THINGS YOU LEARNED IN A HUMAN SEXUALITY COURSE

WilliamL.YarberBarbaraW.Sayad-HumanSexuality_DiversityinContemporaryAmerica2013McGraw-Hill.pdf

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Human Sexuality

Human Human

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Human Sexuality

HumanHu DIVERSITY IN CONTEMPORARY AMERICA

William L. Yarber INDIANA UNIVERSITY

Barbara W. Sayad CALIFORNIA STATE UNIVERSITY, MONTEREY BAY

EI G

H TH

E D

IT IO

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HUMAN SEXUALITY: DIVERSITY IN CONTEMPORARY AMERICA, EIGHTH EDITION

Published by McGraw-Hill, a business unit of Th e McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY, 10020. Copyright © 2013 by Th e McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Previous editions © 2010, 2008, 2005, 2002, 1999, 1997, and 1996. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of Th e McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

Th is book is printed on acid-free paper.

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ISBN 978-0-07-803531-9 MHID 0-07-803531-7

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Library of Congress Cataloging-in-Publication Data Yarber, William L. (William Lee), 1943- Human sexuality : diversity in contemporary America / William L. Yarber, Barbara W. Sayad, Bryan Strong.—8th ed. p. cm. ISBN 978-0-07-803531-9 (alk. paper)—ISBN 0-07-803531-7 (alk. paper) 1. Sex. 2. Sex customs. 3. Sexual health. I. Sayad, Barbara Werner. II. Strong, Bryan. III. Title.

HQ21.S8126 2013 306.7—dc23 2012027980

Th e Internet addresses listed in the text were accurate at the time of publication. Th e inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill, and McGraw-Hill does not guarantee the accuracy of the information presented at these sites.

www.mhhe.com

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www.mhhe.com

This book is dedicated with admiration to Herman B Wells,

president of Indiana University when Dr. Alfred Kinsey

conducted and published his research on the sexual

behavior of Americans. Wells was a courageous and

unwavering defender of Kinsey's research, despite pressure

on Wells to end Kinsey's studies. Wells’s support of Kinsey’s

research 60 years ago is considered a landmark and

defi ning victory for academic freedom, which paved the way

for future research on human sexuality at other universities.

—W. L. Y.

To my family—with all my love and gratitude.

—B. W. S

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entsBrief Contee tse Co te

1 Perspectives on Human Sexuality 1

2 Studying Human Sexuality 29

3 Female Sexual Anatomy, Physiology, and Response 68

4 Male Sexual Anatomy, Physiology, and Response 105

5 Gender and Gender Roles 125

6 Sexuality in Childhood and Adolescence 158

7 Sexuality in Adulthood 187

8 Love and Communication in Intimate Relationships 218

9 Sexual Expression 256

10 Variations in Sexual Behavior 298

11 Contraception, Birth Control, and Abortion 325

12 Conception, Pregnancy, and Childbirth 361

13 The Sexual Body in Health and Illness 396

14 Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy 437

15 Sexually Transmitted Infections 481

16 HIV and AIDS 518

17 Sexual Coercion: Harassment, Aggression, and Abuse 557

18 Sexually Explicit Materials, Prostitution, and Sex Laws 596

vii

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viii

1 Perspectives on Human Sexuality 1

STUDYING HUMAN SEXUALITY 2 ■ Practically Speaking ASSESSING SEXUAL SATISFACTION 4

SEXUALITY, POPULAR CULTURE, AND THE MEDIA 5 Media Portrayals of Sexuality 5 Television 8 Feature-Length Films 9 Gay Men, Lesbian Women, Bisexual and Transgender People in Film and

Television 10 Online Social Networks 11

■ Think About It BEFORE PRESSING “SEND”: TRENDS AND CONCERNS ABOUT TEXTING, SEXTING, AND DATING 12

SEXUALITY ACROSS CULTURES AND TIMES 14 Sexual Interests 14 Sexual Orientation 17 Gender 18

SOCIETAL NORMS AND SEXUALITY 19 ■ Think About It AM I NORMAL? 20

Natural Sexual Behavior 20 Normal Sexual Behavior 21

■ Think About It DECLARATION OF SEXUAL RIGHTS 23 Sexuality Behavior and Variations 24

■ Think About It “MY GENES MADE ME DO IT”: SOCIOBIOLOGY, EVOLUTIONARY PSYCHOLOGY, AND THE MYSTERIES OF LOVE 25

FINAL THOUGHTS 26 | SUMMARY 26 QUESTIONS FOR DISCUSSION 27 | SEX AND THE INTERNET 27 SUGGESTED WEBSITES 28 | SUGGESTED READING 28

ContentsContents VISUAL PREFACE xxvi | LETTER FROM THE AUTHORS xxxv

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Contents • ix

2 Studying Human Sexuality 29 SEX, ADVICE COLUMNISTS, AND POP PSYCHOLOGY 30 Information and Advice as Entertainment 31

■ Practically Speaking EVALUATING POP PSYCHOLOGY 32 The Use and Abuse of Research Findings 32

THINKING CRITICALLY ABOUT SEXUALITY 33 Value Judgments Versus Objectivity 34 Opinions, Biases, and Stereotypes 34 Common Fallacies: Egocentric and Ethnocentric Thinking 35

SEX RESEARCH METHODS 36 Research Concerns 37 Clinical Research 38 Survey Research 39

■ Practically Speaking ANSWERING A SEX RESEARCH QUESTIONNAIRE: MEASURE OF SEXUAL IDENTITY EXPLORATION AND COMMITMENT 40

Observational Research 42 Experimental Research 42

THE SEX RESEARCHERS 44 Richard von Kraff t-Ebing 44 Sigmund Freud 45 Havelock Ellis 46 Alfred Kinsey 46 William Masters and Virginia Johnson 48

CONTEMPORARY RESEARCH STUDIES 49 ■ Think About It SEX RESEARCH: A BENEFIT TO INDIVIDUALS

AND SOCIETY OR A THREAT TO MORALITY? 50

The National Health and Social Life Survey 50 The National Survey of Family Growth 52 The Youth Risk Behavior Survey 53 The National College Health Assessment 53 The National Survey of Sexual Health and Behavior 54

EMERGING RESEARCH PERSPECTIVES 55 Feminist Scholarship 56 Gay, Lesbian, Bisexual, and Transgender Research 57 Directions for Future Research 59

ETHNICITY AND SEXUALITY 59 African Americans 59 Latinos 61 Asian Americans and Pacifi c Islanders 62 Middle Eastern Americans 64

FINAL THOUGHTS 64 | SUMMARY 65 QUESTIONS FOR DISCUSSION 66 | SEX AND THE INTERNET 66 SUGGESTED WEBSITES 67 | SUGGESTED READING 67

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3 Female Sexual Anatomy, Physiology, and Response 68

FEMALE SEX ORGANS: WHAT ARE THEY FOR? 69 External Structures (the Vulva) 71 Internal Structures 73

■ Practically Speaking PERFORMING A GYNECOLOGICAL SELFEXAMINATION 75 Other Structures 78 The Breasts 78

FEMALE SEXUAL PHYSIOLOGY 81 Reproductive Hormones 81 The Ovarian Cycle 81 The Menstrual Cycle 84

■ Practically Speaking VAGINAL AND MENSTRUAL HEALTH CARE 89 FEMALE SEXUAL RESPONSE 90 Sexual Response Models 90

■ Think About It SEXUAL FLUIDITY: WOMEN’S VARIABLE SEXUAL ATTRACTIONS 91 Desire: Mind or Matter? 95

■ Think About It THE ROLE OF ORGASM 98 Experiencing Sexual Arousal 98

FINAL THOUGHTS 101 | SUMMARY 101 QUESTIONS FOR DISCUSSION 103 | SEX AND THE INTERNET 103 SUGGESTED WEBSITES 103 | SUGGESTED READING 104

4 Male Sexual Anatomy, Physiology, and Response 105

MALE SEX ORGANS: WHAT ARE THEY FOR? 106 External Structures 106

■ Think About It THE PENIS: MORE THAN MEETS THE EYE 108 Internal Structures 110 The Breasts and Anus 112

MALE SEXUAL PHYSIOLOGY 113 Sex Hormones 114

■ Practically Speaking SEXUAL HEALTH CARE: WHAT DO MEN NEED? 115 Spermatogenesis 116

■ Practically Speaking MALE BODY IMAGE SELFCONSCIOUSNESS SCALE 118 Semen Production 118 Homologous Organs 119

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Contents • xi

MALE SEXUAL RESPONSE 119 Erection 120 Ejaculation and Orgasm 120

■ Practically Speaking CAN AN ERECTION BE WILLED? 122 FINAL THOUGHTS 123 | SUMMARY 123

QUESTIONS FOR DISCUSSION 124 | SEX AND THE INTERNET 124

SUGGESTED WEBSITES 124 | SUGGESTED READING 124

5 Gender and Gender Roles 125 STUDYING GENDER AND GENDER ROLES 127 Sex, Gender, and Gender Roles: What’s the Diff erence? 127 Sex and Gender Identity 128 Masculinity and Femininity: Opposites or Similar? 130 Gender and Sexual Orientation 131

GENDERROLE LEARNING 131 Theories of Socialization 131 Gender-Role Learning in Childhood and Adolescence 133 Gender Schemas: Exaggerating Diff erences 136

CONTEMPORARY GENDER ROLES AND SCRIPTS 137 Traditional Gender Roles and Scripts 137

■ Think About It THE PURITY STANDARD: DEFINING WOMEN BY THEIR SEXUALITY 140

Changing Gender Roles and Scripts 141 Androgyny 142

GENDER VARIATIONS 143 The Transgender Phenomenon 144 Disorders of Sexual Development/Intersex 144

■ Think About It A NEW APPROACH TO ADDRESSING DISORDERS OF SEXUAL DEVELOPMENT OR INTERSEX 147

Unclassifi ed Form of Abnormal Development 151 Gender Identity Disorder 151 Transsexuality 152 Coming to Terms With Diff erences 153

■ Think About It SEX REASSIGNMENT 154 FINAL THOUGHTS 155 | SUMMARY 155

QUESTIONS FOR DISCUSSION 156

SEX AND THE INTERNET 156

SUGGESTED WEBSITES 157 | SUGGESTED READING 157

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6 Sexuality in Childhood and Adolescence 158

SEXUALITY IN INFANCY AND CHILDHOOD AGES 0 TO 11 159 Infancy and Sexual Response (Ages 0 to 2) 160 Childhood Sexuality (Ages 3 to 11) 160 The Family Context 163

SEXUALITY IN ADOLESCENCE AGES 12 TO 19 164 Psychosexual Development 164 Adolescent Sexual Behavior 172

■ Think About It THE “ORIGINS” OF HOMOSEXUALITY 175 ■ Practically Speaking FIRST SEXUAL INTERCOURSE REACTION SCALE 177

Teenage Pregnancy 178 Sexuality Education 181

■ Think About It ABSTINENCEONLY VERSUS COMPREHENSIVE SEXUALITY PROGRAMS: IT’S A NEW DAY 182

FINAL THOUGHTS 184 | SUMMARY 184

QUESTIONS FOR DISCUSSION 185 | SEX AND THE INTERNET 185

SUGGESTED WEBSITES 185 | SUGGESTED READING 186

7 Sexuality in Adulthood 187 SEXUALITY IN EARLY ADULTHOOD 188 Developmental Concerns 188

■ Think About It LIFE BEHAVIORS OF A SEXUALLY HEALTHY ADULT 190 Establishing Sexual Orientation 191

■ Think About It BISEXUALITY: THE NATURE OF DUAL ATTRACTION 194 Being Single 196

■ Think About It WHY COLLEGE STUDENTS HAVE SEX: GENDER DIFFERENCES, OR NOT? 199

Cohabitation 201

SEXUALITY IN MIDDLE ADULTHOOD 203 Developmental Concerns 203 Sexuality in Established Relationships 204 Divorce and After 205

SEXUALITY IN LATE ADULTHOOD 208 Developmental Concerns 208 Stereotypes of Aging 208 Sexuality and Aging 209

FINAL THOUGHTS 215 | SUMMARY 216

QUESTIONS FOR DISCUSSION 216 | SEX AND THE INTERNET 216

SUGGESTED WEBSITES 217 | SUGGESTED READING 217

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Contents • xiii

8 Love and Communication in Intimate Relationships 218

FRIENDSHIP AND LOVE 220

LOVE AND SEXUALITY 221 Men, Women, Sex, and Love 223 Love Without Sex: Celibacy and Asexuality 224

■ Think About It ARE GAY/LESBIAN COUPLES AND FAMILIES ANY DIFFERENT FROM HETEROSEXUAL ONES? 225

HOW DO I LOVE THEE? APPROACHES AND ATTITUDES RELATED TO LOVE 225

Styles of Love 226 The Triangular Theory of Love 227 Love as Attachment 230

■ Think About It THE SCIENCE OF LOVE 232 Unrequited Love 233

JEALOUSY 233 Defi ning Jealousy 234

■ Think About It THE PASSIONATE LOVE SCALE 235 Managing Jealousy 236 Extradyadic Involvement 236

MAKING LOVE LAST: FROM PASSION TO INTIMACY 238

THE NATURE OF COMMUNICATION 239 The Cultural Context 239 The Social Context 240 The Psychological Context 241 Nonverbal Communication 241

SEXUAL COMMUNICATION 243 Sexual Communication in Beginning Relationships 243 Sexual Communication in Established Relationships 246 Initiating Sexual Activity 246

DEVELOPING COMMUNICATION SKILLS 247 Talking About Sex 247

■ Practically Speaking COMMUNICATION PATTERNS AND PARTNER SATISFACTION 248

CONFLICT AND INTIMACY 250 ■ Practically Speaking LESSONS FROM THE LOVE LAB 251

Sexual Confl icts 251 Confl ict Resolution 252

FINAL THOUGHTS 252 | SUMMARY 252

QUESTIONS FOR DISCUSSION 254 | SEX AND THE INTERNET 254

SUGGESTED WEBSITES 254 | SUGGESTED READING 255

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xiv • Contents

9 Sexual Expression 256 SEXUAL ATTRACTIVENESS 258 A Cross-Cultural Analysis 258 Evolutionary Mating Perspectives 260

■ Think About It “HOOKING UP” AMONG COLLEGE STUDENTS 262 Views of College Students 263 Sexual Desire 266

SEXUAL SCRIPTS 266 Cultural Scripting 267 Intrapersonal Scripting 267 Interpersonal Scripting 267

AUTOEROTICISM 268 Sexual Fantasies and Dreams 269 Masturbation 271

■ Practically Speaking ASSESSING YOUR ATTITUDE TOWARD MASTURBATION 274 SEXUAL BEHAVIOR WITH OTHERS 278 Most Recent Partnered Sex 278 Couple Sexual Styles 279

■ Think About It YOU WOULD SAY YOU “HAD SEX” IF YOU . . . 280 Touching 282 Kissing 284 Oral-Genital Sex 284

■ Think About It GIVING AND RECEIVING PLEASURABLE TOUCH: “GEARS OF CONNECTION” 285

■ Think About It THE FIRST KISS: A DEALBREAKER? 286 Sexual Intercourse 289 Anal Eroticism 291 Health Benefi ts of Sexual Activity 294

FINAL THOUGHTS 295 | SUMMARY 295

QUESTIONS FOR DISCUSSION 296 | SEX AND THE INTERNET 296

SUGGESTED WEBSITES 296 | SUGGESTED READING 297

10 Variations in Sexual Behavior 298 SEXUAL VARIATIONS AND PARAPHILIC BEHAVIOR 299 What Are Sexual Variations? 299 What Is Paraphilia? 300

■ Think About It “SEXUAL INTEREST DISORDER”: A VIABLE ALTERNATIVE TO PARAPHILIA OR A RADICAL DEPARTURE? 302

Sexual Variations Among College Students 303

SEXUAL VARIATION: DOMINATION AND SUBMISSION 304

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Contents • xv

NONCOERCIVE PARAPHILIAS 306 Fetishism 306 Transvestism 308

■ Practically Speaking SEXUAL SENSATION SEEKING SCALE 309 COERCIVE PARAPHILIAS 310 Zoophilia 311 Voyeurism 311

■ Think About It WOULD YOU WATCH? COLLEGE STUDENTS AND VOYEURISM 312 Exhibitionism 313 Telephone Scatologia 315 Frotteurism 315

■ Think About It “SEXUAL ADDICTION”: REPRESSIVE MORALITY IN A NEW GUISE? 316 Necrophilia 316 Pedophilia 317 Sexual Sadism and Sexual Masochism 318

ORIGINS AND TREATMENT OF PARAPHILIAS 321

FINAL THOUGHTS 322 | SUMMARY 322

QUESTIONS FOR DISCUSSION 323 | SEX AND THE INTERNET 323

SUGGESTED WEBSITES 323 | SUGGESTED READING 323

11 Contraception, Birth Control, and Abortion 325

RISK AND RESPONSIBILITY 326 Women, Men, and Birth Control: Who Is Responsible? 327 Family Planning Clinics 328

■ Think About It RISKY BUSINESS: WHY COUPLES FAIL TO USE CONTRACEPTION 329

METHODS OF CONTRACEPTION AND BIRTH CONTROL 330

Birth Control and Contraception: What’s the Diff erence? 330

Choosing a Method 331 Sexual Abstinence 331 Hormonal Methods 333 Barrier Methods 338

■ Practically Speaking TIPS FOR EFFECTIVE CONDOM USE 340

■ Practically Speaking CORRECT CONDOM USE SELFEFFICACY SCALE 341

Spermicides 344 The IUCs (Intrauterine Contraceptives) 346 Fertility Awareness–Based Methods 347 Lactational Amenorrhea Method (LAM) 348 Sterilization 349 Emergency Contraception (EC) 351

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ABORTION 352 Methods of Abortion 352 Safety of Abortion 353 Women and Abortion 354 Men and Abortion 355 The Abortion Debate 355

RESEARCH ISSUES 357

FINAL THOUGHTS 357 | SUMMARY 358

QUESTIONS FOR DISCUSSION 359 | SEX AND THE INTERNET 359

SUGGESTED WEBSITES 359 | SUGGESTED READING 360

12 Conception, Pregnancy, and Childbirth 361

FERTILIZATION AND FETAL DEVELOPMENT 362 The Fertilization Process 362 Development of the Conceptus 364

■ Think About It A MATTER OF CHOICE 367 BEING PREGNANT 367 Preconception Care 368 Pregnancy Detection 368 Changes in Women During Pregnancy 369

■ Think About It SEXUAL BEHAVIOR DURING PREGNANCY 372 Complications of Pregnancy and Dangers to the Fetus 372 Diagnosing Fetal Abnormalities 377 Pregnancy Loss 378

INFERTILITY 379 Female Infertility 379 Male Infertility 380 Emotional Responses to Infertility 380 Infertility Treatment 380

GIVING BIRTH 384 Labor and Delivery 384 Choices in Childbirth 386

■ Think About It THE QUESTION OF MALE CIRCUMCISION 387 ■ Practically Speaking MAKING A BIRTH PLAN 388

Breastfeeding 390 ■ Practically Speaking BREAST VERSUS BOTTLE: WHICH IS BETTER

FOR YOU AND YOUR CHILD? 391

BECOMING A PARENT 392

FINAL THOUGHTS 393 | SUMMARY 393

QUESTIONS FOR DISCUSSION 394 | SEX AND THE INTERNET 395

SUGGESTED WEBSITES 395 | SUGGESTED READING 395

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Contents • xvii

13 The Sexual Body in Health and Illness 396

LIVING IN OUR BODIES: THE QUEST FOR PHYSICAL PERFECTION 398 Eating Disorders 398

■ Think About It “OH TO BE BIGGER”: BREAST AND PENIS ENHANCEMENT 399 Body Image and Its Impact on Sexuality 402 Anabolic Steroids: A Dangerous Means to an End 403

ALCOHOL, DRUGS, AND SEXUALITY 403 Alcohol Use and Sexuality 403 Other Drug Use and Sexuality 405

SEXUALITY AND DISABILITY 408 Physical Limitations and Changing Expectations 408 Vision and Hearing Impairment 410 Chronic Illness 410 Developmental Disabilities 412 The Sexual Rights of People With Disabilities 412

SEXUALITY AND CANCER 413 Women and Cancer 413

■ Practically Speaking BREAST SELFEXAMINATION 416 Men and Cancer 424

■ Practically Speaking TESTICULAR SELFEXAMINATION 427 ■ Think About It FEMALE GENITAL CUTTING: MUTILATION OR

IMPORTANT CUSTOM? 429

Anal Cancer in Men and Women 430

ADDITIONAL SEXUAL HEALTH ISSUES 430 Toxic Shock Syndrome 430 Vulvodynia 431 Endometriosis 431 Lesbian Women’s Health Issues 432 Prostatitis 432

FINAL THOUGHTS 433 | SUMMARY 433

QUESTIONS FOR DISCUSSION 435 | SEX AND THE INTERNET 435

SUGGESTED WEBSITES 435 | SUGGESTED READING 436

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14 Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy 437

SEXUAL FUNCTION DIFFICULTIES: DEFINITIONS, TYPES, AND PREVALENCE 439

Defi ning Sexual Function Diffi culties: Diff erent Perspectives 439 Prevalence and Cofactors 443 Disorders of Sexual Desire 446

■ Practically Speaking SEXUAL DESIRE: WHEN APPETITES DIFFER 448 Sexual Arousal Disorders 450

■ Think About It IS INTERCOURSE ENOUGH? THE BIG “O” AND SEXUAL BEHAVIORS 452 Orgasmic Disorders 452 Sexual Pain Disorders 455 Other Disorders 456

PHYSICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 457

Physical Causes in Men 457 Physical Causes in Women 457

PSYCHOLOGICAL CAUSES OF SEXUAL FUNCTION DIFFICULTIES AND DISSATISFACTION 458

Immediate Causes 458 Confl ict Within the Self 459 Relationship Causes 460

SEXUAL FUNCTION ENHANCEMENT 461 Developing Self-Awareness 461

■ Think About It “GOOD ENOUGH SEX”: THE WAY TO LIFETIME COUPLE SATISFACTION 462

■ Think About It SEXUAL TURNONS AND TURNOFFS: WHAT COLLEGE STUDENTS REPORT 463

Intensifying Erotic Pleasure 465 Changing a Sexual Relationship 466

TREATING SEXUAL FUNCTION DIFFICULTIES 467 Masters and Johnson: A Cognitive-Behavioral Approach 467 Kaplan: Psychosexual Therapy 471 Other Nonmedical Approaches 471 Medical Approaches 472

■ Think About It THE MEDICALIZATION OF SEXUAL FUNCTION PROBLEMS 475 Gay, Lesbian, and Bisexual Sex Therapy 475

■ Practically Speaking SEEKING PROFESSIONAL ASSISTANCE 477 FINAL THOUGHTS 477 | SUMMARY 478

QUESTIONS FOR DISCUSSION 479 | SEX AND THE INTERNET 480

SUGGESTED WEBSITES 480 | SUGGESTED READING 480

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Contents • xix

15 Sexually Transmitted Infections 481

THE STI EPIDEMIC 483 STIs: The Most Common Reportable Infectious Diseases 483 Who Is Aff ected: Disparities Among Groups 483 Factors Contributing to the Spread of STIs 486

■ Practically Speaking PREVENTING STIs: THE ROLE OF MALE CONDOMS AND FEMALE CONDOMS 489

■ Practically Speaking STI ATTITUDE SCALE 492 Consequences of STIs 493

PRINCIPAL BACTERIAL STIs 493 Chlamydia 493 Gonorrhea 497 Urinary Tract Infections 498 Syphilis 498

■ Think About It THE TUSKEGEE SYPHILIS STUDY: A TRAGEDY OF RACE AND MEDICINE 500

PRINCIPAL VIRAL STIs 500 HIV and AIDS 501 Genital Human Papillomavirus Infection 502 Genital Herpes 504 Viral Hepatitis 505

VAGINAL INFECTIONS 506 Bacterial Vaginosis 506 Genital Candidiasis 507 Trichomoniasis 508

OTHER STIs 508

ECTOPARASITIC INFESTATIONS 509 Scabies 509 Pubic Lice 509

STI AND WOMEN 510 Pelvic Infl ammatory Disease (PID) 510 Cervicitis 510 Cystitis 511

PREVENTING STIs 511 Avoiding STIs 511 Treating STIs 513

■ Practically Speaking SAFER AND UNSAFE SEX PRACTICES 514 FINAL THOUGHTS 515 | SUMMARY 515

QUESTIONS FOR DISCUSSION 516 | SEX AND THE INTERNET 517

SUGGESTED WEBSITES 517 | SUGGESTED READING 517

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xx • Contents

16 HIV and AIDS 518 WHAT IS AIDS? 520 Conditions Associated With AIDS 520

■ Think About It THE STIGMATIZATION OF HIV AND OTHER STIs 521 Symptoms of HIV Infection and AIDS 522 Understanding AIDS: The Immune System and HIV 522 The Virus 523 AIDS Pathogenesis: How the Disease Progresses 524

THE EPIDEMIOLOGY AND TRANSMISSION OF HIV 526 The Epidemiology of HIV/AIDS in the United States 527 Myths and Modes of Transmission 530 Sexual Transmission 531 Injection Drug Use 532 Mother-to-Child Transmission 532 Factors Contributing to Infection 533

AIDS DEMOGRAPHICS 533 Minority Races/Ethnicities and HIV 533 The Gay Community 536 Women and HIV/AIDS 538 Children and HIV/AIDS 539 HIV/AIDS Among Youth 540 Older Adults and HIV/AIDS 541 Geographic Region and HIV 541

■ Practically Speaking HIV PREVENTION ATTITUDE SCALE 542 PREVENTION AND TREATMENT 542

■ Practically Speaking HEALTH PROTECTIVE SEXUAL COMMUNICATION SCALE 543

Protecting Ourselves 543 Saving Lives Through Prevention 544

■ Think About It “DO YOU KNOW WHAT YOU ARE DOING?” COMMON CONDOMUSE MISTAKES AMONG COLLEGE STUDENTS 545

HIV Testing 548 Treatments 550

LIVING WITH HIV OR AIDS 552 If You Are HIV-Positive 553

FINAL THOUGHTS 554 | SUMMARY 554

QUESTIONS FOR DISCUSSION 555 | SEX AND THE INTERNET 556

SUGGESTED WEBSITES 556 | SUGGESTED READING 556

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Contents • xxi

17 Sexual Coercion: Harassment, Aggression, and Abuse 557

SEXUAL HARASSMENT 558 What Is Sexual Harassment? 559 Flirtation Versus Harassment 561 Harassment in School and College 562 Harassment in the Workplace 564

HARASSMENT AND DISCRIMINATION AGAINST GAY, LESBIAN, BISEXUAL, AND TRANSGENDER PEOPLE 565

Heterosexual Bias 565 Prejudice, Discrimination, and Violence 566

■ Think About It PUBLIC OPINION ABOUT GAY AND LESBIAN ISSUES AND RIGHTS 569

Ending Anti-Gay Prejudice and Enactment of Antidiscrimination Laws 570

SEXUAL AGGRESSION 572 The Nature and Incidence of Rape 572 Myths About Rape 573

■ Practically Speaking PREVENTING SEXUAL ASSAULT 574 Forms of Rape 576

■ Think About It DATE/ACQUAINTANCE RAPE DRUGS: AN INCREASING THREAT 578

Motivations for Rape 583 The Aftermath of Rape 584

■ Practically Speaking HELPING SOMEONE WHO HAS BEEN RAPED 585

CHILD SEXUAL ABUSE 586 Forms of Intrafamilial Sexual Abuse 587 Children at Risk 588 Eff ects of Child Sexual Abuse 588 Treatment Programs 591 Preventing Child Sexual Abuse 592

FINAL THOUGHTS 593 | SUMMARY 593

QUESTIONS FOR DISCUSSION 594 | SEX AND THE INTERNET 594

SUGGESTED WEBSITES 595 | SUGGESTED READING 595

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xxii • Contents

18 Sexually Explicit Materials, Prostitution, and Sex Laws 596

SEXUALLY EXPLICIT MATERIAL IN CONTEMPORARY AMERICA 597 Pornography or Erotica: Which Is It? 598 Sexually Explicit Material and Popular Culture 598 Sexually Explicit Materials on the Internet 599

■ Think About It COLLEGE STUDENTS AND THE VIEWING OF SEXUALLY EXPLICIT MATERIALS 602

The Eff ects of Sexually Explicit Material 602 Censorship, Sexually Explicit Material, and the Law 606

PROSTITUTION 610 Females Working in Prostitution 611

■ Think About It HUMAN TRAFFICKING: INTERNATIONAL CHILD AND TEEN PROSTITUTION 612

Males Working in Prostitution 617 Prostitution and the Law 618 The Impact of HIV/AIDS and Other STIs 619

SEXUALITY AND THE LAW 620 Legalizing Private, Consensual Sexual Behavior 620 Same-Sex Marriage 621

■ Think About It AN EXPANDING DEFINITION OF “FAMILY”: A TREND LEADING TO FURTHER LEGALIZATION OF SAMESEX MARRIAGE? 623

Advocating Sexual Rights 623

FINAL THOUGHTS 624 | SUMMARY 624

QUESTIONS FOR DISCUSSION 625 | SEX AND THE INTERNET 626

SUGGESTED WEBSITES 626 | SUGGESTED READING 626

GLOSSARY G1

BIBLIOGRAPHY B1

CREDITS C1

NAME INDEX NI1

SUBJECT INDEX SI1

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WILLIAM L. YARBER is a senior research fellow at Th e Kinsey Institute for Research in Sex, Gender, and Reproduction and the senior director of the Rural Center for AIDS/STD Prevention at Indiana University, Bloomington. He is also professor of applied health science and professor of gender studies at IU. Dr. Yarber, who received his doctorate from Indiana University, has authored or co-authored numerous scientifi c reports on sexual risk behavior and AIDS/STD prevention in professional journals and has received several federal and state grants to support his research and AIDS/ STD prevention eff orts. He is a member of the Th e Kinsey Institute Condom Use Research Team (CURT) comprised of researchers from Indiana University, University of Kentucky, University of Guelph (Canada), and University of Southampton (United Kingdom). For over a decade, with federal and institutional research support, CURT has investigated male condom use, particularly use errors and problems, and has devel- oped behavioral interventions designed to improve correct condom use. At the request of the U.S. government, Dr. Yarber authored the country’s fi rst secondary school AIDS prevention education curriculum, AIDS: What Young People Should Know (1987). He also co-edited the Handbook of Sexuality-Related Measures, Th ird Edition (2011). Dr. Yarber chaired the National Guidelines Task Force, which developed the Guidelines for Comprehensive Sexuality Education: Kindergarten–12th Grade (1991, 1996, 2004), pub- lished by the Sexuality Information and Education Council of the United States (SIECUS). Dr. Yarber is past president of Th e Society for the Scientifi c Study of Sexuality (SSSS) and a past chair of the SIECUS board of directors. His awards include the SSSS Distinguished Scientifi c Achievement Award, the Professional Stan- dard of Excellence from the American Association of Sex Educators, Counselors, and Th erapists, the Indiana University President’s Award for Distinguished Teaching, and the inaugural Graduate Student Outstanding Faculty Mentor Award at Indiana Uni- versity. Dr. Yarber has been a consultant to the World Health Organization Global Program on AIDS. He regularly teaches undergraduate and graduate courses in human sexuality. He was previously a faculty member at Purdue University and the University of Minnesota, as well as a public high school health science and biology teacher. Dr. Yarber is married and is the father of two adult daughters.

About the AuthorsAbout the Authors

William L. Yarber

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xxiv • About the Authors

BARBARA W. SAYAD is a faculty member at California State University, Monterey Bay, where she teaches human sexuality, women’s health, behavior change, service learning, and health promotion in multicultural populations. Dr. Sayad holds a Ph.D. in Health and Human Behavior, an M.P.H. in Community Health Education, and a B.S. in Foods and Nutrition. Along with co-authoring six editions of Human Sexuality: Diversity in Contemporary America (McGraw-Hill), she has also co-authored Th e Marriage and Family Experience (Wadsworth) and has contributed to a number of other health-related texts, curricular guides, and pub- lications. In addition to her 30 years of teaching and mentoring in the university setting, Dr. Sayad has facilitated a number of training programs, presented at professional organizations, and worked as a training and curriculum consultant in nonprofi t and proprietary organizations. Dr. Sayad is married and with her hus- band, Bob, has three adult children.

Barbara W. Sayad

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A Guided Tour Through the Eighth Editionthe Eighth Edition

Since the fi rst edition, Human Sexuality: Diversity in Contemporary America has presented students with a nonjudgmental view of human sexuality while encouraging them to become proactive about their own sexual well-being. Th is sex-positive approach, combined with an integrated exploration of cultural diversity and contemporary research, continues today. Th e new edition emphasizes the importance of affi rming and supporting intimacy, pleasuring, and mutual satisfaction in human sexuality. Th is empha- sis can be found throughout the book but particularly in Chapter 8, Love and Communication in Intimate Relationships and Chapter 9, Sexual Expression. In addition, students are encouraged to critically assess their own values and modes of sexual expression. For instance, Th ink About It boxes prompt students to evaluate their knowledge of and opinions about high-interest topics in sex- uality such as sexting or the expanding defi nition of family.

• Expanding Students’ Knowledge of Human Sexuality How many students think they know everything about human sexuality but struggle on the fi rst exam? LearnSmart, McGraw-Hill’s adaptive learning sys- tem, helps students identify what they know—and, more importantly, what

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they don’t know. Based on Bloom’s Taxonomy, LearnSmart creates a customized study plan, unique to every student’s demonstrated needs. With virtually no administrative overhead, instructors using LearnSmart are reporting an increase in student performance by one letter grade or more.

• Assessing Student Progress McGraw-Hill’s Connect Human Sexuality off ers a wealth of assignable and assessable course materials. Videos, interactivities, and self-assessments engage students in human sexuality course concepts. Detailed reporting helps the stu- dent and instructor gauge comprehension and retention—without adding admin- istrative load.

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xxviii

• Chapter-by-Chapter Changes Th e amount of research in gender and gender and queer studies is ever increasing, media continues to have a signifi cant impact on sexuality, and the approaches and language used to describe these areas are perpetually evolving. Th e eighth edition of Human Sexuality: Diversity in Contemporary America addresses these and many other important changes:

Chapter 1: Perspectives on Human Sexuality ■ Expanded and updated material on media portrayals of sexuality ■ New material on teens “coming out” ■ New research on social networking ■ Added discussion on the sexual revolution and its impact on sexual

expression

Chapter 2: Studying Human Sexuality ■ Findings of the latest CDC Youth Risk Behavior Survey ■ Results of the latest National Survey of Family Growth study on several

measures of sexual behavior, sexual attraction, and sexual identity of men and women aged 15–44 years

■ Th e most recent fi ndings of the American College Health Association research on college student sexual behavior

■ Findings of the National Survey of Sexual Health and Behavior, the most expansive nationally representative study since 1994

■ New Th ink About It box: “Sex Research: A Benefi t to Individuals and Society or Th reat to Morality?”

Chapter 3: Female Sexual Anatomy, Physiology, and Response ■ Expanded discussion on the science behind the G-spot ■ Added theory and discussion around the dual control model ■ Discussion of the circular model of sexual desire and response ■ New research on the brain “in love”

PrefacePreface

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Preface • xxix

■ New research on “faking orgasm” ■ New Th ink About It box: “Sexual Fluidity: Women’s Variable Sexual

Attractions”

Chapter 4: Male Sexual Anatomy, Physiology, and Response ■ Expanded discussion on the sexual health of men ■ New Practically Speaking box: “Male Body Image Self-Consciousness Scale” ■ Updated discussion on low testosterone

Chapter 5: Gender and Gender Roles ■ Updated research and discussion on disorders of sexual development ■ Added discussion on gender bias and violence on college campus ■ Added discussion on nonmedical options for the transgender person ■ New Th ink About It box: “Th e Purity Standard: Defi ning Women by

Th eir Sexuality”

Chapter 6: Sexuality in Childhood and Adolescence ■ New table on childhood sexual behaviors witnessed by parents ■ New research on “precocious puberty” ■ Introduction to the Report of the APA Task Force on the Sexualization

of Girls ■ New research on and discussion of what constitutes having “had sex” ■ New research on physiological and psychological satisfaction of fi rst

vaginal intercourse ■ New Th ink About It box: “Abstinence-Only Versus Comprehensive Sexuality

Programs: It’s a New Day” ■ New Practically Speaking box: “First Intercourse Reaction Scale”

Chapter 7: Sexuality in Adulthood ■ Expanded discussion on an integrated GLBT identity ■ Updated data on and trends in cohabitation ■ New discussion about online dating ■ Updates on menopause and hormone replacement therapy ■ New research on sexuality among older adults

Chapter 8: Love and Communication in Intimate Relationships ■ New research on keeping love alive ■ Added discussion on gender, sexual orientation, and relationship

satisfaction ■ New research on the role of oxytocin and relationship satisfaction ■ New self-assessment: “Dyadic Sexual Communication Scale”

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xxx • Preface

■ New Th ink About It box: “Are Gay/Lesbian Couples and Families Any Diff erent from Heterosexual Ones?”

■ New research on jealousy ■ Updated data and discussion on infi delity among marital and nonmarital

couples

Chapter 9: Sexual Expression ■ Expanded discussion on physical characteristics and scent as related to

sexual attractiveness ■ Updated Th ink About It box: “‘Hooking Up’ Among College Students” ■ New research on “mate poaching” ■ Findings of the prevalence of nine sexual behaviors and contextual factors

and men and women from the National Survey of Sexual Health and Behavior

■ New discussion of couple sexual styles ■ New Th ink About It box: “Giving and Receiving Pleasurable Touch:

‘Gears of Connection’” ■ New discussion on health benefi ts of sexual activity ■ New and lifelike positional art

Chapter 10: Variations in Sexual Behavior ■ New Practically Speaking box: “Sexual Sensation Seeking Scale” ■ Expanded discussion of domination and submission ■ New research on noncoercive paraphilias ■ Recent data concerning coercive paraphilias

Chapter 11: Contraception, Birth Control, and Abortion ■ New Practically Speaking box: “Correct Condom Use Self-Effi cacy

Scale” ■ New data on unintended pregnancies and outcomes ■ Latest research and updates on all birth control devices ■ Updated discussion of emergency contraception ■ New data on the prevalence and legal status of abortion ■ Updated research on and discussion of the role and impact of abortion

on males

Chapter 12: Conception, Pregnancy, and Childbirth ■ New discussion of pre-conception care ■ New research on the role of physical activity and obesity in pregnancy

outcomes ■ New research on Sudden Infant Death Syndrome (SIDS)

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Preface • xxxi

■ Update on policies and procedures for pregnancy, delivery, and new mothers and families

■ Updated Th ink About It box: “Th e Question of Male Circumcision”

Chapter 13: The Sexual Body in Health and Illness ■ Updates on male cosmetic surgery, including a critical look at penis

enhancement ■ New research on eating disorders among gay, lesbian, and transgender

individuals ■ New research on the sexual consequences of eating disorders ■ New research on and discussion of the role of binge drinking and sexual

risk-taking ■ Updated and expanded discussion about recreational drugs and sexual

behaviors ■ Updated discussion of “natural substances” and sexual performance ■ Updates and recommendations for men’s and women’s sexual health care,

including use of mammograms and prostate screening

Chapter 14: Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy ■ New research on the prevalence of sexual function diffi culties ■ New research on changes in sexual desire among men and women from

12 age groups and intercourse prevalence among long-term couples ■ New Th ink About It box: “Sexual Desire: When Sexual Appetites Diff er” ■ Expanded discussion of the role of varied sexual behaviors as related to

experiencing orgasm ■ Added Th ink About It box: “ ‘Good Enough Sex’: Th e Way to Lifetime

Couple Satisfaction” ■ New discussion of developing and maintaining sexual desire ■ Added discussion of ways to deal with discrepancies in sexual desire

among couples

Chapter 15: Sexually Transmitted Infections ■ Updated information on the prevalence and incidence of major STIs ■ Updated medical information on the major STIs ■ New discussion of concurrent sexual relationships as an STI risk ■ Expanded discussion of the factors contributing to the spread of STIs ■ New information on circumcision and STI prevention ■ Updated information on the HPV vaccination

Chapter 16: HIV and AIDS ■ Updated information on the prevalence and incidence of HIV/AIDS in

the United States and worldwide

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xxxii • Preface

■ Updated biological information on HIV/AIDS ■ Expanded discussion of the disproportionate impact of HIV/AIDS on

African Americans, Latinos, and men who have sex with men ■ Updated information on antiretroviral therapy ■ New material on the success of HIV prevention eff orts

Chapter 17: Sexual Coercion: Harassment, Aggression, and Abuse ■ New material on stalking ■ Updated information on the prevalence and outcomes of sexual harassment,

aggression, rape, and child sexual abuse ■ Expanded discussion of the outcomes of anti-gay prejudice and discrimination ■ New public opinion polls on gay and lesbian rights ■ Expanded discussion of antidiscrimination laws

Chapter 18: Sexually Explicit Materials, Prostitution, and Sex Laws ■ New material on Internet sex site use by college students and other

populations ■ Expanded and new information on the eff ects of sexually explicit materials ■ Added Th ink About It box: “Human Traffi cking: International Child

and Teen Prostitution” ■ New material on the nature and outcomes of prostitution ■ Updated discussion of same-sex marriage ■ New Th ink About It box: “An Expanding Defi nition of ‘Family’? A Trend

Leading to Further Legalization of Same-Sex Marriage?” ■ Update on recent milestone rulings affi rming gay rights in the

United States

• Human Sexuality Teaching and Learning Resources Program Human Sexuality is the centerpiece of a complete resource program for both students and instructors. Th e following materials have been carefully developed by a team of experienced human sexuality instructors to support a variety of teaching and learning styles.

Online Learning Center for Instructors Th is password-protected website con- tains the Test Bank, Instructor’s Manual, PowerPoint presentations, and image gallery, as well as access to the entire student side of the website. To access these resources, please go to www.mhhe.com/yarber8e.

Instructor’s Manual prepared by ANSR, a leading academic supplements development company. Th is guide begins with general concepts and strategies for teaching human sexuality. Th e Instructor’s Manual contains a chapter

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www.mhhe.com/yarber8e

Preface • xxxiii

outline, learning objectives, discussion questions, activities, a list of videos, a bibliography, worksheets, handouts, and internet activities for each chapter. Th e Instructor’s Manual can be accessed on the Online Learning Center.

Test Bank prepared by Tori Bovard, American River College. Th e Test Bank has been revised and updated by the author of the previous edition’s Test Bank. Updated and revised for the new edition, each chapter off ers over 100 ques- tions, including multiple choice and short answer questions. Th ese test items are available on the instructors’ Online Learning Center as Word fi les and in EZ Test, an easy-to-use electronic test bank that allows instructors to easily edit and add their own questions.

PowerPoint Presentations prepared by ANSR, a leading academic supplements development company. Available on the Online Learning Center, these presen- tations cover the key points of each chapter. Th ey can be used as-is or modifi ed to support an individual instructors’ lectures and style. Digital version of many images and fi gures are also available in the Image Gallery.

Online Learning Center for Students includes multiple choice, true/false, and fi ll-in the blank practice quizzes to help students prepare for exams. To access these resources, go to www.mhhe.com/yarber8e.

McGraw-Hill publishes Annual Editions: Human Sexuality, a collection of articles on topics related to the latest research and thinking in human sexuality from over 300 public press sources. Th ese editions are updated annually and contain helpful features, including a topic guide, an annotated table of con- tents, unit overviews, and a topical index. An instructor’s guide containing testing material is also available. ISBN: 0078051177.

For information on any component of the teaching and learning package, instructors should contact their McGraw-Hill representative.

• Acknowledgments Many people contributed to the creation and development of this book. First and foremost, we wish to thank the many students whose voices appear in the introductions of each chapter. The majority of these excepts come from Bobbi Mitzenmacher’s, Barbara Sayad’s, and William L. Yarber’s undergraduate human sexuality students (California State University, Long Beach and Monterey Bay, and Indiana University), who have courageously agreed to share their experi- ences. All of these students have given permission to use their experiences and quotations so that others might share and learn from their reflections. A number of reviewers and adopters were instrumental in directing the authors to needed changes, updates, and resources, and we are most grateful for their insights and contributions. Whenever possible, we have taken their suggestions and integrated them into the text. Special thanks are owed to the following reviewers of the sixth edition:

Michael W. Agopian, Los Angeles Harbor College Glenn Carter, Austin Peay State University Ellen Cole, Alaska Pacifi c University Sara L. Crawley, University of South Florida Linda De Villers, Pepperdine University

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xxxiv • Preface

Bety Dorr, Fort Lewis College Amanda Emo, University of Cincinnati Jean Hoth, Rochester Community and Technical College Mary Meiners, Miramar College William O’Donohue, University of Nevada Carlos Sandoval, Cypress College Mary Ann Watson, Metro State College at Denver Laurie M. Wagner, Kent State University

Th anks also to the reviewers of the seventh edition:

Stephanie Coday, Sierra College Jodi Martin deCamilo, St. Louis Community College, Meramec-Kirkwood Dale Doty, Monroe Community College Duane Dowd, Central Washington University, Ellensburg Edward Fliss, St. Louis Community College, Florissant Valley Richard Hardy, Indiana University at Bloomington Lynne M. Kemen, Hunter College Nancy King, Western Michigan University, Kalamazoo Kris Koehne, University of Tennessee, Knoxville Jennifer Musick, Long Beach City College Diane Pisacreta, St. Louis Community College, Meramec-Kirkwood Grace Pokorny, Long Beach City College Michael Rahilly, University of California at Davis Sally Raskoff , Los Angeles Valley College Daniel Rubin, Valencia Community College, West Campus Regine Rucker, University of Illinois, Champaign Catherine Sherwood-Puzzello, Indiana University at Bloomington Peggy Skinner, South Plains College

And most recently, thanks to the reviewers of the eighth edition:

Janell Campbell, California State University, Chico Susan Horton, Mesa Community College Eileen Johnston, Glendale Community College Amanda LeBlanc, University of South Florida Richard McWhorter, Prairie View A&M University Grace Pokorny, Long Beach City College Tina Timm, Michigan State University

Publishing a textbook is similar to producing a stage show in that even with a clear concept and great writing, there are individuals without whom the production (in this case, of the textbook) would not be possible. Our thanks go to Brand Managers Mark Georgiev and Nancy Welcher, and Directors Mike Sugarman and Krista Bettino, whose vision and energy helped guide the pub- lication of this book. Additional kudos and gratitude go to Barbara A. Heinssen, Director of Development, and Cheri Dellelo, Developmental Editor, who were intimately involved with all aspects of this publication. Production Editor Catherine Morris was a constant in assisting us in finding answers to questions and guiding us through the production process. A special thanks to Manuscript Editor Margaret Moore, Design Manager Matt Diamond, Photo Researchers Keri Johnson and Allison Grimes, and Sarah Colwell, Digital Development Editor. Our combined efforts have contributed to a book which we can all be proud of.

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xxxv

When students fi rst enter a human sexuality class, they may feel uncomfortable, nervous, and excited, all at the same time. Th ese feelings are not at all uncom- mon. Th is is because the more an area is judged to be “off limits,” the less likely it is to be discussed. Yet sex surrounds us and impacts our lives every day from the provocative billboard ad on the highway, to men’s and women’s fashions, to prime-time television dramas. People want to learn about human sexuality and how to live a healthy life both physically and psychologically. In our quest for knowledge and understanding, we need to be intellectually curi- ous. As writer Joan Nestle observes, “Curiosity builds bridges. . . . Curiosity is not trivial; it is the respect one life pays to another.” Students begin studying sexuality for many reasons: to gain insight into their sexuality and relationships, to become more comfortable with their sexuality, to learn how to enhance sexual pleasure, to explore personal sexual issues, to dispel anxieties and doubts, to validate their sexual identity, to resolve traumatic sexual experiences, and to learn how to avoid STIs and unintended pregnancies. Many students fi nd the study of sexuality empowering; they develop the abil- ity to make intelligent sexual choices based on reputable information and their own needs, desires, and values, rather than on stereotypical, haphazard, unreli- able, incomplete, or unrealistic information or guilt, fear, or conformity. Th ose studying this subject often report that they feel more appreciative and less apologetic, defensive, or shameful about their sexual feelings, attractions, and desires. Particularly in a country as diverse as the United States, the study of sexuality calls for us to be open-minded: to be receptive to new ideas and to various per- spectives; to respect those with diff erent experiences, values, orientations, ages, and ethnicities; to seek to understand what we have not understood before; to reexamine old assumptions, ideas, and beliefs; and to embrace and accept the humanness and uniqueness in each of us. Sexuality can be a source of great pleasure. Th rough it, we can reveal our- selves, connect with others on the most intimate levels, create strong bonds, and bring new life into the world. Paradoxically, though, sexuality can also be a source of guilt and confusion, anger and disappointment, a pathway to infec- tion, and a means of exploitation and aggression. We hope that by examining the multiple aspects of human sexuality presented in this book, you will come to understand, accept, and appreciate your own sexuality and that of others and learn how to make healthy sexual choices for yourself.

Letter From the Authors

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ch ap

te r

Perspectives on Human Sexuality

M A I N T O P I C S

Studying Human Sexuality 2

Sexuality, Popular Culture, and the Media 5

Sexuality Across Cultures and Times 14

Societal Norms and Sexuality 19

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2 • Chapter 1 Perspectives on Human Sexuality

“The media, espe- cially magazines and television, has had an infl uence on shaping my sexual identity. Ever since I was a little girl, I have watched the women on TV and hoped I would grow

up to look sexy and beautiful like them. I feel that because of the constant barrage of images of beautiful women on TV and in magazines young girls like me grow up with unrealistic ex- pectations of what beauty is and are doomed to feel they have not met this exaggerated standard.”

—21-year-old female

“The phone, television, and Internet became my best friends. I never missed an episode of any of the latest shows, and I knew all the words to every new song. And when Facebook entered my life, I fi nally felt connected. At school, we would talk about status updates: whom we thought was cute, relationship sta- tus, and outrageous photos. All of the things we saw were all of the things we fantasized about. These are the things we would talk about.”

—23-year-old female

“Though I fi rmly believe that we are our own harshest critics, I also believe that the media have a large role in infl uencing how we think of ourselves. I felt like ripping my hair out every time I saw a skinny model whose stomach was as hard and fl at as a board, with their fl awless skin and perfectly coifed hair. I cringed when I realized that my legs seemed to have an extra ‘wiggle-jiggle’ when I walked. All I could do was watch the tele- vision and feel abashed at the diff erences in their bodies com- pared to mine. When magazines and fi lms tell me that for my age I should weigh no more than a hundred pounds, I feel like saying, ‘Well, gee, it’s no wonder I fi nally turned to laxatives with all these pressures to be thin surrounding me.’ I ached to be model-thin and pretty. This fi xation to be as beautiful and coveted as these models so preoccupied me that I had no time to even think about anyone or anything else.”

—18-year-old female

“I am aware that I may be lacking in certain areas of my sexual self-esteem, but I am cognizant of my shortcomings and am willing to work on them. A person’s sexual self-esteem isn’t something that is detached from his or her daily life. It is inter- twined in every aspect of life and how one views his or her self: emotionally, physically, and mentally. For my own sake, as well as my daughter’s, I feel it is important for me to develop and model a healthy sexual self-esteem.”

—28-year-old male

S exuality was once hidden from view in our culture: Fig leaves covered the “private parts” of nudes; poultry breasts were renamed “white meat”; censors prohibited the publication of the works of D. H. Lawrence, James Joyce, and Henry Miller; and homosexuality was called “the love that dares not speak its name.” But over the past few generations, sexuality has become more open. In recent years, popular culture and the media have transformed what we “know” about sexuality. Not only is sexuality not hidden from view; it often seems to surround us. In this chapter, we discuss why we study human sexuality and examine popular culture and the media to see how they shape our ideas about sexuality. Th en we look at how sexuality has been treated in diff erent cultures and at diff erent times in history. Finally, we examine how society defi nes various aspects of our sexuality as natural or normal.

• Studying Human Sexuality Th e study of human sexuality diff ers from the study of accounting, plant biol- ogy, and medieval history, for example, because human sexuality is surrounded by a vast array of taboos, fears, prejudices, and hypocrisy. For many, sexuality creates ambivalent feelings. It is linked not only with intimacy and pleasure but also with shame, guilt, and discomfort. As a result, you may fi nd yourself

Student Voices

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confronted with society’s mixed feelings about sexuality as you study it. You may fi nd, for example, that others perceive you as somehow “unique” or “dif- ferent” for taking this course. Some may feel threatened in a vague, undefi ned way. Parents, partners, or spouses (or your own children, if you are a parent) may wonder why you want to take a “sex class”; they may want to know why you don’t take something more “serious”—as if sexuality were not one of the most important issues we face as individuals and as a society. Sometimes this uneasiness manifests itself in humor, one of the ways in which we deal with ambivalent feelings: “You mean you have to take a class on sex?” “Are there labs?” “Why don’t you let me show you?” Ironically, despite societal ambivalence, you may quickly fi nd that your human sexuality textbook becomes the most popular book in your dormitory or apartment. “I can never fi nd my textbook when I need it,” one of our stu- dents complained. “My roommates are always reading it. And they’re not even taking the course!” Another student observed: “My friends used to kid me about taking the class, but now the fi rst thing they ask when they see me is what we discussed in class.” “People borrow my book so often without asking,” writes one student, “that I hide it now.” As you study human sexuality, you will fi nd yourself exploring topics not ordinarily discussed in other classes. Sometimes they are rarely talked about even among friends. Th ey may be prohibited by family, religious, or cultural teaching. For this reason, behaviors such as masturbation and sexual fantasizing are often the source of considerable guilt and shame. But in your human sexuality course, these topics will be examined objectively. You may be surprised to discover, in fact, that part of your learning involves unlearning myths, factual errors, distor- tions, biases, and prejudices you learned previously. Sexuality may be the most taboo subject you study as an undergraduate, but your comfort level in class will probably increase as you recognize that you and your fellow students have a common purpose in learning about sexuality. Your sense of ease may also increase as you and your classmates get to know one another and discuss sexuality, both inside and outside the class. You may fi nd that, as you become accustomed to using the accepted sexual vocabulary, you are more comfortable discussing various topics. For example, your communication with a partner may improve, which will strengthen your relationship and increase sexual satisfaction for both of you. (To assess your level of sexual satisfaction in a sexual relationship, complete the question- naires in either or both of the boxes “Communication Patterns and Partner Satisfaction” or “Th e Passionate Love Scale” found in Chapter 8.) You may never before have used the words masturbation, clitoris, or penis in a class setting (or any kind of setting, for that matter). But after a while, using these and other terms may become second nature to you. You may discover that discussing sexuality academically becomes as easy as discussing computer sci- ence, astronomy, or literature. You may even fi nd yourself, as many students do, discussing with your friends what you learned in class while on a bus or in a restaurant, as other passengers or diners gasp in surprise or lean toward you to hear better! Studying sexuality requires respect for your fellow students. You’ll discover that the experiences and values of your classmates vary greatly. Some have little sexual experience, while others have a lot of experience; some students hold progressive sexual values, while others hold conservative ones. Some students are gay, lesbian, or bisexual individuals, while the majority are heterosexual people. Most students

“ Sexuality is with us from the moment of birth to the moment of death. We can

deny it or defl ect it, we can pretend it’s something other than what it is, we can refuse to talk about it or act on it, we can do all sorts of things regarding our sexuality. The only thing we can’t do is get rid of it.

—Bernie Zilbergeld (1939-2002)

Studying Human Sexuality • 3

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4 • Chapter 1 Perspectives on Human Sexuality

are young, others middle-aged, some old—each in a diff erent stage of life and with diff erent developmental tasks before them. Furthermore, the presence of students from any of the numerous ethnic groups in the United States reminds us that there is no single behavior, attitude, value, or sexual norm that encom- passes sexuality in contemporary America. Finally, as your sexuality evolves as you yourself change, you will fi nd that you will become more accepting of yourself as a sexual human being.

practically speaking

Most individuals would agree that sexuality is a signifi cant component of one’s quality of life and well-being and that pleasure is a key element for their motivation to have sex. Given that one of the goals of this text is to provide information and tools for enhancing satisfaction in sexual relationships, em- phasis on sexual pleasure and pleasuring will occur throughout the book, but will be particularly highlighted in Chapters 7, 8, and 14. The New Sexual Satisfaction Scale (NSSS) was developed as a tool for assessing sexual satisfaction. This measure can be used by those who are or have been in sexual relationships within the past 6 months or by anyone who might fi nd it infor- mative and perhaps useful for when they do become involved in a sexual relationship. The scale is not specifi c to gender, sexual orientation, or relationship status. When individuals discover the signifi cance of their own sex- ual style and share this information with their partners, bonds can be strengthened, deeper connections can be made, and pleasure can be experienced as a component of holistic health and well-being.

Directions

Thinking about your sex life during the past 6 months, please rate your satisfaction with the following aspects:

1 � Not at all satisfi ed 2 � A little satisfi ed 3 � Moderately satisfi ed 4 � Very satisfi ed 5 � Extremely satisfi ed

1. The intensity of my sexual arousal

2. The quality of my orgasms

3. My “letting go” and surrender to sexual pleasure during sex

4. My focus/concentration during sexual activity

5. The way I sexually react to my partner

6. My body’s sexual functioning

7. My emotional opening-up in sex

8. My mood after sexual activity

9. The frequency of my orgasms

10. The pleasure I provide to my partner

11. The balance between what I give and receive in sex

12. My partner’s emotional opening-up during sex

13. My partner’s initiation of sexual activity

14. My partner’s ability to orgasm

15. My partner’s surrender to sexual pleasure (“letting go”)

16. The way my partner takes care of my sexual needs

17. My partner’s sexual creativity

18. My partner’s sexual availability

19. The variety of my sexual activities

20. The frequency of my sexual activity

Scoring

There are two components of this assessment: the Ego-Centered subscale (items 1–10), which measures sexual satisfaction gener- ated by your personal experiences and sensations, and the Partner/Sexual Activity-Centered subscale (items 11–20), which measures sexual satisfaction derived from your perception of your partner’s sexual behaviors and reactions and the diversity and/or frequency of your sexual activities. Scores will range between 20 and 100, 10–50 for each of the two subscales with the higher scores leaning toward more satisfaction.

Assessing Sexual Satisfaction

SOURCE: Stulhofer, A., Busko, V., & Brouillard, P. The New Sexual Satisfaction Scale and its short form. In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 530–532). Copyright 2011 by Routledge. Reprinted by permission of the publisher (Taylor & Francis Group, http://www.informaworld.com).

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http://www.informaworld.com

Sexuality, Popular Culture, and the Media • 5

• Sexuality, Popular Culture, and the Media Much of sexuality is infl uenced and shaped by popular culture, especially the mass media. Popular culture presents us with myriad images of what it means to be sexual. But what kinds of sexuality do the media portray for our consumption?

Media Portrayals of Sexuality

What messages do the media send about sex to children, adolescents, adults, and older people? To men and women and to those of varied races, ethnicities, and sexual orientations? Perhaps as important as what the media portray sexu- ally is what is not portrayed—masturbation, condom use, and older adults’ sexuality, for example. Th e media are among the most powerful forces in young people’s lives today (Kaiser Family Foundation, 2010). Next to sleeping, young people spend more time engaging with the media than any other activity—an aver- age of 7½ hours per day, 7 days per week (see Figure 1.1). Watching TV, playing video games, texting, listening to music, and searching the Internet provide a constant stream of messages, images, expectations, and values about which few (if any) of us can resist. Whether and how this exposure is related to sexual outcomes is complex and debatable, depending on the population studied. However, the data that are available may provide an impetus for policy makers who are forming media policies, parents who are trying to support their children’s identity and learning, and educators and advocates who are concerned about the impact of media on youth and who wish to underscore the potential impact of media in individuals’ lives. For those con- cerned about promoting sexual health and well-being, understanding media’s prominence and role in people’s lives is essential.

“ Nature is to be reverenced, not blushed at.

—Tertullian (c. 155 CE–c. 220 CE)

“ One picture is worth more than a thousand words.

—Chinese proverb

Images of sexuality permeate our society, sexualizing our environment. Think about the sexual images you see or hear in a 24-hour period. What messages do they communicate about sexuality?

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6 • Chapter 1 Perspectives on Human Sexuality

Mass-media depictions of sexuality are meant to entertain and exploit, not to inform. As a result, the media do not present us with “real” depictions of sexuality. Sexual activities, for example, are usually not explicitly acted out or described in mainstream media, nor is interracial dating often portrayed. Th e social and cultural taboos that are still part of mainstream U.S. culture remain embedded in the media. Th us, the various media present the social context of sexuality; that is, the programs, plots, movies, stories, articles, newscasts, and vignettes tell us what behaviors are appropriate (e.g., kissing, sexual inter- course), with whom they are appropriate (e.g., girlfriend/boyfriend, partner, heterosexual), and why they are appropriate (e.g., attraction, love, to avoid loneliness). Probably nothing has revolutionized sexuality the way that access to the Internet has. A click on a website link provides sex on demand. Th e Internet’s contributions to the availability and commercialization of sex include live images and chats, personalized pages and ads, and links to potential or virtual sex partners. Th e spread of the web has made it easy to obtain information, solidify social ties, and provide sexual gratifi cation. Th e music industry is awash with sexual images too. Contemporary pop music, from rock ’n’ roll to rap, is fi lled with lyrics about sexuality mixed with messages about love, rejection, violence, and loneliness. In fact, 37% of popu- lar songs refer to sexual activity, and 66% (mostly rap) include degrading sex (Primack, Gold, Schwarz, & Dalton, 2008). Because of censorship issues, the most overtly sexual music is not played on the radio, but can easily be streamed through the Internet. Magazines, tabloids, and books contribute to the sexualization of our society as well. For example, popular romance novels and self-help books disseminate ideas and values about sexuality. And each month, 63% of teens read a maga- zine for fun, with boys preferring sports and activity magazines and girls prefer- ring those on fashion and celebrities (Chartier, 2008). Men’s magazines have been singled out for their sexual emphasis. Playboy, Penthouse, and Maxim, with their Playmates of the Month, Pets of the Month, and other nude pictorials, are among the most popular magazines in the world.

“ Would you like to come back to my place and do what I’m going to tell my friends

we did anyway?

—Spanky

• FIGURE 1.1 Media Use Over Time. (Source: Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2: Media in the lives of 8 to 18 year olds, A Kaiser Family Foundation Study, January 2010. Copyright © 2010 This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to fi lling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profi t private operating foundation, based in Menlo Park, California.)

Among all 8- to 18-year-olds, average amount of time (hours : minutes) spent with each medium in typical day

2009 2004 1999

TV content 4:29 3:51 3:47

Music/audio 2:31 1:44 1:48

Computer 1:29 1:02 :27

Video games 1:13 :49 :26

Print :38 :43 :43

Movies :25 :25 :18

TOTAL MEDIA EXPOSURE 10:45 8:33 7:29

Multitasking proportion 29% 26% 16%

TOTAL MEDIA USE 7:38 6:21 6:19

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Sexuality, Popular Culture, and the Media • 7

Women’s magazines such as Cosmopolitan, Vogue, and Glamour use sex to sell their publications. How do these magazines diff er from men’s magazines such as Men’s Health, Playboy, and Maxim in their treatment of sexuality?

Sports Illustrated’s annual swimsuit edition sells more than 5 million copies, twice as many as its other issues. But it would be a mistake to think that only male-oriented magazines focus on sex. Women’s magazines such as Cosmopolitan and Redbook have their own sexual content. Th ese magazines feature romantic photographs of lovers to illustrate stories with such titles as “Sizzling Sex Secrets of the World’s Sexiest Women,” “Making Love Last: If Your Partner Is a Premature Ejaculator,” and “Turn on Your Man with Your Breasts (Even If Th ey Are Small).” Preadolescents and young teens are not exempt from sexual images and articles in magazines such as Seventeen and YM. Some of the men’s health magazines have followed the lead of women’s magazines, featuring sexuality-related issues as a way to sell more copies. Advertising in all media uses the sexual sell, promising sex, romance, popu- larity, and fulfi llment if the consumer will only purchase the right soap, perfume, cigarettes, alcohol, toothpaste, jeans, or automobile. In reality, not only does one not become “sexy” or popular by consuming a certain product, but the product may actually be detrimental to one’s sexual well-being, as in the case of cigarettes or alcohol. Media images of sexuality permeate a variety of areas in people’s lives. Th ey can produce sexual arousal and emotional reactions, increase sexual behaviors, and be a source of sex information. Studies examining the impact of exposure to sexual content in media have found modest but signifi cant associations, particularly as they relate to adolescents’ sexual beliefs and early sexual initiation (Strasburger, Jordan, & Donnerstein, 2010). Longitudinal studies link heavy exposure to sexual content in mainstream media with more rapid progression of sexual activity (Bleakley et al., 2008), earlier sexual behavior (Collins et al., 2004), greater risk for an unplanned pregnancy (Chandra et al., 2008), and STIs (Wingood et al., 2001). Th is may be because of media’s pervasive and consistent message: Sex is normative and risk-free (Strasburger et al., 2010). (See Figure 1.2 for the proportions of media time spent by 8- to 18-year-olds.)

Sexual images are used to sell products. What ideas are conveyed by this advertisement? How does its appeal diff er according to whether one is male or female?

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8 • Chapter 1 Perspectives on Human Sexuality

Television

Among all types of media, television has been the most prevalent, pervasive, and vexing icon, saturating every corner of public and private space, shaping consciousness, defi ning reality, and entertaining the masses. Between ages 8 and 18, the average youth spends nearly 5 hours a day watching TV and movies. By the time an American teenager fi nishes high school, he or she will have spent more time in front of a television screen than in the classroom or sleeping. At the same time, most of the consumption of media leaves the majority of young people outside the purview of adult comment and with few messages or images that demonstrate the risks and responsibilities that accompany sexuality (Kunkel, Eyal, Finnerty, Biely, & Donnerstein, 2005). While the frequency of TV viewing has been increasing, so has been the number of sexual references in programs. In fact, television shows geared toward teenagers have more sexual content than adult-oriented shows (Kunkel et al., 2005). Television is a major source of information about sex for teenagers, contributing to many aspects of young people’s sexual knowledge, beliefs, and behavior. Reporting on the health eff ects of media on children and adolescents, Strasburger and colleagues (2010) state that “virtually every Western country makes birth control available to adolescents, including allowing birth control advertisements in the media, but the major U.S. television networks balk at airing ads for contraception” (p. 760). In the accumulated volume of media research, media content does not refl ect the realities of the social world; rather, the media images of women and men refl ect and reproduce a set of stereotypical and unequal but chang- ing gender roles (Kim, Sorsoli, Collins, et al., 2007). For example, women wearing skimpy clothing and expressing their sexuality to attract attention underscores the objectifi cation of women seen in many genres of media. And men’s messages are equally unilateral, which is that they should accumulate sexual experience with women by any means possible. Sexist advertising and stereotypical roles in comedy series and dramas may take subtle (or not so subtle) forms that, over time, may have an eff ect on the way some women and men view themselves. For example, studies examining the eff ects of tele- vision have shown a positive correlation between television viewing self- image, and healthy development, particularly among girls and young women (American Psychological Association [APA], 2007). While it is apparent that exposure to television does not aff ect all people in the same way, it is clear

“ The vast wasteland of TV is not interested in producing a better

mousetrap but in producing a worse mouse.

—Laurence Coughlin

Reality shows, such as The Bachelorette, frequently highlight idealized and sexual themes. What are some of the most popular reality shows? Do they diff er according to ethnicity?

Movies

Live TV 25%

TV content on other platforms

17% Music/audio

22%

Computer 14%

Video games 11%

Among all 8- to 18-year-olds, proportion of media time spent with:• FIGURE 1.2 Media Time. (Source: Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2: Media in the lives of 8 to 18 year olds, A Kaiser Family Foundation Study, January 2010. Copyright © 2010 This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to fi lling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profi t private operating foundation, based in Menlo Park, California.)

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Sexuality, Popular Culture, and the Media • 9

that the sexual double standard that does exist taps into our national ambiv- alence about sex, equality, morality, and violence. Unlike the fi lm industry, which uses a single ratings board to regulate all American releases, television has been governed by an informal consensus. In 1997, networks began to rely on watchdog standards and practices depart- ments to rate their shows; however, these divisions have few, if any, hard-and- fast rules (Robson, 2004). While the Federal Communication Commission (FCC) does not off er clear guidelines about what is and is not permissible on the airwaves, the agency does permit looser interpretations of its decency stan- dards for broadcasts between 10 p.m. and 6 a.m. Additionally, in 2006, the television industry launched a large campaign to educate parents about TV ratings and the V-chip, technology that allows the blocking of programs based on their rating category. Because of the vulnerability that parents still feel about their children becoming involved in sexual situations before they are ready, the majority (65%) say they “closely” monitor their children’s media use (Rideout, 2007).

Music and Game Videos MTV, MTV2, VH1, BET, and music Internet programs are very popular among adolescents and young adults. Young peo- ple report watching these programs 2½ hours per day (Kaiser Family Founda- tion, 2010). Unlike audio-recorded music, music videos play to the ear and the eye. Young female artists such as Alicia Keys and Rihanna have brought energy, sexuality, and individualism to the young music audience. Music videos have also objectifi ed and degraded women by stripping them of any sense of power and individualism and focusing strictly on their sexuality. Male artists such as Eminem, Drake, and Jay-Z provide young audiences with a steady dose of sexuality, power, and rhythm. Video games that promote sexist and violent attitudes toward women have fi lled the aisles of stores across the country. Pushing the line between obscenity and amusement, games often provide images of unrealistically shaped and sub- missive women mouthing sexy dialogues in degrading scenes. Men, in contrast, are often revealed as unrealistic, violent fi gures whose primary purpose is to destroy and conquer. Th ough many of these video games are rated “M” (mature) by the Entertainment Software Ratings Board, they are both popular with and accessible to young people.

Feature-Length Films

From their very inception, motion pictures have dealt with sexuality. In 1896, a fi lm titled Th e Kiss outraged moral guardians when it showed a couple stealing a quick kiss. “Absolutely disgusting,” complained one critic. “Th e performance comes near being indecent in its emphasized indecency. Such things call for police action” (quoted in Webb, 1983). Today, in contrast, fi lm critics use “sexy,” a word independent of artistic value, to praise a fi lm. “Sexy” fi lms are movies in which the requisite “sex scenes” are suffi ciently titillating to overcome their lack of aesthetic merit. What is clear is that movies are not that dissimilar from television in their portrayal of the consequences of unprotected sex, such as unplanned pregnancies or STIs, including HIV/AIDS. In an analysis of 87 movies, 53 of which had sex episodes, there was only one suggestion of condom use, which was the only

“ Of the delights of this world man cares most for is sexual intercourse, yet he has

left it out of his heaven.

—Mark Twain (1835–1910)

Confi dent female icons such as Rihanna refl ect mainstream culture’s acceptance of assertive women.

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10 • Chapter 1 Perspectives on Human Sexuality

reference to any form of birth control (Gunasekera, Chapman, & Campbell, 2005). While one might argue that it is bad art to confuse education with entertainment, it is apparent that the Hollywood fi lm industry may be bad for one’s sexual health.

Gay Men, Lesbian Women, Bisexual and Transgender People in Film and Television

Gay men, lesbian women, and bisexual and transgender individuals are slowly being integrated into mainstream fi lms and television. However, when gay men and lesbian women do appear, they are frequently defi ned in terms of their sexual orientation, as if there is nothing more to their lives than sexuality. Gay men are generally stereotyped as eff eminate, fl ighty, or “arty,” or they may be closeted. Lesbian women are often stereotyped as super- feminine and stilettoed. “Coming out” stories are now the standard for television programs that deal with gay characters (Friedlander, 2011). However, what has recently changed is that the age of these characters has become younger. Teen coming-out stories seem relevant in that they refl ect the identity issues of being gay, transsexual, questioning, or unsure about their sexual identity and expose the vulnerability most young people in junior high and high school feel about being bullied. Diff erent from stories in which homosexual adults are marginalized and stereo- typed, the messages in many of the newer shows for younger audiences are quite consistent: that you will be accepted for who you are. Still, television and mainstream media have a long way to go in terms of presenting healthy sexual relationships between gay people. Th e biggest hurdle remains in showing adults, particularly males, kissing on screen as their heterosexual counterparts would. While teen shows may have somewhat overcome this barrier, most “adult” programs have not.

Mainstream movies, such as Milk, have presented their gay and lesbian characters as fully realized human beings.

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Sexuality, Popular Culture, and the Media • 11

Online Social Networks

For millions, surfi ng the web has become a major recreational activity and has altered the ways in which they communicate and carry on interpersonal rela- tionships. Th ough social theorists have long been concerned with the alienating eff ects of technology, the Internet appears quite diff erent from other commu- nication technologies. Its effi cacy, power, and infl uence, along with the ano- nymity and depersonalization that accompanies its use, have made it possible for consumers to more easily obtain and distribute sexual materials and infor- mation, as well as to interact sexually in diff erent ways. In place of dance clubs and bars, the Internet and mobile technology have expanded the ways in which people meet and interact with others. Th e use of online dating sites as a means to meet and/or matchmake has become wide- spread. Additionally, social networking sites allow member users to communi- cate with others in innovative ways such as posting profi le information, sending public or private online messages, or sharing photos instantly (see the “Th ink About It” box on page 12). Newer technologies and interfaces allow users to become the producers and stars of their own productions when they create their profi les and observe those of others. It is apparent that social networking sites, like Facebook, are well integrated into the daily lives of young adults in the United States. Th eir popularity can- not be underestimated: Facebook alone reports to have more than 500 million active users, 50% of whom log on any given day. Th e average user has 130 friends and spends approximately 30 minutes per day or, together with others, 700 billion minutes per month interacting with one another (“Facebook,” 2011). In contrast to high school students, who primarily use social network- ing sites to make new friends, college students report to use it primarily to maintain friendships (Ellison, Steinfi eld, & Lampe, 2007; Pempek, Yermo- layeva, & Calvert, 2009). Adults of all ages are not strangers to social network- ing. Recent data from the U.S. Census Bureau (2011a) reveal that 62% have used social networking sites. Even more surprising might be social networking’s daily use—the percentage of individuals who report using it “yesterday” (U.S. Census Bureau, 2011b):

Ages 18–29 Ages 30–49 Ages 50–64 Over 65 Male Female 60% 39% 13% 13% 34% 41%

Social networking sites provide an opportunity for many to display their iden- tities: religious, political, ideological, work-related, and sexual orientation. While doing so, individuals can also gain feedback from peers and strengthen their bonds of friendship (Pempek et al., 2009). To this extent, sites like Facebook may have a positive eff ect on development and self-esteem. Wall posts are the preferred way of interacting with friends because they can be written quickly and provide a public display of information similar to online bulletin boards and chat rooms. In fact, exchanges with friends in a public wall space occur twice as fre- quently as one-on-one private exchanges with friends. Another common practice— observing others’ actions, such as reading the news feed about what another is doing or looking at others’ profi les or pictures—is more common than posting information or updating fi les. Like other forms of media, the Internet does not simply provide sexual culture; it also shapes sexual culture. With the widespread use of online dat- ing sites, the medium has become an accepted means by which numerous individuals meet new partners for dating, matchmaking, and/or sex. For the

For anyone with a computer, social networks, such as Facebook, provide readily accessible friends and potential partners, help to maintain friendships, and shape sexual culture.

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12 • Chapter 1 Perspectives on Human Sexuality

think about it

The increasing popularity and accessibility of digital media, including cell phones, MP3 players, blogs, and Internet social networking sites (SNS) such as Facebook, are allowing individuals more than ever before to present themselves publicly. Adolescents and young people are increasingly using these relatively new media to engage in activities relevant to sex and sexuality (Brown et al., 2009). Internet-based dating and sexting—the creating, sharing, and forwarding of sexually suggestive text and nude or nearly nude images—have drastically changed the culture of interpersonal communication. In fact, in several nationally representative surveys of those aged 12–26, researchers have found (Brown et al., 2009; Brown & L’Engle, 2009; The National Campaign to Pre- vent Teen and Unplanned Pregnancy, 2009; Pew Internet & American Life Project, 2009):

■ The average number of hours spent online per week was 12.5.

■ 30% of females and 70% of males view Internet porn. ■ 38% of tweens (ages 12–14) and 77% of teens (ages 15–17)

have an SNS profi le.

■ About 1 in 5 teens and 1 in 3 young adults (ages 20–26) are sexting, while 48% of teens and 64% of young adults are sending or posting sexually suggestive messages.

Before Pressing “Send”: Trends and Concerns About Texting, Sexting, and Dating

■ Teens and young adults are confl icted about sending/posting sexually suggestive content: 75% of teens and 71% of young adults say sending suggestive content “can have serious negative consequences.”

Perhaps interesting to note, teens and young adults are not the only age group sending sexual images of themselves. In a recent nationwide survey, 28% of parents of teens reported engaging in sexting (Steinberg, 2010). It may be signifi cant to note that these sexts may not always be with their partners. However, it may be a new and exciting way to explore or recharge a relationship. When asked, teens and young adults provide many reasons for sending and posting sexually suggestive content. The majority admit that it is a “fun and fl irtatious” activity. Three scenarios for sexting include (1) the exchange of images solely between two romantic partners, (2) exchanges between a partner and someone outside the relationship, and (3) exchanges between people who are not yet in a relationship but at least one person hopes to be. While the wide array of media available provides the opportunity for choosing diff erent purposes, including sexual self-expression, experimentation, self-defi nition, and education, it also invites con- cern, especially for girls who share provocative or sexual imagery of themselves, a form of self- objectifi cation. The self- objectifi cation involved in sexting has received some scrutiny from the American

isolated, underrepresented, and disenfranchised whose sexual identities up until now have been hidden, Internet communications may be a lifeline. Research indicates that gay, lesbian, and bisexual individuals use the Internet in similar ways that heterosexual individuals do (Lever, Grov, Royce, & Gillespie, 2008). Specifi cally, they fi nd that it is a means of identifying available partners, shielding themselves from prejudices, and providing a venue for virtual communities and sexual exploration. Th e use of the Internet also provides a means of avoiding the pitfalls inherent in relying solely on real- world meetings and experiences. With thousands of sexual health sites maintained online, new forms of media are also powerful tools for learning. When credible sources are located, these media have become convenient avenues by which people can get impor- tant sexual health information. One study of young adults found that 41% said they had changed their behavior because of health information they found online, while nearly 50% contacted a health-care provider as a result (Ybarra & Suman, 2008). Th ere are, however, two signifi cant concerns associated with

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Sexuality, Popular Culture, and the Media • 13

Psychological Association (2007), which warns that young people “may internalize an observer’s perspective on their physical selves and learn to treat themselves as objects to be looked at and evaluated for their appearance” (p. 18). Though research on how individuals are using media for communicating and learning about sex and their own sexuality is just getting started, some recent and provocative trends are emerging, the results of which (as seen in the above discussion) have parents, teachers, and professionals concerned. It has become apparent that media use and its eff ects on sexuality vary dramatically depending on a number of factors, including gender, race, and sexual maturity (Brown et al., 2009). It’s also known that much of what is available on the Internet is not designed to result in healthy sexuality. Users need to be taught how to resist the temptation and pressure to engage in sexting and, rather, to fi nd and assess media sources that promote healthy sexual behavior. The National Campaign to Prevent Teen and Unplanned Pregnancy (2009) suggests “Five Things to Think About Before Pressing ‘Send’ ”:

1. Don’t assume anything you send or post is going to remain private. Your messages and image will get passed around, even if you think they won’t.

2. There is no changing your mind in cyberspace—anything you send or post will never truly go away. Something that seems fun and fl irty and is done on a whim will never really die. Potential employers, college recruiters, teachers, coaches, parents, and enemies may all be able to fi nd your posts, even after you delete them.

3. Don’t give in to the pressure to do something that makes you uncomfortable, even in cyberspace. More than 40% of teens and young adults say “pressure from guys” is a reason girls and women send and post sexually suggestive messages and images.

4. Consider the recipient’s reaction. Just because the message is meant to be fun doesn’t mean the person who gets it will see it that way. Whatever you write, post, or send does contribute to the real-life impression you’re making.

5. Nothing is truly anonymous. It is important to remember that even if someone knows you only by screen name, online pro- fi le, phone number, or e-mail address, they can probably fi nd you if they try hard enough.

Think Critically 1. Would you consider participating in or have you par-

ticipated in sexting? If so, what kind of image did you or might you send? Under what circumstances? If you would not consider participating in this activity, what prevents you from doing so?

2. Do you believe that Internet sites and their use should be censored? Why or why not?

3. What caveats of the National Campaign to Prevent Teen and Unplanned Pregnancy would you reinforce, add, revise, or omit?

using new media to learn about sexuality and sexual health: the possibility that the information is inaccurate or misleading and that those who turn to the media may turn away from real people in their lives (Brown, Keller, & Stern, 2009). Given that only a small number of new media interventions have been systematically evaluated, it is still unclear about their impact on the health and well-being of youth. For most users, the Internet provides a fascinating venue for experiencing sex. For some users, however, porn consumption gets them in trouble: maxed- out credit cards, neglected responsibility, and overlooked loved ones. Th ere are both online and community resources for those who desire counseling. While searching for such sources, however, consumers and professionals must be aware of the diff erences between therapy, consultation, and entertainment. Additionally, because entrepreneurs can make more money from hype and misinformation than from high-quality therapy and education, consumers must remain vigilant in assessing the background of the therapist and the source of the information.

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14 • Chapter 1 Perspectives on Human Sexuality

Because of the high volume of sexual discussions and material available on the Internet, there is an increasing demand for government regulation. In 1996, Congress passed the Communications Decency Act, which made it illegal to use computer networks to transmit “obscene” materials or place “indecent” words or images where children might see or read them. However, courts have declared this legislation as a violation of freedom of speech. (For further discus- sion of this issue, see Chapter 18.)

• Sexuality Across Cultures and Times What we see as “natural” in our culture may be viewed as unnatural in other cultures. Few Americans would disagree about the erotic potential of kissing. But other cultures perceive kissing as merely the exchange of saliva. To the Mehinaku of the Amazon rainforest, for example, kissing is a disgusting sexual abnormality; no Mehinaku engages in it (Gregor, 1985). Th e fact that others press their lips against each other, salivate, and become sexually excited merely confi rms their “strangeness” to the Mehinaku.

Culture takes our sexual interests—our incitements or incli- nations to act sexually—and molds and shapes them, sometimes celebrating sexuality and other times condemning it. Sexuality can be viewed as a means of spiritual enlightenment, as in the Hindu tradition, in which the gods themselves engage in sexual activities; it can also be at war with the divine, as in the Judeo-Christian tradition, in which the fl esh is the snare of the devil (Parrinder, 1980).

Among the variety of factors that shape how we feel and behave sexually, culture is possibly the most powerful. A brief exploration of sexual themes across cultures and times will give you a sense of the diverse shapes and meanings humans have given to sexuality.

Sexual Interests

All cultures assume that adults have the potential for becoming sexually aroused and for engaging in sexual intercourse for the purpose of reproduction. But cultures diff er considerably in terms of how strong they believe sexual interests are. Th ese beliefs, in turn, aff ect the level of desire expressed in each culture.

The Mangaia Among the Mangaia of Polynesia, both sexes, beginning in early adolescence, experience high levels of sexual desire (Marshall, 1971). Around age 13 or 14, following a circum- cision ritual, boys are given instruction in the ways of pleasing a girl: erotic kissing, cunnilingus, breast fondling and sucking, and techniques for bringing her to multiple orgasms. After 2 weeks, an older, sexually experienced woman has sexual intercourse with the boy to instruct him further on how to sexually satisfy a woman.

Girls the same age are instructed by older women on how to be orgasmic: how to thrust their hips and rhythmically move their vulvas in order to have multiple orgasms. A girl fi nally learns to be orgasmic through the eff orts of a “good man.”

“ Birds do it, bees do it. Even educated fl eas do it.

—Cole Porter (1891–1964)

The sensual movements of Latin American dancing have become mainstream in American culture, as can be seen in the popularity of Dancing With the Stars.

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Sexuality Across Cultures and Times • 15

If the woman’s partner fails to satisfy her, she is likely to leave him; she may also ruin his reputation with other women by denouncing his lack of skill. Young men and women are expected to have many sexual experiences prior to marriage. Th is adolescent paradise, however, does not last forever. Th e Mangaia believe that sexuality is strongest during adolescence. As a result, when the Mangaia leave young adulthood, they experience a rapid decline in sexual desire and activity, and they cease to be aroused as passionately as they once were. Th ey attribute this swift decline to the workings of nature and settle into a sexually contented adulthood.

The Dani In contrast to the Mangaia, the New Guinean Dani show little interest in sexuality (Schwimmer, 1997). To them, sex is a relatively unimpor- tant aspect of life. Th e Dani express no concern about improving sexual tech- niques or enhancing erotic pleasure. Extrarelational sex and jealousy are rare. As their only sexual concern is reproduction, sexual intercourse is performed quickly, ending with male ejaculation. Female orgasm appears to be unknown to them. Following childbirth, both mothers and fathers go through 5 years of sexual abstinence. Th e Dani are an extreme example of a case in which culture, rather than biology, shapes sexual attractions.

Victorian Americans In the nineteenth century, White middle-class Amer- icans believed that women had little sexual desire. If they experienced desire at all, it was “reproductive desire,” the wish to have children. Reproduction entailed the unfortunate “necessity” of engaging in sexual intercourse. A lead- ing reformer wrote that in her “natural state” a woman never makes advances based on sexual desires, for the “very plain reason that she does not feel them” (Alcott, 1868). Th ose women who did feel desire were “a few exceptions amounting in all probability to diseased cases.” Such women were classifi ed by a prominent physician as suff ering from “Nymphomania, or Furor Uterinus” (Bostwick, 1860).

“ Sex is hardly ever just about sex.

—Shirley MacLaine (1934–)

Like beliefs about sexuality, ideals about body image (and what women are willing to do to achieve it) change over time.

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16 • Chapter 1 Perspectives on Human Sexuality

Whereas women were viewed as asexual, men were believed to have raging sexual appetites. Men, driven by lust, sought to satisfy their desires by ravaging innocent women. Both men and women believed that male sexuality was dan- gerous, uncontrolled, and animal-like. It was part of a woman’s duty to tame unruly male sexual impulses. Th e polar beliefs about the nature of male and female sexuality created destructive antagonisms between “angelic” women and “demonic” men. Th ese beliefs provided the rationale for a “war between the sexes.” Th ey also led to the separation of sex from love. Intimacy and love had nothing to do with male sexuality. In fact, male lust always lingered in the background of married life, threatening to destroy love by its overbearing demands.

The Sexual Revolution Between the 1960s and the mid-1970s, signifi cant challenges to the ways that society viewed traditional codes of behavior took place in the United States. Dubbed the “sexual revolution,” or “sexual libera- tion,” this period of rapid and complex changes invited individuals and society to confront the Puritan ideal and begin to recognize a separation and autonomy in what was thought to be unexamined decisions and regulations. Th is coun- terculture movement questioned previously established rules, regulations, and decisions in these areas:

■ Individual self-expression and autonomy. Previously structured around the collective good of the family and community, the countermovement found meaning and purpose in supporting the individual rights of men and women, including the right to sexual expression.

■ Women’s rights. Th e traditional, stereotypical role of the man being bread- winner and of the woman being the homemaker were challenged by roles whereby individuals could choose according to their needs. It became acceptable for women to express their inherent sexuality and for men to be their emotional and authentic selves. It was during this period that abortion became legal and widespread accessibility and dissemination of birth control became available.

■ Relationship status. No longer was marriage the only context within which couples could express their sexuality, love, and commitment for one another. A new philosophy of sex, referred to as “free love,” allowed individuals to broaden and act on their sexual desires without marriage, judgment, or contempt.

■ Sexual orientation. Overriding dogma from church and community, the counterculture encouraged a broader acceptance of homosexuality. Th is recognition was reinforced in 1973 when the American Psychiatric Association removed homosexuality from its list of diagnosable mental disorders.

■ Sexuality education. Th ough a handful of sexuality education programs were introduced prior to the 1960s, few were uniformly embraced or included in school curriculums until the Sexuality Information and Education Council of the United States (SIECUS) became a vocal force in educational and policy circles.

Although a signifi cant amount of time has passed since the end of the Victorian era and the counterculture’s attempt to shift values and attitudes about

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Sexuality Across Cultures and Times • 17

sexuality, many traditional sexual beliefs and attitudes continue to infl uence us. Th ese include the belief that men are “naturally” sexually aggressive and women sexually passive, the sexual double standard, and the value placed on women being sexually inexperienced. While the media continue to push boundaries about what is acceptable and desirable in sexual expression, so do most Americans continue to adapt their thinking about what is acceptable, desirable, normal, and tolerable.

Sexual Orientation

Sexual orientation is the pattern of sexual and emotional attraction based on the gender of one’s partner. Heterosexuality refers to emotional and sexual attraction between men and women; homosexuality refers to emotional and sexual attraction between persons of the same sex; bisexuality is an emotional and sexual attraction to both males and females. In contemporary American culture, heterosexuality is still the only sexual orientation receiving full social and legal legitimacy. Although same-sex relationships are common, they do not receive general social acceptance. Some other cultures, however, view same-sex relationships as normal, acceptable, and even preferable. A small number of countries worldwide and a few states in the United States have legalized same- sex marriage. (See Chapter 18 for further discussion of the legalization of same- sex marriage.)

Ancient Greece In ancient Greece, the birthplace of European culture, the Greeks accepted same-sex relationships as naturally as Americans today accept heterosexuality. For the Greeks, same-sex relationships between men repre- sented the highest form of love. Th e male-male relationship was based on love and reciprocity; sexuality was only one component of it. In this relationship, the code of conduct called for the older man to initiate the relationship. Th e youth initially resisted; only after the older man courted the young man with gifts and words of love

In ancient Greece, the highest form of love was that expressed between males.

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18 • Chapter 1 Perspectives on Human Sexuality

would he reciprocate. Th e two men formed a close, emotional bond. Th e older man was the youth’s mentor as well as his lover. He introduced the youth to men who would be useful for his advancement later; he assisted him in learning his duties as a citizen. As the youth entered adulthood, the erotic bond between the two evolved into a deep friendship. After the youth became an adult, he married a woman and later initiated a relationship with an adolescent boy. Greek male-male relationships, however, were not substitutes for male- female marriage. Th e Greeks discouraged exclusive male-male relationships because marriage and children were required to continue the family and society. Men regarded their wives primarily as domestics and as bearers of children (Keuls, 1985). (Th e Greek word for woman, gyne, translates literally as “childbearer.”) Husbands turned for sexual pleasure not to their wives but to hetaerae (hi-TIR-ee), highly regarded courtesans who were usually edu- cated slaves.

The Sambians Among Sambian males of New Guinea, sexual orientation is very malleable (Herdt, 1987). Young boys begin with sexual activities with older boys, move to sexual activities with both sexes during adolescence, and engage in exclusively male-female activities in adulthood. Sambians believe that a boy can grow into a man only by the ingestion of semen, which is, they say, like mother’s milk. At age 7 or 8, boys begin their sexual activities with older boys; as they get older, they seek multiple partners to accelerate their growth into manhood. At adolescence, their role changes, and they must provide semen to boys to enable them to develop. At fi rst, they worry about their own loss of semen, but they are taught to drink tree sap, which they believe magically replenishes their supply. During adoles- cence, boys are betrothed to preadolescent girls, with whom they engage in sexual activities. When the girls mature, the boys give up their sexual involvement with other males. Th ey become fully involved with adult women, losing their desire for men.

Gender

Although sexual interests and orientation may be influenced by culture, it may be difficult for some people to imagine that culture has anything to do with gender, the characteristics associated with being male or female. Our sex appears solidly rooted in our biological nature. But is being male or female really biological? The answer is yes and no. Having male or female genitals is anatomical. But the possession of a penis does not always make a person a man, nor does the possession of a clitoris and vagina always make a person a woman. Men who consider themselves women, “women with penises,” are accepted or honored in many cultures through- out the world (Bullough, 1991). Thus, culture and a host of other factors help to shape masculinity and femininity, while biology defines men and women. (For more information about gender and gender-related issues, see Chapter 5.)

Two-Spirits Most Americans consider transsexuality, a phenomenon in which a person’s genitals and/or identity as a man or a woman are discor- dant, problematic at best. But this is not the case in all regions of the world.

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Societal Norms and Sexuality • 19

Transsexuality appears in many cultures, crossing age, religion, and social status.

In some communities, an anatomical man identifying as a woman might be considered a “man-woman” and be accorded high status and special privileges. He would be identifi ed as a two-spirit, a man who assumes female dress, gender role, and status. Two-spirit emphasizes the spiritual aspect of one’s life and downplays the homosexual persona (Jacobs, Th omas, & Lang, 1997). It is inclusive of transsexuality, transvestism (wearing the clothes of or passing as a member of the other sex), and a form of same-sex relationship. Two-spirits are found in numerous communi- ties throughout the world, including American Indian, Filipino, Lapp, and Indian communi- ties. In South Asian society, the third gender is known as the hijra. Regarded as sacred, they perform as dancers or musicians at weddings and religious ceremonies, as well as providing blessings for health, prosperity, and fertility (Nanda, 1990). It is almost always men who become two-spirits, although there are a few cases of women assuming male roles in a similar fashion (Blackwood, 1984). Two-spirits are often considered shamans, individuals who possess great spiritual power. Among the Zuni of New Mexico, two-spirits are considered a third gender (Roscoe, 1991). Despite the existence of transsexual people and those born with disorders of sexual development (e.g., two testes or two ovaries but an ambiguous genital appearance), Westerners tend to view gender as biological, an incorrect assumption. Th e Zuni, in contrast, believe that gender is socially acquired. American Indian two-spirits were suppressed by missionaries and the U.S. government as “unnatural” or “perverted.” Th eir ruthless repression led anthro- pologists to believe that two-spirits had been driven out of existence in American Indian communities, but there is evidence that two-spirits continue to fi ll cere- monial and social roles in tribes such as the Lakota Sioux. Understandably, two- spirit activities are kept secret from outsiders for fear of reprisals. Among gay and lesbian American Indians, the two-spirit role provides historical continuity with their traditions (Roscoe, 1991).

• Societal Norms and Sexuality Th e immense diversity of sexual behaviors across cultures and times immedi- ately calls into question the appropriateness of labeling these behaviors as inher- ently natural or unnatural, normal or abnormal. Too often, we give such labels to sexual behaviors without thinking about the basis on which we make those judgments. Such categories discourage knowledge and understanding because they are value judgments, evaluations of right and wrong. As such, they are not objective descriptions about behaviors but statements of how we feel about those behaviors.

“ Put your paws up, I’m beautiful in my way.

—Lady Gaga (1986–)

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20 • Chapter 1 Perspectives on Human Sexuality

think about it

The question “Am I normal?” seems to haunt many people. For some, it causes a great deal of unnecessary fear, guilt, and anxiety. For others, it provides the motivation to study the litera- ture, consult with a trusted friend or therapist, or take a course in sexuality. What is normal? We commonly use several criteria in decid- ing whether to label diff erent sexuality behaviors “normal” or “abnormal.” According to professor and psychologist Leonore Tiefer (2004), these criteria are subjective, statistical, idealistic, cultural, and clinical. Regardless of what criteria we use, they ultimately refl ect societal norms.

■ Subjectively “normal” behavior. According to this defi nition, normalcy is any behavior that is similar to one’s own. Though most of us use this defi nition, few of us will acknowledge it.

■ Statistically “normal” behavior. According to this defi nition, whatever behaviors are more common are normal; less com- mon ones are abnormal. However, the fact that a behavior is not widely practiced does not make it abnormal except in a statistical sense. Fellatio (fel-AY-she-o) (oral stimulation of the penis) and cunnilingus (cun-i-LIN-gus) (oral stimulation of the female genitals), for example, are widely practiced today because they have become “acceptable” behaviors. But years ago, oral sex was tabooed as something “dirty” or “shameful.”

■ Idealistically “normal” behavior. Taking an ideal for a norm, individuals who use this approach measure all deviations against perfection. They may try to model their behavior after Christ or Gandhi, for example. Using idealized behavior as a norm can easily lead to feelings of guilt, shame, and anxiety.

■ Culturally “normal” behavior. This is probably the standard most of us use most of the time: We accept as normal what our culture defi nes as normal. This measure explains why our notions of normalcy do not always agree with those of people from other countries, religions, communities, and historical periods. Men who kiss in public may be considered normal in one place but abnormal in another. It is common for deviant behavior to be perceived as dangerous and fright- ening in a culture that rejects it.

Am I Normal?

■ Clinically “normal” behavior. The clinical standard uses scientifi c data about health and illness to make judgments. For example, the presence of the syphilis bacterium in body tissues or blood is considered abnormal because it indicates that a person has a sexually transmitted infection. Regard- less of time or place, clinical defi nitions should stand the test of time. The four criteria mentioned above are all somewhat arbitrary—that is, they depend on individual or group opinion—but the clinical criterion has more objectivity.

These fi ve criteria form the basis of what we usually consider normal behavior. Often, the diff erent defi nitions and interpre- tations of “normal” confl ict with one another. How does a per- son determine whether he or she is normal if subjectively “normal” behavior—what that person actually does—is incon- sistent with his or her ideals? Such dilemmas are commonplace and lead many people to question their normalcy. However, they should not question their normalcy so much as their con- cept of normalcy.

Think Critically 1. How do you defi ne normal sexuality behavior? What

criteria did you use to create this defi nition? 2. How do your sexual attitudes, values, and behaviors

compare to what you believe are “normal” sexuality behaviors? If they are diff erent, how do you reconcile these? If they are similar, how do you feel about oth- ers who may not share them?

3. In Nepal, young women are isolated for 1 week during their fi rst menses, whereas in Brazil, it is common to see men embrace or kiss in public. What are your thoughts about how other cultures defi ne normality?

SOURCE: Tiefer, L. (2004). Sex is not a natural act and other essays (2nd ed.). Boulder, CO: Westview Press.

Natural Sexual Behavior

How do we decide if a sexual behavior is natural or unnatural? To make this decision, we must have some standard of nature against which to compare the behavior. But what is “nature”? On the abstract level, nature is the essence of all things in the universe. Or, personifi ed as nature, it is the force regulating the universe. Th ese defi nitions, however, do not help us much in trying to establish what is natural or unnatural.

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Societal Norms and Sexuality • 21

When we asked our students to identify their criteria for determining which sexual behaviors they considered “natural” or “unnatural,” we received a variety of responses, including the following:

■ “If a person feels something instinctive, I believe it is a natural feeling.” ■ “Natural and unnatural have to do with the laws of nature. What these

parts were intended for.” ■ “I decide by my gut instincts.” ■ “I think all sexual activity is natural as long as it doesn’t hurt you or

anyone else.” ■ “Everything possible is natural. Everything natural is normal. If it is nat-

ural and normal, it is moral.”

When we label sexuality behavior as “natural” or “unnatural,” we are typi- cally indicating whether the behavior conforms to our culture’s sexual norms. Our sexual norms appear natural because we have internalized them since infancy. Th ese norms are part of the cultural air we breathe, and, like the air, they are invisible. We have learned our culture’s rules so well that they have become a “natural” part of our personality, a “second nature” to us. Th ey seem “instinctive.”

Normal Sexual Behavior

Closely related to the idea that sexuality behavior is natural or unnatural is the belief that sexuality is either normal or abnormal. More often than not, describing behavior as “normal” or “abnormal” is merely another way of mak- ing value judgments. Psychologist Sandra Pertot (2007) quips, “Normal today means that a person should have a regular and persistent physical sex drive, easy arousal, strong erections and good control over ejaculation for males, powerful orgasms, and a desire for a variety and experimentation [for women]” (p. 13). Although “normal” has often been used to imply “healthy” or “moral” behavior, social scientists use the word strictly as a statistical term. For them, normal sexuality behavior is behavior that conforms to a group’s average or median patterns of behavior. Normality has nothing to do with moral or psychological deviance. Ironically, although we may feel pressure to behave like the average person (the statistical norm), most of us don’t actually know how others behave sexually. People don’t ordinarily reveal much about their sexual activities. If they do, they generally reveal only their most conformist sexual behaviors, such as sexual inter- course. Th ey rarely disclose their masturbatory activities, sexual fantasies, or anxieties or feelings of guilt. All that most people present of themselves—unless we know them well—is the conventional self that masks their actual sexual feel- ings, attitudes, and behaviors. Th e guidelines most of us have for determining our normality are given to us by our friends, partners, and parents (who usually present conventional sexual images of themselves) through stereotypes, media images, religious teach- ings, customs, and cultural norms. None of these, however, tells us much about how people actually behave. Because we don’t know how people really behave, it is easy for us to imagine that we are abnormal if we diff er from our cultural norms and stereotypes. We wonder if our desires, fantasies, and activities are normal: Is it normal to fantasize? To masturbate? To enjoy erotica? To be

“ The greatest pleasure in life is doing what people say you cannot do.

—Walter Bagehot (1826–1877)

In some cultures, men who dress or identify as women are considered shamans. We’wha was a Zuni man-woman who lived in the nineteenth century.

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22 • Chapter 1 Perspectives on Human Sexuality

attracted to someone of the same sex? Some of us believe that everyone else is “normal” and that only we are “sick” or “abnormal.” Th e challenge, of course, is to put aside our cultural indoctrination and try to understand sexual behav- iors objectively. Because culture determines what is normal, there is a vast range of normal behaviors across diff erent cultures. What is considered the normal sexual urge for the Dani would send most of us into therapy for treatment of low sexual desire. And the idea of teaching sexual skills to early adolescents, as the Mangaia do, would horrify most American parents.

Kissing is “natural” and “normal” in our culture. It is an expression of intimacy, love, and passion for young and old, heterosexual persons, gay men, and lesbian women.

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Societal Norms and Sexuality • 23

think about it

Sexuality is an integral part of the personality of every human being. Its full development depends upon the satisfaction of basic human needs such as the desire for contact, intimacy, emotional expression, pleasure, tenderness, and love. Sexuality is constructed through the interaction between the individual and social structures. Full development of sexuality is essential for individual, interpersonal, and social well-being. Sexual rights are universal human rights based on the inherent freedom, dignity, and equality of all human beings. Since health is a fundamental human right, so must sexual health be a basic human right. In order to ensure that human beings and societies develop healthy sexuality, the following sexual rights must be recognized, promoted, respected, and defended by all societies through all means. Sexual health is the result of an environment that recognizes, respects, and exercises these rights.

1. The right to sexual freedom. Sexual freedom encompasses the possibility for individuals to express their full sexual potential. However, this excludes all forms of sexual coercion, exploitation, and abuse at any time and situations in life.

2. The right to sexual autonomy, sexual integrity, and safety of the sexual body. This right involves the ability to make autonomous decisions about one’s sexual life within a context of one’s own personal and social ethics. It also encompasses control and enjoyment of our own bodies free from torture, mutilation, and violence of any sort.

3. The right to sexual privacy. This involves the right for individual decisions and behaviors about intimacy as long as they do not intrude on the sexual rights of others.

4. The right to sexual equity. This refers to freedom from all forms of discrimination regardless of sex, gender, sexual orientation, age, race, social class, religion, or physical and emotional disability.

5. The right to sexual pleasure. Sexual pleasure, including autoeroticism, is a source of physical, psychological, intellectual, and spiritual well-being.

6. The right to emotional sexual expression. Sexual expression is more than erotic pleasure or sexual acts. Individuals have a

Declaration of Sexual Rights

right to express their sexuality through communication, touch, emotional expression, and love.

7. The right to sexually associate freely. This means the possibility to marry or not, to divorce, and to establish other types of responsible sexual associations.

8. The right to make free and responsible reproductive choices. This encompasses the right to decide whether or not to have children, the number and spacing of children, and the right to full access to the means of fertility regulation.

9. The right to sexual information based upon scientifi c inquiry. This right implies that sexual information should be generated through the process of unencumbered and yet scientifi cally ethical inquiry, and disseminated in appropriate ways at all societal levels.

10. The right to comprehensive sexuality education. This is a lifelong process from birth throughout the life cycle and should involve all social institutions.

11. The right to sexual health care. Sexual health care should be available for prevention and treatment of all sexual concerns, problems, and disorders.

Think Critically 1. What are your immediate reactions to the “Declaration

of Sexual Rights”? For whom should these rights be promoted? Would you delete, edit, or add rights to the list?

2. Why do you suppose such a declaration is necessary and important?

3. What (if any) consequences should there be for gov- ernments, cultures, or individuals who do not follow these rights?

SOURCE: “Declaration of Sexual Rights” from World Association for Sexual Health, 1999. http://www.worldsexology.org/about_sexualrights.asp.

Are there behaviors, however, that are considered essential to sexual functioning and consequently, universally labeled as normal? Not surprisingly, reproduction, or the biological process by which individuals are produced, is probably one shared view of normal sexuality behavior that most cultures would agree upon (Pertot, 2007). Th at is, “men should feel desire, achieve an erection, and ejaculate within the vagina, and women would participate in sex” (p. 15). All other beliefs about sexual expression and behavior develop from social context.

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http://www.worldsexology.org/about_sexualrights.asp

24 • Chapter 1 Perspectives on Human Sexuality

Sexuality Behavior and Variations

Sex researchers have generally rejected the traditional sexual dichotomies of natural/unnatural, normal/abnormal, moral/immoral, and good/bad. Regarding the word “abnormal,” sociologist Ira Reiss (1989) writes:

We need to be aware that people will use those labels to put distance between themselves and others they dislike. In doing so, these people are not making a scientifi c diagnosis but are simply affi rming their support of certain shared concepts of proper sexuality.

Instead of classifying behavior into what are essentially moralistic normal/ abnormal and natural/unnatural categories, researchers view human sexuality as characterized by sexual variation—that is, sexual variety and diversity. As humans, we vary enormously in terms of our sexual orientation, our desires, our fantasies, our attitudes, and our behaviors. Alfred Kinsey and his colleagues (1948) succinctly stated the matter: “Th e world is not to be divided into sheep and goats.” Researchers believe that the best way to understand our sexual diversity is to view our activities as existing on a continuum. On this continuum, the frequency with which individuals engage in diff erent sexual activities (e.g., sexual intercourse, masturbation, and oral sex) ranges from never to always. Signifi cantly, there is no point on the continuum that marks normal or abnor- mal behavior. In fact, the diff erence between one individual and the next on the continuum is minimal (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pome- roy, Martin, & Gebhard, 1953). Th e most that can be said of a person is that his or her behaviors are more or less typical or atypical of the group average. Furthermore, nothing can be inferred about an individual whose behavior diff ers signifi cantly from the group average except that his or her behavior is atypical. Except for engaging in sexually atypical behavior, one person may be indistinguishable from any other. Many activities that are usually thought of as “deviant” or “dysfunctional” sexual behavior—activities diverging from the norm, such as exhibitionism, voyeurism, and fetishism—are engaged in by most of us to some degree. We may delight in displaying our bodies on the beach or in “dirty dancing” in crowded clubs (exhibitionism). We may like watching ourselves make love, viewing erotic videos, or seeing our partner undress (voyeurism). Or we may enjoy kissing our lover’s photograph, keeping a lock of his or her hair, or sleep- ing with an article of his or her clothing (fetishism). Most of the time, these feelings or activities are only one aspect of our sexual selves; they are not espe- cially signifi cant in our overall sexuality. Such atypical behaviors represent noth- ing more than sexual nonconformity when they occur between mutually consenting adults and do not cause distress. Th e rejection of natural/unnatural, normal/abnormal, and moral/immoral categories by sex researchers does not mean that standards for evaluating sexual behavior do not exist. Th ere are many sexual behaviors that are harmful to oneself (e.g., masturbatory asphyxia—suff ocating or hanging oneself during masturbation to increase sexual arousal) and to others (e.g., rape, child moles- tation, and obscene phone calls). Current psychological standards for determin- ing the harmfulness of sexual behaviors center around the issues of coercion, potential harm to oneself or others, and personal distress. (Th ese issues are discussed in greater detail in Chapter 10.)

“ Imagination is more important than knowledge.

—Albert Einstein (1879–1955)

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Societal Norms and Sexuality • 25

think about it

Do you ever wonder why you do what you do or feel as you feel—especially when it comes to matters like attrac- tion, relationships, and sex? Do you wonder why the object of your aff ection behaves in such inexplicable ways—why he or she fl ies into a jealous rage for no reason? Or why your friend always seems to fall for the “wrong” person? Sometimes, the an- swers may be obvious, but other times, they are obscure. Our motivations come from a variety of sources, including personal- ity traits, past experiences, peer pressure, and familial and cul- tural infl uences. Many of our feelings probably result from a complex yet subtle blending of these infl uences—combined with innate responses programmed into our genes and mani- fested in our brains. Our growing understanding of the biological bases of behavior comes from a variety of disciplines: history, psychol- ogy, sociology, neurophysiology, and endocrinology. Many scholars base their study of sexuality on Charles Darwin’s theory of evolution. According to Darwin’s theory, evolution favors cer- tain physical traits that enable a species to survive. To more fully understand the mechanisms through which the brain and body perpetuate mating and survival, MRI brain scans of people in love are helping scientists understand more about the science of love: why it is so powerful and why being rejected is so painful. From a sociobiological perspective, males, who are consis- tently fertile from early adolescence on, seek to impregnate as many females as possible to ensure genetic success. Diff erences in men’s and women’s brains reveal men’s to have more activity in the region that integrates visual stimuli. This is not surprising, considering that from an evolutionary perspective, men have to be able to size up a woman visually to see if she can bear babies (Fisher, 2004). Females, however, ovulate only once a month. For them, a single episode of intercourse can result in pregnancy, childbirth, and years of child rearing. Women’s brain activities, though more puzzling than men’s, reveal that their brain has more activity in the areas that govern memories. Dr. Helen Fisher, an anthropologist and author, theorizes that this may be a female mechanism for mate choice—that if a woman really studies a man and remembers things about his behavior, she can try to determine whether he’d make a reliable mate and fa- ther. In this way, women can help ensure that the carriers of their genes (their children) will reach adulthood and pass along their parents’ genetic legacy. The bonds of love are what keep the male around, or, in other words, females trade sex for love, and males trade love for sex. Evolutionary psychologists seek to explain the biological bases of love and other emotions such as hope, anger, jeal-

Sociobiology, Evolutionary Psychology, and the Mysteries of Love

ousy, fear, and grief. We may wonder why Mother Nature made us so emotional when emotion so often leads to disas- ter. But there are good reasons (evolutionarily speaking) for having emotions. Even though in the short term emotions can get us into trouble—if we act impulsively rather than ratio- nally—over the long term our emotions have helped our genes survive and replicate (Kluger, 2008). Emotions exist to motivate us to do things that serve (or once served) the best interests of our genetic material—things like fl eeing, fi ghting, or forming close relationships to protect our “genetic invest- ment” (off spring). Critics of sociobiology argue that inferences from animal be- havior may not be applicable to human beings; they feel that sociobiologists base their assumptions about human behavior (such as men wanting sex versus women wanting love) more on cultural stereotypes than on actual behavior. Sociobiologists re- ply that they report what they observe in nature and suggest connections to human behavior (humans are part of nature, af- ter all) but do not make judgments about the meaning or moral- ity of their observations. As you study human sexuality, we hope that the information you gain from this text will help you integrate your own feelings and experiences with the information and advice you get from family, friends, lovers, and society. In the text, we take what might be called a “biopsychosocial” approach to our subject, recognizing that the sexual self is produced by the interconnec- tions of body, mind, spirit, and culture. As you continue your study, remember that, although our culture, beliefs, and cogni- tive processes (what we might call the “software” of the mind) have been created by humans, our bodies and brains (the “hardware” of the mind) are the products of evolution. They’ve been developing over a long, long time.

Think Critically 1. To what extent do you agree or disagree with the bio-

psychosocial approach that the authors of this text take toward sexuality? On what do you base this?

2. To what do you attribute sexual attraction? On what observations and experiences do you base this?

3. How do you feel about the statement “Females trade sex for love, and males trade love for sex”?

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26 • Chapter 1 Perspectives on Human Sexuality

Summary Studying Human Sexuality

■ Students study sexuality for a variety of reasons. Examining the multiple aspects of this fascinating topic can help students understand, accept, and appreciate their own sexuality and that of others.

Sexuality, Popular Culture, and the Media

■ Th e media are among the most powerful forces in young people’s lives today. Mass-media depictions of sexuality are meant primarily to entertain and exploit, not to inform.

■ Th e Internet’s contributions to the availability and commercialization of sex and sexuality information have made it easy for individuals to obtain infor- mation, strengthen social ties, and provide sexual gratifi cation.

■ Television is the most prevalent and pervasive medium. At the same time, the risks and responsibili- ties that accompany TV programs remain sadly dis- proportionate to the sexual images that are portrayed.

Sexuality Across Cultures and Times

■ One of the most powerful forces shaping human sexuality is culture. Culture molds and shapes our sexual interests.

We, the authors, believe that the basic standard for judging various sexual activities is whether they are between consenting adults and whether they cause harm. Understanding diverse sexual attitudes, motives, behaviors, and values will help deepen our own value systems and help us understand, accept, and appreciate our own sexuality and that of others.

Sexuality can be a source of great pleasure and profound satisfaction as well as a source of guilt and means of exploitation. Popular culture both encourages and discourages sexuality. It promotes stereotypical sexual interactions but fails to touch on the deeper signifi cance sexuality holds for us or the risks and responsibili- ties that accompany it. Love and sexuality in a committed relationship are infrequently depicted, in contrast to casual sex. (By ignoring sex between committed partners, popular culture implies that partnership is a “sexual wasteland.” Yet it is within couples that the overwhelming majority of sexual interactions take place.) The media ignore or disparage the wide array of sexual behaviors and choices— from masturbation to gay, lesbian, bisexual, and transgender relationships—that are signifi cant in many people’s lives. They discourage the linking of sex and intimacy, contraceptive responsibility and the acknowledgment of the risk of contracting sexually transmitted infections. What is clear from examining other cultures is that sexual behaviors and norms vary from culture to culture and, within our own society, from one time to another. The variety of sexual behaviors even within our own culture testifi es to diversity not only between cultures but within cultures as well. Understanding diversity allows us to acknowledge that there is no such thing as inherently “normal” or “natural” sexual behavior. Rather, sexual behavior is strongly infl uenced by culture—including our own.

Final Thoughts

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Questions for Discussion • 27

■ Th e Mangaia of Polynesia and the Dani of New Guinea represent cultures at the opposite ends of a continuum, with the Mangaia having an elaborate social and cultural framework for instructing adoles- cents in sexual technique and the Dani downplaying the importance of sex.

■ Middle-class Americans in the nineteenth century believed that men had strong sexual drives but that women had little sexual desire. Because sexuality was considered animalistic, the Victorians separated sex and love. Th e sexual revolution brought signifi cant changes to previous assumptions about sexuality.

■ Sexual orientation is the pattern of sexual and emo- tional attraction based on the sex of one’s partner. In contemporary America, heterosexuality, or attraction between men and women, is the only sexual orienta- tion that receives full societal and legal legitimacy. Homosexuality refers to same-sex attractions, and bisexuality involves attraction to both males and females.

■ In ancient Greece, same-sex relationships between men represented the highest form of love. Among the Sambians of New Guinea, boys have sexual contact with older boys, believing that the ingestion of semen is required for growth. When the girls to whom they are betrothed reach puberty, adolescent boys cease these same-sex sexual relations.

■ Th e characteristics associated with being male or female are otherwise called gender. While culture helps to shape masculinity or feminity, biology defi nes men and women.

■ A two-spirit is a person of one sex who identifi es with the other sex; in some communities, such as the Zuni, a two-spirit is considered a third gender and is believed to possess great spiritual power.

Societal Norms and Sexuality

■ Sexuality tends to be evaluated according to categories of natural/unnatural, normal/abnormal, and moral/immoral. Th ese terms are value judg- ments, refl ecting social norms rather than any quality inherent in the behavior itself.

■ Th ere is no commonly accepted defi nition of natural sexuality behavior. Normal sexuality behavior is what a culture defi nes as normal. We commonly use fi ve criteria to categorize sexuality behavior as normal or abnormal: subjectively normal, statistically normal, idealistically normal, culturally normal, and clinically normal.

■ Human sexuality is characterized by sexual variation. Researchers believe that the best way to examine sexual behavior is on a continuum. Many activities that are considered deviant sexual behavior exist in most of us to some degree. Th ese include exhibition- ism, voyeurism, and fetishism.

■ Behaviors are not abnormal or unnatural; rather, they are more or less typical or atypical of the group aver- age. Many of those whose behaviors are atypical may be regarded as sexual nonconformists rather than as abnormal or perverse.

Questions for Discussion ■ At what age do you believe a young person

should be given a smartphone? What, if any, type of education should accompany it?

■ To what extent do you think your peers are infl uenced by the media? To what extent are you?

■ While growing up, what sexual behaviors did you consider to be normal? Abnormal? How have these views changed now that you are older?

Sex and the Internet Sex and the Media With hundreds of millions of sexuality- related web- sites available, you might wonder about the issues and laws associated with access to cyberspace. Though the following sites each deal primarily with intellectual freedom, they also contain information and links to other sites that address issues of sex and the media. Select one of the following:

■ Electronic Frontier Foundation http://www.eff .org

■ Entertainment Software Rating Board http://www.esrb.org/index-js.jsp

■ National Coalition for Sexual Freedom http://www.ncsfreedom.org

■ Kaiser Family Foundation http://kff .org/entmedia/index.cfm

■ Sexual Literacy http://nsrc.sfsu.edu/what_sexual_literacy

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http://www.eff.org

http://www.esrb.org/index-js.jsp

http://www.ncsfreedom.org

http://kff.org/entmedia/index.cfm

http://nsrc.sfsu.edu/what_sexual_literacy

28 • Chapter 1 Perspectives on Human Sexuality

Suggested Websites The Media Project http://www.themediaproject.com Off ers facts, research assistance, script consultation, and story ideas on today’s sexual and reproductive health issues, including condoms, pregnancy, HIV/AIDS, abstinence, and abortion.

National Gay and Lesbian Task Force http://thetaskforce.org Provides information and referrals on gay, lesbian, bisexual, and transsexual issues and rights.

Noah http://www.noah-health.org/en/healthy/sexuality Run by the New York Online Access to Health; contains informa- tion on various sexual health topics and links.

Suggested Reading Castaneda, L., & Campbell, S. B. (Eds.). (2005). News and

sexuality: Media portrayals of diversity. Th ousand Oaks, CA: Sage. Provides an understanding of issues and perspectives on gender, race, ethnicity, and sexual orientation as addressed in the media.

Francoeur, R. T., & Noonan, R. (Eds.). (2004). Th e continuum complete international encyclopedia of sexuality. New York: Continuum. Th e foremost reference work on sexual behavior throughout the world.

Gauntlett, D. (2008). Media, gender & identity: An introduction. New York: Routledge. An introduction to the main themes of popular culture and the ways in which it infl uences lifestyles and concepts of gender and identity.

Middleton, D. R. (2001). Exotics and erotics: Human culture and sexual diversity. Prospect Heights, IL: Waveland Press. Explores universal human sexuality in conjunction with its local manifestations in specifi c cultural contexts; topics include the body, patterns of sexuality, sexual behavior, romantic passion, marriage, and kinship.

Strasburger, V. C., Wilson, B.J., & Jordan, A. B. (2009). Children, adolescents, and the media (2nd ed.). Th ousand Oaks, CA: Sage. Explores mass media, including the sexual messages the media convey and their impact on adolescents.

Tiefer, L. (2004). Sex is not a natural act and other essays (2nd ed.). Boulder, CO: Westview Press. A revised collection of provocative essays on sex and its many meanings in our culture.

For links, articles, and study material, go to the McGraw-Hill website, located at

www.mhhe.com/yarber8e.

Go to the site and answer the following questions:

■ What is the mission of the site—if any? ■ Who are its supporters and advocates? ■ Who is its target audience? ■ What is its predominant message? ■ What current issue is it highlighting?

Given what you have learned about this site, how do your feelings about sex and the Internet compare with those of the creators of this website?

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http://www.themediaproject.com

http://thetaskforce.org

http://www.noah-health.org/en/healthy/sexuality

www.mhhe.com/yarber8e

M A I N T O P I C S

Sex, Advice Columnists, and Pop Psychology 30

Thinking Critically About Sexuality 33

Sex Research Methods 36

The Sex Researchers 44

Contemporary Research Studies 49

Emerging Research Perspectives 55

Ethnicity and Sexuality 59

ch ap

te r

Studying Human Sexuality

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30 • Chapter 2 Studying Human Sexuality

“A new university study fi nds that many college students lie to a new sexual partner about their sexual past . . . but fi rst, a message from . . .” So begins a commercial lead-in on the news, reminding us that sex research is often part of both news and entertainment. In fact, most of us learn about the results of sex research from television, newspapers, the Internet, and magazines rather than from scholarly journals and books. After all, the mass media are more entertaining than most scholarly works. And unless we are studying human sexuality, few of us have the time or interest to read the scholarly journals in which scientifi c research is regularly published. But how accurate is what the mass media tell us about sex and sex research? In this chapter, we discuss the dissemination of sexuality-related information by the various media. Th en we look at the critical-thinking skills that help us evaluate how we discuss and think about sexuality. When are we making objec- tive statements? When are we refl ecting biases or opinions? Next, we examine sex research methods because they are critical to the scientifi c study of human sexuality. Th en we look at some of the leading sex researchers to see how they have infl uenced our understanding of sexuality. Next, we discuss fi ve national studies as examples of important research that has been conducted. Finally, we examine feminist, gay, lesbian, bisexual, transgender, and ethnic sex research to see how they enrich our knowledge of sexuality.

• Sex, Advice Columnists, and Pop Psychology As we saw in Chapter 1, the mass media convey seemingly endless sexual images. Besides various television, fi lm, Internet, and advertising genres, there is another genre, which we might call the sex information/advice genre,

Ignorance is like a delicate exotic fruit; touch it and the bloom is gone.

—Oscar Wilde (1854–1900)

“

“I’ve heard about those sex surveys, and I wonder how truthful they are. I mean, don’t you think that people who volunteer for those studies only admit to behaviors which they deem

socially acceptable? I just don’t think people who lose their vir- ginity, for instance at age 12 or age 30, would actually report it. Besides, no sex study is going to tell me what I should do or whether I am normal.”

—21-year-old male

“I feel that sexual research is a benefi t to our society. The human sexuality class I took my sophomore year in college taught me a lot. Without research, many of the topics we learned about would not have been so thoroughly discussed due to lack of information. Sexual research and human sexuality

classes help keep the topic of sex from being seen as such a faux pas by society.”

—20-year-old female

“I took a sex survey once, during my undergraduate years. I found that the survey was easy to take, and the process of answering the questions actually led me to ask myself more questions about my sexual self. The survey was detailed, and I was encouraged to answer truthfully. Ultimately, every answer I gave was accurate because I knew that the research would benefi t science (and it was completely anonymous).”

—22-year-old female

“I think sex research is great because it helps remove the taboo from the topic. Sex, in this country, is on TV and the Internet all the time, but people do not want to seriously discuss it, espe- cially adults with children. Sex research, when made public, can help ease the tension of discussing sex—especially when it reveals that something considered abnormal actually is nor- mal and that many people practice the specifi c behavior.”

—24-year-old male

Student Voices

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Sex, Advice Columnists, and Pop Psychology • 31

that transmits information and norms, rather than images, about sexual- ity to a mass audience to both inform and entertain in a simplified man- ner. For many college students, as well as others, the sex information/ advice genre is a major source of their knowledge about sex. This genre is ostensibly concerned with transmitting information that is factual and accurate. In addition, on an increasing number of college campuses, sex columns in student-run newspapers have become popular and sometimes controversial.

Information and Advice as Entertainment

Newspaper columns, Internet sites, syndicated radio shows, magazine articles, and TV programs share several features. First, their primary purpose is fi nan- cial profi t. Th is goal is in marked contrast to that of scholarly research, whose primary purpose is to increase knowledge. Even the inclusion of survey ques- tionnaires in magazines asking readers about their sexual attitudes or behav- iors is ultimately designed to promote sales. We fi ll out the questionnaires for fun, much as we would crossword puzzles or anagrams. Th en we buy the subsequent issue or watch a later program to see how we compare to other respondents. Second, the success of media personalities rests not so much on their expertise as on their ability to present information as entertainment. Because the genre seeks to entertain, sex information and advice must be simplified. Complex explanations and analyses must be avoided because they would interfere with the entertainment purpose. Furthermore, the genre relies on high-interest or bizarre material to attract readers, viewers, and listeners. Consequently, we are more likely to read, hear, or view sto- ries about unusual sexual behaviors or ways to increase sexual attractiveness than stories about new research methods or the negative outcomes of sex- ual stereotyping. Th ird, the genre focuses on how-to information or on morality. Sometimes it mixes information and normative judgments. How-to material tells us how to improve our sex lives. Advice columnists often give advice on issues of sexual morality: “Is it all right to have sex without commitment?” “Yes, if you love him/her” or “No, casual sex is empty,” and so on. Th ese columnists act as moral arbiters, much as ministers, priests, and rabbis do. Fourth, the genre uses the trappings of social science and psychiatry without their substance. Writers and columnists interview social scientists and therapists to give an aura of scientifi c authority to their material. Th ey rely especially heavily on therapists, whose background is clinical rather than academic. Because clinicians tend to deal with people with problems, they often see the problematic aspects of sexuality. Th e line between media sex experts and advice columnists is often blurred. Th is line is especially obscure on the Internet, where websites dealing with sexuality have proliferated. Most of these sites are purely for entertainment rather than education, and it can be diffi cult to determine a site’s credibility. One way to assess the educational value of a website is to investigate its sponsor. Reputable national organizations like the American Psychological Association (http://www.apa.org) and the Sexuality Information and Education Council of the United States (http://www.siecus.org) provide reliable information and links to other, equally reputable, sites.

If you believe everything you read, don’t read.

—Chinese proverb “

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http://www.apa.org

http://www.siecus.org

32 • Chapter 2 Studying Human Sexuality

practically speaking

After you have read several sex books and watched several sex experts on television, you will discover that they tend to be repetitive. There are two main reasons for this. First, the media repeatedly report more or less the same stories because sex research is a small discipline and fewer studies are con- ducted compared to other academic areas. Scientifi c research can be painstakingly slow, and the results are often tedious to produce. Research results often do not change the way we view a topic; instead, they tend to verify what we already know. Although research is seldom revolutionary, the media must nevertheless continually produce new stories to fi ll their pages and programs. Consequently, they report similar material in diff erent guises—as interviews, survey results, and fi rst-person stories, for example. Second, the media are repetitive because their scope is narrow. There are only so many ways how-to books can tell you “how to do it.” Similarly, the personal and moral dilemmas most of us face are remarkably similar: Am I normal? When should I be sexual with another person? Is sex without love moral? With the media awash with sex information and advice, how can you evaluate what is presented to you? Here are some guidelines:

1. Be skeptical. Remember, much of what you read or see is meant to entertain you. If it seems superfi cial, it probably is.

2. Search for biases, stereotypes, and lack of objectivity. Informa- tion is often distorted by points of view. One should assess if there is any reason to suspect bias in the selection of subjects. Research funding from a drug or vitamin company, for exam- ple, may lead to suspicion of the independence of the

researcher. In recent years, eff orts have been made to ensure independence, such as declaring any confl ict of interest (e.g., who funded the study) in published research.

3. Look for moralizing. Many times, what passes for fact is really disguised moral judgment.

4. Go to the original source or sources. The media always simplify. Find out for yourself what the studies really reported. Learn- ing how representative the sample was, the study parame- ters, and the study strengths and limitations is also important.

5. Determine the credentials of the “sex experts” or researchers. Many of those who present sex advice in the media are largely entertainers, authors, or lecturers who typically pro- ject themselves as authorities or experts. However, many do not have adequate academic credentials, such as being a licensed psychologist or having completed graduate-level work in human sexuality. When assessing research studies, it is helpful to note the credentials of the researchers and the type of organization that conducted the study, as well as who, if anyone, funded the study. For example, the study would likely be more creditable if the researchers were from widely respected universities or institutions and the research was funded by a federal agency (e.g., the National Institutes of Health).

6. Seek additional information. The whole story is probably not told. Look for additional information in scholarly books and journals, reference books, or textbooks. Do not put too much credence in one study; later studies may contradict the fi ndings.

Keeping these guidelines in mind will help you steer a course between blind acceptance and off hand dismissal of a study.

Evaluating Pop Psychology

The Use and Abuse of Research Findings

To reinforce their authority, the media often incorporate statistics from a study’s fi ndings, which are key features of social science research. However, as Pulitzer Prize winner Susan Faludi (1991) notes:

Th e statistics that the popular culture chooses to promote most heavily are the very statistics we should view with the most caution. Th ey may well be in wide circulation not because they are true but because they support widely held media preconceptions.

Further, the media may report the results of a study that are contradicted by subsequent research. It is common, particularly in the medical fi eld, for the original results not to be replicated when continued research is conducted (Tanner, 2005). For example, a review of major studies published in three infl u- ential medical journals from 1990 to 2003 found that one third of the results

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Thinking Critically About Sexuality • 33

do not hold up (Ionannidis, 2005). But, of course, changes in “current knowledge” also happen in behavioral research. For example, an assertion that is often presented in the media as defi nitive is that the consumption of alcohol always leads to risky sexual behaviors. Yet, studies have found that among young people the relationship between alcohol use and risky sexual behaviors is com- plex and often the research fi ndings are inconsistent or inconclusive (Cooper, 2006). An alternative explanation is that possibly a high proportion of young people take more risks than other young people in several areas such as cigarette use, drug use, alcohol use, driving, and sex. Th at is, there is a clustering of risk behaviors representing high sensation seeking, and alcohol use alone does not cause risky sex but both are part of the total risk behavior pattern (Coleman, 2001; Coleman & Cater, 2005; Zuckerman, 1994). Th e media frequently quote or describe social science research, but they may do so in an oversimplifi ed or distorted manner. An excellent example of dis- torted representation of sex-related research was some of the media coverage of the research on ram sheep by Charles Roselli, a researcher at the Oregon Health and Science University. Dr. Roselli searched for physiological explanations of why 8% of rams exclusively seek sex with other rams instead of ewes. His research was funded by the National Institutes of Health and published in major scientifi c journals. Following media coverage of his research, animal- rights activists, gay advocates, and others criticized the studies. A New York Times article in January 2007 noted that his research drew outrage based on, according to Dr. Roselli and his colleagues, “bizarre misinterpretation of what the work is about.” Th e researchers contended that discussion of possible human implications of their fi ndings in their reports diff ered from intentions of carrying the work over to humans. Critics claimed that the research could lead to altering or controlling sexual orientation. According to the Times article, Th e Sunday Times in London asserted, incorrectly, that Dr. Roselli found a way to “cure” homosexual rams with hormone treatment, adding that critics feared the research “could pave the way for breeding out homosexuality in humans.” John Schwartz, author of the Times article, concluded that “the story of the gay sheep became a textbook example of the distortion and vituperation that can result when science meets the global news cycle” (Schwartz, 2007). As this example illustrates, scholars tend to qualify their fi ndings as tentative or limited to a certain group, and they are very cautious about making generalizations. In contrast, the media tend to make results sound generalizable.

• Thinking Critically About Sexuality Although each of us has our own perspective, values, and beliefs regarding sexuality, as students, instructors, and researchers, we are committed to the scientifi c study of sexuality. Basic to any scientifi c study is a fundamental com- mitment to objectivity, or the observation of things as they exist in reality as opposed to our feelings or beliefs about them. Objectivity calls for us to sus- pend the beliefs, biases, or prejudices we have about a subject in order to understand it. Objectivity in the study of sexuality is not always easy to achieve, for sexu- ality can be the focal point of powerful emotions and moral ambivalence. We experience sex very subjectively. But whether we fi nd it easy or diffi cult to be objective, objectivity is the foundation for studying sexuality.

He who knows nothing doubts nothing.

—French proverb “

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34 • Chapter 2 Studying Human Sexuality

Most of us think about sex, but thinking about it critically requires us to be logical and objective. It also requires that we avoid making value judgments; put aside our opinions, biases, and stereotypes; and not fall prey to common fallacies such as egocentric and ethnocentric thinking.

Value Judgments Versus Objectivity

For many of us, objectivity about sex is diffi cult because our culture has tradi- tionally viewed sexuality in moral terms: Sex is moral or immoral, right or wrong, good or bad, normal or abnormal. When examining sexuality, we tend, therefore, to make value judgments, evaluations based on moral or ethical standards rather than objective ones. Unfortunately, value judgments are often blinders to understanding. Th ey do not tell us about what motivates people, how frequently they behave in a given way, or how they feel. Value judgments do not tell us anything about sexuality except how we ourselves feel. In study- ing human sexuality, then, we need to put aside value judgments as incompat- ible with the pursuit of knowledge. How can we tell the diff erence between a value judgment and an objective statement? Examine the following two statements. Which is a value judgment? Which is an objective statement?

■ College students should be in a committed relationship before they have sex. ■ Th e majority of students have sexual intercourse sometime during their

college careers.

Th e fi rst statement is a value judgment; the second is an objective statement. Th ere is a simple rule of thumb for telling the diff erence between the two: Value judgments imply how a person ought to behave, whereas objective state- ments describe how people actually behave. Th ere is a second diff erence between value judgments and objective state- ments: Value judgments cannot be empirically validated, whereas objective statements can be. Th at is, the truth or accuracy of an objective statement can be measured and tested.

Opinions, Biases, and Stereotypes

Value judgments obscure our search for understanding. Opinions, biases, and stereotypes also interfere with the pursuit of knowledge.

Opinions An opinion is an unsubstantiated belief or conclusion about what seems to be true according to our thoughts. Opinions are not based on accurate knowledge or concrete evidence. Because opinions are unsubstantiated, they often refl ect our personal values or biases.

Biases A bias is a personal leaning or inclination. Biases lead us to select information that supports our views or beliefs while ignoring information that does not. We need not be victims, however, of our biases. We can make a concerted eff ort to discover what they are and overcome them. To avoid per- sonal bias, scholars apply the objective methods of social science research.

Stereotypes A stereotype is a set of simplistic, rigidly held, overgeneralized beliefs about an individual, a group of people, an idea, and so on. Stereotypical

Morality is simply the attitude we adopt towards people we personally dislike.

—Oscar Wilde (1854–1900)

“

Truth is truth. You can’t have opinions about truth.

—Peter Schickele (1935–)

“

The human understanding when it has once adopted an opinion . . . draws all

things else to support and agree with it.

—Francis Bacon (1561–1626)

“

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Thinking Critically About Sexuality • 35

beliefs are resistant to change. Furthermore, stereotypes—especially sexual ones—are often negative. Common sexual stereotypes include the following:

■ Men are always ready for sex. ■ “Nice” women are not interested in sex. ■ Women need a reason for sex; men need a place. ■ Virgins are uptight and asexual. ■ Th e relationships of gay men never last. ■ Lesbian women hate men. ■ African American men lust after White women. ■ Latino men are promiscuous.

Psychologists believe that stereotypes structure knowledge. Th ey aff ect the ways in which we process information: what we see, what we notice, what we remem- ber, and how we explain things. Or, as humorist Ashleigh Brilliant said, “Seeing is believing. I wouldn’t have seen it if I hadn’t believed it.” A stereotype is a type of schema, a way in which we organize knowledge in our thought processes. Schemas help us channel or fi lter the mass of information we receive so that we can make sense of it. Th ey determine what we will regard as important. Although these mental plans are useful, they can also create blind spots. With stereotypes, we see what we expect to see and ignore what we don’t expect or want to see. Sociologists point out that sexual stereotyping is often used to justify discrim- ination. Targets of stereotypes are usually members of subordinate social groups or individuals with limited economic resources. As we will see, sexual stereotyping is especially powerful in stigmatizing African Americans, Latinos, Asian Americans, gay men, lesbian women, and bisexual and transgender individuals. We all have opinions and biases, and most of us to varying degrees think stereotypically. But the commitment to objectivity requires us to become aware of our opinions, biases, and stereotypes and to put them aside in the pursuit of knowledge.

Common Fallacies: Egocentric and Ethnocentric Thinking

A fallacy is an error in reasoning that aff ects our understanding of a subject. Fallacies distort our thinking, leading us to false or erroneous conclusions. In the fi eld of sexuality, egocentric and ethnocentric fallacies are common.

The Egocentric Fallacy Th e egocentric fallacy is the mistaken belief that our own personal experience and values generally are held by others. On the basis of our belief in this false consensus, we use our own beliefs and values to explain the attitudes, motivations, and behaviors of others. Of course, our own experi- ences and values are important; they are the source of personal strength and knowledge, and they can give us insight into the experiences and values of oth- ers. But we cannot necessarily generalize from our own experience to that of others. Our own personal experiences are limited and may be unrepresentative. Sometimes, our generalizations are merely opinions or disguised value judgments.

The Ethnocentric Fallacy Th e ethnocentric fallacy, also known as ethno- centrism, is the belief that our own ethnic group, nation, or culture is innately superior to others. Ethnocentrism is reinforced by opinions, biases,

No question is so diffi cult as that to which the answer is obvious.

—George Bernard Shaw (1856–1950)

“

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36 • Chapter 2 Studying Human Sexuality

and stereotypes about other groups and cultures. As members of a group, we tend to share similar values and attitudes with other group members. But the mere fact that we share these beliefs is not suffi cient proof of their truth. Ethnocentrism has been increasingly evident as a reaction to the increased awareness of ethnicity, or ethnic affi liation or identity. For many Americans, a signifi cant part of their sense of self comes from identifi cation with their ethnic group. An ethnic group is a group of people distinct from other groups because of cultural characteristics, such as language, religion, and customs, that are transmitted from one generation to the next. Although there was little research on ethnicity and sexuality until the 1980s, evidence suggests that there are signifi cant ethnic variations in terms of sexual attitudes and behavior. When data are available, the variations by ethnicity will be presented throughout this book. Ethnocentrism results when we stereotype other cultures as “primitive,” “innocent,” “inferior,” or “not as advanced.” We may view the behavior of other peoples as strange, exotic, unusual, or bizarre, but to them it is normal. Th eir attitudes, behaviors, values, and beliefs form a unifi ed sexual system that makes sense within their culture. In fact, we engage in many activities that appear peculiar to those outside our culture.

• Sex Research Methods One of the key factors that distinguishes the fi ndings of social science from beliefs, prejudice, bias, and pop psychology is its commitment to the scientifi c method. Th e scientifi c method is the method by which a hypothesis is formed from impartially gathered data and tested empirically. Th e scientifi c method relies on induction—that is, drawing a general conclusion from specifi c facts. Th e scientifi c method seeks to describe the world rather than evaluate or judge it.

All universal judgments are weak, loose, and dangerous.

—Michel de Montaigne (1533–1595)

“

We are the recorders and reporters of facts—not judges of the behavior we

describe.

—Alfred C. Kinsey (1894–1965)

“

Ethnocentrism is the belief that one’s own culture or ethnic group is superior to others. Although child marriage is prohibited in our society, it is acceptable in many cultures throughout the world, including India.

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Sex Research Methods • 37

Although sex researchers, sometimes called sexologists, use the same meth- odology as other social scientists, they are constrained by ethical concerns and taboos that those in many other fi elds do not experience. Because of the taboos surrounding sexuality, some traditional research methods are inappropriate. Sex research, like most social science research, uses diff erent methodological approaches. Th ese include clinical research, survey research (questionnaires and interviews), observational research, and experimental research. And as in many fi elds, no single research paradigm has emerged in sexual science (Weis, 2002).

Research Concerns

Researchers face two general concerns in conducting their work: (1) ethical concerns centering on the use of human beings as subjects and (2) methodological concerns regarding sampling techniques and their accuracy. Without a representative sample, the conclusions that can be drawn using these methodologies are limited.

Ethical Issues Ethics are important in any scientifi c endeavor. Th ey are espe- cially important in such an emotional and value-laden subject as sexuality. Among the most important ethical issues are informed consent, protection from harm, and confi dentiality. Informed consent is the full disclosure to an individual of the purpose, potential risks, and benefi ts of participating in a research project. Under informed consent, people are free to decide whether to participate in a project without coercion or deceit. Studies involving children and other minors typi- cally require parental consent. Once a study begins, participants have the right to withdraw at any time without penalty. Each research participant is entitled to protection from harm. Some sex research, such as the viewing of explicit fi lms to measure physiological responses, may cause some people emotional distress. Th e identity of research subjects should be kept confi dential. Because of the highly charged nature of sexuality, participants also need to be guaranteed anonymity. All colleges and universities have review boards or human-subject commit- tees to make sure that researchers follow ethical guidelines. Proposed research is submitted to the committee for approval before the project begins.

Sampling In each research approach, the choice of a sample—a portion of a larger group of people or population—is critical. To be most useful, a sample should be a random sample—that is, a sample collected in an unbiased way, with the selection of each member of the sample based solely on chance. Fur- thermore, the sample should be a representative sample, with a small group representing the larger group in terms of age, sex, ethnicity, socioeconomic status, sexual orientation, and so on. When a random sample is used, informa- tion gathered from a small group can be used to make inferences about the larger group. Samples that are not representative of the larger group are known as biased samples. Using samples is important. It would be impossible, for example, to study the sexual behaviors of all college students in the United States. But we could select a representative sample of college students from various schools and infer from their behavior how other college students behave. Using the same sample to infer the sexual behavior of Americans in general, however, would mean using a biased sample. We cannot generalize the sexual activities of American college students to the larger population.

Anything more than truth would be too much.

—Robert Frost (1874–1963)

“

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38 • Chapter 2 Studying Human Sexuality

Most samples in sex research are lim- ited for several reasons:

■ Th ey depend on volunteers or clients. Because these samples are generally self-selected, we cannot assume that they are representative of the popula- tion as a whole. Volunteers for sex research are often more likely to be male, sexually experienced, liberal, and less religious and to have more positive attitudes toward sexuality and less sex guilt and anxiety than those who do not choose to participate (Strassberg & Lowe, 1995; Wiederman, 1999).

■ Most sex research takes place in a university or college setting with stu- dent volunteers. Th eir sex-related attitudes, values, and behaviors may be very diff erent from those of older adults.

■ Some ethnic groups are generally underrepresented. Representative sam- ples of African Americans, Latinos, American Indians, Middle Eastern Americans, and some Asian Americans, for example, are not easily found because these groups are underrepresented at the colleges and universities where subjects are generally recruited.

■ Th e study of gay men, lesbian women, and bisexual and transgender indi- viduals presents unique sampling issues. Are gay men, lesbian women, and bisexual individuals who have come out—publicly identifi ed them- selves as gay, lesbian, or bisexual—diff erent from those who have not? How do researchers fi nd and recruit subjects who have not come out?

Because these factors limit most studies, we must be careful in making gener- alizations from studies.

Clinical Research

Clinical research is the in-depth examination of an individual or group that comes to a psychiatrist, psychologist, or social worker for assistance with psy- chological or medical problems or disorders. Clinical research is descriptive; inferences of cause and eff ect cannot be drawn from it. Th e individual is inter- viewed and treated for a specifi c problem. At the same time the person is being treated, he or she is being studied. In their evaluations, clinicians attempt to determine what caused the disorder and how it may be treated. Th ey may also try to infer from dysfunctional people how healthy people develop. Clinical research often focuses on atypical, unhealthy behaviors, problems related to sexuality (e.g., feeling trapped in the body of the wrong gender), and sexual function problems (e.g., lack of desire, early ejaculation, erectile diffi culties, or lack of orgasm). A major limitation of clinical research is its emphasis on pathological behavior, or unhealthy or diseased behavior. Such an emphasis makes clinical research dependent on cultural defi nitions of what is “unhealthy” or “patho- logical.” Th ese defi nitions, however, change over time and in the context of the culture being studied. In the nineteenth century, for example, masturbation

A couple is being interviewed by a sex researcher. The face-to-face interview, one method of gathering data about sexuality, has both advantages and disadvantages.

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Sex Research Methods • 39

was considered pathological. Physicians and clinicians went to great lengths to root it out. In the case of women, surgeons sometimes removed the clitoris. Today, masturbation is viewed more positively.

Survey Research

Survey research is a method that uses questionnaires or interviews to gather information. Questionnaires off er anonymity, can be completed fairly quickly, and are relatively inexpensive to administer; however, they usually do not allow an in-depth response. A person must respond with a short answer or select from a limited number of options. Th e limited-choices format provides a more objective assessment than the short-answer format and results in a total score. Interview techniques avoid some of the shortcomings of questionnaires, as interviewers are able to probe in greater depth and follow paths suggested by the participant. Although surveys are important sources of information, the method has several limitations, as people may be poor reporters of their own sexual behavior:

■ Some people may exaggerate their number of sexual partners; others may minimize their casual encounters.

■ Respondents generally underreport experiences that might be considered deviant or immoral, such as bondage and same-sex experiences.

■ Some respondents may feel uncomfortable about revealing information— such as about masturbation or fetishes—in a face-to-face interview.

■ Th e accuracy of one’s memory may fade as time passes, and providing an accurate estimation, such as how long sex lasted, may be diffi cult.

■ Some ethnic groups, because of their cultural values, may be reluctant to reveal sexual information about themselves.

■ Interviewers may allow their own preconceptions to infl uence the way in which they frame questions and to bias their interpretations of responses.

■ Th e interviewer’s sex, race, or orientation may also infl uence how com- fortable respondents are in disclosing information about themselves.

Interestingly, despite these limitations of self-reporting of sexual behavior, a recent review of seven population-based surveys of adults in the United States concluded that self-reported data may not be as unreliable as generally assumed. Th e study examined the consistency in the number of sexual partners reported in these seven national studies and found a remarkable level of consistency among the studies. Th e researchers concluded that the fi ndings show promise for research that relies on self-reported number of sexual partners (Hamilton & Morris, 2010). Some researchers use computers to improve interviewing techniques for sensi- tive topics. With the audio computer-assisted self-interviewing (audio-CASI) method, the respondent hears the questions over headphones or reads them on a computer screen and then enters her or his responses into the computer. Audio- CASI apparently increases feelings of confi dentiality and accuracy of responses on sensitive topics such as sexual risk behaviors (Cooley et al., 2001; Des Jarlais et al., 1999; Potdar & Koenig, 2005). Even though the use of audio-CASI has advantages, research has found that the use of the audio part by respondents was limited and that gains in more candid responses from the audio component are modest relative to text-only CASI (Couper, Tourangeu, & Marvin, 2009).

The great tragedy of science—the slaying of a beautiful hypothesis by an

ugly fact.

—Thomas Huxley (1825–1895)

“

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practically speaking

To measure variables related to sexuality, many sex researchers use standardized (i.e., reliable and valid) questionnaires. One such questionnaire, the Measure of Sexual Identity Exploration and Commitment (MoSIEC), assesses sexual identity development and can be used by persons of any sexual orientation (Worthington, Navarro, Savoy, & Hampton, 2008). Sexual identity refers to one’s self-label or self-identifi cation as a heterosexual, gay, lesbian, or bisexual person (Hyde & DeLamater, 2011). The MoSIEC is a theoretically based questionnaire that contains four components or subscales: exploration (pursuit of a revised and refi ned sense of self ), commitment (choice to adopt a specifi c identity represented by a unifi ed set of goals, values, and beliefs), synthesis (a state of congruence among all dimen- sions of individual sexual identity and the broader sense of self ), and sexual orientation identity uncertainty (not being sure about one’s sexual identity). The MoSIEC can help sex researchers, for example, understand the relationship between the processes of sexual identity development and sexual risk behavior related to sexually transmitted infections, including HIV, and unintended pregnancy. The MoSIEC is presented below. Take it to fi nd out what it is like to complete a sex research questionnaire, as well as get a general idea about your own sexual identity development.

Directions

Refer to these defi nitions when completing the questionnaire:

Sexual needs An internal, subjective experience of instinct, desire, appetite, biological necessity, impulses, interest, and/or libido with respect to sex.

Sexual values Moral evaluations, judgments, and/or standards about what is appropriate, acceptable, desirable, and innate sexual behavior.

Sexual activities Any behavior that a person might engage in relating to or based on sexual attraction, sexual arousal, sexual gratifi cation, or reproduction (e.g., fantasy to holding hands to kissing to sexual intercourse).

Modes of sexual expression Any form of communication (verbal or nonverbal) or direct and indirect signals that a person might use to convey her or his sexuality (e.g., fl irting, eye contact, touching, vocal quality, compliments, suggestive body movements or postures).

Sexual orientation An enduring emotional, romantic, sexual, or aff ectional attraction to other persons that ranges from exclusive heterosexuality to exclusive homosexuality and includes various forms of bisexuality.

Respond to each below item as honestly as you can, using the key 1 � very uncharacteristic of me to 6 � very characteristic of me. Circle your response. There are no right or wrong answers.

Very Very uncharacteristic characteristic of me of me

1. My sexual orientation is clear to me. 1 2 3 4 5 6

2. I went through a period in my life when I was trying to determine my sexual needs. 1 2 3 4 5 6

3. I am actively trying to learn more about my own sexual needs. 1 2 3 4 5 6

4. My sexual values are consistent with all of the other aspects of my sexuality. 1 2 3 4 5 6

5. I am open to experiment with new types of sexual activities in the future. 1 2 3 4 5 6

6. I am actively trying new ways to express myself sexually. 1 2 3 4 5 6

7. My understanding of my sexual needs coincides with my overall sense of sexual self. 1 2 3 4 5 6

8. I went through a period in my life when I was trying diff erent forms of sexual expression. 1 2 3 4 5 6

9. My sexual values will always be open to sexual exploration. 1 2 3 4 5 6

10. I know what my preferences are for expressing myself sexually. 1 2 3 4 5 6

11. I have a clear sense of the types of sexual activities I prefer. 1 2 3 4 5 6

12. I am actively experimenting with sexual activities that are new to me. 1 2 3 4 5 6

Answering a Sex Research Questionnaire: Measure of Sexual Identity Exploration and Commitment

40 • Chapter 2 Studying Human Sexuality

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Very Very uncharacteristic characteristic of me of me

13. The ways I express myself sexually are consistent with all of the other aspects of my sexuality. 1 2 3 4 5 6

14. I sometimes feel uncertain about my sexual orientation. 1 2 3 4 5 6

15. I do not know how to express myself sexually. 1 2 3 4 5 6

16. I have never clearly identifi ed what my sexual values are. 1 2 3 4 5 6

17. The sexual activities I prefer are compatible with all of the other aspects of my sexuality. 1 2 3 4 5 6

18. I have never clearly identifi ed what my sexual needs are. 1 2 3 4 5 6

19. I can see myself trying new ways of expressing myself sexually in the future. 1 2 3 4 5 6

20. I have a fi rm sense of what my sexual needs are. 1 2 3 4 5 6

21. My sexual orientation is not clear to me. 1 2 3 4 5 6

22. My sexual orientation is compatible with all of the other aspects of my sexuality. 1 2 3 4 5 6

Scoring

Scores for the questionnaire components or subscales are obtained by averaging the ratings on the items for each subscale (this method ensures scores when an item is not answered). Use the below items for an average or mean score for each subscale. Note: Items that should be scored in reverse are listed in bold type; for example, if you marked a 2, give it a 5 score.

Exploration � 2, 3, 5, 6, 8, 9, 12, 19 Commitment � 10, 11, 15, 16, 18, 20 Synthesis � 4, 7, 13, 17, 22 Sexual orientation identity uncertainty � 1, 14, 21

What Do Your Scores Mean?

Exploration Higher average scores on this subscale mean that a person has a greater tendency toward self-exploration across the dimensions of sexual identity (e.g., perceived sexual needs, preferred sexual activities, sexual values, recognition and

identifi cation of sexual orientation, and preferred modes of sexual expression). Sexual identity exploration is a normal aspect of human development, especially for people in their adolescence and young adulthood. Studies have shown that those who are uncertain about their sexual identity or who identify as a lesbian, gay, or bisexual person tend to score higher on this subscale than heterosexual individuals.

Commitment Higher average scores on this subscale mean that a person has a clear and relatively fi xed sense of perceived sexual needs, preferred sexual activities, sexual values, recognition and identifi cation of sexual orientation, and preferred modes of sexual expression. Sexual identity typically becomes stronger as one ages, and high scores can be found in persons of any sexual orientation identity.

Synthesis Higher average scores on this scale mean that the person has expressed greater congruence and correspondence in his/her level of commitment across all dimensions of sexual identity. That is, those who score higher on this subscale tend to perceive their sexual values, needs, activities, modes of sexual expression, and sexual orientation identities as in sync with one another, as well as with their broader sense of self.

Sexual Orientation Uncertainty Higher average scores on this subscale mean that the person has expressed greater uncertainty about his/her sexual orientation as a gay, lesbian, bisexual, or heterosexual individual. Research shows that many people experience sexual orientation uncertainty at some time in their lives, and that uncertainty is often accompanied by lower levels of sexual identity commitment and higher levels of sexual identity exploration. Bisexual persons tend to score higher on this subscale than those of other sexual orientation groups, possibly because of experiencing negative societal biases from heterosexual persons, as well as from lesbian women and gay men, which can result in greater demands for exploration among bisexual persons during the course of sexual identity formation.

Take some time to refl ect on your experience in completing this survey:

■ Did you learn something about your own sexual identity development?

■ How valid do you think the results from a questionnaire such as this are? That is, do you think the questionnaire actually measures what it claims to measure, such as sexual orienta- tion uncertainty?

■ Would your responses have been the same if you had been asked these same questions on the telephone, in an inter- view, or via the computer?

SOURCE: Worthington, R. L., Navarro, R. L., Savoy, H. B., & Hampton, D. (2008). “Development, reliability, and validity of the Measure of Sexual Identity Exploration and Commitment (MoSIEC).” Developmental Psychology, 44, 22- 33 (Table 1, p. 26). The use of APA information does not imply endorsement by APA.

Sex Research Methods • 41

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42 • Chapter 2 Studying Human Sexuality

Another new technique is the use of the Internet to administer question- naires and conduct interviews. Respondents to web-based interviews tend to have a higher income and level of education than those without access to the Internet, making it diffi cult to generalize from their responses. However, geo- graphically isolated individuals can be reached more easily (Ross, Tikkanen, & Mansson, 2000). Stigmatized groups (e.g., bisexual people) may feel more com- fortable participating and much larger samples may be obtained. For example, a British Internet study on sexuality and gender had about 255,000 participants (Reimers, 2007). Daily data collection, using a sexual diary, or personal notes of one’s sexual activity, can increase the accuracy of self-report data (Crosby, DiClemente, & Salazar, 2006). Often, research participants make daily diary entries online or by phone, for example, about sexual variables such as interest, fantasies, and behavior. Or they may be requested to make entries only after a certain sexual activity has occurred, such as intercourse. Research suggests that event-specifi c behaviors such as condom use during sex will be more accurately recalled in diaries than by retrospective methods such as self-report questionnaires and interviews (Fortenberry, Cecil, Zimet, & Orr, 1997; Gilmore et al., 2001; Graham & Bancroft, 1997).

Observational Research

Observational research is a method by which a researcher unobtrusively observes and makes systematic notes about people’s behavior without trying to manipulate it. Th e observer does not want his or her presence to aff ect the subject’s behavior, although this is rarely possible. Because sexual behavior is regarded as signifi cantly diff erent from other behaviors, there are serious ethical issues involved in observing people’s sexual behavior without their knowledge and consent. Researchers cannot observe sexual behavior as they might observe, say, fl irting at a party, dance, or bar, so such observations usually take place in a laboratory setting. In such instances, the setting is not a natural environment, and participants are aware that their behavior is under observation. Participant observation, in which the researcher participates in the behav- iors she or he is studying, is an important method of observational research. For example, a researcher may study prostitution by becoming a customer or anonymous sex between men in public restrooms by posing as a lookout (Humphreys, 1975). Th ere are several questions raised by such participant observation: How does the observer’s participation aff ect the interactions being studied? For example, does a prostitute respond diff erently to a researcher if she or he tries to obtain information? If the observer participates, how does this aff ect her or his objectivity? And what are the researcher’s ethical respon- sibilities regarding informing those she or he is studying?

Experimental Research

Experimental research is the systematic manipulation of individuals or the environment to learn the eff ects of such manipulation on behavior. It enables researchers to isolate a single factor under controlled circumstances to deter- mine its infl uence. Researchers are able to control their experiments by using variables, or aspects or factors that can be manipulated in experiments. Th ere are two types of variables: independent and dependent. Independent variables are factors that can be manipulated or changed by the experimenter;

Discovery consists of seeing what everybody has seen and thinking what

nobody has thought.

—Albert Szent-Györgyi (1893–1986)

“

An increasing number of sex researchers are placing their questionnaires on the Internet so that persons at any location or at any time can participate in the study.

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Sex Research Methods • 43

dependent variables are factors that are likely to be aff ected by changes in the independent variable. Because it controls variables, experimental research diff ers from the previous methods we have examined. Clinical studies, surveys, and observational research are correlational in nature. Correlational studies measure two or more natu- rally occurring variables to determine their relationship to each other. Because these studies do not manipulate the variables, they cannot tell us which variable causes the other to change. But experimental studies manipulate the indepen- dent variables, so researchers can reasonably determine what variables cause the other variables to change. Much experimental research on sexuality depends on measuring physiologi- cal responses. Th ese responses are usually measured by plethysmographs (pluh- THIZ-muh-grafs)—devices attached to the genitals to measure physiological response. Researchers use either a penile plethysmograph, a strain gauge (a device resembling a rubber band), or a Rigiscantm for men and a vaginal ple- thysmograph for women. Both the penile plethysmograph and the strain gauge are placed around the penis to measure changes in its circumference during sexual arousal. Th e Rigiscan, probably the most widely used device to measure male genital response, consists of a recording unit strapped around the waist or the thigh and two loops, one placed around the base of the penis and the other around the shaft just behind the glans. Th e Rigiscan not only measures penile circumference but also assesses rigidity (Janssen, 2002). Th e vaginal ple- thysmograph is about the size of a menstrual tampon and is inserted into the vagina like a tampon. Th e device measures the amount of blood within the vaginal walls, which increases as a woman becomes sexually aroused. Suppose researchers want to study the infl uence of alcohol on sexual response. Th ey can use a plethysmograph to measure sexual response, the dependent variable. In this study, the independent variable is the level of alcohol consump- tion: no alcohol consumption, moderate alcohol consumption (1–3 drinks), and high alcohol consumption (3� drinks). In addition, extraneous variables, such as body mass and tolerance for alcohol, need to be controlled. In such an

Participant observation is an important means by which anthropologists gain information about other cultures.

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44 • Chapter 2 Studying Human Sexuality

experiment, subjects may view an erotic video. To get a baseline measurement, researchers measure the genitals’ physiological patterns in an unaroused state, before participants view the video or take a drink. Th en they measure sexual arousal (dependent variable) in response to erotica as they increase the level of alcohol consumption (independent variable).

• The Sex Researchers It was not until the nineteenth century that Western sexuality began to be studied using a scientifi c framework. Prior to that time, sexuality was the domain of religion rather than science; sex was the subject of moral rather than scientifi c scrutiny. From the earliest Christian era, treatises, canon law, and papal bulls, as well as sermons and confessions, catalogued the sins of the fl esh. Refl ecting this Christian tradition, the early researchers of sexuality were con- cerned with the supposed excesses and deviances of sexuality rather than its healthy functioning. Th ey were fascinated by what they considered the pathol- ogies of sex, such as fetishism, sadism, masturbation, and homosexuality—the very behaviors that religion condemned as sinful. Alfred Kinsey ironically noted that nineteenth-century researchers created “scientifi c classifi cations . . . nearly identical with theological classifi cations and with moral pronouncements . . . of the fi fteenth century” (Kinsey et al., 1948). As we will see, however, there has been a liberalizing trend in our thinking about sexuality. Both Richard von Kraff t-Ebing and Sigmund Freud viewed sexuality as inherently dangerous and needing repression. But Havelock Ellis, Alfred Kinsey, William Masters and Virginia Johnson, and many other more recent researchers have viewed sexuality more positively; in fact, historian Paul Robinson (1976) regards these later researchers as modernists, or “sexual enthu- siasts.” Th ree themes are evident in the work of modernists: (1) Th ey believe that sexual expression is essential to an individual’s well-being, (2) they seek to broaden the range of legitimate sexual activity, including homosexuality, and (3) they believe that female sexuality is the equal of male sexuality. As much as possible, sex researchers attempt to examine sexuality objectively. But, as with all of us, many of their views are intertwined with the beliefs and values of their times. Th is is especially apparent among the early sex research- ers, some of the most important of whom are described here.

Richard von Kraff t-Ebing

Richard von Kraff t-Ebing (1840–1902), a Viennese professor of psychiatry, was probably the most infl uential of the early researchers. In 1886 he published his most famous work, Psychopathia Sexualis, a collection of case histories of fetish- ists, sadists, masochists, and homosexuals. (He invented the words “sadomas- ochism” and “transvestite.”) Kraff t-Ebing traced variations in Victorian sexuality to “hereditary taint,” to “moral degeneracy,” and, in particular, to masturbation. He intermingled descriptions of fetishists who became sexually excited by certain items of cloth- ing with those of sadists who disemboweled their victims. For Kraff t-Ebing, the origins of fetishism and murderous sadism, as well as most variations, lay in masturbation, the prime sexual sin of the nineteenth century. Despite his misguided focus on masturbation, Kraff t-Ebing’s Psychopathia Sexualis brought to public attention and discussion an immense range of sexual behaviors that

Judge a man by his questions rather than by his answers.

—Voltaire (1694–1778)

“

Richard von Kraff t-Ebing (1840–1902) viewed most sexual behavior other than marital coitus as a sign of pathology.

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The Sex Researchers • 45

had never before been documented in a dispassionate, if erroneous, manner. A darkened region of sexual behavior was brought into the open for public examination.

Sigmund Freud

Few people have had as dramatic an impact on the way we think about the world as the Viennese physician Sigmund Freud (1856–1939). In his attempt to under- stand the neuroses, or psychological disorders characterized by anxiety or tension, plaguing his patients, Freud explored the unknown territory of the unconscious. If unconscious motives were brought to consciousness, Freud believed, a person could change his or her behavior. But, he suggested, repression, a psychological mechanism that kept people from becoming aware of hidden memories and motives because they aroused guilt, prevents such knowledge. To explore the unconscious, Freud used various techniques; in particular, he analyzed dreams to discover their meaning. His journeys into the mind led to the development of psychoanalysis, a psychological system that ascribes behav- ior to unconscious desires. He fl ed Vienna when Hitler annexed Austria in 1938 and died a year later in England. Freud believed that sexuality begins at birth, a belief that set him apart from other researchers. Freud described fi ve stages in psychosexual development. Th e fi rst stage is the oral stage, lasting from birth to age 1. During this time, the infant’s eroticism is focused on the mouth; thumb sucking produces an erotic plea- sure. Freud believed that the “most striking character of this sexual activity . . . is that the child gratifi es himself on his own body; . . . he is autoerotic” (Freud, 1938). Th e second stage, between ages 1 and 3, is the anal stage. Children’s sexual activities continue to be autoerotic, but the region of pleasure shifts to the anus. From age 3 through 5, children are in the phallic stage, in which they exhibit interest in the genitals. At age 6, children enter a latency stage, in which their sexual impulses are no longer active. At puberty, they enter the genital stage, at which point they become interested in genital sexual activities, especially sexual intercourse. Th e phallic stage is the critical stage in both male and female development. Th e boy develops sexual desires for his mother, leading to an Oedipal complex. He simultaneously desires his mother and fears his father. Th is fear leads to castration anxiety, the boy’s belief that the father will cut off his penis because of jealousy. Girls follow a more complex developmental path, according to Freud. A girl develops an Electra complex, desiring her father while fearing her mother. Upon discovering that she does not have a penis, she feels deprived and develops penis envy. By age 6, boys and girls resolve their Oedipal and Electra complexes by relinquishing their desires for the parent of the other sex and identifying with their same-sex parent. In this manner, they develop their mas- culine and feminine identities. But because girls never acquire their “lost penis,” Freud believed, they fail to develop an independent character like that of boys. In many ways, such as in his commitment to science and his explorations of the unconscious, Freud seems the embodiment of twentieth-century thought. But in recent times, his infl uence among American sex researchers has dwin- dled. Two of the most important reasons are his lack of empiricism and his inadequate description of female development. Because of its limitations, Freud’s work has become mostly of historical interest to mainstream sex researchers. It continues to exert infl uence in some

The true science and study of man is man.

—Pierre Charron (1541–1603)

“

Sigmund Freud (1856–1939) was the founder of psychoanalysis and one of the most infl uential European thinkers of the fi rst half of the twentieth century. Freud viewed sexuality with suspicion.

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46 • Chapter 2 Studying Human Sexuality

fi elds of psychology but has been greatly modifi ed by other fi elds. Even among contemporary psychoanalysts, Freud’s work has been radically revised.

Havelock Ellis

English physician and psychologist Havelock Ellis (1859–1939) was the earliest important modern sexual theorist and scholar. His Studies in the Psychology of Sex (the fi rst six volumes of which were published between 1897 and 1910) consisted of case studies, autobiographies, and personal letters. One of his most important contributions was pointing out the relativity of sexual values. In the nineteenth century, Americans and Europeans alike believed that their society’s dominant sexual beliefs were the only morally and naturally correct standards. But Ellis demonstrated not only that Western sexual standards were hardly the only moral standards but also that they were not necessarily rooted in nature. In doing so, he was among the fi rst researchers to appeal to studies in animal behavior, anthropology, and history. Ellis also challenged the view that masturbation was abnormal. He argued that masturbation was widespread and that there was no evidence linking it with any serious mental or physical problems. He recorded countless men and women who masturbated without ill eff ect. In fact, he argued, masturbation had a positive function: It relieved tension. In the nineteenth century, women were viewed as essentially “pure beings” who possessed reproductive rather than sexual desires. Men, in contrast, were driven by such strong sexual passions that their sexuality had to be severely controlled and repressed. In countless case studies, Ellis documented that women possessed sexual desires no less intense than those of men. Ellis asserted that a wide range of behaviors was normal, including much behavior that the Victorians considered abnormal. He argued that both mas- turbation and female sexuality were normal behaviors and that even the so- called abnormal elements of sexual behavior were simply exaggerations of the normal. He also reevaluated homosexuality. In the nineteenth century, homosexual- ity was viewed as the essence of sin and perversion. It was dangerous, lurid, and criminal. Ellis insisted that it was not a disease or a vice, but a congenital condition: A person was born homosexual; one did not become homosexual. By insisting that homosexuality was congenital, Ellis denied that it could be con- sidered a vice or a form of moral degeneracy, because a person did not choose it. If homosexuality were both congenital and harmless, then, Ellis reasoned, it should not be considered immoral or criminal.

Alfred Kinsey

Alfred C. Kinsey (1894–1956), a biologist at Indiana University and America’s leading authority on gall wasps, destroyed forever the belief in American sexual innocence and virtue. He accomplished this through two books, Sexual Behavior in the Human Male (Kinsey, Pomeroy, & Martin, 1948) and Sexual Behavior in the Human Female (Kinsey, Pomeroy, Martin, & Gebhard, 1953). Th ese two volumes statistically documented the actual sexual behavior of Americans. In massive detail, they demonstrated the great discrepancy between public standards of sexual behavior and actual sexual behavior. Kinsey believed that sex was as legitimate a subject for study as any other and that the study of sex should be treated as a scientifi c discipline involving compiling and examining data and

Havelock Ellis (1859–1939) argued that many behaviors previously labeled as abnormal were actually normal, including masturbation and female sexuality. For example, he found no evidence that masturbation leads to mental disorders, and he documented that women have sexual drives no less intense than those of men.

Alfred C. Kinsey (1894–1956) photographed by William Dellenback, 1953. Kinsey shocked Americans by revealing how they actually behaved sexually. His scientifi c eff orts led to the termination of his research funding because of political pressure.

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The Sex Researchers • 47

drawing conclusions without moralizing. He challenged the traditional medical fi eld’s dominance of sexual research, leading to the fi eld becoming open to many more disciplines (Bullough, 1994). In the fi restorm that accompanied the publication of Kinsey’s books (popu- larly known as the Kinsey Reports), many Americans protested the destruction of their cherished ideals and illusions. Kinsey was highly criticized for his work—and that criticism continues even today. Many people believe that his fi ndings are responsible for a moral breakdown in the United States. Eminent sex researcher Vern Bullough (2004) stated that

few scholars or scientists have lived under the intense fi restorm of publicity and criticism that he did but even as the attacks on him increased and as his health failed, he continued to gather his data, and fi ght for what he believed. He changed sex for all of us.

Sexual Diversity and Variation What Kinsey discovered in his research was an extraordinary diversity in sexual behaviors. Among men, he found indi- viduals who had orgasms daily and others who went months without orgasms. Among women, he found individuals who had never had orgasms and others who had them several times a day. He discovered one male who had ejaculated only once in 30 years and another who ejaculated 30 times a week on average. “Th is is the order of variation,” he commented dryly, “which may occur between two individuals who live in the same town and who are neighbors, meeting in the same place of business and coming together in common social activities” (Kinsey et al., 1948).

A Reevaluation of Masturbation Kinsey’s work aimed at a reevaluation of the role of masturbation in a person’s sexual adjustment. Kinsey made three points about masturbation: (1) It is harmless, (2) it is not a substitute for sexual intercourse but a distinct form of sexual behavior that provides sexual pleasure, and (3) it plays an important role in women’s sexuality because it is a more reliable source of orgasm than heterosexual intercourse and because its practice seems to facilitate women’s ability to become orgasmic during intercourse. Indeed, Kinsey believed that masturbation is the best way to measure a woman’s inherent sexual responsiveness because it does not rely on another person.

Sexual Orientation Prior to Kinsey’s work, an individual was identifi ed as homosexual if he or she had ever engaged in any sexual behavior with a person of the same sex. Kinsey found, however, that many people had sexual experiences with persons of both sexes. He reported that 50% of the men and 28% of the women in his studies had had same-sex experiences and that 38% of the men and 13% of the women had had orgasms during these experiences (Kinsey et al., 1948, 1953). Furthermore, he discovered that sexual attractions could change over the course of a person’s lifetime. Kinsey’s research led him to conclude that it was erroneous to classify people as either heterosexual or homosexual. A person’s sexuality was signifi cantly more com- plex and fl uid. Kinsey wanted to eliminate the concept of heterosexual and homosexual identities. He did not believe that homosexuality, any more than heterosexual- ity, existed as a fi xed psychological identity. Instead, he argued, there were only sexual behaviors, and behaviors alone did not make a person gay, lesbian, bisexual, or heterosexual. It was more important to determine what proportion

You shall know the truth and the truth shall make you mad.

—Aldous Huxley (1894–1963)

“

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48 • Chapter 2 Studying Human Sexuality

of behaviors were same-sex and other-sex than to label a person as gay, lesbian, or heterosexual. He devised the Kinsey scale to represent the proportion of an individual’s sexual behaviors with the same or other sex (see Figure 2.1). Th is scale charted behaviors ranging from no behaviors with the same sex to behaviors exclusively with members of the same sex, with the behaviors existing on a continuum. His scale radicalized the categorization of human sexual behavior (McWhirter, 1990).

Rejection of Normal/Abnormal Dichotomy As a result of his research, Kinsey insisted that the distinction between normal and abnormal was mean- ingless. Like Ellis, he argued that sexual diff erences were a matter of degree, not kind. Almost any sexual behavior could be placed alongside another that diff ered from it only slightly. His observations led him to be a leading advocate of the toleration of sexual diff erences.

William Masters and Virginia Johnson

In the 1950s, William Masters (1915–2001), a St. Louis physician, became interested in treating sexual diffi culties—such problems as early ejaculation and erection diffi culties in men, and lack of orgasm in women. As a physician, he felt that a systematic study of the human sexual response was necessary, but none existed. To fi ll this void, he decided to conduct his own research. Masters was joined several years later by Virginia Johnson (1925–). Masters and Johnson detailed the sexual response cycles of 382 men and 312 women during more than 10,000 episodes of sexual behavior, including masturbation and sexual intercourse. Th e researchers combined observation with direct measurement of changes in male and female genitals using electronic devices. (See Chapter 3 for a detailed discussion of their four-phase sexual response cycle.) Human Sexual Response (1966), their fi rst book, became an immediate suc- cess among both researchers and the public. What made their work signifi cant was not only their detailed descriptions of physiological responses but also the articulation of several key ideas. First, Masters and Johnson discovered that, physiologically, male and female sexual responses are very similar. Second, they demonstrated that women achieve orgasm primarily through clitoral stimulation.

I don’t see much of Alfred anymore since he got so interested in sex.

—Clara Kinsey (1898–1982)

“

• FIGURE 2.1 The Kinsey Scale. This scale illustrates the degree to which a person may engage in other-sex and same-sex behaviors.

Exclusively other-sex behaviors

Primarily other-sex behaviors but some amount of same-sex behaviors

Mostly other- sex behaviors but considerable amount of same- sex behaviors

Equal amounts of other-sex and same-sex behaviors

Primarily same- sex behaviors but considerable amount of other- sex behaviors

Mostly same-sex behaviors but some amount of other-sex behaviors

Exclusively same-sex behaviors

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Contemporary Research Studies • 49

Penetration of the vagina is not needed for orgasm to occur. By demonstrating the primacy of the clitoris, Masters and Johnson destroyed once and for all the Freudian distinction between vaginal and clitoral orgasm. (Freud believed that an orgasm a woman experienced through masturbation was somehow physically and psychologically inferior to one experienced through sexual intercourse. He made no such distinction for men.) By destroying the myth of the vaginal orgasm, Masters and Johnson legitimized female masturbation. In 1970, Masters and Johnson published Human Sexual Inadequacy, which revolutionized sex therapy by treating sexual problems simply as diffi culties that could be treated using behavioral therapy. Th ey argued that sexual problems were not the result of underlying neuroses or personality disorders. More often than not, problems resulted from a lack of information, poor communication between partners, or marital confl ict. Th eir behavioral approach, which included “homework” exercises such as clitoral or penile stimulation, led to an astound- ing increase in the rate of successful treatment of sexual problems. Th eir work made them pioneers in modern sex therapy.

• Contemporary Research Studies Several large, national sexuality-related studies have been conducted in recent years. We briefl y describe fi ve national surveys here to illustrate research on the general population of men and women, adolescents, and college students. Th e studies cited below, largely directed to determine the prevalence of certain behaviors, give little or no attention to factors that help explain the fi ndings. Further, these studies represent only the tip of the sexuality-related research pertinent to the topics covered in this textbook. Sex research continues to be an emerging fi eld of study. Most studies are not national projects but are smaller ones dealing with special populations or issues and focus on examining factors that are related to or infl uence sexual behavior. Even though these stud- ies may be smaller in scope, they provide valuable information for furthering our understanding of human sexual expression. Th roughout the book, we cite numerous studies to provide empirical information about the topic. Before describing these studies, it is important to note that, just like in the days of Alfred Kinsey, these are diffi cult times to conduct sex research. For exam- ple, members of Congress and some conservative groups are attacking the value of certain sex research topics, even those related to HIV prevention. Th e result: a chilling eff ect on sex research. Funding for sex research has become more lim- ited, and sexuality-related grant applications to the National Institutes of Health

The profoundest of all our sensualities is the sense of truth.

—D. H. Lawrence (1885–1930)

“

William Masters (1915–2001) and Virginia Johnson (1925–) detailed the sexual response cycle in the 1960s and revolutionized sex therapy in the 1970s.

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50 • Chapter 2 Studying Human Sexuality

think about it

Socrates said: “There is only one good, knowledge, and one evil, ignorance.” This philosophy has been a core tenet in the growth of humankind and cultures since it was fi rst written sometime between 469 BCE and 399 BCE. But, in one area of life, human sexuality, some espouse that there is one good, igno- rance, and one evil, knowledge. In our culture, the value of sex- ual knowledge is debated. One way this ambivalence manifests itself is through criticism and barriers to research on human sexuality (Yarber, 1992; Yarber & Sayad, 2011). Sex research faces many issues that other areas of scientifi c inquiry do not, largely because human sexuality in our culture is too often surrounded by fear and denial, and its expression is accompanied by shame, guilt, and embarrassment. These dis- comforts, particularly the fear of sexual knowledge, have fueled eff orts to refute sex research. Some opposed to sex research believe that it has little value, and the research may be discredited. As such, the researchers may face public scorn as Alfred Kinsey did. In fact, because of public outcry, Alfred Kinsey lost foundation funding for his research following the publica- tion of his fi rst book on male sexuality. Additionally, the National Health and Social Life Survey (Lauman et al., 1994) conducted in the 1990s had to seek funding from foundations and private donors after a large federal grant was withdrawn following political pressure. Even today, federal government funding of sexuality-related areas is limited primarily to the study of

Sex Research: A Benefi t to Individuals and Society or a Threat to Morality?

HIV/STI risk behavior and prevention, which means researchers must search for nongovernment funding sources for topics out- side this area. For example, a study of relationships between masturbation and mental health among older adults who no longer have a partner would most likely not be federally funded. The National Survey of Sexual Health and Behavior (Herbenick et al., 2010a), a national study of Americans’ sexual behavior conducted in 2010, was funded by a condom manufacturer. A major test of academic freedom within the university oc- curred over 60 years ago when Alfred Kinsey’s research was heav- ily criticized and outside pressure was exerted upon Indiana University to end Kinsey’s work (Capshew, 2012). Herman B Wells, President of IU then, defended Alfred Kinsey by declaring that the search for truth is an important function of university and that a fundamental university tenet and core value is that a faculty member is free to conduct research on any subject in which the person has competence. Wells (1980) unequivocally articulated the tenet that “… a university that bows to the wishes of a person, group, or segment of society is not free.’’ Wells’s support of Alfred Kinsey’s research is considered a landmark victory for academic freedom and helped pave the way for sex research at other univer- sities (Clark, 1977). William Masters stated that without Kinsey’s work and the support it received from IU, he and Virginia Johnson would not have been able to conduct their observational research on sexual response and dysfunction (Maier, 2009).

that have been approved by peer review have been questioned (Clark, 2003; Navarro, 2004). Sex research is a relatively young area of study when compared to better-established fi elds such as psychology, and the number of researchers specializing in sexuality-related study is small. Hopefully, these eff orts to limit and discredit sex research will not discourage the next generation of researchers from becoming sex researchers. (To read a brief discussion about the controversy surrounding sex research, see the “Th ink About It” box above.)

The National Health and Social Life Survey

In 1994, new fi gures from the fi rst nationally representative survey of Ameri- cans’ sexual behavior were released showing us to be in a diff erent place than when Kinsey did his research a half century earlier. Researchers from the University of Chicago published two titles—the popular trade book Sex in America: A Defi nitive Survey (Michael, Gagnon, Laumann, & Kolata, 1994) and a more detailed and scholarly version, Th e Social Organization of Sexuality (Laumann, Gagnon, Michael, & Michaels, 1994). Th e survey contradicted many previous fi ndings and beliefs about sex in America.

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Contemporary Research Studies • 51

In the face of criticism, sex research has shown value—many in- dividuals and society have benefi ted in so many ways from the deeper understanding of human sexual expression that research brings. But not all persons agree. Here are just three examples of the cultural ambiguity surrounding sex research and sexual knowledge:

■ Some persons believed that Kinsey’s research was destruc- tive, leading to the sexual revolution of the 1960s and the breakdown of traditional mores. Yet, renowned sexologists consider Kinsey’s scientifi c fi ndings profound, making it pos- sible for individuals, couples, and the public to talk about sex as well as freeing many persons from the stigma of abnor- mality (Bullough, 2004; Gagnon, 1975).

■ Some persons were outraged upon learning that Masters and Johnson actually observed persons having sex, believing that such research had gone too far. Yet, Masters and Johnson’s lab- oratory observation and measurement of the sexual responses of men and women led to the development of eff ective behav- ioral therapy for sexual function problems that have benefi ted many individuals and couples (Masters & Johnson, 1970).

■ Some individuals and evangelical religious groups support abstinence-only education and contend that sexuality edu- cation that discusses methods of preventing HIV/STIs and pregnancy other than abstinence leads to sexual behavior among young persons outside of marriage. Yet, research has shown that abstinence-only sexuality education is largely ineff ective in delaying the onset of sex and that a compre- hensive approach which included information about HIV/STIs and pregnancy prevention methods postponed the initiation of sex and increased condom and contraception use (Kirby, 2007, 2008).

Supporters of sex research contend that we all suff er and the public loses when sex research is hampered. They believe that a fundamental principle of a democracy is at stake: the in- dividual right to know. One way of making it possible for peo- ple to learn more about sexuality is through sex research’s goals to increase people’s knowledge about sexuality and its various components and to show them the positive impact that a rewarding and health-enhancing sexuality can have. But many opponents believe that sex research is harmful to society and should be limited or even eliminated. So, what do you think? For human sexuality, was Socrates right or wrong when he said “There is one good, knowledge, and one evil, ignorance”?

Think Critically 1. Do you believe that sex research benefi ts individuals

and society or that it leads to moral decay? Explain. 2. Should researchers at colleges and universities have

the academic freedom to conduct any type of sex research? Defend your answer.

3. Given that the vast majority of federal government– funded sexuality-related research deals with HIV/STI risk behavior, do you think that other areas of human sexual- ity should be funded? If so, what areas? If not, why?

Th e study, titled the National Health and Social Life Survey (NHSLS), involved 3,432 randomly selected Americans aged 18–59, interviewed face-to-face. Even though this study was conducted about two decades ago (1992) and had some sampling limitations, sexual scientists regard it as one of the most meth- odologically sound studies; hence, we highlight major fi ndings here and in subsequent chapters of this text. Released as the fi rst study to explore the social context of sexuality, the NHSLS revealed the following:

■ Americans are largely exclusive. Th e median number of sexual partners since age 18 for men was six and for women, two.

■ On average, Americans have sex about once a week. Nearly 30% had sex with a partner only a few times a year or not at all, 35% had sex once or several times a month, and about 35% had sex two or more times a week.

■ Extramarital sex is the exception, not the rule. Among those who were married, 75% of men and 85% of women said they had been sexually exclusive with their spouse.

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52 • Chapter 2 Studying Human Sexuality

■ Most Americans have fairly traditional sexual behaviors. When respondents were asked to name their preferences from a long list of sexual behav- iors, vaginal intercourse was considered “very appealing” by most of those interviewed. Ranking second, but far behind, was watching a partner undress. Oral sex ranked third.

■ Homosexuality is not as prevalent as originally believed. Among men, 2.8% described themselves as homosexual or bisexual; among women, 1.4% did so.

■ Orgasms appear to be the rule for men and the exception for women. Seventy-fi ve percent of men claimed to have orgasms consistently with their partners, whereas only 29% of women did. Married women were most likely to report that they always or usually had orgasms.

■ Forced sex and the misperception of it remain critical problems. Twenty-two percent of women said they had been forced to do sexual things they didn’t want to do, usually by a loved one. Only 3% of men reported ever forcing themselves on women.

■ Th ree percent of adult Americans claim never to have had sex.

The National Survey of Family Growth

Periodically, the National Center for Health Statistics (NCHS) conducts the National Survey of Family Growth (NSFG) to collect data on marriage, divorce, contraception, infertility, and health of women and infants in the United States. In 2011, the NCHS published Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data from the 2006–2008 National Survey of Fam- ily Growth, which presents national estimates of several measures of sexual behavior, sexual attraction, and sexual identity among males and females 15–44 years of age in the United States. In-person, face-to-face interviews and audio-CASI were used with a nationally representative sample of 13,495 males and females in the household population of the United States. Important fi ndings for this sample include the following:

■ Sexual behaviors among males and females aged 15–44, based on the 2006–2008 NSFG, were generally the same as those reported in a simi- lar report of 2002.

■ Among adults aged 25–44, about 98% of females and 97% of males ever had sexual intercourse, 89% of females and 90% of males ever had oral sex with an opposite-sex partner, and 36% of females and 44% of males ever had anal sex with an other-sex partner.

■ For men aged 15–44, the mean number of lifetime female partners was 5.1 and for women 3.2 lifetime male partners.

■ For ages 15–44, 21% of men and 8% of women reported 15 or more lifetime sexual partners.

■ For ages 15–44, 12.5% of women and 5.2% of men reported any same- sex contact in their lifetimes, and 9.3% of women and 5% of men reported oral sex with a same-sex partner.

■ For ages 15–44, for sexual identity, 92.8%, 1.0%, and 3.5% of women self- identifi ed as heterosexual (straight), homosexual (gay or lesbian), and bisex- ual, respectively. For men, 95.0%, 1.6%, and 1.1% self-identifi ed as heterosexual (straight), homosexual (gay or lesbian), and bisexual, respectively.

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Contemporary Research Studies • 53

■ Of sexually active people aged 15–24, 63% of females and 64% of males had oral sex, down from 69% in 2002.

■ Among teenagers aged 15–19, 7% of females and 9% of males had oral sex with an other-sex partner, but no vaginal intercourse.

For a full copy of the report, see the National Center for Health Statistics website: http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf.

The Youth Risk Behavior Survey

Th e Youth Risk Behavior Survey (YRBS), conducted biannually by the Centers for Disease Control and Prevention (CDC), measures the prevalence of six categories of health risk behaviors among youths through representative national, state, and local surveys using a self-report questionnaire. Sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections, includ- ing HIV, are among those assessed. Th e 2009 YRBS includes a national school- based survey of students in grades 9–12, from 158 schools in 42 states, and 20 local surveys, revealing the following (CDC, 2010a):

■ Forty-six percent of students (46% of females and 46% of males) reported ever having had sexual intercourse.

■ Fourteen percent of students (11% of females and 16% of males) reported having had sexual intercourse with four or more partners during their life.

■ Six percent of students (3% of females and 8% of males) reported hav- ing had sexual intercourse for the fi rst time before age 13.

■ Th irty-four percent of students (36% of females and 37% of males) reported having had sexual intercourse with at least one person during the 3 months before the survey.

■ Sixty-one percent of students (54% of females and 69% of males) who reported being currently sexually active also reported using a condom during their most recent sexual intercourse.

■ Twenty percent of students (23% of females and 17% of males) who reported being currently sexually active also reported that either they or their partner had used birth control pills before their most recent sexual intercourse.

■ Twenty-two percent of students (15% of females and 24% of males) who reported being currently sexually active also reported using alcohol or drugs prior to their most recent sexual intercourse.

■ Seven percent of students (11% of females and 6% of males) reported ever being forced to have sexual intercourse.

■ Th irteen percent of students (18% of females and 11% of males) reported having been tested for HIV (not counting being done while donating blood).

See http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf for more information on the 2009 YRBS.

The National College Health Assessment

Since year 2000, every fall and spring term the American College Health Asso- ciation has conducted research at colleges and universities throughout the United States to assess students’ health behaviors and their perceptions of the prevalence

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54 • Chapter 2 Studying Human Sexuality

of these behaviors among their peers. Areas covered are alcohol, tobacco, and other drug use; sexual health, weight, nutrition, and exercise; mental health, injury prevention, personal safety, and violence. For the Spring 2010 survey, 95,712 students at 139 U.S. campuses participated (American College Health Association, 2010). Findings from the sexual health questions include:

■ Within the last school year, 70% of college men and 72% of college women had at least one sexual partner. Most had one sexual partner— 42.6% of men and 48.9% of women—although 10.7% of men and 5.6% of women had four or more partners. (See Figure 2.2 for the percentage reporting having oral, vaginal and anal intercourse in the past 30 days and the percentage who used protection during these behaviors.)

■ Among sexually active students, birth control pills and male condoms were the most common (about 61% each) birth control methods used to prevent pregnancy by the students or their partner the last time they had vaginal intercourse.

■ Among sexually active students, 16% reported using (or reported their partner used) emergency contraception (“morning-after pill”) within the last school year.

A copy of the report can be found at the American College Health Association website: http://www.acha.org/reports_ACHA-NCHAII.html.

The National Survey of Sexual Health and Behavior

Th e most expansive nationally representative study of sexual and sexual-health behaviors, the National Survey of Sexual Health and Behavior (NSSHB), was published in 2010, 16 years following the fi rst nationally representative study, the 1994 National Health and Social Life Survey described earlier. Th e NSSHB, a study based on Internet reports from 5,865 American adolescents and adults aged 14–94, provides a needed and valuable updated overview of Americans’ sexual behavior and reveals an increase in sexual diversity since the NHSLS. A major strength of the NSSHB is its larger range of ages—spanning 80 years—in contrast to other studies that had narrow age ranges. Th e study was conducted and led by researchers from the Indiana University Center for

Oral sex in past 30 days

aPercentage reporting the behavior.

bPercentage of sexually active students reporting using a condom or other protective barrier during the specific sexual behavior within the past 30 days.

Vaginal sex in past 30 days

Anal intercourse in past 30 days

P er

ce nt

ag e

100

45%a

(5%)b 45%a

(55%)b

52%a

(49%)b

6%a

(36%)b 4%a

(29%)b

Male Female

• FIGURE 2.2 Percentage of College Students Who Reported Having Oral Sex, Vaginal Sex, and Anal Intercourse in the Past 30 Days and the Percentage Reporting Using a Condom or Other Protective Barrier, Spring 2010. (Source: American College Health Association National College Health Assessment, 2010.)

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http://www.acha.org/reports_ACHA-NCHAII.html

Emerging Research Perspectives • 55

Sexual Health Promotion with collaboration from researchers from Th e Kinsey Institute for Research in Sex, Gender, and Reproduction and the Indiana University School of Medicine. Th e fi rst reports of the NSSHB fi ndings were published in 2010 in nine articles as a special issue of the Journal of Sexual Medicine. (Th e NSSHB was funded by Church & Dwight, makers of Trojan condoms.) Th e NSSHB provides data on masturbation (solo and partnered), oral sex (given and received), vaginal intercourse, and anal intercourse, categorized by 10 age ranges. Th ese new data will be highlighted throughout the textbook, particularly in Chapter 9, Sexual Expression. Major generalized NSSHB fi nd- ings include the following (Dodge et al., 2010; Herbenick et al., 2010a, 2010b, 2010c; Reece et al., 2010a, 2010b; Sanders et al., 2010):

■ A large variability of sexual repertoires of adults was found, with numerous combinations of sexual behaviors described at adults’ most recent sexual event.

■ Men and women participated in diverse solo and partnered behaviors throughout their life course, yet in spite of lower frequency of these behaviors among older adults, many reported active, pleasurable sex lives.

■ Masturbation was more common among all age groups, but more com- mon among men than women and individuals aged 25–29.

■ Vaginal intercourse occurred more frequently than other sexual behaviors from early to late adulthood.

■ Partnered noncoital behaviors—oral sex and anal intercourse—were well- established components of couple sexual behavior and were reported in greater numbers than in the NHSLS.

■ Among adults, many sexual episodes included partnered masturbation and oral sex, but not intercourse.

■ Fewer than 1 in 10 men and women self-identifi ed as a gay man, lesbian woman, or bisexual person, but the proportion of study participants hav- ing same-gender interactions sometime in their lives was higher.

■ Masturbation, oral sex, and vaginal intercourse were prevalent among all ethnic groups and among men and women throughout the life course.

■ During a single sexual event, orgasm among men was facilitated by vagi- nal intercourse with a relationship partner, whereas women’s orgasm was facilitated by varied sexual behaviors.

■ Higher rates of condom use during most recent vaginal intercourse were found compared to other recent studies, and condoms were used more frequently with casual partners than relationship partners.

• Emerging Research Perspectives Although sex research continues to explore diverse aspects of human sexuality, some scholars feel that their particular interests have been given insuffi cient attention. Feminist, gay, lesbian, bisexual, and transgender research has focused on issues that mainstream research has largely ignored. And ethnic research, only recently undertaken, points to the lack of knowledge about the sexuality of some ethnic groups, such as African Americans, Latinos, Asian Americans, Middle Eastern Americans, and American Indians. Th ese emerging research perspectives enrich our knowledge of sexuality.

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56 • Chapter 2 Studying Human Sexuality

Feminist Scholarship

Th e initial feminist research generated an immense amount of groundbreaking work on women in almost every fi eld of the social sciences and humanities. Feminists made gender and gender-related issues signifi cant research questions in a multitude of academic disciplines, with the goal of producing useful knowl- edge that can be valuable to individual and societal change (Letherby, 2003). In the fi eld of sexuality, feminists expanded the scope of research to include the subjective experience and meaning of sexuality for women; sexual pleasure; sex and power; erotic material; risky sexual behavior; and issues of female vic- timization, such as rape, the sexual abuse of children, and sexual harassment. Th ere is no single feminist perspective; instead, there are several. For our purposes, feminism is “a movement that involves women and men working together for equality” (McCormick, 1996). Feminism centers on understanding female experience in cultural and historical context—that is, the social con- struction of gender asymmetry (Pollis, 1988). Social construction is the devel- opment of social categories, such as masculinity, femininity, heterosexuality, and homosexuality, by society. Feminists believe in these basic principles:

■ Gender is signifi cant in all aspects of social life. Like socioeconomic status and ethnicity, gender infl uences a person’s position in society.

■ Th e female experience of sex has been devalued. By emphasizing genital sex, frequency of sexual intercourse, and number of orgasms, both researchers and society ignore other important aspects of sexuality, such as kissing, caressing, love, commitment, and communication. Sexuality in lesbian wom- en’s relationships is even more devalued. Until the 1980s, most research on homosexuality centered on gay men, making lesbian women invisible.

■ Power is a critical element in male-female relationships. Because women are often subordinated to men as a result of our society’s beliefs about gen- der, women generally have less power than men. As a result, feminists believe that men have defi ned female sexuality to benefi t themselves. Not only do men typically decide when to initiate sex, but the man’s orgasm often takes precedence over the woman’s. Th e most brutal form of the male expression of sexual power is rape.

■ Ethnic diversity must be addressed. Women of color, feminists point out, face a double stigma: being female and being from a minority group. Although few studies exist on ethnicity and sexuality, feminists are committed to examining the role of ethnicity in female sexuality (Amaro, Raj, & Reed, 2001).

Despite its contributions, feminist research and the feminist approach have often been marginalized. However, the feminist perspective in sex research has expanded in recent years, and many more women are making important con- tributions to the advancement of sexual science. As one consequence, the research literature has increased, resulting in an expansion of our understanding of female as well as male sexuality. For example, renowned sex researcher Charlene Muehlenhard of the University of Kansas has developed a body of research that has defi ned the fi eld of women’s experiences with sexual coercion. She has addressed controversial issues such as token sexual resistance and has challenged researchers to clarify their conceptualizations of wanted and unwanted sex, particularly among young women (Muehlenhard & Peterson, 2005; Peterson & Muehlenhard, 2007). Findings from her research are cited in Chapter 17.

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Emerging Research Perspectives • 57

Gay, Lesbian, Bisexual, and Transgender Research

During the nineteenth century, sexuality became increasingly perceived as the domain of science, especially medicine. Physicians competed with ministers, priests, and rabbis in defi ning what was “correct” sexual behavior. However, as noted previously, medicine’s so-called scientifi c conclusions were not scientifi c; rather, they were morality disguised as science. “Scientifi c” defi nitions of healthy sex closely resembled religious defi nitions of moral sex. In studying sexual activ- ities between men, medical researchers “invented” and popularized the distinc- tion between heterosexuality and homosexuality (Gay, 1986; Weeks, 1986).

Early Researchers and Reformers Although most physician-moralists con- demned same-sex relationships as not only immoral but also pathological, a few individuals stand out in their attempt to understand same-sex sexuality.

Karl Heinrich Ulrichs Karl Ulrichs (1825–1895) was a German poet and political activist who in the 1860s developed the fi rst scientifi c theory about homosexuality (Kennedy, 1988). As a rationalist, he believed reason was supe- rior to religious belief and therefore rejected religion as superstition. He argued from logic and inference and collected case studies from numerous men to reinforce his beliefs. Ulrichs maintained that men who were attracted to other men represented a third sex, whom he called “Urnings.” Urnings were born as Urnings; their sexuality was not the result of immorality or pathology. Ulrichs believed that Urnings had a distinctive feminine quality about them that dis- tinguished them from men who desired women. He fought for Urning rights and the liberalization of sex laws.

Karl Maria Kertbeny Karl Kertbeny (1824–1882), a Hungarian physician, created the terms “heterosexuality” and “homosexuality” in his attempt to understand same-sex relationships (Feray & Herzer, 1990). Kertbeny believed that “homosexualists” were as “manly” as “heterosexualists.” For this reason, he broke with Ulrichs’s conceptualization of Urnings as inherently “feminine” (Herzer, 1985). Kertbeny argued that homosexuality was inborn and thus not immoral. He also maintained “the rights of man” (quoted in Herzer, 1985):

Th e rights of man begin . . . with man himself. And that which is most immedi- ate to man is his own body, with which he can undertake fully and freely, to his advantage or disadvantage, that which he pleases, insofar as in so doing he does not disturb the rights of others.

Magnus Hirschfeld In the fi rst few decades of the twentieth century, there was a great ferment of reform in England and other parts of Europe. While Havelock Ellis was the leading reformer in England, Magnus Hirschfeld (1868– 1935) was the leading crusader in Germany, especially for homosexual rights. Hirschfeld was a homosexual and possibly a transvestite (a person who wears clothing of the other sex). He eloquently presented the case for the humanity of transvestites (Hirschfeld, 1991). And in defense of homosexual rights, he argued that homosexuality was not a perversion but rather the result of the hormonal development of inborn traits. His defense of homosexuality led to the popularization of the word “homosexual.” Hirschfeld’s importance, however, lies not so much in his theory of homosexuality as in his sexual reform eff orts. In Berlin in 1897, he helped found the fi rst organization for homosexual rights.

Magnus Hirschfeld (1868–1935) was a leading European sex reformer who championed homosexual rights. He founded the fi rst institute for the study of sexuality, which was burned when the Nazis took power in Germany. Hirschfeld fl ed for his life.

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58 • Chapter 2 Studying Human Sexuality

In addition, he founded the fi rst journal devoted to the study of sexuality and the fi rst Institute of Sexual Science, where he gathered a library of more than 20,000 volumes.

Evelyn Hooker As a result of Kinsey’s research, Americans learned that same- sex sexual relationships were widespread among both men and women. A few years later, psychologist Evelyn Hooker (1907–1996) startled her colleagues by demonstrating that homosexuality in itself was not a psychological disorder. She found that “typical” gay men did not diff er signifi cantly in personality characteristics from “typical” heterosexual men (Hooker, 1957). Th e reverbera- tions of her work continue to this day. Earlier studies had erroneously reported psychopathology among gay men and lesbian women for two reasons. First, because most researchers were clini- cians, their samples consisted mainly of gay men and lesbian women who were seeking treatment. Th e researchers failed to compare their results against a control group of similar heterosexual individuals. (A control group is a group that is not being treated or experimented on; it controls for any variables that are introduced from outside the experiment, such as a major media report related to the topic of the experiment.) Second, researchers were predisposed to believe that homosexuality was in itself a sickness, refl ecting traditional beliefs about homosexuality. Consequently, emotional problems were automat- ically attributed to the client’s homosexuality rather than to other sources.

Later Contributions: Michel Foucault One of the most infl uential social theorists in the twentieth century was the French thinker Michel Foucault (1926–1984). A cultural historian and philosopher, Foucault explored how soci- ety creates social ideas and how these ideas operate to further the established order. His most important work on sexuality was Th e History of Sexuality, Volume I (1978), a book that gave fresh impetus to scholars interested in the social con- struction of sex, especially those involved in gender and gay and lesbian studies. Foucault challenged the belief that our sexuality is rooted in nature. Instead, he argued, it is rooted in society. Society “constructs” sexuality, including homosexuality and heterosexuality. Foucault’s critics contend, however, that he underestimated the biological basis of sexual impulses and the role individuals play in creating their own sexuality.

Contemporary Gay, Lesbian, Bisexual, and Transgender Research In 1973, the American Psychiatric Association (APA) removed homosexuality from its list of psychological disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM-II). Th e APA decision was reinforced by similar resolutions by the American Psychological Association and the American Socio- logical Association. In 1997 at its annual meeting, the American Psychological Association overwhelmingly passed a resolution stating that there is no sound scientifi c evidence on the effi cacy of reparative therapies for gay men and lesbian women. Th is statement reinforced the association’s earlier stand that, because there is nothing “wrong” with homosexuality, there is no reason to try to change sexual orientation through therapy. In 1998, the APA issued a state- ment opposing reparative therapy, thus joining the American Psychological Association, the American Academy of Pediatrics, the American Medical Asso- ciation, the American Counseling Association, and the National Association of Social Workers.

Evelyn Hooker (1907–1996) conducted landmark research on homosexual individuals in the 1950s, fi nding that “typical” gay men had personalities similar to those of “typical” heterosexual men.

Michel Foucault (1926–1984) of France was one of the most important thinkers who infl uenced our understanding of how society “constructs” human sexuality.

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Ethnicity and Sexuality • 59

As a result of the rejection of the psychopathological model, social and behavioral research on gay men, lesbian women, and bisexual individuals has moved in a new direction. Research no longer focuses primarily on the causes and cures of homosexuality, and most of the contemporary research approaches homosexuality in a neutral manner.

Directions for Future Research

Historically, sex research has focused on preventive health, which “prioritizes sexuality as a social problem and behavioral risk” (di Mauro, 1995). In light of the HIV/AIDS pandemic and other social problems, this emphasis is impor- tant, but it fails to examine the full spectrum of individuals’ behaviors or the social and cultural factors that drive those behaviors. If sex research is to expand our understanding of human sexual expression, it should examine the numer- ous components of a broader defi nition of sexuality. Sex research, globally, faces several challenges. Few sex researchers and sex research centers exist worldwide, particularly in developing countries. Only a few Western countries have comprehensive statistics, and most of them are about fertility or sexually transmitted infections rather than sexual behaviors of various groups. Th ere is no international depository for sex data. Few standardized terms exist in sex research. Lastly, quantitative data are especially diffi cult to obtain, and qualitative data are less suitable for international comparisons (MacKay, 2001).

• Ethnicity and Sexuality Researchers have begun to recognize the signifi cance of ethnicity in various aspects of American life, including sexuality. Although there have been modest increases in ethnic diversity of research samples, important questions must still be addressed (CDC, 2011a). Th ese include the diff erences that socioeconomic status and environment play in sexual behaviors, the way in which questions are posed in research studies, the research methods that are used, and researchers’ preconceived notions regarding ethnic diff erences. Diversity-related bias can be so ingrained in the way research is conducted (Rogler, 1999) that it is diffi cult to detect. Although limited research is available, we, the authors, attempt to provide some background to assist an understanding of sexuality and ethnicity.

African Americans

Several factors must be considered when studying African American sexuality, including sexual stereotypes, racism, socioeconomic status, and Black subculture. Sexual stereotypes greatly distort our understanding of Black sexuality. One of the most common stereotypes, strongly rooted in American history, culture, and religion, is the image of Blacks as hypersexual beings (Staples, 2006). Th is stereotype, which dates back to the fi fteenth century, continues to hold consid- erable strength among non-Blacks. Family sociologist Robert Staples (1991) writes: “Black men are saddled with a number of stereotypes that label them as irresponsible, criminalistic, hypersexual, and lacking in masculine traits.” But the reality is, no one has attempted a comprehensive evaluation of the sexuality of Black males (Grimes, 1999). Evelyn Higginbotham (1992), a leading authority on the African American experience, discussed the racialized constructions of African American women’s sexuality as primitive, animal-like and promiscuous,

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60 • Chapter 2 Studying Human Sexuality

and nonvirtuous. During the days of slavery, this representation of Black sexu- ality rationalized sexual exploitation of Black women by White masters (Nagel, 2003). Th e belief that Black women were “promiscuous” by nature was per- petuated by a variety of media, such as theater, art, the press, and literature. From this, historian Darlene Hine (1989) notes that silence arose among women: a “culture of dissemblance.” To protect the sanctity of inner aspects of their lives and to combat pervasive negative images and stereotypes about them, Black women (particularly the middle class) began to represent their sexuality through silence, secrecy, and invisibility. For example, they would dress very modestly to remain invisible—hence, not drawing attention that might lead to being sexually assaulted. Eff orts to adhere to Victorian ideology and represent pure morality were deemed by Black women to be necessary for protection and upward mobil- ity and to attain respect and justice. Th ese representations continue today for many older African American women. For some younger, “new” African Amer- ican women, however, the opposite is happening: being more visible and less reserved about their sexuality. Th ese younger women feel more self-assured about themselves and their sexuality. Th e emphasis on sexuality of the younger African American woman is often depicted, for example, in advertising and rap music videos, particularly Gangsta rap, shown on Black Entertainment Television (BET). Unfortunately, much Gangsta rap is explicit about both sex and violence and rarely illustrates the long-term consequences of sexual risk behaviors; research has shown that these videos lead to increased sexual risk behavior among African American adolescents (Wingood et al., 2002). Socioeconomic status is a person’s ranking in society based on a combination of occupational, educational, and income levels. It is an important element in African American sexual values and behaviors (Staples, 2006; Staples & Johnson, 1993). For example, a study of White and African American women and Latinas who voluntarily sought HIV counseling and testing found that socioeconomic status, not race, was directly related to HIV risk behavior. Women with lower

In the rich cultural history of African Americans, family life is very important.

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Ethnicity and Sexuality • 61

incomes had riskier (e.g., drug-injecting) sexual partners and higher levels of stress, factors related to risky sexual behaviors (Ickovics et al., 2002). Values and behaviors are shaped by culture and social class. Th e subculture of Blacks of low socio- economic status is deeply infl uenced by poverty, discrimination, and structural subordination. Although there has been a signifi cant increase in African American research, much still needs to be done. For example, researchers need to (1) explore the sexual attitudes and behaviors of the general African American population, not merely adolescents, (2) examine Black sexuality from an African American cultural viewpoint, and (3) utilize a cultural equivalency perspective that rejects diff erences between Blacks and Whites as signs of inherent deviance. (Th e cultural equivalency perspective is the view that the attitudes, values, and behaviors of one ethnic group are similar to those of another ethnic group.)

Latinos

Latinos are the fastest-growing ethnic group in the United States. Th ere is very little research, however, about Latino sexuality. Two common stereotypes depict Latinos as sexually permissive and Latino males as pathologically macho. Like African Americans, Latino males are often stereotyped as being “promiscuous,” engaging in excessive and indiscriminate sexual activities. No research, however, validates this stereotype. Th e macho stereotype paints Latino males as hypermasculine—swaggering and domineering. But the stereotype of machismo distorts its cultural meaning among Latinos. (Th e Spanish word “machismo” was originally incorporated into English in the 1960s as a slang term to describe any male who was sexist.) Within its cultural context, however, machismo is a positive concept, celebrating the values of courage, strength, generosity, politeness, and respect for others. And in day-to-day function- ing, relations between Latino men and women are signifi cantly more egalitarian than the macho stereotype suggests. Th is is especially true among Latinos who are more acculturated (Sanchez, 1997). (Acculturation is the process of adaptation of an ethnic group to the values, attitudes, and behaviors of the dominant culture.) Another trait of Latino life is familismo, a commitment to family and fam- ily members. Researcher Rafael Diaz (1998) notes that familismo can be a strong factor in helping heterosexual Latinos reduce rates of unprotected sex with casual partners outside of primary relationships. He warns, however, that for many Latino men who have sex with men, familismo and homophobia can create confl ict because families may perceive homosexuality as wrong. Rebellion against the native culture may be expressed through sexual behavior (Sanchez, 1997). Traditional Latinos tend to place a high value on female virginity while encouraging males, beginning in adolescence, to be sexually active (Guerrero Pavich, 1986). Females are viewed according to a virgin/whore dichotomy—“good” girls are virgins and “bad” girls are sexual (Espín, 1984). Females are taught to put the needs of others, especially males, before their own. Among traditional Latinos, fears about American “sexual immorality” produce their own stereotypes of Anglos.

In studying Latino sexuality, it is important to remember that Latinos come from diverse ethnic groups, including Mexican American, Cuban American, and Puerto Rican, each with its own unique background and set of cultural values.

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Adolescent boys learn about masturbation from peers; girls rarely learn about it because of its tabooed nature. Th ere is little acceptance of gay men and lesbian women, whose relationships are often regarded as “unnatural” or sinful (Bonilla & Porter, 1990; Raff aelli & Ontai, 2004). In traditional Latino culture, Catholicism plays an important role, especially in the realm of sexuality. Th e Church advocates premarital virginity and prohibits both contraception and abortion. Th ree important factors must be considered when Latino sexuality is studied: (1) diversity of ethnic groups, (2) signifi cance of socioeconomic status, and (3) acculturation. Latinos comprise numerous ethnic subgroups, such as Mex- ican American and Puerto Rican. Each group has its own unique background and set of cultural traditions that aff ect sexual attitudes and behaviors. Given the high rate of immigration of Latinos into the United States, par- ticular research attention has been given to examining the impact of accultura- tion. For example, studies have addressed the relationship between acculturation and sexual risk behavior. Research has examined the personal and family confl ict caused by the traditional Latino values and the progressive sexual values in the United States, and whether acculturation results in liberality among Latinos. For example, one study of college students found that Latinos who had greater iden- tifi cation with mainstream culture had more liberal sexual attitudes than those who had less identifi cation with mainstream culture (Ahrold & Meston, 2010).

Asian Americans and Pacifi c Islanders

Asian Americans and Pacifi c Islanders represent one of the fastest-growing and most diverse populations in the United States. Signifi cant diff erences in atti- tudes, values, and practices in this population make it diffi cult to generalize about these groups without stereotyping and oversimplifying. Given this caveat, we can say that many Asian Americans are less individualistic and more rela- tionship oriented than members of other cultures. Individuals are seen as the products of their relationships to nature and other people (Shon & Ja, 1982). Asian Americans are less verbal and expressive in their interactions and often rely on indirection and nonverbal communication, such as silence and avoid- ance of eye contact as signs of respect. In traditional Chinese culture, the in-laws of a married woman were responsible for safeguarding her chastity and keeping her under the ultimate control of her spouse. Where extended families worked and lived in close quarters for extended periods, many spouses found it diffi cult to experience intimacy with each other. As in other Asian American populations, the rate of cross-cultural marriage among younger Chinese Americans is higher than in their parents’ and grandparents’ gen- erations. Still, Confucian principles, which teach women to be obedient to their spouse’s wishes and attentive to their needs and to be sexually loyal, play a part in maintaining exclusivity and holding down the divorce rate among traditional Chi- nese families (Ishii-Kuntz, 1997). In contrast, men are expected to be sexually experienced, and their engagement in nonmarital sex is frequently accepted. For more than a century, Japanese Americans have maintained a signifi cant presence in the United States. Japanese cultural values of loyalty and harmony are strongly embedded in Confucianism and feudalism (loyalty to the ruler), yet Japanese lives are not strongly infl uenced by religion (Ishii-Kuntz, 1997). Like Chinese Americans born in the United States, Japanese Americans born in the United States base partner selection more on love and individual com- patibility than on family concerns (Nakano, 1990).

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Ethnicity and Sexuality • 63

Traditional Japanese values allowed sexual freedom for men but not for women. Traditionally, Japanese women were expected to remain pure; sexual permissiveness or nonexclusiveness on the part of women was considered socially disruptive and threatening (Ishii-Kuntz, 1997). Over time, attitudes and condi- tions related to sexuality have changed so that sexual activity is no longer con- sidered solely procreational, and there is increased use of contraceptives. As with other groups, the degree of acculturation may be the most important factor aff ecting sexual attitudes and behaviors of Asian Americans. Compared with those who were raised in the United States, those who were born and raised in their original homeland tend to adhere more closely to their culture’s norms, customs, and values. Further, a research study of Asian women attend- ing a large Canadian university found that those who maintained affi liation with traditional Asian heritage became less acculturated with the more liberal, Western sexuality–related attitudes (Brotto, Chik, Ryder, Gorzalka, & Seal, 2005). Th is fi nding was verifi ed in a study at a southern U.S. university in which students with less identifi cation with their heritage culture had sexual attitudes similar to those of Euro-Americans (Ahrold & Meston, 2010). Researcher and psychologist Sumie Okazaki (2002) reviewed the scientifi c lit- erature concerning several aspects of Asian Americans’ sexuality: sexual knowledge, attitudes, norms, and behavior. Okazaki reports that she found notable diff erences in several sexuality-related areas between Asian Americans and other ethnic groups:

For example, relative to other U.S. ethnic group cohorts, Asian American adoles- cents and young adults tend to show more sexually conservative attitudes and behavior and initiate intercourse at a later age. Th ere are indications that as Asian Americans become more acculturated to the mainstream American culture, their attitudes and behavior become more consistent with the White American norm. Consistent with their more sexually conservative tendencies in normative sexual behavior, Asian American women also appear more reluctant to obtain sexual and reproductive health care, which in turn places them at greater risk for delay in treatment for breast and cervical cancer as well as other gynecological problems.

Among Asian Americans (as with other ethnic groups), attitudes toward relationships, family, and sexuality are related to the degree of acculturation.

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64 • Chapter 2 Studying Human Sexuality

As in other areas of social science research, there are gaps concerning the sexuality of Asian Americans and other racial and ethnic groups. Obviously, more empirical work is needed.

Middle Eastern Americans

Th ere is a scarcity of research on the sexuality of Middle Eastern Americans, espe- cially as it concerns women who have migrated from parts of the middle east (Rashidian, 2010). Furthermore, other than in the context of heterosexual relation- ships, research is almost nonexistent in the areas of sexual expression and sexual orientation. Wide historical contexts—cultural and ideological—of gender and gen- der bias suggest that the patriarchal system in place helps to perpetuate some of the struggles that many Middle Eastern women face when they arrive here (Ebadi & Moaveni, 2006). At the same time, it is known that many Middle Eastern immigrants have a poor understanding about sexuality-related topics (Khan & Khanum, 2000). For example, given that traditional beliefs dictate that women should not learn about sexual relationships until marriage, more often than not their primary source of sexuality, besides the media, comes from married friends. In the case of Iranian American women, culture has been a major factor in the construction of women’s sexual self, gender role, gender identity, and knowl- edge about sex. However, many of the messages received regarding their roles as women have been confusing and have resulted in a sense of self-worthlessness (Rashidian, 2010). Gender, birth order, family honor, religion, and traditional cultural values are all highly regarded and are often associated with lower status of women, male dominance, and discrimination against women. Obedience and fear of reprisal often help to sustain many of the related practices.

With increasing numbers of immigrants moving from other countries to the United States, it is important that American professionals be knowledgeable about the signifi cance of culture and gender role in the immigrant community. Research, sexuality education, and counseling need to take into consideration an awareness of individuals’ sexual beliefs; attempt to understand their current view of themselves as individuals, their values, and the presence and types of interpersonal relationships that exist in their lives; and ascertain their level of communication skills related to sexual topics (Rashidian, 2010).

Men do not seek truth. It is the truth that pursues men who run away and will not

look around.

—Lincoln Steff ens (1866–1936)

“

Popular culture surrounds us with sexual images, disseminated through advertising, music, television, fi lm, video games, and the Internet, that form a backdrop to our daily living. Much of what is conveyed is simplifi ed, overgeneralized, stereotypical, shallow, sometimes misinterpreted—and entertaining. Studying sexuality enables us to understand how research is conducted and to be aware of its strengths and its limitations. Traditional sex research has been expanded in recent years by feminist, gay, lesbian, bisexual, and transgender research, which provides fresh insights and perspectives. Although the study of sexuality and ethnicity has yet to reach its full potential, it promises to enlarge our understanding of the diversity of attitudes, behaviors, and values in contemporary America.

Final Thoughts

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Summary • 65

Summary Sex, Advice Columnists, and Pop Psychology

■ Th e sex information/advice genre transmits informa- tion to both entertain and inform; the information is generally oversimplifi ed and sometimes distorted so that it does not interfere with the genre’s primary purpose, entertainment. Much of the information or advice conveys dominant social norms.

Thinking Critically About Sexuality

■ Objective statements are based on observations of things as they exist in themselves. Value judgments are evaluations based on moral or ethical standards. Opinions are unsubstantiated beliefs based on an in- dividual’s personal thoughts. Biases are personal lean- ings or inclinations. Stereotypes—rigidly held beliefs about the personal characteristics of a group of people—are a type of schema, which is the organiza- tion of knowledge in our thought processes.

■ Fallacies are errors in reasoning. Th e egocentric fallacy is the belief that others necessarily share one’s own values, beliefs, and attitudes. Th e ethnocentric fallacy is the belief that one’s own ethnic group, nation, or culture is inherently superior to any other.

Sex Research Methods

■ Ethical issues are important concerns in sex research. Th e most important issues are informed consent, pro- tection from harm, and confi dentiality.

■ In sex research, sampling is a particularly acute prob- lem. To be meaningful, samples should be represen- tative of the larger group from which they are drawn. But most samples are limited by volunteer bias, de- pendence on college students, underrepresentation of ethnic groups, and diffi culties in sampling gay men and lesbian women.

■ Th e most important methods in sex research are clin- ical, survey, observational, and experimental. Clinical research relies on in-depth examinations of individu- als or groups who come to the clinician seeking treat- ment for psychological or medical problems. Survey research uses questionnaires, interviews, or diaries, for example, to gather information from a representative sample of people. Observational research requires the researcher to observe interactions carefully in as un- obtrusive a manner as possible. Experimental research presents subjects with various stimuli under con-

trolled conditions in which their responses can be measured.

■ Experiments are controlled through the use of inde- pendent variables (which can be changed by the ex- perimenter) and dependent variables (which change in relation to changes in the independent variable). Clinical, survey, and observational research eff orts, in contrast, are correlational studies that reveal rela- tionships between variables without manipulating them. In experimental research, physiological re- sponses are often measured by a plethysmograph, strain gauge, or Rigiscantm.

The Sex Researchers

■ Richard von Kraff t-Ebing was one of the earliest sex researchers. His work emphasized the pathological aspects of sexuality.

■ Sigmund Freud was one of the most infl uential think- ers in Western civilization. Freud believed there were fi ve stages in psychosexual development: the oral stage, anal stage, phallic stage, latency stage, and genital stage.

■ Havelock Ellis was the fi rst modern sexual theorist and scholar. His ideas included the relativity of sexual values, the normality of masturbation, a belief in the sexual equality of men and women, the redefi nition of “normal,” and a reevaluation of homosexuality.

■ Alfred Kinsey’s work documented enormous diversity in sexual behavior, emphasized the role of masturba- tion in sexual development, and argued that the dis- tinction between normal and abnormal behavior was meaningless. Th e Kinsey scale charts sexual behaviors along a continuum ranging from exclusively other- sex behaviors to exclusively same-sex behaviors.

■ William Masters and Virginia Johnson detailed the physiology of the human sexual response cycle. Th eir physiological studies revealed the similarity between male and female sexual responses and demonstrated that women achieve orgasm through clitoral stimula- tion. Th eir work on sexual inadequacy revolutionized sex therapy through the use of behavioral techniques.

Contemporary Research Studies

■ Th e National Health and Social Life Survey (NHSLS) in 1994 was the fi rst nationally representa- tive survey of Americans’ sexual behavior, and its

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66 • Chapter 2 Studying Human Sexuality

fi ndings contradicted many prior fi ndings and be- liefs about sex in America.

■ Th e National Survey of Family Growth (NSFG) is a periodic survey that collects data related to marriage, divorce, contraception, infertility, and the health of women and infants in the United States. A 2005 NSFG is one of the most recent comprehensive sur- veys of the prevalence of certain sexual behaviors in the general population.

■ Th e Youth Risk Behavior Study (YRBS) is a large, national, school-based study of the health behaviors of adolescents. Behaviors related to sexuality and risk taking are assessed.

■ Th e American College Health Association National College Health Assessment has conducted research on campuses throughout the United States since 2000 to determine students’ health and sexual behaviors.

■ Th e National Survey of Sexual Health and Behavior (NSSHB), conducted in 2010, was a nationally rep- resentative Internet study of adolescents and adults aged 14–95, an age range much greater than in other studies. Th e NSSHB provided an update on Americans’ sexual behavior, showing an increase in sexual diversity since the NHSLS.

Emerging Research Perspectives

■ Th ere is no single feminist perspective in sex research. ■ Most feminist research focuses on gender issues,

assumes that the female experience of sex has been devalued, believes that power is a critical element in female-male relationships, and explores ethnic diversity.

■ Research on homosexuality has rejected the moralistic- pathological approach. Researchers in gay and lesbian issues include Karl Ulrichs, Karl Kertbeny, Magnus Hirschfeld, Evelyn Hooker, and Michel Foucault.

■ Contemporary gay, lesbian, bisexual, and transgen- der research focuses on the psychological and social experience of being other than heterosexual.

Ethnicity and Sexuality

■ Th e role of ethnicity in human sexuality has been largely overlooked until recently.

■ Socioeconomic status is important in the study of African American sexuality. Other factors to consider include the stereotype of Blacks as hypersexual and “promiscuous,” and racism.

■ Two common stereotypes about Latinos are that they are sexually permissive and that Latino males

are pathologically macho. Factors to consider in studying Latino sexuality include the diversity of national groups, the role of socioeconomic status, and the degree of acculturation.

■ Signifi cant diff erences in attitudes, values, and prac- tices make it diffi cult to generalize about Asian Americans and Pacifi c Islanders. Degree of accultur- ation and adherence to traditional Asian heritage are important factors aff ecting sexual attitudes and be- haviors. Religious and cultural values still play an important role in the lives of many Asian Americans and Pacifi c Islanders. Little research has been con- ducted on the sexuality of Middle Eastern Ameri- cans, yet it is known that many immigrants from the Middle East have a poor understanding about sexuality-related topics.

Questions for Discussion ■ Is sex research valuable or necessary? If you

feel that it is, what areas of sexuality do you think need special attention? Which, if any, areas of sexuality should be prohibited from being researched?

■ Alfred Kinsey was, and continues to be, criticized for his research. Some people even believe that he was responsible for eroding sexual morality. Do you think his research was valuable, or that it led to the sexual revolution in the United States, as many people claim?

■ Would you volunteer for a sexual research study? Why or why not? If so, what kind of study?

Sex and the Internet The Kinsey Institute for Research in Sex, Gender, and Reproduction Few centers that conduct research exclusively on sexuality exist in the world. One of the most respected and well-known centers is The Kinsey Institute for Research in Sex, Gender, and Reproduction (KI) at Indi- ana University, Bloomington. The institute bears the name of its founder, Alfred C. Kinsey, whose research was described earlier in this chapter. Visit the institute’s

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Suggested Reading • 595

Suggested Websites Feminist Majority Foundation http://www.feminist.org Discusses its latest projects and gives information about feminist issues.

Human Rights Campaign http://www.hrc.org Off ers the latest information on political issues aff ecting lesbian, gay, bisexual, and transgender Americans.

Movement Advancement Project http://www.lgbtmap.org An independent think tank that provides research, insight, and analyses that help expedite equality for lesbian, gay, bisexual, and transgender people.

National Coalition Against Domestic Violence http://www.ncadv.org Provides information about domestic violence and suggestions for getting help.

National Sexual Violence Resource Center http://www.nsvrc.org A project of the Pennsylvania Coalition Against Rape; is a resource for information about rape and links to other sites.

U.S. Department of Justice, Bureau of Justice Statistics http://www.ojp.usdoj.gov/bjs Gives statistics and information on legal and enforcement issues related to victimization crime, as well as press releases.

U.S. Equal Employment Opportunity Commission http://www.eeoc.gov Provides information on federal laws prohibiting job discrimina- tion and gives directions for fi ling a charge.

confi dential counseling and support 24 hours a day. I also has an information-fi lled website: http://www .rainn.org. Go to the RAINN site and answer the following questions:

■ What type of information is provided? ■ What are some of the RAINN highlights? ■ What is in the “Latest News” section? ■ What types of programs and events does RAINN

off er?

■ How can one support or volunteer for RAINN?

Suggested Reading Bass, E., & Davis, L. (2008).Th e courage to heal (4th ed.). New

York: HarperCollins. A comprehensive guide that weaves together personal experience and professional knowledge to assist survivors of sexual abuse.

Fetner, T. (2008). How the religious right shaped lesbian and gay activism. Minneapolis: University of Minnesota Press. Descriptions of the two movements are signifi cantly shaped by their rivals.

Koenig, L. J., Doll, L. S., O’Leary, A., & Pequegnat, W. (Eds.). (2004). From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention. Washington, DC: American Psychological Association. Examines the relation between child sexual abuse and adult sexual health outcomes in men and women.

Lalumière, M. L., Harris, G. T., Quinsey, V. L., & Rice, M. E. (2005). Th e causes of rape: Understanding individual male propensity for sexual aggression. Washington, DC: American Psychological Association. Examines why some men are prone to rape, off ers probable causes for this inclination, and provides a comprehensive review of scientifi c studies of coercive sex.

Maltz, W. (2001). Th e sexual healing journey. New York: HarperCollins. A comprehensive guide designed to help survivors of sexual abuse improve their relationships and discover the joys of sexual intimacy.

Reddington, F. P., & Kreisel, B. W. (2009). Sexual assault: Th e victims, the perpetrators, and the criminal justice system. Durham, NC: Carolina Academic Press. A discussion of the legal aspects of victimization and other topics such as rape myths, male victims, and perpetrators. Great reference for clinics, survivors, and families.

Sandy, P. R. (2007). Fraternity gang rape: Sex, brotherhood, and privilege on campus. New York: New York University Press. Discusses the nature of fraternity gang rape and how Greek life in general contributes to a culture that promotes the exploitation of women on college campuses.

Schewe, P. A. (2002). Preventing violence in relationships: Interventions across the lifespan. Washington, DC: American Psychological Association. Focuses on building healthy relationships and preventing family violence.

Temkin, J., & Krahe, B. (2008). How ignorance perpetuates sexual assault myths, abuse, and injustice. Portland, OR: Hart Publishing. A concise and detailed discussion of the justice gap, the gap between the number of off enses recorded by the police and the number of convictions.

For links, articles, and study material, go to the McGraw-Hill website, located at

www.mhhe.com/yarber8e.

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http://www.feminist.org

http://www.hrc.org

http://www.lgbtmap.org

http://www.ncadv.org

http://www.nsvrc.org

http://www.ojp.usdoj.gov/bjs

http://www.eeoc.gov

http://www.rainn.org

www.mhhe.com/yarber8e

18 ch

ap te

Sexually Explicit Materials, Prostitution, and Sex Laws

M A I N T O P I C S

Sexually Explicit Material in Contemporary America 597

Prostitution 610

Sexuality and the Law 620

596

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Sexually Explicit Material in Contemporary America • 597

Money and sex are bound together in the production and sale of sexually explicit material and in prostitution. Money is exchanged for sexual images or descriptions contained in fi lms, electronic media, magazines, books, music, and photographs that depict people in explicit or suggestive sexual activ- ities. Money is also exchanged for sexual services provided by streetwalkers, call girls, escorts, massage parlor workers, and other sex workers. Th e sex industry is a multibillion-dollar enterprise with countless millions of consumers and cus- tomers. As a nation, however, we feel ambivalent about sexually explicit material and prostitution. Many people condemn it as harmful, immoral, and exploit- ative and wish to censor or eliminate it. Others see it as a harmless and even benefi cial activity, an erotic diversion, or an aspect of society that cannot (or should not) be regulated; they believe censorship and police action do greater harm than good. In this chapter, we examine sexually explicit material, including depic- tions of sex in popular culture, the role of technology in the distribution of sexually explicit material, the effects of sexually explicit material, and censorship issues. We then examine prostitution, focusing on females and males working in the sex industry, the legal issues involved, and the impact of HIV and other STIs. We then discuss current laws dealing with private, consensual sexual behavior among adults and end the chapter with gay marriage.

• Sexually Explicit Material in Contemporary America Studying sexually explicit material objectively is diffi cult because such material often triggers deep and confl icting feelings we have about sexuality. Many people enjoy sexually explicit material, others fi nd it degrading, and still others may simultaneously feel aroused and guilty.

Since the human body is perfect in all forms, we cannot see it often enough.

—Kenneth Clark (1903–1983)

“

Obscenity is best left to the minds of man. What’s obscene to one may not

off end another.

—William O. Douglas (1898–1980)

“

Student Voices

this would be a fan- tastic way for me to become a ‘man.’ I felt embarrassed, dirty, and ashamed of myself.”

—24-year-old male

“She (my aunt) actu- ally started molest- ing me when I was six. She would come home late at night, drunk, and carry me into her bed so that she could perform oral sex on me. She mo- lested me until I was twelve years old. She was a prostitute, so later in my molestation she tried to include her tricks, but I cried my way out of it every time.”

—26-year-old female

“My boyfriend and I sometimes use X-rated movies while we have sex. We have learned some new techniques from them, and they really help us get turned on. Some of our friends had recommended that we get them. At fi rst, we were a little hesi- tant to use them, but now watching the movies has become a regular part of our sex. But I wonder if something is wrong with us having to use the movies. And, at times, I still feel un- comfortable using them. I sure haven’t told any of my friends about them.”

—21-year-old female

“I was only sixteen when I traveled to Peru with Carlos, who was twenty-nine. We were in Lima for two days, and while we were there, Carlos took me to a hotel so we could both have sex with prostitutes. At the time, I did not really understand what was happening until after it occurred. Carlos knew that I was a virgin and thought

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598 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

Pornography or Erotica: Which Is It?

As sexual themes, ideas, images, and music increasingly appear in art, literature, and popular culture, the boundaries blur between what is socially acceptable and what is considered erotic or obscene. Much of the discussion about sexu- ally explicit material concerns the question of whether such material is, in fact, erotic or pornographic—that is, whether viewing it causes positive or harmful outcomes. Unfortunately, there is a lack of agreement about what constitutes erotica or pornography. Part of the problem is that “erotica” and “pornography” are subjective terms, and the line separating them can be blurred. Erotica describes sexually explicit material that can be evaluated positively. (Th e word “erotica” is derived from the Greek erotikos, meaning “a love poem.”) It often involves mutuality, respect, aff ection, and a balance of power and may even be considered to have artistic value. Pornography represents sexually explicit material that is generally evaluated negatively and might include anything that depicts sexuality and causes sexual arousal in the viewer. (“Pornography” is a nineteenth-century word derived from the Greek porne, meaning “prostitute,” and graphos, meaning “depicting.”) Webster’s New World Collegiate Dictionary defi nes pornography as “writing, pictures, etc. intended to arouse sexual desire.” Sexually explicit materials are legal in the United States; however, materials that are considered to be obscene are not. Although the legal defi nition of obscenity varies, the term generally implies a personal or societal judgment that something is off ensive; it comes from the Latin word for “fi lth.” Often, material depicting the use of violence and aggression or degrading and dehu- manizing situations is deemed obscene. Because such a determination involves a judgment, critics often point to the subjective nature of this defi nition. (Obscenity and the law are discussed in detail later in the section.) Th e same sexually explicit material may evoke a variety of responses in dif- ferent people. “What I like is erotica, but what you like is pornography” may be a facetious statement, but it’s not entirely untrue. It has been found that people view others as more adversely aff ected than themselves by sexually explicit material. Judgments about sexually explicit material tend to be relative. Because of the tendency to use “erotica” as a positive term and “pornogra- phy” as a negative term, we will use the neutral term “sexually explicit material” whenever possible. Sexually explicit material (SEM) is material such as pho- tographs, videos, fi lms, magazines, and books whose primary themes, topics, or depictions involve sexuality that may cause sexual arousal; the genitals or intimate sexual behaviors typically are shown. Sometimes, however, the context of studies we are citing may require us to use either “erotica” or “pornography” rather than “sexually explicit material.” Th is is especially true if the studies use those terms or are clearly making a positive or negative evaluation.

Sexually Explicit Material and Popular Culture

In the nineteenth century, technology transformed the production of sexually explicit material. Cheap paper and large-scale printing, combined with mass literacy, created an enormous market for books and drawings, including sexu- ally explicit material. Today, technology is once again extending the forms in which this material is conveyed. In recent decades, sexually explicit material, especially soft-core (material that portrays sexual behaviors in a highly suggestive rather than an explicit way), has become an integral part of popular culture. In recent years, Playboy,

The diff erence between pornography and erotica is lighting.

—Gloria Leonard (1940–)

“

Obscenity is whatever happens to shock some elderly and ignorant magistrate.

—Bertrand Russell (1872–1970)

“

Perversity is the muse of modern literature.

—Susan Sontag (1933–2004)

“

How can you accuse me of liking pornography when I don’t even have a

pornograph?

—Groucho Marx (1890–1977)

“

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Sexually Explicit Material in Contemporary America • 599

Penthouse, and Hustler were among the most widely circulated magazines in America. Th e depiction of sexual activities is not restricted to books and mag- azines, however. Various establishments off er live entertainment. Bars, for example, feature nude dancers. Some clubs or adult entertainment establish- ments employ erotic dancers who expose themselves and simulate sexual behav- iors before their audience, and some even have “live sex shows.” Th e Internet, cable and satellite television sex channels, and DVD revolutions have been so great that homes have largely supplanted adult theaters or “porno” movie houses as sites for viewing sexually explicit fi lms. Th e sexually explicit material industry is big business in the United States, with an estimated revenue of several billion dollars annually (Dines, 2010). Th e availability of in-home sexually explicit fi lms and downloadable clips and fi lms on the Internet have had a profound eff ect on who views erotic fi lms. In the past, adult movie houses were the domain of men; relatively few women entered them. Most explicit DVDs or fi lms, as well as books and magazines, have been marketed to heterosexual men. However, in part because of the success of shows like Sex and the City and books like Fifty Shades of Grey, women are becoming the fastest-growing consumers of the adult entertainment and erotica including sexu- ally explicit materials and sex toys (Comella, 2008). But with erotic fi lms available for viewing in the privacy of the home, women and couples have become consumers of sexually explicit material. Th e inclusion of women in the audience has led to the produc- tion of femme porn, sexually explicit material catering to women and heterosexual couples. Compared to other types of porn, femme porn typically involves women in its produc- tion and has story lines that depict emotional intimacy and greater equality between the sexes, is less male centered, avoids violence, and is more sensitive to women’s erotic fantasies (Milne, 2005). Another group of sexually explicit fi lms is the educational “Good Sex Video Series” by the Sinclair Institute. Th ese videos feature a sex therapist’s commentary about varied sexual behaviors with a focus on enhancing individual and couple sexual expression.

Sexually Explicit Materials on the Internet

Searching for sexually explicit materials is the most common online sexual activity. Certainly, online sexual materials are one of the most profi table revenue generators on the Inter- net. (See Chapter 1 for further discussions of other ways the Internet provides and shapes our sexual culture.) A nonrandom survey of 15,246 respondents in the United States assessed the viewing of erotic materials and sex-seeking behaviors online (Albright, 2008). Th e results provide us with a snapshot of adult viewing of online erotica. Important fi ndings include:

■ 75% of men and 41% of women reported that they had intentionally viewed or downloaded erotic images or fi lms online.

■ A larger portion of women than men reported benefi ts related to improving sexual behavior with their current partner, such as being more open to new things (26% vs. 24%), making it easier to talk about what

Singer Adam Lambert kisses musician Tommy Fever during a musical performance, prompting debate amongst viewers about what kinds of public displays of aff ection are acceptable.

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600 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

they want (26% vs. 23%), and watching together to enhance arousal (19% vs. 16%).

■ Men, in contrast to women, were more likely to indicate a solitary benefi t: enhancing arousal when alone (16% vs. 14%).

■ Women more often than men reported that watching online pornography decreased the amount of sex they had (12% vs. 9%), that online pornography was likely to make their partner more critical of them (9% vs. 2%), and that porn led to a perception of pressure to perform (15% vs. 2%).

■ Men more often than women reported that online pornography lowered their interest in having sex (9% vs. 3%) and made them more critical of their partner’s body (8% vs. 2%).

Note that the diff erences in perceived outcome of watching online explicit materials was small when comparing men and women and that the prevalence of many outcomes, particularly negative ones, was low. A study of 6,054 Swiss youth aged 16–20 who had used the Internet during the previous month concluded that pornography exposure was not associated with sexual risk behaviors. Th e research also found no diff erences in sexual risk behaviors between those who were willingly versus unwillingly exposed to the erotic online images (Luder et al., 2011). For the most part, college students are in the age group—18 to 25 years—that has the greatest number of persons reporting having seen an X-rated movie in the last year (Buzzell, 2005). With the dramatic increase in computer technology and availability, college students have ample access to sexually explicit websites. Studies of college students help us understand the factors related to the preva- lence of sex site use by this population. Th e reason people utilize online pornography has been understudied. A study of 321 undergraduate male and female students assessed specifi c motiva- tions for Internet pornography use and how gender and erotophilia/erotophobia are associated with motivations (Paul & Shim, 2008). Four motivations for online viewing of erotic material were found: (1) to build or maintain a rela- tionship; (2) for mood management, such as to increase arousal or for enter- tainment; (3) out of habit; and (4) for the purpose of sexual fantasy—to feel as if they themselves were interacting with the actors in the sexual scenes. Males showed stronger motivations for viewing the pornography than females for all four of the motivations. Lastly, the more erotophilic students (who had more positive sexual attitudes) were more likely than the more erotophobic students to be motivated to use Internet pornography for all four motivations. A study published in 2008 that assessed the viewing of sexually explicit media, including the Internet, movies, and/or magazines, among college students from six colleges across the United States found a viewing gap by gender: 87% for men, 31% for women (Carroll et al., 2008). Another study of college students (from the northwestern U.S.) found that 92% of men and 50% of women reported having used SEM in their lifetime (Morgan, 2011). (For more information about the fi ndings of these two studies, see the “Th ink About It” box on page 602.)

Content and Themes Many of the themes found in sexually explicit material are also found in the mainstream media. Music videos, TV shows, and movies, for example, contain sexual scenes and innuendos and images of the subordina- tion of women. Th ey diff er primarily in their levels of explicitness.

“ The older one grows, the more one likes indecency.

—Virginia Woolf (1882–1941)

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Sexually Explicit Material in Contemporary America • 601

Many “mainstream” sexually explicit fi lms target a male, heterosexual audience and portray stereotypes of male sexuality: dominant men with huge, erect penises, able to “last long” and satisfy eager and acquiescent women who are driven mad by their sexual prowess. Th e major theme of the fi lms is “cookbook” sex; they show fellatio, cunnilingus, vaginal and anal sex, climax with the man ejaculating on the woman’s body, and the woman often faking an orgasm. Th e focus is typically on the physical beauty of the woman “star,” with threesomes (two women and one man) or group sex often featured. Th e male actors may not even be “good-looking” (Cassell, 2008; Paul, 2006). One criticism is that fi lms like these do not represent the unique individuality of sexual expression nor how women experience erotic fulfi llment. Very little focus is on relationships, emo- tional intimacy, nonsexual aspects of life, or the woman’s sexual satisfaction. Rarely are lovers shown massaging each other’s shoulders or whispering “I love you.” Nor do lovers ask each other questions such as “Is this OK?” or “What can I do to help you feel more pleasure?” (Castleman, 2004). Some sex therapists criticize these fi lms as reinforcing an unhealthy and unrealistic image of sexuality: that men are all-powerful and that women are submissive objects, deriving all sexual satisfaction from male domination. Gay and lesbian sexually explicit fi lms diff er somewhat from heterosexual- focused fi lms. Gay porn typically features attractive, young, muscular, “well- hung” men, and focuses on the eroticism of the male body. Lesbian-explicit fi lms usually depict realistic sexual interactions with a range of body types and both butch (notably masculine in manner or appearance) and femme styles. Sex between men is rarely shown in heterosexual fi lms, presumably because it would make heterosexual men uncomfortable. But heterosexual-focused fi lms may sometimes portray sex between women because many heterosexual men fi nd such depictions sexually arousing.

The performances of pop music artists are often highly sexual; Beyoncé Knowles uses sexuality as an integral theme in her videos and concerts, as do many pop music artists.

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602 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

think about it

Accessibility to and acceptability of sexually explicit materials (SEM) is becoming more widespread in our increasingly technological world. In contrast to the 1980s, when one would have to go to a store and ask for “porn” maga- zines (often located behind the counter) or visit an adult theater (located in a “seedy” part of town), young people today can easily access SEM on the Internet or on satellite television. Given the easy access to SEM, it is important to examine the prevalence, acceptance, and associations of SEM among young people. The major fi ndings of three studies of SEM and college students are presented here. Researchers at Indiana University used a study group of 245 college students to assess the eff ects of pornography from their perspective (Weinberg, Williams, Kleiner, & Irizarry, 2010). The study focused on determining if viewing pornography appeared to expand sexual horizons through normalization as well as en- hance willingness to try new sexual behaviors and relationships through empowerment. The qualitative data found that viewing pornography can expand the appeal and expression of a variety of sexual behaviors. That is, pornography’s profusion and dissemination of sexual scripts seems to have, for some people, a liberating impact. For example: there was an association be- tween the frequency of viewing pornography among heterosex- ual men and the appeal of vibrator use as sometimes depicted in pornography. The researchers concluded that, in general, the “fi ndings were consistent with our theoretical assumption.” They noted, however, that this normalization did not necessarily lead to desire or empowerment to engage in sex with partners outside the relationship.

College Students and the Viewing of Sexually Explicit Materials

Family life researcher Jason Carroll of Brigham Young University and his colleagues assessed pornography use among 813 men and women college students from six college sites across the United States (Carroll et al., 2008). Pornography was defi ned as media (such as Internet, movies, and/or magazines) portraying nudity and sexual behaviors used to increase or intended to increase sexual arousal. Here are some of their major fi ndings:

■ About two thirds of the men and one half of the women agreed that viewing pornography is an acceptable way to express one’s sexuality.

■ Nearly 9 in 10 of the men and nearly one third of the women reported using pornography. Nearly half of the men and only 3% of the women reported pornography use weekly or more often.

■ For men, signifi cant associations were found between use of pornography and greater number of lifetime sexual partners and higher acceptance of premarital, casual, and extramarital behaviors.

■ For women, higher acceptance and use of pornography was signifi cantly related to higher acceptance of casual sexual behavior, greater number of sexual partners in the past 12 months and lifetime, and alcohol use, binge drinking and cigarette use.

Psychology researcher Elizabeth Morgan of Boise State University examined how levels of SEM use during adolescence and young adulthood are related to sexual preferences, sexual

The Eff ects of Sexually Explicit Material

Th ere are a number of concerns about the eff ects of sexually explicit material. Beyond what was discussed in the prior section on the Internet and SEM, researchers have questions such as: Does SEM cause people to engage in “deviant” behavior? Is it a form of sex discrimination against women? And, fi nally, does it cause violence against women?

Sexual Expression People who read or view sexually explicit material usually recognize it as fantasy; they use it as a release from their everyday lives. Exposure to such material temporarily encourages sexual expression and may activate a person’s typical sexual behavior pattern or enhance experimentation. A study of a nationally representative sample of 398 Norwegian heterosexual couples aged 22–67 found that 15% of the couples had used pornography to enhance their sex lives and that these couples lived in a more permissive erotic climate compared to couples who did not use pornography (Daneback, Traeen, & Mansson, 2009).

“ Western man, especially the Western critic, still fi nds it very hard to go into

print and say: “I recommend you go and see this because it gave me an erection.”

—Kenneth Tynan (1927–1980)

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Sexually Explicit Material in Contemporary America • 603

behaviors, and sexual and relationship satisfaction among 782 college men and women from the northwestern region of the United States (Morgan, 2011). Viewing pornography was defi ned as intentionally looking at pictures of nude individuals, movies in which there are nude individuals, pictures or movies of people having sex, written or audio material that describes people having sex, or real-life nude individuals. Sex was defi ned as vaginal, anal, or oral penetration. Major fi ndings include:

■ Slightly over 9 in 10 young men and one half of young women reported ever having used various types of SEM.

■ Men participants were more likely to have used all types of SEM than women except sexually explicit books.

■ Women users were more likely to report viewing SEM with a dating partner, whereas men users were more likely to report viewing SEM alone, when not in a relationship, and when masturbating.

■ Higher frequency of SEM use and consuming a greater num- ber of SEM types was found to have signifi cant association with more sexual experience (i.e., higher number of sexual intercourse partners, higher number of casual partners, and lower age of fi rst intercourse).

■ Higher frequency of SEM use was associated with less sexual and relationship satisfaction.

■ The frequency of SEM use and number of types of SEM viewed were both associated with stronger sexual preferences for the types of sexual behaviors typically presented in the SEM.

Both of these studies were exploratory in nature. Given the relatively high prevalence of SEM use among college students, further studies of SEM use, such as longitudinal and experimental research, should be conducted. For example, does the viewing of SEM among young people for long periods of time cultivate unrealistic expectations in their own sexual expression with a

partner that could lead to pervasive dissatisfaction, or do most young adults recognize the diff erence between some SEM and real-life experiences? Further, the two studies reported here examined the association of SEM use with other variables such as frequency of sexual behaviors; cause and eff ect was not established. Exploring whether the sex-related attitudes, behaviors, and feelings precede or follow SEM use would be benefi cial (Morgan, 2011).

Think Critically 1. Do any of the fi ndings surprise you? If so, which ones

and why are they surprising? 2. After reading the fi ndings, do you feel more or less

accepting of SEM as a positive way of expressing your sexuality?

3. Do you believe that SEM use impacts college students’ sexual attitudes and behavior negatively (e.g., leads to unrealistic expectations) or positively (e.g., is a healthy way for a couple to learn new sex techniques that improved their relationship)? If no, why? If yes, why and how?

4. If you were presenting a lecture on SEM to college students, what are the most important messages you would convey?

SOURCES: Carroll, J. S., Padilla-Walker, L. M., Nelson, L. J., Olson, C. D., Barry, C. M., & Madsen, S. D. (2008). Pornography acceptance and use among emerging adults. Journal of Adolescent Health, 23, 6–30; Morgan, E. M. (2011). Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction. Journal of Sex Research, 48, 520–530; Weinberg, M. S., Williams, C. J., Kleiner, S., & Irizarry, Y. (2010). Pornography, normalization, and empowerment. Archives of Sexual Behavior, 39, 138–141.

Th e researchers concluded that for this sample of Norwegians, pornography was more of a solitary activity and was not part of the sexual script of most commit- ted lovers. To study the impact of early exposure to sexually explicit materials, 1,528 heterosexual Croatian men and women aged 18–25 were assessed. Research- ers found no signifi cant association between early exposure to pornography (at age 14) and high sexual compulsivity in late adolescence and young adulthood among either men or women (Stulhofer, Jelovica, & Ruzic, 2008). Sexually explicit material deals with fantasy sex, not sex as we know it in the context of human relationships. Th is sex usually takes place in a world in which people and situations are defi ned in exclusively sexual terms. People are stripped of their nonsexual connections. People are interested in sexually explicit material for a number of reasons. First, they enjoy the sexual sensations erotica arouses; it can be a source of intense pleasure. Masturbation or other sexual activities, pleasurable in them- selves, may accompany the use of SEM or follow it. Second, since the nineteenth

“ The only thing pornography has been known to cause is solitary masturbation.

—Gore Vidal (1925–)

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century, SEM has been a source of sexual information and knowledge. Eroticism generally is hidden from view and discussion. Because the erotic aspects of sexuality are rarely talked about, SEM can fi ll the void. Th ird, sexually explicit material, like fantasy, may provide an opportunity for people to rehearse sexual activities. Fourth, reading or viewing SEM to obtain pleasure or to enhance one’s fantasies or masturbatory experiences may be regarded as safer sex. Sex therapist Barbara Keesling (2006) states that she often recommends the use of sexually explicit materials to women who experience low sexual desire and sexual arousal problems. She notes that “women can sometimes learn to become more aroused by retraining themselves in the ability to feel physical arousal at the sight of sexually explicit images.” Keesling also states that since some women may “shut down” because of their belief that some sexually explicit material may be disgusting, they should try to fi nd material that is both accept- able and arousing to them. Men are cautioned that sexually explicit materials are typically all-genital and that such focus can cause problems in sexual expres- sion with others; they should not buy into the idea that sex should occur like it does in most adult fi lms. Medical writer Michael Castleman (2004) suggests the following for men, although his advice could also apply to women:

Stop trying to imitate what you see in pornography—the rushed, mechanical sex that’s entirely focused on the genitals. Instead, cultivate the opposite of porn: leisurely, playful, creative, whole-body, massage-based lovemaking that includes the genitals, but is not obsessed with them.

Sexual Aggression In 1970, the President’s Commission on Pornography and Obscenity concluded that pornography did not cause harm or violence. It

recommended that all legislation restricting adult access to it be repealed as inconsistent with the First Amendment.

In the 1980s, President Ronald Reagan estab- lished a new pornography commission under Attorney General Edwin Meese. In 1986, the Attorney General’s Commission on Pornography stated that “the most prevalent forms of pornog- raphy” were violent; it off ered no evidence, how- ever, to substantiate its assertion (U.S. Attorney General’s Commission on Pornography [AGCOP], 1986). Th ere is, in fact, no evidence that the majority of sexually explicit material is violent; actually, very little contains aggression, physical violence, or rape.

In the 1970s, feminists and others working to increase rape awareness began to call attention to the violence against women portrayed in the media. Th ey found rape themes in sexually explicit material especially disturbing, arguing that those images reinforced rape myths. Again, however, there is no evidence that nonviolent sexually explicit material is associated with actual sexual

aggression against women. Even the conservative commission on pornography agreed that nonviolent sexually explicit material had no such eff ect (AGCOP,

“ Whatever you choose, however many roads you travel, I hope that you choose

not to be a lady. I hope you will fi nd some way to break the rules and make a little trouble out there. And I also hope that you will choose to make some of that trouble on behalf of women.

—Nora Ephron (1941–2012)

Some contemporary video games have strong, suggestive sexual messages.

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Sexually Explicit Material in Contemporary America • 605

1986). It did assert that “some forms of sexually explicit materials bear a causal relationship . . . to sexual violence,” but it presented no scientifi c proof. Researchers have studied the relationship between violent sexually explicit material and aggression and negative attitudes toward women. Most studies have been experimental; that is, male college students were exposed to various media, and factors related to their attitudes about, for example, the rape of women were measured. In studying male responses to depictions of rape, researchers have found that realistic portrayals of rape tend not to be arousing to men and may actually produce negative emotional responses (Bauserman, 1998). Th is is in contrast to the responses that are elicited to “rape myths,” or unrealistic portrayals in fi lms in which women become aroused and participate willingly. In a national sample of men enrolled in postsecondary education, researchers reported that men having the highest levels of hostility, sexual “pro- miscuity,” and pornography use were the most likely to report a history of sexual aggression against women. But the researchers noted that we cannot conclude from this analysis that pornography use causes or is an outcome of aggressive sexual tendencies (Malamuth, Addison, & Koss, 2001). Sometimes, the consumption of sexually explicit fi lms and sexual assault are linked in the popular media, but with no evidence. An analysis of the trend of sexual assaults in the United States from 1995, when Internet pornography availability began to increase, to 2005 revealed a steady decline in the number of sexual assaults. Th e scientists who analyzed the trend of assaults concluded that “after a full decade of the easiest availability of every type of erotic, degrad- ing and violent pornographic material, no increase in rates of reported sexual assault was found” (Whitty & Fisher, 2008). A study of 1,023 Australian con- sumers of sexually explicit materials (in magazines, DVDs, novels, and the Inter- net) found no association between consumption of sexually explicit media and negative attitudes toward women (McKee, 2007). Contact with sexually explicit material is a self-regulated choice, and research on factors related to such self-directed behavior is very limited: “Existing fi nd- ings by and large fail to confi rm fears of strong antisocial eff ects of self-directed exposure to sexually explicit media” (Fisher & Barak, 2001). Despite some of these more recent fi ndings, whether violent sexually explicit material causes sexual aggression toward women remains a fractious issue.

Sex Discrimination Since the 1980s, feminists have been divided over the issue of sexually explicit material. One segment of the feminist movement, which iden- tifi es itself as antipornography, views sexually explicit material as inherently degrad- ing and dehumanizing to women. Many in this group believe that sexually explicit material provides the basis for women’s subordination by turning them into sex objects. Th ey argue that SEM inhibits women’s attainment of equal rights by encouraging the exploitation and subordination of women. Feminist and other critics of this approach point out that it has an antisexual bias that associates sex with exploitation. Sexually explicit images, rather than specifi cally sexist images, are singled out. Furthermore, discrimination against and the subordination of women in Western culture have existed since ancient times, long before the rise of sexually explicit material. Th e roots of subordina- tion lie far deeper. Th e elimination of sexual depictions of women would not alter discrimination against women signifi cantly, if at all. Sex researchers William Fisher and Clive Davis, in their review of research on the impact of sexually

“ My reaction to porno fi lms is as follows: After the fi rst ten minutes, I want to go

home and screw. After the fi rst twenty minutes, I never want to screw anything as long as I live.

—Erica Jong (1942–)

“ What’s wrong with appealing to prurient interests? We appeal to killing interest.

—Lenny Bruce (1925–1966)

“ Censorship can’t eliminate evil; it can only kill freedom.

—Garrison Keillor (1942–)

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explicit materials, state that sexual scientists are against any anti-woman attitudes and aggression that some people may fear would result from experience with pornography. Th ey suggest that remedies for such attitudes and behavior linked to pornography could be achieved through education, policies and laws, and social change, for example (Fisher & Davis, 2007). However, they also state:

Th e inconsistent evidence connecting pornography with harm would indicate that eff orts to fi ght pornography as a way of combating anti-woman attitudes and anti-woman aggression would not eff ectively bring about the sought-after result.

Leonore Tiefer (2004), clinical associate professor of psychiatry at the New York University School of Medicine and sex therapist who is a primary spokes- person for newer views of women’s sexuality, states that sexually explicit mate- rials can contribute to women’s sexual power. She notes that empowerment, not protection, is the path to sexual growth in women. Tiefer states that

if we accept that women’s sexuality has been shaped by ignorance and shame and is just beginning to fi nd new opportunities and voices for expression, then now is exactly the wrong time to even think about campaigns of suppression. Suppressing pornography will harm women struggling to develop their own sexualities.

Child Pornography Child pornography is a form of child sexual exploita- tion. Children used for the production of sexually explicit materials, who are usually between the ages of 6 and 16, are motivated by friendship, interest in sexuality, off ers of money, or threats. Younger children may be unaware that their photographs are being used sexually. A number of these children are related to the photographer. Many children who have been exploited in this way exhibit distress and poor adjustment; they may suff er from depression, anxiety, and guilt. Others engage in destructive and antisocial behavior. Digital cameras and smartphones with cameras, plus the ability to download photographs onto computers, have made this into what some call the “golden age of child pornography.” Children and teenagers have been reported taking pictures of each other and posting them on the Internet or sending them to each other, a practice called “sexting.” (See Chapter 1 for discussion of sexting.) Th e fact that the possession of such images is a crime does not deter people from placing or viewing them on the Internet. Laws governing obscenity and child pornography already exist and, for the most part, can be applied to cases involv- ing the Internet to adequately protect minors. Unlike some sexually explicit mate- rial, child pornography has been found to be patently off ensive and therefore not within the zone of protected free speech. Internet child pornography is common.

Censorship, Sexually Explicit Material, and the Law

To censor means to examine in order to suppress or delete anything considered objectionable. Censorship occurs when the government, private groups, or individuals impose their moral or political values on others by suppressing words, ideas, or images they deem off ensive. Obscenity, as noted previously, is the state of being contrary to generally accepted standards of decency or moral- ity. During the fi rst half of the twentieth century, under American obscenity laws, James Joyce’s Ulysses and the works of D. H. Lawrence were prohibited, Havelock Ellis’s Studies in the Psychology of Sex was banned, nude paintings were removed from gallery and museum walls, and everything but chaste kisses was banned from the movies for years.

“ Congress shall make no law . . . abridging the freedom of speech, or of

the press . . .

—First Amendment to the Constitution of the United States

“ A dirty book is seldom a dusty one.

—Anonymous

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Sexually Explicit Material in Contemporary America • 607

U.S. Supreme Court decisions in the 1950s and 1960s eliminated much of the legal framework supporting literary censorship on the national level. But censorship continues to fl ourish on the state and local levels, especially among schools and libraries. Th e women’s health book Th e New Our Bodies, Ourselves has been a frequent object of attack because of its feminist perspective and descriptions of lesbian sexuality. More recently, two children’s books have been added to the list of most censored books: Lesléa Newman’s Heather Has Two Mommies and Michael Willhoite’s Daddy’s Roommate. Both books have come under attack because they describe children in healthy lesbian couple and gay couple families. Judy Blume’s books for teenagers, J. D. Salinger’s Th e Catcher in the Rye, and the Sports Illustrated swimsuit issue are regular items on banned- publications lists. And exhibits of the photographs taken by the late Robert Mapplethorpe have been strenuously attacked by the more conservative groups for “promoting” homoeroticism.

Obscenity Laws Sexually explicit material itself is not illegal, but materials defi ned as legally obscene are. It is diffi cult to arrive at a legal defi nition of obscenity for determining whether a specifi c illustration, photograph, novel, or fi lm is obscene. Traditionally, U.S. courts have considered material obscene if it tended to corrupt or deprave its user. Over the years, the law has been debated in a number of court cases. Th is process has resulted in a set of crite- ria for determining what is obscene:

■ Th e dominant theme of the work must appeal to prurient sexual inter- ests and portray sexual conduct in a patently off ensive way.

■ Taken as a whole, the work must be without serious literary, artistic, political, or scientifi c value.

■ A “reasonable” person must fi nd the work, when taken as a whole, to possess no social value.

“ If a man is pictured chopping off a woman’s breast, it only gets an “R”

rating; but if, God forbid, a man is pictured kissing a woman’s breast, it gets an “X” rating. Why is violence more acceptable than tenderness?

—Sally Struthers (1948–)

Two of the most heavily censored books in America are Lesléa Newman’s Heather Has Two Mommies and Michael Willhoite’s Daddy’s Roommate (shown here). These books are opposed because they depict a lesbian couple family and a gay couple family, respectively.

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Th e problem with these criteria, as well as the earlier standards, is that they are highly subjective. For example, who is a reasonable person? Most of us would probably fi nd that a reasonable person has opinions regarding obscenity that closely resemble our own. (Otherwise, we would think that he or she was unreasonable.) However, there are many instances in which “reasonable people” disagree about whether material has social value. In 1969, the U.S. Supreme Court ruled, in Stanley v. Georgia, that private possession of obscene material in one’s home is not illegal (Sears, 1989). Th is does not, however, apply to child pornography. As we saw earlier, our evaluation of sexually explicit material is closely related to how we feel about such material. Our judgments are based not on reason but on emotion. Justice Potter Stewart’s exasperation in Jacobelis v. Ohio (1965) reveals a reasonable person’s frustration in trying to defi ne pornography: “But I know it when I see it.”

The Issue of Child Protection In 1988, the United States passed the Child Protection and Obscenity Enforcement Act, which supports stiff penalties for individuals involved in the production, distribution, and possession of child pornography. Since then, the development and distribution of child pornogra- phy, as well as minors’ access to online pornography, has been the focus of the U.S. Congress, resulting in the passing of numerous legislative acts. As you can see in Table 18.1, the bills have most often been turned down by the courts, usually based on protection of free speech; however, there have been a few instances of the courts upholding the law. Th e Communications and Decency Act of 1996 tried to address the prob- lem of sexual exploitation of children and teens over the Internet by making it a crime to send obscene or indecent messages to minors via e-mail, chat rooms, and websites (Biskupic, 2004). In 1997, the U.S. Supreme Court ruled that the statute was not constitutional because it violated the First Amend- ment’s guarantee of free speech. In two subsequent rulings, the Court rejected the law that made it a crime to send an indecent message online to a person under age 18 and the ban on computer-generated “virtual” child pornography and other fake images of sex, saying that the law could have banned works of art (Biskupic, 2002, 2003a, 2004). However, in 2008, the U.S. Supreme Court upheld the Child Obscenity and Pornography Act of 2003, a law that made it a crime to produce or possess sexually explicit images of children as well as to “pander” to willing audiences through advertising, presenting, dis- tributing, or soliciting such material. Th e 2003 law applies even if the mate- rial consists solely of computer-generated images or digitally altered photographs of adults, and even if the off er of material is fraudulent (e.g., the material does not exist) (Greenhouse, 2008; Mears, 2008). Justice Antonin Scalia, writing for the majority, noted, “Off ers to provide and obtain child pornography are categorically excluded from the First Amendment” (quoted in Greenhouse, 2008). Free-speech proponents question whether mainstream movies or inno- cent photographs of babies and young children, for example, might now be subject to prosecution. Another law intended to keep adult material away from Net-surfi ng children is the Child Online Protection Act (COPA). Passed in 1998, it sought to require Internet users to give an adult ID before accessing a commercial site containing “adult” materials (Miller, 2000). Th e law has been blocked twice by the U.S. Supreme Court. Table 18.1 provides a summary of congressional

“ I would like to see an end to all obscenity laws in my lifetime. I don’t know that it

will happen, but it’s my goal. If I can leave any kind of legacy at all, it will be that I helped expand the parameters of free speech.

—Larry Flynt (1942–)

“ To slurp or not to slurp at the fountain of fi lth is a decision to which each of us is

entitled.

—Stephen Kessler

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Sexually Explicit Material in Contemporary America • 609

eff orts to protect children from online pornography and subsequent court rul- ings. In its 2004 ruling, the U.S. Supreme Court stated that the use of fi ltering software on home computers might be the best method of shielding children from pornography while preserving the rights of adults. Justice Kennedy wrote for the majority, stating that the Court presumes that any government attempts to limit explicit materials on the web are unconstitutional (Biskupic, 2004). In 2007, COPA was again struck down. A U.S. district court judge ruled that the defendant (the federal government) had failed to show that COPA is the least restrictive, most eff ective alternative in achieving the goal of shielding minors from online pornography and that COPA is impermissibly vague and over- broad. Th e judge also noted that “perhaps we do the minors harm if First Amendment protections, which they will inherit fully, are chipped away in the name of their protection” (U.S. District Court, Eastern District of Pennsylvania, 2007). In January 2009, COPA ended more than a decade after Congress had approved it. Th e U.S. Supreme Court rejected the government’s fi nal eff ort to revive the law by turning away the appeal without comment (“Internet pornog- raphy law dies quietly in Supreme Court,” 2009). With millions of children accessing the Internet from home, serious ques- tions must be asked about their access to certain kinds of information, pic- tures, graphics, videos, animation, and interactive experiences. Government censorship, academic freedom, constitutionally protected speech, child safety concerns, public health dilemmas—these and other troublesome issues are at the core of the Internet–free-speech debate. Our inability to fi nd criteria for objectively defi ning obscenity makes it potentially dangerous to censor such material. We may end up using our own personal standards to restrict speech otherwise guaranteed by the First Amend- ment. By enforcing our own biases, we could endanger the freedom of others.

“ Murder is a crime. Describing murder is not. Sex is not a crime. Describing sex is.

—Bill Margold (1943–)

“ I may disagree with what you say but I will defend to the death your right to

say it.

—Voltaire (1694–1778)

SOURCE: Adapted from “Congress’ Attempts at Limits Have Faced Several Obstacles,” USA Today, June 30, 2004, p. 6A (Years 1996–2004). Reprinted with permission.

TABLE 18.1 • Congressional Eff orts to Protect Children From Online Pornography and Court Rulings

1996 The Communications Decency Act is passed by Congress, banning the posting or sending of obscene or indecent messages on the Internet to persons under age 18.

1998 The Child Online Protection Act (COPA) is passed by Congress, targeting material “harmful to minors” only on commercial websites. The age of those protected is lowered to under 17. COPA is challenged by the American Civil Liberties Union and online publishers on the grounds that it violates free-speech rights.

1999 The Communications Decency Act is rejected by the U.S. Supreme Court, calling it too vague and broad.

2000 COPA is struck down by a U.S. appeals court citing the statute’s attempt to set “community standards” for the Internet. COPA defi ned materials that should be banned as those that “the average person, applying contemporary community standards, would fi nd . . . designed to appeal to . . . the prurient interest.”

2002 The Supreme Court rules that the use of community standards does not, by itself, make COPA too broad.

2003 A U.S. appeals court again rejects COPA, saying that the law is not the least restrictive way the government can shield minors from online porn.

2004 COPA is not permitted to take eff ect by ruling of the U.S. Supreme Court. The justices suggest that the law is likely unconstitutional and that software computer fi lters may be a less restrictive way to screen sexually explicit materials. The statute is sent back to a lower court.

2007 U.S. district court judge issues a permanent injunction against COPA, stating that it violates the First and Fifth Amendments of the U.S. Constitution. The federal government appeals the ruling.

2009 COPA ends as the U.S. Supreme Court turns away the government’s fi nal attempt to revive the law.

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• Prostitution Th e exchange of sexual behaviors such as intercourse, fellatio, anal intercourse, discipline and bondage, and obscene insults, for money and/or goods, is called prostitution. More recently, instead of the term “prostitute,” the terms “sex worker” and “commercial sex worker” have often been used, particularly by prostitutes, to identify themselves and other work in the “sex industry” they might do such as phone sex, exotic dancing, Internet sex, and acting in sexu- ally explicit fi lms. Many individuals who enter prostitution do so for monetary gains; hence, prostitution can represent a form of work. However, given that some research shows negative aspects of prostitution and that some prostitutes are coerced by a third party, some feminists are uncomfortable with connoting prostitution as a type of sex work and are hesitant to “celebrate the existence of a market for commoditized sex” (Davidson, 2002). We have decided to use the term “prostitution/prostitute,” to distinguish it from other types of “sex work.” Yet, we recognize that “sex work” is a preferred term by many prosti- tutes and is becoming more frequently used to describe prostitution. Boys and girls as well as men and women, including transvestites and trans- sexuals, work as prostitutes. By far the most common form of prostitution is women selling sex to men. Th e second most common is male prostitutes mak- ing themselves available to men. Less common is males selling sex to females. Prostitution between two women is rare. A growing international market of child sex slaves has fueled the economies of developing countries and spawned a multibillion-dollar industry commonly referred to as “sex travel” (see the “Th ink About It” box on page 612). Male customers of female prostitutes, called “johns,” represent a wide range of occupations, ethnicities, ages, and marital statuses. Although the seeking of prostitution is often considered a natural part of the masculine sexual experi- ence, research has shown that most men do not seek prostitutes and very few are regular customers (Monto, 2004). Men go to prostitutes for many reasons. Some want to experience a certain sexual behavior that their partner is unwill- ing to try, or they may not have a regular partner. Some desire to have sex with someone having a certain image, such as sexy or very athletic looking, and some customers fi nd that the illicit nature of being with a prostitute is attractive. Some like the anonymity of being sexual with a prostitute: No courting is required, there are no postsex expectations, and it is less entangling than having an aff air. Some men with very active sex lives simply want more sexual partners. Nonsexual reasons, such as companionship, sympathy, and friendship, can also be motives for seeking prostitutes. Finally, some young men go to a prostitute as their fi rst sexual experience (Bernstein, 2001; Brents, Jackson, & Hausbeck, 2010; Jordon, 1997; Monto, 2004; Xantidis & McCabe, 2000). Curiously, a study of 140 men from large cities in the Midwest and on the West Coast who have used prostitutes found that 6 in 10 men were currently in a sexual relationship, only one third reported that they enjoyed sex with a female prostitute, and 57% reported that they had tried to stop using prostitutes. Th e study also found that the common impression that men seek prostitutes when sexually dissatisfi ed with marital sex was only mildly supported, and the data did not support the notion that men seek “unusual” sexual behaviors such as bondage with a female prostitute. Nearly 30% indi- cated that they had used alcohol prior to visiting a prostitute (Sawyer, Metz, Hinds, & Brucker, 2001–2002; Weitzer, 2005).

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Prostitution • 611

Females Working in Prostitution

Determining the number of women who are prostitutes is diffi cult for many reasons, including diff erent defi nitions of prostitution as well the secrecy often involved with the accepting of money for sex. Some studies of female prostitutes and their male clients can give us an idea of the prevalence of female prostitutes, although the numbers may not refl ect the true prevalence because the stigma associated with prostitution may result in underreporting. Sociologist Edward Laumann and his colleagues (1994) report that 16% of the men surveyed ever paid for sex. A more recent study of a representative sample of men from around the world found that, on average, about 9–10% of the men had purchased sex from a female prostitute in the past 12 months (Carael, Slaymaker, Lyerla, & Sarkar, 2006). A study of 2,665 British men completing a health-screening questionnaire found that 10% reported pay- ing for sex over the decade 1990 to 2000, with 96% of these reporting paying women and 4% paying men (Groom & Nandwani, 2006). And, in a national study of 4,545 Norwegian men, 13% reported ever paying for sex (Schei & Stigum, 2010).

Sex as Work Many women who accept money or drugs for sexual activities do not consider themselves prostitutes. Prostitutes often identify themselves as “working girls” or “sex workers,” probably an accurate description of how they perceive themselves in relation to sex. Common, but more pejorative, terms are “whore” and “hooker.” Th ey are usually sex workers not because they like anonymous sex and diff erent partners per se, but because they perceive it as good-paying work. Th ey generally do not expect to enjoy sex with their cus- tomers and avoid emotional intimacy by drawing boundaries around their emotional selves, thereby dissociating their physical sexuality from their inner selves. Th ey separate sex as a physical expression for which they are paid from sex as an expression of intimacy and pleasure (Brents et al., 2010). Two pros- titutes who work in Nevada’s legal brothels (see discussion of Nevada’s brothels on page 615) talk about the diff erence between sex at work and sex at home (quoted in Brents et al., 2010). Many prostitutes don’t kiss their clients; one said, “You don’t get personal. Kissing is personal and romantic.” In contrast to clients, sex with husbands or boyfriends is where “I really put my feelings into it, and I give him all my love, you know, I’m giving him me.”

Entrance Into Prostitution Many women begin working as prostitutes in their younger years, even in their early teens (Albert, Warner, Hatcher, Trussell, & Bennett, 1995; Dittman, 2004). Analysis of the National Longitudinal Study of Adolescent Health, a nationally representative sample of 13,294 U.S. ado- lescents, found that 3.5% of these adolescents (32.1% of whom were girls) had ever exchanged sex for drugs or money (Edwards, Iritani, & Hallfors, 2006). Childhood sexual abuse is often a factor in both adolescent girls’ and boys’ entrance into prostitution, for two reasons (Widom & Kuhns, 1996). First, sexual abuse increases the likelihood that a preadolescent or adolescent will become involved in deviant street culture and activities. Physically and sexually abused youths are more likely to be rejected by their conventional peers and to become involved in delinquent activities. Second, one major reason young people fl ee home is parental abuse—generally sexual abuse for girls and physi- cal abuse for boys.

“ Identifying women as sexual beings whose responsibility is the sexual service

of men is the social base for gender specifi c slavery.

—Kathleen Berry

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think about it

An estimated 12.3 million adults and children worldwide are forced into prostitution and labor. Called human traffi cking, this involuntary servitude is an estimated $32 billion industry aff ecting 161 countries around the globe (Polaris Project, 2010). According to the United Nations International Children’s Emergency Fund (UNICEF), as many as 2 million children are forced into prostitution in the global commercial sex trade (U.S. Department of State, 2010). With profi ts soaring and prosecution diffi cult, this patho- logical phenomenon shows no signs of abating. Families may sometimes feel they have little choice but to send their children into deplorable situations because, for example, they are simply too poor to feed their children. Increased trade across borders, lack of education (including sexuality education) of children and their parents, inadequate legislation, lack of or poor law enforcement, the eroticization of children by the media—all have contributed to commercial sexual exploitation of children (Chelala, 2000). In eastern and southern Africa, children who are orphaned as a result of AIDS may lack the support they need from other family members. Children from industrialized countries may be fl eeing abusive homes. In Southeast Asia, attitudes and practices perpetuate the low status of girls (Sternberg, 2005a). Sex traffi cking of children and young teens is not limited to countries other than the United States. Nearly 300,000 American children and teens, most of them young girls, are at risk for sex traf- fi cking (Polaris Project, 2010; The Advocates for Human Rights, 2009; U.S. Department of State, 2010). Most of those traffi cked into the United States are from Latin America, Southeast Asia, and eastern Europe. The Federal Bureau of Investigation (FBI) estimates that tens of thousands of children and young women have been traffi cked into the United States. These victims, both girls and boys, range in age from 9 to 19, with the average being 11. Many of these children and young teens are runaways or kids who have been abandoned, whereas others are from “good families” or lured or coerced by skillful predators who promise jobs, money, clothing, and modeling careers. Pimps move these young people from state to state, which makes this a federal

Human Traffi cking: International Child and Teen Prostitution

matter. In 2003, the FBI initiated a project called Lost Innocence, which specializes in child and teen sex traffi cking (Fang, 2005; FBI, 2010; “Teen Girls Tell Their Stories,” 2006). This project has successfully rescued more than 1,200 children and has resulted in the conviction of over 600 pimps and madams. Children who enter sexual servitude at an early age suff er profound physical and psychological consequences. They can become malnourished, be at an increased risk for STIs including HIV/AIDS, and suff er feelings of guilt and inadequacy, to name just a few of the eff ects. In the United States, the Traffi cking Victims Protection Act of 2000 made human traffi cking within the U.S. a federal crime. Further, the law allows women traffi cked into the U.S. to receive permanent residence status after 3 years from the issuance of a temporary residence visa (Victims of Traffi cking and Violence Pro- tection Act of 2000, 2000). Also, according to U.S. law, Americans caught paying children for sex while in foreign countries can be prosecuted in the United States (National Center for Missing and Exploited Children, 2011). Education, social mobilization and awareness building, legal support, social services, psychosocial counseling, and prosecution of perpetrators are but a few of the strategies that have been used to address this problem. Much more must be done to protect the endangered lives and well- being of the world’s children.

Think Critically 1. What, in your opinion, contributes to the demand for

child sex workers? 2. What more do you think could be done to address sex

traffi cking worldwide? 3. What, if any, additional laws should the United States

enact to prevent the traffi cking of children and young women into the United States?

Girls usually are introduced into prostitution by pimps, men upon whom prostitutes are emotionally and fi nancially dependent. Prostitutes give their pimps the money they earn; in turn, pimps provide housing, buy them clothes and jewelry, and off er them protection on the streets. Many girls and young women are “sweet-talked” into prostitution by promises of money, protection, and companionship. Adolescent prostitutes are more likely than adults to have pimps.

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Once involved with pimps, women are frequently abused by them. Th e women also run the risk of abuse and violence from their customers. Prostitutes who solicit customers on the streets (called streetwalkers) are especially vulnerable.

Personal Background and Motivation Adult prostitutes are often women who were targets of early male sexual aggression, had extensive sexual experience in adolescence, were rejected by peers because of sexual activities, and were not given adequate emotional support by their parents. Th ere are high rates of physical and sexual abuse (including intrafamilial abuse) and neglect in their childhoods (Widom & Kuhns, 1996). Often, their parents failed to provide them with a model of aff ectionate interaction. As a result, as the girls grew up, they tended to be anxious, to feel lonely and isolated, and to be unsure of their own identity. Another common thread running through the lives of most pros- titutes is an economically disadvantaged background. However, there is a wide range of motivations and backgrounds among those who enter this “oldest profession.” As one ex-prostitute notes (quoted in Queen, 2000):

When I began sex work, I did not expect the range of education and life experience I found in my colleagues. Like many people, I believed prostitution was mainly engaged in by women who have no options. But I ended up working with women who were saving to buy houses, put kids through school, put themselves through school, start businesses.

Research has shown that adolescent prostitutes describe their general psycho- logical state of mind as very negative, depressed, unhappy, or insecure at the time they fi rst entered prostitution. Many had run away from home and engaged in sexual risk behaviors. Th ere were high levels of drug use, including alcohol, meth- amphetamines, marijuana, cocaine, and heroin, and many of those who became drug addicts later turned to prostitution to support their drug habit (Edwards et al., 2006; Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 1998). Th eir emotional state made them particularly vulnerable to pimps. No single motive seems to explain why someone becomes a prostitute. It is probably a combination of environmental, social, fi nancial, and personal factors that leads a woman to this profession. When women describe the most attractive things about life in the prostitution subculture, they describe them in monetary and material terms. One prostitute notes, “I said to myself how can I do these horrible things and I said money, money, money” (quoted in Weisberg, 1990). Compared with a minimum-wage job, which may be the only alternative, pros- titution appears to be an economically rational decision. Prostitutes are aware of the psychological and physical costs. A 15-year lon- gitudinal study of 130 sex workers found that sex work was associated with higher incidences of illness—including STIs, mental health problems, and sub- stance abuse—and death (Ward & Day, 2006). Prostitutes fear physical and sexual abuse, AIDS and other STIs, harassment, jail, and legal expenses. Th ey are aware as well of the damage done to their self-esteem from stigmatization and rejection by family and society, negative feelings toward men and sex, bad working conditions, lack of a future, and control by pimps. Many do not enjoy being a prostitute, and one international study found that nearly 90% wanted out of prostitution (Farley et al., 2003). In many countries, the availability of prostitutes has become part of the tourist economy, with the money paid to prostitutes an important part of the

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national income (“Asia,” 1996; Baker, 1995; Sternberg, 2005a). In developing countries such as India, Th ailand, and the Philippines, where social and economic conditions combine with a dominant male hierarchy and acceptance of a sexual double standard, prostitution is seen by many people in those countries as a necessary and accepted occupation.

Forms of Female Prostitution Female prostitutes work as streetwalkers, in brothels, in massage parlors, as call girls or escorts, and solicit heavily on the Internet. Some academics believe that the great majority of prostitutes in the United States live indoor and, for the most part, unnoticed lives.

Streetwalkers Estimates vary, but approximately 10% of American prosti- tutes are streetwalkers (Queen, 2000). Streetwalking is usually the fi rst type of prostitution in which adolescents become involved; it is also the type they pre- fer, despite its being at the bottom of the hierarchy of prostitution and having the greatest cultural stigma. Many advertise by dressing provocatively and hang- ing out at locales noted for prostitution. Women working as streetwalkers are often high school dropouts or runaways who fl ed abusive homes and went into prostitution simply to survive. Not all streetwalkers come out of desperate situ- ations, however; some are married and have satisfactory sexual relationships in their private lives. Because streetwalkers make their contacts through public solicitation, they are more visible and more likely to be arrested. Without the ability to easily screen their customers, streetwalkers are more likely to be beaten, robbed, or raped. One study found that more than 95% of street prostitutes had been sexually assaulted and 75% had been raped (Farley, 2003). Th e study also found that people often consider prostitutes to be “unrapable” or even deserving of being raped. Streetwalkers are also susceptible to severe mental health problems. A qualitative study of 29 street youths engaged in the sex trade found that they had a high rate of attempted suicide (Kidd & Kral, 2002). Further, most women interviewed in a study of streetwalkers in Scotland indi- cated that their work had a profoundly negative impact on their self-esteem and their life with family, friends, and partners (McKeganey, 2006).

“ Prostitutes are degraded and punished by society; it is their humiliation through

their bodies—as much as their bodies— which is being purchased.

—Phyllis Chester (1940–)

Because of their inability to screen clients or control their working conditions, streetwalkers are the most likely of prostitutes to be victimized.

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Prostitution • 615

Streetwalkers suff er more occupational hazards such as assault, kidnapping, threats by a weapon, robbery, and rape than the so-called indoor prostitutes of the brothels, massage parlors, and escort services or independent call girls, or Internet purveyors. Th ey have less control over working conditions such as free- dom to refuse clients and particular sexual behaviors, are more likely to have been coercively traffi cked into prostitution, have less access to protective services, and depend more on pimps than indoor workers do (Weitzer, 2005). In contrast to other types of prostitutes, streetwalkers’ sexual activity with clients typically is less varied and shorter (Hock, 2007). Fellatio was their most common activity; less than one quarter of their contacts involved sexual inter- course. In a study of men arrested for soliciting female prostitutes in three western U.S. cities, fellatio was the most common behavior experienced in prior contact with a prostitute (Monto, 2001).

Brothels Brothels, also called “houses of prostitution,” “whorehouses,” and “houses of ill repute,” can be found in most large cities but, in the United States, are legal only in 10 rural counties in Nevada. A study of women work- ing as prostitutes at the Nevada brothels found that, prior to coming to the brothels, they had worked as illegal prostitutes and wanted relief from the stress of such work, had been working in other legal sex work such as stripping or in adult movies, and had worked in low-paying, service-industry jobs and needed a better paying job to survive (Brents et al., 2010). Prostitution in brothels has higher status than streetwalking, and it is safer. Indeed, protection from violence is a major advantage of Nevada’s legal brothels; they are the saf- est of all environments in which women sell consensual sex for money (Brents & Hausbeck, 2005). Several safety precautions, such as panic buttons, listening devices, and management surveillance, are used in Nevada brothels (Weitzer, 2005). Further, the Nevada brothel prostitutes are required to have regular medical and STI exams of which one outcome is less STI transmission. Also, to help prevent STIs, men who pay for services must submit to inspection of their genitals by the prostitutes. A major attraction of brothels is their comfort- able and friendly atmosphere. In brothels, men can have a cup of coff ee or a drink, watch television, or casually converse with the women. Many customers are regulars. Sometimes, they go to the brothel simply to talk or relax rather than to engage in sex. Researchers from the University of Nevada, Las Vegas, conducted an in- depth peer-reviewed study of the women who are prostitutes in the Nevada brothels. Th e fi ndings of the nearly 40 women who were interviewed were published in their 2010 book, Th e State of Sex (Brents, Jackson, & Hausbeck, 2010). From the fi ndings, the researchers stated that “we do not believe that selling sex itself is inherently harmful to women.” And they found no evidence of traffi cking or women working against their will. Th ey concluded that Nevada’s legal brothels are preferable to criminalization of prostitution and that they prevent violence, STIs, and severe exploitation, but that improved labor practices are needed. Th e fi ndings fueled the debate on prostitution among those who were critical of the study and believe that prostitution exploits women and should be ended (Schmidt, 2011). Male brothels, often called “stables,” are common in Southeast Asia and in some large cities in the United States. Th ese stables are where male prostitutes are available for sex with male customers, although there are also some male brothels for female customers called “stud farms.”

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Masseuses Th ere are relatively few brothels today; most have been replaced by massage parlors. Th e major diff erence between brothels and massage parlors is that brothels present themselves as places specifi cally dedicated to prostitu- tion, whereas massage parlors try to disguise their intent. Most massage parlors provide only massages. However, some massage parlors are fronts to prostitu- tion and off er customers any type of sexual service they wish for a fee, which is negotiated with the masseuses. But most are “massage and masturbation only” parlors. Th ese so-called M-and-M parlors are probably the most wide- spread; their primary service is the “local,” “hand fi nishing,” or “relief ” massage in which there is only masturbation. By limiting sex to masturbation, these parlors are able to avoid legal diffi culties, because most criminal sex statutes require genital penetration, oral sex, discussion of fees, and explicit solicitation for criminal prosecution. Women who work M-and-M parlors are frequently referred to as “hand whores”; these women, however, often do not consider themselves prostitutes, although they may go into prostitution later. Many masseuses run newspaper and website ads for their services and work on an out-call basis, meeting customers at their hotel rooms or homes.

Call Girls Call girls have the highest status among prostitutes, experience less social stigma than other prostitutes, and have among the safest working envi- ronments as they can experience more control over their working conditions and who they have as customers than streetwalkers. Th ey are usually better educated than other prostitutes, often come from a middle-class background, and dress fashionably. A call girl’s fee is high—much higher than those of a streetwalker or masseuse. She operates through contacts and referrals; instead of the street, she takes to the telephone or computer and arranges to meet her customers at the customer’s residence or at his hotel room or hers. Th e call girl is the one, not the agency, who arranges for the sex, thus providing the agency some protection from prosecution. Another major diff erence between call girls and streetwalkers is that streetwalkers usually have fl eeting interactions with customers whereas call girls are much more likely to provide “emotional work,”

Prostitution is legal and subject to government regulation in 10 rural counties in Nevada.

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Prostitution • 617

such as counseling and befriending their customers (Lever & Dolnick, 2000; Lucas, 1998). Further, call girls often have interactions that resemble a dating experience involving conversation and receiving gifts, hugs, kisses, massages, and oral sex from the clients (Weitzer, 2005). Call girls often work for escort services that advertise through newspapers and the web. Escort agencies supply attractive escorts for social occasions and never advertise that they provide sexual services, although most do. Agencies usually specialize in one type of sex, that is, female-for-male, male-for-male, female-for-female, or male-for-female. Some off er transgender prostitutes. Not all escorts work through an agency; some are independent and communicate with clients themselves (“Prostitution,” n.d.).

Males Working in Prostitution

Although there has been extensive research into prostitution, most of it con- cerns female prostitution. Most research on male prostitution focuses on street hustlers, the male equivalent of streetwalkers. Th ere are other kinds of male prostitutes, such as call boys, rent boys, masseurs, and prostitutes who work out of gay bars, who have not been extensively investigated. Male sex workers represent varied backgrounds ranging from those with few literacy skills to middle-class and wealthy men working in varied conditions such as the street, clubs, and escort agencies. Increasingly, they are utilizing escort agencies and making their availability known through the Internet (Minichiello, Marino, & Browne, 2000). Few males who work as prostitutes are gigolos—heterosexual men providing sexual services for women in exchange for money. Th eir custom- ers are usually wealthy, middle-aged women who seek sex, a social “compan- ion,” or a young man. Th e gigolo phenomenon illustrates that women, like men, will pay for sex. Another type of male prostitute is kept boys—young men fi nancially supported for sexual services by an older “sugar daddy.” Th e overwhelming majority of male prostitutes sell their sexual services to other males. Young male prostitutes are called “chickens,” and the customers who are attracted to them are known as “chickenhawks.” Th e most common types of sexual behaviors male prostitutes engage in are fellatio and anal sex. Male sex workers are usually expected to ejaculate during the sexual encounters. Because of the refractory period, the number of clients seen by male sex workers in a short period of time is limited, in contrast to female sex workers. Women usually do not have orgasms during sex with a client; further, women do not have a refractory period. Most males are introduced to prostitution through the infl uence of their peers. A typical male begins when a friend suggests that he can make “easy money” on the streets. Hustlers sometimes live alone or with roommates, whereas female streetwalkers usually live with their pimps. However, one inter- view study of 90 street-based male sex workers (mean age 32 years) found that they had high levels of homelessness. Th ese men also had contact with the criminal justice system for drug and property off enses, and a high rate of attempted suicide (Kidd & Kral, 2002; Ross, Timson, Williams, Amos, & Bowen, 2007). Male prostitution is shaped by three subcultures: the peer delinquent subcul- ture, the gay subculture, and the transvestite subculture. Th e peer delinquent subculture, an antisocial street subculture, is characterized by male and female prostitution, drug dealing, panhandling, theft, and violence. Young people in

Street hustlers, like female prostitutes, are often young adults with drug, alcohol, and health issues.

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this culture sell sex for the same reason they sell drugs or stolen goods—to make money. Teenage hustlers may not consider themselves gay, because they are sell- ing sex rather than seeking erotic gratifi cation. Instead, they may identify them- selves as a bisexual or heterosexual person. Th ey may fi nd their customers in urban “sex zones”—adult bookstores, topless bars, and adult movie houses— which cater to the sexual interests of people of all sexual orientations. And they are more likely to work the street than bars. Recall that earlier in this section we mentioned that 3.5% of 13,294 adolescents of a nationally representative study reported that they had exchanged sex for drugs or money. Two thirds of these youth (68%) were boys. For both genders, the odds of having exchanged sex for money or drugs were higher for those who had used drugs, had run away from home, and were depressed (Edwards et al., 2006). In contrast to male delinquent prostitutes, gay male prostitutes engage in prostitution as a means of expressing their sexuality and making money. Th ey identify themselves as gay and work primarily in gay neighborhoods or gay bars. Many are “pushed-away” children who fl ed their homes when their parents and peers rejected them because of their sexual orientation. Th e three most important reasons they give for engaging in prostitution are money, sex, and fun/adventure. Very little is known about male transvestite prostitutes. Th ey are a diverse group, distinct from other male and female prostitutes, and they can be found in most major cities. Th eir clients are heterosexual, bisexual, and gay men. Many of their heterosexual clients believe that the transvestites are women, but others are aware that the prostitutes are transvestites. Another type of male prostitute is the she-male, a male who has undergone breast augmentation. Th e she-male’s client may mistakenly believe that the he is a she. Often, the client is another she-male or a male who knows that the prostitute is genitally a male (Blanchard, 1993).

Prostitution and the Law

Arrests for prostitution and calls for cleanups seem to be a communal ritual practiced by infl uential segments of the population to reassert their moral, political, and economic dominance. Th e arrests are symbolic of community disapproval, but they are often selective and ineff ective at ending prostitution. Female prostitution is the only sexual off ense for which women are extensively prosecuted; the male patron is seldom arrested. Prostitutes are subject to arrest for various activities, including vagrancy and loitering, but the most common charge is for solicitation. Solicitation—a word, gesture, or action that implies an off er of sex for sale—is defi ned vaguely enough that women, and men, who are not prostitutes occasionally are arrested on the charge because they act “suspi- ciously.” It is usually diffi cult to witness a direct transaction in which money passes hands, and such arrests are also complicated by involving the patron. Th ere are periodic attempts to repeal laws criminalizing prostitution because it is perceived as a victimless crime: Both the prostitute and the customer engage in it voluntarily. Other people, especially feminists, want to repeal such laws because they view prostitutes as being victimized by their pimps, their customers, the law enforcement system, and social stigmas (Barry, 1995; Bullough & Bullough, 1996; Valera, Sawyer, & Schiraldi, 2001). Reformers propose that prostitution be either legalized or decriminalized. In recent years, there has been a shift throughout the world from prohibition of

“ I regret to say that we of the FBI are powerless to act in cases of oral-genital

intimacy, unless it has in some way obstructed interstate commerce.

—J. Edgar Hoover (1895–1972)

“ Driven underground, prostitution became integrated into the underworld

of crime. Like the prohibition of liquor, the criminalization of prostitution became a self-fulfi lling prophecy. Like the birth control movement—which also began with the aim of elevating women’s status—the antiprostitution movement resulted in the professional and offi cial victimization of poor women.

—Ruth Rosen (1945–)

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Prostitution • 619

prostitution to legalization, refl ecting new sexual norms and a new economic climate. For example, New South Wales of Australia, New Zealand, and Germany have decriminalized prostitution, and most Western European countries as well as Turkey, Senegal, Denmark and Greece, have eliminated some criminal aspects of prostitution. Th e Netherlands has decriminalized prostitution and legalized brothels. Th e United States still lags behind in changing prohibitionist policies (Brents et al., 2010). Th ose who support legalizing prostitution want to subject it to licensing and registration by police and health departments, as in Nevada and parts of Europe. Th ose who propose decriminalization want to remove criminal penal- ties for engaging in prostitution; prostitutes would be neither licensed nor registered. Many reformers believe that prostitutes should be accorded the same political and legal protections and rights of all citizens (Davidson, 2002). Some prostitutes have organized groups like the North American Task Force on Pros- titution (NTFP), Prostitutes’ Education Network, and COYOTE (Call Off Your Old Tired Ethics) to push for decriminalization and support. NTFP’s goals include the repeal of existing prostitution laws, ensuring the rights of prostitutes and other sex workers, promoting the development of social support services for sex workers, and ending the public stigma associated with sex work. Whatever one’s opinion about decriminalizing adult prostitution, the crim- inalization of adolescent prostitution needs to be reevaluated. Treating juvenile prostitutes as delinquents overlooks the fact that in many ways adolescent prostitutes are more victims than criminals. As researchers and concerned oth- ers examine such social problems as the sexual and physical abuse of children, running away, and adolescent prostitution, they are discovering a disturbing interrelationship. Th e law, nevertheless, does not view adolescent prostitution as a response to victimization and an attempt to survive on the streets. Instead, it treats it as a criminal behavior and applies legal sanctions. A more appropri- ate response might be to off er counseling, halfway houses, alternative school- ing, and job training.

The Impact of HIV/AIDS and Other STIs

Prostitution has received increased attention as a result of the HIV/AIDS epidemic. Numerous studies have documented a high frequency of many STIs, including HIV, among female, male, and male-to-female transgender prostitutes (e.g., Cohan et al., 2006; Edwards et al., 2006; Jin et al., 2010; van Veen, Gotz, van Leeuwen, Prins, & van de Alaar, 2010). Th ere are sev- eral reasons female and male prostitutes are at higher risk than the general population. First, many prostitutes are injection drug users, and injection drug use is one of the primary ways of transmitting HIV infection. Prosti- tutes exchanging sex for crack in crack houses are also at high risk for HIV infection as well as other STIs. Second, prostitutes are at higher risk for STI/ HIV infection because they have numerous partners. Th ird, prostitutes do not always require their customers to use condoms. Male prostitutes are at even greater risk than female prostitutes because of their high-risk sexual practices, especially anal intercourse, and their high-risk gay/bisexual clien- tele (see Chapter 17 for discussion of anal intercourse and HIV risk). What can we learn from all of the above? Th at clients of prostitutes are putting themselves, as well as their partners, at high risk for HIV and other STIs if they do not use condoms.

“ Upon these women we have no right to turn our backs. Their wrongs are our

wrongs. Their existence is part of our problem. They have been created by the very injustice against which we protest.

—Carrie Chapman Catt (1859–1947)

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• Sexuality and the Law A basic tenet of our society is that all Americans are equal under the law. But state laws relating to sexuality vary from one state to another, with people having widely diff ering rights and privileges. Th ough most Americans don’t give much thought to the government’s decision making concerning their sexual lives, they generally agree that sexual behavior is private and that what occurs in their bedrooms is their own business. Th ey may even think that sexuality-related laws are for other people, not themselves. As a result, most Americans don’t think about how their lives can be impacted by the law depending on where they live or visit. Laws related to various aspects of human sexuality, such as HIV/AIDS, child sexual abuse, prostitution, and hate crimes based on sexual orientation and gender identity, have been discussed throughout the book. In this section, we discuss laws related to two specifi c sexuality-related areas: private, consensual sexual behavior between adults and same-sex marriage.

Legalizing Private, Consensual Sexual Behavior

Historically, the United States has enacted laws that criminalize certain sex-related behaviors, such as sexual harassment, rape, incest, sexual assault, public indecency, and prostitution. For the most part, there has been a strong consensus among Americans as to the need for and value of such laws. However, one area of sexual behavior, referred to as sodomy, has provoked considerable debate. Sodomy has had several defi nitions, including any sexual behaviors between members of the other or the same sex that cannot result in procreation (some of which were considered “crimes against nature”) and sexual behaviors con- sidered to be “homosexual acts.” Oral and anal sex are the behaviors typically considered to be sodomy. Rooted in sixteenth-century English laws prohibiting nonprocreative sex, the fi rst American antisodomy law was passed in 1610 in colonial Virginia; the penalty was death. In 1873, South Carolina became the last state to repeal capital punishment for sodomy. More recently, sodomy laws had been used to target individuals participating in same-sex behaviors (Greenberg, 2003; “Social Evolution Changed,” 2003). Every state had laws banning sodomy until 1961, when Illinois repealed its sodomy ban. By mid-2003, only 13 states had sodomy laws, of which nine states had laws prohibiting sodomy between both same-sex and other-sex partners, and four states outlawed sodomy between same-sex partners only. Civil rights activists and the gay community protested that the laws violated individual rights, were rarely enforced, and provided grounds for other types of discrimination based on sexual orientation. Other groups, particularly those that believe homosexuality is immoral, fought to retain the laws. In 2003, in Lawrence et al. v. Texas, the U.S. Supreme Court struck down, by a decisive 6–3 vote, the Texas law that banned sex between people of the same gender. Considered by many as a “watershed moment” in advancing sexual rights in America, the verdict reversed the Supreme Court’s 1986 ruling in Bowers v. Hardwick that upheld a state’s right (Georgia) to criminalize sodomy. Th e Court said that the Bowers ruling was incorrect then and is incorrect today. Th is landmark ruling also invalidated the antisodomy laws in the 13 remaining states that have them. Th ereafter, the sexual behaviors of consenting adults, in private—no matter the gender of the partners—was legal in every state.

“ I would rather be exposed to the inconveniences attending too much

liberty than to those attending too small a degree of it.

—Thomas Jeff erson (1743–1826)

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Sexuality and the Law • 621

Th e Texas case originated in 1998 when John Geddes Lawrence and Tyron Garner were discovered having sex by a Harris County sheriff ’s offi cer who had entered Lawrence’s residence while responding to a false report about an armed intruder. Th ey were fi ned $200 each (Biskupic, 2003b) for violating state law prohibiting oral and anal sex between same-sex partners. In writing for the majority, Justice Anthony Kennedy (Supreme Court of the United States, 2003a) stated that

the case does involve two adults who, with full and mutual consent from each other, engaged in sexual practices common to a homosexual lifestyle. Th e petitioners [Lawrence and Garner] are entitled to respect for their private lives. Th e State cannot demean their existence or control their destiny by making their private sexual conduct a crime. Th e right to liberty under the Due Process Clause gives them the full right to engage in their conduct without intervention of the government.

Th e Lawrence et al. v. Texas ruling by the U.S. Supreme Court is considered a milestone ruling for gay rights advocates. For gay men in particular, not only did the decriminalization of same-sex behavior bring relief, but it also helped validate them as human beings and reduced some of the stigma they face. In recent years there have been several court rulings signifi cant to gay rights issues. A highlight of milestone court rulings in the United States at the time this book went to press is shown in Table 18.2. As discussed in Chapters 12 and 17, gay men and lesbian women can be fi red from their jobs, denied the opportunity to adopt children, denied custody of their own children, and denied housing because of their sexual orientation. To keep current on legal issues related to gay men and lesbian women, go to the Human Rights Cam- paign website: http://www.hrc.org.

Same-Sex Marriage

Th e right for same-sex couples to legally marry has become a major social and political issue in the United States. Table 18.2 presents a brief summary of major legal rulings on gay marriage in the United States. When this book was printed, marriage between same-sex individuals was legal in eight states (and the District of Columbia): Connecticut, Iowa, Massachusetts, Maryland, New Hampshire, New York, Washington, and Vermont. Comprehensive civil union or domestic partnership law was legal in nine states (and the District of Colum- bia): California, Delaware, Hawaii, Illinois, Nevada, New Jersey, Oregon, Rhode Island, and Washington (Movement Advancement Project, 2012). To learn of the status of individual state laws relative to same-sex marriage go to the Human Rights Campaign website: http://www.hrc.org and the Williams Institute (http://www.williamsinstitute.law.ucla.edu). Concerned that some states might legalize gay marriages, Congress in 1996 passed the Defense of Marriage Act (DOMA), which defi ned marriage as a union between one man and one woman. By mid-2011, 12 states created their own version: Twelve prohibited gay marriage by statue and 29 by state constitu- tion. President Obama has expressed his opposition to the DOMA, and in February 2011 the Department of Justice said that it would no longer defend the law but would enforce it until the courts decide it constitutionality. Lawsuits challenging the DOMA are likely to reach the Supreme Court (Schwartz, 2011). Th e controversy surrounding same-sex marriage continues to be divisive in the United States even though more persons support gay marriage than ever before, with a slight majority supporting for the fi rst time in 2011 (see the box

“ Whether and to whom to marry, how to express sexual intimacy, and whether

and how to establish a family—these are among the most basic of every individual’s liberty and due process rights.

—Margaret Marshall, chief justice of the Massachusetts Supreme Court

(1944–)

“ In considering deviant behavior, it is wise to remember that it is not the prevalence

of deviance that triggers social reforms, but rather what deviance symbolizes.

—Ruth Rosen

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http://www.hrc.org

http://www.williamsinstitute.law.ucla.edu

622 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

“Public Opinion About Gay and Lesbian Rights” in Chapter 17). Some oppo- nents to gay marriage declare themselves as “pro-family” and contend that same- sex couples do not fi t their defi nition of a family and hence should not receive similar legal rights as a “family.” See the “Th ink About It” box on page 623 to read a discussion on recent research on public opinion about whether gay cou- ples should be considered a family. While gay marriage remains an unsettled issue in the United States, over the past decade 10 countries legalized same-sex marriage beginning with the Netherlands in 2001. Several other countries have legalized same-sex part- nerships and off er spousal rights to same-sex couples, yet stop short of gay marriage (Bruni, 2011; Freedom to Marry, 2011). In June 2011, a landmark resolution was passed by the United Nations Human Rights Council reject- ing abuses against people based on their sexual orientation and commis- sioning a global report on discrimination against homosexuals and transgender persons (United Nations Human Rights Offi ce of the High Commissioner, 2011).

TABLE 18.2 • Recent Milestone Rulings Affi rming Gay Rights in the United States

1986 U.S. Supreme Court backs Georgia law that criminalizes sodomy.

1996 The federal Defense of Marriage Act was enacted, defi ning marriage as a “legal union between one man and woman” and stating that states do not have to recognize same-sex marriages from other states.

2000 Vermont becomes the fi rst state to legally recognize civil unions between same-sex couples, providing most of the same benefi ts of marriage.

2003 U.S. Supreme Court rejects Texas law that prohibited sex between adults of same sex, invalidating antisodomy laws in the 13 states that still had them.

2004 Same-sex marriage becomes legal in Massachusetts.

2005 The California Supreme Court issues the fi rst-of-its-kind ruling that recognizes co-parenting rights of same-sex couples.

2008 California becomes the second state to legalize gay marriage (for about 4 months), but voters later approve a constitutional amendment (Proposition 8) banning same-sex marriage.

2008 The Connecticut Supreme Court rules that same-sex couples have a legal right to marry.

2009 The California Supreme Court upholds a ban on same-sex marriage, ratifying voters’ decision in 2008.

2009 The Supreme Court of Iowa unanimously rejects state law that bans same-sex marriage.

2009 The Vermont legislature overrides the governor’s veto of a bill allowing gay men couples and lesbian women couples to marry, legalizing same-sex marriage, and becoming the fi rst state legislature to legalize same-sex marriage.

2009 Maine’s governor legalizes same-sex marriage in that state, but residents vote to overturn the law in the November polls.

2009 New Hampshire legalizes same-sex marriage.

2010 A U.S. district court rules California’s Proposition 8 unconstitutional, but the decision is being appealed and is expected to be decided by the U.S. Supreme Court.

2010 Congress legalizes same-sex marriage in the District of Columbia.

2010 Same-sex couples’ adoption of children becomes legal in Arkansas and Florida.

2011 New York passes a law legalizing same-sex marriage and recognizes gay marriage from other states.

2011 The military’s “Don’t Ask, Don’t Tell” policy that banned openly gay men and lesbian women from serving in the military is ended.

2012 Maryland and Washington legalize same-sex marriage.

2012 A U.S. appeals court struck down part of the Defense of Marriage Act that deprives married same-sex couples the same federal benefi ts accorded married other-sex couples.

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Sexuality and the Law • 623

think about it

As we know, the family is a core component of society that is tied to many social institutions. Families have certain societal privileges such as inheritance and child rearing. Traditionalists, many of whom declare themselves as “pro-family,” defi ne family as a husband, a wife, and children, whereas progressive persons have expanded their defi nition to include other options such as same-sex couples. Whether the accepted societal defi nition remains the traditional man-woman couple or is expanded has far-reaching implications. For example, when same-sex couples are excluded from the legal defi nition of family, which they often are, their rights, such as the right to marry, are limited. Sociologist Brian Powell at Indiana University led a team of researchers in conducting three nationally representative surveys of the American public’s defi nition of family. The fi ndings from 2003 and 2006 were published in their book Counted Out: Same- Sex Relations and Americans’ Defi nitions of Family (Powell, Bolzen- dahl, Geist, & Steelman, 2010). A subsequent study was conducted in 2010. The major fi nding of these surveys is this: The American public has been moving steadily toward greater acceptance of same-sex couples as family units, particularly if they have children. Here are some of the specifi c fi ndings:

■ In 2010, about two thirds of respondents agreed that same- sex couples with children count as family units, but only about one half agreed if the couple did not have children. Just over half in 2003 believed that gay men and lesbian women living with children are families.

■ About 8 in 10 respondents considered cohabiting other-sex couples with children as family units, but only half thought the same about similar couples without children.

■ The proportion of respondents supporting gay marriage increased from about 4 in 10 in 2003 to slightly over half in 2010.

■ The proportion of respondents indicating that they did not have any friend or family who was gay decreased from 6 in 10 respondents in 2003 to 4 in 10 in 2010.

An Expanding Defi nition of “Family”: A Trend Leading to Further Legalization of Same-Sex Marriage?

■ Four in fi ve respondents indicated that they knew someone who was gay.

In contrasting the researchers’ fi ndings to prior laws and mores against interracial marriage, Powell stated, “We envision a day in the near future when same-sex families also will gain acceptance by a large plurality of the public” (quoted in Roberts, 2010). Powell also noted that he did not think that the American people are ready to embrace gay marriage but that they are ready to accept it (Roberts, 2010). Greater acceptance may result in increasing legal- ization of gay marriage as when public opinion toward a specifi c societal issue becomes consistently stronger, subsequent public policy and laws refl ecting the majority opinion sometimes follow. This is occurring now: More rights are being legalized for same- sex couples as the American public has become more accepting of gay couples.

Think Critically 1. How do you defi ne “a family”? Does the sexual orien-

tation of the couple or whether they have children impact your view?

2. Do you think that if more people accepted same-sex couples as family units more states would legalize same-sex marriage?

3. How would you explain the increase in the American public accepting same-sex couples as family units?

SOURCES: Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. A. (2010). Counted out: Same-sex relations and Americans’ defi nitions of family. New York: Russell Sage Foundation; Powell, B. (2010, August). “Family” divided: Confl icting visions of “the American family.” Paper presented at the annual meeting of the American Sociological Association, Las Vegas, NV; Roberts, S. (2010, September 15). Study fi nds wider view of “family.” New York Times, p. A13.

Advocating Sexual Rights

Policymakers and advocates of free speech continue to scrutinize states’ sexuality laws and enforcement practices and to monitor and report on them. One such advocacy group is the Sexuality Information and Education Council of the United States (SIECUS), which states (n.d.):

Sexual rights are human rights, and they are based on the inherent freedom, dignity, and equality of all human beings. Sexual rights include the right to bodily integrity, sexual safety, sexual privacy, sexual pleasure, and sexual healthcare; the

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624 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

right to make free and informed sexual and reproductive choices; and the right to have access to sexual information based on sound scientifi c evidence.

In many ways, sexuality-related laws refl ect an ambivalence about sexuality in America’s culture. For some sexuality-related issues, there is not a consensus, although laws have been enacted. Th is is particularly evident with issues relating to sexuality education and abortion. Although some laws seem to be based on sexuality as something from which we must be protected, in other cases, the absence of laws speaks loudly. For example, many states have yet to protect against sexual harassment and discrimination based on sexual orientation, and every state has work to do in developing laws that support sexual rights and sexual health. Recall that in Chapter 1 we presented the World Association for Sexual Health’s Declaration of Sexual Rights, which identifi es 11 sexual rights. As discussed in various chapters of this book, the expression of many of these rights has been hampered by laws and social restriction. Further legal protection of fundamental sexual rights is needed for people to fully attain individual sexual health.

The world of commercial sex is one our society approaches with ambivalence. Society simultaneously condemns sexually explicit material and prostitution, yet provides both to customers. Because of confl icting attitudes and behaviors, our society rarely approaches the issues surrounding sexually explicit material and prostitution with disinterested objectivity. Now, in every state, adults can legally participate in private consensual sexual behavior with other adults, no matter what their sexual orientation is; but other fundamental sexual rights remain hampered by laws or social restriction.

Final Thoughts

Summary Sexually Explicit Material in Contemporary America

■ Th ere is a lack of agreement about what constitutes erotica, pornography, and obscenity because they are subjective terms. Th e term sexually explicit material is a more neutral term.

■ Th e viewing of sexually explicit materials is becoming more common.

■ Th e increasing availability of erotic fi lms in the privacy of the home via DVDs, pay-for-view television, and the Internet has led to an increase in viewers. Th e inclusion of women in the audience has led to femme porn.

■ Th e legal guidelines for determining whether a work is obscene are that the dominant theme of the work

must appeal to prurient sexual interests and portray sexual conduct in a patently off ensive way; taken as a whole, the work must be without serious literary, artistic, political, or scientifi c value; and a reasonable person must fi nd the work, when taken as a whole, to possess no social value. Obscene material is not protected by law.

■ People who read or view sexually explicit material usually recognize it as fantasy. Th ey use it as a release from their everyday lives. Sexually explicit material temporarily encourages sexual expression, activating a person’s typical sexual behavior pattern. People are interested in sexually explicit material because they enjoy sexual sensations, it is a source of sexual infor- mation and knowledge, it enables people to rehearse sexual activities, and it is safer sex.

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Questions for Discussion • 625

■ Child pornography is a form of sexual exploitation that, because of the Internet, has become a world- wide problem. U.S. courts have prohibited its pro- duction, sale, and possession.

■ Some feminists believe that sexually explicit material represents a form of sex discrimination against women because it places them in what they believe to be a degrading and dehumanizing context. Other feminists believe that opponents of sexually explicit material have an antisex bias.

■ In 1970, the President’s Commission on Pornogra- phy and Obscenity concluded that pornography does not cause harm or violence. Over the years, there has been a heated debate over the eff ects of sexually ex- plicit material. Th ere is no defi nitive evidence, how- ever, that nonviolent sexually explicit material is associated with sexual aggression against women, nor is there evidence that sexually violent material pro- duces lasting changes in attitudes or behaviors.

Prostitution

■ Prostitution, also called sex work, is the exchange of sexual behaviors for money and/or goods. Both men and women work as prostitutes. Women are gener- ally introduced into this type of sex work by pimps.

■ Adolescent prostitutes describe their psychological state as negative when they fi rst entered prostitution. Streetwalkers run the risk of abuse and violence from their customers. Prostitutes report various motives for entering prostitution, including quick and easy money, the prostitution subculture, and the excite- ment of “the life.” Fellatio is the most common sex- ual behavior of streetwalkers.

■ Prostitutes solicit on streets and work in brothels and massage parlors. Some masseuses have intercourse with clients, but most provide only masturbation. Call girls (escorts) have the highest status among prostitutes.

■ Most research on male prostitution focuses on street hustlers. Male prostitution is shaped by the peer de- linquent, gay male, and transvestite subcultures. Th e three most important reasons given for engaging in prostitution are money, sex, and fun/adventure.

■ Prostitution is legal in the United States in 10 rural counties in Nevada. A study of these brothels con- cluded that they are a good alternative to criminaliza- tion of prostitution.

■ Arrests for prostitution are symbols of community disapproval; they are not eff ective in curbing prostitu- tion. Female prostitution is the only sexual off ense for

which women are extensively prosecuted; the male patron is seldom arrested. Decriminalization of pros- titution is often urged because it is a victimless crime or because prostitutes are victimized by their pimps, customers, police, and the legal system. Some people advocate regulation by police and health departments.

■ Prostitutes are at higher risk for HIV/AIDS than the general population because some are injection drug users, have multiple partners, and do not always re- quire their customers to use condoms. Female and male prostitutes and their customers may provide a pathway for HIV and other STIs into the general heterosexual community.

Sexuality and the Law

■ In 2003, the U.S. Supreme Court overturned state antisodomy laws in the 13 remaining states that had them, making it legal for consenting adult gay men and lesbian women, as well as heterosexual individu- als, to have sex in private in all states.

■ At the time of the printing of this book, marriage be- tween same-sex individuals was legal in eight states (and the District of Columbia): Connecticut, Iowa, Maryland, Massachusetts, New Hampshire, New York, Washington, and Vermont. Nine states and the District of Columbia off er comprehensive civil unions or domestic partnerships for same-sex couples.

■ In 2011, the U.S. military’s “Don’t Ask, Don’t Tell” policy banning openly gay men and lesbian women from serving in the military was ended.

Questions for Discussion ■ Imagine that you were assigned to argue that

the federal government should regulate sexually explicit material. What would you say? Imagine the converse: that sexually explicit material should be available freely to adults in the marketplace. How would you advocate that position?

■ Do you think that sexually explicit materials are helpful, harmful, or neutral? What place, if any, do they have in a society? Explain your position on this issue.

■ Do you think that prostitution should be legalized/regulated (i.e., licensed and/or registered by health and police departments) or decriminalized (i.e., no criminal penalties

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626 • Chapter 18 Sexually Explicit Materials, Prostitution, and Sex Laws

and no licensing or registration) or neither? Defend your stance.

■ Do you believe that gay marriage will ever be legalized in every state in the United States? Why or why not?

Prostitution Research and Education www.prostitutionresearch.com Advocates for alternatives to prostitution, including emotional and physical health care for sex workers.

U.S. Supreme Court http://www.supremecourtus.gov Lists U.S. Supreme Court decisions by year and volume. Type in “sodomy” in the search box to locate the Court’s ruling on the Lawrence et al. v. Texas case.

Suggested Reading Angell, J. (2004). Call girl. Sag Harbor, N.Y. Permanent Press. A

revealing memoir of a university professor who is also a call girl.

Brents, B. G., Jackson, C. A., & Hausbeck, K. (2010). Th e state of sex: Tourism, sex, and sin in the New American heartland. New York: Routledge. A decade-long multimethod study of Nevada’s legal brothels that captures the voices of the brothels’ sex workers.

Flowers, R. B. (2001). Runaway kids and teenage prostitution: America’s lost, abandoned, and sexually exploited children. Westfi eld, CT: Greenwood Press. A concise text that examines the correlations between runaway children and teenage prostitution in the United States from a criminological, sociological, and psychological perspective.

Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. C. (2010). Counted out: Same-sex relations and Americans’ defi nitions of family. New York: Russell Sage Foundation. A report of national surveys that asked Americans their views on the defi nition of “a family,” gay marriage and adoption, legal rights of unmarried partners, among others.

Ringal, N. J., & Daly, R. (2003). Love for sale: A world history of prostitution. New York: Grove Press. A panoramic tracing of the global history of prostitution.

Spector, J. (Ed.). (2006). Prostitution and pornography: Philosophical debate about the sex industry. Stanford, CA: Stanford University Press. Th is anthology examines the debates about the sex industry, discussing the ways prostitution, pornography, and other forms of commercial sex are made subject to legislation.

Strosser, N. (2000). Defending pornography. New York: New York University Press. A lucid, broad exploration of the long debate over pornography.

Weitzer, R. (Ed.). (2010). Sex for sale: Prostitution, pornography, and the sex industry (2nd ed). New York: Routledge. Examines sex work and the sex industry.

y y

Sex and the Internet American Civil Liberties Union Protection of our First Amendment rights is part of the mission of the American Civil Liberties Union (ACLU). But what exactly is this organization, what does it do, and how can it help you? To fi nd out, click to the ACLU’s home page (http://www.aclu.org) and fi nd one topic related to this chapter or text that interests you. This could include Internet issues, free speech, HIV/AIDS, lesbian and gay rights, privacy, reproductive rights, or women’s rights. After reading information related to this topic, answer the following:

■ What new information or news release did you fi nd related to this topic?

■ What is the history or background of laws related to it? ■ What is the ACLU’s stance? ■ What is your position, and why?

Suggested Websites Human Rights Campaign http://www.hrc.org Th e HRC advocates for equal rights for LGBT individuals.

National Center for Missing and Exploited Children http://www.missingkids.com Serves as a resource on the issues of missing and sexually exploited children.

National Coalition Against Censorship http://www.ncac.org Provides action alerts, censorship news, and frequently asked questions about censorship.

Polaris Project http://www.polarisproject.org Named after the North Star, which guided slaves toward freedom along the Underground Railroad, Polaris Project provides a compre- hensive approach to combating human traffi cking and modern-day slavery.

Prostitutes’ Education Network http://www.bayswan.org Provides information and resources related to prostitution.

For links, articles, and study material, go to the McGraw-Hill website, located at

www.mhhe.com/yarber8e.

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www.prostitutionresearch.com

http://www.supremecourtus.gov

http://www.aclu.org

http://www.hrc.org

http://www.missingkids.com

http://www.ncac.org

http://www.polarisproject.org

http://www.bayswan.org

www.mhhe.com/yarber8e

G-1

abortifacient A device or substance that causes an abortion. abortion Th e expulsion of the conceptus, either spontane-

ously or by induction. abstinence Refraining from sexual intercourse. acculturation Th e process of adaptation by an ethnic group

to the attitudes, behaviors, and values of the dominant culture.

acquaintance rape A nonconsensual sexual encounter by two people who just happen to be in the same place and know each other.

acquired immunodefi ciency syndrome (AIDS) A chronic disease caused by the human immunodefi ciency virus (HIV), in which the immune system is weakened and unable to fi ght opportunistic infections such as Pneumocystis carinii pneumonia (PCP) and Kaposi’s sarcoma.

adolescence Th e social and psychological state that occurs between the beginning of puberty and full adulthood.

afterbirth Th e placenta, the remaining section of the umbilical cord, and the fetal membranes.

agape In John Lee’s typology of love, altruistic love. age of consent Th e age at which a person is legally deemed

capable of giving consent. AIDS See acquired immunodefi ciency syndrome. alveoli (singular, alveolus) Small glands within the female

breast that begin producing milk following childbirth. amenorrhea Th e absence of menstruation, unrelated to

aging. amniocentesis A process in which amniotic fl uid is with-

drawn by needle from the uterus and then examined for evidence of possible birth defects.

amnion An embryonic membranous sac containing the embryo and amniotic fl uid.

amniotic fl uid Th e fl uid within the amniotic sac that surrounds the embryo or fetus.

ampulla Th e widened part of the fallopian tube or the vas deferens.

anabolic steroids A class of natural and synthetic hormones that are derivatives of the male hormone testosterone. Th ey promote the growth of several tissues, especially muscles and bones.

anal eroticism Sexual activities involving the anus. anal intercourse Th e insertion of the erect penis into the

partner’s anus.

anal stage In Freudian theory, the period from age 1 to 3, during which the child’s erotic activities center on the anus.

analingus Th e licking of the anal region. anatomical sex Identifi cation as male or female based on

physical sex characteristics such as gonads, uterus, vulva, vagina, and penis.

androgen Any of the male hormones, including testosterone. androgen insensitivity syndrome (AIS) A condition whereby

a genetic male (XY) is resistant to male hormones or andro- gens. As a result, the person has some or all of the physical characteristics of a woman.

androgyny Th e unique and fl exible combination of instru- mental and expressive traits in accordance with individual diff erences, situations, and stages in the life cycle.

andropause or male climacteric A constellation of changes that occur in older men, including decreased libido and sexual performance, decreased sperm quantity and quality, frailty, decreased muscle and bone mass, and increased body fat.

anodyspareunia Pain occurring during anal intercourse. anorexia nervosa An eating disorder characterized by the

pursuit of excessive thinness. antibody A cell that binds to the antigen of an invading cell,

inactivating it and marking it for destruction by killer cells. anti-gay prejudice A strong dislike, fear, or hatred of gay

men and lesbian women because of their same-sex behavior. antigen A molecular structure on the wall of a cell capable

of stimulating the immune system and then reacting with the antibodies that are released to fi ght it.

antiretroviral therapy (ART) Drugs designed to control the reproduction of HIV and slow the progression of HIV disease.

anus Th e opening of the rectum, consisting of two sphincters, circular muscles that open and close like valves.

anxious/ambivalent attachment A style of infant attach- ment characterized by separation anxiety and insecurity in relation to the primary caregiver.

Apgar score Th e cumulative rating of the newborn’s heart rate, respiration, color, refl exes, and muscle tone.

aphrodisiac A substance that supposedly increases sexual desire or improves sexual function.

areola A ring of darkened skin around the nipple of the breast.

GlossaryGlossary

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G-2

birth control patch (also called Ortho Evra) A transdermal reversible method of birth control that releases synthetic estrogen and progestin to protect against pregnancy for 1 month.

birth control shot (also called Depo-Provera) An injectable, hormonal method of birth control that is used to prevent pregnancy for 12 weeks.

bisexuality An emotional and sexual attraction to members of both sexes.

blastocyst A collection of about 100 human cells that develops from the zygote.

bondage and discipline (B&D) Sexual activities in which one person is bound while another simulates or engages in light or moderate “disciplinary” activities such as spanking and whipping.

Braxton-Hicks contractions Uterine contractions during the last trimester of pregnancy that exercise the uterus, preparing it for labor.

breast self-examination (BSE) A method of checking one’s own breasts for lumps or suspicious changes.

bulimia An eating disorder characterized by episodes of uncontrolled overeating followed by purging (vomiting).

calendar (rhythm) method A contraceptive method based on calculating “safe” days depending on the range of a woman’s longest and shortest menstrual cycles.

capacitation Th e process by which a sperm’s membranes become fragile enough to release the enzymes from its acrosomes.

caring Making another’s needs as important as one’s own. castration anxiety In Freudian theory, the belief that the

father will cut off the child’s penis because of competition for the mother/wife.

celibacy Not engaging in any kind of sexual activity. censorship Th e suppression of words, ideas, or images by

governments, private groups, or individuals based on their political or moral values.

cervical cancer Invasive cancer of the cervix (ICC). cervical dysplasia or cervical intraepithelial neoplasia

(CIN) A condition of the cervical epithelium (covering membrane) that may lead to cancer if not treated.

cervical mucus method A contraceptive method using a woman’s cervical mucus to determine ovulation.

cervicitis Th e swelling (infl ammation) of the cervix, usually the result of an infection.

cervix Th e end of the uterus, opening toward the vagina. cesarean section (C-section) Th e delivery of a baby

through an incision in the mother’s abdominal and uterine walls.

chancre A round, pea-sized, painless sore symptomatic of the fi rst stage of syphilis.

child-free Individuals or couples who choose not to have children.

child sexual abuse Any sexual interaction (including fondling, erotic kissing, oral sex, and genital penetration) between an adult and a prepubertal child.

artifi cial insemination (AI) See assisted reproductive techn ology.

asexuality Th e state of having no sexual attraction for either sex or no sexual contact with another person by choice.

assigned gender Th e gender ascribed by others, usually at birth.

assisted reproductive technology (ART) A procedure in which a woman’s ovaries are stimulated and her eggs surgi- cally removed, combined with sperm, and returned to her body. Commonly referred to as artifi cial insemination.

attachment Th e emotional tie between an infant and his or her primary caregiver.

attitude Th e predisposition to act, think, or feel in certain ways toward particular things.

atypical sexual behavior Sexual activity that is not statisti- cally typical of usual sexual behavior.

autoerotic asphyxia A form of sexual masochism linking strangulation with masturbation.

autoeroticism Sexual self-stimulation or behavior involving only the self; includes masturbation, sexual fantasies, and erotic dreams.

autofellatio Oral stimulation of the penis by oneself. avoidant attachment A style of infant attachment charac-

terized by avoidance of the primary caregiver as a defense against rejection.

bacterial vaginosis (BV) A vaginal infection commonly caused by the bacterium Gardnerella vaginalis.

Bartholin’s gland One of two small ducts on either side of the vaginal opening that secretes a small amount of moisture during sexual arousal. Also known as vestibu- lar gland.

basal body temperature (BBT) method A contraceptive method based on a woman’s temperature in the morning upon waking; when her temperature rises, she is fertile.

B cell A type of lymphocyte involved in antibody production. BDSM An acronym used to describe the variant sexual

behaviors that combine bondage, discipline, sadism, and masochism.

behavior Th e way a person acts. benign prostatic hyperplasia (BPH) Enlargement of the

prostate gland, aff ecting many men over age 50. benign tumor A nonmalignant (noncancerous) tumor that

grows slowly and remains localized. bestialists People who have sexual contact with animals. bias A personal leaning or inclination. biased sample A nonrepresentative sample. binge eating disorder An eating disorder characterized by

rapid eating, eating to the point of discomfort or beyond, continual eating, and eating when not hungry. Also called compulsive overeating.

biopsy Surgical removal of tissue for diagnosis. birth canal Th e passageway through which an infant is

born; the vagina. birth control Any means of preventing a birth from taking

place, including contraception and abortion.

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G-3

confl ict A communication process in which people perceive incompatible goals and interference from others in achieving their goals.

congenital adrenal hyperplasia A group of inherited disor- ders of the adrenal gland whereby individuals born with this conition lack an enzyme needed by the adrenal gland to make the hormones cortisol and aldosterone.

contraception Th e prevention of conception. contraceptive fi lm A small, translucent tissue that contains

spermicide and dissolves into a sticky gel when inserted into the vagina.

contraceptive foam A chemical spermicide dispensed in an aerosol container.

contraceptive patch A reversible method of birth control that releases estrogen and progestin to protect against preg- nancy for 1 month.

control group A group that is not being treated in an experiment.

coprophilia A paraphilia in which a person gets sexual plea- sure from contact with feces.

corona Th e rim of tissue between the glans and the penile shaft. corpora cavernosa Th e hollow chambers in the shaft of the

clitoris or penis that fi ll with blood and swell during arousal. corpus luteum Th e tissue formed from a ruptured ovarian

follicle that produces important hormones after the oocyte emerges.

corpus spongiosum A column of erectile tissue within the penis enclosing the urethra.

correlational study Th e measurement of two or more natu- rally occurring variables to determine their relationship to each other.

Cowper’s gland or bulbourethral gland One of two small structures below the prostate gland that secrete a clear mucus into the urethra prior to ejaculation.

cross-dressing Wearing the clothing of a member of the other sex.

crura (singular, crus) Th e internal branches of the clitoral or penile shaft.

crytorchidism A condition that occurs in a minority of infants whereby one or both of the testes fail to descend. Also known as undescended testicle.

cultural equivalency perspective Th e view that attitudes, behaviors, and values of diverse ethnic groups are basi- cally similar, with diff erences resulting from adaptation to historical and social forces such as slavery, discrimina- tion, or poverty.

cunnilingus Oral stimulation of the female genitals. cystitis A bladder infection aff ecting mainly women that is

often related to sexual activity, although it is not transmit- ted from one partner to another.

date rape Sexual penetration with a dating partner that occurs against the victim’s will, with force or the threat of force.

delayed ejaculation A sexual function diffi culty character- ized by a male not being able to ejaculate easily during intercourse.

chlamydia An STI caused by the Chlamydia trachomatis organism. Also known as chlamydial infection.

chorion Th e embryo’s outermost membrane. chorionic villus sampling (CVS) A procedure in which tiny

pieces of the membrane that encases the embryo are removed and examined for evidence of possible birth defects.

cilia Tiny, hairlike tissues on the fi mbriae and ampulla that become active during ovulation, moving the oocyte into the fallopian tube.

CIN See cervical dysplasia. circumcision Th e surgical removal of the foreskin which

covers the glans penis. See also clitoridectomy. clinical research Th e in-depth examination of an individual

or group by a clinician who assists with psychological or medical problems.

clitoral hood A fold of skin covering the glans of the clitoris. clitoridectomy Th e surgical removal of the clitoris and all

or part of the labia. Also known as female genital cutting and female circumcision, or female genital mutilation.

clitoris (plural, clitorides) An external sexual structure that is the center of arousal in the female; located above the vagina at the meeting of the labia minora.

cloning Reproduction of an individual from a single cell taken from a donor or parent.

coercive paraphilia Sexual behavior involving victimization and causing harm to others.

cognitive development theory A child development theory that views growth as the mastery of specifi c ways of per- ceiving, thinking, and doing that occurs at discrete stages.

cognitive social learning theory A child development theory that emphasizes the learning of behavior from others, based on the belief that consequences control behavior.

cohabitation Th e practice of living together and having a sexual relationship.

coitus Penile-vaginal sex. coitus interruptus Th e removal of the penis from the vagina

prior to ejaculation. Also called withdrawal. colostrum A yellowish substance containing nutrients and

antibodies that is secreted by the breasts 2–3 days prior to actual milk production.

coming out Th e public acknowledgment of one’s sexual ori- entation, such as gay, lesbian, or bisexual.

commitment A determination, based on conscious choice, to continue a relationship or a marriage.

communication A transactional process in which symbols such as words, gestures, and movements are used to estab- lish human contact, exchange information, and reinforce or change attitudes and behaviors.

conceptus In medical terminology, the developing human off spring from fertilization through birth.

condom or male condom A thin, soft, fl exible sheath of latex rubber, polyurethane, or processed animal tissue that fi ts over the erect penis to prevent semen from being transmitted and to help protect against STIs. See also female condom.

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G-4

egocentric fallacy An erroneous belief that one’s own personal experiences and values are held by others in general.

EIA (enzyme immunoassay) A test used to detect antigen- soliciting molecules specifi cally related to autoimmune dis- orders and cancer.

ejaculation Th e process by which semen is forcefully expelled from the penis.

ejaculatory duct One of two structures within the prostate gland connecting with the vasa deferentia.

ejaculatory inevitability Th e point at which ejaculation is imminent in the male.

elective delivery Birth delivery that is scheduled prior to the baby’s intended due date.

Electra complex In Freudian theory, the female child’s erotic desire for the father and simultaneous fear of the mother.

embryo Th e early form of life in the uterus between the stages of blastocyst and fetus.

embryonic membranes The embryo’s membranes include the amnion, amniotic fl uid, yolk sac, chorion, and allantois.

emergency contraception (EC) Th e use of hormones or a copper IUD to prevent a pregnancy from occurring.

emission Th e fi rst stage of ejaculation, in which sperm and semen are propelled into the urethral bulb.

endometriosis A disease caused by endometrial tissue (uterine lining) spreading and growing in other parts of the body; a major cause of infertility.

endometrium Th e inner lining of the uterine walls. epidemic A wide and rapid spread of a contagious disease. epidemiology Th e study of the causes and control of disease

epidemics. epididymis Th e coiled tube, formed by the merging of the

seminiferous tubules, where sperm mature. epididymitis Infl ammation of the epididymis. epidural A method of anesthetic delivery during childbirth

in which a painkilling drug is continuously administered through a catheter in the woman’s lower back.

episiotomy A surgical procedure during childbirth that enlarges the vaginal opening by cutting through the perineum toward the anus.

erectile dysfunction A sexual function diffi culty character- ized by not having or maintaining an erection during inter- course. Previously referred to as impotence.

erection Th e process of the penis becoming rigid through vasocongestion; an erect penis.

erogenous zone Any area of the body that is highly sensitive to touch and associated with sexual arousal.

eros In John Lee’s typology of love, the love of beauty. erotica Sexually explicit material that is evaluated positively. erotic aid or sex toy A device, such as a vibrator or dildo, or

a product, such as oils or lotions, designed to enhance erotic responsiveness.

erotophilia A positive emotional response to sexuality. erotophobia A negative emotional response to sexuality.

delayed labor Pregnancy that has gone 2 weeks beyond full term.

demographics Th e statistical characteristics of human populations.

dependent variable In an experiment, a factor that is likely to be aff ected by changes in the independent variable.

DHT defi ciency A genetic disorder in which some males are unable to convert testosterone to the hormone dihydrotes- tosterone (DHT), required for the normal development of external male genitals; usually identifi ed as girls at birth, the children begin to develop male genitals in adolescence.

diabetes mellitus A chronic disease characterized by excess sugar in the blood and urine due to a defi ciency of insulin.

diaphragm A rubber cup with a fl exible rim that is placed deep inside the vagina, blocking the cervix, to prevent sperm from entering the uterus.

dilation Gradual opening of the cervix. dilation and evacuation (D&E) A second-trimester abor-

tion method in which the cervix is slowly dilated and the fetus removed by alternating curettage with other instru- ments and suction.

disinhibition Th e phenomenon of activating behaviors that would normally be suppressed.

disorders of sexual development (DSD) Variations in con- genital sex anatomy that are considered atypical for females or males. Also called intersex.

domestic partnership A legal category granting some rights ordinarily reserved to married couples to committed, cohab- iting heterosexual, gay men, and lesbian women couples.

domination and submission (D/S) Sexual activities involv- ing the consensual acting out of fantasy scenes in which one person dominates and the other submits.

dominatrix In bondage and discipline, a woman who special- izes in “disciplining” a submissive partner.

doulas Specially trained individuals who off er birthing mothers emotional support and help in managing pain during the birth process.

drag Cross-dressing, often with comic intent. drag queens Gay men who cross-dress to entertain. dual control model A theoretical perspective of sexual

response based on brain function and the interaction between sexual excitation and sexual inhibition.

dysmenorrhea Pelvic cramping and pain experienced by some women during menstruation.

dyspareunia A female sexual functioning diffi culty charac- terized by painful intercourse.

eating disorder Eating and weight management practices that endanger a person’s physical and emotional health.

ectoparasitic infestation Parasitic organisms that live on the outer skin surfaces, not inside the body.

ectopic pregnancy A pregnancy in which the fertilized ovum is implanted in any tissue other than the uterine wall. Most ectopic pregnancies occur in the fallopian tubes. Also known as a tubal pregnancy.

eff acement Th inning of the cervix during labor.

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G-5

fertility awareness–based (FAB) method One of several contraceptive methods based on a woman’s knowledge of her body’s reproductive cycle, including calendar (rhythm), basal body temperature (BBT), cervical mucus, and symp- tothermal methods.

fetal alcohol eff ect (FAE) Moderate alcohol consumption by pregnant women resulting in some intellectual and behavior defi cits.

fetal alcohol syndrome (FAS) Chronic ingestion of alcohol by pregnant women resulting in unusual facial features, congenital heart defects, defective joints, and behavioral and intellectual impairment in children.

fetishism A paraphilia in which a person is sexually attracted to certain objects.

fetus Th e stage of life from 8 weeks of gestation to birth. fi brocystic disease A common and generally harmless

breast condition in which fi brous tissue and benign cysts develop in the breast.

fi mbriae Fingerlike tissues that drape over the ovaries, but without necessarily touching them.

5-alpha reductase defi ciency A condition whereby a genetic male (XY) will not produce enough of a hormone called dihydrotestosterone (DHT), a shortage of which will disrupt the formation of the external sex organs, causing individuals to be born with external genitalia that appear female.

follicle-stimulating hormone (FSH) A hormone that reg- ulates ovulation.

follicular phase Th e phase of the ovarian cycle during which a follicle matures.

foreskin Th e portion of the sleevelike skin covering the shaft of the penis that extends over the glans penis. Also known as prepuce.

45,X (Turner syndrome) A chromosomal disorder aff ect- ing females born lacking an X chromosome, resulting in the failure to develop ovaries.

frenulum Th e triangular area of sensitive skin on the under- side of the penis, attaching the glans to the foreskin.

friends with benefi ts An uncommitted, non-long term casual sexual relationship between acquaintances.

frotteurism A paraphilia involving recurrent, intense urges to touch or rub against a nonconsenting person for the purpose of sexual arousal.

gamete A sex cell containing the genetic material necessary for reproduction; an oocyte (ovum) or sperm.

gender Th e social and cultural characteristics associated with being male or female.

gender identity A person’s internal sense of being male or female.

gender identity disorder (GID) A strong and persistent cross-gender identifi cation and persistent discomfort about one’s assigned sex.

gender presentation Th e way in which we present our gender to others, whether it be through gestures or personality.

gender role Th e attitudes, behaviors, rights, and responsi- bilities that society associates with each sex.

estrogen Th e principal female hormone, regulating repro- ductive functions and the development of secondary sex characteristics.

ethnic group A group of people distinct from other groups because of cultural characteristics transmitted from one generation to the next.

ethnicity Ethnic affi liation or identity. ethnocentric fallacy or ethnocentrism Th e belief that one’s

own ethnic group, nation, or culture is innately superior to others.

exhibitionism A paraphilia involving recurrent, intense urges to expose one’s genitals to a nonconsenting person.

experimental research Th e systematic manipulation of an individual or the environment to learn the eff ect of such manipulation on behavior.

expressiveness Revealing or demonstrating one’s emotions. expulsion Th e second stage of ejaculation, characterized by

rapid, rhythmic contraction of the urethra, prostate, and muscles at the base of the penis, causing semen to spurt from the urethral opening.

extradyadic involvement (EDI) Sexual or romantic relation- ship outside of a primary marital or dating dyad.

extrafamilial abuse Child sexual abuse by someone unrelated to the child.

fallacy An error in reasoning that aff ects one’s understand- ing of a subject.

fallopian tube One of two uterine tubes extending toward an ovary.

familismo Emphasis on family among Hispanics/Latinos. Family and Medical Leave Act (FMLA) (Public Law 103-3)

Allows an employee to take unpaid leave for the birth and care of a newborn child, during his or her own illness, or to care for a sick family member.

feedback Th e ongoing process in which participants and their messages create a given result and are subsequently modifi ed by that result.

fellatio Oral stimulation of the penis. female condom A soft, loose-fi tting, disposable polyure-

thane sheath with a diaphragm-like ring at each end that covers the cervix, vaginal walls, and part of the external genitals to prevent conception and to help protect against sexually transmitted infections.

female genital cutting (FGC) Th e surgical removal of the clitoris and all or part of the labia. Also known as clitoridec- tomy, female circumcision, or female genital mutilation.

female impersonators Men who dress as women. female orgasmic disorder Th e absence of or delay in

orgasm for women following typical sexual excitement. female sexual arousal disorder Th e persistent or recurring

inability of a woman to attain or maintain the level of vaginal lubrication and swelling associated with sexual excitement.

feminism Eff orts by both men and women to achieve greater equality for women.

femme porn Sexually explicit material catering to women and heterosexual couples.

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G-6

helper T cell A lymphocyte that “reads” antigens and directs the immune system’s response.

hepatitis A viral disease aff ecting the liver; several types of the virus can be sexually transmitted.

herpes simplex virus (HSV) Th e virus that causes genital herpes.

heteronormativity Any set of norms that hold that people fall into distinct genders, with natural roles, and are pre- sumed to be heterosexual.

heterosexual bias or heterosexism or heterocentric behavior Th e tendency to see the world in heterosexual terms and to ignore or devalue homosexuality.

heterosexuality Emotional and sexual attraction between members of the other sex.

HIV See human immunodefi ciency virus. HIV transmission rate Th e annual number of new HIV

infections transmitted per 100 people living with HIV. homoeroticism Sexual attraction, desire, or impulses directed

toward members of the same sex; homosexuality. homologous structure A similarity in structures that per-

form the same function. homophobia An irrational or phobic fear of gay men

and lesbian women. See also anti-gay prejudice, hetero- sexual bias.

homosexuality Emotional and sexual attraction between members of the same sex.

hooking up Sexual encounters with a nonromantic partner, often a friend.

hormone A chemical substance that acts as a messenger within the body, regulating various functions.

hormone replacement therapy (HRT) Th e administration of estrogen, often with progestin, in the form of pills, vaginal cream, or a small adhesive patch. Also known as menopausal hormone use, postmenopause hormone therapy (PHT), or hormone therapy for menopause.

hostile environment As related to sexuality, a work or edu- cational setting that interferes with a person’s performance because of sexual harassment.

hot fl ash An eff ect of menopause consisting of a period of intense warmth, fl ushing, and perspiration, typically lasting 1–2 minutes.

human chorionic gonadotropin (HCG) A hormone pro- duced right after a fertilized egg attaches to the uterus; its function is to promote the maintenance of the corpus luteum.

human immunodefi ciency virus (HIV) Th e virus that causes AIDS.

hymen A thin membrane partially covering the introitus prior to fi rst intercourse or other breakage.

hypoactive sexual desire (HSD) or inhibited sexual desire A sexual function problem characterized by low or absent sexual desire.

hypospadias A hormonal condition in which the opening of the penis, rather than being at the tip, is located some- where on the underside, glans, or shaft or at the junction of the scrotum and penis.

hysterectomy Th e surgical removal of the uterus.

gender-role attitude Beliefs about appropriate male and female personality traits and activities.

gender-role behavior Th e activities in which individuals engage in accordance with their gender.

gender-role stereotype A rigidly held, oversimplifi ed, and overgeneralized belief about how each gender should behave.

gender schema A set of interrelated ideas used to organize information about the world on the basis of gender.

gender variation A person’s inability or unwillingness to conform to societal gender norms associated with his or her biological sex.

genetic sex Identifi cation as male or female based on chro- mosomal and hormonal sex characteristics.

genital candidiasis A yeast infection caused by an overgrowth of Candida albicans, which is always present in the body.

genital herpes An STI caused by the herpes simplex virus (HSV).

genital human papillomavirus infection Viruses, many of which are sexually transmitted, that infect the genital and rectal areas of both females and males. Certain types of human papillomavirus infection (HPV) can cause genital warts in men and women.

genitals Th e reproductive and sexual organs of males and females. Also known as genitalia.

genital stage In Freudian theory, the period in which adoles- cents become interested in genital sexual activities, especially sexual intercourse.

genital warts An STI caused by the human papillomavirus (HPV).

gestation Pregnancy. gestational carrier A carrier who is not related to the fetus.

In this case, a woman with ovaries but no uterus uses her own egg and the man’s sperm to create the embryo, which is then placed within the carrier’s uterus.

GIFT (gamete intrafallopian transfer) An ART procedure that transfers gametes into the woman’s fallopian tubes through small incisions in her abdomen.

glans clitoris Th e erotically sensitive tip of the clitoris. glans penis Th e head of the penile shaft. gonad An organ (ovary or testis) that produces gametes. gonadotropin A hormone that acts directly on the gonads. gonadotropin-releasing hormone (GnRH) A hormone that

stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), initiating the follicular phase of the ovarian cycle.

gonorrhea An STI caused by the Neisseria gonorrhoeae bacterium.

Grafenberg spot (G-spot) According to some researchers, an erotically sensitive area on the upper front wall of the vagina midway between the introitus and the cervix.

gynecomastia Swelling or enlargement of the male breast. halo eff ect Th e assumption that attractive or charismatic

people possess more desirable social characteristics than are actually present.

Hegar’s sign Th e softening of the uterus above the cervix, indicating pregnancy.

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G-7

in vitro fertilization (IVF) An ART procedure that com- bines sperm and oocyte in a laboratory dish and transfers the blastocyst to the mother’s uterus.

involuntary ejaculation Th e male not being able to control the moment of his ejaculation.

jealousy An aversive response that occurs because of a partner’s real, imagined, or likely involvement with a third person.

Kaplan’s tri-phasic model of sexual response A model that divides sexual response into three phases: desire, excite- ment, and orgasm.

Kaposi’s sarcoma A rare cancer of the blood vessels that is common among people with AIDS.

Kegel exercises A set of exercises for women designed to strengthen and give voluntary control over the pubococ- cygeus and to increase sexual pleasure and awareness. For males, the exercises can be valuable in improving erectile function and learning ejaculatory control.

killer T cell A lymphocyte that attacks foreign cells. Klinefelter syndrome A condition in which a male has one

or more extra X chromosomes, causing the development of female secondary sex characteristics.

klismaphilia A paraphilia in which a person gets sexual pleasure from receiving enemas.

labia majora (singular, labium majus) Two folds of spongy fl esh extending from the mons pubis and enclosing the labia minora, clitoris, urethral opening, and vaginal entrance. Also known as major lips.

labia minora (singular, labium minus) Two small folds of skin within the labia majora that meet above the clitoris to form the clitoral hood. Also known as minor lips.

lactation Th e production of milk in the breasts (mammary glands).

lactational amenorrhea method (LAM) A highly eff ective, temporary method of contraception used by exclusively breastfeeding mothers.

lanugo Th e fi ne, downy hair covering the fetus. laparoscopy A form of tubal ligation using a viewing lens

(the laparoscope) to locate the fallopian tubes and another instrument to cut or block and close them.

latency stage In Freudian theory, the period from age 6 to puberty in which sexual impulses are no longer active.

leukocyte White blood cell. Leydig cell Cell within the testes that secretes androgens.

Also known as an interstitial cell. libido Th e sex drive. lifetime risk Th e risk within one’s lifetime of a disease. limbic system A group of structures in the brain associ-

ated with emotions and feelings; involved with producing sexual arousal.

lochia A bloody vaginal discharge following childbirth. Loulan’s sexual response model A model that incorporates

both the biological and the aff ective components into a six-stage cycle.

low-birth-weight infants Th ose born weighing less than 2,500 grams, or 5.5 pounds.

ludus In John Lee’s typology of love, playful love.

implant A contraceptive device inserted under the skin that protects against pregnancy for up to 3 years. Implanon is the most common among them.

implantation Th e process by which a blastocyst becomes embedded in the uterine wall.

incest Sexual intercourse between individuals too closely related to legally marry, usually interpreted to mean father- daughter, mother-son, or brother-sister activity.

incidence Th e number of new cases of a disease within a specifi ed time, usually 1 year.

independent variable In an experiment, a factor that can be manipulated or changed.

induction A type of reasoning in which arguments are formed from a premise to provide support for its conclusion.

infertility Th e inability to conceive a child after a year of unprotected intercourse, or the inability to carry a child to term.

infi bulation Th e stitching together of the sides of the vulva or vaginal opening; part of the process of female circumci- sion or female genital mutilation.

informed consent Assent given by a mentally competent individual at least 18 years old with full knowledge of the purpose and potential risks and benefi ts of participation.

infundibulum Th e tube-shaped ends of the fallopian tubes. inhibited ejaculation A sexual function problem in which the

male does not ejaculate despite an erection and continued stimulation.

inhibited sexual desire A common condition in which the person has very low sexual interest or desire, rarely responds to a partner’s sexual initiation, and rarely initi- ates sexual activity. Also known as hypoactive sexual desire (HSD).

instrumentality Being oriented toward tasks and problem solving.

interfemoral intercourse Movement of the penis between the partner’s thighs.

internalized homophobia Negative attitudes and aff ects toward homosexuality in other persons and toward same- sex attraction in oneself.

intersex Variations in congenital sex anatomy that are con- sidered atypical for females or males. Also called disorders of sexual development (DSD).

intimate love Love based on commitment, caring, and self- disclosure.

intracytoplasmic sperm injection (ICSI) An ART proce- dure that involves injecting a single sperm directly into a mature egg; the embryo is then transferred to the uterus or fallopian tube.

intrafamilial abuse Child sexual abuse by biologically and step-related individuals.

intrauterine contraceptive (IUC) A long-acting reversible contraceptive method that prevents fertilization from occurring. Also referred to as intrauterine device or IUD.

intrauterine device (IUD) See intrauterine contraceptive (IUC).

introitus Th e opening of the vagina.

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G-8

menstrual synchrony Simultaneous menstrual cycles that occur among women who work or live together.

metastasis Th e process by which cancer spreads from one part of the body to an unrelated part via the bloodstream or lymphatic system.

miscarriage Th e spontaneous expulsion of the fetus from the uterus. Also called spontaneous abortion.

Mittelschmerz A sharp twinge that may occur on one side of the lower abdomen during ovulation.

mons pubis In the female, the mound of fatty tissue cover- ing the pubic bone; the pubic mound. Also known as mons veneris.

mons veneris Th e pubic mound; literally, mountain of Venus. Also known as mons pubis.

mosaicism A condition in which cells within the same per- son have a diff erent genetic makeup.

myotonia Increased muscle tension. necrophilia A paraphilia involving recurrent, intense urges

to engage in sexual activities with a corpse. neonate A newborn. neural tube defect screening A test on a pregnant woman’s

blood during the second trimester to measure the level of alpha-fetoprotein; test results reveal possible defects of the spine, spinal cord, skull, and brain.

neurosis A psychological disorder characterized by anxiety or tension.

nocturnal orgasm or emission Orgasm and in males, ejacula- tion while sleeping; usually accompanied by erotic dreams. Also known as wet dream.

noncoercive paraphilia Harmless and victimless paraphilia sexual behavior.

nongonococcal urethritis (NGU) Urethral infl ammation caused by something other than the gonococcus bacterium.

nonoxynol-9 (N-9) Th e sperm-killing chemical in spermicide. nonpedophilic sexual abuse An adult’s sexual interaction

with a child that is motivated not by sexual desire but by nonsexual motives such as for power or aff ection.

nonspecifi c urethritis (NSU) Infl ammation of the urethra with an unspecifi ed, nongonococcal cause.

normal sexuality behavior Behavior that conforms to a group’s typical patterns of behavior.

nulliparous woman A woman who has never given birth. nymphomania A pseudoscientifi c term referring to “abnor-

mally high” or “excessive” sexual desire in a woman. objectivity Th e observation of things as they exist in reality

as opposed to one’s feelings or beliefs about them. obscenity Th at which is deemed off ensive to “accepted”

standards of decency or morality. observational research Studies in which the researcher

unobtrusively observes people’s behavior and records the fi ndings.

Oedipal complex In Freudian theory, the male child’s erotic desire for his mother and simultaneous fear of his father.

oocyte Th e female gamete, referred to as an egg or ovum.

lumpectomy Breast surgery that removes only the malignant tumor and surrounding lymph nodes.

luteal phase Th e phase of the ovarian cycle during which a follicle becomes a corpus luteum and then degenerates.

luteinizing hormone (LH) A hormone involved in ovulation. lymphocyte A type of leukocyte active in the immune response. machismo In Latino culture, highly prized masculine traits. macrophage A type of white blood cell that destroys foreign

cells. male condom See condom. male climacteric or andropause A constellation of changes

that occur in older men, including decreased libido and sexual performance, decreased sperm quantity and quality, frailty, decreased muscle and bone mass, and increased body fat.

male erectile disorder Th e persistent or recurring diffi culty of a man attaining or maintaining an adequate erection until completion of sexual activity.

male impersonators Women who dress as men. male orgasmic disorder Th e persistent delay in or absence

of orgasm for men following typical sexual excitement. malignant tumor A cancerous tumor that invades nearby

tissues and disrupts the normal functioning of vital organs. mammary gland A mature female breast. mammogram A low-dose X-ray of the breast. mammography Th e use of X-rays to detect breast tumors

before they can be seen or felt. mania In John Lee’s typology of love, obsessive love. mastectomy Th e surgical removal of part or all of the breast. Masters and Johnson’s four-phase model of sexual response

A model that divides sexual response into four phases: excitement, plateau, orgasm, and resolution.

masturbation Stimulation of the genitals for pleasure. mate guarding A person’s eff orts to keep an existing rela-

tionship partner in the relationship. mate poaching A deliberate eff ort to lure a person who is

already in a relationship to a brief or long-term relation- ship with oneself.

medication abortion A two-drug regimen used to terminate early pregnancy. Previously known as RU-486.

menarche Th e onset of menstruation. menopausal hormone therapy (MHT) Th e administration

of estrogen (often along with progestin) to relieve the symptoms of menopause. Also known as hormone replace- ment therapy (HRT).

menopause Th e complete cessation of menstruation. menorrhagia Heavy or prolonged bleeding that may occur

during a woman’s menstrual cycle. menses Th e menstrual fl ow, in which the endometrium is

discharged. menstrual cycle Th e more-or-less monthly process during

which the uterus is readied for implantation of a fertilized ovum. Also known as uterine cycle.

menstrual phase Th e shedding of the endometrium during the menstrual cycle.

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pedophilia A paraphilia characterized by recurrent, intense urges to engage in sexual activities with a prepubescent child.

peer delinquent subculture An antisocial youth subculture. pelvic fl oor Th e underside of the pelvic area, extending

from the top of the pubic bone to the anus. pelvic infl ammatory disease (PID) An infection of the

fallopian tube (or tubes), caused by an organism such as C. trachomatis or N. gonorrhoeae, in which scar tissue may form within the tubes and block the passage of eggs or cause an ectopic pregnancy; a leading cause of female infertility. Also called salpingitis.

penis Th e male organ through which semen and urine pass. penis envy In Freudian theory, female desire to have a penis. perimenopause A period of gradual changes and adjust-

ments a woman’s body goes through prior to menopause, before menstruation stops completely.

perinatal HIV transmission (mother to child) Women who transmit HIV to their babies during pregnancy or labor and delivery.

perineum An area of soft tissue between the genitals and the anus that covers the muscles and ligaments of the pelvic fl oor.

persistent sexual arousal syndrome (PSAS) Sexual arousal in women that does not resolve in ordinary ways but con- tinues for hours, days, or weeks.

Peyronie’s disease A painful male sexual disorder, resulting in curvature of the penis, that is caused by fi brous tissue and calcium deposits developing in the corpora cavernosa of the penis.

phallic stage In Freudian theory, the period from age 3 through 5 during which both male and female children exhibit interest in the genitals.

pheromone A sexually arousing chemical substance secreted into the air by many kinds of animals.

placenta Th e organ of exchange between mother and fetus. Plan B One-Step A backup method of preventing preg-

nancy that, if taken 72 hours (3 days) after unprotected intercourse, can reduce the chances of pregnancy. Also referred to as “emergency contraception.”

pleasuring Erotic, nongenital touching. plethysmograph A device attached to the genitals to measure

physiological response. PLISSIT model A model for sex therapy consisting of four

progressive levels: Permission, Limited Information, Specifi c Suggestions, and Intensive Therapy.

Pneumocystis carinii pneumonia (PCP) An opportunistic lung infection caused by a common, usually harmless organism, frequently occuring among people with AIDS.

polyamory Th e practice or lifestyle of being open to having more than one loving intimate relationship at a time, with the full knowledge and consent of all partners involved.

pornography Sexually explicit material that is generally evaluated negatively.

postpartum depression A form of depression thought to be related to hormonal changes following the delivery of a child.

oogenesis Th e production of oocytes; the ovarian cycle. oophorectomy Th e removal of one or both ovaries. open marriage A marriage in which both partners agree to

allow each other to have openly acknowledged and inde- pendent relationships with others, including sexual ones.

opinion An unsubstantiated belief in or conclusion about what seems to be true according to an individual’s personal thoughts.

opportunistic infection (OI) An infection that normally does not occur or is not life-threatening, but that takes advantage of a weakened immune system.

oral contraceptive (OC) A series of pills containing synthetic estrogen and/or progesterone that regulate egg production and the menstrual cycle. Commonly known as “the pill.”

oral-genital sex Th e touching of a partner’s genitals with the mouth or tongue.

oral stage In Freudian theory, the period lasting from birth to age 1 in which infant eroticism is focused on the mouth.

orgasm Th e climax of sexual excitement, including rhyth- mic contractions of muscles in the genital area and intensely pleasurable sensations; usually accompanied by ejaculation in males beginning in puberty.

orgasmic platform A portion of the vagina that undergoes vasocongestion during sexual arousal.

os Th e cervical opening. osteoporosis Th e loss of bone density that can lead to

weaker bones. ovarian cycle Th e more-or-less monthly process during

which oocytes are produced. ovarian follicle A saclike structure in which an oocyte develops. ovary One of a pair of organs that produces oocytes. ovulation Th e release of an oocyte from the ovary during

the ovarian cycle. ovulatory phase Th e phase of the ovarian cycle during

which ovulation occurs. ovum (plural, ova) An egg; an oocyte; the female gamete. oxytocin A hormone that stimulates uterine contractions

during birth and possibly orgasm. Known as the “love hor- mone,” oxytocin has a major role in pair bonding.

Pap test A method of testing for cervical cancer by scraping cell samples from the cervix and examining them under a microscope.

paraphilia A mental disorder characterized by the American Psychiatric Association as recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors generally last- ing at least 6 months and involving nonhuman objects, the suff ering or humiliation of oneself or one’s partner, or chil- dren or other nonconsenting persons.

parous woman A woman who has given birth. partialism A paraphilia in which a person is sexually

attracted to a specifi c body part. participant observation A method of observational

research in which the researcher participates in the behav- iors being studied.

pathological behavior Behavior deemed unhealthy or dis- eased by current medical standards.

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proximity Nearness in physical space and time. psychoanalysis A psychological system developed by Sigmund

Freud that traces behavior to unconscious motivations. psychosexual development Development of the psycho-

logical components of sexuality. puberty Th e stage of human development when the body

becomes capable of reproduction. pubic lice Phthirus pubis, colloquially known as crabs; tiny

lice that infest the pubic hair. pubococcygeus A part of the muscular sling stretching

from the pubic bone in front to the tailbone in back. queer theory Identifi es sexuality as a system that cannot be

understood as gender neutral or by the actions of hetero- sexual males and females. It proposes that one’s sexual identity and one’s gender identity are partly or wholly socially constructed.

random sample A portion of a larger group collected in an unbiased way.

rape Sexual penetration against a person’s will through the use or threat of force.

rape trauma syndrome Th e emotional changes an individual undergoes as a result of rape.

refractory period For men, a period following ejaculation during which they are not capable of having ejaculation again.

relaxin A hormone produced by the placenta in the later months of pregnancy that increases fl exibility in the ligaments and joints of the pelvic area. In men, relaxin is contained in semen, where it assists in sperm motility.

representative sample A small group representing a larger group in terms of age, sex, ethnicity, socioeconomic status, orientation, and so on.

repression A psychological mechanism that keeps people from becoming aware of hidden memories and motives because they arouse guilt or pain.

reproduction Th e biological process by which individuals are produced.

retrograde ejaculation Th e backward expulsion of semen into the bladder rather than out of the urethral opening.

retrovirus A virus capable of reversing the normal genetic writing process, causing the host cell to replicate the virus instead of itself.

reverse transcriptase An enzyme in the core of a retrovirus enabling it to write its own genetic program into a host cell’s DNA.

root Th e portion of the penis attached to the pelvic cavity. RU-486 See medication abortion. sadomasochism (S&M) A popular, nonclinical term for

domination and submission. satyriasis An excessive, uncontrollable sexual desire in a man. scabies A red, intensely itchy rash appearing on the genitals,

buttocks, feet, wrists, knuckles, abdomen, armpits, or scalp, caused by the barely visible mite Sarcoptes scabiei.

schema A set of interrelated ideas that helps individuals process information by organizing it in useful ways.

postpartum period Th e period (about 3 months) following childbirth, characterized by physical stabilization and emo- tional adjustment.

postpartum psychosis A serious and rare postpartum mental illness thought to be biologically based and related to hor- monal changes.

postrefusal sexual persistence Continued requests for sexual contact after being refused.

posttraumatic stress disorder (PTSD) A group of charac- teristic symptoms, such as depression, that follow an intensely distressing event outside a person’s normal life experience.

pragma In John Lee’s typology of love, practical love. precocious puberty Refers to the appearance of physical

and hormonal signs of pubertal development at an earlier age than is considered normal.

preconception care Interventions that aim to identify and modify medical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management.

pregnancy-induced hypertension Condition characterized by high blood pressure, edema, and protein in the urine.

premature ejaculation or rapid ejaculation A sexual func- tion diffi culty characterized by not being able to control or delay ejaculation as long as desired, causing distress.

premenstrual dysphoric disorder Severe premenstrual symp- toms, suffi cient enough to disrupt a woman’s functioning.

premenstrual syndrome (PMS) A set of severe symptoms associated with menstruation.

prepared childbirth or natural childbirth Based on knowl- edge of conditioned refl exes, women learn to mentally separate the physical stimulus of uterine contractions from the conditioned response of pain.

prepuce Th e foreskin of the penis. preterm birth Birth that takes place prior to 27 weeks of

gestation. prevalence Overall occurrence; the total number of cases of

a disease, for example. priapism Prolonged and painful erection due to the inability

of blood to drain from the penis. progesterone A female hormone that helps regulate the

menstrual cycle and sustain pregnancy. proliferative phase Th e buildup of the endometrium in

response to increased estrogen during the menstrual cycle. prostate gland A muscular gland encircling the urethra that

produces about one third of the seminal fl uid. prostate-specifi c antigen (PSA) test A blood test used to

help diagnose prostate cancer. prostatic hyperplasia A benign condition in which the

prostate gland enlarges and blocks the fl ow of urine. prostatitis Infl ammation of the prostate gland. prostitution Th e exchange of sex for money and/or goods. protection from harm A basic entitlement of all participants

in research studies, including the right to confi dentiality and anonymity.

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sexting Th e creating, sharing, and forwarding of sexually suggestive text and nude or nearly nude images.

sexual abuse trauma A dynamic marked by traumatic sexu- alization and feelings of betrayal, powerlessness, and stig- matization exhibited by children and adults who have been sexually abused.

sexual aggression Any kind of sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or authority.

sexual assault Legal term for forced sexual contact that does not necessarily include penile-vaginal intercourse.

sexual aversion disorder A sexual function disorder charac- terized by a consistently phobic response to sexual activities or the idea of such activities.

sexual coercion A broad term referring to any kind of sex- ual activity initiated with another person through the use of argument, pressure, pleading, or cajoling, as well as force, pressure, alcohol or drugs, or authority.

sexual debut or fi rst sexual intercourse Penile-vaginal or anal intercourse that occurs for the fi rst time in a person’s life; it is often considered a milestone for many adolescents.

sexual diary Th e personal notes a study participant makes of his or her sexual activity and then reports to a researcher.

sexual double standard A standard applied more leniently to one sex than to another.

sexual dysfunction An impaired physiological response that prevents an individual from functioning sexually, such as erectile diffi culties or absence of orgasm. Also called sexual function dissatisfaction or sexual function problems.

sexual fl uidity Situation-dependent fl exibility in the gender of a woman’s sexual attraction.

sexual function dissatisfaction A condition in which an individual or couple, not based on a medical diagnosis, decide they are unhappy with their sexual relationship and that they have a problem. Also known as sexual function diffi culties or sexual dysfunction.

sexual function enhancement Improvement in the quality of one’s sexual function.

sexual harassment Th e abuse of power for sexual ends; the creation of a hostile work or educational environment because of unwelcomed conduct or conditions of a sexual nature.

sexual health Physical, mental, and social well-being related to sexuality.

sexual identity One’s self-label or self-identifi cation as a heterosexual, homosexual, or bisexual person.

sexual intercourse Th e movement of bodies while the penis is in the vagina. Sometimes also called vaginal intercourse or penile-vaginal intercourse.

sexual interest An inclination to behave sexually. sexuality Th e emotional, intellectual, and physical aspects

of sexual attraction and expression. sexually explicit material (SEM) Material such as photo-

graphs, fi lms, magazines, books, or Internet sites, whose primary themes, topics, or depictions involve sexuality or cause sexual arousal.

scientifi c method A systematic approach to acquiring knowledge by collecting data, forming a hypothesis, testing it empirically, and observing the results.

script In sociology, the acts, rules, and expectations associated with a particular role.

scrotum A pouch of skin that holds the two testicles. secondary sex characteristics Th e physical changes that

occur as a result of increased amounts of hormones target- ing other areas of the body.

secretory phase Th e phase of the menstrual cycle during which the endometrium begins to prepare for the arrival of a fertilized ovum; without fertilization, the corpus luteum begins to degenerate.

secure attachment A style of infant attachment characterized by feelings of security and confi dence in relation to the primary caregiver.

self-disclosure Th e revelation of personal information that others would not ordinarily know because of its riskiness.

semen or seminal fl uid Th e ejaculated fl uid containing sperm. seminal vesicle One of two glands at the back of the blad-

der that secrete about 60% of the seminal fl uid. seminiferous tubules Tiny, tightly compressed tubes in

which spermatogenesis takes place. sensate focus Th e focusing on touch and the giving and receiv-

ing of pleasure as part of the treatment of sexual diffi culties. serial monogamy A succession of monogamous (exclusive)

marriages or relationships. seroconversion Th e process by which a person develops

antibodies. serodiscordant A couple in which one person is HIV-

positive and the other is HIV-negative. serosorting Having sex with a partner one believes has

the same HIV status (negative or positive) as one’s own HIV status.

serostatus Th e absence or presence of antibodies for a partic- ular antigen.

sex Identifi cation as male or female based on genetic and anatomical sex characteristics.

sex fl ush A darkening of the skin or a rash that temporarily appears as a result of blood rushing to the skin’s surface during sexual excitation.

sex information/advice genre A media genre that transmits information and norms about sexuality to a mass audience.

sexism Discrimination against people based on their sex rather than their individual merits.

sexologist A specialist in the study of human sexuality. Also called sex researcher.

sex reassignment surgery A process that brings a person’s genitals in line with his or her gender identity and dimin- ishes the serious suff ering the person experiences.

sex selection Pre- and post-implantation methods that allow couples to choose whether to have a boy or a girl. (Also marketed as “family balancing.”)

sex surrogates In sex therapy, sex partners who assist clients having sexual diffi culties without spouses or other partners.

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spontaneous abortion Th e natural expulsion of the con- ceptus, commonly referred to as miscarriage.

squeeze technique A technique for the treatment of early or involuntary ejaculation in which the partner squeezes the erect penis below the glans immediately prior to ejaculation.

stalking A course of action that would cause a reasonable person to feel fear.

status An individual’s position or ranking in a group. statutory rape Consensual sexual intercourse with a female

under the age of consent. stereotype A set of simplistic, rigidly held, overgeneralized

beliefs about a person or group of people. sterilization A surgical procedure that makes the reproductive

organs incapable of producing or “delivering” viable gametes (sperm and eggs).

storge In John Lee’s typology of love, companionate love. strain gauge A device resembling a rubber band that is

placed over the penis to measure physiological response. streetwalker A prostitute who solicits on the streets. sudden infant death syndrome (SIDS) A phenomenon in

which an apparently healthy infant dies suddenly while sleeping.

surrogate motherhood An approach to infertility in which one woman bears a child for another.

survey research A method of gathering information from a small group to make inferences about a larger group.

sweating Th e moistening of the vagina by secretions from its walls. Also called vaginal transudation.

swinging A wide range of sexual activities conducted between three or more people. Typically, swinging activi- ties occur when a married or otherwise committed couple engages with another couple, multiple couples, or a single individual.

symptothermal method A fertility awareness method com- bining the basal body temperature and cervical mucus methods.

synthesis A whole formed by combining or integrating. syphilis An STI caused by the Treponema pallidum

bacterium. tantric sex A sexual technique based on Eastern religions in

which a couple shares “energy” during sexual intercourse. T cell Any of several types of lymphocytes involved in the

immune response. telephone scatologia A paraphilia involving recurrent,

intense urges to make obscene telephone calls. tenting Th e expansion of the inner two thirds of the vagina

during sexual arousal. teratogen A toxic substance that causes birth defects. testicle or testis (plural, testes) One of the paired male

gonads inside the scrotum. testosterone A steroid hormone associated with sperm

production, the development of secondary sex character- istics in males, and the sex drive in both males and females.

sexually transmitted infections (STIs) Infections most often passed from person to person through sexual contact.

sexual masochism A paraphilia characterized by recurrent, intense urges to engage in real (not fantasy) sexual behaviors in which the person is humiliated, harmed, or otherwise made to suff er.

sexual orientation Th e pattern of sexual and emotional attraction based on the gender of one’s partner.

sexual orientation uncertainty Being unsure of the gender of one’s sexual attraction.

sexual response cycle Sequence of changes and patterns that take place in the genitals and body during sexual arousal.

sexual sadism A paraphilia characterized by recurrent, intense urges to engage in real (not fantasy) sexual behav- iors in which the person infl icts physical or psychological harm on a victim.

sexual scripts Sexual behaviors and interactions learned from one’s culture.

sexual strategies theory Postulates that men and women have diff erent short-term and long-term mating strategies.

sexual variation Sexual variety and diversity in terms of sexual orientation, attitudes, behaviors, desires, fantasies, and so on; sexual activity not statistically typical of usual sexual behavior.

shaft Th e body of the penis. she-male A male who has undergone breast augmentation. smegma A cheesy substance produced by several small glands

beneath the foreskin of the penis and hood of the clitoris. social construction Th e development by society of social

categories such as masculinity, femininity, heterosexuality, and homosexuality.

social construction theory Views gender as a set of prac- tices and performances that occur through language and a political system.

socioeconomic status Ranking in society based on a com- bination of occupational, educational, and income levels.

sodomy Term used in the law to defi ne sexual behaviors other than penile-vaginal intercourse, such as anal sex and oral sex.

solicitation In terms of prostitution, a word, gesture, or action that implies an off er of sex for sale.

sonogram A visual image created by ultrasound. spectatoring Th e process in which a person becomes a spec-

tator of his or her sexual activities, thereby causing sexual function diffi culties.

sperm Th e male gamete. Also known as a spermatozoon. spermatic cord A tube suspending the testicle within the

scrotal sac, containing nerves, blood vessels, and a vas deferens.

spermatogenesis Th e process by which a sperm develops from a spermatid.

spermicide A substance that is toxic to sperm. spirochete A spiral-shaped bacterium. sponge A contraceptive device consisting of a round

polyurethane shield with a pouch in the center that covers the cervix.

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uterus A hollow, thick-walled, muscular organ held in the pelvic cavity by fl exible ligaments and supported by several muscles. Also known as womb.

vacuum aspiration A fi rst-trimester form of abortion using vacuum suction to remove the conceptus and other tissue from the uterus.

vagina In females, a fl exible, muscular organ that begins between the legs and extends diagonally toward the small of the back. It encompasses the penis during sexual inter- course and is the pathway (birth canal) through which an infant is born.

vaginal ring A vaginal form of reversible, hormonal birth control. Commonly referred to as NuvaRing.

vaginismus A sexual function diffi culty characterized by muscle spasms around the vaginal entrance, preventing the insertion of a penis.

vaginitis Any of several kinds of vaginal infection. value judgment An evaluation as “good” or “bad” based on

moral or ethical standards rather than objective ones. variable An aspect or factor that can be manipulated in an

experiment. varicocele A varicose vein above the testicle that may cause

lowered fertility in men. vas deferens (plural, vasa deferentia) One of two tubes that

transport sperm from the epididymis to the ejaculatory duct within the prostate gland.

vasectomy A form of surgical sterilization in which each vas deferens is severed, thereby preventing sperm from enter- ing the seminal fl uid.

vasocongestion Blood engorgement of body tissues. vernix Th e waxy substance that sometimes covers an infant

at birth. vestibule Th e area enclosed by the labia minora. virus A protein-coated package of genes that invades a cell

and alters the way in which the cell reproduces itself. voyeurism A paraphilia involving recurrent, intense urges

to view nonconsenting others while they are engaged in sexual activities.

vulva Th e collective term for the external female genitals. vulvodynia Chronic vulvar pain without an identifi able

cause. Western blot A test to determine whether antibodies are

specifi c to HIV. window period Th e variable amount of time it takes for the

immune system to produce enough antibodies to be detected by an antibody test.

yolk sac Th e producer of the embryo’s fi rst blood cells and the germ cells that will develop into gonads.

ZIFT (zygote intrafallopian transfer) An ART procedure whereby a woman’s eggs are fertilized in the laboratory and then transferred to her fallopian tubes.

zoophilia A paraphilia involving recurrent, intense urges to engage in sexual activities with animals. Also referred to as bestiality.

testosterone replacement therapy Treatment that is indi- cated when both clinical symptoms and signs suggestive of androgen defi ciency and decreased testosterone levels are present.

toxic shock syndrome (TSS) A potentially life-threatening condition caused by the Staphylococcus aureus bacterium and linked to the use of superabsorbent tampons and other devices that block the vagina or cervix during menstruation.

transcervical sterilization A permanent method of birth control that does not require surgery.

transgender Individuals whose appearance and behaviors do not conform to the gender roles ascribed by society for people of that sex.

transition Th e end of the fi rst stage of labor, when the infant’s head enters the birth canal.

transsexuality A phenomenon in which a person’s genitals and/or identity as a man or a woman are discordant.

transvestic fetishism A paraphilia in which a heterosexual male cross-dresses for sexual arousal.

transvestism A clinical term referring to the wearing of clothing of the other sex, usually for sexual arousal.

triangular theory of love A theory developed by Robert Sternberg emphasizing the dynamic quality of love as expressed by the interrelationship of three elements: intimacy, passion, and decision/commitment.

tribidism A behavior in which one partner lies on top of the other and moves rhythmically for genital stimulation.

trichomoniasis A vaginal infection caused by Trichomonas vaginalis. Also known as trich.

trust Belief in the reliability and integrity of another person, process, thing, or institution.

tubal ligation Th e cutting and tying off (or other method of closure) of the fallopian tubes so that ova cannot be fertilized.

Turner syndrome A genetic condition in which a female does not have the usual pair of X chromosomes. Also called 45,XO.

two-spirit In many cultures, a male who assumes female dress, gender role, and status.

ultrasound Th e use of high-frequency sound waves to create a visual image, as of the fetus in the uterus.

umbilical cord Th e cord connecting the placenta and fetus, through which nutrients pass.

unrequited love Love that is not returned. urethra Th e tube through which urine (and, in men, semen)

passes. urethral bulb Th e expanded portion of the urethra at the

bladder. urethral opening In females, the opening in the urethra,

through which urine is expelled. urethral orifi ce In males, the opening in the urethra,

through which semen is ejaculated and urine is excreted. urethritis Infl ammation of the urethra. urophilia A paraphilia in which a person gets sexual plea-

sure from contact with urine.

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Photo Credits

Chapter 1

Opener: Purestock/PunchStock; p. 6: © Stacy Walsh Rosenstock / Alamy ; p. 7: PhotoAlto via AP Images; p. 8: Rudi Von Briel/PhotoEdit ; p. 9: © DP/ Retna Ltd./Corbis; p. 10(top left): Ethan Miller/Getty Images for ABC; p. 10(bottom): © AF archive/ Alamy ; p. 11: © AF archive/ Alamy ; p. 15: Ethan Miller/Getty Images for AEG Live; p. 16(left): © Th e Granger Collection, New York; p. 16(right): Mirrorpix/Newscom; p. 18: © Erich Lessing/Art Resource, NY; p. 19: © REUTERS/Jagadeesh Nv/ Landov; p. 21: © Smithsonian Institution, National Anthropological Archives. Neg. #85-8666; p. 22(top left): © Th inkstock; p. 22(top right): JupiterImages/Cornstock Images; p. 22(bottom left): Th e McGraw-Hill Companies, Inc./Christopher Kerrigan, photographer; p. 22(bottom right): Stockbyte/Getty Images.

Chapter 2

Opener: Ryan McVay/Getty Images; p. 36: David Ryan/Lonely Planet Images; p. 38: Mark Th ornton/Getty Images; p. 42: © Joel Gordon; p. 43: © Irven DeVore/AnthroPhoto; p. 44: © Mary Evans Picture Library; p. 45: © Mary Evans Picture Library; p. 46(top): © Hulton-Deutsch Collection/Corbis; p. 46(bottom): Photo by Bill Dellenback. Reprinted with permission of Th e Kidney Institute for Research in Sex, Gender, and Reproduction; p. 49: John Chiasson/Getty Images; p. 57: © AP/Wide World Photos; p. 58(top): Courtesy of “Changing Our Minds: Th e Story of Dr. Evelyn Hooker”; p. 58(bottom): © Raymond Depardon/Magnum Photos; p. 60: © BananaStock/PunchStock; p. 61: ©JGI/Blend Images LLC ; p. 63: Dex Image/ PunchStock .

Chapter 3

Opener: Nacivet /Photographer’s Choice/Getty Images; p. 72: © Georgia O’Keefe, (1887–1986). Black Iris, 1926. Oil on canvas, H. 36, W. 29-7/8 inches (91.4 � 75.9 cm). Alfred Stieglitz Collection, 1969 (69.278.1). Photo: Malcom Varon . Image copyright © Th e Metropolitan Museum of Art/Art Resource, NY. © 2009 Georgia O’Keefe Museum/Artists Rights Society (ARS), New York; p. 74: © Susan Lerner/Joel Gordon Photography; p. 74: © Susan Lerner/Joel Gordon Photography; p. 74: © Susan Lerner/Joel Gordon Photography; p. 75: © Susan Lerner/Joel Gordon Photography; p. 79: Anthony Saint James/Getty Images; p. 81: © Petit Format/Photo Researchers, Inc.; p. 85: © Th e McGraw-Hill Companies, Inc./Jill Braaten , photographer; p. 85: © Th e McGraw-Hill Companies, Inc./Jill Braaten , photographer; p. 96: Design Pics /Darren Greenwood.

Chapter 4

Opener: Patrik Giardino /Photographer’s Choice/Getty Images; p. 109: © Joel Gordon; p. 109: © Joel Gordon; p. 109(right): © Susan Lerner/Joel Gordon Photography; p. 112(top left): © Bill Bachmann/ PhotoEdit ; p. 112(top right): © Luca I. Tettoni /Corbis; p. 112(bottom left): Purestock /Getty Images; p. 119: CNRI/Photo Researchers, Inc.

Chapter 5

Opener: © John Cordes /Icon SMI/Corbis; p. 128: Katrina Wittkamp / Digital Vision/Getty Images; p. 129: © Creatas/PunchStock ; p. 131: © Aristide Economopoulos/Star Ledger/Corbis; p. 134: trbfoto /Brand X Pictures/ JupiterImages p. 135: Brendan Smialowski /Getty Images; p. 136: © Allison Rocks! Photography; p. 142: AP Photo/Lincoln Journal Star, Eric Gregory; p. 144: CRIS BOURONCLE/AFP/Getty Images; p. 145: © 2009 MICHAEL ENGLISH, M.D. – Custom Medical Stock Photo, All Rights Reserved; p. 152: Courtesy of Dr. Daniel Greenwald; p. 152: Courtesy of Dr. Daniel Greenwald; p. 153(top left): AP Photo/Steve Nesius ; p. 153(top right): China Photos/Getty Images; p. 153(bottom right): Beck Starr/ FilmMagic .

Chapter 6

Opener: © Artiga Photo/Corbis; p. 161: Jose Luis Pelaez Inc/Blend Images LLC; p. 162: © Christine DeVault ; p. 167(left): Rob Melnychuk / Getty Images; p. 167(center): © Lindsay Hebberd /Corbis; p. 167(right): © Inge Yspeert /Corbis; p. 169(top): © Andrew Lichtenstein/Th e Image Works; p. 169(bottom): Purestock/PunchStock ; p. 171: © Stacy Walsh Rosenstock/Alamy ; p. 174: Masterfi le ; p. 180: Tina Stallard /Edit by Getty Images.

Chapter 7

Opener: Lyn Balzer and Tony Perkins/Riser/Getty Images; p. 191: © Purestock/PunchStock ; p. 195: Justin Sullivan/Getty Images; p. 197: Digital Vision/Getty Images; p. 200(top): AP Photo/ABC/MARIO PEREZ; p. 200(bottom): Waldie /Getty Images; p. 201 Jason LaVeris/ FilmMagic/Getty Images; p. 203: Royalty-Free/Corbis; p. 204: Noel Hendrickson/Digital Vision/Getty Images; p. 207: PNC/Digital Vision/ Getty Images; p. 209: © Jean Mounieq /ANA, Paris; p. 211: © Lisette Le Bon/ Purestock/SuperStock .

Chapter 8

Opener: Reggie Casagrande /Getty Images; p. 220: © Tim Pannell/ Corbis; p. 222: Kirk Weddle/Getty Images; p. 224: Creatas/PunchStock ; p. 226: Purestock/SuperStock ; p. 231(top right): © PBNJ Productions/ Blend Images LLC; p. 231(bottom left): Asia Images Group/Getty Images; p. 237: Ghislain & Marie David de Lossy /Th e Image Bank/Getty Images; p. 241: Sonda Dawes/Th e Image Works; p. 244: Neil Marriott/ Digital Vision/Getty Images; p. 245: © Th inkstock ; p. 250: Image Source/Getty Images.

Chapter 9

Opener: © Laureen March/Corbis; p. 259(top left): Jon Feingersh /Blend Images/Getty Images; p. 259(top center left): ICHIRO/Taxi Japan/Getty Images; p. 259(top center right): Bigshots /Th e Image Bank/Getty Images; p. 259(top right): Jose Luis Pelaez/Iconica/Getty Images; p. 259(bottom left): Vladimir Pcholkin /Photographer’s Choice/Getty Images; p. 259(bottom center left): Marcy Maloy /Digital Vision/Getty Images; p. 259(bottom

CreditsCredits

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center right): Yukmin /Asia Images/Getty Images; p. 259(bottom right): Dan Hallman/ Photodisc /Getty Images; p. 267: Leland Bobbe /Taxi/Getty Images; p. 271: © Joel Gordon; p. 273: © Joel Gordon; p. 283: Tom & Dee Ann McCarthy/Corbis.

Chapter 10

Opener: Buena Vista Images/Photographer’s Choice/Getty Images; p. 305: © Francis Hanna/ Alamy ; p. 306: Michael Ochs Archives/Getty Images; p. 307: Fuse/Getty Images; p. 308: © Joel Gordon; p. 310: AP Photo/ Mark J. Terrill; p. 314: David McNew /Getty Images; p. 319: © Eddie Gerald/ Alamy .

Chapter 11

Opener: Alex Cao /Digital Vision/Getty Images; p. 328: © Joel Gordon; p. 330: © AF Archive/ Alamy ; p. 334: Don Farrall /Getty Images; p. 336: © Michael Keller/Corbis; p. 337: © vario images GmbH & Co.KG/Alamy ; p. 339: Image Source via AP Images/Associated Press; p. 340: © Joel Gordon; p. 340: © Joel Gordon; p. 340: © Joel Gordon; p. 340: © Joel Gordon; p. 342: © McGraw-Hill Companies Inc./Jill Braaten , Photographer; p. 343: © McGraw-Hill Companies Inc./Jill Braaten , Photographer; p. 344(top): © McGraw-Hill Companies Inc./Jill Braaten , Photographer; p. 344(bottom): © Joel Gordon; p. 345: © McGraw-Hill Companies Inc./Jill Braaten , Photographer; p. 346: © Joel Gordon; p. 350: Courtesy of Conceptus Incorporated.

Chapter 12

Opener: Blend Images via AP Images/Associated Press; p. 365(top left): Science Photo Library RF/Getty Images; p. 365(top right): BIOPHOTO ASSOCIATES/Photo Researchers, Inc./Getty Images; p. 365(middle left): Neil Harding/Stone/Getty Images; p. 365(middle right): DEA/ L.Ricciarini /Getty Images; p. 365(bottom left): © Lennart Nilsson Photography/ Scanpix ; p. 365(bottom right): Tissuepix /Photo Researchers, Inc.; p. 369: © age footstock/ SuperStock ; p. 376: Widmann Widmann/ F1online/Getty Images; p. 377: Blend Images/ Alamy ; p. 382: © Medical RF/ Phototake —All rights reserved.; p. 383(top): Big Cheese Photo/ JupiterImages ; p. 383(bottom): Bruce Rogovin/Photolibrary/Getty Images; p. 386: RubberBall Productions/Getty Images; p. 386: © Bubbles Photolibrary/Alamy ; p. 386: Ruth Jenkinson /Dorling Kindersley/Getty Images; p. 389(top left): ©Brand X Pictures/ JupiterImages ; p. 389(bot- tom right): Huichol People, Nayarit or Jalisco , Mexico. Th e Husband Assists in the Birth of a Child, mid 20th century. Yarn, 23 3/4 � 23 3/4 in. Fine Arts Museums of San Francisco, Gift of Peter F. Young, 74.21.14; p. 390: © Jose Luis Pelaez , Inc ./ Corbis.

Chapter 13

Opener: © Michael Schwarz/Th e Image Works; p. 397: © Image Source/Corbis; p. 400(top): © Christopher LaMarca/Redux ; p. 400(bot- tom): © Bubbles Photolibrary/Alamy ; p. 402: © Lars A. Niki ; p. 404: PNC/Getty Images; p. 407: John Stanmeyer /VII/AP Images; p. 409: P. Broze /Getty Images; p. 412: Realistic Refl ections; p. 416: Taeke Henstra /

Petit Format/Photo Researchers, Inc.; p. 417: Michael Caulfi eld/Stand Up To Cancer via Getty Images; p. 419(top left): Steve Wisbauer / Photographer’s Choice/Getty Images; p. 419(bottom right): National Cancer Institute/Photo Researchers, Inc./Getty Images; p. 427: © John Henderson/ Alamy ; p. 428: Robert Laberge /Getty Images; p. 429: Catherine Leroy/ Sipa Press.

Chapter 14

Opener: Image Source via AP Images/Associated Press; p. 440: © KG-Photography/Corbis; p. 456: © Jose Luis Pelaez , Inc ./ Blend Images/ Corbis; p. 458: altrendo images/Getty Images; p. 461: Jonnie Miles/Getty Images; p. 464: apply pictures/ Alamy ; p. 465: © Rachel Torres/ Alamy ; p. 473: © Stuwdamdorp/Alamy ; p. 476: © Beau Lark/Corbis.

Chapter 15

Opener: Peter Dazeley /Photographer’s Choice/Getty Images; p. 490: © BananaStock/PunchStock ; p. 497: Courtesy of the Center for Disease Control, Atlanta; p. 499: Image courtesy of the Centers for Disease Control and Prevention, Dr NJ Fiumara , Dr Gavin Hart.; p. 499: Image courtesy of the Centers for Disease Control and Prevention, Dr NJ Fiumara , Dr Gavin Hart.; p. 503(top right): © 2009 Custom Medical Stock Photo, All Rights Reserved; p. 503(bottom right): Image courtesy of the Centers for Disease Control and Prevention, Joe Miller; p. 505: Courtesy of the Center for Disease Control, Atlanta; p. 505: © 2009 NMSB – Custom Medical Stock Photo, All Rights Reserved; p. 509: Courtesy of the Center for Disease Control, Atlanta; p. 512: © IDREAMSTOCK/ Alamy .

Chapter 16

Opener: © Patrick Seeger/epa/Corbis ; p. 522: National Cancer Institute (NCI); p. 523: MedicalRF.com; p. 534: Michael Newman/ PhotoEdit ; p. 538: JES AZNAR/AFP/Getty Images; p. 547(top right): Chip Somodevilla /Getty Images; p. 547(bottom left): © Jeff Greenberg/ Alamy ; p. 548: AP Photo/Brennan Linsley ; p. 552: Royalty-Free/Corbis.

Chapter 17

Opener: © helloworld images/ Alamy ; p. 559: © Digital Vision; p. 568(top left): Scala /Art Resource, NY; p. 568(top right): Bettmann / Corbis; p. 568(bottom right): © Woodfi n Camp and Associates; p. 575: Ryan McVay /Getty Images; p. 577: © Stockbyte /Getty Images; p. 584(top left): © SCPhotos/Alamy ; p. 584(bottom left): Chris Hondros / Getty Images; p. 591: Courtesy of Network Publications.

Chapter 18

Opener: © Alex Segre/Alamy ; p. 599: Kevork Djansezian /Getty Images; p. 601: AP Photo/ Kevork Djansezian ; p. 604: AP Photo/Paul Sakuma; p. 607: © Michael Wilhoite from Daddy’s Roommate, Alyson Books, 1991; p. 614: Th e McGraw-Hill Companies, Inc ./ Christopher Kerrigan, photographer; p. 616: AP Photo/K.M. Cannon; p. 617: Chris Schmidt/ Vetta /Getty Images

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www.MedicalRF.com

NI-1NI-1

Abbey, A., 405 Abdsaleh, S., 417 Abma, J., 168 Abma, J. C., 178 Abrams, R. C., 97 Abramson, P. R., 274, 275 Absi-Semaan, N., 135 Accord Alliance, 145, 147 Adami, H. O., 417 Adams, G., 108 Addison, T., 605 Adimora, A. A., 236, 487 Adler, N. A., 588 Administration on Children, Youth and

Families, 586 Advocates for Human Rights, 612 Agnew, K., 485 Agyei, Y., 175 Ahmed, S. F., 143, 147 Ahrold, T. K., 62, 63 Ahrons, C., 206 Ainsworth, F., 313 Ainsworth, M., 231 Akrfe, C., 600 Al-Attar, Z., 313 Albert, A. E., 611 Albert, B., 167, 170, 181 Albright, J. M., 599 Alcott, W., 16 Alden, B., 421 Alfi revic, Z., 367 Alison, L., 319 Allen, E. S., 237 Allen, K. R., 90 Allen-Taylor, L., 488 Al-Tayyib, A., 39 Altekruse, S. F., 414 Althof, S. E., 455, 473 Altman, D., 490 Amaro, H., 56 Amato, P. R., 206 American Academy of Child and Adolescent

Psychiatry, 592 American Academy of Gynecological

Laparoscopists, 423 American Academy of Pediatrics, 147, 379,

387, 391, 428 American Association of Retired Persons,

204, 209, 210 American Association of University

Women, 563 American Cancer Society, 214, 414, 415,

417, 418, 419, 420, 421, 422, 423,

424, 425, 426, 427, 428, 430, 457, 474

American College Health Association, 53, 54, 135

American College of Obstetricians and Gynecologists, 76, 377, 388

American Psychiatric Association, 17, 58, 151, 314, 400, 401, 402, 439, 440, 441, 446, 447, 448, 450, 451, 452, 453, 454, 455, 584

American Psychiatric Association Work Group on Eating Disorders, 400

American Psychological Association, 9, 13, 31, 58, 166, 301, 302, 303, 305, 307, 309, 311, 312, 313, 314, 315, 317, 318, 319

American Social Health Association, 483, 484, 491, 498, 502, 503, 505, 510

American Society for Reproductive Medicine, 380

American Society of Plastic Surgeons, 399 American Sociological Association, 58 Amos, C., 617 Andersen, A. M. N., 373 Andersen, P. K., 373 Anderson, A. M., 424 Anderson, C., 589 Anderson, C. L., 377 Anderson, G. L., 213 Anderson, P. B., 578 Anderson, S. E., 165, 166 Andrew, G. R., 221 Andriole, G. L., 426 Angier, N., 474 Angotti, 170 Annan, N. T., 496 Annang, L., 488 Annon, J., 472 Apicella, C. L., 259 Applegate, C., 417 Appugliese, D., 166 Aragaki, A., 213 Aral, S. O., 487, 491 Araujo, A. B., 451 Archer, J., 584 Armstrong, L., 428 Armstrong & Wilson, 72 Arndt, W. B., Jr., 314 Aron, A., 96 Ashton, A. K., 474 Assalian, P., 455 Associated Press, 313 Atkins, D., 237

Atrash, H., 368 Auchincloss, A. H., 541 Austin, S. B., 566 Auvert, B., 387 Avila, L., 375 Ayala, G., 200 Ayoub, M. A., 544

Babb, P. J., 421 Baidoobonso, S. M., 485 Bailen, J. L., 473 Bailey, J., 175 Bailey, J. M., 175 Bailey, J. V., 507 Bailey, R. C., 387, 491 Bajos, N., 402 Baker, C. P., 614 Baker, J. A., 422 Baldwin, J., 116 Balsam, K., 224 Balsam, K. F., 224 Bancroft, J., 42, 72, 94, 97, 161, 163, 172,

303, 317, 443, 451, 459, 474, 475 Bandura, A., 131, 160 Barak, A., 605 Barbach, L., 139, 466 Barnes, J. E., 572 Barnes, M. L., 229 Barry, C. M., 602, 603 Barry, K., 618 Bartky, S. L., 132 Basena, M., 586 Basile, K. C., 560, 573, 586 Basson, R., 411, 442 Baucom, D. H., 237 Bauer, G. R., 485 Baughman, A. L., 567 Baum, K., 560 Baumeister, R. F., 91, 222, 579 Bauserman, R., 605 Bavendam, 473 Beach, 237 Beach, F., 258, 259, 268 Beals, K. P., 224 Becher, M., 448, 476 Beech, A. R., 321 Beetz, A. M., 311 Begley, E. B., 500 Belin, T., 387 Bell, A., 193 Bell, R. J., 96 Belsky, J., 167 Beltrami, J. F., 498

Name Index Name Index

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NI-2

Bem, D. J., 175 Bem, S. L., 137, 142 Bennett, C., 611 Benson, P. J., 259 Berchtold, A., 600 Beren, S. E., 61, 534 Beresford, S., 213 Berg, C., 357 Berg, C. A., 250 Bergner, D., 95 Berlin, F. S., 318 Berman, S., 485 Bernadel, L., 411 Bernhardt, J. M., 60 Bernstein, D. J., 503 Bernstein, E., 610 Berry, S. H., 8 Best, K., 286 Bettens, F., 260 Beyer-Flores, C., 77, 96, 98, 100,

116, 120 Bhasin, S., 411 Bianchi, D. W., 368 Biely, E., 9 Bilbrey, S., 423 Billingham, R., 407 Billioux, V. G., 546 Billy, J. O. G., 487, 511 Bimbi, D. S., 305, 314, 319, 320,

399, 432 Bingham, A., 484, 488 Binik, Y. M., 101, 121, 585 Bin Mohd Tambi, M., 457 Birnbaum, H. J., 583 Biskupic, J., 608, 609, 621 Bitzer, J., 294, 295 Black, 573 Black, M. C., 560, 573, 586 Blackwood, E., 19 Blair, J. M., 539 Blair, K. L., 99, 447 Blakeslee, S., 206 Blanchard, R., 175, 618 Blank, H., 178 Bleakley, A., 8, 521 Blechman, E. A., 257 Blum, D., 223 Blumberg, E. S., 301 Blumstein, P., 223, 285, 287, 288, 289 Bogaert, A. F., 175, 224 Bogart, L. M., 275, 500 Bogle, K. A., 262 Boland, M. L., 564 Bolzendahl, C., 623 Bonas, M., 487 Bonilla, L., 62 Bono, C., 153 Borneman, E., 159 Borrello, G., 226 Bostwick, H., 16 Botterill, P. M. B., 321 Bourdeau, B., 134 Bowen, A., 617 Bowen, D., 415 Boyd, C. J., 407 Boyer, C. B., 487 Boyett, B. C., 500 Boyle, E. M., 367

Boyle, F. M., 589 Boyle, P. S., 413 Bradley, R. H., 166 Bradley, S. J., 130, 152 Bradshaw, C. S., 507 Bradshaw, D., 230, 231 Brandon, B. J., 55, 173 Brantley, C., 269, 303, 304 Braun, M., 456 Braverman, E. R., 294, 295 Braverman, P., 531 Brawley, O. W., 426 Braxton, J. K., 494 Brecklin, L. R., 584 Breedlove, S., 175 Breiding, M. J., 560 Brents, B., 615 Brents, B. G., 610, 611, 615, 619 Bretherick, K. L., 374 Brett, M. J., 421 Brewaeys, 154 Breyer, J., 619 Bridgeland, W. M., 577 Briere, J. N., 589 Brizendine, L., 131, 232 Brock, G., 474 Brody, S., 294 Brookmeyer, R., 533 Brotto, L. A., 63, 95, 442 Brouillard, P., 5 Brower, K. J., 403 Brown, C., 451 Brown, C. E. L., 377 Brown, J., 12, 14, 128, 147, 411 Browne, A., 590 Browne, J., 617 Brucker, R. A., 610 Brufsky, A., 116 Bruni, F., 622 Buck, P. O., 405 Buff ardi, A. L., 490, 534 Buisson, O., 76 Bull, S., 521 Bullough, V. L., 19, 47, 51, 153, 618 Bunker, C. H., 388 Burgess, A. W., 583 Burke, W., 204 Busko, V., 5 Buss, D. M., 100, 101, 199, 234, 258, 260,

263, 265, 312 Bussey, K., 160 Butchart, A., 503 Butler, J., 132 Butler, S. M., 545 Butler, W. T., 483, 486, 490 Butterworth, M., 152 Buzzell, T., 600 Byard, R. W., 321 Bybee, D., 415 Byers, E. S., 247, 248, 281 Byers, F. S., 281 Byrd-Craven, J., 260, 261

Calam, R., 589 Calderone, M. S., 161 Calvert, S. L., 12, 13 Campbell, S., 11 Campos-Outcalt, D., 485

Canavan, M. M., 588 Cann, A., 234 Cantor, J., 175 Cantor, J. M., 175 Caplan, A. L., 501 Carael, M., 611 Carelli, R., 592 Carey, M. P., 261, 262, 487, 546, 590 Carlin, L., 177 Carlsen, E., 424 Carlson, B. E., 589 Carmichael, M. S., 97 Carnes, P., 316 Caron, S. L., 310 Carpenter, L. M., 223 Carrere, S., 247, 248, 252 Carroll, 600 Carroll, J. L., 314, 318 Carroll, J. S., 120, 602, 603 Casey, B. R., 503 Cason, M. J., 262 Cassell, C., 265, 601 Cassidy, L., 575 Castalano, S., 560 Castleman, M., 448, 449, 454, 455, 459,

461, 469, 470, 475, 601, 604 Catanese, K. R., 579 Catania, J. A., 248, 543 Cate, R. M., 203 Cater, S. M., 33 Cates, J. R., 483, 515 Cates, W., 331, 332, 338, 339, 344, 347,

352, 353, 484, 485, 526, 533 Catlett, J., 460 Cecil, H., 42, 275 Center, B., 317 Centers for Disease Control and Prevention,

53, 59, 177, 181, 196, 379, 381, 387, 391, 392, 411, 483, 484, 485, 488, 489, 491, 493, 494, 495, 496, 497, 498, 500, 501, 502, 503, 504, 505, 506, 507, 508, 509, 510, 511, 519, 520, 522, 526, 527, 528, 529, 530, 531, 532, 533, 534, 535, 536, 537, 538, 539, 540, 541, 544, 546, 547, 548, 550, 566, 573

Central Intelligence Agency, 378 Cespedes, Y., 134 Chae, D. H., 200 Chambers, W. C., 287 Chan, C., 200 Chan, K. L., 411 Chandra, A., 8, 170, 174, 200, 236, 546 Chang, M., 490, 539, 544 Chapman, S., 11 Chartier, D., 7 Chatterjee, N., 96 Chatzi, L., 373 Chaves, B., 410 Chelala, C., 612 Chen, A., 374 Chen, H., 488 Chen, J., 573, 586 Chen, L. P., 589 Chesney, M. A., 526, 533 Chesson, H. W., 493 Cheung, F. M., 240 Chevret-Measson, M., 455

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NI-3

Chia, M., 97 Chik, H. M., 63 Child Trends, Inc., 201, 202 Chivers, M. L., 95, 99 Choi, D. Y., 589 Christensen, B. S., 443 Christensen, S., 175 Christoff , 122 Christopher, F. S., 245 Chuanjun, L., 525 Civic, D., 490 Clark, D. B., 488 Clark, H. A., 500 Clark, J., 50 Clark, L. R., 488 Clark, M., 182 Clark, S., 503 Clark, T. D., 50 Clausell, E., 225 Cleary, P. A., 411 Clinton-Sherrod, A. M., 405 Cloniger, C., 619 CNN.com/Law Center, 592 Cochran, S. D., 415 Coff ey, P., 484, 488 Cohen, D., 490, 513, 585, 619 Cohen, E., 232, 294 Cohen, M. S., 526, 533 Coleman, E., 153, 316, 317, 456 Coleman, L. M., 33 Colgan, P., 153 Collins, K., 9 Collins, R. L., 8 Collins, T., 503 Collins, W. A., 233 Comella, L., 599 Commons, M. L., 315 Comstock, J., 204 Connell, R. W., 132 Cook, D. A., 357 Cook, R. L., 488 Cooke, B., 175 Cooley, P. C., 39 Cooper, D. A., 525 Cooper, M. L., 33 Copas, A. J., 293 Copen, C., 168, 170, 174, 200 Copen, C. E., 546 Corliss, H. L., 566 Corwyn, R. H., 166 Cosby, B., 168 Costanza, M. E., 204 Cotton, A., 613 Couch, M., 171 Couper, M. P., 39 Coury-Doniger, 590 Couture, M., 311 Coviello, A., 411 Cowan, G., 576 Cox, A., 589 Coxeter, P. D., 589 Crawford, M., 133 Creanga, D. L., 473 Crepault, C., 311 Crepaz, N., 538, 548 Crocker, M. M., 413 Crombie, G., 135 Cronkite, R. C., 565

Crosby, R. A., 42, 55, 173, 280, 341, 488, 489, 503, 541, 545

Cubbins, L. A., 487 Cummings, J., 408 Cunningham, I., 79 Cupach, W. R., 204 Curtis, B., 513, 544 Curtis, M., 368 Cutler, W., 87

Dahinten, V. S., 511, 513, 544 Daling, J. R., 415 Dalton, M. A., 7 Damon, W., 456 Daneback, K., 602 Darcangelo, S., 307 d’Arcy, H., 407 Darling, C. A., 277 Darroch, J. E., 483, 487, 515 Darrow, W. W., 613 Darwin, C., 25 Davidson, 176 Davidson, J. K., 277 Davidson, J. M., 97 Davidson, J. O., 610, 619 Davidson, P., 619 Davies, M., 313, 584 Davies, S., 8 Davies, S. L., 60 Davila, V., 211 Davis, C. M., 235, 605, 606 Davis, J., 295 Davis, K. C., 404 Davis, K. E., 220 Davis, M., 503 Davis, S. L., 235 Davis, S. R., 96 Davison, S. L., 96 Dawson, B. S., 179 Day, A., 589 Day, S., 613 de Bruin, W. B., 488 Decker, M. R., 487 DeGarmo, D. S., 580 de Keizer, M., 450, 459, 478 Dekker, R., 409 DeLamater, J. D., 40, 160, 161, 208, 260,

304, 310, 460 De La Pena, E., 286 Delgado, V., 485 Delk, J., II, 456 Dempsey, A. F., 503 Denny, D., 144 Deogracias, J. J., 130, 152 Des Jarlais, D. C., 39 Desmond, K., 387 Devaney, B., 182 Devaney, S., 368 de Visser, R. O., 170, 193, 293, 452, 453 Diamond, L. M., 91, 152, 194, 195 Diamond, M., 147 Diaz, R. M., 61 Dick-Read, G., 390 Dickson, N. P., 491 DiClemente, R. J., 8, 42, 60 Dijkstra, P. U., 409 di Mauro, D., 59 Dinero, T. E., 579

Dines, G., 599 Dinh, T., 502 Dittman, M., 611 Dixen, J., 97 Djerassi, C., 357 Docter, R. F., 308 Dodge, B., 50, 55, 172, 194, 276, 277, 278,

293, 445, 446, 452, 453, 464, 531, 545

Dodge, R. C., 422 Doherty, I. A., 487 Dolnick, D., 617 Donaldson, R. H., 487 Donath, S., 96 Donnell, D., 551 Donnerstein, E., 8, 9 Donovan, B., 503 Dorey, G., 464 Douglas, J. M., 488 Dowdall, G. W., 405 Downs, J. S., 488 Dowsett, G. W., 171 Draper, C., 308 Draucker, C. B., 589 Dreger, A., 145 Druley, J. A., 61, 534 Duane, E. A., 577 Dube, S. A., 589 Ducharme, S. H., 409 Duff y, S. W., 417 Dunn, C. D. R., 464 Dunne, E. F., 502 Dunne, M. P., 175, 589 DuPont, S., 542 Dutertrc, S., 171 Dworkin, S. L., 268 Dyky, M. A., 116 Dzokoto, V. A., 108

Eagly, A., 263 Eaker, E. D., 250 Eap, S., 580 Eardley, I., 473 Earls, C. M., 311 Easton, J. A., 234, 236 Ebadi, S., 64 Edozien, F., 200 Edwards, J. M., 611, 613, 618, 619 Edwards, R. P., 422 Eke, N., 429 El-Bassel, N., 490, 539, 544 Elieff , C., 225 Ellen, J. M., 487 Ellin, A., 408 Elliott, D. M., 589 Elliott, L., 269, 303, 304 Elliott, M. N., 8 Ellis, C. D., 578, 583, 584 Ellis, H., 46 Ellis, L., 175, 193 Ellis, R., 202 Ellison, C. R., 461, 471 Ellison, N. B., 12 Eng, T. R., 483, 486, 490 Engelmann, U., 456 Enquist, M., 307 Enzlin, P., 409, 411 Epstein, A., 201

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www.CNN.com/LawCenter

NI-4

Erens, B., 293, 443 Espín, O. M., 61 Essien, E. J., 500 Estcourt, C. S., 485 Estrada, I., 565 Evans, W. P., 204 Exner, D., 567 Eyal, K., 9

Fagan, P. J., 318 Fagin, D., 175 Fahey, T., 427 Fairbrother, N., 374 Fairley, C. K., 507 Faludi, S., 32 Family Profi les, 201 Fang, B., 612 Farley, M., 613, 614 Farley, T. A., 544 Farnsworth, C. H., 567 Farquhar, C., 507 Farrer, F., 373 Fauci, A. S., 525 Federal Bureau of Investigation, 612 Federal Communication Commission, 9 Feinberg, L., 144 Feldman, H., 451 Feneley, R. C. L., 464 Fenigstein, A., 263 Fenton, K. A., 293, 443 Feray, J. C., 57 Feresu, S. A., 374 Ferguson, D. M., 97 Fernandez, C., 374 Fetters, K., 485 Fichner-Rathus, L., 240 Fichter, M. M., 402 Field, D. J., 367 Fielder, R. L., 261, 262 Figueredo, A. J., 587 Fincham, F. D., 237, 261, 262 Finer, L. B., 487 Fingerhut, A., 224 Finkelhor, D., 586, 587, 588,

590, 592 Finn, P., 407 Finnerty, L., 9 Firestone, L. A., 460 Firestone, R. W., 460 Fischhoff , B., 488 Fish, L. J., 490 Fishbein, M., 8, 513, 521, 544 Fisher, D., 321 Fisher, H., 25, 230, 232, 244,

259, 260 Fisher, T. D., 235 Fisher, W. A., 266, 294, 295,

605, 606 Fishman, M., 582 Fitzpatrick, J. H., 227 Fleming, D. T., 533 Flores, S. A., 493 Florsheim, P., 250 Foldes, P., 76 Food and Drug Administration, 335,

337, 351, 399, 430, 474, 503, 550

Ford, C. A., 258, 259, 268, 486

Fortenberry, J. D., 42, 50, 55, 71, 172, 176, 193, 194, 272, 276, 277, 278, 293, 430, 445, 446, 452, 453, 464, 473, 521, 531

Fortson, K., 182 Fortuna, K., 225 Foucault, M., 58 Foxman, B., 406, 407, 487 Franklin, E. A., 388 Franzetta, K., 486 Fraser, M., 71 Frazier, P. A., 584 Frederick, D. A., 260, 399, 400 Frederickson, B. L., 225 Freedom to Marry, 622 Freeman, C., 135 Freud, S., 45–46, 108 Friedlander, W., 11 Friederich, W. N., 160–162 Friesen, C., 175 Frisch, M., 443 Frohwirth, L. F., 355 Frost, D. M., 460

Gades, N. M., 457 Gage, S., 415 Gagliradi, G., 318 Gagnon, J. H., 50, 51, 132, 170, 172, 188,

193, 204, 223, 224, 266, 269, 278, 453, 486, 586

Galletly, C. L., 544 Gallup, G. G., 286 Gallup Poll, 569 Galvan, F. H., 500 Gardiner, K., 582 Garland, S. M., 507 Gatcomb, P., 411 Gatzeva, M., 234 Gavrilova, N., 115, 204 Gay, Lesbian, and Straight Education

Network, 567 Gay, P., 57 Gaylord, J., 42 Geary, D. C., 260, 261 Gebhard, P., 24, 46, 47, 271, 311 Geertzen, J. H. B., 409 Geist, C., 623 Gentry, A. C., 539 Genuis, M. L., 589 George, W. H., 309, 404 Georgiadis, J. R., 96 Gergen, K. J., 132 Germain, A., 584 Gerressu, M., 275, 277 Ghassemi, A., 464 Ghavami, N., 400 Ghirlanda, S., 307 Gidyez, C. A., 581 Giesen, D., 237 Gijs, 154 Gilbert, E., 419 Gilbert, L., 490, 539, 544 Giles, L. C., 221 Gill, K. M., 409 Gillen, K., 577 Gillespie, B. J., 13 Gilmore, M. R., 42 Giovannucci, E., 424

Giusti, L. M., 577 Glasgow, D., 589 Glasser, D. B., 457, 611 Gleave, M., 474 Gleghorn, A., 485 Glonek, G. F. V., 221 Glosser, A., 582 Goetz, A. T., 261 Gold, M. A., 7 Goldberg, A. E., 90 Golden, M. R., 537 Goldstein, I., 451 Golombok, S., 160 Golub, S. A., 305, 314, 319, 320 Gomez, S., 139 Goodenow, C. S., 566 Goodman, A., 321 Gooren, L., 153 Gorbach, P. M., 487 Gore-Felton, C., 404 Gorzalka, B. G., 63, 122 Gosink, P. D., 320 Gossett, E., 286 Gotta, G., 224 Gottman, J. M., 225, 247, 248,

251, 252 Gotz, H. M., 619 Gøtzsche, P. C., 417 Grady, W. R., 511 Graham, C. A., 42, 55, 94, 173, 224, 275,

277, 280, 341, 463, 545 Grajek, S., 227 Grant, J. E., 314 Gratch, L. V., 583 Graugaard, C., 443 Gravitt, P. E., 491 Gray, 373 Gray, R. H., 387, 491, 533 Green, B. C., 193 Green, R. J., 224 Green, T., 527 Greenberg, J. C., 620 Greene, A., 586 Greenfeld, L., 575 Greenhouse, L., 608 Greenleaf, W., 97 Gregor, T., 14 Grello, C., 227, 262 Gribble, J., 39 Griffi n, 565 Grigorenko, E. L., 61, 534 Grimbos, T., 95, 99 Grimes, T. R., 59 Grimley, D. M., 488, 521 Grnapathi, L., 39 Gronback, M., 443 Grønboek, M., 373 Groom, T. M., 611 Gross, J., 225 Gross, M., 489 Groth, A. N., 583 Groth, N., 583 Grothaus, L., 490 Grov, C., 13, 399 Grubin, D., 318 Grulich, A. E., 193, 293, 525 Guay, A., 97 Guerrero Pavich, E., 61

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NI-5

Guest, F., 484 Gunasehera, H., 11 Gupta, J., 487 Gutheil, T. G., 315 Guttmacher Institute, 115, 173, 179,

189, 326, 328, 330, 333, 354, 356, 393

Haavio-Mannila, E., 448 Hadden, W., 541 Hadeed, V., 116 Hall, C. T., 383 Hall, G. C. N., 580 Hall, H. I., 529, 530, 544, 546 Hall, K., 447, 459, 461 Hall, L. R., 357 Hall, S. A., 451 Hallfors, D. D., 611, 613, 618, 619 Halpern, C. T., 222, 486 Halpern-Felsher, B. L., 168, 170 Hamilton, B. E., 367, 374, 389 Hamilton, C., 457 Hamilton, D. T., 39 Hammersmith, S., 193 Hampton, D., 40, 194 Han, M., 134 Handsfi eld, H. H., 504 Hanson, R. K., 579 Harbord, S. H. A., 375 Hardenberg, S. A., 301, 313 Harmon, T., 131 Harper, M. S., 227, 262 Harrington, K., 8, 60 Harris, G. T., 168, 572 Harris, S. M., 227 Harrison, M. A., 286 Hart, T. A., 538 Harte, C. B., 474 Hartzell, R. M., 545 Harvard Health Publications, 214 Harvey, J. H., 221 Haselton, M. G., 260 Hatcher, R. A., 331, 332, 338, 339, 344,

347, 352, 353, 484, 611 Hatfi eld, E., 235 Hatway, J., 42 Hatzenbuehler, M. L., 567 Hatzichristou, D., 451 Haugaard, J. J., 587 Hausbeck, 610, 611, 615, 619 Hausbeck, K., 615 Hawkins, M., 250 Hawkins, Y., 419 Haydon, K., 233 Hayes, D. K. 374 Hayes, A., 226 Hayes, R. J., 491 Hazan, C., 230, 231 Heesacker, M., 223 Hefl ing, K., 565 Heiman, J. R., 95, 97, 404, 423, 473 Heiss, G., 213 Hellquist, B. N., 417 Helms, D. J., 508 Henderson, J., 281 Hendrickson, C. S., 309 Hennessy, M., 8, 513, 544 Henning, K., 269, 270

Henshaw, S., 177 Herbenick, D., 50, 55, 71, 161, 172,

176, 193, 194, 272, 276, 277, 278, 293, 445, 446, 452, 453, 464, 473, 531

Herbert, J. H., 493 Herbison, P., 491 Herdon, A., 145 Herdt, G., 18 Herlyn, A., 619 Hernandez, A., 527 Herndershot, C. S., 404 Herndon, N. L., 483, 515 Herz, R., 260 Herzberger, S. D., 588 Herzer, M., 57 Hetherington, E. M., 206 Hicks, T. V., 270 Higginbotham, E. B., 59 Higgs, D. C., 588 Hill, C. A., 223, 562 Hill, G. J., 224 Hillis, S. D., 423 Hinds, J. D., 610 Hine, D. C., 60 Hines, M., 160 Hiripi, E., 401 Hirschfeld, M., 57, 58 Hirschfeld, S., 565 Hobson, K. M., 281 Hock, R. R., 615 Hoff man, V., 490, 513 Holden, A. E. C., 487, 540 Holland, A., 225 Holland, P., 206 Hollifi eld, M., 584 Holmberg, D., 99, 447 Holmes, K. K., 406, 407, 487, 490, 534 Holmes, R. M., 581 Holmes, T. H., 565 Holmstrom, L. L., 583 Holstege, G., 96 Holtgrave, D. R., 544, 546 Hood, J., 368 Hook, E. W., 8 Hooker, E., 58 Hook III, E. W., 521 Hopkins, P. N., 250 Hoppe, M. J., 42 Horne, L., 589 Horwith, M., 459 Hosmane, B., 97 Houk, C. P., 147 Houser, S., 488 Houts, R. M., 167 Howells, K., 321 Hsu, A., 378 Huang, B., 541 Hucker, S. J., 320, 321 Hudson, J. I., 401 Huey, S., 134 Huff , M., 577 Hughes, A., 143, 147 Hughes, I. A., 147 Hughes, J. P., 537 Hughes, S. M., 286 Human Rights Campaign, 143, 144, 152,

432, 621

Human Rights Watch, 593 Humbert, R., 97 Humphreys, L., 42 Humphreys, T. P., 577 Hunter, J. A., 193, 195, 587 Hunter, S. B., 8 Hurrell, R. M., 575 Hurwitz, S., 485 Hutchinson, A., 500 Hutchinson, A. B., 529, 530 Hutchinson, K. B., 488, 500, 507 Huws, R., 320 Hyde, J. S., 40, 260, 304, 310, 459 Hymel, S., 135

Ickovics, J. R., 61, 534 Ieuan, A., 147 Insel, P. M., 400, 402, 427 Institute of Medicine, 415, 439,

476, 547 InteliHealth, 87 International AIDS Vaccine Initiative, 552 International Rectal Microbicide

Advocates, 552 Ionannidis, J. P., 33 Iritani, B. J., 611, 613, 618, 619 Irizarry, Y., 602, 603 Ishii-Kuntz, M., 62, 63

Ja, D., 62 Jackson, C. A., 610, 611, 615, 619 Jackson, G., 411 Jackson, M., 488 Jackson, R. L., 318 Jackson-Brewer, K., 448, 476 Jacobs, S. E., 19 Jadva, V., 160 Jairam, J. A., 485 Jamiesons, D. J., 423 Jannini, E. A., 294, 295, 307 Janssen, D. F., 166 Janssen, E., 43, 94 Janssen, R., 548 Janus, C., 305 Janus, S., 305 Jasienska, S., 259 Javanbakhtg, M., 531 Jayson, S., 260 Jelovica, B., 603 Jenness, S. M., 531 Jin, X., 619 Johnson, A. M., 275, 277, 443 Johnson, B. T., 546 Johnson, D., 134 Johnson, J., 511, 513, 544 Johnson, K., 368 Johnson, L. B., 60, 179 Johnson, L. L., 130, 152 Johnson, V., 213, 410, 450 Johnson, V. E., 48–49, 51, 93, 108, 282,

459, 467 Johnston, J. C., 320 Joint Commission, 368 Jonason, R. K., 262 Jones, J. H., 236, 327, 349, 352, 500, 501 Jones, L. M., 586 Jones, R. K., 355 Jordan, A. B., 8, 9

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NI-6

Jordon, J., 610 Joyce, G. F., 432 Jumbelic, M. I., 320 Just the Facts Coalition, 171

Kaciroti, N., 166 Kaestle, C. E., 222, 485, 486 Kafatos, A., 373 Kafka, M., 315 Kahn, J. A., 503 Kaiser Family Foundation, 6, 8, 10, 169,

511, 542, 567 Kajumulo, K. F., 404 Kalager, M., 417 Kaldor, J. M., 525 Kalichman, S. C., 309, 538 Kalof, L., 574 Kanouse, D. E., 8 Kantrowitz, B., 213 Kaplan, A., 142 Kaplan, H. S., 91, 93, 455, 459, 471 Kaplowitz, P. B., 165 Karlin, G., 474 Kaufman, M., 410 Kavanaugh-Lynch, M. H. E., 415 Kaye, R., 565 Kayser, K., 419 Kearl, H., 562 Keele, B. F., 533 Keesling, B., 450, 451, 452, 453, 470, 604 Keller, S., 14 Kellerman, S. E., 500 Kellogg, N., 163 Kelly, J., 206 Kelly, M. P., 277 Kennedy, A., 609, 621 Kennedy, E., 500 Kennedy, H., 57 Kent, H., 368 Kenyon, E. B., 314 Kertbeny, K. M., 57 Kessler, R. C., 401 Keuls, E., 18 Keys, D., 171 Khalife, S., 585 Khan, A., 64 Khanum, P. A., 64 Kibblewhite, S. J., 130, 152 Kidd, S. A., 614, 617 Kidder, L. H., 564 Kigozi, G., 387, 493 Kigozi, K., 491 Kim, J., 9 Kim, Y. J., 223 Kimerling, R., 565 King, P. A., 501 Kingston, D. A., 319 Kinkel, D., 8 Kinsey, A., 24, 44, 46, 47, 48, 116, 166,

192, 193, 271, 289, 311 Kip, K. E., 488, 500, 507 Kirby, D., 51, 168, 169, 174, 182, 183 Kircher, J. R., 277 Kirkpatrick, L. A., 263, 265 Kissinger, P. J., 544 Klausner, J., 485 Klebanoff , M. A., 507 Klein, D. J., 500

Klein, M., 470, 471, 475 Kleiner, S., 602, 603 Kleinplatz, P., 318 Kleinplatz, P. J., 302 Klentrou, P., 175 Kloner, R. A., 473 Klotz, T., 456 Kluger, J., 25 Knowles, J., 294 Koch, P. B., 98, 442 Koch, W., 593 Kochanek, K. D., 260 Koenig, M. A., 39 Kogevinas, M., 373 Kohlberg, L., 132 Kolata, G., 50 Kolodny, R. C., 213, 410, 450 Komisaruk, B. R., 76, 77, 96, 98, 100, 116,

120, 270 Kong, X., 491 Kontula, O., 447, 448, 449 Koss, M., 405, 584, 605 Koss, M. P., 579, 581 Kost, K., 177 Koumans, E. H., 488, 507 Koutis, A. D., 373 Kowal, D., 331, 332, 338, 339, 344, 347,

352, 353 Kraff t-Ebing, R. v., 44–45 Krakow, B., 584 Kral, M. J., 614, 617 Krane, R., 451 Krivickas, K. M., 225 Kuhns, J. B., 611, 613 Kunkel, D., 9 Kurinczuk, J. J., 367

Laborde, C., 402 Lacey, R. S., 227 Ladas, A., 76 Lafl eur, R. A., 564 Lagarde, E., 387 Lalumière, M. L., 95, 99, 175, 311, 572 Lamaze, F., 390 Lampe, C., 12 LaMunyon, C. W., 261 Landry, V., 349 Lang, S., 19 Langmark, F., 417 Langstrom, N., 309, 313 Larsen, R. J., 234, 263, 265 Larsen, U., 429 Larsson, I., 160 Laties, A. M., 473 Lauman, 50, 236 Laumann, E., 50, 170, 172, 193, 204, 223,

224, 269, 278, 453, 486, 586 Laumann, E. O., 266, 267, 444, 453, 611 Law, M. G., 525 Lawrence-Webb, 134 Laws, D. R., 321 Lee, J. A., 226 Lee, J. E., 407 Lee, J. M., 166 Lee, P. A., 143, 147 Legenbauer, T., 400 Lehne, G. K., 301 Leiblum, S. R., 451, 455

Leibowitz, A. A., 387 Leigh, B. C., 42 Leitenberg, H., 269, 270 Leitzmann, M. F., 424 Lenahan, B., 457 L’Engle, K. L., 12 Lenz, R., 410 Leonard, A. C., 503 Lethbridge-Cejku, M., 411 Letherby, G., 56 LeVay, S., 116 Levenson, R. W., 225 Lever, J., 13, 283, 287, 293, 399, 400, 617 Lewis, J., 206 Lewtas, A. J., 547 Li, N. P., 262 Li, X., 533 Lichtenstein, B., 521 Lidegaard, O., 353 Lindau, S. T., 115, 204 Linden, D. J., 232 Lindstrom, P., 175 Linton, M. A., 579 Lips, H., 116, 241, 247 Lipshultz, L., 474 Lipson, P., 259 Little, A. C., 259 Littlefi eld, 134 Lloyd, B., 404 Lloyd, E., 98 Lloyd, S. A., 203 Locke, B. D., 577 Loenser, K., 400 Lofquist, D., 202, 225 Loftus, J., 443 Logan, C., 301 Logan, T. K., 561 London, S., 375 Long, S., 443 Loulan, J. A., 93 Lovejoy, T. J., 541 Lovell, N., 487 Lowe, K., 38 Lowenstein, L., 307 Lubienski, S. T., 135 Luder, M., 600 Lumeng, J. C., 166 Lussier, P., 315 Luszca, M. A., 221 Lutalo, T., 533 Lutnick, A., 619 LWPES/ESE Consensus Group, 143, 147 Lyerla, R., 611 Lyna, P., 490 Lynne, J., 613

Macaluso, M., 489 Macdowall, W., 443 MacKay, J., 59 Mackey, R. A., 240 Mackey, S., 96 MacNeil, S., 247 Madsen, L., 318 Madsen, S. D., 602, 603 Magnus, M. K., 544 Mah, K., 101, 121 Mahabeer, P., 565 Mahajan, A. P., 521

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NI-7

Mahalik, J. R., 577 Mahay, J., 266, 267 Maier, T., 50 Maisel, N., 400 Malamuth, N. M., 579, 587, 605 Mangum, J. L., 234 Manhart, L. E., 487, 490, 534 Manlove, J., 486 Mann, R. E., 313 Mansfi eld, P. K., 98, 442 Mansson, S., 602 Mansson, S. A., 42 Marchione, M., 426 March of Dimes, 375, 378, 389 Marcofty, J., 199 Margolies, L., 448, 476 Marino, R., 617 Markowitz, L. E., 491, 502 Marks, C., 485 Marks, G., 493, 538, 548 Marlow, F. W., 259 Marrazzo, J. M., 484, 485, 488 Marshall, D., 15 Marshall, L. E., 321 Marshall, W. L., 321 Marsolo, K. A., 503 Martin, C., 24, 44, 46, 47, 116, 166, 192,

193, 271, 289, 311 Martin, E. K., 581 Martin, J. A., 260, 367, 374, 389 Martin, N., 175 Martinez, G. M., 178 Martino, S. C., 8 Martinson, F. E. A., 487 Martsolf, D. S., 589 Marvin, T., 39 Masaro, C. L., 511, 513, 544 Masters, W. H., 48, 49, 51, 93, 108, 213,

282, 410, 450, 459, 467 Matarazzo, H., 172 Matek, O., 315 Matich-Maroney, J., 413 Matteson, D., 200 Maxmen, J., 309 Mayo Clinic, 432, 433, 511 Mays, V. M., 415 McAussian, P., 405 McBean, A., 317 McBride, C. M., 490 McBride, K. R., 430 McCabe, M. P., 408, 410, 575, 583, 610 McCabe, S. E., 403, 407 McCarthy, B. W., 279, 284, 285, 290, 438,

447, 450, 462, 464, 465, 474, 475, 477

McCarthy, E., 279, 284, 285, 290, 438, 447, 450, 464, 465, 477

McClung, M. W., 488 McConaghy, N., 321 McCormick, N., 56 McCoy, K., 225 McDonagh, L. K., 118 McDonald, A., 591 McFarland, W., 485 McFarlane, M., 521 McGarvey, E. L., 404 McGuire, B. E., 118 McKee, A., 605

McKeganey, N., 614 McKinlay, J., 451 McKinney, K., 204 McLawsen, J. E., 318 McMahon, C. G., 294, 295 McManus, B., 226 McManus, S., 293, 443 McNaughton-Collins, M., 432 McNeill, B., 139 McNutt, L., 589 McPherson, K., 586 McWhirter, D. P., 48, 192, 193 Mead, M., 98, 130 Meana, M., 585 Meaney, G. J., 312 Mears, B., 608 Meiners, L. C., 96 Men Can Stop Rape, 582, 584, 585, 586 Menvielle, E., 147 Mercer, C. H., 275, 277, 293, 443, 485 Merrick, M. T., 560 Meston, C. M., 62, 63, 100, 101, 199,

474, 577 Mettenburg, J., 586 Metz, M. E., 462, 610 Meuleman, E. J. H., 115 Meyer, I. H., 460 Meyer-Bahlburg, H. F. L., 130, 152 Meyers, A., 168 Michael, R., 50, 170, 172, 193, 204,

223, 224, 269, 278, 453, 486, 586

Michaels, S., 50, 170, 172, 193, 204, 223, 224, 266, 267, 269, 278, 453, 486, 586

Michaud, P., 600 Miletski, H., 311 Milhausen, R. R., 55, 173, 280, 341, 463,

489, 503, 541 Miller, H., 39 Miller, L., 608 Miller, W. C., 486 Millet, G. A., 493 Milliken, J., 39 Milne, C., 599 Milner, J., 587 Mindel, A., 485 Miner, M. H., 317 Minichiello, V., 617 Mintzes, B., 475 Miu, A., 8 Moalem, S., 259, 260 Moaveni, A., 64 Mohler-Kuo, M., 405 Mokotoff , E. D., 539 Molitor, F., 485 Moller, L. C., 135 Monahan, P., 407 Money, J., 302, 319 Monroe, J., 578 Montagu, A., 242 Montgomery, J. P., 539 Monto, M. A., 289, 610, 615 Montorsi, F., 473 Moore, N. B., 176 Moore, A. M., 355 Moore, G. R., 503 Moreau, C., 402 Moreiba, E., 457

Morgan, E. M., 600, 602, 603 Morrill, A. C., 61, 534 Morris, M., 39 Morrison, D. M., 42 Morrison, T. G., 118 Mortensen, P. B., 353 Morton-Bourgon, K. E., 579 Moser, C., 302, 304, 318 Moses, S., 387, 491 Mosher, B. S., 178 Mosher, D. L., 274, 275 Mosher, W. D., 170, 174, 200, 236, 327,

349, 352 Motluk, A., 175 Movement Advancement Project, 570,

571, 621 Moynihan, R., 475 Moysich, K. B., 422 Muehlenhard, C. L., 56, 99, 287, 575,

577, 579 Mukherjee, R. A. S., 373 Munabi, S. K., 491 Muncher, S. J., 577 Munk Laursen, T., 353 Munk-Olsen, T., 353 Murphy, W., 314 Murray, P. J., 488 Mushovic, I., 566 Must, A., 165, 166 Muth, S. Q., 613 Myers, W. J., 588

Nacopoulos, A. G., 547 Nagaraja, J., 311 Nagel, J., 60 Najman, J. M., 589 Nakano, M., 62 Nalugoda, F., 491 Nanda, S., 19 Nandwani, R., 611 Nasserzadeh, S., 77, 96, 98, 100,

116, 120 Nathan, S. G., 451, 455 Nathanson, C. A., 223 Th e National Campaign to Prevent Teen and

Unplanned Pregnancy, 12, 13, 176, 177, 178, 179, 180

National Cancer Institute, 211, 413, 414, 415, 424

National Center for Environmental Health, 457 National Center for Family & Marriage

Research, 201 National Center for Health Statistics, 52,

53, 531 National Center for Missing and Exploited

Children, 612 National Coalition of Anti-Violence

Programs, 567 National Guidelines Task Force, 190 National Institute of Allergy and Infectious

Diseases, 525, 551 National Institute of Child Health and

Human Development, 431, 432 National Institute of Mental Health, 400,

401, 402, 403 National Institute on Aging, 115, 211, 212,

213, 215, 411 National Institutes of Health, 491

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NI-8

National Organization for Victim Assistance, 585

National Vulvodynia Association, 431 National Women’s Health Information

Center, 432, 491 Navarro, M., 50 Navarro, R. L., 40, 194 Neale, M. C., 175 Nehra, A., 474 Nelson, A. L., 331, 332, 338, 339, 344, 347,

352, 353, 484 Nelson, L. J., 602, 603 Nelson, T. F., 403 Ness, R. B., 422, 488, 500, 507 Nevid, J. S., 240 Newman, L., 607 Newring, K. A. B., 308 Niccolai, L. M., 544 Nichols, L., 566 Nichols, M., 450 Nicolosi, A., 457 Nielsen, M., 417 Nielson, C. M., 488 Niemann, Y., 139 Nkanginieme, K., 429 Noar, S., 546 Nobre, P., 120 Nordling, N., 319 Nordone, A., 209 Norris, J., 309, 404 North American Menopause Society, 212 Nusbaum, M. R., 451, 457

Oades, G., 71 Oakley, A., 133 O’Brien, B. A., 240 Odette, F., 410 O’Donohue, W. T., 321 Offi ce on Women’s Health, 578 Ogden, G., 270, 463 Ogilvie, G., 511, 513, 544 Ohl, M. E., 541 Okazaki, S., 63, 139, 240 O’Keeff e, G., 72 Okonofua, F. E., 429 Okundaye, 134 Oldenberg, C. M., 564 Olsen, J., 373 Olson, C. D., 602, 603 Ontai, L. L., 62 Oronsaye, F., 429 Orr, D. P., 42 Oskin, T. A., 473 Osler, M., 443 Ostrow, D. E., 538 O’Sullivan, L. F., 268, 447, 577 Ott, A., 542 Ousterhout, M. M., 547 Owen, C., 507 Owen, J., 261, 262 Owen-Anderson, A., 130, 152 Owens, A. F., 316

Paans, A. M., 96 Pace, C. R., 473 Padilla-Walker, L. M., 602, 603 Padma-Nathan, H., 473 Paepke, A. J., 260

Page, J., 314 Page-Shafer, K., 485 Paik, A., 234, 262, 444, 453, 611 Palmateer, N., 547 Palmisano, G., 97 Palomaki, G., 368 Panzer, C., 97 Paolucci, E. O., 589 Paone, D., 39 Papp, J., 488 Parke, S., 96 Parker, C. B., 387, 491 Parker, R., 132 Parker, W. Y., 357 Parrinder, G., 14 Parson, J. T., 432 Parsons, C., 577 Parsons, J. T., 305, 314, 319, 320, 399 Parsons, S., 318 Partrick, D. M., 511, 513, 544 Pasco Fearon, R. M., 167 Patelarou, E., 373 Paterson, A. D., 175 Patnaik, J. L., 488 Patterson, T. L., 407 Paul, B., 600 Paul, C., 491 Paul, E. L., 226 Paul, P., 601 Pavao, J., 565 Paz-Bailey, G., 488 Pazol, K., 357 Pearce, G., 250 Pedersen, B., 443 Pedersen, C. B., 353 Pempek, T. A., 12, 13 Pepitone, M., 175 Peplau, L. A., 224, 399, 400 Perdue, S. T., 487, 540 Perel, E., 449, 460 Perencevich, E., 541 Perera, B., 407 Perrin, P. B., 223 Perry, J. D., 76 Pertot, S., 21, 24, 448, 449, 468 Perz, J., 419 Petersen, J., 424 Peterson, I., 485 Peterson, Z. D., 56, 575, 577 Peterson, Z. E., 423 Peterson-Badali, M., 130, 152 Petta, I., 586 Pew Internet & American Life Project, 12 Pew Research Center, 205 Phelan, P., 588 Phelps, J. L., 577 Phillips, J. A., 504 Phillips, M., 99 Phillips-Plummer, L., 613 Piche, L., 315 Pierce, A., 488 Pillard, R. C., 175 Pinheiro, A. P., 402 Pinkerton, S. D., 275, 544 Pinto, 373 Pistole, M. C., 233 Pittet, I., 600 Pitts, M., 171

Pizarro, M., 139 Plana, E., 373 Planned Parenthood, 334, 335, 336, 337,

338, 416 Platz, E. A., 424 Poehling, 374 Pogrebin, L. C., 160 Polaris Project, 612 Policar, M. S., 331, 332, 338, 339, 344,

347, 352, 353 Pollis, C. A., 56 Pomeroy, W., 24, 44, 46, 47, 116, 166, 192,

193, 271, 289, 311 Ponch, I. G., 577 Pontari, M. A., 432 Pope, H. G., 401 Popp, D., 133 Population Connection, 376 Porter, J., 62 Potdar, R., 39 Potterat, J. J., 613 Poulson, G., 367 Powell, B., 623 Powell, E., 560 Prause, N., 224 Prejean, J., 527 Preston, M., 263 Price, M., 315 Price, P., 240 Prieto, L., 139 Primack, B. A., 7 Prince, V., 308 Prins, M., 619 Pruitt, S. L., 503 Purdie, D. M., 589 Puren, A., 387 Putnam, F. W., 586, 587 Pyke, K., 134

Qian, A., 529, 530 Quay, L., 182 Quayle, E., 315 Queen, C., 613, 614 Quigley, M., 367 Quinn, M., 421 Quinn, S. C., 500 Quinn, T. C., 387, 525, 533 Quinsey, V. L., 572 Quintus, B. J., 261

Racette, S., 320 Raff aelli, M., 62 Raffl e, A. E., 421 Raj, A., 56, 487 Rakai Project Team, 533 Ramsey, S., 71 Rand, M., 560 Randall, H. E., 281 Randolph, M. E., 404 Raney, T. J., 402 Rankin, J., 374 Rape, Abuse, and Incest National Network,

573, 578, 580, 582, 584, 585 Rape Network, 584 Rashidian, A., 64 Rathus, S. A., 240 Rawlinson, L., 451 Raymond, N., 317

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NI-9

Reece, M., 50, 55, 71, 172, 176, 193, 194, 272, 276, 277, 278, 293, 407, 445, 446, 452, 453, 464, 473, 531

Reece, R., 450, 459, 476 Reed, E., 56 Reed, J. B., 493 Regan, P. C., 286 Regnerus, M. D., 170 Reifenrath, B., 456 Reifman, A., 227 Reimers, S., 42 Reinders, A. A., 96 Reinholtz, R. K., 287 Reinisch, J. M., 192, 193, 280, 281 Reiss, I., 24, 198, 219 Reitman, V., 474, 475 Renfro, S., 144 Reppucci, N. D., 587 Resick, P. A., 581 Resnick, P. J., 316 Reuters, 378 Reverby, S. M., 500, 501 Reynolds, G., 370 Reynolds, M., 161 Reyonds, A., 310 Reznik, Y., 168, 170 Rhodes, P. H., 544, 546 Rice, M. E., 572 Richards, K., 144 Richters, J., 170, 193, 293, 452, 453 Rickert, V. I., 576 Rideout, V., 9 Ringwood, K., 485 Riscol, L., 474 Rissel, C. E., 170, 193, 293, 452, 453 Roan, S., 431 Roberts, S., 623 Roberts, S. J., 415 Robertson, K., 587 Robillard, A., 60 Robinson, J. P., 135 Robinson, P., 44 Robinson, W. P., 375 Robson, S., 9 Rochkind, J., 542 Rodin, J., 61, 534 Roesler, T. A., 586 Rogan, W. J., 374 Rogers, S. M., 39 Rogler, L. H., 59 Roisman, G. I., 225 Roller, C., 589 Romanowski, B., 504 Rompa, D., 309 Rosario, M., 193, 195 Roscoe, W., 19, 153 Roselli, C., 33 Rosen, D. S., 400, 402, 403 Rosen, R., 411, 451 Rosen, R. C., 444, 453 Rosenberg, S. J., 473 Rosenthal, L., 225 Rosman, J., 316 Ross, M. W., 42, 317, 500, 617 Ross, R., 589 Rosser, B. R. S., 456 Roth, W., 427 Roth, W. T., 400, 402

Rothblum, E. D., 224 Rothblum, R., 224 Rothenberg, R. B., 613 Rothenberg, R. M., 423 Rothman, E. F., 567 Royce, T., 13 Rozas, A., 593 Rubin, K. H., 135 Rudd, J. M., 588 Ruiz, J., 485 Rupp, L. J., 308 Rural HIV/STD Prevention Work

Group, 541 Rutledge, B., 411 Rutter, 373 Ruzic, J., 603 Ryan, S., 486 Ryder, A. G., 63 Rye, B. J., 312

Sachs-Ericsson, N., 589 Sadker, D., 134 Salazar, L. F., 42 Saltzman, L. E., 573, 586 Sampson, R., 576, 580, 581 Sanchez, Y. M., 61 Sandberg, D. E., 149 Sanders, S. A., 50, 55, 71, 94, 172, 173,

176, 192, 193, 194, 272, 276, 277, 278, 280, 293, 341, 445, 446, 452, 453, 464, 473, 488, 531, 545

Sandfort, T. G., 450, 459, 478 Sandnabba, N. K., 319 Sandoval, M., 419 Sansom, S., 529, 530 Santtila, P., 319 Sarkar, S., 611 Sarnquist, C. C., 541 Sarri, K., 373 Saslow, D., 204 Satterwhite, C. L., 494 Sauvageau, A., 320 Savic, I., 175 Savin-Williams, R. C., 171, 172 Savoy, H. B., 40, 194 Sawyer, K. A., 204 Sawyer, R., 618 Sawyer, S., 610 Sayad, B. W., 182 Scalia, A., 608 Scalora, M. J., 318 Schact, R. L., 404 Schecter, E., 91 Scheer, S., 485 Schei, B., 611 Schick, V., 50, 55, 71, 172, 176, 193, 194,

272, 276, 277, 278, 293, 445, 446, 452, 453, 473, 531

Schiller, J. S., 411 Schiraldi, G., 618 Schmidt, C. W., 318 Schmidt, P., 615 Schmitt, D. P., 260, 263 Schnarch, D., 277, 448, 460, 466 Schoenbach, V. J., 236, 487 Schooler, D., 9 Schootman, M., 503 Schrader, R., 584

Schrimshaw, E. W., 539 Schultz, J., 588 Schulz, S. L., 483, 515 Schwartz, 307, 321, 451 Schwartz, I. M., 178 Schwartz, J., 33, 621 Schwartz, P., 223, 224, 285, 287, 288, 289 Schwarz, E. B., 7 Schwarzer, U., 456 Schwimmer, B., 15 Scorolli, C., 307 Scott, J. A., 368 Scott, J. L., 419 Scott, J. P., 227 Scott-Sheldon, A. J., 487, 546 Scrimshaw, E. W., 193, 195 Seal, B. N., 63 Sears, A. E., 608 Sedlak, A. J., 586 Seebeck, T., 260 Seeberg, D., 487 Seger, M., 474 Seligman, L., 301, 313 Semmelroth, J., 234 Semple, S. J., 407 Senn, T. E., 487, 590 Serran, G. A., 321 Serwadda, D., 387, 491, 525, 533 Seto, M. C., 95, 99, 313, 317, 318 Sevgi, A., 406, 407 Sewankambo, N. K., 525, 533 Seward, D. X., 487 Shackelford, T. D., 263, 265 Shackelford, T. K., 234, 236, 261 Shackelton, R., 451 Shafer, M., 487 Shain, R. N., 487, 540 Sharma, A. K., 521 SHARP Research Team, 546 Shaver, P., 230, 231 Shen, W., 286 Shilts, R., 490, 536 Shim, J. W., 600 Shippee, S. K., 99 Shirai, J., 457 Shlay, J. C., 488 Shon, S., 62 Short, B. J., 456 Sickmund, M., 587 SIECUS, 17, 31, 181, 182, 183, 190, 623 Siegel, J. M., 585 Siegel, K., 539 Sigmundson, H. K., 147 Sili, M. E., 511 Sill, M., 208 Silverberg, C., 410 Silverman, J. G., 487 Simon, W., 188, 266 Simonelli, C., 455 Simon Rosser, B., 317 Simpson, J., 233 Simpson, V. L., 586 Simpson, W., 315 Singer, D., 503 Singh, D., 130, 152 Singh, S., 487 Sionean, C., 170, 174, 200, 546 Sitta, R., 387

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NI-10

Skakkebaek, N. E., 424 Slanger, T. E., 429 Slater, L., 232 Slater, P., 98 Slaymaker, E., 611 Slowinski, J., 474, 475 Smith, A., 452, 453 Smith, A. M., 170 Smith, A. M. A., 193, 293 Smith, M. W., 565 Smith, R. A., 204 Smith, S. C., 560 Smith, T. W., 250 Smoak, N. D., 546 Snow, R. C., 429 Snyder, D., 237 Snyder, H. N., 587 So, H., 240 Sobngwi-Tambekou, J., 387 Sockloskie, R. J., 579 Solomon, J., 565 Solomon, S., 224 Solomon, S. E., 224 Sommer, F., 456 Song, R., 527 Sorenson, S. B., 585 Sorsoli, C. L., 9 Speakman, M. J., 464 Sprecher, S., 168, 204, 221, 223, 245 Stahn, C. A., 400 Stampfer, M. J., 424 Stancil, T. R., 487 Staples, R., 59, 60, 179 Steelman, L. A., 623 Stein, R., 286 Steinberg, S., 12 Steinfi eld, C., 12 Steingraber, S., 166 Stekler, J., 537 Stern, S., 14 Sternberg, M., 488, 502 Sternberg, M. R., 491 Sternberg, R. J., 227, 229, 230 Sternberg, S., 526, 612, 614 Stewart, C. S., 577 Stewart, F., 484 Stewart, P., 608 Stigum, H., 611 Stinnett, R., 315 Stohl, E., 408 Stoner, S. A., 309, 404 Storms, M. D., 193 Stothard, K. J., 374 Strage, M., 108 Strandberg-Larsen, K., 373 Strasburger, V., 531 Strasburger, V. C., 8, 9 Strassberg, D. S., 38, 277 Strathdee, S. A., 407 Street, A. E., 565 Striepe, M. I., 131 Strobino, D. M., 260 Strote, J., 407 Struckman-Johnson, C., 578 Struckman-Johnson, D., 578 Stulhofer, A., 5, 108, 603 Su, J. R., 498 Sue, S., 580

Sullivan, P. S., 500, 550 Suman, 14 Sundquist, K., 419 Supreme Court of the United States, 621 Suris, J., 600 Sutton, P. D., 374 Svedin, C. G., 160 Svoboda, E., 260 Swain-Campbell, 585 Swan, A. W., 223 Sweeney, C., 71 Swinkels, A., 464 Symons, D., 98

Taberner, P. V., 405 Tabrizi, S. N., 507 Taft, T. T., 581 Taleporos, G., 408, 410 Taljaard, D., 387 Talley, D. R., 473 Tanaka, J. S., 579 Tandberg, D., 584 Tanfer, K., 487 Tannen, D., 248 Tanner, L., 32 Tao, G., 484 Tasker, K., 259 Tavernise, S., 201 Taylor, V., 308 Tbarra, 14 Teitle, E., 487 Templeman, T., 315 Tennant, P. W. G., 374 Tepper, M. S., 316 Teten, A. L., 580 Th ables, V., 206 Th ayer, L., 243 Th omas, 237 Th omas, K. K., 485, 490, 534 Th omas, S. B., 500 Th omas, S. L., 491 Th omas, V., 134 Th omas, W., 19 Th ompson, B., 226 Th ornton, S., 500 Th orton, L. M., 402 Th une, I., 259 Th urlow, K., 589 Th urman, A. R., 487, 540 Th urmes, P. J., 456 Tian, L. H., 494 Tider, D., 432 Tiefer, L., 20, 99, 209, 475, 606 Tiegs, T. J., 223 Tikkanen, R., 42 Timpson, S. C., 617 Tobian, A. A., 387 Tobian, A. A. R., 491 Todd, M. J., 220 Tolman, D. L., 9, 95, 131 Tomassilli, J. C., 305, 314, 319, 320 Torabi, M. R., 489, 492, 542 Toro-Morn, M., 223 Torres, H., 404 Torres, I., 500 Tourangeu, R., 39 Tovee, J., 259 Traeen, B., 602

Trager, J. D., 72 Tran, S., 233 Treas, J., 237 Trenholm, C., 182 Tronstein, E., 504 Trujillo, C. M., 200 Trump, D. L., 116 Truong, H. M., 537 Trussell, J., 176, 331, 332, 338, 339, 344,

347, 352, 353, 484, 611 Tully, C. T., 432 Turner, A. N., 491 Turner, C. F., 39 Turner, J. S., 588

Uchino, B. N., 250 Ullman, S. E., 584 Ulrichs, K., 57 UNAIDS, 521, 526, 527 Unger, E. R., 488 United Nations General Assembly, 413 United Nations Human Rights Offi ce of the

High Commissioner, 622 United Nations International Children’s

Emergency Fund, 612 Urban, M., 590 U.S. Attorney General’s Commission on

Pornography, 604, 605 U.S. Bureau of Justice Statistics, 560 U.S. Census Bureau, 12, 196, 197, 201,

202, 205, 207 U.S. Department of Health and Human

Services, 195, 413, 490, 493, 503, 551

U.S. Department of Justice, 573, 575, 580, 582, 586

U.S. Department of Labor, 392 U.S. Department of State, 612 U.S. Equal Employment Opportunity

Commission, 559, 562 U.S. Merit Systems Protection Board,

559, 561 U.S. Public Health Service, 391 Ussher, J., 419

Valente, S. M., 587 Valenti, J., 140, 141 Valera, R., 618 Vanable, P. A., 590 van Cott, T., 533 van de Alaar, M. J. W., 619 van der Graff , F. H., 96 Vanderpool, R., 503 van Lankveld, J., 442 van Leeuwen, P. A., 619 Vannier, S. A., 447 Vannoy, S. D., 318 Van Ora, J., 432 van Roode, T., 491 van Veen, M. G., 619 Vardavas, C. I., 373 Veenker, C. H., 492 Velez-Blasini, C. J., 405 Ventura, S. J., 367, 389 Vera, E., 139 Verschuren, J. E. A., 409 Vigil, J., 260, 261 Vinikoor, L. C., 439

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NI-11

Violato, C., 589 Vitale, A., 152 Vocks, S., 400 Vrangalova, Z., 172 Vukadinovic, Z., 317

Wabwire-Mangen, F., 525, 533 Wade, B. H., 574 Wagner, G. J., 500 Wald, A., 488 Waldner-Haugrud, L., 583 Walker, J., 584 Wallace, H. M., 579 Wallace, R., 213 Waller, M. W., 485 Wallerstein, J. S., 206 Walls, N. E., 565 Walster, G. W., 235 Walter, C., 232 Walters, M. L., 560 Wan, J., 451 Wang, L., 388 Ward, H., 613 Ward, N., 309 Ward, T., 321 Warner, D. L., 611 Warren, T., 504 Wasserheit, J. N., 533 Wauchope, M., 575, 583 Wawer, M. J., 491, 525, 533 Webb, P., 10 Wechsler, H., 403, 405, 407 Wedekind, C., 260 Weekes-Shackelford, V. A., 261 Weeks, J., 57 Weinberg, M. S., 193, 304, 311, 602, 603 Weingert, P., 213 Weinstock, A. A., 498 Weinstock, H., 485, 494 Weis, D. L., 37 Weisberg, D. K., 613 Weiss, H. A., 491 Weissfeld, J., 116 Weitzer, R., 610, 615 Wellings, K., 275, 277, 293, 402, 443 Wells, B. E., 116, 432 Wells, C. V., 564 Wells, H. B., 50 Wells, M., 234

Welsh, D. P., 227, 262 Wenzel, A., 221 Werner, M., 504 Wessels, H., 411 West, B. T., 403 West, S. L., 439 Westen, D., 234 Wheeler, J., 182, 308 Whipple, B., 76, 77, 96, 98, 100, 116, 120,

270, 294 White, E., 415 Whitehead, M., 206 Whitemean, M., 423 Whitty, M., 605 Wibbelsman, C. J., 487 Widdice, L. E., 503 Widom, C. S., 611, 613 Wiederman, M. W., 38 Wiegel, M., 411 Wiemann, C. M., 576 Wienke, C., 224 Wierman, M. E., 442 Willet, W. C., 424 Willhoite, M., 607 Williams, C. J., 304, 311, 602, 603 Williams, M. L., 617 Williams, T., 175 Willis, G., 39 Wilson, D. P., 525, 537 Wilson, S., 456 Wingood, G. M., 8, 60 Winters, J., 122 Winters, S. J., 116 Wise, M., 432 Wise, T. N., 318 Wiseman, J., 318 Witte, S. S., 490, 539, 544 Wolitski, R., 537 Wolitski, R. J., 544, 546 Wolke, D., 367 Wolliscroft, J., 589 Wolman, W., 405 Wonderlich, S. A., 589 Wood, J. M., 98, 442 Wood, M. L., 240 Wood, R. W., 537 Woodworth, T. W., 578 Working Group for a New View of Women’s

Sexual Problems, 440, 442

World Association for Sexual Health, 23 World Health Organization, 129, 145,

182, 183, 387, 391, 398, 429, 440, 491

World Professional Association for Transgender Health, 154

Worthington, R. L., 40, 194 WPATH, 153 Wright, E. M., 487 Wu, E., 490, 539, 544

Xantidis, L., 610 Xu, F., 491

Yarber, W. L., 5, 50, 55, 173, 178, 182, 235, 280, 341, 463, 488, 489, 492, 493, 503, 541, 542, 545

Yarnall, K. S. H., 490 Yates, A., 405 Yates, P. M., 319 Yawn, B. P., 179 Yawn, R. A., 179 Yee, C., 400 Yermolayeva, Y. A., 12, 13 Ying, Y., 134 Yoon, H. C., 250 Yost, M. R., 269 Young, J., 134 Younger, J., 96 Young Women’s Survey Team, 485

Zaidi, A. A., 498 Zane, S. B., 357 Zattoni, S., 307 Zawacki, T., 405 Zelen, M., 417 Zians, J., 407 Ziebell, R., 527 Zilbergeld, B., 138, 214, 439, 461, 463 Zimet, G. D., 42 Zimmerman, R., 489 Ziomkiewicz, A., 259 Zittleman, K., 134 Zolnoun, D., 439 Zucker, K. J., 130, 152, 175, 309 Zuckerman, M., 33 Zurbriggen, E. L., 269 Zurenda, L., 149 Zylbergold, B. A., 9

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SI-1

AAP (American Academy of Pediatrics), 387, 391

AAUW (American Association of University Women), 563

“abnormal” sexual behavior, 20, 24, 48 abortifacients, 346 abortion

constitutional issues, 356–357 men and, 355 methods of, 346, 352–353, 353 f pro-choice argument, 355–356 pro-life argument, 355 Roe v. Wade court decision, 356 safety of, 353 spontaneous, 352, 378 stage of pregnancy and, 352,

352 f, 353 statistics on, 352, 352 f, 354, 354 f women and, 354, 354 f

abstinence aff ection and, 332 as birth control, 181–183,

331–333 celibacy vs., 331 defi nitions of, 281 education programs, 51, 181–183 eff ectiveness of abstinence-only programs,

51, 182–183 sexually transmitted infections

and, 511 abstinence-only sexuality education,

51, 181–183 abstinence standard, 198 abuse. See child sexual abuse; rape; sexual

aggression academic freedom, 50 acaults, 153 acculturation, 61–63, 62 f ACHES acronym, 335 acne, 114 ACOG. See American College of

Obstetricians and Gynecologists acquaintance rape, 576, 578, 580. See also

date rape acquired immunodefi ciency syndrome

(AIDS). See HIV/AIDS acrosomes, 363 activity exposure, gender-role learning

and, 133 addiction, sexual, 303, 316 Adiana, 350

adolescents. See also boys and young men; girls and young women

contraception and, 330, 337 defi nition of adolescence, 164 eating disorders in, 400–402 fi rst intercourse, 173–174, 173 t,

176, 176 f, 178 Gardasil vaccination of, 420, 424,

430, 503 gay, lesbian, and questioning, 11,

170–172, 540, 566–567 gender-role learning by, 133–137 health risk behaviors in, 53, 540 HIV/AIDS among, 540–541, 540 f masturbation by, 172–173, 173 t media exposure in, 6, 6 f, 8, 8 f, 10 online social networks and, 11–14 parental infl uence on psychosexual

development, 167–168, 168 f peer infl uence on, 135–136 physical changes in, 164–166, 165 f pregnancy in, 176–181, 177 f, 179 f in prostitution, 612, 613 risk behavior by, 53 rural, 541 sexting by, 12–13, 606 sex traffi cking of, 612 sexual activity with love in, 221–224 sexual assault of, 573 sexual harassment in high school,

562–563 sexuality education, 181–183, 181 f, 190 sexually transmitted infections in, 483,

485, 486, 491 sexual scripting by, 268 statutory rape, 581–582 suicide by, 566–567 teenage fathers, 180–181 teenage mothers, 179–180

adoption infertility and, 380 by same-sex couples, 225

adulthood. See early adulthood; late adulthood; middle adulthood

advertising, sexual sell in, 7–8, 403 advice columns, 31 Th e Advocate magazine, 283, 293 aff ection

abstinence and, 332 in families, 164 sexual activity and, 199

aff ectionate touch, 284 Africa, HIV/AIDS in, 526 f African Americans. See also race and

ethnicity abortions in, 354 breast cancer in, 414 breastfeeding by, 391 communication about sex and sexuality

by, 240 gay men and lesbian women, 200,

536–537, 537 f HIV/AIDS conspiracy beliefs among,

500–501 HIV/AIDS in, 528–529, 528 f, 529 f,

529 t, 534–535, 538, 540, 553 homosexual identities of, 200 precocious puberty in, 165 prostate cancer in, 424, 424 f sexual assaults on, 573 sexual behavior prevalence in, 276 f sexually transmitted infections in, 485 f,

486 f, 497, 500–501 sexual stereotypes of, 59–60 socioeconomic status and, 60–61 teenage pregnancy in, 179, 374 traditional gender roles of, 134, 139 Tuskegee syphilis study, 500–501

afterbirth (placenta), 364 f, 366, 385–386, 385 f

agape, 226 age groups

HIV infection by, 540 f masturbation and, 272 t oral contraceptives and, 335

age of consent, 581 aging. See also late adulthood

accepting the aging process, 203 male erectile disorder and, 451 sexual activity and, 209–210, 210 f sexual desire and, 447, 447 f sexual dysfunction and, 444 f, 445, 451 sexuality and, 209–215, 210 f sexually transmitted infections and, 485 sexual response and, 213–214 stereotypes of, 208–209 testosterone replacement therapy and,

115, 215 AI (artifi cial insemination), 381, 383 AIDS (acquired immunodefi ciency

syndrome). See HIV/AIDS AIDS Memorial Quilt, 552 f

Subject Index Subject Index

Note: Page references followed by italicized “ f ” or “ t ” refer to fi gures or tables, respectively.

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SI-2

Alaska Natives. See also American Indians HIV/AIDS in, 528 f, 529 f, 529 t, 536 sexually transmitted infections in,

485 f, 486 f alcohol use

adolescent sexual activity and, 33 binge drinking, 404 casual sex and, 262 by college students, 33, 404–405 date rape and, 576, 578, 580 male rape and, 582 in pregnancy, 372–373 prostitution and, 610, 613 risky sex behavior and, 404–405, 488 sexual function diffi culties and,

404–405, 457 sexually explicit materials and, 602 sexually transmitted infections and, 487,

488, 490, 536, 538–540 sexual response and, 43–44, 95–96,

404–405, 406 f allergies

to latex condoms, 342, 489, 512 to spermicides, 345

alpha-fetoprotein, 378 5-alpha reductase syndrome, 150–151 alveoli, in the breast, 78, 79 f amebiasis, 508 amenorrhea, 88, 400 American Academy of Pediatrics (AAP),

387, 391 American Association of University Women

(AAUW), 563 American Cancer Society

on breast cancer screening, 415, 415 f, 417 on cervical cancer, 420, 421 on prostate cancer, 424–426 on testicular cancer, 426–428

American College of Obstetricians and Gynecologists (ACOG)

on circumcision, 387 on episiotomy, 388 on hymenoplasty, 76 on pregnancy screening, 377

American College of Physicians, 417 American Indians

eating disorders in, 400 HIV/AIDS in, 528 f, 529 f, 529 t, 536,

537 f, 538 homosexuality in, 201 sexually transmitted infections in,

485 f, 486 f teenage birth rates in, 177 f, 179 two-spirits in, 19, 153

American Psychiatric Association on anorexia nervosa, 400 Diagnostic and Statistical Manual of

Mental Disorders, 151, 300, 300 t, 302, 439–440

on eating disorders, 400–401 on paraphilias, 304, 309 removal of homosexuality from disorder

list, 17, 58 on sexual function categories, 439–442,

441 f, 447 American Psychological Association

on body image, 9, 13 on gender identity disorder, 151

on paraphilias, 300, 300 t, 302 removal of homosexuality from disorder

list, 17, 58 on the sexualization of girls, 166 support for sex research by, 31

American Social Health Association (ASHA), 503

American Society of Plastic Surgeons, 399 American Sociological Association, 58 amniocentesis, 377, 377 f amnion, 364 amniotic fl uid, 364, 384 amniotic sac, 364, 364 f ampulla, 78, 110 f, 111 amyl nitrate, 320, 406 anabolic steroids, 403 anal cancer, 424, 430, 503 anal eroticism . See also anal intercourse

analingus, 113, 291, 293 anal-manual contact, 293 condom use in, 341 defi nition of, 291 statistics on, 174, 293

analgesics, 387 analingus, 113, 291, 293 anal intercourse. See also anal eroticism

anal cancer and, 424, 430, 503 anodyspareunia in, 456 antisodomy laws, 567, 568 f, 620–621 aversion to, in gay men, 476 by college students, 54, 54 f condoms in, 341, 514, 531, 537 by gay men, 293, 294 f as “having sex,” 281 hepatitis A transmission in, 505 lubrication in, 112–113 by male prostitutes, 617 microbicidal gels in, 552 prevalence of, 174, 293 prostate and, 113 race and ethnicity and, 276 f, 293 safety of, 78, 293 sexually transmitted infections and, 294,

487, 531, 537–538, 552 anal-manual contact, 293 anal stage, 45 anatomical sex, defi nition of, 127 anatomy. See female sex organs; male

sex organs androgen insensitivity syndrome (AID),

146 t, 149–150 androgens, 114. See also male reproductive

hormones; testosterone androgyny, 142–143 andropause, 213–214 anesthetics, 387 anger, sexual desire and, 447 anger rapes, 583 Anglo Americans. See White Americans animals, sexual contact with, 311 anodyspareunia, 392, 441 t, 456, 457 anorexia nervosa, 88, 400–401, 400 f, 401 f anorgasmia, 452 antibiotic resistance, 491, 497 antibodies, 523, 524 antibody tests, 549 anti-gay prejudice, 566–570 antigens, 523

antihistamines, 457 antiprostaglandins, 89 antiretroviral therapy (ART), 546, 551, 553 antisodomy laws, 567, 568 f, 620–621 anus, 71 f, 73 f, 78. See also anal eroticism anxieties, sexual, 108, 459 anxious/ambivalent attachments, 233 Apgar score, 386 aphrodisiacs, 405 appearance, sexual attractiveness and. See

sexual attractiveness Arapesh people, 130 areola, 78, 79 f arguments. See confl ict, about sex arousal. See sexual arousal ART (antiretroviral therapy), 546, 551, 553 ART (assisted reproductive technology), 381 arthritis

chlamydia and, 496 sexuality and, 411–412

artifi cial insemination (AI), 381, 383 asexuality, 192 f, 193, 224 ASHA (American Social Health

Association), 503 Asian Americans. See also race and ethnicity

acculturation of, 62–63 communication about sex and

sexuality, 240 gender roles, 134, 139 HIV/AIDS in, 528 f, 529 f, 529 t,

535–536, 537 f, 538 homosexuality in, 200 sexual behavior prevalence in, 276 f sexuality in, 62–64 sexually transmitted infections in,

485 f, 486 f teenage birth rates in, 177 f, 179 f

asphyxiphilia, 305, 320–321 assigned gender, 127, 129 assisted reproductive technology (ART), 381 atherosclerosis, sexual dysfunction in, 457 attachment, 230–231, 233 attractiveness. See sexual attractiveness atypical sexual behavior. See sexual variations audio computer-assisted self-interviewing

(audio CASI), 39 Australian Study of Health and

Relationships, 452 autoerotic asphyxia, 305, 320–321 autoeroticism, 268–278. See also masturbation

autofellatio, 289 defi nition of, 268 Freud on, 45 sexual dreams, 271 sexual fantasies, 269–271

autofellatio, 289 Avodart, 426 avoidant attachments, 233 “azoles,” 507

babyism, 306 bacterial vaginosis (BV), 484–485, 488, 490,

506–507 Bad Blood: Th e Tuskegee Syphilis Experiment

(Jones), 500 Bartholin’s glands, 71 f, 73 basal body temperature (BBT) method,

347, 348

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SI-3

B cells, 523 B&D (bondage and discipline), 305,

305 f, 318 BDSM (bondage, discipline, sadism, and

masochism), 318 beginning relationships, 243–246 behaviorist approach, 131–132 benign prostatic hypertrophy (BPH), 214–215 benign tumors, 413 benzodiazepines, 578 bestialists, 311 bestiality (zoophilia), 311 betrayal, in child sexual abuse, 590–591 biased samples, 37 biases, 34–35 bicycle-riding, sexual diffi culties and, 457 big brother eff ect, 175 binge drinking, 404 binge eating, 401 binge eating disorder, 401–402, 401 f biopsies, 421, 425 biopsychosocial approach, 25 biphobia, 194 birth. See childbirth birth canal, 74. See also vagina birth control

abstinence, 181–183, 331–333 adolescents and, 330 barrier methods, 338–345 birth control patch (Ortho Evra),

336–337, 336 f birth control shot (Depo-Provera),

335–336 college students and, 54, 54 f condoms, female, 342–343, 342 f,

489, 512 condoms, male ( See condoms, male) contraception vs., 330 contraceptive fi lm, 345, 345 f contraceptive foam, 345 contraceptive patch, 336–337, 336 f costs of, 329, 330 diaphragm, 343–344, 343 f education on, 51, 181–183 emergency contraception, 351–352 failure rates of, 327, 332 t family planning clinics, 328, 330 FemCap and Lea’s Shield, 344, 344 f fertility awareness–based methods,

347–348, 347 f hormonal methods, 333–338 implants, 338 injectable contraceptive, 335–336 intrauterine devices (IUC or IUD),

346–347, 346 f in Japanese American culture, 63 lactational amenorrhea method, 348–349 in Latina culture, 62 media portrayals of, 9 method choice, 331 oral contraceptives, 333–335, 334 f ovarian cancer risk and, 422 parenthood as choice and, 367 “perfect use” vs. “typical use,” 331, 332 t prevalence of use, 327, 327 f reasons for failure to use, 329 research issues, 357 responsibility for, 327–328

spermicides in, 343–345 sponges, 344, 344 f sterilization, 349–351, 349 f, 350 f, 351 f unintended pregnancies, 326–327, 327 f vaginal ring (NuvaRing), 337–338, 337 f vaginal suppositories, 345

birth control patch (Ortho Evra), 336–337, 336 f

birth control pills, 333–335, 334 f birth control shot (Depo-Provera), 335–336 birth defects, 372–373, 381 birthing rooms and centers, 390 birth order, homosexuality and, 175 birth plans, 388 birth rates, 176, 177 f, 179 f, 367–368 bisexuality. See also gay men, lesbian women,

bisexual and transgender individuals defi nition of, 17 discrimination against, 566–567 HIV infection in, 536 identity formation, 194 media stereotypes of, 11 in models of sexual orientation,

192–193, 192 f nature of, 194 sexually transmitted infections and,

484–485, 488, 490 in sexual orientation continuum, 193

Black Americans. See African Americans Black Iris (O’Keeff e), 72 f bladder infections, 511 blastocyst, 364 blood transfusions, HIV and, 530 “blue balls,” 100, 122 BMI (body mass index), 374 body image

breast cancer and, 419 eating disorders and, 400 sexuality and, 402–403

body mass index (BMI), 374 body odor, 244, 260 body piercing, 506 body ratios, sexual attractiveness and, 260 body type, sexual attractiveness and, 260 bondage and discipline (B&D), 305,

305 f, 318 “booty calls,” 262 bottlefeeding, 391 bowel movements, wiping after, 89 Bowers v. Hardwick, 620 boys and young men. See also adolescents; men

Freud on sexual development of, 45 masturbation by, 172–173 nocturnal emissions, 116, 166 peer pressure on, 135–136, 168–169 as prostitutes, 617 puberty in, 164–166, 165 f teenage fathers, 180–181

BPH (benign prostatic hypertrophy), 214–215

brain “cheating hearts” and, 232 homosexuality and, 175 love and, 175, 232 sexual response and, 95–96

Braxton-Hicks contractions, 384 breast augmentation, 154, 399, 417,

419–420

breast cancer, 413–420 breast reconstruction and implant surgery,

419–420, 419 f detection of, 415–417, 415 f, 416 f in lesbian women, 415 in men, 429–430 prevalence of, 413–414, 414 f risk factors for, 335, 414 sexual adjustment after treatment, 419 treatment of, 417–418, 418 f

breastfeeding benefi ts of, 391 colostrum in, 390–391 HIV/AIDS transmission in, 530, 533 oxytocin in, 82 t

breast implants, 154, 399, 417, 419–420 breast reconstruction, 419–420, 419 f breasts, female, 78–79, 79 f, 100, 165 breasts, male, 112, 112 f breast self-examination (BSE), 416,

416 f, 417 bris. See circumcision, male brothels, 615 brother-sister sexual abuse, 588 BSE (breast self-examination), 416,

416 f, 417 bulbourethral glands (Cowper’s glands),

110 f, 111 bulimia, 401–402, 401 f BV (bacterial vaginosis), 484–485, 488, 490,

506–507

calendar (rhythm) method, 348 call girls, 616–617 cancer, 413–430

in AIDS, 521 anal, 424, 430, 503 breast ( See breast cancer) cervical, 420–422, 484, 502–503 hysterectomy in, 422–423 Kaposi’s sarcoma, 519, 521 ovarian, 422 penile, 428–429 prostate, 424–426, 424 f testicular, 426–428, 427 f, 428 f tumors and metastasis in, 413 uterine, 88, 421, 422 vaginal, 423–424, 503

candidiasis (yeast infection), 507–508, 522 cantharides, 406 capacitation, 363 CAP (child abuse prevention) programs,

592–593 cardiovascular disease, sexuality and, 411 caring, 239 case histories, 44 castration anxiety, 45, 108 casual sex

among adolescents and young adults, 261, 262, 263

among college students, 262 drug use and, 407 evolutionary mating perspectives on, 262

Catholic Church child sexual abuse in, 586 on contraception and abortion, 62 on fertility awareness–based methods, 347 sexuality and, 62

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SI-4

caudate nucleus, 232 CDC. See Centers for Disease Control and

Prevention CD4 count, 520, 525–526 CD4 receptors, 523, 524 f, 525, 551 celibacy. See also abstinence

abstinence vs., 331 asexuality and, 192 f, 193, 224 choice of, 200 f, 224

cell phones in preventing sexual assault, 574 voyeurism by, 313

censorship, 606–609, 609 t Centers for Disease Control and

Prevention (CDC) on HIV prevention, 544, 546–547 on HIV testing, 548–549 on male circumcision, 491, 493 on the role of condoms, 489 on STIs in pregnancy, 374

cervical cancer cervical dysplasia and, 420 HIV and, 420 Pap test and, 421, 502 from sexually transmitted infections,

484, 502 treatment of, 421–422 vaccine against, 420, 503

cervical caps, 85, 344, 344 f cervical dysplasia, 420–422 cervical intraepithelial neoplasia (CIN),

420–422 cervical mucus method, 347, 348 cervicitis, 498, 510–511 cervix, 73 f, 77 cesarean section. See also C-section 389 chancres, 499, 499 f chancroid, 508 channeling, gender-role learning and, 133 Chemistry.com, 199 “chickens” and “chickenhawks,” 617 child abandonment, 393 child abuse. See child sexual abuse child abuse prevention (CAP) programs,

592–593 childbirth

becoming a parent, 372–373 birthing rooms and centers, 390 birth plans, 388 by cesarean section, 389 elective deliveries, 389 home birth, 390 hospital birth, 387–388 labor and delivery, 384–386, 385 f, 386 f male circumcision decision, 387 midwifery and doulas in, 390 premature, 375–376 prepared, 390

child-free couples, 367 child marriage, 36 f child molesters, 587, 587 f . See also child

sexual abuse Child Obscenity and Pornography Act, 608 Child Online Protection Act (COPA),

608–609, 609 t child pornography, 606, 608 Child Protection and Obscenity

Enforcement Act, 608–609, 609 t

children. See also child sexual abuse abandonment of, 393 child pornography, 606, 608 curiosity and sex play in, 160–161, 162 t in divorce, 206–207 eating disorders in, 400, 403 expressing aff ection, 164 gender-role learning by, 133–136 HIV/AIDS and, 532–533, 539 human traffi cking of, 610, 612 masturbation by, 161–163 nudity and, 163 pedophilia and, 302, 317–318 privacy need of, 163 problematic sexual behavior in, 163 of same-sex parents, 383–384 sexting by, 606 sexually explicit materials and,

608–609, 609 t child sexual abuse, 586–593

betrayal in, 590–591 in the Catholic Church, 586 child pornography, 606, 608 children at risk, 588 convicted sex off enders and, 592–593 defi nition of, 586 entrance into prostitution after, 611 human traffi cking of, 610, 612 incest, 587–588 initial eff ects of, 589 long-term eff ects of, 460, 589–590 pedophilia, 302, 317–318 perpetrators of, 587, 587 f powerlessness after, 591 prevalence of, 586 prevention of, 592–593 prostitution after, 611 rape, 587 repressed memories of, 589 sexual abuse trauma, 590–591 sexual functional diffi culties after, 471 stigmatization after, 591 traumatic sexualization, 590 treatment programs for victims of, 591 warning signs of, 592

chlamydia (Chlamydia trachomatis) HIV infection and, 496 as notifi able disease, 484 f pelvic infl ammatory disease and, 510 in pregnancy, 496 prevalence of, 493–495, 496 f race/ethnicity and, 485 f symptoms of, 494 t, 496 testing for, 497 transmission of, 494 t

cholesterol, estrogen and, 212 chorion, 364, 364 f chorionic villus sampling (CVS),

377, 377 f Christianity, 14, 200 Christina (methamphetamine), 407 chronic illness, sexuality and, 410–412 chronic pelvic pain, 484, 510 churches, 14, 200. See also Catholic Church Cialis (tadalafi l), 473–474, 475 cilia, on fi mbriae, 78 CIN (cervical intraepithelial neoplasia),

420–422

circumcision, female, 429 circumcision, male

debate over, 387 hypospadias and, 150, 151 penile cancer and, 428–429 penis appearance, 107 f, 109 f procedure for, 107 sexually transmitted infections and,

491, 493 sexual pleasure and, 493

civil unions, 225, 621, 622 t “the clap.” See gonorrhea class. See socioeconomic status clinical research, 38–39 clitoral hood, 71 f, 72, 457–458 clitoral tumescence, 100 clitoridectomy, 39, 429 clitoris, 71 f, 72, 73 f clomiphene citrate, 422 cloning, 382 CMV (cytomegalovirus), 508, 522 cocaine, 407 cognitive-behavioral approach in sexual

diffi culties, 467–471, 471 t cognitive development theory, 132 cognitive social learning theory,

131–132 cohabitation

acceptance of, 201–203 extradyadic involvements in, 234, 237 of same-sex couples, 201 f, 237

coitus. See penile-vaginal intercourse college students

alcohol use and sexuality, 33, 404–405 attractiveness rating by, 263–265,

264 f, 265 f birth control use by, 54, 54 f casual sex among, 262 condom-use mistakes by, 545 confusion over consent by, 577 on defi nitions of “having sex,” 281 on the fi rst kiss, 286 frotteurism by, 315 gay, lesbian, or bisexual identity formation

in, 193 “hooking up” among, 262 masturbation by, 274–275 oral-genital sex by, 287 postrefusal sexual persistence by,

578–579, 579 f rape of, 577, 580 reasons for having sex, 199 sexual activity by, 53–54, 54 f sexual arousal factors in, 463 sexual harassment of, 563–564, 563 f sexually explicit materials viewed by, 600,

602–603 sexual scripting by, 268 sexual variations among, 303, 304 f single, 197–198, 199 voyeurism and, 312

colostrum, 390–391 “coming out,” 11, 38, 171, 195 commercial sex workers. See prostitution commitment

intimacy and, 238–239 in triangular theory of love, 227 f, 228,

229, 230 f

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www.Chemistry.com

SI-5

communication confl ict and, 250–252, 250 f cultural context of, 239–240 defi nition of, 239 developing skills in, 247–250 directing sexual activity, 246 Dydaic sexual communication scale,

in established relationships, 246 feedback, 249–250, 249 f fi rst move and beyond, 244–245 halo eff ect, 243–244 Health Protective Sexual Communication

Scale, 543 initiating sexual activity, 246–247 interest and opening lines, 244 Love Lab lessons, 251 nonverbal, 241–243, 245, 249 f obstacles to, 247 partner satisfaction and patterns of, 248 during pregnancy, 369 psychological context of, 241 in same-sex couples, 245 self-disclosure, 189, 238–239, 243,

247–248, 537 sexually transmitted infections and, 513,

537, 543–544 sexual scripts and, 243 social context of, 240–241 trust and, 248–249

Communications Decency Act, 14, 608, 609 t

companionate love, 227 f, 229 complementary sexual style, 279 compromise, 248, 449 compulsive overeating, 401 f, 402 computers. See Internet conception, 362–363, 363 f conceptus, 330 conceptus development, 364–367,

365 f, 366 f condoms, female, 342–343, 342 f,

489, 512 condoms, male

adolescent use of, 330 advantages of, 342 in anal intercourse, 78, 341, 514,

531, 537 college student use of, 545 eff ective use of, 340, 340 f, 341, 489 fi t problems with, 545 inconsistent and incorrect use of,

488, 545 latex and synthetic, 339, 489, 512 lubricants for, 339, 340 possible problems with, 342 prostitution and, 619 in same-sex sexual activity, 341, 514,

531, 537 STI prevention, 489, 504, 512, 544 women and, 340–341, 539

confi dentiality, in research, 37 confl ict, about sex, 248, 250–252,

250 f, 459–460 confl ict resolution, 252 Confucianism, 62 congenital adrenal hyperplasia, 146 t, 150 conjunctivitis, 497 consummate love, 227 f, 229

contraception. See also birth control birth control vs., 330 emergency, 351–352 trends in, 173 t

contraceptive fi lm, 345, 345 f contraceptive foam, 345 contraceptive patch, 345, 345 f control groups, 58 COPA (Child Online Protection Act),

608, 609 t Copper T 380A, 346, 346 f coprophilia, 305–306 corona, of the penis, 106, 107 f coronary artery disease, sexuality and, 411 corpora cavernosa, 71 f, 72, 107,

107 f, 110 f corpus luteum, 77, 83–84, 86, 86 f corpus spongiosum, 107, 107 f, 110 f Correct Condom Use Self-Effi cacy Scale, 341 correlational studies, 43 couple counseling, 467–468 couple sexual styles

complementary sexual style, 279 emotionally expressive sexual style, 281–282 pleasure-oriented touch in, 284 soulmate sexual style, 280–281 traditional sexual style, 279–280

couvade, 129, 389 f Cowper’s glands, 110 f, 111 COYOTE (Call Off Your Old Tired

Ethics), 619 “crabs,” 495 t, 509–510, 509 f cramps, 88, 89 cremaster muscle, 109 critical thinking

biases, 34–35 egocentric fallacy, 35 ethnocentric fallacy, 35–36 opinions, 34–35 on pop psychology, 32 on sex advice columns, 31 stereotypes and, 34–35 value judgments vs. objectivity, 34

cross-dressing. See transvestites crura (singular, crus ), 71 f, 72, 73 f, 107 cryptorchidism, 110 crystal (methamphetamine), 407 C-section, 389 . See also Caesarean section culdoscopy, 349 culpotomy, 349 cultural equivalency perspective, 61 culture

aging and sexuality and, 209 communication and, 239–240 female orgasm and, 15, 98–99 gender and, 18–19, 136–137 gender identity and, 129–130 kissing and, 285 normal behavior and, 21, 22–24 sexual attractiveness and, 258–260 sexual desire and, 15, 120 sexual harassment and, 561 sexual interests and, 14–15 sexually explicit material and, 598–599 sexual orientation and, 17–18 sexual scripts and, 139, 266, 267 transgendered and transsexual

persons and, 19

cunnilingus. See also oral-genital sex in child sexual abuse, 587 concerns in, 288, 514 female sexual scripts and, 139 HIV transmission in, 531 lesbian women, 288, 450, 476 as “normal” behavior, 20 during pregnancy, 372 prevalence of, 20, 452 prior to penile-vaginal intercourse, 453 as sexual activity, 285, 287–288, 287 f in sexually explicit materials, 601 sexually transmitted infections and,

514, 531 cutaneous phase, 159 cutting, 429 CVS (chorionic villus sampling), 377, 377 f cystitis, 511 cytomegalovirus (CMV), 508, 522

Daddy’s Roommate (Willhoite), 607, 607 f DADT (“Don’t Ask, Don’t Tell”) policy,

571, 622 t Dani people, 15 dartos muscle, 109 date rape

acquaintance rape and, 576, 580 alcohol and drug use and, 576, 580 date-rape drugs, 578 incidence of, 576–577 prevention of, 574 rapist profi le, 579–580

date-rape drugs, 578 dating, 199, 207, 237 D&E (dilation and evacuation), 353 death of a fetus, 379 death of a partner, 208 “Declaration of Sexual Rights,” 23, 624 Defense of Marriage Act (DOMA), 621 delayed ejaculation, 454, 470 delayed labor, 377 delivery, 384–386, 385 f, 386 f . See also

childbirth demographic facts of life, 376 t demographics of AIDS, 533–541, 537 f,

540 f . See also HIV/AIDS dental dams, 514, 531, 539, 549 dependent variables, 42–43 Depo-Provera (DMPA), 335–336 depression

in aging, 213 after being abused as a child, 589, 591 casual sex and, 262 in divorce, 206 in eating disorders, 400, 401, 402 exhibitionism and, 314 in gay, lesbian, and bisexual

adolescents, 567 in menopause, 212, 213 oral contraceptives and, 335 physical disabilities and, 408, 410, 411 postpartum, 390, 391, 392–393 after rape, 583, 584, 586 sexual desire and, 457, 469, 473, 476 in teenage parents, 180

DES (diethylstilbestrol), 175, 420, 423 desire. See sexual desire desogesterel, 338

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SI-6

development, sexual. See sexual development developmental disabilities, sexuality and,

412, 413 Developmental Disabilities Assistance and

Bill of Rights Act, 413 diabetes mellitus, 411, 457 Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV-TR) on disorders of sexual desire, 446 on gender identity disorder, 151 on orgasmic disorders, 452, 454, 455 on paraphilias, 300, 300 t, 302 on sexual function diffi culties, 439–441,

441 t, 446 on sexual pain disorders, 455 on sexual variation, 305, 319, 320

diaphragms, 343–344, 343 f dichotomous-psychoanalytic model, 192 f diet, sexual functioning and, 122 diethylstilbestrol (DES), 175, 420, 423 digital rectal exam (DRE), 425, 430 dihydrotestosterone (DHT), 150 dilation, in labor, 384 dilation and evacuation (D&E), 353 dildos, 514 direct syringe sharing, 532 disabilities

arthritis, 411–412 cardiovascular disease, 411 changing expectations in, 408–410 developmental, 412 diabetes mellitus, 411, 457 “ideal” bodies and, 409–410 sexual esteem and satisfaction and, 408 sexual rights of people with, 412–413 spinal cord injuries, 408–410 vision and hearing impairment, 410

Discovering Your Couple Sexual Style (McCarthy and McCarthy), 279–282, 284

discrimination against gay men, lesbian women, bisexual

and transgender individuals, 566–570

heterosexual bias, 565–566 pornography and sex discrimination,

605–606 disinhibition, 404 disorders of sexual development (DSD).

See also gender variations androgen insensitivity syndrome, 146 t,

149–150 coming to terms with, 153 congenital adrenal hyperplasia, 146 t, 150 delaying gender surgery in children, 147 5-alpha reductase syndrome, 150–151 gender identity disorder, 128, 144,

151–152 hypospadias, 150, 151 Klinefelter syndrome, 146 t, 148–149,

149 f, 430 mosaicism, 149 sex assignment/reassignment in, 152–153,

152 f, 154 sexual aversion disorder, 441 t, 448,

450, 471 tabulated summary of, 146 t Turner syndrome, 145, 146 t, 148, 148 f

DivaCup, 85 divorce

changing climate of, 205 consequences of, 206–207 dating after, 207 rates of, 205 serial monogamy, 202 single parenting, 207–208

DMPA (Depo-Provera), 335–336 DOMA (Defense of Marriage Act), 621 domestic partnership laws, 201, 621 domination and submission (D/S), 304–306 dominatrix, 305 “Don’t Ask, Don’t Tell” (DADT) policy,

571, 622 t dopamine, 232 double standards, 133 douching, 491, 507, 512 doulas, 390 Down syndrome, 375, 377 drag queens, 308. See also transvestites DRE (digital rectal exam), 425, 430 “the drip.” See gonorrhea Drug-Induced Rape Prevention and

Punishment Act, 578 drug use

aphrodisiacs, 405 casual sex and, 407 date-rape drugs, 578 injecting drugs, 532, 538 during pregnancy, 373 in prostitution, 613, 619 sexual functioning and, 406 sexually transmitted infections and, 407,

488, 513 syringe exchange programs, 547–548

“dry humping,” 282 “dry orgasm,” 122 D/S (domination and submission), 304–306 DSD. See disorders of sexual development DSM-IV-TR. See Diagnostic and Statistical

Manual of Mental Disorders dual control model, 94 dysmenorrhea, 88 dyspareunia, 392, 441 t, 455–456, 457

early adulthood being single, 196–201 cohabitation, 201–203, 201 f, 202 f college environment, 197–198 developmental concerns, 188–191 gay, lesbian, and bisexual people,

193–196 life behaviors of the sexually healthy

adult, 190 relationship status in, 202 f sexual and reproductive time line, 189 f sexual orientation establishment,

188–189, 191–193 early ejaculation, 441 t, 454–455,

469–470, 469 f early puberty, 165–166 eating disorders, 398–402, 401 f EC (emergency contraception), 351–352 ecstasy (MDMA), 406 f, 407, 578 ectoparasitic infestations, 493, 495 t,

509–510, 509 f ectopic pregnancy, 347, 375, 484, 510

edema, in pregnancy, 370 EDI (extradyadic involvement), 236–238 education. See sexuality education educational attainment, sexuality and,

275, 445 EEOC (Equal Employment Opportunity

Commission), 559 eff acement, 384 egocentric fallacy, 35 Egyptians, ancient, 108 eHarmony.com, 199 EIA (enzyme immunoassay), 549 ejaculation

aging and, 444 f, 445 Cowper’s glands in, 111 electroejaculation, 409 in fellatio, 289 female, 77 inhibited or delayed, 454, 470 male, 111, 120–121, 121 f onset of fi rst, 166 premature, 441 t, 454–455,

469–470, 469 f prostate cancer risk and, 424 retrograde, 121 semen in, 111 sperm in, 111–112

ejaculatory duct, 110 f, 111 ejaculatory inevitability, 120 ELA (Employment Law Alliance), 565 elderly. See late adulthood elective deliveries, 389 Electra complex, 45 electroejaculation, 409 elementary school, sexual harassment in,

562–563 Ellis, Havelock, 46, 46 f embryo, 364 embryonic development

diff erentiation of external reproductive organs, 69–70, 70 f, 364–366, 364 f, 366 f

oogenesis, 81–82, 83 f overview of, 69

embryonic membranes, 364 emergency contraception (EC), 351–352 emission, female, 77 emission, male, 120, 121 f . See also

ejaculation emotionally expressive sexual style, 281–282 emotions

evolution and, 25 fi rst intercourse reaction, 178 gender roles and, 130 infertility and, 380 postpartum, 392–393 during pregnancy, 369–370

Employment Law Alliance (ELA), 565 empty love, 227 f, 229 endogeneous opioids, 96 endometrial (uterine) cancer, 88, 421, 422 endometriosis, 88, 375, 431–432, 457 endometrium

location and function of, 73 f, 77 shedding of, 85–86, 86 f

endorphins, 89 Enduring Desire (Metz and McCarthy), 462 enemas, in sexual activity, 305

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www.eHarmony.com

SI-7

enhancement. See also sexual function enhancement

breast, 154, 399, 417, 419–420 penis, 399

enteric infections, 508 enzyme immunoassay (EIA), 549 epidemics, defi nition of, 526 epidemiology, defi nition of, 526 epididymis, 110–111, 110 f, 111 f, 116 epididymitis, 496 epidurals, 387–388 episiotomy, 388 Equal Employment Opportunity

Commission (EEOC), 559 erectile dysfunction

infi delity and, 237 myths about, 469 prevalence of, 451 quality of life and, 445 symptoms of, 441 t, 451 treating, 451, 468–469, 473–474, 475

erections anxieties and, 459 exercises to improve, 464 in infants, 162 lifestyle aids to, 122 myths about, 469 natural enhancement products, 474 nocturnal, 116 persistent sexual arousal syndrome,

451–452 Peyronie’s disease, 456 physical causes of problems in, 457 priapism, 456–457 process of, 108, 109, 120 sexual excitement and, 93 t treating diffi culties in, 451, 468–469,

473–474 triggers for, 122

erogenous zones, 96 eros, 226 erotica, defi nition of, 598. See also sexually

explicit material erotic aids. See sex toys erotic dreams, 271 erotic fantasies, 269–271 erotic “sexual voice,” 464 erotic touching, 282–283, 284 erotophilia, 266 erotophilic/erotophobic continuum,

192, 192 f erotophobia, 266 Escherichia coli, 511 escort agencies, 617 Essure , 350 established relationships. See also marriage

changing a sexual relationship, 466–467 child-free, 367 cognitive-behavioral approach to

diffi culties in, 467–468 decline of sexual passion in, 460 evolutionary mating perspectives on,

260–263, 261 t extradyadic relations and, 236–237 gay and lesbian, 223–224, 225 gender diff erences in desires for, 223 initiating sexual activity in, 246 painful feelings from childhood in, 460

sexual communication in, 246 sexual desire diff erences in, 448–449 sexual dysfunction caused by, 442 sexual styles in, 279–282

estradiol, 114 estrogenic phase, 86 f estrogen replacement therapy, 212–213, 214 t estrogens

breast cancer and, 414–415 cholesterol and, 212 functions of, 81, 82 t hot fl ashes and, 212 in menopause, 211–213 in menstrual cycle, 81, 82 t, 84, 86 in oral contraceptives, 333 in ovarian cycle, 83, 86 f in sexual functioning, 97

ethics in sex research, 37 Tuskegee syphilis study and, 500–501

ethnic groups, 36. See also race and ethnicity ethnocentric fallacy, 35–36 evolutionary mating perspectives,

260–263, 261 t evolutionary psychology, 25 evolutionary theory, sexual pleasure and,

25, 98 Examining Tuskegee: Th e Infamous Syphilis

Study and Its Legacy (Reverby), 500 exclusiveness, 234–236. See also jealousy exercise, premenstrual changes and, 89 exhibitionism, 24, 313–314 experimental research, 42–44, 58 explicit material. See sexually explicit material expressiveness, 130 expulsion, 120–121, 121 f extradyadic fantasies, 270 extradyadic involvement (EDI), 236–238 extrafamilial abuse, 587 extramarital sex, 51 eye contact, 242, 244

FAB (fertility awareness–based) methods, 347–348, 347 f

Facebook, 12, 199 FAE (fetal alcohol eff ect), 373 fallacies, in reasoning, 35–36 fallopian tubes, 73 f, 77–78, 80 t, 363 f families. See also parents

acceptance of diff erent sexual orientations, 171

aff ection expressed in, 164 children’s psychosexual development and,

167–168, 168 f incest in, 587–588 in Latino culture, 61 nudity in, 163 parents as socializing agents, 133–134 of same-sex parents, 383–384, 623 single-parent, 207–208 of teenage mothers, 179–180

familismo, 61 Family and Medical Leave Act (FMLA), 392 “family balancing,” 382–383 family planning clinics, 328, 330 Family Research Lab, 251 fantasy sex, 603 FAS (fetal alcohol syndrome), 373

father-daughter sexual abuse, 587–588 fatigue, sexual function and, 458 fatuous love, 227 f, 229 FDA (Food and Drug Administration), 357 Federal Bureau of Investigation

(FBI), 612 Federal Communications Commission

(FCC), 9 feedback, 249–250, 249 f fellatio. See also oral-genital sex

autofellatio, 289 condom use in, 514 HIV transmission in, 531 prevalence of, 20, 452 in prostitution, 610, 615, 617 as sexual activity, 20, 285, 288–289,

288 f, 293 sexually transmitted infections and, 514

female circumcision, 429 female condoms, 342–343, 342 f,

489, 512 female ejaculation, 77 female genital cutting (FGC), 429 female impersonators, 308 female orgasmic disorder, 441 t, 452,

470–471, 471 t females. See girls and young women; women female sex organs, 69–80

breasts, 78–79, 79 f, 100, 165 embryonic-fetal diff erentiation of,

69–70, 70 f external structures, 71–73, 71 f, 74 f, 80 t homologous structures, 119, 119 f internal structures, 73–78, 73 f, 74 f,

76 f, 80 t other structures in genital area, 78, 80 t self-examination of, 75, 75 f shaving hair from, 71–72 summary table of, 80 t vaginal mucus and secretions, 77

female sexual arousal disorder, 441 t, 450 female sexual disorders. See women’s sexual

dysfunctions female sexual response, 90–101

brain and, 95–96 desire, 95–98 dual control model, 94 hormones in, 96–98 Masters and Johnson on, 48–49, 91–93,

92 f, 93 t orgasm, 49, 98–99, 100–101 senses and, 96 sexual excitement, 99–100 sexual response models, 90–94, 92 f, 93 t vasocongestion and myotonia in, 98–99

FemCap™, 344, 344 f femininity, 130–131. See also gender roles feminism, 56, 132, 605 femme porn, 599 fertility awareness–based (FAB) methods,

347–348, 347 f fertility awareness calendar, 347,

347 f, 348 fertilization, 362–363, 363 f fetal alcohol eff ect (FAE), 373 fetal alcohol syndrome (FAS), 373 fetal development, 364–367, 365 f, 366 f fetishism, 24, 301, 306–307

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SI-8

fetus, 364–367, 365 f, 366 f . See also pregnancy

fever blisters, 504 FGC (female genital cutting), 429 fi brocystic disease, 417 fi lms, sexism in, 10–11 fi mbriae, 73 f, 78 fi ngering, 293 fi nger length, homosexuality and, 175 First Intercourse Reaction Scale, 178 fi rst kiss, 286. See also kissing fi sting, 113, 293 5-alpha reductase syndrome, 150–151 “Five Th ings to Th ink About Before Pressing

‘Send’,” 13 fl ashers. See exhibitionism fl irtation, sexual harassment vs., 561–562 FMLA (Family and Medical Leave Act), 392 foam, contraceptive, 345 folic acid, 378 follicle-stimulating hormone (FSH)

in men, 114 t in menstrual cycle, 86, 86 f in ovarian cycle, 82–84, 82 t, 86 f

follicular phase, 82–83, 84 f folliculitis, 72 Food and Drug Administration (FDA), 357 forced sex. See rape; sexual aggression forceps, in childbirth, 388 foreplay, female orgasm and, 98 foreskin, 107, 107 f Foucault, Michel, 58, 58 f Fourth National Incidence Study of Child

Abuse and Neglect, 586–587 French kissing, 532 frenulum, 106 Freud, Sigmund, 45–46, 45 f friendship, love and, 220–221 “friends with benefi ts,” 221, 261–263 frigidity (female sexual arousal disorder),

441 t, 450, 452 frotteurism, 315–316 FSH. See follicle-stimulating hormone

Gallup Poll, 569 gamete intrafallopian transfer (GIFT), 381 gamete production, 77 gang rape, 581 Gangsta rap, 60 Gardasil, 420, 424, 430, 503 Gardnerella vaginalis, 506 gay bashing, 568 f “gaydar,” 245 gay men. See also gay men, lesbian women,

bisexual and transgender individuals; men who have sex with men

anal sex and, 291, 293–294, 294 f anodyspareunia in, 456 antisodomy laws, 567, 568 f, 620–621 domination and submission in, 306 drag queens, 308 eating disorders in, 400 extradyadic involvements of, 237 fellatio and, 289 HIV/AIDS in, 476, 534, 536–538, 537 f initiating sexual activity, 246 kissing, 285 longevity and quality of relationships of, 225

on love and sex, 223, 225 media stereotypes of, 11 as parents, 571 performance anxiety in, 459 prostitution and, 618 serosorting by, 537 sexual aversion in, 450 sexual communication by, 245 sexual fantasies of, 270 sexual function diffi culties in, 439, 448,

450, 456, 459–460, 475–476 touching activities, 283 violence towards, 171, 567, 568 f, 570

gay men, lesbian women, bisexual and transgender individuals. See also sexual orientation; specifi c group

adolescents, 170–172 adoption of children by, 225 antidiscrimination laws, 570–572,

570 f, 571 f anti-gay prejudice, 566–570 antisodomy laws and, 567, 568 f child sexual abuse, 590 cohabitation, 201 f, 237 “coming out,” 11, 38, 171, 195 contemporary research, 58–59 early researchers and reformers, 57–58 eating disorders in, 400 hate crime legislation, 567, 570, 571 f heterosexual bias and, 565–566 HIV/AIDS and, 476, 536–538, 537 f identity process, in early adulthood,

170–172 importance of love to, 223–224, 225 internalized homophobia in, 195–196,

460, 476 language and, 240 in late adulthood, 209, 211 longevity and quality of relationships

of, 225 media portrayals of, 11 meeting places for singles, 199–200 in the military, 571–572 prejudice against, 566–570 psychiatric distress in, 200 public opinion on rights of, 569 race and ethnicity and, 200 rape and, 583 relationship longevity in, 225 same-sex marriage ( See same-sex marriage) sex therapy for, 475–476 sexual aversion disorder in, 450 sexual coercion in relationships of, 583 sexual communication by, 245, 246 sexual desire disorder in, 448 sexual function diffi culties, 439, 448, 450,

456, 459–460, 475–476 sexual harassment of, 563 sexual identity process, 193–196 sexually explicit fi lms for, 601 social networking and, 13–14 violence against, 171, 567, 568 f, 570

Gay/Straight Alliance, 171 “gears of connection,” 284 gender. See also gender roles; gender

variations assigned, 127, 129 biology and, 128–130

continuum of, 24, 47–48, 48 f, 143, 143 f, 193

culture and, 18–19, 153 emotional processing and, 130 equality, 222 gender-role learning, 131–137 gender roles vs., 127–128 masculinity and femininity, 130–131 sexual orientation and, 131

gender atypical behavior, 128 gender diff erences. See also men; women

in birth control responsibility, 327–328

in body image, 402–403 in brain response to stimulation, 232 in confl ict, 250, 250 f in cross-dressing, 308 in evolutionary mating perspectives,

260–261, 261 t, 263, 264 f, 265 f in HIV/AIDS cases, 527–528,

527 f, 539 in inhibitory response, 94 in jealousy, 234 in love styles, 227 in masturbation, 172–173 in moral standards of nonmarital

sexuality, 61 in orgasm frequency, 452–454 in paraphilias, 301 in partner communication, 247 in psychosexual development, 45 in reasons for sexual activity, 199 in self-disclosure, 247–248 in sex and love, 223–224 in sexual activity, 272 t, 276 f in sexual arousal factors, 90, 463 in sexual attractiveness, 258 in sexual fantasies, 269–270 in sexual function diffi culties, 442,

443–446, 444 f, 446 f in sexual harassment, 561–562 in sexually transmitted infections, 340,

484–485, 491, 496 f, 504 in telephone scatologia, 315 in Victorian sexual views, 15–16 in viewing sexually explicit materials, 600

gender dysphoria, 128, 310 gender identity

development of, 129–130 disorders of, 128, 144, 151–152, 400 transgender and, 144, 152–153, 152 f

gender identity disorder (GID) eating disorders and, 400 as gender variation, 128 symptoms of, 151 transgender phenomenon, 144 treatment for, 152

gender presentation, 128 gender-role attitude, 128 gender-role behavior, 128 gender roles

androgyny, 142–143 in contemporary sexual scripts,

141–142 in female sexual scripts, 138–141 gender schemas, 136–137 gender vs., 127–128 learning of, 133–136

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SI-9

in male sexual scripts, 137–138 masculinity and femininity, 130–131 media and, 136 parents and, 133–134 peers and, 135–136 as schemas, 136–137 sexual double standards, 133 in socialization theories, 131–133 stereotypes of, 127–128, 130 teachers and, 134–135 traditional female, 138–139 traditional male, 137–138

gender-role stereotypes, 127–128, 130 gender schemas, 136–137 gender studies, 156 gender variations, 143–154. See also

disorders of sexual development coming to terms with, 153 defi nition of, 128 gender continuum, 24, 47–48, 48 f, 143,

143 f, 193 gender identity disorder, 128, 144,

151–152 intersex, 144–145 medical treatment for, 147, 152–153, 152 f transsexuality, 19, 152–154, 152 f, 310

gene therapy, for HIV/AIDS, 551–552 genetic counseling, 377 genetics

breast cancer and, 414, 430 chromosomes in fertilization process, 117 gender and, 117, 119, 145 homosexuality and, 175 number of sex chromosomes, 145 pregnancy after age 35 and, 374–375 sex chromosome anomalies, 145,

148–149, 148 f, 149 f sex of zygotes, 117 sexual behavior and, 25

genetic sex, defi nition of, 127 genital candidiasis (yeast infection),

507–508 genital herpes (herpes simplex virus)

AIDS and, 504 in bisexual and lesbian women, 484 causes of, 504 management of, 504–505 prevalence of, 504 symptoms of, 495 t, 504, 505 f transmission of, 504 treatment of, 491, 495 t

genital human papillomavirus infection (genital HPV infection). See also genital warts

in anal cancer, 430 in cervical cancer, 420, 495 t, 502 circumcision and, 491 condom use and, 489 Gardasil vaccine against, 420, 424,

430, 503 in penile cancer, 428 prevalence of, 502 social support for people with, 503 symptoms of, 495 t tests for, 502 transmission of, 502 treatment for, 495 t in vaginal and vulvar cancer, 424, 503

genital retraction syndrome, 108 genitals, gender and, 71. See also female sex

organs; gender variations; male sex organs

genital sexual arousal disorder. See sexual arousal disorders

genital stage, 45 genital warts

appearance of, 502–503, 503 f in bisexual and lesbian women, 484 condom use and, 489 human papillomavirus and, 502 prevalence of, 502 treatment of, 491 vaccine against, 420, 503

German measles, during pregnancy, 373 GES (“Good Enough Sex”) model, 462 gestation, 364 gestational carrier, 382 GHB, 578 giardiasis, 508 GID. See gender identity disorder GIFT (gamete intrafallopian transfer), 381 gigolos, 617–618 girls and young women. See also adolescents;

women chlamydia and gonorrhea in, 494–496, 497 female genital cutting, 429 Freud on sexual development of, 45 Gardasil vaccination of, 420, 424,

430, 503 in Latino culture, 134, 139 masturbation by, 172–173 media infl uences on, 136 menarche in, 86, 165 peer pressure on, 135–136 pelvic infl ammatory disease in, 510 physical changes of puberty in,

164–166, 165 f sexualization of, 166 susceptibility to HIV infection, 531 as teenage mothers, 179–180 television portrayals of, 9, 11

glans clitoris, 71 f, 72 glans penis, 106–107, 107 f, 110 f glycogen, in menstrual cycle, 86 golden showers, 305 gonadotropin-releasing hormone (GnRH),

82, 82 t, 84, 114 t gonadotropins, 81, 164–165 gonads, 77 gonorrhea (Neisseria gonorrhoeae)

ectopic pregnancy and, 497 HIV and, 497 as notifi able disease, 484 f pelvic infl ammatory disease and, 510 prevalence of, 497 race/ethnicity and, 486 f symptoms of, 494 t, 497 f transmission of, 494 t, 497 treatment of, 497

“Good Enough Sex” (GES) model, 462 “good sex,” 461–463 “Good Sex Video Series” (Sinclair Institute),

599 Grafenberg spot (G-spot), 70, 73 f,

76–77, 76 f Graffi an follicles, 77

granuloma inguinale, 508–509 Great Sex: A Man’s Guide to the Secret

Principles of Total-Body Sex (Castleman), 448

Greece, ancient, male-male relationship in, 17–18

grieving for death of a fetus, 379 groping, 315–316 group marriage, 238 group therapy, 472 G-spot, 70, 73 f, 76–77, 76 f, 277 Guidelines for Comprehensive Sexuality

Education (SIECUS), 181–182 gynecomastia, 112

halo effect, 243–244 handedness, homosexuality and, 175 harassment. See sexual harassment hate crime legislation, 567, 570, 571 f Hate Crimes Prevention Act, 570 “having sex,” defi nitions of, 173–174, 278,

280–281 HCG (human chorionic gonadotropin),

82 t, 84, 364, 368 HDL (high-density lipoprotein), 212 health care

homosexuality and, 415, 432 men’s needs, 115, 425 prenatal, 376 sexually transmitted infections and, 490 for teenage mothers, 179–180 women’s needs, 213, 328, 330, 417,

431, 452 health insurance, 115 Health Protective Sexual Communication

Scale (HPSCS), 543 Healthy People 2020, 195 hearing impairment, 410 heart attacks, sexuality and, 411 Heather Has Two Mommies (Newman),

607, 607 f Hegar’s sign, 369 helper T cells, 523, 524, 525 Hemophilus ducreyi, 508 hepatitis, viral, 495 t, 505–506 herbal remedies, 408, 474 hermaphroditism, 144–145 herpes. See genital herpes Herpes Resource Center, 505 herpes simplex virus (HSV), 495 t, 504.

See also genital herpes hetaerae, 18 heteroeroticism, 192 f, 193 heteronormativity, 131 heterosexual bias (heterosexism), 565–566 heterosexuality. See also sexual orientation

defi nition of, 17 in models of sexual orientation,

192–193, 192 f power and, 56 transvestic fetishism in, 300 t, 309–310

high-density lipoprotein (HDL), 212 “highly sexual” women, 301, 303 high-risk behaviors. See risk behaviors high school, sexual harassment in, 562–563 hijras, 153 Hinduism, 14 Hirschfeld, Magnus, 57–58, 57 f

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SI-10

Hispanics. See Latinos/Latinas Th e History of Sexuality, Volume I (Foucault), 58 HIV/AIDS, 519–554. See also human

immunodefi ciency virus; sexually transmitted infections

in adolescents, 540–541, 540 f anal intercourse and, 531, 537–538 behavioral factors in spread of, 533 breastfeeding transmission of, 530, 533 CDC defi nition of AIDS, 520 in children, 532–533, 539 circumcision and, 491, 493 conspiracy beliefs about, 500–501 counseling for HIV-positive

individuals, 550 demographics of, 533–541, 537 f, 540 f disclosure of status, 537, 544 discovery of, 501 disease progression, 524–526, 525 f epidemiology in the United States, 526 f,

527–530, 527 f, 528 f, 529 f epidemiology in the world, 526 f fear of, 553 female-to-female transmission, 539 gay community and, 476, 536–539, 537 f as “gay plague,” 547 geographic region and, 541 immune system and, 522–523, 523 f,

525, 525 f injection drug use and, 532, 538 Kaposi’s sarcoma and, 519, 521 lifetime risk, 529–530, 529 t, 535 living with, 552–554 male-to-male transmission, 536–538, 537 f microbicides in prevention of, 552 myths about, 530 in older adults, 540 f, 541 opportunistic infections in,

520–521, 525 f oral sex and, 531 partner notifi cation, 484 f, 554 in pregnancy, 513, 532–533 prevalence of, 526–527, 526 f prevention attitude scale, 542 prevention education, 51, 181–183, 544 prevention obstacles, 547 prevention programs, 544, 546–547 prostatitis and, 432 prostitution and, 547, 615, 619 protecting ourselves, 543–544 race/ethnicity and, 528–530, 528 f, 529 f,

529 t, 533–536, 538, 553 recreational drug use and, 407 sexual activity after infection, 551–552 sexually transmitted infections and

acquisition of, 493, 496, 497, 504, 506, 507

spermicides and, 344 stigmatization of, 490, 521, 553 symptoms of, 494 t, 522 syringe exchange programs, 547–548 testing for, 544, 548–550 transmission of, 527–528, 527 f, 530,

531–533, 536–539 transmission rate, 527–528, 527 f, 537 f,

544, 546–547, 546 f treatment of, 491, 550–552 women and, 531, 538–539

HIV transmission rate, 527–528, 527 f, 537 f, 544–547, 546 f

Home Access HIV-1 Test System, 550 home birth, 390 homelessness, homophobia and, 171 homeopathic sexual enhancers, 474 home testing kits, for HIV infection, 550 homoeroticism, 193 homologous structures, 119, 119 f homophobia

adolescents and, 171 defi nition of, 566 heteronormativity and, 131 HIV/AIDS and, 519, 534, 538 homelessness and, 171 impact on sexual functioning, 476 internalized, 171, 195–196, 460,

476, 590 sexual harassment and, 563, 563 f

homosexuality. See also gay men, lesbian women, bisexual and transgender individuals; sexual orientation; specifi c groups

African American culture and, 200 in ancient Greece, 17–18 Asian American culture and, 200 biological theories of, 175 defi nition of, 17 discrimination against, 566–570 distortions of research on, 33 early rights eff orts, 57–58 Ellis on, 46 gay, lesbian, and questioning adolescents,

170–172 gender-role beliefs and, 131 hate crime legislation, 567, 570, 571 f in history, 17–18 homoeroticism and, 193 homophobia ( See homophobia) in Kinsey scale, 47–48, 48 f,

192–193, 192 f Latino culture and, 200 in models of sexual orientation,

192–193, 192 f moral judgments on, 569 not considered a psychological disorder,

17, 58 origins of, 175 prevalence of, 170 same-sex marriage ( See same-sex marriage) social constructionist and psychological

theories, 175 Hooker, Evelyn, 58, 58 f “hooking up.” See casual sex hormone disrupters, early puberty and, 166 hormone replacement therapy (HRT),

212–213, 214 t, 473 hormones. See reproductive hormones,

female; reproductive hormones, male hormone therapy

in menopause, 212–213, 214 t, 473 for primary amenorrhea, 88 in sex reassignment, 154 testosterone replacement therapy, 97, 115,

215, 473 hospital births, 387–388 hostile environment, 558. See also sexual

harassment

hot fl ashes, 212 HPSCS (Health Protective Sexual

Communication Scale), 543 HPV See genital human papillomavirus

infection HPV and Cervical Cancer Prevention

Resource Center, 503 HRC (Human Rights Campaign), 144 HSDD (hypoactive sexual desire disorder),

441 t, 446–448, 447 f, 471 HSV (herpes simplex virus), 495 t, 504.

See also genital herpes Huichol people, 389 f human chorionic gonadotropin (HCG), 82 t,

84, 364, 368 human immunodefi ciency virus (HIV).

See also HIV/AIDS disclosure of status, 537, 544 HIV-1 and HIV-2, 524 living with, 552–554 pattern of infection, 523–526,

524 f, 525 f replication of, 523, 524–525, 524 f structure of, 523, 524 f symptoms of, 521, 525–526, 525 f T cells and, 523–524, 523 f, 525–526 testing for, 544, 548–550 transmission rate, 527, 544,

546–547, 546 f treatment during pregnancy, 533 window period, 549

human papillomavirus (HPV). See genital human papillomavirus infection

Human Rights Campaign (HRC), 144 Human Sexual Inadequacy (Masters and

Johnson), 49 human sexuality education, 3–4, 51,

181–183, 190 Human Sexual Response (Masters and

Johnson), 48–49, 49 f human traffi cking, 612 humiliation, in sexual activity, 305–306,

319, 320 hymen, 73 f, 74–76 hymenoplasty, 75–76 hypermasculinity, 319 hypersexuality (sexual addiction), 303, 316 hypertension, pregnancy-induced, 375 hypoactive sexual desire disorder (HSDD),

441 t, 446–448, 447 f, 471 hypospadias, 150, 151 hypothalamus, 95, 114 t, 164 hypoxphilia, 320–321 hysterectomy, 213, 422–423

ICC (invasive cancer of the cervix), 420–422 ICD-10 (International Classifi cation of

Diseases), 440 ICSH (LH), 114 f ICSI (intracytoplasmic sperm injection), 381 identical twins, homosexuality in, 175 identity integration, 195 IDU (injection drug use), HIV transmission

in, 532, 538 immune system, HIV/AIDS and, 522–523,

523 f, 525, 525 f Implanon, 338 implantation, 364

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SI-11

implants breast, 154, 399, 417, 419–420 contraceptive, 338 pectoral, 112 penis, 399

impotence. See erectile dysfunction incest, 587–588. See also child

sexual abuse incidence, defi nition of, 482 income. See socioeconomic status indecent exposure. See exhibitionism independent variables, 42 India, rites of passage in, 167 f Indians, American. See American Indians induction, 36 induction abortions, 353 infant-caregiver attachment, 230 infantilism, 306 infant mortality, 378–379 infants

breastfeeding, 82 t, 390–391 circumcision of male, 387 gender-role learning by, 160 HIV in, 530, 533 importance of touch to, 159–160 low birth weight in, 178, 179 mortality rates, 378–379 neonates, 386 safe havens for relinquishment of, 393 sexuality in, 159–160 sudden infant death syndrome in,

378–379 infatuation, 227 f, 228–229 infectious diseases, during pregnancy,

373–374. See also sexually transmitted infections

infertility defi nition of, 379 emotional responses to, 380 female, 379–380 male, 380 medical intervention for, 381–384 from sexually transmitted infections,

484, 510 treatment for, 379, 380–381

infi bulation, 429 infi delity, 236–237 infl uenza, pediatric, 373–374 informed consent, 37 infundibulum, 78 inhibin, 114 t inhibited (delayed) ejaculation, 454, 470 inhibited female orgasm, 452 inhibited sexual desire, 447 inhibited (hypoactive) sexual desire

disorder (HSDD), 441 t, 446–448, 447 f, 471

inhibitory response, 94 injectable contraceptives, 335–336 injection drug use (IDU), HIV transmission

in, 532, 538 inorgasmia, 452 Institute of Medicine (IOM), 483, 486 instrumentality, 130 intellectual freedom, 27 intercourse. See anal intercourse; penile-

vaginal intercourse; sexual intercourse interfemoral intercourse, 282

internalized homophobia, 195–196, 460, 476

International AIDS Vaccine Initiative, 552 International Classifi cation of Diseases

(ICD-10), 440 Internet

dating Web sites, 13–14, 199 fetishism and, 307 laws on access to, 27 online sexual activity, 599–602 pedophilia and, 318 questionnaires and interviews on, 39, 42 restricting access by children,

608–609, 609 t sex information/advice, 14 sex site use by college students, 600,

602–603 sexual exploitation of children on,

606, 608 sexual health information, 14 sexually explicit materials on, 14,

599–602, 606 social networks, 11–14

interpersonal scripting, 267–268 intersex, 144–145. See also disorders of

sexual development interstitial (Leydig) cells, 111 f, 114 interviews, 38 f, 39, 42 intimacy

confl ict and, 250–252, 250 f in early adulthood, 189 kissing and, 232 signs of, 227–228 in triangular theory of love, 227–229,

227 f, 230 f intimate love, 238–239 intracytoplasmic sperm injection (ICSI), 381 intrafamilial abuse, 587 intrapersonal scripting, 266, 267 intrauterine contraception (IUC)

for birth control, 346–347, 346 f for emergency contraception, 352 for menopausal hormone therapy, 213

introitus, 73 f, 74 invasive cancer of the cervix (ICC), 420–422 in vitro fertilization (IVF), 381 involuntary (premature) ejaculation, 441 t,

454–455, 469–470, 469 f IOM (Institute of Medicine), 483, 486 Iranian Americans, 64 Islam

circumcision and, 387 marriage and, 240

“It Gets Better” Project, 171, 171 f “I-Th ou” relationship, 239 IUC/IUD. See intrauterine contraception IVF (in vitro fertilization), 381

Jacobelis v. Ohio, 608 Japanese Americans, sexuality in, 62–63.