Sexology in the Internet - Our New Frontier
(A shorter version of this paper was presented to the 9th congress of the European Federation of Sexology (EFS) in Rome on April 16, 2008. Copyright E. J. Haeberle 2008)
Most universities and professional organizations have not yet understood the implications of the current electronic revolution. These range from design problems and copyright issues to new ways of financing. Moreover, the issue of "open access" to scientific information is becoming increasingly important and must be faced with all its consequences. Most importantly, academic teachers and their students must learn to take advantage of the vast amount of the now available free information. The one field that could profit most from these recent developments is sexology. The lecture will point out various ways in which sexological organizations and individual sexologists can use the new opportunities offered by the internet.
As we all know, teenagers in many countries today use the internet for their information and entertainment. Needless to say, they also use it to watch freely available pornography, but, in addition, they look at "clean" web sites that offer free music videos, sports videos, comedy videos and, indeed, whole movies. One of the most popular of these sources is YouTube, a web site offering all of this and much more (1). Its videos are being watched by over 100 million viewers every day. Many of these videos are also enjoyed by the older generation: Historical performances by famous opera stars from Maria Callas and Renata Tebaldi to Beniamino Gigli, Jussi Björling, and Tito Schipa, by great musicians like Jascha Heifetz and Arthur Rubinstein, popular singers like Al Jolson, Carlos Gardel, Frank Sinatra, Elvis Presley and Edith Piaf, dancers like Fred Astaire and Ginger Rogers, comedians like Charlie Chaplin and Buster Keaton - indeed, the list is sheer endless: Almost anything once captured on film eventually seems to become available on YouTube or similar sites.
It is perhaps less well known that YouTube also offers videos of high-quality academic lectures, for example by professors of the UC Berkeley (2). The lectures cover a very wide range of subjects from biology and physics to history, law, philosophy and political science. The lecture videos are very popular not only in the US, but also in the developing world. However, before I say more about them, allow me to mention two recent developments that illustrate the accelerating pace of the present electronic revolution.
A few weeks ago, the long-established and best known German encyclopedia "Brockhaus" announced that it would cease publication of its expensive 30-volume printed addition and, instead, would make all of it freely available in the internet, starting on April 15 - that was yesterday (3). The publisher thereby followed the example of the "Columbia Encyclopedia", the "Catholic Encyclopedia", the Merck Manual, and several other encyclopedias and dictionaries (4).
I will address the economic implications of this development later. Right now, let me just state that we are seeing here an obvious and irresistible trend, and the reasons are clear:
I am not talking here about well-meaning, but sometimes unreliable sources like Wikipedia, no, I am talking about very serious, quotable, solid works of scholarship. The internet is now overflowing with freely accessible official reports and research papers by governmental and non-governmental agencies, think tanks, international and national scientific bodies and respected academic institutions and organizations. For example, the Harvard Medical School has, for some time now, been offering free accurate information about any imaginable illness and other health topics, including sexual health, and the Massachusetts Institute of Technology (M.I.T.) has made the materials of 1800 of its undergraduate and graduate courses freely accessible online. In the meantime, others are following suit, for example Yale University, which is now offering complete "open access" introductory courses in several fields from astronomy to psychology and religious studies (5). These pioneering efforts have vast implications for all of us, even if we do not yet realize it. However, before I go into detail, I must call your attention to another, even more momentous, indeed revolutionary, decision made in the USA just two months ago.
On February 13 of this year, Harvard University announced that its Faculty of Arts and Sciences will now offer the scholarly articles of its faculty members "in an open-access repository, making them available worldwide for free" (6).
The reason for this decision is clearly stated:
"There is no question that scholarly journals have historically allowed scholars to distribute their research to audiences around the world. But, the scholarly publishing system has become far more restrictive than it need be. Many publishers will not even allow scholars to use and distribute their own work. And, the cost of journals has risen to such astronomical levels that many institutions and individuals have cancelled subscriptions, further reducing the circulation of scholars’ works "(7).
The announcement then adds:
Why does Harvard consider its decision so important? And why should we European sexologists even bother to take note of it? In order to answer these questions, allow me to give you some background information.
The free dissemination of scientific knowledge has long been an ideal shared by many academic writers. It became a hotly debated topic with the arrival of the internetand the formation of an "open access" movement demanding free access to digital scientific and scholarly material. Thus, in the last few years, concerned scholars have issued several "open access" declarations in Budapest (2002), Bethesda (2003) and Berlin (2003), collectively called the BBB Declarations (9). These declarations and the various responses to them are a vast subject in itself, and here I cannot discuss all of its implications. Instead, I will simply concentrate on one of its aspects – direct publication online, and I will give you a practical example:
My own web site was originally part of a larger site run by the Robert Koch Institute, a German federal research institution supported by the Ministry of Health. As such, it was, from the very beginning, freely accessible as all other German government web sites are. When I retired seven years ago, the government closed my unit and encouraged me to take the then still very modest web site with me as my own. I then transferred it to the server of Humboldt University in Berlin. However, to this day, the university has not found any use for my online offer and does not support it. Thus, in law and in fact it remains my private property, and I have been paying for it out of my own pocket ever since. Indeed, I have redesigned, constantly updated and greatly enlarged it. I have also kept all of it freely accessible, because I am convinced that "open access" is the way of the future. Please, allow me to quote myself from the introduction to my online sexual health curriculum:
"I believe that, in the long run, it will not be possible to keep scientific information restricted to paying customers. Eventually, all of it will become freely available in the internet and other electronic media. … Scientific research… has always been published in print, but the new electronic media are expanding its reach and increasing the speed of its distribution. They are also changing the economic ground rules, because they can make all public research freely accessible to anyone who is interested. Still, so far, few academic institutions seem to have grasped the implications of the electronic revolution. Most of them continue to restrict their information to their own pre-paying students. …A similar observation can be made with regard to the publishers of scientific journals. Some of them sense that the economic ground is shifting beneath their feet. Therefore, they insist on owning the copyright to all articles they publish and try to restrict access to subscribers or pre-paying online readers. Quite clearly, this is not in the interest of their authors who receive neither honoraria nor royalties and who would welcome more readers. Indeed, the unpaid authors will eventually come to see this arrangement as an unnecessary obstacle to the free exchange of ideas. Since many of the journals are the official organs of scientific organizations and are largely financed through membership fees, the members will one day realize that they can "cut out the middleman" and reach a much larger readership by publishing freely accessible issues directly online" (10).
This is the context in which Harvard made its decision to provide an "open access" platform for its faculty members:
"The goal of university research is the creation, dissemination, and preservation of knowledge. At Harvard, where so much of our research is of global significance, we have an essential responsibility to distribute the fruits of our scholarship as widely as possible…Today's action …will promote free and open access to significant, ongoing research. It is a first step in the creation of an open-access environment for current research that may one day provide the widest possible dissemination of Harvard's distinguished Faculties' work" (11).
In other words, the faculty members want as many readers as possible for their unpaid articles and therefore want to control the distribution themselves. Or, to put it more bluntly: What we are seeing here is the open rebellion of academic authors against the traditional journal publishers, and Harvard is supporting the rebels.
Naturally, the publishers now see their very existence threatened and have therefore developed some counter strategies. For example, they argue that the necessary peer review of articles would be lacking in "open access" online publications. However, this argument is easily refuted, because many successful examples have already shown that
"open access is compatible with copyright, peer review, revenue (even profit)…prestige, career-advancement, indexing, and other features and supportive services associated with conventional scholarly literature. …The primary difference is that the bills are not paid by readers and hence do not function as access barriers " (12).
Not surprisingly, therefore, "open access" publications like the Public Library of Science (PLoS) and Biomed Central have a much wider readership than "pay per view" journals (13) However, these new online projects do not offer a lasting solution either, rather the contrary. While they give free access to readers, they still charge publication or membership fees, thus shifting the financial burden to the authors and, once again, to the libraries. Indeed, this kind of "open access" could end up being more costly to all of us than the present system. So who should eventually "pay the bills"? Again, Harvard, Yale, and the M.I.T. have shown us some of the ways:
1. The university itself, foundations and sponsors can very well maintain "open access" web sites.
2. Some of these sites also finance themselves through advertising, or they provide additional special services for a fee.
3. Moreover, university libraries, unable to pay the rising cost of journal subscriptions, might use the money they do have more wisely by starting online publication platforms of their own. Indeed, libraries could form cooperatives, pool their financial resources and thus could end up offering more journal articles to their readers at a lower cost than ever before.
4. Many universities already have their own publishing companies, i.e. university presses. These can more closely cooperate with their libraries and add "open access" journals to their regular publishing programs. This kind of cooperation can greatly reduce cost. The cost can be reduced even further if several university presses cooperate with each other and run the "open access" sites together.
5. And let us not forget the membership fees of those scientific organizations with their own journals! Instead of going to print publishers, these fees could just as well go directly to the organizations’ own web sites.
However, the possibilities do not end there, as I will explain shortly when discussing the new opportunities of e-learning.
In any case, it should already be clear that, in my opinion, the European Federation of Sexology (EFS) made a serious mistake when it recently took its journal "Sexologies" to a new print publisher instead of publishing it directly online. It was a step backward into the past instead of a confident stride into a promising future. As it stands now, the publisher charges prohibitive fees for very limited access and also forbids the authors to put their own texts on freely accessible web sites. Thus, instead of striving for global recognition, the EFS journal chose to retire into self-imposed and self-satisfied provincial obscurity. It will remain unknown and unread exactly where it could do the most good - in the poor European countries and, generally, in the developing countries of Latin America, Africa and Asia where sexology can expect its greatest expansion. Indeed, in contrast to the timid EFS, the newly founded World Association of Chinese Sexologists (WACS) has just set a future-oriented example by starting its own journal "Chinese Sexuality Research" directly online (14).
Still, freely accessible online books and journals will only be part of our future. Anyway, it will take years to replace the current publication system with a comprehensive "open access" system deserving of that name. More important and much easier to achieve will be the open access to actual academic courses, indeed to whole curricula leading to certificates, diplomas, and academic degrees.
Earlier, I had mentioned the academic lecture videos by professors at the UC Berkeley and Yale University that are now freely available in the internet. Yale even explains why this serves its own long-term interests:
"While it has long upheld the principle that education is best built upon direct interactions among teachers, students, and staff, Yale also believes that leading universities can make an important contribution to expanding access to educational resources through the use of internet technology. The goals of the project also align with the University's aim to increase its presence and strengthen its relationships internationally." (15)
Filming lectures for the use of students is nothing new, of course. Over 30 years ago, when I was teaching in San Francisco at The Institute for Advanced Study of Human Sexuality, we already routinely filmed every lecture by every faculty member and visiting scholar. The lectures were then put on video and could be studied at leisure over and over again by all of our students. The difference today is that such videos are now freely distributed in the internet by the UC Berkeley, Yale, and other traditional universities.
Obviously, these videos offer several advantages:
However, the videos also have some disadvantages:
Nevertheless, many universities now produce lecture videos of classes taught by their faculty. Often they combine the videos with material copied from books and journal articles written by various authors and then make the whole package available to their own, officially enrolled students. In addition, they usually combine the internet offer with some form of personal interaction on campus between student and teacher in special classes and seminars. This system, which blends internet instruction with traditional teaching methods, has now become known as "blended learning". Obviously, for reasons of copyright, the internet element in such packages cannot allow "open access", but must remain restricted to a university’s own pre-paying students. This is also true if the packages are used in distance learning programs. In order to avoid any possible copyright infringement, such programs therefore charge registration fees and tuition before they make the courses available to the users.
There is no question that these developments greatly facilitate both teaching and learning and thus amount to real progress. However, I believe that this progress can go much further much faster than most universities realize.
First of all, in our present global information society every academic teacher faces the direct world-wide competition of his or her colleagues. As we have already seen, lectures can easily be compared with those given by professors at the UC Berkeley and Yale, for example, and the quality of course materials can be measured against those offered by the M.I.T. Also, free services like the popular Science Daily provide constant updates of new research, including sexual health research (16). Not only that: Any subject taught and any factual statement made can be independently researched and cross-checked by the students with the help of Google and other powerful search engines. None of this needs to intimidate dedicated teachers. On the contrary, they will consider it a challenge and a help in improving their own performance. However, there is a more serious problem lurking in the background:
As already mentioned, for copyright reasons, many online courses remain restricted to pre-paying students, and this also true of distance education. Yet, at the same time, we see more and more solid scientific information becoming freely accessible in the internet, and more and more of it covers the same ground as do the restricted courses. Indeed, much of this free information is already didactically structured and illustrated for easier comprehension. Therefore it will become harder and harder to justify the present access fees for certain general, introductory courses in distance education programs. For example: Why should a student pay for basic information about sexually transmitted diseases, contraception, or infertility, if he can get it for free from the Harvard Medical School,to say nothing of dozens of other specialized authoritative sources? In the end, the only valid justification of access fees will not be the information as such, but the university’s good name, its ability to pre-select, evaluate and structure the freely available information for its students, the guidance and personal attention of its teachers and, most important of all, its right to award certificates, diplomas, or degrees
This brings me back to my earlier point, namely that it is no longer possible to sell information in the internet. I believe this also applies to the content of university classes. If this content is worth knowing, it is worth sharing, and this means that, sooner or later, it will have to become openly accessible. After all, even if a certain text is controlled and restricted to a select group of pre-paying readers, it takes only one of them to copy it and make it instantly available to dozens of "unauthorized" friends, and each of these can do the same. This kind of financial control is an illusion.
Now, where does that leave the university and its professors? If they cannot escape the demand for "open access", how can they generate a sufficient return on their investment of knowledge, effort, equipment, and expenses? And, more specifically, what does all of this mean for sexology?
Actually, it means the most welcome news we have heard in a very long time. The "open access" movement gives us sexologists the best break we have ever had or are likely to have. All we have to do is to take advantage of it.
The first thing we must realize is this: The internet is a global medium. That sounds like a platitude, but it is remarkable how few universities really understand this simple sentence. Neither do they understand their own role in the new global context. Universities and scientific organisations are repositories of knowledge, and they exist for the sole purpose of preserving and increasing this knowledge for the benefit of their contemporaries and future generations. This is why they maintain libraries, publish books and journals, and train students to continue the knowledge transfer from one generation to the next.
The internet now enables us, indeed, forces us, to turn our attention to the next generation not only in our own countries, but in countries all over the world. There are millions of highly intelligent, highly motivated potential students in developing countries who, until now, have never had a chance to receive professional training or a university education. Many of them are too poor to take advantage of the opportunities that do exist in their region, but most often there are simply no libraries and no institutions of higher learning anywhere near where they live.
However, a growing number of these young people have access to the internet. Not only that: There is now also a number of "internet universities", i.e. degree granting institutions that exist mostly or even only online. Some of them simply have one central office, others have regional centers in various locations. In any case, these universities offer distance learning programs at both the undergraduate and graduate levels to part-time students in many fields, from the humanities and health care to business and management, engineering, mathematics and statistics, and the law. Two of the better known of these online institutions are The Open University in the UK and the University of Phoenix in the USA (17).
At the same time, we know of at least 30 sexological training programs in 20 countries that offer certificates, diplomas, or degrees to their students (18). Some of these programs also provide distance education. However, we can only guess at the quality. We do not know whether they provide the same basic knowledge, incorporate the most recent research, reflect the current scientific consensus, encourage critical thinking, use the same terminology, or meet the same academic standards. Since they remain restricted to their own students, outsiders have no way of comparing these programs.
On the other hand, the students themselves can make comparisons by looking at related online offers and checking various authoritative sources in the internet. This gives scientific organizations the opportunity to develop and promote international standards. In the field of sexology, an excellent example is provided by the World Health Organization (WHO), which, as early as 1975, issued its recommendations for the sexological training of health professionals and, in 2001, cooperated with others to spell out several detailed curricula for such training (19). More recently, the European Society for Sexual Medicine (ESSM), in a joint initiative with the European Federation of Sexology (EFS), has developed a "Sexual Medicine Curriculum" (20). All of these documents are freely accessible in the internet. Actually, setting standards for the training in sexual medicine has long been a goal in many countries. In the future, these efforts need to be coordinated at the international level. For Europe, this is a task the European Academy for Sexual Medicine (EASM) has set for itself (21).
However, sexual medicine is only one of several special branches of sexology. I believe that it is even more important for us to devote our energy to world-wide general sexual health education. This is, of course, a much more difficult task, because sexual health is not just a medical issue. It has important socio-cultural, i.e. religious, social, legal, economic and, indeed, political aspects. Dealing with any of these can easily involve educators in minor and major political battles. Sexual health advocates therefore need an ideological basis on which to take a stand, i.e. a set of principles that is shared by their colleagues everywhere. These principles must be clearly stated.
Recognizing this need, the World Association for Sexual Health (WAS), in 1999, adopted a "Declaration of Sexual Rights" and appealed to the world to support the political goals of a special "Millennium Declaration" for the promotion of sexual health (22). Sexual rights are still lacking in many countries, but without them world-wide sexual health cannot be achieved. At the same time, WAS also imposed obligations on itself by adopting a "Code of Ethics" and a set of "Guiding Ethical Principles" for sexologists (23). It thus followed the example of many other scientific and professional organizations whose codes of ethics are available for comparison (24).
With all of these detailed recommendations and declarations already in place, we can - and we must - now devote ourselves to their practical application. Indeed, several far-sighted sexologists took up the challenge early on. Thus, it did not take very long before the first sexological publications became freely accessible in the internet. 10 years ago, my former place of employment, the Institute for Advanced Study of Human Sexuality (IAHS) in San Francisco, began its "Electronic Journal of Human Sexuality" containing whole doctoral dissertations, research papers, and book reviews. Similarly, the American Academy of Clinical Sexologists (AACS) proceeded to put its dissertations online (25).
These examples inspired me to start a sexological online library on my web site as well. However, in contrast to the others that offered their texts in a simple, picture-page PDF format with its long loading time, I decided from the very beginning to present all pages in a fast-loading, searchable HTML text format which is more difficult to produce, but much easier to read. As a result, my online library soon became very popular in many countries, especially since I was also able to include texts in several languages. Today, I am, in fact, able to offer online libraries in English, German, Spanish, and Hungarian. These libraries also keep growing; almost every month we are able to add more titles. Undoubtedly, the whole project now represents the largest sexological online library in the world (26). However, its most important, and most gratifying, aspect is the fact that it is a collaborative effort: It exists, because idealistic colleagues from every continent contribute the books and papers to which they own the copyright. Unfortunately, many now discover that they have signed away their copyright to journal publishers, and these prevent them from republishing the papers in the internet. Even so, I expect a steady expansion of our online library as more and more authors regain control of their own work.
The most satisfying response, however, once again came from some of my unselfish and far-sighted colleagues. Native speakers of Spanish, Hungarian, and Czech began to translate the courses as they became available, and they did this without any financial reward - simply because they were fascinated by this new medium and realized its potential. In fact, 4 years ago, when I had the opportunity to demonstrate my courses in Beijing’s Great Hall of the People (28), eager Chinese colleagues volunteered to start a Chinese translation which is now about to be completed in two versions - simplified (used in the People’s Republic), and traditional (used in Hong Kong, Taiwan, Singapore, and by the "overseas" Chinese). When you think of the growing number of Chinese internet users, you can understand the enormous educational value of these translations. Just last month, the American press reported that China now surpasses the US in internet use (29). In any case, thanks to the spontaneous, voluntary cooperation of sexologists from 3 continents, our multilingual free online sexual health curriculum has now turned in to the world’s largest e-learning project with millions of monthly users in over 100 countries. In the meantime, platforms such as Wapedia have even adapted the courses for mobile phones (with or without pictures), thus making them available to an entirely new, enormously large readership (30). Indeed, I believe that, within the next 5-10 years, the transfer of scientific information per mobile phone will become increasingly important, not only in Western countries, but also in Asia. Right now, most universities do not yet seem very interested in this future development. For us sexologists, it will present yet another chance and an even more challenging new frontier.
I have taken the liberty of mentioning these two projects, because I believe that they can serve as models for what we sexologists can and should do in the future. The cooperation I have described was a spontaneous response to a concrete project that everyone in the field could see, understand and put to immediate use. As this cooperation continues and grows, so will our ability to promote our common agenda.
The example of my own web site shows that "open access" has the power to bring us together in pursuit of our common goal - the promotion of our field, the world-wide acceptance of sexology. Open internet access has put this goal within our reach, because it has opened the door to a world-wide readership in both rich and poor countries. We can now find and directly address millions of potential students, including vast numbers of women and men who never had a chance to receive health education before. At the same time, we can introduce ourselves as trustworthy authorities. However, in order to take advantage of our new opportunities, we all must understand the unique advantages of "open access":
1. An "open access" site has, by its very nature, more readers than a restricted site.
2. An "open access" site is attractive to commercial advertisers because of its high traffic volume.
3. An "open access" site is also an advertisement in itself, i.e. it advertises the services of the university or organization that runs it, thus creating global name recognition.
What does this mean for world-wide sexual health education? It means, first of all, that, in the future, we will have to think differently about how we publish our work. If we want to find a truly global readership, we must choose the medium with the widest global reach. In practical terms:
There is no doubt in my mind that, in combination, these steps could greatly advance our common agenda and gain us sexologists greater global recognition.
For some, suggestions like these may sound radical and unreasonable. The enormous amount of additional work may seem frightening, the additional cost may seem prohibitive, and it may seem impossible to generate any income from the courses. In short: It may seem that there is no way of ever seeing a reasonable return on the required investment. However, as I pointed out earlier when talking about direct online publishing, there are several proven ways of financing "open access" sites. Indeed, in the case of online courses, there is an additional, potentially very lucrative way.
We have to accept the fact that, in the long run, no one will remain able to sell information in the internet. Information that is restricted to paying readers will, in the end, simply be ignored, because the same or equivalent information will be freely accessible online. However, it is also clear that colleges, universities, and scientific organizations will always be entitled to ask their students for money, whether they live on campus or in distant lands. In other words: In the future, students, wherever they are, will expect and receive free access to e-learning courses, but they will gladly pay tuition and fees for the chance to earn an academic degree, diploma, or certificate.
This is exactly the point at which the "open access" principle pays off for the providers, especially in distance education. Free sexological sites will be found by millions of interested users, and many of them are potential students. Since even the distance education courses can be read in advance without pay, the readers know their quality and can compare them to similar offers. Thus, a good training program can attract many more students than was ever possible before. All of them can be invited to apply, register, get in touch with their professors and fellow students, send in their assignments, and take their exams - all online and, possibly, at greatly reduced cost. Even so, the educational institution or organization may end up making more money this way than with any traditional teaching method. Thus, if used wisely, a good "open access" site can turn into a money printing machine.
Obviously, since the same free courses may form the basis of different programs in different countries, there is bound to be some competition between universities trying to attract the best or the largest number of students. Here, several factors will come into play - the university's name and reputation, the academic record of its professors, the price of tuition, the duration of the program, the quality of its interactive components, the individual attention given to each student, etc. Given the right combination of factors, formerly unknown small colleges may, in certain disciplines, rise to positions of international prominence, and schools that are now world-famous may fall behind. In any case, those universities that insist on developing their own restricted programs, must know that they nevertheless remain in competition with the freely available courses. After all, they will be freely available to their own paying students as well. These will compare all internet offers and continue to pay tuition only if their restricted courses are better than the others.
As I mentioned before, there is now an increasing number of "internet universities". However, since none of them offers sexual health education of the kind recommended by the World Health Organization (WHO), it is up to us to seize the opportunity and to meet the enormous world-wide demand.
Yes, we are now called upon to be pioneers, to enter the new frontier of online teaching and to conquer its vast territory. Many potential students have, so far, been excluded from higher education, including sexual health education. Thanks to the electronic revolution, they can now benefit from our efforts. However, if we hesitate and refuse to go forward, we betray their hopes and condemn ourselves and the entire field of sexology to irrelevance. Instead, let us seize this unique historical moment. The internet is waiting to give all of us "open access" to a bright future.
2. UC Berkeley, video lectures:
4. For example:
- ICD (International Classification of Diseases) and Medical Terminology Dictionary 2006: http://icd9cm.chrisendres.com/
- Columbia Encyclopedia, Sixth Edition http://www.bartleby.com/65/
- MEDLINEplus: Medical Dictionary: http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
- Merck Manual of Diagnosis and Therapy: http://www.merck.com/pubs/mmanual_home/contents.htm
- Wikipedia: http://www.wikipedia.org/
- Stats4Schools: http://www.stats4schools.gov.uk
Open Yale Courses: http://open.yale.edu/courses/index.html
6. Harvard University Gazette Online, Feb. 13, 2008:
9. The BBB Declarations: http://wiki.icommons.org/index.php/The_BBB_Declarations
10. E. J. Haeberle, Introduction: Purpose and Use of
11. Harvard University Gazette Online, Feb. 13, 2008:
some free online journals devoted to health issues are:
13. Peter Suber, op. cit.
- Science Daily (Sexual Health) http://www.sciencedaily.com/news/health_medicine/sexual_health/
18. Sexological Training Programs: http://www.sexarchive.info/TRAIN/index.htm
19. World Health Organizations (WHO):