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CHAPTER OUTLINE

Introduction, 2 What Drives Us to Have Sex?, 2

Psychological Influences, 2 Cultural and Societal Influences, 3 Biological and Evolutionary Influences, 6

Major Theoretical Perspectives on Human Sexuality, 8 Psychoanalytic Theory, 8 Cognitive-Behavioral and Learning Theories, 10 Exchange Theories, 14 Personality Theories, 15 Evolutionary Theory, 18

The Perspective of This Text, 20

Theoretical Perspectives on Human Sexuality

Lehmiller, J. J. (2017). The psychology of human sexuality. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a> Created from umuc on 2020-11-02 13:13:38.

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http://www.wiley.com\go\lehmiller2e

1 Theoretical Perspectives on Human Sexuality2

Introduction

For centuries, societies around the world defined sex as just one thing: penis-in-vagina inter- course within the context of marriage for the purpose of procreation. Any other form of genital stimulation was not only viewed as sinful, but it could potentially get you thrown in jail or, in some cases, put to death. In stark contrast to this view, the concept of sex in modern times has been significantly expanded, and sexual activity has become quite complex. For instance, “sex” now refers to a wide range of behaviors, including everything from mutual masturbation to oral, vaginal, and anal stimulation, not to mention things like “sexting” and phone sex. Sexual activity today is no longer legally or morally restricted to traditional heterosexual marriage either; sex occurs between unmarried romantic partners, “friends with benefits,” and people of varying sexual orientations. Furthermore, sexual acts can serve a wide range of purposes, with procreation being just one possibility. In fact, in a study in which people were asked why they have sex, participants reported 237 distinct reasons for “getting it on” (Meston & Buss, 2007)! The most commonly cited reasons for both men and women included feeling attracted to another person, wanting to have fun or experience physical pleasure, and wanting to show affection or love for someone else. The least common reasons included making money, punish- ing oneself, wanting to give a sexually transmitted disease to another person, and feeling closer to God. This immense variation in sexual activities, relationships, and motivations means that understanding sex in today’s world is a complicated task. The goal of this chapter is to give you the theoretical foundation necessary for appreciating the complexities and intricacies of modern human sexuality from a psychologist’s perspective.

As a starting point, it is useful to acknowledge that every single sexual act is the result of several powerful forces acting upon one or more persons. These forces include our individual psychology, our genetic background and evolved history, as well as the current social and cul- tural context in which we live. Some of these influences favor sexual activity, whereas others oppose it. Whether sex occurs at any given moment depends upon which forces are strongest at the time.

Let us consider in more detail some of these different forces and the ways they can impact human sexual decision making and behavior. Following that, we will consider some of the domi- nant theoretical perspectives used by psychologists in understanding human sexuality, before ultimately presenting the model that we will use to organize the remaining chapters in this book.

What Drives Us to Have Sex?

The forces that interact to produce sexual behavior can be lumped into three broad categories: psychological variables, cultural and societal factors, and biological and evolutionary influ- ences. We will consider each of these in turn, providing specific examples of some of the ways they can shape human sexuality.

Psychological Influences

An enormous number of psychological factors can affect sexual behavior, including our mood states, level of cognitive alertness, our attitudes toward sex and relationships, others’ expecta- tions for our behavior, as well as associations learned through reinforcement. Some of these factors are transitory, meaning they can change from moment to moment, whereas others are relatively stable characteristics we carry with us throughout our lives. Regardless of their stabil- ity, each of these psychological variables can promote or inhibit sexual behavior.

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For instance, personality is a relatively stable individual characteristic that may affect both the nature and frequency of our sexual activities (e.g., Markey & Markey, 2007; Miller et al., 2004). To illustrate this idea, just imagine the types of sexual situations that a very extraverted thrill- seeker might get into compared to someone who is very introverted and likes to play it safe. Throughout this book, we will discuss many personality characteristics, from the Big Five to sensation-seeking to erotophilia, that can have a profound influence on our sex lives (all of these personality characteristics will be defined later in this chapter).

Learned associations are another relatively stable characteristic that can affect sexual behav- ior (e.g., Plaud & Martini, 1999). Each of us associates something different with sex, based upon our prior learning experiences. When someone believes that sexual behavior will be helpful in some way (e.g., because that person was previously rewarded with social acceptance for engag- ing in this activity), sex is more likely to occur. In contrast, when someone expects that sexual behavior might be harmful (e.g., if one’s perceived risk of contracting a sexually transmitted infection (STI) appears high or if one’s previous sexual experiences have been bad), sex is less likely to occur.

Likewise, if someone has a negative attitude toward sex or toward a given partner, the odds of sexual activity decrease; in contrast, positive attitudes are likely to increase sexual activity, even in cases where that person might not necessarily be “in the mood” (e.g., someone who is tired might not be particularly interested in sex, but could acquiesce to a partner’s request for sex to make that partner happy).

Finally, one’s current mood state is important as well—and this is one example of a psy- chological characteristic that varies from moment to moment in terms of the impact it has on sex. Another example along these lines would be level of cognitive distraction (Masters & Johnson, 1970). When someone is in a negative mood or is highly distracted, not only is that person likely to be less interested in sex but the sex that an individual has will probably be less satisfying; positive mood states and low levels of distraction tend to generate an opposite pat- tern of effects.

It is important to note that all of the effects discussed above are bidirectional (i.e., attitudes and mood states shape sexual behavior, but sexual behavior also shapes our attitudes and mood states, thereby creating a feedback loop). Moreover, keep in mind that these are just a few of the many ways that psychology and sexuality can intersect. Later in this chapter, we will explore several important theories that provide evidence of other, additional psychological variables that can affect sexuality. These include classical and operant conditioning, observational learn- ing, and social exchange, among others.

Cultural and Societal Influences

The cultural and societal context in which we live plays a large role in determining sexual behavior. Virtually all societies around the world regulate sexuality in one form or another (DeLamater, 1987), effectively establishing standards for sexually “normal” and “deviant” behaviors among certain groups of people. However, there is huge variability in these stand- ards. For instance, although most industrialized societies today have established a norm of sexual monogamy, there are other cultures that not only permit, but explicitly encourage a free exchange of sex partners, even within marriage (see Ryan & Jetha, 2010). Although it is true that some sexual views and practices are more widely shared than others across cul- tures, such as the promotion of marriage and the discouragement of incest (i.e., sexual activ- ity among blood relatives; Gregersen, 1996), there do not appear to be many (if any) truly universal principles of sexuality. For a few provocative examples of how sexual practices vary cross-culturally, see Table 1.1.

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1 Theoretical Perspectives on Human Sexuality4

One of the major forces behind these cultural variations in sexuality is religion. As some evi- dence of the powerful role that religion exerts on people’s views of sexuality, we will explore a few prominent historical examples. First, consider the ancient Greeks and Romans, who shared a belief in multiple gods. Many of the most common myths and stories from these early times centered around the sexual exploits of those gods, which included everything from incest to sex with animals. These ancient peoples even had gods and goddesses devoted exclusively to sex, such as Aphrodite (Greek) and Venus (Roman). Perhaps not surprisingly, the Greeks and Romans are thought to have been quite sexually active and to possess relatively permissive attitudes toward a wide range of sexual practices, including homosexuality and bisexuality (Boswell, 1980). For instance, relatively common in ancient Greece was pederasty: an arrange- ment in which an older man would educate and mentor a male adolescent, who would have sex with him in return (Scanlon, 2005).

As a sharp contrast to the sexual permissiveness of the Greeks and Romans, consider the early Christians, who believed in a single deity and enforced a set of sharply defined rules that governed sexual behavior and the roles of men and women in society. Those who did not fol- low these rules were subject to severe punishment, both here on earth and (as they believed) in the afterlife. For example, one of the most prominent Christian scholars, St. Paul, wrote exten- sively about the sinful nature of any form of sex outside of heterosexual marriage and praised the ideals of celibacy and chastity (i.e., remaining unmarried and sexually pure). St. Augustine expanded upon these notions in his writings, but went even further in declaring that female submissiveness was part of God’s plan. As part of this, he considered the only “natural” sexual position to be one in which the man was on top of the women (Wiesner-Hanks, 2000). Given these strict rules for sexual and gender roles and the harsh punishments for violating them, sexuality became very restricted in Christian countries, and these effects can still be felt today.

Most other early religions viewed sex in similar terms (i.e., as a sinful activity that should only exist within the confines of marriage) and promoted gender roles characterized by male domi- nance and female submissiveness. However, the extremity of these views varied. For instance, according to Islam, a religion that spread throughout the Middle East and Asia a few centuries after the birth of Christianity, intercourse within marriage is seen as a religious deed and is viewed positively. In fact, it is seen as a higher state than remaining single and celibate, which is quite a departure from the writings of Christian scholars such as St. Paul. Despite promoting a slightly more permissive view in this regard, Muslims are in many ways more restrictive when it comes to gender. For example, in a high proportion of Muslim societies past and present, female modesty in clothing is mandated, and women have very few rights—they may not even be permitted to leave their homes unless accompanied by their husband or a male relative.

Table 1.1 Cross-cultural variations in human sexual behavior.

Sexual behavior with a member of the same sex is controversial in many parts of the world, but is punishable by death in several countries, including Saudi Arabia, Pakistan, Iran, and Afghanistan (ILGA, 2013). Among certain tribes in New Guinea, adolescent boys ingest the semen of older men because it is believed to promote strength and virility (Herdt, 1982). In parts of South Asia, a third gender, hijra, is observed. Hijra consist of biological men who have had their genitalia removed in ritual castration. They are believed to possess special powers (Nanda, 2001). Although kissing is considered a normal sexual behavior in most Western societies, it is viewed as disgusting among the Thonga of South Africa (Gregersen, 1996). In some Asian and African countries, the practice of arranged marriage is relatively common. In such marriages, parents are responsible for selecting their child’s future spouse (Malhotra, 1991).

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Taoism (a belief system with its origins in ancient China) offers another somewhat more per- missive view when it comes to sex. For example, according to Taoist beliefs, sexual intercourse serves to balance the opposing forces of yin and yang, with yin representing female energy and yang representing male energy. Sex is thus held in very high regard, and is seen as serving a number of important functions beyond reproduction. However, this belief system was largely replaced by much more sexually conservative views with the rise of Confucianism about a thousand years ago. As a result of this shift, China continues to hold relatively conservative views of sex to this day.

Of course, religion is not the only cultural force acting upon sexuality. Science and the popu- lar media play very large roles as well. We will discuss the role of science in detail in the next chapter, and the ways in which the emergence of a scientific enterprise devoted exclusively to understanding sexuality has impacted sexual attitudes and behaviors. We will focus here on the role of the media, which in today’s world includes television and movies, songs, advertise- ments, newspapers, magazines, as well as the Internet. Because of the media’s omnipresence in our everyday lives, it has multiple opportunities to affect us in very visual and dramatic ways.

Since its invention, television has gradually come to include more and more sexual content, albeit with a bit of social resistance along the way. Believe it or not, it was once considered con- troversial for a television program to include an interracial couple (such as on the 1970s program The Jeffersons) or a single, pregnant woman who decides to have a baby on her own (such as on the 1990s program Murphy Brown). These things are pretty tame by today’s standards, espe- cially when you consider that programmers are now talking about showing full-frontal nudity and group sex scenes on prime time cable (Strauss, 2010). For a sampling of some of the ways that television shows have pushed the sexual envelope in recent years, see Table 1.2. Of course, televi- sion’s evolution in this regard was not in isolation. Popular songs, music videos, and video games have become more explicit over time as well. Proponents of social learning theory (a topic we will discuss later in this chapter) argue that these sexualized media depictions have contributed to some profound changes in sexual attitudes and behaviors over the past few decades.

However, TVs, radios, and game consoles are not the only forms of media we are exposed to—our computers and phones matter, too, and there is no denying that our constant access to the Internet has forever changed our sex lives. For one thing, a vast selection of sexual informa- tion and pornography is now available for free at the click of a button. Thus, people can readily

Figure 1.1 The ancient Greeks and Romans believed in gods and goddesses devoted to love and sex, such as Aphrodite, from whom aphrodisiacs got their name. ©perseomedusa/123RF.COM.

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1 Theoretical Perspectives on Human Sexuality6

obtain sexually explicit material that they might otherwise be unable to get, and they can avoid potential embarrassment by doing it in the privacy of their own homes. However, the Internet has done much more than that. It has also opened up the world of online dating and hookups, not to mention sexual self-expression through webcams and mobile phones via “cyber sex” and “sexting” (i.e., sending sexually explicit images via text message). Sexting in particular has become very common, but also quite controversial. For example, one study of high school students found that 18.3 % of male students and 17.3% of female students had sexted images of themselves, and about twice as many were the recipients of a sext by others (Strassberg, McKinnon, Sustaita, & Rullo, 2013). Although such photos are often meant for just one other person’s eyes, these images are sometimes circulated publicly after breakups (“revenge porn”), which can create significant distress and embarrassment. In addition, many adolescents fail to realize that it is a criminal act in the United States to take and distribute sexual photos of anyone under the age of 18 (see chapter 15), which means sexting can generate potential legal troubles. We will elaborate on the complex effects of the media on sexual behavior throughout this book when we begin talking about lifespan sexual development, sexual education, risky sexual behavior, and pornography.

Biological and Evolutionary Influences

The other major forces affecting human sexual behavior are biological and evolutionary fac- tors. Before we go on, I should clarify that, on some level, all behavior—sexual and nonsexual— is biologically caused. After all, behavior must be preceded by some pattern of activity inside

Table 1.2 Television shows that have pushed the sexual envelope.

Show title Basic premise Selected sexual content

Californication Tells the story of Hank Moody, a middle-aged novelist who has problems with sex, drugs, and booze.

Hank has a sexual relationship with a 16-year old girl. Hank has a dream about receiving oral sex from a nun in church.

Girls Follows the lives of four millennial women living in New York City.

Marnie receives anilingus from her boyfriend, Desi. Hannah’s middle-aged parents have sex in the shower. Adam ejaculates on his girlfriend Natalia’s chest in a scene that lacks explicit sexual consent.

How to Get Away with Murder

Follows the lives of a law professor in Philadelphia and five of her students.

Several episode feature explicit heterosexual, gay, and bisexual sex scenes. (These scenes were especially controversial because they aired on network TV instead of cable).

The L-Word Follows the lives of several lesbian, bisexual, and transgender women living in Los Angeles, California.

Full-frontal female nudity present in many episodes, along with explicit simulations of various sexual activities between women. Nikki has sex with her girlfriend, Jenny, while wearing a strap-on penis.

Queer as Folk Follows the lives of five gay men living in Pittsburgh, Pennsylvania.

Full-frontal male nudity present in many episodes, along with explicit simulations of oral and anal sex between men. A male high-school student, Justin, carries on a sexual relationship with a significantly older man (Brian).

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the brain. Thus, it is important to be clear regarding what we mean by a “biological influence on behavior” or a “biological cause of behavior.” For purposes of this book, when we refer to biological factors, we will be talking about how things such as a person’s genes or hormone levels might influence how their brain develops or functions. In recent years, genetics has been linked to sexuality in several ways. For instance, research has increasingly shown that homo- sexuality appears to be driven, at least in part, by a variety of hereditary factors, an issue we will return to in chapter 6 (e.g., Dawood, Bailey, & Martin, 2009). Likewise, the gender roles adopted by men and women seem to be influenced by the sex hormones they were exposed to while developing in the womb (Beltz, Swanson, & Berenbaum, 2011). For example, individuals with congenital adrenal hyperplasia (CAH) are exposed to a higher than usual level of “male” sex hormones (i.e., androgens) in utero. As adults, women with CAH tend to have much more stereotypically masculine interests (e.g., technology) than women without CAH. In contrast, when a male fetus is insensitive to “male” sex hormones in utero, a more feminine gender iden- tity and role tend to emerge later in life. Findings such as these demonstrate how biology has the potential to profoundly influence us in ways that we are completely unaware of.

Evolutionary factors have also been proposed to play a role in human sexuality. In making a case for this, researchers have looked at how human sexual behavior compares to that of other animal species. To the extent that our species and others around us evolved from common ances- tors, we should expect to see similarities with other species in the ways we behave sexually. The results of this research suggest that, by and large, there is little that is unique about humans’ sex- ual activities. For instance, same-sex sexual activity has been documented in hundreds of animal species, from fruit flies to flamingos (Bagemihl, 1999). Likewise, oral sex (Tan et al., 2009) and masturbation (Bagemihl, 1999) occur in other species as well. Humans cannot even stake a claim to being the only species that has sex for pleasure, or mates face to face! Thus, although there are certainly major differences in culture, society, intelligence, and communication between us and other species, there are numerous similarities when it comes to our sexual behaviors.

Human sexuality is thus a complex phenomenon with many contributing factors, from the psychological to social to the biological. Although the goal of this text is to primarily provide you with a psychological understanding of sexual attitudes and behaviors, we will also address and acknowledge the important roles played by these other factors.

Figure 1.2 Flamingos are just one of many animal species in which same-sex sexual behavior has been observed. ©smileus/123RF.COM.

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Major Theoretical Perspectives on Human Sexuality

At this point, we will turn our attention to some of the major theoretical perspectives on human sexual behavior. We will focus exclusively on theories put forth by psychologists. However, please be aware that many different theories exist in other fields of study, such as sociology and anthropology; by no means is this a comprehensive list of all possible theories of sexual behavior. In this section, theories will be addressed in approximate chronological order from oldest to newest in order to give you some appreciation of how psychological perspectives have changed over time. As you will see, different psychologists may evaluate a given sexual act in very different terms, depending upon their theoretical orientation. Also, please note that none of these perspectives is necessarily better than any of the others because each provides some unique insight into the diversity of sexual behaviors and attitudes that exist. For a handy sum- mary of the main idea(s) behind each theory, see Table 1.3.

Psychoanalytic Theory

Psychoanalytic theory is the oldest perspective on sexuality in the field and is credited to Sig- mund Freud. Freud believed that human behavior was driven by two factors: sex and death. He termed our sexual and life instincts libido (a term that is still in use today, even outside of the psychoanalytic tradition), and our death instinct, thanatos.

Table 1.3 Summary of the major psychological theories in the study of human sexuality.

Theory Main point(s)

Psychoanalytic theory Personality structure consisting of the id, ego, and superego drives behavior. Sexual “abnormalities” arise when individuals become fixated during one of the psychosexual stages of development.

Classical conditioning Repeated pairing of a neutral stimulus with one that produces a specific behavior will eventually lead the neutral stimulus to elicit the same behavior.

Operant conditioning Reinforced behaviors increase in frequency; punished behaviors decrease. Reinforcement is more effective than punishment.

Social/Observational learning

Behavior can be learned through observation of others (e.g., peers, parents) or through media exposure, including pornography.

Exchange perspectives Exchange of resources is fundamental to social relationships. Behavior is driven by perceived costs and benefits derived from trades occurring between partners.

Personality theories Relatively stable individual traits generate consistent patterns of behavior across situations. Big Five, erotophobia-erotophilia, sensation seeking, and sociosexuality are major personality traits associated with sexual behavior.

Evolutionary theory Human beings are motivated to produce as many of their own offspring as possible. We have evolved preferences for physical and psychological traits and characteristics in sexual partners that promote reproductive success.

Biopsychosocial model Biological, psychological, and social factors interact to produce variations in sexual orientations and behaviors. The mind and body are fundamentally intertwined. Sexual health is not just the absence of biological dysfunction; it runs on a continuum with varying degrees of sexual illness and wellness.

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Freud believed that personality consisted of three distinct parts. First is the id, which is the most basic part of the personality and contains the libido. The id operates according to the pleasure principle, meaning it seeks to obtain gratification and fulfillment of its needs. Second is the ego, which exists to keep a check on the id. The ego operates under the reality principle, meaning it tries to satisfy the id’s desires in a way that is rational and avoids self-destruction. The last portion of personality is the superego, which can be thought of as our conscience. The superego tries to persuade the ego to do not what is realistic, but what is moral.

These personality aspects work together to produce behavior across all situations, sexual and otherwise. To consider just one example, imagine that you meet a friend’s spouse for the first time and find that person to be very attractive. Your id would probably be telling you to ignore the poten- tial consequences of acting upon your attraction and start flirting right now. At the same time, your ego would probably step in and tell you to wait until your friend goes to the bathroom so as to avoid starting a fight. However, the superego would ultimately chime in and tell you to forget about the whole thing because you do not want to hurt your friend or become a “home-wrecker.”

In addition to this personality structure, Freud proposed an elaborate theory of psychosexual development. The basic idea is that all children pass through a series of five stages in which different parts of the body serve as a source of pleasure: oral, anal, phallic, latent, and genital. To the extent that a child does not pass through all of the stages in their expected order, that child can become “fixated,” which leads to a lifelong urge to gratify the relevant body part from that stage (e.g., someone fixated in the oral stage might wind up constantly chewing on pens or fingernails as an adult). Perhaps the most well-known aspect of Freud’s psychosexual theory was the notion of the Oedipus complex in boys (i.e., sexual desire for one’s mother and hatred for one’s father), as well as penis envy and the Electra complex in girls (i.e., psychological trau- matization due to either the lack of a penis or sexual desire for one’s father, respectively).

Figure 1.3 Freud made numerous contributions to the study of sexuality from a psychological perspective, including his theorized personality structure consisting of the id, ego, and superego. ©basphoto/123RF.COM.

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Although certain aspects of Freudian theory are fascinating and provocative, it has long since been rejected, on numerous grounds. For one thing, much of what Freud proposed could not be tested scientifically because most of his work was based on case reports of his clinical patients (we will discuss the limitations of this research method in detail in chapter 2). Also, if you have ever taken a course on the psychology of gender, you are probably well aware that many of Freud’s theories and writings smack of sexism, especially the idea of penis envy, which suggests that women will always be “incomplete” because they lack penises. In addition, consider that Freud frequently argued that women who reach orgasm through clitoral stimulation are not as “mature” as women who can reach orgasm through vaginal intercourse alone. There is no rational or scientific basis for such a claim. Despite the obvious biases and problems inherent in Freud’s work, we still owe a great debt to him for getting the field of psychology to recognize the importance of studying sexuality.

Cognitive-Behavioral and Learning Theories

Psychoanalytic theory and its emphasis on unconscious factors that influence behavior fell out of favor with psychologists in the early part of the twentieth century, when a new school of thought known as behaviorism emerged. The focus shifted from studying the unknowable unconscious to an empirical investigation of overt behavior. Initially, most behaviorists adopted a rather extreme view that it was impossible to scientifically measure mental processes, thereby leaving observable behavior as psychologists’ only unit of analysis. However, the field later backed away from this radical view, and began to acknowledge and addresses the vital role that cognitive processes play in producing behavior. Central to the behaviorism movement was the idea that behaviors are learned from experience. Also, through this learning process, appropriate behaviors can come to replace previously learned behaviors that are ineffective or maladaptive. The major types of learning that emerged from this movement were classical con- ditioning, operant conditioning, and social (observational) learning. Each of these perspectives is still relevant to psychologists’ understanding of sexual attitudes and behaviors today and you will see them referenced repeatedly throughout this book.

Classical Conditioning The first and perhaps most well-known learning theory that emerged from behaviorism is clas- sical conditioning. Every student of psychology is familiar with Pavlov’s (1927) famous experi- ments in which he was able to induce salivation in dogs by the simple ringing of a bell. Pavlov accomplished this by repeatedly pairing the bell with the presentation of meat powder. To dem- onstrate its applicability to human sexuality, we will walk through the steps involved in classical conditioning with a relevant example. First, we must identify a specific stimulus that produces a specific behavior. For example, when someone’s genitals are gently touched or stroked, it will typically produce sexual arousal. Next, the original stimulus must be paired with a new stimu- lus that does not cause that same behavior. For instance, dirty talk (e.g., “Let me be your per- sonal sex toy. Use me any way you want tonight!”) is something that is not inherently sexually arousing to everyone. So let us imagine that while someone’s genitals are being touched, that person’s partner starts talking dirty. If these two stimuli are paired together frequently enough, each one will eventually be capable of eliciting the same behavior independently. Thus, in our example, both genital touching and dirty talk will eventually lead that person to experience sexual arousal, even in cases where dirty talk is not accompanied by any genital touch. Classi- cal conditioning has been implicated as one of the major psychological roots of many sexual behaviors, including fetishes (an issue we will return to in chapter 14). Conditioning of this nature can also be useful in the treatment of sexual difficulties (see chapter 13).

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Operant Conditioning Of course, classical conditioning is limited in that it cannot provide a complete understand- ing of all behavior, sexual or otherwise. Not every behavior is cued by a stimulus that appears immediately before it. Psychologists quickly recognized the need to explore other types of learning and the result was operant conditioning, initially proposed by B.F. Skinner (1938). The main idea behind operant conditioning is that when behaviors are reinforced (i.e., when they are rewarded or lead to pleasurable consequences), they tend to be repeated; in contrast, when behaviors are punished (i.e., when the consequences are unpleasant or undesirable), they tend to occur with less frequency. In order for this form of learning to occur, the reinforcement/ punishment must follow the behavior immediately and consistently, otherwise the association will not be learned. As a general rule, reinforcements are generally more effective than punish- ments in shaping behavior.

Operant conditioning is very applicable to the study of sex because sex is not only a behavior than can be increased or decreased through reinforcement and punishment, but sex is also a reinforcing variable that can increase or decrease the frequency of other, nonsexual behaviors. Demonstrating the former role, people who typically experience pleasurable consequences from sex (e.g., bonding with or getting closer to a partner) will likely have sex more frequently; those who find sex to be punishing (e.g., because of pain or embarrassment caused by a sexual dysfunction) will likely have sex with less frequency. Demonstrating the latter role, an individ- ual may use sex as a way of reinforcing desirable behaviors in a partner, such as enticing some- one to do more housework with the prospect of a having sex more often. Incidentally, research has found that people who do more housework have sex more frequently, so there might be something to this idea (Gager & Yabiku, 2010)! For more on the use of operant conditioning as applied to sexual behavior, see the Digging Deeper 1.1 box.

Social/Observational Learning Operant conditioning is incapable of providing a complete understanding of human behavior because some of our behaviors develop independently of direct reinforcement and punishment.

Figure 1.4 Pairing dirty talk or other stimuli with sexual activity may lead those stimuli to become sexually arousing in and of themselves. ©Vojtech VIK/123RF.COM.

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Digging Deeper 1.1 Can You Change Someone’s Sexual Orientation through Operant Conditioning?

A small number of therapists have attempted to use operant conditioning principles to change the sexuality of some of their clients from homosexual to heterosexual through a controversial process known as reparative therapy (also known as conversion therapy). This is often per- formed by having the therapist subject clients to physical punishment upon their exposure to homoerotic stimuli (note that the use of punishments to change behavior is sometimes referred to as aversive conditioning). For example, the therapist might present a gay or lesbian client with erotic photos of members of the same sex and pair that with electric shocks to the genitals. Alter- natively, a therapist might ask a client to wear a rubber band on the wrist all day long and snap it every time the client has a sexual thought about a member of the same sex. Are such “treat- ments” effective at changing someone’s sexuality?

There is no scientific evidence published in reputable, peer-reviewed journals indicating that reparative therapy works. In fact, the weight of the published research suggests that it is psycho- logically harmful to those who undergo this treatment (Halderman, 2003). The use of condition- ing principles to change one’s sexual orientation is not even warranted in the first place, given that homosexuality is not a psychological disorder. A listing for homosexuality is not included in either the iagnostic and Statistical anual of ental isorders (DSM-5) or the International Statis- tical Classification of iseases and Related Health Problems (ICD), both of which are considered the definitive guides for diagnosing psychological disorders. In addition, the American Psychologi- cal Association, the American Psychiatric Association, and the World Health Organization have long held the position that homosexuality is not a disorder. Thus, reparative therapy is perhaps the most prominent example of the misuse and abuse of psychological theory in the context of sexuality.

Figure 1.5 There is no reliable evidence that therapies designed to change patients’ sexual orientation actually work. In fact, the evidence suggests that they may do more harm than good. ©milosb/123RF.COM.

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The perspective of those who adopt a social or observational learning approach is that some behavioral tendencies are acquired through simple observation of others’ activities. If we see others rewarded for engaging in certain behaviors, we tend to imitate them; if we see others experience negative outcomes as a result of engaging in certain behaviors, we typically avoid those behaviors.

Perhaps the most well-known example of social learning in the field of psychology is Albert Bandura’s classic Bobo doll experiments (Bandura, Ross, & Ross, 1962). In these studies, Ban- dura and his research associates examined how exposure to violent media affects children’s aggressive tendencies. What they found was that children who watched a video of an adult act- ing aggressively toward an inflatable Bobo doll (e.g., hitting it with a hammer, throwing it across the room) ended up terrorizing the Bobo doll when given an opportunity; kids who watched a control video of an adult sitting quietly exhibited far less aggression toward the Bobo doll.

The social learning perspective has obvious and important implications for the development of sexual behavior. For example, if high school students see others receive a popularity boost for becoming sexually active, those students may become inclined to do the same. This per- spective also speaks to the especially powerful role that the media and pornography can have on our sexuality. The sexual depictions that appear in popular music, films, television shows, advertisements, and the Internet may shape our views of what is and is not appropriate sexual behavior. To the extent that the media depicts positive sexual role models (e.g., people who practice safe sex and communicate about their sexual history), this is not inherently bad. How- ever, if the media depicts poor sexual examples (e.g., people who have multiple sexual partners and fail to use or even discuss protection), this can be incredibly dangerous. As it turns out, most media depictions of sex portray it in quite risky and unrealistic terms. For example, an analysis of sexual content in the most popular movies released between 1983 and 2003 found that most sex acts depicted (70%) occurred among people who had just met (Gunasekera, Chapman, & Campbell, 2005). Moreover, almost every scene (98%) failed to address the topic

Figure 1.6 Both adolescents and adults imitate the activities they see depicted in sexually explicit material. ©wrangel/123RF.COM.

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of contraception, and virtually none of these sexual acts resulted in negative consequences (e.g., unintended pregnancies, STIs, etc.). Given these findings, it is perhaps not surprising that longitudinal research has revealed that the more sexual content adolescents are exposed to in popular films, the earlier they start having sex, the more sexual partners they accumulate, and the less likely they are to practice safe sex (O’Hara et al., 2012). Of course, the media is not the sole contributing factor, and other explanations are possible for these effects, such as a lack of parental supervision and involvement (for more on the limitations of correlational research, see chapter 2).

A related concern is that a growing number of adolescents are turning to pornography to determine what “normal” sexual behavior is because they are not getting this information any- where else (Bowater, 2011). However, there is nothing “normal” about what is depicted in most pornography. Not only do most porn actors and actresses have very atypical bodies (some- times from extreme dieting and/or plastic surgery), but their sexual activities and practices do not necessarily mirror reality either (we will return to this issue in chapter 15 when we cover pornography in greater detail). Thus, there are potential dangers in having porn serve as one’s primary source of sex education and social comparison.

Despite their inherent value and intuitive appeal, none of the learning theories discussed above tell us the entire story when it comes to sexual behavior. For example, these theories have been criticized for being oversimplified and depersonalized (i.e., they do not take into account idiosyncratic features of the individual, such as personality or mood states), and for failing to address important biological and hormonal influences on behavior.

Exchange Theories

Exchange theories offer another psychological explanation of human behavior, and primar- ily help us to understand how social relationships are formed, maintained, and terminated. Specifically, the main idea advanced by the social exchange perspective is that the way we feel about a given relationship and behave toward our partner depends upon the type of outcomes we receive in return for what we have put into the relationship (Homans, 1961; Thibaut & Kelley, 1959). Thus, relationships are fundamentally about exchanges between the parties involved, and those trades can involve sex, money, time, or anything else you can think of. When our exchanges yield high rewards and low costs, we act so as to maintain our relationship; however, when the costs begin to exceed the benefits, we are likely to end things and move on.

To determine whether our outcomes are good, we hold them up to some comparison level (i.e., the standard by which we judge our relationships). For example, we may compare the outcomes we are receiving in our current relationship to those that we received in the past. What we are looking for is a cost-benefit ratio that is favorable relative to our comparison level. Whether the ratio is perceived as favorable depends largely upon whether the exchange is equi- table, or whether the distribution of outcomes is fair (Walster, Walster, & Berscheid, 1978). In other words, are you getting what you think you deserve?

Social exchange theorists have proposed that sex is a fairly common resource traded in het- erosexual relationships, with women more likely to be the “sellers” and men more likely to be the “buyers” of it (Baumeister & Vohs, 2004). The theory is that female sexuality has much more “value” than male sexuality, thereby enabling women to obtain more resources in exchange for sex than men. Female sexuality is more valuable because it is in demand, given that there are lots of men who are interested in and are looking for sex at any given time. Also, because women are less interested in having casual sex with multiple partners than are men, female

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sexuality is in limited supply. Several research findings lend support to this proposition. First, and perhaps most obvious, prostitution is a more common and profitable activity for women. Second, women are significantly more likely to view their virginity as a “gift” that is given to someone special than are men (by contrast, men tend to see their virginity as something stig- matizing that they need to get rid of; Carpenter, 2001). However, none of this should be taken to mean that all or even most women go around trading their bodies to the highest bidder! The point of this theory is simply to suggest that in cases where sex is traded in a heterosexual social exchange, it is more likely to be offered by a woman than it is by a man.

The social exchange view of relationships and sexuality has its own problems, of course. For one thing, not all relationship behavior is motivated by a perceived cost–benefit analysis—sometimes people act altruistically, seeking to help another person without expecting anything in return. In fact, research indicates that willingness to sacrifice one’s own self-interest for the sake of one’s partner is a sign of a very healthy and high-functioning relationship (Van Lange et al., 1997).

Personality Theories

After the rejection of psychoanalytic theory, most psychological research focused solely on the study of behavior, because it was both observable and measurable. However, this emphasis on behavior gradually subsided and cognitive process started coming back into favor, which can be seen happening in both the social learning and exchange perspectives. This ultimately paved the way for a rebirth of personality psychology, or the study of relatively stable, intra- psychic factors that generate consistent patterns of behavior. In other words, personality refers to something enduring that resides within an individual, which leads that person to respond to specific stimuli in a certain way. In developing and validating these theories of personality, psy- chologists moved away from clinical case reports (the basis for Freud’s work) and began apply- ing the scientific method. Over the years, psychologists have identified numerous personality factors that are important for understanding sexuality.

For example, if you have taken other psychology courses, you have probably learned about the Big Five personality factors (McCrae & Costa, 1987). The idea behind the Big Five is that we can gain a reasonably good understanding of an individual’s personality by looking at that person’s standing on five distinct factors: openness to experience, conscientiousness, extraver- sion, agreeableness, and neuroticism. For a brief definition of each of these traits and how they relate to sexual behavior, see Table 1.4. Of the five factors, extraversion and agreeableness have been the most consistently related to sexual behavior.

Beyond the Big Five, research has uncovered a number of additional personality traits that have implications for sexual behavior. For example, erotophilia and erotophobia refer to two ends of a personality continuum that comprises how individuals approach sex (Fisher, White, Byrne, & Kelley, 1988). Erotophilia refers to a tendency to exhibit strong, positive emotions and attitudes toward sex; erotophobia refers to a tendency to exhibit strong, negative emo- tions and attitudes toward sex. For example, someone who scores high on the trait of erot- ophilia would likely agree with statements such as “engaging in group sex is an entertaining idea,” and “masturbation can be an exciting experience.” In contrast, people who score high on erotophobia would likely agree with statements such as “if people thought I was inter- ested in oral sex, I would be embarrassed,” and “it would be emotionally upsetting to me to see someone exposing themselves publicly” (all of these statements are items on the actual Erotophilia–Erotophobia scale). These personality traits may have important implications for sexual behavior. For example, among women, greater erotophobia is linked to less sexual

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satisfaction (Hurlbert, Apt, & Rabehl, 1993) and less consistent contraception use (Kelly, Sme- aton, Byrne, Przybyla, & Fisher, 1987). To see where you fall on the dimensions of erotophilia and erotophobia, check out the Your Sexuality 1.1 box.

Another personality trait relevant to sexual behavior is sensation seeking, which refers to a tendency to pursue thrilling and risky activities (Zuckerman, Eysenck, & Eysenck, 1978). Some research has suggested a biological basis for this trait, such that sensation seekers look for excitement as a means of compensating for lower levels of certain brain chemicals, with the prime candidate being the neurotransmitter dopamine (Geen, 1997). Dopamine is part of the brain’s “reward pathway,” meaning that release of this chemical makes us feel good. Persons who are less sensitive to the effects of dopamine may need to continually engage in thrilling activities in order to achieve the same psychological “highs” as everyone else. Con- sistent with this idea, research has found that a specific variation of the dopamine D4 recep- tor gene that leaves individuals with fewer dopamine receptors is linked to engaging in a variety of sensation-seeking behaviors, such as taking financial risks, substance use, and com- mitting infidelity (Garcia et al., 2010). More generally, research has consistently found that sensation seekers tend to take a lot of sexual risks, including having much larger numbers

Table 1.4 The big five personality traits and their association with sexual behavior.

Personality trait Definition (McCrae & Costa, 1987) Noted relations to sexual behavior

Openness to experience

Desire for new and varied experiences. Inventive and curious.

High openness is related to lower sexual anxiety (Heaven et al., 2003). Most other studies have failed to find an association between openness and sexual behavior.

Conscientiousness Dependable and responsible. Self-disciplined. Tendency to plan behavior rather than act spontaneously.

Low conscientiousness is linked to having unprotected sex (Hoyle, Fefjar, & Miller, 2000) and combining alcohol and drugs with sex (Miller et al., 2004).

Agreeableness Caring and compassionate about other people. Generally friendly and helpful.

Low agreeableness is linked to having casual sex with someone other than one’s romantic partner and combining drugs and alcohol with sex (Hoyle, Fefjar, & Miller, 2000; Miller et al., 2004) Both high and low levels of interpersonal warmth are linked to having more sexual partners (Markey & Markey, 2007).

Extraversion Desire to interact with other people. Self-confident and sociable.

High extraversion is linked to having more sexual partners (Miller et al., 2004; Schenk & Pfrang, 1986) and sexual risk taking (Turchik et al., 2010). Interpersonal assertiveness and dominance are linked to having more sexual partners (Markey and Markey, 2007).

Neuroticism Characterized by feelings of anxiety and insecurity. Emotional instability.

High neuroticism is linked to risky and unprotected sex (Trobst et al., 2002). Most other studies have shown no relation to sexual behavior.

Note: Research on the association between the Big Five personality factors and sexual behavior has not produced entirely consistent results across studies, particularly in the cases of openness to experience and neuroticism. Thus, caution is warranted in drawing too many conclusions about the role of these two personality traits in sexual behavior.

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of sexual partners and a greater frequency of unprotected sex (Gullette & Lyons, 2005). Per- haps as a result, sensation seekers also tend to contract more STIs (Ripa, Hansen, Mortensen, Sanders, & Reinisch, 2001).

One other personality trait that is particularly relevant here is sociosexuality, which refers to a person’s willingness to have sex in the absence of commitment and without an emotional connection to one’s partner (Gangestad & Simpson, 1990). Persons with what is known as a restricted sociosexual orientation require feelings of closeness to a partner before having sex and tend to seek out more long-term relationships (e.g., they would agree with statements such as “I would have to be closely attached to someone before I could feel comfortable and fully enjoy having sex”); in contrast, persons with an unrestricted sociosexual orientation do not need to establish such an emotional connection first and tend to seek more short-term rela- tionships (e.g., they would agree with statements such as “sex without love is OK”; Simpson & Gangestad, 1991). The more unrestricted a person’s sociosexual orientation is, the more fre- quently they have sex and the more sexual partners they report. In addition, research has found that having an unrestricted orientation is linked to greater impulsivity, as well as a higher like- lihood of having unprotected sex (Seal & Agostinelli, 1994). On a side note, popular media portrayals might lead one to assume that there is a huge difference between men and women in sociosexuality, with men tending toward unrestricted and women tending toward restricted. While there is a hint of truth to this, it is important to note that there is far more variability within the sexes than between them (Simpson & Gangestad, 1991). What this means is that whereas men are more interested in casual sex on average, this is not true for all men. It also means that there are some women who are more interested in casual sex than some men. This is but one of many reminders throughout this book that it is not wise to assume anyone’s sexual interests and practices based solely upon their sexual or gender identity.

Your Sexuality 1.1 Are You Erotophilic or Erotophobic?

Below is a subset of items from the erotophilia–erotophobia scale. Please indicate how much you agree with each statement on a scale ranging from 1 (strongly disagree) to 7 (strongly agree).

1) I think it would be very entertaining to look at hardcore pornography. 2) Pornography is obviously filthy and people should not try to describe it as anything else. 3) Masturbation can be an exciting experience. 4) If people thought I was interested in oral sex, I would be embarrassed. 5) Engaging in group sex is an entertaining idea. 6) Almost all pornographic material is nauseating. 7) It would be emotionally upsetting to me to see someone exposing themselves publicly. 8) Touching my genitals would probably be an arousing experience. 9) I do not enjoy daydreaming about sexual matters.

10) Swimming in the nude with someone else would be an exciting experience.

Add up your scores for items 1, 3, 5, 8, and 10 (erotophilic items). Then add up your scores for items 2, 4, 6, 7, and 9 (erotophobic items). Which of the two scores is higher? Is there a big differ- ence between them? Are your scores consistent with how you view your own sexuality? Please note that there are no correct or incorrect answers to any of these questions. It is not necessarily “better” to be erotophilic or erotophobic.

Note: Adapted from Fisher et al. (1988). The wording of some items has been modified from the original scale and scoring criteria have changed to fit the abbreviated version presented here.

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The personality perspective is appealing to many psychologists who study sexual behavior, but it has its own limitations. For one thing, some of the scales used to measure personal- ity appear to measure attitudes more than enduring traits or characteristics (e.g., erotphilia– erotophobia). This calls into question whether we are measuring personality or something else (e.g., learned associations based upon past experience). In addition, it seems to be the case that some personality effects may be accounted for by genetics (e.g., consider our discussion of the role of the D4 receptor gene in sensation seeking; Garcia et al., 2010). Thus, is the key factor here really one’s personality or one’s biological makeup?

Evolutionary Theory

One of the more recent theoretical developments applicable to the study of human sexuality comes from evolutionary psychology. The idea of evolution itself is certainly not new (Dar- win’s On the Origin of Species was originally published in 1859), but the study of psychologi- cal traits as evolved adaptions has only become a major area of research in the past three or four decades. Because evolution-based studies of human sexuality have undergone explosive growth in recent years, evolutionary psychology will be covered extensively in this book. At this point, however, we will simply summarize some of the major highlights and findings of this theoretical perspective.

One of the main ideas promoted by evolutionary psychologists is that human beings have an inherent motivation to produce as many of their own offspring as possible. To assist us in achieving this goal, it is thought that we have gradually developed preferences for specific physical and psychological characteristics in our romantic and sexual partners that are likely to result in successful reproduction. In other words, the reason you find certain traits to be attractive and “sexy” in another person may be a result of thousands of years of selection pres- sures pushing humans to gravitate toward partners who are genetically fit and who are likely to have the best reproductive potential. For example, heterosexual men today tend to be attracted to young, “hourglass”-shaped women with long, silky hair (Hinsz, Matz, & Patience, 2001;

Figure 1.7 Sensation seekers tend to engage in activities that bring more thrills and excitement, such as seeking multiple partners, perhaps because their brains require greater stimulation in order to feel pleasure. ©altafulla, 2013. Used under license from Shutterstock.com.

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aaorTheoreticalPerspectivesonHumanSexuality 19

Singh, 1993). Each of the characteristics signifies a woman who is healthy and capable of hav- ing children. Specifically, younger women are more fertile, women with “hourglass” figures face fewer risks during childbirth, and long, silky hair indicates good physical health. It is theorized that our early ancestors recognized the reproductive value associated with such traits (either consciously or unconsciously) and developed preferences for them, thereby laying the seeds for what we in the modern era deem attractive.

Another key component of evolutionary psychology is the idea that men and women have developed different approaches to mating. From the perspective of sexual strategies theory (Buss & Schmitt, 1993), these differences evolved because the parental investment required to produce a child (i.e., the amount of time and bodily effort expended) differs across the sexes. Specifically, the investment required by men to make a baby is relatively small. In fact, some of them can do their part in under a minute. As a result, in order to maximize their chances of reproductive success, it is in men’s best interest to pursue sexual activity with a lot of fertile women. This could help to explain modern man’s well-documented desire for many sexual partners and his disproportionate attention to physical appearance. In contrast, the invest- ment required to make a baby is huge for women—pregnancy lasts nine months and after that, the child needs to be taken care of until it is self-sufficient. Thus, to maximize reproductive success, it is in women’s best interests to look for men who are going to stick around and pro- vide the resources necessary to help raise any children conceived. This may explain modern woman’s well-documented tendency to desire reliable men with high social status and good jobs. Numerous studies have found support for these sex differences in mating preferences (e.g., Okami & Shackelford, 2001).

While fascinating and heavily researched, the evolutionary perspective is not free of prob- lems or controversy. For example, evolutionary psychology has always struggled to explain why

Figure 1.8 Evolutionary theory posits that heterosexual men are attracted to women whose bodies are shaped like an hourglass and who have long, silky hair because these are signs of good health and fertility. ©domenicogelermo/123RF.COM.

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1 Theoretical Perspectives on Human Sexuality20

variations in sexual orientation exist. If human beings are inherently motivated to reproduce, why would anyone be anything other than heterosexual? Additionally, recent research sug- gests that many of the noted sex differences in attraction and mating preferences have been overstated and that some of these differences can be reduced in size or eliminated completely when certain social factors are taken into account, such as the fact that women are judged more harshly than men for being sexually active (Conley, Moors, Matsick, Ziegler, & Valentine, 2011). Finally, some have argued that evolution-based interpretations of human sexuality are fun- damentally flawed and that modern mating preferences have little, and perhaps nothing, to do with parental investment and an inherently “selfish” drive to propagate one’s genes (Ryan & Jetha, 2010). We will consider these critiques in more detail in chapter 7.

The Perspective of This Text

As you probably noticed above, psychological theories of sexuality largely fall into one of two camps (DeLamater & Hyde, 1998). On the one hand, we have so-called “essentialist” theories, which view sexuality as an essential aspect of humans, rooted in evolution and biology. Such theories look to factors including hormones, genetics, evolved processes, or innate characteristics for the answers to their questions. On the other hand, we have so- called “social constructionist” theories, which view sexuality largely as a product of sociali- zation and cultural influences. Such theories argue that our sexuality is not “hardwired” and, instead, is largely learned.

My perspective is that taking a singular approach to the study of sexuality would be both misleading and unfulfilling. It is clear that human sexuality is determined by multiple factors. In addition, despite a vast range of theories designed to explain our sexual attitudes and behav- iors, each one offers only a partial explanation at best. In order to address this issue and to create a unifying theme and perspective to organize the remainder of this book, we will adopt a biopsychosocial perspective.

If you have ever taken a course in health psychology, you are probably familiar with the biopsy- chosocial model, which proposes that one’s health status is the result of a complex interaction of biological, psychological, and social factors (Engel, 1977). For example, a health psychologist might view coronary heart disease as the product of not just biological (e.g., cholesterol and blood pressure levels) and genetic factors (e.g., family history of heart problems), but also psychological traits (e.g., Type A personality pattern) and social variables (e.g., occupational and marital stress). The objective of this textbook is to view sexual health and behavior through a similar lens. For instance, if we want to understand why a given woman has difficulty reaching orgasm, we need to consider possible explanations at the biological (e.g., is intercourse painful due to the presence of a sexually transmitted infection or a lack of lubrication?), psychological (e.g., is she depressed or under a lot of stress?), and social levels (e.g., is there a lot of conflict in her relationship?).

Although the biopsychosocial approach is not often discussed in relation to sexuality, it is extremely applicable to this area. As discussed at length earlier, sexual behavior is a conse- quence of multiple disparate forces acting upon a person. Some of these forces are internal and specific to the individual, whereas others are broad, external factors that affect everyone in a given culture or society. Moreover, some of these factors are under our complete conscious control, while we are victims of circumstance to others. Some of these factors are certainly more important than others in helping us to understand human sexuality, and the relative importance of these factors can vary considerably across individuals and across the lifespan. However, the biopsychosocial perspective acknowledges this complexity and allows us to look

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ThePerspectiveofThisText 21

at sexuality as a product of the whole person, with the mind and body being fundamentally and intimately interconnected.

One unique advantage of adopting a biopsychosocial perspective is that it allows us to put sexual health on a continuum, running from wellness to illness (just as health psychologists do with the more general concept of “health”). Thus, rather than seeing sexual health as simply the absence of disease or dysfunction, we can view it as having different degrees of wellness and illness. Individuals may move back and forth on this continuum from exhibiting healthy to unhealthy sexual behavior depending upon the unique biological, psychological, and social forces acting upon them at the time. For instance, imagine that someone were to experience an episode of clinical depression. The resulting emotional state and lack of energy might seriously undermine that person’s sex life, pushing them toward the unhealthy end of the continuum. However, after undergoing treatment and making some major life changes, the patient’s sex life might improve back to the point that it was before and possibly even exceed the previous level. The strength of looking at sexuality on such a continuum is that it offers a much more holistic approach where we consider the entire person, rather than just looking for a specific sexual problem. Thus, having an optimum state of sexual health is a function of possessing physical, psychological, and social well-being—it is so much more than just being free of physical dys- function and disease.

Another important implication of this model and its focus on the mind–body connection is that psychology can be viewed not only as a factor that causes or drives sexual behavior, but also as a product of sexual behavior. In other words, not only do our emotions, cognitions, and behaviors affect our sex lives, but our sex lives have a direct impact on our psychology.

Throughout the remainder of this book, we will consider sexuality from a biopsychosocial perspective. However, because this is inherently a psychological textbook, psychology will have a more prominent, front and center role than some of the other factors. This will allow you to see how the study of sex is approached in the field of psychology and understand how the mate- rial connects to other psychology courses, while still acknowledging the irreducible complexity of human sexuality.

Biology Genetics and evolution, prenatal environment, hormones, puberty,

menopause, substances

Psychology Personality, attitudes, learning and memory, mood and emotions

Sexual Health

Social Culture, religion, media, relationships, education, socio-economic status

Figure 1.9 The biopsychosocial model as applied to sexual health.

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1 Theoretical Perspectives on Human Sexuality22

Key Terms

incest pederasty libido id ego superego classical conditioning operant conditioning

reparative therapy social or observational

learning comparison level exchange theories personality psychology big five erotophilia

erotophobia sensation seeking sociosexuality evolutionary psychology sexual strategies theory biopsychosocial

perspective

Discussion Questions: What is Your Perspective on Sex?

● We know that biological, psychological, and social factors all contribute to human sexual behavior; however, do you see one of these factors as being relatively more important than the others? Why?

● Does sexual content in television and film truly affect people’s sexual behavior, or does it simply reflect contemporary sexual practices?

● Some research has suggested that as gender equality has increased, men’s and women’s mat- ing preferences have become more similar. What does this mean for our understanding of evolution-based accounts of human sexuality?

References

Bagemihl, B. (1999). Biological exuberance: Animal homosexuality and natural diversity. New York: St. Martin’s Press.

Bandura, A., Ross, D., & Ross, S. A. (1961). Transmission of aggression through imitation of aggressive models. Journal of Abnormal and Social Psychology, 63, 575–582. doi:10.1037/ h0045925

Baumeister, R. F., & Vohs, K. D. (2004). Sexual economics: Sex as female resource for social exchange in heterosexual interactions. Personality and Social Psychology Review, 8, 339–363. doi:10.1207/s15327957pspr0804_2

Beltz, A. M., Swanson, J. L., & Berenbaum, S. A. (2011). Gendered occupational interests: Prenatal androgen effects on psychological orientation to Things versus People. Hormones and Behavior, 60, 313–317. doi:10.1016/j.yhbeh.2011.06.002

Boswell, J. (1980). Christianity, social tolerance, and homosexuality: Gay people in Western Europe from the beginning of the Christian era to the fourteenth century. Chicago: The University of Chicago Press.

Bowater, D. (2011). Pornography is replacing sex education. The Daily Telegraph. Retrieved from http://www.telegraph.co.uk/education/educationnews/8961010/Pornography-is-replacing-sex- education. html (accessed August 16, 2013).

Buss, D. M., & Schmitt, D. P. (1993). Sexual strategies theory: A contextual evolutionary analysis of human mating. Psychological Review, 100, 204–232. doi:10.1037/0033-295X.100.2.204

Carpenter, L. M. (2001). The ambiguity of “having sex”: The subjective experience of virginity loss in the United States. Journal of Sex Research, 38, 127–140. doi:10.1080/00224490109552080

Conley, T. D., Moors, A. C., Matsick, J. L., Ziegler, A., & Valentine, B. A. (2011). Women, men, and the bedroom: Methodological and conceptual insights that narrow, reframe, and eliminate

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http://www.telegraph.co.uk/education/educationnews/8961010/Pornography-is-replacing-sex-education.html

References 23

gender differences in sexuality. Current Directions in Psychological Science, 20, 296–300. doi:10.1177/0963721411418467

Dawood, K., Bailey, J. M., & Martin, N. G. (2009). Genetic and environmental influences on sexual orientation. In Y. Kim (Ed.), Handbook of behavioral genetics (pp. 269–280). New York: Springer.

DeLamater, J. (1987). A sociological perspective. In J.H. Geer & W.T. O’Donohue (Eds.), Theories of human sexuality (pp. 237–256). New York: Plenum.

DeLamater, J. D., & Hyde, J. S. (1998). Essentialism vs. social constructionism in the study of human sexuality. Journal of Sex Research, 35, 10–18. doi:10.1080/00224499809551913

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136. doi:10.1126/science.847460.

Fisher, W. A., White, L. A., Byrne, D., & Kelley K. (1988). Erotophobia–erotophilia as a dimension of personality. Journal of Sex Research, 25, 123–151. doi:10.1080/00224498809551448

Gager, C. T., & Yabiku, S. T. (2010). Who has the time? The relationship between household labor time and sexual frequency. Journal of Family Issues, 31, 135–163. doi:10.1177/01925 13X09348753

Gangestad, S. W., & Simpson, J. A. (1990). Toward an evolutionary history of female sociosexual variation. Journal of Personality, 58, 69–96. doi:10.1111/j.1467-6494.1990.tb00908.x

Garcia, J. R., MacKillop, J., Aller, E. L., Merriwether, A. M., Wilson, D. S., & Lum, J. K. (2010). Associations between dopamine D4 receptor gene variation with both infidelity and sexual promiscuity. PLoS ONE 5(11): e14162. doi:10.1371/journal.pone.0014162

Geen, R. G. (1997). Psychophysiological approaches to personality. In J. Hogan, J. Johnson, & S. Briggs (Eds.), Handbook of personality psychology (pp. 387–416). San Diego, CA: Academic Press.

Gregersen, E. (1996). The world of human sexuality: Behaviors, customs, and beliefs. New York: Irvington.

Gullette, D. L., & Lyons, M. A. (2005). Sexual sensation seeking, compulsivity, and HIV risk behaviors in college students. Journal of Community Health Nursing, 22, 47–60. doi:10.1207/ s15327655jchn2201_5

Gunasekera, H., Chapman, S., & Campbell, S. (2005). Sex and drugs in popular movies: An analysis of the top 200 films. Journal of the Royal Society of Medicine, 98, 464–470.

Halderman, D. C. (2003). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33, 260–264. doi:10.1037//0735-7028.33.3.260

Heaven, P. C. L., Crocker, D., Edwards, B., Preston, N., Ward, R., & Woodbridge, N. (2003). Personality and sex. Personality and Individual Differences, 35, 411–419. doi:10.1016/S0191- 8869(02)00203-9

Herdt, G. H. (1982). Rituals of manhood: Male initiation in Papua New Guinea. Berkeley: University of California Press.

Hinsz, V. B., Matz, D. C., & Patience, R. A. (2001). Does women’s hair signal reproductive potential? Journal of Experimental Social Psychology, 37, 166–172. doi:10.1006/jesp.2000.1450

Homans, G. C. (1961). Social behavior and its elementary forms. New York: Harcourt, Brace, and World.

Hoyle, R. H., Fejfar, M. C., & Miller, J. D. (2000). Personality and sexual risk taking: A quantitative review. Journal of Personality, 68, 1203–1231. doi:10.1111/1467-6494.00132

Hurlbert, D. F., Apt, C., & Rabehl, S. M. (1993). Key variables to understanding female sexual satisfaction: An examination of women in nondistressed marriages. Journal of Sex & Marital Therapy, 19, 154–165. doi:10.1080/00926239308404899

ILGA (2013). Lesbian and Gay Rights in the World. Retrieved from http://old.ilga.org/ Statehomophobia/ILGA_map_2013_A4.pdf (accessed September 2, 2013).

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://old.ilga.org/Statehomophobia/ILGA_map_2013_A4.pdf

1 Theoretical Perspectives on Human Sexuality24

Kelley, K., Smeaton, G., Byrne, D., Przybyla, D. P. J., & Fisher, W. A. (1987). Sexual attitudes and contraception among females across five college samples. Human Relations, 40, 237–253. doi:10.1177/001872678704000404.

Malhotra, A. (1991). Gender and changing generational relations: Spouse choice in Indonesia. Demography, 28, 549–570.

Markey, P. M., & Markey, C. N. (2007). The interpersonal meaning of sexual promiscuity. Journal of Research in Personality, 41, 1199–1212. doi:10.1016/j.jrp.2007.02.004

Masters, W., & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown. McCrae, R. R., & Costa, P. T. (1987). Validation of the five-factor model of personality across

instruments and observers. Journal of Personality and Social Psychology, 52, 81–90. doi:10.1037/0022-3514.52.1.81

Meston, C. M., & Buss, D. M. (2007). Why humans have sex. Archives of Sexual Behavior, 36, 477–507. doi:10.1007/s10508-007-9175-2

Miller, J. D., Lynam, D., Zimmerman, R. S., Logan, T. K., Leukefeld, C., & Clayton, R. (2004). The utility of the Five Factor Model in understanding risky sexual behavior. Personality and Individual Differences, 36, 1611–1626. doi:10.1016/j.paid.2003.06.009

Nanda, S. (2001). Gender diversity: Crosscultural variations. Prospect Heights, IL: Waveland Press. O’Hara, R. E., Gibbons, F. X., Gerrard, M., Li, Z., & Sargent, J. D. (2012). Greater exposure

to sexual content in movies predicts earlier sexual debut and increased sexual risk taking. Psychological Science, 23, 984–993. doi:10.1177/0956797611435529

Okami, P., & Schackelford, T. K. (2001). Human sex differences in sexual psychology and behavior. Annual Review of Sex Research, 12, 186–241.

Pavlov, I. P. (1927). Conditioned reflexes. Oxford: Oxford University Press. Plaud, J. J., & Martini, J. R. (1999). The respondent conditioning of male sexual arousal. Behavior

Modification, 23, 254–268. doi:10.1177/0145445599232004 Ripa, C. P. L., Hansen, H. S., Mortensen, E. L., Sanders, S. A., & Reinisch, J. M. (2001). A Danish

version of the Sensation Seeking Scale and its relation to a broad spectrum of behavioral and psychological characteristics. Personality and Individual Differences, 30, 1371–1386. doi:10.1016/S0191-8869(00)00119-7

Ryan, C., & Jetha, C. (2010). Sex at dawn: How we mate, why we stray, and what it means for modern relationships. New York: HarperCollins.

Scanlon, T. F. (2005). The dispersion of pederasty and the athletic revolution in sixth-century BC Greece. Journal of Homosexuality, 49, 63–85. doi:10.1300/J082v49n03_03

Schenk, J., & Pfrang, H. (1986). Extraversion, neuroticism, and sexual behavior: Interrelationships in a sample of young men. Archives of Sexual Behavior, 15, 449–455. doi:10.1007/BF01542309

Seal, D. W., & Agostinelli, G. (1994). Individual differences associated with high-risk sexual behaviour: Implications for intervention programmes. AIDS Care, 6, 393–397. doi:10.1080/09540129408258653

Simpson, J. A., & Gangestad, S.W. (1991). Individual differences in sociosexuality: Evidence for convergent and discriminant validity. Journal of Personality and Social Psychology, 60, 870–883. doi:10.1037/0022-3514.60.6.870

Singh, D. (1993). Adaptive significance of female physical attractiveness: Role of waist-to-hip ratio. Journal of Personality and Social Psychology, 65, 293–293. doi:10.1037/0022-3514.65.2.293

Skinner, B. F. (1938). The behavior of organisms: An experimental analysis. New York: Macmillan. Strassberg, D. S., McKinnon, R. K., Sustaíta, M. A., & Rullo, J. (2013). Sexting by high school

students: An exploratory and descriptive study. Archives of Sexual Behavior, 42, 15–21. doi:10.1007/s10508-012-9969-8

C op

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S on

s, In

co rp

or at

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References 25

Strauss, G. (2010). Sex on TV: It’s increasingly uncut – and unavoidable. USA Today. Retrieved from http://www.usatoday.com/life/television/news/2010-01-20-sexcov20_CV_N.htm (accessed August 16, 2013).

Tan, M., Jones, G., Zhu, G., Ye, J., Hong, T., Zhou, S., . . . Zhang, L. (2009). Fellatio by fruit bats prolongs copulation time. PLoS ONE, 4(10), 1–5. doi:10.1371/journal.pone.0007595

Thibaut, J. W., & Kelley, H. H. (1959). The social psychology of groups. New York: John Wiley & Sons.

Trobst, K K., Herbst, J. H., Masters, H. L., & Costa, P. T. (2002). Personality pathways to unsafe sex: Personality, condom use, and HIV risk behaviors. Journal of Research in Personality, 36, 117–133. doi:10.1006/jrpe.2001.2334

Turchik, J.A., Garske, J. P., Probst, D. R., & Irvin, C. R. (2010). Personality, sexuality, and substance use as predictors of sexual risk taking in college students. Journal of Sex Research, 47, 411–419. doi:10.1080/00224490903161621

Van Lange, P.A., Rusbult, C. E., Drigotas, S. M., Arriaga, X. B., Witcher, B. S., & Cox, C. L. (1997). Willingness to sacrifice in close relationships. Journal of Personality and Social Psychology, 72, 1373–1395.

Walster, E., Walster, W., & Berscheid, E. (1978). Equity: Theory and research. Boston: Allyn & Bacon.

Wiesner-Hanks, M. (2000). Christianity and sexuality in the early modern world. London: Routledge.

Zuckerman, M., Eysenck, S. B., & Eysenck, H. J. (1978). Sensation seeking in England and America: Cross-cultural, age, and sex comparisons. Journal of Consulting and Clinical Psychology, 46, 139–149.

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©fuzzbones/123RF.COM.

CHAPTER OUTLINE

Introduction, 27 A Brief History of Sexology, 28 Sexology as a Science, 31 Sample Selection, 32 Nonexperimental Research, 33

Surveys, 33 Direct Observation, 37 Case Reports, 41

Experimental Research, 42 A Sample Sexperiment, 42 Strengths and Limitations of the Experimental Method, 43

A Note on Statistics, 43 Means and Medians, 43 Incidence and Prevalence, 44 Correlation, 44

Ethics in Sexology Research, 44 Informed Consent, 48 Debriefing, 48 Confidentiality, 49

Evaluating Sex Research, 50

Sexology Research: History, Methods, and Ethics

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IntroduntrI 27

Introduction

It is admittedly the most important subject in life. It is admittedly the thing that causes the most shipwrecks in the happiness of men and women. And yet our scientific knowledge is so meager. . . Those of us who try to salvage some of the shipwrecks need to have a thousand questions answered before we can guide other human beings intelligently. And we want them answered not by our mothers and grandmothers, not by priests and clergymen in the interest of middle-class mores, nor by general practitioners, not even by Freudians; we. . . want them answered by scientifically-trained students of sex.

John B. Watson (as cited in Magoun, 1981, p. 374)

The above quote comes from the writings of John B. Watson, one of the preeminent psy- chologists of the twentieth century. Perhaps you know him from other psychology courses as the founder of the behaviorism movement, or from his research on Little Albert (a young boy in whom Watson classically conditioned a fear of white rats). However, it is probably safe to assume that none of these other courses taught you about Watson’s interest in human sexuality. Not only was he very vocal about the need for sex to be studied scientifically, but he practiced what he preached. Watson was actually one of the first psychologists to study sex in a labora- tory setting, even going so far as to develop scientific instruments that could record human sexual responses (Magoun, 1981). Watson allegedly served as his own subject, as did his mis- tress, Rosalie Rayner (whom, as some of you may recall, assisted Watson in his research with Little Albert). Being the good scientist that he was, Watson took detailed notes on all of his “sexperiments.” However, that may have ultimately been his undoing. When Watson’s wife and the university at which he was working discovered his sexual exploits with Rayner, he lost both his marriage and job (McConnell, 1974).

Even though it was not politically popular at the time and may have “shipwrecked” his personal and professional life, Watson was willing to acknowledge the important role of sex in human life and the relative dearth of scientific knowledge on the subject. We owe a great debt to Watson and several like-minded researchers who followed, including Alfred Kinsey, William Masters, and Virginia Johnson, all of whom were willing to stand against the prevailing social norms and values of their time and declare sex a worthy topic of sci- entific inquiry.

The result of these early researchers’ efforts is the modern field of sexology, the scientific study of sex. Although sexology is a relatively young field, it has a rich, fascinating, and some- what scandalous history (including some wife-swapping scientists who filmed each other’s sex- ual exploits! For good and obvious reasons, that would be considered a research no-no today.) However, before we delve into those details, let me first paint a better picture of the field of sexology for you. The goal of sexology is to increase our understanding of all aspects of human sexuality, including everything from why different sexual orientations exist, to the frequency of specific sexual practices across cultures, to the motivations behind rape and other sex crimes, to therapies that can treat sexual problems. Given the broad array of topics studied within this field, sexologists necessarily consist of a diverse group of scientists who employ a wide range of research methodologies; these scientists include psychologists, sociologists, anthropologists, biologists, and many others.

In this chapter, we will consider what it is that makes sexology a science, detail some of the major methodological tools utilized in this field, and highlight the unique ethical issues and difficulties associated with the study of sex. Before we do, let us first consider the evolution of sexology as a field and how we got where we are today.

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2 Sexrlrgy Reseatuh: Htsnrty, Menhros, aIo Enhtus28

A Brief History of Sexology

In some ways, the study of sex dates back as early as the ancient Greeks (Haeberle, 1983). Some of the most prominent figures of that period, including Hippocrates, Aristotle, and Plato, wrote and theorized about a variety of topics pertaining to sex. However, the scientific study of sex as we know it today did not begin to take shape until the mid-nineteenth century, when several physicians, such as Heinrich Kaan and Richard von Krafft-Ebing, began publishing books on sexual behavior. These books signified a radical shift in perspective because rather than view- ing sexual “aberrations” and dysfunctions as moral failings (as most cultures and societies had for centuries), they reconceptualized them as medical and mental issues.

This medicalization of sexuality began to pick up steam and psychology took center stage at the turn of the twentieth century, when Sigmund Freud began the psychoanalytic move- ment. Psychoanalytic theory increased the momentum of the idea that a true understand- ing of sexual behavior rests with an in-depth exploration of human psychology. However, the Freudian approach, which largely relied upon case studies of highly unusual clinical patients (a research method we will discuss later in this chapter), was not satisfying to those who wanted the study of human sexuality to be grounded in science and experimentation. To meet this need, researchers began to move sex into the laboratory.

Those who attempted scientific studies of sex in the pioneer days faced numerous challenges. For one thing, the prevailing attitudes of society were still negative, if not outright hostile, toward open discussion of sex. As a result, few scientists were willing to risk their careers to even speak publicly about this topic, let alone research it (John Watson was clearly an excep- tion). Those researchers who did were confronted with funding agencies that were unwilling to back their work, a significant segment of the population that was either too embarrassed or too offended to participate in their studies, and publishers who rejected their articles out- right, especially if the researchers were studying “deviant” sexual behaviors (e.g., masturbation, homosexuality). Even research on topics that many people would consider mundane today (e.g., people’s attitudes toward sex outside of marriage) sparked public outcry and those who dared to study such topics risked ending their careers (Magoun, 1981). Early sex research thus necessitated some degree of secrecy. However, this heightened level of secrecy combined with a lack of formal oversight, led to some ethical lapses that arguably threatened some researchers’ reputations and the legitimacy of their work.

The scientific study of human sexuality remained almost completely underground until the 1940s and 50s when Dr. Alfred Kinsey entered the limelight. Kinsey’s interest in the study of sex came about after he began teaching a college-level marriage course and, in the process, discovered that our scientific knowledge of sex was incredibly narrow and rife with inaccura- cies. It was this glaring problem that eventually spurred Kinsey and his team of colleagues to travel across the United States and interview thousands of Americans regarding their sexual lives (we will discuss the specifics of his methods later in this chapter). Kinsey, who received his graduate training in biology, published two books based upon the results of his research (Sexual Behavior in the Human Male and Sexual Behavior in the Human Female). Both were national bestsellers and made Kinsey an instant celebrity; however, they were also very risqué for the time and resulted in controversy and scandal. Not only did the FBI begin compiling a dossier on Kinsey and his associates, but his work resulted in a congressional investigation of the Rockefeller Foundation, the source of Kinsey’s research funding.

Although Kinsey was most famous for the sex interviews he conducted, it is no big secret that he (like many early sexologists) had a strong interest in studying sex from a more biological standpoint. Specifically, Kinsey wanted to observe systematically how the body reacts to sexual stimulation. Given the harsh public criticism he endured after the publication of his first book,

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A tteef Htsnrty ref Sexrlrgy 29

Kinsey realized that if wanted to study the mechanics of sexual response, he would need to do it rather discreetly. Thus, it was in the attic of Kinsey’s house that his lesser-known observational studies of sex took place. Kinsey and his research associates filmed each other while engaging in various sexual activities, sometimes with their wives, and sometimes with each other’s wives (for a more colorful description of some of the activities they filmed, I encourage you to read the first chapter of Bonk: The Curious Coupling of Science and Sex by Mary Roach. It provides an informative, albeit cheeky look at Kinsey’s life and work).

Certainly, we owe a lot to Kinsey for his systematic and enlightening studies of sex; however, it appears that he may have become a little too personally “involved” in his work toward the end. It was around this time (in the 1950s and 60s) that the husband and wife team of Wil- liam Masters and Virginia Johnson came along and brought a renewed sense of objectivity to the study of sex. Masters (a gynecologist) and Johnson (a student of psychology and aspiring country singer) sought to conduct the most elaborate and scientifically grounded observational research on sex to date. All of their work was conducted in a laboratory setting with the latest technology and with the utmost professionalism (we will discuss the details of their methods later in this chapter). Masters and Johnson observed thousands of complete sexual responses in both men and women and published several influential books based upon their findings, with Human Sexual Response being perhaps the most well-known. Despite their best efforts at keeping things on the up-and-up, Masters and Johnson’s work did not escape controversy. For example, as part of their research, they interviewed sex workers, filmed individuals and couples as they engaged in sexual activity, and even created a sex toy with a built-in camera that allowed them to observe the physical changes that happen inside the vagina during sexual arousal and orgasm. In light of this, and society’s negative attitudes toward sex at the time, it is perhaps not surprising that many people considered their work immoral. In fact, part of the reason Masters

Figure 2.1 Alfred Kinsey was a pioneer in the field of sex research and conducted some of the most well-known and highly cited sex research of all time. Photograph by William Dellenback and provided by The Kinsey Institute for Research in Sex, Gender, and Reproduction.

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2 Sexrlrgy Reseatuh: Htsnrty, Menhros, aIo Enhtus30

and Johnson (and Kinsey too, for that matter) published their work in book format was because most academic journals deemed their research “pornographic.”

The popularity of Masters and Johnson’s books, coupled with the sexual revolution of the 1960s and 70s, moved the study of human sexuality further into the open. Since then, societal and cultural attitudes toward sex have gradually become more progressive and sexuality research has come to achieve greater levels of acceptance. Gradually is the key word here, though. Just consider that it was not until the 1990s that the first nation- ally representative survey of sexual behavior was conducted in the United States! Even today, despite the fact that there are several academic journals that exclusively publish sex research, and the popular media frequently highlights this work, the legitimacy of sexuality research is still questioned. For example, there are some politicians who regularly threaten to rescind federal grant funding from research projects that focus on sexuality or relation- ships, even though those projects have already been deemed worthy of study by a panel of scientific experts. Studies of sexual and gender minorities, sex workers, pornography, and the sex lives of older adults are particularly prone to political criticism as topics that are “inappropriate” for government grants. Thus, sexuality research still has its detractors, and probably always will.

The struggle to find sex a place within science may have cost some researchers their careers and ruffled the feathers of more than a few politicians, but the benefits gained by these research endeavors have far outweighed the costs. It is through this research that we have

Figure 2.2 William Masters and Virginia Johnson became household names after they began publishing books detailing the results of their observational sex research. As part of their work, they pioneered the use of electronic devices for recording sexual arousal. ©Bettmann/Getty Images.

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Sexrlrgy as a SuteIue 31

begun to correct a multitude of myths and misconceptions about sex and the human body, reset our expectations about what is “normal” when it comes to sexual attitudes and behav- iors, and discovered how to prevent and treat various sex and relationship problems. You will read more about these and other benefits of sex research as you progress through this book, but keep in mind that sexology is still a very young field of science and much remains that we do not yet know.

Sexology as a Science

In most regards, sexology operates in a similar way to any other field of science. The only real difference is that sexologists use some unique technologies and, of course, have more fun! Thus, the basic building blocks of research that you learned in other science classes still apply (e.g., the scientific method, the principles and values that scientists must uphold). For this reason, we will not review the fundamentals of how a science operates. Instead, we will focus primarily on understanding the specific research methods and techniques employed in the field of sexology and consider when such methods are appropriate for use. As you will soon discover, sometimes it is impossible or unethical to use certain methods in answering some research questions. We will divide our discussion of research techniques into two sections: nonexperimental approaches (which include surveys, direct observation, and case reports) and the experimental method. Table 2.1 provides a concise summary of these different method- ologies. Before detailing these methods, we will briefly cover the basics of sample selection, because the value and importance of any scientific study of sexuality (whether experimental or nonexperimental) depends upon the nature of the research participants. Without a good sample, it may be impossible to know how meaningful the findings really are and to what extent they might apply to the rest of the population.

Table 2.1 A summary of sexology research methods.

Research method Definition Strengths Limitations

Survey A large number of participants report on their own sexual attitudes and practices via an interview or questionnaire.

Quick and easy way of collecting data. Several modes of administration.

Nonresponse. Self-selection. Social desirability and other response biases. Writing a good survey requires skill and effort.

Direct Observation

Researchers observe participants and record what they see.

Less chance of response biases. Observations can be preserved on film.

Self-selection. Reactivity.

Case Report One participant or a small group of participants is studied in great detail.

In-depth information is provided about an unusual case.

Limited generalizability. Often rely upon subjective self- reports.

Experiment Researchers manipulate or change one variable (the independent variable) in order to see what effect this has on a measurable outcome (the dependent variable).

Precise control of variables. Ability to infer cause and effect.

Not possible or ethical to implement for all research questions. Several threats to external validity.

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Sample Selection

In sexology research, we typically gather data from a very small group of individuals and use that information to draw conclusions about a much larger group of people. In order to accomplish this, researchers must first identify their target population, or the group of people about whom they wish to learn. For example, assume a sexologist is interested in determining whether there is a link between taking birth control pills and sexual satisfaction. This researcher might iden- tify the target population as pre-menopausal, sexually active, heterosexual women. It would not be sufficient to simply state that “women” are the target population in this case, because the researcher is not interested in learning about all women—only those women who might be using this form of birth control.

Once the target population is specified, researchers choose a sample, or a smaller group of people who will actually participate in the study. A sample is chosen because it is not practical to study every single member of the target population. In our example, just think about how many millions (if not billions) of pre-menopausal, sexually active, heterosexual women there are in the world and what an impossible task it would be to survey all of them.

There are two main types of samples researchers can recruit: convenience samples and ran- dom samples. Convenience samples consist of those individuals who are most readily acces- sible for research purposes. Because a large number of sexologists work in university settings, convenience samples often consist exclusively of undergraduate students. Thus, in our exam- ple study of birth control and sexual satisfaction, we might recruit a group of sexually active, heterosexual, female students enrolled in introductory psychology courses to participate.

The advantage of this type of sampling is that we can complete our study quickly and easily without spending much (if any) money, given that psychology students are sometimes required to participate in studies in exchange for course credit. However, there are numerous drawbacks, with the main concern being whether the sample is representative enough of the target popula- tion to allow us to draw conclusions. College samples have a notoriously limited demographic composition. Not only are they more highly educated than average, but they tend to be very young, mostly White, and most of them are from the United States (Gosling, Vazire, Srivastava, & John, 2004). Thus, we must be very cautious about the generalizations we make from college samples, especially if we are at all concerned about how the variables we are studying might be affected by age, race, culture, and education—and when we are talking about sexual attitudes and behaviors, these are extremely important factors to take into account!

To get around the limitations of convenience sampling, researchers sometimes turn to ran- dom selection. This sampling procedure involves identifying all members of the target popula- tion and contacting a subset of them at random to participate. In this process, each member of the population has an equal chance of being selected to take part in the study. For example, if a sexologist were interested in studying attitudes toward legalizing prostitution among likely vot- ers in their city, they might get a list of all registered voters and contact 500 of them at random about being in the study. When the randomization procedure is implemented appropriately, it typically results in a sample that is reflective of the broader population from which it was drawn.

If random selection is so much better than convenience sampling, how come sexologists do not use it all of the time? The reason is because random selection is much more challenging to implement. It is difficult to get people outside the university community to participate unless you have some incentive to offer. As previously mentioned, convenience samples with college students often involve no financial cost because participants typically receive course credit as compensation.

Throughout this book, we will reference the results of studies employing random selection whenever possible in an attempt to provide the most definitive information. However, keep

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rIexxettieInal Reseatuh 33

in mind that sexology, like most other fields of science, relies heavily on studies that employ convenience samples, which means that much of our knowledge base is limited and may not necessarily be reflective of or generalizable to all sexual and gender minority groups.

Nonexperimental Research

Nonexperimental research methods allow us to describe people’s thoughts, feelings, and behaviors in a systematic manner with as much objectivity as possible. In studies of this nature, researchers do not directly manipulate or change any variables; rather, they simply make obser- vations and note which variables seem to go together. In this section, we will discuss three types of nonexperimental research. As we address each method, we will consider the nature of the information it can provide about human sexuality, as well as detail its unique strengths and limitations.

Surveys

The vast majority of our knowledge on human sexuality comes from survey research, in which people are simply asked to report on their own sexual attitudes and practices. There are multi- ple modes of survey administration, including face-to-face interviews, questionnaires adminis- tered over the phone or online, as well as the increasingly antiquated pencil-and-paper format. Surveys are ideal for researchers who want to consider general trends in attitudes and behav- iors across a relatively large group of people.

Strengths and Limitations of Surveys The primary advantage of the survey method is that data can be collected quickly and easily from large numbers of people. The advent of online research has made these advantages even more apparent, enabling sexologists to conduct research 24 hours per day all over the world! In addition, online surveys have opened up a new and much more diverse audience than the typi- cal college student subject pool, with online samples typically yielding more variation in age, socioeconomic status, and geographic location (Gosling et al., 2004). Online surveys also offer enhanced anonymity and privacy to participants. As we will see later in this section, anonymity is extremely important for gathering accurate data about people’s sex lives.

Another advantage of this method is that there are multiple methods of administration, and researchers can choose the one that best fits their budget and needs. For example, if you wanted to survey people about whether they have ever cheated on their romantic partner, an anonymous online survey might be your best bet to ensure honest responding. In comparison, if you wanted to find out how people first learned about sex and what that experience was like for them, a face-to-face interview might be most appropriate. Interviews provide much greater depth of information than surveys and are advantageous in that they can be adapted to each interviewee. For instance, both the interviewer and interviewee can seek clarification if they find anything to be confusing or unclear.

Of course, the survey method has some notable limitations. First, no matter how much effort you put into identifying the right sample, not everyone you contact will want to participate in your study. This problem is known as nonresponse, and it has always been a major issue in sex research (Wiederman, 2001). There are many reasons individuals might refuse to partici- pate, which can include anything from lack of time or interest to discomfort with the research topic. Nonresponse ultimately hurts the representativeness of your sample because those who refused to participate may be different in some way from those who agreed to take part in the

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study. For example, to the extent that people who opt out of sexuality surveys are more likely to be virgins, have more conservative religious or political backgrounds, or have unusual sexual interests or desires, researchers’ ability to make accurate generalizations about their findings is dramatically reduced.

The flip side of this problem is an issue known as self-selection. This is a broad term that refers to all of the ways that research volunteers differ from nonvolunteers. For example, in published research on sexuality and relationships, it is often the case that women far outnum- ber men (e.g., Lehmiller & Agnew, 2006; Lehmiller, VanderDrift, & Kelly, 2011). Likewise, those who sign up to participate in sexuality studies tend to be more sexually experienced and have more favorable attitudes about sex than those who do not (Plaud, Gaither, Hegstad, Rowan, & Devitt, 1999). Again, this reduces our ability to make inferences about target populations.

Response biases and self-presentational concerns are another factor complicating sexuality surveys. These biases encompass everything from whether subjects are accurately remember- ing the past, are lying, or are misrepresenting themselves. Perhaps the largest concern here is socially desirable responding, or the tendency for subjects to present themselves in the most favorable light possible. This is a concern in all psychological survey research, but it is especially problematic in studies of sexuality (Meston, Heiman, Trapnell, & Paulhus, 1998). Divulging one’s sexual history can be embarrassing or threatening, especially when it is unclear who might eventually see or hear about this information. In order to cope with this uncertainty and maintain a positive sense of self, research participants may intentionally skip questions when they are afraid answering would make them look bad, or they may respond in a way that makes them look good, even if it is not the truth. As one example of socially desirable respond- ing, consider that female participants completing sex surveys report less sexual experience (e.g., less masturbation and less exposure to pornography) when they believe their responses might become known to others compared to when they are assured anonymity (Alexander & Fisher, 2003). Thus, when women are concerned that their sexual history might become pub- lic knowledge, they are inclined to present themselves in a way that society is more likely to approve of. Assuring participants that their responses will remain anonymous and confiden- tial helps to address this problem, but no safeguards can completely eliminate all tendencies toward socially desirable responding.

Finally, it is important to recognize that the overall quality of a survey depends upon the quality of the individual questions and how they are organized. Writing high-quality survey questions is not as easy as it sounds. For one thing, you must ensure that your word choices are appropriate and understandable for your audience. For instance, if you were conducting a survey of sexual behaviors among inner-city adolescents, it would be ill-advised to ask them whether they have ever given or received fellatio or cunnilingus. Although these are technically the correct terms for oral stimulation of the penis and vulva respectively, they are very clinical and some adolescents may not know what they mean. With such an audience, slang terms such as blowjob or eating out may be more appropriate.

Researchers must also take great care to avoid the use of leading and double-barreled ques- tions. Leading questions direct participants to a specific answer. For example: “Most Americans believe that abortion should be legal. Do you support a woman’s right to choose?” A question like this pressures participants to respond in a certain way. To avoid such bias, the question should instead be phrased more generally, such as: “Do you favor or oppose legalized abor- tion?” Double-barreled questions inquire about multiple things, thereby muddling responses. For instance: “Do you consider yourself to be experienced and knowledgeable about sex?” Par- ticipants may not know how to respond to such a question because sexual experience and knowledge are completely different things. Two separate questions should be asked instead.

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In addition, it is vital to consider the order in which you ask the questions in your survey. For example, when married people are first asked how satisfied they are with their life over- all before being asked how satisfied they are with their marriage, these two ratings are only modestly associated; however, when the question order is reversed, the ratings become very strongly associated (Schwartz, Strack, & Mai, 1991). It appears that when people reflect on their marital satisfaction first, the information brought to mind changes how they think about their life as a whole. As you can see, sexologists must think very carefully about how they put all aspects of their surveys together.

Examples of Major Sex Surveys Given their importance to the field of sexology, a few of the most influential sex surveys ever con- ducted are discussed below. These surveys are useful to consider not only for historical purposes, but also because they further highlight the strong and weak points of utilizing this method.

The Kinsey reports Perhaps the most famous sexuality surveys ever conducted are those of Alfred Kinsey, a former professor at Indiana University. Kinsey’s goal was to provide the first comprehensive examina- tion of men’s and women’s sexual behavior in the United States. In his bestselling and highly controversial books, he and his research team detailed the results of their interviews with 5,300 men and 5,940 women. Although people of different racial backgrounds were initially interviewed, only data from White participants were included in the final publications because Kinsey felt that his racial minority samples were of inadequate size to draw conclusions. More- over, although his sampling efforts were admirable and ambitious for the time, his participants were disproportionately young, well-educated, Protestant, and from larger cities.

Whereas Kinsey’s sampling methods have long been criticized for their lack of diversity, his actual data-collection techniques have always been well respected. Kinsey collected most of his data during face-to-face interview sessions that followed a very careful and elaborate protocol. This involved working hard to establish a rapport with interviewees as a means of putting them at ease, building in checks for false responding, and only allowing a select group of highly trained researchers to conduct the interviews.

Kinsey’s research reports shocked the American public because they suggested that masturba- tion, homosexual behavior, extramarital sex, and many other historically “deviant” sexual activities were occurring with much greater frequency than anyone ever thought possible. For instance, Kinsey found that most men (92%) and women (62%) had masturbated before, that a significant number of men (37%) and women (13%) reported at least one sexual experience with a mem- ber of the same sex, and that the vast majority of men (69%) reported having at least one sexual experience with a prostitute (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin, & Geb- hard, 1953)! Even today, many of you are probably surprised by some of these numbers. However, it is important to note that although some of Kinsey’s findings have held up in subsequent research (e.g., his findings about masturbation), others have not (e.g., his findings about the prevalence of same-sex activity). Thus, Kinsey’s findings must be interpreted in light of his sampling limita- tions (e.g., restricted geographic diversity) and the time in which they were conducted. In order to understand sexuality in today’s world, it is necessary to consult more recent research efforts.

The National Health and Social Life Survey For the better part of the past two decades, the National Health and Social Life Survey (NHSLS; Laumann, Gagnon, Michael, & Michaels, 1994) has been considered the definitive survey of sexual attitudes and behaviors in the United States, and for good reason. It was the first attempt to conduct a comprehensive survey of Americans’ sexual practices since Kinsey’s work in the

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1940s. The NHSLS originally came about in response to the AIDS crisis that emerged in the 1980s. In the wake of this devastating disease, the US government recognized that our scien- tific knowledge of sexuality was extremely limited and this lack of information was hampering efforts to stop the spread of AIDS.

A team of researchers at the University of Chicago was initially granted enough government funding to conduct a national survey of 20,000 people. However, this financial support was later revoked by a conservative Congress that felt taxpayer money should not be spent studying sex. The research team was not deterred and went to private sources in order to secure funding that would allow them to complete their project. They did not raise enough money to carry out the study as originally intended, but they achieved enough to finish the project on a smaller scale. In the end, a representative sample of 3,432 individuals across the United States was surveyed. Participants ranged in age from 18 to 59 and exhibited some variability in terms of race, with the two largest racial minority groups (African and Hispanic Americans) well represented.

The study involved a mix of face-to-face interviews and pencil-and-paper questionnaires. Interviews were conducted first in order to obtain more in-depth and detailed information from interviewees, but also because it was believed that starting with an interview would yield a higher compliance rate than starting with a written survey (and they were right—nearly four out of five people contacted for the study were willing to participate!). The interviewees then filled out a written questionnaire that addressed more personal topics (e.g., questions about masturbation), which they returned in a sealed envelope. This was done in order to provide them with more privacy on the most sensitive matters.

Upon their release, the results of the NHSLS provoked controversy, but not in the way that Kinsey’s studies did. For one thing, the NHSLS suggested that Americans were more sexually conservative than previously thought! For example, most people reported having sex only a few times each month. Likewise, one in five men and nearly one in three women reported having had only one sexual partner in their lifetime. Furthermore, the reported prevalence of same-sex activity was much lower than Kinsey’s estimates.

Since its publication, the NHSLS has been lauded by the scientific community for the quality of its sample and research design. Of course, it is not without its limitations. For example, older adults and some racial minority groups, including Asian Americans and Native Americans, were not ade- quately reflected in the sample. In addition, given that the survey was carried out a few decades ago, the NHSLS may not be an accurate account of the sexual practices of Americans today.

The National Survey of Sexual Health and Behavior American sexuality has changed dramatically since the NHSLS. For instance, Viagra and other med- ications for sexual dysfunction have been introduced, online dating and hooking up have become increasingly common, and societal attitudes toward homosexuality have become more accepting. In order to keep up with such changes and to address the problem of the aging NHSLS dataset, the National Survey of Sexual Health and Behavior (NSSHB; Herbenick et al., 2010) was conducted.

The NSSHB is the largest and most diverse nationally representative survey of sexuality ever completed, with a sample consisting of 5,865 adolescents and adults ages 14 to 94 living in the United States. The project was carried out by researchers at the Center for Sexual Health Promotion at Indiana University (the same university where Alfred Kinsey spent most of his career). Participants for this study were initially recruited by mail or phone, which yielded a high response rate of 82% for adults. However, recruiting adolescent participants (one of the unique strengths of this survey) was more challenging because it was necessary to seek paren- tal permission first. Only 62% of parents contacted were willing to let their children under age 18 participate, which is revealing of Americans’ attitudes toward adolescent sexuality (a topic we will return to in chapters 10 and 11).

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Unlike the previous sex surveys discussed in this chapter, the NSSHB did not involve face- to-face interviews. Instead, all data were collected entirely over the Internet. For people who wanted to participate but did not have Internet access, it was provided for them by the research- ers. The first results from the NSSHB were published in 2010 in the Journal of Sexual Medicine and were greeted with relatively little controversy, which suggests attitudes toward sex have come a long way since Kinsey. We will continue to learn more from the NSSHB, given that new waves of data collection are being conducted annually each year through at least 2020. A sum- mary of some of the major findings from the NSSHB can be seen in Table 2.2. In later chapters, we will explore additional results from this and some of the other surveys mentioned above.

Other prominent sex surveys Several large scale sexuality surveys have been conducted outside of the United States. These include the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), a study that has taken place approximately every ten years since 1990, as well as the Australian Study of Health and Relationships, which was administered in 2001 and 2013. Extensive information about each of the surveys, including summaries of the key findings, is freely available online (for the Natsal, see http://www.natsal.ac.uk; for the Australian study, see http://www.ashr.edu .au). These surveys reveal trends that are similar in many ways to those observed in the United States. Among other things, across most Western countries, sex surveys reveal that the vast majority of adults are sexually active, men report having more sexual partners than women, and experiences with oral and anal sex appear to be on the rise.

National sex surveys in non-Western countries are more difficult to come by, due to cultural differences in the acceptability of talking about sex publicly. However, the few surveys that have been administered have enlightened us considerably with respect to the role that culture and soci- ety play in shaping sexual behavior. For example, a national sex survey in China revealed that most people do not begin having sex until their early to mid-20s, compared to ages 16 or 17 in many Western countries (Parish, Laumann, & Mojola, 2007). Likewise, Chinese men and women typi- cally get married very quickly (i.e., within a year or two) after they begin having sex, whereas West- erners often wait a decade or more between when they first have sex and when they get married.

Direct Observation

Although sex surveys are perhaps the most common research method in the field of sexology, they are far from perfect. This is largely because surveys require participants to report their

Table 2.2 Selected findings from the NSSHB.

Among adults, 7% of women and 8% of men identified as gay, lesbian, or bisexual. 85% of men and 64% of women reported reaching orgasm during their most recent sexual experience. Among participants who were single, one in three acts of vaginal intercourse involved condom use. Black and Hispanic men were more likely to use condoms during intercourse than White men. Adolescents reported being more likely to use condoms during intercourse than adults over age 40. Sex means a lot of different things to Americans. Adults reported a total of 41 different ways of “getting busy” during their most recent sexual encounter. When adults have sex, they do not just have intercourse—they typically engage in multiple sexual activities during each sexual event, which may include oral sex, anal sex, mutual masturbation, and other activities.

Source: The National Survey of Sexual Health and Behavior, http://www.nationalsexstudy.indiana.edu/

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own behavior, and they may or may not provide accurate descriptions. The reasons for this may be unintentional (e.g., memory loss) or intentional (e.g., socially desirable responding). To get around this issue, sexologists sometimes turn to a seemingly more objective research technique: direct observation. This is exactly what it sounds like—rather than having subjects describe their own behavior, researchers watch them with their own eyes and record what they see. Although observing the subject directly may result in a more accurate account of behavior, this method is not commonly utilized in sexology for many reasons, which we discuss below.

Strengths and Limitations of Direct Observation The major strength of direct observation is that it takes a number of response biases out of the picture by eliminating participants’ subjective reports of their own behavior. Another benefit is that observations can be filmed, thereby allowing researchers to go back in case they missed something or want to look at the behaviors in a different way.

However, there are obvious drawbacks. First and foremost, think for a moment about whether you would be willing to have sex on camera or in front of a researcher, while various pieces of recording equipment are attached to your genitalia. Many of you would probably be reluctant to agree to this. Thus, self-selection is a big concern with studies of this nature, perhaps because it is only those of us who are very comfortable with our bodies and our sexuality who are willing to participate in such research. As support for this idea, a survey of 485 college undergradu- ates found that only 15% said they would be willing to participate in an observational study of sexual arousal (Plaud et al., 1999). Another major concern is reactivity, which refers to the idea that research participants sometimes alter their behavior when they know others are watching. How might people alter their sexual behavior when others are present or if they know they are being filmed? It probably depends upon the person, with some people acting more inhibited than usual, and others getting especially excited. Researchers need to take great care in how they code the results of observational studies, too, because two scientists could watch the same event, but document it in very different ways if the coding scheme is ambiguous. Consider this: I once attended a presentation at a sex research conference in which researchers talked about a study in which they content-coded hardcore online pornography for a variety of sex acts, including “fisting” and “double penetration.” This led to one of those interesting and entertain- ing debates that only occur at academic sex conferences: does inserting four fingers at once into the vagina or anus constitute “fisting,” or do all five fingers have to be inserted? And does it count as “double penetration” if someone has penises inserted in two different orifices at the same time, or do both penises have to be inserted in the same orifice? Put another way, sex researchers need to carefully operationalize the variables in observational studies so that they can be recorded as accurately and unambiguously as possible. Finally, observational studies are expensive to conduct and often require a lot of special equipment and technology that can be hard to come by (see section—“Technologies Used in Observational Sex Research”—for more on this).

The Research of Masters and Johnson The most famous and well-known example of observational research in sexology is the work of William Masters and Virginia Johnson. The data reported in their book Human Sexual Response came from laboratory studies of 694 men and women, who ranged in age from 18 to 89. Subjects consisted mostly of White, highly educated students from the local com- munity in St. Louis, Missouri. Efforts were made to screen out exhibitionists and individuals with emotional problems during the recruitment process. Although the sample was far from

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representative of the US population, Masters and Johnson deserve some credit for finding such a large number of people willing to participate in their research, especially given that they were conducting their work in a time and setting that was not overly enthusiastic about sexual science.

Masters and Johnson sought to understand exactly how men’s and women’s bodies respond to sexual stimulation. To do so, they had subjects engage in sexual activities in their lab, including masturbation, sexual intercourse, and simulated intercourse, all while various pieces of technology recorded the changes that happened to their bodies (e.g., changes in muscle tension and blood flow). In case you are curious, the simulated intercourse trials refer to instances in which female participants were stimulated with an “artificial coition machine” (i.e., the sex toy with a built in camera previously mentioned). It was essentially a motorized dildo that had a remote control women could use to adjust the speed and depth of thrusting. Did this really happen in Missouri? In the 1960s? It sure did! After engaging in sexual activ- ity, participants were thoroughly interviewed, which provided an extra level of depth to the data obtained.

The results of Masters and Johnson’s research were greeted with much controversy, but they provided a wealth of information and new insights into human sexuality. It is also important to note that the data they collected on the bodily changes that accompany sexual arousal appear to be consistent across diverse groups of people, despite their aforementioned sampling limita- tions. As a result, you will see their research findings presented throughout this book.

Technologies Used in Observational Sex Research Masters and Johnson were among the first sex researchers to use electronic devices for studying sexual arousal. Variations of these devices are still in use today and are frequently mentioned in published reports of both observational and experimental sex studies. Below are some of the most common technologies used in sexuality research today.

To measure male sexual arousal, a device called a penile strain gauge is often employed. It consists of a small circular tube that is placed around the base of the penis, just like a “cock ring” (a sex toy that some men use to make their erections last longer by restricting blood flow out of the penis). Attached to this tube are wires that connect to a recording device. The strain gauge works by measuring changes in penile circumference. In other words, as blood flows into the penis, leading it to increase in size, the machine records this—and it is very sensitive to even the tiniest changes in size. To avoid potential embarrassment and maintain privacy, male participants in sex studies usually attach this device to themselves.

To measure female sexual arousal, a vaginal photoplethysmograph is usually employed. This device consists of a small, acrylic rod that is inserted into the vagina (again, this is something subjects can introduce to their bodies in private). Like the penile strain gauge, wires are attached that connect it with a recording instrument. The photoplethysmograph works by giving off light, and then measuring how much of that light is reflected back from the vaginal walls. When women are sexually aroused, the vaginal walls fill with blood, which decreases the amount of reflected light. Clearly, the strain gauge and photoplethysmograph operate very differently; however, they are similar in that they both measure sexual arousal in terms of increased blood flow to the genital region. Other devices for measuring female sexual arousal have been devel- oped, including the labial photoplethysmograph (Prause, Cerny, & Janssen, 2005) and the clito- ral photoplethysmograph (Gerritsen et al., 2009), but they have not yet achieved widespread use.

A somewhat newer technology that has the potential to be used in both men and women is thermal imaging. As blood flows to the genital region during sexual arousal, that part of the

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body literally “warms up,” and high-tech thermal cameras can be used to pick up on those temperature changes (Kukkonen, Binik, Amsel, & Carrier, 2007). Two advantages of thermal imaging over strain gauges and photoplethysmographs are that participants can remain fully clothed the entire time, and they do not have to attach anything to their genitals.

Although these and other tools for measuring physiological arousal are increasingly used, they are not without controversy. One concern is that while a person’s genitals may show signs of arousal, the individual may not feel aroused psychologically. Thus, it is not always clear what these measures are telling us. In addition, although many sex researchers believe these tools allow for more objective measurement of sexual arousal, some research has found that genital responses can be faked. For instance, one study found that men can successfully inhibit their erectile responses while viewing a pornographic image by thinking about something disgust- ing, such as a filthy bathroom (Trottier, Rouleau, Renaud, & Goyette, 2014).

One other technology frequently used in studies of sexual arousal in men and women is functional magnetic resonance imaging (fMRI). With fMRI scans, we can see what areas of the brain respond when individuals are turned on or experience orgasm. For example, fMRI scans of men and women viewing erotic videos have revealed some similarities and some differ- ences in the way that the sexes’ brains operate (Karama et al., 2002). Specifically, while viewing erotic stimuli, both men and women show increased activation of the amygdala; in contrast, men show significant activation of the hypothalamus, whereas women do not. Both the amyg- dala and hypothalamus are part of the limbic system, a portion of the brain that helps regu- late sexual behavior (more on this in chapter 4). Such findings can not only help us to better understand differences in how men and women experience sex psychologically, but they can also potentially help us to better understand cases of sexual dysfunction (e.g., a brain scan of a person with arousal difficulties could help to identify whether there is a neurological basis for the problem based upon the pattern of activation observed).

Figure 2.3 A mercury-in-rubber penile strain gauge. The loop at the end of the wires is placed around the base of the penis and measures changes in penile circumference. ©Sarah Sudhoff.

Figure 2.4 An early-generation vaginal photo- plethysmograph. The acrylic rod is placed inside the vagina to measure changes in vaginal blood volume. ©Sarah Sudhoff.

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Case Reports

The final method of nonexperimental research we will consider is the case report. Researchers who utilize this method study either one participant or a small group of participants in great depth and detail. In general, the subject selected for a report of this nature is unusual in some way or engages in sexual activities outside of the mainstream. For example, a sexologist might perform a case study on someone with a sexual dysfunction, someone who has an unusual sexual desire (i.e., a paraphilia), or a sex worker.

Case reports were a reasonably common method of data collection among early sex research- ers, particularly Sigmund Freud (some of you may recall his famous case reports of Anna O. and Little Hans from other psychology courses). Such studies still appear in the sexology lit- erature today, but they are primarily conducted by those who have clinical or medical training (e.g., clinical psychologists or psychiatrists). We will consider the findings of a couple of rel- evant case reports in chapter 4.

Strengths and Limitations of Case Reports The major benefit of case reports is that they provide great depth of information about an unusual subject. If a similar subject is encountered in the future, the case report can provide a very valuable source of information for guiding potential therapeutic intervention (e.g., if the subject suffered from a sexual problem, a therapist could review the report to see what treat- ments worked and what did not).

However, case reports are of inherently limited value from the standpoint that they sample either a single individual or a very small group of people who are not representative of the

Figure 2.5 fMRI and other neuroimaging techniques are increasingly being used in sex research to explore differences in how people process sex-related stimuli and to identify neurological and physiological causes of sexual dysfunction. ©Levent Konuk/123RF.COM.

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broader population. Thus, generalizing the findings of case studies to larger groups of people is difficult, if not impossible. In addition, case reports rely heavily on participants’ subjective reports of the past, which are subject to the same self-presentational issues and response biases that affect survey research.

Experimental Research

Up until this point, all of the research designs we have considered are correlational. In other words, surveys, direct observation, and case reports can tell us what sexuality variables are related to one another, but they cannot tell us anything about the causes of sexual behavior. The only way sexologists can establish cause and effect is to conduct an experiment. In an experi- ment, researchers manipulate or change one variable in order to see what effect this has on a measurable outcome. The manipulated variable is known as the independent variable, while the measured outcome is known as the dependent variable. Thus, the independent variable is presumed to be the cause of any changes in the dependent variable.

In order to make inferences about cause and effect in an experiment, researchers must hold all factors constant other than the independent variable. If other factors change alongside the independent variable (this is known as confounding), it becomes impossible to determine why the results turned out the way they did. One of the most vital methods of protecting the integ- rity of an experiment is to ensure participants are randomly assigned to different experimental conditions. In other words, the level of the independent variable a participant receives (e.g., placebo vs. active drug) should be determined at random. Random assignment helps to ensure that the groups of participants you are comparing have a similar composition, thereby prevent- ing third variables (e.g., group differences in attitudes or demographic composition) from serv- ing as alternative explanations for the findings.

A Sample Sexperiment

To give you a better idea of how the experimental method is employed in sexology, let us con- sider a study conducted by Galliot and Baumeister (2007). The idea behind this study was to examine the link between self-control and sexual behavior. To give you a little theoretical back- ground, research shows that human beings have a limited capacity for self-control (Baumeister, Bratslavsky, Muraven, & Tice, 1998). That is, no matter how strong we are, sometimes our willpower gives out and we subsequently find it difficult to curb our impulses (e.g., just think about the last time you tried dieting. How long were you able to hold out before you gorged on junk food?). Self-control can thus be thought of as a muscle, such that when we use it too much, it gets tired and leads us to act in uncontrollable ways. What Galliot and Baumeister wanted to do was see whether depletion of self-control affects how people behave sexually.

To test this idea, college students in romantic relationships brought their partner to the lab. The independent variable was a self-control manipulation, such that couples were randomly assigned to either expend their self-control abilities or not. This was accomplished by having each couple watch a silent video that depicted a woman talking. At the bottom of the screen, words would flash for a few seconds at a time. Half of the couples were asked to refrain from looking at the words (the depletion condition), whereas the other half were given no such instruc- tions (the no-depletion condition). The thought here is that consciously avoiding the words on the screen would require effort, thereby depleting self-control reserves for those participants.

The dependent variable was the extent of the couple’s sexual behavior after watching the video. Specifically, couples were given a private room and were asked to express some type of physical intimacy with their partner (they could do anything as long as it was consensual).

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Afterward, participants filled out a questionnaire in which they reported the extent of their sexual behavior.

Results indicated that participants in the depletion condition “kissed open-mouthed for pro- longed periods of time, groped and caressed each other. . . and even removed articles of cloth- ing so as to expose themselves” (pp. 182–183). However, these findings only held for couples who were sexually inexperienced. It is thought that sexually inexperienced couples may have been more depleted to begin with because they must engage in more sexual self-control on a daily basis. As a result, they may have experienced a form of double depletion. We will return to the concept of self-control depletion in chapter 9 and consider further implications of this phenomenon for sexual behavior.

Strengths and Limitations of the Experimental Method

The major strength of experiments is the ability to control variables precisely, thereby allowing us to make claims about causality. Thus, if we find differences in the dependent variable across conditions, we may be able to infer that they were caused by the independent variable. No other research method allows us to draw such conclusions.

Unfortunately, however, experiments are not always a viable option for sexology studies because certain research questions do not lend themselves readily to this method. Sometimes it is impossible or unethical to manipulate a variable of interest. For example, if we wanted to study the impact of parental divorce on children’s academic performance, we could not ran- domly assign some couples to get divorced and some to stay together! To address that topic, we would have to take a nonexperimental approach. Another limitation of experiments is that people may act differently in a laboratory setting than they do in the real world, thereby threat- ening external validity (i.e., the ability to generalize the findings beyond the lab). For instance, subjects may purposely alter their behavior because they like/dislike the experimenter or because they have guessed the purpose of the study.

A Note on Statistics

As we go forward in this book, we will discuss the results of several sexuality studies, both experimental and nonexperimental. To understand the results of these studies, it is important for you to have knowledge of some basic statistical concepts. We will review these briefly here, but please do not be intimidated! You do not need to have a strong statistical background to comprehend this information.

Means and Medians

In sexuality research, we often want to speak in terms of what the average person does, rather than focus on the extremes (although we will certainly cover some extremes in chapter 14, when we discuss sexual behavior variations). In statistical terms, the mean refers to the average value of all of the scores in a dataset. Sometimes it is also useful to consider the median, which is the middle score in a distribution.

However, please do not confuse the terms mean and median with “normal.” When it comes to sexual behavior, it is important to keep in mind that there is huge variability. As a result, “normal” does not represent a single value, but rather a large range of values. Thus, please do not fall into the habit of comparing yourself to every single average presented in this book and make judgments about your own normalcy. Chances are that even if you seem pretty far from average, you would still be considered normal.

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Incidence and Prevalence

When we begin to talk about sexual dysfunction and disease, we will frequently use the terms incidence and prevalence. Incidence refers to the rate at which new cases of a problem or disease occur. It is usually expressed as the number of new cases that appeared in a given time (e.g., one year) divided by the total size of the population. Thus, incidence is useful for help- ing us to understand how quickly a problem is spreading. In contrast, prevalence is a broader measure of the total number of people who are currently afflicted with a given problem or disease. It is often expressed in terms of the number of people per 100,000 who have it. Thus, prevalence helps us to understand the overall scope of the issue.

Correlation

The last statistical concept you should know is correlation, a concept we briefly introduced earlier. Correlation refers to the statistical association between two variables (i.e., the degree to which two variables are related). A correlation can be negative, positive, or zero. Negative correlations refer to cases where two variables move in opposite directions (i.e., as one vari- able increases, the other decreases). For example, the frequency of condom use is negatively correlated with likelihood of contracting a sexually transmitted infection, such that as condom use goes up, infection risk goes down. Positive correlations refer to cases where two variables move in the same direction (i.e., both variables increase together and decrease together). For instance, the number of partners with whom you have unprotected sex is positively correlated with the risk of contracting a sexually transmitted infection, such that as number of partners increases, so does infection risk. Finally, a correlation of zero occurs when two variables have no relationship whatsoever. One example of this would be the size of a woman’s breasts and the amount of breast milk she produces. This may surprise you, but women with larger breasts do not necessarily produce more milk (we will address the reason for this in the next chapter when we cover sexual anatomy).

Please keep in mind that correlations are useful for summarizing patterns in data, but they tell us nothing about cause and effect. Thus, just because two variables are correlated does not mean that one is causing the other. As one example of this, consider that a strong, positive cor- relation has been found between the stork population and the birth rate in several European countries (Matthews, 2000). As children, some of you probably learned that storks delivered human babies—and this correlation would seem to support that theory, right? Wrong. This is but one of many examples of a spurious correlation (i.e., an association that exists due to some third factor that links the variables together—in this case, what was happening is that as the human population increased, so did the number of houses, and more houses provided more roofs for storks to build nests). Thus, whenever we talk about variables being correlated, keep in mind that we do not necessarily know why that association exists.

Ethics in Sexology Research

To round out our discussion of the scientific study of sex, let us consider research ethics. Ethics is something that should be at the forefront of any researcher’s mind, whether that researcher studies sexuality or not. Historically, however, this has not always been the case. For example, in other psychology courses, you probably discussed the potential ethical violations associ- ated with Stanley Milgram’s classic studies on obedience to authority (Milgram, 1963) and the Stanford Prison Experiment (Haney, Banks, & Zimbardo, 1973). Sexology has had its own

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ethically questionable moments in the past, and these have served to shape the field’s modern- day approach to research ethics. Before we consider the ethical principles that sexologists must uphold, let us first look back at some of the most controversial sex studies ever conducted so that you can better appreciate why these ethical requirements are in place.

First, let us consider Laud Humphreys’ (1970) Tearoom Trade Study. Humphreys was a soci- ologist who wanted to understand why some men are motivated to have anonymous sexual encounters with other men in public restrooms. Before we go on, I should note that in the 1970s, the bathrooms where men would meet up for this purpose were known colloquially as “tearooms,” hence the name of this study (and just so you know, the Russian Tea Room in New York City is actually a pretty fancy and exclusive restaurant, not an actual tearoom). At that time, a lot of men were being arrested for tearoom sex all across the United States. Hum- phreys believed that attempting to understand who these men were and what motivated them to engage in this behavior would be of inherent value to society.

In carrying out his research, Humphreys visited a number of tearooms, where he volun- teered to be the “lookout” for men who wanted to have a quick sexual encounter in a stall. His job was to cough or otherwise signal the men in the stall if police were coming. As if this behavior were not questionable enough for a scientist, Humphreys sometimes followed these tearoom visitors back to their cars and surreptitiously recorded their license plate numbers. One year later, he used this information to track the men down. Specifically, he showed up at their homes unannounced (disguised, of course, so that he would not be recognized) and pro- ceeded to interview them to learn more about their lives, supposedly as part of a completely unrelated study.

Humphreys’ results were interesting and influential from the standpoint that they disproved a number of stereotypes about the typical tearoom patron. For example, more than half of the men were married to women and, aside from the occasional tearoom rendezvous (which their

Figure 2.6 Although there may be a correlation between the stork population and the rate of human births, it would be erroneous to conclude that storks are responsible for delivering babies. Correlations do not imply cause-and-effect. ©James Steidl/123RF.COM.

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wives presumably did not know about), many of them appeared to be in model marriages. Fur- thermore, after Humphreys’ research was published, police departments began to devote less attention and resources to investigating and prosecuting tearoom sex, which many would view as a positive outcome (e.g., some would argue that limited police resources should be spent preventing and punishing nonconsensual sex crimes, such as sexual assault, rather than regu- lating the sexual activities of consenting adults). However, it is clear that Humphreys deceived those who took part in his research. In fact, many of the subjects were not even aware that they were taking part in a study. Humphreys also invaded his subjects’ privacy in more than one way. Do you think the ends justified the means in this study? Visit the Your Sexuality 2.1 box and weigh in with your perspective.

If you thought the Humphreys study was ethically dubious, you might want to brace yourself for our discussion of the Tuskegee Syphilis Study (for a more in-depth account of this study, see Jones, 1992). This study was conducted by the United States Public Health Service from the 1930s until the 1970s. The goal of this research was to track the progression of syphilis among a group of 399 low-income, African American men from Tuskegee, Alabama (hence the name of the study). All of the men already had syphilis, but none were told they had it. Instead, partici- pants were told that they had “bad blood” and would receive free medical treatment for their condition along with meals in exchange for their participation in the study.

If these researchers had simply been tracking patients with an incurable disease to see what happened, that would be one thing. However, a cure for syphilis, penicillin, was developed in the 1940s and was intentionally withheld from the men. Even more egregious than just with- holding treatment, the men were told that they would lose their benefits if they sought treat- ment elsewhere for their “bad blood.” Researchers also went out of their way to inform local doctors that they were not to provide these patients with antibiotics! By the time this study

Figure 2.7 Laud Humphreys studied men who have sex with men in public restrooms. Was it ethically appropriate for Humphries to deceive the men about his true identity and intentions? ©mrosica/123RF.COM.

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became public knowledge, it was too late for these men; they had suffered irreparable physi- cal harm and many had died as a result of the disease (we will discuss the debilitating effects of untreated sexually transmitted diseases in more detail in chapter 12). Also, the failure to provide treatment to these men may have allowed the disease to be spread to their partners. In the end, not only were the participants seriously deceived, but they (and their families) expe- rienced substantial physical harm and some died as a result. There is no justifying that under any circumstances. To add insult to injury, the US government did not even issue a public apol- ogy for this horrendous study until the 1990s.

The ethics of both the Tearoom Trade and Tuskegee Syphilis Studies are no doubt question- able, and each was conducted in a time where there was less oversight of scientific research and where fewer policies were in place to prevent physical and psychological mistreatment of research participants. In the early 1970s, these studies came to light (right around the same time as the controversial Milgram studies and the Stanford Prison Experiment). Ethical con- cerns in psychology and sexology had reached a boiling point and more strict research regula- tions were put into place. As a result, modern sexology research is subject to much higher levels of scrutiny and must meet certain ethical standards before it can be carried out. However, it is possible that we may have overcorrected because we now subject even very minor and routine sex surveys to extremely high levels of scrutiny, even though they pose little risk of harm to participants (for more on this idea, see the Digging Deeper 2.1 box).

Your Sexuality 2.1 Was the Tearoom Trade Study Ethically Acceptable?

Opinions on Laud Humphreys’ Tearoom Trade study vary widely, with some arguing that the study was entirely too unethical to have ever been carried out, and others arguing that the meth- ods were relatively harmless and that the study did more good than anything. Below are some of the most common arguments on both sides of the issue. Which do you find most persuasive? Why? What other arguments can you come up with that support your perspective?

● CON: Subjects did not provide their consent to participate. If they would have known they were being observed, many subjects might have chosen not to participate. PRO: Tearoom activities were illegal at the time. Requiring written informed consent would have created a permanent record linking the subjects to the research, which could have put them at risk for later identification and arrest.

● CON: Subjects had a right to privacy in the bathroom and in their homes. PRO: Public bathrooms are by definition “public,” meaning that they do not inherently offer privacy from researchers or nonresearchers. In addition, subjects were engaging in sexual behavior in public, which suggests that they did not necessarily mind if anyone else observed. In terms of privacy in the home, unannounced door-to-door solicitations for product sales, political canvassers, and census takers are a commonplace occurrence.

● CON: Humphreys was observing what was, at the time, an illegal behavior. By collecting data on these subjects and recording their license plate numbers, he was putting them at risk of arrest if his data fell into the wrong hands. PRO: Humphreys went to great lengths to maintain the anonymity of his participants, including keeping any potentially identifying information in a safe-deposit box 1,000 miles away from the research site. In addition, by studying this population, it ended up reducing the social stigma associated with same-sex sexual behavior.

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The specific ethical guidelines followed by sexologists vary somewhat depending upon their field of study, the requirements of their institution’s ethics board, the organization that funds their work, as well as local and federal laws. However, there are several general principles all sexologists must uphold, including the requirements of informed consent, debriefing, and con- fidentiality, all of which apply in psychological research more broadly.

Informed Consent

Before beginning any research study, participants must provide their informed consent. This means that individuals must be told up front the nature of the study, their rights as a research participant, and the potential risks and rewards associated with their involvement. With this information in mind, individuals must make a conscious decision as to whether they want to participate, free from pressure or coercion.

During the informed consent process, researchers cannot withhold significant informa- tion about the study. Does this mean that deception (i.e., intentionally withholding certain information from subjects or misleading them) is never ethically permissible? Certain types of deception are acceptable and appropriate, especially if they are necessary to ensure the validity of your data. For example, during informed consent, you do not have to explicitly tell subjects the hypothesis you are testing and the true purpose of your study. However, you cannot withhold or lie about something that could potentially affect a subject’s deci- sion to participate. For example, if you planned to expose subjects to violent pornography in order to see how it affects their acceptance of violence toward women, it would not be ethically permissible to tell subjects that they will simply be “watching some videos and answering some questions.” The informed consent process would need to make clear that subjects may be viewing sexually explicit materials and answering questions about their personal views.

Debriefing

At the end of any study, participants must receive a thorough debriefing. This means that after completing all study requirements, participants must be told the true purpose of the research and be informed of any deception that took place. In other words, researchers must give sub- jects all of the information they did not receive up front in order to ensure that they do not walk away with any misconceptions. This is especially important in any instances in which participants are intentionally misled about facts or information.

For example, consider a study by Dana Bramel (1963). Male college student participants were hooked up to a machine that measured galvanic skin response (GSR). Subjects were told that GSR was a reliable indicator of one’s sexual arousal and that, when aroused, the needle on the measurement instrument would move higher. Participants were then shown photographs of men who varied in their degree of attractiveness and how much clothing they were wearing. Unbeknownst to the subject, the machine was rigged, such that the experimenter was control- ling the movement of the needle! Regardless of participants’ own sexual orientation, many of them saw the machine register very high levels of arousal in response to the photos of attrac- tive and semi-nude men. Thus, some men were falsely led to believe that they possessed “latent homosexuality.” The value of debriefing should be apparent from a study like this. It would not be ethically acceptable to simply allow these participants to walk away from this study without correcting such misinformation. Subjects should never leave a research study harboring false impressions or feeling any kind of stress or anxiety.

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Confidentiality

One additional ethical requirement of sexology research is maintaining confidentiality, or protecting the privacy of your research subjects. In sexuality studies, keeping confidentiality is vital for several reasons. First, sexologists sometimes collect very personal information from their subjects, and this information could potentially damage people’s lives if it got out. For example, I have conducted research on people who keep their romantic relationships secret (Lehmiller, 2009). Although there are many reasons someone might hide a relationship, one that frequently comes up is that the individual is having an affair. No matter what my personal

Digging Deeper 2.1 Do Sex Surveys Pose Harm to Student Participants?

Ever since the pioneering work of Alfred Kinsey, there has been a persistent concern that asking people questions about sex on surveys is too personal and is likely to make them feel distressed and uncomfortable. Although there may have been some validity to this concern several decades ago, times have changed. We now live in a world where people talk about sex more freely than ever before and sex is represented everywhere in the media. So should ethics review boards scrutinize sex studies more than other types of research?

In a study by Yeater, Miller, Rinehart, and Nason (2012), 504 college student participants were randomly assigned to complete one of two surveys. Half of the participants were given a survey that inquired about their own sexual attitudes and experiences, including traumatic events they have endured. The survey items they completed were deliberately chosen because they were thought to have the highest potential to cause distress. These participants were asked hundreds of questions about topics such as rape, masturbation, childhood sexual abuse, body image, sex- ual history, and so forth. The other half of the participants completed a very general psychologi- cal survey, which included tests of vocabulary, abstract thinking, and analogies.

The results indicated that completing the sex survey did not increase reports of negative emo- tions among participants – in fact, negative emotions oeuteaseo among participants, regardless of which survey they completed! Participants who completed the sex survey also reported feel- ing less mentally taxed and believed that they benefitted more from having participated in the study than those who completed the cognitive tests. In addition, both surveys were rated as being less stressful than many normal, everyday stressors that everyone occasionally experiences (e.g., getting a paper cut, waiting in line, spilling your coffee, etc.).

The researchers also looked specifically at women who had a previous history of sexual victimi- zation because there is a commonly held belief among ethics review boards that such women are especially susceptible to distress in research of this nature. However, women who were previ- ously victimized did not report feeling any worse at the end of the study no matter which survey they completed.

This research indicates that sex surveys clearly fall in the category of minimal risk – that is, they are unlikely to cause more harm to someone than might ordinarily be experienced in eve- ryday life or when completing other, more general psychological tests. Of course, there are some limitations of this study, given that participants were undergraduate students from just one university in the United States. Further research with more diverse samples would be advisable before making sweeping recommendations. For now, however, it would at least appear reason- able to conclude that American college students probably are not as sensitive about sex as ethics boards have made them out to be.

Note: Reprinted with permission from Sex aIo Psyuhrlrgy (www.lehmiller.com).

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feelings are about this, I must keep the identities of my participants private. I have no legal obligation to report known or suspected adultery to the authorities, and releasing participants’ identities could create emotional distress, conflict, and breakup. Second, if research partici- pants are not assured confidentiality, they will be less likely to respond honestly and accurately, thereby under-mining the validity of the data. For example, in my study of secret relationships you can bet that people would not have told me about their affairs if they thought I might pub- licly divulge that information or contact their partner.

On a side note, researchers may need to break confidentiality on very rare occasions if it is required by law. For example, if a developmental psychologist studying children or adolescents discovered that a participant was the victim of sexual abuse, that scientist would have a legal duty to report this information to the authorities, even though it means violating a research subject’s trust.

Evaluating Sex Research

As we close out this chapter, I hope you have come to appreciate the science of sexology. Researchers in this field take great care in designing each and every study by giving ample con- sideration to how they select their participants, how they phrase and order their questions, as well as how they manipulate and measure their variables. Keep this in mind any time you see sex surveys or research reports about sex in the popular media. For example, many men’s and women’s magazines (e.g., Playboy, Men’s Health, Cosmopolitan, Glamour) regularly report the results of reader sex surveys. Likewise, many major news websites have a daily “quick poll,” in which a single question (sometimes pertaining to sexual matters) is asked of visitors. People who do not have a strong research background may look at these results and accept them as

Figure 2.8 At the beginning of any study on sex and sexuality, participants must be informed of their rights, the nature of the research, and the potential risks involved. This usually entails obtaining a written or electronic signature. ©gajus/123RF.COM.

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fact, or at least ascribe some importance to them. After reading this chapter, however, you should be aware that such “research” requires scrutiny. Specifically, you should always ask:

● Who conducted the study and why? Do they have the training and credentials necessary to conduct research of this nature? Also, are they truly seeking to increase our understanding of human sexuality, or do they simply want to sell you a product?

● What are the characteristics of the sample? To whom can we generalize these results? Be wary of research reports that provide no information or only very limited information about the sample.

● Were the survey questions high-quality and free from bias? ● Are the results consistent with what you learned in this book?

In summary, when it comes to learning about human sexuality, we need to carefully consider the source of our information. John Watson said it best when he argued that we deserve to have our questions answered not by those who are pushing a social or moral agenda, but “by scientifically-trained students of sex.”

Key Terms

Discussion Questions: What is Your Perspective on Sex?

● In your own view, how big of an issue is self-selection in the scientific study of sex? What are some ways in which sex researchers can reduce this problem?

● A researcher is interested in studying the effects of exposure to pornography on heterosexual men’s attitudes toward women. What type of study design would you use to address this research question and what are the strengths and limitations of your chosen method?

● Would it be possible to carry out the Tearoom Trade Study in a way that meets modern ethical requirements of informed consent, debriefing, and confidentiality? Do you think it is permis- sible to breach ethical guidelines in order to study certain research topics? Why or why not?

References

Alexander, M. G., & Fisher, T. D. (2003). Truth and consequences: Using the bogus pipeline to examine sex differences in self-reported sexuality. Journal of Sex Research, 40, 27–35. doi:10.1080/00224490309552164

Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M. (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74, 1252–1265. doi:10.1037/0022-3514.74.5.1252

sexology survey research convenience samples random selection nonresponse self-selection socially desirable responding direct observation

reactivity penile strain gauge vaginal photoplethysmo-

graph case report experiment mean median

incidence prevalence correlation minimal risk informed consent deception debriefing confidentiality

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

2 Sexrlrgy Reseatuh: Htsnrty, Menhros, aIo Enhtus52

Bramel, D. A., (1963). Selection of a target for defensive projection. Journal of Abnormal and Social Psychology, 66, 318–324. doi:10.1037/h0044935

Gailliot, M. T., & Baumeister, R. F. (2007). Self-regulation and sexual restraint: Dispositionally and temporarily poor self-regulatory abilities contribute to failures at restraining sexual behavior. Personality and Social Psychology Bulletin, 33, 173–186. doi:10.1177/0146167206293472

Gerritsen, J., Van Der Made, F., Bloemers, J., Van Ham, D., Kleiverda, G., Everaerd, W., . . . Tuiten, A. (2009). The clitoral photoplethysmograph: A new way of assessing genital arousal in women. Journal of Sexual Medicine, 6, 1678–1687. doi:10.1111/j.1743-6109.2009.01228.x

Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? American Psychologist, 59, 93–104. doi:10.1037/0003-066X.59.2.93

Haeberle, E. J. (1983). The birth of sexology: A brief history in documents. Retrieved from http:// www.iub. edu/˜kinsey/resources/sexology.html (accessed August 26, 2013).

Haney, C., Banks, W. C., & Zimbardo, P. G. (1973). Interpersonal dynamics in a simulated prison. International Journal of Criminology and Penology, 1, 69–97. doi:10.1037/h0076835

Herbenick, D., Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14–94. Journal of Sexual Medicine, 7(Suppl. 5), 255–265. doi:10.1111/j.1743- 6109.2010.02012.x

Humphreys, L. (1970). Tearoom trade: A study of homosexual encounters in public places. London: Duckworth.

Jones, J. H. (1992). Bad blood: The Tuskegee syphilis experiment. New York: The Free Press. Karama, S., Lecours, A. R., Leroux, J.M., Bourgouin, P., Beaudoin, G., Joubert, S., & Beauregard,

M. (2002). Areas of brain activation in males and females during viewing of erotic film excerpts. Human Brain Mapping, 16, 1–13. doi:10.1002/hbm.10014

Kinsey, A., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia: Saunders.

Kinsey, A., Pomeroy, W. B., Martin, C. E., & Gebhard, P. (1953). Sexual behavior in the human female. Philadelphia: Saunders.

Kukkonen, T. M., Binik, Y. M., Amsel, R., & Carrier, S. (2007). Thermography as a physiological measure of sexual arousal in both men and women. Journal of Sexual Medicine, 4, 93–105. doi:10.1111/j.1743-6109.2006.00399.x

Laumann, E. O., Gagnon, J., Michael, R., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

Lehmiller, J. J. (2009). Secret romantic relationships: Consequences for personal and relational well-being. Personality and Social Psychology Bulletin, 35, 1452–1466. doi:10.1177/0146167209342594

Lehmiller, J. J., & Agnew, C. R. (2006). Marginalized relationships: The impact of social disapproval on romantic relationship commitment. Personality and Social Psychology Bulletin, 32, 40–51. doi:10.1177/ 0146167205278710

Lehmiller, J. J., VanderDrift, L. E., & Kelly J. R. (2011). Sex differences in approaching friends with benefits relationships. Journal of Sex Research, 48, 275–284. doi:10.1080/00224491003721694

Magoun, H. W. (1981). John B. Watson and the study of human sexual behavior. Journal of Sex Research, 17, 368–378. doi:10.1080/00224498109551127

Matthews, R. (2000). Storks deliver babies (p = 0.008). Teaching Statistics, 22, 36–38. doi:10.1111/1467-9639.00013

McConnell, J. V. (1974). Understanding human behavior. New York: Holt, Rinehart & Winston. Meston, C. M., Heiman, J. R., Trapnell, P. D., & Paulhus, D. L. (1998). Socially desirable

responding and sexuality self-reports. Journal of Sex Research, 35, 148–157. doi:10.1080/00224499809551928

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://www.iub.edu/~kinsey/resources/sexology.html

ReefeteIues 53

Milgram, S. (1963). Behavioral study of obedience. Journal of Abnormal and Social Psychology, 67, 371–378. doi:10.1037/h0040525

Parish, W. L., Laumann, E. O., & Mojola, S. A. (2007). Sexual behavior in China: Trends and comparisons. Population and Development Review, 33, 729–756. doi:10.1111/j.1728- 4457.2007.00195.x.

Plaud, J. J., Gaither, G. A., Hegstad, H. J., Rowan, L., & Devitt, M. K. (1999). Volunteer bias in human psycho-physiological sexual research: To whom do our research results apply? Journal of Sex Research, 36, 171–179. doi:10.1080/00224499909551982

Prause, N., Cerny, J., & Janssen, E. (2005). The labial photoplethysmograph: A new instrument for assessing genital hemodynamic changes in women. Journal of Sexual Medicine, 2, 58–65. doi:10.1111/j.1743-6109.2005.20106.x

Schwarz, N., Strack, F., & Mai, H. P. (1991). Assimilation and contrast effects in part–whole question sequences: A conversational logic analysis. Public Opinion Quarterly, 55, 3–23. doi:10.1086/269239

Trottier, D., Rouleau, J. L., Renaud, P., & Goyette, M. (2014). Using eye tracking to identify faking attempts during penile plethysmography assessment. Journal of Sex Research, 51, 946–955. doi:1 0.1080/00224499.2013.832133

Wiederman, M. (2001). Understanding sexuality research. Belmont, CA: Wadsworth. Yeater, E., Miller, G., Rinehart, J., & Nason, E. (2012). Trauma and sex surveys meet minimal risk

standards: Implications for institutional review boards. Psychological Science, 23, 780–787. doi:10.1177/ 0956797611435131

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©Jeff Thrower, 2013. Used under license from Shutterstock.com.

CHAPTER OUTLINE

Introduction, 55 Male Sexual Anatomy, 55

A Historical and Cultural Overview of the Penis, 55 External Anatomy, 56 Internal Anatomy, 60 Psychology of the Penis: Male Genital Concerns, 63 Male Genital Health Issues, 65

Female Sexual Anatomy, 66 A Historical and Cultural Overview of the Vulva, 66 External Anatomy, 67 Internal Anatomy, 72 Breasts, 74 Psychology of the Breasts and Vulva: Female Bodily Concerns, 75 Female Breast and Genital Health Issues, 78

Conclusions, 81

Human Sexual Anatomy

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Introduction

“What's the average penis size?” “Can a woman have an orgasm without clitoral stimulation?” “Does penis size really matter?” “Is female ejaculation real?”

The above questions were asked by college students taking my human sexuality course, but not just once—these and many other such questions have come up semester after semester. As a result, I have come to realize that most students taking this course never learned the things they really want and need to know about their bodies and their sexuality. The goal of the cur- rent chapter is to address this fundamental need.

You may be wondering why you are reading an entire chapter about human anatomy in a psychology textbook, but I can assure you that there are several good reasons for it. For one thing, many people are unfamiliar with the exact names and locations of certain portions of their genitalia. To the extent that this lack of information prevents you from knowing what is and is not normal, that can create a number of problems. For instance, if you do not know how things are supposed to look or function, you will be unable to identify potential health threats. Likewise, lacking knowledge about your own physique can cause unnecessary anxiety about body image, which can feed into sexual dysfunction and relationship problems. Lacking knowledge about a partner’s body can lead to similar issues by reducing sexual satisfaction for the both of you. As we will see in chapter 13, one of the first steps involved in many forms of sex therapy is giving the client(s) specific information, often consisting of the anatomy lesson you will get in this chapter. This alone is enough to solve many sexual problems. Thus, learn- ing about anatomy has definite psychological importance because it can help you to feel better about yourself, enhance the quality of your sex life, and potentially prevent future problems from developing in your sexual relationships.

We will begin by covering genital anatomy in men, followed by women. However, as we dis- cuss anatomy, please keep in mind that not everyone who has a penis necessarily identifies as a man and not everyone with a vulva necessarily identifies as a woman. One’s gender identity does not always match one’s genital anatomy. Also, keep in mind that not every person has a penis or a vulva. For example, intersexed individuals may have genitals that appear to be a mix of male and female genital structures. We will return to these points in chapter 5 when we dis- cuss gender issues in more detail. For the time being, however, we will describe genital anatomy in terms of how things typically appear and function in most biological men and women.

Male Sexual Anatomy

A Historical and Cultural Overview of the Penis

Humans have been obsessed with the penis for thousands of years. However, the nature of phallic attitudes has varied considerably. At times, the penis has been celebrated and openly displayed as a symbol of fertility. This view was perhaps best exemplified by the ancient Romans, who surrounded themselves with artistic representations of penises in everyday life. For instance, it was once considered a sign of prestige for Roman boys to wear a tiny replica of an erect penis around their neck known as a fascinum (on a side note, the word “fascinating” is derived from fascinum. Thus, when we say that something is “fascinating,” we are actually lik- ening it to the wonders and intrigue of nothing other than the penis!) At other times, however,

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the penis has been seen as vulgar, and every effort has been made to hide it from view. This has been the case throughout much of recent history. The penis has little place in the modern media (e.g., when was the last time you saw a penis on primetime TV?), and it makes only infrequent appearances in the world of art. In fact, it is not uncommon to see artistic repre- sentations of the penis painted over in pictures or broken off of sculptures so as to keep any semblance of the penis out of public view.

Given that much of the modern world is anti-penis, most of us know relatively little about it, including how it works and how it is “supposed” to look. This has led to a lot of penile mis- conceptions and misinformation. For instance, many people think that the penis consists of muscles and/or bone, when in reality it is composed mostly of fibrous tissue and blood vessels. Thus, despite the fact that an erection is often referred to as a “boner,” there are no bones in the human penis. In contrast, some other species, such as chipmunks and dogs, do have a penis bone (known as the baculum), which assists during sexual intercourse. Another thing people frequently get wrong when it comes to the human penis is that they assume it is supposed to be extremely large, like the ones they may have seen in porn videos. Many people also assume that bigger is better when it comes to penises, such that men who are more well-endowed are more sexually satisfied and better able to please their partners. However, as we will see later in this chapter, this is not necessarily the case.

External Anatomy

With the preceding in mind, let us begin our discussion of the external sexual anatomy of biological men. The penis consists of three parts: the root, shaft, and glans. The root is the completely internal portion of the penis that serves to anchor it to the pubic bones. The shaft and glans are the external portions of the penis that are visible to the naked eye. The shaft (in its non-aroused state) is loose and pendulous, and is usually covered with hair at the base.

Figure 3.1 In recent history, the penis has largely been seen as vulgar and makes infrequent appearances even in artistic depictions of the male body. ©Karashaev under Shutterstock.com.

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The glans (head) sits at the end of the shaft and contains the urethral opening (meatus). The glans is the most sensitive portion of the penis, containing the largest concentration of nerve endings.

At the base of the glans is the corona (“crown”), which is the distinctive ridge encircling the head. The flared shape of the glans and the surrounding corona is theorized to have evolved that way as a potential “semen displacement device” (Gallup et al., 2003). That is, the unique shape of the penis combined with the thrusting action of intercourse may exist to enable men to remove any semen deposited in the female reproductive tract by other men before deposit- ing their own. In fact, research by Dr. Gordon Gallup and colleagues in which they simulated intercourse with artificial penises, ejaculate, and vaginas found that just one thrust of their mock penis was enough to displace more than 90% of any previously deposited “ejaculate.” They tested a variety of alternative “penises” that did not have the same features (i.e., penises without a flared glans and corona), but found that they were far less effective at semen dis- placement. Of course, we cannot say for sure why the head of the penis has the shape that it does, and Gallup’s theory has been disputed by others. For example, Bowman (2013) argues that because sperm travel into the uterus very quickly, and any sperm remaining outside the uterus will not live long in the acidity of the vagina anyway, semen displacement is unlikely to have significant effects on conception likelihood. Bowman’s argument is that the penile glans is instead optimized for absorption of chemicals in the vaginal secretions, such as oxytocin (see chapter 4), which helps facilitate bonding between partners. Some scientists think that such bonding is adaptive in that it helps facilitate the survival of any offspring produced.

Covering the corona and glans is the foreskin (prepuce), a loose and retractable layer of skin that can be thought of as a sheath for the head of the penis. Not all men have foreskin because it is sometimes removed during infancy in a procedure known as circumcision. For men who retain their foreskin into adulthood, it requires proper care and attention. Specifically, it is important for the foreskin to be gently pulled back and cleansed with some regularity to pre- vent the buildup of smegma, a smelly, cheese-like substance that consists of an accumulation of glandular secretions and dead skin cells.

In the United States, just over half of all male infants today are circumcised, although the per- centage of parents opting for this procedure has decreased dramatically in recent years (Cent- ers for Disease Control and Prevention, 2011). Circumcision rates in other countries around the world vary, with the highest rates in the Middle East and the lowest rates in Europe. There are vast differences in opinion on this procedure, which has made it a subject of hot debate. See the Digging Deeper 3.1 box for a discussion of some of the oft cited pros and cons of male circumcision. It is also worth pointing out that foreskin cutting may take other forms in differ- ent cultures. For instance, in some Polynesian cultures, a procedure known as a superincision (sometimes called a dorsal slit) is performed, in which a lengthwise slit is made in the upper portion of the foreskin (Diamond, 2004). This reveals the glans of the penis without necessarily removing the foreskin.

Removal or cutting of foreskin is obviously one major factor that affects the external appear- ance of the penis. However, penises also vary substantially in terms of several other features, including the presence or absence of pubic hair, degree of curvature, and overall length. First, pubic hair naturally varies from man to man in terms of density, color, and coarseness. Of course, some men opt to trim and, in some cases, completely shave off their pubic hair for a variety of reasons (e.g., some men prefer the sensation of no hair, while others think it makes their genitals look larger). Male pubic hair removal is becoming increasingly common, with survey studies finding that most men under 50 have done it at least once before, with gay men being some- what more likely to report having removed their pubic hair than heterosexual men (Martins,

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Digging Deeper 3.1 Should Men be Circumcised?

Circumcision used to be performed on virtually all infant boys in the United States. However, this practice has become increasingly controversial and the number of US parents opting to sub- ject their male children to it has dropped to 55–57% (Centers for Disease Control and Preven- tion, 2011). Many parents have asked me whether circumcision is a good idea. Although there are strong arguments for and against it, no scientific consensus exists.

One argument in favor of circumcision is that it serves religious and cultural purposes. For instance, this procedure is commonplace in the Jewish religion, where it has a basis in scrip- ture and is performed during a bris eight days after birth. Circumcision is frequently practiced in Islamic cultures as well, although it is typically performed at puberty as a rite of passage instead of during infancy. The other major argument on this side is that circumcision provides hygienic and health benefits. For example, circumcision is a medical treatment for a condition known as phiotsis, in which one’s foreskin is too tight and is not easily retracted, thereby creating painful erections. In addition, circumcision is linked to a reduced risk of contracting sexually transmitted infections, including HIV. The thought here is that the foreskin contains certain cells that are highly susceptible to infection, and by removing them, it may cut off that route to disease transmission. A clinical trial in Africa in which adult men were either circumcised or not (voluntarily, of course) had to be called off because the observed rate of contracting HIV was so much lower among newly circumcised men that ethical concerns were raised about withholding circumcision from men who still had their foreskin (Roehr, 2007). Other studies have shown that circumcision is linked to a reduced risk of contracting the human papilloma virus (HPV; Larke, Thomas, Dos San- tos Silva, & Weiss, 2011a) and syphilis (Weiss, Thomas, Munabi, & Hayes, 2006), as well as a lower likelihood of developing penile cancer (Larke, Thomas, Dos Santos Silva, & Weiss, 2011b). There is no evidence that circumcision necessarily harms sexual functioning either. A meta-analysis of the research in this area found that circumcision was not related to negative effects on genital sensation, sensitivity, or sexual satisfaction (Morris & Krieger, 2013). This research, combined with a low rate of side effects, has resulted in significant support for circumcision within the medical community.

On the other hand, however, circumcision research has been critiqued by those who argue that any STI-preventative benefits of circumcision are culturally relative and that we cannot generalize research on circumcision in Africa to the rest of the world. If circumcision were really so beneficial, they argue, we would expect to see that rates of HIV and other STIs are lower in the United States (where most men are circumcised) than they are in Europe (where most men are uncircumcised); however, we see precisely the opposite pattern (more on this in chap- ter 12)! In other words, there’s not a lot of evidence that high rates of circumcision in the United States are improving American men’s sexual health. Others have argued that circumcision should never be performed unless there is a true medical need and that routine circumcision amounts to nothing more than male genital cutting/mutilation. They believe that everyone has the right to an intact body, and that extends to the sexual organs (Hammond, 1999). As a result, some see it as cruel to irreversibly modify another person’s body, especially when they cannot consent to the procedure themselves. Likewise, others have focused on the pain and trauma that circumcision is likely to cause to male infants, given that anesthetics are not always used (particularly when the procedure occurs as part of a religious ritual). Some have argued against the religious practice of circumcision, suggesting that it is an affront to try and improve upon God’s creation. Yet one additional argument is that if delaying circumcision until adulthood can still yield potential health benefits, such as reducing HIV risk (Roehr, 2007), why not let men decide whether they want the procedure when they become adults and can evaluate the pros and cons themselves?

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Tiggemann, & Churchett, 2008). Second, with respect to curvature, it is normal for penises to not be perfectly straight and instead curve slightly to one side or the other. In cases where there is a severe curvature (known as Peyronie’s disease, caused by a build-up of scar tissue), intercourse may be difficult and painful. However, surgical intervention can correct this. Third, penile length can vary considerably. A review of 20 studies of penis size that, together, included over 15,000 male participants who had their penises measured by trained clinicians revealed that the median (i.e., 50th percentile) flaccid penis length was 3.6 inches (9.2 centimeters) and the median circumference was 3.7 inches (9.3 centimeters; Veale et al., 2015). This same review reported that, for an erect penis, the median length was 5.2 inches (13.1 centimeters) while the median circumference was 4.6 inches (11.6 centimeters). Most men appeared to fall within a relatively narrow range, with men in the 25th percentile measuring about one centimeter less on each dimension, and men in the 75th percentile measuring about one centimeter more; how- ever, at the extreme ends of the spectrum, measurements were dramatically different. That said, keep in mind that conclusions from this review are limited because observational studies have a selection bias. For example to the extent that these studies disproportionately sampled men who are more comfortable with their bodies and, therefore, have larger than average penises, these numbers might actually be overestimates. One final note about penis size is that some studies have suggested that there are racial differences, and that those differences are consistent with common stereotypes, with men of African descent tending to be above average and men of Asian descent tending to be below average (Lynn, 2013). However, these data are based almost exclusively upon self-reports of men from nonrepresentative Internet samples, which means that a hefty dose of caution is in order when considering these findings. The question of racial differences in penis size is one that remains controversial and is far from settled.

Aside from the penis, the other major external portion of male sexual anatomy is the scrotum. The scrotum is a pouch of skin hanging behind the penis that houses the testicles. The scrotum is sparsely covered in hair (although, as previously mentioned, some men opt to shave it off ) and usually hangs loosely. However, in colder temperature and during sexual excitation, the scrotum elevates closer to the body. Like the penis, scrotal appearance varies from man to man, particularly in terms of size and symmetry. It is difficult to say what the average scrotal size is because most studies have measured only the size of the penis. With respect to appear- ance, it is perfectly normal for men to have an asymmetrical scrotum where one side hangs lower than the other. Specifically, the left testicle tends to hang lower than the right, generally because the spermatic cord (which suspends the testicles inside the scrotum) it typically longer on the left side.

It is also worth mentioning that some men regret having had their foreskin removed. This includes some men who made this decision themselves as adults, as well as some men who had this decision made for them when they were children. A few of these men have gone to great lengths to have their foreskin restored, either surgically (using skin grafts) or non-surgically (using weights to stretch existing penile skin over a period of years); however, these procedures carry risks and we do not have good data on the outcomes (Brandes & McAninch, 1999). Because regret is a possible outcome, we cannot predict who will and will not experience regret, and foreskin cannot be easily replaced, some have argued that the decision to circumcise should not be taken lightly.

As you can see, there are compelling arguments on both sides of this issue that make it difficult to state whether circumcision is categorically good or bad. The important thing is to educate yourself about the different perspectives and come to your own conclusions.

Note: Reprinted with permission from lee MAd Psmchtatgm (www.lehmiller.com).

Digging Deeper 3.1 (Continued)

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Internal Anatomy

We begin our discussion of the internal workings of the penis by considering the makeup of the shaft and glans. The shaft is composed of three long cylinders, all of which fill with blood during sexual arousal, thereby creating an erection. Two of these cylinders are known as the cavernous bodies (corpora cavernosa) and run right next to each other on the upper portion of the penis. Sitting below the cavernous bodies is the smaller spongy body (corpus spongio- sum), which encases the urethra (i.e., the tube that carries urine and semen out of the body) and expands to become the glans.

At the base of the penis is a complex musculature. The muscles here are used primarily to eject semen from the body during ejaculation. These muscles can be strengthened by doing Kegel exercises, and men who practice these exercises frequently tend to report more ejacu- latory control and better orgasms. Because of these benefits, Kegel exercises are sometimes used as a treatment for premature ejaculation (LaPera & Nicastro, 1996). These exercises are easy enough to do (if you have a penis you can even do them while you read this book, if you like). The muscles you are looking to strengthen are the ones you would use to stop the flow of urine midstream. Once you know which muscles to exercise, you simply start by squeezing and releasing them rapidly several times. When you are comfortable doing a lot of repetitions, add in some “long Kegels,” where you squeeze the muscles for a few seconds before releasing them. After a few weeks of daily exercise, the benefits are likely to start kicking in.

Inside the scrotum are the testes, or male gonads, which are suspended by the spermatic cord. Most men have two testes that are usually similar in size, with each serving two func- tions: (1) production of sex hormones (largely testosterone) and (2) production of sperm. On an interesting side note, there are some who argue that testicle size (like the distinct shape of the penis) is an evolutionary adaptation, such that the testes tend to be larger in societies that have historically had more “sperm competition” (see Ryan & Jetha, 2010). In other words, in societies where men tend to clash over access to mates, testicle size may be larger in order to enable more sperm production and, hence, the potential for intravaginal sperm wars when

Figure 3.2 The appearance of the penis and scrotum varies substantially across persons. ©stnu (Own work) [CC-BY-SA-2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons.

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multiple men have had sex with the same woman. We cannot definitively say why any differ- ences in testicle size might exist across people of different races and ethnicities; however, we will consider some additional evidence for sperm competition theory at the end of this section.

Returning to testicular functions, sperm production begins inside the testes in a series of tightly coiled tubes known as the seminiferous tubules. This is where the manufactur- ing of sperm occurs. Sperm production begins at puberty (a developmental stage known as

Figure 3.3 ©Ramjet (Own work) [CC-BY- SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

Figure 3.4 ©Krittika (Own work) [CC-BY-SA -3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

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spermarche) and continues through old age. The interstitial cells, which sit in between the seminiferous tubules, carry out the testes’ other job: production of sex hormones. These cells secrete hormones directly into the bloodstream.

In order for healthy sperm production to occur inside the testes, a constant temperature must be maintained. The testes sit outside of the body and maintain the ideal temperature for sperm health, which is slightly below a man’s normal body temperature. However, in order to account for the rapid temperature changes we experience throughout the day, the testes are capable of moving closer or further from the body via the cremaster muscle. In warmer tem- perature, the muscle relaxes, letting the testes fall further from the body; in colder temperature, the muscle contracts, drawing the testes in and generating “shrinkage.” Because this tempera- ture regulation is so vital for sperm health, men who have undescended testes (or in medical terms, cryptorchidism) are infertile.

After sperm are produced in the seminiferous tubules, they proceed to the epididymis, where they are stored for several weeks to allow them time to mature. The epididymis is shaped like a crescent moon and sits on the top and back of each testicle. Eventually, sperm are carried away from the epididymis via the vas deferens. Because the vas deferens is what transports sperm from the testes, this is the tube that is cut during a vasectomy (a procedure we will cover in more detail in chapter 11). The vas deferens exits the scrotum through the spermatic cord, goes up into the abdomen, and loops around the bladder before joining up with the prostate.

The portion of the prostate where the vas deferens enters is known as the ejaculatory duct, which empties into the urethra. In the ejaculatory duct, sperm from the vas deferens mix with secretions from the seminal vesicles and the prostate to create semen. The seminal vesicles are two small glands that empty into the ejaculatory duct. They produce the bulk of the seminal fluid (60–70% of the volume) by secreting an alkaline, sugary substance that appears designed

Cavernous body

Urethra

Bladder

Prostate

Cowper’s gland

Anus Vas deferens

Epididymus

Testis

ScrotumMeatus

Glans

Seminal vesicle

Ejaculatory duct

Figure 3.5 The male reproductive system. ©Tsaitgaist (Derivative work) [CC-BY-SA-3.0 (http:// creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

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to enable nutrition and survival of sperm (Gonzales, 2001). Once sperm come into contact with these secretions, they gain the ability to move on their own.

The remaining portion of the seminal fluid (30–40%) is produced by the prostate gland. The prostatic secretions are also very alkaline, which aids sperm survival in the acidity of the male urethra and the female reproductive tract. The prostate gland, which sits just below the blad- der, is sometimes referred to as the male equivalent of the G-spot (sometimes referred to as the P-spot), because some men have reported that prostate stimulation results in very intense orgasms. The prostate gland can be stimulated gently through rectal insertion, or by pressing on the perineum (the strip of skin that runs between the scrotum and the anus).

Where the ejaculatory duct empties into the urethra, there are the two small Cowper’s glands (bulbourethral glands). As a man becomes sexually aroused, these glands release a small amount of fluid that will appear as a drop or two on the glans prior to ejaculation. This pre- ejaculate is thought to alkalinize the urethra, making it more hospitable for sperm to travel through. Although this secretion is not semen, it can potentially contain active sperm. In one study, male participants were instructed to touch a Petri dish to the tip of the penis while mas- turbating if any fluid appeared prior to ejaculation (Killick et al., 2010). It turned out that 41% of the obtained samples contained sperm. What this means is that, even if a male–female couple stops sexual intercourse before the man ejaculates, it is theoretically possible for a pregnancy to occur and, of course, for sexual infections to be transmitted as well.

During ejaculation, semen is released from the body via contractions of the urethra and the muscles at the base of the penis. The amount of semen expelled varies from man to man and depends upon a number of factors (e.g., a longer duration of sexual activity will typically produce more semen); however, it consists of one or two teaspoons of fluid on average. Each ejaculate contains hundreds of millions of sperm. Given that a single sperm cell is necessary to fertilize an egg, the huge number of sperm produced is yet another theorized evolutionary adaptation (i.e., men may have evolved a tendency to produce sperm in such large quantities as a way of competing with other men’s sperm in the female reproductive tract; Baker & Bel- lis, 1993). The concept of human sperm competition is a controversial and unsettled subject, but researchers have produced some provocative evidence in support of this idea. For example, in one study, heterosexual male participants who viewed erotic images depicting two men with one woman (a scenario suggestive of sperm competition) subsequently produced ejaculate containing more active sperm than male participants who viewed erotic images consisting of three women together (Kilgallon & Simmons, 2005).

Psychology of the Penis: Male Genital Concerns

The biggest concern men have about their genitals is penis size. Although survey studies have reported that the majority of gay (65%) and heterosexual men (55%) sampled were satisfied with their penis size, there was a substantial minority who wished they could change it (Grov, Parsons, & Bimbi, 2010; Lever, Frederick, & Peplau, 2006). Among the latter, there was an almost unanimous desire to be larger; less than 1.5% of men of both sexualities wished for a smaller penis. Many of those men who were unhappy with their penis size were of average or above average size to begin with. So why do they want to change? Probably because we are surrounded by constant media messages telling us that “bigger is better” and “size matters.” In addition, the penises that appear in most porn videos are much larger than average, and measuring up to them is enough to make almost any guy feel inadequate. Unfortunately, most men fail to recognize just how rare those gigantic porn penises actually are. In fact, research- ers estimate that only about 2.5% of men have penises larger than 6.9 inches (17.5 centimeters; Lever et al., 2006).

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As a result of the pressure to be big, many guys have gone to great lengths to try and increase the size of their penis, including everything from the pursuit of penile augmentation surgeries to the use of “natural male enhancement,” stretching devices, and vacuum pumps. It is impor- tant to note that none of these techniques have been subject to rigorous scientific testing and, thus, it is not clear whether any provide the benefits frequently touted on the Internet and in popular men’s magazines. In fact, these methods can be quite dangerous and carry the risk of potentially serious side effects. For example, penile augmentation surgery (also known as phal- loplasty) usually involves cutting the ligaments that attach the penis to the pubic bone (which theoretically increases length by letting more of the penis hang outside of the body) and/or adding tissue grafts or fat injections to the penile shaft (the goal of which is to increase penile “girth” or circumference). Many men who have undergone phalloplasty have been disfigured and have required follow-up surgery to correct some of the complications, which frequently include scarring, penile lumps, and an erection that points down instead of up (Alter, 1997; Dillon, Chama, & Honig, 2008).

So what is all the fuss about? Does penile size really matter? Yes and no. First, men with larger penises typically report better body image (Lever et al., 2006) and greater psychosocial adjust- ment (Grov et al., 2010). Thus, having a larger penis may make men feel better about themselves. Some guys appear to let this go to their head, though, because well-endowed men also tend to be more narcissistic (i.e., self-obsessed; Moskowitz, Rieger, & Seal, 2009). In addition, having a bigger penis does not necessarily translate into a greater ability to please a sexual partner. For example, as you will see when we cover female sexual anatomy, most of the nerve endings in the female genital area are on the outside of the body, not inside of it. Thus, a penis capable of deeper penetration does not necessarily result in a more pleasurable experience for women. Consistent with this, the vast majority of heterosexual women (85%) report being satisfied with the size of their partner’s penis (Lever et al., 2006). Likewise, in a study that surveyed women about penis

Figure 3.6 Penis size is one of men’s biggest body concerns. Some men pursue dangerous and untested treatments with the hope of enhancing the size of their genitals. ©PrinceOfLove, 2016. Used under license from Shutterstock.com.

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length and sexual pleasure, most women (66.3%) reported that size made no difference in their own pleasure or that shorter than average penises were more pleasurable than longer penises (Costa, Miller, & Brody, 2012). Thus, women certainly do not seem to be clamoring for larger male genitals. Of course, there are some women who prefer larger penises and who find them to be more sexually pleasing; however, the majority of women appear to be content with their partners’ penis just the way it is, and most of those penises are of average size.

How does penis size play out with respect to sexual satisfaction in male same-sex relation- ships? Unfortunately, we do not have enough empirical data to address whether gay and bisex- ual men are typically content with their partners’ penis size and the implications this might have for sexual pleasure and enjoyment. However, I would theorize a similar pattern such that most would be satisfied with their partners’ size and, furthermore, that penis size would not necessarily affect likelihood of orgasm. I should also add that regardless of whether a man’s partner is male or female, smaller penises may be preferred to larger penises for certain sexual activities that people sometimes find to be painful (e.g., anal sex).

Although size concerns are largely confined to the length and width of the penis, there are some men who are dissatisfied with the size of their scrotum. Among the men who believe their scrotum is too small, a growing number of them have resorted to self-injecting saline solution into their scrotums in order to temporarily increase its size (Summers, 2003). There are also some men who do this because they enjoy the feeling of a distended scrotum and find it to be sexually pleasurable (i.e., it has a fetish quality to it). The fluid is usually absorbed by the body within a few days, after which time the genitals return to their normal appearance. However, this procedure is very risky and can result in serious complications (e.g., it could result in sterility if the testes themselves were injected or, potentially, an embolism should air be injected into a vein). Indeed, there are several care reports in the literature of men who have wound up in the emergency room after engaging in some variation of this practice. As a result, no matter what you read on websites about “scrotal infusion” or “scrotal inflation” being harmless, it should be avoided. Among the men who believe their scrotum is too large or too droopy, some doctors are performing scrotum reduction surgery (CBS News, 2012). Thus, male genital modification is certainly not confined to the penis!

It is important to note that male genital concerns vary considerably across cultures. Thus, not every culture is equally obsessed large penises, and some cultures have their own unique genital concerns. Two such concerns that are practically nonexistent in the modern Western world are dhat and koro (Bhugra, Popelyuk, & McMullen, 2010). Dhat, which is found almost exclusively on the Indian subcontinent, is anxiety that stems from a fear of semen loss. Persons with dhat believe that semen is made from blood, and that it takes a significant amount of blood to make even a very small amount of semen. As a result, semen is seen as a very precious and vital bodily fluid, and loss of it (e.g., through masturbation, nocturnal emissions, etc.) cre- ates anxiety and depression. In contrast, koro (found most commonly in southeast Asia) is a fear that the penis is shrinking and retracting inside the body, which creates anxiety and panic. It is thought that the term “koro” is derived from the Japanese word for “tortoise.”

Male Genital Health Issues

It is important for men to take proper care of their genitals because not only are they delicate, but they are a common site of infection and other potential health problems. First, regular geni- tal cleansing can prevent the buildup of smegma in uncircumcised men. Some in the medical community have also argued that washing one’s genitals before and after sex may reduce the likelihood of transmitting certain infections, but research in that area has been mixed and, make

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no mistake, regular washing is in no way a substitute for safer sex practices (i.e., condom or other barrier use).

Second, take care when trimming or removing pubic hair. Serious injuries related to groom- ing of pubic hair are rare, but they can happen. In fact, one study estimated there to be almost 12,000 emergency room visits between 2002 and 2010 in the United States that stemmed from such injuries (Glass et al., 2012)! Men made up about 43% of the incidents, which mostly involved cuts to the scrotum and penis. Approximately 1 in 5 incidents arose from use of scis- sors, which are not an advisable tool for pubic hair grooming under any circumstances. Instead, consider an electric shaver with a pubic hair setting or use a new, high quality safety razor—and avoid shaving while you are in a hurry and, especially, if you are inebriated.

Third, regular self-exams of the penis and scrotum can reveal signs of sexually transmitted infections and cancers. We will talk more about potential infection signs you should look for in chapter 12 when we cover sexually transmitted diseases in detail. With respect to signs of cancer, check for any kinds of bumps or masses on each of the testicles once per month. Men can do this by rolling each testicle gently between the thumb and forefinger. The surface should feel smooth, except for the epididymis, which hangs over the back of each testicle. Be sure to check for any sores or growths on the penile shaft and glans as well. Any time you detect one of these things, it is important to get it checked out by a doctor, even if you are not experiencing any pain. Many of the early signs and symptoms of testicular and penile cancer are completely painless, but can progress into major problems and potentially become deadly if left untreated. Fortunately, survival rates for both of these cancers are high if caught and treated early.

Lastly, it is important to be careful with the penis during sexual activity. For example, although you know there are no bones in the human penis, you should be aware that it is still possible to fracture an erect penis during sexual activity (Yapanoglu et al., 2009). What happens in such cases is a rupturing of the cavernous bodies due to some type of blunt trauma (e.g., attempt- ing very forceful intercourse and missing one’s target). Penile fractures are usually reported as being very painful and they have the potential to result in deformity and sexual dysfunction. However, if treated appropriately, normal functioning may return. It is also important for men to take great care when inserting their penis into any type of sex toy or (I wish I did not have to say this) household appliance. With respect to sex toys, be careful with “cock rings.” These are circular pieces of rubber or metal that tightly grip the base of the penis, with the goal of generating longer-lasting and fuller erections. If you use one of these rings, it is advisable not to wear it for more than thirty minutes at a time, otherwise it can cause death of penile tissue and lead to permanent erectile difficulties. Thus, do not put it on before you head out to the bar for the evening or fall asleep wearing it. With respect to household appliances, please watch where you put your penis! Over the years, I have read news stories about men putting their penises in everything from swimming pool suction pumps to vacuum cleaners, and these stories often do not have happy endings, ranging from embarrassing rescues from the local fire department to penile decapitation. Ouch.

Female Sexual Anatomy

A Historical and Cultural Overview of the Vulva

Throughout history, attitudes toward the vulva have varied just as much as attitudes toward the penis. In the earliest of times, the vulva was seen as the source of life and was prized above all other fertility symbols (Blackledge, 2003). In fact, the penis did not even become a fertility symbol until long after the vulva, because early societies did not necessarily see a direct link

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between the penis and childbirth. Thus, artistic representations of the female body and genita- lia were common and celebrated. More recently, however, the vulva has been seen as both dirty and pornographic—something that should be hidden. This idea is reflected in the fact that in the Western world, the female genitals are often referred to as the pudendum, which comes from the Latin word pudere, literally meaning “to be ashamed.” Also, like the penis, the vulva has no place in the modern media. It is certainly not visually depicted, and the only time it is even alluded to is in advertisements for “feminine hygiene products,” which perpetuate the idea that the female genitals are unclean.

Because our world is rather anti-vulva, most people (both men and women) know relatively little about it. For instance, most of us do not know how the vulva is “supposed” to look because it is something we see so rarely. Not only does this generate unnecessary anxiety for a lot of women who wonder whether they look normal, but this lack of familiarity with the female geni- talia creates confusion for women and their sexual partners because they often have no idea what the different structures are and how they function. This also contributes to misinforma- tion about female sexuality, such as the idea that all women “should” experience orgasm from vaginal penetration. As we will see later in this chapter, however, vaginal penetration is not the primary means by which most women reach orgasm.

External Anatomy

With this information in mind, let us discuss external sexual anatomy in biological women. The collective term that encompasses all of the external genital structures is the vulva. The vulva thus includes everything from the pubic hair to the labia to the vaginal opening. You may or may not realize this, but vulvas (like penises) can come in all different shapes and sizes. Its appearance can be incredibly variable.

One of the most prominent parts of the vulva is the mons veneris (mons pubis). This is the pad of fatty tissue that covers the front portion of the pubic bones. The mons contains many nerve endings, which makes compression of this tissue sexually pleasurable. The primary pur- pose of the mons would seemingly be to protect the internal genital structures during sexual activity. Although the mons is typically covered with pubic hair in adulthood, Western women are increasingly opting to have this hair partially or wholly removed through shaving, waxing, and/or laser treatments, usually because they feel it improves the aesthetic appearance of their genitals or makes them feel “sexier.” Research finds that most women under age 40 report hav- ing removed at least some of their pubic hair in the last month and, further, that those who remove some or all of their pubic hair report having more sex than women who go au naturel (Herbenick, Schick, Reece, Sanders, & Fortenberry, 2010); however, we do not know if that is because women who shave are simply more sexually active, or if shaving begets more sex.

Next, we have the labia. The labia majora (outer lips) are folds of tissue usually covered with pubic hair that begin at the mons and extend downward, encasing most of the remaining geni- tal structures. The labia minora (inner lips) are hairless folds of tissue situated between the outer lips that serve to protect the vaginal and urethral openings. The labia are richly endowed with nerve endings and blood vessels. As a result, they are very responsive to stimulation and they swell and deepen in color during sexual arousal. The labia may take on incredibly different appearance from one woman to the next, with wide variation in how prominent and sym- metrical the lips are. Some women are concerned about the appearance of their labia, at least partly because we typically only see “perfectly” shaped and proportioned labia in pornography. In fact, research has found that in the last few decades, the labia minora have almost become invisible in certain types of pornography (Schick, Rima, & Calabrese, 2010). Perhaps as a result, labial reduction surgery has become increasingly common. However, a recent study of women

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undergoing this procedure found that all of the women actually had normal sized labia to begin with (Crouch, Deans, Michala, Liao, & Creighton, 2011)! Thus, just as it is important for men to avoid comparing their penises to those that they see in porn, women should refrain from making the same comparisons with their vulvas.

Just below the mons, the inner lips join to form the prepuce (clitoral hood). The prepuce is akin to the male foreskin and provides a loose covering over the clitoris. As we discussed in our section on male anatomy, it is important for men to thoroughly cleanse their foreskin to avoid the buildup of smegma. It is equally important for women to gently wash under the prepuce for the same reason.

Figure 3.7 The appearance of the vulva can vary widely. ©Hutanisa, Ingrid w, Peter Klashorst, Amateurlover, and Knuter (Derivative work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

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The clitoris is composed of a glans, a shaft containing two cavernous bodies, and crura that anchor it to the pubic bone (O’Connell, Sanjeevan, & Hutson, 2005). Given the structural simi- larities between them, the clitoris is often likened to the penis; of course, it could just as easily be claimed that the penis is like the clitoris, depending on your point of reference. The glans may be seen by gently retracting the clitoral hood, whereas the shaft and crura are completely inter- nal. Because the clitoris contains erectile tissue, it increases in size during sexual arousal. Thus, women technically get erections, too, although they are not quite as prominent as men’s tend to be. As with all features of the vulva, there is wide individual variability in the size of the clitoris.

The clitoris is unique in the sense that its sole purpose is to provide sexual pleasure—there is no other organ in the human body (male or female) like it. Although relatively small in size, the clitoris contains about as many nerve endings as a penis and is therefore a major source of sexual pleasure. Given this information, it should come as no surprise that the most com- mon means by which women reach orgasm is through clitoral stimulation, not vaginal pen- etration (Fugl-Meyer, Oberg, Lundberg, Lewin, & Fugl-Meyer, 2006). Some research suggests that women who experience orgasm during vaginal intercourse are the beneficiaries of an ana- tomic variation in which their clitoris is closer to their vaginal opening than usual (Wallen & Lloyd, 2011). Specifically, when the distance between these structures is one inch (2.5 cen- timeters) or less, the clitoris is likely to receive more friction during vaginal penetration. For women who have a larger distance between the clitoris and vagina, they may find it easier to orgasm during intercourse by trying different sexual positions or different pelvic movements that enhance clitoral contact.

Because of the unique role the clitoris plays in producing female sexual pleasure, it has become one of the most controversial aspects of female genitalia. In fact, in some cultures, the clitoris is surgically removed for a variety of social and religious reasons. For a more in-depth discussion of this topic, see the Digging Deeper 3.2 box.

Continuing our discussion of the vulva, within the labia minora is a region known as the vestibule, which houses the openings to the urethra and the vagina. The meatus (i.e., the ure- thral opening) is located between the clitoris and vaginal opening and has excretory functions. The introitus (i.e., the vaginal opening) is situated between the urethral opening and the anus. On either side of the introitus are the Bartholin’s glands, which secrete a drop or two of fluid during sexual arousal, perhaps to create a genital scent; however, scientists do not necessarily agree on the precise function of the Bartholin’s secretion. The introitus is partly covered by a thin, circular piece of tissue known as the hymen, another structure that has a variable appear- ance. In fact, scientists have described as many as seven different types of hymens, includ- ing the annular (which has a rounded appearance and one hole in the center), septated (in which a strip of tissue in the center of the hymen creates two holes), and cribiform varieties (a hymen with several small holes in it; Stukus & Zuckerbraun, 2009). The hymen often remains intact until a woman’s first intercourse, although it frequently breaks sooner as a result of other activities (e.g., masturbation, athletics). In fact, in one study involving medical examinations of female virgins, just 57% were observed to have an intact hymen, which indicates that this struc- ture is not necessarily a reliable sign of virginity status (Underhill & Dewurst, 1978). When the hymen initially breaks, it may be accompanied by light bleeding and some pain, but it is usually not a traumatic experience, especially among women who practice stretching it out prior to their first sexual experience.

The thickness and appearance of the hymen varies across women. In fact, some women’s hymens are so thick that they are difficult to break during intercourse and, on rare occasions, the hymen may close off the entire vaginal opening, not even allowing menstrual blood to flow out (this is known as an imperforate hymen). In these cases, medical intervention is usually nec- essary to allow intercourse and to prevent women’s sexual partners from mistaking the meatus

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Digging Deeper 3.2 Female Genital Cutting: What is it, and What Should Be Done about it?

Female genital cutting (FGC) involves permanently damaging or removing portions of a wom- an’s external genitals when it is not medically necessary. FGC has been practiced in many parts of the world for centuries, but today is most commonly performed in Africa and the Middle East, where millions of women have undergone some variation of it. FGC is done for a variety of rea- sons, with one of the most common being to ensure that a woman remains a virgin until mar- riage. In other cases, FGC is practiced as an initiation rite to adulthood, as a way of aesthetically “improving” the appearance of the genitals, and as a means of preventing women from becom- ing “over-sexed.”

FGC is usually performed on young girls who have not gone through puberty (although age varies across cultures, ranging from infancy to adulthood) and involves cutting the genital tis- sues with sharp objects, such as knives, scissors, or broken glass. The least invasive form, sxAAM, involves removing or creating a slit in the prepuce. Alternatively, a caiatridlecatom may be per- formed, in which the clitoris is completely removed. A few cultures have adopted the even more extreme practice of iAfibxaMaitA, in which both the clitoris and labia are removed. In this case, the remains of the labia are stitched together and the girl’s legs are bound for a few weeks to allow the tissues to heal. All that remains is a tiny opening to permit the exit of urine and menstrual blood.

Regardless of how FGC is performed, it usually occurs in unsanitary conditions and anesthetic is rarely administered. Thus, not only is there a high risk of infection, but it is incredibly painful. There is also a high likelihood of complications, especially for women undergoing infibulation. Potential problems include difficulty urinating, painful intercourse (it may take weeks or months for the opening to stretch to the point where intercourse is possible, and sometimes it never is), as well as childbirth dangers.

Most Western cultures have outlawed the practice, viewing FGC as inhumane and deeming it a form of genital “mutilation.” Westerners typically consider FGC an unnecessary threat to women’s health that permanently impairs female sexual pleasure and functioning. However, in the 28 cul- tures where FGC is currently practiced, it is rarely questioned (at least publicly), even by women. In fact, many women say they want the procedure because it is a requirement for marriage, which is usually the only path for a woman in these cultures. The resistance to ending FGC stems from the fact that this tradition dates back centuries and has become part of the cultural psyche about how to properly raise a girl.

On a side note, FGC is often referred to as “female circumcision.” However, it is unwise to equate this procedure with male circumcision because FGC is far riskier and much more invasive. Also, GC is M wMm ahMa oMAm stcileailes Maaleopa at ctAarta wtoleA’s sleexMaiam. This stands in stark contrast to male circumcision, which is generally not intended to affect men’s sexual behavior (although there was a time in recent history in which boys were sometimes circumcised as a means of dis- couraging masturbation). Certainly, there are some parallels between these practices (e.g., both are frequently performed on infants who cannot consent, they are often practiced as part of a cultural ritual), but they are hardly the same thing.

The controversy over FGC is unlikely to be resolved any time soon because those challenging this practice face a number of ethical and legal dilemmas. For example, what authority does one culture have to tell another that it must abandon its traditions? Think about it from this perspec- tive: What if another country tried pressuring the United States to ban male circumcision alto- gether on the grounds that it is inhumane to remove a portion of the genitals of a non-consenting male infant? Given that male circumcision is so widely accepted and practiced in American cul- ture, there would probably be a lot of resistance to any outside group that demanded an end to it.

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for the introitus, which I am sorry to say has happened in at least a few documented cases in the medical literature. Unfortunately, when neither partner has particularly good knowledge of female sexual anatomy and the only obvious orifice on the vulva is the urethral opening, some people have treated it as the entrance to the vagina.

While the hymen serves no true medical function, the fact that it has the potential to signal a woman’s virginity status (albeit unreliably) has caused many societies to place great social value on this tiny piece of tissue. For instance, in some African and Middle Eastern cultures, a woman is not eligible for marriage unless her hymen is intact. Women may be required to undergo pelvic exams prior to marriage in order to verify their virginity, or they may be required to produce a blood-stained sheet after their wedding night as proof that they lost

Also, some of the most common arguments against FGC are that women are socially pres- sured into it, that it is medically unnecessary, and that it creates health risks; however, can we not level similar arguments against many forms of cosmetic bodily modification performed on West- ern women (e.g., breast augmentation, “vaginal rejuvenation,” labial reduction)? I do Ata wish to imply that FGC and these other procedures are equivalent, because they are not, especially in terms of the risks they carry, whether the procedure is voluntary, and whether it is performed on adults or children. I am simply stating that drawing a line between which forms of bodily modifi- cation are acceptable and which are not is harder than it sounds.

Note: Reprinted with permission from lee MAd Psmchtatgm (www.lehmiller.com). To learn more about FGC, please consult Momoh (2005).

Digging Deeper 3.2 (Continued)

Introitus

Labia minora

Clitoral hood

Meatus

Labia majora

Figure 3.8 In this photo you can see some of the structures of the vulva, including the labia, clitoral hood, and introitus. ©Bobisbob (en.wikipedia) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

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their virginity to their new husband (Roberts, 2006). Given the great social pressure to be a demonstrable virgin at marriage, many women are undergoing “revirginization” surgery (also known as hymenoplasty) to reconstruct broken hymens. In this procedure, the original hymen is sutured back together, or a new hymen is fashioned out of other vaginal tissue. Upon request, a gelatin capsule containing artificial blood may be inserted to create the appearance of bleeding at her next intercourse. Among women who have had this procedure, they typi- cally report being very satisfied with the outcome (Logmans, Verhoeff, Raap, Creighton, & van Lent, 1998). On a side note, there are some women in the Western world who are getting “revirginized” for a completely different set of reasons. Most commonly, it is because they want to physically and psychologically recreate their first sexual experience (e.g., perhaps they regretted who they had sex with the first time and want to try it again with someone they care more about).

The final portion of the vulva is the perineum, an area of skin that runs between the introitus and the anus. During childbirth, an episiotomy is sometimes performed, in which an incision is made into the perineum to expand the size of the birth canal. This procedure reduces vaginal tearing and can make childbirth easier when the baby is larger than average or when a mother has undergone certain forms of female genital cutting (see the Digging Deeper 3.2 box).

Internal Anatomy

Beneath the vulva are several important structures, including the pelvic floor muscles, a com- plex, crisscrossed set of muscles that contract involuntarily when a woman reaches orgasm. These muscles can be strengthened through Kegel exercises, and women who do them expe- rience numerous benefits (Beji, Yalcin, & Erkan, 2003). These exercises were first developed in the 1950s by Dr. Arnold Kegel as a way of helping women who suffer from incontinence problems after childbirth. Kegel and others found that these exercises are indeed an effective means of regaining urinary control, but they have sexual benefits as well, such as relief from painful intercourse and increased ability to reach orgasm. These exercises are easy enough to do and the steps involved are similar to the Kegel exercises men do to strengthen the muscles at the base of the penis. To begin, locate the muscles used to stop the flow of urine midstream. Once familiar with the muscles, simply start by squeezing them, holding for several seconds, and then releasing. After several repetitions, move onto squeezing and releasing the muscles rapidly a few times. These exercises must be done a few times per day for several weeks before the benefits start to become noticeable.

Next, let us consider the structure of the vagina, which is the canal that extends from the introitus to the uterus. The vagina expands in size and changes in shape during sexual inter- course and childbirth. As reported by Masters and Johnson (1966), the vagina is 2.8–3.1 inches (7–8 centimeters) in an unaroused state, and up to 4.3–4.7 inches (11–12 centimeters) in an aroused state. The interior lining of the vagina (the vaginal mucosa) is a mucous membrane through which a lubricating substance is secreted during arousal. Some women produce less of this natural lubrication than others, which can make intercourse painful; however, artificial lubricants offer an inexpensive and practical solution. Surrounding the mucosa are layers of muscle and fibrous tissue that aid in expansion and contraction. Contrary to popular belief, most of the nerve endings in the vagina are concentrated around the introitus. The inner por- tions of the vagina have far fewer nerves, which means that a longer penis will not necessarily provide more pleasurable stimulation to women who have sex with men. The vaginal depth measurements reported by Masters and Johnson (which are a little shorter than the average penis length) suggest another reason why longer penises may not necessarily enhance female pleasure: there isn’t necessarily room for them.

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On each side of the vagina near the introitus are the vestibular bulbs. They consist of spongy tissue (similar to the tissue in men responsible for penile erections) and expand in size during sexual arousal, causing the vulva to extend outward.

Deeper within the vagina is the Grafenberg spot (or G-spot), another controversial portion of female sexual anatomy. The location of the G-spot is most commonly described as being a couple of inches inside the vagina on the front wall (i.e., just underneath the mons veneris) and can be stimulated by inserting two fingers into the vagina and making the “come here” motion. Many women have reported that stimulation of this area results in very intense orgasms, some- times accompanied by an ejaculation of fluid. Some women release a small amount of milk-like fluid, whereas others release a large amount of thin, watery fluid, with the latter often referred to colloquially as “squirting.” One contributor to this fluid is thought to be the Skene’s glands, which consist of prostate-like tissue and surround the urethra. However, with regard to squirt- ing in particular, the bulk of this fluid appears to originate in the bladder. Pelvic scans of women who experience squirting have shown that the bladder fills during sexual arousal and is empty following orgasm (Salama et al., 2015). The fluid released is comparable to urine in its chemical makeup, but prostatic secretions are detectable in it for most women.

A recent review of the scientific literature failed to provide conclusive evidence that the G-spot is a distinct anatomical structure (Kilchevsky, Vardi, Lowenstein, & Gruenwald, 2012). Not all women seem to have a G-spot (in fact, survey research finds that just 56% of women think they have one; Burri, Cherkas, & Spector, 2011), and studies trying to pinpoint the loca- tion of the G-spot have not provided consistent results. This has led some scientists to refer to the G-spot as a “gynecological UFO”—it has many sightings, but no confirmation of its exist- ence. This does not mean that there is no such thing as the G-spot; rather, what some scientists are arguing is that the area people typically think of as the G-spot is actually the internal por- tion of the clitoris, which falls in the same general region and is highly sensitive to stimulation.

Uterus

Fallopian tube

Ovary

Fimbriae

Cervix

Vagina

Bartholin’s gland

Introitus

Clitoris

Pubic bone

Bladder

AnusMeatus

Figure 3.9 The female reproductive system. ©Tsaitgaist (Derivative work) [CC-BY-SA-3.0 (http:// creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

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At the end of the vagina is the cervix, which is the lower end of the uterus. The opening of the cervix (the os) permits sperm to enter and menstrual fluid to exit. The cervix secretes mucus that has different effects depending upon the stage of the menstrual cycle a woman is in. This mucus assists the entry of sperm during fertile periods, but blocks sperm during the rest of the cycle. A woman who is very comfortable and familiar with her body can test the consistency of her cervical mucus to figure out where she is in her cycle and whether conception is likely to occur (see chapter 11 to learn more about women who use this as a method of birth control). On a side note, the cervix may be a source of sexual pleasure for some women, with research indicating that cervical stimulation activates the same area of the brain as vaginal and clitoral stimulation (Komisaruk, Wise, Frangos, Liu, Allen, & Brody, 2011).

The uterus is a muscular organ suspended by ligaments in the pelvic cavity. Its primary purpose is to protect and nourish the fetus as it develops during pregnancy. The innermost lining of the uterus is the endometrium, which builds up and sheds during each menstrual cycle. Surrounding the endometrium are layers of muscle (the myometrium) and fibrous tissue (the perimetrium) that enable the uterus to change greatly in size during pregnancy. The uterus of a woman who has given birth will be much larger compared to a woman who has never been pregnant.

At the upper end of the uterus, a fallopian tube extends out on each side. This tube carries eggs from the ovaries to the uterus. At the end of the fallopian tubes are fimbriae, which are fingerlike projections that “catch” eggs and direct them into the tubes. Once inside the fallopian tube, an egg moves slowly toward the uterus via tiny hairs (cilia). It is in the upper portion of the tube near the fimbriae where fertilization is most likely to occur. When an egg is fertilized, it must implant itself in the uterine wall in order to generate a successful pregnancy. Occasion- ally, a fertilized egg will implant in the fallopian tube before it reaches the uterus, which creates a dangerous situation known as ectopic pregnancy. Pregnant women who experience severe abdominal pain, vaginal bleeding, and/or shoulder pain should consult a physician to check for ectopic pregnancy. If left untreated, it is potentially deadly.

Finally, we have the ovaries, or female gonads, which have two primary functions: (1) pro- duction of sex hormones (namely estrogen and progesterone), which play an important role in regulating the menstrual cycle, and (2) production and release of eggs (ova). During ovulation (i.e., the fertile period of a woman’s menstrual cycle), either the left or right ovary will release an egg. Throughout her lifetime, a woman releases somewhere between 300 and 500 eggs (Mack- lon & Fauser, 1999).

Breasts

The breasts are not technically part of a woman’s sexual anatomy (they are considered secondary sex characteristics, or physical indicators of sexual maturity); however, they are important to discuss because they have roles in both sexual pleasure and reproduction. Externally, breasts are composed of a nipple through which maternal milk can be released. The nipple is sur- rounded by a round, darkened area known as the areola. Both the nipple and areola contain many nerve endings, making them sensitive to touch. In fact, some women’s nipples are so sensitive that they can reach orgasm through nipple stimulation alone (Levin, 2006)! See the Digging Deeper 3.3 box for more on this.

Internally, breasts are composed of fatty tissue and mammary glands. What determines the size of a woman’s natural breasts is the amount of fatty tissue. All women have approximately the same number of mammary glands, the structures that generate maternal milk. Thus, women with larger breasts do not necessarily produce more milk during lactation. It is also important to note that larger breasts do not necessarily contain more nerve endings. In fact, smaller breasts may be more erotically sensitive than larger breasts because they have the same

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number of nerve endings in a much denser concentration. Women with smaller breasts may therefore find more intense forms of stimulation (e.g., biting) unpleasant.

Breast appearance varies considerably across women. Not only are there huge differences in size and shape, which have only been exaggerated by the increasingly popular trend of surgical augmentation, but the look of the nipple and areola varies too. For instance, some areolas are much larger than others, and some nipples point outward, while others are inverted. It is also often the case that one breast (usually the one on the left side of the body) is slightly larger than the other.

On a side note, some scientists have theorized that the appearance of the breasts has evolu- tionary significance (just like the size and shape of the male penis). The thought here, known as genital echo theory, proposes that women developed larger and more pendulous breasts after humans began walking upright as a way of mimicking the appearance of the buttocks, which used to be the biggest visual source of excitement for men (Fisher, 1992). In other words, women’s main fertility symbol moved from the back to the front when we stood up.

Psychology of the Breasts and Vulva: Female Bodily Concerns

One of women’s biggest concerns about their bodies is the size of their breasts. In fact, research has found that only a minority of women (30%) reported being satisfied with the appearance of their chest (Frederick, Peplau, & Lever, 2008). Of the 70% who were dissatisfied, most of these women were worried that their breasts were either too small (28%) or too droopy (33%). Only a small number of women (9%) wished they could reduce the size of their breasts. Across all

Digging Deeper 3.3 Can Women Orgasm From Nipple Stimulation?

Some women have reported that they can reach orgasm simply by having their breasts and nip- ples stimulated (Levin, 2006). The idea of a woman experiencing orgasm without any genital touching whatsoever might seem perplexing to some, but research suggests there is a sound biological basis for it.

Komisaruk and colleagues (2011) sought to determine what areas of the brain are active in response to stimulation of different parts of the female body. Female participants were asked to lie inside an fMRI machine and alternate between stimulating the clitoris, vagina, cervix, and nipple. An experimenter instructed the women to “comfortably” stimulate one of those body parts for 30 seconds, then rest for 30 seconds before repeating the process with a different part of the body. All participants were asked to stimulate themselves in the exact same way to keep the results as constant as possible (e.g., when it came to nipple stimulation, women were asked to use their right hand to “tap the left nipple rhythmically”).

The researchers discovered that stimulation of the nipple activated an area of the brain known as the gleAiaMa sleAstrm ctralee. This is the same brain region activated by stimulation of the clito- ris, vagina, and cervix. What this means is that wtoleA’s brMiAs sleleo at prtcless Aippale MAd gleAiaMa saioxaMaitA iA ahle sMole wMm. In light of this, it is not at all surprising that many women are aroused by having their nipples touched and that, for some, this may be enough to lead to orgasm.

If I may offer one note of caution, keep in mind that when it comes to nipple stimulation, there is good touching and bad touching. The nipple can be a highly sensitive part of the body, which means that more aggressive handling (e.g., twisting) can potentially be unpleasant. As always, it is best to communicate with your partner about what is and is not pleasurable.

Note: Reprinted with permission from cileAcle tf RleaMaitAships (www.scienceofrelationships.com).

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stages of the lifespan, most women expressed some form of breast dissatisfaction. The only thing that appeared to change with age is the nature of women’s concerns. Specifically, younger women were more concerned being larger, whereas older women were concerned with being less droopy. Why are women so concerned with the appearance of their chests? It is likely the product of social learning. From a very young age, women are bombarded with messages that big breasts are better. For instance, Barbie dolls are a popular toy among young girls, but the bodies of these dolls (which typically have exaggerated breasts, tiny waists, and wide hips) are far from realistic. In fact, it is estimated that only 1 in 100,000 women have bodies that match Barbie’s extreme proportions (Norton, Olds, Olive, & Dank, 1996)! Also, a large number of the female celebrities young girls look up to have had their breasts surgically enhanced, which further reinforces the notion that breasts are “supposed” to be huge and that they make women more popular, attractive, and likeable.

Given the immense pressure on women to have large chests, it should come as no surprise that breast augmentation surgery has become perhaps the most popular form of cosmetic sur- gery in the world. In 2014, more than 286,000 women had their breasts enlarged in the United States alone (American Society of Plastic Surgeons, 2015). Breast augmentation involves surgi- cally inserting implants into the chest that consist of either saline or silicone encased in rubber shells. As with any form of surgery, breast augmentation carries a number of risks, including hardening of the breasts, changes in breast and nipple sensitivity, deformity, and implant rup- ture (Food and Drug Administration, 2012). Breast implants also have the potential to impair a woman’s ability to breast feed. Overall, breast augmentation is probably safer than penile aug- mentation surgery, given that surgical breast enhancement has been around a lot longer and has been the subject of more scientific study. However, any woman considering breast implants should carefully weigh the risks before deciding whether to go forward.

Should women be so obsessed with how their breasts look? It may comfort some of you to know that, at least in heterosexual relationships, the majority of men (56%) reported being

Muscle

Fat

Milk ducts

Nipple Areola

Mammary glands

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satisfied with the size and shape of their female partners’ chests (Frederick et al., 2008). Of course, that still makes for a substantial minority of men who report some form of dissatis- faction. If we compare these results to the previously discussed study of penis size (Lever et al., 2006), it appears that men tend to judge women’s bodies more harshly than women judge men’s bodies. In some ways, this is not particularly surprising because most societies unfairly hold women to higher standards of beauty than they do men.

In addition to breast concerns, many women are worried about the appearance of their vulva. For instance, as previously discussed, many women are concerned that their labia are too large or asymmetrical and have thus undergone labial reduction surgery. In addition, some women believe that their vaginas are too large or too loose. It is a myth that women’s vaginas become “looser” as a result of frequent sexual activity, so do not let anyone convince you otherwise; however, some degree of looseness may occur with older age and following vaginal delivery of children. Among those women who believe they are too loose, some are pursuing “vaginal rejuvenation” surgery, which is advertised to tighten the vagina. There are also a growing num- ber of women who are concerned about their lack of ability to reach orgasm during vaginal intercourse and will try almost anything to make it happen. Some of these women have sought out “G-spot amplification,” in which collagen is injected into their supposed G-spot. Women should be especially wary of these procedures. For one thing, if scientists cannot agree on the location of the G-spot or whether it even exists (Kilchevsky et al., 2012), how can one possibly “amplify” it? More importantly, these procedures that attempt to sell women “designer vaginas” have not been subject to scientific scrutiny, which means we do not even know whether they are safe or effective (American Congress of Obstetricians and Gynecologists, 2007). Any claims to the contrary are simply deceptive marketing. It is therefore advisable to be extremely cau- tious about these and any of the other new genital surgeries.

Figure 3.11 Female dolls often have extreme and unrealistic bodily proportions, some of which would be nearly impossible to obtain in real life. ©Leah-Anne Thompson, 2016. Used under license from Shutterstock .com.

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All of the female breast and genital procedures discussed in this chapter (breast augmenta- tion, revirginization, labial reduction, vaginal rejuvenation, G-spot amplification, and female genital cutting) are evidence that societies and cultures around the world consider the female body and women’s sexuality to be highly malleable. There are many more cosmetic procedures available for women than there are for men, and women are much more likely to be socially pressured into undergoing these surgeries. This is but one small piece of evidence that there is a sexual double standard, in which men’s and women’s bodies and sexualities are evaluated very differently, with women being subject to the harshest criticism. For more on the nature and scope of the sexual double standard, check out the Your Sexuality 3.1 box.

Female Breast and Genital Health Issues

The Menstrual Cycle A healthy woman of reproductive age will likely have an established menstrual cycle. This cycle is regulated by a complex interplay of hormones that produces a number of effects in the ova- ries and uterus. There are four phases of this cycle: the follicular phase, ovulation, the luteal phase, and menstruation. Of most interest to us in this book because of their effects on female psychology are ovulation and menstruation. During ovulation, a mature egg is released by one of the ovaries. As we will discuss in chapter 11, ovulation produces a number of impor- tant changes in women’s sexual behavior, including everything from how she dresses to the types of partners she finds attractive. The other stage of interest, menstruation, is when the

Your Sexuality 3.1 Does the Sexual Double Standard Still Exist?

Researchers have recorded evidence of a sexual double standard dating back several decades. However, recent research has produced conflicting findings, with some studies finding support for the typical double standard, others showing no effect, and some even showing a rlevlersle dou- ble standard (i.e., that men are judged more harshly than women in certain cases; Milhausen & Herold, 1999). So is the notion that women’s bodies and sexual behaviors are subject to greater scrutiny than men’s actually on the wane? Answer each of the questions below and see what your own experiences would suggest about the nature of modern day sexual attitudes.

● Culture and society dictate what the “ideal” male and female body looks like; however, are men and women penalized to the same extent for falling short of these ideals? Do they experience the same degree of pressure to have their body look a certain way in order to find a sexual and/ or romantic partner?

● What names or labels would most people apply to a woman who frequently engages in one- night stands? What names or labels would most people apply to a man who engages in the same behavior? How did the number and nature of the labels you generated differ between groups?

● Would you encourage a heterosexual male friend to date a woman who you knew had ten pre- vious sexual partners? Would you encourage a heterosexual female friend to date a man who you knew had ten previous sexual partners?

● Is a woman who has sex on the first date potential “marriage material?” What about a man who does the same thing?

● Imagine someone doing a “walk of shame.” What is the sex of the first person who pops into your head?

● How would society evaluate a woman who carries condoms in her purse? How would society evaluate a man who carries condoms in his pocket?

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endometrial lining of the uterus, which has built up in anticipation of pregnancy, sheds if con- ception does not occur, thereby producing a bloody discharge (often referred to as a “period”). On average, a complete menstrual cycle lasts 28 days, although there is significant variability across women in terms of cycle length and at what point ovulation occurs. There is also a lot of variation in the age at which a woman experiences her first menstruation (menarche) and when menstruation permanently ceases (menopause).

The average age of menarche in the United States is 12.5, with earlier onset linked to race, typi- cally occurring earlier in Black and Hispanic girls and later in White girls (Chumlea et al., 2003). Earlier onset is also related to environmental factors, such as obesity and lack of exercise. Menarche is viewed in different terms cross-culturally. For instance, in some American Indian cultures, a girl’s first menstruation is a blessed event that is celebrated with an eight-day ceremony (Crawford, O’Brien, & Kelley, 2005). By contrast, menstruation is considered taboo in Nepal, where girls are banished to an outdoor shed to eat, sleep, and live during their periods (Greenhalgh, 2015).

In industrialized nations (including the United States), the median age of menopause is between 50 and 52 and, as is the case with menarche, earlier onset is linked to a number of environmental and lifestyle factors (e.g., malnourishment, smoking), as well as race (Black and Hispanic women tend to experience menopause the soonest; Gold 2011). Cultures also vary in their views on menopause, with some viewing it as a natural transition in life, and others (particularly those in the Western world) viewing it as a “condition” or set of symptoms that requires a medical fix. Menopause has several implications for older women’s sex lives, a topic we will return to in chapter 10.

Menstrual Cycle Problems Most women experience at least some physical and psychological effects during each men- strual cycle. On a psychological level, changes in mood are common. This is often chalked up to premenstrual syndrome (PMS), a very general term that encompasses all of the emotional changes and physical discomfort a woman might experience prior to getting her period. In more severe cases, the term premenstrual dysphoric disorder (PMDD) is sometimes used, which is an actual diagnostic category in the DSM-5. Specifically, PMDD is diagnosable when a woman presents with at least five of the symptoms specified by the DSM (e.g., marked changes in mood, difficulty sleeping, concentration problems, physical symptoms) and is experiencing personal distress or interference in daily life as a result.

In the medical literature, hundreds of symptoms of PMS have been identified (e.g., depres- sion, irritability; O’Brien, Wyatt, & Dimmock, 2000), and studies suggest that as many as 80% of women report at least some of them (Stanton, Lobel, Sears, & DeLuca, 2002). However, one might reasonably wonder what use there is in defining this term so broadly as to apply to almost all women and, if that is the case, why we call it a “syndrome,” which sounds like a prob- lem. In fact, some argue that we are medicalizing and pathologizing normal female experience by using terms like PMS and PMDD. It is important to keep in mind that the psychological changes that women experience during menstruation are usually small on average and the wild mood swings depicted on television sitcoms are exaggerations.

Two of the most common menstrual cycle problems are dysmenorrhea and amenorrhea. Dys- menorrhea refers to painful menstruation. The most common symptom is cramping, but other women experience nausea, headaches, disorientation, and fatigue. Primary dysmenorrhea is diag- nosed when the body produces too many prostaglandins, a substance that causes very intense contractions of the uterus. Secondary dysmenorrhea is diagnosed when a pre-existing medical condition creates painful menstruation. Perhaps the most common cause of secondary dysmenor- rhea is endometriosis, a condition in which a woman has endometrial cells outside of her uterus, often on the ovaries or fallopian tubes. These cells respond the same way as the endometrial cells

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inside the uterus (i.e., they build up and then shed during the menstrual cycle). If left untreated, endometriosis can permanently damage reproductive structures, resulting in infertility.

Amenorrhea occurs when menstruation is absent and may take two forms. Primary amen- orrhea is when an adolescent girl fails to menstruate by age 16, often because of a congenital malformation of the uterus, an imbalance of hormones, or as a result of being intersexed (i.e., not fitting the biological definitions of female or male; a topic we will return to in chapter 5). Secondary amenorrhea is when a woman who has already had at least one period experiences an interruption in her menstrual cycle. This type of amenorrhea occurs naturally during preg- nancy, but is also normal among women who have recently stopped using birth control pills and among older women who are approaching menopause. It is also common among girls who are very athletic as well as girls who have anorexia.

Gynecological Health Issues Just as proper genital health care is important for men, it is vital for women to take care of their vulvas and vaginas. First, maintaining good genital hygiene by bathing regularly can prevent the build-up of smegma and reduce the likelihood of urinary and vaginal infections. Thus, it is advisable for a woman and her partner to wash their hands and genitals prior to sexual activity. Again, this is not a substitute for safer sex—it is simply an extra precaution. A woman’s genital cleansing routine should not include douching, though. Douching (i.e., rinsing the vaginal canal with liquids) can actually make vaginal infections more likely by changing the natural pH and bacteria balance. Second, as discussed earlier in this chapter, it is important to take care when grooming pubic hair in order to avoid injury. For example, if using safety razors, make sure they are new and use them slowly and carefully. Third, women should perform regular self-exams of their genitals to look for changes that might indicate potential health issues (e.g., redness, unu- sual discharge). However, before you start looking for problems, begin by spending some time just getting acquainted with your genitalia under normal circumstances. You need this baseline so that you will know in the future what is normal for your body and what is not.

It is also important for women to have regular gynecological exams from a physician, because a physician can observe things that a woman cannot do on her own. In particular, physicians can perform Pap tests, a procedure in which a scraping of cells is taken from the cervix to test for cancer. Cervical cancer is one of the most common types of cancer in women, but if it is caught and treated early, the survival rate is very high (Mayr, Small, & Gaffney, 2011). Because one of the most common causes of cervical cancer is a sexually transmitted infection, HPV, it is especially important for sexually active women to get regular Pap tests. Specifically, the current recommendation is that women over age 21 get tested once every three years (US Preventive Services Task Force, 2012). Until recently, the medical community recommended annual test- ing, but they now believe testing at less frequent intervals is likely just as effective. Pap tests may be simultaneously combined with a test for HPV, which is the preferred strategy.

Breast Issues Breast cancer is the second most common and second most deadly type of cancer in women. The chance of an American woman developing breast cancer in her lifetime is approximately 1 out of 8, and her chance of dying from it is approximately 1 out of 36 (American Cancer Society, 2012). There appears to be a strong genetic component to breast cancer, which means that a woman’s risk of developing it is higher to the extent that she has close female relatives who have had this type of cancer.

Although women are frequently told that they should do self-exams as part of the cancer screening process, research indicates that they are not all that effective at reducing death rates (Gaskie & Nashelsky, 2005). By the time a lump can be felt, it is often too late to do anything

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about it if it is a malignant cancer. Likewise, most of the lumps detected by women end up being benign cysts or fibroadenomas, which result in a lot of unnecessary healthcare utiliza- tion. Thus, while there may be some value to performing self-exams on occasion to become familiar with one’s own body, they are by no means a substitute for regular clinical exams.

Mammography is the primary clinical technique for detecting breast cancer; it involves tak- ing an X-ray of each breast. The traditional recommendation is that women over the age of 40 should get an annual mammogram; however, a recent US government task force argued that mammograms should instead be conducted biennially starting at age 50 and that regu- lar breast cancer screenings should only begin before that if warranted by individual patient circumstances (e.g., previous family history of breast cancer; US Preventive Services Task Force, 2009). The reason for this recommendation change is that administering mammograms routinely to women under age 50 is unlikely to provide a large benefit and there is a risk that repeated exposure to radiation from mammograms may itself cause cancer. This recommenda- tion has proved controversial and the medical community remains split on it.

Conclusions

By this point, I hope I have successfully made the case that there is psychological value to learning about sexual anatomy, and that a lack of knowledge about your own body or that of your partner could have a wide range of implications. That said, you will want to keep in mind everything you have learned here about the human body because going forward in this text, you need to understand the basics of genital anatomy in order to appreciate our upcoming dis- cussions of sexual arousal and response (chapter 4), biological sex variations (chapter 5), sexual behaviors (chapter 9), lifespan sexual development (chapter 10), contraception and pregnancy (chapter 11), as well as sexual problems and sex therapy (chapter 13).

Figure 3.12 Research has found that breast self-exams are not as effective as doctors once believed. Thus, they are not a substitute for consulting with a physician. ©National Institutes of Health via Wikimedia Commons.

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Key Terms

foreskin circumcision superincision Peyronie’s disease cavernous bodies spongy body testes labia minora prepuce clitoris female genital cutting introitus Bartholin’s glands hymen perineum vagina

seminiferous tubules interstitial cells cremaster muscle epididymis vas deferens semen seminal vesicles vestibular bulbs Grafenberg spot cervix uterus fallopian tube ovaries nipple areola ovulation

prostate gland Cowper’s glands dhat koro vulva mons veneris labia majora menstruation premenstrual syndrome

(PMS) premenstrual dysphoric

disorder (PMDD) dysmenorrhea endometriosis amenorrhea

Discussion Questions: What is Your Perspective on Sex?

● How is pornography changing our perceptions and standards of physical attractiveness? Do producers of pornography select actors and actresses who conform to contemporary stand- ards of beauty? If so, what effect does this have on our perceptions of the human body?

● Some scientists believe routine male circumcision would significantly reduce rates of sexu- ally transmitted infections among men and their sexual partners, thereby lowering health- care costs by billions of dollars over time. However, others argue that everyone has a right to an intact body and that circumcision causes pain, trauma, and potentially serious side effects. What is your view on this issue?

● Should penile augmentation, vaginal rejuvenation, and other such cosmetic medical procedures be legal or illegal? Do individuals have a right or pursue experimental genital surgeries for which the benefits are unclear and the risks are very high?

References

Alter, G. (1997). Reconstruction of deformities resulting from penile enlargement surgery. The Journal of Urology, 158, 2153–2157.

American Cancer Society (2012). How many women get breast cancer? retrieved from http:// www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-key-statistics (accessed August 28, 2013).

American Congress of Obstetricians and Gynecologists (2007). Vaginal “rejuvenation” and cosmetic vaginal procedures. Retrieved from http://www.acog.org/Resources_And_Publications/ Committee_Opinions/Committee_on_Gynecologic_Practice/Vaginal_Rejuvenation_and_ Cosmetic_Vaginal_Procedures (accessed August 28, 2013).

American Society of Plastic Surgeons (2015). American Society of Plastic Surgeons reports cosmetic procedures increased 3 percent in 2014. Retrieved from: http://www.plasticsurgery.org/news/2015/ plastic-surgery-statistics-show-new-consumer-trends.html (accessed December 30, 2015).

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http://www.plasticsurgery.org/news/2015/plastic-surgery-statistics-show-new-consumer-trends.html

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Vaginal_Rejuvenation_and_Cosmetic_Vaginal_Procedures

http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-key-statistics

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Baker, R. R., & Bellis, M. A. (1993). Human sperm competition: Ejaculate adjustment by males and the function of masturbation. Animal Behaviour, 46, 861–885. doi:10.1006/anbe.1993.1271

Beji, N. K., Yalcin, O., & Erkan, H. A. (2003). The effect of pelvic floor training on sexual function of treated patients. International Urogynecology Journal, 14, 234–238. doi:10.1007/s00192-003-1071-2

Bhugra, D., Popelyuk, D., & McMullen, I. (2010). Paraphilias across cultures: contexts and controversies. Journal of Sex Research, 47, 242–256. doi:10.1080/00224491003699833

Blackledge, C. (2003). The story of V: Opening Pandora’s box. London: Weidenfeld & Nicolson. Bowman, E. A. (2013). Sperm competition and the absorption of neuropeptides by the prepuce.

Archives of Sexual Behavior, 42, 701–702. doi:10.1007/s10508-013-0086-0 Brandes, S. B., & McAninch, J. W. (1999). Surgical methods of restoring the prepuce: A critical

review. BJU international, 83(S1), 109–113. doi:10.1046/j.1464-410x.1999.0830s1109.x Burri, A. V., Cherkas, L., & Spector, T. D. (2011). Genetic and environmental influences on

self-reported G-spots in women: A twin study. Journal of Sexual Medicine, 7(5), 1842–1852. doi:10.1111/j.1743-6109.2009.01671.x

CBS News (2012). 14 most shocking beauty treatments. Retrieved from http://www.cbsnews. com/2300-204_162-10004213-5.html (accessed August 28, 2013)

Centers for Disease Control and Prevention (2011). Trends in in-hospital newborn male circumcision – United States, 1999–2010. Retrieved from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w (accessed August 28, 2013)

Chumlea, W. C., Schubert, C. M., Roche, A. F., Kulin, H. E., Lee, P. A., Himes, J. H., & Sun, S. S. (2003). Age at menarche and racial comparisons in US girls. Pediatrics, 111, 110–113.

Costa, R., Miller, G. F., & Brody, S. (2012). Women who prefer longer penises are more likely to have vaginal orgasms (but not clitoral orgasms): Implications for an evolutionary theory of vaginal orgasm. Journal of Sexual Medicine, 9, 3079–3088. doi:10.1111/j.1743- 6109.2012.02917.x

Crawford, S. J., O’Brien, S. J. C., & Kelley, D. F. (2005). American Indian Religious Traditions: AI (Vol. 1). Santa Barbara, CA: ABC-CLIO.

Crouch, N. S., Deans, R., Michala, L., Liao, L. M., & Creighton, S. M. (2011). Clinical characteristics of well women seeking labial reduction surgery: A prospective study. International Journal of Obstetrics and Gynaecology, 118, 1507–1510. doi:10.1111/j.1471- 0528.2011.03088.x

Diamond, M. (2004). Sexual behavior in pre contact Hawai’i: A sexological ethnography. Revista Española del Pacifico, 16, 37–58.

Dillon, B. E., Chama, N. B., & Honig, S. C. (2008). Penile size and penile enlargement surgery: A review. International Journal of Impotence Research, 20, 519–529. doi:10.1038/ijir.2008.14

Fisher, H. E. (1992). Anatomy of love. New York: Fawcett Columbine. Food and Drug Administration (2012). Risks of breast implants. Retrieved from http://www.fda.

gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ ucm064106.htm (accessed August 28, 2013).

Frederick, D. A., Peplau, L. A., & Lever, J. (2008). The Barbie mystique: Satisfaction with breast size and shape across the lifespan. International Journal of Sexual Health, 20, 200–211. doi:10.1080/19317610802240170

Fugl-Meyer, K. S., Oberg, K., Lundberg, P. O., Lewin, B., & Fugl-Meyer, A. (2006). On orgasm, sexual techniques, and erotic perceptions in 18- to 74-year-old Swedish women. Journal of Sexual Medicine, 3, 56–68. doi:10.1111/j.1743–6109.2005.00170.x

Gallup, G. G., Burch, R. L., Zappieri, M. L., Parvez, R. A., Stockwell, M. L., & Davis, J. A. (2003). The human penis as a semen displacement device. Evolution and Human Behavior, 24, 277–289. doi:10.1016/S1090-5138(03)00016-3

Gaskie, S., & Nashelsky, J. (2005). Are breast self-exams or clinical exams effective for screening breast cancer? The Journal of Family Practice, 54, 803–804.

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://www.cbsnews.com/2300-204_162-10004213-5.html

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064106.htm

3 HxoMA leexMa AMatom84

Glass, A. S., Bagga, H. S., Tasian, G. E., Fisher, P. B., McCulloch, C. E., Blaschko, S. D., . . . & Breyer, B. N. (2012). Pubic hair grooming injuries presenting to US emergency departments. Urology, 80, 1187–1191. doi: 10.1016/j.urology.2012.08.025

Gold, E. B. (2011). The timing of the age at which natural menopause occurs. Obstetrics and Gynecology Clinics of North America, 38, 425–440. doi:10.1016/j.ogc.2011.05.002

Gonzales, G. F. (2001). Function of seminal vesicles and their role on male fertility. Asian Journal of Andrology, 3, 251–258. doi:10.1038/aja.2008.47

Greenhalgh, J. (2015). A girl gets her period and is banished to the shed: #15girls. NPR. http:// www.npr.org/sections/goatsandsoda/2015/10/17/449176709/horrible-things-happen-to-nepali- girls-when-they-menstruate-15girls (accessed December 30, 2015).

Grov, C., Parsons, J. T., & Bimbi, D. S. (2010). The association between penis size and sexual health among men who have sex with men. Archives of Sexual Behavior, 39, 788–797. doi:10.1007/ s10508-008-9439-5

Hammond, T. (1999). A preliminary poll of men circumcised in infancy or childhood. British Journal of Urology International, 83(Suppl. 1), 85–92. doi:10.1046/j.1464-410x.1999.0830s1085.x

Herbenick, D., Schick, V., Reece, M., Sanders, S., & Fortenberry, J. D. (2010). Pubic hair removal among women in the United States: Prevalence, methods, and characteristics. Journal of Sexual Medicine, 7, 3322–3330. doi:10.1111/j.1743-6109.2010.01935.x

Kilchevsky, A., Vardi, Y., Lowenstein, L., & Gruenwald, I. (2012). Is the female G-spot truly a distinct anatomic entity? Journal of Sexual Medicine, 9, 719–726. doi:10.1111/j.1743- 6109.2011.02623.x.

Kilgallon, S. J., & Simmons, L. W. (2005). Image content influences men’s semen quality. Biology Letters, 22, 253–255. doi:10.1098/rsbl.2005.0324

Killick, S. R., Leary, C., Trussell, J., & Guthrie, K. A. (2011). Sperm content of pre-ejaculatory fluid. Human Fertility, 14(1), 48–52. doi:10.3109/14647273.2010.520798

Komisaruk, B. R., Wise, N., Frangos, E., Liu, W. C., Allen, K., & Brody, S. (2011). Women’s clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. Journal of Sexual Medicine, 8, 2822–2830. doi:10.1111/j.1743-6109.2011.02388.x

LaPera, G., & Nicastro, A. (1996). A new treatment for premature ejaculation: The rehabilitation of the pelvic floor. Journal of Sex & Marital Therapy, 22, 22–26. doi:10.1080/00926239608405302

Larke, N., Thomas, S. L., Dos Santos Silva, I., & Weiss, H. A. (2011a). Male circumcision and human papillomavirus infection in men: A systematic review and meta-analysis. Journal of Infectious Diseases, 204, 1375–90. doi:10.1093/infdis/jir523

Larke, N. L., Thomas, S. L., Dos Santos Silva, I., & Weiss, H. A. (2011b). Male circumcision and penile cancer: A systematic review and meta-analysis. Cancer Causes Control, 22, 1097–110. doi:10.1007/s10552-011-9785-9

Lever, J., Frederick, D. A., & Peplau, L. A. (2006). Does size matter? Men’s and women’s views on penis size across the lifespan. Psychology of Men and Masculinity, 7, 129–143. doi:10.1037/1524- 9220.7.3.129

Levin, R. J. (2006). The breast/nipple/areola complex and human sexuality. Sexual & Relationship Therapy, 21, 237–249. doi:10.1080/14681990600674674

Logmans, A., Verhoeff, A., Raap, R. B., Creighton, F., & van Lent, M. (1998). Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? British Medical Journal, 316, 459–460

Lynn, R. (2013). Rushton’s r–K life history theory of race differences in penis length and circumference examined in 113 populations. Personality and Individual Differences, 55, 261–266. doi:10.1016/j.paid.2012.02.016

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://www.npr.org/sections/goatsandsoda/2015/10/17/449176709/horrible-things-happen-to-nepali-girls-when-they-menstruate-15girls

RleflerleAcles 85

Macklon, N. S., & Fauser, B. C. J. M. (1999). Aspects of ovarian follicle development throughout life. Hormone Research, 52, 161–170. doi:10.1159/000023456

Martins, Y., Tiggemann, M., & Churchett, L. (2008). Hair today, gone tomorrow: A comparison of body hair removal practices in gay and heterosexual men. Body Image, 5(3), 312–316. doi:10.1016/j.bodyim.2008.04.001

Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown. Mayr, N. A., Small, W., & Gaffney, D. K. (2011). Cervical cancer. In J. J. Lu & L. W. Brady (Eds.)

Decision Making in Radiation Oncology. New York: Springer. Milhausen, R. R., & Herold, E. S. (1999). Does the sexual double standard still exist? Perceptions of

university women. Journal of Sex Research, 36, 361–368. doi:10.1080/00224499909552008 Morris, B. J., & Krieger, J. N. (2013). Does male circumcision affect sexual function, sensitivity, or

satisfaction? A systematic review. The Journal of Sexual Medicine, 10, 2644–2657. doi:10.1111/ jsm.12293

Momoh, C. (2005). Female genital mutilation. Milton Keynes: Radcliffe Publishing. Moskowitz, D. A., Rieger, G., & Seal, D. W. (2009). Narcissism, self-evaluations, and partner

preferences among men who have sex with men. Personality and Individual Differences, 46, 725–728. doi:10.1016/j.paid.2009.01.033

Norton, K. I., Olds, T. S., Olive, S., & Dank, S. (1996). Ken and Barbie at life size. Sex Roles, 34, 287–294. doi:10.1007/BF01544300

O’Brien, P. M., Wyatt, K., & Dimmock, P. (2000). Premenstrual syndrome is real and treatable. Practitioner, 244, 185–195.

O’Connell, H. E., Sanjeevan, K. V., & Hutson, J. M. (2005). Anatomy of the clitoris. The Journal of Urology, 174, 1189–1195. doi:10.1097/01.ju.0000173639.38898.cd

Roberts, H. (2006). Reconstructing virginity in Guatemala. The Lancet, 367, 1227–1228. doi:10.1016/S0140-(06)68522-X

Roehr, B. (2007). Dramatic drop in HIV infections halts circumcision trials. British Medical Journal, 334, 11. doi:10.1136/bmj.39073.473634.DB

Ryan, C., & Jetha, C. (2010). Sex at dawn: How we mate, why we stray, and what it means for modern relationships. New York: HarperCollins.

Salama, S., Boitrelle, F., Gauquelin, A., Malagrida, L., Thiounn, N., & Desvaux, P. (2015). Nature and origin of “squirting” in female sexuality. The Journal of Sexual Medicine, 12, 661–666. doi:10.1111/jsm.12799

Schick, V. R., Rima, B. N., & Calabrese, S. K. (2010). E vulva lution: The portrayal of women’s external genitalia and physique across time and the current Barbie doll ideals. Journal of Sex Research, 48, 74–81. doi:10.1080/00224490903308404

Stanton, A. L., Lobel, M., Sears, S., & DeLuca, R. S. (2002). Psychosocial aspects of selected issues in women’s reproductive health: Current status and future directions. Journal of Consulting and Clinical Psychology, 70, 751–770. doi:10.1037/0022-006X.70.3.751

Stukus, K. S., & Zuckerbraun, N. S. (2009). Review of the prepubertal gynecologic examination: Techniques and anatomic variation. Clinical Pediatric Emergency Medicine, 10, 3–9. doi:10.1016/j.cpem.2009.01.006

Summers, J.A. (2003). A complication of an unusual sexual practice. Southern Medical Journal, 96, 716–717.

Underhill, R. A., & Dewhurst, J. (1978). The doctor cannot always tell: Medical examination of the “intact” hymen. The Lancet, 311(8060), 375–376.

US Preventive Services Task Force (2009). Screening for breast cancer. Retrieved from http://www. uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm (accessed August 28, 2013).

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

3 HxoMA leexMa AMatom86

US Preventive Services Task Force (2012). Screening for cervical cancer: U.S. preventive services task force recommendation statement. Retrieved from http://www.uspreventiveservicestaskforce. org/uspstf11/cervcancer/cervcancerrs.htm (accessed August 28, 2013).

Veale, D., Miles, S., Bramley, S., Muir, G., & Hodsoll, J. (2015). Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU International, 115(6), 978–986. doi:10.1111/bju.13010

Wallen, K., & Lloyd, E. A. (2011). Female sexual arousal: Genital anatomy and orgasm in intercourse. Hormones and Behavior, 59, 780–792. doi:10.1016/j.yhbeh.2010.12.004

Weiss, H. A., Thomas, S. L., Munabi, S. K., & Hayes, R. J. (2006). Male circumcision and risk of syphilis, chancroid, and genital herpes: A systematic review and meta-analysis. Sexually Transmitted Infections, 82, 101–9. doi:10.1136/sti.2005.017442

Yapanoglu, T., Aksoy, Y., Adanur, S., Kabadayi, B., Ozturk, G., & Ozbey, I. (2009). Seventeen years’ experience of penile fracture: Conservative vs. surgical treatment. Journal of Sexual Medicine, 6, 2058–2063. doi:10.1111/j.1743-6109.2009.01296.x

C op

yr ig

ht ©

2 01

7. J

oh n

W ile

y &

S on

s, In

co rp

or at

ed . A

ll rig

ht s

re se

rv ed

http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm