THE AMERICAN ACADEMY OF CLINICAL SEXOLOGISTS

AT MAIMONIDES UNIVERSITY

GUIDE FOR MENTAL HEALTH PROFESSIONALS

IN THE RECOGNITION

OF SUICIDE AND RISKS TO ADOLESCENT HOMOSEXUAL MALES

A DISSERTATION SUBMITTED TO THE FACULTY OF THE AMERICAN

ACADEMY OF CLINICAL SEXOLOGISTS AT MAIMONIDES UNIVERSITY IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

BY

KENDALL FIELDS

NORTH MIAMI BEACH, FLORIDA

DECEMBER 2005

Copyright © by Kendall L. Fields

All rights reserved

ii

DISSERTATION COMMITTEE

William Granzig, Ph.D., MPH, FAACS. Advisor and Committee Chair

James O Walker, Ph.D. Committee Member

Peggy Lipford McKeal, Ph.D. NCC, LMHC Committee Member

Approved by dissertation Committee

Maimonides University North Miami Beach, Florida

Signature Date

______William Granzig, Ph.D.

James Walker, Ph.D.

_ Peggy Lipford McKeal, Ph.D.

iii

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to those who assisted in the formulation of this dissertation: Dr. William Granzig, professor, advisor, and friend, who without his guidance, leadership, and perseverance this endeavor would not have taken place. To Dr.

Walker, thank you for your time, patience, insight and continued support. To Dr.

McKeal, thanks for you inspiration and guidance. You kept me grounded and on track during times when my motivation was waning. To Dr. Bernie Sue Newman, Temple

University, School of Social Administration, Department of Social Work and in memory of Peter Muzzonigro for allowing me to reprint portions of their book.

To those professionals who gave of their time to complete and return the survey questionnaires. To my darling wife, Irene Susan Fields, who provided support and faith in me.

iv ABSTRACT

This qualitative research study reviews the literature associated with the high risk of suicide among adolescent homosexual males. It has been reported that gay youth are two to three times more likely to attempt suicide and may comprise up to 30 percent of completed youth suicides annually. Suicide is not only distressing to clinicians caring for youth at risk, but it is also a significant liability risk to the clinician. Assessment of suicide is one of the most important functions exercised by mental health professionals.

This study and review looks at these risks, liabilities, experience and training of clinicians and suggests ways of limiting suicidal behavior in homosexual adolescent males.

Despite progress in defining the predictive factors associated with suicide, knowledge on which to base sound clinical and public policies regarding suicide prevention and treatment remains remarkably limited for this group. This study focuses on what counselors do know and what they need to know in order to work effectively with sexual minority adolescents. Several approaches have been suggested in the past according to research. One recommended approach suggested diversity training, which begins with awareness of the counselors’ own attitudes and beliefs, moves into the acquisition of knowledge, and then toward the final stage of skill acquisition. It is this writer’s opinion that effective counseling with homosexually oriented youth, or those questioning their sexual identity, cannot happen if the provider has not first come to terms with his or her own feelings and attitudes about homosexuality

Currently, no known empirical data exists that encompasses or addresses the question of what mental health professionals should be aware of, or know, concerning homosexual adolescent male’s risk of suicide. There is no data addressing the number of

v homosexual males seen in therapy who have active or passive thoughts of suicide directly related to their homosexual identity.

This review of literature summarizes some of the current knowledge regarding the risk to adolescent homosexual males. A list of topics by chapter provides an overview of covered areas: Introduction to the Problem, A Brief History of Suicide, Mental

Health/Higher Level of Pathology, Substance Abuse, Social Support/Relationships,

Social Stigma Coming Out, Homophobia and Suicide.

Information and later a guide to assist mental health professionals in the assessment, treatment, and understanding of the intricate problems associated with this special population are addressed by the author.

vi TABLE OF CONTENTS

Pages

TITLE PAGE------

APPROVAL------iii

ACKNOWLEDGEMENTS------iv

ABSTRACT------v

Table of Contents------1

Chapter 1 – Introduction------2

Chapter 2 – Brief History of Homosexuality------6

Chapter 3 – Suicide ------16

Chapter 4 – Substance Abuse------22

Chapter 5 – Social Support/Relationships------32

Chapter 6 – Social Stigma coming out------40

Chapter 7 – Mental Health/Higher Level of Pathology------46

Chapter 8 – Homophobia ------58

Chapter 9 – Conclusions------78

APPENDIX A. SURVEY INSTRUMENT------88

APPENDIX B. RESULTS------92

APPENDIX C. DEFINITIONS------99

REFERENCES ------166

1 CHAPTER ONE

INTRODUCTION

A tiny blade will sever the sutures of the neck, and when that joint, which binds together head and neck, is cut, the body’s mighty mass crumbles in a heap. No deep retreat conceals the soul, you need no knife at all to root it out, no deeply driven wound to find the vital parts; death lies near at hand…. Whether the throat is strangled by a knot, or water stops the breathing, or the hard surface, or flame inhaled cuts off the course of respiration---be it what it may; the end is swift. (Seneca, 1935)

Death, as Seneca states, has always lain close at hand: yet it is a mystery why the first person to kill him/herself did. Was it a sudden impulse, or prolonged disease? An inner voice commanding death? Perhaps shame or the threat of capture by an enemy tribe? Seneca (1935), a Roman statesman and philosopher, was forced to take his own life after having been accused of conspiracy by Nero, emperor of Rome. Three years later

Nero, too, was forced to commit suicide.

There is no written data reflecting an account of when or where the first suicide took place, or the method formulated to consummate it. What is known is that suicide can be extremely contagious and final (Jamison 1999). The assessment of suicide is among the most important functions exercised by mental health professionals. This qualitative research study reviews the literature associated with the high risk of suicide among adolescent homosexual males. It has been reported recently that gay youth are two to three times more likely to attempt suicide than others and that they may comprise up to

30 percent of completed youth suicides annually (Gibson 1989). It is also recognized, based on the best research data available (Bagley and Tremblay 1996; Bell and Weinberg

1978), which a major suicide problem has existed in the gay and bisexual male youth

2 population for at least 50 years. Available information suggests that the problem has existed for at least 100 years. Statistics on behaviors that may precede completed suicides also indicate the seriousness of the problem. A study using a large, nationally representative sample found that 31 percent of eighth graders and 36 percent of tenth graders reported having thought at some point in their lives about committing suicide, while 13 percent of eighth graders and 15 percent of tenth graders reported having attempted suicide (Windle, Miller-Tutzauer, and Domenico 1992).

Even these striking estimates, based on World Health Organization (WHO) and government surveys, almost certainly underestimate suicide rates by at least one third and possibly by half, due to underreporting (American Association of Suicide 1998;

Jamison 1999).

Currently, no known empirical data exists that encompasses or addresses the question of what mental health professionals should be aware of, or know, concerning homosexual adolescent male risk of suicide. As such, this review of the literature represents an attempt to provide information and, later a guide to assist mental health professionals in the assessment, treatment and understanding of the intricate problems associated with this special population. Areas of specific concern are

• history of homosexuality

• mental health problems / higher level of pathology

• social support

• social stigma coming out process

• homophobia (sexual prejudice)

• substance abuse

3 • suicide

In a culture already uncomfortable about adult sex and worried about adolescent sexual behavior, the idea of homosexual sex generates hostile and almost reflexive contempt. Society’s abhorrence, and hence avoidance, of homosexuality is reflected in the dearth of articles in the professional literature of counseling and psychology. From

1978-1989, only 43 of 6,661 articles published in six major psychological journals addressed gay and lesbian issues (Buhrke, Ben-Ezra, Hurley, and Ruprecht, 1992). This omission is even more striking when reviewing literature on adolescent homosexuality.

For example, from 1977 to 1993, only three articles on gay and lesbian adolescents were published in The School Counselor , the primary professional journal for a counseling group that has access to the entire population of adolescents. This neglect, coupled with lack of coverage in counselor preparation programs (Bodnar and Fontaine, 1993; Buhrke

1989; Graham, Rawlings, Halpern, and Hermes, 1984), essentially precludes professionals from receiving adequate preparation for ethical and competent counseling of gay, lesbian, and bisexual adolescents.

What do counselors need to know in order to work effectively with sexual minority adolescents? Pederson (1988) identifies a tripartite approach to diversity training that begins with awareness of the counselor’s own attitudes and beliefs, moves into the acquisition of knowledge, and then toward the final stage of skill acquisition. Effective counseling with homosexually oriented youth or those questioning their sexual identity cannot happen if the provider has not first come to terms with his or her own feelings and attitudes about homosexuality.

4 The primary goal of this study is to provide information to mental health professionals that will assist them in providing an appropriate level of safety and security for at-risk homosexual adolescent males thus decreasing the high incidence of suicide to this population. The results attained from this editorial review and survey of mental health professions will assist in the development of a guide designed to enhance mental health professional’s knowledge and understanding of the risks to adolescent homosexual males. This information although addressing mainly adolescent homosexual males, may be applied to those whose sexual orientation is other than heterosexual.

5 CHAPTER 2

BRIEF HISTORY OF HOMOSEXUALITY

Modern attitudes toward homosexuality have religious, legal, and medical underpinnings. Before the High Middle Ages, homosexual acts appear to have been widely tolerated or ignored by the Christian church throughout Europe. Beginning in the latter twelfth century, however, hostility toward homosexuality began to take root, and eventually spread throughout European religious and secular institutions. Condemnation of homosexual behavior as unnatural, which received official expression in the writings of Thomas Aquinas and others, became widespread and has continued through the present day (Boswell 1980).

Religious teachings soon were incorporated into legal sanctions. Many of the early American colonies, for example, enacted stiff criminal penalties for sodomy which the statutes often described only in Latin or with oblique phrases such as wickedness not to be named. In some places, such as the New Haven colony, male and female homosexual acts were punishable by death (Katz 1976). By the end of the 19th century, medicine and psychiatry were effectively competing with religion and the law for jurisdiction over sexuality (Katz 1976). As a consequence of the competition, discourse about homosexuality expanded from the realms of sin and crime to include that of pathology. This historical shift was generally considered progressive because a sick person was less blameful than a sinner or criminal (Chauncey 1982, 1983; D’Emilio and

Freedman 1988; Duberman et al. 1989).

Even within medicine and psychiatry, however, homosexuality was not universally viewed as a pathology. Richard von Kraft-Ebing described it as a

6 degenerative sickness in his Psychopathia Sexualis , but Sigmund Freud and Havelock

Ellis both adopted more accepting stances. Early in the twentieth century, Ellis (1901) argued that homosexuality was inborn and therefore not immoral, that it was not a disease, and that many homosexuals made outstanding contributions to society (Robinson

1976).

Karl Heinrich Ulrichs (1825-1895)

Nineteenth-century German activist Karl Heinrich Ulrichs was the first modern

theorist of homosexuality. A tireless campaigner against injustice, he directed early

sexologists to the subject of homosexuality. Using the pseudonym Numa Numantius he

published in 1864-1865 five booklets under the collective title Forschungen über das

Rathsel der mannmännlichen Liebe (Researches on the Riddle of Male-Male Love). They

set forth a biological theory of homosexuality, the so-called third sex theory, which he

summed up in the Latin phrase anima muliebris virili corpore inclusa (a female psyche

confined in a male body) (Kennedy 2004).

Ulrichs coined the term Urning for the male subject of this condition; he variously

called the female counterpart Urningin, Uranierin, Urnin, and Urnigin. The term

homosexual, coined by Karl Maria Kertbeny, first appeared in 1869 (Kennedy 2004).

Using his real name in his next booklet, Ulrichs described his appearance at a

Congress of German Jurists in Munich, where on August 29, 1867, he urged repealing the

anti-homosexual laws. He was shouted down and not allowed to finish, but this was the

first time that a self-acknowledged Urning / homosexual spoke out publicly for his cause.

Thus, Ulrichs was not only the first theorist of homosexuality, but also the first

homosexual to come out publicly (Kennedy 2004).

7 Ulrich’s impact on sexology was more significant for directing medical researchers’ attention to the subject of homosexuality than for changing their view of it.

Richard von Krafft-Ebing, for example, whose book Psychopathia sexualis (1886) established the medical view of homosexuality, became interested in the subject as a result of Ulrichs writings. Ulrich’s original biological theory of homosexuality has since been abandoned, but for more than a century some form of biological determinism has prevailed, both in the popular mind and in scientific circles; it has been adopted by both homosexual liberationists and their enemies (Kennedy 2004).

Ulrich will be best remembered for his courageous stand for the equal rights of all and, as Magnus Hirschfield wrote, “as one of the first and noblest of those who have striven with courage and strength in this field to help truth and charity gain their rightful place” (as cited in Kennedy 2004, 10).

Richard von Krafft-Ebing (1840-1903)

Psychopathia Sexualis , first published in German in 1886 and in English in 1892 by the German sexologist Richard von Krafft-Ebing, was among the first works in the new discipline to argue that homosexuality was part of nature and could thus not be condemned. Here the voices of real-life homosexuals were for the first time recorded, and these case studies led Krafft-Ebing to the belief that homosexuality was not an acquired vice. The idea of the naturalness of homosexuality was at this time radical. Accordingly, the sexual knowledge was disseminated in a somewhat conspiratorial manner, as it was ostensibly directed solely at medical and legal practitioners to exclude the lay reader.

During his lifetime, Krafft-Ebing revised Psychopathia Sexualis twelve times: the

first edition was a mere 110 pages long and contained 45 case studies; the last edition

8 held an impressive 238 case studies on 437 pages. The main thesis Krafft-Ebing put forward in this work was that there exists numerous sexual behaviors and sexual practices. He considered them to be natural variations of the same phenomenon, in the same way that, for example, different eye colors are natural. He was eager to identify various sexual practices. For example, he made popular the terms sadism and masochism as he explored information given by others.

While he thought that some individuals engaged in acts of vice which he called

Pervesitat (translated as perversity), Krafft-Ebing believed that the majority of people fell

into the different category of Perversion (translated as perversion).

Under the heading of perversion he assembled a vast range of sexual desires that

differed from the heterosexual norm. Krafft-Ebing emphasized that perversion was not

criminal behavior, and he took part in Magnus Hirschfeld’s petition to abolish paragraph

175 of German law, which criminalized homosexuality. In Psychopathia Sexualis , he

offered a forum for the perverts themselves, in which their experiences were recorded,

not least for their own use.

Magnus Hirschfeld (1868-1935)

Magnus Hirschfeld was born to Jewish parents in the Prussian city of Kolberg, on

the Baltic Sea, on May 14, 1868. He studied modern languages in Breslau, and then

medicine in Strasbourg, München, Heidelberg, and Berlin, where he took his degree in

1892 (Bauer 2004).

As the most prominent leader of the early homosexual emancipation movement in

Germany, Hirschfeld campaigned tirelessly on behalf of the sexual rights of minorities.

9 He attempted to create organizational and editorial frameworks that would support the liberation of the sexually oppressed (Bauer 2004).

In 1897, Hirschfeld founded, along with Eduard Oberg, Max Spohr, and Franz

Josef von Bülow, the Wissenschaftlich-humanitäre Komitee (Scientific-Humanitarian

Committee), whose first project was a petition calling for the repeal of the anti- homosexual paragraph 175 of the Imperial Penal Code of 1871. Paragraph 175 was the

German law prohibiting sex between men. Strengthened by the Nazis, it was the statute under which homosexuals were sent to concentration camps (Bauer 2004).

In 1899, Hirschfeld began publishing the Jahrbuch für sexuelle Zwischenstufen

[Yearbook of Intermediate Sexual Types ], the world’s first scientific journal dealing with

sexual variants. It was published until 1923. The studies published by the Yearbook range

from articles about homosexuality among primitive people to literary analyses and case

studies. Hirschfeld was a widely recognized speaker and a prolific writer. His

publications dealt not only with all major areas of the nascent sexual science, but also

with general health issues, sexual reform, politics, the history of morals, and racism

(Bauer 2004).

At an early stage of film history, Hirschfeld also participated in the production of

Anders als die Andern (Different from the Others), the first homosexual liberation film.

The somewhat melodramatic silent film premiered in May 1919. Its purpose was to expose the evil of paragraph 175 and the vulnerability of sexual variants to blackmail because of the paragraph. It was banned by the German government in August 1920

(Bauer 2004).

10 When the Nazis came to power in 1933, they destroyed the Institute for Sexual

Science, including its library and files, the largest archive of its kind in the world. In

1934, the Nazi regime deprived Hirschfeld of German citizenship. After moving to

Ascona in Switzerland and then briefly to Paris, Hirschfeld finally settled in Nice in the south of France in 1934. He died there on his 67th birthday, May 14, 1935 (Bauer 2004).

Havelock Ellis (1859-1939)

Though he was trained as a doctor, Englishman Havelock Ellis never practiced medicine. Instead, he devoted his life to the scientific study of sex. His most controversial book, Sexual Inversion, was suppressed in England because it advocated tolerance, but it eventually garnered a wide following in England and the U. S. Ellis’ interest in sex and sexuality probably came from his own unorthodox tastes. He was a confirmed masturbator and found female urination exquisitely stimulating. A diffident man disinterested in fame or followers, Ellis never gained the following of his contemporary

Sigmund Freud. Early in the twentieth century, Ellis (1901) argued that homosexuality was inborn and therefore not immoral, that it was not a disease, and that many homosexuals made outstanding contributions to society (Robinson, 1976).

Sigmund Freud (1856-1939)

Sigmund Freud’s basic theory of human sexuality was different from that of

Ellis. He felt that all human beings were innately bisexual, and that they become heterosexual or homosexual as a result of their experiences with parents and others

(Freud, 1905). Nevertheless, Freud agreed with Ellis that a homosexual orientation should not be viewed as a form of pathology.

11 Later psychoanalysts did not follow this view, however. Rado (1940, 1949) rejected Freud’s assumption of inherent bisexuality, arguing instead that heterosexuality is inborn and that homosexuality is a phobic response to members of the other sex. Other analysts later argued that homosexuality resulted from pathological family relationships during the Oedipal period (around 4-5 years of age) and claimed that they observed these patterns in their homosexual patients (Bieber et al. 1962).

Charles Socarides (1968) speculated that the etiology of homosexuality was pre-

Oedipal and, therefore, even more pathological than had been supposed by earlier

analysts (Bayer 1987; Lewes 1988; Silverstein 1991).

Alfred Kinsey (1894-1956)

A more tolerant stance toward homosexuality was adopted by researchers from

other disciplines. Zoologist and taxonomist Alfred C. Kinsey, in his groundbreaking

empirical studies of sexual behavior among American adults, revealed that a significant

number of his research participants reported having engaged in homosexual behavior to

the point of orgasm after age 16 (Kinsey et al. 1948) (Kinsey et al. 1953). Furthermore,

Kinsey and his colleagues reported that 10 percent of the males in their sample and 2-6

percent of the females, depending on marital status, had been more or less exclusively

homosexual in their behavior for at least three years between the ages of 16 and 55

(Escoffier 2004).

Evelyn Hooker (1907-1996)

Hooker published the first empirical research to challenge the prevailing

psychiatric assumption that homosexuality was a mental illness. Her work was the

12 cornerstone for an entire body of research that ultimately led to removal of the diagnosis of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders.

Hooker’s (1957) study was innovative in several important respects. First, rather

than simply accepting the predominant view of homosexuality as pathology, she posed

the question of whether homosexuals and heterosexuals differed in their psychological

adjustment. Second, rather than studying psychiatric patients, she recruited a sample of

homosexual men who were functioning normally in society. Third, she employed a

procedure that asked experts to rate the adjustment of men without prior knowledge of

their sexual orientation.

This method addressed an important source of bias that had vitiated so many

previous studies of homosexuality. In her 1957 essay she offered the following

summation of her research findings:

What is difficult to accept for most clinicians is that some homosexuals may be

very ordinary individuals, indistinguishable, except in sexual pattern, from ordinary

individuals who are heterosexual. Or--and I do not know whether this would be more or

less difficult to accept--that some may be quite superior individuals, not only devoid of

pathology but also functioning at a superior level. (Babst, 2004, 16)

In 1973, the weight of empirical data, coupled by changing social norms and the

development of a politically active gay community in the United States, led the Board of

Directors of the American Psychiatric Association to remove homosexuality from the

Diagnostic and Statistical Manual of Mental Disorders (DSM). Their decision was

supported in 1974 by a vote of the membership. Subsequently, a new diagnosis, ego-

13 dystonic homosexuality , was created for the DSM third edition in 1980. Ego dystonic homosexuality was indicated by:

1. A persistent lack of heterosexual arousal, which the patient experienced as

interfering with initiation or maintenance of wanted heterosexual relationships,

2. A persistent distress from a sustained pattern of unwanted homosexual

arousal (American Psychiatric Association 1980)

The new diagnostic category, however, was criticized professionally on numerous

grounds. It was viewed by many as a political compromise to appease those psychiatrists,

mainly psychoanalysts, who still considered homosexuality a pathology. Others

questioned the appropriateness of having a separate diagnosis that described the content

of an individual’s dysphoria. They argued that the psychological problems related to ego-

dystonic homosexuality could be treated as well by other general diagnostic categories,

and that the existence of the diagnosis perpetuated antigay stigma. Moreover, widespread

prejudice against homosexuality in the United States meant that almost all people who

are homosexual first go through a phase in which their homosexuality is ego dystonic

(American Psychiatric Association 1980).

In 1986, the diagnosis was removed entirely from the DSM. The only vestige of

ego dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders Not

Otherwise Specified, which included persistent and marked distress about ones sexual orientation view (American Psychiatric Association 1987)

The American Psychological Association (APA) promptly endorsed the psychiatrists’

actions and has since worked intensively to eradicate the stigma historically associated

with a homosexual orientation (APA, 1975; 1987). Although some psychologists and

14 psychiatrists may personally hold negative attitudes toward homosexuality, empirical evidence and professional norms do not support any linkage of sexual orientation with

psychopathology (APA, 1975, 1987).

15 CHAPTER 3

SUICIDE

The overall rate of suicide among youth has declined slowly since 1992

(Lubell,Swahn, Crosby, and Kegler 2004). However, rates remain unacceptably high.

Adolescents and young adults often experience stress, confusion, and depression from

situations occurring in their families, schools, and communities. Such feelings can

overwhelm young people and lead them to consider suicide as a “solution.” Few schools

and communities have suicide prevention plans that include screening, referral, and crisis

intervention programs for youth.

Suicide is the third leading cause of death among young people ages 15 to 24. In

2001, 3,971 suicides were reported in this group (Anderson and Smith 2003).

Of the total number of suicides among ages 15 to 24 in 2001, 86%

(n=3,409) were male and 14% (n=562) were female (Anderson and Smith 2003).

• American Indian and Alaskan Natives have the highest rate of suicide

in the 15 to 24 age group (CDC 2004).

• In 2001, firearms were used in 54% of youth suicides (Anderson and

Smith 2003).

Statistics on behaviors that may precede completed suicides also indicate the seriousness of the problem. A study using a large, nationally representative sample found that 31 percent of eighth graders and 36 percent of tenth graders reported having thought at some point in their lives about committing suicide, while 13 percent of eighth graders and 15 percent of tenth graders reported having attempted suicide (Windle et al. 1992).

16 Even these striking estimates, based on World Health Organization (WHO) and government surveys, almost certainly underestimate suicide rates by at least one third and possibly by half, due to underreporting (American Association of Suicide 1998; Jamison

1999).

Suicide among young people in the United States has increased dramatically in recent decades and is the second leading cause of death in college students, the third leading cause of death for 15 to 24 year-olds, and the sixth leading cause of death for 5 to

14 year-olds. Since 1950, the suicide rate for white males aged 15 to 24 has tripled, while for white females it has more than doubled. From 1980 to 1996, the suicide rate for

African American males also has doubled ( The Journal of American Medical Association

2001). Important risk factors for attempted suicide in youth are depression, alcohol or other drug use disorders, and aggressive or disruptive behaviors.

In 1996, more teenagers and young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. Americans under the age of 25 accounted for 35 percent of the population and

15 percent of all suicide deaths in 1996. (“The Surgeon General's Call to Action to

Prevent Suicide” 1999)

In a survey of students in 151 high schools around the country, the 1997 Youth

Risk Behavior Surveillance System found that Hispanic students (10.7 percent) were significantly more likely than white students (6.3 percent) to have reported a suicide attempt. Hispanic male students (7.2 percent) were significantly more likely than white male students (3.2 percent) to report this behavior ((“The Surgeon General's Call to

Action to Prevent Suicide” 1999).

17

Youth Suicide Fact Sheet

Note: In this fact sheet, youth refers to the age groups of 15 to 19 and 20 to 24.

Unless otherwise specified, information presented refers to the latest available data (i.e.,

2002).

• In 2002, suicide ranked as the third leading cause of death for young people (ages

15-24); only accidents and homicides occurred more frequently.

• Whereas suicides accounted for 1.3 percent of all deaths in the U.S. annually, they comprised 12.7 percent of all deaths among 15-24 year olds.

• Each year, there are approximately 10 youth suicides for every 100,000 youth.

• Each day, there are approximately 11 youth suicides.

• Every 2 hours and 11 minutes, a person under the age of 25 completes suicide.

• In 2002, 31,655 people completed suicide. Of these, 4,010 were completed by people between the ages of 15 and 24.

• Suicide rates for 15 to 24 year olds have more than doubled since the 1950s, and remained largely stable at these higher levels between the late 1970s and the mid 1990s.

They have declined 25.6 percent since 1995.

• In the past 60 years, the suicide rate has quadrupled for males 15 to 24 years old,

and has doubled for females of the same age (Center for Disease Control 2002).

Suicide rates for those 15 to 19 years old increased 19 percent between 1980 and

1994. Since the peak in 1994 with 11 suicides per 100,000, there has been a 33 percent decrease. In 2002, the rate was 7.4 per 100,000.

18 • Males between the ages of 20 and 24 were 6 times more likely than females to complete suicide. Males between 15 and 19 were 5 times more likely than females to complete suicide (2002 data).

• Firearms remain the most commonly used suicide method among youth, accounting for 52 percent of all completed suicides.

• In the last decade, for youths aged 15 to 19, the suicide rate by firearm decreased

(from 7.3 in 1992 to 3.7 in 2002); correspondingly, suicide rates by suffocation increased

(from 1.9 in 1992 to 2.7 in 2002). Firearms remain the most commonly used method

(Center for Disease Control 2002).

Research has shown that the access to and the availability of firearms is a significant factor in observed increases in rates of youth suicide. Guns in the home are deadly to its occupants. For every completed suicide by youth, it is estimated that one hundred to two hundred attempts are made. According to findings in the 2003 Youth Risk

Behavior Surveillance Survey (YRBSS), 8.5 percent of students in grades 9 through 12 reported making an attempt at suicide in the previous 12 months (11.5 percent female and

5.4 percent male). These percentages decreased from grades 9 (10.1 percent) to 12 (6.1 percent).

A prior suicide attempt is an important risk factor for an eventual completion. In fact, according to the YRBSS, 16.9 percent of students seriously considered attempting suicide in the previous 12 months and 16.5 percent of students made plans for an attempt

(Department of Health Human Services, Centers for Disease Control and Prevention,

National Center for Chronic Disease Prevention and Health Promotion Division of

Adolescent and School Health 2003).

19 Other Factors

In this author’s opinion, research indicates most adolescent suicides occur after

school hours and in the teen’s home. Although rates vary somewhat by geographic

location, within a typical high school classroom, it is likely that three students, one boy

and two girls have made a suicide attempt in the past year.

The typical profile of an adolescent nonfatal suicide attempter is a female who

ingests pills, while the profile of the typical completed suicide is a male who dies from a

gunshot wound. Not all adolescent attempters may admit their intent. Therefore, any

deliberate self-harming behaviors should be considered serious and in need of further

evaluation. Most adolescent suicide attempts are precipitated by interpersonal conflicts.

The intent of the behavior appears to be to effect change in the behaviors or attitudes of

others.

Repeat attempters, those making more than one nonfatal attempt, generally use

their behavior as a means of coping with stress and tend to exhibit more chronic

symptomology, poorer coping histories, and a higher presence of suicidal and substance

abusive behaviors in their family histories.

Many teenagers may display one or more of the problems or signs detailed below.

The following list describes some potential factors of risk for suicide among youth:

• Presence of a psychiatric disorder (e.g., depression, drug or alcohol, behavior

disorders, conduct disorder [e.g., runs away or has been incarcerated]).

• The expression/communication of thoughts of suicide, death, dying or the afterlife

(in a context of sadness, boredom, hopelessness or negative feelings).

• Impulsive and aggressive behavior; frequent expressions of rage.

20 • Increasing use of alcohol or drugs.

• Exposure to another’s suicidal behavior.

• Recent severe stressor (e.g., difficulties in dealing with sexual orientation;

unplanned pregnancy, significant real or anticipated loss, etc.).

• Family instability; significant family conflict. (National Center for Injury

Prevention and Control (NCIPC), Division of the Center for Disease Control and

Prevention (CDC), and the Morbidity and Mortality Weekly Reports 2004).

For the first time in North America, a database estimate was produced for the proportion of the male-youth-attempted-suicide problem, accounted for by gay/bisexual males. That population accounted for more than 62.5 percent of the problem of male youths who attempted suicide (Bagley and Tremblay 1996). This estimate was made possible as a result of the demographic data, based on self-identification and/or current sexual activity, produced in the same study. One important and carefully conducted study found suicide attempts among homosexuals were six times greater than that of the average of the statistics known (Remafedi et al. 1998).

According to research conducted in the past two decades, sexual minority youth, gay, lesbian, and bisexual, exhibit more suicidal ideation than do their heterosexual peers.

Estimated rates of suicidal ideation range from 50 percent to 70 percent, and actual suicide attempt rates range from 30 percent (Gibson, 1989) to 42 percent (DAugelli and

Hershberger 1993), or three times that of heterosexual youth (DAugelli and Hershberger

1995; Rotheram-Borus et al. 1995). For racial minorities who are also gay or lesbian

(Smith and Crawford 1986), rates of suicidal activity are suspected to be even higher and may reflect prejudice toward both sexual orientation and race.

21 CHAPTER 4

SUBSTANCE ABUSE

According to reports, more than 16.6 million people aged twelve or older have problems with substance abuse or substance dependency in the United States (U.S.

Department of Health and Human Services, 2002). The scope of the substance abuse problem facing the U.S. is capsulated in the Drug Abuse Warning Network (DAWN), emergency department (ED) visits published in 2000 by the Substance Abuse and Mental

Health Services Administration (SAMHSA). The most recent DAWN data from a national probability survey of 466 hospital (ED) visits in twenty one metropolitan areas in the U.S. during the year revealed the following 2000 findings: There were 601,776 estimated drug-related ED episodes in 2000 and, among these, there were 1,100,539 drug mentions. More than one drug may be in a persons system at the time of admission.

• Alcohol-in-combination with other drugs was the most frequently mentioned drug

at time of ED admissions, 204,524, followed by cocaine, 174,896,

heroin/morphine, 97,287, and marijuana, 96,446.

• ED visits involving the club drug MDMA Ecstasy, increased 58 percent in the

U.S., from 2,850 visits in 1999 to 4,511 in 2000.

• The number of ED visits involving heroin/morphine increased 15 percent, from

84,409 to 97,287.

• From 1999 to 2000, ED mentions of prescription drugs containing oxycodone

increased 68 percent, from 6,429 to 10,825, and mentions of drugs containing

hydrocodone increased 31 percent, from 14,639 to 19,221,. From 1998 to 2000,

22 mentions of oxycodone and hydrocodone increased 108 percent and 53 percent,

respectively. (Data from Youth Risk Behavior Surveillance-United States, 1997)

Among drug-related ED visits in 2000, dependence (217,224, or 36 percent of visits) and suicide (193,061, or percent) were the most frequently cited motives for taking the substances. Overdose (264,240 or 44 percent) was the most common reason given for contacting the emergency department. Between 1999 and 2000, ED visits involving overdose increased 14 percent (from 232,283 to 264,240), and increased 24 percent (from

72,960 to 90,625) for patients seeking detoxification (Data from Youth Risk Behavior

Surveillance-United States, 1997).

From 1999 to 2000, total drug related ED visits increased 20 percent for patients age 12 to 17 (from 52,783 to 63,448) and 13 percent for patients age 18 to 25 (from

109,580 to 123,438), but remained stable for older age groups. From 1999 to 2000 visits involving Hispanic patients increased 20 percent (from 56,891 to 68,282). There were no significant changes for visits involving other racial/ethnic subgroups (Data from Youth

Risk Behavior Surveillance-United States, 1997).

In our society, individuals who are sexually attracted to and emotionally attached to persons of the same gender are treated with discrimination and called deviants and child molesters (Hardin, 1999; Hogan and Hudson, 1998; Kantor, 1998). Unfortunately, individuals who are without a well-developed repertoire of coping mechanisms may turn to alcohol and other drugs to relieve their emotional pain. Then they may be doubly stigmatized (Lewis and Jordan, 1989). Many people also view them as sinners and morally corrupted for abusing drugs (Erickson, 1998).

23 There is no single explanation why some people develop substance abuse problems and others don’t (Mendelson and Mello, 1985). From the environmental and psychosocial perspectives, there are several explanations for the high rate of substance abuse within the gay community including effects of the gay bar scene, internalization of societies homophobia and non-acceptance of self, the experience of childhood sexual abuse (CSA), the effects of HIV/AIDS, and painful coming-out experiences (Kus, 1988;

McKirnan and Peterson, 1989).

Traditionally, the gay bar scene has been regarded as a key risk factor for substance abuse problems among the gay community (Steven-Smith and Smith, 1998;

Weinberg, 1994). For many individuals who are gay, gay bars have functioned as a haven for them to meet new friends and sex partners. Also, it is a place which is free from the stigma and prejudice of a largely homophobic society (Benshoff and Janikowski, 2000;

Hooker, 1967). Cohler and Galatzer-Levy (1996) state that “ among young gay men and lesbians, the bar represents an important opportunity for affirming ones identity, being together with others like oneself, meeting friends, and enjoying music and dancing. That is, the attraction of the bar is not merely alcohol, illicit drugs, or sex; it is a place where a person can feel normal” (223). Cabaj (1996) indicates that the role models for some young people who are coming-out may be those individuals using alcohol and other drugs whom they met at parties or in bars.

In addition, Weinberg (1994) suggests that pressures experienced by gay men in a bar setting derived from a number of different sources which include the use of alcohol to facilitate cruising, the expectations of friendship groups, and a variety of inducements provided by bar management. Another study conducted by Mattison, Ross, Wolfson,

24 Franklin, and HNRC group (2001) indicates that 50 percent of their gay male subjects who attended the gay circuit parties reported using alcohol, Ecstasy, and Special K within the past 12 months.

Homophobia is defined as the irrational fear of people and things related to lesbians and gay men (Weinberg, 1972). As a result of these ideal expectations, they usually experience a certain degree of negative feelings about themselves when they are aware of their same sex attractions (Herek, 1996). Studies show that homophobia is one of the most insidious and pervasive factors affecting the gay population (Baker, 2002;

Hilton, 1992; Warn, 1997). Warn suggests that homophobia most likely contributes to the persistence of alcohol abuse among the gay population. He further points out that alcohol may be used to ameliorate the tension created by environmental homophobia. In addition, internalized homophobia induces shame that overwhelms the client who then resorts to further substance use to reduce the negative feelings (Hardin, 1999; Weinberg, 1994).

Youth suicide has been of particular concern in the past few decades. Schuckit and Schuckit (Report of the Secretarys Task Force on Youth Suicide), in a rather complex review of the literature, found that youth who are heavy substance abusers had a four-fold increased death rate. Among adolescent suicide completers, they found 70 percent had used drugs frequently, 50 percent had alcohol in their blood and 75 percent fit the criteria for a drug or alcohol use disorder. The substance abuse/suicide connection is so strong that others (Fowler, Rich, and Young, 1986) concluded that the increasing rate of drug abuse is part of the reason for the increase in suicide more likely to be drunk or high on drugs than their counterparts 20 years ago. He also found, if intoxicated, teens are seven times more likely to use a gun

25 The term substance abuse is now frequently used because of the broad range of substances, including alcohol and inhalants, which fit the addictive profile. Psychological dependence is the subjective feeling that the user needs the drug to maintain a feeling of well being; physical dependence is characterized by tolerance--the need for increasingly larger doses to feed the addiction-- and withdrawal symptoms experienced when the user practices abstinence.

The preponderance of studies concerning affective influences on adolescent substance use has focused on such predictors as depression, emotional distress, anxiety, and anger (Hussong and Chassin 1994; Swaim, Oetting, Edwards, and Beauvais 1989;

Windle 1994). Although sometimes weak in magnitude and varying across different forms of negative affect (Hussong and Chassin 1994; Hussong, Hicks, Levy, and Curran

2001), a positive association between negative affect and adolescent substance use typically emerges from this research (though see Windle and Barnes (1988) for studies not supporting this association). These effects are often interpreted as being consistent with the self-medication hypothesis that posits that adolescents use substances more heavily when they drink or use drugs as a means of coping with, alleviating or regulating negative emotions (Greeley and Oei, 1999).

Suicidal behavior and chemical dependency are two of society’s most serious problems. Research points to correlations between the two. For example, in the adult population, associations between suicide and alcoholism have been reported (Agren and

Jakobsson 1987; Babigan, Lehman, and Reed 1985; Lindberg and Agren 1988; Ohara et al. 1989; Mayfield and Montgomery 1972).

26 Links between adolescent suicide and substance use have also been noted

(Farberow, Litman, and Nelson 1988; Kirkpatrick-Smith, Rich, Bonner, and Jans 1989;

Lewinsohn, Rohde, and Seeley 1994). Holland and Griffin (1984) found that adolescents, when compared with adults, had higher rates of suicide attempts prior to receiving treatment for substance use disorders--36 percent vs. 26 percent, respectively. Both chart review and psychological autopsy retrospective studies of adolescent suicide have reported the presence of alcohol and drug abuse/dependency prior to the suicidal incident, as well as increased use at the time of the incident (Brent, Perper and Allmon 1987;

Cromley 1979; Hoberman and Garfinkel 1988; Poteet 1987; Rich, Sherman, and Fowler

1990; Shaffer et al. 1988).

Cabaj (1996) indicates professionals that help in substance abuse treatment

centers may often lack knowledge about lesbian and gay issues and be unaware that they

have clients who are lesbians or gay men. Although it has become known that lesbians

and gay men have a higher rate of substance abuse compared to that of the general

population, studies show that only about 1 percent of the clients in traditional substance

abuse treatment programs identify themselves as being a lesbian, gay man, or another

sexual minority such as bisexual, transgender, or transvestite (Hellman et al 1987). It is

speculated that many lesbians and gay men are not comfortable with the idea of sharing

the secret of their sexual orientation with their counselors or their fellow clients in the

mainstream treatment agencies (Pride Institute 1997). The reason behind this secrecy

might be their fears of not being supported by their counselors and worries about being

harassed by their fellow clients once their sexual orientation becomes known. After all,

mental health counselors (MHCs) are usually trained to deal with clients’ substance abuse

27 issues, but they may not have received multicultural education on issues related to clients with a non-heterosexual orientation (Eldridge and Barnett 1991).

Laws and regulations, passed over the years, can encourage clients with substance abuse problems to seek mental health services. In addition, both federal law and professional standards of practice provide protection and guidelines for providing services to lesbians and gay men.

The reasons for discriminating against a client vary, e.g., a client’s age, gender, sexual orientation, personality traits, nationality origin, socioeconomic status, religious belief, or HIV/AIDS status. However, Principle 1 (Welfare of the Consumer) in the Code of the American Mental Health Counselors Association. (AMHCA 2001) states that

MHCs shall not condone or engage in any types of discrimination based on the factors listed above.

The most significant federal law addressing issues associated with people who

have substance abuse problems is the Americans with Disabilities Act of 1990 (Benshoff

and Janikowski 2000).

Affirmation of substance abuse as a disability is found in the Americans with

Disabilities Act (ADA) passed in 1990 (Rubin and Roesller 2001). ADA started a new

era in which people with substance abuse problems were encouraged to seek services

under its protection. Although ADA recognized substance abuse as a disability, there are

a few restrictions when considering alcohol and illicit drugs. The first restriction indicates

that individuals with illicit drug problems will be excluded from coverage under the ADA

if they are currently using drugs and not under the direction of a doctor (Benshoff and

Janikowski 2000). However, if they are no longer using the illicit drugs and have

28 successfully completed treatment or are currently in treatment, they then are perceived as people with disabilities. Alcohol abuse and dependence problems, however, are not specifically addressed in the ADA. Therefore, it is interpreted that employers and MHCs cannot discriminate against those who abuse alcohol. But it is strongly believed that employers may discipline workers who violate policies that conform to the Drug-Free

Workplace Act passed in 1988. Meanwhile, MHCs may refuse to work with clients who come for services while intoxicated (Benshoff and Janikowski 2000).

Taking these restrictions and ADA disability criteria into consideration, discrimination against a qualified client with substance abuse issues could result in legal actions against the MHC.

ADA also classifies individuals with HIV+/AIDS as people with disabilities.

They are protected by ADA as long as they do not pose a direct health or safety threat to others (Benshoff and Janikowski 2000). Actions such as requiring people to take an HIV test as a condition for admission to mental health services, refusing to admit eligible individuals, and providing segregating services to such clients are in violation of federal and state nondiscrimination laws (U.S. Department of Health and Human Services 1995).

Studies show that gay men, bisexual people, some heterosexual individuals, and injection drug users constitute the largest numbers of people who are HIV+ or diagnosed with

AIDS in the United States (Brooks and Klosinski 1999; Hogan and Hudson, 1998). ADA explicitly prohibits employers, government agencies, and places of public accommodation from discriminating against them on the basis of sero-positive status

(Rubin and Roessler 2001). Therefore, MHCs have the obligation to treat clients who are

HIV+ or diagnosed with AIDS in a professional manner.

29 MHCs should actively participate in any discussions or presentations regarding the legal issues related to ADA. They should also be informed about the criteria and restrictions set for people with disabilities by ADA. This mandate is especially true when

MHCs diagnose clients with substance abuse. Professionals should understand that ADA and the AMHCA Code of Ethics prohibit MHCs from discriminating against any individual on the basis of gender, religious belief, sexual orientation, race, age, socioeconomic status, etc. In addition, MHCs should be familiar with ADAs protection of people with HIV+/AIDS. It is also important for MHCs to remember that ADA does not cover homosexuality, transvestitism, exhibitionism or other less socially acceptable sexual behaviors (Benshoff and Janikowski 2000). MHCs should seek legal advice from

ADA experts when it becomes necessary (Rubin and Roessler 2001).

The Code of Ethics of the American Mental Health Counselors Association

(2001) provides specific guidelines on the issue of confidentiality. In addition, MHCs should adhere to the resolution passed by American Psychological Association (1998)

Council of Representatives when working with clients who are lesbians or gays. Finally, preventing any kind of sexual harassment and physical assault in the work place should be emphasized throughout the practices of mental health counseling services (Riggar

2002).

There are federal laws that MHCs need to be aware of when they work with

lesbians and gay men’s substance abuse issues. First, in 1970 Congress passed the

Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation

Act, also known as the Hughes Act (Dickman and Challenger 1988). Benshoff and

30 Janikowski (2000) pointed out that for the first time in federal legislation, the Hughes act advanced the notion that alcoholism was a disease, amenable to treatment.

Professional Therapeutic Standard of Practice: Before 1973, the standard

procedure for treating substance abuse issues with lesbians and gay men was to first re-

orient the client’s sexual orientation before dealing with substance abuse issues (Cheng

2002). That standard was changed after the American Psychiatric Association removed

homosexuality from its list of mental disorders in 1973. Besides helping clients with

substance abuse problems stay clean and live a meaningful life, MHCs have acted in

affirmative and professional ways to deal with discriminations and stigma attached to

clients due to their homosexual orientation.

However, some MHCs still approach substance abuse problems in the old harmful

way (Cabaj 1996; Committee on Lesbian and Gay Concerns 1990). It is important to note

that some MHCs may assume that a client’s sexual orientation is the real cause of his or

her substance abuse problems. Therefore, they may attempt to convert a client’s lesbian

or gay male sexual orientation to a heterosexual orientation before dealing with a client’s

substance abuse problems. Actions like this one violate Principle 1 (Welfare of the

Consumer) specified in the Code of Ethics of the American Mental Health Counselors

Association (AMHCA, 2001). The resolution passed by American Psychiatric

Association Council of Representatives (Schneider et al. 2002, 276) concludes:

Therefore be it further resolved that the American Psychological Association APA opposes portrayals of lesbian, gay, and bisexual youth and adults as mentally ill due to their sexual orientation and supports the dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs about sexual orientation.

31

CHAPTER 5

SOCIAL SUPPORT/RELATIONSHIPS

Social support refers to such interpersonal processes as one person emotionally

comforting another, helping to discuss problems, giving advice, providing material goods

and services, and making another feel part of a social network (Cohen and Wills 1985).

Two ways in which social support can have salubrious effects on mental and physical

health are buffering and direct effects. Under the buffering model, support helps a person

remain healthy in adverse circumstances but has little effect in normal circumstances.

Under the direct-effects model, support benefits all individuals, irrespective of particular

circumstances (Cohen and Wills 1985).

Adolescence is defined here as including not only the teen years (ages 13--19), but also between the onsets of puberty (approximately ages 10--14) and the time of exit from the parental home (frequently ages 18--21). A primary developmental task of this period is to individuate, or separate, from the family of origin in order to establish a mature identity and capacity for intimacy, which allow one to assume adult roles and responsibilities (Crespi and Sabatelli 1993). By the time normal, healthy children enter adolescence, they have, at least in theory, successfully negotiated the stages of psychosocial development that deal with basic trust, autonomy, initiative, and industry

(Erikson 1959).

The peer group assumes an increasingly important role in the life of the adolescent as he or she begins to move away from the family. While the child (infancy through latency) looks to the parents for gratification of the self, the younger adolescent displaces this function to the peer group, and the older adolescent to a dyadic love

32 relationship and ultimately to personal and professional relationships within society at large. Although parental support continues to be a significant factor in adolescents’ sense of self and self-esteem, acceptance by peers clearly takes precedence during early and middle adolescence. The goal of being popular--or at least integrated--with ones peers becomes crucial, and not being accepted or being criticized by the peer group can be an excruciating narcissistic injury. The values of the peer group are highly influential, and may supersede those of parents, particularly if acceptance by the group is predicated upon acceptance of said values (Kaplan 1991; Sklansky 1991).

The developmental stages of adolescence, described above, allow for entry into adulthood with a more clearly defined sense of self, and an awareness of societal expectations. That these expectations are culturally influenced is something seldom taken into consideration. For members of the dominant culture, progression through Eriksons developmental stages occur relatively predictably, with norms and mores passed along from generation to generation. For members of minority groups, however, the progression may be more complex. For those who belong to racial, ethnic, and religious minorities, members generally (and optimally) are instilled with a sense of who they are and from whence they came, as well as information on how to survive in a frequently hostile social environment. This knowledge can provide a sense of pride and sustenance, in addition to a means for survival, invaluable when the dominant society presents with persecution and disenfranchisement (Dank 1971).

For gay adolescents, however, there is no such group identity, no system by which the elder members can protect, nurture, and socialize the younger ones (Martin and

Hetrick 1988). Those whose sexual orientation is other than heterosexual clearly

33 constitute a minority that suffers from negative treatment at the hands of the socially dominant. Only relatively recently did the social scientific and therapeutic communities begin to utilize the concepts of homophobia and heterosexism to portray the discrimination faced by gay people. With the biological and cognitive changes that have begun, the development of the capacity for abstract thought allows gay adolescents to realize not only that they often have felt different for some time, but also allows the realization that they are members of a stigmatized minority (Hetrick and Martin 1987).

Children have learned to see themselves as beings separate from the primary caregiver, have developed a sense of self-control and the ability to make choices, and have begun to experience the desire to explore the world and to achieve mastery over it.

The symbiotic, fused attachment that characterizes the parent-child relationship during early infancy (Mahler 1975) has evolved into a dependent, symmetrical parent-child relationship during middle and later childhood (Anderson and Sabatelli 1990).

With adolescence, however, there are at times an overwhelming number of intrusions upon their relatively ordered world. From the dramatic physical changes of puberty and the accompanying awakening of sexuality, to demands by peers for increased involvement in social activities and a resulting need for additional independence, to burgeoning expectations of responsibility and performance (at school, in the home, and in other social contexts), adolescents may begin to exhibit a sensitivity toward their own helplessness, loss of control, and transparency (Amanat and Beck 1994).

Studies describe early adolescents as looking to the peer group for direction and the family for support. Gay adolescents, however, are often shut out from such supports.

The quest for individuation demands a balance between separateness and connectedness,

34 but gay adolescents often feel a total lack of connectedness, largely due to the institutionalized heterosexism into which they have been socialized. The push toward heterosexuality (e.g., family and peer pressure to date members of the opposite sex or not get too close to same-sex peers), derogatory comments and jokes about gay people and about homosexuality in general, and the lack of positive role models related at least in part to the very real fear that many gays have of revealing their sexual orientation openly, all lead to a strong need for the adolescent to deny, to hide, or to attempt to fight their own sexual orientation. Given this backdrop, intimate experiences with other gay youths must occur under a cloak of secrecy and may result in feelings of shame and guilt.

(Rudolph 1988, 1989b).

Baumeister’s (1990) theory of suicide as escape from self also includes a role for social support. Escape theory posits that heightened awareness of ones own failures to meet personal and social standards, accompanied by intense negative affect and feelings of worthlessness, motivate the individual to avoid thinking about situations that carry negative implications about the self. This avoidance of meaningful thought or cognitive deconstruction may then disrupt the individuals normal thought processes in a way that makes suicide more likely. Social support would thus be protective to the extent that it could help bolster an individual’s self-worth. Baumeister also noted that submergence in a social network or community can prevent the individualistic self-focus that is deleterious. Both peer and parental support appear to contribute to adolescents general psychological well being, with parental support being somewhat more effective (Berndt

1992; Wills 1990).

35 Social supports relation to suicidal behaviors in particular: (Kandel et al. 1991) found that close, supportive relations to parents were negatively related to suicidal ideation, independent of depressive symptoms, among high school students. (Lewinsohn et al. 1994) found that both family and friend support predicted future suicide attempts in high school students, not controlling for other psychological variables; support from family (but not from friends) maintained its significant relation with suicide attempts when depression was controlled, but was not significant in a final multivariate model containing additional predictors.

Relationship Breakups Motivate Suicide Attempts

Do gay lifestyle factors, or society’s stigmatization that lead a person to attempted suicide? Saghir and Robins (1978) examined reasons for suicide attempts among homosexuals and found that if the reasons for the attempt were connected with homosexuality, about 2/3 were due to breakups of relationships --not outside pressures from society.

Similarly, Bell and Weinberg (1981) also found the major reason for suicide attempts were the breakup of relationships. In second place, they said, was the inability to accept oneself. Since homosexuals have greater numbers of partners and breakups, compared with heterosexuals, and since long-term gay male relationships are rarely monogamous, it is hardly surprising if suicide attempts are proportionally greater. The median number of partners for homosexuals is four times higher than for heterosexuals

(Laumann et al. 1994; Whitehead and Whitehead 1999).

36 How Common is Non-monogamy?

Sexual exclusivity is by no means the norm among contemporary gay couples. In understanding patterns of monogamy versus sexual openness, it is useful to distinguish between partners agreements about sexual openness and their actual behavior. A recent study surveyed 115 gay men who obtained a civil union under a new Vermont law that affords gays the legal benefits of marriage (Campbell 2002). Among this highly committed group of gay men who had been in their relationships for an average of 12 years, 83 percent of men characterized their relationship as sexually exclusive. Most men acted entirely in accord with this arrangement; 61 percent of the sample reported being sexually exclusive in their behavior since their current relationship began. In contrast, other studies find lower rates of sexual exclusivity (see early review Harry, 1984). For example, in Harry and DeVall’s (1978) sample of gay men in committed relationships, only 32 percent of partners agreed to be faithful and fewer, only 25 percent of the men studied, were sexually faithful in their behavior during the past year. A third of couples agreed to have a sexually nonexclusive relationship, and the remaining 35 percent disagreed about sexual exclusivity. In all, 75 percent of the men had sex with someone other than their partner during the past year. Bryant and Demian (1994) reported that 63 percent of gay men considered their relationship to be sexually exclusive, although a third of these men broke their monogamy agreement at least once. In a sample of African

American gay men, 65 percent reported that they had extra dyadic sex since their current relationship began (Peplau et al. 1997).

Another consistent finding is that the longer a gay male couple stays together, the more likely the partners are to have sex outside the primary relationship (Harry 1984;

37 Harry and DeVall 1978). In the American Couples Study sample, 66 percent of the male couples who had been in a relationship two years or less had engaged in extra dyadic sex, whereas 94 percent of the couples who had been together ten years or more had done so.

McWhirter and Mattison (1984) found that 73 percent of their male couples began their relationship with an understanding, sometimes explicit, sometimes implicit, that the relationship would be sexually exclusive. Yet, 100 percent of those couples that had been together five years or longer had engaged in extra dyadic sexual relations. Thus, it appears that even those gay men who start a relationship with intentions of being monogamous either change their intentions or fail to live up to this standard.

In understanding patterns of monogamy versus sexual openness, it is important to recognize that extra dyadic sex comes in a variety of forms. Some couples have an explicit and consensual agreement to be open to outside sexual affairs. It is clear to both partners that extra dyadic sex is acceptable. Other couples agree to be sexually monogamous. For these couples, a partner who has sex outside the relationship is cheating. For still other couples, rules about monogamy are not explicitly discussed and any agreement is implicit. Unfortunately, much of the research on sexual exclusivity has failed to distinguish among these various types of couples or to account for discrepancies between agreements and actual behavior. Future research should examine these issues in detail and consider their possible consequences for the well being of the couple.

Negotiating Sexual Openness

Because extra dyadic sex is common among gay couples, partners often make

agreements concerning the nature of their sexual relationship. Although some couples

agreements are unstated, it is often the case that gay male partners discuss their beliefs

38 about sexual exclusivity and openness. Once a decision is made as to whether a couple will be exclusive or not, a whole host of rules must often be negotiated. Although clinical psychologists and counselors working with gay couples once viewed extra dyadic affairs as evidence of instability, gay affirmative therapists today often help gay couples to work through the negotiations of an open relationship (LaSala 2001;

McWhirter and Mattison 1984).

39 CHAPTER 6

SOCIAL STIGMA COMING OUT PROCESS

Coming out is defined as a process by which an individual acknowledges his or her sexual orientation in the face of societal stigma and with successful resolution accepts himself or herself. Successful coming out involves the individual accepting his or her sexual orientation and integrating it into all domains of life.

According to Zera (1992), Cass (1979) was the first to articulate a model of homosexual identity. Cass proposed that individuals go through six non-age-specific stages: (1) identity awareness--the individual is conscious of being different; (2) identity comparison--the individual believes that he or she may be homosexual, but tries to act heterosexual; (3) identity tolerance--the individual realizes that he or she is homosexual;

(4) identity acceptance--the individual begins to explore the gay community; (5) identity pride--the individual becomes active in the gay community; and (6) synthesis--the individual fully accepts himself or herself and others.

In Troiden’s (1979) study, gay male adults retrospectively reported a sense of alienation, gender inadequacy, and less opposite-sex interest as children than did other males. Sensitization may be an important part of the coming out process, even though the child in most cases does not understand what the feelings mean. Sensitization may set the groundwork for the acquisition of a homosexual identity by preconditioning gay youth to the idea that they are unlike many of their peers.

Troiden (1989) has postulated that an individual goes through four stages in the formation of a homosexual identity: sensitization, identity confusion, identity assumption, and commitment. Unlike Cass (1979), Troiden's stages are age-specific. In the

40 sensitization stage, beginning before puberty, the individual has homosexual feelings or experiences without understanding the implications for self-identity. In the identity confusion stage, which usually occurs during adolescence, the individual realizes that he or she may be homosexual. In the identity assumption stage, the individual comes out as a homosexual. Coming out usually occurs first in the homosexual community, with attempts at coming out in the heterosexual community, if any, following. In the commitment stage, the individual adopts a homosexual lifestyle.

Research indicates that coming out may begin in childhood, adolescence, or at any stage of adulthood (Cass 1979; Cates 1987; Lewis 1984; Mercier and Berger 1989;

Minton and MacDonald 1984; Reiter 1989; Troiden 1989). For many, the process begins during adolescence (Bell et al. 1989; Schneider and Tremble 1985, 1886). Several authors point out that, in the last two decades, the age of coming out has dropped noticeably and that an increased number of lesbians and gays are recognizing their sexual orientation during adolescence (Gibson 1989; Herdt 1989; Troiden 1989).

Over the past fifty years, research has revealed that parenting styles have a strong impact on child and adolescent development (Parish and McCluskey 1992). The amount of love and acceptance parents provide has been found to be related to their children’s self-concept and self-esteem. Recently, researchers have begun to broaden their investigation of familial influences on homosexual youth. Studies have addressed the relationship between parental variables, homosexuals’ self-concept and self-esteem, and the coming out process (Cramer and Roach 1988; Newman and Muzzonigro 1993; Parish and McCluskey 1992; Savin-Williams 1989; Strommen 1989). For example, Savin-

Williams (1989) found that lesbians feel most comfortable with their sexual orientation

41 when both parents accept their homosexuality. However, the mother’s acceptance was found to be more important as compared with the father’s acceptance.

The reactions of parents to the disclosure of homosexuality are often unpredictable, making the decision to come out difficult (Cramer and Roach 1988; Savin-

Williams 1989). Many homosexual youth fear rejection by their parents and other relatives should they choose to reveal their sexual orientation. A study of gay males by

Cramer and Roach (1988) found that sexual revelation causes stress in the parent- adolescent relationship. Over time, however, the relationship with parents tends to improve. In some cases, the relationship becomes better than before the disclosure of sexual orientation.

Newman and Muzzonigro (1993) found that gay adolescent males in families with more traditional values are less likely to come out to their parents than are those in families with less traditional values. The following criteria were used to define traditional family values: importance of religion, emphasis on marriage, emphasis on having children, and whether a non-English language was spoken in the home. Newman and

Muzzonigro stressed the importance of support for these youth during the coming out process, because many experience stigmatization and disapproval from family and peers.

It can be conjectured that adolescents from highly supportive families would tend to come out at a younger age because of higher self-esteem, greater feelings of security in terms of their relationships with family members, and a more positive attitude about their sexual orientation. Conversely, the effects of a low-support or no-support family environment may hamper the coming out process, and make the achievement of a positive outcome much less certain. Thus, strong parental and familial support may help

42 to reduce the personal and social conflicts that plague many homosexual youth during this difficult period (Roesler and Deisher 1971).

The psychosocial problems of gay and lesbian adolescents are primarily the result of societal stigma, hostility, hatred, and isolation. The gravity of these stresses is underscored by current data that document that gay youth’s account for up to 30 percent of all completed adolescent suicides. Approximately 30 percent of a surveyed group of gay and bisexual males have attempted suicide at least once. Adolescents struggling with issues of sexual preference should be reassured that they will gradually form their own identity and that there is no need for premature labeling of ones sexual orientation. A theoretical model of stages for homosexual identity development composed by Troiden

(1979.) follows:

Staying in the Closet versus Coming Out

Adolescent homosexuals may experience problems with their families, peers, and

other social/community environments. Homophobia and traditional values limit the

capability for social growth as with their heterosexual counterparts. Parents may react

with anger, shock, and/or guilt when learning that their child is gay. Peers may engage in

cruel name-calling, ostracize, or even physically abuse the identified individual. School

and other community figures may resort to ridicule or open taunting, or they may fail to

provide support. Such rejection may lead to isolation, runaway behavior, homelessness,

domestic violence, depression, suicide, substance abuse, and school or job failure.

Another point that individuals and couples must eventually confront is the degree

of disclosure of sexual orientation to the external world. Difficulty in negotiating coming

out and disclosure is a common cause of relationship difficulties. Conflict can also arise

43 within a relationship when there is disagreement on the degree of disclosure between partners. Based on rejection total disclosure may cause depression, isolation and rejection all of which could contribute to suicide.

A number of studies reveal that those who begin the process in childhood seem to experience a feeling of difference (Gibson 1989; Herdt 1989; Hunter and Schaecher,

1987; Lewis 1984; Minton and MacDonald 1984; Troiden 1979); this has also been labeled as sensitization (Troiden 1979, 1989). Bell et al. (1981) found that although many in their heterosexual sample also reported feeling different as children, a higher percentage of their homosexual sample recalled these feelings and often expressed reasons for feeling different that varied from those of the heterosexuals. In Troiden’s

(1979) study, gay male adults retrospectively reported a sense of alienation, gender inadequacy, and less opposite-sex interest as children than did other males. Sensitization may be an important part of the coming out process, even though the child in most cases does not understand what the feelings mean. Sensitization may set the groundwork for the acquisition of a homosexual identity by preconditioning gay youth to the idea that they are unlike many of their peers.

During puberty, many lesbians and gays begin to recognize that they may be homosexual (Cates 1987; Lewis 1984; Mercier and Berger 1989; Minton and MacDonald

1984; Reiter 1989; Troiden 1979). In this period, lesbian and gay adolescents frequently experience confusion, because most children are encouraged by society to become heterosexual (Cass 1979; Herdt 1989). If they experience same-sex attractions or have sexual encounters incongruent with their own internalized expectations, they also may become distressed and experience feelings of guilt or shame (Cates 1979; Mercier and

44 Berger 1989; Minton and MacDonald 1984; Troiden 1989). A common defense mechanism for such painful feelings is denial (Cass 1979; Gibson 1989; Lewis 1984;

Troiden 1989). Because homosexuality is frightening to many adolescents, some try to repress all homosexual urges in order to preserve their sense of an acceptable sexual orientation. Minton and MacDonald (1984) theorize that an internal transference from role identity to ego identity occurs. In other words, the person moves from an awareness of same-sex attraction to the acknowledgment that he or she is gay or lesbian. Once this is accomplished, the last stage of the coming out process begins. According to Cass

(1979), total acceptance of, and pride in, a homosexual identity is the highest level of development. Young persons who describe themselves as lesbian, gay, or bisexual (LGB) are at least twice as likely as their heterosexual peers to report a history of suicidal behavior (Russell and Joyner 2001). It has been estimated that one in three LGB youths has engaged in suicidal behavior (DAugelli et al. 2001; Remafedi et al. 1991; Safren and

Heimberg 1999).

Coming to terms with ones sexual minority status can be psychologically challenging. At this vulnerable time, LGB youths are often rejected by key persons in their lives, including family, teachers, and friends. For many, coming out leads to isolation and even homelessness. These experiences likely tax LGB youths’ capacity for coping. Problems with depression and substance abuse may emerge. Given this context, it is not surprising that a frequently reported antecedent of nonfatal suicidal behavior among lesbian and gay youths is the personal and interpersonal turmoil associated with coming to terms with ones sexual identity (Saulnier 1998).

45 CHAPTER 7

MENTAL HEALTH/HIGHER LEVEL OF PATHOLOGY

While no one illness or set of circumstances can predict suicide, certain vulnerabilities, illnesses, and events make some individuals far more likely than others to kill themselves. The most common element in suicide is psychopathology, or mental illness; of the disparate mental illnesses, a relative few are particularly and powerfully bound to self-inflected death: the mood disorders (depression and manic-depression), schizophrenia, borderline and antisocial personality disorders, alcoholism, and drug abuse. Study after study in Europe, the United States, Australia, and Asia have shown the unequivocal presence of severe psychopathology in those who die by their own hand; indeed, in all of the major investigations to date, 90 to 95 percent of the people who committed suicide had a diagnosable psychiatric illness. (Weissman 1960, 1971)

Suicide and Mental Disorders

Studies from both developing and developed countries reveal two factors. First, a majority of people who commit suicide have a diagnosable mental disorder. Secondly, suicide and suicidal behaviors are more frequent in psychiatric patients. The various diagnostic groups, in decreasing order of risk of suicide, are:

Depression (all forms)

Personality disorder (antisocial and borderline personality with traits of

impulsivity, aggression and frequent mood changes);

Alcoholism (and/or substance abuse),

Schizophrenia; Approximately 10 percent of schizophrenics ultimately commit

suicide.

46
Organic mental disorder;

Other mental disorders.

Though most of those who commit suicide have mental disorder, a majority of them do not see a mental health professional, even in developed countries. Hence the role of primary health care staff becomes vital. Source: (World Health Organization 2000).

Completed suicide for all ages is strongly associated with mental disorders. In general, the more thorough the data collection is, the higher the reported proportion of suicide victims with mental disorders. In studies of adolescent suicides based on report data (e.g., coroners records), the frequencies of depressive symptomatology, substance abuse, or general psychiatric symptomatology have ranged from approximately 50 percent to 90 percent of the cases (Cosand et al. 1982; Graham and Burvill 1992;

Hoberman and Garfinkel 1988; Poteet 1987; Thompson 1987).

The influence of psychosocial stressors on suicidal behavior among adolescents has been emphasized (Brent et al. 1993b; Garrison et al. 1991; Shafii et al. 1988). The most commonly reported precipitating events in adolescent suicide have been interpersonal conflict, separation, rejection, and problems with discipline or the law

(Brent et al. 1988a; Marttunen et al. 1993; Rich et al. 1990). Humiliating or shameful events may be particularly important as suicide precipitants (Apter et al. 1993; Shaffer

1974).

Brent et al. (1993c) reported that adolescent suicide victims under age 20 with no

apparent psychopathology less often had histories of psychiatric treatment, suicide

attempts, and other family members with affective illnesses, and had fewer interpersonal

conflicts and total life stressors during their last 12 months, as compared with adolescent

47 suicide victims with a psychiatric disorder. The following mental health diagnoses have been correlated with increased suicide rates:

Major Depression

Major depression is the psychiatric diagnosis most commonly associated with suicide. Risk of suicide among patients with untreated depressive disorder is nearly 20 percent (Gotlib and Hammen 2002). About 2/3 of people who complete suicide are depressed at the time of their deaths. About 7 out of every hundred men and 1 out of every hundred women who have been diagnosed with depression in their lifetime will go on to complete suicide. The risk of suicide with major depression is about 20 times that of the general population. Individuals who have had multiple episodes of depression are at greater risk for suicide than those who have had one episode. People who have a dependence on alcohol or drugs in addition to being depressed are at greater risk of suicide (American Association of Suicide 2004). The presence of major depressive disorder increases the risk of suicide for adolescent males, and a previous suicide attempt is the most significant predictor followed by depression, disruptive behavior, and substance abuse (HHS 1999). The most common diagnosis in suicidal adolescents is a mood disorder with or without a substance abuse disorder and/or anxiety disorder

(Shaffer et al. 1996).

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a mood disorder in which episodes of depression alternate with periods of mania. The cause of manic- depressive illness is not known. Fortunately, information about manic-depressive illness in youth has increased in recent years. For example, recent research shows that

48 adolescents with bipolar disorder demonstrate a high frequency of mixed manic states, suicide, and more depressive features than adults with the disorder. It is also increasingly clear that adolescents with bipolar disorder are at increased risk of suicide. Both children and adolescents who have bipolar disorder have a high incidence of completed suicide.

Psychological autopsy studies show that 90 percent of adolescent suicides occur in individuals with a pre-existing psychiatric disorder. Approximately 50 percent of these had a psychiatric diagnosis for two years or more. Mood disorders are the most common psychiatric illnesses associated with increased suicide among adolescents. Alcohol or drug use and aggressive or disruptive behaviors are also major risk factors for suicide in youth. Goodwin and Jamison (1990) offer evidence that suicide attempts occur early in the course of manic-depressive illness. There is also an increased risk of suicide during a first episode of a mood disorder. Suicide occurs in ten to 15 percent of all persons with a bipolar disorder. Brent et al. (1993) compared 67 suicide completers with community matched controls and found a high incidence of adolescents with bipolar mixed states.

Borderline Personality Disorder (BPD)

BPD is characterized by unstable relationships, self-image and affect, as well as impulsivity that begin by early adulthood. Suicidal and non-suicidal self-injury is extremely common in BPD. Zanarini et al. (1990) found that over 70 percent of patients with BPD had self-injured or made suicide attempts, as compared to only 17.5 percent of patients with other personality disorders.

Panic Disorder

Panic disorder in susceptible individuals, panic disorders debilitating symptoms can lead to major depression. Imagine being constantly plagued by recurrent, unexpected

49 panic attacks where there is intense apprehension, fearfulness or terror, often associated with feelings of impending doom (American Psychiatric Association 1994). Patients may become reluctant to go outside the home alone or into public places-behaviors associated with agoraphobia. After repeatedly experiencing such uncomfortable symptoms that affect ones ability to function in personal and professional realms, some patients develop major depression. According to the DSM-IV , major depressive disorder occurs frequently

(50 percent to 65 percent) in individuals with panic disorder. In one-third of the patients

with both disorders, the depression precedes the onset of panic disorder, whereas in the

remaining two-thirds, depression occurs coincident with or following the onset of panic

disorder. There is also high co morbidity with anxiety disorders. Among individuals with

panic disorder, 15 percent to 30 percent have co morbid social phobia and 25 percent

have generalized anxiety disorder.

Conceptualizing Self-Harm

Suicidal behavior is usually defined as a self-destructive behavior with the intent

to die. Thus, there must be both an act and intent to die for a behavior to be considered

suicidal. Non-suicidal self-harm generally implies self-destructive behavior with no intent

to die and is often seen as being precipitated by distress, often interpersonal in nature, or

as an expression of frustration and anger with oneself. It usually involves feelings of

distraction and absorption in the act, anger, numbing, tension reduction, and relief,

followed by both a sense of affect regulation and self-deprecation. Confusion in the field

regarding the definition of the term Para suicide can lead to a misunderstanding of the

differences in function and danger of suicidal and non-suicidal self-injury. Para suicide,

or false suicide, groups together all forms of self-harm that do not result in death--both

50 suicide attempts and non-suicidal self-injury. Many people who engage in non-suicidal self-harm are at risk for suicidal behavior.

Linehan (1993) pointed out that self-injury may help patients to regulate their

emotions--an area with which they have tremendous difficulty. The act itself tends to

restore a sense of emotional equilibrium and reduces an internal state of turmoil and

tension. One striking aspect is the fact that physical pain is sometimes absent or,

conversely, may be experienced and welcomed, as validation of psychological pain

and/or a means to reverse a sense of deadness. Patients often report feeling less upset

following an episode. In other words, while the self-injury is borne out of a sense of

distress, it has served its function and the patient’s emotional state is improved.

Biological findings pointing to relationships among impulsivity and suicide support the

notion that suicide and self-mutilation, particularly within the context of BPD, may occur

on a continuum (Oquendo and Mann 2000; Stanley and Brodsky in press).

It is crucial to recognize, however, that even if patients with BPD self-mutilate

and attempt suicide for similar reasons, death may be the accidental and unfortunate

result. Because patients with BPD try to kill themselves so often, clinicians often under

estimate their intent to die. In fact, individuals with BPD who self-injure are twice as

likely to commit suicide as others (Cowdry et al. 1985), and 9 percent of the 10 percent

of outpatients who are diagnosed with BPD eventually commit suicide (Paris et al. 1987).

Stanley et al. (2001) found that suicide attempters with cluster B personality disorders,

who self-mutilate die just as frequently but are often unaware of the lethality of their

attempts, compared to patients with cluster B personality disorders who do not self-

mutilate.

51 Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicide in homosexuals, particularly among adolescents and young adults, has been consistently reported to be higher over the past 25 years. It has been recently reported that gay youth are 2 to 3 times more likely to attempt suicide than other young people that may comprise up to 30 percent of completed youth suicides annually (Remafedi et al. 1998).

One important and carefully conducted study found suicide attempts among homosexuals were six times greater than the average (Remafedi et al. 1998).

More recently, in the Archives of General Psychiatry -- an established and well- respected journal--three papers appeared with extensive accompanying commentary

(Bailey 1000; Fergusson et al. 1999; Herrell et al. 1999; Sandfort et al. 2001).

J. Michael Bailey included a commentary on the above research; Bailey, it should be noted, conducted many of the much-publicized gay twin studies which were used by gay advocates as support for the born that way theory (Whitehead 1999).

Bailey said,

These studies contain arguably the best published data on the association between homosexuality and psychopathology, and both converge on the same unhappy conclusion: homosexual people are at substantially higher risk for some forms of emotional problems, including suicide, major depression, and anxiety disorder, conduct disorder, and nicotine dependence...The strength of the new studies is their degree of control (Whitehead 1999, 65).

The first study was on male twins who had served in Vietnam (Herrell et al.

1999). It concluded that on average, male homosexuals were 5.1 times more likely to exhibit suicide- related behavior or thoughts than their heterosexual counterparts. Some of this factor of 5.1 was associated with depression and substance abuse, which might or might not be related to the homosexuality. When these two problems were factored out,

52 the factor of 5 decreased to 2.5, which is still somewhat significant. The authors believed there was an independent factor related to suicide that was probably closely associated with some features of homosexuality itself.

The second study (Fergusson et al. 1999) followed a large New Zealand group

from birth to their early twenties. The birth cohort method of subject selection is

especially reliable and free from most of the biases that bedevil surveys. This study

showed a significantly higher occurrence of depression, anxiety disorder, conduct

disorder, substance abuse and thoughts about suicide, among those who were

homosexually active.

The third paper was a Netherlands study (Sandfort et al. 2001), which again

showed a higher level of mental-health problems among homosexuals, but remarkably,

subjects with HIV infection were not any more likely than those without HIV infection to

suffer from mental health problems. People who are HIV-positive should at least be

expected to be anxious or depressed.

The paper thus concluded that HIV infection is not a cause of mental health

problems--but that stigmatization from society was likely the cause--even in the

Netherlands, where alternative lifestyles are more widely accepted than in most other

countries. That interpretation of the data is quite unconvincing.

The commentaries on those studies brought up three interesting issues.

1. First, there is now clear evidence that mental health problems are indeed

associated with homosexuality. This supports those who opposed the APA actions in

1973. However, the present papers do not answer the question; is homosexuality itself

pathological?

53 2. The papers do show that since only a minority of a non-clinical sample of homosexuals has any diagnosable mental problems (at least by present diagnostic criteria), then most homosexuals are not mentally ill.

The assumption that the range of psychopathology that may be found among homosexual individuals (male or female) are higher than heterosexuals have not been confirmed in several controlled studies. Distress resulting only from conflict between gay men and lesbians and the societal value structure is not classifiable as a disorder.

Nevertheless, homosexuals both male and female have been reported to display increased vulnerability to depression and adjustment disorders when they encounter severe psychological and emotional difficulties (Bancroft 1989).

Another factor in suicide attempts would be the compulsive or addictive elements in homosexuality (Pincu 1989), which could lead to feelings of depression when the lifestyle is out of control (Seligman 1975). There are some, (estimates vary, but perhaps as many as 50 percent of young men today), who do not take consistent precautions against HIV (Valleroy et al. 2001) and who have considerable problems with sexual addiction and substance abuse addiction, and this of course would feed into suicide attempts.

Third, does pressure from society lead to mental health problems? The authors of the study done in The Netherlands were surprised to find so much mental illness in homosexual people in a country where tolerance of homosexuality is greater than in almost all other countries.

Another good comparison country is New Zealand, which is much more tolerant of homosexuality than is the United States. Legislation giving the movement special legal

54 rights is powerful, consistently enforced throughout the country, and virtually never challenged. Despite this broad level of social tolerance, suicide attempts were common in a New Zealand study and occurred at about the same rate as in the U.S. In his cross- cultural comparison of mental health in the Netherlands, Denmark and the U.S. Ross

(1988) could find no significant differences between countries - i.e. the greater social hostility in the United States did not result in a higher level of psychiatric problems.

There are three other issues not covered in the Archives journal articles that are

worthy of consideration. The first two involve DSM category diagnoses.

Promiscuity and Antisocial Personality: The promiscuous person--either

heterosexual or homosexual --may in fact be more likely to be antisocial. It is worth

noting here the comment of (Rotello 1997), who is himself openly gay: ...the outlaw

aspect of gay sexual culture, its transgressiveness, is seen by many men as one of its

greatest attributes.

Ellis et al. (1995) examined patients at a clinic which focused on genital and

urological problems such as STDs; he found 38 percent of the homosexual men seeking

such services had antisocial personality disorder, as well as 28 percent of heterosexual

men. Both levels were enormously higher than the 2 percent rate of antisocial personality

disorder for the general population, which in turn, compares to the 50 percent rate for

prison inmates (Matthews 1997).

Perhaps the finding of a higher level of conduct disorder in the New Zealand

study foreshadowed this finding of antisocial personality. Therapists, of course, are not

very likely to see a large number of individuals who are antisocial because they are

probably less likely to seek help.

55 It was previously noted that 43 percent of a bulimic sample of men were homosexual or bisexual (Carlat et al. 1997), a rate about 15 times higher than the rate in the population in general--meaning homosexual men are probably disproportionately liable to this mental condition. This may be due to the very strong preoccupation with appearance and physique frequently found among male homosexuals.

A strong case can be made that the male homosexual lifestyle itself, in its most extreme form, is mentally disturbed. Rotello, a gay advocate, notes the outlaw aspect of gay sexual culture, its transgressiveness, is seen by many men as one of its greatest attributes. Same-sex eroticism becomes for many, therefore, the central value of existence, and nothing else--not even life and health itself--is allowed to interfere with pursuit of this lifestyle. Homosexual promiscuity fuels the AIDS crisis in the West, but even that tragedy it is not allowed interfering with sexual freedom.

And, according to Rotello, the idea of taking responsibility to avoid infecting others with the HIV virus is completely foreign to many groups trying to counter AIDS.

The idea of protecting oneself is promoted, but protecting others is not mentioned in most

official condom promotions; France in the 80s was an interesting exception. Bluntly,

then, core gay behavior is both potentially fatal to others, and often suicidal.

Surely it should be considered mentally disturbed to risk losing ones life for

sexual liberation. This is surely among the most extreme risks practiced by any

significant fraction of society. I have not found a higher risk of death accepted by any

similar-sized population.

A preponderance of evidence shows that more than 90 percent of children and

adolescents who commit suicide have a mental disorder (Shaffer and Craft 1999) --21

56 percent of those who completed suicide saw a mental health professional within 3 months of their death (Shaffer et al. 1996).

57 CHAPTER 8

HOMOPHOBIA, SEXUAL PREJUDICE

Though the acceptance of homosexuals has increased in recent years, anti- homosexual prejudices continue to persist in many societies and cultures. This sexual prejudice, took its roots in part from socio-cultural upbringing in many cultures.

Homosexual acts are usually condemned as an unnatural behavior, and seen as a sin or a crime. This approach justifies many homophobic acts taken against homosexual in the eyes of society. (Herek et al 1999). People with homosexual or bisexual orientations have long been stigmatized. With the rise of the gay political movement in the late 1960s, however, homosexuality’s condemnation as immoral, criminal, and sick came under increasing scrutiny. When the American Psychiatric Association dropped homosexuality as a psychiatric diagnosis in 1973, the question of why some heterosexuals harbor strongly negative attitudes toward homosexuals began to receive serious scientific consideration. Society’s rethinking of sexual orientation was crystallized in the term homophobia , which heterosexual psychologist George Weinberg coined in the late 1960s.

Weinberg used homophobia to label heterosexuals’ dread of being in close quarters with homosexuals as well as homosexuals’ self-loathing. The word first appeared in print in

1969 and was subsequently discussed at length in Weinberg’s 1972 book, Society and the

Healthy Homosexual . The American Heritage Dictionary (1992 edition) defines homophobia as aversion to gay or homosexual people or their lifestyle or culture and behavior or an act based on this aversion.

Other definitions identify homophobia as an irrational fear of homosexuality.

Around the same time, heterosexism began to be used as a term analogous to sexism and

58 racism, describing an ideological system that denies, denigrates, and stigmatizes any non- heterosexual form of behavior, identity, relationship, or community (Herek 1990). Using the term heterosexism highlights the parallels between antigay sentiment and other forms of prejudice, such as racism, anti-Semitism, and sexism.

Scientific analysis of the psychology of antigay attitudes will be facilitated by a new term. The term sexual prejudice serves this purpose nicely. Broadly conceived, sexual prejudice refers to all negative attitudes based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual. Given the current social organization of sexuality, however, such prejudice is almost always directed at people who engage in homosexual behavior or label themselves gay, lesbian, or bisexual (Herek 2000). Like other types of prejudice, sexual prejudice has three principal features:

• It is an attitude, i.e., an evaluation or judgment.

• It is directed at a social group and its members.

• It is negative, involving hostility or dislike.

Conceptualizing heterosexuals’ negative attitudes toward homosexuality and bisexuality as sexual prejudice, rather than homophobia, has several advantages.

• First, sexual prejudice is a descriptive term. Unlike homophobia, it conveys no a prior

assumptions about the origins, dynamics, and underlying motivations of antigay

attitudes.

• Second, the term explicitly links the study of antigay hostility with the rich tradition

of social psychological research on prejudice.

• Third, using the construct of sexual prejudice does not require value judgments that

antigay attitudes are inherently irrational or evil.

59 The Negative Effects of Homophobia:

As children many gays and lesbians lived with homophobic parents. Now as adults they all live in a homophobic society. They live with homophobic individuals on the job, where they suffer professionally, and at home, where they suffer personally.

Couser (1996), in an article on the effects of homophobia on gays, describes how he felt when someone thinking he was gay defaced his car by writing fag all over it. He says,

The possibility that I was being watched made me feel paranoid. Is this, I thought, a taste of what it’s like to be homosexual in America -- to fear random harassment by utter strangers. In the space of those few moments I began to appreciate, that to be openly gay takes considerable courage. . . . How vulnerable I . . . felt. For several days I experienced shock and fear -- fear that the incident might be repeated or that the violence would escalate. I felt violated, and I was angered by my inability to retaliate. . . . I felt as though I had been conspicuously branded. . . . Gender stereotypes and homophobia diminish and dehumanize us all. (45)

In Massachusetts a youth risk behavior survey (Massachusetts Department of

Education 1999) found that when gay, lesbian, and bisexual students were compared with

their peers, they were four times more likely to have attempted suicide and five times

more likely to have missed school because of feeling unsafe.

The Gay, Lesbian, and Straight Education Network (1997) issued a national report card on the protection of gay and lesbian students by their schools. They gave the nations schools a C and reported that 19 percent of gay and lesbian students suffered physical attacks associated with sexual orientation; 13 percent skipped school at least

60 once a month; and 26 percent dropped out of school altogether. The type of threat that is inherent in peer sexual harassment by students of the same sex takes on new dimensions when studies indicate that heterosexual students are upset by sexual harassment that implies they are gay. What message does that give to the students who are gay? (Gay,

Lesbian, and Straight Education Network 1997).

It is also important to link same-sex sexual harassment behaviors in schools to homophobia and heterosexism. Social workers need only look to the youth surveys conducted in individual states showing the percentages of youths who identify themselves as gay, lesbian, bisexual, or transgender and who experience homophobic behaviors, which can include violence. In Massachusetts 23.5 percent of students who identified as gay, lesbian, or bisexual, 5.5 percent of the total school population, reported being threatened with a weapon, 29 percent have attempted suicide, and 19.1 percent missed school because of being afraid (Massachusetts Department of Education,

2000).

Homophobic Violence

When young men seek a violent outlet for their internal conflicts, disappointments, and rage, they commonly direct their attacks at the dehumanized, if not demonized, other. They displace their aggression more often onto a target that they had earlier been led to dislike than onto a neutral target (Berkowitz and Green 1962). Not surprisingly, highly prejudiced people are likely to take out their anger on the targets of their prejudice. (Monteith et al. 1993). Thus social norms often dictate which group is to be the scapegoat (Ashmore and DelBoca 1976). The most frequent victims of hate

61 violence today are blacks, Hispanics, Southeast Asians, Jews, and gays and lesbians.

Homosexuals are probably the most frequent victims (Finn and McNeil 1987).

The incidence of hate crimes directed at those perceived to be gay or lesbian has been

documented to some degree:

• In 1994 the overall number of bias-related crimes rose 25 percent nationwide, with

gay and lesbian victims in 25 percent of assaults and nearly 66 percent of murders

(Southern Poverty Law Center 1994).

• In 1995, the total number of hate crimes against gays and lesbians in 11 major cities

had decreased by 8 percent, but the violence of the attacks escalated (Nationline

Report 1996).

• 2,399 incidents of antigay hate crimes were reported in just 14 locations across the

country in 1996. These included 27 murders and 1,128 physical assaults (Report of

the National Coalition of Anti-Violence Programs 1997).

• 2,655 antigay hate crimes in 1997 (i.e., 14 murders, 53 hospitalizations) were

reported in 16 localities (Report of the National Coalition of Anti-Violence Programs

1998).

• 2,552 antigay hate crimes were reported in 16 localities in 1998 (i.e., 33 murders,

110 hospitalizations). There were stark increases in some weapon categories (i.e.,

guns, blunt objects, knives/sharp objects, and vehicles) and in verbal and physical

abuse by police (Report of the National Coalition of Anti-Violence Programs 1998).

• In New York City alone antigay bias crimes reported from January to October

jumped from 46 in 1997 to 82 in 1998 N.Y.P.D (Cooper 1998).

62 • Antigay murders are often characterized by extreme viciousness (Miller and

Humphreys 1980). Nearly 60 percent of 151 antigay slayings reported in 29 states

from 1992 to 1994 involved extraordinary and horrific violence, involving fewer guns

than other killings, 26 percent versus 68 percent, and more knives, bats, clubs, and

hammers (New York City Gay and Lesbian Anti-Violence Project 1994; “Murders of

Gay Men and Lesbians More Brutal, Police Less Effective” 1995).

These statistics may reflect increased reporting, but many such hate crimes are in

fact not reported because of victims concerns about being revealed as homosexual or fear

of hostile or indifferent police response ( Anti-Gay/Lesbian Violence, Victimization, and

Defamation report 1993 ) (National Gay and Lesbian Task Force Policy Institute 1994).

Most jurisdictions lack discrete and sensitive community-based reporting mechanisms

(Levin and McDevitt 1993). The majority of hate crimes are committed for a thrill by

white teenage males, sometimes substituting one minority person for another when a first

target is unavailable (Levin and McDevitt 1993).

In a nationwide 1994 study of lesbian and gay homicides, 98 percent of the

killers were male (Plasek and Allard 1984). As a rule, the victimizers are school-age

(Herek, 1989; Berrill 1992). Their crime, usually executed by more than one attacker and

boasted of to others, is a ritual assertion of group membership and shared values

(Franklin 1998).

The ghastly 1998 murder of Wyoming college student Matthew Shepard could be

the most notorious gay bashing of the century (Los Angeles Times 1996). The near

crucifixion of the diminutive Shepard by two high school dropouts appalled the country,

yet his fate was not much different from previous victims. For example, in a New York

63 borough in the early nineties three young men went out looking for a homo to tune up

(Chua-Eoan 1998). They used a knife, a wrench, and a hammer to kill a man they did not know and later bragged to friends of having done it. Only one had a violent reputation.

Another attended college and the third went to art school. The one who did the stabbing said that his knife went in so easily it was like sticking a watermelon. (Doyle 1992). He was the college student. It took police nine months to classify the case as a bias crime.

Trial spectators spewed homophobic bile at reporters and others in the courtroom (Doyle

1992)

In Texas, eight homosexual men were stalked, terrorized, and killed by teenage boys between 1993 and 1995 (Bissinger 1995). In Oregon, a man who executed two lesbians in 1995 admitted in a letter, “I have no compassion for . . . lesbians, or bisexual or . . . gay men. I can’t deal with it” (Burress 1996, 12).

In Baltimore, just a month after Matthew Shepard’s killing, a cross-dressing man barely survived being pursued by a mob and shot six times (OBrien and Morgan 1998).

Because he was black and a transvestite, the crime did not make the cover of the weekly newsmagazines. And in the same week, a dozen teenage males invaded a gay pub in

Palm Springs, California, and began hurling obscenities, ashtrays, and fire extinguishers

(MSNBC 1988).

One columnist has called the correspondence between defamation and violence trickle-down homophobia (Quindlen 1992). The escalation of homophobic political rhetoric in 1998, such as the Senate majority leaders likening the sin of homosexuality to alcoholism, kleptomania, and sex addiction, is a classic example of reckless pandering to the Right (Mitchell 1998). Gay-bashing is the extreme of what may begin as adolescent

64 bullying. A 1984 survey of over 2,000 adults found that 45 percent of the males and 20 percent of the females reported verbal or physical assaults in high school because they were thought to be gay or lesbian (National Gay and Lesbian Task Force 1984). Nine years later a major study of sexual harassment in schools reported the following:

• For school-age boys the most disturbing form of harassment was being called gay.

• 23 percent of boys and 10 percent of girls reported being called gay or lesbian

when they did not want to be.

• 86 percent of high school students said they would be upset if classmates called

them gay or lesbian (American Association of University Women 1993).

The power of the homophobic slur has driven heterosexual teens to suicide (Locke

1997). And at other times the rage is directed at the tormentors. In 1998, a Paducah,

Kentucky, youth killed three classmates after years of teasing over middle school

newspaper gossip that he had feelings for another boy (Giordano 1998). Shortly after

this Kentucky rampage, a Massachusetts student killed his harasser (Hart 1998).

Even the best students may be homophobic: 48 percent of top-achieving high

school students in a major 1998 survey admitted to being prejudiced against

homosexuals, 19 percent more than the previous year. This startling increase among

voluntary respondents who are mostly white females from two-parent non-urban homes

is indicative of a worsening climate of hate (Ness 1998). Gay and lesbian students may be

victimized in or outside of school or at home. In one study of gay minority youth, 61

percent of those who had been physically assaulted said their attacker was a family

member (Hunter 1990).

65 Many of those in charge claim that homophobic harassment is not an issue at their schools. The experience of a Massachusetts high school gives the lie to this kind of denial: Someone burned a swastika and the words BOBO IS A FAGGOT into the boys’ lavatory ceiling. It was thought that the graffiti referred to a teacher who was a Jewish

Austrian refugee. Treating the incident as an anti-Semitic hate crime, school authorities decisively summoned the police and the FBI. The homophobia was disregarded. Later, when one of the suspects stood drunk on a park table and wailed to his friends that he himself was gay, nothing was done for him. In the end, he dropped out of school and was hospitalized for depression (Confidential report to the author 1997).

Coming Out Is Risky: Despite the study’s findings that disclosure promotes attitude change, Herek warned that coming out also carries risks. Many heterosexual

Americans hold strongly negative feelings toward homosexuality, he noted.

The study found, for example, that two-thirds of the U.S. public feels that homosexuality is wrong, 60 percent feel that it is disgusting, and only about one-fourth believe that it is a natural expression of sexuality. These attitudes are strongest among heterosexuals who say that they do not know anyone who is lesbian or gay about two- thirds of U.S. heterosexual adults, according to Herek.

Herek noted that many gay men and lesbians meet with rejection, discrimination, and even violence when they come out. Job discrimination on the basis of sexual orientation is legal in most states, and antigay hate crimes are common throughout the

United States, according to Herek.

The PrejudiceTheories of Kite and Herek

Kite lays out three reference points for analyzing stereotyping or prejudice:

66 1. Socio-cultural stereotypes are provided by the culture and are stable across time and region; are employed by individuals to demonstrate membership and loyalty to the culture; can be based on the social role that particular out-groups play within the culture; in the absence of personal contact, may depend on impressions from the mass media; may vary among competing subcultures with differing values and interests.

2. Motivational prejudice serves to bolster ones personal identity; is related to ones willingness to subscribe to negative stereotypes; is related to self-esteem or depression; may serve different functions for different individuals.

3. Cognitive stereotyping employed to categorize/interpret a complex world, is the compilation of lists of characteristics assumed to apply to all members of certain groups, for example, all spheres roll; (Ashmore and DelBoca 1976; Katz 1976) is protective, since one cannot know all individuals (Kite 1994, 46).

These three modes, social, psychological, or intellectual, may build upon each other. Prejudice begins as a blameless attempt to organize a puzzling world. Then, distorted by ones emotional needs and manipulated by social forces, it becomes a sinister bigotry.

Gregory Herek has studied the social/psychological function of homophobic prejudice (Herek 1984). In his analysis, clearly related to Kites, attitudes toward gay/lesbian people can be characterized as follows:

1. Experiential/Schematic

Categorizing social reality based on ones own interactions with homosexual persons; Can result in confirmation of negative stereotypes but more often reduce prejudice than exacerbates it.

67 2. Defensive

Coping with inner conflicts/anxieties by projecting them onto homosexual persons; Actual contact often makes attitudes worse.

3. Self-Expressive/Symbolic

Expressing abstract ideological concepts, closely linked to self-concept, social

network, and reference groups; needing high level of social approval; more likely to be

attending a religious service at least monthly, belonging to a conservative denomination,

and endorsing an orthodox religious ideology; pressured toward conformity by closely

bonded social networks.

Herek stipulates that these functions may overlap and that no single frame can

account for differences among heterosexual homophobes, yet his (and Kites’) categories

appear to delineate three distinct kinds of homophobia: intellectual, emotional, or

cultural.

There is no experiential domain that is not colored by intellectual and subjective

factors. The experience of meeting a homosexual person is without meaning until it is

both examined and symbolically recast. Regardless of the limits of ones interpretive

capacities, the world is understood in the light of ones existing knowledge, feelings, and

values, which have in turn been influenced by ones environment/culture. Therefore

defensive homophobia cannot be separated from the symbolic. Feelings about sex and

gender are not merely instinctive. One is uncomfortable with or frightened by

homosexuality because it threatens ones understanding of self and society. To understand

peoples prejudice, we must examine their reactive thoughts and feelings and understand

what exactly provokes them (Herek 1986).

68 Likewise, although heterosexism may serve a societal function, individuals will

only subscribe to homophobic views that are personally meaningful to them. Following

Kite, motivational prejudice makes sociocultural prejudice possible and conversely, using

a constructionist axiom, sociocultural prejudice helps dictate the terms of motivational

prejudice. Three mutually reinforcing threads, analytical, emotional, and social, are

woven into the fabric of an individuals prejudice (Baird and Rosenbaum 1992).

Although bigotry may not be entirely rational and may indeed involve intuition and the intangible influences of context, (Baird and Rosenbaum 1992), symbolic value is learned and therefore is an ingredient of prejudice upon which education may have some impact. Of course, schools may also usefully provide for the expression and examination of feelings.

Kite claims that the cognitive perspective has not been adopted by most researchers into homophobia (Baird and Rosenbaum 1992); nevertheless, one psychologist has said of prejudice in general, “Research shows a lot more cognitive influence than the public is aware of” (Baird and Rosenbaum 1992, 34)

Anti-homophobia educators must pay attention to cognition, particularly to why people construe difference as they do and how they respond to new knowledge that contradicts stereotype (Davidson 1995).

Homophobia and Moral Development

Elisabeth Young-Bruehl writes that sexism and homophobia are related to our rock bottom notion of who we are, who we ought to be, how we should be regarded by others and ourselves (Young-Bruehl 1996). The pivotal question for anti-prejudice educators is how people learn who they ought to be.

69 Children do not spring full-blown to mindful guardianship of heterosexism.

Seventh graders, for example, do not consciously shout faggot in conspiracy to preserve male hegemony. Although they are being socialized into that repressive project, they have their own justifications for such harassment. And as they mature, their social awareness and reasons change. For teachers to intervene effectively, they must tailor their strategies to the students’ level of rationalization (Kohlberg, 1984).

This developmental view of prejudice reduction can be fleshed out with the help of moral development theory and feminist analysis. Although Lawrence Kohlberg does not emphasize bigotry, let alone mention homophobia in his work, his findings can lead to a better grasp of bigotry as a product of moral judgment, Young-Bruehls who we ought to be.

Kohlberg studied how people determine right and wrong in a social context, how they find symbolic meaning in human interaction, and how they move from an instrumental to a more highly principled moral system (Kolberg 1984). His theory helps explain the relationships among the various functions of homophobia. It also exposes different layers within its symbolic and sociocultural meanings.

Kohlberg’s general schema should not be rashly caste aside, particularly since it can be so useful in reconciling the prejudice theories of Kite, Herek, and others. The success of bias reduction in a school program inspired by Kohlberg also supports examining moral development more closely. Exploring how individuals at Kohlbergs developmental levels might think about difference is worth the effort (Larrabee 1993).

70 Cognitive Stages and Homophobia

Stage 1

At Stage 1, the child views moral action as punishment avoidance: Whatever

course prevents an authority figure's displeasure is good. Youngsters do pay attention to

their elders’ bigoted remarks and conversations (Ashmore and Delboca n.d). If parents or

older children speak apprehensively and derogatorily of a minority group, the child is

likely to mimic their fear and hatred. There is good evidence that imitation of and

identification with parents plays a role in socializing children to be prejudiced (Ashmore

1970).

There is no early need to persuade the child of the despised group’s inferiority:

Majority-group children first learn affective, good-bad reactions to out-groups, and only

later acquire specific beliefs about them (Ashmore and Delboca n.d). The child learns

that put-downs like nigger or fag are effective weapons approved by the powerful (Warm

1995). Children begin to see homophobic denigration as expressions of cultural norms

(Franklin 1998). Of course, with a rather limited milieu at this age, his or her notion of

culture is narrow.

Parents and others transmit their prejudice at varying levels of explicitness. They

might discourage a child from associating with a gender atypical playmate or with the

child of a gay parent. They may respond to questions about differences by changing the

subject, looking pained or disgusted, or more directly, answering with stereotypes. They

might even behave rudely toward or attack a minority person (Franklin 1998).

As elementary school teachers know, such learning begins well before children have any idea of what renders this group despicable. Challenged by his principal for

71 using the word faggot and asked what it means, a second grader responded, I don’t know, but Francisco said it was the king of swears (Personal communications to the author

1997).

Stage 2

The individual at Stage 2 determines the morality of an action by calculating what its personal benefit will be. This stage subsumes the egocentric materialism of Stage 1 but adds the notions of instrumentalism and reciprocity. It is the you scratch my back and

Ill scratch yours stage (Davidson 1995).

Because people want predictability in an exchange, they are probably suspicious of agents who appear different from themselves and their usual counterparts in the marketplace. One is comfortable with someone who clearly operates from ones own moral framework. That is, one cannot depend on reputed outsiders for a quid pro quo.

The circumscribed world of a Stage 1 or 2 thinker would appear safer if there were no outsiders in it. This moral attitude builds on the child’s earliest fears of the unfamiliar, wherein young children react to superficial characteristics that are foreign to them

(Davidson 1995). Or, as history professor Robert Davidoff puts it, “Human beings have a real hard time with the fact that something that looks and feels totally different can be another form of love (Arnett 1998, 54).

Stage 3

The Stage 3 moral criterion is clan approval, to be acceptable to those with whom one directly associates in daily life. Intentions are important at this stage, and one behaves fairly toward another by virtue of common membership in the circle. Whatever list of aliens constitutes ones clan heritage becomes ones own phobic registry. One hates

72 more for its value in making one fit with the clan than for any other reason. In some groups, prejudice toward an out-group and the assumption that the in-group includes none of them endears individuals to their cohort. Regardless of ones previous opinions, bigotry would become a virtue, as one moved from individuality and reciprocity toward such a groups norms (Ashmore and Delboca n.d).

Stage 4

A Stage 4 moral universe enlarges from the immediate circle of the clan to a larger society of relative strangers. Ones primary concern is the maintenance of the given familiar social order by means of rules and laws. At this stage, prejudice could emanate from a perception of social threat, rather than personal danger or a need to belong. As such the perceived danger and the response to it are abstract or symbolic.

For example, symbolic racism is a combination of the generalized feeling that the social, economic, and political status quo should be maintained with the belief that blacks are somehow responsible for threatening this status quo and, by implication, the whole

American way of life. [It] is centered around highly abstract or symbolic issues (Plasek and Allard 1984). Homosexuality also may seem wrong, if it is seen to challenge the existing social order.

Some researchers appear unsure what their interview subjects mean when they refer to the societal consequences of homosexuality (Plasek and Allard 1984). For people at Stage 4, social preservation requires the enforcement of traditional patriarchy by various means, including controlling the gender and sexuality system. It is at this point that young people’s homophobia becomes a systematic heterosexist practice. In fact, some may be so certain of a socially condoned and necessary homophobic license they

73 are surprised when challenged. How else can we explain the reaction of a boy arrested for gay-bashing an undercover policeman? Led from the scene by other officers, he is taken aback and offers this justification: I thought he was a damned fag! (ABC News 1998)

The social symbolic danger of gender nonconformity and homosexuality is clear:

A 13-year-old tomboy and a 17-year-old drag queen do more than threaten persons with insecure gender identities; they threaten the social order (Sears 1993). This mentality leads to school rules forbidding boys to wear clothing associated with females (Beason

1996). Additionally, homosexuals become scapegoats for displacing the horrors of maintaining the patriarchal system: child abuse had 2.9 million reported cases in 1993 and the primary cause of death for children under 4 (U.S. Department of Health and

Human Services 1993) and woman battering (Mohr et al. 1992).

Under fascism, the extreme of Stage 4 thinking, homosexuals, and Jews were singled out as antithetical to the cult of masculinity and were thought to sap the national strength (Bamyn and Eliason 1996; Blumanfeld 1996; Mosse 1996).In the United States today, less-homophobic people describe themselves as moderate or liberal, and more hostile people rate themselves politically conservative (Herek 1987, 1988; Herek and

Glunt 1993).

There might be a sociobiological aversion to the assumed childlessness of homosexuals, a societal extension of the hypothetical inborn prejudice toward anyone who appears to put ones family gene pool at risk (Van Den Berghe et al. 1992). However, even gays and lesbians with children are often seen as enemies of social conservation.

74 Stage 5

Moral reasoning at the post conventional stages casts aside rigid adherence to

traditional law and order in favor of underlying principles, such as those articulated in the

U.S. Declaration of Independence. A person at Stage 5 sees democratic lawmaking as a

pursuit of justice and is occasionally conflicted over the failure of legislation to sustain

values like liberty and equality. The area of individual and minority rights is rich with the

potential for such conflict (Herek and Arnett 1998).

Difference does not upset the concept of social order at this stage. A number of

competing interests are enjoined to resolve their competing claims under a system of

amendable laws. One could support minority rights even if one felt personally

uncomfortable about that minority. The following research observation illustrates such a

possible Stage 5 mentality among college students:

The willingness to accord civil liberties to homosexuals is not, however, to be

confused with a generally favorable attitude toward homosexuality. Several studies report

that for well-educated young respondents, favorable attitudes toward civil liberties often

go hand in hand with repugnance toward homosexual activities. (Plasek and Allard n.d.,

7).

Some research shows that although most Americans think homosexuality is

wrong on moral or religious grounds, they favor employment and free speech rights for

homosexuals (Herek and Arnett 1998). This may sound like a Stage 5 judgment, but it

probably represents a Stage 3 or 4 parroting of glib American egalitarianism. The college

students above might have a higher-stage reason than that for granting rights to people

whose behavior disgusts them. The question they would have to answer is whether their

75 disgust is prompted by morality or taste. If it is merely a discomfort with the unfamiliar, like the response of some to interracial dating), it is not a moral issue and may abate with greater exposure (Herek and Arnett 1998).

Those who have not internalized higher principles of nondiscrimination can be

swayed by low-stage arguments. The popularity of claims that gay rights are special

rights, that military homophobia is caused by homosexuals, and that gays should not be

allowed to marry proves that most Americans find such arguments appealing. Down

deep, gays and lesbians are deemed second-class citizens toward whom it is acceptable to

be bigoted (Kite 1994).

Stage 6.

Stage 6 reasoning hinges on a priori principles. Its moral imperatives can lead to

civil disobedience (Kant 1949; Rawls 1971). One Stage 6 criterion is universality: One

weighs an obligation by asking if everyone ought to do the same thing. Should everyone

tell the truth, for example, or keep a promise? Occasionally one principle must be

sacrificed for a higher principle, ultimately the absolute value of human life (Socarides

1993).

Attacks on homosexuality often employ the test of universality: If everybody

chose to be gay, the world would end because nobody would reproduce. Both the premise

and conclusion are flawed: Most people do not choose their orientation; it is impossible

that every human would lead an exclusively homosexual life; and gays and lesbians do

have children. Should the human race be imperiled by under population, many ethically

driven homosexuals would have children, if they had not already had them (Socarides

1993).

76 What really motivates this argument is not alarm for the species but rather a Stage

4 concern that only heterosexual families can reproduce themselves as patriarchal institutions (Socarides 1993). Here, an observation about homophobia among African

Americans can be applied to the broader society: “Homophobia is not so much a fear of homosexuals but a fear that homosexuality will become pervasive in the community”

(Simmons 1991, 12). Homosexuality is seen as dangerous because its acceptance could undo the community as, it is currently constituted.

Stage 6 thinkers are not dismayed by difference. Human beings are seen not as

means to preserve a system but as ends in themselves. Diversity is to be cultivated and

celebrated as a reminder to value people individually (Riddle et al 1987). This mind-set

informs a commitment to pluralism that goes beyond mere tolerance (Eck 1997).

77 Conclusions

The purpose of this study was threefold. First, to review the literature, relationships and interaction associated with the following constructs, and how each contribute to the high risk among adolescent homosexual males; mental health pathology, substance abuse, social support, relationships, social stigma coming out, homophobia and suicide. Second, establish a correlation between attitude and knowledge of mental health professionals and the high rate of suicide. Third, to provide a much needed guide to assist mental health professionals in understanding the risk mechanisms for prediction, individualizing treatment, and tailoring preventive interventions for adolescent homosexual males.

What they need most is support, encouragement, education, and acceptance; what they most often receive is rebuke, reproach, ridicule, and rejection. Future research needs to move beyond mental health professionals to those who share the responsibility of providing care and protection of those whose sexual orientation is other than heterosexual. e.g., educators, physicians, the legal system and clergy etc. Bridging the gap between what is needed and what is available is the challenge not only for gay youth, but also for those of us who care about, live with, and/or work with them. As we move toward increased awareness and understanding of the gay adolescent experience, and as we apply this learning, it is anticipated that the occurrence of the high-risk behaviors will decline.

The Present Study

Survey Instrument: A survey instrument was developed by the researcher. Design of the instrument assessed demographic variables; age range, gender, years of experience,

78 occupation, ethnicity and profession/occupation. In addition study participants were to answer twenty (20) questions designed to measure attitude and knowledge of risk to adolescent homosexual males. Participants were selected from three community based mental health facilities in central and northern Florida. Forty (40) surveys were sent out via self-addressed envelopes. Twenty-one answered surveys were returned. One response was eliminated (not a mental health professional). Others indicated on the form did not address themselves as being licensed e.g., mental health therapist, substance abuse counselor etc. Results of the survey are as follows:

Average age range of the participants: 20-30------5 percent 31-40------25 percent 41-50------15 percent 51+------45 percent

Race: Hispanic------0 percent White------80 percent Black------10 percent Asian------0 percent Other------10 percent

Gender: Male------25 percent Female------65 percent Unknown------10 percent (DID NOT ANSWER QUESTION).

Occupation/profession: LMHC------8 LCSW------6 Psychotherapist------2 Registered Intern------2 Other------3

79 Average years of experience working with adolescents:

LMHC------12.5 LCSW------17.3333 Psychotherapist------10 Registered Intern------7 Other------6

1. Have you received any training in the recognition of suicidal risk to homosexual adolescent males?

Yes------35 percent No------65 percent

Significance: 65 percent of survey participants have not received training of suicide risk to homosexual adolescent males.

2. Where did you receive this training?

Graduate program------20 percent Undergraduate program------0 percent Participation in course instruction or seminar---25 percent Other------0 percent No Response------55 percent

Significance: 20 percent of responders received training at the graduate level while 55 percent failed to identify training level or program.

3. How much training have you received in the past year on signs and symptoms of suicide risk?

More than eight hours-----35 percent Less than eight hours------40 percent None------25 percent Significance: 100 percent of participants who participated in the survey 40 percent received less than eight hours of suicide risk training, 25 percent received none.

80 4. Have you ever provided counseling to a homosexual adolescent male?

Yes------70 percent No------30 percent

Significance: Although 60 percent of the responders stated they have had no training in suicide risk for this group, 70 percent of responders report counseling them.

5. What knowledge do you possess of the risk of suicide to all homosexual adolescent males?

High------25 percent Moderate------50 percent Low------25 percent None------0 percent

Significance: 75 percent of survey participants had moderate to low knowledge of risk of suicide to adolescent homosexual males.

6. What level of risk, if any, would you associate to a homosexual adolescent male who explained to you that he was having relational problems at school, with friends and at home?

High------55 percent Moderate------45 percent Low------0 percent Other------0 percent

Significance: 45 percent of the responders reported only moderate risk for this male.

7. 90 percent of adolescent suicide victims have at least one diagnosable, active psychiatric/psychological problem at the time of death, most often depression, substance abuse, and conduct disorders.

Strongly Agree------70 percent Disagree------10 percent Agree------19 percent Neutral------0 percent

81 Significance: While 90 percent of all adolescent homosexual male suicides have a diagnosable mental health problem , only .35 percent of responders had training in suicide

prevention for this group.

8. In the event you did consider a homosexual adolescent male suicidal, what immediate action would you take?

Referral to another professional------0 percent Report/call 911------45 percent Supportive and intervention therapy--55 percent Ignore it------0 percent

Significance: Although reporting the possibility of suicide is crucial if a professional

feels a person will harm themselves, and is called Baker Act in Florida, only 45 percent

of responders said they would report or call for help, and 55 percent believed that

supportive therapy would be the action to take.

9. When counseling an adolescent, do you ask about their sexual orientation?

Always------55 percent Frequently ------5 percent Occasionally------40 percent Never------0 percent

Significance: 45 percent of survey recipients indicate they do not always question sexual

orientation during counseling of adolescents who are in therapy for problems related to

troubling issues in their lives.

10. When counseling an adolescent, do you ask about suicide contemplation or attempts?

Always------80 percent Frequently------10 percent Occasionally------10 percent Never------0 percent

82 Significance: All responders reported asking about suicidal thoughts or attempts at some time during therapy, however the majority has no training in this area for youths at high risk.

11. Homosexual adolescents are at no more risk than heterosexual males?

Strongly Agree------5 percent Disagree------80 percent Agree------0 percent Neutral------15 percent

Significance: 15 percent of responders are neutral on this myth.

12. Homosexual adolescent males coming out of the closet would be considered to be at what risk?

High------60 percent Moderate------35 percent Low------5 percent None------0 percent

Significance: 40 percent of responders believe this high risk group to be at no more than moderate risk.

13. What observable attitudes in an adolescent homosexual male would cause you to seriously consider him to be suicidal?

Wanting to escape from a situation that seems intolerable-----5 percent Difficulty at school-----0 percent Drug or alcohol abuse--0 percent Rejection from family or friends------0 percent All of the above------95 percent

Significance: 95 percent of responders recognize that all specifics listed are high risk indicators for this group; however, the majority has had no training to work with this topic. Five percent of this group did not recognize all topics as danger signals.

83 14. What percent does alcohol/drugs contribute to adolescent homosexual suicide?

1-15 percent------5 percent 16-25 percent------40 percent 26 percent +------45 percent Unknown------5 percent Not at All------5 percent

Significance: While 26 percent + of all adolescent homosexual suicides are contributed to by alcohol/drugs, 55 percent of responders do not recognize this as a dangerous trigger for completed suicides and suicide attempts.

15. DO you feel our current public or private education system provides adequate information concerning adolescent homosexual male issues?

Yes------5 percent Yes, but more is needed------55 percent No, and none is needed------15 percent This should not be provided in school------20 percent No Response------5 percent

Significance: 45 percent of recipients indicate sex education regarding homosexual male concerns, including suicidal risk, need not be increased or be provided in the school system or they gave no response to this issue.

16. Therapy directed specifically at changing sexual orientation in adolescents is

Always effective------0 percent Sometimes effective------15 percent Rarely effective------55 percent Never effective------30 percent Unknown------0 percent

Significance: While research indicates therapy directed at changing ones sexual orientation is never effective, 70 percent of responders believe it to be effective

84 17. The term homophobia can be best defined as:

Sexual prejudice------80 percent Character defect------0 percent An inappropriate act------0 percent Other------20 percent

Significance: 20 percent of responders may not have known the definition of this term or felt it did not apply negatively as defined above.

18. Which of the following would you consider a homosexual act?

Sin/crime------0 percent Unnatural act------15 percent Neutral------40 percent Other------40 percent No Response------5 percent

Significance: 80 percent of responders may be saying they do not consider a homosexual act to be a sin, crime or unnatural act, while 15 percent of responders to this survey consider it unnatural. Research should look at the percentage of the last group who are untrained mental health professional, if any.

19. Coming out of the closet can be defined as:

Individual acknowledgement of sexual orientation in the face of social stigma------95 percent False disclosure to others of heterosexual orientation------0 percent Moving on with ones life ignoring the issue------0 percent None of the above------5 percent

Significance: 95 percent of responders understand the impact of social stigma regarding coming out but of that group the majority is untrained in suicide risk for this group.

85 20. Remaining in the closet can be defined as?

Non-disclosure or hiding ones sexual orientation from others------100 percent Affirming orientation and isolating ones self------0 percent Total isolation from others------0 percent None of the above------0 percent

Significance: All responders, 100 percent, were aware of the definition of this term and the real life issues for this group who choose to remain in the closet.

Discussion

These findings provide valuable information about the attitude and knowledge of mental health professionals. In this review of literature, adolescent male homosexuality was significantly associated with increased risk of suicide.

Study Limitations

The design of this study is limited because the data are cross-sectional and cannot establish causal relationships. Validity is threatened because of sample size e.g., three community based mental health centers were selected, northwestern and central Florida, twenty questionnaires received is a small sample size based on the number of licensed mental health/social workers, numbering 6366 and 5949 respectively, let alone the entire

U.S. In several instances, respondents were reluctant to respond to some of the survey questions.

Need for Further Research

The data presented herein verify the need to further investigate the relationship between attitudes/knowledge of mental health professionals and risk associated with high

86 risk adolescent homosexual males. This research should be extended to include other professionals who provide services to adolescents e.g., teachers, educators, healthcare and the clergy etc. If this survey can be seen as a limited, but perhaps valid, sample of training, knowledge, and education of those in the mental health field regarding homosexual youth, their life stressors and inherent risks, one can suggest that focus be placed on more research to corroborate the study, and immediate training sessions specific to mental health providers and this high risk population

As stated in chapter one, articles on adolescent homosexuality in professional

journals for school counselors, who have constant contact with youth, are nearly

nonexistent. Across the board, mental health counselors, medical doctors, medical

students, and other health related professional, who might be able to help, have almost no

training in sexuality, let alone education and training in counseling this vulnerable and

high suicide risk group (McKeal 2004). This kind of neglect coupled with lack of

coverage in counselor preparation programs (Bodnar and Fontaine, 1993; Graham,

Rawlings, Halpern, and Hermes, 1984) essentially precludes professionals from receiving

adequate preparation for ethical and competent counseling of gay, lesbian, and bisexual

adolescents. That the need for this training exists, is available, and must be done is well

documented.

87 APPENDIX A

RESEARCH PROJECT QUESTIONAIRE

My name is Kendall Fields. I am a licensed mental health counselor working on a research project towards a terminal degree. As such, I am seeking your assistance in participating in my research project. Your responses to the questions and information requested will be anonymous and confidential. There is no requirement for you to put any information on the questionnaire that will identify you. Questions are designed to measure your knowledge of suicide risk to homosexual adolescent males. This survey is strictly voluntary, and I ask that your answers be based on attitudinal values and knowledge.

Personal survey information requested:

Age (circle) 20 - 30 31 - 40 41 - 50 51 +

Race (circle):

Hispanic Black White Asian Other

Gender: M / F

Profession/Occupation: ______

Years experience working with adolescence: ______

Please share the information requested and your attitude about the following aspects of risk to adolescent homosexual males:

88

1. Have you received any training in the recognition of suicide risk to homosexual adolescent males? Yes No

2. Where did you receive this training? Graduate program Undergraduate program Participation in course instruction or seminar Other

3. How much training have you received in the past year on signs and symptoms of suicide risk? More than eight hours Less than eight hours None

4. Have you ever provided counseling to a homosexual adolescent male? Yes No

5. What knowledge do you possess of the risk of suicide to all homosexual adolescents males? High Moderate Low None

6. What level of risk, if any, would you associate to a homosexual adolescent male who explained to you that he was having relational problems at school, with friends and at home? High Moderate Low None

7. 90 percent of adolescent suicide victims have at least one diagnosable, active psychiatric/psychological problem at the time of death--most often depression, substance abuse, and conduct disorders. Strongly Agree Disagree Agree Neutral

89 8. In the event you did consider a homosexual adolescent male suicidal what immediate action would you take? Referral to another professional Report/call 911 Supportive and intervention therapy Ignore it

9. When counseling an adolescent do you ask about their sexual orientation? Always Frequently Occasionally Never

10. When counseling an adolescent do you ask about suicide contemplation or attempts? Always Frequently Occasionally Never

11. Homosexual adolescent males are at no more risk than heterosexual adolescent males? Strongly Agree Disagree Agree Neutral

12. Homosexual adolescent males coming out of the closet would be considered to be at what risk? High Moderate Low None

13. What observable attitudes in a adolescent homosexual male would cause you to seriously consider him to be suicidal? Wanting to escape from a situation that seems intolerable Difficulty at school Drug or alcohol abuse Rejection from family or friends All the above

14. What percent does alcohol/drugs contribute to adolescent homosexual suicide? 1-15 percent 16-25 percent 26-+ percent Not at all

90 15. Do you feel our current public or private education system provides adequate information concerning adolescent homosexual male issues? Yes Yes, but more is needed No, and none is needed This should not be provided in school

16. Therapy directed specifically at changing sexual orientation in adolescents? Always effective Sometimes effective Rarely effective Never effective

17. The term homophobia can best be defined as: Sexual prejudice Character defect An inappropriate act Other

18. Which of the following would you consider a homosexual act? Sin/crime Unnatural act Neutral Other

19. Coming out of the closet can be defined as? Individual acknowledgement of sexual orientation in the face of social stigma False disclosure to others of heterosexual orientation Moving on with ones life ignoring the issue None of the above

20. Remaining in the closet can be defined as? Non-disclosure or hiding ones sexual orientation from others Affirming orientation and isolating ones self Total isolation from others None of the above

Please mail your contributions to:

Ken Fields P.O. box 4823 Fort Walton Beach, Florida 32549-4823

Thank you!

Kendall L. Fields, LMHC

91 APPENDIX B

RESULTS

PSYCHO - REGIST THERAP PERCENTAGES LMHC LCSW OTHER ERED IST/PSY INTERN CHOLO GIST 20 - 30 5 percent 1 31-40 25 percent 1 2 2 41-50 15 percent 2 2 1 51+ 45 percent 4 3 1 1 TOTAL 20 7 6 3 2 2

RACE Hispanic 0 percent White 80 percent 7 6 1 1 1 Black 10 percent 1 1 Asian 0 percent Other 10 percent 1 1 TOTAL 20 7 6 3 2 2

GENDER Male 25 percent 2 1 0 1 1 Female 65 percent 5 4 2 1 1 Unknown 10 percent 0 1 1 TOTAL 20 7 6 3 2 2

Profession/Occupati on Years working with adolescents 12.5 17.3333 6 10 7 Please share the information requested and your attitude about the following aspects of risk to adolescent homosexual males

1. Have you received any training in the

recognition of suicidal risk to homosexual adolescent males? Yes 35 percent 2 3 1 1

92 No 65 percent 5 3 2 2 1 TOTAL 20 7 6 3 2 2

2. Where did you receive this training Graduate program 20 percent 1 2 1 Undergraduate program 0 percent Participation in course instruction or seminar 25 percent 2 1 1 1 Other 0 percent No Response 55 percent 4 3 2 1 1 TOTAL 20 7 6 3 2 2

PSYCHO REGIST - PERCENTAGES LMHC LCSW OTHER ERED THERAP INTERN IST 3. How much training have your received in the past year on signs and symptoms of suicide risk? More than eight hours? 35 percent 1 2 2 2 Less than eight hours? 40 percent 4 2 1 1 None 25 percent 2 2 1 TOTAL 20 7 6 3 2 2

4. Have you ever provided counseling to a homosexual adolescent male? Yes 70 percent 5 5 2 2 No 30 percent 2 1 1 2 Total 20 7 6 3 2 2

5. What knowledge do you possess of the risk of suicide to all homosexual adolescent males? High 25 percent 2 2 1 0 Moderate 50 percent 4 2 3 1

93 Low 25 percent 1 2 0 1 1 None 0 percent TOTAL 20 7 6 3 2 2

6. What level of risk, if any, would you associate to a homosexual adolescent male who explained to you that he was having relational problems at school, with friends and at home? High 55 percent 2 5 3 1 Moderate 45 percent 5 1 2 1 Low 0 percent Other 0 percent TOTAL 20 7 6 3 2 2

PSYCHO REGIST - PERCENTAGES LMHC LCSW OTHER ERED THERAP INTERN IST 7. 90 percent of adolescent suicide victims have at least one diagnosable, active psychiatric/psycholo gical problem at the time of death, most often depression, substance abuse, and conduct disorders. Strongly Agree 70 percent 4 4 3 2 1 Disagree 10 percent 1 1 Agree 20 percent 2 1 1 Neutral 0 percent TOTAL 20 7 6 3 2 2

8. In the event you did consider a homosexual adolescent male suicidal, what immediate action would you take?

94 Referral to another professional 0 percent Report/call 911 45 percent 3 4 1 1 Supportive and intervention therapy 55 percent 4 2 2 1 2 Ignore it 0 percent TOTAL 20 7 6 3 2 2

9. When counseling an adolescent, do you ask about their sexual orientation? Always 55 percent 5 3 1 2 Frequently 5 percent 1 Occasionally 40 percent 1 3 2 2 Never 0 percent TOTAL 20 7 6 3 2 2

10. When counseling an adolescent, do you ask about suicide contemplation or attempts? Always 80 percent 7 5 2 0 2 Frequently 10 percent 1 1 Occasionally 10 percent 2 Never 0 percent TOTAL 20 7 6 3 2 2 PSYCHO REGIST - PERCENTAGES LMHC LCSW OTHER ERED THERAP INTERN IST 11. Homosexual adolescents are at no more risk than heterosexual males? Strongly Agree 5 percent 1 Disagree 80 percent 7 5 2 2 Agree 0 percent Neutral 15 percent 1 2 TOTAL 20 7 6 3 2 2

95 12. Homosexual adolescent males coming out of the closet would be considered to be at what risk? High 60 percent 5 5 1 1 Moderate 35 percent 2 1 1 2 1 Low 5 percent 1 None 0 percent TOTAL 20 7 6 3 2 2

13. What observable attitudes in an adolescent homosexual male would cause you to seriously consider him to be suicidal? Wanting to escape from a situation that seems intolerable 5 percent 1 Difficulty at school 0 percent Drug or alcohol abuse 0 percent Rejection from family or friends 0 percent All of the above 95 percent 7 6 2 2 2 TOTAL 20 7 6 3 2 2

14. What percent does alcohol/drugs contribute to adolescent homosexual suicide? 1-15 percent 5 percent 1 16-25 percent 40 percent 3 4 1 26 percent + 45 percent 3 1 3 2 Unknown 5 percent 1 Not at All 5 percent 1 TOTAL 20 7 6 3 2 2

PSYCHO REGIST - PERCENTAGES LMHC LCSW OTHER ERED THERAP INTERN IST

96 15. DO you feel our current public or private education system provides adequate information concerning adolescent homosexual male issues? Yes 5 percent 1 Yes, but more is needed 55 percent 6 2 2 1 No, and none is needed 15 percent 1 1 1 This should not be provided in school 20 percent 3 1 No response 5 percent 1 TOTAL 20 7 6 3 2 2

16. Therapy directed specifically at changing sexual orientation in adolescents is Always effective 0 percent Sometimes effective 15 percent 2 1 Rarely effective 55 percent 5 2 1 2 1 Never effective 30 percent 2 4 Unknown 0 percent TOTAL 20 7 6 3 2 2

17. The term homophobia can be best defined as: Sexual prejudice 80 percent 6 4 2 2 2 Character defect 0 percent An inappropriate act 0 percent Other 20 percent 1 2 1 TOTAL 20 7 6 3 2 2

18. Which of the following would you consider a homosexual act? Sin/crime 0 percent Unnatural act 15 percent 1 2 Neutral 40 percent 4 2 1 1

97 Other 40 percent 2 3 2 1 No Response 5 percent 1 TOTAL 20 7 6 3 2 2 PSYCHO REGIST - PERCENTAGES LMHC LCSW OTHER ERED THERAP INTERN IST 19. Coming out of the closet can be defined as: Individual acknowledgement of sexual orientation in the face of social stigma 95 percent 7 6 3 2 1 False disclosure to others of heterosexual orientation 0 percent Moving on with ones life ignoring the issue 0 percent None of the above 5 percent 1 TOTAL 20 7 6 3 2 2 20. Remaining in the closet can be defined as. Non-disclosure or hiding ones sexual orientation from others 100 percent 8 6 2 2 2 Affirming orienta tion and isolating ones self 0 percent Total isolation from others 0 percent None of the above 0 percent TOTAL 20 8 6 2 2 2

Other includes: Substance Abuse Counselor Therapist Mental Health Counselor Note: No determination if licensed or not.

98 APPENDIX C

Critical Dictionary of Sexology

The following dictionary was taken from Erwin J. Haeberle’s

Glossary of Inappropriate Scientific and Professional Terms.

A

Aberration. (lat. the action or condition of erring on the wrong side) Originally a term used in medieval theology to describe heresy, i.e. false religious belief. Later applied by doctors to false sexual behavior. However, since objective criteria do not exist in the realm of human behavior, the term is simply a value judgment and as such unscientific (see also deviation and perversion)

abnormal behavior . This term denotes sexual behavior of which the speaker disapproves. The norm implied here, however, is his own value system, not some objective criterion. There are no objective norms for human behavior to be found in nature. There are only man-made moral norms more or less widely accepted in society.

abortifacient . (lat. something that produces an abortion) A liquid, herbal mixture, chemical, drug or other agent which induces or is believed to induce an abortion.

abortion. (lat.) The term is applicable to both the unintentional and the intentional premature termination of a pregnancy. The unintentional termination of a pregnancy is called abortion if it occurs within the first 4 months; after that time it is usually called miscarriage . However, this distinction is not always strictly observed, and sometimes the terms abortion and miscarriage are used interchangeably. The popular use of the term abortion normally restricts itself to the intentional termination by means of drugs or surgery of an unwanted pregnancy , an issue with numerous social, medical, legal, and moral implications.

abstinence. (lat.) Avoidance of certain substances (such as foods or drugs) or of certain activities (such as masturbation or sexual intercourse). Sexual abstinence can be the result of a voluntary decision, when for certain reasons a person decides that sexual activity is inappropriate at a given time or place. Abstinence can also be forced and involuntary (for example, in prison, army barracks, or hospital). Finally, sexual abstinence can stem from a conscious or unconscious fear of sex.

acceleration (lat. speeding up) of physical development. As compared to the last century, the physical and emotional development of teenagers has accelerated considerably. Today most 14-year-olds are taller than their ancestors of the same age were a 100 or even 50 years ago. It is also no longer unusual that boys and girls experience their first

99 ejaculation or first menstruation at the age of 10. Generally, the sexual development of young people today presents a much less uniform picture than it did in the past.

Adams apple. Colloquial term for the male larynx, which usually protrudes from the front of the neck. One of the secondary male sexual characteristics. addiction, sexual. This term was created in analogy to drug addiction. It is used to describe sexual behavior that is overly intensive or extensive, therefore proof of an addiction. However, this semantic maneuver is all too convenient. It paints too many different things with the same brush and, by the same token, blocks the insight into the manifold real causes of habitual, compulsive, unsatisfactory, foolish, egotistical, self- destructive, inconsiderate and aggressive sexual behavior. Furthermore, some especially vigorous sexual behavior may be condemned as addictive by envious individuals with lesser sexual needs. The belief in the existence of a sex addiction also leads to questionable assumptions about the necessity, form, duration, and goal of therapeutic interventions . adolescence. The period between the beginning of puberty and adulthood. The phenomenon of adolescence as we know it today is the result of certain social and historical developments. Pre-civilized cultures do not know an adolescence in the modern sense of the word, but use so-called puberty or initiation rites by which they confer the status of adults on their children as soon as these have reached a certain age (usually between 12 and 14 years). This means that, in these cultures, the period of transition from childhood to adulthood is very short. The same was true for our own culture in ancient times. The traditional customs from that period live on in contemporary religious ceremonies, such as the bar mitzwah and the Catholic and Protestant confirmations. However, with the development and growing complexity of civilization, the transitional period between puberty and adulthood has gradually become longer until, as in many contemporary societies, it now extends well over 10 years and more. It is not impossible that, in the future, the period of adolescence will last even longer. As is obvious from this short sketch, adolescence is less a biological than a cultural phenomenon.

adultery. Sexual intercourse between partners of whom at least one is married to someone else. According to certain religious views, all sexual relationships outside of marriage are considered adulterous, including not only premarital intercourse and self- pleasuring (masturbation) , but even sexual desires, dreams, and fantasies of married partners which are not directed towards their own spouses. However, it seems more sensible to restrict the use of the word adultery to cases where certain acts or attitudes actually threaten an existing marriage. Such a threat case result not only from irresponsible sexual behavior, but also from other forms of neglect, egotism, jealousy, and unfairness.

agape. (gr. love or charity) Non-sexual love, i.e. a selfless love for ones neighbor. The greatest of the Christian virtues.

100 algolagnia . (gr. enjoyment of pain) Misleading term for masochism, which is not so much the enjoyment of pain as the enjoyment of being submissive to a dominant sexual partner. An aspect of this submission may very well be the enjoyment of pain. alimony. Traditionally, the payments that a husband has to make to his former wife after a divorce . Also the allowance payable in the case of a legal separation. Alimony was once the exclusive privilege of women. However, in recent years, there have been cases where courts have ordered women to pay alimony to their former husbands. This is a sign of the growing equality of the sexes . ambisexual (adjective and noun. from Latin ambo: both, and sexus: sex). Literally translated, the term means that the person in question is erotically attracted to members of both sexes. An ambisexual is a man who falls in love with women as well as with other men, or a woman who falls in love with men as well as with other women. ambisexuality. This term is used for the sexual disposition of people who are neither exclusively heterosexual nor exclusively homosexual in their desires or responses. In popular language, the terms ambisexual and ambisexuality are often replaced by the terms bisexual and bisexuality, a usage that can lead to confusion. amenorrhea. (gr.) Lack of menstrual bleeding in females after puberty. amor lesbicus . (lat.) Lesbian love. Sexual love between women. anal intercourse. Sexual intercourse by inserting the penis into the rectum (anus). Since the rectum is normally one of the erogenous zones, many people enjoy anal intercourse. However, some others may vehemently reject it, considering it disgusting or dirty. In the final analysis, its appropriateness depends entirely on the judgment and understanding of the partners involved. However, in many states of the USA it is illegal, even between husband and wife.

androgynous. (adj. from gr. andros = man and gyne = woman) Having both male and female characteristics. andrology. (gr. from andros = man) Branch of medicine specializing in problems of the male sexual and reproductive organs. Corresponding to gynecology (from gyne = woman), the branch of medicine specializing in problems of the female sexual and reproductive organs. anejaculation. (gr. lack of ejaculation) A medical term referring to a male orgasm without ejaculation. This can happen in the following cases: 1. The male has not yet reached puberty and thus does not yet produce semen. 2. There have been several previous ejaculations within a short time and the supply of semen is temporarily exhausted. 3. There is, in fact, an ejaculation, but not to the outside, but into the bladder (retrograde ejaculation, see there). 4. (very rare:) There is some malformation of the

101 prostate or some clogging of vessels, in which case a urologist should be consulted who will search for the exact cause. anilinctus (sometimes also falsely anilingus) Licking of the rectal opening. The rectum is usually one of the erogenous zones, and some men and women therefore engage in anilinctus, either as a foreplay to anal intercourse, or for its own sake as one of many possible forms of intimate physical contact. There are people who have strong personal reservations against anilinctus, just as against cunnilinctus and fellatio. However, the ultimate evaluation of these sexual practices depends entirely on the attitude of the sexual partners involved. It must be pointed out, however, that, unless caution is exercised and the most scrupulous cleanliness is observed, anilinctus can lead to the transmission of intestinal parasites, bacteria, and viruses, resulting in serious illnesses. anorgasmia . (gr.) Lack of orgasm. anorgasmic . (adj. gr.) without orgasm. The term is usually applied to women who either (1.) cannot reach orgasm during coitus or (2.) cannot reach it through any sexual activity at all. (The first case is not uncommon, the second is rare.)

anorexia nervosa. (gr. u. lat.) An eating disorder in females usually occurring during puberty. An unreasonable and unjustified fear of being or becoming fat prompts a refusal to eat enough, leading to a dramatic weight loss and very serious health problems, even to death. anovulation . (gr. and lat.) Lack of ovulation. aphrodisiac (after Aphrodite, the Greek goddess of love). A substance intended to increase sexual desire and potency. No foods, drinks, or chemicals can increase the capacity for love, or restore it where it has been impaired, or create it where it has failed to develop. However, it is possible to influence a persons physical reactions. There are, for instance, special diets that can build general physical strength and endurance. There are also certain natural substances and artificial drugs (like sildenafil) that can increase blood circulation in the sex organs. This, in turn, may facilitate an erection. Alcohol can reduce or remove emotional inhibitions. Certain drugs can heighten a persons sensory perception or alter the state of his consciousness. Such effects may indeed help some people to establish sexual contact or to deepen their sexual experiences, but there is nothing automatic about such responses. Equally uncertain is the effect of additional hormones. Temporary abstinence can occasionally build up sexual energies and, for a time, result in increased sexual activity. The most obvious and effective aphrodisiac is an attractive sexual partner. His or her body, talk, gestures - in short, the partners individuality and love - are the strongest stimulants for sexual desire. They are also the basis for a continuing, rewarding relationship. The entire range of behavior that sexual partners develop towards each other contains innumerable stimuli which act as aphrodisiacs, and which give each sexual relationship its particular character. Some people have also coined the term anaphrodisiac, meaning a substance that reduces or even eliminates sexual desire. Over the years, a number of such substances have been

102 developed by the pharmaceutical industry, and they are being used for the treatment of certain violent sex offenders. areola mammae. The ring around the breast nipples, darker than the rest of the skin. artificial birth control . Opposite of natural birth control (see there). The speaker usually means contraception, not birth control (see there). In any case, the distinction between artificial and natural is, in this case, based on religious beliefs and value judgements, not on objective criteria. Scientifically, the terms are meaningless, because, objectively speaking, any means of contraception is as natural or artificial as any other. Even the so- called natural means of contraception involve careful observation and calculation as well as the use of artificial tools such as calendar and/or thermometer. All forms of contraception use the knowledge of certain laws of nature to prevent certain other laws of nature from taking effect. artificial insemination. A simple procedure in which a doctor injects male semen into a womans uterus by means of a fine tube. Artificial insemination is sometimes performed in cases where a married woman fails to conceive because of certain malfunctions of her sexual organs or the subfertility (insufficient fertility) of her husband or male partner. Artificial insemination may also be considered by couples in certain cases of involuntary separation, since sperm can be preserved and stored in so-called sperm banks. The sperm used in artificial insemination, which is gained by self-masturbation , is usually that of the husband. However, if he is sterile, the sperm of an anonymous donor is used. In recent years, female couples who wanted children have also used artificial insemination by anonymous donors or even by male friends known to them. asceticism. Renunciation of pleasure in favor of some special goal. In a sense, we are all ascetics. Every life offers more possibilities than can be explored. Everyone has to restrict himself and constantly has to give up something in order to get something else. There is an inescapable, permanent, and occasionally frustrating necessity to make selections. In short, our lives are made up of innumerable individual choices according to some basic set of priorities. In everyday language, however, the term asceticism is often used for the renunciation of comfort and luxury, or for abstinence from sexual pleasure . asexual. (adj.) Non-sexual; without sex. Generally speaking, the term should not be applied to a person, since every man and woman is a sexual being. However, there are some individuals who, in their entire lives, never show any interest in sexual activity. In these very few cases, the term could be a suitable characterization of their personalities. The word asexual also provides a useful description of kinds of behavior which do not have or which seek to avoid any overt sexual implications. For example, there is an asexual way of describing human reproduction by concentrating on the biological facts without reference to the feelings of the man and the woman involved. There are also asexual relationships between men and women, such as professional cooperation at work. In fact, the ability of both sexes to engage in asexual relationships for the sake of some objective social goal is important for a healthy society.

103 autoeroticism. (gr. self-love) A term sometimes used for self-pleasuring (masturbation).

autofellatio. (gr. and lat.) Self-sucking of the penis. Requires unusual physical dexterity. Only ca. 1 in 100 males can do it.

automutilation. (gr. and lat.) Self-mutilation. In a sexological context, the term is usually applied to a persons self-mutilation of the sex organs or erogenous zones which provides him or her with some sort of sexual excitement or satisfaction.

aversion therapy. A highly questionable form of therapy in which undesirable sexual desires or responses are linked to unpleasant stimuli (such as electric shocks, or induced vomiting). This treatment assumes that the unpleasant or painful experiences will, with sufficient repetition, become associated with the sexual responses and thus help to suppress them. The success of the treatment has always been dubious at best. Moreover, in the past, aversion therapy has been used in cases in which it was clearly unethical and unjustified (homosexuality, transvestism).

azoospermia. (gr.) Lack of mature sperm cells in the ejaculate (semen). One of the causes can be a blockage in the spermatic duct. Another, less common, cause can be a lack of sperm production (spermatogenesis, see there).

B

basal temperature. Body temperature taken early in the morning while still resting. This temperature varies with the course of the menstrual cycle, a variation that is used to determine a womans fertile and infertile days in the rhythm method of contraception (see rhythm method).

bastard. A child born out of wedlock (formerly also called an illegitimate child). The word bastard was once a neutral term which could be used in normal, polite conversation. In the meantime, however, it has degenerated into a highly derogatory and offensive term, which is now often used without regard for its original meaning. On the other hand, depending on the context, the word bastard can also become almost a term of endearment (the poor bastard).

bestiality. Sexual contact with animals.

bigamist. A person who is married to two people at the same time. bigamy . Marriage to two spouses at the same time (one husband having two wives or one wife having two husbands.) birth control. This broad term should be used only in cases where births are to be prevented by any means available, including abortion. Unfortunately, it is often used interchangeably with contraception, but this is wrong. Contraception prevents only conceptions, i.e. pregnancies, and it is therefore a much more restrictive and precise term.

104 bisexual. (lat. adjective and noun) A term with several different meanings: 1 Humans, like other mammals, are a bisexual species, i.e. they are a species with two sexes - male and female. 2. The human body is, in some ways, bisexual, i.e. each sex shows certain characteristics of the other (the male breast also has nipples, although it produces no milk; some females have strongly developed prostatic glands, i.e. the paraurethral glands; the sex organs of males and females develop from the same embryonic cell mass and have a number of homologous structures). 3. A person who is erotically attracted to both sexes (noun) or the description of a sexual orientation toward both sexes (adj.). The third meaning is better conveyed by the less confusing term ambisexual, see there). bisexuality. (lat.) Sexual orientation toward both sexes, erotic attraction to both males and females. Better: ambisexuality, see there).

brothel . A house or large apartment where people can rent sexual partners for money and where the sexual contact takes place right on the premises.

C carezza. (also karezza or coitus reservatus) A form of sexual intercourse during which the man and the woman remain motionless for a long time, as soon as the penis has entered the vagina. Some women are said to experience several orgasms this way, while men do not try to reach, and generally do not have an orgasm. Instead, they derive satisfaction from the prolonged duration of the sexual union. Since there is no ejaculation of sperm, carezza has sometimes been recommended as a method of contraception. However, it cannot be considered reliable, since it obviously demands a great deal of self- control from both partners. Already known in ancient India, carezza was introduced to the modern Western world by the Oneida community, a 19 th century American experimental commune and spiritual group whose members put great emphasis on the union of souls.

castration. Removal. or loss of the sex glands (the testicles in men; the ovaries in women). A castration results in infertility and causes a number of other physiological and psychological changes because of a drastic reduction sex hormones . However, it is possible to make up for this loss to a certain extent by hormone injections, although fertility cannot be restored. The surgical removal of the sex glands is sometimes necessitated by injury or disease. Castration should not be confused with sterilization (see there) . It is not always certain that a castration in adulthood ends a mans sexual capacity, although in most cases it will significantly reduce it over time. However, while it may greatly weaken his sexual urges, it will not redirect his sexual orientation or change his sexual interests. castrato. (ital.) A type of opera singer common in the 18 th century. Musically gifted boys with beautiful voices were castrated before puberty, i.e. before their voice changed and then given a rigorous musical training. Some of them became famous opera stars in adulthood, combining very high, female-type voices with a male strength of tone. The greatest composers of the time (Handel, Hasse, and Mozart) wrote operas for them. The

105 most famous castrato, Farinelli, even held a politically influential position at the Spanish royal court. Today, if the operas in question are performed at all, the castrato roles are assigned to female altos or mezzo sopranos or to male countertenors. Neither can recapture the sound of the music as it was originally conceived and performed. celibacy. The state of being unmarried for professional or institutional reasons. The term is most often used in connection with the fact that Roman Catholic priests and members of most religious orders take a vow to remain unmarried and to lead a life of chastity, i.e. sexual abstinence . cervical cap. A mechanical means of contraception similar to a diaphragm , but smaller and more difficult to apply. The cervical cap can be inserted only by a doctor, which greatly complicates its use. On the other hand, once capping the cervix, it has the advantage of being able to remain in place for up to a month at a time. cervix. The neck of the uterus . chastity . In everyday usage today, chastity simply means sexual abstinence. However, this is a modern, limited view which has given the term overtones of prudery. In a wider sense, chastity is an attitude of sexual responsibility resulting in concern and respect for ones sexual partners, treating them as individuals in their own right, not as sexual objects to be used at ones own convenience. A chaste person is considerate and sensitive to the sexual needs, hopes, and fears of others. child abuse, sexual. An unfortunate term that seems to imply that there could be a good sexual use of a child. However, neither children nor adults should ever be used sexually. What is most often meant is something else: illegal sexual contact between adults and children. circumcision. Surgical removal of foreskin from penis. Traditionally, Jews, Muslims, and many African peoples have circumcised boys in compliance with their religious laws and traditions. Among other religious groups or nations, circumcision of boys or adult men has also occasionally occurred for medical reasons when the foreskin proved too tight, inflamed, or infected. In the United States today, circumcision has become general practice, with the result that almost all American boys are routinely circumcised at an early age, usually at birth. However, in recent years, the issue has become controversial, as more and more objections to the practice are being raised, not only by doctors, but also by parents, who prefer their sons remaining uncircumcised. Occasionally, on also encounters the term female circumcision. This is a misnomer for clitoridectomy, i.e. cutting out of the clitoris, a much more radical operation than a mere circumcision. climacteric. (gr. ladder rung) Menopause . Change of life in women, resulting from the gradual extinction of the reproductive capacities. The climacteric, which extends over a period of several years, usually begins towards the end of their fourth decade. It brings the gradual cessation of the menstrual flow and, finally, infertility . There may also be a number of other physiological and psychological changes. The sexual (as distinct from

106 the reproductive) powers are not necessarily affected by the climacteric. According to some medical opinion, there is also a climacteric in men, which supposedly begins at the end of their fifth decade. However, there is no doubt that the resulting changes, if indeed they occur, are less pronounced in males. climax. In sexology: Orgasm.

clitoris. (gr. that which is closed in) The female pleasure organ. The glans (head) of the clitoris, which is partly covered by a prepuce (foreskin) is considered one of the external female sex organs. It is situated at the upper frontal part of the vulva where the labia minora (inner lips) meet. The actual shaft of the clitoris extends further inside the body and then divides into two legs (forming a shape similar to the letter Y) , so that the clitoris as a whole is really an internal sex organ, more or less equal in size with the penis. clitoridectomy . (gr.) Cutting out of the clitoris. cohabitation . (lat. dwelling together) Misleading, if it is meant to refer to vaginal intercourse (coitus). coition. (lat. going together) Coitus. coitus . (lat. going together) Vaginal intercourse. Sexual intercourse by inserting the penis into the vagina . coitus interruptus (lat. interrupted coitus) Withdrawal of penis from the vagina before ejaculation. The term is misleading, because this ejaculation outside the vagina does not interrupt, but end the coitus. It would therefore be more precise to call it coitus abruptus. After all, it does not continue after this interruption. coitus reservatus. Medical term for karezza (see there).

Coming out. is a term used to describe the process of acknowledging your sexual orientation or gender identity to yourself or to others. For some individuals, awareness of ones own sexual orientation or gender identity comes as early as the onset of puberty; for others, during the high school or college years; and for some, not until later in life. commune. A commune is a modern form of the extended family and usually consists of several married and single adults and their children who pool their financial resources and share a house or an apartment. In some cases, the individual members retain their own rooms and their personal privacy. In other cases, they may develop a closer relationship, which may even include some form of group sex. In recent years, the shortcomings of the nuclear family have led many young people to experiment with communal living arrangements. However, not many experiments in communal living have been successful in the long run, since thus far few people have been able to develop the necessary democratic lifestyle.

107 conception. Beginning of pregnancy. A conception is the result of three sequential processes: 1. Fertilization of an egg, 2. segmentation and initial growth of the fertilized egg, and 3. implantation of the fertilized and segmented egg in the uterus. If any of these processes goes awry, there is no conception and no pregnancy.

concubine. In certain traditional polygamous societies, concubines were wives of minor rank and part of the household. In other societies they were simply acknowledged mistresses, usually living apart from the mans family. Today, the term refers most often to a woman who lives with a married man in a relationship of free love and who therefore does not enjoy the social and legal privileges extended to a wife.

condom . A condom is made of thin rubber (latex) and is shaped like the finger of a glove. As it fits tightly over the penis , it prevents the sperm from entering the vagina. It also offers protection against infection with a sexually transmissible disease. Careful application can increase its effectiveness. There are also special condoms which increase the size of the penis, or which have a rough or irregular surface in order to provide greater vaginal stimulation (so-called French ticklers). So called natural condoms made of sheep gut do not offer effective protection against infections. continence. A word sometimes used for sexual abstinence, but also for the ability to hold urine or feces. The loss of the latter ability is called incontinence. contraception. Literally, the prevention of a conception . The term is used for methods or policies aimed at the avoidance of unwanted pregnancies. It is a more precise term than birth control.

contraceptive. Condom. Sometimes the term is also used to refer to other methods of contraception, such as IUDs, diaphragms, pills, etc.

conversion therapy. The term refers to the missionary work of psychiatrists who try to convert homosexuals to the true faith of heterosexuality. This is moralism masquerading as science, because the silent assumption that anyone should need this conversion is nothing but a religious value judgement or, to be more precise, a prejudice. Not surprisingly, the reverse has never been tried (psychiatrists have never tried to convert heterosexuals to homosexuality). History offers some illuminating examples of conversions, from the forced conversion of Jews to Christianity in 16th-century Spain to the voluntary conversion of Martin Luther from catholicism to protestantism. The converted Jews (sp. conversos) were generally suspected of lying and of secretly remaining true to Judaism. Martin Luther and other protestants were first declared outlaws and heretics, but, after long religious wars, they eventually could practice their new faith under any sovereign who shared it (in the latter case, it was the catholics who had to convert or leave the country according to the rule cujus regio, ejus religio, i.e. the religion of the sovereign determined the religion of his subjects). Todays parallels are striking: The new heterosexuals converted by therapy are suspected of lying and of secretly remaining true to their previous homosexuality; the voluntary converts to homosexuality often lead make-believe heterosexual lives or move to states or countries

108 without sodomy laws (for example from Alabama to California or from Malaysia to Germany). The whole issue of religious and sexual conversion is a depressing example of never-ending human folly. Science should not contribute to it. In recent times, some psychiatrists have replaced the term conversion therapy with the equally unacceptable term reparative therapy (see there). copulation. Physical union of penis and vagina . Vaginal intercourse. (See coitus. ) crime against nature. An obsolete legal term referring to certain kinds of sexual behavior (usually oral and anal intercourse). To a modern lay person this usage may appear strange and peculiar, since the words themselves seem to suggest something else. Indeed, it would appear that the term would be more appropriate for water- and air pollution or other destructive acts that ruin mans natural environment and upset the ecology. However, this particular legal term dates back to the Middle Ages, and the word nature has here a very different, rather mystical meaning which is inaccessible to modern science and even ordinary common sense. (See unnatural sex.) cuckold. Derogatory term for a husband whose wife has a lover. A traditional literary and theatrical motive. Many classical comedies show the artful cunning of wives who deceive their unloved husbands, thus making them objects of ridicule. The dramatic stereotype of the aging cuckold was an expression of the popular opinion that impotent and insensitive husbands had no right to the fidelity of their wives. This opinion belongs to a time when marriages were arranged by the couples families, most often without regard for the brides own interests and wishes. cunnilinctus. (Often falsely cunnilingus. Lat. from cunnus: vulva and linguere: to lick)) Licking or sucking of the female sex organs. As with fellatio, this is a common form of sexual activity.

D defloration. (lat. taking the flower away) Rupture of the hymen as a result of vaginal penetration . The first coitus which ends a girls or a womans virginity. Traditionally, the only appropriate occasion for a womans first sexual intercourse was her wedding night , when her husband expected to find her hymen intact as proof of her premarital sexual abstinence . However, there have been cultures in which a girls hymen was incised by a priest as part of the initiation rites. A secularized version of this custom survived until about 200 years ago in certain parts of Europe, where the feudal lords reserved the right to deflower the brides of their serfs. (See jus primae noctis.)

deviance . A sociological term meaning behavior that is not in conformity with the rules, norms, or values of a particular society. Originally, the word deviance implied a going astray from some right path of life, but today it is merely a formal term. Its concrete meaning depends on the particular norms of the society under consideration, and these can differ considerably from one place and historical period to another.

109 deviant. A person whose behavior differs from the socially accepted norm and is therefore considered a candidate for religious, legal, or medical interventions designed to bring him back to conformity. A sexual deviant is somebody whose sexual behavior deviates in this sense from the sexual standards of his society. As these standards vary, so does deviance. What is considered deviance at one time and place may be accepted behavior at another time and place. deviation, sexual. (lat. the action of leaving or the condition of having left the right path) Originally a term used in medieval theology to describe heresy, i.e. false religious belief. Later applied by doctors to false sexual behavior. However, since objective criteria do not exist in the realm of human behavior, the term is simply a value judgement and as such unscientific (see also aberration and perversion) diaphragm. (gr. separating wall) A contraceptive device. The diaphragm is a small bowl- shaped device made of soft rubber which is placed inside the vagina covering the cervix . As a result, the sperm entering the vagina during coitus is mechanically blocked from reaching the uterus. In order to increase its effectiveness, the diaphragm is normally used together with a spermicidal jelly (see spermicides). The diaphragm is available only on prescription, since it has to be properly fitted by a doctor, who also has to instruct the woman in its use. Given the proper instruction, the woman can later insert the diaphragm herself. The diaphragm is inserted before each coitus , and must not be taken out until 8- 12 hours after the last ejaculation. However, it should never remain in its place for more than one day. After removal, it is cleaned with soap and water and can be used again.

dildo . (from ital. diletto: delight) An artificial penis made of plastic, rubber, wood or other material. There are also penis-shaped electric vibrators on the market which are used by some women and men for the purpose of self-pleasuring (masturbation).

droit du seigneur. (fr. Right of the Lord) The right of a feudal lord to deflower the brides of his serfs.(See jus primae noctis.) dyspareunia. (gr. the condition of not fitting together) The term is used by some doctors for pain during vaginal intercourse (coitus).However, since such pain can have a multitude of causes, the term is just as useless diagnostically as reddening of the skin or cough. It is always necessary to name the exact nature and cause of the pain.

E ectopic pregnancy. (gr. out-of-place pregnancy, also called extrauterine pregnancy) A pregnancy during which the fertilized ovum , instead of moving on into the uterus, attaches itself somewhere else, for example to the wall of one of the Fallopian tubes (tubal pregnancy or Fallopian pregnancy) . This leads to the eventual bursting of the tube and to internal hemorrhage, requiring immediate surgery. The remaining second Fallopian tube preserves the womans ability to have other children.

110 ecstasy . (gr. being outside oneself) 1. A state of extreme pleasurable excitement. In a state of ecstasy, a person loses his self-control and expresses his deepest emotions through unconscious and involuntary sounds and gestures. At the same time, his sensual perception is partially impaired. Sexual excitement and orgasm are typical examples of ecstasy. 2. Colloquial term for a drug often consumed in the disco scene. effeminacy (noun), effeminate (adj). Exaggerated female traits or behaviors in males. Girlishness in boys. An effeminate male (slang: sissy) is often ridiculed, bullied, or otherwise socially ostracized by other males who feel threatened in their own masculinity. Effeminate males of any age are also often suspected of a homosexual orientation, although there is not necessarily a connection. For example, the especially effeminate male transvestites are usually sexually attracted to women. Very often, they are married and have children, i.e. their sexual orientation is heterosexual. ejaculatio praecox . (lat. ejaculation coming too early or prematurely) The term is completely misleading, because it confuses ejaculation with orgasm. It is the orgasm, not the ejaculation, that is felt to occur too early. An ejaculation can, but does not have to, accompany a male orgasm. Not every male orgasm is accompanied by an ejaculation (examples: before puberty, after a prostactectomy etc.) However, after an orgasm the penis usually loses his erection, and it is this loss of erection that causes the concern. In other words, the real problem has nothing to do with an ejaculation of semen, but with an untimely softening of the penis after orgasm. It is therefore more appropriately called unsatifactory timing of orgasm. (See also premature ejaculation) ejaculation. The sudden emission of semen from the penis during orgasm. An ejaculation may occur spontaneously, as for instance in the form of an orgasm during sleep (wet dream), or it may be brought about deliberately during masturbation or sexual intercourse . Boys experience their first ejaculation during puberty , usually between the ages of 11 and 13. The semen discharged in an ejaculation consists of a blend of several secretions which are produced by the prostate and seminal vesicles (almost all of it) and the testicles (a very small portion of it). One ejaculation may contain several hundred million spermatozoa . However, the quantity of sperm cells contained in the semen decreases with the mans age and with repeated ejaculations within a short period of time. This biological fact has led some men to the erroneous belief that they can avoid making a woman pregnant by masturbating before engaging in coitus . They thus hope to have exhausted their sperm supply long enough to allow for intercourse without release of additional sperm. Apart from the fact that, under these circumstances, sexual intercourse can become difficult and frustrating, this supposed method of contraception is so unreliable as to be virtually useless. ejaculate, female. See female ejaculate. ejaculation, female. See female ejaculation. ejaculatory dysfunction. The term almost always means some problem of orgasm. There are only two real male ejaculatory dysfunctions, which, by the way, are very rare -

111 a complete lack of ejaculation and retrograde ejaculation, i.e. ejaculation of semen not to the outside, but into the bladder. ejaculatory incompetence . Misleading term which confuses ejaculation with orgasm. The speaker usually means a males inability to reach orgasm, an entirely different matter. ejaculatory overcontrol . The speaker usually means a males inability to achieve orgasm at all or within a reasonable time frame. The ejaculation of semen has nothing to do with it and will be absent in any case before puberty. However, the problem may occur even in boys before their first ejaculation. embryo. Medical term for the developing baby during its first stages of life inside the mothers womb. Within three months, the embryo grows to a length of about 4 inches. After the third month of pregnancy, the unborn baby is called a fetus. endogamy. (gr.) Marriage within the social group, tribe, or clan endometrium. (gr.) Interior mucous membrane of the uterus. endometriosis . (gr.) Growth of endometrium outside the uterus, for example inside the Fallopian tubes or in the abdominal cavity. Can cause pain and other problems.

English vice. (Also: English culture) Erotic spanking. The term is most often used for the passive, masochistic enjoyment of spanking or whipping. enuresis. (gr.) Involuntary urination. Bedwetting. eonism. (after the Chevalier d Éon 1728 –1810). An old-fashioned term for male transvestism. DÉon, a French diplomat, lived a substantial part of his long life as a woman. He displayed his legendary fencing prowess in both gender roles. episiotomy. (gr.) Surgical cut into the edge of the vulva in order to prevent tearing during birth. ephebophilia. (gr.) Love for male adolescents. Sexual attraction to males who are in or just barely beyond their puberty. epispadia. (gr.) Malformation of the penis, with the urethra opening not at its tip, but on its upper side. erectile dysfunction. Weak or absent erection in situations where it is wanted. A males inability to have an erection or a full erection of the penis when trying to have sexual intercourse. Often treatable by behavioral therapy and/or medication or microsurgery, depending on the individual case.

112 erection . Swelling, stiffening, and rising of the penis , usually caused by sexual excitement . The stiffening results from the fact that the hollow erectile tissue inside of the penis becomes filled with blood. Boys normally experience erections consciously for the first time during puberty , although it is not unusual that even children have erections. (In these cases, there is, of course, no potential discharge of semen.) An erection is usually caused by erotic thoughts or sights, or by the touching of the erogenous zones . It can, however, also result from a variety of other causes.

erogenous zones. (gr. love-producing zones) Certain parts of the body can, when touched by a sexual partner, cause or increase sexual excitement. These so-called erogenous zones are usually the following: the external genital organs, breasts, nipples, mouth , rectum , and certain areas of the skin (face, neck, inside of thighs). It depends very much on the individual and on the situation whether any or all of these erogenous zones develop their particular sensitivity. Only time and experience can make a person aware of his erogenous zones. Their response is never automatic. They stimulate sexual excitement only in situations of mutual sexual consent, and do not respond at all in cases of rape. On the other hand, new pleasurable sexual encounters can lead to the discovery of new erogenous zones and of their various responses to certain stimuli such as kisses, caresses, licking, rubbing, slapping, or tickling. Potentially, every part of the human body can be an erogenous zone. Just as each individual is different from others, so are his reactions. For this reason, everyone has to find out by himself which parts of his own (or his partners) body react as erogenous zones.

EROS. (Latin: Amor or Cupid) The god of love, in paintings and sculpture often portrayed as a winged youth or even as a little boy with bow and arrow. According to Greek mythology, Eros symbolized life and creativity. To be in love meant to be possessed by a divine force (The God is in the lover, not the beloved.). This force caused people to long for beauty and excellence, not only in the physical world, but also in the realm of the spiritual. Man could love not only his sexual partner, his family, or his friends, but also his country, national heroes, or artistic ideals. Although we still use the word love in all of these cases today, we see a great difference between such love and sexual desire. To us moderns, only the latter seems erotic. On the other hand, there are people who insist that there is a difference between the erotic and the merely sexual. According to this usage, the term sexual refers exclusively to the baser biological needs, while the word erotic implies higher spiritual desires. (See Platonic love.) Our everyday language has thus far failed to adopt this distinction. In fact, the word erotic is sometimes found to be more base and objectionable than sexual. However, the exact meaning and effect of these and similar words depend very much on the context and on the cultural background of the speaker or listener.

erotic . (adj.) Sexually stimulating or simply related to love or sexual intercourse .

erotica. (gr. noun pl.) Materials (books, pictures, films, videos, or records) dealing with sexual matters.

113 eroticism. A term with several meanings: 1. A strong sex appeal. 2. A cultivation or refinement of sex. 3. A preoccupation with sexual matters.

erotomania. (gr. love craze) The word, formerly often used by disapproving psychiatrists, refers to a persons frequent wish to have sexual intercourse or to change sexual partners. A learned term of denigration without scientific value. (See also nymphomania and promiscuity)

erotophobia. (gr.) Fear of love. Anxiety and negative feelings toward sexual matters in general or certain sexual behaviors in particular.

estrus. The cyclically recurring phase - tied to her ovulation - in which a female animal is sexually receptive and fertile (also known as being in heat). In many animals this phase occurs only once a year and is very short. In the higher mammals (primates), estrus occurs more frequently. However, in human females there is no estrus as such. Between puberty and menopause, a woman has a fertile period of several days every month, but she may be sexually receptive every day even beyond menopause.

ethology . (gr.) Comparative study of animal behavior in its natural settings (as opposed to laboratory settings). The results are often used to understand the behavior of the human animal better as well.

ethnology, sexual. The comparative study of sexual behavior in various peoples, tribes, or ethnic groups. The pioneer of this field of study was Friedrich Salomon Krauss (1859- 1938), who studied sexual customs in the Balkans and edited a respective multi-volume standard work Anthropophyteia. eugenics. (from gr. well born) The study of forces under social control which enhance or impair the inborn qualities of future generations. Since heredity is governed by certain biological laws, it is possible to influence the result of the breeding process by selective mating. This is constantly being done in animal breeding. However, basically the same laws also apply to human procreation. While there is no compulsion for men or women to choose their marriage partners according to these laws, prospective parents can take advantage of modern genetic knowledge in order to avoid needless suffering. For instance, a person afflicted with a hereditary disease, such as hemophilia, Huntingtons chorea, or certain other diseases, may decide against having children of his own. On the other hand, the idea of eugenics has, in the past, led to objectionable policies, first in the US and later in Nazi Germany, where mentally incompetent or otherwise socially undesirable persons were forced to undergo sterilizations. Such policies, that were widely copied in still other countries, have discredited the eugenics movement. However, the issue of improving human offspring has not disappeared, but prompted new discussions in view of the recent, continued progress of genetic research. eunuch. (gr.) A man whose testicles have been surgically removed before puberty. This operation is called castration. As a result, the body fails to develop such typically male characteristics as a beard and a deep voice. The sexual capacities also remain

114 underdeveloped. The term eunuch is normally used only for harem guards in China or some Islamic countries in premodern times. However, the practice of castrating young boys was also known in 18th-century Europe. The so-called castrati (male altos) were then in great demand for the opera stage, and some of them became very rich and famous. The leading parts in the operas of George Frederick Handel, for example, were written for castrati. Since today this type of voice can no longer be provided, the operas are either rearranged for modern voices or left unperformed. exhibitionism. (lat. showing off) The urge to show ones nude body or sex organs in public. Specifically: The compulsive behavior of some men who display their erect penis suddenly to unsuspecting and surprised females. In many countries this behavior is punishable as a sex offense, especially if the females file a complaint. However, there are degrees and various kinds of exhibitionism. Some men, for example like to show off before willing females, masturbating in front of an open window, because they know that curious women are watching them from across the street. Similarly, there are men and women who post nude pictures of themselves or their sex organs in the internet or exchange such pictures with strangers via e-mail. Still others arrange to be watched by paying internet customers during all kinds of sexual activity. Exhibitionistic tendencies can also be found in some porno stars, female and male strip-tease dancers, or nude go-go girls and boys. exhibitionist . A man who compulsively shows his erect penis in public, usually to unsuspecting and surprised females. In many countries the man is considered a sex offender and punished, in some countries only if there is a complaint. The psychological harm done by an exhibitionist is frequently exaggerated by over-concerned parents and public officials. There is a fear that little girls might experience a shock at the sudden sight of a penis. However, such shocks do not occur where children are given early and proper sex education. extended family. A family consisting of more than a man, a woman, and their children. There are two types of extended family:

1. A household including several generations of one family (parents, children, grandchildren) plus various married and unmarried relatives (aunts, uncles, cousins) plus a number of domestic servants. In such a household, power is distributed unequally according to age, sex, and relation to the head of the family. For thousands of years this was the normal type of family. Its structure corresponded to the needs of a basically agrarian society. However, since the beginning of the industrial revolution, the extended family has gradually been replaced by the nuclear family.

2. A communal household of several adults and their children, intended to overcome the disadvantages of a nuclear family. Today there are various models for such communal living: - The kibbutzim in Israel, where people share the means of production and are equally trained to join in their defense. - Socialist communes, in which people share everything, and which often impose a great deal of conformity on their members. - New communal living arrangements (also often called communes) in Western Europe and in

115 the United States, where a number of married and unmarried adults and their children pool their material resources (or part of them) without surrendering their personal independence. The advantages of the modern extended family are:

- Living costs are lower, because more people share the cost for food, rent, and appliances. - There is a more democratic division of labor; privileges can be abolished. - There is more intellectual and cultural stimulation. - The individual enjoys a greater amount of emotional and economic security. - The individual has more time for professional, social, and political activities. - There are no unwed mothers, and no illegitimate children. Such modern extended families are still rare, and where they exist, they are still in a state of experiment. So far, only a few mature persons have been able to adopt the truly democratic life-style that these experiments require for their success. The final shape and structure of the modern extended family cannot now be predicted, although it is clear that it does not necessarily have to mean group sex and socialized property. However, there is reason to believe that the extended family has a future in one form or another. extramarital intercourse. Intercourse outside of marriage. The term is usually applied to married people who have sexual intercourse with a partner other than their spouse. The term is inappropriate in connection with single , widowed, or divorced persons. exogamy. (gr.) Marriage outside the group, clan, or social unit.

F

Fallopian pregnancy. (Also called tubal pregnancy or ectopic pregnancy) A pregnancy during which the fertilized ovum , instead of moving on into the uterus, attaches itself to the wall of one of the Fallopian tubes . This leads to the eventual bursting of the tube and to internal hemorrhage, requiring immediate surgery. The remaining second Fallopian tube preserves the womans ability to have other children.

Fallopian tubes. (named after Gabriele Fallopio, the 16 th -century anatomist who discovered them) Oviducts. Two tubes connecting the ovaries with the uterus . After ovulation, the ovum moves through the Fallopian tubes into the uterus, a passage that takes between 8 to 14 days. The fertilization of the ovum usually occurs inside the Fallopian tubes.

family. (lat. from famulus: house slave) Originally, the term referred to a group of slaves belonging to one man, then, by extension, to all persons ruled by one man or descended from one man, and finally to all persons living in a mans household, such as servants, wives, children, parents, grandparents, other close and distant relatives, friends, and permanent guests. These various meanings were still alive in Europe until ca. 500 years ago. Indeed, well through the Renaissance the world family was used to mean either a body of servants, or the retinue of a nobleman, or a group of people related by blood, or a group of people living together. Today, the term is most often used to describe a social unit consisting of a married couple and their children. This modern definition

116 corresponds to the social reality in most industrial nations, where the former extended family has been replaced by the nuclear family . The extended family traditionally united several generations under one roof. The house, the land, and the family business passed on from father to son to grandson and provided the main element of stability. As a result, the choice of individual marriage partners was mainly determined by this basic consideration. The survival of the family and the increase of its property were the primary goals to which every member was expected to contribute. More children meant more contributors to the familys wealth and power. Sons were particularly welcome as additional workers and defenders of the clan. They also insured the welfare of their parents during old age. Sex was a means to provide family continuity; potentially, all sexual acts served the purpose of procreation. Today, a wedding usually marks the beginning of something entirely different. A marriage may very well express the intent to found a new family; however, this family in the modern sense does not come into existence until after the birth of the first child, and it dissolves again when the adult children leave the house of their parents. In other words, marriage in the past took place within the larger framework of the family, while today the family is a passing aspect of marriage. Formerly, the family outlasted the marriage; now the marriage outlasts the family. This fundamental change in the family structure has also meant changes in human sexual behavior. Sexual intercourse now mostly serves to strengthen the personal relationship between marriage partners, and it leads to procreation only if and when they decide to have children.

family planning. This term is often falsely used as a synonym for contraception. However, many women and men who use contraception have no intention of planning a family, whatever family means. This is especially true if they are and want to remain unmarried. The term can correctly be used only when couple living together is planning the number of children, i.e. the eventual size of their family. fecundity. (lat.) The potential in a certain population of producing offspring. In demographics, the number of potential births as opposed to actual births (fertility). fellatio. (lat. sucking ) Licking or sucking of the penis, which can lead to orgasm. Fellatio, like cunnilinctus (licking of the vulva) , is a common form of sexual activity. However, it is illegal, even between husband and wife, in some states of the US (see crime against nature). female ejaculation. The expulsion of liquid during orgasm from the paraurethral glands. These glands in the female lie next to the urethra and open into it. They correspond to the prostate gland in the male. However, in most females they are underdeveloped and do not produce any liquid. Therefore, a female ejaculation is relatively rare. Still, in some females, the paraurethral glands are well developed and produce enough prostatic liquid to be expelled during orgasm. female ejaculate. The liquid expelled by some females from the paraurethral glands during orgasm.

117 femaleness. The quality of belonging to the female sex. Not to be confused with femininity (see there): A female may very well be masculine in appearance and behavior.

femidom also femidon. Female condom. A combination of condom and diaphragm, i.e. a contraceptive tube made of latex which is introduced into the vagina. Its outer ring remains outside the vulva, and its inner ring covers the cervix. It thus provides protection from both unwanted pregnancy and infection with a sexually transmissible disease.

femininity. Quality of character, physical appearance, or behavior considered to be typical of females. The expression of the social role assigned to females. In all human societies the biological difference between female and male is used as the basis for different social and sexual roles . Although such roles may vary from one time and culture to another, they are, in each case, declared to be natural and unchangeable. In our own culture, femininity is usually equated with pretty looks, passivity, and sentimentality. As a result, the active social and sexual contributions of women are often underestimated or even denied. There is also a whole industry devoted to the cultivation of femininity by means of make-up, perfumes, hair-dyes, dresses, and jewelry. However, the proper use of such feminine accessories is meant to create nothing more than sex appeal, a quiet attractiveness that leaves the sexual initiative to the male.

feminism. The attitude, philosophy, or social movement which demands equal rights for women.

feminist. A female or male person who fights for the emancipation of women in order to achieve the equality of the sexes.

femme. (fr . woman) Slang for the passive, feminine partner in a lesbian relationship if the other partner is butch, i.e. acting out a masculine role. The stereotype of a butch- femme lesbian couple had some credibility in the past, when many female couples conformed to social prejudices, but today is rarely found in reality.

fertility. (lat.) 1. The ability to produce offspring. More specifically: in men, fertility is the ability to cause pregnancy in a fertile woman; fertility in women is the ability to become pregnant by a fertile man. Male and female fertility begins with puberty and, in women, comes to an end with the climacteric (menopause) . 2. In demographics : The result and living proof of fecundity, i.e . the number of actual births as opposed to potential births (fecundity).

fetish. Generally : An object of religious significance in some traditional, natural societies, especially in Africa. Very often, the fetish has magical powers, since it incorporates or represents some good or evil spirit.

fetish, sexual . Some body part or excretion, some inanimate object or material, that serves certain persons (fetishists) as a source of sexual excitement.

118 fetishism, sexual. The tendency, inclination, habit or urge to be sexually aroused by body parts (for example: hair, breasts, buttocks, feet, amputation stumps) or body excretions (sweat, spit, urine, feces), or inanimate objects or materials (shoes, fur, underwear, leather, latex, etc.). Also the fascination with these things (sexual fetishes). The spectrum of possible fetishes is very wide. Practically anything can become a sexual fetish. However, fetishism is largely a matter of degree, since nearly everyone has some fetishistic tendencies (treasuring a lock of hair, a love letter, or piece of clothing of the beloved or being especially stimulated by some physical features). The line to fetishism proper is crossed when the fetish becomes more important for the sexual response, indeed for sexual functioning, than the person to whom it belongs. fetishist, sexual. A person whose sexual response depends on being aroused by a sexual fetish (body part or excretion or an inanimate object or material). fetus. (lat. offspring) Medical term for the unborn baby after the third month of pregnancy. flirt. (from French fleurette: amorous flattery) A psychological game in which one partner displays a certain erotic interest in the other who, in turn, responds with hints of approval or leaves his admirer deliberately in doubt. Flirting is a pleasant form of erotic encounter, an intermediate stage between a polite acquaintance and a sexual relationship. Flirting is based on mutual attraction and keeps potential sexual partners in a pleasant state of suspense without allowing for intimacies. It is a playful way of indirect courtship without personal obligations. foreplay. A term used by certain people for the description of caresses that lead to coitus. This usage indirectly declares coitus to be the main event, degrading everything else to preliminaries. However, all gestures and physical movements that establish contact between sexual partners belong to the total experience of sexual intercourse . It is shortsighted to divide sexual activity into acts, chapters, or escalating phases that have to build up to some sort of dramatic climax. Such a mechanistic view of sex can lead to severe misunderstandings and may ruin the chance for a truly intimate relationship. Sexual partners should never fear to break with prescribed behavioral patterns, but should rather explore their mutual desires, respond to each others wishes, and follow their own instincts as the best method of achieving sexual satisfaction. foreskin. prepuce (lat.praeputium) 1. In males: Movable part of skin at the tip of the penis, usually covering the glans. In the case of an erection, the glans protrudes from the foreskin and becomes fully exposed. In some very rare cases the foreskin proves too tight. Such a condition is called a phimosis, and it may require minor surgery called circumcision. It is always necessary to wash the penis regularly, including the glans. In so doing, uncircumcised boys and men have to push back the foreskin, because residues of urine, perspiration, and some glandular secretions (smegma) may be trapped underneath. In some religions (for example Judaism and Islam) and in some cultures (for example the modern USA) it is customary to remove the foreskin of boys either shortly after birth or at the onset of puberty (see circumscision) 2. In females: The clitoris also has a prepuce

119 which may cover its head. However, with mounting excitement, the glans of the clitoris will not protrude but retract under its prepuce (hood). In some cultures (for example some countries in Africa and the Near East)it is customary to perform an operation on young girls that is misleadingly called female circumcision. However, in fact it consists of a removal not just of the prepuce, but of the clitoris itself (clitoridectomy) often accompanied by other deliberate injuries designed to impair female sexual functioning. The operation is therefore better described as genital mutilation (see there). fornication. An old-fashioned term of disapproval referring to sexual intercourse between unmarried partners.

four-letter words. A euphemism for certain slang expressions referring to sexual or scatological matters. In English, most of these words have only four letters. An enlightening joke asks the following: Give me a four-letter word meaning intercourse! Answer: Talk. Indeed, talk is an important element in sexual relationships, and where this element is missing, a couples sex life will remain stunted and become unsatisfactory in the long run.

fraternal twins. Twins resulting from the simultaneous fertilization and subsequent implantation of two eggs in the uterus. Fraternal (dizygotic) twins doe not resemble each other more than other brothers and sisters.

freemartin. A sterile (infertile) female calf who, before birth, was exposed to androgens by her male twin with whom she shared a fused placenta.

French culture. Oral intercourse. The term is often used in the context of prostitution or in personal sex ads referring to the sucking of the penis (fellatio).

French kiss. An open-mouth kiss which brings I the tongues of both I partners into direct contact. The adjective French in this and other English terms for sexual objects or practices originally indicated disapproval and a tendency to characterize them as outlandish and abnormal. The French, who have always had a reputation for having a certain savoir vivre, or, in other words, for being able to enjoy life to the full, were often credited with all those things that created feelings of guilt and embarrassment in other nations, although they were no less prevalent there than in France. Thus, at one time, a condom was called a French letter in England and a sexually transmitted disease was called French disease (The French themselves called it la maladie anglaise: the English disease.)

French postcards. Old-fashioned English term for erotic photographs.

French tickler. Colloquial English term for a condom with a rough or irregular surface, intended to increase vaginal stimulation. frigidity. (lat.coldness) This vague, denigrating term was formerly used to refer to a lack of orgasm in women or their lack of sexual excitement or generally the absence of female

120 sexual interest. No thought was given to the possible causes, but some female inadequacy was simply assumed. Very often, the problem lay with the partner, however. Since scientific discourse today requires precision, the term is no longer acceptable.

G gay. Slang for homosexual. gay liberation. A social movement devoted to the emancipation of homosexuals. The beginnings of this movement are in Germany, where, in the 1860s, the lawyer Karl- Heinrich Ulrichs published a series of pamphlets demanding the abolition of laws against sexual contact between men. Pursuing the same goal, the Berlin physician Magnus Hirschfeld and others founded the Scientific-Humanitarian Committee, the worlds first gay rights organization in 1897. However, the Nazi dictatorship prevented any reform in Germany. After some modest attempts in the 1920s, the movement was reborn in the US in the 1950s and 1960s were the Mattachine Society (gay men), the Daughters of Bilitis (lesbian women) and similar groups began to fight for their sexual rights. Finally, in 1969, the violent resistance to a routine police raid of a gay bar (Stonewall Inn) in New York City marked the beginning of a new, militant gay activism. As a result, a phase of liberalization set in which helped the American gay movement to reach at least some of its goals. Thus, it became a model for oppressed sexual minorities in many other countries. gender . (from lat. genus: breed or kind) The socio-psychological side of sex. The gender role/identity determines whether a person acts and self-identifies as a female or male. The term gender thus refers to those characteristics of human females and males that are socially constructed, while the term sex refers to those that are biologically determined. People are born female or male but are taught by their social surroundings to be girls and boys, women and men. This learning process results in their acceptance of the proper gender roles and creates and supports a respective gender identity: Females and males not only learn to play their expected roles, but also to identify with them. Thus, gender in both of its aspects (role and identity) is the result of social learning. Nevertheless, a note of caution: While, in many contexts, science has found it very useful to distinguish between gender and sex, they should not be misconstrued as independent absolutes, because, at some fundamental level, they are connected. In other words: Gender is learned in response to suggestions by the persons social environment, but, like sex, it also seems to have a biological basis, less obvious perhaps, but nevertheless present. Indeed, there seems to be a limit to what these suggestions can accomplish. To a certain extent even the gender role, but especially the self-identification as female or male does not seem to be shaped by social learning alone. Indeed, some individuals may resist even the most comprehensive and consistent suggestion by their environment. This resistance seems to be rooted in the persons sex. gender identity. A persons self-identification as female or male i.e. the individuals core conviction of being either female or male. In rare cases a person may have a female

121 gender identity and still reluctantly play a male gender role (and vice versa as, for example, in transsexualism). gender role. A persons social role as female or male. In rare cases a person may reluctantly play a female gender role while having a male gender identity (and vice versa, as, for example in transsexualism). More common, if still rare, are cases of men with male gender identities who enjoy playing a female gender role, either occasionally or frequently or even permanently (as, for example, in transvestism). genital intercourse. Sexual intercourse involving the sex organs of both partners. More specifically: coitus, i.e. vaginal intercourse.

genital mutilation . Deliberate injury to the sex organs, either for reasons of custom (before or during puberty) or for erotic reasons.

1.The surgical removal of the foreskin of the penis (circumcision) is not considered a mutilation by Jews, Moslems and most Christian Americans, who now practice it as a routine matter of hygiene. However, there is also growing minority in the US and Europe who consider the practice unnecessary, harmful, and cruel. There is more agreement on the so-called female circumcision practiced in some African and Asian countries. This is, in fact, no circumcision at all, but a clitoridectomy, often accompanied by a cutting of the labia majora and minora and even a sewing up of the vaginal opening. This painful mutilation, often performed under unsanitary conditions, is dangerous to the health of the victim whose sexual responses are usually impaired as a result. The women who perform the operation on young girls have no feelings of guilt, but, on the contrary, believe that they do them a favor. However, the practice is now widely being condemned not only in the industrialized West, but also by many religious leaders of all faiths and by international organizations.

2. Men and women may also deliberately injure their own sex organs for erotic reasons. They may feel that piercing them with metal studs or rings makes them more attractive. This is often associated with some fetishistic tendency. Or they may cut or surgically alter their own or their partners sex organs in some way, fulfilling some other, more pronounced fetishistic desire.

genitals. (lat.organs of generation) This term falsely restricts the sex organs to a single function or purpose. Better term: Sex organs. The organs which determine the sex of males and females, enable them to experience pleasure during sexual activity, and make procreation possible. There are external and internal sex organs.

gerontophilia . (gr.) A young persons preference for old or even very old sexual partners.

gigolo. (fr.) A male for hire, either as an escort, dance partner or even as a sex partner for women.

gonads . (gr.) Sex glands (the ovaries in females, the testicles in males.)

122 group sex. Sexual intercourse between various partners within a group. Such a group may be a commune , or a circle of married or single friends, or a so-called swingers club. Sometimes partners for group Sex are solicited through newspaper ads. Participants meet at parties where they exchange their sexual partners or, as in the case of some nude parties, join the other guests in an orgy . Group sex in one form or another has existed at all times, although today many people are much more open about it than their ancestors might have been in the past. Nevertheless, our society generally disapproves of the practice since it runs counter to the official demand for monogamy . On the other hand, sex in company with others and the exchange of sexual partners have always been part of the human sexual imagination as expressed in works of literature and art, or in the daydreams and fantasies of ordinary people. It is also true that in the course of history, not all cultures have demanded secrecy, privacy, or exclusiveness for sexual acts. In certain societies, group sex was and is an accepted fact of everyday life.

G spot. In many (not all!) women a spot behind the anterior wall of the vagina that is especially responsive to sexual stimulation, i.e. manual stimulation or vaginal intercourse in a position that will allow the penis to touch this particular area. Named after the German-American gynecologist Ernst Gräfenberg (1881-1957), who first described it in 1950.

gynecomastia. (gr.) Development of breasts in boys or men. Can be a temporary phenomenon in adolescence. In other cases, it may indicate a more serious underlying cause. In all cases, a medical examination and diagnosis (and, if necessary, treatment) are indicated.

H hedonism. (from gr. hedone: pleasure) A philosophy or a way of life based upon the belief that pleasure is the highest value. Today the hedonistic attitude towards life in general and sex in particular is also known under the popular label fun morality. Its proponents believe that sex is fun and, as such, needs no further justification. Fun morality can therefore be described as a morality of indulgence. However, such indulgence does not necessarily lead to licentiousness and irresponsibility. On the contrary, responsible hedonists try to avoid short-lived, dangerous, or destructive pleasures in favor of lasting personal satisfaction and the development and< refinement of the best human potential.

hermaphrodite. Poetic, but now obsolete medical term for intersex. (Hermaphroditos, the beautiful son of the Greek deities Hermes and Aphrodite was embraced by a nymph so passionately, that her body merged with his.) See intersex hermaphroditism. Better: Intersexuality (see there)

123 heterosexual. (gr. and lat. different-sexual) 1. Noun: A male or female who is predominantly sexually attracted to persons of the other sex. 2. Adjective: The behavior of such a male or female. The use of this term is always somewhat arbitrary, because the speaker determines what predominantly means in each case.

heterosexuality. (gr. and lat. different-sexuality) The behavior or alleged condition of erotically preferring partners of the other sex.

hirsutism. Excessive hairiness of the body. Can be hereditary or result from hormonal dysfunctions or from medication.

homophobia. (gr.) Unreasonable fear or unjustified strong dislike of homosexuals as a class of people and of homosexuality as a sexual orientation. A form of prejudice often resulting in religious, legal, and social discrimination.

homosexual. (gr. and lat. same-sexual.) 1.Noun: A male or female who is predominantly sexually attracted to persons of the same sex. 2. Adjective: The behavior of such a male or female. The use of this term is always somewhat arbitrary, because the speaker determines what predominantly means in each case.

homosexuality. (gr. and lat. same-sexuality) )The term means either homosexual behavior or an alleged condition of desiring same-sex erotic contact. However, these are two very different matters that should not be denoted by the same word. Instead, one should avoid this noun altogether and state exactly whether one is referring to a form of conduct or to an (alleged) condition of wanting to engage in such conduct. The hybrid word itself was coined in 1869 by the Austrian-Hungarian writer Karoly Maria Kertbeny (1824-82) in an open letter to the Prussian minister of Justice demanding the abolition of laws against erotic contact between men.

homosocial. (adj. gr. and lat.) Preferring the company of persons of the same sex. Being especially comfortable in a group of people of ones own sex. Examples: All-male clubs, all-male working environments, all-male athletic activities, all-female cafés. etc.. Many heterosexual men and women are homosocial in large parts of their daily lives.

honeymoon. The period after the wedding when husband and wife begin to adjust to their new roles, and when they devote their full attention to each other. During this delicate period of adjustment, many newly married couples take a honeymoon trip, in order to be undisturbed by their families and their friends. Such a honeymoon trip can also be considered a special vacation before settling down to the realities of everyday life. For many couples today, the honeymoon no longer retains its former meaning and importance, as they often have had intimate personal contact with each other and, in some cases, already have lived together before the wedding for some time.

hooker. Slang term for a female prostitute.

124 hormones. Substances which are produced by the so-called endocrine glands and which are released into the bloodstream. The normal physical development and health of the body depends on the proper functioning and balance of all hormonal glands. The hormones produced by the sex glands (the testicles in men; the ovarie s in women) are called sex hormones. They control the development of the sexual characteristics , the sexual response of males and females and their fertility. Although male and female hormones are present in both sexes, there is a considerable preponderance of male hormones (androgens) in men, and of female hormones (estrogens) in women. hustler. Slang for a male prostitute . In most cases the term refers to homosexual prostitution. A hustler who engages in heterosexual prostitution is also sometimes called a stud. hygiene. (gr.) The science of health. Preventive medicine. Also a euphemism for the cleaning of the female sex organs, the use of tampons, or of special deodorants. hymen . (gr. Hymen, the god of weddings) A thin membrane stretched across and partly covering the opening of the vagina. Since the hymen is usually ruptured during the first vaginal intercourse (coitus) , an intact hymen is often considered proof of a womans virginity . However, such proof is inconclusive, because the hymen may be torn not only during coitus , but also by self-exploration or self-pleasuring (masturbation) , or as a consequence of certain athletic activities. In some cases, the hymen may even be absent. On the other hand, oral and anal intercourse leave the hymen intact. The high value placed on a womans intact hymen is a patriarchal obsession resulting from ignorance of the female sexual anatomy and of human sexual behavior. It is a relic of former times, when women were the property of men.

hysterectomy. (gr.) Surgical removal of the uterus.

hysterical pregnancy. False pregnancy. A pregnancy imagined by a woman who is not, in fact, pregnant. In some cases, the imagination is so strong that various outward signs of pregnancy, such as an enlarged abdomen, manifest themselves.

hysterotomy. (gr.) Incision in the uterus, for example in some late-term abortions.

I iatrogenic (adj. gr. and lat.) Literally: Caused by a doctor. There can be good or bad iatrogenic conditions. A bad one may result from either a false medical diagnosis or an inappropriate treatment. identical twins. Twins resulting from the same fertilized egg (zygote) which later separates into two embryos. They are therefore also called monozygotic twins. Such twins share the same genetic make-up and resemble each other closely.

125 illegitimate child. Old, denigrating, and now obsolete term for the child of an unmarried mother. The term illegitimate referred to the fact that, in our society, the conception and birth of children was, for centuries, socially approved and protected only within marriage . This meant, in practical terms, that an illegitimate birth usually put children at a great disadvantage. However, modern Western societies have made great strides in securing equal right for such children. They can now receive the same support and can inherit on equal terms with children born within marriage. immissio penis. (lat.) Insertion of the penis into the vagina, the mouth or the anus. A legal term used in establishing disputed details of a sexual encounter that has to be evaluated by a court of law. incubus. (lat.) A figure of medieval superstition. The devil or a demon in the form of a man who, lying on top of her, offers herself to a woman for sexual intercourse. (See also succubus.) infancy. (from lat. infans: unable to talk) Early childhood (from birth to age 2or 3). The first period of life in which the child learns to walk and to talk. impotence. (lat. powerlessness) The term usually refers to a lack of erection in situations where it is wanted. The reasons for this can be very many, and none of them have anything to do with power or the lack of power (even a potentate can be impotent, i.e. even powerful men can have erection problems). The term is too imprecise to be scientifically useful. impotentia coeundi. (lat.) A mans inability to insert his penis into a vagina, i.e. his inability to perform coitus.

impotentia procreandi. (lat.) A mans inability to cause pregnancy in a woman. Male infertility.

incest. Sexual intercourse between close relatives, such as parent and child, or brother and sister. (Sexual contact between brothers or between sisters have usually not been considered incest.) Incestuous relationships are illegal in virtually all countries. The reason normally given is that children born as a result of such relationships might; to an disproportionate extent, be afflicted, with hereditary diseases. However, the incest taboo is older than any knowledge of the laws of heredity. Indeed, it is one of the oldest taboos of mankind, and its violation has almost universally carried severe penalties. Exceptions have been extremely rare and have usually applied only to royal families or persons of high rank. One example is ancient Egypt, where the pharaoh was compelled by law to marry his sister. This practice continued over many centuries without apparent negative consequences up to the days of Cleopatra, who was married to her brother Ptolemy. The original reason behind the incest taboo was probably the need to marry outside ones own family or clan in order to create the ever-widening social groups necessary for the survival of the human race and the development of civilization.

126 infertility. (or sterility) The inability to procreate. A couples inability to achieve a pregnancy can result from male or female infertility. A mans infertility may be caused by erectile dysfunction , castration , or sterilization , or it may be due to a lack or insufficient number of fertile sperm cells in his semen. A womans infertility, if not also caused by castration or sterilization, can result from a malfunction of her ovaries, or from the after- effects of certain diseases, such as tuberculosis, gonorrhea, or chlamydia. Apart from such obvious causes for infertility, there may be a variety of others that are more subtle and complicated. Sometimes the cause cannot be determined. In some very rare cases, a couple remains childless simply because they never have sexual intercourse during the womans fertile period. intersex. (lat. between sexes) Intersexes are persons born with indeterminate or ambiguous sex organs, and their immediate sexual identification can therefore be in doubt. However, there is a wide spectrum of possible variations from the male or female anatomical norm. About 1 in 100 newborns differ in some minor or major way from the standard male or female anatomy, and ca. 1 or 2 in a 1000 children receive surgery at one time in their lives to normalize the appearance of the sex organs. While each child has the right to a definite gender role, i.e. the right to be raised as either a girl or a boy, the traditional medical approach to such cases has recently been called into question as hasty and simplistic by intersex organizations who demand that, wherever possible, at least surgery should be delayed until puberty or after, giving the person concerned a well- informed choice in the matter. intersexuality. The condition of being an intersex, i.e. of having indeterminate or ambiguous sex organs.

In the closet. Nondisclosure or hiding ones sexual orientation from others. inversion. (lat. turning around) Obsolete general term referring to 1. A switching of gender roles (males feeling and behaving like females and vice versa), and 2. Homosexuality, i.e. a switching of sexual orientation from the generally expected pattern (males loving males instead of females as expected; females loving females instead of males as expected). This second usage always implied the first, and male homosexuals were therefore also called inverts, presupposing that they had female souls in their male bodies. As a result, the term always created a lot of confusion, because it equated, as it were, apples and oranges. In real life, people can very well switch gender roles without switching sexual orientations. Extremely effeminate men (for example transvestites) can very well be, and most often are, heterosexual in orientation. On the other hand, men who love men can very well be, and often are, extremely masculine in appearance and behavior. Today, there is justification only for a more precise term which restricts itself the first of the above meanings: gender role inversion.

invert. (noun) Obsolete and misleading term for homosexual.

127 IUD . Intra-uterine (contraceptive) device. The intra-uterine device is an old method of contraception already known to the ancient Greeks and Persians. In recent decades, new types of such devices have been developed, and they are now in use in many parts of the world. As the name indicates, the IUD is inserted by a doctor into the uterus , where it prevents pregnancy. At the present time, there is still no satisfactory explanation of how the device works. It is known, however, that it is almost 100 percent effective, although not suitable for every woman.

J jock itch. A fungal infection in the groin area (crotch). jus primae noctis. (Latin: the right of the first night) Until well into the 18th century, the feudal lords in certain parts of Europe claimed the right to deflower the brides of their serfs (i.e. the right to have intercourse with the bride before her wedding). Today this right may appear strange and even unbelievable, and, indeed, doubts have been raised whether it was ever really enforced. However, most opera lovers are probably aware of the custom, as it serves as a starting point for the plot of Mozarts opera The Marriage of Figaro. (The enlightened Spanish Count Almaviva has publicly renounced his right of the first night, but regrets having done so when he falls in love with the bride of his servant Figaro.) See also droit du seigneur.

K karezza. (also carezza or coitus reservatus) A form of sexual intercourse during which the man and the woman remain motionless for a long time, as soon as the penis has entered the vagina. Some women are said to experience several orgasms this way, while men do not try to reach, and generally do not have an orgasm. Instead, they derive satisfaction from the prolonged duration of the sexual union. Since there is no ejaculation of sperm, carezza has sometimes been recommended as a method of contraception. However, it cannot be considered reliable, since it obviously demands a great deal of self- control from both partners. Already known in ancient India, carezza was introduced to the modern Western world by the Oneida community, a 19 th century American experimental commune and spiritual group whose members put great emphasis on the union of souls.

Kegel exercises . (named after the American gynecologist Arnold H. Kegel who invented them in the 1950s) Exercises designed to strengthen the pubococcygeus muscle (also known simply as PC muscle). This pelvic floor muscle runs from the pubic bone (os pubis) in the front to the os coccyx in the back, surrounding the vagina (in females) and the anus (in both sexes). Kegel found that, in his women patients, urinary incontinence and a diminished sexual response could often be traced to poor muscle tone in the pelvic area. He therefore designed some exercises to strengthen the PC muscle and, with it, the female sexual response: When urinating, the woman identified the muscle by trying to stop the flow of urine. The muscle used in doing that is the PC. Once she has thus identified the muscle, the woman can strengthen it by contracting and relaxing it for 3

128 seconds each time, then repeating this sequence 10 times. In addition, she can contract and relax the muscle several times in quick succession. These and similar exercises can be done anytime anywhere, even at the workplace. They are useful not only in preparing for childbirth, but will also restore muscle tone after birth and enhance pleasure during vaginal intercourse (coitus).

Kinsey scale. A seven-point rating scale designed by the American sex researcher Alfred C. Kinsey (1894 - 1956) measuring the balance of heterosexual and homosexual experiences in the life of an individual. Experience here means not only overt behavior, but also psychic reactions that are not acted out. The scale in detail: 0 = exclusively heterosexual, 1 = incidental homosexual, 2 = more than incidental homosexual, 3 = equal heterosexual and homosexual, 4 = more than incidental heterosexual, 5 = incidental heterosexual, 6 = exclusively homosexual. Kinsey himself found that 50 percent of his American male respondents had to be rated 0, and 4 percent rated 6. That left 46 percent falling somewhere between these two extremes, i.e. a very large percentage of the male population showed both heterosexual and homosexual responses in various degrees at least sometime in their lives. Kinseys figures have since been disputed, but never totally disproved, since this would require a repeat of Kinseys studies, something that has now become financially unaffordable.

Klein sexual orientation grid. A grid forming 21 individual boxes designed by the American psychiatrist and sex researcher Fritz Klein (1932 - ). The grid measures a persons sexual orientation according to 7 factors (sexual attraction, sexual behavior, sexual fantasies, emotional preference, social preference, life style, self-identification) and in 3 dimensions (past, present, ideal). The grid owes much to the Kinsey scale, but amplifies it considerably, thus allowing for a great variety of response patterns which, even in a large student class, are almost never exactly duplicated.

Klinefelter syndrome . A chromosomal variation: Males with one extra X chromosome (XXY). They usually have underdeveloped testicles and are infertile. Beard, body hair and other secondary sexual characteristics are only weakly developed or absent. koro. A special kind of individual panic occurring in parts of Southeast Asia. It manifests itself in a sudden, obsessive, unjustified fear of a male that his penis is shrinking and being reabsorbed in to the abdomen. (In the rarer case of a female being affected, she believes that her breasts are shrinking and being reabsorbed in to the chest cavity.) This fearful obsession is obviously tied to a particular sexual culture, because it occurs nowhere else in the world. The afflicted individual usually turns to relatives for help, and their empathy, concern and care usually lead to a resolution.

L labia majora. (lat.the greater lips) The outer lips of vulva. During puberty, hair (the so- called pubic hair) begins to grow on the labia majora.

129 labia minora. (lat.the smaller lips) The inner lips of the vulva, which lie between the labia majora. lesbian. (adjective and noun) A term sometimes used for a woman with a homosexual orientation and her sexual behavior. In ancient Greece, the island of Lesbos was known as the home of the poetess Sappho, who wrote many love poems in praise of her girl students. lesbianism A term sometimes used for female homosexuality (i.e. homosexual behavior and/or an alleged condition of desiring such behavior). libido. (lat . desire ) 1. In medical language: Sexual desire. 2. In psychoanalysis: A term referring to the fundamental psychic energy whose dynamic expression is love . A persons libido comprises not only his love for a sexual partner, but also that for himself, his parents, children, friends, or humanity in general. In early childhood , the libido is directed towards the childs own self. (See narcissism.) Later, parts of the libido are gradually transferred to the parents (see Oedipus complex) and then also to other persons, objects, and ideas. (See also sublimation.) life cycle, the human. Misleading when applied to an individual. When a person dies, his life does not begin all over again, i.e. the individual human life is not cyclical. Applying cyclical models is perhaps permissible in the case of species, but even then they are problematic because they stand in some contradiction to the theory of evolution. Applying the term life cycle to an individual is simply thoughtless. lingam. (sanskrit) In Indian mythology the symbol of the male principle. Usually represented in sculptural form as the male sex organ. Corresponds to the female symbol yoni. love. Different people may associate the word love with different things, such as high esteem, friendship, desire, tenderness, passion, lust, or sexual intercourse. All of these terms refer to contacts and relationships that correspond to fundamental human needs. The need to be close to someone may be described as a natural expression of human sexuality. However, it has to be remembered that sexual needs can appear in many shapes and forms, and that they may be satisfied in just as many ways. It is for this reason that every analysis or description of love must remain unsatisfactory. Today every kind of sexual attraction between people is called love, and there is a general assumption that it should lead not only to sexual intercourse, but also to marriage. However, this concept of love is relatively new. Until well into the 19th century, even in the Western world love was not usually considered a precondition of marriage. The prosperity and continuity of the then extended family were believed to be more important than the mutual satisfaction of two people. Indeed, as countless old European novels, plays, and operas make clear, love was often seen as a threat to the institution of marriage at a time when most marriages were arranged by the parents or dictated by economic necessities. Therefore, the complete sexual compatibility of husband and wife was not seen as decisive, and was generally not expected. The ancient Greek and Roman idea of love was even more

130 different from our modern concept. In ancient times, people put the emotional emphasis on sexual desire itself, not on its object. Love, for them, was a driving force that originated in the lover. It was directed towards others, but its strength was not dependent on their reactions. Someone was loved, not because he was desirable in himself, but because the love felt for him made him appear desirable. This view was summarized in the Greek saying: The god of love dwells in the lover, not in the beloved. It was always the god of love who was worshipped, never another person. Love could be frustrated, if it remained unaccepted, but it could not be disappointed. There was no such thing as the modern unhappy love. In contrast to this philosophy, love today is most often seen as an attracting force which originates in the beloved and attracts the lover. The beauty or excellence of the beloved is the cause of love and its only justification. As a consequence, people are usually preoccupied not with the love they themselves feel, but with the object of their love. This love object, the other person, is therefore often idealized to a point where eventual disappointment becomes inevitable. In other words, men and women are more concerned with receiving love than with giving it, and they tend to expect, indeed even demand, too much from each other. The disadvantages resulting from this modern understanding of love can, perhaps, be avoided, if we return to an examination of our fundamental needs as human beings. Sexual love alone cannot satisfy all our needs for human contact. Love, especially in the long run, is more than sexual desire. This realization is best expressed in the Christian concept of agape , a selfless, tolerant love for our fellow men, who share with us our shortcomings and imperfections. Such an attitude is also the best foundation for a happy sexual relationship. As this brief summary indicates, love is subject to various social and historical influences. Our modern concept of love is the result of a long and complicated cultural development, and it may well continue to change in the future. No predictions are possible, but this much can already be learned: For the sake of ones own happiness, one should not simply follow established patterns, or models presented by popular magazines, movies, records, or television. Instead, one should try to develop truly personal contacts with those one loves.

lubricant. In sexology : A substance which facilitates the insertion of the penis into the vagina or the anus . Sexual excitement usually stimulates vaginal secretions which adequately prepare the female body for coitus . If the vagina does not provide a sufficient amount of secretion, the insertion of the penis can be painful. In such cases, the application of a lubricant is advisable, provided the woman really wants to engage in vaginal intercourse.. A lubricant is also necessary for anal intercourse . The simplest lubricant is saliva, but there are also a number of special, water-soluble lubricants on the market. This is important, since fat-based lubricants like butter, cooking oil, and Vaseline can destroy a condom. Some condoms are pre-lubricated by the manufacturer.

lues . Another name for syphilis, a sexually transmissible disease (see there).

M machismo. Spanish term referring to a particular brand of masculinity which manifests itself in fanatical sexual pride, jealousy , and an exaggerated concern with male sexual capacity and performance . Machismo is an extreme expression of male supremacy.

131 male chauvinism. A term intended to describe the attitude of men who claim privileges because of their sex. The word chauvinism (after the character of a French super-patriot by the name of Chauvin in an old play) is usually employed to characterize an exaggerated and fanatical patriotism. maleness. The quality of belonging to the male sex. Not to be confused with masculinity (see there). marriage. A sexual partnership that is officially recognized and privileged as a personal union that is important and beneficial to society. In most cultures and in most of human history this has meant a union of women and men. Usually it also meant that this union was intended to produce and raise children. However, this latter intention was never decisive, since all societies have always allowed post-menopausal women to marry. Even if they could not possibly bear children, they were allowed or even encouraged to marry if they could find a husband to care for them. In human history there have been four forms of marriage, some of which continue to exist in some parts of the world today: 1. Monogamy: One man - one woman. 2. Polygyny: One man - several women. 3. Polyandry: Several men - one woman. 4. Group marriage: Several men - several women. Not all marriage forms have always been intended to last for life. Indeed, there have been recognized temporary marriages in a number of cultures (for example ancient Japan). In some cultures, there have also been same-sex marriages: A recognized formal union of two or several males, or of two or several females. Some European countries have recently revived such customs and have allowed formal same-sex marriages or same-sex registered partnerships resembling marriages. In conformity with Western tradition, these are monogamous in the sense that, in each case, there are only two partners. masculinity. A quality of character, physical appearance, or behavior considered to be typical of males. The expression of the social role assigned to males. The term must be distinguished from maleness, i.e. the persons physical sex. (Male does not equal masculine: A male person can very well be feminine.)

In all human societies the biological difference between male and female is used as the basis for different social and sexual roles. Such roles may vary from one time and culture to another. Nevertheless, in order to insure their acceptance, each society presents them as natural and unchangeable. Failure to conform to these roles is therefore usually punished not just as a breach of custom, but as a deviation from nature. In our own culture, masculinity is generally believed to manifest itself in rugged looks and extrovert, active, and aggressive behavior. In contrast, a smooth, sensuous physique and a quiet, introvert, passive demeanor are usually associated with femininity. These cultural stereotypes are imprinted early on childrens minds, for instance when they are told that boys are made of snips and snails and puppy dog tails and girls of sugar and spice and everything nice. Later, in adult society, women are supposed to be sensitive, receptive, and dominated by feelings, while men are considered to be demanding, productive, and largely controlled by reason. In short, our concepts of masculinity and femininity mirror the values of a society in which men dominate and women serve. It is obvious that not every man and every woman can hope to live up to these concepts. In many cases the

132 sexual roles prove to be too confining. However, people who try to break out of them can encounter considerable difficulties, particularly if they themselves remain confused about their social and sexual identities. This confusion is the result of a life-long ideological indoctrination that constantly misrepresents cultural values as biological facts. Thus a man who begins by doubting his own masculinity may end up doubting his maleness. Finding himself considered a sissy by others, he may wrongly conclude that he is a man only by mistake, and that he should rather be a woman or, at least, dress and behave like one. (See transsexualism, transvestism.) Others may, for the same reason, develop a fear of sexual failure and a constant need to prove their masculinity by turning into promiscuous brutes. (See machismo ) Still others believe that a lack of masculinity is identical with a homosexual orientation. In actual fact, however, homosexual interests and masculinity (or the lack of it) are no more related than homosexual interests and left- handedness. There are too many effeminate heterosexuals and too many super-masculine homosexuals to justify such a simplistic jump to conclusions. masochism. (after the Austrian writer Leopold von Sacher-Masoch (1836-95), who loved to be sexually dominated by women and wrote about it.) Sexual preference for submission to a female or male dominant partner, a so-called sadist.(See sadism and sadomasochism)) The submission can include a desire for verbal denigration, humiliation, corporal punishment, tying up, and physical pain. Since the masochists ask for this treatment and determine its limits, they are, in fact, using the sadists for the fulfillment of their sexual desires. Thus they are, contrary to any outward appearance, the truly dominant partners in the relationship, a paradox that provides the kick in sadomasochistic encounters. masochist. 1. Specifically: The submissive person in a sadomasochistic relationship (see sadomasochism). 2. Generally: A person who enjoys being humiliated, hurt, or abused. masturbation. (from lat. manus: hand and turbare: to disturb) Sexual self-stimulation, manipulation of sex organs leading to orgasm . Although it is not unusual for sexual partners to masturbate each other (mutual masturbation), masturbation occurs most frequently as solitary sex without partners. It is the simplest and most common form of sexual activity, always available, and known to both sexes in all age groups. Ancient Greek and Roman physicians considered it necessary for the preservation of health. Many modern sex therapists also recommend it for the treatment of sexual dysfunctions. It is therefore hard to understand today how such a universal and harmless practice as masturbation could ever have been widely condemned. Nevertheless, this was the case in most Western countries from the 17 th century until a few decades ago. First the English Puritans began to condemn masturbation in the name of religion, and later ignorant doctors, in the name of science, advanced the most fantastic and nonsensical theories as to the dangers of masturbation, claiming, among other things, that it led to acne, weakness, blindness, tuberculosis, insanity, and even death. In spite of the fact that absolutely no evidence for such claims was ever presented, these superstitions were widely believed and can, in fact, occasionally still be encountered today. The fact of the matter is, however, that masturbation does neither physical nor mental harm. Nor is there such a thing as excessive masturbation. The frequency of possible orgasms (whether

133 through masturbation or other forms of sexual activity) varies considerably from one individual to the next. There is no right amount of sex that can serve as a standard for everybody. There is also no way in which any outsider can tell whether a boy or girl, a man or a woman, privately masturbates or not. matriarchy. (gr. mother rule) A form of society in which all important decisions are made by women. In the past, certain cultures were dominated by women. However, in the course of history, these matriarchal societies have been replaced by male-dominated cultures (see patriarchy). Today there are only very few and very small matriarchal societies left in distant and isolated parts of the world. membrum virile. (lat. male member) Medical term for penis. ménage à trois. (fr. household of three) A steady sexual relationship (resembling a marriage) between three partners, of whom two may be legally married to each other. A ménage à trois usually consists of one man and two women, occasionally of one woman and two men. (However, there are also rare cases of three men or three women living together in sexual partnerships.) Since this kind of private arrangement can be interpreted as a sort of unofficial bigamy (at least in heterosexual partnerships) , it is considered immoral by many people. The lack of social approval together with the possible conflicts between the partners themselves put a particular strain on such relationships, and very few of them last long. menarche (gr. men: month and arche: beginning) Medical term for the first menstruation . menopause. (gr. months stopping) The time in a womans life when her menstrual bleeding begins to recur less frequently until it finally ceases altogether (usually between the ages of 45 to 50). The menopause ends the womans ability to conceive and can also produce other physical and psychological changes. However, these changes do not necessarily affect her sexual capacities. menstrual cycle. The biological process which takes place in the female body between two menstruations. The cycle begins on the first day of a menstruation and ends on the day before the next menstruation. The length of menstrual cycles is subject to variation, but, on the average, lasts 28 days. menstruation. (from lat. menses: months) A periodic discharge of blood and other materials from the reproductive organs of a sexually mature female. A menstruation may be accompanied by some physical discomfort, although many women experience hardly any inconvenience at all. In most women, menstruation recurs about every 4 weeks (28 days).Usually, each menstruation or period lasts between 2 to 5 days. During this time, women wear sanitary napkins or tampons which absorb the menstrual flow and thus allow for a continuation of normal daily activities. The first menstruation (or menarche) of a girl occurs when she reaches puberty , usually between the ages of 11 to 13. However, neither an early nor a late arrival of the menarche is cause for alarm. A womans menstruations cease during her 5th decade. Some women feel increased sexual

134 desire before or during their menstruations. Nevertheless, many men and women avoid sexual intercourse during that time for esthetic and other reasons. However, there is no need to make this a universal rule. During a pregnancy, menstruation ceases. However, the absence of an expected menstruation is not necessarily a symptom of pregnancy . On the other hand, it is not impossible that bleeding can occur even after a conception without terminating the pregnancy. In these and similar cases, where suspicious or unusual irregularities occur, a hysician should be consulted. miscarriage. Spontaneous premature end of an advanced pregnancy resulting in death of fetus. A termination of pregnancy can also be purposely induced. (See abortion) A miscarriage after the 24th week of pregnancy is called a stillbirth. miscegenation. Mixing of the races. Ideological term based on the obsolete assumption that different, clear-cut human races exist that can be, but should not be, mixed. In the United States, the term used to be applied especially to marriages between whites and blacks (however these categories were defined at the time). Several Southern states and South Africa had so-called miscegenation laws, which made such marriages illegal. However, in the meantime, these laws have been found to violate basic human rights and have been abolished. The whole idea of pure human races that should not be mixed is an expression of European and American white anxieties and fairly modern in origin. It was unknown in ancient and medieval times, began as a form of self-justification with the ever-expanding Western colonialism, and reached its greatest influence in the 19 th and early 20 th centuries in the social-political ideology of racism. However, from the standpoint of human biology, the category of race is meaningless. In the latest American census, the concept of race finally revealed its absurdity for everyone to see, when many respondents with mixed ancestry did not know how to check the appropriate boxes. The racial categories proved to be arbitrary, illogical and inconsistent.(For example, immigrants from Spain (Hispania, España) were NOT to classify themselves as Hispanic, but as Caucasian, i.e. originating from the Caucasus mountains in Russia. The alleged race Hispanic was reserved for immigrants from Latin American countries which, of course, had previously been settled by people from Spain. In other words: Spaniards immigrating from Latin America and Spaniards immigrating from Spain were declared by the American census to belong to two different races. Question: If immigrants from these two different races then marry each other in the US, is it miscegenation?

monogamy. (gr.) Marriage of one man to one woman. (or, in some European countries, also of two partners of the same sex). Opposite of polygamy.

morning-after-pill. Colloquial term for a large dose of contraceptive hormones (estrogen) taken orally within 3 to 5 days after unprotected vaginal intercourse. This pill can still prevent a potential unwanted pregnancy and may be especially indicated in cases of rape or incest.

135 N naked. Fully revealed without the protection of clothing. The term has undertones of helplessness and shame. There may also be an element of erotic provocation (see also nude and nudity). narcissism. An unconscious or conscious fixation on oneself and a sexual desire for ones own body. According to an ancient Greek legend, Narcissus was a beautiful youth in love with himself who drowned admiring the reflection of his face in the water. natural birth control. The speaker usually means contraception, not birth control (see there). The term refers to contraceptive methods approved by the Catholic church, such as the rhythm method or cervical mucus observation. The word natural as used here has a moral, not scientific, meaning derived from the theological doctrine of Natural Law. However, from the scientific point of view, any method of contraception is as natural or artificial as any other. (See also artificial birth control). natural childbirth. A term sometimes used for a physical and psychological technique which greatly reduces the pain of giving birth by an adequate preparation and active participation of the expectant mother. The method of natural childbirth was first advanced in 1942 by Dr. Grantly Dick-Read, a British obstetrician, who also developed a program of exercises designed to train the expectant mother in controlling her muscles. The final objective of these exercises is to make childbirth a process in which the mother, instead of playing an unpleasant passive role, can actively participate. necking. Colloquial term used to describe kisses and caresses without complete bodily contact, and avoiding strong sexual excitement. (Contact above the neck, not below.) nocturnal emission. (lat. emission during the night) This misleading term refers to an ejaculation during sleep (wet dream). However, a man can also have an orgasm and ejaculate during an afternoon nap. This would then be a diurnal emission. Moreover, if the orgasm occurs before puberty, there is no emission of semen. Finally, women can also have orgasms in their sleep. Therefore, it is better to say so and simply speak of orgasm during sleep. This term is applicable to both sexes. normal. This term belongs in the context of statistics. When applied to sexual matters, it usually is supposed to mean good. Correspondingly, abnormal then means bad. However, when it comes to details, the exact meaning of both terms may change from speaker to speaker. As a result, there is usually an argument about the very concept of normality, and this argument almost always remains unresolved. In sexology, the term should be avoided altogether, since it never describes facts, but only expresses value judgements.. nuclear family. Family consisting of only two successive generations: parents and children. The smallest nuclear family consists of only two persons: mother and child. But even parents with many children form nothing more than a nuclear family as long as no further relatives (grandparents, aunts, uncles, cousins) are part of their household. The

136 nuclear family is the result of social developments which have their roots in general technological changes as well as in the demands for greater individual freedom, independence, and privacy. However, the nuclear family has several disadvantages: Since few persons share expensive appliances (kitchen, washer, dryer, refrigerator, TV, computer, car, lawnmower), there is a certain amount of waste that increases the cost of living. The functions of father and mother tend to become totally separated. The father works outside of the house and is unavailable to his children most of the time. The mother, on the other hand, may be tied to her household and the children, and may have to give up most of her cultural, intellectual, and professional ambitions. This further enhances her husbands privileged position. If, on the other hand, the mother also works outside the home, the children may have no one to look after them most of the time. All of this can result in serious problems, including sexual problems. nude. Unclothed. Should be distinguished from naked (see there).

nudism. A movement which advocates a natural way of life with much physical exercise in the open air, and without the restrictions of clothing. For this reason, nudists usually form private clubs and build their own camps, where they spend much of their free time in complete nudity without interference from others. The nudist philosophy rejects many of the traditional laws and social conventions concerning dress. For a nudist, they are expressions of an unhealthy, exaggerated sense of modesty and fear of the body. In contrast, nudists maintain that, in the natural state of nudity, people become more beautiful, more relaxed, and, ultimately, more humane. This philosophy is expounded in nudist magazines, which usually carry pictures of nude men, women, and children whose appearance is supposed to suggest the nudist ideal. It is a moot question whether the nudist philosophy is hypocritical or sincere, sophisticated or simple-minded, reasonable or foolish. Basically, it is a matter of taste rather than rational argument. Some people join a nudist group temporarily, or spend only their vacations at a nudist camp. Nudism is more common in Europe than in the US, and it is practically unheard of in Asia and in Muslim countries. nudity. The state of being unclothed. The impression of nudity on the observer depends very much on his cultural background and on his education. In general, Europeans are more comfortable with nudity than Americans, Germans are more comfortable with it than are the Irish. Recent years have seen an increase of nudity in advertising, fashions, and entertainment. However, this does not necessarily mean that there has been an equal increase of sexual excitement in the viewer. In fact, some people complain that certain formerly hidden charms now no longer provide the expected stimulation. Generally, the more open display of the nude body today can be considered a symptom of growing emotional maturity and of a more relaxed attitude towards human sexuality. nymphomania . (gr. nymph-like craze) This denigrating term alludes to the love-sick nymphs (pretty girl spirits or fairies) in ancient Greek mythology. Well educated 19th century psychiatrists introduced the term to brand female sexual promiscuity as sick , i.e. symptomatic of mental illness. A learned term of opprobrium without scientific value. If and how a womans frequently changing sexual partners are a problem for her, depends on

137 many different factors that should be clearly named in each case. (See also erotomania and promiscuity)

O obscene. (lat.) Anything that is believed to violate the prevailing standards of sexual propriety.

obscenity . An object or a behavior that violates the prevailing standards of sexual propriety. Apart from considerable theoretical difficulties, the problem of obscenity raises a number of practical questions. To begin with, there is no general agreement as to what the standards of sexual propriety actually are. Different people hold widely divergent views on the subject. But even where there is no doubt about the standards, there is usually a great deal of discussion as to whether they have, in fact, been violated. For instance, it is claimed that a work of art or scholarship can, by definition, never be obscene, no matter how shocking it may appear to some people. This argument often shifts the debate to the question of whether a certain literary text, a sculpture, painting, photograph, book, or film is art or not. However, art is, if anything, even more difficult to define than obscenity. These frustrating disputations are then often settled in court by means of some judicial decision that leaves at least one, and often all the contestants unconvinced. Under the circumstances, it would appear sensible to leave such questions to the individual, as long as he does not actually force his personal taste on others who do not care for it. The demand to be left alone in such cases seems reasonable enough. However, it is questionable whether people who themselves can easily avoid exposure to what they might consider obscene really need the protection of the police.

Oedipus complex. A psychoanalytic term coined by the Viennese physician Sigmund Freud (1856-1939) and used in the interpretation of a certain unconscious crisis in a male childs sexual development . The boys experiences and reactions during this so-called Oedipal phase largely are said to determine his later ability to establish intimate contact with others.

Freuds concept has come under increasing criticism in recent years and, in any case, no longer plays any role in modern sexology. Indeed, outside of psychoanalytic circles the Oedipus complex is now being derided as a simple-minded and even silly fiction, unproven and unprovable and therefore unscientific. The original idea, although intellectually seductive at first, always seemed forced and far-fetched upon closer examination, because it oversimplified a complex ancient myth, reducing it to an alleged sexual subtext and ignoring a variety of crucial non-sexual factors in child development. The term Oedipus complex alluded to the legendary Greek king Oedipus who unknowingly killed his father and married his mother. This allusion seemed justified by the following observation: It is the rule for a young child to be actively interested in a person of the other sex. If we examine the behavior of a 4-year-old boy, for example, we discover that he is in love with a woman - his mother. She is, for him, the only woman he knows and cares to know. However, this woman already has a husband - the father. The boy is jealous of him and would like to push him aside in order to assume his position.

138 This desire is usually expressed openly and spontaneously, as for instance when the boy climbs into his mothers bed announcing: When I grow up, Ill marry you. Freud believed that this situation could be compared to that of King Oedipus, although there was one important difference: Oedipus actually did remove his father forever from his mothers side, and he did marry her. The normal development of a child was to take another course: The boy replaces his desire to marry his mother with the wish to marry a woman like his mother, and his urge to take the place of his father turns into the determination to become a man like his father. The boy can make this transition easily, if the father provides an attractive model to follow, and if he actively encourages his son to become a man. At the same time, it is the mothers task to help her son realize that she has already chosen and is no longer available as a sexual object. These parental attitudes will lead the boy to seek his sexual gratification elsewhere. (In the case of a girl, the development was said to take the opposite course: she loves her father and is jealous of her mother. The respective psychoanalytic term is Electra complex, after Electra, a legendary Greek princess who, after the death of her beloved father, helped kill her mother, who had murdered him.) onanism. Erroneously used as a synonym for sexual self-pleasuring (masturbation). However, the sin of the biblical Onan (1. Moses, 38, 8-10) was not masturbation, but greed. Obliged to impregnate his brothers widow in order to produce heirs for her, he wanted to keep the inheritance for himself. Thus, when having intercourse with her, he let his seed spill upon the ground, i.e. he withdrew before ejaculating, practicing coitus abruptus (see coitus interruptus).

opposite sex. Misleading term. Males and females are not opposites; they are just different in many aspects and in varying degrees. Indeed, even their sex organs grow from an originally undifferentiated cell mass and have a number of homologous structures. Moreover, the male and female sexual responses are quite similar. It is important in science not to construe differences as opposites. Correct term: the other sex.

oral intercourse. Sexual intercourse involving the mouth of one sexual partner and the sex organs of the other. (See cunnilinctus, fellatio.) orgasm. (gr. orgasmos: lustful excitement) Medical term used to describe the climax of sexual pleasure . The culminating phase of the human sexual response, characterized by a quick succession of muscular contractions, and followed by general physical relaxation. Orgasm is a highly complicated physical process, usually accompanied by involuntary movements, sounds, and gestures, such as convulsions of the body, groans, and sighs. Orgasm can make the sexual partners oblivious to their surroundings and even to each other. In fact, it could be said that during orgasm they deeply feel and forget each other at the same time. In the male after puberty, orgasm is usually accompanied by an ejaculation of semen . Orgasm in females is, in principle, the same physical reaction with the same muscular contractions, although only in very few women are the paraurethral glands developed enough to produce a prostatic fluid that can be ejaculated. There is a belief that the most perfect coitus is one that results in the simultaneous orgasm of both partners. However, this can be a dangerous ideal likely to put unnecessary pressure on the

139 partners. Therefore, it should not be considered the decisive criterion for satisfactory intercourse or a happy sexual relationship. orgy. A gathering at which people have sexual intercourse with each other. Originally, orgies had a religious function. On certain occasions (fertility rites), sexual intercourse among members of the celebrating group was considered an appropriate offering to the gods. Today the word orgy has mostly negative connotations. This is an indication of how much our attitude towards sex has changed in the process of civilization. Even so, orgies still take place in privacy, for example in so-called swingers clubs that are devoted to recreational sex. outlet, sexual. Concept developed by the American sex researcher Alfred C. Kinsey (1894-1956). He distinguished between six sexual outlets, i.e. sources of orgasm: 1. Masturbation, 2. Sexual dreams, 3. Heterosexual petting, 4. Coitus, 5. Homosexual contact, 6. Sex with animals. These outlets could be counted and the resulting various figures could then be used for statistical comparisons. The statistics gathered by Kinsey and his collaborators on this basis allowed them to publish their two famous reports Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953). ovaries. (lat. ova: eggs) Two almond-sized glandular organs, one on each side of the uterus, which produce the ova or egg cells. (See ovum.) They also produce hormones which influence the development of a womans secondary sexual characteristics . In their function, the ovaries correspond to a mans testicles . The removal or loss of both ovaries results in infertility. ovulation. The process by which the ripe egg (ovum) is released from the ovaries, after which it travels through one of the Fallopian tubes into the uterus. In a sexually mature woman, ovulation occurs fairly regularly about every 28 days, except during pregnancy and shortly after she has given birth. At the time of ovulation there is a slight rise in body temperature. (See basal temperature .) ovum. (lat.. Plural: ova) Egg. The female reproductive cell produced in the ovaries. An ovum is about 1/200 of an inch in diameter. A womans ovaries contain several hundred thousand potential ova, although only a few hundred are actually involved in the reproductive phase of her life. During the period between puberty and menopause, one egg ripens approximately every 28 days. The fertilization of an egg by a sperm cell (see spermatozoa) marks the beginning of a pregnancy. The human ovum was not discovered until the 19th century.

P pansexualism. (sometimes also pansexuality. From gr. pan: all) All-embracing sexual love . An attitude or a philosophy which is based on the belief that the human sexual potential can and should be directed towards everybody and everything. At one time, the term pansexualism was also used for the theory that all human behavior is somehow

140 sexually motivated. This theory is no longer considered valid. Today the terms pansexualism and pansexuality are often employed by certain advocates of sexual liberation who want to convey the idea that the present sexual and gender roles of men and women are too confining, and that, therefore, an all-embracing sexuality should accept the entire spectrum of sexual orientations and deliberately ignore all other conventional distinctions. paraphilia. (gr. next to and love, i.e. second-class love) Term used by medical, psychological, and legal professionals for sexual behavior of which they disapprove. Indeed, they now prefer this term over the older perversion, aberration and deviation which have fallen into disfavor as too harsh and ideological. However, the new term does not really represent any intellectual progress, since it also assumes and implies the existence of a real, true,natural, and correct love (philia) which has sisters of minor rank standing next, behind, or below it, just as the paramedical personnel stands behind or below the real doctor. Scientifically speaking, this is an unwarranted assumption. Professionals in any field should clearly and openly state the reasons for their disapproval in each individual case. These reasons will prove convincing in some cases, but in other cases they may very well turn out to be no more than prejudices. (See also aberration, deviation, perversion.) paternity. (lat. pater: father) Fatherhood. The state or condition of being a father.

paternity suit. A legal suit aimed at determining the father of a child born out of wedlock . Such a suit is usually filed in order to secure financial support for the child.

patriarchy. (gr. father rule ) A political system or a form of society in which all important decisions are made by men. In a patriarchal society men dominate most spheres of life, such as politics, administration, economy, science, art, and religion. They also enjoy a privileged position sexually. There have been attempts to compensate for the discrimination against women by showing special respect for their roles as young, innocent girls, virgins, wives, and mothers (Mothers Day). Today such attempts are no longer convincing. In fact, many women regard them as insincere and even offensive, while many men have begun to realize that there is no substitute for true sexual equality. Most Western countries have long been and are still today more or less patriarchal. There is usually only one main area where male influence is weak or even absent: the education of small children, which has become the almost exclusive right and obligation of women. In the course of history, there were also cultures dominated by women, and some still exist today in remote corners of the world (see matriarchy ).

pederasty . (gr. pais: boy and eran: to love) 1.Boy love in ancient Greece. The literal translation is misleading, since the term does not refer to a child, but rather to a boy after puberty. The correct meaning is therefore: Sexual relationship between an man and a male adolescent. In ancient Greece such relationships were customary and enjoyed general social approval. Pederasty had an educational function, obliging the adult lover (the inspirer) to teach his young beloved (the listener) good citizenship; the adolescent, in turn, had the obligation to learn from his adult role model. The relationship ended when

141 the adolescent was ready for marriage. 2. Anal intercourse between males. This is a modern usage resulting from a misunderstanding of the original term and ignorance of its historical implications. In this reductionist sense, the term has crept into Western legal jargon and is often used in the context of persecuting sex offenses. pedophile. (gr. pais: boy or child and philia: love) An adult having a sexual preference for children, i.e. girls or boys before puberty.

pedophilia: Sexual preference of adults for children, i.e. girls or boys before puberty. Not all pedophiles have actual sexual contact with children. For example, the author C. L. Dodgson (1832-98), who, under the name Lewis Carroll, wrote Alice in Wonderland was erotically attracted to very young girls. Indeed, with the permission of their parents, he took nude photographs of some of them. However, he never overstepped the boundaries of propriety and never had sexual contact with them. Conversely, not every sexual contact between adults and children is an expression of pedophilia, and not all adults having such contacts are pedophiles. Some may have the contacts out of curiosity, or because the children happen to be available in a particular situation, or because they see them as easy victims of their own destructive impulses, or because they have still other motives. In such cases there is not really a genuine sexual preference and thus no true pedophilia.

peeping Tom. (after the English legend of Lady Godiva, who was forced by her husband to ride though town in the nude. In sympathy to her plight, all citizens locked their windows and refused to look outside. Only peeping Tom broke rank and saw her.) Colloquial term for voyeur, i.e. a man who habitually and secretly observes unsuspecting women and men being nude or engaging in sexual activity.

penilinctus. See fellatio.

penis. (lat. tail) The most obvious male sex organ, consisting of some sponge-like erectile tissue and a bulb-like extremity called glans.

period A term sometimes used for menstruation.

perversion. (lat. Turning around) The term perversion (just as aberration, deviation, or abnormality) implies the transgression of a certain norm for sexual behavior. The concrete definition of this norm is usually left to the religious, legal, and medical authorities. As seen from their particular points of view, a violation of the norm is either a sin, a crime, or a disease, and the word perversion has been used to mean any of these things. However, the various religious, legal, and medical definitions are subject to change and do not necessarily agree with each other. For this reason, the term is not useful in scientific discourse. As far as the general public is concerned, there is a tendency to call every sexual act perverse that is unfamiliar. People who engage in such acts are just as readily called perverts. In everyday language, therefore, the word perverse often means nothing more than strange and disgusting. (See also in our Glossary of Inappropriate Terms under perversion.)

142 pessary. A term sometimes used for the cervical cap or, less frequently, for the diaphragm. petting. Intimate caresses and close physical contact between male and female sexual partners including the touching of the sex organs, but avoiding coitus. Petting is a special form of sexual intercourse common among young people who try to find a compromise between their private desire for sexual gratification and the public demand for their sexual abstinence. phallus. (Lat. from Greek: phallos) Penis . Today the term phallus is most often used for the artistic representation of a penis in the state of erection . In ancient Greece and Rome, the erect phallus was a symbol of life and fertility. Its image was openly displayed in public. Comedy actors in ancient theaters wore large, grotesque phalluses for comic effect. There were also public statues of phallic deities, such as Hermes and Priapus, which were believed to protect the lives of travelers or to insure a good harvest. The phallus symbol was also worn in the form of jewelry, as a good luck charm. It was not until after the rise of Christianity that people began to take offense at the artistic representation of sex organs. This new prudery resulted in the curious practice of covering the penises (gr. phalloi) of classical Greek and Roman statues with biblical fig leaves.

phimosis . (gr. phimoein: to gag) Tightness of the penis foreskin, requiring its surgical removal (see also circumcision).

pimp. A man who forces a woman to become a prostitute , or who helps her to procure business and who profits from her prostitution. Very often a pimp takes advantage of girls who find themselves in desperate circumstances. In some cases, prostitutes welcome the protection and experience of a pimp, and do not object to sharing their income with him. This can be the case when frequent police raids or brutal customers pose a danger to sex workers. On the other hand, where they can work openly in an officially recognized profession (as in the Netherlands) there is no need for pimps and little chance that they can make a living.

Planned Parenthood. The International Planned Parenthood Federation is a worldwide organization composed of family planning organizations from many nations which helps provide voluntary contraceptive services in more than 100 countries.

Platonic love. A love of the soul, not of the body, a deep affection for somebodys personality, without sexual desire. The term was originally used for a certain kind of homosexual love. The ancient Greek philosopher Plato, in his Symposium, has the old and ugly Socrates describe his feelings for Alcibiades, a beautiful young man, whose sexual advances he had rejected. Socrates proposes a higher, non-physical form of love that aspires, above everything else, to a union of souls.

pollution. (lat. dirtying) Term sometimes used to describe an ejaculation during sleep. A moralistic, negative term that should have no place in science.

143 polyamory (from gr. poly: many and lat. amor: love). A new term introduced by certain advocates of multiple, simultaneous erotic relationships. According to their definition, polyamory is based on a conscious decision not to limit ones erotic potential and to engage in several or even many relationships at the same time as long as they are all based on honesty, integrity and mutual caring. The very broad definition thus covers, among other things, not only monogamous open marriages, but also group marriages and intimate networks polygamy. (gr.) Marriage between more than two partners. There are 3 basic forms of polygamy: 1.Polygyny (one man - several wives). 2. Polyandry (one wife - several husbands). 3 . Group marriage (several husbands - several wives). In the course of history, the term polygamy has most often meant that a man had several wives. (This form of polygamy was practiced, for example, by the 19 th -century Mormons in Utah, USA. In some Islamic countries a man can even today have as many as four wives, in some African and East Asian countries an unlimited number.) In some cultures of the past, polygamy also meant that one woman had several husbands. Group marriages have always been rare. Therefore, they have usually not been subsumed under the general term polygamy, but have been listed separately in a category of their own. pornography . (from gr. porne: whore, and graphein: to write) A term used by certain people for pictures, statues, books, or films that depict nudity or sexual activity in a fashion of which they disapprove. This formal definition implies a lack of objective criteria for pornography, and indeed no consensus has ever been reached on the matter. No policeman, lawyer, or judge has ever been able to come up with a generally accepted definition. Neither have artists and critics ever agreed on this point. Nevertheless, there seems to be some sort of understanding among all experts that it is somehow typical for pornography to stimulate sexual excitement in the viewer or reader. However, different viewers and readers are sexually stimulated by different things, and this introduces another element of subjectivity. What is sexually exciting to one person, may leave another one cold. Moreover, the experts totally disagree about the effects of this excitement, if indeed it occurs in this or that individual. Some take it for granted that the effects are harmful; others believe them to be beneficial. It is not surprising, therefore, that definitions of what is pornographic and the restrictions placed upon pornography differ considerably from one time and culture to another. In many countries there is a variety of laws and regulations which, although constantly challenged in court, try to control pornography, even if they can do so only in a capricious and haphazard fashion. However, in view of the fact that the concept of what is pornographic varies from culture to culture, and even from group to group within the same culture, it is unlikely that any final truth is ever going to be discovered in this area. The problem of pornography is basically one of cultural attitudes towards sex. Historically and geographically, such attitudes range from total condemnation to total acceptance.

potency. (from lat. potentia: power) Sexual capacity of the male (i.e. the ability to have erections of the penis and to experience orgasm. A males potency is considered the greater, the more often he can have erections and orgasms.). The term is almost never used in reference to females.

144 pregnancy. The condition of a woman between the conception and birth of her baby. The normal duration of a pregnancy is about 9 months or 280 days. During this period, the developing baby grows from an embryo to a premarital intercourse . Since the term premarital refers to the period between puberty and marriage , it cannot be applied to the behavior of people who remain single throughout their lives. However, it is impossible to know beforehand who will eventually get married, and who will not. Strictly speaking, the term premarital intercourse is appropriate only in the case of a person who has definitely decided to marry. It also makes sense when used in retrospect by people who are married, and who look back on their sexual experiences before marriage. But even within these narrow logical limits, the term fails to make one important distinction: it applies indiscriminately not only to couples who are engaged, but also to couples who have no intention of marrying one another, yet who may, at some later date, get married to someone else. It should be clear from these observations that the term premarital intercourse, as commonly used, is inappropriate, because it oversimplifies and prejudges the issue of sex between unmarried partners. premature ejaculation. The term is completely misleading, because it confuses ejaculation with orgasm. It is the orgasm, not the ejaculation, that is felt to occur too early. An ejaculation can, but does not have to, accompany a male orgasm. Not every male orgasm is accompanied by an ejaculation (examples: before puberty, after a prostatectomy etc.) However, after an orgasm the penis usually loses his erection, and it is this loss of erection that causes the concern. In other words, the real problem has nothing to do with an ejaculation of semen, but with an untimely softening of the penis after orgasm. It is therefore more appropriately called unsatisfactory timing of orgasm. (See also ejaculatio praecox) promiscuity. (lat. indiscriminate mixing) This term is supposed to denote the behavior of people who have sexual contact with many, or rather too many, partners. However, since there will never be a general agreement about how many are too many within which time frame, the word has no clear meaning and is simply a term of disapproval. (see also erotomania and nymphomania) preorgasmic woman. This term falsely implies that a woman who does not have orgasms will sooner or later have them. However, this is not true. Thus, the term creates unrealistic expectations and performance pressures. The same would be true if one were to call the poor milkman Tevye pre-rich. Some poor men become rich, but not all. prepuce. Medical term for foreskin. presbyophile. presbus (Greek) old man + philia (Greek) love. A synonym for gerontophile; one who is erotically attracted to older persons. prophylactic. Old-fashioned term for condom.

145 pudenda . (lat. things to be ashamed of) Obsolete term for the external female sex organs (vulva). However, there is no reason be ashamed of these organs. Curiously enough, the term was never used for the external male sex organs. prostitute. (lat. prostituere: to offer) Sex worker. Someone who provides sexual services for pay. There are female and male prostitutes. prostitution. Providing sexual services for pay. Illegal in many countries, permitted in others, and an officially recognized profession in the Netherlands. Prostitution has sometimes been called the oldest profession in the world, meaning that it has always existed in the past, and among all nations. Occasionally, prostitution served a religious function, as in the case of so-called temple prostitution. At other times, prostitution was a result of the sexual double standard . This standard, while allowing for some male sexual license, demanded total sexual abstinence of all women before and outside of marriage. It usually turned out that the virginity and chastity of respectable women could more easily be protected by providing the men with the opportunity to have sexual intercourse with prostitutes. In a way, then, prostitution was considered both evil and useful for society. It was the fight against this type of social hypocrisy (see G. B. Shaws play Mrs. Warrens Profession) and the growing emancipation of women which helped to end the double standard in large parts of Europe and the United States. prudery. Rejection of sexuality. Prudery is a sign of a conscious or unconscious fear of sex. Prudish people have a low opinion of sex in general. They believe it to be over- emphasized by others, and feel threatened by its open discussion. If forced to talk about it, they will usually stress the procreational function of sex at the expense of its pleasurable aspects. The fact that our language does not possess simple, commonly accepted terms for the various sexual activities is a result of general prudery. puberty. The period of life during which the human body develops the secondary sexual characteristics and becomes capable of reproduction. Puberty normally arrives in the early teens (between the ages of 9-14 for girls and 11-16 for boys). On the average, girls reach puberty about two years earlier than boys. Over the last hundred years, puberty has begun at ever lower ages. reparative therapy. The term refers to psychiatric attempts to repair the damaged minds of homosexuals by trying to turn them into fully functioning heterosexuals. The term and the practice imply that homosexuality is somehow in need of correction. This is a moralistic value judgement, not an objective, scientific finding. Indeed, the intended objects of this repair work usually consider themselves fully functional just as they are and rightfully demand If it aint broke, dont fix it.! The insistence to do so anyway is nothing but the missionary zeal of moral crusaders (see also conversion therapy). reproductive organs. Ideological term for sex organs. These organs also serve other functions besides reproduction and should not be semantically reduced to a single function.

146 retarded ejaculation . This term is misleading, since it confuses ejaculation and orgasm. The speaker usually means to refer to a delayed orgasm, i.e. a male orgasm that comes too late in the opinion of one or both of the sexual partners. After all, it is only after orgasm that the male is sexually satisfied and his penis loses its erection. This then signals the end of the respective sexual encounter. Whether semen is ejaculated durng this orgasm is usually immaterial, unless the female partner wants to become pregnant quickly. (See also premature ejaculation.)

Rh factor. (Short for Rhesus factor) An antigen present in the blood of most people. These people are therefore called Rh-positive. The remaining percentage of the population, who do not possess the Rh factor, are called Rh-negative. When an Rh- negative person receives a transfusion of Rh-positive blood, his blood plasma develops antibodies. These antibodies do not cause any harm unless a second transfusion of Rh- positive blood occurs, in which case the patient may experience severe reactions. A careful classification and separation of Rh-positive and Rh-negative blood types can help avoid such complications. Problems can also arise when a woman with Rh-negative blood becomes pregnant by an Rh-positive man. In such a case, her developing baby is likely to be Rh-positive as well. However, when the Rh-positive blood of the fetus passes into the mothers circulation, her own Rh-negative blood forms antibodies which, in turn, enter the fetal bloodstream. In the case of a first pregnancy, this usually does not cause any harm, but later pregnancies may be adversely affected. Today such conditions can usually be controlled by appropriate medical measures. It is therefore no longer inadvisable for an Rh-negative woman to marry an Rh-positive man. rhythm method. The so-called rhythm method of contraception consists of temporary sexual abstinence from vaginal intercourse (coitus) during a womans fertile period. A woman can become pregnant only as long as an egg is in the Fallopian tubes . This knowledge can, of course, also be used to advantage by couples who want a child, and who can thus select an appropriate time for coitus . However, those who want to avoid a pregnancy only have to avoid coitus during the same period. The fertile days of a woman are those shortly before, during, and after ovulation. It is advisable to begin avoiding coitus a few days before ovulation, because the sperm cells remain alive in the uterus and Fallopian tubes for several days. Abstinence for a while after ovulation is also necessary, because the egg can be fertilized for some time after ovulation. There are basically two ways of determining the fertile days of a woman, namely, the calendar method and the basal temperature method.

1. The calendar method:

In order to use this method, the woman has to keep a careful record of her menstruations over a longer period of time (at least one year). Each period from the first day of menstruation to the day before the next menstruation counts as a separate menstrual cycle . After determining the various lengths of the individual cycles, one subtracts 17 days from the shortest cycle, and 13 days from the longest cycle. For example: Shortest cycle: 24 days; 24 - 17 = 7. Longest cycle: 31 days; 31 - 13 = 18. Now, if one counts

147 again from each first day of menstruation, the fertile days are those between the 7th and 18th day of each cycle. The other days are infertile, that is, safe.

2. The basal temperature method:

In order to use this method, the woman takes her own body temperature while resting. This is called the basal temperature. It has to be taken at the same time each day, for at least a year, and the findings have to be carefully recorded. Looking at the data for one month, the woman will notice an elevation of basal temperature during certain days. These are her fertile days, since the rise in temperature results from her ovulation. By comparing the records of several months, the woman can then arrive at an estimate as to the periodical reoccurance of her fertile period.

Both the calendar method and the basal temperature method should not be used without professional guidance. Yet even under the supervision of a doctor, they are not very reliable. Particularly among younger women, menstrual cycles tend to be irregular. Ovulation can also occur at unexpected times due to emotional shock or illness. A rise in body temperature resulting from an infection can upset normal calculations. Finally, there is the possibility of ovulation in response to coitus itself. Apart from this lack of reliability, the rhythm method has another important disadvantage: it subjects sexual intercourse to the rule of calendar and thermometer and thus puts an emotional strain upon the sexual partners. romance. A romantic love affair. The idea of romantic love , which was unknown to the ancient world, is a product of our Christian Western culture. It began to develop during the Middle Ages, when the notions of chivalry and religious devotion were, for the first time, applied to the courtly love that brave knights felt (or professed to feel) for their virtuous and largely inaccessible ladies. Indeed, the very notion of courtship has its origin in the conventions of a feudal court. However, the concept of romantic love did not necessarily imply sexual intercourse, and it also remained unrelated to the institution of marriage. It was not until the beginning of the industrial revolution and the period of Romanticism that the idea of romantic love as a condition for marriage became conceivable to a wider public. Thus, more and more people began to consider the selection of marriage partners as a matter of personal choice and, indeed, a personal right. At the same time, the traditional family structure also began to change. The former extended family was gradually replaced with the modern nuclear family , and today there is a widespread belief, particularly among young people, that there is only one right woman for every man, that their love should be romantic, and that it should lead to marriage. It should be pointed out, however, that neither happy love relationships nor happy marriages depend on such notions or conditions.

rubber . A colloquial term for condom.

148 S sadism, sexual. (after the French writer Donatien Alphonse Francois, Marquis de Sade 1740-1814) 1. In sexology: A sexual preference for the domination of submissive partners. The reverse of masochism (see there). 2. In everyday language: Cruelty.

sadist. 1. In sexology: A person who has a sexual preference for the domination of submissive partners. The reverse of masochist (see there). 2. In everyday language: A cruel person.

sadomasochism, also S/M. Collective term for the phenomena of sexual sadism and masochism, which not only mirror each other, but often form the basis for the informal and formal organization of interested individuals. Sadists and masochists need each other and thus have, where possible, created a subculture of their own. In S/M clubs, for example, it is quite possible that sadists and masochists occasionally switch roles in order to satisfy each other, although most of the time, individual preferences remain fixed. However, recent reports from the S/M scene indicate a growing flexibility in dominant and submissive orientations. The sadomasochistic encounter or scene involves domination and submission, and can include a desire for active and passive verbal denigration, humiliation, corporal punishment, tying up, and physical pain. Since the masochists ask for this treatment and determine its limits, they are, in fact, using the sadists for the fulfillment of their sexual desires. Thus they are, contrary to any outward appearance, the truly dominant partners in the relationship, a paradox that provides the kick in sadomasochistic encounters. This also explains why, in prostitution, the paying customer usually plays the masochistic, submissive role. He thus merely uses the sadistic, seemingly dominant prostitute for his own sexual purposes. On the other hand, inside the S/M subculture, an increasingly complex picture emerges. According to this view, a sadomasochistic encounter proceeds simultaneously on several levels: 1. The outwardly visible level of the sadist (top) dominating the masochist (bottom). 2. The contractual level with the masochist setting the limits, thus contradicting the visible evidence. This is the level of a true paradox, because the controlling bottom wants, at the same time, be controlled by the top. The latter, in turn, while respecting the imposed limits, wants, at the same time, to exercise limitless control. In short, we are dealing here with a psychologically oscillating situation. 3. The ritualistic level. At this level, the bottom experiences true powerlessness and the top, within the mutually agreed limits, experiences real power. These experiences can cause and enhance deep feelings of trust and essential partnership, at least in non-commercial encounters.

saliromania. (gr.) Psychiatric term for a sexual behavior that depends on dirt, feces, filth, bad smells, or ugliness for excitement and satisfaction. A form of fetishism.

salpingectomy. Surgical removal of one or both of the Fallopian tubes.

salpingitis. Infection of the Fallopian tubes.

149 sapphic. 1. In the context of sexual behavior: Older term for lesbian (adj.). 2. In literature: Typical of the poetry of Sappho (sapphic ode). sapphism. Female homosexuality. Lesbianism. Named after the ancient Greek poetess Sappho (ca. 600 B.C.) who lived on the island of Lesbos and wrote love poems to her female disciples. satyriasis. (named after the satyrs, ancient Greek mythological creatures - half man half goat - who were said to be sexually insatiable) Poetic, but derogatory term for the behavior of men who have too much sex. A negative subjective value judgement without any definite content. (See also erotomania and nymphomania.) scientific. As used in this dictionary, the term scientific characterizes the rational and systematic method of investigating the world in and around us - i.e. the world of tangible things as well as the world of ideas. Accordingly, we can distinguish between the natural and the cultural sciences (humanities). Both employ the scientific method to learn about their objects - data (things that are given in nature) and facta (things that have been done or made by humans). The scientific method studies all of these things with an open mind and does not cling to pre-determined outcomes. Indeed, it also requires strict moral neutrality. In their role as scientists, people must avoid all value judgements except one: Knowledge is better than ignorance. Apart from this, they must proceed impartially. After all, they want to describe how things are and not prescribe how they should be. (Moral judgements are, by definition, unscientific. For a scientist, they come into play only after the scientific work has been done.) Scientists soberly collect, compare, and analyze whatever they want to understand. They then develop models, i.e. preliminary concepts about it and correct these in the light of new discoveries. In other words, the scientific method tries to verify its concepts by trying to falsify them, i.e. it looks for reasons why its current assumptions could be wrong. Therefore scientific also means self-critical. Science is a never-ending process of finding out more by doubting, questioning, and correcting ones own ideas. Thus, it is fundamentally different from religion and other ideologies, i.e. belief systems which never question their basic assumptions. scoptophilia. See voyeurism. script, sexual. See sexual script. scrotum. The bag or pouch of skin which contains the testicles and which hangs between the thighs and behind the penis. The skin of the scrotum belongs to the erogenous zones and may be very sensitive to the touch. self-abuse. Moralistic term of condemnation for sexual self-pleasuring (masturbation). In fact, the use of ones pleasure organs for pleasure is abuse only in the eyes of certain religions. semen. A thick, whitish liquid (about one teaspoon full) that is ejaculated from the penis during orgasm. It is produced mainly by the prostate and the seminal vesicles, but can

150 also contain up to 500 million sperm cells. However, these sperm cells are so tiny that they hardly add to the volume of semen. Indeed, if they are missing (perhaps after a vasectomy), the volume of semen remains practically the same. sensate focus exercises. Exercises for couples in sex therapy, developed by the therapists Masters and Johnson. In order to overcome various sexual dysfunctions, the couple is advised to do some homework in private, consisting of non-coital, non-demanding, non- goal oriented mutual pleasuring like stroking, caressing and the slow exploration of the partners body. sex act, also sexual act. These terms are often used as synonyms of vaginal intercourse (coitus) as if this were the only true sexual interaction. However, this moralistic usage is misleading, because there are many other, equally valid ways of interacting sexually. It is prejudicial to use a term that implicitly denigrates them as secondary or less important. sex aid. A device, instrument or contraption designed to provide sexual stimulation or enhance sexual pleasure, such as a special condom with a rough or irregular surface, a dildo, penis ring, artificial vagina, inflatable doll, vibrator etc.. sex drive, also sexual drive . The concept of a drive is based on the assumption that living creatures are basically inert and must be driven to activity by some hypothetical force. However, modern science has abandoned such ideas. It acknowledges that animals are alive and thus, along with all kinds of other activities, also manifest sexual behavior. (After all, humans also speak, sing, laugh, dance, write, and read without any respective drives.) sex education, also sexuality education . Education about sexual matters in school and high school. sexological education. Scientifically based education about sexual matters in college, graduate school, and beyond. Instruction in sexology as the science of sex. This kind of education, which promotes sexual health, has been recommended by the World Health Organization (WHO) in 1975 at least for health professionals. This can mean in practical terms:

• Colleges, universities, and other institutions of higher learning which train future professional and civic leaders must provide them with an adequate understanding of human sexuality and its vast social implications,

• Professional people such as doctors, teachers, ministers, lawyers , social workers, and police officers need special programs that discuss sexual behavior in its relation to particular professional issues.

• Adult sex-education programs must be greatly expanded. Sex education cannot stop after puberty, but has to continue through life. Adults need to keep up with advancing scientific knowledge to make their own sex lives more satisfying and to avoid a sexual

151 generation gap. Furthermore, there is an urgent need for an informed public opinion which will support reasonable changes in education and legislation.

• Finally, the mass media can greatly contribute to a more rational public approach to sex by avoiding sensationalism and the commercial exploitation of sex in favor of more extensive factual information.

These combined efforts may in time lead to the general realization that people of all ages, adults as well as adolescents and children, are sexual beings with sexual needs, and that the repression of these needs can only lead to fear, intolerance, injustice, misery, and disease. On the other hand, the acceptance of sex as a creative force in human life can free people to engage in open dialogue, thus enabling them to develop genuine and satisfying solutions to their personal problems. This kind of mutual sex education by members of all age groups and cultural backgrounds will not only give everyone access to all sexual facts, but can also serve to bring about richer, happier sexual relationships and more meaningful lives. sexism. An attitude or a philosophy that uses sexual differences as the basis of social discrimination. In practice, this has usually meant discrimination against women.

sexoesthetic invert. The 19th-century English scholar John Addington Symonds was probably the first to use this term in reference to homosexuality. It refers to an orientation that does not express itself in actual sexual contact. Hence, the idea of esthetic homosexuality.

sexual characteristics. Qualities that distinguish the sexes. One distinguishes between primary, secondary, and tertiary sexual characteristics. 1. The primary sexual characteristics are the sex organs. 2. The secondary sexual characteristics, which develop fully at puberty, are for males: facial hair, a protruding larynx (see Adams apple), a deeper voice, and a stronger muscular development. For females: the breasts, softer hair, broader hips, and a generally weaker muscular development. 3. The tertiary sexual characteristics are certain psychological qualities normally attributed to one sex and discouraged in the other. These qualities are culturally determined and usually summarized in the concepts of masculinity and femininity. sexual ethics. The doctrine of good sexual behavior, also the systematic attempt to know good from bad in the realm of human sexuality. All ethical standards are, of course, based upon certain fundamental beliefs, convictions, or assumptions, and the sexual ethics of any given culture reflect its assumptions about the purpose or nature of sex. For example, there have been peoples who were totally unaware of the causal connection between sex and procreation. Obviously, these peoples arrived at different standards for sexual behavior than those who believed that procreation was the only purpose of sex. In our own culture, the latter belief was, for a very long time, shared by most people. The moral demands based on this belief were rarely questioned, because few individuals were ever exposed to other cultures with different value systems. On the contrary, in the closed societies of the past, customs and conventions were stable, and the universal acceptance

152 of the same sexual morality could always be presumed. The common assumptions about the nature of sex seemed so obvious and self-evident to everyone that they did not have to be spelled out. In the meantime, however, the explosive growth of the population, the advance of science and technology, and the increasing communication between different cultures have led to a re-examination of traditional beliefs and created a pluralism of values that was formerly unknown. We thus find ourselves today in a new historical situation. In the course of our lives, we encounter a great variety of conflicting opinions about the purpose of sex and are forced to choose between a number of competing value systems. Although these systems differ in many important details, they can, for the purpose of clarification, perhaps be described as representing two basic types: the absolutistic and the relativistic moralities. 1. The absolutistic or old morality is dogmatic and based on the belief demanded by the Holy Scriptures. Its highest value is compliance with the will of God. It can therefore also be described as a morality of commandment. Those who obey the commandment are righteous; those who disobey thereby commit a sin. This morality assumes that that there is an eternal truth and that it is relevant for all times and for everyone under all circumstances. 2. The relativistic or new morality, on the other hand, is rational and based on the knowledge gained by scientific research. Its highest value is human understanding, and it tries to judge each act individually according to time, place, and circumstances. It can therefore also be called situation ethics. This is a morality of consequences, which evaluates human behavior in the light of its effects on other human beings. (Some people also distinguish a third type of sexual ethics: the hedonistic or fun morality, which holds that the highest value in life is pleasure. However, most hedonists will probably agree that pleasure is relative, that certain pleasures have to be avoided because of their unpleasant consequences, and that, eventually, only experience, understanding, and universal cooperation can lead the way to real happiness. In most respects, therefore, the hedonistic approach to moral questions is similar to the relativistic morality of consequences.) Within each of the two basic moral systems there is a variety of gradations. For example, even those who share the absolutistic approach of the old morality may arrive at quite different conclusions about certain concrete acts, because they disagree on the true nature of things or on the exact meaning of Gods will. The adherents of the relativistic new morality, on the other hand, may also disagree among themselves because they have different opinions about the consequences of certain acts, or because scientific knowledge in certain areas is still limited. The struggle between the resulting different moralities has created the present moral confusion. However, today the new morality in one form or another seems to be gaining ground. It seems better suited to our fast-changing world, as it leaves more room for personal liberty and creativity. This does not necessarily mean that it demands less effort than the old morality which reduced all moral problems to the simple question of obedience. On the contrary, by making love and sex entirely a matter of human encounter and cooperation, the new morality encourages the individual to assume a greater share of responsibility towards his fellow men. sexual intercourse. In humans, there are four basic forms of sexual intercourse: 1. Manual intercourse (from lat. manus: hand), here is the hand of one partner in contact with the sex organs of the other.2. Oral intercourse (from lat. os: mouth), here is the mouth of one partner in contact with the sex organs of the other. 3. Vaginal intercourse

153 (from lat. vagina: sheath) here is the vagina in contact with the penis, 4. Anal intercourse (from lat. anus: rectal opening), here is the anus of one partner in contact with the penis. In everyday language, the term sexual intercourse is, however, most often used as a synonym of vaginal intercourse. This is shortsighted and can be misleading. sexual orientation. A persons sexual preference for either female or male partners or for partners of both sexes. Collective term for heterosexuality, homosexuality and ambisexuality. sexual revolution. The term sexual revolution is an attempt to describe the fact that during the last few decades the problems connected with human sexuality have acquired a new meaning. While the actual sexual behavior of most people has changed less than it might seem, the motivations, implications, and consequences of this behavior have changed a great deal. In other words, the same sexual acts now occur under entirely new conditions, and within a different context. This context is, of course, man-made. As man has learned to control nature, he has, at the same time, created a new social environment for himself, a new historical situation with new, unprecedented problems demanding new, unprecedented solutions. It is becoming increasingly obvious that the time-honored models and old approaches no longer work. A symptom of this development is the dispute over the importance and the virtues of sex education. According to the traditional concept of sexuality, sex education was superfluous. There were only a few known biological facts and a few simple, unalterable moral principles which were handed down from one generation to the next without questioning. As there was little change in the external circumstances of life, and as contact with other cultures and different value systems was limited, the experiences of older people remained valid for their children and grandchildren. In the meantime, however, technological progress has changed the world to such an extent that previous human experiences are becoming irrelevant. The young and the old, the married as well as the unmarried, find themselves confronted with a totally new situation. There is, therefore, a continuous public and private discussion of sex, not because it is fashionable, but because it is indispensable. There is a need for new attitudes which can help us cope with present and future developments. In order to form such an attitude towards sex, one has to examine it in all of its aspects. It is for this reason that sexual values can no longer be found in unquestioned traditions, but have to be newly determined on the basis of our continually increasing scientific knowledge. However, because of its very increase, such knowledge is subject to constant revision. It is obvious, therefore, that modern sex education cannot afford to be dogmatic. In discussing sexual problems, it can and must try to present the available facts, but it cannot impose the solutions. There are several areas where new solutions have to be found:

• The traditional sexual values were patriarchal. Today we need new approaches that can lead us towards true sexual partnership between men and women.

• Because of the threat of overpopulation, and since new, effective methods of contraception have been found, sex can no longer be restricted to the purpose of procreation. The eventual effects of this development are still largely unpredictable.

154 However, it is already apparent that sexual intercourse as such has gained an importance of its own as a means of personal communication. It can be a mere source of pleasure as well as the appropriate expression of a deep human relationship. Thus the founding of a family is no longer the sole purpose of marriage. Two people may marry, not because they want children, but because they want to share their lives with each other. On the other hand, sexual activity can no longer remain the privilege of the married. Neither does the sexual behavior of adolescents or single adults have to follow the pattern of marital sex.

• Since, in the past, sexuality was tied to procreation, the only right sexual activity was vaginal intercourse. Consequently, every sexual act other than coitus was considered perverse or an aberration. Today a sexual relationship tends to involve each partner as a whole person, not just his sex organs. The demand to restrict sexual contact to particular areas of the body is therefore unreasonable and, in itself, perverse. Oral and anal intercourse can be appropriate forms of sexual activity. Laws and statutes aimed at preventing such activity are obsolete and need to be changed.

• In the past, sexuality was believed to be a single, isolated, controllable force which appeared during puberty, and which was to be employed only after the wedding. Before marriage, or outside of it, abstinence was the only accepted behavior. Today we know that sexuality is an integral part of every human life from its beginning, and that our character as adult human beings is the result of a long and complicated sexual development. This new knowledge has important consequences for our moral attitudes.

All of these fundamental changes give people a new sense of freedom. Many traditional rules and regulations are becoming meaningless; their continued enforcement seems irrational and repressive. Sexual repression is the main tool of dictatorships, because it creates a climate of hate and fear which can be exploited for the preservation of power. A democracy, on the other hand, is based on equality, mutual trust, and cooperation. The trend towards such cooperation is world-wide. Changes in the sphere of sex mirror the greater changes that are taking place in human society. Everywhere privileges are being abolished, power has to be shared, and there is a constantly growing demand for democratic participation. However, in a democracy life is not necessarily easier or more comfortable than in a dictatorship. Often it is more complicated and even more frustrating. The old, dictatorial morality repressed sexuality and individual freedom. It gave the appearance of law and order. In this sense, the sexual revolution has created new difficulties. It makes greater demands on the individual and forces him to take on new responsibilities. In our society today, both the old and the new morality exist side by side. The resulting moral confusion can be overcome only by increased understanding, tolerance, and patience. sexual script. Human sexual behavior can be seen as following at least three kinds of sexual scripts: general cultural, interpersonal, and intrapsychic scripts. 1. Cultural script: A model of correct sexual behavior provided by a particular culture, i.e. by its social authorities. Today, different social authorities (parents, teachers, the church, the law, science, media, etc.) provide different sexual scripts which may even contradict each

155 other and which force the individual to choose between them or to blend them together in same fashion compatible with his or her own temperament. 2. Interpersonal script: A model of how sexual partners should interact with each other. A set of rules developed and followed by a couple before, during, and after sexual contact. These rules are usually individual adaptations of general cultural rules and thus may vary from couple to couple. 3. Intrapsychic script: The individual sexual behavior pattern of a particular person, developed in response to the various scripts provided by the social authorities and also in response to his or her experiences with sexual partners. The theory of sexual scripting sees no need for the assumption of an unchanging universal sex drive. Instead, it sees all social behavior, including sexual behavior, as scripted behavior, i.e. as a learned behavior that follows various scripts. In past traditional societies, the general cultural scripts were few and remained stable for long periods. In the modern, fast-paced world, the sexual scripts are many and ever-changing, making it harder for couples and individual to develop suitable sexual scripts of their own. sexually transmissible disease (STD). A disease that can be transmitted from one person to another by sexual contact. The term should not be taken too literally, because virtually all infectious diseases can be transmitted this way. Conversely, some STDs can also be transmitted non-sexually, for example from mother to child. Nevertheless, there is general agreement in medical science that a number of infections should be singled out as a special group called STDs. The most important and common of these are AIDS (Human ImmunoDeficiency Virus), syphilis, gonorrhea, chlamydia, hepatitis B, herpes on the sex organs, soft chancre, and HPV (Human Papilloma Virus). single. A term used for adults who are not part of a married or unmarried steady couple. There was a time when men were not allowed to marry unless they fulfilled certain requirements, such as full qualification in their trade or profession, and the proven ability to support a family. Women, on the other hand, remained unmarried when nobody courted them. Since the unmarried status thus resulted from social customs and regulations, it was considered something necessary and inescapable. The unmarried individual had no choice but to adjust to a single way of life. However, this adjustment was normally helped by the fact that the extended family had room for married couples of several generations as well as for a number of unmarried relatives. Today more people get married (and divorced) than ever before. According to the now prevailing opinion, a single person has quite voluntarily chosen his way of life because he did not want to get or stay married. This presumption is not always correct, however. Nevertheless, in recent years, the single existence has more and more been advertised by various media as an enviable lifestyle. sissy. (from sister) A derogatory slang expression referring to a boy or a man who fails to display the expected signs of masculinity. Since the concept of masculinity is subject to change, the concrete meaning and the effect of the word sissy depend very much on the cultural context in which it is used.

sixty-nine. Slang term used to describe a form of oral intercourse in which the sexual partners simultaneously lick each others genitals. (See cunnilinctus, fellatio.) In doing so,

156 the position of their bodies in relation to each other is similar to that of the inverted numerals in the number 69. sleeping together, or sleeping with someone. An unfortunate euphemism for vaginal intercourse (coitus). The participants are, of course, usually wide awake. Such deliberately vague terms can lead to serious misunderstandings and misinterpretations. (Example: A man sleeps with his wife seven nights per week, but has intercourse with her only once a week.) smegma. A secretion from glands under the foreskin of the penis. Clear and odorless at first, it turns cheesy and foul-smelling if allowed to accumulate. Regular washing of the uncircumcised penis is therefore necessary. sodomy. (after the biblical city of Sodom) Obsolete religious term, still used in some unreformed criminal codes, for anal intercourse. Originally, the term was much broader and encompassed all unnatural sexual activity, i.e. also oral intercourse and sexual contact with animals. Obviously, this Christian term of condemnation, being based on very specific beliefs not shared by Buddhism, Shintoism, and many other religions, has no place in science. (See also unnatural). soft chancre. A sexually transmissible disease caused by the bacterium haemophilus ducreyi. solitary vice. A 19th-century term of disapproval referring to sexual self-pleasuring (masturbation). spermatic duct. (lat.: vas deferens) The male body contains two spermatic ducts which carry the spermatozoa from the testicles to the urethra, which, in men, serves for the discharge of both urine and semen. The cutting and tying of the spermatic ducts for the purpose of sterilization is called vasectomy. spermatozoon. (gr.) Male sex cell (pl. spermatozoa). A spermatozoon has a length of about 1/600 of an inch, and it consists of a short oval head and a long tail which, by its movements, allows the cell to travel through the vagina into the uterus. Spermatozoa can remain fertile inside a womans body up to several days after ejaculation. spermicide. (lat. sperm killer) Vaginal spermicides are available in different forms, such as jellies, creams, aerosol foams, foaming tablets, and suppositories. They are used for the purpose of contraception , sometimes in combination with a diaphragm or a condom. squeeze technique. A simple manipulation designed to postpone orgasm in males. At the point of highest sexual excitement, but before the point of no return is reached, the glans of the penis just below its rim (corona) is squeezed for a few seconds, ideally by the sexual partner. This stops the excitement for the moment and thus delays orgasm.

157 statutory rape. A legal term referring to cases where a partners consent to engage in sexual intercourse, although clearly expressed, is not lawful. For example, the partner may be too young to consent, or mentally unfit, or drunk or otherwise incapacitated at the time.

sterility. (lat.) Inability to produce offspring. (See infertility)

sterilization. The process of making sterile, i.e. infertile. A form of contraception. Men and women who do not want any (more) children may decide to undergo minor surgery resulting in infertility. Such voluntary sterilization is called vasectomy in the case of men, and tubal ligation in the case of women. Both operations are safe and simple, but irreversible. They effectively end fertility, but do not diminish the sexual capacities.

stop-start technique, also stop and go exercises. Technique or exercises designed to delay orgasm in males. The male masturbates (or is masturbated by his partner) to the point of very high excitement, but then stops before reaching the point of no return. Repeating this exercise often enough will help the male in learning to delay his orgasm.

streetwalker. Slang term for a female street prostitute.

striptease. Taking off ones clothes according to certain traditional stage rules in front of a paying audience. Striptease dancers are women and men who professionally remove their clothing in front of an audience according to certain techniques calculated to create suspense and excitement in the spectator. Such performances take place in theatres (burlesque), as well as in bars and nightclubs. Striptease combines elements of show business with sexual stimulation. It offers performers and spectators an opportunity to express tendencies towards exhibitionism and voyeurism that must be suppressed in every-day life.

sublimation. A psychoanalytic term referring to a highly complex process in which erotic energy is channeled into various non-sexual activities. Among laymen, the concept of sublimation is often misunderstood and misapplied. There is a popular notion that a man could easily control, suppress, or even eliminate his sexual desires by exhausting his strength in physical work, sports, or increased intellectual effort, or by devoting his whole attention to helping others. This is a total misconception. People who act on this erroneous assumption are bound to be disappointed. The term sublimation is out of place where practical educational problems are concerned.

succubus. (lat.) A figure of medieval superstition. The devil or a demon in the form of a woman who, lying under him, offers herself to a man for sexual intercourse. (See also incubus.)

surrogate, sexual. This term is meant to refer to females (in rare cases males) who, under the oversight of a sex therapist, offer their sexual services to his or her clients who do not have regular sexual partners (sex surrogate therapy). This kind of therapy operates on the assumption that some clients with sexual problems need practice, and that, in order to

158 practice, they need cooperative partners. If they do not have partners of their own, the therapist will provide them. Unfortunately, the term surrogate denigrates such a paid volunteer as some substitute for a real or rather ideal, imaginary, hitherto unavailable partner. This is quite unfair. No one should be used as a surrogate or substitute for anyone else who would be more legitimate if only he existed. Everyone, including a surrogate is a real person and real sexual partner in his or her own right. People should not be diminished in their human dignity by semantic tricks. The unfortunate term was, of course, initially coined by therapists in order to avoid the accusation of pandering and pimping or of furthering fornication. However, the usage was always and will remain inherently dishonest. A more objective term would be temporary sexual partner or sexual health care worker. swinger. A slang expression meaning a person who regularly seeks sexual encounters as a form of recreation. In a more formal sense, the term is also used for men and women who participate in a so-called swinger scene, usually clubs or resorts, where couples meet other couples for sexual intercourse. This can mean a simple one-time exchange or sharing of partners, or it can mean various forms of group sex over several hours or even days.

syphilis. (lat. lues). A sexually transmissible disease caused by the small organism treponema pallidum. (Syphilis was originally the title of 16 th -century Latin poem by the Italian scholar Hieronymus Fracastor (1483-1553). This long mythological poem mentions a shepherd named Syphilus who offended the sun god and was punished by him with this disease. The poem not only describes its symptoms, but also gives a somewhat fanciful history of its origin according to the state of knowledge at the time.) Syphilis is almost always contracted through sexual intercourse with an infected partner. Only in extremely rare instances is the disease transmitted through contaminated objects, such as towels or toilet seats. Syphilis can also be transmitted from an infected mother to her unborn child.

T taboo. Originally, a Polynesian word referring to somebody or something that is forbidden or sacred. In the meantime, the word taboo has entered the vocabulary of most modern languages, and today it is usually applied to persons, things, or actions that are considered too dangerous or disturbing to talk or even think about. The violation of a taboo is always punished, either directly and officially by law, or indirectly by a variety of private social sanctions. Every society has its own religious, legal, social, political, and sexual taboos, although their number and character may change in the course of time. However, it is always characteristic of a taboo that no reason or justification for its existence is provided. Indeed, a taboo may very well be defined as an unexplained prohibition. In fact, the demand for an explanation is, in itself, already a violation of the taboo.

taxonomy. (gr.) The art and science of classification, i.e. of dividing things or creatures into classes and groups according to some logical principle.

159 tearoom. Slang for a public urinal (pissoir) where men may have sexual contact with each other.

testicles. (lat.) Male sex glands. Two ovoid bodies contained in the scrotum which produce sex hormones and male sex cells (spermatozoa). A mans testicles correspond in their function to a womans ovaries.

tomboy. A boyish girl, i.e. a girl that looks and/or dresses and/or behaves like a boy of her age (counterpart of sissy. See there) transsexual. A person whose sexual self-identification as male or female contradicts his or her physical sex. A transsexual is a person with a male body who self-identifies as female, or a person with a female body who self-identifies as a male.

transsexualism. (lat. trans: across) Term coined by the German-American physician Harry Benjamin (1885-1986) to describe the condition of some persons who feel trapped in the body of the wrong sex. A person who is physically completely male may nevertheless self-identify as female, and a person who is physically completely female may nevertheless self-identify as male. Resenting their bodies as they are, they may want to undergo a sex change operation , i.e. a series of cosmetic operations resulting in an approximation to the physical appearance of the other sex. In some countries, the individual in question can then apply for an official change from male to female or vice versa in his or her personal identification papers.

transvestism, also transvestitism. Cross-dressing. Habitually wearing the clothes of the other sex, either occasionally or often or always.

transvestite. Term coined by the German physician and sex researcher Magnus Hirschfeld (1868-1935) to describe a cross-dresser: 1. Generally : A person habitually wearing the clothes of the other sex. People may habitually cross-dress for different reasons, for example as female impersonators in travesty shows or as male actresses in classical Japanese and Chinese drama or European opera or Christmas pantomimes. In these cases, cross-dressing does not necessarily have any sexual implications. However, this general usage of the term is less common today. In the narrow sense the term now refers to a special case of cross-dressing: 2. A person habitually wearing the clothes of the other sex for some sexual reason. One of the reasons can be a feeling of great emotional comfort while playing the social role of the other sex, another reason can be a feeling of sexual excitement. In this latter case, one usually speaks of fetishistic cross- dressing. However, it is not always possible to make clear distinctions between the different forms of cross-dressing. In reality, there is a wide spectrum of gradations. Transvestites do not want to be of the other sex; they just want to play ist social role. Most transvestites are male, and their sexual orientation is usually heterosexual. Indeed, many of them are married and have children.

tribadism. (gr. tribein: to rub) Old-fashioned term for female homosexuality. The term was quite common until the end of the 19 th century, when it was replaced by the then

160 newly coined lesbianism. (Actually, this latter term is also quite old, but, until then, had meant oral intercourse. To lesbianize, therefore had meant to lick or suck someones sex organs. However, the original meaning of the word is now completely forgotten.) trichomoniasis . (gr. trichos: hair and monas: unit) Infection of the vagina and/or bladder with the protozoan parasite trichomonas urogenitalis. Sexually transmissible. The symptoms (burning, itching, and a bad-smelling discharge) appear more commonly in women, less often in men.

troilism. Sexual contact among three people. Threesome.

tubal ligation. Female sterilization operation, consisting of the tying and cutting of the Fallopian tubes, thus blocking the passage of the ovum (egg) into the womb. This operation results in the womans infertility, but does not, in any way, diminish the sexual capacities. A tubal ligation is just as safe and effective as vasectomy, but somewhat more complicated to perform. The result should be considered final.

twins. Two children of one mother who are born as a result of the same pregnancy. There are two kinds of twins: those born from one egg (identical or monozygotic twins) and those born from two eggs (fraternal or dizygotic twins). (See zygote.) In the case of identical twins the fertilized egg divides into two separate parts and each of these develops into an embryo. Identical twins are always of the same sex and resemble each other closely. Fraternal twins, on the other hand, may resemble each other no more than other brothers and sisters. Although a womans ovaries usually release only one egg (ovum) during a menstrual cycle, occasionally two or more eggs may be released and fertilized by different spermatozoa. In these cases, the birth of fraternal twins, triplets, quadruplets etc. may result.

U unnatural sex. An old-fashioned term intended to express disapproval of certain sexual practices. Depending on the culture and the historical period in which the term was used, it could refer to anything from simple self-pleasuring (masturbation) to the most unusual forms of fetishism. In other words, the meaning of the term has changed so often that it is impossible to provide an objective, clear, and lasting definition for it. However, this lack of definite meaning has, if anything, made the term even more popular. The underlying psychological mechanism operating here is easily explained: People generally have a tendency to attribute objective value to their subjective tastes and opinions. They are apt to confound their personal concepts of reality with reality itself, and therefore call natural everything that they believe to be right. This kind of argument seems particularly attractive to people who want to protect their privileges or unreasonable policies. Thus at one time monarchy was declared to be the only natural form of government, the institution of slavery was explained as representing the natural order of things, and women were considered to be naturally inferior to men. Although such pseudo- justifications have long been rejected in most social areas, they somehow still seem to work in the sphere of sex. For example, a person who considers procreation as the only

161 justification for sexual activity is unlikely to be content stating this moral conviction but rather will insist that, quite apart from his personal views, it is the nature of sex to result in pregnancy, and that all sexual behavior that cannot lead to that goal is unnatural. This then includes masturbation, homosexual acts, coitus abruptus, and all other forms of contraception. On the other hand, there are people who believe that it is the nature of sex to create a life-long bond of affection between two persons of different sex. Accordingly, even anal and oral intercourse, although neither can result in pregnancy, are considered natural as long as they occur between men and women. However, the same acts occurring between same-sex couples would still be described as unnatural. There are still others who maintain that it is the true nature of sex to provide pleasure and personal contact between people, regardless of sex or age. Consequently, for them everything is natural as long as it is enjoyable. Finally, there are those neutral observers for whom nothing can possibly be unnatural, since everything occurs within nature. For them, pain is just as natural as pleasure, disease just as natural as health, and death just as natural as life. In short, the only unnatural thing is one that does not exist, and the only unnatural act is one that cannot be performed. Obviously, it is only this latter, scientific approach that uses the words natural and unnatural as purely descriptive terms. However, it is equally obvious that, as such, they are practically meaningless. Scientists therefore do not use such terms, but relegate them to the sphere of morals. As this brief summary indicates, the term unnatural is a value judgment, not a statement of any fact or actually existing condition, However, since this value judgment appears, as it were, under a false label, disguised as an objective truth, it can easily lead to confusion and is, therefore, unsuitable for any rational discussion. (See also aberration, deviation, crime against nature, perversion.) ureter. (gr.) One of the two ducts through which urine is released from the kidneys to the urinary bladder. urethra. (gr.) Urinary duct. The duct through which urine is released from the urinary bladder to the outside. In males, the urethra also serves for the ejaculation of semen, and, beginning at the bladder, it runs through the penis, ending at the tip of the glans. In females, the external opening of the urethra lies between the clitoris and the opening of the vagina, and it serves exclusively for the release of urine. urolagnia, also urophilia. (gr.) The capacity, habit, inclination, or preference of deriving sexual pleasure from urine. A form of fetishism. This may express itself in many different forms, such as the drinking of urine, watching someone urinate, urinating on the partner or being urinated on, etc.

uterus. A hollow muscular organ inside the female body, situated at the upper end of the vagina, between the bladder and the rectum. In size and shape the uterus resembles a small pear which is turned upside-down. The upper part of the uterus is connected with the Fallopian tubes, through which the ovum enters after ovulation. The neck of the uterus, which is called cervix, opens towards the vagina, from which the spermatozoa enter after ejaculation from the penis during coitus. In the case of a conception, the fertilized ovum develops into an embryo and then into a fetus inside the uterus until, at the end of the pregnancy, it is expelled through the vagina during birth.

162 V vagina. (lat.: sheath) One of the internal female sex organs. The vagina is a muscular tube which extends from the vulva to the uterus. The external opening of the vagina, which is below that of the urethra, is covered by the inner lips (labia minora) and, in the young female, it may be partly closed by the hymen. The vagina serves three main functions: the release of the menstrual flow, the reception of the penis during coitus, and the delivery of the baby during birth. The walls of the vagina are lubricated by secretions which are slightly acid and which serve as a protection against certain infections. (Vaginal douches are unnecessary and may be harmful.) The vaginal secretions increase during sexual excitement, thus facilitating the insertion of the penis for the purpose of coitus. During coitus, the walls of the vagina, which are very elastic, keep close contact with the penis, and the coital friction may eventually leads to orgasm and to the ejaculation of sperm cells, which subsequently move from the vagina into the uterus. A woman can also learn to control her vaginal muscles. For the delivery of a child, the vagina expands considerably. After the birth, it shrinks back to its normal size. vaginismus. Involuntary muscular spasm which closes the vagina, making the insertion of a penis impossible. Vaginismus can occur as a result of sexual fear and apprehension or because previous intercourse was painful. Women suffering from vaginismus can usually be helped by professional treatment. Occasionally one can encounter rumors that such vaginal cramps occurred not before, but during coitus, thus trapping the penis and requiring the help of a physician for the separation of sexual partners. Such rumors are usually based on fantasies and exaggerations, although vaginal cramps after insemination can be observed in certain animals, such as cats and dogs. vasectomy. (lat. vas: vessel and gr. ektome: to cut out) Cutting or surgical closing of the spermatic ducts. Male sterilization operation. The operation consists of the closing of the two small tubes on each side of the scrotum - the vasa deferentia - which carry the sperm cells. This closing of the spermatic ducts makes a man infertile, although he retains his sexual capacity. The result should be considered final. Continuing research is improving the surgical techniques for a reversal of the operation, but its success cannot be guaranteed. Vasectomy is a minor operation, and is usually performed in the doctors office under local anesthesia. Voluntary sterilization is 100 percent effective as a method of contraception. (See also tubal ligation.) venereal disease. (Literally: Disease attributed to Venus.) Old-fashioned euphemism for sexually transmissible disease (see there). vestibular glands. Bartholins glands. Two small glands on each side of the vaginal opening. They correspond to the two Cowpers glands in the male and, like these, also secrete a small amount of lubricating fluid in response to sexual stimulation. However, most of the lubrication necessary for coitus is not provided by these glands, but by the vaginal walls.

163 victimless crime. An unlawful act committed by consenting adults that is not designed to harm anyone. As a result, there are no victims, and none of the participants has an interest in reporting the act to the police or to help any authority in discovering it. Example: Oral intercourse between husband and wife in a US state where it is punishable as a crime.

virgin. virginity. A young female who has not had vaginal intercourse and her physical condition. Traditionally, patriarchal societies insisted on every female entering marriage sexually untouched, i. e .inexperienced. In practical terms, this meant that her hymen had to be intact, i.e. it was to be torn only by the new husband beginning coitus during the wedding night or shortly thereafter. As proof of the brides virginity, a blood-stained bed sheet was often proudly displayed outside the window. However, in our modern societies this custom and the assumptions behind it have become obsolete. A girls hymen may very well be torn many years before marriage, for example by inserting a menstrual tampon, by some vigorous sports exercises, or by inserting a finger or vibrator for self- pleasuring. Moreover, even having an intact hymen does not necessarily prove sexual inexperience. Indeed, the girl may have extensive experience with manual, oral, and anal intercourse, avoiding only coitus. (In the 19th century, such girls used to be called demi vierges, i.e. half virgins.) Therefore, given the sexual behavior of many modern female teenagers, it is quite unclear what the terms virgin and virginity can now possibly mean. Furthermore, everyone is now aware that the term virgin is meaningless when applied to males and has, in fact, never been applied to them except in some joking and metaphoric fashion (self-pleasuring, group masturbation, homosexual contacts, and heavy heterosexual petting being ignored). Thus, the term also carries all the implications of the infamous sexual double standard of days gone by. In modern sexology there is no choice but to be objective and to state exactly what one is talking about virility. (lat. vir: man) Manliness. A term sometimes used instead of either masculinity or male sexual prowess. virilization . The appearance of secondary male characteristics. Welcome in young males, unwelcome in females, where it may indicate a hormonal problem requiring medical attention. voyeur. (fr . voir: to see) 1. Generally: A person who enjoys watching people taking their clothes off, masturbating, or having sexual intercourse (see also peeping Tom). 2. Specifically: A person, usually a male, who, for his own sexual arousal and satisfaction, depends on such watching of others. This dependency is called voyeurism. vulva . (lat. covering) General term for the external female sex organs consisting of the outer lips (labia majora), the inner lips (labia minora), the clitoris and the openings of vagina and urethra (the duct through which the urine is released to the outside).

164 W wet dream. A slang expression for the orgasm of a sexually mature male during sleep. Occasionally, men may involuntarily experience orgasm and an ejaculation of semen in their sleep.

whore. A female prostitute.

witchs milk. Colloquial term for a milklike substance temporarily secreted from the breasts of newborns. The phenomenon is caused by some remaining maternal lactating hormones.

withdrawal method. See coitus abruptus.

womens liberation. A radical social movement devoted to the emancipation of women.

X

X chromosome . (gr. soma: body) The female sex chromosome.

Y yang. In ancient Chinese philosophy the male principle in nature.

Y chromosome. (gr. soma: body) The male sex chromosome. yin. In ancient Chinese philosophy the female principle in nature.

yohimbine. A substance derived form the bark of the West African yohimbine tree (pausinystalia yohimba). It is believed to act as an aphrodisiac, but definite scientific proof of this is still lacking.

yoni. (sanskrit) In Indian mythology the symbol of the female principle. Usually represented in sculptural form as the female sex organ. Corresponds to the male symbol lingam.

Z

zoophilia . (gr. love of animals) 1. Human sexual intercourse with animals. 2. A preference for sexual contact with animals.

zygote. A cell resulting from the union of two reproductive cells. In human reproduction: an egg that has been fertilized by a sperm cell.

zystitis. Infection of the urinary bladder. (Haeberles Archive for Sexology, n.d.)

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