**See course book PDF attached**
Final Thoughts
This is a very straightforward question. I want you to write (in complete, thoughtful sentences) THREE favorite/interesting/surprising/disturbing/good things that you’ve learned in this Human Sexuality course. Think about something that has surprised you, challenged a preconceived notion, or simply changed your perception of something. Name each concept, explain it, and explain why you found it so interesting/surprising/etc.

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You should number each thing (1.2.3.) and explain your reason for choosing that topic/concept.

Human Sexuality
Human Human
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Human Sexuality
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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.
1 2 3 4 5 6 7 8 9 0 DOW/DOW 1 0 9 8 7 6 5 4 3 2
ISBN 978-0-07-803531-9 MHID 0-07-803531-7
Senior Vice President, Products & Markets: Kurt L. Strand Vice President, General Manager: Michael Ryan Vice President, Content Production & Technology Services: Kimberly Meriwether David Director: Krista Bettino Senior Brand Manager: Nancy Welcher Director of Development: Barbara A. Heinssen Content Development Editor: Cheri Dellelo Editorial Coordinator: Kevin Fitzpatrick Digital Development Editor: Sarah Colwell Digital Product Analyst: Neil Kahn Marketing Managers: Ann Helgerson, AJ Laferrera Director, Content Production: Terri Schiesl
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All credits appearing on page or at the end of the book are considered to be an extension of the copyright page.
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.
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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
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1 Perspectives on Human Sexuality 1
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
SEXUALITY ACROSS CULTURES AND TIMES 14 Sexual Interests 14 Sexual Orientation 17 Gender 18
Natural Sexual Behavior 20 Normal Sexual Behavior 21
■ Think About It DECLARATION OF SEXUAL RIGHTS 23 Sexuality Behavior and Variations 24
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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
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
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
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x • Contents
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 THE ROLE OF ORGASM 98 Experiencing Sexual Arousal 98
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
■ 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
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
Changing Gender Roles and Scripts 141 Androgyny 142
GENDER VARIATIONS 143 The Transgender Phenomenon 144 Disorders of Sexual Development/Intersex 144
Unclassifi ed Form of Abnormal Development 151 Gender Identity Disorder 151 Transsexuality 152 Coming to Terms With Diff erences 153
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xii • Contents
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
Teenage Pregnancy 178 Sexuality Education 181
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
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
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Contents • xiii
8 Love and Communication in Intimate Relationships 218
LOVE AND SEXUALITY 221 Men, Women, Sex, and Love 223 Love Without Sex: Celibacy and Asexuality 224
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
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
Sexual Confl icts 251 Confl ict Resolution 252
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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 THE FIRST KISS: A DEALBREAKER? 286 Sexual Intercourse 289 Anal Eroticism 291 Health Benefi ts of Sexual Activity 294
10 Variations in Sexual Behavior 298 SEXUAL VARIATIONS AND PARAPHILIC BEHAVIOR 299 What Are Sexual Variations? 299 What Is Paraphilia? 300
Sexual Variations Among College Students 303
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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
11 Contraception, Birth Control, and Abortion 325
RISK AND RESPONSIBILITY 326 Women, Men, and Birth Control: Who Is Responsible? 327 Family Planning Clinics 328
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
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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xvi • Contents
ABORTION 352 Methods of Abortion 352 Safety of Abortion 353 Women and Abortion 354 Men and Abortion 355 The Abortion Debate 355
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
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Contents • xvii
13 The Sexual Body in Health and Illness 396
■ 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
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
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xviii • Contents
14 Sexual Function Diffi culties, Dissatisfaction, Enhancement, and Therapy 437
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 in Men 457 Physical Causes in Women 457
Immediate Causes 458 Confl ict Within the Self 459 Relationship Causes 460
SEXUAL FUNCTION ENHANCEMENT 461 Developing Self-Awareness 461
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
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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 STI ATTITUDE SCALE 492 Consequences of STIs 493
PRINCIPAL BACTERIAL STIs 493 Chlamydia 493 Gonorrhea 497 Urinary Tract Infections 498 Syphilis 498
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
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
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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
Protecting Ourselves 543 Saving Lives Through Prevention 544
HIV Testing 548 Treatments 550
LIVING WITH HIV OR AIDS 552 If You Are HIV-Positive 553
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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
Heterosexual Bias 565 Prejudice, Discrimination, and Violence 566
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
Motivations for Rape 583 The Aftermath of Rape 584
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
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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
The Eff ects of Sexually Explicit Material 602 Censorship, Sexually Explicit Material, and the Law 606
PROSTITUTION 610 Females Working in Prostitution 611
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
Advocating Sexual Rights 623
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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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• 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
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”
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Preface • xxix
■ New research on “faking orgasm” ■ New Th ink About It box: “Sexual Fluidity: Women’s Variable Sexual
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
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
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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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
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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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
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.
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
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,
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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?
• 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
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?
Live TV 25%
TV content on other platforms
17% Music/audio
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?
SOURCE: From The National Campaign to Prevent Teen Pregnancy (2009) © 2012, The National Campaign to Prevent Teen and Unplanned Pregnancy. Reprinted by permission.
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.
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.
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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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
■ National Coalition for Sexual Freedom
■ Kaiser Family Foundation http://kff .org/entmedia/index.cfm
■ Sexual Literacy
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28 • Chapter 1 Perspectives on Human Sexuality
Suggested Websites The Media Project 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 Provides information and referrals on gay, lesbian, bisexual, and transsexual issues and rights.
Noah 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
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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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 ( and the Sexuality Information and Education Council of the United States ( 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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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
—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.
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
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:
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 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:
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
(5%)b 45%a
(5%)b 45%a
(36%)b 4%a
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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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 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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62 • Chapter 2 Studying Human Sexuality
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 • 67
Society for the Scientifi c Study of Sexuality A nonprofi t organization dedicated to the advancement of knowl- edge about sexuality; provides announcements of the SSSS conferences and other meetings.
Suggested Reading Bancroft, J. (Ed.). (1997). Researching sexual behavior.
Bloomington: Indiana University Press. A discussion of the methodological issues of large-scale survey research in studying human sexuality.
Bullough, V. L. (1994). Science in the bedroom: A history of sex research. New York: Basic Books. A comprehensive history of sex research of the twentieth century.
Garton, S. (2004). Histories of sexuality: Antiquity to sexual revolution. New York: Routledge. A comprehensive historical review of major fi gures, from Havelock Ellis to Alfred Kinsey, and exploration of such topics as the “invention” of homosexuality in the nineteenth century to the rise of sexual sciences in the twentieth century.
Maier, T. (2009). Masters of sex. New York: Basic Books. An unprecedented look at Masters and Johnson and their pioneering work together that highlights interviews with both.
Meezen, W., & Martin, J. I. (Eds.). (2006). Research methods with gay, lesbian, bisexual and transgendered populations. New York: Harrington Park Press. Discusses the unique issues in sexuality-related research among gay, lesbian, bisexual, and transgender populations and provides suggestions for doing this research.
Staples, R. (2006). Exploring Black sexuality. Boulder, CO: Rowman & Littlefi eld. A distinguished Black sexologist explores the sexual mores, folkways, and values among African Americans.
Wiederman, M., & Whitley, B., Jr. (2002). Handbook for conducting research on human sexuality. Mahwah, NJ: Erlbaum. A reference tool for researchers and students interested in research in human sexuality from a variety of disciplines; examines the specifi c methodological issues inherent in conducting human sexuality research.
Wyatt, G. (1997). Stolen women: Reclaiming our sexuality and taking back our lives. New York: Wiley. Discusses sociocultural infl uences such as slavery and institutionalized racism on the expression of sexuality among African American women.
website ( and fi nd out information about the following:
■ The mission and history of KI ■ A chronology of events and landmark publications ■ The KI research staff and their publications ■ KI’s current research projects ■ KI’s exhibitions, services, and events ■ KI’s library and special collections ■ Graduate education in human sexuality at KI and
Indiana University
■ Links to related sites in sexuality research
Suggested Websites Advocates for Youth Focuses on teen sexual health; provides valuable data on issues related to teen sexual health.
Centers for Disease Control and Prevention A valuable source of research information about sexual behavior and related health issues in the United States.
Gallup Poll Provides results of current surveys, including those dealing with sexuality-related issues.
International Academy of Sex Research A scientifi c society that promotes research in sexual behavior; provides announcements of IASR conferences and abstracts of its journal’s recent articles.
Kinsey Confi dential http://kinseyconfi A sexuality information service designed by Th e Kinsey Institute for Research in Sex, Gender, and Reproduction to meet the sexual health information needs of college-age adults.
Magnus Hirschfeld Archive for Sexology Has an extensive history of early and contemporary sex research- ers as well as other valuable sexology resources.
National Sexuality Resource Center Th is center gathers and disseminates the latest accurate informa- tion and research on sexual health, education, and rights.
For links, articles, and study material, go to the McGraw-Hill website, located at
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3 ch
ap te
Female Sexual Anatomy, Physiology, and Response
Female Sex Organs: What Are They For? 69
Female Sexual Physiology 81
Female Sexual Response 90
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Female Sex Organs: What Are They For? • 69
Student Voices
67 or so people one female would have a pad. I remember crying and my grandmother ask- ing me what was wrong. After I told her, she began to laugh and said it was a natural cycle. I knew this from sixth-grade sexuality education class, but I still didn’t want it. I was fi nally a woman.”
—19-year-old female
“I think I am a good sexual partner and enjoy pleasing a woman. I especially love the foreplay that occurs between two people because it gets the body more excited than just going at it. I can go on forever with foreplay because I get to explore my partner’s body, whether it is with my hands, lips, or tongue.”
—25-year-old male
“I identify with the passion [of women], the strength, the calmness, and the fl exibility of being a woman. To me being a woman is like being the ocean. The ocean is a powerful thing, even at its calmest moments. It is a beauty that commands respect. It can challenge even the strongest men, and it gives birth to the smallest creatures. It is a provider, and an inspiration; this is a woman and this is what I am.”
—20-year-old female
“The more I think about things that annoy me about being a woman, the more I realize that those annoyances are what make it so special. When I get my period, it isn’t just a ‘monthly curse’; it is a reminder that I can have children.”
—19-year-old female
“When I started my period, my father kept a bit of a distance. How could I forget [that day]? The entire family was at my aunt’s house, and no one had pads. You would think among
Although women and men are similar in many more ways than they are diff erent, we tend to focus on the diff erences rather than the simi- larities. Various cultures hold diverse ideas about exactly what it means to be female or male, but virtually the only diff erences that are consistent are actual physical diff erences, most of which relate to sexual structure and function. In this chapter and the following one, we discuss both the similarities and the diff erences in the anatomy (body structures), physiology (body functions), and sexual response of females and males. Th is chapter introduces the sexual structures and functions of women’s bodies, including hormones and the menstrual cycle. We also look at models of sexual arousal and response, the relationship of these to women’s experiences of sex, and the role of orgasm. In Chapter 4, we discuss male anatomy and physiology, and in Chapter 5, we move beyond biology to look at gender and the meanings we ascribe to being female and male.
• Female Sex Organs: What Are They For? Anatomically speaking, all embryos are female when their reproductive struc- tures begin to develop (see Figure 3.1). If it does not receive certain genetic and hormonal signals, the fetus will continue to develop as a female. In humans and most other mammals, the female, in addition to providing half the genetic instructions for the off spring, provides the environment in which it can develop until it becomes capable of surviving as a separate entity. She also nourishes the off spring, both during gestation (the period of carrying the young in the uterus) via the placenta and following birth via the breasts through lactation (milk production). In spite of what we do know, we haven’t yet mapped all of the basic body parts of women, especially as they relate to the microprocesses of sexual
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70 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
Genital tubercle
Labioscrotal swelling
Anus Urogenital fold Genital groove
Undifferentiated Stage Prior to 6th Week
Inner labial fold
Urogenital fold
Glans (penis)
Urethral groove
Scrotal swelling
Male7th–8th Week
Labia majora
Labia minora
Opening of vagina
Opening of urethra
Female 12th Week
Urethral closure
Glans (clitoris)
Vulval groove
Labial swelling
• FIGURE 3.1 Embryonic-Fetal Diff erentiation of the External Reproductive Organs. Female and male reproductive organs are formed from the same embryonic tissues. An embryo’s external genitals are female in appearance until certain genetic and hormonal instructions signal the development of male organs. Without such instructions, the genitals continue to develop as female.
response. Such issues as the function of the G-spot, the role of orgasm, and the placement of the many nerves that spider through the pelvic cavity still are not completely understood. Add to these puzzles the types, causes, and treat- ments of sexual function problems and one can quickly see that the science of sexual response is still emerging. Clearly, the female sex organs serve a reproductive function. But they per- form other functions as well. Signifi cant to nearly all women are the sexual parts that bring them pleasure; they may also serve to attract potential sexual partners. Because of the mutual pleasure partners give each other, we can see that sexual structures also serve an important role in human relationships. People demonstrate their aff ection for one another by sharing sexual pleasure and generally form enduring partnerships at least partially on the basis of mutual sexual sharing. Let’s look at the features of human female anatomy and physiology that provide pleasure to women and their partners and that enable women to conceive and give birth.
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Female Sex Organs: What Are They For? • 71
External Structures (the Vulva)
Th e sexual and reproductive organs of both men and women are usually called genitals, or genitalia, from the Latin genere, “to beget.” Th e external female genitals are the mons pubis, the clitoris, the labia majora, and the labia minora, collectively known as the vulva (see Figure 3.2). (People often use the word “vagina” when they are actually referring to the vulva. Th e vagina is an internal structure.)
The Mons Pubis Th e mons pubis (pubic mound), or mons veneris (mound of Venus), is a pad of fatty tissue that covers the area of the pubic bone about 6 inches below the navel. Beginning in puberty, the mons is covered with pubic hair. Because there is a rich supply of nerve endings in the mons, caressing it can produce pleasure in most women. Th e current practice of trimming and shaving pubic hair has become one barometer of fashion (Ramsey, Sweeney, Fraser, & Oades, 2009). Over the past few years, it has become commonplace in both sexes and for similar reasons: aesthetic and psychosexual. Its acceptance and practice among women has been revealed in a recent publication (Herbenick, Schick, Reece, Sanders, & Fortenberry, 2010) which notes that a diverse range of pubic hair–grooming practices appears to be an important component of sexual expression and
People will insist on treating the mons veneris as though it were Mount Everest.
—Aldous Huxley (1894–1963)

Ischiocavernosus muscle
Remnants of hymen
External urethral opening
Frenulum of clitoris
Prepuce of clitoris
Corpora cavernosa of clitoris
Vestibule of vagina; Frenulum of inner lips
External anal sphincter muscle
Greater vestibular gland and its orifice
Vestibular bulb
Vaginal opening
Inner lips
Crura of clitoris
Glans clitoris
Symphysis pubis Suspensory ligament of clitoris
• FIGURE 3.2 External Female Structures (Vulva)
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72 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
participation in sexual activity. Findings were that pubic hair styles are diverse and that it is more common than not for women to have at least some pubic hair on their genitals. Th e authors of the study found that women’s total removal of their pubic hair was associated with being young, being partnered, having looked closely at one’s own genitals, cunnilingus, positive genital self-image, and sexual function. Implicated in the shift in cultural attitudes regarding pubic hair is Internet- based pornography, where removal has become the “norm.” Th is practice, how- ever, is not new; many societies have decorated and sculpted their pubic hair for centuries, while others have removed the hair to avoid body lice. Many anecdotal reports on the removal of pubic hair highlight increased genital sen- sitivity and increased partner satisfaction. From a public health perspective, body hair removal may be a risk factor for folliculitis (the infl ammation of one or more hair follicles) (Trager, 2006). On the other hand, a signifi cant drop has been found in the number of cases of pubic lice (Armstrong & Wilson, 2006). If a woman chooses to shave, wax, or have her genitals pierced, she should use only clean tools and exercise caution, since this is obviously a sensitive area.
The Clitoris Th e clitoris (KLIH-tuh-rus) is considered the center of sexual arousal. It contains a high concentration of sensory nerve endings and is exqui- sitely sensitive to stimulation, especially at the tip of its shaft, the glans clitoris. A fold of skin called the clitoral hood covers the glans when the clitoris is not engorged. Although the clitoris is structurally analogous to the penis (it is formed from the same embryonic tissue), its sole function is sexual arousal. (Th e penis serves the additional functions of urine excretion and semen ejaculation.) Th e clitoris is a far more extensive structure than its visible part, the glans, would suggest (Bancroft, 2009). Th e shaft of the clitoris is both an external and an internal structure. Th e external portion is about 1 inch long and a quarter inch wide. Internally, the shaft is divided into two branches called crura (KROO-ra; singular, crus), each of which is about 3.5 inches long, which are the tips of erectile tissue that attach to the pelvic bones. Th e crura contain two corpora
cavernosa (KOR-por-a kav-er-NO-sa), hollow chambers that fi ll with blood and swell during arousal. Th e hidden erectile tissue of the clitoris plus the surrounding muscle tissue all contribute to muscle spasms associated with orgasm. When stimulated, the clito- ris enlarges initially and then retracts beneath the hood just before and during orgasm. With repeated orgasms, it follows the same pattern of engorgement and retraction, although its swellings may not be as pronounced after the initial orgasm. Th e role of the cli- toris in producing an orgasm is discussed later in the chapter.
The Labia Majora and Labia Minora Th e labia majora (LAY-be- a maJOR-a) (major lips) are two folds of spongy fl esh extending from the mons pubis and enclosing the labia minora, clitoris, urethral opening, and vaginal entrance. Th e labia minora (minor lips) are smaller folds within the labia majora that meet above the clitoris to form the clitoral hood. Th e labia minora also enclose the urethral and vaginal openings. Th ey are smooth and hairless and vary quite a bit in appearance from woman to woman. Another rich source of sexual sensation, the labia are sensitive to the touch and swell during sexual arousal, doubling or tripling in size and changing in color
Really that little dealybob is too far away from the hole. It should be built right in.
—Loretta Lynn (1935–)

Artwork often imitates anatomy, as can be seen in this painting titled Black Iris (Georgia O’Keeff e, 1887–1986).
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Female Sex Organs: What Are They For? • 73
from fl esh-toned to a deeper hue. Th e area enclosed by the labia minora is referred to as the vestibule. During sexual arousal, the clitoris becomes erect, the labia minora widen, and the vestibule (vaginal opening) becomes visible. Within the vestibule, on either side of the vaginal opening, are two small ducts from the Bartholin’s glands (or vestibular glands), which secrete a small amount of mois- ture during sexual arousal.
Internal Structures
Th e internal female sexual anatomy and reproductive organs include the vagina; the uterus and its lower opening, the cervix; the ovaries; and the fallopian tubes. (Figure 3.3 provides illustrations of the front and side views of the female internal sexual anatomy.)
Fallopian tube
Pubic bone
Crura Clitoris (glans)
Urinary opening
Labia majora
Approximate location of the G-spot
Vaginal opening (introitus)
Labia minora
Os Vagina
Fallopian tubes
(a) Side view
(b) Front view
• FIGURE 3.3 Internal Female Sexual Structures
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74 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
The Vagina Th e vagina (va-JI-na), from the Latin word for sheath, is a fl ex- ible, muscular structure that extends 3–5 inches back and upward from the vaginal opening. It is the birth canal through which an infant is born, allows menstrual fl ow to pass from the uterus, and encompasses the penis or other object during sexual expression. In the unaroused state, the walls of the vagina are relaxed and collapsed together, but during sexual arousal, the inner two thirds of the vagina expand while pressure from engorgement causes the many small blood vessels that lie in the vaginal wall to produce lubrication. In response to sexual stimulation, lubrication can occur within 10–30 seconds. Th e majority of sensory nerve endings are concentrated in the lower third of the vagina, or the introitus (in-TROY-tus). Th is part of the vagina is the most sensitive to erotic pressure and touch. In contrast, the inner two thirds of the vagina have virtually no nerve endings, which make it likely that a woman cannot feel a tampon when it is inserted deep in the vagina. Although the vaginal walls are generally moist, the wetness of a woman’s vagina can vary by woman, by the stage of her menstrual cycle, and after childbirth or at meno- pause. Lubrication also increases substantially with sexual excitement. Th is lubrication serves several purposes. First, it increases the possibility of concep- tion by alkalinizing the normally acidic chemical balance in the vagina, thus making it more hospitable to sperm, which die faster in acid environments. Second, it can make penetration more pleasurable by reducing friction in the vaginal walls. Th ird, the lubrication helps prevent small tears in the vagina which, if they occur, can make the vagina more vulnerable to contracting HIV. Prior to fi rst intercourse or other form of penetration, the introitus is partially covered by a thin membrane containing a relatively large number of blood ves- sels, the hymen (named for the Roman god of marriage). Th e hymen typically has one or several perforations, allowing menstrual blood and mucous secretions to fl ow out of the vagina (and generally allowing for tampon insertion). In many cultures, it is (or was) important for a woman’s hymen to be intact on her wed- ding day. Blood on the nuptial bedsheets is taken as proof of her virginity. Th e stretching or tearing of the hymen may produce some pain or discomfort and
The external female genitalia (vulva) can assume many diff erent colors, shapes, and structures.
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Female Sex Organs: What Are They For? • 75
practically speaking
While reading this material, female readers may wish to examine their own genitals and discover their unique features. In a space that is comfortable for you, take time to look at your vulva, or outer genitals, using a mirror and a good light. The large, soft folds of skin with hair on them are the outer lips, or labia majora. The color, texture, and pattern of this hair vary widely among women. Inside the outer lips are the inner lips, or labia minora. These have no hair and vary in size from small to large and protruding. They extend from below the vagina up toward the pubic bone, where they form a hood over the clitoris. The glans may not be visible under the clitoral hood, but it can be seen if a woman separates the labia minor and retracts the hood. The size and shape of the clitoris, as well as the hood, also vary widely among women. These variations have nothing to do with a woman’s ability to respond sexually. You may also fi nd some cheesy white matter under the hood. This is called smegma and is normal. Below the clitoris is a smooth area and then a small hole. This is the urinary opening, also called the meatus. Below the urinary opening is the vaginal opening, which is surrounded by rings of tissue. One of these, which you may or may not be able to see, is the hymen. Just inside the vagina, on both sides, are the Bartholin’s glands. These may secrete a small amount of mucus during sexual excitement, but little else of their function is known. If they are infected, they will be swollen, but otherwise you won’t notice them. The smooth area between your vagina and anus is called the perineum. You can also examine your inner genitals, using a speculum, fl ashlight, and mirror. A speculum is an instrument used to hold the vaginal walls apart, allowing a clear view of the vagina and cervix. You should be able to obtain a speculum and information about doing an internal exam from a clinic that specializes in women’s health or family planning. It is a good idea to observe and become aware of what your normal vaginal discharges look and feel like. Colors vary from white to gray, and secretions change in consistency from thick
to thin and clear (similar to egg white that can be stretched between the fi ngers) over the course of the menstrual cycle. Distinct changes or odors, along with burning, bleeding between menstrual cycles, pain in the pelvic region, itching, or rashes, should be reported to a physician. By inserting one or two fi ngers into the vagina and reaching deep into the canal, it is possible to feel the cervix, or tip of the uterus. In contrast to the soft vaginal walls, the cervix feels like the end of a nose: fi rm and round. In doing a vaginal self-exam, you may initially experience some fear or uneasiness about touching your body. In the long run, however, your patience and persistence will pay off in increased body awareness and a heightened sense of personal health. Once you’re familiar with the normal appearance of your outer genitals, you can check for any changes, especially unusual rashes, soreness, warts, or parasites, such as pubic lice, or “crabs.”
Performing a Gynecological Self-Examination
possibly some bleeding. Usually, the partner has little trouble inserting the penis or other object through the hymen if he or she is gentle and there is adequate lubrication. Prior to fi rst intercourse, the hymen may be stretched or ruptured by tampon insertion, by the woman’s self-manipulation, by a partner during noncoital sexual activity, by accident, or by a health-care provider conducting a routine pelvic examination. Hymenoplasty, a controversial procedure that re- attaches the hymen to the vagina, is now sought by some women, particularly in Muslim countries where traditionalists place a high value on a woman’s virgin- ity, to create the illusion that they are still virgins. Hymen repair, also referred to as “revirgination,” may also be performed for women who have been abused
Examining your genitals can be an enlightening and useful practice that can provide you with information about the health of your body.
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76 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
or those from cultures who risk a violent reaction from their partners. In spite of its availability, the American College of Obstetricians and Gynecologists has issued strong warnings to women that there is no evidence cosmetic genital surgery is safe or eff ective (ACOG, 2007). An area inside the body, surrounding the urethra, is what many women report to be an erotically sensitive area, the Grafenberg spot, or G-spot. Th e name is derived from Ernest Grafenberg, a gynecologist, who fi rst discussed its erotic signifi cance. Located on the front wall of the vagina midway between the pubic bone and the cervix on the vaginal side of the urethra (see Figure 3.4), this area varies in size from a small bean to a half walnut. It can be located by pressing one or two fi ngers into the front wall of a woman’s vagina. Coital positions such as rear entry, in which the penis makes contact with the spot, may also produce intense erotic pleasure (Ladas, Whipple, & Perry, 1982; Whipple & Komisaruk, 1999). A variety of responses have been reported by women who fi rst locate this spot. Initially, a woman may experience a slight feeling of discomfort or the need to urinate, but shortly thereafter, the tissue may swell and a pleasurable feeling may occur. Women who report orgasms as a result of stimulation of the G-spot describe them as intense and extremely pleasurable (Perry & Whipple, 1981; Whipple, 2002). Th ough an exact gland or site has not been found in all women, nor do all women experience pleasure when the area is massaged, it has been suggested that the orgasm occurring in the area called the G-spot could be caused by the contact and connection of the richly innervated internal clitoris and the anterior vaginal wall (Foldes & Buisson, 2009). More specifi cally, by using special instruments and photography that measure changes in the vagina, it was found that the displacement of the anterior vaginal wall that occurs with pressure of the fi nger on this site, along with movement of the engorged and enlarged cli- toris that occurs during sexual arousal, could provide close contact between the internal root of the clitoris and the anterior vaginal wall and thereby lead to what
Urethral opening (exit point for emission)
Pubic bone
Approximate location of G-spot
Emptied bladder
Anterior vaginal wall
• FIGURE 3.4 The Grafenberg Spot (G-Spot). To locate the Grafenberg spot, insert two fi ngers into the vagina and press deeply into its anterior wall.
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Female Sex Organs: What Are They For? • 77
is known as a G-spot orgasm, sometimes with accompanying emission of fl uid. Th is fl uid, referred to as the “female ejaculate,” has the appearance of skim milk and is chemically similar to seminal fl uid, but diff erent from urine (Komisaruk, Whipple, Nasserzadeh, & Beyer-Flores, 2010). It has been suggested that the emit- ted fl uid comes from the para-urethral glands, which recently have been named the “female prostate gland.” Th e orgasm and emission that accompanies G-spot stimulation is a healthy part of sexual expression and can be pleasurable.
The Uterus and Cervix Th e uterus (YU-te-rus), or womb, is a hollow, thick- walled, muscular organ held in the pelvic cavity by a number of fl exible liga- ments and supported by several muscles. It is pear-shaped, with the tapered end, the cervix, extending down and opening into the vagina. If a woman has not given birth, the uterus is about 3 inches long and 3 inches wide at the top; it is somewhat larger in women who have given birth. Th e uterus expands during pregnancy to the size of a volleyball or larger, to accommodate the developing fetus. Th e inner lining of the uterine walls, the endometrium (en-doe-MEE-tree-um), is fi lled with tiny blood vessels. As hormonal changes occur during the monthly menstrual cycle, this tissue is built up and then shed and expelled through the cervical os (opening), unless fertilization has occurred. In the event of pregnancy, the pre-embryo is embedded in the nourishing endometrium. In addition to the more or less monthly menstrual discharge, mucous secre- tions from the cervix also fl ow out through the vagina. Th ese secretions tend to be somewhat white, thick, and sticky following menstruation, becoming thinner as ovulation approaches. At ovulation, the mucous fl ow tends to increase and to be clear, slippery, and stretchy, somewhat like egg white. (Birth control using cervical mucus to determine the time of ovulation is discussed in Chapter 11.)
The Ovaries On each side of the uterus, held in place by several ligaments, is one of a pair of ovaries. Th e ovary is a gonad, an organ that produces gametes (GA-meets), the sex cells containing the genetic material necessary for reproduction. Female gametes are called oocytes (OH-uh-sites), from the Greek words for egg and cell. (Oocytes are commonly referred to as eggs or ova [singular, ovum]. Technically, however, the cell does not become an egg until it completes its fi nal stages of division following fertilization.) Th e ovaries are the size and shape of large almonds. In addition to producing oocytes, they serve the important function of producing hormones such as estrogen, proges- terone, and testosterone. (Th ese hormones are discussed later in this chapter.) At birth, the female’s ovaries contain about half a million oocytes. During childhood, many of these degenerate; then, beginning in puberty and ending after menopause, a total of about 400 oocytes mature and are released during a woman’s reproductive years. Th e release of an oocyte is called ovulation. Th e immature oocytes are embedded in saclike structures called ovarian follicles. Th e fully ripened follicle is called a vesicular or Graffi an follicle. At maturation, the follicle ruptures, releasing the oocyte. After the oocyte emerges, the rup- tured follicle becomes the corpus luteum (KOR-pus LOO-tee-um) (from the Latin for yellow body), a producer of important hormones; it eventually degen- erates. Th e egg is viable for about 24 hours.
The Fallopian Tubes At the top of the uterus are two tubes, one on each side, known as fallopian tubes, uterine tubes, or oviducts. Th e tubes are about 4 inches long. Th ey extend toward the ovaries but are not attached to them.
Girls got balls. They’re just a little higher up, that’s all.
—Joan Jett (1960–) “
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78 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
Instead, the funnel-shaped end of each tube (the infundibulum) fans out into fi ngerlike fi mbriae (fi m-BREE-ah), which drape over the ovary but may not actually touch it. Tiny, hairlike cilia on the fi mbriae and ampulla become active during ovulation. Th eir waving motion, along with contractions of the walls of the tube, transports the oocyte that has been released from the ovary into the fallopian tube. Just within the infundibulum is the ampulla, the widened part of the tube in which fertilization normally occurs if sperm and oocyte are there at the same time. (Th e process of ovulation and the events leading to fertilization are discussed later in this chapter; fertilization is covered in Chapter 12.)
Other Structures
Th ere are several other important anatomical structures in the genital areas of both men and women. Although they may not serve reproductive functions, they may be involved in sexual activities. Some of these areas may also be aff ected by sexually transmitted infections. In women, these structures include the urethra, anus, and perineum. Th e urethra (yu-REE-thra) is the tube through which urine passes; the urethral opening, or meatus, is located between the clitoris and the vaginal opening. Between the vagina and the anus—the opening of the rectum, through which excrement passes—is a diamond-shaped region called the perineum (per-e-NEE-um). Th is area of soft tissue covers the muscles and ligaments of the pelvic fl oor, the underside of the pelvic area extending from the top of the pubic bone (above the clitoris) to the anus. (To learn more about this muscle and Kegel exercises, which can strengthen it, see Chapter 14.) Th e anus consists of two sphincters, which are circular muscles that open and close like valves. Th e anus contains a dense supply of nerve endings that, along with the tender rings at the opening, can respond erotically. (For additional discussion about anal eroticism, see Chapter 9.) In sex play or intercourse involv- ing the anus or rectum, care must be taken not to rupture the delicate tissues. Th is may occur because of the lack of adequate lubrication or very rough anal sex play. Anal sex, which involves insertion of the penis or other object into the rectum, is potentially unsafe, as is vaginal sex, because abrasions of the tissue provide easy passage for pathogens, such as HIV (the virus that causes AIDS), to the bloodstream (see Chapter 16). To practice safer sex, partners who engage in anal intercourse should use a latex condom with a water-based lubricant.
The Breasts
With the surge of sex hormones that occurs during adolescence, the female breasts begin to develop and enlarge (see Figure 3.5). Th e reproductive function of the breasts is to nourish off spring through lactation, or milk production. A mature female breast, also known as a mammary gland, is composed of fatty tissue and 15–25 lobes that radiate around a central protruding nipple. Around the nipple is a ring of darkened skin called the areola (a-REE-o-la). Tiny muscles at the base of the nipple cause it to become erect in response to touch, cold, or sexual arousal. When a woman is pregnant, the structures within the breast undergo further development. Directly following childbirth, in response to hormonal signals, small glands within the lobes called alveoli (al-VEE-a-lee) begin producing milk. Th e milk passes into ducts, each of which has a dilated region for storage; the ducts open to the outside at the nipple. (Breastfeeding is discussed in Chapter 12.) During lactation, a woman’s breasts increase in size from enlarged glandular tissues and stored milk. Because there is little variation in the amount
Uncorsetted, her friendly bust gives promise of pneumatic bliss.
—T. S. Eliot (1888–1965)

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Female Sex Organs: What Are They For? • 79
of glandular tissue among women, the amount of milk produced does not vary with breast size. In women who are not lactating, breast size depends mainly on fat content, which is determined by hereditary factors. In the Western culture, women’s breasts capture a signifi cant amount of atten- tion and serve an erotic function. Many, but not all, women fi nd breast stimula- tion intensely pleasurable, whether it occurs during breastfeeding or sexual contact. Partners tend to be aroused by both the sight and the touch of women’s breasts. Although there is no basis in reality, some believe that large breasts denote greater sexual responsiveness than small breasts. (See Chapter 13 for a discussion of breast enhancement.) (Table 3.1 provides a summary of female sexual anatomy.)
Milk ducts
Suspensory ligaments
Chest wall
Mammary glands
• FIGURE 3.5 The Female Breast. Front and cross-section views.
Western culture tends to be ambivalent about breasts and nudity. Many people are comfortable with artistic portrayals of the nude female body.
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80 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
TABLE 3.1 • Summary Table of Female Sexual Anatomy
External Structures (Vulva)
Mons pubis (mons veneris) Fatty tissue that covers the area of the pubic bone
Clitoris Center of sexual arousal
Clitoral hood Covers the glans clitoris when the clitoris is not engorged
Crura (singular, crus) Tips of erectile tissue that attach to the pelvic bones
Corpora cavernosa Hollow chambers that fi ll with blood and swell during sexual arousal
Labia majora (major lips) Two folds of spongy fl esh that extend from the mons pubis and run downward along the sides of the vulva
Labia minora (minor lips) Smaller, hairless folds within the labia majora that meet above the clitoris to form the clitoral hood
Vestibule (vaginal opening) Area enclosed by the labia minora
Bartholin’s glands Glands that secrete a small amount of moisture during sexual arousal
Internal Structures
Vagina (birth canal) Flexible, muscular structure in which menstrual fl ow and babies pass
Introitus The lower part of the vagina
Hymen Thin membrane that partially covers the introitus and contains a relatively large number of blood vessels
Grafenberg spot (G-spot) Located on the front wall of the vagina, an erotically sensitive area that may produce intense erotic pleasure and a fl uid emission in some women
Uterus (womb) Hollow, thick-walled muscular organ in which a fertilized ovum implants and develops until birth
Cervix Lower end of the uterus that extends down and opens to the vagina
Endometrium Inner lining of the uterine wall to which the fertilized egg attaches; partly discharged (if pregnancy does not occur) with the menstrual fl ow
Os Opening to the cervix
Ovary (gonad) Organ that produces gametes (see below)
Gametes Sex cells containing the genetic material necessary for reproduction; also referred to as oocytes, eggs, ova (singular, ovum)
Ovarian follicles Saclike structures that contain the immature oocytes
Corpus luteum Tissue formed from a ruptured ovarian follicle that produces important hormones after the oocyte emerges
Fallopian tubes (oviducts) Uterine tubes that transport the oocyte from the ovary to the uterus
Infundibulum Funnel-shaped end of each fallopian tube
Fimbriae Fingerlike projections that drape over the ovary and help transport the occyte from the ovary into the fallopian tube
Cilia Tiny, hairlike structures that provide waving motion to help transport the oocyte within the fallopian tube to the ovary
Ampulla Widened part of the fallopian tube in which fertilization normally occurs
Other Structures
Urethra Tube through which urine passes
Urethral opening (meatus) Opening in the urethra, through which urine is expelled
Anus Opening in the rectum, through which excrement passes
Perineum Area that lies between the vaginal opening and the anus
Pelvic fl oor Underside of the pelvic area, extending from the top of the pubic bone (above the clitoris) to the anus
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Female Sexual Physiology • 81
During ovulation, the ovarian follicle swells and ruptures, releasing the mature oocyte to begin its journey through the fallopian tube.
• Female Sexual Physiology Just how do the various structures of the female anatomy function to produce the menstrual cycle? Th e female reproductive cycle can be viewed as having two components (although, of course, multiple biological processes are involved): (1) the ovarian cycle, in which eggs develop, and (2) the menstrual, or uterine, cycle, in which the womb is prepared for pregnancy. Th ese cycles repeat approximately every month for about 35 or 40 years. Th e task of direct- ing these processes belongs to a class of chemicals called hormones.
Reproductive Hormones
Hormones are chemical substances that serve as messengers, traveling within the body through the bloodstream. Most hormones are composed of either amino acids (building blocks of proteins) or steroids (derived from cholesterol). Th ey are produced by the ovaries and the endocrine glands—the adrenals, pituitary, and hypothalamus. Hormones assist in a variety of tasks, including development of the reproductive organs and secondary sex characteristics during puberty, regula- tion of the menstrual cycle, maintenance of pregnancy, initiation and regulation of childbirth, initiation of lactation, and, to some degree, the regulation of libido (li-BEE-doh; sex drive or interest). Hormones that act directly on the gonads are known as gonadotropins (go-nad-a-TRO-pins). Among the most important of the female hormones are the estrogens, which aff ect the maturation of the repro- ductive organs, menstruation, and pregnancy, and progesterone, which helps to maintain the uterine lining until menstruation occurs. (Th e principal hormones involved in a woman’s reproductive and sexual life and their functions are described in Table 3.2.) (Testosterone is discussed later in this chapter.)
The Ovarian Cycle
Th e development of female gametes is a complex process that begins even before a woman is born. In infancy and childhood, the cells develop into ova (eggs). During puberty, hormones trigger the completion of the process of oogenesis
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82 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
(oh-uh-JEN-uh-sis), literally, “egg beginning” (see Figure 3.6). Th e oocyte, oth- erwise referred to as germ cell or immature ovum, marks the start of mitosis, the process by which a cell duplicates the chromosome in its cell nucleus. Oogenesis results in the formation of both primary oocytes, before birth, and as secondary oocytes after it and as part of ovulation. Th is process, called the ovarian cycle (or menstrual cycle), continues until a woman reaches menopause. Th e ovarian cycle averages 28 days in length, although there is considerable variation among women, ranging from 21 to 40 days. In their own particular cycle length after puberty, however, most women experience little variation. Generally, ovulation occurs in only one ovary each month, alternating between the right and left sides with each successive cycle. If a single ovary is removed, the remaining one begins to ovulate every month. Th e ovarian cycle has three phases: follicular (fo-LIK-u-lar), ovulatory (ov-UL-a-tor-ee), and luteal (LOO- tee-ul) (see Figure 3.7). As an ovary undergoes its changes, corresponding changes occur in the uterus. Menstruation marks the end of this sequence of hormonal and physical changes in the ovaries and uterus.
The Follicular Phase On the fi rst day of the cycle, gonadotropin-releasing hormone (GnRH) is released from the hypothalamus. GnRH begins to stim- ulate the pituitary to release follicle-stimulating hormone (FSH) and lutein- izing hormone (LH), initiating the follicular phase. During the fi rst 10 days, 10–20 ovarian follicles begin to grow, stimulated by FSH and LH. In 98–99% of cases, only one of the follicles will mature completely during this period.
TABLE 3.2 • Female Sex Hormones
Hormone Where Produced Functions
Estrogen (including estradiol, estrone, estriol)
Ovaries, adrenal glands, placenta (during pregnancy)
Promotes maturation of reproductive organs, development of secondary sex characteristics, and growth spurt at puberty; regulates menstrual cycle; sustains pregnancy; maintains libido
Progesterone Ovaries, adrenal glands, placenta Promotes breast development, maintains uterine lining, regulates menstrual cycle, sustains pregnancy
Gonadotropin-releasing hormone (GnRH)
Hypothalamus Promotes maturation of gonads, regulates menstrual cycle
Follicle-stimulating hormone (FSH) Pituitary Regulates ovarian function and maturation of ovarian follicles
Luteinizing hormone (LH) Pituitary Assists in production of estrogen and progesterone, regulates maturation of ovarian follicles, triggers ovulation
Human chorionic gonadotropin (HCG) Embryo and placenta Helps sustain pregnancy
Testosterone Adrenal glands and ovaries Helps stimulate sexual desire
Oxytocin Hypothalamus Stimulates uterine contractions during childbirth and possibly during orgasm, promotes milk let-down
Prolactin Pituitary Stimulates milk production
Prostaglandins All body cells Mediates hormone response, stimulates muscle contractions
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Female Sexual Physiology • 83
(Th e maturation of more than one oocyte is one factor in multiple births.) All the developing follicles begin secreting estrogen. Under the infl uence of FSH and estrogen, the oocyte matures, bulging from the surface of the ovary. Th is may also be referred to as the proliferative phase.
Ovulatory Phase Th e ovulatory phase begins at about day 11 of the cycle and culminates with ovulation at about day 14. Stimulated by an increase of LH from the pituitary, the primary oocyte undergoes cell division and becomes ready for ovulation. Th e ballooning follicle wall thins and ruptures, and the oocyte enters the abdominal cavity near the beckoning fi mbriae. Ovulation is now complete. Some women experience a sharp twinge, called Mittelschmerz, on one side of the lower abdomen during ovulation. A very slight bloody discharge from the vagina may also occur. Occasionally, more than one ovum is released. If two ova are fertilized, nonidentical twins will result. If one egg is fertilized and divides into two separate zygotes, identical twins will develop.
The Luteal Phase Following ovulation, estrogen levels drop rapidly, and the ruptured follicle, still under the infl uence of increased LH, becomes a corpus luteum, which secretes progesterone and small amounts of estrogen. Increasing levels of these hormones serve to inhibit pituitary release of FSH and LH. Unless fertilization has occurred, the corpus luteum deteriorates. In the event of pregnancy, the corpus luteum maintains its hormonal output, helping to
Meiosis I
Meiosis II
Polar bodies degenerating
Second polar body
First polar body
Oogonium (46 chromosomes)
Many oogonia
Primary oocyte (46 chromosomes)
Secondary oocyte (23 chromosomes)
Sperm (23 chromosomes)
Diploid zygote
growth and differentiation
before birth
after birth
sexual maturity
• FIGURE 3.6 Oogenesis. This diagram charts the development of an ovum, beginning with embryonic development of the oogonium and ending with fertilization of the secondary oocyte, which then becomes the diploid zygote. Primary oocytes are present in a female at birth; at puberty, hormones stimulate the oocyte to undergo meiosis.
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84 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
Fallopian tube
Uterine lining sloughs off and passes out of the body through the cervix and vagina
Uterine lining
Oocyte disintegrates
Uterine lining renews
Maturing oocyte in follicle
Immature oocytes
(Follicle development)
Uterine lining thickens
Oocyte is released
Oocyte travels through tube
Remaining cells of follicle develop into corpus luteum
Lining continues to thicken
Menstrual Phase Follicular Phase
(also called the Proliferative Phase)
Ovulatory Phase Luteal Phase
• FIGURE 3.7 Ovarian and Menstrual Cycles. The ovarian cycle consists of the activities within the ovaries and the development of oocytes; it includes the follicular, ovulatory, and luteal phases. The menstrual cycle consists of processes occurring in the uterus. Hormones regulate these cycles.
sustain the pregnancy. Th e hormone human chorionic gonadotropin (HCG)— similar to LH—is secreted by the embryo and signals the corpus luteum to continue until the placenta has developed suffi ciently to take over hormone production. Th e luteal phase typically lasts from day 14 (immediately after ovulation) through day 28 of the ovarian cycle. Even when cycles are more or less than 28 days, the duration of the luteal phase remains the same; the time between ovulation and the end of the cycle is always 14 days. At this point, the ovarian hormone levels are at their lowest, GnRH is released, and FSH and LH levels begin to rise.
The Menstrual Cycle
As hormone levels decrease following the degeneration of the corpus luteum, the uterine lining (endometrium) is shed because it will not be needed to help sustain the fertilized ovum. Th e shedding of endometrial tissue and the bleeding
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Female Sexual Physiology • 85
that accompanies it are, collectively, a monthly event in the lives of women from puberty through menopause. Cultural and religious attitudes, as well as personal experience, infl uence our feelings about this phenomenon. (Th e physical and emotional eff ects of menstruation are discussed later in this section. Th e onset of menstruation and its eff ect on a woman’s psychosexual development are dis- cussed in Chapter 6. Menopause is discussed in Chapter 7.) Most American women who menstruate use sanitary pads, panty liners, or tampons to help absorb the fl ow of menstrual blood. While pads and panty liners are used outside the body, tampons are placed inside the vagina. For a wide variety of reasons, including environmental concerns, comfort, chemical residues, and toxic shock syndrome (a bacterial infection that can occur in menstruating women and cause a person to go into shock; discussed in Chapter 13), women are turning to alternative means for catching menstrual fl ow. While some Americans may question the use of alternative products, across time and culture a wide variety of methods have been used to absorb the fl ow of blood. Cloth menstrual pads are reusable, washable, and quite comfortable. For those desiring to wear something internally, other products, called Th e Keeper, DivaCuptm, or Instead, consist of a menstrual cup that is held in place by suction in the lower vagina and acts to collect menstrual fl uid. Some women have used the diaphragm or cervical cap in a similar manner. Reusable sea sponges can work like tampons in absorbing blood. Boiling the sponge before use and between uses can help to rid it of possible ocean pollutants and help to keep it sanitary. Sewing or tying a piece of cotton string on the sponge for easy retrieval is suggested. Most likely, the majority of American women will continue to rely on more widely available and advertised commercial tampons or sanitary pads; however, alterna- tives provide women with an opportunity to take charge of how they respond to their menstrual fl ow and the environmental impacts of that decision. Th e menstrual cycle (or uterine cycle), is divided into three phases: men- strual, proliferative, and secretory. What occurs within the uterus is inextricably related to what is happening in the ovaries, but only in their fi nal phases do the two cycles actually coincide (see Figure 3.8).
The Menstrual Phase With hormone levels low because of the degeneration of the corpus luteum, the outer layer of the endometrium becomes detached from the uterine wall. Th e shedding of the endometrium marks the beginning of the menstrual phase. Th is endometrial tissue, along with mucus, other cer- vical and vaginal secretions, and a small amount of blood (2–5 ounces per cycle),
An array of choices that collect and absorb menstrual fl ow are now available to women.
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86 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
is expelled through the vagina. Th e menstrual fl ow, or menses (MEN-seez), gen- erally occurs over a period of 3–5 days. FSH and LH begin increasing around day 5, marking the end of this phase. A girl’s fi rst menstruation is known as menarche (MEH-nar-kee).
The Proliferative Phase Th e proliferative phase lasts about 9 days. During this time, the endometrium thickens in response to increased estrogen. Th e mucous membranes of the cervix secrete a clear, thin mucus with a crystalline structure that facilitates the passage of sperm. Th e proliferative phase ends with ovulation.
The Secretory Phase During the fi rst part of the secretory phase, with the help of progesterone, the endometrium begins to prepare for the arrival of a fertilized ovum. Glands within the uterus enlarge and begin secreting glycogen, a cell nutrient. Th e cervical mucus thickens and starts forming a plug to seal off the uterus in the event of pregnancy. If fertilization does not occur, the corpus luteum begins to degenerate, as LH levels decline. Progesterone levels then fall, and the endometrial cells begin to die. Th e secretory phase lasts 14 days, corresponding with the luteal phase of the ovarian cycle. It ends with the shedding of the endometrium.
Follicle Corpus luteum degenerates
Menstrual cycle
Ovarian cycle
Ovarian hormone levels in bloodstream
Pituitary hormone levels in bloodstream
Highest intimacy and sex drive
Menstrual flow
Endometrium Menstrual flow
Day 1 Day 14 Day 28
Menses Estrogenic phase
Ovulation Progestational phase
• FIGURE 3.8 The Menstrual Cycle, Ovarian Cycle, and Hormone Levels. This chart compares the activities of the ovaries and uterus and shows the relationship of blood hormone levels to these activities.
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Female Sexual Physiology • 87
Menstrual Synchrony Women who live or work together often report devel- oping similarly timed menstrual cycles (Cutler, 1999). Termed menstrual synchrony, this phenomenon appears to be related to the sense of smell—more specifi cally, a response to pheromones, chemical substances secreted into the air. Th ough there is considerable controversy among researchers as to whether the phenomenon actually exists, if it does, there could be implications for birth control, sexual attraction, and other aspects of women’s lives. (Pheromones are discussed later in the chapter.)
Menstrual Eff ects American women have divergent attitudes toward menstrua- tion. For some women, menstruation is a problem; for others, it is simply a fact of life that creates little disruption. For individual women, the problems associated with their menstrual period may be physiological, emotional, or practical. Th e vast majority of menstruating women notice at least one emotional, physical, or behav- ioral change in the week or so prior to menstruation. Most women describe the changes negatively: breast tenderness and swelling, abdominal bloating, irritability, cramping, depression, or fatigue. Some women also report positive changes such as increased energy, heightened sexual arousal, or a general feeling of well-being. For most women, changes during the menstrual cycle are usually mild to moder- ate; they appear to have little impact on their lives. Th e most common problems associated with menstruation are discussed below.
Premenstrual Syndrome A collection of physical, emotional, and psycho- logical changes that may occur 7–14 days before a woman’s menstrual period is known as premenstrual syndrome (PMS). Th ese symptoms disappear soon after the start of menstrual bleeding. Th ough no one knows for sure what causes PMS, it seems to be linked to alterations in the levels of sex hormones and brain chemicals, or neutrotransmitters. Controversy exists over the diff erence between premenstrual discomfort and true PMS. Premenstrual discomfort is a common occurrence, aff ecting about 75% of all menstruating women (InteliHealth, 2005). Only about 3–8% of women, however, have symptoms that are severe enough to be labeled PMS. While some doctors equate premenstrual dysphoric disorder to PMS, others use a less stringent defi nition for PMS, which includes mild to moderate symp- toms. Symptoms of PMS fall into two categories: physical symptoms, which may include bloating, breast tenderness, swelling and weight gain, headaches, cramping, migraine headaches, and food cravings; and psychological and emo- tional symptoms, which include fatigue, depression, irritability, crying, and changes in libido. For many, symptoms may be worse some months and better other ones. It may also be comforting to know that in most women, PMS symptoms begin to subside after the age of 35 and at menopause.
Menorrhagia At some point in her menstrual life, nearly every woman expe- riences heavy or prolonged bleeding during her menstrual cycle, also known as menorrhagia. Although heavy menstrual bleeding is common among most women, only a few experience blood loss severe enough for it to be defi ned as menorrhagia. Signs and symptoms may include a menstrual fl ow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours, the need to use double sanitary protection throughout the menstrual fl ow, menstrual fl ow that includes large blood clots, and/or heavy menstrual fl ow that interferes with the regular lifestyle. Th ough the cause of heavy menstrual bleeding is unknown, a number of conditions may cause menorrhagia, including hormonal
Menstrual Period Slang that time of the month
monthlies the curse female troubles a visit from my friend a visit from Aunt Flo a visit from George on the rag on a losing streak falling off the roof

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88 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
imbalances, uterine fi broids, having an IUD, cancer, or certain medications. Th e combined eff ect of hormonal imbalances and uterine fi broids accounts for 80% of all cases of menorrhagia. Excessive or prolonged menstrual bleeding can lead to iron defi ciency anemia and other medical conditions; thus, it is advisable for women with this problem to seek medical care and treatment.
Dysmenorrhea While menstrual cramps are experienced by some women before or during their periods, a more persistent, aching, and serious pain suf- fi cient to limit a woman’s activities is called dysmenorrhea. Th ere are two types of dysmenorrhea. Primary dysmenorrhea is not associated with any diagnosable pelvic condition. It is characterized by pain that begins with (or just before) uterine bleeding when there is an absence of pain at other times in the cycle. It can be very severe and may be accompanied by nausea, weakness, or other physical symptoms. In secondary dysmenorrhea, the symptoms may be the same, but there is an underlying condition or disease causing them; pain may not be limited to the menstrual phase alone. Secondary dysmenorrhea may be caused by pelvic infl ammatory disease (PID), endometriosis, endometrial cancer, or other conditions that should be treated. (See Chapters 13 and 15.) Th e eff ects of dysmenorrhea can totally incapacitate a woman for several hours or even days. Once believed to be a psychological condition, primary dysmenor- rhea is now known to be caused by high levels of prostaglandins (pros-ta-GLAN- dins), a type of hormone with a fatty-acid base that is found throughout the body. Drugs like ibuprofen (Motrin and Advil) relieve symptoms by inhibiting the pro- duction of prostaglandins. Some doctors may prescribe birth control pills.
Amenorrhea When women do not menstruate for reasons other than aging, the condition is called amenorrhea (ay-meh-neh-REE-a). Principal causes of amenorrhea are pregnancy and breastfeeding. Lack of menstruation, if not a result of pregnancy or nursing, is categorized as either primary or secondary amenorrhea. Women who have passed the age of 16 and never menstruated are diagnosed as having primary amenorrhea. It may be that they have not yet reached their critical weight (when an increased ratio of body fat triggers men- strual cycle–inducing hormones) or that they are hereditarily late maturers. But it can also signal hormonal defi ciencies, abnormal body structure, or an inter- sex condition or other genital anomaly that makes menstruation impossible. Most primary amenorrhea can be treated with hormone therapy. Secondary amenorrhea exists when a previously menstruating woman stops menstruating for several months. If it is not due to pregnancy, breastfeeding, or the use of hormonal contraceptives, the source of secondary amenorrhea may be found in stress, lowered body fat, heavy physical training, cysts or tumors, disease, or hormonal irregularities. Anorexia (discussed in Chapter 13) is a frequent cause of amenorrhea. If a woman is not pregnant, is not breast- feeding, and can rule out hormonal contraceptives as a cause, she should see her health-care practitioner if she has gone 3 months without menstruating. Lifestyle changes or treatment of the underlying condition can almost always correct amenorrhea, unless it is caused by a congenital anomaly. Because there is no known harm associated with amenorrhea, the condition is corrected when an underlying problem presents itself or it causes a woman psychological distress.
Sexuality and the Menstrual Cycle Although studies have tried to deter- mine whether there is a biologically based cycle of sexual interest and activity
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Female Sexual Physiology • 89
practically speaking
Many factors can infl uence the way we experience the changes that occur over the course of the menstrual cycle. While the vast majority of women feel few and minor changes, others experience changes that are uncomfortable and debilitating. The variations can be signifi cant in any one woman and from month to month. For women, recognizing their men- strual patterns, learning about their bodies, and recognizing and dealing with existing diffi culties can be useful in heading off or easing potential problems. Diff erent remedies work for diff erent women. We suggest that you try varying combinations of them and keep a record of your response to each. Following are some common changes that occur during the menstrual cycle and self-help means to address them.
For Vaginal Changes
The mucous membranes lining the walls of the vagina normally produce clear, white, or pale yellow secretions. These secretions pass from the cervix through the vagina and vary in color, consistency, odor, and quantity, depending on the phase of the menstrual cycle, the woman’s health, and her unique physical characteristics. It is important for you to observe your secretions periodically and note any changes, especially if symptoms accompany them. Because self-diagnosis of unusual discharges is inaccurate over half the time, it is wise to go ahead with self- treatment only after a diagnosis is made by a health-care practitioner. Call a health professional if you feel uncertain or suspicious and/or think you may have been exposed to a sexually transmitted infection. Here are some simple guidelines that may help a woman avoid getting vaginitis:
1. Avoid douching and vaginal deodorants, especially deodorant suppositories or tampons. They upset the natural chemical balance of the vagina.
2. Maintain good genital hygiene by washing the labia and clitoris regularly (about once a day) with mild soap.
3. After a bowel movement, wipe the anus from front to back, away from the vagina, to prevent contamination with fecal bacteria.
4. Wear cotton underpants with a cotton crotch. Nylon does not “breathe,” and it allows heat and moisture to build up, creating an ideal environment for infectious organisms to reproduce.
5. If you use a vaginal lubricant, be sure it is water-soluble. Oil-based lubricants such as Vaseline encourage bacterial growth.
6. Socialize with others or go to a support group to help reduce the stress that may cause or exacerbate the infection.
For Premenstrual Changes
1. Consume a well-balanced diet, with plenty of whole-grain cereals, fruits, and vegetables.
2. Moderate your intake of alcohol, avoid tobacco, and get suffi cient sleep.
3. Exercise at least 30–45 minutes a day. Aerobic exercise brings oxygen to body tissues and stimulates the production of endorphins, chemical substances that help promote feelings of well-being.
For Cramps
1. Relax and apply heat by using a heating pad or hot-water bottle (or, in a pinch, a cat) applied to the abdominal area may help relieve cramps; a warm bath may also help.
2. Get a lower-back or other form of massage, such as acupres- sure, or Shiatsu.
3. Take prostaglandin inhibitors, such as aspirin and ibuprofen, to reduce cramping of the uterine and abdominal muscles. Aspirin increases menstrual fl ow slightly, whereas ibuprofen reduces it. Stronger antiprostaglandins may be prescribed by your health-care practitioner.
4. Having an orgasm (with or without a partner) is reported by some women to relieve menstrual congestion and cramping.
When symptoms are severe, further medical evaluation is needed.
in women that correlates with the menstrual cycle (such as higher interest around ovulation), the results have been varied. Th ere is also variation in how people feel about sexual activity during diff erent phases of the menstrual cycle. Th ere has been a general taboo in our culture, as in many others, against sexual intercourse during menstruation. Th is taboo may be based on religious or cultural beliefs. Among Orthodox Jews, for example, women are required to refrain from intercourse for 7 days following the end of menstruation. Th ey may then resume sexual activity after a ritual bath, the mikvah. Contact with
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90 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
blood may make some people squeamish. Some women, especially at the begin- ning of their period, feel bloated or uncomfortable; they may experience breast tenderness or a general feeling of not wanting to be touched. Others may fi nd that sexual activity helps relieve menstrual discomfort. For some couples, merely having to deal with the logistics of bloodstains, bath- ing, and laundry may be enough to discourage them from intercourse at this time. For many people, however, menstrual blood holds no special connotation. In a study of 108 women aged 18–23, females described their experiences with sexual- ity during menstruation. Nearly one half, most of whom were in committed relationships, stated they had sexual activity during their menstrual cycle (Allen & Goldberg, 2009). Young adults who were comfortable with menstrual sex saw it as just another part of a committed intimate relationship. It is important to note that although it is unusual, conception can occur during menstruation. Some women fi nd that a diaphragm or menstrual cup can collect the menstrual fl ow. Menstrual cups, however, are not a contraceptive. It is not recommended that women engage in intercourse while a tampon is inserted because of possible injury to the cervix. And inventive lovers can, of course, fi nd many ways to give each other pleasure that do not require putting the penis into the vagina.
• Female Sexual Response Th e ways in which individuals respond to sexual arousal are highly varied. Women’s sexuality, though typically thought of as personal and individual, is signifi cantly infl uenced by the social groups to which women belong. Socio- cultural variables include gender, religious preference, class, educational attain- ment, age, marital status, race, and ethnicity. For many women, gender—the social and cultural characteristics associated with being male or female—is probably the most infl uential variable in shaping their sexual desires, behaviors, and partnerships. Because gender is largely defi ned by cultural expectations, women’s sexual experiences must be understood in terms of cultural, political, and relational forces. New research into the anatomy and physiology of sexual- ity has helped us to increase our understanding of orgasm. By looking beyond the genitals to the central nervous system, where electrical impulses travel from the brain to the spinal cord, researchers are examining nerves and pathways to better understand the biology of the orgasm. What is probably most critical to all of these functions are the ways we interpret sexual cues. Th ough scientifi c research has contributed much to our understanding of sexual arousal and response, there is still much to be learned. One way in which researchers investigate and describe phenomena is through the creation of mod- els, hypothetical descriptions used to study or explain something. Although models are useful for promoting general understanding or for assisting in the treatment of specifi c clinical problems, we should remember that they are only models. It may be helpful to think of sexual functioning as interconnected, linking desire, arousal, orgasm, and satisfaction. Turbulence or distraction at any one point aff ects the functioning of the others.
Sexual Response Models
A number of sexologists have attempted to outline the various physiological changes that both men and women undergo when they are sexually stimulated.
Passion, though a bad regulator, is a powerful spring.
—Ralph Waldo Emerson (1803–1882)

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Female Sexual Response • 91
think about it
When the media report stories about same-sex lovers, such as actress Anne Heche leaving Ellen DeGeneres for a man, Cynthia Nixon (from Sex and the City) leaving her male partner of 15 years for a woman, and Julie Cypher leaving a heterosexual marriage for Melissa Etheridge then later leav- ing her for a man, what are your responses? Are these incidents simply fl ukes? Are the women confused? Bisexual? None of these, according to Lisa Diamond, professor of psychology and gender studies at the University of Utah. Rather, she has coined the term “sexual fl uidity” to describe sexual desires and attractions as situation-dependent in sexual responsiveness (Diamond, 2008). Based on her own research and analysis of animal mating and women’s sexuality, Diamond suggests that female desire may be dictated by both intimacy and emotional connection. She came to this conclusion after 10 years following the erotic attractions of nearly 100 young women who, at the start of her work, identifi ed themselves as lesbian, bisexual, or refused a label. From her analysis of their shifts between sexual identities and descriptions of their erotic lives, Diamond suggests that for her participants and possibly for women on the whole, desire is malleable, embedded in the nature of female desire, and cannot be captured by asking women to categorize their attractions. Among the women in her study who called themselves lesbian, one third reported attraction solely to women while the other two thirds revealed periodic and genuine desire and attraction to men. When discussing sexual orientation, Diamond sees sig- nifi cance in the fact that many of her subjects agreed with the statement “I am the kind of person who becomes physically attracted to the person rather than their gender.” Thus it is, in the cases of Diamond’s subjects, that emotional closeness overrode innate orientation, resulting in attraction and desire. This concept seems to violate the core underlying assump- tion of our model of sexuality: that sexual orientation is defi ned by sexual behavior. Not long ago, the sexualities—heterosexual- ity, homosexuality, and even bisexuality—were categorical. Sexual attraction and desire, sexual behavior, and sexual identity were assumed to be congruent; same-gender sexual attraction/ behavior assumed a gay, lesbian, or bisexual identity; and other sexual attraction/behavior assumed a heterosexual identity (Schecter, 2009). Now, Diamond’s work along with others’, reveals
Sexual Fluidity: Women’s Variable Sexual Attractions
this may be true for some women, but not true for all. In fact, desire/behavior and orientation/identity do not always match up. The more scholars learn about sexual desire, the more it becomes apparent that it involves a complex interplay among biological, environmental, psychological, cultural, and interpersonal factors. Evidence points to three characteristics about desire: (1) It is both hormonally and situationally driven, (2) individuals are often unaware of the full range of their de- sires, and (3) women’s sexual desires show more variability than do men’s. Probably the largest review of all the published data on the subject around the variability of women’s sexual desires was published by Roy Baumeister (2000), professor of psychology at Florida State University. The study found that women show greater variability than men in a wide range of sexual behaviors, including desired frequency of sex, preferred contexts for sexual behavior, types and frequency of fantasy, and desirable partner characteristics. Nevertheless, sex researchers still do not understand the mechanisms that underlie sexual fl uidity. While tremendous strides have been made to foster greater acceptance of a diversity of sexual expression, sexual minorities as a whole still remain isolated and unsupported. Textbooks, media, and culture continue to assume that there is a fi xed model of same-sex sexuality, in spite of the fact that many individuals know diff erently. Although the notion of sexual fl uidity may be confusing, frightening, or threatening to some, it does off er one more variable to the broad spectrum of sexual expression of which humans are capable and can celebrate.
Think Critically 1. Is sexual orientation innate and/or fi xed? If so, at what
age? How do you know this? 2. Have you experienced sexual fl uidity? If so, what were
your reactions? 3. What would you do if your same-sex or other-sex
best friend told you that he or she was romantically interested in you?
Th ree important models are described here. Th e sequence of changes and patterns that take place in the body during sexual arousal is referred to as the sexual response cycle. Masters and Johnson’s four-phase model of sexual response identifi es the signifi cant stages of response as excitement, plateau, orgasm, and resolution (see Figure 3.9). Helen Singer Kaplan (1979) collapses the excitement and plateau phases into one, eliminates the resolution phase, and adds a phase
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92 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
Pubic bone
Uterus elevates
Clitoral hood
Urethra Labia minora
Labia majora
Clitoral shaft and glans swell; glans retracts beneath hood
Clitoris remains retracted under hood
Orgasmic platform contracts
Anal sphincter contracts
Labia minora deepen in color and enlarge
Bartholin’s glands may secrete a small amount of fluid
Uterus elevates further
Upper part of vagina expands
Vaginal wall forms orgasmic platform
Color of labia deepens
Rectal sphincter contracts
Rhythmic contractions in vagina
Contractions in uterus
Vaginal lubrication appears
Clitoris engorges with blood
Labia majora swell
Labia minora swell
Late Excitement or Plateau
Clitoris withdraws under clitoral hood
Labia majora separate from the vaginal opening
Uterus lowers
Vagina returns to normal
Orgasmic platform disappears
Seminal pool
Clitoris returns to unaroused position
• FIGURE 3.9 Masters and Johnson Stages of Female Sexual Response (internal, left; and external, right)
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Female Sexual Response • 93
to the beginning of the process. Kaplan’s tri-phasic model of sexual response includes the desire, excitement, and orgasm phases. Th ough Masters and Johnson’s and Kaplan’s are the most widely cited models used to describe the phases of the sexual response cycle, they do little to acknowledge the aff ective parts of human response. A third but much less known pattern is Loulan’s sexual response model, which incorporates both the biological and aff ective components into a six-stage cycle. Beyond any questions of similarities and diff erences in the female and male sexual response cycle is the more signifi cant issue of variation in how individuals experience each phase. Th e diversity of experiences can be described only by the individual. (Th ese models are described and compared in Table 3.3.)
TABLE 3.3 • Models of the Sexual Response Cycle
Psychological/Physiological Process Name of Phase
People make a conscious decision to have sex even if there might not be emotional or physical desire.
Some form of thought, fantasy, or erotic feeling causes individuals to seek sexual gratifi cation. (An inability to become sexually aroused may be due to a lack of desire, although some people have reported that they acquire sexual desire after being sexually aroused.)
Physical and/or psychological stimulation produces characteristic physical changes. In men, increased amounts of blood fl ow to the genitals produce erection of the penis; the scrotal skin begins to smooth out, and the testicles draw up toward the body. Later in this phase, the testes increase slightly in size. In women, vaginal lubrication begins, the upper vagina expands, the uterus is pulled upward, and the clitoris becomes engorged. In both women and men, the breasts enlarge slightly, and the nipples may become erect. Both men and women experience increasing muscular contractions.
Sexual tension levels off . In men, the testes swell and continue to elevate. The head of the penis swells slightly and may deepen in color. In women, the outer third of the vagina swells, lubrication may slow down, and the clitoris pulls back. Coloring and swelling of the labia increase. In both men and women, muscular tension, breathing, and heart rate increase.
Increased tension peaks and discharges, aff ecting the whole body. Rhythmic muscular contractions aff ect the uterus and outer vagina in women. In men, there are contractions of the tubes that produce and carry semen, the prostate gland, and the urethral bulb, resulting in the expulsion of semen (ejaculation).
The body returns to its unaroused state. In some women, this does not occur until after repeated orgasms.
Pleasure is one purpose of sexuality and can be defi ned only by the individual. One can experience pleasure during all or only some of the above stages, or one can leave out any of the stages and still have pleasure.
Willingness (Loulan)
Desire (Kaplan, Loulan)
Excitement (Masters/Johnson, Loulan)
Plateau (Masters/Johnson)
Orgasm (Masters/Johnson, Kaplan, and Loulan)
Resolution (Masters/Johnson) Pleasure
Excitement (Kaplan)
Engorgement (Loulan)
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94 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
To help organize our thinking about the complexities of human behavior, the dual control model provides a theoretical perspective of sexual response that is based on brain function and the interaction between sexual excitation (respond- ing with arousal to sexual stimuli) and sexual inhibition (inhibiting sexual arousal) (Bancroft, Graham, Janssen, & Sanders, 2009). Th e authors of this model argue that, though much research has been dedicated to understanding sexual excitation, little research has been conducted on the inhibitory brain mechanisms which provide an equally signifi cant role in sexual arousal and response. Th ey purport that the adaptive role the inhibitory mechanism pro- duces is relevant to our understanding of “normal” sexuality, individual vari- ability, and problematic sexuality. Th e functions of the inhibitory response can be found in the following circumstances: (1) When sexual activity in a specifi c situation is potentially risky (as when you or your partner suspects an unintended pregnancy could result); (2) when a nonsexual challenge occurs and sex needs to be suppressed (as when a child calls out for help); (3) when excessive involve- ment in the pursuit of sexual pleasure distracts from other important functions (as when someone is late for work because he or she is distracted by viewing sexually explicit materials); (4) when social or environmental pressure results in suppression of reproductive behavior (as when someone is so stressed during fi nals week, he or she doesn’t feel like having sex); and (5) when the conse- quences of continued excessive sexual behavior potentially reduces possible con- ception (as when repeated ejaculations can result in lower sperm count). A major fi nding of the dual control model is that it views excitation and sexual inhibition as separate systems, as opposed to other models that view these as two ends of a single dimension. Additional fi ndings from this model include the following:
■ Th ough most people fall in the moderate range on propensities toward sexual excitation and sexual inhibition, there is great variability from one person to the next.
■ Men, on average, score higher on excitation and lower on inhibition than women.
■ Gay men, on average, score higher on excitation and lower on inhibition than straight men.
■ Bisexual women, on average, score higher on excitation than lesbian and straight women.
■ Excitation lessens with age for men and women; however, inhibition is not age-related in women but is somewhat age-related in men.
■ Th e relation between negative mood and sexuality is best predicted by inhibition scores in men, but by excitation scores in women.
Th e dual control model postulates that individuals who have a low propen- sity for sexual excitation or a high propensity for sexual inhibition are more likely to experience diffi culties related to sexual response or sexual interest. Furthermore, those who have a high propensity for sexual excitation or low propensity for sexual inhibition are more likely to engage in problematic sexu- ality such as high-risk sexual behaviors, for example, not using a condom. Because the focus is on sexual arousal, there remain questions about if and how this model might apply to orgasm. As long as researchers see it as a model rather than as a description of reality, then the model and questionnaire used for investigating it can be improved.
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Female Sexual Response • 95
Desire: Mind or Matter?
Desire is the psychological component of sexual arousal. Although we can expe- rience desire without becoming aroused, and in some cases become aroused without feeling desire, some form of erotic thought or feeling is usually involved in our sexual behavior. Th e physical manifestations of sexual arousal involve a complex interaction of thoughts and feelings, sensory organs, neural responses, and hormonal reactions involving various parts of the body, including the nucleus accumbens, cerebellum, and hypothalamus of the brain, the nervous system, the circulatory system, and the endocrine glands—as well as the genitals. A meta-study, which combined the results of several studies, of men’s and women’s sexual arousal patterns found that in women, lubrication was only one of the physiological changes that occurred when they were sexually aroused, and not a necessary condition for women to report that they were sexually aroused (Chivers, Seto, Lalumière, & Grimbos, 2010). Much of the science behind sexuality was designed around a very linear model: First, there’s desire, then there’s arousal, followed by orgasms, then snuggling. For most women, this process is more circular, whereby sexuality is about intimacy, relationships, and wanting to cuddle fi rst and feel close to someone. It’s also about how women feel about themselves. If they do not feel desirable or comfortable with their bodies, it’s likely that they will not be able to relax and enjoy the sexual interchange. Among men who have trouble getting erect, genital engorgement is aided by drugs such as Viagra because the pills target genital capillaries. (See Chapter 14 for more information about erection-enhancing drugs.) Th us, the medications may enhance male desire by granting men a feeling of power and control, but not necessarily desire or wanting. For some men, desire is not an issue. In women, the primary diffi culty appears to be in the mind, not the body (Brotto, Heiman & Tolman, 2009). Th erefore, experimental attempts to use penile- enhancing drugs to treat women who complain of low sexual desire have proven ineff ective (Bergner, 2010). In both cases, then, the physiological eff ects of the drugs have proven irrelevant.
The Neural System and Sexual Stimuli Th e brain is crucial to sexual response and is currently a focus of research to understanding how we respond to sexual stimulation. Th rough the neural system, the brain receives stimuli from the fi ve senses plus one: sight, smell, touch, hearing, taste, and the imagination.
The Brain Th e brain, of course, plays a major role in all of our body’s func- tions. Nowhere is its role more apparent than in our sexual functioning. Th e relationship between our thoughts and feelings and our actual behavior is not well understood (and what is known would require a course in neurophysiology to satisfactorily explain it). Relational factors and cultural infl uences, as well as expectations, fantasies, hopes, and fears, combine with sensory inputs and neu- rotransmitters (chemicals that transmit messages in the nervous system) to bring us to where we are ready, willing, and able to be sexual. Even then, potentially erotic messages may be short-circuited by the brain itself, which can inhibit as well as incite sexual responses. It is not known how the inhibitory mechanism works, but negative conditioning and emotions will prevent the brain from sending messages to the genitals. In fact, the reason moderate amounts of alcohol and marijuana appear to enhance sexuality is that they
Some desire is necessary to keep life in motion.
—Samuel Johnson (1709–1784)

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96 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
reduce the control mechanisms of the brain that act as inhibitors. Conversely, women who feel persistent sexual arousal and no relief from orgasm reveal unusually high activation in regions of the brain that respond to genital stim- ulation (Komisaruk et al., 2010). (See Chapter 14 for a discussion of persistent sexual arousal syndrome.) Anatomically speaking, the part of the body that appears to be involved most in sexual behaviors of both men and women is the vast highway of nerves called the vagus nerve network that stretches to all the major organs, including the brain. Using MRI scans to map the brain, researchers have found increases in brain activity during sexual arousal (Holstege et al., 2003; Komisaruk et al., 2010). Since specifi c parts of the brain send their sensory signals via specifi c nerves, the diff erent quality of orgasms that result from clitoral or anal stimu- lation, for example, is divided among the diff erent genital sensory nerves. As many of us know, the early stages of a new romantic relationship are characterized by intense feelings of euphoria, well-being, and preoccupation with the romantic partner. Th is was observed in one study in which college students were shown photos of their beloved intermixed with photos of an equally attractive acquaintance (Younger, Aron, Parke, Chatterjee, & Mackey, 2010). Induced with pain during the experiment, students reported their pain was less severe when they were looking at photos of their new love. Th e test results suggest the chemicals the body releases in the early stages of love— otherwise referred to as endogeneous opioids—work on the spinal cord to block the pain message from getting to the brain. MRI scans showed that, indeed, the areas of the brain activated by intense love are the same areas targeted by pain-relieving drugs.
The Senses An attractive person (sight), a body fragrance or odor (smell), a lick or kiss (taste), a loving caress (touch), and erotic whispers (hearing) are all capable of sending sexual signals to the brain. Preferences for each of these sensory inputs are both biological and learned and are very individualized. Many of the connections we experience between sensory data and emotional responses are probably products of the limbic system, or those structures of the brain that are associated with emotions and feelings and involved in sexual arousal. Some sensory inputs may evoke sexual arousal without a lot of con- scious thought or emotion. Certain areas of the skin, called erogenous zones, are highly sensitive to touch. Th ese areas may include the genitals, breasts, mouth, ears, neck, inner thighs, and buttocks; erotic associations with these areas vary from culture to culture and from individual to individual. Our olfac- tory sense (smell) may bring us sexual messages below the level of our conscious awareness. Scientists have isolated chemical substances, called pheromones, that are secreted into the air by many kinds of animals, including humans, ants, moths, pigs, deer, dogs, and monkeys. One function of pheromones, in animals at least, appears to be to arouse the libido.
Hormones Th e libido in both men and women is biologically infl uenced by the hormone testosterone. In men, testosterone is produced mainly in the testes; in women, it is produced in the adrenal glands and the ovaries. Growing evidence suggests that testosterone may play an important role in the mainte- nance of women’s bodies (Davis, Davison, Donath, & Bell, 2005). Although it does not play a large part in a woman’s hormonal makeup, it is present in the blood vessels, brain, skin, bone, and vagina. Testosterone is believed to
Women might be able to fake orgasms. But men can fake whole relationships.
—Sharon Stone (1958–)

Sensory inputs, such as the sight, touch, or smell of someone we love or the sound of his or her voice, may evoke desire and sexual arousal.
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Female Sexual Response • 97
contribute to bone density, blood fl ow, hair growth, energy and strength, and libido. Although women produce much less testosterone than men, this does not mean that they have less sexual interest; apparently, women are much more sensitive than men to testosterone’s eff ects. Th ough testosterone decreases in women as they age, the ovaries manufacture it throughout life. Symptoms produced by the decrease of testosterone can be similar to those related to estrogen loss, including fatigue, vaginal dryness, and bone loss. Signs specifi c to testosterone defi ciency are associated with reduced sexual interest and respon- siveness in men. Th e eff ects of such hormonal changes in women are less predictable (Bancroft, 2009). In spite of widespread claims of testosterone’s eff ect in treating low sex desire in women, in December 2004, the Food and Drug Administration voted against approval of a testosterone patch, citing concerns about the safety of long-term use of the patch and use by groups that have not been adequately studied. More recently, the balance of evidence seems to show that testosterone replacement therapy for surgically and naturally menopausal women has, if used properly under medical supervision, a more positive eff ect than a negative one on women (Panzer & Guay, 2009). Th ough sexual problems, including low libido and/or sexual dissatisfaction, may have physiological causes, they may also be caused by relationship issues, work fatigue, past experiences, or fi nancial problems. It is necessary to look beyond medical solutions when assisting women who have the courage to confront their sexual dissatisfaction. (Testosterone replacement therapy is discussed in Chapter 7.) Estrogen also plays a role in sexual functioning, though its eff ects on sexual desire are not completely understood. In addition to protecting the bones and heart, in women estrogen helps to maintain the vaginal lining and lubrication, which can make sex more pleasurable. Men also produce small amounts of estrogen, which facilitates the maturation of sperm and maintains bone density. Too much estrogen, however, can cause erection diffi culties. Like testosterone replacement, some doctors are also promoting estrogens and bioidentical or natural estrogen supplements to treat conditions caused by estrogen defi ciency. Th e most signifi cant push is aimed at menopausal women. Because no risk-free hormone has ever been identifi ed, claims that human estrogens will protect against cardiovascular eff ects and other maladies are misleading. While a num- ber of estrogens are eff ective treatments for hot fl ashes and vaginal dryness, any health-promotion claims for these drugs are clearly wrong. Shown to be some- what eff ective in relieving symptoms associated with some female sexual func- tion diffi culties is a botanical called Zestra (Ferguson, Hosmane, & Heiman, 2010). By increasing blood fl ow and nerve conduction, this product was found to signifi cantly increase clitoral and vaginal warmth, increase arousal, and improve sexual pleasure. Oxytocin is a hormone more commonly associated with contractions during labor and with breastfeeding. It is also increased by nipple stimulation in men and women. Th is neurotransmitter, which has also been linked to bonding, is released in variable amounts in men and women during orgasm and remains raised for at least 5 minutes after orgasm (Carmichael et al., 1987). It helps us feel connected and promotes touch, aff ection, and relaxation. Interestingly, oxy- tocin is important in stimulating the release of all the other sex hormones and, since it peaks during orgasm, it may be responsible for the desire to touch or cuddle after orgasm occurs (Chia & Abrams, 2005).
The age of a woman doesn’t mean a thing. The best tunes are played on
the oldest fi ddles.
—Ralph Waldo Emerson (1803–1882)

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98 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
think about it
Many of us measure both our sexuality and ourselves in terms of orgasm: Did we have one? Did our partner have one? If so, was it good? Did we have simultaneous orgasms? When we measure our sexuality by orgasm, however, we discount activities that do not necessarily lead to orgasm, such as touch- ing, caressing, and kissing. We discount erotic pleasure as an end in itself. Our culture tends to identify sexual activity with sexual intercourse, and the end of sexual intercourse is literally orgasm (especially male orgasm).
An Anthropological and Evolutionary Perspective
A fundamental, biological fact about orgasm is that male orgasm and ejaculation are required for reproduction, whereas the female orgasm is not. The male orgasm is universal in both animal and human species, but sociobiologists and anthropolo- gists have found immense variation in the experience of female orgasm. Anthropologists such as Margaret Mead (1975) found that some societies, such as the Mundugumor, emphasize the female orgasm but that it is virtually nonexistent in other societies, such as the Arapesh. In our culture, women most consistently experience orgasm through a combination of vaginal intercourse and manual and oral stimulation of the clitoris. In cultures that cultivate female orgasm, according to sociobiologist Donald Symons (1979), there is, in addition to an absence of sexual repression, an em- phasis on men’s skill in arousing women. In our own culture, among men who consider themselves (and are considered) “good lovers,” great emphasis is placed on their abilities to arouse their partners and bring them to orgasm. These skills include not only penile penetration but also, often more
The Role of Orgasm
importantly, clitoral or G-spot stimulation. This, of course, is based on the sexual script that men are to “give orgasms to women,” a message that places pressure on men and that tells women they are not responsible for their own sexual response. According to this script, the woman is “erotically dependent” on the man. The woman can, of course, also stimulate her own clitoris to experience orgasm. Because it is closely tied to reproduction, evolutionary scientists have never had diffi culty explaining the male orgasm; it ensures reproduction. In the same vein, scientists have for decades insisted on fi nding an evolutionary function for female orgasm but have not been as successful. Possibly, one eff ect of orgasm is to increase a suction in the uterus to draw up ejaculated semen thereby increasing the retention of sperm (Komisaruk et al., 2010). Since women can have sexual intercourse and become pregnant without experiencing orgasm, perhaps there is no evolutionary function for orgasm (Lloyd, 2005). However, philosopher and professor Elisabeth Lloyd acknowl- edges, evolution does not dictate what is culturally important. In reviewing 32 studies conducted over 74 years, Lloyd found that when intercourse was unassisted—that is, not accompa- nied by stimulation of the clitoris—just one quarter of the women studied experienced orgasms often or very often and a full one third never did; the rest sometimes did and sometimes didn’t.
The Tyranny of the Orgasm
Sociologist Philip Slater (1974) suggests that our preoccupation with orgasm is an extension of the Protestant work ethic, in which nothing is enjoyed for its own sake; everything is work,
In spite of what we do know about the importance of biological infl uences on sexual desire and performance, when biological determinants or evolutionary accounts are given undue weight and psychosocial forces are ignored or mini- mized, a medical model that negates the signifi cance of culture, relationships, and equality can emerge (Lloyd, 2007; Wood, Koch, & Mansfi eld, 2006).
Experiencing Sexual Arousal
For both males and females, physiological changes during sexual excitement depend on two processes: vasocongestion and myotonia. Vasocongestion is the concentration of blood in body tissues. For example, blood fi lls the genital regions of both males and females, causing the penis to become erect and the clitoris to swell. Myotonia is increased muscle tension accompanying the approach of orgasm; upon orgasm, the body undergoes involuntary muscle
Those who restrain desire do so because theirs is weak enough to be restrained.
—William Blake (1757–1827)

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Female Sexual Response • 99
including sex. Thus, we “achieve” orgasm much as we achieve success. Those who achieve orgasm are the “successful workers” of sexual activity; those who do not are the “failures.” As we look at our sexuality, we can see pressure to be suc- cessful lovers. Men talk of performance anxiety. We tend to evaluate a woman’s sexual self-worth in terms of her being or- gasmic (able to have orgasms). For men, the signifi cant ques- tion about women’s sexuality has shifted from “Is she a virgin?” to “Is she orgasmic?”
Pretending Orgasm
The idea that women “fake” orgasms is familiar, probably because there is considerable pressure on them to do so. What is less well-known is that some men also pretend or- gasm. Research on pretending orgasm can provide interest- ing insights into sexual scripts and their functions and meanings for both sexes (Muehlenhard & Shippee, 2009). Re- searchers and professors Muehlenhard and Shippee found that 25% of men and 50% of women reported pretending or- gasms, but that these rates were even higher for those who had experienced penile-vaginal intercourse. Frequently reported reasons for pretending orgasm (reported by both sexes) were that orgasm was unlikely, they wanted sexual activity to end, and they wanted to avoid negative conse- quences (hurting their partners’ feelings) and obtain positive ones (pleasing their partners). Both men’s and women’s narra- tives suggested a common sexual script in which the woman should orgasm first, ideally during intercourse, and when the man orgasms, sex is over. Thus, the researchers conclude, “It seems that much of people’s sexual behavior is guided by their or their partners’ scripts and expectations—even if this requires pretending.” Such questions are often asked by men rather than women, and women tend to resent them. Part of the pressure to pretend to have an orgasm is caused by these questions. What is really being asked? If the woman enjoyed
intercourse? If she thinks the man is a good lover? Or is the question merely a signal that the lovemaking is over?
“Was It Good for You?”
A question often asked following intercourse is “Was it good for you?” or its variation, “Did you come?” While the question “Was it good for you?” may initiate a dia- logue, the statement “Orgasm is good for us” acknowledges a fact. Though it’s apparent that orgasm feels good, some of us may not recognize that orgasm is indeed good for our health. Sexual activity not only burns quite a few calories and boosts the metabolism, it also improves immune function, helps you sleep better, and relieves menstrual cramps and stress. In fact, substan- tial connections between women’s sexual satisfaction and all three aspects of their well-being (relational, mental, and physical) have been reported (Holmberg, Blair, & Phillips, 2010). Though we don’t yet understand all of the benefi ts of sex and orgasm, there is mounting evidence that the enjoyment we receive from sex moderates our hormones and improves our emotional state.
Think Critically 1. How important is it that each partner experience
orgasm? What (if anything) would you say to a sexual partner who never or rarely experiences one?
2. Do you believe there are diff erences in the amount of emphasis that men and women give to orgasm? If so, why? If not, why not?
3. How would you feel about your partner pretending an orgasm? Would you like to know or not whether your partner actually experienced an orgasm? Why or why not?
contractions and then relaxes. Th e sexual response pattern remains the same for all forms of sexual behavior, whether autoerotic or sex with a partner, het- erosexual or homosexual. Nevertheless, approximately 30% of women report problems related to arousal (Chivers et al., 2010).
Sexual Excitement Many women do not separate sexual desire from arousal (Tiefer, 2004). Additionally, many seem to care less about physical arousal but rather place more emphasis on the relational and emotional aspects of inti- macy. In any case, for women, one of the fi rst signs of sexual excitement is the seeping of moisture through the vaginal walls through a process called vaginal transudation or sweating. Some women also report “tingling” in the genital area. Blood causes lymphatic fl uids to push by the vaginal walls, engorging them, lubricating the vagina, and enabling it to encompass the penis
The reason so many women fake orgasms is that so many men fake
—Graffi to

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100 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
or other object. Th e upper two thirds of the vagina expands in a process called tenting; the vagina expands about an inch in length and doubles its width. Th e labia minora begin to protrude outside the labia majora during sexual excitement, and breathing and heart rate increase. Th ese signs do not occur on a specifi c timetable; each woman has her own pattern of arousal, which may vary under diff erent conditions, with diff erent partners, and so on. Contractions raise the uterus, but the clitoris remains virtually unchanged during this early phase. Although the clitoris responds more slowly than the penis to vasocongestion, it is still aff ected. Th e initial changes, however, are minor. Clitoral tumescence (swelling) occurs simultaneously with engorgement of the labia minora. During masturbation and oral sex, the clitoris is generally stimulated directly. During intercourse, clitoral stimula- tion is mostly indirect, caused by the clitoral hood being pulled over the clitoris or by pressure in the general clitoral area. At the same time that these changes are occurring in the genitals, the breasts are also responding. Th e nipples become erect, and the breasts may enlarge somewhat because of the engorgement of blood vessels; the areolae may also enlarge. Many women (and men) experience a sex flush, a darkening of the skin or rash that temporarily appears as a result of blood rushing to the skin’s surface during sexual excitement. As excitement increases, the clitoris retracts beneath the clitoral hood and virtually disappears. Th e labia minora become progressively larger until they double or triple in size. Th ey deepen in color, becoming pink, bright red, or a deep wine-red color, depending on the woman’s skin color. Th is intense color- ing is sometimes referred to as the “sex skin.” When it appears, orgasm is imminent. Meanwhile, the vaginal opening and lower third of the vagina decrease in size as they become more congested with blood. Th is thickening of the walls, which occurs in the plateau stage of the sexual response cycle, is known as the orgasmic platform. Th e upper two thirds of the vagina contin- ues to expand, but lubrication decreases or may even stop. Th e uterus becomes fully elevated through muscular contractions. Changes in the breasts continue. Th e areolae become larger even as the nipples decrease in relative size. If the woman has not breastfed, her breasts may increase by up to 25% of their unaroused size; women who have breast- fed may have little change in size.
Orgasm Continued stimulation brings orgasm, a peak sensation of intense pleasure that creates an altered state of consciousness and is accompanied by involuntary, rhythmic uterine and anal contractions, myotonia, and a state of well-being and contentment. Th e upper two thirds of the vagina does not contract; instead, it continues its tenting eff ect. Th e labia do not change during orgasm, nor do the breasts (Komisaruk et al., 2010). Heart and respiratory rates and blood pressure reach their peak during orgasm. After orgasm, the orgasmic platform rapidly subsides. Th e clitoris reemerges from beneath the clitoral hood. Orgasm helps the blood to fl ow out of the genital tissue quickly (Meston & Buss, 2009). If a woman does not have an orgasm once she is sexually aroused, the clitoris may remain engorged for up to an hour: Th is unresolved vasocongestion sometimes leads to a feeling of frustration, analogous to what men call “blue balls.” Th e labia slowly return to their unaroused state, and the sex fl ush gradually disappears. About 30–40% of women perspire as the body begins to cool.
What is the earth? What are the body and soul without satisfaction?
—Walt Whitman (1819–1892)

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Summary • 101
Interestingly, when women and men are asked to use adjectives to describe their experience of orgasm, data suggest that, beyond the awareness of ejacula- tion that men report, their sensations bear more similarities than diff erences (Mah & Binik, 2002). Prolactin levels double immediately following orgasm and remain elevated for about 1 hour (Meston & Buss, 2009). Th is prolactin is thought to be responsible for the refractory period, in which men are unable to ejaculate again. In contrast, women are often physiologically able to be orgasmic immediately following the previous orgasm. As a result, women can have repeated orgasms, also called multiple orgasms, if they continue to be stimulated. Th ough fi ndings vary on the percentage of women who experience multiple orgasms (estimates range from 14% to 40%), what is clear is that wide variability exists among women and within any one woman from one time to another.
In the next chapter, we discuss the anatomical features and physiological functions that characterize men’s sexuality and sexual response. The information in these two chapters should serve as a comprehensive basis for understanding the material that follows.
Final Thoughts
Summary Female Sex Organs: What Are They For?
■ All embryos appear as female at fi rst. Genetic and hormonal signals trigger the development of male organs in those embryos destined to be male.
■ Sex organs serve a reproductive purpose, but they perform other functions also: giving pleasure, attracting sex partners, and bonding in relationships.
■ Th e external female genitals are known collectively as the vulva. Th e mons pubis is a pad of fatty tissue that covers the area of the pubic bone. Th e clitoris is the center of sexual arousal. Th e labia majora are two folds of spongy fl esh extending from the mons pubis and enclosing the other external genitals. Th e labia minora are smooth, hairless folds within the labia majora that meet above the clitoris.
■ Th e internal female sexual structures and reproduc- tive organs include the vagina, the uterus, the cervix,
the ovaries, and the fallopian tubes. Th e vagina is a fl exible muscular organ that encompasses the penis or other object during sexual expression and is the birth canal through which an infant is born. Th e opening of the vagina, the introitus, is partially cov- ered by a thin, perforated membrane, the hymen, prior to fi rst intercourse or other intrusion.
■ Many women report the existence of an erotically sensitive area, the Grafenberg spot (G-spot), on the front wall of the vagina midway between the introitus and the cervix.
■ Th e uterus, or womb, is a hollow, thick-walled, muscular organ; the tapered end, the cervix, extends downward and opens into the vagina. Th e lining of the uterine walls, the endometrium, is built up and then shed and expelled through the cervical os (opening) during menstruation. In the event of preg- nancy, the pre-embryo is embedded in the nourishing
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102 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
endometrium. On each side of the uterus is one of a pair of ovaries, the female gonads (organs that produce gametes, sex cells containing the genetic material necessary for reproduction). At the top of the uterus are the fallopian tubes, or uterine tubes. Th ey extend toward the ovaries but are not attached to them. Th e funnel-shaped end of each tube (the infundibulum) fans out into fi ngerlike fi mbriae, which drape over the ovary. Hairlike cilia on the fi mbriae transport the ovulated oocyte (egg) into the fallopian tube. Th e ampulla is the widened part of the tube in which fer- tilization normally occurs. Other important structures in the area of the genitals include the urethra, anus, and perineum.
■ Th e reproductive function of the female breasts, or mammary glands, is to nourish the off spring through lactation, or milk production. A breast is composed of fatty tissue and 15–25 lobes that radiate around a central protruding nipple. Alveoli within the lobes produce milk. Around the nipple is a ring of darkened skin called the areola.
Female Sexual Physiology
■ Hormones are chemical substances that serve as mes- sengers, traveling through the bloodstream. Impor- tant hormones that act directly on the gonads (gonadotropins) are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Hormones produced in the ovaries are estrogen, which helps regulate the menstrual cycle, and progesterone, which helps maintain the uterine lining, until menstruation occurs.
■ At birth, the human female’s ovaries contain approxi- mately half a million oocytes, or female gametes. During childhood, many of these degenerate. In a woman’s lifetime, about 400 oocytes will mature and be released, beginning in puberty when hormones trigger the completion of oogenesis, the production of oocytes, commonly called eggs or ova.
■ Th e activities of the ovaries and the development of oocytes for ovulation, the expulsion of the oocyte, are described as the three-phase ovarian cycle, which is usually about 28 days long. Th e phases are follicular (maturation of the oocyte), ovulatory (expulsion of the oocyte), and luteal (hormone production by the corpus luteum).
■ Th e menstrual cycle (or uterine cycle), like the ovarian cycle, is divided into three phases. Th e shedding of the endometrium marks the beginning of the menstrual
phase. Th e menstrual fl ow, or menses, generally occurs over a period of 3–5 days. Endometrial tissue builds up during the proliferative phase; it produces nutri- ents to sustain an embryo in the secretory phase.
■ Women who live or work together often develop similarly timed menstrual cycles, called menstrual synchrony.
■ Th e most severe menstrual problems have been attributed to premenstrual syndrome (PMS), a cluster of physical, psychological, and emotional symptoms that many women experience 7–14 days before their menstrual period. Some women experience very heavy bleeding (menorrhagia), while others have pelvic cramping and pain during the menstrual cycle (dysmenorrhea). When women do not menstruate for reasons other than aging, the condition is called amenorrhea. Principal causes of amenorrhea are pregnancy and nursing.
Female Sexual Response
■ Masters and Johnson’s four-phase model of sexual response identifi es the signifi cant stages of response as excitement, plateau, orgasm, and resolution. Kaplan’s tri-phasic model of sexual response consists of three phases: desire, excitement, and orgasm. Loulan’s sexual response model includes both biological and aff ective components in a six-stage cycle. Th e dual control model helps to explain the interaction be- tween sexual excitation and sexual inhibition.
■ Th e physical manifestations of sexual arousal involve a complex interaction of thoughts and feelings, sen- sory perceptions, neural responses, and hormonal reactions occurring in many parts of the body. For both males and females, physiological changes dur- ing sexual excitement depend on two processes: vasocongestion, the concentration of blood in body tissues; and myotonia, increased muscle tension with approaching orgasm.
■ For women, an early sign of sexual excitement is the moistening, or vaginal transudation or sweating, of the vaginal walls. Th e upper two thirds of the vagina expands in a process called tenting; the labia may enlarge or fl atten and separate; the clitoris swells. Breathing and heart rate increase. Th e nipples become erect, and the breasts may enlarge somewhat. Th e uterus elevates. As excitement increases, the clitoris retracts beneath the clitoral hood. Th e vaginal opening decreases by about one third, and its outer third becomes more congested, forming the orgasmic platform.
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Suggested Websites • 103
■ Continued stimulation brings orgasm, a peak sensa- tion of intense pleasure that creates an altered state of consciousness and is accompanied by contractions, myotonia, and a state of well-being and contentment. Women are often able to be orgasmic following a previous orgasm if they continue to be stimulated.
Questions for Discussion ■ Are changes in mood that may occur during a
woman’s menstrual cycle caused by biological factors, or are they learned? What evidence supports your response?
■ Given the choice between the environmentally friendly menstruation products and commercial products, which would you choose for yourself (or recommend to a woman), and why?
■ If another adult were to ask you, “What is an orgasm?”, how would you reply? If the person were to proceed to ask you how to induce one in a woman, what would you say?
■ What are your thoughts and reactions to learning about the Grafenberg spot? Do you believe it is an invented erotic spot for some women or a genuine gland or erogenous zone?
■ How important is it to you that both you and your partner enjoy sexual pleasuring and pleasure?
■ For women only: What is your response to looking at your genitals? For men only: What is your response to viewing photos of women’s genitals? Why is it that women are discouraged from touching or looking at their genitals?
■ How do you feel about the idea of having sex during a woman’s menstrual period? Why do you feel this way?
Suggested Websites Centers for Disease Control and Prevention Provides a wide variety of specifi c information and links related to all aspects of women’s health and well-being.
Guttmacher Institute A global research institute that explores aspects of sexuality and relationships.
National Institute of Child Health and Human Development (part of the National Institutes of Health) Provides a wide-ranging research portfolio on women’s health.
National Organization for Women (NOW) An organization of women and men who support full equality for women in truly equal partnerships.
National Women’s Health Network Provides clear and well-researched information about a variety of women’s health- and sexuality-related issues.
North American Menopause Society Promotes women’s health during midlife and beyond through an understanding of menopause.
Our Bodies, Ourselves Provides a multicultural and up-to-date perspective on women’s physical and sexual health.
Sex and the Internet Sexuality and Ethnicity Of the 307 million people living in the United States, over 155 million are women. Many of these women are in poor health, use fewer reproductive health services, and continue to suff er disproportionately
from premature death, disease, and disabilities. In ad- dition, there are tremendous economic, cultural, and social barriers to achieving optimal health. To fi nd out more about the reproductive health risks of special concern to women of color, go to the National Women’s Health Information Center website: http://www From the menu, select one minority group of women and report on the following:
■ One reproductive health concern ■ Obstacles women may encounter that would
prevent them from obtaining services
■ Potential solutions to this problem
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104 • Chapter 3 Female Sexual Anatomy, Physiology, and Response
The Women’s Sexual Health Foundation Focuses on medical treatment and provides a multidisciplinary approach to sexual problems and health.
Suggested Reading Boston Women’s Health Book Collective. (2011). Our bodies,
ourselves. New York: Touchstone. A thorough, accurate, and proactive women’s text covering a broad range of health and sexuality-related issues.
Brizendine, L. (2006). Th e female brain. New York: Broadway Books. An enlightening guide to the biological foundations of human behavior.
Diamond, L. M. (2008). Sexual fl uidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press. Off ers insight into the context-dependent nature of female sexuality.
Komisaruk, B. R., Whipple, B., Nasserzadeh, S., & Beyer-Flores, C. (2010). Th e orgasm answer guide. Baltimore, MD: Johns
Hopkins University Press. Provides a broad overview of women’s orgasm and men’s orgasm, their anatomy and physiology, and their connection to relationships and health.
Meston, C. M., & Buss, D. M. (2009). Why women have sex. New York: Henry Holt. Combines psychology and biology to help uncover women’s sexual motivations.
Ogden, G. (2006). Heart and soul of sex: Making the ISIS connection. Boston: Trumpter. Explores women’s sexual experiences, holistically and with academic rigor.
Wingood, G., & DiClemente, R. (Eds.). (2002). Handbook of women’s sexual and reproductive health. New York: Kluwer Academic/Plenum. A sourcebook for women’s sexuality.
For links, articles, and study material, go to the McGraw-Hill website, located at
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Male Sex Organs: What Are They For? 106
Male Sexual Physiology 113
Male Sexual Response 119
ch ap
te r
Male Sexual Anatomy, Physiology, and Response
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106 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Clearly, male sexual structures and functions diff er in many ways from those of females. What may not be as apparent, however, is that there are also a number of similarities in the functions of the sex organs and the sexual response patterns of men and women. In the previous chapter, we learned that the sexual structures of both females and males derive from the same embryonic tissue. But when this tissue receives the signals to begin diff erentiation into a male, the embryonic reproductive organs begin to change their appearance dramatically.
• Male Sex Organs: What Are They For? Like female sex organs, male sex organs serve several functions. In their repro- ductive role, a man’s sex organs manufacture and store gametes and can deliver them to a woman’s reproductive tract. Some of the organs, especially the penis, provide a source of physical pleasure for both the man and his partner.
External Structures
Th e external male sexual structures are the penis and the scrotum.
The Penis Th e penis (from the Latin word for tail) is the organ through which both sperm and urine pass. It is attached to the male perineum, the diamond-shaped region extending from the base of the scrotum to the anus. Th e penis consists of three main sections: the root, the shaft, and the head (see Figure 4.1). Th e root attaches the penis within the pelvic cavity; the body of the penis, the shaft, hangs free. At the end of the shaft is the head of the penis, the glans penis, and at its tip is the urethral orifi ce, for semen ejacula- tion or urine excretion. Th e rim at the base of the glans is known as the corona (Spanish for crown). On the underside of the penis is a triangular area of sensitive skin called the frenulum (FREN-you-lem), which attaches the glans to the foreskin. Th e glans penis is particularly important in sexual arousal
“Of course the media played a huge role in my sexual identity. It seemed everything in the media revolved around sex when I was young. Magazines such as Playboy and
Penthouse off ered pictures of nude female bodies, while more hard-core media such as Hustler off ered a fi rst look at pene- tration and a man’s penis. Hustler magazine was a big step for me in my childhood; it gave me my fi rst look at another man’s erect penis and a fi rst look at actual intercourse. This was like the bible of sex to me; it showed what to do with the penis, how it fi t into the vagina, and gave me a scale by which I could measure my own penis up to.”
—23-year-old male
“I noticed while talking among my friends about sex that exaggeration was common. Far-fetched stories were frequent and easily spotted based on the frequency and lack of details. At a certain point, I tried separating what I thought were the lies from the truth so that I could get a better understanding of what men did. Later, I found myself occasionally inserting their lies into the stories I shared with my friends.”
—24-year-old male
“In the meantime, I was going through some physical changes. That summer, I worked hard to try to make the varsity soccer team. I was growing, putting on weight, and I was ‘breaking out.’ When school resumed that fall, I returned a diff erent person. Now, instead of being that cute little kid that no one could resist, I became this average-looking teenager with acne. The acne was one factor that aff ected my life more than anything.”
—21-year-old male
Student Voices
Behold—the penis mightier than the sword.
—Mark Twain (1835–1910)

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Male Sex Organs: What Are They For? • 107
because it contains a relatively high concentration of nerve endings, making it especially responsive to stimulation. A loose skin covers the shaft of the penis and extends to cover the glans penis; this sleevelike covering is known as the foreskin or prepuce (PREE- pews). It can be pulled back easily to expose the glans. Th e foreskin of a male infant can sometimes be surgically removed by a procedure called circumci- sion. As a result of this procedure, the glans penis is left exposed. Th e reasons for circumcision seem to be rooted more in tradition and religious beliefs (it is an important ritual in Judaism and Islam) than in any fi rmly established health principles. Beneath the foreskin are several small glands that produce a cheesy substance called smegma. If smegma accumulates, it thickens, produces a foul odor, and can become granular and irritate the penis, causing discomfort and infection. It is important for uncircumcised adult males to observe good hygiene by periodically retracting the skin and washing the glans to remove the smegma. (For further discussion of circumcision, see Chapters 12, 13, and 15.) Th e shaft of the penis contains three parallel columns of erectile tissue. Th e two that extend along the front surface are known as the corpora cavernosa (KOR-por-a kav-er-NO-sa; cavernous bodies), and the third, which runs beneath them, is called the corpus spongiosum (KOR-pus spun-gee-OH-sum; spongy body), which also forms the glans (see Figure 4.2). At the root of the penis, the corpora cavernosa form the crura (KROO-ra), which are anchored by muscle to the pubic bone. Th e urethra, a tube that transports both urine and semen, runs from the bladder (where it expands to form the urethral bulb), through the spongy body, to the tip of the penis, where it opens to the outside. Inside the three chambers are a large number of blood vessels through which blood freely circulates when the penis is fl accid (relaxed). During sexual arousal, these vessels fi ll with blood and expand, causing the penis to become erect. (Sexual arousal, including erection, is discussed in greater detail later in the chapter.) In men, the urethra serves as the passageway for both urine and semen. Because the urinary opening is at the tip of the penis, it is vulnerable to injury and infection. Th e sensitive mucous membranes around the opening may be subject to abrasion and can provide an entrance into the body for infectious organisms. Condoms, properly used, can provide an eff ective barrier between this vulnerable area and potentially infectious secretions.
Shaft of
Testes (in scrotum)
Urethral orifice
Circumcised Uncircumcised
Foreskin Corona
• FIGURE 4.1 External Male Sexual Structures
Corpus spongiosum
Penile urethra
Corpora cavernosa
(Top of penis)
• FIGURE 4.2 Cross Section of the Shaft of the Penis
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think about it
Man’s preoccupation with his “generative organ” extends far back into history and appears in diverse cultures all over the world. The penis is an almost universal symbol of power and fertility. It may also be a source of considerable pleasure and anxiety for the individuals who happen to possess one.
Power to the Penis
Earthenware fi gurines from ancient Peru, ink drawings from medieval Japan, painted walls in the villas of Pompeii—in the art and artifacts from every corner of the world, we fi nd a common theme: penises! And not just any old penises, but organs of such length, girth, and weight that they can barely be supported by their possessors. Whether as an object of worship or an object of jest, the giant penis has been (and continues to be) a symbol that holds deep cultural signifi cance, especially in societies in which men are dominant over women. Although it seems rea- sonable for the erect penis to be used as a symbol of love, or at least lust, many of its associations appear to be as an instrument of aggression and power. In New Guinea, Kiwai hunters pressed their penises against the trees from which they would make their harpoons, thereby ensuring the strength and straightness of their weapons. Maori warriors in New Zealand crawled under the legs of their chief so that the power of his penis would descend onto them (Strage, 1980). In many cultures, the penis has also represented fertility and prosperity. In India, large stone phalluses (lingams), associated with the Hindu god Shiva, are adorned with fl owers and propiti- ated with off erings. Ancient peoples as diverse as the Maya in Central America and the Egyptians in North Africa believed that the blood from the penises of their rulers was especially power- ful. Mayan kings ceremonially pierced their penises with stingray spines, and the pharaohs and high priests of Egypt underwent ritual circumcision. In other places, men have ritually off ered their semen to ensure a plentiful harvest.
“Phallic Phallacies”
It is interesting (but perhaps not surprising) that the responsi- bility of owning an instrument of great power can carry with it an equally great burden of anxiety. In some ways, the choice of the penis as a symbol of domination seems rather unwise. Any man can tell you that a penis can be disturbingly unreliable and appear to have a mind of its own. For men who are already inse- cure about their abilities on the job or in the bedroom, the penis can take on meanings quite beyond those of procreation,
The Penis: More Than Meets the Eye
elimination, or sensual pleasure. How can a man be expected to control his employees or his children when he can’t control the behavior of his own penis? As discussed in Chapter 2, Sigmund Freud believed that women are unconsciously jealous of men’s penises (penis envy). In reality, those who appear to suff er the most from penis envy are men, who indeed possess a penis but often seem to long for a bigger one. The idea that “the larger the penis, the more eff ec- tive the male in coital connection” is referred to by Masters and Johnson as a “phallic phallacy” (Masters & Johnson, 1966). Perhaps not surprising, girth, as opposed to length, has been judged as being more important to women in one study (Stulhofer, 2006). Another manifestation of penile anxiety, also named by Freud, is castration anxiety (see Chapter 2). This term is mislead- ing, for it does not describe what the actual fear is about. Castra- tion is the removal of the testes, but castration anxiety is fear of losing the penis. In China and other parts of Asia, there have been documented epidemics of koro (a Japanese term), the con- viction that one’s penis is shrinking and is going to disappear. Otherwise known as genital retraction syndrome, this malady has no physiological basis and appears to be most common in anxiety-prone men (Dzokoto & Adams, 2005). For his own psyche’s sake, as well as the sake of his partner and that of society, a man would do well to consider how his feelings about his penis and his masculinity aff ect his well- being. Additionally, he might consider learning that there is a wide variation in penis size—and understanding that he is in that range. At this point, we can only speculate, but perhaps there will come a time when men allow themselves to focus less on the size and performance of their “equipment” and more on acceptance, communication, and the mutual sharing of pleasure.
Think Critically 1. What type of symbolism, if any, do you attribute to
the penis? 2. How would you describe the signifi cance of the penis
in U.S. culture to a person from another culture? 3. Do you feel that men’s preoccupation with their penis
size is comparable to a preoccupation of women with their breast size? Explain.
108 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
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Male Sex Organs: What Are They For? • 109
In an unaroused state, the average penis is slightly under 3 inches long, although there is a great deal of individual variation. When erect, penises become more uniform in size, as the percentage of volume increase is greater with smaller penises than with larger ones. Cold air or water, fear, and anxiety, for example, often cause the penis to temporarily be pulled closer to the body and to decrease in size. When the penis is erect, the urinary duct is temporar- ily blocked, allowing for the ejaculation of semen. But erection does not neces- sarily mean sexual excitement. A man may have erections at night during REM sleep, the phase of the sleep cycle when dreaming occurs, or when he is anxious. Myths and misconceptions about the penis abound, especially among men. Many people believe that the size of a man’s penis is directly related to his masculinity, aggressiveness, sexual ability, or sexual attractiveness. Others believe that there is a relationship between the size of a man’s penis and the size of his hands, feet, thumbs, or nose. In fact, the size of the penis is not specifi cally related to body size or weight, muscular structure, race or ethnicity, or sexual orientation; it is determined by individual hereditary factors. Except in very rare and extreme cases, there is no relationship between penis size and a man’s ability to have sexual intercourse or to satisfy his partner.
The Scrotum Hanging loosely at the root of the penis is the scrotum, a pouch of skin that holds the two testicles. Th e skin of the scrotum is more heavily pigmented than the skin elsewhere on the body; it is sparsely covered with hair and divided in the middle by a ridge of skin. Th e skin of the scrotum varies in appearance under diff erent conditions. When a man is sexually aroused, for example, or when he is cold, the testicles are pulled close to the body, causing the skin to wrinkle and become more compact. Th e changes in the surface of the scrotum help maintain a fairly constant temperature within the testicles (about 93�F). Two sets of muscles control these changes: (1) the dartos muscle, a smooth muscle under the skin that contracts and causes the surface to wrinkle, and (2) the fi brous cremaster muscle within the scrotal sac that causes the testes to elevate.
There is nothing about which men lie so much as about their sexual powers. In
this at least every man is, what in his heart he would like to be, a Casanova.
—W. Somerset Maugham (1874–1965)

There is great variation in the appearance, size, and shape of the male genitalia. Note that the penis on the left is not circumcised, whereas the other two are.
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110 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Internal Structures
Male internal reproductive organs and structures include the testes (testicles), seminiferous tubules, epididymis, vas deferens, ejaculatory ducts, seminal vesi- cles, prostate gland, and Cowper’s (bulbourethral) glands (see Figure 4.3).
The Testes Inside the scrotum are the male reproductive glands or gonads, which are called testicles or testes (singular, testis). Th e testes have two major functions: sperm production and hormone production. Each olive-shaped testis is about 1.5 inches long and 1 inch in diameter and weighs about 1 ounce; in adulthood and as a male ages, the testes decrease in size and weight. Th e testicles are usually not symmetrical; the left testicle generally hangs slightly lower than the right one. Within the scrotal sac, each testicle is suspended by a spermatic cord containing nerves, blood vessels, and a vas deferens (see Figure 4.4). Within each testicle are around 1,000 seminiferous tubules, tiny, tightly compressed tubes 1–3 feet long (they would extend several hundred yards if laid end to end). Within these tubes, spermatogenesis—the production of sperm—takes place. As a male fetus grows, the testicles develop within the pelvic cavity; toward the end of the gestation period, the testes usually descend into the scrotum. In about 3–4% of full-term infants and more commonly in premature infants, one or both of the testes fail to descend, a condition known as cryptorchidism, or undescended testicle (“Undescended Testicle,” 2009). In most cases, the testicles will descend by the time a child is 9 months old. If they do not, surgery is often recommended because bringing the testicles into the scrotum maximizes sperm production and increases the odds of fertility. It also allows examination for early detection of testicular cancer.
The Epididymis and Vas Deferens Th e epididymis and vas deferens (or ductus deferens) are the ducts that carry sperm from the testicles to the urethra for ejacu- lation. Th e seminiferous tubules merge to form the epididymis (ep-e-DID-i-mes),
Nowhere does one read of a penis that quietly moseyed out for a look at what
was going on before springing and crashing into action.
—Bernie Zilbergeld (1939–2002)

Pubic bone
Vas deferens
Corpus spongiosum
Corpus cavernosum
Urethral orifice
Glans penis
Seminal vesicle Ureter
Ejaculatory duct
Prostate gland
Cowper’s gland (Bulbourethral gland)
AnusSpermatic cord
• FIGURE 4.3 Internal Side View of the Male Sex Organs
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Male Sex Organs: What Are They For? • 111
a comma-shaped structure consisting of a coiled tube about 20 feet long, where the sperm fi nally mature. Each epididymis merges into a vas deferens, a tube about 18 inches long, extending into the abdominal cavity, over the bladder, and then downward, widening into the fl ask-shaped ampulla. Th e vas deferens joins the ejaculatory duct within the prostate gland. Th e vas deferens can be felt easily in the scrotal sac. Because it is easily accessible and is crucial for sperm transport, it is usually the point of sterilization for men. Th e operation is called a vasectomy (discussed fully in Chapter 11). A vasectomy does not aff ect the libido or the ability to ejaculate because only the sperm are transported through the vas defer- ens. Most of the semen that is ejaculated comes from the prostate gland and the seminal vesicles.
The Seminal Vesicles, Prostate Gland, and Cowper’s Glands At the back of the bladder lie two glands, each about the size and shape of a fi nger. Th ese seminal vesicles secrete a fl uid that makes up about 60% of the seminal fl uid. Encircling the urethra just below the bladder is a small muscular gland about the size and shape of a chestnut called the prostate gland, which produces about 30–35% of the seminal fl uid in the ejaculated semen. Th ese secretions fl ow into the urethra through a system of tiny ducts. Some men who enjoy receiving anal sex experience erotic sensations when the prostate is gently stroked; others fi nd that contact with the prostate is uncomfortable. Men, especially if they are older, may be troubled by a variety of prostate problems, ranging from relatively benign conditions to more serious infl ammations and prostate cancer. (Problems and diseases of the prostate are covered in Chapter 13.) Below the prostate gland are two pea-sized glands connected to the urethra by tiny ducts. Th ese are Cowper’s or bulbourethral (bul-bo-you-REE-thrul) glands, which secrete a thick, clear mucus prior to ejaculation, the process by which semen is forcefully expelled from the penis. Th is fl uid may appear at the tip of the erect penis; its alkaline content may help buff er the acidity within the urethra and provide a more hospitable environment for sperm. Fluid from the Cowper’s glands may contain sperm that have remained in the urethra since
My brain. It’s my second favorite organ.
—Woody Allen (1935–)

Vas deferens
Body of epididymis
Seminiferous tubules
Leydig or interstitial cells
Tail of epididymis
Head of epididymis
Outer layer of testis
Spermatic cord • FIGURE 4.4 Cross Section of a Testicle
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112 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
a previous ejaculation or that have leaked in from the ampullae. Consequently, it is possible for a pregnancy to occur from residual sperm even if the penis is withdrawn before ejaculation.
The Breasts and Anus
Male anatomical structures that do not serve a reproductive function but that may be involved in or aff ected by sexual activities include the breasts, urethra, buttocks, rectum, and anus. Although the male breast contains the same basic structures as the female breast—nipple, areola, fat, and glandular tissue—the amounts of underlying fatty and glandular tissues are much smaller in men. Our culture appears to be ambiv- alent about the erotic function of men’s breasts, but it does appear to place emphasis on their appearance. We usually do not even call them breasts, but refer to the general area as the chest or “pecs.” Some men fi nd stimulation of their nipples to be sexually arousing; others do not. Gynecomastia (gine-a-ko-MAS-tee-a), the swelling or enlargement of the male breast, is triggered by a decrease in the amount of testosterone compared with estrogen. Th is condition can occur during adolescence or adulthood. In puberty, gynecomastia is a normal response to hor- monal changes (see Chapter 6). In adulthood, its prevalence peaks again between the ages of 50 and 80 and aff ects at least one in four men. Its causes may include the use of certain medications, alcoholism, liver or thyroid disease, and cancer. Probably not surprising in this perfection-driven society is the rise in pectoral implants among men who wish to have sculpted chests. Th ough still a niche market, some men are fi nding these semisolid silicon implants to be a confi dence booster. Th e risks of the procedure are similar to those of female implant proce- dures (migration, infection, loss of feelings around the nipple). An organ used primarily for excretion, the anus can also be used by both men and women during sexual activity. Because the anus is kept tightly closed by the external and internal anal sphincters, most of the erotic sensation that occurs during anal sex is derived from the penetration of the anal opening. Beyond the sphincters lies a larger space, the rectum. In men, the prostate gland is located in front of the rectum, and stimulation of this and nearby structures
The penis is a prominent symbol in both ancient and modern art. Here we see a contemporary phallic sculpture in Frogner Park, Oslo, Norway, and a stone lingam from Thailand.
Male breasts, which are usually referred to euphemistically as “the chest” or “pecs,” may or may not be considered erotic areas. Men are allowed to display their breasts in certain public settings. Whether the sight is sexually arousing depends on the viewer and the context.
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Male Sexual Physiology • 113
can be very pleasing. Because the anus and rectum do not provide signifi cant amounts of lubrication, most people use some sort of water-based lubricant for penetrative sexual activity. Both men and women may enjoy oral stimulation of the anus (“rimming”); the insertion of fi ngers, a hand (“fi sting”), a dildo, or a penis into the rectum may bring erotic pleasure to both the receiver and the giver. (Anal sex is discussed more fully in Chapter 9; safer sex guidelines appear in Chapter 15. Table 4.1 provides a summary of male sexual anatomy.)
• Male Sexual Physiology Th e reproductive processes of the male body include the manufacture of hor- mones and the production and delivery of sperm. Although men do not have a monthly reproductive cycle comparable to that of women, they do experience regular fl uctuations of hormone levels; there is also some evidence that men’s moods follow a cyclical pattern.
TABLE 4.1 • Summary Table of Male Sexual Anatomy
External Structures
Penis Organ through which both sperm and urine pass
Root of penis Attaches the penis within the pelvic cavity
Shaft Body of the penis that hangs free
Glans penis Enlarged head of the penis
Corona Rim at the base of the glans
Frenulum A triangular area of sensitive skin that attaches the glans to the foreskin
Foreskin (prepuce) Loose skin or sleevelike covering of the glans. The removal of the foreskin in male infants is called circumcision.
Corpora cavernosa Two parallel columns of erectile tissue that extend along the front surface of the penis
Corpus spongiosum One of three parallel columns of erectile tissue that runs beneath the corpora cavernosa, surrounds the urethra, and forms the glans
Crura Root of the penis that is anchored by muscle to the pubic bone
Urethra Tube that transports both urine and semen and runs from the bladder
Scrotum Pouch of loose skin that holds the two testicles
Internal Structures
Testes (testicles) Male reproductive glands or gonads whose major functions are sperm and hormone production
Spermatic cord Located within the scrotal sac; suspends each testicle and contains nerves, blood vessels, and a vas deferens
Seminiferous tubules Tiny, highly compressed tubes where the production of sperm takes place
Epididymis Merged from the seminiferous tubules, a comma-shaped structure where the sperm mature
Vas deferens A tube that extends into the abdominal cavity and carries the sperm from the testicles to the urethra for ejaculation
Ampulla Widened section of the vas deferens
Ejaculatory duct One of two structures within the prostate gland connecting to the vas deferens
Seminal vesicle One of two glands at the back of the bladder that together secrete about 60% of the seminal fl uid
Prostate gland Produces about 30–35% of the seminal fl uid in the ejaculated semen
Cowper’s glands Also called bulbourethral glands; secrete a clear, thick, alkaline mucus prior to ejaculation
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114 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Sex Hormones
Within the connective tissues of a man’s testes are Leydig cells (also called interstitial cells), which secrete androgens (male hormones). Th e most impor- tant of these is testosterone, which triggers sperm production and regulates the sex drive. Other important hormones in male reproductive physiology are GnRH, FSH, and LH. In addition, men produce the protein hormone inhibin, oxytocin, and small amounts of estrogen. (Table 4.2 describes the principal hormones involved in sperm production and their functions.)
Testosterone Testosterone is a steroid hormone synthesized from cholesterol. Tes- tosterone is made by both sexes—by women mostly in the adrenal glands (located above the kidneys) and ovaries and by men primarily in the testes. Furthermore, the brain converts testosterone to estradiol (a female hormone). Th is fl exibility of the hormone makes the link between testosterone and behavior precarious. During puberty, besides acting on the seminiferous tubules to produce sperm, testosterone targets other areas of the body. It causes the penis, testicles, and other reproductive organs to grow and is responsible for the development of secondary sex characteristics, those changes to parts of the body other than the genitals that indicate sexual maturity. In men, these changes include the growth of pubic, facial, underarm, and other body hair and the deepening of the voice. (In women, estrogen and progesterone combine to develop secondary sex characteristics such as breast development, growth of pubic and underarm hair, and the onset of vaginal mucous secretions.) Testosterone also infl uences the growth of bones and increase of muscle mass and causes the skin to thicken and become oilier (leading to acne in many teenage boys). Th ough numerous studies have attempted to understand the impact of tes- tosterone on personality, fi ndings are mixed. What complicates the research is the fact that testosterone levels vary according to what specifi c components of the hormone testosterone were measured and the fact that levels are rarely stable; they appear to respond positively or negatively to almost every challenge, and not necessarily in a way we might predict. Consequently, if a man suspects he has a testosterone defi ciency, he would be wise to have his bioavailable testosterone levels assessed (“Low Testosterone,” 2009). Th e increasing research about testosterone and its derivatives, the anabolic- androgenic steroids, has fueled a market for those seeking anti-aging therapies,
Women say it’s not how much men have, but what we do with it. How many
things can we do with it? What is it, a Cuisinart? It’s got two speeds: forward and reverse.
—Richard Jeni (1957–2007)

The sex organ has a poetic power, like a comet.
—Joan Miró (1893–1983)

TABLE 4.2 • Male Reproductive Hormones
Hormone Where Produced Functions
Testosterone Testes, adrenal glands Stimulates sperm production in testes, triggers development of secondary sex characteristics, regulates sex drive
GnRH Hypothalamus Stimulates pituitary during sperm production
FSH Pituitary Stimulates sperm production in testes
ICSH (LH) Pituitary Stimulates testosterone production in interstitial cells within testes
Inhibin Testes Regulates sperm production by inhibiting release of FSH
Oxytocin Hypothalamus, testes Stimulates contractions in the internal reproductive organs to move the contents of the tubules forward; infl uences sexual response and emotional attraction
Relaxin Prostate Increases sperm motility
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Male Sexual Physiology • 115
desiring athletic bodies and performance, and feeling entitled to unfailing and lifelong sexual prowess and fulfi llment. Th e complex interaction of hormonal, psychological, situational, and physical factors that men experience with age can result in erectile problems, decreased bone density, heart disease, changes in moods, diffi culty in thinking, and weakness (National Institute on Aging, 2010a). (For further discussion about males and aging, see Chapter 7.) Some of these symptoms can be reversed with testosterone replacement therapy; however, research also indicates that those receiving testosterone replacement should be checked often for prostate cancer. Because of lack of solid evidence, testosterone replacement therapy is recommended only for those who prove to have a defi – ciency of testosterone, which is common among men with metabolic syndrome— a constellation of risk factors including abdominal fat, high blood sugar, and high blood-fat levels. (For a discussion of male menopause, see Chapter 7.)
practically speaking
Men’s sexual health is directly related to their general health (Lindau & Gavrilova, 2010). However, because men do not get pregnant or bear children, and because condoms are available without a prescription, men’s sexual and reproductive health needs are not as obvious as women’s and often are ig- nored. In recent years, however, such issues as the high incidence of HIV and other sexually transmitted infections (STIs), prevalence of sexual function problems, and concerns regarding the role of males in teenage pregnancies and births have begun to alter this trend. Clearly, a movement toward a holistic and broad-based ap- proach to sexual and reproductive health care for men is needed. Here are some facts you may or may not know about the sexual health of men (Guttmacher Institute, 2008a; Lindau & Gavrilova, 2010; Meuleman, 2011):
1. Only 5% of those who receive services by the Title X Family Planning Program are men.
2. Of those men aged 15–19 who had a physical exam in the past year, less than 20% received counseling or advice about birth control or STIs, including HIV.
3. Men lose more years of sexually active life as a result of poor health than do women.
4. Considered the most important threat of the twenty-fi rst cen- tury to male sexual health is a common medical condition as- sociated with abdominal obesity called metabolic syndrome (MetS).
From adolescence on, most men need information and refer- rals for their sexual and reproductive concerns. Unfortunately, health insurance often does not cover the services men need, and a high proportion of men, particularly low-income men, do
not have health insurance. Thus, there are signifi cant gaps be- tween needs and services. Furthermore, few health professionals are specifi cally trained to provide men with sexual and repro- ductive health education and services. Men’s reproductive health involves both their own well-being and their ability to engage in healthy, fulfi lling relationships. To achieve this, men need the following:
1. Information and education about contraceptive use, preg- nancy, and childbearing
2. Education about and access to routine screening and treat- ment for sexually transmitted infections
3. Information about where to obtain and how to use condoms correctly
4. Counseling and support regarding how to talk about these and other sexuality-related issues with partners
5. Surgical services for vasectomies, screening and treatment for reproductive cancers (particularly prostate and testicular can- cer), sexual problems, and infertility treatment
Additionally, skills development related to self-advocacy, risk as- sessment and avoidance, resistance to peer pressure, communi- cation with partners, fatherhood skills, and role expectations are both needed and desired. The complex relationships between poverty, high-risk behav- iors, and poor health outcomes are undeniable for both men and women. Helping men lead healthier sexual and reproduc- tive lives is a goal that is garnering attention and legitimacy. What is increasingly seen as good for men in their own right should turn out to be just as good for their partners—to the ultimate benefi t of society as a whole.
Sexual Health Care: What Do Men Need?
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116 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Male Cycles Studies comparing men and women have found that both sexes are subject to changes in mood and behavior patterns (Lips, 2004). Whereas such changes in women are often attributed (rightly or wrongly) to menstrual cycle fl uctuations, it is not clear that male changes are related to levels of tes- tosterone or other hormones. Men do appear to undergo cyclic changes, although their testosterone levels do not fl uctuate as dramatically as do women’s estrogen and progesterone levels. On a daily basis, men’s testosterone levels appear to be lowest in the evening and highest in the morning (midnight to noon) (see Figure 4.5) (Winters et al., 2001). Moreover, their overall levels appear to be relatively lower in the spring and higher in the fall. Th roughout the night, specifi cally during REM sleep, men experience spon- taneous penile erections. (Women experience labial, vaginal, and clitoral engorgement.) Th ese erections are sometimes referred to as “battery-recharging mechanisms” for the penis, because they increase blood fl ow and bring fresh oxygen to the penis. Typically, men have penile engorgement during 95% of REM sleep stages (Komisaruk, Whipple, Nasserzadeh, & Beyer-Flores, 2010). If a man has erectile diffi culties while he is awake, it is important to determine whether he has normal erections during sleep. If so, his problems may have to do with something other than the physiology of erection. Approximately 90% of men and nearly 40% of women have ever experienced nocturnal orgasms; for men, these are often referred to as “wet dreams” (Kinsey, Pomeroy, & Martin, 1948; Wells, 1986).
Within the testes, from puberty on, spermatogenesis, the production of sperm, is an ongoing process. Every day, a healthy, fertile man produces several hundred million sperm within the seminiferous tubules of his testicles (see Figure 4.6). After they are formed in the seminiferous tubules, which takes 64–72 days, immature sperm are stored in the epididymis. It then takes about 20 days for the sperm to travel the length of the epididymis, during which time they become fertile and motile (able to move) (see Figure 4.7). Upon ejaculation, sperm in the tail section of the epididymis are expelled by muscular contractions of its walls into the vas deferens; similar contractions within the vas deferens propel
Men always want to be a woman’s fi rst love—women like to be a man’s last
—Oscar Wilde (1854–1900)

Noon 6P.M. 6A.M.Midnight Noon
0 Te
st o
st er
o ne
(n g
/m l)
• FIGURE 4.5 Testosterone Cycles. Every 2–4 hours, testosterone levels in the blood peak. (Source: Human Sexuality, 3rd ed., by LeVay, S., and Baldwin, J. Copyright © 2008 by Sinauer Associates, Inc. Reprinted with permission.)
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Male Sexual Physiology • 117
the sperm into the urethra, where they are mixed with semen, also called sem- inal fl uid, and then expelled, or ejaculated, through the urethral orifi ce. Th e sex of the zygote produced by the union of egg and sperm is determined by the chromosomes of the sperm. Th e ovum always contributes a female sex chromosome (X), whereas the sperm may contribute either a female or a male sex chromosome (Y). Th e combination of two X chromosomes (XX) means that the zygote will develop as a female; with an X and a Y chromosome (XY), it will develop as a male. In some cases, combinations of sex chromosomes other than XX or XY occur, causing sexual development to proceed diff erently. (Th ese variations are discussed in Chapter 5.)
Primary spermatocyte (46 chromosomes)
Secondary spermatocytes (23 chromosomes)
Spermatids (23 chromosomes)
Type A cell
Type B cell
Mitosis (16 days)
growth and differentiation
Meiosis I (24 days)
Meiosis II (few hours)
• FIGURE 4.6 Spermatogenesis. This diagram shows the development of spermatozoa, beginning with a single spermatogonium and ending with four complete sperm cells. Spermatogenesis is an ongoing process that begins in puberty. Several hundred million sperm are produced every day within the seminiferous tubules of a healthy man.
• FIGURE 4.7 The Human Spermatozoon (Sperm Cell). The head contains the sperm’s nucleus, including the chromosomes, and is encased in the helmetlike acrosome.
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118 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Semen Production
Semen, or seminal fl uid, is the ejaculated liquid that contains sperm. Th e func- tion of semen is to nourish sperm and provide them with a hospitable environ- ment and means of transport if they are deposited within the vagina. Semen is mainly made up of secretions from the seminal vesicles and prostate gland, which mix together in the urethra during ejaculation. Immediately after ejaculation, the semen is somewhat thick and sticky from clotting factors in the fl uid. Th is con- sistency keeps the sperm together initially; then the semen becomes liquefi ed, allowing the sperm to swim out. Semen ranges in color from opalescent or milky white to yellowish or grayish upon ejaculation, but it becomes clearer as it lique- fi es. Normally, about 2–6 milliliters (about 1 teaspoonful) of semen are ejaculated at one time; this amount of semen generally contains between 100 million and
practically speaking
The Male Body Image Self-Consciousness Scale was devel- oped to measure the extent to which one feels self- conscious about one’s body and physical features during sexual intimacy. Since body image is often an important com- ponent to a rewarding and fulfi lling sexual interaction with an- other person, this scale will help assess it. If you are a woman, you can also take this scale by inserting some of the vulnerable parts of your body into the questions and then responding appropri- ately. Think about someone with whom you are or have been ro- mantically or sexually intimate and indicate the most appropriate response next to each statement. The response format is:
1 � Strongly disagree 2 � Disagree 3 � Don’t know 4 � Agree 5 � Strongly agree
1. During sex, I would worry that my partner would think my chest is not muscular enough.
2. During sexual activity, it would be diffi cult not to think about how unattractive my body is.
3. During sex, I would worry that my partner would think my stomach is not muscular enough.
4. I would feel anxious receiving full-body massage from a partner.
5. The fi rst time I have sex with a new partner, I would worry that my partner would get turned off by seeing my body without clothes.
6. I would feel nervous if a partner were to explore by body be- fore or after having sex.
7. I would worry about the length of my erect penis during physically intimate situations.
8. During sex, I would prefer to be on the bottom so that my stomach appears fl at.
9. The worst part of having sex is being nude in front of another person.
10. I would feel embarrassed about the size of my testicles if a partner were to see them.
11. I would have diffi culty taking a shower or bath with a partner.
12. During sexual activity, I would be concerned about how my body looks to a partner.
13. If a partner were to put a hand on my buttocks I would think, “My partner can feel my fat.”
14. During sexually intimate situations, I would be concerned that my partner thinks I am too fat.
15. I could feel comfortable enough to have sex only if it were dark so that my partner could not clearly see my body.
16. If a partner were to see me nude, I would be concerned about the overall muscularity of my body.
17. The idea of having sex without any covers over my body causes me anxiety.
Add the scores to provide a total score (possible range is 17 to 85), with higher scores denoting greater levels of body image self-consciousness during physical intimacy.
Male Body Image Self-Consciousness Scale
SOURCE: McDonagh, L. K., Morrison, T. G., & McGuire, B. E. (2008). The naked truth: Development of a scale designed to measure male body image self- consciousness during physical intimacy. Journal of Men’s Studies, 16, 253–265. Reprinted by permission of the publisher.
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Male Sexual Response • 119
Homologous Organs Glans penis Glans clitoris
Penile prepuce (foreskin) Clitoral prepuce (hood) Corpus cavernosum of the penis Corpus cavernosum of the clitoris
Urethral surface of the penis Labia minora Prostate gland Skene‘s glands
Scrotum Labia majora Corpus spongiosum Vestibular bulbs
Glans penis
Penile prepuce (foreskin)
Corpus cavernosum of the penis
Prostate glandand
Corpus spongiosum
Glans clitoris
Clitoral prepuce (hood)
Labia majora
Labia minora
Skene’s glands (either side of urethra)
Corpus cavernosum of the clitoris
Vestibular bulbs (either side of the vaginal opening)
Urethral surface of the penis
• FIGURE 4.8 Homologous Structures of Males and Females. Note that males and females share many of the same structures since they developed from the same cells during fetal development.
Between 100 million and 600 million sperm are present in the semen from a single ejaculation. Typically, following ejaculation during intercourse, fewer than 1,000 sperm will get as far as a fallopian tube, where an ovulated oocyte may be present. Though many sperm assist in helping to dissolve the egg cell membrane, typically only one sperm ultimately achieves fertilization.
600 million sperm. In spite of their signifi cance, sperm occupy only about 1% of the total volume of semen; the remainder comes primarily from the seminal vesicles (70%) and the prostate gland (30%). Fewer than 1,000 sperm will reach the fallopian tubes. Most causes of male infertility are related to low sperm count and/or motility. When the sperm count is low and if the goal is implantation, the optimal frequency for intercourse with ejaculation is every other day. (For more information about infertility, see Chapter 12.)
Homologous Organs
Interestingly, each of the male sexual structures has a homologous structure, or similar characteristic, that is developed from the same cells in the developing female fetus. Th e presence of a Y chromosome in a male produces testosterone in greater amounts. Without this Y chromosome, the fetus would become a female. (See Figure 4.8 for the homologous structures of males and females.)
• Male Sexual Response At this point, it might be useful to review the material on sexual arousal and response in Chapter 3, including the models of Masters and Johnson, Kaplan, Loulan, and Janssen and Bancroft. Even though their sexual anatomy is quite diff erent, women and men follow roughly the same pattern of excitement and orgasm, with two exceptions: (1) Generally (but certainly not always), men become fully aroused and ready for penetration in a shorter amount of time
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120 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
than women do; and (2) once men experience ejaculation, they usually cannot do so again for some time, whereas women may experience repeated orgasms. Probably one of the most controversial topics in the fi eld of sexuality theory is whether sexual desire is shaped more by nature or culture. One recent study suggests that the most signifi cant predictor of sexual desire among men is the lack of erotic thoughts during sexual activity (Carvalho & Nobre, 2011). As suggested in Chapter 3, societal expectations, health, education, class, politics, and relational factors are thought to infl uence both men’s and women’s sexual desire and functioning. Combined, these infl uence sexual desire and response in profound ways. (See Chapter 14 for further discussion of sexual desire.) Sexual arousal in men includes the processes of myotonia (increased muscle tension) and vasocongestion (engorgement of the tissues with blood). Vasocon- gestion in men is most apparent in the erection of the penis.
When a male becomes aroused, the blood circulation within the penis changes dramatically (see Figure 4.9). During the process of erection, the blood vessels expand, increasing the volume of blood, especially within the corpora caver- nosa. At the same time, expansion of the penis compresses the veins that nor- mally carry blood out, so the penis becomes further engorged. (Th ere are no muscles in the penis that make it erect, nor is there a bone in it.) Secretions from the Cowper’s glands appear at the tip of the penis during erection.
Ejaculation and Orgasm
What triggers the events that lead to ejaculation are undetermined, but it appears that it may be the result of a critical level of excitation in the brain or spinal cord (Komisaruk, et al., 2010). Regardless, increasing stimulation of the penis generally leads to ejaculation. Orgasm occurs when the impulses that cause erection reach a critical point and a spinal refl ex sets off a massive dis- charge of nerve impulses to the ducts, glands, and muscles of the reproductive system. Ejaculation then occurs in two stages.
Emission In the fi rst stage, emission, contractions of the walls of the tail portion of the epididymis send sperm into the vasa deferentia (plural for vas deferens). Rhythmic contractions also occur in the vasa deferentia, ampullae, seminal vesicles, and ejaculatory ducts, which spill their contents into the urethra. Th e bladder’s sphincter muscle closes to prevent urine from mixing with the semen and semen from entering the bladder, and another sphincter below the prostate also closes, trapping the semen in the expanded urethral bulb. At this point, the man feels a distinct sensation of ejaculatory inevita- bility, the point at which ejaculation must occur even if stimulation ceases. Th ese events are accompanied by increased heart rate and respiration, elevated blood pressure, and general muscular tension. About 25% of men experience a sex fl ush.
Expulsion In the second stage of ejaculation, expulsion, there are rapid, rhythmic contractions of the urethra, the prostate, and the muscles at the base of the penis. Th e fi rst few contractions are the most forceful, causing semen to spurt from the urethral opening. Gradually, the intensity of the contractions decreases and the interval between them lengthens. Breathing rate and heart
Bring me to my bow of burning gold. Bring me my arrow of desire.
—William Blake (1757–1827)

An erection at will is the moral equivalent of a valid credit card.
—Alex Comfort, MD (1920–2000)

When the prick stands up, the brain goes to sleep.
—Yiddish proverb “
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Male Sexual Response • 121
(1) Excitement
(3) Orgasm
(2) Late Excitement or Plateau
Prostate enlarges
Color of penile glans deepens
Cowper’s gland secretion
Testes increase in size and are fully elevated
Scrotum thickens and tenses
Cowper’s gland activates
Internal sphincter of bladder contracts
Vas deferens contracts
Seminal vesicles contract
Prostate gland contracts
Rectal sphincter contracts
Penile contractions
Sperm and semen expelled by rhythmic contractions of urethra
Vasocongestion of penis results in erection
Partial erection
Unstimulated state
Testes elevate toward perineum
Skin of scrotum tenses, thickens, and elevates
(4) Resolution
Erection subsides
Unstimulated state
Testes descend
Scrotum thins, folds return
Loss of testicular congestion
rate may reach their peak at expulsion. When the sensations of orgasm were compared among college-age women and men, the only signifi cant gender dif- ference involved the “shooting” sensations reported by men. Th is variation most likely refl ects ejaculation (Mah & Binik, 2002). Some men experience retrograde ejaculation, the “backward” expulsion of semen into the bladder rather than out of the urethral opening. Th is unusual malfunctioning of the urethral sphincters may be temporary (e.g., induced by tranquilizers), but if it persists, the man should seek medical counsel to determine if there is an underlying problem. Retrograde ejacula- tion is not normally harmful; the semen is simply collected in the bladder and eliminated during urination.
• FIGURE 4.9 Masters and Johnson Stages in Male Sexual Response
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122 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Orgasm Th e intensely pleasurable physical sensations and general release of tension that typically accompany ejaculation constitute the experience of orgasm. Orgasm is a series of muscular contractions of the pelvis that occurs at the height of sexual arousal. Orgasm does not always occur with ejaculation, however. It is possible to ejaculate without having an orgasm and to experience orgasm without ejaculating. Additionally, ejaculation and orgasm don’t necessarily require an erection. Some men have reported having more than one orgasm without ejaculation (“dry orgasm”) prior to a fi nal, ejaculatory, orgasm. Follow- ing ejaculation, men experience a refractory period, during which they are not capable of having an ejaculation again. Th is is the time in which nerves cannot respond to additional stimulation. Refractory periods vary greatly in length, ranging from a few minutes to many hours (or even days, in some older men). Other changes occur immediately following ejaculation. Th e erection diminishes as blood fl ow returns to normal, the sex fl ush (if there was one) disappears, and fairly heavy perspiration may occur. Men who experience intense sexual arousal without ejaculation may feel some heaviness or discomfort in the testicles; this is generally not as painful as the common term “blue balls” implies. If discom- fort persists, however, it may be relieved by a period of rest or by ejaculation. When the seminal vesicles are full, feedback mechanisms diminish the quantity of sperm produced. Excess sperm die and are absorbed by the body. For some men, the benefi ts of strengthening the muscles that surround the penis by doing what are called Kegel exercises can produce more intense orgasms and ejacula- tions. (For a description of Kegel exercises, see Chapter 14.)
When the appetite arises in the liver, the heart generates a spirit which descends
through the arteries, fi lls the hollow of the penis and makes it hard and stiff . The delightful movements of intercourse give warmth to all the members, and hence to the humor which is in the brain; this liquid is drawn through the veins which lead from behind the ears to the testicles and from them it is squirted by the penis into the vulva.
—Constantinus Africanus (c. 1070)

practically speaking
The erection refl ex can be triggered by various sexual and nonsexual stimuli, including tactile stimulation (touching) of the penis or other erogenous areas; sights, smells, or sounds (usually words or sexual vocalizations); and emo- tions or thoughts. Even negative emotions such as fear can produce an erection. Conversely, emotions and thoughts can also inhibit erections, as can unpleasant or painful physical sen- sations. The erectile response is controlled by the parasympa- thetic nervous system, a component of the involuntary or “autonomic” nervous system, and therefore cannot be con- sciously willed. What can be regulated in some men is their sexual arousal (Winters, Christoff , & Gorzalka, 2009). This knowl- edge can provide some men with a sense of comfort and re- duce their vulnerability in precarious situations. The length of time an erection lasts varies greatly from indi- vidual to individual and from situation to situation. With experi- ence, most men are able to gauge the amount of stimulation that will either maintain the erection without causing orgasm or cause orgasm to occur too soon. Not attaining an erection when one is desired is something most men experience at one
time or another. (Erectile diffi culties are discussed further in Chapter 14.) There are, however, some things you can do to maximize your chances of producing viable erections. Because you need a steady fl ow of blood to your penis, you should get enough aerobic exercise and refrain from smoking to maintain your circulation. A diet low in fat and cholesterol and high in fi ber and complex carbohydrates may also prevent hardening of the arteries, which restricts blood fl ow. Also, learning to relax during sexual activity with a partner can help with erections. Some conditions, including diabetes, stress, depression, and abnormalities in blood pressure, and some medications that treat these conditions may have an adverse eff ect on blood fl ow and erectile capacity. If any of these conditions are present, or if the failure to attain an erection is persistent, see your physician. What can you do about unwanted erections at inappropri- ate times? Distract yourself or stop your thoughts or images. Remember, the brain is the most erotic (and unerotic) organ of the body.
Can an Erection Be Willed?
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Summary • 123
In this chapter and the previous one, we have looked primarily at the physical char- acteristics that designate us as female or male. But, as we discover in the following chapter, there’s more to gender than mere chromosomes or reproductive organs. How we feel about our physical selves (our male or female anatomy) and how we act (our gender roles) also determine our identities as men or women.
Final Thoughts
Summary Male Sex Organs: What Are They For?
■ In their reproductive role, a man’s sex organs produce and store gametes and can deliver them to a woman’s reproductive tract. Th e penis is the organ through which both sperm and urine pass. Th e shaft of the penis contains two corpora cavernosa and a corpus spongiosum, which fi ll with blood during arousal, causing an erection. Th e head is called the glans penis; in uncircumcised men, it is covered by the foreskin. Myths about the penis equate its size with masculinity and sexual prowess. Th e scrotum is a pouch of skin that hangs at the root of the penis. It holds the testes.
■ Th e paired testes, or testicles, have two major func- tions: sperm production and hormone production. Within each testicle are about 1,000 seminiferous tubules, where the production of sperm takes place. Th e seminiferous tubules merge to form the epididy- mis, a coiled tube where the sperm fi nally mature, and each epididymis merges into a vas deferens, which joins the ejaculatory duct within the prostate gland. Th e semi- nal vesicles and prostate gland produce semen, or semi- nal fl uid, which nourishes and transports the sperm. Two tiny glands called Cowper’s or bulbourethral glands secrete a thick, clear mucus prior to ejaculation, whereby semen is forcefully expelled from the penis.
■ Male anatomical structures that do not serve a reproductive function but that may be involved in or aff ected by sexual activities include the breasts, urethra, buttocks, rectum, and anus.
Male Sexual Physiology
■ Th e reproductive processes of the male body include the manufacture of hormones and the production and delivery of sperm, the male gametes. Although men do
not have a monthly reproductive cycle comparable to that of women, they do experience regular fl uctuations of hormone levels; there is also some evidence that men’s moods follow a cyclical pattern. Th e most im- portant male hormone is testosterone, which triggers sperm production and regulates the sex drive. Other important hormones in male reproductive physiology are GnRH, FSH, LH, inhibin, and oxytocin.
■ Sperm carry either an X chromosome, which will produce a female zygote, or a Y chromosome, which will produce a male.
■ Semen is the ejaculated liquid that contains sperm. Th e function of semen is to nourish sperm and pro- vide them with a hospitable environment and means of transport if they are deposited within the vagina. It is mainly made up of secretions from the seminal vesicles and prostate gland. Th e semen from a single ejaculation generally contains between 100 million and 600 million sperm, yet only about 1,000 make it to the fallopian tubes.
Male Sexual Response
■ Male sexual response, like that of females, involves the processes of vasocongestion and myotonia. Erection of the penis occurs when sexual or tactile stimuli cause its chambers to become engorged with blood. Continuing stimulation leads to ejaculation, which occurs in two stages. In the fi rst stage, emission, semen mixes with sperm in the urethral bulb. In the second stage, expul- sion, semen is forcibly expelled from the penis. Ejacula- tion and orgasm, a series of contractions of the pelvic muscles occurring at the height of sexual arousal, typi- cally happen simultaneously. However, they can also occur separately. Following orgasm is a refractory period, during which ejaculation is not possible.
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124 • Chapter 4 Male Sexual Anatomy, Physiology, and Response
Questions for Discussion ■ Make a list of anything you have heard about
men’s sexuality. Identify the myths and compare them with information from the text.
■ If you had a son, would you get him circumcised? Why or why not? Do you think that the decision to circumcise a boy should be postponed until the child is old enough to decide for himself?
■ Do you believe that men have cycles, similar to women’s menstrual cycles? If so, what might contribute to this phenomena? If not, why not?
Male Health Center Provides information on a wide variety of issues related to male genital health, birth control, and sexual functioning, from the male perspective.
Men’s Health Resource Guide A resource guide from Men’s Health magazine that off ers links to many topics in men’s health and to discussions of relationship and family issues.
National Organization of Circumcision Information Resource Centers Contains information and resources about male and female circumcision.
WebMD Focuses on popular men’s health topics.
Suggested Reading Friedman, D. (2003). A mind of its own: A cultural history of the
penis. New York: Free Press.
Hoberman, J. (2005). Testosterone dreams: Rejuvenation, aphrodisia, doping. Berkeley: University of California Press. Investigates the history of synthetic testosterone and other male hormone therapies and their implications and dangers.
McCarthy, B., & Metz, M. E. (2008). Men’s sexual health: Fitness for satisfying sex. New York: Routledge. Aimed to help men and women overcome sexual problems with the goal of greater acceptance and satisfaction.
McLaren, A. (2007). Impotence: A cultural history. Chicago: University of Chicago Press. By investigating the history of impotence, the author reveals the enormous pains a culture and society take in goading men in the painful pursuit of what is normal and natural.
Peate, I. (2005). Men’s sexual health. New York: Wiley. For nurses and others who need to consider the often complex sexual health-care needs of men.
Zilbergeld, B. (1999). Th e new male sexuality (Rev. ed.). New York: Bantam Books. An explanation of both male and female anatomy and sexual response, plus communication, sexual problem solving, and much more; authoritative, interesting, and readable; written for men (but recommended for women as well).
Sex and the Internet Men’s Sexuality Try to locate Internet sites about men’s sexuality. You’ll fi nd that, apart from those relating to erectile dysfunction, AIDS, and sexually explicit materials, few sites address this topic. What does this say about men? About the topic of men and sexuality? Because of this absence of content- specifi c sites, it is necessary to search a broader topic: men’s health. Go to the Men’s Health Network (http:// and, in the Library section, scroll down to one of the health links. If you don’t fi nd a topic there that interests you, go to “Links” and search for a relevant subject. When you fi nd a topic that interests you, see if you can fi nd the following:
■ Background information about the topic ■ The incidence or prevalence of the issue/problem ■ Whom it impacts or aff ects ■ The causes and potential solutions ■ A related link that might broaden your understand-
ing of this topic
Last, what recommendation might you make to someone who identifi ed with this issue?
Suggested Websites American Urological Association Provides a variety of information on adult sexual functioning and infertility.
For links, articles, and study material, go to the McGraw-Hill website, located at
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Studying Gender and Gender Roles 127
Gender-Role Learning 131
Contemporary Gender Roles and Scripts 137
Gender Variations 143
ch ap
te r
Gender and Gender Roles
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126 • Chapter 5 Gender and Gender Roles
How can we tell the diff erence between a man and a woman? Everyone knows that women and men, at a basic level, are distinguished by their genitals. However, as accurate as this answer may be academically, it is not particularly useful in social situations. In most social situations—except in nud- ist colonies or while sunbathing au naturel—our genitals are not visible to the casual observer. We do not expose ourselves (or ask another person to do so) for gender verifi cation. We are more likely to rely on secondary sex characteris- tics, such as breasts and body hair, or on bone structure, musculature, and height. But even these characteristics are not always reliable, given the great variety of shapes and sizes we come in as human beings. And from farther away than a few yards, we cannot always distinguish these characteristics. Instead of relying entirely on physical characteristics to identify individuals as male and female, we often look for other clues. Culture provides us with an important clue for recognizing whether a person is female or male in most situations: dress. In almost all cultures, male and female clothing diff ers to varying degrees so that we can easily identify a per- son’s gender. Some cultures, such as our own, may accentuate secondary sex characteristics, especially for females. Traditional feminine clothing, for exam- ple, emphasizes a woman’s gender: dress or skirt, a form-fi tting or low-cut top revealing cleavage, high heels, and so on. Most clothing, in fact, that emphasizes or exaggerates secondary sex characteristics is female. Makeup (lipstick, mas- cara, eyeliner) and hairstyles also serve to mark or exaggerate the diff erences between females and males. Even smells (perfume for women, cologne for men) and colors (blue for boys, pink for girls) help distinguish females and males. Clothing and other aspects of appearance further exaggerate the physical diff erences between women and men. And culture encourages us to accentuate
There is no essential sexuality. Maleness and femaleness are something we are
dressed in.
—Naomi Wallace (1960–)

“As early as pre- school I learned the diff erence between boy and girl toys, games, and colors. The boys played with trucks while the girls played with dolls. If a boy were to play with a doll,
he would be laughed at and even teased. In the make-believe area, once again, you have limitations of your dreams. Girls could not be police, truck drivers, fi refi ghters, or construction workers. We had to be people that were cute, such as models, housewives, dancers, or nurses. We would sometimes model ourselves after our parents or family members.”
—23-year-old female
“I grew up with the question of ‘why?’ dangling from the tip of my tongue. Why am I supposed to marry a certain person? Why do I have to learn how to cook meat for my husband when I am a vegetarian? Why can’t I go out on dates or to school formals? The answer was the same every time:
‘Because you’re a girl.’ Being that she is such a strong woman, I know it tore a bit of my grandmother’s heart every time she had to say it.”
—19-year-old female
“My stepfather and I did not get along. I viewed him as an out- sider, and I did not want a replacement father. Looking back, I feel like I overcompensated for the lack of a male fi gure in my life. I enlisted in the Navy at 18, have a huge fi rearm collection, and play ice hockey on the weekends. All of these activities seem to be macho, even to me. I guess it’s to prove that even though a woman raised me I’m still a man’s man.”
—27-year-old male
“I was in fi fth grade, and my parents put me on restriction. My mom inquired where I got the [Playboy] magazine. I told her we found it on the way home from school. She wanted to know where. I lied and said it was just sitting in somebody’s trashcan and I happened to see it. She wanted to know where. I said I forgot. My sexual identity was being founded on con- cealment, repression, and lies. Within my family, my sexual identity was repressed.”
—27-year-old male
Student Voices
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Studying Gender and Gender Roles • 127
(or invent) psychological, emotional, mental, and behavioral diff erences. But what happens when these lines are blurred, especially in young children who defy gender norms? Should parents and their doctors be permitted to block puberty medically in order to buy time and fi gure out who these children are? While a biological understanding of gender identity remains somewhat of a mystery, medical, ethical, and parental maps are being created to respond to the growing number of individuals who see gender variance as a normal phenomenon rather than a disorder. In this chapter, we examine some of the critical ways being male or female aff ects us both as human beings and as sexual beings. We look at the connec- tion between our genitals, our identity as female, male, or intersex, and our feelings of being feminine, masculine, or other. We also examine the relation- ship between femininity, masculinity, and sexual orientation. Th en we discuss how masculine and feminine traits result from both biological and social infl u- ences. Next, we focus on theories of socialization and how we learn to act masculine and feminine in our culture. Th en we look at traditional, contem- porary, and androgynous gender roles. Finally, we examine gender variations: disorders of sexual diff erentiation/intersex, gender identity disorder, and transsexuality—phenomena that involve complex issues pertaining to gender, gender variance, and gender identity.
• Studying Gender and Gender Roles Let’s start by defi ning some key terms, to establish a common terminology. Keeping these defi nitions in mind will make the discussion clearer.
Sex, Gender, and Gender Roles: What’s the Diff erence?
Th e word sex refers to whether one is biologically female or male, based on genetic and anatomical sex. Genetic sex refers to one’s chromosomal and hor- monal sex characteristics, such as whether one’s chromosomes are XY or XX or something else and whether estrogen or testosterone dominates the hormonal system. Anatomical sex refers to physical sex: gonads, uterus, vulva, vagina, penis, and so on. Although “sex” and “gender” are often used interchangeably, gender is not the same as biological sex. As noted in Chapters 1 and 3, gender relates to femininity or masculinity, the social and cultural characteristics associated with biological sex. Whereas sex is rooted in biology, gender is rooted in culture. Assigned gender is the gender given by others, usually at birth. When a baby is born, someone looks at the genitals and exclaims, “It’s a boy!” or “It’s a girl!” With that single utterance, the baby is transformed from an “it” into a “male” or a “female.” Gender identity is a person’s internal sense of being male or female. Gender roles are the attitudes, behaviors, rights, and responsibilities that particular cultural groups associate with each sex. Age, race, and a variety of other factors further defi ne and infl uence these. Th e term “gender role” is gradually replacing the traditional term “sex role” because “sex role” continues to suggest a connection between biological sex and behavior. Biological males are expected to act out masculine gender roles; biological females are expected to act out feminine gender roles. A gender-role stereotype is a rigidly held, oversimplifi ed, and overgeneralized belief about how each gender should behave.
Whatever women do they must do twice as well as men to be thought half
as good. Luckily, this is not diffi cult.
—Charlotte Whitton (1896–1975)

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