Healthcare and Sexual & Gender Issues
Sex and Gender Research
Sex and gender research has exploded over the course of the past
half century and consequently traditional ideas have been challenged and, in
many cases, radically modified.
Two factors seemed to be the driving forces
behind modern sex research: the need to explain the existence of sexual
variation, eg, prostitution, homosexuality, transvestic, and bisexuality on the
one hand, and the desire to find some scientific means of family planning or
control of reproduction and disseminating information about this on the other
hand.
Germany was the home of early researchers such as Magnus Hirschfeld and
Richard von Krafft Ebing, who explored what Krafft-Ebing called sexual
pathology. Both authors are still reading today although the key writings of
Hirschfeld on homosexuality and transvestic were not translated into English
until the 1990s.
In England, the leading figure was Havelock Ellis, who used
historical and sociological data to challenge many of the sexual beliefs of his
generation. All three were data collectors about human sexual variation but
were not able to explain why there was so much variation in human behavior
(Bullough, 1994).
Sexual Research in Health Care
In the 20th century two Americans, John D. Rockefeller II and
Margaret Sanger, a nurse, were extremely influential in establishing the United
States as a center for sexual research.
Rockefeller originally was concerned
with understanding why prostitution and prostitutes existed, while Margaret
Sanger was concerned with family planning. Rockefeller in the 1920s established
and financially supported the Committee for Research in the Problems of Sex,
which concentrated on research about the biological and psychological sources
of human sexuality.
Sanger in her campaign for effective birth control realized
the importance of changing public attitudes about sexuality, since actual
dissemination of any kind of information about birth control or many other
kinds of sex information across state lines was illegal in the United States.
Public Sexual Education
For her, educating the public about what science knew was all important, while
Rockefeller felt finding out about what people did sexually as well as the
reasons for doing it was the key.
One result of Rockefeller’s efforts were the
books by Kinsey and colleagues (1948, 1953), which revolutionized the understanding
of human sexuality, and the ultimate result of Margaret Sanger’s work was the
development of the pill for contraception which contributed immeasurably to a
changing role and status for women in the United States.
Some sexual topics are
more controversial than others. For example, concern over the effects of
pornography has led to many studies on the topic, with the majority of them
concluding that it seems to have little correlation with the actual conduct of
the viewer or reader.
Type of Literature and Affect on Sexual Health
It is a sort of a fantasy literature, an adult Superman
comic, which almost all research indicates is not particularly harmful to the
adult reader (Elias et al., 1999). One of the most intensely studied topics in
childhood is that of gender identity.
Usually by the time children begin to
talk they can apply the appropriate gender identity to themselves, although
they do not necessarily understand the concept of gender constancy. A little
boy may believe, for example, that at some later point in life he will be a
girl or vice versa.
Gradually as their gender identity becomes stronger, they
also learn gender roles, what is expected of females or males in the culture,
and begin to acquire a gender role identification (Money & Ehrhardt, 1972).
Not all children accept or adopt the norms expected of them.
One study of this
nonconformity was by Richard Green (1987). He recruited 66 families in which
there was a boy (age 4 to 10 years) who was regarded as extremely feminine and
in a longitudinal study over a period of 15 years he compared them with a
sample of other boys.
He started with the assumption that socialization and
parental treatment were the main determinants of gender but found that this was
not the case. Most of the feminine boys in his study later identified as
homosexuals, a development which did not take place in his control study.
This
study and similar studies tended to give growing credibility to biological
factors in the development of homosexuality, bisexuality, and transgender
behaviors, resulting in a deemphasis on psychodynamic theories. There is still
a lot that remains unknown.
The Bulloughs (1993) in their studies of
transvestites and transsexuals argued that there were variations in gender and
sexual behavior which had some biological basis and that, instead of one
standard of definition of what was male and what was female, individuals
appeared on different levels of two bell-shaped curves which had considerable
overlap.
There were in essence females who had a strong masculine component and
males with a strong feminine one. These differences were not due to genetic
factors per se (although this might have entered in) but more to developmental
factors in the fetal period.
Studies have shown that adults who as children
witnessed parents engaging in sex were not harmed by so doing (Okami, Olmstead,
Abramson, & Pendleton, 1998; Lewis, RJ, & Janda, 1988).
Boarding School Life and Homosexuality
Interestingly, boys and girls who engage in consensual same sex
experiences in boarding schools or other sex-segregated institutions do not
seem to become homosexual and lesbian as adults in any greater proportion than
those who do not. There are also gender differences.
Women as a group seem to
have their sexual feelings more strongly influenced by considerations of love
and intimacy than men do, and this might result in greater fluidity in their
sexual orientation than that of men (Peplau, LA, & Garnets, 2000; Peplau,
LA, Spaulding, Conley, & Veniegas, 1999). Girls seem to be more traumatized
by child sexual abuse than are boys, but the reason why is still not clear.
Sexual Interaction
One of the most difficult problems for researchers to study is that
of adult child sexual interaction. One reason for the difficulty is the intense
emotions involved by the general public to such behavior. Perhaps the easiest
way to do so is to survey adult collections of such experience.
Even here
results are contradictory. One major study found about 15% of women and 7% of
men had at least one childhood sexual experience involving physical contact
with an adult (Gorey & Les lie, 1997).
But the definition of what physical
contact was is unclear. Other contemporary estimates based on random samples of
adults indicate different rates, ranging from 12% to 55% for females and from
3% to 6% for males. Figures vary to some extent as a function of the population
being sampled, the definition of sexual abuse, and the cut-off age employed
(eg, before 14, 16, or 18).
In the national sample by Finkelhor (1990), 9% of
the males and 22% of the females who reported being victims of attempted or
completed sexual relations during childhood had experienced them with
relatives aunts or uncles, siblings, parents or step parents, or cousins.
In
general, it appears that children in disrupted, isolated, and economically poor
families are at higher risk of sexual abuse than youngsters in more stable and
high-in-come families.
The effect of such relationships is not clear. Although
most people vehemently condemn them and claim that associations have direct
effects on the child that last into adulthood, the data did not necessarily support
such a view (Rind, Tromo, Viten, & Bauserman, 1998).
This finding, which
was a summary of numerous studies, went contrary to popular beliefs and was
quickly denounced by the US Congress.
One of the areas in which current research is focused is sexual
function in physically compromised, the blind, the deaf, the severely
physically handicapped; it is only in the past few years that the sexual
problems have begun to be understood (Knuth & Smith, 1984; Rubin, E.,
1997).
Research into sexuality has revealed a wide variety of sexual behaviors
and society is adjusting its attitudes towards the people involved. There are,
however, many questions that sex research has not yet answered, particularly in
how some of these paraphilias develop and what is the prognosis of many of
them.