8. Significant Unconventional Sexual Behaviors

In this section, we consider a group of “other” sexual behaviors. These include sexual coercion (rape, sexual harassment, and child sexual abuse), prostitution, pornography, paraphilias, and fetishes. As a general rule, Americans tend to view heterosexual relations between consenting adults in an ongoing relationship, such as marriage, as the norm. It is true that such sexual relations are the modal pattern in the U.S.A. (Laumann, et al., 1994), as is true of every culture. However, the earlier reviews of extramarital sex, alternative lifestyles, homosexuality, and bisexuality all serve to illustrate that sizable percentages of Americans engage in sexual behavior which departs from this assumed norm. American sexologists have struggled for some time to develop acceptable terminology to describe other sexual practices. The concept of sexual orientation has allowed us to view homosexuality and bisexuality as variations in orientation. Similarly, the concept of gender transposition has provided a terminology for examining cross-gender behaviors.

Typically, non-marital sexual practices have been labeled as sexual deviance or sexual variance. There are, however, at least two problems with such terms. First, no matter what the proper sociological conceptualization, these terms inevitably convey a sense of pathology, dysfunction, or abnormality to behaviors which are situationally defined. For example, consider the act of exhibitionism, exposing one's genitals to another. When practiced in the streets, the act is defined as a crime and is quite rare. When practiced in certain business establishments, the practitioner is paid for the act and clients pay to see it; and when practiced in the privacy of one's home with an intimate partner, it is seen as normal and healthy sexual interaction. Second, some of these behaviors are, in fact, quite common. Muehlenhard reviews evidence that shows many women are victims of sexual coercion. Several recent surveys provide evidence that nearly one quarter of Americans view pornographic video tapes each year (Davis 1990; Laumann, et al. 1994). It appears that relatively small percentages of Americans participate in any one of the various fetish groups reviewed below. However, taken together and added to the forms of non-marital sexual expression we have already reviewed, it seems clear that rather large percentages of Americans do participate in some “other” form of sexual practice [D. L. Weis, Coeditor].

A. Coercive Sex

Sexual Assault and Rape

Basic Concepts. The conceptualization of rape and the treatment of rapists and rape victims in the United States have changed substantially since the 1970s, largely due to the work of feminists. The situation is complex, however; there are many perspectives on these issues. Even the terminology related to rape is at issue. Some persons have suggested that the term “rape” be replaced by “sexual assault” in order to emphasize the violent nature of the act and to place greater emphasis on the behavior of the perpetrator; recent reforms in the criminal codes of some states no longer speak of rape, but of varying degrees of sexual assault (Estrich 1987; Koss 1993a). Others, however, prefer to retain the term rape “to signify the outrage of this crime” (Koss 1993a, 199). Some regard rape as different and more serious than assault and contend that “to label rape as a form of assault... may obscure its unique indignity” (Estrich 1987, 81). There is no clear consensus in the law, the popular media, research literature, or feminist writings. We will use the term rape.

Similarly, some persons have suggested that the term “rape victim” be replaced by “rape survivor.” Each term has advantages. The term “victim” highlights the harm that rape causes. The term “survivor” has more optimistic connotations and, thus, may empower someone who has been raped; it also highlights similarities between people who have survived rape and people who have survived other life-threatening events. The term “survivor,” however, may perpetuate the stereotype that only rapes that are life-threatening - that is, that involve a great deal of extrinsic violence - are worthy of being regarded as “real rape.” Thus, we will use the term rape victim.

Definitions. Rape can generally be defined as one person's forcing another to engage in sex against that person's will. This general definition, however, leaves many questions unanswered (Muehlenhard et al. 1992b). What behaviors count as sex? Whom do these definitions cover? What counts as force? In the United States, thinking about each of these questions has changed since the 1970s, and controversy remains.

Defining rape is complicated by the fact that there are many types of definitions. In the legal domain, the federal government and all fifty states each have their own definition. Legal definitions are written by legislatures, which are composed primarily of men; thus, these definitions are likely to be written from men's perspectives (Estrich 1987). The definitions held by the general public are influenced by the law, the media, folk wisdom, jokes, and so forth. Some researchers base their definitions on legal definitions, which makes them subject to the same biases as legal definitions; others make conscious decisions to deviate from legal definitions, which they find biased or inadequate. Finally, there are political definitions, written by activists wanting to make various political points. For example, MacKinnon (1987, 82) wrote,

Politically, I call it rape whenever a woman has sex and feels violated. You might think that's too broad. I'm not talking about sending all of you men to jail for that. I'm talking about attempting to change the nature of the relations between women and men by having women ask ourselves, “Did I feel violated?”
Persons who regard legal definitions as the most valid criticize such political definitions as being too broad (e.g., Farrell 1993). Based on the assumption that language is power, however, political activists have resisted the status quo by challenging widely held definitions and encouraging people to think about the assumptions behind these definitions.

Prior to the 1970s, rape definitions of sex often included only penile-vaginal sexual intercourse. This definition has been criticized as too phallocentric, promoting the ideas that an act must involve a man's penis and must have the potential for reproduction to count as “real sex” (Muehlenhard, et al. 1992b; Rotkin 1972/1986). Currently, most definitions of rape use a broader conceptualization of sex, including many kinds of sexual penetration (e.g., penile-vaginal intercourse, fellatio, cunnilingus, anal intercourse, or penetration of the genitals or rectum by an object). Some definitions are even broader, including behaviors such as touching someone's genitals, breasts, or buttocks (Estrich 1987; Koss 1993a).

Another contentious question involves whom these definitions cover. If rape is defined as forced penile-vaginal intercourse, then by definition an act of rape must involve a woman and a man; this definition would exclude coercive sex between two individuals of the same sex. In requiring the perpetrator to penetrate the victim sexually, such definitions would exclude situations in which a woman forced a man to engage in penile-vaginal intercourse, because such situations would involve the victim penetrating the perpetrator (Koss 1993a). Some definitions of rape include only the experiences of adolescents and adults (e.g., Koss et al. 1987), whereas others also include the experiences of children (e.g., Russell 1984).

Prior to the 1970s, rape laws in the U.S. included a “marital exclusion,” exempting husbands from being charged with raping their wives. As of the mid-1990s, this marital exclusion has been removed from the laws of all fifty states, as well as from federal law (X 1994). In some states, however, laws still define rape between spouses more narrowly than rape between non-spouses, giving married women less legal protection than unmarried women. Furthermore, some state laws still treat rape less seriously if it occurs between two people who have previously engaged in consensual sex (X 1994).

Yet another contentious question involves what counts as force. Most definitions include physical force and threats of physical force. Many also include sex with someone who is unable to consent due to being intoxicated, asleep, or otherwise unable to consent. There is disagreement, however, regarding how intoxicated one needs to be, whether the alcohol or drugs need to be administered to the victim by the perpetrator, what happens if both persons are intoxicated, and so forth. This is particularly relevant in cases of date or acquaintance rape (Muehlenhard et al. 1992b).

Even regarding threats of physical force, there is disagreement about how direct such threats need to be. For example, in some court cases, appellate judges have made it clear that a woman's acquiescing to sex with a man because she is afraid that he will harm her (e.g., because he has harmed her in the past, or because they are in an isolated location and he is behaving in a way she regards as threatening) is not sufficient to define the incident as rape. Instead, these judges interpreted the law to mean that a woman should not cry and give in; she should fight like a “real man” (Estrich 1987).

Conceptualizations of Rape and Rapists. Prior to the changes initiated by feminists in the 1970s, rape was commonly conceptualized as a sexual act in which a man responded to a woman's sexual provocations. Rapists were often assumed to be either black men who raped white women or else men who were lower class or crazy and who were provoked by women who dressed or behaved too provocatively (Davis 1981; Donat and D'Emilio 1992; Gise and Paddison 1988; LaFree 1982; Mio and Foster 1991). Amir (1971, 273), for example, discussed “victim precipitated rape,” which he conceptualized as rape incited by female victims who spoke, dressed, or behaved too provocatively (e.g., who went to a man's residence or who attended “a picnic where alcohol is present.”) MacDonald (1971, 311) wrote that

the woman who accepts a ride home from a stranger, picks up a hitchhiker, sunbathes alone or works in the garden in a two-piece bathing suit which exposes rather than conceals her anatomy invites rape. The woman who by immodest dress, suggestive remarks or behavior flaunts her sexuality should not be surprised if she is attacked sexually. These ladies are referred to as “rape bait” by police officers.
Female victims were often thought to have desired or enjoyed the experience (Gise and Paddison 1988; Griffin 1971; Mio and Foster 1991; Muehlenhard et al. 1992a). For example, Wille (1961, 19) wrote about the typical rape victim's “unconscious desires to be the victim of a sexual assault.” Husbands, in effect, “owned” their wives and were entitled to their sexuality; thus, the concept of marital rape was nonexistent (Clark and Lewis 1977; Donat and D'Emilio 1992). Sexual acts that occurred between acquaintances or on dates were often assumed to be sexual encounters that the woman had let get out of hand (Amir 1971).

In the 1970s, feminist writers began to conceptualize rape as violence (e.g., Brownmiller 1975; Griffin 1971). In a classic article, Griffin (1971, 312) wrote that

rape is an act of aggression in which the victim is denied her self-determination. It is an act of violence which, if not actually followed by beatings or murder, nevertheless always carries with it the threat of death. And finally, rape is a form of mass terrorism, for the victims of rape are chosen indiscriminately.
Griffin also emphasized that the fear of rape limits women's freedom, and as such, rape functions as do other forms of violence. Conceptualizing rape as violence has numerous advantages: acknowledging the serious consequences of rape; highlighting the similarities between the effects of rape and the effects of other kinds of violence; taking the emphasis of rape prevention off restricting women's sexual behavior; and acknowledging that rape affects all women, even those who have not actually been raped, by instilling fear and, thus, restricting women's freedom.

Currently, in the United States, it is common to hear people say, “Rape isn't sex; it's violence.” Nevertheless, many writers, both feminist political activists and researchers, have found value in conceptualizing rape as having elements of sex as well as violence (Muehlenhard et al. in press). Feminists have discussed similarities between rape and other sexual situations, which may also be coercive:

So long as we say that [rape involves] abuses of violence, not sex, we fail to criticize what has been made of sex, what has been done to us through sex, because we leave the line between rape and intercourse... right where it is. (MacKinnon 1987, 87, emphasis in original)
Understanding rapists has been enhanced by investigating both the sexual and the violent aspects of their behavior and attitudes. Rapists are more likely than nonrapists to become sexually aroused by depictions of sexual violence, as well as to feel hostile toward women, to accept rape myths and violence against women, and to view heterosexual relationships as adversarial. They drink more heavily and are more likely to have drinking problems, which may serve as a release or an excuse for sexually violent behavior. They are also more likely to have witnessed parental abuse or to have been physically or sexually abused in their childhoods. They begin having sexual experiences, either consensual or nonconsensual, earlier than nonrapists (Berkowitz 1992; Burt 1991; Koss and Dinero 1988; Finkelhor and Yllo 1985; Malamuth 1986; Russell 1982/1990).

Drawing on over thirty years of rehabilitation work with convicted sex offenders at the New Jersey State facility, William Prendergast (1991) has described a developmental-descriptive profile of typical compulsive-repetitive sex offenders. This profile involves two childhood experiences or characteristics: an unresolved inadequate personality and an unresolved preadolescent or early adolescent sexual trauma. Rapists try to cope with these unresolved personality traits by denial and overcompensating. In seeking to control their victims, they use terror, physical force, and any behavior that will degrade the victim. Pedophiles, on the other hand, accept their unresolved traits and seek to control their victims by seduction.

Current research has also dispelled other myths about rape. Rapists represent all ethnic groups and social classes (Russell 1984, 1990), and the overwhelming majority of rapes occur between acquaintances (Kilpatrick et al. 1987; Koss et al. 1988; Russell 1984) and between members of the same race or ethnicity (Amir 1971; O'Brien 1987). Research shows that men can be raped and women can be rapists (Brand and Kidd 1986; Muehlenhard and Cook 1988; Sarrel and Masters 1982; Waterman et al. 1989). Still, because rape and the fear of rape affects women more than men, and because of the differences in how women's and men's sexuality is conceptualized in the United States, some claim it would be a mistake to treat rape as a gender-neutral phenomenon (MacKinnon 1990; Rush 1990). Finally, “thanks to the feminist movement, no one any longer defends the dangerous claim that rape is a sexually arousing or sought-after experience on the part of the victim” (Palmer 1988, 514).

Prevalence. How prevalent is rape? Estimates of prevalence depend not only on how rape is defined, but also on the methodology used. Telephone surveys consistently result in lower prevalence estimates than do questionnaires or face-to-face interviews. Conducting interviews in the presence of family members yields low prevalence estimates, which is understandable given that many rape victims do not tell their families about having been raped, and some rape victims have been raped by family members. Asking respondents if they have been “raped” yields low prevalence estimates because many rape victims do not label their experience as “rape.” Asking respondents a single question about their experiences generally yields low estimates, perhaps because asking only one such question fails to elicit memories of rapes that may have occurred in numerous contexts (e.g., with strangers, casual acquaintances, dates, or family members, obtained by force or threats of force or when the victim was unable to consent, and so forth; Koss 1993a).

Two sources of information on rape published by the government are generally inadequate: The Uniform Crime Reports, published by the Federal Bureau of Investigation (FBI 1993), include only rapes that were reported to the police - a small minority of all rapes (Russell 1984). The National Crime Victimization Surveys, conducted by the government's Bureau of Justice Statistics (BJS), also have serious methodological flaws (BJS 1993; Koss 1992; Russell 1984).

The best approach to studying the prevalence of rape involves confidentially asking respondents a series of questions about various experiences that meet the definition of rape. Studies using this procedure have found that approximately 20 percent of adult women in the United States have been raped (see Koss 1993b, for a review). As mentioned previously, most of these rapes occur between acquaintances of the same race. Percentages of men who report being raped or otherwise sexually victimized are generally lower than the percentages of women who report such experiences (Koss 1993a), although because most prevalence studies have focused on female respondents, information on men's being raped is scant.

Consequences for Rape Victims. American research on the consequences of rape has improved dramatically in the past several decades. Prior to the 1970s, studies of rape victims consisted of occasional case studies of victims who sought psychotherapy, a biased sample because most rape victims do not seek therapy and those who do are likely to be atypical (e.g., to be in greater distress, to be of higher socioeconomic status, etc.). The next generation of studies involved assessing rape victims who reported the rapes to police or emergency-room personnel; this practice allowed longitudinal assessment of the effects of rape, but the samples were still biased because most rapes are never reported. Currently, the consequences of rape are often studied by surveying random samples of people; this practice allows comparisons of rape victims with nonvictims, regardless of whether the rape victims had reported the rapes to authorities or had labeled their experiences as rape. Some researchers even conduct prospective studies, in which members of a high-risk group (e.g., first-year college students) are assessed annually; if someone in the sample is raped during the time span of the study, their pre- and postrape adjustment can be compared (Muehlenhard et al. 1992a).

Research shows that most rape victims experience psychological, physical, and sexual problems after being raped. It is important to remember, however, that not all rape victims experience all of these consequences; some experience many consequences, whereas others experience relatively few consequences.

The psychological consequences of rape can include: depression; fear; anxiety; anger; problems with self-esteem and social adjustment; feeling betrayed, humiliated, or guilty; and experiencing problems with trust (Lystad 1982; Muehlenhard et al. 1991; Resick 1993). Recently, some of these psychological consequences have been conceptualized as post-traumatic stress disorder (PTSD) (American Psychiatric Association 1994). This symptom constellation includes reexperiencing the rape (such as in dreams or flashbacks), feeling numb and avoiding reminders of the rape, and experiencing hyperarousal (such as insomnia, difficulty concentrating, outbursts of anger, or an exaggerated startle response; see Herman 1992; Resnick et al. 1993).

Sexual problems resulting from rape can include avoidance of sex, decreased sexual satisfaction, sexual dysfunctions, and flashbacks to the rape during sex (Kilpatrick et al. 1987; Lystad 1982; Warshaw 1988). Some rape victims engage in sex more than before, perhaps because the rape made them feel devalued, as if “they now have nothing left that's worth protecting” (Warshaw 1988, 74).

The physical consequences of rape can include physical injuries (including injuries from weapons or fists, as well as vaginal or anal injuries), sexually transmitted diseases, pregnancy, reproductive problems causing infertility, and various psychosomatic problems. Physical consequences can also include alcohol and drug abuse and dependency (Koss 1993b; Resick 1993; Warshaw 1988).

Divulging the rape to someone else may result in various problems: feeling embarrassed or uncomfortable; reliving aspects of the experience; being disbelieved or blamed; and being questioned about one's behavior and dress, which might lead victims to feel as if they are “on trial,” needing to prove their innocence to others. When rape victims report the rape to the police, their report may be disbelieved or trivialized, although police attitudes and sensitivity have improved during the last several decades. Should the case go to trial, recent “rape shield laws” generally prohibit defense attorneys from inquiring about the victim's sexual past; nevertheless, defense attorneys typically try to discredit victims (Allison and Wrightsman 1993; Estrich 1987; Gelles 1977; Griffin 1971; Roth and Lebowitz 1988).

Contrary to stereotypes, acquaintance or date rape is as traumatic as stranger rape. Victims of acquaintance rape are as likely as victims of stranger rape to experience depression, anxiety, problems with relationships, problems with sex, and thoughts of suicide (Koss et al. 1988). Women who are raped by acquaintances they had trusted may doubt their ability to evaluate the character of others and may be reluctant to trust others. Women raped by acquaintances are less likely than women raped by strangers to be believed and supported by others. If the victim and rapist have mutual friends, the friends may be reluctant to believe that a friend of theirs could be a rapist; they may thus be reluctant to take the victim's side against the perpetrator, and the victim may feel unsupported. If the rapist goes to the same school, workplace, or social functions as the victim, the victim may feel uncomfortable and withdraw from these activities (Kilpatrick et al. 1987; Koss et al. 1988; Russell 1982/90; Stacy et al. 1992; Warshaw 1988). There has been considerable controversy about the prevalence of date or acquaintance rape, especially on college campuses (Roiphe 1993).

People raped by their spouses or cohabiting partners may experience consequences that other rape victims do not experience. Whereas stranger rape is typically a one-time occurrence, the rape of wives and other partners is likely to occur repeatedly and may last for years. The more frequently women are raped by their husbands or partners, the more likely they are to suffer from grave long-term consequences. Many victims of marital or partner rape are also physically abused. Victims raped by a spouse or partner must decide either to live with the perpetrator and risk subsequent rapes or to divorce or separate, which requires many lifestyle adjustments, and which does not guarantee that they will not be raped by their ex-spouse or ex-partner (Koss et al. 1988; Lystad 1982; Russell 1982/90). The consequences may also extend to children living in the household (Mio and Foster 1991). Children may be aware of the problem and may even witness the rapes. They may fear the parent or stepparent who is the perpetrator and may develop negative views of sex and relationships.

Boys and men who have been raped experience many of the same consequences that girls and women do, although being a male victim may result in additional consequences that female victims do not encounter. Being forced into submission is incongruous with the male sex-role stereotype that espouses control and dominance. Males raped by females often confront beliefs that they must have desired and enjoyed the act and that male victims are less traumatized than are female victims. Males raped by other males, regardless of their sexual orientation, often confront homo-phobic attitudes. Males also confront the belief that, if they had an erection, they must have wanted sex (Groth and Burgess 1980; Russell 1984; Smith et al. 1988; Sarrel and Masters 1982; Warshaw 1988).

Lesbian and gay rape victims may encounter difficulty in attempting to obtain services from crisis-intervention and social-service centers, as these agencies are not prepared to serve lesbian and gay clients (Waterman et al. 1989). Obtaining services may require that gay or lesbian rape victims “come out,” revealing their sexual orientation and risking possible discrimination, possibly even losing their jobs, housing, or children should others find out (legal protection of lesbians and gays in the United States varies from city to city and state to state). If rape occurs in a lesbian or gay relationship in which the perpetrator is the biological parent of the children, if the victimized partner leaves the relationship, she or he will probably have to leave the children with the perpetrator. Furthermore, the gay and lesbian community is often tight-knit, so lesbian or gay rape victims maybe reluctant to tell mutual friends or to participate in the community's social functions (Grover 1990; Muehlenhard et al. 1991).

Punishment of Rapists. The modal punishment for rapists is no penalty, given that most rapes are not reported to the police (Koss et al. 1988; Russell 1984). Even those that are reported rarely result in arrest and conviction (Allison and Wrightsman 1993). Among those who are convicted of rape, punishment varies from merely being placed on parole to life in prison.

Until the 1970s, the penalty for rape included the death penalty; 89 percent of the men executed for rape in the United States from 1930 to 1967 were African-American (Estrich 1987, 107). In 1977, the U.S. Supreme Court found the death penalty for rape to be unconstitutional (Coker v. Georgia, 433 U.S. 584, 1977; see Estrich 1987). Studies of actual sentences given to convicted rapists reveal that the harshest penalties for rape are still imposed on African-American men accused of raping white women (Estrich 1987; LaFree 1980). There is also a bias against convicting affluent, successful men and men who rape women they know or who rape women who do not conform to cultural expectations of how a “good woman” should behave (Estrich 1987; LaFree et al. 1985).

Prevention. Prior to the 1970s, rape prevention was generally regarded as women's responsibility. Because rape was regarded as an act of sex incited by provocative women, rape prevention consisted largely of expecting women to restrict their behavior (expecting women not to talk or dress provocatively, not to go out at night, etc.).

Currently, a variety of prevention strategies are common in the U.S. (Muehlenhard et al. 1992a). There are still those who urge women to restrict their behavior, and research shows that women do indeed restrict their behavior due to the fear of rape: Women report avoiding going outside alone at night, not talking to strangers, wearing bulky clothing, having unlisted phone numbers, and so on (Gordon and Riger 1989). These efforts limit women's freedom and diminish women's quality of life. Furthermore, this approach focuses on stranger rape, a minority of all rapes, and does not address the causes of rape.

There are other prevention strategies that are not predicated on women's restricting their behavior. For instance, many universities have installed extra lighting and emergency telephones (often marked by blue lights) to help women feel safer. These strategies are aimed primarily at preventing stranger rape, however, and will not help women who are raped indoors by husbands, partners, dates, or other acquaintances. To address these problems, many universities have initiated lectures and workshops presented to college dormitory residents, fraternities, sororities, and athletic groups; some high schools and even junior high schools have also initiated such programs, although they sometimes meet resistance from parents and school boards (Donat and D'Emilio 1992). There is evidence that such programs can lead to attitude change (Jones and Muehlenhard 1990), although the effectiveness of these strategies in actually preventing rape is unknown.

Some women take self-defense classes. For example, Model Mugging or En Garde programs teach women self-defense strategies that utilize women's physical strengths, such as lower-body strength (Allison and Wrightsman 1993). Research shows that active-resistance strategies (e.g., physically fighting, screaming, and running away) are generally more effective than the passive-resistance strategies (e.g., coaxing, begging, crying, reasoning, or doing nothing), and active strategies do not increase the risk of physical harm (Bart and O'Brien 1984; Ullman and Knight 1992; Zoucha-Jensen and Coyne 1993). Unfortunately, no strategy is effective all of the time or for all people, and even experiencing an attempted rape can be traumatic. Furthermore, many feminist theorists have argued that, because most rapists are men, it is unfair to place the burden of rape prevention on women (Berkowitz 1992; Koss 1993b).

The most important strategies for preventing rape involve working for broader social change: changing men's and women's attitudes about rape, sex, and gender roles; working toward gender equality; discouraging violence as a problem-solving technique; and emphasizing that coercive sex in any context, whether with a stranger or acquaintance, is never acceptable.

Child Sexual Abuse and Incest

Knowledge of child sexual abuse (CSA) has undergone cycles of awareness and suppression, as both professionals and the general public have struggled to come to terms with its existence since CSA first gained widespread attention in the 1890s, when Freud proposed that it was at the root of hysterical neurosis. Although modern clinical work tends to confirm the link between CSA and various neuroses, Freud quietly abandoned his early belief in response to the strong opposition from Victorian attitudes of that era. Linking neuroses with repressed childhood sexual conflict, Freud's Oedipal and Electra complexes, was revolutionary, but at least much more acceptable than admitting the reality and prevalence of child sexual abuse.

During the past twenty years, CSA has received renewed attention from American clinicians, researchers, and the general public. Recently, CSA has been the focus of a substantial amount of American research that has, in turn, led to broader recognition of the initial and long-term problems associated with CSA.

Definitions. The definition presented by the National Center on Child Abuse and Neglect is “Contact and interactions between a child and an adult when the child is being used for the sexual stimulation of the perpetrator or another person.” This definition is problematic, however, in that it leaves key terms open to question. For example, in considering who is a child, researchers have employed cutoff ages anywhere between 12 and 17 years for victims of CSA. In deciding who is an adult, some researchers have required perpetrators to be at least 16 years of age; others have required age differences between victim and perpetrator of Five years or ten years; still others have not required any age difference at all if force or coercion was used. In determining what is sexual stimulation, some authors include noncontact experiences, such as exhibitionism or propositioning, whereas others require manual contact, and still others, genital contact. In a 1987 study designed to determine the effect of varying the operational definition of CSA on its prevalence, the percentage of college men identified as victims ranged from 24 percent to 4 percent based on how restrictive the criteria used were. The parameters defining CSA, therefore, will have strong implications for how widespread a problem society considers it.

A second major issue is determining, in the absence of physical injury, what has been damaged. This issue is complicated by a consistently identified minority of victims who report such experiences as having been positive. Some authors have pointed to this subset and wondered whether the abuse was against the individual or societal values, and further, whether in defining CSA, consideration should be given to the victim's view of the experience as negative or positive. Yet, a victim's view of a CSA experience as positive does not preclude the possibility that it was a harmful or damaging one.

A cogent argument against using the victim's assessment of the experience as positive or negative in defining abuse is that the inequalities of knowledge, sophistication, and power inherent in any child-adult relationship prevent the child from giving informed consent to engage in sexual behavior. From this perspective, it is the emotional and intellectual immaturity of the child that causes the developmentally inappropriate exposure to adult sexuality to be harmful and abusive.

These issues of definition influence the composition of the groups studied by researchers and, thereby, the results obtained. As yet, there has been no completely satisfactory way to define CSA to ensure that the research results are relevant and helpful to the greatest number of people. Currently, the most widely used set of criteria for defining CSA are contact experiences between a child aged 12 or younger with an individual five or more years older, or between a child aged 13 to 16 with an individual ten or more years older. These criteria emphasize the differences in developmental maturity between the victim and perpetrator, while minimizing the inclusion of age-appropriate sexual exploration between peers as sexual abuse.

Prevalence of CSA. Accurate estimates of the prevalence of CSA in either the general population or clinical populations have been difficult to obtain, due in part to the differences in operational definitions discussed above, in part to the sensitive nature of the topic, and in part to differing methods of assessment (e.g., questionnaire, face-to-face interview, or telephone interview). Estimates of the percentage of adult women who have experienced CSA vary from 6 percent to 62 percent and of adult men from 3 percent to 31 percent. In general, percentages are higher among clinical samples than among community-based samples. Additionally, more people disclose abuse histories when information is gathered via an interview rather than by questionnaire, when specific questions about childhood sexual experiences are asked, and when such terms as “sexual abuse” and “molestation” are avoided (see also Prendergast 1993).

More confidence can be placed in the accuracy of prevalence rates when the samples used are large, random, and community-based. In a 1990 random sample of over 2,000 adults across the United States, 27 percent of women and 16 percent of men reported having experienced such abuse as children. In other large-scale studies, about 25 percent of women and 17 percent of college men have been identified as having histories of CSA. The majority of CSA cases are perpetrated by a nonrelative, generally an acquaintance or family friend; about 30 percent of girls are abused by a relative (with about 4 percent involving father-daughter incest), whereas about 10 percent of boys are abused by a relative. Finally, the prevalence of CSA does not seem to vary with social class or ethnicity (Hunter 1990).

Theories Explaining CSA. Upon hearing of CSA, people generally react strongly, wondering how such abuse could occur. Originally, professionals held a simplistic view of CSA, considering it to be the result of the isolated actions of a depraved and flawed perpetrator. In the past several decades, however, two more-complicated theories of CSA have dominated the field.

Family systems theory posits that families function as integrated systems and that irregularities in the system are displayed through symptomatic behavior in one or more family members. From this perspective, the occurrence of incest reflects a distortion in the family system, specifically in the marital subsystem, that is being expressed through a parent's (usually the father's) sexual behavior with a child. This model proposes, then, that CSA occurs as a misguided attempt to cope with problems in the family. Treatment, therefore, involves recognition of the underlying problems and the institution of changes by all family members rather than through removal of the perpetrator.

Although less simplistic than earlier proposals, this model has been criticized for seeming to blame the victims for the abuse and by removing responsibility from the perpetrator. Additionally, the model is relevant only to incest, which is a relatively small fraction of the CSA cases.

In order to address these concerns, Finkelhor proposed a four-factor model of CSA incorporating some aspects of the family systems' perspective, but shifting responsibility for the abuse back to the perpetrator. He conceptualized CSA as resulting from an interaction between environmental circumstances and the personality of the perpetrator, rather than simply as inherent in the perpetrator or in the family system.

In this model, four preconditions must be met for CSA to occur. First, the offender must have some motivation to abuse sexually; thus, CSA satisfies some emotional or sexual need in the perpetrator that is not readily satisfied in other ways. Second, the offender must overcome his or her inhibitions against CSA. Inhibitions may be overcome in a variety of ways, such as substance use, rationalization, the influence of stressors, or personality factors (e.g., impulsivity). Third, environmental impediments to the abuse must be removed; the offender must have private access to a child. Therefore, she or he may target children who are without consistent adult supervision or obtain employment that provides contact with children. Fourth, the offender capitalizes on the lowered resistance of the child; children who are insecure, needy, uneducated about sexuality, and/or have a trusting relationship with the offender have lowered resistance. These children are less likely to be assertive in refusing abusive overtures or to disclose immediately that the abuse took place. All of these factors, working in concert, allow CSA to occur.

Some people remain uncomfortable with the third and fourth preconditions of this model, because they appear to place some responsibility for the CSA outside the perpetrator and onto the child and his or her non-offending parent(s). Finkelhor stresses, however, that without the first and second preconditions, qualities, and behaviors of the offender alone, CSA would never occur. These preconditions place responsibility for the act squarely with the perpetrator.

Who Is at Risk for CSA? The environmental circumstances in which boys are sexually abused versus those in which girls are sexually abused differ in some important ways. Some of these differences were highlighted by Tzeng and Schwarzin (1987), who compared the demographic characteristics of boys and girls in over 15,000 substantiated cases of sexual abuse in Illinois. They found that girls who had been sexually abused tended to live in homes that did not differ from those of the general population in the numbers and kinds of parents/caretakers present, whereas boys who had been sexually abused were significantly more likely to come from single-parent homes and/or from families with either new or many children/dependents. On the other hand, the girls' families tended to display significantly more dysfunction, and caretakers were more physically and/or mentally impaired than caretakers in the boys' families. These results are similar to those of Finkelhor, who found the risk of CSA among girls increased approximately twofold when a mother was absent from the home. These findings point to an increased risk of sexual abuse when parents are absent, impaired, or overworked (see also Prendergast 1993).

Some differences in the perpetrators of abuse of boys versus girls have also been identified. Tzeng and Schwarzin (1987) and others reported that sexual abuse of boys is more likely to be perpetrated by a stranger, whereas abuse of girls is more likely to be perpetrated by a relative. Further, when boys are abused by a relative, these relatives are more likely to be within five years of age of the boys, whereas relatives who abuse girls are more likely to be ten or more years older than the girls. Although the vast majority of perpetrators of both boys and girls are men, boys are more likely to be abused by women than are girls (17 percent versus 2 percent). Thus, for boys, CSA experiences tend to occur outside the home and to be perpetrated by a nonfamily member or, if inside the home and perpetrated by a relative, the relative is less likely to be a parent-figure or to have adult status. Girls are more likely to be abused within the home by a relative ten or more years older. Risk to girls is increased by sevenfold for girls with a stepfather. A general consensus among researchers is that more boys are somewhat more likely to experience severe abuse (actual intercourse) than are girls.

These differences suggest boys and girls may be experiencing CSA situations that require differing coping skills. Girls may, more typically, need to adjust to the notion that an adult in a position of trust has been abusive, and boys may, more typically, need to adjust to the notion that the world outside the home is not safe and may need to react to a more-severe physical experience. It should be stressed that all of these differences are generalizations, and there is substantial overlap in the nature of the CSA experiences of boys and girls.

Initial Effects of CSA. Although researchers have identified a wide array of problems occurring among children who have been sexually abused, most have failed to find any substantial differences in symptomatology between male and female victims. When studying these initial effects, researchers have recently begun to divide subjects into three groups based on their stage of development: preschool (ages 3 to 6), school age (ages 7 to 12), and adolescent (ages 13 to 17). By using these groupings, the presence and frequency of various behaviors and symptoms can be compared to those considered developmentally appropriate for the stage.

Among both preschool boys and girls, the most frequent behavioral symptom associated with CSA experiences is an increase in sexualized behaviors (Beitchman et al. 1991). This increase has been noted in a number of studies using a variety of methodologies, including chart review, parent rating, observed play with anatomically correct dolls, and human-figure drawing. However, the prevalence of this behavior varies widely depending on the context, from 10 percent of the sample in the case of human-figure drawing to 90 percent of the sample in play with anatomically correct dolls; still, this finding is among the most robust in the literature. [Note: These studies do not make comparisons to groups of “normal” children and their rate of sexual behavior. (D. L. Weis, Coeditor)]

Emotionally, preschool children are likely to respond to sexual abuse with anxiety, signs of post-traumatic stress (e.g., nightmares, vigilance, or bed wetting), and depression (Kendall-Tackett et al. 1993). These children are also likely to exhibit greater immaturity than nonabused controls, showing increases in both dependency and impulsivity relative to physically abused and nonabused age peers.

Among school-age children, researchers have focused on behavioral problems that interfere with academic and social success. Sexually abused children have been assessed by their teachers as significantly less able than their nonabused peers to learn in the school environment. This difficulty may be a function of the wide range of behavioral and emotional problems they display. For example, approximately half of the school-age girls with histories of CSA show high levels of immaturity and aggression (Kendall-Tacketts et al. 1993). Similarly, both parents and teachers rated sexually abused children as more emotionally disturbed and neurotic than their classmates, displaying both depression and a wide range of fears (Beitchman et al. 1991; Browne and Finkelhor 1986; Kendall-Tackett et al. 1993). Additionally, like preschool children, the sexually abused school-age boys and girls display clear-cut increases in sexualized behaviors, including such problems as excessive and inappropriate masturbation and sexual aggression (Browne and Finkelhor 1986; Kendall-Tackett et al. 1993). All of these symptoms would be expected to lead to problems in school for children, regardless of their intelligence.

A somewhat different presentation has been observed among adolescents with a history of sexual abuse. Although acting-out behaviors, such as running away, substance use, and sexual promiscuity were more common in these adolescents than their nonabused peers, they were less common than among clinical groups of adolescents (Beitchman et al. 1991). The predominant Finding among sexually abused adolescents is an increase in depressive symptomatology, such as low self-esteem and suicidal ideation. This depression may be expressed through self-injurious behaviors, as exhibited by more than two thirds of sexually abused adolescents (Kendall-Tackett et al. 1993), or through suicide attempts made by a third of these adolescents in a clinical sample.

Although there is an extensive list of symptoms and problems associated with the initial effects of sexual abuse, it should be noted that not all children display such effects. Indeed, 20 percent to 40 percent of sexually abused children have been found to be asymptomatic at the time of initial assessment (Kendall-Tackett et al. 1993). Unfortunately, some of these children have become symptomatic by the time of later assessments. There is fairly consistent evidence that from a third to a half of sexually abused children show improvement in symptom presentation twelve to eighteen months after the abuse, although another quarter to a third show deterioration in function.

Long-Term Effects of CSA. Although the long-term effects of CSA experiences have been studied in both men and women, the majority of the work has been done with women. Reviews of this research have been conducted by Browne and Finkelhor (1986) and Beitchman et al. (1992). The results vary somewhat, depending on whether the samples were community-based or clinically based; still, there is substantial overlap across the two populations.

In both clinical and community-based surveys of women with histories of CSA, the most common long-term effect is depression. Depression is particularly striking among the community-based samples of victims, in which significantly more women with a history of CSA report both more-severe and more-frequent episodes of depression compared to those with-out such experiences. Almost one in five college women reporting a history of CSA had been hospitalized for depression compared to one in twenty-five women who had not been abused. In a community-based study of the Los Angeles area, researchers found that a history of CSA was associated with a fourfold increase in the lifetime prevalence rate for major depression among women. Other prominent depression-related symptoms include problems with self-esteem, which appear to intensify as time elapses from the abuse, and an increased risk for self-injurious or destructive behaviors (Browne and Finkelhor 1986).

Increases in problems with anxiety occur among some women with sexual abuse histories. Problems with anxiety are more prominent among clinical samples than community samples (Beitchman et al. 1992; Brown and Finkelhor 1986). Anxiety seems to be particularly prevalent among women sexually abused by a family member and in cases in which force was used during the abuse.

Relationship difficulties are more common among women with histories of CSA compared to nonabused women. Abused women are more likely to fear intimacy and to have sexual dysfunctions, particularly when the abuse was more severe and/or was perpetrated by a father or stepfather (Beitchman et al. 1992). A history of CSA in women is also associated with an increased risk of further revictimization in the forms of rape and domestic violence.

Much less research has been conducted on the long-term effects of sexual abuse in men; much of the information available has been based on clinical case studies or extrapolated from studies with some adult male victims, but in which the majority of the subjects were women. Therefore, conclusions are much more tentative. Several community-based surveys found that men who reported CSA experiences exhibited a higher rate of psychopathology (e.g., depression, anxiety, or symptoms of post-traumatic stress) than those who did not report such experiences. Men who have been sexually abused have reported significant problems with poor self-esteem and self-concept. Men may respond to such feelings by self-medicating with alcohol and drugs, as indicated by the large degree of substance abuse and dependence among male victims; sexually abused women, on the other hand, report greater levels of depression and anxiety.

Clinicians suggest that intense anger, sexual dysfunction, problems with intimacy, gender-identity confusion, and substance abuse are prominent symptoms for males with a history of CSA seeking therapy. Additionally, disclosure of sexual abuse is particularly difficult for men. Issues related to disclosure include fears of not being believed (particularly if the perpetrator was female), fears others will consider them homosexual, concerns that they are homosexual because they have been abused by a man, and issues related to masculine identity.

Correlates of More-Severe Effects. Although the preceding paragraphs present a grim picture of the aftereffects of CSA, not all individuals suffer such severe effects. In fact, in a given sample of abuse survivors, a quarter to a third of the individuals can be expected to appear symptom-free on the chosen assessment instruments (Kendall-Tackett et al. 1993). About one third of these asymptomatic individuals may become symptomatic at later assessments. Still, these differences in outcome have led researchers to examine variables associated with more-severe effects.

One variable consistently associated with more-severe effects is the use of force (Beitchman et al. 1992; Browne and Finkelhor 1986; Kendall-Tackett et al. 1993). This finding has been most robust in studies of the initial effects of CSA among children (Kendall-Tackett et al. 1993). A number of researchers also have identified an association between the use of force and victims' reports of the degree of trauma experienced among adult survivors as well (Beitchman et. al. 1992; Browne and Finkelhor 1986). There is also some evidence that family-background variables, such as high levels of conflict and low levels of support, are related to more-severe effects. The situation is further complicated in that, for some individuals, the use of force has been associated with a decrease in self-blame, thereby reducing the severity of effects.

The relationship of the perpetrator to the victim has also been examined. Among children, the initial effects of abuse are more severe when the perpetrator has a closer relationship to the child (Kendall-Tackett et al. 1993). The situation is less clear for the long-term effects among adults. In general, whether the perpetrator was a family member has little impact on later outcome among adults (Beitchman et al. 1992; Browne and Finkelhor 1986) with one important caveat: Trauma and psychopathology effects are more severe if the abuse was perpetrated by a father or stepfather (Beitchman et al. 1992; Browne and Finkelhor 1986). This difference may represent a greater degree of family dysfunction and a more significant breach of trust when a father perpetrated the abuse (Beitchman et al., 1992). The lack of a general effect of intrafamilial versus extrafamilial abuse among adults may be a reflection that it was the quality of the relationship with the abuser (i.e., how much he was trusted) that influenced outcome rather than whether he was a relative. Finkelhor has extended this notion by proposing that the important variable is the degree to which the child was seduced and persuaded by the perpetrator, whether or not the child had a prior relationship with the perpetrator.

A third major variable examined to determine its relationship to long-term effects has been the duration of the abuse. This variable has been difficult to assess for a number of reasons. First, the criterion for CSA of long duration varies among researchers, from abuse that occurred for more than six months to abuse that occurred for more than five years. Second, as noted by Beitchman et al. (1992), researchers have tended to use very different measures, some assessing a subjective sense of harm, and others assessing a more objective degree of psychopathology. There is some evidence, however, that CSA of longer duration leads to an increase in psychopathology in community-based samples. The two major reviewers of long-term effects of CSA (Beitchman et al. 1992; Browne and Finkelhor 1986) have both concluded that more research must be conducted before firm conclusions can be drawn, whereas reviewers of initial effects have suggested that longer duration is associated with a worse outcome (Kendall-Tackett et al. 1993).

The severity of the CSA experience has also been examined in relation to psychopathology and harm in adulthood; here again, the results are mixed. There is general agreement that increased trauma and maladjustment are associated with contact abuse versus noncontact abuse, both initially and in the long term. Further, abuse involving genital contact, whether manual, oral, or invasive, is associated with more-serious outcomes than kissing or clothed contact. Researchers differ, however, in whether invasive contact as compared to manual contact is associated with increased trauma in the long term. Initially, invasive contact is associated with a worse outcome (Kendall-Tackett et al. 1993). Further research is necessary to determine the long-term effects of invasive contact.

One nonabuse-related variable, family support, has also been consistently identified as contributing significantly to both the initial and long-term effects of CSA. Kendall-Tackett et al. (1993) reviewed three studies examining the relationship of maternal support to symptom outcome in children who had been sexually abused. All three studies concluded that children whose mothers were low in support exhibited worse outcomes following the abuse. This conclusion was supported by the findings of other researchers who examined long-term coping among college women with histories of CSA.

Theories about the Nature of the Effects. Researchers have cataloged a multitude of symptoms associated with CSA that therapists have, in turn, attempted to address in treatment. Therapeutic treatment of any type is greatly facilitated by a theory or framework to organize and to approach symptoms. Many clinicians note that it is an impaired trust in self and others that underlies many of the symptoms associated with CSA.

This difficulty with trust has led some researchers and therapists to conceptualize the symptoms associated with CSA as a function of post-traumatic stress disorder (PTSD). This disorder encompasses some of the more-troubling symptoms experienced by sexual abuse survivors, such as depression, nightmares, and affective numbing. All of the PTSD conceptualizations of sexual abuse incorporate the idea that exposure to the abuse is experienced by the victim as overwhelming, due to intense fear and/or to extreme violations of beliefs about the way the world operates. When confronted with the abuse then, the child is unable to cope, given his or her current level of internal resources, and so must distort cognitions and/or affect in an effort to adjust to the experience. These distortions are, then, the basis for the symptoms that appear following the abuse.

However, there are some limitations to the application of PTSD to sexual abuse symptomatology. Among the most compelling of these limitations is the fact that the symptoms of PTSD do not encompass all of the problems associated with CSA. Also, many survivors do not meet the criteria for PTSD. In one group of survivors, only 10 percent could be diagnosed with PTSD at the time of the survey, and only 36 percent could have ever been diagnosed with the disorder. Clearly, more work is needed in the conceptualization of the symptoms associated with a history of CSA.

Toward this end, Finkelhor has proposed a theory of CSA symptomatology, the Traumagenic Dynamics Model of Child Sexual Abuse (TD), which attempts to address the empirical findings more fully. The TD model emphasizes that the trauma associated with CSA may be due to the stress of the ongoing nature of the abuse situation, rather than an isolated event that is overwhelming and far removed from usual human experience (as described by the PTSD criteria in the Diagnostic and Statistical Manual III Revised (DSM III-R)). This differentiation does not suggest that one type of trauma is more harmful than another; it simply highlights a qualitative difference in events that may lead to different coping responses and/or symptomatology.

The TD model includes four dynamics that occur to varying degrees in any CSA situation and that are postulated to contribute to the symptoms identified in the research literature. These dynamics include: (a) Traumatic Sexualization, which occurs when the child is taught distortions about his or her sexuality, and may lead to the increase in sexual dysfunctions observed among adult survivors; (b) Betrayal, which occurs in two ways, either when the child finds that an adult she or he trusted has hurt him or her or when the child discloses the abuse to an adult who refuses to believe or help the child. Finkelhor characterized the increased depression and revictimization seen among survivors as a result of the lost trust and unmet dependency needs. It can also lead to increased anger and hostility as a mechanism of keeping others at a distance; (c) Powerlessness, which occurs in a variety of ways in the CSA situation; for example, when the child finds himself or herself incapable of physically warding off the perpetrator. Powerlessness is further manifest when the child is unable to extricate himself or herself from the abuse situation or unable to do so in a satisfactory way (e.g., without being removed from the home). This powerlessness dynamic leads to anxiety and fear in adult survivors as well as a decreased coping ability; (d) Stigmatization, which occurs either directly through the labeling of the child by others as bad or dirty following disclosure of the abuse or indirectly through the sneaking behavior of the perpetrator and the admonitions that the abuse be kept secret. Stigmatization may be associated with the low self-esteem and the self-destructive behaviors, such as substance abuse and suicide attempts, observed among survivors.

However the effects are conceptualized, recent evidence has demonstrated that CSA is prevalent and commonly results in harmful effects. Finkelhor and others have attempted to make sense of a confusing array of symptoms presented by many, but not all, victims of CSA. More-sophisticated research designs (e.g., involving structural equation modeling) are required before the relationship between various experiences of CSA and outcomes become more clear.

Clergy Sexual Abuse

In the past ten years, sexual abuse of minors by clergy has become a major public scandal and crisis for all the churches, although the public attention is often focused on the Catholic clergy because of their requirement of celibacy. Until recently, charges of sexual abuse by clergy were treated as an internal problem within Church jurisdiction and not reported to police. The main issue for Church officials was to control damage to their institution's image. That silence exploded with national media coverage of the case of James Porter, a Massachusetts priest, who victimized, often sadistically, over 200 minors in several states between 1960 and 1972, and a similar case in Louisiana. Media coverage triggered a flood of new charges of abuse. Ten of 97 priests in a southwestern diocese, nine of 110 in a midwestern diocese, seven of 91 in a southern diocese, and fifteen of 220 and forty of 279 in the eastern United States were charged in civil and criminal suits. In December 1993, twelve of 44 priests in a California minor seminary were charged with having been sexually active with 11- to 17-year-old boys between 1964 and 1987. Between 1984 and 1994, an estimated 5,000 survivors reported their abuse to Church authorities. By early 1995, over 600 cases were pending (Sipe 1995, 26-28). Meanwhile, the Catholic dioceses of Sante Fe and Chicago admitted being in danger of bankruptcy; between 1984 and 1994, Catholic officials admitted to paying out over a half billion dollars in damages to survivors (Rossetti 1991).

Sipe (1995, 26-27) estimates that, at any one time, 6 percent of Catholic clergy are sexually involved with minors; the situation does not appear to be as serious in Protestant and Jewish circles. One third of the cases of abuse by priests can be classified as true pedophiles, with a three-to-one preference for boys. Two thirds of the abusive priests are involved with adolescents with a more even gender distribution. Four times as many priests are involved with adult women as with minors.

“The crisis of image has been compounded by church authorities who were slow, defensive, and even duplicitous in their public response as abuse by clergy became public and other indications of trouble mounted” (Sipe 1995, 8). Even as late as 1992, fully two thirds of the American Catholic bishops were confused or unconvinced that there is a problem of sexual abuse by the clergy, although even the Pope has acknowledged the crisis.

Civil authorities have responded by extending the statutes of limitations on reporting such abuse. New laws in all states require any professional to report suspected sexual abuse of a minor; in many states, any person is required to report suspected abuse. However, such laws are often vague in defining “reasonable suspicion.”

The year 1990 was a watershed as confused Church authorities began losing their damage-control efforts to the rising tide of victims' voices expressed in civil and criminal lawsuits against priests, dioceses, and religious orders. Support groups for survivors spread across the nation: Victims of Clergy Abuse LINKUP, Survivors Connections, American Coalition for Abused Awareness, and Survivors Network of Those Abused by Priests (SNAP).

In 1992, the Catholic Archdiocese of Chicago adopted a model plan for processing allegations of clergy abuse; unfortunately, it remains incompletely and unevenly implemented. In 1993, St. John's (Benedictine) Abbey and University in Collegeville, Minnesota, established an ecumenical Interfaith Institute to study this problem.

How survivors are treated by a religious community varies greatly, and survivors should be reminded that, when they set out to seek legal action against anyone, the course may be extremely difficult. Far too often, survivors feel that they are revictimized by a system that protects the abuser, rather than one that is sensitive to the trauma of the victim.

Satanic Ritual Abuse

“Satanic” ritual abuse is another area of recent concern. As the 1989 report by the ritual abuse task force by the Los Angeles County Commission for Women shows, it is a controversial area that requires careful and serious attention. Books and groups dealing with cult and ritual abuse continue to expose this alarming and controversial topic. Unfortunately, it often takes on the atmosphere of a circus and witch hunt. There is no scientific evidence that this type of CSA is widespread or common.

Recovered Memories and False Memory Syndrome

Of great concern recently are a number of cases involving children in day-care centers reporting that they were sexually abused by their caretakers. Although some investigations have led to convictions, other cases have been found to lack any substance at all. In one case, a middle-aged male retracted his charge that a prominent Catholic cardinal archbishop had sexually abused him when he was in the seminary, claiming that his lawyer had probably prompted or influenced his “recovered memory” of being abused.

Concern over false reporting is not limited to young children. Teachers all over the country report that they no longer touch their students as they once did. Hugging a child, allowing a young child to sit on one's lap, or being alone in a room with a child are just some of the things that teachers must now monitor. Cases in which children have projected sexual abuse that was happening at home onto a teacher, and the false reporting of sexual abuse by a teacher in order to get back at the teacher are now issues that mental-health workers and the legal system must unravel in some of the more unusual cases placed before the courts.

Better questioning of young victims by mental-health and legal workers is one area that continues to improve. As with any inquiry, it has become evident that the invitation to tell what happened cannot, in any way, be colored by suggestive questioning on the part of the interviewer.

Increasing numbers of adult women and men have begun to disclose incidents of sexual abuse that happened to them when they were children. Their sexual abuse occurred during a time when it Was not safe for children to disclose such information and when the support systems of the state and therapeutic communities were not in place.

In some incidents where adults disclose what happened to them as children, they have always known what happened to them, but they have never before spoken out or sought help. In some instances, however, adults report “remembering” or retrieving lost memories of childhood sexual abuse. Remembering and dealing with unresolved issues of childhood sexual abuse can often explain to a victim how and why his or her life has been affected by the abuse. Weight problems, depression, sleep disturbances, intimacy and sexual disorders, unexplained fears, compulsive behaviors, self-esteem issues, and psychosomatic disorders are just a few of the symptoms that can be resolved when an adult finally confronts the repressed and unresolved trauma of childhood sexual abuse.

In a response to their own daughter's accusation of being sexually abused by her father, the Freyds' of Philadelphia started an organization that examines the False Memory Syndrome. Dr. Pamela Freyd and her husband have been most public in their denial of their daughter's accusations, basing their response on a belief that her “memories” were suggested by her therapist. After a period of silence on her part, Dr. Jennifer Freyd publicly countered her parents' denial of what happened to her, citing her mother's public debate as yet another example of her intrusiveness. Whatever the struggle between the members of the Freyd family, this small organization has brought forth a concern about the authenticity and reliability of retrieved memories.

Sexual Harassment

Public awareness of sexual harassment is also a recent phenomenon in American culture, even though sexual discrimination was prohibited by federal law over thirty years ago by Title VII of the 1964 Civil Rights Act. In 1979, Stanford University Law School professor Catharine MacKinnon broadly defined sexual harassment as “the unwanted imposition of sexual requirements in the context of a relationship of unequal power.” More-recent definitions include unwanted sexual advances, touches, and actions between peers and coworkers. Sexual harassment can also occur when a subordinate offers sexual favors in return for a promotion, better evaluation, or grade.

A 1976 Redbook magazine survey reported that 88 percent of the more than 9,000 women responding reported having experienced overt sexual harassment and regarded it as a serious work-related problem. A 1988 Men's Health survey reported 57 percent of the magazine's male readers stated they had been sexually propositioned at work, and 58 percent admitted they had at least occasional sexual fantasies about coworkers.

In a broad survey of over 20,000 federal government workers, 42 percent of the women and 15 percent of the men reported having been sexually harassed at work in the preceding two years. Most of the harassers, 78 percent, were male. Both women and men victims reported that the harassment had negative effects on their emotional and physical condition, their ability to work with others on the job, and their feelings about work. Women were considerably more likely than men to have been harassed by a supervisor, 37 percent versus 14 percent (Levinson et al. 1988).

A random-sample survey of undergraduate women at the Berkeley campus of the University of California found that 30 percent had received unwanted sexual attention from at least one male instructor during their undergraduate years. Examples of harassment included: verbal advances and explicit sexual propositions; invitations to date or to one's apartment; touches, kisses, and fondling; leering or standing too close; writing emotional letters; being too helpful; and offering grades in exchange for sexual favors (see Table 5).

Table 5: Varieties of Sexual Harassment in the Workplace

Type of Harassment

% of Males Reporting

% of Females Reporting

Uninvited sexual attention






Suggestive invitations, talk, joking



Harassed by same sex



Based on De Witt 1991; U.S. Merit Systems Board, 1981, 1988, and other sources.
It took over 15 years for the government to identify the sexual-harassment implications of the 1964 Civil Rights Act, and even longer for business corporations to understand the law. In a 1981 Redbook - Harvard Business Review survey, 63 percent of the top-level managers and 52 percent of middle managers believed that “the amount of sexual harassment at work is greatly exaggerated.” Although the amount of sexual harassment in the workplace has probably decreased because of the growing awareness of its risks, Working Woman reported that at least some business managers believe that “More than 95 percent of our complaints have merit” (Gutek 1985).

Although most research on sexual harassment has focused on its occurrence in the workplace and academia, sexual harassment has also been studied in the relationship between psychologists or psychotherapists and their clients, and between physicians and other health-care workers and their patients.

In 1991, televised hearings of Supreme Court nominee Clarence Thomas and Anita Hill captured the nation's attention and sparked considerable debate and a growing awareness of sexual harassment. About the same time, the United States Navy became the focus of congressional investigations and media headlines when close to a hundred male pilots and officers at an annual Tailhook convention were charged with blatant examples of sexual harassment. Sexual harassment was also the subject of Disclosure, a popular and powerful 1994 film dealing with a female executive sexually harassing a male employee. As a result, practically every American corporation, professional organization, and educational institution has been forced to develop and adopt a statement defining the nature of sexual harassment and its policies for responding to it.

The “interim guidelines” issued by the Equal Employment Opportunity Commission in 1980, established that “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment” when

1. submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment,

2. submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual, or when

3. such conduct has the purpose or effect of substantially interfering with an individual's work performance or creating an intimidating, hostile, or offensive working environment.

In 1985, sociologist Barbara Gutek explained the occurrence of sexual harassment in the workplace in terms of a gender-role spillover model. She defined a work role as “a set of shared expectations about behavior in a job,” and a gender role as “a set of shared expectations about the behavior of women and men.” Gender-role spillover occurs when gender roles are carried into the workplace, often in inappropriate ways; for example, when the woman in a work group is expected to make coffee or take notes at the meeting. Despite many attitudinal changes in American society, women are still often seen as subservient and sex objects. When these aspects of gender roles spill over into the workplace, sexual harassment can easily occur, despite its negative effects on the employees and organization (Gutek 1985, 17).

B. Prostitution-Sex Workers

Historical Perspective

In the American colonies and early days of the United States, prostitution did not thrive in the sparse rural population. Despite a shortage of women, there were still women on the financial fringe in the small cities - recent immigrants and unattached, single women with few skills - for whom prostitution provided a way of survival and, at times, a way to Find a husband or other male supporter. Female servants, apprentices, and slaves were not allowed to marry - a custom that encouraged prostitution. In contrast, indentured male servants are apprentices and could earn money to support themselves and their families, although they received no salary. Until the end of the American Civil War, African and Caribbean women brought to the United States in the slave trade were frequently and regularly exploited sexually by their owners (Barry 1984).

In the nineteenth century, the Industrial Revolution in New England and Middle Atlantic cities precipitated a massive influx of women from rural areas and from abroad looking for work and other opportunities. For example, women preferred the freedom that textile-mill work gave them to the tightly regulated life of a domestic servant, even though the wages were lower. There was little, if any, social life available after work hours for these single persons living apart from their families. Since they often shared a boarding house room with six to eight women, sometimes sleeping three to a bed, they frequently found their only relief at the local tavern. With men moving to the western frontier and a surplus of women, some women turned to prostitution for escape or affection. Too often they found that only sex work offered them a living wage (D'Emilio and Freedman 1988).

Throughout the mid-1800s, waves of immigration created a surplus of males who left their wives and families in Europe. In each new wave of immigration, some of the unattached immigrant women turned to prostitution in an effort to survive; some were already involved in “the trade.” Males far outnumbered women in the western frontier towns and mining camps. Thousands of women were imported from Mexico, Chile, Peru, the South Pacific, and China to work in the flourishing brothels. After the Civil War, American cities followed the European practice of segregating prostitutes to certain areas of the city, which came to be known as “red-light” districts, and requiring them to register or be licensed. Regular physical examinations were required of all sex workers.

Between 1880 and 1920, prostitution was commonplace and legal. Since few prostitutes bothered to register, licensing was not effective in controlling disease. Police supervision only spawned crime and corruption via bribes for protection or “looking the other way.” In 1910, Congress passed the Mann Act, which forbade the transportation of women across state lines for “immoral” purposes. In the decade before World War I, the Social Hygiene Movement, Women's Christian Temperance Union, Young Men's Christian Association, and other “purity” organizations worked for the criminalization of prostitution. By the end of World War I, these efforts were successful in ending politicians' tolerance of prostitution. “Legal brothels were destroyed and prostitutes were dispersed from stable homes in red-light districts to the city at large where they were less likely to be self-employed or work for other women and more likely to be controlled by exploitive men including pimps, gangsters, slum landlords, unscrupulous club owners, and corrupt politicians” (McCormick 1994, 91).

Currently, prostitution is illegal in all states except Nevada, where a 1971 court decision allowed counties with a sparse population the discretion of legalizing and licensing prostitution. State legal codes forbid making money from the provision of sexual services, including prostitution, keeping a brothel, and pandering, procuring, transporting, or detaining women for “immoral” purposes. Patronizing a prostitute is illegal in some states; a convicted offender may face a fine of $500 or more and a year or more in jail. In some states, pimps may be sentenced to ten to twenty years in jail and fined $2,000 or more.

The Spectrum of Sex Workers and Their Clients

Sex workers vary greatly in status, income, and working conditions, as well as in the services they offer - oral sex being the most common sexual practice offered. The vast majority of sex workers are females with male customers. Most prostitutes view their work as temporary, often on a part-time basis to supplement their traditionally female, poorly paid employment, and to support themselves and their families (McCormick 1994). The average prostitute's career lasts five years since youthful attractiveness is valued by customers. The sexual orientation of female sex workers reflects that of the larger population, and includes heterosexual, lesbian, and bisexual women. While sex workers are predominantly female, the “managers,” at all levels, are predominantly male. Pimps - those who live off the earnings of a sex worker - often exploit the workers' romantic feelings, emotional needs, or fear of violence, and often come from disenfranchised groups themselves.

On one hand, many believe that females turn to prostitution because of dysfunctional families and individual psychopathology. The belief that female prostitutes are more likely than other women to be depressed, alienated, emotionally volatile, or engage in criminal activities and excessive use of alcohol and street drugs are often based on small, specialized samples (McCormick 1994). Research is also inconclusive as to the proportion of sex workers who abuse alcohol and other drugs. At least one study has indicated that call girls were as well adjusted as a control group of nonsex-worker peers who were matched for age and educational level (McCormick 1994). Yet, for many juveniles, sexual and physical abuse seems to be related, at least indirectly, to their becoming involved with prostitution.

On the other hand, economic survival, not psychopathology, may be the most important contributing factor to engaging in prostitution. Poor and disadvantaged women may engage in sex work because it is the best paying or only job available. More-advantaged women may also engage in sex work because of the often unparalleled economic rewards, coupled with the flexibility in working hours, and the sense of control over clients. Although noncommercial sex is described as more satisfying by most sex workers, many report achieving satisfaction and orgasm though their work (Savitz and Rosen 1988).

On the lowest rung of female and male sex workers are those who solicit on the street; above them are those working in bars and hotel lobbies. Their limited overhead is matched by their low fees. Streetworkers, usually from the lower-socioeconomic class or run-away teenagers, face high risks of violence, robbery, and exploitation, as well as drug addiction, STDs, and HIV infections. Approximately 35 percent of streetwalkers have been physically abused and 30 to 70 percent raped while on the job (Delacoste and Alexander 1987). In addition, because of their visibility, Streetworkers are the most vulnerable to harassment and arrest by law enforcement agents. While 10 to 20 percent of sex workers are streetwalkers, they constitute 90 percent of sex-worker arrests. Prostitution is the only crime in America in which the majority of offenders are female. In dealing with prostitutes, the courts often become a “revolving door system,” with the sex worker posting bail and back on the street shortly after being arrested. Paradoxically, she is often fined, making it financially important for her to turn again to sex work to survive.

Government estimates suggest that half of the five million teenagers who run away from their homes each year spend at least some time as sex workers. Poor self-images, rejection by peers, few friends, unsupervised homes, and emotional, if not sexual, abuse in the home make them susceptible to the lure of big-city glamor where their survival needs force them to find work on the streets.

Houses of prostitution are less common today than they were in the past. The famous houses of the Storyville area of New Orleans or San Francisco's Barbary Coast were often very luxurious, and women both lived and worked in the same brothel for many years. Because of legal problems, most brothels today are run-down and in disrepair. If tolerated by the local police, they may be better maintained. In many places, regular, “go-go,” and “topless” bars and massage parlors double as “fast-service” brothels. Brothels sometimes advertise their services in “underground” newspapers or in the “free press.”

Escorts and call girls are at the upper level of sex workers. Young, slender, attractive, middle- and upper-class white women command the highest fees and the best working conditions among sex workers. Call girls typically see a small number of regular, scheduled clients. For them, sex work provides a much higher income than they would earn in almost any other profession, plus better control over their working hours.

The typical customer of a female sex worker, a “John,” appears indistinguishable from the average American male. They are often involved in sexual relationships with another woman and report that they purchase sex by choice - perhaps for the adventurous, dangerous, or forbidden aspects of sex with a prostitute. Some frequent prostitutes because their usual sexual partners are unwilling to participate in certain sexual behaviors (like oral or anal sex). Other men frequent prostitutes because they have difficulty in establishing an ongoing sexual relationship because of lack of opportunity or physical or emotional barriers.

Most heterosexual male prostitutes are not street hustlers, but have steady customers or relationships that are ongoing and similar to those of a high-priced call girl. Their clients are often wealthy older women. Much more common are males who sell their sexual services to other males. In fact, most male prostitutes identify themselves as homosexual or bisexual. In large cities, gay male prostitutes cruise gay bars, gay bath houses, public toilets, bus and train stations, and other areas known to local clients.

Sex work also includes a variety of erotic entertainment jobs, including erotic dancing, live pornography or “peep shows,” and acting in pornographic films and videos. Female burlesque shows have long been part of the American scene. However, the professional burlesque queens of the past have been replaced by amateur, poorly paid “table dancers.” Feminists Barbara Ehrenreich, Gloria Hass, and Elizabeth Jacobs (1987) maintain that male go-go dancers play a role in advancing the rights of women and in breaking down patriarchal biases, because their female viewers treat them as sex objects and reduce their phallic power to impotence within bikini shorts.

The incidence of HIV infection and AIDS varies among sex workers and is increased by IV drug use, untreated STDs, and unsafe-sex practices. In general, it is high among female and gay male sex workers on the street, and lowest among high-priced call girls and heterosexual male prostitutes.

Economic Factors

In the early 1990s, there were an estimated 450,000 female prostitutes working in the United States, a profession lacking job security and fringe benefits, such as health insurance and social security. Most working outside the high-class escort services do not pay taxes. Nor are taxes paid on any of the monies that are exchanged in the underground economy associated with prostitution, such as: the monies that pass between prostitutes and their pimps; the hotel, motel, massage parlor, or bar owners and clerks; or the recruiters like cab drivers and doormen who make prostitution possible.

A 1985 survey of the cost of enforcing antiprostitution laws in the sixteen largest cities of the U.S. estimated police enforcement costs at $53,155,688, court costs at $35,627,496, and correction costs at $31,770,211, for a total 1985 cost of $119,553,395. In 1985, Dallas, Texas, police made only 2,665 arrests for the 15,000 violent crimes reported. They made 7,280 prostitution arrests at a cost of over $10 million and almost 800,000 hours of police work. In 1986, Boston, Cleveland, and Houston police arrested twice as many people for prostitution as they did for all homicides, rapes, robberies, and assaults combined. Meanwhile, 90 percent of perpetrators of violent crimes evaded arrest. Between 1976 and 1985, violent crimes in the sixteen largest cities rose by 32 percent while arrests for violent crimes rose only 3.7 percent, and arrests for robbery and homicide actually dropped by 15 percent. Equally important, the sixteen largest cities continue to spend more on enforcing prostitution laws than they do on either education or public welfare (Pearl 1987).

Working in pairs, police spend an average of twenty-one hours to obtain a solicitation, make an arrest, transport the prostitute to the detention center, process her papers, write up a report, and testify in court. Undercover police cruising the street looking to get a solicitation need frequent changes of disguises and rented cars. Making an arrest of a call girl is even more difficult, requiring greater expense for false identification and credit cards, hotel room, luggage, and other paraphernalia to convince the call girl this is a legitimate customer and not a policeman. The hotel room is usually wiretapped and the solicitation videotaped.

Arrests of prostitutes working in massage parlors present their own difficulties. It usually takes half an hour for an undercover policeman to undress, shower, and get into the massage, before an illegal service is offered. For a while, Houston police ran their own parlor. When that was declared entrapment by the courts, teams of 10 undercover officers began working existing modeling studios as customers. “Ten officers at a time, at $60 each, with no guarantee that we'd get solicited.... We could spend $3000 or $4000 and not make a case” (Pearl 1987).

Current and Future Status

Historically, sex workers have been blamed for the spread of sexually transmissible diseases (STDs). However, recent research has indicated that sex workers are much more likely to practice safer sex than the “average teenager” (McCormick 1994). While prostitutes are being blamed for transmitting HIV to their clients, data from the Centers for Disease Control indicate that only a small proportion of persons with AIDS contracted HIV from a prostitute. However, rates of HIV infection are quite high - up to 80 percent - among sex workers who also use intravenous drugs. Unfortunately, sex workers are usually at higher risk of contracting an STD, including HIV, from their lovers with whom they do not use a condom than from their clients with whom they use a condom.

Today in the United States, religious and political conservatives and radical feminists continue to oppose prostitution through such groups as WHISPER (Women Hurt in Systems of Prostitution Engaged in Revolt), an organization devoted to rescuing women and children from sex work. On the other hand, sex workers have begun to organize and advocate better working conditions and treatment through such groups as COYOTE (Call Off Your Old Tired Ethics), Scapegoat, and U.S. PROStitutes. These groups lobby for the decriminalization and legalization of prostitution, inform the public about the realities of prostitution, and offer various services to sex workers. In addition, liberal feminists inside and outside of the sex industry have founded the International Committee for Prostitutes' Rights (ICPR) in order to preserve their rights to life, liberty, and security.

In spite of continued economic inequities in the United States, some observers believe prostitution will decline because of the availability of effective contraceptives, a continued liberalization of sexual attitudes and divorce, a decline in the double standard in employment and sexual expression between the genders, and the risk of AIDS. In the Kinsey study of male sexuality in the late 1940s, 69 percent of white males reported having had at least one experience with a prostitute. The recent national study of 18- to 59-year-olds, Sex in America, found that only 16 percent of the men ever paid for sex (Gagnon, Laumann, and Kolata 1994). Yet, it seems that prostitution will continue to exist in some form or another. Although some people support the decriminalization of sexual activity between consenting adults, whether or not money is exchanged, this is not likely to happen in the United States.

C. Pornography and Erotica

The Legal Context

A landmark legal definition of obscenity was established by the Supreme Court in the 1957 Roth v. the United States decision. For a book, movie, magazine, or picture to be legally obscene,

· the dominant theme of the work, as a whole, must appeal to a prurient interest in sex;
· the work must be patently offensive by contemporary community standards; and
· the work must be devoid of serious literary, artistic, political, or scientific value.
This ruling permitted the publication in the U.S.A., for the first time, of such works as D. H. Lawrence's Lady Chatterly's Lover, James Joyce's Ulysses, and works by Henry Miller. However, this definition left the meaning of the term “community standards” unclear.

In the 1973 Miller v. the United States decision, the Supreme Court attempted to tighten the restrictions on obscene material by requiring that defenders of an alleged obscene work prove that it has “serious literary, artistic, or scientific merit.” Despite this clarification, the courts still faced the near-impossible task of determining what has “literary, artistic, or scientific merit,” who represents the “average community member,” and what the “community” is. In 1987, the Supreme Court attempted to refine the Roth and Miller decisions by saying “a reasonable person,” not “an ordinary member of the community,” could decide whether some allegedly obscene material has any serious literary, artistic, political, or scientific value. Justice Potter Stewart further confused the situation when he remarked that “You know it when you see it.”

In 1969, the Supreme Court ruled that private possession of obscene material was not a crime and is not subject to legal regulation. However, federal laws continue to prohibit obscene material from being broadcast on radio and television, mailed, imported, or carried across state lines. In recent years, pornographic material of any kind involving underaged children has been the target of repeated federal “sting” operations, raising issues of police entrapment.

Research Models

For at least two decades, there has been often-heated debate among the public, among feminists groups, and among scientists regarding the social and psychological impact of pornography, particularly materials that link sex with the objectification of women and with violence. A psychological research theory, the catharsis model, assumes that pornography and other sexually explicit materials provide a “safety valve” in a sexually repressive society. This model views pornography and other sexually explicit materials as “not so good, perhaps disgusting, but still useful” in diverting tensions that otherwise might trigger aggressive antisocial behavior. A different hypothesis suggests an imitation model in which sexually explicit books, pictures, and movies provide powerful role models that can, by conditioning and scripting, promote antisocial, sexually aggressive behavior. A third model of pornography addresses the personal and societal uses of pornography in different cultures, as a product designed as an alternative source of sexual arousal gratification and a way of enhancing masturbation. There are also models of pornography based on communication, Marxist, psychoanalytic, feminist, and religious theories (Francoeur 1991, 637).

Commission Studies

A 1970 White House Commission funded research by experts in the field and concluded that neither hard-core nor soft-core pornography leads to antisocial behavior and recommended that all obscenity laws except those protecting minors be abolished. The majority of the commission concluded that pornography provides a useful safety valve in an otherwise sexually repressive culture. President Richard Nixon refused to officially accept the commission's report.

A 1986 investigation by then-Attorney General Edwin Meese did not sponsor any new research and took a different approach in reaching its conclusion. This commission reexamined the alleged connection between pornography and child abuse, incest, and rape by inviting anyone interested in speaking to the issue. The commission was widely criticized for having a preset agenda, for appointing biased commission members, and for relying on “the totality of evidence,” which gave equal weight to the testimony of fundamentalist ministers, police officers, antipornography activists, and putative victims of pornography. This allowed the commission to conclude there is a “proven” causal connection between violent pornography and sexual assaults. This commission concluded that there is a causal connection between viewing sexually explicit materials, especially violent pornography, and the commission of rape and other sexual assaults. The commission recommended stricter penalties to regulate the pornography traffic, enactment of laws to keep hard-core pornography off home cable television and home telephone service, more vigorous prosecution of obscenity cases, and encouraged private citizens to use protests and boycotts to discourage the marketing of pornography. Among the many criticisms of the Meese Commission, Robert Staples, a black sociologist, pointed out that in the black community, pornography is a trivial issue. It is “a peculiar kind of white man's problem,” because blacks see the depiction of heterosexual intercourse and nudity, not as a sexist debasement of women, but as a celebration of the equal rights of women and men to enjoy sexual stimuli and pleasure (Nobile and Nadler 1986).

Concurrent with the Meese Commission Report, the 1986 Report of the U.S. Surgeon General concluded that we still know little about the patterns of use or the power of attitudes in precipitating sexually aggressive behavior. Much research is still needed in order to demonstrate that the present knowledge of laboratory studies has significant real-world implications for predicting behavior. This report did not call for censorship, boycotts, and other tactics advocated by the Meese Commission. Rather, it recommended development of “street-based, innovative approaches” to educate the public about the different types of sexually explicit material and their possible effects.

Local Efforts at Regulation

In 1985, Andrea Dworkin, Catherine MacKinnon, and Women Against Pornography joined forces with local citizens' groups in Minneapolis, Minnesota, and Long Island, New York, to promote a new kind of pornography legislation. Using a civil rights argument, the proposed legislation stated that

Pornography is sex discrimination. [Where it exists, it poses] a substantial threat to the health, safety, peace, welfare, and equality of citizens in the community.... Pornography is a systematic practice of exploitation and subordination based on sex that differentially harms women. The harm of pornography includes dehumanization, sexual exploitation, forced sex, forced prostitution, physical injury, and social and sexual terrorism and inferiority presented as entertainment.
The proposed legislation would have made producing, selling, or exhibiting pornography an act of sex discrimination. Women forced to participate in pornographic films, exposed by force of circumstances to view pornography in any place of employment, education, home, or public place, or assaulted by a male inspired by pornography could sue in civil court for damages based on sex discrimination. The American Civil Liberties Union (ACLU), Feminist Anti-Censorship Taskforce (FACT), and others challenged this kind of legislation. After considerable nationwide debate about civil rights, sex discrimination, and the constitutional right to free speech, these legislative efforts were abandoned.

Contemporary Aspects

The availability of sexually explicit, X-rated videocassette rentals and sales has become a major factor in American home entertainment. In the past decade, feminist soft-core pornography or erotica has made its mark in the popular media by portraying women as persons who enjoy sexual pleasure as much as men. This material appears in the pages of such mainstream women's magazines as Cosmopolitan. It is promoted by sex boutiques, with names like Eve's Garden, Adam and Eve, and Good Vibrations, catering to women. Another growing phenomenon is a variation on the Tupperware and Mary Kay Cosmetics home parties that bring women the opportunity to examine and, of course, purchase sex toys, love lotions, and lingerie in the privacy of their homes, surrounded by other women with whom they are friends. Exotic lingerie is also available in specialty stores in major shopping malls and by mail order from Victoria's Secret and Frederick's of Hollywood. Since 1992, Feminists for Free Expression, opposed to censorship and supported by such notables as Betty Friedan, Erica Jong, and Nancy Friday, has countered the efforts of some feminists to suppress pornography with an alternative view for the feminist community.

Erotic romance novels have become an acceptable form of soft-core pornography for women. Far outselling gothic novels, science fiction, self-help, and other books aimed at women, erotic romances often center around a traditional rape myth, a story in which the woman is at first unwilling, but finally yields in a sensual rapture to a man. In nonsexual characteristics, women who read erotic romantic novels are very much like women who do not. However, they appear to enjoy sex more and have a richer sexual fantasy life (Coles and Shamp 1984; Lawrence and Herold 1988).

Researchers and theorists, both feminist and nonfeminist, have almost completely ignored the existence of gay pornography. Lesbian pornography tends towards two extremes, about evenly divided in popularity, with little middle ground. Small independent presses publish soft-core pornography or erotica. Erotica on audiocassettes are very popular among lesbians. On the other side is a hard-core lesbian literature with a strong SM character that makes some feminists uncomfortable. On Our Backs, a tabloid magazine, is the largest publication of this type. Eidos, another tabloid, carries numerous ads for lesbians who desire bondage and dominance or sadomasochistic relations.

Considerably more pornography designed for homosexual men is available. Most of this genre is hard-core pornography with an emphasis on leather, SM, and younger males. At the same time, gay videos have pioneered in eroticizing the condom, nonoxynol-9, and safer-sex practices.

Dial-a-porn, or telephone sex, is a multimillion-dollar-a-year business producing massive profits for telephone companies and the companies providing phone-in services. In one year, dial-in services, including dial-a-porn, earned Pacific Bell $24.5 million and the phone-in companies $47.2 million. Because of constitutional concerns, the Public Utilities Commission and Federal Communications Commission (FCC) do not allow telephone companies to censor telephone messages or to discriminate among dial-for-a-message 1-900 services on the basis of content. Telephone companies cannot legally deny telephone lines to adults willing to pay the bill, although at least one court has ruled that it is not unlawful discrimination for a telephone company to refuse to provide services for dial-a-porn services. The FCC does require dial-a-porn services to screen out calls by minors by supplying their customers with special access numbers or having them pay by credit card. Concerned parents may pay a one-time fee to block all phones in a residence from access to dial-a-porn.

D. Paraphilias and Unusual Sexual Practices

In 1990, a Los Angeles man named Jeff Vilencia formed a group called Squish Productions. Through magazine articles, television appearances, and radio interviews, Vilencia had attracted more than 300 members to his group by 1995, all of whom shared the fetish of becoming aroused by the sight of others stepping on small living things such as snails and insects.

Although the fetish shared by Vilencia and his fellow members in Squish Productions may seem - and may in fact be - novel, paraphilias are nothing new. Paraphilias and fetishes have most likely been in existence in the U.S. for as long as there have been inhabitants on the Western continents. Although while a few immigrants may have brought sexual preferences, such as autoerotic asphyxiation, sadomasochism (SM), foot fetishes, and bestiality with them, other paraphilias have unquestionably developed here. In the world of paraphilias and fetishes, there is always something new. And thanks to increased awareness of and access to information about unorthodox sexual practices and their practitioners, interest in paraphilias appears to be growing in the United States.


“Fetish,” as defined for the American health professional by the Diagnostic and Statistical Manual of Mental Disorders III (DSM III), “is the use of nonliving objects (fetishes) as a repeatedly preferred or exclusive method of achieving sexual excitement.” Such objects “tend to be articles of clothing, such as female undergarments, shoes, and boots, or, more rarely, parts of the human body, such as hair or nails” (American Psychological Association 1980).

The manual also states that the fetish object “is often associated with someone with whom the individual was intimately involved during childhood, most often a caretaker.... Usually the disorder begins by adolescence, although the fetish may have been endowed with special significance earlier, in childhood. Once established, the disorder tends to be chronic” (APA 1980).

“Paraphilias,” on the other hand, are defined by DSM III as recurrent, fixed, compulsive, sexually motivated thoughts or actions by a personally or socially maladjusted individual that interfere with the individual's capacity for reciprocal affection. It is important to note that a paraphilia is not merely an activity that may appear strange or disgusting to an observer; rather, the activity or compulsion must meet all of the above criteria to be considered a problem requiring therapy.

It is also important to note in the area of paraphilias that many patients mention their unusual sexual interest simply to receive validation. The therapist can do much for the mental health of a patient by mentioning a support group or club for people with the interest, or by giving the patient the clinical name for the practice, stressing that the term paraphilia only applies when the above DSM III criteria apply. This can be followed by therapy to improve the person's self-esteem, communication, and social skills. The confession of activities involving minors or nonconsensual activities, however, of course requires immediate intervention by health professionals.

Background on Fetishes and Paraphilias in the U.S.A.

Fetishes change according to current fashions and customs. A hundred years ago, fetishists were aroused by such things as handkerchiefs, gloves, black rubber aprons, garters, corsets, enemas, seeing females wring the necks of chickens, or whipping horses. Today many of these stimuli have been replaced by pantyhose, high heels, tennis shoes, cigarettes, escalators, latex, or phone sex.

In addition, today's technology adds to the variety of ways a fetishist can pursue his or her predilection. In the past, one had either to create one's own drawings, or hope to catch a glimpse of an arousing person, object, or situation. Today, the fetishist has access to television, photographs, Internet newsgroups, clubs, videos, and magazines. Membership in fetish groups has increased during the last decade. And as computer technology has decreased the cost of publishing, groups or individuals have been increasingly able to print their own sex magazines, books, and newsletters, thereby avoiding the censorship imposed by mainstream publications.

At the same time, even the more straitlaced mainstream media have helped to increase the information available about fetishes and paraphilias. Unfortunately, many national television talk shows have “cashed in” on fetishes and victims of sexual trauma by sensationalizing their lives, rather than trying to educate the public. Hollywood also sensationalizes the issue, portraying erotic asphyxia, lust murder, sadomasochism, and nipple piercing. An example of the media's exploitation and sensationalization of unusual sex practices was the hundreds of hours of air time devoted to keeping the public informed of the status of John Wayne Bobbit, the circumstances leading to his castration at the hands of his wife, the subsequent surgical reattachment of his penis, and his appearance in an X-rated video.

Perhaps the most important development in the growth of interest in paraphilias and fetishes has been the Internet, the worldwide computer network through which up to 500,000 “lurkers” a month enter the “” newsgroups. Users of these newsgroups, which offer uncensored forums devoted to a wide variety of sexual interests, can exchange or download photos and information, including what would normally be considered illegal in the United States, with other Internet users.

While the Internet has played an increasing role in the lives of fetishists in recent years, it would not be correct to attribute the growing popularity of fetishism and other unorthodox forms of sexuality to the Internet alone, as those in Washington who seek to censor the Internet seem to believe. The role of the Internet is more modest according to Robin Roberts, an Internet guru in California and founder of Backdrop, one of America's oldest fantasy and bondage clubs. Established in 1965, Backdrop promoted itself with discreet ads in the Berkeley Barb with post office boxes or mail-drop services as the method of contact. Today, Backdrop has about 5,700 members, but Roberts does not attribute the club's growth to exposure on the Internet.

Roberts explains that Internet lurkers rarely participate in dialog and tend not to join sex clubs. They are typically readers of Forum magazine or “Letters to the Editor” columns. For those users who do participate in sex on-line, computers provide anonymity, and a way to explore taboos in a safe, non-threatening environment. Roberts does note, however, that for those who are active participants in computer sex, rather than just lurkers, the Internet provides twenty-four-hour access to other users, an equal chance to express one's opinions, and an unlimited number of fantasies. At the same time, Roberts does not feel computer sex will replace fetish clubs, due to the simple fact that electronic mail does not provide touch, intonation of the voice, nuances of speech, or visual impressions.

The Growing Popularity of Fetishes and Paraphilias

Not everyone who accesses information about paraphilias and fetishes through these new technological avenues is a fetishist. Many are among the growing number of experimenters who, even though they do not have a fetish, will join groups or purchase sex toys and SM paraphernalia. Such experimentation seems to be on the increase; a 1994 survey conducted in two San Francisco sex boutiques indicated that approximately 55 percent of their customers had at least experimented with SM (Love 1994).

Ann Grogan, owner of San Francisco's Romantasy boutique, has seen an increase in such experimentation among the customers who frequent her sex-accessory establishment, one of two operating in San Francisco in 1995 geared toward women customers.

“Gender play is becoming more and more popular among customers of all ages, primarily ages 30-50 years,” Grogan says. “Couples now buy matching corsets and wrist restraints.” During the last five years, females in increasing numbers have shown an interest in transgender play, assuming the dominant role in the sexual relationship. Many men are also expressing an interest in anal sexuality, measured in part by the purchase of dildoes and harnesses to be used on men by the women. And a growing number of recently divorced female customers in their 50s have shown a curiosity about safe sex and pleasuring themselves.

Grogan can also testify to the increasing influence of the Internet:

The latest trend seems to be the appearance of couples who have met on the Internet. They appear together at Romantasy after only one or two meetings, because in previous communications they have gotten far beyond the awkward preliminary dialog about each other's sexual preferences and have jumped into a willingness to act out each other's fantasies. Meeting on the Internet seems to be a “fast track to intimacy.” (Grogan 1995)
Ted McIlvenna, president of the Institute for the Advanced Study of Human Sexuality, expects that interest and participation in paraphilias and fetishes will continue to grow. “In the next five years,” McIlvenna believes,
we will see a group of people seeking information and support groups for their sex interests which, in the past, people have considered excessive or compulsive. This is not an evil path; instead it is remedial sex education. Because of the massive number of people involved - in the U.S. the estimate is forty million people - I have labeled this the “sexual accessories movement.” Mental health professionals, including sexual health professionals, must monitor and study but leave this movement alone; their sexuality belongs to them. We can expect people to buy more, join more, and experiment more, and we can only hope that out of this will emerge societal control methods that will enable people to have better and more fulfilling sex lives. (McIlvenna 1995)
Given the recent and anticipated growth of many of the fetish clubs described below, it is important to ask about what causes paraphilias. Although there has been much scientific interest in this question, science has not yet discovered the etiology of fetishes or “paraphilic lovemaps,” according to John Money (1988), the leading expert on paraphilias. It does appear, however, that, as is the case with substance abuse and addiction, a small percentage of the population seems more predisposed toward the development of paraphilias, often due to childhood trauma. Money says,
The retrospective biographies of adolescent and adult paraphiles point to the years of childhood sexual rehearsal play as the vulnerable developmental period.... The harsh truth is that as a society we do not want our children to be lustfully normal. If they are timorous enough to be discovered engaging their lust in normal sexual rehearsal play or in masturbation, they become, in countless numbers, the victims of humiliation and abusive violence. (Money 1988)
Money has explained how these early traumas can lead to paraphilias:
They [adults who subject sexually curious children to abuse] do not know that what they destroy, or vandalize, is the incorporation of lust into the normal development of the lovemap. The expression of lust is diverted or detoured from its normal route. Thus, to illustrate: those adults who humiliate and punish a small boy for strutting around with an erected penis, boasting to the girls who watch him, do not know that they are thereby exposing the boy to risk of developing a lovemap of paraphilic exhibitionism. (Money 1988)
Fetish and Paraphilia Clubs

The United States is probably home to more fetish clubs than any other country. As Brenda Love (1992) wrote in The Encyclopedia of Unusual Sex Practices, which catalogs over 700 sexual practices,

international advertising is fairly inexpensive and computerized printing of newsletters has made it simpler to form clubs. People with fetishes as obscure as large penises, big balls, hairy bodies, mud wrestlers, shaving, cigars, used condoms, genital modification, and throwing pies have been able to Find others with similar interests willing to form clubs.
Sadomasochist (SM) clubs are probably the most prevalent type of fetish clubs in the U.S.A. today, although very few of the members could be defined as having a true SM fetish or paraphilia.

SM has become an umbrella term for many sexual activities, and because of its accouterments and role playing, people wanting to experiment with or improve their sexuality join these groups. “It was only in the late fifteenth century that the first unambiguous case report of SM was reported, and then as a medical curiosity rather than a problem” (Ellis 1936). William Simon has eloquently described the allure of SM:

The sadomasochistic script plays upon the potential absolutism of hierarchy, not merely to experience hierarchy with the relief accompanying the elimination of its ambiguities but to experience the dangerous emotions that invariably accompany acknowledgment of its exercise, the rage and fear of rage in both the other and ourselves. (Simon 1994)
Charles Moser (1988) estimates that approximately 10 percent of the adult population are SM practitioners. This estimate is based on Kinsey's report that approximately 50 percent reported some erotic response to being bitten (Kinsey 1953). However, there is no direct empirical evidence verifying this estimate. Moser divides SM behaviors
into two types, physical and psychological.... Physical behaviors may be further subdivided into the following categories: bondage, physical discipline, intense stimulation, sensory deprivation, and body alteration.... Psychological pain is induced by feelings of humiliation, degradation, uncertainty, apprehension, powerlessness, anxiety, and fear.... Both physical and psychological behaviors are devised to emphasize the transfer of power from the submissive to the dominant partner. SM practitioners often report it is this consensual exchange of power that is erotic to them and the pain is just a method of achieving this power exchange. (Moser 1988)
Moser lists the common types of clinical problems presented by SM practitioners to their therapists as: “1) Am I normal? 2) Can you make these desires go away? 3) SM is destroying our relationship; 4) I cannot lead this double life anymore; 5) I cannot find a partner; and 6) Is it violence or SM?” (Moser 1988). All but the last question are also the concern of most fetishists.

Foot-fetish club members have a more focused interest than do SM practitioners. Weinberg et al. (1994) conducted a survey of 262 members of a gay foot-fetishist group called the Foot Fraternity that had approximately 1,000 members in 1990, but had grown to over 4,000 by 1995. These sexologists also compared the ratio of self-masturbation during sexual encounters to that of oral-genital activity and to anal intercourse. Fetishists tended to masturbate to orgasm while engaging in foot play rather than experiencing orgasm as a result of some type of penetrative sex with a partner. Furthermore, the researchers discovered that 76 percent responded that they masturbated themselves to orgasm frequently, whereas 48.1 percent performed oral-genital activity, and only 9.55 percent performed anal intercourse.

Weinberg et al. (1994) reported that their research highlighted the psychological importance a support group or club has for fetishists.

Despite the lack of a widespread fetish subculture, the Foot Fraternity itself can be considered an embryonic subculture. Almost 70 percent of the respondents said membership in the Foot Fraternity allowed them to pursue their fetish interests more easily. Some 66 percent said membership increased their interest in feet and footwear, and over 40 percent said that they learned new ways of expressing their sexuality. Thus, the organization helped to sustain, as well as expand, its members' unconventional sexual interest. Almost 70 percent said the Foot Fraternity got them to correspond with others with similar interests, 50 percent that it got them to meet others with similar interests, and 40 percent that this led them to engage in foot play with another member. Finally, over 40 percent said that membership in the Foot Fraternity helped remove confusion about their interest in feet and footwear and almost 60 percent that it increased their self-acceptance. (Weinberg et al. 1994)
These statistics regarding benefits of membership can most likely be applied to other sexual interest groups as well.

Doug Gaines, founder of this Cleveland-based club, estimates that 15 percent of the U.S. population has a foot or related fetish, an opinion based on the fact that he has received 80,000 requests for club information. He promotes the group in magazines, radio interviews, and a foot-fetish Internet newsgroup.

Interestingly, Gaines seconded the Findings of researchers on the genesis of fetishes by identifying childhood experiences, such as being tickled, riding on the foot of a parent (“playing horsey”), or seeing a parent's foot immediately prior to being picked up and nurtured, as predominant memories of most of his members. The Foot Fraternity offers a newsletter, glossy magazine, and videos of men modeling their feet. The selection of photos is determined by a detailed membership questionnaire which asks what type of shoe, sock, or foot the new member finds erotic.

The activities in which foot enthusiasts participate include masturbation while looking at photos of feet, slipping off a partner's shoes in order to smell the stockings and foot, or placing oneself underneath the foot in a submissive posture. The foot is massaged and licked completely (toes, between toes, bottom, etc.). SM dominance and submission scenes, for example, where a partner takes on the role of a policeman and the fetishist must kiss his boot to get out of being given a traffic ticket, are popular.

Another common scene consists of acting out the roles of principal and student. Foot fetishists rarely use pain in their dominance/submission; rather, these scenes simply serve as an excuse for foot worship. A few foot fetishists attend auctions where they are able to purchase shoes once belonging to their favorite sports figures or movie stars hoping that the “scent” of the person remains in the shoe.

Squish Productions, mentioned earlier, can also be viewed as a foot-fetish club. Unlike the Foot Fraternity, Squish has yet to be the subject of any in-depth survey by sexologists. Even so, the genesis of the Squish fetish appears to be similar to that found in other fetishes, as evidenced by Squish founder Jeff Vilencia's recollections of his childhood. Identifying what he considers to be his childhood trigger point in the development of his fetish, Vilencia recalled that, as the younger of two children, he was the “victim” of an older sister who enjoyed kicking and stepping on him. Upon reaching puberty, he discovered feeling aroused when seeing females step on bugs. The bug apparently only serves as a projection of himself, because his fantasy involves taking the bug's place under the woman's foot.

Cross-dressing and other forms of transgender activity are found in many countries. The new DSM IV no longer lists this activity as a paraphilia, but rather as “gender dysphoria.” Clubs such as ETVC in San Francisco have an extensive library for members, social outings, support-group hot line, newsletter, make-up classes, and lingerie modeling. Membership in ETVC increased from 329 in 1988 to a total of 433 in 1995.

Another group, Texas Tea Party, sponsors an annual party that, after eight years of existence, drew about 400 people in 1995. Estimates on the percentage of the population who have ever cross-dressed range from 1.5 to 10 percent. Groups attract new members with newspaper and magazine advertisements, appearances on television and radio, magazine articles on the subject, and by staffing a booth at the annual San Francisco Lesbian and Gay Freedom Day Parade and Celebration.

A recent survey of 942 transgenderists by Linda and Cynthia Phillips indicates that most members experienced cross-dressing in puberty, although one member did not begin cross-dressing until the age of 72. The average transgenderist did not seek out a transgender club until his early 40s. Sexual arousal while cross-dressing is also more common during adolescence, and appears to diminish as the boy grows older. Therefore, an adult male transgenderist dresses to feel “feminine,” whereas an underwear fetishist uses the lingerie for sexual arousal. (Females who cross-dress do not tend to experience arousal while cross-dressing) (Phillips 1994).

No one knows how many cross-dressers or clubs exist in the U.S., but it is known that many people purchase special-interest cross-dressing magazines. One of these, Tapestry, had a 1995 quarterly distribution of 10,000 issues compared to 2,000 five years earlier. And a fairly new magazine, Transformation, had an international distribution of 50,000 in 1995.

Infantilism is fairly unique to the U.S. and growing in popularity. Its practitioners take on the persona of infants or young children. They may wear diapers under their business suits, drink from a baby bottle, use an assortment of toys and baby furniture, and, if they have a partner, they may participate by reading bedtime stories, diapering, spanking, or using other forms of affection or punishment.

One practitioner, who asked to be identified only as Tommy, is the founder of Diaper Pail Friends. Inside his home in a prestigious San Francisco suburb, a visitor will find an adult-sized high chair, bibs, and numerous baby bottles in the kitchen. Downstairs, Tommy's bedroom features a large crib with a view of the Bay area, a collection of adult-sized baby clothes, and a trail of toys leading to a train set that fills the center of an adjacent room.

Diaper Pail Friends is about 15 years old, and grew from about 1,000 members in 1990 to more than 3,000 in 1995. Most of the members discovered the group through articles in magazines or books, television talk shows, or an Internet newsgroup. The club publishes a newsletter, short stories, videos, and distributes adult-sized baby paraphernalia.

A group of sexologists conducted an extensive survey of the Diaper Pail Friends, but had not yet published their findings as of 1995. Tommy, however, concluded from an informal survey of the group's members that

Even a casual review of infantilists in the DPF Rosters show that there are tremendous differences between one infantilist and another. In fact, there would seem to be as many personal, individual variations as there are people. Nevertheless, certain patterns do seem to become evident, patterns that seem to encompass a very large percentage of the environmental and inborn factors that are involved with the creation of Infantilism in human personality. These patterns are [in order of prevalence] (1) deficient early nurturing, (2) rejection of Softness, (3) childhood sexual abuse [primarily in female members], and (4) bed wetting. Every infantilist probably has one or more of these patterns in their history, and each infantilist combines them in varying degrees. The variations are limitless. (Tommy 1992)
A Chicago-based national acrotomophile club (people aroused by seeing amputees) has a membership of about 300. They sponsor an annual conference during the first week of June and have spawned local chapters that also hold meetings. Quarterly pamphlets are sent to members and a couple of Internet newsgroups exist. New membership is not aggressively recruited, but the number of self-identified acrotomophiles has increased since 1989 publication of Grant Riddle's book, Amputees and Devotees, which examines the psychological basis of this phenomenon.

According to Riddle, many “devotees” are aware of this preference as a child, but there seems to be a wide variety of reasons for its development. One of these is being overly criticized by parents and wishing to be like a handicapped neighbor, assuming this would relieve some of the pressure. Another cause is being taught that sex is dirty, and from there, having to rationalize that if one cares for someone handicapped, one can justifiably ask for sex in return. Activities of acrotomophiles include having a healthy partner pretend to limp or use crutches; most acrotomophiles, however, content themselves with viewing photos (mostly of clothed females) or possibly catching a glimpse of an amputee on the street (Riddle 1989).

Autoerotic asphyxia (self-strangulation) seems originally to have been carried to Europe by French Foreign Legionnaires returning from war in Indochina (Michaldimitrakis 1986). Erotic asphyxia involves using a pillow, gag, gas mask, latex or leather hood, plastic bag, or other object to block oxygen intake. It may also involve strangulation by a partner's hands, or with a scarf or Velcro blood-pressure cuff. Corseting of the waist is another less obvious method of impeding oxygen intake.

This practice takes the lives of an estimated 250 to 1,000 Americans each year. It is believed that many more people experiment with asphyxia safely alone and/or with a partner, but because this act carries great legal liability if things go wrong, it is impossible to estimate the number of people who engage in it. During the early 1990s, a Seattle man made an effort, through workshops and lectures, to teach safety techniques to practitioners. Although he found many interested parties, he had to limit his public appearances and advice due to legal concerns.

Although there is little information available about the asphyxiphile's childhood, John Money has described one case in his book, Breathless Orgasm. This subject recalled first becoming interested in asphyxia when his childhood sweetheart drowned. He began by thinking of her drowning experience and soon discovered he was becoming aroused by visualizing her nude body under water and thinking about her suffocating (Money et al. 1991).

Another asphixiphile, who related his experience to the audience at a San Francisco lecture on the subject, described being raised as a Jehovah's Witness and taught that masturbation was a sin. This did not deter him from engaging in masturbation, but rather made it much more exciting, because he felt he could be “struck by lightning.” After giving up his religious practice in his late teens, he immediately discovered that masturbation lost its intensity. He then found that by putting himself in a life-or-death situation, i.e., asphyxia, he could recover this lost intensity.

Most data on asphyxiphiles have been collected from the death scene of the victims. Ray Blanchard and Stephen J. Hucker have collected a vast data bank of coroner's reports and other materials on the subject. In their study of 117 incidents, they discovered that older men

were more likely to have been simultaneously engaged in bondage or transvestitism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestitism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestitism. (Blanchard et al. 1991).
Sexual asphyxia is rarely depicted in print media, but has been shown in a few films, such as the 1993 movie, The Rising Sun, and also in the 1976 French-Japanese movie, In the Realm of the Senses.

Chubby Chasers, a San Francisco club of men attracted to the obese, almost doubled in membership between 1990 and 1995 and grew to include 50 different international groups. This club was involved on the Internet early and recruited many of its members there. This club also staffs a booth at the annual San Francisco Lesbian and Gay Freedom Day Parade. Membership in the organization includes a newsletter and invitation to many social activities. Many, but not all, “chasers” had a parent or close relative who was very obese, and recall having a preference for “chubbies” when they were as young as 4 or 5. For those with this interest, there are full-color commercial magazines depicting obese nude females, sometimes with a slender male partner, available in adult book stores.

There are a number of food fetishists or “piesexuals,” a word coined by a well-known pie enthusiast, Mike Brown, who began his affair with pies at age 13. Mr. Brown produces pie videos and also hosts annual “bring your own pie” throwing parties, where couples undress and hit each other with pies. There is an Internet newsgroup and also several clubs catering to this interest. Splosh magazine, although not sexual, features attractive females smeared with an assortment of food and mud, another messy fetish.

Other more obscure fetish/paraphilia organizations include WES (We Enjoy Shaving) of Reno, Nevada; the Wisconsin STEAM journal for agoraphiles, who enjoy engaging in sex in public; and Hot Ash, a New York club for people aroused by partners who smoke. Hot Ash publishes a newsletter and sells videos for those with this interest.

New York is also the home of a vampire sex club whose members make small cuts on others and rub or lick the blood off. Blood sports are also common among some SM practitioners in forms of caning, cutting, or piercing. San Francisco had coprophilia (feces) and urophilia (urine) clubs before the AIDS epidemic. Some of the newest groups include Fire Play, whose members drip hot wax on their partners, rub lit cigarettes on their bodies, and/or use chemical irritants. Some with this interest rub a small part of the body with diluted alcohol and ignite it.

In another new paraphilic activity, some men catch bees and use them to sting the penis. The venom not only doubles the size of the penis for a few days, but also seems to bring about a change in the neural system that enhances the arousal stage.

The foregoing are but a few of the many unorthodox sexual practices now being pursued in the United States. Many more exist, and new ones are being invented all the time. And thanks to technology, including the Internet, advances in the quality and availability of home-based desktop publishing, and the rise of sensationalist television talk shows, interest and participation in these activities is on the increase.

In the coming years, the continuing growth of fetish/paraphilia sex groups will require therapists to learn to make clear determinations among people who experiment with various activities, those who self-report to have a fetish but five years later become bored with it, and the few clinically defined paraphiles who truly need some type of intervention or treatment.