Chapter Outline

  1. Becoming a sexual person
    1. Key aspects of sexual identity (the complex of personal qualities, self-perceptions, attitudes, values, and preferences that guide one's sexual behavior)
      1. Sexual orientation
        1. Heterosexuals seek emotional-sexual relationships with members of the other gender
        2. Homosexuals seek emotional-sexual relationships with members of the same gender
        3. Bisexuals seek emotional-sexual relationships with members of both genders
      2. Body image
        1. How you see yourself physically
        2. Positive body image is correlated with greater sexual activity, higher satisfaction
      3. Sexual values and ethics
        1. Culturally imposed constraints on expectations regarding sexual behavior
        2. Nature of these messages depends on gender, race, ethnicity, socioeconomic status
      4. Erotic preferences
        1. Individual differences in what people find enjoyable
        2. Encompass attitudes about self-stimulation, oral sex, etc.
    2. Physiological influences
      1. Hormones and sexual differentiation
        1. Hormones play key role in sexual differentiation
        2. Gonads (sex glands) produce hormonal secretions
          1. In males, testes produce androgens, the principal class of male sex hormones (e.g., testosterone)
          2. In females, ovaries produce estrogens, the principal class of female sex hormones
        3. Hormones regulate development of primary, secondary sex characteristics during puberty
      2. Hormones and sexual behavior
        1. Androgen seems to be related to sexual activity in males and females
        2. Estrogen levels in women not correlated well with sex drive
    3. Psychological influences
      1. Families
        1. Home environment a significant influence on sexual identity in early years
        2. Open communication about sex related to better sexual adjustment in college students
      2. Peers
        1. Friends are main source of information about sex for both males and females
        2. Peers can be source of misleading information, but also can be highly effective force for sexually responsible behavior
      3. Schools
        1. Sex education programs tend to ignore psychological, social aspects of sexuality
        2. Research indicates sex education programs lead to neither experimentation nor restraint
      4. Media
        1. Sources of information
          1. Television becoming increasing source of information
          2. Sexually explicit images available on Internet
          3. Books, magazines another main source
        2. Exposure to erotic materials seems to elevate likelihood of sexual activity for few hours
        3. Men who view aggressive pornography may increase aggressive behavior toward women
    4. Gender differences in sexual socialization
      1. Women taught to be "person-centered"; men taught to be "body-centered"
      2. American males encouraged to experiment sexually, initiate sexual activities, enjoy sex without emotional commitment; whereas females are taught to view sex in context of romantic relationship
      3. Sexual socialization takes longer in females
        1. Fear of pregnancy
        2. Girls hear negative messages about sex and men
        3. Girls develop negative associations with their genitals and sex
        4. Females tend to develop sexual guilt
      4. Differing views mean males and females are likely to be out of sync, particularly in adolescence, early adulthood
      5. Research suggests homosexual couples less likely to have "incompatibility problems"
    5. Sexual orientation
      1. Key considerations
        1. Experts suggest homosexuality, heterosexuality should be viewed as end points on a continuum
        2. Frequently cited estimate of number of people who are predominantly homosexual is 10%
          1. But recent surveys have reported lower estimates
          2. Ten percent figure may be accurate for males when homosexuals, bisexuals are lumped together, but an overestimate for females
      2. Origins of sexual orientation
        1. Not much support for environmental explanations
        2. Research on influence of prenatal hormonal factors is inconclusive
        3. Biological or genetic factors may play a role, according to a number of studies
        4. Bottom line is that it isn't yet clear what determines sexual orientation
      3. Attitudes toward homosexuality
        1. Homosexuality much more visible today than in past
        2. Homophobia: the intense fear and intolerance of homosexuality
          1. Characteristics include being older, having conservative religious beliefs, endorsing traditional gender roles, etc.
          2. Negative attitudes sometimes translate into hate crimes
        3. Not all societies view homosexuality negatively
      4. Adjustment
        1. Homosexuality no longer classified as psychological disorder
        2. Research indicates no differences in adjustment
      5. Identity development
        1. Homosexuals seem to take longer to recognize sexual orientation
          1. Assumption that heterosexuality is universal
          2. Fear of social rejection
          3. Homosexuals report both same- and other-gender sexual behavior during adolescence, early adulthood
        2. Clarity about sexual orientation seems to take longer in lesbians than in gay men
        3. Developmental milestones
          1. Initial awareness of same-gender erotic desires
          2. Reconciling sexual orientation with negative societal attitudes
          3. Exploring gay and lesbian subcultures
          4. Disclosing sexual orientation to others
        4. Coming to terms with one's homosexuality in hostile environment is difficult
  2. Interaction in sexual relationships
    1. Motives underlying sexual interactions
      1. Motives quite diverse, including affection, lust, duty, boredom, self-affirmation
      2. Motives tend to vary by gender
        1. For men, lust and pleasure are main motives
        2. For women, love and emotional reasons are main motives
    2. Communicating about sex
      1. Disagreements about sex are common
        1. Couples have to negotiate aspects of sexual relationship
        2. Negotiation process may not be explicit
      2. Many people find it difficult to talk to partner about sex
      3. Four common barriers to sexual communication
        1. Fear of appearing ignorant
        2. Concern about partner's response
        3. Conflicting attitudes about sex
        4. Early negative sexual experience
      4. Research indicates that open communication about sex is associated with greater relationship satisfaction
  3. The human sexual response
    1. The sexual response cycle
      1. Excitement phase
        1. Level of arousal escalates rapidly
        2. In males, vasocongestion (engorgement of blood vessels) produces penile erection
        3. In females, vasocongestion produces swelling of clitoris and vaginal lips, vaginal lubrication; most women also experience nipple erection and swelling of breasts
      2. Plateau phase
        1. Physiological arousal continues to build
        2. Distractions can delay or stop movement to next phase
      3. Orgasm phase
        1. Orgasm occurs when sexual arousal reaches its peak intensity and is discharged in a series of muscular contractions that pulsate through the pelvic area
        2. Male orgasm usually accompanied by ejaculation of seminal fluid
        3. Subjective experience of orgasm similar for men and women
      4. Resolution phase
        1. Physiological changes subside
        2. Men experience refractory period, a time following male orgasm during which males are largely unresponsive to further stimulation
    2. Gender differences in patterns of orgasm
      1. As a whole, sexual responses of men and women are similar
      2. During intercourse, women somewhat less likely to reach orgasm
        1. Intercourse not optimal mode of stimulation for women
        2. Intercourse may be too brief or mechanical
      3. Incidence of orgasm among lesbians supports socialization-based explanation of gender differences in orgasmic consistency
      4. Women are more likely to fake an orgasm
  4. Sexual expression
    1. Erogenous zones: areas of the body that are sexually sensitive or responsive
      1. Virtually any area of body can function as erogenous zone
      2. Ultimate erogenous zone may be the mind
    2. Fantasy
      1. Sexual fantasies are common in both men and women
        1. Women's fantasies tend to be more romantic
        2. Men's fantasies tend to contain more explicit imagery
      2. Most sex therapists view sexual fantasies as harmless ways to enhance sexual excitement
      3. Dominance, submission fantasies not uncommon, but don't mean people really want to have such an experience
    3. Kissing and touching
      1. Most two-person sexual activities begin with kissing
      2. Men often underestimate importance of kissing, touching
    4. Self-stimulation (masturbation)
      1. Although traditionally condemned as immoral, it's normal, healthy
      2. A common practice in our society
    5. Oral and anal sex
      1. Oral sex refers to oral stimulation of genitals
        1. Cunnilingus: oral stimulation of the female genitals
        2. Fellatio: oral stimulation of penis
      2. Oral sex is a component in most couples' sexual relationships, although there is residue of negative attitudes
        1. Particularly among African Americans, Hispanics, religious conservatives, and those with less education
        2. Prevalence has increased dramatically since late 1940s, early 1950s
      3. Anal intercourse: insertion of the penis into a partner's anus and rectum
        1. Legally termed sodomy, it's still illegal in some states
        2. More popular among homosexual male couples than heterosexual couples
    6. Intercourse
      1. Known technically as coitus, involves insertion of the penis into the vagina and (typically) pelvic thrusting
      2. Partners may use variety of positions
      3. Sexual activities homosexual couples use in absence of coitus
        1. Gay men: mutual masturbation, fellatio, anal intercourse
        2. Lesbians: mutual masturbation, cunnilingus, tribadism (one partner lies on top of other, makes thrusting movements)
  5. Patterns of sexual behavior
    1. Sex in the age of AIDS
      1. American sexual attitudes, behaviors have become more liberal over past 30 years
        1. Trend appears to be continuing
        2. But these changes have had serious downsides (e.g., increases in teenage pregnancy, sexually transmitted diseases, spread of HIV infection)
      2. Some evidence that college students' attitudes toward casual sex are becoming more disapproving, sexual behavior seems unaffected
      3. Some evidence that concerns about contracting AIDS are affecting sexual practices, but more likely to be the case for older individuals
    2. "Premarital sex"
      1. Premarital sex increasingly involves relationships between mature adults
      2. Attitudes
        1. Compared to generation ago, more people believe that sex before marriage is acceptable
        2. Males more accepting of premarital sex under casual circumstances
      3. Prevalence
        1. Has increased since 1960s
        2. Some attributable to later marriages, but incidence among teenagers has also increased
        3. Gender differences in reactions to first experience with sexual intercourse
          1. Males tend to feel glad
          2. Females more likely to feel sadness, disappointment
    3. Sex in committed relationships
      1. Sex between dating couples
        1. Decision is often difficult
        2. Dating couples that have sex may be more likely to stay together
      2. Marital sex
        1. Overall marital satisfaction is related to satisfaction with sexual relationship
        2. Frequency of sex tends to decrease with age
        3. With age, sexual arousal tends to build more slowly and orgasms tend to diminish in frequency and intensity
      3. Sex in homosexual relationships
        1. Homosexual couples have sex about as often as heterosexual couples
        2. Homosexual couples more likely to have egalitarian sexual relationships
        3. Tend to have non-goal-oriented view of sexual activities
        4. Tend to rate subjective quality of sex higher
    4. Infidelity in committed relationships
      1. Generally, gay couples more permissive than lesbian, married couples
      2. Prevalence
        1. Substantial number of people get involved
        2. Accurate estimates are difficult to come by
      3. Motivations
        1. Common reasons include anger toward partner, dissatisfaction with relationship, desire for new sexual experiences, etc.
        2. Men's motivations tied to sex; women's to emotions
      4. Impact
        1. Has not been investigated extensively
        2. Experts speculate that about 20% of divorces caused by infidelity
        3. Findings regarding gay relationships are contradictory
  6. Practical issues in sexual activity
    1. Contraception
      1. Barriers to effective contraception
        1. A third to half of sexually active American teenagers don't use contraception or use it only on occasion
          1. Many adolescents believe they don't need to take precautions if they're not gay, intravenous drug users, or don't have frequent sex
          2. Harbor the illusion that pregnancy, sexually transmitted diseases "could never happen to me"
          3. Girls who feel guilty about sex often fail to use contraception
          4. Access to contraceptive devices may be a problem
        2. Conflicting norms about gender and sexual behavior among college students
        3. Alcohol a contributing factor in college students
      2. Selecting a contraceptive method
        1. Couples should be informed about contraceptive methods and understand difference between the ideal failure rate and the actual failure rate
        2. Couples should discuss preferences for method
        3. Two most widely used birth control methods
          1. Oral contraceptives (i.e., pills taken daily)
            1. Contain synthetic forms of estrogen, progesterone
            2. Use does not appear to increase a woman's overall risk for cancer
            3. High doses taken within 72 hours after intercourse can prevent pregnancy
          2. Condom (i.e., sheath worn over penis during intercourse)
            1. Only widely available contraceptive device for males
            2. Highly effective if used correctly
            3. Oil-based creams, lotions should not be used with rubber condoms (or diaphragms) because they may create microscopic holes
    2. Sexually transmitted diseases (STD): illnesses transmitted primarily through sexual contact
      1. Prevalence and transmission
        1. Occur more frequently than widely realized
        2. Most STDs are increasing in prevalence
        3. Concerning transmission, six points worth emphasizing
          1. Should consider any activity that exposes you to blood, semen, saliva, etc. as high-risk unless you're in sexually exclusive relationship with unaffected partner
          2. The more partners you have, the greater the risk
          3. Sexual labels people attach to themselves (e.g., heterosexual, homosexual) may not be accurate
          4. People can be carriers of STDs without being aware of it
          5. People who know they have STD may not abstain from sex
          6. Anal intercourse a particularly risky behavior
      2. Prevention
        1. Abstinence is best way to minimize risk, but may not be realistic
        2. Talk with your partner about safer sexual practices
        3. Suggestions for safer sex
          1. Avoid anal intercourse
          2. Use rubber, polyurethane condom if involved in nonexclusive relationship
          3. Wash genitals before, after sexual contact
          4. Urinate soon after intercourse
          5. Don't have sex with someone who has had many previous partners
          6. Watch for sores, rashes, etc. around vulva, penis
        4. If you have several partners in a year, you should have regular STD checkups
  7. Application: Enhancing sexual relationships
    1. General suggestions
      1. Pursue adequate sex education
      2. Review your sexual value system
      3. Communicate about sex
      4. Avoid goal setting
      5. Enjoy your sexual fantasies
      6. Be selective about sex
    2. Understanding sexual dysfunction
      1. Sexual dysfunctions: impairments in sexual functioning that cause subjective distress
      2. Sexual problems tend to belong to couples rather than individuals
      3. Both physiological, psychological factors contribute
      4. Three common sexual dysfunctions
        1. Erectile difficulties occur when a man is persistently unable to achieve or maintain an erection adequate for intercourse
          1. Organic factors may contribute to as many as 50% of all cases
          2. Most common psychological cause is anxiety about sexual performance
        2. Premature ejaculation occurs when sexual relations are impaired because a man consistently reaches orgasm too quickly
          1. Psychological factors are typical cause
            1. Some men don't exert much effort to prolong intercourse
            2. These men tend not to view their ejaculations as premature
          2. Other causes can include depression, anger at one's partner
          3. May occur because early experiences emphasized desirability of rapid climax
        3. Orgasmic difficulties occur when people experience sexual arousal but have persistent problems in achieving orgasm
          1. Much more common in women
          2. Physical causes are rare
          3. Leading psychological cause is negative attitude toward sex
          4. Lack of authentic affection for partner can be factor
    3. Coping with specific problems
      1. Sex therapy: involves the professional treatment of sexual dysfunctions
      2. Erectile difficulties
        1. Viagra is about 80% effective
          1. But may have life-threatening drawbacks
          2. Many therapists argue that medical approach fails to address psychological causes
        2. For psychologically based difficulties, key is to decrease man's performance anxiety
        3. One procedure for treatment of erectile difficulties and other dysfunctions is sensate focus: an exercise in which partners take turns pleasuring each other while giving guided verbal feedback and in which certain kinds of stimulation are temporarily forbidden
      3. Premature ejaculation
        1. May involve decreasing tempo of intercourse
        2. Two treatments used for cases of instant ejaculation
          1. Stop-start method
          2. Squeeze technique
      4. Orgasmic difficulties
        1. In women, often a result of negative attitudes about sex
        2. Treatment sometimes focuses on couple's general relationship problems
        3. Not uncommon for women to be troubled by orgasmic difficulties only in context of intercourse