Sexual and Gender Issues In Healthcare Sex and Gender Research
Research on sex and gender has grown exponentially over the past half-century, challenging traditional ideas and leading to significant modifications in our understanding of these concepts. Two major factors have driven the development of modern sex research: the need to explain sexual variation, such as prostitution, homosexuality, transvestism, and bisexuality, and the desire to find scientific methods for family planning and reproductive control.
Early pioneers in this field, such as Magnus Hirschfeld and Richard von Krafft-Ebing in Germany, explored what Krafft-Ebing termed “sexual pathology.” Although their key writings on topics like homosexuality and transvestism were not translated into English until the 1990s, their work continues to be studied today. In England, Havelock Ellis used historical and sociological data to challenge many of the sexual beliefs of his generation. All three researchers were significant data collectors of human sexual variation, but they could not fully explain the vast diversity in human behavior (Bullough, 1994).
Sexual Research in Health Care
In the 20th century, two Americans, John D. Rockefeller II and Margaret Sanger, played pivotal roles in establishing the United States as a center for sexual research. Rockefeller was initially interested in understanding the reasons behind prostitution, while Margaret Sanger, a nurse, focused on family planning. Rockefeller founded and funded the Committee for Research in the Problems of Sex in the 1920s, which concentrated on investigating the biological and psychological aspects of human sexuality. Sanger, in her campaign for effective birth control, emphasized the importance of changing public attitudes towards sexuality. At the time, disseminating any information about birth control or other sexual topics across state lines was illegal in the U.S.
Rockefeller and Sanger’s efforts laid the groundwork for significant advancements in sexual health. Rockefeller’s initiatives contributed to the publication of Kinsey’s groundbreaking studies on human sexuality in 1948 and 1953, which revolutionized our understanding of sexual behavior. Meanwhile, Sanger’s work led to the development of the contraceptive pill, significantly impacting women’s roles and status in the United States.
Public Sexual Education
For Sanger, public education about scientific knowledge of sexuality was crucial, while Rockefeller focused on understanding people’s sexual behaviors and motivations. Their combined efforts led to a shift in public perception and awareness about sexual health and behavior. Some topics, however, remain more controversial than others. For instance, the effects of pornography have been the subject of numerous studies, most of which suggest little correlation between viewing pornography and changes in the behavior of the viewer (Elias et al., 1999). This type of literature is seen as fantasy, similar to an adult Superman comic, and research generally indicates it is not harmful to adult readers.
Type of Literature and its Effect on Sexual Health
Research into gender identity is one of the most intensely studied topics in childhood development. By the time children begin speaking, they usually understand and apply gender identity to themselves, though they might not grasp the concept of gender constancy. For example, a young boy might believe he will become a girl later in life or vice versa. As children grow older, their gender identity strengthens, and they learn the gender roles expected of them in their culture, forming a gender role identification (Money & Ehrhardt, 1972).
However, not all children conform to the gender norms expected of them. Richard Green (1987) conducted a longitudinal study of 66 families with a boy aged 4 to 10 who exhibited feminine behaviors. Over 15 years, he compared these boys with a control group and found that socialization and parental treatment were not the primary determinants of gender identity. Most of the feminine boys in his study later identified as homosexuals, a development not observed in the control group. This and similar studies have given increasing credibility to biological factors in the development of homosexuality, bisexuality, and transgender behaviors, leading to a decreased emphasis on psychodynamic theories.
Research by the Bulloughs (1993) on transvestites and transsexuals suggested that gender and sexual behavior variations might have some biological basis. They argued against a single standard definition of male and female, suggesting instead that individuals exist on different levels of two overlapping bell-shaped curves. They proposed that some males have strong feminine components, while some females have strong masculine ones. These differences may not be directly due to genetic factors but may be influenced by developmental factors during the fetal period.
Boarding School Life and Homosexuality
Interestingly, research shows that boys and girls who engage in consensual same-sex experiences in boarding schools or other sex-segregated institutions do not become homosexual or lesbian as adults at a higher rate than those who do not have such experiences. There are notable gender differences; women, as a group, seem to have their sexual feelings more influenced by considerations of love and intimacy than men, which may result in greater fluidity in their sexual orientation (Peplau & Garnets, 2000; Peplau et al., 1999). Additionally, studies suggest that girls may be more traumatized by child sexual abuse than boys, though the reasons remain unclear.
Sexual Interaction
One of the most challenging topics for researchers to study is adult-child sexual interaction. The intense public emotions and ethical concerns surrounding this behavior make it difficult to research. Surveys of adult recollections of such experiences have yielded contradictory results. For example, one major study found that about 15% of women and 7% of men had at least one childhood sexual experience involving physical contact with an adult (Gorey & Leslie, 1997). However, definitions of “physical contact” in these studies are often unclear, and contemporary estimates vary widely.
A national sample by Finkelhor (1990) reported that 9% of males and 22% of females who reported being victims of attempted or completed sexual relations during childhood experienced these incidents with relatives. Children in disrupted, isolated, and economically disadvantaged families are generally at higher risk of sexual abuse than those in more stable, affluent families.
The effects of such relationships are not universally clear. Although most people vehemently condemn them and believe these experiences have long-term negative effects, data do not necessarily support this view (Rind et al., 1998). This finding, which contradicted popular beliefs, was quickly denounced by the U.S. Congress.
Recent Research on Sexual Function
Current research also focuses on sexual function in individuals with physical impairments, such as those who are blind, deaf, or severely physically handicapped. Only in the past few years have the sexual problems faced by these groups begun to be understood (Knuth & Smith, 1984; Rubin, 1997). Research has revealed a wide variety of sexual behaviors, prompting society to adjust its attitudes towards the people involved. However, there remain many unanswered questions, particularly regarding the development and prognosis of various paraphilias.
Public Health Implications and Education
Public health education about sex and gender is essential to promote healthy attitudes and behaviors. Educational efforts should be inclusive and consider diverse sexual identities, orientations, and behaviors to reduce stigma and improve health outcomes. Efforts to integrate comprehensive sexual education in schools and communities have shown promise in reducing rates of sexually transmitted infections (STIs), unwanted pregnancies, and sexual violence.
Research also highlights the importance of addressing sexual health disparities among marginalized populations, such as LGBTQ+ individuals, who face higher rates of mental health issues, substance abuse, and STIs due to discrimination and lack of access to appropriate healthcare services. Culturally competent healthcare services and inclusive sexual education can help address these disparities and promote health equity.
Conclusion
Sex and gender research has significantly evolved over the past century, challenging traditional views and fostering a deeper understanding of human sexuality and gender diversity. Pioneers like John D. Rockefeller II and Margaret Sanger laid the groundwork for modern sexual research, public sexual education, and the development of effective contraceptive methods.
Current research continues to explore the complexities of sexual behavior, identity, and function, highlighting the importance of both biological and social factors. While some questions remain unanswered, ongoing research and public health education efforts aim to promote a more inclusive and comprehensive understanding of sexual and gender health, ultimately improving outcomes for all individuals, regardless of their sexual orientation, gender identity, or physical abilities.