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Mary Calderone (1904 - 1998), was the daughter of the renowned photographer Edward Steichen and one of the pioneers of sexuality education. She received her M.D. from the University of Rochester in 1939 and her M.P.H. from Columbia University in 1942. From 1953 to 1964, Calderone was medical director of Planned Parenthood-World Population, during which time she wrote Abortion in the U.S. and The Manual of Family Planning and Contraceptive Practice.

In 1964, Calderone and Lester Kirkendall co-founded the Sex Information and Education Council of the United States (SIECUS) to enhance the study and understanding of human sexuality. Through her leadership in SIECUS, Calderone demonstrated her dedication to promoting sexuality education, and as its executive director (1964-75), she developed the organization's public image. From 1975 to 1982, Calderone was both president of SIECUS and chairperson of its board of directors. She retired in 1982 and died after a long illness in 1998 at the age of 94.

A strong proponent of sex education for children, Calderone co-authored both Family Book About Sexuality and Talking With Your Child About Sex. She was also editor of Sexuality and Human Values.

Calderone has received many distinguished awards, including the Society for the Scientific Study of Sex Award for Distinguished Scientific Achievement and the 1992 Award for Outstanding Contributions to the Field of Human Sexuality. She was named one of America's 75 Most Important Women by Ladies Home Journal in 1971 and one of the 50 Most Influential Women by the U.S. Newspaper Enterprises Association in 1975. She has received more than six honorary degrees and is an honorary life-member of the Society for the Scientific Study of Sex, of the American Association of Marriage and Family Counselors, and of the American Medical Association.


Calderone, M.S. The Manual of Family Planning and Contraceptive Practice. 1970.

Calderone, M.S., ed. Abortion in the U.S. New York: Paul B. Hoeber, Inc., 1958.

Calderone, M.S., ed. Sexuality and Human Values. New York: Association Press, 1974.

Calderone, M.S., and E. Johnson. Family Book About Sexuality. New York: Harper & Row, 1981.

Calderone, M.S., and J. W. Ramey. Talking With Your Child About Sex. New York: Random House, 1982.

Leah Cahan Schaefer  (updated by Erwin J. Haeberle  2011)


Effects of Cancer Treatment on Male Sexuality
Effects of Cancer Treatment on Female Sexuality

The Catholic Theological Society defines sexuality as "one's being in and relating to the world as male or female." Clearly, it has both psychological and physiological functions. Within this broad context, this entry examines the effects of cancer therapy on reproductive and sexual functioning, as well as the related alterations in body image and self-esteem.

Treatment for cancer often involves radical surgery, chemotherapy, and/or radiation therapy. Many times these therapies can adversely affect the functioning of the reproductive or genital organs and the sexual response cycle. The person with cancer may also experience altered sexual identity or decreased self-esteem as a result of real or imagined bodily changes resulting from disease or therapy. How the person feels about and deals with the disease and an altered body image or lowered self-esteem can cause sexual problems.

Until the early 1980s, the sexuality of the person with cancer was largely ignored by health care professionals and researchers of human sexuality. However, earlier diagnosis and more effective treatments have lengthened survival, so sexuality issues have emerged for these people. These issues are part of what is commonly called "quality of life" and demand the attention of health professionals and scientists. Patients now question members of their health care team about the effects, short- and long-term, of their cancer therapy on their ability to have children and to engage in sexual activities. Informed consumers of health care now expect more information related to their treatment, and cancer patients, specifically, have become more aware of their right to sexual information.

Effects of Cancer Treatment on Male Sexuality

Prostate Cancer
Testicular Cancer
Bladder Cancer
Colon Rectal Cancer
Penile Cancer
Chemotherapy and Radiation Therapy

Radical treatment for cancer can affect the male's ability to engage in sexual acts and to reproduce. Certain therapies interfere with penile erection, ejaculation, or emission and decrease sexual desire. Sperm production may also be affected, resulting in temporary or permanent infertility or sterility.

Body image changes may also occur related to the loss, or alteration in function, of a body part, with accompanying feelings of decreased self-worth and loss of masculinity. Other related psychological problems that can affect sexuality include depression, fear of (or actual) pain; fear of rejection or abandonment by family, friends, and significant others; and fear of transmission of disease or even the effects of treatment.

Prostate Cancer

Radical prostatectomy (i.e., the removal of the prostate gland and surrounding area) often results in erectile dysfunction, which is the inability to achieve or to maintain a penile erection sufficient for sexual penetration with a partner. Loss of erectile function or ejaculation does not usually affect penile sensation or the ability to reach orgasm, however. Orgasm is basically a function of the brain and can be experienced even by men who are almost completely paralyzed (although this function may need to be relearned). For a large percentage of males erectile function does not return; but if a nerve-sparing surgical approach is utilized, many may regain the ability to achieve adequate erections. Recovery of this function, however, may take up to two years.

Since ejaculation and emission are not possible after prostatectomy, the operation always produces a "dry" (and sometimes weaker) orgasm. In addition, the male is functionally sterile. This may not be a concern for a man age 60 or older, but such an assumption is dubious without more evidence than advancing age.

In cases of advanced or recurrent prostate cancer with metastasis, castration may be performed to halt the production of testosterone to slow the progression of disease. The surgical method of castration involves removal of both testicles, which may be replaced with silicone prostheses for cosmetic reasons. This procedure produces profound body image changes for many males and for this reason chemical castration by drugs may be preferable. The effects of hormone therapy are outlined in Table 1.

Testicular Cancer

Testicular cancer, although rare, is the most common cancer in males ages 15 to 34. The initial treatment is orchiectomy (i.e., removal of the testicle). This is usually a unilateral procedure, since cancer is almost always found in only one testicle. A prosthesis can replace a surgically removed testicle to help maintain body image and appearance.

Fertility is not compromised by the removal of one testicle; however, men with testicular cancer often have a decreased sperm count upon diagnosis, probably related to the disease. If fertility is affected by therapy, it usually results from additional surgery to remove lymph nodes from the abdomen (i.e., retroperitoneal lymph node dissection, or RLND). This procedure may cause a reduction in the amount of semen ejaculated or, more often, loss of the ability to ejaculate, either temporarily or permanently, resulting in sterility. Erectile function should not be affected, but orgasmic pleasure may be mildly reduced. Recovery of ejaculation may occur over time, in months to years. A modified approach to the RLND usually preserves the function of ejaculation. In addition, some testicular cancer patients may receive radiation therapy that can also cause loss or reduction of ejaculation, as well as erectile dysfunction and infertility.

Bladder Cancer

Extensive surgical removal of the urinary bladder and surrounding structures (radical cystectomy) produces many of the same results as radical prostatectomy. There is a high incidence of erectile dysfunction (unless nerve-sparing surgery is utilized), and ejaculation and emission are lost. Bladder cancer mainly affects older males, but advancing age does not preclude sexual desire and activity. Therefore, the impact of loss of penile erections on the sexuality of these men and the options for sexual rehabilitation (e.g., penile implants for achieving a mechanically assisted erection) must be considered.

The patient with bladder cancer may also receive a urinary ostomy, which necessitates wearing a bag on the abdomen to collect urine. An ostomy may profoundly affect body image and sexual identity. Some men even react to it as if it were castration or demasculinization. Fortunately, surgeons are exploring alternatives to urinary ostomies that do not involve wearing a collection device.

Colon Rectal Cancer

Surgical removal of the upper portion of the rectum and the adjacent tissue, by a procedure known as an abdominal perineal resection (APR), can result in sexual dysfunction for some men. It may not be possible for the surgeon to spare the nerves that control erection during this procedure, but sometimes these nerves are only slightly affected and erectile function can return in six months or longer. Recovery of erectile function is greater in males under age 60 and in men who had full erections before surgery.

The ability to ejaculate may also be lost after an APR. resulting in functional sterility. This loss of reproductive capacity may be significant to the male with rectal cancer even at older ages.

Cancer of the colon or of the lower rectum may be surgically treated by a less radical procedure called a low anterior resection, which often preserves erectile function.

Some surgical procedures for colon rectal cancer may result in a colostomy. The psychological impact of this ostomy, whether permanent or temporary, on the quality of the patient's life must be considered. Fortunately, recent advances in surgical techniques have eliminated permanent colostomies for the majority of patients.

Penile Cancer

Early, noninvasive cancer of the penis can be treated with topical chemotherapy or radiation implants. More commonly, partial or total amputation of the penis is required.

A partial penectomy (resection of some of the penis) rarely affects the male's ability to achieve and maintain an erection, and ejaculation and orgasmic sensation remain normal. Penile reconstruction may be an option for some of these patients for cosmetic and functional reasons.

Total amputation of the penis precludes sexual intercourse; however, the ability to be a sexually functioning male is not lost. Stimulation of the remaining genital tissue can be pleasurable and can lead to ejaculation (through the new urinary passage) and to orgasm.

Chemotherapy and Radiation Therapy

The effects of cancer chemotherapeutic agents on sexuality vary depending on the drug(s), total dose, duration of treatment, age of the patient, and time since therapy was completed. Often, the effects of cancer chemotherapy on sexual and reproductive functions are not known. Some losses in fertility may be temporary, although lasting for years; others may be permanent. When several drugs are used in combination, the effect on sperm production is greater and more prolonged than with a single drug.

Disruptions of sexual functioning due to chemotherapy are less common; however, there are a few drugs that may cause erectile dysfunction or disturbances in ejaculation. Side effects of therapy, such as fatigue, can decrease sexual desire temporarily. Chemotherapy does not affect the production of testosterone.

Cancer chemotherapy may also affect self-concept and body image because of loss of hair, nausea and vomiting, skin changes, weight gain or loss, and other effects.

Sperm production and erectile function are adversely affected by radiation therapy to the pelvis or testicles, with greater effects resulting from direct radiation than from indirect or scatter radiation. If the testicles are shielded, fewer reproductive effects result. Radiation therapy is seldom used alone; most often it is combined with chemotherapy to treat certain cancers. The combination of chemotherapy and radiation has a multiplying effect, reducing sperm production more than the sum of the effects of each therapy.

Effects of Cancer Treatment on Female Sexuality

Gynecologic Cancers
Bladder Cancer
Colon Rectal Cancer
Breast Cancer
Chemotherapy and Radiation Therapy

Radical surgery, chemotherapy, and/or radiation therapy for cancer can affect the female's ability to reproduce, to engage in, and to enjoy sexual activities. Loss of the ovaries or their function may cause sterility and side effects (e.g., hot flushes, night sweats, irritability, depression, decreased vaginal lubrication, decreased sexual desire, and pain on vaginal penetration).

Women can experience body image changes related to loss of a body part or its function, lowered self-concept, and feelings of loss of femininity as a result of cancer therapy. They may also experience fear of abandonment and rejection. In addition, disease-related depression often causes loss of sexual desire.

Gynecologic Cancers

A common procedure in the treatment of female reproductive cancers is the radical hysterectomy. The surgical removal of the uterus, ovaries, and Fallopian tubes and surrounding structures produces sterility. The vagina is shortened by as much as one-third by this procedure, which may cause pain on vaginal penetration. Pain on vaginal penetration always has the potential to adversely affect the sexual response cycle: desire, arousal, and orgasm. Surgical removal of the ovaries also causes abrupt premature menopause, often accompanied by severe symptoms related to decreased estrogen. Reduced estrogen usually causes loss of vaginal lubrication and elasticity over time, resulting in pain on vaginal penetration. If testosterone levels are also reduced, as they may be in some women, decreased sexual desire may occur. Moreover, some females report less pleasurable orgasms due to the loss of the uterus.

Any gynecologic cancer therapy—such as radical surgery, chemotherapy, or radiation therapy— may produce menopausal symptoms or premature menopause, infertility or sterility, and sexual dysfunction. (See Table 2.)

Cancer of the cervix is often treated locally with radiation. This therapy can cause loss of vaginal elasticity, fragile vaginal tissue, lack of vaginal lubrication, pain or tenderness on vaginal penetration, and sexual dysfunction.

Vulvar cancer, if advanced, is usually treated with radical surgery. In this surgery, the vulva (outer and inner lips surrounding the vagina), the clitoris, and part of the vagina are removed. Even with these losses, it is often possible for women to experience sexual pleasure and orgasm. If vulvar cancer is treated at an early stage, it does not require such radical surgery and sexual functioning is not usually affected. Although vulvar cancer is generally found in older women in their sixties and seventies, many of these women may be sexually functioning individuals.

Bladder Cancer

A radical cystectomy in the female is almost always accompanied by a radical hysterectomy with the above-mentioned side effects. Because this surgical procedure produces a much narrower or shallower vagina, the vagina often needs to be reconstructed. The anterior vaginal wall may be an erotic zone for some women, and its loss can result in sexual dysfunction. Even with reconstruction, some women may experience pain on vaginal penetration. If pain is not a problem, the female's orgasmic potential remains the same.

An ostomy and an external urinary collection device may alter body image and self-concept and interfere with sexual activities and relationships.

Colon Rectal Cancer

Extensive surgery for colon or rectal cancer in the female also often includes a radical hysterectomy. In addition to the sterility, menopausal symptoms, and sexual problems related to the hysterectomy, some women experience genital numbness after the abdominal perineal resection procedure.

If a colostomy is required, women often have difficulty coping with this alteration in body image, but many of them adjust over time. Intimate relationships can suffer during this adjustment period.

Breast Cancer

Surgery for breast cancer is usually performed by one of two procedures. A modified radical mastectomy is removal of the breast, minor chest muscle, and underarm lymph nodes. The limited resection, or "lumpectomy," involves removal of only the tumor and the surrounding tissue, and the lymph nodes, followed by radiation therapy to the chest. Neither of these procedures should affect sexual functioning, but because of the sometimes profound effects on body image and self-esteem, a woman may avoid intimate physical encounters. However, many report no decrease in feelings of femininity or in sexual identity.

Some women are treated with anti-estrogen therapy after breast cancer. This therapy appears to prevent the growth of undetected breast cancer cells and subsequent spread of disease. Currently, tamoxifen is the sole drug used for this purpose. Administration of this preparation to the premenopausal female results in premature menopause with its related side effects. In the postmenopausal woman, hot flushes may be exacerbated. The advantages of this treatment, however, usually outweigh any side effects.

Chemotherapy and Radiation Therapy

The female gonads (the ovaries) are more sensitive to chemotherapy and radiation than are the male testicles. Cancer chemotherapeutic effects for the female depend on the type of drug(s), dose, length of administration, time of therapy and, to a great degree, the age of the patient. Ovarian function may be temporarily or permanently affected by chemotherapy. The closer a woman is to menopause, the greater the effect. Females between ages 35 and 40 years are more likely to experience premature menopause. Sometimes in slightly younger women, menstrual periods cease but resume in time. In other cases, the ovaries may fail after pregnancy.

Some cancers are treated with radiation therapy and chemotherapy. Combined therapy produces greater effects on gonadal function in the female than in the male, often resulting in infertility or sterility, and menopausal symptoms or early menopause.

External radiation therapy directly to the pelvis produces loss of vaginal elasticity, fragile vaginal tissue, lack of vaginal lubrication, and pain or tenderness on vaginal penetration, plus some degree of ovarian dysfunction. Even if an attempt is made to shield the ovaries during radiation therapy, there may be some disruption in menstrual periods and fertility. Scatter radiation to the ovaries from treatment to nearby areas can also suppress ovarian function, temporarily or permanently.

Chemotherapy and/or radiation therapy can affect body image and self-concept if nausea and vomiting, hair loss, weight loss/gain, or skin changes are experienced. Sexual dysfunction may also result from these effects. In addition, infertility may cause sexual dysfunction because of psychological reasons. If lowered testosterone levels result from ovarian failure, loss of sexual desire may also occur.


Cancer therapy can affect many aspects of human sexuality: sexual function, gonadal function, fertility, body image, self-esteem, sexual identity, and sex roles. In addition, relationships may be disrupted. These are important issues for patients as they recover from and become survivors of cancer. As one former cancer patient said, "We are all survivors, no matter how long we live." The assessment of the quality of life for people with cancer should include sexuality. If problems arise, these men and women should know where to go for help. Fortunately, many cancer health care professionals see the need to address the sexuality of their patients. They possess the comfort, knowledge and skills to intervene appropriately and assist clients with cancer-related alterations in sexuality. Furthermore, important and much-needed research is being carried out by physicians, nurses, and mental health professionals to identify alterations in sexual and reproductive function and appropriate interventions.

If health professionals fail to address sexuality, patients may seek out information from other sources. Organizations such as the American Cancer Society, the National Cancer Institute, the Cancer Information Service, and the Sex Information and Education Council of the United States, among others, may be useful in helping patients find answers to their questions. (See Appendix.)

Table 1. Effects of Cancer Treatment on Male Sexuality

Cancer Treatment

Sexual Function


Radical prostatectomy

loss of emission & ejaculation, erectile dysfunction


Unilateral orchiectomy

none, usually


Retroperitoneal lymph node dissection

reduced, absent or retrograde ejaculation (into bladder), possible decreased orgasm

sterility with loss of ejaculation

Bilateral orchiectomy

loss of desire, decreased semen volume, erectile dysfunction


Hormone therapy for prostate cancer

loss of desire, reduced semen volume, erectile dysfunction, penile atrophy


Radical cystectomy

loss of emission & ejaculation, erectile dysfunction


Abdominal perineal resection

sometimes loss of ejaculation &/or erectile function (temporary or permanent)

sterility with loss of ejaculation

Partial penectomy

none, usually


Total penectomy

absence of penis does not affect desire, arousal, ejaculation, or orgasm


Pelvic radiation therapy

loss of emission or ejaculation or reduced semen volume, erectile dysfunction (temporary or permanent)

infertility or sterility (temporary or permanent)


none, usually

infertility or sterility with some agents (temporary or permanent)

Table 2. Effects of Cancer Treatment on Female Sexuality

Reproductive/Cancer Treatment

Sexual Function

Gonadal Function

Radical hysterectomy

decreased vaginal lubrication, reduced vaginal size, sometimes decreased desire & change in orgasmic sensation

sterility, premature menopause

Abdominoperineal resection

sometimes decreased desire; decreased vaginal lubrication; sometimes reduced vaginal size, genital numbness &/or pain on vaginal penetration

sterility & premature menopause with removal of ovaries

Radical vulvectomy

reduced vaginal size, sometimes difficulty reaching orgasm


Radical cystectomy

sometimes decreased desire, decreased vaginal lubrication, reduced vaginal size

sterility & premature menopause with removal of ovaries

Pelvic radiation therapy

sometimes decreased desire, decreased vaginal lubrication, reduced vaginal elasticity & size, pain &/or bleeding on vaginal penetration

infertility or sterility (temporary or permanent), menopausal symptoms


none, usually


Anti-estrogen therapy

sometimes decreased desire & decreased vaginal lubrication

infertility or sterility & menopausal symptoms


sometimes decreased desire & decreased vaginal lubrication (if ovarian function is affected)

infertility or sterility (temporary or permanent), menopausal symptoms/premature menopause with some agents


Resources for People with Cancer

American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
(Or a local division of the American Cancer Society)

National Cancer Institute
Office of Cancer Communications
Building 13, Room 10A-24
Bethesda, MD 20892

Cancer Information Service

Sex Information and Education Council of the U.S. (SIECUS)
130 West 42nd Street, Suite 2500
New York, NY 10036

American Association of Sex Educators, Counselors, and Therapists (AASECT)
11 Dupont Circle, NW, Suite 220
Washington, DC 20036

Society for the Scientific Study of Sex
P.O. Box 208
Mount Vernon, IA 52314


Schover, L. R. Sexuality and Cancer. For the Woman Who Has Cancer, and Her Partner. New York: American Cancer Society, 1988.

Schover, L. R. Sexuality and Cancer. For the Man Who Has Cancer, and His Partner. New York: American Cancer Society, 1988.

Marianne Glasel


St. Augustine's Influence
The Penitentials
Gratian's Influence
Sexual Sins and Offenses

Canon law, the legal system of the Christian church, dates back to the beginning of the second century of the Common Era. Since then, the Christian church, through its canons and the mechanisms used to enforce them, has played a key role in enunciating and defining the norms of sexual behavior within Christian communities, particularly among members of the Catholic, Orthodox, Lutheran, and Anglican branches of Christianity.

Canonical rules from the beginning were markedly concerned with the moral and disciplinary problems arising from sexual attractions and desires. Christians, like pagan Romans, were expected to be monogamous; unlike their pagan contemporaries, however, married Christians were also expected to remain sexually faithful to their mates, to refrain from divorce (save perhaps on the grounds of the spouse's adultery), and generally to observe restraint in their sexual behavior within marriage, while avoiding entirely any sexual intimacy outside of it.

Christian writers soon began to justify their canonical rules and other teachings about sex by arguing that these rules were grounded either in divine revelation or in human reason, or (when all else failed) in "nature" or "natural law." They felt compelled to do this in order to respond to criticisms of their way of life put forward not only by pagan and Jewish critics outside the Christian fold, but also by unorthodox critics within their ranks, whom mainstream Christians denounced as heretics.

St. Augustine's Influence

In the Western church, by far the most influential early writer on Christian sexual ethics was St. Augustine of Hippo (354-430). St. Augustine vigorously disapproved of any sexual laxity; more important, he gradually developed an elaborate rationale for the basic tenets of Christian sexual morality that seemed to him—and even today seem to many Christians—both reasonable and persuasive. Human sexuality, according to St. Augustine's theory, departs in many important ways from the original intentions of the divine Creator. In paradise, before Adam and Eve (the progenitors of the entire human race) had committed the first sin, sexual feelings and sexual relations were radically different from those that we now know. Intercourse in paradise brought none of the intense pleasure now associated with orgasm; the human sex drive was entirely subordinate to reason, and Adam and Eve knew nothing of the insistent urges and passions their descendants have experienced ever since the Fall from grace and the consequent expulsion of Adam, Eve, and all their descendants from the bliss of paradise. Sex, therefore is (like its sister, death) a consequence of sin, an aspect of humankind's continuing rebellion against God's wishes. It is a part of the punishment all must bear for being descendants of the first sinners and a depraved craving that must be repressed and overcome to merit salvation and the friendship of God in the world to come.

It seems to follow from these premises, as later Christians have often concluded, that sexual behavior presents a key moral issue, a benchmark by which virtue may be measured. Canonical rules about sexual conduct, therefore, aimed to encourage everyone who could do so to reject sexual pleasure entirely and to embrace instead a life of perpetual virginity, unblemished by sexual experience. Those unable to renounce sex completely were sternly admonished to confine their obscene gropings to the marriage bed and under no circumstance allow themselves to experience sexual pleasure outside of marriage. Even within marriage, they were to engage in intercourse only when they intended to beget a child and never for carnal gratification and pleasure.

The Penitentials

General exhortations along these lines became specific guidelines for acceptable sexual behavior in the penitentials, or handbooks for confessors, that Christian spiritual authorities produced in considerable numbers beginning in the sixth century. The authors of penitentials agreed, for example, that married couples must abstain entirely from sexual relations during Lent, Pentecost, and Advent. In addition, it was grievously sinful for married persons to have intercourse on Wednesdays, Fridays, and Saturdays throughout the year, during the wife's menstrual period, during pregnancy, and after pregnancy so long as the child nursed at the mother's breast. Penitentials further warned couples that they sinned if they engaged in sexual relations during daylight, while they were naked, or in positions other than the one now described as the missionary position (i.e., with the wife supine and the husband on top of her). Nonmarital sex— whether social or solitary, heterosexual or homosexual, sleeping or waking, voluntary or involuntary—was likewise sinful according to these authorities, who often advised confessors in considerable detail about possible infractions of these prohibitions that repentant sinners might disclose to them in confession and prescribed penances they deemed appropriate for each situation.

During the second half of the 11th century, high-ranking church authorities began to require all clerics (or at least those in the upper ranks of the church's hierarchy) to renounce marriage and sex absolutely as a condition of ordination. While earlier spiritual writers and some church authorities had long praised clerical celibacy and encouraged all clergymen to embrace it, celibacy had previously been required only of monks and nuns who lived in religious communities. Now a vow of celibacy was required for ordination. This new asceticism created innumerable personal crises, not only for priests and other clerics, but also for their wives, children, families, and parishioners.

Gratian's Influence

Canon law first developed into a systematic intellectual discipline during the 12th century. With the appearance of the Decretum of Gratian in about 1140, canonists were provided with a reasoned, analytical textbook, which remained the basis for the teaching of canon law in the universities and schools throughout the Middle Ages; indeed the Decretum continued in use among Roman Catholics until the beginning of the 20th century. Medieval and modern canonistic treatments of sexual behavior were thus grounded largely on positions and ideas that canonists found in Gratian's work.

Gratian viewed sexual pleasure as a disturbing influence in human life, a temptation that distracted Christians from the goal of salvation, and an instrument that the devil regularly used to entice souls into hell. The clear message of Gratian's Decretum, therefore, was that sexual activity must be confined within stringent limits. Sex was lawful only between husband and wife and even then it must be carefully limited and controlled. A married person could properly engage in intercourse only under one of three conditions: to beget a child, to avert temptations to marital infidelity, or to accommodate the insistent (and probably sinful) demands of the spouse.

All other sexual activity, within marriage or outside of it, as well as any sexual desire or arousal other than that permitted for lawful purposes between husband and wife, was sinful and under many circumstances might be subject to criminal prosecution as well. Thus, even within marriage, one had to be careful. The husband who loved his wife too passionately, according to St. Jerome (c. 331-419/20), was an adulterer, and canonists strove to prescribe strict operational limits on legitimate marital intimacy. Among other things, for example, they focused on positions couples adopted during sexual relations. Medieval canonists and theologians were prepared to condone as "natural" only marital intercourse conducted in the missionary position. Intercourse in any position in which the woman lay or sat atop the man seemed to canonists "unnatural," since they believed that such a posture reversed the proper order of relationship between the sexes by making the female superior to the male. Canonists and theologians likewise condemned intercourse "from behind" (retro), that is, in which the husband entered his wife from the rear, since they considered intercourse in such a posture "beastly" and hence entirely inappropriate for humans. Church authorities vehemently rejected all anal or oral sexual practices, which Gratian's book described as "extraordinary sensual pleasures" and "whorish embraces," both because such practices were clearly nonprocreative and because sexual pleasure seemed to be their sole objective. Writers on theology and canon law frequently branded any departure from heterosexual relations in the missionary position as "sodomy," on the theory that the biblical story of God's destruction of the city of Sodom (Genesis: 18-19) definitively demonstrated divine disapproval of activities, heterosexual or homosexual, that aimed primarily at enhancing sexual pleasure.

Gratian classed adultery as a heinous crime, much more serious than fornication, although not quite as grave a lapse as incest or sodomy. Both incest and sodomy (by which he apparently meant any sexual encounter between persons of the same gender or extra-vaginal intercourse between persons of different genders) deserved in his eyes to rank with such atrocious crimes as murder, forgery, arson, sacrilege, and heresy. While simple fornication between two unmarried persons was, to be sure, both a serious sin and a canonical crime, Gratian and other canonists tended to treat it as a routine offense, which called for fines and a humiliating penance that might discourage others from such unacceptable behavior. Most canonists followed Gratian in treating masturbation as a minor peccadillo, although a few later writers, particularly Jean Gerson (1363-1429), considered solitary sex so serious an offense that only a bishop might pardon the offender and prescribe suitable punishment.

The canonists in principle proscribed every sort of sexual experimentation or deviation from the approved version of marital intercourse, and even more stringently barred all types of non-matrimonial sexual activity. In practice, even the most devout occasionally strayed from the strict paths authority prescribed, and sexual offenses, together with marriage problems, accounted for most of the business that came before local ecclesiastical courts almost everywhere.

Sexual Sins and Offenses

Numerous sex offenses, however, rarely found their way into the courts, but rather were usually dealt with privately in the so-called internal forum of confession. This was understandably true of solitary offenses, such as masturbation, as well as private deviations from the prescriptions for marital conduct—engaging in intercourse unclothed, for example, or during daylight, at forbidden times, or in unconventional postures. Pastoral manuals and handbooks for confessors often dealt at such great length and in such detail with sexual sins that one could conclude these behaviors must have flourished among medieval people; they certainly fascinated the celibate clergymen who constituted the intended audience for these works. Confessors' manuals also routinely cautioned priests to inquire diligently into the sexual habits of the penitents who came to them, but at the same time warned the confessor to take care that his questioning not supply penitents with fresh ideas for disapproved sexual behavior that had not already occurred to them. The dividing line was exceedingly fine, and many a confessor must have found it difficult to be sure he had not crossed it.

Punishment of sex offenses by canonical courts might, in theory, be extremely severe; in practice, the more common sex crimes, such as fornication, often brought little more than a casual fine, occasionally accompanied by ritual public humiliation to impress upon the rest of the community the seriousness of the offense. Even so, ample evidence suggests that many medieval people found it difficult to accept the theological opinion that something so common and natural as fornication could be a sin, much less that it was so grave an offense that it would doom its perpetrators to eternal torment in hell.

Adultery was far more serious, often punishable by both canonical tribunals and secular judges, not only because the act violated marital vows and threatened the stability of marriage, but also because children conceived in an adulterous relationship created formidable problems in the law of inheritance. Incest was likewise a troublesome problem in medieval society, and the courts tended to treat convicted offenders very harshly. The most serious sexual crime, most authorities agreed, was sodomy, by which they meant both sexual relations between persons of the same gender and also all sexual relations between a man and a woman other than vaginal intercourse—thus heterosexual fellatio, cunnilingus, or anal intercourse, for example, might be classified as sodomy and subject participants in these activities to severe penalties. Many authorities were inclined to class sexual contacts between humans and other animals as another type of sodomy, although some writers distinguished between these offenses and treated bestiality as a separate class of sex crime, slightly less serious than homosexual sodomy.

Despite their moral condemnation of all extramarital sex, most canonical writers, oddly enough, were prepared to tolerate prostitution in practice and even in principle. The reigning theory, enunciated by St. Augustine, argued that if prostitutes were not available to slake male lust, men would inevitably solicit sexual favors from respectable matrons and other "honest women." That, St. Augustine held, would dislocate the peaceful order of society. It was better, according to this line of reasoning, to allow prostitutes to continue their sinful and unsavory trade rather than to risk the social disorder that would accompany successful prohibition of commercial sex. Some medieval writers went so far as to argue that, although it was morally wrong for both the prostitute and her client to engage in relations, prostitution was necessary for the public good. One authoritative commentator compounded this paradox by explaining that sex with a prostitute was doubly evil, for it was a wrongful use of an evil thing, as opposed to marital sex, which was a rightful use of an evil thing. Nonetheless, just as God tolerated the evil of marital sex because of the good effects that it might produce (e.g., children and the mutual support and companionship of married couples), so Christian society must tolerate prostitution to secure the benefits of social harmony and domestic peace.

Prostitution, then, was not only tolerated in many medieval communities, but was sometimes treated as a public utility. When towns began to build and operate municipal brothels to regulate the sex trade, they realized a profit from it at the same time. Moral ambiguity concerning the prostitution industry long persisted and still remains a controversial topic.

Both lawyers and lawmakers typically sought to contain prostitution by restricting harlots and their trade to specially designated regions within towns. Municipal statutes, following a suggestion of the Fourth Lateran Council (1215), also required prostitutes in many towns to wear distinctive colors and clothing so as to spare respectable women from the sexual importuning of randy men, and incidentally to preserve civic peace and harmony at the same time.

Church leaders and civic authorities alike, moreover, were concerned to provide women who wished to abandon the life of shame with realistic opportunities to do so. Thus, for example, Pope Innocent III (1198-1216) early in the 13th century reversed a long-standing policy that had prohibited good Christian men from marrying prostitutes and instead promised spiritual favors for those who would do so, provided they kept close watch over their wives to make sure that they remained sexually faithful and did not return to their wanton ways. The prospect of marrying a reformed prostitute was especially alluring, no doubt, to financially disadvantaged men, since successful strumpets sometimes managed to accumulate substantial dowries from the profits of their trade.

The 13th century similarly witnessed the creation of convents and religious orders of women, which provided a haven and some security and chaste companionship for reformed daughters of joy. The most successful of these religious institutes, the Order of St. Mary Magdalene (whose members were informally known as the White Ladies), established houses in many major European cities, and in a surprising number of minor ones as well. Such institutions constituted a social security system of sorts for prostitutes who wished to retire from their occupation, but required both social and economic support to do so.

The moral ambivalence that canonists and other legal experts showed toward prostitution was emblematic of the difficulties medieval societies experienced in confronting the realities of human sexuality. Committed in principle to restricting sexual activity as much as possible, the canonists nonetheless had to take account professionally of the fact that systematic enforcement of the limits they wished to impose was difficult, if not impossible. For private deviations from the sexual norms, periodic confession of sins provided both some surveillance and the opportunity to counsel offenders to avoid future infringements of the rules. For offenses that became publicly known, lawmakers and administrators of the medieval church had to create a law enforcement system to detect suspected offenders and courts to try and punish them, in the hope that this would deter others from imitating their bad examples. The church's enforcement and court systems in the early Middle Ages were neither efficient nor effective. During the late 12th century, however, church leaders began to devise more elaborate and successful mechanisms to repress beliefs and behaviors they considered undesirable. By the end of the 13th century, popes and bishops had put in place a complex system of courts, spanning every level of Christian society, from the courts of the archdeacons at the local level through the consistory courts of the bishops and the regional courts of the archbishops to the central courts of the Roman Curia. Sexual misconduct and marital irregularities furnished all of these courts, especially those at the lower levels of the hierarchy, with most of their business. Offenders against canonistic sexual norms not only made this complex judicial structure necessary, but also supported it financially through the fees and fines the courts generated.

The sexual standards of medieval canon law have persisted with striking tenacity in modern European and American law. In the United States, for example, fornication, adultery, and sodomy remain crimes in many states and occasionally, under unusual circumstances, offenders may be prosecuted for them. The so-called spousal exception, which permits defendants in rape or sexual abuse cases to escape punishment if they can prove they were married to the victim when the alleged offense occurred, remains today the standard rule in many North American jurisdictions and constitutes a further example of the continuing presence of canonical legal doctrine in 20th-century civil law.


Boswell, J. Christianity, Social Tolerance, and Homosexuality: Gay People in Western Europe From the Beginning of the Christian Era to the Fourteenth Century. Chicago: Univ. of Chicago Press, 1980.

Brooke, C.N.L. The Medieval Idea of Marriage. Oxford: Oxford Univ. Press, 1989.

Brundage, J.A. Law, Sex, and Christian Society in Medieval Europe. Chicago: Univ. of Chicago Press, 1887.

Bullough, V.L., and J.A. Brundage, eds. Sexual Practices and the Medieval Church. Buffalo: Prometheus Books, 1982.

Kelly, H.A. Love and Marriage in the Age of Chaucer. Ithaca, N.Y.: Cornell Univ. Press, 1975.

Levin, E. Sex and Society in the World of the Orthodox Slavs. 900-1700. Ithaca, N.Y.: Cornell Univ. Press, 1989.

Noonan, J.T. Contraception: A History of Its Treatment by the Catholic Theologians and Canonists. Cambridge, Mass.: Belknap Press, 1965.

Payer, P.J. Sex and the Penitentials: The Development of a Sexual Code, 550-1150. Toronto: Univ. of Toronto Press, 1984.

Salisbury, J.E. Medieval Sexuality: A Research Guide. New York: Garland, 1990.

Salisbury, J.E., ed. Sex in the Middle Ages. New York: Garland, 1991.

Sheehan, M.M., and J. Murray, comp. Domestic Society in Medieval Europe: A Select Bibliography. Toronto: Pontifical Institute of Medieval Studies, 1990.

James A. Brundage


Giovanni Jacopo Casanova de Seingalt (1725-98) was a Venetian adventurer whose name exemplifies the hypersexual male. Casanova falsely appropriated the aristocratic "de Seingalt" as an aid to seducing women and impressing men; it apparently did both. Almost all of what is known about this libertine comes from his multivolume Memoirs. Written in his old age—a time when memory fades and imagination runs wild—his Memoirs portrays him as a man of engaging wit, charm, and intelligence with a distinguished, if not handsome, face. He both earned a law degree and bedded his first wench—"a pretty girl of thirteen"—at the age of 16, met and enlightened all the best minds of the age, fought and defeated the finest swordsmen, and broke all the casinos and half of the hymens in Italy and France.

Although perhaps a braggadocio, Casanova was indeed a man with an extraordinary sexual appetite; his descriptions and the naming of at least 116 of his conquests give credence to many of his claims. He made love without prejudice of age or social standing; females ranging from ages nine to 70 and of all classes fell to his allure. Nor did the incest taboo cool his ardor; he was sexually involved with at least one of his illegitimate daughters. All, he states, were eternally grateful for his services.

The syndrome to which Casanova lends his name, "Casanovism," is known also as "Don Juanism" (named after Don Juan, a fictional character), satyriasis, hyperphilia, and hypersexuality. Men afflicted with this syndrome view love as a compulsive game played with many partners in order to minimize commitment; women are play objects and notches on the bedpost. Practice has made them charming and attentive, but they lose interest in a woman almost immediately after making their conquest, as Casanova invariably did. Hypersexuality has been linked to manic-depression, psychopathy, and a defect in pair-bonding and childhood attachment. It has also been chemically linked to low levels of a major metabolizer of some major neurotransmitters called monoamine oxydase (MAO), which has been implicated in many psychopathic-like behaviors.

Casanova's life offers much case-study evidence for these claims. He was born (probably illegitimately) to two actors who abandoned him when he was one year old. Given the great importance of early bonding to the healthy formation of later relationships, it is easy to see why he was never able to form lasting attachments. His lack of commitment to, or concern for, his conquests; his many other deviant exploits; and his oft-stated lack of remorse or regret are certainly characteristic of a psychopathic personality. His gay abandon and boundless energy, coupled with the "black sorrow" (depression) he admitted suffering, are indicative of the manic-depression syndrome. All these syndromes have been linked to low MAO.

Casanova spent his last 14 years as the librarian of Count von Waldstein in the Castle of Dux in Bohemia, where he composed his Memoirs. He died in timely piety in 1798 ("I have lived a philosopher, and I die a Christian."), thus having had the best of both worlds.


Bullough, V. Sexual Variance in Society and History. Chicago: Univ. of Chicago Press, 1976.

Casonova, J. The Memoirs of Jacques Casanova de Seingelt. A. Machen, trans. New York: A. & C. Bon, 1932.

Durant, W., and A. Durant. Rousseau and Revolution: The Story of Civilization. Vol. 10, New York: Simon & Schuster, 1967.

Frost, L., and L. Chapman. Polymorphous sexuality as an indicator of psychosis proneness." Journal of Abnormal Psychology, Vol. 96 (1987), pp. 299-304.

Liebowitz, M. The Chemistry of Love. New York: Berkeley, 1983.

Money, J. Love and Lovesickness: The Science of Sex, Gender Difference and Pair Bonding. Baltimore: Johns Hopkins Univ. Press, 1980.

Walsh, A. The Science of Love: Understanding Love and Its Effects on Mind and Body. New York: Prometheus, 1991.

Anthony Walsh


Castration—the removal of the male testes and sometimes the penis—was practiced in many cultures until quite recently. The emperor of China employed 3,000 eunuchs (Greek for "guardian of the bed") as late as 1896, and castration disappeared from the Ottoman Empire only when the empire itself disappeared in 1923. Although valued primarily for their loyal service as guards and bureaucrats, eunuchs were also prized, by those so inclined, for their sexual services. Some believed eunuchs developed highly eroticized mouths and anuses if they lost both penis and testicles. Some young males in China became eunuchs by choice and were emasculated by professional "eunuch makers." Such a sacrifice might provide them with secure employment at the Imperial Palace as guards, secretaries, and many other governmental posts; several rose to become virtual dictators.

The position of eunuchs in the Byzantine Empire was even more exalted than in China—so much so that many ambitious young men voluntarily submitted to the knife. Eunuchs appointed to many prominent posts were loyal and reliable servants. Their privileged position in the paranoid world of Byzantium lay in the knowledge that they served as a foil to the hereditary nobility and, being unable to sire children, could not aspire to hereditary offices.

The Christian church, probably because of the undertones of homosexuality and transsexuality of castration, denounced the practice. Deuteronomy 23:1 warns: "He that is wounded in the stones, or hath his privy member cut off, shall not enter into the congregation of the lord." Nevertheless, aware that the seat of human lust lies in the "stones," Origen, an early church father in Rome, emasculated himself in an overly literal interpretation of Matthew 19:12. The testicle issue was so important to the church at one time that it required new popes to submit to the inspection of the papal privates by its cardinals. Having ascertained the presence of the holy scrotum, the examiners solemnly proclaimed in Latin: "He has testicles and they hang well."

The Catholic church prohibited women in church choirs, so it employed eunuchs to give voice to the higher notes in its musical repertoire while maintaining its opposition to castration. With the rising popularity of opera in Italy at the end of the 15th century, eunuchs were in high demand; many aspiring young opera stars submitted to the cruel operation hoping their fame would compensate them for their loss. These Italian eunuchs were the famed castrati. To maintain their high boyish voices, their testes had to be removed before their larynx enlarged under the influence of male hormones at puberty. (Castration after puberty has very little influence on voice pitch.) The pure tonal quality of these opera stars inspired their fans to cry "Long live the knife!"

No one studied how long the castrati lived, but it is known that cutting off the testes eliminates the primary source of testosterone, and that testosterone is the "villain" in many diseases afflicting primarily males. It is also known that neutered tomcats live longer than their intact brothers (spaying females does not lengthen their life span). A study of 297 "surgically docilized" (castrated) men in a Kansas institution for the mentally retarded found they outlived a matched group of noncastrated inmates by almost 14 years; they also outlived a group of female inmates.

Therapeutic castration of sex criminals has often been advised, but it is not particularly effective in adults, since testosterone and other androgens are also produced by the adrenal glands. Castration does not entirely eliminate the male sex drive; some eunuchs who retained their penises were sexually active, although, obviously, sterile. Castration after puberty often results in a penis of normal adult size that is capable of erection. More effective in the treatment of sex offenders is chemical "castration" through administration of anti-androgen drugs, such as medroxyprogesterone (Depo-Provera).


Bradford, J. The Antiandrogen and Hormonal Treatment of Sex Offenders. In W. Marshall, D. Laws, and H. Barbaree, eds. Handbook of Sexual Assault: Issues Theories, and Treatment of the Offender. New York: Plenum Press, 1990.

Bullough, V. Sexual Variance in Society and History. Chicago: Univ. of Chicago Press, 1976.

Morris, D. Body watching. New York: Crown, 1985.

Runciman, S. The Emperor Romanus Lecapenus and His Reign. Cambridge: Cambridge Univ. Press, 1963.

Anthony Walsh


Sexuality in Marriage
Premarital Sex

A change in the attitude of the Roman Catholic Church toward sexuality has become apparent in contemporary times. Previously, the meaning and purposes of human sexual expression were defined primarily in terms of the natural law, with its emphasis on procreation. With the contemporary emphasis on personal development, the church has become aware of the psychological, social, affective, and religious elements as well as the biological aspects of human sexuality. Because sexuality is an essential factor in human development, it is also an integrating element in the Christian mission to extend God's love for all people. Since humans are by nature sexual beings, a factor that enables them to become lovers, the expression of sexuality must be kept within the context of love.

Love is experienced within a relationship that involves concern, care, and a willingness to assume responsibility for the other. A mutually shared life commitment in the form of marriage provides the best atmosphere for the complete loving gift of self in the act of sexual intercourse. It is in the sacrament of marriage publicly proclaimed that love, both human and divine, is best spread among God's people.

Sexuality in Marriage

The permanence of marriage continues to be a vital element in Catholic teachings on the sanctity of the intimate partnership. The continued existence of the sacred bond is necessary for the good of the spouses, children, and society.

Sexual fidelity contributes to the permanence of the union. Therefore, adultery continues to be prohibited because the couple in the marriage covenant of conjugal love "are no longer two, but one flesh" (Mt 19:6). The partners render mutual help and service to each other through this intimate union of their persons. Children need the stability of this oneness, which imposes total fidelity on the spouses.

The mutual love of the marriage partners is uniquely expressed and perfected through the marital act, the purpose of which is the procreation of children. Historical events, such as the rise in knowledge of techniques of birth control, appeared to frustrate the purpose of marriage. Confessors were looking for guidelines to advise penitents who were using coitus interruptus as well as technical instruments to prevent the birth of children from sexual intercourse. In reaction to the changing attitudes toward contraception, Pope Pius XI, in 1930, issued the encyclical Casti Connubii (On Chaste Marriage). He defined the primary purpose of the conjugal act as the begetting of children, with the secondary purposes of mutual aid of the spouses, the cultivating of mutual love, and the quieting of concupiscence. He went on to say that any time a couple engages in sexual intercourse "in such a way that the act is deliberately frustrated in its natural power to generate life... those who indulge in such are branded with the guilt of grave sin."

Pope Pius XII, in 1951, in an address to the Italian Catholic Society of Midwives, softened the stance toward birth control for serious reasons such as medical, eugenic, or social and economic considerations. Pius XII made the distinction between artificial birth control and the use of periodic abstinence or continence, whereby married couples refrain from sexual intercourse during the woman's fertile period. It follows from this viewpoint that once periodic abstinence or the use of rhythm, or natural family planning, is acknowledged as permissible, the primary purpose of marriage as the procreation and education of children appears to be altered.

Vatican II, in 1965, refused to designate primary or secondary purposes of marriage in the Pastoral Constitution on the Church in the Modern World. Marital acts of love "signify and promote that mutual self-giving by which spouses enrich each other with a joyful and thankful will." Marriage and conjugal love "are ordained for the procreation and education of children, and find in them their ultimate crown." Although both purposes are mentioned, there was no attempt to prioritize them. The concept of responsible parenthood was introduced in which married couples, when planning their families, should "thoughtfully take into account both their own welfare and that of their children, those already born and those which may be foreseen." The Council Fathers encouraged spouses to practice conjugal chastity, which counseled married couples to avoid artificial means of birth control in their regulation of births.

The results of a papal commission appointed by Pope Paul VI to study the issue of contraception gave two divergent views. In 1966, the minority opinion, signed by four theologians, maintained the prohibition against all forms of contraception. The majority report, signed by the remaining members of the commission, recommended a change in the Church's official teaching on methods of contraception. Pope Paul's response came in 1968, when he issued his encyclical letter Humanae Vitae (Of Human Life), which declared that there could be no change in the Church's opposition to the use of artificial contraceptives. He did affirm the use of the "natural rhythm" of fecundity to regulate births. He based his argument on the two purposes of sexual intercourse, unitive (mutual support of the spouses) and procreative (the birth of children), which should not be separated.

In promulgating the encyclical, Pope Paul refrained from mentioning infallibility, and his spokesman, Monsignor Lambruschini, stated that it was "not irreformable." Many dissenting opinions arose against the idea that the procreative and unitive dimensions of human sexuality must be joined in every act of sexual intercourse. Women's recurring infertile periods indicate that a natural infecundity occurs, in which the unitive and procreative functions of sexual intercourse are separated. Humanae Vitae stressed that "every marriage act must remain open to the transmission of life." Dissenting theologians point out that conception cannot always follow intercourse; therefore, responsible parenthood calls for decision making between parents to regulate births.

The dissenters also point out that periodic abstinence places additional emotional or psychological strain on the spouses, especially women, who are more sexually responsive during their fertile periods. Many Catholic theologians maintain that, assuming spouses are responsibly motivated, the use of artificial contraception does not constitute a moral evil or sin and is not an objective moral wrong.

Premarital Sex

The most recent Vatican document (1975) on sexual ethics continues the basic teaching that genital sexual activity finds its truest meaning in marriage. Sexual union is only legitimate if a definitive community of life (i.e., marriage) has been established between the man and the woman. The problems associated with premarital sexual activity are that in the demand for responsible parenthood the act must be contraceptive. Since the intercourse is occurring outside a sacramental love union, it is not a love relationship publicly proclaimed, nor does it reflect God's love for us.

Premarital sexual actions violate the act of mutual self-giving by means of which two people express their willingness to assume unconditional responsibility for each other in a permanent manner. Couples engaging in premarital sex must be more socially sensitive to the view of marriage as the institution that intends to enhance personal relationships by helping each partner to overcome selfishness, immaturity, and dishonesty. Genital expression should reflect the level of personal commitment present between two persons following the example of God's love for humanity as being both creative and eternally faithful.

Some theologians see engaged couples as fulfilling the condition for marital sex because of their intent to provide for the mutual support of each other and to care for children.


The Declaration on Abortion issued by the Sacred Congregation for the Doctrine of the Faith in 1974 reiterated the statement of Pius XI and Pius XII that condemned abortion, which is an end in itself or a means to an end. John XXIII asserted the sacredness of human life, which from its "very inception... reveals the creative hand of God." The Second Vatican Council condemned abortion by stating that "abortion and infanticide are abominable crimes." Paul VI said that this teaching of the church is unchanged and immutable on this subject.

The declaration based its premise on the principle that the right to life is the primordial right of human persons. Thus, every human life must be respected from the moment the process of generation begins. The declaration placed the beginning of life at fertilization of the egg, because a new genetic package develops, which they call an individual human being, with its characteristic traits already fixed. They base their arguments on the premise that "he who will be a human being is already a human being." Neither divine law nor human reason admit any right of directly killing an innocent person. Theologians have sought to clarify, refine, and explain these principles to better understand their particular applications. Moral theologians say that abortion must not be called murder, because abortion is a physical act of expelling, or causing the expulsion of a presently living fetus from the womb prior to its viability. Murder is a moral act that means malicious, unwarranted, or unjust killing, or taking of human life with evil intent. To equate abortion with murder, two presuppositions must have already been reached: that in aborting a fetus a human life has been taken, and that this human life has been taken unjustly.

The questions that must be addressed regard the beginning of human life and on what occasions fetal life is taken unjustly. Although the Roman Catholic Church acknowledges the impossibility of deciding the moment at which life begins, it acts in practice as though human life were present from the moment of fertilization. This reasoning is based on the doubt of fact; since we are not sure when life begins, we must follow the safer course and regard human life as beginning at fertilization.

Some theologians have tried to answer the question about the time when life begins. For those who maintain that life begins at fertilization, they point out the fact that simply because the just-fertilized ovum is a genetically human organism, it does not mean that a human person exists from conception. Although the zygote has the potential for development into a human person, it is not a human person, because as each cell divides, it, too, would be a human person.

The theory of segmentation says that human life can be present only when that point of cellular division and multiplication has been reached so that twinning, tripleting, and so forth are no longer possible. If every person is an individual, one cannot be divided from oneself. The newly fertilized ovum can divide for a period of 14 to 21 days to become two or more beings; therefore, the fecundated ovum can be neither a person nor fully human. This theory is supported by scientists who say that one-third to one-half of the fertilized ova are never implanted in the uterus but rather are expelled during the woman's next menstrual cycle. Scientists support the theory that personal life begins at the establishment of individuality with the information that up to the time of implantation of the fertilized ovum, only the RNA (ribonucleic acid) of the mother is present. The sperm does not begin to play any part until implantation in the uterus, when the genetic capital of the new organism is activated and the conceptus begins to be directed by its own RNA. The transfer to the RNA of the conceptus occurs within 14 to 21 days after fertilization, at the same time that individuality is thought to be established.

The ramifications of these two theories are especially crucial to treatment of victims of rape or incest. Traditionally, the Catholic Church allowed the time limit of 10 to 12 hours for a D&C (dilation and curettage) or vaginal douche for victims of rape to prevent fertilization. Given the rapid entry of the sperm into the Fallopian tubes, this method would be most ineffective. Rather, the use of hormonal agents such as DES (diethylstilbestrol) to act in a contraceptive manner, within the longer period, would be permissible. These hormonal agents and morning-after pills can also act as abortifacients, which causes Catholic theologians to give cautious support to their use, because they also prevent implantation. The extended period of 14 to 21 days before the individuality and the personhood of the fetus are established allows more leniency toward their use for victims of rape and incest.

The Church says that there should be no direct or intended abortions, but does allow indirect abortions under certain conditions. A pregnant woman's cancerous uterus or Fallopian tubes containing an ectopic pregnancy may be removed for the preservation of the woman's life. Such abortions are called therapeutic because they remedy a pathological condition. Diseased organs are removed and the death of the fetus is not intended, but the result of the indirect abortion is to save the mother's life.


The Congregation for the Doctrine of the Faith issued a letter to the bishops of the Catholic Church on the Pastoral Care of Homosexual Persons, signed by Pope John Paul II in 1986. It elaborated and reiterated many of the principles of the 1975 document on sexual ethics, in which homosexual genital activity was labeled as "intrinsically disordered" because it is deprived of its "essential and indispensable finality."

Both Scripture and tradition were cited as a basis for rejecting homosexual acts as immoral. The bishops, clergy, and religious were praised for their care of homosexual persons and encouraging the homosexual person to live a chaste life. Although the church recognizes homosexuals living in loving relationships that strive for permanence, the couple must aim at the elimination of all genital behavior from their lives.

The official Catholic teaching that homo-genital acts must be judged as objectively immoral, regardless of circumstances, has resulted in various reactions on the pastoral level. Moral theologians have tried to find applications of this teaching that would include sensitivity and compassion toward homosexual persons. Some revisionist theologians suggest that in the light of mutual support, love, and enhancement of human growth that accompanies stable relationships that desire permanency, the genital activity occurring within these unions may be viewed as premoral, not objectively morally wrong.

The Roman Catholic Church of Baltimore, in 1981, announced a formal and public ministry to the homosexual community that promised sensitivity and regard to the person rather than emphasis on impersonal law. The Washington State Conference of Bishops as well as the San Francisco Senate of Priests recognized the distinction between objective homosexual acts and subjective culpability in the face of pressures and loneliness, which homosexual persons experience.

All pastoral approaches that try to understand and minister to homosexual persons admit there are elements in the homosexual subculture that are irreconcilable with Christian living. They exclude all violent or coercive, anonymous, impersonal, promiscuous sex or seduction of the young and innocent from acceptable behavior. The American Bishops advise confessors and pastors to avoid both harshness and permissiveness when counseling sexually active homosexuals in order that they may grow to be fuller, happier, and more spiritual Christians.


Genovese, V. In Pursuit of Love: Catholic Morality and Human Sexuality. Wilmington, Del.: Glazier Press, 1987.

Gramick, J., and P. Furey, eds. The Vatican and Homosexuality. New York: Crossroad, 1988.

Keane, P. Sexual Morality: A Catholic Perspective. New York: Paulist Press, 1977.

Kosnick, A. Human Sexuality: Catholic Theological Society of America Study. New York: Paulist Press, 1977.

Lauber, R., OFM, J. Boyle, and W. May. Catholic Sexual Ethics. Huntington, Ind.: Sunday Visitor, 1985.

Liebard, O. Official Catholic Teaching on Love and Sexuality. Wilmington, N.C.: McGrath, 1978.

Noonan, J., Jr. Contraception: A History of Its Treatment by Catholic Theologians and Canonists. Cambridge, Mass.: Harvard Univ. Press, 1986.

Marianne Ferguson


The Narrated and Written Word
Censorship of the Press in England and America
Theater and Performance

Censorship has been defined as: "the active suppression of books, journals, newspapers, theater pieces, lectures, discussions, radio and television programs, films, art works, etc.—either partially or in their entirety—that are deemed objectionable on moral, political, military, or other grounds." More succinct than Hauptman's definition, but quite as telling, is the definition of censor found in the Oxford English Dictionary: "One who exercises official or officious supervision over morals or conduct." (Officious can mean either "informal" or "meddlesome.")

Censor and censorship derive from the title established in Rome under the Lex Canuela of 443 B.C.E. for certain magistrates who drew up the register or "census" of citizens, and also had under their jurisdiction the supervision of public morals regarding, for example, obligations of marriage, behavior towards family and slaves, and conduct of business, agriculture, and religion (Green, 1990, p 47). The practice is even older than the word, however. The Assyrian librarian Ashurbanipal of the 7th century B.C.E. is said to have amassed a collection of over 30,000 clay tablets, which he censored by removing from the collection whatever the king found disagreeable.

Censorship can be applied to any type of information or message, and may take many forms: the author or creator may suppress certain ideas or forms of expression (self-censorship); a publisher, producer, recording company, or other facilitator can refuse to allow the work to achieve its final form or mandate editorial changes; a bookstore, library, theater chain, radio station, or other disseminator can refuse to make the work available; an individual or group can demand, petition, or picket that the work, once available, be withdrawn, stopped, or destroyed; and a legally empowered agent can attempt to block the process at any stage.

The following history and discussion focuses upon United States censorship practice and its antecedents in England. Information about censorship in other countries appears in Green's The Encyclopedia of Censorship.

The Narrated and Written Word

Historically, censorship for moral reasons of speech and writing about sexuality was usually linked with and subordinate to the more primary objective of suppressing material deemed threatening to the status quo in religion or politics and was not considered a separate issue until well into the 18th and 19th centuries. In the 4th century B.C., Plato advocated extensive censorship for the young of tales about the gods so that Greek youth might not be exposed to bad examples. He was most concerned about greed, cowardice, lying, disrespect for religion, and wicked deeds such as rape and murder—all seen from the viewpoint of being detrimental to the character of a loyal (male) citizen of the state and good soldier. It was as a relatively minor point that he also added, "Nor will self-control among our youths be strengthened if they hear the same theme [of unbridled sexual passion] recounted in the story of Hephaestus fastening together the bodies of Ares and Aphrodite [when caught in the act of adultery]."*

In Rome shortly after the birth of Christ, the poet Ovid was exiled reportedly for his "immoral"—work The Art of Love—perhaps the earliest known handbook on "how to pick up girls"—although the charge may have been a pretext to cover a political reason for his banishment. In the days before the printing press, censorship could take the form of imprisonment, banishment, or execution of the offending party, who was thus neatly prohibited from writing or speaking publicly.

In general, however, the classical world was rather permissive by modern standards about sexual expression, judging from the Pompeiian artifacts and the writings of Aristophanes, Ovid, Petronius, and Catullus. In particular, sexual and scatological obscenities were linked to comedy, satire, and polemic, and considered quite appropriate in these contexts.

The medieval world continued in this vein for some centuries, as exemplified by Boccaccio's Decameron (c. 1349-51) and several of Chaucer's Canterbury Tales (c. 1386-1400). Certainly the Catholic church was rising as a censorship power, taking its cue from St. Paul's report of the Ephesians' burning their books on "curious arts" (Acts 19:19); its banning of books began in 150 A.D. with, ironically, an unauthorized biography of St. Paul and continued sporadically until systematized under the pope in 1559 into what was officially termed the Index Librorum Prohibitorum in 1564. However, the early ecclesiastical efforts were nearly all directed toward works deemed religious heresy, including early scientific writings. The sexy Decameron seems to have survived unscathed for 150 years, until the Italian monk and reformer Savonarola burned copies in his "bonfire of vanities" in 1498. Finally, the Index picked up Boccaccio's classic in 1559.

But with the invention of moveable type in the mid-1400s, the entire nature of information and its dissemination changed irrevocably. In censorship, wrote Kendrick, "futility... was already guaranteed five hundred years ago. Once printed, a writer's words acquired a life independent of his and much larger; only neglect can kill a printed book." In a veritable literary dam exploding, some 20 million books were reported produced in England and Europe between 1450 and 1500. Shortly after in 1524, the Western world saw its first recorded purely "dirty" book, that is, prurience unmixed with satire, heresy, or insult: the so-called Aretino's Postures, a series of sonnets illustrated by drawings of a couple in various copulatory positions. Aretino's name became a byword for sexually arousing material for several centuries, and his works were duly condemned by the church.

* Ironically, this and other "illustrations from Homer of the self-indulgences of heroes and gods and disrespect for rulers" are omitted (censored?) from the 1941 Oxford University Press edition of The Republic. See page 79.

Censorship of the Press in England and America

Sixteenth and Seventeenth Centuries
Eighteenth Century
The Nineteenth Century
Twentieth Century

Sixteenth and Seventeenth Centuries

Not only the church, but also civil authorities were beginning to systematize their approaches to censorship, focusing, like the church, on heresy, both political and religious—and sometimes social. Book burning was a favorite technique, supplemented by Draconian punishments and sometimes execution of authors and publishers. In 1534, Henry VIII broke with the Catholic church to establish his own authority over state, church, and heretics with the Act of Supremacy. Henceforth civil censorship in England ran parallel with the ecclesiastical. In 1557, a sort of printers' guild called the Stationers' Company was chartered and empowered to control the English press. Subsequent decrees strengthened its powers, until 1640 when the Long Parliament abolished the entire censorship apparatus of the Stuart monarchs.

For the first few years of the Commonwealth, there were no statutory restrictions on the press, resulting in a massive and undisciplined flow of books, tracts, and pamphlets exhorting many undesirable points of view. To curb this flow, the Puritans soon reestablished full censorship in the Licensing Act of 1643. Despite protests, including Milton's famous pamphlet "Areopagitica," censorship continued into Cromwell's government. The Restoration continued in the same vein with the Licensing Act of 1662, which ultimately remained in effect until 1695.

While the civil authorities in the 17th century continued to focus on challenges to accepted political (and sometimes religious and social) doctrines, the church was slowly beginning to take note of sex in literature, particularly literature from France. The vigorously scatological Gargantua (1635) and Pantagruel (1633) of Rabelais were translated into English by 1660. In 1668, Pepys' Diary immortalized L'escholle de Filles, a "bawdy, lewd book" that led Pepys to masturbate, "and after I had done it, I burned it, that it might not be among my books to my shame." Among English authors, Shakespeare's art had arisen to full flower, including many bawdy references and puns, but apparently falling short of anything that would trigger notice from either the church or the state.

More problematic were the openly licentious writings of John Wilmot, second Earl of Rochester, who continued in the Roman tradition of using sex as a vehicle for comedy, satire, and invective. His poems and play (Sodom: Or, the Quintessence of Debauchery), written for private circulation but published after his death, were regularly prosecuted under the Licensing Act of 1662, probably as much for the anti-establishment satire as for the sexual components. Neither was sex unknown in books published during this period in the American colonies. The first recorded incident of censorship involving erotica was the seizure in 1668 of Neville's The Isle of Pines—a Robinson Crusoe-type tale involving a man and three women shipwrecked on an island—among other unlicensed material.

Eighteenth Century

With the 18th century began several trends that gradually coalesced into a specific consciousness of the sexually obscene and a concomitant desire to suppress it. Sexual explicitness in literature continued to flourish modestly. The year 1708 saw the first publication from the "father of English pornographic publishing," Edmund Curll, a quasi-medical guide on venereal disease later enhanced by certain "bawdy additions." Until his death in 1747, his publishing house specialized in translations from French and Latin of various exposes of alleged clerical concupiscence and treatises on such exotica as eunuchs and flogging. As was consistent with the earlier censorship practices, Curll ran afoul of British law only for his insinuations about the clergy and for a volume of "scandalous and seditious political recollections." Cleland's classic Memoirs of a Woman of Pleasure (1748-49)—usually called Fanny Hill and probably the most prosecuted literary work in history—was also a product of this century. Meanwhile, France produced the Marquis de Sade, whose literary work encompassed total political and religious rebellion as well as sexual anarchy and who served much time in prison from antisocial acts more than from his writing, most of which was not published or translated until much later.

In the colonies, Benjamin Franklin—sometimes credited with having been the first prominent American with a lusty sense of humor—produced "Advice to a Young Man in the Choice of a Mistress" (1745) and other whimsical but spicy pieces. However, most colonial erotica, like Neville's work, appears to have been imported from England or France, native colonial writers still being largely steeped in Puritan morality.

The 18th century also saw a new consciousness of the negative social and medical aspects of sex. The first publications on the "dangers" of masturbation were, in England, Onania, or the Heinous Sin of Self-Pollution (1710) and in France, Tissot's L'Onanism, Dissertation sûr les Maladies produites par la Masturbation (1758). The first significant work on prostitution appeared in 1769, Restif de la Bretonne's Le Pornographe, which outlined—albeit with questionable "levity"—a recommended program for state-run brothels.

The behavior of the small but growing reading public (especially women) was also coming under notice when a writer for the Athenian Mercury warned against "the softening of the Mind by Love" (i.e., romance novels), while an English evangelical journal warned, "Novels generally speaking are instruments of abomination and ruin."

A new consciousness of a more explicitly sexual past also emerged, with the excavations of Pompeii begun in the first half of the 17th century and continuing into the next. Simultaneously, the British Museum and the Louvre were founded, to serve as repositories for artifacts and scholarship. As a result, it became less likely that public law or private caprice (such as Pepys' burning of L'escholle des Filles) would result in the permanent or final destruction of works, even if openly erotic or even seditious or heretical.

On the censorship front, British law remained rather lax from 1695 until George III issued a proclamation in 1787 urging suppression of "all loose and licentious Prints, Books, and Publications, dispensing Poison to the Minds of the Young and Unwary, and to punish the Publishers and Vendors thereof." Still, enforcement was carried out by private agencies and tended to be small-scale efforts with small effect until the mid-18th century. However, private efforts at censorship led to the publication of expurgated (later, "bowdlerized") works, which would become widespread, particularly for Shakespeare and the Bible in both England and the United States. In the United States, the first censorship law appeared in 1711 when the Massachusetts Bay Colony prohibited the "Composing, Writing, Printing or Publishing, of any Filthy, Obscene or Prophane Song, Pamphlet, Libel or Mock-Sermon, in Imitation or in Mimicry of Preaching, or any other part of Divine Worship," making no distinctions between obscenity and anti-religious sentiment as was typical of the period. Other colonies adopted similar laws and carried them on into statehood after 1776.

The Nineteenth Century

Before the 19th century, literature, including bawdy materials, had remained limited in circulation because relatively few people could read, or, if they could, had sufficient leisure time to read for pleasure or enough money to pay for books, often imported from France. Thus, ecclesiastical and civil authorities perceived with some justification far greater dangers to the status quo from heresies and political freethinking than from sexual prurience. This began to change because of the growing middle class with its increased education, leisure, and income.

Consciousness of a need for social reform was also increasing, partly as a result of this newly educated middle class—which began to study itself, as it were, and what it saw it found wanting. The great social reforming censors were all products of the 19th century: notably Thomas Bowdler in England, whose expurgated Family Shakespeare in part gave English a new word to bowdlerize, and Anthony Comstock in the United States, the Carrie Nation of pornography, who claimed single-handedly to have "convicted persons enough to fill a passenger train of sixty-one coaches... [and] have destroyed 160 tons of obscene literature"—and to have caused at least 15 suicides. (See Comstock, Anthony; Comstockery.) Even Noah Webster, founder of America's great dictionary dynasty, abhorred "invective, ribaldry, or immorality" and opposed freedom of the press on the grounds that it would be abused, as was evident to him at the time "by the publication of salacious stories and scandalous libels." Webster's first dictionary of 1829 admitted few "naughty" words, not even "bundling," jocularly requested by one of his critics. Indeed, no Merriam-Webster dictionary was to define any of the four-letter words until the 1970s. Webster capped his career with an expurgated version of the Bible in 1833. Many social-reforming censorship organizations were also founded in the 1800s: the Society for the Suppression of Vice in England (1801) and in the United States (1873), the National Vigilance Association in England (1886), and the Public Morality Council in England (1890)—the last two enduring well into the 20th century.

Simultaneously, social reform consciousness led to the expansion of sex research from its "pornographic" beginnings by Restif de la Bretonne. The years 1830-60 saw additional studies of prostitution, both French and English. Other countries were advancing in this sphere also, with the publication of Psychopathia Sexualis by the Russian physician Heinrich Kaan in 1843 and a work of similar scope and title by the Austrian Krafft-Ebing in 1896. The most controversial in England was probably Havelock Ellis's Sexual Inversion (1892), an early study of homosexuality, whose publisher was prosecuted successfully for obscenity in 1899. Perhaps inevitably, these works were often seen as tarred with the same brush as the other pornography: "[Y]et, to the sensual, the vicious, the young and inexperienced, these scientific books thus popularized are too liable to be converted into mere guidebooks to vice."

Also increasingly under fire from worried social reformers was fiction: the novel became more respectable after Sir Walter Scott, and more novels were being read by many more people. Could there be antisocial effects, especially from the new "sensational" school of popular fiction? A court case in 1859 cited a young woman who connected reading romance novels to her crime of homicide.

As to what was available for reading by these "susceptible" folk in the 19th century, the new "realist" school of French writers was certainly causing some of the raised eyebrows, even in France. Flaubert's Madame Bovary was tried and acquitted of obscenity at home in 1857, but Baudelaire's Les Fleurs du Mal fared less well—six of its poems remained banned in France until 1949. The artists and writers on their part began to strike back at censorship: the image of the disaffected artistic genius at odds with mainstream society dates from this period. In a lighter vein but no less serious was Charles Dickens' benighted and censorious Mr. Podsnap, a caricature of Victorian prurience and prudery inhabiting Our Mutual Friend (1864-65). Meanwhile, some much older English works were coming under fire: a bowdlerized Chaucer appeared in 1831, while Massachusetts discovered Fanny Hill, published for the first time in the United States in 1821, and promptly banned it. Erotica proliferated to the extent that bibliographers and bibliophiles also turned their attention to this genre—the first published bibliography of erotica appeared in 1860, the same date that the British Museum established its "Private Case" collection of obscene and other banned works.

Indigenous American literature about sex remained sparse by comparison, but noteworthy. Hawthorne's Scarlet Letter (1850) portrayed adultery realistically, Whitman's poems Leaves of Grass celebrated the frankly physical and the earthy, and Mark Twain's "1601" (1880) plus other short and largely unknown pieces continued in the long tradition of bawdy humor.

The classics—Greek and Roman literature—had begun to fall out of pedagogical fashion, especially in the United States; thus the hidden erotic treasures reserved for classics scholars in Ovid and Catullus appeared likely to remain even more hidden. However, toward the end of the century, the full ruins of Pompeii had finally come to light, inspiring numerous primitive attempts at the equivalent of airbrushing in the museum catalogues.

During the 19th century, laws against obscenity and pornography per se emerged in full flower. The first U.S. federal statute to mention obscenity was the Customs Act of 1842, which forbid imports of "indecent" and "obscene" books and pictures. Another federal statute of 1865 prohibited the shipment of obscenity through the mails; this was strengthened in 1857 and completely revamped in 1873 into the "Comstock Law," which was much more specific and wide-ranging than its predecessors. In England, the Obscene Publications Act of 1857, also known as Lord Campbell's Act, authorized seizure and destruction of obscene books.

The legal event in the 19th century with perhaps the most impact on censorship was the English trial Regina v. Hicklin in 1868, the first case tried under Lord Campbell's Act. Lord Chief Justice Alexander Cockburn, ruling against a sensationalist and voyeuristic narrative purporting to expose erotic practices during Catholic confession, proposed a definition for what had previously remained undefined: "The test for obscenity is this, whether the tendency of the matter charged as obscenity is to deprave and corrupt those whose minds are open to such immoral influences, and into whose hands a publication of this sort may fall." The "Hicklin test" assumed that an obscene work necessarily resulted from an obscene intent, and that the most susceptible individuals must constitute the yardstick for the definition. This test became the basis for anti-obscenity legislation in Britain and the United States until Roth v. Alberts in 1957.

Twentieth Century

The players all being arranged on stage, the 20th-century narrative of censorship has been largely a playing out of the conflict among them. There are the increased and stubborn interests of artists and authors in depicting frank portrayals of life, sex and all; a large and potentially "vulnerable" reading public, incorporating a growing intelligentsia but also incorporating even more vulnerable subgroups—traditionally, women, children, the poor, and the mentally nonnormal; a consciousness of social harm, perhaps stemming originally from Christian morality but long since encompassing consideration of social welfare and criminal behavior; and independent and liberal traditions of intellectual responsibility in England, plus a sister tradition of First Amendment-inspired intellectual freedom in the United States. The heart of the clash has lain within the movement for social welfare, specifically between those who hold that sexual materials reduce social welfare and those who hold that such materials are innocuous, or even necessary to the social welfare.

The opening salvo was the battle between two giants in their respective forces: Anthony Comstock, for whom all sex reeked social evil, and Margaret Sanger, crusader for birth control and sex education. Comstock, in his waning years, got Sanger indicted and managed to secure the imprisonment of her husband, but Margaret fled the country, and her case was ultimately dismissed in 1916 after Comstock's death. Yet neither side actually "won," for birth control information remained actionable in the United States for decades.

But the major censorship wars of the 20th century have been mostly fought in U.S. courtrooms. Long neglected until Hicklin, the major point of dispute was the definition of obscenity or pornography. The questions in contest have been thus:

· Is "art" different from obscenity?

· Does the intent of the creator enter into the definition?

· Should the most purportedly "vulnerable" audiences be taken as the standard?

· Should social, scientific, or other value of a work under dispute be considered?

· Should an obscene part of a work lead to proscription of the whole?

· What is the nature of the "social harm" deemed to result from obscenity or pornography?

· Is the sexual arousal potential of a work ("prurience") an index of harm per se?

The Hicklin test of 1868 rendered intent irrelevant, assumed evil effects of obscenity, took as a standard the most vulnerable audience, and judged the entire work by one passage. These elements remained relatively inviolate through a number of cases in both England and the United States for a half century. By 1913, however, U.S. Supreme Court Justice Learned Hand remarked in reference to United States v. Kennerley that it was perhaps inappropriate to "reduce our treatment of sex to the standards of a child's library in the interests of a salacious few."

The next step occurred in 1922 when the New York State Court of Appeals vindicated Mademoiselle de Maupin in Halsey v. New York Society for the Suppression of Vice. The judge declared that while certain passages may be vulgar, the book must be considered as a whole. Another milestone came 11 years later in the famous Ulysses case (United States v. One Book Entitled Ulysses), when Judge John M. Woolsey invoked the good intentions of the creator as well as suggesting that great art can, in fact, deal frankly with sex.

Of lesser future importance but also quite interesting were two state court cases: Roth v. Goldman in New York (1948) and Commonwealth v. Gordon in Pennsylvania (1949). The first resulted in a conviction for mailing a translation of Balzac's Droll Stories, but one of the judges questioned whether the arousal of normal sexual desires was socially dangerous. The second trial vindicated nine American novels, including Faulkner's Sanctuary, with Judge Curtis Bok proposing that obscenity statutes should incorporate a test for "clear and present danger"—not merely a presumptive tendency to corrupt.

With Roth v. United States (1957), the Hicklin test was finally superseded. In upholding a conviction for mailing erotic magazines and books, Justice William Brennan declared that: "Obscene material is material which deals with sex in a manner appealing to prurient interest, and the test of obscenity is whether to the average person, applying contemporary community standards, the dominant theme of the material appeals to prurient interest." Brennan also stated, "[I]mplicit in the history of the First Amendment is the rejection of obscenity as utterly without redeeming social importance." The Roth test set the standard for subsequent legal discussions of obscenity, and no doubt influenced England in establishing a new Obscene Publications Act in 1959, in which the concepts of "value" and "work as a whole" were incorporated. The United States had already liberalized its import laws somewhat with the Smoot-Hawley Tariff Act of 1930, which exempted classics and books of merit from prosecution when imported for noncommercial purposes.

In the wake of Roth, publication of erotic materials, including many pornographic classics, expanded greatly in both the United States and Britain, since it was not difficult to prove some "value" for most works. This was exemplified in the 1966 Memoirs v. Massachusetts decision, in which the Supreme Court ruled in favor of the redeeming social value of the notorious Fanny Hill. The value—a change from "importance"—lay in its historical details.

It was probably this sudden outpouring of sexual publications that inspired the 1967 creation by President Lyndon B. Johnson of the Commission on Obscenity and Pornography. The Commission was charged with analyzing current U.S. law on obscenity, traffic in pornographic materials, and the effects of such material on readers, including minors, and instructed to recommend future regulation. After three years and $20 million, the final report was released, stating the opinion of the majority of the Commission that pornography was basically harmless and proposing the repeal of all 114 existing state and federal laws regulating adult use of pornography because such laws are ineffective, are not supported by public opinion, and conflict with individual rights. The Commission did propose laws restricting minors' exposure to pornography and called for a wide-ranging program of sex education. Perhaps not surprisingly, the then President Richard M. Nixon condemned the report as morally bankrupt, and the Senate repudiated its findings.

In 1973, the Roth test was modified somewhat by Miller v. California to produce the standard still used as of 1992:

The basic guidelines must be: (a) whether the average person, applying contemporary community standards, would find that the work, taken as a whole, appeals to prurient interest; (b) whether the work depicts or describes, in a patently offensive way, sexual conduct specifically defined by the applicable state law; and (c) whether the work, taken as a whole, lacks serious literary, artistic, political or scientific value.
The major modifications to Roth include the mention of applicable state law and the replacement of "utterly without redeeming social importance" with the somewhat more strict "lacks serious literary, artistic, political or scientific value." The effect was to turn the definition of obscenity in some measure back to individual communities and states, a development that was no doubt prefigured by the reaction of Congress to the 1970 President's Commission Report and certainly welcomed by the pro-censorship organizations.

For although the Victorian groups such as the Society for the Suppression of Vice had long since ceased functioning, new and vocal contemporary groups sprung up to replace them. The best known perhaps has been the Moral Majority, like many (but not all) such groups based in the U.S. fundamentalist Protestant community. The 1992 Encyclopedia of Associations lists dozens of additional groups working to suppress the sexual and the erotic in its various forms. On the opposing side, other groups fight against censorship, including People for the American Way, the Freedom to Read Foundation, and the American Civil Liberties Union. In the last decade, these organizations have been locked in a passionate battle, often in hand-to-hand combat at the local level over textbooks in public schools and books in public libraries.

The increasing influence of these pro-censorship and anti-obscenity groups led to the establishment in 1985 of another commission, the Attorney-General's Commission on Pornography (the Meese Commission), whose final report a year later presented conclusions different from those of the first commission: that certain kinds of pornography lead to sexual violence, notably against women and children, and that enforcement of existing laws should focus on child pornography and violent pornography. Books and the written word alone, however, were deemed "least harmful" and should be virtually exempt from censure, visual media being considered far more pernicious. The report also included a call to citizens to take grass-roots action against objectionable materials in their own communities—invoking item (a) in the Miller standard.

Meanwhile, a new approach to censorial legislation was under proposal, growing out of feminist antipornography efforts, particularly of the groups Women Against Pornography and Women Against Violence Against Women. The initial law was drafted by author Andrea Dworkin and attorney Catharine McKinnon for the city of Minneapolis in 1983; similar ordinances were subsequently drawn up in Indianapolis and other cities. This new approach defined pornography as a form of discrimination against women and as grounds for civil complaint: any woman could file a complaint either in court or with the local equal opportunity commission charging discrimination via production, sale, exhibition, or distribution of pornography; coercion into pornographic performance; forcing pornography on a person; or assault following the assailant's reading or viewing of pornography. The model ordinance defined pornography at some length according to nine criteria.

In Minneapolis, the bill was passed but vetoed by the mayor. Similar legislation in other cities also failed to be implemented, either through veto or through challenge and reversal in the courts. The judgment against the Indianapolis ordinance was summarily affirmed by the Supreme Court in Hudnut v. American Booksellers Association (1986).

However, the principle behind this type of law has been resurrected in the Pornography Victims Compensation Act, under congressional consideration as of 1992. If this bill becomes law, crime victims could sue the publishers, producers, and distributors of books, films, music, or art that they claim inspired the criminals to commit their crime. (Similar legislation was recently passed in Canada.) As worded in the bill, the "crime" need not be proved or even reported for a suit to be accepted. This development has been seen as inspired by the Meese Commission, as has also a governmental unit called the National Obscenity Enforcement Unit, which spearheaded prosecution of many distributors of recreational sexual material in 1990-91. While few of these cases have been won in court, the attacks are mounted so as to cripple the target financially, whether or not prosecution is successful. Another tactic is to charge the distributors with violating racketeering laws, which command greater penalties.

The federal government has been responsible for another, quite unusual form of censorship of the word in the past few years. Federal regulations termed the "Gag Rule," upheld by the Supreme Court in Rust v. Sullivan (1991), forbid any health care facility receiving Title X funds for family planning services from the Department of Health and Human Services to give a client any verbal or written information about abortion, even if requested and even if medically recommended.

Ironically, censorship of the word has also been promulgated by the educated, liberal establishment under the rubric of a sentiment sometimes called "PC" for "politically correct." In a crystallization of the ideal, socially responsible individual, the perfect politically correct person completely eschews all racist, homophobic, sexist, ageist, or "ablelist" (biased against disabled people) language. In cartoonist parodies of PC talk, juvenile females are called baby women or pre-women—never girls. The university community has been something of an incubator for PC, and many students have been censured for such offenses as yelling derogatory remarks at other students, posting jocular but insulting signs in their rooms, or telling ethnic jokes. Antisexist PC in particular is showing signs of spreading throughout the workplace in the wake of Anita Hill's unsuccessful but well-publicized challenge in 1991 of Clarence Thomas's bid for the U.S. Supreme Court on the grounds of her claim that he sexually harassed her years before. In "workplace PC," telling dirty jokes is taboo and handing out compliments on appearance to the opposite sex can be suspect.

Through PC, the battle of censorship of the sexual word in the 20th century has come full circle, with one side ignoring sexism and damning sex, and the other side censoring much sex also—but entirely under the stated guise of fighting sexism. The locus of social harm changes with the perspective, but speech and writing about sexuality somehow end up in the focus, no matter which lens one looks through.

Theater and Performance

England has had a long tradition of state oversight of the theater, dating back to Henry VIII's Act of Supremacy in 1534, after which the Lord High Chamberlain gradually took over the function of theater censor. The Lord Chamberlain's de facto powers were finally given statutory authority in the Stage Licensing Act of 1737, which continued for over two centuries. The 1968 Theatres Act finally abolished the Lord Chamberlain's role and brought the stage under the general aegis of the 1959 Obscene Publications Act.

The United States does not seem to have had a similar tradition of central regulation of performance through any federal laws. However, individual performances have been ruled obscene or censored based on particular state laws, with the First Amendment being invoked as support about equally with its circumvention on various grounds. In 1932, a New York court ruled in People v. Wendling that the play Frankie and Johnnie could not be suppressed as "obscene" just because the plot was "tawdry" and the characters were vulgar and led lives of vice.

In perhaps a similar vein, the late black humor comic Lenny Bruce was ultimately acquitted by the Illinois Supreme Court in People v. Bruce (1964). The court ruled that because some of the topics commented on were of social importance, his monologue could not be judged obscene. And with an identical result although different legal precedent, the Supreme Court ruled in 1972 that an exhibition permit for the musical Hair must be issued in Chattanooga, Tennessee, because not to do so would constitute unlawful prior restraint and thus violate the First Amendment.

Much less clear have been many cases over recent decades concerned with burlesque and "exotic" dancing, with considerable local variation. In Adams Theatre Co. v. Keenan (1953), the New Jersey Supreme Court ruled (as with Hair) that a license could not be withheld from a production labeled a "burlesque show" because to do so before the performance would be unlawful prior restraint. With an opposite effect, ten years later a district court in Missouri ruled that a particular burlesque stripper violated a local indecent behavior ordinance.

In 1972, a case that generated some precedent was California v. LaRue in which the U.S. Supreme Court upheld the authority of the state of California to ban sexually explicit live entertainment and films in bars within the context of controlling the circumstances involving service of liquor. A similar case in 1981 was New York State Liquor Authority v. Dennis Bellanca. However, because censorship was interpreted as strictly limited to establishments selling liquor, the Supreme Court ruled in Doran v. Salem Inn (1975) that a New Hempstead, New York, ordinance prohibiting any public topless dancing was overbroad because it covered activity outside bars.

In a different approach to the problem, the U.S. Supreme Court ruled in Schad v. Borough of Mt. Ephraim (1981) that a zoning ordinance against performances could not be selectively applied to exclude nude dancing and that the ordinance violated the First Amendment. More recently, the Supreme Court affirmed in Barnes v. Glen Theatre (1991) the validity of Indiana's public indecency law as applied to prohibit nude dancing as entertainment. This decision—which ruled that regulation of nude dancing (in bars or not) could be justified despite the view of the Court that nude dancing was protected by the First Amendment—did not result from a unanimous opinion but from a bare majority of five justices for and four against upholding the Indiana local law.


As with censorship of the word, early art censorship was oriented almost exclusively toward political and religious heresy. The first reported nude statue of Aphrodite around 360 B.C. in Greece was subject to religious disapproval—not for moral reasons, but "because the beauty of her body might seem an inducement to heresy." Christian artists of the Renaissance painted the nude or semi-nude in appropriate biblical contexts: the infant Christ, Adam and Eve, the Crucifixion, etc., with uncertain but usually tacit approval from the church—which disapproved of provocative images. In the 16th century. Pope Clement suppressed not only the notorious sonnets of Aretino, but the explicit illustrations: author, artist, and engraver all had to leave Rome.

One of the most censured works in the history of art has been Michaelangelo's magnificent ceiling for the Sistine Chapel, heavily populated with enormous nude figures. From the 16th to the 20th centuries, at least three popes ordered draperies painted over offending body parts. Even in 1933, U.S. Customs confiscated (but later released) a set of prints based on the ceiling nudes before any of the draperies were applied. After the 16th century, nudity was finally designated by the church as officially unacceptable in Christian art, although tolerated with heroic and mythological subjects.

This pattern continued on the continent for centuries, although there were some exceptions. During the 17th century, the Spanish Inquisition censored all potentially erotic art—including specifying that hairdressers should remove or make decent the wax busts in their windows used to display hairstyles.

The New World started out as much more conservative artistically, but from Puritan rather than Catholic moral influence. The first nude statue exhibited in America, a plaster cast of the Venus de Medici imported from Paris in 1784, raised such an uproar that the owner showed it only privately to friends. This pattern continued for many years: nude statues displayed in U.S. public buildings were often draped or shown only to single-sex groups of adults—even as late as 1937.

The first U.S. national censorship statute, the tariff law of 1842, barred import of obscene art. This was interpreted later in the century that nudes were acceptable in museums but not in photographs or prints that might be sold to anyone. Comstock operated on this principle, and he boasted in 1874 that he had seized 194,000 obscene pictures and photographs, some based on museum works.

Around the turn of the century, nudity became more accepted in the United States as legitimate in artistic contexts, although acceptance varied by locality. Massachusetts, in particular, remained conservative up to 1950, banning issues of Life magazine that showed photographs of museum nudes. Photographs of nude or erotically posed individuals were still grounds for government prosecution, however, and in 1949 Eastman Kodak set up a private system of censoring materials sent in for photo processing. But in 1957, the infamous painting "September Morn"—which had drawn Comstock's ire and had made its owner rich from the ensuing publicity—was sedately deposited in New York's Metropolitan Museum of Art, and the following year, the Justice Department dropped its seven-year battle to keep imported erotic art out of the Kinsey Institute.

In the 1960s and 1970s, the United States actually became more permissive than some European countries. Several displays of erotic art were tried for obscenity and acquitted, while an exhibit of Beatle John Lennon's lithographs of "intimate bedroom scenes" was banned in London but shown in California.

In the 1980s, two new forces for art censorship began to grow in the United States. The first was a popular and congressional backlash, led largely by conservatives and religious groups, against the use of public money to fund art considered indecent or obscene, particularly grant money distributed by the National Endowment for the Arts (NEA). Two NEA-funded artists in particular were subject to censure: Andres Serrano, whose "Piss Christ" (1988) was a photograph of a crucifix suspended in a vat of the artist's urine, and Robert Mapplethorpe, whose subjects included homoerotic and sadomasochistically posed nudes as well as conventional portraits and nature studies. In a test case, director Dennis Barrie of the Cincinnati Contemporary Art Center was indicted on obscenity for hosting a Mapplethorpe show in 1989; however, the case was decided in favor of the museum.

Meanwhile, in 1990, Congress imposed a "decency requirement" on artists applying for NEA grants, and the NEA initiated a pledge to be signed by grantees stating that they would not use funds to create obscene art. In 1991, the pledge was found by a federal judge to be in violation of freedom of speech, while a group of artists filed suit over the statutory decency requirement. As of 1992, the outcome of this suit was still pending.

The second movement resulting in censorship of both art and film has been directed at child pornography and specifically visual depictions of minors (under age 18) that may be considered erotic. Federal statutes originally aimed at producers and dealers in "kiddie porn" were broadened throughout the 1980s to criminalize possession, advertisement, and receipt of such materials through the mail. A 1988 law requires producers of erotic images to maintain records of the ages of models depicted.

The new laws have been interpreted to cover simple nudity of minors as well as erode poses, and have resulted in arrest of a number of artists. In addition, some state laws have criminalized mere viewing of erotic or nude photographs of minors. While Dennis Barrie was acquitted of obscenity even though the Mapplethorpe photographs included some nude youths, it is still unclear to what extent museums and libraries may be subject to prosecutions under these laws for materials in their collections.


Songs about sex have a long history. Bawdy folksong collections were published freely in the 16th and 17th centuries; and during the English Restoration, both bawdy songs and erotic lovers' songs were quite popular. In the 1700s, however, collectors and publishers began to edit, expurgate, and omit most of the sexual material. This censorship of music publication continued well into the 20th century, although without having much effect on singers—neither "folksingers" nor the performers who made the English music hall a particular haven for bawdry, nor the men who sang "dirty songs" in bars and drinking clubs, nor the students and soldiers who did the same.

Collections of unexpurgated bawdy songs began, sporadically, to be published again in the United States starting in the 1920s. In the 1960s, folksinger Oscar Brand popularized a number of classic ballads of this genre, but unfortunately with his own quasi-expurgations to make the obscenities more palatable. At about the same period, certain "party" bands, like The Hot Nuts, became notorious on college campuses for their double-entendre lyrics. These bands, as well as nightclub singers performing in a similar vein, sometimes made records that could be bought at performances or discreetly through the mail.

Sexual lyrics came much more into the open—and were subject to public censorship—with the popularization of rock music from the late 1960s on. No radio station would play the Rolling Stones' "Let's Spend the Night Together" (1967), and some had reservations about "Why Don't We Do It in the Road?" from the Beatles (1968). At that time, however, few rock groups were even that explicit about insinuating sex, with the exception of a few fringe groups like The Fugs who sang, "Do you like boobs a lot?" and "I'm a dirty old man."

In the 1970s, much mainstream rock caught up to the fringe, with the Stones singing, "Black girls just want to fuck all night, and I ain't got the jam." Radio stations did not play it, but the records sold. Shock value of lyrics began to assume equal importance to the erotica, as also indicated in the name of some of the bands (e.g., Sex Pistols, and Cycle Sluts From Hell).

With the advent of rap music in the 1980s, sexual lyrics became easy to understand (after all, who could discern the words with all those loud guitars?). In 1985, a group called Parents Music Resource Center began a campaign to convince the record industry to label voluntarily those recordings with lyrics about sex, drugs, and other taboo topics. The Recording Industry Association of America reluctantly agreed to endorse labeling among its member companies, although compliance was minimal up to 1990 and still sporadic thereafter. Simultaneously, a number of state legislatures considered mandatory record labeling bills; as of 1992, none had been implemented.

In the early 1990s, several rock groups and performers were arrested for obscene performances, and a scattering of music store clerks for selling obscene recordings. Convictions were few; however, reportedly some store chains stopped carrying records with warning labels. Yet other reports indicate that labeled records were selling much better than their nonlabeled "G-rated" counterparts.

Several current federal laws explicitly include recordings within matter that may be declared obscene: Sections 1462, 1465, and 1466 of Title 47 of the U.S. Code. However, rock music is protected by the First Amendment, as ruled by four different U.S. courts of appeals in the 1980s.


Censorship of film in the United States dates back to 1907, when Chicago passed an ordinance requiring that the chief of police approve all films to be shown. A film could be banned for a number of reasons, including "immorality" or "obscenity." In 1909, New York State established the Board for the Censorship of Motion Pictures to review films, prohibiting obscenity and vulgarity among other types of depictions. In 1915, this Board changed its name to the National Board of Review of Motion Pictures (NBRMP), claiming to offer "selection not censorship."

The NBRMP filled the role of a national censor until other states established their own boards. The first federal attempt at control came in 1915 when legislation was proposed in Congress to create the Federal Motion Picture Commission. Wishing to avoid any form of external censorship, the film industry established the National Association of the Motion Picture Industry in 1916, which produced its own standards. However, this was unsuccessful in stemming the rise in state censorship boards. Finally, the industry reorganized in 1922 and established the Motion Picture Producers and Distributors Association (MPPDA), hiring former U.S. Postmaster General Will H. Hays to run the new organization, which became known as "the Hays office."

From 1922 to 1945, Hays involved a number of public groups in setting and implementing a stringent and detailed list of "Don'ts and Be Carefuls," including virtually anything involving sex. In 1931, the Motion Picture Production Code was adopted, largely backed by the Catholic-composed Legion of Decency. Producers were supposed to submit scripts in advance for review; approved films received a seal of approval. Pope Pius XI lent support to this effort with a 1936 encyclical "Vigilanti Cura," advising Catholic censorship of film and noting the role of films as "instruments in seduction."

The MPPDA was renamed the Motion Picture Association of America (MPAA) when Hays was replaced as head in 1945. A major break came ten years later, when United Artists refused to follow the code's dictates about censoring drug-related lines and scenes from The Man With the Golden Arm. The code was subsequently liberalized in 1956 and 1966, responding to several Supreme Court cases: Superior Films v. Department of Education of Ohio, Division of Film Censorship (1953) in which the film M (and by extension, all films) was ruled to be covered by the First Amendment; Kingsley International Pictures Corp. v. Regents of the University of the State of New York (1959), which ruled that local censorship on the basis of content (the adultery presented in the film Lady Chatterley's Lover) was unconstitutional; and Jacobellis v. Ohio (1964), which ruled that the film Les Amants was not obscene because the Roth standard incorporating redeeming "social importance" applied to film as well as to print.

In the late 1960s, the MPAA moved to a classification system for film rather than giving seals of approval, and created the Code and Ratings Administration with an accompanying Code and Ratings Appeal Board. The current classification is:



general audiences
parental guidance suggested for those under age 13
restricted: no admission to those under age 17 unless
accompanied by a parent or adult guardian
no children under age 17 admitted

The previously used "X" (persons under age 17 not admitted) can still be assigned by the film's producer.

The U.S. video market operates in part under a parallel rating system. In 1988, the Independent Video Programmers Association set up a classification system for videos produced outside with MPAA. The rating system, revised in 1990, has the following categories:



children, age 7 and younger
family, some violence and fight scenes
mature, some sex scenes
very mature, extreme language and nudity
extremely mature, extreme language, sex/nudity,
extreme violence, and substance abuse
adults only, ages 18 and over, frontal nudity/erotica

Three sections of federal laws specifically include film as matter that may be declared obscene: Sections 1462, 1465, and 1466 of Title 18 of the U.S. Code.


Regulation of radio in the United States began in 1910; the first formal regulatory body was the Federal Radio Commission (FRC), established by the Radio Act of 1927. The Commission established a broad but indirect form of censorship, generally in the form of selectively awarding frequencies to stations that met the FRC's standards for public interest, convenience, necessity, and—although not admitted—quality of the programs. Radio also established a self-regulation system. The National Association of Broadcasters was organized in 1923 and in 1929 issued a "Code of Ethics" and "Standards of Community Practices," which were apparently subscribed to by less than half of commercial radio stations. The Code of Ethics declared that stations should prevent broadcasts of offensive or obscene matter.

The Communications Act of 1934 created the Federal Communications Commission (FCC), superseding the Federal Radio Commission and continuing today. The FCC, which controls radio, television, wire, cable, and satellite transmissions, is explicitly prohibited from censoring the airwaves by Section 326 of Title 47 of the U.S. Code. This is interpreted as preventing prior restraint. However, Section 1464 of Title 18 of the U.S. Code forbids "any obscene, indecent, or profane language by means of radio communication," and the FCC is charged with promulgating this regulation through fines and warnings about license revocations. Several such sanctions were applied to stations airing material about sex in the 1960s and early 1970s.

This was put to test in 1973, when WBAI in New York City broadcast George Carlin's "Filthy Words" monologue in midafternoon. The FCC characterized the broadcast as "indecent" and issued a warning to WBAI. The radio station appealed on the grounds that while "obscenity" is not protected by the First Amendment, "indecency" is. The case went to the Supreme Court as Federal Communications Commission v. Pacifica Foundation (1978), and the Court ruled that even though the broadcast was not obscene, the FCC under its statutory requirements had the right to make a note in WBAI's file. The Court noted that broadcast speech required special treatment because of possible exposure of children and unconsenting adults to "indecency." As a result of Pacifica, the FCC banned "indecent" speech—at that time, generally restricted to Carlin's "seven dirty words"—between 6:00 A.M. and 8:00 P.M.

In 1987, partly in reaction to so-called shockjock radio, the FCC broadened its definition of indecency to include "material that describes sexual or excretory activities or organs in terms that are patently offensive under contemporary community standards" as well as lengthened the restricted period to midnight. The following year, a court ruled that the lengthened evening ban violated the First Amendment, but simultaneously Congress passed an overriding 24-hour ban on indecency that the FCC did not enforce, pending court review.

In 1989, a court of appeals issued a temporary stay on the ban, and in 1991 struck it down completely as unconstitutional. The case, Federal Communications Commission v. Action for Children's Television went to the Supreme Court, which declined to hear the case in 1992, de facto upholding the earlier ruling on the ban. The FCC has been charged with establishing a "safe-harbor" period for broadcasters, and as of 1992 enforced a ban on indecency only from 6:00 A.M. to 8:00 P.M.


When television emerged commercially in the 1940s, it was assimilated to the same oversight mechanisms as radio: in government, the FCC, and within the industry, the National Association of Broadcasters (NAB). The NAB Code of Good Practice for TV was first written in 1951, although abandoned in the early 1980s.

Sex on television seems to have been a relatively minor problem until the 1960s. The NAB Code, although not universally heeded, did prohibit nudity and obscenity. Enforcement was lax; yet apparently "ribald copy" was not common, probably because of the more proper social climate and because advertisers tended to support programs that were noncontroversial in all dimensions. Occasionally an exception occurred, as in 1959 when 19 television stations lost their NAB seal of good practice for airing advertisements for hemorrhoidal treatment. However, for nearly 30 years, the controversies surrounding television focused on the overabundance of commercials, lack of diversity, network corruption and dishonesty as revealed in the 1959 quiz show scandal, and the growing number of violent episodes and programs.

In the late 1960s, the most popular shows were "Laugh-In" and "The Smothers Brothers Comedy Hour." Peppy, topical, iconoclastic, and sometimes risqué, these programs attracted notice, including an effort from Rhode Island senator John Pastore to reduce both sex and violence on television by exerting pressure on the networks to honor the NAB Code. Nothing substantial resulted from the senator's efforts.

In 1971, "All in the Family" was the first, most famous, and possibly the best of a score of socially relevant comedy-dramas of the 1970s, many produced by Norman Lear and all making frequent use of formerly taboo themes: racial prejudice, the unglorious side of war, intergenerational conflict—and sexual topics like abortion, adultery, pregnancy, impotence, and rape. Concurrently, action and violence-oriented shows, notably police dramas, became more frequent. While both kinds of shows were extremely popular, a number of individuals and groups protested—both within the industry and among the viewers. An episode of "Maude" dealing with abortion was reported to have triggered 24,000 protest letters from right-to-life groups.

In 1975, the three major networks responded by jointly establishing the "Family Hour" under strong pressure from the FCC, which was itself under considerable pressure from Congress. The Family Hour was actually two hours (7:00 to 9:00 P.M.) when only shows "appropriate for family viewing" (i.e., children) were supposed to be aired. Within a year, a suit was filed on First Amendment grounds against the FCC, the NAB, and the three networks by the Writers Guild, the Directors Guild, the Screen Actors Guild, plus Norman Lear and many other independent producers as well as some of the television syndicators. The basis of the suit was that the networks and the NAB had instigated the Family Hour under coercion from the FCC—which, however, was explicitly forbidden from engaging in censorship under Section 326 of Title 47 of the U.S. Code. The case was heard by a federal district court in California, which found for the plaintiffs. The Family Hour concept was effectively finished, even after a U.S. court of appeals later overturned the ruling on the grounds that the FCC should have heard the case.

In the late 1970s, violence on television continued to increase, and shows with sexual themes became more common, although without much of the social relevance earlier in the decade. Opposition to both trends continued, this time with a new leverage mechanism: consumer boycotts against sponsors of shows judged too violent or too sexy. However, sex on television remained stable with even some increases, from 1975 to 1978 and to 1987, particularly in soap operas. The major censorship during this period seems to have been the FCC's attempt to crack down on indecency in broadcasting, as it did with radio, and in 1988 the agency fined a television station for airing an R-rated film at 8:00 P.M.

In the 1980s, some state laws attempted to regulate indecency in cable television, but were overturned by the courts on the grounds that only obscenity, not indecency, may be banned. It remains to be seen what the effects of FCC v. Children's Television will have on television programming.


Obscene telephone calls as harassment are illegal under Section 223 of Title 47 of the U.S. Code and may be prosecuted directly by the courts.

The FCC also has jurisdiction over the telephone. Recent efforts of the Commission, as directed by Congress, have been aimed at regulating the so-called dial-a-porn industry, which began in the early 1980s. These services initially consisted of offering sexually explicit recorded messages for a fee, and have expanded to offer in addition live dialogue and party-line conversations.

In 1983, legislation was passed to prohibit both obscene and indecent commercial telephone services to anyone under age 18. Enforcement was deferred, however, until the FCC promulgated regulations that specified how dial-a-porn providers could effectively screen out minors. Over the next five years, the FCC struggled unsuccessfully to produce regulations that would not be overturned in court on various grounds. The final regulations, specifying several screening techniques, including prepayment by credit card, were deemed acceptable; but the court of appeals in Carlin Communications v. Federal Communications Commission (1988), held that the statute was invalid in that it applied to constitutionally protected indecent communications.

Congress tried a second time to produce a dial-a-porn law, with two separate pieces of legislation in 1988. The first completely prohibited all obscene and indecent commercial telephone services to anyone, regardless of age; the second split the text into two parts, the first applying to obscenity and the second to indecency, each with different penalties. In 1989, however, the section of the law applying to indecency was declared unconstitutional by the U.S. Supreme Court in Sable Communications v. Federal Communications Commission.

That same year, Congress tried a third time to amend the U.S. Code as it applies to dial-a-porn. This law prohibits all obscene commercial telephone services, while restricting indecent commercial telephone services to persons age 18 and older. The FCC subsequently promulgated regulations for screening out minors, but before these went into effect, a group of dial-a-porn providers filed for an injunction enjoining enforcement on the grounds that the statute was vague, that it constituted prior restraint, and that the "least restrictive means" had not been applied in the regulations. A New York district court granted the injunction in American Information Enterprises v. Thornburgh, which was later overturned by a court of appeals in Dial Information Services v. Thornburgh (1991).

Thus, the 1989 law remained in effect as of 1992, with dial-a-porn providers required to use one of the screening methods specified in the FCC regulations. A quick glance at some of the newspaper advertisements for these services suggests that a good many providers are requiring prepayment by credit card.


Over the centuries, censorship of sexuality messages has gradually increased along with the consciousness of social responsibility and social reform. Yet as higher incomes together with increased leisure and education allowed a greater diversification of attitudes and "cultures" within U.S. society, the consciousness of social responsibility is no longer unified. We no longer agree (if we ever did) on what constitutes social reform—which sexual messages (if any) are necessary for health, well-being, and happiness and which (if any) are or might be harmful.

The result, especially in the last few decades, has been a sometimes frantic, sometimes grimly dogged pas de deux between the pro-sex people and the pro-censorship people, who change partners disconcertingly as the issues shift. The educator fighting for an improved sexuality textbook may also protest sexist speech in the workplace or support a new zoning law that limits the location of X-rated video stores. Someone in favor of the Pornography Victims Compensation Act may be against the Gag Rule.

With this "fractalization" of social opinion, it becomes less likely that the extremes of either censorship or free expression of sex will be easily implemented. Rather, the tug of war will continue in small and large battles for some decades, with regulations being passed and repealed, and cases first won, then overturned—and perhaps overturned again.

Yet educational and informational messages about sexuality, the Gag Rule notwithstanding, may be finally breaking free of censorship, as sex-related social issues, new birth and birth control technologies, and especially AIDS have increased the demand and need for sex information for perhaps even a majority within the diversified U.S. cultures. Simultaneously, improved research may also help us target more specifically the origins of social harm—those elements that may lie in sexual messages or may lie elsewhere. The next century will doubtless shed much heat—but hopefully some light—on the matter.

The impulse toward censorship has itself puzzled historians, social commentators, and those who see themselves victimized by censorship. The censors' own view—that they are motivated by the highest ideals of morality, patriotism, and responsibility—covertly implies that others lack these virtues, and that some materials deserve obliteration. However, that "explanation" leaves much unanswered. If it is true that producers of material deserving obliteration are immoral, unpatriotic, or irresponsible, how comes their placental loyalty to such evils? On reflection, we see that the answer must lie in a moral framework external to acts of—or rationalization for—censorship. Thus, censors necessarily must feel themselves generically of superior moral, political, and socially responsible substance than those whose works are deemed fit only for destruction.

An apparent exception may suggest some additional truth for this formulation. At time of war, few deny the need for censoring information of potential use to the enemy. Indeed, wartime censorship, even widespread, of all media—radio, television, print, and "loose talk"—is perceived as a tolerable evil, yet warranted only by the extraordinary circumstances of warfare. Now, modern censors often describe their activities as representing a "war" against immorality, but the war they envision surely differs from the armed combat, espionage, and agent provocateurship of military action. Indeed, one might wonder in what sort of war a man like Comstock envisioned himself immersed. Because it cannot be war in the literal sense, only figurative meanings remain, strengthening the conclusion that censors act not from narrowly founded dislikes of sexual imagery, say, but from a broader worldview in which transcendent immorality wages war against the Good, and must be subdued.

As for censorship of sexual messages, an additional image of war arises—the battle of the sexes. Not a war in the military sense, yet conflicts between men and woman about sexual morality, purity, and expression seem to wax and wane according to a thermometer calibrated in intensity of censorship. Thus, in today's America, a curious conflation exists between urgent calls for restructuring sexual communication and more or less virulent debate about the role of women in society. The observation suggests that the history of censorship is, in part, the history of reaction on the part of moralists to changes in women's status, role, and prerogative. All sides of today's censorship battles hoist the banner of protecting womanhood to rally round the forces they see as threatening, in their enthusiasm for or against censorship. Strong symbols indeed are evoked in this history.

Obviously, few would argue that the battle of the sexes has the gut-bloodied horror of modern combat, or that sexuality messages have the same valence as defense-related information. Again, it seems that issues beyond mere sexuality inform the censoring mind: sexuality is perhaps best described as a symbol of something else when evoked by censors. Women's lives—and rules created so often by men for how women should live—are part of the larger something to which censorship is connected; yet images of masculine sexuality are equally taboo. Thus, the object of censorship appears to be rule-breaking sexual behavior, seen by the censor as a deliberate or inadvertent model for more global anarchistic behavior among the youth, and seen ultimately not so much as simple lust but as heresy and rebellion—a point Plato made long ago in the first defense of censorship. If so, the impulse to censor emerges when rebellion is close to the surface, and it seems probable to the censor that society is about to tear loose from traditional moral and political moorings. So an anarchy of sexuality has come to stand for the anarchy of social and religious heresy against which censorship was first and foremost directed.

It may be that less than we might think has changed since Plato's day. Still preeminent in the censor's mind and fears is the spectre of social dislocation, rebellion, heresy, and revolution, which, from time to time—as in today's America—seems to wear the paradoxical disguise of nudity, as if baring the skin and coupling in morally illicit postures augured both revelations of social evil, and revolutions directed against their perceived causes and patrons. Only time and history will determine if this view of sex prevails or if sexuality ultimately becomes no more radical or revolutionary than an embodied pleasure, a reproductive necessity, and a socially valued activity in reality and in image.


Baughman, J.L. Television's Guardians: The FCC and the Politics of Programming, 1958-1967. Knoxville, Tenn.: Univ. of Tennessee Press, 1985.

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Diffily, A. The Wry Wit Behind "Politically-Correct Person." Brown Alumni Monthly (Feb. 1991), pp. 28-30.

Franklin, B. Fart Proudly: Writings of Benjamin Franklin You Never Read in School. (C. Japikse, comp. and ed.), Columbus: Enthea, 1990.

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Hauptman, R. Ethical Challenges in Librarianship. Phoenix- Oryx, 1988.

Hurwitz, L. Historical Dictionary of Censorship in the United States. Westport, Conn.: Greenwood, 1985.

Hyde, H.M. A History of Pornography. New York: Dell, 1965.

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Martha Cornog
Timothy Perper


The Center for Marital and Sexual Studies in Long Beach, California, was one of the early centers for the treatment of sexual problems. It was founded by William E. Hartman and Marilyn A. Fithian. Hartman was born February 17, 1919, in Meadville, Pennsylvania, the first of four children of Hartley J. and Janet Ellis Hartman. Both his father and maternal grandfather were Methodist ministers. He was educated at New York University and Centenary College and served in the U.S. Army Air Force during World War II for four and a half years. In 1944, he married Iva Decker, and they had seven children and more than two dozen grandchildren. They were divorced in 1980.

After the war, Hartman went on to study at the University of Southern California, from which he received M.A. and Ph.D. degrees. He then joined the faculty of California State University at Long Beach, where he taught sociology for some 30 years before retiring in 1980. He is a past president of the Society for the Scientific Study of Sex.

Marilyn A. Fithian, the cofounder of the Center, was born in 1921 in Wasco, Oregon. She is the mother of four and grandmother of eight. After her children were born she went back to school and received a B.A. degree from California State University at Long Beach; she did graduate work at California State University at Los Angeles. She has an honorary doctorate from the Institute for Advanced Studies in Human Sexuality. She worked for a time in the Counseling Center at California State-Long Beach and eventually became a licensed marriage, family, and child counselor.

In the early 1960s, Hartman was a professor of sociology and chairman of the Department of Sociology and Social Welfare at California State University at Long Beach. He admired and respected the research in human sexuality done by Dr. William H. Masters in St. Louis. He felt that a similar research and therapy facility should be established in California and asked Fithian to join him as a member of a dual-sex research-therapy team.

In 1966, a group of professional people were asked to be an advisory board for the new center, the main purposes of which were to be research and treatment of sexual problems. The board comprised physicians, lawyers, therapists, educators, ministers, and one politician. It was designed to obtain feedback and support not only from professionals but also from the Long Beach community about the need and desire to have a treatment and research center in human sexuality.

Following consultation and advice, the Center opened in 1968 as a California nonprofit organization, and from the first it included a clinic for those with limited income. In 1972, Hartman and Fithian published a book, Treatment of Sexual Dysfunction, dealing with their 34-step treatment process. With publication came numerous requests for training, and eventually 54 dual-sex teams were trained. During the years immediately following, several teams at a time were going through training. Since each team often worked not only with Hartman or Fithian but also with other team members, a number of people were working at the Center at any one time. Training involved an intensive six-week, 360-400 hour, seven-day-a-week program. The time differential was due to required hours as opposed to the extra time most of the trainees spent in nonrequired activities, such as the ongoing physiological research being conducted at the Center.

There was also a demand for shorter training from therapists who wanted more than one- or two-day seminars but not the six-week program. The result was a week-long training program held several times a year for many years, with attendance ranging from 10 to 20 therapists. There were almost always a number of student interns working as well.

Initially, the Center developed audiovisual materials for its own use, but as other professionals saw them they wanted copies. The result was the production of some 35 films, which were made available to others.

In 1970, some rudimentary physiological research began. In 1972, the late Berry Campbell, a research physiologist from the University of California Medical School at Irvine, joined the Center quarter-time as part of his teaching load. Campbell initially used borrowed equipment, but the Center itself eventually purchased a Beckman R411 Dynograph eight-channel recorder.

To support the research, Hartman and Fithian offered short-term seminars on sexual therapy in most of the major cities in the United States. The first seminar was held for about 20 people, but the numbers built up to as many as 600 in such major centers as New York City. Short-term seminars continued to be held until 1982, and in some years more than two dozen such seminars were held. The money earned from them not only allowed the continuation of the research but also the upgrading and purchase of more and newer research equipment, some made specifically for the Center.

Hartman and Fithian not only used the laboratory for their own research, but they allowed a number of other professionals access to it as well. Though the cofounders were usually present, the researchers published the results under their own name. All the research subjects at the Center were volunteers, and none were paid. Those who volunteered to be in films, however, were given a modest amount to enable the Center to have a contract with them.

For the physiological research sample, Hartman and Fithian gathered records on 751 individuals (282 males and 469 females). To date, this is the largest number of subjects ever studied in human sexual response research. Some were monitored as many as 20 times. It is estimated that approximately 10,000 research hours were spent on monitoring and evaluating this body of work, with many more uncalculated hours spent on ongoing study. The first multiply-orgasmic men were monitored in the laboratory in 1972; multiply-orgasmic women were also studied, as was penile sensitivity and many other topics.

The major purpose of the center was therapy, however. The basic therapy program was a 34-step two-week intensive residential treatment program, although there were slight variations to suit the needs of the client. The main therapy focus was on sexual problems, although traditional talk therapy was also provided where indicated.

Almost all the work was with couples, although some singles were also treated, some with the help of surrogates. Hartman and Fithian were the first to treat female singles with surrogates. During the height of the Center's activities in the 1980s, more single females were treated than males. A large proportion of both male and female singles were virgins or had extremely limited sexual experience. To be treated by surrogates clients must have had tests for human immunodeficiency virus (HIV) and sexually transmitted disease and have used safe sex; the treatment was aimed at heterosexual, not homosexual, men or women.

Hartman and Fithian were primarily interested in relationships, and this was just as true for singles as for married couples. Fear of intimacy is a major problem, and helping individuals learn to be warm, caring people has always been an important part of their therapy. Since 1985, Hartman and Fithian have seen fewer clients and have been most interested in analyzing their research data and writing. Some of the more innovative aspects of their work include sexological examination and body imagery.

In the 1970s and 1980s, when their practice was at its height, they conducted sex therapy in groups on a three- and five-day basis, with excellent follow-up results. This is probably the most economical way to do sex therapy for clients, but many people are not comfortable working in a group. Still, some long-standing sexual problems, such as impotency, were often resolved in this format.

At the conclusion of therapy, each client was asked to rate statistically the extent to which his or her goal in entering therapy had been accomplished. The overall ratings in such cases averaged 92 percent satisfaction. Since 1985, Hartman and Fithian have focused on research and writing. Any Man Can, a book on male multiply-orgasmic research subjects, was published in 1984. Further books are in process.


Hartman, W.E. Any Man Can. New York: St. Martin's Press, 1984.

Hartman, W.E., and M.A. Fithian. Treatment of Sexual Dysfunction. Long Beach, Calif.: Center for Marital and Sexual Studies, 1972; New York: Jason Aaronson, 1974.

William E. Hartman
Marilyn A. Fithian


This method of contraception, not in broad use today, was widely used in contraceptive clinics in Great Britain in the 1920s and 1930s and for a brief time in the United States, until it was replaced by the diaphragm and spermicidal jelly. It was developed by Friedrich Adolph Wilde, a German gynecologist in 1838, out of the unvulcanized rubber in use at that time. It was also made with many different materials—gold, platinum, silver, stainless steel, copper, and later plastics. Only one type of cervical cap, the Prentif rubber cap has been approved by the U.S. Food and Drug Administration.

Rubber caps, though more difficult to fit and insert than the diaphragm, can be worn for 48 hours and need not be inserted at the last moment. The cap has about equal contraceptive effectiveness as the diaphragm if made of plastic and can be inserted from the last menstrual period to the onset of the new one. While the diaphragm is equally protective whether it is inserted "dome up" or "dome down," the cap has to sit on the cervix like a thimble on the fingers; to master the technique takes at least two sessions in the physician's office, and for many users somewhat more. Many sexologists, such as Hans Lehfeldt, were strong advocates of the cap and remain so because of the prolonged protection and the separation between contraception and coitus.


Lehfeldt, H., and I. Sivin. Use Effectiveness of the Prentif Cervical Cap in Private Practice. Contraception, Vol. 30 (Oct. 1984), pp. 331-38.

Tietze, C., H. Lehfeldt, and H.C. Liebmann. "The Effectiveness of the Cervical Cap as a Contraceptive Method. American Journal of Obstetrics and Gynaecology, Vol. 66 (1953), pp. 904-08.

Wheeler, C.C., and H. Lehfeldt. Sexual Satisfaction: Diaphragm versus Cervical Cap. In W. Eicher and G. Kockott, eds., Sexology. Berlin: Springer, 1988.

Hans Lehfeldt
Connie Christine Wheeler


Technically, a chastity girdle is a device for ensuring female chastity. It usually consists of a jointed metal part that passes between the legs and hooks both to the back and to the front of a padded hip band. The jointed metal plates are furnished with openings, one over the urethra and one over the anus, which allow urination and evacuation but are not large enough to allow the insertion of a finger.

The earliest known reference to the chastity girdle is in 1405, in a Göttingen manuscript of Kyeser of Eichstadt's Bellifortis, a kind of military encyclopedia that also contains a number of drawings. There are, however, many more or less legendary references both before and after that time. They are often mentioned in fiction, such as Lives of Fair and Gallant Ladies, by Pierre de Bourdeilles, Signeur de Brantôme (1535-1614). He reports that jealous husbands bought them and proceeded to fit them to their wives but were thwarted when locksmiths were commissioned by them to make false keys.

How widespread chastity girdles were is debatable, and the issue is complicated by the fact that they are often confused with antimasturbatory devices, which were widely sold in the 19th century. Many of these were designed on the same principle. Still, it seems likely, in classes and times when female chastity was highly desirable, that chastity belts were regarded as a preventive measure. Several 20th-century legal cases reached the courts in Paris, usually involving husbands who required their wives to wear such items.

Though chastity belts per se are not said to have been designed for men, many of the antimasturbatory devices were. They consisted of sheaths to be worn over the penis, with prickly points on the inside. Any erection would therefore be extremely painful. Most of the devices that turn up in antique shops were developed to prevent masturbation.


Bullough, Vern L. Technology for the Prevention of "Les Maladies Produite par la Masturbation." Technology and Culture, Vol. 28 (Oct. 1987), pp. 828-32.

Dinwall, Eric John. The Girdle of Chastity. London: Routledge & Sons, 1931.

Vern L. Bullough


The Infant's Developing Sexuality
Later Childhood Sexual Development
Pediatric and Adolescent Sexual Problems
Sexual Abuse of Children

The topic of sex and children is broad, complex, and, for many adults, full of fear and ambivalence. It is broad because it covers a wide range of behaviors. Sexual behavior includes such nongenital activity as touching, cuddling, and fondling. It also includes genital activities, such as masturbation, oral stimulation, and sexual contact with another person or persons. The topic is complex because human sexuality is not complete at birth. Completion of an infant's psychosexual makeup awaits the interaction of many environmental factors with those established before birth. Consequently, an infant's sexuality is in the making for years after birth. The topic is fearful for many adults because their sexual development as children and adolescents—complete with their questions, doubts, and confusion—was often addressed with silence, punishment, and overreaction. Consequently, while parents may wish to have their children grow up differently than they did, their own fears and confusion surface. Often they recreate, without meaning to, an environment similar to the one they had as children. Add to this today's fear of AIDS and the awareness of child sexual abuse and it is clear why the topic of children and sex can create strong, sometimes panicky, reactions. Such reactions could result in throwing out the baby (infant and childhood sexuality) with the bath water (the problems of AIDS, sexually transmitted diseases, teenage pregnancy, and sexual abuse). To not accept childhood sexuality and children's need to develop an early solid sexual foundation creates a vacuum where little accurate information exists for the child. The child will fill this vacuum, often with misinformation.

Repression or punishment of childhood sexuality, in its broadest definition, can result in serious sexual and relationship problems in adulthood. By not accepting infants and children as sexual, parents rob themselves of the opportunity to help nurture and guide this most basic dimension of humans.

The Infant's Developing Sexuality

Development of the internal and external sex organs in both males and females occurs during the first trimester of pregnancy. This process is complex and includes the presence or absence of hormones. The brain, which is also involved in sexual function, is developing at this time and continues to do so even after birth. Evidence of male penile erections in utero now exists. Such erections also occur shortly after birth and several times every night during REM sleep for the rest of a male's life. Erections have also been noted to happen during breast feeding and at other times of social interaction, such as a diaper changing or bathing. Those erections during interactions with another human, usually the mother or the father, point to the importance of the parent-child bond in the development of the child's sexual system. Furthermore, some mothers have reported having sexual feelings during breast feeding, and some have discontinued breast feeding because they feel uncomfortable having these feelings. There is no evidence that such feelings are bad, wrong, or pathological; they appear to be a natural response some women have to this intimate situation.

There is currently no evidence of clitoral erection or vaginal lubrication of females in utero. However, female infants have been known to lubricate shortly after birth, so it would not be surprising if this does occur.

It is also during situations of intimacy and caring by the mother (such as bathing or diapering) that male infants discover their genitals. This usually occurs between six and eight months of age, approximately three months before baby girls discover their vulvas. For both infants, male and female, this exploration for the first year consists of casual touching of the external sex organs. Toward the beginning of the second year, boys' genital touching appears to be more focused. They intentionally reach for their penis, and they can self-stimulate, which is accompanied by what appears to be some sort of pleasure as evidenced by cooing, grunting, and smiling. This degree of genital sensitivity has been noted to increase during the latter half of the second year. Both boys and girls explore their external sex organs by touch and visual inspection. They also repetitiously stimulate themselves manually or by rocking, straddling objects, or positioning themselves so as to put pressure on their thighs. For boys, the testicles are often included; girls rub, squeeze, or push their labia and some insert their finger into their vaginal opening. Both girl and boy infants make affectionate gestures and touch their mother's body during or after genital self-stimulation. This behavior toward the mother is soon replaced by almost total self-absorption, suggesting true masturbation (i.e., genital stimulation accompanied by a fantasy or intense feeling state). During this time, girls sometimes use their toys for masturbation and start examining their dolls' crotch area.

Toddlers are also interested in not only their own defecation and urinary functions, but in those of others as well (e.g., peers, adults, and animals). They want to observe their parents, touch their genitals (the father's penis or mother's breasts and vulva), and even touch, by hand or by mouth, their father's urinary stream.

Children are also curious about each other, and it is not unheard of to find them playing the "show me" game. Flirtation and romance can usually be seen within the family, focused on the opposite sexual parent.

From diapering to the emergence of flirtation, the presence of parents or parent substitutes is important to aid the infant's developing sexuality.

Primates other than humans (i.e., monkeys) also engage in sexual exploration, stimulation, and play in their juvenile years in a manner similar to that of human children. In fact, it has been the study and observation of sexual rehearsal play in subhuman primates that suggest the importance of such juvenile behavior for adolescent and adult sexual functioning. Rhesus monkeys growing up in isolation and consequently deprived of juvenile sex rehearsal play (e.g., not touching others or being able to practice sexual positioning) grow up unable to copulate and, thereby, reproduce. If they are allowed a period of play with other juvenile monkeys, some can learn the proper sexual positioning. However, they learn this approximately nine months later than monkeys allowed to grow up in colonies where sex play and exploration are common, and their birth rates are lower as adults. Sanctions against human childhood sex play are typically very negative and, in some cases, cruel and abusive. It is not unreasonable to believe that the result of such negative sanctions might be a range of sexual and erotic problems in adolescence and adulthood.

Later Childhood Sexual Development

Overt heterosexual behavior is not uncommon in children as young as age three or four given the opportunity. Children have been observed running nude and playing with their own and other children's genitals. In some cases, simulated intercourse has been observed. In these situations, the children change roles, one being the male, the other being the female, and vice versa. This mutual exchange of sexual positioning and the pretend-like nature of intercourse point to the role of learning in sexual development and differentiation of human sexuality.

As children get older they continue to show interest in sexuality. They show this by overt behavior and in their increasing knowledge and willingness to discuss this knowledge. For example, children as young as age five are interested in sex differences and where babies come from. They use a range of words to describe various sexual body parts. This interest, revealed in many studies, debunks the concept of sexual latency—that sexual interest declines or is absent between ages seven and 12. For children between these ages interest in sex continues and may even increase.

Overt heterosexual play continues in the preteenage years as does masturbation. At each stage of preadolescence, boys report more sexual activity of every kind than do girls. Various explanations have been given: biological differences, male subculture's emphasis on sexual activity for the male, and the increased restraints placed on girls by their parents as they approach puberty. Friendship, romance, and sexual fantasies (e.g., attachments and crushes) begin to form at this time, if not earlier. How the feelings of love toward another person are expressed depends on many factors: the child's age and level of sexual and social maturity; and the attitudes toward sex and sexual expressions of adults, especially parents. Often these relationships start as close boy-girl friendships and progress to involve such behavior as handholding, kissing, fondling, caressing, and intercourse. Not all intense friendships between boys and girls include all these behaviors. Some may involve intense friendship with talking only. Others include various sexual behaviors. Regardless of the friendship, it appears these heterosexual relationships provide a context within which to learn the skills of sexual interaction, the success or failure of which may have consequences for later adult psychosocial and psychosexual functioning between the sexes.

It would be a mistake to conclude that sexual behavior between children and adolescents takes place only in heterosexual relationships and that if it occurs between the same sex (two boys or two girls) something is wrong. It is also a mistake to automatically believe a problem is present if sex play appears between siblings (same or opposite sex). Even in situations where the children are not the same ages, many factors must be considered. For example, stigmatized children or those who are slow learners can be excluded from social peer groups. Consequently, sexual learning opportunities are excluded too. Hence, the only opportunity may be at home with a sibling, younger or older, or with an adult. Sexual play can occur between siblings who are, for a time, best friends, confidantes, and playmates.

For older children and teenagers, sexual relationships sometimes develop between best friends of the same sex. While it would be correct to describe their sexual behavior as homosexual, it would be wrong to absolutely label them as homosexuals. Homosexuality refers to a person's status; that is, a person's general state of being. A homosexual is sexually orientated, aroused, and capable of falling in love with a person with the same external sex organs. Some children and teenagers are homosexual and their sexual contact with a same sex peer may well be a way of confirming their status. Sometimes fear of sexual contact with their peers means they seek affirmation with older homosexuals. Most adolescents do not have a homosexual status and stop their homosexual acts when they start to date girls or start heterosexual activity. Others continue to have homosexual activity along with their heterosexual activity. Such relationships can last into adulthood.

Pediatric and Adolescent Sexual Problems

Because children's and teenagers' sexuality is continuously unfolding, they can experience difficulties and problems. A developing discipline called pediatric sexology addresses the sexual problems, broadly defined, of children and teenagers. Little is known about sexual problems of the pediatric group because of negative attitudes toward sex in general, but most of all because of a resistance to acknowledge sexuality as an integral part of the developmental process of childhood. Still, some problems do come to the attention of parents, schoolteachers, and others who work with children.

Hypermasturbation (i.e., frequent masturbation which disrupts daily functioning) is one of the problems most typically found. It has been shown in some cases to be associated with an inability to achieve orgasm in children who have previously experienced or nearly experienced orgasm. In other cases, hypermasturbation is a symptom of a stressful environment. In most cases, it is brought to the attention of a professional by an adult who has observed the child, boy or girl, showing the behavior in a public place, such as the classroom.

Gender disorders in childhood exist and are now recognized by professionals. It is not uncommon to observe a boy or a girl change roles at a very early age, and even make statements suggesting that they are not settled as to whether they are male or female. However, children with genuine gender disorders persistently and intensely reject their sexual organs (penis for boys, breasts for girls) and say that they wish to have the sexual organs of the opposite sex. Furthermore, they reject the sex-stereotype play and toys for their sex in favor of the toys and play of the opposite sex. They also prefer the clothes of the opposite sex and often play "dress up" with their parents' or siblings' clothes, or use towels as pretend clothes if real clothes are not available. Such children and their parents need professional help.

Teenagers can experience various sex problems. Boys especially can have their sexual arousal and ejaculation associated with female apparel to such a degree that they must always be dressed partially or totally in female clothes, or they must fantasize such, to function sexually. Such teenagers have the condition of either transvestism or a transvestic fetish. Some teenagers have the more severe gender disorder of transsexualism, where they wish to live, work, and play completely in the role of the opposite sex.

Some teenagers are confused about whether they are heterosexual, homosexual, or bisexual. Perhaps they had a homosexual experience or have homosexual thoughts or fantasies. They and their parents need the guidance of a person specially educated in the psychosexual development of children.

Some teenagers worry about sexual thoughts and feel any sexual thoughts are bad. These adolescents need to be reassured that their sexual thoughts are normal, a sign of healthy development.

Some teenagers have sexual thoughts and fantasies and/or engage in sexual activities that are constant and interfere with their ability to relate in a healthy way to others. Examples are fantasies of sex connected to violence, sex with much younger children, or masturbating with the use of drugs or some device (e.g., a rope) to cut off oxygen to the brain, thereby heightening sexual arousal and orgasm. These adolescents need to be evaluated professionally to assess what type of treatment of those available would be most helpful.

Most important, parents and teachers need to create an atmosphere of open communication on all topics of sex. They should resist the temptation to overreact when adolescents bring their questions or comments to them. Adults should be supportive and help the adolescents seek professional help.

Sexual Abuse of Children

Historically, the 1960s and 1970s might be remembered as a period of sexual revolution when people in Western industrialized countries were more vocal and expressive of their sexuality. The 1980s might be remembered for the advent of AIDS and the recognition of child sexual abuse. Because sexuality is part of being human, which includes childhood and adolescence, everyone must be concerned with AIDS, sexually transmitted diseases, teenage pregnancy, and sexual abuse of children. All of these exist. Sexual abuse of children, however, is not without controversy.

The controversy stems in part from the definition of "child sexual abuse," which is used by both professionals and lay people. It is assumed to have the same meaning for everyone; it does not. Even among professionals—as reviews of the professional literature show—there is no agreement on its meaning. For some, all sexual activity between an adult and a child is abuse. Furthermore, the term sometimes incorporates physical abuse of children. This lack of a clear definition not only reinforces the hysteria over this issue, but also runs the risk of creating problems where none exist (e.g., accusing a father of sexual abuse for applying prescribed medicine on his infant daughter's vagina) and missing actual abuse (e.g., the incident where Milwaukee police returned a teenage boy to a man with severe sexual problems who later killed him).

In addition to the lack of clarity about what constitutes sexual abuse, the term does not distinguish among legal, moral, and psychological issues. The term assumes a violation of a legal standard, that such a violation also violates a moral standard, and that such violation, without question, results in harm to the child as a consequence of the sexual activity. Such assumptions are not always true. Someone might engage in sexual behavior that is neither harmful nor illegal but that may be repugnant to another on moral grounds (e.g., homosexual behavior, sex before marriage, childhood sex rehearsal play). There are also sexual behaviors that are illegal but that are neither repugnant nor harmful to the individuals involved (e.g., heterosexual or homosexual anal sex, which is illegal in some states). On the other hand, there are behaviors that are legal but potentially harmful to the individuals involved (e.g., unprotected teenage sexual intercourse). A man and a 14-year-old boy masturbating each other are breaking the law in the United States. For most people, their behavior is repugnant and immoral; whether it is abusive (i.e., having short- or long-term negative effects) is debated by professionals. Some suggest that once sexual activity between children, between children and adolescents, between adolescents, or between children or adolescents and adults becomes known, the actual trauma the child or adolescent experiences results not from the behavior but from the response of the parents and various professionals within the system. There is no doubt that children are sexually abused and misused. However, given that children are sexual and the possibility that trauma can occur from the system when in fact no trauma may have occurred, it is important for parents and professionals to be appropriately concerned, not to overreact, and to seek guidance and advice. In this way, children can be assured of being protected and at the same time nurtured to develop their sexual potential to its fullest.


Constantine, L.M., and F. Martinson, eds. Children and Sex: New Findings, New Perspectives. Boston: Little, Brown, 1981.

Goldman, J.G.D. Children's Sexual Thinking: A Research Basis for Sex Education in Schools. In M.E. Perry, ed. Handbook of Sexology. Vol. 7: Childhood and Adolescent Sexology. New York: Elsevier, 1990.

Haugaard, J.J., and N.D. Reppucci. The Sexual Abuse of Children: A Comprehensive Guide to Current Knowledge and Intervention Strategies. San Francisco: Jossey-Bass, 1980.

Kilpatrick, A.C. Childhood Sexual Experiences: Problems and Issues of Studying Long-Range Effects. Journal of Sex Research, Vol. 23 (1987), pp. 173-96.

Kilpatrick, A.C. Some Correlates of Women's Childhood Sexual Experiences: A Retrospective Study. Journal of Sex Research, Vol. 22 (1986), pp. 221-42.

Nelson, J.A. Incest: Self-Report Findings From a Nonclinical Sample. Journal of Sex Research, Vol. 22 (1986), pp. 463-77.

Okami, P. Sociopolitical Biases in the Contemporary Scientific Literature on Adult Human Sexual Behavior With Children and Adolescents. In J.J. Feierman, ed. Pedophilia: Biosocial Dimensions. New York: Springer-Verlag, 1990.

Sandford, T. Boys on Their Contacts with Men: A Study of Sexually Expressed Friendships. Elmhurst, N.Y.: Global Academic Publishers.

SIECUS. Guidelines for Comprehensive Sexuality Education: Kindergarten Through Twelfth Grade. New York: Siecus, 1991.

Thomas Mazur


Self-Exploration and Autoerotic Activity
Sexual Fantasy
Encounters With Peers
Inhibiting Sexual Experiences of Infants and Young Children
Child Sexuality as Society Sees It

Humans are born prosocial. During the first minutes, hours, and days after birth, the neonate is in a state of readiness, ready to develop its first intimate relationship with a person. One of the states of consciousness of a healthy neonate is a recurring, quiet, alert stage during which eyes are wide open and the neonate is able to respond to the faces of others, especially their eyes, through eye-to-eye en face interaction. Such interaction captivates the newborn as it watches and responds to the movements and facial expressions of others. A high degree of eye-to-eye contact between mother and infant has been observed to lead to an immediate cessation of crying, for instance, and to the development of a strong bond with the mother. The neonate's motor behavior becomes entrained by and synchronized with the facial and speech behavior of its mother. Their communication becomes a sort of "mating dance" as their responses become synchronized. One researcher characterized the dyad as the true locus of intimacy. An infant-mother relationship at its best is such a dyad as the two interact with a high degree of emotional access to each other. In a healthy relationship, the two develop pronounced feelings for each other as they jointly engage in more and more facial and verbal activity. The interaction is very sensual because of the physical dependency of the neonate and its inability to interact at a distal or symbolic level.

Although the neonate is totally dependent, it is not merely passive and receptive. Those who observe newborns are struck by the initiative they display in the development of attachments. The infant-mother physical interaction is intense, involving physical care, nursing, fondling, kissing, vocalizing, cuddling, and prolonged gazing. Infants who have been held tenderly and carefully early on tend later to respond positively to close bodily contact as well. Intimate, or sensate dyadic, relationships can become so intense, concentrated, and consuming as to appear almost hypnotic. Ecstasy is another word used by interactionists to characterize intense and perhaps erotic activity, such as occurs when a baby nurses at its mother's breast.

Breast feeding is the most physiologically charged relationship of infant and mother. The two organisms mutually excite each other. This ecstatic intimacy for both infant and mother can on occasion be orgasmic for both. The suckling experience gives the infant oral sensate pleasure; penile erections for the boy (and perhaps clitoral erections for the girl) can occur in connection with breast feeding. But attributing erections to stimulations resulting from the pleasant sensual aspects of the sucking experience must be done with caution. Based on observations of sucking infants, one researcher's inclination was to interpret the erections as often related to abdominal pressure, for when thwarting was introduced (e.g., removing a nipple or giving the infant a difficult nipple), the resulting movements were conspicuously characterized by severe contractions of the abdominal wall. Pleasure, pain, and frustration can all result in erections when infants interact with adults.

In American society, mothers are assured that interaction with a baby that is intimate and sensual is appropriate. There is no quarrel with the prescription that the proper socialization of infants calls for intimate, tender, loving care. Child care experts and the society in general approve of it. Developmental studies suggest that infants' emotional maturation depends on such stimulation. On the other hand, clinical studies credit deficient physical contact between infant and parent as the cause of later inability to form attachments. It happens that it is this same intimate socialization that leads to development of the sexual potential of infants, for infants who are given optimum intimate attention are much more likely to masturbate than are children who are raised in an indifferent or inattentive way. Spitz reported that when the relationship between mother and infant was optimal, (i.e., there was tender, loving care of the infant), genital play was present in all infants in his study. In fact, autoerotic activity on the part of an infant in the first 18 months of life may be a reliable indicator of the adequacy of parenting according to Spitz. The highly emotional and physiologically charged interaction of parents and infants is an important phase in a child's sexual development.

Self-Exploration and Autoerotic Activity

During the first year of life, there is progression in an infant's discovery of its body and its exploration of parts of the body, including the genitals. The fingering or simple pleasurable handling of the genitals is referred to as genital play. Infants in their first year are generally not capable of the direct, volitional, rhythmic movement that characterizes masturbation, while genital play requires little coordination and begins as early as the second half of the first year of life. The greater autoerotic satisfaction climaxing in orgasm depends largely on rhythmic, repetitive movement. Rhythmic manipulation of the genitals involving use of the hands does not generally begin until the child is approximately two and one-half or three years old, probably because small muscle control is not well enough developed earlier, yet Kinsey reported on one seven-month-old infant and five infants under age one who were observed masturbating.

Large muscle control involving muscles used in rocking or in rubbing against persons or objects is well enough coordinated by six months of age to make such masturbatory activity possible. Many infants form a pattern of rocking that is more rhythmic and repeated than is possible in manual genital play. Once the infant is able to sit up, many types of rocking may be observed which appear to bring satisfaction. Some infants sit and sway rhythmically, some lift the trunk and pelvis and bounce up and down off the surface on which they are sitting. Elevating to hands and knees and rocking forward and backward appears to be most frequent and is not uncommon as early as six to twelve months. Rocking infants are not as easily distracted from what they are doing as are infants engaged in genital play.

From their observations of 66 infants, and from interviews with their mothers, Roiphe and Galenson hypothesized that there is an endogenously routed early genital phase in children, a sexual current that normally emerges early in the second year that is different from genital play that might occur in the first year of life. They contend that the genital zone emerges as a distinct and differentiated source of pleasure, exerting a new influence on the sense of sexual identity, relation to objects and persons, basic moods, and other aspects of functioning characterized by psychological awareness of the genitals. The height of genital sensitivity begins to serve as a source of focused pleasure with repetitive intense genital self-stimulation and thigh pressure. The accompanying erotic arousal includes facial expressions of excitement and pleasure, flushing, rapid respiration, and perspiration. In both sexes, open affectionate behavior toward the mother begins to disappear as an accompaniment to the new genital self-stimulation and is replaced by an inward gaze and a self-absorbed look more characteristic of a masturbatory state.

At age three, most boys masturbate manually, but many still lie on their stomachs and writhe while engaging in other activities, such as watching television, and a few use other means of stimulation. Girls at this age use many masturbatory techniques, including placing a soft toy or blanket between their legs in the region of the genitals and wriggling the body, manually titillating the clitoris, and, less frequently, inserting fingers or other objects into the vagina. Masturbation appears to be a common experience in the development of normal infants and children, and most parents believe that children do it.

To determine the capacity of infants to respond to sexual stimulation, it is necessary to distinguish between self-stimulation and stimulation by others. It does appear that many more infants are capable of a sexual response, at the reflexive level, than stimulate themselves to such response. One researcher reported that if the edge of an infant's foreskin was tickled with a feather, the penis would swell and become erect and the infant would grasp at it with his hand. Kinsey, reporting on stimulation to orgasm in nine male infants under age one, found that the response involved a series of gradual physiological changes, the development of rhythmic body movements with distinct penis throbs and pelvic thrusts, tension of muscles, and a sudden convulsive release followed by disappearance of all symptoms. This was followed by a quick loss of erection and calm that impressed the observer as typical following orgasm in adults. Further, Kinsey reported that 32 percent of boys two to 12 months old were able to reach climax. One boy of 11 months had ten climaxes in an hour and another of the same age had 14 climaxes in 38 minutes.

Sexual Fantasy

Whether sexual activity engaged in by young children is purely reflexive or whether it is sometimes accompanied or preceded by erotic or sexual fantasy, as it is apt to be in adolescents or adults, has not been determined. It is reasonable to assume that children in societies that are inclined to repress what sexual activity children see, hear about, or do have little sexual content in their fantasy lives and that if they do, they do not readily reveal it to adults. In analyzing stories told by American children ages two to five, researchers found many references to violence in the stories of both boys and girls, even among those as young as age two. Although one researcher did not find kind or friendly stories common at this or at any age, one research team, in its sample of children ages two to five, found that girls did refer to love, courtship, and marriage.

That activities involving bodily functions, including sexual intercourse, are present in the consciousness of the children even in repressive societies is apparent in children's riddles, songs, verses, and games dealing with forbidden topics. Younger children refer mainly to bodily activity related to the anus, (e.g., excrement, flatulence, and enemas), while children ages six and seven have what Borneman refers to as an inordinate number of verses about brother-sister incest and some verses about parental intercourse. A rich sexual fantasy life would depend on more observation and sexual knowledge than children in sexually repressive societies usually have.

Encounters With Peers

Children as young as age two are mobile and prosocial in their sensual and sexual lives, as well as being autoerotic. Healthy children show strong affection toward parents, and kissing, cuddling, and hugging parents and other children and adults are common. On the other hand, abused toddlers are more likely to avoid eye contact with adults and to respond negatively or to ignore friendly overtures and adult caring approaches.

If children are left unsupervised and find nothing to interest them more, their play together can be sexual. In other words, the interest in sex play is not a dominant interest of children; it tends to ebb and flow. In an Israeli kevutza wherein children with a mean age of two slept in the same room, showered together, sat on toilets together, and often ran around the room nude before dressing or after undressing, Spiro found that intimate heterosexual play included a simple embrace as its most common expression, followed in frequency by stroking and caressing, kissing, and touching the genitals.

Based on observation of a large number of peer relationships of children, one researcher reported that love relationships were apparent and that the emotion of love between the sexes during the ages three to eight was characterized by hugging, kissing, lifting each other, scuffling, sitting close to each other, confessing to each other, grieving at being separated, giving gifts, extending courtesies to each other, and making sacrifices for each other. These intimacies have been characterized as social, while intimacies of pairs from age eight and older were characterized as more sexual in nature.

How sexual relationships become after around age eight depends on how much sexual activity the children have observed and how permissive the society is. There are records of societies wherein children engage freely in a variety of sexual practices and where few children are said to be virgins beyond the age ten or eleven.

Inhibiting Sexual Experiences of Infants and Young Children

Children depend on adults, therefore how they are expected to behave sexually depends on the values and norms guiding the thoughts and actions of their parents and others. The sexual socialization of infants and young children in the United States has been largely the responsibility of their mothers throughout the 20th century. Generally, her task has been to discourage sexual self-stimulation, inhibit sexual impulses toward family members, supervise and thus frustrate attempts at sexual play with peers, and teach children to be wary of strangers. Her task, generally with the full support of her husband, includes information control. The family attempts to govern how, when, and how many of the "facts of life" the child learns. As part of the conspiracy of silence, parents maintain a secrecy and privacy concerning their own sexual activity. Sears indicates a number of methods used as aids to sexual control in the home (e.g., closed bedroom doors, separate sleeping arrangements for each child, separate bathing, and early modesty training). Such methods have an implicit goal of keeping dormant the young child's pervasive curiosity and imitativeness, postponing the onset of sexual self-gratification, and limiting sexual activity.

Many families refrain from giving proper names or give no names to the genital organs and genital activity as a way of controlling information. Another form of mislabeling is to unwittingly, or wittingly, characterize a child's sexual activity in a nonsexual way, by suggesting that a child playing with its genitals needs to go to the bathroom, for instance. Controlling sexual observation and experience and nonlabeling or mislabeling have the effect of keeping sexual thoughts and fantasy unfocused, imprecise, and incorrect. As far as Sears and associates could judge, no mother in their study labeled genital activity as sexual activity or encouraged it. Twenty years later, Yates still found no one reenforcing children's sexuality, nor were parents transmitting enthusiasm, providing direction, or aiding in the development of a firm erotic base for their children's sexual lives.

Some change toward greater openness is occurring, however. For example, at least seven books published in the United States during the 1980s instructed parents how to educate their children about sexuality and how to deal with their children's sexuality. In general, the authors recognize that children are sexual and that sexual development and sexual expression are normal characteristics of childhood.

Child Sexuality as Society Sees It

Society's blueprint for child socialization and child-parent interaction is less clear and unequivocal than that for infancy. The child-parent relationship is to be loving and nurturant it is true, but the loving way to treat children in the United States is not necessarily intimate and permissive. Child-parent intimate interaction is restrained and proscribed; the parent represents a more demanding, authoritative, normative structure for the child than for the infant. In defense, it is argued that prolonged infant-parent attachment produces habits of dependency that are to be left behind. The "loving way" to treat a child is to make demands, to apply close supervision, and to use firm disciplinary measures that sometimes include physical punishment. In many homes and elementary schools, the "rod" is used so that the child not be "spoiled." So the ego, already as a young child, enters the stage of socially proscribed sensory and sexual intimacy that begins early in childhood and lasts at least until adolescence, until the getting-together and dating stages that young people enter—and for which they appear to be ill-prepared as witnessed by the number of unplanned, unwanted pregnancies during adolescence.

It has been the American practice to move offspring as rapidly as possible from a proximal, analogic mode of touching, holding, and caressing to a distal and digital mode in which interaction can be performed at a distance: looking at, smiling, and vocalizing. Children are socialized away from body contact with self as well as with others. According to one researcher, the American child-rearing climate is one of weaning before age two, consistent positive reinforcement of self-reliance and achievement, the encouragement of male physical aggression, lower status for the female child, the use of supernatural forces to elicit moral behavior, and culturally sanctioned physical violence in disciplining children.

Children begin early to consciously sense that touching patterns as part of their tactile communications system with their parents are non-reciprocative. In a study of intimacy of four-year-olds, Blackman has shown that at least by that age permission to touch parents has been proscribed. There was not much child-parent touching at all, and what there was, was not interactive. The blocked response was the essence of their emotional experience. Many children still, as young adults, remember their mother's restricted expressiveness—asexual, sexually repressive, or even sexually punitive. Mother's own sexuality is hardly perceived at all. According to Finkelhor, mothers were perceived by the children as holding a greater number of sexually repressive attitudes than their fathers and were over twice as likely as fathers to punish their daughters for masturbating, playing sex games, or asking sex questions.

"Too much" touching, especially for boys, causes discomfort for many parents. The male macho image and the fear of homosexuality appear to inhibit sons in many families from openly shared affection, especially with their fathers. Sons, imitating their fathers, express noticeably less physical affection than do daughters for friends and relatives as well. Appropriate behavior for men in showing affection toward one another is by a handshake, a punch on the arm, or a pat on the back. Some parents report that they would like their sons to be able to experience and express a fuller range of feelings, including affection, intimacy, and vulnerability. Their commitment to this espoused value appears to be tenuous and ambiguous, however. The majority of fathers are not modeling the kind of behavior they say they would like their sons to be able to exhibit. And parents refuse to model intimacy and affection for their children. American parents are more likely to be seen as associates than as lovers by their children; comrades rather than a couple. For American children, the adult is not a sexual, but rather a social, ideal. They experience conflict over how to find a balance between what they believe and what they want their children to believe about intimacy and affection. Equivocal social messages and parental uncertainty, or lack of clarity about their own beliefs, contribute to communication problems. In the Roberts' study, in talking about the most important reasons for educating a child about sexuality, only about ten percent of the parents replied that it is to help the child "enjoy his or her sexuality" when grown up. Two thirds of the mothers and about one half of the fathers said their child was the one who usually took the initiative in raising sexual issues for discussion. Hence, the level of sophistication of conversation about sexuality appears to depend in such homes on the level of the child's sophistication and how inquisitive the child is.

That infants and small children have the physiological capacity for sexual response, that they are curious about their bodies and the bodies of others, that they are attracted to intimate interaction with others have all been established. With a permissive environment, modeling, encouragement, and stimulation, there appears to be no cessation of sensual and sexual activity from first discovery and on through life. The question for any society is: Is there such a thing as age-appropriate sexual behavior for children? There is no agreement on the answer to that question in American society. There is one universal norm of child sexuality that is accepted by all responsible adults; namely, that children should not be sexually abused. Beginning in 1962 with the report on a study on battered children, it came to be recognized that there are parents who abuse their own children, including sexual abuse, and that measures must be taken to protect the child and prevent the abuse. That universal norm does not take one very far in understanding age-appropriate sexual behavior, however. In fact, rational discussion of age-appropriate sexual behavior and research on human sexual development have scarcely begun.


Blackman, N. Pleasure and Touching: Their Significance in the Development of the Preschool Child—An Exploratory Study. In J.M. Sampson, ed., Childhood and Sexuality. Montreal: Editions Etudes Vivantes, 1980.

Borneman, E. Progress in Empirical Research on Children's Sexuality, SIECUS Report, Vol. 12 (1963), pp. 1-6.

Calderone, M.S. Fetal Erection and Its Message to Us. SIECUS Report, Vol. 11 (1983), pp. 9-10.

Constantine, L.L., and F.M. Martinson. Children and Sex: New Findings, New Perspectives. Boston: Little, Brown, 1981.

Finkelhor, D. Sexual Socialization in America: High Risk for Sexual Abuse. In J.M. Samson, ed., Childhood and Sexuality, op. cit.

Ford, C.S., and F.A. Beach. Patterns of Sexual Behavior. New York: Harper, 1951.

Galenson, E., and H. Roiphe. The Emergence of Genital Awareness During the Second Year of Life. In R.C. Friedman, ed., Sex Differences in Behavior. New York: Wiley, 1974.

Honig, A.S. Infant-Mother Communication. Young Children, Vol. 37 (1982), pp. 52-62.

Ilg, F.L., and L.B. Ames. Child Behavior. New York: Dell, 1950.

Kinsey, A.C., W.B. Pomeroy, and C.E. Martin. Sexual Behavior in the Human Male. Philadelphia: W.B. Saunders, 1948.

Kinsey, A.C., W.B. Pomeroy, C.E. Martin, and P.H. Gebhard. Sexual Behavior in the Human Female. Philadelphia: W.B. Saunders, 1953.

Klaus, H.M., and J.H. Kennell. Maternal-Infant Bonding. St. Louis: C.V. Mosby, 1976.

Levine, M.I. Pediatric Observations on Masturbation in Children. Psychoanalytic Study of the Child, Vol. 6 (1957), pp. 117-124.

Martinson, F M. Infant and Child Sexuality: A Sociological Perspective. St. Peter, Minn.: The Book Mark, 1973.

Mead, M., and N. Wolfenstein. Childhood in Contemporary Cultures. Chicago: Univ. of Chicago Press, 1955.

Moll, A. The Sexual Life of the Child. New York: Macmillan, 1913. (Originally published in German, 1909.)

Roberts, E.J., D. Kline, and J. Gagnon. Family Life and Sexual Learning: A Study of the Role of Parents in the Sexual Learning of Children. Cambridge, Mass.: Population Education, Inc., 1978.

Roiphe, H., and E. Galenson. Infantile Origins of Sexual Identity. International Universities Press, 1981.

Sampson, J.M. Childhood and Sexuality. Montreal: Editions Etudes Vivantes, 1980.

Sears, R.R., E.E. Maccoby, and H. Levin. Patterns of Child Rearing. Evanston, Ill.: Row, Peterson, 1957.

Spiro, M. Children of the Kevutza. Cambridge, Mass.: 1958.

Spitz, R.A. Autoerotism: Some Empirical Findings and Hypothesis on Three of Its Manifestations in the First Year of Life. Psychoanalytic Study of the Child, Vol. 3/4 (1949), pp. 85-120.

Spitz, R.A., and K.N. Wolf. Analytic Depression. Psychoanalytic Study of the Child, Vol. 2 (1946), pp. 313-342.

Wolff, P.H. Observations on Newborn Infants. Psychosomatic Medicine, Vol. 21 (1959), pp. 110-118.

Yates, A. Sex Without Shame: Encouraging the Child's Healthy Sexual Development. New York: William Morrow, 1978.

Floyd M. Martinson


Changing Attitudes Toward Sex in China Today

Among the oldest of the surviving Chinese manuscripts are those dealing with sex. The two oldest extant texts, dating from 168 B.C.E., were discovered in 1973 in Chang-sa, Hunan Province, at Tomb No. 3. The interment included 14 medical texts, three of them sexological works: Shi-wan (Ten Questions and Answers), He-yin-yang-fang (Methods of Intercourse between Yin and Yang), and Tian-xia-zhi-tao-tan (Lectures on the Super Tao in the Universe).

Key to Chinese sexology is the concept of yin and yang. According to the yin-yang philosophy, all objects and events are the products of two elements, forces, or principles: yin, which is negative, passive, weak, female, and destructive; and yang, which is positive, active, strong, male, and constructive. It is quite possible that the two sexes—whether conceived of in terms of female and male essences, the different social roles of women and men, or the structural differences between female and male sex organs—are not only the most obvious results of the workings of yin and yang forces, but major sources from which the ancient Chinese derived these concepts. Certainly, it was very natural for yin-yang doctrine to become the basis of Chinese sexual philosophy.

The Chinese have used the words Yin and Yang to refer to sexual organs and sexual behavior for several thousand years. Thus, yin fu (the door of yin) means vulva, yin dao (the passageway of yin) means vagina, and yang ju (the organ of yang) means penis. The combination of these words into the phrases huo yin yang, he yin yang, or yin yang huo he (the union or combination of yin and yang) describes the act of sexual intercourse. These words were also used in constructing more abstract sexual terminology. According to Han Shu (History of the Former Han Dynasty) the earliest terms referring to classical Chinese sexology were yin dao (or yin tao) meaning "the way of yin," and yang yang fang, meaning "the method for maintaining yang in good condition."

Because the yin-yang theory holds that the harmonious interaction of male and female principles is vital, it is the basis of an essentially open and positive attitude toward sexuality. The following passage from the classic I Ching (Book of Changes), which is one of the earliest and most important Chinese classics equally cherished in both the Confucian and the Taoist traditions is representative of the traditional sex-positive viewpoint: "The constant intermingling of Heaven and Earth gives shape to all things. The sexual union of man and woman gives life to all things." Thus, any time a man and woman join in sexual intercourse, they are engaging in an activity that reflects and maintains the order of nature.

Pan Ku (Ban Gu, 32-92 A.D.), one of China's greatest historians, included in his Han Shu (The History of the Former Han Dynasty) a special heading for fang zhong (literally "inside the bedchamber," and usually translated as "the art of the bedchamber," "the art of the bedroom," or sometimes as "the sexual techniques"), immediately after his medical works. Pan Ku concluded his list of fang zhong with a commentary which is the earliest extant essay on Chinese sexology:

The Art of the Bedchamber constitutes the climax of human emotions, it encompasses the Super Tao. Therefore the Saint Kings of antiquity regulated man's outer pleasures in order to restrain his inner passions and made detailed rules for sexual intercourse. A familiar quotation says: "The ancient Kings created sexual pleasure thereby to regulate all human affairs." If one regulates his sexual pleasure he will feel at peace and attain a high age. If, on the other hand, one abandons himself to its pleasure, disregarding the rules set forth in the above-mentioned treatises, one will fall ill and harm one's very life. [Translated by R.H. van Gulik.]
Pan Ku's work demonstrates that more than 2,000 years ago, sexology was not only a well-developed academic field, but a respected subject of inquiry. Unfortunately, the books Pan Ku listed were all lost in the many wars and repeated book-burnings which mar China's history.

In different periods from the Han dynasty (206 B.C.E. to 220 M.E.) until the end of the Tang dynasty (618-907 M.E.), more than 20 sex handbooks were produced and circulated. Some of them are still available including:

· Su Nu Ching (Canon of the Immaculate Girl)
· Su Nu Fang (Prescriptions of the Immaculate Girl)
· Yu Fang Chih Yao (Important Matters of the Jade Chamber)
· Yu Fang Pi Chueh (Secret Instructions concerning the Jade Chamber)
· Tung Hsuan Tzu (Book of the Mystery-Penetrating Master)
These manuals offer detailed advice on the selection of sexual partners, flirting, and every aspect of coitus, including foreplay, orgasm, and resolution.

Hundreds of erotic fictional works were written in the Ming (1368-1644) and Ch'ing (1644-1911) dynasties. Ruan has examined numerous classic Chinese stories and scored them on an eroticism Scale of 1-4 as follows:

Score of 1: Fully erotic fiction—Works receiving this score consist primarily or entirely of explicit sexual descriptions. An example is Jou Pu Tuan (The Prayer Mat of Flesh).

Score of 2: Partially erotic fiction—Works receiving this score include a considerable amount of explicit sexual description. An example is Chin P'ing Mei (The Golden Lotus).

Score of 3: Incidentally erotic fiction—Works receiving this score contain only a small amount of explicit sexual description, which is incidental to the overall character of the novel. Examples are the famous Hung Lou Meng (Dream of the Red Chamber), and 120 Hui Shiu Hu Chuan (The Water Margin of 120 Chapters).

Score of 4: Nonerotic fiction—Works receiving this score contain no explicit sexual description. Examples are Hsi Yu Chi (Journey to the West, also known as Monkey), and San Kuo Yen Yi (The Romance of the Three Kingdoms).

Although the suppression of erotic fiction and other erotica began to occur in the 12th and 13th centuries and gradually became more oppressive, censorship became more extreme with the founding of the People's Republic of China in 1949, when a strict ban on erotic fiction and pornography of any kind was imposed nationwide. In the 1950s and 1960s, the policy of banning erotica was very effective. In the whole country, almost no erotic material was to be found. There were few difficulties implementing this policy until the mid-1970s. Then, the legalization and wide availability of pornography in several Western countries during the late 1960s and early 1970s, coupled with China's increasing openness to the outside world, increased the supply of such material available for underground circulation. In recent years, the suppression of pornography has caused both political and legislative concerns. The number of arrests and the severity of sentences on people involved in pornography have increased in the attempt to suppress it entirely. In 1987, the deputy director of the National Publication Bureau announced that during the preceding three years 217 illegal publishers had been arrested. Perhaps the most massive arrests of 1987 occurred in Nanchang, the capital of Jiangxi province, where by October, 44 dealers in pornography had been arrested, and 80,000 erotic books and magazines confiscated. It was reported that an underground publishing house with 600 salesmen had been circulating erotic materials in 23 of China's 28 provinces, making a profit of one million yuan (in that period about U.S. $300,000) in two years. In Shanghai, a railway station employee named Qin-xiang Liang was sentenced to death. Liang and four other persons organized sex-parties on nine different occasions showing pornographic videotapes and engaging in sexual activity with female viewers. The other organizers were sentenced to prison, some for life. The climax of this wave of repression seemed to occur on January 21, 1988, when the 24th session of the Standing Committee of the sixth National People's Congress adopted supplemental regulations imposing stiffer penalties on dealers in pornography. Under these regulations, if the total value of the pornographic materials is between 150,000 yuan and 500,000 yuan, the dealer shall be sentenced to life imprisonment. However, Deng Xiaoping, China's top leader, went further by declaring that some publishers of erotica deserved the death penalty. In a later nationwide strike against pornography, beginning on the thirty-seventh day after the Tienanmen Square massacre, on July 11, 1989, 65,000 policemen and other bureaucrats were mobilized to investigate publishing houses, distributors, and booksellers. By August 21, more than 11 million books and magazines had been confiscated, and about 2,000 publishing and distributing centers, and 100 private booksellers were forced out of business.

Like other common sexual behaviors, homosexuality was probably a familiar feature of Chinese life in prehistoric times. The earliest record of homosexuality dates from the Shang (or Yin) dynasty (approximately the 16th-11th centuries B.C.E.). Some authors seemingly glorified homosexuality. The best example was The Mirror of Theatrical Life, the most representative Chinese classic novel of homosexuality. The author, Chen Sen, eloquently praises the charms of catamites (young male homosexuals).

In China today, however, the general policy has been to deny the existence of homosexuality. When public figures do speak out on homosexuality, it is usually to condemn it. One of the most famous attorneys of the 1980s, Dun Li, when asked to express his opinion concerning homosexuality, said:

Homosexuality, though it exists in different societies and cultures, with some minor exceptions is considered abnormal and disdained. It disrupts social order, invades personal privacy and rights, and leads to criminal behavior. As a result, homosexuals are more likely to be penalized administratively and criminally.
This official attitude of denial or condemnation began to break down in the 1990s. In 1991, officials in Shanghai, the largest city in China, reported that there were about 10,000 homosexuals in the city. Changzheng Hospital in Tianjin, the third largest city in China, reported that of its 366 cases of sexually transmitted diseases, at least 61 cases of syphilis were acquired through male sexual contacts; 80 percent of them involved anal sex, 10 percent oral sex, and 10 percent anal and oral sex. Most of the incidents that were linked to infection (80 percent) were anonymous contacts in public toilets. The age of the victims ranged from 16 to 60: two thirds were between 20 and 30. Most were workers, some were cadres and teachers.

Lesbians in China are even more closeted than gay males. Some of the women who are willing to discuss their homosexuality have already been imprisoned and have little to lose. Still, two journalists were more successful in contacting lesbians than gay males in their 1989 survey of homosexuality in China, many of them through the criminal court system. Unfortunately, since so many investigations of female homosexuality have been based on interviews with prisoners, it has been all too easy for Chinese people to develop a stereotype of lesbians as immoral, frustrated people. It is clear that many lesbians do live painful lives. Given the general lack of sex information in China, and the repressive attitudes of the leadership, it will be a long time before Chinese homosexuals can hope to live normal, fulfilling lives.

Cross-dressing is a theme in ancient Chinese literature, and transvestism and transsexualism exist today. The first case of transsexual surgery, a male to female, took place in 1983.

Changing Attitudes Toward Sex in China Today

For much of China's history, the government was generally lax in enforcing laws pertaining to sexual behavior. Not until the 12th century, in the Sung dynasty, did the government begin to develop a consistent policy of exercising control over the sexual life of the people, and official constraints on sexual expression developed into a pervasive cultural conservatism. By the beginning of the Ming dynasty, repressive institutions and policies were firmly in place, and continued to be in force throughout the Ming and Ching dynasties. Thus, for example, writing about and publicly discussing sex were forbidden. Strict censorship and other controls persisted after the establishment of the Republic of China in 1912.

Despite the Chinese Communist Party's declared support of women's liberation, little changed after the establishment of Communist rule in 1949. In fact, the prevailing atmosphere, perhaps the most repressive period in all Chinese history, is maintained not only by informal social sanctions, but as a matter of government policy.

The only sexual behavior acknowledged to be legally and morally permissible is heterosexual intercourse within monogamous marriage. Every imaginable variation is explicitly proscribed: prostitution, polygamy, premarital and extramarital intercourse (including cohabitation arrangements), homosexuality, and variant sexual behavior are all illegal. Because sexual expression is viewed with contempt as the least important activity of life, not only are pornography and nudity banned, but any social activity with sexual implications—such as dancing—may be subject to restrictions. Even marriage is given little consideration. Thus, China's official prudishness and restrictiveness are unrelieved by any appreciation of individual happiness or romantic love.

But, beginning in the late 1970s, the increased tolerance of nonmarital cohabitation in the West began to influence China's younger generation. College students and young intellectuals in particular were attracted to this lifestyle. Some of the younger or more open-minded sociologists also asserted the necessity of overcoming the disadvantages of traditional marriage. Actually practicing cohabitation was an act of courage. Unlike Americans dealing with such impediments as reluctant landlords or restrictive zoning ordinances, these young Chinese risked arrest.

These policies are at odds with recent changes of attitude among the Chinese people. In a survey of 23,000 people in 15 provinces conducted by the Shanghai Sex Sociology Research Center in 1989-90, 86 percent of the respondents said they approved of premarital sex. In short, in spite of the official attitude of repression, China is changing.


Chan, W., trans. and comp. A Source Book in Chinese Philosophy. Princeton, N.J.: Princeton Univ. Press, 1963.

Chou, E. The Dragon and the Phoenix. New York: Arbor House, 1971.

Humana, C., and W. Wu. The Chinese Way of Love. Hong Kong: CFW Publications, 1982.

Levy, H.S., and A. Ishihara, trans. The Tao of Sex: The Essence of Medical Prescriptions (Ishimpo). Third Rev. Ed. Lower Lake, Calif.: Integral Publishing, 1989.

Needham, J. Science and Civilisation in China. Vol. 2, Sect. 8-18. Cambridge, U.K.: At the University Press, 1956. Vol. 5, Part V: Sexuality and the Role of Theories of Generation, Cambridge, U.K.: At the University Press, 1983.

Ruan, F.F. Sex in China: Studies in Sexology in Chinese Culture. New York: Plenum Press, 1991.

van Gulik, R.H. Sexual Life in Ancient China: A Preliminary Survey of Chinese Sex and Society From ca. 1500 B.C. till 1644 A.D. Leiden: E.J. Brill, 1961.

Fang-fu Ruan


Medical Procedure
Function of the Foreskin

Circumcision, once accepted as the norm in the United States, has become controversial. Technically, circumcision is the surgical removal of the skin that normally covers and protects the head, or glans, of the penis. At birth, the penis is covered with a continuous layer of skin extending from the pubis to the tip of the penis where the foreskin (prepuce) folds inward upon itself, creating a double protective layer of skin over the glans penis. The inner lining of the prepuce is mucous membrane and serves to keep the surface of the glans penis (also mucous membrane) soft, moist, and sensitive. The prepuce is often erroneously referred to as "redundant" tissue, which allows the medical community and society-at-large to consider the foreskin an optional part of the male sex organ and, therefore, to condone its routine removal in a variety of procedures collectively known as "circumcision."

Circumcision, however, was also a part of religious ritual, including Judaism and Islam as well as others. However, 85 percent of the world's male population is not circumcised. Circumcision in 1992 was still the most commonly performed surgical procedure in America, where 59 percent of newborn males underwent this operation. Circumcision reached its peak of 85 to 90 percent during the 1960s and 1970s. The surgery, usually performed on baby boys within the first few days of life, is often considered "routine." The most popular methods, the Gomco clamp and the Plastibell procedures, differ somewhat in technique and instrumentation but the effects on the penis and the baby are basically the same. Most of the American circumcisions are not done for religious reasons, but rather, for hygienic ones.

Medical Procedure

Usually, the procedure for circumcision in America involves the baby being strapped spread-eagle to a plastic board, with his arms and legs immobilized by Velcro straps. A nurse scrubs his genitals with an antiseptic solution and places a surgical drape—with a hole in it to expose his penis—across his body. The doctor grasps the tip of the foreskin with one hemostat and inserts another hemostat between the foreskin and the glans. (In 96 percent of newborns, these two structures are attached to one another by a continuous layer of epithelium, which protects the sensitive glans from urine and feces in infancy and childhood.) The foreskin is then torn from the glans. The hemostat is used to crush an area of the foreskin lengthwise, which prevents bleeding when the doctor cuts through the tissue to enlarge the foreskin opening. This allows insertion of the circumcision instrument. The foreskin is crushed against this device circumferentially and amputated.

Anesthesia was not used to alleviate infant suffering until recently because it was believed that babies do not feel pain. Additionally, it was recognized that anesthesia was risky for the newborn, thus contributing to the medical reluctance to use it for painful procedures on infants, such as circumcision. Currently, some doctors use a dorsal penile nerve block to numb the penis during infant circumcision. While not always effective, this anesthesia may afford some pain relief during the surgery, although it offers no pain relief during the recovery period (which can last up to 14 days) when the baby urinates and defecates into the raw wound.

Function of the Foreskin

To understand the function of the prepuce, it is necessary to understand the function of the penis. While it is commonly recognized that the penis has two functions—urination and procreation—in reality, it is essential only for procreation, since it is not required for urination.

For procreation to occur, the normally flaccid penis must become erect. As it changes from flaccidity to rigidity, the penis increases in length about 50 percent. As it elongates, the double fold of skin (foreskin) provides the skin necessary for full expansion of the penile shaft. But microscopic examination reveals that the foreskin is more than just penile skin necessary for a natural erection; it is specialized tissue, richly supplied with blood vessels, highly innervated, and uniquely endowed with stretch receptors. These attributes of the foreskin contribute significantly to the sexual response of the intact male. The complex tissue of the foreskin responds to stimulation during sexual activity. Stretching of the foreskin over the glans penis activates preputial nerve endings, enhances sexual excitability, and contributes to the male ejaculatory reflex. Besides the neurological role of the preputial tissue, the mucosal surface of the inner lining of the foreskin has a specific function during masturbation or sexual relations.

During masturbation, the mucosal surface of the foreskin rolls back and forth across the mucosal surface of the glans penis, providing nontraumatic sexual stimulation. During heterosexual activity, the mucosal surfaces of the glans penis and foreskin move back and forth across the mucosal surfaces of the labia and vagina, providing nontraumatic sexual stimulation of both male and female. This mucous-membrane-to-mucous-membrane contact provides the natural lubrication necessary for sexual relations and prevents both the dryness responsible for painful intercourse and the chafing and abrasions which allow entry of sexually transmitted diseases, both viral and bacterial.

When normal, sexually functioning tissue is removed, sexual functioning is also altered. Changes of the penis that occur with circumcision have been documented. These may vary according to the procedure used and the age at which the circumcision was performed, nevertheless penile changes will inevitably occur following circumcision.

Circumcision performed in the newborn period traumatically interrupts the natural separation of the foreskin from the glans that normally occurs somewhere between birth and age 18. The raw, exposed glans penis heals in a process that measurably thickens the surface of the glans and results in desensitization of the head of the penis.

When circumcision is performed after the normal separation of the foreskin from the glans, the damage done by forcible separation of these two parts of the penis is avoided, but the glans must still thicken in order to protect itself from constant chafing and abrasion by clothing.

The thickened, drier tissue covering the glans of the circumcised penis may necessitate the use of synthetic lubricants to facilitate nontraumatic sexual intercourse. Often, it is erroneously considered the woman's lack of lubrication that makes intercourse painful rather than the lack of natural male lubrication, which is more likely the cause. During masturbation, the circumcised male must use his hands for direct stimulation of the glans, and this may require synthetic lubrication as well.

In addition to the predictable physical changes that occur with circumcision, there are inherent risks and potential complications from the surgery. These include, but are not limited to, hemorrhage, infection, surgical damage and, while rare, death. Surgical damage and healing complications can result in extensive scarring, skin bridging, curvature of the penis, and deformities of the glans penis and urethral meatus (urinary opening). Extreme mutilations have resulted from inappropriate electrocautery use in circumcision, causing loss of the entire penis. Sex-change operations have been used as a "remedy" for this iatrogenic condition.

While circumcision has potential risks and alters normal, sexual functioning of the penis, proponents of the practice consider it to confer many "prophylactic" benefits on the recipient. This rationale was initiated in the English-speaking countries during the 19th century when the etiology of diseases was unknown. At that time, circumcision evolved from a religious ritual or puberty rite into routine surgery for "health" reasons.

Within the miasma of myth and ignorance, a theory emerged that masturbation caused many and varied ills, so some physicians thought it logical to perform genital surgery on both sexes to stop masturbation. In 1891, P.C. Remondino advocated circumcision to prevent or to cure alcoholism, epilepsy, asthma, hernia, gout, rheumatism, curvature of the spine, and headaches. As scientific research uncovered legitimate pathological etiology for diseases previously thought to be prevented or cured by circumcision, new rationales were postulated to validate the practice. Prophylactic circumcision of females fell out of vogue in English-speaking countries, but the incidence of male circumcision steadily rose. In the early 20th century, circumcision was advocated as a hygienic measure. Though criticism of the practice mounted, it was not until 1975 that the American Academy of Pediatrics came out in opposition, arguing that good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk. The advent of antibiotics negated the rationale that circumcision was needed to prevent venereal disease.

As a religious ritual, circumcision is practiced by Jews and Moslems in accordance with the biblical account of Abraham's covenant with God. Even so, the "purpose" of the Jewish ritual of circumcision has been argued by Jews throughout history. Noted Rabbi Moses Maimonides, in the Guide of the Perplexed, explains a rationale for circumcision that merits attention when circumcision is considered relative to human sexuality.

As regards circumcision . . . [s]ome people believe that circumcision is to remove a defect in man's formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the foreskin to that organ is evident. This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when it loses blood and is deprived of its covering from the beginning.
The Moslems, who also circumcise in accordance with the biblical covenant between Abraham and God, traditionally circumcised their males at age 13. More recently, however, Moslem boys are circumcised at varying ages from birth to puberty.

In the United States, the religious rights of parents are being questioned in regard to the constitutional rights of infants and children. Freedom of religion became a legal issue when it was introduced in a circumcision lawsuit claiming a male had been denied his right to freedom of religion when his body was marked by circumcision in accordance with his parents' religion.

The inalienable body ownership rights of infants and children continue to be addressed within the U.S. legal system in lawsuits asserting that the only person who can legally consent to a circumcision is a person making this personal decision for himself. The reports of dissatisfaction with parental circumcision decisions by circumcised men help to illustrate this point. Performed on their penises without their consent, thousands are now undergoing foreskin restoration, either medical or surgical, to reconstruct what they consider was violently taken from their bodies early in their lives. The Declaration of the First International Symposium on Circumcision acknowledges the unrecognized victims of circumcision and, in support of genital ownership rights of infants and children, states: "We recognize the inherent right of every human being to an intact body. Without religious or racial prejudice, we affirm this basic human right." Due to the lifelong consequences of the permanent surgical alteration of children's genitals, it becomes imperative that children have the right to own their own reproductive organs and to preserve their natural sexual function.

These, then, are the human genitals. Considering their great delicacy, complexity and sensitivity, one might imagine that an intelligent species like man would leave them alone. Sadly, this has never been the case. For thousands of years, in many different cultures, the genitals have fallen victim to an amazing variety of mutilations and restrictions. For organs that are capable of giving us an immense amount of pleasure, they have been given an inordinate amount of pain. (Morris, 1985)

American Academy of Pediatrics. Care of the Uncircumcised Penis. Evanston, Ill.: American Academy of Pediatrics, 1984.

American Academy of Pediatrics' Task Force on Circumcision. Report of the Task Force on Circumcision. Elk Grove Village, Ill.: 1989.

Morris, D. Body Watching. New York: Crown, 1985.

Remondino, P.C. History of Circumcision From the Earliest Times to the Present. Philadelphia: F.A. Davis Co., 1892. Republished New York: AMS Press, 1974.

Wallerstein, E. Circumcision: An American Health Fallacy. New York: Springer Publishing Co., 1980.

Marilyn Fayre Milos
Donna R. Macris


In females, climacteric refers to the period of gradual decline in ovarian function in the years before menopause and at the time of menopause. In some women, it may be associated with depression, physiological symptoms including hot flashes, and concern about femininity. In males, the climacteric is a parallel physical or psychological phenomenon experienced by some men after about age 50. It may relate to the gradual reduction in sex-steroid hormones, but is more likely to be associated with a consciousness of the aging process. Symptoms in men include weakness, fatigue, poor appetite, decreased sexual drive, reduction or loss of erectile capacity, irritability, and impaired ability to concentrate. In both sexes, it occasionally leads to desperate attempts to prove sexual capacity.

Vern L. Bullough


Clinical Intervention
Women Partners of Transvestites
Clinical Treatment of the Couple
Clinical Treatment of the Transsexual

This entry discusses basic information about situations in which the client expresses a need to emulate the other gender. Such behaviors are called cross-gender, or transgendered, behaviors. Clinicians estimate that less than one percent of the population experiences such feelings, and few of these people are so uncomfortable with the gender roles socially prescribed by their sexual anatomy that they seek out a therapist. Although this entry includes insight into clinical interventions that can be useful with such clients, the information presented is not sufficient to make an unequivocal diagnosis. Some of the sources listed in the references can be useful in reaching such diagnoses.


There are several basic terms used in defining cross-gender behaviors. Gender identity is a person's inner sense of himself or herself as either a man or a woman. Gender role is a person's outward behaviors that define her or him to society as a woman or a man; these actions are often socially defined for each gender. A person's gender identity and gender role usually match. Sexual partner choice is a person's selection of a partner for sexual interactions. There are four subcategories: heterosexual, homosexual, bisexual, and asexual. Gender identity and sexual partner choice are independent. Having some form of transgendered behavior does not automatically mean this person will make a particular sexual partner choice. Any combination of the two is possible. The three major categories of cross-gender behavior that the clinician may encounter are (1) transvestism (or cross-dressing); (2) transsexualism, and (3) transgenderism. This entry uses a differential diagnosis approach to describe the etiology and behaviors because this is more helpful in clinical assessment.

Transvestism literally means cross-dressing and is primarily a male phenomenon, although there have been scattered reports of women who cross-dress for similar reasons. Clinically, the term often describes any behavior in which a male becomes sexually aroused by wearing clothing that is socially reserved for women. It may describe any behavior from wearing a single article of women's clothing to completely dressing as a woman. More broadly the term includes the use of other gender clothing for nonerotic sensuality and psychological escape from the gender role in which the person normally lives. The term does not cover theatrical or political activities.

Transsexualism literally means cross-sex and, while it may share some behaviors with transvestism, there are significant differences. It appears that there are about equal numbers of male-to-female and female-to-male transsexuals, although the overall incidence is much lower than transvestism.

Transgenderism, a term recently coined by the transgender community, has been embraced by some clinicians. It describes a person who shares many characteristics of the transsexual. Transgenderists often live full time in the gender role of the other sex but do not desire genital surgery.

Clinical Intervention

Therapy involving transgender clients may be complicated by the clinician's acceptance of the assumption that sexual anatomy and the internal perception of being masculine or feminine should be integrated. A transgendered client presents behaviors and feelings (which are intense and highly subjective), that conflict with traditional social expectations. Also, the average transgendered person has often researched the behavior. Clients often attempt to "steer" the therapist toward an outcome that may not be in the client's best long-term interests. The clinician's objectivity is a crucial asset in this situation. It is imperative that the clinician take thorough sex and medical histories, looking for specific factors (e.g., alcohol or drug abuse, or that the client is a child of alcoholics or a victim of child abuse). Regardless of the data gathered from this history taking, it is important that the clinician not make an early diagnosis of transvestism or transsexualism. Equally important, the clinician should make his or her own diagnosis rather than accept the client's self-diagnosis at face value. Any intervention should probably always proceed as if the client is a cross-dresser even when transsexualism is suspected. Such an approach is safer for the client because diagnosing transsexualism too early can become a self-fulfilling prophecy.

Cross-dressing is so solidly fixed in a man's personality that it is usually neither possible nor desirable to eliminate it; in fact, many forms of therapy have failed to eliminate the desire to cross-dress. Cross-dressing creates problems for the individual, and those with whom he is intimately involved, because it does not conform to socially established behaviors for men and women. One misperception is that if the cross-dresser uses "enough willpower," he can stop cross-dressing. Under pressure to stop, he may temporarily do so, but the behavior will eventually reemerge. The most common feelings surrounding this behavior are low self-esteem, guilt, and shame. The best approach is to help these clients understand how they benefit from cross-dressing and assist them in finding ways to integrate cross-dressing into their lives without damaging other aspects of it. Any techniques that allow dynamic interaction with the client are useful; hypnosis or guided imagery, dream interpretation, working with artist's media (e.g., paints, crayons, and markers), gestalt techniques, videotaping and playback, and psychodrama have all proven useful.

It may be valuable to determine how the client would handle his cross-dressing if there were no constraints on his behavior or appearance. It can also be worthwhile to have the client investigate the woman's role in society because the average cross-dresser often has only a minimal grasp of this gender role.

Sometimes the client has an intense desire to go out in public dressed as a woman. While some men may carry this off quite convincingly, most cannot. The therapist should discourage this behavior because the risks generally outweigh any perceived advantages. The clinician can suggest alternatives, such as joining a transvestite club that sponsors safe social environments.

Issues of homosexuality may arise. Often the cross-dresser is quite homophobic, which is not inconsistent with the desire to emulate a woman because gender identity issues are not immutably linked to other sexual beliefs. Also, the man may be uncomfortable with the social expectations of the masculine gender role. He may be shy but cover it up with a macho image. He may also be socially immature and uncomfortable in many social situations.

The early counseling sessions are best done without the client being cross-dressed. This has the advantage of allowing the clinician to see the man in his usual state and provides a baseline from which to measure the influences of cross-dressing on the client. In later sessions, it may be appropriate for the client to cross-dress, but this should usually be done at the clinician's office rather than having the client arrive and leave cross-dressed.

Women Partners of Transvestites

Since most cross-dressers are heterosexual, they are often in an intimate relationship with a woman. These women, contrary to strong misunderstandings, are not unique; what is remarkable is that they are so unremarkable. They are neither self-destructive nor do they have "lesbian tendencies." Whether they knew about their partner's cross-dressing before entering the relationship or found out later, they seem to have a common characteristic—they love their partner and often put his needs ahead of their own. They are concerned, however, about themselves, the relationship, and societal issues.

In counseling these women, the clinicians should give immediate attention to supporting their self-image. Although often the woman's sexuality is threatened, and she may feel like a lesbian because she loves a man who sometimes emulates a woman, especially in sexual situations, some women find his sexual arousal from cross-dressing new and exciting. Later, such a woman may discover that he is aroused only by the clothing, not by her. She then has to cope with his sexual arousal, when it is no longer arousing for her.

This woman also needs information. Prey to society's misconceptions about cross-dressing—the most typical being that she is at fault for his cross-dressing—can lead to deep-seated feelings of guilt. She needs to know she is not to blame for her partner's cross-dressing; it began long before she knew him and is an immutable part of his personality. She may have fears generated by information her partner has given her. Much cross-dressing literature contains writing on such subjects as forced cross-dressing and living full time as a woman. Even if fantasy is not present, "helpful" literature may contain biased viewpoints that can leave her feeling confused or inadequate.

Probably the most difficult for her to accept is that he will never be "cured" of this need. It is important for her to understand that his behavior will probably not lead to genital reassignment surgery, although at times it may seem that he wants to spend all his time cross-dressed. So, if she decides to stay in the relationship, she has to accommodate his behavior in some way.

After trying to accommodate his cross-dressing, she may find that she cannot cope with the situations or emotions involved. Because she cannot predict how she may feel, she needs the therapist's support in withdrawing or modifying given situations or agreements. She may experience difficulty talking to her partner about her feelings because she is afraid he will be neither understanding nor supportive. Also, he may view her comments as criticism of his behavior, which can drive them further apart. She has to learn how to negotiate with her partner on issues such as when he can cross-dress and telling family members about his behavior. One of her greatest concerns is for their children, if there are any, and how to balance his needs and theirs.

Because cross-dressing is socially unacceptable, she is often hesitant to discuss her partner's behavior with her close friends, which leads to further isolation. As an adjunct to formal counseling, there are national and local transgender support groups that have groups for wives and partners of transgendered persons. In such groups, she may find support by talking to women who have experienced situations similar to hers.

Clinical Treatment of the Couple

The therapeutic environment should not be used to force the woman to accept her partner's cross-dressing any more than it should be used to force the man to stop cross-dressing. The therapist also has to be careful not to focus on cross-dressing issues and ignore the woman's needs. While her needs may seem simple compared with his, they are equally important. In fact, several typical relationship issues exist. He may want freedom to cross-dress whenever he wants while the woman may be willing to accommodate his cross-dressing so long as it does not dominate their relationship. He may want to cross-dress before lovemaking, during lovemaking, or both, while this may eliminate any sexual desire for the woman. He may be borrowing her clothes; because these are an intimate part of being, she may feel violated if he wears them.

One pivotal issue is trust. If the husband has kept his cross-dressing a secret from his wife and then disclosed it, she may feel betrayed and can lose her trust in him. She may also wonder what other secrets he is still keeping from her. Rebuilding her trust in him is difficult. It takes a lot of time and sensitivity on the man's part to achieve this. While loss of trust is probably not an issue if the woman learns of his cross-dressing before marriage, it is doubtful that either of them truly realized the extent to which that behavior would influence and permeate their relationship over time. When working with the couple, the most important contribution the clinician can make is helping them establish clear communication within the relationship. By providing a safe environment, the therapist can support each person in stating his or her needs without threatening the other partner. Once these needs have been described, the clinician can assist the couple in finding appropriate solutions.

Clinical Treatment of the Transsexual

It takes several months of intensive work to determine that a person is transsexual. Critical to this determination is the clinician's assessment of the client's gender identity, especially whether or not gender identity is stable yet noncongruent with anatomy. It is also difficult to determine any erotic components or feelings because most people are hesitant to discuss this intimate behavior. Of some use are reliable reports of age at onset—the younger the person the more likely that a diagnosis of transsexualism can be made.

Next, it is crucial to assess how the client would function in the other gender role. Factors such as social environment, vocation, and relationships need to be considered. The clinician should not proceed if there is any doubt about any of these aspects. In some respects, clinical intervention is more straightforward when working with the transsexual. Much of this approach can be found in the Harry Benjamin International Gender Dysphoria Association's Standards of Care. There are several stages in this process. The first should not occur until the diagnosis of transsexualism is made, some three to six months after the initial contact. Before a diagnosis, the male client can begin electrolysis for beard removal if this seems appropriate. Once a firm diagnosis of transsexualism is made, hormone therapy can begin. The male-to-female transsexual (M-to-F) will take various female hormones under the supervision of an endocrinologist who is familiar with such intervention. Both physical and psychological effects are anticipated. Physically, there will be some breast growth. Some muscle strength will be lost and there will be a redistribution of fatty tissue in a more feminine pattern. Sex drive may lessen. Eventually, testicular function will cease and the testicles will atrophy. These latter effects are irreversible. Male pattern balding will not reverse, nor will the male's voice assume a feminine pitch or the beard stop growing.

For the female-to-male transsexual (F-to-M) hormone therapy involves taking male hormones. Irreversible effects begin almost immediately. These include deepening of the voice, cessation of menses, increase of muscle mass, and beard growth. Some acne may also occur.

For both the M-to-F and F-to-M transsexual, there can be a variety of psychological effects. It is here that the clinician must provide support and guidance. The M-to-F may experience more mood swings than experienced as a male. The F-to-M will experience increased sex drive and become more assertive. For both, there will be pleasure as their body image changes to fit their gender identity. During this period, the clinician should be laying the foundation for "real life test."

The second stage requires the transsexual client to begin living full time in the gender role of choice—socially, vocationally, and legally. This is the most critical phase because the client is disclosing his or her situation to family members and perhaps in the work environment. Rejection is not uncommon, resulting in isolation and perhaps loss of employment. While there is a sense of relief in being able to present to the world in the desired gender role, the practical problems can be overwhelming. There are groups nationwide that support transsexuals. If the client is not a member, this should be suggested. This stage should last a minimum of one year and usually longer, depending on the clinician's assessment of the client's adaptation to the new role. (A word of caution: the clinician should not force the client to meet the clinician's definition of how a man or woman should act, for there are many variants on gender roles.)

The primary therapist has to make the recommendation to proceed to the final stage—genital surgery. This recommendation should be confirmed by a second opinion. For the M-to-F, this involves the removal of penis and testicles and the construction of the vagina and labia. For the F-to-M, it involves a mastectomy and hysterectomy/oophorectomy. Unfortunately, the construction of a fully functional phallus is beyond today's surgical capability. Often the F-to-M elects not to take this step because of the severe scarring and doubtful outcome. In neither case does the surgery make the person a reproductively functioning member of the other sex. It is less common to have to deal with a significant other when working with a transsexual client; either the relationship has foundered on the complications or the client never chose to get into an intimate relationship due to the gender discomfort. Where a relationship still exists, the approaches and observations outlined above are appropriate.


Transgender feelings and the behaviors it causes influence more aspects of the cross-gendered person's life than almost any other behavior. Such a pervasive influence is difficult to deal with.

The clinician can do much to support each individual and the persons with whom they are in relationship. Yet the outcome is, at best, problematical, especially for cross-dressers. Often the most a clinician can do is to provide support and accurate information while assisting the person or couple find solutions to their unique situation.


American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. Third Ed. Rev. Washington, D.C.: American Psychiatric Association, 1987.

Benjamin, H. The Transsexual Phenomenon. New York: Warner Books, 1966.

Brierly, H. Transvestism: A Handbook of Case Studies for Psychologists, Psychiatrists and Counsellors. Elmsford, N.Y.: Pergamon Press, 1979.

Docter, R.F. Transvestites and Transsexuals. New York: Plenum Press, 1988.

Feinbloom, D.H. Transvestites and Transsexuals. New York: Dell, 1976.

Green, R., and J. Money. Transsexualism and Sex Reassignment. Baltimore: Johns Hopkins Press, 1969.

Money, J. Sex Errors of the Body. Baltimore: Johns Hopkins Press, 1968.

Stoller, R.J. Presentations of Gender. New Haven: Yale Univ. Press, 1985.

Roger E. Peo


Sexual coercion is a term that characterizes phenomena as diverse as rape, child sexual abuse, sexual harassment, and prostitution. Each type of sexual coercion has been heavily researched and has its own associated literature. Since the 1980s, sexual coercion has also been construed more narrowly, focusing on coercive behavior in social, courtship, and dating interactions of adolescents and young adults. This new area of sexual coercion—which is the focus of this entry—developed from survey research demonstrating the high prevalence of unwanted sexual interactions resulting from coercive behaviors. (See also Date Rape.)

Sexual coercion occurs when someone is pressured or forced to engage in a sexual act against his or her will. Definitions and measures of coercion vary from study to study and these variations have led to different estimates of its incidence and prevalence. For example, the coercion may be physical where the aggressor holds a victim down, twists a victim's arm, or uses a weapon such as a knife or a gun. The coercion may involve threats of physical harm to the victim or to someone the victim knows. The coercion may also be psychological or manipulative where the aggressor gives someone alcohol or drugs, makes false commitments and promises of love, overwhelms a partner with continual arguments, threatens to end a relationship or leave someone stranded, uses his or her position of authority or status over a subordinate to pressure another into compliance, or makes another feel obligated or inadequate. In some studies of coercive sexual behavior, more subtle factors contributing to unwanted sexual interactions have been examined, such as peer pressure, self-pressure to be desirable, and the inability to say no. Most legal definitions of rape involve physical force rather than psychological or motivational factors that influence someone to engage in an unwanted sex act.

Most of the incidence and prevalence data on coercive sex have been gathered from studies of college students. In the most comprehensive study done in 1978 by Mary Koss and her colleagues involving over 3,000 women at 32 colleges, the following results were obtained for women who had unwanted intercourse: 25 percent because they were pressured by a man's continual arguments, 8 percent because a man had given them alcohol or drugs, and 9 percent because a man had used physical force. Of the almost 3,000 men in the Koss study, the following results were obtained for men reporting the use of coercive strategies that allowed them to have intercourse with an unwilling woman: 10 percent by pressuring with continual arguments, 4 percent by giving the woman alcohol or drugs, and 1 percent by using physical force. In two other studies of college males in the late 1980s, 42 percent had used verbal coercion in order to have intercourse with an unwilling woman and more than half had initiated some type of coercive sexual interaction. The rates of women who report being coerced have been consistently more than the rates of men who report doing the coercing.

Although most of the studies have focused on men as aggressors and women as victims, some have investigated coercion in homosexual relationships as well as coercive strategies used by women with men. In one study of gay and lesbian relationships, 12 percent of the gay men and 31 percent of the lesbians reported their partner had forced them to have sex against their will. Men report low rates of women using extreme physical force involving infliction of injury and weapons in order to engage in sex acts. More common coercive strategies used by women are psychological tactics, such as cajolery, blackmail, making their partner feel inadequate, and aggressive removal of the man's clothing followed by intense genital stimulation without the man's consent. A recent study of forced sex experienced by men found that 16 percent had had at least one forced sex experience in their lifetime and 9 percent had had forced sex experiences in college. Men also report having unwanted sexual intercourse because they were too drunk to give knowledgeable consent. One study investigating motivational factors contributing to unwanted sexual intercourse found that rates of such intercourse were higher for men than for women. Common reasons cited by men were peer pressure, inexperience, desire to be popular, and enticement.

Women report a series of both short- and long-term negative psychological and behavioral difficulties as a result of being subjected to sexual coercion. These include self-blame, relationship difficulties, and decreased self-esteem. The impact on men who have been raped by another man has also been shown to produce serious harmful effects on the survivors. The short- and long-term effects of nonphysical coercion exerted by women on men is less well known. One study found that few men experienced negative effects and that the most common after-effect mentioned was avoidance of sexually aggressive women.

Traditional socialization and the double standard of sexuality—a permissive standard for men and a restrictive one for women—have often been cited as contributing to high rates of coercive sexual behavior by men. This socialization has encouraged opposite roles and goals for men and women in dating and courtship and may lead to game playing, dishonesty, and adversarial interactions. Men have been socialized to enjoy their sexuality and pursue sexual encounters with numerous partners. For men, sexual conquest is one measure of status, self-esteem, and masculinity. To achieve their sexual goals, men have been taught they must initiate sexual activity and often overcome a woman's resistance to get sex. In contrast, traditional socialization has encouraged women not to make sexual advances, not to respond too eagerly to a man's sexual advances, and not to engage in sexual relationships outside of long-term or love relationships. In addition, women have been socialized to be submissive, kind, passive and accepting, and not to develop skills that would allow them to communicate their feelings assertively to men. Several studies support this view of traditional socialization. One found that 29 percent of women had unwanted intercourse due to altruism, another found that 78 percent of women had engaged in some type of unwanted sexual behavior because of the inability to say no, and a third found that 64 percent of women did nothing to prevent a male from having unwanted sex with them when they were confronted with persuasion.

Social scientists also point out that women's roles have undergone substantial changes in the last 30 years, and there is evidence that the sexual experience of men and women has become more similar in that women typically have several nonmarital sexual relationships. In this view, although women still have not achieved equality with men in political and economic areas, they have made progress toward achieving equality in sexual relationships. Studies investigating traditional roles in dating, such as asking for dates and paying date expenses as well as initiating a first sexual involvement, do show that women are beginning to assume roles once thought to be appropriate only for men. However, although sharing date expenses is common, the role of initiating sex still is much more likely to be the male's. Thus, despite the current popularity of the more permissive norms allowing women to engage in nonmarital sexual relationships, they still appear to be at high risk of experiencing sexual coercion from men.

The solution to any large-scale problem such as sexual coercion is complex. Prevention programs almost always include sex education courses and university workshops that encourage discussions among groups of adolescents and young adults. This could lead to increased knowledge of both gender's feelings, socialization experiences, expectations, and desires regarding intimate relationships. In addition, both genders need to become active agents and assume responsibility for promoting consensus and mutuality in sexual relationships. Men need to know that a "no" response to their sexual advances means no and to proceed further after such a response puts them at risk for a rape charge. Several social scientists have emphasized that more assertiveness and improved communication on the woman's part could make a crucial difference. One study found that when women clearly stated early in the dating stage what they wanted to do sexually, men were less likely to use coercive sexual strategies with them. Another study found that if women gave stronger verbal or physical responses, men's coercive strategies were thwarted in about three fourths of the cases. Although such responses would not stop all coercion, especially attacks involving physical force or threats of force, they would likely reduce the incidence of some forms of coercion. Social scientists also stress that restructuring the male gender role would make a difference. Qualities such as warmth, equality, supportiveness, and sensitivity need to be encouraged and valued instead of sexual competitiveness, dominance, toughness, and violence.

Two other points are often made regarding the sexual coercion problem. The first is that societies with high rates of nonsexual violence and societies in which men have more power than women in the major institutions—especially political and economic institutions—usually have high rates of sexual coercion. So on a broad societal level, it appears what happens with respect to general levels of violence and the status of women directly affects the rates of sexual coercion. The second is that many social scientists, alarmed by the present high rates of coercion, believe that during this time of changing roles and power for men and women, more men will feel threatened and develop more hostile attitudes toward women and perhaps engage in coercive sexual behavior. One general solution to the current situation recommended by social scientists who have studied sexual coercion is widespread sex education courses in schools and colleges. Such courses should cover issues related to the continuum of sexual relationships—from mutual sex to unwanted sex to rape—so that adolescents and young adults can understand and develop skills to avoid sexual coercion.


Craig, M. Coercive Sexuality in Dating Relationships: A Situational Model. Clinical Psychological Review, Vol. 10 (1990), pp. 395-423.

Grauerholz, E., and M. Koralewski, Eds. Sexual Coercion, A Sourcebook on Its Nature, Causes and Prevention. Lexington, Mass.: Lexington Books, D.C. Heath & Co., 1991.

Koss, M., C. Gidycz and N. Wisniewski. The Scope of Rape Incidence and Prevalence of Sexual Aggression and Victimization in a National Sample of Higher Education Students. Journal of Higher Education and Clinical Psychology, 55 (1987), pp. 102-170.

Lottes, I. The Relationship Between Nontraditional Gender Roles and Sexual Coercion. Journal of Psychology and Human Sexuality, Vol. 4 (1991), pp. 89-109.

Poppen, P., and N. Segal. The Influence of Sex and Sex Role Orientation on Sexual Coercion. Sex Roles, Vol. 19 (1988), pp. 689-701.

Ilsa Lottes


Male Superior
Female Superior
Other Positions

"Coitus" is a derivative from the Latin coire, which means "to go together." It is the only word that means insertion of the penis into the vagina. Coital positions, therefore, are those that involve the penis in the vagina.

The earliest depictions of coital positions date from about 3500 B.C.E. in Ur in Mesopotamia. Early Greek, Chinese, Indian, Japanese, Roman, and Peruvian art also depicts coital positions. Depictions are not necessarily of the positions commonly used but they acknowledge their existence.

Acceptable coital positions in a society tend to be based on early religious beliefs. If there was a sky mother and an earth father, the female-superior position tended to be the acceptable position in earlier cultures. Where the earth mother was predominant in a culture and there was a sky father, then the male-superior position was the acceptable position. As humankind moved away from early religious beliefs, the concept of acceptable coital positions tended to stay with the culture, and variations from such positions often were viewed as deviant.

Early Christianity, based on Paulian theology, was a sex-negative religion. Sex was seen to be for procreation only, and a woman was not supposed to enjoy it. The woman did her wifely duty to satisfy her husband's so-called "lustful nature." The acceptable position was the man on top and the passive woman on the bottom. This attitude is still prevalent today and seen in many sex-therapy cases.

The coital position itself may not be as important as where it is or what it is on. The Kagaba Indians of Colombia, South America, for instance, believe semen penetrating the earth will result in sickness and "possibly destroy the world." Therefore, special magical stones must be placed beneath the sex organs to catch any seminal flow. Coitus must also maintain a specific rhythm, otherwise it will cause harm to the man's children, his partner, or himself.

Several cultures, such as those of India, Persia, and Japan, have books on coital positions, often called "pillow books." The Kama Sutra claims it contains 529 possible coital positions. Such a large number is derived by minutely detailing the exact positioning of fingers, arms, and legs as well as bodies. Each change is seen as another position. Even the traditional Christian position of the man on top has many possibilities, depending on where the hands, arms, legs, and trunk are positioned. The verbalizations during a position may be an important part of identifying the position. For example, the rear-entry position may be carried out in tandem with not only "acting like the animal but emitting sounds like a dog, goat, etc."

Books that describe sexual positions were often available only to a certain upper class. Proclivities toward a variety of coital positions were often looked on by the lower classes as "perverted." Anthropologists have found marked differences between the upper classes and the ordinary people in their sexual behavior, including positions. It has been suggested that the preferred coital position in a culture may be related to the woman's status in that culture.

In the last 50 years, as there was more intermingling of cultures and less religious fervor, there has been a greater acceptance of a wider variety of coital positions. Still, the male-superior position tends to be seen as the one most generally used by Western cultures, although it is not found to be the best position for effective sexual functioning.

As sexuality moved from the procreative emphasis to the pleasurable aspect of human relationships more creativity and spontaneity in lovemaking meant more acceptance of coital positions and greater experience of different ones. Early sculpture or writings encouraged wide variation in coital positioning in some cultures, especially among the elite.

In working with couples contemporarily, several things become apparent regarding coital positions. A 250-pound man lying on top of a 125-pound woman does not work very well. The same is also true of the reverse position where the woman is heavy. Differences in height also sometimes pose a problem for coital positioning. The positions used sometimes take the size of the couple into consideration.

A position that is comfortable to both partners is one in which they lie on their backs beside each other. The female is on the left of the male, and she lifts her legs up; the male turns on his left side and moves his pelvis up against her buttocks; then her right leg goes over his right leg and her left leg over his left leg so that the legs are entwined. This is an excellent position when there is a weight differential. It also allows both partners to move in intercourse and to use the hands to caress their bodies and stimulate the clitoris. Both can be involved in the touching and moving so that it is not something someone is doing to someone else. This is a physically comfortable position even after intercourse is over. The partners can lie still and relax with the flaccid penis remaining in the vagina. It is a particularly good position for older people for whom either one's being on top is too fatiguing. Often older, and sometimes younger, people quit having intercourse because of the strenuous nature of the activity or because of discomfort or difficulty in getting into a coital position. It is not only the coital position that is important, but also what is done in that position. Thrusting rapidly for any length of time is fatiguing. To be maintained for some period from ten minutes to several hours, the position needs to be comfortable and the thrusting slow.

Variety of sexual positions among Americans is probably the greatest variant in their sexual behavior. Male above and female below is the main position, used even by those who employ a variety of positions in their lovemaking. In the past, the male on top represented, to many, male dominance. It was only with the advent of women's liberation that people in therapy would consider changing from male-above positions in lovemaking activity.

The degree of latitude in the sexual positions practiced depends on the flexibility of both partners. How one feels about a specific position has a lot to do with whether it is engaged in or not. Positions other than male superior tend to need the cooperation of the female, either to be on top, to roll over for rear entry, or to move to accommodate a specific position. Social class and education also have something to do with accepted coital positions, and in general, research data indicate that the more educated the couple is, the wider the variety of positions that become acceptable.

A Chinese sex manual that identifies 30 basic positions and utilizes names for each without describing the position (e.g., "gamboling wild horses," "hovering butterflies," "winding dragon") leaves the position to the imagination. The manual does mention that some positions are not for pleasure but to cure "various infirmities," especially if a specific number of thrusts occurs.

There are only a few basic positions, and all others are a variation or combination of these basic ones. These are male superior, female superior, rear entry, side by side, face to face, standing, sitting, kneeling, and squatting. The emotional tone of the sexual encounter may allow for behavior that includes coital positions that are seen as deviant in one situation, acceptable in another.

Male Superior

In Western society, the male on top is the most common position, although many other positions are reported to be used. Seventy percent of the males reported having intercourse only with the male on top in the Kinsey study on American sexual behavior published in 1948. His female sample reported that almost all their coital encounters involved the male-superior position.

Male on top has also been found to be the most common position reported from other cultures. It is found in such diverse cultures as those of Japan, Tibet, China, Europe, some tribes in Africa, and American Indians, as well as in some South American and South Pacific groups. However, in some societies, such as the Bororo Indians of southern Brazil, the members feel that such a position is an insult to whoever is underneath.

The advantage of the male-superior position is for pregnancy because the sperm does not easily seep out, as the vagina is lower in the back than at the opening. The penis is also less likely to slip out. It is generally less satisfying to the woman than other positions, although if the man is on his hands and knees while thrusting and her buttocks are on a pillow, she has more movement and less pressure and confinement from weight. The male superior is often dysfunctional since it is conducive to premature ejaculation.

In China, the male-superior face to face was also considered the normal position, although numerous other positions were used. This position is based on the belief that the male is born face down and the female face up.

Augmentation may, as in India, sometimes be part of the position. Biting, scratching, and making the sounds of various birds, as well as striking the partner on various parts of the body, may be a part of the position itself.

Female Superior

A position that is often helpful to non-orgasmic women is the female-superior position. This gives the woman some control, by her own body movements, over where the penis goes in her vagina. Also, if the man's penis is unusually large and full penetration is painful, she can regulate the depth of penetration. This position also allows for positioning the body for clitoral stimulation. If the woman is sitting on the penis, the man is able to do the squeeze technique if he comes close to ejaculation. He does this by using his index finger or several fingers to squeeze and hold at the base of the penis for 15 seconds before the point of ejaculatory inevitability.

Though in some cultures the female on top is the preferred or main position used, female superior is a position a woman can use during pregnancy, where with her knees under her she can freely move without the weight of her partner's body on her. It is often a good position if the male ejaculates rapidly since he is not as actively thrusting and is able to maintain his erection longer. Some men have difficulty ejaculating from this position and will only ejaculate when they move on top. Although this is an excellent position to try, it is difficult to do if the woman has an expectation of the male being on top and thrusting rapidly.

Other Positions

The rear-entry position cross-culturally is less evident in anthropological studies. However, some of the earliest depictions of coital positions have included rear entry. Some cultures see rear entry as "animalistic" behavior. This is most evident where it is labeled with an animal name, such as "doggie style." It is an excellent position for a pregnant woman and can easily be done with her on the floor and her arms and upper torso on the bed for support, especially when she is very large during the last stages of pregnancy. The side position with rear entry or the woman on top can also be used effectively at this time.

It has been suggested that in more primitive cultures rear entry allows a man to make a quick getaway in an illicit relationship or when a number of people share a dwelling or a camp fire, so that the couple can perform coitus on their side with rear entry without the behavior being obvious.

The side position is the preferred or only one utilized in a number of societies, especially in Africa. The Loango Negroes use the side position, and it is believed this is preferable due to the reportedly unusually large penis of the males. If this is true, the side position would produce shallower penetration.

In Western cultures, for example, intercourse while standing is thought to prevent conception. This belief, as well as the belief that withdrawal or failure to have orgasm will prevent conception, is not true.

Some positions are used for specific sexual activities; for instance, the standing position among the Fijians is only used for extramarital or premarital sex. A variation on the standing position allows the woman to wrap her legs around the male's waist, and using the bones of the hips as a fulcrum, the woman can move up and down on the man's penis as he holds her to keep her from falling. He may steady himself by leaning his back against a wall.

Both males and females can use a squatting position with their partner. A woman may squat onto the penis of the man, or in the squatting position the man can have the female sit on his penis. A male may kneel and pull his partner's pelvis up onto his penis or she may squat down on it.

The male sitting in a chair facing his partner is a position said to have been preferred by the ancient Chinese. It is not a strenuous position and the female is able to move freely. Males sometimes have difficulty ejaculating in this position—in fact any position that is new to them. Rear entry can be performed in this way with the woman sitting on the male's penis with her back to his head.

Coitus is often enhanced by where it takes place. Location may be an extension of or may determine the coital position itself. When coitus occurs in the shower, jacuzzi, or swimming pool, water plays an important part in the sexual act. The buoyancy of the water makes the pool an interesting place to experiment with different positions.

Other positions, such as "hanging from the chandelier," tend to be more fantasy than reality. Copulating standing up in a hammock, although difficult, is not impossible. The use of a swing for coitus is depicted in erotic art. There are swings made specifically for sexual activity, in which the male stands and the woman, sitting in the swing, swings against the male's erect penis. These behaviors tend to be for the adventurous few individuals who want to try it all. No one has ever mentioned such behavior occurring with any regularity or frequency. Once is enough seems to be the theme.

Coitus often includes patterned vocalization as well as patterned behavior. Repeated observations of the same couple over many years have shown them to utilize their own pattern of behavior—for example, the same vocalizations, body movements, perfume, and time factors, to name a few of the patterned behaviors that were consistently used in their coital activities. Some sex manuals have long descriptions of various vocalizations.

A couple has to determine through trial and error what coital positions are best for them. Many people avoid trying new positions because they feel awkward, unsure, or afraid they will look foolish due to lack of knowledge or experience. Sex can be fun, and it is all right to fall off the bed trying a new position. Laugh and go on. Variety of positions can make the sexual encounter more interesting for a couple. Trying various coital positions without a thought or concern about orgasm can help a person become more comfortable with more and new ways of having coitus. Factors such as size differential—tall, short, fat, thin—are important in determining a position to use. Also, if there is a handicap, a variety of positions may be needed to be tried to find the best one.


Crowley, E. The Mystic Rose. London: Spring Books, 1902-1921.

Gagnon, J.H., and W. Simon. Sexual Conduct. Chicago: Aldine, 1973.

Gregersen, E. Sexual Practices: The Story of Human Sexuality. New York: Franklin Watts, 1983.

Haeberle, E.J. The Sex Atlas: A New Illustrated Guide. New York: The Seabury Press, 1978.

Highwater, J. Myth and Sexuality. New York: Meridian, 1990.

Kirkendall, L.A., and L.G. McBride. Preadolescent and Adolescent Imagery and Sexual Fantasies: Beliefs and Experiences. In Childhood and Adolescent Sexology. Vol. 7 of Handbook of Sexology, edited by M.E. Perry. New York: Elsevier, 1990.

Mantegazza, P. The Sexual Relations of Mankind, New York: Eugenics, 1935.

Tannahill, R. Sex in History. New York: Stein & Day, 1980.

William E. Hartman
Marilyn A. Fithian


Learning to Communicate
Language Styles Used to Discuss Sexuality
Nonverbal Sexual Communication
Factors Affecting Sexual Communication
Improving Sexual Communication

Communication is necessary for survival. However, there is virtually no other topic about which people have as much difficulty discussing than sexuality. Although there is no universally accepted definition of sexuality, in this entry it means those aspects of being human that relate specifically to being female or male, both socially and biologically, and to human experiences of erotic arousal.

Discussing sexuality could involve talking about reproduction or the chromosomal makeup of females and males. It may mean expressing ideas and feelings about gender roles, such as how we experience being female or male. It may also involve discussing what is erotic, romantic relationships, sexual fantasies and how to enjoy sex, or how to reduce risks of unwanted pregnancy and sexually transmitted disease. Talking about the mechanics of intercourse and sexual function are also topics of sexuality.

Conversations about sexual topics may take place informally between friends and family or more formally between teachers and students or doctors and patients. Discussing sexuality can be a way for people to sort out complex knowledge and experiences or to enhance intimacy. In any case, the words used, the way a message is delivered, and the feelings generated by discussing sexual topics all influence the nature of communication about sexuality.

Learning to Communicate

Earliest lessons in communication begin as infants. The way an infant is held and cared for expresses to the child his or her acceptance into the human family. In return, the infant communicates with adults through body movement and vocal sounds. Only after sufficient maturity does the child learn to communicate through speech and deliberate body expression.

As children develop language skills, they discover a powerful tool that will play a vital role in the way they define reality. Greater capacity for communication will widen their social contacts and possibilities for self-expression. Children eventually learn that the way in which they use words affects their message. Language maintains and creates an understanding of their world and affects lasting patterns of behavior.

As children develop, they learn to ask questions about their bodies, about other people's bodies, and about life's mysteries. Many answers are forthcoming, but not all of their questions and behaviors are met with calm, comprehensible, or meaningful responses. For many children, genitals and their functions, for example, become mystified. In fact, this mystification often lingers well into adulthood and is passed on to the next generation. Often, bound up in the responses from adults about the sexual concerns of children are the limitations and biases language lends to communication about sexuality. (See also Children and Sex; Children: Sexuality of Children.)

Messages are conveyed in three ways: verbally, through words; vocally, through pitch, volume, rate of delivery, and overall quality of the voice; and nonverbally, through body posture and facial expression. All three influence what is communicated. When the three modes deliver a consistent message, the communication is clear; that is, the words spoken are accompanied by a vocal quality and body language that match the intent of the speaker. When the three modes are communicating different messages, a mixed message is delivered.

Language Styles Used to Discuss Sexuality

There are four basic language styles used to discuss sexuality: the child, street, euphemistic, and medical or scientific language styles. Each is used in a different context and provokes a variety of responses from the listener. Many people find a language with which they are most comfortable and use it in most situations. While this makes it easier for them to express their sexual concerns and ideas, the Listener may not be comfortable with the speaker's choice of words. The listener may be unfamiliar or uncomfortable with the sexual language style used and this may lead, at a minimum, to confusion and misunderstanding. Since there is no universal sexual language that suits all situations, awkward interactions between people are not uncommon.

In child language, parents and other adults use various names for the genitals and their functions that are generally reserved for use only with children. Adults use this child language to express affection for children while helping them perform necessary bodily functions. Labels such as "weenie," "pee-pee," "down there," and "privates" are given to genitals, while "number 1," "number 2," "grunt," and "poo-poo" name their functions. Many children carry these early words into adulthood, often with lingering confusion about sexual, elimination, and reproductive functions.

Street language, on the other hand, does not derive from the coddling of loving parents, but rather from the "in" group of peers. Street language empowers differently than early language. It is more adult-like and demonstrates a knowledge about sex that may or may not exist. The suggestive words of the street (e.g., ass, screw, hitting a home run) often create adult disapproval but buy membership in exclusive clusters of admired friends. Many people are offended by the graphic expressiveness of street language so it is generally used with discretion, at times to anger others or to get along with them.

Euphemistic sexual language predominates the adult world. Creative use of language allows sex to be discussed comfortably while disguising the explicit nature of the behaviors being described. Terms like "make love," "sleep with," "that time of the month" are obvious references to sex and menstruation, but they sound sophisticated without being offensive or too clinical.

Medical or scientific language uses time-honored Latin-based words to describe body parts, functions, and behaviors (i.e., penis, clitoris, urinate, coitus). This language style is often viewed as the "correct" one because it is used in text books and by physicians and teachers. Scientific words are perceived to be value-free and more universal, although this may not necessarily be true.

Cashman observes that each verbal style has a typical vocal quality. Child language has a distinctly higher pitch and volume; street language, a rougher, sharper sound; and euphemistic and medical or scientific styles, a more even, blander vocal quality.

Despite the variety of sexual languages, there is no one standard sexual vocabulary that communicates accurate messages to everyone. Difficulty people have in communicating openly about sexuality in their personal and professional lives, in part, stems from not having a universal language. Instead, people tend to use the language with which they are most comfortable regardless of the situation or the person with whom they are talking.

Nonverbal Sexual Communication

Cultural and individual differences create many variables affecting nonverbal communication. It is difficult to describe nonverbal sexual communication in ways that can be applied universally, but researchers have observed its pervasive use. From courtship to sexually intimate behavior, nonverbal expression characterizes every step of the process and plays a significant role in what is communicated sexually.

Despite the communicative nature of body language, it can be misread as easily as verbal language. Brown and Auerback found that in the initiation of sex between spouses, nonverbal cues were frequently misunderstood. They found the receiver's role as important as the sender's because much of what was heard was perceived through a filter of past experiences and expectations.

Factors Affecting Sexual Communication

One factor affecting sexual communications is gender. When communicating verbally, males and females use significantly different sexual vocabularies. For example, men and women use different words when referring to their own and their partner's genitals and to sexual intercourse: women most often say "penis" in any given context while men prefer to say "dick" or "cock." Terms for sexual intercourse are similar between the sexes but males use a wider variety of words where females prefer "make love." Heterosexual males reported rarely saying "make love" in any context other than with their spouse or lover. Despite word choice differences, men and women tend to use their gender-specific vocabularies when having intimate conversations with one another.

Not only do males and females use different words to communicate about sex, they also interpret them differently. Language evokes different meanings for women and men. This may have practical importance not only for sexual partners but for educators, counselors, and therapists.

The differences in gender-specific sexual vocabularies may be attributed to early childhood experiences. For example, parents are generally more permissive with boys in their use of slang terms and sexual language than they are with girls. The sexually repressive or permissive messages received in childhood influence sexual expression and intimate relationships in adulthood.

Gender is not the only factor influencing language choices. The erotic communication of heterosexual and homosexual females and males presents differences in erotic language use. Wells found both gender and sexual orientation as variables that significantly affect the perception and use of erotic vocabulary.

Gay males and lesbians communicate more about sex with their partners and make greater use of slang vocabulary as a way to increase eroticism in their sexual play. They are also more likely than heterosexuals to agree on what is erotic and to use such vocabulary with a mate. On the contrary, heterosexuals more often than homosexuals use sexual language with their partners they do not consider erotic.

In studies investigating communication patterns between college students in intimate relationships, researchers identified several topics most often avoided by couples. The topics that leave partners most vulnerable to hurt and violation of trust are the ones most often avoided. Bowen and Michal-Johnson found the following topics taboo for college students:

1. State of the relationship
2. Extra-relationship activity
3. Relationship norms
4. Prior relationships with people of the opposite sex
5. Conflict-inducing topics
6. Self-disclosures that could be judged negatively
The Bowen and Michal-Johnson study investigated how college students are confronting the threat of AIDS in their intimate relationships. Many students reported avoiding topics where their trust might be violated. Topics that were "too serious" or too high in intensity were also avoided, as were topics that could potentially "ruin the relationship." The researchers found students aware that talking about AIDS would change their relationships, so it was rarely discussed on a personal level.

Resistance to revealing personal information and deep feelings is an aspect of communication not just among college students. In his work with maturing homosexual couples, Lee observed, "[O]ur society does not encourage high levels of self-disclosure. "We are reluctant to hand other people weapons and show them where to stab, by allowing them to know our sensitivities, deepfelt but hidden needs and vulnerabilities."

Feeling apprehensive about communicating sexual feelings, thoughts, and experiences may well be a product of fear of betrayal or loss. To many, challenging one's relationship or oneself may present too great a risk and as a result, one's sexual communication remains undeveloped and the potential for sexual fulfillment limited. This, however, does not have to be the case. Sexual communication can be improved.

Improving Sexual Communication

Communication about sexual topics requires practice and sensitivity. This applies to parent-child, teacher-student, and therapist-client relationships as well as to sexually intimate and romantic ones. The risks and benefits in such discussions are very similar in all relationships. For a child, the risk of punishment for bringing up a sexual topic with a parent is similar to the risk of rejection an adult may fear in initiating a similar topic with a lover. The feeling of relief and the bonding that can take place between the individuals involved is a benefit each may feel when sexual discussions are handled without judgment and with sincerity.

To communicate about sex, some skill is involved. One must develop a vocabulary, vocal style, and body language that can convey a message the listener can understand. Otherwise, barriers to communication are produced when the language styles are offensive or mixed. If, for example, an individual is most comfortable with child language and is confronted with medical or scientific language, or vice versa, the communication may well be blocked by reactions to the actual words used. In this case, communication would be further hampered by expressions of anger or displeasure concerning the words spoken.

Communication difficulties arise when partners have different goals for their communication. One may want to express his or her feelings and to feel understood while the other may want to help solve apparent problems. As each feels misunderstood and frustrated, communication breaks down.

Common communication problems that stifle potentially enriching conversations include blaming the other person. This often results in angry exchanges and limited cooperation. Making the other person feel guilty or shameful can undermine a person's confidence and lead to a deepening silence on the topic. Making threats or giving ultimatums too often results in anger and fear ultimately reducing the likelihood of open talks in the future. Presuming to read one's partner's mind may cause resentment and ultimately limit the possibilities of new discoveries and growth. Saying "always" or "never" leaves open numerous possibilities for argument which can effectively sidetrack the discussion. Interrupting may also result in frustration and truncated communication.

While it is important to express thoughts and feelings clearly, it is equally important to listen carefully. This involves focusing one's attention on the other person while he or she is speaking and not interrupting. Interjecting opinions or advice jeopardizes effective listening. To be an effective listener, one must listen to what the other person is saying and be able to repeat what was said. This is one way to verify that what was heard was what was meant.

Communication is a learned skill that can be enhanced. When discussing sexual topics, Baucom and Hoffman recommend that the following techniques be practiced to improve the quality of the discussion:

1. Do not overreact to the sexual language used and negotiate a mutually acceptable choice if necessary.

2. Keep a sense of humor; humor can relieve embarrassment and tension.

3. Discuss a problem when neither party is greatly upset and when it can be discussed free of distractions.

4. Clarify the goal. Is it to share feelings and be understood or is it to solve a problem?

5. Express acceptance of one another through empathy. Empathy is conveyed through eye contact, warm tone of voice, open body posture and facial expression, and verbal feedback that demonstrates understanding of how the other person feels and thinks. Empathy demonstrates acceptance of another person's feelings and thoughts without necessarily agreeing with them.

To express their thoughts and feelings, people need to have a language. Much of the difficulty people have in discussing sexual topics stems from not knowing the words to use or not feeling comfortable using them. The lack of a universal sexual language, gender differences, early childhood experiences, and sexual orientation all influence sexual communication. Indeed, there may be limitless variables affecting the sexual messages conveyed. From this mosaic of possibilities, however, patterns in human communication can be discerned and even consciously altered. By learning techniques that improve the interpersonal aspects of communication and by increasing comfort and familiarity with sexual language, sexual communication between individuals can be enriched.

Communication is essential for individuals and communities and is vital to the human experience. As sexual beings, from infancy to old age, humans communicate through and about their bodies as a way to connect with others. In this life-long challenge, the satisfaction one achieves in communicating about sexuality can be one's greatest frustration or greatest joy.


Baucom, D., and J.A. Hoffman. Common Mistakes Spouses Make in Communicating. Medical Aspects of Human Sexuality, Vol. 17, No. 11 (1983), pp. 206-19.

Brown, M., and A. Auerback. Communication Patterns in Initiation of Marital Sex. Medical Aspects of Human Sexuality, Vol. 15, No. 4 (1981), pp. 101, 104, 112, 113, 117.

Cashman, P. Learning to Talk About Sex. SIECUS Report, Vol. 9, No. 1 (1980), pp. 3-5.

Hott, L.R., and J.R. Hott. Sexual Misunderstandings. Medical Aspects of Human Sexuality, Vol. 14, No. 1 (1980), pp. 13, 19, 23, 27, 31.

Lee, J.A. Can We Talk? Can We Really Talk? Communication as a Key Factor in the Maturing Homosexual Couple. Journal of Homosexuality, Vol. 20, No. 3/4 (1991), pp. 143-168.

McDermott, R.J., J.C. Drolet, and J.V. Fetro. Connotative Meanings of Sexuality-Related Terms: Implications for Educators and Other Practitioners. Journal of Sex Education & Therapy, Vol. 15, No. 2 (1989), pp. 103-113.

Reiss, I.L. Journey into Sexuality an Exploratory Voyage. Englewood Cliffs, N.J.: Prentice-Hall, 1986.

Sanders, J.S. Male and Female Vocabularies for Communicating with a Sexual Partner. Journal of Sex Education and Therapy, Vol. 4, No. 2 (1978), pp. 15-18.

Simkins, L., and C. Rinck. Male and Female Sexual Vocabulary in Different Interpersonal Contexts. Journal of Sex Research, Vol. 18, No. 20 (1982), pp. 160-72.

Valentich, M. Talking Sex: Implications for Practice in the 1990s. SIECCAN Journal, Vol. 5, No. 4 (1990), pp. 3-11.

Wells, J.W. The Sexual Vocabularies of Heterosexual and Homosexual Males and Females for Communicating Erotically With a Sexual Partner. Archives of Sexual Behavior. Vol. 19, No. 2 (1990), pp. 139-147.

Carrie M. Steindorff


Compulsive sexual behavior (CSB) has been called hypersexuality, hyperphilia, hypereroticism, hyperlibido, hyperaesthesia, erotomania, perversion, nymphomania, satyriasis, promiscuity, Don Juanism, Don Juanita-ism, Casanova type, and, more recently, sex addiction and sexual compulsion. These labels suggest that CSB is an exotic or rare phenomenon, but in fact, many men and women experience periods of intense involvement in sexual activity. Some of these may be short-lived or may reflect normal developmental processes. When sexual behavior becomes part of an obsessive-compulsive drive, the behavior is driven by anxiety-reduction mechanisms rather than by sexual desire. The obsessive thoughts and compulsive behaviors reduce anxiety and distress, but they create a self-perpetuating cycle. The sexual activity provides temporary relief, but it is followed by further distress. An individual engaging in CSB puts himself or herself and others at risk for STDs (sexually transmitted diseases), illnesses, and injuries; often experiences moral, social, and legal sanctions; and endures great emotional suffering.

There are many manifestations of CSB, which can be subsumed under two basic types: paraphilic and nonparaphilic CSB. Paraphilic behaviors are unconventional sexual behaviors that are compulsive and, consequently, devoid of love and intimacy. Money has defined nearly 50 paraphilias. The most common paraphilias are pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, transvestic fetishism, fetishism, and frotteurism.

Nonparaphilic CSB involves conventional and normative sexual behavior taken to a compulsive extreme. There are five subtypes: compulsive cruising and multiple partners, compulsive fixation on an unattainable partner, compulsive autoeroticism, compulsive multiple love relationships, and compulsive sexuality in a relationship.

There are no good national statistics to estimate how many people suffer from CSB. Estimates are complicated by simultaneous under- and overreporting. The best estimate is that the problem occurs in approximately 5 percent of the population.

More men than women have identified themselves with CSB, but this may be due to our restrictive definition of sexuality—or to the fact that we tend to define sexuality from a masculine perspective. Since males are socialized to be more sexually aggressive, visually focused, and experimental, it is not surprising that more males are identified with this problem.

Women are socialized to define their sexuality in terms of relationships and romance. It is not surprising, then, that women are more susceptible to certain types of CSB, such as compulsive multiple sexual relationships or compulsive sexuality in a relationship rather than compulsive cruising and multiple partners. This is not to say that women do not develop paraphilias or the other types of nonparaphilic CSB.

It is dangerous to define compulsive sexual behavior as simply behavior that does not fit normative standards. Individuals have problems related to compulsive sexual behavior to varying degrees. It is difficult to draw a line between someone who has some problems that can be easily corrected through education or brief counseling and someone who needs intensive treatment. It is common to experience periods in which sexuality is expressed in obsessive and compulsive ways. This may be part of a normal developmental process. In other cases, it may be problematic. During adolescence, it is quite normative to become "obsessed" with sex for long periods. However, some adolescents begin to use sexual expression to deal with the stress of adolescence, loneliness, or feelings of inadequacy. Compulsive sexuality can be a coping mechanism similar to alcohol and drug abuse. This pattern of sexual behavior can be problematic.

During adulthood, it is not uncommon for individuals to go through periods when sexual behavior may take on obsessive and compulsive characteristics. Relationships outside committed relationships or frantic searches to fill loneliness following dissolution of a relationship are common. For some, these common behaviors become problematic. When individuals recognize that their behavior is not solving problems but creating them, they can often alter their pattern of behavior on their own or after brief counseling.

Some individuals, however, lack the ability to alter problematic sexual behavior. Their behavior is "hard wired" in the erotosexual pathways in their brain, and the repetitious nature of the self-defeating behavior can be explained by neurotransmitter dysfunction. Compulsive sexual behavior is, at this point, pathological, because brain pathology is causing anxiety and the pattern of sexual behavior is acting as a short-lived anxiolytic (similar to other obsessive and compulsive behaviors). In its obsessive and compulsive form, the sexual behavior is senseless, dysphoric, and harmful. The CSB often has damaging consequences, including arrest, injury, or loss of jobs or relationships.

CSB has been strongly linked to early childhood trauma or abuse, highly restricted environments regarding sexuality, dysfunctional attitudes about sex and intimacy, or low self-esteem, anxiety, and depression. It is speculated that these traumatic experiences create or amplify an underlying or evolving anxiety disorder. Dysthymia is often experienced secondary to this primary anxiety disorder. CSB is seen as a symptomatic response and disorder to this anxiety, and depression. In addition, many individuals with CSB experience acute and chronic anxiety or depression in response to their compulsive sexual behavior. They may describe a sexual act as a "fix" to their anxiety or depression. This relief is short-lived, however, and they experience further anxiety. Some become depressed and even suicidal. They attempt to resist further obsessive thoughts or compulsive behaviors, but these efforts are frustrating, and the individual usually ends up engaging in the behavior.

New developments in the understanding of obsessive-compulsive disorder (OCD) have suggested that most paraphilic and nonparaphilic CSB may be best understood as a variant of OCD. In other cases, the behavior may be caused by other psychiatric or neurological disorders, which explain the compulsive nature of the sexual expression. In most cases, contrary to common beliefs, individuals with CSB are not oversexed (in the sense of having high sexual desire or hormonal imbalances). Their hypersexuality is in response to anxiety caused by neuropsychiatric problems.

Overcoming CSB does not involve eradicating all sexual behavior. Sexual expression is an important ingredient of sexual health. Individuals need to set limits or boundaries around certain patterns of sexual expression. They set these boundaries by clearly identifying their obsessive and compulsive sexual behavior. For example, a man who has been involved in compulsive autoeroticism does not stop masturbating. He identifies the behaviors and patterns of obsessive and compulsive masturbation and eliminates these behaviors. At the same time, he needs to learn new ways and patterns of masturbation that are self-nurturing and pleasuring. At the same time that sexual behavior is being restricted, individuals should be given permission to be sexual human beings.

In conclusion, compulsive sexual behavior is a serious psychosexual disorder that needs to be identified and appropriately treated. CSB does not always involve strange and unusual sexual practices. Many conventional sexual behaviors become the focus of the individual's sexual obsessions and compulsions. Advances in the understanding and treatment of OCD have given us a new direction and hope for better treatment of individuals with CSB. New pharmacotherapies combined with traditional psychotherapies have been shown to be effective in treating the various types of CSB.


Coleman, E. Compulsive Sexual Behavior: New Concepts and Treatments. In E. Coleman, ed., John Money: A Tribute. New York: Haworth Press, 1991.

Coleman, E. Sexual Compulsivity: Definition, Etiology and Treatment Considerations. In E. Coleman, ed., Chemical Dependency and Intimacy Dysfunction. New York: Haworth Press, 1987.

Kafka, M. Successful Antidepressant Treatment of Nonparaphilic Sexual Addictions and Paraphilias in Males. Journal of Clinical Psychiatry, Vol. 52 (1991), pp. 60-65.

Kafka, M., and E. Coleman. Serotonin and Paraphilias: The Convergence of Mood, Impulse and Compulsive Disorders. Journal of Clinical Psychopharmacology, Vol. 11 (1991), pp. 223-24.

Money, J. Lovemaps: Clinical Concepts of Sexual/Erotic Health and Pathology, Paraphilia, and Gender Transpositions in Childhood, Adolescence, and Maturity. New York: Irvington, 1986.

Eli Coleman


Anthony Comstock

Comstockery (sometimes Comstockism) refers to an aggressive prudery aimed at eliminating all mention or depiction of sexual matters or erotic stimulation from public expression or commerce, including art and literature. The term comes from the name of an important American reformer, Anthony Comstock (1844-1915).


Comstockery developed from two streams. One was the traditional English common-law suppression of offensively obscene and scandalous material. The other, which gave the phenomenon a special character, was the purity movement as it developed in 19th-century America. The purity movement in turn grew out of evangelicalism of the early 19th century, in which middle-class Americans used their own aspirations to sexual purity to discredit the lower and upper classes alike, since their sexual standards were at odds with those of the middle-class evangelical Christians.

In Victorian England, evangelicals, along with social conservatives who wished to avoid any discussion of sexual reform, (including, in particular, abating prostitution), introduced what was called "the conspiracy of silence" concerning matters sexual. The double standard of morality, in which men were permitted lustful behavior—or at least forgiven it—but women were expected to remain angelically pure, often coexisted with the conspiracy of silence, since men's animality was hidden in private male areas of society. All formally public discussion was, according to the standards that included the conspiracy of silence, to remain purified of anything that might suggest to "a young girl" the existence of sexuality, much less the indulgence of lust or perversity (perversity including anything outside of monogamous marriage). In the United States, this conspiracy of silence was very successful, in part because of the efforts of Comstock.

But in the United States, the purity movement, as Pivar has written, involved not just suppression of the unclean, disorderly, and corrupting but a positive vision of children brought up to be conscientious and pure, with prosocial attitudes and actions undistracted by vice or even by thoughts about impure matters—hence the attempt to remove stimulants to impure thinking. In a society in which industrialism was bringing disorder and great concern about control and discipline, including self-control and self-discipline, emphasizing personal and social purity was an adaptive strategy that could serve both individuals and society well. Only in the 20th century, when new ideas about how to cope with human sexuality became important, did purity begin to appear as a not necessarily positive alternative.

In the 1910s and 1920s, especially, the idea of supersensitive prudishness forced upon the public became an object of ridicule. To some extent, this antipurity criticism was a continuing application of the traditional Victorian dislike of hypocrisy and craving for honesty. In particular, those who believed that sexuality was a strictly private matter therefore satirized such people as Comstock from many points of view. One was the idea that he embodied a harmful repression of healthy sexuality. Another was the idea that public, and especially legal repression, was a violation of privacy and of freedom of expression. And still another was the notion that openness, frankness, and education about matters sexual was the best method of ultimately taming unfortunate human propensities. It was when significant intellectuals began to rebel, especially around the turn of the 20th century, that it became common to refer to public campaigns for sexual prudishness—and particularly censorship of art, literature, and the media—as Comstockery. The term was apparently coined in 1906 when George Bernard Shaw turned Comstock's name into a word for repressiveness.

Anthony Comstock

Comstock earned the eponym by his vigorous public campaigns. His work included unfair entrapment and asserted an extremist stance in the area of public expression. But it was also a distorting caricature of what he attempted to do, as Johnson has shown.

Comstock was born into an initially prosperous and large farm family in New Canaan, Connecticut. Comstock's mother died when he was only age 10, but by then he had already been imprinted with her moral zeal, and he absorbed also the traditional New England community emphasis on duty. Throughout his life, he adhered to the strictest version of a very conventional 19th-century evangelical Protestant religious standard.

Comstock attended the local district school and then the local church academy (secondary school). In 1864, he enlisted in the Union Army and served creditably. In the army, he used his religious devotion to protect himself against the temptations he saw all around him, and in the process he attempted (with, understandably, little success) to reform his comrades in arms. In 1866, after the war, he went to New York City and entered the dry goods business. He lived there the rest of his life as a public figure devoted to cleaning up New York, the nation, and the world.

The young clerk began his reform career in 1868, when he obtained the arrest of a dealer in pornography. In 1872, he came to the attention of wealthy backers of the Young Men's Christian Association (YMCA), and they encouraged and financed his work, which he carried out as part of a committee of the YMCA, the Committee for the Suppression of Vice. In 1873, his activities had become so notorious that the YMCA could no longer sponsor him (some leaders did not want the muck of society raked over but believed that such matters were better left unmentioned). Therefore Comstock's sponsors formed a separate organization, the Society for the Suppression of Vice, and Comstock left the dry goods business and became a full-time crusader as secretary to the Society.

His dress rehearsal for full-time work was his effort early in 1873 in using a display of offensive materials to persuade congressmen in Washington to pass a law forbidding the use of the Post Office to convey any obscene material, including contraceptive information. It became known as the Comstock Law. Comstock also obtained a commission as (unpaid until 1907) special agent of the Post Office, which gave him an additional legal base from which to operate directly to suppress obscenity.

Comstock, in going after sexually stimulating artifacts, classified them with frauds as well as distractions. At the beginning of 1874, Comstock calculated that he had seized and destroyed 134,000 pounds of improper books, 194,000 pictures and photographs of the same kind plus 14,200 pounds of stereotype plates; and 60,300 rubber articles (e.g., dildoes and condoms). But he had also moved against quack remedies (3,150 boxes of pills and powders), and he was very active in attacking gambling, which he viewed also as fraudulent, whether in the form of lotteries or gaming rooms.

Comstock used laws as the expression of social standards that can and should be enforced. But from the beginning, he found that not everyone interpreted those standards as strictly as he did. In 1887, he raided a respected art dealer and confiscated photographs of French classical art. Thereafter, every time he condemned classics in literature or in art, more and more invective and, most damaging, satire was directed against him. As time passed, Comstock accumulated many articulate critics and outright enemies. They exploited two weaknesses of his campaign. One was his penchant to use entrapment and other insensitive and what appeared to be unfair and inhumane tactics, hounding the weak as well as the responsible. The other weakness was the indiscriminate nature of his approach, particularly his assault on those advocating marriage reform—the very restrained "free love" of the day—ad medical books and the classics. This reached an extreme when in 1906 he arrested a young female bookkeeper of the Art Students' League in New York because the artists were doing nude drawing in class and had published a pamphlet publicizing their work. By that time the sophisticated press had all joined in condemning and ridiculing him and, by implication, the censorship for which he stood.

In 1913, John S. Sumner appeared as Comstock's de facto successor in the Society for the Suppression of Vice, and while Comstock was never officially dismissed, he was already clearly senile and expired at peace with his God in 1915.


Boyer, P.S. Purity in Print: The Vice Society Movement and Book Censorship in America. New York: Charles Scribner's Sons, 1968.

Bremner, R. Editor's Introduction. In A. Comstock, Traps for the Young. Cambridge, Mass.: Belknap Press, 1967.

Broun, H., and M. Leech. Anthony Comstock: Roundsman of the Lord. New York: Literary Guild of America, 1927.

Burnham, J.C. The Progressive Era Revolution in American Attitudes Toward Sex. Journal of American History, Vol. 59 (1973), pp. 885-908.

Johnson, R.C. Anthony Comstock: Reform, Vice, and the American Way. Doctoral dissertation, Univ. of Wisconsin, 1973.

Pivar, D.J. Purity Crusade: Sexual Morality and Social Control, 1868-1900. Westport, Conn.: Greenwood Press, 1973.

Rosenberg, C.E. Sexuality, Class, and Role in 19th-century America. American Quarterly, 25 (1973), pp.131-153.

John C. Burnham


The condom, or penis sheath, is an ancient contraceptive device, although the first published description of one dates from 1564 in the poem De Morbo Gallico by the anatomist Gabriele Fallopio (Latin—Fallopius; 1532-1562). He described a linen sheath. Condoms were also made of animal intestines or skin. Though there are references to condoms made out of the bladders of some air fishes, most historians are suspicious of such references. Since the vulcanization of rubber, most condoms have been made of that material, originally crepe rubber and then liquid latex.

One issue of controversy is the use of the term "condom" itself. The word first appears at the beginning of the 18th century, and some have claimed that the device was named after a Dr. Condom or Conton, a physician at the court of King Charles II (1630-1685) of England. Unfortunately, no such physician has ever been found. Others have argued that the term was derived from the name of a French village, but no historian now accepts this theory. Currently, the origin of the name remains unknown.


Bullough, V.L. A Brief Note on Rubber Technology: The Diaphragm and the Condom. Technology and Culture, Vol. 22 (Jan. 1981), pp. 104-11.

Vern L. Bullough


Confucianism consists of writings attributed to Confucius (Kongzi, or Master Kong, 551-479 B.C.), the first great educator, philosopher, and statesman of China, and his followers, including Mencius (Mengzi, or Master Meng, 372-289 B.C.), a political thinker who believed in democracy. Confucianism dominated Chinese sociopolitical life for most of Chinese history and largely influenced the cultures of Korea, Japan, and Indochina.

There are two components of Confucianism: the earlier Rujia (Confucian school of philosophy) and the later Kongjiao (Confucian religion). The Rujia represents a political-philosophical tradition which was extremely important in imperialist times, and is the element most directly connected with the persons and teachings of Confucius and Mencius—Kong Meng zhi dao (the doctrine of Confucius and Mencius). The Kongjiao represents the state's efforts to meet the religious needs of the people within the framework of the Confucian tradition, an unsuccessful attempt which occurred in the late imperial period (960-1911 A.D.).

For some 2,000 years, Confucianism enjoyed almost unassailable prestige as the ideology of the imperial bureaucracy, an essential element of China's political unity. Regardless of how much a particular ruler might prefer Buddhism or Taoism, Confucianism had a practical importance in the affairs of government that could not be denied or neglected. Philosophical Confucianism was very successful as a political ideology, as well as being an impressive system of moral philosophy.

Generally, it has been said that Confucianism is sex-negative. This is not quite true, since Confucius never spoke against sex and felt the whole subject was open to discussion. The Chinese frequently cited some of the sayings from Confucianism's classics as being supportive of people's sexual desires and rights because Confucius said that everyone loved sex. Unfortunately, in most English translations, the Chinese character se has been translated as "beauty," although "sex" is more accurate. Confucius also said, "Food and drink and the sexual relation between men and women compose the major human desires," while his disciple Mencius wrote, "Eating food and having sex is nature of human beings." The word sex was left out of most English translations until recently.

Mencius's attitude toward sex was both positive and permissive. In fact, some sayings from Mencius concerning marriage are supportive of sexual life. For example: "That male and female should dwell together is the greatest of human relations"; "There are three things which are unfilial, and to have no posterity is the worst of them"; and "When a son is born, what is desired for him is that he may have a wife; when daughter is born, what is desired for her is that she may have a husband."

It was only much later during the Sung dynasty that official or public sexual attitudes began to change, gradually becoming more negative and repressive. The crucial change was initiated by several famous Neo-Confucianists, including Chou Tun-i (1017-73 A.D.), Ch'engHao (1032-185 A.D.) and Ch'eng I (1033-1107 A.D.), the founders of Neo-Confucianism; and Chu Hsi (1130-1200 A.D.) who, as the major interpreter and systematizer, was the true father of Neo-Confucianism. Ch'eng I summarized the Neo-Confucian viewpoint in a remark in his Posthumous Papers: "Discard human desires to retain the heavenly principles." When asked if a widow was justified in remarrying when pressed by poverty and hunger, he replied, "It is a very small thing to die as a result of starvation, but a very serious evil to lose chastity toward one's dead husband by remarrying."

Chu Hsi repeatedly emphasized his agreement with Ch'eng I. For example, Chu Hsi wrote to a friend urging him not to permit his widowed sister to remarry, justifying his viewpoint by quoting Ch'eng I's opinion, which he described as an unchangeable principle. Chu Hsi's strictly Confucianist interpretation of the classics was more rigorous than any that had gone before. He stressed the inferiority of women and the strict separation of the sexes, and forbade any manifestation of heterosexual love outside of wedlock. This narrow attitude is especially manifest in his commentaries on the love songs of The Book of Poetry, the oldest repository of Chinese verse. It was probably first compiled in the early sixth century B.C., collecting 305 poems and folksongs dating from between the 16th and 11th centuries B.C. to the sixth century B.C. Like the I-Ching (see "China and Sex"), it is counted among the five Confucianist classics. Chu Hsi reinterpreted the love songs of The Book of Poetry as political allegories. The foundations of Neo-Confucianism he laid resulted in it becoming the sole state religion and encouraged a strictly authoritarian form of government, which included the establishment of censorship, thought-control, and repressive policy.


Legge,J., trans. The Four Books: The Great Learning, The Doctrine of the Mean, Confucian Analects, and The Works of Mencius, With English Translation and Notes by James Legge, D.D., LL.D. Reprint. Taipei, Taiwan: Culture Book Co., 1983.

Ruan, F.F. Sex in China: Studies in Sexology in Chinese Culture. New York: Plenum Press, 1991.

van Gulik, R.H. Sexual Life in Ancient China: A Preliminary Survey of Chinese Sex and Society From ca. 1500 BC till 1644 A.D.. Leiden: E.J. Brill, 1961.

Fang-fu Ruan


Historical Methods of Birth Control
Cervical Caps
Vaginal Sponges
Oral Contraceptives
Progestin Implants
Intrauterine Devices (lUDs)
Other Birth Control Methods

Theoretically, when a heterosexual couple engages in intercourse without making any attempt to prevent pregnancy, there is a three-percent chance that pregnancy will occur. This means that a pregnancy occurs approximately once in every 33 incidents of coitus. In a healthy population, this could produce a maternity ratio (average number of live births per woman) as high as ten. Since no area has ever had the food supply to sustain such a ratio for long, even with the high infant death rates in the past, people learned to use a variety of methods to control births.

Historical Methods of Birth Control

Celibacy, or abstinence, is one of the surest methods of birth control. Historically, it has been practiced by individual couples, as well as fostered by societies. For example, when large armies went on long campaigns most soldiers were forced by circumstances to be celibate; while it is true that camp followers sold their services as prostitutes during many wars, very often the common foot soldier could not afford the prostitute. The Catholic church maintained celibacy for priests, monks, and nuns. And celibacy has been fostered by raising the marital age, as it was during the potato famines in Ireland during the 19th century when the marriage age went up by almost a decade for both men and women.

Abortions have also been a major method of birth control throughout the ages. (See Abortion.)

The earliest known prescriptions for contraceptives came from Egypt (between 2000 and 1000 B.C.E.). They were written on papyrus scrolls and called for such substances as crocodile dung or honey and gumlike substances to be inserted into the vagina to block the path of the sperm. The ancient Greeks inserted olive oil. The Talmud mentions the use of a sponge soaked in vinegar.

Intrauterine devices were also used. Books attributed to Hippocrates, the great Greek physician, mention their existence in ancient Greece. On a more practical level, Arab camel drivers inserted a round stone into the uterus of the female camel before departing on a long journey to prevent its impregnation during the trip.

Coitus interruptus—the term which describes the withdrawal of the penis from the vagina before ejaculation occurs—is known to have been used in ancient times because it was condemned by Jewish, Christian, and Islamic writers alike. They argued that the male seed was too precious to waste.

The condom was first described by Gabriele Fallopius in the 16th century. (He was also the first to describe the clitoris and the Fallopian tubes which bear his name.) Fallopius probably did not invent the condom but rather described a device that was long in use. He did, however, popularize a linen sheath shaped to fit the erect penis which could be soaked with chemicals and serve as an effective barrier to sperm and to infectious organisms. Condoms of this period were made not only of linen, but also of animal intestines and fish bladders. They were used primarily as a prophylactic device to reduce the possibility of contracting venereal disease rather than as a contraceptive, although their contraceptive properties were known. Because the condoms had to be individually crafted, they were a luxury item used only by well-to-do men. In England, the sheath was named "condom" for reasons that are unknown; stories circulate about a Dr. Condom, supposedly a physician in the king's court, but no actual records of him have been discovered.

The discovery of the process of making liquid latex in 1853 made modern rubber condoms possible and led to the development of diaphragms and cervical caps. Pessaries, which were designed in the 19th century to support a prolapsed uterus, are ring-like structures inserted into the vagina and pushed up to fit around the cervix. Some pessaries blocked the opening in the cervix so they could also be used as a birth control device, although this agenda was often hidden from outsiders. Several of these devices were patented in the 19th century; the precursor to the popular diaphragm used in the 20th century was developed by C. Hasse, a German physician who used the pseudonym Wilhelm P.J. Mensinga to protect himself from the stigma of dealing with a sexual product. The Mensinga diaphragm was a latex covering for the cervix held in place by a coiled spring that fit behind the pubic bone and over the cervix at the back of the vagina. Arleta Jacobs, a student of Hasse, opened a contraceptive clinic in the Netherlands where she was visited by the American nurse Margaret Sanger, who brought the diaphragm to the United States in 1916. Sanger, a militant socialist, was determined to bring birth control information and technology to American women, particularly poor immigrant women who lived in the big cities. Although the diaphragm had been smuggled in by affluent persons before Sanger set up her clinic on the Lower East Side of New York City, her well-publicized activities offended the authorities and she, her sister Ethyl, and Fania Mindell were arrested for opening the clinic. Sanger went on a hunger strike and was later pardoned by the governor and persisted with single-minded fervor to make family planning services available to women who needed them.

But New York is just one state and contraception was illegal in many states until the U.S. Supreme Court decision in Griswold v. Connecticut (1965) made birth control legal in all states, at least for married women. It took several more court cases before all obstacles were removed.


Diaphragms are a barrier method of contraception. (Barrier methods block sperm from reaching the cervix so they cannot travel to the uterus and the Fallopian tubes where fertilization takes place.)

The diaphragm is a circular spring with a dome of rubber. Contraceptive jelly (about one teaspoon) is smeared inside the dome before the diaphragm is inserted in a position that covers the cervix and the front of the vagina. Because diaphragms are sized to fit the individual woman, a diaphragm must be fit and prescribed by a physician, nurse practitioner, or physician's assistant. The diaphragm should be inserted into the vagina before coitus, where it can safely stay for several hours before the sex act. It should be left in place for at least six hours after intercourse but removed in less than 24 hours to avoid infection.

The failure rate of diaphragms is less than ten per 100 woman-years of use. (This means for every 100 women using the diaphragm with a spermicide for one year, fewer than 10 will become pregnant.) Failures are most likely to occur among new users; more experienced users tend to have failure rates as low as two or three per 100 woman-years.

Since the diaphragm is used only when intercourse is likely to occur, the user who has sex infrequently need not be taking something all the time. Properly fitted and inserted, neither partner is particularly aware of its presence. Negative side effects are rare, and plastic diaphragms are available for the few people who are allergic to rubber. A few women develop cystitis (an inflammation or infection of the bladder) because the diaphragm creates pressure on the bladder.

Cervical Caps

The cervical cap, also a barrier contraceptive, is a small thimble-shaped cup smaller than the diaphragm which fits over the cervix. It was widely used at the beginning of the 20th century in Great Britain, but much less so in the United States. Its limited popularity in the United States may have been because it is more difficult to fit and to learn to insert or because Sanger introduced the diaphragm to American women instead of the cervical cap. The cervical cap was again popularized in the United States in the 1970s, when feminist groups advocated making it available to U.S. consumers. A long testing procedure by the federal Food and Drug Administration (FDA) was required, however, before it could be marketed.

One cap, the Prentif cavity-rim cervical cap, was FDA-approved in 1988; other caps are used in Europe. The Prentif cavity-rim cap, made of soft, pliable latex and about half the size of a diaphragm, is still not widely used—perhaps because of the longer fitting and training time (compared with the diaphragm) required for its prescription and usage.

Vaginal Sponges

As suggested by the fact that they were mentioned in the Talmud, sea sponges soaked in vinegar or lemon juice are a traditional folk method of birth control. Modern commercial contraceptive sponges date only from the mid-1970s, when they were developed by an Arizona research group with a grant from the federal government. Originally, the sponge was designed to be washed and reused, but this tended to wash out the spermicide so the failure rate was high. The sponge currently available with the trademark Today is marketed for one-time use only. It is a mushroom-shaped polyethylene sponge impregnated with the spermicide nonoxynol-9 that the user moistens and inserts before the sex act occurs. It can be left in place up to 24 hours and used for subsequent acts of intercourse within these 24 hours.

The sponge has a relatively high failure rate (24 per 100 woman-years among older women who have had several pregnancies, and 14 per 100 woman-years among young women). Its major advantage is that it can be purchased in a drugstore without a prescription.


The first latex condoms were made in the middle of the 19th century and were designed to fit over only the tip of the penis; that design was soon extended to cover the entire shaft of the penis. Seamless condoms were developed in the early 20th century. Condoms could often be purchased in brothels and barbershops but state laws against contraception prevented them from being sold for that purpose (thus emphasizing their prophylactic use). In the 1920s, Merle Young, a drugstore products salesman, started Young Rubber Company, marketing condoms to drugstores and successfully challenging the laws against the dissemination of condoms. Unfortunately, the quality control of condoms at that time was poor. A survey by the National Committee on Maternal Health in 1938 found that 40 percent of the rubber condoms sold in the United States were defective (usually small holes were found). After the FDA brought condoms under its regulation, the quality of the condoms improved. Today, the quality is high.

Condoms, like other barrier contraceptives, require skill to use. First-time users should read the instructions on the condom package ahead of time and practice putting one on. Most condoms are prerolled. If the condom does not have a reservoir tip, it should be unrolled about one-half inch before placing it on the penis. It is then rolled up the shaft of the penis. Condoms are more effective when a spermicide is inserted into the tip. Oily substances used as lubricants (vaseline, for example) should not be used with condoms because oil weakens the rubber.

For those who use condoms consistently, the failure rates are low, between one and three per 100 couple-years (the term used for male-oriented contraceptives). Inexperienced and occasional users have a higher failure rate, almost 10 percent.

Condoms used with a spermicide prevent the spread of most venereal diseases, including syphilis, gonorrhea, chlamydia, and AIDS, so they are highly recommended at this time because many of the venereal diseases have reached epidemic proportions. Condoms are certainly the contraceptive of choice for anyone who has had or plans to have more than one sex partner in a lifetime. It is also possible to supplement the condom with a second barrier contraceptive, such as a diaphragm or sponge, or to use oral contraceptives along with condoms. These steps increase the effectiveness of contraception, and when a second barrier contraceptive is used, offer further protection against venereal diseases.


Ancient people experimented with various spermicidal preparations long before the invention of the microscope made it possible to visualize sperm. Usually, they mixed a paste, gum, oil, or wax with an acid. Research sponsored by the Rockefeller Foundation in the 1920s helped to develop improved spermicides. In 1937, phenylmercuric acid was produced under the trade name Volpar. It was an effective spermicide but it was removed from the U.S. market because of concerns about the safety of mercury which it included. A breakthrough came in the 1950s with the introduction of the surficants. These agents act primarily by disrupting the integrity of the sperm membrane. Since they are not strongly acetic they are rarely irritating to the vagina or the penis. Spermicides containing nonoxynol-9, a surficant spermicide effective as both a contraceptive and a germicide, dominate the market now.

Spermicides, which can be purchased without a prescription, are available as jellies, creams, foaming tablets, or suppositories. The jelly is best for use with diaphragms, cervical caps, or condoms; other preparations can be used alone. The failure rate for spermicide alone is about 15 per 100 woman-years.

Oral Contraceptives

Oral contraceptives are synthetic hormones which prevent pregnancy. First approved by the FDA in 1960—though FDA approval was not then necessary for devices, it was for medications—the pill was the first method of birth control approved by the federal government. The research that finally produced the pill had started three decades earlier as an effort to control menstrual pain. This led to the identification of the hormone progesterone, which prevented ovulation. Ovulation is the process by which the egg ripens and ruptures out of the ovary. If ovulation does not occur there can be no pregnancy, so researchers realized that these hormones could also be used as contraceptives. As research progressed, it was found that a combination of estrogen and progesterone was more effective in preventing ovulation and dysmenorrhea than either hormone alone.

Synthetic progesterone (called progestin) was developed by Carl Djerassi at the Syntex laboratories in Mexico, and this breakthrough led to the development of other synthetic hormones, including estrogen. The experimental trials to test the pill were done in Puerto Rico under the direction of Gregory Pincus. A group of 265 women were given pills containing a combination of synthetic progesterone and estrogen. Before the trial, the pregnancy rate was 63 per 100 woman-years (a very high rate of pregnancy). The results were remarkable. No woman who took the pills faithfully for 20 days of each cycle became pregnant during the two years of the study. However, some women dropped out of the study complaining of nausea, vomiting, dizziness, and pelvic pain. This was also true of those women who took Enovid, the first pill marketed for general use in 1960. However, it was soon realized that the doses of hormone could be reduced markedly, and by 1980 significant side effects had been eliminated for most women.

Oral contraceptives function by interfering with the hormonal control of the female reproductive system. They create a false signaling system so that the brain and the pituitary gland do not send the usual messages to the ovaries and consequently ovulation does not occur. In addition, the oral contraceptives interfere with the work of the Fallopian tubes (which push the egg through the tubes to reach the uterus); they alter the lining of the uterus to make it unfriendly terrain for an egg; and they make the cervical mucous too thick for sperm to penetrate easily.

There are three types of oral contraceptives: combination pills, which include both estrogen and progestin; triphasic pills, which include these same two elements but in different proportions throughout the menstrual cycle; and mini-pills, which are low-dose progestins. The combination pills are the most common. They come in a package that marks off the days of the cycle and are taken from the first day of the cycle until the 21st day. They are then discontinued for seven days while the menstrual period occurs. Some packages include an additional seven pills of some inert substance so the user can take a pill every day. The triphasic pills came on the market in the 1980s and manufacturers claim they have even fewer side effects than the regular pills. Some women report this is true; others see no difference. The minipills made only of progestin may cause heavy menstrual bleeding but eliminate other side effects. They are safe for mothers who are nursing babies because too much estrogen is not good for the baby.

The theoretical effectiveness of the oral contraceptives is 100 percent. In reality, there are between four and ten failures per 100 woman-years because women forget to take their pills or take them off schedule. When a lapse in memory occurs, an alternative form of birth control (such as a condom) should be used in addition to the pills for the remainder of the cycle. Possible side effects of the oral contraceptives include weight gain, edema, nausea, headaches, rash, and sterility for several months after they are discontinued. However, with the current low dosages, most women have no negative side effects after the first couple of months.

Although it is not common, serious cardiovascular problems, including stroke and heart attacks, have been related to oral contraceptive use. Because of this, women with a history of stroke, heart attack, diabetes, or other blood vessel problems should not take the pill. These complications are much more likely to occur in women who smoke because smoking damages blood vessels. For this reason, the pill is ordinarily not given to women over age 30 who smoke. Although it is the smoking that is actually more dangerous, the combination of the pill and smoking may be enough to cause a stroke or related problem.

Oral contraceptives are the most popular form of birth control. They are used by 31 percent of the Americans who use contraceptives. The social impact of the pill is difficult to overestimate. Because of it, for the first time in history, women have the power to control their lives by deciding when and if to become pregnant. The pill is thus clearly an important factor in the revolutionary advances made by women in the last part of the 20th century.

Progestin Implants

Norplant, a progestin implant, which releases small amounts of hormone over three or five years, was approved by the FDA in 1991. The five-year implants come as six hollow capsules made of silicone rubber (silastic); the three-year implants use two solid silastic rods. The capsules or the rods are surgically implanted under the skin on the inside of the upper or lower arm. They gradually release a small amount of progestin which prevents conception. Since women are just starting to use them in the United States, statistics on their effectiveness come from other countries, where a failure rate of less than one per 100 woman-years is recorded. Norplant may cause irregular menses at first, but the bleeding diminishes over time. If the user decides she wants to become pregnant before the implants have spent their hormones, they can be removed early; otherwise they are removed at the end of the designated time period and new implants can be inserted.

Intrauterine Devices (lUDs)

Because almost any foreign body in the uterus prevents conception, intrauterine devices, of various materials, have been used throughout the ages. But the foreign body can also cause infection, so before antibiotics a pelvic infection was often fatal. The first IUD to be widely used was a ring of gut and silver wire developed in the 1920s by Ernst Graefenberg, a German gynecologist and sex researcher. In 1934, Tenrei Ota of Japan introduced gold-plated silver intrauterine rings. Jack Lippes, a Buffalo, New York, gynecologist in 1962 used the basic design developed by these researchers but changed the material to a plastic loop with an attached thread which fell into the vagina for easy checking or removal. More recent IUD designs use copper, which has some contraceptive properties itself, and some lUDs also contain a reservoir of progestin.

Unfortunately, an IUD called the Dalkon shield was marketed in the 1970s. It was poorly designed, untested, and caused serious infections. By 1976, 17 deaths were linked to its use but the pharmaceutical company that had developed it took no steps to notify the public or health care providers of the danger until 1980. This led to many law suits; the company declared bankruptcy and other IUD companies, fearing similar lawsuits, took their products off the market. Since lUDs are devices, not drugs, they were not controlled by the FDA until after the Dalkon shield incident. The lUDs currently on the market are FDA approved and safe.

lUDs work by stimulating a foreign-body reaction in the uterus, thus damaging the sperm and the egg and making implantation in the uterus impossible. They must be inserted and removed by a health care provider, but once in place, they can stay for several years.

lUDs can cause heavy menstrual periods, so women with bleeding disorders should avoid them. They should also be avoided by women who are likely to contract sexually transmitted diseases because they increase the likelihood of the infection traveling to the pelvis. lUDs work best for women who have had at least one child, so they are seldom used for very young women.

Although current lUDs are among the most effective contraceptives now available (with a failure rate of approximately one per 100 woman-years), they are not very popular because of the fear caused by the Dalkon shield incident.


The only totally effective way to avoid pregnancy is to avoid all heterosexual intercourse. Although homosexuals often do this, and others may abstain for religious reasons, most people using abstinence as a method of birth control abstain during the woman's menstrual midcycle when ovulation occurs. This method, once called the rhythm method, is now called natural family planning, and it is the only form of birth control that is not banned by the Catholic church.

To be successful with natural family planning, the couple must be able to identify or calculate when ovulation occurs and abstain from intercourse for several days before and after the expected date of ovulation. While ovulation in most women occurs 14 days before the next menstrual period, it is not always possible to know exactly when the next menstrual period will start. This is particularly true of women with irregular menses. To improve the calculations, some women take their temperature each day. It usually starts to rise midcycle at the time of ovulation. Two Australian physicians, John and Evelyn Billings, have developed a method of periodic abstinence based on changes in the cervical mucous. (The mucous at the time of ovulation is thin and slippery, while it is thick at other times.)

Natural family planning is without risk to the body but the failure rate is high among people with irregular menstrual cycles and those who are not conscientious about measuring and assessing the clues that signal ovulation. The failure rate is approximately 20 per 100 woman-years, but careful use of the method employing multiple indicators of ovulation can lower this figure to eight per 100 woman-years.


Many couples who do not want children or have finished bearing their desired number of children seek voluntary sterilization. In 1992, female sterilization was the most popular worldwide approach to family planning with an estimated 140 million, or 16 percent of the women of reproductive age being sterilized. The procedure is particularly popular in China, South Korea, Thailand, the Dominican Republic, El Salvador, Mexico, and the United States. In 1988, 23 percent of the women and 13 percent of the men in the United States had been sterilized.

Worldwide, an estimated 40 million couples rely on male sterilization using an operation that cuts the vas deferens, the tube that carries the sperm from the testes. The surgery can be done on an outpatient basis, and the record of safety for the procedure is high. It takes about six weeks to clear all of the sperm from the system, so intercourse should be delayed until then, and the ejaculate should be examined under a microscope to make sure it is clear of sperm before the couple resumes intercourse. Vasectomy is a major family planning method in the United States, New Zealand, Australia, Great Britain, Canada, the Netherlands, China, India, and South Korea.

Women are sterilized by blocking or cutting and tying the Fallopian tubes. Since 1960, two simplified procedures have developed: laparoscopy and minilaparotomy. A laparoscope is a slender stainless steel tube containing a set of lenses and a fiber-optic cable connected to a light source. The surgeon visualizes the Fallopian tubes through the laparoscope and blocks or cuts the tubes with instruments inserted through the laparoscope or inserted through a second abdominal incision.

The minilaparotomy involves making a small incision either just above the pubic hair or below the navel for postpartum procedures. Each tube is pulled up to the incision, where it is blocked or cut. Sterilization is also possible by removing the uterus, or ovaries. One of these later procedures might be chosen if the operation is done at the time of a Cesarean section, or if there is some other problem involving the uterus or ovaries.

Other Birth Control Methods

Coitus interruptus—the withdrawal of the penis from the vagina before ejaculation occurs—has a long history of usage, but is less popular now because there are safer approaches with better failure rates. The failure rate with coitus interruptus is 32 per 100 couple-years.

Coitus reservatus, keeping the penis in the vagina until the erection passed, was used as a ceremony in ancient India and China. It was believed that a loss of yang would occur with ejaculation, so many tried to preserve it by practicing coitus reservatus. Actually, the ejaculate oozes out and drains into the bladder (retrograde ejaculation). It is not an effective birth control method because there is seepage of semen even without ejaculation.

Douching with an acidic solution, such as vinegar and water, has a failure rate of 40 per 100 woman-years. It is better than no birth control method at all.

RU-486 is an antiprogesterone developed by the French pharmaceutical firm Roussel-Uclaf. When it is taken four days before the menses, it prevents the fertilized egg from being implanted in the uterus. Dizziness, severe cramps, and heavy bleeding have been reported by some users. It is also used as a "morning after" pill when unprotected intercourse has occurred. It has not yet been approved by the FDA for general use, but it has been approved for testing. It is politically controversial in the United States because it can be used as an abortion pill. However, it shares some of the properties of the oral contraceptives and the IUD since it prevents implantation of the egg in the uterus.


Birth control methods of some type have been used by most peoples in the past, but most of the effective methods have been developed in this century. The three most effective methods are the oral contraceptives, the IUD, and sterilization. However, many experts are advising the condom or the diaphragm, used with contraceptive jelly, because the barrier contraceptives also cut down the spread of disease.


Billings, E., and A. Westmore. The Billings Method: Controlling Fertility Without Drugs or Devices. New York: Random House, 1980.

Boston Women's Health Collective. Our Bodies: Ourselves: A Book by and for Women. New York: Simon & Schuster, 1979.

Bullough, V.L., and B. Bullough. Contraception; A Guide to Birth Control Methods. Buffalo, N.Y.: Prometheus Books, 1990.

Can You Rely on Condoms? Consumer Reports, Vol. 54 (Mar. 1989), pp. 136-141.

Hatcher, R.A., et al. Contraceptive Technology, 1990-92. 15th Rev. Ed. New York: Irvington Publishers, Inc. 1990.

Hormonal Contraception: New Long-Acting Methods. Population Reports, Series K, No. 3 (Mar.-Apr. 1987), Vol. 16, No. 1, K, pp. 66-68

Mishell, D.R. Medical Progress: Contraception. New England Journal of Medicine, Vol. 320 (1989), pp. 777-787.

Sanger, M. Margaret Sanger; An Autobiography. Reprinted. New York: Dover Publications, Inc., 1971.

Voluntary Female Sterilization: Number One and Growing. Population Reports, Series C, No. 10 (Nov. 1990), pp. 1-23.

Bonnie Bullough


Counseling vs. Psychotherapy
Theoretical Perspectives and Techniques
Sexual Counseling

Sexuality counseling is a professional role, a service to clients, and a process of human interaction. What Weinstein and Rosen termed "sexuality counseling" is not sex therapy, although the distinction between counseling and therapy in general never has been resolved. The American Association of Sex Educators, Counselors, and Therapists (AASECT) has as its central mission the certification of sex educators, sex counselors, and sex therapists. The certification program defines the requirements and roles of each specialization, but the certification philosophy acknowledges that the roles overlap. In the end, the distinctions among sex educators, sex counselors, and sex therapists comes down to the commonsense notion that educators educate, counselors counsel, and therapists engage in therapy. In short, these three professional roles describe more professional training and self-identity than articulating what the professionals do when working with clients.

The American Board of Sexology is even less specific in its description of diplomates as sex therapists, sex educators, sex counselors, and sex researchers. Unlike AASECT, the doctorate or appropriate terminal degree for the field of study is specified as a requirement for diplomate status with the American Board of Sexology. Of course, sexuality counseling can be done by persons other than sex counselors and sex therapists. However, sexuality counseling by the general counselor may be an exception rather than the rule. In the past, counseling theorists have tended to shy away from sexual issues. It has only been since the late 1970s that sexual orientation has been given expanded attention in the counseling literature. Even today, students in counseling training programs still are not getting an integration of sexual orientation in their professional development. In fact, the wealth of literature on sexual behaviors and feelings experienced by clients along with sex identity development continues to be neglected in the general training of counselors. The theory and training of the general counselor still tends to avoid sexual issues.

Counseling vs. Psychotherapy

Counseling and psychotherapy are often distinguished from each other. For psychologists, counseling and therapy are contrasted in terms of clinical training of the professional and the severity of the client's distress. However, counselors and therapists often share the same goals and utilize the same theories and allied research data when attempting to help the client. When the counselors or therapists succeed, they tend to do so under the same conditions. In theory, counseling and therapy are different, but in practice the distinction tends to vanish. In part, debates over the similarity and differences between counseling and psychotherapy are associated with the development of the two professional roles of counseling psychology and clinical psychology. Counseling psychology has its roots in the vocational guidance movement. Until recently, the majority of counseling psychologists worked in an educational setting. As the needs of society changed, the roles of counseling psychology changed. Initially clinical psychology emerged under the influence of psychiatric theory and practice. Gradually, clinical psychology broke away from those roots. Today, it is difficult to distinguish between the clinical and counseling psychologists. A survey of college counseling services demonstrated that counseling psychologists provide a variety of services, ranging from counseling for personal problems, short-term counseling during profound emotional crisis, and to a lesser extent, long-term counseling for serious emotional problems. Currently, counseling psychologists are employed in mental health centers. More and more counseling psychologists are engaging in private practice providing services not only to persons who are functioning normally but also to those who are severely disturbed. In private practice, counseling psychologists report doing psychotherapy with the emotionally distressed, vocational counseling, and, to some extent, psycho-diagnostic and preventive services.

Still clinical psychologists to a large extent focus on removing "psychopathological symptoms" while counselors tend to ignore them. Rather than treating a personality problem, the counselor attempts to activate existing resources in order to help the client change his or her circumstances or to cope with them more effectively. In general, counseling psychologists are allied with normality and tend to emphasize developmental phenomena. However, the current curriculum for counseling psychologists puts more emphasis on psychopathology and less on adjustment counseling of the normally functioning individual. More and more counseling psychologists are receiving course instruction on a variety of social issues including child sex abuse, incest, and sexual dysfunctions.

In summary, counseling and psychotherapy (or simply therapy) are distinct but overlapping processes. Counseling, on the other hand, is also associated with professional roles (e.g., the counseling psychologist and the most recent professional identity of the certified clinical mental health counselor). Counseling and therapy are attempts to influence another person in an interpersonal context. Thus, in one sense counseling is not unlike any social relationship. In reality, counseling can be much more than a typical social encounter. Increasingly a counselor is professionally certified or licensed to engage in this influence process. Counselors tend to: (1) have expertise in interpersonal relationships and (2) be motivated to help the client rather than to fulfill some personal need. Regardless of theoretical orientation, the intentions of counselors are to:

· Create an expectation of hope that something will change.

· Encourage talking through problems and feelings.

· Challenge maladaptive thinking and replace it with more rational thought.

· Provide feedback about maladaptive and inappropriate behaviors.

· Enhance personal control of feelings and behaviors.

· Foster acceptance and experience of intense feelings.

· Foster understanding of motivations for thoughts, feelings, behaviors, and attitudes.

· Support the development of new skills.

· Reward adaptive changes in the client.

· Work to overcome obstacles to change.

· Challenge old patterns of thinking, behaving, and feeling.

· Use the counseling relationship as a context for developing effective relationship skills.

Empathy, the ability to assume the role of another person without acting in that person's role, is one of the very important skills that counselors develop. In addition, counselors may serve as a mediator between the client and persons who represent the major social institutions within the society. Throughout the relationship, the emphasis is on growth and enhancement of the decision-making skills of the client.

Theoretical Perspectives and Techniques

Today, counselors and therapists, depending on their training and experience, can draw on a variety of theoretical perspectives in working with the client. These include psychoanalytic therapy, Adlerian therapy, existential therapy, person-centered therapy, Gestalt therapy, transactional analysis, behavior therapy, cognitive-behavioral therapies, and reality therapy. In the end, the therapy the client experiences depends on the counselor's personality and professional decisions. Yet, today it is recognized that some theories and techniques are better than others. When development of the client is the goal, some theories and techniques are more effective than others, which is another way of saying that counseling is more than an ordinary social encounter. The counselor must master certain theories and techniques to be effective in the counseling relationship. Some counseling textbooks essentially leave the theoretical choices up to the counselor. By contrast, Burke attempts to present a specific perspective for counseling, which he calls the self-regulation and maturity two-part model. The self-regulation emphasis is rooted in the theories and techniques of behavior therapy. Identification of specific problems and application of specific ways to change behavior are stressed. The maturity component is based on psychoanalytic and person-centered theories. Thus, the second component makes the counseling relationship central to the therapeutic process. This model is clearly in the counseling tradition with its emphasis on adaptivity and maladaptivity rather than on sickness and health. The counseling goal is not only to gain control over thoughts and behaviors, but also to encourage and support continuing growth toward maturity.

Just as the professional roles of counseling psychologists, clinical psychologists, social workers, marriage and family therapists, and mental health counselors imply unique training and skills, so do sex counselor and sex therapist imply the same. (There is a great wealth of literature written by persons engaged in sex therapy listed in the Reference section. Books on sexuality counseling, however, are rare. Hopefully, that situation will be remedied in the decade of the 1990s.)

Sexual Counseling

The professional backgrounds of sex counselors are diverse. Clients may seek sexuality counseling because of a need to better understand sexuality. More often clients are thrown into sexuality counseling as a result of some traumatic event or crisis (e.g., sexual assault, unexpected pregnancy, or relationship problems with a partner). Sexual counseling is an interactive process involving a client and a professional. In this special relationship, clients are permitted to explore and to seek to understand sexual feelings, values, needs, actions, and responsibilities. The focus in sexuality counseling is on identifying and resolving sexual problems. Professionals who regard themselves as sex counselors tend to deal with a broad range of sexual issues, whereas sex therapists tend to specialize in treating sexual dysfunctions. In the past, sexuality counseling was largely done by psychiatrists and clinical psychologists. But today clients concerned about family planning, relationship problems, or concerns emerging from some trauma or crisis will find sexual health professionals who are neither psychiatrists nor clinical psychologists.

Kaplan has proposed a triphasic model for human sexuality. From that perspective, a sexual dysfunction is a disturbance of sexual desire, sexual excitement, or the orgasmic response. But clients also have a broad range of sexual concerns that can be called sexual problems, which include partner conflicts of frequency of sexual intercourse, partner disagreements over sexual activities, a feeling of sexual dissatisfaction, and sexual boredom. In this context, distinction between sexuality counseling and sex therapy can become blurred. In some cases, sexual functioning may be enhanced by more adequate sex knowledge and improved communication skills. Yet these very same issues may suggest a dysfunctional marital unit or a set of unresolved attitude and value conflicts. In those cases, marital counseling or individual therapy may be more appropriate than sex therapy or sexuality counseling.

No one simple explanation can account for the growing need for sexuality counseling. A part of the need is driven by an exposure to rigid sexual standards of right and wrong and related sex role socialization. More and more individuals are finding the values, attitudes, and guides for behavior learned in childhood out of step with the social realities of adulthood. Media treatment of sexuality has raised expectations for a more satisfying sexual life. Gays and lesbians have become more visible in society. Drug abuse has contributed to a variety of sexual dysfunctions. There is more public awareness of sexual assault and child sex abuse. Greater sexual freedom has resulted in unexpected and unwanted pregnancies among the teenage population. The elderly, brought up in a more restrictive sexual climate, are learning about sexual rights once denied.

Individuals seek sexuality counseling because of problems in sexual functioning or need for support and information during a particular stage in the life cycle. Sometimes individuals seek counseling following divorce or death of a partner. Because of stigmatization, gays and lesbians frequently seek counseling. Some clients are disabled or parents of the disabled. Family planning counseling and counseling for unplanned and unwanted pregnancies are services provided by some sex counselors. More and more sexuality counseling services are extended to the sexually abused and incest survivors as well as victims of sexual assault. Chemical dependency, alcohol abuse, chronic physical illness, and sexually transmitted diseases often prompt individuals to explore sexual concerns.

The need for sexuality counseling can emerge within the context of personal counseling or therapy. However, sexual concerns are more likely to surface when the professional has a sex counselor identity. When a female client discloses the experience of incest during childhood, the sex counselor will probably ask explicit questions about other possible forms of abuse within the family. Within the sex counseling relationship, the reality of the incest is affirmed and acknowledged. Incest is treated as an important life experience and its possible relationship to present sexual concerns is explored. The counseling goal is to develop the identity of an incest survivor rather than that of the "helpless incest victim." In university women who have repressed incest, the general treatment goal is to offer the experience of emotional catharsis in a safe and accepting counseling context, to gain integration of past experiences with present relationships along with fostering insight in understanding the family dynamics that produced the incest, to promote positive sense of self-worth, and to extend trust to others along with increasing comfort for intimate relationships. In some incest and sex abuse case management, the counseling needs of the individual and family may demand more resources than the individual sex counselor can provide. In such cases, case management teams, often composed of psychologists, psychiatrists, nurses, social workers, and marriage and family counselors, may be able to help where the individual counselor cannot. Clients must be made aware that there are legal mandatory reporting requirements associated with incest and child sex abuse.

An unwanted pregnancy may lead to a need for specialized counseling, which includes information about options and support during the decision process. Sexuality counseling may be needed by some women who had an abortion without the knowledge or support of friends and family. In such cases, complaints of depression may be related to failure to process unresolved grief associated with the abortion. Such women may deny grief, the experience of loss, and the need to talk about the experience.

Non-conformity to a heterosexual orientation was indicative of mental illness until 1973, when the American Psychiatric Association Board essentially reversed that long-standing tradition. Just how and why that decision was reached continue to be controversial. Today, sexual orientation is generally viewed as an identity issue. However, the process of sexual identity formation may not be the same for gays, lesbians, and bisexuals. In addition to sex identity clarification, adolescent homosexuals and bisexuals often need support in coping with the stigmatization associated with the emerging sexual orientation, counsel on minimizing the risk of AIDS, and suicide prevention counseling. Because of the continuing stigmatization associated with homosexuality, parents may need counseling to understand and accept the homosexual or bisexual identity of the adolescent. Sex counselors are more likely to be more consistent in attitudes toward homosexuals than are nonspecialized counselors and therapists. Society continues to be antigay. While counselors and therapists formally no longer regard homosexuality as a mental illness, far too often they hold the contradictory view that being gay or lesbian is a problem. Thus, the gay client may be put at risk when the counselor does not recognize the personal prejudicial bias. The development of a gay identity typically starts with a feeling of being different followed by an awareness of sexual attraction for persons of the same sex, an identity crisis, and finally the acceptance of a gay identity. The general pattern may not hold for a developing lesbian identity and does not recognize the additional stigmatization due to racism that black gays and lesbians experience. While the social community may support the development of racial and ethnic identities, because of the prevalence of negative attitudes toward homosexuality, that same social community may not support the development of a homosexual identity. To the extent that the counselor or therapist lacks sensitivity to multicultural issues, the effectiveness of sexuality counseling with minority gays and lesbians may be compromised.

Healthy individuals may seek sexuality counseling because of fear of acquiring AIDS through social contact with an HIV-infected person. Family members may require support in understanding AIDS and in coping while caring for an AIDS victim. The AIDS victim experiences a variety of situations resulting in emotional distress which can be alleviated through counseling. Circumstances producing emotional distress include abandonment by parents, loss of employment, indifference of public agencies, and feeling trapped in a relationship. In some cases, counseling intervention may be required in response to irresponsible behavior that unnecessarily puts others at risk with human immunodeficiency virus (HIV) infection. In addition to all these problems, the AIDS victim has to cope with and come to terms with death. Given the stigmatization associated with homosexuality, unresolved issues about gayness may emerge as well as feelings of shame and guilt for acting on one's gayness. Finally, those who are in grief over the loss of a person having died with AIDS may seek counseling support as well.

Sexual assault (commonly known as rape) is forced sexual contact without a person's consent. The perpetrator of the sexual aggression may be a stranger or someone well known to the victim. Either form of rape can have immediate consequences and long-term effects. In acquaintance rape, or date rape, a woman may not acknowledge that she has been sexually assaulted. Sexual assault is often unexpected, not the result of a woman's behavior, and almost certainly traumatic. Crisis intervention rather than counseling and therapy is a common support for a woman who understands that she has been sexually assaulted. Crisis intervention focuses on processing the traumatic experience and providing the necessary support in dealing with actions and decisions that the circumstances require. However, it is not unusual for a woman to seek counseling and therapy because of complaints of depression, alcohol and drug dependency, irrational fears, panic attacks, and obsessive-compulsive tendencies. Sometimes these symptoms are related to a history of sexual assault. Not uncommonly women develop problems in sexual functioning. For some, the first sexual intercourse occurs during stranger or acquaintance rape. The counseling process can help a woman deal with her feelings about loss of virginity. Sexually experienced women may develop a pattern of avoiding sex with their partners. The goals for these women in counseling are to deal with the shock, denial, symptoms and anger that follow from the rape experience and to reestablish healthy sexual functioning.

Sexism is a social attitude that devalues, restricts, or discriminates based on one's biological sex, gender role, or sexual orientation. Gender role refers to behaviors and social roles expected by society based on one's sex. Sex counselors are developing an appreciation that men and women have different issues to be resolved and needs to be met during counseling. There is also a growing recognition by counselors that the counseling process can be influenced by sexism and assumptions about gender roles made by the counselor. Finally, societal rules about gender role behavior are undergoing radical change. Today, clients have a need to understand these societal changes and to integrate these changes in their identities and relationships.

Sex counselors provide diverse sexuality counseling services. Sexuality counseling is, however, not limited to sex counselors. A person having a need for sexuality counseling must decide who among the professionals has the best training and experience to assist with the sexual concern. A sex counselor can help clarify the client's needs and make appropriate referrals when necessary to do so. The American Association of Sex Educators, Counselors, and Therapists identifies professionals who have met the organization's standards for certification as a sex counselor. The American Board of Sexology lists professional counselors who have met their standards for diplomate status as sex counselors.


American Association of Sex Educators, Counselors and Therapists. 1990-1991 Membership Directory of the American Association of Sex Educators, Counselors and Therapists. Chicago: American Association of Sex Educators, Counselors, and Therapists, 1990.

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Robert A. Embree


As in other professions, prostitution has its status hierarchies. In contemporary society, the common streetwalker and the high-priced call girl are both available—depending on the thickness of his wallet—to attend the biological urgencies of the male. In former times, prostitution was more stratified. In ancient Greece, there were three kinds of prostitutes: the brothel-based pornae, the prettier and more entertaining auletrides (roughly corresponding to current streetwalkers and call girls, respectively), and the exulted hetaerae. The wealthier and more refined Greeks disdained the first two types in favor of the hetaerae, who were high-class courtesans. Thus, courtesans are prostitutes with a courtly, wealthy, or upper-class clientele.

Courtesans in ancient Greece were prized not only for their sexual expertise but also for their intellectual stimulation; the wealthier Greeks liked their lust spiced with literature and philosophy.

In ancient India, too, the devadasis (servants of the Gods) provided cultured conversation along with other services as temple prostitutes. Their singing, dancing, and other diverse entertainment skills marked them as courtesans and distinguished them from the common harlots of the street. Although their services were provided for all who could pay, their primary customers were the Brahmans, the highest members of the Hindu caste system.

Perhaps the most famous courtesans of all are the geisha (person of artistic performance) of Japan. Unlike the hetaerae of Greece, who were women of high birth who had fallen on hard times, the geisha usually came from impoverished homes and were apprenticed out by their parents. They were rigorously trained in conversation, singing, dancing, the tea ceremony, as well as in the more esoteric of the erotic arts.

Courtesans were not limited to the Eastern world; they also existed in Europe, particularly in Renaissance Italy. Although no rigorous training in the intellectual and musical arts was required of the Italian courtesans in the manner of the geisha, the best of them were almost certainly so versed. Probably the height of the courtesan phenomenon was the 19th century in Europe and America when many women used their ability to please men to rise to roles of power and influence.


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Lawner, L. An English Writer Views the Venetian Courtesan. In Lives of the Courtesans. New York: Rizzoli, 1987.

Anthony Walsh


Courtship refers to everything that passes between two people as they become sexually and emotionally interested in each other, and as they become sexually intimate with each other. Sometimes, people say "courtship" when they mean "making plans to get married," but courtship includes much more than either seduction or becoming engaged to marry. It has psychological, emotional, symbolic, religious, and even body-language aspects that involve each person deeply and fully. What passes between the two people during courtship—in the broad sense just defined—can sometimes lead to serious miscommunication and even serious problems, such as date rape.

Heterosexual courtship that leads to marriage has played a large role historically in many people's lives, and they often think that courtship simply means falling in love. But courtship involves more than love rituals, because to be successful, courtship must create deep mutual understanding and agreement of a kind that almost never occurs in any other sort of relationship. So courtship includes everything that passes between the two people, not merely their holding hands in the rain, glancing across a crowded room, or even deciding to share a bank account. It also involves more than happiness, because the courting pair must make decisions that sometimes are difficult—for example, decisions about giving up the pleasures of single life for a life of committed responsibility with another person.

Because courtship is so complex, and because the emotions of joining together with another person are multicolored, many—perhaps most—people feel that it cannot be studied by scientists and scholars. But that is not true. Courtship has many surprises, and no individual can judge the full range of what passes between two people just on the basis of that individual's own personal experiences. Scholars can bring to understanding courtship a wider range of knowledge and sympathy than the layperson may have and can offer insights based on the lives of many other people, from other places, times, and cultures. The following description addresses primarily adult heterosexual courtship. Similar patterns appear in gay couples, but gay courtship has not been so well researched, nor has courtship among teenagers, such as high school students.

In America, and probably elsewhere, courtship depends on women's active engagement in seeking partners and in communicating their interest to them. In research done in the United States and Canada, Perper and Weis found striking similarities in women's courtship plans and strategies and called women's active communication of interest "proceptivity." They defined proceptivity to mean "any behavior pattern a woman employs to express interest in a man, to arouse him sexually, or to maintain her sociosexual interaction with him." This involves her choice of dress and clothing, invitations by her to private or secluded places, establishment of a romantic mood by music and dancing, talking in sexy and romantic ways, smiling, laughing, making eye contact, and, of course, touching and kissing.

Many people know that women can sometimes be seductive, but the important point of speaking of proceptivity is to stress that such strategies are not recipes for random promiscuity or a checklist of things to do to find the perfect man. Instead, women often thoroughly understand their own and the man's reactions to entering into sexual intimacy, and they can describe not only what the woman does but also how the man responds, as well as what it means emotionally when he responds—or does not respond—in a certain way. By contrast, many men are unable or unwilling to explain such things and focus instead on sexual intimacy itself. It is a kind of romantic division of labor, with women initiating the interaction proceptively, and men responding sexually.

This finding is one of the surprises about courtship because there is a common belief that men, not women, are the sexual initiators and that women are usually sexually reluctant and hesitant. Sometimes, of course, women are reluctant and men are eager. That happens most often if the woman is not sure of her own feelings and does not fully understand or trust the man's motivations: are they purely sexual, or is he offering love and a relationship? Under those circumstances, many women adopt a wait-and-see policy; a woman will date the man but forestall his efforts towards sexual intimacy until she knows him, and his motivations, much better. If the woman is sure she likes and wants the man, however, she can be quite direct in letting him know, using many of the strategies previously mentioned.

Some women know they want nothing to do with a man who has just introduced himself. Many women are reluctant to be impolite, and they may talk distantly to the man and avoid sending signals to him, while ignoring whatever signals he sends. Other women may forthrightly tell him they are not interested in him and cut the conversation short.

So there is a spectrum of women's behavior and feeling during a courtship interaction. At one end of the spectrum, she knows she likes him and sends direct, sexy signals, such as wearing enticing clothing, touching him, smiling, and talking about how interesting he is. In the middle ground, the same woman may feel uncertain about a man, holding him off sexually while dating him a few times to test the waters. At the other end of the spectrum, the woman may find a man uninteresting and maybe even obnoxious, and try to send clear, if polite, signals that she is not interested at all.

What about the man? For many men, opening what might possibly be a sexual relationship with a woman is emotionally trying and difficult. Men often speak of "getting shot down" by a woman they liked or found interesting, and after a while many men develop defenses against showing exactly how interested they are. If the woman says she is not interested in sex but is willing to date—the middle ground mentioned above—he may decide that she means no sex at all under any foreseeable circumstances and become emotionally distant with her. Then she will probably decide that he does not like her, and the courtship will fail. Other men feel more or less angry at women in general for previous rejections and express hostile contempt for women. They, too, guarantee failure for themselves. Other men will continue to press the woman for sex, even after she has politely declined the offer. Then the two people may become very angry with each other and exchange insults and accusations. Still other men become awkward and shy, finding themselves unable to behave naturally with the woman and creating an unpleasant, artificial ambience for a date. But other men will find the woman's behavior exactly to his liking, and his and her feelings and behavior mesh.

When that happens, many people say "the chemistry was right" or "it was just electric." Popular magazines and books have been written about such "chemistry," but here the scholar can make a useful contribution to understanding what is really going on. Is it just chemistry—"that ole black magic," as the song goes—or are there patterns and sense in an interaction that succeeds?

It turns out that there are patterns, and both men and women would be greatly helped to understand each other if they accepted that courtship involves a sequence of events, emerging from their interaction itself rather than being foreordained by the stars, or by good chemistry, or by other mysterious forces and processes. And here, based on several thousand hours of observation, is an outline of that pattern.

Often, men and women communicate interest for the first time by eye contact. One woman said, "A held glance says, 'Hey, I like you.'" And she is right. Of course, sometimes a held glance becomes a stare, which many women find extremely unpleasant, especially if the man eyes her body up and down. Such looks are often the best way not to start a relationship. But even so, when it occurs, that held glance can be very powerful indeed, because it is forthright on both sides.

Usually, that held glance is followed by an "approach"—which means that one person, often the woman, moves physically closer to the other person. For many people, this easy-sounding step is one of the hardest of all. One man said that walking over to a woman is like climbing Mt. Everest: he meant that all his buddies were watching him and waiting for him to get shot down. The woman being approached is also watching the man, if only out of the corner of her eye. It is very difficult for the man to tell if she is thinking "Who is this bozo and how do I get rid of him" or "Here comes this cute guy." The man's life is made easier if the woman approaches him, and many women do, but then the woman may feel the same shyness and uncertainty that he feels approaching a woman.

The reason for stressing the approach as the first overt stage of courtship is that many people firmly believe that it all starts with the "opening line," usually something the man says that he thinks is clever, interesting, funny, or otherwise attractive to the woman. But by the time he has walked all the way over to her, she has had a while to make an initial judgment about him—usually based on his looks, dress, and how he carries himself. If she has decided that he is a sloppy-looking drunk, it does not matter at all what his opening line is, and his line may make things much worse—she may well tell him she is not interested. However, if she thinks he is probably all right, she will likely respond pleasantly to him regardless of what his opening line is.

Assuming she does think he is potentially acceptable in looks, manners, and bearing yet she may still be quickly turned off by at least some lines men report using. Sure-fire dead-end lines include insults—"Hey, when did they let you out?"—and efforts to be crude but funny, such as "I bet I can drink you under the table" or "How's your sex life, gorgeous?" The best lines, as described by women, include simple self-introductions, requests by the man to join the woman talking, and comments on the surrounding setting. These are social, friendly, and nonthreatening, and communicate the message that the man is nice and not a foolish buffoon, nerd, or creep.

The approach and the opening of a conversation illustrate an important point. These interactions proceed stepwise, by little increments, not by sudden leaps to sexual intimacy. Each step involves each person testing the other's interests and attractiveness, often in subtle and complex ways. And whenever one person makes an overture that would increase their intimacy, it is the other person who decides to accept or reject that small overture. This last principle is called "escalation." It means that the man who approached the woman escalated their interaction, because she, not he, will determine what happens next. Throughout the entire sequence, the same principle holds: the person who sends the signal does not determine how it is received.

So, imagine that the woman and the man have started talking, each having passed initial muster in the other's eyes. She says something that genuinely interests him, and he smiles and turns a bit to face her as he answers. He has escalated their interaction by turning, whether or not he knows it or intends it. The reason is that now she, not he, determines what happens next. If she likes him, somewhat or a bit, she will find his turning acceptable—it signals his attentive interest in her. So she responds by turning a bit to face him. The escalation has been accepted. But if she is getting bored by him, she might not want to continue talking, and as a result she does not turn toward him. She is rejecting his interest.

The partner whose overture has been rejected has very little recourse but to back down. The man cannot reach out and forcibly turn her body toward him, and if he does, she will be quick to tell him to stop and perhaps even call for help. Many women are extremely sensitive today to men who push their attentions on them, and may express clear dislike and contempt.

But let us assume that she finds his increased interest acceptable and nice. So she turns further to face him, and then he turns more toward her, until, after a while, they are fully facing each other. By this time, they are also probably maintaining eye contact, smiling, talking enthusiastically, gesticulating, and feeling good about each other. As they do so, probably the most crucial step in the entire process may now occur: the first time one of them touches the other.

When women touch men in this manner, they touch lightly, even fleetingly. She might reach out a hand and touch his arm while saying something like "Yes, that's interesting." Such touches are not grabs, caresses, fondles, or even overtly sexual. Nonetheless, they communicate a powerful message.

If the two people are genuinely communicating, the message is one of warmth and continued, growing interest. From there, the interaction is likely to proceed to what is called "body-movement synchronization," not a euphemism for sexual intercourse but a pattern of movement in which each person spontaneously mirrors the movements of the other person. Thus, they each reach for their drinks, lift them, sip, and replace them on the table, as if a mirror had been placed between them. Few people seem to notice synchronization, because emotionally it represents their fascination with each other and not with details of body language.

However, all too often men fail to understand the message the woman intends when she touches him, smiles at him, or even is willing to talk to him in the first place. Many men, if not all, believe—because they want to believe it—that the woman's signals, such as her touching him, mean "I want to have sex with you." Very rarely is that what the woman means. Instead, she is saying, using body language, that "I want to get to know you better." A man who wants sex, and nothing but sex, can ruin whatever chances he might have had by touching the woman too soon, too intimately, and too frequently. She will very possibly be repelled, and not at all attracted, by such a man.

A particularly bad example of such touching occurs when the man, perhaps a bit drunk, suddenly puts his arms around the woman and starts kissing her. In her eyes, she has sent no signals whatsoever that would explain or elicit his sudden sexual attack. So she feels that he is about to rape her—and she is frightened and angry. But, because he has not been paying attention to her signals—perhaps he feels that men make the first move and that all a man has to do is to get the woman alone and then arouse her—he feels that she has suddenly turned on him and is now falsely "crying rape." He might defend himself, perhaps later to a police officer, by saying that she agreed to be alone with him, and that that "meant" she wanted to have intercourse with him. But that is false—she may have initially felt quite safe with him, until suddenly he attacked her sexually.

In this interaction, what actually went wrong? Society all too easily blames the woman, saying that she should have stopped the man earlier, but that is unfair to the woman. Earlier she may have liked him, and not at all been able to foretell that he was going to attack her. But there is one thing she could have done that might have forestalled such an attack, and that is to explain to him, in simple words, that she does not have sex with men until she knows them well. Then he has no excuse at all if he does attack her.

But, in reality, the man is much more to blame in situations like these. He, not she, was out of control, unable to regulate his own sexual urges according to social principles and good manners, to say nothing of respect for her. Unable to face her rejection—or what seems to him to be a rejection—he is then unable to behave like a grown, mature man, who may smile ruefully, perhaps, but still is able to take no for an answer.


Perper, T. Sex Signals: The Biology of Love. Philadelphia: ISI Press, 1985.

Perper, T., and D. Weis. Proceptive and Rejective Strategies of U.S. and Canadian College Women. Journal of Sex Research, Vol. 23 (1987), pp. 455-480,

Timothy Perper


Couvade, or couvade syndrome (CS), when translated literally from French, means "to brood, or to hatch." It is used to describe symptoms of pregnancy in expectant fathers. In recent years, the term has been extended to apply to symptoms manifested by lovers of a pregnant female. CS has been documented in most Western societies; in the United States the reported incidence ranges from 22 percent to 79 percent. In some nontechnological cultures, couvade has been documented as well, with the male ritualistically imitating the pregnancy and delivery of his wife in order to draw evil spirits away from her.

According to Broude, it is important to view the couvade as a set of practices embedded in a larger cultural context rather than as a custom affecting only the behavior of the fathers. There is a tendency for the custom associated with the couvade to apply to other family members as well as to the father. For example, the family's children as well as the father of the Chiriguanoa Indians of Paraguay lie-in and fast at the birth of a new child.

Physical manifestations attributed to CS include a wide spectrum of discomforts, some that are remarkably similar to those experienced by pregnant women. Most are gastrointestinal symptoms (e.g., nausea, vomiting, heartburn, and constipation), abdominal swelling, unintentional weight gain or loss, appetite changes, and general feelings of ill health.

Physiological symptoms often linked to CS include restlessness, irritability, insomnia, generalized anxiety, depression, headache, and difficulty concentrating.

In Clinton's longitudinal study, symptoms of 86 expectant fathers were compared with those of a control group of 66 nonexpectant men. The expectant fathers suffered significantly more bouts of irritability and stomachaches during the first trimester. However, expectant fathers differed most from other men during the early postpartum period, with significantly more frequent and serious episodes of restlessness, insomnia, excessive fatigue, and difficulty concentrating. The most accurate predictors of CS were lower income, poor health status the year prior to the pregnancy, unplanned pregnancy, and high levels of stress during pregnancy.

Until the late 1960s, CS was regarded as primarily a neurotic phenomenon. Recently, it has been associated with developmental crisis theory. In a study, also by Clinton, it was found that previously healthy men developed numerous symptoms during the pregnancy of their wives, suggesting that the transition to fatherhood is a normal development stage accompanied by a certain amount of stress.


Broude, G.J. Rethinking the Couvade: Cross-Cultural Evidence. American Anthropologist, Vol. 90, No. 4(12) (1988), pp. 902-911.

Clinton, J. The Couvade Syndrome. Medical Aspects of Human Sexuality, Vol.21, No. 11 (1987), pp. 115, 132.

Francoeur, R., et al. A Descriptive Dictionary and Atlas of Sexology. Conn.: Greenwood Press, 1991.

Hope E. Ashby


Historical Cross-Dressing
Development of the Medical Model to Explain Transvestism
Current Patterns of Cross-Dressing
Research About Cross-Dressing

Cross-dressing is a simple term for a complex phenomenon. It ranges from wearing one or two items of clothing of the opposite sex to a full-scale burlesque, from a comic impersonation to a serious attempt to pass as the opposite gender, from an occasional desire to experiment with gender identity to an attempt to live full time as a member of the opposite sex. Researchers at the turn of the 20th century, most of them physicians or psychiatrists, tended to use a medical model that conceptualized variations from the norms of gender behavior as an illness. Such definitions were emphasized in an effort to uncover the causes of the "disease" or "problem" on the assumption that once they have been determined, steps could be taken to "cure" the patient or client.

One first step in this process was to name and label the phenomenon. The term "transvestism" (Latin for "cross-dressing") was coined by Hirschfeld in 1910. Ellis, his contemporary, felt that the term was much too literal and that it overemphasized the importance of clothing while failing to include the "feminine" identity factors present in male cross-dressers. More or less ignoring the possibility of female cross-dressers, Ellis coined the term "eonism" based on a historical personage, the Chevalier d'Eon de Beaumont (1728-1810), who spent much of his adult life living as a woman. Since that time other terms have been advanced, including "gynemimesis" (literally "woman mime") and its counterpart andromimesis, femme mimic, femmiphile, androphile, female or male impersonator, fetishistic transvestite, transgenderist, preoperative transsexual (to distinguish the person from a postoperative one), gender dysphoric, and many others. Most of these terms imply more than simple cross-dressing and are used to describe different levels or different points of view.

Historical Cross-Dressing

This entry uses the term "cross-dressing" in order to include all aspects of the behavior and to emphasize that gender-crossing has been a ubiquitous phenomenon which has existed since males and females adopted sex-differentiated clothing and symbols.

Mythology of most cultures includes instances of gods or goddesses impersonating the opposite sex and even of some actually changing their sex. Similarly, mortals had their sex changed by the gods or for some reason impersonated the opposite sex. Many societies have institutionalized a supernumerary gender or third sex to allow certain people to live outside the gender norms of the culture. In scholarly literature, this role traditionally has been described as the berdache one, but in recent years the term berdache has been restricted to men crossing the gender boundary and the term "amazon" has been used to describe women who performed as men. Such crossing over not only existed in tribal societies but also in sophisticated religions such as Hinduism, where a special class of males, the hijras, live as women. Classical Greek culture, while not institutionalizing a permanent role for cross-dressing, did so on a temporary basis at festivals and ceremonies and some of this continued into Roman society.

Cross-dressing was common among early fertility cults, and it was probably to distinguish their believers from these "pagan" cults that the early Hebrews prohibited men from wearing "that which pertaineth to a woman" and women from "that which pertaineth to men" (Deuteronomy 22:5). Such a prohibition, however, was never entirely enforced and in fact there are records of Jewish soldiers adopting women's dress as a disguise during military operations. The Talmud specifically encourages women who are going on a journey among potentially unfriendly peoples to disguise themselves as men. Similarly, men disguised themselves as women at the feast of Purim and the practice of cross-dressing was sanctioned at wedding feasts and celebrations. Though the Christian Bible included the prohibition against cross-dressing, it continued to exist during such occasions as Halloween and festivals such as Mardi Gras.

Generally, it was more permissible for females to cross-dress and impersonate males than vice versa. This was because being male and masculine implied a much higher status in society than being female and feminine. Women in effect gained status by cross-dressing and impersonating males while men who cross-dressed lost status. One of the more fascinating aspects of the history of cross-dressing is the large number of Christian female saints who were thought to be men when they were alive, for example St. Pelagia (also known as Margarite). In fact, it was their successful denial of what society assumed to be feminine weakness and their ability to live as men that led to their sainthood when their true sex was discovered at their death.

Historically, in Western culture, many women are known to have lived and worked as men, literally thousands of them, while, until the 20th century, only a handful of men are known to have lived the role of women full time. A major motivation for the crossover was the restrictions society imposed on women. Women living and working as men had greater freedom of action. Moreover, society in general was very understanding of such women when they were unmasked.

Because women's role was so restricted, however, it allowed for female impersonation in areas where women were not permitted. Women, perhaps because the medieval theater developed in the church and around the altar, were excluded from the stage and males played female roles. These men were not stigmatized for acting in these roles. In the West, it was usually the apprentice actors who played the female roles but by the time of Shakespeare some continued to play such roles. In Japan and China, female impersonation on stage became a life-time occupation and in Japan has been kept alive in the Kabuki theater. In England, it was not until the end of the 17th century that women appeared on stage in their own right. Males even sang the female roles in opera and to enable them to do so as adults, many underwent castration. The castrati remained dominant in opera almost up to the 19th century.

Some of those who cross-dressed were homosexual or lesbian but many of those for whom detailed information exists were not. The primary interest of many of the female cross-dressers was in the greater opportunity and freedom afforded by the male lifestyle.

One of the most detailed accounts of female impersonation is that of the Abbé de Choisy (1614-1713), whose memoirs of his cross-dressing experiences have survived. His fellow cross-dresser, Philippe d'Orléans, brother of King Louis XIV, was homosexual. In the 18th century in London there were special clubs for male cross-dressers, which were also centers of homosexuality.

It was Hirschfeld who emphasized that cross-dressing was more complicated than had been assumed and that there were men who really wanted to express a feminine side and women to express a masculine side by their cross-dressing, and that the cross-dresser could be homosexual, bisexual, heterosexual, or sex neutral.

Development of the Medical Model to Explain Transvestism

Neither Hirschfeld's nor Ellis's studies were widely accepted by the professional medical community. Instead, the developing field of psychoanalysis adopted a medical model to label certain cross-dressers as transvestites and to explain transvestism as a type of fetishism. The link to fetishism occurred because many of the cross-dressers seen by the doctors seemed to be fixated on items of clothing. The medical community attributed the condition to castration anxiety in men and penis envy in women. Later, in the mid-20th century, the psychoanalytic writers argued that the condition stemmed from an overly protective mother and an absent father. Since these were also the explanations for homosexuality at that time, the two conditions were often linked in both the public and medical mind.

Current Patterns of Cross-Dressing

Starting in the late 19th century the pattern of cross-dressing changed, with fewer women changing their sex roles and more men periodically cross-dressing for erotic pleasure. Presently, there is a disproportionate number of men compared with women involved, a quite different situation from the past. This has led to speculation that for many men the feminine role is much more attractive than it once was, and the masculine role is less attractive to women than it once was.

Several factors served to renew public attention to cross-dressing in the 1950s and 1960s. One was the massive publicity given to the Christine Jorgensen case, the American who in 1953 underwent castration and penectomy in Denmark and officially had his sex altered on his passport from male to female. Though the operating surgeon, C. Hamburger, and his colleagues originally called Jorgensen a transvestite, the case led to widespread discussion and ultimately a distinction between transvestism and transsexualism. Benjamin developed a three-point scale of transvestism, with transsexualism being considered an extreme form of transvestism, although he later came to regard it as a different entity.

Further emphasizing the difference were the activities of Virginia Prince, a Los Angeles transvestite, who beginning in the 1960s published a magazine devoted to the heterosexual transvestite. Prince was disdainful of cross-dressers who allowed themselves to be "mutilated" by surgery. Encouraged by readers of the publication Transvestia, Prince established a "sorority" with chapters in various major cities, emphasizing the heterosexuality of transvestism and the importance of allowing the "girl within" to appear. Prince began to live full time as a woman, and decided to devote more or less full time to spreading her ideas of transvestism and establishing a movement. She traveled worldwide, giving interviews, appearing on television, and attracting thousands of followers. One result was a surge in research into the topic, since there were cross-dressers available for research projects who had not come from a psychiatrist's office. As the movement spread and grew, dissident voices also appeared, and Prince, who is still alive at this writing, gradually stepped down from leadership, and a number of different publications and movements emerged. As of 1992, there are cross-dressing groups that emphasize heterosexuality, homosexuality, and bisexuality. Some include transsexuals, others do not, and there is a small industry that fulfills the clothing and other needs of the male transvestite. Some individuals live full time in the opposite gender role, others dress only occasionally and partially; there is also a whole range in between.

Presently, female cross-dressers are less numerous and less noticeable than male cross-dressers, partly because women are generally allowed more deviations in dress before they are noticed and labeled as cross-dressers. The current generation of female cross-dressers is primarily lesbian, although there are a few who focus their erotic attention on their dress rather than on their sex partner, which tends to be the case with male transvestites. The late Lou Sullivan, who edited the newsletter FTM for female-to-male cross-dressers and transsexuals, argued that many of his readers were simply women who cross-dressed and did not want surgery. He held that the literature of transvestism was simply biased in not including more about women cross-dressers.

Research About Cross-Dressing

Researchers are not agreed on the factors involved in cross-dressing but increasingly recognize that some of it is normative and that there is a basic curiosity about the opposite gender and the clothes and ornamentation associated with it. In some people, the curiosity goes deeper, and it probably has biological as well as social-psychological causes. While no particular bio-genic cause for cross-gender behavior has been isolated, research suggests that this may happen in the future. That factor may be common for other related behaviors, such as homosexuality. (In many societies, men who demonstrate a desire for the feminine and who cross-dress are simply labeled as homosexuals. In many of these societies, the cross-dressing homosexual is the receptor rather than the penetrator in intercourse, and in fact the penetrator himself is not labeled as homosexual.)

There are also social factors involved. The heterosexual cross-dresser as an adolescent is able to display a more masculine side to his companions and to keep his cross-dressing secret from them. Studies have indicated that these young men, at least those who end up in the transvestite clubs, were well integrated into the male society of their age group at least superficially.

Most of heterosexual cross-dressers emphasize that they began cross-dressing early, and certainly by their teens. It was also associated with experiencing an erection and masturbation or a spontaneous ejaculation. Cross-dressing is also exhilarating for many because it is forbidden and the dangers associated with being caught and exposed add to the sexual excitement.

There are, however, many forms of cross-dressing, and any attempt to give a simple explanation is doomed to failure. Some of those who cross-dress were kept in clothes of the opposite sex as children or forced to don such clothes as punishment. Recent research, however, has tended to emphasize that something more than simple conditioning must take place to establish a pattern of cross-dressing.

Various studies on the organized transvestite groups indicate that most transvestites were married at some time in their life and two thirds or more were at the time they were studied. In a detailed study of occupations based on a scale of occupational prestige, the occupational level of the transvestite group was higher than the norms for the total American population. Studies done in the 1970s and early 1980s indicate that the majority of the men considered themselves heterosexual, although later studies have modified this somewhat as the club movement has broadened. Other studies report that many transvestites are heterosexual when they are not cross-dressed but prefer male sex partners when they are dressed as women.

As transvestites age, their reasons for cross-dressing change, and if they had fetishistic urges earlier, they have less of this drive later. One researcher reported that many of the older transvestites in his study cross-dress in order to temporarily escape the pressure of being masculine rather than for any erotic experience. It is only in the feminine role that they are able to give release to emotions that society has labeled as feminine.

Various researchers have developed classification schemes to categorize cross-dressers. Most of the schemes try to account for three variables: (1) the extent of the cross-gender orientation, (2) the degree to which there is erotic arousal with cross-dressing, and (3) sexual orientation toward the same or opposite sex. It is clear that there is significant variation on all of these parameters.

It seems clear that the current understanding of cross-dressing is changing. As cross-dressers come out of the closet and become more vocal, appear on television, or have their stories appear in the local newspapers, the numbers of cross-dressers seem to increase. It might well be that the understanding of the phenomenon is where the study of homosexuality was in the 1960s, when homosexuality was still mainly an underground movement. Once homosexuality was removed from the category of a pathology in the American Psychiatric Association's Diagnostic and Statistical Manual, it came to be seen as an alternative form of sexual activity. Though it was recognized that some people had psychological problems because they could not accept their homosexuality, basic homosexuality became one of the potential variants in human sexuality instead of a diagnosis. Similarly, cross-dressing may come to be thought of as a pattern of behavior that does not need a diagnostic label.

In spite of these hopeful assumptions, there are still cross-dressers who want and need professional help. Probably the best thing a therapist can do is to help the client come to terms with himself or herself. If the cross-dresser is a married man, as is often the case, the therapist is often called on to give help and support to the family. Many wives see cross-dressing as a threat to their own feminine image and regard themselves as failures as wives. They are also fearful of exposure and of the effect on children. Certainly cross-dressers who are married and want to remain married have to work out agreements with their spouses on the limits of their cross-dressing activities. Often these are problems that can be worked out only with the help of a neutral third party, such as a therapist.


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Vern L. Bullough
Bonnie Bullough

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