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Leopold Ritter von Sacher-Masoch (1836-1895) was an Austrian novelist, from whose name the term "masochism" was derived by the psychiatrist Richard von Krafft-Ebing. He was born in Lemberg, Galicia, on January 1, 1836. His father, who had recently been created a chevalier by Emperor Francis I, was chief of police of Lemberg. His mother was a Polish aristocrat. His paternal aunt, who lived with the family during his childhood, was the Countess Zenobia. Sacher-Masoch adored her and was enraptured by the beatings she gave him. It was to these experiences that his later fascination with being dominated by women was attributed.

In 1848, his family moved to Prague. He attended school there, receiving excellent reports and winning a prize for his school leaving essay. Although he was interested in writing and the theater, his father wished him to study law. Sacher-Masoch entered the University of Prague, transferring to the university at Graz and receiving the degree of doctor of law in 1855. He began teaching history at the university the following year. His first published work, which appeared in 1857, was a study of the rebellion in Ghent. It was not well received by historians, being criticized as too novelistic.

In 1861, he became enamored of Anna von Kottowitz, the wife of a physician, who was ten years his senior. She eventually left her husband and children and moved in with him. Their relationship developed into a sadomasochistic one; Anna dominated him, with his encouragement, beating him with her fists and also using whips and birches.

Sacher-Masoch's next significant liaison was with Fanny Pistor. The two of them signed a contract, which stated, in part:

Herr Leopold von Sacher-Masoch gives his word of honour to Frau Pistor to become her slave and to comply unreservedly, for six months, with every one of her desires and commands.... The mistress (Fanny Pistor) has the right to punish her slave (Leopold von Sacher-Masoch) in any way she thinks fit for all errors, carelessness or crimes of lese-majeste on his part.
After a long and impassioned courtship with a mysterious woman who called herself "Wanda von Dunayev" after the heroine in his novel Venus im Pelz, Sacher-Masoch married her in a private ceremony in 1872. The woman, whose real name was Aurora Rumelin, and he eventually formally married.

During his marriage, Sacher-Masoch's masochistic tendencies continued to develop. His wife beat him with a cat-o'-nine-tails studded with nails. At his urging, she took lovers, while he also occasionally sought out women who might be convinced to dominate him. Eventually, he left her for Hulda Meister, whom he had hired as his chief translator for a magazine he was publishing.

By the time he was in his late 50s, Sacher-Masoch's mental health had begun to deteriorate. By March 1895, his condition had worsened so much that he was becoming violent and suffering delusions. Finally, on March 9, 1895, he was discreetly removed to the asylum for the insane in Mannheim. The public was told that he had died, and flattering obituaries were written about him. These accounts indicated that Sacher-Masoch died in Lindheim, Hesse, on March 3, 1895. Cleugh, however, claims that he actually died in the asylum in Mannheim in 1905.

Sacher-Masoch's novels were realistic and gained a devoted following. Some of his works, such as Venus im Pelz (Venus in Furs, 1870), depict people deriving sexual pleasure from suffering pain and humiliation. Among his other writings are Das Vermachtnis Kains (The Legacy of Cain), which appeared in four volumes from 1870 to 1877; Falscher Hemelion (False Ermine, 1873); Die Messalinen Wiens (The Messalinas of Vienna, 1874); and Die Schlange im Paradies {The Snake in Paradise, 1890).


Cleugh, J. The Marquis and the Chevalier. Boston: Little, Brown, 1952.

Krafft-Ebing, R. von. Psychopathia Sexualis. Translated by F.S. Klaff. 1886. Reprint. New York: Stein & Day, 1965.

Thomas S. Weinberg


Donatien-Alphonse-Francois, comte de Sade (1740-1814), born June 2, 1740, was a French nobleman whose name has been linked with acts of sexual cruelty. He was educated at the College Louis Ie Grand, in Paris, leaving in 1754 to enter the military as a sublieutenant. He achieved the rank of captain and served in the Seven Years' War with Germany. Returning to Paris, he entered into an arranged marriage with the daughter of a family friend.

The notoriety of the Marquis de Sade stems from two well-publicized incidents. The first of these was known as the Keller affair. During Easter week in 1768, he met a young woman, Rosa Keller, who was begging in the streets. On his promise to give her a job, she accompanied him to a house he kept near Paris. After giving her a tour of the place, he took her to the attic, where he forced her to disrobe. De Sade then bound her hands and whipped her until she bled. Applying salve to her wounds, he kept her captive through the night. The next day, finding that her wounds had begun to heal, he reopened them with a knife. Again, he put salve on the woman's injuries. She managed to escape, running nude into the street. De Sade was arrested and jailed. In his defense, he claimed that he was only testing the efficacy of his salve. De Sade was imprisoned for only six weeks and released after paying Rosa Keller for damages.

The second incident occurred during July 1772. The marquis went to a bordello in Marseilles and distributed bonbons to the prostitutes. These chocolates were laced with cantharides, a supposed aphrodisiac popularly known as "Spanish fly." Some reports of the incident claim that one woman killed herself by jumping out a window and that two others died by poisoning. Bloch, however, believes that no deaths occurred. Sade was arrested, and, on September 11, 1772, he was sentenced to death for sodomy and poisoning. Before the sentence could be imposed, Sade fled to Italy. He was arrested there in December; he managed to escape, so the sentence was never carried out. The death decree was finally removed six years later.

Having returned to France in 1777, Sade was imprisoned once again, this time at the fortress at Vincennes. He was able to secure a release briefly in 1778, but he was reincarcerated and later moved to the Bastille in 1784. On July 4, 1789, ten days before the storming of the Bastille, he was sent to the Charenton lunatic asylum for haranguing a crowd from his cell. In 1790, Sade was released from Charenton. He was arrested once more in 1801 for having written a novel, Zoloe and her Two Acolytes, which defamed, among others, Josephine de Beauharnais, the wife of Napoleon Bonaparte. Without ever having gone to trial, he was transferred from one institution to another and later returned to Charenton, where he died on December 2, 1814.

In all, the Marquis de Sade spent 27 years in jails, prisons, and asylums. During much of this time he devoted himself to producing novels: Les 120 Journées de Sodome (1785), La Nouvelle Justine (1791), Aline et Valcour (1793), La Philosophie dans Ie Boudoir (1795), and Juliette (1797).


Bloch, I. Marquis de Sade: His Life and Works. New York: Castle, 1948.

Cleugh, J. The Marquis and the Chevalier. Boston: Little, Brown, 1952.

Saint-Yves, L. Selected Writings of De Sade. New York: Castle, 1954.

Thomas S. Weinberg


Sadism is the eroticization of dominance and control. The term can be traced to French literature and is linked with the name of Comte Donatien-Alphonse-Francois, marquis de Sade (1740-1814), whose life and erotic writings were filled with incidents and images of sexual cruelty. Sadism has been dealt with separately from masochism in much of the scientific literature, although this distinction between the two phenomena is artificial. As a number of writers have pointed out, both sadism and masochism can be found in the same individual; many sadomasochists consciously alter their own orientation to adjust to the needs of a potential partner. Additionally, it is very common for people who take the dominant role in sadomasochistic interaction to have started out as submissives.

Krafft-Ebing defined sadism as "the experience of sexual pleasurable sensations (including orgasm) produced by acts of cruelty, bodily punishment afflicted on one's own person or when witnessed in others, be they animals or human beings. It may also," he wrote, "consist of an innate desire to humiliate, hurt, wound or even destroy others in order thereby to create sexual pleasure in oneself." Freud acknowledged that "the roots of... sadism can be readily demonstrable in the normal individual." Both he and Krafft-Ebing believed that sadomasochistic-like activities were readily apparent during normal lovemaking. The sadomasochist, however, goes beyond what they saw as acceptable behavior.

Gebhard noted that sadomasochism is embedded in our culture, because our culture is centered on dominance and control in social relationships and that aggression is socially valued. Ellis preferred the term "algolagnia," viewing sadomasochism as a love of pain. He noted that "the sadist desires to inflict pain, but in some cases, if not in most, he desires that it should be felt as love."

Recent writers, starting with the contributions of Gebhard, have begun to study sadomasochism as a sexual subculture, focusing on the organization of the subculture and the norms that serve to regulate social interaction. Both Kamel and Lee, who have studied the leathersex scene among male homosexuals, point out that risk is reduced through agreement on norms and values within the subculture. Kamel, who was particularly interested in how people become sadomasochists, demonstrated that it was part of a learning process, during which the individual becomes aware of role expectations and is socialized into the community.

Sadomasochism has a number of important characteristics. First, central to this phenomenon is control—dominance and submission. Every relationship and interaction explicitly reflects these concerns. Sadomasochistic behavior is highly symbolic; a variety of devices, such as clothing, the use of language, the utilization of restraints, and so forth, serve to indicate a participant's role, either dominant or submissive, in the interaction. Second, fantasy is critical to sadomasochistic interactions. Behavior is frequently scripted, and participants play roles within this interaction. Sadomasochistic scenes are framed by social definitions that give the behavior a specific contextual meaning. This serves to confine the behavior only to that episode, keeping it from spilling over to other aspects of life. It is this fantasy frame that allows people to engage in behaviors or roles that are usually not permitted in everyday life, as, for example, when a man dressed as a maid allows himself to be dominated by a woman. Thus, the framing of interaction enables the participants to enjoy themselves without feeling guilt.

A third characteristic of sadomasochism is that it is consensual. All parties to the interaction must agree to participate. Forced participation is not acceptable within the subculture; it is only the illusion that individuals are coerced that is approved by sadomasochists.

A fourth characteristic, closely intertwined with consensuality, is that sadomasochism is, by its very nature, collaborative. Participants must agree on what will take place during the scene and carefully discuss limits to the interaction. What may appear to the uninitiated observer to be spontaneous behavior is really carefully planned. In this way, the kinds of uncertainties one faces in everyday life do not exist. Participants have a very good idea of what will transpire. Sometimes, however, the dominant partner will test the submissive's limits, going just a bit beyond the agreed on boundaries. This adds a feeling of authenticity to the scene, making the submissive believe that what is happening is "real." Upon receiving any indication that the interaction is becoming too intense, the dominant will back down. This is usually done very subtly, so that the fantasy frame is not broken and interaction can continue on a lower level of intensity.

Fifth, sadomasochistic interaction is explicitly sexual and must be mutually defined in that way by participants. Acts of dominance and submission outside of the sexual arena are simply not perceived by participants as fitting the criteria of sadomasochism. Outside the sadomasochistic scene, dominants are not cruel, nor are submissives necessarily passive. It is only within the sexual context that such behavior is perceived as appropriate.

A sixth characteristic of sadomasochism is that it must be mutually defined in that way. Unless all participants agree on the definition, something other than a sadomasochistic interaction is going on. Finally, sadomasochistic behavior is recreational. It is set aside from other aspects of life, and it is defined as play by participants. They do not see it as "real" in any sense but acknowledge it as a means of temporarily escaping from the everyday world.

Sadomasochistic subcultures are not found universally. According to Gebhard, they appear to be confined to urban-industrial societies. A sociological explanation for the existance of this behavior in some societies but not others is that sadomasochistic interests become institutionalized into a subculture in societies that fill the following criteria: (1) dominance-submission relationships are embedded in the culture and aggression is socially valued; (2) there is a well-developed and unequal distribution of power between social categories, which may make the temporary illusion of its reversal erotically stimulating; (3) there is sufficient affluence enjoyed by at least some segments of the population to enable them to experience leisure-time activities; and (4) imagination and creativity are encouraged and valued assets, as evidenced by the importance of scripts and fantasy in sadomasochism.


Ellis, H. Studies in the Psychology of Sex. Vol. 3, Analysis of the Sexual Impulse, Love, and Pain; the Sexual Impulse in Women. 2d. ed. Philadelphia: Davis, 1903, 1926.

Freud, S. The Basic Writings of Sigmund Freud. Translated by A. A. Brill. New York: Modern Library, 1938.

Gebhard, P. Fetishism and Sadomasochism. In J. H. Masserman, ed., Dynamics of Deviant Sexuality. New York: Grune & Stratton, 1969.

Kamel, G.W.L. Leathersex: Meaningful Aspects of Gay Sadomasochism. Deviant Behavior, Vol. 1 (1980), pp. 171-91.

Krafft-Ebing, R. von. Psychopathia Sexualis. 1881. New York: Stein & Day, 1965.

Lee, J. A. The Social Organization of Sexual Risk. Alternative Lifestyles, Vol. 2 (1979), pp. 69-100.

Weinberg, T. S. Sadomasochism in the United States: A Review of Recent Sociological Literature. Journal of Sex Research, Vol. 23 (Feb. 1987), pp. 50-69.

Thomas S. Weinberg


A birth control reformer and nurse, Margaret Sanger (1879-1966) helped found and was a leader of the birth control movement in the United States. The traumatic death of one of her patients from a self-induced abortion and the belief that her mother died prematurely from the stress of seven miscarriages and the bearing of 11 children caused Sanger to strive for reproductive autonomy for women.

After completing two years of nursing, Margaret Higgins married William Sanger in 1902. The following year, Sanger began to work as a home care nurse, bore the couple's first child, and became an activist for the International Workers of the World (IWW). The IWW introduced her to the world of socialist and radical politics, where she took as her own the feminist demand for women's reproductive rights. She began publishing articles about female sexuality in the socialist weekly New York Call and, later, in her own feminist journal Woman Rebel, whose rallying cry was "No Gods, No Masters." In 1914, she was indicted for violation of the postal code under the Comstock Act of 1873, which forbade distribution of contraceptive information through the mail. Before her trial, she fled to Europe, where she studied various methods of birth control and met the physician and sex reformer Havelock Ellis. Later, the government dropped its charges against her.

In October 1916, Sanger and her sister, Ethel Byrne, opened the first American birth control clinic in the Brownsville section of Brooklyn. It was closed by police ten days later. The sisters were imprisoned, and the ensuing trial helped make Sanger a national figure. Convicted, Sanger appealed and won the right of doctors to provide women with contraceptive advice for "the cure and prevention of disease."

In 1921, Sanger established the American Birth Control League, which in 1942 became the Planned Parenthood Federation of America. Two years later, with money from her second husband, millionaire J. Noah Slee, Sanger established the Birth Control Clinical Research Bureau in New York City. Headed by the gynecologist James F. Cooper and the physician Hannah Stone, it was the first American birth control clinic staffed by doctors. The clinic kept records on the safety and effectiveness of various contraceptive methods and served as a teaching facility for physicians. It served as a model for more than 300 birth control clinics established by Sanger in the following 15 years.

Sanger founded the National Committee on Federal Legislation for Birth Control, in Washington, D.C., in 1929 and became its president. In 1936, the committee initiated the case of United States v. One Package, which challenged the Comstock Act and resulted in the freedom of physicians to receive contraceptives through the mail and import them. >From 1952 to 1958, Sanger served as the first president of the International Planned Parenthood Federation, which she helped create.



Sanger, M. The Case for Birth Control. New York: Modern Art, 1917.

Sanger, M. Happiness in Marriage. New York: Brentano, 1926.

Sanger, M. Margaret Sanger: An Autobiography. New York: W.W. Norton, 1938.

Sanger, M. Motherhood in Bondage. New York: Brentano, 1928.

Sanger, M. My Fight for Birth Control. New York: Farrar, 1931.

Sanger, M. The Pivot of Civilization. New York: Brentano, 1922.

Sanger, M. Woman and the New Race. New York: Brentano, 1920.


Gray, M. Margaret Sanger: A Biography of the Champion of Birth Control. New York: Marek, 1979.

Lader, L. The Margaret Sanger Story and the Fight for Birth Control. Garden City, N.Y.: Doubleday, 1955.

Moore, G., and R. Moore. Margaret Sanger and the Birth Control Movement: A Bibliography, 1911-1984. Metuchen, NJ.: Scarecrow, 1986.

Hilary Sternberg


Satyriasis, also known as the Don Juan syndrome, is excessive, uncontrolled sexual activity by a man with little or no emotional involvement. The female counterpart to satyriasis is nymphomania.

In satyriasis, the sexual drive is constant, insatiable, impulsive, and uncontrolled, involving many partners and unusual frequency, with no feelings of love for the partner; the partner is merely a vehicle or object rather than an actual participating companion.

A satyr finds sex pleasurable but never achieves a feeling of complete sexual satisfaction. Although orgasm occurs most of the time, he still remains unsatisfied; complete physical and psychological gratification is never achieved. This compels him to continually seek another partner in the hope of finding gratification.

The three major psychiatric theories that attempt to explain the psychodynamics of the compulsively promiscuous male are (1) incestuous desire, (2) memories of infantile eroticism, and (3) the Don Juan syndrome.

1. Incestuous desire. The man has an unconscious desire to sleep with his mother but has an unwillingness to recognize this fact. In an effort to deny these feelings, he seeks out women whom he thinks of as bad (i.e., prostitutes), the exact opposites of the "good" mother he has in his mind, in order to act out his frustrations.

2. Infantile eroticism. The memory of having been eroticized (penis fondled) as a baby or child remains in the mind of the adult male, and he will continually try to recapture those pleasurable feelings he had as a child.

3. Don Juan syndrome. This man dedicates his life to seducing women, particularly married women and virgins. Once the women are successfully seduced, they are immediately discarded. Underlying this complex is a deep-seated hatred of women; the man has a Madonna-whore complex in which the woman is considered to be good until she succumbs to his advances; after intercourse, she is immediately associated, in his mind, with the whore. Thus, the woman hater seeks to prove that even the best, most virtuous woman is basically a whore at heart. He will continually seduce women to reinforce his own worldview.

In the 1990s, the term "sexual addiction" came into use by some to describe such behavior, although there are differing opinions on its validity. The term was introduced in a book entitled Out of the Shadows: Understanding Sexual Addiction, by Carnes, a senior fellow at the Golden Valley Institute for Behavioral Medicine, in Minneapolis. Carnes believes that sexual addiction is a loss of control and that the person who engages in this behavior is willing to risk any kind of consequence in order to achieve pleasure; the person is so hooked that he or she cannot stop.

The sexologist Richard K. Sharon believes that until we can define what a "normal" frequency of sexual behavior is, we cannot label people as sex addicts. Another well-known sexologist, John Money, says, "The danger of describing sex as an addiction is that it presupposes that the individual is addicted to all forms of sexual behavior rather than a specific sexual object or set of behaviors."

Others, including Eli Coleman, argue that a better way of describing and treating the insatiable, impulsive, uncontrolled sex drive is to call it a compulsion. This makes it treatable by drugs as well as psychotherapy.

No matter which theoretical approach is used, the important issue that needs to be raised concerning excessive sexual behavior is one of definition. If satyriasis is defined as "excessive" behavior, what is excessive? One definition of excessive could be completely different from another. I could enjoy having sex once a day, which could be considered excessive to someone else. Consequently, we have to be careful in how we categorize what is normal and what is excessive. The controversy continues as to whether the condition exists and, if it does exist, what terminology should be used to describe it.


Auerbach, A. Satyriasis and Nyphomania. Medical Aspects of Human Sexuality, Vol. 2 (1986), pp. 39-41,44,45.

Carnes, P.J. Progress in Sexual Addiction: An Addiction Perspective. SIECUS Report, Vol. 7 (1986), pp. 4-10.

Edwards, S.R. A Sex Addict Speaks. SIECUS Report, Vol. 24 (1986), pp. 1-3.

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

Hope E. Ashby


Feminist and Other Postpositivist Views of Science
Preventing Presuppositions from Overwhelming Science
The Scientific Restructuring of Sexology

The meaning of science has changed dramatically in the last 30 years, and much of the disagreement among sexologists today results from our not having come to terms with the new scientific conceptions. As the status of science rose over the past 400 years, science became increasingly bold in its statements about what should be considered valid knowledge. By the 1920s, logical positivists were affirming that only that which can be verified by sensory experience was to be considered valid knowledge. The certainty and privileged status of scientific knowledge was increasingly emphasized, but it was not to last.

By the 1950s, these logical positivist doctrines came under increasing attack. Popper, in the 1950s and 1960s, attacked positivism by pointing out that events cannot be conclusively verified by sensory experience. In doing so, Popper made science a more vulnerable form of knowledge. Popper proposed that we should accept those theories that cannot be falsified by scientific tests and reject the impossible sensory verification demands of the positivists. This made science only able to say that a particular theory was not, at present, shown to be false. Science could not say that this theory was true, for inductive logic yields only probabilities, and alternate theories are always possible. The significance of Popper for our discussion is his emphasis on the limitations of scientific verification.

Popper's questioning of the verification principle also led others to question the sharp distinction between facts verified by sensory experience and nonverifiable aspects, such as values. Now both facts and values were shown to share this problem of not being fully verifiable. The positivist chasm between empirical observations and nonempirical statements was narrowing. The certainty of our knowledge of the world and the isolation of facts from values were coming under increasing criticism.

After Popper's frontal assault on logical positivism, the barrage intensified. The most lethal blow to positivism came from Kuhn's 1962 book The Structure of Scientific Revolutions. Kuhn's important contribution was to demonstrate with great clarity that the empirical data that science gathers represents a selective perspective and is not a precise representation of the "true external reality" of the world.

Kuhn introduced in his book the now widely used notion of the scientific paradigm. He defined a paradigm as a model for problem statements and problem solutions in science. Kuhn argued that scientists in all fields focus on solving the puzzles presented by the particular paradigm that they adopt, and do not typically question that model. Kuhn both rejected the logical positivist's radical separation of empirical and nonempirical worlds and limited the significance of Popper's falsification doctrine. He asserted that the choice of one model of reality, one paradigm, over another cannot be made on empirical evidence alone. The choice of paradigms is based more on what personally appeals to scientists and the problems they wish to solve with that scientific paradigm. Therefore, the paradigm is not chosen solely on the basis of which model holds up best to the falsification tests proposed by Popper.

It follows from Kuhn's perspective that science does not guarantee a "representational" or accurate photographic view of reality. Rather, science, over time, offers many ways of seeing the world, and the one we accept is the one that we believe works best for the problems that confront us inside and outside science. There is, in Kuhn's scientific outlook, no pure vision of the world and no pure sense data about the world like that which most of the logical positivists assumed. We see the world through the lenses of the paradigm that we accept. Science does not have any privileged or insider view of the universe with which to verify the choice of paradigms we make. Accordingly, it is not surprising that the scientific paradigms change over time. Once more, the priority of scientific knowledge over all other knowledge had to be qualified.

Kuhn's point is that there is no way to see the world independently of some paradigm or, if you will, some presuppositions about how the world operates. We need some presuppositional lenses through which to see the world or we are blind. These presuppositions lead into some theory about how the world operates. What we call empirical data or "facts" are shaped by our prior views of reality. Facts are not just there to be discovered. Rather, we begin to observe them after we formulate our presuppositions about how the world operates and begin to view the world through the lenses prescribed by these ideas.

Presuppositions, as the term is used here, are the general assumptions we make about how the world operates, including moral assumptions about how it should operate. An example would be the assumption that humans are rational creatures and that rationality is a good that we can use to benefit each other. With this presupposition, we can then start to observe the "facts" of our rational behavior. Until we make some such set of assumptions about the world, we are unable to think about that world. Once we assume a particular set of presuppositions and theories, we then have a set of lenses that enables us to perceive the world but also limits our vision of other ways of understanding the reality that is out there.

Hanson reported a playing-card experiment that demonstrated how, on a personal level, our presuppositions and theories determine what registers in our minds. A deck of cards was shown to subjects. Inserted in a typical deck were anomalous cards like a black four of hearts or a red six of spades. Those anomalous cards often went unnoticed because the subjects' "lenses" limited their expectations of what could be seen in a deck of cards. In short, they saw the deck of cards through their paradigm or model of what a deck of cards should be like and not as it "really" was.

We do much the same thing in our scientific research. Feminist social scientists remind us of the classic study of the American occupational structure done in 1967 by Blau and Duncan. Twenty thousand individuals involved in different occupations were studied. Not one subject was a woman, and yet the authors called their book The American Occupational Structure. Their view of occupations ignored women, much as Hanson's subjects ignored the red six of spades. The more aware we are that we make these assumptions about the world in our scientific work, the more likely we are to choose more wisely what assumptions we make. This increased awareness is one major benefit of the "postpositivist" scientific perspective that we are developing today.

Einstein and Infeld presented a view of science that is compatible with Kuhn's thinking and the ideas developed here. Einstein and Infeld compared science's attempt to understand reality with that of people seeking to understand the mechanism of a closed watch that can never be opened. People see the hands move and hear the ticking, but then they must compose their own theory about what sort of mechanism is inside the watch that could produce such an outcome. There are many possible theories that can explain why the watch works as it does, but there is no way to fully compare these conceptions with "reality."

In today's post-Kuhnian age, science is increasingly seen as much more similar to other forms of knowledge. It—like religion, politics, or philosophy—has its own presuppositions and its own obvious limitations. Science has been dethroned from the position logical positivism assigned to it. Science is not privileged knowledge to be taken as superior to all other ways of knowing the world.

Despite these qualifications of science, it still has great value to any society. No other way of looking at the world is as rigorous and precise and as demanding of relevant evidence. Moreover, scientific rules insist on validity, reliability, peer review, publication of results, disciplined inquiry, careful logic, and reasonable conclusions. In short, science remains a special, well thought out, and valuable way of understanding. But to employ science fairly, we must also realize the limitations that exist in scientific work.

The scientific presuppositions about what the social and physical world is like, and what the world should be like, are often influenced by our place in society in terms of such characteristics as ethnic group, social class, gender, and religious perspective. No one would deny that our social location is an important determinant of our views on economic, political, or moral thinking. We now realize that this can also be true of our scientific ideas. As will be indicated shortly, this does not lead to relativism or the dismissal of scientific evidence, but it does show scientific knowledge to be an earthly activity engaged in by socialized humans. It also means that if we are to maintain the distinctive norms of good science, we had best become more aware of our presuppositions and in that way prevent them from biasing our research activity.

Feminist and Other Postpositivist Views of Science

One of the clearest and most useful recent perspectives for establishing a new conception of scientific knowledge comes from feminist philosophers such as Longino, Harding, Haraway, and Keller. Longino, for example, discards traditional positivism and recognizes the social context of science, yet she clearly rejects any relativist position and puts forth a pragmatic notion of scientific objectivity.

Longino illustrates in her examination of research on gender differences the importance of scientists' consciously and explicitly choosing their presuppositions. One presupposition relevant to research on gender differences consists of a biological view that stresses the power of hormones to limit the gender roles that men and women play in society. An alternative presupposition stresses the flexibility and power of our thought processes and our socialization in shaping our gender roles.

These presuppositions place limits on the theoretical explanations and on the policy implications that are developed. The biological view sees gender dichotomously as XX or XY and seeks to find evidence regarding how that gender difference is biologically explained. The outcome of such a strong biological presupposition affords little direct support for advocating changes toward gender equality, for it perceives many gender differences as "natural." The biological approach veers toward what some sexologists call an "essentialist" perspective, and it is in part derived from animal studies of rats, monkeys, and apes rather than from an examination of a wide range of human societies. But it is a relevant perspective, because it cannot be denied that human beings are an animal species.

On the other hand, the socialization presupposition concerning gender highlights humans as flexible, thinking individuals in constant interaction with the social environment. This model allows more of a role for human agency and for social change. The socialization perspective on gender differences is based on human models of intentionality, self-consciousness, and societal power differences. Animal models of hormonal forces are minimized.

The choice between these two models cannot simply be made on the basis of which view presents stronger empirical evidence. There is good evidence for the predictability of various outcomes using both models. The two approaches to gender differences involve different presuppositions about how the gender world operates and also may well reflect how various people think the world should operate.

By becoming aware of the major role of presuppositions in our scientific models, scientists can consciously choose that model which is more in line with their own presuppositions about how the world operates. Some may choose to stress the socialization model, in part because they favor change and flexibility and are more interested in understanding how that can be accomplished than in seeing how hormones shape human behavior. The biological model can be formulated to stress the flexibility of biological tendencies, and in that fashion it, too, can be made attractive to researchers who hold presuppositions favoring change.

No scientific model can possibly represent total reality. But the choice of model does have very real effects on the view of the world we as scientists present to others. It is surely one advantage of postpositivistic science that it makes all scientists more aware of the choices of models they are making. That creates a situation where scientists let others know what their presuppositions are, and this aids vigilance that the research process of gathering evidence is not being biased by these presuppositions. "This is surely an advantage over the positivistic assumption that only research evidence, and not personal values, enter into the choice of scientific models.

The fact that presuppositions play such an important role in scientific work makes many researchers uneasy. But what is the alternative? Can a human being really have a view about the world that does not reflect some set of basic presuppositions about the world? There is no "view from nowhere." Every scientific project assumes some presuppositions about how the world works, and so we always have a "view from somewhere." Moreover, we can never scientifically say that we have the one correct view of reality.

The very language through which we express our thoughts reflects a particular perspective on the world. Languages vary in what words there are for expressing different colors, different values, different perspectives. The impossibility of having a scientific "view from nowhere"—a view that makes no such assumptions about reality—should be apparent. To say a perspective is unaffected by any assumptions and that it is the one correct view of the world is to play what Haraway calls "the God trick," and that surely is an inappropriate position for a scientist to assert.

But if we grant this reasoning, then how do we avoid becoming relativists and asserting that all viewpoints in science are just subjective meanings and cannot be the basis for any empirical generalizations or any notion of "objective" knowledge? The relativist position is endorsed by many who call themselves "postmodernists." Opposed to them are the postpositivists (among whom this author counts himself). Postpositivists reject a relativistic perspective because relativism eliminates the importance of gathering fair scientific evidence in accordance with the norms of science. In addition, relativism is rejected because it makes any understanding of how to build a better society impossible. Relativism does not permit justifying choices. But what position other than relativism can science take and still support both the objectivity of science and the inevitability of alternative presuppositions?

There is a way to arrive at what we can call "objective knowledge"—knowledge that does not solely depend on our very personal view of the world—and still not deny the fact that we can never be certain about what we agree to call "objective knowledge." One solution is suggested by Longino. She asserts that scientific work is not an individual product, but rather it is the product of a community of scientists negotiating with each other. After all, the norms of science do say to publish your results so they may be evaluated by other scientists, and we do have many journals that perform precisely that service. In this sense, science is a negotiated and somewhat adversarial process.

We can define objectivity in science as those views of the world that come to be agreed on by the scientific community at any one point in time. This is not a view from nowhere about absolute reality, nor is it a privileged insight into reality. Instead, it is a means by which we can put forth our best scientific evidence about what the world is like in the area of our research but still recognize that in time this understanding will likely change. "We can accept objective reality without claiming that we possess final knowledge about it.

Change, moreover, is important in science because we can never be certain that we know what the inside of the "closed watch" is like, and thus we can never be certain that we have arrived at the "true" view of the world. There will always be other models that can explain the same set of findings. In science, we have the privilege of criticizing each other's work, and we each strive to show that the scientific quality of our own work will hold up under scrutiny. As that interactive process occurs, certain perspectives gain acceptance and become the "objective" view of that time. In physics, that accepted view was once Newton's mechanistic universe; it is now Einstein's relativistic universe, and a generation or two from now it will likely be modified again. In sexology, our view of the sexual and gender world will grow and change more easily if sexologists accept this more dynamic view of the scientific process.

Preventing Presuppositions from Overwhelming Science

If science is to continue to be one very important way of understanding our world, then we must not permit our presuppositions about our world to become so emotionally charged that they rigidify and overwhelm our scientific enterprise. Though we acknowledge the reality of the influence of our presuppositions on our scientific activity, it is crucial that we not give up our belief in the value of carefully gathered empirical knowledge.

Postpositivism argues for the importance of making explicit the presuppositions we accept and the values incorporated in them so as to put other scientists on guard against our possible biases. No researchers should enter into a project without being aware of the presuppositions they accept, whether they be pro, con, or indifferent to the social issues raised by that research. The point here is that the naive positivist view that says scientists must be "value free" masks the ways in which our presuppositions influence our scientific work. The postpositivist view increases our conscious awareness of potential bias and thereby improves our ability to abide by the norms of fair scientific research. In doing so, it replaces the stress on being value free with an emphasis on being "value aware."

Everyone accepts that our personal preferences may dictate what subject we choose to research, but the postpositivist notion adds that our presuppositions will shape the model we use to understand that subject and the conclusions we are willing to draw from the empirical evidence we gather. In philosophical terms, postpositivism challenges the inviolability of the "context of justification." Our presuppositions will shape the knowledge conclusions we believe are justified by the evidence. If we want more fully to understand the impact of presuppositions on empirical findings, we need to comprehend this idea.

An example from sexological research illustrates this point. In 1989, the author, together with Robert Leik, who is a methodologist and statistician, published a paper evaluating the relative risk of two strategies aimed at lowering an individual's chance of becoming infected with HIV (human immunodeficiency virus). We designed a probability model to estimate the changes in risk of HIV infection when one reduces the number of partners and compared this to the changes in risk that occurred when one used condoms. Of course, reducing partners and also using condoms is the safest strategy, but most people choose one or the other. We compared these two risk-reduction strategies using a probability model that took into account a very wide range of variation in the prevalence of HIV, the infectivity of HIV, the number of partners, and the failure rate of condoms.

This research started with several presuppositions about the sexual world we were examining. Some of the key presuppositions were (1) that sexuality in all its freely chosen forms can be pleasurable and good; (2) that people can and should learn to better avoid for themselves and their partners the unwanted outcomes of sexuality, such as disease, pregnancy, and psychological distress; and (3) that the basis for judging sexual morality should be the amount of honesty, equality, and responsibility in a relationship and not the number of such relationships a person has. Notice that the presuppositions refer to both factual and value assumptions about the world. The tendency is for most of us humans not just to state what the world is like but also to evaluate that aspect of the world.

These presuppositions led me to personally favor condom use as a strategy to avoid HIV infection. Still, I wanted to test that perspective in the most rigorous scientific way to keep my presuppositions from overwhelming the scientific fairness of our model testing. After consulting with the editor of the journal, we decided to add to our probability model a doubling of the prevalence rate every ten months. This would add an epidemic quality to the model and make it more likely that as one added partners over time more of them would be infected and that the risk of condom failure with such partners would be significantly higher. This addition to our probability model helped ensure that my presuppositions about sexuality and condom use would not be allowed to bias our comparison of the two strategies.

The evidence from our probability model showed that even under epidemic conditions, not using condoms and having only one or two partners was far riskier than using condoms and having 20 partners, even when assuming a condom failure rate of 10 percent to 25 percent. This result held under all the many possible combinations of prevalence and infectivity rates that our model contained. We concluded that the evidence supported the greater effectiveness of condom use over partner reduction as a strategy to reduce the risk of HIV infection. It seemed clear to us that this would be good advice to give to people who were deciding between these two strategies. But we soon discovered that people with different presuppositions would interpret our probability findings quite differently.

The great majority of responses to our published study were very supportive, I believe at least partly because my three presuppositions about sexuality are shared by many other sexual scientists. But not all readers were so supportive. One response was from a person working in a disease control clinic. He was primarily interested in the very highest HIV prevalence areas, where even careful condom use contained a risk of HIV infection that he believed was "too high." This person said that although the risk is clearly far lower with condom use, it still was too high in his judgment, and so sex outside very long term relationships should be avoided in these high-risk areas. In areas where HIV prevalence was low, he would still promote having one very long term partner, because he felt that to promote condom use would encourage casual sex, which he believed was not worth even a small increased risk.

Clearly, this critic rejected all three of my presuppositions about sexuality. He did not share my presuppositions about the value of sexuality of various types or the ability to control disease outcomes, and he did seem to believe that having multiple partners was unacceptable. With those different presuppositions, both his interpretation of the evidence and his conclusions about a recommended choice of strategies were radically different. So much for the evidence speaking for itself.

A second type of response we received displayed another questioning of our "clear evidence" for the superiority of the condom-use strategy. This response came from sexologists who counseled young people with sexual problems. They said they did not believe that many people would carefully use condoms, and that if they did use condoms they would likely increase greatly the number of sex partners and be careless with some of them. So they questioned the relevance of our evidence and arrived at different strategy recommendations than we did. The reason once again, I believe, was that they did not accept my three presuppositions—particularly not my second presupposition that asserted that people could learn to control the negative outcomes of sexuality.

One can look at these two types of responses and say that they do not challenge the probability outcome data that our model generated but rather challenge the interpretation of that data. That is true to a degree, but, more important, what all these critics were doing is questioning the worth of the evidence gathered by our particular probability model. Their different presuppositions about sexuality made our model and its evidence useless to them.

These critics did not see any advantage in condom use over partner reduction, primarily because they did not accept my propositions about the disease consequences of sexuality being manageable, nor did they accept my denial of superior moral status to having only one partner. The very design of our model reflected belief in these presuppositions. For example, if I did not believe that condoms could be used effectively, there would be no point in testing a model in which that was one major strategy of avoiding HIV infection. When these critics looked at our findings, they rejected our conclusions about strategy advice regardless of our evidence because they could not accept the assumptions on which our model was based. This example indicates how being explicit about presuppositions can increase understanding concerning how models are chosen and how evidence is interpreted and evaluated in science.

In the case of this HIV strategy project, the scientific community did arrive at a consensus supporting our evaluation of the evidence. But, as indicated, it was not a unanimous decision. Such a negotiated position comprises the objective conclusion of science at any one point in time. Nevertheless, it is important that we listen to scientists with different presuppositions because it broadens our vision of the world and makes us more aware of the type of prescriptive lenses we are wearing. When we choose one set of presuppositions, we at least will be more aware that we are indeed making a choice about what research model is worth examining and what evidence is a sound basis for policy recommendations.

The Scientific Restructuring of Sexology

Awareness of presuppositions in science is vital to the very survival of sexology itself. The future of sexology depends on having a society that shares the presuppositions that legitimate sexological research. The kind of presuppositions that are essential to the continued existence of sexology are the endorsement of a free democratic society, the value of freedom of inquiry, the right to investigate intimate areas of life, and the acceptance of a range of different moral values. There can be no discipline of sexology in a society that lacks fundamental beliefs supporting such values, for sexologists would not be allowed even to undertake sexological research without that type of societal support.

That our society contains powerful political and religious forces that question the values supporting our work was made obvious in the early 1990s, when the federal government took the following actions against sexological research: (1) stopping already funded research into HIV among teenagers by social scientists at the University of North Carolina, and (2) continuing to ban funding of even a pilot test of a national study of sexual behavior related to HIV infection, proposed by the National Opinion Research Center at the University of Chicago. Louis Sullivan, then head of Health and Human Services, stopped the University of North Carolina teenage sexuality study because he thought that being asked questions about sexuality would lead young people to think that Americans approved of casual sex, and this, he felt, would offend many people's values. To think that this position could be taken when more than 140,000 people had already died from HIV infection is proof of how powerful our political value presuppositions can be. Ultimately, Congress acted and directed Health and Human Services, in the future, to fund sex research even into "sensitive" sexual areas. Because sexologists study such sensitive areas, they are especially subject to whatever political presuppositions are operating in a political administration. The continued existence of the scientific study of human sexuality depends on the constant vigilance of sexologists and their willingness to advocate for the presuppositions that make sexological work possible.

Another way in which presuppositions enter into all scientific work on sexuality is in sexology's orientation toward the resolution of our society's sexual problems. The older scientific approaches directed researchers to serve policy makers by giving them information but implied that scientists were to avoid making specific policy recommendations themselves, for that would undermine the belief in their "objectivity." That stance left politicians free to use the research evidence in any way they wished—including ignoring it or misinterpreting it. The postpositivist perspective is aware of how our presuppositions shape our choice of research designs and our judgments about the policy implications of our findings. Therefore, rather than have our findings misused or misinterpreted, it becomes reasonable for scientists to openly affirm what they see as the best ways to utilize their findings toward the reduction of society's many sexual problems.

A science that sees presuppositions about the nature of the world as an inevitable part of scientific activity will place less distance between science and problem solutions. Such a science will be more willing to directly utilize scientific knowledge to help resolve our most threatening sexual problems, such as those involving AIDS (acquired immune deficiency syndrome), teenage pregnancy, rape, and sexual abuse of children. To be sure, all science also needs "pure or basic research" not directly concerned with problem resolution. We need that type of research precisely because it promises to improve our ability to achieve our scientific goals. But the major effort in a postpositivist science will focus on the development of knowledge useful in the control of our society's sexual problems. To effect this change in emphasis, sexology will have to move problem resolution more to its center stage, and sexologists will need to take the risks associated with becoming more directly involved in the resolution of controversial social issues.

If we pretend to be value-free, disinterested scientists, we will be seen by the public and those in power as mere pawns that can be dismissed and manipulated. If sexology is to have a public constituency that will support its research and protect it against future attempts to block the study of "sensitive" areas, then it must convincingly demonstrate to the public that it is useful in resolving America's sexual problems. Sexologists can no longer hide from controversy by pretending to have a scientific "view from nowhere." Whatever stance we take, there will be controversy, and we can better argue our worth if we are focused on problem resolution rather than "just gathering the facts." Postpositivist science is in part an adversarial science. It is adversarial, as all science is, in the competition of scientists with each other to present their views as best they can. It is adversarial also in the competition with other views about problem resolutions that emanate from politicians and other sources.

It is important to note that the approaches in sexology that stress empathy and understanding of the feelings and thoughts of individuals and the social context in which these develop are fully acceptable in a postpositivist view of science. For example, a "social construction," "contextual," or "interpretive" perspective is well integrated with a postpositivist position that also supports the relevance of personal presuppositions about the world. Still, the supporters of such interpretive perspectives need to be able to accept the legitimacy of the scientific endeavor, since postpositivism seeks to strengthen, broaden, and clarify science, not to eliminate it.

The same integration is possible for the more advocacy-oriented "critical" positions taken by feminists, Marxists, humanists, and others. As noted, the postpositivist position integrates well with a focus on social-problem resolution. This, of course, means that our new sexology will speak directly to some of the major concerns about social equality and acceptance of pluralism on which advocacy groups focus. Once again, however, the advocacy stance would be embedded in a scientific institution that believes in the value of careful scientific research as a basis for deciding and explaining the positions taken in advocacy programs. In all these ways, sexology is well positioned and well motivated to explore the many exciting issues on the frontiers of postpositivistic science.


Alexander, J.C. Theoretical Logic in Sociology: Vol. 1, Positivism, Presuppositions, and Current Controversies. Berkeley: Univ. of California Press, 1982.

Blau, P.M., and O. D. Duncan. The American Occupational Structure. New York: John Wiley & Sons, 1967.

Braybrooke, D. Philosophy of Social Science. Englewood Cliffs, NJ.: Prentice Hall, 1987.

Einstein, A., and L. Infeld. The Evolution of Physics: The Growth of Ideas from Early Concepts to Relativity and Quanta. New York: Simon & Schuster, 1950.

Hanson, N. R. Patterns of Discovery. Cambridge: Cambridge Univ. Press, 1958.

Haraway, D. Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective. Feminist Studies, Vol. 14 (1988), pp. 575-99.

Harding, S. Whose Science? Whose Knowledge? Thinking from Women's Lives. Ithaca, N.Y.: Cornell Univ. Press, 1991.

Keller, E. F. Reflections on Gender and Science. New Haven: Yale Univ. Press, 1985.

Kuhn, T. The Structure of Scientific Revolutions. 2d ed. Chicago: Univ. of Chicago Press, 1970.

Longino, H. Science as Social Knowledge: Values and Objectivity in Scientific Inquiry. Princeton, N.J.: Princeton Univ. Press, 1990.

Popper, K. Conjectures and Refutations. London: Routledge & Kegan Paul, 1963.

Popper, K. The Logic of Scientific Discovery. London: Hutchinson, 1959.

Reiss, I. L. An End to Shame: Shaping Our Next Sexual Revolution. Buffalo, N.Y.: Prometheus Books, 1990.

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

Reiss, I. L., and R. K. Leik. Evaluating Strategies to Avoid AIDS: Number of Partners vs. Use of Condoms. Journal of Sex Research, Vol. 26 (Nov. 1989), pp. 411-33.

Ira L. Reiss


Male Sexological Examination
Female Sexological Examination

Undoubtedly, there are various kinds of sexological examinations, but the one described here was created in 1965 as part of a three-year study of nonorgasmic women. Hartman and Fithian developed the procedure, in cooperation with Kenneth Morgan, M.D., who insisted that the senior author have specific training in the female pelvis before beginning the research. At Morgan's suggestion, Hartman spent a year under the tutelage of the late Arnold H. Kegel, M.D., who developed the pelvic exercises that now go by his name. At the time, he was head of the Perineometer Clinic at Los Angeles County General Hospital.

The name "sexological examination" was utilized, since the procedures employed were designed to evaluate and assess various components of human sexuality (e.g., perception, feeling, arousal, and response patterns) present or absent in varying degrees in research and therapy populations. It was created by behavioral scientists for use by behavioral scientists in appropriate research and therapy populations. The examination was in addition to and supplementary to the examination given by a gynecologist or other medical specialist. Hartman and Fithian emphasize that it is important that anyone utilizing the techniques of the sexological examination receive specific training in its use and that their professional status be unquestionable.

The objectives of the examination include:

1. Providing a learning experience in physiological psychology for a husband and wife, committed partners, or singles.

2. Dealing with the self-concept of men and women who want to know, "Am I normal?" "Is my clitoris too big or too small?" "Are my breasts the right size?" "Are my testicles too long?" "Is my penis too small?"

3. Teaching women four specific vaginal exercises, one of which was developed by Kegel and three of which were developed by Hartman and Fithian. Teaching men pelvic exercises to strengthen the pelvic floor, clear capillaries of fatty buildup, and enable men to last longer in intercourse by use of the pubococcygeus muscle.

4. Giving the therapist a clear picture of the response patterns of the subject through verbal reports of sensations to stimulation in each area of the vagina and/or penis.

5. Identifying, where present, causes of dyspareunia in the female and pain or discomfort found in some males. Some pain or discomfort may be psychological.

6. Giving genitalia their correct anatomical names.

7. Making the individual more at ease with his or her sexuality and sexual functioning.

8. Enhancing communications between couples about genitalia and functioning.

9. Overcoming the reluctance by some individuals to have nonintercourse genital contact, such as touching the penis or putting a finger in the vagina.

10. Intimately exploring each other by having the husband insert a lighted speculum, with the assistance and direction of the therapist, so both husband and wife may see what the inside of the vagina looks like. (This is especially indicated in situations where there is a fear of penile penetration by either partner.)

11. Teaching the use of other techniques to be used later during treatment, in privacy, where they may be carried on to fruition. This, for example, might include the squeeze technique.

12. Explaining other sexual options where, in private, the partner may stimulate the spouse to climax without the use of the penis.

13. Observing psychological conditions and responses to be treated during the therapy.

14. Acquainting the female with her own body to dispel some of the feeling that the genital area is a special place forbidden for all but physicians to see.

15. Checking the clitoris to see that it is free of adhesions. Women typically say their physician has never examined it.

16. Searching for areas where nerve endings come together in a systematic way, suggesting that this may develop positive feelings.

17. Assisting women in determining areas of perception, feeling, and awareness in their vagina. Pointing out areas in the vagina that tend to be more sensitive and responsive for many women (i.e., 12 o'clock, 4 o'clock, and 8 o'clock positions).

18. Determining a woman's response and arousal patterns. Indicating to her whether or not she lubricates well and vasocongests when she does.

19. Locating areas digitally that may be producing pain, discomfort, or problems with sexual arousal or intercourse—such as separation of muscle in the vaginal wall; long labia minora; scarring, which may be tender or fibrous—and to pinpoint the source of "pain" when present.

20. Identifying, where present, reasons for vaginismus, which are not only physiological but psychological.

21. Teaching a male partner how to caress the female's vagina.

Male Sexological Examination

The female is present for the entire male sexological examination. One of the things pointed out is the erection of the male nipples with stimulation.

In the male sexological examination, fetal development is described from a basic female at conception to changes if the fetus is to become male. It is explained that changes occur in the male approximately six to seven weeks after conception, when the major vaginal lip begins to close to form the scrotum; the organ that would be the ovaries in the female comes down into the scrotal sack and becomes testicles in the male. The clitoris, which remains small in the female, elongates and forms the penis in the male, enclosing the urethra as it grows.

On occasion, where indicated, more time is spent with the male who reports little or no sensitivity or feeling in the genitalia. When this occurs, further exploration takes place. After the man has closed his eyes, a wet swab is used to touch various areas of the inner thighs, abdomen, penis, and testicles. Response is rated on a scale of 0 to 5. Reflex action is noted on the scrotum by running the back of the fingernail down the inner thigh toward the genitalia.

Men are taught to contract the pubococcygeus muscle in the pelvis to help counteract the prematurity problem that many have. The male is told to contract the pelvic muscles and hold for a count of three and then to rapidly tighten and relax the muscle. These muscles contract at orgasm, and by exercising them, a male is able to better control ejaculation.

Although referrals to physicians are made when medical problems are identified, the sexological examinations are not medical procedures. They are educational experiences in physiological psychology. The emphasis is on perception, feeling, and response. They are designed, in part, to acquaint a spouse with the nature, location, and function of the genitalia of their partner and themselves. They also include specific instruction in the use of the genitalia for effective sexual function. Just as the medical profession has well documented its rationale for routine checkups, so it is felt to be appropriate in certain specific research and therapy situations that human beings are entitled to be evaluated as sexual beings by dual sex therapy and research teams trained to do so.

Males rarely have an erection occur during the sexological examination, but most of those who do have come as clients because they believed they were impotent, and when this happens, the examination can serve as part of the therapy.

Female Sexological Examination

Direct stimulation of a client toward a high level of arousal is not, and never has been, a part of the sexological examination conducted at the Center. Still, some women do become aroused, and occasionally a sex flush will be observed in the process practice of the vaginal caresses.

The stimulation of the clitoris is not necessary for checking sexual arousal, since the client doing pubococcygeus exercises will develop sufficient vasocongestion in the vagina to check levels of lubrication. Among common reasons for female discomfort during intercourse is that the longer labia minora are being pushed into the vagina during thrusting or penetration, or there is a separation in the muscle wall of the vagina, where a penis may penetrate. Tender surgical scars, such as those from an episiotomy, or fibrous areas in the vaginal wall that are uncomfortable when palpated, are problems for some women. Very frequently, "pain" is perceived with any movement of anything in the vagina. For many dysfunctional women, nothing has ever been in the vagina long enough for them to develop any degree of comfort or response. Most of these conditions are amenable to improvement by pelvic exercises and vaginal caress by the husband or lover. Sometimes, a partner needs to learn how to penetrate the vagina so it is not painful. The vagina, on the average, is only four inches deep, and a partner with a large penis may have to insert under the cervix with less than full penetration to prevent pain or discomfort. Some women suffer discomfort because the uterus is somewhat prolapsed, and the cervix can be hit by penile penetration. Ensuring that the penis goes under the cervix at penetration will eliminate discomfort. Pelvic exercises on the part of the woman often will pull the cervix back up and out of the way. Sometimes, however, they need to be evaluated for surgical correction.

More important than the stimulation of the clitoris in the female sexological examination is the determination of whether or not clitoral adhesions are present. This is a condition where the prepuce is stuck or adhered to the glans clitoris. For preorgasmic women, the inability of the clitoris to withdraw as part of sexual arousal may prevent particular women from full response. Even though some women are orgasmic with clitoral adhesions, freeing them usually results in easier, quicker orgasms and less discomfort due to calcified, trapped smegma.

Another important part of the female sexological examination concerns breasts. In America, the general consensus seems to be that breasts come in two sizes, either too large or too small. In spite of the concern with breasts, some women in treatment are found not to have allowed their breasts to be touched even by themselves and have not developed pleasurable feelings of arousal. Even for those who do have pleasurable sensations, having a female show her partner how she would like to have her breasts touched is important, since, typically, the therapist hears, "He grabs my breasts," or, "He tweaks my nipples," and is too rough. As part of therapy (body caress and nondemand pleasuring), it is essential that her partner touch her breasts in a way that is acceptable and pleasurable to her. A woman needs to make it known what it is she likes rather than have her breasts ignored or hurt by an unthinking or insensitive partner. However, it is important that she does not use suggestions as a means of control in the relationship.

In a female sexological examination at the Center, the husband is not present for the first part of the procedure. This removal of the male partner came about after several instances of the man, after learning of his wife's lack of control of the pubococcygeus muscle or flaccid vagina, blaming her for their sexual problems. While this may have been a factor, it was rarely the underlying problem. The assumption by the man that it was the problem handicapped further therapy. Generally, sexological problems go beyond the realm of the physical, even though they may have first manifested themselves as physiological problems. The psychological overlay is often so great that, even with the resolution of the physical problem, function may not be fully restored unless the psychological aspects are dealt with as well.

Though some physicians, such as Hock, hold that the sexological examination should be done only by a physician, in our experience it is the rare physician who has the time to spend (anywhere from 30 to 90 minutes per client) on such an examination. Thus, for the most part, the examination is given either by other health professionals or by therapists. Those who have studied the sexological examination, such as Barbie Taylor, William Hamilton, and Jeff and Pat Patterson, and those who have used it in their practice, such as Wardell Pomeroy and Mildred Brown, have found it to be a particularly effective way of getting at clients' problems. The major concern that professionals have about the sexological examination is that untrained or unethical therapists might use it unwisely.


Hamilton, W. H. The Therapeutic Role of the Sexological Examination. Ph.D. diss., California School of Professional Psychology, 1978.

Hartman, W. E., and M.A. Fithian. Treatment of Sexual Dysfunction. Long Beach, Calif.: Center for Marital and Sexual Studies, 1972; New York: Aronson (scheduled 1994).

Hock, Z. A Commentary on the Role of the Female Sexological Examination and the Personnel Who Should Perform It. Journal of Sex Research, Vol. 18 (Feb. 1982), pp. 58-63. (See rejoinders by W. Hartman and M. Fithian, and by M. Brown and W. Pomeroy, as well as a reply by Hock, in the same issue.)

Kegel, A. Progressive Resistence Exercise in the Functional Restoration of the Perineal Muscles. American Journal of Obstetrics and Gynecology, Vol. 56 (Aug. 1948), pp. 238-48.

William E. Hartman
Marilyn A. Fithian


Sexual Dysfunctions
Sexual Problems and Difficulties

Human sexual behavior is a natural phenomenon that has been biologically programmed in the human species. Sexual behavior and response are subject to and influenced by a number of internal and external mechanisms, including environment, health, and emotions. It is the interplay of the biochemical, physiological, and psychological aspects of the human organism that contribute to and influence the natural expression of sexual behavior. As with any bodily system, dysfunctions occur. Few systems are as complicated and sensitive to influence as sexual behavior, and few problems cause such emotional and personal concerns.

Thanks to a more candid approach to sexual issues by the media and a better general awareness about sexual issues in society, more information about sexual functioning and sexual problems is available to the public. Helpful as well as confusing or inaccurate information is available, and, as a result, more and more people have become aware of their sexuality and their sexual likes and dislikes. This has led some people to make efforts to enhance their sexual relationships, while others remain unsure as to what constitutes real sexual problems.

How common are sexual problems in the general population? Masters and Johnson have stated that, at one time or another, 50 percent of marriages have significant sexual problems. Other studies estimate that at any given time, 10 percent of women are completely anorgasmic, 7 percent of men are impotent, 15 percent complain of rapid or premature ejaculation, and 3 percent experience retarded ejaculation. There is also a new term used by sex therapists— inhibited sexual desire—which refers to a complaint of a growing lack of interest in sexual activity. The sex researchers Harold Lief and Helen Kaplan estimate that inhibited desire is a complaint of 20 percent of adult women.

The incidence of sexual difficulties in the general population is not known, but one recent study is suggestive of the extent of the problem. The study involved 100 "happily married" couples, 80 percent of whom felt their sexual relationship was satisfactory. When questioned further, problems surfaced. Forty percent of the men reported erectile or ejaculatory problems, and 63 percent of the women reported arousal and orgasmic dysfunction. When the researchers looked at the area of sexual difficulties, apart from dysfunctions, the numbers were higher: 50 percent of the men and 77 percent of the women complained of a number of difficulties that interfered with satisfaction in sex. What was of interest was that the presence of sexual difficulties had more to do with overall sexual satisfaction in the couple than did the number of dysfunctions.

Sexual Dysfunctions

Sexual dysfunctions are problems that interfere with the natural response of the body to appropriate sexual stimuli and with the satisfactory ability to perform sexually. Dysfunctions can exist in any or several phases of the sexual response cycle and can be caused by a number of biochemical, physiological, psychological, or environmental agents.

The human sexual response cycle consists of several phases that are both reflexive and psychogenic in response. Initial desire and arousal phases lead to greater sexual excitement that eventually culminates in orgasm. Masters and Johnson pioneered in the study of human sexual response and described the phases of sexual response as excitement, plateau, orgasm, and resolution. A more recent conceptualization by Lief uses the acronym DAVOS to describe phases of sexual function: desire, arousal, vasocongestion, orgasm, and satisfaction. These categories are helpful in separating sexual dysfunctions into identifiable phases of the sexual response cycle.

Sexual functioning occurs on a continuum of a wide normal range that extends from inadequacy and inability to function, on one side, to the other side where behavior occurs that society has considered inappropriate or deviant. The focus of this article is on that part of the continuum that reflects an inability to function adequately. Usually, this is divided into two major categories: dysfunctions in desire and arousal, and dysfunctions in orgasm and ejaculation. Many of these dysfunctions can occur as a primary or secondary complaint. A primary sexual complaint is one in which the person has never been able to function adequately, as in the case of a man who has never had an erection sufficient for intercourse. A secondary sexual dysfunction reflects a current difficulty in a person who in the past had no problem functioning, as in a case of situational impotence.

The current psychiatric diagnostic categories recognize sexual dysfunctions as being psychogenic or biogenic in origin. They may be lifelong or acquired (primary or secondary) and can be generalized or situational in their occurrence. The category of sexual desire disorders includes hypoactive sexual desire disorder and sexual aversion disorder. The first diagnosis describes the persistent or recurrently deficient or absent sexual fantasies and desire for sexual activity. Cases of sexual aversion reflect an extreme aversion and avoidance of genital sexual contact with a partner. Desire-disorder problems often reflect complicated psychological issues and can be difficult to treat.

Sexual arousal disorders exist in both males and females. Male erectile disorders, often referred to as impotence or erectile dysfunction, can have a variety of causes and, in cases of psychogenic origin, can be perpetuated by anxiety and relationship problems. The problem consists of an inability to obtain or maintain an erection sufficient for completion of sexual intercourse. Female sexual arousal disorder describes a condition of recurrent partial or complete failure to attain or maintain the lubrication-swelling response of sexual excitement during sexual activity and intercourse. This can also be accompanied by a lack of a subjective sense of sexual excitement and pleasure in the female during sexual activity.

Orgasm disorders also exist in both men and woman. Inhibited female orgasm is often a natural consequence of inhibition in sexual excitement. While there is a normal variation among women in their ability to experience orgasm, this diagnosis refers to a delay or absence of orgasm response in women following an adequate phase of sexual excitement, during which the focus, intensity, and duration of stimulation is considered adequate. There is a range of response in women, and many women who are able to experience orgasm through noncoital clitoral stimulation (e.g., masturbation) are not able to do so through intercourse.

Some women who do not meet the criteria for the diagnosis of an orgasm disorder still may require or request evaluation to explore possible psychological inhibitions or relationship problems. Many women who otherwise function quite well sexually do not experience coital orgasm. Female orgasm has a wide normal variation, and some of the issues surrounding a woman's "right to orgasm" have many political implications aside from the issues of "normal" sexual response.

Orgasm disorders in the male reflect two types of problems in ejaculation: inhibited ejaculation and rapid ejaculation. The diagnosis of inhibited male orgasm describes a condition in which ejaculation is persistently delayed or even absent following a period of sexual excitement and sufficient stimulation. Retarded ejaculation, as the diagnosis is also called, is relatively infrequent in the general population and usually occurs during intercourse, although it can also occur during masturbation. Cases of absolute or primary retarded ejaculation are rarely reported and often involve organic or drug-related components.

Premature or rapid ejaculation is a fairly common experience among men, especially in young men or when initial excitement is high with a new sexual partner. The frequency of sexual activity is also a component, as is the presence of anxiety. It is difficult to diagnosis rapid ejaculation based on duration of intercourse or a partner's orgasmic response (i.e., the male ejaculating before a female partner reaches orgasm during coitus). However, the diagnosis can be made if the male ejaculates before or immediately upon intromission or with minimal stimulation. Sex therapists tend to stress the concept of reasonable ejaculatory control rather than to invoke time parameters for intercourse. Kinsey, a zoologist, found that the average male ejaculated only after one and a half minutes of intromission. He felt rapid ejaculation may have had an adaptive effect from an evolutionary perspective. Uncomplicated cases of premature ejaculation are usually successfully treated with modern sex therapy techniques.

Another category of sexual dysfunctions that is currently recognized is sexual pain disorders. Painful intercourse, or dyspareunia, describes a condition in which either the male or female complains of persistent genital pain during or immediately after intercourse. The condition is rare in the male, but in the female many physical conditions could be responsible, including insufficient vaginal lubrication, vaginal infections, endometriosis, vaginal atrophy, and pelvic adhesions.

Vaginismus refers to persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with intercourse. Vaginal penetration is accompanied by pain because of the tightness of the vaginal entrance caused by the constriction of the perivaginal muscles. While the condition can cause dyspareunia, vaginismus is a separate diagnosis and can be responsible for "unconsummated" marriages. The problem is usually psychogenic and can also exist in non-sexual situations that can interfere with the use of vaginal tampons during menstruation or with gynecologic examinations. After ruling out organic causes or correcting them through proper medical intervention, vaginismus can be successfully treated with sex therapy.

As with many other diagnostic schemes, there are some sexual dysfunctions that are labeled as atypical or not classified by another diagnoses. Examples would be genital anesthesia or a complaint of no erotic sensation despite stimulation and orgasm as well as during masturbation.

Sexual Problems and Difficulties

While sexual dysfunctions reflect diagnosed inadequacies in sexual functioning, the existence of sexual difficulties refers to problems relating to the emotional tone of sexual relationships. They are varied and, as reported above, can sometimes be cause for greater frustration and unhappiness in relationships than the true sexual dysfunctions. These difficulties are not often reported to doctors by patients, and yet they provide many of the complaints seen by sex therapists in their work with individuals and couples, be they heterosexual or homosexual.

Dysfunctions often arise from a combination of educational deficits, physiological problems, inhibitions, and interpersonal conflict. Many of these difficulties refer not to the quality of sexual performance but to the affective tone in the relationship, which in turn affects the perception of the quality of the sexual interactions. Many are situational and are a by-product of a hectic modern life-style. Others reflect sexual misinformation and dysfunctional patterns of communication. Examples are as follows: partners choosing an inconvenient time for sex, inability to relax during sex, disagreement between partners on sexual habits or practices, lack of interest in or indifference toward sex, insufficient foreplay before sex, little tenderness after intercourse, attraction to someone other than one's partner, boredom with sex or with one's partner, being "turned off" by one's partner, unrealistic expectations about sex, lack of trust between partners, illness and fatigue, and power struggles in which sex becomes the battleground.

When the above partial list of issues that contribute to sexual difficulties is examined, it becomes apparent how many potential interferences there are that serve as barriers to satisfactory sexual relationships. It should also be noted that these difficulties can lead to sexual dysfunctions that are consequences of unfulfilling sex. It would be an error to assume that such things will pass with time; they might if the difficulties are situational and temporary, but there is the risk of patterns of dysfunctional behavior forming that can go on undealt with for years.

For some, corrections can be made through simple education, correction of sexual myths, or better and more effective communication with partners about sexual interests and wishes. Unspoken sexual contracts may need to be renegotiated. Many find that they must find for themselves just what are the essential ingredients for good sex. Often, good sex begins with the "four Ts": talk, time, trust, and touch.


Frank, E., et al. Frequency of Sexual Dysfunction in "Normal" Couples. New England Journal of Medicine, Vol. 299 (July 20, 1978), pp. 111-15.

Kinsey, A., et al. Sexual Behavior in the Human Male. Philadelphia: Saunders, 1948.

Lief, H. Classification of Sexual Disorders. In H. Lief, ed., Sexual Problems in Medical Practice. Washington, D.C.: American Medical Association Press, 1981.

Lief, H. Classification of Sexual Disorders. In H. Lief, ed., Human Sexual Response. Boston: Little, Brown, 1966.

Masters, W., and V. Johnson. Human Sexual Inadequacy. Boston: Little, Brown, 1970.

Slowinski, J. Sexual Dysfunctions: Common Problems Often Overlooked. Ob/Gyn Medical Letter, Vol. 2 (Winter 1989), p. 3.

Julian W. Slowinski


Assessment of Sexual Orientation
Measures of Sexual Orientation
The "Limerent and Lusty" Theory of Sexual Orientation
What Causes Variability in Sexual Orientation?


Although to some people the concept of "sexual orientation" is self-evident, in fact it is usually a poorly defined one, with controversies surrounding each aspect of the definition. There is even controversy about whether the term is itself legitimate, with some scholars preferring "sexual preference" and yet others of the opinion that all such terms are nothing more than social constructions of a particular time and place, of no universal significance.

Those who use the term "sexual orientation" do so to emphasize that what they are talking about is an underlying preference for relationships with a particular sex, a preference which endures despite the circumstances of daily life or the pressures of socialization. For example, men whose spontaneously occurring sexual fantasies only include women can, if imprisoned, make do with males as sex partners. But as soon as they are released, they seek female partners. Likewise, heterosexual female prostitutes are sometimes paid by their male customers to have sexual relationships with other females; the women involved can become aroused under such circumstances, but not because their underlying orientation is homosexual or bisexual. Rather, they are heterosexual women who are engaging in homosexual acts for profit.

This matter is complicated by the fact that most people with persistent homosexual feelings initially deny those feelings (even to themselves), usually for many years or even decades. Sometimes, they succeed in avoiding any homosexual acts that might otherwise have resulted from those feelings, but other times they begin to use what psychologists call the ego defense of splitting. In splitting, one simply decides not to think about or consciously deal with an important aspect of one's personality; one splits it off into its own compartment, so to speak. However, that aspect of the personality continues to be active and will typically have its way sooner or later. The result can be an extremely painful or anxious state of mind in which one feels out of control of one's emotions and (eventually) one's actions. Politicians and other public figures who are embarrassed by being caught in compromising homosexual situations presumably owe their dilemmas to splitting, as do many ordinary people who find themselves engaging in self-destructive behavior patterns pertaining to sexuality.

This acute psychological distress ends when the individual admits his or her homosexual desires to himself or herself, takes responsibility for those feelings, and takes on a homosexual identity. Homosexuals call this process coming out, and it is an essential step forward in the mental health of people with a fundamental homosexual orientation. Coming out can also refer to any subsequent stage of increasing openness in dealing with one's homosexual feelings: for example, coming out to one's family or loved ones means telling them about one's homosexuality, bringing a significant other to family reunions, and so on.

The acutely painful awareness that one's deepest emotions are not in accord with what one has been socialized to expect them to be is the fundamental cause of the awareness most homosexuals have of their sexual orientation. It follows that most heterosexuals may be less fundamentally aware that they have a sexual orientation, because it is in accord with the socialization pressures they experience every day. It also follows that many heterosexuals will conclude, rightly or wrongly, that they became heterosexual as a result of the strong socialization pressures our society provides in that direction, not as a result of any underlying predisposition— and thus that homosexuality probably results from choice or from defects in that socialization process. It finally follows that bisexuals—people who have sexual attractions to both men and women—may have a special perspective on the matter of sexual orientation. On the one hand, pursuit of the heterosexual portion of their feelings may delay their coming to terms with their homosexual aspect. On the other hand, once they do so they may feel separate and distinct from ordinary homosexuals due to the enduring or special nature of their heterosexual attractions. Many homosexuals go through a stage in which they pretend to themselves that they are bisexual; accordingly, they can be slow to admit the reality of that label when other people take it on.

Assessment of Sexual Orientation

This uncertainty in the definition of sexual orientation is reflected in controversy over the appropriate method of assessing it. Some scientists, especially those who prefer the term "sexual preference," believe that one can only assess sexual orientation by asking the person about it. Others believe that observing a person's behavior is the only accurate method, since people can lie about their behavior and can deny their "true" feelings. Yet others believe that sexual orientation is best assessed by an extensive interview, in which a trained professional arrives at a sexual orientation rating on the basis of a combination of behavior, fantasy, and other aspects of life.

One method of sexual orientation assessment was developed by psychologists trying to assess the effectiveness of treatments to change sexual orientation behavioristically. Behaviorists distrust subjective evaluations of any trait (e.g., "true feelings"), and these workers accordingly developed a penile plethysmograph—a device that is attached to the penis and records penile volume in real time, in response to stimuli (e.g., slides, audiotapes) presented to the subject wearing the device. A man is judged heterosexual or homosexual according to whether it is female or male stimuli that are associated with increases in penile volume. There are also vaginal photoplethysmographs, in which a probe measures the reflectivity of the vaginal wall (which is affected by the blood engorgement of sexual arousal in women). As far as the present author knows, however, vaginal photoplethysmographs have never been used for sexual orientation assessment.

Measures of Sexual Orientation

Many of these confusing matters can be clarified by being precise about what kinds of attractions are under discussion and by taking seriously the notion that there may be more than one kind of sexual attraction. The first such attempt was made by Alfred Kinsey, who developed and used the heterosexuality-homosexuality rating scale (now usually called the Kinsey scale), which rates exclusive heterosexuality as 0, exclusive homosexuality as 6, equal attraction to men and women as 3, and other degrees of bisexuality using the other numbers in between. The rating is assessed on the basis of a face-to-face sex history interview.

The inevitable conflicts between desires and behavior, as well as the wish to encompass other aspects of sexual attractions, led Klein to develop the Klein Sexual Orientation Grid (KSOG), which is usually assessed by self-administered questionnaire. Using the same 0-to-6 numbering scheme as Kinsey, Klein postulated the existence of seven aspects of sexual attractions (i.e., sexual fantasy, sexual behavior, sexual attractions, emotional attractions, social attractions, social behavior, and sexual self-identification) and assessed them at three different periods (past, present, and ideal-future), for a total of 21 different numbers. Statistical analyses of KSOG scores suggest that these 21 different aspects are not entirely independent of each other—that is, fewer than 21 numbers can probably suffice to describe a person's sexual orientation with reasonable scientific completeness—but that a single number is probably insufficient. In particular, these analyses suggest that sexual and social attractions are somewhat independent of each other.

The "Limerent and Lusty" Theory of Sexual Orientation

Insights such as these led the author to develop the limerent-and-lusty theory of sexual orientation, which postulates that there are at least two distinct aspects of sexual attraction and names these aspects "limerent" and "lusty" attractions. It is an important postulate that both of these aspects are sexual and have erotic components. Lusty attractions are those in which the sexual attractiveness of an individual is judged by comparison with a physical standard: for example, "I tend to be attracted to tall, muscular, hairy men with dark eyes," or "I'm attracted to thin blonde women with long legs and small breasts." Lusty attractions can presumably be discovered (in men, at least) through plethysmography. Limerent attractions are those in which the sexual attractiveness of an individual is judged by comparison with an emotional-personality standard: for example, "I'm attracted to women who are smart and independent enough to take care of themselves," or "I tend to be attracted to people who can dominate me but who are always sensitive to my needs and desires." Men are more likely than women to think of their sexuality primarily in lusty terms, although many if not most men are able to be aroused by both aspects of sexiness. Women are more likely than men to think of their sexuality primarily in limerent terms, although many if not most women are able to be aroused by both aspects.

Much of the confusion about sexual orientation can be clarified by being precise about which kind of sexual attraction—limerent or lusty—is being discussed. It is the opinion of the present author that there are very few individuals who have lusty attractions of roughly equal salience to both men and women, thus giving credence to the feeling of many people (especially gay men) that "true" bisexuality is rare or nonexistent. However, it is not difficult, in the opinion of the author, to find people who have limerent attractions to both sexes, even though it is probably the case that most adults have limerent attractions to one sex only. This gives credence to the statements of many bisexuals who believe that homosexuals and heterosexuals reject the notion of bisexuality too quickly, based on their own experience of just lust and not limerence.

What Causes Variability in Sexual Orientation?

Some people criticize attempts to uncover the antecedents, if any, of the various sexual orientations, because they believe that such questions reflect an underlying anti-homosexual bias and will inevitably be misused to prevent homosexuality. These critics claim that it is only because our society stigmatizes homosexuality that people care about such questions. After all, why worry about the causes of differences in height, unless they are the pathological extremes of height, or the causes of different tastes in food? Although this point of view has some validity, scientists are nevertheless interested in more than just abnormal variations. For example, personality psychologists have long been interested in traits like introversion and extroversion, neither of which is typically considered pathological. It is the job of scientists to wonder about the causes of all aspects of human behavior, including personality and sexual behavior.

An important era in research on this question ended with the publication of the Kinsey Institute studies of homosexuality in the late 1970s and early 1980s. These researchers conducted an extensive study of black and white homosexual men and women, examining all the commonly proposed theories of sexual orientation popular at the time with psychologists, sociologists, and other social scientists. In a sophisticated path analysis, the only variable that was consistently shown to be both statistically significant and substantively important with respect to sexual orientation was childhood gender nonconformity. Here, the correlations were so high that the Kinsey workers concluded that childhood gender nonconformity was essentially the same thing as homosexuality—or, more probably, constituted one type of homosexuality seen at an earlier stage of development. The fact that they considered this to be only one type of homosexuality was reflected in the title they chose for their work, Homosexualities. Accordingly, these social scientists suggested that biological factors probably play a much larger role in the genesis of the different sexual orientations than they had believed at the time they designed their study. Of course, with one exception (noted below), these researchers had not designed biological variables into their study, so their acceptance of biology was without direct evidence. The exception was that they had asked respondents about their brothers and sisters and, in particular, to report whether those siblings were homosexual or heterosexual. They did not publish these data in their books, but in later unpublished tabulations they did find that their homosexual respondents reported more homosexual brothers and sisters than their heterosexual respondents did. Of course, this does not distinguish between genetic-biological transmission and environmental fostering of the trait, but it is an interesting first step.

The first carefully controlled study of whether sexual orientation tends to run in families was conducted by Pillard and Weinrich, who reported that 22 percent of the homosexual men in their sample reported homosexual brothers, whereas heterosexual men reported only 4 percent homosexual brothers. A corresponding statement held true for homosexual women (unpublished data). This study was the first to confirm the reports of the original subjects by actual inquiries to the brothers and sisters themselves. This finding was confirmed and extended in a recent study by Bailey and Pillard. These workers chose not an ordinary sample of gay men but a sample of homosexual male twins, finding that about half of the co-twins of monozygous ("identical" or single-egg) homosexual twins were also homosexual, whereas only 22 percent of the co-twins of dizygous ("fraternal" or two-egg) homosexual twins were likewise. Further analyses strongly suggested a genetic component to sexual orientation, even in the light of many different parameter values used in their models and no significant evidence that the environments of monozygotic twins were more alike than the environments of dizygotic twins (which otherwise might explain their results). Essentially the same results were obtained in a more recent study of female twins conducted by the same authors.

Note that even in these so-called "biological" studies, substantial amounts of environmental variability were detected. For example, in the Bailey and Pillard twin study, 48 percent of the co-twins of monozygotic homosexual male twins were heterosexual—not a small percentage. Remarkably, very few proponents of the environmental view have shown any interest in examining the environmental contribution to sexual orientation, although it must exist.

Accordingly, any comprehensive theory of the development of the various sexual orientations must take into account genetic, hormonal, early childhood, and later experiences. One such theory is the periodic-table model of the gender transpositions, which assumes that there are not one but at least two underlying dimensions to sexual orientation (as well as other gender transpositions such as transvestism and transsexualism). However, even this theory does not propose a specific mechanism by which sexual orientations are differentiated.

A more recent theory devised by the present author, called the predisposed-imprinting theory, takes its cue from an insight of John Money's: that the true sequence of events in psychosexual development is not just "genetics" followed by "learning," but genetics and hormonal factors followed by sensitive period experiences in early life, followed by ordinary learning. Those sensitive period experiences might be what biologists call imprinting or might merely be sharply constrained and long-lasting learning. The predisposed-imprinting theory proposes that children are strongly predisposed by genetic, hormonal, and perhaps some early life experiences to put themselves into certain situations that, in turn, "imprint" them (or cause certain types of irreversible learning to take place) on sexual objects that will turn out, with the hormones of puberty, to be the sexually attractive objects reflected in their sexual orientations. The most common principle hypothesized for this process is that a mature version of the type of person one is most estranged or separated from in early childhood will become the type of sexually attractive object at puberty and into adulthood.

For example, most typically masculine boys in childhood play with other boys, and not only stay away from girls' play groups but also are excluded (by the girls) from those play groups. Follow-up studies show that the large majority of such boys grow up to be heterosexual men: that is, they are attracted to the mature version (women) of the objects they were excluded from interacting with (girls) when they were boys. In contrast, most so-called "sissy," "effeminate," or feminine boys play with girls in childhood and exclude themselves from boys' play groups (because the boys play "too rough"); also, they are excluded from those groups by the boys in them. Follow-up studies show that the large majority of such boys grow up to be homosexual men: that is, they are attracted to the mature version (men) of the objects they were excluded from interacting with (boys) when they were young.

As another example, boys who lose their father early in life, or boys who have physically abusive fathers, are excluded from ordinary kinds of psychological contact with this important attachment "object." The predisposed-imprinting theory suggests that this kind of boy is more likely to grow into an adult gay man who seeks older sexual partners who are father figures. Likewise, boys who lose their mother early in life or are otherwise prevented from having ordinary attachments to a mother figure are predicted to grow into adult heterosexual men who are strongly attracted to older women rather than women their age.


Many of the most interesting or controversial questions about sexual orientation cannot be answered without being precise about the aspect of sexual attraction being considered. Accordingly, we have not discussed many of these questions in this essay: for example, can sexual orientation change throughout life? Is there any process (some would say "therapy") by which sexual orientation can be changed? What are the types and subtypes of heterosexual, homosexual, and bisexual, and what (if anything) causes these various subtypes to come into being?

Perhaps the most intriguing question concerns the relationship, if any, between one's sexual orientation and one's preferred erotic role (in or out of bed). In the AIDS (acquired immune deficiency syndrome) era, we need to understand what causes people to prefer particular erotic roles and their associated sexual acts over others, because it is only certain sexual acts that are at high risk for transmitting HIV (human immunodeficiency virus) from an infected to an uninfected partner. Although some first steps have been made in this direction, we need much more detailed descriptions of people's sexual attractions to succeed in this arm of the fight against this terrible disease.


Bailey, J. M., and R. C. Pillard. A Genetic Study of Male Sexual Orientation. Archives of General Psychiatry, Vol. 48 (1991), pp. 1089-96.

Bell, A. P., and M.S. Weinberg. Homosexualities: A Study of Diversity among Men and Women. New York: Simon & Schuster, 1978.

Bell, A. P., M.S. Weinberg, and S. K. Hammersmith. Sexual Preference: Its Development in Men and Women. Bloomington: Indiana Univ. Press, 1981.

Klein, F., B. Sepekoff, and T. J. Wolf. Sexual Orientation: A Multi-variable Dynamic Process. Journal of Homosexuality, Vol. 11 (1985), pp. 35-49.

Pillard, R.C., and J.D. Weinrich. Evidence of Familial Nature of Male Homosexuality. Archives of General Psychiatry, Vol. 43 (1986), pp. 808-12.

Pillard, R.C., and J.D. Weinrich. The Periodic-Table Model of the Gender Transpositions: Part I-A Theory Based on Masculinization and Defeminization of the Brain. Journal of Sex Research, Vol. 23 (1987), pp. 425-54.

Weinrich, J.D. The Periodic-Table Model of the Gender Transpositions: Part II—Limerent and Lusty Sexual Attractions and the Nature of Bisexuality. Journal of Sex Research, Vol. 24 (1988), pp. 113-29.

Weinrich, J.D. Predisposed Imprinting: A New Theory of the Proximate Causes of Sexual Orientation. Submitted for publication.

Weinrich, J.D., I. Grant, D. L. Jacobson, S. R. Robinson, J. A. McCutchan, and the HNRC Group. On the Effects of Childhood Gender Nonconformity on Adult Genitoerotic Role and AIDS Exposure. Archives of Sexual Behavior, Vol. 21 (1992), pp. 559-86.

James D. Weinrich


The term "sexual revolution" has been applied by historians to change during two separate periods of American history. The first took place in the opening years of the 20th century and is associated with Prince A. Morrrow and the social hygiene movement. The second was much better publicized and took place in the 1960s. Both of these revolutions had some counterparts in other parts of the world—the social hygiene movement for the first, the expanding sexual revolution for the second, but both were, in fact, so important in the United States that they appeared to be peculiar to the American socio-cultural setting.

The first sexual revolution grew out of the efforts of social hygienists to fight venereal disease; in so doing, they challenged some fundamental social institutions in an attempt to save the health of many Americans and also the family in the United States. The second sexual revolution was speeded by new technological developments and involved largely replacing middle-class feminine standards with lower-class masculine standards.

In the last part of the 19th century, Americans came closer than other people in the world to observing the traditional ideal of chaste monogamy that was common to all of the West. The ideal was enforced by a strong purity movement that had spread from England as part of an antiprostitution campaign, and many middle-class American mothers (this would include a very large number of northern households) succeeded in inculcating ideals of sexual purity and monogamy in their children—boys as well as girls. Particularly notable was a general public agreement on the so-called conspiracy of silence, by which no public discussion of anything sexual occurred—neither in a printed form nor in decent company. Public discourse was rigorously cleansed of anything that might sully the innocence of "a young girl" and convey any knowledge to her or allude to what she might learn by accident.

In a complex way that seemed to work at the time, there was simultaneously a widely observed double standard. Women were expected to be pure and even asexual, despite the fact that many of the most respectable married women, in private, participated with their husbands in lively or at least satisfying lovemaking.

Men, by contrast, were permitted, and to some extent expected, to indulge their bestial passions whenever they had the opportunity, much as Benjamin Franklin had once advocated venery for the sake of health. The chief focus of men's self-indulgence was a group of women who played the social role of prostitutes, and prostitution was well established in every city, where the existence of the institution was the subject of open discussion (in veiled terms, of course), and in many smaller urban centers. With considerable social support, a whole hierarchy of prostitutes served both unmarried male populations and other men who took advantage of the prevailing customs.

This social arrangement lasted until the terrible results of the STDs (sexually transmitted diseases) led physicians to question whether existing institutions were not better overthrown in favor of new social arrangements. The social hygienists under the leadership of Morrow began, about 1905, to advocate simultaneously educating people about the dangers of venereal disease, about the ways in which monogamous marriage and purity could be made fulfilling for both men and women, and about the necessity for wiping out prostitution and ending the double standard, the chief means by which disease spread at that time. To destroy the institutions of the double standard and prostitution, it was necessary also to end, at least to a substantial extent, the conspiracy of silence, still another well-established institution.

The success of these early-20th-century reformers in their endeavors constituted the first sexual revolution. All over the country, cities established vice commissions to expose prostitution and show ways of curbing it, particularly by getting at the economic base of it by first moving against property owners who owned buildings where prostitutes plied their trade and then agitating against business proprietors who paid women so little that at least part-time prostitution was either attractive or necessary. During World War I, pressure by the federal government against prostitution near armed services facilities carried the reformers very far, so that in the United States prostitution was ended as an institution condoned and supported by much of the middle class and was instead rendered deviant and lower class.

The campaign for education about STDs and the necessity to encourage fulfilling marriages to substitute for prostitution enabled sexual reformers to advocate the equality of women in sexual arrangements and the right of all people, including children, to know the truth about sexual activity. Sex education entered the better school systems, and even entertainment that appeared to be serious moved toward a much more open treatment of subject matter and use of language—what became in the 1920s "the cult of frankness." This postwar cult of frankness was accompanied by what Frederick Lewis Allen characterized as "the revolution in manners and morals"—and, in fact, later surveys suggest that younger women of the 1920s did engage in sexual activity more freely than a previous generation.

This first revolution affected primarily middle-class Americans, and thereafter sexual attitudes tended to differentiate by social class far more than earlier, particularly as non-British ethnics constituted an ever-larger part of the population. With World War II, lower-class standards—usually labeled publicly as libertinism—increasingly came to be imposed on middle-class Americans. At the same time, even lower-class people tended to pick up from the middle-class sexual liberals the desirability of much great variety in sexual activity. It was this combination of much more indulgent quantitative and qualitative standards that came in the 1960s to be named the sexual revolution, and it occurred in a social setting in which traditional urban toleration of "loose" and "deviant" behavior spread and intensified.

This sexual revolution came about particularly because of a number of factors: World War II, penicillin, the Kinsey reports, and the birth control pill.

The leadership of the U.S. armed services in World War II was not moralistic, as was the officer group as a whole during World War I. The atmosphere among troops in the World War II barracks was decidedly not uplifting, and barracks talk shaped many young Americans' attitudes along the lines of exploitive, lower-class male sexual behavior. Frank instructions to the troops likewise failed to distinguish between prostitutes and other women: all "girls" were to be regarded as suitable for casual sexual contact. The coming of penicillin at the end of the war eliminated the strictly institutional motive to discourage contact with casual women, for troops with venereal diseases could now quickly be restored to action rather than being disabled. The ending of the fear of venereal disease as an inhibiting motive to casual coupling also spread rapidly to the rest of the population as "wonder drugs" became generally available in the 1940s and after.

The Kinsey reports (1948 and 1953) suggested that if aggregated together, Americans in fact indulged in a wide variety of sexual behaviors that were neither monogamous nor missionary-position lovemaking. In public discourse, Kinsey's work served to confirm the barracks-room standards to the effect that any sexual activity was not deviant, with an additional motivating belief that a lot of Americans were getting a lot of sexual gratification.

"The Pill," which came in at the end of the 1950s, further helped provide both rationale and means to transform sexual behavior into a nonprocreative activity, undertaken for pleasure or some other personal motive—as opposed to the traditional procreative focus. It was against this background that various figures began to proclaim "the sexual revolution."

In 1961, Boroff explicitly identified "Sex: The Quiet Revolution" in sexual standards and behavior. By 1964, the editors of Time and Newsweek had discovered the sexual revolution, and that, of course, made the event official. The sexual revolution even had an unofficial organ, Playboy magazine, which was founded in 1953 and reached a million circulation even before the 1960s.

Those who argued that a sexual revolution was taking place cited four types of phenomena: much more openness of sexual expression, quantitatively increased sexual activity, growth and tolerance of "deviant" practices, and change in the status and condition of women in sexual arrangements.

The openness of expression about sexual matters was evident for everyone to observe. Beginning in the mid-1960s, in every city booksellers openly operated so-called adult bookstores (ironically, dedicated to regressive, not adult, material) and explicitly sexual movie arcades. Over many years, literary critics noted how language and description became ever franker, until virtually nothing was proscribed from literature, and journalists followed suit as quickly as they dared. Social scientists charted how much and how often depictions of sexual activity—and what had formerly been offensive expressions—appeared in prime-time television programs as the decades passed. Sexual minorities, so-called, even for a time pedophiles, took advantage of the civil rights movement openly to advocate actions and attitudes that had formerly suffered severe taboos.

Whether other aspects of sexuality, beyond openness of expression, underwent change in American society remains undemonstrated. The question of a quantitative increase illustrates the difficulties in giving a definitive answer as to how much actually changed. Kinsey used the number of orgasms as a basis for quantifying sexuality. People at that time and since questioned that tabulating orgasms or even sexual partners actually provided information about sexuality. For example, they asked, What about intensity? What about just plain quality? Since prescriptive literature made much lovemaking compulsory and compulsive, or ceremonial or merely an adjunct to consumer culture (one book of instructions, The Joy of Sex, was obviously patterned after a cookbook, The Joy of Cooking), the extent to which such actions were actually sexual came to be questioned. In terms of sexuality as such, a good argument could be made, and some witty essayists did, that it was diluted and displaced, and therefore decreased, in spite of the formal actions that might have been recorded.

Certainly, the many varieties of sexual behavior did gain a great deal more publicity, particularly oral and anal practices and homoerotic partner choice. There was a middle-class movement, with some organization by the 1970s, to further "swinging," that is, multiple-partner orgies. But this movement receded, for reasons that were not clear, and the practice apparently remained restricted to only a tiny minority even before the AIDS (acquired immune deficiency syndrome) scare began in the 1980s.

Gay and lesbian groups that, along with un-censored humorists, did so much to publicize homoerotic partner choice and activity were particularly problematic, because it was not clear that more sexuality of this variety was occurring; many experienced observers believed that it was now being practiced with more openness and dignity rather than more frequency. Certainly, the glimpses that historians had given of the casual occurrence of overtly homosexual practices in earlier periods (e.g., a gay community in Chicago of 10,000 people in 1909) did not support the belief that a sexual revolution had brought more of such behavior.

What the sexual revolution did bring was widespread media publicity about a sexual revolution and so a widely shared belief that something was happening. That actual behavior changed in a revolutionary way, that is, overturning institutions, is extremely dubious. But that the perceived realities of Americans changed was clear, and with these perceptions, as later studies showing generational change suggest, there were changed expectations, particularly about compulsive sexual activity among younger and younger Americans—and, if Playboy writers were to be believed, those seeking youth.

The extent to which belief in a sexual revolution affected women was particularly problematic. On the whole, belief in a sexual revolution defined sexuality in terms of a masculine standard, particularly barracks or even old-fashioned pornographic stereotypes. Insofar as the revolution was defined as casual coupling based on singles bar encounters or irresponsible ("uncommitted") living together, the position of women in sexual relationships was severely degraded. As the belief in romantic love and fulfilling marriage had nurtured the custom of dating, in which women retained some control of the setting, by moving sexuality into the public arena and outside of marriage women lost a significant amount of control over male-female relationships. Insofar as women were persuaded to move into the world of pornography (the quest of Playboy and more openly pornographic readers for an orgiastic "pornotopia"), as studies of the late 20th century documented from popular literature for women, American women were moved toward a world in which women were often degraded and objectified. It was this move to which many feminists objected vigorously.

On the whole, however, few Americans saw that the sexual revolution they believed in, or wanted to believe in, was essentially based on a partial and compulsive sexuality. Only a few others commented on the conservative nature of the so-called sexual revolution. In addition to possibly moving women's status back to times when they were more subservient to men's sexuality, the sexual revolutionaries served social conservatism very well. No social-class assertiveness was required. Not even relatively neutral institutions (comparable to the conspiracy of silence or prostitution earlier) had to be overturned. Instead of upsetting the social hierarchy, the sexual revolution distracted people from it. Indeed, some commentators characterized the vaunted sexual liberation as the new, and most effective, opiate of the masses.


Baldwin, F.D. The Invisible Armor. American Quarterly, Vol. 16 (1964), pp. 432-44.

Boroff, D. Sex: The Quiet Revolution. Esquire, July 1961, pp.95-99.

Brandt, A.M. No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. New York: Oxford Univ. Press, 1985.

Burnham, J.C. Bad Habits: Drinking, Smoking, Taking Drugs, Gambling, Sexual Misbehavior, and Swearing in American History. New York: New York Univ. Press, 1993.

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

Clark, R.L. Changing Perceptions of Sex and Sexuality in Traditional Women's Magazines, 1900-1980. Ph.D. diss., Arizona State Univ., 1987.

D'Emilio, J., and E.B. Freedman. Intimate Matters: A History of Sexuality in America. New York: Harper & Row, 1988.

Ehrenreich, B., E. Hess, and G. Jacobs. Re-Making Love: The Feminization of Sex. Garden City, N.Y.: Anchor Press/Doubleday, 1986.

Model, J. Into One's Own: From Youth to Adulthood in the United States, 1920-1975. Berkeley: Univ. of California Press, 1989.

Morantz, R.M. The Scientist as Sex Crusader: Alfred C. Kinsey and American Culture. American Quarterly, Vol. 29 (1977), pp. 563-89.

Pivar, D.J. Cleansing the Nations: The War on Prostitution, 1917-21. Prologue, Vol. 12 (1980), pp.28-40.

Rosenberg, C.E. Sexuality, Class and Role in 19th-Century America. American Quarterly, Vol. 25 (1973), pp. 131-53.

Schur, E.M. The Americanization of Sex. Philadelphia: Temple Univ. Press, 1989.

Sherman, A. The Rape of the A*P*E*; The Official History of the Sex Revolution, 1945-1973; The Obscening of America. Chicago: Playboy Press, 1973.

Simmons, C. Modern Sexuality and the Myth of Victorian Repression. In K. Peiss and C. Simmons, eds., Passion and Power: Sexuality in History. Philadelphia: Temple Univ. Press, 1989.

Thurston, C. The Romance Revolution: Erotic Novels for Women and the Quest for a New Sexual Identity. Urbana: Univ. of Illinois Press, 1987

John C. Burnham


Sexual Values
Sexual Morality
Modernity Threatens Traditional Morality
Moral Development
Caring and Moral Emotion
Ethical Action Guides for Sexuality

Sexual Values

The relative worth, merit, or importance of an object is called its value. In sociology, the ideals, customs, institutions, and practices in a society toward which the people have positive or negative affective regard are called values. In ethics, any quality or object that is desirable as a means-or end-in-itself is called a value.

A sexual value reveals an ideological stance about the relative worth, merit, or importance of sexuality in human living. Each society defines sexual ideals for sexual practices; violating these ideals activates negative emotions like shame or guilt—first from responses from others, then from the self.

Sexual Morality

Socially learned normative standards become a society's customary and conventional sexual values or sexual morality. Morality is a social institution concerned with a set of practices defining right or wrong that are pervasively acknowledged within a particular society. Individuals are born into a society, learning its sexual morality. The rules of traditional sexual morality are general and abstract prohibitions rather than specified and particularized action guides initiated by concerns for a specific individual in a given context.

Moral philosophy attempts to justify sexual values as means-in-themselves or ends-in-themselves by a reflective and critical analysis of sexual morality. Moral philosophers attempt to introduce clarity, substance, and precision into moral discourse. They seek to justify an ethical theory of sexual morality by challenging presuppositions, clarifying hidden assumptions, and assessing moral arguments.

Although social moralities are culturally relative, morality itself is not ethically relative. For the philosopher, morality means conformity to the rules of right conduct for morally sound reasons. Ethical action guides for human sexuality are justified by arguments from general moral principles, such as respect for personal autonomy, nonmalevolence, beneficence, and justice.

In common usage, however, both "moral" and "morality" also mean to be sexually virtuous or chaste. Sexual virtue as chastity means the person has not engaged in any unlawful sexual conduct in the eyes of the church. This culturally relative usage of "morality" reflects socially and historically constructed Western traditional sexual values. Within Western culture, traditional sexual morality has positively valued monogamous marital coitus in the missionary position for procreative purposes without the experiencing of excess passion or pleasure. All other sexual motives, sexual linkages, and sexual objects are proscribed as immoral by traditional sexual morality.

Modernity Threatens Traditional Morality

Conventional morality is traditional, but not all traditional morality remains conventional. Modernity threatens the moral status quo. Any change, like acknowledging gay rights or defending free choice in determining the outcome of early pregnancy, is seen as undermining traditional morality; such "threats" produce a backlash against sexual immorality.

Nonetheless, contemporary community standards positively affirm the values of love and pleasure in marriage or committed relationships, as well as a variety of positions for coitus and a variety of sexual activities, including oral sex, within such relationships. Love, self-fulfillment, and pleasure often replace reproduction as motives for sex. Although not traditional, such sexual beliefs and practices have become contemporary community standards for married or committed relationships.

Still, contemporary moral opinion is divided on masturbation, child-child sex, adolescent or adult nonmarital sex, premarital sex, adultery, homosexuality, pornography, prostitution, contraception, and abortion. Even though traditional morality proscribes these behaviors as sinful or wrong conduct, and although many people continue to uphold these prescriptive standards as their stated beliefs, people bypass privately these normative standards. For example, in public, few decry the traditional moral line on adultery, but many Americans secretly cross this line. When it comes to nonmarital sex, the present generation of young Americans engages in coitus at younger ages than their parents did but has no public voice to defend such sexual choices.

In this no-man's-land of sexual moralities at war, sides are chosen and battles rage between the pro-choice position and the right-to-life, between anticensorship and antipornography. In 1973, gay men and lesbians successfully challenged the medicalization of their sexual orientations as a mental disorder, but the characterization of homosexuality by traditional morality as a sexual sin continues. As it challenges tradition or modernity, each side offers moral arguments intended to persuade the majority to accept its view as the conventional one. Some religionists claim that AIDS (acquired immune deficiency syndrome) is God's plague to punish homosexuals. Traditional morality is said to defend traditional family values, values that modernists describe as anachronistic and patriarchal and sometimes as immoral in harming others and unjust in infringing on their personal liberty. At present, most Americans occupy a middle ground in this battle, publicly professing agreement with traditional sexual values but privately acting in accordance with modern sexual values.

Beyond the contemporary pale, still firmly nested within traditional sexual morality, lie the forbidden and taboo lands of incest, adult-child sex, rape, and some paraphilias. But no war is waged here. Ethical theories regard harm to others as placing a necessary limit on sexual freedom. Society should limit coerced sex and sex with children, who lack the competence to understand and authorize sex with adults as an autonomous choice that is not controlled by the more powerful adult. Moral arguments soundly justify such constraints by logical argument from moral principles.

Moral Development

Following the Swiss psychologist Jean Piaget, Lawrence Kohlberg pursued the study of moral reasoning and its developmental progression by asking children to respond to hypothetical moral dilemmas, hoping to discover stages in their moral reasoning. Although this research has played an important historical role, it remains subject to criticism by other experts.

What did Kohlberg do and what did he argue? He developed a system for scoring moral reasoning based on the responses of children in America and around the world to hypothetical moral dilemma. For example, the Heinz story asked children what Heinz should do when his wife might die if she did not receive a certain drug, which Heinz cannot afford; the inventor of the drug refuses to give him the drug for free. Using his scoring manual for moral reasoning, Kohlberg specified six stages of moral development divided into three levels.

In Level I, Preconventional Morality, Stage 1, Heteronomous Morality, what is right is obedience to powerful authorities and avoiding breaking concrete rules supported by punishment. The reasons for doing right are to avoid punishment and the power of authorities. From the perspective of moral realism, goodness or badness is believed to reside in the act; a concrete good or bad act is seen as real, inherent, and unchanging. The child is said to have an egocentric point of view as a social perspective, not being able to consider the interests of others or to take their point of view.

In Level I, Preconventional Morality, Stage 2, Individualistic, Instrumental Morality, what is right is following rules when it is in your immediate interest; letting others follow their own interests, knowing that interests may conflict; and doing what is fair in an equal exchange. The reason for doing right is to serve one's own interests while recognizing that others have their own interests, too. The social perspective is a concrete individualistic perspective in which everybody has their own interests, which conflict, making what is right relative to the particular situation and the actor's perspective.

In Level II, Conventional Morality, Stage 3, Interpersonal Normative Morality, what is right is living up to what is expected of you by people close to you; being good means having good motives and showing concern for others by honoring mutual relationships of trust, loyalty, respect, and gratitude. The reasons for doing right include the need to be a good person in your own eyes and those of others, the desire to care for others, the belief in the Golden Rule, and the desire to maintain rules and authority supportive of stereotypic good behavior. The social perspective is that of an individual in relationship to other individuals, aware of shared feelings and expectations, acting reciprocally to fulfill an obligation as a debt of gratitude.

In Level II, Conventional Morality, Stage 4, Social System Morality, what is right is fulfilling the actual duties to which you have agreed, upholding the law except in extreme cases of conflict with fixed social duties, and contributing to society. The reasons for doing right include keeping the social institutions going as a whole, avoiding the breakdown of law and order, and meeting one's defined obligations from the imperative of conscience. The social perspective differentiates the societal point of view from interpersonal agreement or motives by taking the point of view of the system that defines the social roles and moral rules and by considering individual relations within the framework of this system.

In Level III, Principled Morality, Stage 5, Human Rights and Social Contract Morality, what is right ordinarily is upholding the social contract of morality—even as one is aware that people hold a variety of values and opinions and that most rules are relative to one's group; what is right always is upholding such nonrelative rights as life and liberty in any society regardless of the majority's opinion. The reasons for doing right include, first, a sense of obligation to law because of the social contract to abide by laws, to promote social welfare, and to protect all people's rights; second, a feeling of freely contracted commitment to family, friendship, and work; and, third, a concern that laws and duties be based on a rational calculation of utility—"the greatest good for the greatest number." The social perspective recognizes that values and rights are prior to society and social attachments; recognizing rights entails a rational decision to embrace the legal and moral point of view of agreements, contracts, impartiality, and due process.

In Level III, Principled Morality, Stage 6, Universal Ethical Principles, what is right is following self-chosen universal ethical principles of justice: the equality of human rights and respect for the dignity of human beings as individual persons. If laws violate these principles, the principles, not the law, have precedence. The reasons for doing right are the belief, as a rational person, in the validity of universal moral principles and a sense of personal commitment to following them. The social perspective is called the perspective of a moral point of view. Social arrangements are seen as derivatives of universal principles of justice or they do not merit respect. Rational individuals recognize the nature of justice and that people must be treated as ends in themselves.

What Kohlberg did was to mass a considerable amount of evidence in support of this perspective while stimulating much research and much criticism. Now, what did he argue?

Kohlberg argued that the last level of moral development is also the most adequate ethically. This breathtaking claim is that he has empirically established the best moral conception, claiming that he has moved from "is" to "ought," and that Kant and Rawls were right, while Aristotle, Hume, Bentham, and Mill were wrong.

Not only that, Kohlberg argues that the transition in moral stages results from individuals seeking to meet moral problems with adaptive mental structures; if present structures cannot assimilate a moral problem to a moral stage, then accommodation takes place by moving to a higher moral stage. Thus, environmental moral dilemmas generate moral conflict, requiring moral reasoning that is adapted to reality; adapting by assimilating to present moral structures when the social environment confirms their adequacy, and accommodating by achieving a new equilibrium within a higher stage when reality requires such rational adaptation. Thus, an empirical "is" leads to an adaptive "ought."

Such sweeping claims beg for informed criticism. Philosophers, such as Owen Flanagan, have responded. His first set of criticisms focused on the experimental paradigm itself: Kohlberg's use of hypothetical moral dilemmas. The first problem with the hypothetical situation is the presupposition that the subject is putting herself in the role of the protagonist and responding with what she would do in the same situation. Are we assessing the subject's moral reasoning as it occurs in everyday life or only her reflective reasoning about others facing events far from everyday moral concerns? Is talk cheap?

The second problem with the experimental paradigm is the purely verbal nature of the evidence. Whereas Piaget found that his cognitive structures mediate the child's actual behavior when faced with spatial, causal, and logical problems in everyday life, Kohlberg's paradigm describes verbal responses that are not causally linked to everyday moral action or to some convergent criterion of moral action. Moral competence requires not only saying the right things but doing them as well.

The third problem with the paradigm is its lack of comprehensiveness. By selecting dilemmas, there is a small number of options available, usually two. Moreover, the problems are all about justice, only a portion of the domain of morality. Many moral issues remain more open-ended: how can I be a good and loyal friend? Having nothing to say about such actions, how can Kohlberg address the beneficence of the Good Samaritan?

Kohlberg claimed that his six stages are structured wholes that are universal and follow an invariant, irreversible, and increasingly integrative sequence, but Flanagan argued that he has not satisfied these criteria of a stage theory. At best, while awaiting more data, Kohlberg scores a "maybe" on structured wholes and invariant sequence and a "fail" on universality, regression, and integration. All stages do not appear to be found in all cultures and do not appear at specific ages (universality); most people appear lumped into and stuck in the conventional stages. The idealism of stage 5 adolescents may regress to stage 4 concerns with order during adulthood (regression). Integration requires that earlier stages be logically contained within later ones, but it is difficult to see how the principled stages, which deny the meaningfulness of normative moral terms, can integrate the conventional stages, in which normative morality is assumed.

Finally, Flanagan criticizes Kohlberg's thesis that the highest stage is ethically the most adequate. First, Kohlberg has retreated from his claim that stage 6 is more morally adequate than stage 5. Second, there is no constant social or moral world to serve as a ground of convergence in the same way that there was for Piaget to claim a worldwide spatial world that corresponded to his highest stage of spatial development. Third, Kohlberg's highest stage presupposes a technologically advanced social world associated with Western culture. Finally, the most adequate ethical theory must be comprehensive, not limited to a concern with justice.

Caring and Moral Emotion

Gilligan argued that when psychologists traced the origins of morality to the child's discovery of the ideal of justice, they seemed to find that boys were more moral than girls. She countered that women may speak in a different moral voice. She argued that the dynamics of early childhood inequality give rise to a concern with justice and that the dynamics of attachment give rise to a concern with care. Empathy, friendship, and altruism are components of morality, of a caring orientation for which women are well-known. Since everyone is vulnerable both to oppression and to abandonment, two moral orientations develop, both justice and care.

Kagan has pointed out that recent research in psychology has been concerned with three themes in moral development. First, are children biologically prepared to display a moral sense by age two? Emotionality is the obvious feature when a child breaks a toy, dirties a dress, or makes another child cry. By age two, children show distress—about broken or flawed objects, in empathy with another's distress, and over failing to stack blocks high enough.

A second theme is the usefulness of the theoretical distinction between conventional and principled moral standards. The mode of establishment of conventions may rest on fear of punishment and a desire to remain attached to important people, whereas a principle of tolerance may be established through identification with parents or by reflectively seeking to make beliefs more consistent and coherent. Also, psychologists believe that violating conventions gives rise to less intense and less moral emotions than violating principled standards. In children, not reason but feelings may lie at the heart of morality.

The third theme considers the relevance of empirical data on moral development to the adequacy of ethical theory. How do we integrate the data of psychologists with the logical analysis of philosophers? The answer may be that each informs the other, that "is" and "ought" mutually illuminate each other.

In such an emotive view, moral development and moral character are closely bound to one another. Perhaps ethical theories that try to reduce morality to a single principle restrict its scope to the resolution of difficult problems by the application of reductive theory. Pincoffs so argued, stating that the common life of human beings provides the context for moral talk. If we lived in a more bounteous world, then perseverance and sharing would be less valued. If we lived in a world free of physical and emotional pain, then there could be no cruelty. Benevolence, sympathy, justice, fortitude, and kindness are virtues only in the context of the human condition. Moreover, what is the human condition? Near the beginning of the second millennium, the contemporary pressing ethical issues concern life and death: contraception, abortion, euthanasia, and the ratio of costs to benefits in health care.

Ethical Action Guides for Sexuality

From Piaget to Kohlberg, a practical guide to developing moral reasoning must include open discussions with peers about sexuality, its dilemmas, its emotions, and its outcomes. Practical moral reasoning requires practice in making decisions about moral matters. When you just say no, you do not address the role of sexuality in your life. The reflective saying of either yes or no requires that talking about sex be freed from restraints as immoral in itself. Just as talk about justice does not create it, talk about sex does not release it into inevitable expression. Reflective examination and discussion of sexual choices may improve the adequacy of sexual decision making.

Mosher suggested three questions to serve as guides in making responsible sexual choices. First, is this choice consistent with my sense of who I am and with my plan for life? To answer this question, you must consider what a sexual choice means for you now and in the future. Second, does this choice respect the dignity and worth of my sexual partner? To answer this question, you must consider how this choice affects your partner now and in the future. Third, if everyone made this choice for these reasons, would it create a world that I want to live in? To answer this question, you must ask what are the implications for society of people making this choice for these reasons. Taking the perspectives of self, other, and society requires that you play moral musical chairs. Kohlberg suggested this process of multiple-perspective-taking as a way of finding universalizable or disinterested moral choices.

Everyone is born to be a sexual human being. Not everyone, however, is born to make the same sexual choices. Respect for the autonomy of others to make their own sexual choices, so long as they do not harm others, is tolerance. Tolerance is a virtue; moralistic intolerance remains a vice.


Gilligan, C. In a Different Voice: Psychological Theory and Women's Development. Cambridge, Mass.: Harvard Univ. Press, 1982.

Kagan, J., and S. Lamb. The Emergence of Morality in Young Children. Chicago: Univ. of Chicago Press, 1987.

Modgill, S., and C. Modgill. Lawrence Kohlberg: Consensus and Controversy. Philadelphia: Falmer Press, 1985.

Mosher, D.L. The Threat to Sexual Freedom: Moralistic Intolerance Instills a Spiral of Silence. Journal of Sex Research, Vol. 26 (1989), pp. 492-509.

Pincoffs, E.L. Quandries and Virtues: Against Reductivism in Ethics. Lawrence: Univ. of Kansas Press, 1986.

Donald L. Mosher


Group B. Beta Hemolytic Streptococcus
Venereal Warts
Molluscum Contagiosum
Yeasts: Candida Albicans et al.
Mycoplasma and Ureaplasma Infections
Viral Hepatitis
Cytomegalovirus Infections
Pubic Lice and Scabies
Enteric Infections

Like the flu bug, with its constantly changing personality and character, many of the infectious diseases acquired through sexual activity with other people are constantly changing in format and content. As indicated by Holmes, in his printed disclaimer for his textbook, "medicine is an ever changing science so changes are constantly being made in treatment and drug therapy of these some 30 different diseases." Indeed, while this article was being written and rewritten, the Centers for Disease Control and Prevention (CDCP) authorized the use of the new antibiotic Floxin to treat gonorrhea and chlamydia and Zithromycin for the single treatment (eight tablets) of chlamydia during pregnancy. Floxin cannot be used to treat chlamydia during pregnancy.

Curative therapies are still not available for the viral infections (herpes, warts and AIDS). Syphilis, the major threat of the first half of the 20th century, when it caused debilitating illness and death, has been replaced by the new killer, AIDS (acquired immune deficiency syndrome). Abstinence, or no sex at all, is the only 100 percent effective preventive for any STD (sexually transmitted disease), although condoms used along with contraceptive gel or foam are the best protection currently available.


Trichomonas vaginalis was first discovered by a young Frenchman in 1838. Interestingly enough, he thought he had discovered the causative organism for gonorrhea, and the differentiation of the two organisms took another 50 years. Both are caused by organisms, gonorrhea by a gram negative intracellular diplococci, originally called Neisseria gonorrhea, and trichomonas by a protozoa.

Before antibiotic therapy developed, trichomoniasis was dramatically different from what it is today; patients sometimes came in with difficulty walking because the genital area was irritated, and the vaginal discharge was so profuse that it literally ran down their legs when they stood up. The discharge, when viewed with the aid of a vaginal speculum, was seen to be thick, frothy, and yellow-green, and it was extremely smelly.

The diagnosis for this particular infection is made by the physician on the spot, who does a microscopic test called a "wet mount," using a slide with either saline or a stained laboratory vehicle for easier microscopic identification. The protozoa can be easily seen moving around on relatively low-power magnification of the microscope. There are occasional false-negative readouts, probably due to overwhelming activity by the body's white blood cells, so that no actual trichomonal organisms can be seen during a test, but are visible at a later examination. This particular test usually gives an instant diagnosis.

The disease is easily treated using metronidazole. This particular drug has been used worldwide for over a quarter of a century. It has an inherent clinical safety record, never having caused death. When a woman who walks into the gynecologist's office has a trichomoniasis diagnosis made and is given the proper medication, that medication is doubled in amount so as to include her sexual partner (or tripled if there is more than one sexual partner). The same procedure is followed for a man at the urologist's office. The urologist writes a prescription not only for the man but also for the woman if she is not being seen by her physician.

Trichomoniasis is not a reportable disease. It is, however, a disease that can be fairly drug resistant, so in the United States the patient is asked to return to the office for a repeat test to make sure that the problem has been solved.


Another common STD seen in the health care practitioner's office is chlamydia trachomatis. Public health experts currently list this particular disease as the most common disease in the United States, with more than five million new cases discovered and treated each year. Until recently, it was not a reportable infection. One of the reasons it was not reportable is that many if not most physicians treat it on the basis of a sexual and social history, combined with the suspicious physical and microscopic findings. They do this because it is extremely difficult to obtain a good culture result (the cultures have a very high percentage of false-negative readouts). The CDCP and the U.S. Public Health Service have now asked that positive serologic tests for chlamydia be reported. Experts on this particular infection indicate such serologic tests are sometimes reported falsely as positive. This can cause legal problems for the patient and the physician.

The real problem with this obligate intracellular parasite is that it causes infertility in women. It is, however, easily treated. The use of tetracycline for seven to ten days by both partners will clear up this infection. If the tetracycline, a most inexpensive drug, causes severe stomach discomfort or other side effects, erythromycin or doxycycline will achieve the same result. However, chlamydia has a strong silent component to its clinical picture; it is often ignored or interpreted by the person who has acquired it as something else. Consequently, no physician is consulted or asked to run a confirmatory culture, and the infected individual unwittingly spreads the disease to others.

Because it is so common, its presence should always be considered, and, of course, the presence or absence of this particular infection is always considered in the many infertility clinics. Women who have the disease and are unaware of its presence may experience significant damage to the interior of the Fallopian tubes. Normal Fallopian tubes are necessary for fertilized-ovum transport. If that reproductive highway has been destroyed, the patient is rendered unable to have a fertilized egg move down her tubes and into her uterine cavity to begin a pregnancy.

Men with chlamydia may see a urethral discharge, so this infection is a common reason for their seeking medical advice. It is not now presently known whether most of the physicians in the United States who treat this problem of chlamydia discharge in men either double the medication and insist that the woman be also treated, or refer her elsewhere.

A variation (there are three variants of this particular infectious disease) is capable of producing blindness, since it causes a disease of the eyes called trachoma. The presence of chlamydia trachomatis is the most common cause of blindness throughout the world. The United States has several well-known research centers working on this disease. One is at the University of California at San Francisco, and the other is at Indiana University-Purdue University Medical Center in Indianapolis, Indiana.


Another common sexually transmitted infection in the United States is herpes genitalis. In 1980, when herpes occurred in an epidemic form, its presence made the cover of Time magazine and the front page of the Wall Street Journal. It is a viral infection transmitted by sexual activity that causes blistering discomfort. Acyclovir is effective in suppressing the circulating activity of the herpes virus, decreasing the discomfort and making the individual less likely to transmit the infection to others.

It is almost uncivilized in the current era, with acyclovir available, to know that one has herpes and yet to deliberately not take the medication and hence infect others. It is an STD that has active states and inactive states, and the level of discomfort varies widely among individuals. Some men have only mild urinary complaints and do not know they have the disease until they accidentally infect a new female sex partner. The infected woman most often experiences flulike symptoms, has pain urinating, and is covered with blisters on her swollen genital area. The resultant discharge is frequently infected with other organisms and can be quite odoriferous.

If the individual is careless in personal habits and touches the areas of the genitals that are involved, then rubs his or her eyes, the disease can be transmitted to the eye, causing a severe form of conjunctivitis that produces blindness. The problem with the eyes can be arrested by using intravenous acyclovir, but it certainly requires the expert attention of an ophthalmologist just to save the eyesight. If one acquires this infection, soap-and-water hand washing and scrupulous attention to all the details of personal cleanliness are extremely important to confine the blisters and the disease activity to the original site.

The disease can produce mental problems or a severe headache, as well as the aforementioned generalized flulike picture. It is also capable of affecting the long nerves of the legs so as to produce sciatica plus a pain with bowel movements.

Herpes is seen in the office involving all ages and all kinds of health complaints and problems. Clinical diagnosis can be made quickly by anyone who has spent several years practicing medicine. Inexperienced nurses and physicians may, however, misdiagnose it as a chronic yeast infection. However, the obverse of this statement is also true: women with chronic yeast vulvar infections will present the clinical picture similar to a chronic deteriorating herpes infection. The test for herpes is a positive vaginal culture. The culture, however, is not 100 percent correct. It is perfectly possible to have herpes and have a negative culture. This can be a serious problem for the pregnant woman, because if the mother has an acute attack of herpes while she is in labor, the infant, who has no immunity to the disease, will acquire the herpes, and before the advent of intravenous acyclovir therapy most would die.

With acyclovir, herpes has come to be an annoying accompaniment to sexual activity, and its only serious problem now is the transmission of an active infection to a newborn infant. Herpes was originally proposed as the infection causing cancer of the cervix, but that has been demonstrated to be scientifically untrue. Herpes is not now believed to cause cancer.


Another commonly acquired bacterial infection with a reputation for easy diagnosis (i.e., not requiring an expensive laboratory culture test) is gardnerella vaginalis. For many years, this infection was known as hemophilus vaginalis, but Eldon J. Gardner, a physician who spent his life observing, collecting data, and testing for this infection, was honored posthumously by having his name attached to the genus of bacterium involved. Gardner argued that this was an important reproductive tract organism although often overlooked by many practicing physicians and a real troublemaker for a newborn infant. He felt that it was a major cause of problems in the reproductive system and that it could be very easily diagnosed by well-trained physicians when alerted by the presence of a unique vaginal, fish-like odor.

Prior to the work of Gardner, physicians in positions of authority promoted the infection as a silent infection, or an organism that was thought to be a normal inhabitant of the vaginal vault. Such descriptions still exist and are extremely confusing to laypeople doing library research and to medical students and residents trying to figure out how a troublemaker could be normal. It is not a reportable infection. It is easy to treat using metronidazole (see trichomoniasis, above).

Group B. Beta Hemolytic Streptococcus

A very important infection, which also has the distinction of arising from a bed of disinformation labeled "normal vaginal flora" (and similar confusing clinical designations), is group B. Beta hemolytic streptococcus. The importance of this infection to Americans was worked out by the National Institutes of Health and the U.S. Public Health Service under the influence of Dorland J. Davis, an epidemiologist. In the early 1940s, the disease was observed as a cause of death in new-born infants at Harvard's clinical facilities and at Johns Hopkins Hospital, in Baltimore, with the number of infant deaths attributed to it hovering around 40 a year. As the years went by and constant and progressive observation of the clinical phenomena occurred, it became obvious that the behavior of the organism was that of a sexually transmittable bacteria. Gradually, the number of deaths rose to between 3,000 and 4,000 a year, a number that, unfortunately, still prevails in spite of extensive literature and extensive publicity concerning its damaging effects on new-born children. Apparently, a major reason for the indifference to the presence of such a harmful disease was lack of a requirement to report the infection, a problem now remedied. It is a major cause of mental retardation, cerebral palsy, and deafness. Some of the confusion about the disease is because it is a common inhabitant of the prepuce in the uncircumcised male infant as well as the uncircumcised adult male, in whose foreskin it flourishes. The lack of circumcision frequently predisposes young boys to hospital stays for severe urinary tract and kidney infections.

The acquisition by the woman of unusual forms of group B. Beta hemolytic streptococcus, subdivided into categories by Roman numerals, does not occur until they become sexually active, unless unusual circumstances prevail. Since it can be an STD, both sexual partners, or more if there are other partners, must be treated for this organism simultaneously. The organism remains sensitive to penicillin products, and so far it has not developed the usual picture of antibiotic resistance. If the acquisition of the infection occurs at the end of the pregnancy, or if it has been acquired in a form that absolutely refuses to be cured by means of antibiotics, the woman in labor can be given intravenous ampicillin, and the presence of that medication at the time of labor prevents the child from acquiring the infection. Until very recently, the newborn who acquired the infection died as quickly as the infants who acquired herpes from their infected mothers. Fortunately, it has been recently discovered that attention to the hydration of the infant victim gives a greater chance of survival.

The disease itself can cause a localized vulvar skin infection that looks like psoriasis, cervicitis with an abnormal pap smear, or involvement of the Fallopian tubes, so that the victim will end up with ectopic pregnancies as well as urinary and kidney infections, especially in a pregnant woman. Recent work at Parkland Hospital, in Dallas, suggests that it is a major cause of stillbirths in the United States.


Syphilis first appeared in Europe following the return of Columbus from his voyages. There have been extensive arguments as to whether it was a New World disease that was then carried back to the people of Europe. The answer, of course, lies hidden from our view forever. Suffice it to say that an enormous epidemic of syphilis occurred shortly after Columbus's voyage.

The disease was regarded as revolting because it caused huge bony exostoses that were hideous to look at. In the immediate past, syphilis was the major cause of stillbirth and a variety of congenital malformations. It is so highly infectious that doctors and nurses could get syphilis delivering a newborn baby from an infected mother. The baby itself was highly infectious. Syphilis remained a major medical and social problem until the development of Salvarsan by Paul Ehrlich and S. Hata in 1910. Salvarsan rendered the victim of syphilis noninfectious, but the treatment demanded weekly doses of the drug intramuscularly for at least six to eight weeks. The ability of people to comply with such a laborious regimen was a major problem. The other problem was that the laws of the United States would not allow open discussion of this overwhelming health problem. Finally, in 1936, the surgeon general of the United States, Thomas Parran, was allowed to use the word "syphilis" during a radio broadcast, and the push was on, with federal laws creating clinics and funding for discovery of infected partners.

With the arrival of penicillin 50 years ago and the discovery that it could cure syphilis, public health service interest in this particular disease began to fade. In the 1980s, however, it was realized that individuals who suffer from AIDS are especially susceptible to acquiring syphilis, or vice versa. Syphilis has become a marker for the AIDS infection itself. In addition, the cheapness of crack cocaine and other addictive drugs has increased the number of young women prostitutes who fail to use adequate protection, with the result that syphilis is increasing in urban areas.

Syphilis, a reportable disease, starts out with a hard ulcer, called a chancre, which quickly heals on its own, but the spirochete then spreads throughout the body. In the second stage of the disease, it produces a rash, which can be seen even on the palms of the hands and the soles of the feet, but quite often people are not aware of their rash. The organism then starts to invade the tissues of the central nervous system (including the brain), the heart, and the bones and begins to do its chronic disabling feats of work. Syphilis, in fact, can invade every organ system and imitate almost any disease known to humans. It can, however, be diagnosed inexpensively by a blood test which today is called RPR. This test, approved by the CDCP, has many false-positives so that if the test is positive, another test, the FTA-ABS test, which is both more accurate and more expensive, is given. Sometimes early in the disease, the spirochetes themselves can be lifted out of the hard chancre and placed under the microscope in a visual process called a dark field examination where the spirochete can easily be identified by an expert microscopist, but not by amateurs or the family physician or nurse.

Treatment is by means of antibiotic therapy with very large doses of intramuscular penicillin still being the drug of choice. Treatment schedules and alternative medications are outlined in the guidelines for STDs published approximately every three years by the CDCP.


Gonorrhea, acquired in conjunction with syphilis, was also very common in the first part of the 20th century. The Frenchman who discovered the original trichomonad thought he had found the causative organism for gonorrhea. It was not until the German bacteriologist Albert Neisser identified the gonococcus in 1879 that this gram negative diplococcus was precisely defined.

Although gonorrhea can be identified in the doctor's office because of its characteristic yellow discharge and the bacteria easily identified through a gram stain, a culture should always be done to confirm the diagnosis. A reportable disease, it, like chlamydia, is often asymptomatic in women, but it, like chlamydia, can spread into the internal pelvic organs, causing pelvic inflammatory disease. Unrecognized gonorrhea can be spread to newborn infants, causing conjunctivitis and blindness. Because of this, the practice of instilling silver nitrate drops into the eyes of newborns was made mandatory early in the 20th century. In men, gonorrheal urinary tract infections are acutely uncomfortable, so men are likely to seek medical attention. The incidence of gonorrhea fell after the antibiotics became available in the middle of the 20th century and the U.S. Public Health Service mounted a campaign to bring both syphilis and gonorrhea under control. However, success with the campaign brought complacency, and the incidence of both syphilis and gonorrhea has increased. Gonorrhea is as prevalent now as it was 50 years ago.

Venereal Warts

The most commonly discussed but least researched of the worldwide STDs is venereal warts, known since antiquity. Confusion, of course, can reign because there are some 60 different varieties of wart viruses, with each one affecting a specific site on the body. Some of the viruses that create warts in the genital region and around the rectum are not sexually transmitted. As a result, when laypeople set themselves up as experts on the subject of STD and discover that a small child has perirectal warts, guardians, friends, and parents are often falsely accused of childhood sexual abuse because of the widespread ignorance among the general public on the subject. The public is aware of the sexual connotation but totally ignorant of the natural history of the entire spectrum of the disease. We do not consider perirectal warts in little boys and girls sexually transmitted. They are ordinarily due to skin-contact organisms picked up by the child by touching a playmate on the hand or cheek, for example.

The causative organism of genital warts is a papilloma virus; certain strains of this virus are very dangerous and others are not. Although papilloma virus number 6 and papilloma virus number 11 are common causes of genital-area warts, they seldom spread to other parts of the reproductive system, and they cause little lasting damage. The viruses that cause urethral warts in the male are wart virus numbers 53, 54, 55, and 56, and they are not transmitted to the female during sexual activity. The wart viruses that produce cervical cell changes and abnormal pap smears are papilloma virus numbers 16 and 18, with a scattering in some of the other numerical categories; however, those two viruses (16 and 18) are the ones currently identified as being the main troublemakers associated with cervical cancer.

There is presently no cure for the virus and no vaccine to prevent acquisition of the virus. Currently available are various techniques for removing the warts when they grow. Since 50 percent of the people who have the virus do not grow the warts, the transmission of these warts is thoroughly confusing to ordinary people. It seems as though they simply drop out of the sky.

Removal of the obvious wart does not cure the systemic viral disease, so that other new warts can show up as time goes by. This reoccurrence is particularly depressing to the victims. They are extremely upset that the disease will not permanently go away and that repetitive surgical or chemical removal procedures have to be done. Podophyllin is considered to be the first-line office treatment in the nonpregnant female. Interestingly enough, when the warts are removed from the outside of the woman's genital area with the use of laser surgery, that procedure sensitizes the warts to podophyllin treatment—an ancient American Indian remedy—so that, fortunately, in most cases, the subsequent reoccurrence of wart forms can be treated using that particular chemical after laser therapy. There is some evidence that getting rid of a yeast infection, keeping the area clean and dry, and taking vitamin A is also helpful. Podophyllin is now available for home self-treatment by prescription as Condylox.

Molluscum Contagiosum

Another common and frequently seen viral-caused skin involvement is called molluscum contagiosum. This is also a disease of great antiquity, whose early beginnings confuse observers. Quite often, it is mistaken for early new venereal warts when the skin lesions are small, and the white punched-in look in the center of a very red pimple is its common picture. The lesions become raised, and they will not disappear with any antibiotic therapy.

One cannot cure these skin spots (and often there are many) with antibiotics because the cause of the problem is a virus. It will, however, go away by itself. Sometimes, cryotherapy or cutting and lifting out the white plug will speed things up. The small white umbilicated lesions go away principally on their own. They are highly contagious. Cleanliness is important. It is spread by scratching.

Yeasts: Candida Albicans et al.

Candida albicans, one of the yeastlike funguses that reproduce by budding, was formerly called Monilia albicans. Yeast infections are considered by the World Health Organization as well as by the CDCP as an STD, although some women do have a few Candida as persistent inhabitants of their vaginas, and they develop infections when they take antibiotics for some other medical reason. The antibiotic kills the normal bacterial flora of the vagina, which has been inhibiting the overgrowth of yeast, and this allows the yeast to take over and run rampant.

The classification of various infectious agents as capable of sexual transmission is not made to encourage people to categorize themselves or others as good or bad people, but to force the treating practitioners to be aware of the fact that the sexual partners of the individual on whom the diagnosis is made must be considered. If the woman has a yeast infection, not only must she be treated, but inquiries must be made as to whether or not the individuals with whom she is having sexual activity are on antibiotics or have Candida infections of the mouth or genital organs, which should be treated to avoid a cycle of reinfection.

Yeast infections are diagnosed in the office with a wet mount using potassium hydroxide (KOH). Treatment is ordinarily with suppositories or creams containing one of the fungicides: nystatin, clotromazole, miconazole, or terconazole. New forms are being constantly introduced and some are available without prescription.

Mycoplasma and Ureaplasma Infections

Mycoplasma and ureaplasma organisms acquired with sexual activity can persist for years without their victims being aware of any problem whatsoever until they try to get pregnant and find themselves sterile, due to mycoplasma and ureaplasma. The natural history and clinical importance of these organisms are still a matter of argumentation within the medical profession only because they are organisms that are relatively difficult to identify in the laboratory. Hence, their true incidence is probably currently unknown, although it is believed that they are common and are considered a major cause of infertility. Treatment involves long-term antibiotic therapy. The infection can be silent or it can cause pelvic inflammatory disease or Reiter's disease, as well as postpartum fever, kidney stones, male sterility, habitual abortion, and stillbirth. The diagnosis is made by laboratory tests.

Any individual walking into an infertility clinic is thoroughly checked for the presence of these infections. Their importance lies in the fact that if they are present, generic antibiotic treatment for seven or ten days will not even begin to cure them. The amount of time that must be spent taking the brand-name oral antibiotic Vibramycin is from four to six weeks. Therefore, the identification of these particular infections can be important to a woman, especially to make sure that she preserves her future fertility. Their presence in the male creates urinary problems. The diagnosis in the woman is made by vaginal culture.


Donovanosis is a chronic destructive infection of the genitals, also called granuloma inguinale or granuloma venereum. It is sometimes misdiagnosed by untrained people as cancer or syphilis. It is prominent in New Guinea, Australia, India, the Caribbean, and Africa. It is only mildly contagious and apparently repeated sexual exposure is needed for infection. Long-term antibiotic therapy is needed. It seems, at this time, not to be an American problem.


The most common of the STDs worldwide is chancroid, caused by a gram negative bacillus, Hemophilus ducreyi. Although it is not a common infection in the United States, occasionally new emigrants from Latin America bring the disease in with them. It is treated with sulfa drugs, although it can be controlled with just about any antibiotic. It produces a soft, destructive ulcer and painful infections of the groin that can grow and rupture. If it goes untreated, it can destroy the genitals of the man but not those of a woman.

Viral Hepatitis

Hepatitis is a viral inflammation of the liver, characterized by jaundice. It is transmitted by contaminated food, needles, or sexual activity or from a mother to infant. Fecal contamination of food or water supplies and rectal or anal intercourse should be considered when the individual is seen in the office. Reports of hepatitis research are constantly updated in a data base at the National Library of Medicine, in Bethesda, Maryland. A vaccine has been developed for the type B form. Immune globulin given promptly after exposure will prevent hepatitis type A. Most hepatitis, however, is non-A, non-B, so prevention by the use of condoms for anal intercourse is important. Fatal fulminant hepatitis can occur. Even though this infection can be acquired in many ways, it is considered a major STD. This only emphasizes that an STD is not always transmitted by sexual activity.

Cytomegalovirus Infections

This infection was uncommon in Northern Europe and North America until the 1980s, when the virus was found in urine, saliva, breast milk, semen, feces, cervical mucous, and blood. Close interpersonal contact is necessary to be infected. It can be transmitted to an unborn child, causing severe problems. It can cause hepatitis, heterophile negative mononucleosis, pneumonitis, and Guilliain-Barre ascending paralysis. Anemia and its effects can be devastating in people who are immunocompromised. It has been related to Kaposi's sarcoma in homosexuals who have AIDS. There is no cure.

Pubic Lice and Scabies

These microscopic insects move from person to person with intimate contact or through the wearing of another person's dirty underwear. They burrow under the skin, causing a rash and intense itching. They can be visualized using an ordinary magnifying glass. Scabies is a great imitator, and its existence can be covered up by corticosteroid creams and lotions. It is cured with topical applications of lindane or Eurax. Over the counter treatments for pubic lice are available.

Enteric Infections

Giardiasis and amebiasis are due to rectal-oral sexual activity. They are diagnosed by special laboratory tests and are cured with the same therapy used for the treatment of trichomoniasis. Camplyobacteria are a major cause of the gay bowel syndromes of diarrhea and dysentery, or gastroenteritis in homosexual men. Identification is by laboratory culture. Antibiotic therapies are available for the cure. The infections can be transmitted to women, and pregnant women can transmit the infection to their newborn child.


Finally, the last and currently most publicized STD is AIDS. This virally caused STD was first discovered among the male homosexual communities of the major cities of the United States—Miami, New York, and San Francisco. It was early determined using epidemiological methods that it was an STD. Eventually, because of the death and disease pattern, the male homosexual act, especially rectal intercourse, was held to be responsible for the transference of the infection to the uninfected. However, that pattern is now changing, as more women are being infected by heterosexual contact and newborns are exposed to in utero infection.

AIDS seems to be caused by a retrovirus that is constantly changing its characteristics, making it difficult to create a vaccine against the disease, because the moment the vaccine is created, the type and variety of virus involved in the epidemic turns out to be totally different from the one utilized in making the vaccine. (The flu vaccine, for example, acts similarly in that it is different every year.)

Treatment is palliative with various drugs, the original one being AZT, which arrests the replication of the virus. All of these drugs are, however, toxic products and, unfortunately, do not make the person who has AIDS incapable of passing the disease on. Therefore, the current treatment not only prolongs the life of the victim of AIDS but also allows him or her a great deal more time in which to spread the disease. The AIDS virus can also contaminate or attach itself to dirty needles that are used by drug addicts. It can be transmitted through blood transfusion as well as by infected semen. The spread of AIDS can be prevented with the use of condoms, especially those with Nonoxyl 9 plus vaginal contraceptive foam (either in tablet form or in pressurized containers). Condoms made of animal membranes do not work in preventing AIDS since microscopic pores exist in the animal membrane that allow the virus to escape.

Death is from one of the several diseases, which attack the body because of the compromised immune system. Such diseases include pneumocystitis carina, Kaposi's sarcoma, tuberculosis, yeast infections, or other opportunistic infections.


It is important that the average American who has some education become aware of various important facts concerning each of the STDs. The profession of medicine, while it is not the Delphic oracle that victims of disease would wish it to be, still has an important place in the treatment of the severe problems that these infections can cause.

The real message is that if you think that you have acquired a sexually transmitted infection, do not just think about it; make an appointment with a gynecologist if you are a woman, a urologist if you are a man, or a venereal disease clinic if you do not have enough funds to pay for your personal medical diagnosis and treatment, and tell the physician that you want to be checked for STDs.

Physicians are not mind readers. If you walk into an STD clinic, you are going to be checked for STDs, but in the private office the physician does not know what your problem is until you start to communicate. Since the infections that occur because of sexual activity are those most people try not to broadcast, the nature of these problems often does not surface right away. Therefore, be honest with the physician and indicate why you are in his or her office. Many young women have been victimized by date rape and hide the fact. Both women and men silently suffer sexual abuse and refuse to tell the physician. Conversely, given the imperfect status of diagnoses, you may find yourself with a diagnosis of an STD where there is none present. Object if that happens to you, but the diagnosis may also be missed. Communication is the key.

The diagnosis of STDs is not a magic act. The technology is still deficient, but, in spite of all sorts of strange legal harassments, most American physicians try very hard to solve health problems. Aware that most Americans like to hide the evidence in these problems, some physicians become very cynical about the human race, and one must deal with that fact.


CDCP Guidelines on STD—CDCP (USPHS) Atlanta, Georgia, 1990.

Holmes, K.K., P.-A. Mardth, P.F. Spading, and P.J. Wiesner. Sexually Transmitted Diseases. New York: McGraw-Hill, 1983.

Kaminester, L.H. Sexually Transmitted Diseases: An Illustrated Guide to Differential Diagnosis. Burroughs Wellcome Company. N.p., n.d.

What You Need to Know about Sexually Transmitted Diseases, HIV Disease and AIDS-STD. Burroughs Wellcome Company. N.p., n.d.

Allan M. Brandt, No Magic Bullet - A Social History of Venereal Diseases in the United States since 1880, Oxford University Press, 1987

Dorothy I. Lansing


Parental Investment Theory
Mate Selection
R and K Selection

Sociobiology is the application of principles derived from evolutionary theory to issues in psychology and the social sciences. Wilson advocated a Darwinian approach to psychology and sociology because he thought that existing explanations in these disciplines were fragmentary and piecemeal, since they did not take into account the theory of natural selection. All socio-biological concepts are derived, ultimately, from Darwin's theory of natural selection. This is a process where offspring inherit characteristics from their parents that may be more or less adaptive for the particular environmental conditions in which they live. Reproductive success, then, refers to the extent to which organisms are able to reproduce offspring that survive long enough to pass on their genes to successive generations.

Individuals who produce a relatively large number of children are more likely to have their genes (basic units of heredity) transmitted to future generations. The effect of sheer number of offspring, however, is moderated by the characteristics of those offspring. Some of these characteristics, such as the ability to attract mates, hunting prowess, the ability to forage and store food, and so forth, increase the likelihood that the offspring will go on to produce children of their own. Natural selection can favor us not only through our own reproductive success in the transmitting of our genes but also through the survival of our close relatives with whom we have genes in common. Natural selection, therefore, operates for the maximization of inclusive fitness. Inclusive fitness involves both an individual's reproductive contribution to the gene pool of the next generation and that person's contribution in aiding the survival of kin who pass on their shared genes.

Wilson used the theory of inclusive fitness to suggest a possible evolutionary explanation for the continuing existence of homosexual orientation among some people. At face value, it would seem odd to use a theory associated with natural selection to try to explain why a person would select sexual partners with whom he or she cannot reproduce and thus have their genes passed on to the next generation. Wilson hypothesized that there are genes for homosexual orientation and that these exist in the population because they also exist in the heterosexual relatives of gay people. He theorized that homosexual members of primitive societies, rather than raising families of their own, acted as helpers of their close relatives. The generosity, or altruism, of homosexuals toward their relatives increased the likelihood of the survival and reproductive success of the homosexuals' relatives. Thus, genes for homosexual orientation increased in frequency not because of their beneficial effect on the homosexual but because of the benefits received by the relatives aided by the homosexual person. He held that there was a strong possibility that homosexuality is normal in a biological sense, that it is a distinctive, beneficent behavior that evolved as an important element of early human social organization. Homosexuals, in his words, "may be the genetic carriers of some of mankind's rare altruistic impulses."

The hereditary predisposition suggested by Wilson would not necessarily result in homosexual behavior. The actual expression of homosexual feelings would depend on certain environmental conditions. The adaptiveness of homosexuality as presented by Wilson is particularly interesting in the context of two conditions that threaten human beings: scarcity of resources and overpopulation. If Wilson's hypothesis about the adaptiveness of homosexuality is correct, we may see an increase in overt homosexuality, particularly in those parts of the world most suffering from lack of resources and overpopulation.

It should also be noted that Wilson's analysis assumes that homosexuals do not reproduce. However, a substantial proportion of people who engage in homosexual behavior also enter into heterosexual marriages and have children. If there is a genetic component to homosexuality, we would just as easily argue that those genes are passed on to the next generation through homosexuals who have children. Thus far, however, genes affecting sexual orientation have not been found, and it is not known through what mechanisms erotic orientation toward males or females develops.

Sociobiology suggests that we can ask two kinds of questions about the causes of behavior. Contemporary questions concern how a particular behavior came to exist; that is, they seek the proximate cause of a behavior. These questions involve analysis of the genetic, biological, and psychological causes of a particular behavior.

In contrast, evolutionary questions concern why a behavior exists; that is, they seek the ultimate cause. Answers to questions about ultimate causation will involve some variant of the general rule that a behavior functions in specific ways to maximize the organism's inclusive fitness. Questions about the ultimate causes of behavior are problematic in that they are primarily concerned with the species history. The early environment in which the behavior evolved, however, is gone and cannot be studied. Nonetheless, sociobiologists are primarily concerned with ultimate (evolutionary) questions. They assume that sexual behaviors exist and are maintained because, in the past, they have served the ultimate cause of reproduction. According to this perspective, many of our current sexual activities can be traced back to reproductive behaviors that are believed to have existed in early hunting and gathering groups. Thus, evolutionary thinking involves a way of looking at human behavior that is very different from many of the models widely used in psychology and the social sciences. In the following section, we examine some of the basic principles and models developed to explain sexual behavior.

Parental Investment Theory

Trivers proposed that gender differences in the sexual behavior of a particular species are determined by fathers' versus mothers' amount of investment of resources, time, and energy in their offspring. Darwin's theory of sexual selection described a form of natural selection that depended on differential access to the other sex. Darwin identified its usual forms as intermale competition for access to females and female choice of male sexual partners. These processes lead to male features that aid competition and attract females. Trivers maintained that the reason sexual selection took these forms was because the female initially "invests" more than the male in the offspring. This begins with the relatively greater size of the eggs, or ova, compared with the sperm. The female's ovary releases an egg during her monthly reproductive cycle; this is the human body's largest cell from menstruation to menopause. Sperm are among the smallest cells in the body, and viable sperm can be released by the male from adolescence through old age. According to Trivers, this difference produces different strategies for maximizing fitness in the two sexes. In species where the male is required for parental care, the initial disparity between the sexes will be counterbalanced, or even reversed in some cases. But where the female is able to rear young without the male's assistance, there will be accentuated intermale competition with more risky and costly male strategies, and the evolution of polygyny.

To put this into a more concrete perspective, let us consider the average North American family. Both parents commit various resources to the rearing of the child. In the typical family, the mother probably invests a lot more than does the father. After conception, the mother carries the child for about nine months in her uterus. After giving birth, she feeds the child during the period when it was too helpless to feed itself. This pattern of greater investment in offspring by females than by males is characteristic of humans and, in fact, of most species. This does not mean that human males are lacking in the capability for parental investment. During the evolutionary period in which we evolved, males may have incurred significant risks in hunting for meat and fighting off predators to protect their mates and offspring. But among most humans today, parental investment by females is greater than that by males.

In Trivers's theory, the average parental investment of males versus females in a species influences sexual behavior in at least three ways. Among species such as our own, in which the female invests more, Trivers predicts that (1) male-male competition for female mates will be greater than female-female competition for male mates, (2) there will be greater variation in reproductive success among males than among females, and (3) selective pressure will be greater on males than on females because of the competition among males and because some succeed in mating and some do not. This selective pressure on males would produce larger body size, greater strength, and other attributes that help some males compete successfully for mates against other males who do not have these attributes or who have them to a lesser extent. Selective pressure should also result in greater variation in hair and skin color and more aggressiveness, insofar as those traits help males attract females.

To summarize, among species in which females invest more as parents and thus control reproductive success, males are at a disadvantage. Males, therefore, must try harder to succeed in passing on their genes. Whatever strategies and attributes males have that help them to succeed will be passed on. Characteristics that may render males less successful in competing against other males and attracting females, such as passivity and physical limitations, will tend to drop out of the gene pool. In species in which females have greater parental investment, there is less selective pressure on females because they control reproductive success. This theory would predict that females will be much more cautious and selective in choosing sexual partners than males are because of the female's greater investment if pregnancy ensues as a result of the interaction.

Daly and Wilson used the parent-offspring model derived by Trivers to generate hypotheses about the circumstances under which a child is likely to kill its parents. The parent-offspring model predicts that children would demand more resources from parents than parents would be prepared to give. Siblings would tend to value themselves more highly than they do one another, and parents would value similarly aged siblings to the same extent. Rather than being a conduit of cultural beliefs, socialization is seen, from an evolutionary perspective, as a conflict of interest between two types of individuals. Parents use their position of power to stress the importance of moral values, which serve their own interests by either reducing the time and effort required in parenting or reducing conflicts between siblings. In contrast to the Freudian view, parent-offspring conflict, instead of involving sexual motives, occurs over the allocation of parental resources. There is an imbalance in the fitness interest of parent and child, which changes with age in accordance with their relative reproductive value. Caring for existing offspring becomes a relatively more valuable way of enhancing parents' fitness as parents become older, whereas parents become less valuable to their offspring with age. Daly and Wilson therefore predicted that parricide would increase with parents' age at the time the child was born. In a review of all reported murders of children by their parents and all murders of parents by their children in Canada between 1974 and 1988, and in Chicago between 1965 and 1981, they found this to be the case.

Mate Selection

The Darwinian principle of sexual selection indicates that there will be sex differences in mating. For males, this principle holds that genetically based characteristics that best attract mates will show up in succeeding generations in spite of the threats they may pose to individual survival. Males compete for mates by acquiring and displaying signs, such as personal and material resources, of their ability to provide for a family. Females accentuate their fertility by trying to appear youthful and attractive. Thus, female mate choices determine which inherited characteristics will persist through the generations as potent sexual attractors. Since females spend more time caring for offspring, they have more incentive to carefully select a partner. This would suggest that men tend to marry women younger than themselves and women would seek out older men who had access to more resources than younger men. Buss attempted to test the veracity of this assumption by studying 33 different societies with more than 10,000 respondents. In all but one of the samples, women placed higher value on the financial prospects of potential partners than men did. In most of the samples, women rated a potential partner's ambition and industriousness more highly than men did, providing moderate support for that expectation. In all but three of the samples, men rated physical attractiveness as more important in selecting a mate than did women. Thus, it appears that men show strong preferences for physical attractiveness when evaluating potential mates, while women pay more attention to a man's social status and material resources.

R and K Selection

A concept used to distinguish between reproductive strategies in the animal kingdom is that of r and K selection. Reproductive strategies are conceptualized as falling on a continuum from r, where organisms produce large numbers of offspring but provide little to no parental care, to K, where organisms produce few offspring and make a large investment in the care and development of offspring. Rushton illustrates the end points of the r-K. continuum by placing oysters (thousands of offspring and no parental care) at the r extreme and great apes (few offspring with substantial parental investment) at the K end of the continuum. Rushton proposed that there were racial differences in temperament related to differences in socialization, sexual behavior, impulsivity, and criminality. He maintained that Mongoloids can be found at the K end of the spectrum of reproductive strategies, while Negroids occupy the r end of the spectrum, with Caucasoids occupying an intermediate position with a great deal of interracial variability within each broad grouping. He further claimed that environmental influences account for about 50 percent of the variance on most of the traits that he studied. Rushton's work has been severely criticized as racism in scientific clothing and is an extreme example of the ongoing controversy over the application of evolutionary concepts to human behavior. At its most basic level, this debate focuses on the politically conservative implications of arguing that group differences in behavior are the result of adaptation and are difficult or impossible to alter as a consequence of their genetic basis. Thus, sociobiology has been attacked as a defender of the social status quo by scholars of a liberal persuasion who advocate social change through a more equitable distribution of resources and a restriction of the power that protects the privilege of the elite.

Sociobiology has come under attack for lending ideological support for capitalism, racism, and sexism. It has been argued that sociobiologists pay scant attention to cultural evolution in their attempt to reduce complex social behavior to a genetic drama. This debate is more political than scientific and often involves a great deal of misunderstanding on both sides. Partially in response to the charges of genetic determinism and reductionism, many individuals working in an evolutionary framework now describe themselves as evolutionary psychologists. Evolutionary psychology considers humans to be an evolved species with an evolutionary history, just as sociobiology does. It is more interested, however, in the psychological mechanisms arising from evolution. Regardless of the labels attached to those working within an evolutionary framework, evolutionary theory will continue to play a major role in our understanding of human beings.


Buss, D. M. Sex Differences in Human Mate Preferences: Evolutionary Hypotheses Tested in 37 Cultures. Behavioral and Brain Sciences, Vol. 12 (1989), pp. 1-49.

Daly, M., and M. Wilson. Evolutionary Social Psychology and Family Homicide. Science, Vol. 242 (1988), pp. 519-24.

Daly, M., and M. Wilson. Homicide. New York: Aldine de Gruyter, 1988.

Fairchild, H. F. Scientific Racism: The Cloak of Objectivity. Journal of Social Issues, Vol. 17 (1991),pp. 101-15.

Rushton, J. P. Race Differences in Behavior. A Review and Evolutionary Analysis. Personality and Individual Differences, Vol. 9 (1988), pp. 1009-24.

Trivers, R. E. Parent-Offspring Conflict. American Zoologist, Vol. 14 (1974), pp. 249-64.

Trivers, R. E. Parental Investment and Sexual Selection. In B. Campbell, ed., Sexual Selection and the Descent of Man. Chicago: Aldine, 1972.

Wilson, E. O. Sociobiology: The New Synthesis. Cambridge, Mass.: Harvard Univ. Press, 1975.

Wilson, E. O. On Human Nature. Cambridge, Mass.: Harvard Univ. Press, 1978.

Zuckerman, M. Some Dubious Premises in Research and Theory on Racial Differences: Scientific, Social and Ethical Issues. American Psychologist, Vol. 45 (1990), pp. 1297-1303.

A. R. Allgeier


Structural-Functional Theories of Sexuality
Conflict theories
Symbolic Interactionism
Ethnomethodology and Phenomenology

Sociological explanations of human sexuality cover a wide range of perspectives, from macrosociological theories, such as structural functionalism and conflict theories, which focus on social structures and institutions, to the microsociological theories of symbolic interactionism, ethnomethodology, and phenomenology, which are concerned with the perceptions and behaviors of individual actors. They differ in the kinds of questions they ask as well as in the level of explanations they use. Some of these theories see people as passive role players, acting in terms of role expectations and social definitions they have learned, or as being controlled by external social forces. Others conceptualize humans as active creators of their own interpretations of situations and see norms and expectations as constantly evolving products of interaction. All sociological perspectives, however, make certain common assumptions about people and their sexuality. They all see human sexuality as determined by social, rather than biological, factors. Hormones and other biological forces are seen as potentiating, rather than controlling, sexual responses. Norms, values, and attitudes, which are social products, are viewed as the ultimate elements of sexual response. Sociologists point out that sexual norms, attitudes, and practices vary widely among cultures and that they are consistent with other components of these societies. Structural functionalists, for example, see the particular social expectations a society holds about sexuality as adaptive mechanisms, keeping the family reproductive unit viable and thus having survival value for the social system. The family serves as the primary unit of socialization and, therefore, as the transmitter of social values.

Some sociological theories attempt to account for the role of sexuality in society; others are concerned with sexual development as a social phenomenon; still others attempt to understand the acquisition of sexual identities or the development of particular patterns of sexual behavior. The following discussion gives some idea of the variety of sociological perspectives as they are applied to human sexuality.

Structural-Functional Theories of Sexuality

The structural-functional perspective, most fully developed by the late Talcott Parsons, conceives of society as being in a state of equilibrium. Society is orderly, and there is general consensus among its members about goals, values, and behavior, which are reflected in the social structure and its institutions. The society's norms reflect its values and serve to facilitate the achievement of its goals. The particular norms of a society, its social institutions, and the patterns of behavior regulated by them exist because they serve a social function. Behavior that is no longer functional eventually disappears.

Davis has applied the structural-functional perspective to the study of sexuality. He pointed out that norms regulating sexuality, like other norms, have gone through a long selective process, during which they have proved advantageous for collective survival. The only difference between sexual norms and other kinds of norms is that the former regulate powerful libidinal drives, which have the potential, when unregulated, to disrupt orderly social interaction. By its very nature, sexuality is intertwined with the issues of interpersonal relationships, competition, and reproduction. Thus, sexual norms are linked with a number of social institutions, such as law and religion, and they function to define and regulate a variety of roles and behaviors. Human societies differ, according to Davis, in their sexual norms and patterns of behavior. The sexual norms that exist are generally compatible with other social arrangements and beliefs of a particular society. He noted, for example, that the double standard found in Puerto Rico, which allows married men to engage in sexual adventuring but tightly restricts the behavior of their wives, "survives well in an agrarian and highly stratified society. It tends to disintegrate under urban-industrial conditions."

Structural functionalists see the role of sexuality as facilitating, through its connection with affection, trust, and dependence, the formation of interpersonal bonds conducive to the survival of society. Structural functionalists acknowledge the potential of sexual drives to disrupt societal functioning. Incest taboos, for example, which are present in every society, serve to help families avoid sexual conflicts and tension by directing the sexual drive outside of the primary unit. Homosexuality is disapproved of in many societies because it conflicts with the institutionalization of male-female relationships. It does not eventuate in the formation of a family structure within which reproduction can occur.

Conflict theories

Conflict theories, which may be traced back to Karl Marx, view society as composed of opposing forces, differentiated in terms of their economic power. The powerful segments of society, from this perspective, exploit the weaker members. Sexuality, seen from this point of view, involves the exploitation of women by men who are economically more powerful. Women are viewed as mere property, and their sexuality is controlled by men. Women are forced to exchange their sexuality for economic security in a process of sexual bartering.

Heyl used a conflict approach to study prostitution. She observed that economic, status, and power differences exist between males and females in all social systems and that even in the world of prostitution, males dominate females. For example, she identified three male groups, police, pimps, and businessmen, as "differentially powerful" at the different levels of prostitution. "But males dominate at all levels by controlling the conditions under which the prostitute will work in her occupation." Control includes the power to arrest, the ability to take part or all of a woman's earnings, and the capacity to set her up in business, providing apartments, recruiting clients, and so forth. Additionally, clients control her behavior with their consumer power. Calling prostitution "the most sexist of them all," Heyl concluded that "the analysis...reveals prostitution as an extreme case of sex stratification—all the males win, and only the women pay the costs."

Symbolic Interactionism

The symbolic interactionist approach sees meaning as central to human experience. Unlike animals, people interpret the actions of themselves and others and act in terms of those meanings. This perspective, along with other microsociological positions such as phenomenology and ethnomethodology, is social constructionist. That is, it is more concerned with social realities than with physical realities. What is important to people, according to symbolic interactionists, is the meanings they place on identities, acts, and situations. Human behavior, including sexual behavior, takes place within a social context, from which people take their cues. They emphasize that sexual situations do not exist apart from their social definitions. Standards of attractiveness, sexually appropriate situations and the like are all socially defined. Sexual activity is activated not by hormones but by social definitions. Gagnon points out that social arrangements create biological responses, not the other way around. Becoming a sexual person, he states, is not a matter of physical maturation; rather, it is a process of acquiring meanings.

In examining the social sources of human sexuality, Gagnon and Simon developed the concept of the sexual script:

Without the proper elements of a script that defines the situation, names the actors, and plots the behavior, nothing sexual is likely to happen.... Scripts are involved in learning the meaning of internal states, organizing the sequences of specifically sexual acts, decoding novel situations, setting the limits on sexual responses, and linking meanings from nonsexual aspects of life to specifically sexual experience.
Given their emphasis on meaning, symbolic interactionists have been particularly interested in the acquisition of sexual identities. For example, Troiden studied how men come to label themselves as homosexual. He noted that what differentiated men who eventually labeled themselves as homosexual from homosexually active men who did not consider themselves to be gay was the meanings they came to attribute to their feelings and behavior. In another study of male homosexuals, Weinberg found that young men engaged in sex with other males without defining either their behavior or themselves as homosexual until they acquired a definition of homosexuality that included sexual behavior. When they defined homosexuals only as men who dressed like women or who kissed each other, they were unable to relate their own sexual behavior to this label. Even when they learned more accurate definitions of homosexuality, they did not consider themselves to be homosexual if their friends persisted in this activity. When the social context changed (i.e., their friends became involved with females), they began to interpret their feelings and behaviors as homosexual.

Ethnomethodology and Phenomenology

Ethnomethodology and phenomenology are closely allied perspectives, which grew out of the work of philosopher Edmund Husserl. Alfred Schutz, building on his ideas, developed them into phenomenological sociology. Harold Garfinkel, a student of Schutz, further refined them, drawing from linguistics, anthropology, and other sociologies. Both frameworks see actors as active rather than passive creators of their social environments. They have in common an interest in how people construct reality and then act on the basis of these social constructions. Phenomenology remains more philosophical than ethnomethodology, which is much more empirical, and it places a greater emphasis on consciousness.

Warren and Johnson, for example, who take a phenomenological approach to understanding homosexual identities, point out that members of the homosexual community see "being gay" as something quite distinct from performing homosexual acts. Thus, they correctly observe that a married man who has sexual relations with his wife can, nonetheless, perceive himself to be "100 percent homosexual," thus "violating the... act-definition of bisexuality, and at the same time validating the being significance of homosexuality." They thus emphasize the subjective, rather than the objective, definition of homosexuality. Ethnomethodologists go beyond these philosophically based conceptions by attempting to uncover the actual methods that ordinary people use to construct meaning in their everyday lives, and they have developed a number of concepts to facilitate their studies. They examine how people use language, typifications, and commonsense theories to construct reality. Watson and Weinberg, for instance, studied the ways in which men impute homosexual identities to themselves. One of the techniques they use is what Sacks has called the "consistency rule" in the selection of membership categorizations. The consistency rule says that once people have categorized some population of persons using a particular device, they continue to use that same device to organize their perceptions both retrospectively and in the future. Thus, once a man has labeled himself as homosexual, he looks for confirming evidence, characteristics known as "indexical particulars" (e.g., feminine appearance), which are seen as defining the "underlying pattern" of homosexual. He may now also retrospectively reinterpret previously inconsequential events as "leading up to" and consistent with his new identity.

As can be seen from the brief survey of sociological perspectives, although they vary in the questions they ask and the emphasis they place on social factors, they hold a common view that sexuality is best understood in terms of social, rather than nonsocial, factors.


Davis, K. Sexual Behavior. In R. K. Merton and R. Nisbet, eds. Contemporary Social Problems. 2d ed. New York: Harcourt Brace & World, 1966.

Gagnon, J. Human Sexualities. Glenview, Ill.: Scott, Foresman, 1977.

Gagnon, J., and W. Simon. Sexual Conduct: The Sources of Human Sexuality. Chicago: Aldine, 1973.

Heyl, B. Prostitution: An Extreme Case of Sex Stratification. In F. Adler and RJ. Simon, eds., The Criminology of Deviant Women. Boston: Houghton Mifflin, 1979.

Troiden, R. Becoming Homosexual: A Model of Gay Identity Acquisition. Psychiatry: Journal for the Study of Interpersonal Processes, Vol. 42 (Nov. 1979), pp. 362-73.

Warren, C. A. B., and J. M. Johnson. A Critique of Labeling Theory from the Phenomenological Perspective. In R. A. Scott and J.D. Douglas, eds., Theoretical Perspectives on Deviance. New York: Basic Books, 1972.

Watson, D. R., and T. S. Weinberg. Interviews and the Interactional Construction of Accounts of Homosexual Identity. Social Analysis, Vol. 11 (Oct. 1982), pp. 56-78.

Weinberg, T. S. Gay Men, Gay Selves: The Social Construction of Homosexual Identities. New York: Irvington, 1983.

Thomas S. Weinberg



According to Gen. 18:20-21 and 19:24-28, Sodom was a city in ancient Palestine notorious for its inhospitality, wickedness, and corruption. Its destruction by God was held out as the example of the type of punishment that comes to those who neglect or sin against God. Sin was so great and widespread in Sodom that God could not even find ten righteous persons, who could have saved the city from total destruction.

According to the biblical account, after Abram had bargained with the Lord to save the city if ten righteous men could be found, the Lord sent two angels to Sodom, disguised as men. They found Lot sitting at the side of the gate to the city. Lot invited them to his home to be his guests. He would feed them and give them a place to sleep for the night. That evening, all the men of the city, both young and old, came to Lot's house and inquired about the men that they might "know" them. Lot seemed to know that there was no good intent on the part of the men of the city. He begged them not to act so wickedly and offered his two virgin daughters to them for sexual purposes. The men then started to attack Lot, and the angels pulled him back into the house and blinded the men of the city so they could not find the door to the house. The angels then persuaded Lot, his wife, and their two daughters to flee from Sodom. "Then the Lord rained on Sodom and Gomorrah brimstone and fire from the Lord out of heaven; and he overthrew those cities, and all the valley, and all the inhabitants of the cities, and what grew on the ground."

The question that plagues biblical scholars is what was the great sin of Sodom. Christian tradition has held that the destruction of Sodom was a sign of God's disapproval and hatred of homosexuality. There is no agreement among biblical scholars because the text poses a number of questions. First, the homosexual interpretation rests entirely on the verb "to know." It appears 953 times in the Bible; 943 times this verb means "to get acquainted with"; only 10 times is it used to mean sexual intercourse, and each of those times it means heterosexual intercourse. An entirely different Hebrew word was used to describe sexual activity between two men. If for some reason the story is referring to sexual activity, it would seem that the issue was gang rape, presumably by heterosexual men. There is no allegation that there has ever been a city or town just for persons of the same sexual orientation. In fact, sexual orientation was not a concept known to the writers of the Bible. The frightening thing about this passage is that it is not used as an example to describe the treatment of Lot toward his unmarried, virgin daughters. This story does a better job of telling the low place that women held in the society and how easy it was for Lot to offer up his virgin daughters, who were probably quite young, to be sexually abused and raped in order to protect his male guests. There is a parallel story that is even more sexually explicit and violent towards females in Judges, chapter 19.

The second thing about linking this passage with homosexuality is that nowhere in the Scriptures is this linkage made. The first references to the sins of Sodom come from two contemporary prophets, Ezekiel and Jeremiah, many hundreds of years later (c. 600 B.C.E.). Both had basically the same traditional understanding. Ezekiel said it clearly: "Behold, this was the sin of your sister Sodom: she and her daughters lived in pride, plenty, and thoughtless ease; they supported not the poor and needy; they grew haughty, and committed abomination before me; so I swept them away; as you have seen" (Ezek. 16:49-50). Thus, the sin of Sodom was inhospitality, which was a very important issue for the early Hebrew community. There was a high value on hospitality. Jesus also makes reference to Sodom several times in the Gospel stories, always referring to inhospitality as the terrible sin. An example is found in Luke 10:10-13.

The first reference to the sin of Sodom being homosexuality comes from outside the Bible, in the writings of a Hebrew historian, Josephus, who was born in 37/38 C.E. and died sometime after 100. He was a commanding officer of the Galilean Jewish forces in the war against Rome (66-70 C.E.). He hated Rome and wrote history in a way that would question God accepting common Roman practices. One of those practices was homosexual behavior. Josephus went back to the story of Sodom and used the destruction of Sodom as proof that God hated homosexual acts.


Nevertheless, sodomy has come to refer to any number of "unnatural" sexual acts (or "crimes against nature"). From the first century C.E. to the present time, "sodomites" became interchangeable with the term "sodomy" and has been linked at various times to "crimes against nature" like masturbation; oral-genital, oral-anal, anal intercourse; bestiality; some rare and bizarre sexual practices, such as sex with a cadaver (necrophilia); and any other type of sexual activity that did not lead to procreation. "Natural" sex came to mean heterosexual intercourse within the bounds of marriage leading to pregnancy. "Unnatural" was anything that did not enhance the possibility of pregnancy. Therefore, heterosexual or homosexual oral-genital or anal intercourse and any gay or lesbian sexual activity were considered "unnatural" and named sodomy.

Early concepts of sodomy were limited to sexual activity between and among men. Roman emperors who embraced Christianity began to enact laws against sodomy, (i.e., male homosexual behavior). Offenders were often given the death penalty of burning at the stake.

During the Middle Ages sodomy, heresy and disbelief became interchangeable. For example, during the Spanish Inquisition, Jews, heretics, and "sodomites" were burned at the stake. Then, as heterosexuals engaged in the same type of sexual activity, they also became known as "sodomites." Sex was defined by the act, not the orientation of the person, which was an unknown concept before the 19th century.

Sodomy laws in the United States still reflect an intolerant attitude toward noncoital sexual behavior and do not differentiate most of the time between single and married, heterosexual and homosexual, men and women. The penal codes in the majority of our states forbid oral-genital, oral-anal, and anal intercourse, as well as sex with animals, and link them all as "sodomy" or "crimes against nature." While it does not matter whether the persons are heterosexual or homosexual, homosexual persons are prosecuted more often than heterosexuals under the sodomy laws. The penalties are severe and can range up to life imprisonment. Others include being committed to mental institutions as a sexual psychopath.

Some states have repealed their sodomy laws, but the majority have not. Many believe that the final resolution will be through the U.S. Supreme Court. Several years ago, a president of the American Psychiatric Association wrote a letter to the chief justice, pointing out that the vast majority of American heterosexuals and 20 million homosexuals regularly engage in "sodomy," and thus well over 100 million American citizens, without any court record or criminal intent, are "sodomites."

Ironically, those in the field of sex education and therapy often promote or recommend certain behaviors listed as "sodomy" as a way of enhancing the sexual relationship of two consenting partners, regardless of sexual preference.


Bailey, D.S. Homosexuality and the Western Christian Tradition. London: Longman, Green, 1955.

Francoeur, R. T. Becoming a Sexual Person. New York: Macmillan, 1991.

Haeberle, E. The Sex Atlas. New York: Seabury Press, 1978.

Nelson, J. B. Embodiment: An Approach to Sexuality and Christian Theology. Minneapolis: Augsburg, 1979.

Strong, B., and C. Devault. Understanding Our Sexuality. 2d ed. St. Paul: West, 1988.

Trible, P. Texts of Terror. Philadelphia: Fortress Press, 1984.

William R. Stayton


Sterilization is the most effective method of contraception known. At the present time, it is the most widely used method of contraception not only in the United States but in the world. Sterilization, however, has a rather controversial history because of its association with eugenics.

Eugenics grew out of the research of Francis Galton, who published his Hereditary Genius in 1869. Galton felt that to improve the human race it was necessary to breed selectively and, in a word, discourage the mating of the unfit. He founded the Eugenics Education Society and established a National Eugenics Laboratory at University College, London. Eugenicists campaigned for effective contraception, at least for certain groups, while at the same time encouraging the intellectually (and materially) endowed to have children. They also encouraged sterilization of the mentally defective, and many states in the United States adopted laws to permit sterilization of certain classes of people. The state of Virginia, for example, adopted a sterilization law in 1924 that permitted sterilization for individuals adjudicated insane, epileptic, or feebleminded by a commission composed of two physicians and a justice of the peace. Before being brought to the commission, the superintendent of one of the state hospitals had to certify that, in his opinion, the patient's condition was caused by heredity and that such a condition could be transmitted to the offspring. Though there were various safeguards, including the appointment of a guardian, to protect the patient, and the ability to appeal in court, the state, over a ten-year period (to 1935), sterilized some 2,000 individuals.

This policy of sterilization eventually came into widespread disrepute with the Nazi adoption of genetic ideas of superior and inferior races and their attempt to exterminate the Jews and sterilize the "morally" unacceptable. As an aftermath, most of the legislation in the United States requiring sterilization for "defectives" was either repealed or declared unconstitutional.

Sterilization today has essentially become a voluntary method of contraception and as such is widespread. Both males and females can be sterilized, although most often it is the woman who is sterilized. Increasingly, however, men also are opting for sterilization, in part because the male operation, until recently, was freer of complications than the female one. The standard method of sterilization in males is the vasectomy. This involves cutting into the vas deferens, the excretory duct of the testis, which transport the sperm from each testicle to the prostatic urethra. It is a simple surgical procedure, usually performed under local anesthesia, and takes from 10 to 15 minutes to complete. The surgeon makes a small opening in the scrotum and severs the vas deferens, either by tying it, blocking it, or cutting out a small piece. He then repeats the operation on the other side, since there are two vas deferens.

The problem with male sterilization seems to be mainly psychological, which is why careful and accurate counseling is essential. Recent research, however, has suggested some immune-system problems related to the development of antibodies to sperm and there is a possible link to prostate cancer. A vasectomy is not suitable for men who desire children at a future date because, in most cases, the procedure is not reversible, and the longer one has a vasectomy, the less reversible it becomes.

Female sterilization is aimed at blocking the Fallopian tubes, which transmit the ova from the ovaries into the uterus. Tying the tubes (tuballigation) is one of the oldest forms of tubal occlusion. The technique recommended by the International Planned Parenthood Federation's panel of experts involves picking up the tube near the midportion to form a loop, tying (ligating) the base of the loop with an absorbable suture and cutting off (resecting) the top of the loop. The procedure, in recent years, has become greatly simplified with the development of minilaparotomy and laparoscopy. The minilaparotomy can be performed under local anesthesia, and a small insertion of about 2.5 centimeters (approximately one inch) is made. Each Fallopian tube is then pulled up into the incision to be cut and tied.

Laparoscopy involves inserting a laparoscope into the abdomen. The incision is smaller than for a minilaparotomy and can be made close to the umbilicus (navel), where normally no scar is visible. It is easier, however, to make the incision at a spot somewhat lower in the abdomen, since this brings the scope closer to the target organs. It is also possible for the surgeon to enter the abdomen through the vagina (a colpotomy), and this practice is used extensively in India. All these procedures can be carried out on an outpatient basis under local anesthesia and can be completed in about 10 to 20 minutes.

The Chinese have developed a method of female sterilization through chemical occlusion, that is, by occluding the tubes through chemical burning. This method can be done without surgery and is done in China without anesthetic. It involves the insertion of a cannula (a tube) through the cervix and uterus up into the Fallopian tubes, through which an injection of a phenol (carbolic acid) gel is inserted. The procedure is then performed on the other tube. The result is a scarring of the tubes, which ultimately closes the opening. Chemical occlusion is a very low-cost method of sterilization, but it is not reversible.

Except for the chemical-burning method, reversibility is possible in a majority of cases of female sterilization. Some surgeons have achieved restoration to the point at which pregnancy rates of 60 percent have been recorded. As in the case of men, however, the prognosis for reversibility becomes poorer the longer the person has been sterilized. Reversal is considered major surgery, involving microsurgical techniques, and general anesthesia is necessary.


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

Vern L. Bullough


Baron Friedrich Wilhelm von Steuben (1730-1794), as abundant material suggests, was gay. There is only one thing historians can point to that suggests von Steuben was heterosexual, and it comes from the first biography on the baron in 1859, “The Life of Frederick William von Steuben” by Friedrich Kapp. At the end of the 700-plus-page work, Kapp writes, “Steuben was never married. It seems, however, that he met with a disappointment in early life. While preparing to remove to his farm, the accidental fall of a portrait of a most beautiful young woman, from his cabinet, which was picked up by his companion and shown to him, with the request to be told from whom it was taken, produced a most obvious emotion of strong tenderness, and the pathetic exclamation, ‘O, she was a matchless woman!’ He never afterwards alluded to the subject.” This flimsy story is one of the few items in the book with no attribution. It has since been attributed to a host of the baron’s acquaintances. But most interesting of all is that each time von Steuben encountered the charge of being “homosexual,” he never denied it or defended himself, he just moved on.

There are few historians today who would doubt that von Steuben was gay, and no accredited historian has refuted that, without von Steuben, there would be no United States and that, in today’s terms, von Steuben would be considered a gay man. This update contains new historical material to add to the growing list of details about him. This new information might prove Baron von Steuben was the first case of “Don’t Ask, Don’t Tell.”

To appreciate the contributions von Steuben (1730-94) made to the American Revolution, consider this: Before his arrival in Valley Forge in 1778, the colonies were on the path to defeat. Without his leadership, our modern America might still be the British Colonies.

Before von Steuben arrived at Valley Forge, the Revolutionary Army was a loosely organized, rag-tag band of men with little military training or discipline. The military fumbled through the beginning of the war for independence lacking training and organization. Gen. George Washington and the Continental Congress knew that, without help from additional seasoned military experts, the colonies would clearly lose. Since Washington himself was the best the colonies had, they looked to Europe for someone who could train the troops. To that end, Washington wrote the colonies’ representatives in Paris, among them Benjamin Franklin, to see what he could come up with. Franklin, a renowned inventor, was treated as a celebrity in the French court. This would be pivotal in achieving his two major objectives in France: winning financial support for the American Revolution and finding military leaders who could bring a semblance of order to the Revolutionary Army.

Franklin learned of a “brilliant Prussian” military genius, Lt. Gen. Baron Friedrich Wilhelm von Steuben, who had a string of successes across Germanic Europe. But there was one problem. He’d been asked to depart many of those states and countries because of his “affections for members of his own sex,” according to biographer Paul Lockhart’s “The Drillmaster of Valley Forge.”

This became urgent in 1777 when von Steuben literally escaped imprisonment in what is now Germany and traveled to Paris. There, Franklin was interviewing candidates to assist Washington back in the colonies when his fellow Colonial representative Silas Deane brought von Steuben to his residence for an interview in June.

During the process, Franklin discovered von Steuben’s reputation for having “affections” with males and the issue became pressing, as members of the French clergy demanded the French court, as in other countries, take action against this sodomite, whom they considered a pedophile. They had decided to make their effort a crusade and run him out of France.

Lockhart’s biography tells of von Steuben’s being summoned from Paris for Karlsruhe, at the court of the Margrave of Baden, for a military vacancy. But, Lockhart notes, “what he found waiting for him at Karlsruhe was not an officer’s commissioner but a rumor, a horrible, vicious rumor” that the Baron had “taken familiarities with young boys.”

Those allegations were fueled by von Steuben’s close ties to Prince Henry and Frederick the Great, also “widely rumored to be homosexual.”

Von Steuben returned to Paris, and Franklin had a choice here — and he decided von Steuben’s expertise was more important to the colonies than his sexuality. While it can be debated how much a part Franklin played in the recruitment of von Steuben, one cannot doubt that one of the most informed people at the French court would know of the allegations against the baron. With that knowledge, and with von Steuben about to be jailed, Franklin, along with Deane, wrote what must be the nation’s first example of “Don’t Ask, Don’t Tell” as they mutually signed a recommendation letter to Gen. Washington that embellished von Steuben’s military expertise and titles and suggested he had been recommended by various princes and “other great personages.” Most surprisingly, it remarked that “his distinguished character and known abilities were attested to by two judges of military merit in this country.”

The judges of character that Franklin referred to were two of the four involved in the plot to bring von Steuben to America, along with Franklin and Deane, and personal friends of the baron: Pierre Beaumarchais, author of the “Figaro” plays and an arms dealer who supplied arms for the ship von Steuben eventually sailed on, and Claude Louis, Comte de Saint-Germain, the minister of war under Louis XVI.

What the letter didn’t mention was that he was about to be arrested and appear before judges in France.

Franklin, working with Deane, decided von Steuben’s “affections” were less important than what he, Washington and the colonies needed to win the war with England. Deane learned of von Steuben’s indiscretions — and that the French clergy was investigating — from a letter to the Prince of Hohenzollern-Hechingen, which read in part:

It has come to me from different sources that M. de Steuben is accused of having taken familiarities with young boys, which the laws forbid and punish severely. I have even been informed that that is the reason why M. de Steuben was obliged to leave Hechingen and that the clergy of your country intend to prosecute him by law as soon as he may establish himself anywhere.”

The proof of Franklin and Deane’s knowledge lies in the letter to Washington recommending von Steuben and their quick action to secure the baron from France. So in September 1777, von Steuben boarded a 24-gun ship named Heureux — but, for this voyage, the ship’s name was changed to Le Flamand, and the baron’s name was entered onto the captain’s log as “Frank.” And he was on his way to the colonies.

Washington and Franklin’s trust in von Steuben was rewarded. He whipped the rag-tag army of the colonies into a professional fighting force, able to take on the most powerful superpower of the time, England. Some of his accomplishments include instituting a “model company” for training, establishing sanitary standards and organization for the camp and training soldiers in drills and tactics such as bayonet fighting and musket loading. According to the New York Public Library, (“The Papers of Von Steuben”) these were his achievements:

• February 1778: Arrives at Valley Forge to serve under Washington, having informed Congress of his desire for paid service after an initial volunteer trial period, with which request Washington concurs.

• March 1778: Begins tenure as inspector general, drilling troops according to established European military precepts.

• 1778-79: Writes “Regulations for the Order and Discipline of the Troops of the United States,” which becomes a fundamental guide for the Continental Army and remains in active use through the War of 1812, was published in over 70 editions.

• 1780-81: Senior military officer in charge of troop and supply mobilization in Virginia.

• 1781: Replaced by Marquis de Lafayette as commander in Virginia.

• 1781-83: Continues to serve as Washington’s inspector general, and is active in improving discipline and streamlining administration in the Army.

• Spring 1783: Assists in formulating plans for the post-war American military.

Washington rewarded von Steuben with a house at Valley Forge, which he shared with his aide-de-camps Capt. William North and Gen. Benjamin Walker. Walker lived with him through the remainder of his life, and von Steuben, who neither married nor denied any of the allegations of homosexuality, left his estate to North and Walker. There wasn’t much else to claim, as the baron was in debt at the time of his death, according to both Kapp and Lockhart. His last will and testament has been described as a love letter to Walk and has been purported to describe their “extraordinarily intense emotional relationship,” yet that line was not in the Kapp biography of 1859.

Both North and Walker are featured in the statue of von Steuben in Lafayette Park across from the White House.

Von Steuben and with whom he slept was long a matter of discussion — from Prussia to France to the United States. Yet he never publicly denied it. The closest he came was to ask Washington to speak on behalf of his morals in a letter to Congress so he could get his pension. And why did he ask Washington?

Since his arrival in Philadelphia to assist the Revolution, von Steuben had financial issues caused by a Continental Congress that often didn’t keep its funding promises, a challenge compounded by his own personality: Von Steuben at times could be cold and aloof, which was problematic when diplomacy was needed with an important member of Congress. He also had a tendency to live and spend extravagantly, especially on his uniforms, which were often emblazoned with epaulettes and medals of his own design.

Adding to that were the constant rumors about his sexuality, which by 1790, reached one of the revolution’s first families, the Adamses of Massachusetts.

Charles, the son of John and Abigail Adams — the second president and first lady of the new union — was what today would be called the black sheep of the family. Early on, Abigail considered him “not at peace within himself.” His biggest problem was alcoholism but, as revealed in letters among the various members of the family, the Adamses had other concerns.

As John Ferling wrote in the biography “John Adams: A Life,” “There are references to [Charles’] alleged proclivity for consorting with men whom his parents regarded as unsavory.” One of these men was von Steuben, who, as Ferling writes, many at the time considered homosexual. Charles had become infatuated with and adored Von Steuben. It is clear from the family letters that the Adamses were concerned about a relationship between Charles and the baron. Von Steuben’s sexuality was an open secret, one that he himself never challenged, other than to ask Washington to defend his moral character.

The baron is a puzzle.The man himself was pompous, cold and theatrical, and his uniforms and title were stage props for an officer who didn’t even speak English when he got to Valley Forge. But he did to help Washington’s rag-tag army to defeat the British, eventually leading to the creation of our country. His knowledge created the first sense of military discipline in the colonies. His most recent biographer, Lockhart, in his “The Drillmaster of Valley Forge” offers a complete look at von Steuben’s work.

There is one story in the book that could be considered rather scandalous in today’s terms: Von Steuben most likely threw the first underwear party in the United States military, at his house in Valley Forge.

As Lockhart writes, “The Baron hosted a party exclusively for their lower-ranking friends. He insisted, though, that ‘none should be admitted that had on a whole pair of breeches,’ making light of the shortages that affected the junior officers as they did the enlisted men.”

Apart from this humorous anecdote, it’s hard to question von Steuben’s importance — especially as Washington’s last official act as commander-in-chief of the Continental Army was to write a letter to the baron. Sent from Annapolis and dated Dec. 23, 1783, Washington wrote:

My dear Baron: Altho’ I have taken frequent opportunities, both in public and private, of acknowledging your great zeal, attention and abilities in performing the duties of your office; yet I wish to make use of this last moment of my public life, to signifie [sic] in the strongest terms my entire approbation of your conduct, and to express my sense of the obligations the public is under to you, for your faithful and meritorious services.

“I beg you will be convinced, my dear sir, that I should rejoice if it could ever be in my power to serve you more essentially than by expressions of regard and affection; but in the meantime, I am persuaded you will not be displeased with this farewell token of my sincere friendship and esteem for you.

“This is the last letter I shall ever write while I continue in the service of my country; the hour of my resignation is fixed at 12 this day, after which I shall become a private citizen on the banks of the Potomack, where I shall be glad to embrace you, and to testify the great esteem and consideration with which I am, etc.
” (1)

The nation that von Steuben helped found has memorialized him with numerous statues, including those at Lafayette Square near the White House and at Valley Forge and Utica, N.Y. (where he is buried) and German Americans celebrate his birthday each year on Sept. 17, hosting parades in New York City, Philadelphia and Chicago.

It was von Steuben, a gay man, who played a giant role in not only the creation of the American military, but the idea of military academies, a standing Army and even veterans organizations.

If George Washington was the father of the nation, then von Steuben, a gay man, was the father of the United States military.


Kapp, Friedrich, The Life of Frederick William von Steuben, New York, Mason Brothers,1859

Lockhart, Paul Douglas. The drillmaster of Valley Forge: The Baron de Steuben and the making of the American Army. HarperCollins, New York 2008

 1. From the original letter in the office of the Secretary of the United States Senate.

Mark A. Segal



A pioneer for sex reform and birth control, Helene Stöcker (1869-1943) fought all her life to gain equal rights for women. She was devoted to many progressive causes, among them the acceptance of unmarried mothers and their children (Mutterschutz). She was also, with Magnus Hirschfeld, one of the founders of the Scientific Humanitarian Committee, which campaigned for homosexual rights.

Determined to get a Ph.D., something not possible for a woman in Germany, she went to Switzerland, earning a Ph.D. in Bern in 1901, with the highest distinction (summa cum laude). In 1905, she founded the Bunde for Mutterschutz (League for Protection of Motherhood), and a few years later, in 1908, she started a periodical, New Generation, which she edited until 1933. She participated in establishing sex advisory clinics in many German cities and continued until Hitler closed them. As early as 1910, Stöcker participated in the International Neo-Malthusian Congress for Birth Control in the Hague, in Holland. One year later, she organized a congress on birth control and sex reform. Actually, two conferences had to be organized, as the two topics were held unfit to be discussed at the same time. She was active in the second international conference for sex reform in Copenhagen, in 1928. Under Hitler, Stöcker was deprived of her German citizenship and her doctorate. She fled in 1933, eventually settling in the United States, where she died from cancer.

She, along with Margaret Sanger, is regarded as one of the world pioneers in campaigning for more effective contraceptives. Like Sanger, she also went on to the larger issues of human sexuality in her campaigns.


Wickert, C. Helene Stöcker. Bonn: Dietz, 1991.

Hans Lehfeldt
Connie Christine Wheeler


Marie Charlotte Carmichael Stopes (1880-1958) was a major English sex reformer and popularizer during the first half of the 20th century. Born in Edinburgh on October 15, 1880, she was the daughter of Henry Stopes, a wealthy amateur archaeologist, and Charlotte Carmichael Stopes, a pioneer in women's education who had studied at Edinburgh University.

She had little formal education other than tutoring by her parents until she was 12, when she began attending school in Edinburgh and later a boarding school in London. She graduated from University College, London, in 1902, with honors in botany, geology, and physical geography. She received a doctorate at Munich in botany and joined the science faculty at the University of Manchester, the first woman to do so. In 1911, she married and moved to London, where she was a lecturer on palaeobotany from 1913 to 1920. During this time, she published a textbook on ancient plants and a two-volume catalog of cretaceous flora in the British Museum. During World War I, she engaged in research on coal with R. V. Wheeler.

It was through her work on contraceptives and sex education, however, that she was best known. Her interest in sexuality came from the failure of her 1911 marriage to a Canadian botanist, Reginald Ruggles Gates. In 1916, the marriage was annulled on the basis of nonconsummation, and, in 1918, she married Humphrey Verdon-Roe, an aircraft manufacturer. He was already interested in birth control, and shortly after their marriage they founded the Mothers Clinic for Birth Control, in London, the first of its kind in England. After this, Stopes (who kept her maiden name) relinquished her lectureship at the University of London and devoted herself to family planning and sex education for married people.

Her first book on the subject. Married Love, was published in 1918, although she had originally drafted it in 1914 to crystallize her own ideas. It became an immediate success and was translated into numerous languages, causing a sensation at the time of its publication. Though the first edition dealt scarcely at all with birth control, she received so many requests for instruction on the subject that this was followed up by a short book, Wise Parenthood. This, too, was an immediate success and within nine years had sold half a million copies in its original English edition. She published a number of other books more or less dealing with the same subject, such as Radiant Motherhood and Enduring Passion, many of which sounded somewhat overromantic to later generations of readers.

Her great achievement was to move the topic of birth control in much of the English-speaking world from the confines of the physician's office to public discussion. Her husband and, eventually, her son were alienated from her during the last years of her life. Though still interested in sex education and contraceptives, she increasingly spent her later years writing poetry and engaging in literary pursuits. She died at her estate, Norbury Park, on October 2, 1958. Her estate, including her mansion, was bequeathed to the Royal Society of Literature, of which she was a fellow. A portrait of her, painted by Augustus St. John, was bequeathed to the National Portrait Gallery, while one by Gregorio Prieto went to the National Gallery of Edinburgh.


Briant, K. Marie Stopes. London: Hogarth Press, 1962.

Stopes, M. C. Married Love. New York: Eugenic, 1918.

Vern L. Bullough


Sometimes, sexual dysfunction arises from the stress of a special situation, such as fear of discovery, fear of "not doing well," or even fear of pregnancy. Anxious preoccupation with a situational failure can cause difficulty the next time, starting a vicious cycle of failure involving anticipation, becoming a mental spectator rather than a participant, and further failure. This is one of the commonest causes of secondary impotence and anorgasmia. In such cases, counseling and sex therapy are usually helpful.

There is, however, another kind of stress brought about by such things as unemployment, difficulties on the job, marital and family problems, or any number of factors. Though some stress, like the violin string, is essential to an authentic tone, too much stress produces a questionable tone in both violins and humans, and extreme stress can literally break both violins and humans. The relationship between sexuality and this kind of stress has not been extensively studied, but there are some hints that many individuals seek relief through sexual activity and, in the process, engage in sexual activities that they previously had not done and would not do again, such as exhibitionism.

Some evidence of this came from the experience of Hartman and Fithian with students at California State University at Long Beach. Students in their classes had to keep journals as well as engage in class discussion, and they found an interesting correlation in their sample of some 5,000 students at stress periods such as examination times. Incidence of masturbation increased, as well as incidents of panty raids on female dorms, a common phenomenon for a time on college campuses in the 1950s and 1960s. The health center at the university regularly reported a greater number of women students presenting with vaginal infections during examination times. These observations are congruent with the studies indicating a strong correlation between psychological stress and illness. Hartman and Fithian also found a greater acting out of fantasies among both their students and their clients during times of stress.

If these behaviors violated the law, the danger was that an individual might be arrested and further stigmatized by being labeled "deviant" by himself or herself or by society. Sometimes, the individual was registered as a sex offender if the behavior involved exhibitionism or involved children. Hartman and Fithian emphasize that an individual should not be labeled either by himself or herself or by society as deviant for one or two stress-related incidents but emphasize that the person should seek help and counseling. Early detection and treatment are the best means of prevention.


Pendergast, W. E. Treating Sex Offenders in Correctional Institutions and Outpatient Clinics. New York: Haworth Press, 1991.

William E. Hartman
Marilyn A. Fithian


Masters and Johnson reported in 1970 that they had treated 54 single men and three women with what they called "partner surrogates." Though 13 of the men and all three women had provided their own partners, the remaining 41 men were partnered by some 13 different surrogates chosen from 31 volunteers. Masters and Johnson concluded that the use of surrogates could be a wise clinical decision.

In 1970, Hartman and Fithian began training surrogate volunteers, all of whom were licensed professionals. From this group of trained professionals, the training of surrogates spread and led to an organized group, the International Professional Surrogates Association (IPSA), founded in Los Angeles in 1973. One of the first steps IPSA took was to develop a set of professional guidelines, including a code of ethics and standards for surrogate training. Members were carefully screened and agreed to the IPSA code defining 17 specific ethical standards.

Several surrogate therapy programs evolved, with the best known being the Berkeley group that worked with Apfelbaum, a Chicago group working with Dauw, and two groups in southern California, one working with Hartman and Fithian's Center for Marital and Sexual Studies, in Long Beach, and the other with the Center for Social and Sensory Learning, founded by Barbara Roberts, in Los Angeles.

At a May 1976 conference at the University of California at Los Angeles devoted to the professional and legal issues in the use of surrogate partners, Roberts reported findings based on client responses for the past three years. Interestingly, she found that coitus was the least significant aspect of the clients' exploration of emotional intimacy and that becoming comfortable with nudity, touch, and erotic stimulation were far more important.

Similarly, Dauw found that the problem of the sexually dysfunctional male was more social than sexual; that his heterosexual male clients could not effectively relate to a woman either verbally, intellectually, emotionally, or physically; and that the clients needed to learn to love themselves before they could love one another. Over the period from 1970 to 1980, he treated some 501 males (apparently no females), ranging in age from 18 to 78, and his success rate was 98.2 percent for primary impotence to 84.8 for secondary impotence. Similar findings were made by others.

It is in teaching intimacy that sex surrogates have been most effective. One of Dauw's publications is subtitled A Guide to Emotional Intimacy, while the book by the former male sexual surrogate, DeHaan, emphasizes the importance of intimacy in dealing with his female clients. Interestingly, where males most often sought out surrogate help in the 1970s and early 1980s, single females have been far more common since then. Many, but probably not the majority, of both single men and single women have never engaged in coitus before coming to the therapist. The average age of the clients reported by Hartman and Fithian ranged from the mid-to-late-30s, although they also had a 62-year-old woman and a 72-year-old man who worked effectively with surrogates.

Surrogates are selected by the therapists on the basis of the common interests, education, goals, or even occupations with those they work with, and there is an attempt to match couples agewise. Hartman and Fithian, however, reported matching a 70-year-old single male to a much younger woman, since he had always dated younger women. Obviously, the needs and practices of individual clients have to be taken into consideration.

Since the surrogate is considered as a replacement partner for the client, her or his feelings are as important as those of the client. Though different therapists have different rules, Hartman and Fithian insist that the surrogate be regarded as part of the therapy team and impose strict prohibitions against drugs, alcohol, and contact with each other except under therapeutic conditions. Therapists and clients are known to each other only by their first names and do not know each others' telephone number or address. They do allow a client to contact a surrogate after the therapy is over and a waiting period of six months has passed. Several individuals have ultimately married their surrogates, and many become close friends at a later date.

Though surrogates are paid for their interaction with the client, the interaction is not superficial, since the pay is for the surrogate to be honest, express their own feelings, and interact with the partner in a way that can help him or her to overcome problems. It is not only in the United States that surrogate therapy has been established, but it early spread to Canada, where it was started by Frank Sommers, and to Australia, where Derek Richardson utilized it in his practice. The practice, however, remains controversial.

One of the problems is that many view surrogate therapy as a form of prostitution. Defenders of surrogate therapy emphasize that surrogates do not give instant gratification, and sexual intercourse may occur only a few times. Moreover, the quicker a prostitute turns a trick, the more money she makes. This is not true for the surrogate, whose obligation is to overcome the negative feelings about sexuality and intimacy in slow and carefully developed stages. Moreover, a surrogate cannot be provocative in speech, manner, or dress, and the most valued aspect of the therapy is the time spent talking and helping. Surrogates also make far less money than a prostitute. Wardell Pomeroy, one of the early advocates of sexual surrogates, emphasized that the surrogates could not be compared to prostitutes or call girls because the surrogate was a professional whose work was supervised by a therapist, and he or she is carefully brought into the treatment program as well as given homework and instructions for dealing with each case. Most do not earn their living as surrogates but have other jobs, and assumed the surrogate role usually because they had personal or family or close friends who had some kind of sexual problem.

Surrogates have also been criticized for not having a real relationship with their clients. This implies a lack of commitment. Critics also argue that the surrogate is chosen for the client and not by them and that this does not correspond to reality. In contrast, some therapists argue that the use of a surrogate helps resolve sexual problems more easily than working with a married couple, since they do not have the other emotional entanglements which come with a committed relationship.

The American Association of Sex Educators, Counselors and Therapists, an organization that certifies therapists, has no official stand on sex surrogates but emphasizes that if a therapist does use surrogates, they should be used in an ethical way. With the advent of AIDS (acquired immune deficiency syndrome), even though surrogates insist on testing for STDs (sexually transmitted diseases) and all therapists insist on a sex history, the use of surrogates has decreased, and though the teaching of intimacy remains important, sexual intercourse has become even less important. Safe sex itself can become a way to teach intimacy.

Same-sex surrogates have been used in treatment of gay men and lesbians and have been successful here, since they provide a safe and supportive environment for a client who is fearful or apprehensive. Surrogates have also been used in dealing with people with special sexual problems, such as the physically handicapped. They have proven particularly helpful in dealing with some of the emotional problems associated with sex, such as women who have a fear of penetration, or in helping males who have performance anxiety.

In sum, the use of a surrogate is basically a decision that the therapist and the client must themselves agree on. Those therapists who have successfully used surrogates are strong advocates, but there is also much opposition to their use.


Apfelbaum, B. The Ego-Analytic Approach to Body-Work Sex Therapy. Journal of Sex Research, Vol. 20 (1984), pp. 44-70.

Apfelbaum, B. The Myth of the Surrogate. Journal of Sex Research, Vol. 13 (1977), pp. 238-49.

Dauw, D. Evaluating the Effectiveness of the Sex Surrogate Assisted Model. Journal of Sex Research, Vol. 24 (1988), pp. 269-75.

Dauw, D. The Stranger in Your Bed: A Guide to Emotional Intimacy. Chicago: Nelson-Hall, 1984.

DeHaan, J. Reaching Intimacy—A Male Sex Surrogate's Perspective. New York: St. Martin's Press, 1986.

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

Kaplan, H. S. The New Sex Therapy. New York: Brunner, 1974.

Kaufman, S.A. Sexual Sabotage. New York: Macmillan, 1981.

Masters, W. A., and V. E. Johnson. Human Sexual Inadequacy. Boston: Little, Brown, 1970.

William E. Hartman
Marilyn A. Fithian

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