Yury Zharkov: Three Contributions of Russian Sexology to National Sexual Reform

1. Introduction

The idea that Russia needs sexual reform on a national level was born in discussions within the Russian Sexological Society.

In general, the current situation in Russia is well known:

There is a trend of depopulation (Fig.1), and in politics there is a trend toward authoritarianism. Russians now often joke that an "oil world view" is dominating their government. Indeed, many see the Soviet era returning with its goal of establishing full control over all public life.

Fig.1

The idea of a Russian national sexual reform was presented to the scientific community for the first time at the conference held by the Nordic Association of Clinical Sexology (NACS) in Helsinki in October, 2012. This paper describes three contributions of Russian sexology: 1. A concept for birthrate regulation, 2. An addiction prevention and education model based on the concept of an Impaired Sexuality Syndrome (ISS), and 3. A methodology for transcultural opinion surveys.

2. Brief historical overview

Historically, the sexual culture of Russia can be traced back to the seasonal erotic and mating rituals of Slavic tribes and peoples. These rituals promoted positive attitudes towards pleasure and reproduction. Then followed a period of "soft" domination by Christianity with a relatively tolerant attitude toward sexuality and, after that, the country saw a brief flowering of freedom and erotic culture during early days of the Russian Revolution. Finally, there were the dark times of a repressive sexual morality from the end of 1920s until about half a century later. The "age of darkness" for Russian sexology continued until the end of the 1960s when the totalitarian regime slowly began to loosen its grip (Kon Igor S. (2001).

The results were deplorable:

- There was a prolonged absence of sexological research.

- All social manifestations of sexuality became distorted.

- Russians experienced a denial of sexual rights and freedoms, an increase in sexual violence, homophobia, and a complete lack of sex education. Maternity was the only approved sexual model.

Toward the end of the 1970s, a powerful state medical sexology system was created, providing care to the entire population. It was designed for both treatment and sexual outreach by a professor of medicine, George Vassiltchenko. As a pioneer of modern medical sexology in the USSR and Russia, he had followed classical ideas of medicine and introduced them to his home country. He designed a diagnostic system of sexual disorders based on different combinations of sexological syndromes, and he described their development as well as their interdependence (Vassiltchenko G.S, ed., 1977). Interestingly, Vassilchenko combined his concept of a "sexual constitution" with Alfred Kinsey's data and created an algorithm for specific diagnostic purposes. In Russian sexual medicine this concept continues to be employed in spite of the fact that It was developed at the beginning of the 20th century. In those days, there was still an intensive intercultural exchange between Russia and Western Europe. European concepts of human sexuality were widely accepted, and, as some Russian doctors, who had patients with sexual problems explained: People are different in their sexual lives and activities, because they differ in the anatomy and physiology of their sex systems, i.e. patients differ in their sexual constitutions. (Jacobson, Ludwig 1915). These ideas never reached Western Europe because of the subsequent repression under Stalin.

G.S.Vassiltchenko

However, in the 1970s a small group of enthusiasts joined in a struggle for personal sexual rights, against violence and homophobia. Igor Kon was their well-known leader. Russian citizens also remember Prof. Alexey Ignatov who authored a bill to stop criminal prosecution for consensual homosexual contact, and also offered other amendments to the Criminal Code of the Russian Federation. They also remember Prof. Abram Svjadosh, the organizer of medical sexology in Leningrad (today once again St. Petersburg), who wrote the first monograph about the sexuality of women. The book became an instant bestseller.

I.S.Kon

After a collapse of the USSR, a rapidly growing liberation movement led to a partial restoration of sexual rights and freedoms and the development of sexual outreach. Not surprisingly, this process was accompanied by an increased visibility of pornography, prostitution, sexual violence, an increase in abortions, and a reduced birthrate. However, all attempts to introduce sex education in schools faced strong opposition from government bureaucrats and the Church.

Now Russians formally live in a nearly liberal sexual culture, but this culture is not really supported by their government. Instead, we see a growing anti-gay extremism and a continued lack of sex education. We also see a trend to merge state and religion. Under these circumstances, it is difficult to expect progress in public sex education in the near future.

3. The current situation of Russian sexology

Today, Russia has only one medical sexology research center. It is located at the Moscow Research Institute of Psychiatry. Naturally, it deals predominantly with psychiatric issues in medical sexology. There is no specialized council for sexological dissertations, and sexology does not exist as an independent scientific enterprise. It is impossible to obtain a degree in sexology.

This situation has continued since the Soviet era and still shapes public attitudes. Many people - schoolteachers, government officials at different levels of power and even some sexologists - still cling to the mistaken belief that all issues related to sex and gender should be referred to medical sexologists.

No regular sexological conferences are being held, only conferences of mental health. Urological and gynecological conferences sometimes contain sections on human sexuality. In Moscow, we have only one annual sexological forum, supported by the Ministry of Public Health and Social Development. However, this forum is dedicated exclusively to men's health. Some Russian sexologists also participate in seminars during annual "erotic fairs", which advertise sex toys etc.. Indeed, the respective businesses invite sexologists in order to raise the prestige of these fairs. However, not all doctors want to cooperate with such commercial enterprises.

3.1 Professional associations and training

Russian sexologists are organized in the Russian Sexological Society (RNCO). Since 2007, the society counts about 100 sexologists, who are active in the areas of outreach, education and training. Training for sexual medicine and medical psychology is carried out at the following institutions: The Moscow Research Institute of Psychiatry at the Federal Center for Medical Sexology. In St. Petersburg it is the State Medical University, Department of Sexology. In Moscow there is also the State Research Center for Social and Forensic Psychiatry, Sexological Laboratory, which was organized in 1994. It produces ca. 200 expertises per year including cases from Moscow and different Russian regions (these are non-official data). In addition, in Moscow there is the Russian Postgraduate Medical Academy at the Department of Psychotherapy and Sexology and the private Academy of Social and Economic Development.
For a better understanding of modern Russian sexology, it is necessary to keep in mind that it exists both within and outside the government framework. Russian official medical sexology (including the legal framework, the state educational institutions and the state system for sexological care) aims to create the legal basis, a high quality trainings and care, and it monitors medical practices thorough certification, training, and licensing. However, non-state organizations develop counseling, training, and education for adult people. The Professional Psychotherapeutic League and the Russian Psychoanalytic Society develop and apply theoretical and practical aspects of West European approaches and ideas to sexological counseling. Anyway, state or non-state – the distinction is somewhat artificial, because many professionals simultaneously work in public hospitals and in commercial health centers. But, we should realize that in Russia the official state sexology is medical sexology, and sexology in it modern sense is being promoted primarily outside the state by sexological communities.

3.2 Professional training and practice regulations by the Ministry of Public Health and Social Development

By order of the Public Health and Social Development Ministry (Appendix 1, Table 1) medical sexologist must have post-graduate training in psychiatry. The state norm is one sexologist working in a psycho-neurological dispensary in cities with a population of 250 000 people. Therefore, many people who live in towns and villages, cannot get help, and patients are forced to seek out gynecologists and urologists. There are another state norms, for example: One urologist for a population of 20 000 people. At the same time, in cities and capitals there are many sexologists working in commercial clinics. There, people seeking help can more easily make appointment to get help from an expert.

3.3 Restrictions by Federal law

On September 1, 2012, the Federal Law N 436-FZ took effect in Russia: "For the protection of children from information which is harmful to their health and development". This important law tries to stop the spread of information about violence, alcohol, and drugs. However, it also includes a highly questionable sexological part. (There are some quotes in Appendix 1, Table 2.)

First of all, the law contains a short and very broad definition of pornography. This definition can land not only many artists in court, but also sexologists and sex-educators, if their textbooks with their pictures and slides happen to be seen by children. By law, there are no "teenagers" in Russia, only children from 12 to 16 (Quote 4). Some people suspect that the sexological content of this law reflects the interests of a small group of top bureaucrats who want to make money from granting permissions or imposing prohibitions when dealing with certain kinds of information. At any rate, the sexological concepts in the law are unscientific and unacceptable. Lawyers also criticize the law for the vagueness and imprecision of its definitions. This law puts unnecessary restrictions on the work of sexologists and blocks any attempt to introduce sex education in Russian schools.

3.4 No general sex education in Russia

We never had general sex education in Russian schools, only some modest attempts and limited projects. Now, with the new law in force, even these are likely to cease. Why is sex education impossible in the present situation? In general, the educational system in Russia, just as in some other countries, is based on two models or traditions (Petranovskaya L., 2000). According to the first one, education takes place "from the top down". The government, its bureaucracy, and the Church define the framework, striving to instill values in children that are compatible with the existing ideology. This education is, by its very nature, always conservative, and any attempts to change the status quo are fiercely resisted by the system’s supporters. The system justifies violence in some forms; it is based on dogmas, and relies on compulsion rather than arguments.

The second model is democratic. Parents are perceived as customers who pay for their children's education directly (as in private schools) or through taxes. This model is more flexible, which sometimes makes the study less uniform and systematic. Still, such schools are better geared to prepare children and teenagers for real life, since they focus not only on the transmission of scientific knowledge, but also on the healthy development of their young students children.

In order to understand the contemporary Russian school, we should remember that both before the Bolshevik revolution and during the Soviet period the educational principles were based on the first model, conservative and inflexible. This tradition had a significant impact and continues to prevail, though some changes are being slowly introduced. The traditional system neglects children's rights viewing them as "a vessel to be filled with knowledge". This explains why even the most brilliant projects and ideas developed within the democratic system framework will not be accepted by the traditional system. Their acceptance threatens the existence of the conservative system. The proof for this point is the failure to introduce sexual education in Russian secondary and high schools.

4. Russian National Sexual Reform

Sexual reforms in Russia should not be considered as something special or extraordinary, but as a natural extension of other reforms, for example those in the Russian economy. Sexology in Russia should be recognized as an independent scientific enterprise. Indeed, we need a separate law to guarantee and to safeguard sexual research and human sexual rights . We also need a "Federal Institute for Sex Research" with an extensive network of departments throughout the country. Sex education for all should be initiated in cooperation with the various branches of the Institute. In the first phase of sexual reform, a working group should be created to prepare a draft of the law and the constituent documents of the Institute. The group should also provide estimates of the financial costs involved. This stage would end with passing the law and providing the necessary financial support. In the second phase the Institute would conduct training for sexologists, i.e. researchers and educators. In the third phase opinion surveys and other studies and three types of sex education programs should be launched including sex education for teens, programs for parents and for schoolteachers. These reforms aimed at future generations would lead to a rapid positive movement in sexual culture and improve the demographic situation in the country.

5. Three contributions o f Russian sexology

Russian sexologists can offer three contributions to national sexual reform: 1. A method of birth rate regulation, the concept of Impaired Sexuality Syndrome (ISS) in alcohol and drug abuse, and a methodology for transcultural opinions surveys. The following sections describe them in detail.

5.1 Birth rate regulation

The concept for birth rate regulation consists of multidisciplinary prezygotic sex determination theory (Zharkov Y., Zharkov Y., et all, 1997), a Russian patent "The method for choosing a baby’s sex before conception" (Zharkov Y., 1995), and additions to sexual and reproductive rights. This would be augmented by professional Codes of Ethics, training modules for sexologists, and an education program for couples.

An attempt at human birthrate regulation was made in Russia from 1999 to 2009. In 1999 patent restrictions were lifted, we discussed ethics of reproductive technology and published in the Internet a surrealistic story about 50 pages called "Neither son nor daughter!". It had the method's description attached. From the preface:
"This book is based on real-life situations supplemented by elements of fantasy. It contains scientific information. A new method allows couples to choose the sex of their future child without any risk for health to the baby and the parents. A woman and a man should form a couple united in love, eroticism, and sexual contacts. Choosing a baby's sex strengthens the marital relationship because it prevents abortion. If a couple can plan a pregnancy, the development of a new life will not artificially terminated. We should not forget the two most important and interdependent functions of sexuality: The raising of children and the joy of their parents’ intimacy. Women and men find a new meaning in their sexual relations through their desire to continue themselves in their children."
And Russia boomed as it chose the sex of its babies.

Today, birth and death rates are almost the same in Moscow (Fig.2). It is only in the Southern regions of Russia where fertility exceeds mortality (Fig.3). It is not possible to prove a causal relationship here, because we lack the necessary research. Perhaps be we are seeing the beginning of a natural process of restoring the population size, but it is also possible that the public discussions about the selection of a baby's sex really are influencing reproductive attitudes. Since 2007, Russian families get a "parent bonus" of about 10 000 Euro for the second-born or adopted child, but the family will have access to these funds only after the child reaches the age of 3. We do know that monetary incentives alone do not increase birthrates. Perhaps a combination of factors is at work. Perhaps we will know more when the necessary studies have been done.

Fig.2

Fig.3

Another result of our project is the emphasis on human sexual rights. The first sketch of a Declaration of Sexual and Generative Basic Rights was presented by Rudolf Goldscheid at the 4th congress of the World League for Sexual Reform in Vienna 1930: Magna Charta of Human Sexual Rights. Two paragraphs of this document were ignored in subsequent versions of Sexual Rights Declarations: "Human rights before birth" and "The sexual and generative responsibilities of the individual and of society". What is the reason for this omission? Is it the unresolved question of who will take the responsibility for enforcing these rights? We think that it is the responsibility of the couple. But again, what is a "couple"? Do we mean only married couples? Perhaps this question is irrelevant.

Based on the two positions mentioned above, we offer the idea of the "Sexual and Reproductive Rights of the Couple". Choosing a baby’s sex then is a couple’s "sexual and reproductive right". It is the couple that takes responsibility for human rights before birth. The couple also has a reproductive responsibility in relation to society. By the same token, society has the responsibility to support couples in choosing their baby’s sex. This means, among other things, that no person, organization, or government should restrict the right of couples to choose the sex of their future child or to promote the priority of conception of either boys or girls.

Fig.4

Most couples prefer a family with two children of different sex (Fig. 4). Therefore, no major changes in the sex ratio will occur, if even all couples apply the method. Conversely, if a state or society forbids people to achieve their reproductive goals or encourages the preference for male children, there may be changes in the sex ratio. See Fig 5 for practical aspects of the relevant studies.

Fig.5

5.2 Impaired Sexuality Syndrome (ISS) in drug and alcohol abuse

Many people in Russia and all over the world suffer from addictions. Unfortunately, the treatment has a high failure rate, so prevention is of exceptional importance. The concept of an Impaired Sexuality Syndrome (ISS) describes the role of sexuality in these addictions (Zharkov Y., 2002). The syndrome consists of three interrelated and drug use-related symptoms consistently found in drug and alcohol abuse:

a). reduced libido (reduced or irregular sexual activity, indifference to oneself as a representative of one's gender, over-emphasized or vulgarized eroticism),

b). subordination of libido to the consumption of drugs or alcohol (the addicted person first uses drugs or alcohol before sex; drugs are of primary, relationships of secondary importance),

c). lack of self-criticism (indifferent attitude towards negative changes in the addict’s intimate life).

The syndrome has specific dynamics and degrees of severity, and it varies with different types of addiction. The concept of the syndrome is helpful in the diagnosis, treatment, rehabilitation, and prevention of the patient’s problems, because it destroys the myth of positive effects of alcohol and drugs on sexuality.

As sexologists, we created special psychotherapy and sex education programs aimed at rendering more effective aid to drug and alcohol addicted people during their rehabilitation. In a more general way, such programs included three stages and were aimed at supporting the patient’s sexuality in its competition with addicted behavior (Zharkov Y., 2009).

5.3 Methodology for transcultural opinion surveys in sexology

We offer a new approach to comparative research for attitude opinion surveys.

A survey should reveal the quanta of typical behavioral patterns. Sexological categories included in a questionnaire should therefore reflect both social and personal factors. With this in mind, we turned to the categories postulated in E. Burn's theory. Fundamentally, the quanta of typical sexual behavior have both cognitive and emotional contents, and also fulfill a prognostic, or anticipatory function i.e. the intuitive component (Fig.6).

Fig. 6

To identify all these factors in the cases of individual respondents, we use so-called semantic compositions, which, like the quanta themselves, include all three elements. This methodology (http://sexarchive.info/BIB/ZH2/zh.htm) greatly widens the scope of sexological studies because 1. it allows for a greatly increased amount of sexological information and, 2. It abandons the idea of a "standard questionnaire for all" . Instead, it provides a "tree of hierarchic sexological categories". This tree of categories is the theme for professional discussions and agreements and looks like the result of a preliminary study. After that is done semantic compositions should be developed for every category, and native speakers must translate them whenever possible to better express the emotional nuances of Bern's "Parent, Adult and Child". In other words: The texts lines in semantic compositions are not subject to professional discussion, but are the task of an interpreter.

The essence of this preliminary study is to suggest an association between the professional point of view and the real views in any social group. Therefore, the total process of questioning reveals how it matches these ideas (Anastasi A,1982).

An example of a tree of sexological categories is offered below (Zharkov.Y., 2009). The categories of this tree conform to those in the 2008 WAS Declaration Sexual Health for the Millennium.

Sexual Health Attitudes’ Components

Primary (I, II, III) and secondary (a,b,c) sexological categories included:

I. Level of sexual knowledge about

a) sexual health

b) gender equality

c) sexual rights

II. Sexual activity preferred

a) free love

b) marriage

c) sex work/prostitution

III. Self-estimation of sexual health

a) intensity of libido

b) intensity of sexual activity

c) experience of pleasure and happiness

Results analysis is leading to three fields of descriptions, as there are three types of calculations: 1. - frequency characteristics of every viewpoint estimated by statistics (as it is in a current tradition for survey analysis) - Fig.7; 2. - an estimation of intensity of Bern's categories in a social group studied - Fig.8; 3. - an estimation of intensity of Social norms, Actual opinions (attitudes), Personal norms, and Excluded opinions by a special math procedure called Social-Personal Coordinates Diagrams - Fig.9. It is an original statistics calculation for semantic compositions only and still under construction. For more information, please, visit www.semagroups.com (English) or www.semagroups.ru (Russian). All this together allows a researcher to make a detailed portrait of a social group. It is very suitable for young sexologists writing dissertations.

Fig.7

Fig.8

Fig.9

Once created and coordinated by experts a structure (tree) of sexological categories can easily be converted into a questionnaire (a list of semantic compositions) and can be translated into different languages for opinion polls. Such a profile will identify the same sexological categories in any culture medium.

Of course, a questionnaire should be complemented by necessary information about a respondent (age, sex, gender, occupation, etc.). These items were not discussed, because they do not fit in semantic compositions’ concept.

Longitudinal studies will observe categories’ behavior under different conditions, for example, during sex education in different countries.

The proposed approach seems to be relevant, because today we see an umprecedented world-wide migration of populations and a corresponding mixing of cultures.

6. Conclusion

Russian sexology today is multifaceted consolidation of recognized concepts, original theories and methods developed in the framework of a national sexological tradition. The Russian sexological community is open to communication, information sharing and participation in educational projects and research supporting sexual reforms in our country.

7. References

1. Anastasi A. Psichologicheskoe Testirovanie: Kniga 1. Perevod s angl. M.: Pedagogika, 1982, 320 p.

2. Bern E. Transakcionnii analis I psichoterapia. Perevod s angl . SPb., «Bratstvo», 1992 - 224 p.

3. Jacobson Ludwig (1915) Polovoe bessilie, Petrograd, Izdanie K.L.Rikkera, Morskaya 17.

4. Kon Igor S. (2001) Sexual Culture and Politics in Contemporary Russia. Paper presented at the International Social Science Conference, Dubrovnik, Croatia, June 12-16, 2001 - http://www2.hu-berlin.de/sexology/GESUND/ARCHIV/KON.HTM

5. Magna Charta of Human Sexual Rights. First Sketch of a Declaration of Sexual and Generative Basic Rights. http://www2.hu-berlin.de/sexology/GESUND/ARCHIV/MAGNA.HTM

6. Petranovskaya L. (2000) Two trends in education (Report at conference "Frontier 2000", dedicated to the forecast development in the XXI century in various aspects of human life), in "Russian language" newspaper, No. 33

7. Vassiltchenko G.S, ed. (1977): Obschaya Sexopatologia. Moscow,-«Medicina»:486 p.

8. World Association for Sexual Health. (2008). Sexual Health for the Millennium. A Declaration and Technical Document. Minneapolis, MN, USA: World Association for Sexual Health.

9. Zharkov Y. The Theory of Pre-zygotic Sex Determination - http://www2.hu-berlin.de/sexology/BIB/ZH/zhark2.htm

10. Zharkov Y., (1995) The method for choosing baby’s sex before conception. Patent.

11. Zharkov Y.N., Vasilchenko G.S., Masalskiy N.V.,Bitchenko A.I. (1997) : Human sexuality conception: the way to combine recreative and procreative sexuality functions. In.: 13th World Congress of Sexology, Sexuality and Human Rights. 25-29 June 1997, Valencia, Spain, Program. Abstracts. P. 205.

12. Zharkov Y. (2002) Sexuality of heroin addicts: applied aspects of studies. Sexologies. European Journal of Medical Sexology: VOL.XI-N39: 33-44

13. Zharkov Y. (2005) Methodology of questionnaires design for intercultural sexological investigations. Sexologies. European Journal of Medical Sexology. On-line: http://www2.hu-berlin.de/sexology/BIB/ZH2/zh.htm

14. Zharkov Y. (2009) Le Syndrome de réduction de la vie sexuelle chez les héroïnomanes In.: Psy Cause, N 55, 3e trimestre 2009, p.18 - 23

15. Zharkov Y., (2009) Sexual Health and Addictions Questionnaire (in Russian).

16. Zharkov Y. (2012) Sexology in Russia. In.: Pleasure and Health by education, counselling and treatment. Proceedings of NACS 2012 conference in Helsinki. Edited by Osmo Kontula. The Finnish Association for Sexology (FIAS) 2012, 164p., p.p. 95 - 97

Appendix

Table 1.

Regulations by Public Health and Social Development Ministry

Order number, year	Title	Notes
Public Health Ministry Order N 370 on May 10, 1988	"About further improvement of sexopathological health care to the population..."	Sexopathologist works in psycho-neurological dispensary in cities with a population of 250 thousand people
Public Health Ministry Order N 337 on August 27, 1999	"The list of specialties in health care of the Russian Federation"	Renaming Doctor-sexologist instead of doctor-sexopathologist
Public Health and Social Development Ministry Order N 415n on July 7, 2009	"Approval of qualifying requirements to specialists with higher and postgraduate medical and pharmaceutical education in health care "	Training in sexology for doctors is possible if they have post-graduate professional education in psychiatry

Table 2.

Quotes from Federal Law N 436-FZ "About a protection of children from information which is harmful to their health and development"

Quotes	Law Article & Item	Content
Quote 1	Article 2. The basic concepts used in this Federal Law. Item 8.	Pornography is information provided in a form of naturalistic images or descriptions of sexual organs and (or) sexual intercourse or sexual acts which are comparable to sexual intercourse, including such acts committed against animals.
Quote 2	Article 2. Item 11	Naturalistic image or description is image or description in any form and by any means of human, animal, individual, and parts of the body and (or) animal body and action (or inaction), events, phenomena and their consequences with the fixation of attention to details, and anatomical details and (or) physiological processes
Quote 3	Article 5. Types of information that is harmful to health and (or) development of children. Item 3.3	Information is limited for children of certain age groups, if it includes images or descriptions of sexual relations between a man and a woman.
Quote 4	Article 6. Classification of information products.	1) Information products for children below the age of six years; 2) Information products for children reached the age of six years; 3) Information products for children reached the age of twelve years; 4) Information products for children reached the age of sixteen years; 5) Information products that is prohibited for children.