Sexuality in Perspective lecture 1

Clinician about sexuality.

Aims of the course

>introduce ideas how we can look into sexuality form scientific perspective
>question the myths prevalent in society and our own ideas about what sexuality is
>Developments in historical and cultural views on sexuality
>scientific, psychological, sociological points of view to sexuality
>What’s normal vs abnormal about sexuality
>Evolutionary approach
>Situating of sexuality in a lifetime prespective: when does sexuality start for people?
>Religious, ethical, and legal discourse on sexuality
>To make us speak and articulate our own ideas about values, norms, and attitudes towards sexuality

Outline of the course

Question: what is sexuality?
Points of view:
1. Biology: evolutionary perspective; Sexual anatomy, sexual psychology, sexual desire, sexual arousal;
Genes, hormone, brain differentiation
2. Psychology: Sexual developments through the life cycle; Gender similarity and differences; (Wo)men,
relationships, and sex
3. Socio-cultural: what is ‘normal’ or ‘abnormal’ sexuality?; bioethics and sexuality; Laws and sexuality.

Definition of sexuality

Four dimensions of sexuality: Psychology, biology, behavior, culture. Professor thinks that culture is the
most important part is culture because it influences how we look at biology (the way that first
menstruation is treated in different cultures), the same is true with psychology (intimacy, relationship, love
– only in Western societies), and with behavior (culture has impact on it).

Sexuality seems to be related to all of these. Sexuality is being studied by different sciences.

Sex Etymology

>Latin
Sexus – group, part, sort, kind form (to divide)
Secare – to cut, to divide

>English
With gender identity problems in 1950’s the term gender came into existence. John Money introduced
the idea of gender. It is both about how people feel about themselves and the roles and things that some
one what culture is prescribing them. (Gender identity and Gender roles)
Sex became a word that refers to sexual activities, especially intercourse.
The idea that you can divide people in to categories has become more and more questionable during last
years.
Etimology of sexuality

>First time used in French language – sexualité – “what is related to a certain sex”

>Sexuality – broader meaning (all that is related to sexual life). Its softer and broader than sex
(=intercourse)

Sexuality -definition

It is all aspects of being sexual, including narrow definition of sexuality (sexual acts: kissing, masturbation,
intercourse) and broad definition (Sexual behavior: being flirty, dressing in a seductive way, romantic
dining, reading playboy, pornography, sexting)

Also, it is important to note that behaviors that are described as sexual vary over time, between different
groups and cultures. (Time: For example, until 1974 homosexuality was a mental disorder. It means that
over time our normative sexuality has change, we accepted other things as ‘normal’. It has changed to the
idea that sex is good if it is performed by two (or more) consenting people)
(Groups: slutshaming – if you are women, she is shamed, but men are not.)
(Cultures: india has kamasutra, they were making pornographic pictures about what people can do a long
time ago and that’s not what could have been accepted in other cultures. ‘Normality’ of sexual activities in
different cultures).

“Would you say you had sex if..?” survey indicates that people think of bodily interaction as sex most of the
time only when genitals are involved.
(In professors opinion masturbation is as good as having sex with someone else, it is a good way to learn
about your own body)

Different dimetions of sexuality

(Framem) De Bois, Duch psychiatrist, 1940’s-50’s. Wrote books at the time when there still some ideas
about what good sex should be. He said that sex is like a table standing on four pillars and good sex always
includes these four ideas or four dimensions:
> Lust (erection) /sex has to do with fun and desire
> Relation /interaction, relationship, intimacy
> Reproduction (procreation) / procreation of species
> Institutionalization / you are a couple, you are together officially
he said in the 1940’s – 1950’s that good sex was balancing between these four dimensions

Now we have different idea, currently good sex has to do with consent.

Other way of seeing the dimentions of sexuality:

>Biological
.controls sexual development (hormones and fat cause first menstruations, for example)
.affects sexual desire, sexual functioning and sexual satisfaction
.influence sex differences (man/women)
.sexual turn-ons influence biological events (erection, lubrication, etc)
>Psychological
.emotions, thoughts, and personality (sensation seeker/neurotic personalities will have different
approaches to sexuality)
.Interaction between people; interaction with oneself
>also social dimension: there are laws that regulate sex, pressures to follow certain paths of sexual
behavior. Our biological drive is very much influenced by our society.
>Behavioral
.What people do? We think that what we do is normal.
>Cultural
.Cultural attitudes towards sexuality are not universal
>Clinical
.Sexual problems:
-Pain in women and erection problems in men
-Epidemiology
-causes
Predisposing
Precipitating
Maintaining
-treatments

Lecture 2

Definitions of sexuality

 Definitions by research in the field of sexuality

1. Kinsley (1948, 1953)
He started doing research in this field after being asked to do a course on sexuality in university.
His idea was that sexuality is something natural and human, and thus sexuality has become a
legitimate object of study, i.e. studying human behavior involves studying of sexuality. We don’t
have to talk about rules and norms, we can just say sth about behavior. It is the start of empirical
sexology.
In his studies he provided a detailed description of human sexual behavior based on what people
have told him (used a questionnaire).
He found out that as opposed to what people thought sexuality to be (activity between two people
in a marital relation, dedicated to reproduction), people were not behaving according to the
generally accepted norm. He started questioning our judgements about ‘normal’ and ‘abnormal’
sexuality because people seem not to act according to ‘normal’ standards.
2. Masters & Johnson (1966, 1970)
Wanted to know more about biology and physiology of sexuality.
They had people have sex in a lab while connected to devices measuring various physiological
parameters.
It couldn’t have been done if sexuality had not started to be understood as sth natural and human.

First definition based on the research of these people: sex is natural and sex is human.

 Definitions by media

Sex is everywhere because ‘sex sells’.

But we get a very narrow image of sexuality from the media. People that are being shown in sexual
 situations in the media are young, sun-burned, muscular men, thin women.
Orgasm is simultaneous and amazing for both partners.

The media is giving us a definition of sexuality that is not so easy to comply to.

 Sex defined by ‘psychiatrists’

At the end of the 19th century psychologists changed norms of sexuality (that sex is activity of
married people aimed at reproduction)
At that period there were two blocks of power: the church and the law. They both were saying the
same thing: sex is good if it is happening between two married people aiming at reproduction.
At that same time psychiatrists started having a say about sex. They said this is not what it is good,
or bad, legal, or illegal. They started to say “this is healthy”, or “this is unhealthy”; “this is normal”,
“this is abnormal”.
That is what they did until certain moment until homosexual, LGBT communities started to fight
against the idea that they had a mental disorder. Then psychiatrists admitted that these people are
not mentally ill, but the problem with our definition of ‘normality’ arose because according to our
definition we needed a woman and a man seeking to reproduce to have ‘normal sex’. But, say,
calling two men having sex with each other meant that the reproduction should no longer be
involved in the definition of “normal” sex. So they had to reinvent a new kind of ‘normalcy’ and
they said that normal are “most means that are used for sexual gratification between consenting
adults, independent of their sex”. Consent became much more important.

Freud said things that are not related to sexuality that kept the possibility of reproduction (oral sex
and masturbation) were immature practices of sexuality. Any individual not ending up a
heterosexual according to Freud must have suffered a traumatic experience during his childhood.

Parafilias are still considered to be a mental disorder.

Also, if consent is a crucial part of a definition, there is a problem with BDSM. But it is also based on
consent, however somewhat paradoxical.

Transsexuals are still thought to have a mental disorder = a gender dysphoria.

 Sex as defined by ‘laws’

There are legal frameworks that decide what is normal (i.e., legal) in terms of sexuality.
There are types of sexual behavior that are illegal and prosecutable in court.
illegal=non-consensual

> paraphilia
> sex with youngsters <14 yo (even when consenting) = prosecutable
> rape
rape within a marriage is not yet very long recognized as illegal (it was considered that you
consent with all sexual practices within marriage while marrying)
rape of men – even much later recognized.
  Sex defined by public health debate

Good sex is safe sex, safe sex is sex with a condom.

Sexuality was realized as being dangerous. You can protect yourself from STD/I and unwanted
pregnancy.

Paradox – the weakest arty is responsible for its own safety:

.women should wear decent clothes to protect themselves from rape
.the one who has an STI is responsible to protect his sexual partner

 Sex defines by ‘moral’ standards

Religion looks sexuality as coming from God, and thus good. But god had a specific idea about
sexuality:
> sex is only acceptable in marriage
> Only for procreation. Sex is not meant for pleasure. (but in old testament and in koran sexuality is
sth that creates pleasure
>contraception is not acceptable
>masturbation, oral and anal sex, sex during period is not allowed since it doesn’t help the
procreation

> celibacy is commended. Spiritual love is of a higher rank than carnal love.

All in all, there are different groups having power who say sth about sexuality.

 sexuality is relational as it always involves certain relationships. Even those who only masturbate
usually imagine some kind of interaction with someone other.

Relations are diverse:

> long term – short term
> based on physical attraction, emotional bonding, obligation, wish to become father or mother, to
comply or to fight to cultural standards, economical reasons.
> bringing happiness to both partners or only one, be abandoning, or abuse
> two ore more people
> relationships can be confirmed, disapproved, hidden or illegal in the cultural context you live in
> can be centered around sex or asexual

 Sexuality is related to identity

> Sexual identity

(it is about whom you are attracted to in terms of sexual orientation)
feeling who, how, what you are
feeling of belonging to a certain group

Orientations:
.heterosexuality
.homosexuality
 .bisexuality
.asexuality. They masturbate but they do not connect this activity with any sexual objective. They
have no sexual aims while masturbating.
.parafilia – sexual object that is not related to a person, but to an object. Dyper lovers. Furries –
people who wear specific costumes often related to cartoons. Shoes, lace, etc.
Parafilia can also be related to non-normative activity. Certain activities create sexual arousal.
Old term for parafilia is perversions.

Preferences:
>BDSM
>Sexual delinquents
>Sex workers
>religious people – celibate
>Polyamory

We live in a heteronormative society. People living in other groups are minority groups. They are
often confronted with minority stress, or discrimination and offence, homophobia.
We have more sympathy to the group that we ourselves are in and thus there exist to some extent
negative feelings towards each other between the groups.

>Gender identity
(it is about who you feel to be in terms of gender)
Feeling to be a men and a women. For most people this feeling is in line with anatomical
biological sex.
Gender dysphoria – transgender- transsexual

 What is sexuality? = (always) difficult to answer

Bancroft: maybe we don’t really know what sexuality is. “It is a complex phenomenon of which we
always have to make a kind of construction to be able to better understand it..” “a construction of
reality rather than true reality” – we can think about sexuality, we can have ideas about sexuality
but we can never know whether these are true ideas, whether they cover everything that there is
to sexuality.

Professors idea: There is an unbridgeable difference in perspectives:

> inner-perspective experience and meaning given by those who are involved in sexual activities
> outer-perspective meaning that outsiders give to other’s sexual experiences. In making our
construction it is very difficult to have good ideas about what sexuality is.

Thus we must be very critical when we do sex research.

 The tension and unclarity that we have about the definition and the meaning of sexuality
Is a tension that is maybe based on ideas of philosophy of science.

There are two ways of looking at reality which are also seen in sexuality as a science:
 1. Essentialist approach. They believe that based on gees, hormones, brain, evolution people do
have sex because the species have to survive. That leads to believing in predestined goal of
sexuality. “It has to be that way because biology is driving us over there”. There is no choice about
it.
2. Social constructivist perspective. In this postmodern view of sexuality there are no more strict
norms with regard to sexuality. We have to invent ourselves, invent what is sex for me (and for us).
“Sexuality is a socially constructed reality that again and again has to be re-invented and re-defined
and in which there is room for sexual diversity – that is broader than hetero- and homosexuality.”
(O’Donnovan & Butler)
You reinvent sexuality every time you have sex.

 Historical perspective to sexuality

Bullough – someone who has done a lot of research into the history of sexuality.

“A major obstacle to understanding our own sexuality is realizing we are prisoners of past societal
attitudes towards sex”.

Our own ideas about sexuality (liberal) maybe are an answer to very illiberal ideas that we
previously had of the topic.

> Early times – prior to 1000 B.C

idea that women are property of men, with sexual and reproductive value. Sex was accepted as a
fact of life.
Incest was considered to be a taboo.

> With start of Judaism (Old testament)

Sex is understood as creative and pleasurable force, not evil and not restricted to procreation.
(we think of bible that it depicts sexuality negatively)
Rules about sexual conduct:
Adultery is forbidden
Homosexuality is not accepted

> Ancient Greece

Tolerance of homosexual behavior:

In educational relationship with a prepubescent boy sexual acts were accepted
Not between adult men.
Strong emphasis on marriage and family:
women were second class citizens
They were gyne = bearer of children.
Women were property of men.

> Christianity
Intermingling between Greek and Jewish attitudes
-eros – carnal love
-Agape – spiritual, non-physical love. This was considered superior and higher to carnal love
Denial of pleasure in favor of developing spiritual love. Celibacy was an ideal.
> Christianity – end of 4th century A.D.
With Saint Augustine church developed a negative attitude towards sex.
Lust which caused the first sin is also part of sexual life, and it is bad.
Only men have lust, god does not. It separates men from god.
The fact that we have carnal desires about sexuality is typical for men and sex should be
condemned.
Procreative sex within the marriage was considered the least evil kind of sex and thus accepted.

> Medieval and renaissance period

Theology became a common law and supported oppressive attitude towards sex. It was allowed
only for procreation.
Emotional bonding and intimacy in the relationships were not invented up until 20 th century.
Women were made to wear chastity belts as a way of guarding men’s property and preventing
rape.
Courtly love – incompatible with the temptations of the flesh.

>16th and 17th century A.D.

Loosening of sexual restrictions. It was realized that sex was not inherently sinful. Chastity belts
and celibacy were no longer seen as signs of virtue.
There were less restrictions concerning sexuality at that time.

Massive epidemic of syphilis. People saw it was related to sex. Then again the rules and limitations
about sexuality popped up again. Sex became sth dangerous. And thus you had to prevent people
from having it. The freedom they had won have been breaking down again. (1960’s revolution of
free love, HIV, then again freedom evaded)

>18th 19th centuries

Broad tolerance towards sexuality.

Mid -1800’s, the Victorian era – restrictive era about sexuality. It was not anymore the church who
limited sexuality, but the idea of modesty.
It was not anymore the church that was giving the ideas what sexuality should be but by the fact
that there was a new group coming up – burgeois, they wanted to make distinction between
themselves, namely a higher class, and those lower classes. Not having sex has shown that you are
modest, that you belong to a new kind of class of people who were able to control themselves.
This era stressed the purity and innocence of children and women. Sex is sth reserved for men and
women should be pure. Children should be kept away from sex.

On the other hand, there seems to exist a sexual underground among lower and middle classes
with pornographic writings and pictures. (Often new technological developments are used for
production of pornography)
Also, prostitution was legal and regulated by British parliament. At the same period of time they
tried to make people less eager to engage in sexual activities and restrict their sexual inclinations,
but on the other hand prostitution and brothels had a huge life.
Two different ways of looking into sexuality emerged at that time based on social class.

Science and medicine of that era supported anti-sexualism

Masturbation was considered sth that causes deafness, brain damage, even death.
 Women were considered to have no capacity for sexual response. Women were less allowed to be
sexually active than men.

> end of 19th century

Change from the medical perspective: sex is no longer “sinful” of “non-sinful”, it is healthy or
unhealthy, normal, or abnormal.
Here sexology as a science started.
So-called ‘abnormal’ sexual behaviors were considered to require a medical treatment.

Hterosexual coitus within a marriage was a norm and everything that was deviant from that was
considered “bad, unhealthy, abnormal”.

 Richard Von Krefft Ebing, 1886, psychiatrist, Psychopathia Sexualis

In his book he gave an overview and a classification of what we call perversions. The only thing that
he did at that moment was fenomenological descriptions of diseases. Phenomenological
methodology was widely used in psychiatry as a science. The only thing Ebing did was using that
methodology on this new subject that has not been studied by science yet, i.e. sexuality, and more
specifically the sexuality which was not within the normal range.

He wrote (described) 238 cases of different people doing strange things about sexuality and that
what is what he brought together. Before all those descriptions he wrote a very shirt chapter in
which he tried to classify all these cases. (That’s a starting point of sexology as a science.)

He made a change between normal and abnormal.

Bio-psycho-social reasoning in sexology as a science in the very first quote by Ebing.

This book was very important and was used by 3 groups of people:
> medical doctors – the book helped them to classify patients
> lawyers (he was not responsible for what he did, he has a mental illness so cannot be held
accountable)
> Participants – people who could identify their perversions. They could be given the idea that they
are not alone who are attracted to those things, those people, etc.

Most of what is happening in the field of sexology before the fist world war is in Germany.

 Iwan Bloch, dermatologist, 1906, The Sexual life of Our times

He was an advocate of the idea that we should develop a sexology or sexual science. It should be an
autonomous scientific enterprise and it should combine insights and methods of positive and
cultural sciences.
Thus we should think both about methodology and cultural influences.

Sexology should be an interdiscipline in which the insights coming from different sciences (like
psychology, sociology, culture, biology) are brought together.
 And then there was a flourishing period during which sexology as a science become bigger and
more influential.

 Magnus Hirschfeld (medical doctor), 1908

He started the first journal of the science of sexology. It was a new developing science.
Journal was shut down after one year because of the lack of money and the lack of research that
could be published in it. Only one volume was published.

Also, apart from the journal, Hirschfeld started organizing specific professional organizations and
conferences:
> “Medical society of science of sexuality and eugenetics”
> Albert Moll started international society for sexresearch.

 1919 Institut für Sexualwissenshaft – institute for science about sexuality

There has always been tension between politics and sexology as a science.
Hirschfeld started this institute which had threefold aim:
1. Health care – to help people who have sexual problems
2. Prevention – syphilis, other STD’s, unwanted pregnancies
3. Research

Institute was destroyed by the Nazis in 1933. The Nazis publicly burned all the books from the
institute.

Differences between Hirschfeld and Albert Moll:

> Hirschfeld was homosexual (at least that’s what is now being thought about him). Sexology for
him as a science had an aim to fight for sexual freedom, emancipation and tolerance. It should not
only describe, but also fight for freedom of experience of sexuality. Reformatory sexology –
sexology should try to reform society based on the specific ideas that it has.
>Moll: sexology should be purely scientific endeavor in which you try to understand sexuality and
that is all we should do: we should not try to have an influence on politics, or we should not try to
question political order: the idea of confirmatory sexology – it is what it is and we just describe it.
Third lecture – sexual anatomy and physiology
Leonardo da Vinci made drawings of intercourses
Masters & Johnson studied sexual response under laboratory conditions
Weijmar Schultz (1999) did a first MRI study during sex.
Robert Latou Dickinson (1933/1959) book – “Atlas of Human Sexual Anatomy” – gynecologist who made
drawings of genitals of his patients.

Two categories of Sexual Organs:

1. Internal organs
2. External organs

Our complex relationship with our genitals

We are quite comfortable describing most parts of our bodies, but genitals do not fall into this category.
>We cover them.
>we punish children when they touch ad play with their genitals
>We don’t (all) know the (right) words for sexual anatomy. Slang or acceptable scientific language.
>We are discouraged to speak and ask questions about sex

Our feelings about our genitals are ambivalent and complex. The ambivalence comes from a lot of learning:
for children there is no ambivalence regarding their genitals.
>Fear, shame, guilt
>Curiosity, mystery, pleasure

Vulva – everything that is external to woman’s sexual organs

Vagina is not the vulva. Vaginal opening is part of the vulva. But the vaginal opening is not vagina, vagina is
on the inside.
Male Sexual & Reproductive Organs

Women

Mons pubis
1. Also called mons, latin for “mountain” or mons veneris, latin for “venus”
2. Rounded, fatty pad of tissue, covered with pubic hair at front of the body.
3. Lies on top of the pubic bones

The labia
1. Labia majora (outer lips)
Rounded pads of fatty tissue lying along both sides of the vaginal opening, covered with pubic hair.
2. Labia minora (inner lips)
Two hairless folds of skin lying between the outer lips and running right along the edge of the vaginal
opening.
The inner lips extend forward and come together in front, forming the clitoral hood.

The Hymen
1. curvy little membrane that, if present, partially covers the vaginal opening. (Women vary immensely in
the size and the shape of the hymen. There are quite a few women who do not have a hymen. Some
cultures thing absence of hymen to be indication of not being virgin, but that is not true)
2. Varies in physical types
3. It is not a sign of virginity

Clitoris
Most densely innervated area of the female genitalia – most nerve endings, most sensitive to touch. (not
even comparable to the vagina. The reason for the absence of high innervation in the vagina is that its
initial function is to give birth)
Clitoris has three parts:
1. Tip: knob of tissue externally in front of the vaginal opening and urethral opening
2. Shaft: consists of 2 corpora cavernosa
3. Crura: two longer spongy bodies that lie deep in body and run from tip to either side of vagina.

Glans clitoris – tip of clitoris. It is covered by clitoral hood.

Crura of clitoris – leglike structures, inside of the clitoris
Corpora cavernosa of clitoris – components that provide tumescence (not that rigidity as a penis)
Prepuce of clitoris
Frenulum of clitoris

Research by Helen E. O’Connell. Paper “Anatomy of the clitoris”, 2005

Prior to this there were almost no information about clitoris in the medical textbooks. Largely because it is
culturally embedded and clitoris has nothing to do with the reproductive function.
She showed that internally there is a lot of clitoris. The crura was not considered part of clitoris before this
research.
She concluded that the bulbs appear to be part of the clitoris.
Female internal organs:
1. Vestibular bulbs
2. Vagina
3. Skene’s gland (of Female Prostate)
4. Uterus
5. Fallopian tubes
6. Ovaries

1. Vestibular bulbs
i. Bulbs of the clitoris
ii. Two organs about the size and shape of a pea pod
iii. Lie on earther side of the vaginal wall, near the entrance, under the labia minora
iv. They are erectile tissue and lie close to the crura of the clitoris

2. Vagina
i. Tube-shaped organ into which penis is inserted during coitus
ii. Passageway through which a baby travels during birth (sometimes called birth canal)
iii. At the bottom it ends in the vaginal opening or introitus
iv. Pubococcygeus muscle may be stretched during childbirth.

3. Skene’s gland
i. Female prostate or paraurethral glands
ii. Lies between the wall of the urethra and the wall of the vagina
iii. Its ducts empty into urethra
iv. Secretes fluid that is biochemically similar to male prostate fluid

4. Uterus
i. Also called womb
ii. Size of a fist and is shaped like an upside-down pear
iii. Has three parts:
1. Cervix – narrow lower third of uterus
2. Fundus – top of uterus
3. Body – main part of uterus

5. Fallopian tubes
i. go to the ovaries

6. Ovaries
i. Two organs about the size and shape of unshelled almonds.
ii. Lie on either side of uterus
iii. Contain numerous follicles: capsule that surround an undeveloped egg
iv Has two functions:
1. Produces eggs
2. Manufactures female sex hormones: estrogen and progesterone.
Man

Male external organs:

1. Penis
2. Scrotum or Scrotal Sac

External parts of the penis:

1. Glans – end or tip of the penis
2. Meatus or urethral opening – opening at the end of the glans; urine and semen pass through
3. Body or shaft – main part of the penis
4. Corona – raised ridge separating glans from the body of the penis
5. Foreskin or prepuce – additional layer of skin that forms a sheath-like covering over the glans.
Absent in circumcised penises.

Internal parts of the penis: (internally penis consists of a number of corpora)

internally penis contains 3 long, spongy cylinders
1. Corpora cavernosa – the two bodies lying on top.
2. Corpus spongiosum – goes through the middle and ends at the glans of the penis. Urethra runs
through the middle of it.

Scrotum
1. Loose pouch of skin lightly covered with hair
2. Contains the testes

Testes
1. The gonads or reproductive glands
2. Manufactures reproductive cells – sperm
3. Manufacture sex hormones – testosterone

Prostate
1. Lies below the bladder
2. Size and shape of a chestnut
3. Ejaculates a milky alkaline fluid that is part of the ejaculate (semen). Man ejaculates not only
sperm but a fluid that’s a mixture of various thing (including Cowper’s gland’s liquid)

Cowper’s glands

Physiology

Masters & Johnson, 1966

They were first to systematically look what happens during sex in a laboratory.
Individuals who were stimulating themselves, couples have sex together.
One of the things they concluded that sexual arousal depends on increased blood flow into the genitals.
Changes in the vagina:

1. Increased blood flow to clitoris and vagina

Lubrication in the vagina is the direct result of the increased blood flow.
Increased blood flow is called vasocongestion (of the clitoris and of the penis)
It increases sensitivity.

Vaginal photoplethysmograph – developed by Sintchak & Geer, 1975.

It measures blood flow in the vaginal wall.
It is still used to measure sexual arousal in women.

2. Increase in vaginal fluid production

increase in transudate (plasma filtrate)

3. Increase in vaginal fluid pH

4. Increase in vaginal surface pO2

Facilitat

5. Vaginal tenting (balloon effect)

During sexual arousal the inner part of the vagina towards the uterus balloons, becomes wider,
moves away the cervix and the uterus a bit.
There is still speculation going on about why does that happen.

Interpretations of the function:

1. It reduces penile friction
2. It may create a reservoir for ejaculate to form a seminal pool
It delays sperm transport, allowing semen liquefaction.
It is called precapacitation – when sperm comes out of the penis it is not really ready to fertilize
an egg. It needs to go through different processes to be capacitated. The idea is that all those fluids
mix up from glands.

Slower is better – sperm needs capacitation

Sperm seeds delay to allow ‘reprogramming’ (capacitation – the final step in the maturation of
spermatozoa, which takes place in the female reproductive tract and is required to render sperm
competent to fertilize) for fertility (involving both male and female fluids)

Faster sperm transport would only transport sperm that are uncapacitated – unprimed for
fertilization.

Orgasm in women

Freud said that clitoral orgasms are immature, real women have vaginal orgasms.
But if you combine to these questions the recent findings about the structure of clitoris, the distinction
between clitoral and vaginal becomes problematic. How do you make sure that the orgasm is only induced
vaginally if clitoris is actually so big?

The Grafenberg (G) spot

Grafenberg suggested that there’s part of the vagina that is particularly sensitive to stimulation. Which is
also, as we now know, is where the legs of the clitoris run.

More recent studies show that there’s really sth special in that frontal part of the vagina.

All we can know for know may be that the G-spot is more functional than anatomical.
Functional means that there is increased sensitivity in that part for a lot of women but what causes that we
don’t know. It might be the crura of the clitoris.

Female ejaculation

Controversial. Some women report a few drops or squirting.

The majority of studies do seem to suggest that when we are talking about these huge amounts of liquid
(squirting) it involves urine.
Some research seems to suggest that female ejaculation is possible due to female prostate.

Men
Different types of erection:
1. Psychogenic
2. Reflexogenic – has nothing to do with sex.
3. Nocturnal erections – during REM sleep. We don’t know why.

Veno-occlusive mechanism

Tunica albuginea – a membrane that goes around the penis that allows it to get really hard. That can handle
all the pressure on the outside.

Three important features of erection:

1. Vasodilatation of the arteries (VIP)
2. Relaxation of the corpora cavernosa smooth muscle (NO)
Those corporas are like sponge. Erection is when the sponge relaxes and is filled with blood.
Mechanism of relaxation of smooth muscle tissues in the corpora -> erection.
PDE5 leads to relaxation of smooth muscle tissue. Viagra is PDE5 inhibitor.
3. Veno-occlusive mechanism.

The four E’s of male sexual arousal:

1. Excitation
2. Erection
3. Emission
4. Ejaculation

Orgasm – independent mechanism.

Some men experience orgasm prior to or after the ejaculation - Disconnections are reported.
Ejaculation is the spinal reflex. Orgasm is central event and subjective feeling, but there’s no generally
accepted method to measure it.

Fourth lecture

What’s the role of theories? It sth that sums up current knowledge, sth from which we can derive new ideas,
hypotheses, questions, it helps us organize us thinking, address certain questions.

For example, why do people fall in love and why they are sexually attracted to each other? How do we explain
attraction between men and women, men and men, women and women?
There are different ways of trying to answer those questions. The answers are shaped on certain assumptions.

Plato’s theory why we are attracted to each other and why we fall in love: Originally we had two heads,
four hands, four legs. Zeus was fearing the power of men so he split them all in two so now everyone’s
searching for his other half. Some of us originally consisted of man and woman, or man and man, etc.

So why theories? R. Harre: “Theories are the crown of science, for in them our understanding of the world
is expressed. The function of theories is to explain. “
Theories:
>Help us describe things, processes, and causal relationships
>Help us understand how and why observed regularities occur
>Help us predict unobserved relationships
>Guide research in new directions

Theories themselves can be debated on the basis of data we have AND on the basis of what we believe is
actually possible: how much we can know about things.

There comes the distinction between ontology and epistemology:

>Ontology: What exists? Is there really a universe? What is there to know?
>Epistemology: How can we tell? What is it possible to know? What constitutes valid and reliable
knowledge?

It is best when people from different methodological backgrounds come together and expose each other’s
inefficiencies of methods. Also, our ontological assumptions determine how we think about things in
general: there is an essence, a nature of things or there is not.

What makes a good theory?

Scientific theories have to have proof.
Parsimony – the ability to explain in relatively few terms and statements
Breadth of phenomena explained – how much can you explain
Accuracy of the predictions of new phenomena
Ability to be disproved – falsifiability.

The field of sexuality does not have many theories with a lot of empirical support but it does have
theoretical models and conceptual frameworks.
The theories in sexology are combinations of ideas that people use to create predictions. Biological theories
in sexology usually are just summing up of what’s known, proven, true.
Differences between theory, theoretical model, and conceptual framework.
Sexual desire and arousal

Sexual response cycle by Masters and Johnson

Model of sexual arousal.
Studied and observed 10000 episodes of sexual activity, including masturbation.
Thanks to their work we know of phenomena such as ballooning effect in the vagina, etc.
They organized their observations that led to the development of the model of sexual response cycle.
Their modelled cycle has three parts:
Excitement/plateau
Orgasm
Resolution (and refractory period in men)

It is a very descriptive model.

Criticism of the model:
>It focuses entirely on physiological aspects of sexual response, ignores what people are thinking or feeling,
desire is not the part of the model. The problem is that they could not study desire because they conducted
all their experiments in the lab, which is not a very romantic environment.
>Orgasm is a necessary part of the sexual response cycle, however, many people, especially women, not
necessarily experience orgasm.
>Stages are arbitrarily defined, it is not necessarily clear when someone goes from excitement to the
plateau phase, etc.

However, they themselves wrote that only one sexual response cycle was diagramed for the male but
admittedly there are many identifiable variations in the male sexual reactions. And the same applies to
women.
However, the variations become problem when scientists are trying to create models which sum up what
happens most of the time.

Important conclusion of Masters and Johnson was that fundamental physiological process involves
vasocongestion: erection in men and swelling of labia, clitoris, vaginal lubrication in women.

Kaplan’s triphasic model of sexual response

Three relatively independent phases:

>Sexual desire
>Excitement / vasocongestion
>Orgasm / muscular contractions

It is another descriptive model.

The Dual Control Model

The basic idea is that sexual response is controlled by two processes:

> Excitation – responding with arousal to sexual stimuli
> Inhibition – inhibiting sexual arousal

Both processes can be adaptive (stop when the environment makes it necessary to do so) or distractive
(make forget the environment)
Also, important part of the model is that people vary in the propensities towards both of these processes.
We differ in how easily we become sexual excited and how easily we inhibit our sexual arousal.
The model allows us to understand sexual behavior in terms of balance between the two, for example: high
levels of inhibition can result in sexual dysfunction, while low levels of inhibition result in sexual risk-taking.

Sexual desires depend on the balance between excitement and inhibition.

Methodology used: Sexual inhibition and excitation questionnaire. Sample size: over 50 000 men and
women.
The model is relevant because it emphasizes individual differences.
Results: women score more than men in sexual excitement.

These two things (inhibition and excitation) are not mutually exclusive, you can be very easily sexually
excited and very prone to inhibitions.

Kinsey:
“The living world is a continuum in each and every one of its aspects. The sooner we learn this concerning
human sexual behavior the sooner we shall reach a sound understanding of the realities of sex.”

Theories that inform our thinking about sexuality:

Evolutionary
Biological
Psychological
Sociological
Feminist
Queer

Evolutionary perspective
As a species, reproduction is part of our design, because we need to have sex in order to exist.
Why do we have sex? Because it has certain advantages over reproduction without sex. You can also
reproduce asexually (like plants). The advantage ox sexual reproduction: variation is good, when you have
two sets of DNA, you get all kinds of new variations, and if the environment changes we have more chance
of survival. However, sexual reproduction is complicated and costly: you have to seek and find a mate, you
have to take care of the offspring. You need chemical attractants. Also there is danger: exposure to
predators during sex (and with the offspring), injuries during sex, disease transmission.

Evolutionary psychology
Human species is product of evolution -> thus evolution is a key to understanding human sexuality.
David Buss: humans have nature which is the product of evolution and thus we can get insights into that
human nature by looking at our evolutionary origins.

Peacock – only males have tale. In general, female and male specimens of the same species have different
appearances.
The reason why Darwin had trouble with peacock was that large differences between male and female
animals didn’t fit that well with basic and initial conceptualization of natural selection.

Thus Darwin came up with the second principle: sexual selection (first being natural selection) It is more
relevant in terms of variation in mating success.
Differences between sexual and natural selection [ ]
Two kinds of sexual selection:
Intrasexual selection – mating success determined by within-sex interactions, e.g. male aggression
Intersexual selection – mating success determined by between-sex interactions, e.g. female choice of
males.

Theory of parental investment

Any investment by the parent in an individual offspring that increases offspring’s chances of surviving (and
hence reproducing) at the cost of parent’s ability to invest in other offspring.
The sex that invests in offspring should be more choosy about potential mates than the sex that invests less
in offspring.

From an evolutionary pint of view it is good that men are just going about injecting their sperm
everywhere. When it comes for women, it is natural that they are more picky about their mates because
they only cam make one child per year, while a man can make a few.

Evolutionary psychology takes these things further and looks at the implications. Things that EP studies, not
necessarily proven (culturally strong and evolutionally reinforced ideas, but not necessarily true):
1. Short-term mating is more important to men than women
Man have more casual sex and sexual partners. Also they are more interested in short term mating
strategies
2. Men seeking a short-term mate will solve the problem of identifying women who are sexually accessible:
looking for a one night stand, man will have to judge where to go
3. Men seeking a short-term mate will minimize commitment and investment
“Women fake orgasms, men fake relationships”
4. Man seeking a short term mate will solve a problem of identifying a fertile women. That is very
controversial.
5. Men seeking a long-term mate will solve the problem of identifying reproductively valuable women.

Indications of what may be better reproductive material.

7. Women seeking a short-term mate will prefer men willing to share immediate resources.
8. Women will be more choosey than men when picking a short-term mate
body symmetry, etc
9. Women seeking a long-term mate will prefer men who can provide resources for her offspring.
(Women seek successful, wealthy men) “Man view women as sex objects, women view men as success
objects.

Other Theories that are relevant to understanding sexuality

Psychoanalytic theory
Psychological theories (learning theory, social exchange theory, cognitive theory, gender schema theory)
Critical theories (feminist theories, queer theory)
Sociological theories (symbolic interaction theory, script theory, field theory)

Psychoanalitic theory
Freud. Distinction between two major forces motivating human behavior:
Libido – Sex drive or sex energy
Thanatos – the death instinct

Sexuality is the background of everything. “Sexuality is the key to the problem of psychoneuroses and of
the neuroses in general”. Psychological problems come from sth related to sex.
Freud’s scheme of psychosexual development:
oral 0-1
anal 1-3
phallic 3-6/6
latency 7-puberty
genital (adolescence-adulthood)

Phallic Stage for boys – Oedipus complex, castration anxiety.

Phallic stage for girls – Electra Complex, penis envy.

Evaluation of Psychoanalytic theory:

>most of its concepts cannot be evaluated scientifically (ego, superego, penis envy, castration anxiety – all
they are hardly possible to test scientifically)
>Data on which he based his theory was collected from clinical patients of Freud himself.
>Overemphasis on biological determinants of behavior and instincts
>Very male-centered theory:
Female sexuality is inherently passive and masochistic
He made a distinction between vaginal (mature) orgasm and clitoral (immature) orgasm.

He was and still influential, some researchers base their scientific studies on psychoanalytic thinking. Media
research, literature studies. The notion of the sex drive as sth that is in us and if we don’t use it, act on it, it
is going to explode, is very influential in terms of how people think about sexuality, although these notions
are not that scientifically useful. Most modern theories of human sexual motivation give a place for desire
as sth that emerges from the interactions with sexual stimuli, not sth that originates within us, within our
body as Freud said.

Learning theory

Covers the role of conditioning processes (Pavlov’s dog).

In sexuality studies, theory is used in studying, for example paraphilia (being sexually attracted to certain
objects). This attraction to objects may be originating from the processes of conditioning. As a theory, it
may help us understand why do people develop specific preferences.

Homosexuality was also studied in terms of this theory, but the answer is that most likely homosexuality is
not learned. Scientific consensus was that it is not really possible to make gay men stop being aroused by
sexual images of men by, for example, combining showing of those images with electric shock.
Or, you can make gay men not to act upon his desires and preferences, but there’s no way of removing
these preferences.

Due to this type of theory we also can learn what the limits are of the influence of learning on our
preferences. Preferences and fetishes may be learned, but some of them (like sex or gender of your
partner) are not learned.

Principles of learning theory [in slides]

Social exchange theory

A theory based on the principle of reinforcement. It states that we are hedonistic, we try to maximize
rewards and minimize costs when we act.

Principles of Social Exchange Theory:

>Comparison level for alternatives (Comparing the profits of one relationship over alternative relationships)
>Equity (Believing rewards are proportionate to costs in a relationship)
>Matching hypothesis (men and women choosing mates who match them on physical and social
characteristics)

It is not a sexology theory. It is a psychological theory that you can apply to trying to understand how our
sexual relationships work.

Cognitive theory
The study of the way people perceive and think. How we interpret events and signals from the other.
Sexual aggression-sexual violence and consent: all these things are hard to determine and involves
interpretation of other’s actions.
What we think influences how we feel. How we perceive a sexual event makes a difference.

Gender Schema theory

Gender Schemas: set of attributes that we associate with males and females. We have ideas of what ‘real’
men and women are like and the rest is kind of departure. The schema theory discusses how these ways of
thinking come about and remain prevalent in our societies.
>Schemas predispose us to process information on the basis of gender
>Schemas filter out stereotype-inconsistent information, making those stereotypes (schemas) slow to
change

The findings of dual model challenges these stereotypes: variation within each gender is much bigger than
the differences between averages of both genders.

Feminist theory

>Gender signals status in a culture, with men having greater status and power.
>’Sexuality’ includes many specific issues, including rape, abortion, birth control, sexual harassment in the
job, and pornography.
According to feminist analysis, women sexuality has been repressed and depressed, but rarely expressed.

>

> Intersectionality in becoming increasingly influential in such discilines as gender studies, but also in other
areas.

Queer theory
>Once ‘queer’ being a derogatory term, now it has a positive meaning
>It questions the social categorization of sexuality and gender. It challenges binaries (the idea that people
fall into just one of the two categories), especially the sexual orientation binary.
>It also challenges heteronormativity – the belief that heterosexuality is the only pattern if sexuality that is
normal and natural.

It is not necessarily a sexological theory, but it has been important and influential in the studies of sexuality.
Sociological Perspetives – the influence of Society
Three assumptions:
1. Every society regulates the sexuality of its members
2. Basic institutions affect the rules governing sexuality
3. Appropriateness/inappropriateness of a particular sexual behavior depends on the culture in which it
occurs.

Sociology tries to understand why things work in a specific way in this or that culture.

Script Theory

Was applied more specifically to sexuality – there is a sexual script theory which was introduced by Gagner
and Simon.

What we do sexually is a result of elaborate prior learning that teaches us an etiquette of sexual behavior.
Scripts also tell us the meaning we should attach to a particular sexual event.

Fifth lecture
Historical perspective

Institute of sexology science, Germany.

Two opponents: Hirschfeld and Moll. Apart from each other organized several conferences. From the topics
of the conferences you can see what was covered at that time.

Hirschfeld:
5 conferences: societal change and sexual education, birth control, prevention of unwanted pregnancies,
same/equal rights for homosexuals, an acceptable way to treat prostitution, STD’s.

Those topics are still covered today, you can see some parallelisms. We’re still thinking about best way to
do sex education and everything else that was discussed in Hirschfield’s conferences. For example, in
Sweden there recently has been a debate that those who USE prostitutes should be criminalized rather
than prostitutes themselves. Absolutely different situation is in Netherlands where thay say that
prostitution should not be criminalized at all, and, on the contrary, there should be established a better
legal framework for protection of them.

Moll
Went for international congress for sex research, while Hirschfelds initiatives were limited to german
audience.

By 1933 when the Nazis came to power there was an abrupt end of the first period of growth of sexology as
a science that was characterized by
European based
Advocated by medical doctors
Advocacy for scientific research and methods
Casuistic clinical methodology – von craft ebeng – phenomenology(?)
Strong belief in sexual instincts (sex was men dominated and women were not really playing a big role
there. For them sex is only a reproduction)
Medical illnesses should be treated by medical means. Deviances from what is normal in terms of sexuality
is an illness.

After the second world war new movement (2 nd growth and flourishing period of sexuality) is coming up
which is not that European based, but especially coming from American background. Not only medical
doctors, but various other disciplines are taking part in doing sex research: biologists, psychologists,
sociologists. You see a broadening of perspective.

Everything starts with Kinsey. He was a zoologist. He was invited to give a course for couples (engaged) to
give them info what sexuality should be within a couple.
Kinsey did his PhD on Gal wasps – it was very methodologically strong. He was keen to do a research based
on a strong, specific methodology. More than one million wasps.
Based on the request to give that course in university, he bought some books from Europe and after
reading them he realized he cannot find the data: there were theories but they lacked data on which thay
are based. So Kinsey started a huge study where he wanted to make an interview of over 100 000 people.
At the end he didn’t realized this goal and did a research with the sample of 16 000 people of which kalf of
them he did himself. It was 1.5-2 hours interviews.
Based on the data collected he and his coworkers wrote two books:
Sexual behavior in the human male (1948)
Sexual behavior in the human female (1953)
What he learned from his research was that he learnt that there were some specific moral ideas about
what sexuality should be (marital context, FOR reproduction – norm of American society). But he found out
that many people in this respect were ‘abnormal’ because they did not adhere to this norm. They were
having premarital sex, a lot people had sex with an animal. These findings were really striking at that time.
He also said that he doesn’t want to write sth about norms, he just wanted to provide people with the data,
so that people know what’s going on in terms of sexual behavior in America.

Also, in the book on the female it was shown that not only men, but also women were not adhering to the
norm. It invoked a huge reaction, “how was he daring to say what he said?!”

Frank Beach, 1948

Hormones and behavior – a book.
The idea that testosterone is what determines our sexual desire is coming from Beach. He was a founding
father of behavioral endocrinology: hormones are driving behavior.
Lower animals are more influenced by behavioral hormones, while higher animals such as humans are
much more inspired cultural and social influences because our brain is working in a different way.
Hormones and behavior is still a very important journal focusing on this sphere of research.

John Money, 1955

He coins the term of Gender. He did that based on a fact that as a clinician psychologist he encountered
people having intersex problems: hermaphroditism. He started to think what should we do with such
people: should we educate and socialize them to be one or another sex? Should we do that asap, or wait?
Based on these things he coined a term gender.
His book Man and Woman, Boy and Girl.
Sex, gender and gender differences are still important. Gender is not a biological sex, but one’s feeling of
belonging to certain sex along with all gender roles.

William Masters & Virginia Johnson, 1966

Gynecologist and behavioral sociologists. They research was mainly based on physiology.
They are founding fathers of sex therapy. Based on their research on sexual response cycle they started to
think of how they could improve the sexual functioning of people giving clinical or sex therapy.
Two important starting points for them:
1. Sex problems are couple problems – due to the fact that if u have sex in the partner, one has influence
on another – influence is reciprocal; both partners are involved when they are facing a specific sexual
problem.
2. In sex therapy you have to go with the couple. Also, they both together were doing the therapy. People
had to go to sex therapy with a partner. If there was no partner available for a man who came to therapy,
Masters and Johnson would provide him a surrogate partner. But if you were a woman who came to
therapy alone, you would be just sent away. This once again illustrates the idea that for women sex is of
primarily reproductive function and certainly not the one of pleasure.

Hellen Singer Kaplan, 1974

Was a psycho-analytic psychiatrist.
Introduced a new idea of sexual desire. Said that it is really important what we learn from masters and
Johnson for people who come to therapy with having problems of, say, vagina lubrication or erection, but
there are people who have problems with having sexual desire, having interest in sex. And that made a
sexual response cycle a little bit more extended: before all the physiology started they added the idea of
sexual desire. And after all the physiology the idea of sexual satisfaction.
Based on the fact that she focused on sexual desire she adapted a sex therapy and publishes a very
important book A New Sex Therapy in 1974.

Kinsey, Beach, Money, Masters and Johnson

All these authors hold that sexuality is something biologically and evolutionally determined. (Masters and
Johnson and their sexual response cycle is completely based on physiological research, it is biology that
really counted)
It was a certain essentialism of sexuality research.

At that time a new movement has started which said that not everything is biologically determined, it is
also something that is created – it is a result of social, cultural and economic circumstances.
It was the birth of Social constructionism

John Gagnon & William Simon

Two important authors of social constructionism.
A book Sexual conduct: the social sources of human sexuality. This book gives us a new way to look at
sexuality. The main questions posed by the book were:
Who has sex with whom
In what kind of relational context
What kind of sex do they have and
what kind of consequences?

These are different questions than could be easily asked about sex. Because the answers were supposed to
be known: man and woman, in marital context, vagina penis intercourse, with the consequence of a
conception of a child.

Of course the fact that the questions are posed means that they saw that other things are going on
They reject the theory of sexual instincts and that they are driving especially man to take woman.
Sexual behavior is social role behavior that is determined by means of cultural scripts.
There are specific scripts that prescribe how we should behave in terms of sexuality.
The script is a scenario that defines a specific situation as sexual, it determines the actors and prescribes
them a role in a story line, combined with the intra-personal dimension and inter-personal dimension. That
means that we, participants, can decide that context is sexual and to behave in this context in a specific
way and that behavior is sth that we, intra-personally and for myself prescribe specific meaning to. Inter-
personal dimension: while having sex with someone you both can have the same goals or they also can be
different.
So we see that we have a story line that is being told, we do certain things in a certain way. Our behavior is
socially regulated.
“Sexuality is a socially determined significance given to the (biological) possibility to get/become excited”.
So there are biological functions but what we do with that, the meaning it gets is sth that is being
prescribed in a certain culture.

As insightful Gagnon’s and Simon’s research may be, they do not provide answer to the question to from
where does the power come from to determine what is sexually normal?
They also do not ask what kind of role or function has sexual violence in a society?

Susan Brownmiller
She has put on the agenda of violence and power. She said that sexual violence was a strategy used by men
in order to keep women in their subordinate situation. It was socially accepted strategy.

Kenneth Plummer
He described the idea of sexual diversity not only in terms of homo-, hetero-, bi-, but in terms of vast range
of sexualities that exist.

The methodology that we use to get more scientific data from a social constructivist perspective: we need
much more narrative methodology and qualitative methodology instead of quantitative research which was
common in previous sex researchers.

So, all in all, sexuality is a societal product. Society stipulates what is normal, the extent to which man and
women have right to their own kind of sexuality (very often there’s a man dominated idea about sexuality,
only in last two decades there was more attention to female sexuality).

In 1974, a new organization was established, International Academy of Sex Research.

It was a closed group of sex researchers, they wanted to discuss with each other new data they had found
without the influences from outside. Interdisciplinary group: psychologists, sociologists, animal researchers.
Journal – “Archives of sexual behavior” – highest ranked journal of sex research we have.

Idea of Sexual Medicine, 1980

An important problem we had from the 1980’s is that of erectile dysfunction.
The idea of sexual medicine came up at that time because they found specific medical solutions for helping
men who had erectile dysfunction.
It started with vacuum devices.
The 2nd kind of therapy: injection therapy (into penis) (prostine, papaverine/phentolamine, prosteglindine
e-1). Injections created the erections.
This was all we had until 1998, when Viagra came on a market and oral therapy for ED has started:
all compounds which were phosphodiesterase-5 inhibitors.

If you could help people just by giving medication, and the problem of ED was very common, it was soon
realized that there is a big market for such a medication. The problem is that there still is a market of
women. While Viagra and similar things were generating millions of dollars by selling their products, a huge
research was being done to find a pill to make women feel more sexual desire. The pill-kind solution was
being searched for women.

Side effect utilization: Antidepresants were used for fixing premature ejaculation in men, botuline (botox)
for vaginismus (a contraction of a muscle covering the vagina). Botulin relaxes the muscles.

Based on the idea that we can fix sexual problems with medication, a new kind of market came to the
world and a new kind of economy has started to develop. That’s positive because we have a lot of new
theories and research.
What’s negative is that industry which is funding the research is very much driven by economic thinking and
its really fixing the research agenda. They are more willing to fund research which makes sth sellable.

Another negative aspect is that if there’s a medication available, we don’t know how much sexual health is
being promoted by these things. You may restart having vaginal intercourse but maybe the penetrating sex
is causing harm for your partner.

Sexual problems are couple problems, and if you really want to treat people, you have to treat partners.
But since medications are so available, people are less inclined to do talk therapies. Doctors are claiming
the field of sexual problems: they are always prescribing medication, but that doesn’t mean that they
promote sexual health.

New organizations related to the new field: ISIR-ESIR (International society for impotence research), 1982
Spec dedicated to research focusing on the lack of erections in man. There was international and European
society. International journal for impotence research. Also, yearly congress is held.

In 2003 there’s a shift from ISIR to ISSM (International society for sexual medicine)
That means that there’s a broader approach: attention dedicated not only to men’s sexuality but also to
that of women.
They started lobbying about an official European Course on sexuality from a medical pint of view.
They have a Journal of Sexual Medicine.
Emphasis is back on the medical doctors, so here we are at the start of sexology as a science with Ebing.
Current international trends:
Bio-psycho-social approach is generally accepted – idea that different perspectives are complementary.
We start with the idea that normal sex is consensual sex.
Methodologically there is a lot of heterogeneity in terms of theories that are being built starting from
different disciplines, combining both qualitative and quantitative methods and everything that lies in
between.

There is still a very prevalent movement started by Leonore Tiefer 1995, who sad that opposed to what
Masters and Johnson said (that sex is a natural function), sex is not a natural act.
“Sex is not an uncomplicated and universal biological function that, without training, has to be experienced
by all people in about the same way and with pleasure”
“Sex is about functioning organs and what people do with each other to reach specific goals [maybe you are
having sex to show how much you love someone or out of violence, or as a gratuitous act for someone in
need] and how the ways of/and goals of having sex are being created within a certain societal and
interpersonal context at a certain moment in history.” Sex is different at a certain moment of history.
Of course, this means narrative and qualitative research methods.

However the ideas of essentialism are still going on

There are people who claim that specific genes or specific circuits in our brains or spinal cord are creating
sex in certain way. They want to prove that biology is really important and that from the moment of birth
highly determines our sexuality.

Interactionists
John Bancroft and Raymond Rosen They say that sexuality is interaction of biological and psychological
factors. They are heavily weighing on empirical research methods that we have now.

Cross-cultural perspective of sexuality

In Belgium media says it’s normal to have sex 2-3 times a week in a normal sexual relationship.

There were studies on that and the results were 1,3-1,5 times a week. Both man and women have sex
about three times every two weeks. In general, about once a week is a frequency found among many
cultures.

In general, we are always carrying the burden of our culture and measure everything to our cultural
standard.
Ethnocentric idea:
That the values and norms of our culture are superior and have to be held as a standard according to which
we measure the values and norms of other cultures. Because from our own perspective, the things that are
different in other cultures we find to be strange. It is easy to make from strange to abnormal.

As much cultures we have, as much values and norms about sexuality we have.
Eye contact
Smile
Drink
Use body
Conversation
Toutch hands and arms
Then hair
Looking at the mouth
Kiss
Dancing
Asking consent
Undressing

Question: who invented those rules? Who decided that women should shave their pubic hair? Media? Femininity is hairlessness.
But maybe there are some other ideas. Ponography – hair in 80’s and 90’s. But after that – hair removals. Playboy – more and more
skinny and more hairless women.
Why don’t we circumcised in Europe?

There are powers in each society which get to determine what is acceptable. Media is very much one of them.

The sexually repressive, naïve culture of the Inis Beag

It is a small population of poor fisher men and farmers in an island before the Irish coast. They never talk
about sexuality, nudity is forbidden. Female sexuality is totally denied in this culture.

Mangaia islands
Boys and girls can masturbate in public.
Yet you cannot be together as a boy and girl in public places, but it’s acceptable for you to go to your own
bedroom. The boy has an intercourse with an older experienced woman who teaches him how to make
love in different ways and in different positions

Mehinaku

Gender
Biological sex:
Chromosomes
Gonods
Inner reproductive organs
Outer reproductive organs

Psycho-social gender:
Gender identity – how and what you feel
Gender role – what’s prescribed by the society that you should do

We have a tendency in society to divide people into two groups.

Other cultures sometimes manage to escape the dualistic framework. In these cultures a third gender
category is (better) accepted.

Examples:
Indians -> Berdaches
members of both sexes engage in the activities appropriate for other gender, engage in sexual relations
with members of the same sex and even marry them

Indie -> Hijras

Castrated men who often work in prostitution, but are accepted in society

Birma -> Acaults

Man who show cross-gender behavior.

The specter of acceptance:

Rejection – acceptance - deification

Sixth Lecture
Sexual development through the life cycle

Questions:
1. Phases (age/periods) of sexual life cycle
2. Developmental domains in the sexual life cycle
3. Different elements/normal facts if life that influence sexual life cycle in different developmental phases.

Life course according to developmental psychologists:

Childhood 0-12
baby 0-1
Toddler 1-3
Childhood 3-6
Primary school child 6-12
Puberty and Adolescence 12-25
Young adulthood 25-…
Relationship and family development 25-50
Middle age 50-70
Elderly 70-…

Sexual development consists of domains of development:

Biological
Emotional
Social
Language and speech
Moral

Sexual development is a development on each of these domains of development

Sexual development is a way an individual makes an integration of all these domains of development.
Some say that sexual development is sth specific in itself, not merely an integration of all these domains of
development.

Integration of these domains of development

It is very dangerous to claim that sexual development is something specific because it allows to say that
children can be sexually attracted and that they can give their consent for having sex.

Other say that children GO through sexual development and that helps them later to have an
understanding of what adult sexuality is as such.
But the reason why children have sex is different that from adults.

Models of development

Until 1950, Essentialist view

Sexual development is the expression of sth that is already there, we just have to follow that. And by
following that we end up there, where we have to end up. (Freud’’s idea, for example, is very essentialistic.)

From 1960, Social constructionist view

Our environment influences our sexual development and all our sexual behavior is learned behavior, picked
up in the environment.

Currently
Bio-psycho-social interaction with an active role of individuals (you are active, you chose what you do in
terms of sexuality) in development.

Definition of sexuality in children , Rademakers, 2000

She made a distinction of three essential aspects that come together in sexuality:
Sex and sexuality as such:
biological sex
gender identity
sexual preference/orientation

Physical aspects:
Sexual responsivity
Touch, be touched, which affects someone else

Intimacy:
Possibility to develop contact and relationships with others
Coddle, dating. Making contact with other people, interacting them.

These all three are influenced by bio-psycho-social factors

Discontinuous model:
says that these three lines of development until a certain age (adolescence and puberty) you see that all
these different lines integrate and you end up with a sexual identity and sexual competence. Sexual
identity leads to having experience in sex and these sexual experiences will get feedback from others and
your own self-reflection of them. This feedback (of yours and of others) will lead again to changes in your
sexual identity and sexual competence.

Sexuality in childhood
Abnormal sexual behavior:
If children show excessive sexual behavior we usually infer that they experience sexual abuse.
Lack or too little sexual behavior is also frightening.

What is sexual for children?

It is something different from adults.
It is “all acts, touching that ensure overall enjoyment and pleasure feelings”, not necessarily focused on the
genitals

Normal sexual behavior

There is little research of sexuality in children because there are methodological restrictions in studying it
and a taboo regarding the sexuality of children.

Methodological problems:
Usually the memories of adults are used but they are not that trustworthy and it would be influenced by all
the experiences one had in the meantime.
Observation by parents, teachers, educators – they don’t dare to see the sexual behavior in their children.
Also, children at a certain moment start hiding it.
Professional observers – participative research. Criteria – certain behavior is sexual and certain is not.
Also, there is a problem of language: for example, babies cannot tell.
There also are discussions in ethical commissions. They believe that asking children questions relating to
sexuality will traumatize them.

When does the sexual development start?

In the womb, prenatally. Erection visible in the fetus. At least physical, biological, sexual development starts
in the womb.

Baby 0-1
Boy or girl determines how you are treated
The biggest sexual organ we have is skin. This organ is part of how we touch each other. It is the
source/organ of pleasure.
This means that how and if we touch babies is really important. We know that from attachment theory
which says that cuddling lays the basis for feelings if warmth, intimacy, security and familiarity.
Erogene zone: the mouth for babies. (Oral phase)
Genital ‘play’ at the age of babies. When you are changing diapers, you can often inflict an erection of penis
in babies. The swelling of vagina is present in girls. It means that touching genitals is pleasurable for babies.
Babies start to intentionally touch their genitals: boys at 6-7 months and girls at 10-11 months.
(Nocturnal) erection and vaginal lubrification often occurs while the babies are being breastfed.

Babies are also able to make a distinction between men and women. It has to do with habituation. They are
given sounds of different women, they are interested in voices at first, but after hearing several voices of
women, their attention fades away. But when you let them hear the sound of man’s voice, thay become
interested again.
Similar things are happening with showing faces.
Toddler 1-3
Skin is still largest general zone of lust
Anal phase: anus is erogenous zone for toddlers (according to Freud)
In terms of sexual behavior they try to discover their own body but at the same time they try to discover
each other’s body. By that time they know that they are boy or a girl and they love to show their nudity.
They not only show themselves but they also touch themselves shamelessly. The moral development is not
yet that present. Self stimulation is more direct in boys, they do it with hands. Girls usually sit on sth and do
some rhythmic stimulation, it less involves hands. Behavior that girls are doing is less easily interpreted as
sexual.

Discovering each other’s bodies: they want to see and experience the body of the other sex.

I terms of sexual knowledge, it is hard to know what they know. They are able to say whether they are boy
or a girls, but the reason why they say so is usually not based on specific knowledge, but on social ideas
that are over there. Gender roles are not yet very well understood, but they know that if they’re, for
example, a boy, they can play football, and if they are girl, they are wearing ponytails, etc.

Children 3-6
Freud says, that now children enter the genital stage – they want to marry their father or their mother.

In terms of sexual behavior, children create different kinds of contexts and role plays in which they try to
get more ideas about how other’s body does look like. They try to create situations in which they try to
discover and compare both: “playing doctor”, “playing father and mother”, “playing big sister”.
These things hitherto said about sexual development of children are normative, they are normal stages to
which every individual has to go in order to be properly sexually developed.
It is not looking at each other’s bodies at this stage, but also touching. It can include French kissing, oral
contact with the genitals of other children. It is all very normal, it is a way of exploring the world, not the
same as adult oral sex.
It is normal and healthy as long as people have ability to say stop and to limit what’s going on.

Sexual knowledge of children is based on cultural aspects and knowledge of peeing. Children at this stage
usually don’t know that the penis and vagina have to be combined in order to have sex.

Primary school children 6-12

Freud: period of latency – (at least in Freuds era, Victorian era) – sexuality is taboo, moral development in
children. They have learnt through those six years that it is better not to show anything related to sexuality.

But in primary school there are a lot of things to do about sexuality, relationships and falling in love,
physical intimacy but they know that they should not show things, they feel a bit guilt and shame about it.
So Freuds latency is not actually latency, he was wrong. It is just that children of that age hide their
sexuality.

Usually you learn about the sexual anatomy, pregnancy, and function of the genitals, menstruation, in
primary school.

Adolescence and young adulthood 12-25

Puberty is kind of a point of integration in which different lines of development are coming together.
During puberty have fragmented pieces of knowledge about sexuality and relationships, experiences of
pleasure or lust.

In puberty, sexual and relational learning is initiated by:

>Hormonal changes. Adrenarche – more testosterone being produced in both bodies of women and men.
The consequence of that is increased sensitivity and interest to erotically colored things, relationships,
physical experiences.
>Longitudinal growth, development of secondary sexual characteristics. It all influences your social position
because with these changes you become someone else for the outside world.
>Intelligence is growing. This leads to increased self-criticism and outside criticism. Also, idealization of
certain people or things. Mirror is really important at this stage since most of self-criticism is focused on
one’s appearances.
>Participation in socio-cultural environment. Seeing what sexual interests show your peer group. In puberty
people usually try to abide by the pressure they create for each other.

Puberty thus is not only about biological changes, but also about acquiring a new position in your family
and your social environment.

Now there are talks about the phase of emerging adulthood – the phase between 20’s and 30’s when
people are not yet taking up a full responsibility for their lives.

Also it is quite possible that puberty is a social construct: ideas of childhood and puberty are relatively new.

Sexual experience comes gradually:

50% of 14 y.o. have French kissed
50% of 15 y.o. have caressed under clothes
50% of 17 y.o. have done nude lovemaking (not an intercourse)
50% of 17,7 y.o. sexual intercourse

Girls begin later, but at the age of 16 there are no more differences anymore between the sexes.
The period between first French kiss and first sexual intercourse is shorter among girls than among boys.

Male adolescents in Belgium with a migrant background have more sexual experience than Flemish
adolescents. But the opposite is true for girls, which means that other cultures are more patriarchal and
allows less sexual freedom for girls.

When people start living their sex life really depends on education. The higher the educational level, the
later the first sexual intercourse.

Sexual experience

Homosexuality
Usually our societies are very heteronormative. People have hopes that it is a strange phase they’re going
through.
Seventh Lecture
Gender similarity and differences

It is hard to put variation and individual differences under the categories of certain theories and morels, to
come up with general rules about how things work.

In majority of cases your sex is the first aspect by which you are defined upon coming into this world (it’s a
boy! Or It’s a girl!)

Sex and gender

Sex refers to the biological characteristics of being male or female

Gender refers to the psychological and sociocultural meaning of being male or female.

Gender identity – how you perceive yourself (as a man or as a woman)

Gender role – how you act (masculine or feminine). You might act according to a gender role that does not
match your identity.

Gender identity is self-defined.

Gender role is socially defined.

Gender differences and similarities

>Most of gender differences show up in sexual desire and sexual activities.

Gender differences in sexual arousal:

1. Sexual excitation and inhibition – differences among men and among women are larger than the
differences between the sexes.
2. Sexual Orientation – gender differences in the connection between sexual arousal and sexual orientation.
3. Concordance – Gender differences in the connection between physiological and subjective sexual
arousal.

Main things that are found in literature when it comes to gender differences and sexuality:
1. Attitudes about casual sex: men are more approving of it than women
2. Sex Drive: men think about it more often, have more varied phantasies, they desire more sex and sexual
partners than women do
3. Masturbation: men are more likely to have masturbated than women
4. Use of pornography: men are considerably more likely to use pornography
5. Orgasm consistency: men more consistently have orgasms during sex (in terms of penis/vagina
intercourse)

Examples of attitudes:
1. Peterson and Hyde (2010)
Performed a meta-analysis of 834 papers, 730 studies, involving 1.5 million participants worldwide.
 Found very few sex differences. The only relevant difference was that in general men have more
permissive sexual attitudes than females. The largest difference was in the attitudes of casual intercourse:
overall men seem to be much more accepting than women.

Orgasm gap – women do not have that many and consistent orgasms during an intercourse as men do.
Women report experiencing pain during sex but they continue to do that. That’s why casual sex is usually
not that rewarding for women as it is for men. There is a speculation that after a woman knows her body
better, know what kind of stimulation makes her feel good, she will be just as interested in casual and all
sex as men are.
Some of the gender differences may be a mix of culture and biology.

Issues in the research of gender differences:

People may overestimate or underestimate when answering questions. Also, their answers might be
influenced by socially constructed ways of thinking. Also, the questions themselves are in a way ambiguous:
for example, what do we mean by masturbation?
Maybe, after all, there are not that many differences?

Are the differences bogus?

>Study using bogus pipeline. It involves connecting people with various mechanisms and telling them it is a
lie detector (Done in US). The scientists asked people questions on different conditions:
One of the questions: how many sex partners have you had in life?
It was asked on three different conditions:
1. Anonymous – women report more sexual partners than under an exposure threat, but less than under
“lie detector”, while men report more than both under the lie detector and under the exposure threat.
2. Bogus pipeline (lie detector) – gender differences is close to disappearing, but women report more
sexual partners than men.
3. Exposure threat (someone can see your answers) – women report considerably less sexual partners than
men

This study shows that the differences between men and women may consist not (only) in the actual
behavior, but (also) in the way the sexes interpret and evaluate their behavior.

Biological factors as distant contributors to those sex differences:

>Anatomy
>Hormones – a myth to a large degree. There are differences between men and women in testosterone
although women have four times as much testosterone as they have estrogens (yes, the absolute value is
higher in men, however). And this may play a role but also there’s not much correlation between
testosterone levels and sexual desire in men. To some degree we refer to hormones as a universal term to
designate all the biological differences that might play a role, while actual influence of hormones on the
differences between sexes is not that significant.

Cultural factors:
>Double standard (men are usually allowed more sexual freedom than women but this attitude is in the
decline, especially in Western societies)
>Gender roles (stereotype of man as initiator and woman as passive object may not encourage a woman to
take active steps to bring about her orgasm)

! Differences within genders are larger than differences between the genders.

Kinsey, 1948: Some males masturbate a lot, some never do that. (biggest interview study in the world).
Gender differences in Sexual Arousal:
Dual Control of Sexual Response model.
One excitation factor (SES) and two inhibition factors (SIS1/SIS2):

SES: Sexual arousal resulting from:

1. Social interactions
2. Visual Stimuli
3. Fantasy
4. Nonsexual Stimuli

SIS1 (inhibition factor more relevant to sexual function) “Threat of Performance failure” – threat of not
being good in sex, not performing well. Not getting aroused/losing sexual arousal due to:
1. Performance Concerns
2. Partner concerns
3. Low dependability – lack of focus

SIS2 (inhibition factor concerning how easily you lose your sexual arousal in response to external threats).
“Threat of Performance Consequences”. Not getting aroused/losing sexual arousal due to:
1. Risk of being caught
2. Negative consequences of sex
3. Pain - values

What is important, that SIS and SES do not really correlate with each other: you can score high in both.

The results of the study: men score higher on sexual excitation, women score more on sexual inhibition
than men do. These differences are significant in all studies based on this dual model.

What this also shows that there is a lot of variation within the sexes, and that those internal differences are
much bigger than the average difference between the sexes. Individual differences trump gender
differences.

Sexual orientation – concordance

The sexual orientation is a complex multi-dimensional thing. To some degree we don’t even know what
sexual orientation is about, there is still a lot of discussion going on about what it really consists of.

In the old days it was about whether you prefer a man or a woman. It is a simple and straightforward way
of looking at things. Another way of looking at it is to say “you are a men having sex with men thus you are
homo”. But then he says no, I’m straight, I just happened to have sex with men. So who are we to say then?
That the difficulty of the question of orientation was recognized we see in that in the 60’s when the
epidemic of HIW spread out, the studies of homosexual relationships referred not to “gays” but to “men
who have sex with men”.

So the question of sexual orientation is complicated: we rely on how people define themselves but we
don’t know where do they get their knowledge or whether they just don’t want to be seen as this or that.
How does sexual orientation relate to actual preferences? Preferences can be understood as sth that turns
you on. A lot of gay men say that women do not turn them on. But what can we know beyond the self-
report?

Paper “Sex differences and the Specificity of Sexual Arousal”

How does sexual orientation relate to sexual arousal?

For decades we have known that men respond in a very orientation-congruent way to sexual stimuli, which
means that when you show men straight men straight porn, they get aroused. When you show straight
men gay porn, they don’t. When you show gay men straight point, you don’t get arousal.
In general, men seem to be very congruent about the sexual arousal when it comes to different sexual
orientation groups.

In women, we don’t see that. Studie’s findings tells us that when a woman say “I’m straight/bi/homo”,
apparently she refers to sth else than what it is that turns her on. The studies have shown that women
become more or less equally aroused by all kind of porn. Everything turns them on.
All this might mean that sexual orientation might mean different things for men and women: for men it is
clearly related to what turns them on. For women it must be related to sth else.

Article which tries to explain this: “The Specificity if Women’s Sexual response and Its Relationship with
Sexual Orientations: A Review and Ten Hypotheses” by XXXXXXXX

Hypothesis 1: sexual plasticity – women demonstrate greater erotic plasticity than men, i.e. women have
sexuality that is more malleable by external influences such as social, cultural and other contextual factors.
Hypothesis 2: preparation hypothesis posits that any sexual stimulus, preferred or not, provokes an
automatic genital response that produces vaginal vasocongestion and genital lubrication as a protective
mechanism, reducing pain, and/or injury during wanted or unwanted vaginal penetration.

Gender differences in the role of our bodies when it comes to sexual arousal
Concordance – the connection of how we feel, the feelings of sexual arousal or desire and what our
genitals are doing on their part.

This is studied by the field of sexual psychophysiology (-the application of psychophysiological methods to
the study of sexual arousal processes in individual human participants, with special emphasis on the
interplay between the subjective and physiological determinants of arousal.)
This field measures sexual arousal with instruments: changes in the penis, changes in the vagina and other
physical changes are measured. And at the same time scientists ask people how do they feel.

What is interesting, is that when we start asking people how they actually feel, it becomes evident that
subjective and physical arousals are not congruent.

In men, erection is being measured.

In women, blood flow in the vagina; size, blood flow of the clitoris; labia; lubrication can be measured, but
most studies use Vaginal Photoplethysmography. Measures the blood in the vagina wall the light gets more
or less reflected (Vaginal Pulse Amplitude VPA). The blood changes occur only in response to sexual stimuli.

Concordance research results:

>relationship between genital and subjective responses varies within and between subjects.
>Relationship is generally less strong in women than in men.
Concordance and discordance.

Masters and Johnson have never taken these things into account. For them sexual arousal is one thing,
namely what happens in your genitals.

With psychophysiology we have a problem, what is sexual arousal then? In which should we believe more –
in genital arousal or in subjective arousal? We still don’t know.

Fact: women get increased blood flow and men get an erection during sleep and this has nothing to do with
sex.

Meta-analysis. The average correlation between subjective and genital arousal is higher in men.

These findings show that whatever happens with female genitals are not that good illustrations of how they
feel. It has been used against women in situations of rape: legal cases – but you got wet so you wanted it.
Even in Belgium. Women report orgasm in unwanted sex situations. Research shows that there is
disconnection between how are we feeling and what are we thinking.

Interpretation of differences in corcordance and discordance between men and women:

Chivers, 2010: “men may have high sexual concordance because their subjective sexual arousal is highly
influenced by their perception of the internal sensory cues that indicate the extent of their penile erection
(e.g. fullness in the penis and groin, tightening of suspensory ligaments)”
It means that men follow their penis: when it gets erect, they know that they are sexually aroused.
However, there is no evidence for this, that’s another gender stereotype.

Also, not all of these concordance studies show the same.

Discordance is also found among men: men can experience erections in the absence of feelings of sexual
arousal. Qualitative analysis also tells us that.
However, in most studies women show less correlations, but there are studies in which women show more
correlation.

Sum up: gender differences exist and have been measured in a lot of areas: human sexuality, behavior,
attitude. But they are not necessarily that large.
What is important, and the same in both men and women is that men are very different from each other
and women are very different from each other.
The extent to which biology determines differences is not known. The culture plays very important role
also. But in this context we have to admit that biology influences how we learn from our culture, too.

The sexology perspectives which report gender differences:

>Sexual orientation: for men it is connected to what turns them on, for women it is not that connected.
>Concordance more prevalent in men, discordance in women
>Inhibition and excitation differences.

Eight lecture – sexual aggression #me too

Student thesis : she thought that sexual violence was not a problem in KU Leuven.
She gave a number of scenarios and asked their opinion about them – to what degree would you see the
behavior described in situations as sexually transgressive (a word used in Europe, esp. Dutch speaking part.
In USA they say sexual violence or aggression).
Almost all women considered the behavior to be transgressive. 15 percent of them said that it has
happened to them (KU Leuven).
More than 25 percent of men did not think that it was sexually transgressive.

All these things depend on how we think on ‘consent’.

Me too

Started with the tweet by Alyssa Milano.

October 15, within hours, over 800.000 tweets.

Me too movement is not that new. Tarana Burke started a movement 10 years ago.

But it was the tweet which made everything explode.

It was not happening only in America.

Most situations of sexual violence are more complex than rapist coming from a bush.

Sexual violence occurs along a spectrum:

>Sexist humor
>Rape myths (Case in Belgium: man who committed rape was not sentenced because women was dressed
in a certain way) – women who drink too much ask for it
>Hyper-masculine behavior
>Media misogyny
>Sexual harassment
>Sexual assault and rape

Ways of engaging in behaviors that are sexually violent:

1. Grooming
2. Cyberlokking
3. Sexual intimidation
4. Revenge porn

Terms:
Sexual harassment
Sexual violence
Sexual aggression
Sexual assault

-the last three are used interchangeably, in similar ways.

In this context sexual abuse and sexual offending are not used because they apply to sexual abuse of
children.

Definitions of these behaviors vary between countries and organizations and researchers.

General definition of sexual harassment:

>unwelcome sexual advances
>requests for sexual favors
>other unwanted verbal or physical conduct of sexual nature
- of course, it depends on how we interpret these kinds of actions

Sexual assault
>Sexual penetration or sexual touching obtained by force (including threats of force) or incapacitation due
to drugs and alcohol.
In US when you are drunk, it is rape, because you cannot give consent drunk. Men are accused of rape in
cases when both of the parties were drunk. The fact that he was drunk too is not relevant to the legal
aspect in US.

Example: in Sweden now sex without explicit consent is rape (sex in this case it is penal vaginal intercourse).

How do we communicate consent?

Who’s doing what?

Perpetrators tend to be men (but not always). Perpetrator can be stranger, intimate partner, acquaintance.
One-time or repeating their actions.
Victims are mostly women/girls, but also men/boys, queer.

Consent - a feeling or decision, an explicit agreement, behavior indicative of willingness; something that
can be assumed or something that must be given explicitly; a discrete event or an ongoing, continuous
process. (Muehlenhard) These are potential constituents of consent. But some universities and legal
systems hold that consent has to be verbally communicated. But it doesn’t stop there because you can
change your mind. Consent is a continuous process. Behavior can also indicate consent but one has to
interpret behavior and that is where things can, and do, go wrong.

What helps to understand the complexity of the question of consent, is the distinction between consent
and wantedness (wanted experiences).
Peterson and Muehlenhard model which says that wanting and consent are two distinct concepts. Sex can
be wanted, but not consensual.

Prevalence of all these behaviors

Barbara Krahé – German researcher who’s done a lot of studies in Europe on sexual aggression.
Paper of the review of 27 countries. Reports by women.
The paper depicts enormous variation between EU countries in the numbers of sexual violence. It is so
because of methodological and conceptual differences. In NL numbers are very high because the verbal
aggression of sexual nature is considered to be sexual aggression.

Differences between US and Europe

Reflected in the research that is being done: In EU there’s less research into sexual violence than there is in
America.
In the EU research focuses on “young people”, not necessarily students.
In US, there is a huge amount of research on students.
Professor says that it is because in US students travel very far away from home so there’s a lot of concern
from universities on what is happening around campus.

The research in universities of America became a kind of precursor to Me Too. Especially much attention
was given to these topics under Obama.
“Dear Collegue” letter from government in which all universities across US were required to adequately
respond to the cases of sexual assault. Violations could leave universities vulnerable to legal liability.

Sexual Violence Elimination (SaVE) act, 2013

Universities have to keep records and disclose all crimes on and near campus, including sexual assault.
Also, prevention programes are required.
Violations can result in universities being fined.

The question then arises: why is this all necessary? Is sexual violence at universities an epidemic?

According to a lot of researchers and university administrations, it is a problem.

Older study by Kirkpatrick and Kanin, 1957

1954-1955 academic year, surveyed 291 college women about their experiences with men’s sexual
behavior. 55,7% reported having experienced at least one episode of sexual aggression during the period of
one year.

So the problem is not necessarily new, in this sense it is not an epidemic.

Is it unique to universities?
It is not.
Three studies that directly compared rates of sexual assault among college women and their same-age non-
college peers.
1 study found no difference.
2 studies found higher rates of sexual assault among non-college women.

Perpetrators

Studies show that relatively high rates of men report at least one sexually aggressive act in their lifetime.

Longitudinal research has demonstrated that many men who rape in college do so only during a single
academic year. Serial rape is not what you see in the majority of cases.

31.7% of college men say that they would force a woman to engage in sexual intercourse “if nobody would
ever know and there wouldn’t be any consequences.

Bogus pipeline vs Standard testing.

37,9% under bogus pipeline has admitted to engage in sexual coercion
8,6% admitted that under normal testing conditions

What plays a role in all of this?

Personality related factors (ex. Masculinity/femininity stereotypes; childhood history factors, family
relationships, preferences of casual sex, porn use – already in the 70’s there were tons of studies funded by
US government that looked at the negative effects of porn. Video’s brought porn into everyone’s home.
There was a lot of concern about the effects of porn on how men think about women. Now there’s less
concern about porn making men sexually violent because porn is everywhere and all men should be rapists
if porn is responsible for that. Nowadays porn research mostly focuses of the effect of porn on the
relationships (erectile dysfunction, etc.).
Psychosocial factors (aggression, self-esteem, ideas about sex)
Interpersonal factors (Intimacy deficit, social desirability, etc.)
Gender-based cognitions
Violence-related cognitions
Sebstance use

Professor’s research
Compering responses to consensual and coercive sex clips of those men who scored high on sexual
inhibition and of those who scored low.
The results were that the ones who scored low on sexual inhibition were aroused by coercive sex scenes
almost as much as by regular porn. The coercive sex scenes even did not involve explicit nudity.

What is interesting, that those having low levels of sexual inhibition got erections, but they did not like it.
They found the rape films very unpleasant to watch but they got erections anyways. Their facial expressions
and body language during watching those clips confirmed their statements.

Also, there is correlation in men between scoring low on sexual inhibition and reporting al least once
committed a sexually aggressive act (verbal, physical threats).

Sexual excitation was not correlative to engagement in sexual aggression. That means that it is not the
levels of sexual excitation, but the (low) levels of inhibition are what play a role in men’s proneness to
sexual aggression.

It is not the high sexual excitation but low sexual inhibition that predicts sexual aggression.

The confluence model of sexual aggression

There are so many things that can play into sexually aggressive behaviors but we tend to often point at just
one thing: certain personality types (antisocial men, hypermasculine men), or porn use, or something else.

Confluence model says that the combination of factors makes things go wrong in terms of sexual
aggression. Confulence of factors.

Two pathways:
1. Abusive home environment -> Early delinquent behavior -> Impersonal sexuality
2. Attitudes accepting violence towards women -> Narcissism

Also, low empathy feeds into that also.

Belgium – new development

A few years before me too a federal government started a program in Belgium Ja squared.
Federal government invited students from universities all over Belgium to come up with the idea of
prevention program. There was a contest.

Fun fact: the man who came up with confluence model recently wrote a review article which states that
those prevention programs do not work, not in US but in the whole world. Also, he has stated that these
prevention programs may actually have the opposite effect and lead to more instances of sexually
aggressive behavior by men.
If you start a prevention program without understanding what determines such behavior, you will end up
simply telling men not to do certain things.
Students came up with ideas, but Belgian government never actually provided money to create the real
prevention problem.

KU Leuven recently created office where people can report their negative experiences.

Ninth lecture – paraphilias and paraphiliac disorders

When deciding on ‘(ab)normality’ of sexual behaviors we have a problem of which reference scheme to
use: legal, psychiatric, etc.

Criminal sexual behavior – any behavior if defined as such by law. It is not the content of specific behavior
that leads to the definition by law as ‘abnormal’, it is the perspective of the law – what law is saying about
the behavior that it is criminalizing. (e.g. homosexuality)

Sexual violence – interpersonal sexual behavior without consent. It is not about attractions, it is a different
part of sexology.

Paraphilia/Paraphilic disorder – attraction to “atypical sexual object”/distress; harm [individual trait]

Hypersexuality/Sex addiction/Sex compulsion/Obsession - dysfunctional regulation of sexual behavior,

despite distress and aversive consequences. It is not about the content of one’s attractions, but about the
extent to which you can control your sexual desires.

Dimensions of sexual attractions

Sexual orientation – typical variations (homo, hetero, bi) and atypical variations (paraphilias)

Basic dimensions are sexual attraction and sexual arousal. In other words, in order to understand what a
sexual orientation is you have two questions you can answer: 1. What turns a person on in terms of sexual
attraction and 2. What makes person sexually aroused?

Difference between attraction and arousal:

Attraction refers to an image, a feeling.
Arousal refers to what is happening in a sexual way with you, what is happening to your genitals?

Difference between sexual orientation and romantic orientation: one can feel romantic attraction to a
person but do not feel sexual attraction to a person. For most people these orientations correlate.

Prevalence of paraphilias

Differences between wishes and doing: in general, there are more people who are attracted to atypical
sexual objects than there are people who actually have sex with those atypical objects.
Also, in general males are more prone to being attracted to atypical sexual objects.
A recent study by Ahlers et al. (2010) from Germany.
Asked 1915 males are they attracted to an unusual sexual object.
They used the term “Paraphilia-associated sexual arousal pattern”
They found that 62,4% of males are attracted at least to one atypical object.

If you ask the same males “are you distressed by your paraphilic attractions?” just 1,7% says that they are
distressed by them. It poses a question what leads to distress about the sexual attractions that people have.

21,8/100 of males have sadistic sexual desires

19,9/100 males are using sadistic sexual phantasies with masturbation
15,5/100 perform sadistic sexual behavior in interaction with other person
1,1/100 experienced these desires as problematic
0/100 distressed by that

One more question: what’s the relation between having some phantasies sometimes and having only very
atypical phantasies?

The fact of having paraphilia is compatible with having normal and typical attractions to human beings.

Basic views

What’s happening in sexology in terms of understanding and treating paraphilias: since 1886, con Kraft
Ebing, Psychopathia Sexualis, there has been a lot of debate in sexology about what is normal and what is
abnormal. Basically, at this moment there’s no consensus.

There are two broad perspectives on variation in sexual attractions:

1. Majority view: paraphilia is a disorder, we should cure and prevent it, control, or eventually learn to live
with it. Historically it has been the dominant view, which is saying that if a person has atypical sexual
attractions, especially when they are strong and exclusive (=person has no other sexual attractions), then
this is a disorder, something has gone wrong in the development of a person. The disorder should be cured.
If it is impossible, then we need to control and prevent paraphilia.
2. Minority view: no disorder. The problem is not that people have atypical attractions, but that there’s
discrimination, oppression, stigmatizing of those paraphilic attractions. So, the problem is not the variation,
the problem is how the variation is treated by the culture; the labelling of the attraction by the society as
normal or abnormal.
Homosexuality is best known historical example of such ‘abnormal’ sexual attraction. Until 1973
Homosexuality was classified as abnormal by American psychiatric association. Since then it’s normal
variation.
The paraphilic attractions are not disorders, they are variation, atypical in a statistical sense, but
nevertheless normal. We should not cure them, we should try to understand them, to accept them, to
develop them, so that you can incorporate those atypical attractions into your identity and you can practice
them in a pro-social way.
BDSM for example, is the best example of this minority view: “BDSM” with consent is not a disorder, it is
just a variation. But consent is key there.
Many people are arguing that we should remove BDSM from diagnostic and statistic manual of psychiatric
disorders. If you look at ICD (international classification of diseases), BDSM is no longer listed as psychiatric
disorder.

From the historical perspective, we don’t have an answer to what is normal or abnormal, we just have two
important main perspectives.
DSM (The Diagnostic and Statistical Manual of Mental Disorders) – classification system, used by the
American psychiatrists to determine the disorder according to the symptoms.

It says that paraphilia is a psychiatric disorder.

[definition of mental disorder]
Thus assumption is that if you have atypical attractions which are structural (intensive, strong), then you
have a psychiatric disorder and then you can be classified as a person that has psychiatric disorder.
Paraphilic attractions are a symptom of underlying psychiatric disorder.

Old version of DSM (1952):

Paraphilia is an expression of a pathological personality structure. The persons who have paraphilic
disorders ALSO have disordered personality structures – you have an antisocial psychopathic personality
disorder.
(DSM-5 is no longer making any assumption about the personality of a person with paraphilia or paraphilic
disorder. In other words, current DSM is saying that you can have a paraphilia which does not mean
anything about your personality. The evolution has been from inclusive definition to descriptive definition)

Definitions of DSM-5 (2013):

Difference between paraphilia and a paraphilic disorder. This distinction is an attempt of classification of
what counts as disorder and what does not. Classification goes as this:

“Atypical sexual attractions are defined as paraphilia.”

Paraphilia: “Any intense and persistent sexual interest other than sexual interest in genital stimulation or
prepatory fondling with phenotypically normal, physically mature, consenting human partners”
That’s the definition of the content. And the important point is that the definition of the content is not
sufficient to speak of a disorder. If a person just HAS these attractions to, say, children, but doesn’t harm
anyone, he DOES NOT have a disorder. (if you abuse a child, then you have not only a paraphilia, but also a
paraphilic disorder)

There is a problem: what if person says “I’m not distressed by having cancer thus I am not distressed by it”.
Also, the thing is that the criteria of doing harm should not be used as a criteria of a psychiatric disorder, it
should be used as legal criteria. Unfortunately, there is no consensus on these things in the field of
sexology. All doctors have to decide for themselves.
Many people are arguing that if paraphilia is with consent and there is no distress, then it is not a problem
even if it’s not normal or typical.

As a professional you can move to one of two sides, following the DSM:
If a person is attracted to BDSM and is distressed by it, professional can:
1. Thy to cure the distress and make the paraphilia accepted
2. Try to cure paraphilia and then there’s no distress.

Also, for example the treatment and approach to pedophilia is complicated by the fact that different
countries are using different legal age of consent.

Kinsey on paraphilias.
The problem is not the variation in sexual attraction, the problem is what society is doing with them.

Kinsey’s perspective resembles that of Peggy Kleinplatz and Lisa Diamond.

Theories: biological viewpoints

Causes of paraphilias. During the last twenty years sexology has moved from psychological explanations to
biological explanations. Biological explanations are dominant at the moment.

The line of reasoning: currently there is no hormonal explanation of paraphilias.

Some are saying that maybe unusual endrogenic levels before birth are playing a role in the development
of paraphilias. This, of course, raises a question, can a person be held responsible for his unusual sexual
attractions.

Genetic influences – not much of research. There is an indication that there’s a genetic component in the
development of pedophilia. However, nothing is known about the role of genetics in the development of
other paraphilias.

There are more indications that there are more neurologic atypical developments in persons with
paraphilias.
The prevalence of paraphilias in Parkinson and other neuro degenerative disorders show that prevalence is
higher than in a ‘normal’ population. This means that there are correlations between neuro circuits that are
disturbed and dysregulated by the diseases of Parkinson and dementia and having of expressing paraphilia.

There are also some ideas that the regulations of neurotransmitters, especially dopamine, serotonin and
norepinephrine is dysregulated in the paraphilias.

Thus people are arguing that paraphilia is not a psychological phenomenon, but is instead a neurobiological
phenomenon. It is not about psychological functioning, it has to do with brain disorder.

However, we are still not sure.

The brain of person’s with paraphilia (more like pedophilia*)

*because almost all the work on people with paraphilias is done on people with pedophilias, so there’s a
huge bias in this field. For example, there are no studies on the brain functioning of rapists from a
neurobiological perspective.

The brain: in pedophilia there are two different problems at hand:

1. Frontal cortex (responsible for executive functions – how do people regulate their decisions and
behavior). Some are saying that problem of sexual abuse of children is not a problem of sexual attractions,
but the problem of dysfunction of frontal cortex and executive functions. (In other words, if I fantasize
about having sex with children, it is not a problem. The problem is if I cannot stop having sex with them).
The problem is not enough control of your regulation capacity with children.
But this does not explain where from do the pedophilic attractions originate.

Part of the brain that is responsible for emotions and attractions. 4F’s.
There are two dysfunctions which are important when thinking from pathological perspective about curing
of pedophilia and other paraphilias:
1. Maybe a disorder in 4f’s part which is causing paraphilic attraction
2. If you have not enough regulative capacity, you will not control your behavior and as a result, you will act
upon your attractions.

This dual theory is called Dual Lobe theory.

Treatment of paraphilias:
1. Psychotherapy
2. Medications – SSRI’s, anti-endrogens

The treatments are not really effective. They are a little bit more successful in changing the control
mechanisms, so that people do not act upon their pedophilic attractions, but it is very hard to eliminate
attractions themselves.

Therapeutic approaches

Two perspectives:
1. Paraphilias are disorders and we should cure them
2. Accepting approaches: no curing, but accepting, no longer discriminating, integrating in identity
development.

From the perspective of Accepting:

Research by Lawrence and Love-Crowell on what’s a good therapist when you are working on people with
people having paraphilia from an accepting perspective.
(there are no therapists arguing for sex without consent, and for accepting sexual abuse)

The accepting perspective seeks to accept paraphilias with consent, without distress, without harm.

Their findings on what is a good therapist in this context:

1. Has cultural competency – know what people are doing, in what practices they engage, how they access
those practices.
2. Has an accepting, non-judgemental attitude.
3. Has knowledge, skills, and values
4. No pathologizing of BDSM
5. Has supervision and intervision
6. The therapist is a member of sexual minority
7. A sound knowledge of BDSM activities ad subculture

Know there is nearly no evidence on the effectiveness of the accepting therapy.

Tenth lecture

Law:
1. Private law
2. Public law
Criminal law is a very important part of public law. There are other parts of other law, for example, the
houses that you are allowed to build. The law that concerns sexuality is criminal law.
Criminal law is for punishing people who transgress certain norms, but it also is to protect the freedom of
people against the state: the state is not allowed to do more to us than is stated in the criminal law.

European court of human rights: decide whether the law of particular EU member state is in compliance
with European convention of Human Rights.

General principles of human rights developed by the European court. In the context of sexual activity there
are three general principles:
1. Right to privacy (‘private life’) – in the beginning it was a right of a person against the state. Later this
right was further developed: states were considered to have a positive obligation to ensure that other
persons are not violating each other’s rights to privacy.
2. Right to sexual autonomy – the right to decide for yourself whether or not you want to engage in a
sexual activity.
3. Right to sexual integrity – that’s a notion that has to do with human dignity.

>Looking at these three principles we can ask ourselves, how do member states protect the right of us
against unwanted sex.
>The question about the right to protection of wanted sex. Some people like to do strange things in a
sexual context: how should the state deal with that? We have a right to sexual autonomy but almost none
of our human rights are absolute – they can interfere with one another.

Example: in Belgium incestuous relationships are not by definition criminal offences if the youngest person
is older then 18. So there is in Belgium a protection of wanted sex between relatives as long as they are
both over 18.
Before Belgian independence Church dogmas and criminal law was correlative. The Belgian government
wanted to introduce new liberal freedoms and to distinguish criminal law from what church was saying so
people would be no longer punished for sins.
In 1967 Belgian government wanted to punish everything that is harmful. But not harmful in what
individual person suffers. The harm that they saw to be really important were sexual scandals, because they
were considered detrimental for families, and stable families were considered to be cornerstone of society.
So what they wanted to prevent with their criminal code was the outbreak of sexual scandals.
Incest was considered as sinful, but not as sth that the legislator has to deal with as long as all persons
involved were of certain age and freely consenting.

Unwanted sex – everything that is criminalized by Belgian law

1. Grooming – prepping a victim so he/she does not resist when you start to engage in sexual activity with
her/him. Making sure that all the thresholds to commit sexual abuse are lowered: making someone trust
you, having confidential relationship)
2. Cyberlokking – using ICT to influence people to commit crimes
3. Sexual intimidation (sexual harassment)
4. Exhibitionism
5. Voyeurism
6. Revenge porn
7. Indecent assault
8. Rape

Wanted sex – treated

1. Sexual ‘majority’ – age at which you can have sex – age of consent.
2. Incest
3. Same sex sex
4. Prostitution
5. Group sex
6. BDSM
7. Porn

SEX AND THE LAW – SELECTION OF CRIMINAL OFFENCES

Online Grooming
It is a criminal offence in Belgium (but all EU member states are obliged to criminalize online grooming
because this demand originated from the convention of Lanzarote. It tries to protect young people from
sexual crime)

Online grooming is an activity where a person tries to build a relationship of trust with (usually) young
person in order to abuse that person sexually without that person raising alarm.

If you want to abuse child and do it over a long period of time with as little risk of being caught as possible.
Pedophiles know that they are doing sth that is not allowed. So they invest into relationship of trust with a
victim because that is best guarantee that a victim will not tell anyone about the abuse.
Gifts, taking out, vacations. The child is of course emotionally invested in that person. This makes harder for
the victim to denounce what is happening.

Very often people who sexually abuse children are very pleasant and helpful people.

Conditions for grooming to be a crime:

1. Victim has to be younger than 16 year old; perpetrator older than 18.
2. Perpetrator has to do it over ICT (grooming can be also done in real life, but then it is considered a crime
only if there are actual sexual acts.)
3. There has to be proposition of a meeting (if it’s just a sexual conversation)
4. Material acts that could lead to such a meeting (perpetrator actually does things to make that meeting
happen)
5. It all should be done with an intention to commit a sexual crime against the child or youngster

This was introduced to Belgian law on the basis of convention of Lanzarote. Convention of Lanzarote tried
to create a new regulation because we have to be aware of the fact that ICT has made grooming of young
people much easier. They understood that it is not easy for parents to control the online behavior of their
children and they wanted to help them and be able to prosecute people who were using internet to search
for the victims.

Statutory rape & indecent assault

Belgian age of consent. Statutory rape – with penetration, but consenting; indecent assault – without
penetration.
Illogical Belgian system.

1. Sexual acts without penetration

2. Sexual acts with penetration

Rape
The notion of rape dates from a time when ‘rape’ meant penis in vagina that are not married. A man
penetrating a woman in a non-marital relationship was called ‘rape’.
By 1989 it was clear that there are other forms of sexual violence that have a very bad impact on people,
not just penis and vagina. The fact that you are married doesn’t change that.

Rape now is any form of sexual penetration committed on a person who does not consent. (it is no longer
only penis and vagina intercourse that counts as rape. You can be raped with another body part, with an
object; in the vagina, anus, mouth.)

2/3 of the cases of rape are committed by the perpetrator who is known to the victim. In most cases of
rape there is no violence and in majority of rapes there is no sign of violence afterwards.

Voyeurism & Revenge Porn

Voyeurism

Articles on voyeurism and revenge porn were introduced after another scandal in Belgian justice system.
Basketball coach prosecuted for secretly filming girls when they were showering or changing clothes. First
he was convicted but after appeal he was cleared of all charges. Initially he was convicted of indecent
assault, but the highest court in Belgium said that indecent assault needs to involve physical violence
between victim and the perpetrator.

It is a criminal offence to:

Observe a person or to make a visual or audio record or recording of a person,
>directly or by means of technical or other device
>without that persons’ consent or knowledge
>while that person is naked or performing an actual sexual act, and
>when that person could reasonably expect to be in circumstances where her or his right to privacy would
not be violated

Revenge porn

Revenge porn is kind of a bad title because whether you do it out of revenge or not, doesn’t matter for law.

It is a criminal offence to show, make accessible or distribute the visual or audio record or recording of a
naked person or of a person performing an explicit sexual act without that persons’ consent or knowledge,
even if that person had consented to the making of that record or recording.

The sentence is the same as for indecent assault. If you do this with young people the sentence goes up
really quickly. It means years and years of prison.

Prostitution and ‘debauchery’

It has the same legal framework as BDSM.

Prostitution – any sexual act for payment that involves physical contact.

Debauchery – larger notion than prostitution. It is considered everything that is contrary to ‘decency’, as a
value protected by the law, like that value is perceived at that time.
It involves BDSM, group sex, voyeurism/exhibitionism, bestiality, urolagnie, coprofagie.

Prostitution and debauchery in itself are not considered to be criminal offence under the Belgian law.
If you want to sell sex, it is not a criminal offence. The one buying the sex is also not an offender.
However, the pimp – the one who brings together the prostitute and her client is considered to be
committing criminal offence.
The rationale of legislator – we will never avoid prostitution, so what we have to do is preventing supply
and demand meeting each other. Behavior of middle man is criminalized.

Europe in general is struggling with prostitution. Sweden and France have criminalized buying sex.
On the other hand, there are Netherlands and Germany which have decriminalized everything. It is legal to
own brothel there.
All countries are doing these things in order to avoid illegal exploitation of people in prostitution.

The issue in Sweden and France – the prostitution goes to the underground.
Regulated prostitution also does not bring about the end of illegal prostitution and prostitution of minors.

The only exception on this third party system: when the prostitute or sex worker is a minor. In this case
buying sex is criminal offence.