13. Research and Advanced Education

A. A Research Assessment

The United States has a long tradition and unequaled wealth of sexological research. The survey work of Alfred Kinsey and his colleagues in the 1940s and 1950s and the clinical/therapeutic research of William Masters and Virginia Johnson are but tips of the iceberg, referred to and cited in almost any discussion of sexological research anywhere in the world (Brecher 1979; Bullough 1994; Pomeroy 1972).

Sexological research in the United States today is vital to the management of many social and public health problems. Each year, one million teenage girls become pregnant, a per-thousand-rate twice that of Canada, England, and Sweden, and ten times that of the Netherlands; the disproportion is similar for teenage abortions (Jones et al. 1986). The nation spends $25 billion on families begun by teenagers for social, health, and welfare services. One million Americans are HIV-positive and almost one quarter of a million have died of AIDS. Yet only one in ten American children receives sexuality education that includes information about HIV/AIDS transmission and prevention. One in five adolescent girls in grades eight through eleven is subject to sexual harassment, while three quarters of girls under age 14 who have had sexual relations have been raped. These and other public health problems are well documented and increasingly understood in the context of poverty, family trauma, ethnic discrimination, lack of educational opportunities, and inadequate health services. However, there is little recognition of the need for sexological research to deal effectively with these problems. Congress has several times refused or withdrawn funding for well-designed and important surveys because of pressure from conservative minorities (di Mauro 1995).

In 1995, the Sexuality Research Assessment Project of the Social Science Research Council (605 Third Avenue, 17th Floor. New York, New York 10158) published a comprehensive review of Sexuality Research in the United States: An Assessment of the Social and Behavioral Sciences (di Mauro 1995). This report identified and described major gaps and needs in American sexological research. There is a serious lack of a framework for the analysis of sexual behaviors in the context of society and culture. This framework is needed to examine how sexual socialization occurs in families, schools, the media, and peer groups, and to address the complex perspectives of different situations, populations, and cultural communities. Areas of need identified by the project include: gender, HIV/AIDS, adolescent sexuality, sexual orientation, sexual coercion, and research methodology. Three major barriers hindering sexuality research are (1) the lack of comprehensive research training in sexuality, (2) inadequate mechanisms and efforts to disseminate research findings to policymakers, advocates, practitioners, and program representatives in diverse communities who need this information, and (3) the lack of federal, private-sector, and academic funding for research.

B. Advanced Sexological Institutes, Organizations, and Publications

Advanced Sexuality Education and Institutes

The premier American sexological research institute is the Kinsey Institute for Research in Sex, Gender and Reproduction, based at Indiana University, Bloomington, Indiana. Two other major institutes are: the Institute for the Advanced Study of Human Sexuality (Address: 1525 Franklin Street, San Francisco, CA 94109); and the Mary Calderone Library at the Sexuality Information and Education Council of the United States. A more complete selection of libraries specializing in various sexuality topics may be found by consulting the index to the Directory of Special Libraries and Information Centers (Gale Research).

About two dozen universities grant degrees with majors or concentrations in sexology and/or sex education, counseling, or therapy. These include Indiana University, the University of Minnesota, New York University, and the University of Pennsylvania. A full list is available from the national office of the Society for the Scientific Study of Sexuality (see address below).

In the late 1960s, several medical schools introduced programs in human sexuality into their curricula for training physicians. These programs reached their zenith in the early 1980s. By the late 1980s, many of them were under fire from newly appointed conservative administrators, and threatened with cutbacks and elimination. Indications suggest a significant decline in sexuality training for physicians and other health-care professionals, but the picture is not clear because no one has studied the situation nationwide (see Section E below). Likewise, students seeking an advanced degree or major concentration in sexology find the current situation of prospects for the future of individual graduate study cloudy.

Sexological Organizations

There are four major American sexological organizations:

The Society for the Scientific Study of Sexuality (SSSS). Founded in 1957; currently over 1,000 members. Address: P. O. Box 208, Mt. Vernon, Iowa 52314.

The American Association of Sex Educators, Counselors, and Therapists (ASSECT). Founded in 1967; currently over 3,000 members. Address: 435 North Michigan Avenue, Suite 1717, Chicago, Illinois 60611.

The Sexuality Information and Education Council of the United States (SIECUS). Founded in 1964; currently about 3,600 members. Address: 130 West 42nd Street, Suite 350, New York, NY 10036.

The Society for Sex Therapy and Research (SSTAR). Founded in 1974; currently about 300 members. Address: c/o Candyce Risen, The Center for Sexual Health, 2320 Chagrin Boulevard, 3 Commerce Park, Beachwood, Ohio 44122.

Several dozen other groups are oriented to various types of professionals concerned with sexuality. Typical among these are: Association for the Behavioral Treatment of Sexual Abusers, Association of Nurses in AIDS Care, National Council on Family Relations, Society for the Psychological Study of Lesbian and Gay Issues, and Society for the Study of Social Problems. (For addresses of many of these groups, see the listing in the Directory of Sexological Organizations at the end of this volume.)

There are at least one hundred advocacy and common-interest organizations that deal in one way or another with advocacy for gay and lesbian viewpoints, or provide a vehicle for the gay and lesbian practitioners of a profession or hobby to socialize or work together. The largest and most comprehensive are the National Gay Rights Advocates, the Lambda Defense and Education Fund, and the National Gay and Lesbian Task Force, each with 15,000 or more member-contributors and budgets in the millions of dollars. Typical of smaller special-interest groups are: Federal Lesbians and Gays (federal government workers), International Gay Travel Association, Good Gay Poets, Lesbian and Gay Bands of America, Girth and Mirth (overweight gay men), and Gay and Lesbian History on Stamps Club.

Similar organizations exist for many sexual viewpoints and behaviors other than homosexuality - and for sexual matters perceived as problems. An all-too-brief sampling from the Encyclopedia of Associations (EoA) (Gale Research Publications) includes: Americans for Decency, American Coalition for Traditional Values, American Sunbathing Association (nudism), Adult Video Association (pro-pornography/erotica), Christian Voice, Eagle Forum, Focus on the Family, North American Swing Club Association and Lifestyles (both recreational nonmonogamy), National Clearinghouse on Marital and Date Rape, National Task Force on Prostitution (pro-prostitution, formerly COYOTE), PONY (Prostitutes of New York), Society's League Against Molestation (child sexual abuse), Society for the Second Self (TRI-Ess) (transvestites), Sexaholics Anonymous, Impotents Anonymous, People with AIDS Coalition, Women Exploited by Abortion, Renaissance (Philadelphia-based with a dozen local chapters for transvestites and transsexuals), and Women Against Pornography. Check EoA for a full listing. Other special-interest groups are not listed in the EoA but can be located by scanning sex-related publications. Such groups include: Club Latexa (rubber fetishists), DPF (Diaper Pail Friends; infantilism and nepiophilia), Janus (bisexuals), SAMOIS (lesbian sadomasochism), and Eulenspiegel (sadomasochism).

Sexological Journals and Sexually-Oriented Magazines

Professional journals that publish sexuality-related research include: Archives of Sexual Behavior, Annual Review of Sex Research, Journal of Gay and Lesbian Psychotherapy, Journal of Gender Studies, Journal of Homosexuality, Journal of Marriage and the Family, Journal of Psychology and Human Sexuality, Journal of Sex and Marital Therapy, Journal of Sex Education and Therapy, Journal of Sex Research, Marriage and Family Review, Journal of Social Work and Human Sexuality, Journal of the History of Sexuality, Maledicta (language), Medical Aspects of Human Sexuality, and the SIECUS Report.

Major popular magazines that publish sexually oriented nonfiction and sometimes fiction include: Eidos, Frighten the Horses, Libido, Penthouse, Playboy, Screw, Tantra, and Yellow Silk (entirely literary). Resource directories include: Gayellow Pages, Gaia's Guide, and Gay and Lesbian Library Service. The major gay/lesbian nationwide periodicals are: Advocate (out of Los Angeles) and Blade (out of Washington, D.C.). Dozens of other publications exist, such as Deneuve and On Our Backs (for lesbians). Addresses for these and similar journals and magazines can be found in the Gale Directory of Publications and Broadcast Media, Ulrich's International Periodical Directory, The Standard Periodical Directory, or other directories.

C. Sexuality Education of Physicians and Clergy

Medical School Sexuality Education

Medical schools have always taught certain aspects of sexuality, e.g., the anatomy of the male and female sex organs, the menstrual cycle, basic obstetrics, and some psychology and psychiatry. That picture began to change about thirty years ago when Harold I. Lief (1963, 1965), a psychiatrist at Tulane University Medical School in Louisiana, wrote articles pointing out that most Americans regarded physicians as authorities on human sexuality, that the field of sexology was changing fast, and that only three medical schools in the country were even trying to teach modern sexology. The situation gradually improved, and when Harold Lief and Richard J. Cross, a physician who had introduced sexology education at the Robert Wood Johnson Medical School at Rutgers University in New Jersey, sent a questionnaire to all medical schools in the U.S. and Canada in 1980, they found only three schools that said they did not teach sexuality. However, they did not publish their results because of the poor response rate and apparent unreliability of self-serving responses from medical school administrators. It was clear, however, that the improvement was limited; part of the change reported was due to different interpretations of the questionnaire and differing definitions of “sexuality.” No one knows just what is being taught in the different medical schools today.

Part of the problem is that medical schools have traditionally defined education as the acquisition of factual information and certain skills by students. In the field of sexuality education, affective learning is also important. The greatest shortcoming of most practicing physicians is their discomfort. Since early childhood, they have been taught that sex is a private subject and that it is impolite and/or improper to talk about it. Physicians, who have not learned to confront and overcome their discomfort in talking about sex, transmit to their patients nonverbal, and sometimes verbal, messages that they do not want to hear about sexual problems. Their patients, who are often equally uncomfortable, cooperate by not raising any sexual issues. The result, too often, is “a conspiracy of silence,” in which sexual issues that sometimes have a great impact on health never get discussed.

A number of medical schools have instituted courses or short programs in sexuality that emphasize attitudes, values, and feelings, rather than the memorization of factual information. These courses make extensive use of sexually explicit, educational films and videos and panels of people who are willing and able to talk about their personal sexual experiences. Following each large-group session, the students break into smaller groups who meet with facilitators to process what they have heard and seen with an emphasis on their personal feelings and reactions. Such programs seem to give medical students a better understanding of their own sexuality, a greater tolerance for unusual sexual attitudes they may encounter in their patients, and greater comfort in dealing with and discussing sexual issues.

Unfortunately, these programs rarely elicit enthusiastic support from the medical school faculties, who, after all, have been selected for their expertise in analyzing scientific data. Time is jealously guarded in the medical school curriculum. Money has always been a concern in higher education, but money gets tighter year by year, and small groups are expensive to organize and run. Many sexuality programs in medical schools are elective, which is sad, because the students who need these courses most are often the least likely to register for them.

Despite thirty years of improved sexuality education, most American doctors still do an inadequate job of helping patients with sexual problems. Comprehensive courses seem to help, but in the current conservative political and economic climate, it seems unlikely that they will be greatly expanded in the near future. In fact, there are indications that some programs are in danger of being cut back. There is, on the other hand, a small but growing move in the Association of American Medical Colleges to go beyond stuffing facts into students by dealing with attitudes and feelings in the medical school curricula. If this takes hold, sexuality courses may lead the way. Time alone will tell.

Sexuality Education for Clergy in Theological Schools and Seminaries

History. Protestantism has historically enjoyed the status of dominant religion in this country, but democracy, with its emphasis on religious freedom and pluralism, has nourished the establishment of countless religious groups. Because these groups are numerous, and the education of their leadership varies considerably, a discussion of clergy training in sexuality requires qualification.

The main focus here will be on the seminaries and students included in the studies conducted by Conklin (1995) and Goodson (1996). Denominationally, the emphasis in these studies was mainly on Protestant and Roman Catholic clergy, although Jewish seminary faculty members were interviewed for the study by Conklin. By including both conservative and liberal schools and denominations, the largest religious groups are represented, but the samples are neither random nor the results generalizable.

Seminaries and theological schools are defined, here, as institutions of higher education accredited by the Association of Theological Schools (ATS). They offer post-baccalaureate degrees leading to ordination and licensure of pastors, priests, ministers, rabbis, chaplains, and pastoral counselors (categories broadly referred to as clergy).

Traditionally, clergy students have been characterized as young, white, and male, but this profile is slowly changing. First, it is becoming an older population composed of more part-time and second-career students. Second, diversity in both ethnicity and gender is increasing. In a comparison of motivations, women were more inclined to report entering seminary to discover “ways to best serve Christ in the church and the world” or “personal spiritual growth and faith development” rather than “preparing to be a parish minister,” which was the overwhelmingly reported motivation for men entering seminary (Aleshire in Hunter 1990, p. 1265). In terms of sexuality education, seminary students are now perceived as being “more diverse in attitudes, more willing to share personal experiences, and more open about sexual orientation” than in previous generations (Conklin 1995, p. 231).

Conflict over whether seminary education accents professional training or personal formation may be a factor accounting for the apparent lack of emphasis on sexuality content (Kelsey 1993). As the percentage of female students has increased, greater awareness and sensitivity about the negative sexual experiences of women has been accompanied by curricular changes. As clinical settings for counseling practice have been included in most seminary curricula, less emphasis has been placed on foundational education (languages, such as Latin, Greek, and Hebrew, are less often required), but issues of training remain problematic, especially concerning sexuality education.

The scientific literature contains abundant evidence of the positive role that clergy may have in health promotion generally and in sexual health promotion, specifically. One study affirmed, for instance, that nearly half of all referrals made by clergy to mental-health professionals “involved marriage and family problems” (Weaver 1995, p. 133).

Recently, however, this supportive role has come into question as trust in clergy generally has been undermined by the misconduct of a few. Fortune (1991) contends that omission of sexuality components in professional training misses an intervention opportunity for clergy students to explore ethical boundary issues concerning what appropriate sexual conduct consists of prior to entering the profession. Such evidence clearly points to the appropriateness of marriage, family, and sexuality content in clergy training, but such content seems lacking or is limited by various internal and external restrictions.

Prevalence. When seminary course offerings were surveyed in the early 1980s, only a small number of courses included the term sex or sexuality in their title or description (McCann-Winter 1983). It might be assumed that sexual content is included in courses not so named, but this low prevalence still indicates that sexuality content is not prevalent in most clergy training programs.

A review of literature on training in pastoral counseling cites one study in which 50 to 80 percent of the sampled clergy thought their training in pastoral counseling was inadequate and did not equip them to deal with marital counseling issues (Weaver, 1995). A study by Allen and Cole (1975) comparing samples of Protestant seminary students in 1962 and 1971 found that the students in the more recent sample did not perceive themselves as better trained in family-planning issues than those students in 1962. A recent study by Goodson (1996) documented that 82 percent of the Protestant seminary students surveyed declared having had zero hours of training in family planning in their seminaries, and 66 percent expressed desire for more training on this topic.

When seminary faculty members who include some aspect of sexuality in their courses were interviewed (Conklin, 1995), they indicated that they did not identify themselves as sexuality educators, and they expressed anxiety about how their teaching of sexuality content would be viewed by others. Yet, they expressed optimism and hope, because sexuality content and courses are sought and positively evaluated by students, even though not required. There is eagerness and enthusiasm by students, congregants, and clergy to have sexuality issues addressed openly and to move in the direction of health, justice, and wholeness.

Content. Profound changes have occurred in the past four decades regarding sexuality education in seminaries. Resources which were once viewed as advantageous are now seen as outdated. More use is being made of commercial films, literature, and case studies. Printed materials with sexuality content have vastly increased in both quantity and quality. The Sexual Attitude Reassessment (SAR) model, providing intense and condensed exposure to a range of explicit materials, panels, and speakers interspersed with small-group processing, is still viewed with both affirmation as effective and with suspicion as risky (Rosser et al. 1995).

Increased awareness of the pervasiveness of negative outcomes related to sexuality has provided the impetus for continuing-education requirements, mandatory screening of various sorts, development of training programs, trainers, centers, and professional counselors, therapists, and consultants focusing on prevention of various kinds of violations. An understanding of sexuality based upon the content of sexual relationships, rather than the form of sexual acts, is described as a paradigmatic change now underway.

In the Conklin study (1995), sexual orientation and related terms were included, either as central concerns or peripherally, in all but one of the thirty-nine interviews with seminary faculty. Prevention of harm seemed a more common goal than promotion of sexual health, and resources, language, and experiences for classroom use which focus on positive aspects of sexuality seem to be lacking. Examples of content frequently mentioned in the interviews included sexual violence, such as rape, abuse, and incest, sexual harassment and misconduct, sexually transmitted diseases, and sexual compulsivity. Content having religious connections included ordination, celibacy, incarnation, sexual theology, and sacrament.

Support and Resistance. While the need for professional sexuality education within seminaries has been documented in a few studies, and Conklin's qualitative assessment has indicated strong faculty support for teaching sexuality content, some resistance is still expected. Limitations may arise from diverse sources, such as denominational executives and curriculum committees, seminary reward and assignment systems for faculty, financial restrictions, and students' reluctance to deal with sexual issues or be in value conflict with their institution or instructor's teaching.

Goodson's survey (1996) of the attitudes of Protestant seminary students toward family planning identified 4.5 percent of conservative students, as compared to 0.9 percent of non-conservative students (p<.05), espousing unfavorable views of family planning, and potentially opposing its teaching in seminary. With this same sample, when analyzing a statistical model to predict intention to promote family planning in their future careers, the variable “attitudes toward sexuality” emerged as a strong mediator of the relationship between the variables “religious beliefs” and “attitudes toward family planning.” While “religious beliefs” exhibited a correlation of 0.81 with the “attitudes toward sexuality” variable, conservative students had, on average, more negative views of sexuality when compared to their non-conservative counterparts. The difference was statistically large: 1.04 standard deviation units, and significant at the 0.001 level of probability.

Resources and Intervention Needs. Given these findings, it is clear that religious beliefs need to be considered when selecting resources and planning interventions. At present, it seems broad-based support for sexuality education comes from insurers encouraging risk-reduction measures to prevent actionable behaviors which could lead to claims or litigation. Some administrative encouragement of faculty efforts has been reported, especially in response to student pressure or suggestions from peers or superiors. However, this support seems to be far outweighed by administrative indifference or caution, although perceived hostility has decreased.

A high standard has been set by faculty members who have taught and written about sexuality. Impetus to do more, not less, seems dominant, especially among faculty. However, no one has clearly articulated as a unified plan of action what there should be more of in this area. There is, however, some openness toward planning and development rather than a rigid adherence to an already conceived plan or model. A current resource encouraging the development of plans or models is the Center for Sexuality and Religion in Wayne, Pennsylvania.

As we see it, a two-pronged approach to sexuality education is needed, in which promotion of assets and prevention of deficits are both necessary (Conklin 1995). Clearly, the main assets of Protestant and Catholic churches include their nurturing, caring, and supportive environments, as well as maintenance of centers for dissemination of knowledge and training of their leaders. Nevertheless, such training has been characterized as deficient, and the need to plan, implement, and evaluate appropriate sexuality programs is notorious. The outcomes of a successful two-pronged intervention, which balances emphasis on both sexual health and sexual harm, may be worth pursuing, if we consider the important role clergy and churches have had and may continue to have in promoting the health and well-being of people in this country.