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Overview of Sexuality

By

George R. Brown

, MD, East Tennessee State University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Manuals.TopicPage.WhatsNew
  • This new chapter covers human sexuality independent of discussion of gender dysphoria and paraphilias (frequent, intense, sexually arousing fantasies or behaviors that may involve suffering or humiliation of oneself or a partner).

Sexuality is the way in which people experience and express the instincts and feelings that make up physical 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. As such, the types of sexual behavior that are considered normal vary greatly within and among different cultures. In fact, defining “normal” sexuality may be impossible.

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.

Concepts of Sex and Gender

Various terms are used to talk about sex and gender. Sex and gender are not the same thing.

  • Sex refers to a person's biologic status: male, female, or intersex.

  • Sexual identity refers to the sex to which a person is sexually attracted (if any).

  • Gender refers to a person's public, lived role as boy or girl, man or woman.

  • Gender identity is the subjective sense of knowing to which gender one belongs; that is, whether people regard themselves as male, female, transgender, or another identifying term (for example, genderqueer, nonbinary, agender).

  • Gender role is the objective, public expression of gender identity and includes everything that people say and do to indicate to themselves and to others the degree to which they are the gender with which they identify.

Some adolescents struggle with the issue of sexual identity and may be afraid to reveal their sexual identity to friends or family members. Helping adolescents put sexuality and sexual identity into a healthy context is very important. Adolescents and their parents should be encouraged to speak openly regarding their attitudes toward sex and sexuality. Parents' opinions remain an important determinant of adolescent behavior in spite of the influences of social media and internet sources of information.

Gender dysphoria involves a person's strong persistent feeling that their anatomic sex does not match their inner sense of self, or gender identity. This feeling of mismatch causes significant distress or greatly impairs the person's ability to function.

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.

Masturbation

Once regarded as a perversion and even a cause of mental disease, masturbation has now long been recognized as a normal sexual activity throughout life. About 97% of males and 80% of females have masturbated. In general, males masturbate more frequently than females. Many people continue to masturbate even when they are involved in a sexually gratifying relationship. Although masturbation is normal and is often recommended as a safe sex option, it 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.

Homosexuality

As with masturbation, homosexuality, once considered abnormal by the medical profession, has not been considered a disorder for more than four decades. It is widely recognized as a sexual orientation that is present from childhood. An estimated 4 to 5% of adults are involved exclusively in homosexual relationships throughout their lives, and an additional 2 to 5% of people engage in sex with people of either sex (bisexuality). 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).

Gay and lesbian people discover that they are attracted to people of the same sex, just as heterosexuals discover that they are attracted to people of the opposite sex. The attraction appears to be the result of biologic and environmental influences and is not a matter of choice. Therefore, the popular term “sexual preference” makes little sense in matters of sexual orientation, whether the orientation is heterosexual, homosexual, or bisexual.

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, herpes simplex, hepatitis, syphilis, gonorrhea, and human papillomavirus, which causes cervical cancer) and may also signify difficulty in forming meaningful, lasting intimate relationships.

Extramarital sex

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 developed 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 diseases to unsuspecting spouses or sex partners.

Sexual Problems

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 practitioner 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) 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, erectile dysfunction, the inability to ejaculate, or premature ejaculation. Women may experience low sexual interest or a sexual arousal disorder, pain during sexual intercourse (genitopelvic pain/penetration disorder), or problems with orgasm (female orgasmic disorder). Sexual problems tend to be more common among older people. Many of these problems can be effectively treated.

People's sexual problems can be influenced by their parents, who 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

  • Rejecting children

  • Being cruel

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