Turkey
(Türkiye Cumhuriyeti)
(The Republic of Turkey)

Hamdullah Aydin, M.D., and Zeynep Gülçat, Ph.D.

Contents

  1. Demographics and a Historical Perspective
  2. Basic Sexological Premises
  3. Religious and Ethnic Factors Affecting Sexuality
  4. Sexual Knowledge and Education
  5. Autoerotic Behaviors and Patterns
  6. Interpersonal Heterosexual Behaviors
  7. Homoerotic, Homosexual, and Ambisexual Behaviors
  8. Gender Conflicted Persons
  9. Significant Unconventional Sexual Behaviors
  10. Contraception, Abortion, and Population Planning
  11. Sexually Transmitted Diseases
  12. HIV/AIDS
  13. Sexual Dysfunctions, Counseling, and Therapies
  14. Research and Advanced Education
  15. A Final Remark
  16. References and Suggested Readings

Demographics and a Historical Perspective

A. Demographics

Turkey is located at the intersection of two continents, with the small region of Thrace and the ancient city of Istanbul in Europe, and the larger part of the country, Anatolia, in Asia Minor. Turkey is twice the size of the state of California, with an area of 301,382 square miles (780,580 square kilometers). Anatolia (Asia Minor) is surrounded by the Black Sea, the Aegean Sea, and the Mediterranean. An inland sea, the Marmara, separates Anatolia from Thrace and Istanbul to the northwest. Turkey has 4,471 miles (8,333 kilometers) of coastline. Rectangular in shape, Turkey stretches 1,565 kilometers east to west, and 650 kilometers north to south. Its neighbors are Greece and Bulgaria to the west, the Black Sea, Georgia, and Armenia on the northeast, Azerbaijan and Iran to the east, and Iraq and Syria on the south. Mid Anatolia and the eastern regions are typically hot and dry during the summer and cold and rainy during winter. The coastline along the north, west, and south of Turkey has a milder climate throughout the year.

Turkey’s agricultural production is, on the whole, self-sufficient, but the country is not rich in the natural resources. A radical transition toward industrial development has occurred in Turkey’s economy, which was based on agriculture in the past. State intervention in the economy has gradually diminished since the 1980s, and at present, the economy relies on freemarket rules. Turkey possesses a wealth of historical and tourist sites, with a rich potential for summer as well as winter tourism.

Many ancient cultures of Anatolia, including the Mesopotamian, Sumerian, and Hittite, constitute Turkey’s basic cultural heritage. An Islamic culture is woven into this background.

Ankara, the capital of Turkey, with 2.7 million people, is in the center of Anatolia. Turkey’s largest city, Istanbul, has a population of 7.3 million. Located in the northwest, along the shores of the Bosphorus, the point where East and West meet, Istanbul and its environs are the most densely populated, urbanized, and developed part of the country. The city is a center of trade, large and small-scale industry, as well as a center of arts and historical places.

The age distribution of Turkey’s 1999 estimated 65.6 million population was 30.9 percent below age 15, 63.4 percent between ages 15 and 65, and 5.7 percent over age 65. Turkey has a young population, with more than half under age 24. Eighty percent of the population is Turkish and 20 percent are Kurds; 99.8 percent are Muslim, mostly Sunni.

Turkey’s total life expectancy at birth in 1999 was 70.8 years for males and 75.9 years for females. The 1999 birthrate was 20.9 per 1,000 persons and declining, and the death rate 5.27 per 1,000, giving Turkey an annual natural increase of 1.57 percent. The infant mortality rate was 35.8 per 1,000 live births in 1999 and is expected to drop to 3.5 by the year 2000. The mean family population is 4.75 people. In 1997, Turkey’s Total Fertility Rate (TFR) was 2.5 births per fertile woman, placing it 128 among the 227 nations of the world. In 1997, Turkey had one hospital bed per 450 persons and one physician per 1,200 persons. The 1995 literacy rate was 82 percent, with 95 percent attendance for free and compulsory school between ages 6 and 14. The per capita gross domestic product in 1997 was $6,100.

Turkey, like many countries, has experienced a huge population shift in the past fifty years. The percentage of the population living in the cities has doubled in 35 years, from 25 percent in 1950 to 53 percent in 1985. Now, in 2000, it is between 65 and 70 percent. Istanbul is one of the most densely populated cities in Europe, with 9.5 million inhabitants. Ankara, the capital, has 2.8 million. This dramatic population shift is almost entirely attributed to the massive departure of people from the rural areas of central, eastern, and southeastern regions of Anatolia. This population shift facilitates changes in the family structure from the patriarchal to the nuclear model. This rapid transformation and urbanization has also created difficulties in religious, moral, and sociocultural adaptation. Housing problems in urban areas induced migrants into building shanty houses, called gecekondu (“built overnight”), in the vicinity of big cities. These gecekondu are lacking in municipal services and facilities. As a result, a whole new subculture has emerged with its own lifestyle, bringing with it many social and economic problems. Gecekondu families are employed in smallscale or marginal jobs. Although they have now become permanent and essential factors in the urban economy, they are not yet fully integrated into the urban culture, because of their low education levels, limited income, and cultural differences reflecting the traditional lifestyles.

Another important social phenomenon has been the out-migration of labor from the rural parts of Turkey to the countries of Western Europe, beginning in the early 1960s. It is estimated that two to three million Turkish workers currently reside in western European countries. The so-called “second generation” born in these countries are subject to ethnic identity problems. They call themselves “European Turks,” while they are labeled as “Almancilar” (Germaners) in Turkey. A considerable number of workers have migrated back to Turkey in the last decade, bringing back Western values, which have affected male and female roles, as well as relations between men and women. The response to this process depends on many factors, including environmental support, family background, and individual characteristics. It remains to be seen how this out-migration and backmigration will affect overall sexual attitudes and behavior in Turkey.

Thus, as Kagitçibasi (1982a) has noted, Turkish society presents a highly complex, heterogeneous picture, with diverse ethnic, cultural, and religious influences, which differentiate along social class, rural-urban, and regional development dimensions. From the historical point of view, various cultural influences, which include the nomadic-Turkish, ancient Anatolian, Islamic-Middle Eastern, the Mediterranean, and contemporary Western attitudes and values, have shaped and are still shaping Turkish society today.

B. A Brief Historical Perspective

The ancient inhabitants of Turkey were among the world’s first agriculturalists. The Hittite, an Indo-European people, created an empire in Anatolia over four thousand years ago and controlled much of what is modern-day Turkey for a thousand years. Phyrgian and Lydian cultures also flourished in Asiatic Turkey. The rise of Greek civilization, with city-states like Troy on the coast of Asia Minor, and expansion of the Assyrian empire led to the collapse of the Hittites about 900 B.C.E. In the early centuries, among the ancient Turkish tribes in central Asia, both sexes were considered as equals in a society where men and women took equal share of responsibility in affairs of the country, although there has been a dominance of patriarchal or matriarchal family structures in different Turkish tribes throughout history. Records of ancient Turkish families reveal that monogamy was the basic model, although some tribes were polygynous. In some tribes, the marital union only became valid after the birth of the first child (Tezcan 1998). There are also records indicating that there was an annual tradition of freedom, in terms of social and sexual interaction, which could be an ancient model of contemporary carnivals or mardi gras in Western countries.

In the sixth century B.C.E., Anatolia, except for some city-states on the Aegean coast, was incorporated into the Persian Empire. Alexander the Great conquered the area, but it returned to Persian rule when his empire collapsed around 300 B.C.E. By the end of the first century of the Common Era, Thrace and Anatolia were incorporated into the Roman Empire. Constantine the Great founded the city of Constantinople on the site of ancient Byzantium in 330 as the empire’s eastern capital. Following the decline of the Roman Empire in the west, Constantinople became the capital of the independent Eastern Roman (Byzantine) Empire in the seventh century and retained this role for a thousand years. Repeated attacks by Arab Islamic forces were fought off in the seventh and eighth centuries, but the empire lost control of central Anatolia to the Seljuk Turkish rulers of Persia after 1038. The thirteenth century Mongul invasions left Turkey mainly untouched, but they weakened both Byzantine and Seljuk power.

In 1453, the Byzantine Empire fell to the Ottoman Turks, who established a vast empire that lasted until the end of World War I. After embracing the Muslim religion, the social life of Turkish women became restricted, and they lost most of the rights of their ancestors. In the six centuries of Islamic influence and Ottoman control prior to the twentieth century, discrimination between the sexes grew and women were forced to live as a separate group. The harem life was introduced, and in the fifteenth century, the palace of the sultan was divided into a Harem (women’s section) and a Selamlik (men’s section). Soon, harem life and polygyny became customary throughout the state. According to the Islamic family laws adopted by the Ottomans, women could not choose their husbands, marriages were arranged by the older members of the family, a woman was not supposed to be seen by her husband before or during the marriage ceremony, and a wife could be easily divorced by her husband, who alone could decide to do so.

Towards the end of the nineteenth century, with the penetration of Western ideas into Ottoman society, women were allowed some education, and their status began to improve. Turkey’s independence war under the leadership of Mustafa Kemal Atatürk resulted in the fall of the sultanate and abolishment of the religious authority and spiritual leadership of the caliphate. Thus, the religiously based system of the Ottoman Empire was ended. The Turkish Republic was declared in 1923 and a sudden break was made with old values and concepts. Secularism, Statism, Nationalism, Reformism, Populism, and Republicanism were declared the ideologies of the new state. Turkish civil law was accepted in 1926, triggering a wave of rapid change in social life throughout the country. Polygyny was ended and religious marriages were rendered legally (but not always socially) invalid. Women gained equal rights with men, including the rights of inheritance, divorce, and owning property. In 1934, Turkey was among the first nations to give women the political rights to vote and hold elected office. At the beginning, however, these radical changes could not be assimilated equally in all parts of the country. Thus, for example, polygyny can still be seen today in the less developed regions of Turkey, though it is relatively rare. Many uneducated women are still not aware of their civil rights. Also, for many women, legal rights may have little practical value if social and economic pressures do not allow them to use these rights.

In summary, with the declaration of the Turkish Republic and the adoption of Western values and lifestyle in the first quarter of the twentieth century, a major break or even a social split has occurred in the community, which has a rich and complex background. Such an abrupt change undoubtedly affected concepts and experiences in sexuality in contradictory ways. While liberating women and mitigating segregation between male and female roles, it has at the same time created gaps between generations and various social structures that are difficult to bridge.

1. Basic Sexological Premises

A. Character of Gender Roles

The Effects of Social Change

At the beginning of the twentieth century, a movement against Ottoman marriage customs and concerned with the plight of Turkish women began. The protesters were mostly upper- and middle-class men who were allowed by Islamic rules to marry up to four wives, supplement them by concubines, repudiate them at will, and exercise strict control over their mobility outside the household. These protesters were against arranged marriages; they desired educated wives with whom they could have intellectual as well as emotional communication, and a social life where the sexes could mingle freely (Kandiyoti 1995).

In this period, the Turkish nationalist movement also introduced new elements into the debate between Western ideologies and Islam. The ideologues of the Turkish nationalism asserted that ancient Turkish customs in Central Asia involved total equality between conjugal partners in a monogamous and democratic family. In 1917, the Family Code was accepted, and represented the first intervention of the central state into the family, which had previously been under the control of the religious authorities. With the establishment of the Turkish Republic in 1923, a major break had taken place; the caliphate was abolished, the new constitution was based on secularism, and measures were taken to heighten Turkey’s national consciousness in place of an Islamic identification. Revolutionary changes in the new state included the romanization of the alphabet, the new dress code, and an interpretation of Turkish history stressing its pre-Islamic cultural heritage. Laws were passed for compulsory and standard primary education throughout the country. The state and parents were made responsible for the education of each child. The modern woman of the Turkish Republic experienced a kind of metamorphosis, becoming a prominent figure, dressed in the Western style or in a school or military uniform, and wearing evening dresses for ballroom dances. In the maleoriented society where son preference was the main attitude, Atatürk, the founder of the Turkish Republic, set a new tone by adopting daughters. Highly trained professional women started working in the republican offices. However, as members of a strictly segregated society in which male honor was dependent on the behavior of their womenfolk, women could only enter the public arena by emphasizing their respectability and nonavailability as sexual objects (Kandiyoti 1995).

Initially, these changes affected only a small urban layer. The spread of schooling and health services throughout the country proceeded gradually. Marriage alliances remained firmly under the control of local communities and followed customary practices, which were now denounced as “traditional” or even “backward” by the enlightened technocrats of the republic. Turkey was assumed to be moving from tradition to modernity, and the idealized model of the “modern” nuclear family involved companionate marriage, role-sharing between spouses, and child orientation. The ideology of the modern nuclear family was a radical departure from the pressures and control of older kin characteristic of Muslim societies. However, Kagitçibasi (1982b) argued that the “modern” Turkish family was not based on the autonomy of its members, which modernization theory implied, and that emotional interdependence between family members persisted. Ayata (1988) has commented that tradition and modernity are being lived concretely in Turkish households as a literal “split” between the styles of consumption, formal dress, and conduct displayed in the guest room; and those adopted in the intimate inner space of the rest of the house, which is a place of informality and closeness.

Social change is almost an everyday matter for people in Turkey. Technological innovation and a new monetary economic base for agriculture, land fragmentation and shifts in income distribution, the growth of industry, cultural diffusion, education, and the mass media have all helped precipitate this social change, along with internal and international migration. This unceasing mobility has caused people to change.

The Turkish state, through family legislation and the inclusion of women in the definition of full citizenship, has brought about a decrease in the legitimacy of patriarchy. On the other hand, discriminatory practices in many areas, such as employment, education, and social welfare, have not ended, and women’s basic role as caretaker within the family has not changed substantially. Meanwhile, women’s monetary contributions have become necessary for the survival of households, leading to some conflict in the sexual division of labor within the family.

Family, Kinship, and Community

In traditional Turkey, members of a whole village are often related to each other through marriages and blood relations. Thus, kinship forms the basis of social relations in the rural setting. Brothers and nephews stand together in disputes and are called upon for help, support, defense, or even revenge.

With economic change, out-migration from the village took place, and accordingly, the pattern of daily contact, mutual services, and solidarity has been weakening. Still, in times of need and crisis, family and kin are called upon for help. Whenever the husband has to leave the village for long periods to work in the city or abroad, he may leave his wife with his or her parents, as she is accepted as a member of her husband’s core family when she marries. When this is not possible, other kin take over this function. Similarly, kinship ties are functional in shared agricultural work, house building, child-care, etc., and this function continues even in the urban gecekondu context.

If, as a result of migration, kinship bonds weaken, the neighborhood assumes greater importance as a support system, because public services are still insufficient in rural areas. Thus, as family extends into kin, so kinship extends into neighborhood and community in terms of networks of bonds involving duties, responsibilities, common concerns, support, and help.

It seems that male power is more prominent in lower-class families, where males have less resources in terms of income and occupation than in the middle classes. Kuyas (1982) found that middle-class women perceive mutuality or sharing between spouses, and think this is how it should be, whereas lower-class women perceive almost total male control, but again feel this is how it should be. Despite the overwhelming prevalence of nuclear-family residences, extended family and wider kinship ties have not decreased in importance in the city.

Sex Roles

Although Turkey is in the process of rapid social change, it can safely be claimed that the general family pattern is predominantly patriarchal. While there are powerful crosscurrents acting both to reinforce and to mitigate male dominance in different contexts, the second-class status of women in the Middle East still prevails in Turkey. Clearly defined sex roles, division of labor, and separate social networks both help the women endure the status difference, and yet at the same time serve to reinforce and perpetuate this difference. Supportive same-sex friendship/kinship networks further contribute to this separation (Kagitçibasi 1982a).

The concept of honor, referring to the sexual modesty of a woman, implies that men control the sexuality of women. Honor is largely dependent on others’ evaluations, and an insult to honor results in disputes, fights, or even blood feuds. The ties among the family members, kin, and community are so close that sometimes the honor of a whole village or community is affected by the honor of one man.

Within the family, young women are controlled and their status is low. The young bride, in particular, is expected to serve all adults within the patrilocal household. Once she bears a son, however, her status improves, especially when the son grows up and brings in a bride and the cycle thus repeats itself. Hence, every woman in the traditional rural society prefers a son as a child; if she does not bear one, her marriage may be threatened (Kagitçibasi 1982a).

The preference for sons does not only depend on an economic basis. The son, especially the eldest one, is responsible for all women in the family, including his mother in the absence of his father. In contrast to the central role of the son in the patrilocal family, a daughter leaves the household to get married when she reaches an age to be “useful.” However, Kiray (1976) noted the changing value placed on daughters, who now often replace sons as the “dependable” child.

In the traditional Turkish family, the mother’s relationship to her son is intimate and affectionate, in contrast with that of the father who is authoritative and distant. In some ethnic groups, the father is such an authority figure that his son cannot even talk to his own wife or show affection to his own children in the presence of his father. In fact, the mother often protects the son from the father’s disciplinary acts. The mother-son relationship is generally stronger than the husband-wife relationship in the traditional family, where any public show of affection between spouses is disapproved of. A man does not even talk about his wife in the company of others, and if he has to, often he uses the word “family” to mean “wife.” Communication and role sharing between spouses is limited, and sex roles are well differentiated and non-overlapping. Males are the decision-makers in the family.

Özgür and Sunar (1982), who examined the problem of homicide in Turkey, attributed the high rates of homicide to a traditional system of norms that condone and require a violent response to violations of personal honor. Male homicide was found to stem from more normatively approved motives, such as self-defense, property defense, or honor, whereas a greater proportion of female homicides stemmed from domestic quarrels, jealousy, and similar motives.

Status of Women as Laborers and Professionals

The effect of introducing modern technology into agriculture, and the resultant economic-structural change for rural women, has been a general reduction in their workload. With farm mechanization and the monopoly of such farming by men, women’s farming decreased. With the introduction of ready-made goods, such as clothing and food, women’s domestic chores have also decreased. This change has been considered to have a positive effect on women’s well being, relieving them from some of their heavy burdens. However, it can also be claimed that decreased workload has alienated women from production and has stressed their reproductive role (Kagitçibasi 1982a).

In some areas, with the participation of men in factory work, an opposite outcome of economic-structural change has taken place, with women again being disadvantaged, just as they are completely tied down in agricultural and domestic work and do not have access to education and mobility. Most “unskilled” women in the rural areas are engaged in production of handicrafts, such as embroidery and carpetmaking, which is also considered a part of women’s duties and responsibilities for her home. Years before they marry, young girls and their mothers begin preparing çehiz, handmade carpets, rugs, quilts, tablecloths, and scarves, which will be needed when they establish their own homes. These handicrafts constitute a major part of the folk arts, and during the past few decades, they have become a source of income for the households, because they have gained monetary value as well.

Women’s work in the rural economy is often not considered “work,” for it is, rather, a total lifestyle. It is not differentiated as to locality or time, and different types of work may be done in the same place and at the same time, such as food production, housework, and childcare. Neither does it involve specialization or formal training.

Underestimation of women’s work also derives from social values, which assign the provider role to men. In the idealized image of the affluent family, the woman does not have to work, an image that is especially prevalent in urban and small-town culture and that is spreading among gecekondu dwellers and villagers, who emulate townspeople (Kagitçibasi 1982a).

Kandiyoti (1982) noted that urban Turkish women do not in any way challenge the male role. Lower-class urban women may retreat into domesticity, or if they have to work, it is considered unimportant or temporary. In the case of lower- and middle-class women, subordination is reflected in their very limited access to the outside world. In the case of professional women, husbands are still reluctant to take over roles traditionally accepted as belonging to women, such as taking care of children or sharing housework.

In rural areas, a negative relationship pertains between socioeconomic development and women’s labor participation. Özbay (1982) points to the fact that women’s labor force participation is decreasing, though it is still high; and women’s literacy is increasing, though it is still low. In urban areas, on the other hand, the substantial percentage of professional, highly educated, highly skilled women is notable in view of the low overall female education and skills in Turkey. The overall figures show that the proportion of working women has been declining in Turkey. According to the 1997 figures of the State Institute of Statistics (SIS), women’s labor-force participation was 34.7 percent in 1990, 31.4 percent in 1992, and 25.2 percent in 1997 (Aydin 1998).

Erkut (1982) addressed the fact that, “despite the low levels of educational attainment for women in general, substantial numbers of Turkish women obtain professional degrees and practice in what are considered to be male-dominated occupations in the West.” She explained that this has happened as women have been able to pursue professional careers without posing a threat to the male sex role and its privileged status. Highly educated women have had access to the support and services of other women, from the extended family and kin or from among the less advantaged, so that their professional roles have not had to hinge upon their husband’s help in carrying out their domestic chores. Men have thus enjoyed the enhanced family prestige and income provided by career women, without themselves changing their status or incurring more work. Erkut points out that men are the real beneficiaries of “the rise of a few women made possible by the exploitation of many.” Thus, positive attitudes toward professional education of elite women exist side by side with negative attitudes toward women’s universal education deriving from traditional culture.

Fertility and the Value of Children

As a result of high fertility rates in the past, the population of Turkey is young. Government policy changed from a pronatalist to an antinatalist one during the 1960s and, accordingly, fertility rates started to decline.

In the face-to-face interpersonal relations of the small community, every one is a “significant other,” and no one can be ignored; thus, other-directed behavior tendencies develop from childhood on. In the village setting, the child is socialized not only in a family, but also in a kinship-community system characterized by mutual obligations. Expectations from the child, accordingly, are not only individual and familial, but communal as well.

Kagitçibasi (1982b) noted that with development and especially with education, the perceived economic value of children decreases, but their perceived psychological value increases, at least in relative terms. When the economic value of children is high, the number of children increases, whereas when a low economic value is coupled with a high psychological value, the result is lowered fertility. Thus, the value of children forms an explanatory link, at the individual level, between the level of development and fertility rates. The economic value of children goes hand in hand with son preference, as sons are more dependable sources of economic benefits, especially in old age. This is of key importance in the sociocultural economic context, where patriarchal traditions are strong and institutional support of the elderly is lacking. The dependent, inferior status of the uneducated woman is crucial in this context. It is apparent in widespread male decision-making and low levels of communication and role sharing between spouses. It is an inherent part of a general pattern of interdependent relationships, appearing first as the dependency of the child on the parents and then as the reversal of this relationship. Socioeconomic development, and especially women’s education and professionalization, are the key precipitators of change in this pattern.

The traditional Turkish way of adopting a child, which was also prevalent during the Ottoman Empire, is significant in some aspects. Wealthy traditional families usually adopt a child who is in economic or social need. Moreover, it is usually a girl, which seems to reflect the inclination to protect the weak. The child, called an evlatlik, is sometimes of an age when she (or he) is well aware that she is adopted and has a different position in the family. The evlatlik is well-cared for, is educated like other children, and is provided for until she marries. On the other hand, she is expected to help with the housework, which constitutes her different role in the household. This tradition, which, partly because of economic and social changes, is on the decline, may be considered as an informal social support system to protect the child where state supports are lacking. The evlatlik tradition does not exclude the more contemporary legal adoption system. Couples who wish to legally adopt a child must meet specific strict rules and usually have to wait for long periods. The couples (on the whole, those without children) usually prefer a newborn child as they wish the child to think that he or she is their biological offspring.

Another way of adoption is seen in infertile couples in highly traditional Turkish communities in which one child of a relative (who is usually a brother or sister of one of the spouses) is adopted. The purpose of choosing a close relative’s child seems to be related to the wish to keep the family ties together.

B. Sociolegal Status of Males and Females

Today, civil marriage is generally practiced with or without an additional religious ceremony. However, the practice of religious marriage alone has not disappeared. Polygyny was prohibited in 1926, with the acceptance of the Civil Code. Nevertheless, it is still possible to see it in some regions, though it is rare and was not very common even before 1926.

According to the Constitution of the Republic of Turkey, citizens cannot be discriminated against on the basis of their gender, and all individuals have personal, inviolable, non-transferable, vested basic rights and liberties. In spite of this legal foundation for equality between the sexes, there are articles in laws that contradict this principle. For example, according to the Civil Code, the husband is the head of the marital union and is in charge of the choice of residence. The Civil Code states that the husband speaks for and represents the marital union; the woman only has the right to represent the union for the permanent needs of the house. Nevertheless, a Draft Amendment of the Civil Code has been submitted to the Parliament, and if the draft is ratified, a number of inequalities will be eliminated (Ergöçmen 1997).

Equality between the sexes was introduced in the legal structure through the reforms implemented following the declaration of the Republic, and opportunities were provided for effective participation of women in public life. One of the most important steps in this respect was recognizing women’s right to vote and eligibility to be elected as early as 1934. In spite of this relatively early access to participation in the political decision-making process, women in Turkey have limited political involvement in terms of representation in the Parliament.

Even though under the Civil Code women have inheritance rights equal to men’s, in some rural areas, women still get either nothing or much less than what men get, and inheritance issues are resolved informally within the family or the village. This practice is, however, on the decline, and equal sharing is the rule for urban people.

On the other hand, there are two types of regulations with regard to women in the labor force. The first set of regulations prevents women from undertaking dangerous work, while the second set relates to protective measures regarding maternal functions of women.

Since the foundation of the Turkish Republic in 1923, the basic principles in education have been the universality of services and the equality of opportunities. There are also principles like coeducation and the right of all to education. Primary education, which had been five years but was recently raised to eight years after much debate, is compulsory for every Turkish child and is free in public schools.

Almost all boys and girls attend primary education, although the dropout rate at later stages of education is higher for girls. For instance, whereas 91 percent of boys and 87 percent of girls attended primary school in the 1994-1995 academic year, 78 percent of the boys continued on to secondary school while only 53 percent of the girls continued into secondary schools. Women thus still lag behind men in literacy and level of education (Ergöçmen 1997).

The legal age of marriage, which had been 15 for females and 17 for males until recently, has been raised to 18 for both sexes. To secure the family unit is both a part of the main Turkish traditional approach and the official policy of the state. Thus, for example, if both the husband and the wife are government employees appointed in different cities, they have the right to demand to be employed in the same town to maintain the family union. In 1989, the State Department of Family Research was established as an independent branch under the Prime Ministry to develop national policies for the maintenance and welfare of the Turkish family.

In the Turkish Civil Code, punishment for adultery for women constituted the husband’s right to divorce her, while the woman was also sentenced to imprisonment. For men, the same behavior was not punished as severely. Recent regulations in the Civil Code abolished this inequality for both sexes. Indeed, adultery is currently not considered a criminal act for either men or women.

On the other hand, adultery (zina) is severely punished by religious tradition and by society. In Islam, adultery must be witnessed by four adult Muslim males. A woman who commits the crime of adultery is supposed to be stoned to death, whereas no such strict punishment exists for adulterous men. Interestingly, there has been no recorded case of punishment for adultery during the whole history of the Ottoman Empire, which implies that religious rules were less harshly practiced during the Ottoman reign.

The civil law of Turkey accepts the absolute divorce of couples. Moreover, judges have the right to decide a legal separation of couples for a certain time period before absolute divorce. Turkish divorce law has been reviewed as a result of changes in social life, and the new regulations of 1988 make attaining a divorce much easier. For example, if one of the spouses does not agree to a divorce, a three-year period of separation is sufficient to grant a divorce.

Divorce rates showed an increase in 1988 because of the enactment of the new law, but have stabilized and remained constant during subsequent years. The most commonly cited cause of divorce is incompatibility between spouses, with willful desertion and adultery following (SIS 1995). As far as women are concerned, the causes of divorce are adultery (81.3 percent), intrafamilial violence (65.5 percent), and alcoholism (59 percent).

C. General Concepts of Sexuality and Love

Reflections of the Oedipal theme can be traced in the Anatolian culture and folklore. The colloquial Turkish language and Turkish slang is full of examples of male sexual aggression toward the mother, sister, and wife, or threats of castration directed toward boys and men. In rural Turkey, the custom of firing guns during the wedding ceremony, sometimes with fatal consequences, can also be regarded as an example of the Oedipal theme.

Physical contact between same-sex people is common in Turkey. It is socially acceptable for women and men to embrace, kiss, and walk hand-in-hand with others of the same sex in public. However, physical closeness and any show of affection between the sexes in public are generally not condoned, even between husband and wife.

In Turkish folklore and legends (such as those of Yusuf and Züleyha, Ferhat and Sirin, Kerem and Asli, and Leyla and Mecnun), the main theme is longing for the loved one. Love and passion, almost devoid of bodily senses and sexuality, is experienced as a search for the mystical, a way to reach God. Ancient Turkish verses, tales, and music reflect the mystical quality of love. In traditional Turkish arts, such as carpet-making, which is usually woven by women, decorations and ornaments carry messages for the loved one.

Turkish melodrama represents the woman by her changing status in society as well as by the split in her identity. Films present prudent, poor, but highly talented women who are exploited in the patriarchal household and become very famous and rich by the help of a man who is financially and socially in a higher position. However, fame and fortune do not help her to form a stable identity; she is abused again, because she cannot attain the idealized love and security she has aspired to.

With few exceptions, Turkish media serve to accentuate traditional gender roles. Imamoglu (1996), in her review of newspapers, noted that, whether representing leftist, rightist, or liberal viewpoints in the political spectrum, Turkish papers share the ideology of perpetuating gender stereotypes in a subtle but consistent way. She concludes that, similar to Western papers, women seem to be defined in terms of their relationship to men. Women’s maternal and marital roles and sex-object images are emphasized while their femininity is defined from a male perspective.

It is not easy to reach a conclusion regarding the basic concepts of sexuality, love, and sexual attitudes of people in modern Turkey. Besides the media, which carry Western values into the very homes of the most isolated, many ancient cultures and civilizations have contributed to the present, as well as Islamic, Arabic, and Persian influences. These effects can be traced in Turkish legends and folk tales, while common themes can be observed with other cultures in the Middle East.

2. Religious and Ethnic Factors Affecting Sexuality

A. Source and Character of Religious Values

Turkey is a secular state according to the Constitution. Although the community is predominantly Muslim, mostly Sunni with a considerable proportion in the Alevi tradition, Turkish people are unique in their mild interpretation of Islam. A number of varieties of Islamic interpretation exist, as well as non-Muslim groups. In the past decade, radical religious movements in the Middle East have found supporters in Turkey, and these fundamentalist religious groups have been exerting pressure in favor of a return to Sharia (laws according to the Koran). Their political party was closed down in early 1998 by the legal authorities, because their activities were against the Constitution. More recently, a new party with a much milder religious discourse was established and is now represented in the Turkish Parliament.

The Turkish Constitution is based on secularity and does not permit any religious ideology to control the political system. Although contemporary interpreters of the Koran believe in the equality of males and females in the Western sense, fundamentalists refrain from any interpretation of the Koran other than the original form of the Koran.

On the other hand, the effects of Islam on many sexual behavior patterns of Turkish men and women can be discerned, except among a highly educated minority residing in major metropolitan areas. There are significant differences in the sexual lifestyles of people from rural and urban areas. In terms of sexual behavior, Turkey manifests a very complex picture, because the Turkish cultural mosaic is made up of many different value systems. There are insufficient data to support a conclusion. Along with ancient Turkish traditions and Islamic influences, elements of secular Western culture, atheistic socialism, and various regional cultures interact with each other to create an extremely rich and complex whole (Tekeli 1995). This mix gives Turkish citizens their distinctive, more liberal characteristic.

During the Ottoman Empire, the presence of two witnesses who testified that the woman and the man (or their representatives) had decided to marry was the sufficient condition to marry. Marriages were not recorded officially until the establishment of the Turkish Republic. The marital union was basically a contract between the two partners. Thus, no official approval was considered necessary. Later, this ceremony took place in the presence of an imam, a religious leader, and this practice was called imam nikahi, a religious marriage.

More legendary than real, a man who intended to marry was supposed to present the bride with the amount of gold which equaled her body weight. A man could marry four wives, but he had to treat them all equally. Contemporary authorities of Islam in Turkey do not regard polygamy as a valid norm of religion in modern times, and they mostly approve only of monogamy. In spite of this, most couples prefer a religious ceremony in addition to the official marriage, as it is accepted rather as a declaration of the marital union before God and society.

On the other hand, the religious marital union could easily be broken if the husband alone so desired. This marital arrangement rested on the absolute fidelity of the woman, while permitting the man much sexual freedom. The woman could not divorce her husband and marry again under any circumstance, except when her husband divorced her. The most she could do was to leave home if her husband brought in a new wife.

According to religious rules, a man could marry again as soon as he divorced his wife, whereas a woman had to wait for at least three months if she wished to marry another man, because of possible pregnancy from the former husband. However, if the man divorced his wife more than twice, he could not marry her again if the woman did not marry and had sexual intercourse with another man. This Islamic custom, called hülle, has, in a way, a protective function for women, although in modern Turkey, which interprets Islam in a very mild manner, it is never seen.

A kind of Islamic marriage contract called mut’a, which is valid for a short period of time or under certain conditions, is not prevalent in Turkey, although in some fundamentalist religious groups, it is sometimes resorted to, presumably with the purpose of justifying sexual involvement. (See discussion of mut’a in the chapter on Iran, Section 5C, Interpersonal Heterosexual Behaviors, Adults, Marriage and the Family.)

An old custom called mehir (a kind of dowry), which involved paying a certain amount of money to the bride’s parents has been known from ancient times. This custom probably originated during the process of transition from the matriarchal to the patriarchal social order, when women began to be regarded as commodities, with a price that could be paid for. Starting with the early years of Islam, this custom took the form of a payment made directly to the woman for her security. Thus, while the woman was withdrawn from social life and productivity, a certain means of security were provided for her. This practice, which could be regarded as progressive centuries ago, is maintained today as a tradition. Today, in rural areas, this custom prevails as a baslik (bride price or dowry), an amount of money paid by the groom to the girl’s family. Baslik is an indication of social and economic power for both sides, although this practice is declining with urbanization and the nuclearization of the family.

Only 1.6 percent of all married women are or once were in religion-based polygynous marriages, according to a nationwide survey in 1988 (Hacettepe-HIPS 1989a). Thus, it is obvious that polygynous marriages are not widespread. However, there are some variations by rural/urban, geographical, socioeconomic, and sociocultural characteristics. For example, polygynous marriages are more widespread in the east, in rural areas, and among those who have no education.

On the other hand, while marriages with religious ceremonies are socially recognized, they have no legal standing. Surveys imply that the prevalence of such marriages is of a sizable magnitude. Among all marital unions in Turkey, 8.3 percent are based only on religious ceremonies, whereas 80.5 percent of the officially married couples have chosen to have both a civil and a religious ceremony (Hacettepe-HIPS 1989b). Since marital unions based only on religious ceremonies are not legally recognized, the partners are deprived of their institutional rights within the family, such as inheritance or parental rights on the education of their children. Whereas 4 percent of urban women live in religious unions, three times as many do so in rural areas.

B. Character of Ethnic Values

The family as a valued social system has always been important for Turkish people. According to the traditions of ancient Turkish states, such as Hun Turks and Göktürks, which serve to keep the family secure and united, males married their stepmothers or their brother’s wife if their husbands died.

Since the acceptance of Islam, religious and ethnic factors have become so mingled with each other through the centuries that it is not always possible to distinguish their separate effects on sexual attitudes and behavior. Although ethnic minorities exist, they are not recognized by the state, which accepts everyone as Turkish citizens, and statistical data are not available for these groups as separate entities.

If the traditional Turkish agrarian society - the core society - and its values are taken as a reference point, modifications in outlooks and ways of life can be better understood. The family system in the small agricultural community is generally assumed to be patriarchal with close kin and family relations. However, surveys have shown that the majority of families are nuclear and probably have always been. Kagitçibasi (1982a) noted that the extended family is an ideal, especially in rural areas.

This extended-family ideal involves expectations of living in old age with the adult son’s family and being supported by him. Underlying this ideal is, on the one hand, economic necessity, mainly lack of institutional support or other means of old-age security, resulting in dependence on children and a consequently high value put on children’s loyalty to the parents and the family. On the other hand, idealization of the extended family is partly the continuation of a tradition or a sign of longing for the past, as well as a sort of status aspiration. Generally, rural patriarchal extended families have been the rich families, which could afford to keep all the family members under the same roof, as they had large land holdings to live on. Consequently, in the eyes of the poor peasant, the extended family has been identified with wealth, thus symbolizing an ideal.

The dynamic nature of the family undergoes modifications in the face of changing socioeconomic conditions in Turkey. A typical pattern of change through the life cycle of the rural family involves first, the newly married couple living with the husband’s parents as a valued pattern and because of economic necessities - the patriarchal extended family - then moving out as the young man gains more income and autonomy - the nuclear family - and then later on, the aged parent(s) moving in again for protection in old age - a “transient extended family.”

Even when conjugal families live in separate households, the functions of an extended family are served by them, in that they are called upon to provide material support when needed, forming what might be called the “functionally extended family.” Thus, close family ties extending into kinship relations serve an important function of security in times of crises and conflicts, which are often faced by the families undergoing change in both the rural and the marginal urban context (Kagitçibasi (1982a).

The spatial proximity of the separate family and kin households, even in urban areas, symbolizes and may even strengthen the close mutual bonds of family and kin. Mutual support within the family is the rule. Thus, for example, older brothers are expected to finance younger siblings’ education and be available for assistance for their parents in old age. Family relations are mostly patriarchal, with men having authority over their wives and children. Brides in rural areas often have to live within their husband’s family, which can cause many interpersonal and role problems between her and the in-laws. This extended-family type contains three generations, with the grandfather and grandmother having authority to manage the family income and take care of grandchildren. After the bride has a child, particularly if it is a boy, she ascends to a higher status in the family. Usually, men work outside the home whereas women do the housework and take care of the children. Relations with the relatives are still very close in Turkey.

Endogamous marriage - marriage within one’s own religion, ethnic, or kinship group - which is still commonly practiced in some regions, has various social functions, such as maintaining local cohesiveness, control over land, and protection of the family from “strangers.” Twenty-one percent of marriages were found to be consanguineous. This rate increases to 31 percent in eastern Anatolia and decreases to 13 percent in western Anatolia. Educational level of the women seems to be an important determinant, and the proportion of consanguineous marriages drops with increased education (Hacettepe-HIPS 1989b).

Marriage in the rural context appears to assume more of a social than an individual or conjugal character, as a means of establishing economic and social ties. It is especially instrumental in strengthening existing kinship relations or extending them outside the village to similar ethnic groups or in forming neighborhood and territorial ties, and in increasing the number of relations and friends who are potential sources of aid. Thus, arranged marriages are common in rural parts of Turkey and not rare in small towns and cities.

Related to the social function of marriage, a widespread custom is “asking for the girl.” The elderly, respectable, usually male family members of the groom candidate visit the girl’s parents at home and ask for their permission for the young couple to get married. This visit is usually accompanied with presents, such as flowers or sweets in a silver plate, which may show variations according to regional custom. This custom has been modified throughout the modernization process. In transitional families, mostly in small towns and gecekondu areas, families of both parties bargain on the household needs for the young couple. Sometimes this may take months.

In the peasant culture, although abduction and elopement still exist, they are not condoned; only 1.3 percent of marriages in 1989 involved elopement. The responses to such action range from tolerance to strong disapproval, and even vengeance and strife between the families involved. It is also seen as a breach of the proper standards for formal marriage and the financial contract, namely, the dowry.

During the marriage ceremony, relatives present the couple with household needs, jewelry, and gold. Jewelry and gold belong to the woman and constitute a kind of security for her. If later it has to be exchanged for money, the husband is obliged to ask his wife’s permission to sell them. Valuable presents given during the engagement period are supposed to be returned if the engagement is broken.

In arranged marriages, the man is not supposed to see the bride until the wedding night. After the wedding ceremonies, the husband presents his wife a gold coin as a gift in exchange for seeing her in person. This is called yüz görümlülügü (price for seeing the bride’s face).

The dowry has traditional functions, such as the economic gains it brings in exchange for the loss of the labor of the girl and providing security for the wife if the husband dies. However, if the man is unable to pay the dowry, abduction may provide a solution. Another function of the dowry is providing support for the wife in case of divorce, yet divorce is quite rare in rural Turkey as it is not condoned and is resorted to only under extreme conditions. Since endogamy is more prevalent in rural areas, or, at least because people are tied in close kinship bonds with patriarchal, authoritarian relations, this social structure limits individual acts, such as divorce. One acceptable reason for divorce may be suspicions about the wife’s infidelity. Divorcing an officially married wife for special reasons, such as her infertility or failure to give birth to a son, may lead the man to a religious marital union with another woman. Divorce, in this case, does not result in separation from the first wife, because the man behaves as a responsible husband for both women.

Although some groups organize their life according to Islam, it cannot be generalized to the whole community. Ancient Turkish influences and Anatolian civilizations constitute the main background, while Islamic and Western effects are woven into this pattern. It can be claimed that traditional institutions, such as marriage and kinship relations, serve both individual and social functions. Such ceremonial relationship patterns help people perceive themselves both as individuals and as a part of the community.

3. Sexual Knowledge and Education

A. Government Policies and Programs

In the last fifteen years, sexual education has been a topic of debate in Turkey. In the past, even in medical schools, sexual education was limited to courses on the anatomy and physiology of the sexual organs. Recently, in medical schools and in some psychology undergraduate programs, human sexuality, sexual functions, and dysfunctions have become a part of the curriculum. However, it remains to be decided what sort of a sexual education program should be given in primary and high schools. In elementary education and high schools, there was no formal sexual education programs, while biology courses included only information about reproduction in various life forms, including humans. In a study of 13,000 female high school students, it was found that 75 percent had some information on sexuality, including contraceptive methods and sexually transmitted diseases, although on the whole, the level of sexual knowledge was low in this group (Vicdan 1993). On the other hand, students in the 12- to 15-year-old age cohort reported that sexual education should be included in the school curriculum (Basgül 1997).

In the 1999-2000 academic year, a sexual education project was put into practice by the Ministry of Education. The education program covers topics such as physical growth, development, and maturation, male and female reproductive systems, adolescence, sexuality and sexual identity, contraception, and sexually transmitted diseases (Ministry of Education, 2000).

A number of non-governmental organizations, among them the Family Planning Association and various women associations, provide educational programs on family planning and contraceptive methods in rural and gecekondu areas.

B. Informal Sources of Sexual Knowledge

A conservative attitude in discussing sexual matters with children is apparent in Turkish families. Moreover, parents may not possess an idea about how and what kind of information and experience they should share with their children. Thus, the majority of young people do not have much opportunity to consult with their parents about sexuality. On the other hand, former generations probably lack objective, scientific information with which they can supply their children. In such a situation where the young group cannot obtain information from their trusted elders, they turn to popular publications they can obtain or share experiences with each other. Unnecessary fears and anxieties arise from tales about, for example, the first night in which girls are led to expect to suffer great pain and face excessive bleeding during coitus. Many young men are worried about the size of their penis or their performance or whether they will be able to satisfy their partner.

Various studies indicate that the main sources of sexual information are peers and publications. A study of adolescents revealed that for 15 percent, the source of sexual knowledge was the family, for 35 percent peers, for 20 percent the media, for 8 percent the school, and for 12 percent other sources. A quarter of adolescents reported that they had no information about sexual matters before puberty. Negative feelings toward changes in puberty were much more prominent in girls. On the other hand, 7 percent of college students reported that their most important problem area was sexuality, among various psychosocial problems (Eksi 1982). In another study, the adolescents’ same-sex peer group seemed to be the main source of information about sexuality, followed by the mother for girls and the father for boys. Within same-sex friend groups, sex is a frequently talked about topic. Younger members learn about sex in these intimate groups. The media was again another important source of sexual information for both male and female students (Basgül 1997).

In rural communities, the elders traditionally supply the adolescents with information about sexuality. Rural youth also learn by watching the copulation of animals.

Every adolescent is personally responsible for his (or her) own thoughts and behavior in the name of God and obliged to follow the Islamic rules when he or she reaches puberty. When a child reaches puberty, he (or she) has to regulate his (or her) own life and start to pray regularly according to the Koran. Parents are responsible to provide religious information for their children. As a part of this, a Muslim is obliged to follow religious rules and perform rituals. One of the rituals is called abdest, which involves washing parts of the body in a predetermined order before prayers and after any type of sexual activity whether intentional or spontaneous. Parents warn their children to wash whenever they have a “wet dream.” This tradition implies that nocturnal ejaculations are not provoked by erotic stimuli alone, and sexual content in dreams may occur without any experience or information about sexuality.

Another traditional attitude is a religion-based responsibility of the family members to provide sexual information for the adolescent before marriage. An elder male member of the family, the sagdiç (best man), gives sexual information to the boy, while yenge (chaperon), a female family member, informs the girl about sexual matters.

In summary, while there are still no governmental policies to regulate sex education, in rural areas, at least, the traditional Turkish family system supplies some information about sex and sexuality to children and adolescents.

4. Autoerotic Behaviors and Patterns

A large-scale population survey on autoerotic activity in Turkey does not exist. Studies in student populations show that for 50 percent, the main sexual activity was masturbation (Çok et al. 1998). In another study, 11.5 percent of female and 87.2 percent of male university students admitted to having masturbated, while 21 percent of the females and 26 percent of the males reported that masturbation was unhealthy (Erkmen et al. 1990). Similarly, Eksi (1990) reported that male students regarded masturbation as a “problematic” issue, particularly those whose fathers were less educated. These studies imply that while autoerotic activities are not rare among unmarried young males and females, nevertheless they are not very comfortable with such activities. Even the most highly educated people still do not regard masturbation as an acceptable sexual outlet.

Clinical observations and ongoing studies with sexually dysfunctional patient groups imply that masturbation is more common in Turkish males than females. Sexual fantasies and autoerotic activities seem to be reported rarely by Turkish females. However, these observations rest on clinical samples and may not reflect patterns of sexual behavior in the normal population. Attempts to study sexual behavior in the normal population are hindered by a reluctance on the part of the respondents, because sexuality is still considered as a taboo topic of discussion by the larger part of the population.

Masturbation is commonly regarded as a kind of sin in Islam, as it is in most other religions. Although there is no written rule in the Koran that prohibits masturbation, most people who refrain from autoerotic activities believe that such behavior is sinful.

5. Interpersonal Heterosexual Behaviors

A. Children

According to Islam, puberty is a stage when a child is ready to take on some adult responsibilities. As a part of this, while adolescent girls are expected to behave and dress as mature women, every male child should be circumcised before he reaches puberty as a step into manhood. In the traditional context, sünnet (circumcision) is usually performed by a “sünnetçi,” always a male, who has been trained and is experienced in circumcision but does not have a medical degree. During the operation, which usually takes place at home, the kirve (a close friend of the father or a male relative) holds the child, and the sünnetçi conducts the operation, usually without any anesthetics if performed in the traditional way.

Great importance is attached to this ritual in traditional Turkey, as it is accepted as a step into manhood. A special feast is prepared, and the child is dressed in a white gown and a cap adorned with decorations. Following the operation, he is laid down in a decorated bed while prayers are said and visitors bring in presents and are offered food and sherbet. Sünnet is a religious rule, although many people believe that it is also a requirement for healthy sexuality, both in the medical and functional sense. As a result of this, if the child is born in a hospital, many parents now prefer the operation to take place in the hospital setting, a few days after birth, out of hygienic as well as economic concerns.

Although circumcision is an obligation for males according to Islamic rules, it is also seen in many pre-Islamic cultures and religious practices. The age of circumcision in Islam varies from birth to adolescence, while Turkish boys are mostly circumcised between 3 and 6 years of age (Öztürk 1963). As is well known, this period has been regarded as a critical stage in terms of psychosexual development, and circumcision at this age might be deleterious for later stages of development. Öztürk, who studied this phenomenon in Turkish males, found no evidence to support the hypothesis that circumcision at an early age (or during the phallic stage) might have a negative effect later on.

B. Adolescents

The primary and secondary sexual characteristics in Turkish male adolescents develop at roughly the same age as in Europeans, whereas the rate of physical development of females is closer to that of the Mediterranean region, where they enter adolescence at an earlier age compared to northern countries. Along with the development of secondary sex characteristics, menarche and first nocturnal ejaculation are accepted as an indication to start sex education in the traditional sense.

Girls and boys have attended school together during primary education since the establishment of the Turkish Republic. In the past, they were separated after completing primary school. During the Ottoman Empire, private teachers educated young girls in special subjects, such as music, literature, and the arts. During the past few decades, sexual segregation in schools has been totally abolished.

Studies of the sexual activities of Turkish students indicate that about half of unmarried male college students report that they have had sexual relations with the opposite sex, whereas the percentage drops to between 4 and 19 percent for college girls (Çok et al. 1998; Eksi 1990). This great difference probably reflects male’s experiencing sexual intercourse with prostitutes. Overall, 66.2 percent of male and 8.5 percent of female university students reported having had premarital sexual intercourse (Erkmen et al. 1990).

C. Adults

Marriage

About 92 percent of the Turkish population get married to establish a family. In rural areas, the age of marriage is quite low, although it is customary for young men to complete their compulsory military service before they can be accepted as candidates who can support a family. For urban men and women, because of the longer time spent in education, the age of marriage is higher.

Marriages are highly concentrated in the 15- to 24-year-olds for females and the 20- to 29-year age group for males. Medical screening is obligatory for men and women before marriage, according to the law enacted in 1930. As a preventive measure, the aim was to recognize and cure people with contagious diseases. The law was passed in the period between the two World Wars, when serious economic and social problems had to be overcome. At that time, one of the main concerns of the newly established Turkish Republic was to prevent epidemics of tuberculosis, syphilis, malaria, etc.

Hamams (Turkish baths) had been a major locus of social interaction until modern facilities supplied hot water to houses. There were separate sections or days for men and women in hamams. Children of both sexes were accepted into the women’s section. Women went to the hamams with their female friends and kin and spent long hours bathing, chatting, gossiping, singing, dancing, and sharing the food they prepared for these occasions. Older women looked for young girls whom they could choose as wives for their sons. Hamams are still a social factor in Turkish life.

Weddings, Virginity, and Childbirth

Traditional wedding ceremonies in Anatolia last for four to seven days. The ceremony starts with music played on local instruments and a flag hung over the groom’s house. Men and women entertain themselves separately until the gerdek (first night of the wedding). Some traditional activities common during the ceremonies are: the hamam (Turkish bath) custom lasting for hours, during which food is served, and the kina gecesi (henna night), during which the hands and feet of the bride are colored with henna. Visitors sing and dance and are served food and drinks. During the wedding day proper, a group of men and women take the bride from her home. She rides on horseback to the groom’s house with the crowd while everyone sings and dances. When the bride enters the house, coins (or gold, if the groom is wealthy) are spread over her. The groom’s friends punch him before the couple is left alone as a symbol of their rejecting him as a bachelor. The ceremonies end with prayers.

As a symbol of passing from virginity to womanhood, a lock of the bride’s hair is cut the day after the wedding. Magical practices, such as holding a mirror to the bride’s face and spilling water as the bride leaves her home for the wedding ceremony, are believed to facilitate the bride’s adaptation to marriage.

Virginity is still a much-treasured value for women in most parts of Turkey. Even among the higher educated young people, who flirt and make love with each other like their Western contemporaries, most reserve sexual intercourse for the first night of marriage. In traditional regions, parents or older members of the family wait outside the newly married couples’ room for the realization of the sexual act. Tradition dictates that a bloodstain on the bedsheet caused by the perforation of the hymen proves that nothing is wrong, dishonorable, or shameful with the man or his wife. This bloodstain is then displayed to the waiting members of the family and is taken as proof of chastity on the part of the woman as well as the honor of the man who has successfully performed the sexual act. This custom inevitably exerts a great deal of pressure on the young couple. The bride is expected to have no sexual experience, and for many young men also, the first night of the marriage is the first time he experiences sexual intercourse. There are many cases of erectile or intromission difficulties that can be attributed to this stressful situation on the wedding night and a general lack of sexual knowledge. Tragic consequences may ensue if the girl is not a virgin or if it is a case of a penetrable hymen, often mistaken for previous loss of virginity. However, it is not unheard of that the couple escapes the forces of tradition by showing their parents or family members red paint or some bloodstain caused by other means.

The lohusa period is the forty days after childbirth, during which it is believed that both the mother and the child require special care. The mother is usually confined to bed in the first ten days, after which she gets up, but does not go out of the house. She is helped by female members of her family or by other female relatives. A special bed adorned with ornaments is prepared for her. She puts on her best traditional dress and jewelry, accepting visitors in her bedroom during the first ten days. She is fed with sweets and dishes believed to make her stronger and to increase her milk. Visitors bring presents, such as gold coins or clothes for the child. Prayers are said and visitors are offered a special sweet sherbet. In the lohusa period, the woman is also restricted in her sexual activities.

Divorce and Widowhood

The crude divorce rate of Turkey, less than one in a thousand marriages per year, is low compared to divorce rates in many other countries. Reasons for this can be the country’s strong religious and family ties, and the traditional nature of Turkish society. However, it should be noted that statistics do not reflect the divorces among religious marriages in the rural areas. (See also earlier comments about divorce in Section 2B, Religious and Ethnic Factors Affecting Sexuality, Character of Ethnic Values.)

In Turkey, 49 percent of all divorces occur in the first five years of marriage and 45 percent occur in childless couples - an indication that children help to keep the continuity of marriage (SIS 1995). In other words, not having children may be considered as a social implication and probably a reason for divorce.

Levine (1982), who investigated the nature of divorce in Turkey, considered divorce as a “barometer of social change,” “a struggle against conservatism,” and “an act of female emancipation.” Reviewing national divorce statistics, he noted that divorce is associated more with urbanism and urban occupations, with a higher level of development, with changing women’s roles, with developed agriculture rather than with full-scale industry, and with being barely literate (especially among women). Thus, it is the people “caught in the middle” of economic and structural change who are most vulnerable to divorce, as they are subject to the most stress. In effect, the urban poor who are dislocated and economically vulnerable are more likely to get divorced. Levine views the patriarchal family as a hindrance to individual autonomy and initiative, in which the needs of the family hold primacy over those of individual members. In this family type, divorce can be seen as a liberating act, although it brings with it serious problems of readjustment, especially for the woman, in a society which does not condone it.

If the husband dies, it used to be the duty of one of his brothers to marry the widow. This tradition, which was functional in providing security for the woman, as well as for the children of the deceased man in the rural context, is rare at present.

Potency and Fertility Potions

Sexual potency and fertility have been important aspects of the Turkish male’s sexual identity throughout history. Thus, methods to enhance sexual potency, such as kuvvet macunu (herbal pastes) and potions were invented, and selected foods were recommended, to enhance potency and fertility. Pastes and potions are still prepared today and handed out freely in some regions on special feasts. The preparations may take days, and large amounts of herbs are boiled in huge pots during festival days. These annual ceremonies are local celebrations led by townsmen dressed in traditional Anatolian costumes for the occasion. Kuvvet macunu are handed out with prayers to everyone. These potions are believed to protect the user from diseases, make people sexually potent, and guarantee the health of children born that year.

6. Homoerotic, Homosexual, and Ambisexual Behaviors

A. Children and Adolescents

Case histories of psychiatric patients sometimes reveal homoerotic activity during childhood, although empirical studies for this period are not available. On the other hand, a number of retrospective studies with late adolescent male homosexuals and transsexuals imply that, in both groups, the first sexual experience occurs at an early age. Most transsexuals and about a third of homosexuals reported that they had their first sexual experience before age 12 (Gülçat et al. 1988; Inci 1993). These studies also show that sexual intercourse is mostly initiated by the youths, that is, without being forced, which seems particularly to be the case for transsexuals.

Most homosexuals and transsexuals came from families with more than three children, had pathological relations with parents, and traumatic childhood experiences. Based on their study using the MMPI with subjects in the 20- to 25-year-old age group, Battal et al. (1989) argued that transsexuals were characterized by the existence of early infantile conflicts and fixations, while homosexuals showed pathological resolutions for identification processes. Inci (1993) found that the self-esteem and self-image of homosexuals were lower than in transsexuals in the late adolescent group. Anxiety, depression, and over-sensitivity were also characteristic of homosexuals, while suicide attempts seemed to be common in both groups.

B. Adults

Males who play the “active” role in homosexual relations are not socially regarded as homosexuals in the Turkish culture. The active homosexual role is more likely to be assumed as a variety of sexuality experienced by a heterosexual male. That is, homosexuality is rather restricted in meaning and covers almost exclusively effeminacy and the “passive” homosexual role. This attitude is even apparent in some legal and official practices of establishments like the armed forces. Homosexuals are not accepted in the army and if such acts are witnessed during the military service, which is compulsory for every Turkish male citizen, the effeminate, passive partner is sent for medical evaluation and eventually discharged from the army.

Little is known about lesbians in present-day Turkey. Legends about females who lived and fought like brigands are still told, without their sexual orientation being directly mentioned or alluded to.

7. Gender Conflicted Persons

Sex-reassignment operations have been occasionally performed in Turkey in recent years, along with debates centering around ethical issues about the incompleteness of evaluation processes of such cases. It is legally accepted that transsexuals can obtain an identity in accordance with their acquired sex; they can change their name with a court order and they can officially marry.

It can be claimed that there is a double standard concerning attitudes toward male homosexuals and transsexuals in Turkey. On the one hand, they are alienated, ridiculed, and even persecuted by the society in general and by the police, as they are regarded as a threat to social values. On the other hand, they are condoned, especially those in show business, who usually claim that God willed them to be as they are. Although rare, female-to-male sex-reassignment operations have been performed in Turkey.

8. Significant Unconventional Sexual Behaviors

A. Coercive Sex

Child Sexual Abuse and Incest

Statistical data about child sexual abuse are almost nonexistent in Turkey. During the last decade, several initiatives have been started to prevent child sexual abuse with the support of international organizations. Several associations, such as Çocuk Ihmali ve Istismarini Önleme Dernegi (The Association for the Prevention of Child Neglect and Abuse), were founded to help abused children and to conduct studies in this area (TC Hükümeti ve UNICEF 1991).

Although no statistical data are available, child sexual abuse does not seem to be rare in Turkey. Occasional news in the media indicates that child sexual abuse, including incest, occurs. However, such acts are not condoned, and child molesters, whether homosexual or heterosexual, are strongly disapproved of in the community. Indeed, prisoners convicted of such acts are usually punished further and alienated or even killed by other prisoners.

Among cases of child abuse, sexual abuse seems to be the most frequent type. It is estimated that child sexual abuse is involved in approximately 50 percent of all kinds of child abuse, including unreported and unregistered cases. According to forensic medical records, 350 to 400 cases of child sexual abuse are documented each year. These figures are not conclusive though, because Turkish society is sensitive in sexual matters, and a considerable proportion of cases may not even come to the attention of legal authorities because families are concerned about the protection of children and the honor of the family from publicity. On the other hand, because scandalous news sells, the media may also be exaggerating the news and figures to increase their sales (Kozcu 1991).

Child sexual abuse rehabilitation services have been established in a number of university and state hospitals in Turkey. Victims of abuse are generally referred to these centers by legal authorities.

Although incest is defined in all cultures, the boundaries of definitions may vary. The Turkish culture does not consider sexual relations and marriage between cousins as incestuous behavior. Thus, it is not uncommon for daughters and sons of brothers and sisters to marry. In fact, in arranged marriages, it is often regarded as a preferred way of marital union, especially in the eastern parts of Turkey, if it serves to keep the unity of land and power.

Other Unconventional Sexual Outlets

Although there is no recorded case, it is claimed that males occasionally use animals (such as sheep) as a sex object in rural areas. Especially in isolated villages, where sexual outlets for unmarried adolescents are lacking, sexual intercourse with animals may provide experience and can be viewed as educative more than perversion.

B. Prostitution

Commercial sex is legal in Turkey, and registered prostitutes are under periodic medical control. There is also illegal prostitution, which stems mostly from immigrants coming from neighboring countries. Many unregistered male and female prostitutes constitute a threat for public health, because they are not subject to routine medical check-ups. Prostitutes may play a special role for male adolescents in their first sexual experience. An older male kin may facilitate the adolescent relative’s first experience by offering to take him to the prostitute who is usually informed on the matter beforehand.

C. Pornography and Erotica

Many publications on sexuality can be found in Turkish bookstores and newsstands. A number of popular magazines frequently publish articles on sexuality, mostly focusing on ways to enhance sexual satisfaction. Serious books on sexuality, including an encyclopedia on sexuality and books on human sexuality written for children and adolescents, have been published in recent years.

Although there is no strict control over them, pornographic publications are not distributed freely. Sale of these publications to persons under the age of 18 is illegal. In one 1990 study by Erkmen at al. (1990), 26 percent of the females and 48 percent of males reported that pornographic material should be allowed to be freely published. However, many social organizations have campaigns against pornography and violence, particularly to protect children and moral values.

9. Contraception, Abortion, and Population Planning

A. Contraception

The shift from a pronatalist to an antinatalist policy during the 1960s influenced contraceptive use by the introduction of modern methods to the public. In the early 1960s, only one fifth of Turkish women used any method of contraception and traditional methods were more common. The proportion of users was 38 percent in 1978, rose to 51 percent in 1983, and to 64 percent in 1988. By 1988, modern methods accounted for almost half of all contraceptive use, which shows that there were significant changes in contraceptive methods as well (Hancioglu 1997). Turkish women usually breastfeed their children, and many believe that lactation prevents pregnancy. The Family Planning Project began functioning by the end of the 1960s.

Almost all women, 99.1 percent, in the 15-to-49 age group have some idea about contraceptive methods, and 62.6 percent of women are currently using a method of contraception. The most common method is the IUD (18.8 percent), followed by condoms (6.6 percent), and contraceptive pills (4.9 percent). Regional differences in terms of contraception are very high. In the east, 42 percent use a contraceptive, whereas in the west the proportion is 72 percent (Hacettepe-HIPS 1989a).

Among the reasons for non-use of contraceptives, the most common one was health concerns related to the method. Other reasons were the husband’s opposition, lack of knowledge, difficulty in availability, and religious beliefs (Hacettepe-HIPS 1989a).

The preferred method of contraception for Turkish males seems to be withdrawal before ejaculation. More than one quarter of sexually active males report using the withdrawal method, while 6.6 percent use condoms, and 1 percent refrain from intercourse during the ovulation period (Hacettepe-HIPS 1989a).

There is a strong positive correlation between education and use of modern contraceptives such as the pill, the diaphragm, and IUDs. In urban areas, the main source of obtaining IUDs is private doctors, whereas in rural areas, the majority of women obtain IUDs from health centers (Hacettepe-HIPS 1989a).

A majority of college students claim that they would refrain from unsafe sexual activities that might expose them to AIDS, and most are willing to use condoms during sex (Çok et al. 2000). The media has played an important role in campaigns for condom use in the prevention of HIV/AIDS, which has also promoted indirectly their use as a contraceptive.

Turkey also has some interesting traditional methods of contraception. These include taking herbal preparations made with boiled selected local plants and vegetable skins, and homemade or readymade materials, such as soap inserted into the vagina. There is also a local belief that if a woman is able to pass a kitten over the saddle of a horse while riding, she will be protected from pregnancy.

B. Teenage (Unmarried) Pregnancies

Statistical data are not available for unmarried teenage pregnancies. Since pregnancy out of wedlock is traumatic for both parties involved, these incidents are covered up and are not referred to state hospitals, where the signed consent of the parent is required before any medical intervention. Those who can afford to do so seek abortion in the private offices of gynecologists. In small towns or rural areas, where there is a risk of scandal or where private gynecologic services are not available, traditional methods of abortion are resorted to. On the other hand, pregnancy in the married adolescent presents a more common problem for Turkey, because the age of marriage is low in rural areas. In 1991 to 1992, 4 percent of all pregnancies were to teenagers. These pregnancies are usually unplanned and antenatal follow-up is lacking. Risks of pregnancy increase with low education and younger age of the mother, where symptoms may not be understood and spontaneous abortions may occur. However, if the pregnant adolescent is living in the traditional household with elder members of the family, there is a good chance that she is well cared for, even if medical care is not sought. In 1995, the State Department of Social Services started a project for teenage mothers.

C. Abortion

Until 1983, induced abortion in Turkey was prohibited except for eugenic reasons and when the life of the pregnant woman was in danger. In May 1983, the law on population planning was liberalized to provide abortion in a legal and safe manner. At present, women may obtain an abortion on request up to the tenth week of pregnancy for medical or social reasons. In 1988, it was found that 23.6 percent of pregnancies were terminated by induced abortion, 8.2 percent by spontaneous miscarriages, and 1.0 percent by stillbirths (Hacettepe-HIPS 1989b). The number of abortions induced for legal and medical indications was 15,571, while there were 49,655 abortions for unspecified causes, with 121 deaths in 1995.

Traditional methods of abortion, such as pushing sticks or long bird feathers into the uterus are still resorted to in rural areas. To induce abortion, some women take herbal preparations, such as boiled onions or aspirin, to trigger bleeding in the uterus. Carrying heavy loads and being exposed to heavy massage on the lower back area are other traditional methods believed to cause abortion (Hacettepe-HIPS 1989b).

D. Population Programs

Following the loss of males during the War of Independence (1918-1924), a shortage of manpower and a high mortality rate led the Turkish state toward a pronatalist policy to increase fertility and population growth until the mid 1960s. As a part of this policy, the government provided its employees financial support for each child. During the late 1950s, public opinion began to change, and the adverse effects of rapid population growth were gradually accepted. An antinatalist population planning law was enacted in 1965, legalizing contraception and promoting avoidance of unwanted pregnancies by public education.

Illegal abortion under unhealthy conditions was a cause behind high maternal mortality rates until 1983. The population planning law was revised, and abortions up to the tenth week of pregnancy and voluntary surgical contraception were legalized, while midwives were permitted to insert IUDs (Hanciogu 1997). In 1996, there were 274 Mother-Child Health and Family Planning Centers throughout Turkey, while the number of units giving exclusively family planning services was 5,328.

10. Sexually Transmitted Diseases

Syphilis is one of the diseases for which there is compulsory reporting to the Ministry of Health. The disease was considered a primary health problem in the years following the establishment of the Turkish Republic in the 1920s. Because of its high incidence, it had been a major health problem in Turkey. Thus, information on syphilis and other sexually transmitted diseases was an important part of the curricula of medical schools in the past. At present, each case of syphilis is followed up until the treatment is completed. According to figures of the Ministry of Health, 2,870 recorded and 196 new cases of syphilis were diagnosed in 1994. Syphilis does not now constitute a major health problem; its prevalence rate has decreased from 7.1 per 100,000 to 5.1 in the ten years between 1987 and 1997.

A. Incidence, Patterns, and Trends of STD

The Ministry of Health declared that the number of cases with gonococcal infections was 1,071 and cases of hepatitis B was 2,435 in 1996. Out of 3,267 prostitutes screened in 1997, 1,136 were infected with gonorrhea, 36 with syphilis, and 27 with hepatitis. Only a small percentage of college students reported gonorrhea (1.3 percent) and hepatitis B (3 percent), whereas none reported having a history of syphilis (Çok et al. 1998).

B. Availability of Treatment and Prevention Efforts

There are twelve venereal disease dispensaries in Turkey, in addition to services for sexually transmitted diseases in most public hospitals. The Ministry of Health has organized courses and conferences, and prepared brochures and booklets for the public and professionals, in accordance with the World Health Organization (WHO) for the control, prevention, and care of STD and HIV infections.

11. HIV/AIDS

The number of diagnosed HIV/AIDS cases was 753 by the end of 1997 in a population of about 63 million in Turkey. Regarding the 1997 Turkish HIV/AIDS statistics, the Ministry of Health stated that 84.6 percent of HIV/AIDS cases were Turkish citizens, while 15.4 percent were foreigners. Nine percent of HIV cases were infected by homosexual contact, 11.2 percent by intravenous injections, 6.4 percent by blood transfusions, 44.2 percent by heterosexual contact, 0.9 percent by infected mothers, and 28.3 percent by unknown causes.

Because of low public awareness of HIV/AIDS, the prevalence of commercial sex, the lack of educational campaigns, and immigration patterns, tourism, and returning workers from Europe, HIV/AIDS is considered as a potentially serious health problem in Turkey.

While the majority of college students are aware of the disease, 30 percent reported that they had never discussed HIV/AIDS with anyone. Students learn about AIDS from a variety of sources, including the media, books, and peers. Only a small percentage of the students obtain information from health professionals, family members, or at school (Çok et al. 2000). This study revealed that Turkish students had a moderate level of knowledge about the transmission, symptoms, and prevention of HIV/AIDS. A majority of students believed that they were not at risk for getting AIDS or that the risk was very low. Six percent stated that AIDS does not concern them. About half of the students stated that they would avoid people with AIDS, whereas 23 percent were willing to open their houses to anyone with AIDS.

12. Sexual Dysfunctions, Counseling, and Therapies

A. Concepts of Sexual Dysfunction

Because having children is socially regarded as a natural consequence of marriage in Turkey, there is a strong expectation of a child almost immediately after marriage on the part of the parents, relatives, neighbors, and friends of the couple. Indeed, most young couples themselves expect to have a baby and are almost impatient to do so. In unconsummated marriages as a result of sexual dysfunction, the couple faces the additional burden of explaining to inquisitive relatives and friends why they do not yet have a baby. Thus, for the majority of these couples, to make conception possible is the main reason they offer for seeking sex therapy. In childless couples, the blame is usually attributed to the women. In such cases, couples often seek help from traditional healers. Traditional healers generally supply the couple with charms, prayers, or sacred objects. Visits to the tombs of holy persons (türbe) are another traditional way to deal with various social and health problems, especially for women. During the türbe visit, the usual practice is to pray to the spirit of the holy person and ask for his or her help. Sometimes pieces of rags or colored strings are tied to the branches of trees or just left over the tombs. Whereas young girls may pray for husbands, childless women pray for a child.

Various magical beliefs and customs are still seen in some parts of Turkey as a remedy for sexual problems, childbearing, or infertility. One of these beliefs is a vow or a promise to God that if the woman can give birth to a son, they will not cut his hair, will dress him as a girl, and give sacrifices to God every year until his seventh birthday (Soylu et al. 1997).

Traditionally, sexual dysfunctions and infertility, along with many other health problems and diseases, were explained by folkloric beliefs, some of them based in Islam and others apparently unrelated to religion. There are still many people, even in cities, who believe that erectile dysfunction, vaginismus, or lack of sexual desire are consequences of evil forces, such as büyü, or magical procedures conducted by those who mean to destroy the happiness of the couple. In other cases, the supposed cause is the nazar, or the evil eye, or the djins, spirits described in the Koran, which sometimes reveal themselves to human beings. One example of such a djin is alkarisi, a witch-woman who visits women who have just given birth to a child. Alkarisi Turkey · 631 is believed to inflict a disease called albasmasi, characterized by the woman seeing everything in red, turning hot, getting cramps, and choking. If the cause of the sexual dysfunction or infertility is attributed to magical forces, treatment is usually sought from traditional healers called hoca, medyum, falci, etc., rather than medical doctors. Although prohibited by law, such paramedical healers provide their clients with preventive or curative measures, such as charms, prayers, and specific rituals. Doctors and psychologists have observed that many young couples with sexual problems, while claiming that they do not believe in supernatural phenomena, were pressed by their older relatives to seek a solution for their problems from traditional healers.

A study of patients at a primary health care clinic revealed that one in thirteen patients had a symptom of sexual dysfunction during the last month and one in twenty had a sexual dysfunction sometime in the past. Lack of sexual desire is the most prevalent symptom, occurring in 3.9 percent of all patients.

In a survey of 15- to 65-year-old men and women by Sagduyu (1997), 32.1 percent refused to participate in a study related to sexuality, 11.8 percent reported having no sexual experiences, while 92.8 percent of males and 54.0 percent of females valued sexuality positively. Negative feelings about sexuality were prominent in the older age group. Among patients with sexual dysfunction, 25 percent of females and 5 percent of males have suffered from lack of sexual desire.

Sexual dysfunctions are most commonly perceived as a failure of men. Therapists usually have difficulty in getting in contact with wives even as a part of therapy. It is not socially appropriate for a woman to have a sexual problem, because she is not even expected to desire sex. On the other hand, sometimes men resist participating in sex therapy if they think the problem belongs exclusively to the wife.

Kayir (1990) reported that among women with sexual dysfunctions, vaginismus was diagnosed in 52 percent, low sexual desire in 25 percent, anorgasmia in 15 percent, and painful intercourse (dyspareunia) in 2 percent. Among male sexual dysfunction patients, 48 percent experienced erectile dysfunction, 20 percent had premature ejaculation, 22 percent were mixed sexual dysfunction, 5 percent had low sexual desire, and 2 percent experienced inhibited ejaculation. Özkan (1981) has reported similar findings in a psychiatric population, with 49 percent of male patients having erectile dysfunction. He found that 52.9 percent complained of premature ejaculation, whereas 35.5 percent of female psychiatric patients complained of dyspareunia, 53.3 percent of vaginismus, 66.6 percent of anorgasmia, 60 percent of sexual arousal problems, and 84.4 percent of low sexual desire.

The figures and clinical observations imply that vaginismus is seen relatively frequently in Turkey, compared to Western countries. Five to ten percent of patients with sexual dysfunctions suffer from vaginismus. Many of these can be traced to a lack of sexual education and conservative attitudes, which, in turn, lead women to see sexual intercourse as an activity to be feared and avoided. During the evaluation process, it is observed that the majority of sexually dysfunctional couples’ problems are initially related to mild or moderate cases of vaginismus-like complaints, which on further interview turn out not to be true vaginismus cases. Rather, the vaginismuslike symptoms are the result of the wife consciously or otherwise taking over the sexual problem (or, in other words, she assumes the blame for the husband’s lack of desire, or erectile or ejaculation problem). Thus, the problem becomes more complicated, where tactful and original approaches on the part of the therapist may be needed.

B. Availability of Diagnosis and Treatment

Centers for treatment of sexual dysfunctions have been established in Turkey’s university-associated hospitals during the past twenty years. In these units, patients are fully screened upon admission. The screening covers psychological and physical examinations. Methods such as Doppler ultrasonography and endocrinological and neurological examinations are available in most centers. In some sexual dysfunction units, more detailed examinations, such as neurophysiological evaluation and nocturnal penile tumescence (NPT), can be made if necessary.

Kayir (1995) argued that this improvement in diagnostic and therapeutic services has encouraged people with sexual dysfunctions to refer to these units, while perhaps also leading to the idea that each sexual problem is an illness that can be treated by doctors.

Many couples who seek treatment for their sexual problem are not highly motivated for sex therapy, because they expect the therapist to almost magically “cure” the problem by a simple intervention such as by prescribing a drug (Sungur 1998).

Treatment is available according to the etiology of the sexual problem and the specific needs of the patient. Couple therapy based on Masters and Johnson’s techniques is the main approach if the etiology is psychological and both partners are willing to attend therapy sessions. Individual therapy and group therapy for men and women with similar sexual problems are also available in some centers. However, traditional values may sometimes hinder the man or his wife from taking part in therapeutic attempts to solve problems that prevail in the sexual area.

Generally, professional help is not sought when the couple is first faced with a sexual problem, especially if it is a case of female sexual dysfunction. The typical Turkish couple at first communicates the problem to their families and tries to tackle the problem within the family or with the help of traditional healers. In some cases, suggestions, reassurances, and parapsychological approaches work and the presenting problem is solved. In many cases, as expected, the difficulties persist and the relationship of the couple is threatened. The couple and families begin to split and blame each other. Usually, it is only then that the couple is referred for sex therapy. This delay and the introduction of other variables, such as the couple’s blaming attitude and the families’ concern and even intrusion are factors, which make the therapeutic process more difficult and complicated. The sexual problem of the couple can easily become a problem of the whole family, including the parents, siblings, and even relatives, which places an additional burden on patients and therapists. When incomplete sexual knowledge, erroneous expectations, lack of sexual experience, fears, and false beliefs are added to the picture, therapists are faced with multifaceted problems, which they have to deal with even though the couple is initially referred with a sexual dysfunction problem. Thus, the therapy proceeds on several levels at the same time, which may range from a teaching process to marital counseling and even to an insight-oriented approach. Thus, as Sungur (1994) has pointed out, formal training in sex therapy in Turkey is not sufficient for sex therapists who must also have experience in handling marital problems, as well as giving special attention to cultural factors that may necessitate modifications in treatment programs.

In some cases with organic etiology, the psychotherapeutic approach is also utilized to help the adaptation of the patients before or after organic interventions. Penile prosthesis is the most common method for male organic sexual dysfunctions. A penile revascularization operation is made for selected patients.

Sildenafil (Viagra) has become very popular. It was approved by the Ministry of Health and became available in the market in May 1999. Although strict regulations on the prescription were imposed in the beginning, these were shortly changed, and specialists, such as cardiologists, psychiatrists, and endocrinologists can now freely prescribe the medication.

13. Research and Advanced Education

Two main lines of sexual research can be delineated in Turkey. The first consists of surveys in student populations, which cover mainly the sexual attitudes, knowledge, and experience of this group. Some of these studies have been reviewed elsewhere in this chapter. The other area in which sexual research is conducted is in the clinical population, mainly in those who apply with sexual problems. A series of studies have focused on psychological factors involved in sexual dysfunctions: Igikli (1993) found that sexually dysfunctional couples’ problems in the relationship accumulated in emotional, cognitive, and communication areas.

Bozkurt (1996) found that patients with psychogenic erectile problems were significantly more anxious and depressed when compared to organogenic patients. In the psychogenic impotence group, 19.4 percent had mood disorders, 5.6 percent had anxiety disorders, and 22.2 percent had mixed mood and anxiety disorders, whereas in the organically impotent group, no pathology in the mood and anxiety disorders spectrum was found. The MMPI profiles of psychogenic impotence subjects had more similarity to neurotics than normal controls. The personality patterns of psychogenic erectile dysfunction patients revealed by the MMPI suggested that while they have no problems with the sexual role, they have depressive tendencies with difficulty in implementing activities and an inclination to introversion (Aydin 1991).

Özgen et al.’s (1993) study indicated that organic causes more commonly underlie sexual dysfunctions in the older age group, whereas psychological factors predominate in younger patients. If a dysfunction appears in one area of sexuality, it tends to spread to other areas, causing problems in experiencing sexuality. As a result, it was claimed that the person’s perception of and being in the sexual sphere are distorted.

In a recent large-scale population survey on the prevalence of erectile dysfunction, in the sample comprised of 1,982 men, 64.3 percent of the men over 40 years of age reported some degree of erectile dysfunction (35.7 percent minimal, 23 percent moderate, and 5.6 percent complete). The prevalence of erectile dysfunction increased by age, with diabetes, and cardiovascular and prostatic diseases contributing to the increase (Akkus et al. 1999).

Gülçat (1995) found that 30 percent of non-clinical male subjects had a sexual problem. While this finding is in accordance with surveys in Western countries, it also implies the need for further studies in the area of sexuality and sexual problems in Turkey.

Advanced education in sexual dysfunctions, evaluation methods, and treatment has been offered in some university hospitals for the last ten to fifteen years. There has been growing interest and data accumulation in this area in the last decade. Since 1988, several congresses and symposia were organized on issues in sexual dysfunctions and treatment. The main aim has been to adopt a multidisciplinary approach in which psychiatrists, psychologists, urologists, and gynecologists work together in the assessment and treatment of patients. In late 1999, a Sexual Education, Treatment, and Research Association was founded to integrate the studies of various disciplines, prepare educational programs for the layman as well as for professionals, conduct research, and set ethical standards in the patienttherapist relationship.

The Turkish Family Health and Planning Foundation, located at Sitesi A Blok D, 3-4, 80660 Etiler, Istanbul, Turkey, is the main organization dealing with sexuality issues, family planning, and sexual health.

A Final Remark

Social change involving modifications in social structure, attitudes, beliefs, and norms is rapidly altering Turkish society. Shifts in the demographic composition of rural and urban areas, industrial growth, and related changes in the economy and social structure precipitate modifications in family structure, functions, and dynamics, as well as in traditional male and female roles.

The Turkish panorama of sexuality reveals that modern and traditional attitudes exist side by side, and this fact, while contributing to the richness of the Turkish culture, is also fertile ground for social, interpersonal, and intrapsychic conflicts.

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