Lecture 1

definition of sex: creates arousal and increases chances of orgasm

Reasons?

1. physical
2. Goal attainment
3. Emotional subfactors
4. 3 insecurity subfactors

Janet shibley

Freud, psychoanalytic theory

It -

Superego – ideals, drives,

Ego – outcome between it and s upergero

Freud thought about sex through drive theory. Old fashioned to see sex through drive theory. It may not
be a basic need for someone. Can't compare to eating or drinking water.

From freud’s perseverance, u can compare sex to eating it is connected to dopamine. Opportunity,
Exchange, love, total experience, depression/emotional coping. Lots of motives to sex.

Libido – incentive motivation.

Learning theory:

Conditioning

1. Classical conditioning – operan

2. 2a positive reinforcement
3. 2b negative reinforcement

Social exchange thoery

Rewards and costs

- eg sex for love

- Love for sex

- Sex for “money’

Social exchange theory, rusbult

Equity, matching hypothesis

Equality norm

Satisfaction – alternatives + investments (children, house, emotions) = commitments in relationship

Equality through social exchange perspective – high rewards low costs (not always the motive with sex)
you want to establish his equality with partner. U don’t always go for high rewards. You go for equality.
For balance.

Two information processing routes + feedback loop

Automatic and controlled processing

Stimulus based:

Fast, automatic, causation of behavior can occur outside conscious time

Goal based:

(holstege)

Stimulus > sexual arousal module +/- regulation module > action

Evolution theories

Reproduction

Sexual selection:

- Competition between members of one gender (usually male)

- Preferential choice by

Parental investment

Mating strategies

Critical theories

- Feminist theory

The right to sex

Lecture 2

Sexual pleasure

Is it about orgasm? Identity? Physiology?

Can we put sexual pleasure as a human right? Sexual rights are often framed to prevent harmful
consequences. No one talks about eroticism or pleasure.

Sexual pleasure is a principle more than a right.

Triangle approach to sexual pleasure:

 - Sexual pleasure well being as a missing elemnt of public health agenda
- Recognition that sexual pleasure is part of sexual health and wellbeing
- Ethical and sexual justice perspectives

Sexual pleasure definition

First sexual experience is crucial to sexual well-being.

Emotional aspects – are u afraid of expressing yourself or the exchange?

Self esteem is an important element to enjoyment

Direct link between being happy about your sexuality and general health.

See it in context of rights – explore and see pleasure in their own right. Sexual pleasure is different for
everyone, it is diverse, we should have a positive approach to sexuality but understand that there are
dareker side.

Cultural factors that may influence views on sexuality and sexual pleasure

Sexual culture – political factors, religoion, economic factors, societal norms, social and other media,
legislative factors, educational plicies, social history, political factors.

Masturbation and sexual pleasure

The more couples masturbate more sex partners have sex.

Sexual pleasure is not a luxry.

Physical arousal does not equal to sexual pleasure.

Lecture 3

Lecture 4

- Sexual health and healthy sexual development

o Important preconditions for healthy sexual development
▪ Experience with love and affection (skin contact) and absence of (sexual)
violence and abuse
▪ Positive examples of an intimate and caring relationship
▪ Positive messages about sexuality
▪ Possibility and opportunities for discovering own body and the bodies of peers
in a playful way
▪ Intact anatomy and functioning of genitals
▪ Empathetic ability to adjust your behavior to the wishes and limits of another
 - Healthy sexual development is healthy social development
- Sexuality versus sex and what this means for the sexual development
o Sex is mostly focusing on very specific behavior and sexuality has to do with more
aspects and all these aspects are:
▪ Emotions
▪ Diverse relationships
▪ Physical aspects (anatomy, genitals)
▪ Gender, gender diversity, gender identity
▪ Behavior and consequences of behavior ( reproduction, STIs..)
o Sex --> sexuality
▪ Adults
• Physical attraction between 2 or more people
• Physical behavior (individual or between 2 or more people)
• Physical arousal: blood circulation, erection of the penis, lubrication of
the vulva
• Awareness of sexual adults
▪ Children
• Curiosity to see body and genital of others
• Discovery of special feelings when watching and touching own and
other’s body and genitals
• Development of gender identity
• Development of
o Sexual development (sexual behavior)
▪ Genital stimulation
• 0-1 old (touching their own genitals
• 1-2 years old (auto erotic behavior, genital stimulation, ‘masturbation’)
▪ ‘masturbation’
• Has another functional/goal than adult’s masturbation
• Children have different ways
• Between 2-6 yearls old very frequently (NL)
• From 4-5 years old, less in public due to learning social rules (NL)
• Several research data show that children are able to orgasm
o Gender identity
▪ Children know what people around them are telling them – calling them a boy
or a girl, they should do this or that, wear this or that, that is how they develop
their gender identity. Based on very traditional notions that society puts on
them. When they are told they are boy or a girl then children are going to copy
and adapt the outlook and behavior that is related to that specific gender. A
period in their life where they will show very stereotypical behavior.
▪ Sexual play
• Part in their development that belongs to the part where they discover
how their bodies and others bodies work
• Watching and touching, playing doctor, father/mother, getting a baby,
kissing games, copying sexual behavior with dolls
 •
Also, imitation sexual intercourse, licking gmes, is less frequent but
doesn’t have to be harmful
• Until 6 yo in public, after that secretly
o Issues to consider with children playing sexual games
▪ Age of the child
▪ Difference in ages of the children (>3 yr diff = not ok)
▪ Difference in body height
▪ Mutual (in) consent, is the child capable of saying no
▪ Frequency of the behavior
▪ In combination
- Adolescence
o

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Sexual dysfunctions in women

Etiology

Incentive motivation model, toates (2010) - you always need stimulus to activate sexual motivation. You
also need physical state. When stimulus interacts with physical state sexual activity is stimulated. It also
is connected to memory. It will influence the meaning of stimuli and meaning. For exmple a specfic smell
can have a really erotic meaning for someone. It can be a strong erotic que. For another person, this
smell can be asociaed to a negative experience. Stimuli can earn meaning by learning experiences. All of
this will result in a genital response, sexual activity. This response is of course very regulated. Context is
very important, in specific context it is not “normal” or expected to behave sexually.

Different from old psycoanalytic model (freud)

Sex is an emotion – when you process a sexual stimulus there will be automatic response that will
prepare you for sexual activity. When you become aware of these feelings it will result in behaviour

It starts in subconscious level.

Stimulus -> (automatic) physiological response -> awareness (feeling) or behavior (fight, flight, freeze,
approach)

The sensitivity is important in this model.

And this sensitivity is influenced by hormones. For men and wome. When there is low testestorone
women can develop problems of sexual excitement. Low estrogen can also sexual drive – it influences
the lubrication during sex

Somatic diseases can have an impact on sexual arousability – multiple sclerosis, spinal cord injury,
endocrine disorder: hypothyroidism, hyperprolactine

Medication – anti-depressives, anti-psychotics (dopamine antagonists), andti-androgens (diane pill,

other contraceptives)
Arousability of healthy women with sexual interest/arousal disorder

- Laboratory study in medically healthy women (n=30) with sexual interest/arousal disorder
(n=29)
- Genital and subjective arousal response to erotic film

Genital response: vaginal photophlethysmografy – light sensor picks up on the blood flow in vaginal
walls. You can assess with this device changes win the vaginal blood flow.

Genital responses in vaginal blood flow in the group there was no difference between women with
sexual interest problems and women without it. However there was a difference between subjective
response. Women with this problem don’t have problem with sexual arousability rather a problem with
positive experience/memory with sexual stimuli.

Heterosexual women experience less often orgasm than men

Treatment?

1. Sensitivity of the sexual system (arousability)?

a. Hormones, illness, medication?
b. Intervention: medication change, hormone substitution
c. Lust pill? (flibanserin (only in USA) shows weak clinical effect, voor review,
2. Sexual stimuli (meaning)?
a. Negative meaning? (trauma, negative upbringing, pain)
b. Trauma therapy
c. Stimulate new positive sexual experiences with attention for thoughts that can inhibit
arousal and desire (cognitive behavior therapy)
d. Psychoeducation about female sexuality, increase assertiveness (come as you are)
3. Relatioal context
a. Relationship satisfaction, communication
b. Intervention: couple therapy: discuss feelings, promote positive intimate experince,
improve communication

Sexual pain disorders

Dyspareunia – recurrent or persistent pain associated with sexual intercourse

- Pain vagina opening during and after penetration

- Penetration of penis, tampon, fingers
- Pain during cycling and wearing tigh clothing
- Provoked vestibulodynia (PVD)

Vaginismu – strong fear of penetration

Readings

Chapter 11

Attraction, love and communication

Mere exposure effect – the tendency to like a person more if we have been exposed to him or her
repeatedly

Homophily – tendency to have contact with people who are equal in social status (greatest homophily is
by race, followed by education and age)

We are attracted to people who are approximately the same as we are in age, race or ethnicity, social
and economic status

Research shows that spouses share more genetic similarities than people randomly paired from same
population

Why are we attracted to a person who is similar to us in attitude? - we get positive reinforcement from
that person agreeing with us – the other person's agreement bolsters our sense of rightness, and we
anticipate positive interaction with them

Similarity in attitudes is important but similarity in personality is not – research shows that real couples
are significantly more similar on values, religiosity and political attitudes but no more similar than
random couples on personality

Similarity on attachement styles was associated with indicators of marital satisfaction but similarity in
attitudes was not

Physical attractiveness

Physical attractiveness in more important to males evaluating females than it is to females evaluating
males

Our perception of attractiveness or beauty of another person is influenced by our evaluation of their
intelligence, liking and respect and by our own objective attractiveness

Whom we are attracted to and pair off with depends on how much we think we have to offer and how
much we think we can "buy" with it

Matching phenomena – tendency for men and women to choose as partners people whose social worth
matches their own

- Principle seems to be that a woman's worth is based on their physical beauty, men's is based on
their success
- Tencendy for beautiful women to be paired with wealthy, successful men
- For both, the person's physical attractiveness is highly correlated with their education, income
and measure of social status
- People select mates who match them on these characteristics and that matching on any one of
them will lead to a match on others

Why is there a correlation between person's attractiveness and their educational achievement or
socio-economic status?

- Attractiveness in high school is associated with greater social integration and favorable
treatment by teachers and classmates – this in turn predicts education, work, and mental health
outcomes in adulthood
The importance of similarity and matching principles apply in everyday life as well as in the laboratory

Perceived similarity – the extent to which individual believes his or her partner is similar on important
characteristics

Online dating

- In online dating there's a lack of scripts and this reflects the newness of the phenomenon but
also reflects the difficulty of devising scripts for diverse types of users with diverse types of
motives

Explaining our preferences

- Men and woman prefer physically attractive people

o Reinforcement theory
▪ We tend to like people who give us rewards and dislike ones who give us
punishments
▪ Our attraction to another person in proportionate to the number of
reinforcements that person gives us
▪ We prefer people who are similar because interaction with them is rewarding.
People similar to our age, race, education etc. are likely to have similar outlooks
on life and prefer same activities – these shared values and beliefs provide the
basis for smooth and rewarding interaction
▪ We prefer pretty or handsome partners because we are aware of the high value
placed on physical attractiveness in society and we believe others will have
higher opinions of us if we have a good-looking partner
▪ We prefer someone with high social status or earning experience because all
the material things that people find rewarding cost money
▪ We are attracted to a person who is similar because they activate our positive
views of ourselves
o Sociobiology: sexual strategies theory
▪ Sexual behavior is viewed within an evolutionary perspective – the functioning
of mating historically is reproduction
▪ Men need to identify reproductively valuable women – younger women are
more likely to be fertile than older women leading to a preference for youth
▪ Men want to be certain about the paternity of their offspring and for this reason
want a woman who will be sexually faithful – woman who is hard to get and is
not promiscuous
▪ Physically attractive people are more likely to be healthy and fertile than
someone who isn't – explains preference for good looking people
▪ Physical attractiveness is considered more important by residents in societies
that had greater prevalence in pathogens
▪ More attractive person is ranked as healthier
▪ Women rate income and earning potential as more important than good looks
- Reproduction is a major goal for most adults in every society. Successful reproduction is very
reinforcing
Intimacy

1. Openness, honesty, mutual self-disclosure, caring, warmth, protecting, surrendering control, etc
a. This definition focuses on intimacy as a characteristic of a person
b. Certain people have more of a capacity for intimacy or engage in more intimacy-
promoting behaviors than others
2. Emotional intimacy is defined in behavioral terms as mutual self-disclosure and other kinds of
verbal sharing – declarations of liking, loving and as demonstrations of affection
a. Characteristic of a relationship
3. Definition of intimacy in romantic relationships is the level of commitment and positive
affective, cognitive and physical closeness one experiences with a reciprocal partner

Self-disclosure – involves telling your partner some personal things about yourself, leads to reciprocity –
self-disclosure by one member of the couple can essentially get the ball rolling

- Self disclosure by our partner can make us like and trust that person more
- Simple modeling and imitation may occur
- Balance – after one partner has opened up the other may follow suit in order to maintain a
sense of balance or equity in the relationship
- Positive correlation between self-disclosure and their satisfaction with the relationship
- Sexual self-disclosure leads to a better understanding by your partner of your likes and dislikes –
leads to a sexual scrip that is more rewarding
- Promotes intimacy
- Self-disclosure of emotion rather than facts is more closely correlated to intimacy
- Risk that partner may evaluate you negatively for disclosing some info or past behavior

Theories of love

Three components of love

Triangular theory of love

1. Intimacy – emotional component, feelings of closeness or bondedness

2. Passion – motivational component, physical attraction, sex drive – passion is faster to arouse but
fades the most quickly. Often intertwined with intimacy but sometimes separate (casual sex)
3. Decision or commitment – cognitive component – short-term aspect is the decision that one
loves the other, long-term – commitment to maintain the relationship

All these components must be translated into action

commitment scores increase as time of the relationship increases

Intimacy to decrease over time as familiarity with partner increases

Intimacy is closely related to sexual behavior and sexual satisfaction

Attachment theory of love

The person's perception of the quality of the relationship with each parent is key and predicts the
attachement style
Secure:
Intimacy, trust, satisfaction
Self confidence, exploration, open communication, better coping, help seeking, no fear of
abandonment

Anxious:
Obsessive love, clingy, extreme proximity, fear of abandonment, separation anxiety
Fuse sex and love, use sex to bind, performance demand, sex barometer of relationship.

Avoidant:
Independence and interpersonal distance, autonomy, problems with intimacy, commitment
anxiety
Seperate sex and love, performance demand, inhibit sexual needs casual sex. Sex is ultimate
intimacy.

Anxious people fight

Avoidant flight
They both fear to lose the connection.
Attachment theory suggests that important for of similarity is similarity in attachment style
Adults bring to any romantic relationship their own personal history of love and attachment
Attachment theory helps us understand that conflict in some relationships may be caused by
mismatch of attachment styles
Anxious attachment style was related to lower sexual function and sexual satisfaction, anxious
style is associated with anxiety about sexual performance which interferes with functioning
Attachment style affects relationships by affecting the way partners interact – individuals with
secure attachment reported responding constructively to potentially destructive behavior of their
partners with efforts to discuss and examine the problem

⁃ relationship does not fail because of many conflicts but because there are too little emotional
and intimate interactions
⁃ First secure the safe base (EFT)
Love as a story
Love story – a story about what love should be like – has:
- Characters
o 2 central characters who play a role that complements each other
- Plot
o Details the kind of events that occur in a relationship
- Theme
o Central, provides the meaning of the events that make up the plot and gives
direction to the behavior of the principals
more to love than interaction – what matters if how each partner interprets the interaction
Falling in love occurs when you meet someone with whom you can create a relationship that fits
your love story – we are satisfied with relationships in which we and our partner match the
characters in our story
Our stories have origins in culture, folk tales, literature, theater films etc – cultural context
interacts with our own personal experiences and characteristics – each person has more than
one story and the stories often form a hierarchy
Love stories derive their power from the fact that they are self-fulfilling – we create events in our
relationships according to the plot and then interpret those events according to the theme
Our love relationships are literally social constructions.
Our love stories are self confirming, they can be difficult to change
Passionate and companionate love
Passionate – a state of intense longing for union with the other person and of intense
physiological arousal – has 3 components:
1. Cognitive – preoccupation with the loved one, idealization of the person,
2. Emotional – psychological arousal, sexual attraction, desire for union
3. Behavioral – taking care of the other and maintaining physical closeness
Involves release of dopamine – increased energy, focused attention, reduced need for food and
sleep – presence of loved one also involves production of prolactin and oxytocin
Prolactin rises after orgasm in human and relates to pair-bonding
Oxytocin – stimulated by touch and sexual activities contributes to long-term relationships,
pleasure satisfaction and interpersonal trust
Visual stimuli associated with lover stimulates subcortical activity in
- Ventral tegmental area
- Caudate nucleus
- Putamen
These areas are associated with motivation, reward and euphoria
Companionate – a feeling of deep attachment and commitment to a person with whom one has
an intimate relationship
Sexual desire and love may often be independent processes
Sexual desire – motivational state leading to a search for opportunities for sex – leads to
feelings of passion
Love vs sexual desire
Love is assiciated with reduced activity in the hypothalamus, amygdala and somatosensory
cortex compared to sexual desire
This difference suggests that love is a more abstract and complex phenomenon not
solely dependent on physical presence, while sexual desire is more goal-oriented and
focused on physical intimacy.

Jealousy
An unpleasant emotion that arises in response to a perceived threat to a valued
relationship. Jealousy involves cognitive appraisal, emotional reactions, and behavioral
responses, and can have both constructive and destructive consequences.
Evolutional perspective - theoretical approach that suggests gender differences in
jealousy based on adaptive problems related to reproductive success. It proposes that
men are more upset by sexual infidelity due to concerns about paternity uncertainty,
while women are more upset by emotional infidelity due to concerns about resource
availability.
Research on Love
The two-component theory of love
suggests that passionate love occurs when there is intense physiological arousal
combined with the label of "love" assigned to the experience.
- Psychological arousal – when increased heartrate and sweating can be attributed
to different emotions depending on the individual's interpretation or label
- Misattribution of arousal occurs when people mistakenly attribute their arousal to
feelings of love or attraction toward a specific person
Culture and Love
- Cross-cultural research explores how different cultures perceive love, attraction,
and the role of love in decisions regarding marriage.
- Individualistic cultures, like the United States, emphasize personal goals and
romantic love
- collectivist cultures prioritize group goals and family harmony.
- Cultural values and norms influence how love is understood and experienced.
- Mate selection criteria differ across cultures, but intelligence, kindness, and
understanding are generally highly valued.
- Men tend to prioritize reproductive cues, such as physical attractiveness, while
women often place importance on cues of resources and stability.
- Beauty standards may vary across cultures, but there are also commonalities in
preferences for physical attractiveness.

Communication and relationships

Editing – censoring or not saying things that would be deliberately hurtful to your partner
or is not relevant
Leveling – expressing thoughts and feelings clearly and honestly
The purposes of leveling are to make communication clear and clarify expectations
between partners.
Effective communication involves ensuring that the impact matches the intent of the
message.
Distressed couples may use their communication skills to send negative messages.

Chapter 12
Gender and Sexuality
- Gender is considered one of the most basic status characteristics and is highly
significant in our individual interactions and societal position.
- The first statement made about a newborn baby often reflects the gender binary,
categorizing them as "It's a boy" or "It's a girl."
- Uncertainty about someone's gender can cause consternation, leading to
confusion in interactions until their gender is identified.
- Gender roles are culturally defined expectations that dictate how individuals of a
particular gender should behave.
- Stereotypes are generalizations about groups of people, such as men and
women, that distinguish them from others.
- Heterosexuality plays a significant role in gender roles, with feminine women
expected to be sexually attractive to men and attracted to them.
- The concept of intersectionality emphasizes considering the simultaneous effects
of multiple categories of identity, difference, and disadvantage, such as gender,
race, social class, and sexual orientation.
- Different ethnic groups have variations in gender roles influenced by their
respective cultures.
- Intersectionality recognizes that some individuals experience multiple
disadvantages, while others may belong to both disadvantaged and privileged
groups.

African Americans:
- Cultural heritage influenced by African culture and experience of slavery and
racial oppression.
- Emphasis on collective over individual.
- Mother-child bonds and motherhood highly valued.
- Stereotyped images of Black women's sexuality include Jezebel and Mammy.
- Stereotypes of Black men include hypersexuality and being dangerous.
 - Discrimination and stereotypes create stress and affect employment and
relationships.
Latinos:
- Concept of acculturation: process of incorporating beliefs and customs of a new
culture.
- Mexican American culture combines Mexican heritage with Anglo components.
- High value placed on family loyalty and warm, supportive relationships.
- Traditional gender roles are sharply defined, with boys given more freedom and
girls expected to be passive and obedient.
- Concepts of machismo and marianismo influence gender roles and expectations.
- Young Latinas may feel pressure to choose between being a "good girl" and a
"flirt girl."
Asian Americans:
- Historical recruitment of Chinese, Japanese, Korean, and Filipino laborers.
- Cultural values include emphasis on achievement and education, as well as
family and group interdependence.
- Conflicts may arise between traditional gender roles of Asian culture and Anglo
culture's emphasis on independence and assertiveness.
- Asian American men have been stereotyped as asexual
- Stereotypes of Asian American women include being exotic sex toys.
- Compared to European Americans, Asian Americans tend to hold more conservative
sexual attitudes and experience more anxiety about sex.
- Acculturation plays a role in shaping the sexual attitudes of Asian American women,
with more acculturated individuals having attitudes closer to European American
women.
- Importance of family and obligation to family emphasized.
- Higher level of education among Asian American women compared to white
American women.
Native Americans:

- Some Native American tribes had relatively egalitarian gender roles compared to
white culture, but male dominance increased with acculturation.
- Many Native languages have terms for a third gender beyond male and female,
referred to as "two-spirit."
- The concept of "berdache" used by Anglo anthropologists to label these
individuals is rejected by Native peoples, who prefer the term "two-spirit."
- Native American cultures recognized the roles of "manly hearted women" and
"warrior women," allowing women to express masculine traits or participate in
male-stereotyped activities.
Generally:
- Gender roles differ among different ethnic groups in the United States.
 - Gender-role socialization occurs through various processes, including rewards
and punishments for gender-appropriate behavior, imitation of adult models, and
conveying norms of appropriate behavior.
- Parents, peers, and the media contribute to gender socialization.
- The media, including television and advertising, continue to show females and
males in stereotyped roles.
- Television and video games can influence children's gender stereotypes and
expectations.

Psychological Gender Differences

gender differences in aggressiveness and communication styles, as well as some
gender differences in sexuality
1. Aggressiveness: Males tend to be more aggressive than females across various
indicators of aggression, such as physical aggression, verbal aggression, and
fantasy aggression. This difference is observed from childhood and continues
into adulthood. It is important to note that not all males or females exhibit the
same level of aggressiveness, as there is variability within each gender.
Implication: The higher level of aggressiveness in males may contribute to gender
differences in conflict resolution and assertiveness in relationships.
2. Communication styles: Research suggests that men and women have different
styles of communication, both verbally and nonverbally. Females tend to engage
in more self-disclosure, both offline and online, compared to males. Women also
tend to be better at decoding nonverbal cues and discerning others' emotions.
Implication: These communication differences may affect how individuals express their
sexual needs and desires to their partners. Men's reluctance to disclose personal
information about themselves may hinder effective communication in sexual
relationships.
3. Masturbation: There is a gender difference in the incidence of masturbation, with
men being more likely to masturbate than women. Men also tend to start
masturbating at an earlier age compared to women.
Implication: This difference in masturbation habits may contribute to variations in sexual
experiences and self-exploration between men and women.
4. Attitudes about casual sex: Men are generally more approving of casual sex
compared to women. Women often view intercourse as acceptable or ethical only
within an emotionally committed relationship, while men may be more open to
casual sexual encounters.
Implication: These differing attitudes can lead to conflicts and misunderstandings
between partners regarding expectations and preferences regarding casual sex.
5. Use of pornography: Men are more likely to report using pornography compared
to women.
Implication: The gender difference in pornography use may influence sexual attitudes,
preferences, and expectations within intimate relationships.
It is important to note that while these gender differences exist, there are also many
similarities between males and females in various aspects of sexuality. Additionally,
gender patterns may vary across different cultures. It is crucial to consider both
similarities and differences to have a comprehensive understanding of gender and
sexuality.

6. Similar responses to erotic materials: Men and women show similar responses to
erotic materials, but women may sometimes be unaware of their own physical
arousal.
7. Low correlation between self-reports and physiological measures: Studies have
found a low correlation between women's self-reports of arousal and
physiological measures of arousal, suggesting that women may not always
accurately perceive their own physical arousal. However, when instructed to
focus on their genital signs of arousal, women showed high correlations between
self-reports and physiological measures.
8. Orgasm consistency: Men are more consistent than women at achieving orgasm
during sexual encounters and masturbation.
9. Sex drive: Men, on average, have a stronger sex drive than women. Men think
about sex more frequently, have more sexual fantasies, desire more sexual
partners, and have a greater frequency of intercourse compared to women.
However, it is important to note that these are average differences, and individual
preferences and desires can vary.
10. Possible explanations for differences: Various factors can contribute to the
observed gender differences in sexuality. Biological factors such as anatomy and
hormones may play a role, with men having more visible sexual organs and
higher levels of testosterone. Cultural factors, including societal expectations and
restrictions on women's sexuality, such as the sexual double standard, may also
contribute to differences. Gender roles and body image issues are additional
factors that can influence sexual functioning and desire.
11. Reporting biases: It is suggested that some gender differences observed in self-
report studies may be influenced by reporting biases. Men may overstate their
desire for sex due to societal expectations, while women may understate their
desire. Studies using physiological measures are less vulnerable to reporting
biases.
12. Implications: The discussed gender differences are likely real, but the extent of
the differences may not be as dramatic as sometimes suggested. It is essential
to consider both biological and cultural factors when explaining these differences.
13. Pregnancy: Women's fear of pregnancy, especially in the absence of effective
contraception, can affect their enjoyment of sex. Even today, pregnancy
concerns can dampen sexual desire and pleasure.
14. Ineffective techniques: The traditional technique of intercourse may provide more
stimulation for men than for women, as it may not provide sufficient clitoral
 stimulation. This could contribute to differences in orgasmic experiences between
men and women.
15. Masturbation experiences: Differences in childhood and adolescent experiences
with masturbation may impact adult sexual experiences. Boys often learn about
masturbation from other boys, developing a sense of control over their own
sexual pleasure. In contrast, girls often learn about sex from boys and may
develop a sense of dependency on male partners for sexual pleasure.
16. Cultural forces: Cultural factors such as the double standard and ineffective
techniques of stimulation can also contribute to gender differences in sexuality.
Societal expectations and norms may influence women's sexual experiences and
inhibit their exploration and pleasure.
17. Lifespan differences: The research on gender differences in sexuality has
predominantly focused on young adults, providing a narrow view of male and
female sexuality. However, sexuality changes across the lifespan. Men may
experience changes in sexual intensity, orgasm frequency, and the emotional
aspects of sex as they age. Women may have a later sexual awakening, with a
slower and inconsistent orgasmic response in their teens and twenties, but an
increased intensity and consistency in their thirties. Women may also initiate sex
more frequently as they age
.
- Much of the research on gender differences in sexuality has focused on college
students or young adults, providing a narrow view of male-female differences.
- Female sexuality and male sexuality change in nature and focus across the
lifespan.
- Men are often believed to reach their sexual peak at around age 19, while
women reach theirs at around age 35-40.
- Scientific evidence supports the idea that women have more consistent orgasms
at older ages compared to their younger years.
- Psychiatrist Helen Singer Kaplan proposed differences between male and female
sexuality across the lifespan.
- Kaplan suggested that teenage males have intense, genital-focused sexuality,
but as they approach age 30, their interest in sex becomes less urgent and more
emotionally driven.
- Women may experience sexual awakening later, and their sexual response
becomes quicker, more intense, and more consistent as they reach their mid-
thirties.
- Women initiate sex more frequently and have a higher incidence of extramarital
sex in their late thirties.
- Middle-aged women's satisfaction with sex is linked to the physical aspects of
sex, while for men, relationship factors are more important for satisfaction

18. Person-centered vs. body-centered sex: The text introduces the concepts of
person-centered and body-centered sex. Adolescent male sexuality is described
 as primarily body-centered, with a later development of appreciation for the
emotional aspects of sex. In contrast, adolescent female sexuality is described
as person-centered, with a later development of intense genital response.

Transgender
individuals have a gender identity that does not align with the gender assigned to them
at birth. Some may identify as a third gender or outside the gender binary. Others may
pursue medical interventions, such as hormone therapy or surgery, to align their
physical appearance with their gender identity. The term "trans" is a broad term that
includes transgender, transsexual, genderqueer, and other gender-variant people.
19. Gender Dysphoria: Gender dysphoria refers to psychological distress caused by
a mismatch between a person's gender identity and their assigned gender at
birth. It may manifest in a desire to be the other gender, discomfort with assigned
gender roles, and a preference for gender-atypical clothing and activities.
20. Experiences of Trans People: Transgender individuals often face discrimination,
prejudice, and violence. Transphobia and anti-trans prejudice contribute to high
rates of harassment, rejection, and discrimination in various areas of life, such as
public spaces, healthcare settings, and families. These negative experiences can
have a significant impact on their mental and physical well-being.
21. Pronouns: Pronouns play a crucial role in affirming a person's gender identity.
Trans individuals may prefer pronouns that match their gender identity. This
includes traditional pronouns like "he" or "she" as well as gender-neutral
pronouns such as "they" or alternative sets of gender-neutral pronouns like "ze."
22. Sexual Orientation and Transgender Identity: Gender identity is separate from
sexual orientation. When discussing sexual orientation in the context of
transgender individuals, the terms gynephilic (attraction to women) and
androphilic (attraction to men) are used to avoid confusion.
23. Trans Health: Transgender individuals have healthcare needs similar to
cisgender individuals. They may require services related to general health,
mental health, reproductive health, and other medical conditions. Access to
comprehensive healthcare, including transition-related treatments, is crucial for
their well-being.

The medical and surgical transition process for transgender individuals typically involves
a combination of hormone therapy and surgical interventions. It is important to note that
not all transgender individuals choose to undergo these treatments, as each person's
journey is unique and personal.

1. Hormone Therapy:
a. Pubertal Suppression: In early adolescence, individuals experiencing strong
gender dysphoria may opt for hormone therapy to suppress the onset of
puberty. This treatment provides them with time to explore their gender identity
 and make informed decisions. Pubertal suppression is reversible if the individual
decides not to pursue a transition.
b. Feminizing/Masculinizing Hormone Therapy: Older adolescents and adults who
have made a definite decision to transition may choose hormone therapy to
feminize or masculinize their bodies. This therapy leads to secondary sex
characteristics aligned with their gender identity. The effects differ based on the
assigned sex at birth (e.g., deepened voice and facial hair growth for Female-to-
Male individuals and breast growth and body fat redistribution for Male-to-
Female individuals).
2. Surgical Interventions:
a. Chest Surgery (Top Surgery): Female-to-Male (FTM) individuals may opt for the
removal of breasts, while Male-to-Female (MTF) individuals may choose breast
augmentation.
b. Genital Surgery for MTF Transsexuals: This surgery may include multiple
procedures such as penectomy (removal of the penis), orchiectomy (removal of
the testes), vaginoplasty (creation of a vagina), clitoroplasty (creation of a
clitoris), and vulvoplasty (surgery to create a female-appearing vulva).
It is important to highlight that the decision to undergo surgical interventions is irreversible and
typically reserved for mature adolescents (over the legal age of consent) or adults who have
lived as a member of their identified gender for at least 12 months. This requirement helps
ensure that the decision to transition is well-considered and desirable.

- Research indicates that transsexual individuals who undergo surgery generally

experience improved adjustment and satisfaction with their bodies.
- A study found that a high percentage of both Male-to-Female (MTF) and Female-
to-Male (FTM) individuals were satisfied with their genital surgeries.
- Psychotherapy can be beneficial for individuals with gender dysphoria, and not
all transgender individuals seek medical interventions.
- Some individuals may find that a social transition is sufficient for their needs and
may not feel the need for surgery.
- The exact causes of transsexualism and gender variance are not fully
understood.
- Prenatal development processes may be involved in gender variance, where
genitals and gender identity differentiate differently.
- Differences in brain structures, such as the bed nucleus of the stria terminalis
(BST), have been observed between MTF individuals and typical men.
- Brain regions in FTMs have been found to display intermediate characteristics
between cisgender males and cisgender females.
- Certain genes have been associated with transsexualism, with different genes
identified for MTFs and FTMs, although not all individuals carry these genetic
variations.
Chapter 13
Sexual Orientation: gay, straight or bi?

- Heteronormativity is the belief that heterosexuality is the norm, and all people are
assumed to be heterosexual.
- Stereotypes and negative attitudes exist towards gays and lesbians, leading to
discrimination and hate crimes.
- In a 2012 survey, 46% of adult Americans believed that sexual relations between
two adults of the same sex are always wrong.
- The gay liberation movement has slowly changed negative attitudes towards
homosexuality.
- Homophobia refers to a strong, irrational fear of homosexuals, while antigay
prejudice or sexual prejudice describes negative attitudes and reactions towards
homosexuals.
- Heterosexism is the belief that everyone is heterosexual, and homosexuality is
denigrated.
- Hate crimes, discrimination, and harassment against sexual minority individuals
are common, with significant psychological consequences.
- The media now includes more representations of sexual minorities, but the
portrayal can vary from positive to stereotypical.
- Attitudes towards homosexuality influenced by the media are complex, with some
positive and negative effects.
- Americans show a mixture of tolerance and support as well as bigotry towards
homosexuality.

Gays and Lesbians as a Minority Group

- ike other minority groups, gays and lesbians (LGB) face negative attitudes and
discrimination, including job discrimination and wage disparities.
- A study on workplace discrimination found that wearing a cap that identified the
person as gay led to shorter and more negative interactions with staff members.
- Stereotypes, such as the false belief that gay men are child molesters, contribute
to discrimination against LGB individuals.
- Some states and cities have passed laws prohibiting discrimination based on
sexual orientation.
- Unlike other minorities, LGB individuals can hide their sexual orientation, which
can have both advantages and disadvantages.
- Concealing one's sexual orientation can be psychologically stressful and
contribute to living a dishonest life.
- Combating prejudice against LGB individuals requires efforts at the individual,
interpersonal, organizational, and societal levels.
- Individuals need to examine their own attitudes and values, educate themselves,
and challenge antigay biases.
 - Parents, peers, and the media play a role in shaping attitudes towards LGB
individuals and need to promote acceptance and equality.
- Intergroup contact and education designed to reduce prejudice have been
effective interventions.
- Creating an inclusive and tolerant society requires systemic efforts to reduce
antigay prejudice.

Life Experiences of LGBs

24. Variability of experiences: There is a wide range of experiences within the LGB
community, influenced by factors such as whether a person is covert (in the
closet) or overt (out of the closet) about their sexual orientation, social class,
occupation, personality, and other factors.
25. Covert and overt homosexuality: A covert homosexual keeps their sexual
orientation a secret and may be heterosexually married and engage in secret
same-gender sexual behavior. An overt homosexual may live within an LGB
community, especially in large cities with a gay subculture.
26. Differences between gay men and lesbians: Due to societal gender roles and
upbringing, the lifestyles of gay men and lesbians may differ. Discrimination
against gay men is more prevalent than against lesbians.
27. Development of sexual orientation: The exact determination of sexual orientation
is not fully understood. Some experts suggest it may be determined by age 5 or
6, while others propose age 10 or 12. Childhood gender variance or
nonconformity can predict later LGB orientation, but it is not a perfect predictor.
Most gender-variant children do not turn out to be gay.
28. Challenges faced by sexual minority youth: LGB youth often experience
harassment, bullying, and a negative climate in middle school, high school, and
college. Homophobic epithets and cyberbullying are common forms of
harassment. Peer support and acceptance from adults, especially parents and
school staff, are crucial for the well-being of sexual minority youth.
29. Fluidity of sexual orientation: Some individuals experience sexual fluidity, which
refers to changes over time in sexual attractions, identity, or behavior. This
fluidity can occur in people's twenties, thirties, or later. People may be attracted
to individuals rather than a specific gender.
30. Diverse self-labeling: In contemporary American culture, there is a wider variety
of self-labels for sexual orientation. People can identify as bisexual, queer,
questioning, or choose not to label themselves strictly as heterosexual or
homosexual.

Lesbian, Gay, and Bisexual Communities

31. Global LGB Communities: LGB communities exist worldwide and are connected
through common interests, culture, and experiences. Increased international
travel, globalization, and the internet have facilitated these connections.
32. Historical Development: LGB communities began to flourish in the United States
after World War II. Activist groups emerged in the 1950s and 1960s, with the
Stonewall rebellion in 1969 serving as a catalyst for the gay liberation movement.
The HIV/AIDS crisis in the 1980s further strengthened the sense of community
and led to the formation of support networks and activist groups.
33. Local Communities: LGB communities often develop in neighborhoods of large
cities, featuring establishments such as bookstores, restaurants, theaters, and
social organizations that cater to the community's needs.
34. Lesbian Culture: The lesbian community has played a significant role in creating
a distinct lesbian culture expressed through music, literature, festivals, and
women's sporting events.
35. Symbols and Rituals: Symbols such as the pink triangle (formerly used by the
Nazis to label gay men) and the Greek letter lambda have been adopted as pride
symbols. Pride marches held in June commemorate the Stonewall uprising. The
use of slang is also prevalent within the LGB community.
36. Gay Bars: Gay bars are an important aspect of LGB social life, providing spaces
for socializing, dancing, and the possibility of finding partners. Bars are typically
gender-segregated, with more options available for gay men than for lesbians.
The atmosphere and purpose of bars may vary, with some focused on finding
sexual partners and others emphasizing conversation and social interaction.
37. Online Communities: The internet, particularly through websites and chat rooms,
has become a significant platform for LGB individuals to connect, form
relationships, and find community, especially in areas where physical LGB
communities may be lacking. Mobile technologies and dating apps have also
facilitated connections among gay men, such as Grindr.
38. Impact of the Gay Liberation Movement: The gay liberation movement has had a
significant impact on the LGB lifestyle and community, encouraging individuals to
be more open about their identity and reducing feelings of guilt. Organizations
like the National Gay and Lesbian Task Force have played a central role in
activism and provide information on local groups.
39. Socialization Beyond Bars: LGB individuals have various avenues for socializing
beyond bars, including gay churches (e.g., Metropolitan Community Church), gay
athletic organizations, and gay political groups.
40. Media and Publications: The gay liberation movement has led to the
establishment of numerous LGB-focused newspapers, magazines, and online
sites. These platforms cover political issues, human-interest stories, and fashion
news. One prominent LGB magazine is The Advocate, which also published The
Advocate College Guide for LGBT Students in 2006.
Gay and Lesbian Relationships
41. Long-Term Relationships: A significant number of lesbians and gay men form
long-term, cohabiting relationships. Surveys indicate that between 8 and 21
percent of lesbian couples and between 18 and 28 percent of gay male couples
have been together for 10 or more years.
42. Commitment to Long-Term Relationships: The enthusiasm for legal gay marriage
serves as a testimony to the commitment of many gays and lesbians to long-term
relationships.
43. Negotiating Relationship Aspects: Like heterosexual couples, gay and lesbian
couples face challenges in finding a balance that suits both individuals. Three
common aspects that need negotiation and can be sources of conflict are money,
housework, and sex.
44. Research Findings: Studies comparing the dynamics of gay, lesbian, and
heterosexual relationships have shown no differences in interaction measures.
Positive and negative behaviors observed during problem-solving discussions
were similar across all three types of couples.
45. Similarities to Heterosexual Relationships: Research on gay and lesbian
relationships consistently highlights their similarities to heterosexual relationships
in terms of satisfactions, loves, joys, and conflicts.

Lesbian and Gay Families

46. Controversy and Bias: Some heterosexual individuals in the United States hold
the belief that a lesbian or gay family is a damaging environment for children.
Courts have often assumed that lesbians and gay men are unfit parents, leading
to custody decisions favoring the heterosexual parent following a divorce.
47. Diverse Family Types: Families headed by gay and lesbian couples are diverse,
encompassing different races, social classes, and gender dynamics. Children in
these families may have been born to one partner in a previous heterosexual
relationship, adopted, or conceived through artificial insemination.
48. Concerns and Research Findings: Three common concerns about children in gay
and lesbian families are their gender and sexual identity development,
psychological well-being, and peer relationships. However, research consistently
dismisses these fears. Children growing up in gay and lesbian households
overwhelmingly have a heterosexual orientation, show no differences in
adjustment and mental health compared to children in heterosexual families, and
exhibit similar social skills and popularity.
49. Positive Outcomes and Support: Recognizing the positive outcomes and
research findings, the American Academy of Pediatrics issued a policy statement
in 2002 supporting adoptions by gay parents, emphasizing the importance of
having at least one loving and supportive parent, which can be found in various
family constellations.
How Many People Are Gay,
Straight, or Bi?

50. Sexual Behavior, Gender, and Sexual Orientation: It is important to differentiate

between sex (sexual behavior), gender (being male or female), gender identity
(psychological sense of maleness, femaleness, or non-binary), and sexual
orientation (heterosexual, homosexual, or bisexual). Additionally, sexual identity
refers to how individuals label or identify themselves.
51. Contradictions in Sexual Identity and Behavior: There can be contradictions
between a person's sexual identity and their actual sexual behavior. For
example, someone may identify as lesbian but occasionally engage in sexual
activities with men. Similarly, some individuals who identify as heterosexual may
also engage in same-gender sexual encounters.
52. Kinsey's Research: Kinsey's research indicated that a large percentage of males
(37%) and females (13%) had at least one homosexual experience leading to
orgasm in adulthood. However, experts believe that Kinsey's statistics on
homosexuality were likely inflated due to sampling problems.
53. National Survey of Family Growth (NSFG): The NSFG provides improved
estimates of homosexuality in the United States. The percentages vary
depending on how homosexuality is defined. According to the NSFG, about 5%
of men and 14% of women have had at least one same-gender sexual
experience in adulthood, while approximately 4% of both men and women
experience sexual attraction to their own gender. Roughly 2% of men and 1% of
women identify as homosexual.
54. Continuum of Sexual Orientation: Kinsey conceptualized sexual orientation as a
continuum rather than two distinct categories.
a. He created a scale from 0 (exclusively heterosexual) to 6 (exclusively
homosexual), with varying degrees of heterosexual and homosexual
experiences in between.
b. Contemporary research supports the idea that sexual orientation exists on
a spectrum.
55. Estimated Percentages: Based on the NSFG data, it is estimated that
approximately
a. 90% of men and 90% of women are exclusively heterosexual
b. around 10% of both men and women have had at least one same-gender
sexual experience in adulthood.
c. 2% of men and 1% of women have a homosexual identity. These figures
have been adjusted to account for potential underreporting and
concealment by some respondents.

Historical Views on Homosexuality:

 - Prior to the 20th century, homosexuality was considered a sin or heresy in
Europe and the United States. People accused of being homosexuals were often
burned at the stake during the Spanish Inquisition.
- In the past, mental illness was also seen as a sin, and all forms of mental
disturbance were regarded as such.

The Medical Model and Criticism:

- In the 20th century, the medical model replaced the belief that homosexuality
was a sin. Homosexuality, along with other forms of mental disturbance, was
viewed as a sickness or illness.
- Psychiatrist Thomas Szasz and others criticized the medical model, arguing that
it was obsolete and calling for a more humane and realistic approach to mental
disorders, including homosexuality.
- LGB activists expressed their opposition to being labeled as "sick" and viewed
the medical model as another form of persecution.

Research Designs and Findings:

- Four research designs have been used to study homosexuality, each with
different assumptions and levels of sophistication.
- Clinical studies focused on homosexuals in therapy and often assumed mental
illness. These studies reported poor adjustment and neuroticism among
homosexuals but had circular reasoning.
- Studies with control groups compared homosexuals in therapy to heterosexuals
not in therapy. They generally found more psychological disturbances among the
homosexual group.
- Nonpatient research involved comparing nonpatient homosexuals to nonpatient
heterosexuals. These studies generally found no differences in psychological
adjustment between the two groups.
- Population studies using random samples have found slightly higher rates of
depression, anxiety, suicide attempts, and PTSD among LGB individuals
compared to heterosexuals.
- The interpretation of these statistics is debated, with some emphasizing the
differences and others considering the gaps relatively small. It is agreed that
higher rates of mental health issues among LGB individuals are influenced by
factors such as discrimination, lack of support, and concealment of identity.

Resilience in Sexual Minority Individuals:

- Positive psychology focuses on resilience and factors that contribute to it.

- LGB individuals often display resilience in the face of stigma.
 - Social support, particularly support for one's sexual orientation, and personal
traits like hope and optimism contribute to the psychological well-being of LGB
individuals.

Factors Affecting Sexual Orientation

- Genetic Factors: Research studies have shown evidence of a genetic

contribution to sexual orientation. Studies with twins and adoptive siblings have
indicated higher concordance rates for homosexuality among identical twins
compared to nonidentical twins, suggesting a genetic influence. However, the
concordance rates are not 100%, suggesting that other factors also play a role.

- Prenatal Factors: Some researchers propose that sexual orientation is influenced

by prenatal factors during fetal development. Studies have suggested that
exposure to atypical hormones during this period might contribute to
homosexuality. Stress during pregnancy and birth order have also been explored
as potential influences on sexual orientation, but the findings have been mixed
and require further research.

- Brain Factors: Anatomical differences in brain structure have been investigated

as a potential cause of sexual orientation. While some studies have reported
differences in specific brain regions between gay and straight individuals, the
findings are not consistent. More research is needed to establish any clear
anatomical differences.

- Learning Theory: According to the learning theory approach, sexual orientation is

learned through early experiences and conditioning. Pleasurable or aversive
experiences with same- or opposite-gender individuals may influence sexual
preferences. However, the evidence on learning theory's explanation of sexual
orientation is inconclusive, with mixed findings from studies.

- Sociological Theory: Sociologists emphasize the role of labeling in shaping

sexual orientation. The label "homosexual" and societal attitudes and norms
associated with it may influence an individual's self-identification and behavior.
However, it is important to note that homosexuality is not solely a result of
parental influence, as studies have shown that the majority of children raised by
gay or lesbian parents identify as heterosexual.

Differences Between Gay Men and Lesbians

- Bisexuality: Women are more likely to identify as bisexual compared to men. In

the NSFG data set, 4 percent of women and 1 percent of men indicated their
 bisexual identity. This suggests that women may exhibit more flexibility or fluidity
in their sexual orientation over time.

- Sexual Fluidity: Research indicates that women, both heterosexual and lesbian,
show more sexual fluidity or flexibility in their sexual orientation compared to
men. Women tend to exhibit arousal to both male and female stimuli, whereas
men show more specific sexual arousal patterns based on their sexual
orientation.

- Sexual Arousal Patterns: In laboratory research, heterosexual men typically show

physiological arousal to female stimuli and not male stimuli, while gay men
exhibit the reverse pattern. Women, regardless of their sexual orientation, show
arousal to both male and female stimuli.

- Fraternal Birth Order Effect: The fraternal birth order effect, where the likelihood
of being gay increases with the number of older brothers, has been found in gay
men but not in lesbians. Lesbians do not show a significant difference in birth
order compared to heterosexual women.

- Gender-Specific Theories: Some theories that explain the development of sexual

orientation may apply to either gay men or lesbians but not both. Therefore, it is
likely that different theories are needed to explain the development of sexual
orientation in women and men.

Bisexuality

- Scientific Evidence: Emerging research supports the existence of true

bisexuality. Studies have shown that self-identified bisexual men and women
exhibit attraction to both male and female stimuli. Behavioral measures and
physiological arousal studies have provided evidence for distinct attraction
patterns in bisexual individuals.

- Bisexual Development: Bisexuality is not necessarily a transitional phase.

Longitudinal studies have shown that a significant percentage of individuals
maintain their bisexual or unlabeled identity over time. Sexual identity can
change over time, often influenced by relationship experiences. Women tend to
have more flexible attraction patterns compared to men.

- Timing and Flexibility: Late-occurring experiences and relationships play a role in

shaping sexual behavior and identity. The assumption that sexual orientation is
determined solely by childhood or prenatal factors is challenged. Some
individuals have their first heterosexual or homosexual experience in their
twenties, suggesting that sexual orientation may continue to evolve in adulthood.
 - Open Questions: The determination of sexual orientation is still an open
question. While it may be influenced by genetic factors or early-life experiences
for some, it can also be determined in adulthood or remain fluid for others.
Sexual identity seems to evolve in adulthood, contradicting the notion that it is
solely determined before adolescence.

Chapter 14
Variations in sexual behavior

When Is Sexual Behavior

Abnormal?

- Establishing abnormal behavior is challenging due to cultural differences

- Statistical definition: defines abnormal sexual behavior as rare or not practiced by

many people. Lacks insight into the psychological or social functioning of individuals
engaging in such behaviors

- Sociological approach – deviant sexual behavior is defined as one that violates societal
norms – emphasizes importance of individual's interaction with society and the
consequences of deviant labeling

- Psychological Approach:
o Arnold Buss proposed three criteria of abnormality:
▪ Discomfort - highlights the psychological aspects of abnormal sexual
behavior.
▪ Inefficiency - highlights the functional aspects of abnormal sexual
behavior.
▪ Bizarreness - culturally defined

- Medical approach
- Paraphilia – intense and persistent sexual interests outside typical genital stimulation or
sexual behaviors
o Not necessarily a mental disorder but may require attention if they cause distress to self
or others

- Additional Diagnostic Criteria: Specific paraphilias have additional criteria, including the
duration of at least six months and clinically significant distress or impairment in
functioning. These definitions influence treatment decisions and insurance coverage.
 - Continuum of Sexual Behavior: Normal and abnormal sexual behavior, like other
behaviors, exist on a continuum rather than as separate categories.
- Mild fetishes or preferences are within the range of normal behavior, while extreme or
compulsive forms may be considered abnormal.
- Example of Lingerie Fetish: Lingerie can be sexually arousing for both men and women,
and it is also a common sexual fetish object. Mild preferences for such objects are
considered normal, while extreme behaviors, such as dependence, obsession, or
criminal activities associated with the fetish, cross into abnormal territory.
- Conceptualizing the Continuum - Preferences within the normal range can become
abnormal when they become necessities, obsessions, or disorders causing distress and
impairment in functioning.
- Application to Various Sexual Variations: The continuum from normal to abnormal
behavior applies to other sexual variations - voyeurism, exhibitionism, sadism, and
fetishism.

- Fetishism and Fetishistic Disorder: Fetishism refers to a sexual fixation on an object

other than a human being, with great erotic significance attached to it. Fetishistic
disorder involves sexual fantasies, urges, or behaviors using nonliving objects to produce
or enhance arousal, causing distress and lasting for at least six months.

Development of fetishes
- Fetishistic Disorder: Fetishistic disorder is characterized by sexual fantasies, urges, or
behaviors involving the use of nonliving objects to enhance sexual arousal, either with
or without a partner, lasting for at least six months and causing distress. In extreme
cases, individuals may be unable to become aroused or have an orgasm without the
presence of the fetish object. The fetish item is typically closely associated with the
body, such as clothing.
- Subcategories of Inanimate-Object Fetishes:
o media fetishes (objects associated with a specific material, such as leather)
o form fetishes (objects associated with a particular shape or body part).
- 3 theoretical explanations for the development of fetishes
o Learning theory – fetishes result from classical conditioning, an association is
established between the fetish object and sexual arousal and orgasm. Feelings of
guilt maybe attributed to sexual arousal leading to reinforcement of sexual
behavior
o Cognitive theory – suggests that fetishists have cognitive distortion where they
perceive nonconventional stimuli as erotic – perception of arousal is a also
distorted driving them to engage in fetish behavior
o Sexual addiction model
- Fetishes develop early in life sometimes during childhood
Cross dressing
Transvestic disorder: The practice of dressing as the opposite sex in order to experience sexual
excitement, which causes emotional distress or impairs social or interpersonal functioning.
Some men regurarly engage in cross dressing to promote sexual arousal

Frotteurism: Deriving sexual satisfaction from fantasies, urges, or behaviors involving touching
or rubbing one’s genitals against the body of a nonconsenting person.

Troilism (TROY-uhl-ism): Three people having sex together.

Saliromania: A desire to damage or soil a woman or her clothes.

Coprophilia (cop-roh-FILL-ee-uh): Deriving sexual satisfaction from contact with feces.

Necrophilia: Deriving sexual satisfaction from contact with a dead person.

Sexsomnia: Refers to automatic, unintentional sexual behaviors during sleep; also called sleep
sex.

Treatments
- Various medical treatments have been tried over the last century to treat sexual
variations believed to be caused by biological factors.
- Surgical castration was used in the past as a treatment for uncontrollable sexual urges,
but it is not recommended due to its inhumane nature and lack of effectiveness.

- Hormonal treatments, such as chemical castration or antiandrogens, have been used to

reduce sexual desire. Medroxyprogesterone acetate (MPA) and cyproterone acetate
(CPA) have been used, but they have side effects and limited effectiveness.

- Leuprolide acetate (LA), a synthetic analog of gonadotropin-releasing hormone (GnRH),

has been used to suppress androgen production and reduce deviant sexual interests and
behavior.

- Psychopharmacological treatments, particularly selective serotonin reuptake inhibitors

(SSRIs) and antidepressants, have been used to reduce paraphilic fantasies and urges.
They have shown some success in reducing compulsive behaviors.

- Cognitive-behavioral therapies (CBT) are often used in treatment programs for sex
offenders. These programs aim to reduce inappropriate sexual arousal, enhance social
skills, challenge distorted thinking, and prevent relapse.
 - Skills training, including social skills training and sexuality education, can be beneficial
for individuals with paraphilias who have difficulty forming relationships and accessing
appropriate forms of sexual gratification.

- AA-type 12-step programs, modeled after Alcoholics Anonymous, are used to treat
sexual addiction. They focus on acknowledging and addressing addictive sexual
behaviors.

- Meta-analyses have shown that CBT-based programs are consistently effective in

reducing sexual recidivism among sex offenders. Classic behavioral programs, skills
training, and hormonal treatments have shown smaller effects.

- Treatment programs are most effective with rapists, followed by exhibitionists, and
have the smallest effect on intrafamily child sex offenders.

Preventions

Primary prevention:

- aims to intervene during childhood or address factors in home life to prevent sexual
problems from developing.
- involves teaching coping skills to minimize the development of problems.
- challenging due to the lack of clear-cut diagnostic categories and the co-occurrence of
paraphilia with other psychiatric conditions.

Secondary prevention:

- focuses on diagnosing and treating sexual variations as early as possible to minimize

difficulties
- An alternative approach is to analyze the components of sexual development and
address disturbances in these components during childhood.
- The components proposed for sexual development include gender identity, sexual
responsiveness, and the formation of relationships with others.
- Disturbances in different components may lead to different sexual variations, such as
gender identity disturbance in cross-dressing or disturbance in sexual responsiveness in
fetishism.
- Ensuring healthy development in each of these components during childhood may help
prevent sexual variations.
- Childhood sexual abuse is identified as a risk factor for paraphilic behavior and
paraphilic disorders later in life.
Chapter 15
Sexual Coercion