity” refers to masculinity as it is “constructed within what rural social scientists would recognize as rural spaces and sites” (Campbell and Bell 2000, 540). Rural masculinities differ based on local context as

a buddy out,” relieving “urges,” acting on sexual desires for men without sexual attractions to them, relieving general sexual needs, and/or a way to act on sexual attractions. “Bud-sex” cap- tures these interpretations, as well as how the participants had sex and with whom they part- nered. The specific type of sex the participants had with other men—bud-sex—cemented their rural masculinity and heterosexuality, and dis- tinguishes them from other MSM. . . .

THE SOCIAL CONSTRUCTION OF SEXUALITY

How individuals understand and experience sexuality is profoundly social: scripts (Simon and Gagnon 1986), discourses (Foucault 1978), and interactions between individuals (Plum- mer 1996) and among structures, agency, and practice (Stein 1989) all inform perceptions of sexuality and the forms sexualities take. Cul- tural norms about what sexual practices are acceptable, their significance, their relation to identity, and even what practices are considered sexual are all socially constructed (Foucault 1978). Identification based on sexual behavior emerged only in the late nineteenth century (Chauncey 1994; Foucault 1978). As Sedgwick (1990) explains, defining individuals in this way is only one of many ways sexual identities could potentially operate. Sexual identities are socially constructed and differ by culture and time period (Katz 1995), and often these identities cannot fully describe complex combinations of sexual practices, attractions, and desires. Relat- edly, the relationship between sexual identity and gender practices differs between cultures and time periods. . . . Within the United States, individuals with similar sexual attractions may adopt different sexual identities because of a differing emphasis placed on sexual attractions and current sexual behaviors (Rust 1992) or the presence—or lack thereof—of emotional attrac-

B U D -S E X 43

I used an interview guide. Inquiries included the following: Describe yourself in terms of masculinity and femininity. How has [growing up/living in] a rural area affected how you see yourself in terms of [masculinity/femininity]? Describe the kind of guy you prefer to meet up with. Do you view sex with men outside of your [marriage/partnership] as cheating, and why or why not? Walk me through the last time you met up with another guy for action. In what ways was this encounter typical or not typical of other encounters you’ve had? I reordered and rephrased questions to make the interview less formal, which allowed me to follow up on leads. Interviews lasted approximately one-and-a-half hours. . . .

All the participants live in Missouri, Illi- nois, Oregon, Washington, or Idaho; these rural spaces share similarities by virtue of their social conservatism and predominant white populations (Bump 2014; United States Cen- sus Bureau 2016). All but two participants cur- rently live in, or were raised in, a rural area. Thirteen currently live in a rural area, and 15 were raised in rural areas. By rural, I refer to an area with fewer than 25,000 residents. The only two exceptions were participants who were raised in urban areas but currently live in what I term semirural areas: cities with 25,000–60,000 residents in isolated areas of the Pacific North- west. All the participants are white, challeng- ing the perception of straight MSM as urban blacks on the “down low” (Ward 2015). They are skewed toward older ages with the majority over 50: 20s (1), 30s (3), 40s (1), 50s (6), 60s (6), and 70s (2). The participants have a variety of educational and occupational backgrounds, but most are middle class. One reported a doc- torate as his highest degree, five a master’s, three a bachelor’s, five an associate’s, two some college, and three high school. . . . [T]he sample has considerable diversity in sexual attraction. Further, although all tell others they identify as straight, 17 actually identify as straight or some

well as intersections of social identities, and central to many of them are physical labor and toughness (Morris 2008; Kazyak 2012). The strong link between heterosexuality and masculinity is especially evident in rural areas, which are often more conservative than urban locales (Bump 2014). Rural men are likelier than urban men to engage in unsafe behav- iors, and intersections with non-normative sexualities can exacerbate these dangers (Courtenay 2006). For rural men with mar- ginalized sexualities, normative rural mas- culinity is particularly important because it provides them a degree of social acceptance (Boulden 2001; Fellows 2001). Many rural gay men even distance themselves from feminine gay men and point out their similarities with (purportedly masculine) straight men (Annes and Redlin 2012). Relatedly, in her interview study of rural Midwestern gays and lesbians, Kazyak (2012) found that gay men had little flexibility in gender practices; they either per- formed conventional rural masculinities or were rejected by their community. Research on rural queer youth (Gray 2009) and rural trans men (Abelson 2014) indicates that challenging gender norms often leads to fear of physical harm, encouraging gender normativity. . . .

METHODS

I posted advertisements in several men-for-men casual encounters sections of Craigslist, which is organized regionally. Unlike most other apps/websites, Craigslist is widely used, anony- mous, free, and frequented by individuals with a variety of sexual identities. I also included project information on Grindr, an app catering to gay and bisexual men, which recruited two participants. Of the approximately 100 men who inquired about participation, 19 agreed to participate: 15 over the phone and four in per- son. This study utilizes phone/in-person semi- structured interviews. During each interview,

44 C AT EG O R I Z I N G S E X

variation thereof, one as gay, and one as bisex- ual. Thus, while all are secretive about their same-sex sex, only two are “closeted” in terms of sexual identity, as only two identify as gay or bisexual but tell others they identify as straight.

CONSTRUCTING BUD-SEX

“Strictly Masculine”: Average, Rural, Masculine Guys . . . The men’s gender self-descriptions largely conform to conventional understandings of masculinity. Brad (48) is a “T-shirt and Levi kind of guy” who is “straight-acting [and] masculine.” Jon (39) is “pretty much masculine” because “I’m a . . . straight guy that likes to hunt, fish, camp, and I raise cattle for a living.” Jack (52) shared similar sentiments: “The things I do, interests, all masculine. I like to shoot, I like to hunt. . . .” Cain (50) explained, “My de meanor may be more gentleman-like than . . . the rug- ged cowboy type,” but described himself as hav- ing “a type A personality” with the potential to “be kind of aggressive.” Similarly, David (74) is an “alpha male” who enjoys shooting and fish- ing. Richard (75) described himself “as mascu- line as John Wayne; I’m definitely not feminine in any way, shape, or form.” Kevin (69) noted, “I’ve always done blue-collar type work, I live in a rural area, I’m a farmer.” Will (52) leans “a lot toward masculine,” because “I can clean a deer . . . I can catch some fish . . . and I’m a very good handyman,” while Billy (59) enjoys “trudgin’ in the wilderness, cuttin’ firewood and throwin’ logs.”. . .

The participants’ rural locations played a large role in their self-descriptions as mascu- line. Eleven described themselves using ele- ments of rurality, such as hobbies (hunting, fishing, shooting, cutting firewood), occupa- tions (farming, ranching), ways of dressing (camo, T-shirts, and Levi’s jeans), or images of rugged rurality (John Wayne). Another used

rural tropes (rugged cowboys) as a comparison to his own masculinity. Central to the men’s self-understanding is their rural background; they perform a rural masculinity, which they seek to reaffirm through their same-sex sexual encounters. . . .

“Guys Like Me”: Partnering with Other Masculine, White, Non-Gay Men The participants overwhelmingly preferred to have sex with men like themselves: masculine, white, and not gay—straight or secretly bisex- ual. This is a key element of bud-sex. Partnering with other men similarly privileged on several intersecting axes—gender, race, and sexual identity—allowed the participants to normal- ize and authenticate their sexual experiences as normatively masculine, as Ward (2015) also describes. . . .

Seventeen participants—all of those who identify as straight—stated that they prefer mas- culine male sexual partners, and each explained that the majority of their male sexual partners are masculine. Masculinity in sexual partners helped construct and validate their own nor- mative masculinity. The straight participants often equated masculinity with non-gayness (heterosexuality or secretive bisexuality) or nor- mality. As Cain said, “I’m really not drawn to what I would consider really effeminate faggot type[s],” but he does “like the masculine look- ing guy who maybe is more bi.” Similarly, Matt (60) explained, “If they’re too flamboyant they just turn me off,” and Jack noted, “Femininity in a man is a turn off.” Ryan (60) explained, “I’m not comfortable around femme” and “masculin- ity is what attracts me,” while David shared that “femme guys don’t do anything for me at all, in fact actually I don’t care for ’em.” Jon shared, “I don’t really like flamin’ queers.” Mike (50) simi- larly said, “I don’t want the effeminate ones. I want the manly guys. . . . If I wanted someone that acts girlish, I got a wife at home.”. . .

B U D -S E X 45

or bisexual men did so because of perceived greater compatibility and greater confidence in discreetness. As Jeff stated, he is “basically seeking the same” kind of guy as himself. . . . Marcus feels more comfortable with straight or bisexual men because he dislikes a “gay vibe,” reinforcing how social factors such as culture affect sexual desires. Similarly, Tom noted choosing a bisexual man as his ideal male sex- ual partner because he would “kinda be closer in tune to what I am.” Joe would also choose a bisexual man “because he would be of the same mind that I am. He would understand what I’m feeling, and would respond probably similarly. So we could engage with common knowledge.” Jack noted, “He would be in the same boat as me. He would be straight, preferably married or definitely partnered up with a female, with one thing on his mind, getting his rocks off with me. . . . They’re not gonna out me.”. . .

That a majority of 13 straight participants’ male sexual partners are straight or secretly bisexual, despite bountiful opportunities for sex with gay and openly bisexual men on Craigslist, indicates that partnering with non-gay men is a strategy to reaffirm their own normatively masculine sense of self. It also reflects that the sexual meanings attributed to encounters are socially produced; while many gay men are also masculine and enjoy romance-free sex, most of the participants view straight or secretly bisexual partners as more desirable because of the link between normativity and non-gayness. Given the centrality of heterosexuality to nor- mative rural masculinity, the participants were able to align themselves closer to both by select- ing straight and secretly bisexual male sexual partners. While most expressed frustration about the difficulty of finding sexual partners in rural areas, they nonetheless mostly chose men who are masculine, white, and straight or secretly bisexual, underscoring the importance of these characteristics for their normative masculinity and bud-sex.

The four participants who reported exclusive sexual attractions to women also stated a pref- erence for normatively masculine male sexual partners, revealing the social origins of their attractions. . . . Like Jeff, Marcus finds norma- tive straight, masculine men like himself bet- ter sex partners than feminine and/or gay men. Echoing Mike, Richard stated, “Given a choice I prefer masculine; I don’t want a substitute woman,” and Joe (63) shared, “Feminine guys don’t interest me at all.” Preferences for mas- culine men both validate the participants’ own normative masculinity and reveal the socially constructed nature of sexual desires.

Similarly, the vast majority of the past and present male sexual partners of 16 participants— all except Reuben, Tom (59), and Mark—are white. Unlike many urban straight MSM who fetishize interracial sex, as Robinson and Vidal- Ortiz (2013) found with the largest proportion of their sample and Ward (2015) found with a sizable minority, the participants in this study fetishized whiteness. For most of the straight participants, racial sameness was a strategy to align themselves with normativity and, in so doing, to construct normative masculinity. Thus, whiteness is central to bud-sex, which reinforces the participants’ straightness and normative rural masculinity. Twelve participants stated that they prefer white male sexual partners, and four others explained their mostly white sexual his- tory as happenstance. When explaining why he prefers white men, Kevin noted, “I guess because I’m white and, I guess you’d say more normal for me to be with white guys.”. . .

Of the 17 straight participants, nine reported preferences for straight or bisexual men and 13 noted that a majority of their sexual part- ners are straight, bisexual, and/or married to a woman. Their partners’ not-gay sexual identities—straight or secretly bisexual—are an important component of the men’s nor- mative masculinity. . . . Many of the straight participants who noted preferences for straight

46 C AT EG O R I Z I N G S E X

that each attempt to find a new sexual partner opens the participants to potential discovery in a small pool of acquaintances.

While relationships with regulars were free of romance and deep emotional ties, they were not necessarily devoid of feeling; participants enjoyed regulars for multiple reasons: conve- nience, comfort, sexual compatibility, or even friendship. Pat described a typical meetup with his regular: “We talk for an hour or so, over coffee . . . then we’ll go get a blow job and then, part our ways.” Similarly, Richard noted, “Sex is a very small part of our relationship. It’s more friends, we discuss politics . . . all sorts of shit.” Likewise, with several of his regulars, Billy noted, “I go on road trips, drink beer, go down to the city [to] look at chicks, go out and eat, shoot pool, I got one friend I hike with. It normally leads to sex, but we go out and do activities other than we meet and suck.” While Kevin noted that his regular relationship “has no emotional con- nection at all,” it also has a friendship-like quality, as evidenced by occasional visits and sleepovers despite almost 100 miles of distance. . . .

No Big Deal: Extramarital Same-Sex Sex For the 17 straight participants, a key aspect of their straightness was marriage and/or child rearing. Each currently married man indicated a desire to stay married. As they explained, sex with men either does not constitute cheating or is less threatening to their marriage than extra- marital sex with women, because it is devoid of deep emotional ties. Sex with women is far more threatening to marriage, as this breaks vows and/or has the potential to involve emo- tional attachment. As Tom explained, “Being romantic and emotional is more cheating than just havin’ sex.” Similarly, Cain shared, “I’m not cheating on my wife. I don’t have the intention of leaving her.” Kevin echoed this: “Meetin’ up with women would be cheating on my wife. And when I meet up with guys, I justify it by sayin’

Secretive and Nonromantic: Ingredients for Bud-Sex . . . [T]he participants preferred secretive, nonromantic same-sex sex, key ingredients of bud-sex. They did not necessarily prefer one- time meet-ups, however; their histories with “regular” male sexual partners indicate they appreciate the benefits of a sexual friendship. Departing from content analyses, data indicate that relationships with sexual partners are not necessarily emotionless, but are rather nonroman- tic. Further, like Robinson and Vidal-Ortiz’s (2013) findings, the participants had a wide range of sexual preferences—all had either oral or anal sex (or both). Few, however, tied spe- cific sex acts with masculinity or straightness. For these men, what was paramount to their masculinity was not what they did sexually, but how they did it. All 19 participants described the need for sexual encounters to be secretive, and this secrecy was tied to rurality. Rurality had both its advantages and drawbacks. On one hand, vast expanses of unpopulated land meant participants could easily find places to have secretive sex. On the other, community interconnectedness necessitated increased caution. As Pat said, “[I]n a small town every- one knows more about your business than you do. . . . I suppose in the city you don’t have to be discreet. But here in [a] small rural area, yes, you’ve gotta be discreet.” . . . The absence of romance reframed encounters as normatively masculine and compatible with straightness. Even while avoiding romantic attachments, 13 participants currently have regulars, three others had regulars in the past, and two others would like one or are open to it. While most are open to one-time hookups, most also prefer regulars. By doing so, they reinforce their masculinity by seeking consis- tent partners on the same page about what sex between straight guys should constitute. This is especially important in rural areas, given

B U D -S E X 47

ful for my wife to have sex, I have no problem taking care of myself with another guy.” Simi- larly, David explained, “I’m not getting sex at home, and I want sex,” and “older men are a lot more receptive to sex; they’re more enthu- siastic,” because “senior women have kinda lost their desire to do much of anything.” Two others began having sex with men because of erectile dysfunction, which limited their ability to pen- etrate. As Tom described, “I’m a straight guy that has ED and doesn’t want to give up havin’ sex.” Turning to sex with men or increasing the relative frequency of sex with men was a way for each to maintain their sex lives and masculinity despite bodily changes related to aging. . . .

CONCLUSION

The results demonstrate that some rural straight men who have same-sex sex construct norma- tive masculinity through their choice of sexual partners on the axes of masculinity, race, and sexual identity, as well as through the type of sex they prefer. By having sex mostly with other privileged men—conventionally masculine, white, and not gay—and by enjoying secretive and romance-free same-sex sex, the participants framed their encounters as straight and norma- tively masculine. Through complex interpretive processes, they reframed same-sex sex, usually antithetical to rural masculinities, such that it actually helped them construct normative rural masculinity. The type of same-sex sex they have is distinguishable from that of other groups of MSM: bud-sex captures their unique sexual interpretations (Silva, forthcoming), as well as their partnering preferences and the type of sex they have, and it helps construct their norma- tive masculinity and straightness. The concept of bud-sex helps clarify that similar sex practices have different meanings across contexts and populations. Non-normative sexual practices— same-sex sex—can actually be used to reinforce normative masculinity and straightness. The

‘well it’s only fun between me and the other guy, it’s not like I have another woman. . . . ’ I’m sure she or other people would argue [with] that, but that’s just the way I feel.”

For the currently married straight men, their perceptions of their extramarital same-sex sex bolster their normative masculinity: sex with men is simply a way for them to fulfill sexual desires without affecting any other part of their lives. Four framed sex with men as not cheating in part because they no longer had sex with their wives. . . . [B]y framing same-sex extramarital sex as insignificant, the men interpret their sex- ual practices in ways that make them compat- ible with the marriages that are central to their heterosexuality and normative rural masculinity.

Aging: Not Ready to Give Up Sex Age affected the participants’ interpretations of their sexuality and gender, both because of gen- erational dynamics and aging itself. Fourteen participants are 50 or older and internalized het- eronormativity and strict masculine norms dur- ing some of the most difficult decades to express sexual or gender non-normativity (Seidman 2002). This, combined with the lack of visibility of non-normative sexualities and gender expres- sions in most rural areas in the 1950s–1980s, shaped the participants’ relationship with mas- culinity and straightness. As Kevin shared, “I grew up in an area where that [being gay/ bisexual] wasn’t an option, in a time and area both,” and Jack noted, “Back in the day when I was growing up, it was absolutely not accepted.”

Additionally, sex with men helped nine participants bolster their masculinity, despite the fact that they or their wives were experi- encing age-related bodily changes that made sex more difficult. Seven explained that sex became uncomfortable or undesirable for their wives, and sex with men helped relieve sexual desires. As Ryan shared, “As physically there’s been changes to our bodies and it’s even pain-

48 C AT EG O R I Z I N G S E X

Adam, Barry. 2000. Love and sex in constructing identity among men who have sex with men. International Journal of Sexuality and Gender Studies 5 (4): 325–39.

Anderson, Eric. 2008. “Being masculine is not about who you sleep with . . . ”: Heterosexual athletes contesting masculinity and the one-time rule of homosexuality. Sex Roles 58 (1–2): 104–15.

Annes, Alexis, and Meredith Redlin. 2012. The careful balance of gender and sexuality: Rural gay men, the heterosexual matrix, and “effeminophobia.” Journal of Homosexuality 59 (2): 256–88.

Boulden, Walter. 2001. Gay men living in a rural environment. Journal of Gay and Lesbian Social Services 12 (3/4): 63–75.

Bridges, Tristan. 2014. A very “gay” straight? Hybrid masculinities, sexual aesthetics, and the changing relationship between masculinity and homophobia. Gender & Society 28 (1): 58–82.

Britton, Dana. 1990. Homophobia and homosociality: An analysis of boundary maintenance. Sociological Quarterly 31 (3): 423–39.

Bump, Philip. 2014. There really are two Americas. An urban one and a rural one. The Washington Post, 21 April.

Campbell, Hugh, and Michael Bell. 2000. The question of rural masculinities. Rural Sociology 65 (4): 532–46.

Carrillo, Héctor, and Amanda Hoffman. 2016. From MSM to heteroflexibilities: Non-exclusive straight male identities and their implications for HIV prevention and health promotion. Global Public Health 11 (7–8): 923–36.

Chauncey, George. 1994. Gay New York: Gender, urban culture, and the making of the gay male world 1890–1940. New York: Basic Books.

Connell, R. W. 1987. Gender and power: Society, the person, and sexual politics. Palo Alto, CA: Stanford University Press.

Connell, R. W. 2005. Masculinities, 2nd ed. Berkeley: University of California Press.

Courtenay, Will. 2006. Rural men’s health: Situating risk in the negotiation of masculinity. In Country boys: Masculinity and rural life, edited by Hugh Campbell, Michael M. Bell, and Margaret Finney. University Park, PA: Pennsylvania State University Press.

Dean, James. 2014. Straights: Heterosexuality in post-closeted culture. New York: New York University Press.

Fellows, Will. 2001. Farm boys: Lives of gay men from the rural Midwest. Madison: University of Wisconsin Press.

Foucault, Michel. 1978. The history of sexuality: An introduction, volume 1. New York: Vintage Books.

Gray, Mary. 2009. Out in the country: Youth, media, and queer visibility in rural America. New York: New York University Press.

Halberstam, Judith. 2005. In a queer time and place: Transgender bodies, subcultural lives. New York: New York University Press.

Katz, Jonathan. 1995. The invention of heterosexuality. New York: Dutton.

results also demonstrate the flexibility of male heterosexuality over the life course, and the importance of heterosexuality to rural mascu- linity. Given the centrality of heterosexuality to normative masculinity in rural areas, the participants’ identification with straightness— bolstered by their interpretations of their sex- ual practices—reinforced their normative rural masculinity. Because normative masculinity is critical for social acceptance in rural areas, iden- tification with heterosexuality to bolster norma- tive masculinity was especially important. . . .

The social implications of straight mascu- linities open to same-sex sex are complex. On one hand, diversity within expressions of het- erosexuality and masculinities demonstrates that normativity can be unintentionally chal- lenged from within dominant identities. On the other, the participants’ masculinity reinforces inequality. All 19 participants in this study maintain straight  privilege by publicly identify- ing as straight and keeping secret their same-sex encounters. All of the straight men avoid effemi- nate men, and several disparaged male effemi- nacy, contributing to the widespread devaluation of femininities. Moreover, 13 were married and had extramarital sex without their wives’ knowl- edge, underscoring their male entitlement and unwillingness to consider ethical nonmonog- amy.2 The participants enjoy marginalized sex- ual practices, but they are unwilling to challenge heterosexism or other forms of domination, maintaining numerous systems of inequality.

NOTES 1. The participants did not use any particular phrasing to describe their sex, necessitating a new term. I use “MSM” to refer to broader populations of men that have sex with men, given that there are few other terms that can describe them.

2. Only Joe was in an open relationship with his wife; as he said, “I like big dicks; she likes big tits.”

REFERENCES Abelson, Miriam J. 2014. Men in context: Transmasculinities

and transgender experiences in three US regions. Ph.D. diss., University of Oregon, Eugene, OR.

B I S E X UA L I T Y A N D B I I D E N T I T Y 49

Rust, Paula. 1992. The politics of sexual identity: Sexual attraction and behavior among lesbian and bisexual women. Social Problems 39 (4): 366–86.

Sedgwick, Eve. 1990. Epistemology of the closet. Berkeley: University of California Press.

Seidman, Steven. 2002. Beyond the closet: The transformation of gay and lesbian life. London: Routledge.

Silva, Tony. Forthcoming. “Helpin’ a buddy out”: Perceptions of identity and behavior among rural straight men that have sex with each other. Sexualities.

Simon, William, and John Gagnon. 1986. Sexual scripts: Permanence and change. Archives of Sexual Behavior 15 (2): 97–120.

Stein, Arlene. 1989. Three models of sexuality: Drives, identities, and practices. Sociological Theory 7 (1): 1–13.

United States Census Bureau. 2016. Annual estimates of the resident population by sex, age, race alone or in combination, and Hispanic origin for the United States and states: April 1, 2010, to July 1, 2015. Washington, DC: United States Census Bureau, Population Division. http://factfinder.census.gov/faces/tableservices/jsf/pages /productview.xhtml?src=bkmk#.

Ward, Jane. 2015. Not gay: Sex between straight white men. New York: New York University Press.

Kazyak, Emily. 2012. Midwest or lesbian? Gender, rurality, and sexuality. Gender & Society 26 (6): 825–48.

Kimmel, Michael. 1994. Masculinity as homophobia. In Theorizing masculinities, edited by Harry Brod and Michael Kaufman. Thousand Oaks, CA: Sage.

Kitzinger, Celia, and Sue Wilkinson. 1995. Transitions from heterosexuality to lesbianism: The discursive production of lesbian identities. Developmental Psychology 31 (1): 95–104.

McCormack, Mark. 2013. The declining significance of homophobia. Oxford: Oxford University Press.

Morris, Edward. 2008. “Rednecks,” “rutters,” and ’rithmetic: Social class, masculinity, and schooling in a rural context. Gender & Society 22 (6): 728–51.

Pascoe, C. J. 2011. Dude, you’re a fag: Masculinity and sexuality in high school, 2nd ed. Berkeley: University of California Press.

Plummer, Ken. 1996. Symbolic interactionism and the forms of homosexuality. In Queer theory/sociology, edited by Steven Seidman. Cambridge, MA: Blackwell.

Robinson, Brandon, and Salvador Vidal-Ortiz. 2013. Displacing the dominant “down low” discourse: Deviance, same-sex desire, and Craigslist.org. Deviant Behavior 34 (3): 224–41.

“Sexuality” conceals significant complexity. Even when limited to basic components, sexuality is an amalgamation of what we do, what we wish we could do, what we think about doing, how we see ourselves, and how others see us.1 Which of these components is (or should be) most important when defining “sexuality” is socially and individually variable. Social groups also “package” the basic components of sexuality— behavior, desire, and identity—in different ways. Thus, different cultures, different histori- cal moments, even subcultures within a larger society sometimes have different “sexualities.” Contemporary forms of desire are defined by the sexual anatomy of the partners; hence,

homo, hetero, and bi. As recently as the 1930s, though, sexualities were defined by gender expression. Thus, traditionally masculine men who had sex with effeminate males were con- sidered “normal” men, but their “fairy” part- ners were seen as “third-sexers” (Chauncey, 1994). Although the categories of sexuality are social creations, we don’t usually experience them that way. Sexualities seem natural. We take for granted that there are sexual “types” of people, and presume that sexual behavior, desire, and identity “line up”—that what we do and what we think “match” who we are, and that who we are corresponds to our society’s sexual categories.

Bisexuality and Bi Identity

P J McGann

50 C AT EG O R I Z I N G S E X

the 1980s, as women—many of whom had previ- ously identified as lesbian—founded bi networks in cities such as Minneapolis, Chicago, New York, and Boston. By the mid-1980s explicitly political organizations had formed, ultimately leading to regional, national, and international conferences. By the early 1990s there were col- lege courses and several books on bisexual- ity, as well as a national bisexual organization. After initial resistance, in 1993 lesbian and gay organizations formally recognized bisexual- ity (Hutchins, 1996; Rust, 2000, 2002; Udis- Kessler, 1996). As bisexuality became socially visible and more positively defined, it became possible not only to act bisexually, but to be a bisexual.

Visibility and recognition created a base for bi identity, but even today, bisexuality is still not necessarily valued. Stereotypes of bisexuals as immature, deceitful, and promiscuous persist. The gendered nature of the images means female and male bisexuals face different attitudes. For example, both gays and lesbians have criticized bisexuals for a presumed unwillingness to “fully” come out. But gay men have historically been more tolerant of bisexual behavior than have les- bians, a discrepancy rooted in critique of male control of female sexuality and the politicization of lesbianism (Echols, 1989; Rust, 1995; Stein, 1992; Udis-Kessler, 1996).

In contrast to the suspicion and, at times, hostility female bisexuals have faced from some lesbians, straight society sometimes celebrates female bi behavior. Indeed, some forms are deeply eroticized. But even ostensibly positive “hot bi babe” stereotypes—more liberated, more daring, with a large if not insatiable sexual appe- tite—constrain, given how easily such images facilitate objectification (Sheff, 2005). What’s more, in a context of gender inequality, female bisexuality is consumed for male pleasure, yet dismissed as not “really” sex. This situation may provide cover for “hetero-flexible” sexual explo- ration but the hyper-visibility may undermine bi

Identity, though, is a complex thing. Indi- vidual identity is who we are to ourselves; social identity is who we are to others. These facets of identity don’t always align; sometimes this is intentional (as when someone is “in the closet”), sometimes not (as when we think somebody’s sexuality is one thing, but it is something else). Either way, sexual identity is built on a culture’s sexual categories and is dependent on others for recognition. Identity, then, isn’t just something individuals “have.” It is instead a process that emerges from dynamic interplay with the social world. Consider how we “know” someone’s sexual identity. Even if they don’t tell us directly, indi- viduals “announce” identity through appearance, gestures, and acts. For such announcements to work, others must know how to inter pret the signs (a wedding ring, for instance), know which sexuality they point to, and accept the signs as legitimate indicators of the person’s sexuality. However, the prevalence, persistence, and vis- ibility of the hetero–homo binary underpin a belief that most people are “really” straight or gay/lesbian. Such “monosexism” fuels anti-bisex- ual stereotypes and skepticism of the reality of bisexuality, leaving bi identity in a precarious position (James, 1996; Rust, 1993, 2002).2

Contemporary bisexual identity—a sense of self based on attraction to more than one gender—is linked to the emergence of bisex- ual politics in the early to mid-1970s. Bisexual behavior existed before then, of course, as did bisexuality as a category of sexuality, but peo- ple didn’t necessarily think of themselves as bi (Savin-Williams, 2005; Weinberg et al., 1994). Even when they did, bi often wasn’t an iden- tity recognized by others (Rust, 2000, 2002; Storr, 1999; Udis-Kessler, 1996). This changed when a newly visible bisexuality3 converged with countercultural ideals of sexual and gender experimentation, leading to the creation of local bisexual groups. The first were mostly male, and by 1978 there were only four such groups in the United States. Things changed significantly in

B I S E X UA L I T Y A N D B I I D E N T I T Y 51

Millet; films such as Cabaret (1972) and The Rocky Horror Picture Show (1975); and stories about “bisexual chic” in Time and Newsweek (1974).

REFERENCES Armstrong, Elizabeth. 1995. “Traitors to the Cause?

Understanding the Lesbian/Gay ‘Bisexuality Debates.’” In Naomi Tucker, ed., Bisexual Politics: Theories, Queries, and Visions. Binghamton, NY: Haworth.

Chauncey, George. 1994. Gay New York: Gender, Urban Culture, and the Gay Male World, 1890–1940. New York: Basic Books.

Echols, Alice. 1989. Daring to Be Bad: Radical Feminism in America, 1967–1975. Minneapolis: University of Minnesota Press.

Hutchins, Loraine. 1996. “Bisexuality: Politics and Community.” In Beth A. Firestein, ed., Bisexuality: The Psychology and Politics of an Invisible Minority. Thousand Oaks, CA: Sage.

James, Christopher. 1996. “Denying Complexity: The Dismissal and Appropriation of Bisexuality in Queer, Lesbian, and Gay Theory.” In Brett Beemyn and Mickey Eliason (eds.) Queer Studies: A Lesbian, Gay, Bisexual, and Transgender Anthology. New York: NYU Press.

Rust, Paula C. Rodriguez. 1993. “‘Coming Out’ in the Age of Social Constructionism: Sexual Identity Formation Among Lesbian and Bisexual Women.” Gender & Society, 71: 50–77.

———. 1995. Bisexuality and the Challenge to Lesbian Politics. New York: NYU Press.

———. 2000. “Popular Images and the Growth of Bisexual Community and Visibility.” In Bisexuality in the United States: A Social Science Reader. New York: Columbia University Press.

———. 2002. “Bisexuality: The State of the Union.” Annual Review of Sex Research, 13: 31–68.

Savin-Williams, Ritch C. 2005. The New Gay Teenager. Cambridge, MA: Harvard University Press.

Sheff, Elisabeth. 2005. “Polyamorous Women, Sexual Subjectivity, and Power.” Journal of Contemporary Ethnography, 34, 3: 251–83.

Stein, Arlene. 1992. “Sisters and Queers: The Decentering of Lesbian Feminism.” Socialist Review, 22, 1: 33–55.

Storr, Merl. 1999. “Editor’s Introduction.” In Bisexuality: A Critical Reader. London: Routledge.

Udis-Kessler, Amanda. 1996. “Identity/Politics: Historical Sources of the Bisexual Movement.” In Brett Beemyn and Mickey Eliason (eds.) Queer Studies: A Lesbian, Gay, Bisexual, and Transgender Anthology. New York: NYU Press.

Weinberg, Martin S., Colin J. Williams, and Douglas W. Pryor. 1994. Dual Attraction: Understanding Bisexuality. New York, NY: Oxford University Press.

identity (however unintentionally). In contrast, male bi behavior is less visible but more roundly denounced in the dominant culture. Concerns about the “Down Low” phenomenon demonize African American and Latino men as dishon- est and scorn them as sources of contaminating disease, attitudes which reflect racial inequality and historic fear of Black male sexuality (see “No Brokeback for Black Men” in Chapter 8). There may be less overt hostility directed at the private sex of white “str8 dudes,” but the clan- destine nature of it and Down Low sexuality alike suggest homophobia and underscore the threat male same-sex activity may pose to het- erosexuality and masculinity.

The depiction of male bisexual activity as the deceitful selfishness of closeted gays and the “embrace” of female bisexuality are two sides of the same monosexist coin. Despite bisexual activism, many insist that everyone is “really” either gay or straight. The rigidity of the hetero– homo binary leaves little room for the both/and of bisexuality. Confusion and disagreement as to what bisexuality is—attraction to both genders? attraction regardless of gender?—compound the instability, yet underscore the social nature of identity. The “in betweenness” of bisexual- ity provokes debate. As discussion proceeds, new categories emerge—queer, fluid, pan- and omni-sexual—giving individuals new ways to make sense of their sexual experience in terms (potentially) intelligible to others.

NOTES 1. A more complete consideration of sexuality would include things such as emotional connection, capacity, preference, lifestyle, group membership, community involvement, political commitment, and so on.

2. The complexity of heterosexual identity is often overlooked—not because heterosexuality is inherently more stable or natural, but because it is the default, taken-for- granted form of sexuality woven into (and thus supported by) nearly every other social institution.

3. The visibility was linked to the high-profile coming-out of pop icons such as David Bowie, Elton John, and Kate

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sex is common—the lifetime prevalence among women ages 18–44 was 17 percent (triple that of men)—and “bisexual” identification is more common than “lesbian” or “gay.” Sexual behav- ior, attraction, and identity do not necessarily correlate: 85 percent of women who said they were “mostly [but not exclusively] attracted to the opposite sex” identified as straight, and 13 percent of straight-identified women reported same- gender sex (Copen, Chandra, and Fabo- Vezquez 2016). These patterns have been repli- cated across different national surveys (Baumle 2013; Savin-Williams and Vrangalova 2013).

HOW COLLEGE CAMPUSES SHAPE YOUNG WOMEN’S SEXUALITY

Qualitative research on young women’s sexualities has relied disproportionately on convenience samples drawn from student pop- ulations. This scholarship routinely recognizes this sampling strategy as a limitation, calling for greater race and class diversity (Allison and Ris- man 2014; Armstrong, England, and Fogarty 2012; Diamond 2008; Manning, Giordano, and Longmore 2006; Rupp et al. 2014); nonethe- less, it has provided rich insight into how col- lege campuses shape young women’s sexuality. Once functioning as an “extended adolescence” for an elite minority of women “in the transition to adulthood,” higher education’s “new major- ity” includes students who are older, people of

C ontrary to stereotypes of college as a “hive of same-sex experimentation” (Lewin 2011), women with the low- est levels of educational attainment report the highest lifetime prevalence of same-gender sex (Chandra et al. 2011).1 Straight-identified young women commonly have same-gender sexual or romantic experiences, but existing research cannot adequately explain this behav- ior among young mothers or women who never attended college. Research on sexual fluid- ity (Diamond 2008), hooking up (Armstrong, England, and Fogarty 2012; England, Shafer, and Fogarty 2007; Hamilton and Armstrong 2009; Rupp et al. 2014), and “straight girls kiss- ing” (Hamilton 2007; Rupp and Taylor 2010) has largely focused on white women living on the progressive campuses of selective univer- sities. In the same age group, less privileged women report higher rates of same-gender sex but have earlier paths toward family formation (Edin and Kefalas 2005; Finer and Zolna 2011) and access to different sexual discourses. This leaves sociologists of sexuality with a puzzle: how does context shape the experience, conse- quence, and meaning of same-gender sexuality2 for women beyond the elite college campus? . . .

DEMOGRAPHY, LIFE COURSE TRAJECTORIES, AND SEXUAL IDENTITY

. . . The National Survey of Family Growth (NSFG) has asked questions about sexual behavior, attrac- tion, and identity over the last 15  years. Several consistent patterns have emerged. Same-gender

“STRAIGHT GIRLS KISSING”? UNDERSTANDING SAME- GENDER SEXUALITY BEYOND THE ELITE COLLEGE CAMPUS

J A M I E B U D N I C K

From “‘Straight Girls Kissing’? Understanding Same- Gender Sexuality beyond the Elite College Campus,” Gender & Society 30(5), pp. 745–68. Copyright © 2016 by the Author. Reprinted by permission of SAGE Publications, Ltd.

“ S T R A I G H T G I R L S K I S S I N G” ? 53

improve understandings of female bisexuality, argues that in addition to their stable underly- ing sexual orientation, women have a varying capacity for fluidity, defined as a “sensitiv- ity to situations and relationships that might facilitate erotic feelings” (2008, 84). Diamond’s influence looms large in the study of women’s sexuality, but her work, like that of most sexu- alities scholars, draws disproportionately on the experiences of white and middle-class women. Given that sexuality can be fluid, who gets to act on fluidity and how does context shape how it is expressed and understood? . . .

METHODS

. . . Data come from 35 in-depth semistructured interviews with participants systematically recruited from the Relationship Dynamics and Social Life (RDSL) study. RDSL is a federally funded longitudinal survey (2008–2012) pri- marily interested in exploring the context and consequences of unintended pregnancy. RDSL followed a representative sample of 1,003 young women living in a socioeconomically diverse Michigan county (aged 18–19 when enrolled in RDSL, and 22–23 when interviewed in Fall 2013).3 . . .

The weekly RDSL survey asked a stan- dard question about (presumably heterosex- ual) romantic and sexual experiences, which I rephrased to specify same-gender behavior: “Have you ever had physical or emotional con- tact, such as kissing, dating, spending time together, sex, or other activities with a woman?” The response options were “Yes” and “No.” Twenty-nine percent of respondents answered “Yes.” The attraction question read, “When I think about who I am romantically and sexu- ally attracted to, it is:.” The response options were “Always women,” “Usually women, but sometimes men,” “A person’s gender isn’t really important when it comes to who I’m attracted to,” “Usually men, but sometimes women,” and

color, and [students] balancing work and fam- ily responsibilities (Armstrong and Hamilton 2013). “College” has expanded beyond selective, residential, nonvocational four-year institutions (Armstrong and Hamil ton 2013), but sexuali- ties research is disproportionately conducted at schools meeting this elite definition (Allison and Risman 2014). Even within selective univer- sities, there is considerable diversity of student experiences: “pathways” through college vary significantly by race and socioeconomic status, contributing to the reproduction of social class and stratification (Armstrong and Hamilton 2013). . . .

[R]esearch on sexuality at college has iden- tified “straight girls kissing” as an increasingly common phenomenon—the latest iteration of stereotypes about experimental college women (such as the older trope of “lesbian until gradua- tion”) (Lewin 2011). Sociological research char- acterized this behavior as attention-seeking performances for men, now part of the hetero- normative sexual scripts of college party cul- ture (Hamilton 2007; Rupp and Taylor 2010). More recently, this behavior also has been rec- ognized as a way for queer college women to explore and legitimate their sexualities (Rupp et al. 2014) without adopting stigmatized and isolating lesbian identities (Stone and Gorga 2014). “Straight girls kissing” has largely been framed as a white and middle-class phenom- enon, and we know little about the experience and meaning of similar behavior outside the college hookup scene. . . .

THEORIZING YOUNG WOMEN’S SEXUALITIES

Sexual fluidity has become the paradigmatic way of understanding young women’s same- gender experiences, especially in the context of inconsistent or changing sexual identifi- cation. This influential model, proposed by developmental psychologist Lisa Diamond to

54 C AT EG O R I Z I N G S E X

Interviewees varied in their class backgrounds and educational experiences. About a quarter grew up in poverty or on public assistance, about a third grew up with a single parent, and more than half had neither a mother nor a father with a bachelor’s degree. Nearly half of interviewees were living at home (typically with parents in the residence where they grew up). Fewer than half of participants attended any four-year college. With one exception, the col- leges attended were not selective universities but regional commuter colleges, low- to midrange state schools, or satellite campuses of the state flagship university. The colleges represented here were located in rural Midwest towns or in economically depressed urban centers, were largely nonresidential, and offered night and online courses for commuting and working stu- dents. The sexual possibilities enabled by these locations differed from the progressive cam- puses of selective universities reflected in much of the sexualities literature. The personal lives of my interviewees presented a contrast to elite college students: about a quarter of the white women and about half of the women of color were already mothers. An additional quarter of white women and 13 percent of women of color were preparing to become mothers, meaning they had gone off birth control to try to con- ceive or were actively planning to do so in the near future. Many were married, engaged, or cohabiting (63 percent of white women and 56 percent of women of color; almost all of whom were in relationships with men).

SAME-GENDER SEXUALITY BEYOND THE ELITE COLLEGE CAMPUS

How are young women’s experiences and under- standings of same-gender sexuality shaped by their context? To answer this question, I lever- age comparisons to women attending the elite

“Always men.” Twenty-three percent of respon- dents chose answers other than “Always men.” The identity question read, “Please choose the description that best fits how you think about yourself.” The response options were “Lesbian, gay, or queer,” “Bisexual,” “Straight,” and “I don’t label myself in this way.” Sixteen per- cent of respondents selected a response other than “Straight.” In total, 37 percent of all sur- vey respondents (213 women) gave at least one non-heterosexual response (that is, they reported same-gender sexual or romantic expe- riences, attraction to women, and/or an identity other than “straight”). I invited all 213 women to participate in a one-time interview, con- tinuing contact attempts until I had recruited a similar number of Black and white women with the most common combinations of survey responses.

Among interviewees, approximately one- third reported same-gender behavior only; one-third reported consistent non-heterosexual behavior, attraction, and identity; and one- third reported some other combination. Dur- ing interviews, I asked participants about their current sexual identity and to reflect on changes from their original survey responses. Nearly everyone wanted to revise or explain their original answers. Specifically, many who chose “straight” on the survey complicated the definition and described themselves with con- siderably more flexibility. Probing uncovered a variety of same-gender romantic and sexual experiences that interviewees were comfort- able discussing but were unsure “mattered,” including adolescent experiences, intimate friendships with ambiguous boundaries, or hooking up with women while maintaining a straight identity. . . .

Among the 35 interview participants . . . , 19 were white and 16 were women of color (14 of whom identified as Black; the absence of many non-Black women of color in my sample is a limitation reflecting the region where they live).

“ S T R A I G H T G I R L S K I S S I N G” ? 55

figure to her child and a partner in parenting. Summer, a Black woman with a high school diploma, similarly reconsidered her progres- sive sexual values and the place of same-gender attraction in her life after becoming a mom in her late teens. She struggles to answer her four- year-old daughter’s questions about her cousin, who has two moms. Summer calls herself “pro- tective,” explaining, “I know my nephew got teased a lot for having two moms. . . . I don’t want her to have to go through that.” Jayla and Summer are confronting observations about what it is like for their gay friends and lesbian cousins to be “out” in their communities.

The mothers I interviewed describe the waning salience of their same-gender attraction and romantic or sexual experiences, instead drawing on raced, classed, and heteronorma- tive discourses of “good motherhood” (Bell 2014), foregrounding self-sacrifice and “settling down.” If their child’s father was in the picture, this could mean going to great lengths to work things out—these expectations differed by cur- rent relationship status, which is itself raced and classed. White women were more likely to be married, describing their non- heterosexuality as “moot,” while Black women were more likely to be single, dating, or cohabiting and expe- riencing social and family pressures to marry. Marriage may have a waning salience for many Americans’ definition of family (Powell et al. 2012), and it remains to be seen how options and expectations might broaden following fed- eral recognition of marriage equality. But for my interviewees, the idea of settling down with a woman is an unintelligible option for them- selves and in conflict with the discursive imper- atives of “good motherhood.”

Monogamy similarly forecloses possibili- ties for LGBTQ identification. Noel, a white woman working on her GED, had her son shortly after dropping out of high school and leaving her impoverished family to marry her husband. Before this tumultuous period, she

colleges disproportionately reflected in sexuali- ties scholarship. In what follows, I discuss three findings that emerged from my interviews: the first looks at life course considerations in identification, the second at strategies for and meanings of same-gender sex, and the third at discourses of identification.

Foreclosed Possibilities Following Early Motherhood Both on and off campus, women of lower socio- economic status have earlier trajectories toward family formation (Edin and Kefalas 2005; Kost and Henshaw 2012) and are less comfortable hooking up (Allison and Risman 2014; Arm- strong and Hamilton 2013). At the same time, bisexual and unlabeled women report declines in same-gender sex over time (Diamond 2008). These patterns intersect earlier in the lives of my interviewees. These classed timelines fore- close possibilities for same-gender sexual iden- tification in two ways: young moms prioritize their identity as good and self-sacrificing par- ents over LGBTQ identification, and women in committed relationships with their child’s father or other men felt their same-gender sex- ualities were rendered irrelevant.

My interviewees described reconsidering sexual identities, relationships, and values after becoming mothers. Jayla, a Black woman with a recent bachelor’s degree from a regional state university, became pregnant after her on-again/ off-again boyfriend pressured her to stop using condoms. Cradling her sleeping daughter, she described how “humbled” she was since mov- ing back in with her parents. Jayla isolated herself from her best friend (a gay man) and refused to reciprocate a godmother relation- ship with her lesbian-identified friend. . . . Jayla described emotionally walling herself off from the attraction and love she felt for her lesbian- identified friend, feelings overshadowed by the hope of meeting a man who could be a father

56 C AT EG O R I Z I N G S E X

foreclose possibilities to develop and express same-gender sexual identities. Conversely, those same circumstances may facilitate pos- sibilities for acting on same-gender desire. At elite colleges, women are confronted with sex- ual discourses that pressure them to name their experiences and label themselves (Armstrong and Hamilton 2013; Rupp et al. 2014). Women outside this environment draw on different dis- courses when describing their identity, and may have more leeway to act on same-gender desire. My interviewees’ descriptions of sexual friend- ships present a contrast to same-gender relation- ships among privileged white college students. However, their narratives of strategically choos- ing same-gender hookups based on perceptions of safety looked remarkably similar.

Some interviewees described exploring same-gender desire within sexual friendships. Chantelle, a Black woman with a high school diploma, lives with her parents so that she can make ends meet raising her two-year-old son. She says she is too busy parenting and too frustrated with her child’s father to date, but described reconnecting with a woman she knew in high school. . . . She laughs about the situa- tion, and describes preferring the openness of a sexual friendship to expectation-laden relation- ships: “It’s funny, because it actually brought us a lot closer. . . . She didn’t know if she was ready for a girlfriend. I didn’t either. . . . That could have ruined our friendship, because rela- tionships have a different degree and different standards. But with a friendship it’s kind of like everything is an open book.” Chantelle’s sex- ual friendship exists in a space unconstrained by identity or relationship labels that presents a contrast to both heterosexual “friends with benefits” hookups and the intimate female friendships of comparatively privileged women engaging LGBTQ discourses. . . .

With less pressure to label sexual identi- ties and experiences, the boundary between intimate and sexual friendships is difficult to

strongly identified as bisexual, but feels her monogamous relationship renders her attrac- tion to women moot: “I’m with my husband, and I don’t intend on being with anybody else for my future. That’s where I’m at now.” For Noel, same-gender attraction and identity labels became irrelevant when she married her husband. Rachel, a white woman with a high school diploma, embraces and even acts on her same-gender attraction, but her marriage simi- larly forecloses identification. She had a three- some with her husband and a close woman friend to whom she had long been attracted, but does not want to label herself: “I’m pretty open. I don’t know that it’s because I’m married— because I know that I’m with [my husband] and I always plan on being with [him]—that I would be straight. But I don’t know. . . . Maybe just no label is easier to think about.”

Having or planning threesomes was one possible way to act on same-gender attraction without threatening my interviewees’ primary identity as a mother or their committed relation- ships. Although it was not a topic included in my initial interview guide, many women brought up threesomes: they reacted to stereotypes that bisexual women want threesomes (many were offended), recalled stories of friends who had threesomes, or discussed the role threesomes had in their own sex lives. For women in this latter category, threesomes were a low-stakes way to raise the issue of same-gender attraction within a relationship without making any threat- ening claims about identity, thus involving their partner in their sexuality without challenging their relationship. Threesomes functioned as a site of possibility for some of my interviewees to offload attraction and longing. . . .

Sexual Friendships and Safety Strategies Certain circumstances more prevalent among women of lower socioeconomic status (such as earlier paths toward family formation) may

“ S T R A I G H T G I R L S K I S S I N G” ? 57

mothers and poor and working-class women meaningfully explore same-gender sexuality. Something that young mothers seem to be get- ting out of their sexual friendships is friendship with a woman who deeply understands and shares their experience as struggling, often isolated, single parents navigating frustrating relationships with unsupportive men. Public lesbian relationships are described as “impos- sible” or “unimaginable,” and conversations acknowledging a sexual friendship might be something more are dismissed as “joking” or “playing around.” . . . While college-attending women describe a preference to socialize and hook up with women based on perceptions of physical and reputational safety (Hamil- ton 2007; Rupp et al. 2014), these strategies enacted by women from lower socioeconomic positions are embedded in their increased risk of sexual assault (Barber, Kusunoki, and Budnick 2015) and better awareness of crime (Jones 2009; Levine 2013).

Labels Outside the Women’s Studies Classroom Rejecting sexual identity labels is increasingly common across different populations (Dia- mond 2008; Savin-Williams and Vrangalova 2013), but working-class and non–college attending women draw on different discourses when doing so. My interviewees embrace “bisexual” and reject “queer” in the exact oppo- site pattern observed among women sampled from women’s studies courses and LGBTQ stu- dent spaces at selective universities. The latter characterize “bisexual” as an outdated term rife with negative connotations circulating in straight society and lesbian subcultures (Rust 1992), and they say that it incorrectly suggests “equal, continuous, or simultaneous attraction to both men and women” (Tabatabai 2015, 26). For my interviewees, “bisexual” is a relatively untainted and utterly intelligible term, and

discern. Jayla (introduced above) describes her relationship with one particular close friend as intimate but not sexual. . . . Their friendship is serious (Jayla was chosen to be godmother to her friend’s daughter), but also playful. Their playfulness is expressed both physically and in how they characterize their relationship. . . . Lost in her recollection, Jayla suddenly stops and remembers that her friend once had a “forbidden relationship” with another woman, exclaiming, “To this day, my friend will tell you that the best relationship that she’s ever been in has been with a woman. I can’t believe I forgot about that.” This recollection surprises her, and as she struggles to make sense of their friend- ship, her sleeping daughter begins to stir and Jayla asks to end our interview. . . .

Some interviewees described choosing hookups with women based on perceptions of safety—physical safety and safety for their reputation. Tara, a white woman with a bach- elor’s degree from a regional public university, explicitly said she thought same-gender hook- ups would decrease her risk of being sexually assaulted and simultaneously safeguard her reputation. She lives with her grandma and has a boyfriend, but in college she shared an off- campus apartment with a lesbian couple and frequently made out with women when they all went to parties together. She describes always feeling open and comfortable expressing her sexuality, but says she experienced less nega- tivity at parties when hooking up with women than men. . . . In her experience, making out at parties with women not only has fewer reper- cussions for her reputation, it’s physically safer as well: “It’s safer too, because you never know if you’re making out with a guy, what might happen in that situation. Like if I want to make out with you, it doesn’t mean I want to have sex with you. But in a lot of guys in party scenes, that’s their mentality.” . . .

These narratives of sexual friendships and safety strategies shed light on how young

58 C AT EG O R I Z I N G S E X

college hookup scene (Hamilton 2007; Rupp and Taylor 2010). For women in lower socioeco- nomic positions, choosing same-gender hookups is a strategy embedded in their increased risk of sexual assault and better awareness of crime (Barber, Kusunoki, and Budnick 2015; Jones 2009; Levine 2013). My interviewees reject “queer” and embrace “bisexual” in the opposite pattern observed among their more privileged peers. . . .

Processes of sexual identification and the enactment of desire are intersectional. Too often, this fundamental observation of feminist sexualities research remains at the level of the- ory alone and is undermined by the entrenched focus on samples of educated middle-class white women. My study contributes to the growing body of scholarship on same-gender sexual- ity among working-class women and women of color (Acosta 2013; García 2012; Kazyak et al. 2014; Moore 2011; Rust 1992; Trautner 2005), underscoring how our knowledge about sexual fluidity is critically situated—driven by research with women residing on elite college campuses. I offer an intersectional analysis of the everyday expectations and structural con- straints encountered by working-class women and women of color navigating their sexuality beyond the elite campus. I describe the specific strategies and negotiations these women use to enact sexual desire, foster intimate connec- tions with other women, and cultivate sexual identities that are intelligible to themselves and their communities.

NOTES 1. The National Survey of Family Growth has continuously collected data since 1973. The patterns described here draw on national data available at the time of my study (Chandra et al. 2011). The latest report presents a slightly different picture: women reporting same-gender sex increased (from 13 to 17 percent), but no statistically significant pattern by education was found. However, prevalence among women with the lowest educational attainment remains high and under-examined (Copen, Chandra, and Fabo-Vezquez 2016).

“queer” is an alienating slur rather than an anti- label panacea.

My interviewees who rejected labels did not draw on queer discourses challenging sex- ual classification, but rather discourses about individualism and openness (in addition to discourses about self-sacrifice and good moth- erhood, as described earlier). . . . “Bisexual” was viewed as an acceptable and intelligible label among my interviewees. Nikki, a Black woman and part-time commuting student working on a bachelor’s degree at a regional public univer- sity, succinctly concludes, “I always thought ‘bisexual’ was a pretty good term for it.” Krys- tina, a white woman with a bachelor’s degree from a regional public university, explains, “I feel like that’s much more acceptable in today’s society.”

“Queer” was overwhelmingly viewed as a derogatory slur among my interviewees. . . . Taylor, a white woman and full-time commut- ing student working on a bachelor’s degree at a regional public university, has identified as lesbian and bisexual, but about queer says, “I personally feel it’s a slur word. I would never use queer to identify my own sexual identity. In my opinion, ‘queer,’ regardless of a gay con- notation, just means weird. I don’t think my sexuality is weird. So I wouldn’t feel comfort- able identifying with queer.” . . .

CONCLUSIONS

. . . I find that early motherhood forecloses pos- sibilities to develop or claim LGBTQ identities as women prioritize seemingly incompatible dis- courses of self-sacrifice and good motherhood. At the same time, sexual friendships provide opportunities to explore same-gender sex and desire. These findings demonstrate how sexual fluidity is enacted among women outside spaces permeated with LGBTQ discourses (Diamond 2008), and present meanings of same-gender sex for “straight girls kissing” located outside the

“ S T R A I G H T G I R L S K I S S I N G” ? 59

sexual orientation among adults aged 18–44 in the United States: Data from the 2011–2013 National Survey of Family Growth. National Health Statistics Reports 88.

Diamond, Lisa. 2008. Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.

Edin, Kathryn, and Maria Kefalas. 2005. Promises I can keep: Why poor women put motherhood before marriage. Berkeley: University of California Press.

England, Paula, Emily Fitzgibbons Shafer, and Alison Fogarty. 2007. Hooking up and forming romantic relationships on today’s college campuses. In The Gendered Society Reader, edited by Michael Kimmel and Amy Aronson. New York: Oxford University Press.

Finer, Lawrence, and Mia Zolna. 2011. Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception 84 (5): 478–85.

García, Lorena. 2012. Respect yourself, protect yourself: Latina girls and sexual identity. New York: New York University Press.

Hamilton, Laura. 2007. Trading on heterosexuality: College women’s gender strategies and homophobia. Gender & Society 21 (2): 145–72.

Hamilton, Laura, and Elizabeth A. Armstrong. 2009. Gendered sexuality in young adulthood: Double binds and flawed options. Gender & Society 23 (5): 589–616.

Jones, Nikki. 2009. Between good and ghetto: African American girls and inner-city violence. New Brunswick, NJ: Rutgers University Press.

Kazyak, Emily, Nicholas Park, Julia McQuillan, and Arthur Greil. 2014. Attitudes toward motherhood among sexual minority women in the United States. Journal of Family Issues October: 1–26.

Kost, Kathryn, and Stanley Henshaw. 2012. U.S. teenage pregnancies, births and abortions, 2008: National trends by age, race and ethnicity. Guttmacher Institute. http://www .guttmacher.org/pubs/USTPtrends08.pdf (accessed July 31, 2015).

Laumann, Edward, John Gagnon, Robert Michael, and Stuart Michaels. 1994. The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

Levine, Judith. 2013. Ain’t no trust: How bosses, boyfriends, and bureaucrats fail low-income mothers and why it matters. Berkeley: University of California Press.

Lewin, Tamar. 2011. Study undercuts view of college as a place of same-sex experimentation. The New York Times, 17 March.

Manning, Wendy, Peggy Giordano, and Monica Longmore. 2006. Hooking up: The relationship contexts of “nonrelationship” sex. Journal of Adolescent Research 21 (5): 459–83.

2. In this [reading], I use “same-gender sexuality” (except when directly citing others) because I am referring to intimacies between women, and we—as gender scholars— need to take seriously the distinction between terms used to describe sex and gender. “Same-gender sexuality” is one specific language choice available to us that has been used in fundamental sexualities scholarship, including Social Organization of Sexuality (Laumann et al. 1994). For a recent Gender & Society article theorizing the relationship between scientists’ use of sex and gender language and the construction sex/gender knowledge in social life, see Westbrook and Saperstein (2015).

3. For more information on the Relationship Dynamics and Social Life (RDSL) study, see Barber, Kusunoki, and Gatny (2011).

REFERENCES Acosta, Katie. 2013. Amigas y amantes: Sexually nonconforming

Latinas negotiate family. New Brunswick, NJ: Rutgers University Press.

Allison, Rachel, and Barbara J. Risman. 2014. “It goes hand in hand with the parties”: Race, class, and residence in college student negotiations of hooking up. Sociological Perspectives 57 (1): 102–23.

Armstrong, Elizabeth A., Paula England, and Alison Fogarty. 2012. Accounting for women’s orgasm and sexual enjoyment in college hookups and relationships. American Sociological Review 77 (3): 435–62.

Armstrong, Elizabeth A., and Laura Hamilton. 2013. Paying for the party: How college maintains inequality. Cambridge, MA: Harvard University Press.

Barber, Jennifer S., Yasamin Kusunoki, and Jamie Budnick. 2015. Women not enrolled in four-year universities and colleges have higher risk of sexual assault. Council on Contemporary Families. https://contemporaryfamilies .org/not-enrolled-brief-report/.

Barber, Jennifer S., Yasamin Kusunoki, and Heather Gatny. 2011. Design and implementation of an online weekly journal to study unintended pregnancies.

Baumle, Amanda K. 2013. Introduction: The demography of sexuality. In International handbook on the demography of sexuality, edited by Amanda K. Baumle. Dordrecht, the Netherlands: Springer.

Bell, Ann. 2014. “I’m good at the job”: How women achieve “good” motherhood. Chapter 2 in Misconception: Social class and infertility in America. New Brunswick, NJ: Rutgers University Press.

Chandra, Anjani, William Mosher, Casey Copen, and Catlainn Sionean. 2011. Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth. National Health Statistics Reports 36.

Copen, Casey, Anjani Chandra, and Isaedmarie Fabo- Vezquez. 2016. Sexual behavior, sexual attraction, and

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Savin-Williams, Ritch, and Zhana Vrangalova. 2013. Mostly heterosexual as a distinct sexual orientation group: A systematic review of the empirical evidence. Developmental Review 33 (1): 58–88.

Stone, Amy L., and Allison Gorga. 2014. Containing pariah femininities: Lesbians in the sorority rush process. Sexualities 17 (3): 348–64.

Tabatabai, Ahoo. 2015. Lesbian, queer, and bisexual women in heterosexual relationships: Narratives of sexual identity. Lanham, MD: Lexington Books.

Trautner, Mary Nell. 2005. Doing gender, doing class: The performance of sexuality in exotic dance clubs. Gender & Society 19 (6): 771–88.

Westbrook, Laurel, and Aliya Saperstein. 2015. New categories are not enough: Rethinking the measurement of sex and gender in social surveys. Gender & Society 29 (4): 534–60.

Moore, Mignon. 2011. Invisible families: Gay identities, relationships, and motherhood among Black women. Berkeley: University of California Press.

Powell, Brian, Catherine Bolzendahl, Claudia Geist, and Lala Carr Steelman. 2012. Counted out: Same-sex relations and Americans’ definitions of family. New York: Russell Sage.

Rupp, Leila J., and Verta Taylor. 2010. Straight girls kissing. Contexts 9 (3): 28–32.

Rupp, Leila J., Verta Taylor, Shiri Regev-Messalem, Alison Fogarty, and Paula England. 2014. Queer women in the hookup scene: Beyond the closet? Gender & Society 28 (2): 212–35.

Rust, Paula C. 1992. The politics of sexual identity: Sexual attraction and behavior among lesbian and bisexual women. Social Problems 39 (4): 366–86.

If you know which sexual orientation people identify with, how much does that tell you about whether they have sex with women, men, or both? How similar or different are the links between identity and behavior for women and men? . . .

We’re using data from the 2002, 2006–2010, and 2011–2013 National Survey of Family Growth for men and women 15 to 44 years of age. . . . Here we focus on a few specific questions:

HOW COMMON IS IT FOR HETEROSEXUAL MEN AND WOMEN TO HAVE SEX WITH SAME-SEX SEXUAL PARTNERS?

Unsurprisingly, almost none of the men identi- fying as heterosexual have had only male sexual

partners and only 2% say they have had even one male sexual partner. For women, like men, almost none of those who identify as heterosex- ual have had only female partners, but 10% say they have had at least one same-sex partner, five times the rate reported by men. . . . In sum, it is more common for heterosexual women than men to have had sex with members of their same sex.

We can get a little closer to assessing how common inconsistency between identity and behavior is by comparing men and women’s current identity with whether they’ve had same-sex sexual partners in the last year. Here we get a much smaller figure—only 0.4% of men and 2% of women who called themselves heterosexual on the survey report that they had sex with a same-sex partner in the last year. . . . Thus, behavior usually aligns with identity in any short (one year) time range. But here, too,

Sexual Orientation versus Behavior—Different for Men and Women?

Eliza Brown and Paula England

S E X UA L O R I E N TAT I O N V E R S U S B E H AV I O R— D I F F E R E N T F O R M E N A N D WO M E N ? 61

sexual partners is much larger than the propor- tion of heterosexual men and women who have had sex with same-sex sexual partners. And it is much larger than the proportion of gay men/ lesbians who have had sex with an other-sex partner in the last year, 5% (3% + 2%) for men and 18% (5% + 13%) for women.

As for how things differ by gender, it is clear that lesbians are more likely than gay men to have ever had sex with an other-sex sexual partner, whether in the last year (5% for men and 18% for women) or ever (39% for men and 59% for women). The larger share of lesbians than gay men who had other-sex partners in the past year comes both from lesbians being more likely than gay men to have partners of both sexes (13% of lesbians), as well as being more likely to have had sex with only other-sex partners (5% of lesbians).

Why would this be, that lesbians have sex with men more than gay men have sex with women? One explanation is that women’s sex- ual attractions don’t fit the three categories allowed by the survey as well, or that women are more likely than men to change the sexual orientation with which they identify. Either can be seen as more fluidity in women’s sexuality than men’s, a topic taken up by Lisa Diamond and Leila Rupp and her coauthors.1 Another possibility is that either evolution or cultural conditioning make . . . [men] the initiators in sex. So it is probably a less likely scenario that a young man who thinks that he may be gay is approached by a woman for sex and acqui- esces despite not wanting it, compared to an analogous scenario in which a young queer woman has sex with a man she doesn’t want. Indeed, both lesbians and gay men are likely to have men as their first sexual partners, according to research conducted by Karin Martin and Ritch C. Savin-Williams. In some cases, these early partners may have raped them, as indicated by research on the preva- lence of sexual assault among gay, lesbian,

the percent of heterosexuals having same-sex partners is larger for women than men.

How should we interpret the finding that some men and women who identify as hetero- sexual have had sex with same-sex partners? It may mean that they had sex that doesn’t match their stated sexual orientation at the time, perhaps because of the stigma associated with same-sex partnerships in some quarters. Another possibility is that, although they see themselves as straight now, they identified as gay/lesbian or bisexual at the time they had same-sex partners, so there was no inconsis- tency between identity and behavior. This is especially plausible regarding with whom one has had sex “ever.” If that is the explanation, then women’s higher rate may mean that they are more likely than men to change the sex- ual orientation they identify with. But we are speculating; we would need panel data follow- ing the same people over time and repeatedly asking about orientation and recent behavior to distinguish (a) changing sexual orientation where behavior and identity are almost always consistent from (b) inconsistency between cur- rent identity and current behavior. It is also possible that the ways people see their own orientations don’t fit neatly into the three cat- egories provided in the survey in most years, so some respondents choose the best fit of not- well-fitting categories.

HOW COMMON IS IT FOR GAY MEN AND LESBIANS TO HAVE SEX WITH OTHER-SEX SEXUAL PARTNERS?

. . . Thirty-nine percent (37% + 2%) of gay men have had a female sexual partner sometime in their lives, whereas a much higher 59% (5% + 54%) of lesbians have had a male sexual partner sometime. The proportion of either gay men or lesbians who have ever had sex with other-sex

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men and 12% for women), but it is much more likely for bisexual women than men to have had sex only with the other sex in the last year— 34% for men but 53% for women. . . .

CONCLUSION

We have shown that identity—the sexual ori- entation one identifies with—is strongly, but by no means perfectly, associated with whether men and women have had sex with women, men, or both. Heterosexual men and women are the most likely to have had sex only with other-sex partners, bisexual men and women are the most likely to have had sex with both women and men, and gay men and lesbians are the most likely to have had sex only with same- sex partners. In this sense, behavior is roughly consistent with sexual orientation. Unsurpris- ingly, this consistency between current identity and behavior is much stronger when the behav- ior being asked about is in the last year rather than over the whole lifetime.

However, the patterns differ between men and women. Women, both lesbian and straight, are more flexible with either their identities or behavior than men. Thus, they are more likely than men to have what could be seen as mis- matches between identity and behavior. As an example of this, looking at behavior in the last year, heterosexual women are more likely than heterosexual men to have had sex with women, and lesbians are more likely than gay men to have had sex with an other-sex partner.

As part of women’s “flexibility,” women are more likely to have partners of both sexes than men are. Taking people of all sexual orienta- tions combined, 14% of women but only 4% of men have ever had both male and female sexual partners. . . . Similarly, in the past year, 3% of all women had both male and female sexual partners, compared with less than 1% of men. This is partly because more women than men identify as bisexual, but is also influenced

and bisexual individuals by Emily Rothman and her coauthors. We suspect, however, that greater sexual fluidity among women and the frequency of male initiation contribute more to the gender differences in partnership pat- terns than sexual assault.

HOW DOES THE BEHAVIOR OF BISEXUAL MEN AND WOMEN DIFFER FROM THAT OF GAY AND HETEROSEXUAL MEN AND WOMEN?

Given that the commonsense meaning of the term “bisexual” is an interest in having sex and romantic relationships with men and women, we would expect more bisexual than hetero- sexual or lesbian/gay individuals to have had sex with both men and women. Indeed, we find that 62% of bisexual men and 73% of bisexual women have (ever) had sex with both sexes, higher than the analogous figures for gay men and lesbians, and drastically higher than the figures for heterosexual men and heterosexual women.

Who have bisexual men and women had sex with in the last year? . . . [T]he percent that have had sex with both women and men in the last year is 33% for bisexual men, 27% for bisexual women; 2% for gay men, 13% for lesbians; and 0.4% for heterosexual men, and 2% for heterosexual women. Thus, as we would expect, bisexuals are much more likely than either gays/lesbians or straight men or women to have had sex with both sexes. They are also more likely to have had sex only with other-sex partners in the last year than are gay men or lesbians, but are less likely to have done so than are heterosexuals.

. . . What about gender differences between bisexual men and bisexual women? The two groups have a similarly low percent who have ever had sex only with the other sex (14% for

S E X UA L O R I E N TAT I O N V E R S U S B E H AV I O R— D I F F E R E N T F O R M E N A N D WO M E N ? 63

general attraction during the study. While timing wasn’t fixed, she found increased fluidity as women aged. Single powerful relationships could shift a person’s identity, in the short or long term. While Diamond’s book focused on women’s sexuality, she has also called attention to sexual fluidity among men. Men’s sexuality can also be fluid, although the patterns of this fluidity may differ across genders.

by the higher proportion of women than men among those who identify as either hetero- sexual or gay having had both male and female sexual partners. . . .

NOTE 1. Editor’s note: In her book Sexual Fluidity: Understanding Women’s Love and Desire, Lisa Diamond defined sexual fluidity as “situation-dependent flexibility in women’s sexual responsiveness.” Diamond studied 100 women with a same-sex sexual or romantic orientation for a decade. She found that most women showed signs of this capacity to change, shifting either their sexual identity, behavior, or

Source: “Sexual Orientation versus Behavior: Different for Men and Women?” Contexts Blog, February 29, 2016. Reprinted by permission of the authors.

INVESTIGATING SEXUALIT Y

A N I N T E R V I E W W I T H

M I G N O N R . M O O R E

Mignon R. Moore, PhD, is an associate professor of sociology at Barnard College, Columbia University. Professor Moore received a Faculty Career Award from the Woodrow Wilson Foundation and a national award from the Human Rights Cam- paign for her professional work and outreach with LGBT communities of color. She was also selected as a Russell Sage Foundation Visiting Scholar. She holds a grant from the National Institutes of Health for her study examining the social histories, current health outcomes, and sources of social support for older African American sexual minorities. Her 2011 book, Invisible Families: Gay Identities, Relationships, and Motherhood among Black Women (University of California Press), examines how lesbian women of color form and raise families and experience their gay identities while retaining connections to their racial/ethnic communities. Her current research includes a new book project on the social histories of LGBT seniors in New York and Los Angeles, the negotiation of religious and community life for lesbians and gay men of faith, and the promotion of healthy aging for racial and ethnic minority elders.

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What led you to begin studying sexuality? I became interested in studying various aspects of sexuality, particularly as they relate to African American women, in part because of the existing negative stereo- types in society and in the literature regarding Black women and their processes of family formation. Much of the research on this population lacks an in-depth analysis of the choices Black women and girls make around their bodies, their relationships, and more generally their lives. My dissertation examined the predictors of early sexual debut and pregnancy among African American adolescents in high-poverty neighborhoods. Rather than compare them to their White, middle-class peers as other work had done, I looked at the risk and protective factors within these social contexts that were associated with more positive outcomes for these young women.

I began studying lesbian, gay, and bisexual women in 2003. After meeting and getting to know a working-class Black lesbian couple, I realized that the literature in LGBT studies, family studies, and even African American studies provided almost no information about the family experiences of Black gay women. I wrote Invisible Families: Gay Identities, Relationships and Motherhood among Black Women as a cor- rective to these literatures, and as a way to increase the visibility of working-class and middle-class gay women of color.

How do people react when you tell them you study sexuality? These days, people usually show great interest in the type of work I do and the methods I use for uncovering and studying LGBT populations. However, when I first started my book project, the country was not talking as openly about gay sexu- ality. This was before many of the political debates on legalizing same-sex marriage had really begun to permeate the discourse of regular, everyday people. At earlier stages in my career I was hesitant to let people know that the focus of my research was Black gay women. I feared I would be marginalized in the scholarly community, or that my work would be ignored and seen as insignificant. However, I knew that there were important sociological understandings that would come from this work, and that it was necessary to be brave and to take the lead in helping several areas of study move forward.

What ethical dilemmas have you faced as you’ve studied sexuality? Could you tell us about a particularly thorny dilemma and how you solved it? When writing my book Invisible Families, I had to decide how much to reveal about my own sexuality. I knew that readers would want to know whether I am gay and how that might have influenced my research, both in the data collection and in the way I portray the families in the study. I knew that once it was written in the book that I am a gay woman, it would stand forever and anyone who read the book would know. I grew up in a conservative Christian denomination and knew that some of the parishioners in my family’s church might read the book. I worried that my parents would be uncomfortable with their friends knowing about my sexuality.

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Nevertheless I decided to be upfront about my sexuality in the book because I did not want fear of knowledge to be present in the work or in my own personal life. Thus far, my parents have only had positive things to say about my work. They are proud of my accomplishments.

What do you think is most challenging about studying sexuality? One of the most challenging things about studying sexuality is that it elicits such strong feelings from so many groups! Sexuality is something that is difficult for people to talk about, particularly those who deem themselves “respectable.” Several studies have shown, for example, that even many physicians are uncomfortable talk- ing about sexuality with their patients. It is an area of scholarship that has not always received serious consideration in the field of sociology, so as a sociologist studying lesbian families I have had to show connections between sexuality and other areas of the discipline that are more easily accepted, such as family and gender.

Why is sex research important? The study of sexuality in society is important because it gives us a window into an important aspect of human behavior. Studying the sexuality of different groups adds to our understandings of how social groups operate. I focus on the ways context influences how individuals in groups understand their own sexuality.

Of the projects you’ve done over the course of your academic career, which was most interesting and why? Completing my book Invisible Families was one of the most challenging and rewarding feats of my career because it required me to forge new ground in several fields of study. In the book I challenge several assumptions in the feminist literature, I show a new applicability to the intersectionality paradigm, and I make visible the multifaceted lives of a stigmatized population. Ultimately I want people to know that social contexts— including race, ethnicity, gender, region, social class, and religiosity—all influence how individuals enact a sexuality.

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R E A D I N G 7

From “Alfred Kinsey and the Kinsey Report: Histori- cal Overview and Lasting Contributions,” Journal of Sex Research, Vol. 35, Issue 2, 1998, pp. 127–31. Copyright © 1998 Routledge, reprinted by permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com).

Havelock Ellis, one of the dominant figures in promoting sexual knowledge in the first third of the twentieth century, said that he sought a medical degree primarily because it was the only profession in which he could safely study sex. Inevitably, most of the so-called experts were physicians. Equal in influence to Ellis was Mag- nus Hirschfeld, another physician. Both Ellis and Hirschfeld compiled what could be called sexual histories, as Kinsey later compiled. Ellis, however, acquired almost all of his histories from correspondence of volunteers and, as far as I know, never interviewed anyone. Hirschfeld, later in his career, compiled many case histories based on interviews, but early on he depended mainly on historical data and personal knowl- edge. Unfortunately, Hirschfeld used only a small portion of his data in his published books, and before he could complete a comprehensive study of sexuality, his files were destroyed by the Nazis (Bullough, 1994).

Although some of the data physicians reported about sex [were] gathered from their own prac- tices, these [data] were usually interpreted in terms of traditional views and were supple- mented by historical materials or reports of anthropologists [in order] to increase their authenticity. Simply put, most physicians writ- ing  about sex were influenced more by the zeitgeist of the time rather than by any special- ized base of knowledge. A few early physician investigators, such as the American obstetrician

The more I study the development of modern sexuality, the more I believe in the importance and significance of Alfred Kinsey. Although his research was on Americans, it came to be a worldwide source of information about human sexuality and set standards for sex research everywhere. In America and much of the world, his work was a decisive factor in changing attitudes toward sex. Within the field of sexuality, he reoriented the field, moving it away from the medical model and medical dominance, to one encom- passing a variety of disciplines and approaches. In short, his work has proved revolutionary.

To understand what Kinsey wrought, one must look at the field of sexuality when Kinsey began his studies. One must also look briefly at Kinsey as an individual to understand his accomplishments.

SEX RESEARCH, 1890–1940

The modern study of sexuality began in the nineteenth century, and these early studies were dominated by physicians. It was assumed that since physicians were the experts on body functions, they should be the experts regarding sexual activities. In a sense, this was a diver- gence from the past, when sexuality had been regarded almost entirely as a moral issue. And although there were still moral issues involved, physicians were also judged as qualified to speak on these issues as well. Although few physicians had any specialized knowledge on most sexual topics, except perhaps for sexually transmitted diseases, this did not prevent them from speaking with authority on most aspects of human sexuality.

ALFRED KINSEY AND THE KINSEY REPORT

V E R N L . B U L L O U G H

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in 1921 was to complete such general studies, the committee members were either unwilling or unable to find a person to carry out this kind of study. I suspect that the first factor was more important than the second: There is considerable evidence to indicate that the committee members were uncomfortable with studies on actual sexual behavior and much preferred to fund what might be called bench (i.e., laboratory-based) scientists to social sci- entists. I should add that this attitude was not shared by the Rockefeller Foundation or John D. Rockefeller, Jr.: both funded other survey projects dealing with sex, including that of Katherine Bement Davis (1929).

Funding for research projects when Kinsey began his work operated much more accord- ing to an old-boy network than it does today. There was little advertisement of fund availability and individuals were invited to apply, had to be nominated to apply, or had to have a connection. Certain universities and individuals dominated the disbursement of the money available. To an observer [today] examining most of the research grants given for sex research, the relationships look almost incestuous.

Unfortunately for the committee, sex activ- ity could not be studied exclusively in the laboratory or even in the field by observing animals or gathering historical data. There had been nongrant-supported popular studies of sex, but their samples were not representative and the questionnaires were poorly designed. Moreover, in keeping with its reliance on aca- demia, the committee seemed reluctant to give its imprimatur to individuals conducting such studies. What was needed was a person will- ing to blaze new trails, dispassionately exam- ining sex without the preconceived notions of most of the physicians then involved in writing about sex. The qualified individual or individu- als needed an academic connection, preferably one with an established reputation for scientific studies.

Robert Latou Dickinson (Dickinson and Beam, 1931, 1934), had over 1,000 case studies, but most had only a handful. As the twentieth cen- tury progressed, the ordinary physician prob- ably was regarded as the most easily available authority on sex, but most of the medical writ- ings on sexual topics came from psychiatrists, particularly those who were psychoanalytically trained (Bullough, 1997). Unfortunately, even the most comprehensive sex studies under- taken by psychiatrists, such as that of George Henry, were flawed by the assumptions of the investigators interpreting data. For example, they assumed that homosexuals were ill. More- over, whether the answers to their questions were valid for determining differences with het- erosexuals is uncertain, as there was a lack of any comparative study of heterosexuals (Henry, 1941).

Still, assumptions about medical exper- tise remained. When the Committee for Research in the Problems in Sex (CRPS), the Rockefeller-funded grant-giving body oper- ating under the umbrella of the National Research Council, began to explore the pos- sibilities of carrying out surveys of sexual behavior, they first sought out physicians. For example, Adolf Meyer of Johns Hopkins Uni- versity was commissioned to complete a study of attitudes of medical students, but failed to complete his work. The only social scien- tists funded in the first 20 years of the CRPS were psychologists, although anthropologi- cal consultants and members of other fields provided occasional input. Lewis Terman, for example, was given funds to carry out studies on attitudes toward sex and marriage. Though his and similar studies were valuable, they depended on questionnaires rather than inter- views to gather their data (Terman, Butten- weiser, Ferguson, Johnson, and Wilson, 1938), and the sexual part of their studies was sec- ondary to other interests. Even though one of the major reasons the CRPS had been created

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Hygiene Association. The approach to sex of these hygiene classes was quite different from that of the marriage and family courses, as they generally emphasized the dangers of sexually transmitted diseases and masturbation. In a sense, these hygiene-type courses were con- ceived to preserve sexual purity, whereas the sexual portions of marriage and family courses provided information, following the outlines of the better sex manuals of the time.

Kinsey went even further in his discussion of sexuality than the sex-positive marriage manuals, and soon clashed with Thurman Rice, a bacteriology professor who had writ- ten extensively on sex, primarily from the point of view of eugenics. For many years, Rice had delivered the sex lectures in the required hygiene course, where the males were sepa- rated from the females when he gave his lec- tures. Kinsey deliberately had not included Rice in his recruited faculty, which probably furthered Rice’s antagonism. Rice was typical of an earlier generation of sex educators in that he considered moral education an essential part of sex education. He believed and taught that masturbation was harmful, condemned premarital intercourse, and was fearful that Kinsey’s course on marriage was a perversion of academic standards. For example, he charged Kinsey with asking some of the women stu- dents about the length of their clitorises. To show that his accusations were based on more than gossip, Rice demanded the names of students in Kinsey’s class so that he could verify such classroom voyeurism. Rice opposed Kinsey’s questioning of students because he believed that sexual behavior could not and should not be analyzed by scientific methods because it was a moral topic, not a scientific one. Rice’s perspective thus was perhaps typi- cal of the hygiene approach to sex.

Kinsey had probably been doing at least some of the things that Rice mentioned because he had approached sex as a taxonomist—as one

KINSEY COMES ON THE SCENE

It was in this setting that Kinsey entered the scene. He was the right person at the right time; that is, a significant amount of money was available for sex research and there was an interest within the CRPS for some general kind of survey of American sex behavior. Who was Kinsey?

In terms of overall qualification, Kinsey’s best asset was that he was a bench scientist, a biologist with a Ph.D. from Harvard, and an internationally known expert on gall wasps. But he was also a broad-based scientist. Unlike most research scientists today, who often are part of a team, researchers in the 1930s in the United States were self-dedicated and carried a major teaching load. Kinsey, for example, simultaneously taught general biology, pub- lished two editions of a popular introductory general biology text, two editions of a work- book, and a general text on methods in biology, and carried out major research. His entry into sex seems to have been serendipitous, taking place after he had completed his studies on gall wasps. Professors at the University of Indiana had discussed the possibility of an introduc- tory cross-discipline course on marriage, then a topic beginning to receive some attention in academic circles. Kinsey was not only involved in such discussions but took the lead. In 1938, he was invited to coordinate and direct the new course on marriage and family. As a sign of the time, the course was taught by an all-male faculty from a variety of disciplines, including law, economics, sociology, philosophy, medi- cine, and biology.

Before the appearance of courses on mar- riage and family, the academic discussion of human sexuality had been confined to lec- tures in the hygiene-type courses that had been established on many campuses in the second decade of the twentieth century, largely through the efforts of the American Social

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of his probing of student lives, or to devote more time to his sex research and not teach the course. Because Kinsey had already begun to extend his interviews off campus, the answer was perhaps inevitable. Although Kinsey con- tinued to teach courses in biology, his load was reduced, and much of his life came to be devoted to sex research.

Because Kinsey was already well connected to the scientific establishment, his initial efforts to study sex received encouragement from the CRPS. He received an exploratory grant from them in 1941, during which time he would be evaluated as to suitability for a larger grant. George W. Corner, a physician member and later the chair of the CRPS, visited Kinsey as one of the grant investigators to determine whether Kinsey deserved further funding. He was tremendously impressed and reported that Kinsey was the most intense scientist he had ever met. He added that Kinsey could talk about little besides his research. According to Corner (1981), Kinsey was an ideal person for a grant to study sex:

He was a full professor, married with adolescent chil- dren. While carrying on his teaching duties in the zoology department he worked every available hour, day and night, traveling anywhere that people would give him interviews. He was training a couple of young men in his method of interviewing. Dr.  Yerkes and I submitted separately to his technique. I was astonished at his skill in eliciting the most intimate details of the subject’s sexual history. Introducing his queries gradually, he managed to convey an assurance of complete confidentiality by recording the answers on special sheets printed with a grid on which he set down the information gained, by unintelligible signs, explaining that the code had never been written down and only his two colleagues could read it. His questions included subtle tricks to detect deliberate misinformation. (p. 268)

Important to the continuation of the grant was the support of the university administration and its president, which Kinsey received despite

interested in classifying and describing—as a dispassionate scientist and not as a reformer or politician. In a sense, he was a political innocent. He believed that science could speak for itself, and he criticized his faculty colleagues who took any kind of political stand. He refused to join organizations that he felt had any kind of politi- cal agenda, including the Society for the Scien- tific Study of Sexuality (SSSS) in its early years.

There is, however, much more to Kinsey’s interest in sex than the dispassionate scien- tist. In his personal life, he was not inhibited about body functions. Even before starting his course on marriage, he had sought information about the sex life of his students. His openness about sex (see Jones, 1997; 1997a) was what Rice objected to.

It might well be that when Kinsey began teaching the sex course, he was undergoing a kind of midlife crisis, feeling that he had come to know all he wanted to know about gall wasps and needing to explore new fields. Sex to him represented an unexplored new field where comparatively little was known, and where there was much information to be gleaned. He began his study as he had that of gall wasps: finding out what was known and, in the process, build- ing up a personal library of serious books on sex (hardly any of these had found their way into university libraries) and reading extensively. He also sought first-hand information by ques- tioning his students about topics such as their age at first premarital intercourse, frequency of sexual activity, and number of partners.

All this gave fodder to Rice and his allies, including a number of parents who, perhaps at Rice’s urging, complained about the spe- cific sexual data given in the course and par- ticularly about questions that Kinsey asked of his students. The president of the university, Herman Wells, a personal friend of Kinsey who had appointed him coordinator of the course, counseled him and gave him two options: to continue to teach the course and give up some

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subjects as possible, and he hoped initially to conduct 20,000 interviews and later to conduct 80,000 more. He did not live to achieve this. Before he died, the funding sources had dried up for such research, and other methods based on statistical sampling grew more popular.

WHAT KINSEY DID

Kinsey’s major accomplishment was to chal- lenge most of the assumptions about sexual activity in the United States. In so doing, he aroused great antagonism among many who opposed making sexual issues a matter of pub- lic discussion and debate. One reason for the antagonism is that he brought to public notice many sexual practices that previously had not been publicly discussed. Although Kinsey prided himself as an objective scientist, it was his very attempt to establish a taxonomy of sex- ual behaviors—treating all activities as more or less within the range of human behavior— that got him into trouble. Karl Menninger, for example, said that “Kinsey’s compulsion to force human sexual behavior into a zoological frame of reference leads him to repudiate or neglect human psychology, and to see normal- ity as that which is natural in the sense that it is what is practiced by animals” (quoted in Pomeroy, 1972, p. 367).

Most sex researchers today accept the fact that total objectivity in our field is probably impossible. Some of Kinsey’s difficulty resulted from his belief that he could be totally objec- tive. He did not realize that the way he orga- nized his data sometimes could challenge his objectivity, even though the organization seemed logical. For example, Kinsey developed a seven-point bipolar scale, which was one of the standard methods of organizing data in social science research at that time. He did not trust people’s self-classification as homosexual or heterosexual. Therefore, he decided that regardless of how they might have classified themselves, the only objective indicator that he

sniping by some fellow faculty members such as Rice and others who regarded Kinsey’s inter- est in sex with suspicion. As Corner’s reference to Kinsey’s family indicates, the committee wanted to make certain that the researcher had no special agenda except, perhaps, to establish some guides to better marriages. Kinsey satis- fied them on this account and was well aware that any indication otherwise might endanger his grant. Thus, his own sex life remained a closed book, only to be opened by later gen- erations of scholars (Jones, 1997). The CRPS came to be so committed to Kinsey that by the 1946–1947 academic year, he was receiving half of the committee’s total budget.

Before the interviews stopped with Kin- sey’s death, about 18,000 individuals had been interviewed, 8,000 by Kinsey himself. Kinsey strongly believed that people would not always tell the truth when questioned about their sexual activities and that the only way to deal with this was through personal interviews in which the contradictions could be explored. He did not believe that self-administered questionnaires produced accurate responses: He regarded them as encouraging dishonest answers. He also recognized that respondents might lie even in a personal interview, but he provided a variety of checks to detect this and believed his checks were successful. Subjects were usually told that there were some con- tradictions in their answers and were asked to explain them. If they refused to do so, the inter- view was terminated and the information not used. Kinsey was also aware of potential bias of the interviewer. He sought to overcome this bias by occasionally having two people conduct the interviews at different times and by relying mainly on four interviewers, including himself, to conduct the study. If there was a bias, it came to be a shared one. The questions, however, were so wide-ranging that this too would limit much of the potential for slanting the data in any one direction. Following taxonomic prin- ciples, he wanted to gather data from as many

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tions (i.e., adults with children or minors). One of his more criticized sections in recent years is the table based on data he gathered from pedophiles. He is accused of not turning these people over to authorities, although one of the major informants was already serving time in jail for his sexual activities when interviewed. Kinsey gathered his data wherever he could find it, but he also reported on the source of his data. His own retrospective data tended to show that many individuals who experienced intergenerational sex as children were not seri- ously harmed by it, another statement that got him into trouble.

Kinsey is also criticized for his statistical sampling. Although his critics (even before his studies were published) attempted to get him to validate his data with a random sample of individuals, he refused on the grounds that not all of those included in the random sample would answer the questions put to them and that, therefore, the random sample would be biased. It is quite clear that Kinsey’s sample is not random and that it overrepresents some segments of the population, including students and residents of Indiana. Part of the criticism, however, is also due to the use and misuse of the Kinsey data without his qualifications. This is particularly true of his data on same-sex rela- tionships, which are broken down by age and other variables and therefore allowed others to choose the number or percentage of the sample they wanted to use in their own reports.

Another assumption of American society that Kinsey also challenged was the asexual- ity of women. This proved the issue of greatest controversy in his book on females. A total of 40% of the females he studied had experienced orgasm within the first months of marriage, 67% by the first six months, and 75% by the end of the first year. Twenty-five percent of his sample had experienced orgasm by age of 15, more than 50% by the age of 20, and 64% before marriage. On the other hand, he also reported cases in which women failed to reach

could use was to define sex in terms of outlet— namely, what activity resulted in orgasms.

In most seven-point scales, the extremes are represented by 0 and 6 (or by 1 and 7, depending upon the number with which the scale starts). Most people tend to respond using the middle of the scale. When one rates heterosexual orgasm as 0 and homosexual orgasm 6, a logical decision in terms of taxonomy, he in effect weights the scale by seeming to imply that exclusive heterosexual- ity is one extreme and exclusive homosexuality the other. Although his data demonstrated that far more people were identified as exclusively heterosexual than as any other category, his scale also implied that homosexuality was just another form of sexual activity, something that I think Kinsey believed was true. For his time and place this was revolutionary. His discussion of homo- sexuality and its prevalence resulted in the most serious attacks upon him and his data (Kinsey, Pomeroy, and Martin, 1948).

Kinsey was a trailblazer, openly and will- ingly challenging many basic societal beliefs. It was not only his dispassionate discussion of homosexuality that roused controversy, but also his tendency to raise questions that soci- ety at that time preferred to ignore. In his book on males, for example, he questioned the assumption that extramarital intercourse always undermined the stability of marriage and held that the full story was more complex than the most highly publicized cases led one to assume. He seemed to feel that the most appropriate extramarital affair, from the stand- point of preserving a marriage, was an alliance in which neither party became overly involved emotionally. Concerned over the reaction to this, however, he became somewhat more cau- tious in the book on females. He conceded that extramarital affairs probably contributed to divorces in more ways and to a “greater extent than the subjects themselves realized” (Kinsey, Pomeroy, Martin, and Gebhard, 1953, p. 31).

Kinsey was interested in many different sex- ual behaviors, including that between genera-

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several impressive collections of this kind in the country, Kinsey’s collection is still tremen- dously important.

In sum, Kinsey was the major factor in chang- ing attitudes about sex in the twentieth century. His limitations and his personal foibles are appropriately overshadowed by his courage to go where others had not gone before. In spite of the vicious attacks upon him during his last few years of life, and the continuing attacks today, his data continue to be cited and used (and mis- used). He changed the nature of sexual stud- ies, forced a reexamination of public attitudes toward sex, challenged the medical and psychiat- ric establishment to reassess its own views, influ- enced both the feminist movement and the gay and lesbian movement, and built a library and an institution devoted to sex research. His reputa- tion continues to grow, and he has become one of the legends of the twentieth century. . . .

REFERENCES Bullough, V. L. 1994. Science in the bedroom: A history of sex

research. New York: Basic Books. Bullough, V. L. 1997. American physicians and sex

research. Journal of the History of Medicine, 57, 236–53. Corner, G. W. 1981. The seven ages of a medical scientist.

Philadelphia: University of Pennsylvania Press. Davis, K. B. 1929. Factors in the sex life of twenty-two

hundred women. New York: Harper. Dickinson, R. L., and Beam, L. 1931. A thousand marriages.

Baltimore: Williams and Wilkins. Dickinson, R. L., and Beam, L. 1934. The single woman.

Baltimore: Williams and Wilkins. Henry, G. 1941. Sex variants: a study of homosexual patterns

(2 vols.). New York: Hoeber. Jones, J. H. 1997, August 25 and September 1. Annals of

sexology: Dr. Yes. New Yorker, pp. 99–113. Jones, J. H. 1997a. Kinsey: A Public/Private Life. New York:

Norton. Kinsey, A., Pomeroy, W., and Martin, C. 1948. Sexual

behavior in the human male. Philadelphia: Saunders. Kinsey, A., Pomeroy, W., Martin, C., and Gebhard, P. 1953.

Sexual behavior in the human female. Philadelphia: Saunders. Pomeroy, W. B. 1972. Dr. Kinsey and the Institute for Sex

Research. New York: Harper and Row. Terman, L., Buttenweiser, P., Ferguson. L., Johnson, W. B.,

and Wilson, D. P. 1938. Psychological factors in marital happiness. New York: McGraw-Hill.

orgasm after 20 years of marriage. In spite of the controversies over his data on orgasms, it helped move the issue of female sexuality on to the agenda of the growing women’s movement of the late 1960s and the 1970s, and to encour- age further studies of female sexuality.

In light of the challenges against him, Kinsey ignored in his writings what might be called sexual adventurers, paying almost no attention to swinging, group sex, and alternate lifestyles such as sadism, masochism, transvestism, voy- eurism, and exhibitionism. He justified this neglect by arguing that such practices were statistically insignificant. It is more likely that Kinsey was either not interested in them or not interested in exploring them. He was also not particularly interested in pregnancy or sexually transmitted diseases. However, he demystified discussion of sex insofar as that was possible. Sex, to him, was just another aspect of human behavior, albeit an important part. He made Americans and the world at large aware of just how big a part human sexuality played in the life cycle of the individual and how widespread many kinds of sexual activities were.

Kinsey was determined to make the study of sex a science, a subject that could be stud- ied in colleges much the same way that animal reproduction was, with succeeding generations of researchers adding to the knowledge base. He succeeded, at least in the long run. He had a vision of the kind of studies that still needed to be done, some of which were later done by his successors at Indiana and elsewhere, but he himself died before he could do them and the funds dried up.

Another of his significant contributions was to establish a library and to gather sources about sexuality from all over the world. He blazed a trail for future sex researchers: The library he established at Indiana University served as an example that helped many of us to persuade other university libraries to collect works from this field. Although there are now

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less-than-reliable data gathered by mainstream publications like Cosmopolitan, Redbook, and Playboy (Laumann et al., 1994a; Michael et al., 1994). Unfortunately, magazine surveys are fraught with problems; a major one is that their samples are usually drawn from a small por- tion of the magazine’s own readers. Thus, their samples are not representative of the general American population (i.e., Redbook readers are mostly affluent married white women). In addi- tion, those who volunteer to participate in such surveys may be very different from those who do not (Michael et al., 1994). So, when we want to learn about Americans’ sexual behavior— to answer these questions about the “average American,” or Americans in general—a nation- ally representative sample is necessary.

Nationally representative research is useful in a number of ways, but foremost is the fact that it is the only kind of research that allows us to generalize to the overall population. Rep- resentative samples use probability sampling techniques, which means that everyone in the population has an equal and known chance of being selected to participate. But how does one randomly select a set of Americans in a way that ensures that everyone has an equal chance of participating? There is no “list” of Ameri- cans that one could randomly select from; even a semicomplete list (from each state’s Depart- ment of Motor Vehicles, for example) would exclude some people, like those who cannot afford to own a car, cannot drive, or use public transportation.

There are a variety of ways to do it, but many researchers use multistage area prob- ability sampling. Two of the studies reviewed

We know gossip about the sex lives of famous people. . . . What we don’t know—and what is of immensely greater importance—is what the rest of us ordinary folks have been doing between the sheets.

—Erickson and Steffen, 1999: 207

Have you ever wondered how old the aver-age American is when they lose their virginity? Or how many sexual partners they have in a lifetime? Since Alfred Kinsey completed his revolutionary sex research in the 1950s, sex researchers have been struggling to answer these questions (and many more) about Americans’ sexual practices. While Kinsey’s research was large-scale (collecting the sexual histories of more than 11,000 Americans), his sample was not representative of the general population. At the time, Kinsey did not believe that it was possible to collect data on sexual practices successfully from a random sample of Americans (Kinsey Institute, 2011; Michael et al., 1994). Since the 1950s, few research- ers have taken on the challenge of conducting large-scale representative studies on the sexual practices of Americans, “perhaps because it was considered too dull, trivial, and self-evident to deserve attention” (Laumann et al., 1994a: 37).

More recently, sexuality researchers have reported feeling marginalized or stigmatized because of their research, as well as being subjected to undue oversight or interference by institutional review boards (committees intended to ensure research is conducted ethi- cally and with minimal harm to participants) (Irvine, 2012, 2015). The absence of reliable research did not allay Americans’ curiosity about sex and sexuality; instead, they turned to

LARGE-SCALE SEX: METHODS, CHALLENGES, AND FINDINGS OF NATIONALLY REPRESENTATIVE SEX RESEARCH

A M A N D A M . J U N G E L S A N D S TA C Y G O R M A N H A R M O N

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groups are often underrepresented in national samples. To combat this pattern, most nation- ally representative surveys “oversample” minor- ity groups to ensure that they are represented in final samples in high enough numbers for analysis. Sexual minorities (particularly salient to sex researchers) such as gay men and lesbi- ans are not as “easily identifiable” as members of racial and ethnic minority groups, making it challenging to oversample for them (Michael et al., 1994: 29). A final challenge of large-scale research is that it describes “general” expe- riences and patterns; these patterns do not always coincide with an individual’s specific experience. Large-scale representative studies offer us a snapshot of the American population at the time the research is conducted (Michael et al., 1994).

But selecting a representative sample is not the only challenge that researchers have to face. In addition to practical design challenges, researchers also must contend with the cost of implementing such large surveys. Outside of government agencies, there are few organiza- tions with the resources to fund large projects, and receiving government funding is fraught with complications and problems [see “Funding Sex Research” in Reading 10]. Two of the stud- ies reviewed in this reading had major funding challenges—the NHSLS lost its government funding in the 1990s, and the National Survey of Sexual Health and Behavior (NSSHB) used exclusively private funding because of the lack of available govern ment funding (Reece et al., 2010a). The gov ernment funds the NSFG, but it does not focus exclusively on sexual practices or attitudes.

We present findings in the next section for all three of these nationally representative sur- veys, as well as discuss their strengths, their limitations, and the challenges the research- ers faced. Ideally, comparisons would be made across studies to look for changes across time in the sexual behaviors of the participants.

in this reading used this form of sampling— the National Health and Social Life Survey (NHSLS), conducted in the early 1990s, and the National Survey of Family Growth (NSFG), which has been conducted every few years since the 1970s. Both of these studies began their sampling by using primary sampling units (PSUs), which are large geographic areas (including major metropolitan areas or several counties grouped together). The research- ers randomly selected a set of PSUs; within these larger areas, smaller areas that are analo- gous to neighborhoods (called “segments”) were selected. After segments were randomly selected, all addresses in that segment were listed. Not every address in a given neighbor- hood is a residential address—there are vacant lots, empty houses, and businesses. To address this issue, researchers would often dispatch an assistant who traveled the neighborhood and confirmed which addresses were residences. After this information had been confirmed, the researchers randomly selected addresses to include, and then randomly selected someone from the household to participate.

While nationally representative surveys are an important part of understanding the lives of the general population, there are many chal- lenges to conducting such large-scale research. The greatest of these challenges—whether the research is about sexual behavior or not—is ensuring that the sample reflects the demo- graphic characteristics of the population and that no groups are left out of the sample. For example, while researchers acknowledge that sampling “households” is an acceptable method of drawing a national sample, around 3 percent of the population in this country do not live in households and will be excluded, such as those in institutional settings like college dorm residents, incarcerated individuals, seniors in assisted living facilities, and homeless people (Laumann et al., 1994a). A related challenge is that members of racial and ethnic minority

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be excluded from the research (Michael et al., 1994). Given that government approval (and funding) was necessary to conduct the research, the research team relented and narrowed their field of study to specific sexual health and HIV/ AIDS-related questions (Michael et al., 1994).

After the research team had refined the sur- vey and research design, they awaited approval from several government agencies that were involved with the funding of the project. During this review process, the magazine Science ran a story about the project, illustrated with a pic- ture from Bob and Carol and Ted and Alice—a film about two couples that partner-swap (Lau- mann, Michael, and Gagnon, 1994b). Several conservative members of Congress honed in on the article and photo and began attacking the research. Representative William Dannemeyer argued that the research was “a plot by homo- sexuals to legitimate the normality of gay and lesbian lifestyles . . . and the project staff had an anti-family agenda” (Laumann, Michael, and Gagnon, 1994b: 35). Dannemeyer also deliberately sensationalized the content of the study by reading questions from the survey out of context on the floor of Congress and to the press (Laumann, Michael, and Gagon, 1994b). Defending the scientific merits of the study was left to the few in Congress and government who supported the project because the research team was under a government gag order (Lau- mann, Michael, and Gagnon, 1994b). In 1991, after several years of debate and deadlock, the House of Representatives removed all fund- ing for the project (Laumann, Michael, and Gagnon, 1994b). The research team eventually received private funding from several organiza- tions (although the amount was significantly reduced) and, “freed of political constraints,” was able to conduct much broader research. Unfortunately, the reduction in funding meant dramatically reducing the scale of the project, from 20,000 to fewer than 4,000 individuals (Michael et al., 1994: 28).

However, this is difficult because of major dif- ferences across the studies themselves. The methods used and questions asked are not the same across all three studies, and there are even differences in the specific focuses and goals of the researchers. For these reasons, we highlight what we consider to be major findings that might be new or different in comparison to other studies, or that challenge mainstream perceptions of the “average American’s” sexual experiences.

NATIONAL HEALTH AND SOCIAL LIFE SURVEY (1994)

The National Health and Social Life Survey began in 1987 as a government-funded effort to better understand Americans’ sexual prac- tices, largely in response to the developing HIV/ AIDS crisis (Laumann, Michael, and Gagnon, 1994b). Besides Kinsey’s results, scholars had very little information about Americans’ sexual behaviors. What was missing was how sexual behaviors had changed in the intervening years and how sexual behaviors and attitudes would impact sexually transmitted infection rates (Laumann et al., 1994a).

Designing and implementing the study was complicated by the fact that the researchers from the University of Chicago and the gov- ernment officials who were spearheading the project seemed to have different goals (Michael et al., 1994). The researchers wanted to include broad questions about sexual behavior, but government officials wanted a strict focus on sexually transmitted infections (STIs) and HIV/AIDS. The researchers wanted to focus on a wide variety of issues connected to sexu- ality, arguing that so little was known about Americans’ sexual practices that they would not assume to know what factors were relevant; government officials argued that some topics (including masturbation) had nothing to do with the transmission of STIs and thus should

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relationships among an individual’s social posi- tion, sexual practices, and attitudes by looking at patterns that developed between them.

Sexual Behaviors and Number of Sexual Partners Popular media often tell us that the average American has a varied and exciting sex life, including high numbers of sex partners and very frequent sex; the NHSLS suggests that these representations are inaccurate. Accord- ing to the NHSLS, the vast majority of Ameri- cans tended to be monogamous, had either zero or one partner per year, and had sex with fewer than four partners after age 18. In terms of gender differences, men had sex earlier in life and reported more sexual partners over their lifetimes than did women.

Sexual Orientation One of the most innovative parts of the NHSLS was how the researchers measured sexual orientation. Many Americans believe that same-sex sexual behavior, identity, and desire are intrinsically linked. Guided by a sociological perspective, the researchers mea- sured these concepts separately. While there was, of course, some overlap between desire, behavior, and identity (for example, most indi- viduals who self-identified as gay or lesbian also reported same-sex desire and behaviors), there were significant numbers of participants who reported either same-sex desire without corresponding behavior or same-sex behavior without corresponding self-identification. Fur- ther reinforcing the idea that desire, behavior, and self-identity are conceptually different is the fact that 10 percent of men reported either same-sex attraction, desire, or identity but less than 3 percent of men indicated all three; simi- larly, 8 percent of women reported some form of same-sex sexuality (either desire, behavior, or self-identity) but less than 2 percent of women reported all three (Erickson and Steffen, 1999).

During these delays and funding negotia- tions, the research team conducted a number of pilot studies, which heavily informed their research methods and survey questions. For example, researchers learned that many Ameri- cans at the time did not understand terms like vaginal or heterosexual, requiring the research- ers to think carefully about question wording and ordering to avoid terminology that par- ticipants might consider confusing, offensive, provocative, or “sexy.” After deciding to con- duct interviews rather than distributing self- administered surveys, the researchers held focus groups to determine how to select interviewers who would be able to gain the trust of the par- ticipants and with whom participants would be comfortable discussing their sexual histories. Almost everyone who participated in the focus groups, including men, and Hispanic and Afri- can-American men and women, said they would prefer to be interviewed by middle-aged white women (Michael et al., 1994). In the end, 220 highly trained interviewers conducted 3,432 face-to-face interviews across the United States, each of which lasted about 90 minutes (Michael et al., 1994). Nearly 80 percent of those who were selected for participation completed their interview, a rate that challenged the widely held belief that Americans would simply not partici- pate in a study about sex (Michael et al., 1994).

Findings of the National Health and Social Life Survey1

The researchers behind the NHSLS approached their task from a distinctly sociological per- spective, acknowledging that “an individual’s social environment affects sexual behavior” (Laumann et al., 1994a: 4). Any number of social factors, including age, race, socioeco- nomic status, and gender, affect an individual’s sexual behavior, the meanings they associate with sex, and even what they believe “counts” as sex. The NHSLS attempted to describe the

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people found appealing, respondents were asked to rate a wide variety of sexual activities, ranging from oral sex and anal stimulation to group sex and sex with a stranger. Some crit- ics have argued that what was excluded from this list are “activities that women’s sexual scripts define as pleasurable, such as kissing and mutual masturbation. . . . The authors, like many male researchers before them, described a world in which men owned desire and initi- ated sexual activity and women chose whether to respond” (Erickson and Steffen, 1999: 215).

CONTINUOUS NATIONAL SURVEY OF FAMILY GROWTH (2006–2010)

The National Survey of Family Growth (NSFG) was created in 1971 by the Centers for Disease Control and Prevention. Over time, the NSFG has changed dramatically, but the goal of the study—to interview a nation- ally representative sample of Americans about pregnancy, marriage, and contraceptive use through in-person interviews—has remained the same (Groves et al., 2009). Since 1973, data have been gathered every few years using the area probability technique. All the inter- views are conducted by women interview- ers. Each time a cycle was completed, major changes were made. When the survey was first conducted in 1973, for example, only women who had been or were married were included because it was deemed “too sensitive” to ask women who had never been married about pregnancy and marriage (Martinez, Copen, and Abma, 2011). Over the years, many modi- fications have been made: young people, never-married women, and adult men were added to the sample, and changes in technol- ogy have allowed researchers to use laptops and interviewing software to encourage par- ticipants to give honest answers to questions about sensitive topics (Groves et al., 2009; Martinez, Copen, and Abma, 2011).

Forced Sex One of the results that Laumann and his col- leagues found most shocking were the rates of forced and coerced sex among the respondents. The researchers found that almost 22 percent of women reported that they had been forced by a man to do something sexual that they did not want to do; almost all (over 95 percent) reported that they knew the person that forced them. Interestingly, less than 3 percent of men reported that they had forced a woman to do something sexual they did not want to do. One of the explanations that Laumann and his col- leagues offered for this gap was a difference in sexual scripts: Men, they argued, are encour- aged to “negotiate” for sex with women, and women are encouraged through traditional gender roles to resist sex. The resultant conflict creates “not a gender gap, but a gender chasm” between men and women’s understanding of forced sex (Michael et al., 1994: 221).

Limitations of the National Health and Social Life Survey Because it used an area probability sample, the NHSLS excluded those individuals who do not live in a household. The limited availability of funding forced the researchers to limit the sample size, which resulted in some minority groups (gays and lesbians, for example, and some racial/ethnic groups) being inadequately represented. In addition, the sample age range had to be limited to those between 18 and 59 (Michael et al., 1994).

Despite the care with which the interview questions were created, the wording of some of the questions has been criticized. For example, one of the major findings of the NHSLS was that women had less sexual experience than men and reported being less interested in every type of sexual activity compared to men (Erickson and Steffen, 1999; Michael et  al., 1994). To understand what kinds of activities

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and Human Services, 2015). Some behaviors are quite common among adults; for example, almost all adult women (94 percent) and adult men (92 percent) have engaged in vaginal inter- course. Oral sex is also quite common among adults. The vast majority of those aged 18–24 have engaged in heterosexual oral sex (78 per- cent of men and 77 percent of women). There are, however, differences in this behavior by education level among women and men (see table below). For men and women, there is a greater likelihood of having engaged in oral sex as education level increases. This effect of edu- cation, though, seems to be greater for women than for men.

Percent of Men and Women Who Have Engaged in Oral Sex with Opposite-Sex Partner by Education Level

women men No high school 72.6% 80.2% High school/GED 87.3% 90.9% Some college 92.2% 92.7% Bachelor’s or higher 91.5% 91.7%

Women and men with no high school education are less likely to report having engaged in oral sex (72.6 percent for women, 80.2 percent for men) than those with more education. When we compare those with the highest level of edu- cation, we find that a similar proportion of men (91.7 percent) and women (91.5 percent) have engaged in oral sex and in greater percentages than those with either no or only a high school education.

Sexual Identity Like the National Health and Social Life Sur- vey from the 1990s, the NSFG assessed sexual orientation in a variety of ways and found dif- fering levels of same-sex activities depending on how they were measured; the survey also found large gender differences in the reporting

By the time the sixth cycle of the NSFG was completed in 2002, American society had changed dramatically. It was becoming prohibi- tively expensive to continue using the same data- collection methods (including recruiting and interviewing participants) because Americans were less willing to participate in large-scale research (Groves et al., 2009). To address these changes, the NSFG underwent a major method- ological and design change in 2006. Rather than doing data collection in one 12-month cycle, the researchers decided to collect data continuously throughout the year by using a rotating sample of PSUs (Groves et al., 2009). Collecting data con- tinuously saved the researchers money by allow- ing them to employ a smaller number of highly skilled interviewers. It also meant researchers could release results more often. More than three-quarters of those contacted participated in the 2006–2010 cycles of the NSFG. Interviewers conducted 22,682 face-to-face interviews with men and women between the ages of 15 and 44 over that four-year period (Martinez, Copen, and Abma, 2011). Interviewing has continued in the years since. From 2011 to 2015, 20,621 interviews were conducted with men and women around the country (U.S. Department of Health and Human Services, 2016). In September 2015, the NSFG expanded the age range for partici- pants by five years to include men and women up to age 49 (U.S. Department of Health and Human Services, 2016).

Findings of the 2006–2008 National Survey of Family Growth2

Sexual Behaviors and Number of Sexual Partners Many of the findings across the most recent cycles of the NSFG have remained remarkably consistent. The median number of lifetime sex- ual partners has remained essentially the same since 2002, about 4 for women and 6.5 for men aged 25–44 (U.S. Department of Health

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2013–2015, these numbers had increased to 72 percent of girls and 78 percent of boys. The NSFG also assesses the consistency with which people use condoms by asking unmarried men and women who had ever used a condom and who had sex within the four weeks prior to the interview whether they used condoms “none of the time,” “some of the time,” or “every time” they had sex. For men in this age range, con- dom use became more consistent over time. The percentage of men answering “none of the time” fell from 71 percent in 2002 to 64 percent in 2013, and the percentage report- ing they used condoms “some of the time” and “every time” increased by 4 percent and 2 percent, respectively. Women’s consistency in condom use has fluctuated a small amount over time. Approximately 74 percent of women reported using condoms none of the time in the four weeks prior to their interview, about 7 percent reported using condoms some of the time, and between 19 percent and 21 percent reported using condoms every time they had sex. Though their condom use may be slightly less consistent than men’s, women’s use of con- traceptives over the lifetime and at last sex have remained relatively consistent over time (98 percent and 62 percent, respectively). While condoms and long-acting reversible contracep- tives (e.g., Depo-Provera, intrauterine devices), emergency contraceptives, and contraceptive patches have increased in popularity over time, other methods (such as the hormonal birth con- trol pill) have decreased slightly in popularity.

Limitations of the National Survey of Family Growth Like the National Health and Social Life Sur- vey, the NSFG excludes those who do not live in a household. In addition, because the origi- nal focus of the NSFG was fertility and mar- riage, it only includes people who are in their reproductive years. While it would certainly

of same-sex sexual experiences. For example, in the 2011–2013 NSFG, approximately 1 percent of women and 2 percent of men self-identified as “homosexual, gay, or lesbian,” and approxi- mately 5 percent of women and 2 percent of men self-identified as bisexual. Those numbers are significantly lower than the percentage of women (17.4) and men (6.2) who reported having “any same-sex sexual experiences.” The ability to compare findings across time is one of the major strengths of the NSFG, espe- cially since there is “considerable fluidity in the development and expression of sexual behavior and orientation over time” (Gartrell, Bos, and Goldberg, 2011: 3). For example, comparing the data for adolescent girls across the cycles shows that since 2002, the percentage of girls who had sex with boys dropped significantly, while the percentage of girls reporting same- sex contact doubled (from 5 to 10 percent) (Gartrell, Bos, and Goldberg, 2011). The ado- lescent girls in the most recent cycles were also older the first time they had sexual contact with boys compared with girls in the earlier cycles, and were less likely than the earlier cohorts to have experienced a pregnancy (Gartrell, Gos, and Goldberg, 2011).

Condom and Contraceptive Use In addition to sexual practices and identity, the NSFG also collects information about repro- ductive health, including condom and contra- ceptive use (U.S. Department of Health and Human Services, 2015). Overall, condom use has increased in the last 15 years. In 2002, 42 percent of women and 48 percent of men reported having used a condom the first time they had sexual intercourse. When this was measured again from 2011–2013, 56 percent of women and 66 percent of men reported using a condom at first sex. Condom use has increased for teenagers as well. In 2002, 66 per- cent of girls and 71 percent of boys aged 15–19 used condoms the first time they had sex; by

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The National Survey of Sexual Health and Behavior (NSSHB) was designed with the intention of assessing how individuals “make health-related decisions once they decide to become sexually active” (Reece et al., 2010a: 245). Unlike the earlier large-scale studies that used face-to-face interviews, the NSSHB relied on an internet-based survey—the first of its kind. The researchers partnered with a pri- vate company to create a representative sample that was then used to conduct research online (Herbenick et al., 2010a). The probability sam- ple they created used both phone numbers and addresses, allowing those individuals who only used cell phones to be included. Respon- dents were initially contacted through mailings and phone calls. When they agreed to partici- pate, they either accessed the internet on their own  to complete the survey or were provided a computer and internet access by the research company (Herbenick et al., 2010a). In total, there were 5,865 participants in the NSSHB (Herbenick et al., 2010a). The researchers con- tinued to collect data annually from 2012 to 2015, using a diverse set of questions (Dodge et al., 2016).

Findings from the National Survey of Sexual Health and Behavior3

Sexual Behaviors over the Life Course One of the major strengths of the NSSHB is the broad age range of the respondents, which allowed the researchers to better under- stand the “developmental trajectory of sexual expression” (Herbenick et al., 2010a: 261). The NSSHB demonstrated how the behaviors individuals engaged in changed over the life course. For example, masturbation was more common than partnered sexual activities for men under age 24 and over age 50. Vaginal intercourse, too, was quite common—it was the most common sexual activity for men and women between the ages of 25 and 49, but

be beneficial to include teens in the study, it is especially important because the baby boomer generation is rapidly aging out of their repro- ductive years—excluding a large portion of the population from participating in the NSFG.

Another concern with the NSFG is how the survey measures same-sex sexual behaviors. Although the most recent cycle of the NSFG measures same-sex sex between men based on giving or receiving oral sex and anal sex, it asks women about less specific practices (giving or receiving oral sex with another woman and vague “sexual experiences”). This could lead to larger numbers of women being classified as having same-sex sexual behavior. The differ- ence in wording might also reflect heteronor- mative understandings of gender and sexuality; namely, that sexual acts can be quantified as events that prioritize penile penetration.

NATIONAL SURVEY OF SEXUAL HEALTH AND BEHAVIOR (2010)

By the early 2000s, sexual norms and atti- tudes in the United States had shifted again. Doctors were frequently prescribing Viagra and other medications to help with sexual dysfunction, allowing older adults to engage in sexual practices later in the life course. Attitudes about same-sex practices were lib- eralizing, sex education in schools continued on an abstinence-only path, and access to the internet and social networking sites became widespread (Reece et al., 2010a). Clearly, more research was needed to understand how these changes in American society were affect- ing our sexual lives, especially with regard to adults who were past middle age. In 2007, researchers at the Center for Sexual Health Promotion at Indiana University partnered with Church & Dwight Co. Inc. (the makers of Trojan condoms) to conduct a nationally representative study on sexual behavior (Her- benick et al., 2010a).

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for this, more research is needed to explore the inconsistency (Herbenick et al., 2010c).

With whom individuals had sex also appeared to affect both their evaluations of their last encounter and the rates that they orgasmed, but the effects were different for men and women. Men reported that they expe- rienced greater arousal, greater pleasure, and fewer problems when their last encounter was with a relationship partner than when it was with someone with whom they were not in a relationship. The researchers concluded that this difference might occur because as men age and experience sexual difficulty, being com- fortable with and receiving patience from a partner is important (Herbenick et al., 2010c). Women, on the other hand, reported more sexual difficulties when their last encounter was with a relationship partner than not. This finding challenges the common notion that for women, love and emotional connection are nec- essary in order to be sexually satisfied. Though the majority of those who participated in the NSSHB were in a relationship, a significant proportion of men (30 percent) and women (18 percent) of all ages reported that their last sexual encounter was with a “friend” or “new acquaintance,” indicating that the “friends with benefits” phenomenon is not limited to young adults (Herbenick et al., 2010c).

Limitations of the National Survey of Sexual Health and Behavior Like the other nationally representative studies already described, the NSSHB relied on house- hold-level data, which excludes institutionalized individuals. And although the NSSHB features a broader age range than any other large-scale sex survey, it is not representative of older adults, who may be more likely than adults of younger ages to be in an institutional setting (i.e., hos- pitalized or in an assisted-living facility). Older adults might also be less comfortable using

became less frequent among women begin- ning at age 30. Oral sex and anal sex “appear to be well established aspects of a contem- porary sexual repertoire” (Herbenick et al., 2010a: 259). Forty percent of respondents had engaged in anal sex during their lifetime (an increase since the NHSLS in 1994). Despite cultural fears of rampant sexual activity among young people, teen sex was episodic and “safer” than anticipated. Less than one-third of teens had partnered sex in the past year, and dur- ing sex, “condom use appears to have become a normative behavior for many adolescents” (Fortenberry et al., 2010: 314).

Sexual Behaviors at Last Sexual Encounter Some of the most interesting findings from the NSSHB concerned what types of behaviors people engaged in when they last had sex. The researchers investigated where individuals had sex, with whom they had sex (i.e., a relation- ship partner, a friend/acquaintance, etc.), any sexual difficulties that occurred, whether they had an orgasm, and how pleasurable they rated the encounter (Herbenick et al., 2010c). While vaginal intercourse was most common, partici- pants reported more than 41 combinations of sexual activities (including giving and receiving oral sex, anal sex, and partnered masturbation) (Herbenick et al., 2010c). Men and women reported that they were more likely to have an orgasm if they engaged in a variety of behav- iors. Women in particular reported higher rates of orgasm if vaginal intercourse was paired with other behaviors (Herbenick et al., 2010c). Despite everyone reporting high rates of plea- sure at their last encounter, men tended to overestimate how often their female partner had an orgasm. The vast majority of men (85 percent) reported their partner had an orgasm, compared to the 64 percent of women who said they did. This gap is too large to be explained by same-sex couples included in the study. While there may be a variety of explanations

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challenges (including inadequate funding, limited government support, and the shortcomings of the methods themselves), the studies outlined in this article show the value of large-scale research on sexual behaviors. Research conducted by main- stream publications, such as Cosmopolitan and Playboy, is inadequate and often misleading, giv- ing a false impression of what is “normal” under the guise of “research.” Readers must be critical of these studies, analyzing the research design and sampling methodology to fully understand how the research was conducted and whether it is valid. In addition to large-scale sexual surveys, many qualitative and in-depth studies have been done on small populations. Although these stud- ies are not generalizable to the larger population, they do contribute a nuanced understanding of sexual practices, attitudes, and identities that is often lost in large-scale representative research. If we want to continue to answer questions about “average Americans” and what their sexual lives are like, the government and the general public must support both quantitative and qualitative research projects.

NOTES 1. All results from Laumann et al., 1994a (unless otherwise noted).

2. All data from Copen, Chandra, and Febo-Vazquez, 2016 (unless otherwise noted).

3. All data from Herbenick et al., 2010a (unless otherwise noted).

REFERENCES Chandra, Anjani, William D. Mosher, Casey Copen and

Catlainn Sionean. 2011. “Sexual Behavior, Sexual Attraction and Sexual Identity in the United States: Data from the 2006–2008 National Survey of Family Growth.” National Center for Health Statistics, National Health Statistics Reports 36.

Copen, Casey E., Anjani Chandra, and Isaedmarie Febo- Vazquez. 2016. “Sexual Behavior, Sexual Attraction, and Sexual Orientation among Adults Aged 18–44 in the United States: Data from the 2011–2013 National Survey of Family Growth.” National Center for Health Statistics, National Health Statistics Reports 88.

Dodge, Brian, Debby Herbenick, M. Reuel Friedman, Vanessa Schick, Tsung-Chieh (Jane) Fu, Wendy

computers and the internet. Like the other stud- ies reviewed in this reading, the NSSHB did not oversample some minority groups (in particu- lar, those with same-sex behaviors) (Herbenick et al., 2010a). Because the NSSHB focused more on public health and the life course than the previous studies, the questions were struc- tured differently. This makes it difficult to compare results across time (to, for example, the NHSLS). The use of the internet was both a strength and a weakness. While the internet might create the feeling of increased confiden- tiality when reporting stigmatized behaviors, it was unclear whether this held true for all ages. Also, it was unclear whether individuals who could not read or were not comfortable using a computer would have been as likely to partici- pate (Reece et al., 2010a).

Although the NSSHB collected detailed information about sexuality across age groups, what it lacks is contextual data. One of the ben- efits of in-person interviewing is that it allows the researcher to build rapport with the partici- pant, promoting disclosure and offering insight into the individual’s sexual experiences. Previ- ous studies allowed for analysis of sexual experi- ences based on individuals’ life experiences and social demographics (like age, race, and class), something that the NSSHB cannot offer (Reece et al., 2010a). The NSSHB is less sociological than the National Health and Social Life Sur- vey; while health information is certainly valu- able, it is equally important to understand the sociological context of sexual behaviors, includ- ing how social groups and culture shape our understanding of sex and our sexual practices.

CONCLUSION

Using probability sampling methods and con- ducting representative research is an important way for us to understand the sexual behaviors of large portions of Americans. Though these methods are complex and come with a host of

D O I N G I T D I F F E R E N T LY 85

———. 2015. “The Other Sex Work: Stigma in Sexuality Research.” Social Currents 2(2): 116–25.

Kinsey Institute. “Alfred Kinsey’s 1948 and 1953 Studies.” Retrieved December 8, 2011 from http://www .kinseyinstitute.org/research/ak-data.html.

Laumann, Edward O., John H. Gagnon, Robert T. Michael and Stuart Michaels. 1994a. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press.

Laumann, Edward O., Robert T. Michael, and John H. Gagnon. 1994b. “A Political History of the National Sex Survey of Adults.” Family Planning Perspectives, 26(1): 34–38.

Martinez, Gladys, Casey E. Copen, and Joyce C. Abma. 2011. “Teenagers in the United States: Sexual Activity, Contraceptive Use and Childbearing, 2006–2010.” National Survey of Family Growth, National Center for Health Statistics. Vital Health Statistics, 23: 31.

Michael, Robert T., John H. Gagnon, Edward O. Laumann and Gina Kolata. 1994. Sex in America: A Definitive Survey. Boston: Little Brown.

Reece, Michael, Debby Herbenick, Vanessa Schick, Stephanie Sanders, Brian Dodge and J. Dennis Fortenberry. 2010a. “Guest Editorial: Background and Considerations on the National Survey of Sexual Health and Behavior (NSSHB) from the Investigators.” Journal of Sexual Medicine, 7(5): 243–45.

——— 2010b. “Sexual Behaviors, Relationships, and Perceived Health Status among Adult Women in the United States: Results from a Probability Sample.” Journal of Sexual Medicine, 7(5): 291–304.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2015. “Key Statistics from the National Survey of Family Growth.” Retrieved from https://www.cdc.gov/nchs/nsfg /key_statistics.htm.

———. 2016. “User’s Guide: Public Use Data File Documentation, 2013–2015.” National Survey of Family Growth, National Center for Health Statistics.

Bostwick, Elizabeth Bartelt, Miguel Muñoz-Laboy, David Pletta, Michael Reece, and Theo G. M. Sandfort. 2016. “Attitudes towards Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States.” PLoS One, 11(10): 1–18.

Erickson, Julia A., with Sally A. Steffen. 1999. Kiss and Tell: Surveying Sex in the Twentieth Century. Cambridge, MA: Harvard University Press.

Fortenberry, J. Dennis, Vanessa Schick, Debby Herbenick, Stephanie Sanders, Brian Dodge, and Michael Reece. 2010. “Sexual Behaviors and Condom Use at Last Vaginal Intercourse: A National Sample of Adolescents Ages 14 to 17 Years.” Journal of Sexual Medicine, 7(5): 305–14.

Gartrell, Nanette K., Henny M. W. Bos, and Naomi G. Goldberg. 2011. “New Trends in Same-Sex Sexual Contact for American Adolescents?” Archives of Sexual Behavior, 40(6): 1–3.

Groves, Robert M., William D. Mosher, James M. Lepkowski, Nicole G. Kirgis. 2009. “Planning and Development of the Continuous National Survey of Family Growth.” National Center for Health Statistics, Vital Health Statistics, 1: 48.

Herbenick, Debby, Michael Reece, Vanessa Schick, Stephanie Sanders, Brian Dodge and J. Dennis Fortenberry. 2010a. “Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14–94.” Journal of Sexual Medicine, 7(5): 255–65.

———. 2010b. “Sexual Behaviors, Relationships, and Perceived Status among Adult Women in the United States: Results from a Probability Sample.” Journal of Sexual Medicine, 7(5): 277–90.

———. 2010c. “Event-Level Analysis of the Sexual Characteristics and Composition Among Adults Ages 18–59: Results from a National Probability Sample.” Journal of Sexual Medicine, 7(5): 346–61.

Irvine, Janice M. 2012. “Can’t Ask, Can’t Tell.” Contexts, 11(2): 28–33.

A national survey of sexual practices found that men report having more sexual partners than women over the course of their lifetimes

(Smith et al., 2011). Theoretically, hetero- sexual men’s and women’s estimates should be the same, because for each new female

Doing It Differently: Women’s and Men’s Estimates of Their Number of Lifetime Sexual Partners

Mindy Stombler and Dawn M. Baunach

86 I N V E S T I G AT I N G S E X UA L I T Y

when researchers shorten the time frame for estimation to the past year or the past five years (see table below), indicating that both men and women estimate more accurately over a shorter period of time. In addition, the cultural mean- ing that we attach to our accumulated lifetime number of sexual partners carries more weight than, say, the number of partners we might have in a year. Taking the double standard into account, it might be in women’s best interest to carefully consider their number of lifetime sexual partners and in men’s best interest to round up.

Mean Number of Sexual Partners

diffeRence women men (men–women)

Last five 1.59 2.08 0.49 years (n = 942) (n = 803) Last year 1.01 1.26 0.25 (n = 953) (n = 804)

Note: Weighted sample sizes used. Source: General Social Survey, 2016.

REFERENCES Brown, Norman R., and Robert C. Sinclair. 1999.

“Estimating Number of Lifetime Sexual Partners: Men and Women Do It Differently.” Journal of Sex Research, 36(3): 292–97.

Smith, Tom W., Peter Marsden, Michael Hout, and Jibum Kim. 2011. General Social Surveys, 1972–2010 [machine-readable data file]. Principal Investigator, Tom W. Smith; Co-Principal Investigator, Peter V. Marsden; Co-Principal Investigator, Michael Hout; Sponsored by National Science Foundation. Chicago, IL: National Opinion Research Center [producers]; Storrs, CT: Roper Center for Public Opinion Research, University of Connecticut [distributor].

Weiderman, Michael. 1997. “The Truth Must Be in Here Somewhere: Examining the Gender Discrepancy in Self- Reported Lifetime Number of Partners.” Journal of Sex Research, 34(4): 375–86.

partner a man adds to his “lifetime account,” a woman adds a new male partner to her “lifetime account.” The discrepancy between women’s and men’s estimates remains even when researchers define sexual partners very specifically and account for possible sampling problems (such as undersampling female sex workers). What explains the gender gap in claims people make about numbers of sexual partners?

One possibility is that women and men misrepresent their number of lifetime sexual partners to others. Our society tends to hold a double standard regarding the sexual behavior of women and men. Men who have a great deal of sexual experience generally are not subject to shame (and in some circles their behavior is lauded), whereas women with “too many” life- time partners are stigmatized. Attempts to give interviewers the socially approved response (called social desirability bias) may lead women to intentionally underreport their numbers or men to inflate theirs.

Another possibility is that people misrepre- sent their behaviors to themselves. If women discount partners for whom they feel little affec- tion, such partners could slip from memory, thereby erroneously lowering their reported lifetime account. Women and men also rely on different estimation strategies. Women tend to enumerate (actually count), whereas men tend to give rough estimates (Brown and Sinclair, 1999; Weiderman, 1997). Weiderman notes a clear tendency for men reporting larger  num- bers of lifetime sexual partners to choose numbers that end in 0 or 5. Men prefer “round” numbers rather than exact counts.

The number of sexual partners that women and men report does become more similar

87

R E A D I N G 9

From “Racism and Research: The Case of the Tuskegee Syphilis Study,” Hastings Center Report, Vol. 8, No. 6, 1978, pp. 21–29. © 1978 The Hastings Center. Reprinted by per- mission of John Wiley & Sons, Inc.

been largely misunderstood. The most basic questions of how the study was undertaken in the first place and why it continued for forty years were never addressed by the HEW inves- tigation. Moreover, the panel misconstrued the nature of the experiment, failing to consult important documents available at the National Archives which bear significantly on its ethi- cal assessment. Only by examining the specific ways in which values are engaged in scientific research can the study be understood.

RACISM AND MEDICAL OPINION

A brief review of the prevailing scientific thought regarding race and heredity in the early twenti- eth century is fundamental for an understand- ing of the Tuskegee Study. By the turn of the century, Darwinism had provided a new ratio- nale for American racism.3 Essentially primitive peoples, it was argued, could not be assimilated into a complex, white civilization. Scientists speculated that in the struggle for survival the Negro in America was doomed. Particularly prone to disease, vice, and crime, black Ameri- cans could not be helped by education or phi- lanthropy. Social [Darwinists] analyzed census data to predict the virtual extinction of the Negro in the twentieth century, for they believed the Negro race in America was in the throes of a degenerative evolutionary process.4

In 1932 the U.S. Public Health Service (USPHS) initiated an experiment in Macon County, Alabama, to determine the natu- ral course of untreated, latent syphilis in black males. The test comprised 400 syphi- litic men, as well as 200 uninfected men who served as controls. The first published report of the study appeared in 1936 with subse- quent papers issued every four to six years, through the 1960s. When penicillin became widely available by the early 1950s as the pre- ferred treatment for syphilis, the men did not receive therapy. In fact, on several occasions, the USPHS actually sought to prevent treat- ment. Moreover, a committee at the federally operated Centers for Disease Control (CDC) decided in 1969 that the study should be con- tinued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education, and Welfare (HEW) halt the experiment. At that time seventy-four of the test subjects were still alive; at least twenty-eight, but perhaps more than 100, had died directly from advanced syphilitic lesions.1 In August 1972, HEW appointed an investigatory panel which issued a report the following year. The panel found the study to have been “ethically unjustified,” and argued that penicillin should have been provided to the men.2

This [reading] attempts to place the Tuske- gee Study in a historical context and to assess its ethical implications. Despite the media atten- tion which the study received, the HEW Final Report, and the criticism expressed by several professional organizations, the experiment has

RACISM AND RESEARCH: THE CASE OF THE TUSKEGEE SYPHILIS STUDY

A L L A N M . B R A N D T

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The attacks on defenseless white women are evi- dences of racial instincts that are about as ame- nable to ethical culture as is the inherent odor of the race.  .  .  .  When education will reduce the size of the negro’s penis as well as bring about the sen- sitiveness of the terminal fibers which exist in the Caucasian, then will it also be able to prevent the African’s birth-right to sexual madness and excess.11

One southern medical journal proposed “Cas- tration Instead of Lynching” as retribution for black sexual crimes. “An impressive trial by a ghost-like kuklux klan [sic] and a ‘ghost’ physi- cian or surgeon to perform the operation would make it an event the ‘patient’ would never for- get,” noted the editorial.12

According to these physicians, lust and immo- rality, unstable families, and reversion to barbaric tendencies made blacks especially prone to vene- real diseases. One doctor estimated that over 50 percent of all Negroes over the age of twenty- five were syphilitic.13 Virtually free of disease as slaves, they were now overwhelmed by it, accord- ing to informed medical opinion. Moreover, doctors believed that treatment for venereal disease among blacks was impossible, particu- larly because in its latent stage the symptoms of syphilis become quiescent. As Dr.  Thomas W. Murrell wrote:

They come for treatment at the beginning and at the end. When there are visible manifestations or when harried by pain, they readily come, for as a race they are not averse to physic; but tell them not, though they look well and feel well, that they are still dis- eased. Here ignorance rates science a fool. . . .14

Even the best educated black, according to Murrell, could not be convinced to seek treat- ment for syphilis.15 Venereal disease, according to some doctors, threatened the future of the race. The medical profession attributed the low birth rate among blacks to the high prevalence of venereal disease which caused stillbirths and miscarriages. Moreover, the high rates of syphilis were thought to lead to increased

The medical profession supported these findings of late nineteenth- and early twentieth- century anthropologists, ethnologists, and biol- ogists. Physicians studying the effects of emancipation on health concluded almost uni- versally that freedom had caused the mental, moral, and physical deterioration of the black population.5 They substantiated this argument by citing examples in the comparative anatomy of the black and white races. As Dr. W. T. Eng- lish wrote: “A careful inspection reveals the body of the negro a mass of minor defects and imperfections from the crown of the head to the soles of the feet.  .  .  .”6 Cranial structures, wide nasal apertures, receding chins, projecting jaws, all typed the Negro as the lowest species in the Darwinian hierarchy.7

Interest in racial differences centered on the sexual nature of blacks. The Negro, doctors explained, possessed an excessive sexual desire, which threatened the very foundations of white society. As one physician noted in the Journal of the American Medical Association, “The negro springs from a southern race, and as such his sexual appetite is strong; all of his environments stimulate this appetite, and as a general rule his emotional type of religion certainly does not decrease it.”8 Doctors reported a complete lack of morality on the part of blacks:

Virtue in the negro race is like angels’ visits—few and far between. In a practice of sixteen years I have never examined a virgin negro over fourteen years of age.9

A particularly ominous feature of this overzeal- ous sexuality, doctors argued, was the black males’ desire for white women. “A perversion from which most races are exempt,” wrote Dr. English, “prompts the negro’s inclination towards white women, whereas other races incline towards females of their own.”10 Though English esti- mated the “gray matter of the negro brain” to be at least a thousand years behind that of the white races, his genital organs were overdeveloped. As Dr. William Lee Howard noted:

R AC I S M A N D R E S E A RC H 89

Three years later, in 1932, Dr. Taliaferro Clark, chief of the USPHS Venereal Dis- ease  Division and author of the Rosenwald Study report, decided that conditions in Macon County merited renewed attention. Clark believed the high prevalence of syphilis offered an “unusual opportunity” for observation. From its inception, the USPHS regarded the Tuske- gee Study as a classic “study in nature,”* rather than an experiment.20 As long as syphilis was so prevalent in Macon and most of the blacks went untreated throughout life, it seemed only natural to Clark that it would be valuable to observe the consequences. He described it as a “ready-made situation.”21 Surgeon General H. S. Cumming wrote to R. R. Moton, director of the Tuskegee Institute:

The recent syphilis control demonstration carried out in Macon County, with the financial assistance of the Julius Rosenwald Fund, revealed the presence of an unusually high rate in this county and, what is more remarkable, the fact that 99 per cent of this group was entirely without previous treatment. This combina- tion, together with the expected cooperation of your hospital, offers an unparalleled opportunity for carry- ing on this piece of scientific research which probably cannot be duplicated anywhere else in the world.22

Although no formal protocol appears to have been written, several letters of Clark and Cum- ming suggest what the USPHS hoped to find. Clark indicated that it would be important to see how disease affected the daily lives of the men:

The results of these studies of case records suggest the desirability of making a further study of the effect of untreated syphilis on the human economy among people now living and engaged in their daily pursuits.23

It also seems that the USPHS believed the experiment might demonstrate that antisyphi- litic treatment was unnecessary. As Cumming noted: “It is expected the results of this study may have a marked bearing on the treatment, or conversely the non-necessity of treatment, of cases of latent syphilis.”24 . . .

insanity and crime. One doctor writing at the turn of the century estimated that the number of insane Negroes had increased thirteen-fold since the end of the Civil War.16 Dr. Murrell’s conclusion echoed the most informed anthro- pological and ethnological data:

So the scourge sweeps among them. Those that are treated are only half cured, and the effort to assim- ilate a complex civilization [is] driving their dis- eased minds until the results are criminal records. Perhaps here, in conjunction with tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.17

This particular configuration of ideas formed the core of medical opinion concerning blacks, sex, and disease in the early twentieth century. Doctors generally discounted socioeconomic explanations of the state of black health, argu- ing that better medical care could not alter the evolutionary scheme.18 These assumptions pro- vide the backdrop for examining the Tuskegee Syphilis Study.

THE ORIGINS OF THE EXPERIMENT

In 1929, under a grant from the Julius Rosen- wald Fund, the USPHS conducted studies in the rural South to determine the prevalence of syphilis among blacks and explore possibilities for mass treatment. The USPHS found Macon County, Alabama, in which the town of Tuske- gee is located, to have the highest syphilis rate of the six counties surveyed. The Rosenwald Study concluded that mass treatment could be successfully implemented among rural blacks.19 Although it is doubtful that the necessary funds would have been allocated even in the best economic conditions, after the economy collapsed in 1929, the findings were ignored. It is, however, ironic that the Tuskegee Study came to be based on findings of the Rosenwald Study that demonstrated the possibilities of mass treatment.

90 I N V E S T I G AT I N G S E X UA L I T Y

had made initially regarding the prevalence of the disease in Macon County. Overall rates of syphilis fell well below expectations; as opposed to the USPHS projection of 35 percent, 20 per- cent of those tested were actually diseased.30 Moreover, those who had sought and received previous treatment far exceeded the expecta- tions of the USPHS. Clark noted in a letter to Vonderlehr:

I find your report of March 6th quite interesting but regret the necessity for Wassermanning [sic] . . .  such a large number of individuals in order to uncover this relatively limited number of untreated cases.31

Further difficulties arose in enlisting the subjects to participate in the experiment, to be “Wassermanned,” and to return for a subse- quent series of examinations. Vonderlehr found that only the offer of treatment elicited the cooperation of the men. They were told they were ill and were promised free care. Offered therapy, they became willing subjects.32 The USPHS did not tell the men that they were par- ticipants in an experiment; on the contrary, the subjects believed they were being treated for “bad blood”—the rural South’s colloquialism for syphilis. They thought they were participat- ing in a public health demonstration similar to the one that had been conducted by the Julius Rosenwald Fund in Tuskegee several years ear- lier. In the end, the men were so eager for medi- cal care that the number of defaulters in the experiment proved to be insignificant.33

To preserve the subjects’ interest, Vonderlehr gave most of the men mercurial ointment, a noneffective drug, while some of the younger men apparently received inadequate dosages of neoarsphenamine.34 This required Vonderlehr to write frequently to Clark requesting sup- plies. He feared the experiment would fail if the men were not offered treatment. . . .

The readiness of the test subjects to par- ticipate of course contradicted the notion that blacks would not seek or continue therapy.

SELECTING THE SUBJECTS

Clark sent Dr. Raymond Vonderlehr to Tuskegee in September 1932 to assemble a sample of men with latent syphilis for the experiment. The basic design of the study called for the selection of syphilitic black males between the ages of twenty-five and sixty, a thorough physi- cal examination including x-rays, and finally, a spinal tap to determine the incidence of neuro- syphilis.25 They had no intention of provid- ing any treatment for the infected men.26 The USPHS originally scheduled the whole experi- ment to last six months; it seemed to be both a simple and inexpensive project.

The task of collecting the sample, however, proved to be more difficult than the USPHS had supposed. Vonderlehr canvassed the largely illiterate, poverty-stricken population of share- croppers and tenant farmers in search of test subjects. If his circulars requested only men over twenty-five to attend his clinics, none would appear, suspecting he was conducting draft physicals. Therefore, he was forced to test large numbers of women and men who did not fit the experiment’s specifications. This involved considerable expense since the USPHS had promised the Macon County Board of Health that it would treat those who were infected but not included in the study.27 Clark wrote to Vonderlehr about the situation: “It never once occurred to me that we would be called upon to treat a large part of the county as return for the privilege of making this study. . . .  I am anxious to keep the expenditures for treat- ment down to the lowest possible point because it is the one item of expenditure in connection with the study most difficult to defend despite our knowledge of the need therefor.”28 Vonder- lehr responded: “If we could find from 100 to 200 cases . . .  we would not have to do another Wassermann on useless individuals. . . .”29

Significantly, the attempt to develop the sample contradicted the prediction the USPHS

R AC I S M A N D R E S E A RC H 91

sense of therapy. Should these cases be followed over a period of from five to ten years many interest- ing facts could be learned regarding the course and complications of untreated syphilis.37

“As I see it,” responded Wenger, “we have no further interest in these patients until they die.”38 Apparently, the physicians engaged in the exper- iment believed that only autopsies could scien- tifically confirm the findings of the study. . . .

Bringing the men to autopsy required the USPHS to devise a further series of deceptions and inducements. Wenger warned Vonderlehr that the men must not realize that they would be autopsied:

There is one danger in the latter plan and that is if the colored population become aware that accept- ing free hospital care means a post-mortem, every darkey will leave Macon County and it will hurt [Dr. Eugene] Dibble’s hospital.39

The USPHS offered several inducements to maintain contact and to procure the contin- ued cooperation of the men. Eunice Rivers, a black nurse, was hired to follow their health and to secure approval for autopsies. She gave the men non-effective medicines—“spring tonic” and aspirin—as well as transportation and hot meals on the days of their examinations.40 More important, Nurse Rivers provided continuity to the project over the entire forty-year period. By supplying “medicinals,” the USPHS was able to continue to deceive the participants, who believed that they were receiving therapy from the government doctors. Deceit was inte- gral to the study. When the test subjects com- plained about spinal taps, one doctor wrote:

They simply do not like spinal punctures. A few of those who were tapped are enthusiastic over the results but to most, the suggestion causes violent shaking of the head; others claim they were robbed of their procreative powers (regardless of the fact that I claim it stimulates them).41

Letters to the subjects announcing an impend- ing USPHS visit to Tuskegee explained: “[The

The final procedure of the experiment was to be a spinal tap to test for evidence of neuro- syphilis. The USPHS presented this purely diagnostic exam, which often entails consider- able pain and complications, to the men as a “special treatment.” Clark explained to Moore:

We have not yet commenced the spinal punctures. This operation will be deferred to the last in order not to unduly disturb our field work by any adverse reports by the patients subjected to spinal puncture because of some disagreeable sensations following this procedure. These negroes are very ignorant and easily influenced by things that would be of minor significance in a more intelligent group.35

The letter to the subjects announcing the spinal tap read:

Some time ago you were given a thorough examina- tion and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examina- tion. This examination is a very special one and after it is finished you will be given a special treatment if it is believed you are in a condition to stand it. . . . 

Remember This Is Your Last Chance For Special Free Treatment. Be Sure To Meet The Nurse.36

The HEW investigation did not uncover this crucial fact: the men participated in the study under the guise of treatment.

Despite the fact that their assumption regarding prevalence and black attitudes toward treatment had proved wrong, the USPHS decided in the summer of 1933 to con- tinue the study. Once again, it seemed only “nat- ural” to pursue the research since the sample already existed, and with a depressed economy, the cost of treatment appeared prohibitive— although there is no indication it was ever con- sidered. Vonderlehr first suggested extending the study in letters to Clark and Wenger:

At the end of this project we shall have a consider- able number of cases presenting various complica- tions of syphilis, who have received only mercury and may still be considered untreated in the modern

92 I N V E S T I G AT I N G S E X UA L I T Y

cluded, “We now know, where we could only surmise before, that we have contributed to their ailments and shortened their lives.”49 As black physician Vernal Cave, a member of the HEW panel, later wrote, “They proved a point, then proved a point, then proved a point.”50

During the forty years of the experiment the USPHS had sought on several occasions to ensure that the subjects did not receive treat- ment from other sources. To this end, Vonder- lehr met with groups of local black doctors in 1934, to ask their cooperation in not treating the men. Lists of subjects were distributed to Macon County physicians along with letters requesting them to refer these men back to the USPHS if they sought care.51 The USPHS warned the Alabama Health Department not to treat the test subjects when they took a mobile VD unit into Tuskegee in the early 1940s.52 In 1941, the Army drafted several subjects and told them to begin antisyphilitic treatment immediately. The USPHS supplied the draft board with a list of 256 names they desired to have excluded from treatment, and the board complied.53

In spite of these efforts, by the early 1950s many of the men had secured some treatment on their own. By 1952, almost 30 percent of the test subjects had received some penicillin, although only 7.5 percent had received what could be considered adequate doses.54 Vonder- lehr wrote to one of the participating physi- cians, “I hope that the availability of antibiotics has not interfered too much with this proj- ect.”55 A report published in 1955 considered whether the treatment that some of the men had obtained had “defeated” the study. The article attempted to explain the relatively low exposure to penicillin in an age of antibiotics, suggesting as a reason: “the stoicism of these men as a group; they still regard hospitals and medicines with suspicion and prefer an occa- sional dose of time-honored herbs or tonics to modern drugs.”56 The authors failed to note

doctor] wants to make a special examination to find out how you have been feeling and whether the treatment has improved your health.”42 In fact, after the first six months of the study, the USPHS had furnished no treat- ment whatsoever.

Finally, because it proved difficult to per- suade the men to come to the hospital when they became severely ill, the USPHS promised to cover their burial expenses. The Milbank Memorial Fund provided approximately $50 per man for this purpose beginning in 1935. This was a particularly strong inducement as funeral rites constituted an important component of the cultural life of rural blacks.43 One report of the study concluded, “Without this suasion it would, we believe, have been impossible to secure the cooperation of the group and their families.”44

Reports of the study’s findings, which app eared regularly in the medical press begin- ning in 1936, consistently cited the ravages of untreated syphilis. The first paper, read at the 1936 American Medical Association annual meeting, found “that syphilis in this period [latency] tends to greatly increase the frequency of manifestations of cardiovascular disease.”45 Only 16 percent of the subjects gave no sign of morbidity as opposed to 61 percent of the controls. Ten years later, a report noted coldly, “The fact that nearly twice as large a propor- tion of the syphilitic individuals as of the con- trol group has died is a very striking one.” Life expectancy, concluded the doctors, is reduced by about 20 percent.46

A 1955 article found that slightly more than 30 percent of the test group autopsied had died directly from advanced syphilitic lesions of either the cardiovascular or the central nervous system.47 Another published account stated, “Review of those still living reveals that an appreciable number have late complications of syphilis which probably will result, for some at least, in contributing materially to the ultimate cause of death.”48 In 1950, Dr. Wenger had con-

R AC I S M A N D R E S E A RC H 93

of them black, concentrated on two issues. First, was the study justified in 1932 and had the men given their informed consent? Sec- ond, should penicillin have been provided when it became available in the early 1950s? The panel was also charged with determining if the study should be terminated and assess- ing current policies regarding experimentation with human subjects.61 The group issued their report in June 1973.

By focusing on the issues of penicillin ther- apy and informed consent, the Final Report and the investigation betrayed a basic misun- derstanding of the experiment’s purposes and design. The HEW report implied that the fail- ure to provide penicillin constituted the study’s major ethical misjudgment; implicit was the assumption that no adequate therapy existed prior to penicillin. Nonetheless medical author- ities firmly believed in the efficacy of arseno- therapy for treating syphilis at the time of the experiment’s inception in 1932. The panel fur- ther failed to recognize that the entire study had been predicated on nontreatment. Provi- sion of effective medication would have vio- lated the rationale of the experiment—to study the natural course of the disease until death. On several occasions, in fact, the USPHS had prevented the men from receiving proper treat- ment. Indeed, there is no evidence that the USPHS ever considered providing penicillin.

The other focus of the Final Report— informed consent—also served to obscure the historical facts of the experiment. In light of the deceptions and exploitations which the experi- ment perpetrated, it is an understatement to declare, as the Report did, that the experiment was “ethically unjustified” because it failed to obtain informed consent from the subjects. The Final Report’s statement, “Submitting vol- untarily is not informed consent,” indicated that the panel believed that the men had vol- unteered for the experiment.62 The records in the National Archives make clear that the men did

that the men believed they already were under the care of the government doctors and thus saw no need to seek treatment elsewhere. Any treatment which the men might have received, concluded the report, had been insufficient to compromise the experiment.

When the USPHS evaluated the status of the study in the 1960s, they continued to ratio- nalize the racial aspects of the experiment. For example, the minutes of a 1965 meeting at the CDC recorded:

Racial issue was mentioned briefly. Will not affect the study. Any questions can be handled by say- ing these people were at the point that therapy would no longer help them. They are getting bet- ter medical care than they would under any other circumstances.57

A group of physicians met again at the CDC in 1969 to decide whether or not to terminate the study. Although one doctor argued that the study should be stopped and the men treated, the consensus was to continue. Dr. J. Lawton Smith remarked, “You will never have another study like this; take advantage of it.”58 A memo prepared by Dr. James B. Lucas, assistant chief of the Venereal Disease Branch, stated: “Noth- ing learned will prevent, find, or cure a single case of infectious syphilis or bring us closer to our basic mission of controlling venereal disease in the United States.”59 He concluded, how- ever, that the study should be continued “along its present lines.” When the first accounts of the experiment appeared in the national press in July 1972, data were still being collected and autopsies performed.60

THE HEW FINAL REPORT

HEW finally formed the Tuskegee Syphilis Study Ad Hoc Advisory Panel on August 28, 1972, in response to criticism that the press descriptions of the experiment had triggered. The panel, composed of nine members, five

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men were fortunate to have been spared the highly toxic treatments of the earlier period.67 Moreover, even these contemporary defenses assume that the men never would have been treated anyway. As Dr.  Charles Barnett of Stanford University wrote in 1974, “The lack of treatment was not contrived by the USPHS but was an established fact of which they pro- posed to take advantage.”68 Several doctors who participated in the study continued to justify the experiment. Dr. J. R. Heller, who on one occasion had referred to the test subjects as the “Ethiopian population,” told reporters in 1972:

I don’t see why they should be shocked or horrified. There was no racial side to this. It just happened to be in a black community. I feel this was a perfectly straightforward study, perfectly ethical, with con- trols. Part of our mission as physicians is to find out what happens to individuals with disease and with- out disease.69

These apologies, as well as the HEW Final Report, ignore many of the essential ethical issues which the study poses. The Tuskegee Study reveals the persistence of beliefs within the medical profession about the nature of blacks, sex, and disease—beliefs that had tragic repercussions long after their alleged “scien- tific” bases were known to be incorrect. Most strikingly, the entire health of a community was jeopardized by leaving a communicable disease untreated.70 There can be little doubt that the Tuskegee researchers regarded their subjects as less than human.71 As a result, the ethical can- ons of experimenting on human subjects were completely disregarded.

The study also raises significant questions about professional self-regulation and scien- tific bureaucracy. Once the USPHS decided to extend the experiment in the summer of 1933, it was unlikely that the test would be halted short of the men’s deaths. The experi- ment was widely reported for forty years with- out evoking any significant protest within the

not submit voluntarily to an experiment; they were told and they believed that they were get- ting free treatment from expert government doctors for a serious disease. The failure of the HEW Final Report to expose this critical fact— that the USPHS lied to the subjects—calls into question the thoroughness and credibility of their investigation.

Failure to place the study in a historical con- text also made it impossible for the investiga- tion to deal with the essentially racist nature of the experiment. The panel treated the study as an aberration, well-intentioned but misguided.63 Moreover, concern that the Final Report might be viewed as a critique of human experimentation in general seems to have severely limited the scope of the inquiry. The Final Report is quick to remind the reader on two occasions: “The position of the Panel must not be construed to be a general repudiation of scientific research with human subjects.”64 The Report assures us that a better designed experiment could have been justified:

It is possible that a scientific study in 1932 of untreated syphilis, properly conceived with a clear protocol and conducted with suitable subjects who fully understood the implications of their involve- ment, might have been justified in the pre-penicillin era. This is especially true when one considers the uncertain nature of the results of treatment of late latent syphilis and the highly toxic nature of thera- peutic agents then available.65

This statement is questionable in view of the proven dangers of untreated syphilis known in 1932.

Since the publication of the HEW Final Report, a defense of the Tuskegee Study has emerged. These arguments, most clearly articu- lated by Dr. R. H. Kampmeier in the Southern Medical Journal, center on the limited knowl- edge of effective therapy for latent syphilis when the experiment began. Kampmeier argues that by 1950, penicillin would have been of no value for these men.66 Others have suggested that the

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1. The best general accounts of the study are “The 40-Year Death Watch,” Medical World News (August 18, 1972), pp. 15–17; and Dolores Katz, “Why 430 Blacks with Syphilis Went Uncured for 40 Years,” Detroit Free Press (November 5, 1972). The mortality figure is based on a published report of the study which appeared in 1955. See Jesse J. Peters, James H. Peers, Sidney Olansky, John C. Cutler, and Geraldine Gleeson, “Untreated Syphilis in the Male Negro: Pathologic Findings in Syphilitic and Nonsyphilitic Patients,” Journal of Chronic Diseases 1 (February 1955), 127–48. The article estimated that 30.4 percent of the untreated men would die from syphilitic lesions.

2. Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel, Department of Health, Education, and Welfare (Washington, D.C.: GPO, 1973). (Hereafter, HEW Final Report.)

3. See George M. Frederickson, The Black Image in the White Mind (New York: Harper and Row, 1971), pp. 228–55. Also, John H. Haller, Outcasts From Evolution (Urbana, Ill.: University of Illinois Press, 1971), pp. 40–68.

4. Frederickson, pp. 247–49.

5. “Deterioration of the American Negro,” Atlanta Journal- Record of Medicine 5 (July 1903), 287–88. See also, J. A. Rodgers, “The Effect of Freedom upon the Psychological Development of the Negro,” Proceedings of the American Medico-Psychological Association 7 (1900), 88–99. “From the most healthy race in the country forty years ago,” concluded Dr. Henry McHatton, “he is today the most diseased.” “The Sexual Status of the Negro—Past and Present,” American Journal of Dermatology and Genito-Urinary Diseases 10 (January 1906), 7–9.

6. W. T. English, “The Negro Problem from the Physician’s Point of View,” Atlanta Journal-Record of Medicine 5 (October 1903), 461. See also, “Racial Anatomical Peculiarities,” New York Medical Journal 63 (April 1896), 500–01.

7. “Racial Anatomical Peculiarities,” p. 501. Also, Charles S. Bacon, “The Race Problem,” Medicine (Detroit) 9 (May 1903), 338–43.

8. H. H. Hazen, “Syphilis in the American Negro,” Journal of the American Medical Association 63 (August 8, 1914), 463. For deeper background into the historical relationship of racism and sexuality see Winthrop D. Jordan, White Over Black (Chapel Hill: University of North Carolina Press, 1968: Pelican Books, 1969), pp. 32–40.

9. Daniel David Quillian, “Racial Peculiarities: A Cause of the Prevalence of Syphilis in Negroes,” American Journal of Dermatology and Genito-Urinary Diseases 10 (July 1906), p. 277.

10. English, p. 463.

11. William Lee Howard, “The Negro as a Distinct Ethnic Factor in Civilization,” Medicine (Detroit) 9 (June 1903), 424. See also, Thomas W. Murrell, “Syphilis

medical community. Nor did any bureaucratic mechanism exist within the government for the periodic reassessment of the Tuskegee experiment’s ethics and scientific value. The USPHS sent physicians to Tuskegee every sev- eral years to check on the study’s progress, but never subjected the morality or usefulness of the experiment to serious scrutiny. Only the press accounts of 1972 finally punctured the continued rationalizations of the USPHS and brought the study to an end. Even the HEW investigation was compromised by fear that it would be considered a threat to future human experimentation.

In retrospect the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis; more about the nature of scientific inquiry than the nature of the disease process. The injustice committed by the experiment went well beyond the facts outlined in the press and the HEW Final Report. The degree of deception and damages have been seriously underestimated. As this history of the study suggests, the notion that science is a value-free discipline must be rejected. The need for greater vigilance in assessing the spe- cific ways in which social values and attitudes affect professional behavior is clearly indicated.

EDITOR’S NOTE On May 16, 1997, President Bill Clinton apologized to the participants in the Tuskegee Study. He acknowledged that the U.S. government had done “something that was wrong—deeply, profoundly, and morally wrong.”

NOTES * In 1865, Claude Bernard, the famous French physiologist, outlined the distinction between a “study in nature” and experimentation. A study in nature required simple observation, an essentially passive act, while experimentation demanded intervention which altered the original condition. The Tuskegee Study was thus clearly not a study in nature. The very act of diagnosis altered the original conditions. “It is on this very possibility of acting or not acting on a body,” wrote Bernard, “that the distinction will exclusively rest between sciences called sciences of observation and sciences called experimental.”

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Group 90, Box 239, National Archives, Washington National Records Center, Suitland, Maryland. (Hereafter, NA-WNRC.) Materials in this collection which relate to the early history of the study were apparently never consulted by the HEW investigation. Included are letters, reports, and memoranda written by the physicians engaged in the study.

22. H. S. Cumming to R. R. Moton, September 20, 1932, NA-WNRC.

23. Clark to Davis, October 29, 1932, NA-WNRC.

24. Cumming to Moton, September 20, 1932, NA-WNRC.

25. Clark Memorandum, September 26, 1932, NA-WNRC. See also, Clark to Davis, October 29, 1932, NA-WNRC.

26. As Clark wrote: “You will observe that our plan has nothing to do with treatment. It is purely a diagnostic procedure carried out to determine what has happened to the syphilitic Negro who has had no treatment.” Clark to Paul A. O’Leary, September 27, 1932, NA-WNRC.

27. D. G. Gill to O. C. Wenger, October 10, 1932, NA-WNRC.

28. Clark to Vonderlehr, January 25, 1933, NA-WNRC.

29. Vonderlehr to Clark, February 28, 1933, NA-WNRC.

30. Vonderlehr to Clark, November 2, 1932, NA-WNRC. Also, Vonderlehr to Clark, February 6, 1933, NA-WNRC.

31. Clark to Vonderlehr, March 9, 1933, NA-WNRC.

32. Vonderlehr later explained: “The reason treatment was given to many of these men was twofold: First, when the study was started in the fall of 1932, no plans had been made for its continuation and a few of the patients were treated before we fully realized the need for continuing the project on a permanent basis. Second it was difficult to hold the interest of the group of Negroes in Macon County unless some treatment was given. Vonderlehr to Austin V. Diebert, December 5, 1938. Tuskegee Syphilis Study Ad Hoc Advisory Panel Papers, Box 1, National Library of Medicine, Bethesda, Maryland. (Hereafter, TSS-NLM.) This collection contains the materials assembled by the HEW investigation in 1972.

33. Vonderlehr to Clark, February 6, 1933, NA-WNRC.

34. H. S. Cumming to J. N. Baker, August 5, 1933, NA-WNRC.

35. Clark to Moore, March 25, 1933, NA-WNRC.

36. Macon County Health Department, “Letter to Subjects,” n.d., NA-WNRC.

37. Vonderlehr to Clark, April 8, 1933, NA-WNRC. See also, Vonderlehr to Wenger, July 18, 1933, NA-WNRC.

38. Wenger to Vonderlehr, July 21, 1933, NA-WNRC. The emphasis is Wenger’s.

39. Wenger to Vonderlehr, July 21, 1933, NA-WNRC.

40. Eunice Rivers, Stanely Schuman, Lloyd Simpson, Sidney Olansky, “Twenty-Years of Followup Experience in a Long- Range Medical Study,” Public Health Reports 68 (April 1953), 391–95. In this article Nurse Rivers explains her role in the

in the American Negro,” Journal of the American Medical Association 54 (March 12, 1910), 848.

12. “Castration Instead of Lynching,” Atlanta Journal- Record of Medicine 8 (October 1906), 457. The editorial added: “The badge of disgrace and emasculation might be branded upon the face or forehead, as a warning, in the form of an ‘R,’ emblematic of the crime for which this punishment was and will be inflicted.”

13. Searle Harris, “The Future of the Negro from the Standpoint of the Southern Physician,” Alabama Medical Journal 14 (January 1902), 62. Other articles on the prevalence of venereal disease among blacks are: H. L. McNeil, “Syphilis in the Southern Negro,” Journal of the American Medical Association 67 (September 1916), 1001–04; Ernest Philip Boas, “The Relative Prevalence of Syphilis Among Negroes and Whites,” Social Hygiene 1 (September 1915), 610–16. Doctors went to considerable trouble to distinguish the morbidity and mortality of various diseases among blacks and whites. See, for example, Marion M. Torchia, “Tuberculosis Among American Negroes: Medical Research on a Racial Disease, 1830–1950,” Journal of the History of Medicine and Allied Sciences 32 (July 1977), 252–79.

14. Thomas W. Murrell, “Syphilis in the Negro: Its Bearing on the Race Problem,” American Journal of Dermatology and Genito-Urinary Diseases 10 (August 1906), 307.

15. “Even among the educated, only a very few will carry out the most elementary instructions as to personal hygiene. One thing you cannot do, and that is to convince the negro that he has a disease that he cannot see or feel. This is due to lack of concentration rather than lack of faith; even if he does believe, he does not care; a child of fancy, the sensations of the passing hour are his only guides to the future.” Murrell, “Syphilis in the American Negro,” p. 847.

16. “Deterioration of the American Negro,” Atlanta Journal-Record of Medicine 5 (July 1903), 288.

17. Murrell, “Syphilis in the Negro: Its Bearing on the Race Problem,” p. 307.

18. “The anatomical and physiological conditions of the African must be understood, his place in the anthropological scale realized, and his biological basis accepted as being unchangeable by man, before we shall be able to govern his natural uncontrollable sexual passions.” See, “As Ye Sow That Shall Ye Also Reap,” Atlanta Journal- Record of Medicine 1 (June 1899), 266.

19. Taliaferro Clark, The Control of Syphilis in Southern Rural Areas (Chicago: Julius Rosenwald Fund, 1932), 53–58. Approximately 35 percent of the inhabitants of Macon County who were examined were found to be syphilitic.

20. See Claude Bernard, An Introduction to the Study of Experimental Medicine (New York: Dover, 1865, 1957), pp. 5–26.

21. Taliaferro Clark to M. M. Davis, October 29, 1932. Records of the USPHS Venereal Disease Division, Record

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51. See, for example, Vonderlehr to B. W. Booth, April 18, 1934; Vonderlehr to E. R. Lett, November 20, 1933, NA- WNRC.

52. “Transcript of Proceedings—Tuskegee Syphilis Ad Hoc Advisory Panel,” February 23, 1973, unpublished typescript, TSS-NLM, Box 1.

53. Raymond Vonderlehr to Murray Smith, April 30, 1942; and Smith to Vonderlehr, June 8, 1942, TSS-NLM, Box 1.

54. Stanley H. Schuman, Sidney Olansky, Eunice Rivers, C. A. Smith, and Dorothy S. Rambo, “Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study,” Journal of Chronic Diseases 2 (November 1955), 550–53.

55. Raymond Vonderlehr to Stanley H. Schuman, February 5, 1952, TSS-NLM, Box 2.

56. Schuman et al., p. 550.

57. “Minutes, April 5, 1965,” unpublished typescript, TSS- NLM, Box 1.

58. “Tuskegee Ad Hoc Committee Meeting—Minutes, February 6, 1969,” TF-CDC.

59. James B. Lucas to William J. Brown, September 10, 1970, TF-CDC.

60. Elizabeth M. Kennebrew to Arnold C. Schroeter, February 24, 1971, TSS-NLM, Box 1.

61. See Medical Tribune (September 13, 1972), pp. 1, 20; and “Report on HEW’s Tuskegee Report,” Medical World News (September 14, 1973), pp. 57–58.

62. HEW Final Report, p. 7.

63. The notable exception is Jay Katz’s eloquent “Reservations About the Panel Report on Charge 1,” HEW Final Report, pp. 14–15.

64. HEW Final Report, pp. 8, 12.

65. Hew Final Report, pp. 8, 12.

66. See R. H. Kampmeier, “The Tuskegee Study of Untreated Syphilis,” Southern Medical Journal 65 (October 1972), 1247–51; and “Final Report on the Tuskegee Syphilis Study,’ ” Southern Medical Journal 67 (November 1974), 1349–53.

67. Leonard J. Goldwater, “The Tuskegee Study in Historical Perspective,” unpublished typescript, TSS-NLM; see also, “Treponemes and Tuskegee,” Lancet (June 23, 1973), p. 1438; and Louis Lasagna, The VD Epidemic (Philadelphia: Temple University Press, 1975), pp. 64–66.

68. Quoted in “Debate Revives on the PHS Study,” Medical World News (April 19, 1974), p. 37.

69. Heller to Vonderlehr, November 28, 1933, NA-WNRC; quoted in Medical Tribune (August 23, 1972), p. 14.

70. Although it is now known that syphilis is rarely infectious after its early phase, at the time of the study’s inception latent syphilis was thought to be communicable.

experiment. She wrote: “Because of the low educational status of the majority of the patients, it was impossible to appeal to them from a purely scientific approach. Therefore, various methods were used to maintain their interest. Free medicines, burial assistance of insurance (the project being referred to as ‘Miss Rivers’ Lodge’), free hot meals on the days of examination, transportation to and from the hospital, and an opportunity to stop in town on the return trip to shop or visit with their friends on the streets all helped. In spite of these attractions, there were some who refused their examinations because they were not sick and did not see that they were being benefited” (p. 393).

41. Austin V. Diebert to Raymond Vonderlehr, March 20, 1939, TSS-NLM, Box 1.

42. Murray Smith to Subjects, (1938), TSS-NLM, Box 1. See also, Sidney Olansky to John C. Cutler, November 6, 1951, TSS-NLM, Box 2.

43. The USPHS originally requested that the Julius Rosenwald Fund meet this expense. See Cumming to Davis, October 4, 1934, NA-WNRC. This money was usually divided between the undertaker, pathologist, and hospital. Lloyd Isaacs to Raymond Vonderlehr, April 23, 1940, TSS-NLM, Box 1.

44. Stanley H. Schuman, Sidney Olansky, Eunice Rivers, C. A. Smith, Dorothy S. Rambo, “Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study,” Journal of Chronic Diseases 2 (November 1955), 555.

45. R. A. Vonderlehr and Taliaferro Clark, “Untreated Syphilis in the Male Negro,” Venereal Disease Information 17 (September 1936), 262.

46. J. R. Heller and P. T. Bruyere, “Untreated Syphilis in the Male Negro: II. Mortality During 12 Years of Observation,” Venereal Disease Information 27 (February 1946), 34–38.

47. Jesse J. Peters, James H. Peers, Sidney Olansky, John C. Cutler, and Geraldine Gleeson, “Untreated Syphilis in the Male Negro: Pathologic Findings in Syphilitic and Non-Syphilitic Patients,” Journal of Chronic Diseases 1 (February 1955), 127–48.

48. Sidney Olansky, Standley H. Schuman, Jesse J. Peters, C. A. Smith, and Dorothy S. Rambo, “Untreated Syphilis in the Male Negro, X. Twenty Years of Clinical Observation of Untreated Syphilitic and Presumably Nonsyphilitic Groups,” Journal of Chronic Diseases 4 (August 1956), 184.

49. O. C. Wenger, “Untreated Syphilis in Male Negro,” unpublished typescript, 1950, p. 3. Tuskegee Files, Centers for Disease Control, Atlanta, Georgia. (Hereafter TF-CDC.)

50. Vernal G. Cave, “Proper Uses and Abuses of the Health Care Delivery System for Minorities with Special Reference to the Tuskegee Syphilis Study,” Journal of the National Medical Association 67 (January 1975), 83.

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The fact that members of the control group were placed in the test group when they became syphilitic proves that at least some infectious men were denied treatment.

71. When the subjects are drawn from minority groups, especially those with which the researcher cannot identify, basic human rights may be compromised. Hans Jonas has clearly explicated the problem in his “Philosophical Reflections on Experimentation,” Daedalus 98 (Spring 1969), 234–37. As Jonas writes: “If the properties we adduced as the particular qualifications of the members of the scientific fraternity itself are taken as general criteria of selection, then one should look for additional subjects where a maximum of identification, understanding, and spontaneity can be expected—that is, among the most highly motivated, the most highly educated, and the least ‘captive’ members of the community.”

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university bureaucracies, having a vague plan and heading into the field is becoming less of an option. Anecdotally it can be said that eth- ics committees have treated the sex industry as a problematic area of inquiry, which can some- times result in projects failing at this initial stage. An example from Mattely (1997) demonstrates how funding research into prostitution continues to be stifled by stigma and excluded by research councils. This section teases out three familiar areas of suspicion that are charged at those want- ing to research sex work: the methods employed, the setting of the fieldwork and concerns for the reputation of the institution.

Methodological concerns are often raised at ethics committees when the method of inquiry is based on an ethnographic style that places informality at the heart of the data collection. Invariably this method requires lengthy peri- ods of observation, interviews that can take the form of informal conversations and other methods that are unorthodox in the minds of positivist thinkers. As a result, committees can query the validity of the methods, whether enough information will be collected and the quality of the data. For instance, in situa- tions where interviews cannot be taped, data collection relies on fieldnotes and memory, which raises questions about how informa- tion can be accurately recorded. In addition, as Shaver (2005) documents, researchers in

D espite the interdisciplinary accounts of the sex industry, apart from some reflec-tive revelations (for instance by Hart, 1998; Hubbard, 1999a; Maher, 2000; Melrose, 2002; O’Connell Davidson, 1998; O’Neill, 1996; Sharpe, 2000; Shaver, 2005), researchers have been reluctant to report on the methodologi- cal demands of this topic. These pieces of work highlight the importance of reflexivity in the researcher process—a research account that is aware that the researcher is of the world being studied and therefore should be included in the process of analysis.  .  .  .  This article explores the methodological challenges that question existing procedural boundaries and push the parameters of the qualitative method as the subject becomes increasingly sexual. Drawing on my own ethnography in the indoor prostitu- tion markets (see Sanders, 2005a), this article reflects mostly on research into female adult consensual prostitution but will refer to other aspects of the non-contact sexual services such as pornography and erotic dancing.

STUMBLING AT THE FIRST HURDLE: ETHICS COMMITTEES

Much of what has been written about the eth- ics of fieldwork and the sex industry focuses on what happens in the field. Yet increasingly, one of the first stumbling blocks for the researcher (especially students) is gaining approval for the project from the internal institution’s ethics com- mittee. With these regulatory bodies becoming an increasing part of funding applications and

SEXING UP THE SUBJECT: METHODOLOGICAL NUANCES IN RESEARCHING THE FEMALE SEX INDUSTRY

T E E L A S A N D E R S

From “Sexing Up the Subject: Methodological Nuances in Researching the Female Sex Industry,” Sexualities 9(4), pp.  449–68. Copyright © 2006 by the Author. Reprinted by permission of SAGE Publications, Ltd.

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was scrutinized by the senior officials in the university before it was vetoed as an unaccept- able area of inquiry and methodological design (see Sanders, 2005b). Behind this decision was apprehension related to preserving the repu- tation of the university and concerns about media headlines that linked students to the seedy underworld environment in the name of completing a doctorate. . . .

However, there are solutions to these ethical trials. The plethora of successful work in this field, using both ethnographic and more main- stream methods, is a testament to the appro- priateness of the sex industry as a field site. The general literature that explains the limita- tions of informed consent in all circumstances and the acceptability of covert inquiry within an ethical framework that prioritizes the ano- nymity of those being studied, can be used to demonstrate the feasibility of the design. There are few horror stories reported (this does not mean that researchers have not experienced some difficult and vulnerable situations), and good quality accounts of ethnography explain the basic rules of engagement, such as finding a gatekeeper who acts as a protector (Hart, 1998: 55; O’Connell Davidson and Layder, 1994). Therefore, it can be demonstrated that despite common conceptions, there are regula- tors (health workers, sauna owners, police, key informants) in the sex industry who researchers can align themselves with in order to stay out of trouble and learn the local scene.

In addition, researchers in this field can rely on the professional codes of practice pro- moted by the subject discipline that set out procedures, obligations and expectations of the research process (for example, the British Sociological Association produces guidelines for its members). Often, universities have their own codes of etiquette, which can include safety procedures when researchers are work- ing alone or at night, for instance. Basic safety

the sex industry are constantly struggling with the unknown size and boundaries of the population, leading to queries of sample rep- resentation. Covert methods have also been adopted in sex work research, highlighting the difficulties of informing all parties that are being observed, often for the sake of access and at the request of sex workers and manag- ers. Ethics committees are usually hostile to covert methods, as they can appear unethical and potentially dangerous for the researcher. Stereotypes and misunderstandings about the research setting exacerbate these generic con- cerns about the methods often employed when studying the sex work field.

The setting, whether it is a “red light dis- trict,” crack house or illegal brothel, is often the focus of concern raised by ethics committees. Is this the correct environment for research to be conducted, or for a student to be initiated into the research culture? Questions of danger always arise because of stereotypes that link prostitution to criminality, especially drug- related crimes. Associations between HIV, drug-injecting sex workers, vicious and violent male pimps and the sex work setting all surface with the prospects of researching the sex indus- try. Fuelled by assumptions about the type of people who organize and work in the sex industry, as well as the men who buy sex, the researcher is expected to take extra precautions when assessing participants and field sites. In addition, the routines that the researcher will be expected to engage in usually entail long hours in fairly unknown or secluded locations, often late at night, and sometimes alone.

The danger that the researcher is exposed to is a central concern of officials, but this can sometimes be a disguise for more press- ing anxieties about the reputation of the insti- tution. As a postgraduate student, my own research (which was originally based on an internet survey of the sex work community)

S E X I N G U P T H E S U B J EC T 101

is a woman. Owners, managers and workers are suspicious of unknown inquirers, and women who enter the building are normally looking for work (i.e., competition) or are spying for the opposition. Rarely has it been reported that a researcher has introduced herself or himself to sex workers without a third party mediating the initial introductions.

To sidestep these closed environments, researchers use various gatekeepers to over- come initial hostilities. Some access routes have been outside the sex work environment. For example, the criminal justice system (pris- ons, bail hostels, courts, probation service and so on) or sexual health and welfare services have traditionally been a successful introduc- tion route to women and men involved in pros- titution. Specific sex work outreach projects (see Cooper et al., 2001) have been the most prolific gatekeepers, as their established and trusted ties with street workers and indoor establishments provide researchers with the opportunity to prove their credibility. Hubbard (1999b: 233) explains four principles that must be demonstrated to outreach projects and sex workers to achieve success in the negotiation phase. First, the investigator must establish how the research will produce knowledge to help reduce stigma surrounding prostitution; second, that the researcher has an insight into the reality of prostitution and the circum- stances in which sex is sold; third, a recogni- tion that prostitution is a legitimate form of work; and fourth, a belief that health and safety risks should be minimized for sex workers. However, as Melrose (2002: 340) documents, securing access through sexual health proj- ects is not straightforward. This route can be met with refusal because of concerns that the research will demand too much time from the  project, disagreement with the premise of the research or the worry that their clients are “over-researched” or exploited. . . .

checks such as never meeting people alone in private, always in a public place, letting a third party know of your whereabouts and checking in after the session has ended, are assurances that go a long way to maintaining safety (see Shaver, 2005: 302 for a thorough account of safety procedures for sex work researchers). The potential dangers and strong stereotypes associated with the sex industry are issues that researchers have to confront before the project gets off the ground. Although this means that research designs are perhaps over-scrutinized and charged with queries that expect more insight from the novice researcher, this encour- ages the researcher to be reflective even at this initial stage. Thinking ahead to foreseeable problems, having a set of plan B’s if the initial methods fail, and taking time out of the field- work to reassess are good practice in an intense and volatile environment.

ACCESS AND ACCEPTANCE INTO THE SEX INDUSTRY

For the researcher, the legal status of prostitu- tion and the actual environment are the key considerations when planning the access route.

Prostitution is often located outside a legiti- mate legal framework and even where the sex industry is legitimate, there are always issues of stigma and deviancy to consider. The dif- ferent environments that facilitate street and off-street prostitution offer some peculiarities (for a lengthy discussion, see Shaver, 2005). On the street, the environment is vulnerable, as women mainly work at night, in deserted and unlit industrial areas, in an economy that can be linked to other forms of acquisitive crime. Indoors, although not usually characterized by the violence and vulnerabilities of the street scene, the premises of illegal brothels may be well known but getting a foot in the door is a difficult prospect—especially if the researcher

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the combination of studying sex and money in an illegal arena affects how the research is executed, the dilemmas for the researcher and the immediacy of making decisions in the “sexual” field. For those who are unaware, a typical sauna or brothel can be characterized by televisions showing hard-core pornography, pornographic magazines, sex toys, domination equipment, a menu of sexual services on offer, an explicit photographic gallery of the women who are available and other sex paraphernalia. This environment can be distasteful at best but is often violently shocking and disturbing.

The sexual subtext of the environment is impossible to escape as participants are in their work clothes (which usually consist of very little), buying into the fantasies that tempt customers to part with their cash (see Sanders, 2005c). The physical sexual environment is not the only sexualized element to the fieldwork setting. Men are constantly wandering into the premises and engaging in a set of negotiations with the receptionist (maid) and then (often in private) with the sex worker. Men linger in the communal lounge while they wait for a worker to finish her current client, idling the time away by flicking through a pornographic magazine or watching graphic images on the screen, before they are called to the shower room and finally the specifically chosen bedroom, until, 30 minutes later they come out the other side, £60 lighter. This routinization of the sexual negotiation is a process with which the observer becomes familiar (and perhaps desensitized) and after several sessions of data collection, the process of negotiating sexual services becomes part of the momentum of the fieldwork. . . .

My own experiences of being in the sexual field of the sauna and brothel involved two other methodological nuances that at the time became routinized yet had an intrinsic effect on the way in which information was collected, my role in this foreign arena, and establishing rapport with participants. First, as my role in

ACCESSING PRIVATE AND THE PUBLIC LIVES

Once access to sex establishments or sex work- ers has been achieved, researchers then negoti- ate  whether the research will be conducted in either the working environment or in the private lives and spaces of the sex workers. Despite the difficulties of the prostitution environment, research is often conducted in the working spaces of the commercial sex exchange. By striking “research bargains” and “exchanges” that involve giving out condoms, sterile needle equipment and hot drinks on the street, researchers have been able to observe successfully how the street markets operate. . . .  A combination of methods (usually a mixed approach that includes observa- tions and interviews) appears to be a successful recipe for data collection. . . .

Entering the private worlds of women who are involved in activities that are largely disap- proved of presented additional ethical issues. On the few occasions I was permitted into the private worlds of participants, I would often be asked to collude with the secrecy stories that sex workers had constructed to hide their money-making activities. I would have to pre- tend I was a colleague from the office or an acquaintance whilst I chatted to a participant’s husband or was invited to stay for tea with the children. An example of the role-playing that I describe in the next section shows how it is an essential tool in the field.

MAKING SENSE OF THE SEXUAL FIELD

When actually doing research in the sex indus- try where the exchange of sexual services, bodily functions and flesh-to-flesh contact is the everyday trade, the reality of research can- not avoid these characteristics. Although there are similarities with other illicit economies, the setting of the sex industry is unique because

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a combination of physical, sexual and emotional labour, the role of the body and their sexuality was afforded different meanings in the context of a money-making economic exchange.

WHAT IS PARTICIPANT OBSERVATION IN THE SEX INDUSTRY?

The ethnographic method in the sex work arena brings into question what participation means, and whilst there are those who maintain “going native” jeopardizes the professional status of the researcher (Hart, 1998: 55), others have used complete participation as the key to the insider status. For example, Wahab (2003: 629) describes how she not only conducted obser- vations in strip clubs but decided to engage in the sex work venue. Encouraged by her partici- pants, who insisted that to really understand the job it had to be lived, Wahab took part in a peep show as a dancer, immersing herself in the context of the culture. . . .

Like the familiar debates in qualitative social science inquiry (see Labaree, 2002), the insider– outsider dilemma is a point of negotiation, con- fusion and reflection for the researcher in the sex work setting. Rarely are researchers’ identities clearly defined as only “information gatherers.” In the spirit of transparency, researchers inter- ested in sex work qualify their intentions and character, which often means blurring the roles and boundaries that other types of research and methods have the luxury of maintaining. . . .

PLEASURES AND DANGERS OF THE RESEARCH PROCESS

One account of my fieldwork experience in the sex work setting could read as a list of uncom- fortable moments, scary confrontations, mis- takes that led to insults, embarrassments, treading on toes and appearing unprofessional and out of my depth. Another positive account

the sauna was overt to the sex workers but, at the request of the managers, the clients were unaware of my researcher status, I was often propositioned by interested customers. Men would assume I was another worker or a new member of the team and would make propo- sitions and innuendo that had to be managed. Initially flustered, embarrassed and uncomfort- able, I soon adopted strategies to deflect their requests: I would either pretend I was “fully booked,” a friend of a worker or a sexual health professional, switching between these roles depending on how confident I felt at the time and the amount of backup I had from those around me. Ultimately, role-playing became a necessity in the field, especially where a delicate “research bargain” existed that required keeping my researcher status anonymous to one party while others were aware of the investigation.

Second, the majority of the fieldwork in the indoor sex work venues was conducted amongst women who were semi-naked for most of the time. For instance, my interviews with Beryl, a 39-year-old mother of four who had worked in a range of sex markets for 20 years, took place in the 30-minute slot she allocated each day as her “preparation time” before she welcomed her first customer. In this time, Beryl was show- ering, shaving, applying makeup, styling her hair, putting on lingerie and at the same time answering my questions. It became natural to see women naked as they changed from one outfit to another, were flitting between bath- room and bedroom or needed a hand squeezing into a particular costume. These situations were non-sexualized and non-erotic, as the women conducted their behaviour in a professional matter-of-fact manner, relegating luxurious lin- gerie or kinky outfits to the function of a work uniform. Participants approached their work and ultimately the display of their bodies in an entirely pragmatic, de-sexualized and business- like manner with no sense of shame, embarrass- ment or vulnerability. Explaining their trade as

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in a complex social activity. What Melrose (2002) calls the “labour pains” of researching sensitive areas like prostitution are often given little attention, as the researcher is expected to apply emotional labour to manage the feel- ings of others as well as their own responses. Although not always the case, informal conver- sations and taped interviews with women who work in prostitution can involve the disclosure of disturbing and unpleasant data consisting of tales of exploitation, abuse, violence, despera- tion, drug use and hopelessness.

Melrose, like others (Miller, 1997; O’Connell Davidson and Layder, 1994: 216–7; Sharpe, 2000: 365), documents how stories provoke feelings of anger, rage and despair both in the data-collection phase and again in the analysis stage. In a current project with men who buy sex from female sex workers, such feelings of anger and contempt have been a consequence of listening to the other side of the story. In a minority of cases, as interviewees have left my office, I have felt pure rage at their misogynist attitudes and belief that if they buy the services of a sex worker, then they can do as they please. It is difficult to understand or accept these experiences as research but maintaining a pro- fessional attitude and response to people who incite such negative feelings is the only reason why the project has not been shelved.

The dangers of the sexual field are not only related to the physical safety of the researcher, as the emotional investment in the endeavour is significant and needs to be reflected upon and managed. At times the field relations with participants can prove to be very intense. To bridge the scepticism and doubts held by potential participants, the researcher know- ingly or unknowingly enters into a degree of self-disclosure.  .  .  .  Participants always wanted to know why I was interested in sex work and whether I could be tempted or indeed had the guts to sell sexual services for money. Such curi- osity could not be ignored and a natural process

could reflect the strong bonds and lasting friend- ships I built with key informants, idling time away putting the world to rights, and sharing our histories, hopes and expectations. This section will reflect on some of the contrasting experi- ences of dangers and pleasures when conducting research in the sex work environment, highlight- ing the complexity of the method and the neces- sity of investing oneself in the process.

The practical challenges of doing research in the field have been discussed in relation to dan- gerous fieldwork settings or sensitive topics of inquiry (Ferrell and Hamm, 1998; Lee, 1995; Sharpe, 2000). . . .  In the sexual field, despite the advantages of collecting different types of live data when immersed in the working environ- ment, there are inherent dangers for research- ers who operate in illegal environments that are isolated. Several researchers describe how they have met with opposition from potential par- ticipants, other hustlers on the street and ter- ritorial pimps who take issue with a researcher on their patch (see O’Neill, 1996).  .  .  .  Some- times obvious risks are expected when working with populations at the margins of society, but, as I describe later, the emotional risks of such work are often unknown when the research is designed. Other hazards in the field make sex work a tricky subject for the well-intended researcher. Researchers have been mistaken for plainclothes police (see Barnard, 1992: 145; Sharpe, 2000: 366), journalists (Sanders, 2005b), or accused of spying for rival competi- tors (Lever and Dolnick, 2000)—all of which add extra hurdles to achieving safety, credibility and, of course, a sample! . . .

THE EMOTIONAL TOIL OF DATA GATHERING

The emotional effort needed to research sex work is stark in both the pragmatics of the field- work and the efforts needed to dissect, reflect and understand the researcher’s own position

S E X I N G U P T H E S U B J EC T 105

the research process, is a step toward reduc- ing the exploitative nature of social science research. . . .

CONCLUDING COMMENTS

Despite its criticisms and dwindling appli- cation, here I have argued that there is great value in small-scale ethnographic research, especially collaborative in nature, into the sex industry that is concentrated both in time and space. Yet, at every stage, there are hurdles and challenges, often from within the institution, as questions are posed by ethics committees of the appropriateness and feasibility of the sex industry as a worthy topic of study.

Sex work research diverges from institu- tional patterns and accepted paths of informa- tion gathering, transgressing expectations of the types of group that are worthy of research or will produce useful knowledge (Pyett, 1998). In addition, the nature of the sex work envi- ronment and the political issues surrounding prostitution demand that the researcher make personal investment (such as self-disclosure) into the research process. The demands of emotional labour on the researcher are com- plex and intense. Researchers have to confront hostile and volatile environments that need to be managed with care, making skills in nego- tiation, conflict management, role-playing and keeping quiet an essential part of the fieldwork tool kit.

The challenges do not stop as the researcher leaves the field. The writing-up process demands considerable reflection on all aspects of the field- work and decisions have to be made about what to reveal and what to confine to the fieldwork diary. Continually promoting research into sex work, tirelessly applying (and re-applying) for funding, and pushing to disseminate findings amongst the decision-makers are also part of the methodological challenges that face those com- mitted to this important social issue. Pragmatics

of self- disclosure and identification became an integral part of how field relations were secured. I recall this process as natural rather than manipulative because it was not a chore to engage in in-depth conversation with the partic- ipants as I shared many experiences with them. Yet, although disclosure brought me closer to the women, this self-investment also opened up vulnerabilities and concerns about keeping my private life protected from the demands of the fieldwork setting and the public academic eye. At the same time, having to do some per- sonal soul searching also made me confront my stereotypes and prejudices about sexuality and lifestyles. Not something that is generally writ- ten into the research design.

The intensity of the research does not nec- essarily decrease as time lapses between the fieldwork and the safety of the academic cor- ridors. In processes of self-reflection, what was experienced cannot be fully understood until the “after” phase of the data collection, writ- ing up and dissemination (see Roberts and Sanders, 2005). It is in the after phases that the journey can be considered as a whole, the mistakes highlighted and good practice recog- nized as worthy of repeating or sharing with peers. It is also in the “after” phase that there are dilemmas about whether we make our aca- demic careers off the backs of the people who have supplied the material. Making a success- ful academic career through permanent posi- tions, book contracts and promotions from the experiences of those in the sex industry brings added suspicions of exploitation. The informa- tion used to make that career is based on expe- riences of individuals involved in what some consider an immoral or inhumane exchange of sex for money, or an institution that exists as a prop for patriarchy and wider unequal power structures that subjugate women.  .  .  .  Collaborative research partnerships that work alongside informants, offering directorship and control to those who are normally subjected to

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Lee, R. 1995. Dangerous Fieldwork. London: Sage. Lever, J., and Dolnick, D. 2000. “Clients and Call Girls:

Seeking Sex and Intimacy,” in R. Weitzer (ed.). Sex for Sale, pp. 85–100. London: Routledge.

Maher, L. 2000. Sexed Work: Gender, Race and Resistance in a Brooklyn Drug Market. Oxford: Oxford University Press.

Mattley, C. 1997. “Field Research with Phone Sex Workers,” in M. Schwartz (ed.). Researching Violence Against Women, pp. 146–58. London: Sage.

Melrose, M. 2002. “Labour Pains: Some Considerations on the Difficulties of Researching Juvenile Prostitution,” International Journal of Social Research Methodology 5(4): 333–51.

Miller, J. 1997. “Researching Violence Against Street Prostitutes,” in M. Schwartz (ed.). Researching Sexual Violence Against Women, pp. 144–56. London: Sage.

O’Connell Davidson, J. 1998. Prostitution, Power and Freedom. London: Polity.

O’Connell Davidson, J., and Layder, D. 1994. Methods, Sex and Madness. London: Routledge.

O’Neill, M. 1996. “Researching Prostitution and Violence: Towards a Feminist Praxis,” in M. Hester, L. Kelly and J. Radford (eds.). Women, Violence and Male Power, pp. 130–47. London: Open University Press.

O’Neill, M. 2001. Prostitution and Feminism. London: Polity Press.

Pyett, P. 1998. “Doing It Together: Sex Workers and Researchers,” Research for Sex Work, 1. URL (accessed June 2006): http://hcc.med.vu.nl/artikelen /pyett.htm.

Roberts, J. M., and Sanders, T. 2005. “ ‘Before, During and After’: Ethnography, Reflexivity and Pragmatic Realism,” Sociological Review 53(2): 294–313.

Sanders, T. 2005a. Sex Work. A Risky Business. Cullompton, UK: Willan.

Sanders, T. 2005b. “Researching the Online Sex Work Community,” in C. Hine (ed.). Virtual Methods in Social Research on the Internet, pp. 66–79. Oxford: Berg.

Sanders, T. 2005c. “It’s Just Acting: Sex Workers’ Strategies for Capitalising on Sexuality,” Gender, Work and Organization 12(4): 319–42.

Sharpe, K. 2000. “Sad, Bad and (Sometimes) Dangerous to Know: Street Corner Research with Prostitutes, Punters and the Police,” in R. King and E. Wincup (eds.). Doing Research on Crime and Justice, pp. 362–72. Oxford: Oxford University Press.

Shaver, F. 2005. “Sex Work Research: Methodological and Ethical Challenges,” Journal of Interpersonal Violence 20(3): 296–319.

Wahab, S. 2003. “Creating Knowledge Collaboratively with Female Sex Workers: Insights from a Qualitative Feminist and Participatory Study,” Qualitative Inquiry 9(4): 625–42.

aside, to advance the theoretical arguments and knowledge regarding the nature and place of prostitution in contemporary life, research needs to be directed at wider issues relating to the politics of gender and social issues. O’Neill (2001: 187) suggests some of these wider social issues, such as the feminization of poverty, vio- lence and abuse in the home, and routes into sex work such as homelessness and leaving care are intrinsically linked to finding out more about prostitution. Researchers have the responsibility not to produce more of the same but to address the questions and areas that are often pushed to one side, constantly rejected by funding bodies, and appear to be in discord with national politi- cal objectives. As Shaver (2005: 307) comments, challenges to stereotypes and the victimization of sex workers need to be implicit in the methods that are employed to produce knowledge about these groups. If there is to be any advancement in the sociology of sex work, separate aspects of the industry should not be studied in isolation, and female sex workers should not remain the only focus of investigation.

REFERENCES Barnard, M. 1992. “Working in the Dark: Researching

Female Prostitution,” in H. Roberts (ed.). Women’s Health Matters, pp. 141–56. London: Routledge.

Cooper, K., Kilvington, J., Day, S., Ziersch, A., and Ward, H. 2001. “HIV Prevention and Sexual Health Services for Sex Workers in the UK,” Health Education Journal 60(1): 26–34.

Ferrell, J., and Hamm, M. S. 1998. Ethnography at the Edge: Crime, Deviance and Field Research. Boston. MA: Northeastern University Press.

Hart, A. 1998. Buying and Selling Power: Anthropological Reflections on Prostitution in Spain. Oxford: Westview Press.

Hubbard, P. 1999a. Sex and the City. Geographies of Prostitution in the Urban West. Aldershot: Ashgate.

Hubbard, P. 1999b. “Researching Female Sex Work: Reflections on Geographical Exclusion, Critical Methodologies and ‘Useful’ Knowledge,” Area 31(3): 229–37.

Labaree, R. 2002. “The Risk of ‘Going Observationalist’: Negotiating the Hidden Dilemmas of Being an Insider Participant Observer,” Qualitative Research 2(1): 97–122.

F U N D I N G S E X R E S E A RC H 107

Getting funding for sex research has always been challenging. In the 1950s, Alfred Kin- sey and his colleagues lost funding from the Rockefeller Foundation following publication of their controversial report on women’s sexual- ity. The National Health and Social Life Survey (1994)—the closest we’ve come to a national sexual “census”—lost federal funding follow- ing Republican opposition led by Representa- tive William Dannemeyer and Senator Jesse Helms.1 The researchers were subsequently forced to dramatically reduce the scope of their project. Other grant-seekers report that they find themselves in a very defensive posi- tion. According to James Wagoner, president of Advocates for Youth, “For 20 years it was about health and science, and now we have a political ideological approach. . . . Never have we experi- enced a climate of intimidation and censorship as we have today [2004].”2

In 2003, there was a strong congressional effort to block the funding of four National Institutes of Health (NIH) grants. These grants had already been judged as outstanding by peer scientists in an independent review pro- cess. The grants called for research on sexual risk taking and its link to sexual arousal, the sexual habits of older men, Asian sex workers, and sexual and gender identity among Ameri- can Indians. Conservative politicians argued that the government had no business funding research on such inappropriate topics. Efforts to block the funding were narrowly defeated by two votes in the House.3

The economic climate caused by the Great Recession has made funding sex research even

more tenuous. As local, state, and federal gov- ernments wrestle with reduced budgets and increasing debts, funding for many types of research has been threatened—but sexuality research is often singled out as “wasteful” and “bizarre.” In 2011, the Traditional Values Coali- tion (TVC) called for a moratorium on grants awarded by the NIH and a federal investiga- tion of the NIH’s granting process because of “bizarre projects” that amounted to “insti- tutional waste.”4 One study that was heavily criticized was characterized by the TVC as a ten-year, $10 million study to determine the average penis size of gay men; in reality, this study was conducted to understand the rela- tionship among penis size, condom slippage/ breakage, and sexually transmitted infection (STI) rates—and it was not federally funded.5 In 2017, the Trump administration canceled more than $213 million in awarded grants for already-in-progress research intended to evalu- ate evidence-based interventions to reduce teen pregnancy, leaving researchers scrambling to find funds to complete their projects.6 Cancel- ing funding in the middle of multiyear grants, as happened in these cases, is quite unusual because it means researchers are unable to analyze the data they have already collected or make modifications to social problems based on the results. Thus, the money spent and work completed prior to cancellation are often wasted.7

Although some scientists will continue to apply for large government grants, others are becoming increasingly discouraged and are turning to alternative sources. The National

Funding Sex Research

Mindy Stombler and Amanda M. Jungels

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the elimination of all funding for research that did not have “practical uses outside of academic circles and clear benefits to mankind and the world.”13 Psychologist Geoffrey Miller claims that his research on kissing (why couples kiss less the longer they remain involved) is valuable for society but not necessarily fundable: “Kiss- ing could help couples rejuvenate a marriage and reduce divorce rates . . . but it’s less threat- ening and more profitable to study orgasms.”14

In fact, Mark Schwartz, former director of the Masters and Johnson Institute, claims that the survival of the study of sexual behavior is a result of the HIV/AIDS epidemic and the devel- opment of Viagra “because the pharmaceutical companies suddenly became very interested in the fact that they can make huge amounts of money off the genitals.”15 Leonore Tiefer, a sex researcher interviewed in Chapter 5, cau- tions sex researchers about their overreliance on pharmaceutical money, insisting it contrib- utes to a medical model of sexuality where all sexual problems can be fixed with a pill.16 In her research on the stigmatization of sexual- ity research, Janice Irvine notes that sexuality researchers whose research critically examines pharmaceutical companies’ “promise of better sex” will likely not receive funding from this industry.17

Following the AIDS crisis and the public’s concern with teen pregnancy rates, research- ers who studied sexually transmitted infec- tions (STIs) and reproductive health had a decent chance of being funded. But today, even these researchers have their share of chal- lenges. Recently, scientists who study HIV/ AIDS and other STIs claim they have been warned by government officials to avoid the use of certain key words in their grant appli- cations. Grants that include terms like sex workers, men who sleep with men, anal sex, needle exchange, prostitute, gay, homosexual, and trans- gender are rumored to face additional scrutiny in an already fiercely competitive arena.18 In

Survey of Sexual Health and Behavior, dis- cussed in Reading 8, turned to the makers of Trojan condoms to fund the project.8 Aside from the federal government and select corpo- rations, sources for funding sex research tend to include a handful of private institutions and universities. Convincing private foundations to fund sex research can be challenging, as Dr. Miro Gudelsky, a sex therapist, explains: “Few individuals are willing to put up their money, or their family’s money, behind sex- related research. ‘Grandpa worked really hard so that we can find out the most sensitive part of the penis’ generally isn’t the sort of story family foundations want to tell.”9 Even when researchers can find nongovernmental fund- ing, these resource pools are often more lim- ited.10 This lack of available funding reduces the scope of the sex-related research projects that do get carried out. For example, an exten- sive sex survey conducted by the Centers for Disease Control and Prevention (CDC) (see Reading 8) initially had to cap its sample at age 44, ignoring the sexual behaviors of the older generation that brought us the sexual liberation movement.11 The economic stimulus package of 2009 (formally known as the American Recov- ery and Reinvestment Act) included additional funding for scientific research, but those proj- ects that would not “reap economic rewards in the foreseeable future” (including social science and public health research) were criticized by John McCain of Arizona and other Republican senators as being wasteful.12

As conservative politicians fight to reduce funding available for sex research, researchers feel pressured to focus on topics for which fund- ing is available, such as pharmaceutical research. This trend necessarily narrows the breadth of researchable topics to those connected to potential profit making. This trajectory was advanced in 2011 when Senator Tom Coburn (a Republican from Oklahoma) singled out the National Science Foundation and suggested

F U N D I N G S E X R E S E A RC H 109

and the media outlets, it can also “threaten funding, result in restrictive policies, and lead to negative consequences for the individual or the field.”26 This fear of reprisal has led some researchers to avoid appearing in the media at all to report findings; in today’s global media culture, local media coverage of a research controversy can quickly turn into “unwelcome” national attention.27

Frustrated by the increasing interference of politicians, researchers—and even federal agency directors—have been fighting back. For example, scientists from a range of disciplines have formed the Coalition to Protect Research, an organization “committed to promoting pub- lic health through research [and promoting the idea that] sexual health and behavior research is essential to providing a scientific foundation for sound public health prevention and interven- tion programs.”28 Organizations like the Coali- tion to Protect Research and the Society for the Scientific Study of Sexuality call for politicians to respect the scientific peer-review process and to actively fund sex research. Some researchers, particularly those targeted by the congressio- nal effort to block NIH funding in 2003, have been reinvigorated by the controversy brought on by their research, wearing it as a “badge of honor” and insisting that they will continue to do sex research, even if they must engage in self- censorship to do so.29

NOTES 1. Senator Helms and Representative Dannemeyer were also leaders in the successful effort to de-fund the American Teenage Study, a project designed to study “patterns of adolescent sexual and contraceptive behavior and the cause of these patterns” (106). In Udry, J. Richard. 1993. “The Politics of Sex Research.” Journal of Sex Research, 30(2): 103–10.

2. Navarro, Mireya. 2004. “Experts in Sex Field Say Conservatives Interfere with Health and Research.” New York Times, July 11.

3. McCain, Robert Stacy. 2003. “Sex and Child Health: Critics Wonder Why NICHD Funds Studies.” Washington Times, September 19, A2.

her study of sexuality researchers, Irvine found that 18 percent reported a funding organiza- tion seeking modification of researchers’ grant proposals “in a way that downplayed its focus on sexuality.” This included removing words the funder saw as “dirty.” Funders labeled sex research as less serious and more controversial than other research.19 In one case, a researcher seeking a grant was told that “we do not wish to support research that will land [the univer- sity] on the front page of the newspaper.”20

Ironically, this self-censorship of controversial terms and topics has made it harder to assess whether funding has declined for sex research, as it is difficult to determine what researchers are actually studying when they submit dis- guised or reframed research proposals.21 Even research that is clearly related to public health concerns (such as why young men do not use condoms correctly or the effect alcohol has on college students’ casual sex habits) can come under fire as being inappropriate uses of federal funding.22 Other researchers have found that this stigma about sex research exists beyond funding agencies, noting that “some people who were not directly involved in our research field, either as a participant, peer, or colleague, viewed our topic and our jobs as researchers as a ‘joke’ and ‘unworthy’ of academic research.”23 These researchers frequently had to carefully manage whether to disclose information about their research, and if so, how much.

In addition to reframing how they present their research proposals to funding sources, researchers must tackle the issue of how to present their research results to the media: Issues of inaccurate, politicized, sensational- ized, or misused findings are common concerns for sex researchers.24 Presenting sensitive or controversial findings to the public is viewed as a “fundamental skill” by many researchers, especially those who fear that their results may be “misused or misinterpreted.”25 While con- troversy generates publicity for the researchers

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14. Clark, Justin. 2005. “Sex: The Big Turnoff.” Psychology Today, January/February.

15. Clay, Rebecca. 2003. “Sex Research Faces New Obstacles.” APA Online. Retrieved December 12, 2005 from www.apa.org/monitor/apr03/obstacles.html.

16. Tiefer, Leonore. 1995. Sex Is Not a Natural Act and Other Essays. Boulder, CO: Westview Press.

17. Irvine, Janice. 2014. “Is Sexuality Research ‘Dirty Work’?: Institutionalized Stigma in the Production of Knowledge.” Sexualities, 17(5–6): 632–56.

18. Goode, Erica. 2003. “Certain Words Can Trip Up AIDS Grants, Scientists Say.” New York Times, April 18, A10.

19. Irvine, 2014.

20. Irvine, 2014: 648.

21. Kempner, Joanna. 2008. “The Chilling Effect: How Do Researchers React to Controversy?” PLoS Medicine, 5(11): 1–8.

22. Radnofsky, Louise. 2010. “Science Stimulus Funds Called Wasteful.” Wall Street Journal, August 12. Retrieved September 28, 2011 from http://online.wsj.com/article /SB10001424052748704268004575417541178463762.html.

23. Hammond, Natalie, and Sarah Kingston. 2014. “Experiencing Stigma as Sex Work Researchers in Professional and Personal Lives.” Sexualities, 17(3): 329–47.

24. McBride, Kimberly R., Stephanie A. Sanders, Erick Janssen, Maria Elizabeth Grabe, Jennifer Bass, Johnny V. Sparks, Trevor R. Brown, Julia R. Heiman. 2007. “Turning Sexual Science into News: Sex Research and the Media.” Journal of Sex Research, 44(4): 347–58.

25. Kempner, Joanna, Jon F. Merz, and Charles L. Bosk. 2011. “Forbidden Knowledge: Public Controversy and the Production of Nonknowledge.” Sociological Forum, 26 (3): 475–500.

26. McBride et al., 2007.

27. Kempner et al., 2011.

28. Coalition to Protect Research (CPR). Retrieved December 16, 2005 from www.cossa.org/CPR/cpr.html.

29. Kempner, 2008.

4. Traditional Values Coalition (TVC). 2011. “NIH Wastes Millions on Bizarre ‘Research.’” Retrieved September 28, 2011 from http://www.traditionalvalues.org/content /Press%20Releases/31645/NIH%20Wastes%20Millions.

5. Moisse, Katie, and Mikaela Conley. 2011. “Study of Gay Men’s Sexual Health Called Waste of Taxpayer Money; Study Not Government-Funded.” Retrieved September 28, 2011 from http://abcnews.go.com/Health/MensHealth /study-gay-mens-sexual-health-called-waste-taxpayer /story?id=14125898.

6. Molteni, Megan. 2017. “Teen Pregnancy Researchers Regroup after Trump’s HHS Pulls Funding.” Wired, July 19. Retrieved July 27, 2017 from https://www.wired.com/story /teen-pregnancy-researchers-regroup-after-trumps-hhs -pulls-funding/.

7. Kay, Jane. 2017. “Trump Administration Suddenly Pulls Plug on Teen Pregnancy Programs.” Reveal from the Center for Investigative Reporting, July 14. Retrieved July 27, 2017 from https://www.revealnews.org/article/trump -administration-suddenly-pulls-plug-on-teen-pregnancy -programs/.

8. Herbenick, Debby, Michael Reece, Vanessa Schick, Stephanie Sanders, Brian Dodge and J. Dennis Fortenberry. 2010a. “Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14–94.” Journal of Sexual Medicine 7(s5): 255–65.

9. Alptraum, Lux. 2015. “Masters of Sex and the Ongoing Stigma of Sex Research.” The Verge, July 15. Retrieved July 26, 2017 from https://www.theverge .com/2015/7/14/8958097/masters-of-sex-science-research -sexuality.

10. American Experience: Kinsey, Online Forum, Day 2. February 15, 2005. Retrieved December 12, 2005 from www.pbs.org/wgbh/amex/kinsey/sfeature/sf_forum_0215 .html.

11. Hunter, Jennifer. 2005. “Sex Study Spurns Generation of Love.” Chicago Sun-Times, October 5: 63.

12. Radnofsky, Louise. 2010. “Science Stimulus Funds Called Wasteful.” Wall Street Journal, August 12. Retrieved September 28, 2011 from http://online.wsj.com/article /SB10001424052748704268004575417541178463762.html.

13. Coburn, Tom A. 2011. “The National Science Foundation: Under the Microscope.” Retrieved September 28, 2011 from http://coburn.senate.gov/public /index.cfm?a=Files.Serve&File_id=2dccf06d-65fe-4087 -b58d-b43ff68987fa.

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REPRESENTING SEX

A N I N T E R V I E W W I T H

J O S H U A G A M S O N

Joshua Gamson, PhD, is a professor of sociology and assistant dean at the University of San Francisco. His research and teaching focus on the sociology of culture, with an emphasis on contemporary Western commercial culture and mass media; social movements, especially on cultural aspects of contemporary movements; participant- observation methodology and techniques, particularly as applied in urban settings; and the history, theory, and sociology of sexuality. He is the author of Claims to Fame: Celebrity in Contemporary America (University of California Press, 1994); Freaks Talk Back: Tabloid Talk Shows and Sexual Nonconformity (University of Chicago Press, 1998); The Fabulous Sylvester: The Legend, the Music, the Seven- ties in San Francisco (Henry Holt, 2005), and Modern Families: Stories of Extraor- dinary Journeys to Kinship (New York University Press, 2015).

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What led you to begin studying sexuality? I didn’t know it at the time, but studying sexuality began for me as part of what some scholars have called “identity work.” I was a 23-year-old graduate student at UC Berkeley, and I’d decided it was time to figure myself out a bit better, and a big part of that seemed to be figuring out my sexuality a bit better. I knew that the Bay Area was a great place to do that, given the history of sexual subcultures—gay ones, especially—but somehow I didn’t want to just take myself out exploring. So I decided to study it, come at my personal life from the outside in, as it were. When I had a sta- tistics paper to do, I made it about public opinion about homosexuality, for instance. When I took a graduate seminar in participant-observation research, I eventually decided on a field site that would get me into San Francisco, among gay and lesbian people: the AIDS activist group ACT UP. That turned into a very rewarding research experience, and to do it I had to teach myself some of the literature on sexuality- based social movements, so it fed my head. But it also fed my identity. That work moved me into a part of the gay community that I liked, felt comfortable in, and identified with; it helped me see myself as gay, and to actually experience gayness without shame or apology. It was a case of personal identity leading to intellectual pursuit and then back to personal identity. That back and forth continues to this day.

How do people react when you tell them you study sexuality? It depends on which people are doing the reacting, I suppose. Back when I started, my more senior colleagues would generally seem mystified, as if they couldn’t quite figure out what there was to study about sexuality. Some, I’m certain, didn’t and still don’t think it’s a legitimate area of study, but I think a lot of people just didn’t know how to have a conversation about studying sexuality. That’s rarely the case anymore, partly because over the last decade the field has become much more established and much less marginalized in sociology—and partly because sexuality has been such a sig- nificant political and public policy focal point. Younger people seem to think it’s kind of cool that I study sexuality, or cool that there is such a field of study. Then there are always those who want to joke about how much fun the “research process” must be.

Which of your projects have you found most interesting? Why? The book on TV talk shows, Freaks Talk Back, was interesting to me for a whole slew of reasons. I found it really interesting to investigate how the everyday production routines—the kinds of things talk show producers think about, talk about, worry about, and do all the time to get a show made—affected LGBT topics. Usually, when scholars and activists talk about “cultural visibility,” they have only a vague sense of what kinds of institutional and organizational processes shape that visibil- ity, and I felt like I was pushing past that vagueness. I was also really interested in the experiences of guests, and learned a lot about sexuality politics from that—in particular, the internal struggle over who best represents “gayness,” which is very much a class-based divide. I became very interested in how complicated media visibility was for sexually stigmatized and gender- nonconforming populations: how

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gay and lesbian respectability was shored up on the shows by demeaning or stereo- typing transgender and bisexual guests; how the exposure of class and race diver- sity among LGBT populations only really came about through the extraordinarily exploitative, confess–accuse–pull hair kind of shows, like [ Jerry] Springer. Media visibility has really changed since then, but that project tuned me in to dynamics of gay visibility I still see all around me.

My book The Fabulous Sylvester was interesting in a whole other kind of way. It’s a sort of combination biography (of the 1970s openly gay, sometimes crossdress- ing, African American disco star Sylvester) and cultural history (of San Francisco’s gay subcultures, in which Sylvester lived and through which he rose to fame; and of AIDS, from which Sylvester died). So it was interesting partly because it was a dif- ferent sort of project, more narrative and less analytical scholarly. It was interesting to me because it put me into contact with Sylvester’s life and friends, and his story is just beautiful, and beautiful largely because his sexuality was such an integrated part of who he was—he was never closeted, and he suffered quite a bit for that, but he eventually became an international disco star by putting gay “fabulousness” to music, while refusing to be reduced to, or by, sexuality, and by never apologizing for being gay and sexual. I also loved delving into 1970s gay liberation cultures, which were so creative and novel and important, and which have been largely lost to AIDS, assimilation, and fear.

What ethical dilemmas have you faced as you’ve studied sexuality? I haven’t really experienced ethical dilemmas, frankly. I’m not studying sexual behavior, and I’ve never studied covert sexual populations, so I’ve never had con- cerns about revealing things that might hurt the subjects. I always tell people I’m a researcher, and give them the option of not participating, or of participating with- out having their name used, and sometimes people take me up on that. When I’m interviewing, they always have the option of having me turn off the tape recorder. The closest I’ve come to an ethical dilemma is in dealing with the question of how what I write might be used by others, such as journalists or policymakers who have an anti-gay agenda—which is, of course, totally out of my control. I don’t think I’ve ever made a decision to censor myself for fear that the wrong people would use it in a way that damages those to whom I’m loyal and allied, but I certainly am careful how I frame and phrase things.

What do you think is most challenging about studying sexuality? The most challenging thing for me is that it’s a constantly moving target. Again, I don’t study sexual behaviors, but instead sexual identities, movements, politics, cultures, and cultural representations. One can easily be at the end of a project and find the phenomenon entering some radically different new phase, so one has to be ready to always rethink and revise. (Maybe that’s one of the reasons I enjoyed doing the Sylvester book, since it was more historical.) Media visibility is a good example: When I finished the talk show book, the issue was still that LGBT people

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were mainly invisible on television or restricted to narrow stereotypes; the issues now, after Ellen, Will and Grace, Queer as Folk, The L Word, Queer Eye, and so on, are quite different. The talk show study, over the course of just a few years, went from being a statement about the limits and paradoxes of LGBT media visibility to being an account of a historical moment. That’s not an insurmountable challenge, and I’d rather study something that is active and volatile than something inert. But sexual cultures and politics don’t stand still for their snapshot.

Why is it important to do sex research? Most basically, because sex is an important part of human existence, and it’s been so smothered by shame and negativity that there’s still plenty that’s not well understood. Although it hasn’t always been the case, and I suspect won’t be forever, sexuality has also become a significant basis for people’s identities and self- understandings, and it affects their life chances and life paths in various ways— where they wind up living, what kinds of jobs they can and can’t get. And sexuality is one of several significant bases of social inequality, and therefore is a very significant arena of politics. These are things that need to be understood, both just because more knowledge is better than less, and because sexualities research can help us figure out what needs to be changed and how to change it—the research can inform the pursuit of social justice.

If you could teach people one thing about sexuality, what would it be? That it’s both more significant and less significant than it’s been made out to be: Sexuality is not just a phenomenon of nature, and not just “personal,” but a phe- nomenon of society, and political; at the same time, at the root of all of this politics is just sex, just the fun and sometimes funny things people do with their bodies, together and alone.

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R E A D I N G 1 1

In the recent HBO documentary Middle Sexes: Redefining He and She, narrator Gore Vidal introduces us to Qui, a Thai katoey, or lady- boy, who posted her picture online looking for a partner. The ad, placed when Qui was still a teenager, was answered by Mark, a 40-some- thing white man who “left wife, family, and job behind to follow an obsession.” Describing the first time he met Qui, Mark explains:

First time I’d ever been to Asia in my life. First country in Asia I’ve ever been to. And she met me at the air- port, so she was the very first person I ever met, about 8 o’clock at night, looking, she’s 19, I think, just turned 19 years old, just looking cute as a button.

About their first night together, Mark continues:

Took me to a hotel, you know, our first, I still remem- ber our first kiss. Of course, I never kissed a boy before so that was interesting. I still remember how it feels like. The smell of her and every single thing.

As for Qui, she explains:

I never planned on having a foreign lover. I just wanted someone who wouldn’t exploit me, someone to give me opportunities. To be born a katoey in a poor family is difficult.

One might wonder why a seemingly heterosex- ual man would leave behind a wife, his family, and his career for such an “obsession.” When such a question is posed to Mark, that is, when he is asked what he finds so attractive about a katoey, particularly Qui, he answers simply:

She’s very feminine. She’s sexy like a girl is sexy, but she’s also horny like a boy is horny. You couldn’t really ask for more than that in a person.

Later Mark explains that he would prefer that Qui not undergo surgery to remove his male sex organs. . . . Mark explains:

Yeah, I mean I enjoy it. I find it a big turn-on. I find very feminine Asian ladyboys who can perform the same as I can, who can’t, definitely can’t, fake an orgasm, I find that a huge turn-on. I mean, when I first met Qui, when we were first getting together and doing interest- ing things in private, I was shooting bullets into the headboard. It was really just the best sex I’ve ever had.

This exchange is more than just a narrative from a television special. While a self-described straight white man and a Thai katoey are hardly representative of the gay community, the pre- ceding narrative is representative of how west- ern media presents gay Asian men. Long vilified in popular western press, images of Asian men in the popular media, by the mid-1980s, “[were] at their best, effeminate closet queens like Charlie Chan and, at their worst, [were] homosexual menaces like Fu Manchu.”1 The feminization of Asian men in popular western media can be traced to the growing yellow peril of the early twentieth century, the Cold War years of the mid- and late twentieth century, and the continuing xenophobia surrounding global labor and capital that has had the chill- ing consequence of equating Asian Americans with Asians, thereby making them perpetu-

SEXY LIKE A GIRL AND HORNY LIKE A BOY: CONTEMPORARY GAY “WESTERN” NARRATIVES

ABOUT GAY “ASIAN” MEN

C . W I N T E R H A N

From “Sexy Like a Girl and Horny Like a Boy: Contem- porary Gay ‘Western’ Narratives about Gay ‘Asian’ Men,” from Geisha of a Different Kind: Race and Sexuality in Gay- sian America. Copyright © 2015 by New York University. Reprinted by permission of New York University Press.

racial and cultural boundaries while outlining who does and does not “belong” to a nation or a people. . . .

Perhaps in no other arena of social life is the act of identity construction and contesta- tion more evident than in media productions. As Stuart Hall reminds us, cultural identities are born and maintained “within, not outside, representations.”8 It is these representations that shape how we come to see ourselves and others. . . . Intimately tied to this notion is that representations reflect power differen- tials within the larger society. Representations of “oppressed groups were, and by and large still are, a relentless parade of insults.”9. . . [N] egative representations of oppressed groups have the consequence of representing the dominant group in a positive light along the dichotomy of difference. It’s a simple logic—if we are different from them, and they are bad, we must be good. For those who control the images, it is in their best interest to either (a) portray other groups negatively or, in the event that such negative portrayals will have unacceptable consequences, (b) erase them altogether when attempting to patrol the bor- ders of inclusion. . . .

To maintain racial borders, media produc- tions rely on stereotypes to patrol the margins, and gay media is no exception. Within the gay press, stereotypes are deployed to delineate between those who belong in the gay com- munity and those who do not. . . . Stereotypes reflect the values and beliefs of those who cre- ate them and work to maintain the privilege of those who deploy them for use.10 When thought about in this way, stereotypes tell us more about those who manufacture them than those who are actually stereotyped. More important, the ability to deploy stereotypes implies a power relationship where the group with power is able not only to deploy stereotypes but to actually have those stereotypes taken as reality.11. . .

Given “journalism’s centrality in politics and culture, as well as its vested economic and

ally foreign, and desexualizing Asian men in a society that values masculinity over feminin- ity.2 By neutralizing Asian male sexuality with feminine undertones, western masculinity was able to maintain its sense of superiority, par- ticularly over those it was dominating.3

In more recent decades, the rise of media activism among Asian Americans, along with texts and images created by them, has begun to challenge these stereotypes. Gay men and women of color have also begun to challenge old assumptions regarding what it means to be gay, posing a threat to older notions of gay identity.4 When previously marginalized groups begin to challenge dominant narratives and images used to marginalize them, they also challenge the taken-for-granted beliefs that help to maintain group hierarchies. When the hierarchies that maintain domination over marginalized groups become weaker, social representations about “others” may emerge more strongly because the dominant group’s identity is also threatened.5 In this [reading], I analyze The Advocate and OUT magazines from 2005 to 2010 in order to examine how images of gay Asian men are con- structed and maintained within larger western gay narratives. . . .

A MATTER OF REPRESENTATION

. . . [S]ocial representations don’t exist outside of the individual, inherent in the object they describe, but lie within individual and group experiences.6 Therefore, representations are embedded in historical, cultural, and social conditions confronted by those who create these representations at the time that they are created. . . .

According to [Edward] Said, representations are never neutral but reflect the power dynam- ics inherent in stratified social systems.7 In such systems, representations are deployed for the purpose of creating and maintaining ideo- logical definitions of “difference.” Once cre- ated, representations have the power to define

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homophobia is subtly implied repeatedly, mark- ing Asians as somehow not really a part of the gay community. For example, while questions asked in western localities such as Las Vegas are usually mundane and neutral, such as, “Is Las Vegas a gay Mecca?” the question asked on the streets of Shanghai was, “How openly can gays and lesbians live in China?” The ques- tion, when asked this way, is rather loaded as it assumes that the answer is that they can’t live openly in China but are celebrated in the gay Mecca of Las Vegas.

While feature stories about gay Asian men were rare, Asian men were often included in profile stories. However, when Asian men were the subject of a profile story in The Advocate or OUT, either alone or as a part of a group of people being featured, their race was only an issue when discussing homopho- bia in the Asian American community but not racism in the gay community. The subtle message, of course, is that homophobia is a problem to be addressed in the magazine, but racism is not.

Likewise, while gay Asian men were included in a small number of covers for The Advocate that consisted of a composite of people . . . there were no issues of the magazine that fea- tured a gay Asian man as the primary focus of the cover during the entire period, with the exception of the July 19, 2005, issue that fea- tured voiceover actor James Sie.

. . . [I]n 2005[, The Advocate ran a] review of an article that [first] appeared in the magazine on June 25, 1985, called “Gays in China.” The review is reproduced verbatim:

While we look at the struggles faced by gay Asian- Americans in the current issue of The Advocate, 20 years ago we were examining the difficult lives of gay men in China. Author “Jay Michael” used a pseud- onym so that he would be able to later return to the People’s Republic.

While there he met a Shanghai local known as “Chang Fulai,” another pseudonym. Homosexual- ity was illegal, and gays were often thrown in jail,

occupational interests, questions regarding its boundaries, uses and contingencies [are] more than idle concern.”12 Rather, it becomes criti- cal to examine the role that journalism plays in maintaining and promoting social inequality by exposing journalistic practices that add to further marginalization of subaltern groups.

WHERE ARE ALL THE GAY ASIAN MEN?

Looking at gay media, it is clear that the strat- egy deployed by gay publications to maintain white male privilege is one of exclusion. Asian men, and other men of color, rarely appear as subjects of a story and are rarely represented as contributors to the debates. Because of this, gay print media often speaks only to white men. . . . The invisibility of Asian men in gay media is most evident in the pages of The Advocate and OUT magazines, the largest gay and lesbian news magazines in the United States.

Gay Asian men (and other gay men of color) are virtually nonexistent within the pages of The Advocate and OUT magazines. For example, during the year 2010, gay Asian men appeared in OUT only four times. . . . In fact, during the entire period covering 2005 through 2010, gay Asian men were the subjects of only four feature stories, two stories each in The Advocate and OUT magazines. Ironi- cally enough, the first of these was about the invisibility of gay Asian American men in the larger gay community, which appeared in The Advocate in 2005.  .  .  . To be fair, Asian men appear in the magazines much more frequently than four times. However, they often appear as a wink and nod toward diversity, rather than as the subjects of stories. For example, they are most likely to be included as a respon- dent in The Advocate’s recurring feature “Out on the Streets,” where random gay and lesbian people are asked questions while they are out and about. Yet in this recurring feature, Asian

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with the story of Andy Wong, who, despite having gotten over his “mistake” of joining the Mormon Church in high school, nonethe- less “still struggles with being gay in his tradi- tional Chinese immigrant family.” Ironically, little is said about his Mormon background, which one might suspect had a lot to do with his remaining closeted as a gay man. Instead, numerous references are made throughout the article about gay Asian American men and women who are hesitant to come out of the closet because of traditional Asian values and pressure from Asian families. While his struggle with homophobia by Asian Americans is highlighted, there is virtually no mention of racism that is routinely experienced by gay Asian American men in the gay community or the homophobia inherent in the Mormon Church. In fact, when racism is mentioned at all, it seems to be in order to minimize the effects of racism on gay Asian American men. For example, [the author] quotes Pauline Park, a transgender Asian American activist, as stat- ing: “There’s racism in the gay community. But there’s a bigger problem of homophobia in the Asian Pacific Islander community.”

This quote, along with the tone of the article, is problematic given that existing aca- demic studies do not support this conclusion. While homophobia may prevent some gay Asian American men from coming out of the closet, several scholars have noted that rac- ism from the gay community plays an equal, if not greater, role in the lives of gay Asian American men.13 So while The Advocate pres- ents the issue of homophobia as the “big prob- lem” among gay Asian Americans and nearly ignores the racism that they experience from gay white men, evidence suggests otherwise. . . . [The author] does address issues of rac- ism within the gay community, but at the same time, the larger gay community is portrayed as actively working to address this issue as allies of gay Asian Americans. . . . [T]he struggle for

so Fulai had to be careful not to get caught with other men. Because the government assigned hous- ing, Fulai had not lived with any of his boyfriends. When he did occasionally bring them home, he had to sneak them into his room.

Fulai saw himself as “very modern” because he had sex with Western foreigners, dressed in elegant Western-style clothes, and identified himself as “gay.” And he was cautiously hopeful that Chinese leader Deng Xiaoping’s push for increased per- sonal wealth and openness to Western trade might improve the lives of gays.

. . . [I]ncluding this short narrative . . . accomplishes two goals. First, it conveniently places gay Asian American men outside of the gay mainstream. The “From The Advocate Archives” column is solely intended to draw a connection between the main feature and a similar issue from the past and showcase the continuity of the issues covered by the maga- zine. . . . Using a story on gay men in China to reflect on the situations encountered by gay Asian American men in the United States, the editors of The Advocate equate Asian Ameri- cans with Asia and conflate gay Asian Ameri- cans with gay men in Asia, marking them as foreigners. Also, the vivid descriptions of how difficult it is to be gay in China are reminiscent of the racist defense that Asian Americans, who by popular imagination are foreign, should not complain about any mistreatment they receive by “Americans” because it is inevitably better than how “Americans” would be treated in . . . Asian nations. By marking gay Asian Ameri- can men as foreigners, it takes away from the validity of their complaints about racist treat- ment. . . . [N]o article about gay life in Europe is used to harken back to a feature story about gay whites.

The narrative images created by the “From The Advocate Archives” column are more strik- ing when compared to the main Asian-themed feature titled “Invisible No More.” In this piece, the author sets the narrative stage by beginning

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“give up” their children and the Chinese gov- ernment’s homophobic attitudes. As compared to this homophobia in Asian cultures, whites, whether in the United States or elsewhere, are given a pass. . . .

Although there are a number of profiles of gay Asian men between 2005 and 2010, . . . gay Asian men do not appear as the subject of a full-length feature story in The Advocate again until September 2010, . . . in an article about author Michael Lowenthal’s trip to Nanjing, China. The tagline to the story, which reads, “Author Michael Lowenthal travels across 12 time zones to find a gay experience as for- eign as the culinary delicacies his hosts won’t stop serving,” preestablishes the inherent and essentialistic “difference” between gay Asian men and Lowenthal, a gay white man. Sadly, the article is full of stereotypes that are already well-established in the western imagination about Asian men. For example, Lowenthal notes: “Homosexuality was classified as a men- tal disorder in China until less than a decade ago, and it was only in December that the first government-backed gay bar in the country opened.”

True as that statement might be, the passage is meant to highlight the homophobia among the Chinese, an extension of the “Asians are homophobic” trope encountered in many of the articles about people in Asia and Asian Ameri- cans in both The Advocate and OUT. What Lowenthal doesn’t mention, or even allude to, is that homosexuality was also classified as a men- tal disorder in the United States during his own lifetime, making the classification of homo- sexuality as a mental disorder a recent part of America’s past as well, rather than an ancient homophobic legacy that is well in our historical past. So, while China’s recent labeling of homo- sexuality as a mental disorder is condemned, America’s similar practices are ignored. Rather than being an isolated incident, Lowenthal’s discussion about the way homosexuality is

recognition in the Asian American community is portrayed as being a lonely battle waged by gay Asian Americans, without straight allies, to win acceptance in a largely homophobic community. . . .

. . . [In the] June 21, [2005,] issue, . . . The Advocate ran a brief sidebar article called “End- ing Hong Kong’s Homophobia.” Much like the retrospective piece “Gays in China” discussed earlier, this short piece also discussed the rigid homophobia in Chinese societies and described how protesters were encouraged to wear masks to show that gays and lesbians in Hong Kong “lived in the shadow of homophobia.”. . .

. . . [T]he July 19, 2005, issue of The Advocate featured a gay Asian man on the cover, mak- ing him the only Asian person, man or woman, to appear on the cover of The Advocate in 2005 and the only Asian man to be featured prominently on the cover of either magazine for the entire six-year period. Voiceover actor James Sie, [pictured] with his partner, musi- cian Douglas Wood, was featured as a part of the magazine’s coverage of gay parenting and adoption. In both the photos, one on the cover and the photo accompanying the story, Wood is shown holding their adopted son while Sie is in the background. . . . [P]resenting Wood as the active parent and Sie as the passive par- ent blatantly gives Wood primacy in the article while relegating Sie to the background. In addi- tion, . . . Wood’s occupation, and by extension his role as family provider, is given primacy, while Sie’s work is merely a footnote. . . .

While depicting Chinese officials as being overly homophobic and Asian American women as unwilling to “give up” their children, the article makes no mention of laws in the United States that forbid gay men and women from adopting any children, or the scarcity of white babies available for adoption. In fact, the trials endured by Wood and Sie in having to seek a child outside of the United States are blamed on Asian American women’s unwillingness to

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Rather than the exotic difference that the title and tagline suggest, what he finds in the dingily lit bar is no different than what gay men would find from Kansas to Copenhagen. One would be hard-pressed to find a well-lit gay bar any- where in the world, east or west. Given these similarities, what exactly is this “gay experience as foreign as the culinary delicacies his hosts won’t stop serving”? The foreign experience that Lowenthal encounters is not one of exotic and essentialistically different men with exotic and essentialistically different lives, but an intimate encounter with a drag queen in the bathroom of a rather mundane and typical gay bar. As the author writes: “Next I knew, Miss Ming smashed her lipsticked mouth on mine. I started to resist: Sorry–not into drag queens. But how would I know? When had I ever tried one? I had journeyed all this way, and finally, here I was.”

The “foreign experience” that the article’s tagline refers to is not one of exotic lands or exotic people but one of an exotic sexual expe- rience, with a drag queen, which the author engages in for the first time, one that he could have easily and readily experienced in the United States. . . . The irony is that the author finds nothing that is exotic, including the “culi- nary delicacies” alluded to in the title. . . . What is exotic is his sexual encounter with a drag queen, an Asian drag queen no less. In this way, the gay Asian man, drag queen or not, is clearly a sexual other, outside of the author’s norma- tive definition of sexually desirable and, thus, a “foreign” and “exotic” experience only to be indulged 12 time zones away.

ASIANS ARE HOMOPHOBIC BUT GAYS ARE NOT RACIST

. . . The trope of Asian homophobia is pre- sented in both subtle and blatant ways. For example, the March 14, 2006, issue of The Advocate included a sidebar article as part of

criminalized and marginalized simply echoed an earlier article in The Advocate titled “Gay China Comes Out Online” about China-based gay websites, written by Morgan Kroll, that noted, “The show reflects slowly changing atti- tudes in China. Sodomy was decriminalized in 1997, though homosexuality was still considered a mental illness by the government until 2001.” Again, while portraying Chinese people and the Chinese government as homophobic, no mention was made that sodomy laws remained on the books in 14 states in the United States until 2013. . . .

Lowenthal’s description of the gay Chi- nese men that he meets is also emblematic of the western view of Asian men, both gay and straight. In describing the first person he encounters at a Nanjing gay bar, Lowenthal had this to say:

A femmy man—or a butch woman: again my gaydar failed me—emerged from a shadow toward some stairs. When I approached, the person, in a panic, waved me off. “Please,” I said. I smiled and showed my map. The nervous nelly (even this close, I couldn’t tell the gender) made a rueful book-shutting gesture and scuttled up the stairs.

. . . Through . . . Lowenthal’s western eyes, it is difficult to ascertain if the Asian person in front of [him] is a man or a woman, quite simply because all Asian men are, by nature, feminine.

Lowenthal’s attempt to subtly exotify and foreignize gay life in Asia through descriptions of dark alleys and confusing signs seems even more problematic given his own admission that the gay life he finds in China is neither exotic nor foreign to him. In his own words:

The queen on stage, peddling her cartoonish sexual- ity, her stringy wig, the cheesy disco lighting: The club resembled ones I’ve seen from Kansas to Cape Cod, from Copenhagen to Lisbon to Havana. It called to mind the set of RuPaul’s Drag Race. But I had crossed 12 time zones to a vast, exotic land, had braved its maze of mystifications, for this?

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racism that the members of this group might experience from the gay community. While Phia Xiong’s personal experiences with his fam- ily may have led to the formation of the group, his experiences with his family are presented as a universal Asian American experience by tying his racial background to a specific famil- ial experience. More important, while the for- mation of a gay Asian American group in the twin cities is covered by the magazine, other gay Asian American groups, such as Queer and Asian in Seattle, GAPIMNY in New York City, and Gay Asian Pacific Alliance in San Fran- cisco, that have a much larger membership and a much longer history, as well as a history of confronting racism in the gay community, are not mentioned at all. . . .

The problem is that the “Asians are homo- phobic” trope is often used by gay white men to justify gay racism toward gay Asian Ameri- can men. For example, in a rare online dis- cussion about racism in the gay community hosted by mainstream gay website Queerty. com, the first comment to the editorial titled “Is the Gay Community Racist?” was: “Is the black, Asian, and Latino community homo- phobic?” As this example demonstrates, for many gay white men, it isn’t important if members of the gay community are racist. Nor does it matter how they treat other mem- bers of the gay community. What is impor- tant is how people who look like those gay men might allegedly treat them. The realization that if there is homophobia in communities of color, those particular gay men would also be victims of that homophobia is entirely lost on some of the gay white men who continue to conflate all people of color. In addition, any accusation of racism on the part of gay white men can be easily dismissed with references to the “homophobic” communities of color. This alleged homophobia in the Asian American community, and other communities of color, is used to excuse gay racism and provide cover

their “World Focus” series that discusses gay issues from around the globe. In this partic- ular issue, the column discussed the “Gay in Japan” cover story that appeared in the Japa- nese edition of Newsweek magazine. The side- bar begins with the sentence, “Coming out is still very difficult in Japan’s traditional culture” and continues to discuss the difficulty of being gay in Japan. The very next issue, March 28, 2006, includes another “World Focus” sidebar article on the South Korean military’s policy of discharging gay men from military ser- vice. The tone of the article, which is clearly meant to highlight homophobia in the South Korean military, ignores the homophobia in the U.S. military while denouncing the alleged homophobia in the South Korean military. Ironic given the policy of “don’t ask, don’t tell” that the U.S. military was practicing at the time of the article’s printing, a policy that also discharged gay men from military service in the United States. In another sidebar article, which appeared in the April 25, 2006, issue on a gay Hmong support group in Minneapolis and St. Paul, author Bao Ong writes: “When Phia Xiong came out to his family at a young age, he was disowned, accused of recruiting straight people, and told there was no such thing as gay—there’s not even a word for gay in Hmong.”

The fact that there is no word for “gay” in the Hmong language is immediately associ- ated with homophobia rather than a cultural tradition that did not mark and stigmatize homosexual behaviors or think of sexuality as a central core of a person’s identity. Because the judgment is made entirely from a western perspective, with no regard to Hmong cultural history, the Hmong community is condemned for what the magazine deems homophobic behavior. The formation of the [support] group, and its continued growth, is attributed entirely to homophobia among Hmong community members rather than to any potential or actual

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partners as being biologically determined is contradicted by his own observation that “tastes even change sometimes. I’ve had friends whose lack of sexual interest in black or Asian men was reversed after a trip to Africa or Asia.” It is fairly safe to assume that Brocka has no gay male friends whose sexual orientation changed. So, while sexual orienta- tions don’t change, a preference for certain attributes certainly does. Clearly, racial pref- erences, much like preferences for blue eyes or blond hair, are socially determined, not biologically determined, and do therefore “change sometimes.” And while Brocka notes that “any number of things could shape what we look for in a partner,” he further states, “all that matters to me is that people aren’t jerks about their tastes.” One wonders why the rac- ist beliefs surrounding alleged racial prefer- ences do not matter to the author.

The photo accompanying the column is doubly problematic. An image of a gay Asian man wearing a shirt imprinted with the line “Imported from Asia” marks all Asian men as foreign and part of an immigrant wave rather than as native to American soil. The idea that Asian men are all immigrants is further pro- moted by the author’s closing remark, “Maybe you can’t control whom you’re attracted to, but you can control how you respond to finding an IMPORTED FROM ASIA label on your date.” Why is there an expectation that Asian Ameri- can men would have an “imported from Asia” label on them, while white men would never have an “imported from Europe” label? The stereotype that all Asian American men are immigrants, therefore foreign, is not only left unchallenged but is promoted. Furthermore, with this closing comment, Brocka transforms a structural problem of racism in the gay com- munity into a personal matter that could be addressed by encouraging gay white men to simply be more polite as they are engaging in racist behavior.

for gay white men’s racist behaviors, making these behaviors almost justified in their eyes. These justifications erase the existence of gay men and women of color, marking the bound- aries of group membership along either race or sexuality, but not both.

Racism toward gay Asian American men by gay white men is not only ignored but actively dismissed as trivial. Perhaps the most direct discussion about gay racism is in the “Min- ute Rice Queens” column by writer Q. Allan Brocka that appeared in the November 6, 2007, issue of The Advocate. In this column, Brocka addresses the well-noted phenomenon of racial “preference” among gay white men and the racist tone that underlines these sup- posed “preferences.” As noted by several gay commentators of color and discussed on web- sites such as sexualracismsux.com and sexual racismonmanhunt.blogspot.com, white men’s defense of “racial preference” is deeply rooted in racist beliefs about the social worth of men of color.14. . . [G]ay white men often resort to a biological rationale when confronted with sexual racism, largely ignoring the racialized language that they use to describe their racial preferences of sexual partners or the racial- ized hierarchy that defines who is and is not desirable. For example, one online poster on the public forum hosted by Queerty.com noted, “Not liking women doesn’t make me sexist, so not liking Asians doesn’t make me racist.” Rather than confront this absurd assumption, Brocka justifies it by stating, “I suppose if we could choose whom we are physically attracted to, there might be no gay community.” The idea, of course, is that if we can indeed “choose” whom we are physically attracted to, we would all choose women, therefore leaving no gay men. Even putting aside the ridiculous idea that one’s sexuality is “chosen” the way one prefers blond hair or blue eyes, the absurdity of his own defense of gay white men’s racial preferences in sexual

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In addition, the column plays upon old ste- reotypes of Asian Americans; for one, it sug- gests that Asian men are perpetually foreign, and as such are outside of the gay mainstream. While an adjective to describe a recent immi- grant is provided, there is no attempt to define slang terms that describe American-born Asians. Not surprising is the inclusion of the term dogeater, meant to conjure up stereotypi- cal images of Asians and perceived dietary patterns. . . .

The same issue of OUT magazine also included an article titled “A Whole New Play- ing Field,” about the supposed emerging gay culture and politics in Thailand. . . .

Despite the purported focus of the article being about the increase in gay visibility in Thailand, the alleged new gay movement in Thailand is largely attributed to western influences. As [Chandler] Burr argues: “Two forces are moving gay rights: the Internet— Thai gay people are connecting with U.S. and European gay people, thus learning about Western identity politics—and HIV/ AIDS. Just as it did in the West, HIV/AIDS is relentlessly forcing the growth of gay politi- cal power.”

While Burr states that two forces are mov- ing gay rights in Thailand, western gays are given credit in both. It is the western gays who are providing Thai men with a lesson about gay identities, and it is the “western” model that Thai men are following in responding to HIV/ AIDS. Here, gay white men are seen as com- ing to the aid of gay Thai men who, before the onset of western influence, had “no vocabu- lary” for being gay and thus, “use the English word ‘gay’ for men whose sexual orientations are homosexual.” Much like The Advocate arti- cle on the formation of the gay Hmong support group, the author takes it as a given that having no word for “gay” is equated with being homo- phobic. Rather than examine cultural patterns that may have excluded labels for exclusively

ADDING INSULT TO INJURY

While the treatment of gay Asian men by The Advocate may be lacking, at least it is not out- right degrading. In fact, given the relatively small number of gay Asian American men in the United States compared to gay white men, a few articles that represent the needs of a small portion of their potential readers might be expected. However, articles in OUT maga- zine seem to actively degrade gay Asian men for entertainment value while relegating gay Asian American men to the margins of the gay community or placing them outside of the gay community altogether. For example, the Feb- ruary 2005 issue of OUT magazine ran a col- umn titled “How to Gab in Gaysian.” A pitiful and unfortunate attempt at comic relief, OUT magazine introduced the column in this way:

Sometimes members of a group pepper their conver- sations with sexual euphemisms, saucy slang terms, and just flat-out un-PC parlance. Since there isn’t an official English-Gaysian dictionary, OUT offers you a small menu of words you might want to know in order to verbal-vogue it like a queer Asian.

Included in the list of words to be translated into English were FOBulous, an adjective meaning “fresh off the boat and fabulous,” and dogeater, a noun to describe a “gaysian who unapologetically uses men for all their emo- tional, sexual, and financial worth because they feel men are dogs by nature.”

First, the column works to highlight the for- eignness of gay Asian American men compared to gay white men. . . . In implying that readers of OUT magazine would need an “English- Gaysian dictionary,” the column presupposes that such readers are white, or at least not Asian. It is the implied gay white reader who is provided with a lesson on how to decipher the “foreign” language of gay Asian American men, and it is the implied gay white reader who is to receive a “lesson” about a “foreign” group.

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To be fair, two Asian men do appear on the “hot list” in 2005. However, one is Buddhist monk Dzongsar Khyentse Rinpoche, who the magazine features as the “hottest Lama” for being “open about his gay ‘tendency’” rather than for being sexually desirable, and an Asian stripper who is used to feature Rem- ington’s in Toronto, which the magazine notes is the “hottest male strip club.” The use of a nameless Asian stripper, whose most promi- nent asset in the photo is his ass, to represent a strip club where bodies on display are spe- cifically meant for consumption, is an inter- esting contrast to the named white men who are included as the hottest alt-rock record executive, hottest DJ, hottest reality person- ality, hottest straight guy we wish was gay, hottest crooner, hottest returning gay rock icon, hottest up-and-coming filmmaker, hot- test has-been, hottest author, hottest photog- rapher, hottest gay romance-writing couple, hottest contractor, hottest porn star, and hot- test designers. . . .

The only other images of Asian men to appear in OUT magazine before the yearend issue in 2005 are in a September review of the nude photography book The Asian Male. Although the brief review states that the photos in the book “clearly challenge the stereotype of Asian men as passive geeks,” it nonetheless quotes the photographer as stating that the thing that makes Asian men sexy is their “delicious skin; really nice butts; sensuous, alluring eyes.” It’s good to know that the author of the review is aware of the geek stereotype thrust upon all Asian men; however, it’s obvious that they believe it is the stereotypical beliefs about Asian male femininity that make Asian men attractive to white audiences. . . .

Gay Asian men don’t make it onto the “hot list” again until 2009, when three gay Asian men are featured. The first is designer Jason Wu, who is quoted as stating, “I played

“gay” men and the westernized notions of equating sexual behavior with sexual identity, the author implies that the lack of such labels is an indication of a society that has not yet come to terms with having homosexual members. Yet any reading of Thai sexual history would show that Thailand has a long history of accepting men who have sex with men.15

Western gay men are also given credit for the rising “gay consciousness” found in Thailand. . . .

Gay white men are also portrayed as help- ing Thai men who are inept at simple rational activities such as planning. Burr explains that after [gay activist] Pakorn [Pimton] organized the first Bangkok Gay Festival in 1999, Bang- kok Pride “almost died several times” because of what Burr characterizes as a lack of planning and coordination. . . .

Despite Burr’s own contention that HIV/ AIDS is central to political organizing among gay Thai men, little is said about the role that sex tourism by white men contributed to the rising epidemic. Instead, Burr attempts to remove blame from western tourists on what he presents as largely a Thai problem. . . .

. . . [D]escriptions of white male celebri- ties, gay and straight, as being “hot” or sexu- ally desirable are routine in OUT magazine. Yet, despite the fact that a number of Asian celebrities . . . are profiled or discussed in the magazine, none of them is described as being sexually desirable in any way. In fact, allusions to their attractiveness are strikingly absent. Even when a man is described as “handsome,” as is nightclub host Xiao Gang in Dan Levin’s article “Comrades and Boundaries,” in the October 2008 issue, about gay nightlife in China, the description is torturously desexual- ized by describing him as “a slim, handsome man of 31 with an impish face and great hair.” So, while an Asian man may be considered “handsome,” it is in a child-like “impish” way, devoid of sexual connotations. . . .

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argument, gay Asian American film director Quentin Lee writes:

I often get slightly depressed when I wander through queer stores, whether it’s in San Francisco, Mon- treal or Hawaii. It’s the same everywhere, in every part of North America. There are so few porno products about us Asian queers, and these few are not created by us, they are exotified for the pleasure of the white man.17

To illustrate his point, Lee discusses a story in Beau Magazine titled “Thai’ed up for the eve- ning,” about a sailor, presumed to be white, and his sexual encounter with two Thai “boys.” Lee quotes from the story as follows:

Their childlike, scrawny bodies didn’t do much for me, I dream of the Jeff Stryker type, and these kids weren’t it. Even when I had been a boy I never lusted after boys, only strong adult men. These were going to take some getting used to. Let’s face it: A scrawny five-foot kid isn’t going to have the size of Godzilla. They told me they were 20 and 23. When I asked them their names and got some Thai back in return, I told the one with the big dick that his name was “Butch” and the other that his was “Sundance.” I doubt they saw the humor, but did I give a fuck?18

Although not common in gay pornographic magazines, these are the only such stories that feature Asian characters. Asian charac- ters are never the narrators, rather they are the narrated. As Lee notes, in these stories, the subject is the assumed white male, while Asian men are simply the objects present for sexual gratification. . . . By making the sharp contrast with Stryker, a famous porn actor notorious for being the muscular, masculine, and active “top” in gay porn films, the narrator constructs the Thai boys as feminine, passive, and submissive. . . .

Richard Fung also notes that gay Asian actors in gay porn exist only for the pleasure of white men.19 In . . . “Looking for My Penis,” Fung finds that gay Asian porn actors always, with the exception of one instance, take the

with dolls. I made little clothes for them.” . . . Wu . . . also [states] that it would have been “traumatic” if his family did not immigrate to Vancouver from Taipei when he was a young child, given his own description of Taiwan as an “extremely conventional society.” The allu- sion, of course, is that a young boy dressing dolls would have been persecuted in Taiwan but was somehow fully accepted in Vancou- ver, an allusion that is laughable at best. Yet, characterizing Asian countries as conventional, and thus homophobic, and western nations as progressive on issues of gender and sexuality allows OUT magazine to continue to promote the trope of Asian homophobia and western acceptance. . . .

NO SHORTAGE OF ASIAN MEN HERE

While virtually invisible in feature stories, gay Asian men are amply present in advertise- ments placed in gay periodicals. Full-page ads for pornographic films with all-Asian casts are scattered generously throughout the pages of gay publications, although Asian men are excluded from the features. While advertise- ments in gay periodicals seem to advertise to gay white men, they advertise gay Asian men as a commodity for consumption. Per- haps this is nowhere more evident than in the pages of Oriental Guys Magazine. Originally published in Sydney, the recently defunct Oriental Guys Magazine was essentially a nine-year advertisement of gay Asian men for white men. The Asian men who grace the pages of Oriental Guys Magazine and other such “rice queen magazines,” named in refer- ence to rice queens—gay white men who prefer Asian sex partners—are meant for white male consumption, and sexual narratives regard- ing the men pictured are almost always writ- ten by white men.16 Further highlighting this

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2. David Eng, Racial Castration: Managing Masculinity in Asian America (Durham: Duke University Press, 2001). See also, Darrell Hamamoto, Monitored Peril: Asian Americans and the Politics of TV Representation (Minneapolis: University of Minnesota Press, 1994) and Robert Lee, Orientals: Asian Americans in Popular Culture (Philadelphia: Temple University Press, 1999).

3. Lisa Lowe, Immigrant Acts: On Asian American Cultural Politics (Durham: Duke University Press, 1996).

4. Roderick Ferguson, Aberrations in Black: Toward a Queer of Color Critique (Minneapolis: University of Minnesota Press, 2003). . . .

5. Serge Moscovici, “Introduction,” in Health and Illness: A Social Psychological Analysis, ed. Claudine Herzlich (London: Academic Press, 1973).

6. Ibid., xi.

7. Edward Said, Culture and Imperialism (New York: Alfred A. Knopf, 1993), 314.

8. Stuart Hall, “Cultural Identity and Cinematic Representation,” Framework, 36 (1989): 69.

9. Richard Dyer, The Matter of Images: Essays on Representation (London: Routledge, 2002), 1.

10. Walter Lippman, Public Opinion (New York: Harcourt, Brace and Company, 1922), 96.

11. Peter Berger and Thomas Luckman, The Social Construction of Reality (London: Allen Lane, 1967).

12. Peter Dahlgren, “Introduction,” in Journalism and Popular Culture, ed. Peter Dahlgren and Colin Spark (London: Sage, 1992), 18. See also, John Storey, Cultural Studies and the Study of Popular Culture (Athens: University of Georgia Press, 1996).

13. Stephen Murray. “Representations of Desire in Some Recent Gay Asian-American Writing,” Journal of Homosexuality, 45 (2003). See also, Maurice Poon, “The Discourse of Oppression in Contemporary Gay Asian Diasporal Literature: Liberation or Limitation?” Sexuality and Culture, 10 (2006).

14. Alex Blaze, “John Mayer and Sexual Racism: The Bilerico Project,” February 11, 2010, http://www.bilerico .com/2010/02/john_mayer_and_sexual_racism.php. Daniel W. K. Lee, “Don’t Ask, Just Tell: Sexual Racism Is at the Core of What Many Gay Men Believe to Be ‘Preferences,’” Metro Weekly, September 23, 2010, http://metroweekly.com/news /opinion/?ak=5613. Andy Quan, “I Don’t Have a Racist Bone in My Body,” Crank Magazine, 2 (2002). Alex Rowlson. “Not Just a Preference,” FAB Magazine, October 12, 2011, http:// www.fabmagazine.com/story/not-just-a-preference.

15. Peter A. Jackson and Gerard Sullivan, eds., Lady Boys, Tom Boys, Rent Boys: Male and Female Homosexualities in Contemporary Thailand (Binghamton, NY: Haworth Press, 1999).

bottom role of passive recipient of anal sex. Even in the one exception where the Asian porn actor plays the active sexual partner, the narra- tive of the plot has him performing the role of the white man’s domestic servant. In this way, even the normally aggressive and active sexual role of the top is couched in the Asian man’s “service” of the white man. . . .

DISMANTLING HEGEMONIC MASCULINITY

It’s not surprising that the feminine image of all Asian men has been easily superimposed onto gay media. Contrasting the “feminine” gay Asian man to the “masculine” gay white man places gay white men in the dominant position in a society and culture that value masculinity over femininity, active over passive, and virile over submissive. In doing so, gay publications create a hierarchy of those who belong in the gay community and those who are simply mar- ginal members. . . .

The real goal needs to be an attempt at changing the dominant view of masculinity within the gay community rather than buying into the existing model provided by the gay mainstream. Doing so, however, is hardly an easy task. Rather than focusing on reproduc- ing the dominant gay images of masculinity with Asian faces, I believe, as Jachinson Chan suggests, that “an ambivalent or ambiguous model of masculinity is a more effective way to counter a hegemonic model of masculinity.”20 However, doing so is a daunting task. But what other options are there if the ultimate goal is to dismantle the very system of gendered expecta- tions that continually places gay men of color in the subordinate position to gay white men? . . .

NOTES 1. Jeffrey Chan et al., The Big Aiiieeee! An Anthology of Chinese American and Japanese American Literature (New York: Meridian, 1991), xiii.

126 R E P R E S E N T I N G S E X

18. Ibid, 11.

19. Richard Fung, “Looking for My Penis,” in How Do I Look? Queer Film and Video, ed. Bad Object Choices (Seattle: Bay Press, 1991).

20. Jachinson W. Chan, “Bruce Lee’s Fictional Model of Masculinity,” Men and Masculinities, 2 (2000): 385.

16. Paul Hagland, “‘Undressing the Oriental Boy’: The Gay Asian in the Social Imagination of the Gay White Male,” in Looking Queer: Body Image and Identity in Lesbian, Bisexual, Gay and Transgender Communities, ed. Dawn Atkin (New York: Harrington Park Press, 1998).

17. Quentin Lee, “The Sailor and the Thai Boys,” Lavender Godzilla, 8 (1999): 12.

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R E A D I N G 1 2

Drew was 8 years old when he was flip-ping through TV channels at home and landed on “Girls Gone Wild.” A few years later, he came across HBO’s late-night soft-core pornography. Then in ninth grade, he found online porn sites on his phone. The videos were good for getting off, he said, but also sources for ideas for future sex positions with future girlfriends. From porn, he learned that guys need to be buff and dominant in bed, doing things like flipping girls over on their stomach during sex. Girls moan a lot and are turned on by pretty much everything a confi- dent guy does. One particular porn scene stuck with him: A woman was bored by a man who approached sex gently but became ecstatic with a far more aggressive guy.

But around 10th grade, it began bothering Drew, an honor-roll student who loves baseball and writing rap lyrics and still confides in his mom, that porn influenced how he thought about girls at school. Were their breasts, he wondered, like the ones in porn? Would girls look at him the way women do in porn when they had sex? Would they give him blow jobs and do the other stuff he saw?

Drew, who asked me to use one of his nick- names, was a junior when I first met him in late 2016, and he told me some of this one Thurs- day afternoon, as we sat in a small conference room with several other high school boys, eat- ing chips and drinking soda and waiting for an after-school program to begin. Next to Drew was Q., who asked me to identify him by the first initial of his nickname. He was 15, a good student and a baseball fan, too, and pretty per- plexed about how porn translated into real life. Q. hadn’t had sex—he liked older, out-of-reach

girls, and the last time he had a girlfriend was in sixth grade, and they just fooled around a bit. So he wasn’t exactly in a good position to ask girls directly what they liked. But as he told me over several conversations, it wasn’t just porn but rough images on Snapchat, Facebook and other social media that confused him. Like the GIF he saw of a man pushing a woman against a wall with a girl commenting: “I want a guy like this.” And the one Drew mentioned of the “pain room” in “Fifty Shades of Grey” with a caption by a girl: “This is awesome!”

Watching porn also heightened Q.’s perfor- mance anxiety. “You are looking at an adult,” he told me. “The guys are built and dominant and have a big penis, and they last a long time.” And if you don’t do it like the guys in porn, Drew added, “you fear she’s not going to like you.”

Leaning back in his chair, Drew said some girls acted as if they wanted some thug rather than a smart, sensitive guy. But was it true desire? Was it posturing? Was it what girls thought they were supposed to want? Neither Q. nor Drew knew. A couple of seats away, a sophomore who had been quiet until then added that maybe the girls didn’t know either. “I think social media makes girls think they want something,” he said, noting he hadn’t seen porn more than a handful of times and disliked it. “But I think some of the girls are afraid.”

“It gets in your head,” Q. said. “If this girl wants it, then maybe the majority of girls want

WHAT TEENAGERS ARE LEARNING FROM ONLINE PORN

M A G G I E J O N E S

From “What Teenagers Are Learning from Online Porn.” From The New York Times, February 7, 2018 © 2018 The New York Times. All rights reserved. Used by permission and protected by the Copyright Laws of the United States. The printing, copying, redistribution, or retransmission of this Content without express written permission is prohibited.

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W H AT T E E N AG E R S A R E L E A R N I N G F RO M O N L I N E P O R N 129

On average, boys are around 13, and girls are around 14, when they first see pornography, says Bryant Paul, an associate professor at Indi- ana University’s Media School and the author of studies on porn content and adolescent and adult viewing habits. In a 2008 University of New Hampshire survey, 93 percent of male college students and 62 percent of female stu- dents said they saw online porn before they were 18. Many females, in particular, weren’t seeking it out. Thirty-five percent of males said they had watched it 10 or more times during adolescence.

Porn Literacy, which began in 2016 and is the focus of a pilot study, was created in part by Emily Rothman, an associate professor at Boston University’s School of Public Health who has conducted several studies on dating violence, as well as on porn use by adolescents. She told me that the curriculum isn’t designed to scare kids into believing porn is addictive, or that it will ruin their lives and relationships and warp their libidos. Instead it is grounded in the reality that most adolescents do see porn and takes the approach that teaching them to analyze its messages is far more effective than simply wishing our children could live in a porn-free world.

Imagine that you are a 14-year-old today. A friend might show you a short porn clip on his phone during the bus ride to school or after soc- cer practice. A pornographic GIF appears on Snapchat. Or you mistype the word “fishing” and end up with a bunch of links to “fisting” vid- eos. Like most 14-year-olds, you haven’t had sex, but you’re curious, so maybe you start searching and land on one of the many porn sites that work much like YouTube—XVideos.com, Xnxx.com, BongaCams.com, all of them among the 100 most-frequented websites in the world, accord- ing to Alexa Top Sites. Or you find Pornhub, the most popular of the group, with 80 million visitors a day and more traffic than Pinterest, Tumblr or PayPal. The mainstream websites

it.” He’d heard about the importance of con- sent in sex, but it felt pretty abstract, and it didn’t seem as if it would always be realistic in the heat of the moment. Out of nowhere was he supposed to say: Can I pull your hair? Or could he try something and see how a girl responded? He knew that there were certain things—“big things, like sex toys or anal”—that he would not try without asking.

“I would just do it,” said another boy, in jeans and a sweatshirt. When I asked what he meant, he said anal sex. He assumed that girls like it, because the women in porn do.

“I would never do something that looked uncomfortable,” Drew said, jumping back into the conversation. “I might say, ‘I’ve seen this in porn—do you want to try it?’”

It was almost 4 p.m., and the boys started to gather their backpacks to head to a class known as Porn Literacy. The course, with the official title The Truth About Pornography: A Pornography-Literacy Curriculum for High School Students Designed to Reduce Sexual and Dating Violence, is a recent addition to Start Strong, a peer-leadership program for teenagers headquartered in Boston’s South End and funded by the city’s public-health agency. About two dozen selected high school students attend every year, most of them black or Latino, along with a few Asian students, from Boston public high schools, including the city’s com- petitive exam schools, and a couple of parochial schools. During most of the year, the teenagers learn about healthy relationships, dating vio- lence and L.G.B.T. issues, often through group discussions, role-playing and other exercises.

But for around two hours each week, for five weeks, the students—sophomores, juniors and seniors—take part in Porn Literacy, which aims to make them savvier, more critical consumers of porn by examining how gender, sexuality, aggression, consent, race, queer sex, relation- ships and body images are portrayed (or, in the case of consent, not portrayed) in porn.

Jill Bauer and Ronna Gradus, creators of the 2017 Netflix documentary series “Hot Girls Wanted: Turned On,” about technology and porn, paired with several foundations and phi- lanthropists to fund a national survey about porn viewing, sexual attitudes and behaviors. As part of the survey, led by Debby Herbenick, a professor at the Indiana University School of Public Health and director of the university’s Center for Sexual Health Promotion, along with her colleague Bryant Paul, 614 teenagers ages 14 to 18 reported what their experiences were with porn. In preliminary data analy- sis from the study (Herbenick is submitting an academic paper for publication [in 2018]), of the roughly 300 who did watch porn, one- quarter of the girls and 36 percent of the boys said they had seen videos of men ejaculating on women’s faces (known as “facials”), Paul says. Almost one-third of both sexes saw B.D.S.M. (bondage, domination, sadism, masochism), and 26 percent of males and 20 percent of females watched videos with double penetra- tion, described in the study as one or more penises or objects in a woman’s anus and/or in her vagina. Also, 31 percent of boys said they had seen “gang bangs,” or group sex, and “rough oral sex” (a man aggressively thrusting his penis in and out of a mouth); less than half as many girls had.

It’s hard to know if, and how, this translates into behavior. While some studies show that a small number of teenagers who watch higher rates of porn engage in earlier sex, as well as in gender stereotyping and in sexual relation- ships that are less affectionate than their peers’, these findings only indicate correlations, not cause and effect. But surveys do suggest that the kinds of sex some teenagers have may be shifting. The percentage of 18- to 24-year-old women who reported trying anal sex rose to 40 percent in 2009 from 16 percent in 1992, according to the largest survey on American sexual behavior in decades, co-authored by

aren’t verifying your age, and your phone allows you to watch porn away from the scruti- nizing eyes of adults. If you still have parental- control filters, you probably have ways around them.

Besides, there’s a decent chance your parents don’t think you are watching porn. Preliminary analysis of data from a 2016 Indi- ana University survey of more than 600 pairs of children and their parents reveals a parental naïveté gap: Half as many parents thought their 14- and 18-year-olds had seen porn as had in fact watched it. And depending on the sex act, parents underestimated what their kids saw by as much as 10 times.

What teenagers see on Pornhub depends partly on algorithms and the clips they’ve clicked on in the past. Along with stacks of videos on the opening page, there are several dozen categories (“teen,” “anal,” “blonde,” “girl on girl,” “ebony,” “milf”) that can take them to more than six million videos. The clips tend to be short, low on production value, free and, though Pornhub tries to prevent it, sometimes pirated from paid sites. Many of the heterosex- ual videos are shot from the male point of view, as if the man were holding the camera while he has sex with a woman whose main job, via oral sex, intercourse or anal sex, is to make him orgasm. Plot lines are thin to nonexistent as the camera zooms in for up-close shots of genitals and penetration that are repetitive, pounding and—though perhaps not through the eyes of a 14-year-old—banal. (There are alternative nar- ratives in L.G.B.T. and feminist porn, and stud- ies show that for gay and bisexual youth, porn can provide affirmation that they are not alone in their sexual desires.)

We don’t have many specifics on what kids actually view, in large part because it’s extremely difficult to get federal funding for research on children and pornography. A few years ago, frustrated by the dearth of large, recent United States studies, Rashida Jones,

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mainstream media—everything from the TV show “Family Guy” (which references choking and anal sex) to Nicki Minaj’s song “Truffle Butter” (with an apparent allusion to anal sex followed by vaginal sex) to the lyrics in Rihan- na’s “S&M” (“Sticks and stones may break my bones, but chains and whips excite me”)—made anal and rough sex seem almost common- place. Drew told me he got the sense that girls wanted to be dominated not only from reading a few pages of “Fifty Shades of Grey” but also from watching the movie “Mr. & Mrs. Smith,” with Brad Pitt and Angelina Jolie. “She’s on the table, and she’s getting pounded by him. That’s all I’ve seen growing up.”

These images confound many teenagers about the kinds of sex they want or think they should have. In part, that’s because they aren’t always sure what is fake and what is real in porn. Though some told me that porn was fantasy or exaggerated, others said that porn wasn’t real only insofar as it wasn’t typically two lovers having sex on film. Some of those same teenagers assumed the portrayal of how sex and pleasure worked was largely accurate. That seems to be in keeping with a 2016 sur- vey of 1,001 11- to 16-year-olds in Britain. Of the roughly half who had seen pornography, 53 percent of boys and 39 percent of girls said it was “realistic.” And in the recent Indi- ana University national survey, only one in six boys and one in four girls believed that women in online porn were not actually experiencing pleasure: As one suburban high school senior boy told me recently, “I’ve never seen a girl in porn who doesn’t look like she’s having a good time.”

It’s not surprising, then, that some adoles- cents use porn as a how-to guide. In a study that Rothman carried out in 2016 of 72 high schoolers ages 16 and 17, teenagers reported that porn was their primary source for infor- mation about sex—more than friends, siblings, schools or parents.

Herbenick and published in the Journal of Sexual Medicine. In data from that same sur- vey, 20 percent of 18- to 19-year-old females had tried anal sex; about 6 percent of 14- to 17-year-old females had. And in a 2016 Swedish study of nearly 400 16-year-old girls, the per- centage of girls who had tried anal sex doubled if they watched pornography. Like other stud- ies about sex and porn, it only showed a corre- lation, and girls who are more sexually curious may also be drawn to porn. In addition, some girls may view anal sex as a “safer” alternative to vaginal sex, as there’s little risk of pregnancy.

The Indiana University national survey of teenagers asked about other sex behaviors as well. Though the data have not been fully ana- lyzed, preliminary findings suggest that of the teenagers who had had sex, around one-sixth of boys said they had ejaculated on someone’s face or choked a sex partner. The survey didn’t define choking, but the high school and col- lege-age students I spoke to referred to it as anything from placing a hand gently on a part- ner’s neck to squeezing it.

We don’t have longitudinal data on the fre- quency of ejaculating on a girl’s face or choking among American teenagers to know whether either practice is more common now. And, as David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire, told me, fewer teenagers have early sex than in the past (in a recent study, 24 percent of American ninth graders had sex; in 1995 about 37 percent had), and arrests of teenagers for sexual assault are also down. But you don’t have to believe that porn leads to sexual assault or that it’s creat- ing a generation of brutal men to wonder how it helps shape how teenagers talk and think about sex and, by extension, their ideas about masculinity, femininity, intimacy and power.

Over the year in which I spoke to dozens of older teenagers at Start Strong and around the country, many said that both porn and

addictive, but that people can become compul- sive about it.

In the first class, Daley led an exercise in which the group defined porn terms (B.D.S.M., kink, soft-core, hard-core), so that, as she put it, “everyone is on the same page” and “you can avoid clicking on things you don’t want to see.” The students also “values voted”— agreeing or disagreeing about whether the legal viewing age of 18 for porn is too high, if working in the porn industry is a good way to make money and if pornography should be illegal. Later, Daley held up images of a 1940s pinup girl, a Japanese geisha and Kim Kardashian, to talk about how cultural values about beauty and bodies change over time. In future classes, they would talk about types of intimacy not depicted in porn and nonsexist pickup lines. Finally, Daley would offer a lesson about sexting and sexting laws and the risks of so-called revenge porn (in which, say, a teen- ager circulates a naked selfie of an ex without consent). And to the teenagers’ surprise, they learned that receiving or sending consensual naked photos, even to your boyfriend or girl- friend, can be against the law if the person in the photo is a minor.

Now, in the third week of class, Daley’s goal was to undercut porn’s allure for teenag- ers by exposing the underbelly of the business. “When you understand it’s not just two people on the screen but an industry,” she told me, “it’s not as sexy.”

To that end, Daley started class by detail- ing a midlevel female performer’s salary (taken from the 2008 documentary “The Price of Pleasure”): “Blow job: $300,” Daley read from a list. “Anal: $1,000. Double penetration: $1,200. Gang bang: $1,300 for three guys. $100 for each additional guy.”

“Wow,” Drew muttered. “That makes it nasty now.”

“That’s nothing for being penetrated on camera,” another boy said.

“There’s nowhere else to learn about sex,” the suburban boy told me. “And porn stars know what they are doing.” His words reflect a para- dox about sex and pornography in this coun- try. Even as smartphones have made it easier for teenagers to watch porn, sex education in the United States—where abstinence-based sex education remains the norm—is meager. Massachusetts is among 26 states that do not mandate sex ed. And a mere 13 require that the material be medically and scientifically accu- rate. After some gains by the Obama admin- istration to promote more comprehensive sex ed, which includes pregnancy prevention, dis- cussions of anatomy, birth control, disease pre- vention, abstinence and healthy relationships, the Trump administration did not include the program in its proposed 2018 budget; it also has requested increased funding for abstinence education. Easy-to-access online porn fills the vacuum, making porn the de facto sex educator for American youth.

One Thursday afternoon, about a dozen teenagers sat in a semicircle of North Face zip- ups, Jordans, combat boots, big hoop earrings and the slumped shoulders of late afternoon. It was the third week of Porn Literacy, and every- one already knew the rules: You don’t have to have watched porn to attend; no yucking some- one else’s yum—no disparaging a student’s sexual tastes or sexuality. And avoid shar- ing personal stories about sex in class. Nicole Daley and Jess Alder, who wrote the curricu- lum with Emily Rothman and led most of the exercises and discussion, are in their 30s, warm and easygoing. Daley, who until last month was the director of Start Strong, played the slightly more serious favorite-aunt role, while Alder, who runs Start Strong’s classes for teenagers, was the goofier, ask-me-anything big sister. Rothman also attended most of the classes, offering information about pornography stud- ies and explaining to them, for example, that there is no scientific evidence that porn is

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“I never knew any of this,” Drew said, sound- ing a bit glum.

Daley went on to detail a 2010 study that coded incidents of aggression in best-selling 2004 and 2005 porn videos. She noted that 88 percent of scenes showed verbal or physical aggression, mostly spanking, slapping and gag- ging. (A more recent content analysis of more than 6,000 mainstream online heterosexual porn scenes by Bryant Paul and his colleagues defined aggression specifically as any purpose- ful action appearing to cause physical or psy- chological harm to another person and found that 33 percent of scenes met that criterion. In each study, women were on the receiving end of the aggression more than 90 percent of the time.)

“Do you think,” Daley said, standing in front of the students, “watching porn leads to vio- lence against women? There’s no right or wrong here. It’s a debate.”

Kyrah, a 10th-grade feminist with an ath- lete’s compact body and a tendency to speak her opinions, didn’t hesitate. “In porn they glamorize calling women a slut or a whore, and younger kids think this is how it is. Or when they have those weird porn scenes and the woman is saying, ‘Stop touching me,’ and then she ends up enjoying it!”

Tiffany, her best friend, snapped her fingers in approval.

“Yes and no,” one guy interjected. “When a man is choking a woman in porn, people know it is not real, and they aren’t supposed to do it, because it’s violence.” He was the same teen- ager who told me he would just “do” anal sex without asking a girl, because the women in porn like it.

Pornography didn’t create the narrative that  male pleasure should be first and fore- most. But that idea is certainly reinforced by “a male- dominated porn industry shot through a male lens,” as Cindy Gallop puts it. Gal- lop is  the creator of an online platform called

Then, as if they had been given a green light to ask about a world that grown-ups rarely acknowledge, they began peppering Daley, Rothman and Alder with questions.

“How much do men get paid?” one girl asked. It is one of the few professions in which men are paid less, Rothman explained, but they also typically have longer careers. How long do women stay in their jobs? On average, six to 18 months. How do guys get erections if they aren’t turned on? Often Viagra, Roth- man offered, and sometimes a “fluffer,” as an off-screen human stimulator is known.

Daley then asked the teenagers to pretend they were contestants on a reality-TV show, in which they had to decide if they were willing to participate in certain challenges (your parents might be watching) and for how much money. In one scenario, she said, you would kneel on the ground while someone poured a goopy substance over your face. In another, you’d lick a spoon that had touched fecal matter. The kids debated the fecal-matter challenge—most wouldn’t do it for less than $2 million. One wanted know if the goop smelled. “Can we find out what it is?” asked another.

Then Daley explained that each was in fact a simulation of a porn act. The goopy substance was what’s called a “baker’s dozen,” in which 13  men ejaculate on a woman’s face, breasts and mouth.

“What?” a girl named Tiffany protested. The second scenario—licking the spoon

with fecal matter—was from a porn act known as A.T.M., in which a man puts his penis in a woman’s anus and then immediately follows by sticking it in her mouth.

“No way,” a 15-year-old boy said. “Can’t you wash in between?”

Nope, Daley said. “We don’t question it when we see it in

porn, right?” Daley went on. “There’s no judg- ment here, but some of you guys are squea- mish about it.”

Many girls at Start Strong were decidedly less enthusiastic. One senior told me a boy- friend asked to ejaculate on her face; she said no. And during a conversation I had with three girls, one senior wondered aloud: “What if you don’t want a facial? What are you supposed to do? Friends say a boy cleans it with a napkin. A lot of girls my age like facials.” But a few moments later, she reversed course. “I actu- ally don’t think they like it. They do it because their partner likes it.” Next to her, a sophomore added that when older girls talk among them- selves, many say it’s gross. “But they say you gotta do what you gotta do.” And if you don’t, the first girl added, “then someone else will.”

These are not new power dynamics between girls and boys. In a 2014 British study about anal sex and teenagers, girls expressed a similar lack of sexual agency and experienced physi- cal pain. In the survey, of 130 heterosexual teenagers ages 16 to 18, teenagers often said they believed porn was a motivating factor for why males wanted anal sex. And among the guys who reported trying it, many said friends encouraged them, or they felt competitive with other guys to do it. At the same time, a majority of girls who had tried anal sex said they didn’t actually want to; their partners persuaded or coerced them. Some males took a “try it and see” approach, as researchers called it, attempt- ing to put their finger or penis in a girl’s anus and hoping she didn’t stop them. Sometimes, one teenager reported, you “just keep going till they just get fed up and let you do it any- way.” Both boys and girls blamed the girls for pain they felt during anal sex and some told researchers the girls needed to “relax” more or “get used to it.” Only one girl said she enjoyed it, and only a few boys did. Teenagers may not know that even while porn makes it seem commonplace, in the 2009 national survey of American sex habits, most men and women who tried anal sex didn’t make it a regular part of their sex lives. And in another study,

Make LoveNotPorn, where users can submit videos of their sexual encounters—which she describes as “real world,” consensual sex with “good values”—and pay to watch videos of others.

For years, Gallop has been a one-woman laboratory witnessing how easy-to-access mainstream porn influences sex. Now in her 50s, she has spent more than a decade dating 20-something men. She finds them through “cougar” dating sites—where older women con- nect with younger men—and her main criterion is that they are “nice.” Even so, she told me, during sex with these significantly younger nice men, she repeatedly encounters porn memes: facials, “jackhammering” intercourse, more fre- quent requests for anal sex and men who seem less focused on female orgasms than men were when she was younger. Gallop takes it upon herself to “re-educate,” as she half- jokingly puts it, men raised on porn. Some people, of course, do enjoy these acts. But speaking of teenag- ers in particular, she told me she worries that hard-core porn leads many girls to think, for example, that “all boys love coming on girls’ faces, and all girls love having their faces come on. And therefore, girls feel they must let boys come on their face and pretend to like it.”

Though none of the boys I spoke to at Start Strong told me they had ejaculated on a girl’s face, Gallop’s words reminded me of conversa- tions I had with some older high schoolers in various cities. One senior said that ejaculating on a woman’s face was in a majority of porn scenes he had watched, and that he had done it with a girlfriend. “I brought it up, or she would say, ‘Come on my face.’ It was an aspect I liked—and she did, too.”

Another noted that the act is “talked about a lot” among guys, but said that “a girl’s got to be down with it” before he’d ever consider doing it. “There is something that’s appealing for guys. The dominance and intimacy and that whole opportunity for eye contact. Guys are obsessed with their come displayed on a girl.”

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asked me to identify her by the first initial of her middle name, said she wished she had had someplace—home, school, a community sex- ed program—to learn about sex. Instead, she learned about it from porn. She saw it for the first time by accident, after a group of sixth- grade boys cajoled her to look at tube8.com, which she didn’t know was a porn site. She was fascinated. She had never seen a penis before, “not a drawing of one, nothing.” A few years later, she searched online for porn again, after listening to girls in the high school locker room talk about masturbation. A.’s parents, whom she describes as conservative about sex, hadn’t talked to her about female anatomy or sex, and her school didn’t offer any sex education before ninth grade; even then, it focused mostly on the dangers—sexually transmitted infections and diseases and pregnancy.

Aside from some private schools and inno- vative community programs, relatively few sex- ed classes in middle and high school delve in detail into anatomy (female, especially), inti- macy, healthy relationships, sexual diversity. Even more rare are discussions of female desire and pleasure. Porn taught A. the basics of mas- turbation. And porn served as her study guide when she was 16 and was the first among her friends to have sex. She clicked through videos to watch women giving oral sex. She focused on how they moved during sex and listened to how they moaned. She began shaving her vulva (“I’ve never seen anyone in porn have sex with hair on it”).

Porn is “not all bad,” said A., who was frank and funny, with a slew of Advanced Placement classes on her transcript and a self-assured manner that impresses adults. “I got my sexual ways from porn, and I like the way I am.” But what she learned from porn had downsides too. Because she assumed women’s pleasure in porn was real, when she first had intercourse and didn’t have an orgasm, she figured that was just how it went.

by Indiana University’s Debby Herbenick and others in 2015, about 70 percent of women who had anal sex said they experienced pain.

Drew had firsthand experience with what he had seen in porn not translating into actual pleasure. The first time he had sex, he thought he was supposed to exert some physical con- trol over his girlfriend. But the whole thing felt awkward, too rough and not all that fun. And things that looked easy in porn, like sex while taking a shower or mutual oral sex, didn’t go so well.

At one point during sex, Drew’s girlfriend at the time, who was a year older and more expe- rienced, asked him to put his hand around her neck during sex. He did it, without squeezing, and though it didn’t exactly bother him, it felt uncomfortable. Drew never asked if she got the idea from porn, but it made him wonder. Had she also picked up other ways of acting? “Like, how do you really know a girl has had a good time?” he said one afternoon, musing aloud while sitting with some friends before Porn Literacy class. “My girlfriend said she had a good time,” he went on. “She was moaning. But that’s the thing: Is it fake moaning?”

Even if you know porn isn’t realistic, it still sets up expectations, one senior told me. In porn, he said, “the clothes are off, and the girl goes down on the guy, he gets hard and he starts having sex with her. It’s all very simple and well lit.” Before he had sex, porn had sup- plied his images of oral sex, including scenes in which a woman is on her knees as a man stands over her. At one point, he thought that’s how it might go one day when he had sex. But when he talked with his girlfriend, they realized they didn’t want to re-enact that power dynamic.

I spent a couple of hours on a Wednesday afternoon at Start Strong with a senior girl who took the first Porn Literacy class in the sum- mer of 2016. Looking back over the last sev- eral years of middle and high school, A., who

For A., it wasn’t enough to know that porn was fake sex. She wanted to understand how real sex worked. Rothman and her team did consult a sex educator while they were writ- ing the Porn Literacy curriculum but decided to include only some basic information about safe sex. It came in the form of a “Porn Jeop- ardy” game during one class. The teenagers, clustered in teams, chose from four categories: S.T.D./S.T.I.s, Birth Control, Teen Violence/ Sexual Assault and Porn on the Brain.

“S.T.I.s/S.T.D.s for $300,” one student called out.

“Why is lubrication important for sex?” Alder asked.

“What’s lubrication?” Drew asked. “It’s lube,” another teenager said, in an

attempt to explain. “Is lubrication only the little tube-y things?”

a girl with long black hair asked. “Or can it be natural?”

“I never learned this before,” Drew announced to the class after it was mentioned that lubrication decreased friction, increased pleasure and could reduce the risk of tearing and therefore of S.T.I.s and S.T.D.s. Drew’s only sliver of sex ed was in sixth grade with the school gym teacher, who sweated as he talked about sex, “and it was all about it being bad and we shouldn’t do it.”

As if to rectify that, Alder offered a quick anatomy lesson, drawing a vulva on the white- board and pointing out the clitoris, the vagina, the urethra. “This is called a vulva,” she said. Alder repeated the word slowly and loudly, as if instructing the students in a foreign language. It was both for humor and to normalize a word that some of them may have been hearing for the first time. “This is the clitoris,” Alder went on. “This is where women get most pleasure. Most women do not have a G spot. If you want to know how to give a woman pleasure, it’s the clitoris.”

“Let’s move on,” Rothman said quietly. Alder had just inched across a line in which

anatomy rested on one side and female desire and pleasure on the other. It was a reminder that as controversial as it is to teach kids about pornography, it can be more taboo to teach them how their bodies work sexually. “The class is about critically analyzing sexually explicit media,” Rothman told me later, “not how to have sex. We want to stay in our nar- row lane and not be seen as promoting any- thing parents are uncomfortable with.” Daley added: “I wish it were different, but we have to be aware of the limitations of where we are as a society.”

Porn education is such new territory that no one knows the best practices, what mate- rial should be included and where to teach it. (Few people are optimistic that it will be taught anytime soon in public schools.) Sev- eral years ago, L. Kris Gowen, a sexuality educator and author of the 2017 book “Sexual Decisions: The Ultimate Teen Guide,” wrote extensive guidelines for teaching teenagers to critique “sexually explicit media” (she avoided the more provocative term “porn literacy”). Even though Oregon, where Gowen lives, has one of the most comprehensive sex ed pro- grams in the country, Gowen said that teach- ers felt unequipped to talk about porn. And though the guidelines have been circulated at education conferences and made publicly avail- able, Gowen doesn’t know of a single educa- tor who has implemented them. In part, she says, people may be waiting for a better sense of what’s effective. But also, many schools and teachers are nervous about anything that risks them being “accused of promoting porn.” The most recent sex education guidelines from the World Health Organization’s European office note that educators should include discussions about the influence of pornography on sexu- ality starting with late elementary school and through high school. The guidelines don’t, however, provide specific ideas on how to have those conversations.

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desire and pleasure and being made under fair working conditions. I asked Lust if she would steer her daughters in that direction when they are older (they are 7 and 10). “I would recom- mend good sites to my daughters at age 15, when I think they are mature enough. We are so curious to find out about sex. People have doubts and insecurities about themselves sexu- ally. ‘Is it O.K. that I like that, or this?’ I think porn can be a good thing to have as an outlet. I’m not scared by explicit sex per se. I’m afraid of the bad values.”

Tristan Taormino, another feminist porn filmmaker and author, speaks frequently on college campuses and produces explicit sex ed videos for adults. “The party line is we don’t want teenagers watching our videos,” she says, noting they are rated XXX. “But do I wish teenagers had access to some of the elements of it?” In addition to seeing consent, she said, “they would see people talking to each other, and they’d see a lot of warm-up. We show lube, we show sex toys.”

That may be more than most parents, even of older teenagers, can bear. But even if parents decided to help their teenagers find these sites, not only is it illegal to show any kind of porn— good or bad—to anyone under 18, but, really, do teenagers want their parents to do so? And which ones would parents recommend for teen- agers? “Unlike organic food, there’s no coding system for ethical or feminist porn,” Crabbe notes. “They might use condoms and dental dams and still convey the same gender and aggression dynamics.” Also, “good porn” isn’t typically free or nearly as accessible as the mil- lions of videos streaming on mainstream sites.

Al Vernacchio, a nationally known sexual- ity educator who teaches progressive sex ed at a private Quaker school outside Philadelphia, believes the better solution is to make porn literacy part of the larger umbrella of compre- hensive sex education. Vernacchio, who is the author of the 2014 book “For Goodness Sex:

In Britain, nonprofit organizations and a teachers’ union, along with members of Parlia- ment, have recommended that schools include discussions about the influence of porn on how children view sex and relationships. Magdalena Mattebo, a researcher at Uppsala University in Sweden who studies pornography and adoles- cents, would like porn literacy mandated in her country. “We are a little lost in how to handle this,” Mattebo told me.

More than 300 schools, youth and com- munity groups and government agencies in Australia and New Zealand use components of a porn-education resource called “In the Pic- ture” that includes statistics, studies and exer- cises primarily for teenagers. It was created by Maree Crabbe, an expert on sexual violence and pornography education, who lives near Mel- bourne, Australia. As she put it during a United States training program for educators and social workers that I attended in 2016: “We want to be positive about sex, positive about mastur- bation and critical of pornography.” One key component of the program is often neglected in porn literacy: providing training to help parents understand and talk about these issues.

Last year, a feminist porn producer, Erika Lust, in consultation with sex educators, cre- ated a porn-education website for parents. The Porn Conversation links to research and articles and provides practical tips for parents, including talking to kids about the ways main- stream porn doesn’t represent typical bodies or mutually satisfying sex and avoiding accusa- tory questions about why your kid is watching porn and who showed it to them. “We can’t just say, ‘I don’t like mainstream porn because it’s chauvinistic,’” says Lust, whose films feature female-centered pleasure. “We have given our children technology, so we need to teach them how to handle it.” But she takes it a step further by suggesting that parents of middle- and high schoolers talk to their teenagers about “healthy porn,” which she says includes showing female

discussions stayed with them. In surveys from the first three sets of classes, one-third of the students still said they would agree to do things from porn if their partner asked them to. Sev- eral also wanted to try things they saw in porn. They were, after all, normal, sexually curious, experimenting teenagers. But only a tiny num- ber of students agreed in the post-class survey that “most people like to be slapped, spanked or have their hair pulled during sex,” compared with 27 percent at the start of class. And while at the beginning, 45 percent said that porn was a good way for young people to learn about sex, now only 18 percent agreed. By the end of the class, no one said pornography was realistic; just over one quarter had believed that at the outset. The survey didn’t reveal the catalyst for the changes. Was it the curriculum itself? Was it something about Daley and Alder’s teach- ing style? It’s possible the students created the changes themselves, teaching one another through their in-class debates and discussions.

A., the young woman who said she had never seen an image of a penis until she watched porn, resisted the idea that porn was uniformly bad for teenagers. “At least kids are watching porn and not going out and getting pregnant,” she said. But recently, she told me that she’d given up watching it altogether. She disliked looking at women’s expressions now, believing that they probably weren’t experienc- ing pleasure and might be in pain. When Drew watched porn, he found himself wondering if women were having sex against their will. As another student said with a sigh: “Nicole and Jess ruined porn for us.”

In the months after the class, A. had cre- ated a new mission for herself: She was going to always have orgasms during sex. “And I did it!” she told me. It helped that she had been in a relationship with a guy who was open and asked what she liked. But even if Porn Liter- acy didn’t go into as many details about sex as she would have liked, “in this indirect way,

Changing the Way We Talk to Teens About Sexuality, Values, and Health,” is one of those rare teenage-sex educators who talks directly to his high school students about sexual plea- sure and mutuality, along with the ingredients for healthy relationships. The problem with porn “is not just that it often shows misogynis- tic, unhealthy representations of relationships,” Vernacchio says. “You can’t learn relationship skills from porn, and if you are looking for plea- sure and connection, porn can’t teach you how to have those.”

Crabbe notes one effective way to get young men to take fewer lessons from porn: “Tell them if you want to be a lazy, selfish lover, look at porn. If you want to be a lover where your partner says, ‘That was great,’ you won’t learn it from porn.” And parents should want their teenagers to be generous lovers, Cindy Gallop argues. “Our parents bring us up to have good manners, a work ethic. But nobody brings us up to behave well in bed.”

To prepare his students to be comfortable and respectful in sexual situations, Vernacchio shows photos, not just drawings, of genitalia to his high schoolers. “Most people are having sex with real people, not porn stars, and real bodies are highly variable. I would much rather my students have that moment of asking ques- tions or confusion or even laughter in my class- room, rather than when they see their partner’s naked body for the first time.” He, along with Herbenick, who is also the author of the 2012 book “Sex Made Easy: Your Awkward Ques- tions Answered for Better, Smarter, Amazing Sex,” advocates that adolescents should under- stand that most females don’t have orgasms by penetration alone, and that clitoral stimulation often requires oral sex, fingers and sex toys, as she notes: “It’s part of human life, and you teach it in smart, sensitive ways.”

As the students from the first Porn Literacy classes moved through their lives in the year after their courses ended, some things from the

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him realize that girls didn’t always respond as they did in porn and that they didn’t all want the same things. And guys didn’t, either. Maybe that porn clip in which the nice, ten- der guy didn’t excite the girl was wrong. What Drew needed was a girl who was open and hon- est, as he was, and with whom he could start to figure out how to have good sex. It would take some time and most likely involve some fum- bling. But Drew was O.K. with that. He was just starting out.

the class shows what you deserve and don’t deserve,” she said. “In porn, the guy cares only about himself. I used to think more about ‘Am I doing something right or wrong?’” Porn may neglect women’s orgasms, but A. wasn’t going to anymore.

Drew, who had once used porn as his main sex educator, was now thinking about sex dif- ferently. “Some things need to come to us natu- rally, not by watching it and seeing what turns you on,” he told me. The discussions about anatomy and fake displays of pleasure made

In early 2014 Ela Darling, 31, a pornographic actress, recorded her first virtual reality sex scene. She was in a college dorm room at the University of Maryland dressed in an R2-D2 swimsuit and high athletic socks. She sat on a twin bed, next to a wooden desk, and spoke to the camera as if it were a real person. There was no story line and no other actors.

“It was a solo masturbation scene,” she said. “I was coy and flirty and then a little bit dirty. I felt sexy as hell.”

Ms. Darling had been filming pornography since she was 22 and took her job seriously. It was her responsibility to convince audiences to connect with her physically and emotion- ally. She tried everything, including acting out bondage fetishes, performing erotic electro- stimulation (“electrosex”) on another woman, and dressing as a real-estate agent. Yet no matter what she did to entice and engage, the results had always been voyeuristic, since

there was always a screen separating her and her fans.

This time, though, was different. Virtual reality uses many camera lenses to record the same scene from hundreds of angles. When the takes are stitched together, the viewer gets a 180—or 240—degree view of the room and the feeling that he or she is there, participating. As soon as Ms. Darling viewed the scene she recorded, she knew virtual real- ity would be a sea change to her job and the adult entertainment industry.

“You can pretend like you are in the bed- room with me, and it is someone you have a crush on,” she said. “You are in the experience.”

While virtual reality pornography may feel like something out of a science fiction movie, it already has a formidable, if underground, pres- ence. According to the website Pornhub, views of VR porn are up 275 percent since it debuted in the summer of 2016. . . .

Virtual Reality Gets Naughty

Alyson Krueger

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By 2025 pornography will be the third- largest VR sector, according to estimates prepared by Piper Jaffray, an investment and management firm. Only video games and N.F.L.-related con- tent will be larger, it predicted, and the market will be worth $1 billion.

“We’re getting more and more of it every day,” said Mark Kernes, a senior editor at AVN Media Network, which covers the industry. “We are leading the technology in this area. Sex sells, and where there is money to be made, there will be entrepreneurs who want to adopt it and make money from it,” some by offering it for free to increase clicks.

Pornography is what rushed along the first printing press, and spurred developments in the internet, online payment systems, and other technology. Now it’s time for virtual real- ity, Mr. Kernes said: “I’m pretty sure there is more porn VR out there than regular VR.”

. . . Ms. Darling first experienced regular old VR at E3, a conference for the video-game indus- try. Excited by the pornography possibilities, she found a college student on Reddit who knew the technology but lacked a star. Before long, Ms.  Darling started streaming weekly VR seg- ments live from her bedroom in Los Angeles. . . .

She then started a company named VRTube .xxx to make the technology, now licensed to Cam4.com, which employs over 40 performers.

Though the pornography industry as a whole is challenging to regulate, considering the potential for abuse, disease, and exploita- tion, the virtual kind comes with extra moral and maybe legal issues. For example, can you use someone’s likeness to have sex with them in virtual reality?

“Virtual reality is like the Wild Wild West,” said Bryony Cole, the host of Future of Sex, a podcast that explores technology and sexuality.

At . . . [the 2017] AVN Adult Entertainment Expo, a convention and trade show held each

January in Las Vegas, the latest advancements in virtual reality pornography were on display.

CamSoda, a website that specializes in live sex videos, had an exhibit featuring pornog- raphy stars dressed in plunging bathing suits and waving visitors into the booth. They were showing off OhRama, a small canister that attaches to virtual reality headsets and releases scent during the action. . . .

There are also companies that are adding taste and touch to the experience.

Another big player is CamasutraVR, a start-up using 142 cameras that all look at one person, or one body part. “They are creating images from that, which they are hoping will be indistinguishable from an actual person,” Mr. Kernes said. . . .

Still other virtual reality companies were showing off their partnerships with sex toy companies to create vibrators or penis pumps that link to VR material. “As the action ramps up so does the vibrations of the vibrator,” he said.

One of the most buzzed-about inventions has been the sex robot. The first one, Harmony, was introduced in May [2017] by a company named Realbotix. In seductive videos posted on YouTube, Harmony shows off her long legs, her firm breasts, her full lips, her lifelike hand gestures, even her intellect.

“How do you feel about sex?” an unknown presenter asks her in one video.

“Sex is one of the most fascinating things in the world,” she responds in a raspy voice. “I don’t see anything wrong with it.” Harmony can connect with virtual reality so the user can interact with her in that space; she can perform all the acts the viewer is watching.

“It’s a little bit of a video game combined with sci-fi,” said Matt McMullen, the C.E.O. and creative director of Realbotix. The com- pany has been making dolls for 20 years that

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Barbara Rothbaum, a professor in the department of psychiatry and behavioral sci- ences at Emory University School of Medicine and the director of Emory’s Veterans Program, is studying how virtual reality can help treat people suffering from post-traumatic stress dis- order caused by military sexual trauma.

The program is building scenes that take victims to barracks, tents, private living quar- ters, latrines, offices, or remote buildings and vehicles where the trauma may have taken place. The idea is that going back to these places virtually will help victims confront their memories so they can move forward with more internal peace.

But for virtual reality to work, the scenes have to be so lifelike that users get lost in them and take them for reality. They have to feel like they are participants, not just observ- ers. “We can create 3-D bodies in virtual real- ity and do whatever we want with them,” Ms. Cole said. As the technology becomes good enough to make that happen, issues are bound to arise.

Mr. McMullen said an issue his company has is clients commissioning dolls that look exactly like people they know in real life, maybe an ex-girlfriend they never got over or some- one about whom they fantasize. His company requires written consent from the model for his or her likeness to be used.

Ms. Cole said VR companies are going to have to address this same problem as they get better at customizing avatars to look exactly like what their customers desire. “What are the lines between reality and fantasy and what can we do in this space?” she said. “What does consent mean in virtual reality? Can you do something to your girlfriend in virtual real- ity that you wouldn’t do in real life? If you are using someone’s likeness in virtual reality, do you require their permission? And what about

were linked to artificial intelligence but not virtual reality. “Based on our experiences with thousands of clients,” Mr. McMullen said, “people do use them for sex, but there is something more that exists. We focus on companionship.”

Virtual reality has been nicknamed the empathy machine because it allows people to feel like they are truly connected to the action. “It’s neurological,” said Holly Richmond, a somatic psychologist based in Los Angeles and Portland, OR. “You aren’t just watching and thinking about it. You are feeling it, and it’s not just your genitals. There is literally a mind- body connection.”

When Ms. Darling does live X-rated perfor- mances, users can leave comments and chat to one another on the side of the screen. “The people who are in virtual reality tell the other people watching me in 2-D to stop being jerks and knock it off,” she said. “They feel like they know me and are in the bedroom with me.”

Many sex therapists and educators are inter- ested in the new technology. . . . Ms. Richmond worked with BaDoinkVR, a virtual reality com- pany in Rochester, N.Y., to create Virtual Sexol- ogy, a series of free videos that help men and women overcome common sex problems. . . .

The first video, aimed at men, was the most downloaded video on BaDoinkVR.com in 2016—an impressive feat considering it was competing with noneducational pornography.

Ms. Cole, the podcast host, is most excited about how virtual reality can be used in sex education.

“What if we had young people watch videos where they practice consent or practice identi- fying at-risk behaviors?” she said. “Or they can be in a room with someone who said, ‘I con- tacted herpes and this is my experience.’ That is way more informative than a gonorrhea slide.”

Indeed.

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it. “There are people who are already lonely, and people who live their lives being alone. They work all day and come home to an empty house,” he said. “This is just offering an alterna- tive to those types of people. They don’t have anyone else.”

Source: “Virtual Reality Gets Naughty.” From The New York Times, October 28, 2017 © 2017 The New York Times. All rights reserved. Used by permission and protected by the Copyright Laws of the United States. The printing, copy- ing, redistribution, or retransmission of this Content with- out express written permission is prohibited.

revenge porn? That will be even harsher in virtual reality.”

She is worried about the technology assimi- lating into the culture as easily as dating apps, drawing people away from flesh-and-blood encounters.

Certainly partners will also have to nego- tiate whether virtual reality sex constitutes cheating. It is, after all, much more lifelike than traditional pornography.

But Mr. McMullen said a lot of people accuse his sex robot of doing that, but he believes he is helping alleviate a bad situation, not causing

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R E A D I N G 1 3

A cademic researchers and cultural critics have primarily focused on gender rela-tions in porn created for heterosexual men and manufactured by corporate producers. Overall, these discussions illuminate the racist and sexist sexual discourses that pervade such pornography (Collins, 1993). However, the socio- cultural phenomena that create and maintain the “age of the selfie” suggest that we extend these explorations. For instance, the widespread avail- ability of porn on the internet has likely encour- aged the proliferation of pornography intended for nonheterosexual communities, particularly gay men. In addition, user-created social media have opened new avenues for individuals to con- sume and create self-produced erotica. Other than policies of the host sites—which tend to function more as suggestions than mandates— users produce pornography with very little, if any, corporate (or other) oversight. My goal here is to unpack attitudes and behaviors at the inter- section of gender and race in gay men’s pornog- raphy. I do so by comparing discussions of race in an “ebony” category versus categories that do not specifically advertise black men’s participa- tion. I contrast themes in content produced by users versus corporate enterprises. To do so, I investigate how gay men’s sexual culture repre- sents and understands black men, as well as how black participants reaffirm or resist sexual ste- reotypes of black masculinity.

THE SEPARATION OF BLACK AND QUEER

In so many contexts, society portrays and understands blackness and queerness as

incompatible (Ferguson, 2004). Consequently, mainstream black cultures disenfranchise black queer and trans folks, while mainstream queer cultures disenfranchise people of color. These cultural representations are associated with white and black men occupying racially segregated spaces. And the infrequent inclu- sion of gay black men in the mainstream gay community is often predicated on white sex- ual fantasy, where encounters with black men mean little more than sexual conquest. Thus, the only places in which some white and black gay men meaningfully interact are hookup sites like Grindr.

For black men, maintaining a healthy sense of self in such an environment can be diffi- cult. Few have the social resources necessary to overcome the cultural barriers that prevent their queerness and blackness from interlock- ing into a single cohesive sense of self. To cope, black men who have sex with men (or MSM) often privilege one identity over the other, see- ing themselves as “black then gay,” while others separate their private identity as gay men from their public identity as black men (Hunter, 2010). Social institutions, too, present extraor- dinary barriers to queer men of color—and negotiating them with intersecting minority identities “produces a new set of structured choices and survival strategies” (Green, 2007: 758). As such, spaces generally deemed safe for black communities or LGBT communities may not be safe for queer black folks. In black churches and families or LGBT-oriented estab- lishments, black gay men must often reshape themselves in ways that minimize sexual or racial identification.

RACE AND MASCULINITY IN GAY PORN

D E S M O N D F . G O S S

nonwhite bodies pushed Mapplethorpe’s pho- tos out of the sunnier realm of nude art and into the darker underworld of pornography. More- over, Mapplethorpe (a gay white man) has been extensively critiqued for fetishizing black mas- culinity in this series (Chittenden, 2009). Such situations illustrate the malleability of defini- tions of pornography, as they are undoubtedly delineated with intersecting social parameters like age and race.

Few studies have examined the presentation of nonnormative (that is, nonwhite, less fit, or older) bodies in gay porn. In these studies, researchers typically find a contradictory rela- tionship between fetishism and empowerment in corporatized pornography. In other words, though such representations create space for marginalized communities, they also reinforce stereotypical beliefs and exclusionary sexual practices. For example, “Daddy porn” and “bear porn” present older men and fat men as sexu- ally desirable, in contrast to the emphasis on youth and muscularity that dominates main- stream gay men’s sexual culture (Highberg, 2011). However, participants in such pornog- raphy are often typecast to restrictive niches; it is uncommon, for instance, to see “Daddies” penetrated by younger men. Moreover, neither “Daddy” nor “bear” porn typically features men of color.

METHODS

I collected most of the data for this study from Xtube.com, a website where viewers can access pornography for free produced by both indi- vidual users and companies. I used Xtube as a source of data because, unlike other similar sites, it archives videos, allows users’ comments, centers on gay men’s pornography, and fosters a unique sense of community among consumers. I sampled the 20 most-viewed user-generated, noncorporate gay men’s videos categorized as “ebony”; the 20 most-viewed corporate gay

PORNOGRAPHIC REPRESENTATIONS

Pornography has probably existed in some form for as long as there has been human record; however, its context and contents evolve with changing social environments. Throughout its history, porn has been extensively critiqued by agents of both liberal and conservative political orientations. On the right, local, state, and fed- eral governments have attempted to regulate and even ban pornography (Lehman, 2012). On the left, some radical feminists deride porn as a catalyst for the sexual objectification and victimization of women—for them, “pornogra- phy is the theory, and rape the practice” (Mor- gan, 1980: 128). And in the 1990s, feminists of color began critiquing and protesting the portrayal of women of color in pornography, noting the uniqueness of such representations at the intersection of womanhood and black identity (Bernardi, 2007).

In 2007, an art exhibit titled Seduced: Art and Sex from Antiquity to Now opened in London, celebrating artistic representation of sexuality through history. Folding under pressure from the surrounding community, the Barbican Gal- lery prohibited visitors under 18 from viewing the show (Chittenden, 2009). Of particular concern were several photographs by New York photographer Robert Mapplethorpe, which pre- sented nude and erotic images of black men. Nearly two decades earlier, a Mapplethorpe exhibition at the Contemporary Arts Center in Cincinnati, Ohio, led to large antipornog- raphy protests, an executive resignation, and an obscenity trial (Dobush, 2015). Although other photographic art in the Barbican exhibi- tion featured homoerotic and sadomasochistic portrayals of nude subjects, the racial charac- ter of Mapplethorpe’s series of photographs seemed to add insult to the already sexually explicit, and thus problematic, presentation ( Chittenden, 2009). In a way, the inclusion of

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Overall, ebony videos were considerably more focused on penises than non-ebony videos. In fact, videos featuring black participants gave more camera time to penises than faces, while the opposite was true in videos with only white participants. Size was of particular interest to both white and black producers and consumers of ebony porn, and there were twice as many references to penis size in video descriptions and viewer comments in ebony than in non- ebony videos.

Transforming ordinary anatomy into dark phalluses involves a process I call dismember- ment. In gay porn, this process of detachment transmuted black men’s penises into cultural matter that fits into one or more of just three categories. When black men’s penises became dissociated organs, consumers conceptualized and discussed them in ways that render the persona and often the rest of its “owner” invis- ible, even useless. For example, users often used relative rather than possessive pronouns (referring to “that” penis instead of “his” penis), or they simply referred to black men’s penises as “meat.” Producers and consumers also more often characterized black men’s penises as wielded tools, often referring to specific objects of utility like “poles,” “towers,” “pipes,” and “machines.” Not only did such references sever black men’s genitalia and bodies from the rest of their humanity, they also recalled the his- tory of white America’s exploitation of black productivity through systems such as chat- tel slavery, indentured servitude, cheapened labor, and prison labor. Moreover, a few “tool” references are also infused with undertones of violence, such as one commenter’s praise of a “weapon of mass destruction.” The final arche- type—the sentient monster—was more than twice as prevalent as the dissociated organs and wielded tools archetypes combined. In contrast to the lifelessness of dissociated organs and wielded tools, sentient monsters are directly or indirectly endowed with personality

videos categorized as “ebony”; and the 20 most-viewed gay videos (without the “ebony” classification). I did not split most-viewed vid- eos like the other categories because my inter- est in the relationship between corporatization and agency concerns only black performers, who are rare in this category. Since these lists change, I collected all videos in one sitting. I  recorded descriptive information about the videos (including tags, number of views, run time, etc.), summaries of the videos, and any viewer comments that alluded to race. The race of commenters or producers was either inferred from profile pictures or explicitly stated in profiles or usernames. I also sampled related content by searching material linked to each case, such as advertisements, user pro- files, and images from other websites, to sup- plement the primary data. With the assistance of NVivo analytic software, I reviewed explicit content and interpreted deeper latent mean- ings from the data. I also relied on the “con- stant comparison” grounded theory method: I grouped emergent themes into broader cat- egories, and then connected these categories theoretically through the themes that emerged (Seale, 2004). Ultimately, three significant cat- egories emerged: dark phalluses, missing links, and separate spaces.

DARK PHALLUSES: PREOCCUPATION AND DISMEMBERMENT

The first category of findings concerned the symbolic transformation of black men’s penises into dark phalluses—that is, from mundane anatomy to a powerful symbol of black mas- culine sexuality. This is accomplished in gay men’s pornography through two rhetorical mechanisms. The first is preoccupation: Almost every video featuring black participants made some reference to a “BBC” (big black cock).

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“A bitch instinctively surrenders to a real Man, who exercises His natural right to relentlessly fuck the cunt or cunts of His choice. . . . When the power of His loins can no longer be con- tained, He triumphantly spurts His sacred essence in or on the reamed bitch, and His vic- tory is complete.” This comment typified white commenters’ view of black masculine “realness” as a coercive, phallocentric, barbaric, competi- tive sexual authoritarianism that is in opposi- tion to femininity.

Another aspect of the subordination of black men in gay porn entailed an association with rancidity. In gay men’s pornography, noxious odors (“amazing piece of black meat, i would hope it smells bad too”), noncircumcision, hair- iness, and bare-backing (condomless anal sex) all contributed to the fetishized primitiveness of black masculine sexuality. Each is deployed to link black masculinity with the lack of hygiene implied by primitiveness, and this link is especially eroticized by white consumers and producers (e.g., “Thank goodness your bush is not shaved, you’re still a real man!”).

The project of primitivizing black men also included portraying black men as less human (more animalistic) than white men. Here, pro- ducers and consumers characterized black men as aliens (“The black guy must be from another world”) and associated them with imagined ancestral African communities (“gorgeous face with a mandingo cock”), as well as with non- human animal behavior, especially “feeding” (“THERES ENOUGH HUNGRY FAGS IN THE WORLD TO FEED WITH THAT”). In addition to subordination, black men are primi- tivized in gay men’s porn through diminution. So, despite the bombastic allocation of power and prowess to black masculinity, gay men’s pornography simultaneously diminished black masculinity to juvenility. Typically, this pro- cess entails referring to black men as “boys” (“YEAAAHHHHHHHHHHHHH Dadddy feed his cute Black Boyyy mouth”), as well as

and animus. For instance, site users frequently made reference to black men’s penises as humanoid creatures, especially gods (“that is God”) and monsters (“you have a monster out there!”), as a metaphor for the intimidating posture of large creatures.

MISSING LINKS: PRIMITIVENESS AND PRIMALITY

The second category of findings concerned the portrayal of black men as missing links in the context of primitiveness and primality. In gay men’s pornography, consumers and producers construed black men as less human (that is, more primitive) than their counterparts, and this image then served as a source of erotic attraction. Typically, this process involves rele- gating black men to one or more of three subor- dinating associations: natural rawness, rancidity, and animality. For instance, in gay men’s por- nography, black men demonstrated the defini- tion of “real” masculinity. In a video titled Chino in the Raw, three young black men engaged in various sexual activities, as a superimposed text reads, “Aight, yo, the thugs are back with some serious gangtsa lovin. . . . No bullshit— just straight up gangstas doing it raw.” Here, rawness redefined gay sex as both natural phe- nomena and perilous adventure, based in a conceptualization of black masculinity as less defined by femininity and thus more realized by naturality: “No bitches allowed . . . this da real shit nigga.” A  rhetorical association with the concepts of raw and natural epitomized the “realness” of black men in gay porn, who are apparently unaltered by the supposedly feminizing forces of civilized humanity. Para- doxically, however, these same forces produce socially valued qualities such as intelligence, emotional aptitude, and others that account for the human capacity for self-control. As one user (whose favorited videos included Latin Jerkoff 2 and huge black dick cuming loads) summarized,

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men’s culture. Here, black men are to “mons- ters” as white men are to “innocent humans.” Thus, it is no surprise that several of the pro- files of white users I reviewed named violence as a desired quality in sexual encounters with black men (“Turn Ons: Being used like a slut by black men”). Racist portrayals of black men in gay porn were normalized through the asso- ciation of monstrosity and violence with power, which commands fascination and admiration from black and white users alike (“it is clear that as white people we have no choice but to surrender to the superiority of blacks”).

SEPARATE SPACE: BIFURCATED PERFORMANCES AND ESSENTIALIZED IDENTITIES

The final category of findings concerns how racial ideology in gay men’s pornography emphasized separation through bifurcated per- formances (performances divided into two parts) and essentialized identities (identities assumed to be innate or inherent). The performances of black and white men in gay porn diverged starkly by race, particularly in terms of sexual desirability. These divergences dichotomized black and white gay identities by emphasizing or deemphasizing racial visibility. For instance, a non-ebony video featured a white man per- forming oral sex on several different men in succession. In the comments, many viewers were enamored with the performer’s eye color (“so blue!”). In this case, regardless of inten- tion, there was an unspoken but clear relation between the celebration of blue eye color and the celebration of whiteness, especially when considering the lack of similar comments about physical features (other than penises) in ebony videos. However, the most obvious way gay men’s pornography bifurcated black and white masculinity was by making black men’s genitals hypervisible. Here, penis sizes did

the concerted infantilization of black partici- pants in corporate “bait” films, where straight men are coerced into performing in gay por- nography. In these films, “straight” white participants are generally portrayed as partici- pating only for pay, while “straight” black par- ticipants, too simple to know better, are more often portrayed as having been tricked into participating.

On the one hand, primitivity entailed an ide- ology that positions black masculinity as a pre- historic state of identity located within modern surroundings. On the other hand, primality emphasized primeval savagery. This is the dif- ference between an ape in a cage at the zoo and an ape on the loose in your neighborhood. Both are spectacle, for sure, but the latter stimulates a tension not present in the former. And it is this sexual tension, this implication of danger, that drove the erotic allure of pre- sumed black masculine primality in gay men’s pornography. For black men in gay porn, the portrayal of primality entailed presenting black masculinity as violent and powerful, intended to arouse the viewer by offering an image of black masculinity as “sensuous but dangerous.” For instance, the ebony category was saturated with references to “monsters”—eight times as many references compared to non-ebony vid- eos. There is even a website where viewers can “see monsters fuck innocent humans.” Most of the animated men on the site were slim and white, in stark contrast to the animated mon- sters that are much larger and darker. All the monsters are menacing, and since our cultural notion of “monster” is inherently violent, the presentation of consent in these fantasies is inherently problematic. But this was part of the allure—to be taken by the big, dark monster, to lose the power of consent, and to revel in that loss, is the fantasy. And the symbolism of such a tagline (“see monsters fuck innocent humans”) was significant given the network of racialized sexual ideologies that inform gay

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men find a place in gay porn may be off-limits to black performers, as well as less palatable to black viewers.

In Queering the Color Line, Somerville (2000) illustrates how dichotomization aids essentialism (that is, an interpretation of human attitudes and behaviors as created and maintained by biology or divinity rather than social practices) by positioning social variables as oppositional. By defining one in contrast to the other, social psychologies are transformed into embodied identities. In gay men’s sexual culture, “white or black,” “man or woman,” and “gay or straight” continue to define and concretize one another through the deploy- ment of gendered and racialized archetypes of sexuality. For example, the type of sex acts performed and appreciated in gay men’s por- nography was highly dependent upon the race of the participants. In ebony porn, there was much less discussion and portrayal of rimming, masturbation, and any activity that was not anal sex. And whatever the activity, white com- menters assigned blanket sexual characteristics to participants of color based on preexisting ideas about the sexual behaviors supposedly endemic to their racial communities (“Blatinos so rico suave”). Nowhere was the essentializing force of gay men’s sexual culture more apparent than in discourses surrounding topping and bottoming. Who tops and who bottoms, who’s “femme” and who’s “masc,” as well as how these roles were successfully fulfilled or disrupted, demonstrated the impact of rooted and racial- ized sex and gender scripts. And there was very little deviation from the norm of black tops and white bottoms.

While viewers consistently praised white bottoms for their masculine physique and virility (best demonstrated by how well they “take it”), almost all evaluations of black bot- toms were critical, with most expressing disap- pointment in performers’ feminine qualities. Though femininity was frowned upon in

not simply vary across communities but were instead an essential trait of every man’s racial identity. For example, a viewer expressing his disappointment in a black performer’s endow- ment sarcastically suggested that “he is defi- nitely half black and half Chinese.” Through such discourses, gay pornography works to solidify a perspective of irreconcilable differ- ence between black and white men. Moreover, this dichotomization essentialized blackness and whiteness by linking race with longstand- ing gender archetypes regarding sexual behav- ior. In essence, black men were almost always penetrating partners (“tops”) while white men tended to be penetrated partners (“bottoms”), a set-up that mimics the gendered assump- tions of agency in heterosexual relationships, where “man fucks woman; subject verb object” (MacKinnon, 1982: 124).

Furthermore, pornographic performances, and evaluations of these performances, had racially distinct focuses. Producers and consum- ers of gay porn were much more attentive to technique, occupation, hairiness, and age in non-ebony versus ebony videos. In this way, it seemed that whiteness allowed for more varia- tion in pornographic norms. For example, sex- ual scripts about hair and age in “Daddy” and “bear” porn provided discourses through which gay white men could simultaneously pray at the altar of youth, revere the wisdom and con- fidence that accompany aging, and play with the normative dynamics of heteropatriarchal family (“The hard determined face of Dad as he pile drives his [son] and the final ejacula- tion of both [son] and Dad”). In ebony porn, however, the significance of youth was implicit in its overemphasis on black virility. And with- out the platform provided by “bear” culture, older black men were generally denied a space in the zeitgeist of gay men’s sexuality. More- over, given the history of misrepresenting and dismantling black families in North America, the sort of “Daddy–son” play where many older

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intrusion from capitalist marketing, which may more readily bend to pressures of racist, sex- ist, and femme-antagonistic public demand. Indeed, some aspects of user-submitted videos in this sample are somewhat more inclusive than corporate producers. For example, cor- porate producers are more than twice as likely to reproduce gendered archetypes about gay men’s sexuality, with a focus on straightness and youth. Corporatized pornography more frequently borrows language from heterosex- ual romantic culture to characterize same-sex sex acts between men. Black men in user- submitted porn are also more likely to engage in masturbation and oral sex, while corporate ebony videos are more likely to depict anal penetration and focus on penis size. However, comparing indicators reveals far more simi- larities than differences between corporate and noncorporate pornography. Many of the dis- crepancies are small, and problematic rhetoric remains steady across categories. Thus, though user-submission clearly offers black performers the agency to deconstruct and challenge rac- ist sexual imagery, it does not automatically translate into such resistance. Moreover, black participants cannot control the interpretation of their performances by white consumers. Thus, the power of porn self-produced by black men to transform gay men’s sexual culture may be limited by white men’s continuing fetishiza- tion of black masculinity.

In any regard, a thorough analysis of gay men’s pornography illustrates the political significance of sexual desire, despite cultural attitudes that position gay sex as “color-blind.” If academics and activists interested in the intersection of race, gender, and queerness are to ever deconstruct such politics of desire, we must begin with this premise: Sexual prefer- ence is not, in any circumstance, an apolitical phenomenon. Of course, this may mean rein- troducing uncomfortable conversations about the origins of sexual attraction in sex studies—

non-ebony porn, it was expressly condemned in sex between black men, as it disrupted the continual attempt to de-gay sex between black men, in preservation of the “dark phallus” and “missing link” fantasies. For instance, there were high premiums for “straightness” and “virginity” in gay men’s pornography, and both concepts were heavily advertised and policed, yet they were barely mentioned in the ebony category. Blackness, therefore, implied het- erosexuality and hypersexuality, and white- ness homosexuality and virginity. The use of concepts and language borrowed from hetero- sexual culture also aided the co-constitution of racial, gendered, and sexual identities in gay men’s pornography. This process involved the rhetorical and conceptual reconfiguring of men’s mouths and anuses into “pussies,” “cunts,” and even “wombs,” and suggests that bodies cannot be both penetrated and mascu- line. Race was an important delineator of such references, and there were two times as many in ebony versus non-ebony pornography. This language gendered gay sex acts by borrowing discursive concepts from heterosexual cul- ture. In this way, gay pornography operated as a tool of racialized homonormativity, deny- ing black men any characterization other than heterosexual hypermasculinity.

THE PORNOGRAPHIC IS POLITICAL

On the whole, by helping solidify a sociocul- tural image of black men as “missing links,” by reducing black masculinity to a “dark phallus,” and by aggravating the segregation of black and white men, gay men’s pornography reifies existing stereotypes about black masculinity and extends them into queer contexts. In doing so, gay men’s porn participates in the ongo- ing exclusion of black men from equal and just queer citizenship. In theory, user-submitted pornography offers black participants more agency to perform sexuality without explicit

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another reserved for members of black commu- nities (Du Bois, 2008). Similarly, Anzaldúa—a queer, Chicana, indigenous woman—describes life at the border of multiple identities as being a member of many different communities but never fully accepted into any one as “border- lands” (Anzaldúa, 1999). In the development of “quare theory,” Johnson retools the per- spectives of Du Bois and Anzaldúa to match the particular common experiences of black MSM (Johnson, 2001). Here, Johnson pro- vides a “queer of color critique” by attending to the connection between these experiences and black cultures—a connection historically ignored, diminished, or denigrated by white- centered queer theory. Moreover, because sexuality is crucial to the practice of mascu- linity, we cannot separate sexual performance from masculine identity. Therefore, since nor- mative expression of masculinity is limited to cis, heterosexual, middle-class white men, the masculinity of queer men of color is socially marginalized and subordinated.

Collins’s concept of “controlling images” delineates how these performances legitimize the structural oppression of black Americans (Collins, 2005). Controlling images, Collins argues, construct racial difference by provid- ing stereotypical images of black people to which Americans constantly compare to the white ideal. For example, the racist notion of black “welfare queens” who produce offspring to game “the system” symbolically contrasts with the idealized stereotypical nurturing, responsible, suburban white mother. Images of black men in gay pornography may contrib- ute to a similar process of constant evaluation, where the standardization of white bodies is contrasted to the fetishization of black bod- ies. Controlling images of black masculinity buttress the eroticism of gay men’s pornogra- phy (Collins, 2005). By supporting a sociocul- tural image of black men as “missing links,” by reducing black masculinity to a “dark phallus,”

conversations that have historically been used to pathologize queerness and marginalize queer people. But, for too long, queers and academics alike have unproblematized the “my preference, my business” explanation of sexual desirability (Robinson, 2015). Such an individ- ualized and neoliberal discourse only upholds the “right” of gay white men to proclaim “no fats, no femmes, no blacks, no Asians” without recourse. Moreover, this sort of exclusion can have negative implications for the physical and mental health of gay black men, as well as the well-being of queer black communities. Public health research, for example, has already linked racism and risk taking among people of color, such as lack of condom use among black and Latino MSM (Smith, 2012).

CONCLUSION

Despite the display of cultural messages to the contrary, sex is a social interaction steeped in identity politics. Though there is plenty of existing research critiquing pornography as an institutional and cultural transmitter of white supremacist heteropatriarchal messaging, much of it lacks a queer-intersectional perspec- tive. As such, many of the current ideological conclusions on the topic frame masculinity as singularly white and heterosexual. However, as the perspectives of Johnson (2001), Du Bois (2008), and Anzaldúa (1999) suggest, the mas- culinities of queer men of color are experienced and understood in a different political, social, and cultural context, as they are situated at the intersection of more than one marginal- ized identity. Uniting relevant queer, critical race, and black feminist perspectives is use- ful for deconstructing racialized expressions and interpretations of masculinity and sexu- ality in gay pornography. Du Bois reasoned that black Americans move through Ameri- can culture and institutions with two separate consciousnesses: one for all U.S. citizens and

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and by aggravating the segregation of black and white men, gay men’s pornography participates in the ongoing exclusion of black men from community.

Future research should attempt to address the following methodological limitations of this study. First, the data used here are not representative and should therefore not be gen- eralized to make causal explanations of social attitudes and behaviors. Although procuring a representative sample of internet pornogra- phy is unrealistic, future projects may collect a more varied representation of content. Second, despite all attempts to avoid doing so, this study likely reproduces cultural ideology that con- ceptualizes gay men as a community without internal differences. It is especially important to acknowledge this limitation as it applies to gay black men, as the experiences of oppressed communities are too often singularized. How- ever, for ease of analysis and discussion, it was most efficient at times to discuss gay men in these terms. Third, Xtube’s declining popular- ity should prompt future research projects to analyze websites at the forefront of user-sub- mitted pornography to give a timelier account of how race works in gay men’s porn presently. Fourth, I did not include in-depth analyses of nonwhite and nonblack ethno-racial categories because of time and resource constraints, but further research into the representations of these identities is certainly warranted.

Problematizing white masculinity in gay pornography also has serious and interesting implications for social organizing concerned with the experiences of queer people of color. Sex is a social interaction steeped in the poli- tics of racial and gender identities. As such, we must appreciate that racism in gay men’s por- nography is a symbolically violent phenome- non in which “all of [our] culture’s racist myths become just another turn-on” (Leidholdt, 1981: 20). Therefore, the discussions presented are framed by the broader culture of sexual

oppression experienced by trans folks, people of color, people with disabilities, fat people, and femmes in gay communities. Though seemingly unrelated, all such experiences are linked by white supremacist heteropatriarchy, and each is a manifestation of its impact on the social psychologies of LGBT communi- ties. Nevertheless, marginalized queer and trans people are already making space for themselves. However, macro-level changes in cultures and institutions are difficult to accom- plish without cis, able-bodied, “masc” white men acknowledging and deconstructing their participation, either passive or active, in sys- temic oppression.

REFERENCES Anzaldúa, Gloria. 1999. Borderlands La Frontera: The New

Mestiza. San Francisco: Aunt Lute Books. Bernardi, Daniel. 2007. “Racism and Pornography:

Evidence, Paradigms, and Publishing.” Cinema Journal, 46(4): 116–21.

Chittenden, Tara. 2009. “Sexing Up the Secondary Art Curriculum: A Strategy for Discussing Robert Mapplethorpe’s Photographs of S&M and the Black Male Nude in Art Classrooms.” International Journal of Education through Art, 5(2): 157–67.

Collins, Patricia Hill. 1993. “Pornography and Black Women’s Bodies.” In D. Russell, ed. Making Violence Sexy. 97–104. New York: Teacher’s College Press.

–––––. 2005. Black Sexual Politics: African Americans, Gender and the New Racism. New York: Routledge.

Dobush, Grace. 2015. “25 Years Later: Cincinnati and the Obscenity Trial Over Mapplethorpe Art.” The Washington Post, October 24. Retrieved October 7, 2016 from https://www.washingtonpost.com/entertainment /museums/25-years-later-cincinnati-and-the-obscenity -trial-over-mapplethorpe-art/2015/10/22/07c6aba2-6dcb -11e5-9bfe-e59f5e244f92_story.html.

Du Bois, W. E. B. 2008 [1903]. The Souls of Black Folk. Oxford: Oxford University Press.

Ferguson, Roderick. 2004. Aberrations in Black: Toward a Queer of Color Critique. Minneapolis: University of Minnesota Press.

Foucault, Michel. 1978. The History of Sexuality. Vol 1: An Introduction. Trans. Robert Hurley. New York: Pantheon Books.

Green, Adam Isaiah. 2007. “On the Horns of a Dilemma: Institutional Dimensions of the Sexual Career in a Sample of Middle-Class, Urban, Black, Gay Men.” Journal of Black Studies, 37(5): 753–74.

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Morgan, Robin. 1980. “Theory and Practice: Pornography and Rape.” In L. Lederer, ed., Take Back the Night: Women on Pornography. 134–40. New York: HarperCollins.

Robinson, Brandon Andrew. 2015. “‘Personal Preference’ as the New Racism.” Sociology of Race and Ethnicity, 1(2): 317–30.

Seale, Clive. 2004. “Generating Grounded Theory.” In C. Seale, ed., Researching Society and Culture. 240–47. London: Sage Publications.

Smith, William Pastor. 2012. “Exploring Dimensions of Racism, Homophobia, and Social Network as Concomitant Predictors of Condom Use in a Sample of Black MSM.” Journal of Gay & Lesbian Social Services, 24(4): 417–45.

Somerville, Siobhan. 2000. Queering the Color Line. Durham, NC: Duke University Press.

Highberg, Nels. 2011. “More Than a Comic Sidekick: Fat Men in Gay Porn.” Performing Ethos, 2(2): 109–20.

Hunter, Marcus Anthony. 2010. “All the Gays Are White and All the Blacks Are Straight: Black Gay Men, Identity, and Community.” Sexuality Research and Social Policy, 7(2): 81–92.

Johnson, E. Patrick. 2001. “‘Quare’ Studies or (Almost) Everything I Know About Queer Studies I Learned from My Grandmother.” Text and Performance Quarterly, 21(1): 1–25.

Lehman, Peter. 2012. “Bad, Worse, Worst: 8MM and Hollywood’s Bad Boys of Porn.” In M. Pomerance, ed. Bad: Infamy, Darkness, Evil, and Slime on Screen. 79–92. Albany, NY: SUNY Press.

Leidholdt, Dorchen. 1981. “Where Pornography Meets Fascism.” Women’s International Newsletter, March: 18–22.

MacKinnon, Catherine. 1982. “Feminism, Marxism, Method and the State: An Agenda for Theory.” Signs: Journal of Women in Culture and Society, 7: 515–33.

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this sort of well-intentioned query is the ever- present assumption that I am in need of help. I  get this also when I am sitting somewhere waiting to meet a friend. People just come up to me and ask if I am okay.

As the bus pulled away, I was thinking about how back-to-back these moments were when I heard a loud shrill voice from the back of the bus, “you’re amazing!” I froze. “The way you just whipped that little cart of yours right in that spot.” I ignored it, too tired after three ableist encounters in ten minutes to offer any witty comebacks in response, and too angry to feel like educating anyone.

These three encounters are not isolated or individual experiences. Sadly, they are com- mon and systemic. These three moments only tell us some of what disability means, how it appears, and how it is done. Disabilities, and many associated experiences, are often reduced to essentialized biomedical1 limita- tions or malfunctions of certain bodies. Dis- ability can more accurately be described as a process enacted through social relations. While the term disability appears to describe bodies and how they act/move/inhabit/sense/ think/exist/communicate, the label carries the weight of how these bodies are deemed infe- rior to other bodies through illusory, arbitrary, and compulsory social and economic standards designed to enable certain ways of being over

I’d like to tell you a story, which as it turns out, is in fact at least three related stories. STORY ONE: A DAY LIKE ANY OTHER DAY

One day, which really could be any day, I left my house in a rather good mood. I had found a lovely patch of sunshine to sit in while I waited for the bus. Soon I was joined by another bus rider who stood about four or five feet away from me. In a minute or two another person passed by with no real difficulty but found it necessary to grumble at me while passing that I should have “parked [my] car” (more appro- priately called a wheelchair) elsewhere, as I was blocking the sidewalk. I wasn’t blocking any- thing. The person who was waiting with me was shocked that this other person had made such a rude, ableist comment. I was not surprised. Nor was I surprised by the message behind his words, which was: You are in the way. You and “your car” are taking up too much space. I just let it go and waited. I was relieved when the bus that arrived moments later was acces- sible, and was a bit surprised when the other person waiting stepped to the side to allow me on, rather than rushing/pushing past me—as many people tend to do, making the bus more difficult to navigate.

As I waited for the driver to ready the bus, the person who had been waiting with me looked at the step of the bus and then to my power wheelchair and asked if I needed help. I simply replied that the bus has a ramp. Behind

OUT OF LINE: THE SEXY FEMMEGIMP POLITICS OF FLAUNTING IT!

L O R E E E R I C K S O N

From “Out of Line: The Sexy Femmegimp Politics of Flaunting It!” by Loree Erickson, http://www.femmegimp .org/femmegimp%20files/outofline.pdf. Reprinted by per- mission of the author.

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others. Disability is a complex, intersectional, cultural, and fluid constellation of experiences and constructs.

While this is my story of systemic ableism, it is not—and could not be—every story of systemic ableism. My story is reliant on my particular embodiment and cultural context, which includes, but is not limited to, physical disability, whiteness, with a high level of edu- cation. As a thirty-something-year-old queer femmegimp who lives below the poverty line, I am marked by a unique interplay of identi- ties. Disability never appears in isolation; it is always interrelated with a matrix of other marginalities and privileges. Systemic ableism manifests based on other marginalities (race, other experiences of disability, class, gender, and beyond).

The encounters in the story above tell some- thing about how people make sense of my body: both the anxieties they project onto it and the simultaneous erasures they enact. These are moments among many where the relations of power reveal themselves. For example, the idea that people take up “too much space” under- scores the notion that some people are worthy of occupying space and others are not—and is reminiscent of other sociohistorical practices of isolation and segregation. In Reading and Writing Disability Differently, Tanya Titchkosky writes, “The meaning of disability is composed of conflicts of inclusion and exclusion as this intersects with our ordinary ways of recogniz- ing people . . . or not.” (2007: 6)

STORY TWO: WHY I BECAME A PORN STAR

Disabled people are often imagined as being in the way, unimportant, in need of help, or called “inspirational” for doing ordinary things. Disabled people are imagined as less capable than or not as good as “normal” people (a prob- lematic term as well). All of these attitudes

simultaneously bolster and create policies and practices that propagate the association of dis- ability with undesirability. We see this in state- sponsored practices of funding and mandating institutionalization via incarceration in prisons, psychiatric wards/hospitals, group homes, and nursing homes over community-based support; immigration policies using racist, capitalist, and ableist definitions of who counts as a desirable citizen; in historic and contemporary eugenic ideals (affecting marginalized bodies and minds of all varieties), “lives not worth living” rhetoric and consequent denial of medical treatment to those deemed unworthy; as well as welfare and disability income programs that keep us impov- erished and hungry.

The same structures that impact other areas of our lives, creating an overwhelming climate of devaluation, also regulate our sexual lives.2 From forced and coerced sterilization to insti- tutional surveillance that limits privacy, there are multiple systems that pathologize, control, and punish the sexual explorations and expres- sion of disabled people. Common paternalistic assumptions hypersexualize and/or portray disabled people as hypervulnerable. This dam- aging ideology is used to justify segregation. Disabled people—all people—need affirming resources, sex-positive information, and ways to realize their sexual potentials. Anti-sex laws in many U.S. states criminalize certain sexual activities that may be preferred ways for some disabled people to experience pleasure and express desire.

Disabled people are also often subjected to medical and psychological gawking that objectifies, stigmatizes, and pathologizes our experiences of our bodies, including our minds (Blumberg, 1994). Many children who are born with or acquire their disabilities early on are told directly and indirectly to not expect to have a family or anyone ever romantically love them (Willing and Able: Sex, Love and Dis- ability, 2003). Disabled people experience the

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silence or isolate others’” (Wilkerson, 2002: 45). I would like to expand this idea to include how shame is used not only as a tool of social con- trol to isolate us from each other, but to keep us from accessing those very parts of ourselves, our bodies, our desires, and our experiences (usually wrapped up in our differences from that illusory ideal mentioned earlier) that hold the most potential for change by offering us a different way of being in the world.

Rather than hide away, deny, and ignore those very sites of the deepest shame, we must not only embrace them and learn from them, we need to flaunt them.

What better way to flaunt conventions of sexuality than by making porn? Pornography is surrounded by shame. We feel shame for watching it, enjoying it, making it, and buying it. The content of porn also often instills shame in us. We can feel badly for not living up to certain standards (both in terms of not fitting the mold of which bodies are seen as beautiful and in terms of not measuring up in regards to sexual prowess and skills). There is porn that demeans our identities and experiences and replicates oppressive power dynamics. Porn is complex, multifaceted—and yes—powerful. Rather than attempt to regulate and control it, which only drives it more underground and into the hands of those with privilege, we need to follow in the work of sex-positive feminists and explore the many benefits that pornogra- phy made from such alternative perspectives has to offer (Erickson, 2007).

This all may seem an unlikely beginning to porn stardom. By making queercrip porn, I moved out of line and took the “queer” and “wonky” path to place new stories within reach. I took this path to open up new possibilities and imaginings.

My journey began in a progressive sex shop in San Francisco in 2000; I was looking at an issue of On Our Backs, a lesbian porn maga- zine, featuring an article on sex and disability.

cumulative effects of this extensive system of desexualization every day.

People have begun organizing around this site of oppression as honestly and effectively as we have for other issues of access and justice. There are many particular barriers associated with this type of organizing and it is often depri oritized. In part, this is because there has been a disconnection between sexuality and other needs. It can be argued that one should focus more on needs such as housing, adequate attendant care, employment, transportation, and the like. However, this omission of sexual- ity ignores how profoundly interconnected all of these aspects of our lives are. Another part of the struggle to include sexuality as an orga- nizing goal requires us to challenge the way sex operates in Western society. We learn to associate shame with sex. We are surrounded by images that convey a very narrow definition of sex and of desirable bodies. We learn we are not supposed to talk about sex. This framing of normative desire is larger than life and does not make room for a whole range of enjoyable expe- riences and possibilities. When sex is thought of as a bountiful playground for the relatively few who can approximate the illusory ideals of the desirable body (skinny, white, able-bodied, rich, etc.), then sex, desire, and pleasure for the rest of us remain relatively invisible. Sex and sexual expression are also often dismissed as frivolous “wants” rather than fundamental aspects of humanity. This is especially true for people with disabilities.

Felt as a personal and private emotion, shame is spun to internalize, naturalize, and individu- alize many of the oppressions mentioned above as well as others. As Abby Wilkerson argues, “Shame is not so much a psychological state of individuals as such (even though it may shape individual subjectivity), but rather a socially based harm which oppressed groups are subject to in particular ways. . . . Shame is deployed as a ‘political resourc[e] that some people use to

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I was so excited—until I opened to the article. There was one picture of someone in a wheel- chair with someone sitting on their lap kiss- ing them. This one picture—the only image combining sex and disability I had found up to that point in my life—was inverted, so the image was obscured and barely recognizable. I wanted to see bodies that looked and moved and felt like mine represented in the exciting, but clearly still problematic, queer sexual cul- ture. I wanted to see something that reflected my desires! I wanted to know that desiring people like me was possible. I resolved then and there to become a porn star.

I began with a series of photos and in the summer of 2006, I made a short film called want. Want weaves together sexually explicit images with everyday moments and scenes of the ableist world. It works to get people hot and poses an insightful, complex, honest, and sexy image of disability and gender-transgressive bodies. Want was clearly wanted. It won several awards, and continues to screen internationally at numerous film festivals, conferences, and workshops.

I wouldn’t be making porn right now if I weren’t so pissed off. I would not be making porn if I hadn’t struggled for most of my life to be recognized as a sexy and sexual being, or if the world wasn’t so fucked up. But making porn is one of the best things I’ve ever done. On a political level it allowed me to make a movie that would offer not only a moment of recognition of how sexy queercrips could be, but also a way to tell others how I wanted to be seen. Making this video allowed me to take up space and reconceptualize what is sexy.

Personally, it was an amazing experience— and not just because of all the really great sex. The three of us (my co-star, the video artist, and I) created a space of comfort, beauty, respect, and desire. To be able to share that with others is truly remarkable. That day was one of the first times in my life that I truly felt

wanted for exactly who I am. The first time was with my first lover. Unfortunately, experiences like these are rare for many people. Despite the sheer joy of the day—I must have been smiling for days afterward—it took me a while to work up the nerve to watch the video footage. I was afraid that what I might see would allow all those stories I was trying to erase to reemerge and pollute my experience of that day. While there were some bits that were hard to watch, it turned out to be not so bad—and kind of hot. I could see that I was sexy. I still feel that pull of doubt, but I am building up a whole host of stories, salacious stories, to counter the other ones.

STORY THREE: BEING A PORN STAR IS HARD WORK

Before this turns into a simple story of over- coming adversity, I would like to complicate things a bit. “Flaunting it” is not without its dif- ficulties, but it does help to loosen up the knots a bit and free up more space for imagining. Our bodies, identities, desires, and experiences have multiple meanings, and thus, we need multiple stories. We need stories of love, lust, and other stuff. We need the success stories and the stories of pain and frustration. We also need stories about the work that stories being told about us, without us, do. These stories still inform our stories. We also need to look at the work that our stories do. Here are some stories that attempt to do that work.

Mainstream porn uses a series of conven- tions to shape the discourse of what is consid- ered sexy. As I mentioned earlier, we can feel shame for not measuring up to these stan dards. Despite my politics, while editing, I found myself tempted to recreate those standards. I wanted to edit out the messy stuff, the very things that made this particular porn different. Wouldn’t leaving in these sites of shame make it so that we wouldn’t have to feel bad when

erase the desiring of gender-transgressive bodies (both his and mine). This assumption also pre- sumes that desire occurs along hetero normative binary axes of gender and sex and sexuality. In addition, the way that disabled people are often denied agency contributes to a lack of recogni- tion of subversively performed gender expres- sion. Hot boy/femme lovin’ action must be made unintelligible, yet again, to keep certain bodies and desires in line.

The first time I screened want at a festival, during the Q and A section, one of the other directors commented that “eventually your chair just faded away and you were just a hot girl getting fucked.” For this viewer, this was meant as praise: the all-too-familiar “I was so hot he forgot I was in a wheelchair” compli- ment. I was not fulfilling the asexual poster- child stereotype that he views as being what disability is; and thus, disability and hot sexi- ness could not exist simultaneously. So in his viewing, he made what he considered to be the less desirable bit disappear. But my wheelchair will not just fade away; when I am hot, I am still disabled. I feel it is important to mention here that I had to win an obnoxious email argu- ment about why my screening had to be held in an accessible theatre to make the exchange even possible. And sorry, no, you can’t keep your little bubble of queer sex-positivity or the locations of said activities exactly the same and include me. The alignment of the inaccessible location of the event and his ableist views of hotness are not accidental.

Films like mine are unsettling as well as pro- ductive. What is made possible in the moments where we recognize being out of line, being crooked, being variant, as red smoking hot? This is especially true when being in line means hiding the parts that don’t fall in line so that we never feel fully recognized. As already dis- cussed, shame is a panoptical device used to urge bodies toward assimilation and normalcy. In my life, the many ways of not having the

we don’t fall seamlessly into bed with our hair splayed out perfectly on the pillow? I’ve seen other porns that do this; they show pauses for gloves and lube, the negotiation process: “try moving my leg here,” or “I like this,” or “touch me here.” How powerful would it be to show that when we fell back or slipped, it didn’t ruin anything? We just kept going. Then I realized that, within the constellation of power rela- tions, I had somewhat contradictory aims. How far could I go toward a new vision of sexy and still be recognized as sexy? How far could I go away from that standard referent and not be discounted as too different or have my film written off as a fetish film? If, as Foucault con- tends, we can never get outside of power, then how do we create something new without rein- forcing oppressive ideologies? In the end I com- promised; I showed bits of both.

Despite all the recognition, there are also times of misrecognition. I find these particu- lar moments quite revealing. They are useful not just in highlighting how difficult it can be to unlearn conceiving of only certain bodies as desirable, but also what possibilities there are for bodies to take. A perfect example of this is how people assume that my co-star and I are lesbians. I only have space to offer partial explanations here. Some of this assumption is explained by normative readings of gender, which argue that a certain tone of voice implies a corresponding gender or that a dildo is a dildo, when sometimes what may appear to some as a dildo is someone’s cock. Another explana- tion is that representations of genderqueer boy/ femmegimp love are still rare, leaving many to not even realize that these experiences and identities are imaginable. I am also interested in thinking through what work it does to read the film and thus the identities and bodies por- trayed in the film as lesbian. I am often either seen as straight or a lesbian—this is more com- plicated and interesting than I can really take up here—but both readings (straight or lesbian)

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crips truly disappear. And I say it’s time for us to reappear. Time for us to talk sex, be sex, wear sex, relish our sex, both the sex we do have and the sex we want to be having. I say it’s time for some queer disability erotica, time for an anthology of crip smut, queer style. Time for us to write, film, perform, read, talk porn. I’m serious. It’s time (Clare, 2002: n.p).

I screened want at a queer conference in Mas- sachusetts; afterward, a young woman with a disability thanked me for my video and told me she had never had a romantic relationship. She said before that moment she had never even thought it was a possibility for her. So while my story tells many stories, there is most definitely a love story or two in there that are also stories of resistance and systemic change.

NOTES 1. The term biomedical here is used to encompass biological, psychological, intellectual, and medical practices and praxis not acting as interrelated systems.

2. This is true of many experiences of marginalization. An easy comparison is made when looking at laws regarding marriage in the prohibition of interracial marriages, same-sex marriages, and so on.

REFERENCES Blumberg, L. 1994. Public Stripping. In B. Shaw (ed.).

The Ragged Edge: the Disability Experience from the Pages of the First Fifteen Years of The Disability Rag. Lousiville, KY: Advocado Press. 77–81.

Clare, E. 2002. Sex, Celebration, and Justice: A Keynote for QD2002. Paper presented at the Queer Disability Conference, San Francisco, CA.

Erickson, Loree. 2007. Revealing Femmegimp: Sites of Shame as Sites of Resistance for People with Disabilities. Atlantis: A Journal of Women’s Studies 32: 1.

Lurie, S. 2002. Loving You Loving Me: Tranny/Crip/Queer Love and Overcoming Shame in Relationships. Retrieved July 15, 2004, from www.bentvoices.org.

Titchkosky, Tanya. 2007. Reading and Writing Disability Differently: The Textured Life of Embodiment. Toronto: University of Toronto Press.

Wilkerson, A. 2002. Disability, Sex Radicalism, and Political Agency. NWSA Journal, 14(3): 33–57.

Willing and Able: Sex, Love and Disability, SexTV Documentary, 2003.

privilege of hiding certain sites of shame has been complicated and in some ways hard, but it has also opened up new possibilities and ways of being in the world. In want I show myself as a body that is explicitly sexual and also needs inti- mate daily personal care. Bodies that cannot or do not hide their interdependence, needs, and leakiness as well as others do, have faced a long history of violence, discrimination, and desexualization. Being regarded as a depend- ent body is certainly one of the major ways that disabled bodies have been cast as undesirables. I wanted to bring these two supposedly dispa- rate parts of me together because I am certain that disability will never be fully desirable until notions of dependency and care are reworked. I also wanted to show how adopting a nontradi- tional model of meeting my care needs through a collective of people has not only enabled my sexual expression, but opened up a space for so much more. The mutuality of these car- ing relationships contributes to new ways of being-in-the-world-with-others.

In the article “Loving You Loving Me: Tranny/ Crip/Queer Love and Overcoming Shame in Relationships,” Samuel Lurie states, “being desired, trusting that, reciprocating that cracks us open” (2002: n.p.). Remaining open and vul- nerable is scary because of shame, past hurts (both systemic and interpersonal), and the very real chance of harm, but it is also hard because it means we have to tell new stories. We have to tell stories that contradict the omnipresent cho- rus that tells us that we are not good enough to be wanted. These stories can be hard to tell because they can sometimes be hard to believe, but they need to be told because in their telling, they make change possible. As Eli Clare argues:

Never are we seen, heard, believed to be the crea- tors of our own desires, our own passions, our own sexual selves. Inside this maze, the lives of queer

159

R E A D I N G 1 5

On April 25, 2008, Melissa Bruen, then a senior at the University of Con-necticut, was sexually assaulted as she walked home from a party during the campus’s Spring Weekend Celebration. The Hartford Courant reported that “a young man pinned her to a tree, thrust himself against her and began moaning as a crowd gathered” (Merritt 2008). Then, another young man pulled down her tube top and grabbed her bare breasts as the drunken crowd cheered. The Courant painted this episode as an assault on a vulnerable female victim. For example, it described the aftermath of the assault in the following way: “Bruen’s friend Kevin Meacham found Bruen after the incident. She had collapsed on the ground and was frantically calling his name. ‘She was hys- terical,’ he said. ‘She was almost hyperventilat- ing.’” The article also mentions the warnings Bruen had received that women should not walk alone at night, as well as her boyfriend’s sense of guilt that he wasn’t with her to protect her. In other words, the Courant’s description of this assault fits well with our societal ideas about how assaults happen to women: they are attacked, generally by male strangers, in public places. They are vulnerable and helpless, and even if they do manage to escape rape or other serious assault, they are hysterical, weeping, and calling for male support.

But does this report portray what really hap- pened? At the time of the assault, Bruen was the editor of the University of Connecticut’s Daily Campus. In one of her final contributions

to the paper, she published her first-person account of her experience. Here, in part, is how she describes what unfolded as she walked along a path nicknamed the “Rape Trail”:

When he came toward me, I grabbed him by the shoulders and pushed him down to the ground. I held onto his shoulders and climbed on top to strad- dle him. He started thrashing side to side, but I was able to hit him with a closed fist, full force, in the face. A small crowd had gathered, mostly men. Now they seemed shocked. I was supposed to have been a victim, and I was breaking out of the mold. I hit him in the stomach, while clenching my legs around him to prevent another man from pushing me off. In all, it took three men to pull me off my assailant. . . . Another man, around 6’1”, approached me and said, “You think that was assault?” and he pulled down my tube top, and grabbed my breasts. More men started to cheer. . . . I punched him in the face, and someone shoved me into a throng of others. I was surrounded, but I kept swinging and hitting until I was able to break free. (Bruen 2008)

This is a very different description than the one offered by the Courant. In her full account, Bruen does blame herself for walking alone at night. She focuses not on her escape but on what might have happened if she hadn’t fought back. But regardless, she used her fists and determination to break free not just from one man, but from many. She sustained only bruises, not rape.

CONSTRUCTING VICTIMS: THE ERASURE OF WOMEN’S RESISTANCE TO SEXUAL ASSAULT

J O C E LY N A . H O L L A N D E R A N D K AT I E R O D G E R S

From “Constructing Victims: The Erasure of Women’s Resistance to Sexual Assault,” Sociological Forum, Vol. 29, No. 2, 2014, pp. 342–64. © 2014 Eastern Sociological Soci- ety. Reprinted by permission of John Wiley & Sons, Inc.

LITERATURE REVIEW

Rape Resistance There is now an abundance of evidence that on average, actively resisting sexual assault reduces the risk of completed rape (see Ullman 1997, 2007 for a comprehensive review of this litera- ture). In particular, forceful physical resistance (e.g., kicking or hitting), nonforceful physical resistance (e.g., blocking an assailant’s blows or fleeing), and forceful verbal resistance (e.g., yelling) are all associated with avoiding rape. Nonforceful verbal resistance (e.g., pleading or reasoning), on the other hand, does not seem to reduce the likelihood of rape. Moreover, it is now clear that women’s physical or forceful verbal resistance does not, on average, increase their risk of serious injury beyond the sexual assault itself. Rather, while there is an asso- ciation between victim resistance and injury, research that examines the sequence of assault finds that it is the injury that typically occurs first (Tark and Kleck 2004; Ullman 1998). In the most comprehensive study of this issue, Tark and Kleck (2004) concluded that in all types of crimes, including sexual assaults, vic- tim resistance is nearly always the most effec- tive course of action.1

National surveys find that women take self- protective action in the majority of assaults.2 According to the National Crime Victimiza- tion Survey (NCVS), 66% of U.S. women who reported being sexually assaulted also reported taking some sort of self-protective action (Bureau of Justice Statistics 2007). . . .

In addition to increasing women’s likeli- hood of escape, resisting assault also con- fers other benefits. For example, women who resist assault report fewer post-assault symp- toms, both physical and psychological (Koss, Woodruff, and Koss 1991). They also report more rapid psychological healing (Bart and O’Brien 1985) and less self-blame (Rozee and

Bruen’s case offers an unusual opportunity to compare two accounts of a single assault: a first-person narrative by the target of the assault and the news media’s reporting of the same event. In this case, it seems clear that the Courant’s writer reframed Bruen’s experience. In her own account, she is brave and power- ful and ultimately successful—even if she was also, understandably, scared and shocked. In the Courant’s description, she is only vulner- able and weak, with very little attention to her resourcefulness and strength in resisting a crowd of drunken and abusive men.

Most of the time, however, we do not have access to the intended victim’s version of what happened, but are exposed only to the news media’s account of an assault. As we discuss below, large-scale survey research over the past two decades has found that, as in Melissa Bruen’s case, women resist sexual assault—and do so successfully—in the major- ity of attempted attacks. Of course, we do not expect the details of newspaper reports to perfectly mirror the findings of social science research. Media accounts of sexual assault are influenced by both patterns of police report- ing and the perceived “newsworthiness” of a particular incident. Nonetheless, the news media are an influential source of informa- tion for the public on crime and other events outside their own experience. The question we ask in this [reading] is what information about women’s responses to sexual assault is available to newspaper readers. Are readers exposed to information about women’s resis- tance and successful self-defense? Or do news reports tend to emphasize a conventional story line of vulnerability, as they did in the Bruen case, ignoring women’s strength and highlighting their weakness? If so, these sto- ries may reinforce the belief that women can- not defend themselves from men’s violence, distorting readers’ understanding of sexual assault.

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C O N S T RU C T I N G V I C T I M S 161

METHODS

Data We used the Lexis-Nexis Academic online data- base of U.S. newspapers as the source of data for our analysis. . . . To capture a diverse group of newspapers, we stratified the sample by region (Northeast, Midwest, Southeast, South- west, and West) and circulation (over 1 million, 400,000 to 1 million, 100,000 to 400,000, and below 100,000). We included two newspapers with over 1 million circulation, USA Today and the New York Times, because they command a national audience. We then used a random number generator to choose one newspaper from each of the remaining geographic area/ circulation size groups.3 The final sample included 16 newspapers from communities of various sizes around the United States. . . .

We then returned to the Lexis-Nexis data- base to search for articles in these newspapers that focused on the sexual assault of women. We used three search terms: sexual assault, sex offenses, and rape. Because there may be sea- sonal differences in rates of sexual assault, we searched for all articles on these topics over a full calendar year, January 1–December 31, 2007. We scanned each article and selected for inclusion those articles that involved male assailants and female targets, focused on a par- ticular incident, and included some description of the sequence of the assault (thus providing an opportunity for writers to include details about women’s resistance to attacks). . . .

The final sample included 922 articles that described 1,084 incidents of assault. . . .

Coding and Analysis We developed a coding scheme to capture descriptions of women’s resistance, as well as representations of the assault, the perpetrator, and the target. We distinguished between two

Koss 2001). Finally, fighting back can result in more compelling physical evidence for any later criminal justice process (Rozee 2005).

Media and the Social Construction of Reality These findings about women’s resistance to violence stand in contrast to societal beliefs about women’s ability to resist sexual assault. For example, women are believed to be natu- rally weaker than men and thus inevitably vul- nerable to violence, especially sexual assault (Hollander 2001; McCaughey 1997). Men, in contrast, are believed to be both inherently dangerous and, paradoxically, the source of women’s protection. These beliefs make the idea of women’s resistance to violence literally unthinkable (Hollander 2009). . . .

How the media portray social problems can have real consequences. The news media pro- vide information about events that we have not personally experienced and frame that informa- tion for us, suggesting particular interpretations and meanings (Heath, Gordon, and LeBailly 1981). Media framings of social issues influence public opinion and perception (Berns 2004; Gilliam and Iyengar 2000; Holbert, Shah, and Kwak 2004; Leverentz 2012; Lowney and Hol- stein 2001; Repogle 2011; Wozniak and McClo- skey 2010). . . . For women in particular, media depictions of sexual assault and other forms of violence have been argued to disempower them (Reid and Finchilescu 1995), induce fear (Chiri- cos, Eschholz, and Gertz 1997), teach them the “victim role” (Gerbner and Gross 1976), and serve as a form of social control, instructing women on the boundaries of virtuous behav- ior as well as “safe” and “unsafe” environments (Meyers 1997). Through its influence on public perception, news coverage of violence against women can also affect public policy (Berns 2004; Carll 2003) and facilitate continued vio- lence against women (Meyers 1997: ix). . . .

did not resist or that her resistance was unsuc- cessful. In 34 incidents (3.1%), the writer noted explicitly that the target chose not to resist. Of those articles that did mention resistance, 73 cases, or 6.7% of all incidents, mentioned only passive resistance; as noted above, passive resistance has been found to be associated with completed rape. Of these mentions of passive resistance, approximately three-quarters were verbal (e.g., crying or begging) and one-quarter were physical (e.g., going limp). In only 26.6% (288 cases) of all incidents did the newspa- per article mention women’s active resistance. These cases were fairly evenly divided between physical resistance (12% of all incidents), verbal resistance (14%), and escape (10%).4

In only about one-third of the total sample of incidents, then, did the newspaper report mention any kind of resistance on the part of the target of the assault. . . .

Resistance Outcomes When women resist a sexual assault, what happens? Survey research has found that active resistance reduces women’s risk of rape. According to Clay-Warner’s (2002) analysis of NCVS data, for example, there is an 87% reduc- tion in the probability of completed rape when women use any form of self-protective action. In newspaper accounts, however, resistance is not strongly associated with avoiding completed rape. Of the 361 incidents for which some form of resistance was reported, that resistance was successful in stopping the assault in only 42% of the cases. . . . In the other 58% of incidents, the woman’s resistance was described as unsuc- cessful (38%), the assault outcome was unclear (14%), or the assault was ended by outside inter- vention (6%). Women’s active physical and ver- bal resistance was more frequently reported as successful (48.2% of 311 incidents) than unsuc- cessful (35.4% of incidents). In contrast, pas- sive resistance (nonforceful physical and verbal

types of resistance based on previous discus- sions of women’s self-defense in the research literature. Active resistance includes what other scholars have described as forceful physical and verbal resistance, and is characterized by targets using their own physical or verbal resources to assertively attempt to prevent an attack in progress. This may mean striking an assailant, yelling, or simply running away. Passive resistance includes nonforceful reac- tions that convey that the sexual interaction is unwanted but do not assertively refuse victim- ization, instead relying on the perpetrator or outside intervention to stop the assault. Exam- ples include crying, pleading, or going limp. We also coded other characteristics of the article and assault; most relevant for this analysis are the type of article, the relationship between target and perpetrator, and the outcome of the resistance (successful or unsuccessful at ending the assault). . . .

We focused our analysis on two questions. First, did the article mention women’s resis- tance to assault? And second, if it did so, what was the outcome of this resistance and how was it described? . . . Because past research has found that media reports of violence against women tend to mirror societal beliefs about gender, we hypothesized that newspapers would neglect to include information on wom- en’s resistance to violence, especially when it is successful at stopping an assault.

RESULTS

Do Newspapers Report Women’s Resistance? Of the 1,084 incidents in our sample, 689, or 63.6%, included no information about resis- tance by the target of the assault . . . , leaving readers to draw their own conclusions—and perhaps, given societal narratives of women’s vulnerability and weakness, to assume that she

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and 16.7% involving family members, described women’s successful resistance to violence. . . . Although there is little research on the efficacy of resistance to strangers versus known perpe- trators, the few studies that do measure this find forceful resistance to be equally effective in both situations (Ullman and Siegel 1993).

It is impossible to be certain why newspapers overrepresent stranger rapes but underreport resistance to them, or why they underreport the effectiveness of resistance to assaults by acquaintances and intimates. One possibility is the fact that newspapers often obtain informa- tion about sexual assaults from police reports, and women are more likely to report assaults by strangers than acquaintances or intimates. Another possibility is that reports of assaults by strangers are seen as more “newsworthy,” either because they fit with widespread stereotypes about rape or because they are more sensational. Whatever the reason, these patterns distort the information available to readers and thus may perpetuate myths about sexual assault.

Variation by Type of Article and Type of Newspaper Although the patterns described above held true for virtually all articles in the sample, we found some variation by article type. The arti- cles fell into four categories based on length, level of detail, and focus. Crime reports (18% of the 922 articles) are brief, formulaic descrip- tions of reports made to the police, and aver- age 48 words per article. . . . Short reports (31%), which average 163 words per article, are con- cise descriptions of a specific, very recent event. Long reports (46%) also focus on a single crime or series of related crimes but tend to be lon- ger (averaging 547 words per article) and more detailed, often following up on a short report and providing context or interview quotes. Fea- ture stories (6%), in contrast, tend to be much longer (1,576 words per article, on average)

resistance) was reported as unsuccessful (64.6% of 73 incidents) more frequently than as suc- cessful (12.3% of incidents). These results mir- ror the findings of social science research, which also find active resistance to be more effective than passive resistance (e.g., Clay-Warner 2002; Ullman 2007).

When articles did report women’s resis- tance, the power of those actions was fre- quently diluted by the way they were described. For example, reporters often wrote that resis- tance or escape was something women “man- aged” to do, implying that it was not easy and that women were lucky, rather than skillful, if they achieved it. In other cases, a strong action such as escape was modified by descriptions of weak emotions, such as a description of a target who “ran into the house crying” (Anon. 2007). Only rarely was women’s forceful resis- tance described with unmodified verbs such as “fought,” “hit,” or “resisted.”. . .

Relationship between Perpetrator and Target In about one-third of all incidents (31.9%), the newspaper report did not specify the relation- ship between the perpetrator and the target. Of the remainder, slightly more than half (51.7%) involved perpetrators who were described as strangers to the target, 41.0% involved acquain- tances and other known assailants, and 7.3% involved intimate partners or family members. . . .

Interestingly, there were few differences in the reporting of women’s resistance across dif- ferent types of perpetrators. . . . This finding is surprising given that most research has found that women are much more likely to resist attacks by strangers than by known assailants (see Ullman 1997, 2002).

However, successful resistance was much more frequently reported in incidents involving strangers: 60% of these incidents, compared with 24% of incidents involving acquaintances

C O N S T RU C T I N G V I C T I M S 163

Depictions of unsuccessful resistance, unsurprisingly, follow the opposite pattern: longer articles provide more detail about unsuc- cessful resistance, while shorter articles provide less. A notable pattern here was that in longer articles, women were portrayed as being over- whelmed by men’s strength and speed. . . .

Crime reports, however, describe the oppo- site pattern: although women’s initial attempts at resistance may be unsuccessful, they keep trying and often get away or escape greater harm. . . .

Overall, the longer the article, the closer the story adhered to conventional narratives of female vulnerability and weakness. In the brief, “just-the-facts” articles, women’s resistance was more evident, though still less frequent than victimization surveys report. This pattern is particularly striking because one might expect longer stories to describe more, not less, female resistance. Longer stories present the writer with the greatest opportunity to elaborate the details of the assault, and might be expected to describe the actions women took to protect themselves. Instead, however, writers appear to use this extra space to sketch a conventional picture of sexual assault, emphasizing women’s weakness and minimizing or ignoring their agency. It is notable that resistance is virtually invisible in this type of reporting. Our data cannot tell us, of course, whether the focus on women’s vulnerability in these articles reflects the types of incidents that feature stories choose to focus on or the writers’ interpreta- tions of these incidents. In either case, how- ever, these stories serve to make conventional narratives of women’s vulnerability more avail- able to readers. . . .

CONCLUSIONS

What information do newspapers present about women’s resistance to sexual assault? Accord- ing to our analysis of a representative sample

and focus not on a single event but rather on a larger story or issue (e.g., sexual assault in the military), embedding accounts of specific assaults within this larger context. . . .

[The crime and short reports provide] a simple reporting of the facts, rather than a detailed narrative about why she chose not to fight back. Of course, longer articles inevitably provide more details than short crime reports. What we found notable, however, was that only some types of information were elabo- rated in longer reports. There were virtually no lengthy or detailed descriptions of women’s resistance, for example, even though resistance was reported much more frequently than sub- mission. Descriptions in different article types, then, differ in both quantity and quality: Longer articles not only more frequently report women’s submission; they also include additional detail that focuses on women’s vulnerability and fear.

The four types of articles also varied in the way they reported the outcomes of women’s resistance. About one-third of all types of arti- cles noted a resistance outcome. Overall, lon- ger articles were less likely to report successful resistance. . . .

Longer articles also tended to emphasize the ways in which outsiders helped facilitate a woman’s escape or resistance, downplaying her own efforts at self-protection. One article, for example, reported that a woman fought off an attacker in an elevator but concluded by not- ing that “Workers chased him down and held him until police arrived” (Cooper 2007). . . . Instead, feature stories and long reports tended to describe passive resistance such as begging, ignoring, or going limp. . . .

At the other end of the spectrum, shorter articles were not only more likely to report suc- cessful resistance, but also tended to frame this resistance in more empowering ways. For example, some short articles describe women as “fighting,” rather than “struggling,” and some even provide details about the resistance. . . .

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men, for protection (Hollander 2009; Mey- ers 1997; Stanko 1995). Conversely, potential attackers may learn from newspaper reports that women are vulnerable and unlikely to resist assault; this portrait of weakness may actually encourage sexual assaults (Reid and Finchilescu 1995).

An alternate presentation of sexual assault, however, could have very different effects. Pre- senting full accounts of women’s active resis- tance could challenge gender expectations, according agency to women and making resis- tance a more cognitively available response to assault (Cermele 2010). Melissa Bruen’s first- hand account of her assault, with which we began this [reading], is a good example of how newspapers could report sexual assaults in ways that are empowering to women. Although Bruen does not discount the fear and pain she suffered, her account makes clear that she was not a pas- sive victim. She fought back ferociously and ulti- mately succeeded in escaping her attackers. . . .

Although we believe that newspapers should more fully report women’s resistance to violence, it is important to acknowledge the potential pit- falls. As other writers have argued, encouraging women’s resistance can be used to blame victims by implying that women should resist assault or that they are at fault if they are unable to do so effectively. Moreover, focusing on women’s resis- tance can reduce sympathy for victims or rein- force myths about “real rape” as occurring only when a woman resists and is physically overpow- ered. In our view (see Hollander 2009 for a more extended discussion), saying that women can effectively resist sexual assault does not imply that women should resist or that they should be blamed if they could not do so. Responsibility for sexual assault always lies squarely on the shoul- ders of the assailant, not the target. Moreover, as the recent revision of the definition of rape in the Uniform Crime Reports makes clear (U.S. Department of Justice 2012), women’s resistance is not necessary for “real rape” to have occurred.

of 16 newspapers across 1 full year, newspaper reports of sexual assault reinforce a conven- tional narrative that assumes women’s vulner- ability to assault and their inability to respond to it effectively. About two-thirds of the news- paper descriptions contain no mention of wom- en’s resistance. When newspapers do report women’s self-defensive behavior, they often do so only to note its failure; this was especially true when the assailant was known to the vic- tim. The variation by article length multiplies this effect. . . . And in the relatively few cases when successful resistance is described, the fact that the woman defended herself is frequently undermined by the language used to describe it. In only a very small minority of cases are women described as strong, competent social actors who possess the ability to protect them- selves from men’s violence. . . .

Newspaper descriptions of victims of sexual assault, as we have described, nearly always conform to interpretations of women as weak, vulnerable, and dependent on others for their safety. This is true even for women who resist violence: although these situations present writers with the opportunity to deviate from the typical gender script, they virtually never do so. Newspapers “victimize” the targets of sexual assault even when they fight back, con- structing them as victims (and particular kinds of feminized victims) rather than resisters. . . .

If women are presented with a barrage of information confirming their vulnerability, why would they believe themselves capable of fighting off a male attacker?5 These patterns may also affect women’s everyday behavior outside of assault situations. For example, if women believe self-defense to be impossible, they are left only with infantilizing options for preventing assault: limiting their participation in public life (though of course this may not protect them, since so much violence against women is perpetrated by acquaintances and intimates) or relying on others, particularly

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REFERENCES Bart, Pauline B., and Patricia H. O’Brien. 1985. Stopping

Rape: Successful Survival Strategies. Elmsford, NY: Pergamon.

Berns, Nancy. 2004. Framing the Victim: Domestic Violence, Media, and Social Problems. New York: Aldine de Gruyter.

Brecklin, Leanne R. 2008. “Evaluation Outcomes of Self- Defense Training for Women: A Review.” Aggression and Violent Behavior 13: 1: 60–76.

Brecklin, Leanne R. and Sarah E. Ullman. 2005. “Self- Defense or Assertiveness Training and Women’s Responses to Sexual Attacks.” Journal of Interpersonal Violence 20: 6: 738–62.

Bruen, Melissa. 2008. “My Spring Weekend Nightmare: A Firsthand Account of Sexual Assault on ‘The Rape Trail.’” The Daily Campus, May 2. Retrieved May 27, 2011 from www.dailycampus.com/2.7440/my-spring -weekend-nightmare-1.1053994.

Bureau of Justice Statistics. 2007. National Crime Victimization Survey. Washington, DC: Bureau of Justice Statistics. Retrieved May 25, 2011 from http://bjs.ojp .usdoj.gov/index.cfm?ty=pbdetail&iid=1743.

Carll, E. K. 2003. “News Portrayal of Violence and Women: Implications for Public Policy.” American Behavioral Scientist 46: 12: 1601–10.

Cermele, Jill. 2010. “Telling Our Stories: The Importance of Women’s Narratives of Resistance.” Violence against Women 16: 10: 1162–72.

Chiricos, Ted, Sarah Eschholz, and Marc Gertz. 1997. “Crime, News and Fear of Crime: Toward an Identi- fication of Audience Effects.” Social Problems 44: 3: 342–57.

Clay-Warner, Jody. 2002. “Avoiding Rape: The Effects of Protective Actions and Situational Factors on Rape Outcome.” Violence and Victims 17: 6: 691–705.

Eschholz, Sarah, Ted Chiricos, and Marc Gertz. 2003. “Television and Fear of Crime: Program Types, Audience Traits, and the Mediating Effect of Perceived Neighborhood Racial Composition.” Social Problems 50: 3: 395–415.

Gerbner, George, and Larry Gross. 1976. “Living with Television: The Violence Profile.” Journal of Communication 26: 2: 172–99.

Gilliam, Franklin D., and Shanto Iyengar. 2000. “Prime Suspects: The Influence of Local Television News on the Viewing Public.” American Journal of Political Science 44: 3: 560–73.

Heath, Linda, Margaret T. Gordon, and R. LeBailly. 1981. “What Newspapers Tell Us (and Don’t Tell Us) about Rape.” Newspaper Research Journal 2: 1: 48–55.

Holbert, R. Lance, Dhavan V. Shah, and Nojin Kwak. 2004. “Fear, Authority, and Justice: Crime-Related TV Viewing and Endorsements of Capital Punishment and

Despite these risks, we speculate that if depictions of women’s resistance became more widespread, they could both encourage women to resist attackers and discourage men from attempting such attacks. Women, armed with the knowledge that they have both the power to defend themselves and a good chance of succeeding, would be able to participate more fully in social life. Empowering women in this way could not only prevent sexual violence but would also “challenge the status quo by encour- aging women to break with traditional role expectations” in all areas of their lives (Mey- ers 1997:82). Reporting women’s resistance to violence against women, in other words, could play an important role in deconstructing gen- der inequality.

NOTES 1. Of course, every assault situation is different, and in some situations resistance may not be the most effective response.

2. Most women who resist sexual assault do so without any formal self-defense training. A growing body of research suggests, however, that such training can reduce women’s risk of victimization (e.g., Brecklin and Ullman 2005; Hollander 2014; Orchowski, Gidycz, and Raffle 2008; Senn, Gee, and Thake 2011; Sinclair et al. 2013), as well as increasing their self-confidence and changing gender scripts that prescribe female passivity and vulnerability (Brecklin 2008; Hollander 2004; McCaughey 1997).

3. Because there were no newspapers in the southeast region with a circulation between 400,000 and 1 million, the sample includes no paper from this geographic/ circulation group.

4. Note that the number of descriptions of resistance sum to more than the number of incidents mentioning resistance because in some incidents women used more than one resistance strategy. In addition, in some incidents women initially resisted but then decided to submit to the assault; in others, the assault had multiple parts, some of which the woman resisted.

5. Of course, the large-scale survey research discussed above reports that women often do fight back when they are attacked. Our argument here is not that women do not resist sexual assault, but that the patterns of newspaper reporting we discuss here may reduce their belief that they can be successful in doing so.

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Senn, Charlene Y., Stephanie S. Gee, and Jennifer Thake. 2011. “Emancipatory Sexuality Education and Sexual Assault Resistance: Does the Former Enhance the Latter?” Psychology of Women Quarterly 35: 1: 72–91.

Sinclair, Jake, Lee Sinclair, Evans Otieno, Munyae Mulinge, Cynthia Kapphahn, and Neville H. Golden. 2013. “A Self-Defense Program Reduces the Incidence of Sexual Assault in Kenyan Adolescent Girls.” Journal of Adolescent Health 53: 3: 374–80.

Stanko, Elizabeth A. 1995. “Women, Crime, and Fear.” The Annals of the American Academy of Political and Social Science 539: 46–58.

Tark, Jongyeon, and Gary Kleck. 2004. “Resisting Crime: The Effects of Victim Action on the Outcomes of Crimes.” Criminology 42: 4: 861–910.

U.S. Department of Justice. 2012. “Attorney General Eric Holder Announces Revisions to the Uniform Crime Report’s Definition of Rape.” January 6. Retrieved March 27, 2012 from www.fbi.gov/news/pressrel/press-releases /attorney-general-eric-holder-announces-revisions-to-the -uniform-crime-reports-definition-of-rape.

Ullman, Sarah E. 1997. “Review and Critique of Empirical Studies of Rape Avoidance.” Criminal Justice and Behavior 24: 4: 177–204.

Ullman, Sarah E. 1998. “Does Offender Violence Escalate When Women Fight Back?” Journal of Interpersonal Violence 13: 2: 179–92.

Ullman, Sarah E. 2002. “Rape Avoidance: Self-Protection Strategies for Women.” In Paul A. Schewe (ed.), Preventing Violence in Relationships: Interventions across the Lifespan: pp. 137–62. Washington, DC: American Psychological Association.

Ullman, Sarah E. 2007. “A 10-Year Update of ‘Review and Critique of Empirical Studies of Rape Avoidance.’” Criminal Justice and Behavior 34: 3: 1–19.

Ullman, Sarah E., and J. M. Siegel. 1993. “Victim– Offender Relationship and Sexual Assault.” Violence and Victims 8: 2: 121–34.

Wozniak, Jessica A., and Kathy A. McCloskey. 2010. “Fact or Fiction? Gender Issues Related to Newspaper Reports of Intimate Partner Homicide.” Violence against Women 16: 8: 934–52.

APPENDIX A: NEWSPAPER ARTICLES QUOTED IN TEXT Anon. 2007. “Man Accused of Assault on a Woman in

Orem.” Deseret Morning News, July 24. Cooper, Todd. 2007. “Reversal of DNA Ruling Pleases

Victims; A Judge Says a Convicted Rapist Can’t Seek Evidence That Wasn’t Originally Part of the Case against Him.” Omaha World-Herald, August 8, 01A.

Gun Ownership.” Journalism & Mass Communication Quarterly 81: 2: 343–63.

Hollander, Jocelyn A. 2001. “Vulnerability and Dangerousness: The Construction of Gender through Conversation about Violence.” Gender & Society 15: 1: 83–109.

Hollander, Jocelyn A. 2004. “‘I Can Take Care of Myself’: The Impact of Self-Defense Training on Women’s Lives.” Violence against Women 10: 3: 205–35.

Hollander, Jocelyn A. 2009. “The Roots of Resistance to Women’s Self-Defense.” Violence against Women 15: 4: 574–94.

Hollander, Jocelyn A. 2014. “Does Self-Defense Training Prevent Sexual Violence against Women?” Violence Against Women 20: 3.

Koss, Mary P., W. J. Woodruff, and Paul G. Koss. 1991. “Criminal Victimization among Primary Care Medical Patients: Incidence, Prevalence, and Physician Usage.” Behavioral Sciences and the Law 9: 1: 85–96.

Leverentz, Andrea. 2012. “Narratives of Crime and Criminals: How Places Socially Construct the Crime Problem.” Sociological Forum 27: 2: 348–71.

Lowney, Kathleen, and James A. Holstein. 2001. “Victims, Villains, and Talk Show Selves.” In Jaber F. Gubrium and Holstein, James A. (eds.), Institutional Selves: Troubled Identities in a Postmodern World: pp. 23–45. New York: Oxford University Press.

McCaughey, Martha. 1997. Real Knockouts: The Physical Feminism of Women’s Self-Defense. New York: New York University Press.

Merritt, Grace E. 2008. “UConn Student Editor Describes Being Sexually Assaulted.” Hartford Courant, May 3. Retrieved May 9, 2008 from articles.courant.com/2008 -05-03/news/uconnassault0503.art_l_three-sexual -assaults-university-and-police-path.

Meyers, Marian. 1997. News Coverage of Violence against Women: Engendering Blame. Thousand Oaks, CA: Sage.

Orchowski, Lindsay M., Christine A. Gidycz, and Holly Raffle. 2008. “Evaluation of a Sexual Assault Risk Reduction and Self-Defense Program: A Prospective Analysis of a Revised Protocol.” Psychology of Women Quarterly 32: 2: 204–18.

Reid, Penny, and Gillian Finchilescu. 1995. “The Disempowering Effects of Media Violence against Women on College Women.” Psychology of Women Quarterly 19: 3: 397–411.

Rozee, Patricia D. 2005. “Rape Resistance: Successes and Challenges.” In Andrea Barnes (ed.), The Handbook of Women, Psychology, and the Law: pp. 265–79. San Francisco, CA: Wiley.

Rozee, Patricia D., and Mary P. Koss. 2001. “Rape: A Century of Resistance.” Psychology of Women Quarterly 25: 4: 295–311.

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LEARNING ABOUT SEX

A N I N T E R V I E W W I T H

J E S S I C A F I E L D S

Jessica Fields is a professor of sociology and sexuality studies at San Francisco State University and the author of Risky Lessons: Sex Education and Social Inequality (Rutgers University Press, 2008), which received the Distinguished Contribution to Scholarship Book Award from the American Sociological Association’s Race, Class,  and Gender Section. Her second book, Problems We Pose: Feeling Differ- ently about Qualitative Research (University of Minnesota Press) explores emotion as an opportunity to reimagine power and knowledge production.

What led you to begin studying sexuality? My research focus is teaching and learning about sexuality in a variety of set- tings, including middle school sexuality education classrooms; sexuality education debates and policy; lessons schools offer about lesbian, gay, bisexual, transgender,

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and queer (LGBTQ) gender and sexuality; and participatory sexuality education for incarcerated women. I’m especially interested in intersections among sexuality, gender, and race, and I’m interested in teaching and learning as opportunities to reimagine sexual possibilities.

While I was a graduate student in North Carolina, the state passed legisla- tion requiring public schools to teach abstinence until marriage. School boards and teachers had to decide what the legislation would mean for local practice. I  recognized that those debates would be a chance to observe communities debat- ing the relationship between schooling and sexuality and articulating a vision of what sort of sexual lives they would value and what sort of learning they would promote.

How do people react when you tell them you study sexuality? To state the obvious: People think that if I study sexuality, I am interested in sexu- ality. And, of course, I am interested in what I study. But this interest can confuse people. For some, my interest in sexuality becomes permission to speak freely and comfortably about a topic that is often taboo. Sometimes people imagine I am a confessor—someone with whom they can share secrets: an identity they haven’t disclosed to many people or a troubling experience in their past. Other times, they think I have the knowledge and authority of a trained sexuality educator and can help them answer a question they have about their own or a loved one’s sexual health. I try to receive those disclosures respectfully, answer as best I can, and, if necessary, direct people to those who can be more helpful: a friend, teacher, coun- selor, or other resource.

What ethical dilemmas have you faced as you’ve studied sexuality? Could you tell us about one particularly thorny dilemma and how you solved it?  University institutional review boards (IRBs) have many concerns about research with vulnerable populations, and my work with young people in schools and with women of color in jails raises lots of ethical questions with IRBs. I have spent a lot of time designing studies that ensure I’ve protected participants from exploitation, given them adequate opportunity to offer and refuse consent to participate, and protected their privacy.

Ironically, responding to IRB requirements sometimes raises an even thornier dilemma. In order to work inside schools and jails, I have to comply with institu- tional regulations that I otherwise critique. Our research team has to reassure the jail warden and staff that our study will not undo the logic of the jail—an institution we consider oppressive. Similarly, we have to promise school principals that we will respect the rules and culture of their schools, even though we know that those rules and cultures routinely work against the interests of queer youth, youth of color, and other disenfranchised groups. In order to conduct research that interrogates inequalities, I first have to bear witness to those inequalities and that has meant being, at least momentarily, complicit.

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What do you think is most challenging about studying sexuality? Could you share any particular challenges you’ve faced conducting sex research? I am lucky to be a sociology professor at San Francisco State University, where sexuality studies has been integral to the university’s teaching and research mis- sion for decades. In general, across disciplines, departments, and generations, my colleagues respect my work and share my interests. On many campuses and in aca- demia more broadly, this isn’t the case. Sexuality is often considered a peripheral and even suspect subfield in sociology—a topic less prestigious and less fundamen- tal to social life than more established subfields. Janice Irvine has demonstrated that this thinking has all sorts of material consequences for sociologists: IRBs are more forbidding, funding is more difficult to obtain, and journals are harder to break into. These consequences make it harder to secure and retain professional posi- tions, support students, disseminate research, and launch ambitious studies. Even for someone like me—employed in a supportive department—these conditions limit the possibilities for sexuality research. Overall, my colleagues and I do our work with fewer resources than our colleagues in other fields, and that limits the reach and impact of our work.

Can you describe some of the findings from your recent research? My latest project began with a worry: In focusing so much attention and so many resources on preventing anti-gay bullying, were schools muting other experiences of LGBTQ sexuality and gender? With funding from the Ford Foundation, my col- leagues (Jen Gilbert, Nancy Lesko, Laura Mamo) and I conducted the Beyond Bullying Project, a school-based study of LGBTQ gender and sexualities in high schools. We set up storytelling booths inside three high schools and invited students and educators to step inside to tell their stories of LGBTQ sexuality and gender. Our aim was to identify and explore stories of LGBTQ sexuality and gender beyond the bullying framework that dominates schools’ approach. We also wanted to know what might be required of schools who want to think “beyond bullying” in their teaching and learning about LGBTQ sexuality and lives.

In the hundreds of stories we collected in three U.S. schools, we heard accounts of friendship, family, love, activism, and—sometimes—vulnerability and bullying. One of the most important findings is that students’ friendships are a crucial site for learning about and trying on LGBTQ sexual identities and affiliations. Some stu- dents told stories about losing friends after coming out; other students talked about struggling to be good friends to those who had recently come out as LGBTQ. Many students learned about the challenges of coming out by witnessing their friends’ struggles, and still others talked about how a friend’s coming-out put their own sexuality into question—could they survive the stigma that often comes with being friends with a member of the LGBTQ community? In story after story, students called out for ideas and support that would help them sustain friendships in the wake of anti-gay sentiment. The stories suggest that schools, adults, and teachers would do well to explore friendship in sexuality education.

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Why is sex research important? How does your research relate to everyday life? Sexuality research helps us understand, among other things, how everyday concerns like intimacy, desire, and health are implicated in broader social identities, differ- ences, hierarchies, and injustices. Too often, these concerns feel simply natural—we are hardwired for certain sorts of relationships and not others, we like who and what we like, or policies and norms are just well-intentioned efforts to promote and protect the health of community members. Sexuality research illuminates the many ways those seemingly organic sensations and inclinations emerge from, sus- tain, or challenge existing conditions. With that insight in mind, sexuality education becomes an opportunity for educators and students to do more than prevent dis- ease, infection, and unwanted pregnancies. Sexuality education becomes an oppor- tunity to reimagine social and sexual realities.

Of the projects you’ve completed over the course of your career thus far, which is the most interesting and why? The insight that most interests me spans multiple research projects. In studies of middle school students, African American girls and young women, LGBTQ teach- ers and students, and incarcerated adult women of color, I’ve realized these dispa- rate groups share an important experience: youth, queers, and women in jail are all assumed to have poor judgment and not to know how to take care of themselves and others. Education becomes a necessary correction to their bad inclinations and habits—not an opportunity to think critically and creatively about their sexual lives. Not everyone has access to my experience of education as sexually liberatory; access is tied to racial, socioeconomic, and other social privileges. Efforts to transform sexuality education must confront social stratification in order to ensure all students have access to teaching and learning built on a sense of possibility.

If you could teach people one thing about sexuality, what would it be? I want people to ask more of sexuality education, to hold on to a utopian vision of what we could pursue in the classrooms, hallways, assemblies, and informal spaces of schooling. In the face of limited funding, shrinking budgets, contentious debate, and vulnerable youth, our hopes for sexuality education easily become modest. I encourage people to resist the urge simply to be practical. Sure, compromise may be necessary, but let’s always remember that we’ve compromised and hold out for more next time.

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WHY NOT THE STORK?

You may say, “Isn’t it easier and less embar-rassing to tell them about the stork?” There are several reasons. . . . Even if he doesn’t suspect anything at 3, he is surely going to find out the truth or the half-truth when he’s 5 or 7 or 9. It’s better not to start him off wrong and have him later decide that you’re something of a liar. And if he finds out that you didn’t dare tell him the truth, it puts a barrier between you, makes him uneasy. He’s less likely to ask you other questions later, no matter how troubled he is. (Spock and Rothenberg, 1992: 511)

“Does it feel good when a mommy and daddy make a baby?” he asked.

Joey’s father answered, “It feels very nice, especially since you’re able to be so close to someone you love.”

“Hey,” Joey said in an excited voice, “maybe some- time you two can show me how you do it.”

Joey’s parents smiled and laughed, but Joey knew it was a nice laugh and they weren’t making fun of him.

“Joey, when a mommy and daddy make love, it’s pri- vate, just something for the two of them,” said Joey’s father.

“Well, when can I do it? When can I make a baby?”

“When you get older, Joey,” said Joey’s mother. (Brooks and Perl, 1983)

This hokey conversation excerpted from So That’s How I Was Born!, a sex education book aimed at preschoolers, exemplifies the sort of sexual honesty Spock and Rothenberg prescribe in advising against the stork story in the first extract. And certainly everyone believes that

honesty is the best policy. But there’s more than one way to be honest, and there are multiple truths about sexuality. We educate kids based on our perceptions of social reality, often without questioning norms to which we’ve grown accus- tomed. We also educate kids without knowing we’re doing it—with offhand remarks or behav- iors that we’re not aware they notice. When we do intend to teach, we can now select from a variety of texts designed to help us. Parents may choose sex education books (or other resources) because doing so gets them off the hook altogether from discussing sex with their kids, or they may use them as supplementary material. Many of these books have introductory notes to parents instructing them about instructing their kids. Sex education resources for children both represent and shape cultural ideologies about children, sexuality, and procreation.

In the United States, teaching sex to chil- dren in any form seems to induce cultural anxi- ety and controversy. An early sex ed pamphlet addressed to teens by Mary Ware Dennett, The Sex Side of Life: An Explanation for Young People (1919), was deemed obscene under the Com- stock Law in 1922, which banned sending any materials related to sexuality, contraception, or abortion through the U.S. mail (see Moore, 2007, and Solinger, 2005, for more complete historical discussions). This decision was over- turned on appeal in 1930; the ruling stated: “an accurate exposition of the relevant facts of the sex side of life in decent language and in manifestly serious and disinterested spirit can- not ordinarily be regarded as obscene” (cited in Solinger: 106). Sex ed books gained legal

THE DEATH OF THE STORK: SEX EDUCATION RESOURCES FOR CHILDREN AND PARENTS

W E N D Y S I M O N D S A N D A M A N D A M . J U N G E L S

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picture books about sex geared toward young children, sex ed books for older kids, and advice books for parents regarding talking with children about sex that were available through Amazon. com. (The books we surveyed are arranged by category in the references.) In earlier versions of this reading, we limited ourselves to what we felt were “professional” publishers, but, as in the past, used Amazon “popularity” as our source. Now there are so many online and self-publishing out- lets that it can be difficult to define or tell what’s “professional.” This time, we did not limit our investigation to books produced by established publishing companies. Additionally, we include a chart that lists current websites offering secular advice about sex to older children and parents (though we do not discuss these resources here).

These sources, taken together, address a loose set of problems parents face in their presumed desire to present a variety of complex, baggage- laden topics to children in an understandable way without feeling deeply uncomfortable in the process. Talking about sexuality and child- bearing with children creates a multifaceted dilemma. Parents are, in essence, attempting to create openness about a range of topics they may feel unable to be truly open about. First there is the issue of deterrence: How can par- ents present sex without making it  seem too appealing? Second, how should adults avoid frightening children with all the ways that sexual encounters and their outcomes can be painful, even horrible? Third, how can parents balance a desire not to frighten with the goal of offering kids information that might pro- tect them from sexual dangers and unintended consequences (sexual predators, rape, sexually transmitted diseases, teen pregnancy, abor- tion, not to mention heartbreak)? Fourth, how can parents deal with, acknowledge, respond to evidence of, and instruct children about their own sexuality? And fifth, how do adults teach children appropriate contexts for expressions of sexuality?

respectability on shaky grounds. What, after all, constitutes “accuracy”? Who decides what the “facts” are and which of them are “relevant” to children? Authors, since this time, have con- tinually asserted their credibility by present- ing themselves as scientific authorities on what morally constitutes “accurate facts about sex.”

In this reading, we discuss sex ed media for children from the 1970s to the 2010s. In our research, we found no books about sex targeted to young children published before the late 1960s. Publishers apparently began to perceive young children as a market for this sort of didac- tic material in the late 1960s and early 1970s as a result of a particular combination of cultural forces that promoted resistance to authority and more openness about sexual matters: the student movement, the feminist movement, the gay rights movement (all of which are indebted to the civil rights movement); hippie subculture; the so-called sexual revolution; and the human potential movement (promoting psychologi- cal growth techniques and practices). Advice books on sexuality for adults also flourished during this time (see, e.g., Ehrenreich and Eng- lish, 1986; Simonds, 1992), and sex education programs proliferated in U.S. public schools (Moran, 2000). The notion that children should be educated about sex before adolescence developed as cultural views of adolescents as sexual became accepted by educators and doc- tors. Thus, adolescents were in need of sexual education—especially regarding management and control. Moran describes the develop- ment of these ideas, beginning at the turn of the twentieth century (2000). Patton (1996) writes that the way in which we now conceive of adolescence is “as a time of turmoil between a period of innocence (childhood) and one of accomplished identity and safety (adulthood)” (75). So how do we present sexuality to inno- cents to prepare them for impending turmoil?

We analyze a range of androgynous (not ad- dressed specifically to one gender), nonreligious

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a girl, you have a vulva, clitoris, and vagina” (11–12). This text appears alongside illustra- tions of a naked boy and girl, with labeled body parts. The cartoon girl proclaims, “Look! Our bodies are more alike than different!” Harris and Emberley (1999) include a similar picture, with the text “Most parts of our bodies . . . are the same and look quite the same whether we are female or male. . . . The parts that are different are the parts that make each of us a female or a male” (10). Occasionally, authors omit the clitoris from their depictions of girls’ bodies, as in Saltz’s (2005) book Amazing You, or describe girls’ sex organs as if they are some- how based on boys’ sex organs. For example, in a description of sexual arousal in girls, Foster (2005) describes the elongation of the clitoris as an example of how, “in some ways, a female’s clitoris is like a male penis” (29). In the book Boys, Girls and Body Science, Hickling (2002) frames her discussion of sexual development with the device of a teacher interacting with elementary-aged students; these students pres- ent their ideas about sexual development and the teacher redirects them along the “correct” path. For instance, a student asks whether “girls have balls,” and the teacher responds that “girls have two ovaries inside their abdo- men and they are sort of like balls” (n.p.). Early fetal development begins with undifferentiated female internal sex organs, not male parts. So, in actuality, “balls” are like ovaries, not vice versa. Yet authors’ language tends to centralize boys’ bodies and make girls’ bodies secondary and/or deviant.

Authors typically do not mention the possi- bility of not being able to tell bodies apart eas- ily, or of gender identity that doesn’t “match” genitalia, nor question the bifurcated social constructs of girl and boy, man and woman. As Joey’s mother says in So That’s How I Was Born! (Brooks and Perl, 1983), “a boy’s body isn’t better than a girl’s body and a girl’s body isn’t better than a boy’s. They’re just different

What are appropriate contexts, after all? In the rest of this reading, we look at how authors of sex ed books for children and advice books for parents contextualize sexuality. Authors tend to reify (and occasionally resist) hetero- normative, gendered, and medicalized socio- sexual conventions through an examination of five general topics: procreative/sexual anatomy; procreative sex; childbirth; managing child- hood sexuality; and alternatives to procre- ative sex. Our primary focus is on the books for young children; we supplement the discus- sion of these books with interpretations of the books for older children and for parents.

CHANGING BODIES

In sex ed books for young and older kids, authors foreground the primary discussion of procreative sex with brief anatomy lessons. Until recently, they have almost universally equated biological sex with gender, telling this general narrative: There are people with penises and people with vaginas, and this is what makes them boys or girls. Eventually, boys and girls grow up into men and women and make babies together utilizing these parts. Brown and Brown (1997) preface their pre- sentation of genital difference with a litany of ways in which boys and girls may be different (clothes, hairstyles, playing styles, emotions). After each example, they write that the differ- ence is “sometimes, but not always” evident. Harris (2006) has a similar discussion (includ- ing that “girls play with dolls and teddy bears! And so do boys!” and “boys have very big and strong muscles. So do girls!”), and concludes that boys and girls are “not all that different” (12–13).

Despite claims of similarity, divergent anat- omy is central in these discussions of difference: “Actually the only sure way to tell boys and girls apart is by their bodies. If you’re a boy, you have a penis, scrotum, and testicles. If you’re

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with more than one gender or do not identify with any gender at all. (34)

Hasler goes on to discuss people who “change genders,” though most trans people see becom- ing trans as a full realization of their gender, not a “change.” Hasler, like many authors, conflates gender and sex in her discussion of trans kids: “Some people hide their desire to be the opposite sex. . . . It sucks because you can’t live your life the way you feel most comfortable (dressing and living as someone of the oppo- site gender) out of fear of people judging you or being jerks about it” (2010: 35).

Authors try to be accepting of diversity, even when their discussions are short and reify binary rather than fluid notions of sexual and gender identity. In 100 Questions You’ d Never Ask Your Parents (2013), in response to the question, “I’m unsure about my sexual orientation. What do I do?” the authors rec- ommend: “Give yourself some more time to figure it out. With time, you will begin to notice yourself becoming attracted to peo- ple, and your orientation will show itself to you. . . . Some guys and girls are sure about their orientation early on; for others it takes time, doubt, and exploration. Discover your feelings and you’ll discover your orientation” (77). The authors don’t address gender iden- tity specifically, but here they suggest that there are two categories (“guys” and “girls”), and four categories for sexual identity (“guys” and “girls” who like “guys,” and “guys” and “girls” who like “girls”).

The vast majority of illustrations and pho- tographs of children and their families in these books only show racially alike families. Though the majority of those pictured are white, illus- trators and photographers include children and adults interacting with each other across racial boundaries. Over time, illustrations have become more diverse. In the original version of this reading, written in 2001, we cited only one clear depiction of an interracial family

from the time they’re born and each is special in their own way.” In this way, most authors proclaim gender difference as essential (rooted in dimorphic biological sex), while also contra- dictorily claiming the difference doesn’t mat- ter. Perhaps they think that introducing sex and gender ambiguity and fluidity would confuse kids. The majority of babies are born geneti- cally dimorphous, after all, and most people appear to grow up relatively comfortable with socially constructed gender divisions. Yet in many other instances, it is not the frequency of a phenomenon that determines whether authors present it; many books include dis- cussions of occurrences at least as infrequent as intersexuality or gender-bending identities (e.g., multiple births, home births, adoption), apparently without worrying about the confu- sion these mentions might cause. Authors seek to demystify some social practices but leave others untouched and, in so doing, appear to take most cultural norms for granted.

A recent exception is Silberberg and Smyth’s Sex Is a Funny Word: A Book about Bodies, Feel- ings, and You (2015), where diversity and dif- ference recur throughout in the text. Silverberg clearly describes gender as a social construc- tion: “When we are born, a doctor or midwife calls us boy or girl because of what we look like on the outside.” They also say that these assignments could be wrong, and that they are “based on who they think we are. What about our whole body, inside and out? What about who we think we are?” (81).

Authors of books for older kids tend to dis- cuss the social construction of gender and sex- ual identity explicitly. In Sex: A Book for Teens: An Uncensored Guide to Your Body, Sex, and Safety (2010), Nicole Hasler explains:

While most biological boys feel more or less like boys and most biological girls feel more or less like girls (regardless of being gay or straight), some peo- ple really feel they do not identify with the gender they are given at birth. Some people also identify

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body. . . . When an egg and sperm meet, they swirl together in a special kind of dance. As they dance, they talk to each other. . . . When their dance is done they are not two things anymore. They danced around and shared so much that they became one brand new thing. (Silverberg, 2012: n.p.)

Fewer than half of the books for young chil- dren depict sexual acts. When they do, men are either on top of women, or the man and woman are side by side. In almost all cases, the copulators are under the covers. When authors do discuss penile–vaginal intercourse, they describe it as pleasurable and functional for both men and women, and portray it tak- ing place within the context of loving relation- ships. For instance, Harris and Emberley warn explicitly that, however enticing it may seem, “kids” should not have “sexual intercourse”:

Sexual intercourse may seem gross or nice, scary or funny, weird or cool—or even unbelievable to you. But when two people care for each other, sexual intercourse is very loving. Kids are much too young to have sexual intercourse. (Harris and Emberley, 1999: 29)

None of the authors writing for young chil- dren describes orgasm, though clearly they present the emission of sperm as momentous. Eggs and sperm are personified in gendered ways: Lisa Jean Moore writes, “There is a pre- ponderance of narratives describing the excep- tionalness of the one sperm that gets to fertilize the egg. Other than primping and batting eyes to be attractive to the sperm, eggs typically are passive” (2007: 62). Authors depict sex cells as engaged in analogous romances to those of their producers.

The reason for sex in these books is parent- hood. Brooks and Perl (1983) label the lovers “mommy” and “daddy” before the fact, thus presenting sex as predicated on this goal of future parenthood:

One of the ways a mommy and daddy show they love one another is by hugging each other very close.

(Smith and Wheatley, 1997: 14), and Harris and Emberley (1999) had a few illustrations that might have been interracial family groups. Harris’s books typically depict and discuss families in a multitude of other ways, including multiracial, foster, adoptive, blended, queer, and intergenerational families (2004, 2006, 2013). While other authors do discuss different family forms (adoptive, foster, and intergenera- tional), and also present and promote multicul- tural interactions among people, depictions of interracial intimacy within families still occur relatively infrequently.

MAKING LOVE AND MAKING BABIES

Children do indeed ask their parents, “Where did I come from?” or “How are babies made?” Thus, many parents find themselves working backward from baby (or pregnancy) to hetero- sexual sexuality. We suspect that if children ini- tiate conversations about sexuality apart from procreation, many parents don’t know what to do or say, so they may end up in the procreation story because it’s easier for them to deal with than sexuality on its own.

Sexual information conveyed in the books for young children tends to be vague, to reinforce heteronormativity, and to represent penile– vaginal intercourse as the only example of sex- ual activity in which men and women engage. Sometimes authors omit the act altogether, as in Joanna Cole’s How You Were Born (1993) and Cory Silverberg’s What Makes a Baby (2012).

In a woman’s body are egg cells. The egg cell is round. It does not have a shell like a chicken’s egg. In a man’s body are sperm cells. The sperm cells have long tails and can swim. When a sperm and an egg join together, they form a special cell that can grow into a baby. (Cole, 1993: 19)

When grown ups want to make a baby they need to get an egg from one body and sperm from another

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One of our favorites among the books for young children is Babette Cole’s Mommy Laid an Egg OR Where Do Babies Come From? (1993). Cole uses humor throughout the book, both in the prose and in her illustrations, which mix a cartoon family together with raucous, childlike stick-figure drawings. The book begins with the cartoon parents misinforming their children that “some babies are delivered by dinosaurs,” “you can make them out of gingerbread,” and “some- times you just find them under stones.” The children respond with laughter, and say, “What a bunch of nonsense!” They proceed to instruct their parents about procreative sex, all the while pointing to their crude, comical illustrations.

Girl: “Mommies do have eggs. They are inside their bodies.”

Boy: “And daddies have seeds in seed pods outside their bodies. Daddies also have a tube. The seeds come out of the pods and through the tube.”

Girl: “The tube goes into the mommy’s body through a hole. Then the seeds swim inside using their tails.” (Cole, 1993)

On the page where the boy proclaims, “here are some ways . . . mommies and daddies fit together,” Cole illustrates his words with child- like drawings of the mommy and daddy cavort- ing in a variety of imaginative positions while linked at the crotch, including holding balloons, bouncing on a big ball (labeled “space hopper”), and lying on a skateboard. These are raunchy yet clean, because they are children’s draw- ings (and do not depict genitalia, only breasts). The language is crude in a childish way, yet the botanical allegories don’t seem embarrassingly goofy, just goofy in a fun way. Sex seems fun for once—not just a pleasant sperm-delivery arrangement. Why else would the participants wear party hats? Yet, at  the same time, this language of “fitting together” and identifying the participants as “mommies and daddies,” which recurs in several books, reinforces the notion that heteronormative, procreative sex is natural and right.

In bed, they can get really close when a daddy puts his penis inside the special opening between a mommy’s legs which is called a vagina. The sperm comes out of the daddy’s penis and goes into the mommy’s vagina, and then the sperm meets the egg and a baby starts. (Brooks and Perl, 1983: 9)

Andry, Schepp, and Hampton’s How Babies Are Made (1979) and Baker’s The Birds and the Bees (1990) are more lackluster than the others in their descriptions of procreative sex:

The sperm, which come from the father’s testicles, are sent into the mother through his penis. To do this, the father and mother lie down facing each other and the father places his penis in the mother’s vagina. Unlike plants and animals, when human mothers and fathers create a new baby they are shar- ing a very personal and special relationship. (Andry, Schepp, and Hampton, 1979: n.p.)

When men and women mate, the penis becomes stiff and is inserted into the vagina, which has become larger and moist, ready to receive it. (Baker, 1990: n.p.)

Many books present humans’ procreative method after first laboriously introducing habits of other plant and animal species. This approach makes sex seem natural and scien- tific. “By relying on science, these children’s books bolster their contents as being objec- tive and truthful” (Moore, 2007: 51). Andry, Schepp, and Hampton (1979) interestingly sever this naturalistic connection with other living things, separating humans out by insist- ing on our emotional superiority (“unlike plants and animals . . .”). They want to show that sex is more than just the casual rubbing together of stamens and pistils. The experts writing for parents endorse grounding sex in satisfying long-term connections between adults. For instance, Spock and Rothenberg (1992) advise, “Parents shouldn’t ever let the anatomical and physiological explanation of sex stand alone but always connect it with the idealistic, spiritual aspects” (509).

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been written by midwives, they tend to depict the medical management of the process as nor- mal. Few authors mention alternatives to hospi- tal birth, and even fewer depict it. Joanna Cole (1993) writes: “Your mother and father went to the hospital or childbirth center where you were to be born. If you were born at home, then the doctor or midwife came to your house” (31). The photographs accompanying this text show couples in more casual hospital or birth center settings than the settings depicted in the other books, but none are at home. Sol and Judith Gordon write: “Some babies are born at home. But most women like to go to the hospital for the birth of their baby” (1992). This text is accompanied by a drawing of a woman lying in the lithotomy position in a hospital, a masked woman birth attendant standing between her legs holding a screaming baby up for her (and us) to see. We are positioned behind and above the woman’s head, watching the baby come out from her vantage point, but we can also see her face, and she looks happy. We rarely see a vagi- nal view of birth: in Cole’s (1993) child draw- ing, we see a baby sticking out of a round-blob mother and saying, “Hello Mommy!”; and in Harris’s (2004) illustration, we see both a vagi- nal view of birth and a woman in the lithotomy position in the same set of illustrations (63). In What Makes a Baby (Silverberg, 2012), we see one illustration of a cesarean section, and the only illustration of a nonmedical birth in the collection of books we reviewed: from the same “above and behind” vantage point, we see a woman being attended by a person not in med- ical garb, on what appears to be a blanket on a hardwood floor (possibly at home). All other illustrations show babies attended by medical personnel in medical settings both during and after birth.

As mentioned, authors writing for young children often seek to present labor and birth from the baby’s perspective—these authors tend to present the birthing process as both

HAVING BABIES

The next step after procreative sex in all these books is pregnancy and birth. After a brief dis- cussion of the growth of the fetus and changes in the mother’s body, authors explain how babies are born. Many authors tell the story of birth from the point of view of the baby, which is apparently the perspective with which they imagine child readers will identify. Authors typically do not discuss pain in childbirth, although Silverberg (2012) does, stating that “sometimes it takes a long time, sometimes it is quick, sometimes it hurts a little, and some- times it hurts A LOT.” Authors portray labor as a biological (muscular) activity, as hard work that a woman does, or both. They depict child- bearing as wonderful, a job to be done together by a mommy and a daddy (who cheers her on).

Typically, birthing women are depicted in the lithotomy positions (on their backs, with feet in stirrups), surrounded by masked and gowned people (Brown and Brown, 1997; Harris and Emberley, 1999; Cole, 2001; Harris, 2013). Fre- quently, the daddy is also decked out in medi- cal garb, though in some illustrations he doesn’t wear a mask. Laura Krasny Brown (1997) writes, “When a baby is ready to be born, muscles in the mother’s womb begin to tighten and relax, tighten and relax, helping her push out the baby. In most births, the baby comes out the vagina, which stretches to let it pass through” (28). Similarly, the text accompanying Emberley’s drawing reads:

When a baby is about to be born, the muscles in the mother’s uterus begin to squeeze tight. This is called “labor.” “Labor” is another word for “work.” A moth- er’s muscles work very hard to push and squeeze the baby out of the uterus and into the vagina. Then the mother’s muscles push and squeeze the baby’s body through the vagina. The vagina stretches wide as the baby’s soft, wet, and slippery body travels through it. (Harris and Emberley, 1999: 56–57)

Even though these authors’ descriptions of labor and birth sound like they might have

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masturbation and sexual abuse. Brown and Brown (1997) write:

Touching and rubbing your genitals to feel good is called masturbation. Some of us try this; some of us don’t. However, it’s best to do this private kind of touching off by yourself.

Touching others is just as important. . . . If some- one doesn’t want to be touched, then respect his or her wishes—don’t do it! . . . Everyone needs good touches to feel loved and happy. . . . But no one has the right to touch you in a way that feels wrong or uncomfortable.

If you don’t like the way someone touches you, speak up and tell him or her to stop. If that doesn’t work, tell your mom or dad or another grownup. Your body belongs to you, and you should say who touches it! (16–19)

Harris (1999) goes into more detail about both masturbation and abuse, and as in Brown and Brown, the discussion of masturbation leads  into the issue of abuse. The Browns dif- ferentiate between self-touches that feel good, touches from others that are good, and those that  feel wrong or are somehow dislikable. Harris (1999) makes the same points, and goes into more detail about contentious views on mas- turbation: “Every family has its own thoughts and feelings about masturbation. . . . Some people and some religions think it’s wrong to masturbate. But most doctors agree that mas- turbation is perfectly healthy and perfectly nor- mal, and cannot hurt you or your body” (69). Apparently, doctors are the authority on the subject and have the last word. This is ironic, given that well into the twentieth century, sex educators backed up denouncements of mas- turbation as pathological with medical author- ity. (See Conrad and Schneider, 1992: 180–81, on nineteenth-century conceptualizations of masturbation as disease; and Moran, 2000: 57, on lasting sex educational prohibitions.)

In Kleven’s book The Right Touch (1997), a mother tells her son the story of the attempted

fun and exciting. In Boys, Girls and Body Sci- ence (Hickling, 2005), Nurse Meg describes to a class of elementary students how the birthing process happens. This dialogue is accompanied by a picture of a woman in the lithotomy posi- tion who appears serene and peaceful—if not unconscious:

“But what would happen if you kept squeezing on a balloon?” asked Meg.

“It would pop,” said Nicholas.

“That is exactly what happens,” said Meg. “After a few hours, the water bag breaks and the water comes pouring out of the mum’s vagina and makes it all wet and slippery, just like a water slide. So, the first water slide that you ever had was the day you were born when you came slip-sliding down your mum’s vagina.”

All the children loved the water slide story and made swooshy noises as they waved their arms around.

Harris (2006) uses the same “balloon” anal- ogy in a much more effective way, explaining that a pregnant woman’s uterus does not pop because her uterus and skin are stretchy—“like a balloon.” This response is an excellent exam- ple of how an analogy can be used to explain a phenomenon to a young child in a way that is correct yet still understandable.

TEACHING ABOUT TOUCHING

Over time, books for young children have increasingly come to address children’s sexual- ity within the context of danger; the number of books dedicated solely to this issue has also increased. The primary goals of authors who address the theme of “good touch/bad touch” or sexual abuse are to teach kids to recognize dangerous abusive touch, and to encourage them to seek help if they feel something bad has happened or could happen to them. Brown and Brown (1997) and Harris and Emberley (1999) attempt to differentiate between touching that is “okay” and “not okay”—that is, between

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and no one should show me pictures of private parts. If any of these things happen, I must tell a trusted adult on my Safety Network. . . .

5. NO SECRETS. I don’t keep secrets, only happy surprises that will be told. If someone asks me to keep a secret, I tell them I don’t keep secrets. If someone asks me to keep a secret that makes me feel unsafe or uncomfortable, I must tell an adult on my Safety Network straightaway. (7)

A mother-son team pair up in I Said No! A Kid-to-Kid Guide to Keeping Private Parts Private (King and King, 2017 [2010]) to explain “special rules” about “private parts” (4–6), and warning signs of inappropriate “red flag” touching or coercion toward abuse (8–20). The book culmi- nates in a story about Zack going to his “first ever sleepover party with [his] best friend” (22), and being confronted with a “red flag” situa- tion. The “best friend” tells him, “Did you know that all cool kids touch each other’s privates?” and “If you don’t touch mine, I’ll never be your friend again.” Zack knew that the first question was a “big lie,” and that the second statement was a “threat.” He thought, “DANGER RED FLAG! Private parts are not for sharing with friends! I SAID NO! NO WAY! I was loud and clear!” There is absolutely no space for consen- sual touching between friends here, nor any discussion of masturbation; the only examples of “green flag” touching the Kings discuss are “grownups that take care of you have to wipe your private parts to keep them healthy and clean” and a doctor (depicted as a man) who “wants to make sure that all of the parts of your body are healthy” (3–4). There is minimal dis- cussion about how trusted adults may abuse their positions of authority in order to abuse children using just this type of language.

In Sex Is a Funny Word, Silberberg and Smyth  (2015) offer a slightly less alarmist approach to discerning what’s dangerous and what’s safe. They also refuse the language of “private” parts, referring instead to “middle parts.” They discuss “secret touching,” so called

sexual abuse of a young girl by a neighbor. The text is accompanied by Bergsma’s illus- trations of “whimsical, elfin-like people” (n.p.) that seem too cute to us for this topic. Kleven portrays child abuse as potentially everywhere: “grown-ups, babysitters, and bigger kids” can be abusers. Child readers are urged to be self- protective at all times. The mother in the story says, “No one has the right to touch private parts of your body without a good reason, not even Dad or me” (Kleven, 1997). How a child determines what constitutes a “good reason” is not clear. Kleven asserts that many children in bad-touch-situations-in-the-making have “warning feelings” when “things are not safe.” This position suggests that knowing how to recognize a sexual predator is innate and uni- versal, so if one fails to escape danger, one may be somehow to blame.

These books have a lot of explanations to offer about how confusing bodies, emotions, and relationships can be. Authors work hard to provide clear warnings that can make adults and other kids sound pretty scary. Telling the difference between safety and danger is com- plicated, so authors recommend kids consider whom they can trust among their adult sig- nificant others. Sanders and Hancock offer “5 BODY SAFETY RULES” for young kids (2016):

1. MY BODY IS MY BODY . . . and it belongs to me. I can say “NO!” if I don’t want to kiss or hug someone. . . .

2. SAFETY NETWORK . . . These are 3 to 5 adults who I trust. I can tell these people anything and they will believe me. . . .

3. EARLY WARNING SIGNS. If I feel frightened or unsafe, I might feel sick in the tummy or my heart might beat really fast. . . . If I feel this way about anything, I must tell an adult on my Safety Network straightaway.

4. PRIVATE PARTS. I always call my private parts by their correct names. No one can touch my private parts. No one can ask me to touch their private parts,

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say yes only when you mean yes; and to really mean no when you say no” (1998: 129).

Basso discusses date rape and stranger rape in a way that infantilizes women and rein- forces heteronormative sexual scripts, victim- blaming, and male dominance. His definition of rape seems only to include those cases that include physical harm, verbal threats, or lim- ited capacity due to drugs or alcohol (2003: 233). Even though Basso argues that “it doesn’t matter what a female wears, says, or does, there is never any excuse for rape” (234), and that “ladies, you are free to wear anything you want any way you want, and you can act any way you want” (237), he contradicts these statements, advising young women to be careful about what they wear; to know their dancing might be interpreted as sexually pro- vocative; and to avoid casual touches to avoid sending the wrong message to their dates. He advises boys that “when a female says no, she means no. Although the female may have led you on, she has every right to change her mind, and you must honor her decision” (234). Basso continues with a bizarre analogy, in which he compares committing rape to getting ticketed for speeding:

It’s like driving a shiny red Corvette with a racing stripe down the side. Suddenly a police officer pulls up behind you, flashes his/her lights and gives you a speed- ing ticket. Is it fair to get a speeding ticket just because you’re driving a shiny red Corvette? Just because a female dresses a certain way doesn’t mean she should be treated a certain way based on YOUR assumptions. Of course, comparing rape to a speeding ticket is like comparing a nuclear explosion to a firecracker—rape is a devastating crime. (234)

Well, the good news is that boys “can avoid the embarrassment of being arrested as a rap- ist” if they just drive their dates home and behave like a “gentleman” (Basso, 2003: 240). Basso clearly identifies with male readers. Beyond the offensive analogy, we are troubled by the message that what a boy should seek to

because the person doing it “make[s] you keep it a secret” (110). They describe the confusion that could be involved (“they might try to scare you so you won’t tell. They might be nice to you so you won’t tell” [110]). They acknowledge (as do the Kings) that the person could be “some- one you thought you could trust,” and endorse the idea that “you should never feel like you have to keep a secret when it’s about touching” (119). Their description of “secret touching” follows their discussion of “touching yourself,” as is common in books for young children. The common proximity of these topics— masturbation and sexual abuse—in books for small children is logical on the one hand (they are both types of touch, after all), yet we are troubled by their repeated linkage.

Authors writing for teenagers typically dis- cuss masturbation and sexual abuse in terms similar to those utilized by those writing for young children (but they are less likely to segue from one to the other). Authors writing for teens describe masturbation as normal and healthy (but occasionally pathological); they describe sexual abuse/violence as always wrong (even as they occasionally blame the victims).

In Changing Bodies, Changing Lives (1998), Bell writes that “having masturbated helps you enjoy lovemaking more,” and gives descrip- tions of how boys and girls masturbate (1998: 83). In addition, Bell provides advice for what to do “if you don’t have orgasms and want to,” and addresses the pressure that many teenag- ers, especially girls, feel about orgasms, as a result of a lack of sex education and “the dou- ble standard.” Bell discusses the “sexual script” that occurs because the “man is ‘supposed’ to be dominant, to be sexually powerful and demanding. The woman, on the other hand, is ‘supposed’ to be coy and shy and passive, to lead men on but not let them get ‘too far’” (1998: 128). She argues that girls have to learn to “give straightforward messages. Boys have to learn to believe what girls are saying. It is important to

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children to feel they can ask their parents about sex. (506)

This seemingly conflicting advice could be confusing to parents, especially those who have themselves been brought up by parents who disapproved of masturbation.

The Eyres (1998) propose telling children who ask about masturbation: “Everyone at least experiments with it. But it can be a problem if it becomes a habit or happens too often” (105). Maxwell (2008) warns that “obsessive mastur- bation to only one kind of stimulation” can lead to “difficulty reaching orgasm within a relation- ship” (58). She claims to have seen this in her practice as a clinical psychologist, but admits that “there is no current research to support that this is the case with most men” (58). Thus, she urges parents to talk to their children (read: boys) about porn. She proclaims, “Demeaning pictures or pictures that promote dominance of one person over another, can, over time, train a person to respond only to that form of stimula- tion” (58–59). All authors who write about sexual urges in children emphasize that urges are natu- ral or normal, even as they coach parents about how to best protect, contain, constrain, and train their children’s desires in socially desirable ways.

WORDS YOU MAY HAVE HEARD

Authors of sex books for young children tend to limit discussion of sexual issues to procreative sex and occasional mentions of masturbation and child abuse. Authors of sex books for ado- lescents typically cover masturbation and sexual abuse, but beyond this they tend to discuss sex- ual diversity (anything other than penile–vaginal intercourse) in a very limited way. For instance, Westheimer offhandedly mentions anal and oral sex in her section on AIDS: “some people think they can avoid AIDS by practicing anal inter- course (putting the penis in the anus) or oral sex (putting it in the mouth). They are dead wrong” (Westheimer and deGroat, 1998:74).

avoid is the “embarrassment of being arrested as a rapist,” rather than being a rapist.

In these books, sexual touching and sexual activity during childhood are almost never okay, no matter who does it, and no matter the con- text. In adolescence, the messages become mixed: unwanted sexual touching and sexual activity is usually not all right, unless you confused your partner—then, can you blame them? It’s not always clear-cut, according to authors. Didactic presentations of boundaries can become mired in a discourse of thwarted or dangerous desires for boys and provocative yet (rightfully) reluctant girls, as in Basso’s pre- sentation, in which he ultimately places the responsibility for control of sexual limits on young women, and implicitly blames girls when boys feel “led on.” It is not possible that a girl might pressure a boy to have sex or attempt to rape him. Same-gender situations are notably absent in most of these discussions of coercive sexual requests or acts.

In contrast to the warnings authors offer about abusive sex, when they do discuss “sex play” between children, they describe it as generally harmless. In books for parents where masturbation and/or sex-play are discussed, the goal seems to be allaying parents’ fears of impending gayness or sexual excessiveness (non- normativity). Most authors endorse mas- turbation as normal and healthy for young chil- dren. But a few warn against too much of this good thing (Eyre and Eyre, 1998; Maxwell, 2008; Spock and Rothenberg, 1992). Spock and Rothenberg discuss what they call “excessive masturbation,” never specifying how often is too much. Even as they introduce this behavior as abnormal, Spock and Rothenberg (1992) reas- sure parents that sexual exploration is natural:

I think that whatever your personal beliefs or feel- ings, you should avoid threatening or punishing your children when they reveal their natural sexuality. . . . It’s important to try to say something about how normal and universal the activity is. It’s good for

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Even as they attempt to advocate open- mindedness, authors frame sexual noncon- formity as deviant by using the clinical term homosexual, by discussing lesbian/bisexual/ gay sexuality via questions that are point- edly negative, and by emphasizing that it was once officially pathological. By consistently presenting medicine as the arbiter of the cur- rent nonpathology of “homosexuality,” authors do not question medical authority or effectively critique its past or enduring homophobia.

The Eyres (1998) are the only authors among our sample who are overtly homophobic. They discuss “homosexuality” in one paragraph (which precedes a paragraph on AIDS), saying, “we shouldn’t judge a person who is gay, but it can be a sad situation because it doesn’t allow for the birth of children or for the kind of fam- ily that a heterosexual couple can have” (97). In contrast, many authors do actually denounce homophobia, usually by explaining that gay- ness is “not a choice” (Levkoff, 2007: 89), and then proclaiming that, anyway, discrimination is morally wrong:

There has never been a reason to treat people with disrespect. Homophobia is as bad as any other type of hatred—including racism and religious persecution. People should be judged according to their character, not who they sleep with. (Levkoff, 2007: 90)

Some people disapprove of gay men and lesbians. Some even hate homosexuals only because they are homosexuals. Usually these people know little or nothing about homosexuals, and their views are based on fears or misinformation, not facts. People are often afraid of things that they know little or nothing about. (Harris, 2004: 18)

Even advocates of respect for sexual diversity tread with a great deal of caution, and in so doing, undercut their affirmation of gayness in children.

Many of the authors writing for older kids and adults seek to reassure readers that non- heterosexual urges and experiences might

Throughout books for teens, authors depict loving sexual relationships between men and women as normative. When they do discuss alternatives, gayness, lesbianism, and bisexu- ality predominate. Only a few authors discuss trans or intersex people. Authors treat all these topics with a liberal touch, yet cordon them off into short sections of their own, which connotes otherness. These authors advocate acceptance but are careful to avoid endorsing or advocat- ing nonheterosexual activities. The following are examples of discussions of “homosexuality” from two books for teens:

Some people prefer to have sexual experiences with persons of their own sex. They are called homosexu- als. Most boys and girls have homosexual thoughts occasionally. Some even have homosexual experi- ences. This doesn’t mean that they are homosexual. The people properly called homosexual are those who, as adults, have sexual contacts only with per- sons of their own sex. . . . Some people enjoy sexual relations with both sexes throughout their adult life. They are called bisexuals. Modern psychologists no longer see homosexual or bisexual behavior between consenting adults as a disorder. (Gordon and Cohen, 1992: 28)

Why Are Some People Straight and Others Gay? Psychologists do not really know what causes a person’s sexual preferences. Some believe that whether a person is straight or gay depends on experiences in early childhood. Others think homosexuality might be an inherited, or built-in preference. . . .

Is Homosexuality a Sickness? No. People used to believe that homosexuality was a form of mental illness, but now psychiatrists say that it is not. Homosexuality is just one way people can express sexual love.

Can Homosexuals Choose Not to Be Gay? Homosexuals can choose not to practice homo- sexuality. . . . But for most gay people, it is prob- ably not possible to choose how they feel inside and which sex they are attracted to. (Cole and Tiegreen, 1988: 75)

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or care why,” is also a sexual orientation. Everyone has one, and none of them is a default. And in case you haven’t read The Gay Chapter before? It’s all okay. (82)

Corinna explicitly states that sexual orien- tation occurs on a spectrum, that no sexual orientation is “normal” or the default, and reas- sures teen readers that sexual development is a process for all teens, not just those who are “deciding” to be LGBT (2007).

Most of the books addressed to parents offer advice about what parents should do if they think their kids aren’t straight. Ratner and Chamlin (1985) pose the hypothetical ques- tion, “Will my son’s love of ‘dressing up’ lead to homosexuality?” And they respond, “No. Many parents discourage boys from playing ‘dress-up’ and ‘house,’ but at certain ages, certainly pre- school, it’s appropriate. Preschoolers actively assume many different roles” (35). They imply that at a certain age, gender-bending will—and should—straighten out. Spock and Rothenberg (1992) imply this as well, saying, “When par- ents think that their little boy is effeminate or their little girl too masculine, they may worry that the child will grow up to be a homosexual or lesbian. In fact, the majority of such children will grow up to be heterosexual” (52). How- ever, they then recommend therapy for a boy who wants to play with girls and dolls and who wants to wear dresses (“I would assume that something had gotten mixed up in his identi- fication”), as well as for a girl who plays “only with boys” and is “always unhappy about being a girl” (52). A girl who prefers to play with boys and who “occasionally” wishes she were a boy, “but also [enjoys] playing with girls” does not concern them (52).

Increasingly, authors addressing parents are discussing the social construction of gender and of sexual identity. For instance, Levkoff endorses parental acceptance of all forms of self-expression among kids, yet she simultane- ously presents parental emotional responses to

well be transitory. Though the categories they introduce have the same essentialist ring to them as gender does in the books for young kids, authors recognize some flux on the road to a permanent sexual identity. But because authors explain that eventually sexual identity (straight, gay, lesbian, bisexual) is permanent, this changeability often comes across as an experimentation phase before settling into a heterosexual identity.

Are you homosexual? It’s difficult to know. Some people don’t figure out if they’re gay or straight until their late teens or their twenties. Having a crush on, or even kissing or touching, someone of your own sex does not necessarily mean that you’re gay. (Westheimer, 1993: 54)

Because there are so many negative ideas in our society about being gay, young people may panic if they have any feelings or daydreams about people of their own sex. Yet most of them will not end up being gay. Naturally, a small percentage will—about five to ten percent. . . . But most will not. They are simply going through a stage of growing up. (Cole, 1988: 76)

An exception to many of the implicitly nega- tive approaches to LGBT topics and to this “cordoned off” approach occurs in Corinna’s (2007) book S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You through High School and College. Corrina’s book explic- itly addresses “The Gay Chapter” that is pres- ent in many books for teenagers, while also addressing the notion that teens should “wait a while longer” before deciding their sexual orientation:

This isn’t The Gay Chapter: you know, the one that says it’s okay to be gay and it really will all be okay, but maybe we should wait a while longer before we decide we’re not heterosexual. Any of us who are queer and who needed that chapter have already read it in most sex books before, and already know that people tell us it’s okay. Heterosexuality is a sexual orientation. Bisexuality is a sexual orientation. “I’m attracted to whom I’m attracted to, and I don’t know

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You may have noticed that people often talk about relationships between men and women as if those are the only kinds of relationships that can have a crush, love, or sexy feelings. But they aren’t. Have you heard people use the words gay or lesbian? How about asexual or queer? Those are words people use to describe themselves, the kinds of relationships they have, and who they have them with. Every com- munity has its own words. . . . Some of these words may be new to you. (They may be new to a grown-up you’re reading this with too!) (151)

Authors seek to promote harmony across dif- ference by positing that difference is over- shadowed by commonalities among people, regardless of sexual identity.

SO WHAT SHOULD WE TELL THE KIDS?

First, let us sum up what we do tell the kids in the discourse of these didactic books: that the central focus of sexuality is procreative penile– vaginal intercourse; that this form of sexuality is “natural” and good; that participants should be monogamous adults; and that proper sexual expression is based in love and enacted in pri- vate. Many authors writing for older kids and adults do acknowledge other sorts of sexual behavior, but these discussions are limited and not integrated into presentations of what is clearly the main event. Nonheterosexual activities are marginalized. The books can be seen as precursors to school-based sex educa- tion programs, which increase the focus on dangers, often advocate abstinence, and are notoriously heterosexist and devoid of discus- sions of gendered or sexual power dynamics (see, e.g., Irvine, 2004; Luker, 2007; Raymond, 1994; Watney, 1991). Over time, there has been an increase in feminist approaches to gender and sexuality in these resources that offer kids some views of unconventional sexual prac- tices. Despite the centrality of heterosexual- ity in these resources, some authors do depict

a child’s coming out as gay as almost entirely unpleasant: “It can be an emotionally challeng- ing time. . . . Most people speak of grief and mourning, as if they have lost a loved one. . . . It is natural and it will pass. What we hope is that these turbulent and complex feelings will bring you, in the end, to acceptance. But it isn’t an easy road” (2007: 99). Similarly, Heffner (2004: 187) describes parents as having mostly unpleasant feelings, even if they find their feel- ings surprising: “you may be scared, confused, worried, or upset. Even the most liberal het- erosexual parents I know have told me their initial response to their child’s coming out to them was surprising. One woman confided in me that she was surprised by her reaction: ‘We have gay friends, we march in pride parades, so why am I feeling so disappointed?’”

Harris and Emberley (1999) were the first authors of books for young children to explore alternatives to heterosexuality, and they, along with Levkoff, are among the few authors who explain that love and sexual behavior can be multifaceted without invoking the past pathol- ogizing or current acceptance of medical experts: “There are lots of kinds of love—like love between a parent and child, love between friends, love between kids, love between teen- agers, and love between grownups. There can be love between a female and a male, or a male and a male, or a female and a female” (Harris and Emberley, 1999: 31). They go on to explain the terms homosexual, heterosexual, gay, lesbian, bisexual, and straight, and proclaim, “A person’s daily life—having friends, having fun, going to work, being a mom or dad, loving another person—is mostly the same whether a person is straight or gay.” This text appears with an illus- tration of a possibly interracial gay male couple and their two kids eating dinner (32). Similarly, Silverberg (2015) notes that heteronormativity is common (without using the term heteronorma- tivity), and that some terminology and concepts may be new to kids and to their adult readers:

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other than penile–vaginal intercourse as satis- fying and good for body and soul (or even just for body!). Imagine sex education books that acknowledge and contest power dynamics based on gender and sexual categories, as Corrina’s book does—books that would urge children to interrogate, rather than reify, these categories— and affirm for children that their experiences and desires are valid and worthy of respect. Imagine the sex lives that might develop out of such an anti-foundational foundation. Would you buy these books for your children?

REFERENCES Sex Books for Young Children Andry, Andrew, Steven Schepp, and Blake Hampton (Ill.).

1979 (1968). How Babies Are Made. Boston: Little, Brown. Baker, Sue. 1990. The Birds and the Bees. Swindon, Bologna,

New York: M. Twinn. Brooks, Robert, and Susan Perl (Ill.). 1983. So That’s How I

Was Born! New York: Aladdin. Brown, Laura Krasny, and Marc Brown. 1997. What’s the

Big Secret?: Talking about Sex with Girls and Boys. Boston: Little, Brown.

Cole, Babette. 1993. Mommy Laid an Egg OR Where Do Babies Come From? New York: Chronicle Books.

Cole, Joanna, and Margaret Miller (Photo.). 1993 (1984). How You Were Born. New York: Mulberry.

Davis, Jennifer, and Laura Cornell (Ill.). 1997. Before You Were Born: A Lift-the-Flap Book. New York: Workman.

Gordon, Sol, Judith Gordon, and Vivien Cohen (Ill.). 1992 (1974). Did the Sun Shine before You Were Born?: A Sex Education Primer. Amherst, NY: Prometheus Books.

Harris, Robie H., and Michael Emberley (Ill.). 2006. It’s Not the Stork! A Book about Boys, Girls, Babies, Bodies, Families and Friends. Cambridge, MA: Candlewick Press.

. 2014 (1999). It’s So Amazing!: A Book about Eggs, Sperm, Birth, Babies, and Families. Cambridge, MA: Candlewick Press.

Harris, Robie H., and Nadine Bernard Wescott. 2013. What’s in There? All about Before You Were Born. Cambridge, MA: Candlewick Press.

Hickling, Meg, and Kim La Fave (Ill.) 2002. Boys, Girls and Body Science. Maderia Park, British Columbia, Canada: Harbour Publishing.

King, Zack, Kimberly King, and Sue Rama (Ill.). 2017 [2010]. I Said No!: A Kid-to-Kid Guide to Keeping Private Parts Private. Weaverville, CA: Boulden Publishing.

Kleven, Sandy, and Jody Bergsma (Ill.). 1997. The Right Touch: A Read Aloud Story to Help Prevent Child Abuse. Bellevue, WA: Illumination Arts.

sexuality and gender as fluid and advocate acceptance of unconventional identities, but these resources are not the norm.

When do we tell children that some sex is amazing, some is lovely, some is dull, some becomes repugnant in retrospect, and some is horrible while it’s happening? When do we tell them about its potential variety and variabil- ity? When do we expose children to a peerlike level of sexual honesty in which we speak to them of the intensity of desire, the fickleness of lust, the pain of rejection? Or do we simply not venture this far into the murky depths of sexuality? Do we just let them find out what- ever they’ll find out by themselves from people we can only hope will not hurt them or mess up their lives? All the while, we must bear in mind that something we say to them today could be the impetus for therapy later. What truths, warnings, and recommendations do we dare to communicate? In short, our task is absurd and impossible the more we ponder it, yet most of us would agree that to say nothing would be worse than to make some kind of attempt.

So we’re back where we started, with Spock and Rothenberg’s (1992) admonition against the stork, in favor of the truth. There is no abso- lute truth about sexuality, so we have to decide what and how we want to discuss sexuality with our children. Sex education books for children and parents are generally a step in the right direction, and are certainly better than nothing, in our view. But they are not as comprehensive or critical or political as they could be.

Imagine if most sex education books pre- sented gender and genitals as socially con- structed, as Silverberg’s work best exemplifies; sexuality could then more easily be conceived by young readers as taking place on a continuum rather than as written in stone. Imagine books that present sex as not only the cause of pro- creation but also as recreational, as indeed it is for most people engaged in it most of the time. Imagine books that present sexual activities

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Pardes, Bronwen. 2013 (2007). Doing It Right: Making Smart, Safe, and Satisfying Choices about Sex. New York: Simon Pulse.

Westheimer, Ruth, and Diane deGroat (Ill.). 1998 (1993). Dr. Ruth Talks to Kids: Where You Came From, How Your Body Changes, and What Sex Is All About. New York: Aladdin.

Sex Books for Parents Berkenkamp, Lauri, and Steven C. Atkins. 2002. Talking

to Your Kids about Sex from Toddlers to Preteens: A Go Parents! Guide. Chicago: Nomad Press.

Calderone, Mary S., and James W. Ramey. 1982. Talking with Your Child about Sex: Questions and Answers for Children from Birth to Puberty. New York: Random House.

Eyre, Linda, and Richard Eyre. 1998. How to Talk to Your Child about Sex. New York: Saint Martin’s Griffin.

Haffner, Debra W. 2004. From Diapers to Dating: A Parent’s Guide to Raising Sexually Healthy Children. New York: Newmarket Press.

Levkoff, Logan. 2007. Third Base Ain’t What It Used to Be: What Your Kids are Learning about Sex Today—and How to Teach Them to Become Sexually Healthy Adults. New York: New American Library.

Maxwell, Sharon. 2008. The Talk: What Your Kids Need to Hear from YOU about Sex. New York: Avery.

Morris, Lois B. 1984. Talking Sex with Your Kids. New York: Simon and Schuster.

Ratner, Marilyn, and Susan Chamlin. 1985. Straight Talk: Sexuality Education for Parents and Kids 4–7. New York: Viking.

Richardson, Justin, and Mark A. Schuster. 2003. Everything You Never Wanted Your Kids to Know about Sex (But Were Afraid They’d Ask). New York: Three Rivers Press.

Roffman, Deborah M. 2002. How’d I Get in There in the First Place?: Talking to Your Young Child about Sex. New York: Perseus Publishing.

Schwartz, Pepper, and Dominic Cappello. 2000. Ten Talks Parents Must Have with Their Children about Sex and Character. New York: Hyperion.

Spock, Benjamin, and Michael B. Rothenberg. 1992 (1945). Dr. Spock’s Baby and Child Care. New York: Pocket Books.

Saltz, Dr. Gail, and Lynne Cravath (Ill.). 2005. Amazing You! Getting Smart about Your Private Parts. New York: Penguin Group USA.

Sanders, Jayneed, and Anna Hancock. 2016. My Body! What I Say Goes!: A Book to Empower and Teach Children about Personal Body Safety, Feelings, Safe and Unsafe Touch, Private Parts, Secrets and Surprises, Consent and Respectful Relationships. Educate2Empower Publishing (online).

Silverberg, Cory, and Fiona Smyth (Ill.). 2012. What Makes a Baby. New York: Seven Stories Press.

. 2015. Sex Is a Funny Word: A Book about Bodies, Feelings, and You. New York: Seven Stories Press.

Smith, Alastair, and Maria Wheatley (Ill.). 1997. How Are Babies Made? London: Usbourne Publishing.

Sex Books for Older Children Basso, Michael J. 2003 (1998). The Underground Guide to

Teenage Sexuality. 2nd ed. Minneapolis: Fairview Press. Bell, Ruth. 1987. Changing Bodies, Changing Lives.

New York: Random House. Cole, Joanna, and Alan Tiegreen (Ill.). 1988. Asking about

Sex and Growing Up: A Question-and-Answer Book for Boys and Girls. New York: Beech Tree.

Corrina, Heather. 2007. S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You through High School and College. Philadelphia: Perseus Books.

Foster, Lorri. 2005. Let’s Talk about S-E-X. 2nd ed. Minnetonka, MN: Book Peddlers.

Gordon, Sol, and Vivien Cohen (Ill.). 1992 (1977). Facts about Sex for Today’s Youth. Amherst, NY: Prometheus Books.

Harris, Robie H., and Michael Emberley (Ill.) 2004. It’s Perfectly Normal: Changing Bodies, Growing Up, Sex and Sexual Health. Cambridge, MA: Candlewick Press.

Hasler, Nikol. 2010. Sex: A Book for Teens: An Uncensored Guide to Your Body, Sex and Safety. San Francisco: Zest Books.

. 2015. Sex: An Uncensored Introduction. Revised and expanded edition. San Francisco: Zest Books.

Henderson, Elizabeth, and Nancy Armstrong. 2013. 100 Questions You’d Never Ask Your Parents: Straight Answers to Teens’ Questions about Sex, Sexuality, and Health. New York: Roaring Brook Press.

Online Resources (compiled by Samantha Howat)

sex, etc. https://sexetc.org • “By teens, for teens” • Run by Rutgers University

Planned Parenthood “For Teens”

https://www.plannedparenthood.org /learn/teens

• Includes chat feature • Includes “Find Birth Control” feature

T H E D E AT H O F T H E S TO R K 189

Other Sources Conrad, Peter, and Joseph W. Schneider. 1992.

Deviance and Medicalization: From Badness to Sickness. Philadelphia: Temple University Press.

Ehrenreich, Barbara, and Deirdre English. 1986. ReMaking Love: The Feminization of Sex. Garden City, NY: Anchor Press/Doubleday.

Irvine, Janice. 2004. Talk about Sex: The Battles over Sex Education in the United States. Berkeley: University of California Press.

Luker, Kristin. 2007. When Sex Goes to School: Warring Views on Sex and Sex Education since the Sixties. New York: W. W. Norton.

Moran, Jeffrey P. 2000. Teaching Sex: The Shaping of Adolescence in the 20th Century. Cambridge, MA: Harvard University Press.

Moore, Lisa Jean. 2007. Sperm Counts: Overcome by Man’s Most Precious Fluid. New York: NYU Press.

Patton, Cindy. 1996. Fatal Advice: How Safe-Sex Education Went Wrong. Durham, NC: Duke University Press.

teensource.org “SEX + HEALTH + YOU”

http://www.teensource.org • Run by Essential Access Health • Focus on California resources (e.g., includes

“FIND A CLINIC” feature for CA only)

SCaRLeTeeN “sex ed for the real world”

http://www.scarleteen.com • “Most popular and most widely used site” • Includes “Sex and Disability/Disabled Sex Yes!”

feature (others do not)

Teen Health Source http://teenhealthsource.com • Located in Toronto; peer educators available by phone and chat

• Includes “queering sexual education” videos

STAYTEEN http://stayteen.org • Run by National Campaign to Prevent Teen and Unplanned Pregnancy

• Includes “Ask Us Anything” feature

I Wanna Know: Sexual Health for Teens and Young Adults

http://www.iwannaknow.org • Run by American Sexual Health Association

Advocates for Youth “Rights. Respect. Responsibility”

http://www .advocatesforyouth.org

• Geared more toward advocacy and policy, but provides some info for teens and parents

KidsHealth

http://kidshealth.org • Run by Nemours Children’s Health System (pediatricians)

• Covers overall health • Sections for parents, kids, teens, and educators

SexInfo Online

http://www.soc.ucsb.edu /sexinfo

• Run by UC-Santa Barbara • Sex ed for people in general, but also has a

section for teens

Go Ask Alice! http://www.goaskalice .columbia.edu

• Run by Columbia University • Overall health (sexuality a part of it)

It’s Your (Sex) Life http://www.itsyoursexlife .com

• Run by MTV • Focus on pregnancy prevention and STDs

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Solinger, Rickie. 2005. Pregnancy and Power: A Short History of Reproductive Politics in America. New York: NYU Press.

Watney, Simon. 1991. “School’s Out.” In Diana Fuss, ed., Inside/Out: Lesbian Theories, Gay Theories. New York: Routledge. 387–401.

Raymond, Diane. 1994. “Homophobia, Identity, and the Meanings of Desire: Reflections on the Cultural Construction of Gay and Lesbian Adolescent Sexuality.” In Janice M. Irvine, ed., Sexual Cultures and the Construction of Adolescent Identities. Philadelphia: Temple University Press. 115–50.

Simonds, Wendy. 1992. Women and Self-Help Culture: Reading between the Lines. New Brunswick, NJ: Rutgers University Press.

Sex-Positive Parenting, or We Don’t Touch Our Vulvas at the Table

Lea Grover

It happened yet again. As I was sitting at the table for dinner with my children, I noticed my daughter’s hand fishing around under her skirt.

“We don’t play with our vulvas at the table. Go wash your hands and finish your food,” I scolded. She nodded, ran off to wash her hands, and resumed picking at her dinner instead.

Small children, they touch themselves. A lot. It’s fascinating to them. And when you’re a small child, you have no sense of shame or disgust or fear of your body. Your body is what it is. It does what it does. And everything that it does is kind of amazing, because you’re not old enough for lower back pain. It’s not sexual, it’s just . . . fact. The first time I caught one of my kids playing with their genitals, I said absolutely nothing. I was momentarily para- lyzed with indecision. One thing I knew for a fact I did not want to do was to shout, “No!” or “Stop!” What good could that possibly do? Sure, I would be spared the awkwardness of catching my child playing with her genitals on the living room floor, but what kind of lesson is that? To fear or ignore your own vagina? I thought about it almost constantly for two days, and of course she gave me a second chance to react.

“Sweetie, we don’t play with our vulvas in the living room,” I said. Which sounded ridic- ulous and strange, but nonetheless true. Why is everything with little kids “we” statements? “It’s okay to touch your vulva, but people are pri- vate, and it’s a private thing. The only places where you should touch your vulva are in the bathroom or in your bedroom. If you want to play with your vulva, please go to the bed- room.” And she smiled and did, without ques- tion, because compartmentalizing where you do certain activities makes sense to little kids.

“We don’t eat in the bathroom, and we don’t touch our vulvas in the living room,” became the new mantra. And yes, eventually it became, “We don’t touch our vulvas at the table.”

I’m what some people call “sex positive.” That doesn’t mean I talk with my four-year- olds about how great sex is and how good it feels. It means I don’t pretend it’s something other than it is. As parents, we lie all the time. About the Easter Bunny or Santa or the Tooth Fairy, about how long ten minutes is, about whether or not we remembered they wanted to have grilled cheese for dinner again, we lie a lot. But one thing I never lie about is sex. I don’t

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want them to grow up ashamed of their bod- ies or confused about what they do. I don’t tell them about Cabbage Patches or storks; I make an effort, always, to be honest about human reproduction. Every aspect of it.

I’ve had talks with lots of other moms about having “the talk.” I don’t think my kids and I will ever have that particular talk, because they already know. And we talk about it often— kids are obsessive creatures. We read Where Did I Come From? and What Makes a Baby, which together cover every aspect of the sub- ject. We can talk about IVF and C-sections, because both of those are part of the story of their births, and we can talk about the fact that yes, mommy and daddy still have sex regard- less. And when they’re older, we’ll start talking about contraception. Because lying to your kids about sex helps nobody. Telling them that sex is “only between mommies and daddies” is a lie that leads to confused, hormone-charged teenagers. Telling them that sex is “only some- thing that happens when two people love each other very much” is a lie that causes hormone- charged teenagers to confuse “love” with “lust,” or “obsession.” It leads to leaps of logic like, “If I have sex with them, we must be in love.” Or worse—“If I love them, I have to have sex with them.” And how many teenage tragedies are based on that misconception?

The truth is that human beings, almost universally, like sex. It feels good. And it’s sup- posed to feel good. If it didn’t, the human race would die out. The truth is that sex isn’t special and magical just because it’s sex. The truth is that you can have spectacular sex with strang- ers whose names you don’t even know. The truth is that just because you can, that doesn’t necessarily mean you should. And that’s what sex-positive parenting really is. Not telling my kids lies about sex to keep them from behav- iors I don’t think are healthy. It’s telling them the truth, the whole truth, and letting it sink in so they can make their own good choices.

It’s telling them that sex is good, but that it’s dangerous if you’re not careful. It’s teaching them to require their partners to use condoms, to buy their own condoms if they’re planning on having sex. It’s teaching them that while sex feels good, they can feel good on their own too. (Just not at the table.) That while sex combined with love is often the best sex—transcendent sex—that grows the bond of love and builds a closeness that is almost impossible to find oth- erwise, sex isn’t always like that—even with people you love. That sex can lead to preg- nancy, even with protection, so engaging in it is a commitment to deal with any consequences. It’s telling them they’re not wrong, or sinful, or bad, if they have sexual feelings. Or even if they have sex. It’s teaching them that sex happens, whether people always make good choices or not. And it’s giving them the tools to ensure that when they’re ready, they’re smart and cau- tious and conscientious.

There’s a lot of black and white comparisons when it comes to sex education. Some people think that once kids hit puberty, if they don’t have a strong fear of sex they’ll have as much as they can, as often as they can. There’s a lot of abstinence-only sex education based on telling kids, “SEX IS SCARY! DON’T DO IT!” and it’s about the least successful program anyone has ever invented. In states with abstinence-only sex ed, teen pregnancy rates only go up and up and up. Telling children the truth about sex isn’t giv- ing permission for them to have it—and this is the most important part—because nobody has the right to deny them permission for sex but themselves. And that’s the thing I try to keep in mind when I say things like, “We don’t touch our vulvas at the table.” Sex is something that ONLY happens when both people WANT it to happen. And that means that the only people in the entire world with any kind of say over whether or not my daughters have sex is them. I don’t get to tell my daughters they have to have sex, but I also don’t get to tell them they can’t.

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They’re in charge. Your body, your decision. I never want to be responsible for setting the precedent that another person gets to tell them what to do with their bodies, and especially with their sexuality. I don’t want to be the gateway for a manipulative, potentially abusive boyfriend. So I teach boundaries. Appropriate places. Hygiene. I teach my children that nobody is allowed to touch their bodies without permis- sion. When we get in tickle fights and they say, “Stop!” I stop. And when we talk about pregnant friends, we talk about uteruses and sperm and eggs. And most of the time, it’s not uncomfort- able. Most of the time, I’m verifying information and the conversation lasts fifteen seconds.

And someday the conversation is going to be a lot uglier. Someday, we’ll have to actually talk about rape, and explicit and enthusiastic con- sent, and contraception. Someday we’ll have to talk about healthy masturbation and pornog- raphy and realistic expectations of sex and sex partners and body image and a lack of shame for their bodies. And those conversations are not going to be as brief or straightforward. But I’m ready. Whenever that day comes, I’m prepared. Because the groundwork is there.

“We don’t touch our vulvas at the table.” It’s absurd, but it’s got all the important pieces. It’s a micro-lesson in safety and consent and social propriety. I don’t think I’ll be able to say, “We don’t lose our virginity in the back seat of a car after a prom party” with a straight face, but I will be able to say, “We don’t have sex with- out thinking long and hard about it first, and we certainly don’t do it without being careful, and being safe, and being totally confident in the maturity of our partner and our ability to handle the repercussions if we get a disease or get pregnant.”

Because it’s true. We don’t. But I like that when that time comes, I’m

part of the “we.” Because if I can tell my girls “we” have to be careful, they’ll know that no matter what happens, I’m still in their corner. I’ve still got their backs. Even if “we” make bad choices, I’ll still be there to help make things right again.

Source: “Sex Positive Parenting, or ‘We Don’t Touch Our Vulvas at the Table,’” Becomingsupermommy.blogspot .com, June 19, 2014. Reprinted by permission of the author.

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Interest and curiosity regarding sexual behav-ior and sexuality are normal and healthy for adolescents (Tolman & McClelland, 2011); however, sexual activity can carry sig- nificant costs (e.g., unintended pregnancy, sexually transmitted infections [STIs], and depressive symptoms) for adolescents’ well- being (Deptula, Henry, & Schoeny, 2010; Zimmer-Gembeck & Helfand, 2008). Often what distinguishes healthy from unhealthy sexual development is the degree to which adolescents are knowledgeable about sexual health practices, possess self-efficacy over their sexual decision making, and consistently use safer sex practices (Beckmeyer & Jamison, 2015; Hoff, Greene, & Davis, 2003; Martino, Collins, Kanouse, Elliott, & Berry, 2005). Par- ents play a key role in promoting healthy sexual development for adolescents by initiating and discussing sexuality with their children. Unfor- tunately, it is rare for parents and/or caregivers to be adolescents’ primary or even secondary source of sexual health information (Bleakley, Hennessy, Fishbein, Coles, & Jordan, 2009; Epstein & Ward, 2007). To help sex and family educators promote greater parent–adolescent sexual health communication, we conducted a literature review to identify common rea- sons why parents do or do not engage in sexual health conversations with their children. The goal of this review was to identify barriers that could be influenced by sex and family educa- tors. After summarizing the prior literature, we formulated strategies that sex and family edu- cators can follow to promote parent-initiated sexual health conversations.1 . . .

PARENT–ADOLESCENT COMMUNICATION ABOUT SEX

Although adolescents and parents do report dis- cussing sexuality (see Jerman & Constantine, 2010; Stidman-Hall, Moreau, & Trussell, 2012), estimates of discussion frequency can be mis- leading since they are typically derived from global measures of parent–adolescent sexual communication (e.g., have you ever talked to your parent about birth control?), which do not convey the consistency, frequency, or dura- tion of these discussions. Open and frequent sexual health conversations are associated with indicators of adolescent sexual development, including delayed sexual initiation (DiIorio, Kelley, & Hockenberry-Eaton, 1999; Martinez, Abma, & Copen, 2010), increased use of con- doms (DiIorio, McCarty, Resnicow, Lehr, & Denzmore, 2007), fewer sexual partners (Secor- Turner, Sieving, Eisenberg, & Skay, 2011), lower risk of STIs (Deptula et al., 2010), and dis- cussing sexual issues with romantic partners (Widman, Coukas-Bradley, Helms, Golin, & Prinstein, 2013). Those results are consistent with a broader literature noting that higher- quality parent–adolescent relationships, paren- tal knowledge of adolescents’ daily lives, and

TALKING TO TEENS ABOUT SEX: PARENT–ADOLESCENT COMMUNICATION ABOUT SEX AND SEXUALITY

M O N A M A L A C A N E A N D J O N AT H O N J . B E C K M E Y E R

From “A Review of Parent-Based Barriers to Parent–Ado- lescent Communication about Sex and Sexuality: Impli- cations for Sex and Family Educators,” American Journal of Sexuality Education, Vol. 11, Issue 1, 2016, pp. 27–40. Copyright © 2016 Taylor & Francis Group, LLC, reprinted by permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com).

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Jaccard, Dodge, & Dittus, 2002). For example, in a study of inner-city youth, Jaccard et al. (2000) found that the second most reported reservation to discussing sex with their child was fear that the child would ask a question to which the parent did not know the answer. When parents perceive that they are unknowl- edgeable about sexual health, the conversa- tions they do have with their children tend to be brief, vague, and indirect (Hyde et al., 2013). When parents are educated about sexual health, have confidence in their knowledge of sexual health topics, and believe they have the skills to effectively communicate this information, they are more likely to self-initiate communication with their child (Byers, Sears, & Weaver, 2008; Villarruel, Loveland-Cherry, & Ronis, 2010). Similarly, when adolescents perceive their par- ents to be knowledgeable, they are less likely to avoid sexual discussions with them and are also less anxious about the discussions (Afifi, Joseph, & Aldeis, 2008). Moreover, when ado- lescents report that their parents have a mod- erate amount of general expertise (i.e., general competence), they feel they can trust their par- ents more and subsequently are more open to having discussions about sex (Guilamo-Ramos et al., 2006). Based on prior research, it is clear that parental knowledge of sexual health plays a key role in promoting open parent–adolescent communication about sexuality and sexual behavior (Miller et al., 2009).

Perceptions of Adolescents’ Readiness for Sex Parents also avoid discussions about sex when they perceive their children are not ready to have these conversations. Parents’ percep- tions of readiness for sexual health conversa- tions may be based on age (e.g., thinking that their child is too young) (Pluhar, DiIorio, & Mccarty, 2008; Wilson, Dalberth, Koo, & Gard, 2010) and [a belief] that children are not involved in romantic relationships and/or

positive parenting behaviors are associated with better sexual health among adolescents.2 . . .

BARRIERS TO PARENT– ADOLESCENT COMMUNICATION ABOUT SEX

Adolescents want to learn about sex from their parents (Somers & Surmann, 2004). However, researchers have consistently found that peers and the media are more common sources of sexual health information for adolescents than are parents (Epstein & Ward, 2007; Secor- Turner et al., 2011; Whitfield, Jomeen, Hayter, & Gardiner, 2013). Additionally, researchers have found that when parents do discuss sex with their adolescents, they tend to shy away from “tougher” topics (e.g., how to say no and where to access birth control; Hyde et al., 2013; Planned Parenthood, 2014). Parents do have the ability to promote adolescents’ healthy sexual development, but research illustrating that they rarely serve as adolescents’ primary source of sexual health information would suggest that they may be reluctant to directly engage their adolescents in conversations about sex and sexu- ality. In order to better understand why this is the case, we searched article databases (e.g., Psych-INFO and Academic Search/EBSCO) to identify empirical literature pertaining to parent– adolescent sexual health communica- tion. After reviewing this literature, we identified four broad categories of barriers to parent– adolescent sexual health communication: lim- ited sexual health knowledge, perceptions of adolescents’ readiness for sex, parental comfort discussing sex, and demographic factors.

Limited Sexual Health Knowledge Parents with a real or perceived lack of knowl- edge about sexuality and sexual behavior are unlikely to engage in conversations about sex with their children (Guilamo-Ramos, Jaccard, Dittus, & Bouris, 2006; Jaccard et al., 2000;

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sex with their parents when they were teen- agers and found that when parents avoided discussing sex, adolescents felt closed off from an important and reliable source of informa- tion. Therefore, by avoiding discussions with adolescents, parents are potentially creating an environment in which adolescents will be reluctant to seek them out for sexual health information.

Demographic Factors Researchers have noted that cultural, political, and demographic factors are associated with parent–adolescent sexual communication. . . . Among non-Caucasian racial and ethnic groups, African American parents report signif- icantly more sexual communication and talks about birth control with their children than Asian American or Hispanic parents (Widman et al., 2013). Asian American parents report the least frequent and fewest number of sexual top- ics discussed with their children (Kim & Ward, 2007; Martino, Elliott, Corona, Kanouse, & Schuster, 2008). Mothers communicate with adolescents about sex more than fathers do (DiIorio et al., 1999; Rosenthal & Feldman, 1999; Swain et al., 2006), and mothers are more likely to have had conversations with daughters than sons (Kim & Ward, 2007; Martin & Luke, 2010; Miller et al., 2009; Pluhar et al., 2008). Differences in the frequency of mothers’ and fathers’ communication about sex with their adolescents may reflect gender norms pertain- ing to parenting roles. Researchers have also found that girls report talking about more sex- related topics with their parents than do boys (Jerman & Constantine, 2010; Widman et  al., 2013). Lastly, parents’ political and religious beliefs can influence the decision to discuss sexuality. A recent study found that politically conservative and religious parents—those who report attending a religious service more than once per week—discuss the negative conse- quences of sex with their children more often

are not yet sexually active (Eisenberg, Sieving, Bearinger, Swain, & Resnick, 2006; Swain, Ackerman, & Ackerman, 2006). Such appre- hensions are, to a degree, understandable, as parents have reported being concerned that these discussions could expose their children to topics that are inappropriate for their age or tacitly encourage sexual behavior (Hyde et al., 2013; Wilson et al., 2010). Therefore, parents may believe they are acting in their children’s best interest by delaying conversations about sex until they are older or exhibit signs of becoming sexually active. However, by avoid- ing conversations about sex because they per- ceive their children are “not ready,” parents are missing crucial opportunities to convey their expectations for adolescents’ sexual behavior and to help adolescents make healthy sexual choices. Finally, adolescents commonly con- ceal information about dating and romantic relationships from their parents (e.g., Daddis & Randolph, 2010); therefore, parents may not truly know when their child has begun dating, again missing opportunities to promote sexual health.

Parental Comfort with Discussing Sex Parents have reported they feel embarrassed when discussing sex, making it difficult to know what to say to adolescents (Eisenberg et  al., 2006; Lefkowitz, 2002; Wilson et al., 2010). Relatedly, parents have also reported feeling that they lack the communication skills or tact necessary to facilitate conversa- tions about sex (Pluhar et al., 2008; Wilson et al., 2010). Some parents also believe that adolescents will feel uncomfortable talking about sex and avoid conversations based on this assumption (Afifi et al., 2008; Guilamo- Ramos, Jaccard, Dittus, & Collins, 2008; Mazur & Ebesu Hubbard, 2004). However, in a recent study, Goldfarb, Lieberman, Kwiat- kowski, and Santos (2015) interviewed college students about their experiences discussing

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constructs of the TPB, supporting its use as a framework to illustrate how sexual health and family educators can increase parent– adolescent communication about sex and sexuality.  .  .  . Additionally, sex and family educators may find that presenting the TPB model to parents (e.g., in a workshop or a print or web-based resource) could help them recognize reasons for why they are or are not choosing to engage in sexual com- munication with their children so they are able to identify the most personally useful resources and information.

Strategies to Improve Behavioral Beliefs In the TPB, behavioral beliefs are the posi- tive and negative attitudes individuals hold about the outcome of a behavior as well as how they feel about the behavior (i.e., if it is valu- able, helpful, or appropriate). These beliefs are shaped by past experiences and consequences of the same or similar behaviors (Azjen, 1991, 2002). Therefore, communication with adoles- cents about sex and sexuality should be more likely when parents are comfortable with such conversations, when they believe they will benefit adolescents, and when they have had positive experiences with prior conversations. We believe existing workshops and classes for parents would be appropriate venues to help parents gain confidence using sexual health terms, initiating conversations, and even han- dling negative responses from their children. For example, parents could be taught tech- niques regarding how to use the media that adolescents are already consuming (e.g., TV shows and movies) to initiate sexual health conversations. Although researchers have not typically viewed sexually laden media content as a positive influence on adolescent sexual socialization (e.g., Collins et al., 2004), it can be used to facilitate conversations with ado- lescents about sex and sexuality. Instances of sexual innuendos and precursory sexual

than liberal and less religious counterparts (Swain et al., 2006). The same study found con- servative parents are also less likely to believe that birth control and condoms are safe and effective; subsequently, they are less likely to discuss where to obtain birth control with their children.

FACILITATING PARENT– ADOLESCENT SEXUAL HEALTH DISCUSSIONS

The second aim of this review was to identify specific practical approaches for sexual health and family educators and medical professionals (e.g., family doctors and nurses) to assist parents in overcoming barriers to sexual health com- munication with their adolescents. Our focus is on parents’ behavioral decision to engage in sexual health conversations with their adoles- cents. Therefore, we used the Theory of Planned Behavior (TPB) to guide and organize our sug- gestions. In the TPB model individual behav- iors are the result of behavioral intentions (i.e., the motivation to engage in specific behaviors), which are determined by three constructs: behavioral beliefs, normative beliefs, and per- ceived behavioral control (Azjen, 1991, 2002). In order to increase the frequency of parent– adolescent communication about sex and sexu- ality, we must first increase parents’ intentions to have those conversations, which are derived from parents’ attitudes toward talking to ado- lescents about sex and sexuality (i.e., behavioral beliefs), their beliefs regarding whether their chil- dren and other individuals (e.g., other parents, teachers, doctors) think such communication is important and/or also engage in the behavior (i.e., normative beliefs), and how much control they perceive having over such communica- tion with adolescents (i.e., perceived behavioral control). We believe that the barriers we identi- fied in the literature can be organized using the

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of early and frequent conversations about sex and that these early conversations may actu- ally promote the health of their adolescent children. Educators can encourage parents to focus on age- appropriate discussion topics such as . . . the names of different body parts, characteristics of healthy and unhealthy rela- tionships, being responsible for your actions, privacy, and respecting other people’s bodies as well as your own (Levine, 2011; Richardson, 2004). Preparing to discuss specific topics may help parents feel more comfortable approach- ing these discussions, but they should also be encouraged to be open to topics adolescents are curious about.

Strategies to Improve Normative Beliefs Normative beliefs reflect individuals’ percep- tions of what important others (e.g., other parents, family doctors, and sex and family educators) think about the behavior, if these important others have engaged in the behavior themselves, and if they are motivated to comply with those expectations (Azjen, 1991, 2002). A potential approach to impact normative beliefs is through mass media campaigns aimed at par- ents of adolescents. These campaigns typically involve promoting factual information to spe- cific groups in order to overcome mispercep- tions regarding health behaviors (Davis, Evans, & Kamyab, 2012; DuRant, Wolfson, LaFrance, Balkrishnan, & Altman, 2006). Applied to parent–adolescent communication about sex, campaigns could focus on the importance of sexual health discussions, how frequently most parents talk about sex with their adolescents, adolescents’ own interest in having conversa- tions with their parents, and what are other, less reliable, sources of adolescents’ sexual health information. Sex and family educators can be involved in these campaigns by working with interventionists to ensure that the content is appropriate and reflects current knowledge

behaviors can help parents segue into conver- sations with adolescents about sex. Parents and adolescents may find discussing the hypo- thetical sexuality of fictional characters more comfortable than speaking directly about ado- lescents’ own experiences. Even when discuss- ing hypothetical or fictional sexual experiences parents are able to communicate their values and expectations to their children. Doing so is critically important, as communicating values and expectations have been shown to decrease adolescent sexual risk behavior (Dancy et al., 2009; Jaccard et al., 2002).

Additionally, there are existing online evidence-based resources that sex and fam- ily educators can direct parents to about the benefits of these conversations. For instance, Advocates for Youth . . . has a parent-specific section of its website with articles explain- ing the importance and protective factors of parent– child communication, as well as advice from parenting experts and conversation start- ers and activities. The Centers for Disease Control and Prevention (CDC) Division of Adolescent and School Health . . . also con- tains a wealth of free and accessible resources, including podcasts, webinars, brochures, and fact sheets. Educators can use this site to learn about successful evidence-based programs as well as strategies to engage parents and fami- lies in supporting adolescent healthy behaviors.

Parents are also concerned that they will hasten sexual activity, leading to a belief that discussing sex and sexuality may be harm- ful for adolescents. This is related to parents’ expectations regarding the outcomes of sexual health conversations with adolescents. How- ever, the existing literature illustrates par- ent–adolescent sexual health conversations are more likely to do the opposite (Beckett et al., 2010; Deptula et al., 2010; Eisenberg et al., 2006; Martino et al., 2008). Therefore, the role of sex and family educators, family doctors, and nurses is to inform parents of the benefits

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of topics available. The CDC and the Sexual- ity Information and Education Council of the United States (SIECUS) provide research- supported information on their websites for parents and caregivers to become informed and also learn about adolescent sexual devel- opment (CDC, 2014; SIECUS, n.d.). Sex and family educators can also increase parents’ sex- ual health knowledge through parent-focused interventions . . . , which have found positive associations between knowledge and  increased self-efficacy (DiIorio et al., 2007) and comfort (Kirby & Miller, 2002; Pluhar et  al., 2008) in having sexual talks with children.

There are no “perfect” times or methods guar- anteed to make parents’ discussion with adoles- cents about sexuality comfortable. However, an easy and flexible way to broach the subject is to use everyday experiences to initiate conversa- tions (Wilson et al., 2010), for example, talking during a commercial break about a romantic moment in a television show, listening to song lyrics and discussing what they mean while driving in the car, seeing a group of co-ed teen- agers at the mall, or simply asking what their peers do in co-ed groups. Educators can also assist parents by modeling and teaching active communication techniques. During the discus- sions, parents should keep the tone informal and temper their emotional reactions to ques- tions asked by their children (Afifi et al., 2008). By moderating their emotional responses, par- ents can foster a judgment-free environment where their children feel more comfortable and open to discuss sensitive topics with them. By working . . . sex-related topics into day-to-day life, parents can gradually become more com- fortable with discussing these topics and subse- quently change their behavioral norms toward them. The more frequent these conversations are, the easier and more comfortable it becomes to talk about sex topics in general, thereby reducing the embarrassment felt by both parent and child (Guzman et al., 2003).

and best practices on this topic. They can also implement smaller-scale, more targeted pro- grams within their communities. An example of an effective mass media campaign is Par- ents Speak Up, which seeks to promote sexual communication “early and often” with children (Evans, Davis, Ashley, & Khan, 2012). The cam- paign used television, radio, and print adver- tisements as well as an accompanying website to target parent self-efficacy to have conversa- tions about sex, explain the long-term benefits of talking to your children, and [share] norms surrounding adolescent sexual activity (Davis, Blitstein, Evans, & Kamyab, 2010). Research on parents exposed to the campaign messages reported more frequent sexual communication and discussions about abstinence with their children (Davis et al., 2012; Evans et al., 2012).

Strategies to Increase Perceived Behavioral Control The final area of the TPB model is perceived behavioral control, reflecting one’s belief in their ability to perform a behavior (Ajzen, 1991, 2002). Based on the literature we reviewed, parents’ perceived behavioral control appears to be related to their sexual health knowledge and self-efficacy in initiating conversations with adolescents. Sex and family educators can play a significant role in helping parents learn (or re- learn) information about sexual behavior, safer sex practices, and STIs. Sex and family educators can help parents identify appropriate sources of sexual health information such as the Advocates for Youth website noted above. Further, many sexual health websites for teens contain accu- rate information from qualified professionals (Buhi et al., 2010; Noar, Clark, Cole, & Lustria, 2006), and Guilamo-Ramos and colleagues (2014) found that parents perceived a number of benefits to using resources on the Internet with their children, such as the immediacy and con- venience to access information and the scope

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readers elsewhere for this type of research (e.g., Asampong, Osafo, Bingenheimer, & Ahiadeke, 2013).

CONCLUSION

It is unfortunate that the media, friends, and peers, which typically provide adolescents with inaccurate information about sex and sexual- ity, are more common sources of sexual health information than parents (Whitfield et al., 2013). Unmediated, sex information from the media can lead to misinformation among ado- lescents. For example, content analyses of TV shows popular among adolescents have found that although shows are skilled at showing and talking about sex (Kunkel et al., 2003; Kunkel, Eyal, Finnerty, Biely, & Donnerstein, 2005), they generally lack messages about sexual risk and responsibility and do not show teens using safer sex practices (Kunkel et al., 2005; Wright, 2009) and frequently couch sexual health top- ics in jokes or portray sexual development as embarrassing and uncomfortable (Hust, Brown, & L’Engle, 2008). Similarly, relying on friends and peers for sexual health infor- mation can lead to misperceptions about the prevalence and consequences of sexual behav- ior during adolescence (Bleakley et al., 2009; L’Engle & Jackson, 2008). Sex and family edu- cators can promote parent–adolescent com- munication about sex and sexuality by actively targeting parents’ sexual health knowledge, perceptions of adolescents’ readiness for con- versations about sex, and how comfortable they are discussing sex with adolescents. Regardless of why parents avoid or do not discuss sex and sexuality with their adolescents, it is important for them to remember, and be reminded, that their adolescents will be confronted with sex- related issues whether they have private con- versations with them or not. Therefore, having control over the accuracy of this information, and making oneself available as a resource in

Although this review was primarily focused on parents as sexual health educators due to the well-documented associations between parent–adolescent communication and ado- lescent sexual health outcomes (Wight & Fullerton, 2013), other family members such as siblings and cousins can be sources of sex- ual health information. For example, adoles- cents have reported talking to siblings about sex more frequently than to parents (Bleakley et al., 2009; Secor-Turner et al., 2011; Wood, Senn, Desmarais, Park, & Verberg, 2002). Older siblings in particular may be viewed as more approachable than parents as sources of sex information given that they generally grow up together, share similar experiences, and their relationships have a mix of peer and familial qualities (Grusec, Chapparro, John- ston, & Sherman, 2012; Haurin & Mott, 1990; Smetana, Campione-Barr, & Metzger, 2006). Future studies could investigate the effective- ness and outcomes associated with sibling communication about sex. Another avenue of research could investigate [whether and] why parents choose to take advantage of the wealth of resources designed specifically for this audi- ence and this topic. We believe the resources discussed in the sections above contain repu- table, evidence-based information; however, given that parents still report feeling unpre- pared, uncomfortable, and unsure about sex- ual health discussions, it is likely that resources designed to address these concerns among parents are not being widely used despite their availability. Future research should investi- gate the barriers to access and knowledge of resources for parents seeking this informa- tion. Finally, the research reviewed above has primarily been conducted with American or European samples and the recommendations would likely be different for other countries and cultural, religious, and social contexts. It was beyond the scope of this review to do a cross- cultural review or comparison and we direct

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relate to adolescents’ beliefs about sex. American Journal of Health Behavior, 33: 37–48. doi:10.5993/AJHB.33.1.4.

Buhi, E. R., Daley, E. M., Oberne, A., Smith, S. A., Schneider, T., & Fuhrmann, H. J. (2010). Quality and accuracy of sexual health information web sites visited by young people. The Journal of Adolescent Health, 47: 206–08. doi:10.1016/j.jadohealth.2010.01.002.

Byers, E. S., Sears, H. A., & Weaver, A. D. (2008). Parents’ reports of sexual communication with children in kindergarten to grade 8. Journal of Marriage and Family, 70: 86–96. doi:10.1111/j.1741-3737.2007.00463.x.

Centers for Disease Control and Prevention (CDC) (2014, June). Parent and guardian resources. Retrieved from http://www.cdc.gov/teenpregnancy/parent -guardian-resources/index.htm.

Collins, R. L., Elliott, M. N., Berry, S. H., Kanouse, D. E., Kunkel, D., Hunter, S. B., & Miu, A. (2004). Watching sex on television predicts adolescent initiation of sexual behavior. Pediatrics, 114: 280–89.

Daddis, C., & Randolph, D. (2010). Dating and disclosure: Adolescent management of information regarding romantic involvement. Journal of Adolescence, 33: 309–20. doi:10.1016/j.adolescence.2009.05.002.

Dancy, B. L., Hsieh, Y. L., Crittenden, K. S., Kennedy, A., Spencer, B., & Ashford, D. (2009). African American adolescent females: Mother-involved HIV risk-reduction intervention. Journal of HIV/AIDS & Social Services, 8; 292–307. doi:10.1016/j.biotechadv.2011.08.021. Secreted.

Davis, K. C., Blitstein, J. L., Evans, W. D., & Kamyab, K. (2010). Impact of a parent–child sexual communication campaign: Results from a controlled efficacy trial of parents. Reproductive Health, 7; 1–12. doi:10.1186/1742- 4755-7-17.

Davis, K. C., Evans, W. D., & Kamyab, K. (2012). Effectiveness of a national media campaign to promote parent–child communication about sex. Health Education & Behavior, 40: 97–106. doi:10.1177/1090198112440009.

Deptula, D. P., Henry, D. B., & Schoeny, M. E. (2010). How can parents make a difference? Longitudinal associations with adolescent sexual behavior. Journal of Family Psychology, 24: 731–39. doi:10.1037/a0021760.

DiIorio, C., Kelley, M., & Hockenberry-Eaton, M. (1999). Communication about sexual issues: Mothers, fathers, and friends. The Journal of Adolescent Health, 24: 181–89.

DiIorio, C., McCarty, F., Resnicow, K., Lehr, S., & Denzmore, P. (2007). REAL men: A group randomized trial of an HIV prevention intervention for adolescent boys. American Journal of Public Health, 97: 1084–89. doi:10.2105/AJPH.2005.073411.

DuRant, R. H., Wolfson, M., LaFrance, B., Balkrishnan, R., & Altman, D. (2006). An evaluation of a mass media campaign to encourage parents of adolescents to talk to

spite of the initial discomfort that comes along with the talks, is healthier for adolescents in the long run (Guzman et al., 2003).

NOTES 1. We note that this review did not focus on the consequences or effectiveness of parent–adolescent sexual health communication because there are recent, high- quality summaries of those topics (e.g., Akers, Holland, & Bost, 2011; Santa Maria, Markham, Bluethmann, & Mullen, 2015); rather we concentrated on what can prevent such communication in order to develop practical recommendations to overcome those barriers.

2. . . . [F]or reviews, see Jaccard, Dittus, & Gordon, 2000; Zimmer-Gembeck & Helfand, 2008).

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Rosenthal, D. A., & Feldman, S. (1999). The importance of importance: Adolescents’ perceptions of parental communication about sexuality. Journal of Adolescence, 22: 835–51. doi:10.1006/jado.1999.0279.

Santa Maria, D., Markham, C., Bluethmann, S., & Mullen, P. D. (2015). Parent-based adolescent sexual health interventions and effect on communication outcomes: A systematic review and meta-analyses. Perspectives on Sexual and Reproductive Health, 47: 37–50. doi:10.1363/47e2415.

Secor-Turner, M., Sieving, R. E., Eisenberg, M. E., & Skay, C. (2011). Associations between sexually experienced adolescents’ sources of information about sex and sexual

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sexual behavior: Developmental correlates of sexual intercourse, and the importance of age, gender and ethnic background. Developmental Review, 28: 153–224. doi:10.1016/j.dr.2007.06.001.

Wright, P. J. (2009). Sexual socialization messages in mainstream entertainment mass media: A review and synthesis. Sexuality & Culture, 13: 181–200.

Zimmer-Gembeck, M. J., & Helfand, M. (2008). Ten years of longitudinal research on U.S. adolescent

Sex talks. They may make many parents anx- ious, but talking to teens about sex is an essen- tial part of parenting. Thanks to research on sexual communication between parents and teens, we know that teens who talk to their par- ents about sex have sex later in life and are more likely to use condoms when they do (Whitaker and Miller, 2000; Widman et al., 2016). Tradi- tionally, sexual communication research cen- tered the experiences and perspectives of white families, using them as the standard. In more recent years, however, researchers have shifted focus to explore how parents of color commu- nicate with their teens about sex.

Much of the literature on young people of color, particularly African American and Latino teenagers, focuses on sexual risk behaviors and the prevention of the social problems commonly associated with these groups, such as unplanned pregnancy and sexually transmitted infections (STIs). Researchers have paid less attention to the ways in which parent sexual communication contributes to the sexual health and emotional well-being of their teens, or the specific types of messages teens of color receive from their par- ents about sex. I discuss some of the common themes found in the literature.

Like white teens, teens of color report having more frequent conversations with

their mothers than their fathers (Raffaelli and Green, 2003; Hutchinson and Cederbaum, 2011; Sneed et  al., 2013), which essentially makes parent sexual communication a gen- dered activity. In fact, mother–daughter com- munication is associated with reduced sexual activity and increased condom use for African American and Latina teens (Hutchinson et al., 2003; Hutchinson and Montgomery, 2007). But how do parents of color talk about sex with their teens? Awkwardly, as it turns out.

African American, Latina, and Asian Ameri- can mothers report feeling less comfortable communicating with their teens about sex than do white mothers (Meneses et al., 2006), and this discomfort is often detected by their children (Dennis and Wood, 2012). Despite their dis- comfort, African American parents have been found to have more frequent talks with their teens than parents of other groups (Hutchinson & Cooney, 1998; Hutchinson, 2002). Yet more frequent discussions about sex do not necessar- ily translate to open communication; compared to white, Asian American, and Latina mothers, African American mothers are least likely to know how much sexual experience their teens actually have (Meneses et al., 2006).

For black parents, firmly rooted ideas and stereotypes about sexuality and respectability

Let’s Talk about Sex: How Parents of Color Communicate with Teens

Lauren Fannin

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control, and legalized exploitation. Controlling images like the “Jezebel”—a sexually promis- cuous black woman—were used to justify the abuse black women endured while simulta- neously blaming and shaming black women (Collins, 2004). In light of this history, the emphasis on being a good girl may be a protec- tive measure.

For Latino families, deeply held beliefs about gender and tradition influence the messages parents communicate to their teens. Like Afri- can American mothers, Latina mothers’ discus- sions with their daughters tend to be protective in nature, focusing on preventing pregnancy and STIs, and many also encourage abstinence or delaying sex until adulthood (Romo et al., 2010; Stauss et al., 2011). There are diverse themes in the messages Mexican American mothers send to their daughters about sex. While some mothers view sex as strictly a male domain and encourage their daughters to remain chaste until marriage, others acknowledge that their daughters have sexual feelings (Reyes, 2016). That Latino male teens do not receive the same messages may be attributed in part to the tra- ditional gender values, notions of female purity (Caal et al., 2013), and the concepts of machismo and marianismo1 present in many Hispanic cul- tures (Guilamo-Ramos et al., 2006; Guilamo- Ramos et al., 2007).

For Asian American families, taboos about sex talk and cultural conservatism impede open sexual communication, but the dearth of parent–teen sexual communication does not affect Asian American youth the way it affects other groups. Asian American parents are least likely of all groups to engage in sexual commu- nication with their teens. Asian American teen- agers report that their parents talk more about dating norms and general standards of behav- ior with romantic partners than they do about sex, likely because explicit sexual discourse is considered taboo due to cultural norms (Kim and Ward, 2007). A survey of Chinese, Korean,

inform the way they talk to their children about sex; the gendered messages African American teens receive from their parents are a reflec- tion of those ideas. One study of mother–teen pairs revealed an underlying theme of “clean versus dirty” girls in discussions about sex. The moms admonished their sons to avoid being infected by “dirty” girls by using condoms, while teaching their daughters to avoid being labeled “dirty.” Many of the mothers attempted to control their daughters by forbidding them to date and discouraging them from obtaining birth control (which they felt was for promiscu- ous girls). Most of the moms reported provid- ing their sons with condoms, but only one mom provided them to her daughter (Fasula, Miller, and Wiener, 2007). Subsequent research uncov- ered similar themes: black girls are more likely than black boys to be taught about waiting until marriage, protecting their reputation (being a good girl), and not allowing boys to use them for sex, while black boys are more likely to be taught to use condoms and prevent pregnancy (Santa Maria et al., 2014; Fletcher et al., 2015). A study of African American father–daughter dyads revealed similar patterns in sexual com- munication: girls were encouraged by their fathers to be “good,” protect their reputations, and be wary of boys, who the fathers believed have bad intentions (Brown et al., 2014).

Throughout the literature, there is a con- sistent lack of discussion about sexual asser- tiveness or sex-positivity, particularly for girls (Kapungu et al., 2010). In fact, some African American young women perceived sexual con- versations with their mothers to be fraught with negativity about and criticism of the act itself, framing sex as dangerous or harmful (Dennis and Wood, 2012). Mothers’ negative attitudes toward sex may be related to black women’s centuries-long experiences with racist stereotypes about their sexuality. Since their arrival in the Americas, black women’s bodies and sexuality have been subject to surveillance,

Brown, Danice L., Christopher B. Rosnick, Traice Webb- Bradley, and Jonathan Kirner. 2014. “Does Daddy Know Best? Exploring the Relationship between Paternal Sexual Communication and Safe Sex Practices among African-American Women.” Sex Education, 14(3): 241–56.

Caal, Selma, Lina Guzman, Amanda Berger, Manica Ramos, and Elisabeth Golub. 2013. “Because You’re on Birth Control, It Automatically Makes You Promiscuous or Something”: Latina Women’s Perceptions of Parental Approval to Use Reproductive Health Care.” Journal of Adolescent Health, 53(5): 617–22.

Cauce, Ana Mari, and Melanie Domenech-Rodriguez. 2002. “Latino Families: Myths and Realities.” In Latino Children and Families in the United States: Current Research and Future Directions. 3–25.

Collins, Patricia Hill. 2004. Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge.

Dennis, Alexis C., and Julia T. Wood. 2012. “We’re Not Going to Have This Conversation, But You Get It”: Black Mother–Daughter Communication about Sexual Relations.” Women’s Studies in Communication, 35(2): 204–23.

Fasula, Amy M., Kim S. Miller, and Jeffrey Wiener. 2007. “The Sexual Double Standard in African American Adolescent Women’s Sexual Risk Reduction Socialization.” Women & Health, 46(2–3): 3–21.

Fletcher, Kyla Day, L. Monique Ward, Khia Thomas, Monica Foust, Dana Levin, and Sarah Trinh. 2012. “Will It Help? Identifying Socialization Discourses That Promote Sexual Risk and Sexual Health among African American Youth.” The Journal of Sex Research, 52(2): 199–212.

Guilamo-Ramos, Vincent, Patricia Dittus, James Jaccard, Vincent Goldberg, Eileen Casillas, and Alida Bouris. 2006. “The Content and Process of Mother–Adolescent Communication about Sex in Latino Families.” Social Work Research, 30(3): 169–81.

Guilamo-Ramos, Vincent, Patricia Dittus, James Jaccard, Margaret Johansson, Alida Bouris, and Neifi Acosta. 2007. “Parenting Practices among Dominican and Puerto Rican Mothers.” Social Work, 52(1): 17–30.

Hutchinson, M. Katherine. 2002. “The Influence of Sexual Risk Communication between Parents and Daughters on Sexual Risk Behaviors.” Family Relations, 51(3): 238–47.

Hutchinson, M. Katherine, and Julie A. Cederbaum. 2011. “Talking to Daddy’s Little Girl about Sex: Daughters’ Reports of Sexual Communication and Support from Fathers.” Journal of Family Issues, 32(4): 550–72.

Hutchinson, M. Katherine, and Teresa M. Cooney. 1998. “Patterns of Parent–Teen Sexual Risk Communication: Implications for Intervention.” Family Relations, 185–94.

Filipina, and Vietnamese students found that among school, peers, medical professionals, and parents, the students learned the least about sex education from their parents (Lee et al., 2013). When sexual communication did occur, Asian American parents were much more likely to talk about abstinence than birth control (Lee et al., 2013). In the absence of direct mes- sages about sex, Asian American teens rely on indirect messages from their parents through observation; listening to what their parents say about other members of their community and watching how their own parents behave yield important information regarding sexual norms and expectations (Kim, 2009). Despite mini- mal parent–teen sexual communication, Asian American youth begin having sex later and take fewer sexual risks than other groups, a paradox that deserves further study (Trinh et al., 2014).

The methods, themes, frequency, and impact of sexual communication between parents and teens vary across racial and ethnic groups. It is imperative that researchers do not overlook these differences when conducting research on teens and young adults. Additionally, we must move past descriptive data to understand why these differences occur, as each group’s unique cultural history informs the sexual socializa- tion that occurs in their families. We have a responsibility to understand the diversity of the human experience, especially when it comes to sex, one of the most natural human experi- ences there is.

NOTE 1. Machismo and marianismo are gender constructions. Machismo stresses the man’s dominant role as the head of household. Marianismo, inspired by the Virgin Mary, emphasizes the woman’s role as mother and nurturer (Cauce and Domenech-Rodriguez, 2002).

REFERENCES Aspy, Cheryl B., Sara K. Vesely, Roy F. Oman, Sharon

Rodine, LaDonna Marshall, and Ken McLeroy. 2007. “Parental Communication and Youth Sexual Behaviour.” Journal of Adolescence, 30(3): 449–66.

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and Contraception.” The Sociological Quarterly, 46(1): 79–105.

Reyes, Daisy Verduzco. 2016. “Conundrums of Desire: Sexual Discourses of Mexican-Origin Mothers.” Sexuality & Culture, 20(4): 1020–41.

Romo, Laura F., Magali Bravo, Maria Elena Cruz, Rebeca M. Rios, and Claudia Kouyoumdjian. 2010. “‘El Sexo no es Malo’: Maternal Values Accompanying Contraceptive Use Advice to Young Latina Adolescent Daughters.” Sexuality Research and Social Policy, 7(2): 118–27.

Santa Maria, D., C. Markham, J. Engebretson, E. Baumler, and S. McCurdy. 2014. “Parent–Child Communication about Sex in African American Mother–Son Dyads.” Family Medicine & Medical Science Research, 3(3): 134.

Sneed, Carl D., Christian G. Somoza, Taurean Jones, and Sandra Alfaro. 2013. “Topics Discussed with Mothers and Fathers for Parent–Child Sex Communication among African-American Adolescents.” Sex Education, 13(4): 450–58.

Stauss, Kimberly, Yvette Murphy-Erby, Javier Boyas, and Van Bivens. 2011. “Parent–Child Communication Related to Sexual Health: The Contextual Experiences of Rural Latino Parents and Youth.” Advances in Social Work, 12(2): 181–200.

Trinh, Sarah L., L. Monique Ward, Kyla Day, Khia Thomas, and Dana Levin. 2014. “Contributions of Divergent Peer and Parent Sexual Messages to Asian American College Students’ Sexual Behaviors.” The Journal of Sex Research, 51(2): 208–20.

Whitaker, Daniel J., and Kim S. Miller. 2000. “Parent– Adolescent Discussions about Sex and Condoms: Impact on Peer Influences of Sexual Risk Behavior.” Journal of Adolescent Research, 15(2): 251–73.

Widman, Laura, Sophia Choukas-Bradley, Seth M. Noar, Jacqueline Nesi, and Kyla Garrett. 2016. “Parent– Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis.” JAMA Pediatrics, 170(1): 52–61.

Hutchinson, M. Katherine, John B. Jemmott, Loretta Sweet Jemmott, Paula Braverman, and Geoffrey T. Fong. 2003. “The Role of Mother–Daughter Sexual Risk Communication in Reducing Sexual Risk Behaviors among Urban Adolescent Females: A Prospective Study.” Journal of Adolescent Health, 33(2): 98–107.

Hutchinson, M. Katherine, and Arlene J. Montgomery. 2007. “Parent Communication and Sexual Risk Among African Americans.” Western Journal of Nursing Research, 29(6): 691–707.

Kapungu, Chisina Tsvakayi, Donna Baptiste, Grayson Holmbeck, Cami McBride, Melissa Robinson-Brown, Allyse Sturdivant, Laurel Crown, and Roberta Paikoff. 2010. “Beyond the ‘Birds and the Bees’: Gender Differences in Sex-Related Communication among Urban African-American Adolescents.” Family Process, 49(2): 251–64.

Kim, Janna L. 2009. “Asian American Women’s Retrospective Reports of Their Sexual Socialization.” Psychology of Women Quarterly, 33(3), 334–50.

Kim, Janna L., and L. Monique Ward. 2007. “Silence Speaks Volumes: Parental Sexual Communication among Asian American Emerging Adults.” Journal of Adolescent Research, 22(1): 3–31.

Lee, Christine, Denise Yen Tran, Deanna Thoi, Melissa Chang, Lisa Wu, and Sang Leng Trieu. 2013. “Sex Education among Asian American College Females: Who Is Teaching Them and What Is Being Taught.” Journal of Immigrant and Minority Health, 15(2): 350–56.

Meneses, Lisa M., Joan K. Orrell-Valente, Sylvia R. Guendelman, Doug Oman, and Charles E. Irwin. 2006. “Racial/Ethnic Differences in Mother-Daughter Communication about Sex.” Journal of Adolescent Health, 39(1): 128–31.

Raffaelli, Marcela, and Stephanie Green. 2003. “Parent– Adolescent Communication about Sex: Retrospective Reports by Latino College Students.” Journal of Marriage and Family, 65(2): 474–81.

Regnerus, Mark D. 2005. “Talking about Sex: Religion and Patterns of Parent–Child Communication about Sex

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R E A D I N G 1 8

A ll U.S. states require public schools to teach sex education in some form (National Conference on State Legisla- tures, 2012), and well over 200 million federal dollars are earmarked for sex education each year (Boonstra, 2010). Decisions about what is included in sex education curricula in pub- lic schools occur at the state level and at the discretion of the local school boards, who may expand upon, but not violate, state mandates (Sexuality Information and Education Council of the United States, 2015). The enactment of these regulations on sex education curricula falls to sex educators. As sex education curri- cula are legislated, these educators are bound, by law, to teach according to approved man- dates or risk losing their jobs. In this study, sex educators are defined as individuals who teach human sexuality curricula. However, as par- ticipants in this study made clear, this is often just a small part of their teaching load, and the level of training they receive varies, with some receiving little to no formal training in sex edu- cation instruction.

Although numerous studies have evaluated the effectiveness of various types of programs (e.g., Byers et al., 2003; Caron & Free, 2008; Spriggs & Halpern, 2008), few have taken into account the experiences of the individuals who are responsible for implementing sex education programs within the confines of organizational structures. Existing research that does account for health educator experiences has explored educators’ enactive mastery experiences, as well as their curricular decision-making pro- cesses (Carrion & Jensen, 2014; Jensen, 2012).

These studies demonstrate how sex educators’ experiences and choices play a role in the qual- ity of sex education programs and, by exten- sion, in students’ sexual-health outcomes. What remains unexplored, however, is how educators negotiate conflicting ideological viewpoints con- cerning that which they are required to teach by their employing organization and that which they believe is professionally appropriate and/or effective.

In the present study, we address this gap in the literature by drawing from semi-structured interviews with 50 sex educators employed at public secondary schools throughout a Mid- western U.S. state, 22 of whom expressed a degree of conflicted identification within the context of their employment. Conflicted iden- tification refers to a state in which an indi- vidual alternates between (and/or otherwise negotiates) feelings of connection with and dis- connection from a social collective (e.g., their profession or organization; Pratt, 2000; Wil- liams & Connaughton, 2012). We begin our study by reviewing extant literature on identi- fication in general and conflicted identification in particular. Next, we provide an overview of our data collection methods before analyz- ing how interview participants described their experiences with conflicted identification in the sex education classroom. Finally, we delin- eate the implications of our findings.

CONFLICTED IDENTIFICATION IN THE SEX EDUCATION CLASSROOM

E L I Z A B E T H A . W I L L I A M S A N D R O B I N E . J E N S E N

From “Conflicted Identification in the Sex Education Classroom: Balancing Professional Values with Organi- zational Mandates,” Qualitative Health Research 26(11), pp. 1574–86. Copyright © the Authors, 2015. Reprinted by permission of SAGE Publications, Ltd.

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2000). Pratt (2000) explained that conflicted identification emerges when individuals “alter- natively move toward, away, or against the orga- nization” (p.  480).1 For instance, individuals may develop a sense of conflicted identification when they identify strongly with some aspects of the organization’s (or other social collec- tive’s) ideological positioning at the same time they actively (although not necessarily openly) disagree with other key elements of the orga- nization’s values or endorsements. Kreiner and Ashforth (2004) offered several more specific examples of this including “critical theorists in business schools (who embrace the general ideologies of scholarship and learning, but are at odds with the predominant positivist para- digm),” or “gays in conservative institutions (who could feel strong identification with most of the values of the  organization, but perceive that their lifestyle is not accepted)” (p. 4). These authors have argued that conflicted identifica- tion and other similar states “may predict a host of cognitive, affective, and behavioral outcomes, ranging from satisfaction to intentions to quit, and from organizational citizenship behaviors to whistle-blowing” (Kreiner & Ashforth, 2004, p. 22). Correspondingly, Scott (2007) noted the continued need to study the experience and expression of various forms of attachment, as little is known about their communicative indicators and the potential implications of their discursive manifestations. The present study joins diverse attempts to answer this call within the context of U.S. public sex education and poses the following research questions:

Research Question 1: What identification- oriented conflicts do sex educators de- scribe encountering in the context of their employment?

Research Question 2: What strategies do sex educators identify as mechanisms they use for alleviating identification-oriented con- flict in the context of their employment?

THEORIES OF ORGANIZATIONAL IDENTIFICATION

Identification has been conceptualized as the psychological attachment that an individual feels to a social collective (i.e., an organization, a team, a professional community). Many iden- tification studies trace their theoretical roots to Burke (1969) and his theory of consubstantial- ity, or what Sass and Canary (1991) have inter- preted as “the extent to which one shares one’s substance with another idea, value, person, organization, etcetera” (p. 280). Likewise, Lar- son and Pepper (2003) have defined identifica- tion as “the communicative process through which individuals either align themselves with or distance themselves from . . . targets/sources of identity” (p. 530). In this respect, identifica- tion is the process by which individuals form their identity through their relationship with various social collectives, including organi- zations, teams, and professions (Lammers, Atouba, & Carlson, 2013).

Indeed, research suggests individuals’ sense of identity creates a series of premises upon which they are likely to rely as they make choices and develop an understanding of the world around them (Tompkins & Cheney, 1985). For instance, individuals who become ingrained within a social collective’s value structure rely on those values as they interact with others and make decisions both within and outside the confines of the social collec- tive. Using this framework, one would assume educators’ decisions about what, how, and why to teach their students are influenced by the school or school district through which they are employed.

To date, a growing body of research is dedicated to examining diverse categories of alternative identifications (i.e., neutral, dei denti- fication, disidentification), including con flicted identification (Kreiner & Ashforth, 2004; Pratt,

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came from the list of public school teachers des- ignated to teach health on the state’s Depart- ment of Education website. Depending on available contact information, individuals were recruited by either email or formal letter. Four hundred teachers were contacted with a final sample size of 50 sex educators. Recruitment ended when the authors felt they had achieved a maximum variation sample representing a wide range of participant demographics and experi- ences (Lindlof & Taylor, 2002).

A semi-structured interview protocol was used to conduct telephone interviews with participants. The semi-structured format not only allowed for consistency across interviews but also provided flexibility to inquire about participants’ unique experiences (Corbin & Strauss, 2008). Telephone interviews allowed individuals to participate when it was conve- nient for them and alleviated some of the limi- tations inherent to a statewide study.

Dr. Jensen conducted all of the interviews. During the interviews, she first explained informed consent to each of the participants and, upon receiving verbal consent to audio- record the interview, a short battery of demo- graphic questions was given. This was followed by a series of open-ended questions about par- ticipants’ experiences derived, in part, from existing research on the communication of sex information targeting young people (Allen, 2009; Buston, Wight, Hart, & Scott, 2002). These questions focused on (a) their training and job history, (b) how they obtained information about what to include in their curriculum, (c) their description of the curriculum, (d) their per- ceived self-efficacy in the classroom, and (e) spe- cific strategies they used to teach sex education. Taped interviews ranged from 20 to 60 minutes in length with an average length of 40.94 min- utes (SD = 10.14). Interviews were transcribed verbatim. All participants were given a U.S. $20 gift certificate following the interview.

METHOD

Participants Fifty sex educators employed at public schools throughout a Midwestern, U.S. state partici- pated in this study. Participants were employed at junior high schools (n = 27), high schools (n = 22), or at a joint junior/senior high school (n = 1). Their self-reported ages ranged from 23 to 65 years (M = 40.68, SD = 12.38), with 13 iden- tifying as male and 37 as female, and all partici- pants reporting their race/ethnicity to be either White or Caucasian. Correspondingly, 95% of public school teachers identified as White in the state in which the study took place and during the school year in which this study took place (K. Lane, personal communication, April 28, 2009). Sixty percent (n = 30) of the participants had gone beyond the required bachelor’s degree and obtained a master’s degree. Participants’ ten- ure in their position ranged from 1 to 40 years (M = 17, SD = 13.18). Of these 50 sex educators, 22 (44% of the sample as a whole) expressed in their interviews a sense of conflicted identifi cation (see the subsequent Analysis section for discussion of construct operationalization). Their demograph- ics largely aligned with the demographics of the sample as a whole. They were employed at junior high schools (n = 11), high schools (n = 10), or at a joint junior/senior high school (n = 1). Their self- reported ages ranged from 23 to 65 years (M  = 41.5, SD = 12.25), with 5 identifying as male and 17 as female. Sixty-three percent (n = 14) of the participants had gone beyond the required bach- elor’s degree and obtained a master’s degree. Par- ticipants’ tenure in their position ranged from 2 to 40 years (M = 20.86, SD = 12.33).

Procedures Following the attainment of institutional review board approval, sex educators were recruited to participate in this study. The sampling frame

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Analysis The authors did not go into the analysis expect- ing to find conflicted identification, but, rather, conflicted identification emerged through the analysis, which was guided by constant- comparative techniques (Charmez, 2006). Each transcript was read in its entirety before coding commenced. As the authors began to see themes emerge, memos were generated exploring those themes. Open coding (Strauss & Corbin, 1998) then occurred, during which the authors began a list of theoretical categories and continu- ously compared the readings of the interview transcripts with the theoretical categories and revised as necessary. Themes were collapsed and refined throughout the process of cod- ing and after discussion between the authors (Strauss & Corbin, 1998). During this process, it became clear that a number of participants were experiencing identification conflicts related to the curricular mandates of their employing organization. Thus, the authors decided to focus their analysis on the con- flicted identification participants were describ- ing and the ways in which educators reported managing these conflicts.

After creating coding criteria for conflicted identification, the authors divided the remain- ing 40 transcripts and coded them individually to ascertain how many participants expressed conflicted identification, as well as to collect examples of its expression and explore com- municative responses to these conflicts. The examples provided throughout this [reading] are drawn from the 22 cases in which conflicted identification was recognized. Pseudonyms are used in place of interviewees’ names.

RESULTS

Our analysis suggests that a number of par- ticipants (n = 22) reported an ideological per- spective on sex education (i.e., beliefs about

how and what to teach) at odds with the per- spective mandated by the school/district of their employment. For the majority of these educators, this discrepancy was experienced as a significant ideological difference. But, for a number of reasons (e.g., job security, norma- tive pressure from parents), they nonetheless tended to follow the dominant ideology and adhere to the goals/objectives of their organiza- tion (i.e., their school/school district). We argue that the identification experiences described by these individuals mirror what scholars have termed conflicted identification. The remain- der of this section delineates the ideological struggles facing participants, why many par- ticipants reported following the dominant ide- ology despite personal concerns, and how these dominant ideologies are discursively negotiated and even subverted.

Sources of Conflicted Identification Our participants described a range of diverse identification-oriented conflicts they encoun- tered while teaching sex education. Although participants were not explicitly asked to speak about their identification(s), interviewees used language suggesting they felt connections with the various social collectives of which they were a part. Specifically, participants expressed degrees of both implicit and explicit identifica- tion with their profession. This identification was evidenced in statements from participants that noted (a) a calling to the profession (e.g., “I had a gift, so I was gonna pursue that. . . . I’ve been told, I’ve always been told I was a born teacher.”—Nathan, a 30-year-old junior high school teacher), (b) significant work to maintain professional standards (e.g., conference partici- pation, continuing education), (c) their position as one they personally selected and perceived as valuable (e.g., “I started teaching because I wanted to teach.”—Julie, a 55-year-old junior/ senior high school teacher), and/or (d) their role

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with an ideology of “American-ism” involving the separation of church and state. Nathan suggested the organizational mandate to teach abstinence-only curricula was so closely aligned with religious messages that he “hated it” when he had to follow this dictate in the context of public schools.

Other participants expressed a similar sense of inauthenticity emerging when their beliefs about the goals of their profession (i.e., teach- ing children to be decision makers, providing accurate information) were at odds with what they had to teach as educators in organizations endorsing abstinence-only programs. These feelings stemmed from a belief that the cur- riculum was ineffective because some students were already engaging in sexual practices. For instance, John, a 26-year-old high school teacher, shared,

I am not a proponent of abstinence-only sexual edu- cation. It doesn’t work. . . . I feel that I’m doing the students kind of an injustice because it’s kind of like teaching with textbooks from the 1800s. You know, the information they need is not there.

Similarly, Paige, a 56-year-old junior high school teacher, explained that she had been able to teach what she wished until the HIV/AIDS epidemic forced the district to revise their sex education curricula, which resulted in what she saw as an inappropriate and ineffective mandate:

Paige: And when this committee began I was told that these are the things I could not address in my classroom: masturbation, homosexuality, birth control.

Interviewer: Wow, birth control entirely. Paige: Yeah. And I’m thinking that’s it. So I said,

“I’ve taught too long to know that that wasn’t gonna work! How do you do any AIDS instruc- tion without any of those kinds of issues or even sexuality education?”

Julie, a 55-year-old junior/senior high school teacher, expressed a similar degree of frustration

as significant as it involved educating youth for the betterment of the community (i.e., several educators noted they taught in schools/com- munities in which they had grown up and, thus, had vested interests in teaching students how to contribute to those communities). Although participants seemed strongly entrenched within their professions, they also explained how these identification-oriented connections become stressed at times, particularly in the context of teaching sex education in mandated ways. Their interviews revealed conflicts of identification, which manifested in terms of feelings of inau- thenticity, fear for job security, and concerns about angering community stakeholders. Many participants expressed having more than one of these feelings concurrently.

Feelings of Inauthenticity For some interviewees, the conflict they expe- rienced seemed to originate from a sense of potential inauthenticity in carrying out their job. Nathan, a 30-year-old junior high school teacher, explained the moments he struggled with these feelings:

When I have to say what abstinence is, I don’t feel, I don’t feel successful because I hate it. I hate say- ing that. I hate, only because I feel like I’m Bible- pushing. I feel like religion is getting into the schools and it’s supposed to be that church and state are sep- arated and I don’t feel like that’s what it is. Again, I don’t have a religious affiliation and that may be a component of that. But people should have a choice. I guess it’s my American-ism talking but I hate it because, kids, we’re trying to teach them to be deci- sion makers and now we are telling them, “No, you can’t do that.” And I was the type of kid that if you were to tell me “No,” I’m going to find a way to do it. So that’s personal. I don’t, I just have a hard time saying abstinence.

Earlier in the interview, Nathan had expressed a strong degree of identification with his pro- fession and the mission of his school. But, in this case, he also noted he closely identified

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of conflict that sometimes led her to thwart the rules, thus putting her job on the line, because key decision makers in her organization were unwilling to address the problems at hand:

Well, the problem, I think, is that [the school board] is not comfortable with [discussing birth con- trol]. You know they knew that there is a problem with teen pregnancy, however it’s not something they’re willing to budge on, so in lieu of job secu- rity you kinda have to [discuss birth control in class despite the abstinence-only mandate] sometimes, unfortunately.

Samantha’s use of the word “unfortunately” at the end of her comment highlights the disso- nance and even disappointment she felt at the prospect of having to risk her job for the sake of the children she was appointed to educate. For many participants, their experiences teaching sex education repeatedly put them in a precari- ous position where they were forced to balance or choose between their organization’s policies, perceived student needs, and their own job security.

Fear of Angering Organizational Stakeholders For still other participants, the key source of identification-oriented conflict they encoun- tered in teaching sex education came from their perception/fear of angering organizational stake- holders such as parents or community members. Belinda, a 27-year-old junior high school teacher, highlighted the seemingly unresolvable tension she experienced in the face of this concern:

Some parents want me to teach their child how to put on a condom, other parents would prefer that their child stay naïve and innocent. Parents who don’t care about their child, they’re not involved in their child’s life, they don’t care one way or the other, but parents who are involved with their child, they’re usually either, “No, I don’t want you to talk about it,” or “Yes, please talk about it, BUT don’t talk about this.” There are a lot of “buts.”. . . So, you know, it’s just a trial by fire.

about a curriculum she deemed unrealistic and a student body she felt was due information about contraception and abortion. She explained, “The only [guideline] was, supposedly, I wasn’t supposed to talk about birth-control options, abortion. I think those were the main two. And I just argued and said, ‘That’s unrealistic.’ . . . And I just, truthfully, ignored it.” For both Paige and Julie, rather than take on a role they found at odds with their sense of professional ethics, they decided to teach a curriculum that was not endorsed by their employers. This choice did not necessarily alleviate feelings of conflicted iden- tification, but it nonetheless seemed to alleviate feelings of inauthenticity.

Concern for Job Security For other participants, the biggest source of their sense of conflicted identification was their concern for job security. These participants dis- agreed with their employing organization’s sex education policy but emphasized the fact that, if they were not to adhere to the policy, it would put them in danger of losing their jobs. As Eloise, a 60-year-old junior high school teacher, shared, “No matter how much you enjoy the students or you know the students, it’s just not safe, as a teacher, to explain those kinds of things.” Safety was not something Eloise could be assured if she overstepped the bounds of her school mandate.

Heidi, a 27-year-old high school teacher, admitted she had discussed things in the class- room that could have led to her dismissal:

Yeah there’s kind of like a black hole there . . . and when I look back on it, if somebody really wanted to cite me on it, I guess I technically could have lost my job if someone, and I guess I’m still in that same situ- ation, I mean I hope to god that somebody doesn’t want to take it that far.

Heidi described the tension of having to choose whether or not to jump in the black hole and risk one’s own job security. This was a struggle echoed by Samantha, a 35-year-old high school teacher, who indicated she felt an ongoing sense

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they felt would not support them in the face of stakeholder objections.

Discursive Strategies for Managing Conflicted Identification In spite of the sense of futility individuals such as Jake seemed to associate with their experiences of conflicted identification in the sex education classroom, a number of participants nonetheless delineated distinct communicative strategies allowing them to subvert the dominant ideology and lessen their feelings of conflict and futility. These strategies included finding ways to be stu- dent-focused, relying on sources external to the organization, and choosing silence or evasion.

Student-Centered Communication Strategies Throughout the interviews, participants repeat- edly indicated that they sought out ways to be student-centered in the classroom and thereby limit their sense that they were doing either their students or their employing organizations a disservice. In other organizational contexts, this strategy may be best translated as a client- focused orientation. In this sample, participants reasoned, given that the schools’ objective is to educate and thereby meet the needs of students, the choices teachers made to respond to stu- dents’ experiences and inquiries would always align with schools’ objectives in some respect, even if they technically defied schools’ absti- nence-only mandates. As Keri, a 52-year-old high school teacher, explained, being student- centered and thereby serving the needs of the employing organization in an overarching sense involved accounting for the specific subjectivi- ties and experiences of the populations served:

Well, in the inner city I answer [questions that fall out- side of the scope of the abstinence-only curriculum]. If I know it. Otherwise, if I tell them I don’t know it, I’ll go find out. Because you can’t, with inner-city kids, I  mean you have to answer the questions or they’ll get,  I’m telling you, they just won’t believe in the curriculum. They won’t think you’re authentic.

From this perspective, sex educators feeling conflicted about diverse parental goals will likely always face dissent. However, without an employer sharing ideological perspectives about curricula, educators may feel especially ungrounded in their professional choices.

In a number of these cases, participants’ sense of conflicted identification was revealed in light of their concerns about potentially nega- tive parental responses. Nathan, the 30-year-old junior high teacher who expressed anger at being forced to teach an abstinence-only curriculum, indicated that he only teaches out of the text- book “because I don’t want parents calling me” and because “I’m scared of getting sued. I’m so scared of getting sued. You get sued left and right and it’s all based on that.” Nathan, an individual adamant about what should be taught, still fol- lowed the organization’s mandate because of the potential for stakeholder objections. Similarly, Joy, a 65-year-old junior high school teacher, explained, “Parents—they can be pretty scary.” Concerns about “scary” organizational stake- holders and getting sued were compounded by concerns about job security, as well as accep- tance within the larger community. Jake, a 52-year-old junior high teacher, explained,

And it’s like anything else, it only takes one person to write a letter to the editor, to call a school board member, and if those people don’t want to deal with it, it comes from the top down. Watch what you do, watch what you say, don’t be controversial. And like I said, you have to pick your battles and most of the time it’s not worth the hassle.

Jake argued that a single disgruntled stake- holder had the power to set off a chain reac- tion in which an employee would be framed as, at best, problematic and, at worst, unfit for their job. Given that parents may become upset regardless of course content or teaching meth- ods, sex educators in this sample seemed to feel an almost constant tension related to the choices they made in their job and their sense of identification with employing organizations

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what do we do?” And that’s all I have to do, and then I can teach it.

This strategy offers the added benefit of giving teachers additional control over when, where, how, and whether specific questions were answered, as Jennie, a 47-year-old high school teacher, made clear:

Yeah, and I’ve had, you know, just very few times over the course of 25 years where a kid has taken me some place where, uncharted waters or what not, and if I know that there’s no malice on their part, I can respectfully say just within the normal classroom management, I can say, “Let’s you and I chat about that at a different time,” not trying to be demeaning to them, but yeah, I’ll deal with it at some point, maybe not in front of 32 of them, but I’ll deal with it.

Beyond speaking with specific students one- on-one, other teachers drew from student-sub- mitted questions and rephrased them in ways they deemed more appropriate for class discus- sion. That these discussions ultimately seemed to be generated from students, rather than from the teacher, offered teachers a degree of justifi- cation for extending the curriculum and allevi- ated their sense of conflicted identification.

Employing Sources External to the Organization Another strategy participants used for provid- ing students with information outside of the mandated curriculum, without explicitly defy- ing the mandate itself, involved directing stu- dents to external resources. Evan, a 49-year-old junior high school teacher, explained he would provide students with abbreviated answers to their questions and then refer them to a nurse for further information. Other participants, such as Carolyn, a 43-year-old junior high school teacher, relied on resources outside of the school for student referrals:

I said there were [questions about things like abor- tion or pregnancy], I will give them that lady’s number [an external organization], because she’s been ok’d by the school and then she can get into

It takes a long time to get their trust anyway. Once you’ve got their trust, then you can help educate them. But these kids are not trusting people. But their lives are not trusting; these kids have hard lives. They come to school; we have a 99% attendance rate. So they come to school because they live in unsafe neighbor- hoods. They don’t have stable home lives. A lot of time, they’re switching places to live every 2 months. I mean, it’s just not, and they need someone they can trust that can give them the right information. My kids have really hard lives.

In accounting for the lived experiences of her students, Keri came to the conclusion that student questions must guide her curriculum because anything other than a student-led dis- cussion would result in students’ lack of faith in her and her ability to teach.

Other participants explained how they cre- ated the space in which to answer the difficult questions students might ask and thereby extend the mandated curriculum. Several participants indicated they utilized question boxes for stu- dents to submit inquiries, or they opened the floor for discussion. These participants operated under the philosophy that if the student asked the question, they, as educators, were at liberty to answer said question. Heidi, a 27-year-old high school teacher, explained her approach, stating:

I kind of have an environment where the kids can feel open to ask questions and I like that because kind of where our school stands on how you go about teaching it is abstinence-only. That’s all that they really want us to tell our students but I feel that if they ask the question, I feel that I have the obliga- tion to tell them, at least give them the knowledge or where they can go to find the correct answer.

Emily, a 47-year-old high school teacher, echoed that she had also found success with this approach:

In the [state] that’s all we’re supposed to teach [abstinence], but the little leeway is that if somebody asks then I can teach it. So I usually do a lead-in and get them to ask a question about, well, “If you don’t want to have a kid but you want to have sex, then

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or teaching strategies with others. The following interview exchange with Justine, a 29-year-old high school teacher, highlights this strategy:

Justine: I guess I go by the “don’t ask, don’t tell” phi- losophy but I’ve never had anybody question as far as . . .

Interviewer: And so if they do start asking, it sounds like people start getting concerned about what’s going on.

Justine: Right, right.

By keeping to herself, Justine suggested she evaded the extra attention and corresponding concern that might be generated from discus- sions about her teaching. Later in the same inter- view, Justine explained she makes information from Planned Parenthood available to students, but she has to be strategic in how she does so:

Interviewer: Do you think that your school board would find [giving students information about Planned Parenthood] problematic, or do you think that would be okay . . . ?

Justine: It’s hard to say. I’m thinking that, again, they would be, if they found out it was going on, I think they would have a problem with it. So I would be hesitant just to . . .

Interviewer: Right. Just to have the [Planned Par- enthood] cards [handed out to all students].

Justine: Yeah, but I might put a number on a bulletin board so it’s there.

In this case, Justine, like Carolyn, Eloise, and Keri, used the strategy of referring students to sources external to the organization.

Another example of evasion strategies at work involved situations wherein educators felt compelled to expand on the information pro- vided by external sources. For example, Katie, a 31-year-old junior high teacher, noted her dis- trict contracts with a religious-based organiza- tion to teach an abstinence-only curriculum. In their presentations, this contracted orga- nization takes the stance “no birth control is 100% effective except for self-control. . . . They say condoms do not work effectively 100% of the time.” Katie explained that explanation

it further and she can keep it quiet if she wants or whatever she wants to do.

Similarly, Eloise, a 60-year-old junior high teacher, relied extensively on external resources. One of the external presenters who visited her classes ultimately became a long-term resource for stu- dents as he

gives a telephone number, where they [the students] can call if they need help with anything or if they have any more questions. He has a website that he really encourages them to use, to keep in touch with him, let him know [what] they’re doing, if they’re having any questions or feelings that they’re having some trouble with.

Furthermore, Eloise explained that she actively fostered a persona that encourages students to go to others with their questions: “Students don’t generally talk to me. I’m not one that they come talk to. I’m pretty strict.”

This practice of encouraging students to ask other individuals about their questions seemed to help teachers feel they were staying within the bounds of their employing organization’s directives without denying students the infor- mation they felt was needed. In some cases, this strategy involved directly answering some beyond-the-pale questions first and then refer- ring students elsewhere. For instance, Keri, the 52-year-old inner-city high school teacher quoted above, explained to her students “come and talk to me about STDs and I refer them to the County health department and get the social worker involved.” But in other cases, such as that of Carolyn and Eloise, this strategy involved no more than a referral and thereby offered a rela- tively conservative approach to stretching the limits of organizational mandates and alleviat- ing the tensions of conflicted identification.

Evasion A final strategy several participants delineated for alleviating their sense of conflicted identifica- tion was silence or evasion. That is, they indicated that they simply did not share their curriculum

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conflict (i.e., feelings of inauthenticity, concerns about job security, concerns about organiza- tional stakeholder disapproval), all of which may actually be grounded in overarching structural issues related to the organization as a whole. For instance, some participants pointed to a lack of formal training or guidance about what should/ could be covered in their sex education courses. They were familiar with the overarching ideol- ogy of the program but were not given formal training about how their teaching should mirror this ideology. Therefore, these individuals were left in a quandary, deciding what is and what is not appropriate as they balanced their desire to follow organizational rules with their per- sonal beliefs concerning what students needed to be taught. Furthermore, many participants also noted they received no training on teach- ing techniques specifically useful for teaching sex education. They indicated their particular teaching techniques came from trial and error. This suggests a more formalized training pro- gram for sex educators, either as part of college curricula or district/state-wide initiatives, may help ameliorate the organizational conflicts sex educators face and provide them with use- ful educational tools for communicating perti- nent information. This suggestion is in line with Petriglieri’s (2011) model proposing social sup- port as a moderator between identity threats and individuals’ responses to said threats.

In an applied sense, regardless of whether partici- pants’ sense of professional conflict was the result of a lack of guidance/training or of something else, participants in these interviews provided many com- ments suggesting their own sense of conflicted iden- tification affected their ability to do their job and students’ ability to learn. Students, they argued, could tell when they were being inauthentic and feeling conflicted about their degree of honesty and forthrightness in the classroom. Participants implied students probably picked up on this feeling and were less forthcoming with questions and less aggressive about seeking out sexual-health information than if they had encountered a more centered, open, and

results in “a lot of kids they walk away with the attitude ‘Well, if condoms don’t work, why bother?’” In response, she gives what she calls the “seat belt speech” once the organization has finished their presentation:

So I address it as, well, you can say that seat belts don’t always save your life in a crash, but you could say why bother, but if you are going to do something that’s risky, it’s probably a better idea to try to pro- tect yourself in some way, than not protect yourself at all. “Would it be safer to never get into a car?” Yeah, probably. But you have to protect yourself somehow.

Katie, it seems, took liberty to expand on the mandated curriculum, and she did so without making that information known to others in her organization.

What set this strategy apart from some of the examples discussed earlier is that the teachers were fairly certain that their employing organi- zation would not approve of the external source (in Justine’s case) or the message provided (for Katie). In this way, this strategy may actually function to heighten, rather than alleviate, the sense of conflicted identification employees experience as they are forced to carry out their job from within a context fraught with evasion and potential exposure.

DISCUSSION

The results of this study suggest that many of the sex educators who participated (n = 22) experienced an ideological conflict between what they were required to teach by an employ- ing organization and what they personally and professionally believed needed to be taught. This conflict left them in a precarious orga- nizational position as they constructed lesson plans and navigated classroom interaction.

Pragmatic Implications In the context of teaching sex education specifi- cally, participants who expressed a sense of con- flicted identification cited specific sources of

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NOTE 1. Conflicted identification has also been termed ambivalent or schizo-identification (see Elsbach, 1999).

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supportive instructor. These comments not only sup- port research highlighting negative professional and organizational outcomes of conflicted identification among employees (Kreiner & Ashforth, 2004) but also provide one possible reason why sex education in this country is, and long has been, failing. Future research needs to further explore the relationship between conflicted identification among sex educa- tors and students’ learning and health outcomes.

Limitations The present study is limited in that participants were all employed in the same state and, thus, do not represent the experiences of sex educators employed in other parts of the United States, par- ticularly those states with different educational mandates. In addition, the study was not able to include information about individual teacher rankings and reviews and, therefore, cannot speak objectively about the potential relationship between, for instance, professional success and the experience and negotiation of conflicted iden- tification. What the study does provide insight into, however, is the possibility that conflicted identification is often central to the experience of teaching sex education, and this subjectivity, and its implications may be managed via more-or-less subtle discursive mechanisms.

DECLARATION OF CONFLICTING INTERESTS

The authors declared no potential conflicts of interest with respect to the research, author- ship, and/or publication of this [reading].

FUNDING

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this [reading]: This research was supported by a research incentive grant from Purdue University’s College of Liberal Arts.

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The Case for Starting Sex Education in Kindergarten

Saskia de Melker

“Who here has been in love?” Anniek Pheifer asks a crowd of Dutch elementary school stu- dents. It’s a spring morning in Utrecht, and the St. Jan de Doper elementary school gym is decked in heart-shaped balloons and stream- ers. Pheifer and Pepijn Gunneweg are hosts of a kids’ television program in the Netherlands,

and they’re performing a song about having a crush. Kids giggle at the question. Hands— little and bigger—shoot up. Welcome to “Spring Fever” week in primary schools across the Netherlands, the week of focused sex ed classes  . . . for four-year-olds. Of course, it’s not just for four-year-olds. Eight-year-olds learn

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about self-image and gender stereotypes. Eleven-year-olds discuss sexual orientation and contraceptive options. But in the Netherlands, the approach, known as “comprehensive sex education,”1 starts as early as age four.

You’ll never hear an explicit reference to sex in a kindergarten class. In fact, the term for what’s being taught here is sexuality educa- tion rather than sex education. That’s because the goal is bigger than that, says Ineke van der Vlugt, an expert on youth sexual development for Rutgers WPF, the Dutch sexuality research institute behind the curriculum. It’s about hav- ing open, honest conversations about love and relationships. By law, all primary school stu- dents in the Netherlands must receive some form of sexuality education. The system allows for flexibility in how it’s taught. But it must address certain core principles—among them, sexual diversity and sexual assertiveness. That means encouraging respect for all sexual pref- erences and helping students develop skills to protect against sexual coercion, intimidation and abuse. The underlying principle is straight- forward: Sexual development is a normal pro- cess that all young people experience, and they have the right to frank, trustworthy information on the subject. “There were societal concerns that sexualization in the media could be having a negative impact on kids,” van der Vlugt said. “We wanted to show that sexuality also has to do with respect, intimacy, and safety.”

BEYOND RISK PREVENTION

The Dutch approach to sex ed has garnered international attention, largely because the Netherlands boasts some of the best outcomes when it comes to teen sexual health. On aver- age, teens in the Netherlands do not have sex at an earlier age than those in other European countries2 or in the United States.3 Research- ers found that among 12- to 25-year-olds in the Netherlands, most say they had “wanted and

fun” first sexual experiences. By comparison, 66 percent of sexually active American teens surveyed said they wished that they had waited longer to have sex for the first time.4 When they do have sex, a Rutgers WPF study found that 9 out of 10 Dutch adolescents used con- traceptives the first time,5 and World Health Organization data shows that Dutch teens are among the top users of the birth control pill.6 According to the World Bank, the teen preg- nancy rate in the Netherlands is one of the lowest in the world, rates of HIV infection are five times lower than in the United States, and sexually transmitted diseases are also low.7

There are multiple factors that likely con- tribute to these numbers. Easy access to con- traception is one. Condoms, for example, are available in vending machines, and the birth control pill is free for anyone under age 21. But there’s also a growing body of research that specifically credits comprehensive sexuality education. A recent study from Georgetown University shows that starting sex ed in pri- mary school helps avoid unintended pregnan- cies, maternal deaths, unsafe abortions and STDs.8 Proponents of the Dutch model argue that their approach extends beyond those risks. Their brand of sex ed reflects a broader empha- sis on young people’s rights, responsibility and respect that many public health experts say is the foundation of sexual health. A 2008 United Nations report found that comprehensive sex ed, when taught effectively, allows young people to “explore their attitudes and values, and to practice the decision-making and other life skills they will need to be able to make informed choices about their sexual lives.”9 Students who had completed comprehensive sex education in the Netherlands were also found to be more assertive and better commu- nicators, according to an independent health research agency that conducted a study of the Dutch programs.10 “We have to help young people navigate all the choices they face and

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students are comfortable enough to navigate pointed discussions about reproduction, safe sex, and sexual abuse.

LET’S NOT TALK ABOUT SEX

In the United States, sexual education var- ies widely from state to state. Fewer than half of U.S. states require schools to teach sex ed, according to the Guttmacher Institute, a global nonprofit that researches sexual and reproduc- tive health.11 Just last month Congress extended the Personal Responsibility Education Program (PREP), which funds comprehensive adoles- cent sexual health initiatives across the coun- try.12 At the same time they increased funding for programs that promote sexual abstinence until marriage to $75 million a year. And Deb Hauser, president of Advocates for Youth, a nonprofit dedicated to sexuality education, says that sex ed in the U.S. still overwhelmingly focuses on minimizing the risk of pregnancy and STDs from heterosexual intercourse.13 And nearly 4 in 10 millennials report that the sex education they received was not helpful, accord- ing to a survey by the Public Religion Research Institute.14 “We have failed to see that sexual health is far more than simply the prevention of disease or unplanned pregnancy,” says Hauser. That narrow focus, she says, leaves young peo- ple with few skills to cope with their feelings and make decisions in sexual encounters.

Not everyone agrees. In fact, comprehen- sive sex ed has yet to take hold in most parts of the country. Utah, for example, requires that abstinence be the dominant message given to students. It bans discussing details of sexual intercourse and advocating for homosexuality, the use of contraceptives or sexual activity out- side of marriage. Utah state representative Bill Wright has further tried to restrict sex ed. In 2012, he proposed a bill requiring that absti- nence-only be taught and that it be an optional

stand up for themselves in all situations, sexual and otherwise,” said Robert van der Gaag, a health promotion official at Central Holland’s regional public health center.

“LITTLE BUTTERFLIES IN MY STOMACH”

At the St. Jan de Doper school, a group of kin- dergartners sit in a circle as their teacher, Mar- ian Jochems, flips through a picture book. The pages contain animals like bears and alligators hugging. “Why are they hugging?” she asks the class. “Because they like each other,” one girl answers. Jochems asks them to think about who they like the most. Several kids say their mom or dad. One girl names her little sister. A few name other children at school. “How does it feel when that person hugs you?” Jochems asks. “I feel warm from the inside,” one boy replies. “It’s like there are little butterflies in my stomach.” Lessons like this are designed to get kids thinking and talking about the kind of intimacy that feels good and the kind that doesn’t. Other early lessons focus on body awareness. For example, students draw boys’ and girls’ bodies, tell stories about friends tak- ing a bath together, and discuss who likes doing that and who doesn’t. By age seven, students are expected to be able to properly name body parts including genitals. They also learn about different types of families, what it means to be a good friend, and that a baby grows in a moth- er’s womb. “People often think we are start- ing right away to talk about sexual intercourse [with kindergartners],” van der Vlugt says. “Sexuality is so much more than that. It’s also about self-image, developing your own identity, gender roles, and it’s about learning to express yourself, your wishes and your boundaries.”

That means the kindergartners are also learning how to communicate when they don’t want to be touched. The goal is that by age 11,

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LESSONS IN LOVE

Sabine Hasselaar teaches 11-year-olds. In a recent class, Hasselaar posed a series of hypo- thetical situations to her students: you’re kissing someone and they start using their tongue, which you don’t want. A girl starts dancing close to a guy at a party, causing him to get an erection. Your friend is showing off pornographic photos that make you feel uncomfortable.

The class discusses each scenario. “Every- one has the right to set their own limits and no one should ever cross those limits,” Hasselaar says. There is an anonymous “Question Box” in her class during “Spring Fever” week. Students submit questions that teachers later address in class. “Nothing is taboo,” Hasselaar says. One of her students, for example, wrote: “I think I am lesbian. What should I do?” Hasselaar addressed the issue in class: “It’s not strange for some girls to like other girls more than boys. It’s a feeling that you can’t change, just like being in love. The only difference is that it’s with some- one that is the same sex as you.” And in fact, most of the questions from her students aren’t about sex at all. “Mostly they are curious about love. I get a lot of questions like, ‘What do I do if I like someone?’ or ‘How do I ask some- one to go out with me?’” Questions like these are taken just as seriously as the ones about sex. “Of course, we want kids to be safe and to understand the risks involved with sex, but we also want them to know about the positive and fun side of caring for someone and being in a healthy relationship,” van der Vlugt says. That’s why you’ll find teachers discussing the differ- ence between liking someone (as a friend) and liking someone. There’s even a lesson on dat- ing during which a teacher talked about how to break up with someone in a decent way: “Please do not do it via text message,” the teacher said.

After elementary school, these students will likely go on to receive lessons from a widely used

subject. It passed but was vetoed by the gov- ernor. Sex ed is “not an important part of our curriculum,” Wright said.15 “It is just basically something out there that takes away from the character in our schools and takes away from the character of our students.”

Utah is far from alone. Half of U.S. states require that abstinence be stressed.16 “We have created generations of people who are not comfortable with their own sexuality,” says Dr.  David Satcher, the former U.S. surgeon general. That extends to parents and teach- ers, he says. In other places, the tide is shift- ing toward an approach closer to that of the Dutch. Two of the largest school districts in the country—Chicago Public Schools and Florida’s Broward County—have recently mandated sex education for elementary school students. Chicago Public Schools requires at least 300 minutes a year of sex education for kindergar- ten through fourth-grade students and twice as much time for fifth through twelfth graders.17 In 2014, schools in Broward County began teaching sex  education at least once a year in every grade,18 and the curriculum includes information about topics like body image, sex- ting and social media.

In the Netherlands, schools aim to educate parents too. Parents’ nights are held to give parents tools to talk to their kids about sex. Public health experts recommend that parents take cues from their kids and make it an ongo- ing conversation, rather than one awkward, all-encompassing “birds and the bees” talk. For example, they advise, if you walk in on your child masturbating, don’t react shocked; don’t punish or scold them. Have a talk about where it is appropriate for such behavior to occur. “We talk about [sex] over dinner,” said one father at a Spring Fever Parents’ Night. Another said he recently answered questions about homo- sexuality posed by his twin six-year-olds during bath time.

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8. http://irh.org/wp-content/uploads/2014/05/Investing_in _VYAs_SRH_2014.pdf.

9. http://unesdoc.unesco.org/images/0018/001832/183281e .pdf.

10. http://www.rescon.nl/.

11. https://www.guttmacher.org/state-policy/explore/sex -and-hiv-education. [Editors’ note: While all U.S. states and the District of Columbia provide some level of sexuality education (see Reading 20), only 24 states and the District of Columbia mandate sex education. Other states may allow school districts or individual schools to opt out of sex education or provide limited content such as HIV education.]

12. https://www.acf.hhs.gov/opre/research/project/personal -responsibility-education-program-prep-multi-component.

13. http://www.advocatesforyouth.org/.

14. https://www.prri.org/wp-content/uploads/2015/03 /PRRI-Millennials-Web-FINAL.pdf.

15. https://www.ksl.com/?sid=19180217.

16. https://www.guttmacher.org/state-policy/explore/sex -and-hiv-education.

17. http://www.siecus.org/index.cfm?fuseaction=Feature .showFeature&featureID=2297.

18. http://miami.cbslocal.com/2014/05/06/broward-school -board-to-vote-on-new-sex-ed-policy/.

19. https://www.langlevedeliefde.nl/docenten.

20. http://www.amyschalet.com/not-under-my-roof-parents -teens-and-the-culture-of-sex/.

curriculum called Long Live Love.19 “In the U.S., adults tend to view young people as these bun- dles of exploding hormones. In the Netherlands, there’s a strong belief that young people can be in love and in relationships,” says Amy Schalet, an American sociologist who was raised in the Netherlands and now studies cultural attitudes toward adolescent sexuality, with a focus on these two countries.20 “If you see love and rela- tionships as the anchor for sex, then it’s much easier to talk about it with a child,” Schalet says. “Even a young one.”

NOTES 1. http://www.unfpa.org/comprehensive-sexuality- education.

2. http://www.euro.who.int/__data/assets/pdf_file/0003 /163857/Social-determinants-of-health-and-well-being -among-young-people.pdf.

3. https://www.cdc.gov/nchs/data/series/sr_23/sr23_031 .pdf.

4. http://www.whijournal.com/article/S1049-3867%2811 %2900008-9/abstract.

5. https://www.rutgers.nl/sites/rutgersnl/files/PDF -Onderzoek/Factsheet_Seksonderje25ste_ENG.pdf.

6. http://www.euro.who.int/en/health-topics/Life-stages /child-and-adolescent-health/child-and-adolescent-health2 /youth-friendly-services/health-behaviour-in-school-aged -children-hbsc2.-who-collaborative-cross-national-study-of -children-aged-1115.

7. https://data.worldbank.org/indicator/SP.ADO.TFRT.

Source: “The Case for Starting Sex Education in Kindergar- ten,” PBS NewsHour, May 27, 2015. Reprinted by permis- sion of Creative News Group.

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R E A D I N G 1 9

Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth need and deserve to learn in settings that are inclusive of their experiences and that give them the education necessary to stay safe and healthy. Far too many LGBTQ youth are sitting in classrooms where their teachers and text- books fail to appropriately address their iden- tities, behaviors, and experiences. Nowhere is this absence more clear, and potentially more damaging, than in sex education.

Sex education can be one of the few sources of reliable information on sexuality and sexual health for youth. Hundreds of studies have shown that well-designed and well- implemented sex education can reduce risk behavior and sup- port positive sexual health outcomes among teens, such as reducing teen pregnancy and sexually transmitted infection (STI) rates.1

For LGBTQ youth to experience compara- ble health benefits to their non-LGBTQ peers, sex education programs must be LGBTQ- inclusive. Inclusive programs are those that help youth understand gender identity and sexual orientation with age-appropriate and medically accurate information; incorporate positive examples of LGBTQ individuals, romantic relationships, and families; emphasize the need for protection during sex for people of all identities; and dispel common myths and stereotypes about behavior and identity.

Whether legally barred or simply ignored, LGBTQ-inclusive sex education is not available for most youth. The GLSEN 2013 National

School Climate Survey found that fewer than 5 percent of LGBT students had health classes that included positive representations of LGBT-related topics.2 Among Millennials sur- veyed in 2015, only 12 percent said their sex edu- cation classes covered same-sex relationships.3

To right these inequities, Advocates for Youth, Answer, GLSEN, the Human Rights Campaign, Planned Parenthood Federa- tion of America, and the Sexuality Infor- mation and Education Council of the U.S. (SIECUS) are calling on parents, youth, educators, and policymakers to help by:

1. Becoming advocates for LGBTQ-inclusive sex education

2. Ensuring that school is a safe and accepting space for LGBTQ students

3. Implementing LGBTQ-inclusive sex edu- cation in schools, community settings, and online

4. Talking to their own children and teens about sex and sexuality

5. Working to remove state-level legal and policy barriers to LGBTQ-inclusive sex education in schools and to require inclusive programs

LGBTQ YOUTH NEED INCLUSIVE SEX EDUCATION

H U M A N R I G H T S C A M P A I G N , I N C O L L A B O R AT I O N W I T H A D V O C AT E S F O R Y O U T H , A N S W E R , G L S E N , P L A N N E D

P A R E N T H O O D F E D E R AT I O N O F A M E R I C A , A N D T H E S E X U A L I T Y I N F O R M AT I O N A N D E D U C AT I O N C O U N C I L O F T H E U . S . ( S I E C U S )

From “A Call to Action: LGBTQ Youth Need Inclu- sive Sex Education,” from HRC.org. Copyright © 2018 Human Rights Campaign Foundation. All rights reserved. Reproduced with permission. Any further use without the express written consent of Human Rights Campaign Foundation is prohibited.

224 L E A R N I N G A B O U T S E X

that homosexual conduct is a criminal offense under the laws of the state.”8 In addition to this list, states such as Florida and North Carolina mandate that sex education focus on “monoga- mous heterosexual marriage.”9

While there are many other states that do not have such prohibitions against discussing homosexuality, few states require education about sexual orientation or programs that are inclusive of LGBTQ youth. According to HRC’s 2014 State Equality Index, only four states— California, Colorado, Iowa, and Washington— and the District of Columbia have state laws or regulatory guidance requiring sex education provided to students to be specifically inclusive of LGBTQ youth.10 Only 12 states require that sexual orientation be discussed in sex educa- tion at all. The lack of such requirements leaves states without clear guidance.11 The specific content of sex education is typically decided on a local level by school boards, advisory com- mittees, or even individual teachers—the result too often being the exclusion of LGBTQ youth.

Exclusionary and Hostile School Environments for LGBTQ Youth Only 12 percent of Millennials said their sex education class covered same-sex relationships.12 Across the United States, less than 5 percent of middle and high school students reported hav- ing positive discussions of LGBT-related topics in their health classes.13 According to the CDC, in states that allow LGBTQ-inclusive content, the percentage of secondary schools that actu- ally provided sex education curricula or supple- mentary materials that were LGBTQ-inclusive ranged from 8 to 44 percent.14 In other words, even in the states where educators are allowed to include LGBTQ-specific information, the vast majority of them do not.

In areas that implement abstinence-only curricula, students may hear messages that:15

• Promote fear of same-sex attraction: “Young persons may sense affection and

THE PROBLEM

Background and Funding The provision of sex education in public schools has a long and complicated history in the United States that is fraught with contro- versy stemming from disagreements over what youth should be taught about sex. Abstinence- only-until-marriage education, which began receiving major federal funding in the early 1980s during the Reagan administration, pro- motes abstaining from sex outside of marriage, emphasizes the failure rates of condoms and other methods of birth control, and generally overlooks or stigmatizes LGBTQ people.4

Despite evidence of its ineffectiveness,5 it then went on to receive significant funding increases during the George W. Bush administration. Since 1996, abstinence-only-until- marriage edu- cation has received more than $1.8 billion in fed- eral taxpayer funding.

The Legal Landscape State laws regarding sex education vary widely across the country. Sex education is legally mandated in [24] states and the District of Columbia.6 When sex education is provided in schools, only 13 states require that the instruc- tion be medically accurate; 26 states and the District of Columbia require that the informa- tion be appropriate for the students’ age; and 18 states and the District of Columbia require that information on birth control be provided.7

There are also laws and policies that explicitly or in effect prohibit inclusion of LGBTQ con- tent in sex education. There are eight states that explicitly restrict the teaching of LGBTQ-related content in schools: Alabama, Arizona, Louisi- ana, Mississippi, Oklahoma, South Carolina, Texas and Utah. While some states, like Arizona, prohibit instruction that “promotes a homosex- ual lifestyle,” others like Alabama, require teach- ers to “emphasize [. . .] that homosexuality is not a lifestyle acceptable to the general public and

LG B TQ YO U T H N E E D I N C LU S I V E S E X E D U C AT I O N 225

students who reported high levels of victim- ization and discrimination at school because of their sexual orientation or gender expres- sion were more than three times as likely as their peers to have missed school in the past month, have lower GPAs, lower self-esteem, and higher levels of depression compared to their less frequently victimized peers.22

THE SOLUTION

LGBTQ-Inclusive Sex Education Quality sex education provides students with opportunities for learning sexual health infor- mation, exploring attitudes and values about sexuality and relationships, and developing criti- cal interpersonal skills. Sex education encour- ages students to talk with their parents about sex and teaches students communication, nego- tiation, and refusal skills they can use to form healthy relationships. Hundreds of studies have shown that well-designed and well-implemented sex education programs can reduce sexual risk and support positive sexual health outcomes among teens:23

• delaying the age of first sexual intercourse • reducing the overall number of sexual partners • reducing unprotected sex and increasing use

of condoms and contraception • reducing unintended teen pregnancy • reducing rates of teen HIV and other STIs

LGBTQ youth deserve to receive the same ben- efits from sex education as their non-LGBTQ peers. Overcoming the current health dispari- ties experienced by LGBTQ youth requires supportive learning environments and sex edu- cation programs that are inclusive of their iden- tities, needs, and experiences.

Sex education that is LGBTQ-inclusive should, at a minimum:

• Include information for all students about sexual orientation and gender identity that is medically accurate and age-appropriate.

even infatuation for a member of the same sex. This is not the same thing as ‘being’ homosexual. Any same-sex ‘sexual experi- mentation’ can be confusing to young per- sons and should be strongly discouraged.”16

• Reinforce gender stereotypes and het- erosexual relationships: “What do guys talk about in the locker room? (Girls) What do girls talk about at sleepover parties? (Guys)”17

• Mandate heterosexual marriage: “The only safe sex is in a marriage relationship where a man and a woman are faithful to each other for life.”18

• Disparage nontraditional families: “Sin- gle women are trying to be both mother and father. The absentee dad has become a norm in many communities. It is interest- ing that domestic violence, child abuse, and poverty have also increased in proportion to the decline in the sanctity of marriage.”19

Sex education programs that stigmatize LGBTQ people help cultivate hostile school environments by ignoring LGBTQ identities and experiences, or worse, actively promot- ing LGBTQ stigma. LGBT students who reported receiving an abstinence-only sex education curriculum were less likely to feel safe at school, more likely to miss school because they felt unsafe or uncomfortable, less likely to feel comfortable talking about LGBT issues with school personnel, and less likely to be able to identify educators who were supportive of LGBT students.20 In the eight states that prohibit the positive discus- sion of homosexuality in schools, students were more likely to hear homophobic remarks from school staff, less likely to report feel- ing supported by school staff, less likely to receive an effective response to harassment from school staff, and less likely  to have LGBTQ resources in schools such as compre- hensive anti-harassment/assault policies and Gay-Straight Alliances.21 Furthermore, LGBT

226 L E A R N I N G A B O U T S E X

nity settings, or online that are designed or adapted to be LGBTQ-inclusive can make a difference for LGBTQ youth—particularly if they are evidence-based.

A study of the impact of LGB-inclusive HIV education found that LGB students receiv- ing inclusive education reported fewer sexual partners, less recent sex, and less substance use before having sex than LGB youth in other schools.26 In a survey of more than 1,200 mid- dle and high school students across California, students whose health and sexuality classes expressed support for LGBTQ people were less likely to report bullying based on sexual orien- tation and gender expression.27 These students were also more likely to feel safe at school. Inclusive content in other subjects made a dif- ference, but sexuality and health education classes mattered most across various measures of school climate.

Public Support for LGBTQ-Inclusive Sex Education Parents and leading health organizations alike support providing more LGBTQ-inclusive sex education. Ninety-six percent of parents sup- port providing sex education in high school and 94 percent support it in middle school. Further, 85 percent of parents specifically support dis- cussion of sexual orientation as part of sex edu- cation in high school and 78 percent support it in middle school.28

Many health organizations have issued statements and position papers expressing their support for LGBTQ-inclusive education:

• The Society for Adolescent Medicine: “Health educators and clinicians caring for adolescents should promote social and cul- tural sensitivity to sexually active youth and gay, lesbian, bisexual, transgendered [sic], and questioning youth. Health education cur- ricula should also reflect such sensitivity.”29

• Be designed with the needs of LGBTQ stu- dents in mind and be implemented with awareness that all classes are likely to have some LGBTQ students.

• Include depictions of LGBTQ people and same-sex relationships in a positive light in stories and role-plays.

• Use gender-neutral terms such as “they/ them” and “partner” whenever possible.

• Ensure that prevention messages related to condom and birth control use are not relayed in a way that suggests only hetero- sexual youth or cisgender male/female cou- ples need to be concerned about unintended pregnancy and STI prevention.

• Avoid making assumptions about students’ sexual orientation or gender identity.

Comprehensive sex education delivered in schools from kindergarten through 12th grade is the best way to provide truly LGBTQ- inclusive sex education and ensure positive sexual health outcomes for all youth. These programs provide medically accurate and age-appropriate information on human devel- opment, relationships, personal skills, sexual behavior, including abstinence, sexual health, and society and culture.24 Most importantly for LGBTQ youth, comprehensive sex education provides factual, non-stigmatizing information on sexual orientation and gender identity as a part of human development and teaches youth to respect LGBTQ people with messages like “Making fun of people for not acting the way society expects them to based on their biologi- cal sex [sic] is disrespectful and hurtful” and “People deserve respect regardless of who they are attracted to.”25

Though comprehensive sex education is far from common in U.S. schools, sex education of any kind is a logical venue to help young people learn about identity and encourage acceptance for LGBTQ people and families. Even smaller- scope programs delivered in schools, commu-

LG B TQ YO U T H N E E D I N C LU S I V E S E X E D U C AT I O N 227

members, so consider joining to advocate for inclusive curricula. School clubs, such as Gay- Straight Alliances, can also play a role in educat- ing peers and advocating with educators at school for inclusive sex education. When possible, orga- nize other people to advocate with you. Consult Youth Activist’s Toolkit from Advocates for Youth for more ideas. GLSEN and the Gay-Straight Alliance Network also have many resources to help build or strengthen Gay-Straight Alliances.

Parents and Community Members Find out what is being taught in your local schools. Many people have no idea whether their schools are providing abstinence-only-until-marriage education, sex education programs that are non-inclusive, or truly inclusive programs.

Become an advocate. The way that decisions about sex education curricula are structured varies by school district but there is generally a school health advisory committee that helps oversee curriculum choice. Parents and other community members can speak to school health advisory committees (SHACs), school boards, school administrators, and teach- ers about the need for LGBTQ-inclusive sex education programs. When possible, join the health advisory committee to help positively influence curriculum decisions.

Talk about sex with your own children. Learn about parent–child communication techniques and talk to your own children about the range of gender identities and expressions, as well as  healthy sexuality and relationships. Advocates for Youth has a comprehensive guide to help parents through difficult conver- sations and Planned Parenthood has a section on its website with tools for parents.

Educators Develop and implement LGBTQ-inclusive sex education curricula. Educators should incor- porate best practices for LGBTQ inclusion in

• The American Public Health Asso- ciation: “Urges all states to require and adequately fund local school districts and schools to plan and implement comprehen- sive sexuality education as an integral part of comprehensive K-12 school health educa- tion. This education must be . . . consistent with community standards and efforts to foster safe and welcoming schools [and] be implemented in a nonjudgmental manner that does not impose specific religious view- points on students. . . . Districts should use multiple sources of data regarding students’ needs, knowledge, and behaviors so that they can plan programs that meet the prevention needs of all students, with due attention to those who might be at greater risk for HIV, other STIs, and pregnancy, such as young men who have sex with men and members of populations with high prevalence rates.”30

• The American Medical Association: “The American Medical Association (AMA) urges schools to implement comprehensive, developmentally appropriate sexuality edu- cation programs that . . . utilize classroom teachers and other professionals who have shown an aptitude for working with young people and who have received special train- ing that includes addressing the needs of gay, lesbian, and bisexual youth.”31

A CALL TO ACTION FOR YOUTH, PARENTS, COMMUNITY MEMBERS, EDUCATORS, AND POLICYMAKERS

Youth Become an advocate for inclusive sex education. LGBTQ youth and allies can speak to school health advisory committees (SHACs), school boards, school administrators, and teachers about the need for sex education programs that meet their needs. Some SHACs include student

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NOTES 1. Advocates for Youth. (2008). Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, D.C.: Alford, S. et al.; Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344–51; Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40(3), 206–17.

2. GLSEN. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014).

3. Public Religion Research Institute. How Race and Religion Shape Millennial Attitudes on Sexuality and Reproductive Health: Findings from the 2015 Millennials, Sexuality, and Reproductive Health Survey. Washington, D.C.: Jones, R. P., & Cox, D.

4. Sexuality Information and Education Council of the United States. A History of Federal Funding for Abstinence-Only-Until-Marriage Programs. Retrieved from http://www.siecus.org/index.cfm?fuseaction=page .viewpage&pageid=1340&nodeid=1.

5. Kantor, L. M., Santelli, J. S., Teitler, J., & Balmer, R. (2008). Abstinence-only policies and programs: An overview. Sexuality Research & Social Policy, 5(3), 6–17.

6. Guttmacher Institute. (2018, July 1). State Laws and Policies: Sex and HIV Education. Retrieved from https://www .guttmacher.org/state-policy/explore/sex-and-hiv-education.

7. Ibid.

8. GLSEN. “No Promo Homo” Laws. Retrieved from http:// www.glsen.org/learn/policy/issues/nopromohomo.

9. National Coalition to Support Sexuality Education. State Mandates and Coalitions. Retrieved from http://www.ncsse .com/index.cfm?pageid=939.

10. Human Rights Campaign Foundation. (2015). 2014 State Equality Index. Washington, D.C.: Gill, A.M.

11. Guttmacher Institute. (2018, July. 1). State Laws and Policies: Sex and HIV Education. Retrieved from https://www .guttmacher.org/state-policy/explore/sex-and-hiv-education.

12. Public Religion Research Institute. How Race and Religion Shape Millennial Attitudes on Sexuality and Reproductive Health: Findings from the 2015 Millennials, Sexuality, and Reproductive Health Survey. Washington DC: Jones, R. P., & Cox, D.

sex education curricula delivered in schools, community settings, and online. Resources for developing inclusive programs include your local Planned Parenthood affiliate, Answer’s professional development workshop, LGBTQ Issues in Schools, and “Responsive Classroom Curriculum for Lesbian, Gay, Bisexual, Trans- gender, and Questioning Students” in Creating Safe and Supportive Learning Environments: A Guide for Working with Lesbian, Gay, Bisexual, and Questioning Youth and Families.32

Promote inclusivity throughout the school expe- rience. The more that LGBTQ topics are dis- cussed in the classroom and visible on campus, the better it is for LGBTQ youth. It is safe to assume that you have LGBTQ students in your class, whether you know it or not. Support or help students start affirming student organiza- tions like Gay-Straight Alliances. Ensure an early and integrated approach to all LGBTQ issues by talking about LGBTQ people in his- tory, using examples of same-sex couples in math word problems, and using terminology that acknowledges different family structures and gender identities. For more ideas on cre- ating inclusive classrooms, consult GLSEN’s LGBTQ- Inclusive Curriculum Guide for Edu- cators and lesson plans on bullying, bias, and diversity.

Policymakers Remove legal barriers. Policymakers are in a unique position to create change and clear legal roadblocks to LGBTQ-inclusive sex education. Federal, state, and local policymakers should work to address gaps and remove restrictions in the policy landscape, requiring sex education that goes beyond disease or pregnancy and is truly LGBTQ-inclusive. Policymakers can also support funding for effective sex education and resources for teacher training, program evalua- tion, and research.

LG B TQ YO U T H N E E D I N C LU S I V E S E X E D U C AT I O N 229

24. Sexuality Information and Education Council of the United States. The Guidelines for Comprehensive Sexuality Education; Kindergarten–12th Grade, 3rd Ed. Retrieved from http://www.siecus.org/_data/global/images /guidelines.pdf.

25. Ibid.

26. Blake, S. M., Ledsky, R., Lehman, T., Goodenow, C., Sawyer, R., & Hack, T. (2001). Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health, 91(6), 940–46.

27. Snapp, S. D., McGuire, J. K., Sinclair, K. O., Gabrion, K., & Russell, S. T. (2015). LGBTQ-inclusive curricula: Why supportive curricula matter. Sex Education, (ahead-of- print), 1–17.DOI: 10.1080/14681811.2015.1042573.

28. Let’s Talk Poll. (2015). New York: Planned Parenthood Federation of America and Center for Latino Adolescent and Family Health.

29. Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health, 38(1), 72–81.

30. American Public Health Association. Policy Statement: Sexuality Education as Part of a Comprehensive Health Education Program in K to 12 Schools. Retrieved from http:// www.apha.org/policies-and-advocacy/public-health-policy -statements/policy-database/2015/01/23/09/37/sexuality -education-as-part-of-a-comprehensive-health-education -program-in-k-to-12-schools.

31. Council on Scientific Affairs. Report of the Council on Scientific Affairs. [Action of the AMA House of Delegates 1999 Interim Meeting, CSA Report 7-I-99]. Chicago, IL: American Medical Association, 1999.

32. Greytak, E. G., & Kosciw, J. G. (2013). Responsive classroom curriculum for lesbian, gay, bisexual, transgender, and questioning students. In E. Fisher & K. Komosa-Hawkins, eds., Creating Safe and Supportive Learning Environments: A Guide for Working with Lesbian, Gay, Bisexual, and Questioning Youth and Families. New York: Routledge. 157–75.

13. Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.

14. Demissie, Z., Brener, N. D., McManus, T., Shanklin, S. L., Hawkins, J., & Kann, L. (2013). School Health Profiles 2012: Characteristics of Health Programs among Secondary Schools. Atlanta: Centers for Disease Control and Prevention.

15. Sexuality Information and Education Council of the United States. (2008). Pride or Prejudice: How Fear-Based Abstinence-Only-Until-Marriage Curricula Present Sexual Orientation. Retrieved from http://www .communityactionkit.org/index.cfm?fuseaction=page.view Page&pageID=1095&nodeID=3&stopRedirect=1.

16. Fuller, R., McLaughlin, J., & Asato, A. (2000). FACTS —Family Accountability Communicating Teen Sexuality, Middle School and Senior High School Editions. Portland, OR: Northwest Family Services.

17. Cook, B. (2000 & 2003). Choosing the Best LIFE. Atlanta, GA: Choosing the Best, Inc.

18. Phelps, S., & Gray, L. A. C. Green’s Game Plan. Glenview, IL: Project Reality, undated.

19. Frainie, K. (2002). Why kNOw. Chattanooga, TN: Abstinence Education Inc.

20. Kosciw, J. G., Diaz, E. M., and Greytak, E. A. (2008). 2007 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.

21. Kosciw, J. G., Greytak, E. A., Diaz, E. M., and Bartkiewicz, M. J. (2010). The 2009 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.

22. Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.

23. Advocates for Youth. (2008). Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, D.C.: Alford, S., et al.; Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344–51; Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40(3), 206–17.

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For the past decade, as a disabled sex educator, I have traveled the nation speaking at confer- ences, taught classes at the university level, and engaged in community-based sexual education. I have worked with other disabled people, their parents, and academics. Along the way I have run up against some commonly held myths about disability and sexuality. In this process, I have found “flipping the script” useful. Instead of merely ranting about social barriers to robust sexual lives for disabled people, I offer lessons that all people can learn from by dismantling tired disability and sexuality myths! Most of these myths are so widespread and ingrained in our psyches that few people are prepared to challenge these fallacies.

The most prominent disability and sexuality myth is that disabled people are either desex- ual or hypersexual. I intentionally use the term desexual rather than asexual. Desexualization is a social process in which people perceive others as not having sexual interest or activi- ties (Silverberg, Odette, & Kaufman, 2003), whereas asexuality is a sexual orientation, usu- ally referring to an absence of sexual attraction to others. In contrast, the term hypersexual, often associated with a clinical diagnosis, sug- gests an unnatural obsession with sex (Shake- speare, Gillespie-Sells, & Davies, 1996). People with mental health or intellectual disabilities often are viewed as hypersexual, while those with mobility or sensory disabilities are thought to be desexual. The lack of positive media rep- resentation about the nuances of life with a disability reinforces these misconceptions, like

too many oppressive cultural tropes. Too often we are flattened into characters that reflect lives that are fundamentally different from nondisabled lives; we are either inspirational or depressed and angry about our disabilities (Barnes, 1992). We are only our disabilities. Many portrayals of disability and actual encounters in society are loaded with patron- izing tones and assumptions of our childlike nature, leading to a desexualizing conclu- sion (Silverberg, Odette, & Kaufman, 2003). Disability is a unique marginalized identity because anyone can join at any moment due to accident or illness, and it cuts across all identity markers (e.g., political leaning, sexual orien- tation, race, class). It is then only logical that there are many sexual permutations among disabled people. Most of us are having sex or working on it. Some of us have clinical issues with hypersexuality. Some of us are asexual. We are just as diverse sexually as members of nondisabled communities, despite contend- ing with barriers erected socially. Ask yourself: If you had an injury or acquired a disability, would it cancel your desire? Would it increase your libido?

The second disability and sexuality myth is that disabled people are undesirable. Close your eyes and visualize what you consider to be a beautiful person. Reflecting on character- istics of beauty, my students often rely on soci- etal norms that represent interlocking systems of oppression (or how racism, homophobia, classism, fatphobia, transphobia, and ableism connect) (Collins, 2004). This means that when

Disability and Sexuality Myth-Busting: Non-normative Sex Liberates Us All

Bethany Stevens1

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disabilities and chronic conditions. At times, it is assumed our lives are not worth living, some- thing one can see in movies such as Million Dollar Baby (Eastwood, 2004) and Me Before You (Sharrock, 2016). The nondisabled people who opt to date, marry, and/or love us are assumed to be sacrificing good sex and there- fore are often viewed as valiant. While modi- fications may be necessary when approaching sex and modes of living, these adjustments often enhance intimacy and strengthen rela- tionships by requiring people to think outside the box of traditional sexual tropes.

The mainstream media and pornography tend to view passionate sex as spontaneous in nature. Women are expected to be slammed against a wall and penetrated without commu- nication about desires or safe-sex practices; the process cannot slow down because that would break the passionate thrust of the moment and the need to attend to men’s erections with immediacy. Yet, slowing down and having open and honest communication about needs and abilities, as well as formal negotiation of trig- gers and possible positions, can actually serve to reinforce sexual pleasure for all. While that may not be viewed as “hot” by some, planned sex can be just as hot or hotter than spontane- ous sex because you know your body will be protected (one of the best ways to show you love yourself), and fun activities such as role- playing can be added with just a bit of pre-sex conversation! How often do you have these conversations with your partners? How would it change your sexual script?

The fourth disability and sexuality myth is that disabled people do not have “real sex.” Some types of disabilities entail the inability to engage in penile–vaginal intercourse (PVI); others are more limited. While PVI can be pleasurable or exciting for many people, it reinforces het- eronormative sexual norms and simply should not be exalted as the ideal or the only appropri- ate sexual activity. Along with assuming PVI

they think about beauty, they tend to talk about young, thin, often white (though that depends on the crowd), gender-typical people. When asked about whether disability was part of their conception of beauty, most students admit it was not. It is sometimes assumed that if a non- disabled person is dating a disabled person the nondisabled person must have a perverted fetish; it is “unnatural” to find disabled people unattractive. The media reinforces what beauty entails, disenfranchising not just those with disabilities but anyone who does not meet the media’s unachievable standards.

Pornography and mainstream media also teach us that we should be orgasming simulta- neously and that our hair and makeup should look perfect in the process (Paul, 2006). People expect bodies to conform to a certain gram- mar of movement, in which people walk, move, talk, and even have sex in typical ways (Garland-Thomson, 1997). Although so-called beautiful imagery often defines sexual activ- ity, the reality for all is much more diverse and messy. The cinematic climax is vastly different than intimate climax. For example, it’s abso- lutely normal not to climax at the same time as your partner(s), and most people don’t look like perfectly coiffed models while doing it. The website Beautiful Agony (beautifulagony.com) offers a great myth-busting series of videos of the faces of people orgasming. Most seem to be consumed in the moment and not con- cerned at all that their faces are contorted in odd, lovely ways. Disability provides space to expand what beauty and sexuality can look, move, and feel like. How do we identify beauty beyond socially sanctioned Eurocentric youth- ful nondisabled imagery?

The third myth is that disabled people are pathetic partners who lack an adventurous spirit. Undoubtedly, this is tied to the widely held belief that disabled people are pitiable or frail. This notion is reinforced by telethons and organized races to raise money to cure us of our

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one gets the experience of figuring out plea- sure points in the body. I have my students do this and write about it. They marvel at hidden sexual gems in their body, such as finding the back of their knees are sensitive to touch. Addi- tionally, we do breathing exercises in class to help instill some tantra principles. Directed and conscious breathing can focus pleasure in an area of the body; it also has the capac- ity to elongate moments of pleasure peaking or orgasming. For example, Rafe Biggs explains that his training in tantra enabled him to shift his orgasmic body part away from his penis after acquiring a spinal cord injury. Through focused breath and mindfulness practices, he can achieve an orgasm through having some- one suck on his thumb (http://sexability.org). The bodymind—a term used by mental health scholars to show the interconnectedness between the mind and body, where when the body is in pain the brain may be foggy and vice versa—is remarkable when working in tandem to facilitate sexual pleasure in ways that do not meet the norm. How could you move beyond heteronormative, PVI-focused ideas of sex?

I hope this reading challenges your percep- tions of sexuality, enhancing your sexual life and helping you see disabled people as typical humans. I will end with some insight into my sexological life focus; it is largely inspired by one of the first leaders in disability and sexual- ity, Barbara Waxman Fiduccia, as well as my own experiences in disability and sexuality. Waxman Fiduccia brazenly encouraged the politicizing of disability and sexuality at a time when no one in the movement was discussing it. This was a time when more “important” social change was afoot with the passing of a major piece of civil rights legislation: the Americans with Disabilities Act (ADA). In 1991, Wax- man Fiduccia wrote, “Our movement has never addressed sexuality as a key political issue, though many of us find sexuality to be the area of our greatest oppression. That’s because we

sex is the best sex, many also assume it’s the one way to orgasm. Thank goodness there are multiple ways to orgasm, so people can have their choice of g-spot, breast or nipple, anal, mental, clitoral, or prostrate orgasms (Otto, 1999). Each type of orgasm can manifest dif- ferently in different people. An exciting truth about sexual activity is that it does not neces- sarily need to be genital-focused or end in an orgasm; we all have the capacity to experience pleasure in different parts of our body. Being sexually goal-oriented (or viewing sex as a stair- case in which one sequentially moves from kiss- ing, to fondling, to genital touching, and then to coitus with expectations of orgasm) can be anxiety-provoking and not pleasurable to some. Instead of thinking of sexual activity in steps, it’s useful to consider sexual activity as a wheel in which one can choose from a buffet of activities and enjoy the play. Sexual activity need not even include a partner. Indeed, mas- turbation is one of the suggested practices to learn more about your body and sexual needs. Sexual activity may not even require touch. Drs. Barry Komisaruk, Carlos Beyer-Flores, and Beverly Whipple (2006) completed fMRIs (or colorful brain scans) to demonstrate that people can even experience orgasms through fantasy alone; some people working in tantra— the art of merging meditation and sexual activ- ity to encourage mindfulness and attention to the breath—call this “thinking off” (Carrellas, 2007). Disability helps liberate orgasms by expanding our notions of what sex looks and feels like. It helps us learn that sex can be what we want it to be, not what we have learned from the media.

A really wonderful activity one can do alone or with partner/s to learn about their pleasure points is to complete a sexual blueprint. This entails going over the entire body—head to toe—with various forms of touch and pressure. Through touching softly, scratching, or press- ing with fingers, feathers, or leather floggers,

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on refuting the myths I have been taught about disability, sexuality, and beauty. It is important to critically engage with these issues as though your life depends on it, because for some of us, it does. Sexuality does not have to remain a silenced social problem; it can be our screamed solution to confining bonds of our sexualities. It can be a needed push against the accultur- ated hate of our bodyminds. It can be a space for needed moments of sexual utopia.

NOTE 1. Follow Bethany Stevens on Twitter as @disaBethany and her blog cripconfessions.com.

REFERENCES Barnes, Colin. 1992. Disability Imagery and the Media: An

Exploration of the Principles of Media Representations of Disabled People. Halifax: Ryburn Publishing Limited.

Carrellas, Barbara. 2007. Urban Tantra: Sacred Sexuality for the Twenty-First Century. New York: Ten Speed Press.

Collins, Patricia Hill. 2004. Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge.

Durkheim, Emile. 2007 (1897). On Suicide. Trans. Robin Buss. London: Penguin Classics.

Garland-Thomson, Rosemarie. 1997. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York: Columbia University Press.

Kauman, Miriam, Cory Silverberg, and Fran Odette. 2007. The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness. San Francisco, CA: Cleis Press Inc.

Komisaruk, Barry, Carlos Beyer-Flores, and Beverly Whipple. 2006. The Science of Orgasm. Baltimore, MD: The Johns Hopkins University Press.

Otto, Herbert Arthur. 1999. Liberated Orgasm: The Orgasmic Revolution. Silverado, CA: Liberating Creations, Inc.

Paul, Pamela. 2006. Pornified: How Pornography Is Transforming Our Lives, Our Relationships, and Our Families. New York: Times Books.

Shakespeare, Tom, Kath Gillespie-Sells, and Dominic Davies. 1996. The Sexual Politics of Disability: Untold Desires. London and New York: Cassell Wellington House.

Waxman, Barbara. 1991. “It’s time to politicize our sexual oppression.” The Disability Rag: 23–26.

are afraid we are ultimately to blame for not getting laid” (Waxman, 1991: 25). Regardless of how life-changing and empowering the ADA continues to be in the United States, Waxman Fiduccia’s thoughts about disability and sexual- ity remain true today.

I work to continue the legacy of Barbara Wax- man Fiduccia by bringing disability to sexuality spaces, and sexuality to disability spaces. I try to spread the good word about disability and sexu- ality to anyone who will listen! This is an impor- tant issue in my life because it has been such a strong force in sculpting my self-esteem, inter- actions with others, and overall socialization. As a teenager, I was sexually eager; I was aching to throw my (socially constructed) virginity at any- one who would take it. It was not until college that I started dating and having sex, and most of it was not so wonderful sex. I went from hating myself for not having sex to not loving myself enough to believe I deserved something better than the people I had sex with. I also had the youthful problem of having not figured out how to say what I want and get it.

A love of my life committed suicide because he was so exhausted from not being able to achieve nonchemically assisted erections after acquiring a spinal cord injury. It did not mat- ter what I said, or anyone else really; his mind was made up. When I learned of his death, I wailed from deep inside of me for what seemed like a month. I realized in that intense grieving process that I was not just grieving the death of a loved one, I was grieving all my comrades in disability communities who come close to los- ing or do lose their lives due to sexual stigma. As Durkheim (2007) showed, suicide is a pub- lic problem, and considering many of us think in patterns, it makes sense that myths and assumptions about manhood and disabled sex- uality could destroy a person. Every day I work

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In some respects, the problems associated with adolescent sexuality in America are sur- prising. Certainly, age at first intercourse has dropped in the United States since the sexual revolution, but not as steeply as often assumed. In a recent survey of the adult American pop- ulation, sociologist Edward Laumann and colleagues found that even in the 1950s and 1960s, only a quarter of men and less than half of women were virgins at age nineteen. The majority of young men had multiple sexual partners by age twenty. And while women espe- cially were supposed to enter marriage as vir- gins, demographer Lawrence Finer has shown that women who came of age in the late 1950s and early 1960s almost never held to that norm. Still, a 1969 Gallup poll found that two-thirds of Americans said it was wrong for “a man and a woman to have sex relations before marriage.”

But by 1985, Gallup found that a slim major- ity of Americans no longer believed such rela- tions were wrong. Analyzing shifts in public opinion following the sexual revolution, sociolo- gists Larry Petersen and Gregory Donnenwerth showed that among Americans with a religious affiliation, only conservative Protestants who attended church frequently remained unchanged. Among all other religious groups, acceptance of premarital sex actually grew, although Lau- mann and colleagues reported a majority of Americans continued to believe sex among teen- agers was always wrong. Even youth agreed: six in ten  fifteen- to nineteen-year-olds surveyed in

T he vast majority of American parents oppose a sleepover for high school–aged teenagers, while Dutch teenagers who have steady boyfriends or girlfriends are typi- cally allowed to spend the night with them in their rooms. This contrast is all the more strik- ing when we consider the trends toward a liber- alization of sexual behavior and attitudes that have taken place throughout Europe and the United States since the 1960s. In similar envi- ronments, both parents and kids are experienc- ing adolescent sex, gender, and relationships very differently. A sociological exploration of these contrasts reveals as much about the cul- tural differences between these two countries as it does about views on adolescent sexuality and child rearing.

ADOLESCENT SEXUALITY IN CONTEMPORARY AMERICA

Today, most adolescents in the United States, like their peers across the industrialized world, engage in intercourse— either opposite - or same-sex— before leaving their teens ( usually around seventeen). Initiating sex and exploring romantic relationships, often with several successive partners before settling into long-term cohabitation or marriage, are now normative parts of adolescence and young adulthood in the developed world. But in the United States, teenage sex has been fraught with cultural ambivalences, heated political struggles, and poor health outcomes, generat- ing concern among the public, policy makers, scholars, and parents. American adolescent sexuality has been dramatized rather than normalized.

SEX, LOVE, AND AUTONOMY IN THE TEENAGE SLEEPOVER

A M Y T . S C H A L E T

From “Sex, Love, and Autonomy in the Teenage Sleepover,” Contexts 9(3), pp. 17–21. Copyright © 2010, American Sociological Association. Reprinted by permission of SAGE Publications, Ltd.

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also documented intense struggles. Comparing teenage boys and girls, for example, University of Michigan sociologist Karin Martin found that puberty and first sex empowered boys but decreased self-esteem among girls. Psycholo- gist Deborah Tolman found the girls she inter- viewed confronted dilemmas of desire because of a double standard that denies or stigmatizes their sexual desires, making girls fear being labeled “sluts.” Analyzing the National Longi- tudinal Study of Adolescent Health, research- ers Kara Joyner and Richard Udry found that even without sex, first romance brings girls “down” because their relationship with their parents deteriorates.

Nor are American girls of the post–sexual revolution era the only ones who must navigate gender dilemmas. Sociologist Laura Carpenter found that many of the young men she inter- viewed in the 1990s viewed their virginity as a stigma, which they sought to cast off as rap- idly as possible. And in her ethnography Dude, You’re a Fag, C. J. Pascoe found boys are pres- sured by other boys to treat girls as sex objects and sometimes derided for showing affection for their girlfriends. But despite public pres- sures, privately boys are as emotionally invested in relationships as girls, found Peggy Giordano and her associates in a recent national study out of Toledo, Ohio. Within those relation- ships, however, boys are less confident.

In the 1990s, the National Longitudinal Study of Adolescent Health found that steady roman- tic relationships are common among American teenagers. Girls and boys typically have their first intercourse with people they are dating. But the Toledo group found that once they are sexu- ally experienced, the majority of boys and girls also have sex in non-dating relationships, often with a friend or acquaintance. And even when they have sex in dating relationships, a quarter of American girls and almost half of boys say they are “seeing other people” (which may or may not include sexual intercourse).

the 2002 National Survey of Family Growth said sixteen-year-olds with strong feelings for one another shouldn’t have sex.

Part of the opposition to adolescent sexu- ality is its association with unintended con- sequences such as pregnancy and sexually transmitted diseases. In the United States, the rate of unintended pregnancies among teenagers rose during the 1970s and 1980s, dropping only in the early 1990s. However, despite almost a decade and a half of impres- sive decreases in pregnancy and birth rates, the teen birth rate remains many times higher in the United States than it is in most European countries. In 2007, births to American teens (aged fifteen to nineteen) were eight times as high as in the Netherlands.

One would imagine the predominant public policy approach would be to improve educa- tion about, and access to, contraception. But “abstinence-only-until-marriage” programs, ini- tiated in the early 1980s, have received generous federal funding over the past fifteen years, and were even written into the recent U.S. health reform law (which also supports comprehen- sive sex education). For years, schools funded under the federal “abstinence-only” policy were prohibited from educating teens about con- doms and contraception and required to teach that sex outside of heterosexual marriage was damaging. A 2004 survey by NPR, the Kaiser Family Foundation, and Harvard University found that most parents actually thought that contraception and condom education should be included, but two-thirds still agreed sex edu- cation should teach that abstinence outside of marriage is “the accepted standard for school- aged children.” And for most parents, absti- nence means no oral sex or intimate touching.

While American parents of the post–sexual revolution era have wanted minors to abstain, few teens have complied. Many American teenagers have had positive and enriching sexual experiences; however, researchers have

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heterosexual marriage. There was also serious new deliberation among the general public, health professionals, and the media about the need to adjust the moral rules governing sex- ual life to real behavior. As researchers for the Guttmacher Institute later noted, “One might say the entire society has experienced a course in sex education.” The new moral rules cast sexuality as a part of life that should be gov- erned by self-determination, mutual respect, frank conversation, and the prevention of unin- tended consequences. Notably, these new rules were applied to minors and institutionalized in Dutch health care policies that removed financial and emotional barriers to accessing contraceptives— including the requirements for a pelvic examination and parental consent.

Indeed, even as the age of first sexual inter- course was decreasing, the rate of births among Dutch teenagers dropped steeply between 1970 and 1996 to one of the lowest in the world. What distinguished the very low Dutch teenage birth rate from, for instance, that of their Swedish counterparts, was that it was accompanied by a very low teen abortion rate. Despite the AIDS crisis, by the mid-1990s, funding agencies were so confident that, in the words of demographer Joop Garssen, youth were doing “wonderfully well,” they decided further study of adolescent sexual attitudes and behavior wasn’t warranted.

Sex education has played a key role. Soci- ologists Jane Lewis and Trudie Knijn find that Dutch sex education curricula are more likely than programs elsewhere to openly dis- cuss female sexual pleasure, masturbation, and homosexuality. The Dutch curricula also emphasize the importance of self-reliance and mutual respect in negotiating enjoyable and healthy sexual relationships during adolescence.

A 2005 survey of Dutch youth, ages twelve to twenty-five, found the majority described their first sexual experiences— broadly defined— as well-timed, within their control, and fun. About

TEEN SEXUALITY IN THE NETHERLANDS

In a late 1980s qualitative study with 120 parents and older teenagers, Dutch sociolo- gist Janita Ravesloot concluded that in most families, parents accepted that sexuality “from the first kiss to the first coitus” was part of the youth phase. In middle-class families, teen- agers reported that parents accepted their sex- ual autonomy, but didn’t engage in elaborate conversations with them because of lingering feelings of shame. Working-class parents were more likely to use their authority to impose norms, including that sex belonged only in steady relationships. In a few strongly religious families— Christian or Islamic— parents cat- egorically opposed sex before marriage: here there were “no overnights with steady boy- or girlfriends at home.”1 But such families remain a minority. A 2003 survey by Statistics Nether- lands found that two-thirds of Dutch fifteen- to seventeen-year-olds with steady boy- or girl- friends are allowed to spend the night with them in their bedrooms, and that boys and girls are equally likely to get permission for a sleepover.

This could hardly have been predicted in the 1950s. Then, women and men typically ini- tiated intercourse in their early twenties, usu- ally in a serious relationship (if not engagement or marriage). In the late 1960s, a national sur- vey conducted by sociologist G. A. Kooy found most respondents still rejected premarital sex when a couple was not married or planning to do so very shortly. But by the early 1980s, the same survey found that six out of ten respon- dents no longer objected to a girl having inter- course with a boy as long as she was in love with him. Noting the shift in attitudes since the 1950s, Kooy spoke of a “moral landslide.” His colleague, sociologist Evert Ketting, even went as far as to speak of a “moral revolution.”

What changed was not just a greater acceptance of sex outside of the context of

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toward  the sexual experiences of teenagers? Two factors immediately spring to mind. The first is religion. As the Laumann team found, Americans who do not view religion as a cen- tral force in their decision-making are much less likely to categorically condemn teenage sex. And devout Christians and Muslims in the Netherlands are more likely to exhibit attitudes toward sexuality and marriage that are similar to those of their American coun- terparts. That Americans are far more likely to be religiously devout than the Dutch, many of whom left their houses of worship in the 1960s and 1970s, explains part of the difference between the two countries.

A second factor is economic security. Like most European countries, the Dutch govern- ment provides a range of what sociologists call “social” and what reproductive health advo- cates call “human” rights: the right to housing, health care, and a minimum income. Not only do such rights ensure access, if need be, to free contraceptive and abortion services, govern- ment supports make coming of age less peril- ous for both teenagers and parents. This might make the prospect of sex derailing a child’s life less haunting. Ironically, the very lack of such rights and high rates of childhood poverty in the United States contribute to high rates of births among teenagers. Without adequate support systems or educational and job oppor- tunities, young people are simply more likely to start parenthood early in life.

While they no doubt contribute, neither religion nor economics can solve the whole puzzle. Even Dutch and American families matched on these dimensions still have radi- cally divergent views of teenage sexuality and the sleepover. After interviewing 130 white middle-class Dutch and American teenagers (mostly 10th graders) and parents, I became convinced that a fuller solution is to look at the different cultures of independence and control that characterize these two middle classes.

first intercourse, 86 percent of women and 93 percent of men said, “We both were equally eager to have it.” This doesn’t mean that gen- der doesn’t matter. Researcher Janita Ravesloot found that more girls than boys reported that their parents expected them to only have inter- course in relationships. Girls were also aware that they might be called sluts for having sex too soon or with too many successive partners. And although most of the 2005 respondents said they were (very) satisfied with the pleasure and contact they felt with their partner dur- ing sex, men were much more likely to usually or always orgasm during sex and less likely to report having experienced pain.

It also appears that having sex outside of the context of monogamous romantic relationships isn’t as common among Dutch adolescents, especially older ones, as among their American counterparts. Again in the 2005 survey, two- thirds of male youth and 81 percent of Dutch females had their last sex in a monogamous steady relationship, usually with a partner with whom they were “very much in love.” Certainly, Dutch adolescents have “non-relational” sex— indeed, one in three males and one in five females had their last vaginal or anal sex outside of a monogamous romantic relationship. That said, relational sex seems to remain the norm, especially as young people age: two-thirds of fifteen- to seventeen-year-olds, and three- quarters of those eighteen to twenty, had their last intercourse in a monogamous relationship. Among the oldest group— nineteen- to twenty- four-year-olds— almost half of gay men sur- veyed, six in ten straight men and lesbians, and nearly three-quarters of straight women were in long-term relationships.

EXPLAINING THE DIFFERENCES

So why do parents in two countries with simi- lar levels of development and reproductive technologies have such different attitudes

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ceptualizes the self and society as interdepen- dent. Based upon the assumption that young people develop autonomy in the context of ongoing relationships of interdependence, Dutch parents don’t see teenage sexuality in the household as a threat to their children’s autonomy or to their own authority. To the con- trary, allowing teenage sexuality in the home— “domesticating” it, as it were— allows Dutch parents to exert more informal social control.

WHAT IT MEANS FOR KIDS

The acceptance of adolescent sexuality in the family creates the opportunity for Dutch girls to integrate their sexual selves with their roles as family members, even if they may be subject to a greater level of surveillance. . . . By con- trast, many American girls must physically and psychically bifurcate their sexual selves and their roles as daughters. . . .

American boys receive messages ranging from blanket prohibition to open encourage- ment. One key message is that sex is a symbol and a threat— in the event of pregnancy— to their adult autonomy. . . . By contrast, Dutch boys, . . . like their female counterparts . . . say permission comes with a social control that encourages a relational sexuality and girl- friends their parents like. . . .

These different templates for adolescent sex, gender, and autonomy also affect boys’ and girls’ own navigation of the dilemmas of gen- der. The category “slut” appears much more salient in the interviews with American girls than Dutch girls. One reason may be that the cultural assumption that teenagers can and do fall in love lends credence to Dutch girls’ claims to being in love, while the cultural skepticism about whether they can sustain the feelings and form the attachments that legitimate sexual activity puts American girls on the defensive. . . .

In both countries, boys confront the belief and  sometimes the reality that they are

In responding to adolescent sexuality, American parents emphasize its dangerous and conflicted elements, describing it in terms of “raging hormones” that are difficult for young people to control and in terms of antagonistic relationships between the sexes (girls and boys pursue love and sex respectively, and girls are often the losers of the battle). Moreover, Amer- ican parents see it as their obligation to encour- age adolescents’ separation from home before accepting their sexual activity. Viewing sex as part of a larger tug-of-war between separation and control, the response to the question of the sleepover, even among many otherwise socially liberal parents is, “Not under my roof!”

Dutch parents, by contrast, downplay the dangerous and difficult sides of teenage sexual- ity, tending to normalize it. They speak of . . . a process of becoming physically and emo- tionally ready for sex that they believe young people can self-regulate, provided they’ve been encouraged to pace themselves and prepare adequately. Rather than emphasizing gender battles, Dutch parents talk about sexuality as emerging from relationships and are strik- ingly silent about gender conflicts. And unlike Americans who are often skeptical about teen- agers’ capacities to fall in love, they assume that even those in their early teens fall in love. They permit sleepovers, even if that requires an “adjustment” period to overcome their feelings of discomfort, because they feel obliged to stay connected and accepting as sex becomes part of their children’s lives.

These different approaches to adolescent sexuality are part of the different cultures of independence and control. American middle- class culture conceptualizes the self and (adult) society as inherently oppositional during ado- lescence. Breaking away from the family is nec- essary for autonomy, as is the occasional use of parental control (for instance, in the arena of sexuality), until teenagers are full adults. Dutch middle-class culture, in contrast, con-

S E X , LOV E, A N D AU TO N O M Y I N T H E T E E N AG E S L E E P OV E R 239

templates people have available. Normalization and dramatization each has “costs” and “bene- fits.” On balance, however, the dramatization of adolescent sexuality makes it more difficult for parents to communicate with teenagers about sex and relationships, and more challenging for girls and boys to integrate their sexual and relational selves. The normalization of adoles- cent sexuality does not eradicate the tensions between parents and teenagers or the gender constructs that confine both girls and boys. But it does provide a more favorable cultural climate in which to address them.

NOTE 1. This quote and subsequent quotes from Dutch sources are the author’s translations. Names have been changed to protect anonymity.

interested in sex but not relationships. But there is evidence in both countries that boys are often emotionally invested. The American boys I have interviewed tend to view themselves as unique for their romantic aspirations and describe themselves, as Jesse does, as “romantic rebels.” “The most important thing to me is maintaining love between me and my girlfriend,” while “most guys are pretty much in it for the sex,” he says. The Dutch boys I interviewed did not perceive themselves as unusual for falling in love (or for wanting to) before having sex. Sam, for instance, believes that “everyone wants [a relationship].” He explains why: “Someone you can talk to about your feelings and such, a feeling of safety, I think that everyone, the largest percentage of people wants a relationship.”

CULTURE’S COST

How sexuality, love, and autonomy are perceived and negotiated in parent-child relationships and  among teenagers depends on the cultural

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R E A D I N G 2 1

C opious amounts of literature have examined sexuality education for ado-lescents and emerging adults; however, few studies have investigated sexuality educa- tion for the general public over 18 years of age. Sexuality education that only targets adoles- cents mistakenly assumes that it is only young people who encounter sexual health problems and require education (Paiva 2005; The National Campaign to Prevent Teen and Unplanned Pregnancy 2008). Rates of unintended preg- nancy, abortion and sexually transmitted infec- tion (STI) among those over 18 tell us otherwise. For example, in 2013, reported cases of gonor- rhea in the USA were highest among men and women aged 20–24 years, and cases of chla- mydia were highest among women aged 19–20 and men aged 20–24 years (CDC 2014). Older adults are also at risk for STIs. In 2014, people aged 50 and over accounted for more than 16% of new HIV diagnoses (CDC 2015).

Although these statistics suggest that adults need sexuality education, there are few places where adults can receive this education (Schick et al. 2013; Sexuality Information and Educa- tion Council of the United States 2015). Col- lege sex education programs (Eisenberg et al. 2012) or progressive church programs such as Our Whole Lives, developed jointly by the Uni- tarian Universalist Association and the United Church of Christ, are available for segments of the population, but not the general public (Lamb, Lustig, and Graling 2013). The inter- net has also been examined as a setting that can provide advantages and disadvantages for adults seeking to learn about sex (Adams, Oye,

and Parker 2003). However, the most com- monly investigated setting remains the health care professional’s office (Penna and Sheehy 2000; Brandenburg and Bitzer 2009; Golin et  al. 2010; Bahouq et al. 2013; Ussher et al. 2013; Dyer and das Nair 2014).

Research reveals that adult patients and physicians often have difficulty communicat- ing about sex for a variety of reasons, includ- ing lack of awareness about sexual concerns, embarrassment and time constraints (Bran- denburg and Bitzer 2009; Jeffers and DiBartolo 2011). Lindau et al. (2007) found that although men and women aged 57–85 years reported having at least one sexual problem, only 38% of men and 22% of women discussed sex with their doctors. In a study of 1150 obstetrician- gynecologists, the majority reported not discussing sexual problems or sexual satisfac- tion with their patients (Sobecki et al. 2012). Furthermore, there is a gender difference with respect to mature patient–provider conversa- tions. According to Noland (2010), physicians are more likely to discuss sex with male patients than with female patients. In contrast, Politi et  al.’s research reveals that women would like their physician to initiate discussions about sex- ual health with them. Thomas, Hess, and Thur- ston’s (2015) research stresses the importance of clinicians discussing sexual relationships and sexual satisfaction with women patients, as

“PUT ME IN, COACH, I’M READY TO PLAY”: SEXUALITY EDUCATION FOR ADULTS AT GOOD VIBRATIONS

J E S S I C A A . N O D U L M A N

From “Put Me in, Coach, I’m Ready to Play: Sexuality Education for Adults at Good Vibrations,” Sex Education Vol. 16, No. 6, 2016, pp. 649–62. Copyright © Informa UK Limited, reprinted by permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com).

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retail venues—such as adult retail stores—that cater to a more diverse population. Herbenick and Reece (2006) report that employees of adult retail stores frequently disseminated sex- ual health information to customers, often with a focus on maximizing pleasure. However, they also answer questions on a range of other top- ics, including relationships as well as health and safety. Even adult sexual retail stores that have a mission to educate the community are still profit-motivated and, as a result, adult retail- ers face challenges in their role as providers of adult sexuality education (McCaughey and French 2001; Herbenick and Reece 2006; Black 2012). It is clear that adult retail stores are ven- ues of sexuality education, and it is important to investigate how these organizations actually accomplish sexuality education for adults.

In this paper, I investigate the sex- positive approach to sexuality education at Good Vibra- tions (GV), an adult sexual retail store with eight locations predominately in the San Francisco, California, area and an online presence. Sex- positive approaches focus on sex as a positive component of life, are honest about the posi- tive and negative consequences to sex, aim to remove fear and shame, do not focus solely on reproduction, are inclusive of diverse genders and sexualities, teach competent communi- cation skills such as gaining enthusiastic con- sent before engaging in sexual activities, and embrace the idea that pleasure for all people— but with special attention to women—is a cru- cial component to sex and sexuality (Nodulman 2014). GV embodies the philosophy of sex-pos- itive sexuality education in its organizational mission, promotes education and career oppor- tunities for women, promotes sexual diversity, provides sexual health resources, and partici- pates in social activism and community build- ing (Comella 2010). Being in business for nearly 40 years, GV is something of a trendsetter in the community and a pioneer among feminist sex stores. It is also a relevant site to study

sexual activity is common among older women. Initiatives to incorporate sexual health commu- nication training to medical students (Ferrara et al. 2003; Jayasuriya and Dennick 2011) and other health care professionals (Macdowall et al. 2010) may help adults and practitioners discuss these issues during a medical encounter, but there still remain few other non-clinical set- tings where adults can learn about sex.

One less traditional setting is the adult retail industry—including in-home sex toy par- ties and adult sexual retail stores. Reece, Her- benick, and Sherwood-Puzzello (2004) have investigated the adult retail industry (e.g. adult bookstores, sex shops, adult video and retail outlets) as a venue of sexual health informa- tion. They argue:

Given the magnitude of the adult retail industry and the fact that a significant percentage of the US pop- ulation looks to it for products related to safer sex, sexual pleasure, or alleviating sexual dysfunction, it is logical to consider whether its retail establish- ments might be able to serve as resources that could simultaneously promote sexual health and sexual pleasure while retaining, and perhaps expanding, a profitable consumer base. (Reece, Herbenick, and Sherwood-Puzzello 2004, 177)

In-home sex toy parties are a way in which “lit- erally millions of women now learn about (and often purchase) sexual enhancement products” (Herbenick and Reece 2009, 191). Previous research has investigated the types of ques- tions asked by consumers and answered by facilitators at these in-home parties and found that there are teachable moments to educate women on a host of topics, including human development, relationships, sexual behavior, health, and society and culture (McCaughey and French 2001; Storr 2003; Herbenick and Reece 2009; Fisher et al. 2010). However, in-home sex toy or lingerie parties are usu- ally marketed toward heterosexual women (McCaughey and French 2001; Storr 2003). Therefore, it is important to explore other adult

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I focused on how they make decisions that affect the company, SESAs and the commu- nity. In the interview with an SESA, I inquired about the day-to-day operations of GV and her job as both a sex educator and sales associ- ate. I was not allowed to discuss my role as a researcher when I was observing in the stores (a request Glickman made at the onset of my project to protect the privacy of the customers); therefore, I did not interview any patrons about their experiences at GV.

The last type of data I analyzed was 11 educational brochures about various sexuality and  sex-toy topics. These free brochures were placed next to their corresponding products within the stores. Brochure topics were as follows: “Lubricants,” “Vibrators,” “Silicone & Glass/Cleaning Your Toys,” “Prostate,” “Anal Sex,” “G-Spot,” “Condoms,” “PC muscle & Kegels/Pumps,” “Harnesses/ Dildos,” “Cock Rings” and “Bondage & Spanking.” They pro- vided quick, key information and were written in a conversational tone.

All research activities were reviewed and approved by the University of New Mexico’s institutional review board. Interviewees gave informed consent, and all observations were conducted in public with no identifying infor- mation recorded in my field notes. . . .

FINDINGS

Based on an analysis of my observations, inter- views and texts from GV, three factors emerged for understanding how sex-positive sexuality education is enacted in this context: communi- cational, organizational and environmental fac- tors. To inquire more deeply into sex-positive sexuality education as practiced in this particu- lar context, I kept analyzing the data. Catego- ries developed during this subsequent analysis included preparation, instruction, development, encouragement, critique, ensuring and recruit- ment. Because of the affinity between these

because the staff includes some of the founders and pioneers of sex-positive sexuality education, such as Carol Queen, an originator of the sex- positive movement in the USA. GV has been recognized as a leader in the adult retail field. In 2015, the company was named Boutique Adult Retailer of the Year by xBiz (an adult industry news publisher) and the Best  Place to Shop for Sex Toys by San Francisco magazine (San Francisco magazine 2015; xBiz 2015).

METHODS

I evaluated the sexuality education provided at GV using observation, interview and textual analysis. I observed four GV stores . . . in one- to two-hour time blocks between June and July of 2011, spending an average of 10 hours in each store and a total of 50 hours in the field. . . . In order to understand how sexuality education was accomplished, I investigated shop design, products, floor plans, product layout, and other nonverbal elements such as color and smells. I also observed employees’ and customers’ ver- bal and nonverbal communication. In addition to observing the stores as a participant, I also observed and participated in the GV booth at the Dyke Rally in Dolores Park, the GV Pink Pleasure Party, a tour of the Mission Street store by a GV administrator, and an educa- tional workshop entitled “Strap it to me! with Dr. Carol Queen,” held at the Valencia Street store. During the observation of these events, I gathered data on the language the educa- tors used, the materials that were used (vid- eos, handouts, diagrams, etc.), what questions patrons were asked and information about the overall experience.

I also conducted in-depth interviews with three representatives from GV: Charlie Glick- man,1 the Education Program manager; Carol Queen, the Staff Sexologist; and a Sex Edu- cator/Sales Associate (SESA) called Vickie.2

During my interviews with administrators,

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activities and the practice of “coaching,” I there- after used a coaching framework to specifically address how GV prepares, instructs, develops, encourages, critiques, ensures and recruits their patrons.3

Preparing Coaches need to be knowledgeable about what they are coaching and have competent strat- egies to pass to participants. They are also responsible for providing the participant the necessary equipment and . . . [ensuring] the event meets the needs of the participant. This is true of GV as well, whose staff are experts in sexuality education: Charlie Glickman has an interdisciplinary studies doctorate with a focus in adult sexuality education and Carol Queen also has a doctorate with a focus on human sex- uality. All GV’s SESAs receive extensive train- ing in sexuality education. This sex-positive training enables them to work with customers of varying needs. As SESA Vickie recalled:

At GV, when I first started, my manager would catch me saying terms that even as a gender [studies] stu- dent I should know better. Like I was showing some- one a toy and I would say, “Oh, this would go into a women’s vagina,” and she’d be like, “You know what, you need to be careful when you say that because men can have vaginas as well.” So, that really stuck out, because that was like my first week. (Vickie, Personal communication, July 2011)

In addition to education that prepares the SESAs to be competent, the variety of products GV retails supports a multitude of customer interests and needs. For example, along with selling female condoms and vegan condoms, the store also sells “snugger fit” and larger condoms. The store’s approach also does not assume that all of its customers want the same things. In the brochure on Bondage & Spank- ing, for example, it is explained that “different desires mean different approaches to bondage” (Bondage and Spanking, n.d.). Furthermore,

GV works from a broad definition of what con- stitutes pleasure and is prepared for customers to find pleasure in a variety of ways. For exam- ple, some customers may find pleasure in read- ing about sex and sexuality, and therefore the stores carry numerous titles of erotica. Other customers may want to experience the pleasure of relaxing, and various products are available that customers can use alone or with a part- ner to help relax, such as luxury oils, bath balls, lotions and scented candles. To promote enjoy- ment and fun, the stores also sell products such as edible body paint, couples’ board games, candy bras and G-strings, and even pasta in the shape of penises or breasts.

Stores are also designed to provide custom- ers with a positive experience. City zoning laws often limit sex stores to industrial rather than residential or commercial spaces; therefore, the public often associates sex stores with being in dirty, dark and seedy sections of town (Come- lla 2010; Riley 2014). GV’s locations are just the opposite. The stores are bright, clean and located in the midst of bustling neighborhoods that serve both tourists and locals. All of the stores ensured the privacy of patrons through the use of frosted glass or window coverings or partitions; however, the doors were always propped slightly open. . . . Across all of the stores, the floor plans were open and all of the products and display cases were in pristine condition.

Instructing Having knowledge and preparing the environ- ment are important to being a good coach, but coaches also need to instruct their participants on an individual and team basis. GV does this instructing in many ways. During Queen’s workshop on strap-on/hands-free sex, she was extremely clear in her instruction. Since the class was for beginners interested in this type of activity, she made sure to start off with basic

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groups, student groups, nonprofits, a few companies here and there. Last year I think we did almost 100 of those over the course of a year, and that is in addition to the 70 or 80 workshops that happen in our stores. (Glickman, Personal communication, July 2011)

Developing Another responsibility of a coach is to develop the skills of the individual participant. This may be done through personalized attention. GV does this individual development in many ways. SESA Vickie explained that the most impor- tant skills are to be able to listen to a customer and negotiate the customer’s individual needs and wants (Personal communication, July 7, 2011). Such practices were observed repeat- edly throughout the fieldwork. For example, because some customers may feel intimidated by the variety of lubricants available, when indi- viduals were looking at the lubricants, an SESA might walk over and describe the differences between them and explain why one lubricant might serve their needs better than another.

At times, GV staff appeared to be personal shoppers for patrons, even though SESAs do not work on commission. I commonly observed SESAs working for a half hour to an hour with one customer. During these interactions, the SESA first would find out what the patron was looking for and then provide them with options. However, explaining each option can be a lengthy process. At the Berkeley store, I observed an SESA spend over an hour with one woman interested in buying a vibrator. The SESA explained in great detail what the differ- ent vibrators provided and then encouraged the woman to touch each one and get a sense for what she liked best. Once the woman had nar- rowed her selection down, she continued to ask the SESA more questions about vibrator use until she made her final choice.

In order to develop the individual custom- er’s knowledge and skills, GV encourages its

information—explaining what harnesses and dildos are and how they operate. When she described how something works, she made sure to demonstrate it using demo products she pulled from the shelf. When topics arose and she realized she did not have the products handy, she made sure to get relevant products to demonstrate.

Queen’s teaching also included referring people to other products that could help them best understand the process. Since GV does not demonstrate live sexual acts within their store, it can be difficult to teach about specific acts without showing the learners how they are done. To remedy this, Queen listed many resources, including DVDs or books, for peo- ple to learn more about the topics discussed. Since the presentation lasted only an hour, these resources provided learners with access to trusted sources from which to receive addi- tional instruction.

At certain stores, beneath every product is a business card size “info card.” This card details the product title alongside several bullet points explaining the product. Sometimes the cards provide recommendations. For example, on one card, the information encouraged the use of condoms with non-silicone-based toys. The brief instructions are also useful because some customers may have lower literacy skills or may be apprehensive discussing these products with an SESA.

In addition, the staff at GV provides instruc- tion for practitioners and the community, as Glickman explained:

Carol Queen and I do a lot of interviews for things or organizations. For that matter, we are also a resource for anytime or anything people have a question about something. They are welcome to email us, and we get quite a few. Everything from doctors who aren’t sure how to answer a question . . . [to] therapists saying, you know, what books are there on this topic? And we do outreach. Our OFSE program, Off-Site Sex Edu- cation, that’s where we send sex educators to college

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What we do is let folks know, yeah, alright, let me give you the information that you need. And I will make whatever level of eye contact you are comfort- able with, and I will share this information with you. And I will show you that I don’t think there is any- thing wrong with it. I don’t think this [way of com- municating] is something you can learn from like a website or book. It is something that happens in relation to someone else, and we put a lot of energy into our relationships with our customers. (Glick- man, Personal communication, July 2011)

After initially greeting a customer, an SESA usually would follow up with the person in an encouraging manner in order to break the ice. For example, at the Polk Street store, when one customer was looking at vibrators, an SESA came up to her and said, “That is a really great product. Let me know if you have any ques- tions, okay?” (Author’s notes, June 2011). The SESA broke the ice by reassuring the customer that the product she was looking at was a good choice, and also provided a nonthreatening way for the customer to follow up with her that came across as just a friendly conversation. I often observed SESAs explaining the benefits of products. On another occasion, at the Polk Street store, I observed an SESA asking a cus- tomer who was looking at cock rings if she had ever tried one. The SESA explained to her how “awesome” they were and how they can provide an amazing sensation for both men and women (Author’s notes, July 2011).

In addition to verbal encouragement, a vari- ety of nonverbal techniques are used by GV to motivate and encourage customers to feel com- fortable. Each store plays upbeat pop or light rock music from artists such as Britney Spears, Lenny Kravitz, the Scissor Sisters and Ke$ha. The songs were played at a comfortable vol- ume so as not to distract customers, but keep a lively feeling in the store. There are also store displays to encourage customers to feel at ease in the store. One of the promotions happening during my visit was “water fun.” In line with this

customers to experiment with products in the store and at home. Having a demo version or tester of most every product allows SESAs to work with customers to find the best option. In addition, GV also provides opportunities for personal experimentation. Glickman explained on a tour of the Mission Street store that GV makes a conscious decision to sell products that are inexpensive, single size or “loose” to encourage such experimentation. For example, single-use packets of lubricants, individually wrapped condoms and $10 vibrators are sold to enable customers to find a product that works best for them. Glickman said that these oppor- tunities for experimentation are “similar to the philosophy behind a wine tasting”—a person needs to try something first to be able to deter- mine whether it is a good match to their palate (Author’s notes, July 2011).

In sum, development of a customer’s knowl- edge and skills is not an isolated event; rather, it is seen as a mission.

I will say, one of my most favorite customers ever . . . was in her fifties and she had just gotten divorced. And for the first time in her life she was exploring what she wanted to do. She was coming to every sin- gle workshop, and for about six months she was like a kid in a candy store. And every time she would see me she would come up and tell me about this new thing that she had just done. And one of the things that I like most about working here is knowing that she is out there, and other people are out there somewhere having a happier sex life because of what we do. And if somebody is not getting that, we want to do what we can to help them find what that means. (Glick- man, Personal communication, July 2011)

Encouraging Competent coaches teach their participants skills but must also find ways to motivate and reassure them. GV uses a variety of methods of encouragement. The staff at GV encourages customers by putting them at ease. As Glick- man explained:

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to be hesitant to use lubricants because men feel inadequate sexually if they cannot arouse a woman. Thus, some men believe a woman’s lack of arousal is a reflection of how good of a sex partner they are or is an indictment of their masculinity. Glickman explained that GV staff tell customers that this is a myth, and that a variety of factors, including medications, cigarette or marijuana smoking, birth control, post-childbirth and menopause, can impact women’s arousal.

I observed many instances where SESAs approached customers and asked them to not play inappropriately with products. In one instance, an SESA asked a young man to put his shirt back on because they try to “de-sexualize” the store (Author’s notes, June 2011). A sign posted in front of the spankers and floggers in the Mission Street store read, “Spanking! We love it, but for the safety and consideration of our customers we ask that you refrain from doing it in the store” (Author’s notes, July 2011). Glickman explained how SESAs work actively to maintain a positive but professional environment:

If some customers are getting a little rowdy or rau- cous, which does happen sometimes . . . we will go up to them and say, “Look, we are glad you are here. We are glad you are having a great time, and we need you to tone it down because it is making other people uncomfortable.” (Glickman, Personal com- munication, July 2011)

Ensuring Coaches help to ensure a participant’s health and wellness by informing of any risks, discuss- ing safety measures and promoting healthy behaviors. Based on my observations and field- work, GV appears to take this responsibility seriously. Shops ensure their customers under- stand the risks that can be associated with sex and inform them about how to be healthy and safe. Throughout Queen’s “Strap It to Me” presentation, for example, it was repeated

promotion, the Berkeley store had a red betta fish swimming in a fish bowl with blue gravel on a table next to blue vibrators, lubricants with blue labels and GV shot glasses with blue rib- bons in them as a decoration. . . . SESAs’ cloth- ing also aims to give an uplifting impression. The SESAs generally dress in a casual style that may include unique and funky accents. . . .

Critiquing In order for participants to improve or master certain skills, coaches must critique and evalu- ate the participants. GV, while being very wel- coming, is not afraid to criticize stereotypes and reprimand customers who may not be upholding the spirit of the store.

Glickman, during the tour of the Mission Street store, was a harsh critic of using por- nography to judge one’s sexual ability or per- formance. He discussed how oftentimes people who have viewed pornography mistakenly believe that anal sex should be easy. How- ever, once they try it themselves they are upset because they encounter difficulties. Glickman explained that in reality, anal sex takes a lot of time and practice in order to ease physical and emotional tension. He explained that the performers in pornography are professionals who have used lubricants and “warmed up.” However, these actions are edited out of the film and/or are done offscreen (Author’s notes, July 2011). Although GV sells numerous titles of pornography, Glickman went out of his way to explain that pornography is not real sex and should not be treated as such.

It is also important to critique some com- monly held myths their customers have. Carol Queen explained in her workshop that anal sex is often mistakenly stereotyped as a sexual act only between gay men. In reality, research shows that heterosexual women constitute the largest percentage of people to engage in anal sex. According to Glickman, it is also common for men with women sexual partners

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party within their store for marchers and rally- goers to celebrate Pride. When I got to the party, many people were standing outside the shop laughing, dancing and taking photos. Two young women, wearing pasties (stickers that cover the nipples), lingerie, high heels and styl- ish hair and make-up, took turns dancing in the store’s one display window with a sign that read “Photos for Tips.” People were stopping in front to take photos with them, without always tip- ping, or dancing alongside them. Some people would go into the store and place dollar bills into the dancers’ garters (Author’s notes, June 2011). The laughter, loudness of the music and overall party atmosphere could be heard outside of the store and helped to welcome and encour- age other people to come inside. As I exited the store, night had fallen. However, the streets were still crowded with people milling about and partying, and GV remained crowded as well (Author’s notes, June 2011).

GV also recruits new customers by serving as a resource for local organizations. During my visit, the back room of the Polk Street store was being used as a gallery for an art exhibit of work by the noted erotic photographer Phyllis Christopher. According to Glickman:

We also host events for other [non–Good Vibrations] groups. There was one organization, an organization that teaches people about bicycle safety. And so we let them use our room. ’Cause we weren’t using it, so come on in and bring your folks in, and no problem. (Glickman, Personal communication, July 2011)

GV also recruits through their large online presence. Much time is spent maintaining and updating the company’s Facebook and Twitter accounts. Through these social media accounts, GV advertises special promotions, provides links to articles about sex and sexuality from a variety of sources, including nonprofit and government agencies, and distributes informa- tion about community and cultural events. The store’s social media presence serves to remind existing customers about the store and entice

several times that dildos and harnesses must be cleaned. She also encouraged learners to put dildos in the dishwasher as a way to keep them clean4 and stressed that harness activity should not hurt unless that is something more advanced users are aiming for. Similarly, every brochure discusses some aspect of health and safety. For example, in the Vibrators brochure, there is a section entitled “Care & Cleaning.” Along with cleaning reminders, it also tells the reader to “never insert any object into the anus if it doesn’t have a base. It may slip all the way inside, requiring a trip to the emergency room” (Vibrators, n.d.).

Ensuring the health and wellness of patrons was also witnessed in the products sold. In addition to selling dozens of different types of male condoms, stores also sell female condoms. GV also sells less mainstream safer sex materi- als such as finger cots, dental dams and gloves. Along with safer sex materials, the stores also sell numerous books that promote health, well- ness and safety. Some of the titles of the books I observed included Our Bodies, Ourselves by the Boston Women’s Health Collective, Talking to Your Kids about Sex by Laura Berman, Anal Pleasure and Health by Jack Morin and The Ultimate Guide to Sex and Disability by Miriam Kaufman, Cory Silverberg and Fran Odette.

Recruiting In a sports context, participants often search out a program that fits their interests, but many times coaches need to recruit partici- pants. Coaches often use a variety of methods to advertise and build their brand with potential participants. Similarly, although many custom- ers seek out GV, they also utilize recruitment strategies. One way in which GV recruits poten- tial customers is by hosting events that incor- porate or appeal to the community. The Dyke March during Pride Week passes along Valencia Street, right in front of the Valencia Street GV store. The shop celebrates this fact by hosting a

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many things to make itself an inviting place for customers to learn about sex and purchase products. However, in a coaching framework, an individual’s achievement is ultimately left up  to the participant. GV can instruct and develop a customer’s knowledge about sex, but it is up to the customer to choose to act upon this knowledge. This shared responsibility between coach and participant balances a ten- sion in sexuality education—that people want to know more about sex (Hilton 2007; Fields 2008), but that they are also agentic individuals who can make decisions about sex for them- selves (Fine and McClelland 2006; Tolman 2012; Niccolini 2013).

A coaching framework implies that sexuality education should be inclusive and accessible. Coaches work with participants of varying skill levels, and they help all participants, from nov- ice to advanced, succeed. GV seeks to be inclu- sive and accessible by withholding assumptions and letting customers lead the conversation. Furthermore, coaches realize that participants will have different goals. While one participant may just hope to learn specific techniques to better her skill for participation in a sport for hobby, others may be hoping to specialize in something specific. Using a coaching frame- work, GV does not privilege particular experi- ences, acts or sexualities and thus lets everyone become a player.

A coaching framework also stresses the importance of communication. The impor- tance of good communication skills as part of high-quality sexuality education cannot be underestimated (Fisher et al. 2010; Noland 2010; Thomas, Hess, and Thurston 2015). The coaching functions that GV performs, such as encouraging or critiquing their customers, can- not be accomplished without competent com- munication skills.

Finally, a coaching framework implies that people participate in activities in order to gain positive and exciting experiences whereby they

them to visit. It also serves to promote the store to potential new customers. Through the use of social media, people can see when their Face- book friends “Like” a GV post or re-tweet a GV message.

In addition to a social media presence that serves to brand the store and promote it to potential customers, GV also sells branded merchandise. Participants on sports teams often wear “gear” from their team or collect memorabilia. GV also provides customers with that option. Merchandise includes shot glasses, coffee mugs, stickers and sweatshirts that have the GV logo on them and read, “Creating a Buzz since 1977” (Author’s notes, July 2011).

DISCUSSION AND CONCLUSIONS

Previous research and commentary (Reece, Herbenick, and Sherwood-Puzzello 2004; Her- benick and Reece 2006; Black 2012) indicate that adult sexual retail stores are a place for adults to receive much-needed sexuality edu- cation. However, to date, besides Comella’s (2010) ethnographic analysis of the environ- ment of feminist sex stores, no other research using qualitative ethnographic methods has examined how adult sexual retail stores edu- cate adults about sex. In this paper, I describe how GV—a pioneer in the field of sex-positive sexuality education—uses a coaching frame- work to transmit sex-positive sexuality educa- tion in the retail environment.

The coaching framework used by GV starts with an educated staff who instructs customers and develops their skills, encourages and cri- tiques customers when necessary, ensures cus- tomer safety by discussing health and wellness and recruits new participants. This framework carries useful implications for those interested in sexuality education. First, a coaching frame- work implies a shared responsibility in the process of sexuality education. Coaches have responsibilities to their participants. GV does

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5. Certainly, there are instances when people are coerced into, or are not interested in participating in, a particular activity. Just as there is no excuse for sexual coercion, I base my coaching framework on the assumption that parties fully and enthusiastically consent to participate.

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can better themselves and receive pleasure from participation.5 GV plays upbeat music to their customers to feel good in the stores and sells tester-size products so customers can experiment with what product feels the best to them.

In the past, much sexuality education has downplayed the importance of pleasure. More recently, pleasure has been conflated with risk, excess or danger (Fine and McClelland 2006; Lamb, Lustig, and Graling 2013). As Hirst (2013) discusses, pleasure and positivity within sexuality education are crucial to “improving sexual health, rights, and equality” (432). A coaching framework can provide an opportu- nity for individuals to experience satisfaction and pleasure through sexuality education.

In sum, a coaching framework provides a way to fill the gaps in teaching sexuality educa- tion. It promotes shared responsibility between learner and teacher; enacts sexuality educa- tion that is inclusive, accessible and tailored; highlights communication skills; and honors the importance of pleasure and positivity. The coaching framework described here contrib- utes to the evidence concerning how adult sex- ual retail stores can disseminate sex-positive sexuality education. The principles involved are something that other sex educators can emu- late as well. . . .

NOTES 1. Glickman left GV in 2013.

2. Vickie requested that I use her real name.

3. This coaching framework should not be confused with sex coaching, which is performed in private and includes touching and homework. That said, sex coaching is a client- centered sex-positive approach to educating people of all genders and sexual identities and therefore does share some of the same characteristics of the work done at GV (Britton and Bright 2014).

4. Recent research (Anderson et al. 2014) suggests STIs may still be transmitted via sex toys even after standard cleaning procedures. As my data were collected in 2011, I am not aware of whether GV has updated the information provided to patrons.

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Leonore Tiefer, PhD, is an independent scholar, sex researcher, therapist, author, and critic.  Dr. Tiefer has become internationally known as the primary spokesper- son for a movement that challenges the medicalization of women’s sexual problems by the pharmaceutical industry (for more information, see www.newviewcampaign .org). Dr. Tiefer organized the 2016 Feminist Scholar Activism and the New View Campaign conference and made a video about the conference and the campaign. Dr. Tiefer gave the inaugural Masters and Johnson lecture at Washington University in St. Louis in November 2017. Both the Society for the Scientific Study of Sexuality and the Association for Women in Psychology selected her for their Distinguished Career awards in 2004.

What led you to begin studying sexuality? I see sexuality as one of the most interesting and complex topics in all of academia. In the 1960s I majored in psychology, and in psychology grad school (UC Berkeley), I was at first attracted to the subject of learning and conditioning. But after two

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years of research on learning in rats I felt bored, and I became more interested in physiological psychology—the study of the biological bases of behavior. Frank Beach had a very active research group studying mating behavior in rodents and dogs, and although at that time (he changed later) he wouldn’t fund women grad students to work in his lab, he allowed us to do experiments and participate in seminars. I stud- ied hamster sexuality for my dissertation and then directed an animal lab for seven years in my first academic job. But, and this is a big but, I began to question the value of animal research on sexuality when the women’s liberation movement (now called “second wave”) hit me in the 1970s. After a sabbatical working with human sexuality issues, I decided I was really interested in sexuality, but that I wasn’t suited to animal work and I doubted its ultimate significance. I re-specialized as a clinical psycholo- gist specializing in sexuality. I also studied the new work in sexuality emerging from women’s and gay and lesbian studies. Feminist politics combined with my biological and psychological background provided a well-rounded view of sexuality.

How do people react when you tell them you study sexuality? Usually they express political opinions first (about abortion or porn or sex ed), and ask personal questions about their own sexual life second. I have learned that no matter how strong the opinions, most people feel undereducated when it comes to sexuality and appreciate the opportunity to talk with an “expert.” Ironically, how- ever, my “expert” opinion is that sexuality is complicated and my answers to their questions usually involve more variables than they had anticipated.

Which of your projects have you found most interesting? Why? I had the opportunity to participate in a monthly New York intellectual seminar on sexuality that lasted 11 years (1982–1993). Participants were journalists, writers, political activists, and a wide range of humanities professors. I was the only “official” sex expert. Members presented papers on topics ranging from gays in World War II to Picasso’s sojourn in Barcelona to histories of food to “dirty” postcards. You cover a lot of ground in 11 years! The seminar always focused on how these various cultural events arose from and affected sexuality. The seminar completely changed my idea of what kind of thing sexuality was—from a biopsychological aspect of individual experience to a socially constructed ever-changing sociocultural phenomenon. This consciousness-changing occurred slowly. Standards of evidence were completely different than in my psychological training and the topics taxed my general knowl- edge base (World War II? Barcelona?). But when, slowly and gradually, I finally got it that sex was constructed differently within groups, generations, genders, religions, and regions, my eyes were permanently opened in a way few conventionally trained sexologists can understand.

What ethical dilemmas have you faced studying sexuality? I became an activist against the medicalization of sexuality after Viagra was approved in 1998. I saw corporations taking advantage of people’s lack of education about

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sexuality to promote drugs with marginal benefits and various dangers. It made me angry to see few other sexologists resisting the financial opportunities and propa- ganda of the pharmaceutical industry, but I have found many allies in public health, women’s health, investigative journalism, and health reform. My ethical dilemma has occurred because throughout my years of activism, I have continued my clinical private practice doing sex therapy. People come to me for help with their personal sexual problems and I have to put their concerns and perspectives first, and refrain from lecturing or moralizing about the things that are on my mind. On occasion I even recommend that someone try one of the new sex drugs because in his or her individual case they might be helpful, even though I believe that for society at large they are the very opposite. Even when I think a person’s problem has been caused by all the exaggerated public relations claims about the new drugs, I don’t ever say, “I told you so.” That’s not my role as a clinical psychologist.

What do you think is most challenging about studying sexuality? The subject is very complicated, and many professionals and academics are unwill- ing to read widely outside their primary field. I think to be a good sexologist you have to be somewhat well versed in psychology, physiology, sociology, anthropology, history, law, religion, media studies, and gender studies.

Why is it important to do sex research? It’s important to do good sex research, but it’s a waste of time to do foolish or trivial sex research. Good-quality research—qualitative research, especially—can help shed light on topics many areas of society want to be hidden in darkness. Igno- rant people can be shamed, guilt-tripped, and manipulated, and they raise ignorant children. Our media-saturated world requires an informed public, and good sex research is part of the information base essential in modern culture. For example, many states in the United States now have grossly uninformed laws about the dan- gers of “sex offenders” and are punishing people far too harshly for minor offenses. Ambitious politicians manipulate an ignorant public. The same thing happens with sex education or new contraceptive methods. The public is easily scared into taking a repressive position because they are uninformed. Movies and TV (and drug ads) promote ecstatic sex, but the public lacks the knowledge to assess these images. Good sex research will narrow the gap.

If you could teach people one thing about sexuality, what would it be? As the title of my book says, I believe that “Sex Is Not a Natural Act.” At least in the twenty-first century it’s not. Everything about sex is the result of cultural influ- ences and totally saturated with cultural meaning. Madison Avenue has hyped the pleasures and right-wing values have hyped the dangers—and, oddly, both insist that sex is a “natural” result of evolution (or God)—and that learning, practice, reading, reflection, conversation, and research are unnecessary. I believe just the opposite.

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Is there anything else you’d like to add? Every college and university should have a department of sexuality studies. At the present time it is impossible to get the kind of multidisciplinary education I think every sexologist needs. You have to do it all on your own. As a consequence, few sexologists are well trained. Such departments would employ sexuality scholars who would generate interesting new theory and research. I wish I could be in such a department.

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Is there a G-spot? One common question about female sexuality is whether there is a localized place in the vagina, often referred to as the G-spot, which causes especially pleasur- able sensations when stimulated. The G-spot, or Grafenburg spot, was named for Dr. Ernst Grafenburg, a German gynecologist who first described this spot in 1950. Although Grafen- burg often is credited with discovering this spot, descriptions of sensitivity in a specific area of the vagina can be found across cultures and historical periods (Sevely and Bennett, 1978; Ladas, Whipple, and Perry, 1982). Yet, contemporary sexologists disagree about the significance of the G-spot and its prevalence in the female population. Those in support of the G-spot claim that it is either a bundle of nerves, possibly representing the root of the clitoris, or a gland, or series of glands, that produces lubrication. More recently, Ostrzenski and col- leagues have identified a complex neurovascu- lar structure on the anterior wall of the vaginas of cadavers. They believe that this verifies the existence of the G-spot (Ostrzenski, 2012; Ostrzenski et al., 2014). Those who believe the G-spot is a myth argue that there is no ana- tomical evidence that it exists (Kilchevsky, Vardi, Lowenstein, and Gruenwald, 2012; Pan, Leung, Shah and Kichevsky, 2015) and dispute Ostrzenski’s research (Puppo, 2014).

Over the past few decades, the G-spot has gained widespread acceptance by the mass media. Numerous articles on sexual pleasure in the popular press, self-help literature, and on the Internet describe the G-spot and provide instructions on using it for sexual pleasure (for instance, Cass, 2007; Hicks, 2006; Miller, 2016;

Paget, 2004; Solot and Miller, 2007; Sundahl, Ladas, and Sprinkle, 2003; and Winks, 1998). New media provide an infinite array of good and bad information about sexual health and often focus on locating the G-spot to enhance sexual pleasure. Ladas, Whipple, and Perry (1982) argue that the G-spot feels like a spongy mass, about the size of a quarter and the shape of a bean, and can be found about halfway up the anterior (or belly) side of the vagina. The mass becomes more rigid or identifiable when a woman is sexually aroused (Perry and Whipple, 1981; Zaviacic, Zaviacicova, Holo- man and Molcan, 1988; Zaviacic and Whipple, 1993). According to self-reports, the G-spot produces “full body” orgasms and orgasms that are “more intense” than other female orgasms (Davidson, Darling, and Conway-Welch, 1989; Ladas et al., 1982; Perry and Whipple, 1981). Ladas et al. (1982) report that in a study super- vised by Perry and Whipple, a medical profes- sional was able to locate a G-spot in each of over 400 female volunteers (p. 43). Because Ladas et al. found that all women in their study had G-spots, they explain that women who have not been able to locate their G-spot are either not sufficiently aroused or not using the proper technique to locate it.

Yet, while many women believe the G-spot exists, not all women have heard about the G-spot and many women have not found their own G-spot. A survey of over 1,000 women found that although 85.3 percent of the women surveyed believed that a sensitive area existed in the vagina, only 65.9 percent reported hav- ing such an area (Davidson et al., 1989). This survey also found that angle of vaginal entry,

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and Jacobs, 1987; Gerhard, 2004). Other femi- nist researchers believe that, because of cultural preferences about (hetero) sexual behavior, many women prefer to view the vagina as an important location of orgasmic response. These scholars recognize that orgasm is not merely a physiological response but is also an emotional and psychological response to sexual stimuli and, as such, orgasms centered in the vagina should not be ignored (Hite, 1976; Schneider and Gould, 1987). However, if such a spot does exist, even supporters such as Ladas (2001) argue that it is harmful to think of the G-spot as the holy grail of female sexuality. In a criti- cal review of the discourse of female orgasm, Tuana (2004) argues that this false dichotomy of clitoral and vaginal orgasm ignores the perspective that the majority of the clitoris is internal (see also Moore and Clarke, 1995; O’Connell, Sanjeevan, and Hutson, 2005). Moreover, Tuana finds that some models of female anatomy that do include the G-spot ignore the feminist argument for a perineal sponge which is located between the posterior wall of the vagina and the rectum and also can become engorged during sexual stimulation.

Recent medicalization of women’s sexual health has led to cluster of procedures loosely referred to as female genital cosmetic surgery (FGCS). The latest procedure, G-spot ampli- fication or G-shot, is designed to expand the size of the G-spot by injecting it with a colla- gen-based filler with the intent of increasing sexual pleasure. There is no scientific evidence that FGCS improves sexual function (Bar- bara, Facchin, Meschia, and Vercellini, 2015), and Puppo (2014) argues that the focus on proving the existence of the G-spot only pro- motes industries such as G-spot amplification. Puppo and Gruenwald (2012) go even further, arguing that these “procedures have been quickly and unprofessionally introduced” and “are widely performed without monitoring or control” (p. 1668).

position of vaginal intercourse, and a woman’s degree of emotional involvement with her part- ner affected her ability to orgasm from being stimulated in this area. Because traditional sexual positions such as the “missionary posi- tion” fail to stimulate the anterior wall of the vagina, women who explore other sexual prac- tices such as manual stimulation from a part- ner or vibrator may be more likely to discover a G-spot (Ladas et al., 1982).

In contrast, some researchers strongly dis- pute the existence of the G-spot. Alzate and colleagues (Alzate and Hoch, 1986; Alzate, 1985) argue that the walls of the vagina are sensitive to touch, but there is no specific area in the vagina that produces orgasm. These authors also argue that there is no anatomi- cal evidence of a G-spot and critique previ- ous research for using small clinical samples and anecdotal evidence. In recent reviews of the literature on the G-spot, Hines (2001) and Kilchevsky and colleagues (2012) call it a myth and argue that despite widespread acceptance, there is little scientific evidence to support its existence. Other prominent sex researchers, including Masters and Johnson, do not dis- cuss the G-spot or an especially sensitive area in the vagina but instead focus on the clitoris as the locus of female orgasms (Masters and Johnson, 1966). Others suggest that the focus on a G-spot or vaginal orgasm sets women up for sexual frustration (Hines, 2001; Jannini et al., 2010; Kilchevsky et al., 2012; Puppo and Gruenwald, 2012).

Some feminist sex researchers also dispute the existence of the G-spot, but for different reasons. These scholars fear that the “discov- ery of the G-spot” and subsequent emphasis on vaginal orgasms support Freudian notions about the female orgasm and privilege het- erosexual male-centered models of sexuality. These authors emphasize the clitoris as the pri- mary location of the female orgasm and sexual empowerment for women (Ehrenreich, Hess,

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female ejaculation are not more likely to expe- rience urinary problems than women who do not report ejaculation (Cartwright, Elvy, and Cardozo, 2007). One reason for the confu- sion is that the ejaculate may be from differ- ent sources. In a review of the literature, Pastor (2013) found that women may expel several kinds of fluids during sexual stimulation, including vaginal fluids, female ejaculate, and urine, or a combination of these fluids. Regard- less of these findings, without larger samples of ejaculate, it would be difficult to reach any definitive conclusions.

A related controversy associated with female ejaculation concerns the source of the fluid. The most common theory is that the Skene’s glands (also known as the female prostate), which sur- round the urethra, secrete fluid into the urethra that is then ejaculated upon orgasm. Research- ers who support this theory argue that female ejaculate may have a different consistency, at different times, for different women. In addition, reported rates of ejaculation among women vary from 10 to over 50  percent (Ladas et al., 1983; Bullough, David, Whipple, Dixon, Allgeier, Rice, and Drury, 1984). Only a few women report ejaculating fluid with every orgasm. Although manipulation of the G-spot is not required to produce female ejaculation, women who experience pleasure or orgasms through stimulation of the  G-spot are more likely to report experiencing ejaculation (Davidson et al., 1989). Either way, by focusing solely on chemical components of the fluid, researchers are ignoring the role this event plays in sexual satisfaction.

Female ejaculation also has become the subject of several self-help sexuality books and sexuality workshops. According to an article by Taormino (2000), female ejaculation was the subject of one of the workshops at the 2000 Michigan Womyn’s Festival. After the work- shop, several women participated in the “First Annual Ejaculation Contest,” competing in

In sum, regardless of the politics of measur- ing and defining female genitalia, the female body contains many potential erogenous zones. Whether individuals find stimulation of these locations pleasurable depends on the social context, the expertise of their partner, and personal preference. Women (and men) should continue to seek out reliable information to understand their sexual bodies. One interest- ing new development doing just that is the subscription website OMGYES (www.omgyes .com), which provides research-based informa- tion about sexual health through videos and how-to guides for individuals and couples.

Do women ejaculate? Another common debate about the sexual body is whether women ejaculate. For centuries, erotic litera- ture and sex research have alluded to the elu- sive female orgasm that results in a squirt of liquid from the woman (Belzer, 1981; Korda, Goldsein, and Sommer, 2010). Contemporary researchers disagree as to where it comes from, what it is, and whether it is something that all women are capable of releasing.

Most often associated with G-spot stimula- tion, female ejaculation is the release of fluid through the urethra at the climax of an orgasm. One common concern about female ejaculation is whether the fluid is urine, a result of inconti- nence, or whether it is similar to male ejaculate. Self-reports indicate that this fluid is different from urine in smell, consistency, and color (Davidson et al., 1989; Belzer, 1981; Taormini, 2000). Chemical analyses of female ejaculate have been less conclusive. While Goldberg et al. (1983) found the expelled fluid to be chemi- cally similar to urine, numerous other clinical studies argue that the consistency of this fluid is significantly different from urine (Addiego, Belzer, Moger, Perry, and Whipple, 1981; Belzer, Whipple, and Moger, 1984; Wimpiss- inger, Stifter, Grin, and Stackl, 2007; Zaviacic et al., 1988). Additionally, a recent study con- cluded that women who reported experiencing

260 S E X UA L B O D I E S

Cartwright, Rufus, Susannah Elvy, and Linda Cardozo. 2007. “Do Women with Female Ejaculation Have Detrusor Overactivity?” Journal of Sexual Medicine, 4(6): 1655–58.

Cass, Vivienne. 2007. The Elusive Orgasm: A Woman’s Guide to Why She Can’t and How She Can Orgasm. New York: Marlowe and Company.

Davidson, J. Kenneth, Carol A. Darling, and Colleen Conway-Welch. 1989. “The Role of the Grafenburg Spot and Female Ejaculation in the Female Orgasmic Response: An Empirical Analysis.” Journal of Sex and Marital Therapy, 15: 102–20.

Ehrenreich, Barbara, Elizabeth Hess, and Gloria Jacobs. 1986. Re-Making Love: The Feminization of Sex. New York: Anchor Books.

Gerhard, Jane. 2004. “The Politics of the Female Orgasm.” In M. Stombler, D. M. Baunach, E. O. Burgess, D. Donnelly, and W. Simonds, eds., Sex Matters: The Sexuality and Society Reader. Boston: Allyn and Bacon. 213–24.

Goldberg, Daniel C., Beverly Whipple, Ralph E. Fishkin, Howard Waxman, Paul J. Fink, and Martin Weisberg. 1983. “The Grafenberg Spot and Female Ejaculation: A Review of Initial Hypotheses.” Journal of Sex and Marital Therapy, 9: 27–38.

Hicks, Donald L. 2006. Unleashing Her G-Spot Orgasm: A Step-by-Step Guide to Giving a Woman Ultimate Sexual Ecstasy. Berkeley, CA: Amorato Press.

Hines, Terence M. 2001. “The G-Spot: A Modern Gynecological Myth.” American Journal of Obstetrics and Gynecology, 185: 359–62.

Hite, Shere. 1976. The Hite Report: A Nationwide Study of Female Sexuality. New York: Dell.

Jannini, E. A., B. Whipple, S. A. Kingsberg, O. Buisson, P. Foldès, and Y. Vardi. 2010. “Who’s Afraid of the G-Spot?” Journal of Sexual Medicine, 7(1pt1): 25–34.

Kilchevsky, A., Y. Vardi, L. Lowenstein, and I. Gruenwald. 2012. “Is the Female G-Spot Truly a Distinct Anatomic Entity?” Journal of Sexual Medicine, 9(3): 719–26.

Korda, J. B., S. W. Goldstein, and F. Sommer. 2010. “Sexual Medicine History: The History of Female Ejaculation.” Journal of Sexual Medicine, 7(5): 1965–75.

Ladas, Alice. 2001. “Review of Secrets of Sensual Lovemaking and the Good Vibrations Guide.” Journal of Sex Education and Therapy, 26: 150–51.

Ladas, Alice, Beverly Whipple, and John Perry. 1982. The G-Spot and Other Recent Discoveries about Human Sexuality. New York: Plenum.

Masters, W. H., and V. E. Johnson, 1966. Human Sexual Response. Boston: Little, Brown.

Miller, Korin. 2016. “How to Find Your G-Spot.” Cosmopolitan. Retrieved January 15, 2018 from http:// www.cosmopolitan.com/sex-love/advice/g2126/how -to-find-your-g-spot/.

Moore, Lisa Jean, and Adele E. Clarke. 1995. “Clitoral Conventions and Transgressions: Graphic

categories such as “speed,” “distance,” “quan- tity,” and “best single-handed job.” While reports based on nonclinical trials do not receive scien- tific approval, the nature of this contest helps to alter negative stigma associated with female ejaculation.

There are several important implications of this research on female ejaculation. Because female ejaculation is not a widely known phe- nomenon, women who experience the expul- sion of fluids frequently feel shame or anxiety (Davidson et al., 1989). Many women, particu- larly those who are uncomfortable examining the fluid, assume that any release of fluid is urine and a sign of urinary incontinence. In some cases, women may seek and receive med- ical treatment for urinary incontinence when this is not, in fact, the problem. If women were aware that the expulsion of fluid was a normal and healthy bodily function, they would feel free to enjoy a pleasurable event rather than perceiving themselves as deviant (Cartwright et al., 2007; Winton, 1989).

REFERENCES Addiego, Frank, Edwin G. Belzer, Jill Comolli, William

Moger, John D. Perry, and Beverly Whipple. 1981. “Female Ejaculation: A Case Study.” The Journal of Sex Research, 17: 13–21.

Alzate, Heli. 1985. “Vaginal Eroticism: A Replication Study.” Archives of Sexual Behavior, 14: 529–37.

Alzate, Heli, and Zwi Hoch. 1986. “The ‘G-Spot’ and ‘Female Ejaculation’: A Current Appraisal.” Journal of Sex and Marital Therapy, 12: 211–20.

Barbara, G., F. Facchin, M. Meschia, and P. Vercellini. 2015. “‘The First Cut Is the Deepest’: A Psychological, Sexological and Gynecological Perspective on Female Genital Cosmetic Surgery.” Acta obstetricia et gynecologica Scandinavica, 94(9): 915–20.

Belzer, Edwin G. 1981. “Orgasmic Expulsions of Women: A Review and Heuristic Inquiry.” Journal of Sex Research, 17: 1–12.

Belzer, Edwin G, Beverly Whipple, and William Moger. 1984. “On Female Ejaculation.” Journal of Sex Research, 20: 403–06.

Bullough, Bonnie, Madeline David, Beverly Whipple, Joan Dixon, Elizabeth Rice Allgeier, and Kate Cosgrove Drury. 1984. “Subjective Reports of Female Orgasmic Expulsion of Fluid.” Nurse Practitioner, 9: 55–59.

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Sevely, J. L., and J. W. Bennett. 1978. “Concerning Female Ejaculation and the Female Prostate.” Journal of Sex Research, 14: 1–20.

Solot, Dorian, and Marshall Miller. 2007. I Love Female Orgasm: An Extraordinary Orgasm Guide. New York: Marlowe and Company.

Sundahl, Deborah, Alice Ladas, and Annie Sprinkle. 2003. Female Ejaculation and the G-Spot: Not Your Mother’s Orgasm Book! Alameda, CA: Hunter House, Inc.

Taormini, Tristan. 2000. “Pucker Up.” Village Voice, September 5, 45(35): 130.

Tuana, Nancy. 2004. “Coming to Understand: Orgasm and the Epistemology of Ignorance.” Hypatia, 19(1): 194–232.

Wimpissinger, Florian, Karl Stifter, Wolfgang Grin, and Walter Stackl. 2007. “The Female Prostate Revisited: Perineal Ultrasound and Biochemical Studies of Female Ejaculate.” Journal of Sexual Medicine, 4(5): 1388–93.

Winks, Cathy. 1998. The Good Vibrations Guide: The G-Spot. San Francisco: Down There Press.

Winton, Mark A. 1989. “Editorial: The Social Construction of the G-Spot and Female Ejaculation.” Journal of Sex Education and Therapy, 15: 151–62.

Zaviacic, Milan, and Beverly Whipple. 1993. “Update on the Female Prostate and the Phenomenon of Female Ejaculation.” Journal of Sex Research, 30: 148–51.

Zaviacic, Milan, Alexandra Zaviacicova, Igor Karol Holoman, and Jan Molcan, 1988. “Female Urethral Explusions Evoked by Local Digital Stimulation of the G-Spot: Differences in the Response Patterns.” Journal of Sex Research, 24: 311–18.

Representations in Anatomy Texts, c. 1900–1991.” Feminist Studies, 21(2): 255–301.

O’Connell, H. E., K. V. Sanjeevan, and J. M. Hudson. 2005. “Anatomy of the Clitoris.” Journal of Urology, 174: 1189–95.

Ostrzenski, A. 2012. “G-Spot Anatomy: A New Discovery.” The Journal of Sexual Medicine, 9(5): 1355–59.

Ostrzenski, A., P. Krajewski, P. Ganjei-Azar, A. J. Wasiutynski, M. N. Scheinberg, S. Tarka, and M. Fudalej. 2014. “Verification of the Anatomy and Newly Discovered Histology of the G-Spot Complex.” BJOG: An International Journal of Obstetrics and Gynaecology, 121(11): 1333–40.

Paget, Lou. 2004. Orgasms: How to Have Them, Give Them, and Keep Them Coming. New York: Broadway Books.

Pan, S., C. Leung, J. Shah, and A. Kilchevsky. 2015. “Clinical Anatomy of the G-Spot.” Clinical Anatomy, 28(3): 363–67.

Pastor, Z. 2013. “Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review.” Journal of Sexual Medicine, 10(7): 1682–91.

Perry, John D., and Beverly Whipple. 1981. “The Varieties of Female Orgasm and Female Ejaculation. SIECUS Report.

Puppo, V. 2014. “The G-Spot Does Not Exist.” BJOG: An International Journal of Obstetrics and Gynaecology, 121(11): 1341–41.

Puppo, V., and I. Gruenwald. 2012. “Does the G-Spot Exist? A Review of the Current Literature.” International Urogynecology Journal, 23(12): 1665–69.

Schneider, Beth E., and Meredith Gould. 1987. “Female Sexuality Looking Back into the Future.” In Beth B. Hess and Myra Marx Ferree, eds., Analyzing Gender: A Handbook of Social Science Research. Newbury Park, CA: Sage. 120–53.

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R E A D I N G 2 3

The cutting of healthy genital organs for non-medical reasons is at its essence a basic violation of girls’ and women’s right to physical integrity. This is true regardless of the degree of cutting or the extent of the complications that may or may not ensue.

—Anika Rahman and Nahid Toubia1

Most illogical is the use of the term “‘male genital muti- lation” to refer to male circumcision . . . in an attempt to equate the latter with female genital mutilation, with which it has little in common, either anatomically or health-wise.

—Brian J Morris2

T he non-therapeutic surgical alteration of children’s genitals is treated very differ-ently in Western societies depending on the sex or gender of the child whose genitals are being altered.3–8 Why such divergent treatment? As one prominent ethicist has noted, “these two practices, dramatically separated in the public imagination, actually have significant areas of overlap.”9 For example, both types of interven- tion involve the incision (and usually, though not always, the excision) of healthy, erogenous tissue.10–12 Both concern an individual’s “private parts,” yet are done without the person’s own consent. And neither involves the treatment of disease, nor the correction of an acknowledged deformity.13 Prima facie, then, at least according to this way of thinking, a similar medical- ethical analysis—based on conventional bioethical principles—would seem to apply to both.

Yet this is not the predominant opinion expressed in Western popular discourse, nor in much of the scholarly literature. In these domains, as well as in many others, the two

types of intervention are rarely discussed in the same context.14 Moreover, when they are char- acterized as being potentially comparable, the reaction is often incredulous. For example, when the anthropologist Kirsten Bell put forward such a comparison in her university lectures, the  response from her students was “immedi- ate and hostile”: “How dare I mention these two entirely different operations in the same breath! How dare I compare the innocuous and beneficial removal of the foreskin with the extreme mutilations enacted against females in other societies!”15

One recurrent claim is that FGM [female genital mutilation] is analogous to “castration” or a “total penectomy,” such that any sort of comparison between it and male circumci- sion is entirely inappropriate.16 This perspec- tive alludes to a harm-based argument for the (distinctive) impermissibility of female forms of genital alteration. On this sort of view, the sheer level of harm entailed by FGM passes a threshold of intolerability that is not passed by male circumcision. FGM is also seen as lack- ing in any benefit (as the World Health Orga- nization states: FGM has “no health benefits, [and] only [causes] harm”),17 whereas poten- tial health-based benefits are not infrequently raised in support of male circumcision.18–19

In the first section of this essay, I call into question the claims upon which these distinc- tions are typically premised. Specifically, I show

FEMALE GENITAL MUTILATION AND MALE CIRCUMCISION: TOWARD AN AUTONOMY-BASED ETHICAL FRAMEWORK

B R I A N D . E A R P

From “Female Genital Mutilation and Male Circumci- sion: Toward an Autonomy-based Ethical Framework,” Medicolegal and Bioethics, 2015, Vol. 5, pp. 89–104. Pub- lished by Dove Press Ltd. Reprinted by permission.

F E M A L E G E N I TA L M U T I L AT I O N A N D M A L E C I RC U M C I S I O N 263

which female genital cutting is practiced, the prac- tice reflects deeply rooted attitudes about the lower status of women. Thus, even if male and female geni- tal cutting were perfectly identical in terms of net health benefits and effects on sexual pleasure, the relationship in some cultures between female geni- tal cutting and a failure to respect women as moral equals would give an additional reason to object to female circumcision.21 (emphasis added)

This line of thought, which I will refer to as the “symbolic meanings” argument, will be the focus of the second section of my paper. In this section, I argue that Mazor’s proposed distinction, while potentially appealing on a first-pass assessment, is ultimately untenable. First, as Mazor himself concedes, male and female forms of genital alteration are carried out for different reasons, and reflect different norms and attitudes, in different cultural con- texts. In some cases, the “symbolic meanings” of these respective alterations are in fact quite similar. Indeed, contrary to common wisdom, non-therapeutic FGA is not always associated with, nor a reflection of, sexist and patriarchal norms; nor are the norms associated with male genital cutting always as morally innocent as is typically assumed.

Accordingly, even if one were to grant that the moral permissibility of each type of genital cutting—stipulated to be equally (physically) harmful for the sake of this analysis—hinged on the attitudes or norms that they “reflected,” it would still be necessary to distinguish between such attitudes and norms on a context-specific basis, and possibly even case-by-case. Apart from the practical difficulties that would be incurred by such a task, there are a number of epistemological difficulties as well.

As I conclude, therefore, the Western habit of drawing a stark moral distinction between male and female forms of non-therapeutic, non- consensual genital alteration may be impos- sible to maintain on principled grounds—or if not impossible, certainly much more difficult

that at least certain forms of FGM (or female genital alteration [FGA]),9 including forms that are legally prohibited in Western societies, are demonstrably less harmful than the most prev- alent forms of male circumcision. I also show that certain forms of male circumcision (or male genital alteration [MGA]), including forms that are common in parts of Africa and elsewhere, can be at least as harmful as the most extreme forms of FGA as practiced in any context. I will also question the claims that have been made on the point of health benefits, with respect to both types of genital alteration.

The harm-based argument, then, does not turn out to be sufficient to draw a strict moral distinction between male and female forms of genital cutting practices. The consequence of this conclusion can be stated as a conditional: if the degree of harm vs. benefit commonly attributed to male circumcision is seen as being compat- ible with its permissibility in Western societies, then forms of female genital cutting that result in a similar degree of harm vs. benefit must also be considered permissible on these grounds.20 Yet many would resist this conclusion. Indeed, the official position of such influential bodies as the World Health Organization (WHO) and the United Nations is that any kind of medically unnecessary, non-consensual alteration of the female genitalia—no matter how minor the inci- sion, no matter what type of tissue is or is not removed, no matter how slim the degree of risk, and no matter how sterile the equipment used— is by definition an impermissible “mutilation.”10

Granting this view for now (although it is not uncontroversial),10,9 perhaps we can find some other moral basis on which to ground a gender- or sex-based distinction. The philoso- pher Joseph Mazor has recently advanced an intuitive-sounding possibility:

There is an important moral difference [between male and female forms of genital alteration] that does not have to do with the physical effects of the operation[s]. Namely, in some . . . of the cultures in

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body envelope,26 and is therefore not removed by this type, or any type, of FGM.

FGM Type 2—This refers to the partial or total removal of the external clitoral glans and/ or the clitoral hood (in the senses described above), and/or the labia minora, with or without removal of the labia majora. This form of FGM is sometimes termed “excision.” Type 2(a) is the “trimming” or removal of the labia minora only; this is also known as labiaplasty when it is per- formed in a Western context by a professional surgeon (in which case it is usually intended as a form of cosmetic “enhancement”).23 In this context, such an intervention is not typically regarded as being a form of “mutilation,” even though it formally fits the WHO definition. Moreover, even though such “enhancement” is most often carried out on consenting adult women in this cultural context, it is also some- times performed on minors, apparently with the permission of their parents.10,27 There are two further subtypes of FGM Type 2, involving combinations of the above interventions.

FGM Type 3—This refers to a narrowing of the vaginal orifice with the creation of a seal by cutting and repositioning the labia minora and/or the labia majora, with or without exci- sion of the external clitoris. This is the most extreme type of FGM, although it is also one of the rarest, occurring in approximately 10% of cases.10,28 When the “seal” is left in place, there is only a very small hole to allow for the pas- sage of urine and menstrual blood, and sexual intercourse is rendered essentially impossible. This type of FGM is commonly called “infibu- lation” or “pharaonic circumcision” and has two additional subtypes.

FGM Type 4—This refers to “all other harmful procedures to the female genitalia for non- medical purposes” and includes such interven- tions as pricking, nicking, piercing, stretching, scraping, and cauterization.22 Counterintuitively for this final category—which one might expect to be even “worse” than the ones before it—several

than is commonly assumed. In the final sec- tion of this paper, I provide a very brief sketch of an ethical framework that could be used to evaluate such alterations in a more consistent and principled way. Instead of being based on considerations of sex or gender, my proposed framework will be based on considerations of bodily autonomy and informed consent.

MALE AND FEMALE FORMS OF GENITAL ALTERATION: THE QUESTION OF HARM

That FGA is harmful to women and girls—and certainly much more harmful than MGA—is a truism in Western societies. This is the harm- based argument to which I alluded earlier, and I have already suggested that it cannot suc- ceed. To see why this is the case, it is neces- sary to begin with a widely accepted definition of FGM . . . so that we can understand what is at stake in such a procedure, followed by an analysis of male circumcision. The WHO gives us the following typology:22

FGM Type 1—This refers to the partial or total removal of the clitoral glans (the part of the clitoris that is visible to the naked eye) and/ or the clitoral prepuce (“hood”). This is some- times called a “clitoridectomy,”17 although such a designation is misleading: the external clito- ral glans is not always removed in this type of FGM, and in some versions of the procedure— such as with so-called “hoodectomies”—it is deliberately left untouched.23 There are two major sub-types. Type 1(a) is the partial or total removal of just the clitoral prepuce (i.e., the fold of skin that covers the clitoral glans, much as the penile prepuce covers the penile glans in boys; in fact, the two structures are embry- onically homologous).24–25 Type 1(b) is the same as Type 1(a), but includes the partial or total removal of the external clitoral glans. Note that two-thirds or more of the entire clitoris (includ- ing most of its erectile tissue) is internal to the

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of the interventions just mentioned are among the least severe forms of FGM. Piercing, for example, is another instance of a procedure—along with labiaplasty (FGM Type 2) and “clitoral unhood- ing”23 (FGM Type 1)—that is popular in Western countries for “non-medical purposes,” and can be performed hygienically under appropriate conditions.10,29–31

The Harms of FGM/A Several points can now be emphasized. First, “FGM” is not just one thing. Instead, there are many ways to nick, scratch, or cut off parts of a girl’s vulva, ranging from (at the lowest end of the harm spectrum) an anaesthetized prick on the clitoral hood, as is common in Malaysia and in some other Muslim communities,10,32 to (at the highest end of the spectrum) the exci- sion of the outer clitoris with a shard of glass, and the suturing of the labia with thorns.33 It should be clear that these different forms of intervention are likely to result in different degrees of harm, with different effects on sex- ual function and satisfaction, different chances of developing an infection, and so on, among the other possible adverse consequences that may be associated with these procedures.34 But as Carla Obermeyer has observed:

It is rarely pointed out that the frequency and severity of complications are a function of the extent and cir- cumstances of the operation, and it is not usually rec- ognized that much of [our] information comes from studies of the Sudan, where most women [in contrast to the majority of other contexts] are infibulated. The ill-health and death that these practices are thought to cause are difficult to reconcile with the reality of their persistence in so many societies, and raises the question of a possible discrepancy between our “knowledge” of their harmful effects and the behav- ior of millions of women and their families.35

A further point to consider is that many of  the risks and harms that are associated with  FGM—such as pain, infection, and

hemorrhage—could be substantially reduced, if not eliminated, by transitioning toward the less invasive forms of the procedure, coupled with an increased focus on “medicalization.”36–37 In light of this recognition, more minor forms of female genital alteration are indeed being performed in hospital settings in an increas- ing number of communities worldwide, on the model of routine male circumcision as per- formed in the United States.38 This trend has not been welcomed, however, by those who oppose FGM regardless of implementation or type,10,38–39 and it has been explicitly con- demned by both the WHO and the United Nations.10

What about effects on sexuality?40 While a popular assumption is that any form of FGM deprives women of all sexual feeling, “[r]esearch by gynecologists and others has demonstrated that a high percentage of women who have had genital surgery have rich sexual lives, includ- ing desire, arousal, orgasm, and satisfaction, and their frequency of sexual activity is not reduced.”41 Indeed, in one study,42 up to 86% of women—some of whom had undergone even “extreme” forms of FGM—reported the ability to orgasm, and “the majority of the interviewed women (90.51%) reported that sex gives them pleasure.” These counterintuitive findings might be explained by the fact, noted earlier, that much of the clitoris is actually underneath the skin layer and is therefore not removed by even the most invasive types of FGM. Of course, there are other parts of the vulva/ vagina to consider as well, whose stimulation can likewise contribute to sexual pleasure. All told, the degree and quality of subjective sexual feeling are likely to vary considerably. . . .43

On the other side of the ledger, there is a great deal of evidence that FGM can be harm- ful to sexual function and experience, especially when one considers the more extreme forms.44–46 Women in some studies have reported feeling “cold” during sex, deriving “no satisfaction” from

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removes between one-third to one-half of the movable skin system of the penis,50 or about 50 square centimeters of sensitive tissue in the adult organ.51–52 The operation also eliminates the gliding function of the prepuce (which may help to reduce chafing in the female sexual partner), as well as any and all sexual sensation in the prepuce itself;12,52 and it exposes the head of the penis to environmental irritation.12,50 Just as with various forms of non-therapeutic FGA, male circumcision has been associated with numerous sexual difficulties, ranging from reduced sensitivity in the exposed glans, to problems with orgasm, to pain in the recep- tive female partner.53–55 Nevertheless, many, if not most, circumcised men report being able to enjoy their sexual experiences, notwithstand- ing the loss of erotogenic tissue. . . .56–57

The literature concerning the sexual effects of male circumcision is hotly contested. . . .58–59 “Adverse self-reported outcomes associated with foreskin removal in adulthood include impaired erectile functioning, orgasm diffi- culties, decreased masturbatory functioning (loss in pleasure and increase in difficulty), an increase in penile pain, a loss of penile sensi- tivity with age, and lower subjective ratings of penile sensitivity” (internal references omit- ted).57 While “other studies have found no significant differences in self-reported sexual functioning following adult circumcision,” it must be remembered that (a) adult vs. infant/ child circumcision may not necessarily yield equivalent outcomes,12 and (b) that a lack of statistical significance does not entail a lack of underlying effect. . . .60

Just as with FGA, male genital cutting can take many different forms. In Pakistan, tradi- tional Muslim circumcisions are done while the boy is fully conscious, usually between the ages of 3 and 7. . . . “[T]he child is held in a seated position, with both legs apart . . . [then] a probe, a cutter made of wood, and a razor are used [to excise] the prepuce,” at

intercourse, and “having pain during sex.”47. . . FGM—of whatever degree of severity—will lead to different psychologically mediated outcomes, depending upon the beliefs, attitudes, and other internal states of the affected individual.42–43 As I have argued elsewhere:

While many African women feel enhanced by hav- ing modified genitals—feeling more beautiful, “cleaner,” more “smooth” and “neat”—increasing numbers of them are aware of just how controver- sial their local customs have become on the world stage. Many of them are learning about how other cultures and societies regard the innervation and functions of the clitoris. Some of them are dating outside of their cultural groups [and finding] out that “cut” genitals are not considered beautiful by the prevailing group in such contexts, and so on. Accordingly, they may feel humiliated, deprived, diminished—and yes, “mutilated.” There is even [some] evidence of women seeking reconstructive surgery of their genitals to try to reclaim what was “taken from them” when they were too young to fully understand what was happening.10

. . . [I]t is clear that FGM, and especially its more invasive forms, poses a distinct risk of causing sexual harm, even if this harm may not be experienced in the same way, or to the same degree, by every woman who has been sub- jected to genital surgery. . . .

The Harms of MGA These same considerations apply to male cir- cumcision. As with FGM/A, circumcision is not a monolith: it isn’t just one kind of thing. The original form of circumcision within Juda- ism, for example, until about 150 AD, was comparatively minor: it involved cutting off the overhanging tip of the foreskin—whatever stretched out over the end of the glans—thus preserving (most of) the foreskin’s protective and motile functions, as well as limiting the amount of erogenous tissue removed.48 The “modern” form adopted by the United States49 is significantly more invasive: it typically

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hemorrhage, shock or sepsis” as a result of their non-therapeutic circumcisions at a single children’s hospital in Birmingham, England.70

. . . [B]oth male and female forms of genital alteration fall on a wide spectrum, and . . . the harms they may entail substantially overlap.9 That this is not commonly understood in the popular discourse is most likely due to the fact that when Westerners hear the term “FGM,” they tend to think of the most extreme forms of female genital cutting, done in the least sterilized environments, with the most drastic consequences likeliest to follow (since these are the forms to which they will typically have been exposed, due to their disproportionate representation in the media and in other popu- lar accounts).41 When people hear the term “male circumcision,” by contrast, they are much more likely to think of the least severe forms of male genital cutting, done in the most steril- ized environments, with the least drastic con- sequences likeliest to follow, largely because this is the form with which they are culturally familiar. . . .10,71

THE OTHER SIDE OF THE COIN: THE QUESTION OF BENEFITS

So far, I have discussed the potential harms of male and female genital alterations, but I have not yet considered the question of benefits. MGA, but not FGA, is believed by some medi- cal professionals to confer a number of possible health benefits—most notably, a small reduc- tion in the absolute risk of female-to-male, het- erosexually transmitted HIV in areas with high base rates of such infection62,72–75—although the likelihood and the magnitude of such benefits outside of sub-Saharan Africa are the subject of considerable dispute. If these authorities are correct, then the benefits of circumcision might conceivably offset the drawbacks and risks in a way that is not the case for FGA, thereby pre- serving the moral distinction between them.

which point “ashes of burnt wood are [applied] to establish haemostasis.”61 The operation is performed “with no anaesthesia, no sutures and with unsterilized instruments.”61 In the United States, routine (non-religious) cir- cumcisions are performed in a hospital set- ting, and take place in the first few days of life. These, too, often involve inadequate (or no) pain control, and have been known to result in serious “botches,” including partial amputations of the penis. While such an out- come is typically described as “rare,” the true incidence of complications is unknown.7,62– 63 Metzitzah b’peh, done by some ultra-Ortho- dox Jews, requires the sucking of blood from the circumcision wound, and carries the risk of herpes infection and permanent brain damage.64 Subincision, performed by some Australian aboriginal groups, involves slicing open the urethral passage on the underside of the penis from the scrotum to the glans, often affecting urination as well as sexual func- tion.65– 66. . . “[T]he bleeding is staunched with sand, and the edges of the wound may be cau- terized . . . the resultant defect in the urethral wall is kept open [with] pieces of wood, bone, or clay.”65 Circumcision among the Xhosa in South Africa is traditionally done in the bush as a rite of passage, sometimes with the use of spearheads and dirty knives, and frequently by medically untrained practitioners. Just as with female genital altering rites performed under comparable conditions (and often by the very same groups), these kinds of opera- tions frequently cause hemorrhage, infec- tion, mangling, and loss of the sexual organ.67 In fact, between 2008 and 2014, more than half a million boys were hospitalized due to botched circumcisions in South Africa alone; more than 400  lost their lives.68– 69 But even when performed in a modern clinical set- ting, circumcisions are not without their risks and complications. In 2011, nearly a dozen infant boys were treated for “life-threatening

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be unethical12,34—to conduct a study to find this out. Obviously, the more extreme types of FGA will not contribute to good health on balance, but neither will the spearheads-and- dirty-knives versions of MGA performed on boys. What about more mild forms of FGA? As I have noted elsewhere, “the vulva has all sorts of warm, moist places where bacteria or viruses could get trapped, such as underneath the cli- toral hood, or among the folds of the labia; so who is to say that removing some of that tissue (with a sterile surgical tool) might not reduce the risk of various diseases?”71

As a matter of fact, defenders of FGA in some countries actually do cite such “health benefits” as “a lower risk of vaginal cancer . . . less nervous anxiety, fewer infections from microbes gather- ing under the hood of the clitoris, and protection against herpes and genital ulcers.”14 Moreover, at least one study by Western scientists has shown a link between “female circumcision” and reduced transmission of HIV—a result that the authors, both experienced statisticians, charac- terized as a “significant and perplexing inverse association between reported female circumci- sion and HIV seropositivity.”81–82

. . . The thought experiment can be taken a step further. With respect to causal plausi- bility, it is often argued that the biological mechanism through which the foreskin in males becomes a vector for HIV transmission (although the details are somewhat conten- tious)81–82 is the presence of Langerhans cells in the inner mucosa of the foreskin. What is rarely mentioned in these discussions, how- ever, is that the external female genitalia are also richly endowed with Langerhans cells.83 If the removal of tissue with Langerhans cells is seen as an acceptable means of reducing HIV transmission, then the excision of portions of the female genitalia (on these grounds) should logically be entertained as well.

The point here is . . . that regardless of any evidence for such a possibility, serious research

An important qualification is in order. First, almost all of the controlled evidence pointing to potential health benefits for MGA has been derived from studies of adult (and hence vol- untary) circumcision, rather than from infant/ child (and hence involuntary) circumcision.57 Since “the spread of disease, including sexually transmitted infections, is determined much more by socio-behavioral and situational fac- tors than by strictly anatomical-biological factors, such as the presence or absence of a foreskin . . . the apparent findings from these studies cannot be simply mapped on [to] cir- cumcisions performed earlier in life, i.e., before an age of sexual debut.”76 This distinction is important. From an ethical perspective, few people would argue that fully informed adult males should not be permitted to undergo elec- tive surgeries on their own genitals. . . .

With respect to neonatal or childhood cir- cumcision, by contrast, the primary health bene- fit that has been attributed to this version of the surgery is a slight reduction in the absolute risk of urinary tract infections.77 However, the over- all chance of contracting such an infection (in the first year of life) is low—approximately 1%— regardless of one’s circumcision status. . . .78 In the rare event that a child does in fact become infected, UTIs are both “easily diagnosed and treatable, with low morbidity and mortality.”79 A further point to consider is that: according to one recent estimate, about 111 circumcisions would have to be performed to prevent a sin- gle case of UTI.80 Accordingly, “a more conserva- tive, humane, and effective course of treatment would be to prescribe oral antibiotics—if and when an infection does occur. This is just what we do for girls, who get UTIs (after the age of 1) about 10 times more frequently than boys do, with no pre-emptive surgery recommended.”52

But what if such surgery were recom- mended?  . . . [W]e do not actually know whether some minor form of FGA might confer health benefits, because it is illegal—and would

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sure.41,88 Indeed, such cutting is nearly always carried out by women themselves, who do not typically view their rites as being an expression of patriarchal norms, but rather as conducive to good hygiene, beautifying,28,89 empowering, and as a rite of passage with high cultural value.28,88 As Lisa Wade has argued, “attribut- ing [the] persistence [of female genital altering rites] to patriarchy grossly oversimplifies their social, cultural, and economic functions” in the diverse societies in which they are performed.90

It has sometimes been argued that women who endorse FGA are victims of “false con- sciousness” and are thus mistaken about the nature of their own most cherished customs— that they are so oppressed, for example, that they have become unwitting instruments to their own oppression.91 However, this sort of  argument is increasingly being seen as both simplistic and condescending.10,28,91–94. . . [T]he supportive voices of women who have actually undergone genital alterations are “almost entirely absent, literally silenced by [a Western] insistence that the horrendousness of the practice precludes any possible positive evaluation.”95. . .

. . . [A]s Ahmadu has argued, there has been an “unjustified conflation” of the var- ied practices of FGA in the popular dis- course, resulting in an overemphasis on the most symbolically problematic form, namely infibulation. . . .88 This conflation is unjusti- fied, she suggests, because infibulation is simultaneously the most extreme form of FGA, the rarest, and the form most closely associated with norms of male dominance and sexual control. It is also “associated with a specific region and interpretation of Muslim purdah ideology,”88 and appears to be concen- trated in northeast Africa.

In most other African contexts, by contrast, both FGA and MGA are at least superficially egalitarian: they are carried out regardless of the sex or gender of the child, and are intended

into the question is unlikely ever to be con- sidered, simply because such procedures are unacceptable to Western ethical and cultural norms.84 Bell has highlighted the contradic- tory policies of international health organiza- tions on this point, “which seek to medicalize male circumcision on the one hand, oppose the medicalization of female circumcision on the other, while simultaneously basing their opposition to female operations on grounds that could legitimately be used to condemn the male operations.”15

IS THERE A “SYMBOLIC” DIFFERENCE?

. . . [T]here may be a “symbolic” difference to consider as well. This is the view suggested by the philosopher Joseph Mazor, as indicated in the introduction, and it is one that has been advanced by Martha Nussbaum, among many others. “Female genital mutilation is unam- biguously linked to customs of male domina- tion,”85 Nussbaum has written; whereas male circumcision is not ordinarily seen as being linked to such customs, nor perhaps to other problematic norms.86

In contrast to this perspective, I sug- gest that male genital cutting can indeed “be understood as a gendering practice tied to [patriarchal notions of] masculinity” as well as to customs of male domination;87 and also, fol- lowing Ahmadu,88 that female forms of genital cutting are not “unambiguously” tied to such customs. . . .

The Symbolic Meanings of FGA [ . . . ] As is increasingly being emphasized by scholars in this area, female genital cutting is performed for different reasons in different social contexts, and is not always associated with a lower status for women and girls, nor with the aim of reducing their sexual plea-

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Jewish women were Jewish by birth, but their Jewishness was assumed to be inferior to that of Jewish men.”97–98 “A true egalitarian would think it unfair that a boy is cut while a girl is not [and would] either extend the burden [of circumcision] to girls or remove it from [the] boys.”99 The sociologist Michael Kimmel goes a step further:

Circumcision means . . . the reproduction of patriar- chy. [In the Jewish tradition] Abraham cements his relationship to God by a symbolic genital mutilation of his son. It is on the body of his son that Abraham writes his own beliefs. In a religion marked by the ritual exclusion of women, such a marking not only enables Isaac to be included within the community of men . . . but he can also lay claim to all the privileges to which being a Jewish male now entitles him. . . . To circumcise [one’s son, therefore, is] to accept as legitimate 4000 years [of] patriarchal domination of women.100

Male circumcision may be related to other problematic norms as well. One connection that has been raised in the literature is with an attempt to exercise control over boys’ sexu- alities.9,101 While most contemporary Western parents who choose circumcision for their sons do not (very likely) have such a motivation consciously in mind, neither, apparently, do most African parents when they choose “cir- cumcision” for their daughters. Instead, as the renowned anti-FGA activist Hanny Lightfoot- Klein has stated: “The [main] reasons given for female circumcision in Africa and for routine male circumcision in the United States are essentially the same. Both promise cleanliness and the absence of odors as well as greater attractiveness and acceptability.”102

Nevertheless, male genital cutting has indeed been used as a form of sexual control, and even punishment, for a very long time.9,101 The Jewish philosopher Maimonides (b. 1135) argued that diminished sexual sensitivity was part of the point of performing circumcisions (to reduce excessive “lust” as well as “weaken . . . the organ

as a means of conferring adult status within the group.41,84 Among the Kono of Sierra Leone, for example, “there is no cultural obsession with feminine chastity, virginity, or women’s sexual fidelity, perhaps because the role of the biologi- cal father is considered marginal and periph- eral to the central ‘matricentric unit.’”108 In this context, male and female genital alterations are performed in parallel ceremonies, are not primarily intended to reduce sexual pleasure, and the operations are seen as mirror images of each other.10,41,84

Nancy Ehrenreich and Mark Barr provide a general lesson:

[ . . . ] The mainstream anti-FG[A] position is pre- mised upon an orientalizing construction of FG[A] societies as primitive, patriarchal, and barbaric, and of female circumcision as a harmful, unnecessary cultural practice based on patriarchal gender norms and ritualistic beliefs. . . . Lambasting African soci- eties and practices (while failing to critique similar practices in the United States [and Europe]) . . . essentially implies that North American [and Euro- pean] understandings of the body are “scientific” (i.e., rational, civilized, and based on universally acknowl- edged expertise), while African understandings are “cultural” (i.e., superstitious, uncivilized, and based on false, socially constructed beliefs). [Yet] neither of these depictions is accurate. North American medicine is not free of cultural influence, and FG[A] practices are not bound by culture—at least not in the uniform way imagined by opponents.96

The Symbolic Meanings of MGA What about the other side of things? The usual claim is that male circumcision is not associated with a lowered status for women, but in Judaism, at least, this is not obviously the case. Indeed, only the males are permitted to “seal the divine covenant” by having their foreskins removed, so the custom is sexist on its face.9. . . “Jews of antiquity seem not to have been bothered by this question probably because the funda- mental Otherness of women was clear to them.

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that this “solution” would create more prob- lems than it would solve. For example, it would require that Western laws regarding physical assault on a minor be rewritten, potentially creating large-scale disturbances throughout the legal system. This is because—as others have argued—cutting into a child’s genitals without a medical diagnosis, and without its informed consent, meets the formal definition of criminal assault under the legal codes of most of these societies. . . .108

Another problem . . . is that it would be very difficult indeed to “police” such newly approved “minimal” forms of FGA, to ensure that they were not being used as a cover for more inva- sive and harmful procedures. In fact, a very basic problem with the suggestion of harm- tolerance is the difficulty it presents in terms of specifying an appropriate threshold for harm that could be measured in an objective way. As Blackstone noted more than 200 years ago, “the law cannot draw [a] line between different degrees of violence. . . . The law is an impor- tant symbol and if [it] allows parents, carers and teachers to [so much as hit their] children, it is sending a message to these people and to the community generally that children are not entitled to the same right to bodily integrity as adults.”109

The question of rights is arguably central to this issue. In Western societies, we teach our citizens (including our children) that they have a right to bodily integrity:110 “a right to make decisions about what happens to [their] own body, [a] right to say no to unwanted touch- ing, [a] right not to be physically or sexually assaulted.”109 This, Ludbrook argues, is “the most personal and arguably the most impor- tant of all human rights,” next to the right to life itself.109 Some authors have argued that FGA performed before an age of consent is a violation of such a right, “regardless of the degree of cutting or the extent of the complica- tions that may or may not ensue.”1

in question”);103 circumcision was adopted into Western medicine in the Victorian period largely as a means to combat masturbation and other expressions of juvenile sexuality. . . .104

. . . [I]t could be argued that these appar- ent associations with problematic norms are superficial,105 outdated, or only apply to a lim- ited number of cases. But this is exactly the point. Neither male nor female forms of geni- tal cutting can be successfully “boiled down” in terms of the attitudes that they supposedly express, and both have been plausibly asso- ciated with both (seemingly) unproblematic as well as (seemingly) extremely problematic norms. . . .

Given that both male and female forms of genital cutting express different cultural norms depend- ing upon the context, and are performed for dif- ferent reasons in different cultures, and even in different communities or individual families, how shall we assess the permissibility of either? Do we need to interview each set of parents to make sure that their proposed act of cutting is intended as an expression of acceptable norms? If they promise that it isn’t about “sexual control” in their specific case, but rather about “hygiene” or “aesthetics” or something less symbolically problematic, should they be permitted to go ahead? But this is bound to fail.71

TOWARD AN AUTONOMY-BASED ETHICAL FRAMEWORK

At a first glance, there seem to be at least two ways of resolving this inconsistency. First, if Western societies remain convinced that the non-therapeutic alteration of boys’ genitalia should be considered permissible so long as it does not cross an arbitrary thresh- old of “harm,” then they should consider allowing similar alterations to the genitals of little girls (if requested by the parents). Some authors . . . have in fact made just such a sug- gestion.9,10,106–107 It seems evident, however,

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of choice . . . and the recognition of all non-therapeutic bodily modifications” as being “culturally” motivated.94 “This could mean making a distinction,” she continues, “between adults who can choose how to modify their bodies in irreversible ways— however much the majority might deplore their choices—and children who cannot.”94 The application of this framework would have several important implications:

It would mean saying that male circumcision of baby boys, where it has been established that it has no . . . medical benefits, is unacceptable; it would mean that it would be illegal to circumcise a girl under the age of consent; and it would mean [by contrast] that if an adult woman wants to have her genitals “tidied up” after childbirth or her labia reduced through “cosmetic” surgery, then she should be allowed to make that choice. This may not be a satisfactory position but it is a way of avoiding double standards while the real work of changing the attitudes that produce these practices takes place.94

I am sympathetic with this general frame- work. As I have argued elsewhere, “Children of whatever [sex or] gender should not have healthy parts of their most intimate sexual organs removed, before such a time as they can understand what is at stake in such a surgery and agree to it themselves.”34 Conversely, . . . adults should be free to use medical technolo- gies to modify their own bodies and minds, in a process of self-creation, if that is what they truly want.114–116 While I do not suggest that (non-therapeutic) MGA should be banned, nec- essarily,117–119 it is clear that the current laissez- faire attitude toward this practice that is typical of Western societies—and in particular the United States—can no longer be maintained without facing serious objection. FGA and MGA are both highly problematic practices, with far more overlap between them . . . than is commonly understood: they should not be dis- cussed, therefore, in hermetically sealed moral discourses.9,84 Instead, the relevant framework

Undoubtedly, such a view is motivated at least in part by the fact that such cutting involves a very “private” part of the body—i.e., a part with unique psycho-sexual significance— and that it is done before a girl can understand what is at stake in such a procedure, much less offer effective resistance. Indeed, genitals are not like other parts of the body. This can be seen in the fact that sexual assault, in Western societies, is typically regarded as a more severe and more personal violation than other kinds of bodily assault. Accordingly, the outright cut- ting and/or alteration of a child’s genitals seems much more likely to be the sort of interference that would later be experienced as a harm, compared against various other childhood bodily alterations that are sometimes raised in the literature. . . .

A New Ethical Framework Taking all of these considerations into account, let me offer a second approach to resolving the “inconsistency” alluded to above, which has the potential to avoid the serious disadvantages that seem likely to follow from an increased tol- erance for FGA. This approach would involve a decreased tolerance for MGA, and on the same grounds that have just been discussed. According to this approach, the test for moral permissibility (if not legal permissibility, as that may raise a different set of issues)111 would rest not so much on considerations of sex or gender—according to which boys, compared to girls, are treated less favorably—but more on considerations of informed consent, reflecting an underlying concern for the “genital auton- omy”112–113 of children.

Moira Dustin has described just such an approach. She suggests that one way to resolve the apparent double standard regard- ing male vs. female forms of genital altera- tion in Western societies, “would be to argue for the application of consistent principles

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13. Dekkers W, Hoffer C, Wils J-P. Bodily integrity and male and female circumcision. Medicine, Health Care and Philosophy. 2005; 8(2):179–91.

14. Svoboda JS, Darby R. A rose by any other name: symmetry and asymmetry in male and female genital cutting. In Fearful Symmetries: Essays and Testimonies Around Excision and Circumcision, ed. Zabus C. Amsterdam and New York: Rodopi. 2008; 272–86.

15. Bell K. Genital cutting and Western discourses on sexuality. Medical Anthropology Quarterly. 2005; 19(2):125–48.

16. Schwartz RL, Johnson D, Burke N. Multiculturalism, medicine, and the limits of autonomy: the practice of female circumcision. Cambridge Quarterly of Healthcare Ethics. 1994; 3(3):431–41.

17. World Health Organization. Female Genital Mutilation. 2014. Available at http://www.who.int/mediacentre /factsheets/fs241/en/.

18. Tobian AA, Gray RH. The medical benefits of male circumcision. Journal of the American Medical Association. 2011; 306(13):1479–80.

19. Blank S, Brady M, Buerk E, et al. Circumcision policy statement. Pediatrics. 2012; 130(3):585–86.

20. And conversely, if the degree of net harm commonly attributed to FGA is seen as being incompatible with its permissibility in Western societies, then forms of MGA that result in a similar (or greater) degree of net harm must also be considered impermissible on these grounds.

21. Mazor J. The child’s interests and the case for the permissibility of male infant circumcision. Journal of Medical Ethics. 2013; 39(7):421–28.

22. World Health Organization. Global Strategy to Stop Healthcare Providers from Performing Female Genital Mutilation. 2010. Available at http://whqlibdoc.who .int/hq/2010/WHO_RHR_10.9_eng.pdf?ua=1.

23. Renganathan A, Cartwright R, Cardozo L. Gynecological cosmetic surgery. Expert Review of Obstetrics and Gynecology. 2009; 4(2):101–04.

24. Cold CJ, McGrath KA. Anatomy and histology of the penile and clitoral prepuce in primates. Male and Female Circumcision. New York: Springer. 1999; 19–29.

25. Note that, on some interpretations, FGM Type 1(a) is the strict anatomical equivalent of male circumcision, since both procedures constitute the removal of the genital prepuce. However, such comparisons are not quite exact: in the male version of the procedure, many more square centimeters of erogenous tissue are removed due to the larger size of the penile prepuce.

26. O’Connell HE, Sanjeevan KV, Hutson JM. Anatomy of the clitoris. The Journal of Urology. 2005; 174(4): 1189–95.

27. Liao L-M, Taghinejadi N, Creighton SM. An analysis of the content and clinical implications of online advertisements for female genital cosmetic surgery. BMJ Open. 2012; 2(6):e001908.

is one that analyses a child’s right to bodily integrity, and carefully considers how tolerant we are willing to be, in these societies, of prac- tices which irreversibly alter a person’s “private parts” in a non-trivial fashion, in the absence of medical necessity,120 and before the person has a chance to say “no.”. . .

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R E A D I N G 2 4

More recently, however, scholars have been interrogating the assumptions behind this discussion of Okin’s question. These scholars have argued that the object driv- ing the multiculturalism/feminism debates is not “culture,” but our model of culture. While most anthropologists and sociologists of culture adopt various dynamic models (e.g., Bourdieu, 1977; Sewell, 1992; Swidler, 2001), public debates often assume a reified model, selectively applied, in which culture is characterized by timelessness, internal coherence, clear boundaries, and determin- ism (Benhabib, 2002; Merry, 2006; Narayan, 2000). It is this reified model that makes the answer to Okin’s question appear to be “yes” by presupposing that some groups, but not others, are rigidly bound to an un-reformable (patriarchal) culture.

I contribute to this emerging literature in two ways. First, instead of looking at cultural practices and cultural groups, I focus on cul- tural change. I show that the reified model of culture also shapes our perception of accultur- ation, with serious consequences for our ability to manage the compromise and accommoda- tion essential to multicultural democracies. Second, I interrogate how the dynamic model of culture is discursively mobilized. I show that the dynamic model, just like the reified model,

M odern democracies around the globe are struggling to build functional, integrated, egalitarian nations in the face of social conflicts deemed “cultural.” This crisis of culture derives, in part, from the mul- tiplicitous and paradoxical meanings of the term. Used to describe time-honored traditions, unconscious habits, group identities (racial, ethnic, and other), the character of nation- states, religious practices, and both “high” and “folk” art, culture is both condemned as a pri- mary obstacle to the spread of human rights and celebrated as a human right in itself (Ben- habib, 2002; Cowan, Dembour, and Wilson, 2001; Merry, 2006). Indeed, the term seems to have lost any coherent meaning even as it has become increasingly politicized (Eriksen, 2001; Fraser, 1995; Turner, 1993).

As illustrated by Susan Okin’s (1997) famous question, “Is multiculturalism bad for women?” the challenge of managing (so-called) cultural difference is crystallized in conflicts over women’s rights. Practices like dowry murders, honor crimes, sex-selective abortion, forced or arranged marriage, and female genital cut- ting (FGC) are all framed as cultural problems that test the limits of cross-cultural tolerance. Culture itself is often held accountable for the perpetuation of these practices, alongside or instead of individuals, such that the well-being of girls and women seems to be incompatible with cultural preservation (Narayan, 1997). The apparent incommensurability between feminism and multiculturalism has spurred a voluminous literature in which culture has been both defended and derided. . . .

THE POLITICS OF ACCULTURATION: FEMALE GENITAL CUTTING

L I S A W A D E

From “The Politics of Acculturation: Female Genital Cutting,” Social Problems, Vol. 58, Issue 4, 2011, pp. 518 –37. Copyright © 2011, The Society for the Study of Social Problems Inc. By permission of Oxford Uni- versity Press.

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the procedure as essentially symbolic; it was, literally, the least they could do. From their perspective, then, adoption of the alternative procedure would be a testament to Somali cultural flexibility and their own respect for cultural differences.

I argue that these dramatically different interpretations of the physicians’ proposal are explained by differences in the implicit mod- els of culture used by opponents and physi- cians. Physicians assumed a dynamic model of culture that attributed to Somalis an abil- ity to adapt to (a presumably egalitarian) U.S. culture. Opponents, in contrast, applied a reified model of culture that made anything but abandonment appear to be cultural per- sistence. I argue, further, that both models, as mobilized by these actors, failed to capture the complexity of this difficult compromise. Because opponents used the reified model of culture, they reinforced negative stereotypes and fomented cross-cultural intolerance. They failed to recognize Somali women’s autonomy, privileged Western over Somali ideas about the symbolic meaning of genital cutting, and trivialized the abandonment of infibulation. Physicians using the dynamic model of cul- ture did not make these mistakes, granting Somali women autonomy from culture, inde- pendence from the men in their lives, and the ability to reflect thoughtfully. Physicians, however, used the dynamic model against opponents. Romanticizing acculturation to the United States, and their own ability to rather effortlessly chaperone the abandon- ment of infibulation and its patriarchal mean- ings, they felt comfortable excluding socially relevant constituencies such as feminists and anthropologists from their deliberations and, when their proposal brought opposition, they dismissed opponents’ concerns as irrelevant, even ridiculous.

This incident occured in 1996, but the inter- vening years have brought little clarity. In 2010,

can be used by actors to shape perceptions of social change in troubling ways. The adoption of a dynamic model, then, does not necessarily mean that contests will be more civil, inclusive, or productive.

I make these arguments with an examination of the role that culture played in a debate over a proposal by U.S. physicians to offer a modi- fied female genital cutting procedure to immi- grants. Somali patients at Seattle, Washington’s Harborview Medical Center were requesting that physicians perform genital cutting on their daughters. In Somalia, 98 percent of women undergo infibulation, a practice that involves the removal of labial tissue, trimming of the cli- toris, and fusing of the anterior vulva (WHO, 2008). Wanting to attend to their patients’ “cul- tural needs,” and desiring to reduce the chance that girls would be subjected to infibulation, a group of physicians proposed to offer a proce- dure in the clinic: a one-centimeter incision in the clitoral foreskin. Before they could imple- ment the plan, however, opponents to the pro- cedure began calling and writing the hospital. Those targeted reported that the objectors were angry and sometimes threatening. Cowed by the level of controversy and the intensity of the opposition, the medical center revoked its support for the proposal . . .

Drawing on interviews, original documents, and newspaper coverage, I analyze how advo- cates and critics of the proposal used culture to defend and attack the procedure. I show that the conflict rested on whether the move from infibulation to an incision was framed as cultural change or persistence. Opponents of the proposal (hereafter: “opponents”) argued that Somali interest in the incision was proof of their inability to throw off the ancient patri- archal practices to which they were obedient. They critiqued Somalis for being inflexible and physicians for being grossly flexible. From the physicians’ perspective, however, this was a stunning mischaracterization. They saw

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that it amounts to cultural imperialism (Jackson, 1995:19; see also Chanock, 2002; Cowan, 2001; Merry, 2001; Narayan, 1997; Sieder and Witch- ell, 2001). Western countries have made similar moves: French lawmakers, for example, resisted passing anti-sexual harassment laws with the argument that doing so required seeing France through an American cultural lens (Saguy, 2003). Individuals can also use respect for cul- tural difference to claim special rights based on cultural membership, such as the right of Sikhs to refrain from wearing motorcycle helmets and hardhats and the right to turn to faith- based conflict resolution instead of secular law (Cowan et al., 2001; Razack, 2007). Groups not previously identified as cultural are also tapping into pro- multiculturalism discourses. For example, some religious groups are fight- ing the separation of church and state by claim- ing that the inclusion of their beliefs in public education is consistent with multiculturalism (Davies, 1999).

Culture, however, can also be used to nega- tively portray group members and justify the withdrawal of rights and resources. Economi- cally and politically powerful nation-states penalize less powerful nation-states who do not work to eradicate “harmful traditional practices” (Boyle, 2002; Merry, 2006), wars and other aggressive interventions are justi- fied with references to backward, barbaric, and evil cultures (Abu-Lughod, 2002; Cooke, 2002; Stabile and Kumar, 2005), and cultural practices, like veiling, are banned on the prem- ise that they are incompatible with a “neutral” public sphere (Bloul, 1994; Dustin and Phillips, 2008; Mushaben, 2005). Individuals can also demonize their own culture for individual gain. They can, for example, obtain asylum by claim- ing that they are persecuted members of an oppressive culture (Piot, 2007; Razack, 1995) and gain leniency in sentencing on the sup- position that “their culture made them do it” (Fournier, 2002; Phillips, 2003; Volpp, 1994).

the American Academy of Pediatrics published a position statement endorsing a “ritual nick.” Their logic, and that of those who emerged to oppose them— which I discuss in more detail below— was essentially the same as in 1996. And, just as they did 15 years [earlier], the physicians responded to the opposition by revoking their recommendation. This case study, then, remains timely and illuminates a still active debate. . . .

REVIEW OF THE LITERATURE

The Politics of Culture Many sociologists of culture, even when they otherwise disagree, understand culture to be a complex collective repertoire of practices and ideas (e.g., Bourdicu, 1977; Sewell, 1992; Swidler, 2001). Because its logics and impera- tives are often contradictory, people’s values and behaviors are not determined; instead, culture serves as a resource with which people strategically and pragmatically make sense of the world. Culture inevitably evolves as actors accept and challenge meanings, borrow from other cultures, negotiate with other individu- als, and react to economic, political, and tech- nological change. Among sociologists, Ann Swidler’s (1986) “toolkit” is the most well- known metaphor for what I will call a “dynamic model of culture.”

One of the tools in this cultural toolkit is “culture” itself (hereafter sans quotations) and politics is one arena in which the idea is mobi- lized (Fraser, 2000). Indeed, it is now common to use culture as a basis for rights claims and resource allocation at both national and trans- national levels (Cowan et al., 2001; Eriksen, 2001; Fraser, 1995; Turner, 1993). In some cases we see strategic essentialism (Spivak, 1985). Indigenous groups “orientalize” them- selves (Said, 1978) to appeal to both national and international audiences and national lead- ers defend against “Westernization” by claiming

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context does not mean, then, that the practice must be preserved exactly as is, nor eradicated completely for the sake of human rights.

Importantly, powerful groups often charac- terize themselves as culture-less or only lightly cultural (the dynamic model) at the same time that they frame others as culture-bound (the reified model). . . . Members of non-Western societies, then, are often portrayed as hope- lessly backward, incapable of change and, ulti- mately, “imperfectible” (Lazreg, 1988:87; see also Pournier, 2002; Merry, 2006; Mohanty, 1988; Volpp, 1994, 2000).

These divergent relationships to culture attributed to Western and non-Western soci- eties influence not just portrayals of cultural groups, but portrayals of their cultural prac- tices, and even what practices are understood to be cultural at all. In many instances, social problems in societies deemed culture-bound are described by members of other societies as cultural practices related to the beliefs, val- ues, and traditions of the entire group. In con- trast, social problems in Western societies are often individualized, understood to be caused by bad people, not bad societies. Uma Nara- yan (1997), for example, has shown that the rationale behind “dowry murders” in India is framed in U.S. discourse as cultural and char- acterized as a normative national characteristic with deep historical roots. Domestic murders in the United States, however, which occur at a similar frequency, are seen as the unfortu- nate result of a few unusually bad men and not reflective of American culture. . . .  Meanwhile, Pascale Fournier (2002), examining the use of the “cultural defense” to moderate sentencing in sexual assault cases, has found that lawyers sometimes argue that immigrants are prone to violence by virtue of their membership in a “primitive” culture; lesser sentences are justi- fied by pointing to culture as a co-perpetrator. Drawing on Narayan’s observation that dowry murders are often framed as “death by culture”

The Power of Culture: Reified and Dynamic Models The power of culture in these arguments comes from its reification. To reify culture is to (1) pre- sume that cultural groups have nonambiguous boundaries and nonoverlapping memberships (Benhabib, 2002; Gupta and Ferguson, 1992; Narayan, 1997, 2000); (2) essentialize cultural content as unchanging, internally coherent, and universally embraced (Abu-Lughod, 1991; Anthias, 2002; Parekh, 1995; Rudy, 2000); and (3) attribute causal power to culture such that it is “superautonomous” relative to the auton- omy of its members (Calmore, 1992:2185; see also Appadurai, 1988; Benhabib, 2002; Phillips, 2007). Widely criticized by academ- ics, this view of culture is also called a “pack- age picture” (Narayan, 1998, 2000), a “billiard ball conception” (Tully, 1995), an “essentialist model” (Cowan et al., 2001; Merry, 2006), and a “reductionist sociology of culture” (Benhabib, 2002). Following Nancy Fraser (2000), I call it a “reified model of culture.”

A reified model is strategically useful because  only a culture that is presumed to persist independent of historical change and interpenetration with other cultural groups can be argued to deserve perfect preserva- tion or require total destruction. When the culture or cultural practice in question is cel- ebrated, a reified model allows insiders to insist on protectionism and isolationism; only if we imagine cultures to be unchanging is change threatening to cultural survival. When a culture or cultural practice is condemned, the same model calls for intervention to force cultural group members to abandon their culture; only if we imagine culture to be totalizing is forced abandonment the route to the enhancement of human rights. In contrast, a dynamic model takes for granted that cultures change and, thus, are never perfectly authentic or entirely unre- deemable. To frame a practice as cultural in this

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liberated by members of societies to which we ascribe gender egalitarianism and dynamism. Lightly cultural people, then, must step in to help the culture-bound. The phenomenon is succinctly described by Gayatri Spivak’s (1988) phrase “white men [and women] are saving brown women from brown men” (p. 296). . . .

[This logic is] used to invalidate the opin- ions of women who support female genital cut- ting. Wairimu Ngaruiya Njambi (2004) argues that the “decision to avoid as well as to opt for female circumcision is both within the realm of cultural possibility” (p. 283; see also Ahmadu 2001). Yet, U.S. discourse about FGCs all too often portrays women who support genital cut- ting as patriarchal pawns, contrasting them with a supposedly liberated American woman (Wade, 2009). . . .

Okin’s question as to whether multicultural- ism is bad for women, then, depends very much on how the idea of culture is mobilized. Insofar as a reified model of culture is driving our national and transnational politics— and there is good evi- dence to suggest it is (Benhabib, 2002; Fraser, 1995; Merry, 2006; Narayan, 1997)— then soci- eties can either be multicultural or egalitarian, but not both. Driven by this logic, states take the counterintuitive step of restricting women’s rights in the interest of their own liberation. . . .

Cultural change, like practices and peoples, is subject to social construction. The perception that a culture has changed, or not, is the product of ideological and discursive projects, as well as practical and material realities. Whether some- thing counts as cultural preservation or disrup- tion, then, is the outcome of contests between social agents who select and fetishize certain aspects of cultural practice and specific time periods as “traditional.” Describing research by Olayinka Koso-Thomas (1987), Narayan (1998) offers the example of changes in genital cutting rituals in Sierra Leone. Some Sierra Leonean proponents of the cutting insisted that con- tinuing the practice was crucial to the survival

(p. 103), Fournier calls the cultural defense “rape by culture” (p. 81).

In each of these cases, culture is identified as the cause of social problems, a tendency that functions primarily to condemn the cul- ture in question, at the expense of providing an explanation for why a problematic practice persists. Foreign men rape, murder, and muti- late women, the culture frame implies, because that is “how they are.” At best, to say “they do it because they do it” is tautological and, at worst, it misrepresents cultural beliefs and practices as independent from the economic, technological, and political forces that influ- ence their persistence, emergence, and disap- pearance (Narayan, 1997; Turner, 1993). . . .

Models of Culture and the Compatibility of Multicultural and Feminism Just as the reified model gives cultural argu- ments their power, it is this model, especially as it is applied asymmetrically, that makes it seem as if feminism and multiculturalism are incom- patible. A dynamic model of culture assumes that women in different cultural contexts can use their own cultural tools to empower them- selves. This is the premise behind the insistence on the existence of feminisms. Pluralizing the term acknowledges that women’s liberation may look differently for different women (e.g., Abu-Lughod, 2002; Collins, 1991; Narayan, 1997). . . .

If we believe that the culture to be integrated is immutably patriarchal, however, embracing [it] is equivalent to embracing patriarchy, logi- cally leading to a denial of the agency of some women. [They] must reject [their] culture, we imagine, or embrace patriarchy. When women contest the idea that their choices are manifes- tations of their complicity with patriarchy, they can be dismissed as falsely conscious. Since they are believed to be incapable of liberating themselves, it is concluded that they must be

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knowledge about different healing traditions through a website, EthnoMed (ethnomed.org). Aimed at the wider medical community, the site is a repository of “cultural information” about ethnic groups and their health beliefs. Harborview also modifies standards of care in ways that satisfy “cultural” as well as “medical” needs. . . .

Blending Western with non-Western medi- cine placed significant demands on the hospital and its employees, but they prided themselves on trying to live up to their mission. Accord- ingly, when a resident obstetrician/gynecologist, Leslie Miller, asked her colleagues if they could devise a productive way to respond to Somali mothers’ requests for female “circumcision,” the response was positive. My informant, describing their reaction, continued: “it didn’t seem to be an odd and unusual thing . . .  that’s what we do, is we try to make sure that everybody is really comfortable . . .  that’s what we were so proud of doing at Harborview  .  .  .  meeting people’s cul- tural needs” (Int6). Finding a way to fold geni- tal cutting into Harborview’s practice, then, fit nicely with the mission of the institution, which both ascribed cultural motivations to its patients and counted upon their ability to adapt to a modified Western medical approach.

On this rationale, the medical director approved a plan to hold focus groups with Somali mothers. The initiating physician, Miller, facilitated three discussions with a total of 36 women. Notes from the focus groups indicate that the mothers were amenable to a modified version of genital cutting. Because they had all undergone infibulation as girls, they were intimately familiar with the short- and long-term suffering that often accompa- nied the practice and they did not want their daughters to be infibulated. But neither did they want to abandon the practice entirely. An informant reported: “[T]hey were not inter- ested in their  daughters having that [infibu- lation] done to them. But at the same time

of local culture. Koso-Thomas observed that almost all of the related ceremonial and edu- cational practices had disappeared in response to other economic and social changes. The cutting itself, however, was fetishized as the critical link between the present and the past, while the fact that the practice of genital cut- ting was very different today was dismissed as unimportant. . . .

METHODS

Data used to investigate the controversy at Harborview Medical Center (hereafter: “Har- borview”) included newspaper coverage, material from the University of Washington archives, and interviews. . . .

The first set of interviewees was culled from  .  .  .  newspaper accounts. Using a snow- ball method of sampling, I identified additional individuals to interview, ultimately complet- ing nine interviews with physicians, other hos- pital staff, and individuals involved with the media.1 . . .  I attempted to determine the trajec- tory of events, the important participants, and perceptions of various actors and their motiva- tions. . . .  When I include quotations from these interviews, I indicate the interviewee with an “Int” for “interview” and a number ranging from one to nine (e.g., Int9). Because of the small number of high-profile individuals involved in this controversy, I offer no additional details as to their identities in order to protect confidenti- ality. . . .  I reconstituted a timeline and the facts of the controversy with the newspaper accounts, archived documents, and interviews. . . .

FINDINGS

Overview of the Controversy Harborview Medical Center’s mission is to provide culturally responsive health care. To achieve this goal, the hospital disseminates

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or interest groups, such as anthropologists or anti-FGC activists.

Subsequent to deliberation, the committee wrote a proposal recommending that the medi- cal staff at the Children’s Clinic offer a one- centimeter incision in the prepuce (foreskin of the clitoris) under a topically applied local anesthetic. Described as a “prepotomy” (“prep” referring to the prepuce and “otomy” meaning incision), there would be no tissue removal, no need for sutures, and little or no scarring. The procedure would be performed on girls 11 and older who signed a consent form after being interviewed separately from their parents to ascertain their understanding of and desire for the procedure. It would then be performed by physicians under “direct supervision and assis- tance of Somali midwives,” with a follow-up three days later. The clinic and the midwife would split a $40 fee. The medical director sent the recommendation to the state attorney gen- eral for review in light of the (then-pending, but soon to be passed) federal law against “female genital mutilation.”

The effort to stop implementation of the pro- posal was led by Patricia Schroeder, Meserak Ramsey, and Mariama Barrie- Diamond. Schro- eder was a U.S. Representative (D– Colorado) and the sponsor of the anti-FGM law. Ramsey and Barrie-Diamond grew up in Ethiopia and Sierra Leone, respectively, and later moved to the United States; both underwent infibula- tion as children. Barrie-Diamond had writ- ten about her genital cutting experience for Essence magazine. Ramsey had founded the U.S. arm of an organization dedicated to the eradication of FGCs, the Foundation for Women’s Health Research and Development. In addition to contacting the hospital person- ally, all three publicized the proposal through the media, activist networks, and conferences. As a result, the hospital began receiving let- ters and phone calls from individuals opposed to the proposal.

they weren’t interested in the daughters not having anything  done” (Int8). The mothers explained that  they desired to preserve some form of the practice as a nod to their religion and tradition, but also because they believed that it bonded their daughters to their com- munity and marked the transition from girl to woman. Aesthetics, “purity,” and the preven- tion of premarital sex, they claimed, were not considerations.

The notes revealed that the mothers asked that clinics offer a procedure in which a small piece of tissue would be removed as pain- lessly as possible. Miller explained that they would not remove tissue, but could possibly offer a small incision in the prepuce (or fore- skin) of the clitoris that would draw blood. The mothers, with one exception, agreed that this would be sufficient. Similar compromises had been made in East Africa and elsewhere, so some of the mothers may have been familiar with this kind of alternative (though Somalia has been particularly isolated in this regard) (Gruenbaum, 1991; see also Abed et al., 1995; Isa, Shuib, and Othman, 1999).

The following June a committee convened to discuss whether Miller’s proposal satis- fied principles of medical ethics and, if so, to work out the details of its delivery. The eight- member committee included only physicians: a urologist, a plastic surgeon, and five pedia- tricians, one of whom was a specialist in bio- ethics. Defending the idea of an impermeable professional boundary, physicians saw the issue as firmly within their “scope of practice” and subject to the same privacy laws that guaran- tee the right to abortion in the United States. When asked if nonphysicians had been con- sulted, one informant insisted: “this is a matter of privacy between a patient and a family. . . .  [It’s not any] outsiders’ business if there is con- sent with discussion with a patient and family. So, no . . .” (Int3). In line with this thinking, the physicians did not consult with other experts

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with female circumcision. . . . Medical and ethi- cal standards would prohibit any procedures that mutilate or unnecessarily remove tissue from a female’s genitals” (Paulson, 1996). Simi- larly, the obstetrician-gynecologist who initi- ated the deliberations was quoted saying that the mothers were “asking for a small incision, a bloodletting. . . . It’s very different than what happened to them” (Paulson, 1996). And a public relations officer explained: “We are not now doing female circumcisions at Harborview, nor are we considering doing female circumci- sions” (Brune, 1996). From their perspective, prepotomy was not “mutilation”; the move to prepotomy, then, marked a significant and pos- itive cultural change.

Reflecting the medical center’s commitment to cultural compromise, physicians expressed mixed ideas about Somali culture. Ultimately, though, they applied a dynamic model of cul- ture, believing that the Somalis were capable of choosing to adapt to U.S. culture without entirely abandoning their traditions. On the one hand, physicians saw culture as a pow- erful force in the lives of their patients. They expressed this with the language of “cultural need,” a phrase that was used by four of my informants and appeared in two news articles and four of the archived correspondences. That they took cultural influence seriously is evident in their concerns that the mothers of their Somali patients would have their daugh- ters infibulated in the absence of an alterna- tive. Physicians remarked that the mothers threatened to take their daughters to Soma- lia if Harborview did not offer a procedure; others mentioned that there was a traditional practitioner in Vancouver who was known to do infibulations, and they discussed one focus group participant who said that, if the physi- cians did not offer a procedure, she would do it herself. Physicians believed, then, that immigrants held “traditional” or “historical” health-related beliefs that they could not be

My informants interpreted the outcry to be the machinations of “rabid feminists” (Int5), “zealots” (Int3), and “radicals” (Int2). Never- theless, the opponents were ultimately suc- cessful in halting the implementation of the physicians’ proposal. The attorney general con- cluded that the procedure would not violate the law, but told the medical director to abandon the proposal nonetheless. Still frustrated many years later, one informant behind the proposal remarked that they had made a “spectacular misjudgment of the political climate” (Int6). Reflecting the weariness of the proposal’s advo- cates, The Seattle Times (1996) story about the decision to abandon the proposal was four sen- tences long and quoted a hospital spokesperson saying only: “we’re not going to do it.” How did the physicians and their opponents come to have such diametrically opposed evaluations of the proposed procedure?

The Physicians’ Logic The minutes from the committee meeting, my interviews, and the quotations from physicians included in newspaper accounts reveal physi- cians’ rationale for endorsing the proposal. Prepotomy, they argued, was a significant departure from infibulation and, therefore, a meaningful cultural change enacted thought- fully by a self-conscious community. Though they were proposing to cut girls’ genitals, physicians and hospital staff insisted that the prepotomy was different: “No one was out to practice female genital mutilation,” said one informant (Int6); while another explained, “It’s not that you are doing a procedure down there, it’s what you’re doing down there” (Int1). When pushed in the news coverage, the hos- pital staff insisted that they were not propos- ing to perform “female genital mutilation” or “female circumcision.” The medical director, for example, explained: “No one is contemplat- ing doing those rituals most people associate

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“traditional”; they were like Jewish Americans who also followed a tradition of medically unnecessary genital cutting because of its sym- bolic meaning.

Physicians and hospital staff also believed that the ritual could be modified symbolically as well as physically. One informant suggested that

there was a possibility to transform this particular procedure into really a coming-of-age procedure that involved a lot of intergenerational communica- tion, really history, health training, and education; that you could transform this into something that could be very positive for families and for their own communities (Int6).

They believed, then, that something quite good could come out of prepotomy. This sense was facilitated by their dismissal of the concern that genital cutting was a way to symbolically indoctrinate Somali girls into a gendered sub- servience. They saw Somali women as powerful members of their community. One informant said:

The stereotype of, you know, the submissive woman being forced to have this procedure by sort of a patriarchal society doesn’t really hold up, you know, in my own personal experience with this culture. These [Somali women] are very strong, capable women who run their families with a usually pretty clear control (Int6).

Drawing on familiar feminist ideas, committee members agreed that, if anything, it would be inequitable to deny girls the procedure, espe- cially given that the procedure they had in mind involved less physical alteration and risk than male circumcision. Prepotomy, committee members felt, was simply a matter of “medical equity” or equal treatment for different kinds of patients (Int9). They had already modified the standard of care for Somali boys: they were cir- cumcising them at puberty instead of infancy, per Somali tradition. Offering a procedure to girls, too, seemed only fair.

expected to abandon wholesale upon arrival in the United States.

On the other hand, physicians did not see Somalis as culture-bound. In fact, they envi- sioned that prepotomy would be a “bridg[e]” between infibulation and abandonment of genital cutting altogether. One informant explained:

We were dealing with a group that’s not yet fully acculturated into the United States. . . . You are probably more likely to make progress by working with them in a way that didn’t harm their chil- dren, and then sort of allowing them to . . . rec- ognize that this past practice was not such a good idea. . . . The odds were that their daughters who would become acculturated to the United States would probably not be coming back in 20 years seeking the same sort of thing for their daughters. And so this was seen as sort of a bridging proce- dure (Int1).

Instead of a blind following of tradition, physicians argued that the Somalis’ desire for genital cutting was “analogous” to that of Jew- ish families in the U.S. who practice male cir- cumcision (Int5):

So the male circumcision  .  .  .  is very important and everybody recognizes it as a legitimate cul- tural need. Female circumcision, you know, has not had that same recognition. But it certainly has the same long tradition. It’s been done for thousands of years. It’s been done over many different religious groups. It continues to be done, even though it’s been made illegal in many countries. And so I think you have to ask, well, why are people doing it? Are they doing it just because they are uneducated and, you know, don’t understand this is a barbaric proce- dure? Or is it really meeting some need within the society (Int5)?

Comparing FGCs and male circumcision, physicians resisted the idea that Americans were culture-less and Somalis culture-bound. Instead, they drew connections between Somali and American culture. From their per- spective, Somalis were not incomprehensibly

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whereas Somalis were “traditional” and genital cutting was the embodiment of their cultural backwardness. Representative Schroeder’s let- ter is illustrative of this approach, contrast- ing “mainstream” Western medicine with “barbari[sm].” She writes: “Quite frankly this apparent push for such a barbaric procedure by a respected, mainstream medical establish- ment both baffles and horrifies me.” Another opponent insists, simply, “This horrible vio- lence has no place in a civilized and democratic society . . .” (Manitoba, Canada).

Echoing Okin, some opponents explicitly placed the idea that Somalis have a right to culture in opposition to human rights. One, for example, argued: “even if the parents of chil- dren are authorising this operation, the rights of little girls should be considered above the so-called ‘cultural rights’ of ignorant parents” (West Sussex, UK). Other speakers also freely described the difference between “them” and “us” in terms of a linear notion of progress. One, who used the term “slice” (instead of the physicians’ preferred “incision”), wrote:

We, as a civilized society must be vigilant in pro- tecting the rights of all children, especially in this country. . . .  The little girl’s [sic] whose parents come from Somalia or wherever, are growing up Ameri- can, which means equality and protection is their right (New York, NY).

This opponent contrasted America, a civilized country that protects children’s rights, to Soma- lia, a country that does not. Similarly, Ramsey, one of the activists who spearheaded the oppo- sition, was quoted in The Seattle Times (Ostrom, 1996) arguing that girls “in this country  .  .  .  have a right to protect their bodies” (emphasis added). Another opponent echoed her: “this is taking away their rights.” Opponents’ argu- ments against the proposal, then, characterized Somalis as irrational and ignorant carriers of old traditions. In contrast, the United States was culturally superior or, perhaps, culture-less,

In sum, committee members believed that the Somali community “needed” an alternative to infibulation. They felt strongly that, if they failed to offer a procedure, girls would undergo a procedure that was more extensive, painful, and dangerous than the one they could offer. In that sense, they ascribed power to culture to shape Somali choices. However, they rejected the idea that Somalis could not change and the notion that Somali women were subject to a superautonomous culture. Instead, Somali cul- ture included traditions that were followed for complex reasons that Somalis could be reflec- tive about, just like Americans. With the sup- port and encouragement of physicians, they believed, Somalis would choose prepotomy and later abandon cutting altogether. Even as they saw culture as an influential force, then, their model of culture allowed for cultural evolution. This was a dynamic model. . . .

The Opponents’ Logic One of the physicians named in the newspa- per coverage received phone calls and letters from opponents of the proposal. He kept and archived 25 letters and 17 postcards from an elementary school class (which I count as one “letter”); all but one objected to the proposal. These letters reveal that the resistance to the physicians’ proposal centered around disagree- ment as to whether the move from infibulation to prepotomy was, truly, change.

The opponents’ contrasting evaluation of the Somali interest in abandoning infibulation in favor of a prepotomy reflected a belief that they were essentially culture-bound. Oppo- nents’ arguments against the proposal involved a contrast between a “traditional” Somali cul- ture and a culture-less or lightly cultural Amer- ica characterized primarily by its commitment to protecting the supposedly universal rights of its citizens. For many opponents, the United States was an exemplar of social progress,

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becoming comfortable with the idea of cut- ting female genitals and facing an “escalation” of “demands and pressures” from immigrants (Seattle, WAb). This concern is certainly not baseless. Given that physicians perform male circumcisions and intersex and cosmetic female genital surgeries, it seems reasonable to worry that they might do to Somali teenagers what they are already doing to adult women and children of both sexes.

For opponents, prepotomy also represented the persistence of Somali cultural practice because they believed that the ritual, however minor, would allow the symbolic meaning of cutting to survive. Less optimistic than phy- sicians about the possibility that the move to prepotomy would be accompanied by change in the practice’s meaning, opponents argued that genital cutting was designed to teach girls their subordinate place in Somali society and, therefore, infibulation and prepotomy were symbolically identical. They explained: it “is the manifestation of society’s fear of women’s sexuality” (Manitoba, Canada) and is done “solely to make men feel as though they are in control of the womyn [sic] in their lives” (Ontario, Canada). The reporter for The Seattle Times (Ostrom, 1996) articulated this objection when, after describing the proposed procedure and discussing the medical rationale, she noted that: “None of that has placated those who say that even talking about cutting female geni- tals legitimizes a barbaric practice, one that disempowers women and serves to keep them out of the American mainstream.” The reporter explains that opponents are uncomfortable entertaining the idea of an alternative cutting procedure on the assumption that doing so threatens to prop up foreign patriarchy in the United States. So, when physicians argued that the prepotomy was only “symbolic,” opponents explained that this was precisely the problem. In truth, how exactly prepotomy would have been made meaningful is difficult to know.

having evolved into a rational society organized around universal truths.

Believing the Somalis to be culture-bound, opponents evaluated the move to prepotomy as a continuation instead of an interruption of their cultural practices. While the extent of cutting and tissue removal was significant to physicians, it failed to impress opponents. They asserted that all forms of genital cutting were unacceptable, prepotomy no less than infibula- tion. They noted, correctly, that the prepotomy involved cutting genitals and was, thus, genital cutting. One informant explained that oppo- nents argued that the practice was “a bad thing in any form and we can’t do it” (Int8). Another, recalling a conversation with a particular oppo- nent, explained that she objected to “anybody having anything to do with anything about sex- ual parts of a woman’s body . . .” (Int5).

The letters, too, suggested that opponents felt that both infibulation and prepotomy were fairly and accurately described by the phrase “female genital mutilation.” One opponent, who described the prepotomy as a “limited form of female genital mutilation,” explicitly objected to any genital cutting, no matter how minimal; she headlined her letter: “stop any type of female genital mutilation” (Seattle, WAa; capitalization in the original). For this opponent, that the procedure was “limited” did not mean it was not “mutilation.” Likewise, Representative Schroeder warned physicians that she entirely intended for a “ritual bloodlet- ting” to be equivalent to infibulation under the law. She wrote: “The clear intent of the legis- lation the President signed was to criminalize any medically unnecessary procedure involving female genitalia. What Harborview appears to be considering would violate that clear intent.”

In addition to objecting to the prepotomy, some opponents were concerned that offer- ing one version of genital cutting would open the door to others. Physicians might per- form increasingly extensive procedures once

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but not others in nonpermeable packages with straightforward memberships and discrete boundaries. Their description of Somali culture as “traditional” and the unfavorable compari- son with a modern, progressive United States, placed Somalis among those people [who] are assumed to bring an ancient culture unchanged through time. Attributing a profound resilience to Somali culture, they foreclosed the possibil- ity of (true) cultural adaptation. Even if the material practice changed, they argued, the symbolic meaning of genital cutting would persist. From the opponents’ point of view, then, Somalis were not compromising, they were demanding that the United States adapt to them. Likewise, physicians were not multi- cultural heroes modeling cross-cultural toler- ance, they were culturally relativist villains who were sacrificing sacred American values by capitulating to the backward beliefs of an immigrant group.

Despite their strong language and use of a reified model, however, opponents raised important questions. We do not know how prepotomy would have been made meaningful by the Somalis. Nor could we ensure that social pressure would not make adolescent consent meaningless. And physicians do, indeed, per- form more extensive procedures on infants and adult women; it is not unreasonable to be con- cerned that we might add adolescent girls to the list of individuals who can legally undergo genital cutting practices.

SUMMARY OF FINDINGS AND ONGOING RELEVANCE

. . . The physicians’ argument that the adop- tion of prepotomy signified meaningful cul- tural change was driven by a commitment to a dynamic model of culture. They rejected the idea that Somalis were irrationally committed to uniquely barbaric practices as well as the idea that Americans were entirely autonomous

The extent of the cutting and potential for harm was significant for physicians, then, but not for opponents who felt that the prepotomy was physically and symbolically equivalent. For them, a move to prepotomy represented a con- tinuance of the Somali’s genital cutting prac- tice, not its end. Therefore, it was not cultural change, it was cultural persistence.

Based on the beliefs that compromise was impossible (because Somali culture was deeply traditional and resistant to change) and that adoption of the prepotomy represented continu- ance and not adaptation, opponents concluded that the physicians were capitulating to, instead of compromising with, Somali culture. Criticiz- ing physicians for being excessively flexible, one opponent wrote: “Are we bending over back- wards to meet demands from an immigrant cul- tural group that we envision as not having much power in the United States?” (Seattle, WA). For opponents, then, offering a genital cutting pro- cedure did not help Somalis adapt to Ameri- can culture through compromise; rather, it was adopting (backward) Somali values wholesale. The physicians’ flexibility was equivalent to becoming “barbaric” and “uncivilized.”

Indeed, if prepotomy was “savage,” “evil,” and “an act of barbarism,” then so were the phy- sicians and their procedure (East Sussex, UK; also Hempstead, NY; New York, NY; San Jose, CAa; Washington, DC; Westhung, NY; West Sussex, UK). One opponent wrote: “What- ever your reasoning concerning cutting young girls, it is clearly wrong. Even if a child asks for this ritual, she is only speaking the words of her parents. Barbaric, uncivilized words. Just like yours” (New York, NY). For the oppo- nents, offering a prepotomy was a misguided attempt at political correctness and a ceding of American values to an immigrant group who was “insist[ing]” upon cultural accommodation (Napa, CA; San Jose, CA).

These arguments are consistent with a reified model of culture that wraps some cultures

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pressure the AAP to retract its recommenda- tion (p. 1).

The World Health Organization, United Nations Population Fund, United Nations Children’s Fund, and United Nations Devel- opment Fund for Women also issued a joint press release condemning the AAP recom- mendation (WHO et al., 2010). Joining Equal- ity Now in using the term “mutilation” instead of the physicians’ “cutting,” they described a nick as a violation of human rights, contest- ing the claim that “some forms of FGM are not harmful,” and they argued that offering a “nick” may “give way to more invasive proce- dures” (pp. 1-2).

One month after the statement, the AAP revoked their recommendation (AAP 2010a).

CONCLUSIONS

The lessons learned from the controversy at Harborview Medical Center are consistent with the literature on debates about veiling in Western societies  .  .  .  and other practices like voluntary sex segregation, the desire to enter polygamous relationships, and arranged mar- riages (Ahmed, 1982; Arndt, 2000; Deveaux, 2007; Dustin and Phillips, 2008). This research has shown that a reified model of culture can harden cross-cultural antagonism, in part by making cultural tolerance seem incompatible with feminist principles, thereby justifying controlling and penalizing policies. In my case study, opponents of the prepotomy, informed by this model, reinforced negative stereotypes of Africa and rejected the possibility that the Somalis could transform genital cutting into something materially and symbolically consis- tent with gender equality. They also trivialized

from culture. Comparing FGCs to male cir- cumcision and emphasizing Somali women’s autonomy from both men and their culture, physicians described a group of women who were negotiating issues familiar to Americans: imperfect traditions and sensitive family and community relationships. . . .

In contrast, opponents subscribed to a reified model of culture that led them to inter- pret the request for the modified procedure as the persistence of a genital cutting tradition. Opponents characterized Somali culture as obstinately tied to an ancient patriarchy. They observed that the change was only a move from one form of genital cutting to another and they imbued the practice with a stable, discernable, coherent meaning that would persist even in the face of changing contexts (from Somalia to Seattle) and practices (from infibulation to prepotomy). . . .

This debate is far from resolved. In 2010, the American Academy of Pediatrics (2010b) released an official statement in support of a similar procedure in clinics: a “pricking or incis- ing the clitoral skin . . .  no more of an alteration than ear piercing” (p. 1092). They supported such a procedure with the same logic articu- lated by the physicians in 1996. “The ritual nick,” they argued:

is not physically harmful and is much less extensive than routine newborn male genital cutting . . .  [and it] may build trust between hospitals and immi- grant communities, save some girls from undergo- ing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC (p. 1092).

Using a now-familiar logic, Equality Now (2010) mobilized an opposition movement in response. In their “Urgent Alert,” they argued that “pricking, piercing and incising of girls’ genitalia are forms of female genital mutila- tion . . .” designed to oppress women and they recommended a letter writing campaign to

Editor’s note: In November 2012, the United Nations Mem- ber States approved a groundbreaking resolution calling for an end to “female genital mutilation” worldwide (United Nations, 2012).

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as were at play in the opponents’ framing of prepotomy, it is likely that some will say that she is seeking “female genital mutilation.” No matter how similar “their” practices become to “ours,” then, Somalis and other members of groups deemed culture-bound may face scru- tiny that others do not. The same choices that nonimmigrant American women make— the choice to undergo cosmetic genital surgery, but perhaps also the choice to marry young, be a stay-at-home mother, eschew higher educa- tion, dress modestly, or attend a fundamental- ist or orthodox church— may be more likely to be interpreted as a sign of internalized oppres- sion when Somali women make them. In other words, all choices made by someone who is presumably culture-bound can be interpreted as manifestations of her lack of autonomy, and can be used to condemn her culture as well.

It remains to be seen if using this lens to analyze similar debates will reveal similar phe- nomenon. If a young Somali girl did not submit to any kind of genital cutting, but still chose to protect her “honor” until marriage, is she inter- preted as principled or traditional? If a Mus- lim woman chooses not to cover her hair, but wears, instead, a cloth-covered barrette as a reference to the hija– b, is she oppressed or inno- vative? Likewise, if an Indian woman refuses to allow her parents to arrange her marriage, but promises not to marry unless she has their approval, is this compromise or submission? Understanding how models of culture shape perceptions of cultural change may shed great light on these debates. . . .

The dynamic model of culture  .  .  .  may be used to mischaracterize cultural change in two ways. First, it may undersell cultural resilience, offering those who mobilize it an opportunity to trivialize social justice concerns and dis- miss activists and scholars as irrelevant. This is the concern that Okin (1997) was articu- lating when she posed her question: “is mul- ticulturalism bad for women?” Okin is taking

the abandonment of infibulation, castigat- ing physicians for pursuing a harm reduction strategy designed to protect girls from the worst kind of genital cutting. Instead, they endorsed zero tolerance, a position echoed in the federal U.S. law against “female genital mutilation” that would pass that year. Mean- while, American culture remained uninterro- gated on the assumption that it was superior, based on rational truths, or both. For the oppo- nents, feminism was indeed incompatible with multiculturalism.

In addition to confirming the existing lit- erature on cultural groups and practices, this case shows that a reified model can also shape perceptions of cultural change by disallowing the possibility of meaningful cultural adapta- tion altogether. If opponents could perceive the move from infibulation to prepotomy as no change at all— if they objected to both the potential symbolic meaning of the practice as well as the material outcome— then it is likely that there is nothing the Somalis could have done, short of an overt rejection of Somali culture in favor of mainstream American val- ues, that would have been satisfying to the opponents.

This is a suggestive finding. It suggests that, for some, perceptions of a lack of autonomy from culture are not dependent on the choices a presumably culture-bound person makes. Instead, insofar as the reified model of culture drives perceptions, the fact that people are believed to be culture-bound may shape the evaluation of all of their choices. As a hypo- thetical, imagine that a Somali girl who immi- grated with her parents as a child, and who was spared genital cutting, elects to undergo labiaplasty as an adult. Imagine she approaches the plastic surgeon with the same concerns that nonimmigrant American women bring: a concern that her labia are too large, too long, or asymmetrical. If the same dynamics are at play in the interpretation of her motivations

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This hypothetical suggests that people draw- ing on the dynamic model of culture may take for granted that acculturation will conform to a set of progressive values that they believe permeate their own culture. This may lead to overly simple evaluations of the ease with which cultural change can be chaperoned and the easy dismissal of the need to engage with other constituencies. An analysis informed by the dynamic model, in other words, can be facile if it suggests that life-affirming cultural change is easy and inevitable, erasing the vision and vigilance required to establish truly func- tional, integrated, egalitarian nations.

NOTE 1. My university’s institutional review board (IRB) did not grant me permission to interview Somali community members because of concerns that they might self- incriminate.

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Second, the dynamic model of culture allows one to dismiss the possibility that acculturation into American society may reinforce or even introduce the ideology and practice of women’s subordination. An immigrant group can be acculturated into new ways of oppressing its women (Espiritu, 2000; Hondagneu-Sotelo, 1994). The physicians believed that the prepot- omy would initiate acculturation to a society in which “genital mutilation” did not happen. In fact, however, adult women increasingly undergo genital alteration in U.S. clinics and hospitals: a woman can legally have collagen injected into her “g-spot” or her hymen “recon- structed”; she can have her clitoral foreskin removed (circumcision proper) or her clitoris reduced in size; she can have her labia trimmed if she thinks they are “obtrusive” or engorged with injections of fat if she thinks they are “too thin”; and she can have [the] size of her vagi- nal opening reduced with stitches for a tighter fit during penile-vaginal intercourse (colloqui- ally known as a “husband’s stitch” when it is performed during an episiotomy repair). These are defined by some as “enhancing” instead of “mutilating,” but in some cases the effect is not dissimilar to what we include under the label “female genital mutilation” when it occurs else- where (Lewis and Gunning, 1998; Sheldon and Wilkinson, 1998). In other words, while the physicians saw the prepotomy as a “bridging” procedure between infibulation and the aban- donment of genital cutting, it could just as eas- ily become a bridge between American-reviled and American-endorsed genital cutting, with an already available, legal cosmetic procedure emerging as a new coming-of-age ritual for young Somali girls.

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R E A D I N G 2 5

A ppearance for men (and women) is becoming an increasingly important feature of modern consumerist and individualistic societies and a key resource for identity construction (Featherstone, 1991; Giddens, 1991). Where once a man’s identity was largely drawn from work, sport and family discourses, the exponential growth in consum- erism and the media has provided men with a multitude of alternative identity discourses— ones which they are tasked with, and account- able for, designing and maintaining (Giddens, 1991). The payoff for such identity and body work is social and psychological well-being, that is, as many marketers promote, “look good, feel good” (Featherstone, 1991; D’Alessandro and Chitty, 2011). Whilst more traditional dis- courses clearly remain available and influential, men are increasingly held accountable if they fail to invest time and resources in their appearance (see Hall et al., 2012a, 2012b). As Grogan (2010) points out, these modern pres- sures often lead to men and boys (and women and girls) developing anxieties around body image—size, shape, colour, muscularity, thin- ness and tone for the body as a whole and its individual body parts.

Men’s genital size and shape appear to be no exception (Tiggemann et al., 2008; Veale et al., 2013; Wylie and Eardley, 2007). Indeed, the Online Slang Dictionary (http://onlineslangdic tionary.com/) boasts 165 English slang terms for the penis. Many of these refer to size and specifically the penis as long and thick. For example: babies arm, bratwurst, chopper, dong,

one-eyed-monster, one-eyed-trouser-snake, poc- ket rocket, pork sword, trouser meat, whanger and so on. This isn’t surprising given that penis size has traditionally been a symbol of masculin- ity, particularly when erect. Wylie and Eardley (2007: 1449) point out that “in many cultures it has come to symbolise attributes such as largeness, strength, endurance, ability, cour- age, intelligence, knowledge, dominance over men, possession of women; a symbol of loving and being loved,” and also fertility. Given this symbolism, it’s understandable that some men may feel inadequate if they don’t meet perceived cultural norms. Indeed, two-thirds of men in a recent UK study (Veale et al., 2013) reported some dissatisfaction with their genital size and shape. Tiggemann et al.’s (2008) research reported penis size as the third biggest concern for men (behind body weight and muscularity).

Much of this is arguably perpetuated by perceptions of the penis in the media. For example, the UK newspaper The Daily Mail (Gayle and Jones, 2012) ran an article titled “Sorry boys, size DOES matter: Scientific journal confirms men’s worst bedroom fear.” Apparently, researchers found that women who reported regular vaginal orgasms (as opposed to clitoral) said size is a key factor. Similarly, Time magazine (Szalavitz, 2013) ran an article titled “Size does matter: Study shows women

“WHEN THERE’S NO UNDERBRUSH THE TREE LOOKS TALLER”: A DISCOURSE ANALYSIS OF MEN’S

ONLINE GROIN SHAVING TALK

M AT T H E W H A L L

From “‘When There’s No Underbrush the Tree Looks Taller’: A Discourse Analysis of Men’s Online Groin Shaving Talk,” Sexualities 18(8), pp. 997–1017. Copyright © the Author, 2015. Reprinted by permission of SAGE Publications, Ltd.

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men and women. Kilmartin (2000: 215–16) points out that psychological-based issues with the penis manifest because “Real men are . . . described as having huge penises.” Wylie and Eardley (2007) report “these concerns, when severe, can lead a man to go to extreme lengths to try to change the size of his penis.”

Many marketers now offer remedies and procedures for those interested in alter- ing their penis. One only has to look in one’s “junk mail” box or conduct a simple Google search to see the vast array of quick fix solutions such as non-surgical remedies to extend and reshape the penis. These range from weights . . . to electrical devices . . . and pumps . . . , herbal . . . and pharmaceutical interventions . . . , self-administrable such as clamping . . . and Jelqing (massaging blood flow). On a more extreme level penile-augmen- tation surgery procedures such as penoplasty or phalloplasty2 are available. The numbers of men opting for these types of cosmetic proce- dures are steadily increasing according to the American Society for Aesthetic Plastic Surgery and the British Association of Aesthetic Plastic Surgeons (see Aitkenhead, 2005).

The plethora of penis enhancement prod- ucts, along with men’s psychological presenta- tion to physicians (Lever et al., 2006; Levine, 2000; Kilmartin, 2000; Phillips and Castle, 2001; Wylie and Eardley, 2007), are markers of men’s penis size disturbances. Marketers such as Gillette—the global men’s grooming giant (Forbes, 2012)—have been quick to furnish and contribute to such insecurities by expand- ing the use of their product range from facial hair to include non-head body hair removal. For example, in a recent animated tutorial video, doubling as an advert, Gillette instruct men on how to shave their groin. Apparently shaving the groin area makes the penis look bigger and better, marketed with the amusing and catchy slogan “when there’s no underbrush the tree looks taller.” “How to Shave Down There” [was]

judge male attractiveness by penis size.” Yet men might be consoled in other media articles such as “Does size matter to women?” (Burton, 2013), reporting that “women simply don’t care about size. There will be the odd ones who say it is very important, but they are usually the ones who love aggressive sex.” With such mixed messages it’s not surprising then that some men are sensitive about their genitals. For some, an inordinate fascination with size leads to the development of “small penis syndrome” and associated psychological issues (Wylie and Eardley, 2007; see below).

Penis size is not the only concern for men. Besides the traditional importance of symbol- ism and function, men are increasingly inter- ested in its aesthetics. Flowers et al.’s (2013) paper elegantly presents an overview of recent trends in which long-standing penis anxiet- ies have been reframed within the context of health and aesthetics. New penis enhancement possibilities for size and aesthetics, not previ- ously available, mean that men are increas- ingly confronted with ideas that they should change their penis. Marketers now capitalize upon and promote penis-related products, helping to increase mediated penis anxieties. Size and aesthetic concerns are reported to produce a multitude of psychological problems such as body dysmorphophobia.1 Phillips and Castle (2001) argue that about 15% of men have presented to physicians in the UK with this more severe body image disturbance con- dition which manifests itself as a preoccupa- tion with an imagined or slight defect in the appearance of their penis, which has caused clinically significant distress or impairment in its function. Indeed, conditions such as erec- tile dysfunction, obsessive-compulsive disor- der, social phobia, relationship and emotional problems, along with anxiety and depression, were also reported in Lever et al.’s (2006; see also Levine, 2000, for a more detailed exami- nation) internet survey of 52,031 heterosexual

“ W H E N T H E R E’ S N O U N D E R B RU S H T H E T R E E LO O K S TA L L E R” 297

everyday practices and signal whether all, or aspects of these, might need to be reworked or rethought in light of modern developments. These would include concepts such as “hege- monic masculinity,” which is understood to be the variety of masculine identities amassed around expectations of what masculinity is presumed to be; even though most men do not enact them, all men are required to position themselves in relation to them (Connell, 1995: 77). Such masculinities are often portrayed in films by characters played by Vin Diesel— tough, emotionally stoic and muscular. Yet many men seem to reject some aspects of the dominant attitudes or traits in various contexts and are more willing to embrace traditional feminized ones instead (e.g., childcare and grooming). Bridges (2014) argues such prac- tices indicate that masculinities are becom- ing more “hybrid.” Yet other scholars, such as MacInnes (2001), argue that because of femi- nist equality pressures, some men have found it difficult to orientate to traditional gender- distinct identities or embrace aspects of femi- ninity (e.g., work in traditionally feminine jobs) and, as such, this has resulted in masculinities being in “crisis.” In the realm of body image, too, men’s increasing attention to the body to enhance image suggests that theoretical notions of gender- discrete practices (e.g., cos- metics use, body hair removal) and body struc- ture (e.g., muscularity, thinness, curvature) might be in the process of being challenged and reworked (Grogan, 2007, 2010). . . .

DATA AND METHOD

The dataset is drawn from the premier inter- net video publisher YouTube (Nielsen, 2009). Founded in February 2005, YouTube allows people to easily upload and share video clips on a range of topics, including “how to” demonstrations and adverts. As with other online sites, YouTube provides viewers with the

the most popular viral video on groin shaving out of the seven specifically targeted at men, with over 6,074,474 views and 5129 comments (as of 6 June 2014). . . .

There are two potential problems for men who openly ascribe to undertaking groin shav- ing. Firstly, to do so might imply one is con- cerned with their penis size and, secondly, genital grooming, like many modes of groom- ing for men, has traditionally been associated with women and femininity (Edwards, 2003). Indeed, Edwards (2003: 141–42) argues that men and image-enhancement practices are still considered “antithetical if not an outright oxy- moron.” Other image-conscious research on the metrosexual (Hall et al., 2012a, 2012b), men’s health and lifestyle practices (Watson, 2000), obesity (Gough et al., 2013), illness (Robertson et al., 2010) and body hair removal (Immer- gut, 2010) support this view, showing that men must simultaneously disavow any “inappropri- ate” interest in their own appearance in order to maintain “manliness” or risk being cast as vain, weak, effeminate or gay. In other words, they can’t appear to be feminine but neither can they get away with being a slob (Gill et al., 2005). Building on this work, I examine how men account for pubic hair grooming.

Focusing on men’s electronic responses to the Gillette groin shaving advert also offers several important points of entry into the study of men and masculinities. Firstly, examining men’s talk offers an example of how some men construct and negotiate masculinity in rela- tion to a traditionally non-typical gender activ- ity. Secondly, the focus on men’s groin shaving offers an important example of a wider trend in men’s image-conscious practices (Hall et al., 2012a, 2012b) and what that means for our understanding of men’s embodiment (Grogan, 2007, 2010). Lastly, examining the deployment of masculinities in situ helps us evaluate the application of existing theoretical concepts on masculinities and men’s body image to men’s

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ability to engage with the material they encoun- ter through computer-mediated communica- tion channels—text and video comments. These allow viewers to write comments on, and rate responses to, their favourite videos. . . .

Having downloaded all 5129 comments from the Gillette video “How to Shave Down There,” I coded the talk by response type. Admittedly, some responses could have fitted into two or more response types. For these I added an additional code to avoid overlooking their potential importance. Since my interest was in why men shave their pubic hair, I fur- ther clustered responses drawing out the main themes. . . .

The analysis I present is a selection of the accounts that emphasized eloquently the specific reasons for their groin shaving. I pres- ent the extracts in full as they appear on You- Tube, including spelling mistakes, colloquial language and emoticons.

Before analysing the electronic data it’s important to discuss the goals of discourse analysis in general. A general aim is to explore how “versions of world, of society, events and inner psychological worlds are produced in discourse,” and so discourse analysis has “a concern with participants’ constructions and how they are accomplished and undermined” (Potter, 1996: 146). In other words, there is a multiplicity of versions of the world that can be  worked up at any given time and on a moment-to-moment basis during conversa- tional interaction. . . .

In order to see how such things come into play within a stretch of talk I follow a step-by- step procedure identifying how each extract fits together and what the respondent was achieving at each and every stage (Edwards and Potter, 1992). Each segment of text is analysed for its individual, sequential, rela- tional and contextual relevance following these three steps: locate the central themes that are named and/or implied in the talk; focus on

the discursive activities with each text; look at how respondents construct accounts, produce descriptions, manage stake, frame specific activities and make connections for the implied social actions. . . .

ANALYSIS

One would expect most respondents to be male given the focus of the video. However, research suggests that some online users pres- ent unrealistic or deceptive images of them- selves (Epstein, 2007; Gibbs et al., 2006; Schmitt, 2002; Toma et al., 2008; Wiszniewski and Coyne, 2002), creating a “mask.” Individu- als and groups are able to do this because they are in a position to control the flow of informa- tion that others receive (Hollingshead, 2001). Since the “true” identity of the respondents is almost impossible to ascertain without direct contact, the gender of the respondent can be presumed through their gender indexing. Indexing can be explicit with traditional names for men (now anonymized), male positioning in relation to females (girls, women, their, us), male action references . . . and invoking typical masculine markers. . . . These are treatable as “male” even without this identity being “named out aloud” (Antaki and Widdicombe, 1998: 4). In the following analytical section I examine the response types; size, health and hygiene, heterosexual pay-off, equality, self-respect and individuality. For ease of understanding and reading I have loosely presented them within the analytical sections: “(Dis)engaging with Size,” “A Female and Heterosexual Impera- tive,” “Gender Distinction or Equality?,” and “Individuality and Minimization.”

As expected, size was evident in many responses. The following two extracts show interesting ways in which men both engaged or disengaged with size concerns. The respondent in the next extract is orientating to Gillette’s claim that ‘the tree looks taller’:

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deceptive crap” regarding penis size. Indeed, penis size “insecurities” are presented as predominantly adolescent (“juvenile”). Like Jimbob, Ontherodney’s critique requires an account, which centres on the presented “fact” that “Most of us” (men) aren’t concerned with trying to make our penis look longer; genital grooming is about “hygiene and natural beauty.” In other words, cleanliness and aesthetics. The implication is that this pubic hair shaving is a common practice for men and a modern aspect of masculinity. What’s also notable is that “Most” is a “softener” or “non- extreme-case formulation” (Edwards, 2000: 352). The use of softeners indicates the possibility of  some readers undermining his claims (Edwards and Potter, 1992). That is, if a respondent anticipates others questioning their claims an account may be worked up beforehand, espe- cially if, like pubic hair shaving, it is a “deli- cate” topic or non-typical gender activity (Silverman and Perakyla, 2008). So, although Ontherodney positions pubic hair grooming as common for men, it also references it as a non-traditional practice for some men—a point made more explicit in other responses, as we will see.

The non-normativity of genital grooming for some men combined with his pragmatic justification (“It’s just getting it cleaner and free of unwanted hair”) summons discourses of choice, individuality and self-respect. . . . Ontherodney is therefore reframing this mas- culine activity with recourse to conventional masculine markers. In doing so, he masculin- izes this activity but also inoculates it from charges of penis size and feminine interests. . . . Since body hair removal has traditionally been seen as an activity of women and femininity (Edwards, 2003), and since nearly two-thirds of men have genital dissatisfaction (Veale et al., 2013), it is hardly surprising that this topic is “delicate,” requiring careful management to avoid unwarranted charges.

(Dis)engaging with Size Extract 1: Jimbob Nope, it reveals nothing. Because no matter how  big  dick is, it still is good when it looks even bigger . . .

Jimbob’s opening line “Nope, it reveals nothing” contains a definitive “Nope” and an extreme-case formulation “nothing” (Pomer- antz, 1986). As Edwards (2000: 348) points out, these serve as discursive devices in “defending positions against refutation, mak- ing complaints, and justifying factual claims.” Therefore Jimbob’s initial sentence is readable as a refutation. In refuting people tend to, or are required by others to, provide an account for this discursive action (Potter, 1996). Jim- bob’s account centres on the presumption that any practice that makes . . . one’s “dick” “look even bigger” is “good” regardless of “how big dick is.” In doing so he is refuting Gillette’s implied claim that this practice is for those with a smaller penis. What this also does, how- ever, is imply that penis size is important for many men (see Kilmartin, 2000: 215–16; i.e., and Eardley, 2007: 1449), and so any practice that increases size potentially also increases one’s masculinity (Wylie and Eardley, 2007). In contrast to this response, the poster’s comment in the next extract discounts size concerns.

Extract 2: Ontherodney They put a negative spin on it with a corrupt motive—to “make the tree look taller.” Bad idea. Don’t fall for that crap. Most of us aren’t trying to fool anyone. [It’s] just getting it cleaner and free of unwanted hair. I don’t see why they have to repeat that juvenile deceptive crap. It sends a bad message about insecurity and trickery. Gillette hits a sour note for no reason. It’s about hygiene and natural beauty of the skin, nothing else.

The overall context of Ontherodney’s response is a critique of the advert for containing a “negative spin,” “a corrupt motive,” “juvenile

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Sammyboy begins by personalizing his account “I,” which is immediately followed by an extreme-case formulation (Pomerantz, 1986) “really.” The deployment of this maxi- mizes the properties of his claim “I . . . didn’t want to,” reducing the basis for others to search  for . . . additional accounts—possibly penis size or aesthetic interests. Yet like other posters, Sammyboy still manages his stake in this non- typical masculine practice by offering an account which centres on framing it as his girlfriend’s demand . . . (like Diamondgeezer the payoff is heterosexual activity).

Extract 5: Justintime Most of the (str8) young males that I know say they shave-off their bush. It is b/c females want the guys to shave their bush so it doesn’t scratch their sen- sitive shaved pubic area during sexual intercourse. Twenty years ago it was unheard of, or weird, for a guy shave-off his bush

It would be easy to simply gloss this response as another “(str8) young male” justi- fying pubic hair shaving as a female require- ment for intercourse. Yet that would miss many other important features of the text. For example, although “most” is a softener (Edwards, 2000), it also acts as an orienta- tion device for him as a member of the col- lective category [“(str8) young male”] but in referencing “their.” His membership of this category of men is affirmed by his access to other members (“young males that I know”) and members’ knowledge (“they shave-off their bush”). In doing so, Justintime sets up a contrasting pair of identity catego- ries—those who do/ don’t shave pubic hair (Smith, 1978). By invoking the commonality of “Most,” it positions those who don’t shave pubic hair as in the minority and therefore accountable for their non-activity. Like the previous two extracts, this is accounted for by recourse to heterosexuality . . . and what

In the following extracts Diamondgeezer, Sammyboy and Justintime reframe pubic hair grooming as a requirement of female prefer- ence and heterosexual endeavour, albeit in dif- fering ways.

A Female and Heterosexual Imperative Extract 3: Diamondgeezer Ffs i shaved down there before I watched this video and now its itchy as fuck. Btw if you have no pubes girls will give head easier and won’t be disgusted by your pubes

Diamondgeezer’s opener “Ffs” (Acronym for, for fuck’s sake; Urban Dictionary, 2014) acts as an exclamation for the activity “i shaved down there” which “now its itchy as fuck.” What’s also evident is that the marker of time “before” works to position himself as a novice who should have watched the advert before trying this activ- ity. Yet we get a sense of the  “delicacy” in the account which he provides (Silverman and Pera- kyla, 2008). Diamondgeezer manages his “stake” (Edwards and Potter, 1992) in this practice by stating as ”fact” that “girls will give head easier” (fellatio), which centres on pubic hair as unpal- atable “disgusted by your pubes.” This achieves several things. It places some accountability for shaving pubic hair with women’s prefer- ences but  ultimately with men’s own pleasure. The implied pleasure payoff “girls will give head easier” draws on a classic marker of masculine status— frequent heterosexual activity. . . . The final point to note is that by  undertaking this reframing action, Diamondgeezer deflects attention from charges that he is doing this to enhance his penis. Similarly, this framing of genital grooming as sexual pleasure and female preference is evident in the next extract, albeit differently:

Extract 4: Sammyboy I really didn’t want to do that but my girl said I had to or else I don’t get any :(

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beards and shaggy hair look gross. But this is an extreme.

Silversimon I disagree. For one, I have a tongue ring, hair wrappes around that easily. Plus, it don’t matter how short you trim it, you have the prickly feeling on your tongue, and for some people, its like a jungle down there. Disgusting. I don’t shave/remove hair all over my body, there are many places I like hair to be, but thats just a place I think is so 70’s and its just gross looking. Skin against skin will ALWAYS feel better then skin against hair.

Silversimon links pubic hair shaving as an activity for keeping genitalia clean. . . . His questioning of gender inequity based on “Its respect” identifies this as a typical activity for women and femininity, supported also by Silversimon’s personalized perspective . . . which suggests others may not agree. Like previous accounts, Silversimon presents this firstly as a desire of women . . . which is then upgraded to a fact-based assessment. . . . This upgrading of his knowledge from “presumed” to “known” supports his discursive strategy of inoculation from charges of doing this for reasons other than equality. What’s also inter- esting is that, like Justintime, this activity is seen as a modern aspect of masculinity . . . one that draws on contemporary notions of the equality of the sexes and a rejection of some aspects of conventional masculinities. . . . In doing so, those who don’t participate in this activity can be held accountable for being sexist.

Similarly, Dannyboy invokes a reverse style of equality (“Women shouldn’t be shaving ‘down there’ either”), presenting it as a cri- tique (“You can be clean without removing every piece of hair on your body”). But risking advocating no body hair removal at all he gen- ders aspects of body hair removal (“men’s faces and backs, womens legs and underarms”),

women want. . . . Also like Diamondgeezer, Justintime provides this as a “factual” descrip- tion “so it doesn’t scratch their sensitive pubic area,” which works to strengthen his position. However, Justintime does still recognize that some might not agree with his participation in this activity and so further positions this act as modern . . . and in doing so is able to hold those who don’t participate in this action as outmoded.

Implicating women for men’s actions was a common feature of the dataset even when men (and teenage boys) did state that they “shave their junk becuz it can get pretty sweaty and stuff down there” or “i like the feel of no hair down there” for personal reasons. Yet what was also evident from all the comments that did reframe pubic hair shaving in this way was that none of them said that women wanted it removed so that their penis size would be enhanced (sexual activity and pleasure were instead foregrounded).

In the following sequence the debate cen- tres on gender equity and whether this practice should be suitable for either sex as a practice for cleanliness.

Gender Distinction or Equality? Extract 6: Silversimon Why should women be expected to keep it clean down there but not guys? Its respect. I don’t like hair, and I’m sure women don’t either. They appreci- ate a clean shaven man and I’m happy to give it to them. Welcome to the 21st century.

Dannyboy Women shouldn’t be shaving “down there” either. You can be clean without removing every piece of hair on your body. Certain aspects of shaving (men’s faces and backs, women’s legs and under- arms) I will admit make a person look neat and con- tribute to a nice appearance. Woman with matted leg hair under stockings or men with messy long

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authority to the account he is about to deliver. But rather than a simple account of personal preference . . . and tolerance and respect . . . , Cityboy draws on experience to counter poten- tial critiques. . . . Indeed, in positioning himself as a “man-of-the-world” and inviting others to recall their own experiences . . . he is able to trivialize this activity and anybody who wishes to challenge him.

This style of countering and reframing of groin shaving as seasoned masculinity, individ- uality and rebelliousness was also deployed by Davetherave. But what is interesting and novel about this response is the way the respondent is able to discount conventional gender- discrete activities.

Extract 8: Davetherave I have pretty much always lived my life in an unorth- odox fashion. I never really TRIED to be different for the sake of being different . . . just interested in new and unusual things and experimentation. You only live once so I want to do more than everyday mundane things to make life a bit more exciting. And I do mean more exciting than groin shaving . . . HaHah!!

As with other posters, Davetherave person- alizes his account. . . . But whereas Sammy- boy’s deployment of “I” positioned himself as like many other men . . . , Davetherave positions himself outside gender norms. . . . In doing so he draws on the masculine mark- ers of individuality . . . , rebelliousness . . . , and a man-of-the-world . . . (Bridges, 2014; Donaldson, 1993; Gill et al., 2005; Wether- ell and Edley, 1999). What also supports his masculinized account of groin shaving is that it is presented as authoritative, marked by experience and time . . . , and addition- ally supported by the deployment of several extreme-case formulations. . . . What’s also notable is the way he manages his “stake” as non-accountable and an inherent aspect of

accounting for non-participation as “gross.” What is evident from Dannyboy’s post is that whilst he critiques modern body hair practices as “extreme,” he is simultaneously advocating the status quo, that is, gender-specific groom- ing to “look neat and contribute to a nice appearance.”. . .

Silversimon’s initial rebuttal centres on Dannyboy’s account as being outdated, since keeping pubic hair “wrappes around” a tongue ring—aspects of some modern identities (Carroll and Anderson, 2002). Yet “I dont shave/ remove hair all over my body, there are many places I like hair to be” suggests he doesn’t want to risk appearing too “extreme” and distances himself from Dannyboy’s more normative gen- der position. Interestingly, the second way he manages stake is in recycling his earlier com- ment of this being a modern aspect of mascu- line identity. . . . Combined with supporting gender equality, Silversimon’s account can be read as both an “inclusive” masculinity (Bridges, 2014) but also a “gender rebel” (Wetherell and Edley, 1999).

Positioning oneself as “gender rebel” was a similar tact by Cityboy in the following extract. However, unlike Silversimon, he doesn’t draw on more modern “inclusive” aspects of mascu- linity, but rather draws on more conventional “individuality” (Gill et al., 2005).

Individuality and Minimization Extract 7: Cityboy I have been shaving down there for a long time and I like and prefer it that way. To each his own and everyone should respect that. I’m sure people have searched much more weird and bizarre things than that! Groin shaving is tame compared to things I’ve seen here.

Cityboy’s initial sentence . . . marks him as seasoned and perhaps a fair bit older than some of the other posters. What this does is lend

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relationships and emotional interactions when respondents report shaving for women. . . . But what is evident from an increasing number of men and teenage boys willing to engage with this non-typical gender activity, whether by action or response (more than six million hits and over 5000 comments), is that it supports Veale et al.’s (2013) findings that men and boys are both fas- cinated by and dissatisfied with their genitals. Men’s interest in and concern with their penises is not a new phenomenon, but what this paper suggests is that men and boys may be developing a new fascination and anxiety with the aesthet- ics of their penis. Fascination with the aesthet- ics of the penis also fits with other studies which report men increasingly “window dressing” their bodies (e.g., cosmetic use, tattoos, hair removal etc.; see Hall et  al., 2012a, 2012b and Grogan, 2007, 2010) to the demands of an image-con- scious society in which the body and identity are becoming more fluid.

Although some men talked about wanting to enhance the size and look of their penis, there was no evidence to suggest these respon- dents had anxieties about penis size (“small penis syndrome”; Wylie and Eardley, 2007). One might speculate that men may not openly admit to shaving the groin for this reason since it would potentially invite ridicule. Perhaps an open, widely available public forum is not the best place to examine these issues. Yet what this study does show is that penis size is not the only concern for men. Men seem to be increasingly interested in penis aesthetics (see Flowers et al., 2013). New penis-enhancement possibilities mean that men are increasingly confronted with ideas that they should change their penis. As we saw, marketers have been quick to capitalize upon and promote penis- related products. However, for men to invest in these, they risk being cast as insecure or vain (Edwards, 2003). Therefore, men must simul- taneously negotiate (dis)interest in their penis.

his identity. . . . In other words, his “effort- lessness” repertoire allows him to orient to potential critiques regarding vanity and sensation-seeking.

DISCUSSION

Clearly, in-depth discourse analysis of men and teenage boys’ accounts of groin shaving can cast light on the manifold ways interest in penis size and aesthetic practices are accounted for in masculine ways. For example, in contem- porary terms groin shaving was practised for cleanliness (“hygiene and natural beauty”) and gender equality (“It is b/c females want the guys to shave their bush”). Whereas, in more conventional terms, individuality was signalled (“You only live once”) along with rebelliousness (“unorthodox”) and being worldly (“Groin shav- ing is tame compared to things I’ve seen here”). Indeed, having a “dick” that “looks even bigger” was also presented as advantageous. Reframing groin shaving in masculine ways isn’t surpris- ing given that a concern with the body (other than perhaps muscularity, thinness and func- tion; Gill et al., 2005; Grogan, 2007, 2010) and hair-removal (Toerien and Wilkinson, 2003) have traditionally been seen as in the realm of women and femininity.

What was also noticeable was that only two respondents engaged with size issues (Extracts 1 and 2). Jimbob implied he already had a “big dick” . . . , whereas Ontherodney vehemently dis- missed size concerns. . . . The absence of posts stating that they wanted to “make the tree appear taller” is also not surprising since to suggest that is one’s objective signals to other readers and respondents that one has penis-size anxiet- ies. Whilst it would be foolish to speculate on whether the respondents suffered more extreme psychological issues (e.g., dysmorphophobia; Wylie and Eardley; 2007: 1449), we do get a sense of the changing dynamics of heterosexual

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Other research might focus on other aspects of men’s body work such as “back, sack and crack,” “manscaping” or changing masculin- ity pre-, peri-, post-penis-augmentation sur- gery. Such insight may help practitioners deal with men in vulnerable contexts, e.g., during prostate screening or when managing sexually transmitted disease. Investing time in examin- ing men’s penis concerns and activities offers the potential to identify valuable insights in which to help men (and boys) deal with the demands of modern society.

NOTES 1. Dysmorphophobia or body dysmorphic disorder (BDD) is a psychiatric condition in which the individual has a fixation on a perceived imagined flaw, leading to an inordinate amount of anguish.

2. Penoplasty refers to the enlargement of the penis by surgery. Although phalloplasty is often used interchangeably with penoplasty, phalloplasty more specifically refers to the surgical (re-)construction or artificial modification of the penis for cosmetic purposes.

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R E A D I N G 2 6

You sit on what is essentially a mini-throne, and a com- bination of infrared and mugwort steam cleanses your uterus, et al. It is an energetic release—not just a steam douche—that balances female hormone levels.

—Goop, 2015

A practice called vaginal steaming (aka “v-steam” “yoni steam,” “chai-yok”) has been offered by “holistic health spa clinics” in Australia, New Zealand, the UK and the USA for some time (Heifetz 2010). Wide- spread public attention and media coverage only occurred after celebrity and self-professed health and lifestyle guru Gwyneth Paltrow blogged enthusiastically about it on her popu- lar site Goop.com in early 2015. In this practice, the vulva is exposed to heated steam, typically infused with herbs such as mugwort and worm- wood (Burd 2015). Various “medicinal” bene- fits, often evidenced by client testimonials, are claimed; responses to vaginal steaming have ranged from adoration to scepticism, rejection and concern, with some, often medical profes- sionals, critiquing the practice as potentially hazardous (e.g., Gunter 2015).

We can conceptualise vaginal steaming as the newest addition to an existing arsenal of practices available to Western women to “improve” their (troublesome) genitalia, includ- ing douching, pubic hair removal (Braun, Trick- lebank, and Clarke 2013; Herbenick et al. 2013) and even cosmetic surgery (Braun 2005, 2010). Vaginal douching, the existing Western prac- tice most akin to steaming, involves “cleans- ing” the vagina through an injected liquid solution, such as vinegar and water (Martino,

Youngpairoj, and Vermund 2004). Douching has a long history (Nicoletti 2006), but now is usually practised after menstruation or sexual intercourse, for perceived hygiene, cleanliness, the elimination of odour, relief of vaginal irri- tations and to tighten the vagina (Anderson et al. 2008; Cottrell, 2010; Martino, Young- pairoj, and Vermund 2004). It is a practice most common in the USA (Farage and Len- non 2006)—one quarter of US women aged 15–44 are believed to douche regularly (Office of Women’s Health 2015). Public health pro- fessionals dismiss douching as at best unnec- essary and at worst unhealthy, linked with various adverse gynaecological outcomes (see Luong et al. 2010; Martino and Vermund 2002; Zhang, Thomas, and Leybovich 1997). Regu- lar douching can damage the mucosal lining of the vagina and increase women’s vulnerability to infection (Fashemi et al. 2013; Luong et al. 2010; Martino and Vermund 2002).

Vaginal steaming also bears similarities to practices associated with “dry sex” in various African, South American and Southeast Asian countries (van Andel et al. 2008; Hilber et al. 2010; Hull et al. 2011), which aim to dry the vagina and/or alter or eliminate “unpleasant” odours and discharge (Hilber et al. 2010; Hull et al. 2011). Performed most commonly post- partum, to purify the body and “make it attrac- tive again” for male partners (van Andel et al.

“BASICALLY, IT’S SORCERY FOR YOUR VAGINA”: UNPACKING WESTERN REPRESENTATIONS OF VAGINAL STEAMING

T Y C H O VA N D E N B U R G A N D V I R G I N I A B R A U N

From “‘Basically, It’s Sorcery for Your Vagina’: Unpacking Western Representations of Vaginal Steaming,” Culture, Health & Sexuality Vol. 19, No. 4, 2016, pp. 470–85. Copy- right © 2016 Informa UK Limited, reprinted by permis- sion of the publisher (Taylor & Francis Ltd, http://www .tandfonline.com).

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sexuality and their well-being, as well as the practices they engage in (Brown 2006). Neo- liberalism asserts “an almost hyper-responsible self,” who understands themself as “free from the influence of cultural norms and expecta- tions” (Braun 2009, 236) in how they choose to act and what they desire (Brown 2006; Gill 2008a; Phipps 2014), an “enterprising” self, invested in “self-help” and transformation (Rose 1996) towards perfection. The ideology dubbed “healthism” situates the pursuit of not just health, but health optimisation, as a moral obli- gation (Cairns and Johnston 2015; Crawford 1980, 2006) and vital to contemporary (neolib- eral) selfhood. . . .

The ideology of neoliberalism folds into and congeals with postfeminism (Gill 2007; McRobbie 2004), where the female subject is positioned as “liberated,” free to choose and enact any femininity, how and when they see fit. Postfeminist rhetoric of “choice” and “empow- erment” has become central to how body modification practices are marketed to women (Braun 2009; Gill 2003, 2008a, 2008b; Lazar 2006; McRobbie 2004). The self-as-project, “improved” through “proper” consumption, produces a culture of self-scrutiny (Gill 2007) in which women engage in constant self- monitoring and body-disciplining practices, such as “routine surveillance and maintenance” (Fahs 2014, 214) of their genitalia. The pos- session of “perfect” genitalia becomes vital to empowered (authentic and sexy) womanhood. This context produces accountability and culpability: women who do not engage in bodily (and psychological) “improvement” options become responsible for a less-than-desirable self/body, knowable as somehow defective or deficient (Lazar 2006; Phipps 2014). Women who use vaginal douches report perceiving those that do not as dirty and irresponsible, as not taking care of themselves (Lichtenstein and Nansel 2001); unmodified or visible pubic hair is similarly read as dirty or disgusting (Braun et al. 2013; Tiggemann and Hodgson

2008, 86; Hull et al. 2011), these practices are also potentially risky—heated steam may dis- rupt healthy vaginal flora, leading to infection, or result in scalding of sensitive vulvar tissues; women report experiencing vaginal irritation, pain, bleeding and sores; “dry sex” has been linked to increased risk of infection (Hull et al. 2011; Smit et al. 2011).

Vaginal steaming is worth examining as part of a broader pattern of imperatives to work on and improve the female body, and for how it potentially re-inscribes ideas of the female body as (always, potentially) defective or even disgusting, to be feared and managed (Fahs 2015). Women’s genitalia have long been a source of both fear and fascination, positioned as abhorrent, uncontrollable, dangerous and to be feared (Braun and Wilkinson 2001; Ussher 2006). Contemporary Western sociocultural representations of women’s genitalia tend to be more nuanced than in the past, but still in subtle ways position them as unhygienic, dis- gusting and/or shameful (Braun and Wilkinson 2001; Fahs 2014). Our aim is to examine online media coverage of Western vaginal steaming to explore the constructions and rationalities the practice relies on, and reinforces, includ- ing ideas about women, women’s bodies and women’s engagement with such modificatory practices, and to interrogate their implications for women’s well-being.

Our analysis is situated within construction- ist theoretical frameworks (Burr 2015) and an understanding of the meanings and practices of the female body as socially produced rather than inherent or natural (Braun and Wilkinson 2001). . . . The concept of neoliberalism (Brown 2006; Rose 1996) has also proved fruitful for analyses of the body (Phipps 2014) and genital modification practices (e.g., Braun 2009). Neo- liberalism’s ideology of “privatisation, personal responsibility, agentic individualism, autonomy, and personal freedom” (Weiss 2008, 89) has quite radically shaped the ways Westerners now think about their selves, their bodies, their

“ B A S I C A L LY, I T ’ S S O RC E RY F O R YO U R VAG I N A” 309

(Convery and Cox 2012; Hookway 2008). Data were analysed using a social constructionist version of thematic analysis (Braun and Clarke 2006, 2012). . . . Data extracts are numbered sequentially (e1, e2, etc.) and identified by type of data item and a number (N = news/magazine; L = health/lifestyle; S = spa/ providers; B = per- sonal blogs). Spelling errors/typos have been cor- rected to facilitate readability.

ANALYSIS: A SELF-IMPROVING WOMAN WHO STEAMS

E1: Often, I think some take the care of their vagi- nal/perianal area a little too lightly. It is the core of who and what we are as women; it brings forth life, love, pleasure, etc. We must learn to take care, treat and respect our vagina and womb. (B5)

A woman1 who engages in various “self- improvement” strategies for both body and mind was the imagined subject who dominated the data-set. A perfect child of neoliberalism, this imagined subject operates within the ide- ology of “healthism” (Crawford 1980, 2006), where the pursuit of not just health, but health optimisation, becomes a moral obligation and vital to contemporary selfhood. We discuss four themes that evoke the self-improving woman in distinct ways. The first two—(1) the naturally deteriorating, dirty female body and (2) con- temporary life is harmful—construct vaginal steaming as effectively a solution for a (health) problem. The others—(3) physical optimisation and the enhancement of health and (4) vagi- nal steaming for life optimisation—construct vaginal steaming as enhancement for already healthy women.

The Naturally Deteriorating, Dirty Female Body The first way this self-improving woman was  evidenced was in constructions of an inherently “faulty” female reproductive body,

2008). Despite “free choice” rhetoric, choice has a strong moral dimension—certain choices are “right” (genital “improvement”); others are “wrong” (no genital modifications). The indi- vidual woman is expected—even obliged—to make the right choice (Braun 2009); non-com- pliance is seldom feasible (Bordo 2003).

METHODS

The data-set comprised a stratified sample of 90 online items related to vaginal steaming, from a number of predetermined site types (news/magazines [30]; health/lifestyle [20]; blogs [20]; spa/provider sites [20]). Data were collected through web searches (April–June 2015) using Google regional search engines (Australia, Canada, New Zealand, the UK, the USA). Search terms used were “vaginal steaming” and “v steam”; as search results were initially saturated with news and maga- zine articles pertaining to Paltrow’s recent blog post, search terms were delimited to include sites specific to “health and lifestyle” (“life- style”), spas and service providers (“spa”) and personal blogs (“blog”). Our sampling criteria excluded certain other site types (YouTube; online marketplace/classified advertisements; discussion forums; non-English websites). The 90 items in the sample represent the top- ranked hits from each search, after removal of duplication, as we were interested in accessing the types of text-based pages laypersons are likely to encounter if they turn to the Internet for information about vaginal steaming. After review, we decided to exclude user comments, as we were interested in the initial construction of vaginal steaming.

We followed Hookway’s (2008) ethical “fair game–public domain” (105) approach when determining what content was suitable to col- lect and analyse: the content of webpages that were open access. Information that could poten- tially identify the individual respondent was dis- guised or excluded from data extracts presented

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which reinforced and justified a need for self- surveillance and action:

E2: The combination of steam and essential oils from the plants penetrates deeply into the cervix and uterus to dislodge indurated menstrual fluids and pathological accumulations that have not prop- erly sloughed off with each monthly cycle. (S12)

E3: After the steam you may notice some slight cramping or vaginal discharge. This is normal and ok. The cramping is a way for the uterus to rid itself of toxins and any blood that is stagnant and old. (P4)

The female reproductive body here is inevi- tably “unclean” and “toxic.” Concern about toxicity reflects and reinforces the entrenched cultural narrative around women’s genitalia as a dirty contaminating “liability” that require ongoing maintenance and purification (Braun and Wilkinson 2001, 2003; Fahs 2014), part of a broader discourse of women’s bodies as pol- luting (Douglas 2002). In these extracts, a spe- cific defectiveness is applied to menstruation, a metaphoric construction of menstruation as a “machine in disrepair” (Martin 1987, 45) which permeated the data-set. Here, women suffer through their defective bodies, with defective- ness evident in both mechanical and structural aspects. The uterus, an organ with an amazingly long history of blame related to women’s health (Meyer 1997), was itself singled out as faulty:

E4: My uterus sits pretty far back and is slightly tilted and as a result old blood gets stuck up in there relatively easily. Unfortunately this means that with each new period, my uterus has to contract some- thing fierce to get all this hardened and thickened old blood out, hence the painful cramping. What a job our uteruses have, huh?! (B8)

E5: A lot of discomfort to do with menstruation et al. can actually be caused by having a misaligned uterus. I never knew that the uterus could become misaligned, but I guess it makes sense. I mean, the uterus does a lot of work. (B20)

These extracts link design faults (loca- tion, orientation, alignment) with problematic

menstrual experiences. However, reflecting the contradictory social meanings ascribed to women’s genitalia (e.g., Braun and Wilkinson 2001, 2003; Fahs 2014), negative construc- tions coexisted with a more positive account of a “hardworking” organ. At the same time, this ultimately relies on an imagined problem- atic female body—a body that requires hard work. Building on the idea of defective-by- design, women’s reproductive bodies were also described as reaching a point of “stagnation”:

E6: Many infertility problems are related to cold- ness and stagnation. . . . The chai-yok treatment is effective for coldness or poor circulation in the lower part of the body because it increases the blood cir- culation, and blood supplies nutrition, so the more blood supply, the faster the healing process. (L2)

E7: Stagnation is not a good thing when it comes to any organ system, but when it comes to the uterus it can cause a myriad of issues with menstruation and fertility. (L3)

. . . The female body was regularly posi- tioned as inevitably deteriorating from an opti- mal to a sub-optimal state, a process depicted as both natural and inherently problematic, and to be battled against. Vaginal steaming was, for instance, framed as a “detox”:

E8: Vaginal steam baths are basically a detoxing facial for your lady parts. They cleanse, tone, and nourish your cervix, uterus, and vaginal tissues. (B4)

E9: I was drawn to it as a way to detoxify a part of my body that is not easily accessible yet important to keep clean. (L14)

A claim to “detox” evokes a needed cleans- ing process, and a starting state of pathology that is removed. Through a factually oriented claim around “importance” (E9), a responsible and self-policing neoliberal subject (Neasbitt and Rodriguez 2011) is evoked, a woman who recognises a problem and seeks to resolve it.

Within the data, the female body was situ- ated within this biologically determinist nar- rative of inevitable decline (Twigg 2004), but

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“Modern Women Are Really Suffering”: Contemporary Life Is Harmful E12: What’s really ruining our health is all the toxic sh*t we keep putting into our bodies, not a tradi- tional practice that’s been used by women for a very long time. (B8)

The female body wasn’t only positioned as naturally defective and deteriorating. The dete- rioration of women’s bodies and health was fre- quently positioned as a result of contemporary Western cultural contexts and meanings, with vaginal steaming situated as a practice that women should use to liberate themselves from these forms of sociocultural oppression. The female body was situated often as effectively under assault:

E13: With all the torture we inflict on our vagi- nas these days—waxing, lasering, chemical-laden douches, synthetic tampons and pads, antibiotics, hormonal birth control, vaginal rejuvenation sur- gery, bleaching, spermicides. I could go on and on— I’m frankly shocked at the recent backlash in the media about vaginal steaming. (B8)

E14: We live in a culture that likes to [traumatize] its vaginas. We wax it, shave it, give it a buzz cut and pluck it within an inch of its life. We pierce it. We vajazzle it. We “cleanse” it even though it cleans itself just fine. And we are constantly bombarded with perfumed products to douse it with because some people are afraid of what a real woman smells like. But this steamy vagina business sounds like something I could get on board with. (L19)

In such accounts, genital modification and “maintenance” become normalised, the “we” positioning all women as participating, as com- plicit. Here, the damage or risk to women’s bodies effectively comes from the practices women (choose to) engage in. While some women referred to contemporary life in a gen- eralised way (“toxic sh*t”; E10), others singled out specific practices as a point of comparison:

E15: I question why people are up in arms about hot water near a vulva when people are still putting

decay was positioned as something that could and should be resisted. . . . [V]aginal steam- ing is positioned as a (new) technique women can now use to disrupt decline and dirtiness, the “solution” that rational, responsible women should utilise to maintain their declining “unruly” bodies and bodily processes.

This was particularly evident in relation to fertility enhancement, a key desired outcome of vaginal steaming processes. Fertility was con- structed as inherently fraught; always at risk, always potentially sub-optimal or declining— that ticking “biological clock” (Friese, Becker, and Nachtigall 2006). Given that gendered identity for women and childbearing are almost inextricably linked in pronatalist Western societies (Greil, Slauson-Blevin, and McQuil- lan 2011), women were unsurprisingly often depicted in states from eagerness to improve fertility to desperation to (re)gain fertility:

E10: That brings me to the story of my one experi- ment with vaginal steaming, when I was a desper- ate woman about to try IVF [in vitro fertilization] for the second and last time and was willing to give anything a shot. . . . When you’re dealing with infertility, you end up reading about anything and everything that has ever helped a woman get pregnant. (L16)

Stories of “the miracle pregnancy” following vaginal steaming were not uncommon:

E11: In fact, Niki Han Schwarz, owner of Tikkun Spa (where Gwyneth gets steamed), told the LA Times that after battling three years of infertility, she was able to get pregnant at age 45 after only five V-Steam treatments. (L15)

Decay (infertility) is here conquered through vaginal steaming. Infertility was often described using warfare metaphors, such as “battling” (E30), explicitly as well as implicitly framing the female body as an enemy, some- thing to be “battled” against and beaten. So although decline was positioned as inherent in womanhood, it was to be resisted by the self- improving woman who steams.

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and reproduces, very particular and norma- tive ideas of what is ideal for women’s “repro- ductive” body and sexuality, and indeed what is normal. Through evocation of this critique, vaginal steaming is positioned as a holistic modality that women can use as both alterna- tive, and resistance, to Western medicine, as potentially empowering (Barrett et al. 2003; Madden 2012) and authentic. However, the language of Western medicine remains in the texts, through reference to “symptoms,” “con- ditions” and “ailments,” which vaginal steam- ing is claimed to resolve. Despite a critique of medicalisation, the terms of reference blend and blur, used to legitimate vaginal steaming as a “cure” for real problems.

“Isn’t Your Health Worth That?” Physical Optimisation and the Enhancement of Health E18: The periodic use of the yoni steam technique can enhance overall reproductive health for women. (S17)

Women’s health was situated as something to endlessly be “improved,” “enhanced” and “optimised.” Vaginal steaming was routinely portrayed as a means to optimise the body and maintain general health:

E19: The V-Steam can be used to maintain health and wellness in addition to treating more complex issues. (B19)

E20: The vaginal steam bath is used for just about everything, it is used to promote . . . healing and rejuvenation for just about any woman’s reproduc- tive health ailment. (S3)

Vaginal steaming is constructed here as an almost all-in-one solution to whatever ails a woman—both specific “ailments” as well as more ephemeral well-being. Reflecting healthism, the only acceptable body becomes situated as the ultimately health-optimised

toxic cotton tampons IN their vaginas . . . talk about changing the vaginal flora! (L11)

Setting up a contrast between contempo- rary “damaging” practice and vaginal steam- ing achieves two things: it legitimates vaginal steaming as normative within a range of mod- ificatory practices and it situates it as inher- ently different to those. . . . [V]aginal steaming is explicitly positioned as a “safe” alternative that contrasts with toxic and damaging yet normative practices. . . . This constructs a sort of imperative that “responsible” women would take up vaginal steaming in an effort to pre- serve their health, as conscientious consumers in postfeminist neoliberal times (Evans and Riley 2013; Gill 2007; Lazar 2011).

The theme of a female body damaged by Western culture was also evident in accounts of a medicalised and pathologised female (repro- ductive) body:

E16: You may snicker at the idea of steaming your vagina, but in a culture that pathologises our bodies and medicalises our reproductive ailments, bringing back this time-tested technique could serve a lot of women well. (N4)

Western biomedicine was often positioned negatively in data items that promoted vaginal steaming:

E17: Maybe you’d like to turn this into a protective rite, to ensure that various institutional ignoramuses keep their grubby paws off of your vagina . . . and stop treating your body as the property of their dubi- ous enterprises. (S16)

Here, the entire medical establishment is suspect, a “dubious” mode of control of wom- en’s bodies. The caution in extract E17 extends a long (feminist) critique of both the institu- tion of medicine and the processes around the medicalisation of women’s “normal” bodies and bodily changes, particularly related to women’s genitalia, sexuality and fertility (e.g., Braun and Tiefer 2009; Cacchioni 2015; Moynihan and Cassels 2005). Medicalisation relies on,

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Vaginal steaming was regularly depicted as a tool to improve women’s sexual experiences:

E25: For women looking to boost their sexual energy. An energetic steam that aids in increasing blood flow and circulation enhancing chi thereby improving sexual response and sexual vigour. (S13)

This appears to offer an “empowered” narra- tive: with women the primary beneficiaries of “increase[d] sexual gratification” (S11), they are situated as entitled to sexual pleasure (Braun 2005). Such sexual pleasure was, however, often situated within very heteronormative framings: sexual pleasure was framed as occurring typi- cally only within heterosexual couplings, and even often specifically heterosexual marriage:

E26: We have some clients who say that after they’ve had the V-steam their husbands can’t stay away from them. (N16)

The claim that vaginal steaming would “improve the marital relationship” (S11) was sometimes explicit. The (often) unspoken risk of not having a vaginal steam becomes marriage decline, through her inattention to body or sex- ual response. Like the domain of female genital cosmetic surgery (Braun 2005), vaginal steaming becomes a legitimate, potentially even obliga- tory, practice for women in pursuit of an optimal body and (through that) hetero-relationship.

The texts frequently utilised “feminist” lan- guage evoking an empowered woman, to frame this as an activity women undertook for them- selves. Concepts such as being “in contro”’ (N4) or having (self)confidence appeared regularly:

E27: It can be used to enhance sexual arousal and self-confidence. (S11)

E28: And why should you do this before Valentine’s Day?? Nicole specifically told me that after the treat- ment, many of her clients feel confident, refreshed and ready to hurry home to their man!! (L17)

A claim to self-confidence and/or increased sexual control affords a “moral justification” (Braun 2005) for vaginal steaming, through

body (Cairns and Johnston 2015). In some cases, a state of perfection was positioned as something women had had, and could return to, evoking the narrative of decline evidenced in the previous theme:

E21: The 30-minute service—which costs $75 for one session, or $750 for 12—uses healing herbs to irrigate the vaginal passage to restore optimum health. (N16)

E22: Vaginal steaming to help maintain internal health as well as keep your skin looking young and healthy. (S1)

Although sometimes situated as “mainte- nance” (E19, E22), others evoked restoration, and a return to an optimal past. “Youth” and “health” were conflated—implicitly position- ing change as bad, and resonating with broader discourse not only of healthism, but a related “successful aging” discourse (Meletiou and Meylahn 2015). Fertility and sexual pleasure were particularly targeted for optimisation. . . . Women were encouraged to use vaginal steam- ing as a preventive measure, a way of optimis- ing something not (yet) “broken”:

E23: Vagi-steam is best done every two weeks when used for treating a fertility issue. For general fer- tile vitality (preventative maintenance), Vagi-steam baths are best done twice a year. (L3)

E24: Renew Fertility V-Steam: For women who are trying to get pregnant or are interested in preserving their fertility. (S13)

Vaginal steaming here becomes a practice for every woman who cares about her fertility— something to be attended to, worked on and optimised. . . . Within the neoliberalist dis- course evident in the data, women are encour- aged to adopt a “self-policing gaze” (Gill 2003) to work to ameliorate the risks to fertility; fertility optimisation via vaginal steaming becomes positioned as a key marker of “produc- tive and conscientious citizenship” (Lavrence and Lozanski 2014, 85).

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to do just after your monthly or if you just feel like giving your little friend a little special treat! (B17)

E31: Think of this luxurious modality as a facial for your lady parts. (S13)

Comparison to the “facial” and evocations of “TLC” (tender loving care) situates vaginal steaming within the domain of luxury, and for the perfectly fine body rather than a body in deficit that needs some improvement. Again echoing “because you’re worth it,” this situ- ates certain (sometimes painful) female body practices as “pampering” (Gill 2007). The spa visit has been positioned as an important part of women’s regular health-and-well-being rou- tines  (Little 2013) and steaming is here linked with practices presented to women as entitle- ment, the “earned” right to be “pampered” (Lazar 2009). Positioned thus within neolib- eral framing, vaginal steaming becomes a treat women should do for themselves, if they really value themselves. This final theme reveals an inherent paradox in many of these texts: vagi- nal steaming is depicted as both a necessity for health, and a “treat” that a woman does “for her- self.” This sets up an ontological state for wom- en’s genitalia as never there, as always available for (more) intervention, whether “faulty” or fine.

Frequent references were also made to the notion that women will be able to “reconnect” with their bodies or selves as a result of vaginal steaming:

E32: Yoni steaming is about more than uterine health. . . . The practice brings a reconnection to the female body and to the wisdom of plant medicine. It is an opportunity for women to celebrate and cher- ish our bodies, and learning to enjoy our wombs as the beautiful, sacred center from which we radiate our capacity to change the world. (S7)

E33: It was a beautiful experience! Every woman should do this because it does feel good. It sensu- ally awakens the senses of my yoni. It feels differ- ent afterwards, like, I am in touch with myself as a woman. It feels very intimate and sexy. (B14)

evoking an empowered, confident woman whose sexuality is her own—even if it was depicted, as in extract E25, as revolving around a man. This discourse echoes contemporary “sex advice” texts where women are coached on how to become sexually “self-assured” (Gill 2009). Such claims situate vaginal steaming within the cluster of practices marketed to women under “because you’re worth it” rhetoric (see Gill 2008b), where physical actions are psychologi- cal actions, with broader and widespread rami- fications. In a medicalised context where a “sex for health” discourse is prevalent, and sex posi- tioned as crucial to diverse facets of well-being (see Gupta and Cacchioni 2013; Marshall 2012), vaginal steaming for better sex becomes steam- ing for better health and well-being.

Overall, vaginal steaming was depicted as a tool already-well women should utilise to opti- mise their body, and in particular, their repro- ductive capacity and sexuality. Despite the neoliberal tone, the rhetoric employed echoes longstanding Western-cultural definitions of the vagina (Braun and Wilkinson 2001, 2005) as the “centre of a woman’s being” (S14); the sexual and reproductive enhancement focus mirrors the two modes through which Western societies have traditionally valued women: sexual availability for men (within marriage) and childbearing.

“Go for It—Pamper Yourself!” Vaginal Steaming for Life-Optimisation E29: I have a great vagina. Really, I do. I’ve never had a problem with yeast infections, never had a Pap smear come back abnormal, never had to deal with menstrual cramps. I have the kind of vagina that deserves to be pampered, so when I heard about “vaginal steaming,” I thought to myself: Vagina, you deserve a spa day. (N15)

Finally, vaginal steaming was situated as a way for women to “pamper” themselves:

E30: It is called a Vagina Steam and yes, my Vagina really loves it! It feels really cleansing and is perfect

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quite different truth-base to validate their promotion or debunking (sometimes both!) of vaginal steaming. Eastern mysticism, which appeared most commonly in data items that sought to promote vaginal steaming (e.g., spa sites, personal blogs), rationalised the practice by chronicling a tradition of vaginal steam- ing and attributing its origin to one or more non-Western cultures, typically within Asia. Vaginal steaming tended to be described as a long-standing practice that has “stood the test of time” (L1), evoking effectiveness and cred- ibility. Exhibiting orientalist (Said 1978) dis- course, “the East” was exoticised and implicitly positioned as more authentic and “uncon- taminated” than Western nations. Vaginal steaming, constructed as a “holistic” practice that “incorporates body, mind and spirit well- ness” (S8), was often contrasted with Western medicine, which was positioned as too heavily focused on the body, or extensively critiqued (as noted in theme 2). Vaginal steaming was, in contrast, often depicted as completely natural and non-invasive, and positioned as therefore a safe alternative to many “conventional” medi- cines. Indeed, claims based within Eastern mysticism often portrayed vaginal steaming as a form of resistance to Western medicine and, sometimes, Western culture more broadly.

In contrast, Western biomedicine privileged scientific evidence and rationality, and was typically deployed to dispute beneficial claims about the practice, and the practice itself, not least through highlighting the lack of “credible evidence” (L20). Claims used to justify the prac- tice were often positioned as “dubious” (N7) and pseudo-scientific, both anatomically and physiologically. Texts drawing on Western bio- medicine often positioned the female body as basically naturally physiologically competent— with vaginal steaming positioned as a threat to that. Risks were emphasised—“Worst case scenario? Death” (N21)—and claimed-healthy alternatives (e.g., diet, exercise, medication)

Some made reference to the idea of “reawak- ening” (L12) an “inner goddess”:

E34: To awaken your inner goddess, please call us at . . . (S4)

E35: For women who want to connect to “their inner goddess.” A pampering, nurturing and relax- ing steam for your “down there area.” (S13)

Located within new-age “inner self” dis- course, this argument appears the opposite of neoliberal “pampering” discourse, yet both rely on the logic of improvement of an essentially OK (reproductive) body—and through that, self. And, albeit in a different way to the idea of a facial, the notion that vaginal steaming can unlock an “inner power” (S20) constructs it as a transformative practice. . . . The outcome of vaginal steaming is more than a “toned” repro- ductive system or even “comfort and relaxation” (S15); it offers an opportunity to become the “sensual” and “divine” goddess the woman already has the potential to be. Metaphors of interiority—references to “reconnecting with” or “reawakening” something “inside” (see also Donaghue, Kurz, and Whitehead 2011)— evoke an unknown entity blocking a woman from accessing her “true” self. Vaginal steam- ing, resembling a search and rescue device tailored to discover/recover formerly neglected, repressed or forgotten qualities, liberates. It is presented as a way for women to experience the self-exploration and self-realisation that are a crucial element of both the neoliberal “project of the self” (Rose 1996) and new-age discourse. . . .

DISCUSSION

. . . Accounts of vaginal steaming are sites of meaning-making and meaning-contestation. Cutting across the themes discussed, three notable and distinct epistemological frame- works were utilised to make and refute truth claims: Eastern mysticism, Western biomedi- cine and/ or Experience. Each oriented to a

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sociocultural constructions of women’s bodies and genitalia, and to the question of what selves, subjectivities and practices are offered to women in neoliberal times. Our analysis suggests the meanings associated with vaginal steaming are still highly contested, and not (yet) sociocultur- ally solidified, but the practice, and the way it is discussed and described, remains familiar and resonant. Whether it poses the same risks as vaginal douching remains to be seen.

NOTE 1. An essentialised notion of womanhood, whereby (1) a woman has a vagina and (2) a vagina is regarded as central to being a woman (Braun and Wilkinson 2005), as well as an orientation to the female body as reproductive, permeated the data-set. Although such cis- and heteronormative assumptions trouble us, we use the terms “woman,” “women” and “female” in a way consistent with the data—to reference cissexual/cisgender women (women whose sex and gender identities match those assigned at birth). In noting these assumptions, we attempt to avoid simply reproducing societal heterosexism and cisgenderism in and through research (see Ansara and Hegarty 2014).

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The Experience epistemological frame—used to argue both for and against the practice by women who have tried it—based claims in the author’s personal, embodied experiences of vaginal steaming—evoking a hard-to-dispute “experiential authority” (Kitzinger 1994). Per- sonal testimony–based framing was used to dis- pute the validity of “any randomised controlled double-blinded clinical trial” (L2) as the basis for deciding whether the practice had merit, sit- uating it as more important or valid than West- ern biomedical “evidence” standards. Vaginal steaming was commonly promoted on the merit that it felt good—“I felt great: clean, relaxed, at ease” (N15, emphasis in original)—even if it did not deliver the claimed or desired effects.

. . . The way vaginal steaming is promoted online simultaneously reflects and reinforces traditional derogatory understandings of the vagina and women’s reproductive bodies as dirty and defective (e.g., Braun and Wilkinson 2001) and, despite the rhetoric of liberation and empowerment, appears to operate as a con- servative regulatory practice (Ussher 2006). It appears to promote very particular forms of feminine embodiment, and particular modes of selfhood practice for women, which fit with neoliberalism, healthism, postfeminism and the production of self-hood through consumption.

We examined a range of easily accessible online texts. Examination of online texts offers a way to understand and unpack sociocultural assumptions and logics, but it does not tell us how women make sense of these texts. The ways everyday women make sense of these practices is another important step for understanding their implications for women’s health and well- being. . . . This study contributes to the wider literature on genital modification practices and

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R E A D I N G 2 7

I think I’d be grossed out if I had to watch two characters with rolls and rolls of fat kissing each other . . . because I’d be grossed out if I had to watch them doing anything. To be brutally honest, even in real life, I find it aestheti- cally displeasing to watch a very, very fat person simply walk across a room.

I n an article about the television sitcom Mike & Molly, Maura Kelly (2010) expressed her disgust at the idea of having to watch the fat characters engage in displays of affection. The comments on the piece demonstrated that she is not the only one to find acts of sexual expres- sion among fat people to be gross. But agree- ment was not the only response Kelly’s piece received. A range of responses, from the online fat community, the online feminist community, and even mainstream presses, cried out over the fat-shaming and hatred contained in the article. Emily Exton (2010) at Entertainment Weekly suggested in her piece that not only do viewers need to get over any objection to seeing fat people be amorous on screen, but that pro- ducers of on-screen material need to get over their reliance on fat jokes to tell a fat story.

Examining more recent mainstream media coverage around fat sexuality reinforces the negative perception that many, like Kelly, may have. In the Sydney Morning Herald, Matty Silver (2014) argues that a better sex life can be found through weight loss. Focusing in on issues of erectile dysfunction and sterility in heterosexual men, Silver suggests that fat men often find sex difficult because of their lack of stamina or lower levels of testosterone. She also highlights the low self-esteem that may plague fat men, noting that “fat in the abdominal area can make the penis look smaller than it really is,

which doesn’t help self esteem.” An article from CNN (2014) promotes a new book, XL Love: How the Obesity Crisis Is Complicating America’s Love Life. The author of the book, Sarah Varney, suggests that fatness has a “chilling effect on sexual relationships, from physical barriers to intimacy to attitudinal shifts with weight gain and even loss.” The article frames the discussion around concerns of the “obesity epidemic” and the impact it may have on the lives of fat people.

The mainstream media’s representations and discussions around sex make it clear that fat people are not considered sexually attractive, or as individuals with sexual agency. As noted by LeBesco (2004), mainstream discourses on what is sexy and how sexy is embodied usually exclude fatness and fat bodies. Murray (2004) argues this is due to heteronormative systems that construct the values and meanings sur- rounding sex and sexual identification. Systems such as capitalism and neoliberalism place value on discipline, conformity, and fulfilling the fantasies of the dominant subject (hetero- sexual men in power). Fatness, according to these systems, is not desirable or valued. The rejection of fatness as acceptable has led to fat identity being classified as a spoiled identity; one in which the bearer of the stigma (fatness) is held responsible for the stigma (Pausé, 2012). All identities are constructed, maintained, and revised through an interaction of individu- als’ beliefs about themselves and the messages one receives from  the environment. A spoiled

HUMAN NATURE: ON FAT SEXUAL IDENTITY AND AGENCY

C AT P A U S É

From “Human Nature: On Fat Sexual Identity and Agency,” in Helen Hester, Caroline Walters, eds., Fat Sex: New Directions in Theory and Activism. © Helen Hester and Caroline Walters, 2015, reproduced by permission of Tay- lor & Francis Books UK.

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to consider some of the narratives presented to people around what fat sexuality means and how it is embodied and performed.

Given the prevalent anti-fat attitudes in het- eronormative Western cultures, it is not sur- prising that most of the empirical scholarship around body size and sexuality have concluded that fat individuals, especially fat women, are significantly disadvantaged in the areas of het- erosexual dating and sexual activity (Regen, 1996; Tiggemann and Rothblum, 1988; Wider- man and Hurst, 2008). Focus has more recently turned to examining the impact of fatness on sexual activity and behavior.

Obesity research on sexuality can be grouped into three categories based on the sample being studied: population studies, clinical studies, and weight loss studies. In population studies, where participants are pulled from a general population, no significant relationship between weight and sexual functioning and satisfaction are found with the exception of the relation- ship between BMI and sexual dysfunction in men. For example, Adolfsson and others (2004) sampled 4,781 men and women, aged 18–74, and determined there to be no relationship between BIW and sexual satisfaction. In clini- cal studies, studies where the sample has been drawn from a specific group of individuals (such as those with an existing condition), BMI was found significant in sexual functioning and sat- isfaction for some clinical populations (Chung, Sohn, and Park, 1999; Esposito et al., 2007), but not all (Kadioglu et al., 2010; Paranhos et al., 2009). In weight loss studies, however, the findings are consistent. Research drawn from samples of individuals engaged in weight loss find that weight loss improves both function- ing and satisfaction (Hammoud, Gibson, Hunt, Adams, Carrell, Kolotkin, and Meikle, 2009; Kolotkin, Zunker, and Østbye, 2012; Larsen, Wagner, and Heitmann, 2007). This could suggest that individuals who are unhappy with their sex lives  pursue weight loss as a possible

identity, like fatness, is further complicated by the individuals’ beliefs about themselves being shaped by the internalized oppression that many in marginalized populations hold. For example, fat individuals are just as likely as non-fat individuals to hold anti-fat attitudes (Schwartz, Vattanian, Nosek, and Brownell, 2006; Wang, Brownell, and Wadden, 2004). Harding (2008) illuminates this internalized oppression and how it reflects back on fat sex- ual identities and behaviours, “When you’re a fat woman in this culture, everyone—from jour- nalists you’ll never meet to your own mother, sister, and best friend—works together to con- stantly reinforce the message that you are not good enough to be fucked” (p. 74). The negative messages integrated into a fat person’s sexual identity are then unchallenged, as fat people are rarely included in displays and discourses related to sex; or reinforced as the discourses and displays that do exist in mainstream sex discourses do not look favourably upon fat sex.

If fat individuals are excluded from main- stream discourses around sex, what does this mean for a fat individual who is forming and performing an identity as a sexual being? As Murray points out,

One only has to reflect on the ways in which we speak about fatness in this historical moment in Western societies. . . . We talk about fatness as a major health crisis, an epidemic, a drain on resources, a symbol of the failed body, and as an aesthetic affront. We do not talk about fat and sex. (2004, p. 239).

Perhaps Murray is correct; we do not talk about fat sex as a normative part of our discourse. It is, as LeBesco (2004) suggests, excluded from con- structions of normal sexuality. So how then is fat sexual activity presented? And how are fat indi- viduals to construct positive sexual identities in a fat-hating world? This piece does not intend to propose the ways in which fat individuals con- struct their understanding of sexuality, or them- selves as sexual beings. It does, however, attempt

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curiosity while labelling it as “deviant.” Pro- haska and Gailey (2009) present a piece on hogging in the Fat Studies Reader. Hogging is the act of straight men pursuing fat women as sexual partners, often at the bidding of friends, and for the result of satiating sexual desire in an easy manner. They argue that hogging, to the men who participate in the activity, is based on the assumption that “fat women are sexually easy and can help men out of a losing streak” (p. 158). So we have on the one hand, men who pursue fat women as sexual partners out of deviant desire, and on the other, men who pursue fat women as sexual partners to reinforce their virility.

Most of the scholarship on sexuality has focused on men’s sexual activities, behaviors, and desires. Both within and outside academic scholarship, women have often been denied sexual agency, especially those that fall out- side of heteronormative culture (Richardson, 2000). Those women routinely excluded from normative representations of sexuality (fat women, lesbian women, trans women, women of colour, etc.) are presented with the dilemma as to whether to construct their own ideas of sexuality, independent from heteronormative narratives, or to deconstruct the existing nar- ratives and position their sexual identities as contrasting.

Sitting outside of academic scholarship are books that are written by fat people about fat sex. Two such tomes are Rebecca Jane Wein- stein’s Fat Sex: The Naked Truth (2012) and Vir- gie Tovar’s Hot and Heavy: Fierce Fat Girls on Life, Love and Fashion (2012). While both books are presentations on fat sex from fat individu- als, the messages of the books are strikingly different.

Fat Sex: The Naked Truth presents itself as a book about fat sex. Weinstein’s book has been crafted around narratives about sex from fat people, and people who enjoy having sex with fat people. Framing the narratives is

remedy; more likely it suggests that individuals who are pursuing weight loss are unhappy with their current weight and perceive improvements in all areas of life if weight loss occurs.

As noted by a review of the literature by Kolotkin, Zunker, and Østbye (2012), most of the empirical studies around fatness and sexu- ality in obesity research draw from samples of individuals engaged in weight loss. And the majority of the available research in this area has focused on sexual dysfunction (often measured as erectile dysfunction in men). In their conclusion, Kolotkin, Zunker, and Østbye (2012) call for a wider understanding of sexual functioning and satisfaction in the literature.

Not surprisingly, the tenor of work in obe- sity research is negative, assuming from the start that being fat is negative and thus impacts negatively on sexuality. For example, several studies (Kolotkin et al., 2006; Kolotkin et al., 2008) in this area assess sexual functioning and satisfaction using the Impact of Weight on Quality of Life (IWQOL) questionnaire. This questionnaire is grounded in a deficit view, with six questions around sexuality that inquire as to the impact of an individual’s weight on: “not feeling sexually attractive,” “not enjoying sexual activity,” “avoidance of sexual encoun- ters,” “difficulty with sexual performance,” and “not wanting to be seen undressed” (Kolotkin, Binks, Crosby, Østbye, Nfitchell, and Hartley, 2008). Measures such as the IWQOL work from the position that being fat must negatively affect an individual’s sex life, fitting in with the standard assumption that grounds all of obe- sity research: fat is bad. Slightly more positive in tone is the work surrounding heterosexual men who prefer fat sexual partners. These men are labelled Fat Admirers (FAs). FAs are likely to identify fat bodies as more attractive than non-fat bodies and regularly choose fat women as sexual partners (Swami and Tovée, 2009). The research surrounding FAs often explores this sexual choice with a hint of disgusted

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commentary about society’s perspective on fat sexuality and factoids about information relevant to understanding fat sex within our culture. Weinstein’s book, unfortunately, often promotes tired ideas around fatness (suggest- ing that fat is the new gay, asserting that fat is the last acceptable form of prejudice, etc.) while also reinforcing many of the negative ste- reotypes held about fat people. Overall, read- ers of Fat Sex may find themselves wishing that more of the personal stories had been included in the manuscript; the individual voices of fat individuals talking about their sex lives are often muted.

A very different telling of fat sexual lives may be found in Virgie Tovar’s (2012) edited collection, Hot and Heavy: Fierce Fat Girls on Life, Love and Fashion. In this collection, 31 fat women share their personal stories of rejecting cultural constructions of fat shame and hatred and embracing their inner fierceness. All of the narratives in Tovar’s text are stories of redemp- tion. The writers share stories of embracing sexuality, encouraging others to embrace their own sexual pleasure in their fat bodies, and finding pride in oneself through sexual iden- tity and agency. These narratives, while more positive than those presented in Fat Sex, are still often problematic. Many of the stories presented rely on patriarchal assertions that a woman’s worth is based in her ability to be desirable to others (specifically, heterosexual men). The focus for heterosexual fat women in mainstream media images is usually on vali- dating their sexual desirability (Kyrölä, 2014). In contrast, representations of heterosexual fat men in media (think Shallow Hal or The Nutty Professor) focus on validating their sexual desires.

Alongside the scholarship from obesity research, and collections published by fat indi- viduals, are the writings of fat women who embrace their bodies and enjoy the pleasure they may take from them. Much of this work is

presented in a self-help fashion, written both to express the individual’s own pleasure in sexual- ity, but also as a means of assisting others in experiencing a more satisfying sex life.

One of the best known self-help books for fat people is Big Love by Hanne Blank (2000, 2011). The book is a practical, instructional, and, dare it be said, inspirational guide on rela- tionships and sexual activity for fat individuals and their partner(s). The revised text is heavily influenced by the growing fat activism move- ment, the emergence of fat studies within aca- demia, and the advancement of sexual politics in the decade since the original release. Also included in the 2011 edition is information drawn from the Big Big Love Survey, collected by Blank in 2010 from over 700 participants. Blank weaves the information shared by par- ticipants into the revised edition, often using survey material to illustrate her arguments.

Blank’s sex-positive tome covers a range of sexual topics, including physical accommo- dations with bellies for better sex, and gentle advice on how to negotiate through the inter- nalized fat hatred that often rears to the sur- face when nakedness and pleasure are involved. Blank also presents discussions of ethics in fat sex, taking a considered approach to address- ing Fat Admirers in the segment “How Not to Be an Asshole.”

In her piece, “How to Have Sex While Fat: A Short Guide to Sexy Fun for Fatties and Peo- ple Who F#&@ Them,” Marianne Kirby (2013) suggests that being fat-sex positive is not advo- cating that all people must have sex with fat people. She suggests that the taboo that sur- rounds fat sex (and turns it into a fetish) often makes it difficult for fat people to develop sexual identity and enjoy sexual activity. She suggests some simple guidelines for navigating through the taboo, the internalization of fat hatred, and the myth that fat people are not sexual beings. Asserting that fat people are often denied sexual agency, Kitty Stryker takes

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involved to “[redefine] the fat body as an object of sexual desire” (p. 300). Performance is an important part of identity, as demonstrated by the women in Asbill’s work. These women were given/took permission to publicly perform as fat sexual beings, allowing themselves to develop or reinforce positive fat sexual identities. Doing so in a group allowed these women to support each other through the process. Fat-positive communities provide safe spaces for indi- viduals to construct positive fat identities; for some, they may be the only spaces in which fat-positive identities may be constructed, maintained, and performed.

Gailey (2012) interviewed over 30 fat women from size/fat acceptance organizations about their romantic and sexual lives. The women in her study reported having poor body image and unsatisfactory romantic and sexual histo- ries, illustrating that body image dissatisfaction often detracts from sexual agency in women. This changed for most, however, when these women became involved in size acceptance, and began to take pride in their fat bodies. “Women who accept their bodies, or are begin- ning to, not only experience freedom from the pressure to diet or change their bodies, but also a freedom to be sexual,” argues Gailey (p. 124). Without body image satisfaction, it is difficult to construct positive sex identities, as Gailey found in her work. Engaging in fat- positive communities allowed these women to construct fat-positive sexual identities.

Is it surprising that women produce much of the fat-positive sex information? Perhaps this stems from the (re)production of domi- nant social phenomena that position women and their experiences as “inferior, deviant, or significant only in the ways they serve male interests” (Anderson, 2012). This may be seen as reinforced by the focus in obesity research on sexuality on sexual dysfunction, specifically erectile dysfunction. In contrast, fat-positive sex resources suggest that fat sex is enjoyable

to her blog to present tips and tricks for hot fat sex. The inclusion of tools and techniques is common in pieces about fat sex, and suggests a market for such items. Perhaps this is one way that fat sex will become more mainstream, as capitalistic systems will embrace the opportu- nity to provide desirable goods to individuals looking to facilitate fat sex.

In “Fat Sex: What Everyone Wants to Know but Is Afraid to Ask,”1 msvaginascience intro- duces herself as a fat woman who has enjoy- able sex with partners who are usually smaller than she is. Her biggest piece of advice is that fat women need to “overcome the idea that your partner doesn’t know how fat you are.” For a marked difference though, msvagina- science spends most of the piece exploring different sexual positions and how they can work for fat bodies. These pieces are accom- panied by illustrations of her (clothed) fat body demonstrating.

This is in no way an exhaustive accounting of the materials about fat sex that have been written by fat individuals, merely a selection of the better-known offerings available. The intro- duction of the World Web Wide, and Web 2.0, has opened up a never-ending supply of spaces for individuals of all sizes to share information (Pausé, 2014a). It has especially been taken up by individuals in marginalized groups, whose sexuality is often denied (or, at least, ignored) by mainstream media and culture.

Participation in fat communities, both online and off, may be one way for fat people to develop positive sexual identities. “In a culture that rarely associates fat bodies with sexuality, publicly claiming sexual agency, desire, and desirability allows fat women to take pleasure in their bodies” (p. 300), writes Asbill (2009). In  her qualitative work, Asbill explores the experience of fat women participating in bur- lesque, and considers how this activity shapes their fat identity. Engaging in explicitly sexual performance for others allowed the women

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body weight with sexual function in women. International Journal of Impotence Research, 19(4), 353–57.

Exton, E. 2010. Should “fatties” get a room? No. But it is time for TV to move beyond fat jokes. Entertainment Weekly [online]. Retrieved from http://popwatch .ew.com/2010/10/28/marie-claite-fatties-mike-and-molly/ (30 April 2014).

Gailey, J. A. 2012. Fat shame to fat pride: Fat women’s sexual and dating experiences. Fat Studies: An Interdisciplinary Journal of Body Weight and Society, 1(1), 114–27.

Hammoud, A., Gibson, M., Hunt, S. C., Adams, T. D., Cattell, D. T., Kolotkin, R. L., and Meikle, A. W. 2009. Effect of Roux-en-Y gastric bypass surgery on the sex steroids and quality of life in obese men. The Journal of Clinical Endocrinology & Metabolism, 94(4), 1329–32.

Harding, K. 2008. How do you fuck a fat woman? In J. Friedman and J. Valenti, Yes means yes! Visions of female sexual power & a world without rape (pp. 67–76). Berkeley: Seal Press.

Kadioglu, P., Yetkin, D. O., Yahn, A. S., Onem, K., and Kadioglu, A. 2010. Obesity might not be a factor for female sexual dysfunction. BJU International, 106(9), 1357–61.

Kaukua, J., Pekkarinen, T., Sane, T., and Mustajoki, P. 2012. Sex hormones and sexual function in obese men losing weight. Obesity Research, 11 (6), 689–94.

Kelly, M. 2010. Should fatties get a room? (Even on TV)? Claire [online]. Retrieved from http://www.matieclairecom /sex-love/dating-blog/overweightcouples-on-television (29 April 2014).

Kirby, M. 2013. How to have sex while fat: A short guide to sexy fun for fatties and people who f#&@ them. xoJane [online]. Retrieved from http://www.xojane.com /sex/sex-with-a-fat-person (21 March 2013).

Kolotkin, R. L., Binks, M., Crosby, R. D., Østbye, T., Gress, R. E., and Adams, T. D. 2006. Obesity and sexual quality of life. Obesity, 14(3), 472–79.

Kolotkin, R. L., Binks, M., Crosby, R. D., Østbye, T., Mitchell, J. E., and Hartley, G. 2008. Improvements in sexual quality of life after moderate weight loss. International Journal of Impotence Research, 20(5), 487–92.

Kolotkin, R. L., Zunker, C., and Østbye, T. 2012. Sexual functioning and obesity: A review. Obesity, 20(12), 2325–33.

Kyrölä, K. 2014. The weight of images: Affect, body image and fat in the media. Farnham: Ashgate.

Larsen, S. H., Wagner, G., and Heitmann, B. L. 2007. Sexual function and obesity. International Journal of Obesity, 31, 1189–98.

LeBesco, K. 2004. Revolting bodies? The struggle to redefine fat identity. Amherst: University of Massachusetts Press.

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and normative. And they argue that fat people are sexual beings with sexual agency who are engaging in satisfying sex lives, a stark juxtapo- sition to the themes in the literature of obesity research.

As individuals increasingly produce large amounts of knowledge in the Web 2.0 age, marginalized communities are able to pres- ent their truths and suggest representations of themselves that contrast with the dominant discourses (Pausé, 2014b). If, as Gailey (2012) suggests, involvement in size acceptance leads to decreased body image dissatisfaction and greater sexual agency for fat women, then per- haps turning to fat activist communities for information about sex, and drawing on sexu- ality scholarship from the field of Fat Studies (a field that rejects the negative assumptions associated with fatness and the fat body) will allow more fat women to construct positive fat sexual identities and exercise their sexual agency.

NOTE 1. Find the “Fat Sex Week Table of Contents” on The Queer Fat Femme Guide to Life at http://queerfatfemme .com/tag/fat-sex-week/.

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Asbill, L. 2009. “I’m allowed to be a sexual being”: The distinctive social conditions of the fat burlesque stage. In E. Rothblum and S. Solovay, eds., The fat studies reader (pp. 299–304), New York: New York University Press.

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Stryker. K. 2011. Fuck me, I’m fat: A hot guide to fat sex. Kitty Stryker: PurrVersatility [Weblog]. Retrieved from http://kittystryker.com/2011/06/fuck-me-im-fat-a-hot -guide-to-fat-sex/ (1 July 2013).

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SEXUAL PR ACTICES

A N I N T E R V I E W W I T H

M I C H A E L R E E C E

Michael Reece, PhD, MPH, is a professor of applied health science in the School of Public Health at Indiana University.   Dr. Reece’s research is focused on sexual health in both domestic and international settings and is conducted under the auspices of his research team, the Center for Sexual Health Promotion.  The center conducts research designed to advance conceptual and methodological approaches to studying sexual health and trains the next generation of sexuality and sexual health scholars. The center’s work is focused on four key areas, including (1) conducting nationally repre- sentative assessments of sexual and sexual health behaviors that provide an empirical foundation for those who need population-based data to support their work in public health and medicine, (2) advancing the methods used to study sexual behavior through innovative designs like technology-based daily diaries, (3) developing measures for sexuality-related research that are not only valid and reliable but that are attentive to unique cultural norms and changes in the human sexual repertoire, and (4) exploring the manner in which humans acquire and use products that promote sexual health and that improve sexual function and pleasure, such as vibrators, condoms, and lubricants.

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What led you to begin studying sexuality? When I was an undergraduate student, I volunteered as a peer sexuality educator at the University of Georgia. I used to conduct workshops for fraternities and sorori- ties, mostly on the topic of sexual assault and acquaintance rape. Later, after earning my MPH degree, I led the office of HIV prevention for a state health department in the southwestern United States. In that work, I started to believe that our public health interventions were off-base; we were focused only on things like condom use, but we didn’t understand that condom use doesn’t occur in a vacuum, it occurs within the context of a sexual event. I became convinced that the only way to pre- vent public health problems like HIV, STIs, and unintended pregnancy was to better understand the nature of sexual behavior itself. I felt that we needed to understand sexual behavior at its core and that by only looking at sexuality for its potential con- tributions to disease we were missing something. That led me to pursue a doctoral degree and ultimately led me to Indiana University, which has always been known as a leading university for studying sexuality.

How do you tell people you study sexuality and how do they react? It depends. I don’t tell everyone. . . . However, when I do tell people, what I find is that they think that it is much more mystical than it actually is. People seem to think that it must be so exciting to know lots of things about people’s sexual lives. I’ve never had a negative reaction actually. I think . . . that people are genuinely curious about sexuality; most have never had a chance to discuss it and they are intrigued by the fact that there is research that helps them to compare their sexual lives to those of others.

What ethical dilemmas have you faced studying sexuality? My team is incredibly attentive to assuring people that they can trust us when they disclose information about their sexual lives. We go to extremes to inform people about what we are going to ask, why we are asking it, and what we will be doing with it. So one important ethical issue is that you have to be sincere about keep- ing people’s data confidential and about assuring them that there is a really valid scientific purpose.

In an early study at Indiana University, my team studied the behaviors of men who were having sex with other men in campus bathrooms, locker rooms, and other locations. This was called “cruising” and it was incredibly taboo. One of the most popular places for men to “cruise” was in a bathroom that was right down the hall from my office. This study was conducted over ten years ago, but on a regular basis I still run into men who participated in that study when I am on campus or out in the community. We told these men at the beginning of the study that if we were to encounter them in a public place after the study that we would pretend that we did not know them. And I do that. When I see these men I don’t make any gestures toward them at all. I think they are surprised that I still do this after ten years, but we had made a commitment that we would not acknowledge them unless they

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spoke first. So it is not just the notion of maintaining data confidentially in tradi- tional ways like not using identifiers in data sets. Maintaining high ethical standards also requires a long-term pledge to being absolutely sincere in your commitments to participants.

Why is sex research important? From an everyday perspective, sexuality research is very important because people are incredibly curious about who does what with whom and about how the behavior of others compares to their own. Particularly in the United States, we are rarely provided with the opportunity to have open discussions about sexuality, creating incredible challenges in people’s romantic and sexual lives. So, sexuality research is vital to helping people have access to information that enables them to better understand their own sexuality.

From an academic perspective, sexuality research is also essential. Sexual behav- ior is perhaps the most common behavior of humans. . . . So, in terms of an aca- demic commitment to understanding societies and behaviors, we must remain committed to sexuality research. Academic institutions should be willing to support sexuality research because it is among the most common of all denominators of our existence.

From a sexual health or public health perspective, we must understand sexual behaviors if we are going to change them. We can’t understand condom use with- out understanding the relational, situational, and other factors that influence the decision-making process of two or more individuals during a sexual event. We just can’t change behaviors that we don’t understand.

Can you describe some of the findings from your recent research? The National Survey of Sexual Health and Behavior (NSSHB) was the first nation- ally representative study of the sexual lives of Americans in close to two decades. It provided important data about the current nature of the sexual repertoires of both adolescents and adults, indicating that our sexual lives are incredibly diverse. The results also illustrated that “sex” is more than intercourse. While intercourse remains the most common behavior, there are many sexual events that don’t involve intercourse, and when it does occur, it is typically accompanied by other behaviors. This study also provided data that suggested that adolescents are among the most responsible when it comes to sexuality—with those aged 14–17 having the highest rates of condom use in the country, a trend that public health has been documenting for the past decade. We followed this study with one that was very similar but was focused on gay and bisexual men. In that study, we surveyed over 25,000 men and found that gay and bisexual men also have extremely varied sexual lives. Among the least reported behaviors was anal intercourse—which is completely contrary to what most people think constitutes gay sex. The most common behavior reported by gay and bisexual men was kissing their partner. People always ask me if I’m surprised that kissing was the most frequent behavior; I usually say that I’m not surprised by

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the finding but instead I’m shocked that most researchers have never collected data on kissing and that when we only ask about gay sexuality in the context of HIV (and thus mostly having asked only about condom use and anal intercourse), we get very warped understandings of their lives.

Of the projects you’ve done over the course of your academic career, which did you find most interesting and why? I would say that I think our early study of men’s cruising on college campuses was one of the most interesting studies that I’ve ever done. Cruising is incredibly taboo; at its foundation, it is reliant upon anonymity and secrecy. So I learned an incredible amount about how to do sexuality research on such topics. The men’s willingness to participate in extensive interviews about this behavior still fascinates me. Also, most people who had considered this issue before had never considered the positive aspects of cruising; what do men get out of it other than sex? Participants in that study were incredibly articulate about how such behaviors helped them to better understand their own sexuality and about how it often resulted in many positive outcomes—that is just something that had never been documented.

If you could teach people one thing about sexuality what would it be? There is no “normal” when it comes to sexual behaviors. All of us have very diverse desires and needs when it comes to sexuality and communicating with your partners about those desires and needs is critical.

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R E A D I N G 2 8

THE PURSUIT OF SEXUAL PLEASURE

B . J . R Y E A N D G L E N N J . M E A N E Y

discussion on a very North American version of the pursuit of sexual pleasure.

THE PURSUIT OF SEXUAL PLEASURE

What Is Sexual Pleasure? Broadly defined, sexual pleasure involves the positive feelings that arise from sexual stimuli (Abramson and Pinkerton, 1995). Sexual plea- sure may result from a variety of activities that involve sexual arousal, genital stimulation, and/ or orgasm. . . . While it may seem self-evident, people are more likely to engage in sexual behaviors they consider pleasurable than sex- ual behaviors that they find less pleasurable (Browning et al., 2000; Pinkerton et al., 2003).

It is seldom overtly stated, but sexual plea- sure is very important in our society. Achieving sexual arousal and orgasm is significant enough to people that manuals of sexual technique have been compiled—such as the venerable Kama Sutra (trans., 1994), The Joy of Sex (Com- fort, 1972), and Sex for Dummies (West heimer, 1995). There are university courses, television shows (e.g., The Sex Files, Colby, 2006), web- sites (e.g., www.sexualityandu.ca), sex stores, and shows (e.g., The Stag Shop, see www . stagshop.com; The Everything to Do with Sex Show, see www.everythingtodowithsex.com) devoted to human sexuality and the attain- ment of the highest level of sexual satisfaction

Sex and sexuality are surprisingly dif-ficult terms to define. In one sense, sex can be seen as a collection of behaviors related directly or indirectly to stimulation of the genitals; our bodies then respond to this stimulation with a reflex that is pleasurable and tension-releasing (i.e., orgasm). This . . . defini- tion does not, however, provide much insight into the role that sexuality plays in our lives. Rather, sexuality can be thought of as an insti- tution defined by shared social meaning that is constructed around the simple stimulation of genitals; sex, in this sense, is what we make it (e.g., DeLamater and Hyde, 1998; Foucault, 1976/1978). At the individual level, human sexuality is subjective and represents how we experience and express ourselves as sexual beings. At a cultural level, sexuality can be constructed to serve a variety of needs: sex is a means of procreation, an intimate bonding ritual, even a form of social control (Foucault, 1976/1978; Hawkes, 1996; Weeks, 1981). For some, sex is work (e.g., prostitution, “spousely duty”). For others, sex is play. . . . [T]his read- ing will focus on the “playful” aspect of sex. In particular, we will discuss the more physical gymnastics involved in the pursuit and attain- ment of sexual pleasure—“sex for fun.” We hope to show how pleasure is a primary motivator for sexual activity and how social constructions of sexuality are built around this fundamental desire for sexual pleasure. . . .

Our perspective on sexual pleasure is con- structed from a review of mainly Canadian and U.S. literature concerning sexual activ- ity and sexual behavior. We supplement this review from our own ongoing survey of Cana- dian university students. . . . We . . . focus our

From “The Pursuit of Sexual Pleasure,” Sexuality & Culture, Volume 11, Issue 1, December 2007, pp. 28–51. Copyright © 2007, Springer. Reprinted by permission of the authors.

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Symons, 1990). Women tend to have more emo- tional and romantic fantasies and to see them- selves in positions of submission (Hsu et  al., 1994; McCauley and Swann, 1978). Lesbians and gay men tend to have fantasies similar to heterosexual women and men, respectively, except that they typically imagine same-sex partners (Hurlbert and Apt, 1993; Keating and Over, 1990; Masters and Johnson, 1979; Robinson and Parks, 2003). In general, people report a wide variety of content in sexual fan- tasy. People who have more sexual fantasies tend to have fewer sexual problems and report more sexual satisfaction than people who have fewer fantasies (Byrne and Osland, 2000; Leit- enberg and Henning, 1995).

. . . Renaud and Byers (1999) found that all of their New Brunswick university student sample reported having had sexual thoughts at some time. Both men and women reported more positive than negative thoughts, with men reporting more of both positive and negative thoughts. Participants reported a wide variety of content in sexual thoughts. . . . Little and Byers (2000) [found that] . . . [p]eople often enjoyed having sexual fantasies while in pub- lic places, and people in committed relation- ships were not more likely to evaluate sexual thoughts as negative. Our survey of Ontario students enrolled in an introductory sexuality course (1999–2006) indicated that 63 percent of women and 78 percent of men—who have had sex—fantasize while engaging in sexual activity with a partner. Our students fantasize in greater numbers (98 percent of men; 93 per- cent of women) during masturbation—sexual self-stimulation.

Masturbation Historically, masturbation has been stigma- tized and associated with immorality and pathology, but it is quickly gaining respect as a common and healthy sexual activity (Coleman, 2002). A [2002] survey of American university

possible. Clearly, people have a great interest in sexual pleasure. This pleasure can be pursued in many forms—and can occur in solitary and/ or partnered contexts. Perhaps the simplest sexual activities are those in which an individ- ual can engage alone, such as masturbation and sexual fantasy.

Solitary Sex

Fantasy Sexual fantasy has the appeal of being the saf- est form of sexual enjoyment: One can fanta- size any time, one can have total control, and there are no (direct) consequences (Doskoch, 1995). Sexual fantasy is difficult to research, especially because it is difficult to define exactly what constitutes fantasy (see Byrne and Osland, 2000). Leitenberg and Henning (1995: 470) define sexual fantasy as “almost any men- tal imagery that is sexually arousing or erotic to the individual.” Byers and colleagues (Byers, Purdon, and Clark, 1998; Little and Byers, 2000; Renaud and Byers, 1999) prefer the term sexual cognitions, which may have positive or negative connotations. Sexual thoughts can take many forms, some of which may not be pleasurable to the individual. . . .

The great majority of men and women engage in sexual fantasy, either as an activity by itself (i.e., daydreaming), or in conjunction with other sexual activities, including mastur- bation and partnered sex. For example, when asked “how often do you think about sex?”, 97 percent of men and 86 percent of women responded with a few times a month or more (Laumann et  al., 1994). In terms of content, men seem more likely to have explicitly sexual fantasies (Ellis and Symons, 1990), to imagine themselves in positions of dominance (Byers, Purdon, and Clark, 1998; Hsu et al., 1994), to see themselves as the “doer” (Byers, Purdon, and Clark, 1998; Knafo and Jaffe, 1984) and to fantasize about multiple partners (Ellis and

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usually kiss when they have sex (Blumstein and Schwartz, 1983). In a U.S. study of uni- versity students, most (96%) had “dry” kissed someone and a large majority (89%) reported having “French-kissed” (i.e., kissed with open mouths). Ninety-one percent of men and 95 percent of women who participated in our human sexuality student survey indicated that they were experienced French-kissers as well. A representative study of Canadian youth found that about a third to half of seventh-grade stu- dents, approximately two-thirds of ninth-grade students, and about eight out of ten eleventh- grade students reported engaging in “deep, open-mouth” kissing (Boyce et  al., 2003). It should be noted that, while kissing is generally considered an erotic activity in North Ameri- can society, it is not considered erotic in all cultures (Harvey, 2005). When kissing is con- sidered erotic, however, it is often a precursor to petting (kissing, of course, may accompany petting).

Touching Petting is a rather odd term for sexually touch- ing another person—usually interpreted as meaning in the genital region. This is also known as mutual masturbation or being mas- turbated by a partner. This is a common behav- ior amongst university students . . . (Browning et  al., 2000; Pinkerton et  al., 2003). . . . Over a third of seventh-grade students, about two- thirds of ninth-grade students, and eight out of ten eleventh-grade students indicated that they had engaged in “touching above the waist at least once.” The incidence of hand-genital con- tact was less common—with about a quarter to a third of seventh-grade students, slightly over half of ninth-grade students, and about three- quarters of eleventh-grade students responding yes to “touching below the waist at least once” (Boyce et  al., 2003). Mutual masturbation is a common sexual behavior and being mastur- bated by one’s partner tends to be ranked as

students (Pinkerton et  al., 2002) found that about two-thirds of the women and almost all of the men reported masturbating at least once. Both genders reported frequent masturbation in the past three months. People masturbated more if they perceived social norms in support of this behavior (Pinkerton et al., 2002). More sexually active people masturbated more often, indicating that masturbation is not a substitute for other sexual activity (also see Davis et  al., 1996).

Men tend to masturbate fairly uniformly whereas women tend to have more varied mas- turbation techniques from woman to woman (see Masters and Johnson, 1966). There were no gender differences in reasons for mastur- bating: the majority of men and women stated that they masturbated to relieve sexual tension and the second most commonly cited reason was for physical pleasure (Laumann et  al., 1994). . . . Of all sexual behaviors, masturba- tion seems most clearly motivated by pleasure, or at least, release of tension. . . .

Partnered Sexual Activity A common North American sexual script sug- gests that we have a shared idea about the sequence of partnered sexual behaviors that proceeds from kissing and touching (“petting” above the waist) to more intensive touching (“petting” below the waist or manual stimula- tion of the genitals) to oral sex to genital-to- genital contact to vaginal or anal intercourse (Gagnon and Simon, 1987; Laumann et  al., 1994; McKay, 2004). Of course, there are a multitude of variations on this script and many behaviors have been omitted from this generic description. In almost all cases, kissing is a starting point.

Kissing Kissing is a very common behavior, with same- sex and other-sex couples reporting that they

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Penis-in-Vagina Intercourse Pinkerton and others (2003) found that penis- in-vagina intercourse was rated as the most pleasurable sexual activity (as did Laumann et al., 1994). This is a behavior in which almost all adults have engaged at least once (Laumann et  al., 1994; Mosher et  al., 2005; Wellings et  al., 1994). In terms of U.S. university stu- dents, around 80 percent have had vaginal intercourse (Browning et  al., 2000; Pinkerton et al., 2003). Our sample of Canadian sexuality students had slightly fewer men indicating that they have had vaginal intercourse (75%) com- pared to women (79%). Most of these students (40–45%) had their first intercourse between the ages of 16–18 years; this is congruent with the representative survey of Canadian youth finding that between 40–46% of eleventh- grade students have had intercourse at least once (Boyce et al., 2003).

While there are many different positions for intercourse, there are four “basic” positions: man on top (“missionary”), woman on top, side by side, and rear entry (“doggie style”). Each position has certain “advantages.” For exam- ple, the woman-on-top position is good when a man has poorer ejaculatory control, allows the woman to control sexual positioning and rhythm, and allows greater accessibility to the clitoris (a key organ to female sexual plea- sure). Man on top is the recommended position when a couple is trying to become pregnant. Rear entry is good when a woman is pregnant or when particularly deep penile insertion is desired. . . . While vaginal intercourse is con- sidered pleasurable by most people, a substan- tial minority of people also report enjoying anal sex.

Anal Sex Anal sex can take different forms. There is penis-in-anus intercourse whereby a man inserts his penis into the rectum of his partner.

highly pleasurable relative to some other sexual behaviors (Pinkerton et  al., 2003). Another form of touching is oral sex: sexual stimulation of the genitals by mouth.

Oral Sex People frequently engage in oral sex. Recent national surveys in the United State indicated that a large majority of adult men (79–85%) have had oral sex performed on them (called fellatio) while many women (73–83%) have received oral sex (called cunnilingus) (Lau- mann et  al., 1994; Mosher, Chandra, and Jones, 2005). About 90 percent of adults have had oral sex (Mosher et  al., 2005). This has changed somewhat since the Kinsey surveys (1949, 1953), which indicated that about 60 percent of men and women had engaged in oral sex. Our survey of sexuality students indi- cated that between 80 percent and 85  per- cent of women and men had performed and received oral sex. Not surprisingly, oral sex is becoming more common among Cana- dian adolescents as well (Boyce et  al., 2003; McKay, 2004).

There is an emerging literature where researchers and lay people alike discuss ado- lescent oral sex as an activity on the rise as a “substitute” for intercourse—as this helps pre- vent pregnancy, reduce STIs risk, and main- tain “virginity” (Barrett, 2004; McKay, 2004). Mosher and others (2005) found that just over 10 percent of teenagers (15–19 years old) have had oral sex without intercourse, with about 55 percent of all teens having had oral sex.

. . . [E]ducators and researchers consider this to be a natural increase as oral sex rates have increased for adults as well (Burnett, 2004; McKay, 2004). One of the major rea- sons why youth engage in oral sex is that it is fun and pleasurable (Barrett, 2004). Similarly, university students ranked receiving oral sex as the second most pleasant activity after vaginal intercourse (Pinkerton et al., 2003).

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anus, having anus stimulated by a partner’s fin- ger, and anal intercourse).

Techniques of Same-Sex Couples A substantial minority of people are lesbian, gay, or bisexual (LGB; Laumann et al., 1994). A [2005] representative U.S. survey found that around 8–10 percent of adults identified as LGB (Mosher et  al., 2005). About 9 percent of men and 6 percent of women in our human sexuality class self-identified as LGB. One does not need to be LGB to engage in same- sex behavior; 6 percent of men and 11 percent of women indicated that they have had a same- sex sexual partner in their lifetime (Mosher et al., 2005). Laumann and others (1994) found that about 3 percent of men and women rated having a same-gendered sexual partner as “very appealing.”

Same-sex couples tend to engage in similar sexual behaviors as other-sex couples, includ- ing kissing, hugging, mutual masturbation, oral stimulation, and penetrative sex (Blum- stein and Schwartz, 1983; Masters and John- son, 1979). Male couples sometimes engage in interfemoral intercourse; this is where one man thrusts his penis between the thighs of the other man. Female couples may engage in tribadism whereby “two women rub their vulvae together to stimulate each other’s cli- toris to orgasm” (Wikimedia Foundation, 2006; also see Caster, 1993) or there may be mons-to-thigh stimulation. Other-sex couples also engage in this non-penetrative genital-to- genital stimulation (Kinsey et  al. [1953] call this apposition; “dry humping” is a more com- mon, but less sophisticated, description).

Masters and Johnson (1979) observed and compared the sexual behaviors of same-sex couples to other-sex couples and found differ- ences in arousal techniques rather than sexual behaviors. In general, the same-sex couples tended to “take their time” in comparison to

As the anus has no natural lubrication, a ster- ile lubricant gel is recommended (e.g., Astro- glide, K-Y Jelly) so as to reduce the likelihood of trauma to the anus (e.g., tearing tissue, dam- aging sphincters). It is recommended that the inserter wear a condom. Because anal inter- course typically involves some tearing of the tissue, there is a direct route for pathogens into the bloodstream, making this a very effi- cient route for HIV transmission and other STIs. It is important that the penis be washed after anal intercourse and prior to any further genital contact. For example, if a man removes his penis from the anus and inserts it into the vagina, various bacteria can be transferred to the vagina.

Anilingus or “rimming” is oral stimulation of the anus. Again, because of the presence of bacteria and possibly other STI pathogens (e.g., gonorrhea, hepatitis), it is prudent to use a barrier (e.g., cut a condom up the side or use a dental dam). Some people enjoy digital stimu- lation of the anus by having fingers or the hand inserted in the anus during sexual arousal.

Anal intercourse is not as commonly per- formed as the other sexual activities discussed thus far. A representative U.S. sample found that roughly a third of adults have had anal sex (Mosher et  al., 2005). . . . About one-fifth to a quarter of university students in two U.S. samples reported ever having experienced anal intercourse (Browning et  al., 2000; Pinkerton et  al., 2003). In our sexuality student survey, about one-fifth reported having had anal inter- course. Laumann and others asked their par- ticipants if they had experienced anal sex in the past year and approximately 5–10% had experi- enced anal sex that recently. Finally, Laumann and others posed an interesting set of ques- tions to their participants about how “appeal- ing” a variety of sexual behaviors were. When asked about various forms of anal sex, between 1% and 5% of people rated anal contact as “very appealing” (including stimulating a partner’s

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Golin, and Kennar, 2006) and books and stores devoted to sex toys (e.g., Venning and Cavanah, 2003). . . . In our survey of human sexuality students, about a third of women had experience with a “mechanical aid” compared to 8 percent of men. This is quite different from the representative survey of American adults, which found less than 1 in 20 (< 5%) of men and women rated vibrator/dildo use as appeal- ing (Laumann et al., 1994). Laumann and oth- ers found that the more educated women in their sample found vibrator/dildo use the most appealing—education may impact attitudes toward sex toy use.

Davis et  al. (1996) conducted a study of women who use vibrators. . . . The results sug- gested that many of the women . . . found that clitoral-vibrator stimulation usually triggers an orgasm; they used their vibrators on a variety of sexual sites (clitoral, vaginal, and anal), and in a variety of ways (circular motion, up/down, or back/forth). Most (80%) of the sample used the vibrator during partnered sex—sometimes with the partner watching the woman use the vibrator while sometimes the partner held the vibrator for the woman. Women, who were les- bians and were more likely to, reported being younger when they first used a vibrator and were slightly more likely to use a vibrator with a partner than were bisexual or heterosexual women.

Sexually Explicit Material Use of erotica—sexually explicit depictions—is also a relatively common aid in autosexual or partnered sexual activity. Erotic materials are broad-ranging and may include books, maga- zines, videos/DVDs, live shows (e.g., exotic dancers), telephone sex, and cybersexuality (e.g., sex in chat rooms, webcam sex). Laumann and others (1994) found that as many as one out of five men used some form of erotic mate- rial when fantasizing/masturbating, while fewer women did (as many as one out of ten). These

opposite-sex couples. That is, Masters and Johnson characterized heterosexual couples as more “performance oriented”—oriented toward the penis-in-vagina act—in contrast to the same-sex couples, who engaged more in plea- sure-seeking throughout the sexual encounter. There were no differences between heterosex- ual and homosexual people of the same gender in terms of masturbation techniques.

Spicy Sex Thus far, we have discussed relatively common sexual activities. There are practices that are not necessarily common or usual but that are pleasurable for many people. . . . [I]t is impor- tant to remember that uncommon does not equal pathological. Most sexual behaviors can be placed on a continuum from healthy (e.g., having a mild or strong preference) to patho- logical (e.g., when the behavior/object becomes a necessity or a substitute for a human relation- ship; see Hyde, DeLamater, and Byers, 2006). Spicier activities may be an indication of the importance of sexual pleasure. While many of the “vanilla” techniques are quite pleasurable, they are often socially scripted, and are cheap and easy in which to engage. More “spicy” techniques may require creative thought, mon- etary expense, or even travel plans. The trouble that people are willing to go through for the “spicier” activities might indicate that these are primarily pleasure-seeking activities.

Sex Toys Sex toys are devices that people use to enhance their sexual pleasure (e.g., vibrators, dildos). While sex toys have been around for years (in the late 1800s, early 1900s as “medi- cal devices”; see Maines, 1999), people have become more open about discussing sex toys perhaps because of popular media portrayals (e.g., Sex and the City, King, Chupack, Melfi, Bicks, Raab, et al., 2006; The L Word, Chaiken,

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Sadomasochism Sadomasochism (S&M) is a term that col- lectively describes a variety of sexual behav- iors which may involve the administration of pain (e.g., use of clothespins/clamps, hot wax, spanking), deliberate humiliation (e.g., use of a gag, face slapping), physical restriction (e.g., handcuffs, chains), and hypermasculine activi- ties (e.g., cockbinding, watersports, rimming) that are experienced as pleasurable by both partners (Alison, Santtila, Sandnabba, and Nordling, 2001; Sandnabba, Santtila, and Nord- ling, 1999). The S&M scene typically involves fetishistic elements such as leather clothing and whips, and ritualistic activity such as bond- age. S&M has been characterized as fantasy- oriented and role-playing scripted behavior.

. . . [T]here is a distinct subculture of psy- chologically well-adjusted individuals who engage in S&M activities—many of whom belong to S&M “clubs” (Alison et  al., 2001; Sandnabba et  al., 1999). Partners in S&M activities described here refer to consenting S&M participants. People who have partici- pated in research studies about the S&M sub- culture have been found to be well-integrated into society in general as they tend to be highly educated and earn high incomes (Alison et al., 2001; Mosher and Levitt, 1987; Sandnabba et  al., 1999). Most of these people report engaging in S&M activities occasionally and in non-S&M sexual activities frequently—which indicates that the S&M activities were not part of a “diagnosable paraphilia” (Sandnabba et  al., 1999). Most of the information known about S&M involves men; it is sometimes dif- ficult to obtain adequate samples of women within the S&M subculture (Mosher and Lev- itt, 1987; Sandnabba et al., 1999). In a study of men, Sandnabba and colleagues (1999) found the most common S&M behaviors to include (in order): oral sex, bondage, wearing leather outfits, flagellation (e.g., whipping), anal

researchers asked about the appeal of “watch- ing other people do sexual things” (which might be interpreted as erotica or, alternatively, voy- eurism) and found that 5 percent of men and 1 percent of women found this activity sexually appealing. In the human sexuality student sur- vey, a majority of men and women had favor- able attitudes toward erotic materials, although there was a gender difference such that men were more favorable than women were.

Online sexual activities have increased in recent years. . . . A study of people who use the Internet indicated that 80 percent of par- ticipants used the web for sexual purposes. Of those people, about a third had engaged in “cybersex.” Cybersex was defined as “when two or more people are engaging in sexual talk while online for the purposes of sexual plea- sure and may or may not include masturbation” (Daneback, Cooper, and Månsson, 2005: 321). This cybersex most commonly took the form of a sexual encounter in a “chat room” with the second most popular medium being instant messenger–type programs.

Sexual Internet activities are probably on the rise because of the fact that these materi- als are affordable, readily available, and can be accessed anonymously (Cooper, McLoughlin, and Campbell, 2000). The Internet allows people with uncommon sexual proclivities to both find and support others with similar interests. As well, the Internet offers users the opportunity to experiment with new behav- iors in a relatively safe setting, satisfy curi- osity, and seek out new information. While there has been a substantial discussion of “Internet sex addiction,” sexually compulsive Internet users typically already have a his- tory of unconventional sexual practices (i.e., diagnosable paraphilias, risky sexual activ- ity). Many people who are recreational users of online sexual material spend less than an hour per week, on average, visiting sexual websites (Cooper et al., 1999).

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These women did not view themselves as being consumers of prostitution services despite the economic element to their relationship; rather, they tended to characterize these sexual behav- iors as “holiday romances.” However, the men tend to be in lower socioeconomic positions (e.g., “beach boys,” hotel workers), often live in poverty, and earn a living through various forms of “hustling.” Interviews with the men indicated that they do not conceptualize them- selves as prostitutes or sex trade workers but they acknowledge that they reap financial and material benefits from entering into a series of fleeting sexual relationships with female tour- ists. These men even have strategies to assess which women are likely to be the most “gener- ous” (Sánchez Taylor, 2001).

A different type of sex tourism is popu- lar with university students who are on vaca- tion. This involves having casual sex with a relative stranger while on spring break. By relative stranger, researchers mean that the indi- vidual has met the sexual partner while on vaca- tion and typically known the sex partner for 24 hours or less. . . . Matika-Tyndale and col- leagues . . . 1997; 1998) found . . . approximately 16 percent of students vacationing in Daytona Beach had engaged in sexual intercourse with a new casual partner (this excludes those travel- ing with their boyfriend/girlfriend). Almost half (46%) reported “fooling around in a sexual way” with a new partner; this involved sexual activity excluding intercourse. In the spring break sub- culture, sexual norms are more permissive than what is expected “back home” . . . (Mewhinney, Herold, and Maticka-Tyndale, 1995). Having a partner “back home” did not seem to deter vacationers from having casual sex; one-fifth to one-quarter of people who were currently in a relationship had intercourse with a casual part- ner while they were on vacation.

It seems that being on vacation—away from the social constraints of “home”—creates a subculture of sexual permissiveness whereby

intercourse, rimming, handcuffs, and the use of chains, dildos, and verbal humiliation; at least 70 percent of the men interviewed participated in each of these behaviors. The most popular role-play for heterosexual men was master/ slave (for Mosher and Levitt’s, 1987, sample, too) while, for gay men, the most common role- play was a “uniform scene” (e.g., police officer and arrestee).

Although we do not know how many people practice S&M, we do know that people fan- tasize about and/or have a sexual response to S&M activities. . . . While S&M fantasies appear to be fairly common, we do not know how many people act upon these fantasies.

Sex on Vacation There is a phenomenon that has recently begun to be documented whereby people travel for the purpose of obtaining sex outside of their com- munity. Much of this literature has focused on heterosexual men who travel to areas such as the Caribbean or Southeast Asia for sexual gratification. While most of these men do not view themselves as engaging prostitution ser- vices, the transactions are clearly a form of commercialized sex. Researchers and theorists in this area actually find that sex tourists of this sort tend to be racist, sexist, and believe in their own Western cultural superiority over the people in these Third World locales (O’Connell Davidson and Sánchez Taylor, 1999).

Heterosexual women are also sex tourists who “purchase” the sexual services of local men (e.g., Cabezas, 2004; Herold, Garcia, and DeMoya, 2001). In Sánchez Taylor’s (2001) study of single women vacationing at resorts in the Dominican Republic and Jamaica, approxi- mately a third had engaged in sexual relations with local men; this was significantly more new sexual contacts compared to single women vacationing in Europe. Over half of the women with “vacation” sex partners had remunerated the sex partner in some way (e.g., cash, gifts).

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values, there is a tendency to view the pursuit of sex for pleasure’s sake as hedonistic; for example, a person who has casual sex tends to be viewed negatively (Parrinder, 1996). The pleasure of sex for a particular person depends not entirely on attaining orgasm but on the context and psychological state of the individ- uals involved (Mah and Binik, 2005). How a person has internalized the cultural messages about various aspects of sexuality will have a profound impact on the person’s experience of sexual pleasure. For example, if sex is seen solely as a means of procreation—a strongly Christian perspective (Parrinder, 1996)—there may be great guilt associated with feeling plea- sure if one engages in sexual behavior solely for pleasure purposes. Similarly, when sex is funda- mental to the maintenance of a long-term rela- tionship, it can become an obligatory duty (see Hawkes, 1996, . . . for a discussion). In both cases, sex can become a matter of performance pressure and anxiety.

In the eighteenth and nineteenth centu- ries, sex was officially defined in terms of the social and interpersonal functions it fulfilled; there was little mention of sex as a pleasurable experience (or, if so, it was pleasurable only for men). When attention was drawn to the sexual pleasure of women (somewhat ironically, by the work of Freud), social forces constrained that pleasure to marriage. People seeking sexual pleasure outside of marriage were labeled as “deviant” (Hawkes, 1996). Our current societal views on sexual pleasure have their roots in our Victorian history of sex negativity and the sub- sequent need to “quell” or control a dangerous instinct (Foucault, 1976/1978; Weeks, 1981, 1986).

Current North American attitudes toward sexual pleasure run the gamut from “only for procreation” to “okay when in love or when dating” to “anything goes.” While there is no consensus, sex with love or in the context of a committed relationship tends to be deemed

one can have sex for solely the purpose of having sex (e.g., for fun, to “let loose”). As one student characterized casual sex during spring break vacation: “It is generally expected . . . to have a great time and that includes having sex” (Mewhinney et al., 1995: 278). There are similar destinations that are known for tourist-tourist casual sex such as Ibiza and Côte d’Azur that cater to non-student populations (O’Connell Davidson and Sánchez Taylor, 1999). The fact that some will go through so much trouble for the purpose of having sex lends credence to the unspoken value we place on sexual plea- sure. The pursuit of sexual pleasure can be seen clearly, not only in sex tourism, but in the multi-faceted behaviors we have chosen to call “spicy” sex.

Spicy sex encompasses a diversity of behav- iors, many of which we have not discussed (e.g., group sex and swinging, other commercialized sex, cross-dressing, etc.). What is interesting about these diverse behaviors is that, while not popular with everyone, people who engage in these behaviors tend to find social groups that are supportive of the activities (e.g., fantasia parties for those who have an interest in sex toys, S&M clubs, online chat groups devoted to various sexual acts). It is possible that when there is a supportive social network for the “spicy” sexual behavior, people will be more comfortable with their “less common” sexual behavior (see Kutchinsky, 1976; Sandnabba et al., 1999). . . .

What Can We Conclude about Sexual Pleasure? What is sexually pleasurable is in the eye of the beholder. “Sex” and “sexual pleasure” are very much “social constructions” in that certain attitudes, behaviors, and activities are consid- ered taboo. Societal norms exert a great deal of social control over what is “acceptable” sexual- ity. In Western society dominated by Christian

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Hyde, J. S., DeLamater, J. D., and Byers, E. S. 2006. Understanding human sexuality (3rd ed., Canadian). Toronto, ON: McGraw-Hill Ryerson.

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Teen Sex in the United States

Chris M. Vidmar

Moral panic about teen sex is nothing new. Most recently, parental concerns have been focused on the availability of sexually explicit content on the Internet (Bilton, 2015), the prevalence of sexting among teens (Lohmann, n.d.), and the possibility that vaccinations for sexually transmitted infections (STIs) might encourage risky behavior (Fox News, 2011). However, recent studies tell a different story about U.S. teens and sex. According to a 2017 report from the National Center for Health Sta- tistics (NCHS), the number of teens who have ever had sex has been dropping since 1988,

more teens are using contraception, and teen pregnancy has hit a historic low (Abama and Martinez, 2017). Dr. Brooke Bokor of the Chil- dren’s National Health System, in comments made to the Washington Post, attributed these shifts to the availability of information online (Paquette and Cai, 2015). Despite parents’ concerns about the Internet, the ability to pri- vately locate reliable sexual health information has helped teens navigate sexual risk. While lit- tle empirical research on teen sexting has been completed, the current approach of criminal- ization under child pornography statutes has

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been shown to be an ineffective and arguably unconstitutional response (Lampe, 2013). As for the fear that STI vaccines might encourage casual sex, the American Academy of Pediat- rics reported that HPV vaccination in girls was not associated with increased markers of sexual activity (AAP, 2012; Bednarczyk et al., 2012).

While the moral panic over teen sex may be misinformed, there is ample reason to continue researching teen sexuality. Even though teen pregnancy and birth rates in the United States have dropped to a rate of 22.3 per 1,000 females ages 15–19, the United States continues to have higher rates than other developed countries— double the rates in Canada and four times the rates in France and Germany (Abama and Martinez, 2017). Furthermore, adolescents in the United States continue to be at higher risk for STIs than adults, with an estimated one in four sexually active adolescent women having an STI (Abama and Martinez, 2017). Clearly, a lot more work needs to be done, but to help young people make healthy decisions we need evidence-based public policy, not conjecture and moral panic.

Some of the best sources for understanding teen sexuality are the reports produced by the Centers for Disease Control and Prevention (CDC). An example of these is the aforemen- tioned 2017 NCHS report Sexual Activity and Contraceptive Use among Teenagers in the United States, 2011–2015, which utilizes data from the National Survey of Family Growth (NSFG) and the Youth Risk Behavior Surveillance Sys- tem (YRBSS) (Abama and Martinez, 2017). Both these survey efforts produce large, nation- ally representative data sets. And because they are administered repeatedly, they can be used to show changes over time. The most recent NSFG data (collected from 2011 to 2015) produced a sample of 4,134 interviews with teenagers (2,047 females and 2,087 males), and the YRBSS has administered 3.8 million paper surveys to high school students since 1991.

Below are some details from the most recent CDC reports (from Abama and Martinez, 2017, unless otherwise specified).

Overall, the number of teens who have had sex has declined significantly over the last 20  years, but there are important differences based on gender, race, and family structure. The number of never-married females age 15–19 who have ever had sex has gone down from 51% in 1988 to 42.2% in the 2011–2015 data. For males, that number has decreased even more drastically: from 60.4% to 44.2%, only 2% higher than females. However, males still tend to become sexually active earlier than females, with 16% of males reporting sexual intercourse by age 15 compared to 11% of females.

Historically there were race and ethnic differ- ences in sexual onset among female teens, but in the 2006–2010 data the rate of sexual expe- rience for non-Hispanic black females declined significantly. Since then, among never-married females ages 15–19 there has been no signifi- cant difference in sexual onset between non- Hispanic blacks, Hispanics, or non-Hispanic whites. For males, there remains a difference, with 58.6% of non-Hispanic black males report- ing they have had sex, compared to 45.7% of Hispanic males and 42.8% of non-Hispanic white males. Finally, family structure may influ- ence when teens first have sex. In the 2011–2015 data, teens who lived with both parents at the age of 14 had lower rates of sexual onset (36.8% females; 39.4% males) compared to those living in any other family arrangement (50.8% females; 51.9% males).

Contraceptive use among sexually active teens is a major focus of the reports, with data on what kinds of contraceptives respondents have ever used, the method they used the first time they had intercourse (if any), and the method used the last time they had sex. In all data collected from 2002 on, nearly all female teens who have had intercourse have used some form of contraceptive (99.4% in the 2011–2015

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a steady partner, but this was more true for females (74.1%) than for males (51.1%).

Since the number of teens having sex continues to drop, one of the most important questions might be why more teens are choosing to wait. According to the newest CDC reports, 57.6% of females and 55.8% of males ages 15–19 have not yet had intercourse, and “data on their reasons for not having had sex aids in under- standing the context of teen decision making about sexual activity” (Abama and Martinez, 2017: 6). According to the 2011–2015 data, ideas about morality, religion, and relationships domi- nated teens’ reasons for not having sex. Among teens who had not had sex, 35.3% of females and 27.9% of males said their main reason was that having sex was against their religion or morals. Relationship ideas about who to have sex with and when to do it were also important: 21.9% of females and 28.5% of males reported that they had not yet found the right person, and 6.2% of females and 6.6% of males said they were in a relationship but waiting for the right time. Want- ing to avoid pregnancy was reported by 19.3% of females and 21.2% of males, and only 7.1% of females and 4.7% of males said their main rea- son for abstinence was because they didn’t want to get a sexually transmitted disease.

While these reports show that U.S. teens overall are waiting longer to have sex and being safer about it when they do, there is still room for improvement. Lower rates of safe-sex prac- tices among blacks and Hispanics, for instance, suggest that community-outreach programs and continued research should focus on these populations. In addition, reduced rates of safe- sex practices among younger teens call for improved sexual education and availability of contraceptives earlier in life. Most important, we must approach these challenges empirically and resist reactionary policies that are based on moral panic.

data). The most common types ever used were the condom (97.4%), withdrawal (59.7), and the pill (55.5%). The number of female teens who have ever used emergency contraception increased notably from 8.1% in 2002 to 22.9% in 2011–2015. The most recent research found 81% of female teens used a contraceptive dur- ing first intercourse, with condoms as the most common method at 74.6%—an increase from 68% in the 2006–2010 data. Race and His- panic origin are related to contraceptive use at first intercourse, with non-Hispanic black teen females having the lowest rate (62.2%) com- pared to Hispanics (78.8%) and non-Hispanic whites (87.2%).

According to the CDC, “data on the cir- cumstances of first intercourse aid in under- standing what underlies current differentials and potential future changes in sexual activ- ity” (Abama and Martinez, 2017: 5). A prime example of this is the relationship between contraceptive use at first intercourse and teen pregnancy. By the age of 19, women were more than twice as likely to have had a teen birth if they didn’t use contraception when they first had sex (Martinez and Abama, 2015). Whether a teen uses contraception dur- ing their first sexual encounter is also related to their age at the time. Teens who were 14 or younger when they first had sex were less likely to use a contraceptive method (70.1% females; 71.3% males) compared to teens who first had sex when they were 17–19 (84.2% females; 94.7% males).

Contraception use among teens the first time they have sex is related to relationship structure with the chosen partner. If they were going steady with a partner the first time they had sex, male teens were more likely to use con- traception (88.4%) than if they were just friends or had just met (76.4%). In the 2011–2015 data, most teenagers’ first sexual experience was with

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Fox News. 2011. “The Truth about Teens, Sex and Vaccines.” LiveScience. Retrieved November 27, 2017 from http://www.foxnews.com/health/2011/09/16/truth -about-teens-sex-and-vaccines.html.

Lampe, Joanna R. 2013. “A Victimless Sex Crime: The Case for Decriminalizing Consensual Teen Sexting.” University of Michigan Journal of Law Reform, 46: 703.

Lohmann, Raychelle. n.d. “When Your Teen Won’t Stop Sexting.” Retrieved November 27, 2017 from https:// health.usnews.com/wellness/for-parents/articles /2017-06-21/when-your-teen-wont-stop-sexting.

Martinez, Gladys, and Joyce Abama. 2015. “Sexual Activity, Contraceptive Use, and Childbearing of Teenagers Aged 15–19 in the United States.” Retrieved November 27, 2017 from https://www.cdc.gov/nchs /data/databriefs/db209.pdf.

Paquette, Danielle, and Weiyi Cai. 2015. “Why American Teenagers Are Having Much Less Sex.” Washington Post, July 22. Retrieved November 27, 2017 from https:// www.washingtonpost.com/news/wonk/wp/2015/07/22 /why-american-teenagers-are-having-much-less-sex/.

REFERENCES AAP. 2012. “HPV Vaccination Does Not Lead to Increased

Sexual Activity.” Retrieved November 25, 2017 from https://www.aap.org/en-us/about-the-aap/aap-press -room/pages/HPV-Vaccination-Does-Not-Lead-to -Increased-Sexual-Activity.aspx.

Abama, Joyce, and Gladys Martinez. 2017. “Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011–2015.” Retrieved November 25, 2017 from https://www.cdc.gov/nchs/data/nhsr/nhsr104.pdf.

Bednarczyk, Robert A., Robert Davis, Kevin Ault, Walter Orenstein, and Saad B. Omer. 2012. “Sexual Activity– Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds.” Pediatrics (October 2012): 798–805.

Bilton, Nick. 2015. “Parenting in the Age of Online Pornography.” The New York Times, January 7. Retrieved November 27, 2017 from https://www.nytimes .com/2015/01/08/style/parenting-in-the-age-of-online -porn.html.

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T he church conference in a small Mid-western town was called “Intimacy in Marriage,” so Kelsy expected speakers and participants to talk about sex. A graduate student just beginning research on evangelicals and sexuality, she was not expecting the prayers for couples to experience “the deepest sexual pleasure in the name of Jesus Christ” or a raffle for a vibrating massager that sat on a table in the sanctuary. Her field notes were punctuated with exclamation points, like after the phrase, “There is a vibrator in a church!”

On the other side of the globe, in Israel, an Orthodox Jewish bridal counselor discussed with Orit the sexual education component of a twelve-session marriage preparation course. A stern-looking woman in her fifties, she served as an example for brides-to-be of Jewish mod- esty codes—hair covered, she was dressed in a long skirt and shirt with long sleeves and high neckline. Yet she spoke enthusiastically and directly to the sexually uninitiated young women enrolled in the course, telling them to “Get the mood right. Tell him what you want.”

Were it not for the obvious markers of reli- gion, these scenes might not be surprising in the 21st century. At least within Western popu- lar culture, “good sex” has seemingly won out over sexual shame and become a prerogative of modern adult life. From advice books like The Joy of Sex to TV shows like Sex and the City and popular podcasts like Savage Love, a fulfilling sex life is promoted as integral to happiness and personal fulfillment. But religious tradi- tions are notorious for sexual rules and norms that seem to fly in the face of modern secular culture, with its emphasis on sexual expres- sion, experimentation, and satisfaction. In

fact, many observers associate the expansion of progressive sexual norms and practices with the decline of organized religion.

It is in this context that we examine how some religious followers live and love amid secular and religious messages about sex and sexuality. Kelsy observed, surveyed, and inter- viewed American evangelical Christians who used websites or attended workshops to dis- cuss sexual pleasure in Christian marriages. Orit interviewed Orthodox Jewish women in Israel about the sexual education that is part of an elaborate marriage preparation. The believ- ers, educators, and experts we interviewed and observed contradicted the stereotype that reli- giosity is incompatible with sexual pleasure. They self-identified as “traditional,” “conserva- tive,” and “devout,” yet insisted that their reli- gious traditions encouraged sexual pleasure and could even improve how they experienced sexuality. Our respondents learned to navigate the religiously prescribed boundaries surround- ing sexuality and embrace “good,” religiously sanctioned sex.

LEARNING TO EXPERIENCE PLEASURE

How believers develop a religious prerogative for sexual pleasure hinges on three related tasks: learning to embrace sexual pleasure, contextualizing sex as part of a larger religious narrative, and establishing religious rules for permissible sex.

GOD’S CASE FOR SEX

O R I T AV I S H A I A N D K E L S Y B U R K E

From “God’s Case for Sex,” Contexts 15(4), pp. 30–35. Copyright © 2016 American Sociological Association. Reprinted by permission of SAGE Publications, Ltd.

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respondents said they struggled with making a “180-degree switch” on their wedding night. One evangelical woman described her church as “schizophrenic”: “sex is bad, bad, bad, and then suddenly good, good, good.”

The evangelical Christians and Orthodox Jews we spoke with emphasized that God encourages sexual pleasure, if one knows where to look. They look to sex therapists, workshops, premarital preparation classes, Internet con- versations, and Christian and Jewish sex advice books, with titles that make abundantly clear that God approves of good sex: A Celebra- tion of Sex; The Gift of Sex; Holy Sex; Kosher Sex, Kosher Lust. They also seek sex-positive messages in scripture while rejecting secu- lar sexual ethics, deemed as hedonistic, and the dominant view of Christian sexual ethics, perceived to be sex negative. Indeed, religious studies scholar Jennifer Wright Knust points out that although the Bible is a political and sexual battleground in contemporary debates about sexuality, it is not a systematic or conclu- sive sexual code. Rather, biblical teachings on desire, sexual practices, marriage, and the body are inconsistent and open to interpretation. As such, religious adherents collectively construct interpretations claiming that sexuality is not “forbidden,” “shameful,” or “disgusting”—as was once their impression. Instead, sex is holy, normal, and good.

But theologically redeeming sexuality is insufficient—followers still need concrete advice on how to have good sex. In Orthodox Jewish circles, much of this education occurs during premarital preparation. One bridal counselor, a high school teacher in her fif- ties, told Orit how she harnesses Jewish laws of menstrual purity to help brides prepare for sex. These laws entail that women check for remnants of blood for seven days after men- struation ceases, and this counselor encour- ages young women to use the opportunity to explore themselves “there” as preparation for

Historically, the list of perceived sexual sins  has been much longer than that of reli- giously permitted sexual desires and practices. Religious rules range from the familiar— prohi bitions against extramarital, premarital, and homosexual sex common to many reli- gious traditions—to the foreign. In Orthodox Judaism, marital sex is forbidden for roughly two weeks of every menstrual cycle. Catholic teaching forbids sex acts unless they lead to procreative, penile–vaginal intercourse within marriage, and Latter-day Saints prohibit mutual masturbation within marriage. Such religious proscriptions can serve as obstacles for followers who want to learn about and experience sex in a meaningful way. Orthodox Jewish women Orit talked to drew on a range of euphemisms for sex, referencing “the first night,” “physical relations,” and a husband and wife “meeting” or “coming together.” One evan- gelical woman told Kelsy that, until her mar- riage, she had “no idea” how her body worked “down there.” Religious regulations and conver- sational unease among believers may seem to imply that religion is bad for one’s sex life—but that’s not what we found when we talked to evangelical Christians and Orthodox Jews who purport to live and love by God’s rules.

For these believers, God’s case for sex involves explicit sex education along with a sex- ual re-education that affirms the pleasures of sex. Secular sex education and advice—found in Cosmopolitan magazine and the like—are largely off-limits to, or are at least treated with skepticism by, religious conservatives. Follow- ers of conservative religions must instead filter out the secular messages about sex that they believe disregard God’s messages, while also filtering out religious messages that empha- size sexual sins. We call this an inhibition paradox—growing up, evangelicals and Ortho- dox Jews receive numerous negative mes- sages about sex but are expected to embrace and enjoy sex once married. Orthodox Jewish

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Despite the “anything goes” in marriage attitude that seems to dominate Christian sex advice, the rationale for pursuing and opti- mizing sexual pleasure is a theological one. As historian of religion Amy DeRogatis has also argued, evangelicals believe that follow- ing God’s rules makes possible a unique and exceptional sexual experience that contributes to a larger story about being born again. At the “Intimacy in Marriage” conference, David, a pastor, explained that the stakes of marital sex are high: “There’s a party being thrown in heaven when married Christians have sex. Just by having sex, you are winning a battle in the war against Satan.” By having sex in the way that God designed (in heterosexual, monoga- mous marriage), couples can help defeat the devil. David outlined specific steps that spouses could take to “use weapons to fight to keep your marriage out of Satan’s hands”: pray- ing before, during, and after sex and having sex frequently. David explained, “Sex should be spiritually comforting, spiritually connect- ing, and spiritually productive for the two most important relationships in your life: God and your spouse.” Good sex aligns with living a Christian life.

Jewish scriptures contain seemingly con- flicting messages about sex. On the one hand, sexual desire is known as yezerhara, or the evil desire. But marital sex is also a mitzvah, a reli- giously prescribed obligation. To resolve this apparent conflict, some Orthodox Jews infuse an otherwise carnal act with spirituality and morality. As one Orthodox bridal counselor described, authentic Jewish “marital relations” can be “happy, wonderful, sanctified, as long as it’s in the right place, at the right time, and with the right intention.” Marriage sanctifies the sexual act: the self-exploration and arousal dis- cussed above were sanctioned because they pre- pared the bride for her husband. This approach to sex posits that sex is good because it facili- tates the creation of “one flesh.” By connecting

the marital relationship, especially the dreaded “first night.” Her affirmation of self-exploration serves as “a way to connect with the body so it doesn’t seem alien, so the place is not for- eign” and flies in the face of years of teaching that masturbation is immoral and sinful, but she assures brides that “it’s not negative. It’s positive, permissible, essential, important for you to get to know your body. . . . It’s good to arouse yourself; you have to incite yourself.”

Christian sexuality websites and advice books also offer couples tools to help achieve physical pleasure: step-by-step instructions for arousal, anatomical drawings identifying “mysterious” body parts like the clitoris, advice on lubricants, suggestions about what time of day to have sex, lists of romantic gestures, and descriptions of sexual positioning. Evangelicals prioritize mutuality and consent and sex acts that benefit a heterosexual marital relationship. This gives both spouses a clear voice within a marriage, even among those Christians who support men’s headship and women’s submis- sion. Authors Ed and Gaye Wheat insist that women are entitled to experience sexual plea- sure: “If you [directed toward women] desire to have an orgasm, [it is] because you know it is your right, your provision from God. . . . Your goal, now, is satisfaction given by a loving hus- band, and achieving the fulfillment of orgasm.” Evangelicals like the Wheats contextualize pleasure as good for the spiritual and marital lives of believers. In contrast to much secular sex advice, God’s case for sex constructs sex as a means, not an end.

A GREATER GOOD

Orthodox Jews and evangelical Christians face a dilemma: how to affirm sexual desires without descending into the vulgarities associ- ated with secular culture? Their solution is to normalize pleasure but insist that sex is funda- mentally a spiritual pursuit.

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couples, sex strengthens the marital relation- ship, the building block of Jewish communities. Spiritual “marital relations” hinge on having sex with the “right intention”: rather than pursue satisfaction of carnal desires, couples sanctify sex by bringing “the Almighty to it.” Accord- ingly, one bridal counselor does not instruct brides about desire, pleasure, or the mechanics of sex, but teaches them to recite prayers about holiness and redemption before and after “rela- tions.” Another counselor instructs brides to “think pure thoughts and recite psalms before coming together.”

But not everyone buys this spiritual model of sex. Increasingly, Orthodox Jews are seeking to articulate an alternative sexual ethics that would let Orthodox Jewish women “just have fun.” Recent years have seen the emergence of Facebook groups (for women only) and the expansion of body-focused study groups and pools of therapists and instructors well-versed in Jewish teachings as well as the latest sexo- logical research. Nevertheless, even in these more forgiving spaces it is clear that religious rules about marriage, bodies, and good sex still need to be followed.

PLAYING BY THE RULES

For religious authorities within Orthodox Judaism and evangelical Christianity, God’s embrace of sex does not mean that anything goes. Sex requires regulation, though opin- ions vary about what practices are allowed. Some authorities restrict sex to acts associated with penile–vaginal intercourse, but scriptural ambiguity leaves room for some competing interpretations.

Most evangelical authorities permit het- erosexual married couples to explore almost any sexual act imaginable so long as there is monogamy and mutual consent. Evangeli- cals who believe that the Bible is the literal word of God must read between the lines to

determine God’s stance on a wide range of marital sex acts that the Bible does not dis- cuss. Author Shannon Ethridge summarizes the prevailing attitude that sex is permitted by God “as long as no harm is done and all is kept solely between consenting spouses.” Similarly, a popular blogger explains: “There are far more things that you can enjoy together than those you cannot.” Kelsy surveyed almost 800 users of Christian sexuality websites about their attitudes toward a range of sexual activi- ties. Over 90% of respondents agreed that, within marriage, oral sex and using a vibrator are “not wrong at all.” About anal sex and mas- turbation within marriage, only 20 and 10%, respectively, reported that the acts are “always wrong.” One message board user explained her attitude about anal sex: “I am undecided. . . . It’s not something DH [dear husband] and I are interested in. . . . If DH were really interested in it, I’d be willing to look into it from a Biblical and health standpoint and hope we could reach some common ground on it.” Respondents who reported those acts are “sometimes” or “usually” wrong explained in follow-up interviews that they did  not feel comfortable making judgments about these acts without knowing the relational context in which they occur.

Likewise, for many Jewish couples, “kosher sex” is murky terrain. Orthodox Jews draw sexual directives from the Bible, its elabo- rators and interpreters, and contemporary rabbis with whom they consult on all mat- ters pertaining to Jewish law and practice. Orthodox Jewish authorities are quick to point out that Jewish sex is not about pro- creation. Referring to the Jewish mitzvah (religious deed) of Onah— Jewish law that regards a wife’s sexual pleasure as a marital obligation—one bridal counselor explained to Orit that, “unlike Christians, in Judaism com- ing together is first and foremost about plea- sure.” Yet, this religiously prescribed pleasure

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SEXUAL AMBIVALENCE

Religious sexual debates operate on multiple levels: interpretations of scripture and founda- tional religious documents; talk about sexuality by religious leaders, teachers, and experts; and laypeople’s sexual practices and ideas about sexuality. But at each level, conservative reli- gious traditions simultaneously encourage sex- ual expression—albeit in specifically prescribed circumstances—while admonishing sexual sins. We have identified two reasons why this “sexual ambivalence” persists in religious communities.

First, narratives that sex is wrong remain salient in the lives of religious believers (regard- less of what the Bible “really” says). Tradition- ally, Jewish and Christian leaders have spent far more time discussing sexual sins than sexual enjoyment, and people’s minds are hard to de- and re-program. One woman told Orit about an episode that occurred three years into her marriage, when she was pregnant with her second child: “Once I woke up in the middle of the night, thinking ‘THERE IS A MAN IN MY BED! WHAT IS A MAN DOING IN MY BED?. . .’ I told myself, ‘It’s ok, this is your hus- band.’ It’s entrenched in us, the sense that this whole thing is forbidden.” Evangelicals’ stories about using Christian sexuality websites sug- gest similar unresolved anxieties about the possibility of Christian sexual pleasure. Many users turned to “Googling” their questions about sex because they felt they could not dis- cuss them with anyone in real life. One user explained to Kelsy, “I never felt like it would be okay for me to date or have sex ever. I mean, intellectually I knew that my parents would be happy if I got married, but it didn’t seem to make sense in my head.”

Second, even though conservative religious communities are hardly unique bastions of sexual hang-ups, sex functions as a boundary- making mechanism that sets religious believers apart from the secular world. Discussions of

is highly regulated. Expectedly, intimate and sexual acts are restricted to marriage and require mutual consent. In addition, Jewish law prescribes periods of impermissible sexual activity depending on the woman’s menstrual status and prohibits “wasting of seed.” This term refers to the prohibition against sexual acts in which the male’s sperm is consciously wasted, and it is traditionally cited in prohi- bitions against male homosexual acts and masturbation, though some authorities also use it to restrict marital sex to penile–vaginal intercourse. A thirty-something woman who had been married for almost fifteen years told Orit about how she struggled early in her marriage: “the fun was lost amidst concerns about non-vaginal ejaculation!” She later took a bridal counseling course and began working with young women herself. Only then did she become comfortable speaking in such direct terms—and with alternatives to intercourse.

The people we talked to and spaces we stud- ied suggest that conservative religions articu- late a sexual ethic that blends limits on who is allowed to have sex with expansive possibilities for sexual pleasure within those limits. This is how evangelical Christians declare there is “tremendous freedom” within the (heterosex- ual) “marriage bed,” but remain vehemently opposed to same-sex relationships and other non-heterosexual or non- monogamous sex- ual expressions. The co-creator of one evan- gelical message board that hosts supportive conversations about a wide range of sexual interests writes to the site’s members: “The basic tenets of the Christian faith are not debatable issues” and later explains that “any defense of the practice of homosexuality, so called ‘gay marriage,’ or the like” will not be tolerated. In Orthodox Jewish marriage prepa- ration courses, the message is clear: women prepare to wed men. In both of these faith traditions, heterosexuality is as sacrosanct as marriage itself.

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than they are about unequivocal and time- less biblical sexual codes, religious groups’ notions of sexual morality can incorporate a wide range of beliefs and practices—account- ing for the presence of a vibrator in church and exhortations for brides-to-be to explore “down there.” These religious traditions, then, are not unequivocally sexually repressive, nor are they uniformly sexually liberating. To appreciate their complexity, we need to understand reli- gious traditions’ approaches to sexuality from within their own logics and sensibilities. From there, we find that religious boundaries are not simple or fixed, and they can and do change with the broader social world in which believers practice their faith.

RECOMMENDED RESOURCES Avishai, Orit. 2012. “What to do with the Problem of the

Flesh? Negotiating Jewish sexual anxieties,” Fieldwork in Religion 7:148–62.

Burke, Kelsy. 2016. Christians under Covers: Evangelicals and Sexual Pleasure on the Internet. Berkeley, CA: University of California Press.

DeRogatis, Amy. 2015. Saving Sex: Sexuality and Salvation in American Evangelicalism. New York: Oxford University Press.

Gardner, Christine J. 2011. Making Chastity Sexy: The Rhetoric of Evangelical Abstinence Campaigns. Berkeley, CA: University of California Press.

Knust, Jennifer Wright. 2011. Unprotected Texts: The Bible’s Surprising Contradictions about Sex and Desire. New York: Harper-One.

sex, vibrators, and sexual pleasure are sites of ideological battles. Religious communities reg- ulate sex not simply to suppress “worldly” plea- sures but to negotiate conflicting worldviews and ethical systems about life’s purpose. In the Orthodox Jewish case, yoking sex to marriage draws a bright line between a religious and sec- ular sexual ethic. For evangelicals, embracing sexual pleasure within the criteria of hetero- sexual, monogamous matrimony means that they can experience the pleasures encouraged by the secular world but remain committed to their religious foundation.

For sexual pleasure to function as a religious ethic, it needs to be regulated—hence enduring sexual rules. Political debates about abortion, contraception, pornography, sexual education, and marriage equality typically present reli- gious attitudes as constraining sexual expres- sions, rejecting sexual diversity, and squashing sexual pleasure. There’s some truth to this. Numerous injuries have been inflicted in the name of religious morality through legislation and public debates that portray heterosexual- ity and modesty as normative and universal. In the coming-out stories of gays and lesbians, religion is often a hurdle on the path to self-love and acceptance.

Yet, if sexual regulations are more about communal efforts to define sexual morality

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R E A D I N G 3 0

An asexual individual is commonly defined as one who does not experi-ence sexual attraction (Bogaert, 2004; Jay, 2008a). Based on this definition, preva- lence of asexuality is estimated at 1% (Bogaert, 2004; Poston & Baumle, 2010). However, the heterogeneity of the asexual community is well-documented (Bogaert, 2015; Carrigan, 2011; Chasin, 2011) and there is considerable disagreement among asexual individuals and researchers regarding the degree to which this definition truly captures asexual identity (Jay, 2003; Prause & Graham, 2007; Scherrer, 2008; Westphal, 2004).

Alternate definitions of asexuality have included a lack of sexual behavior (Rothblum & Brehony, 1993) and a lack of sexual desire (Prause & Graham, 2007). Yet, endorsing an asexual identity does not necessitate lack of affection or romantic interest toward others (Bogaert, 2006). Many see “asexual” as an umbrella term that encompasses myriad varia- tions. For example, it might include those who seek romantic relationships devoid of sex, those who experience sexual attraction but have no desire to act on it, those who are repelled by sex, those who are disinterested in having sex, and many other attitudes and behaviors (Bogaert, 2012; Carrigan, 2011; Chasin, 2011). For the purposes of the current study, asexual individuals are self-identified.

Brotto, Knudson, Inskip, Rhodes, and Ers- kine (2010) identified the distinction between romantic and aromantic relationships as an important aspect of asexual identity. Aromantic

asexuals are not interested in romantic rela- tionships, sexual or otherwise. Some aroman- tic asexuals describe their ideal relationship as resembling a typical friendship and lacking any physical intimate activity (Scherrer, 2008). Conversely, romantic asexuality refers to those asexuals who seek closeness, companionship, and the intellectual and emotional intimacy of a romantic relationship, without a sexual com- ponent (Brotto et al., 2010). Among romantic asexuals, there are those who desire physical intimacy, excluding sex, and those who do not (Brotto et al., 2010). Endorsing a romantic asex- ual identity does not necessarily involve com- plete abstinence from sex. The data from Brotto et al. suggest that some romantic asexuals have negotiated consensual sexual relationships with non-asexual partners.

The implications of asexuality as a sexual ori- entation are far-reaching. Science has tradition- ally understood human nature to be essentially sexual, yet the presence of the asexual commu- nity challenges this assumption. Skeptics have conjectured that asexuality may be the result of some past sexual trauma, a deficiency in hor- mones, or a “rest stop” on the way to another sexual orientation. In fact, recent research pro- vides support for an underlying physiological etiology for this lack of sexual attraction. Yule, Brotto, and Gorzalka (2013a) found a number of biological correlates of asexuality, including

A QUALITATIVE EXPLORATION OF THE “COMING OUT ” PROCESS FOR ASEXUAL INDIVIDUALS

N I C O L E T T E Z A N G A R I , K AT H R Y N G R A F F L O W, A N D A N N A N . Q U E R Y

Reprinted by permission from Springer Nature: Springer, Archives of Sexual Behavior, “A Qualitative Exploration of the ‘Coming Out’ Process for Asexual Individuals.” © 2015.

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In a recent study, researchers found increased mental health problems and suicid- ality among asexual individuals compared to their heterosexual and non-heterosexual coun- terparts (Yule, Brotto, & Gorzalka, 2013b). Further clarification is needed on whether or not psychological stress is associated with being asexual and how the coming-out period may play a role in such distress. Coming out as asexual may be especially difficult in a society that puts great emphasis on sex and sexuality. Prause and Graham (2007) reported that asex- ual participants struggled with negative public perceptions of asexuality and pressure to con- form to the universal assumption that humans are sexual beings. A recent study by MacInnis and Hodson (2012) found that asexuals were more likely to be dehumanized and seen as “animalistic” and “machinelike” than other sex- ual minorities. Research has not explored how these challenges may influence the decision to come out, and there is a critical need to better understand this process for asexuals (Prause & Graham, 2007; Yule et al., 2013b).

Past asexuality research has employed quali- tative methods to enhance general understand- ing of the asexual experience (Brotto et  al., 2010; Carrigan, 2011; Prause & Graham, 2007). Using open-ended prompts, Scherrer (2008) found that many asexual respondents reported endorsement of an asexual identity to be affirming. Yet, many also reported chal- lenges related to describing asexuality. AVEN, a website dedicated to education about asexu- ality, has been instrumental in creating both a venue and a lexicon for asexual individuals to communicate about the experience (Chasin, 2011; Scherrer, 2008). Although AVEN has facilitated discussion among asexuals in its online forums, the extent to which asexuals share their identities outside online platforms remains unknown (Jay, 2003; Westphal, 2004). Coming out may be uniquely challenging for asexual individuals because many have not

increased rates of non-right-handedness in both male and female asexuals, and a greater likeli- hood for asexual men to have more older broth- ers and fewer older sisters compared to other groups. The authors speculate that older male siblings may affect the prenatal environment, perhaps influencing the development of sex- ual attraction in the asexual male (Yule et al., 2013a). These results indicate that there may be certain biological pathways implicated in the development of asexuality. Furthermore, labo- ratory studies have shown that asexual women are physiologically similar to other sexual ori- entation groups in their response to sexual stimuli, despite varying subjective reports of arousal. This suggests that their lack of sexual desire cannot be explained by an organic inabil- ity or hormone deficiency (Brotto & Yule, 2011). Moreover, in Bogaert’s (2006) study on concep- tualizing asexuality, it was pointed out that a sizable minority of individuals across several studies chooses to identify with the term “asex- ual” and we must amend our clinical discourse to accommodate this designation. Although researchers do encourage further exploration of the genetic, hormonal, environmental, and social influences on the development of asexual- ity, there is conceptual and theoretical evidence to support asexuality as being its own unique sexual orientation (Bogaert, 2006, 2008).

Research is just beginning to explore the process of identity development for asexual individuals. Within other sexual minority communities, coming out appears to be an important aspect of identity development and has psychological as well as practical benefits. For example, research suggests that com- ing out may increase access to romantic or sexual partners, allow membership to a com- munity, and increase commitment to advocacy (Vaughan & Waehler, 2010). It is unknown how generalizable these findings are to the asexual community or whether asexual individuals relate to the coming-out experience at all. . . .

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a graduate degree. Among the entire sample, 13% reported currently being in a romantic asexual relationship, 7% reported currently being in a sexual relationship, 48% identified as single seeking a non-sexual relationship, and 26% are single not seeking a relation- ship. In terms of masturbation frequency, 36% reported never masturbating, while 17% reported masturbating about once a month, and 7% reported masturbating once a day. According to the narratives, 84% of the sam- ple had revealed their asexual identity to at least one person, while 16% had not disclosed their asexuality to anyone. Of note, 86% of the total sample reported no history of child- hood sexual abuse, while the remaining 14% reported a possible or probable history of childhood sexual abuse. Data on the sample’s racial composition were not collected.

Procedure The narratives were collected as part of a larger project on the assessment of asexuality. . . . Participants were required to be over 18 and fluent in English. After completing a 96-item survey assessing asexuality, sexual aversion, sexual desire, and demographic information, participants were asked to respond to an open- ended prompt about the development of their asexual identity and the disclosure of that iden- tity to others. The specific phrase “coming out” was never used in the prompt so as to facilitate an open description about the experience of disclosing asexual identity to others.

Analyses A phenomenological approach was utilized to explore the narratives in order to facilitate open examination of lived experiences in the absence of a specific hypothesis (Shinebourne, 2011). This approach was used to identify and analyze themes related to coming out as an asexual and is supported by past qualitative

yet determined how to articulate their asexual identity off-line (Jay, 2003; Scherrer, 2008). It is also possible that since asexuality is not always necessarily associated with any overt behaviors, disclosing such an identity to others may be unnecessary. Coming out as asexual may not be critical to acceptance of the iden- tity, which may be particularly true in the case of aromantic asexuals who do not seek any type of partnership, thus eliminating the utility of coming out to others.

. . . Despite being a psychologically stressful experience, the coming-out process may lead to personal growth and improved self-esteem among sexual minority individuals (Vaughan & Waehler, 2010). . . . Research has not yet touched upon the potential benefits and out- comes of coming out as asexual, or how coming out may influence the process of forming an integrated asexual identity.

Toward that end, the current study aims to obtain a deeper understanding of how asexual individuals view their identity and the role that coming out plays in identity formation, if any. . . .

METHOD

Participants Participants were recruited for a separate study that included 225 participants from three online communities dedicated to asexuality (AVEN, Apositive.org, Asexuality LiveJournal). Among these participants, 169 individuals provided “coming out” narratives. Of the total sample, 69% were female, 16% were male, and the remaining 15% identified as “other” or “undifferentiated.”

Most participants (71%) were between 18 and 25 years of age, 20% were 26–32 years of age, and the remaining 8% were above 33 years of age. The sample was well-educated, with 48% having some college education, 28% holding a university degree, and 9.2% having

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and friends to start dating, get married, have kids” (Asexual, Female, age 18–25). Provid- ing an explanation for the absence of romantic involvement alleviated pressure from family. Coming out also relieved social pressure from peers, for example, to address uncomfortable questions about sexual preferences or experi- ences: “I told . . . some of my close friends a few years ago in college, mostly to stop them from assuming I was sexual, asking me whether I was dating and trying to set me up with people” (Panemotional Aromantic Asexual, Female, age 18–25).

Salience to Identity Many considered asexuality to be a defining identity characteristic and chose to come out as an act of self-expression and a step toward identity integration. These respondents felt compelled to come out in order to develop authentic and meaningful relationships.

I told my parents and siblings because I thought it was vital information to help them understand me and my life experiences. . . . I wanted the people I cared about in my life to actually know me and who I am. (Hetero-affectional Asexual, Female, age 18–25)

Another participant commented, “It wasn’t a difficult decision for me to reveal my discov- ery about this integral part of my identity to close friends and family” (Asexual, Female, age 18–25). Narrative analysis revealed a pattern: the more central asexuality was to personal identity, the more likely participants seemed to come out as asexual.

Discovering Asexuality Discovering online information about asexual- ity was described as exciting and liberating for many individuals who believed that their lack of sexual desire was pathological. “I discovered that asexuality is a true orientation when I was about 16; I was thrilled that I fit in with a group

research on asexuality (Brotto et al., 2010; Carrigan, 2011). . . .

RESULTS

Similar to past research, the current study found that a majority (69%) of the asexual sample identified as female (Bogaert, 2004; Brotto et al., 2010; Prause & Graham, 2007; Scherrer, 2008). As studies on asexuality have consistently shown significant gender differ- ences within samples, researchers have specu- lated that these findings may be the result of a population disparity rather than a sampling flaw (Brotto et al., 2010). Bogaert (2004) sug- gested that women may be more likely to iden- tify as asexual due to the societal expectation that males are more sexual than females. He also suggests that women may not report expe- riencing sexual attraction as frequently as men because they may not be as aware of their own sexual arousal.

Theme 1: Motives for Coming Out as Asexual The majority of participants (84%) had come out as asexual to at least one other person. Review of the narratives revealed that partici- pants conceptualized this process of disclosure as “coming out” as asexual. . . . Three motives emerged for those who chose to come out: response to pressure from family and friends, salience to personal identity, and membership in the asexual community.

Response to Pressure Many participants reported that it was not necessary to come out as asexual to family members, but felt that doing so might reduce questions about dating and seeking a partner. One female participant indicated, “I decided to tell my parents in my late teens because I was starting to get pressure from family members

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the individual and his or her partner. “I have only told the person I’m currently in a purely romantic relationship with that I am asexual. I don’t think other people need to know this fact about me. It’s simply not important” (Asex- ual, Female, age 18–25). Another motivation to come out exclusively to a partner was the negotiation of a sexual–asexual relationship. Some respondents felt that it was necessary to disclose their asexuality in order to help their partner understand the experience of sex for an asexual or to address sexual conflicts within the relationship.

[I came out to] the “love of my life” only. It had become a bit of an obstacle between us and when I realized what I was, 1) I needed to tell someone, 2) I wanted him to know why things had gone wrong. He was fine with it. I haven’t told anyone else; I don’t think there’s any need to. It doesn’t affect anyone else. (Asexual, Female, age 26–32)

Coming out appeared to be a step toward seeking acceptance and understanding from sexual partners. In these cases, coming out became necessary because it related to nego- tiation of the couples’ sexual activity.

My ex said, “You just need to change your attitude towards intimacy.” I told him because I was sick of fighting back tears during [sex], crying quietly to myself afterwards, it feeling like rape when it wasn’t, and he deserved to be with someone who likes sex and looks forward to sex as pleasurable as opposed to dreading it. (Celibacy-oriented, Female, age 26–32)

Some participants discovered their asexuality after committing to a sexual relationship or marriage. In these cases, coming out to an inti- mate partner was a step toward negotiating the terms of the relationship, and in some cases, determined the couple’s ultimate separation.

The only person who . . . I have told that I am asex- ual is my ex-husband. Our differences in sexuality were a primary component in our divorce. He was supportive and recognized that it is not something I can control. (Biromantic Asexual, Female, age 33+)

that I could agree with. I don’t see a reason to keep my asexuality hidden” (Asexual, Female, age 18–25). Previously, many participants had assumed that they had low libido or suffered from a sexual disorder. Learning about asex- uality allowed them to legitimize their own experience and embrace their asexual identity: “I came out almost immediately after learning what asexuality was, because I knew beyond a doubt that that’s what I was” (Asexual, Female, age 18–25).

Participants felt relieved and validated to find a community of other asexuals with simi- lar experiences: “I do plan to tell my sister and close friends because I’m so happy to finally feel normal. I’m kind of bursting to tell someone outside of AVEN [asexuality.org]” (Asexual, Female, age 18–25). Finding the appropriate designation to describe their experience and joining the asexual web community was a criti- cal moment for many participants.

Right after I discovered the asexual community, I told my mother and three of my best friends. They all said [it] was like they knew but they didn’t know there was a name for it. . . . After finding out that there are many like me and I needn’t any fixing, I became much more confident in my attitude and I feel more able to express my thoughts and opinions without worry. (Aromantic Asexual, Female, age 26–32)

Theme 2: Motives for Withholding Asexual Identity from Others Among those who chose not to come out, there were several prominent reasons identified for not doing so. Some felt that the information was private, or that their asexuality was not a salient enough part of their identity to war- rant coming out, while others feared the social consequences.

Selective Disclosure Some romantically oriented participants de- scribed asexuality as irrelevant to everyone but

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of my identity for me to need to share it with oth- ers” (Asexual-Questioning, Female, age 26–32). Another participant noted, “I haven’t told any- body yet because I don’t think that my sexual ori- entation has anything to do with my relationships to others or my life in general” (Asexual, Female, age 18–25). These results seem to reaffirm the previous observation that asexual individuals may be more likely to come out if they consider asexuality to be central to their identity. . . .

I have not told anyone at all about my explorations of asexuality. Sexuality/asexuality is by my choice a non-issue in my life (though sometimes it feels like the elephant in the room); it’s like it’s not even there. It never gets talked about. (Asexual-Questioning, Female, age 18–25)

Theme 3: Explaining Indifference about “Coming Out” Respondents also included those who did not intentionally share or conceal their asexuality. They had not put a great deal of thought into coming out, and simply accepted their asexual status. One participant exemplified this theme: “I tell people as it becomes relevant, which isn’t very often. I don’t really feel much one way or the other about telling people” (Homoromantic Asexual, Undifferentiated Gender, age 18–25). For those who were neutral about coming out, many opted to do so because it was simply easier than hiding their sexual identity. Acqui- sition of the proper vocabulary facilitated and sometimes prompted this process.

Having a word to describe myself made conversa- tions about my future much easier to navigate. Otherwise, it doesn’t affect me much. I didn’t start acting differently after I came out; I was always this. All that’s changed is that now I have a name for it. (Asexual, Female, age 18–25)

Endorsing a specific sexual orientation was a useful tool to promote understanding but was not central to the identity-formation process.

Fear of “Coming Out” A theme present in many narratives was anxiety around describing asexuality to others for fear of being ostracized or misunderstood. Many were worried about social stigma and how their relationships might change after coming out as asexual.

I have not told anyone that I am asexual because I don’t want anyone to label me as weird or crazy. I don’t want people to pity me for my life situation or how I feel about things. I just don’t want peo- ple to think less of me or stereotype me. (Asexual- Indifferent, Female, age 18–25)

The public’s general lack of knowledge and understanding of asexuality was a major deter- rent for those who had not come out. As asexual- ity is not widely accepted as a sexual orientation, closeted participants chose to avoid the possibil- ity of facing rejection and alienation.

I have not come out to anyone . . . because I do not think there is very much acceptance of asexuality as a valid orientation. I am afraid that my friends would think there is something wrong with me or that they would feel uncomfortable with me. (Biro- mantic Asexual, Female, age 33+)

Moreover, the prospect of explaining asexu- ality was seen as burdensome and risky. Some were even willing to endure unwanted sexual activity to maintain relationships.

I have not discussed it because I think it would deeply affect my personal relationship. I find occa- sionally giving into sex is worth keeping my roman- tic relationship going. (Asexual, Female, age 26–32)

Non-Salience to Identity A number of respondents reported that their asexual identity did not affect their lives in any way, and was not salient at all to their identity. Because they did not define themselves in terms of their asexuality, sharing their orientation with others was unnecessary. One respondent wrote, “My orientation is not an important enough part

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and that the individual had not yet met the right person. One participant commented: “[My par- ents] brushed it off, saying that I probably didn’t know what asexual meant” (Asexual-Question- ing, Female, age 20). Some participants reported coming out to their queer or LGBT friends, seek- ing empathy from peers with similar experiences. “I came out to my lesbian friend. She laughed at me and told me that I was being ridiculous. . . . My local gay switchboard told me that asexual- ity doesn’t exist and that everyone wants to f*** someone” (Asexual, Male, age 18–25).

Respondents also reported that many were insistent that asexuality was just a stage: “[One friend] took it pretty well but still wanted to believe it wasn’t ‘real’ or that I would ‘grow out of it’” (Panromantic Asexual, Female, age 18–25). Another participant commented, “My parents were insistent that it was just a phase and I would not always feel this way” (Demisex- ual, Female, age 26–32). Similarly, others were convinced that when they found the right per- son, their libido would surface. One female participant commented:

I can’t even count the number of times I’ve been told, ‘Oh, well, you just haven’t met the right guy yet. When you meet the right man everything will work out and you’ll enjoy having sex.’ I strongly doubt that. (Asexual, Female, age 18–25)

Pathologizing asexuality was not uncommon. “They want to fix me, to the extent that I have cut communication with several of them. I’ve been called unnatural, and had people attempt to fix me by taking me to psychologists and ther- apists without my consent” (Asexual, Female, age 18–25). One participant commented,

My family seems to think everyone is sexual. If you’re not you should get hormone treatment to fix yourself. Since none of my blood tests or doctors exams have shown me to be medically lacking in an area that would relate to my zero sex drive or attrac- tion toward people, I just keep my private life just that, and don’t really tell them anything. (Aromantic Demisexual, Female, age 18–25)

People knowing or not knowing doesn’t really affect my life, but it’s easier to avoid awkward topics when they do know and will be sensitive about topics that bore me, such as conversations about sex or relation- ships. (Asexual, Female, age 21)

Theme 4: Negative Reception of Asexual Identity Among those who did choose to publicly dis- close their asexuality, some reported negative reactions from friends and family members. Typically, these negative reactions tended to affect the participants’ views about coming out to others in the future.

Reactions of Disbelief The fact that asexuality is not yet widely ac- cepted as a legitimate sexual orientation was reflected in the negative reactions to disclo- sure. One participant commented, “[My friends] didn’t believe me when I said I was asexual or that asexual was an actual orientation; it was rather unfortunate” (Asexual, Male, age 26–32). Another female participant reported, “My friends didn’t believe me. One friend’s exact response was ‘you’re not a tree’” (Asexual, Female, age 18–25). After discovering and accepting their own asexual identity, they were dismayed to be challenged and rejected by skeptics:

I was fifteen when I told my mother and friends that I was asexual. They didn’t believe me. This was kind of shocking and hurtful to me, because it made so much sense to me. It was like learning that I had brown eyes, but when I mentioned it people just said that I really had blue eyes. I just couldn’t believe that they didn’t believe me and worse, that they thought they knew how I felt better than I did. (Asexual, Female, age 21)

Dismissal of Asexuality The most common negative responses to coming out were suggestions that the asexual individual was confused, that asexuality is “just a phase,”

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of an online asexual community had a profound impact on respondents, and provided a con- text for their experiences. AVEN was a crucial source of answers and validation for individuals questioning their sexual identities.

Most were not even aware that asexuality existed until they found AVEN and other asex- ual web communities. One participant noted, “I [came out] quite late in my life because I just did not know or understand the term ‘asexual’ until I first read about it on the Internet” (Male, Asexual, age 33?). This website even aided the coming-out process for several individuals whose loved ones were skeptical until review- ing the online information: “One friend didn’t believe me and that hurt until I could show her the AVEN site and she understood” (Asexual, Female, age 18–25). Some participants simply forwarded the link to their friends and family to help explain asexuality: “[My sister] had a few questions. . . . I told her that she could look at the FAQ on AVEN.” (Asexual-Questioning, Female, age 20). AVEN also provided a unique community of like-minded peers to help answer questions and give support. In fact, some respondents were only comfortable com- ing out to online acquaintances because they felt that others would not understand.

I’ve only come out to online friends so far. I think people in real life would never understand what asexuality really means; they’d think I’m not normal and send me to therapy. But coming out to my online friends was . . . fun, to say a word. It was just very natural and logical. (Asexual, Female, age 18–25)

The asexual web community is an impor- tant platform for asexuals who have accepted their identities and want to begin the process of coming out safely and anonymously.

Other internet sources aside from AVEN assist individuals in coming out as asexual without directly telling others. For example, the use of social networking sites like Face- book has simplified the passive disclosure of

Theme 5: Positive Reactions to Coming Out as Asexual Narratives also contained reports of positive reactions to coming out as asexual. One woman stated:

Communicating my asexual identity was relatively easy because my family and friends are very sup- portive. They had listened to me talk a lot about feel- ing broken or wrong, and when I found out about asexuality, it was like a light bulb went on over my head. Everyone was very accepting and open to the idea. (Asexual, Female, age 18–25)

In some cases, family members responded with apparent excitement: “When I told my parents, my mom was ecstatic. She knew that I had little to no sexual feelings growing up, so she thought it was great that I found the term ‘asexual’ to legitimize myself” (Asexual, Undifferentiated Gender, age 18–25).

Surprisingly, some participants even reported that those they told were already aware of their asexuality: “When I told my friends none of them were really shocked. They had figured it out long before I did. They still accept me and love me for who I am, which is great” (Asexual, Female, age 18–25). This finding suggests that perhaps acceptance and knowledge of asexual- ity as a legitimate sexual orientation are increas- ing in the public sphere.

Theme 6: The Role of the Internet in Coming Out as Asexual One of the most prevalent themes in the process of discovering, accepting, and sharing an asex- ual identity was the significant role played by the internet. AVEN (asexuality.org) helped inform asexuals about their own identity and validated their experience. Searching the internet for a way to classify their experience often led them to the AVEN homepage, where an asexual is defined as “a person who does not experience sexual attraction” (asexuality.org). The discovery

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I felt relief after ‘coming out’ as asexual because I wasn’t trying to pretend to be something I wasn’t any longer. I tried for a good 10 years to be sexual, up to being bordering promiscuous for a time. . . . Once I realized I didn’t want sex, I was so much happier. (Biromantic Asexual, Female, age 26–32)

Most participants who came out ultimately reported feeling more comfortable with them- selves. One participant noted, “Mostly, telling people now just made me feel like something was off my shoulders. Life didn’t change much, since I just continued not being in relationships, but I personally felt better” (Asexual, Female, age 21). Generally, coming out facilitates identity integra- tion: “Having my asexuality known has caused me to feel less misunderstood and alienated” (Hetero-affectional Asexual, Female, age 18–25).

DISCUSSION

The current study explored the coming-out experiences of a sample of asexual individu- als recruited from three internet sources and provides insight into the process of asexual identity development. Narratives revealed pre- liminary patterns in the process of identity for- mation similar to theoretical models of identity development among homosexual and bisexual samples. . . .

Coleman (1982) suggested that the func- tion of coming out among homosexuals is to begin the process of self-acceptance. Within the asexual community, the function of coming out may instead be an expression of identity salience and may serve as an external indicator of commitment to asexuality as a way of life (Troiden, 1988). Participants also described disclosure as a strategy for coping with sexual- normative expectations, like past models for disclosure of homosexuality (Cass, 1979). The present study suggests that the desire to share crucial identity information and educate others contributed to the decision to come out. Most asexuals found meaning in coming out

personal information. By posting about asexu- ality on Facebook in lieu of face-to-face con- tact, individuals can represent their orientation while avoiding the stress and potential negative outcome of more direct communication.

I came out by Facebook status on coming-out day in 2010, at 18 when I was a freshman in college. . . . I kind of copped out of fully coming out by electroni- cally announcing my orientation, so while my fam- ily knows I identify as asexual, I’ve kind of avoided talking about it much, just because it’s an awkward conversation to have. (Female, Asexual, age 18–25)

In these ways, participants were able to test the waters by disclosing their asexuality without great risk. “I also revealed my asexual identity on Facebook by changing my profile picture to the asexual flag and sneaking a brief mention in the ‘about me’ section” (Female, Asexual, age 18–25). Those who came out in this way seemed to receive milder reactions than those who took a more direct approach to coming out. “On the Internet it is easy for me to reveal my asexual identity and so far I [am] met with indifference or interest. No negative feed- back” (Gray Asexual, Undifferentiated Gender, age 18–25). Another participant wrote: “I’ve posted a link to AVEN on Facebook to start a conversation, no one noticed” (Aromantic Asex- ual, Female, age 21). This response suggests that this method of coming out may not be optimal in terms of encouraging a dialog about asexual- ity, but it may be appealing for those who wish to come out without inviting judgment or rejec- tion. Privacy restrictions also allow individuals to maintain control over the process by selecting who is privy to personal information.

Theme 7: Reflections After Coming Out Coming out as asexual resulted in a deep sense of liberation and increased personal insight for most respondents. There were no reports of regret after coming out.

T H E “C O M I N G O U T ” P RO C E S S F O R A S E X UA L I N D I V I D UA L S 361

LIMITATIONS

There were several important limitations to the current study that should be addressed. A central criticism of past research has been the exclusive use of asexual samples recruited from the internet, excluding those with asex- ual tendencies who may not identify with or be aware of online communities. Research- ers have expressed concern that the diversity within the asexual population may be an arti- fact of using internet sites to recruit partici- pants (Brotto & Yule, 2009; Hinderliter, 2009). For example, those who join online commu- nities may be looking for others with similar identities. Conversely, others have argued that the asexual population contains more diversity than is represented on AVEN, not less (Chasin, 2011). To address these issues, Hinderliter (2009) suggested drawing from multiple online sources—a method employed in the current study. Nevertheless, recruiting from multiple asexual web communities presents many of the same challenges as enlisting participants from a single website. This methodology limits the generalizability of the findings to asexual individuals who are members of online asex- ual communities. Furthermore, the proposed model hinges on the assumption that asexual participants build their identities using these online resources. It is unknown how one would develop an asexual identity without the use of the internet to inform the process. . . . Future research may benefit from approaching asexual identity development in a more struc- tured manner in order to collect specific demo- graphic and descriptive data, or from using a multi-method approach. . . .

REFERENCES Bogaert, A. F. (2004). Asexuality: Prevalence and

associated factors in a national probability sample. Journal of Sex Research, 41, 279–87.

Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology, 10, 241–50.

and reflected positively on the experience. The reports of positive reactions to disclosure dem- onstrate the importance of external validation.

Earlier models emphasize the implications of positive and negative reactions to disclosure, suggesting that the individual’s perception of the reaction has an effect on continuing iden- tity development (Cass, 1979). It is unclear from the narratives how a positive or negative reaction to disclosure affected the process of identity integration in the asexual samples. It is possible that negative reactions do not have the derailing effect suggested by Cass. The current sample reported reactions of incredulity, mini- mizing, and complete repudiation of the con- struct. Negative responses reflected ignorance of the changing social understanding of sexual essentialism. It is possible that being put in the position to defend the validity of asexuality may further strengthen the commitment to this identity and facilitate identity integration rather than impede it, as suggested in homosexual identity development models (Carrion & Lock, 1997; Cass, 1979; Coleman, 1982). Further research is needed to explore this idea. . . .

Like sexuality, asexuality may be a dynamic construct, constantly in flux and always being redefined. This is supported by the existence of many variations within the asexual commu- nity, including Gray-A, aromantic, romantic, biromantic, heteroromantic, homoromantic, panromantic, demisexual, demiromantic, and more (Jay, 2008b). Asexual individuals may also continue to refine the types of intimacy they are comfortable with, if any. Rust (1993) noted that “historical changes in the concep- tualization of sexuality change the meaning of existing constructs and generate new con- structs” (p. 68). Asexual individuals are in a unique position to help construct the social understanding of this identity and change the conceptualization of sexuality. Future research should explore in more depth what it means to have an integrated asexual identity.

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Bogaert, A. F. (2008). Expert commentary B: Asexuality: Dysfunction or variation? Hauppauge, NY: Nova Biomedical Books.

Bogaert, A. F. (2012). Understanding asexuality. Lanham, MD: Rowman & Littlefield Inc.

Bogaert, A. F. (2015). The Demography of Asexuality. In A. Baumle, ed., International handbook on the demography of sexuality. New York: Springer.

Brotto, L. A., Knudson, G., Inskip, J., Rhodes, K., & Erskine, Y. (2010). Asexuality: A mixed-methods approach. Archives of Sexual Behavior, 39, 599–618.

Brotto, L. A., & Yule, M. A. (2009). Reply to Hinderliter (2009) [Letter to the Editor]. Archives of Sexual Behavior, 38, 622–23.

Brotto, L. A., & Yule, M. A. (2011). Physiological and subjective sexual arousal in self-identified asexual women. Archives of Sexual Behavior, 40, 699–712.

Carrigan, M. (2011). There’s more to life than sex? Difference and commonality within the asexual community. Sexualities, 14, 462–78.

Carrion, V. G., & Lock, J. (1997). The coming out process: Developmental stages for sexual minority youth. Clinical Child Psychology and Psychiatry, 2, 369–77.

Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4, 219–35.

Chasin, C. J. D. (2011). Theoretical issues in the study of asexuality. Archives of Sexual Behavior, 40, 713–23.

Coleman, E. (1982). Developmental stages of the coming out process. Journal of Homosexuality, 7, 31–43.

Hinderliter, A. (2009). Methodological issues for studying asexuality [Letter to the Editor]. Archives of Sexual Behavior, 38, 619–21.

Jay, D. (2003). A look at online collective identity formation. Unpublished manuscript.

Jay, D. (2008a). Overview: Asexuality visibility and education network. Retrieved from http://www .asexuality.org/home/overview/html.

Jay, D. (2008b). AVEN Survey 2008—Results: Asexuality visibility and education network. Retrieved from http:// www.asexuality.org/home/2008_stats.html.

MacInnis, C. C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance and discrimination against asexuals. Group Processes and Intergroup Relations, 15, 725–43.

Poston, D. L., & Baumle, A. K. (2010). Patterns of asexuality in the United States. Demographic Research, 23, 509–30.

Prause, N., & Graham, C. (2007). Asexuality: Classification and characterization. Archives of Sexual Behavior, 36, 341–56.

Rothblum, E. D., & Brehony, K. A. (1993). Boston marriages: Romantic but asexual relationships among contemporary lesbians. Amherst: University of Massachusetts Press.

Rust, P. C. (1993). “Coming out” in the age of social constructionism: Sexual identity formation among lesbian and bisexual women. Gender & Society, 7, 50–77.

Scherrer, K. (2008). Coming to an asexual identity: Negotiating identity, negotiating desire. Sexualities, 11, 621–41.

Shinebourne, P. (2011). The theoretical underpinnings of interpretative phenomenological analysis (IPA). Existential Analysis, 22, 16–31.

Troiden, R. R. (1988). Homosexual identity development. Journal of Adolescent Health Care, 9, 105–13.

Vaughan, M., & Waehler, C. (2010). Coming out growth: Conceptualizing and measuring stress-related growth associated with coming out to others as a sexual minority. Journal of Adult Development, 17, 94–109.

Westphal, S. P. (2004). Glad to be asexual. New Scientist, 184, 40–43.

Yule, M. A., Brotto, L. A., & Gorzalka, B. B. (2013a). Biological markers of asexuality: Handedness, birth order, and finger length ratios in self-identified asexual men and women. Archives of Sexual Behavior, 43, 299–310.

Yule, M. A., Brotto, L. A., & Gorzalka, B. B. (2013b). Mental health and interpersonal functioning in self- identified asexual mean and women. Psychology and Sexuality, 4, 136–51.

363

R E A D I N G 3 1

For the last several decades, women in the United States have successfully advo-cated for the recognition of their right to sexual pleasure, with access to sex toys representing one possible avenue to women’s self-pleasure. As the call to “take pleasure into your own hands” has grown—in part due to recognizing the role of clitoral stimulation and the importance of sexual self-reliance—sex toys have entered more women’s sexual lives in both private and partnered sexual experi- ences. Building upon this momentum, much scholarly debate has ensued about whether phallic-shaped sex toys utilized in sex play between women represent literal phalluses or symbolic subversions of patriarchal power (Findlay 1992; O’Keefe et al. 2009). While those in classical semiotics have argued that lesbians utilize sex toys as a means to com- pensate for the relative lack of “phallus” in sex (Bolsø 2007), most postmodern and feminist scholars have theorized that lesbians’ use of phallic sex toys subverts the masculinized power of the phallus and plays with the idea that men are the sole wielders of the pen- etrative penis (Bolsø 2007; Hamming 2001; Minge and Zimmerman 2009; Lamos 1994; Reich 1999). Curiously, though quantita- tive research has shown that heterosexual, bisexual, and lesbian women all use vibrators (Herbenick et al. 2010) and women generally use them to enhance sexual responsiveness and  sexual pleasure (Herbenick et al. 2009a;

Davis et al. 1996; Richters et al. 2006), quali- tative sex researchers have largely ignored women’s own narratives about their sex toy usage, particularly across sexual identity boundaries. In other words, the empirical literature on sex toys has mostly ignored the storylines and common interpretive sche- mas women use when discussing and think- ing about sex toys. In particular, heterosexual women’s use of (phallic) sex toys has rarely received the same conceptual interrogations and empirical analysis that has been directed toward lesbian women’s dildo usage. As such, this study examines women’s subjective nar- ratives about their sex toy usage (including vibrators and dildos) across sexual identity boundaries, as heterosexual, bisexual, and lesbian women discuss their complex relation- ship with, and meanings ascribed to, using (or not using) sex toys and the meaning of sex toys in their sexual experiences, mastur- bation behaviors, and sexual partnerships. By framing women’s sex toy narratives within larger frameworks of feminist theory, queer theory, and the problems of compulsory het- erosexuality, this study addresses many of the contemporary blind spots present in the study of women’s sexual pleasure.

ADVENTURES WITH THE “PLASTIC MAN”: SEX TOYS, COMPULSORY HETEROSEXUALITY,

AND THE POLITICS OF WOMEN’S SEXUAL PLEASURE

B R E A N N E F A H S A N D E R I C S W A N K

Reprinted by permission from Springer Nature: Springer, Sexuality & Culture, “Adventures with the ‘Plastic Man’: Sex Toys, Compulsory Heterosexuality, and the Politics of Women’s Sexual Pleasure.” © 2013.

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researchers found that 52.5% of women used vibrators, with more women stimulating the clitoris (83.8%) than penetrating their vaginas (64%). Further, those who used them described greater likelihood of engaging in other health behaviors like getting regular gynecological exams and performing genital self-examina- tions during the previous month and described [few] negative side effects associated with using vibrators. Also, women’s vibrator [use] posi- tively linked with many other aspects of wom- en’s sexual lives, including increased sexual desire, arousal, lubrication, orgasm, absence of sexual pain, and overall sexual function- ing (Herbenick et al. 2009a, 2011; Richters et al. 2006). Women used vibrators primarily to stimulate the clitoris and to enhance sexual pleasure (Davis et al. 1996). As nearly 2/3 of women used vibrators in partnered sexual activities and masturbation, women described vibrators as contributing to intense orgasms and high levels of sexual satisfaction whether alone or with partners (Davis et al. 1996).

Sex toys have also often enhanced women’s sexual lives by serving as a mech- anism for women to “spice up” their sometimes- monotonous partnered sex (Zamboni and Crawford 2002), though many women also masturbate with sex toys as a complementary practice to an active, fulfilling, partnered sex life (Das 2007). Women use sex toys as part of an active masturbatory life, whether partnered or not (Tiefer 1998). With options available like vibrators, dildos, butt plugs, cock rings, and sex dolls (among others), sex toys represent a viable option for women to take pleasure into their own hands (Herbenick et al. 2009b). Across sexual identity lines, heterosexual, bisexual (see Schick et al. 2012 and Schick et al. 2011), and queer women all report relatively frequent use of vibrators and sex toys (Herbenick et al. 2009b). They may also help women to achieve stereotypical definitions of “empowered” femi- ninity (that is, successful, “hip,” nontraditional,

LITERATURE REVIEW

A Brief History Historical studies show that people have used dildos (from the Italian diletto, for “to delight”) since at least third-century Greece, and that modern rubber dildos first appeared in the nineteenth century (Deka 2005). Most notably, the history of vibrators suggests notable links between sex toys and the regulation and con- trol of women, as doctors may, in some small circles, have used vibrators in the nineteenth century to “cure” hysteria and other ailments, often with women’s husbands’ approval (Chazan 2009; Maines 2001). Because vibrators had a distinctly medical purpose in the nineteenth century, it took several decades—well into the 1920s—to “see” vibrators as mechanisms that induce sexual pleasure. In the 1930s, women’s magazines advertised “massagers” in non- sexual terms instead of “vibrators,” and vibra- tors did not reappear in advertisements until after the sexual revolution (Lindemann 2006). Globally, dildos and vibrators currently have a tangible presence in the developed world and have started to appear in the developing world (India, in particular) (Deka 2005).

Benefits of Using Sex Toys While there have been only a handful of explanatory studies about how women use sex toys, or what potential benefits they offer to partnered sexual dynamics (Herbenick et al. 2009a, 2010; Richters et al. 2006), research has found masturbation (with or without sex toys) to be positive and sexually affirming, noting that masturbation can improve women’s self- awareness, body image, self-esteem, and over- all sexual pleasure (Coleman 2002; Herbenick et al. 2009a; Hurlbert and Whittaker 1991; McFadden 2011; Shulman and Horne 2003). In the most widespread study of women’s vibrator use to date (Herbenick et al. 2009a),

A DV E N T U R E S W I T H T H E “ P L A S T I C M A N ” 365

provide new experiences for sexual pleasure that transcend traditional gender and het- eronormative scripts (Hollows 2007; Rye and Meaney 2007). Still, feminist sex therapists caution that masturbation and partnered sex, with or without sex toys, are beholden to patri- archal cultural scripts that derive from histori- cal, biological, and cultural influences (Tiefer 1998, 2004), including racist, heterosexist, and sexist ideologies (Fahs 2011).

Within the medical world, the medicaliza- tion of women’s sexuality has led to a host of “interventions” that seek to improve wom- en’s orgasmic functioning via medical “toys.” Devices like vacuum pumps for women’s clito- rises (Billups et al. 2001) and “clitoral therapy devices” (Schroder et al. 2005) suggest that sex therapy discourses equate physiological arousal with efficient orgasm and sexual activity for women, even though other studies have found that women’s physiological arousal does not always correlate with sexual desire (Fahs 2011; Harris 2004; O’Connor 2004). That is, medical interventions may induce women’s physiologi- cal arousal (e.g., lubrication and swelling) but women still report little desire for sex with their partners (O’Connor 2004). Nevertheless, sex therapy interventions that ignore systemic sex- ism often equate the use of sex toys with wom- en’s “freedom” to enjoy sexuality, and too often do not adequately account for women’s fluc- tuations in sexual desire that occur because of everyday life responsibilities and stressors (e.g., domestic responsibilities, child care, health sta- tus, full-time careers, and inequities with divi- sion of labor in most households) (Tiefer 2004).

Revisiting the “Lesbian Dildo Debates” While theoretical debates exist about whether phallic sex toys represent the literal, symbolic, or differently imagined participation of the “symbolic man” (O’Keefe et al. 2009; Findlay 1992), most feminist theory suggests that

and career-driven) outlined in fashion-ori- ented magazines like Cosmopolitan, Essence (Buchanan 2010), and shows like Sex and the City (Comella 2003). Popular women’s maga- zines and television shows frequently advocate that women orgasm to empower their sexuali- ties through buying sex toys (Buchanan 2010; Comella 2003; Wright 2009), as cultural norms about sexual pleasure reveal themselves both through the toys themselves and through mar- keting strategies directed at women (Rye and Meaney 2007).

Sex Toys as Therapeutic? Sex therapy literatures often advocate sex toys and other sexual enhancement devices to pro- mote “orgasm positive interventions” (Striar and Bartlik 1999) implicitly targeting hetero- sexual women’s orgasmic functioning as some- thing sex toys can assist with (Billups et al. 2001). While some sex therapies have success- fully deconstructed the centrality of orgasm and penetrative intercourse (Tiefer 2004), the underlying premise of these ‘‘progress through technology’’ interventions assumes that orgasm (via sex toys) correlates with a better overall sex life (Garland 2004; Zamboni and Craw- ford 2002), and that women’s discovery of sex toys would allow them greater happiness and fulfillment (Billups et al. 2001). Sex toy advo- cates within the sex therapy community argue that sex toys can add diversity to a monoga- mous relationship, trigger sexual desire for patients with low libido, inspire arousal and ease performance anxiety, help couples with incompatible sexual fantasies, model new ways to communicate or achieve orgasm, and assist with older patients, those with chronic pain, or those struggling with sexual aversion disorders, sexual abuse, and poor body image (Striar and Bartlik 1999; Warkentin et al. 2006). Dildos and butt plugs may also allow men to experi- ence penetration from a partner . . . and thus

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attachment” and as fundamentally insecure (Costa and Brody 2011), suggesting, as much of their work does, that secure and mature women should primarily rely upon penises and penetration for sexual satisfaction and should avoid all clitoral stimulation. Further, heterosexual women’s sexual satisfaction corre- lated most highly with their partners’ knowledge and perceived liking of vibrator use (Herbenick et al. 2010), suggesting that partner evaluations and relationship scripts informed women’s feelings about their vibrators (just as women evaluate many aspects of their bodies and sexuality based on the evaluation of others, particularly men).

Implicitly, then, there is a sharp divide between the decades-long queer theory work around lesbians using phallic sex toys com- pared with the relatively recent emergence of social science work that examines heterosexual women’s (and all men’s) motives for using sex toys. When women’s sex toy use appears in the social science literature, it is usually framed empirically as (healthy, body-affirming) “vibra- tor use” (Herbenick et al. 2009a; Davis et al. 1996; Richters et al. 2006), while . . . lesbians’ sex toy use is framed more theoretically and focused on (power-heavy, deviant) “dildo use” (Findlay 1992; Hamming 2001) or vibrator use and psychological impairment (Costa and Brody 2011), perhaps suggesting a discursive split between queer women and others. With regard to gender differences, existing studies of men’s sex toy usage point out that men (across sexual identities) who used vibrators more often performed testicular self-exams (Reece et al. 2009), and generally report higher satis- faction (Reece et al. 2009; Satinsky et al. 2011) and higher erectile functioning, orgasmic func- tioning, and sexual desire (Reece et al. 2009), though debate about the symbolic meaning of sex toys for men has not appeared nearly as often as it has for women. And, to demon- strate women’s “deviance” in comparison to

dildos subvert the meaning of the phallus and undermine men’s ultimate power to “please” women via penetration. If women can pen- etrate each other, or if the phallus functions as a symbolically castrated or dismembered man, this undermines men’s monopoly on patriarchal and sexual power (Findlay 1992; Hamming 2001; Lamos 1994; Minge and Zimmerman 2009; Reich 1999). The dildo in lesbian sex may serve as a technological extension that mutates lesbians into “post-gender” beings; this trans- formation disrupts the sense that dildos repre- sent literal penises or lesbians’ repressed desire for a male partner (Hamming 2001; Preciado 2011). Lesbian dildo play may also “resignify” the dildo, reimagine violent sexual narratives, and reshape heteronormative assumptions about the relationship between the body and penetration (Minge and Zimmerman 2009).

Nevertheless, many feminist theorists have expressed concern that the phallus’s role in delivering pleasure to women is rarely chal- lenged in debates about the phallus’s symbolic role, as penetrative pleasure still reigns. Some theorists suggest that dildos represent, for lesbians, “phallic imperialism,” as dildos keep women subjugated while ensuring the mainte- nance of male dominance (Mondschein 2004). Rather than using dildos at all, some wonder, why not completely bar the phallus from enter- ing the lesbian bedroom (Findlay 1992)? Why not embrace non-penetration? This rhetoric of the penetration imperative fits well with histori- cal trends that viewed masturbation (and all non-reproductive sexuality) as trivial, deviant, and causing mental illness (Kay 1992; Laqueur 2004). Theologians, therapists, and medical doctors have historically warned that women who practiced “excessive” masturbation were “crazy” (Laqueur 2004). This characteriza- tion translates into recent medical scholarship as well, as one study in The Journal of Sexual Medicine portrayed women who used vibra- tors for clitoral stimulation as having “anxious

A DV E N T U R E S W I T H T H E “ P L A S T I C M A N ” 367

racist and sexist themes, particularly the rac- ist stereotype of the gigantic (notably dismem- bered) black penis as a “signifier of racial terror and desire” (Findlay 1992, p. 572), and sexist imagery about women as passive sex objects (Fisher 2010; Loe 1998). As Alavi (2004) wrote, while interracial sexual relationships create moral panics in the United States, large black dildos are “constructed to reinforce the stereotype of the ‘big black cock,’ which sup- ports the idea that black men are sexually aggressive” (p. 89). Additionally, sex toys advo- cate heterosexist ideals, as sex toys for women are phallic shaped even though women most often employ clitoral stimulation while mas- turbating (Davis et al. 1996). Only in the last decade have sex toy companies released sex toys shaped like tongues or amorphous shapes (e.g., JimmyJane’s tongue-shaped Form 3 . . .). Though feminist-owned and woman-focused sex toy shops often differ in packaging sex toys, the typical advertising and packaging of sex toys in male-targeted sex toy shops depict women in stereotypically objectified poses, referencing themes found in mainstream por- nography; though sex toys are clearly meant to stimulate women, the packaging in traditional sex toy shops portrays men as the primary pur- chasers and disseminators of sex toys to “their” women. Even for feminist sex toy stores that explicitly fight against these trends, they often admit to struggling between ideological femi- nist beliefs and the ultimate need to generate profits (Loe 1999).

The assumption that sex toys represent an inherently feminist agenda (particularly when sold in more gender-friendly packaging) also undermines the reality that, theoretically, sex toys may teach women not to touch their vaginas and vulvas with their own fingers and hands. In other words, sex toys may encourage women to use devices, rather than fingers, to give them- selves pleasure. Women who use sex toys may learn to masturbate only with technology as

men, women who penetrated themselves dur- ing masturbation before age 18 were found to desire vaginal and anal penetration later on, implying that those who did not self-penetrate developed paraphilias or other sexual dysfunc- tions (O’Keefe et al. 2009). No such studies of men’s early masturbation experiences and correlates with paraphilic behavior exist.

Sex Toys, Capitalism, and Social Identities Some scholars have started to question capital- istic implications of sex toys, including the dan- gerous and financially exploitative conditions in which sex toys are produced. For example, equating sex toy usage with sexual liberation suggests that buying things leads to sexual free- dom and that sexual agents are also sexual con- sumers (Curtis 2004; Smith 2007). The sex toy industry and its targeted audiences rarely ques- tion the equation of shopping and sexual libera- tion, often drawing upon discourses of pleasure, fashion, consumerism, and sexuality to market ‘‘new’’ female sexualities (Attwood 2005). Fur- ther still, the sex toy market may indeed produce sexual desires and therefore produce sexual sub- jects so that women construct their sexualities around the desires that best sell sex toys (e.g., the “double dildo”) (Curtis 2004) even while promot- ing feminist values and consciousness (Comella 2012). Progressives have only recently begun to question the labor conditions, quality of materi- als (particularly plastics), and eco-friendly impli- cations of sex toys, as demand has grown for such information (Thomas 2006). These political economy critiques from progressives offer par- ticular complexity because they arrive in tandem with conservative attacks on the morality of the sex toy industry (Glover 2009), as many states like Alabama still outlaw the purchase of sex toys (Hayes 2009; Rawls 2007).

As another way to critique the hierarchical implications of sex toys, they often replicate

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of the local online section of Craigslist. . . . The study invited women ages 18–59 to participate in [an] interview about their sexual histories, sexual practices, and feelings and attitudes about sexuality. Participants were screened only for their gender, racial/ethnic back- ground, sexual identity, and age. . . . A purpo- sive sample was selected to encourage greater demographic diversity in the sample: sexual minority women and racial/ethnic minority women were intentionally oversampled and a diverse range of ages was represented. . . . The sample included 55% (11 of 20) white women and 45% (9 of 20) women of color, including three African American women, four Mexi- can American women, and two Asian Ameri- can women. For self-reported sexual identity, the sample included 12 heterosexual women (60%), six bisexual women (30%), and two lesbian women (10%). While these labels are informative, women’s reported sexual behavior often indicated far more same-sex eroticism than these self-categorized labels suggest. As advertised in the recruitment materials (and approved by the institutional review board), participants were compensated $20.00 for participating. . . . Participants directly reported a range of socioeconomic and educational back- grounds, employment histories, and parental and relationship statuses.

Participants were interviewed using a semi- structured interview protocol that lasted for approximately 1.5–2 [hours], where partici- pants responded to 36 questions that included aspects of their best and worst sexual experi- ences, feelings about contemporary sexual culture and media, personal experiences with orgasm and other sexual events, negotiations of power with partner(s), and reflections on their bodies. Several of the prompts addressed issues relevant to this study; these questions were asked as a part of a larger study on women’s sexuality. For example, women were asked, “What kind of relationship do you have with

an aid, thereby forgoing the potentially more intimate experience of touching their actual genitals (Fahs and Frank 2014). Further, sex toys may serve a role in infantilizing women, as sex toys in Japan were originally developed as actual toys (with children’s toys’ designs) in order to get around the country’s obscenity laws that banned penis-shaped objects. Conse- quently, toys like the “Rabbit” and Hello Kitty vibrators that clearly mimic children’s toys came onto the market (Taormino 2009). This association between sex toys, sexual pleasure, and treating women like children has largely been ignored, even though it mimics larger trends of treating women as (passive, imma- ture, hairless) girls (Kilbourne 2007; Toerien and Wilkinson 2003).

These theoretical and empirical findings suggest that, while sex toys have received the- oretical and quantitative scholarly attention, qualitative work has not yet explored women’s narratives about using sex toys, particularly related to the ways sexual scripts (and compul- sory heterosexuality) frame women’s private sex- ual experiences. Consequently, this study asks several questions: First, what kinds of themes emerge when women talk about their experi- ences with using sex toys? Second, what differ- ences, if any, appear between lesbian, bisexual, and heterosexual women, and what do these dif- ferences suggest about the relationship between sexual identity and sex toy usage? Third, how do women’s narratives about sex toys reflect broader constructions of patriarchy, power, and the potential for subversive resistance?

METHOD

This study utilized qualitative data from a sample of 20 adult women recruited in 2011 in a large metropolitan Southwestern U.S. city. Participants were recruited through local enter- tainment and arts listings distributed free to the community as well as the volunteers section

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20); (5) embracing sex toys as campy, fun, and subversive (4 out of 20); and (6) resistance to sex toys as impersonal or artificial (5 out of 20). Heterosexual women far more often described experiences that fit into the first four themes, while queer women (lesbian and bisexual women) far more often described experiences that fit into the latter two themes.

Theme 1: Emphasis on Non-penetrative Use of Phallic Sex Toys Whether as a mode of resistance to traditional scripts about how women should derive sexual pleasure, or as an indicator of the imperfect design of sex toys, women overwhelmingly described non-penetrative uses for (mostly phal- lic) sex toys. Of the 18 women who reported sex toy use, only three women penetrated themselves with sex toys yet most used phallic- shaped sex toys. Nevertheless, women used the sex toys, to stimulate their clitorises rather than to penetrate their vaginas; several women described this behavior as deviant or shame- ful, as they believed ‘‘normal’’ masturbation meant self-penetration. Keisha, a 34-year-old African-American bisexual woman, described her lack of penetration as something she believed characterized her as “weird”: “I use a vibrator and to tell you the truth I don’t pen- etrate while masturbating. I just use it on—just go around it, and it’s really actually little. I just go around the clitoris and that’s it. I don’t even penetrate when I use a vibrator.” Her percep- tion that non-penetration was surprising or non-normative suggests that Keisha believed most women penetrated themselves with sex toys. This assumption implies that equating penetration with sexual normality has entered women’s internal masturbation scripts. Keisha’s response also suggests that women do not typi- cally discuss masturbation with each other and that socializing forces found in schools, media, and within women’s networks do not

sex toys or ‘props’ during masturbation or dur- ing partnered sex?”. . . As the questions were broad and open-ended, participants could set the terms of how they would discuss sex toys and what information they wanted to share. The original questions served as “sensitizing concepts” that allowed previous research to lay the groundwork for topics and themes to look for (Charmaz 2006).

Responses were analyzed qualitatively using thematic analysis. This type of analysis was con- sidered the most effective and useful because it allowed for groupings of responses based on women’s attitudes and feelings.  .  .  .  This method of analysis also supported an exami- nation of the intersection between sex toy usage and other components of women’s sexual lives. . . . To conduct the analysis, we familiar- ized ourselves with the data by reading all of the transcripts thoroughly, and we then iden- tified patterns for common interpretations posed by participants. . . .

RESULTS

Overall, 90% (18 of 20) [of the] women des- cribed using sex toys either during mastur- bation or partnered sex (or both), while 10% (2  women, both heterosexual identified) said that they had never used sex toys. This number is higher than earlier studies assessing women’s vibrator use. Because all women reported that they had masturbated at least once, and all had much to say about sex toys, all 20 women were included in this study. . . . [S]ix main themes were generated. . . . [S]ome partici- pants’ responses overlapped between themes in that one woman’s interview often addressed more than one theme. The six themes included (1) emphasis on non-penetrative use of phallic sex toys (8 out of 20); (2) embarrassment about disclosing sex toy usage to partner(s) (6 out of 20); (3) personifying vibrators and dildos (5 out of 20); (4) coercion and lack of power (4 out of

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male partners. Tania, a 25-year-old white het- erosexual woman, described her experiences with past boyfriends and their jealousy about her vibrator use: “Some of the men I’ve chatted with about (my vibrator) become jealous that they can’t perform the same act as the vibra- tor does, so I try to shy away from speaking to them about it. When I can’t have an orgasm during sex with them, they become, you know, kind of self-conscious because I tell them that I can with a vibrator. Now I just don’t talk about it at all with them.” This description of shying away from disclosure starkly contrasted with her overwhelming sense of pleasure when using her vibrator: “I didn’t know what I was doing at first and I just kind of played around with it and I finally had my first orgasm with it and it was incredible! I couldn’t stop from there on! So now it’s definitely become a regular kind of thing. I’ve got the Rabbit, and I can have mul- tiple orgasms. Once I had ten orgasms in an hour and I was very, very excited!” Tania felt she could not share with her partner the sex- ual joy she experienced during masturbation, suggesting that lack of disclosure may corre- spond with uneasiness about challenging men’s sexual power (or “territory”). In other words, women worried that their partners would not automatically feel superior to a machine and that disclosure of sex toy use would under- mine hegemonic masculinity notions of men’s (inherent) sexual mastery.

As another example of women’s fear of dis- closure, some worried that others would find their sex toys or discover their own personal “deviance.” Several women described hiding their sex toys in special places in their houses, buying them discreetly, and worrying about their partners hearing a buzzing vibrator from the next room. Other women worried about other men’s (non-partners) judgments. . . . Patri- cia, a 28-year-old African American hetero- sexual woman, reported her imagined shame when telling a doctor about her (misused) sex

relay accurate information about how women masturbate.

Similarly, Sylvia, a 23-year-old white het- erosexual woman, also described her mastur- bation behavior as not normal because she did not insert it: “I like my vibrator. It’s this little thing and I have to have that on my clit or it just will not work. I don’t ever like even insert it. It doesn’t do anything if I do.” Describing her sex toy as abnormally small, Sylvia believed that most women use larger (and more phal- lic) toys. By deriving pleasure from her “small” vibrator, she subverts the “bigger is better” assumptions about penis size and what pleases women while also showing that “normal” size equals “normal” (male) penis.

A few women, however, felt less uneasiness about their disinterest in penetration and chose devices not intended to resemble (penetrative) penises. Inga, a 24-year-old white bisexual, said that she frankly preferred non-phallic toys: “Anything that’s inserted I just don’t like. I have a sex toy with two prongs. It looks weird, like a tooth, not like most vibrators. I absolutely love it! It’s waterproof so I can take it in the shower with me if I want.” Together, these responses indicate that women conceptualize differences between their own (use of) sex toys and how others use them.

Theme 2: Embarrassment about Disclosing Sex Toy Usage to Partner(s) Although women often derived pleasure from sex toys, they generally felt uncomfort- able expressing these sentiments to others. As a second theme, heterosexual women felt particularly embarrassed about their sex toy usage, often constructing sex toys as a threat to their boyfriends’ or husbands’ sense of sex- ual prowess. As such, several women did not disclose their sex toy use to others (including mothers, sisters, friends, coworkers, and part- ners) and often purposefully hid sex toys from

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but sometimes I would be on top. When I would be on top—generally I don’t have an orgasm during intercourse—I have to have my vibra- tor on hand so that he can do what my husband can’t. . . . My partner is very accommodating. He allows me to have an orgasm and it’s impor- tant for him that I have one.” Jane described her husband both as unable to help her orgasm but as allowing her to orgasm with the (masculin- ized) object, as she turned to “another man” (in this case, her vibrator) for assistance. Jane’s vibrator imposed the presence of a different man rather than serving as something else altogether (e.g., female, a toy, a genderless object, etc.). The vibrator, it seems, is gendered male in het- erosexual sex.

Theme 4: Coercion and Lack of Power in Using Sex Toys Though only a few women described negative experiences with sex toys, these negative expe- riences often followed a similar coercive pat- tern. The worst cases generally happened when women said that their male partners either forced them to use sex toys to accommodate pornographic fantasies, or that sex toys sym- bolized their relative lack of power during sex. As the most clearly coercive example, Sylvia, a 23-year-old white heterosexual woman, recalled that her male partner coerced her into using anal sex toys to fulfill his fantasies: “He watched a lot of porn so he wanted to try every single little thing out there that had to do with anything that he had seen. He wanted to have anal sex so he used anal toys and stuff to loosen me up. It didn’t do anything for me. It hurt a lot but I went along with it anyway. As long as he was happy, then I would try what- ever he wanted. He also wanted to use ropes, gags, and meet up with people on Craigslist to meet other couples.” For Sylvia, using anal sex toys accommodated her partner’s desires even if using them caused her physical pain. In this

toy: “At first I was really all for using sex toys, but once your vagina starts getting wet and your muscles start contracting, I was scared because, well, what if it sucks it up in there? And then what? I gotta go to the doctor and tell him to pull out a toy?! So, that kind of dis- couraged me right there.” Patricia’s fear that a doctor would evaluate her negatively suggests a link between sex toys and implied deviance, as “good girls” would not encounter such trouble. This narrative also reveals how, even though women did not disclose sex toy use to other women, they felt far more distressed imagining other men finding their “secret” sex toys.

Theme 3: Personifying Sex Toys As a common theme, several women admitted that they anthropomorphized and personified their sex toys by naming them, referring to them as a “substitute” for a real person, or imagining a relationship with their (male) sex toys. This personification of sex toys challenged men’s assumed dominance and sexual abilities. For example, Zhang, a 36-year-old Asian American bisexual woman, referred to her vibrator as a ‘‘him’’ and described interactions with “him”: “I had a dildo before, Mr. Cool Guy, but I got too emotionally attached to him. I really liked him and enjoyed my plastic man but my boyfriend didn’t like it. Eventually I just threw him away so he and I couldn’t have our sexual rendez- vous anymore.” In this example, Zhang feared disclosure of using “Mr. Cool Guy” while she also constructed him as a substitute man. Her dildo assumed a gender, an identity, and, most importantly, challenged the phallic power of her boyfriend and must therefore be discarded immediately.

As a more subtle example of personifying sex toys, Jane, a 59-year-old white heterosexual woman, described playing with a sex toy with her husband, using the ‘‘he’’ pronoun for the toy: “Generally we do the missionary style position

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Sex toys also allow same-sex couples to rethink the presence and absence of the phal- lus in their sex lives (often in a humorous and subversive way). Hannah, a 57-year-old white bisexual woman, used a dildo with her female partner to consciously undermine its phallic qualities: “My partner and I love to mess around with our dildo. It’s kind of floppy so sometimes I’ll wear it into the bedroom and she’ll laugh really hard. We have this game where she’ll ask me to take off the penis so she can get to my clit. When I do that, it’s really sexy.” Han- nah constructed the dildo here as a humorous foreplay device rather than the centerpiece of quintessentially phallic intercourse, thus strip- ping the dildo of its (masculinized) power to deliver pleasure.

Theme 6: Resistance to Sex Toys as Impersonal or Artificial As a final theme, several women saw no positive or therapeutic aspects of sex toys and described them instead as too impersonal or artificial. Often as a conscious rebellion against techno- logical and corporate means to women’s sexual pleasure, these women typically preferred to masturbate with their fingers and have part- nered sex without accessories. For example, April, a 27-year-old Mexican American lesbian woman, felt that sex toys alienated her from her body: “I don’t like the ways the toys feel. I mean, it’s plastic and you can tell that it’s dif- ferent from what a person feels like. It’s not as natural. I like to feel connected more than that, not like I just went shopping for a toy.” Rather than admonishing sex toys as bad or immoral, April described them as not meeting her needs for bodily and emotional connection. In doing so, she expected masturbation to meet multiple needs rather than merely delivering sensations.

As another example of sex toys not fully satisfying women, Mei, a 22-year-old Asian American heterosexual woman, described giving

scenario, the toys functioned as an extension of his (misogynistic) power, as she became the physical manifestation of a pornographic scene.

As a more subtle example of sex toys en- abling power imbalances, Angelica, a 32-year- old Mexican American heterosexual woman, used sex toys to please her male partner even when she did not orgasm: “I’ve used masturbat- ing toys while we’re having sex. He liked it quite a bit and thought it was hot. He was fine with it, ’cause I still fake it and he gets what he wants out of it anyway.” For Angelica, sex toys titillated her boyfriend rather than helping her orgasm, again representing the ways women often prioritize male pleasure above their own. . . .

Theme 5: Embracing Sex Toys as Campy, Fun, and Subversive While heterosexual women more often relayed a tone of seriousness about power imbalances with sex toys, lesbian and bisexual women far more often described sex toys as fun or campy, often with a subversive and playful twist. In these examples, women embraced sex toys without as much shame and expressed more openness about enjoying them with partners. Cris, a 22-year-old white lesbian woman, described visiting an adult store and using the toy as a fun partnered interaction: “The dildo was kind of small. We got it in a kit from the adult store, so it doesn’t really do anything. Neither of us (I guess you would say) wants it to be replicated like a penis, but it’s just some- thing different to do. It’s kind of silly. Honestly, sometimes we’ll be laughing because it’s so funny. It’s tiny and laughable and not meant to be taken seriously.” Cris considered the rela- tionship between the fake and real phallus and used humor and fun to undercut the absurdity of sex toys. She clearly did not see the dildo as a means to assert dominance or power over her partner and instead described it as a playful diversion.

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up on using her vibrating cock ring and vibrator when they did not fully satisfy her: “We tried to use it together because it’s one of those couple vibrators, like the U-shaped one. I don’t know if it’s the strength or the continuous buzzing, but it eventually makes you numb. We tried it a few times and we were like, ‘This doesn’t really add much.’ Since then, I’ve used it once or twice alone but I don’t like it that much. I prefer my fingers.” Again, Mei expected sex toys to enhance partnered sex or masturba- tion, and when they failed in this regard, she discarded them. This description of “failing” (or impotent?) sex toys presents a striking con- trast to imagining the sex toys as having power or authority over her pleasure, or as having a persona or a masculinized identity (as previous narratives showed).

DISCUSSION

While sex toy use is relatively widespread, honest and frank discussions about the mean- ings women assign to sex toys remains rare. These six themes—non-penetrative use of phallic sex toys, embarrassment about disclo- sure, personifying sex toys, coercion and lack of power, embracing sex toys as campy and fun, and resistance to sex toys as impersonal or artificial—point to vastly different experi- ences in women’s interactions with, thoughts about, and emotional experiences of sex toys. There are clear advantages to asking women about sex toys rather than assuming univer- sally positive or uncomplicated relationships between women, sex toys, and sexual plea- sure. While this study used a small qualita- tive sample, these narratives did reveal several important (though exploratory) trends regard- ing sexual identity and sex toy narratives: first, a pattern (though somewhat imperfect) emerged between lesbian/bisexual women and heterosexual women’s construction of sex toys, as queer women far more often resisted

thinking about sex toys as threatening to men, representative of phallic power, or coercive. Queer women more often constructed sex toys as fun, campy, and subversive and reported less shame about not using sex toys for penetration. On the other hand, heterosexual women more often described shame and secrecy about their sex toys, and far more often personified their sex toys as men or imagined that they were sup- posed to penetrate themselves with their sex toys. The narratives that women should treat sex toys as either replacements for penises, or as imagined penises, appeared far more often in heterosexual women’s narratives.

This divide suggests that queer women more often constructed sex toys as non-literal in comparison to heterosexual women, and more importantly, queer women seemed less apt to treat sex toys as masculine in nature. With no clear patterns of sex education or educational background found among par- ticipants that could help to explain these dif- ferences, heterosexual women, on the whole, reported a greater tendency to treat sex toys as an inherent threat to their partners’ mascu- linity, sometimes discussing sex toys as actu- ally male gendered. Thus, men’s expectations about “proper sex” affect women’s relationship to sex even when men are absent. Interestingly, even though nearly all women masturbated with clitoral stimulation rather than vaginal stimulation, heterosexual women expressed the most reluctance and shame when disclosing these patterns to male partners. Queer women described masturbating without penetration as a normal and routine part of their lives while heterosexual women described this as some- thing weird or abnormal.

Because of the relatively small sample, we do  not contend that these sexual identity find- ings  are conclusive and warn against over- generalizing from this study. Future research (both qualitative and quantitative) should deter- mine whether sexual identity differences exist

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on a larger scale or within different intersec- tions between women (e.g., age, race, and class). Moreover, it is possible that our recruitment tech- nique or interview questions led to conclusions that differ from earlier research. The fact that more women used sex toys in this sample com- pared to national samples could reflect biases in self-selection, differences in qualitative work that involves face-to-face discussions compared to quantitative pen/paper or online surveys, or more progressive populations in urban centers with more access to sex toys than those in rural areas.

Notably, some themes found in previous research—particularly the theme of women fearing addiction to, or desensitization from, sex toys (Loe 1998)—did not appear in our study, leading to additional questions about how age, media consumption, education, and cohort may affect the themes found in qualita- tive work on sex toys. Nevertheless, our find- ings add to the literature on women’s sex toy usage by suggesting that, because queer women in this sample did not typically construct sex toys as “competition” for men, they could more easily use sex toys for fun, silliness, exploration, play, and subversion of normative scripts (e.g., deconstructing the phallus as all-powerful). Many of these queer women easily upended the (hetero)scripts and thereby changed the sym- bolic and literal meaning of the sex toys. Just as “butch” and “femme” distinctions within lesbian communities lead to different inter- pretations of dildos (Wilson 2009), our study suggests that differences between queer, bisex- ual, and heterosexual women may be worth studying. For example, heterosexual women overwhelmingly retained the patriarchal and phallic qualities of sex toys by envisioning them as literal penises or even as full-on men. Their worries about hiding sex toys or justify- ing any “competition” to their partners indicate that they perceived tension between real and fake penises rather than imagining sex toys as altogether symbolic. The naming of sex toys

(“Mr. Cool Guy”) or the assertion that a sex toy used in partnered sex has the pronoun him both suggest this as well. Nevertheless, subver- sive potential exists in the literal and symbolic displacement of the phallus, as both queer and heterosexual women enacted agency by choos- ing to have sexual pleasure regardless of the normative scripts that dictate their allegiance to patriarchy. Both groups complicate the “pen- etrative imperative.” For heterosexual women, they still masturbate (often in secret) with their sex toys and, in doing so, may subvert the literal power of their (male partners’) phallus by using the “plastic man.” For queer women, they play with the metaphorical dimensions of the dildo and vibrator while also, at times, assuming the role of having a “penetrative cock,” thereby tak- ing that power from men. Neither group lack agency, though the expression of that agency differs and is worthy of close consideration.

These narratives also suggest that, perhaps because of the pervasive qualities of compul- sory heterosexuality, women as a whole largely do not discuss their masturbation habits with others, particularly other women, and that even between partners, masturbation remains a relatively taboo subject. This points to the importance of feminist sex toy stores and sex toy parties as sites of women’s personal sexual conversations (Comella 2012; McCaughey and French 2001) and openness between partners during couples and individual psychotherapy (Tiefer 1998). At its most basic level, this study suggests that women still believe that sexual pleasure during masturbation is not some- thing they can readily discuss. Beyond this broad reading of the data, this research high- lights the ways that heterosexism may enter women’s private masturbatory experiences. Perhaps women believe masturbation serves as a substitute for “real” (that is, penetrative intercourse with a male partner) sex, or it may suggest that women lack a cultural lexicon for conversing about masturbation. (Consider, for

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of women’s sexualities are subject to patriarchal control, even during supposedly empowering and private experiences (Weinberg and Wil- liams 2010). The literal descriptions of coer- cion with sex toys only further cement this pattern, as women mold their desires around men’s fantasies and desires even when this occurs at women’s expense (Fahs 2011).

Though sex toys mostly seem to repli- cate gender imbalances both by reinforcing patriarchy and emphasizing stringent adher- ence to traditional gender roles, these findings also suggest several important resistances women could enact when using, buying, talk- ing about, or thinking about sex toys. First, as some women expressed in this study, women do question, critique, and challenge the divide between the natural and the artificial, between phallic and non-phallic, and between serious and fun. Whether via sex education, consciousness- raising experiences, women and gender stud- ies courses, or informal networks, women can learn, as individuals and as a collective, to inject both a critical consciousness and a sense of fun into sexuality, as both of these elements receive far too little attention and consideration in con- temporary discourses of women’s sexuality (for a great example of how to do this, see Dodson 1996). Any time women take pleasure into their own hands, they subvert cultural scripts about “normal” sexuality. This does not suggest that if women merely “have fun” with dildos, they will fully negate the power-imbalanced impli- cations of these toys. Still, women’s narratives of shame about masturbation and sex toy use could change if women more often questioned the (phallic, patriarchal) implications of sex toys. To further complicate matters, subversive potential exists in a huge range of behaviors with sex toys, as women (queer or hetero- sexual) using sex toys as a literal “penetrative cock” as well as those playfully deconstructing the “realness” of the phallus both subvert norms of gender and power.

example, the number of popular slang terms for men’s masturbation compared to women’s mas- turbation.) Women may not discuss masturba- tion because self-pleasure represents a direct challenge to the notion that men alone have the power to “please” women (with their penises); as such, sex toys, or other women, both threaten the power of hegemonic masculinity and sexual machismo. Just as women feel increasing pres- sure to kiss and fondle other women in front of men (Fahs 2011), perhaps “acceptable” mas- turbation for women involves masturbating in front of men for their pleasure. The silences surrounding women’s sexual pleasure—partic- ularly masturbatory pleasure—represent a piv- otal avenue for the transmission of patriarchal power and control of women.

As a more broad critique, several of these themes suggest that (heterosexual) women generally assume they should orgasm from penetrative intercourse even though they often do not find this pleasurable. By relying upon clitoral stimulation in both masturbation and partnered sex (and then feeling shame about this), women reveal the tensions that exist in the mandate they feel about penetrative inter- course. Similar to the “sexual compliance” lit- erature that suggests that women often engage in unsatisfying sexual intercourse to get or maintain approval of their male partners (Katz and Tirone 2009; Sanchez et al. 2005), cultural prescriptions that maintain men’s power and dominance over women (and keep men pres- ent in solitary sex) take priority over women’s orgasmic pleasure. Women’s overwhelming sense that they should find penetration plea- surable (but they secretly do not) implies that sex toys propagate discourses of heteronor- mativity even during women’s private experiences with masturbation. In other words, women have internalized the message that penetrative intercourse is superior even while masturbat- ing alone. The masculine presence of sex toys only further entrenches the idea that all aspects

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As a second mode of resistance, women can better address some of the racist, sex- ist, classist, and heterosexist implications of sex toys by refusing to buy certain sex toys, demanding better quality material in their sex toys, ensuring that sex toys are produced with better working conditions, and by refusing to purchase and use sex toys that replicate tired racist and heterosexist assumptions about gender and bodies. Fur- ther still, women may want to experiment with using their fingers to masturbate rather than relying upon sex toys exclusively, as they may discover new avenues to pleasure in this way. By collectively abstaining altogether from being sexual consumers, women can use boycotts to shape the industry that (falsely?) assumes women will continue to buy and use objects that perpetuate tired stereotypes, keep women connected to phallic pleasure, and define (in highly simplistic terms) what should please them.

As a third and final mode of resistance, women can decouple sex toys and libera- tion, instead looking closely at how sex toys simultaneously benefit and fail women, how they both empower and disempower women, and how sex toys represent a microcosm of broader contradictory and insidious cultural assumptions about women, gender, and bod- ies. Though this study serves as an early exploratory study about women’s narratives of sex toy use, future research can delve fur- ther into questions about gender, power, and sexual accessories. In doing so, the discussion surrounding sex toys could expand to include questions like: How can we reimagine wom- en’s relationship to buying sexual liberation (however conceived), and what might it mean to buy liberation in the absence of a feminist education? In what other ways do women imagine men as present or in control when they could invest this power in themselves? How do the assumptions of popular culture (or

sex therapy) construct women’s relationship to orgasm, sexual play, and sexual pleasure? Ultimately, sex toys can serve a dual role: they reflect both the worst and most insidi- ous aspects of patriarchy—namely that the invisibility of power allows it to infect wom- en’s private sexual experiences—and the more subversive possibilities of sexuality—that sex can undo, redo, remake, and upend much of the oppression, control, and restraint we face both individually and collectively.

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When we teach about sexuality and aging, the overarching sentiment we get from students of all ages is that they don’t want to know about their parents’ or grandparents’ sex lives. They joke that they know they must have had sex at least as many times as they have children, but they don’t want to know any details or talk to them about it. Even those of us who con- sider ourselves open-minded in regard to sex don’t necessarily want to talk to our parents or grandparents about their fantasies or kinks. In pop culture, with the recent exception of the cougar or MILF,1 sex is the domain of the young and conventionally attractive. Many younger people mistakenly assume that older people do not want sex and are so undesirable and unattractive that nobody would want to have sex with them; they wouldn’t even want sex with each other. Contrary to these senti- ments, many older adults do want and have sex. Hopefully, we can start to think about parents and grandparents in a very different way, and maybe begin to communicate more effectively about these issues.

As life expectancy increases and a larger per- centage of our population is over 65 years old, we are more likely to interact with older adults in our families, workplaces, and communities. Thus, we all need to be more informed about these issues. Family members, health profes- sionals, social workers, direct care workers, and long-term-care staff members should be aware of older adults’ needs for privacy, autonomy, and access to information regarding sexual health, and the ability of older adults to make their own decisions. Furthermore, institutional

policies should reflect those needs and provide training as necessary.

Although the frequency of sexual activ- ity declines with increasing age, more so for women than for men (DeLamater and Koepsel, 2015), age alone does not explain the decline. In a large nationally representative study, Waite et al. (2010) found 84 percent of men and 62 percent of women between the ages of 57 and 64 years old reported having penile– vaginal intercourse (PVI) with a partner in the past year. For people in the 75–85-year-old age group, 38 percent of men and 17 percent of women reported engaging in PVI in the last year. While fewer older adults are sexually active, those who are having PVI tend to have it once or twice a week. This trend remained fairly constant, declining only at the oldest ages (Waite et al., 2010). Additionally, many older adults are still interested in and engage in a wide variety of sexual behaviors that may not include PVI, such as oral sex, mutual masturba- tion, and masturbation (Barmon, 2016).

Sexual activity, such as oral sex and mas- turbation, tends to remain stable over the life course (Bretschneider and McCoy, 1988; DeLamater and Koepsel, 2015; Lindau et al., 2007). Variability in sexual behavior across age groups is better understood by cohort differ- ences than age differences (Twenge, Sherman, and Wells, 2017). Waite et al. (2010) found that more than half of older adults between the ages of 57 and 64 reported engaging in oral sex com- pared to only 28 percent of men and 36  per- cent of women between the ages of 75 and 85. The trends were similar for masturbation.

Grandma Does WHAT!?: Perceptions about Older Adults and Sex

Christina Barmon, Alexis A. Bender, and Elisabeth O. Burgess

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Stereotypes and misconceptions about older adults and sexuality have wide implications. Because of the stigma surrounding aging and sex, many older adults themselves have diffi- culty talking to health care providers about sex (Gott and Hinchliff, 2003). Conversely, health professionals are not always comfortable talk- ing to older adults about sex (Hughes, Rostant, and Curran, 2014). This discomfort can limit health-seeking behavior regarding sexual health (Lindau, Leitsch, Lundberg, and Jerome, 2006) and can diminish older adults’ comfort pursu- ing romantic relationships (Bender, Burgess, and Barmon, 2017). These issues are further complicated for older adults who identify as LGBTQ. They face stigma and discrimination in health care broadly, not just in discussing sex, and may have had to remain in the closet or go back in the closet as they age (Fredriksen- Goldsen, Jen, Bryan, and Goldsen, 2016; Tester and Wright, 2016).

These barriers to communication about sex also affect older adults who live in long-term- care facilities. Our research in assisted-living facilities shows that even when caregivers and family members espouse an ideology support- ing sexual freedom, they still act in a variety of ways that inhibit sexual autonomy, includ- ing staff seeking permission of family, discour- aging interested couples, and limiting privacy (Barmon, Burgess, Bender, and Moorhead, 2017). Perceptions of sexual autonomy are fur- ther complicated by concerns about dementia, such as the ability to consent.

Understanding sexuality and older adults requires the same straightforward approach as with any age group. Sex education, access to protection, and ability to consent must be part of the conversation. For example, due to physiological changes as we age, sexual pleasure, functioning, and desire may shift (Syme, 2014). Sex education can introduce new sexual techniques, positions, and aids to enhance sexual pleasure and accommodate

This  sharp difference between those two age groups most likely represents differences between those who were teenagers in the 1940s and those who came of age during the sexual revolution. In fact, a life course perspective on sexuality suggests that people most likely have similar fantasies, interests, and desires toward the end of their lives as they did in earlier years (Burgess, 2004). In other words, if someone places a higher or lower priority on sex at a younger age, this probably remains constant with age. Similarly, if someone is kinky at a younger age, they will most likely retain their kinkiness as they get older. At all ages, oppor- tunity structure and physical functioning influ- ence our sexual experiences.

A lack of interest in sexual activity is much more dependent on life circumstances than on age. The largest predictors of decline in sex- ual activity among older adults include lack of available partners, health status, and the mental and physical health of one’s partner (Gott and Hinchliff, 2003; Lindau et al., 2007). The major- ity of sex occurs within a monogamous relation- ship and the likelihood of having a sexual partner decreases with age (Karraker, DeLamater, and Schwartz, 2011). Waite et al. (2010) found 89 per- cent of men and 74 percent of women between the ages of 57 and 64 had a current sexual part- ner. But for people in the 75–85-year-old age group that number decreased to 78 percent of men and 41 percent of women. Additionally, the likelihood of having a partner with health prob- lems increases with age. Sixty-three percent of women and 20 percent of men between the ages of 57 and 64 reported not having sex because of a partner’s health problems. For those between the ages of 75 and 85, this increased to 65 percent and 23 percent, respectively. These social factors disproportionately affect women because they have a higher life expectancy and are more likely to form relationships with older men (Austad, 2006; Karraker, DeLamater, and Schwartz, 2011).

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Year-Olds.” Archives of Sexual Behavior, 17(2): 109–29. doi: 10.1007/BF01542662.

Burgess, Elisabeth, O. 2004. “Sexuality in Midlife and Later Life Couples.” In The Handbook of Sexuality in Close Relationships. John H. Harvey, Wenzel A, Sprecher S., eds., Mahwah, NJ: Lawrence Erlbaum Associates Inc. 437–54.

DeLamater, John, and Erica E. Koepsel. 2015. “Relationships and Sexual Expression in Later Life: A Biopsychosocial Perspective.” Sexual and Relationship Therapy, 30(1): 37–59. doi: 10.1080/14681994.2014.939506.

Fredriksen-Goldsen, K. I., S. Jen, A. E. Bryan, and J. Goldsen. 2016. “Cognitive Impairment, Alzheimer’s Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies.” Journal of Applied Gerontology, 1(25). doi:10.1177/0733464816672047.

Fritsch, Teresa. 2005. “HIV/AIDS and the Older Adult: An Exploratory Study of Age Related Differences in Access to Medical and Social Services.” Journal of Applied Gerontology, 24: 35–54. doi: 10.1177/0733464804271452.

Gott, Merryn, and Sharron Hinchliff. 2003. “How Important Is Sex in Later Life? The Views of Older People.” Social Science and Medicine, 56: 1617–28. doi: 10.1016/S0277-9536(02)00180-6.

Gott, Merryn, Sharron Hinchliff, and Elisabeth Galena. 2004. “General Practitioner Attitudes to Discussing Sexual Health Issues with Older People.” Social Science and Medicine, 58: 2093–103. doi: 10.1016/j .socscimed.2003.08.025.

Hughes, Anne K., Ola S. Rostant and Paul G. Curran, 2014. “Improving Sexual Health Communication Between Older Women and Their Providers: How the Integrative Model of Behavioral Prediction Can Help.” Research on Aging 36(4): 450–66. doi:10.1177 /0164027513500055.

Karraker, Amelia, John DeLamater, and Christine R. Schwartz. 2011. “Sexual Frequency Decline from Midlife to Later Life.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 66B(4): 502–12. doi: 10.1093/geronb/gbr058.

Lindau, Stacy T., Sara A. Leitsch, Kristina L. Lundberg, and Jessica Jerome 2006. “Older Women’s Attitudes, Behavior, and Communication about Sex and HIV: A Community-Based Study.” Journal of Women’s Health, 15: 747–53. doi: 10.1089/jwh.2006.15.747.

Lindau, Stacy T., Philip L. Schumm, Edward O. Laumann, Wendy Levinson, Colm A. O’Muircheartaigh, and Linda J. Waite. 2007. “A Study of Sexuality and Health among Older Adults in the United States.” New England Journal of Medicine, 357: 762–74. doi: 10.1056 /NEJMoa067423.

physiological change. Additionally, many older adults do not think they are vulnerable to sexually transmitted infections (STIs). Schol- ars have found that the population of older adults with HIV/AIDS is growing (Lindau et al., 2007; Fritsch, 2005; Poynten, Grulich, and Templeton, 2013), but we know less about other STIs. Lifelong sex education would pro- vide aging individuals with the tools to make healthy decisions about sexual activity. Finally, when some older adults face limitations due to cognitive impairment, families and caregivers should openly confront ethical issues, such as the ability to consent to sex. All these subjects require efforts to achieve comfort commu- nicating about sex across the life course. We will, no doubt, all learn something from the conversation.

NOTE 1. “MILF” (mom I’d like to fuck) is a pop culture slang term popularized by the movie American Pie and primarily associated with teenage boys who are lusting after a friend’s mom they think is hot (Taormino, 2007). The term “cougar” is a derogatory slang term used to describe middle-aged women who are perceived as predatory and are involved in or interested in relationships with younger men.

REFERENCES Austad, Steven N. 2006. “Why Women Live Longer Than

Men: Sex Differences in Longevity.” Gender Medicine, 3(2): 79–92. doi: 10.1016/S1550-8579(06)80198-1.

Barmon, Christina. 2016. “Successful Sexual Aging: A Feminist Gerontological Examination of Sexual Behavior and Health.” PhD dissertation, Department of Sociology, Georgia State University, Atlanta.

Barmon, Christina, Elisabeth O. Burgess, Alexis A. Bender, and James R. Moorhead Jr. 2016. “Understanding Sexual Freedom and Autonomy in Assisted Living: Discourse of Residents’ Rights among Staff and Administrators.” Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 72(3): 457–67. doi: 10.1093/geronb/gbw068.

Bender, Alexis A., Elisabeth O. Burgess, and Christina Barmon. “Negotiating the Lack of Intimacy in Assisted Living: Resident Desires, Barriers, and Strategies.” Journal of Applied Gerontology, forthcoming. doi: 10.1177/0733464817746756.

Bretschneider, Judy, G. and Norma L. McCoy. 1988. “Sexual Interest and Behavior in Healthy 80–102

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Series B: Psychological Sciences and Social Sciences, 72(3): 488–97. doi: 10.1093/geronb/gbw052.

Twenge, Jean M., Ryne A. Sherman, and Brooke E. Wells. 2017. “Declines in Sexual Frequency among American Adults, 1989–2014.” Archives of Sexual Behavior, 1–13.

Waite, Linda J., Edward O. Laumann, Aniruddha Das, and L. Philip Schumm. 2009. “Sexuality: Measures of Partnerships, Practices, Attitudes, and Problems in the National Social Life, Health, and Aging Study.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 64: i56–66. doi: 10.1093/geronb /gbp038.

Poynten, I. Mary, Andrew E. Grulich, and David J. Templeton. 2013. “Sexually Transmitted Infections in Older Populations.” Current Opinion in Infectious Diseases, 26(1): 80–85. doi: 10.1097/QCO.0b013e 32835c2173.

Syme, Maggie. 2014. “The Evolving Concept of Older Adult Sexual Behavior and Its Benefits.” Generations, 38(1): 35–41.

Taormino, Tristan. 2007. “The Rise of MILFs and Mommies in Sexual-Fantasy Material.” The Village Voice, October 30. Retrieved January 26, 2012 from http://www.villagevoice.com/2007-10-30/columns/ the-rise-of-milfs-and-mommies-in-sexual- fantasy- material/.

Tester, G., and E. R. Wright. 2017. “Older Gay Men and Their Support Convoys.” The Journals of Gerontology,

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R E A D I N G 3 2

It would be an exaggeration to define the oppression of disabled people exclusively in the sexual context; not many people with dis- abilities consider themselves a sexual minor- ity. Nevertheless, I want to argue that disabled people do constitute a significant sexual minor- ity and that recognizing their status as sexual citizens will advance the cause of other sexually oppressed groups. “Sexuality is often,” Anne Finger explains about people with disabilities, “the source of our deepest oppression; it is also often the source of our deepest pain. It’s easier for us to talk about—and formulate strategies for changing—discrimination in employment, education, and housing than to talk about our exclusion from sexuality and reproduction” (9). The facets of my argument are multiple, but most of them rely on the power of disability as a critical concept to defamiliarize how we think currently about sex. First, thinking about disabled sexuality broadens the definition of sexual behavior. Second, the sexual experi- ences of disabled people expose with great clarity both the fragile separation between the private and public spheres, as well as the role played by this separation in the history of regu- lating sex. Third, co-thinking sex and disability reveals unacknowledged assumptions about the ability to have sex and how the ideology of ability determines the value of some sexual practices and ideas over others. Finally, the sex- ual history of disabled people makes it possible to theorize patterns of sexual abuse and vic- timization faced by other sexual minorities.

Sexuality is not a right which must be earned or a posses- sion that must be purchased, but a state of being acces- sible to all individuals. Even those who sometimes have to fight for that access.

—Lucy Grealy, “In the Realm of the Senses”

The emergence in recent decades of people who define their identities based on sexual preferences and prac- tices is transforming the landscape of minor- ity politics. Sexual minorities are fighting for the rights and privileges accorded to majority populations on many legal and political fronts. The fight over gay marriage is only the most public and contentious of current struggles for full and equal rights by a sexual minority. Pro- ponents of minority sexual identity attack the neat division between the private and public spheres, the relevance of the traditional fam- ily and its institutions of marriage and child- rearing, and the moral certainty that sexuality is better controlled or repressed than set free. Claims that sexuality is a major part of a per- son’s identity, that sexual liberation is a good in itself, and that sexual expression is a civil right crucial to human happiness have led to new conceptions of civic life linked to sex. . . .

Disabled people have long struggled to take control of their bodies from medical authorities and to gain access to built environments and public institutions. Like [other] sexual minori- ties, . . . disabled people experience sexual repression, possess little or no sexual autonomy, and tolerate institutional and legal restrictions on their intimate conduct. Moreover, legal and institutional forces inhibit their ability to express their sexuality freely and to develop consensual relationships with sexual partners.

A SEXUAL CULTURE FOR DISABLED PEOPLE

T O B I N S I E B E R S

From “A Sexual Culture for Disabled People” from Disability Theory by Tobin Siebers, pp. 135–56. Copyright © 2008, University of Michigan. Reprinted by permission of Univer- sity of Michigan Press.

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their situation is not unique. Gay, lesbian, bisex- ual, queer, and transgendered people also suf- fer from a lack of sexual privacy, and economic resources may determine whether people have sex in private or public. Crowded housing situ- ations, for example, are as offensive to the con- ception of private sexual expression as health care facilities. The distinction between sex life and sexual culture relies not on privacy but on access as defined in a disability context: sexual culture increases access for disabled people not only by breaking down the barriers restricting them from sexual locations but also by bringing sexual rights to where they live. Second, the idea of sexual culture strips away what one might call the existential connotations of a sex life. Existen- tialism posits that identities are constructed by ourselves for ourselves, that all values are subjec- tive, that we are responsible for our choices, and that we are condemned to be free. The notion of sexual culture relies on different presupposi- tions about identity. I define sexual identities as theory-laden constructions, combining both objective and subjective values, used by individu- als to make choices, to test the consequences of their actions, and to explore the possibilities and responsibilities of their sexuality. Sexual culture is designed as a concept to provide a deeper, more sustained idea of how sex and identity interconnect by resisting the partitioning and privatization characteristic of a sex life. It means to liberate sex, allowing it to overflow the bound- aries of secured places and to open up greater sexual access for people with disabilities.

NO WALKS ON THE BEACH

I am looking for an intelligent, literate woman for compan- ionship and, perhaps, sexual play. I am, as you see, com- pletely paralyzed, so there will be no walks on the beach.

—Personal ad

Sex always happens somewhere. We go to certain places to fall in love or to have sex.

My argument will hinge on what I call the “sexual culture” of people with disabilities. This phrase is meant to set in motion a process of defamiliarization directed at experiences so inti- mate and unspoken, so familiar and yet myste- rious, that few people will discuss them. These experiences are bundled under what is colloqui- ally called a “sex life”—a term I contrast heuris- tically to “sexual culture.” Sexual culture refers to neither gender assignation nor sexual prefer- ence, although obviously they are components of sexual being. Sexual culture references the experience of sex itself. By sexual culture, I mean to suggest two ideas about how disabled sexual- ity disrupts the notion of a sex life: first, sexu- ality assumes a larger role in the quotidian life of people with disabilities than the usual phrase “sex life” indicates; second, the idea of a sex life is ableist. Being able- bodied assumes the capac- ity to partition off sexuality as if it were a sector of private life: that an individual has sex or a sex life implies a form of private ownership based on the assumption that sexual activity occupies a particular and limited part of life determined by the measure of ability, control, or assertiveness exercised by that individual. People with dis- abilities do not always have this kind of sex life. On the one hand, the stigma of disability may interfere with having sex. On the other hand, the sexual activities of disabled people do not necessarily follow normative assumptions about what a sex life is. Neither fact means that people with disabilities do not exist as sexual beings. One of the chief stereotypes oppressing disabled people is the myth that they do not experience sexual feelings or that they do not have or want to have sex—in short, that they do not have a sexual culture.

Two cautions must be remarked before I undertake an extended argument about the sexual culture of disabled people. First, the dis- tinction between sex life and sexual culture does not turn exclusively on the issue of privacy. While disabled people sometimes lack privacy for sex,

A S E X UA L C U LT U R E F O R D I S A B L E D P EO P L E 385

The doctor is speaking loosely about sex and membership in the human community, but he employs a widespread prejudice used against those who have lost human status along with the ability to have sex. What is it about sex that bestows human status? Barbara Waxman- Fiduccia argues that disability assumes the characteristic of a sexual perversion because disabled people are thought unable to produce “quality offspring” (168–69). It is reproduction, then, that marks sexuality as a privileged index of human ability. In fact, the ideology of ability underlies the imperative to reproduce at many levels, establishing whether an individual sup- posedly represents a quality human being. First, sex appeal determines the opportunity to have sex. The greater a person’s capacity to attract partners, the more opportunities to have sex. Second, a person must be able physically and mentally to have sex. Third, a person must be able to reproduce, to be either virile or fertile. To fail to be able to reproduce is somehow to fail as a human being. Finally, successful repro- duction is thought to pass our essential abilities and qualities to our children. The predominant assumption is that what we are will be visited upon our children. If a person does not measure up to society’s ideas about ability, that person’s opportunities to have sex will be limited. People with disabilities share with gay men and lesbi- ans the suspicion by majority populations that they cannot, will not, or should not contribute to the future of the human race. They will not reproduce, but if they do, the expectation is that the results will be tainted. Social stigma would have little impact on sexual behavior if it were not for the fact that ability represents the supreme measure of human choices, actions, thoughts, and values.

The concept of a sex life encapsulates many of the ways in which the ideology of ability dis- torts current attitudes about sexuality. At the most superficial level, a sex life is described almost always in the context of health. A sex

A  sex life, perhaps to our disappointment, tends to occur in the same places—the bed- room, hotels, automobiles, health clubs, baths, and so on. Sex will not happen if we do not have access to such places or if we cannot return to them once we discover that they permit sexual activity. If sex is walking together on the beach, if it is running across a field of flowers to meet in an embrace, what is the nature of sex apart from the ability to walk or to run? If a person’s wheelchair gets stuck in the sand or if low vision makes it uncomfortable to dash across a field, does it mean that this person will have little chance of having sex? Clearly, people who do not do these things or go to these places manage to have sex, but that is not exactly the point. The point is to ask how the ideology of ability determines how we think about sex.

The ideology of ability represents the able body as the baseline of humanness. Absence of ability or lesser ability, according to this ideology, marks a person as less than human. The preference for ability permeates nearly every value in human culture, including the ability to have sex. In fact, sex may be the privileged domain of ability. Sex is the action by which most people believe that ability is reproduced, by which humanity supposedly asserts its future, and ability remains the cat- egory by which sexual reproduction as such is evaluated. As a result, sex and human ability are both ideologically and inextricably linked. Mark O’Brien recounts a story about the belief that the inability to have sex robs the disabled person of human status:

We watched a movie about disability and sexuality. The movie consisted of four or five able-bodied men joking and laughing about how they once lugged their crippled friend up a flight of stairs to a whore- house. . . . After the movie, a doctor talked about disability and sexuality. . . . I will always remember his closing line: “You may think you’ll never have sex again, but remember . . . some people do become people again.” (O’Brien and Kendall, 80)

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O’Toole explains, to hear a story in which a man or woman who chooses to be lovers with a disabled person is congratulated by family and friends for making a good choice (217). What sea change in current scientific, medi- cal, political, and romantic attitudes would be necessary to represent disabled sexuality as a positive contribution to the future? To recon- ceive sexuality apart from ability, it would be necessary to imagine the sexual benefit of a given impairment, to claim and celebrate it as a sexual advantage.

PRIVATE PARTS IN PUBLIC PLACES

I was very shy before my accident. Dealing with lots of nurses doing extremely personal things to you— sometimes in front of other people—knocks off your shyness.

—A quadriplegic

If people with disabilities are to develop a sex- ual culture, they will need to access safe spaces where they may develop new erotic theories and modes of being. A major obstacle to this project is the separation between the private and pub- lic spheres and the history of this separation in regulating sexuality in general and disabled sexuality in particular. Feminists identify the private/public split as a source of gender and sexual oppression because it often reifies gen- der differences and disempowers women. First, men have more power than women to draw the lines between private and public life. Second, men often use this power to maintain or to increase their advantage over women, forcing them into dependency, using privacy to con- ceal sexual violence, and stifling any attempts by them at political protest. Because the state is reluctant to enter the private sphere, women are imprisoned there, made vulnerable to abuse by domestic partners and given the status of second-class citizens.

Disability studies support the feminist argu- ment that the private/public split is responsi- ble for political oppression, while deepening

life must be, first and foremost, a healthy sex life, and the more healthy a person is, the better the sex life is supposed to be. Whence the imperative in today’s culture to “work on” one’s sex life, to “improve” or “better” it, to do special exercises or adopt a particular diet for it, “to spice it up”—all for the purpose of dis- covering “the ultimate pleasure.” These and other catchphrases attend the commodifica- tion of sex as healthy and satisfying, but the connection between a sex life and ability runs deeper than cliché. When disability is linked to sex, it becomes a clinical matter in which each disability betrays a particular limitation of sexual opportunity, growth, or feeling. The literature on sex and disability recites a litany of limitations for each category of impair- ment. The blind have trouble with sex because it centers supposedly on a visualization of the body as integral whole, and lacking sight, they cannot visualize what a body is (Hamilton, 239). The mobility impaired and paralyzed are apparently cut off from sources of information about sex from peers, and their sexual develop- ment remains stunted (Shuttleworth, 265–66). Because of language delays, deaf people are believed to be emotionally and sexually imma- ture, living without the language tools needed to meet the high standards of communication required for sex (Job, 2004, 264, 266). Disabled women are said to tolerate sexism and objec- tification (Fine and Asch, 29-30). In general, people with disabilities are thought to suffer from distorted body images, considering them- selves ugly, and they do not feel at home with typical gender roles.

Because a sex life depends on ability, any departure from sexual norms reads as a dis- ability, disease, or defect. Moreover, the equation runs in the other direction as well: disability signifies sexual limitation, regard- less of whether the physical and mental fea- tures of a given impairment affect the ability to have sex. . . . Many people in the disability community are still waiting, as Corbett Joan

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those of us who need attendants and those who don’t,” Cheryl Marie Wade claims, “is the dif- ference between those who know privacy and those who don’t” (88).

Group homes and long-term-care facili- ties purposefully destroy opportunities for disabled people to find sexual partners or to express their sexuality. Even though inhabi- tants in group homes pay rent for their rooms, the money buys no functional privacy or right to use personal space. The staff usually does not allow renters to be alone in their room with anyone of sexual interest. Renters are subjected to intense surveillance, their activities entered in the day log. In many care facilities, staff will not allow two people to sit together alone in the same room. Some facilities segregate men and women. Add to these restrictions the fact that many people with disabilities are involun- tarily confined in institutions, with no hope of escape, and the enormity of their oppression becomes palpable. The intimate lives of dis- abled men and women, as O’Toole phrases it, are “monitored, documented and discussed by others” (220). Medical authorities make deci- sions about access to erotic literature, mastur- bation, and sexual partners.

The unequal power relations between staff and patients encourage sexual abuse. We are only beginning to gather data on the sexual abuse of people with disabilities, but initial sta- tistics indicate that the incidence of abuse is high (Ward, 2006; 1349), perhaps two to ten times more than the experience of the non- disabled population (Kaufman et  al., 2003, 8; Shakespeare, 1999, “Sexual Politics” 63). It is puzzling that paralyzed women are especially vulnerable, given that disabled women are not considered sexually attractive by mainstream society, until a closer look is given to the condi- tions of abuse. A woman unable to leave her bed is a woman always in bed, and conventionally a bed is a sexual site. Paralysis is also pictured easily as sexual passivity or receptiveness—an invitation to sexual predators, since the erotic

the perception that privacy is abandoned at a terrible cost. The experience of disabled people with the medical model has been key to this perception. The medical model thrives by sus- taining an essential difference between nondis- abled and disabled people, defining disability not as a flourishing of biological diversity but as an individual defect that medical profession- als cure or eradicate in order to restore a per- son to the superior state of health required by the ideology of ability. . . .

The presence of disability exposes the fra- gility of the traditional separation between private and public because economic factors do not obtain for disabled people in expected ways. Medicalization opens privacy to assault, and while economic privilege may make this assault less intrusive, it does not eliminate it. A private room in a hospital, no matter how expensive, is not like a hotel room, although it is leased for a certain period. No “Do Not Disturb” sign, controlled by a patient, will ever hang on the doorknob. Doctors, nurses, aides, and janitorial staff enter and exit at will. Despite the persistent fantasy that doctors, nurses, and nurse assistants provide sexual ser- vices, hospital trysts and erotic sponge baths are not part of their job descriptions. In fact, their professionalization hinges on being able to invade privacy while divorcing that invasion from its sexual associations. It may be accept- able, Dominic Davies explains, for a male patient to get an erection when having his penis washed, but “consensual, vigorous wash- ing is seen as forbidden” (183–84). As long as medical staff act professionally, they do not consider themselves responsible for sexual side effects, and yet they cross erotic boundaries constantly, with little real regard for the con- sequences of their actions. Patients in medical institutions do not possess the same rights as non-disabled staff. It is as if sick or disabled individuals surrender the right to privacy in exchange for medical care, even though care- givers work for them. “The difference between

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and erotic feelings. But, aware of their oppres- sion and defiant of its injustice, they have begun to explore an alternative sexual culture based on the artfulness of disability. The progress has been slow because the fight for access has usually tar- geted the public sphere. . . . Consequently, we know much more about the public dimension of disability than about its private dimension; we are at the beginning of a period of sexual investi- gation for disabled people, where information is scarce and ethnography and sharing of practices need to be pursued.

Nevertheless, there are signs that people with disabilities are claiming a sexual culture based on different conceptions of the erotic body, new sexual temporalities, and a variety of gender and sex ed identities. These emerging sexual identities have at least two significant charac- teristics. First, they represent disability not as a defect that needs to be overcome to have sex but as a complex embodiment that enhances sexual activities and pleasure. Second, they give to sexuality a political dimension that rede- fines people with disabilities as sexual citizens. It is crucial to understand that sexual citizen- ship does not translate merely into being able to express sexuality in public—a charge always levied against sexual minorities—but into the right to break free of the unequal treatment of minority sexualities and to create new modes of access for sex. In the case of disabled people, sexual citizenship has particular stakes. Some specific agenda items include access to informa- tion about sexuality; freedom of association in institutions and care facilities; demedicalization of disabled sexuality; addressing sexual needs and desires as part of health care; reprofession- alization of caregivers to recognize, not deny, sexuality; and privacy on demand.

While certain aspects of the body are not open to transformation, sexual desire and erotic sensation are remarkably flexible. For example, people with paralysis, who have lost feeling in traditional erogenous zones, have found ways

imagination thrives on clichéd positions and gestures. . . .

Frequently, . . . abuse is premeditated, rep- resenting acts of discipline, payback, or sexual harassment. O’Toole reports that many disabled women experience unacceptable touching by male doctors during medical examinations; they are sometimes publicly stripped and dis- played to medical students. These women recount feelings of fear, embarrassment, vul- nerability, and shame; they often try to separate themselves from their bodies, pretending that nothing is happening to them.

Personal choice and autonomy are constitu- tive features of the private sphere, but once sub- jected to medicalization, individual preference and self-determination evaporate. When the right to privacy and the medical model come into conflict, a new public sphere, controlled by medical figures and supportive of their author- ity, appears on the horizon. This medical zone of publicness replaces for people with disabili- ties everything formerly considered private. It engulfs them in an invasive and discrimina- tory space where they are viewed exclusively as medical subjects and the most casual stranger feels empowered to touch them, to comment on their disabilities, and to offer medical advice or charity. The medical model too often makes of the world a hospital where the disabled are obliged to be perpetual patients and the non- disabled have the right to play doctor.

THE EROTICS OF DISABILITY

Because I am so sensitive to touch, so acutely aware of a breeze on my neck, a ring on my finger, the rib of a sock pressing into my ankle, when I choose to participate in sexual contact, my unusually heightened physicality works for and not against me.

—Amy Wilensky, “The Skin I’m In”

As a sexual minority, people with disabilities face many limitations on their intimate behavior

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Disabled sexuality not only changes the erotics of the body, Vahldieck implies, but also transforms the temporality of lovemaking. For example, in the same way that narrative tempo- rality has a beginning, middle, and end, norma- tive sexuality requires beginning, middle, and end points. This is especially true of penetra- tive sex. Penetration has a preparatory phase, a period of sustainment, and a climax—all designed to prop up the physiognomy of the penis. One gets it up, gets it in, and keeps it up for as long as possible, until one loses it. Pen- etrative sex figures as a race against fatigue— a performance with a beginning, middle, and end. It also smacks of the assembly or produc- tion line, where part after part is added until the product is finished. The dependence of sex on penetration, incidentally, represents one reason why people tend to partition their sex life from everyday existence. Because the tem- poral phases of penetrative sex are so indelible, its narrative seems relatively autonomous, and it is easy to think of it as an activity apart from all other facets of life.

Because disabled people sometimes require advanced planning to have sex, their sexual activity tends to be embedded in thinking about the day, not partitioned as a separate event. Among disabled people, the so-called sex act does not always qualify as an action or perfor- mance possessing distinct phases such as begin- ning, middle, and end. Moreover, the myth that sex must be spontaneous to be authentic does not always make sense for people who live with little privacy or whose sexual oppor- tunities depend on making arrangements with personal attendants. Rather, disabled sexuality has an ebb and flow that spreads it out among other activities, and its physiognomy does not necessarily mimic conventional responses of arousal, penetration, or orgasm. “I used to get stuck, needing orgasm, needing penetration, etc.,” one woman explains. “Now, my sexual- ity has matured. . . . For example, one of the

to eroticize other parts of their body. They also develop new ways to please their partners by creating erotic environments adjustable to dif- ferently abled bodies. As feminists have made clear, normative sexuality requires a distinctive mapping of the body into limited erogenous zones (Irigaray, 1985). A parallel geography exists between the places on the body marked for sex and the places where bodies have sex. Although it is considered kinky to have sex in out-of-the-way places, it does not usually cross one’s mind to summon sexual feelings in places on the body not already demarcated by them. Andrew Vahldieck (1999) adds a particularly vivid and thoughtful account to the literature on sex after spinal cord injury about the erotics of the disabled body:

There’s a bumper sticker that proclaims, “Quads Make Better Lovers” and perhaps it’s true. One positive by-product of adapting to a disability is hav- ing to learn to go with the flow of experience, both mentally and physically. After severe spinal injury, one must begin again, and this includes developing alternate sense faculties. My erotic self need not be solely localized at the tip of my cock, where I’ve lost much sensation; I have learned that other areas of my body can be erotically sensitive and responsive. Sensation is mobile. My passion, desire and heat can be creatively restrained or refocused on more sensi- tive areas: ears, lips, neck, shoulders. In doing so, I can transfer sensual feeling into areas where sensa- tion is diminished.

Just as important has been learning to free myself from a preoccupation with my own pleasure. To give myself over to my partner. To slow down, not because I’m disabled and have to, but because I want to. This has proved crucial, paradoxically, to building up my own libidinous momentum. By relaxing into a quiet, tender space while stroking and touching my lover, I can engage vicariously in her enjoyment and stimulation so intensely as to share in her—and expand upon my own—felt pleasure. How curious that pleasing women orally has never been held as a form of manly sexual expression. Speaking as a man labeled “severely disabled,” this may truly be consid- ered a high and most subtle erotic art.

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who like extended oral pleasure. She was turn- ing her apparent severe disability into a distinct sexual advantage” (220–21). O’Toole also men- tions an account given by a lesbian amputee about enhancing the pleasure of her partners: “Can I just say that my two leg stumps make fabulous sex toys. I really think my amputated body is tailor-made for lesbian sex: I can crawl on top of my lover and grind my leg into her cunt in ways that I couldn’t if I had ‘real’ legs. Having my little stumps gives me much more freedom of motion and I can get closer, deeper into her that way. Plus, pushing myself into her and away from her and into her again, moving my hips and legs against/on her body is the closest I have come to slow-dancing in years and I love it” (215).

Disabled people may advance a different sexual geography both for the body and for the places where bodies express their sexual- ity. Just as disabled persons may change places on the body not usually associated with sexual feeling into erogenous zones, they reorganize places inhabited by bodies as locations for sex- ual culture. . . . As one woman explains it, “if you are a sexually active disabled person, and comfortable with the sexual side of your life, it is remarkable how dull and unimaginative non-disabled people’s sex lives appear” (Shake- speare, 2000, 163).

New formations of gender and sex ed iden- tity may be the final frontier of sexual citi- zenship for people with disabilities. Although present currents on the Left and Right wish to abolish identity entirely, especially identi- ties connected with sickness and perceived weakness, gender and sex ed identities make sexuality present as a mode of being not eas- ily closeted away or partitioned into isolated temporal and spatial segments. Claiming an identity based on sexual culture thrusts one’s minority status into the foreground, politicizes it, and creates the opportunity to clarify sexual needs and desires. It also resists the closeting

greatest highs I get (full-body orgasms? or spiritual-like orgasms?) is from having my neck bit” (Kaufman et al., 2003, 126). Some people without bodily sensation report experiencing mental orgasms when engaged in kissing, ver- bal play, or sexual fantasy. Others remark that sexual pleasure grows more intense with the advent of disability, owing either to physical changes or to a greater awareness of their body: “Since I became paralyzed in both legs I have noticed that I have varying kinds of orgasms, depending upon the situation. For example, when I play with myself and rub my clit a cer- tain way my orgasms are much more intense. Sometimes my leg will go into spasm and my crotch feels tingly” (Kaufman et al., 2003, 52).

A crucial consideration for people with dis- abilities is not to judge their sexuality by com- parison to normative sexuality but to think expansively and experimentally about what defines sexual experience for them. Sex may have no noticeable physical signs of arousal or may not conclude with an orgasm. When touching is involved, the places being touched may not be recognizable to other people as erogenous zones, which makes sex in pub- lic possible and a lot of fun. Sex may extend beyond the limits of endurance for penetra- tive sex, resembling slow dancing instead of the twist. It may seem kinky by comparison to what other people are doing. According to O’Toole, disabled sex often surprises a per- son’s community, no matter how radical. For example, in Boston in the mid-1990s, Connie Panzarino marched in a gay pride parade with a placard reading, “Trached dykes eat pussy all night without coming up for air” (O’Toole, 2000, 212). That a woman with little movement below the neck could be the active partner in sex and use her disability to enhance her part- ner’s pleasure stunned and shocked people. “This disabled woman,” O’Toole notices, “was using her disability as an advertisement for a sexual partner. She was appealing to partners

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of their own, their status as a sexual minority requires the protection of citizenship rights similar to those being claimed by other sexual minorities. The challenge of sexual citizenship for people with disabilities is great because they remain one of the largest unrecognized minor- ity populations; little awareness exists about the manner of their oppression; sex is a taboo subject for everyone and for disabled people in particular; and the unquestioned embrace in most societies of ability as an ideology denies participation in the public sphere to those not deemed quality human beings. Integral to sex- ual citizenship for people with disabilities is the creation of a safe space with different lines of communication about disabled sexuality; they need in effect to invent a new public sphere receptive to political protest, public discussion, erotic association, and the sharing of ideas about intimate practices and taboos, erotic techniques and restrictions, sexual innovation and mythologies.

In the clash of the culture wars, some people have argued for a monoculture where we aban- don all identities except nationality, while other people argue for a multiculture where we embrace many identities—racial, ethnic, gen- dered, national, and sex ed. The call for a dis- ability culture in general and a sexual disability culture in particular will arouse, no doubt, the anger of the first group and garner, with luck, the support of the second. But the stakes in the emergence of a sexual culture for disabled people are greater than the dispute between these two political factions. The stakes concern questions about fundamental rights expected by all citi- zens in a democratic society: freedom of associa- tion and intimate companionship; authority over their own body; protection from violence, abuse, and oppression; and the right to pursue a sex- ual future of their own choosing. Because every citizen will become sooner or later a disabled citizen, the struggle of people with disabilities for sexual rights belongs to everyone.

of gender and sexuality central to Western attitudes about sex. It may be especially valu- able for people with disabilities to assert sex ed identities, since Western attitudes seem mar- ried to the argument that “sex is sick,” giving people perceived to be “sick” extra purchase in making counterarguments.

Apart from the urgency of political resis- tance, it may simply be the case that different identity formations suit people with disabilities better. They often complain that conventional notions of male and female or straight and gay do not apply to them (Shakespeare, 2000, 163), and it is fairly obvious that their sexual prac- tices depart from many of the founding myths of normative sexuality. Disabled people do not embody gender in “natural” ways because gender stereotypes do not allow it. “It’s like I don’t have any maleness,” one disabled man complains (Shuttleworth, 2000, 272). Cer- tain disabilities appear to offer specific gender limitations. Men with cerebral palsy cannot touch or hug their female partners in the ways to which they are accustomed (Shuttleworth, 2000, 269). Blindness changes sexual flirtation from afar between men. But another person puts a positive spin on flexible gender identity: “Why should men be dominant? Why should sex revolve around penetration? Why should sex only involve two people? Why can’t disabled people be assisted to have sex by third parties?” (Shakespeare, 2000, 163). O’Toole notes that no lesbian equivalent of the missionary posi- tion exists, and that partners are not obliged to have orgasms in the same position at the same time (213). Disabled sexuality embraces a simi- lar flexibility. The sex ed identities of disabled people are of value to all sexually active people, Shakespeare claims, because they allow for a continuum of sexual practices and encourage a greater willingness to embrace diversity, exper- imentation, and alternative sexual techniques (1999, 58). If we are to liberate disabled sexual- ity and give to disabled people a sexual culture

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O’Toole, Corbett Joan. 2000. “The View from Below: Developing a Knowledge Base about an Unknown Population.” Sexuality and Disability 18.3: 207–24.

Shakespeare, Tom. 1999. “The Sexual Politics of Disabled Masculinity.” Sexuality and Disability 17.1: 53–64.

———. 2000. “Disabled Sexuality: Toward Rights and Recognition.” Sexuality and Disability 18.3: 159–66.

Shuttleworth, Russell P. 2000. “The Search for Sexual Intimacy for Men with Cerebral Palsy.” Sexuality and Disability 18.4: 263–82.

Vahldieck, Andrew. “Uninhibited.” Nerve. 19 November 1999 (http://www.nerve.com/PersonalEssays/Vahldieck /uninhibited/).

Wade, Cheryl Marie. 1994. “It Ain’t Exactly Sexy.” The Ragged Edge: The Disability Experience from the Pages of the First Fifteen Years of the Disability Rag. Ed. Barrett Shaw. Louisville: Advocado Press. 88–90.

Ward, Amy Paul. 2006. “Rape.” Encyclopedia of Disability. Ed. Gary L. Albrecht. Thousand Oaks, CA: Sage. 1348–51.

Waxman-Fiduccia, Barbara Faye. 2000. “Current Issues in Sexuality and the Disability Movement.” Sexuality and Disability 18.3: 167–74.

Wilensky, Amy. “The Skin I’m In.” Nerve. 24 October 2001 (http://www.nerve.com/PersonalEssays/Wilensky/skin/).

REFERENCES Davies, Dominic. 2000. “Sharing Our Stories, Empowering

Our Lives: Don’t Dis Me!” Sexuality and Disability 18.3: 179–86.

Fine, Michelle, and Adrienne Asch, eds. 1988. Women with Disabilities: Essays in Psychology, Culture, and Politics. Philadelphia: Temple University Press.

Finger, Anne. 1992. “Forbidden Fruit.” New Internationalist 233: 8–10.

Grealy, Lucy. “In the Realm of the Senses.” Nerve. 25 October 2001 (http://www.nerve.com/dispatches /Grealy/RealmOfTheSenses/).

Hamilton, Toby. “Sexuality in Deaf Blind Persons.” 1979. Sexuality and Disability 2.3: 238–46.

Irigaray, Luce. 1985. This Sex Which Is Not One. Trans. Catherine Porter. Ithaca: Cornell University Press.

Job, Jennifer. 2004. “Factors Involved in the Ineffective Dissemination of Sexuality Information to Individuals Who Are Deaf or Hard of Hearing.” American Annals of the Deaf 149.3: 264–73.

Kaufman, Miriam, Cory Silverberg, and Fran Odette. 2003. The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness. San Francisco: Cleis.

O’Brien, Mark, with Gillian Kendall. 2003. How I Became a Human Being: A Disabled Man’s Quest for Independence. Madison: University of Wisconsin Press.

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R E A D I N G 3 3

BDSM is a project, a practice of developing oneself as a skilled practitioner, of learning how to be a practitioner (see Weiss, 2006). Becoming a practitioner takes work on the self: finding the community, attending events, learn- ing techniques and skills, and educating one- self. These practices are forged in relation to the community norms and rules, but—as Foucault emphasizes—it is not a question of comply- ing with the rules, but of transforming oneself through one’s own interpretation of the rules. As he argues, the proper use of pleasure, one’s self-mastery in relation to pleasure, produces a “solid and stable state of rule of the self over the self” ([1984] 1990, 69; see also 91–92). This rule is less a strict rule of conduct and more about individualizing, moderating, and elaborating conduct, subjecting the self to his own moral mastery. Foucault’s understanding of self-mas- tery in relation to the rules of pleasure is useful here, as SM practitioners also learn to elaborate codes of conduct, to subject themselves to a kind of self-mastery that is supplementary to, rather than in strict compliance with, social and community norms. As Foucault argues, in time, these practices of the self “evolved into procedures, practiced and taught. It thus came to constitute a social practice, giving rise to relationships between individuals, to exchanges and communications, and at times even to institutions” ([1984] 1988, 45). . . . The rules, worked on as part of the labor of becoming an SM practitioner, also produce this particular SM community and the circuits and exchanges it endorses.

Working at BDSM play is also work on the self: it produces and consolidates subjectivities and communities. It is deeply class-inflected,

relying not only on the income and time to attend courses and conferences, but also on shared forms of community recognition— education, expertise, and mastery—that are most available to professional-class practitio- ners. This exclusivity, however, is displaced and obscured in community discourse; these forms of recognition are hegemonic precisely because they construct an ideal, class-restricted com- munity member (the professional practitioner with sufficient means and proper education) toward which other, nonaffluent practitioners aspire. Universalizing ideologies, therefore, normalize such careful work on oneself and one’s pleasures. Bailey, a white, heterosexual bottom in her mid-forties, explains that she got into the scene after joining a local SM e-mail list: “I found out about munches [group meals]. I started showing up, and from there I just networked the hell out of it. So I’ve been active in the public community in the Bay Area going on six years now. Two years ago I did six national events. Last year I probably did four. . . . More-educated people, more- knowledgeable people, more-affluent people tend to be at the national conventions. And I’m like, ‘Well, I want to learn more. That’s why I’m going.’” Thinking of the rules in this way focuses attention on self-mastery and knowledge as an active practice of modula- tion, testing, analysis, and self-cultivation.

BECOMING A PRACTITIONER: THE BIOPOLITICS OF BDSM

M A R G O T W E I S S

From “Becoming a Practitioner: Self-Mastery, Social Con- trol, and the Biopolitics of SM,” in Techniques of Pleasure, Margot Weiss, pp. 61–100. Copyright, 2012, Duke Univer- sity Press. All rights reserved. Republished by permission of the copyright holder. www.dukeupress.edu.

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impact bondage, or that the word slut is accept- able, but whore is not). One should also explain the kinds of SM play one particularly likes. Finally, one should describe one’s limits; the most common limit is “dead people, kids, and shit,” although there are many other limits.

SM guidebooks explain how to negotiate with a partner in excruciating detail; Wise- man’s SM 101, one of the most popular, has a ten-page “long form” for negotiation that lists sixteen categories with spaces so that practi- tioners can fill in the blanks with their own desires, limits, and protocols. The categories include people involved; place; how long the scene will last; emotional and physical limits; presence and kind of sex and safe-sex proce- dures; presence and kind of bondage and pain; what, if any, marks can be left; and safewords (Wiseman, 1998, 58–62). Many people rely on verbal negotiation, but many others use these highly formalized checklist negotiation forms to plan a scene.

Similarly, the use of safewords—words like red or safeword or pineapple that are unlikely to come up during a scene—was introduced in the 1970s and has now become a crucial part of contemporary SM. Wiseman recommends hav- ing two safewords, “one for ‘lighten up’ and one for ‘stop completely.’ ” He adds, “I also strongly recommend using the ‘two squeezes’ tech- nique. If the players will use a gag or a hood, they must agree upon nonverbal ‘safe signals’ ” (1998, 62; italics in original).4 Semipublic play parties almost always have a house safeword, usually safeword or red. Viewed as a last resort, safewords function as an out for when the scene has gone too far—when it has exceeded the boundaries of either player. Thus, like negotia- tion, safewords have become an institutional- ized procedure of safety.

Many practitioners find this level of plan- ning and negotiation ridiculous. Lady Hilary, for example, explained that “rules now are for safety.” “Not that safety’s not important,

This form of self-mastery . . . is articulated especially strongly around the rules, especially rules—like Safe, Sane, and Consensual—that require practitioners to forge their own prac- tices of safety. Safe, Sane, and Consensual (SSC) is the mantra of SM in the United States today. Coined in 1983 by David Stein, as part of the statement of purpose of GMSMA (Gay Male S/M Activists), the slogan was popular- ized across the country and is now widely endorsed by BDSM organizations.1 . . . Stein notes that the slogan was originally under- stood to distinguish “defensible” SM, practiced on “willing partners for mutual satisfaction,” from “harmful, antisocial, predatory behav- ior,” “the coercive abuse of unwilling victims.” Beyond being a motto, however, Safe, Sane, and Consensual has become critical to the social organization of SM; it is the primary way practitioners distinguish between good, safe, acceptable SM and bad, unsafe, unaccept- able practice. To ensure that the community of practitioners corresponds to SSC rules, several practices have become standardized; the two largest, most institutionalized are negotiation and using safewords.

Although it is likely that old guard scenes involved some sort of negotiation, today, all BDSM scenes are supposed to involve fairly formal negotiation.2 Like the infamous Antioch College rules that required explicit and specific verbal consent for every sexual act, negotia- tion ensures that there will be informed con- sent throughout the play, and that each player’s desires and fantasies will be responded to in the course of the scene.3 Unlike the Antioch rules, negotiation is supposed to be done before the play, thus requiring anticipatory foresight. During negotiation, one should divulge any emotional, physical, or sexual information that may be important (for example, one should tell one’s partner about the child abuse that may crop up and force the scene to end abruptly, or how one’s carpal tunnel syndrome might

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counterproductive to many. Indeed, this is one of the most common vanilla responses to SM that I hear: how can a scene that is negotiated ahead of time be hot, believable, or fun?

There are two related ways to approach this question. The first is to note the pleasure that inheres in the rules. So, for example, in a front- page news story in the New York Times on the Antioch rules, Jane Gross reported that stu- dents liked the policy. They thought that talk- ing about sex was erotic, that it was more about setting up “ground rules” than a rigid checklist, and that the policy effectively addressed rape (1993). In this case, negotiation is a practice that carries with it some unintended plea- sures: the pleasures of describing one’s desires in detail, for example, a pleasure (bound to safety) that many people—especially women who have sex with men—emphasized when contrasting SM sex with vanilla sex. . . . The second approach, which I follow here, is to note that community pressure to be safe, sane, and consensual does not ask practitioners to blindly follow the rules, but rather to negotiate their own relationship to these rules, to define safety and risk for themselves. This work cre- ates a relationship between individual subjects and social norms, a relationship in which one’s enactment, disavowal, or disregard of the rules is a form of self-subjugation and self-mastery in accordance with professional-class standards. This provides one way to read SSC SM and the rules as technique, allowing us to see the com- munity debates about the rules and their plea- sures as themselves part of the construction of SM practitioners.

For example, many of the BDSM practi- tioners  with whom I spoke agreed that Safe, Sane, and Consensual was a simplistic slogan, but they had varying opinions about its value. Most thought that SSC was a good policy, but that it couldn’t really be followed to the letter. Many also felt that it was, as Teramis puts it, “an easy sound bite for newbies to digest . . .

but . . . none of the rules enhance the dynamic. ‘Oh, let’s over-process how we’re going to play. So you want to be spanked five times—okay, fine, but six I can’t do.’ And then I have to do this, so that’s how some people negotiate a scene. It’s now lost the tension.” Pam, a white, bisexual slave in her fifties, described com- ing out into the scene in her twenties, when “it wasn’t a bunch of negotiation.” “I found who he [gesturing to Vince] was as a person and his character and everything else and that was enough to serve him.” With the new play- ers, she explained, you sit down and negotiate “an hour and a half for a twenty-minute scene.” “And I’m just like . . . ‘you’re boring the shit out of me.’ ” Pam is in service to her master Vince, a white, gay man in his mid-forties; they play without safewords or negotiation because, as she explains, “he knows just where I am at every moment, and plus if something does hap- pen that he’s not aware of, I can just say it. I don’t have to go ‘beige’ or ‘yellow’ or ‘green’ or whatever the hell they’re all doing.” Vince agrees: “I think that we can think about sex or we can have sex. And so my question and my process has always been ‘Is this someone that I can connect with? Can I sense you? Can I feel you?’. . . If that’s possible, then I don’t really need to negotiate because all I really need to do is pay attention.”

Here, practitioners’ concern that the more mechanical exercise of negotiation destroys the heart of modern BDSM parallels the main- stream press’s response to the Antioch rules. Like the excessive zeal of mandatory bicycle helmet laws, the rules were seen as political correctness gone awry. These critics of both safewords and negotiation argue that by codify- ing very specific ways of doing SM, the intense connection that SM can create between part- ners is destroyed, that excessive negotiation will diminish interpersonal intimacy. Taking sex, a practice that is supposed to be spontaneous and magical, and delineating and codifying it seems

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abuse.” “[But] my opinion is also that we’ve picked the wrong three words. I can’t think of any activity . . . that I would wholeheartedly call safe . . . [and] the definition of sanity is actually a legal issue.” He continued, half jok- ing: “Now if it were something like informed, consensual, and involving a level of risk that was comparable to, say, everything that every- body on the planet does, I’d be all for that.” For this reason, many prefer RACK (risk-aware consensual kink), a term coined by Gary Switch of TES in the late 1990s.6 Teramis argues: “You can’t define for somebody what’s safe for them. You can’t define if what somebody’s doing is sane for them. [What matters is] that I’m aware of the risks, I’m informed, I’ve given consent, and it’s making me happy.”

Practice—being “informed,” learning the risks, being educated—leads here to less safe, sane, and consensual SM, but this is not sur- prising. Rather, it is through these community practices of education, classes, orientations, and the like that practitioners take responsibil- ity for their own practices of safety, that they map out their own relationship to the rules. So, for example, Domina and Hayden told me that they play without limits or safewords, as do Jez- zie and Anton. Jezzie explained that she initially needed SSC to feel comfortable in the scene, but then she “kind of outgrew it.” “Safe, well, what if I knowledgeably want to do something risky? Sane, what the hell does that mean? I mean, I’m in the mental health profession!” For her, SSC is “like training wheels.” Once one is a part of this community, having learned social norms through educational structures, one should “outgrow” or cultivate one’s own rules.

This is why many, like Annalee—a white, bisexual genderqueer/pervert/voyeur in her early thirties—insisted on their own definition of the terms. Annalee explains: “I’m a fan of consensual sex, however you each consent with your partner. You can each consent like, ‘okay, I consent to having you push my boundaries

a good tone to strike for the masses,” or “cre- ated as outreach or propaganda, and I think it’s best in that role,” in Anton’s words. Others liked it for its usefulness in conveying to medi- cal professionals, psychologists, or the police the difference between BDSM and abuse, rape, torture, or violence—as well as between BDSM practitioners and psychopaths.

A few unconditionally liked the phrase. For example, Monique Alexandra—a Latina, bisexual bottom/submissive/masochist in her mid-thirties—thought that the use of negotia- tion and safewords in the community made her feel comfortable and, more important, safe: “I want things that are exciting, but I want to know I decided to have that done, and that at any point I can say whatever the codeword is and it will stop. . . . Safety is very important to me; I would not play with anyone who has the attitude ‘I won’t negotiate because it’s boring.’ ” For some, the emphasis on safety reduced the fear that people coming in to the scene may experience, but it didn’t make BDSM any less erotic. As Mustang explains: “Safe doesn’t mean you’re driving around in your Subur- ban. . . . Some of these people are pretty far out on the edge. . . . It’s people doing things safely and yet still getting what they need.” For him, community resources, experts on things like “rope or whipping or electricity,” and medi- cal doctors and lawyers who are “kink aware,” are all aspects of community development “not available ten years ago.”5 This development means that there is “community support to say, ‘here’s what edge play is, here’s what it means, here’s the things you need to do, here’s what you can’t do, and here are the risks you’re tak- ing when you do it,’ so there’s informed con- sent. I think that’s a wonderful thing. . . . It’s what saved me.”

Yet many people pointed out that there was no way to be truly safe, sane, or even consen- sual. For example, Chris told me that “we need some way of distinguishing this [SM] from

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and this is one reason they remain ambivalent about the rules as well as the cultural main- streaming of SM fashion and, to some degree, practice.

At the same time, practitioners are quick to rely on precisely the binaries established by SSC to assert that SM is not what Stein referred to as “harmful, antisocial, predatory behavior,” and what many would call simple, sociopathic sadism. The rules, then, solicit a complex tech- nology: they create a social context within which SM practice is understandable—as sex- ual and as desirable—and they also demand that individual practitioners chart their own relationship to that edge between safety and risk, control and the “abyss.”

Here, risk must be understood as produc- tive and desirable, not merely aversive. This is, in part, a critique of the “risk society” thesis of Anthony Giddens and Ulrich Beck, which—in the words of Merryn Ekberg—suggests that societies like the United States are character- ized by a “collective consciousness of anxiety, insecurity, uncertainty and ambivalence” that produces “an ethos of risk avoidance” (2007, 346, 344). As Ekberg puts it in a review essay, these understandings posit the risk society “in contrast to primary, industrial modernity, which was characterized by the safety, secu- rity, predictability and permanence of inher- ited traditions, such as class location, gender roles, marriage, family, lifetime employment and secure retirement.” The risk society, how- ever, “is characterized by a dislocation, disinte- gration and disorientation associated with the vicissitudes of detraditionalization” (346).

Although many scholars agree that risk, anxiety, and security are key discourses in the contemporary United States, this univer- salizing meta-theory has come under attack [too] . . . (Zaloom, 2004; see also T. Baker and Simon, 2002; Mythen, 2007). First, as Ekberg notes, “communities have not disap- peared [due to social dislocation], rather they

until I say red,’ which might not be somebody else’s definition of safe, sane, and consensual, which would be like, ‘we will agree on ten acts to be performed in this order.’ I’m not a fan of the ‘ten acts in this order.’ I just think it’s too much to remember. . . . If I’m playing with friends, or partners, we know each other well enough that we can push these limits and [do] whatever the hell we feel like doing. There’s a lot of safety built into it, and that’s how I define safe, sane, and consensual.” All of these debates point to the ways practitioners work with and customize the rules and definitions of safe, sane, consensual, and negotiated. The rules provide a social structure, a scaffolding, within which people cultivate their own ways of being practitioners with—and against—the rules.

RISK AND SOCIAL PRIVILEGE

In a speech critiquing the SSC mantra of con- temporary BDSM, Alison Moore argues that “when we invent these sorts of simplistic slo- gans to differentiate our behavior from non- consensual violence, what we end up with is often a set of definitions that do not reflect anyone’s way of doing SM.” She continues: “For me, the whole beauty of SM play is that it doesn’t always make sense, that it does take us outside our ‘safety zone,’ that it is fright- ening; it taps into the purest essence of sex, which is ultimately chaotic, chthonic, exhila- rating, exuberant, a dizzying abyss, an electri- fying scream. . . . There is no political slogan to describe this.”7 Moore neatly summarizes the desire that many people have: to have sex that is unsafe. SM sex is already edgy sex, in that it is—to the general public, at least— forbidden, dark, and prohibited. It is also risky, although generally no more physically risky than football, rock climbing, or other sports. Maintaining this allure of the clandestine, out- law, or dangerous is important to practitioners,

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want “thrills,” but also “high-risk performers seek controllable risk contexts where their abil- ities can be challenged” so that they can “attain mastery, self-efficacy, and flow” (16). Of course, the edge is not a fixed limit; it changes based on ability, knowledge, experience, and confi- dence level. Hence risk is not to be avoided but managed; not a static relationship but a bound- ary of self-improvement and skill.

In SM, edgework might be productively discussed in terms of edge play, a category of play that is physically or psychologically risky or dangerous (see also Henkin and Holiday, 1996, 66). Examples of edge play include sus- pension bondage, electricity, cutting, pierc- ing, branding, enemas, water sports, scat, breath play, knife play, blood play, gun play, terror play, intense humiliation, race and cul- tural trauma play, singletails, and fire play— all kinds of play in which the risk of physical or emotional damage is fairly high. Patrick Califia adds to this list mind games, consen- sual nonconsent, abduction and kidnapping, catheters and sounds, and scarification (2002, 193–215). The management of risk is central to the classification of edge play. Some of these play forms are edge play because they risk unintentional physical harm, such as falling during suspension bondage. Some risk long- term bodily damage, death (for example, heart stoppage with electricity play and suffocation during breath play), disease, or psychological trauma. Yet these definitions are not stable; familiarity changes what counts as risky SM. For example, many participants think play piercing is no longer edge play because so many people do it, and the techniques have become standardized. Single-tail whips, too, became trendy during my fieldwork, and there were many classes on how to throw or crack them correctly; this made the use of singletails at semipublic parties much less edgy. Breath play, on the other hand, is widely prohibited, at least for now.

have reformed around risk and safety. . . . Risk is now the collective bond holding communi- ties together as imaginary risk communities” (2007, 346). Second, imagining a “collective consciousness” of risk aversion “negates the possibility of a risk-seeking culture” (362). The desirability of risk—its pleasure and benefits— is part of this ethos and combines with the community- and subject-producing aspects of risk. . . .

Building and mastering BDSM skills pro- duce new subjects in relation to an evaluative community. The community evaluates one’s education, trustworthiness, experience, and skill. So, for example, Bailey explained to me that a DM at a party once stopped her friend: “One of the things he’s very good at and he teaches is Japanese rope bondage, in particu- lar suspension bondage. And . . . the last two years in a row they stopped the scene before he [had finished the] suspension because they didn’t think he was safe. And if there’s anyone I would trust to do that, it would be him. He knows his stuff.” Here, trust is based on knowl- edge and skill, in terms of one’s public persona. Waldemar, a white, bisexual mostly top in his early thirties, explains that he has no problem making playdates: “I’m well known, and people trust me and they like what I do.” Francesca, a white, bisexual, pain slut bottom in her late forties, explains that if she were playing with a friend, she “could probably take a lot more stressful [forms of play].” “It’s a matter of trust, how much do I trust this person? And trust is based on knowledge for me.”

Concepts of risk also entail “edgework,” or “the personal exploration of the limits of both the context and the individual’s ability to con- trol it” (Celsi, Rose, and Leigh, 1993, 16). Here, as Richard Celsi, Randall Rose, and Thomas Leigh note, in an essay exploring the motiva- tions of skydivers, “many high-risk perform- ers learn to like working at the edge of their abilities, ‘to push the envelope’” (16). Skydivers

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play, for these practitioners, should be unsafe, a place where boundaries and limits can be pushed outside of a personal safety zone.

Yet these practitioners also forge an ethical relationship with the self based on techniques, self-mastery, and community norms or rules. Sybil—a white, bisexual dominant/mistress in her mid-fifties—told me: “This whole thing about ‘edge play’ is a joke. Edge play is not heavy, it’s what’s heavy to you. So edge play is . . . blood and heavy whipping . . . to some people, [but] that’s not all there is to edge play. If you have a phobia of needles, that’s edge play. If you’re freaked out because you’re a woman and I don’t want you to wear pink lingerie, that’s edge play. Whatever makes you nervous and you don’t want to go there, I want to go there ’cause that’s where the exchange of power comes from.” Sybil’s comments show how community rules incite individual or per- sonal responses: the self-cultivation of prac- tice. The point here is not that breath play or edge play is strictly prohibited, thus inciting the desire to do it. Rather, self-mastery as a practitioner requires the production and sub- sequent personal refinement of community rules.

As Liz Day notes, all the authors in the SM essay collection Leatherfolk (Thompson, 1991) claim that SM is transgressive (of nature, cul- ture, materiality, and discourse) because it is “outlaw” (Day, 1994, 243). These essayists, like the practitioners who argue that SM is (or should be, or used to be) outlaw, read the limitations imposed by community rules as a coercive form of disciplinary power, forcing practitioners to choose between replication (obeying SM community rules) or transgression (operating outside of, or in violation of, these rules). Rather, these community debates about edge play, risk, and safety produce knowledges that, in turn, encourage practitioners to posi- tion themselves in relation to these rules and thus this ethical community. In edge play, then,

The desirability of managed risk, in edge play, is an opportunity to fashion oneself as a person with skills and knowledge in relation to SM as a risk community. This is why many people told me that they do breath play, but not that kind of breath play. Domina, for example, told me: “I don’t do much in the way of breath play. I might put a gas mask on somebody and put my hand over the intake, but I don’t believe in breath play because you can kill people doing it.”8 Anthony described a scene in which a woman was encased in Saran Wrap: the top wrapped it around her body, over the top of her head, and finally across her face. The top then “ripped it off [from the roll] and walked away and left her there flopping and struggling for breath, and then finally when the thing [Saran Wrap] started sucking way in [to her mouth], he pops his finger in it.” Anthony has adapted this scene for himself, using a latex mask that he rips off just in time. But then, he tells me, “in reality I’m only holding her nose for maybe twenty or thirty seconds; it’s not really that long at all. It’s not really breath play.” For Anthony, the scene had what he termed “symbolic value,” but it wasn’t “really all that edgy.” “I do some knife play, but I don’t really slice anybody up. I’ll cut a couple layers of epidermis and then blood will pool up on the cut.” These practitio- ners, by claiming that their play isn’t really dan- gerous, are actively redefining their practices as manageable—SSC—risk.

Other practitioners enjoy imaginatively vio- lating community standards. There are com- munity jokes and T-shirts that say “unsafe, insane, nonconsensual,” an homage to the out- law quality of SM play. In our interview, Vince explained that he and Pam “play with the edges, we play with that monster.” Pam clarified the point: “It’s kind of like running a marathon or climbing a mountain, it’s like ‘Can I do it? Where are my edges? Where do I stop? Where do I start?’ . . . If you always stay in your safety zone, how do you know what you can do?” SM

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continues to appeal to—and produce—these same practitioners. . . .

NOTES 1. David Stein’s essay “Safe, Sane, Consensual” was presented in a workshop at the Leather Leadership Conference in Washington, D.C., in April 2000 and is archived at the Leather Leadership Conference website: http://www.leatherleadership.org. An updated version was published in 2002 as “Safe, Sane, Consensual: The Making of a Shibboleth” in VASM Scene 20 (September/ October).

2. This is not to say that all people negotiate; for example, most people in 24/7 (full-time) or M/s relationships do not use safewords or negotiate with each other, although they may use safewords, limits, and negotiation when they play with others. Many people also cease using safewords and negotiation when they know their partner well. For example, Bailey, who is usually a bottom, told me that she decided to top her partner: “It was awesome because I knew him long enough that I knew he didn’t want to negotiate. He just wanted it to happen. I wouldn’t normally do that with people if I didn’t know them really well, but that’s the cool part about really knowing your partner. You can make judgment calls like that.”

3. The Antioch rules were created in 1992 in response to the crisis of consent in legal and social definitions of rape, especially date rape (see Soble, 1997). Anton reminded me of this link when he said he thought that SSC “has sort of infected the community with . . . this sort of safety-first mentality that I don’t agree with at all. . . . There are some people who I think take [it] too far. You have to go through a rigorous checklist before you do anything—you know, this sort of . . . what is that college, the university that put those rules for dating in place where you had to ask people before you could—‘May I touch your breast?’” “Antioch?” I asked, and he replied “Antioch, yeah, these sort of Antioch rules for BDSM.”

4. “Two squeezes” is a way for a top to check in on a bottom. The top squeezes the bottom’s arm or leg twice; if all is well, the bottom gives two squeezes in return. A “safe signal” or “drop safe” is a non-verbal safeword, such as an object that the bottom can drop on the floor.

5. Mustang is referring to an online community service managed by Race Bannon called “Kink Aware Professionals,” a list of kink-friendly doctors, therapists, and lawyers across the United States.

6. Gary Switch’s essay, “Origin of RACK; RACK vs. SSC,” was originally posted on the Eulenspiegel Society’s (TES) e-mail list in the late 1990s. An archived version of the post can be found at http://www.leathernroses.com /generalbdsm/garyswitchrack.htm.

pleasure comes from defining and marking the boundaries and limits of what can be done; in policing and enforcing these boundaries in the community and in one’s own play; and in mastering the rules—the knowledge, skills, and techniques of self-improvement—that make being a practitioner possible.

Here, risk is not aversive, nor does it stand outside of or serve as an escape from the demands or “constraints of modern social routines” imagined as boring, banal, or rou- tinized (Zaloom, 2004, 365). Although these practitioners—like high-risk hobbyists such as rock climbers and skydivers—imagine their practice as a break from the “real world” that is simultaneously closer to their authentic selves, the management of risk is actually a way of aligning their play selves with “real life.” Indeed, imagining a risk community as a break from the real world is . . . a way of bracketing off SM play as a priori “safe” and “fantasy.” This bracketing works as an alibi to screen off SM as safe precisely when it is most productive—of selves, communities, and social inequalities.

In this way, rather than a general ethos or collective consciousness, risk functions to pro- duce differentiated subjects. As Bruce Braun writes, white, middle-class people “constitute themselves as middle-class and white precisely through the externalization of as many risks as possible . . . and through barricading them- selves from many others. . . . Hence, if you are white and middle-class, ‘risk’ is something you take on voluntarily, not something you are subject to” (2003, 199). Therefore, he argues, adventure-sport advertisements both construct the “proper” risk-taking subject and natural- ize racialized and classed hierarchies (199; see also Simon, 2002). Representations of risk and ability do not passively reflect but rather jus- tify social inequality. In SM, the ability—or desire—to take on a socially constructed risk is one way in which the community is produced as white and middle class, and, cyclically,

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Ekberg, Merryn. 2007. “The Parameters of the Risk Society: A Review and Exploration.” Current Sociology 55 (3): 343–66.

Foucault, Michel. (1984) 1988. The Care of the Self. Vol. 3. The History of Sexuality. Translated by Robert Hurley. New York: Vintage.

Gross, Jane. 1993. “Combating Rape on Campus in a Class on Sexual Consent.” New York Times, September 25.

Henkin, William A., and Sybil Holiday. 1996. Consensual Sadomasochism: How to Talk about It and How to Do It Safely. San Francisco: Daedalus.

Mythen, Gabe. 2007. “Reappraising the Risk Society Thesis: Telescopic Sight or Myopic Vision?” Current Sociology 55 (6): 793–813.

Simon, Jonathan. 2002. “Taking Risks: Extreme Sports and the Embrace of Risk in Advanced Liberal Societies.” In Embracing Risk: The Changing Culture of Insurance and Responsibility, Tom Baker and Jonathan Simon, eds., 177–208. Chicago: University of Chicago Press.

Soble, Alan. 1997. “Antioch’s ‘Sexual Offense Policy’: A Philosophical Exploration.” Journal of Social Philosophy 28 (1): 22–36.

Thompson, Mark, ed. 1991. Leatherfolk: Radical Sex, People, Politics, and Practice. Boston: Alyson.

Weiss, Margot. 2006. “Working at Play: BDSM Sexuality in the San Francisco Bay Area.” Anthropologica 48 (2): 229–45.

Wiseman, Jay. 1998. SM 101: A Realistic Introduction. San Francisco: Greenery.

Zaloom, Caitlin. 2004. “The Productive Life of Risk.” Cultural Anthropology 19 (3): 365–91.

7. Alison Moore’s speech, “Out of the Safety Zone: Codes of Conduct and Identity in SM Communities,” was presented at the Bob Buckley memorial discussion for Sydney Leather Pride Week, April 25, 2002.

8. This is similar to what Califia advises in his section on breath play: “Avoid any activity that may injure or kill someone . . . on the other hand, it’s very common for a top to briefly cut off the bottom’s air with the palm of their hand. I think this can intensify excitement in a low-risk fashion. So please don’t call the S/M police if you see this being done” (2002, 203).

REFERENCES Baker, Tom, and Jonathan Simon, eds. 2002. Embracing

Risk: The Changing Culture of Insurance and Responsibility. Chicago: University of Chicago Press.

Braun, Bruce. 2003. “‘On the Raggedy Edge of Risk’: Articulations of Race and Nature after Biology.” In Race, Nature, and the Politics of Difference, Donald S. Moore, Anand Pandian, and Jake Kosek, eds., 175–203. Durham: Duke University Press.

Califia, Patrick. 2002. Sensuous Magic: A Guide to S/M for Adventurous Couples. Pittsburgh: Cleis.

Celsi, Richard L., Randall L. Rose, Thomas W. Leigh. 1993. “An Exploration of High-Risk Leisure Consumption through Skydiving.” Journal of Consumer Research 20 (1): 1–23.

Day, Liz. 1994. “‘Transgression’: The ‘Safe Word’ in S/M Discourses.” Mattoid 48: 241–53.

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and redefine sexual or relational “deviance” than that available to those burdened by rac- ism, poverty, inadequate education, limited job prospects and other forms of discrimi- nation (Collins, 1996, 2005; Sanday, 2007; Steinbugler, 2005). . . .

Scholars are increasingly emphasising the intersections of sexuality with other elements of social stratification (Collins, 1996, 2005; Schippers, 2000; Sharma and Nath, 2005). Disability, (trans)gender, sexual orientation, age—these elements and more—influence the ways in which people choose to, or are able to, express their sexual selves. In this [reading], we focus on race, education and class for three reasons. First, as white, middle-class sexual- ity researchers, we have attempted to address the implications of the overwhelmingly white populations who participated in our research. Second, race, education and class stand out as important constants in the field, indicating their significance for analysis. Finally, research- ers have identified demographic characteris- tics, and especially race, as important factors impacting sexuality and specifically salient to research on polyamory and BDSM (Harita- worn, Lin, and Klesse, 2006; Langdridge and Barker, 2007). For instance, Willey (2006) and Noël (2006) examined poly discourse and high- lighted the ways in which whiteness and class privilege are central to polyamory and those

This [reading] focuses on kinksters—people involved in “kinky” or “perverted” sexual acts and relationships frequently involv- ing bondage/discipline, dominance/ submission and/or sadism/masochism (BDSM, also referred to as sadomasochism), and polyamorists— people who engage in openly conducted, multiple- partner, romantic and/or sexual relationships. Popular usage among polyamorists and kink- sters indicates that people who identify them- selves as kinky are more likely to accept and celebrate the pervert moniker, and polyamor- ists who do not identify themselves as kinky appear less likely to think of themselves as perverts. Conventional society, however, gen- erally classifies as perverts people who have multiple and concurrent romantic and/or sexual relationships, engage in group sex and/or openly espouse non-monogamy. Polyamorists are thus defined as perverts by the popular imagination, even if they themselves do not identify as such.1

Being accused of being a pervert can have detrimental consequences, such as alien- ation from family and friends (Barker, 2005a; Califia, 2000), harassment (Wright, 2006), loss of a job or custody of a child (Dalton, 2001; Hequembourg, 2007; Klein and Moser, 2006), physical attack (Keres, 1994), public excoriation and incarceration (Attias, 2004; White, 2006). Although everyone involved in “perverted” sex risks social censure, people unprotected by social advantages are more vulnerable to the discriminatory impacts of this sexual stigma than are those shielded by racial and/or class privileges. This insulation provides greater social latitude to engage in

THE PRIVILEGE OF PERVERSITIES: RACE, CLASS, AND EDUCATION AMONG POLYAMORISTS AND KINKSTERS

E L I S A B E T H S H E F F A N D C O R I E J . H A M M E R S

From “The Privilege of Perversities: Race, Class, and Educa- tion Among Polyamorists and Kinksters,” Psychology & Sexu- ality, Vol. 2, No. 3, September 2011, pp. 198–223. Copyright © 2011 Routledge, reprinted by permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com).

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definitions of kinkiness or polyamory. In line with other researchers (Barker, 2005a, 2005b; Haritaworn et al., 2006; Weitzman, 2006, 2007), we define polyamory as a form of association in which people openly maintain multiple romantic, sexual and/or effective relationships. Polyamorists use the term poly as a noun . . . an adjective . . . , and an umbrella term that includes polyfidelity or relationships based in sexual and emotional fidelity among a group larger than a dyad.

With its emphasis on long-term, emotionally intimate relationships, polyamory differs from the form of swinging based on emotional exclusiv- ity with one partner and sexual non- monogamy with multiple partners. Polyamory is also not adultery: the poly focuses on honesty and (ide- ally) full disclosure differs markedly from the attempted secrecy definitional to adultery. Both men and women have access to multiple partners in polyamorous relationships, distinguishing them from those that are polygynous or polyan- drous. Polyamorists routinely debate the defini- tion of the term, the groups it includes and who is qualified to claim it as an identity.

Kinky people, relationships and communities share many characteristics with polyamorists, with a myriad of potential additional dimensions that can make kink even more complex. Kink- sters are people who identify as kinky, frequently including (but not limited to) those who partici- pate in BDSM; have multiple sexual and/or play partners; engage in role-play and/or costuming as part of their sexual behaviour; have fetishes; blend gender characteristics; and/or modify their bodies in conjunction with or to augment their sexual practices. BDSM, the primary umbrella under which many of these identities are encompassed . . . is the practice of consensual exchanges of personal power, including (but not limited to) scripted “scenes” involving some com- bination of corporal or psychic “punishment,” intense physical stimulation (often pain), role- playing and/or fantasy and/or varied sexual inter- actions (Langdridge and Barker, 2007; Moser

claims that seek to “naturalise” the practice of polyamory. As Willey noted, many feminist poly activists justify polyamory on the grounds that monogamy is unnatural and patriarchal because it works to quell our uncontainable sexual “drives” while being deeply implicated in female subjugation. Yet, this same “libera- tionist” rhetoric has historically been used to marginalise and stigmatise the poor and peo- ple of color for their “uncontrollable” urges and their inability to conform to the monogamous, nuclear family (white) ideal.

. . . It is our strong belief that in studying only those who are most accessible and vis- ible within poly and BDSM subcultures—those overwhelmingly white and middle class—we fail as researchers to understand alternative map- pings of non-monogamous desire and BDSM practices. . . . Our objectives here are multi-fold, and we document the affiliation between poly- amory and BDSM; demonstrate through a meta-analysis of extant literature the ways in which research on alternative sexual communi- ties has often (unwittingly) reinforced and (re) constituted a homogenous image of these non- conformist subcultures; support and augment this analysis with our own empirical data; and provide recommendations to improve research methods. By highlighting the race and class privileges that operate throughout these pro- cesses, we aim to foster dialogue about the ways in which we as sexuality researchers can mitigate this privilege and its potential impact on our col- lective research. . . .

COMMUNITY CHARACTERISTICS

Although polyamorous and kinky identities are distinct, the populations practicing them share such a variety of traits and considerable overlap in membership that they warrant joint analysis (Bauer, 2010). . . .

Neither academicians nor community mem- bers have achieved consensus on precise

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populations who have participated in research primarily comprise white, well-educated, middle- class professionals. . . .

METHODS

The data for this [reading] come from three sources: our own original research, others’ stud- ies of kinksters and polyamorists, and commu- nication with other researchers online. . . .

Original Research Sheff’s longitudinal study of polyamorists has thus far produced two waves of data col- lected through participant observation, content analysis, Internet research and in-depth inter- views. The first portion of the study (Gender, family, and sexuality: Exploring polyamorous community 1996–2003) provided the base of 40 in-depth interviews with adults who iden- tified as poly, and extensive participant obser- vation data collected at a wide variety of poly events, including co-ed and women’s support groups, potlucks, community meetings and two national conferences. The second wave of data collection (Polyamorous families study 2007–[2011]) focuses on polyamorous fami- lies with children and includes 15 previous respondents2 and has expanded the sample to incorporate an additional 41 people, for a . . . total sample of 81 across both studies. Race is the most homogeneous demographic charac- teristic, with 89 percent of the sample identi- fying as white. Socio-economic status is high among these respondents, with 74 percent in professional jobs. Fully 88 percent report some college education, with 67 percent attaining bachelor’s degrees and 21 percent completing graduate degrees.

Sheff also conducted a study of intersect- ing sexual identities (Overlapping identities study 2005) examining the overlap between polyamorists, swingers, people with fetishes

and Kleinplatz, 2006a; Weinberg and Kamel, 1995). Among kinksters, definitions of who qualifies as a sexual partner and what counts as a sex act encompass far greater variety than those considered sex acts or partners among “vanilla” (non-kinky) people. Typically, BDSM and poly communities cohere around a specific gender and sexual orientation. For instance, most pub- lic play parties are geared specifically toward gay men, lesbians or bisexual/heterosexual people. This is in part due to the origins of the BDSM subculture in the United States, which began as a gay male phenomen[on] that later diverged to include lesbian, heterosexual and bi/pansexual communities (Ridinger, 2002). These various groups tend to self-segregate by sexual orienta- tion and gender, although the growth of virtual and physical kink community has encouraged some amalgamation as well.

Poly and kinky research respondents empha- sise negotiation, honesty, consent and personal growth as important components of successful relationships (Sheff, 2005a, 2005b, 2006, 2007, 2010; Barker and Ritchie, 2007; Weitzman, 2006, 2007). Similarly, many of them main- tain multiple relationships with varied levels of emotional and sexual intimacy. Kinkiness appears to be a broader base for an identity than polyamory, encompassing a greater range of relationships and types of practices/identi- ties. Many kinky people have multiple partner relationships but do not necessarily primar- ily identify as polyamorous—the number of people involved in their relationships is but one component among many aspects of kink identity, sexuality and relationships. For some, mostly non-kink poly people, the multiplicity of the relationships determines their status as poly. Those polys who engage in kinky sexual activities are more likely to view sexuality more broadly and numerosity as one, not necessarily the defining, element of their sexual identities. Additionally and more importantly, for the purposes of this [reading], the poly and kinky

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bathhouse study, data for this BDSM project come from in-depth interviews with lesbian/ queer BDSM practitioners/attendees and participant-observation data derived from attendance at a variety of public lesbian/queer/ women-only BDSM events in the United States. A total of 40 in-depth interviews with BDSM practitioners and self-identified kink- sters have been conducted thus far. Of these, 36 individuals identify as white. Approximately 76 percent reported some university education, with 70 percent having attained a bachelor’s degree.

Thus, a major interweaving theme that binds our studies and informs our views on race in the research setting, and the inadequate attention paid to race when it comes to alternative sexual subcultures, comes through at this juncture. We find that these alternative sex publics— which encompass such things as community meetings, national conferences, bathhouse events and public BDSM play parties—are predominantly white. It is this whiteness, we believe, that sexuality scholars must address.

Others’ Studies of Kinksters and Polyamorists To find pertinent studies, we searched in Google Scholar, as well as Sociological Abstracts and Sociological Collection in the Galileo search engine, using the search terms BDSM, sadomasochism, kink, SM and polyamor. To be eligible for inclusion, studies had to focus on polyamory and/or kinkiness and contain at least some demographic data relevant to the target populations. Both the communi- ties involved in and the literature on kink and BDSM share a core identity built on sadomas- ochism, so we include them in a single cate- gory. Polyamory is one form of non-monogamy, but other forms of non-monogamy (polygyny, infidelity) are so diverse as to lack a similar common foundation. The intersection between

and those who practice BDSM. Of the 64  respondents (31 men, 27 women and 6 oth- ers),3 31 were involved in BDSM, 19 in poly- amory and 6 in swinging. The majority of respondents (58 or 90%) identified as white, with two African Americans, one Filipina, two people of multiracial heritage and one who identified himself simply as “other” also participating. Respondents were also highly educated, with all but three respondents (95%) having completed or currently enrolled in an undergraduate degree, and 48 (75%) of them completing at least some graduate school. All of the 26 respondents who reported fetishes were also involved in BDSM, and the two groups are so intricately involved that distin- guishing between them did not provide any useful analysis. Swingers, however, stood out as socially distinct—if racially, economically and educationally similar to the other respondents. They neither identified themselves strongly with the other groups, nor were they identi- fied as integral to a joint identity the way polys and kinksters identified each other. Although there are certainly intersections between polys and swingers (and to a lesser extent kinksters and swingers), these focus groups indicated a much stronger affiliation between polyamorists and kinksters than between either group and swingers.

In her ethnographic research on Cana- dian lesbian/queer bathhouses (Bathhouse culture study 2004), Hammers also found a largely white and well-educated population. Approximately 80 percent of the 33 interview respondents identified as white, with over half attaining either undergraduate or graduate degrees. Although highly educated, most of these women were only marginally middle class (Hammers, 2008). Hammers’s current project, which explores the US lesbian/queer BDSM community (2007 to present), has found this population, like the bathhouse subculture, to be a relatively homogenous one. As with the

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and for some supplementary data collection; 12 used interviews; one combined interviews and a questionnaire; and 14 used questionnaires distributed in person or through magazines, at organisation/club meetings or at events. Twenty-one of the studies were conducted in the United States, five in Western Europe, two in Australia and one in China. There are three unpublished master’s theses and four unpub- lished dissertations. Sample sizes range from a low of six (Matthews, 2006; Mosher, Levitt, and Manley, 2006) to a high of 6,997 (Brame, 2000) and span over time from Spengler’s trail- blazing 1977 study of male sadomasochists in Western Germany to Barker and Langdridge’s 2010 volume that includes original research on polyamory. The percent of people of color in the sample varies from a low of zero in four studies (Barker and Ritchie, 2007; Cook, 2005; Matthews, 2006; Mosher et al., 2006) to a high of 48 in Tomassilli, Golub, Bimbi, and Parson’s (2009) study of lesbians and bisexual women in New York City.

Unique Cases Some studies contribute to multiple areas or provide qualitative data unsuitable for tables. Taormino’s (2008) study of 126 people in “open relationships” includes data on polys and kinksters, with 62 percent identifying as polyamorous or polyfidelitous and 51 percent identifying as kinky. Of the entire sample of 126 people, 82 percent identified as white and 77 percent as middle class or above. As previ- ously discussed, Sheff’s Overlapping identities study of polyamorists, swingers, kinksters and those with fetishes yielded similar results.

In the sole randomly selected sample of which we are aware, Richters, de Visser, Ris- sel, Grulich and Smith (2008) surveyed a representative sample of 19,307 residents of Australia aged 16–59 years old and found that 1.8 percent of the sexually active respondents

swinging and polyamory is complex, ambiguous and common enough to gain its own moniker of “swolly”4 and clearly warrants further investi- gation, although space constraints prohibit its inclusion in this analysis.

Communication with Researchers Online Once we had amassed a list of polyamory and kink studies, we posted our bibliogra- phy to PolyResearchers, an online discussion group composed of academicians, journalists, researchers and clinicians dedicated to the dis- cussion of research on polyamory.5 We asked the membership to review the list to inform us if we had missed any studies. No members were able to identify any missing studies.

The Poly Researchers’ list similarly granted us access to many of the researchers whose work we reviewed, allowing us to obtain additional data that were not included in the published pieces. If a published piece did not include demographic data but did include an email address for correspondence, we would contact the investigator(s) and request the additional data. All 12 of the researchers we contacted for more information regarding their studies responded to us with the requested data. . . .

RESULTS OF STUDIES OF KINKSTERS AND POLYAMORISTS

The composite results from these 36 studies (20 of kinksters, 14 of polys and 2 of both) indicate a largely homogeneous universe popu- lated with highly educated, white, middle- and upper-middle-class professionals, confirming numerous researchers’ conclusions (Sheff, 2005a, 2005b; Sandnabba, Santtila, Alison, and Nordling, 2002; Spengler, 1977). These studies employed a variety of methods: six used surveys or e-interviews conducted entirely online; four “offline” studies reported relying heavily on the Internet to recruit their samples

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Australia and/or Western Europe would make it virtually impossible for polys and kinksters to escape the pervasive racism and classism endemic in those societies and the accompa- nying white privilege (or lack thereof) that inflects their lives. In our experiences, poly and kink communities tend to eschew open racism and often support such liberal ideals as equal- ity and celebration of diversity. White privi- lege, however, generally remains as invisible in these groups as it is in more conventional society, thus becoming the dominant racial paradigm. . . .

Internet Recruitment Because the Internet serves as a primary tool for sexuality researchers to both engage and recruit target populations (Waskul, 2004), it is no surprise that numerous respondents in these kink and poly studies identify the Internet as a crucial element of their access to sexual non-conformist communities (Sheff, 2005a; Weber, 2002; Weitzman, 2006). The web has profoundly reshaped sexual minori- ties’ communities, identities, networks and communications, and nine of the researchers cited in this [reading] avail themselves of this expanded opportunity by examining poly and kink populations that would have previously been extremely difficult to find, or may in fact not exist, without the Internet. Although it is reasonable to recognise the Internet as an important site of community evolution, it is not sensible to rely so heavily on a single resource that will definitionally provide a limited sample.

Although the Internet has expanded sexual opportunity (for some) and created a virtual world wherein sexual minorities can find affir- mation and community (Weinrich, 1997), this technological tool also reproduces (and pos- sibly strengthens) pre-existing inequalities. Initial research indicated that the majority of Internet users were male, overwhelmingly

(2.2 percent of men and 1.3 percent of women) reported being involved in BDSM in the last year. Results also indicate that people involved in BDSM are more likely to have been “non- exclusive in a regular relationship (i.e., had sex with someone else besides their regular part- ner)” (Richters et al., 2008, p. 1663) in the last 12 months than are people with no involve- ment in BDSM, confirming the association between non-monogamy and BDSM. The study measured ethnicity through country of birth and language spoken at home, and only 1.3 percent of respondents spoke anything but English in their homes. Although respondents who engaged in BDSM also had higher levels of education, Richters (personal communica- tion, 2009) cautioned that

my impression is that we cannot be certain whether the apparent high education levels and social class of BDSM people as anecdotally reported is an artifact of self-selection for study. It may be real, which would not be surprising given that BDSM is often highly verbal and symbolic. Nonetheless, our analysis clearly showed that demographic and psychological variables were swamped by the strong differences in sexual interest and breadth of experience/repertoire.

Although this most representative sample finds virtually the same racial, ethnic, class and educational characteristics of the other stud- ies with less-randomly selected samples, the authors note that these select demographic characteristics are overshadowed by the sam- ple’s sexual characteristics.

REASONS FOR THESE RESULTS

Although it is quite unlikely that these samples are representative of the actual range of kink and poly people, they are certainly representa- tive of the range of people involved in main- stream poly and kink communities. . . . One plausible rationale is that poly and kinky people hold the same kind of racist views as do others of their social ilk. Living in the United States,

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Their family’s experiences with racism sensi- tised them to the need to remain concealed to avoid further racialised persecution.

As groups comprised mainly white people with relatively high socio-economic statuses, mainstream polyamorists’ and kinksters’ privi- leges can buffer them from some of the negative impacts people risk when they eschew conven- tionally sanctioned roles. Respondents’ levels of education and occupations indicate that they are generally skilled professionals with careers endowed with greater job security than low- skill, low-paying jobs, where employees are far more easily replaced and often subject to greater surveillance and less autonomy. Courts have repeatedly demonstrated their endorse- ment of conventional heterosexual families over those with sexual and/or gender non- conforming members (Klein and Moser, 2006; Polikoff, 1993). The intersections of these var- ied privileges bestow middle-class people with greater freedom to engage in behaviours and relationships that risk social approbation. Cou- pled with a relative lack of public awareness of polyamory and kinky relationships, these privi- leges allow some to pass as sexually or relation- ally conventional when they wish to do so, thus avoiding the consequences that can accom- pany detection. People in disadvantaged posi- tions are often subject to levels of surveillance that make non-conformity riskier than it would be for others with greater resources. “Perver- sity” then becomes another luxury more readily available to those who are already members of dominant groups.

Deterrents to Participation There are a number of factors that can combine to dissuade people of color and those of lower socio-economic status from participating in mainstream poly and kink communities. These include expense, discomfort with being a numer- ical minority, the potential for discrimination,

white, middle class and well educated (Warf and Grimes, 1997), with an average income that was twice that of the national average (Kantor and Neubarth, 1996). . . . [R]esearch identifies lingering disparities in computer ownership (Ono and Zavodny, 2003) and use (Chakraborty and Bosman, 2005), which con- tinue to disadvantage people of color (Moss- berger, Tolbert, and McNeal, 2008). Internet use and its impacts are complex, however, and measuring access alone is insufficient— researchers must also account for a variety of factors that shape the ways in which people use the Internet (Jackson, Ervin, Gardnera, & Schmitt, 2001; Roderick, 2008). Thus, depen- ding on one’s race and class location, the Internet can both enhance and hinder sexual opportunity and sense of belonging for mem- bers of unconventional sexual cultures, often reproducing predominately white and rela- tively affluent alternative sexual communities.

Protections Afforded by Privileges Although they do not completely insulate people from the risks associated with deviance, race and class privileges can provide buffers to mitigate the myriad potential negative outcomes related to sexual and relational non-conformity. Like other sexual minorities, kinky and poly people have lost jobs, child custody and families’ and friends’ esteem. Indeed, Pallotta-Chiarolli (2006, p. 51) found that two indigenous Austra- lian children in her study of poly families

[. . .] kept to themselves in order to discourage any intimacy with other children that could lead to dis- covery and a further reason to harass them, as they were already experiencing ongoing racist harass- ment. They had also been warned by their parents not to let white teachers know or else they’d be taken away from their family, a theme that was all too real for this family whose own childhoods had been mostly spent in mission homes after being removed from their families as part of Australia’s racist and assimilationist policies.

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in that people were neither compelled to nor barred from wearing clothing, the norm was universal nudity while in the swimming pool and various stages of undress to full clothing on the pool deck.

Though Yansa’s initial discomfort eased as she socialised at that and other parties, she remained uneasy about the increased poten- tial risks she faced for sexual non-conformity. She reported already feeling vulnerable at work because of her race and fearing that being a known polyamorist would mean termination. She described her employers as

[. . .] executives who went to Wharton and Harvard and were Republicans and assholes . . . very, very closed-minded. And I got the impression that they were already not comfortable with me being a per- son of color. To throw in the other stuff that I did may confirm their stereotypes about Black people or they may have just thought she’s the weirdest shit on the planet, I don’t trust her. . . . We don’t want her on this job anymore, someone may find her out.

Yansa noted several reasons other African Americans had discussed with her for their lack of desire to attend poly or kink com- munity events or identify as polyamorous or kinky. “I’ve heard from Black folk that they think it’s a nasty white person thing to do. And they throw out the whole scenario of slav- ery[—]you know they raped us and they took our women and impregnated them . . . that any respectable educated cultured Black per- son in their right mind wouldn’t even think about doing something so disgusting.” She similarly reported that

I’ve had Black people in the community tell me that they don’t want to feel like the token Black . . . the novelty like the fat girl or the Asian girl. I don’t want to feel like people are attracted to me and wanting to play with me or date me because they’re trying to figure out something. Like I’m some anthropological experiment or something.

communities of colors’ negative assessments of sexual minorities and issues of identity.

Expense Scarce funds can deter people with low incomes from participating in some kink and poly community events. Fetish wear, admission to public sex environments such as “dungeons” and “toys” such as floggers can be expensive, selecting out entire categories of people with little discretionary income. This is quite prob- lematic, because 11 of the research samples to which we refer were drawn at least in part from those attending public “play parties” and thus reflect only a portion of the population that is readily accessible—people with Internet access and the privacy to use it, who are involved in groups or organisations and/or willing and able to afford to “play” in public. . . .

Tokenism, Potential Discrimination and Community Rejection of Sexual Minorities In her study of polyamorists in the Western United States, Sheff’s respondents of color cited a number of barriers to participation in poly community events. Yansa, a 29-year-old kink- and poly-identified African American health-care provider, reported acute discom- fort when attending a poly pool party in the San Francisco Bay Area. She observed that

I was not sure if they wanted me there. Like I felt like maybe I had walked in on somebody else’s thing and I wasn’t invited. . . . [There were] 75, 80 naked people in this huge pool and I walked in and every- body just turned and looked . . . and I realized I am the only Black person here. I was the only person in a swimming suit so that could have been another issue, too, like maybe she’s lost her way, what is she doing here?

Yansa’s discomfort at being the sole Black person at the party was compounded by her unawareness of the community (un)dress code. Although the setting was “clothing optional”

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identities study who identifies as bisexual, poly and “mostly vanilla,” asserts that

I think African Americans are much less likely to go into a BDSM setting and think, ok, these are my people, this is my family, and take on that label. It is similar to feminism, in that many African American women have feminist principles and take feminist action and even participate in what some would con- sider feminist activism, but do not identify with the label. White people can more readily walk into  the room and identify with the people, see them as their tribe, because race does not stand out to them, so kink can become their organizing identity. But it is not that easy for African Americans; race always stands out to us in a situation like that.

The disadvantage of a stigmatised identity, coupled with the added weight of racial strain that white or ethnic majorities do not experi- ence, as well as feelings of discomfort or lack of belonging in the setting, can contribute to people of color’s reluctance to identify with kink and poly subcultures.

That many who might appear to be poly or kinky by others’ definitions do not self-identify as such has important implications for the con- struction of identities. Although Victor asserted that mainstream African Americans would reject an organised poly identity, he hypothe- sised that there were “. . . communities of color where there are multipartner relationships going on. I don’t know whether they would call it poly or not. Probably not. . . . I think that pop- ulations tend to self select.” Undoubtedly, there are people who openly maintain non-monog- amous relationships or enjoy being spanked during sex, behaviours characteristic of (respec- tively) poly and kinky relationships, but none- theless do not identify with those communities.

Equally certain is the existence of people who identify as poly or kinky but do not attend meetings or join groups. Again, it could be that those who feel marginalised or different from the more “visible” members of the poly and kink community will remain outside the

It was not only their fear of objectification and denunciation of past abuses and negative stereotypes that deterred Yansa’s compatriots of color from joining the local poly commu- nity, but their active rejection of poly or kinky subcultures as white, foreign and potentially corrupt.

Victor, a poly-identified 36-year-old African American therapist, artist and college instruc- tor, was more optimistic. He noted that the poly community in which he socialised was “monochromatic,” though he was not sure if that was because of “issues of either privilege or even cultural interest.” The whiteness of the setting did not bother him, in part because he had grown up in mostly white neighbourhoods and was thus “acclimated” to white people, and in part because he felt that “people who are interested in really relating with people and good whole truth telling are going to tend to be less racist. . . . I’ve actually felt a lot of acceptance.” Victor pointed out that his socio- economic status gave him access to a lifestyle that others did not have the freedom to enjoy. “It’s sort of privilege related. . . . If you’re not worrying about certain things, then you have the privilege or the space to explore alterna- tives. . . . The freedom to explore polyamory sort of comes from a freedom either financially or just psychologically not having to [struggle to] survive in other ways.” Even so, when think- ing about mainstream African American com- munities’ possible reactions to polyamory, he noted that “I can imagine being in a room of Black people and them going ‘That sounds like crazy white folks, that’s some crazy shit.’”

Identity People of color, already labouring under stigma and racism, might be more reluctant to assume a potentially disadvantageous identity than white or ethnic majority people. Laksha, a 26-year-old African American graduate stu- dent and participant in Sheff’s Overlapping

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single nation, much less internationally: some have middle-class status with little disposable income, and others have money to spend but are not considered middle class. Although edu- cation and class can be strongly correlated, some poly or kinky people are highly educated but “underemployed” or work in comparatively low-paid fields of counselling and academia and thus have less disposable income than their level of education might suggest.

Alternately, Bauer (2008, p. 238) questioned the stereotype of

BDSM people being overwhelmingly highly edu- cated and of middle to upper class . . . [because] my sample is rather diverse in this regard. However, some interviewees put forth the idea that high- quality BDSM is only for those whom they perceive to be highly educated, “intelligent” or “classy” indi- viduals, thus endorsing potentially excluding class- based criteria for membership in the community.

Bauer’s (2008, p. 238) respondents report that the majority of the play parties they attend were populated primarily by white people and that “the race thing is partly class stuff and it’s partly because most of the play parties that I’ve been to have been organized by white people.”

Like class, measuring race presents a myriad of complexities, and researchers took a variety of approaches to this task. Of the reviewed studies, eight ignored the category of race altogether, rendering it virtually irrelevant in its invisibility (e.g. Sandnabba, Santtila, and Nordling, 1999, 2002). The fact that race was left unproblematised indicates that the populations were most likely white. . . . Oth- ers (14) collected data on race but refrained from addressing racial issues in their analysis. This lack of discussion indicates that many of these researchers were oblivious to, or actively chose to ignore, the impacts race can have on the construction of sexual identities. Still other researchers have attempted to oversam- ple people of color (e.g., Sheff, 2005a, 2005b,

very organisations that purportedly represent their ilk. It is also possible that people of color involved in unconventional sexual practices are just as active but more clandestine and main- tain their own, more exclusive, list-servs, events and private sexual venues. Precisely how these more underground sexual networks and private play parties might differ from the more visible sexual subcultures requires additional research.

Finally, the (almost all-white) researchers’ race could deter people of color from participat- ing in research on kink and polyamory. Ham- mers’s (2008) attempts to interview women of color who chose to participate in lesbian/ queer bathhouse culture certainly testify to this issue and the power that inheres within the researcher–interviewee relationship. This power differential is particularly salient when the focus is on sex and non-normative sexual prac- tices. Many of the women of color Hammers approached for her bathhouse study refused to speak to her precisely because she is white. Those people of color who chose to participate in the study often linked the lack of participa- tion by other people of color to the perceived potential predation and appropriation of par- ticipants’ experiences by the researcher. Only a few women of color agreed to talk to Ham- mers about their experiences, several of whom expressed concern about other women of color discovering their decision to do so.

RESEARCH STRATEGIES

Past Strategies . . . Researchers examining kinky and poly populations have dealt with issues of class and race in a variety of ways. Measuring race and class is quite complex even in a single soci- ety, and when the research is international it becomes very difficult to establish common meanings indeed. . . . Class status does not necessarily translate directly from income in a

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of color  (0%) in a numerical minority sense because the point of reference is the same racial and ethnic group. They would also evade the stigma, social pressures and disadvan- tages attached to being a “minority” not only numerically, but with the attendant depriva- tion of social privileges. In the larger discussion in literature, however, Ho’s respondents could be classified as 100 percent people of color, because they are all Chinese. In that construc- tion, they are people of color in relationship to the external white measure, rather than their internal measure of majority status.

This begs the question “People of color from whose perspective?” The term people of color implies some neutral colorless other to which they are compared—the white perspective that underlies both mainstream poly and kink com- munities, as well as the research that seeks to understand them. M. Pallotta-Chiarolli (per- sonal communication, 2008) highlighted this linguistic issue and clarified that

in Australia, the respectful term is “indigenous Australians.” Indigenous Australians find the term “people of color” offensive, as it doesn’t differentiate between their experiences of colonialism, genocide, etc., and the experiences of Africans and others who are migrants and refugees.

Although in the United Kingdom some schol- ars use Black and Minority Ethnics to describe these populations, people of color remains the standard language in the United States. We use it here not only because it is the standard scholarly rhetoric of our academic peers, but more importantly because it is the language our respondents use. Even so, the terminology is difficult and we acknowledge the problem- atic nature of the term. . . .

Recommended Strategies There are a number of strategies that schol- ars can use to deal with these research issues. First and most obviously, we must attend to

2006; see also Connolly, 2006; Klesse, 2007, p. 157). Sheff endeavoured to recruit as many respondents of color as possible, interviewed all three people of color in the Midwestern poly community and travelled to the California Bay Area with the explicit intent of increasing sample diversity. Even so, she found the demo- graphic characteristics of the numerous main- stream poly communities in the Bay Area to closely mirror the Midwestern sample. . . .

Some researchers (E. Cook, personal com- munication, 2007; L. Wolf, personal commu- nication, 2008) did not collect data on race because they perceived it as unrelated to their topic of study. Others intentionally avoided collecting data on race. G. Brame (personal communication, 2007) reported that

I did not set out or want to study what role if any race plays in SM. In part that is because, for eco- nomic and socio-political reasons, minorities are under-represented in the Scene. BDSM communi- ties cut across all socio-economic, political lines; but while I suspect just as many minorities engage in kinky sex, . . . they do not tend to join sexual communities in number, the way mainstream white people do, so the population is very heavily skewed towards white. . . .

L. Wolf (personal communication, 2008) . . . pointed out that “racial categories are not read- ily translatable in international research; they are just not meaningful because there is no con- tinuity or agreed-upon definitions.”

The studies we review represent six differ- ent countries, and whereas most of them were conducted in the “West,” one was completed in Hong Kong (Ho, 2006). Ho’s study under- lines the complexity of defining race, especially at an international level. As ethnic Chinese living in Hong Kong, Ho’s respondents are either 0 percent people of color or 100 percent people of color, depending on the perspective used to judge. In their own social context, they are members of the social majority, and thus would not appropriately be considered people

T H E P R I V I L EG E O F P E RV E R S I T I E S 413

Fourth, increasing the number of research- ers of color examining these groups could sig- nificantly boost participation among kinksters and polyamorists of color. Methodological lit- erature indicates that disadvantaged groups such as people of color (Collins, 1996), lesbians (England, 1994) and women (Gilbert, 1994) may be more open to participate in research conducted by those perceived as members of their own underprivileged group. . . .

Fifth, it is important to understand the rea- sons why individuals do not identify with par- ticular alternative sexual communities, despite participating in behaviours characteristic of those communities. Such an understanding will facilitate a broader examination of the full range of people having kinky sex or multiple partners and the ways in which people select the components of their identities. Further- more, these studies can illuminate privileges that facilitate or hinder people’s associations with particular identities, and the interlocking web of characteristics such as age, gender, race/ ethnicity, ability, orientation and experience that shape individuals’ sexualities in idiosyn- cratic ways.

Sixth, researchers should study behaviour as well as identity. Studies that include only peo- ple who identify as kinky or poly will miss these potential respondents whose behaviours may match the target population but whose self- identification precludes their participation in the study. This creates a double bind, because researchers must clearly define their sample populations to conduct a coherent analysis. On the one hand, relying on self- identification as a selection criteria has a long tradition in sexu- alities research (Berenson, 2002; Chung and Katayama, 1996; Golden, 1996; Rust, 2000) in part because it has proven problematic in the past when researchers assigned identi- ties to behaviours and in part because it can be difficult to build a sample when investigat- ing sexual minorities, and seeking people who

them. Measuring class and race/ethnicity should be a standard research practice, on par with measuring gender. . . . Sexual value sys- tems and the meanings attached to particular sex acts and arrangements stem from Western, white heteropatriarchal standards of sex/gen- der normativity. Race is never not related to one’s topic of study: race confounds the study of sexuality precisely because of its continued neglect.

Learning to deal with the complexities of measuring race is key to the success of inclu- sive research and requires a broader discussion of race, nationally and internationally. Schol- ars can use journals, conferences and online forums to discuss methodological issues and establish greater international communica- tion. On an individual methodological level, researchers can ask respondents to self-identify racially and/or ethnically. When reporting their results, scholars should explain their terms and respondents’ social locations to give readers the information necessary to understand respon- dents’ racial and ethnic identities in the context of their own cultures.

Second, scholars studying this area must continue to oversample people of color. This becomes complex, as who is “of color” is diffi- cult to define. . . . This process must be accom- plished with sensitivity to avoid the mistakes of previous researchers who, in the process of get- ting to “know and understand” certain groups, have been guilty of fetishizing “the other” (Probyn, 1993).

Third, researchers in this area must shift their recruitment strategies to include a far broader range of options rather than relying so heavily on the Internet and homogeneous snowball samples (often coordinated through email or other Internet interactions as well). Although these sampling and recruitment methods remain useful, such complete depen- dence on them produces skewed and mono- chromatic samples. . . .

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In fact, to assume that the “we” (the almost exclusively white researchers who study alter- native sexual communities) can control what “they” (people of color who have unconven- tional sex lives) do is the ultimate act of hubris. Maybe “they” elect not to participate.

This dynamic is obviously far more com- plex than simple omission or self-selection. It calls into question the meanings of alternative sexualities and those who found their identi- ties upon them. Who is authorised to deter- mine the particular characteristics associated with any specific identity, much less function as the arbiter of those with legitimate claims to assume that identity? How people construct their identities is, to varying degrees, up to them: identity is inherently self-defined. To deny that choosing to claim or refraining from claim- ing a specific sexual identity is a self-directed, socially constructed moment is to deny people of color sexual subjectivity. . . .

Too frequently white researchers approach their studies from a white frame of reference and thus (usually unintentionally) exclude con- sideration of people of color from the original research design. This initial exclusion then tele- scopes through the research project to shape the questions researchers ask and the popula- tions they query. Research on poly and kinky populations remains impoverished to the degree that people of color, as well as other social and numerical minorities such as people with disabilities and the aged, are absent from the analyses. There must be more sexuality research, particularly research that is mindful of privilege and intersections of oppression. . . .

NOTES 1. The authors do not claim the right to define others’ identities, but rather use the term pervert to describe polyamorists both because conventional society views them as such and for theoretical coherency.

2. Because the initial study was not designed to be a longitudinal research project and the institutional review board (IRB) required that [Sheff] destroy all identifying

self-identify and are willing to participate in research is one of the primary ways in which sexuality scholars have been able to conduct their research. On the other hand, relying on self-identification eliminates the category of persons who engage in the behaviour but do not classify it as an organising principle for self- identification, thus missing large sections of the population of practitioners (Savin-Williams, 2005; Vrangalova and Savin-Williams, 2010).

Most importantly, researchers must move beyond simple “bean counting” to an exami- nation of how race impacts the ways in which people “do” sexuality. How does being Black and queer impact sexuality? Asian and gay affect sexual practices? Latina and poly shape identity formations? Native American and kinky affect participation in public organisa- tions? To date, too many studies neglect to address these issues because they begin from a white frame, often fail to problematise race and thus assume a homogenous sample, all despite (potentially) statistically accounting for race.

CONCLUSION

Finally, we must consider that, on some level, there might not be anything to be done about the dearth of people of color in samples of sexual minorities. It is possible that polys and kinksters of color are less interested in being studied and potentially less desirous of engag- ing in public sexual interactions or becom- ing a member of a group founded on sexual status that might then provide contact with researchers—in effect self-selecting to abstain from community and research involvement. Clearly, attempting to recruit people of color into research samples will provide a far richer analysis of kinky and poly relationships, groups and communities. But is the virtual absence of people of color in these samples so passive—so completely based on exclusion? We think not.

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information, [Sheff] was only able to locate those members of [her] my original sample who retained enough contact with mainstream polyamorous communities to receive the calls for participation in the follow-up study. . . . Of the 17 previous respondents [Sheff] was able to locate, 15 agreed to participate in the follow-up study. Only one of the previous respondents who consented to an interview no longer identified as polyamorous and had started seeking a monogamous relationship.

3. On the questionnaire, there was a line adjacent to the other category for self-identification. The responses were so varied that [Sheff] aggregated them into a single category of other for ease of discussion.

4. Ken Haslam coined the term “swolly” to denote the intersection between poly and swing behaviours, identities and communities.

5. PolyResearchers is an online discussion group that facilitates research into polyamory by allowing members to share resources, research findings and seek each other’s advice. . . .

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SEXUAL HEALTH

A N I N T E R V I E W W I T H

H É C T O R C A R R I L L O

Héctor Carrillo, PhD, is a professor of sociology and gender and sexuality studies at Northwestern University, where he is also the co-director of the Sexualities Project at Northwestern (SPAN). He is a member of the governing board of the Latina and Latino Studies Program; a faculty associate in the Latin American and Caribbean Studies Program; a faculty affiliate in the Science and Human Culture Program; a faculty affiliate in the Center on Social Disparities and Health (C2S) at the Institute for Policy Research; a faculty affiliate in the Institute for Gender and Sexual Minority Health and Wellbeing; and a member of the Buffett Institute Faculty Advisory Coun- cil.  He is the author of two books: Pathways of Desire: The Sexual Migration of Mexican Gay Men (University of Chicago Press, 2017) and The Night Is Young: Sexuality in Mexico in the Time of AIDS (University of Chicago Press, 2002). Professor Carrillo is also the author or co-author of articles in publications such as Sexualities, Global Public Health, Archives of Sexual Behavior, and Citizenship Studies.  His recent awards include Faculty Fellow, Alice Kaplan Institute for the Humanities, Northwestern University; Distinguished Teaching Award, Weinberg

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College of Arts and Sciences, Northwestern University; and the Carlos Monsiváis Award–Sexualities Section, Latin American Studies Association (LASA). His areas of interest include sexualities, race and ethnicity, migration, transnationalism, health promotion, and HIV/AIDS.

What led you to begin studying sexuality? In the late 1980s, I became a staff member at the San Francisco AIDS Founda- tion, where I was put in charge of creating the Spanish AIDS Hotline for Northern California. This was one of the first services of its kind in the nation. As I began to work on this project, I realized that research on the sexual cultures of Latino/a populations was scarce. The little that was known about Latino/a sexualities often reflected a somewhat stereotypical sense of cultural difference between Latinos and non-Latinos. In the literature that existed at the time, Latinos/as were frequently portrayed as Catholic and traditional, and Latino/a sexualities were assumed to always reflect the values of machismo. I felt that to design more effective HIV prevention programs we needed a more nuanced understanding of Latino/a sexual cultures—one that took into account how Latino/a sexualities were changing and that also considered a range of experiences within Latino/a communities. I decided to obtain a doctoral degree in public health at the University of California, Berkeley, and eventually to become a sexuality researcher.

How do you tell people you study sexuality and how do they react? My experience is that people generally feel that we need to know more about this topic. People often refer to the fact that sexuality is an issue about which they learned very little in school or while growing up, and they express the view that more sex education is needed. But, of course, there is no consensus about what shape such education should take. There are also people who, upon learning about the kind of research that I do, do not ask me any further questions. Their silence makes me wonder if the topic does not interest them, whether they find it somewhat awk- ward or embarrassing, whether they see sexuality as a private matter that should not be publicly discussed, or whether they feel (because of conservative values) that sexuality should not be researched.

What do you think is most challenging about studying sexuality? People often think that sexuality, because it can be such a socially charged topic, is a difficult topic to research. However, precisely because sexuality is often a taboo subject, many people want to discuss it and are willing to share their personal stories in the context of sexuality research projects. What is perhaps more challenging is the broader politics of research and the way in which sexuality research is some- times used within the so-called culture wars. Conservative social actors who would prefer that our society not learn more about sexuality or sexual diversity see nothing

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valuable in funding sexuality studies; they thus often strongly oppose any efforts to conduct sexuality research.

Why is sexuality research important? Why is it important to do research on sexual health? Sex and sexuality occupy an important place in people’s lives. They can be an essential source of intimacy and pleasure, and they are powerfully linked to our human sense of connection. However, sexual contact can also result in the trans- mission of sexually related diseases, and the intimacy associated with sexual inter- action can imply a strong emotional component that can result in some emotional vulnerabilities. It is therefore crucial for people to learn how to maximize the positive aspects of their sexualities while minimizing the possible negative ones. That requires that we know more, based on solid research, about sex and sexuality, about our sexual cultures, about our sexual desires, and more generally about how a diversity of people live their sexual lives. More broadly, sexuality also reflects many aspects of how society is organized and vice versa, and thus I find that studying sexuality from a sociological perspective is crucial to understanding our society more generally.

Can you describe some of the findings from your recent research? My research on Mexican sexualities has revealed that, contrary to what is com- monly assumed, there is considerable social change in Mexico in relation to sexual- ity and sexual cultures. This became evident in my research in Guadalajara, Mexico, during the 1990s, and more recently in the research that I have conducted with Mexican immigrants in California. By focusing on migration, my current research is also showing what happens to Mexican sexualities when they are “on the move.” In fact, my study of Mexican gay and bisexual male immigrants has confirmed that for some immigrants, their sexuality and their desire to migrate are tightly linked, as part of a phenomenon that I call “sexual migration”—international migration that is primarily (or at least partially) motivated by sexuality. My research has also revealed that immigrants’ sexualities shift some upon arrival in the United States as a result of cross-cultural interaction and participation in new sexual contexts. In this sense, my research further confirms what social scientists have been saying now for decades: that the social context considerably influences how people interpret their sexualities, a conclusion that questions the idea that sexuality reflects purely individual desires. This has also become evident in my research with heterosexually identified men who have sex with men, which is generating new knowledge about how these men, within the social contexts of the United States, make sense of their heterosexual identities and sexual behaviors with men—that is, why they see no contradiction between the two. Instead of being in denial about their sexual desires, as is commonly assumed, these men indeed have developed elaborate logics for why their heterosexual identities accurately describe them. And those logics reflect cultural expectations about men and masculinity.

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If you could teach people one thing about sexuality what would it be? A central message in my classes is that sexuality provides an interesting and helpful window to understand society and how society works. But I also emphasize that studying sexuality from a sociological perspective is helpful for us to realize that our sexualities are socially shaped and reflect not only our individual desires but also the sexual cultures and expectations to which we have been exposed over the course of our lives.

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R E A D I N G 3 5

INFECTIONS AND THEIR CONSEQUENCES

There are more than two dozen infections that are today recognized as being trans-mitted largely or exclusively through sex- ual contact. U.S. public health authorities, by and large, focus on a limited set of these STIs, according to such factors as how common and contagious they are, how easily they are to detect and treat, and how much impact they may have on the public health.

For a variety of reasons, including because the most common STIs are often or usually asymptomatic, estimates of the incidence (new cases) and prevalence (total existing cases) of most STIs are difficult to make. . . .

Despite their ubiquity, STIs far less com- monly have any major, lasting impact on indi- viduals’ health. HPV is the clearest example, with several million HPV infections among Americans each year leading to 4,000 cervi- cal cancer deaths. Pap tests are so effective, in fact, that current federal guidelines recom- mend testing at three-year intervals, rather than what has been the long-time standard of testing every year.

At the other end of the STI spectrum is HIV. AIDS is, despite considerable medical advances, still considered to be ultimately fatal, but early treatment with antiretroviral drugs and other medical and lifestyle interventions (such as quitting smoking and improving diet) can greatly delay the onset of the disease. And with ongoing, high-quality care, HIV-positive Americans can live long lives with minimal

symptoms. Current federal guidelines, conse- quently, recommend routine HIV screening for all Americans, regardless of perceived risk.

Syphilis, too, is important to catch early, because if untreated for years, the infection can ultimately cause irreversible damage to the nervous system and heart, possibly lead- ing to blindness, insanity, paralysis, and death. Because of the severity of the disease and the then-high prevalence of the infection, the dis- covery that penicillin can cure syphilis com- pletely was a major public health advance in the 1940s, and the U.S. government has since attempted to eliminate the infection in this country.

Somewhere in the middle of this spectrum are chlamydia and gonorrhea. Routine screen- ing for chlamydia among women younger than 26 is widely recommended by the government and medical associations, and is considered a cost-effective, but underutilized, form of pre- ventive health care by the U.S. Preventive Services Task Force because of its ability to reduce rates of pelvic inflammatory disease (PID). Estimates of how often chlamydia (or other infections, including gonorrhea) lead to PID, and of how often PID leads to infertility or other serious complications, vary widely, in large part because it would be unethical to allow an infection to progress untreated. (Indeed, today’s ethical standards were developed largely

SECONDARY PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS: TREATING THE COUPLE AND COMMUNITY

A D A M S O N F I E L D

From “For some sexually transmitted infections, second- ary prevention may be primary,” Guttmacher Policy Review, 2009, 12(2):2–7. Reprinted by permission of the Gutt- macher Institute.

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the partner to come in for testing and treat- ment, can be difficult, particularly when the partner is asymptomatic.

Distributing home-based testing kits—at health centers, schools, workplaces, shelters, or via the Internet—is one potential tactic to address this problem, as are educational and communication skills training efforts to help patients convince their partners to come in for testing and treatment. The tactic that has gen- erated by far the most interest in recent years is expedited partner therapy (EPT), in which the original patient’s health care provider will pro- vide a supply of or prescription for antibiotics to the partner without an actual diagnosis for the partner. This tactic works best with infections like chlamydia and gonorrhea, where effective single-dose therapies are available to minimize the chance of improper or incomplete treatment. It is not considered appropriate for syphilis, in contrast, because single-dose treatment is not available and because of the frequency of aller- gies to penicillin, the standard treatment for that infection.

EPT has received public endorsements over the past several years by the Centers for Dis- ease Control and Prevention (CDC), the Amer- ican Medical Association, and the American Academy of Pediatrics, following several CDC- sponsored studies that found it led to substan- tial reductions in recurrent infections and, at the same time, saved scarce public health resources. Several studies indicate that even before those endorsements, it was widely, if quietly, practiced by providers across the coun- try. However, the CDC has also highlighted a long list of implementation issues, including the possible presence of other STIs, missed oppor- tunities for counseling, difficulties in obtain- ing funding or insurance coverage, and legal liability concerns stemming from EPT’s some- times uncertain legal status, including whether providers may treat or write a prescription for someone they have not directly evaluated.

in response to the infamous Tuskegee study, which did exactly that for black men infected with syphilis.) Roughly, it appears that 10–40 percent of untreated chlamydia cases will lead to PID and that perhaps 20 percent of women with PID will develop infertility. This progress typically occurs over a matter of years, however, and antibiotic treatment will eliminate the infection and stop the progression of PID. . . .

TREATING THE COUPLE

Screening and treating a woman or man [for STIs] also provides benefits to that patient’s partner. Numerous studies have found that people who know that they have HIV or another serious STI are more likely than those without such knowledge to talk with their partners about risk and protection and are less likely to engage in high-risk behavior. And treatment of infected men and women can directly protect their partners against infection—something that is true not only for curable, bacterial infec- tions, but also for many viral infections that can only be suppressed. Recent studies have shown that common drugs to treat and suppress her- pes can reduce transmission by half. The find- ings are even stronger for HIV, with the risk of transmission so low among HIV-positive individuals without detectable viral loads that some experts have begun to argue that condom use may not always be necessary for discordant couples (where one partner is HIV positive and the other, HIV negative).

At the same time, screening and treatment of a patient’s partner are also crucial for that original patient to break the cycle of reinfec- tion that is seen commonly among patients with curable infections such as chlamydia and gonorrhea. The need to break this cycle has long been recognized by health care provid- ers, and they have responded in part by making rescreening three months after treatment the standard of care. But going further, by getting

S EC O N DA RY P R E V E N T I O N O F S E X UA L LY T R A N S M I T T E D I N F EC T I O N S 425

infection by three-quarters between the mid- 1970s and the mid-1990s. . . . Today, facing lim- ited resources to carry out such a labor-intensive activity, the CDC recommends that public health authorities focus their partner services efforts on syphilis and HIV, and limit their use for other STIs to high-risk cases. In fact, EPT for chlamydia and gonorrhea is in many ways a response to the limited resources available for comprehensive partner services, which include counseling, testing, treatment, and referral services. . . . CDC guidelines emphasize that partner services should be client-centered, con- fidential, voluntary, nonjudgmental, culturally appropriate, and free. These ideals, however, pose serious challenges, including the potential to spark physical or emotional abuse and legal obligations related to mandatory reporting and the duty to warn against imminent danger.

Ultimately, partner services and related community-based efforts to promote STI test- ing and treatment can have and have had a substantial impact on STI rates. Part of that success is by identifying and exploiting the same social and sexual networks that help spread STIs in the first place. By identifying the people who are the “hubs” of a network, these efforts can educate them about their STI status and the risks of their behavior, cure or suppress the infection itself, and efficiently identify large numbers of other at-risk mem- bers of the network. All of this can have major, positive ripple effects in curbing the spread of STIs within that network.

Moreover, by linking high-risk members of a community with other key government and non-profit services—to reduce substance abuse, prevent violence, provide job training, and improve nutrition and living conditions— treating STIs can also help to address the broader problems in a community. This approach dovetails with an increasing recogni- tion among public health experts that to effec- tively address STIs in the community, we need

TREATING THE COMMUNITY

The public health response to STIs has tra- ditionally recognized that even treating the couple is not enough. By and large, people’s sexual activity typically occurs within a rela- tively closed network, and epidemiologists have found that the behaviors—especially, having concurrent multiple partners—of even a small fraction of the members of a network can have profound ripple effects. The real-life evidence of these network effects can be seen in the dis- proportionately high STI rates among men who have sex with men (MSM) and among African Americans. The incidence of HIV and syphi- lis, for example, is significantly concentrated among MSM, and the rates of many STIs are several times higher among black women and men than among their white counterparts. . . . In both cases, there is a range of reasons for the disparities, including lack of access to health care and persistent discrimination. But the spread of STIs within these communities is fundamentally fueled by the facts that sexual networks among MSM and among African Americans are largely closed, and that a sub- stantial minority of both communities practice high-risk behaviors.

Part of the traditional policy response to this problem has been to promote sex education to change people’s behavior regarding multiple partners and condom use, and vaccination for those infections (currently, HPV and Hepatitis B) where that option is available. These efforts have had many well-documented successes and will continue to be central to addressing STIs going forward.

Yet, STI testing and treatment have also long been a central component of public health efforts to reduce STI rates in a community. The tactic of tracing, notifying, and treating the partners of infected patients, for example, was central to the U.S. campaign against gonor- rhea, which reduced the prevalence of that

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Program. Fred Wyand, media and communica- tions manager with ASHA, notes that “a key part in breaking the cycle of infection with chlamydia is for all partners to be treated, but this presupposes that individuals (and their health care providers) know their status to begin with. That so many chlamydia infec- tions are asymptomatic underlines the impor- tance of testing, and the need for adherence to screening guidelines.”

On a related front, the CDC has worked . . . to eliminate the legal confusion surrounding EPT for chlamydia and gonorrhea, partner- ing with researchers at Georgetown and Johns Hopkins universities to analyze state laws and with the American Bar Association to convince states to clarify and change those laws when necessary. This effort has paid dividends, with nine states adopting new policies . . . to allow and encourage EPT, including a high-profile law passed by New York. . . .

State-level advocates for EPT report that strong support from health care provider asso- ciations, local health departments, and frontline clinicians has been crucial to gaining legislative support even in conservative areas, such as upstate New York and states like North Dakota and Utah, both of which passed new laws. . . . High prevalence rates for chlamydia and gon- orrhea have also turned heads: According to John Peller, director of government relations at the AIDS Foundation of Chicago, legislation to legalize EPT in Illinois has been boosted by the fact that Chicago’s Cook County is “num- ber one in the nation in gonorrhea rates and number two in chlamydia.”. . .

Public health authorities and clinicians in states that have legalized EPT expect it to be a helpful new tool in their toolbox, particu- larly when partner tracing for many clients is impractical and local health departments are short staffed. . . .

Nevertheless, no one tactic will be a silver bullet in stemming the STI epidemics. Some

to “treat” the community itself. In this “repro- ductive justice” perspective, STIs are a symp- tom of broader community problems, from a lack of jobs and housing to high rates of crime and imprisonment to poor health care access and infrastructure. . . . Many other studies have demonstrated links between high-risk sexual behavior and other high-risk behavior, such as drug use and violence, indicating that they have common root causes.

POLICY AND POLITICS

Advocates, public health experts, and poli- cymakers have all been working to turn the promise of secondary prevention into a real- ity. Leading the way at the federal level is the CDC’s Division of STD Prevention. . . . [The CDC has pursued] overarching strategic goals that emphasize preventing and reducing dis- parities in four potential types of STI-related harm: infertility, cancers, adverse pregnancy outcomes, and increased susceptibility to HIV transmission. (The latter two dangers may stem from a wide variety of STIs, some of which— like herpes and trichomoniasis—are otherwise notable mostly as irritants and as sources of psychological distress.)

Screening and treatment for chlamydia— which can be tied to three of those four poten- tial harms—have been an object of particular focus for the CDC and other public health authorities, as well as nonprofit groups like the American Social Health Association (ASHA). For example, in 2008 the CDC helped launch the National Chlamydia Coalition as a way of bringing together provider and consumer groups to increase knowledge of and support for efforts to increase chlamydia screening and treatment. ASHA and other members of the coalition have also pushed to expand programs that provide free or subsidized screening and treatment at safety-net health centers, such as the CDC’s antichlamydia Infertility Prevention

S T D S AT R EC O R D H I G H 427

to fight STIs is far more difficult, particularly in the current fiscal environment. . . .

Beyond the ever-present need for funding, advocates describe a need to treat the broader problems in the community. Hard-hit com- munities in cities like Minneapolis, Chicago, Baltimore, and New York appear to have reached a tipping point because STIs are so widespread. Reversing that trend is possible, but it is considerably more difficult to find and treat infected men and women than it is for STIs to spread. What is needed, says the AIDS Foundation’s Peller, is to change the environ- ment: “So many factors contribute to STIs, starting with the lack of access to health care in the community.”

experts have promoted steps such as expanded coverage of STI screening in private insurance plans and the promotion of home testing kits for various STIs, to remove barriers related to access, embarrassment, and confidentiality. Sarah Stoesz, [president and CEO of Planned Parenthood Minnesota, North Dakota, South Dakota], . . . emphasizes the critical need for additional funding for outreach, education, and treatment. EPT itself is inexpensive, so it is not adding to clinicians’ funding problems, but it will take some time for EPT to actually save public dollars by reducing the community’s STI rates. “It’s easy to pass EPT when there’s no need for a budget behind it,” she observes, asserting that securing additional state dollars

STDs at Record High

Centers for Disease Control and Prevention

LATEST U.S. DATA REVEAL THREAT TO MULTIPLE POPULATIONS

More than two million cases of chlamydia, gonorrhea, and syphilis were reported in the United States in 2016, the highest number ever, according to the annual Sexually Trans- mitted Disease Surveillance Report released [in 2017] by the Centers for Disease Control and Prevention (CDC).

The majority of these new diagnoses (1.6 million) were cases of chlamydia. There were also 470,000 gonorrhea cases and almost 28,000 cases of primary and secondary syphilis— the most infectious stages of the disease. While all three of these STDs can be cured with anti- biotics, if left undiagnosed and untreated, they can have serious health consequences, including

infertility, life- threatening ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission.

“Increases in STDs are a clear warning of a growing threat,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Pre- vention. “STDs are a persistent enemy, grow- ing in number, and outpacing our ability to respond.”

Epidemic Accelerating in Multiple Populations—Impact Growing in Women, Infants, and Gay and Bisexual Men While young women continue to bear the great- est burden of chlamydia (nearly half of all diagn- osed infections), surges in syphilis and gonorrhea are increasingly affecting new populations.

428 S E X UA L H E A LT H

where they can have the greatest impact. Targeted efforts include:

• Strengthening the congenital syphilis response with focused efforts to improve diagnosis and treatment of pregnant women and ensure prompt treatment of newborns at birth in the ten states hardest hit by congenital syphilis.

• Helping state and local health departments rapidly test for drug-resistant gonorrhea and quickly find and treat affected individuals, as part of the federal government’s Combat- ing Antibiotic Resistant Bacteria (CARB) Action Plan.

• Assisting state health departments and health clinics integrate STD prevention into care for people living with HIV.

Maintaining and strengthening core preven- tion infrastructure is also essential to mount- ing an effective national response to the STD epidemic. CDC provides support to state and local health departments for disease surveil- lance, disease investigation, and health promo- tion. CDC also issues and maintains testing and treatment guidelines for providers so indi- viduals get the most effective care.

Turning back the rise in STDs will require renewed commitment from all players:

• State and local health departments should refocus efforts on STD investigation and clinical service infrastructure for rapid detec- tion and treatment for people living in areas hardest hit by the STD epidemic.

• Providers should make STD screening and timely treatment a standard part of medi- cal care, especially for pregnant women and MSM. They should also try to seamlessly integrate STD screening and treatment into prenatal care and HIV prevention and care services.

Syphilis rates increased by nearly 18 percent overall from 2015 to 2016. The majority of these cases occur among men—especially gay, bisexual, and other men who have sex with men (MSM). However, there was a 36 percent increase in rates of syphilis among women and a 28 percent increase in syphilis among new- borns (congenital syphilis) during this period.

More than 600 cases of congenital syphilis were reported in 2016, which has resulted in more than 40 deaths and severe health compli- cations among newborns. The disease is pre- ventable through routine screening and timely treatment for syphilis among pregnant women.

“Every baby born with syphilis represents a tragic systems failure,” said Gail Bolan, direc- tor of CDC’s Division of STD Prevention. “All it takes is a simple STD test and antibiotic treatment to prevent this enormous heartache and help assure a healthy start for the next generation of Americans.”

While gonorrhea increased among men and women in 2016, the steepest increases were seen among men (22 percent). Research sug- gests that a large share of new gonorrhea cases is occurring among MSM. These trends are particularly alarming in light of the growing threat of drug resistance to the last remaining recommended gonorrhea treatment.

MSM also bear a great syphilis burden. MSM make up a majority of syphilis cases, and half of MSM diagnosed with syphilis were also living with HIV—pointing to the need to integrate STD and HIV prevention and care services.

Essential to Confront Most Urgent Threats, Upgrade Prevention Infrastructure CDC uses STD surveillance data and other tools to detect and respond to these evolving threats and new challenges, directing resources

S T D S AT R EC O R D H I G H 429

who are spending each day protecting commu- nities from STDs,” Dr. Mermin stressed.

Source: Centers for Disease Control and Prevention, “STDs at Record High, Indicating Urgent Need for Prevention,” 2017. https://www.cdc.gov/media/releases/2017/p0926-std -prevention.html.

• Everyone should talk openly about STDs, get tested regularly, and reduce risk by using condoms or practicing mutual monogamy if sexually active.

“CDC uses its national-level intelligence to detect and respond to STD outbreaks while supporting the nation’s on-the-ground workers

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R E A D I N G 3 6

could decide that the true “cause” of syphilis was the microorganism Treponema pallidum, or they could define the “underlying cause” as “promiscuous sexual behavior.” Each claim focuses on a different part of social reality, and each carries different messages of responsibil- ity and blame. Each is part of a different lan- guage in which the disease may be described and defined. The first suggests the primacy of the medical clinic for treating disease; the sec- ond, the primacy of moral exhortation.

Throughout the twentieth century struggles have been waged over the meaning and defini- tion of the venereal diseases. At times these diseases have been blanketed in silence, as though they belonged to a “private” realm, not open to public discussion. Wars, however, have tended to make venereal diseases visible, to bring them out of the private sphere and into the center of public policy discussions; this has highlighted the struggles over their proper definition and treatment. In World War  I,  for example, the American Social Hygiene Asso- ciation consistently equated venereal disease with immorality, vice, and prostitution.3 Its members thus tried to close down broth- els  and taverns, to arrest prostitutes, and to advocate continence and sexual abstinence for the soldiers. The Commission on Train- ing Camp Activities tried to suppress vice and liquor and also to organize “good, clean fun”:

Ways of perceiving and understanding disease are historically constructed. Our social, political, religious, and moral conceptions influence our perceptions of disease, just as do different scientific and medical theories. Indeed, these different ele- ments often cannot be easily separated, as sci- entists and physicians bring their own cultural ideas to bear in the construction of scientific theories. Because these cultural ideas may be widely shared, their presence within medical and scientific theory may not be readily appar- ent. Often, such cultural conceptions are more obvious when reviewing medical and scientific theories of the past than they are in contempo- rary medical practice.1

Just as cultural conceptions of disease may be embodied in the framing of scientific theo- ries, so these theories also influence popular perceptions of disease. At times such scientific theories may reinforce, or contradict, other cul- tural conceptions, such as religious and moral ideas or racial stereotypes.

In the case of the venereal diseases, it is clear that our attitudes embody a fundamental cultural ambivalence: are venereal diseases to be studied and treated from a purely biomedi- cal point of view—are they infectious diseases like any others—or are they to be treated as social, moral, or spiritual afflictions?2 As the name implies, venereal diseases are inevitably associated with sexuality—and therefore our perceptions of these diseases tend to be entan- gled with our ideas about the social meanings and moral evaluation of sexual behaviors. In the case of syphilis, a major killer in the first half of the twentieth century, health officials

VENEREAL DISEASE: SIN VERSUS SCIENCE

E L I Z A B E T H F E E

From “Sin vs. Science: Venereal Disease in Baltimore in the Twentieth Century,” Journal of the History of Medicine and Allied Sciences, Vol. 43, No. 2, 1988, pp. 141–64. Copyright © 1988 by the Journal of the History of Medicine and Allied Sciences, Inc. By permission of Oxford University Press.

V E N E R E A L D I S E A S E 431

TREATMENT FOR VENEREAL DISEASE: THE PUBLIC HEALTH CLINICS

In Baltimore in the 1920s a great social silence surrounded the problem of syphilis. Since venereal diseases carried such negative social stigma, only a small proportion of cases were ever reported. Deaths from syphilis were often attributed to other causes as physicians endeav- ored to save patients and their families from possible embarrassment. A social conspiracy of silence resulted: patients did not talk about their diseases, physicians  did not  report them, the health department did not publicize them, and the newspapers never mentioned them. The diseases were thus largely invisible. Most hos- pitals and some physicians refused to treat patients with venereal diseases; some physi- cians specialized in these diseases and made a great deal of money from private patients.7 Many patients, however, could not afford pri- vate medical care.

In the aftermath of the war, the city health department began quietly to treat venereal dis- eases in its public clinics. The first such clinic, opened in 1922, had 13,000 patient visits in its first year of operation. The clinic population grew so fast that the city soon opened a second clinic, and then a third. These patients, brought to the public clinics through poverty, were recorded in health department files as venereal disease cases. Like all the diseases of the poor, these cases attracted little public attention.

The venereal disease problem in Baltimore was, however, made publicly visible by a survey conducted by the United States Public Health Service in 1931.8 The survey defined syphilis as a major problem in Baltimore, and as a prob- lem of the black population. The reported “col- ored” rate was 22 per 1,000 males and 10 per 1,000 women; this contrasted with a reported white rate of 4 per 1,000 men and 1.3 per 1,000 women. Of course, whites were more likely to

sports events, theatrical entertainments and educational programs.4 The Army, however, quietly issued prophylactic kits to the soldiers and made early treatment after possible expo- sure compulsory. Any soldier who failed to get treatment could face trial and imprisonment for neglect of duty. . . .

When dealing with major disease prob- lems, we often try to find some social group to “blame” for the infection. During the war, edu- cational materials clearly presented the fight- ing men as the innocent victims of disease; prostitutes were the guilty spreaders of infec- tion. Indeed, prostitutes were often presented as implicitly working for the enemy against patriotic American soldiers.5 In many com- munities prostitutes would be the focus, and often the victims and scapegoats, of the new attention to venereal infections. Prostitutes— the women responsible for the defilement of the heroic American soldier—would be regu- larly rounded up, arrested, and jailed in the campaign against vice.

The end of the war, however, brought a wan- ing of interest in venereal disease and a return to “normal life,” freed of the restrictions and regu- lations of military necessity. The energetic pub- lic discussion of venereal disease again lapsed into a public silence. Prostitutes and their cus- tomers were again permitted to operate without much official harassment; health departments quietly collected statistics on venereal disease but avoided publicity on the subject.6

This [reading] will examine the subsequent history of venereal disease, and especially syphilis, by focusing on a major industrial city, Baltimore, to see how the struggle between the moral and biomedical views of disease was played out in the context of city politics in the 1930s and 1940s. Although syphilis is no longer a significant public health problem, this account should be useful in helping us to reflect on the . . . problem of AIDS (acquired immune deficiency syndrome) today.

432 S E X UA L H E A LT H

“diseased, debilitated, and debauched,” the victims of their own uncontrolled or uncon- trollable sexual instincts and impulses.11 . . .   [H]ealth officials were certainly convinced that the main issue was sexual behavior, and they were equally convinced that it was the sexual behavior of the black population that had to be changed.

Since the problem was clearly understood as one of sexual behavior, the city health depart- ment began an energetic public education project aimed at changing sexual attitudes— by persuasion or by fear. In 1934 the depart- ment directed a new program on sex hygiene at the black population. They gave talks at the Colored Vocational School and the Frederick Douglass High School, and organized exhibits for Negro Health Week and for the National Association of Teachers in Colored Schools. They distributed nearly 14,000 pamphlets on venereal diseases. A “social hygiene motion pic- ture” with the discouraging title Damaged Lives played in twenty-three theaters, thus reaching over 65,000 people, one-tenth of Baltimore’s adult population.12

The main aim of this health propaganda was to stress the dangers of sexual promiscuity, but it also emphasized the need for early detec- tion and treatment of disease. . . . Pamphlets distributed by the Social Hygiene Association and the city health department continued to urge chastity before marriage and sexual fidel- ity within marriage as the proper solutions to syphilis.

In 1935 syphilis was by far the most preva- lent of the communicable diseases occurring in the city, with 5,754 reported cases; the next most prevalent disease was chickenpox—not a disease considered of much importance—with 3,816 reported cases.13 . . . The facilities for actually treating syphilis were still completely inadequate.

Syphilis deaths were now running at between 110 and 150 per year. As Reinhard

be seeing private physicians and thus less likely to have their disease reported to the health department. Syphilis, originally perceived as a disease of vice and prostitution, was now a black disease. . . .

THE DEPRESSION: RESTRICTING TREATMENT

During the Depression public clinics became more crowded than ever, with over 84,000 visits in 1932 alone. The city health depart- ment, already burdened with tight budgets and increasing health problems of every kind, com- plained that the hospitals in town were dump- ing poor patients on the city clinics.9 . . .

In 1933 the problem of overcrowding became so acute that the city health depart- ment decided to treat only patients at the infectious stage of syphilis. They discontinued treatment to any patients who had received sufficient drugs to render them noninfectious to others, even though they had not been cured.10 . . .

VENEREAL DISEASE AND RACISM

In the 1930s as today, health statistics were gathered by race but not by income. The sta- tistics on venereal diseases confirmed the definition of syphilis as predominantly a black or “colored” problem. In fact almost all infec- tious diseases were far more prevalent among blacks than whites, reflecting the effects of poverty, poor housing, and overcrowding. . . .

While [Ferdinand] Reinhard [the head of the bureau of venereal diseases] described the black venereal disease problem as an effect of economics and social conditions, most whites saw venereal diseases simply as a question of sexual morality. Blacks were popularly per- ceived as highly sexual, uninhibited, and pro- miscuous. . . . White doctors saw blacks  as

V E N E R E A L D I S E A S E 433

of pointing out that respectable physicians, innocent children, and heads of industry were among those infected.16 . . .

Parran declared that half the victims of syphilis were “innocently infected”: “Many cases come from such casual contacts as the use of [a] recently soiled drinking cup, a pipe or cigarette; in receiving services from diseased nursemaids, barber or beauty shop operators, etc., and in giving services such as those of a dentist, doctor or nurse to a diseased person.”17

Syphilis was just another contagious disease, although a highly threatening and dangerous one. The point was to find syphilis cases and to treat them; the state should be obliged to provide treatment, said Parran, and the patient should be obliged to endure it. Syphilis would be the next great plague to go—as soon as the public broke with the old-fashioned and pre- scientific notion that syphilis was “the wages of sin.” . . .

[W]hile the city health department was consolidating the new biomedical approach to syphilis, it was suddenly challenged with a resurgent moral crusade against vice and pros- titution, led by none other than the redoubt- able J. Edgar Hoover.

MEDICAL TREATMENT OR CRUSADE AGAINST VICE?

“Captives Taken in Weekend Drive Against City’s White Slave Traffic,” declared the head- lines of the Baltimore Sun on May 17, 1937.18 . . . The raids generated great excitement and con- troversy, magnified when local prostitutes impli- cated a number of high level police officers and at least one state senator in Baltimore’s “white slave trade.”19 The local newspapers took delight in reporting the activities of this organized racket, playing up Baltimore as a notorious cen- ter of vice and iniquity. . . .

State Senator Raymond E. Kennedy now implied that the city health department, like

complained, “Any other group of diseases scat- tered throughout the community to this extent would be considered to have taken on epidemic proportions and would be cause for alarm on the part of health authorities.”14 . . .

Reinhard continued for several years to struggle against the partial treatment plan and to advocate extended clinic facilities, suf- ficient for all syphilis patients, and staffed with black physicians, nurses, and social workers. It seemed, at the time, to be a one-man cam- paign. Most physicians approved of the fact that the health department was not offering treatment, the proper domain of fee-for-service medicine. Particularly during the Depression years, when many physicians found it difficult to make a living on patient fees, the medical profession was antagonistic to efforts by public health officers to offer free treatments to any patients, whatever their illness.

SYPHILIS AS EVERYONE’S DISEASE: A NATIONAL CAMPAIGN

In 1936 Reinhard’s “one-man campaign” against syphilis in Baltimore suddenly became part of a major national effort. Thomas Parran, Surgeon General of the United States Public Health Service, now lent the full weight of his author- ity to a campaign against venereal diseases. A forceful and dynamic man, Parran decided to break through the wall of silence and make the public confront the magnitude of the problem. To do this, he redefined syphilis as a diseases that struck “innocent” victims: the educated, respectable, white population. . . . Parran called syphilis “the great American Disease” and declared: “we might virtually stamp out this dis- ease were we not hampered by the widespread belief that nice people don’t talk about syphilis, that nice people don’t have syphills, and that nice people shouldn’t do anything about those who do have syphilis.”15 Parran’s point was that nice people did have syphilis; he never tired

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THE IMPACT OF WAR

In the late 1930s there were considerable grounds for optimism that the campaign against the venereal diseases was beginning to show results. The more open public health atti- tude toward syphilis as a problem of diseases rather than of morality seemed to be success- ful. . . . The numbers of reported cases of syphi- lis were decreasing each year, despite increased screening efforts and more effective reporting mechanisms. In 1938, 8,236 new cases were reported; in 1939, 7,509; and in 1940, only 6,213. . . . These records of syphilis incidence and prevalence may have been quite unreliable from an epidemiological point of view, but this was the first time that syphilis rates had even seemed to be declining; it was a natural conclu- sion that health department efforts were finally showing demonstrable results.

In the midst of this optimism, however, came the prospect of war and, with it, the fear that war mobilization and an influx of 60,000 soldiers would upset all previous gain.23 In 1941, with the institution of selective service examinations, reported venereal disease rates began to climb. In Baltimore that year, 1.7 per- cent of the white enlistees had positive blood tests for syphilis, as had 24 percent of the black recruits.24 Baltimore City won the dubious dis- tinction of having the second highest syphilis rate in the country, second only to Washington, D.C. Baltimore’s rate was 101.3 cases per 1,000 men examined, more than twice the national rate.25 In an effort to justify these statistics, the city health department blamed the situa- tion on the nonwhite population: the relatively high proportion of blacks to whites “explained” why Baltimore had the second highest vene- real disease rate among the country’s largest cities.26 . . .

Such justifications were hardly likely to be sufficient for a country at war. With the war mobilization had come renewed national

the police department, was implicitly involved in condoning vice. He demanded that all pros- titutes being treated in city clinics be imme- diately incarcerated. Parran was called to appear as a witness before a Grand Jury inves- tigation. On his arrival in Baltimore, however, Parran managed to turn this into a public relations coup for the health department. He announced a state survey of venereal diseases, suggested that Baltimore follow the successful Swedish model of disease control, including the provision of free drugs, and he declared to enthusiastic mass meetings that Maryland would take the lead in the fight against “social diseases.”20 . . .

Thanks to citywide publicity and political pressure on Mayor Jackson, [the health com- missioner, Huntington] Williams was able to expand his budget and open the Druid Hill Health Center for black patients in west Baltimore—the first time that adequate public health facilities had been available in this area of the city.21

The city health department now tackled the problem of syphilis in industry. At the time, industrial workers were being fired (or never hired in the first place) if they were found to have positive blood tests for syphilis. Employers fired infected workers on the grounds that they were more likely to be involved in industrial accidents, and thus would increase the costs of workmen’s compensation and insurance premi- ums. The health department started to provide free laboratory blood tests for industrial work- ers; the test results were kept confidential and those infected were referred for appropriate therapy. The health department followed indi- vidual workers to make sure they were receiving treatment but, at least in theory, no worker who accepted treatment could be fired. The fact that no guarantees were offered workers refusing therapy meant, however, that syphilis treatment was essentially made compulsory for industrial workers participating in the plan.22 . . .

V E N E R E A L D I S E A S E 435

told the press he was tired of hearing the VD rate discussed as though it were only a Negro problem: “Negroes are plagued by venereal diseases because of their economic and social position.”32 . . .

The Army was also under attack for fail- ing to organize an effective VD program.33 Its programs and policies were plagued by contra- dictions; publicly, it advocated chastity, while privately, it provided prophylactics for the men. . . . The Army finally adopted a pragmatic approach and attempted to reduce the sources of infection as much as possible. The pragmatic approach lacked the fervor of a purity crusade, but tried to steer some middle course between laissez-faire attitudes and moral absolutism.

In Baltimore the new acting directors of the city’s venereal disease program, Ralph Sikes and Alexander Novey, shared this pragmatic position. . . . Under their leadership health offi- cers cooperated with the armed services in dis- tributing prophylactic kits throughout the city: in police stations, fire houses, transportation terminals, hospitals, and clinics.34 Implicitly, the VD control officers had thus accepted the idea that this was a campaign against disease, rather than a campaign for sexual morality; they concentrated on a fairly mechanical (if effective) approach to prevention while leav- ing the struggle around prostitution to social hygiene reformers, the police, and the courts.

SEX EDUCATION DURING THE WAR

During the war the city health department and a research group at the Johns Hopkins School of Hygiene and Public Health undertook a daring task—to teach “sex hygiene” in the pub- lic schools. They gave talks to groups of high school students (separated by sex), showed plaster models of male and female reproductive systems, and gave simple explanations of “men- struation, conception, pregnancy, nocturnal

attention to protecting the health and fight- ing efficiency of the soldiers. As during World War  I, the first concern was with the control or suppression of prostitution in the vicin- ity of army camps and with “social hygiene” rather than treatment programs. The May Act passed by Congress made prostitution a federal offense in the vicinity of military camps. . . .

[T]he Baltimore police seemed determined to prove their dedication to the attack on prostitu- tion. By early 1943 they claimed to have closed most of Baltimore’s brothels and to have driven prostitutes from the streets.27 Police Commis- sioner [Robert] Stanton demanded statewide legislation to allow police officers to arrest prostitutes and force them to submit to medical examination and, if infected, medical treatment.28

Dr. Nels A. Nelson, head of the state vene- real disease control program, declared that these arrests of prostitutes and compulsory medical examinations were completely ineffec- tive: only a few prostitutes could be arrested at any one time, and as soon as they were treated and released, they would immediately return to the streets to become reinfected and to continue to spread infection until their next arrest. The only real control of venereal disease, concluded Nelson, depended on the complete “repression of sexual promiscuity.”29 Meanwhile, the reported cases of syphilis were rapidly increasing. In 1942 the selective service records showed that almost 3 percent of the white draftees and over 32 percent of the black soldiers had syphilis.30 . . . Between 1940 and 1942 new cases of syphilis had almost doubled, from 6,213 to 11,293, and gonorrhea rates were also climbing. . . .

Nelson of the state health department had . . . abandoned the fight against prostitu- tion. He was busily distributing free drugs for syphilis control to private physicians, while he publicly declared the city venereal disease clinics “little more than drug pumping sta- tions in dirty, unattractive quarters.”31 Nelson

436 S E X UA L H E A LT H

of this was the normal relaxation in the imme- diate aftermath of war, the return to home and family, the desire for stability, and a reluctance to confront social and sexual problems or to dwell on their existence. Even more important, however, was the success of the new drug, peni- cillin: at last, venereal diseases could, it seemed, be quickly and effectively treated. Many felt it was only a matter of time before the venereal diseases were finally eliminated with the aid of modern medicine’s “miracle cures.”

By 1940 the new “miracle drug” penicil- lin had been discovered and purified: in 1943 it was first used against syphilis, but it was not yet generally available; supplies were still strictly rationed.38 Soon, it would completely transform the old methods of treating vene- real diseases. On December 31, 1944, the Bal- timore City Hospitals opened the first Rapid Treatment Center for treating syphilis with penicillin. Penicillin doses for syphilis were given over eight days; since supplies of the drug were then very limited, only cases judged to be highly infectious were sent for “an eight-day cure, or what is for the present considered to be a cure.”39 From all initial reports the new exper- imental treatment was remarkably effective.

On June 20, 1945, Mayor Theodore R. McKeldin approved a new city ordinance mak- ing treatment for venereal diseases compulsory for the first time. Those suspected of having syphilis or gonorrhea were required to take pen- icillin therapy at the Rapid Treatment Center.40 Those refusing treatment could be quarantined and isolated in the Baltimore city hospitals. . . .

The ordinance was, however, rarely invoked. Most patients were eager to go to the Rapid Treatment Center when diagnosed. In 1946 nearly 2,000 people with infectious syphi- lis received treatment; most were reported as completely cured. (Before penicillin, only an estimated 25 percent of patients completed the lengthy treatments considered necessary for a full cure.41) In 1947 the Baltimore Sun

emissions and masturbation, but omitting intercourse and childbirth.”35 . . .

Having been assured that sex was both exciting and dangerous, students were then given a brief description of male reproductive physiology, ending with a caution against mas- turbation. Masturbation was not dangerous, students were told, merely unnecessary and possibly habit-forming. . . . A brief description of the female reproductive system was followed by a discussion of morals and ethics, warning of the need for judgment, but avoiding spe- cific advice. . . . Students were urged to discuss their questions with parents and teachers and to read a social hygiene pamphlet on “Growing Up in the World Today.”36

The third part of the presentation, on venereal diseases, emphasized the dangers of sex. Intimacy brought the germs of syphilis: sexual intercourse was the most threatening, but even kisses could carry disease. The best strategy was to avoid any possible contact with these sexual germs:

They can be caught only from an infected person and therefore, we should avoid intimate contact with an infected person. But we cannot tell by looking at a person whether he or she is infected or not; the answer is to avoid intimate contact with all persons except in marriage. This is the only sure way of avoiding these diseases.37

At least for these high school students, the link between sexual morality and venereal dis- ease was clear: sexual intimacy led to syphilis and was therefore to be avoided except in mar- riage. Why marital sex should be “safe” was never explained, nor was congenital syphilis ever mentioned.

AFTER THE WAR: THE NEW PENICILLIN THERAPY

By the end of World War II, the problem of syphilis was beginning to recede, both in public consciousness and in statistical measures. Part

V E N E R E A L D I S E A S E 437

will be necessary to reduce sexual promiscuity. If fear of disease is a less powerful restraining factor the problem must be attacked more strongly through moral training and suppres- sion of prostitution.”44 . . .

Even those most committed to the bacte- riological view of disease seemed uneasy about the decoupling of venereal disease from sin and promiscuity: How would sexual morality be controlled if not by the fear of disease? Would “rampant promiscuity” defeat the best efforts of medical treatment? . . .

As we have since discovered, the fear and underlying ambivalence toward sexuality were only lying dormant. Public concern, horror, and fear about AIDS have recently reignited the older social hygiene move- ment in a new form. The once prevalent description of the black population as sexu- ally promiscuous, sexually threatening, and a reservoir of disease has now been applied to the gay male population. AIDS is popu- larly seen as “caused” by gay promiscuity and, even more broadly, as a punishment for unconventional or unapproved sexual behav- ior, rather than simply as the result of infec- tion by a microorganism. Venereal disease is again perceived as the “wages of sin,” or, as the Reverend Jerry Falwell says: “A man reaps what he sows. If he sows seed in the field of his lower nature, he will reap from it a harvest of corruption.” . . .

Both the biomedical and moral perspectives on venereal disease highlight specific aspects of a complex social reality. Venereal diseas es, like all other diseases, are experienced and reproduced in a social context. We may sep- arate the biological and social aspects for analysis, but any complete understanding of a disease problem must involve both, as inter- related parts of a single social reality.

Social and cultural ideas offer a variety of ways in which diseases can be perceived  and interpreted. The germ theory provides an

reviewed the city’s experience with the new ordinance:

On the basis of this experience (over the last 16 months), it is clear that the protection of the public against persons carrying the disease and refusing to be treated more than outweighs the sacrifice of individual rights by so small a number. . . . Under the circumstances, the enactment of a permanent ordinance seems fully justified.42

The state health department in 1947 ann ounced that “for the first time in history any resident of Maryland who contracts syphilis can obtain treatment resulting in prompt and almost cer- tain cure.”43

CONCLUSION: THE END OF THE STRUGGLE?

The biomedical approach to venereal diseases had apparently been stunningly successful. Diseases that only ten years before had been described as the most serious of all the infec- tious diseases had now been tamed by che- motherapy with a simple, safe, and effective cure. Diseases that twenty years previously had been guilty secrets, virtually unmention- able in the public press and quietly ignored by health departments, were now glorious exam- ples of the triumph of modem medicine in overcoming ancient plagues. The ideological struggle between those who had seen the fight against venereal disease as a battle for sexual morality and those who had seen it as simply another form of bacteriological warfare was now over. The social hygiene reformers had to concede defeat to the public health officers, epidemiologists, and laboratory researchers. Or did they?

In 1947 the Maryland State Department of Health, announcing the success of the rapid treatment program, concluded its press bulletin with the warning: “To decrease the number of repeat patients and prevent venereal diseases it

438 S E X UA L H E A LT H

7. Baltimore City Health Department, Annual Report (1930).

8. Taliaferro Clark and Lida Usilton, “Survey of the Venereal Diseases in the City of Baltimore, Baltimore County, and the Four Contiguous Counties,” Venereal Disease Information 12 (Washington, DC: 20 October 1931), 437–56.

9. Baltimore City Health Department, Annual Report (1932), 62.

10. Baltimore City Health Department, Annual Report (1933), 93.

11. James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: The Free Press, 1981), 16–29.

12. Baltimore City Health Department, Annual Report (1934), 107.

13. Baltimore City Health Department, Annual Report (1935), 115.

14. Ferdinand O. Reinhard, “The Venereal Disease Problem in the Colored Population of Baltimore City,” American Journal of Syphilis and Neurology 19 (1935): 183–95.

15. Thomas Parran, “Why Don’t We Stamp Out Syphilis?” Reader’s Digest (July 1936), reprinted in Baltimore Health News (August 1936): 3.

16. E.g. Parran, Shadow on the Land: Syphilis (New York: 1937), 207, 230.

17. Parran, “Why Don’t We Stamp Out Syphilis?” Reader’s Digest, 65–73.

18. “G-Men’s Haul in Vice Raids Totals 47,” Baltimore Sun, 17 May 1937.

19. “Vice Witness Names Police Lieutenant,” Baltimore Sun, 18 May 1937; “Vice Arrests May Total 100; Bierman Named,” Sunday Sun, 19 May 1937.

20. “Starts to Survey Venereal Disease,” Baltimore Sun, 29 July 1937; “Venereal Disease Fight Is Planned,” Baltimore Sun, 22 August 1937; “Fight Opens Here on Social Disease,” Baltimore Sun, 25 August 1937; “Syphilis Control Unit Begins Work,” Baltimore Sun, 21 October 1937; “Over 2,000 Attend Talks on Syphilis,” Baltimore Sun, 26 October 1937.

21. Baltimore City Health Department, Annual Reports (1938), 159; (1939), 159.

22. Baltimore City Health Department, Annual Report (1938); 16; “21 Employers Asked in Drive on Syphilis,” Baltimore Sun, 27 March 1938; “Syphilis Control Is Under Way Here,” Baltimore Sun, 22 May 1938; W. M. P., “We Join the Anti-Syphilis Crusade,” The Kalends (June 1938), reprinted in Baltimore Health News 15 (July 1938): 53–54; Baltimore City Health Department, “Syphilis in Industry” (Baltimore: n.d.).

23. Baltimore City Health Department, Annual Report (1940), 149–51.

explanation of disease that largely—but not completely—isolates it from this social context, robbing it of some of its social (and in this case, moral) meaning. But the purely “scientific” inter- pretation is never wholly victorious, for social and cultural meanings of disease reassert them- selves in the interstices of science and prove their power whenever the biomedical sciences fail to completely cure or solve the problem. Only when a disease condition is completely abolished do social and cultural meanings cease to be relevant to the experience and perception of human illness.

NOTES 1. For a fascinating analysis of the history of cultural and scientific conceptions of syphilis, see Ludwig Fleck, Genesis and Development of a Scientific Fact (1935, rpt., Chicago: 1979).

2. For an excellent recent history of the controversies around venereal diseases in the United States, see Allan Brandt, No Magic Bullet: A Social History of Venereal Diseases in the United States Since 1880 (New York: 1985).

3. National Academy of Sciences, Scientific and Technical Societies of the United States and Canada, 8th ed. (Washington, DC: 1968), 62.

4. Edward H. Beardsley, “Allied Against Sin: American and British Responses to Venereal Disease in World War I,” Medical History 20 (1976): 194.

5. As one widely reprinted article, said to have reached eight million readers, described ‘The Enemy at Home’: “The name of this invisible enemy is Venereal Disease— and there you have in two words the epitome of all that is unclean, malignant and menacing. . . . Gonorrhea and syphilis are ‘camp followers’ where prostitution and alcohol are permitted. They form almost as great an enemy behind the lines as do the Huns in front.” “V.D.: The Enemy at Home,” as cited by William H. Zinsser, “Social Hygiene and the War: Fighting Venereal Disease a Public Trust,” Social Hygiene 4 (1918): 519–20.

6. In 1920 William Travis Howard, a member of the city health department, complained: “The Baltimore health department has never inaugurated a single administrative measure directed at the control of the venereal diseases . . . the Baltimore health department has contented itself with receiving such reports as were made and with lending its power, when called upon, to force a few recalcitrant patients to appear at the venereal disease clinic established by the United States Government.” Howard, Public Health Administration and the Natural History of Disease in Baltimore, Maryland: 1797–1920 (Washington, DC: 1924), 154–55.

H I V A M O N G P EO P L E AG E D 5 0 A N D OV E R 439

35. C. Howe Eller, “A Sex Education Project and Serologic Survey in a Baltimore High School,” Baltimore Health News 21 (November 1944): 83.

36. Emily V. Clapp, Growing Up in the World Today (Boston: n.d.).

37. Ibid., 14.

38. For the development of penicillin therapy, see Harry F. Dowling, Fighting Infection: Conquests of the Twentieth Century (Cambridge: Harvard University Press, 1977): 125–57.

39. Baltimore City Health Department, Annual Report (1945), 29.

40. Baltimore City Health Department, Annual Report (1945), 145–46; “Venereal Law Made Specific,” Baltimore Sun, 26 August 1945.

41. “End of VD—Cure Center Seen as Calamity,” Evening Sun, 12 June 1946.

42. “A Temporary Power Made Permanent,” Baltimore Sun, 9 January 1947.

43. “Rapid Treatment,” Press Bulletin No. 1043, Maryland State Department of Health, (27 January 1947), Enoch Pratt Library, Maryland Room, Baltimore.

44. lbid.

24. Baltimore City Health Department, Annual Report (1941), 139.

25. “City Shown Second in Syphilis Survey,” Baltimore Sun, 22 October 1941.

26. “High Syphilis Rate Laid to Race Ratio,” Baltimore Sun, 26 October 1941.

27. “Says Vice Control Has Improved Here,” Baltimore Sun, 27 January 1943.

28. “State Law Held Needed in War on Vice,” Baltimore Sun, 28 January 1943.

29. “Stanton Idea for Examination of Prostitutes Is Denounced,” Baltimore Sun, 29 January 1943.

30. “Venereal Picture Dark: Dr. Huntington Williams Says No Improvement Is Expected for Some Time,” Baltimore Sun, 21 January 1943.

31. “Clinics Here Under Fire,” Baltimore Sun, 30 March 1943.

32. “Venereal Disease Rate High in State,” Baltimore Sun, 15 June 1943.

33. Parran and Vonderlehr, Plain Words about Venereal Disease (New York: Reynal or Hichcock, 1941), especially 96–120.

34. Baltimore City Health Department, Annual Report (1943), 148.

HIV among People Aged 50 and Over

Centers for Disease Control and Prevention

People aged 50 and older account for an estimated 45% of Americans living with diagnosed HIV.

THE NUMBERS

HIV Diagnoses1

• People aged 50 and over accounted for 17% (6,725) of an estimated 39,513 HIV diagno- ses in the United States in 2015. People aged 50 to 54 accounted for 45 percent (3,010) of the 6,725 diagnoses.

• Blacks/African Americans accounted for an estimated 43% of all new diagnoses among

people aged 50 and over in 2015. Whites accounted for 36%, and Hispanics/Latinos2 accounted for 17%.

• In 2014, 40% of people aged 55 and older were diagnosed with AIDS at the time of HIV diagnosis (i.e., diagnosed late in the course of the infection).

Living with HIV and Deaths • In 2014, an estimated 45% of Americans

living with diagnosed HIV were aged 50 and older, 27% were aged 55 and older, and 6% were aged 65 and older.

440 S E X UA L H E A LT H

thinning and dryness of vaginal tissue may raise older women’s risk for HIV infection.

• Although they visit their doctors more fre- quently, older people are less likely than younger people to discuss their sexual habits or drug use with their doctors. And doctors are less likely to ask their older patients about these issues.

Stigma is a particular concern among older people because they may already face isola- tion due to illness or loss of family and friends. Stigma negatively affects people’s quality of life, self-image, and behaviors, and may pre- vent them from seeking HIV care and disclos- ing their HIV status.

Aging with HIV infection also presents special challenges for preventing other dis- eases because both age and HIV increase risk for cardiovascular disease, thin bones, and certain cancers. Older HIV patients and their care providers need to maximize prevention efforts against these conditions and remain vigilant for early signs of illness. They also need to be careful about interactions between the medications used to treat HIV and those used to treat common age-related conditions such as hypertension, diabetes, elevated cho- lesterol, and obesity.

NOTES 1. HIV diagnoses indicate when a person was diagnosed with HIV, not when the person was infected.

2. Hispanics/Latinos can be of any race.

Source: Centers for Disease Control and Prevention, “HIV among People Aged 50 and Over,” September 2017. https:// www.cdc.gov/hiv/group/age/olderamericans/index.html.

• Among people aged 55 and older living with HIV in 2014, 67% received HIV medi- cal care and 55% received continuous HIV care.

• Of the 6,721 deaths from HIV in 2014, 2,610 (39%) were among people aged 55 and older.

PREVENTION CHALLENGES

Older people in the United States are more likely than younger people to be diagnosed with HIV infection late in the course of the infection, which results in their starting treat- ment late and possibly suffering more immune- system damage. Late diagnoses can occur because health care providers may not always test older people for HIV infection, and older people may not consider themselves to be at risk of HIV infection or may mistake HIV symptoms for those of normal aging and not consider HIV as a cause.

Many older people are sexually active, including those living with HIV, and may have the same HIV risk factors as younger people, including a lack of knowledge about HIV and how to prevent getting it, as well as having multiple sex partners. Older people also face some unique issues:

• Many widowed and divorced people are dat- ing again. They may be less aware of their risks for HIV than younger people, believing HIV is not an issue for older people. Thus, they may be less likely to protect themselves.

• Women who no longer worry about becom- ing pregnant may be less likely to use a con- dom and to practice safer sex. Age-related

441

R E A D I N G 3 7

historically located social arrangements and the cultural values of any society” (Conrad and Kern, 1994: 5). Present American social values reflect the longstanding connections between sexual health and morality: Inter- actions with medical practitioners and lay people are the conduit through which the stigma of STDs is reinforced (Brandt, 1987). Pryce (1998) pointed to a critical gap—the “missing” sociology of sexual disease—and asserted that this application of sociology should focus on the social construction of the body as central in the medical and social ico- nography of STDs.

In answer to Pryce’s (1998) challenge, this  research . . . sociologically analyz[es] the impact of genital herpes and HPV on women’s sexual selves. This study adds to this research area by examining sexual self-transformation, starting from the point of how individuals’ sexual selves are transformed by the lived experiences of being diagnosed and treated for chronic STDs. Beginning from a premise that the majority of people grow up feeling sexually invincible, a variety of traumas have the capacity to disrupt a positive sexual self- concept (e.g., molestation, rape, and illness). Social-interactional traumas also transmit messages that can damage sexual selves: Some

T he HIV/AIDS epidemic has garnered the attention of researchers from a variety of academic disciplines. In contrast, the study of other sexually trans- mitted diseases (STDs) has attracted limited interest outside of epidemiology and public health.

. . . This [reading] focuses on how the sexual self-concept is transformed when the experi- ence of living with a chronic STD casts a shadow of disease on the health and desir- ability of a woman’s body, as well as on her perceived possibilities for future sexual expe- riences. The term sexual self means something fundamentally different from gender identity or sexual identity. Invoking the term sexual self is meant to conjure up the innately intimate parts of individuals’ self-concepts that encom- pass how they think of themselves with regard to their experienced and imagined sensuality. Components of a sexual self may include the following: level of sexual experience, emo- tional memories of sexual pleasure (or lack thereof), perception of one’s body as desirable, and perception of one’s sexual body parts as healthy. . . .

To understand the individual-level expe- rience of living with a chronic STD, it is important to take into account how these infections are symbolically constructed in American culture. The meanings that Ameri- cans give to being infected with an STD are inter subjectively formed during interactions. Individuals’ experiences of health, illness, and medical care “are connected to the particular

DAMAGED GOODS: WOMEN MANAGING THE STIGMA OF STDs

A D I N A N A C K

From “Damaged Goods: Women Managing the Stigma of STDs,” Deviant Behavior, Vol. 21, Issue 2, 2000, pp. 95–121. Copyright © 2000 Routledge, reprinted by per- mission of the publisher (Taylor & Francis Ltd, http:// www.tandfonline.com).

442 S E X UA L H E A LT H

physical bodies are undesirable; some sexual preferences are unacceptable; some levels of sexual experience are immoral.

SETTING AND METHOD

The motivation for this study stems from my personal experience with STDs. My “com- plete membership role” (Adler and Adler, 1987) stems from legitimacy and acceptance by other women with STDs as a member of this unorganized and stigmatized group. At 20, sexual health became the center of my world when I was diagnosed with mild cer- vical dysplasia, the result of an HPV infec- tion. I began an informal self-education process that helped me manage the stress of my treatments. My commitment to manag- ing my sexual health status would become the foundation for this research project and provide me with the personal insights needed to connect with others facing STDs and the clinical knowledge necessary to be a sexual health researcher.

As a campus sexual health educator, I began to question what sexual health services were not provided. Seeing that women and men were being diagnosed and treated for STDs without receiving follow-up education and counsel- ing, I developed a women-only support group for individuals dealing with STDs. Because of the topic’s sensitive nature, I chose a gender- segregated approach to the support group and, ultimately, to the research. . . .

Unfortunately, only one woman used the support group. Initially disheartened, I began to question why people flocked to other sup- port groups that were based on shared stigma (e.g., eating disorders and alcoholism) but failed to use this sexual health support group. Even persons living with HIV and AIDS used support groups to collectively manage their stigma. . . .

To investigate the failure of this support group, I conducted a survey among patients using a local women’s health care clinic. Dur- ing a month chosen at random, clinic staff gave each patient who came in for an appointment an anonymous survey about a new service being offered: a women’s sexual health sup- port group. In all, 279 completed surveys were collected. . . . Owing to the population from which the sample was drawn, generalizability is restricted to the population of women who receive women’s health care services from this clinic. . . .

I performed a multiple regression analysis on the data, the results of which supported the hypothesis that a person who has been diag- nosed with an STD is less likely to be inter- ested in a sexual health support group. . . . One of the most revealing findings was that only 23.3 percent of the women were defi- nitely interested (“yes”) in a sexual health sup- port group. . . .

I interpreted this finding to reflect that the stigma of having an STD is so severe that the perceived cost of disclosing this sexual health status to strangers outweighs the possible ben- efits. Because there has yet to be a moral entre- preneurial campaign to destigmatize STDs in our society, the norm remains secrecy (Brandt, 1987). . . .

On the basis of these findings, I determined that in-depth interviews were my best chance for obtaining valid data. I constructed my research methods to reflect a reciprocal inten- tion: As the women gave their stories to me, I would offer my support and resources as a sexual health educator. . . .

My first hurdle was to achieve approval from the campus Human Research Committee. . . . Because of the confidential nature of indi- viduals’ STD diagnoses, I was not allowed to directly recruit participants. Rather, they had to approach me, usually after hearing about

DA M AG E D G O O D S 443

stigma was known to others either because the individuals revealed the deviance or because the deviance was not concealable. In contrast, the discreditable were able to hide their devi- ant stigma. Goffman found that the majority of discreditables were “passing” as nondeviants by avoiding “stigma symbols,” anything that would link them to their deviance, and by using “disidentifiers,” props or actions that would lead others to believe they had a nondeviant status. Goffman (1963) also noted that indi- viduals bearing deviant stigma might eventu- ally resort to “covering,” one form of which he defined as telling deceptive stories. To remain discreditable in their everyday lives, 19 of the women used the individual stigma manage- ment strategies of passing and/or covering. In contrast, 9 women revealed their health status to select friends and family members soon after receiving their diagnoses.

Passing The deviant stigma of women with STDs was essentially concealable, though revealed to the necessary inner circle of health care and health insurance providers. For the majority, passing was an effective means of hiding stigma from others, sometimes even from themselves.

Hillary, a 22-year-old White college senior, recalled the justifications she had used to dis- tance herself from the reality of her HPV infec- tion and to facilitate passing strategies.

At the time, I was in denial about it. I told myself that that wasn’t what it was because my sister had had a similar thing happen, the dysplasia. So, I just kind of told myself that it was hereditary. That was kinda funny because I asked the nurse that called if it could be hereditary, and she said “No, this is com- pletely sexually transmitted”—I really didn’t accept it until a few months after my cryosurgery.

Similarly, Gloria, a Chicana graduate stu- dent  . . . was not concerned about a previous case of gonorrhea she had cured with antibiotics

my research project from other participants or women’s health care practitioners with whom I had consulted. . . . I used snowball sampling to generate interviews.

I conducted 28 conversational, unstructured interviews with consensual participants, who ranged in age from 19 to 56. . . . I conducted the interviews in participants’ preferred loca- tions: their homes, my home, or other private settings. The interviews lasted from 1 to 2 hours and were tape recorded with the par- ticipants’ permission. When appropriate, I concluded the interview with offers to provide sexual health information and resources, either in the form of health education materials or referrals to resources.

I then analyzed the data according to the principles of grounded theory (Glaser and Strauss, 1967). . . . With each interview, I started to cluster participants’ experiences around particular stages to check the validity of my initial model. The six stages of sexual self- transformation [that emerged from the inter- views] in chronological order, are as follows: sexual invincibility, STD suspicion, diagnostic crisis, damaged goods, healing/treatment, and integration. . . .

STIGMA AND THE SEXUAL SELF

For all but 1 of the 28 women, their STD diagnoses radically altered the way that they saw themselves as sexual beings. Facing both a daunting medical and social reality, the women used different strategies to manage their new stigma. Each stigma management strategy had ramifications for the transformation of their sexual selves.

Stigma Nonacceptance Goffman (1963) proposed that individuals at risk for a deviant stigma are either “the discred- ited” or “the discreditable.” The discrediteds’

444 S E X UA L H E A LT H

The women also tried to disidentify them- selves from sexual disease in their attempts to pass as being sexually healthy. Rather than actively using a verbal or symbolic prop or action that would distance them from the stigma, the women took a passive approach. Some gave nonverbal agreement to putdowns of other women who were known to have STDs. For example, Hillary recalled such an interaction.

It’s funny being around people that don’t know that I have an STD and how they make a comment like “That girl, she’s such a slut. She’s a walking STD.” And how that makes me feel when I’m confronted with that, and having them have no idea that they could be talking about me.

Others kept silent about their status and tried to maintain the social status of being sexu- ally healthy and morally pure. . . . Putting up the facade of sexual purity, these women distanced themselves from any suspicion of sexual disease.

Covering When passing became too difficult, some women resorted to covering to deflect fam- ily and friends from the truth. Cleo summed up the rationale by comparing her behavior to what she had learned growing up with an alco- holic father. “ . . . I learned that’s what you do. Like you don’t tell people those things that you consider shameful, and then, if confronted, you know, you lie.”

Hillary talked to her parents about her HPV surgery, but never as treatment for an STD. She portrayed her moderate cervical dysplasia as a precancerous scare, unrelated to sex. . . . When Tasha’s sister helped her get a prescription for pubic lice, she actually provided the cover story for her embarrassed younger sister. “She totally took control, and made a personal inquiry: ‘So, how did you get this? From a toilet seat?’ And, I was like, ‘a toilet seat,’ and she believed me.” . . . For Anne, a 28-year-old . . . graduate student, a

or her chronic HPV “because the warts went away.” Out of sight, out of her sex life: “I never told anybody about them because I figured they had gone away, and they weren’t com- ing back. Even after I had another outbreak, I was still very promiscuous. It still hadn’t reg- istered that I needed to always have the guy use a condom.”

When the women had temporarily con- vinced themselves that they did not have a con- tagious infection, it was common to conceal the health risk with partners because the women themselves did not perceive the risk as real. Kayla, a . . . White college senior, felt justified in passing as healthy with partners who used condoms, even though she knew that condoms could break. Cleo, a White 31-year-old . . . , had sex with a partner after being diagnosed with HPV.

So at the time I had sex with him, yes, I knew but, no, I hadn’t been treated yet. That gets into the whole “I never told him,” and I didn’t. Part of me thought I should, and part of me thought that hav- ing an STD didn’t fit with my self-concept so much that I just couldn’t disclose.

Francine, a White 43-year-old professional . . . , had never intended to pass as healthy, but she did not get diagnosed with herpes until after beginning a sexual relationship with her second husband.

I think there was all the guilt: What if I bring this on you? So, I felt guilt in bringing this into the rela- tionship. Because he had not been anywhere near as sexually active as I had. . . .

Similarly, Tasha, a White graduate student, found out that she might have inadvertently passed as healthy when her partner was diag- nosed with chlamydia. “I freaked out—I was like, ‘Oh my God! I gave you chlamydia. I am so sorry! I am so sorry!’ I felt really horrible, and I felt really awful.” . . . Even if the passing is done unintentionally, it still brings guilt to the passer.

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have a wart on your penis! Ahhh!” All of a sudden, it comes back to me.

Cleo’s decision to pass left her with both the guilt of deceiving and infecting her husband.

Surprisingly, those women who had unin- tentionally passed as being sexually healthy (i.e., they had no knowledge of their STD sta- tus at the time) expressed a similar level of guilt as those who had been purposefully deceitful. Violet, a middle-class, White 36-year-old, had inadvertently passed as healthy with her cur- rent partner. Even after she had preventively disclosed to him, she still had to deal with the guilt over possibly infecting him.

It hurt so bad that morning when he was basically furious at me thinking I was the one he had gotten those red bumps from. It was the hour from hell! I felt really majorly dirty and stigmatized. I felt like “God, I’ve done the best I can: If this is really caused by the HPV I have, then I feel terrible.”

When using passing and covering techniques, the women strove to keep their stigma from tainting social interactions. They feared . . . rejection from their social circles of friends, family, and, most important, sexual partners. For most of the women, guilt surpassed fear and became the trigger to disclose. Those who had been deceitful in passing or covering had to assuage their guilt: Their options were either to remain in nonacceptance, disclose, or transfer their guilt to somebody else.

Stigma Deflection As the women struggled to manage their indi- vidual stigma of being sexually diseased, real and imaginary social interactions became the conduit for the contagious label of damaged goods. Now that the unthinkable had hap- pened to them, the women began to think of their past and present partners as infected, contagious, and potentially dangerous to themselves or other women. The combination of transferring stigma and assigning blame to

painful herpes outbreak almost outed her on a walk with a friend. She was so physically uncom- fortable that she was actually waddling. Notic- ing her strange behavior, her friend asked what was wrong. Anne told her that it was a hem- orrhoid; that was only a partial truth because herpes was the primary cause of her pain. As Anne put it, telling her about the hemorrhoid “was embarrassing enough!”

Deception and Guilt The women who chose to deny, pass as normal, and use disidentifiers or cover stories shared more than the shame of having an STD—they had also told lies. With lying came guilt. Anne, who had used the hemorrhoid cover story, eventually felt extremely guilty. Her desire to conceal the truth was in conflict with her commitment to being an honest person. . . . Deborah, a 32-year-old White professional . . . , only disclosed to her first sexual partner after she had been diagnosed with HPV; she passed as healthy with all other partners. Deborah reflected, “I think my choices not to disclose have hurt my sense of integrity.” However, her guilt was resolved during her last gynecological exam when the nurse practitioner confirmed that after years of “clean” pap smear results Deborah was not being “medically unethi- cal” by not disclosing to her partners. In other words, her immune system had probably dealt with the HPV in such a way that she might never have another outbreak or transmit the infection to sexual partners.

When Cleo passed as healthy with a sexual partner, she started “feeling a little guilty about not having told.” However, the consequences of passing as healthy were very severe for Cleo:

No. I never disclosed it to any future partner. Then, one day, I was having sex with Josh, my current husband, before we were married, and we had been together for a few months, maybe, and I’m like look- ing at his penis, and I said, “Oh, my goodness! You

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lot of partners.” Robin, a 21-year-old White undergraduate, went so far as to tell her ex- partner that he needed to see a doctor and “do something about it.” He doubted her ability to pinpoint contracting genital warts from him and called her a slut. Robin believed that he was the one with the reputation for promiscu- ity and decided to trash him by telling her two friends who hung out with him. Robin hoped to spoil his sexual reputation and scare off his future partners. In the transference of stigma, the women ascribed the same auxiliary traits onto others that others had previously ascribed to them. . . .

In all cases, it was logical to assume that past and current sexual partners may also have been infected. However, the stigma of being sexually diseased had far-reaching consequences in the women’s imaginations. The traumatic impact on their sexual selves led most to infer that future, as yet unknown partners were also sex- ually diseased. . . . They had already been dam- aged by at least one partner. Therefore, they expected that future partners, ones who had not yet come into their lives, held the threat of also being damaged goods.

For Hillary, romantic relationships held no appeal anymore. She had heard of others who also had STDs but stayed in nonacceptance and never changed their lifestyle of having casual, unprotected sex:

I just didn’t want to have anything to do with it. A lot of it was not trusting people. When we broke up, I decided that I was not having sex. Initially, it was because I wanted to get an HIV test. Then, I came to kind of a turning point in my life and realized that I didn’t want to do the one-night-stand thing anymore. It just wasn’t worth it. It wasn’t fun.

At this stage in her sexual self-transformation, Hillary imagined the world of possible partners having been polluted with contagion.

Anne’s lesbian friends [told her] . . . future part- ners should be suspected of being dangerous. . . .

others allowed the women to deflect the STD stigma away from themselves.

Stigma Transference . . . Stigma is neither an emotion nor an impulse; rather, it is a formal concept that cap- tures a relationship of devaluation (Goffman, 1963). Although the participants attributed their devalued relationship with sexual health ideals to real and imaginary others, they were not controlling unacceptable feelings. Rather, stigma transference manifests as a clear expres- sion of anger and fear, and the women did not connect this strategy to a reduction in their levels of anxiety; in fact, several discussed it in relation to increased anxiety.

Cleo remembered checking her partner’s penis for warts after her doctor told her that she could detect them by visual inspection. It became a habit for Kayla to check her partner for any visible symptoms of an STD. Gloria was more careful about checking future part- ners and asking if they had anything. Tasha explained, “I just felt like I was with someone who was dirty.” In all four cases, the women were only sure of their own STD infections, yet in their minds these partners had become diseased.

Transference of stigma to a partner became more powerful when the woman felt betrayed by her partner. When Hillary spoke of the “whole trust issue” with her ex-partner, she firmly believed he had lied to her about his sexual health status and that he would lie to others. Even though she had neither told him about her diagnosis nor had proof of him being infected, she fully transferred her stigma to him. . . .

Kayla also transferred the stigma of sexual disease to an ex-partner, never confronting him about whether he had tested positive for STDs. The auxiliary trait of promiscuity colored her view of him: “I don’t know how sexually pro- miscuous he was, but I’m sure he had had a

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warts from his wild fraternity parties: “We really thought of it as, that woman who did the trains [serial sexual intercourse]. It was still a girl’s fault kind of thing.” By externalizing the blame to the promiscuous women at fraternity parties, Francine exonerated not only herself but also her husband. . . .

For Violet, it was impossible to neatly deflect the blame away from both herself and her partner.

I remember at the time just thinking, “Oh man! He gave it to me!” While he was thinking, “God, [Vio- let]! You gave this to me!” So, we kind of just did a truce in our minds. Like, OK, we don’t know who gave it—just as likely both ways. So, let’s just get treated. We just kind of dropped it.

Clearly, the impulse to place blame was strong even when there was no easy target.

Often, the easiest targets were men who exhibited the auxiliary traits of promiscuity and deception. Tasha wasn’t sure which ex- partner had transmitted the STD. However, she rationalized blaming a particular guy. “He turned out to be kind of a huge liar, lied to me a lot about different stuff. And so I blamed him. All the other guys were, like, really nice people, really trustworthy.” Likewise, when I asked Violet from whom she believed she had contracted chlamydia, she replied, “Dunno, it could’ve been from one guy, because that guy had slept with some unsavory women, so there- fore he was unsavory.” . . .

The actual guilt or innocence of these blame targets was secondary. What mattered to the women was that they could hold someone else responsible.

Stigma Acceptance Eventually, every woman in the study stopped denying and deflecting the truth of her sex- ual health status by disclosing to loved ones. The women disclosed for either preventive or therapeutic reasons. That is, they were either

Anne recalled [one] friend’s reaction. “Those rotten men! You should just leave them alone. It’s clear that you should be with women, and it’s safer and better that way. Women don’t do this kind of thing to each other.” Her friends’ guidance was an  overt attempt to encourage Anne to believe that only potential male part- ners bore the stigma.

Instead of going by gender, Gloria, a self- identified Chicana, made a distinction based on ethnicity as a predictor of sexual health status:

Now, if it was a White man, I made ’em wear a con- dom because I got it from a White man, and so I assumed that there had to be something with their culture—they were more promiscuous. But, one thing I do know culturally and with the times is that Chicano men were more likely to have a single partner.

These women felt justified in their newfound attitudes about sexual partners. What was only supposed to happen to “bad” women had hap- pened to them. Overall, these women tran- sitioned from blaming their own naivete to blaming someone else for not being more cau- tious or more honest.

Blame The women’s uses of stigma transference tech- niques were attempts to alleviate their emotional burdens. First, the finger of shame and guilt pointed inward, toward the women’s core sexual selves. Their sexual selves became tainted, dirty, damaged. In turn, they directed the stigma out- ward to both real and fictional others. Blaming others was a way for all of the women to allevi- ate some of the internal pressure and turn the anger outward. This emotional component of the damaged goods stage externalized the pain of their stigma.

Francine recalled how she and her first hus- band dealt with the issue of genital warts. . . . Francine’s husband had likely contracted genital

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her genital warts to a new boyfriend after they had been “getting hot n’ heavy.” Lying in bed together, she said, “I need to tell you some- thing.” After she disclosed, he lay there, star- ing at the ceiling for a couple of minutes before deeply exhaling, “I thought you were going to tell me you had AIDS.” Similarly, one of Gloria’s partners sighed in relief when she revealed that she had herpes; he thought she was going to say she was HIV positive.

Many of the therapeutic disclosures were done to family members. The women wanted the support of those who had known them the longest. . . . Tasha disclosed to her mother right after she was diagnosed with chlamydia.

My family died—“Guess what, mom, I got chla- mydia.” She’s like, “Chlamydia? How did you find out you got chlamydia?” I’m like, “Well, my boy- friend got an eye infection.” [laughter] “How’d he get it in his eye?” [laughter] So, it was the biggest joke in the family for the longest time!

. . . The women often unburdened their feelings of shame and guilt onto their close friends. Cleo shared her feelings with her room- mate: “I told her that I was feeling weird about having had sex with this second guy, knowing that I had an STD.” Kayla’s therapeutic disclo- sure was reciprocal with her best friend. “At that time, she was also going through a simi- lar situation with her boyfriend, so I felt okay finally to talk about it.” . . . In Anne’s case, her therapeutic disclosure to a friend was twofold: both to seek support and to apologize for ini- tially having used the hemorrhoid cover story. Anne explained to her friend that she had felt too uncomfortable to tell the truth. . . .

Consequences of Disclosure With both therapeutic and preventive disclo- sure, the women experienced some feelings of relief in being honest with loved ones. How- ever, they still carried the intense shame of

motivated to reveal their STD status to prevent harm to themselves or others or to gain the emotional support of confidants.

Preventive and Therapeutic Disclosures The decision to make a preventive disclosure was linked to whether the STD could be cured. Kayla explained,

Chlamydia went away, and I mean it was really bad to have that, but I mean it’s not something that you have to tell people later ’cause you know, in case it comes back. Genital warts, you never know.

Kayla knew that her parents would find out about the HPV infection because of insurance connections. Before her cryosurgery, Kayla decided to tell her mom about her condition.

. . . [I]t was kind of hard at first. But, she wasn’t upset with me. Main thing, she was disappointed, but I think she blamed my boyfriend more than she blamed me.

. . . Preventive disclosures to sexual part- ners, past and present, were a more problem- atic situation. The women were choosing to put themselves in a position where they could face blame, disgust, and rejection. For those rea- sons, the women put off preventive disclosures to partners as long as possible. For example, Anne made it clear that she would not have dis- closed her herpes to a female sexual partner had they not been about to have sex. After “agoniz- ing weeks and weeks and weeks before trying to figure out how to tell,” Diana, a 45-year-old African American professional, finally shared her HPV and herpes status before her current relationship became sexual. Unfortunately, her boyfriend had a negative reaction: “He cer- tainly didn’t want to touch me anywhere near my genitals.” . . .

For Summer, a 20-year-old Native American administrative assistant, and Gloria, their pre- ventive disclosures were actually a relief to their sexual partners. Summer decided to disclose

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CONCLUSION

The women with STDs went through an emo- tionally difficult process, testing out stigma management strategies, trying to control the impact of STDs on both their self-concepts and on their relationships with others. . . .

Ironically, most of the women first tried to deny this deviant health status—one that was virtually secret through the protection of doctor–patient confidentiality laws. Although many used passing and covering techniques that relied on deceiving others, self-deception was impossible to maintain. The medical truth began to penetrate their sexual self-conceptions as soon as they fabricated their first lie. To strat- egize a successful ruse, it was necessary to know the scope of what they were trying to hide.

When guilt caught up with them, making it hard to pass as healthy, their goal shifted to stigma deflection. . . . However, this only delayed the inevitable—a deviant sexual self that penetrated the women’s prior conceptions of their sexual selves.

After mentally transferring their stigma to real and imaginary others, all of the women finally accepted their tainted sexual health status through the reflexive dynamics of disclosure. . . . The women’s sexual selves moved along a deviant career path by means of the interactive dynamics of their stigma management strategies.

. . . As the women made choices on which stigma management strategies to use, they grappled with the ramifications of internal- izing this new label. Choosing passing and covering techniques meant they could remain in nonacceptance and put off stigma internal- ization. When they deflected the stigma onto others by means of stigma transference, the women glimpsed the severity of an STD stigma as reflected in the presumed sexual selves of real and imaginary others. Finally, the women’s disclosures confirmed the new story of their tainted sexual selves.

being sexually diseased women. The resulting emotion was anxiety over how their con fidants would react: rejection, disgust, or betrayal. Fra ncine was extremely anxious about disclos- ing to her husband. “That was really tough on us because I had to go home and tell Damon that I had this outbreak of herpes . . . I was really fearful—I didn’t think that he would think I had recently had sex with somebody else—but, I was still really afraid of what it would do to our relationship.” . . .

Overall, disclosing intensified the anxiety of having their secret leaked to others in whom they would never have chosen to confide. In addition, each disclosure brought with it the possibility of rejection and ridicule from the people whose opinions they valued most. For Gloria, disclosing was the right thing to do but had painful consequences when her partner’s condom slipped off in the middle of sexual intercourse.

I told him it doesn’t feel right. “You’d better check.” And, so he checked, and he just jumped off me and screamed, “Oh fuck!” And, I just thought, oh no, here we go. He just freaked and went to the bath- room and washed his penis with soap. I just felt so dirty.

The risk paid off for Summer, whose boyfriend asserted, “I don’t ever want to be that guy—the one who shuns people and treats them differ- ently.” He borrowed sexual health education materials and spent over an hour asking her questions about various STDs. Even in this best-case scenario, the sexual intimacy in this relationship became problematized (e.g., hav- ing to research modes of STD transmission and safe-sex techniques). Disclosures were the interactional component of self-acceptance. The women became fully grounded in their new reality when they realized that the sig- nificant people in their lives were now viewing them through the discolored lenses of sexual disease.

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REFERENCES Ackerman, Sandra J. 1998. “HPV: Who’s Got It and Why

They Don’t Know.” HPV News 8(2):1; 5–6. Adler, Patricia A., and Peter Adler. 1987. Membership Roles

in Field Research. Newbury Park, CA: Sage. Brandt, Allan M. 1987. No Magic Bullet: A Social History

of Venereal Disease in the United States since 1880. New York: Oxford University Press.

Centers for Disease Control and Prevention. 1998a. “Genital Herpes.” National Center for HIV, STD & TB Prevention. Retrieved from the World Wide Web February 4, 1998.

———. 1998b. “HIV/AIDS Surveillance Report.” National Center for HIV, STD & TB Prevention. Retrieved from the World Wide Web February 4, 1998: URL.

Conrad, Peter, and Rochelle Kern, eds. 1994. The Sociology of Health & Illness: Critical Perspectives. 4th ed. New York: St. Martin’s Press.

Glaser, Barney G., and Anselm L. Strauss. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine.

Goffman, Erving. 1963. Stigma. Englewood Cliffs, NJ: Prentice Hall.

McAdams, Dan P. 1996. The Stories We Live By: Personal Myths and the Making of the Self. New York: Guilford Press.

Pryce, Anthony. 1998. “Theorizing the Pox: A Missing Sociology of VD.” Presented to the International Sociological Association.

Sandstrom, Kent L. 1990. “Confronting Deadly Disease: The Drama of Identity Construction among Gay Men with AIDS.” Journal of Contemporary Ethnography, 19(3):271–94.

Siegel, Karolynn, and Beatrice J. Krauss. 1991. “Living with HIV Infection: Adaptive Tasks of Seropositive Gay Men.” Journal of Health and Social Behavior 32(1):17–32.

Weitz, Rose. 1989. “Uncertainty and the Lives of Persons with AIDS.” Journal of Health and Social Behavior 30(3):270–81.

. . . Unlike the stigma of HIV/AIDS—which carries the threat of life-changing illness, death, and contagion beyond the scope of sex- ual behaviors—the STD stigma lends itself to compartmentalization. The women were able to hide their shame, guilt, and fear (of further health complications, of contaminating others, of rejection, etc.) in the sexual part of their self- concept. They recognized that this part of their self-concept did not have to affect their entire identity. . . . If the impact of the STDs on their sex lives ever became too emotionally painful, the women could always decide to distance themselves from this role: choosing temporary or permanent celibacy. . . .

A narrative model of the self proposes that personal myths create the self and become “the stories we live by” (McAdams, 1996:266). I pro- pose that we seek to understand the significance of the stories we choose not to live by. Personal STD “stories” are rarely told in American mass culture. McAdams (1996:22) proposed that “carrying on affairs in secret”—maintaining a dis- creditable stigma—is a way to keep stigmatizing stories from occupying center stage in people’s personal myth. However, these data suggest that individuals manage identity transformations, especially transformations into deviant identi- ties, by constructing and sharing self-narratives through disclosure interactions. Although the women do not maintain secrecy, they do keep their STD stories from center stage. . . .

HPV and Vaccines

Evelina Sterling and Wendy Simonds

Transmitted through intimate skin-to-skin contact, human papillomavirus (usually called HPV) is the most common sexually trans-

mitted infection (STI). In fact, HPV infects about one in four people, mostly teens and young adults (Centers for Disease Control and

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Prevention [CDC], 2016). There are more than 150 different HPV-related identified viruses now, and most people who become infected with HPV do not even realize they have it, as there are often no symptoms. In 90 percent of HPV cases, a healthy immune system will keep the virus in check, preventing any prob- lems, and HPV infections will usually go away on their own within two years. For the other 10  percent, HPV lasts longer and can cause genital warts or lead to cervical cancer as well as other types of less common (but also serious) cancers that affect the vulva, vagina, penis, anus, tongue, throat, or tonsils. New research also suggests that HPV may even be linked to cardiovascular disease. While most people are exposed to HPV at some point in their lives, predicting whether an individual is at risk for developing any of these long-term and possibly life-threatening complications is impossible (CDC, 2016).

In 2006, the Food and Drug Administra- tion (FDA) approved Gardasil, the first vaccine designed to prevent two types of HPV known to be associated with 70 percent of all cervical can- cers, as well as two other HPV types associated with genital warts. Currently, the CDC recom- mend that all girls and young women and boys and young men between the ages of 9 and 26 receive the three-dose series of the vaccine to be fully protected against the HPV-linked cancers associated with the strains the vaccine covers. More recent research indicates that children under age 12 can receive only two doses. The vaccine, which now includes both Gardasil and Cervarix, is purported to be 100 percent effec- tive against the strains of HPV they include. According to a CDC survey in 2013, only 38 percent of U.S. girls and 14 percent of boys aged 13 to 17 receive the recommended doses of the vaccine (CDC, 2014). Even with this low uptake of the HPV vaccine, HPV prevalence among young women has dropped significantly (National Institutes of Health [NIH], 2017).

Despite any benefits, the introduction of Gardasil was highly controversial, especially since its manufacturer, Merck and Co., actively lobbied states for mandates that would require the vaccine for all girls in order to attend school (Boston Women’s Health Book Collective, 2011). Because the vaccine was found to be less effective if administered after exposure to HPV, guidelines targeted girls as young as nine in order to reach them before their first sexual experience (the initial guidelines were directed at girls only). (Once someone has HPV—and most sexually active individuals do, regardless of sexual orientation or number of partners—the HPV vaccine is much less effective.) Although many states have attempted to introduce legis- lation mandating HPV vaccines, only Virginia and the District of Columbia currently require the vaccine for girls entering the sixth grade. In July 2015, Rhode Island also announced a new requirement that all children entering seventh grade must receive the HPV vaccine. However, numerous exemptions exist for families want- ing to opt out, making the requirements dif- ficult to enforce (National Conference of State Legislatures [NCSL], 2017).

No doubt cancer is a serious health concern. More than 17,000 U.S. women are diagnosed with HPV-related cancers each year, most nota- bly cervical cancer but also sometimes vagi- nal, vulvar, and mouth/throat cancers (CDC, 2016). The American Cancer Society (ACS) reports about 13,000 new cases of cervical can- cer each year in the United States with about 4,000 women dying from the disease. How- ever, about 80 percent of cervical cancer cases occur in developing nations, making cervical cancer the third most common cancer among women and the second most frequent cause of cancer-related deaths worldwide (NIH, 2017). Often it takes years for cervical or other HPV- related cancers to develop, and symptoms typi- cally only become apparent when the cancer is quite advanced. But should the HPV vaccine

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to become available. HPV vaccines are said to be as safe as or safer than other commonly used vaccines, but no vaccine is without risk. Com- mon side effects reported with the HPV vac- cines have included fainting, pain, swelling at the injection site, headaches, nausea, and fever. According to the CDC (2014), out of 90 million doses of HPV vaccines given in the United States between 2006 and 2016, it received 33,945 reports of adverse events; 7 percent were classified as “serious” (CDC, 2016). There have been deaths associated with HPV vaccines, but according to the CDC (2016), none was directly attributable to the vaccine.

Another important issue is that no other vaccines are directed toward one gender. Boys are as susceptible to HPV as girls are and are equally involved in transmitting the virus to others. Roughly 9,500 men are diagnosed with HPV-associated cancers each year, including cancers of the anus/rectum or penis as well as some head and neck cancers. There is neither a test to detect HPV in men nor one to detect early signs of HPV-associated cancers in men. Although the FDA and CDC both recommend the HPV vaccine for boys and young men between the ages of 9 and 21, the vaccine is not being promoted as heavily for boys, and boys are not specifically included in any proposed mandates, although this is starting to change (CDC, 2016). Much of the debate about whether boys should be vaccinated against HPV has focused solely on cost-effectiveness, not its impact on overall health (Bixler, 2011).

Eliminating HPV and associated cancers also requires addressing health disparities. Because the HPV vaccine must be administered in two to three separate doses during a specific age range and over a period of six months to be effective, it is unclear how a successful vaccine campaign aimed at preventing cervical can- cer would be administered among individuals without access to regular health care or other prevention services. The HPV vaccine is also

be mandatory for all girls and young women in order to prevent cancer? The short answer: It’s complicated. Most mandated vaccines are for diseases that spread easily from person to person during regular daily contact. HPV transmission is more difficult and can only be contracted through skin-to-skin contact during sexual activity. Furthermore, protection from HPV and its related complications is not guar- anteed even with the vaccine.

As a result, a wide range of groups are voic- ing their concerns from all across the political spectrum, making it impossible to separate the potential benefits and risks of the HPV vaccine from gender, sexuality, and cultural politics. Religious and moral conservatives are adamantly opposed to mandating HPV vacci- nation. Strong proponents of abstinence-only sex education are afraid that lowering the risk of STDs will promote sex outside marriage. Health education experts also question the mandate, but for different reasons. Separating HPV prevention from comprehensive health education aimed at teaching adolescents to protect their sexual well-being could prove problematic. Perhaps this could give some kids a false sense of security about being pro- tected from the many other STIs. Other critics feel parents should be encouraged to talk with their health care providers openly and honestly about what is right for their particular family, without any government intervention or in d ustry influence.

Causing more concern, Gardasil was introduced to the public much more quickly than other previous vaccines and with lim- ited research. Participants in clinical trials of Gardasil were primarily older girls and adult women, so there is still much to be learned about the most effective dosage and the long-term effects for younger girls, especially pre-teens. Although millions of young girls and boys have been vaccinated against HPV since 2006, the safety profiles of these drugs are just starting

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who don’t want the vaccine would be pressured to have it anyway, but access to those with lim- ited means would be greatly increased. With- out a mandate, some adolescents would be prevented from getting the vaccine due to lack of parental consent, lack of access, and/or lack of financial resources. Adolescents are able to learn about their health options and make deci- sions about birth control and abortion services (though these rights are constrained in many states by parental notification requirements for abortion and decreased access for poor and rural women). As feminists, we strongly advo- cate that everyone be able to make informed choices about any decisions pertaining to their bodies, sexuality, or procreation. Why should HPV vaccine decision-making be treated dif- ferently from other sexual health issues?

Also troubling is the paternalistic framing of the issue of mandatory vaccines—and even heavy-handed recommendations. Casper and Carpenter (2008) further expand on the com- plexities of sexuality and sexual health among young girls:

On balance, the HPV vaccine controversy has reinforced prevailing understandings of women as responsible for controlling sexual activity and reproduction—and as sexually innocent and endan- gered. Yet a significant threat to young women— unwanted sex and abuse—is surprisingly absent from current debates; moral conservatives seem not to have recognized the need to protect “presexual” girls from assailant-transmitted HPV. (p. 896)

Indeed, discussions of the HPV vaccine and the surrounding controversy in public health and medical literature do not consider the gen- dered power dynamics that affect heterosexual adolescent (or adult) experiences.

Regardless of the arguments either support- ing or opposing the vaccine, all experts agree that HPV vaccines are not 100 percent effec- tive in preventing all types of HPV or its com- plications. In fact, 30 percent of cervical cancer

expensive; the current cost for the whole series is $400. Those women who are least likely to be able to afford or access HPV vaccines on their own are also at highest risk for developing cervical cancer due to limited access to health care. Most women who die of cervical cancer never had regular Pap tests, had false nega- tive results, or did not receive proper follow-up (Boston Women’s Health Book Collective, 2011: 616). Large differences exist in the rates of cervical cancer among women from different racial and ethnic groups. In the United States, rates of cervical cancer are 45  percent higher among black women and 65  percent higher among Hispanic women than among white women. Death rates from cervical cancer are the highest among black women, followed by Hispanic women (CDC, 2013).

When discussing HPV, women who have sex with women have been ignored. Many people falsely believe that the risk of HPV and other STIs is relatively low among women who have sex with women. As a result, many health care providers incorrectly assume that these women do not need to be screened, tested, or educated about HPV and other STIs. And scientific agen- cies omit people who identify as transgender or intersex in their discussions of HPV and vac- cinations. Since anyone is at risk for contract- ing HPV if they have contact with the genitals of an infected person, everyone should have access to appropriate information and services regarding HPV prevention.

Informed consent is another complex topic associated with vaccinating young girls for HPV. How much involvement should minors themselves have in the decision-making pro- cess concerning whether to be vaccinated against HPV? Can 9-year-old children be part of informed health care decision-making, or should we depend solely on parents or govern- ment to decide what is right for young people’s sexual health? With a mandate, some families

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Bixler, Jennifer. 2011. “CDC Committee Recommends Boys Receive HPV Vaccine.” CNN Health. http://www .cnn.com/2011/10/25/health/hpv-vaccine/.

Boston Women’s Health Collective. 2011. Our Bodies, Ourselves. New York: Touchstone. 616–17.

Casper, Monica J., and Laura M. Carpenter. 2008. “Sex, Drugs, and Politics: The HPV Vaccine for Cervical Cancer.” Sociology of Health and Illness, 30: 886–99.

Centers for Disease Control and Prevention. 2013. “Cervical Cancer Rates by Race and Ethnicity. http:// www.cdc.gov/cancer/cervical/statistics/race.htm.

———. 2014. “Human Papillomavirus Vaccine Coverage among Adolescents, 2007–2013, and Post Licensure Vaccine Safety Monitoring, 2006–2014—United States.” Morbidity and Mortality Weekly Report, 63(29): 620–24.

———. 2016. Human Papillomavirus (HPV). https://www .cdc.gov/hpv/index.html.

Cervical Cancer Action. 2011. “Why Now? About Cervical Cancer.” http://www.cervicalcanceraction.org/whynow /about.php.

National Conference of State Legislatures. 2017. HPV Vaccine: State Legislation and Statutes. http://www.ncsl .org/research/health/hpv-vaccine-state-legislation-and -statutes.aspx.

NIH. 2017. Cervical Cancer. https://report.nih.gov /nihfactsheets/viewfactsheet.aspx?csid=76.

Udesky, Laurie. 2007. “Push to Mandate HPV Vaccine Triggers Backlash in USA.” The Lancet, 369 (March 24).

cases are caused by HPV strains not covered by the vaccine. Thus, current cancer prevention strategies must continue. It is critical that all women have access to regular health screen- ings and Pap tests. The vast majority of cer- vical cancer cases and cervical cancer deaths occur in developing countries without access to Pap tests (NIH, 2017). Early screening is still the most effective method for preventing and identifying cancer. When found early, cervical cancer is one of the most successfully treated cancers, with a 92 percent survival rate (ACS, 2017). Additionally, the HPV vaccine does not eliminate the need for safer sex practices. Education and barrier methods of protection (such as condoms and dental dams) remain necessary to prevent HPV, other STDs, and unintended pregnancies.

REFERENCES American Cancer Society. 2017. “What Are the Key

Statistics about Cervical Cancer?” https://www.cancer .org/cancer/cervical-cancer/about/key-statistics.html.

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R E A D I N G 3 8

In this [reading], I take a critical discursive perspective to analyse anti-condom discourse and interrogate the “nature” of (hetero) sex that is produced through this discourse. I take an anti-essentialist position, whereby this nature is understood as socially constituted, and contingent on time and place, rather than reflective of some core essence or truth about what (hetero)sex is.

CULTURAL NARRATIVES, SEXUALLY TRANSMITTED INFECTIONS AND THE PARADOX OF SAFER SEX

Condoms are important because they remain one of the key public and sexual health strate- gies to fight the transmission of sexually trans- mitted infections. . . . STIs are a major source of morbidity globally, with potential significant future impacts in terms of fertility and other aspects of sexual and reproductive health, and thus constitute a significant public health con- cern (World Health Organization, 2007). Most STIs are preventable by correct, consistent condom use. However, the research literature on condom use demonstrates that condoms are often not routinely or consistently used in sex- ual encounters (e.g., Abel and Brunton, 2005; Adolescent Health Research Group, 2003; De Visser and Smith, 2001; Fisher and Boroditsky, 2000; Grimley and Lee, 1997; Grunseit, 2004; Measor, 2006; Santelli et al., 1997; Tavory and Swidler, 2009; Wellings et al., 2001), even when there is a common understanding of the

importance of condom use for sexual health (Mantell et al., 2011; Mashinini and Pelton Cooper, 2012; Williamson et al., 2009), and/or an intention or desire to use them (Gavey and McPhillips, 1999; Gavey et al., 2001). The per- sistence and even increase in STI incidence is an outcome of inconsistent use. While it might appear that condoms offer a simple prevention solution to STIs, and thus the failure effectively to implement this strategy within heterosexual communities represents a paradox, the prob- lematic uptake and use of condoms are under- standable if we consider the cultural narratives that exist around them (I focus on heterosexu- ally related condom discourse; the situation with condom use within gay male communities is also complicated, and is an overlapping yet also different story). . . .

Condoms are typically viewed negatively by users—and non-users—(e.g., Chapman and Hodgson, 1988; Flood, 2003; Holland et al., 1998; Lowe, 2005; Mantell et al., 2011; Measor, 2006; Smith et al., 2012; Tavory and Swidler, 2009; Wil- liamson et al., 2009; Winskell et al., 2011), and patterned negative meanings around condoms and condom use are remarkably persistent across time and also across different geographic loca- tions, within, but also beyond, Anglo-western countries. Anti-condom discourse primarily falls into one or more of three main categories:

“PROPER SEX WITHOUT ANNOYING THINGS”: ANTI-CONDOM DISCOURSE AND THE

“NATURE” OF (HETERO)SEX

V I R G I N I A B R A U N

From “‘Proper Sex without Annoying Things’: Anti- condom Discourse and the ‘Nature’ of (Hetero)sex,” Sexu- alities 16(3/4), pp. 361–82. Copyright © The Author 2013. Reprinted by permission of SAGE Publications, Ltd.

456 S E X UA L H E A LT H

20 male) took part in 15 groups. Some groups were composed of strangers, and others of friends or acquaintances. Six were female only, four were male only, and the remaining five were mixed. The average age of participants was 25 (range: 16–36). Almost all participants identified as white, and most were working. The demographic profile of the participants does not reflect the ethnic/cultural diversity of residents of Aotearoa/New Zealand. . . .

All participants had had experiences of het- erosexual sex and the vast majority identified as heterosexual. The average number of sexual relationships was six; the average number of sexual partners was over 12. At the time of data collection, 64% were in a relationship, and the average duration of these relationships was over three years; almost all were monogamous/ exclusive. Seventy-five percent reported that they had engaged in casual sex at least once. Virtually all talked about engaging in “unsafe” sexual practices (e.g., intercourse without a condom, not knowing the STI status of partner or self) at some point, and 73% reported some sort of sexual health check-up (at least once). Twenty-five percent reported having had at least one known STI (of these, 27% reported more than one; 7% overall).

. . . Topics discussed included ideas and meaning around having sex; what sexual health is; knowledge of STIs and STI prevention; fac- tors associated with unsafe sex; Aotearoa/New Zealand’s STI statistics; and ideas about sexual health promotion. . . . Names and other identi- fying features have been changed. . . .

ANALYSIS

. . . Accounts of condoms that could be coded as “positive” were very rare in the data (only 17 extracts were coded as positive in any way across the entire dataset); most commonly, these related to a reassurance, lack of worry or “peace of mind” (Melanie . . .) related to risk of

(1) pleasure/sensation; (2) intimacy/connection; and (3) spontaneity/interruption. Condoms are claimed to reduce the physical pleasure sensa- tion experienced in sex, reportedly making sex like a “shower in a raincoat” (Chapman and Hodgson, 1988) or “‘like eating a sweet in the wrapper” (Mashinini and Pelton Cooper, 2012; Tavory and Swidler, 2009). Such imagery evokes a massively reduced sensory experience for men (pleasure reduction is sometimes also reported by women). Condoms are also claimed to reduce or remove the intimacy of sex, and the sense of emotional connectedness possible, resulting in “fucking not making love” (Measor, 2006: 394). They are also disliked because they disrupt a smooth and insistent “trajectory” of (hetero)sex toward coitus, apparently “killing the moment” and making sexual spontaneity impossible.

. . . In this [reading], I aim to take the analy- sis of condom discourse further, by not only demonstrating the persistence of anti-condom discourse, but by examining the way a partic- ular nature of heterosex is constructed in and through (anti-)condom discourse. I argue that this works to perpetuate ongoing resistance to condom use. In doing so, I examine Lowe’s (2005: 75) contention of a “two-way relation- ship between contraception and heterosexual practices.”

METHOD

The data for this [reading] come from a qualita- tive project on the social contexts of heterosex- ual STI transmission, which involved 15 focus groups with “lay” individuals aged below 35, as well as 32 individual interviews with profes- sionals working in the area of sexual health (see Terry et al., 2012) in Aotearoa/New Zealand. . . .

Focus group participants were recruited through advertising, word of mouth, and snow- balling. Two individuals were hired specifi- cally to recruit participants from their broad networks. In total, 58 participants (38 female,

“ P RO P E R S E X W I T H O U T A N N OY I N G T H I N G S” 457

only around vaginal intercourse.3 The concept and practice of “protected” oral sex (both fel- latio and cunnilingus) was rejected (as is com- mon, see Stone et al., 2006):

VB: What would you think of you know as safe sex? James: Um a condom usually. . . . That’s about it. VB: Mhmm. Jason: I mean I gather that strictly speaking um you

shouldn’t even be having oral sex if it’s going to be (mhm) protected but everyone does, so um.

Brandon: What’s that what’s that thing dental dam or something?

Jason: Exactly[.] I mean it’s like it sounds that sounds like something esoteric. (laughs)

Brandon: And while I go down on, you you know— Jason: (laughs) Yeah I’ll just slip out my my

gladwrap— James: A condom for your mouth. (laughs) . . . [ellipses in original] Dylan: I wouldn’t know about what you could get

off the woman from her giving you oral sex[.] I’d have no idea I’ve heard some people say they reckon it’s quite dangerous and . . . the general consensus seems to be you can’t really catch anything.

VB: So you wouldn’t wear a condom? James: During what? Jason: For a blowjob? VB: For a blowjob. Jason: No. James: No no[;] try and avoid that one. (laughs) Dylan: It’s just not even worth it.

This extract demonstrates what could be called the “standard story” (Nairn and McCreanor, 1991) of safer heterosex: the use of condoms, but their containment to just vaginal (or anal) intercourse. Dylan’s use of “just” in the final line provides a bottom-line position: the use of a condom renders fellatio not just less plea- surable, but “not even worth it.” These par- ticipants normalise not using a condom or a dental dam during oral sex, through invoca- tions of “consensus” and what “everyone does.” While condom use (for coitus) simply is “safe sex,” condom use for fellatio, or dental dam use

pregnancy or contracting an STI following sex. On two occasions, positive accounts related to making sex “nice and contained and unmessy” (Molly). . . . :

Melanie: I might sound like a prude I find it really like I I I I I like to use condoms and I actually find it quite gross not using them just I find—

?: Oh really? Melanie: Like the whole semen in body thing quite

weird. . . .

Here, Melanie’s identity-amelioration work, her hesitation and multiple-repeats of the “I” signal “liking” condoms as uncommon, and as a perspective that’s not easy to express. That this account is unexpected is reinforced by the repeated “oh really” response from one of her co-participants. Overall, then, posi- tive accounts within the data were very rare, and potentially difficult to express, suggesting a widespread cultural norm of anti-condom sentiment.

In contrast, both anti-condom discourse and reports of condom-free “risky” sexual practices were prevalent. While reported relationships to condoms were complex, sometimes contra- dictory,1 and certainly not uniform, a range of repeated and frequent negative meanings was evident, across both women’s and men’s accounts, in mixed- and single-sex groups. I begin by briefly outlining dominant accounts of condoms and “safe-sex” practice, to provide the broader context for making sense of discur- sive framings on condoms that follows.

“Safe Sex Is Condoms I Reckon” but “Condoms Suck”2

In line with public health discourse, the domi- nant account of “safe sex” was of condom use. . . . However, while condoms appear as the standard response to a question about what counts as safe sex, this was bounded and lim- ited, with safer-sex discourse typically located

458 S E X UA L H E A LT H

for cunnilingus, do not form part of standard safer-sex discourse. Indeed, Brandon names the product, but then disclaims certainty of this knowledge—“dental dam or something”— while Jason reinforces non-normality with the adjective “esoteric.” The use of language of “gladwrap” (clingfilm) or a (plastic) “shopping bag” (Jocelyn) similarly positions them outside the conceptual realm of sex. Such talk con- structs the dental dam as an item not designed for the task in hand, as unerotic, and thus as categorically separate from sex. An evocation of “holding hands and wearing gloves” in rela- tion to condom use for fellatio (George) does similar work: it invokes “unnaturalness” and “undesirableness”; the unstated desirable in these acts is skin-on-skin contact. Effectively, the idea of protected oral sex is framed as an unreasonable, excessive, and undesirable “demand”; such talk also constitutes an articu- lation of what “sex” should be about, which I develop further later in the [reading].

Despite a ready articulation of condoms for coitus as safe sex, condom-protected vagi- nal intercourse was similarly often framed as “unnatural” or less than natural by a number of participants. . . . This lack of “naturalness” was one of a range of offered motivations for why people might do “unsafe sex”:

Kate: Pleasure, and doing it the most natural way, and feel good factor, and kind of what we said before about pleasing the guy, and you know, what as a girl, as a woman, knowing that guys hate con- doms generally speaking, and wanting it to have, like, to be good for them.

This extract invokes many common features of anti-condom discourse (e.g., Flood, 2003). Across the dataset, the “safe sex is condoms” account coexisted with overwhelmingly dominant negative constructions of condoms, as negatively impacting across all aspects of  sexual experience. Participants easily articulated dislike of condoms. . . . Kate asso-

ciated “hating” condoms with men; like many other female participants, she also expressed her own “hatred” of them:4 . . . “I think con- doms are awful things[—]I wouldn’t[—]I hate them.”

Kate’s language of hatred evokes a passion- ate, unequivocal and emotional response to condoms. The level of dislike of condoms, and the negative experience of sex with condoms, was often constructed as particularly intense through the use of such extreme language:

VB: So it’s kind of why, you know, people have unsafe sex because?

Hermione: It’s easy. Gertrude: Condoms suck. Bob: Condoms do take away all the feeling. . . . Gertrude: It’s so much more fun without one. Bob: It is definitely better without one. . . . Gertrude: I think it feels horrible. Bob: Yeah definitely. Gertrude: I can’t stand them.

Alongside emotional evaluations, Bob’s use here of an extreme case formulation about a loss of “all the feeling” works to produce a very negative reality for condom use. . . . Here, the “feeling” of sex is constructed in dichotomous terms: with a condom, you have no feeling; without a condom, you have full feeling. . . .

With the use of such language, it becomes inappropriate and even unreasonable to expect condoms to be routinely used in vaginal inter- course, particularly given the current domi- nant Western discourse which focuses on the right—indeed, obligation—to maximise sexual pleasure (Braun, 2005; D’Emilio and Freed- man, 1997). If sex is about pleasure, and con- doms remove, let alone just reduce, pleasure, they effectively remove the purpose of sex. These articulations reveal the entrenched way pleasure and safety remain competing sexual discourses in relation to heterosex (see Khan et al., 2004). . . .

“ P RO P E R S E X W I T H O U T A N N OY I N G T H I N G S” 459

through their mind, things are running through your mind, plus the time.

Here, the “sexual moment” is represented as a fragile thing, easily disruptable (see also Flood, 2003), and a moment/mood, which, it is sug- gested, requires a dislocation from “normal” (rational) concerns and thoughts. Others simi- larly described a loss of desire and a disruption to a presumed trajectory for sex with the intro- duction of a condom. . . .

Jason: It’s just physiologically it just kills everything. Brandon: It does. Jason: And you’re just like and the condom falls off

and you’re like “oh okay.” (laughs) James: Got another one. Jason: (laughs) “I guess we’re not having sex then.”

. . . [I]n Jason’s account, “sex” was obliterated by the physiological actions of his (formerly erect) penis, a response he blamed on the con- dom (see Measor, 2006, for more on men’s sto- ries around condom-induced erectile loss). In this account, the agency in his bodily change is given to the condom, rather than with his body, or his mind. . . . [T]he mind and “conscious thought” are located as a source of desire destruction, but activated by the condom and what it represents.

What is notable in these accounts is how fragile the supposedly robust and ever- present male sexual drive (Hollway, 1989) is. It is represented as something that can be eradi- cated by the mere hint of a condom (see also Vitellone, 2000). The metaphor of condom- as-killer endows the condom with agency within a sexual encounter (indeed, seemingly with more agency than the people involved, or their desires), and this agency is an ability actively to ruin a sexual encounter or experi- ence. Rather than sexual manslaughter, this is sexual murder! The condom: tried, convicted and sentenced. As such, the metaphor works as a profoundly efficient and effective discur- sive resource for resisting condom use, and

The Condom-as-Killer The condom-as-killer destroys an otherwise “natural” progression of sex, and the pleasures of it. Along with accounts of pleasure removal, condoms reportedly killed the mood of sex:

VB: Why do you think people do have, you know, unsafe sex then, why might they?

Samantha: Cos they’d say fuck it, it kills the mood putting on a condom.

Kevin: They’re terrible. Samantha: They’re terrible things really. Kimberly: They are actually.

This account is again characterised by extreme and maximising language (Potter, 1996), where the effects of condoms are brutal and final—death and destruction are not partial effects. As  Edwards, Ashmore and Potter argued, “death” arguments invoke “the real- ity that should not be denied” (1995: 26, emphasis in original). The metaphor of the condom-as-killer appears to operate similarly, to invoke a (brutal) reality that should not be denied and, rhetorically, to invoke guilt (about the need for condom use, see Edwards et al., 1995, who claim the rhetorical effect of such death critiques is guilt induction). “Pleasing your male partner through very good sex” appears in (heterosexual) women’s magazines as an important discourse, coexisting with a discourse of men as “naturally” inclined to cheat if the sex  is  not good enough, thus ren- dering male sexual pleasure an important concern for heterosexual women (Farvid and Braun, 2006).

Condoms were similarly talked about as kill- ing the “moment”:

François: I think it’s also back to trust, ’cause if you gonna put a condom on, right, then you don’t trust them, ’cause you trying to protect yourself from them, so I mean that can kill the moment, “hold on, we need to protect my—I need to pro- tect myself from something you may have,” so that while they’re lying there things are running

460 S E X UA L H E A LT H

commonly deployed across domains as diverse as disease/immunology (Martin, 1989; Sontag, 1990) and the business world (Koller, 2004). If the condom (the bad guy) is attacking sex (the good guy), they must metaphorically battle it out. This works to construct sex and condoms in opposition to each other, and there must be a winner and loser. If the condom is the win- ner, sex (sexual sensation, the man, and even the relationship) is the loser; if sex is the win- ner, the condom is the loser (one does not get used). . . .

Adam, Eve, and the Nature of Heterosex The metaphor of condom-as-killer and the evo- cation of a battle between sex and the condom construct a particular ideal form of heterosex, where sex should be a natural, continuous process, unimpeded by the “interruption” of a condom, following a linear trajectory toward penetration and ultimate pleasure (orgasm). It also re-articulates a particular “essential” nature of heterosex. . . .

The metaphor of condom-as-killer requires not only an opponent, but one that precedes the condom—something for it to kill, destroy or maim. The metaphor only makes sense if sex is positioned as separate from, but importantly also prior to, condoms. This evokes an essence or nature for what (hetero)sex is that conceptually excludes the condom. The model of sex that par- ticipants tended to articulate was one that did indeed exclude condoms. For instance . . . Oli- ver [said], “It’s not like Adam and Eve, Adam and Eve didn’t use condoms.”

Reference to Adam and Eve provides a lovely example of how sex and condoms were conceptually separated. Through an invoca- tion of a biblical past, and, in biblical terms, the origin of humanity and also of sex, sex nec- essarily precedes condoms. Condoms can only logically follow; they become the “unnatural” addition to the original (“natural”) sexual act.5

for perpetuating the negativity of much anti- condom discourse.

The metaphor was deployed to describe both the physical effects of a thin sheath, and also more symbolic, emotional or relational effects. For instance:

Stella: There can be something about sex that can be about becoming really intimate with someone and sharing something really special and when you have a piece of plastic between that, that’s lost, you don’t have that anymore, and it can also put up issues of trust. Like if you’re in relationship when you’re starting out you know, if you have to wear a condom it can be, it’s kind of like a mes- sage to say I don’t trust you, which is unhelpful.

. . . Intimacy and sharing—both emotional experiences and processes—are framed as hin- dered by this “plastic.” The condom is positioned as an intimacy-killer, as well as a passion- and mood-killer. . . .

Alongside the explicit language and imagery of death and destruction that was prevalent in the data, the metaphor of condom-as-killer was also frequently evoked in a more “downgraded” form, through the language of “interruption”:

Apollo: Yeah, it interrupts the heat of the moment. You’ve got to stop and fumble around in front of her and hopefully keep going.

Stella: It’s all very unromantic.

The idea of “the heat of the moment,” another common trope around sex, again invokes a “natural” trajectory for heterosex that is linear and cumulative (Lowe, 2005). Sex involves a build-up of passion (heat), and any disruption to this is thus a disruption to sex. Such accounts work to conceptually separate condoms from “desirable” sex; condoms are constructed as not synonymous with, or even oppositional to, things that sex is or should be about, such as passion, or romance. . . .

This metaphor of condom-as-killer invokes a closely related metaphor—of war or a battle— a (very hegemonically masculine) metaphor

“ P RO P E R S E X W I T H O U T A N N OY I N G T H I N G S” 461

activity and pleasure, work to produce a real- ity whereby heterosex exists conceptually sepa- rately to condoms, and where sex and condoms are oppositional, with condomless sex as the original, the pure and ideal form of sex, and condom sex as a poor imitation. Sex was almost entirely located within a discourse of passion and pleasure, the dominant, but relatively new, Western construction of (hetero)sex (D’Emilio and Freedman, 1997). In contrast, condoms were located within a discourse of sexual “safety,” which is effectively constructed as a discourse of displeasure. Khan et al. (2004) and others have argued for the need to reconstruct condoms as part of the domain of heterosexual “pleasure” rather than “pain.” How this can be done, and how safer heterosex can be eroticised, remains a crucial question (see Warr, 2001, also Allen, 2004). The tenacity of anti-condom dis- course shows that challenge to be a deep one.

What I have argued here, however, is that it is important not just to interrogate and chal- lenge anti-condom discourse for sexual health promotion, but to start to unpack and desta- bilise the foundational constructions of “sex” on which they rest. If we truly believe that sex is not a natural act (Tiefer, 2004), then this meaning is also up for contestation. Without contestation, it seems likely that anti-condom discourse will remain entrenched.

FUNDING

This research was funded by a University of Auckland Vice Chancellor’s Research Excel- lence Award to Virginia Braun.

NOTES 1. . . . For instance, . . . Melanie then went on to say “like I think I me(unclear) from a sexual point like I think sex definitely feels better without a condom (VB: mm) and it’s definitely more enjoyable but it’s just kind of like mm it’s just a bit icky.”

2. First quotation from Jenna; second quotation from Gertrude.

3. Although anal intercourse was too rarely discussed to make conclusive comments, it was framed as desirable

In quite a different way, Jenna also positioned sex as naturally condomless:

Jenna: Yeah[,] they’re just so annoying and like[,] you know[,] half the time they’re just going to like come off or like rip or something it’s just like why (laughs) if it’s going to rip we may as well just not use one anyway and just have proper sex without annoying things.

Like Stella’s earlier account of a piece of “plas- tic,” the condom is here described in a way that positions it as inadequately designed for sex, and thus not really suitable for use in that context. But of primary analytic interest is Jenna’s claim around “proper sex.” If “proper sex” is what you do without a condom, a condom can only detract from sex in its pure form; condom-sex can only be “not proper sex.” Such descriptions invoke a “natural” state of sex that is condom- less, and implicitly contrast with an “unnatural” state of sex: sex that involves condoms (see also Lowe, 2005).

. . . To describe a condom as something that requires “stopping” sex, taking the actors out of  that moment, requires a conceptualisa- tion of sexual activity (and even a sexual mood) as  something separate from a condom, again as something that precedes a condom. The not- sexual status ascribed to condoms is not inherent in the object itself; condoms are, alter- natively, only a sexual object, as they have  no purpose beyond sex. Indeed, if sex is constructed as a build-up toward ultimate pleasure, then the putting on of a condom could be seen as “antici- patory to further pleasure,” rather than “destroy- ing” the moment. But it was not. Instead, through accounts of stopping sex or killing the moment, the action of putting on a condom was framed as an essentially non-sexual event. . . .

CONCLUSIONS

. . . Within my data, the central account of sex as essentially condomless, and the metaphor of condoms-as-killer of the essence of sexual

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to use a condom, but primarily because the anus was constructed as a “dirty” site, with potential for vaginal contamination if (unprotected) vaginal intercourse followed.

4. Although anti-condom discourse was expressed by almost all participants, regardless of gender, positioning and responsibility around sexual safety appeared gendered in certain ways in much of the data, with women in general (not necessarily the participants themselves) positioned as wanting condom use and men (both the participants and men in general) positioned as wanting to avoid condom use. Sex was often framed as an inherently non- communicative experience, but sex and safer sex (non) negotiations were often expressed in gendered terms, with safer sex something women were expected to want but often unable to express (e.g., see Gavey and McPhillips, 1999), and men as exploiting a knowledge of women’s “vulnerability” around this. . . . Men’s dislike of condoms was assumed, and women appeared often to expect to, or be expected to, engage in “work” to manage or accommodate this taken-for-granted truth. . . .

5. . . . The use of Adam and Eve (and the Bible) as the archetype of natural, acceptable or preferred behaviour has also been common in debates around lesbian and gay rights (e.g., Clarke, 2001).

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Measor L (2006) Condom use: A culture of resistance. Sex Education 6(4): 393–402.

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Santelli JS, Warren CW, Lowry R, et al. (1997) The use of condoms with other contraceptive methods among young men and women. Family Planning Perspectives 29(6): 261–68.

Smith J, Fenwick J, Skinner R, et al. (2012) Sex, condoms and sexually transmissible infections: A qualitative study of sexual health in young Australian men. Archives of Sexual Behavior 41(2): 487–95.

Sontag S (1990) AIDS and its Metaphors. London: Penguin. Stone N, Hatherall B, et al. (2006) Oral sex and condom use

among young people in the United Kingdom. Perspectives on Sexual and Reproductive Health 38(1): 6–12.

Tavory I and Swidler A (2009) Condom semiotics: Meaning and condom use in rural Malawi. American Sociological Review 74(2): 171–89.

Terry G, Braun V and Farvid P (2012) Structural impediments to sexual health in New Zealand: Key informant perspectives. Sexuality Research and Social Policy 9(4): 317–26.

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R E A D I N G 3 9

I n the United States, rates of new human immunodeficiency virus (HIV) infections among gay men, other men who have sex with men (MSM), and transgender women are high (Dieffenbach and Fauci, 2011). In 2012, the U.S. Food and Drug Administra- tion (FDA) approved a daily pill for people who are HIV negative but at high risk of infec- tion that significantly reduces their chances of becoming infected. Despite this new treat- ment, called pre-exposure prophylaxis (PrEP), being a groundbreaking new development in HIV prevention, it generated very little media attention but quite a bit of controversy.

Damon L. Jacobs (2016), a licensed mar- riage and family therapist and self-described “PrEP Warrior,” notes his surprise at the absence of media attention and lack of wide- spread celebration in queer communities. In an article published on an online HIV/AIDS resource webpage, The Body, Jacobs recounts the backlash he experienced when he began talking openly about using and advocating for PrEP. After starting an evidenced-based PrEP- focused Facebook group, he writes, “I received emails from strangers full of hate, venom, call- ing me a ‘Truvada whore,’ ‘drug pusher,’ ‘sex addict,’ ‘corporate shill,’ and one person even called me a ‘passive murderer.’” Jacobs had expected community excitement but soon real- ized he underestimated “the persistent toxicity of fear” gay men feel about HIV, which is rooted in decades of sex-negativity, homophobia, and contradictory messages about and meanings attached to “safe sex.” Indeed, the responses Jacobs received about his PrEP advocacy are

not exceptional (see Belluz, 2014). Rather, they are illustrative of the current controver- sies in  gay communities surrounding this new biomedical HIV-prevention approach.

In this reading, we first describe PrEP, the controversies surrounding it, and the biomedi- cal and public health research related to the debates. Then, using the work of Ken Plum- mer (2010), a prominent sexuality scholar and founding editor of the journal Sexualities, we argue that a historical view is crucial to understanding the social context within which PrEP emerged and is currently situated and negotiated. Specifically, we maintain that the controversies surrounding PrEP are related to long-held biases about gay men, particularly as sexual actors who are incapable of making “appropriate” decisions about sexual health. In other words, the current PrEP controversies can be traced to beliefs that date back to the beginning of the epidemic, if not before.

RATES OF NEW HIV INFECTIONS

The Centers for Disease Control and Preven- tion (CDC) reported a 19 percent decline in the annual number of new HIV diagno- ses between 2005 and 2014 in the United States (2016). Decreases among heterosexuals account for the bulk of the decline. During the same time, new diagnoses for gay and bisexual men increased by about 6 percent, particularly among young black and Latino men. This is consistent with other research suggesting that, in the United States, rates of new HIV infections are highest among gay

PrEP FOR HIV PREVENTION: COMMUNITY CONTROVERSY AND GENERATIONAL SEXUALITIES

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the people defined as high risk adhered to the PrEP protocol 62 percent of the time (Jenness et al., 2016). Increasing the number of PrEP users may also result in a significant decline in other STIs over time, since the PrEP protocol requires regular STI screening (Jenness, Weiss, et al., 2017).

Because gay and other MSM account for the bulk of new infections, public health offi- cials have targeted these groups for PrEP. However, PrEP uptake across all groups has been slow (Krakower et al., 2012; Burns et al., 2014; Kirby and Thornber-Dunwell, 2014). Despite a dramatic increase in new prescrip- tions in the last few years, it is estimated that only 80,000 Americans are using PrEP (Rawl- ings et al., 2016), which is significantly lower than the number of estimated Americans who may benefit from it.

Research has shown that the slow uptake of PrEP is related to several factors, includ- ing a lack of awareness among potential users and primary-care providers and the cost of the medication, the required medical visits, and lab work (Grov et al., 2015; Horberg and Raymond, 2013). For many Americans, PrEP remains inaccessible, despite Truvada being covered by most insurance plans, the creation of programs in some states designed to improve access, and the drug manufacturer’s insurance copay assis- tance program (Golub et al., 2013). According to Gilead Sciences, the drug manufacturer, most Truvada users are white men in their late 30s who are geographically concentrated in five states (i.e., California, New York, Texas, Florida, and Illinois) and nine cities (i.e., New York, San Francisco, Chicago, Washington, D.C., Los Angeles, Seattle, Boston, Atlanta, and Philadelphia) (Rawlings et al., 2016). While cost and knowledge are major barriers to the use of PrEP, the controversy surrounding and stigma attached to PrEP also help explain its slow uptake (Calabrese and Underhill, 2015; Gallagher et al., 2014).

men, other MSM, and transgender women, particularly impacting people of color (Dief- fenbach and Fauci, 2011; van Griensven et al., 2009). While rates have remained high since 2014, they are stabilizing for gay and bisex- ual men in all racial and ethnic groups except Latinos (CDC, 2016).

WHAT IS PrEP?

In 2012, the FDA approved Truvada, an anti- retroviral medication, for use by HIV-negative individuals. Oral Truvada contains two drugs that work together to prevent the virus from replicating in the body. PrEP is a prevention strategy that includes taking Truvada daily and making quarterly visits to a medical provider to monitor the impact of the medication on the kidneys and liver and to be tested for sexual transmitted infections (STIs). Truvada has few side effects,1 and when the PrEP protocol is fol- lowed as prescribed, it is 99 percent effective at preventing HIV (Grant et al., 2010; Koester and Grant, 2015). Research shows that PrEP has proven effective for MSM, heterosexual men and women, and intravenous drug users (Baeten et al., 2012; Escudero et al., 2015). In a particularly informative study, researchers at Kaiser Permanente followed 650 MSM using PrEP for 36 months and found no new HIV infections (Volk et al., 2015).

In 2014, CDC issued a recommendation that anyone at “substantial risk” for HIV consider PrEP (CDC, 2014). Using data between 2007 and 2012, the CDC estimated that there are approximately 1.2 million adults in the United States who may benefit from PrEP, including 500,000 gay and other MSM (Smith et al., 2015). Research shows that as more at-risk individuals use PrEP, there will be benefits to the population more broadly. Predictions using mathematical models suggest that one-third of new infections in the United States can be pre- vented over the next ten years if 40 percent of

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In fact, by removing the fear and anxi- ety about HIV, PrEP may actually increase sexual pleasure and sexual agency (Calabreze and Underhill, 2015). Unlike other prevention tools, one partner does not have to convince the other to use a condom or wonder if they are accurately disclosing their HIV status. Likewise, if one’s partner is HIV positive, they do not have to worry if they are consistently taking their antiretroviral therapy medications, which ensures that the virus cannot be passed (Gamarel and Golub, 2015; Grant and Koester, 2016). Additional empowerment comes from the fact that the decision to use PrEP takes place outside of the sexual moment, includ- ing those instances when alcohol or other sub- stances are involved in decision making (Grant and Koester, 2016).

While research shows clear advantages to PrEP as a prevention strategy, opponents express concerns. The most commonly com- municated fear is that PrEP will lead to gay men abandoning condoms, becoming more promis- cuous, and, ultimately, increasing the rates of other STIs, which, at the individual level, Tru- vada does not protect against (Calabreze and Underhill, 2015; Duran, 2012; Spieldenner, 2016; Weinstein, 2015). Some PrEP critics, including some HIV-prevention leaders, have suggested that it is simply a “party drug” that enables promiscuity. In fact, PrEP-related “slut shaming” is widespread in gay spaces online (Belluz, 2014; Spieldenner, 2016). In the online comments section for an article published in the gay magazine The Advocate, posters called PrEP users “whores,” “immature,” and “un- dateable” (May 15, 2017). Another commenter remarked that drug companies were using PrEP to make money “off the backs of the gays” (Anderson-Minshall, 2017).

PrEP opponents maintain that long-standing behavioral strategies—such as remaining absti- nent; practicing monogamy or minimizing the number of sexual partners; status disclosure;

THE “PrEP WARS”

While the widespread celebration initially envisioned by Damon Jacobs did not happen, many within gay communities and health insti- tutions enthusiastically welcomed PrEP onto the prevention scene. Those who support PrEP acknowledge that it is not suitable for every- one, either because some people prefer and effectively use other prevention methods and/ or they lack access to the medical care neces- sary to use PrEP (Calabreze and Underhill, 2015). However, supporters call for expanded access because they believe it is a much- needed HIV-prevention tool for communities at high risk. Prior to PrEP, queer community and public health groups spent nearly three decades stressing individual-level behavioral change tactics for HIV prevention, particularly condoms for penetrative sex. As mentioned earlier, gay and other MSM continue to make up the bulk of new infections in the United States despite these messages. Research shows that gay men’s condom use has been inconsis- tent, and that will likely continue (Dean, 2009; Grant and Koester, 2016).

Some men feel condoms impede sexual pleasure and intimacy (Calabreze and Under- hill, 2015; Gamarel and Golub, 2015; Grant and Koester, 2016). While public health organizations increasingly acknowledge the relationship between sexual pleasure and well-being (Calabreze and Underhill, 2015; Grant and Koester, 2016; Race, 2016), main- stream prevention messages are generally aimed at simply providing health-related information, largely ignoring the role of sexual desire, sexual pleasure, and sexual meanings (Leonard, 2012; Race, 2016). PrEP provides a highly effective prevention option for people who desire barrier-free sexual inti- macy and pleasure (Calabreze and Underhill, 2015; Gamarel and Golub, 2015; Grant and Koester, 2016).

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have more sexual partners, use condoms less often, and have other STIs more frequently than those not using PrEP (de Wit et al., 2015; Grov et al., 2015; Kojima, Davey, and Klausner, 2016; Marcus et al., 2013; Volk et al., 2015). However, questions remain about the relationship among using PrEP, condomless anal sex, and other STIs (Grant et al., 2014). Recent increasing rates of condomless anal sex and a resurgence of STIs among gay men predate PrEP (CDC, 2013; McCormack et al., 2014). There are cur- rently no data on long-term patterns of sexual behavior after an individual begins using PrEP (Jenness, Akshay, et al., 2017). Likewise, with- out studies of gay men not using PrEP, we can- not know for sure whether PrEP use has caused increases in other STI rates. In addition, since STI testing is part of the PrEP protocol, users have more contact with medical providers, and test more frequently, than nonusers. Impor- tantly, research also shows that gay men who are at the greatest HIV risk (e.g., those report- ing receptive anal condomless sex before start- ing PrEP) are adopting PrEP at the highest rates (Grov et al., 2015; Grant et al., 2014). Leading HIV/PrEP researchers Kimberly Koester and Robert Grant (2015: 1605) suggest that, from a public health perspective, rising incidence of treatable STIs, in the context of decreased or no new HIV infections, is a “good problem to have” (2015: 1605).

Recognizing gay men’s agency and resil- ience, and acknowledging the importance of history, they stress:

Trusting that PrEP users and their communities will respond to the threat of STIs can allow for novel and potentially more durable transformation of sexual health–promoting behaviors. For example, members of the gay community historically led the innova- tions around safer sex practices in the face of HIV/ AIDS (Berkowitz, 2003). If the STI burden in the context of PrEP use become too great, communities can and will make course corrections. (Koester and Grant, 2015: 1605)

always using condoms during sex; and regu- lar HIV testing—are safer, cheaper, and more “respectable” (Dieffenbach and Fauci, 2011; Spieldenner, 2016). Additionally, as the com- ment above illustrates, opponents question the motivations of pharmaceutical companies (e.g., pushing profits over prevention or a cure).

There are queer interrogations of PrEP, too. Some queer scholars who may not necessarily oppose PrEP contend that “mass compliance with pharmaceutical mandates” has biopoliti- cal side effects, such as viewing sex as simply a physical encounter that ignores the importance of pleasure, erotic fantasy, and how certain sexual acts, even risky sex, can be meaningful (Dean, 2015: 234; Race, 2016). Bailey (2016) is concerned that emphasizing biomedical prevention strategies benefits pharmaceutical companies and economically harms commu- nity-based organizations on the front lines in poor communities of color, where structural barriers (e.g., racism, homelessness, under- or unemployment, and hunger) to HIV preven- tion, testing, and treatment are high.

In addition to concerns about deemphasizing behavioral changes, opponents express concerns about the difficulties of daily adherence, a pos- sible increase in other STIs, and the long-term side effects of Truvada (Spieldenner, 2016; U.S. Public Health Service, 2014: 24–26; Weinstein, 2015). However, studies show that adherence rates are generally good among gay men, espe- cially among those who are at the highest risk of infection (Grant et al., 2014). Still, adherence is crucial. Like the birth control pill, to which PrEP is often compared, Truvada only works if users consistently take it. With this in mind, PrEP sup- porters suggest that public health officials and advocates in high-risk communities concentrate on developing ways to support adherence, rather than condemning PrEP and those who use or wish to use it (Calabreze and Underhill, 2015).

The existing biomedical and public health research suggests that gay men using PrEP may

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shift, that create collective memories, identities, and new sexual worlds. They reveal the sexual attitudes, desires, and objects that are accept- able and visible, and those that are forbidden and hidden. As we consider below, the over- lapping and clashing viewpoints about PrEP are shaped by the historic and enduring cross- generational sexual standpoints about gay men and gay sex that developed in response to the discovery of HIV/AIDS in 1981 and life-saving treatments in 1996.

Moreover, Plummer challenges the idea that a fully agreed upon dominant sexual culture exists, such as a prevailing “safe sex” ethos. Plummer maintains that if such a culture exists, or is invented, it must be understood in connection to other sexual cultures that are always present, even if they are located beneath the surface. These sexual subterranean traditions are the “lived sexual cultures that run against the grain, where any ideas of a dominant world or a hegemonic dominance are subverted, resisted, quietly ignored, or loudly challenged” (Plummer, 2010: 165). Like their conventional counterparts, rival sexual traditions have a range of generational forms and leave traces on successive generations. Plummer uses sex work as an example of a subterranean tradition that challenges the dominant view that sex is only appropriate in the context of traditional het- erosexual marriage and for procreation.

Dominant and subterranean sexual cultures are evident in the PrEP Wars, too. Condoms have been a fundamental tool of HIV pre- vention for over 30 years and a sexual object uniquely embedded in gay men’s sexual worlds (Chrimp, 1987; Spieldenner, 2016). Indeed, since the mid-1980s, “unprotected” sex meant anal sex without condoms, and, in the con- text of HIV/AIDS, mainstream public health models and society in general labeled gay men who did not always use condoms as mentally deficient or compulsive (i.e., pathological). PrEP’s success has shaken the foundations of

GENERATIONAL SEXUALITIES

Given PrEP’s effectiveness, we have to ask why its adoption has been so controversial within gay communities. We argue that the best way to understand this is to apply Plummer’s generational sexualities framework. Plummer (2010) contends that human sexuality is com- plex, contradictory, and contested, because it is constructed in social situations and lay- ered in social contexts. He declares, “We are the storytelling, historical, political, ethical, symbolic, imaginative, memorializing sexual animal” (2010: 164). Part of the complexity of human life and sexuality stems from its genera- tional character, or how life is shaped by social meanings saturated with historical and per- sonal experiences (Plummer, 2010). As Plum- mer (2010: 165) explains, “At any moment of thinking about the sexual, we will usually find at least five generations helping shape that moment.” Despite life’s generational frames, Plummer emphasizes that generational experi- ences are never fully unified, because of social class, ethnicity, gender, sexuality, and the influence of other social forces. Indeed, “sexual practices (e.g., ‘vanilla,’ ‘kinky,’ ‘raunchy’), sex- ual roles (e.g., ‘top,’ ‘bottom,’ ‘versatile’), sexual types (e.g., ‘bear,’ ‘daddy,’ ‘surfer,’ ‘cowboy’), and more recently serostatus (‘HIV-positive,’ ‘HIV-negative’) and sexual behaviors within the context of serostatus (e.g., ‘safer sex only,’ ‘bareback sex’)” create additional divisions with in and across generations of gay men” (Yep, Lovaas, and Pagonis, 2002: 9).

Generational sexualities do not merely refer to chronological age or age cohorts but encom- pass generational standpoints, particular perspec- tives based on symbolic content experienced within a given time period and eventually com- municated to subsequent age cohorts (Plum- mer, 2010). Generational standpoints emerge based on shared critical sexual life events—those critical moments, as cultures and sexual worlds

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Early on, gay communities shared sex- positive and culturally based messages that attempted to engage with the social, symbolic, and biomedical complexities of sex and HIV. They used homoerotic imagery to situate con- doms as part of the shared sexual and cultural norms of gay men, incorporating them as a way to attain pleasure in an epidemic (Leonard, 2012). For example, in 1982, a San Francisco– based activist group, the Sisters of Perpetual Indulgence, published a pamphlet that noted: “Mysterious forms of cancer and pneumonia are now lurking among us” (this was how the disease was first understood), and they made recommendations, such as using condoms, to remain healthy. In 1983, the year researchers at the Pasteur Institute in Paris isolated the virus that would later be named HIV (Barre- Sinoussi et al., 1983), members of the gay com- munity in New York and their doctor published a pamphlet, How to Have Sex in an Epidemic: One Approach. Berkowitz (2003) contends that these two community-based sexually explicit publications are the foundations of “safe sex.” In using sex-positive imagery, they empowered gay men to respond to the unknown illness by, at least in part, continuing to be sexually active while taking certain precautions (i.e., condoms) (Berkowitz, 2003).

Official U.S. public health HIV/AIDS edu- cation did not appear until 1986, and President Reagan did not publicly mention HIV/AIDS until 1987 (Patton, 1996). Like gay men who are using or considering PrEP now, gay men then found themselves in a “highly politicized position” (Race, 2016: 13). Mainstream health institutions eventually appropriated “safe sex” minus the queer aesthetic, which non-gay groups claimed was offensive and promoted homosexuality (Leonard, 2012). Mainstream health institutions utilized fear tactics and promoted monogamy and constant condom usage (Holt, 2014; Patton, 1996; Race, 2003; 2008). As is still the case with most dominant

the prevailing condom-based notions of “safe/ risky” and “protected/unprotected” sex (Auer- bach and Hoppe, 2015; Dean, 2015; Koester and Grant, 2015; Spieldenner, 2016). What does unprotected sex mean for gay men in the era of PrEP? Many critics claim that an indi- vidual having condomless sex while using PrEP is not practicing “safe” sex, despite the clini- cal data suggesting otherwise, and they imply that gay men who use or wish to use PrEP are pathological. As this suggests, while PrEP is new, the standpoints framing the contentious debates about it are not. Indeed, noncondom- based HIV-prevention approaches (i.e., sexual subterranean traditions), which challenge mainstream positions about sex and risk and the presentation of gay men as sexual actors who are incapable of making “appropriate,” healthy decisions, have deep roots stretching to the beginning of the epidemic. In the next section, we historically ground the current reactions to PrEP by exploring these origins.

GAY MEN, SEX, AND HIV RISKS

Constructing “Safe Sex” Sparked by the threat of illness and death, and framed by a broader homophobic culture that regarded gay men and gay sex as deviant and pathological (i.e., a critical sexual event), gay communities created “safe sex,” or what was later called “safer sex” (i.e., a sexual stand- point). Initially, this happened with little to no help from government or scientific and medical institutions (Epstein, 1996; Kippax and Race, 2003; Patton, 1996; Rofes, 1996). Rather, faced with the uncertainty of the disease and largely abandoned by medical and scientific establish- ments, gay communities developed and shared their own knowledge about their sexual expe- riences/health, ultimately producing their own set of behavioral changes aimed at prevention (Epstein, 1996; Kippax and Race, 2003; Patton, 1996; Rofes, 1996).

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sexually compulsive (Patton, 1996: 125). Rofes (1996) argued that some gay professionals at the helms of HIV/AIDS groups, which were becoming more institutionalized in the early 1990s, maintained rather than challenged the homophobic and oppressive sociopolitical sys- tem. Rofes (1996: 102) asserted that the rela- tionship between the “gay masses” and some gay leaders replicated “a traditional pattern of interaction between marginalized groups and newly formed classes of ‘professionals’ and ‘experts’ who offer assistance”; his comment is relevant to PrEP in the current context.

Others in gay communities pushed back, maintaining a liberationist stance and chal- lenging what they saw as enduring efforts to control sexuality (Patton, 1996; Rofes, 1996). Liberationists asserted that, to counter the per- sistent negative images of gay men, the history of gay men’s resistance against psychological, medical, and social oppression, and their cel- ebration of sex, had to be embraced, not con- demned. They encouraged gay men to explore their own sexual meanings and experiences, and to understand safer sex as something to be constructed and reconstructed, not as a rigid practice without context (Patton, 1996; Rofes, 1996; Dean, 2009). Liberationists observed that, from the beginning of the epidemic, gay men have actively made sense of HIV within a homophobic sex-negative culture by embrac- ing a stance that positioned gay men as capable of making “healthy” decisions that balanced risk, desire, and pleasure (Epstein, 1996; Race, 2016; Rofes, 2007; Spieldenner, 2014; 2016).

Subterranean Ideas about Sex and Risk Like Plummer’s (2010) view of sex, a queer sex- ual perspective comprehends the relationship between sex and risk as complicated and contex- tual. This relationship reflects power relations (i.e., risks are structured by homophobia, rac- ism, poverty, HIV stigma, etc.), changing facts

definitions of sexual health (Bailey, 2016), the focus of these early conventional codes was strictly on eliminating risks and reducing STIs, while ignoring issues of sexual meaning, desire, and pleasure (Halprine, 2007; Race, 2008; 2016; Rofes, 1998).

By the late-1980s, studies showed that most gay men were well informed about HIV/ AIDS, and that they were increasingly using condoms for anal sex. However, these studies also showed that some gay men did not always or ever use condoms (Ames and Beeker, 1990; Hart et al., 1992). This research was limited and did not reflect the complexity of gay men’s sexual lives. For example, researchers did not ask study participants about the types of rela- tionships within which they had “protected” or “unprotected” sex, nor were they asked whether they knew their partners’ HIV status before making sexual decisions (Hart et al., 1992). Nevertheless, the revelation that some gay men were not fully embracing the “condom ethic” (Race, 2008) sparked controversy within and outside of gay communities. Condomless anal sex, regardless of context, was—and, as the PrEP debates show, still is—viewed simply as “bad people” engaging in “bad behavior” (Holt, 2014; Race, 2003; Rofes, 2007). Based on this assessment, HIV-positive gay men became seen as the ultimate sexual deviant, an unde- sirable “other” against which HIV-negative gay men were defined (Román, 1997; Yep, Lovaas, and Pagonis, 2002).

Critiques of gay men and gay sex came from within gay communities, too, where some drew on society’s morality-based sex- negativity, arguing that sexuality needed to be controlled (Patton, 1996; Rofes 1996; 1998; Race, 2016). They recycled stereotypes about the “unrestrained,” abnormal, and immoral gay liberation culture of the 1970s, which linked gay emancipation to sexual freedom, labeling “gay liberation as a simple, selfish libertinism, a cause of AIDS,” and gay men as fatalistic and

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ages, with various identities (e.g., “positive,” “negative,” and “gay” or “queer”) and political positions (e.g., liberationist or assimilationist politics) attempted to make sense of the early AIDS crisis and the substantially altered, but ongoing, threat of HIV. This period was also marked by immense assimilationist gains in les- bian and gay rights (e.g., state and federal laws for marriage equality). However, unlike the increasing mainstream interest in most things gay, such as celebrities and heteronormative gay families, society still refused to acknowl- edge gay sexuality, or to have any meaningful discussions about the complexities of sex and risk (Dean, 2015; Race, 2008).

Despite the shadows cast by mainstream gay politics and an enduring refusal to acknowl- edge gay sex during this time, subterranean sexual behavior flourished, further highlight- ing the intricacies of sexuality and HIV pre- vention. Barebacking surfaced as a sexual and political identity among some gay men, and the fact that this behavior was deliberate, even celebrated, sparked more fervent debates within gay communities (Dean, 2009; 2015). Some queer scholars argue that barebacking is radical defiance to imposed norms of sex and health that have come from both within and outside of gay communities since the early 1980s (Dean, 2009; 2015; Rofes, 2007). Others suggest that barebacking reflects the structural vulnerabilities that some people face, par- ticularly queer people of color (Bailey, 2016). Queer scholar Tim Dean (2009) situates bare- backing on a continuum, distinguishing among barebacking with the desire to avoid HIV transmission, which appears to represent the motivations of the bulk of gay men who engage in condomless sex (Dawson et al., 2005; Grov and Parsons, 2006), barebacking with indiffer- ence to HIV, and barebacking with intention for viral transmission.

The practice of serosorting is a risk-reduction strategy, located on the “desire to avoid HIV”

about HIV, and the lived sexual realities and cul- tural norms of various groups of queer people, including risk-taking and creativity, determina- tion, and resilience in the face of adversity (Diaz and Ayala, 1999; Bailey, 2016; Carballo-Dieguez and Bauermeister, 2004; Peterson and Jones, 2009; Race, 2016; Rofes, 1996). Indeed, Rofes writes that “most of the gay men in their erotic adventures are not sick, immature, or vestiges of a bygone era rebuked by AIDS but instead brave innovators ever expanding the possibilities of intimacy and play, even and especially in the context of risk” (2007: v).

As discussed above, subterranean sexu- alities (i.e., sex without condoms) have existed since the beginning of the epidemic. After 1996, more raucously defiant underground sexual identities and practices, such as “bare- backers” and “barebacking,” or “the conscious and deliberate practice of unprotected anal intercourse” (Yep, Lovaas, and Pagonis, 2002: 4), became more visible in gay communities. In 1996, highly active antiretroviral thera- pies (HAART) were approved for treatment (Holt, 2014). HAART do not cure HIV but can reduce the quantities of the virus in the body to an “undetectable” level, resulting in a relatively normal healthy lifespan for people who are infected (May et al., 2014). Surely, the HAART breakthrough was a critical sexual event, shifting the epidemic from a deadly to a manageable chronic illness, particularly for resource-rich individuals and communities (Elford, 2006; Halkitis et al., 2004). Also, a person who is HIV positive and has an “unde- tectable” viral load is significantly less likely to transmit the virus to their HIV-negative sexual partners even when condoms are absent, which is why medical professionals see testing indi- viduals at high risk and treating those who are as positive as an effective method of prevention (Cohen et al., 2011).

After HAART and throughout the late- 1990s and into the 2000s, MSM of various

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CONCLUSION

Given PrEP’s incredible success at preventing new HIV infections, the lack of widespread celebration within gay communities might be surprising. However, when PrEP is consid- ered within Plummer’s generational sexualities framework, the controversy surrounding PrEP makes more sense. According to Plummer, and consistent with queer/liberationist perspec- tives, sexuality is complex, contradictory, and contested because it is constructed in social situations and layered in social-historical con- texts. Critical events in the sexual histories of MSM, such as the discovery of HIV/AIDS and HAART, create and reinforce sexual stand- points that embody and reveal a society’s cul- tural norms However, there were and still are, several—often opposing—sexual standpoints about gay men and gay sex, which are reflected in the overlapping and clashing viewpoints about PrEP.

The controversies surrounding PrEP have roots that even predate the early epidemic in the 1980s and reflect long-held biases about gay men, gay sex, and sexual health. These biases and the controversy they generated have likely shaped the slow uptake of this new prevention tool among gay men, which is significant con- sidering the high rates of new HIV infections. Narratives of dominant and subterranean sexual cultures form the heart of this debate concerning the use of condoms during sex. The mainstream narrative has been (and continues to be) that the only gay sex that is “safe” is sex with condoms; but gay men’s subterranean sex- ual worlds reveal that this narrative has never fully captured the lived experiences of all gay men and their divergent sexual norms. PrEP’s success has reignited this debate and raised questions, once again, about what it means to have safe sex. In other words, while PrEP is new, the standpoints framing the contentious debates about it are not. Despite the evident

end of the barebacking range. Serosorting involves discussing HIV status with potential casual partners, and only having condomless sex with those who have the same status (Holt, 2014; Suarez and Miller, 2001). Romantic or regular sexual partners who agree to only hav- ing condomless sex with each other, and to always use condoms with casual partners, can reduce risks without always using condoms (Hart et al., 1992; Holt, 2014; Kippax et al., 1993). Cum play, or semen sharing, including “ejaculation over the anus, rubbing semen over the anus, or using semen as lubricant during masturbation or for digital and penile penetra- tion,” is another sexual behavior that defies the normative notion of “safe sex,” since, because of HIV, semen has been characterized as “toxic” and “deadly,” at least for gay men (Dean, 2009; Prestage, Hurley, and Brown, 2013: 1348). Barebacking, like cum play, can be practiced in a way that reduces risk (Prestage, Hurley, and Brown, 2013); and this behavior underlines the symbolic importance of semen as a norma- tively forbidden sexual “object.”

Critics of serosorting question gay men’s ability to effectively negotiate condomless sex, especially with casual partners, because it requires trusting that people accurately and honestly disclose their HIV status (Holt, 2014; Zablotska et al., 2009). Some even doubt gay men’s ability to establish trust and honesty within sexual or romantic relationships, or to maintain sexual agreements (Ekstrand et al., 1993; Hoff and Beougher, 2010). Advocates acknowledge that these are risk-reducing, not risk-eliminating, approaches and argue that these strategies underscore gay men’s agency, desires, and meanings (Holt, 2014). Writing about “desires of defiance,” Rofes (2005: 123), like Plummer, reminds us that “for many, the forbidden becomes desired; taboo produces cravings; the return of the repressed is made corporeal and is experienced as an enormous hunger.”

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need for HIV-prevention approaches that do not involve condoms, which PrEP provides, it is still a challenge to mainstream notions of sex and risk.

NOTE 1. Nausea, abdominal cramping, vomiting, dizziness, headache, and fatigue are possible short-term side effects of Truvada. For most people using the medication, these side effects occur during the first week or two of use and then go away. For a very small number of individuals, Truvada can also effect their renal function, or they can experience a loss of bone mineral density. These side effects are rare and reversed when the individual stops using the medication (Baeten et al., 2012; Grant et al., 2010). In a review of five major PrEP studies, Kojima and Klausner (2016) found that, as far as user safety, Truvada is comparable to aspirin.

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Early on a balmy morning last October, Cedric Sturdevant began his rounds along the bumpy streets and back roads of Jack- son, Miss. Sturdevant, 52, has racked up nearly 300,000 miles driving in loops and widening circles around Jackson in his improvised role of visiting nurse, motivational coach and father figure to a growing number of young gay men and transgender women suffering from HIV and AIDS. Sturdevant is a project coordinator at My Brother’s Keeper, a local social-services nonprofit. If he doesn’t make these rounds, he has learned, many of these patients will not get to the doctors’ appointments, pharmacies, food banks and counseling sessions that can make the difference between life and death.

Negotiating a maze of unpaved roads in Jack- son in the company car, a 13-year-old Ford Expe- dition with cracked seats and chipped paint, he stopped to drop off HIV medication at a couple’s home. One of the men was HIV-positive, the other negative; they lived in the neighborhood locals call the Bottom, where every fifth or sixth home is abandoned, with broken windows, doors hanging off hinges, downed limbs and dry leaves blanketing front yards. Sturdevant banged on the door of a small house, its yard overgrown with weeds, he knew not to leave the package on the doorstep, where it could be stolen. After a while a young man emerged, shirtless, shrugging off sleep. He had just gotten out of jail. Sturdevant handed him the package, shook his hand and told him to “stay out of trouble.”

Sturdevant drove on another 15 minutes to pick up Marq (a shortened version of his name to protect his privacy), a teenager who was still reeling from the HIV diagnosis he received the previous spring. As they headed to

and from a doctor’s appointment and a meet- ing with a counselor, Sturdevant, slow-talking and patient, with eyes that disappear into his cheekbones when he smiles and a snowy beard, gently grilled him, reminding him to stay on his meds. The teenager slumped in the back seat, half listening, half checking his texts. He looked up briefly when Sturdevant told him, “You’ve come a long way. I’m proud of you.” But Marq barely said goodbye as he jumped out of the car in front of a convenience store on an avenue scattered with a pawnshop, a liquor store and several Baptist churches, and he all but admitted he was planning to spend the afternoon smoking weed and looking at Insta- gram. “Knucklehead,” Sturdevant whispered, as the teenager slammed the door. Pulling off his favorite Dallas Cowboys baseball cap and running a hand over his bald head, Sturdevant added softly, “Breaks my heart.”

These patients of Sturdevant’s are the faces of one of America’s most troubling public- health crises. Thanks to the success of lifesaving anti- retroviral medication pioneered 20 years ago and years of research and education, most HIV- positive people today can lead long, healthy lives. In cities like New York and San Francisco, once ground zero for the AIDS epidemic, the virus is no longer a death sentence, and rates of infection have plummeted. In fact, over the past several years, public-health officials have cham- pioned the idea that an AIDS- free generation

AMERICA’S HIDDEN HIV EPIDEMIC

L I N D A V I L L A R O S A

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Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas) died with HIV as an underlying cause, with the highest death rates in Missis- sippi and Louisiana. Among black men in this region, the HIV-related death rate was seven times as high as that of the United States population at large.

Sturdevant, born and raised in Metcalfe, a tiny Mississippi Delta town of about 1,000, understands all too well the fear, stigma and isolation that can come with being a black gay man in the South. “Growing up, I was taught that God was not fixing to forgive a person who was homosexual,” Sturdevant said. “The Bible supposedly said you’re going straight to hell, automatically, there’s no forgiveness. There were several times I thought about suicide. There were several times I wanted to get sick and die. Finally, my thought was, I just want to get out of here.” He moved to Dallas, and then to Memphis.

When he learned he had HIV in 2005, Stur- devant knew little about the virus and was too depressed and ashamed to tell anyone at first. When his partner died the following year, he let the disease consume him. “I was weak, had a fever of 103, couldn’t even keep down water,” he recalled. Sturdevant has shared his story too many times to count, to let young men know that he has been there, too, and to help them understand that they can survive this plague. He also knows that many black gay and bisex- ual men have been rejected and discarded, and has wrapped his arms around as many as he can grab hold of, treating them like family. Sturdevant has two daughters from an early marriage and three grandchildren, but he says he feels just as strongly about his 16 or so unre- lated “children,” most of them living with HIV. He feeds them, sometimes houses them, but mostly listens to them. “Young black men feel abandoned and need someone they can believe in and who believes in them,” Sturdevant said

could be within reach—even without a vaccine. But in certain pockets of the country, unknown to most Americans, HIV is still ravaging com- munities at staggering rates.

Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of HIV for several key populations, predicted that if cur- rent rates continue, one in two African Ameri- can gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of HIV, at 28.8 percent of the population. If gay and bisexual African American men made up a country, its rate would surpass that of this impoverished African nation—and all other nations.

The crisis is most acute in Southern states, which hold 37 percent of the country’s popula- tion and as of 2014 accounted for 54 percent of all new HIV diagnoses. The South is also home to 21 of the 25 metropolitan areas with the highest HIV prevalence among gay and bisex- ual men. Jackson, the capital of Mississippi, the country’s poorest state, is best known for blues [and] barbecue. . . . It also has the nation’s high- est rate—40 percent—of gay and bisexual men living with HIV, followed by Columbia, S.C.; El Paso; Augusta, GA.; and Baton Rouge, LA. In Jackson, a small city of just over 170,000, half a dozen black gay or bisexual men receive the shock of a diagnosis every month, and more than 3,600 people, the majority of them black men, live with the virus.

The South also has the highest numbers of people living with HIV who don’t know they have been infected, which means they are not engaged in lifesaving treatment and care—and are at risk of infecting others. An unconsciona- ble number of them are dying: In 2014, accord- ing to a new analysis from Duke University, 2,952 people in the Deep South (Alabama,

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“My body hates me.” Once a month, his mother or grandmother drove him to medical appoint- ments in Jackson, to receive care from provid- ers experienced in treating people living with HIV and to avoid the small-town gaze at the local facilities; there is no Gay Men’s Health Crisis for him to visit in his small town, as there would be if he lived in New York. “Everybody knows everybody here,” Jordon said. “At the hospital, they know my mom and my brother and my grandmother. I would rather be around people who don’t know me.” Too ashamed to admit that he had the virus, Jordon had told few friends about his diagnosis.

“Are you taking your medicine?” Sturdevant asked. For many young men, the HIV diagno- sis and the illness are so overwhelming that maintaining a new and unfamiliar regimen of medication can be difficult. Jordon looked down. “Not as often as I should.” When he saw Sturdevant’s glare, he continued, sounding like a little boy. “I hate taking medicine; I hate it. I have to take six pills, now seven, eight, plus a shot—”

Sturdevant cut him off. “We all have to do this, Jordon. Don’t you want to get better?”

Jordon let his head fall back on the pillow. “I know I can get better, Mr. Ced,” he said, mas- saging his feet. “I just don’t know how every- thing got so bad.”

Given the advances in research, informa- tion and treatment, it seems inconceivable that someone living with the virus today, like Jor- don, could look as if he had stepped out of the early years of the epidemic. And yet a series of fateful decisions and omissions, dating back to the discovery of the disease, have led to a pres- ent that looks like the past—but only for some.

History marks the beginning of the Ameri- can AIDS epidemic as June 5, 1981, when an issue of the CDC’s Morbidity and Mortality Weekly Report—the authoritative voice of the agency—highlighted five cases of pneumocys- tis pneumonia (PCP) in previously healthy men

as he drove past fields of fluffy cotton, his hands resting lightly on the steering wheel. “I told God I want to be able to help guys like me, that didn’t grow up with their father, and they started coming to me, wanting to talk. After a while, they would bring other people to me and say, ‘Dad, can you help him, too?’”

Sturdevant moved his seat back, preparing for a long drive, and . . . headed to a small town 90 miles east of the city to visit Jordon, an HIV-positive 24-year-old. When Stur- devant himself was at his lowest point, he said, “I looked something like this boy we’re going to see.”

. . . [H]e turned down a dead-end street and pulled up in front of the one-story brick home where Jordon lived. “I’m real worried about him,” Sturdevant said, lowering his voice as he walked up the driveway’s cracked pavement toward the front door. Jordon had recently posted a photo of his skeletal frame on Face- book, asking friends to “pray for me.”

As he stepped into Jordon’s stuffy bedroom, Sturdevant’s eyes scanned from a wheelchair leaning against the wall to a can of Ensure on the bedside table before settling on the young man. He was rubbing his feet, wincing from HIV-related neuropathy that caused what he described as “ungodly pain.” Jordon’s round, hooded eyes were sunk deep into his face. Gray sweatpants pooled around his stick-thin legs, so fragile they looked as if you could snap them in two. His arms were marked with scars from hospital visits and IVs. Over six feet tall, he weighed barely 100 pounds. He smiled slightly when he saw Sturdevant, dimples folding into his hollow cheeks. “Hey, Mr. Ced,” he said, his voice raspy. . . .

With effort, Jordon sat up slightly, untangling himself from a jumble of sheets. Sturdevant asked how he was doing, and he cataloged a laundry list of what he called his “old man” ailments. “I’ve had everything— diarrhea, hemorrhoids, now this neuropathy,” he said.

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This has been true of even the most recent advances. In 2010, the Obama administration unveiled the first National HIV/AIDS Strat- egy, an ambitious plan that prioritized gov- ernment research and resources to so -called key populations, including black men and women, gay and bisexual men, transgender women and people living in the South. With a mandate to “follow the epidemic,” several pharmaceutical companies and philanthropic organizations also started projects to help gay black men, particularly in the Southern states. That same year, the Affordable Care Act and later the expansion of Medicaid in more than half of the country’s states linked significantly more HIV-positive Americans to lifesaving treatment and care.

In 2011, HPTN 052, a study of 1,763 cou- ples in 13 cities on four continents funded by the National Institute of Allergy and Infec- tious Diseases, found that people infected with HIV are far less likely to infect their sexual partners when put on treatment immediately instead of waiting until their immune sys- tems begin to fall apart. This “test and treat” strategy also significantly reduces the risk of illness and death. The data [were] so persua- sive that the federal government began push- ing new HIV/AIDS treatment guidelines to health care providers the following year. And in 2012, the Food and Drug Administration approved the preventive use of Truvada, in the form of a daily pill to be taken as pre- exposure prophylaxis (commonly called PrEP). It has been found to be up to 99 percent effective in preventing people who have not been infected with HIV from contracting the virus, based on the results of two large clinical trials; an estimated 80,000 patients have filled prescrip- tions over the past four years.

But these measures have not extended to most black gay and bisexual men. A CDC re port in February noted that only 48 percent of black gay and bisexual men effectively suppress the

in Los Angeles. Healthy people do not contract a disease like PCP, which had been largely con- fined until then to patients on medication to suppress their immune systems for an organ transplant or cancer patients on chemotherapy. Though not stated explicitly, the language of the report, by omitting race, implied that its “five young men, all active homosexuals,” were white, which they were. But there were two more documented cases, not mentioned in the notice, and these sixth and seventh cases were black—one of them a gay African American, the other a heterosexual Haitian.

Dr. Michael Gottlieb, the lead author of the report and a renowned physician specializing in HIV/AIDS, treated Rock Hudson before he died of AIDS complications in 1985 and still practices in Los Angeles. Gottlieb said he is often asked why he didn’t include in that first report the documented case of the gay Afri- can American man, who had both PCP and cytomegalovirus, a virus that attacks the organs of patients with compromised immune systems. He explains that he discovered the case after the report was finalized. “Until recently, I wouldn’t have thought it mattered,” said Gottlieb, who said that he and others on the front line were grappling with an unprec- edented and frightening medical mystery and largely working in the dark. “But in retrospect, I think it might’ve made a difference among gay black men.”

Including gay black men in the literature and understanding of the origins of the disease and its treatment could have meant earlier out- reach, more of a voice and a standing in HIV/ AIDS advocacy organizations, and access to the cultural and financial power of the LGBT community that would rise up to demand government action. But 35 years of neglect, compounded by poverty and inadequate local health care infrastructure, have left too many black gay and bisexual men falling through a series of safety nets.

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1998. In 2003, she was a co -author of legis- lation that led to the President’s Emergency Plan for AIDS Relief (Pepfar). The five-year, $15 billion global strategy provided preven- tion, treatment and care services to the coun- tries most affected by the disease, almost exclusively in Africa. The largest international health initiative in history to fight a single dis- ease, Pepfar is considered a success story by any measure and a crowning achievement of George W. Bush’s presidency.

Black America, however, never got a Pepfar. Though the raw numbers were much lower than in Africa, parts of our country looked like the continent the program was created to save. Yet while buckets of money went overseas, domes- tic funding for HIV/AIDS remained flat, and efforts to fight the disease here were reduced to a poorly coordinated patchwork affair. “When we saw that the epidemic was out of propor- tion in the black community, we started call- ing for a domestic Pepfar that would bring new resources to the effort, create clear and ambi- tious objectives and rebuild health care infra- structure around the country,” Lee said. “But we just couldn’t get the administration to focus on a domestic plan.”. . .

Beginning in the late ’90s, the United States government funneled billions of federal dollars into abstinence-until-marriage programs here and abroad. In place of effective sex education, these programs often discouraged condom use while teaching abstinence as the only way to pre- vent the spread of AIDS—even as well-regarded research established that this kind of sex educa- tion does not lower the risk of contracting HIV and other sexually transmitted diseases.

During this time, many scientists, researchers and government administrators were afraid to speak openly about condoms, needle exchange and LGBT issues for fear of reprisal and loss of funding. Community organizations became targets of anti-gay crusades, subjected to intense scrutiny, including exhaustive audits, by federal

virus with consistent medication, and the numbers are even lower for these men in their late teens and 20s. In 2014, nearly one in five black gay men who had received a diagnosis of HIV had progressed to AIDS by the time they learned of their infection—which meant that they were generally very ill by the time they began treatment. Only a small percentage of black people use PrEP to prevent contract- ing the virus, accounting for only 10 percent of prescriptions; the vast majority of users are white. Many black gay and bisexual men either can’t afford PrEP or don’t know about it—they may not see a doctor regularly at all, and many medical providers haven’t even heard of PrEP.

Turning things around would mean expand- ing testing and providing affordable treatment for those who are positive—to stop sickness and dying and also to block transmission of the virus. It would also require getting information and medication, including PrEP, to those most at risk. Even more challenging would be reduc- ing the stigma, discrimination and shame that drive gay and bisexual men to hide their sexu- ality and avoid the health care system—and making sure providers have adequate resources and understand how to care for HIV patients.

“It’s deeply troubling when 50 percent of African American gay men are expected to get HIV during their lifetime, but it’s also been a clarion call for all of us to improve on what we’re doing,” said Dr. Jonathan Mermin, the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Pre- vention. “What we have been trying to do is ensure that we’re having the greatest effect with the resources we’re provided.”. . .

For nearly two decades, the United States has focused money and attention on the HIV/ AIDS epidemic elsewhere. Barbara Lee, the longtime United States representative from Northern California, has signed her name as a sponsor to every piece of major federal HIV/ AIDS legislation since she was first elected in

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cities in the South, and from gay white men of means to poorer people of color, LGBT advo- cacy and fund-raising has shifted to marriage equality. In 2013, HIV activists persuaded 35 LGBT leaders to sign a statement and create a video imploring the greater gay community to recommit to the AIDS struggle. The message: “We need you to come back.” But of $168 mil- lion in HIV/AIDS philanthropic dollars spent in the United States in 2015, $31 million was disbursed to the South, just 19 percent of total HIV philanthropy in the United States; only $26 million directly targeted African Ameri- cans, and just $16 million went directly to gay and bisexual men, according to the organiza- tion Funders Concerned About AIDS.

During Millett’s decades in government and nonprofit organizations, he has combed through mounds of data about HIV/AIDS and black gay and bisexual men. Two years ago, he and his amfAR colleagues published a com- prehensive report titled “HIV and the Black Community: Do #Black(Gay)Lives Matter?” When the calm, usually sunny Millett, known for his bookish blue glasses and ready smile, talks about what he calls this “perfect storm,” his voice takes on a harder edge. “We are going to eventually end AIDS in the United States, but I fear it’s not going to happen for black MSM,” he said, referring to men who have sex with men. “We have waited too long. With so many black gay men already infected, the horse is already out of the barn.”

Everybody knows everybody else in Jack- son’s small, tight-knit black gay community, and most men will find their sexual partners in this network. Most scientists now believe that risk of contracting HIV boils down to a numbers game rather than a blame game: If the virus is not present in your sexual network, you can have unprotected sex and not get infected. But if you are in a community, like Jackson, where a high percentage of gay and bisexual men are infected with HIV—and many don’t know it

agencies. “It is no coincidence that new rates of HIV infection among gay men, especially gay black men, began to spike sharply from 2000 on, because of an anti-science campaign that allowed for little or nothing to be done for a maligned community simply due to ideology and bigotry,” Millett said. “The hostile environ- ment made funding effective HIV-prevention programs, messages or research impossible for U.S. communities most impacted by HIV.”

The election of Barack Obama brought renewed attention to the domestic epidemic and loosened the conservative grip on the federal government’s prevention and research agenda. . . . On World AIDS Day in 2011, Obama directly addressed the HIV crisis among gay black men in a speech at George Washington University: “When new infections among young black gay men increase by nearly 50 percent in three years, we need to do more to show them that their lives matter.”

But good intentions have not translated into enough funding and resources—from either the government or philanthropic organizations. Good intentions also have not counteracted the crippled medical infrastructure in states like Mississippi, which the Commonwealth Fund, an independent health-policy research founda- tion, ranks dead last in more than 40 measures of health-system performance. A 2014 study conducted by Dr. David Holtgrave of the Johns Hopkins Bloomberg School of Public Health found that to make any real progress in the HIV/AIDS crisis among black gay and bisex- ual men in the United States, the government would need to invest an additional $2.5 billion to address unmet testing, care, treatment and prevention needs. Despite the higher HIV diagnosis and death rates in the Deep South, the region received $100 less in federal fund- ing per person living with HIV than the United States overall in 2015.

As the center of the epidemic has moved from New York and San Francisco to the smaller

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largely in denial about the fact that HIV/AIDS was a black issue. Worse, most believed the dis- ease was a conspiracy on the part of the federal government to kill off the race, God’s punish- ment for homosexuality or simply not a subject for polite conversation, because the disease was thought to be connected to promiscuity and crack and heroin use.

The community’s awakening came in 1991, when Magic Johnson tearfully announced, “Because of the HIV virus I have obtained, I will have to retire from the Lakers today,” and warned, “It can happen to anyone.” By 1994, AIDS had become the No. 1 killer of all Afri- can Americans ages 25 to 44. The virus was 16 times as common in black women as in their white counterparts—and the gap would widen over the next few years. . . .

. . . [C]oordinated efforts . . . started in the late ’90s, when civil rights groups, politicians, clergy, fraternities and sororities and celebrities stepped up to encourage testing and distribute prevention information. All the major black publications collaborated in a highly visible campaign to spotlight the disease as a major health crisis. Black churches created AIDS ministries and offered HIV testing—and the number of congregations participating in the Black Church Week of Prayer for the Healing of AIDS ballooned to more than 10,000. . . .

Most of the lock-step mobilization efforts focused on preventing the disease in black women, who, for the most part, were contract- ing the virus through sex with male partners. Though the CDC and other agencies offered plenty of alarming statistics confirming the high and growing numbers of HIV cases and deaths among black women, there was a lack of empirical evidence to clearly explain why the rates were so high. Experts in academia and government researchers tried to unravel a knotted tangle of factors: Women were con- tracting the virus from bisexual men; higher rates of sexually transmitted infections among

and go untreated—any unprotected sexual encounter becomes a potential time bomb. This explanation of “viral load” helps dispel the stubbornly held notion that gay and bisexual black men have more sex than other men, a false perception embedded in the American sexual imagination and fueled by stereotypes of black men as hypersexual Mandingos dating back to slavery.

“Black men are not just out here having unprotected sex willy-nilly; the science dis- proves that,” said Terrance Moore, deputy executive director of the National Alliance of State and Territorial AIDS Directors in Wash- ington. He pointed to stacks of studies over the years, including a groundbreaking, exhaustive 2006 data dive led by Greg Millett that was published in The American Journal of Public Health. In this and other studies, Millett and his colleagues found that gay black men engage in risky sexual practices no more frequently, are as consistent about condom use, and have fewer sex partners than their nonblack peers. “It’s that the viral load in communities of black gay men is higher, which puts them at dispro- portionate risk,” Moore explained. “Plus, these are the same individuals that are dealing with structural barriers around lack of employment, lack of education and opportunities, transpor- tation and, of course, very, very overt institu- tional racism.”

An elevated viral load in a smaller sexual network (because most people still tend to have sex with people of the same race), ampli- fied by the structural issues that Moore pointed to, also explains why HIV rates have always been disproportionately high in the black com- munity overall. But in the first decades of the epidemic, these ideas and explanations had not been widely accepted to explain the growing body of data pointing to fast-rising numbers of HIV cases among black heterosexuals—in rates unmatched by those of white Americans. In fact, the African American community was

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All too often, when people living with HIV in Jackson lack the support of their families, com- munity and the church, they end up in Grace House, a homeless facility on a sleepy block in the midtown section of the city. A cluster of four suburban-looking houses, Grace House originally functioned as a hospice, where the sick came to die. Now that the infected are living longer— and the numbers of gay and bisexual men with the virus continue to creep up—more and more young men are seeking shelter.

Until recently, Justin Huff, a former Jack- son State student, shared a room on the second floor of Grace House’s main facility. He was infected with HIV a year and a half ago, when a man he met on Jack’d sexually assaulted him. He received his diagnosis just after his 21st-birthday celebration. “I was throwing up and couldn’t eat anything for a few days; I thought it was from the drinking,” Huff said. “When I went to the doctor, he was like, if I hadn’t made it in the next two days, I would’ve been dead.”

Frightened and overwhelmed, he eventu- ally landed on the doorstep of Grace House. “I couldn’t believe I was living in a shelter,” said Huff, who is now couch-surfing, applying for jobs at fast-food outlets and retail shops and attending Sturdevant’s support group, deter- mined to stay healthy. “I felt like I had no one. Off and on, I got tired of living, because all I was doing was basically dying trying to stay alive.”

Behind Grace House is a small, quiet make- shift graveyard that holds the cremated remains of 35 or so residents whose families did not pick up their bodies after they died. Ceramic angels, pieces of glasswork and other memen- tos left by friends in memory of the deceased dot the patch of earth at the base of a pecan tree. Stacey Howard, 47, the director of pro- grams, remembers one of the last people bur- ied there, a young man who was HIV-positive and addicted to crack, who had lived off and on

black women facilitated the spread of HIV; socioeconomic issues drove up the rates of all disease. The lack of research to create a coher- ent explanation was further confounded by a reluctance on the part of some scientists and activists to perpetuate the dangerous myth of black women as sexually promiscuous—another holdover from slavery.

Given the confusion, it was simplest to latch onto the most provocative idea: that black gay men, who we knew were also contracting HIV in high numbers, provided a “bridge to infection” to black heterosexual women. . . . As the theory went, closeted black gay men were using women as unsuspecting “cover girls” to hide their sexu- ality and then infecting them with HIV. . . . This idea made a certain amount of sense in the frus- trating absence of scientific data.

In retrospect, the high rate of HIV infection among African American women was a result of a complicated combination of all these factors, as well as the reality that after decades of denial and neglect, the viral load piled up in black communities, making any unprotected sexual encounter with anyone a potential “bridge to infection.” But two decades ago, in the midst of a very scary, fast-growing epidemic, the down- low brother became the AIDS boogeyman. . . .

In the end, the organized HIV outreach and education that proved successful to black women never translated to black gay men—and the excessive focus on the down low sucked away critical time, energy and resources. Between 2005 and 2014, new HIV diagnoses among African American women plummeted 42 percent, though the number of new infec- tions remains unconscionably high—16 times as high as that of white women. During the same time period, the number of new HIV cases among young African American gay and bisexual men surged by 87 percent. . . .

The bias that black gay and bisexual men still face poisons the HIV picture in Mississippi and throughout the South. . . .

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Keeper; Us Helping Us in Washington; the Saving Ourselves Symposium . . . ; Our People, Our Problem, Our Solution, the tag line of the Black AIDS Institute. Since last October, the young men in Sturdevant’s orbit have been supported by the fragile scaffolding that “Mr. Ced” has constructed around them and with them. Jordon has gained weight and is up and walking. Marq has promised to stay on his meds and has begun calling Sturdevant “Dad.”

But even Sturdevant knows he can’t save everyone. A shadow passes over his face and his voice grows low when he talks about the one young man he couldn’t save. He remains haunted by him. . . .

“Listen, I know I can’t be there night and day for everyone. But at this point now, I feel like I can’t lose another young man to this disease.”

at Grace House before he was found dead on the street in the spring of 2016.

“They had him at the local funeral home and were getting ready to turn his body over to the state, because no one would claim his remains,” Howard explained as she leaned against the tree. “We got in touch with his fam- ily, who didn’t want anything to do with him but at least signed the paperwork. I think it’s part of our responsibility that when someone in our community passes away, we give them the dignity of a place to rest.”. . .

Black gay and bisexual men and the orga- nizations and activists that support them have come to the painful realization that the nation and society have failed them and that they must take care of themselves and one another. Their group names and slogans reflect a kind of defi- ant lift-as-we-climb self-reliance: My Brother’s