Sexuality is the way in which people experience and express the instincts and feelings that make up sexual attraction for others. It is a normal part of human experience and is determined by several different factors, including genetic makeup, childhood upbringing, influences of those around us, and societal attitudes. Accepted norms of sexual behavior and attitudes vary greatly within and among different cultures.
Generally, what is "normal" and "abnormal" cannot be defined medically. However, when sexual behavior or difficulties cause significant distress for a person or the person’s partner, or cause harm, treatment is warranted.
There are wide variations in people’s sexual behavior, including interest in sex and the frequency of or need for sexual release throughout life. Some people desire sexual activity several times a day, but others are satisfied with infrequent activity (for example, a few times a year). Although younger people are often reluctant to view older people as sexually interested, most older people remain interested in sex and report satisfying sex lives well into old age.
(See also Sexual Function and Dysfunction in Men Overview of Sexual Function and Dysfunction in Men In men, sexual dysfunction refers to difficulties engaging in sexual intercourse. Sexual dysfunction encompasses a variety of disorders that affect Sex drive (libido) The ability to achieve... read more and Sexual Function and Dysfunction in Women Overview of Sexual Function and Dysfunction in Women Sexual dysfunction in women includes pain during intercourse, involuntary painful contractions (spasms) of the muscles around the vagina (vaginismus), lack of interest in sex (low libido), and... read more .)
Concepts of Sex and Sexual Identity
Various terms are used to talk about sex and gender. Sex and gender are not the same thing.
Sex refers to a person's anatomy and is often captured in the phrase "assigned at birth." A person may be considered to be male (AMAB, meaning "assigned male at birth"), female (AFAB, meaning "assigned female at birth"), or not clearly male or female (may be described as having ambiguous genitals Symptoms or being intersex).
Sexual identity/sexual orientation is the pattern of emotional, romantic, and/or sexual attractions that people have toward others. It also refers to a person's sense of personal and social identity based on those attractions, related behaviors, and membership in a community of others with similar attractions and behaviors. There are many different sexual identities, such as heterosexual (attraction to the opposite sex), homosexual (attraction to the same sex), bisexual (attraction to both sexes), and asexual (attraction to neither sex).
Gender identity is different from sexual identity. Gender identity is an internal sense of being male, female, or something else, which may or may not correspond to an individual's sex assigned at birth or sex characteristics (see Gender Incongruence and Gender Dysphoria Gender Incongruence and Gender Dysphoria Gender incongruence is a marked and persistent experience of incompatibility between a person's gender identity and the gender expected based on sex at birth. Gender dysphoria is diagnosed when... read more ).
Developmental Aspects of Sexuality
(See also Development of Sexuality and Gender in Adolescents Development of Sexuality and Gender During adolescence, children become young adults. They undergo striking physical, intellectual, and emotional changes. However, the path to adulthood is not a straight line. Adolescents do not... read more .)
Helping adolescents put sexuality and sexual identity into a healthy context is extremely important. Some adolescents struggle with their sexual identity and may be afraid to reveal their sexual identity to friends or family members, particularly if they have a non-heterosexual identity. Adolescents with a non-heterosexual identity are 2 to 3 times more likely to have suicidal and self-harming behaviors than their heterosexual peers. Adolescents and their parents should be encouraged to speak openly regarding their attitudes toward sex and sexuality.
Parents can damage their children’s ability to develop sexual and emotional intimacy by doing things such as the following:
Being emotionally distant
Punishing children too severely
Being overtly seductive and exploiting children sexually
Being verbally and physically hostile
Parents' opinions remain an important determinant of adolescent behavior in spite of the influences of social media and internet sources of information. Social media may form the basis for most information and misinformation on sexuality obtained by adolescents.
Changing Attitudes about Sex and Sexuality
Societal attitudes about sexuality and gender and what is acceptable vary greatly among cultures and have undergone radical change in some societies. Many people have become more comfortable with their own gender identity (how they present themselves to the world) and with engaging in sexual activities that might have been considered unacceptable in the past. As a result, social norms have been redefined, as illustrated by the following examples of attitude changes in Western culture over recent years.
Doctors have long recognized that masturbation is a normal sexual activity throughout life. Masturbation is the most common of all human sexual behaviors. About 97% of males and 80% of females have masturbated.
Masturbation is considered unhealthy only when it inhibits partner-oriented behavior, is done in public, or is compulsive enough to cause distress or dysfunction in work, social, or other settings. Although a normal sexual activity, masturbation may cause guilt and psychologic suffering that stems from the disapproving attitudes still held by some people. These feelings can result in considerable distress and can even affect sexual performance.
Masturbation often continues at some level even in a sexually healthy relationship. People who masturbate may have a better sense of well-being, better fertility, and achieve sexual satisfaction without risk of sexually transmitted infections.
Homosexuality is sexual attraction to people of the same sex. Like heterosexuality, homosexuality results from complex biologic factors and a person's experiences, leading to an ability to become sexually aroused by people of the same sex. And like heterosexuality, homosexuality is not a matter of choice. Homosexuality is widely recognized as a sexual orientation that is present from childhood. Adolescents may experiment with same-sex play, but this experimentation does not necessarily indicate an enduring interest in homosexual or bisexual activity as adults (see Development of Sexuality and Gender in Adolescents Development of Sexuality and Gender During adolescence, children become young adults. They undergo striking physical, intellectual, and emotional changes. However, the path to adulthood is not a straight line. Adolescents do not... read more ).
A 2022 Gallup poll of Americans found that the proportion of adults who identify as gay, lesbian, bisexual, or transgender has doubled since 2012 to a total of 7.1%. The proportions vary substantially by age group. Among adults who identify as gay, lesbian, bisexual, or transgender, 91% of those born between 1946 and 1964 ("Baby Boomers") self-identify as "straight/heterosexual" versus 76% of those born between 1997 and 2003 ("Generation Z"). See Gallup: LGBT Identification in U.S. Ticks Up to 7.1%.
Frequent sexual activity with different partners
For some heterosexuals and homosexuals, frequent sexual activity with different partners is a common practice throughout life. In Western cultures, this behavior has become more acceptable. However, having many sex partners is linked to the transmission of certain diseases (such as HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more , herpes simplex Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection... read more , hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more , syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more , gonorrhea, Gonorrhea Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover... read more and human papillomavirus Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) can be sexually transmitted and causes changes in cells, which can lead to genital warts or to precancer or cancer of the cervix, vagina, vulva, anus, or throat. Different... read more , which causes cervical cancer Cervical Cancer Cervical cancer develops in the cervix (the lower part of the uterus). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer usually results from infection... read more ) and may also signify difficulty in forming meaningful, lasting intimate relationships.
In the United States, most people engage in sexual activity before they are married or while they are not married. This behavior is part of the trend toward more sexual freedom in industrialized countries. However, most cultures discourage married people from engaging in sex with someone other than their spouse. This behavior occurs frequently despite social disapproval. One objective problem that results is the possible spread of sexually transmitted infections Overview of Sexually Transmitted Infections (STIs) Sexually transmitted infection (STI) refers to an infection that is passed through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with an infected partner... read more to unsuspecting spouses or sex partners.
When sexual feelings, behavior, or dysfunction cause significant distress for a person or the person's partner or harms another person, the person may need to be evaluated by a health care professional and treated. For example, people who have frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children, or nonconsenting adults or that involve suffering or humiliation of oneself or the partner (paraphilias Overview of Paraphilias and Paraphilic Disorders Paraphilias are frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of the person or a partner... read more ) may feel distressed by the paraphilia and seek or be referred for treatment.
Sexual problems may have physical causes, psychologic causes, or both. Problems with sexual function can affect both men and women. Men may experience decreased libido Decreased Libido in Men Decreased libido is a reduction in sex drive. Possible causes include psychologic factors (such as depression, anxiety, or relationship problems), drugs, and low blood levels of testosterone... read more , erectile dysfunction Erectile Dysfunction (ED) Erectile dysfunction (ED) is the inability to attain or sustain an erection satisfactory for sexual intercourse. (See also Overview of Sexual Dysfunction in Men.) Every man occasionally has... read more , the inability to ejaculate Inability to Ejaculate Inability to ejaculate (anejaculation) is usually caused by inability to reach orgasm (anorgasmia). It usually occurs as part of erectile dysfunction. (See also Overview of Sexual Dysfunction... read more , or premature ejaculation Premature Ejaculation Premature ejaculation is ejaculation that occurs too early, usually before, upon, or shortly after penetration. The cause is most likely to be anxiety, other psychologic factors, or very sensitive... read more . Women may experience low sexual interest Sexual Interest/Arousal Disorder Sexual interest/arousal disorder in women is lack of or decreased interest in sexual activity (low libido) and sexual thoughts and/or lack of response to sexual stimulation. Many factors can... read more or a sexual arousal disorder Sexual Interest/Arousal Disorder Sexual interest/arousal disorder in women is lack of or decreased interest in sexual activity (low libido) and sexual thoughts and/or lack of response to sexual stimulation. Many factors can... read more , pain during sexual intercourse (genito-pelvic pain/penetration disorder Genito-Pelvic Pain/Penetration Disorder Genito-pelvic pain/penetration disorder includes pain during sexual intercourse or other sexual activity that involves penetration and involuntary contraction of muscles around the opening of... read more ), or problems with orgasm (female orgasmic disorder Orgasmic Disorder in Women Orgasmic disorder is lack of or delay in sexual climax (orgasm) or orgasm that is infrequent or much less intense even though sexual stimulation is sufficient and the woman is sexually aroused... read more ). Sexual problems tend to be more common among older people. Many of these problems can be effectively treated.