10.3 The Birds and the Bees

THE MAKING OF A SEXPERT

Dr. Stephanie Buehler grew up in California’s San Fernando Valley during the 1970s, when the sexual revolution was in full gear. During this time in American history, many people questioned conventional notions about sex and explored different avenues of sexual expression. “There was a lot of sexual activity at that time,” explains Dr. Buehler, who had many gay, bisexual, and transgender friends. “I was really exposed to a lot of different aspects of sexuality.” At home, she knew it was okay to ask her parents questions about sex and birth control. So, it was no big deal when Stephanie’s family went with her to see the avant-garde and sexually explicit movie Last Tango in Paris (which received an X rating at the time of its release, and currently has an NC-17 rating).

Therapist at Work Dr. Buehler found sex therapy so rewarding that she established her own sex therapy practice: The Buehler Institute, in Newport Beach, California. In addition to meeting with clients, Dr. Buehler is a peer reviewer for The Journal of Sexual Medicine and the author of a new book, What Every Mental Health Professional Needs to Know about Sex.

Mark Buehler

With this upbringing, Dr. Buehler was fairly relaxed talking about sex, and therefore her pursuit of a career as a sex therapist would seem like a plausible path. But graduate school looked like a long shot for a girl growing up in the 1970s, when women were just beginning to establish themselves as a major presence in the workforce. After graduating from college, the first person in her immediate family to do so, she became a teacher at an inner-city elementary school, and then decided to pursue a master’s degree and eventually a doctorate in psychology. Her PsyD concentration was family therapy, but another interest was brewing beneath the surface. During couples’ role-playing sessions in class, Dr. Buehler always was the student asking questions about sex: “What about your sex life?” “What’s going on in the bedroom?” She recalls her classmates looking at her and asking, “Why are you bringing that up? What does that have to do with anything?” The answer, she can now state with confidence, is a whole lot.

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Dr. Buehler: Which gender visits your office more frequently?

After working as a licensed psychotherapist for several years, Dr. Buehler began her sex therapy training. She found it so rewarding that she launched her own sex therapy institute, The Buehler Institute in Newport Beach, California. “I just find I’m never, ever bored with my work,” says Dr. Buehler. Sexuality is quite personal…and that means that everybody is quite different.

Everything You Always Wanted to Know About Sex

When you think of sex, what comes to mind? Genitals? Intercourse? To grasp the complexity of sexual experiences, we must understand the basic physiology of the sexual response. Enter William Masters and Virginia Johnson and their pioneering laboratory research, which included the study of approximately 10,000 distinct sexual responses of 312 male and 382 female participants (Masters & Johnson, 1966).

Sexy Science In the mid-1950s, William Masters teamed with Virginia Johnson to study the bodily changes occurring during masturbation and sex. Their research was groundbreaking, and it upended many long-held misconceptions about sex. For example, Masters and Johnson found that the length of a man’s penis does not determine his ability to give pleasure (Fox, 2013, July 25).

© Bettmann/CORBIS

Masters and Johnson made some of the most important contributions to the study of the human sexual response. Their research started in 1954, not exactly a time when sex was thought to be an acceptable subject for dinner conversation. Nevertheless, almost 700 people volunteered to participate in their study, which lasted a little more than a decade (Masters & Johnson, 1966). In particular, Masters and Johnson were interested in determining the physiological responses that occurred during sexual activity, such as masturbation and intercourse. They used a variety of instruments to measure blood flow, body temperature, muscular changes, and heart rate. What they discovered is that most people experience a similar physiological sexual response, which can result from oral stimulation, manual stimulation, vaginal intercourse, or masturbation. Men and women tend to follow a similar pattern or cycle: excitement, plateau, orgasm, and resolution (Figure 10.2). It is important to note, though, that these phases vary for each individual in terms of duration.

FIGURE 10.2Masters and Johnson’s Human Sexual Response CycleIn the male sexual response (left), excitement is typically followed by a brief plateau, orgasm, and then a refractory period during which another orgasm is not possible. In the female sexual response (right), there is no refractory period. Orgasm is typically followed by resolution (A) or, if sexual stimulation continues, additional orgasms (B).

Sexual arousal begins during the excitement phase. This is when physical changes start to become evident. Muscles tense, the heartbeat quickens, breathing accelerates, the nipples become firm, and blood pressure rises a bit. In men, the penis becomes erect, the scrotum constricts, and the testes pull up toward the body. In women, the vagina lubricates and the clitoris swells (Levin, 2008).

Many factors can dampen the sexual excitement of this phase, among them unhappy babies and ringing phones. But would you guess that a woman’s tears can ruin the moment?

Assuming no tears are shed during the excitement phase, the next likely step is the plateau phase. There are no clear physiological signs to mark the beginning of this phase, but it is the natural progression from the excitement phase. During the plateau phase, the muscles continue to tense, breathing and heart rate increase, and the genitals begin to change color as blood fills this area. This phase is usually quite short-lived, lasting only a few seconds to minutes.

The shortest phase of the sexual response cycle is the orgasm phase. As the peak of sexual response is reached, an orgasm occurs, which is a powerful combination of extremely gratifying sensations and a series of rhythmic muscular contractions. When men and women are asked to describe their orgasmic experiences, it is very difficult to differentiate between them. Brain activity observed via PET scans is also very similar (Georgiadis, Reinders, Paans, Renken, & Kortekaas, 2009; Mah & Binik, 2001).

The final phase of the sexual response cycle, according to Masters and Johnson, is called the resolution phase. This is when bodies return to a relaxed state. Without further sexual arousal, the body will immediately begin the resolution phase. The blood flows out of the genitals, and blood pressure, heart rate, and breathing slow to normal. Men lose their erection, the testes move down, and the skin of the scrotum loosens. Men will also experience a refractory period, an interval during which they cannot attain another orgasm. This can last from minutes to hours, and typically the older the man is, the longer the refractory period lasts. For women, the resolution phase is characterized by a decrease in clitoral swelling and a return to the normal labia color. Women do not experience a refractory period, and if sexual stimulation continues, some are capable of having multiple orgasms.

Masters and Johnson’s landmark research has led to further studies of the physiological aspects of the sexual response cycle, and although their basic model is viewed as valid, research suggests there may be the need for “correction or modification, or additional explanation” (Levin, 2008, p. 2). As mentioned, sex is different for every person, and not everyone fits neatly into the same model.

Armed with this knowledge about the physiology of sex, let’s move on to its underlying psychology. How are sexual activities shaped by learning, relationships, and the need to be loved and belong?

Sexual Orientation

According to the American Psychological Association (APA, 2008), sexual orientation is the “enduring pattern” of sexual, romantic, and emotional attraction that individuals exhibit toward the same sex, opposite sex, or both sexes. When attracted to members of the opposite sex, sexual orientation is heterosexual. When attracted to members of the same sex, sexual orientation is homosexual. When attracted to members of the same sex and members of the opposite sex, sexual orientation is bisexual, although most people tend to prefer one sex or the other. Those who do not feel sexually attracted to others are referred to as asexual. Lack of interest in sex does not necessarily prevent a person from maintaining relationships with spouses, partners, or friends, but little is known about the impact of asexuality because research on the topic is scarce. We can’t be sure how many people would consider themselves asexual, but by one estimate, they constitute 1% of the population (Crooks & Baur, 2014). Dr. Buehler’s mentor once explained sexual orientation like this: There is a universe of orientations and identities, and each person gets to put him- or herself in the constellation.

There is also a universe of labels for different sexual orientations. In America, the most common terminology refers to a homosexual woman as a “lesbian,” and a homosexual man as “gay” (APA, 2008). But sexual orientation is not a trait or characteristic one possesses. It is a label that reflects the relationships someone establishes and the qualities of those relationships, including degree of intimacy, mutual goals, commitment, and affection. We essentially become members of the group with which we have the most in common and in which we are the most comfortable, thus allowing us to build satisfying romantic relationships.

What percentage of the population is heterosexual? How about homosexual and bisexual? These questions may seem straightforward, but they are not easy to answer. This is partly because there are no clear-cut criteria for identifying individuals as homosexual, heterosexual, or bisexual. In other words, there is a vast spectrum representing sexual orientation. At one end are people who are “exclusively heterosexual” and at the other end are those considered “exclusively homosexual.” Between these two poles is considerable variation (Kinsey, Pomeroy, & Martin, 1948; Figure 10.3). Some people might be exploring their sexuality, but not necessarily exhibiting a particular orientation, and this adds to the variability of rates. Estimates are available, but definitions of sexual orientation vary across cultures, and findings can be inconsistent as a result of differing survey designs: data collection in different years, the use of different age groups, different wording of questions, and so forth (Mosher, Chandra, & Jones, 2005). According to one estimate, 8 million people in the United States, or 3.5% of the adult population, are homosexual or bisexual (Gates, 2011).

FIGURE 10.3The Kinsey Sexuality Rating ScaleWhen interviewing people for a study on human sexuality, Alfred Kinsey and his colleagues (1948) discovered that people were not always exclusively heterosexual or homosexual. Instead, some described thoughts and behaviors that put them somewhere in between. This finding led the Kinsey team to develop the scale here, which shows a range associated with sexual orientation.

Reprinted by permission of the Kinsey Institute for Research in Sex, Gender, and Reproduction, Inc.

Other estimates suggest the homosexual population is as low as 1% (referring only to same-sex behavior) and as high as 24% (defined as any sexual attraction to the same sex). This high end refers specifically to young women, who show greater fluidity in their sexual attractions and orientations (Ainsworth & Baumeister, 2012; Savin-Williams, 2009). As you digest these statistics, remember that sex is, first and foremost, a human experience. We may have different preferences, but our bodies react to sexual activity in similar ways. As Masters and Johnson (1979) demonstrated, we all experience a similar sexual response cycle, regardless of orientation. Even our brains display similar patterns of activity, apparent from fMRI and PET studies, when we feel sexual desire (Diamond & Dickenson, 2012). What makes us different is what we find sexually arousing (Cerny & Janssen, 2011).

How Sexual Orientation Develops

We are not sure how sexual orientation develops, although most research supports biological factors (a topic we will revisit in a little while). Among professionals in the field, there is near agreement that human sexual orientation is not a matter of choice. Research has focused on everything from genetics to culture, but there is no strong evidence that sexual orientation is determined by one particular factor (or set of factors). Instead, it appears to result from an interaction between nature and nurture, but this is still under investigation, and may never be fully determined or understood (APA, 2008).

To determine the influence of biology in sexual orientation, we turn to twin studies, which are commonly used to examine the degree to which nature and nurture contribute to psychological traits. Since monozygotic twins share 100% of their genetic make-up, we expect them to share more genetically influenced characteristics than dizygotic twins, who only share about 50% of their genes. In a large study of Swedish twins, researchers explored the impact of genes and environment on “same-sex sexual behavior” (2,320 monozygotic twin pairs, 1,506 dizygotic twin pairs). In their sample, the monozygotic twins were moderately more likely than the dizygotic twins to have the same sexual orientation. They also found that same-sex sexual behavior for monozygotic twins had heritability estimates around 34–39% for men, and 18–19% for women (Långström, Rahman, Carlström, & Lichtenstein, 2010). These findings highlight two important factors: Men and women differ in terms of the heritability of same-sex sexual behavior, and the influence of the environment is substantial.

Researchers have searched for specific genes that might influence sexual orientation. Some have suggested that genes associated with male homosexuality might be transmitted by the mother. In one key study, around 64% of male siblings who were both homosexual had a set of several hundred genes in common, and these genes were located on the X chromosome (Hamer, Hu, Magnuson, Hu, & Pattatucci, 1993). But critics suggest this research was flawed, and no replications of this “gay gene” have been published since the original study (O’Riordan, 2012).

Researchers have also studied the brains of people with different sexual orientations, and their findings are interesting. LeVay (1991) discovered that a “small group of neurons” in the hypothalamus of homosexual men was almost twice as big as that found in heterosexual men. He did not suggest this size difference was indicative of homosexuality, but he did find it intriguing. LeVay also noted that these differences could have been the result of factors unrelated to sexual orientation. More recently, researchers using MRI technology found the corpus callosum to be thicker in homosexual men (Witelson et al., 2008). With the help of MRI and PET, some researchers are studying the neurobiological foundations of sexual orientation, trying to determine if there are similarities in functioning and connectivity between those attracted to women (homosexual women and heterosexual men), as well as between those attracted to men (homosexual men and heterosexual women) (Savic & Lindström, 2008).

How do differences arise in the brain? They may emerge before birth. As we noted earlier, hormones (estrogen and androgens) secreted by the fetal gonads play a role in the development of reproductive anatomy. One hypothesis is that the presence of androgens (the hormones secreted primarily by the male gonads) influences the development of a sexual orientation toward women. This would lead to heterosexual orientation in men, but homosexual orientation in women (Mustanski, Chivers, & Bailey, 2002). Because it would be unethical to manipulate hormone levels in pregnant women, researchers rely on cases in which hormones are elevated because of a genetic abnormality or medication taken by a mother. For example, high levels of androgens early in a pregnancy may cause girls to be more “male-typed,” and promote the development of a homosexual orientation (Berenbaum, Blakemore, & Beltz, 2011; Jordan-Young, 2012).

Interestingly, having older brothers in the family seems to be associated with homosexuality in men, particularly in right-handed men (Blanchard, 2008; Figure 10.4). Why would this be? Evolutionary theory would suggest that the more males there are in a family, the more potential for “unproductive competition” among the male siblings. If sons born later in the birth order were less aggressive, the result would be fewer problems among siblings, especially related to competition for mates and resources to support offspring. A homosexual younger brother would be less of a threat to an older brother than would a heterosexual younger brother.

FIGURE 10.4How Many Older Brothers?The number of older brothers a man has seems to be associated with the probability of his homosexuality. Interestingly, this link has been found to be more prominent among right-handed men.

Source: Reproduced/Adapted with permission of Psychology Press/Taylor & Francis Ltd (informaworld.com) from Blanchard (2008).

How does right-handedness play a role? Researchers suggest that handedness might be related to the production of an anti-male antibody produced by the mother during pregnancy: “Some mothers may eventually become ‘immunized’ to a factor or substance important in male fetal development” (Bogaert, 2007, p. 141). The maternal immune hypothesis suggests that mothers develop an antibody that crosses the placenta and affects the development of the brain structures influencing sexual orientation (for example, the hypothalamus). Although subsequent research has supported the birth order effect, the handedness link has been more difficult to replicate (Bogaert, 2007). And, despite numerous attempts to identify genetic markers for homosexuality, researchers have had very little success (Dar-Nimrod & Heine, 2011). Some suggest that the search for genes underlying homosexuality is misguided. Why do we spend so much time and money seeking biological explanations for a “valid alternative lifestyle” (Jacobs, 2012)?

Bride and Bride Ellen DeGeneres and Portia de Rossi pose for wedding photos at their Beverly Hills home in 2008. DeGeneres and de Rossi are perhaps the most famous lesbian couple to marry, and their union has called attention to the ongoing debate on gay marriage. According to a recent survey, 58% of Americans support same-sex marriage, a significant increase from 37% in 2003 (Neary, 2013, March 25; Cohen, 2013, March 18).

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Although differences in sexual orientation are universal and have been evident throughout recorded history, individuals identified as members of the nonheterosexual minority have been subjected to stereotyping, prejudice, and discrimination. Nonheterosexual people in the United States, for example, have been, and continue to be, subjected to harassment, violence, and unfair practices related to housing and employment.

Counter to some stereotypes, a homosexual or bisexual orientation does not serve as a barrier to maintaining long-lasting relationships. Most same-sex couples experience the same ups and downs as heterosexual couples. When San Francisco’s Mayor Gavin Newsom sanctioned same-sex marriages in the city in 2004, a number of long-partnered same-sex couples were finally able to legalize their relationships. Among those marrying long-time partners was Ronnie Gilbert, the female singer in The Weavers (famous for their song “Goodnight, Irene”), now in her eighties.

What is the purpose of sex? Evolutionary psychology would suggest that humans have sex to make babies and ensure the survival of the species (Buss, 1995). But if this were the only reason, then why would so many people choose same-sex partners? Some researchers believe it has something to do with “kin altruism,” which suggests that homosexual men and women support reproduction in the family by helping relatives care for their children. Homosexual individuals may not “spend their time reproducing,” but they can nurture the reproductive efforts of their “kin” (Erickson-Schroth, 2010).

There are other reasons to believe that there is more to human sex than making babies. If sex were purely for reproduction, we would expect to see sexual activity occurring only during the fertile period of the female cycle. Obviously, this is not the case. People have sex throughout a woman’s monthly cycle and long after she goes through menopause. Sex is for feeling pleasure, expressing affection, and forming social bonds. In this respect, we are different from other members of the animal kingdom, who generally mate to procreate. There is at least one notable exception, however. If you could venture deep into the forests of the Democratic Republic of Congo, you might be surprised at what you would see happening between our close primate cousins, the bonobos.

Sex Conquers All? Two bonobos enjoy a slobbery kiss. In bonobo society, sexual activity appears to reduce social tension and promote unity—a strategy that seems to work very well, because bonobos rarely fight. Females are the dominant sex, and the bonds between them hold communities together (Santa Maria, 2012, February 14).

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The Sex We Have

Thus far we have discussed sex in broad terms, but let’s get into some specifics. Have you ever wondered how common it is to masturbate or think about sex? Do you sometimes wonder how many married people remain faithful to their spouses? You have come to the right chapter.

Alfred Kinsey and colleagues (1948, 1953) were among the first to try to scientifically and objectively examine human sexuality in America. Using the survey method, Kinsey and his team collected data on the sexual behaviors of 5,300 White males and 5,940 White females. Their findings were surprising; both men and women masturbated, and participants had experiences with premarital sex, adultery, and sexual activity with someone of the same sex. Perhaps more shocking was the fact that so many people were willing to talk about their personal sexual behavior in post–World War II America. At that time, people generally did not talk openly about sexual topics.

Radical Research Alfred Kinsey meets with an interview subject in his office at the Institute for Sex Research, now The Kinsey Institute. Kinsey began investigating human sexuality in the 1930s, when talking about sex was taboo. He started gathering data with surveys, but then switched to personal interviews, which he believed to be more effective. These interviews often went on for hours and included hundreds of questions (PBS, 2005, January 27).

Wallace Kirkland//Time Life Pictures/Getty Images

The Kinsey study was groundbreaking in terms of its data content and methodology, which included accuracy checks and assurances of confidentiality. The Kinsey data have served as a valuable reference for researchers studying how sexual behaviors have evolved over time. However, Kinsey’s work was not without limitations. For example, Kinsey and colleagues (1948, 1953) utilized a biased sampling technique that resulted in a sample that was not representative of the population. It was a completely White sample, with an overrepresentation of well-educated Protestants (Potter, 2006; Wallin, 1949). Another criticism of the Kinsey study is that it failed to determine the context in which orgasms occurred. Was a partner involved? Was the orgasm achieved through masturbation (Potter, 2006)?

Subsequent research has been better designed, including samples more representative of the population. Robert Michael and colleagues (1994) conducted the now-classic National Health and Social Life Survey (NHSLS), which examined the sexual activities of a representative sample of some 3,000 Americans between the ages of 18 and 59. A more recent study included a sample of approximately 5,800 men and women between the ages of 14 and 94 years (Herbenick et al., 2010). Some of the findings from these studies are presented below. For more information on sexual activities worldwide, take a look at the Across the World feature.

In the United States, the average age at first marriage is 26 for women and 28 for men. The odds of a first marriage lasting at least 10 years is 68% for women and 70% for men, and the probability of a first marriage lasting 20 years is only 52% for women and 56% for men (Copen, Daniels, Vespa, & Mosher, 2012). Most Americans are monogamous (one partner at a time), and 65–85% of married men and approximately 80% of married women report that they have always been faithful to their spouses (Laumann, Gagnon, Michael, & Michaels, 1994). Although monogamy is preferred in the United States, infidelity within marriages is as high as 76%. In a recent study, 4–5% of the participants reported they are in “open” relationships, that is, consensually nonmonogamous relationships (Conley, Ziegler, Moors, Matsick, & Valentine, 2013).

Around 77% of adults in the United States report they engaged in intercourse by age 20, regardless of cultural background or ethnicity. By the age of 44, 95% of adults have had intercourse. And the overwhelming majority are not waiting for marriage (Finer, 2007; see Figure 10.5.) However, married people do have more sex than those who are unmarried (Laumann et al., 1994). According to a large study of Swedish adults, the frequency of penile–vaginal intercourse is associated with sexual satisfaction, as well as satisfaction with relationships, mental health, and life in general. Other sexual activities, such as masturbation, were found to have an inverse relationship with a variety of measures of satisfaction (Brody & Costa, 2009; see TABLE 10.2 for reported gender differences in frequency of sexual activity). Many studies indicate not only psychological benefits, but also physiological benefits to penile–vaginal intercourse. Correlations are apparent between the frequency of penile–vaginal intercourse and greater life expectancy, lower blood pressure, slimmer waistline, and less prostate and breast cancer risk (Brody, 2010).

FIGURE 10.5Premarital Sex in the United StatesLooking across adolescence and into adulthood, the number of people having sex increases steadily with age. Of those currently having sex, 97% engaged in sex before marriage.

Source: Adapted from Finer (2007), Figure 1.

As stereotypes might suggest, men think about sex more often than women. In the United States, 54% of men report thinking about sex “every day or several times a day”; 67% of women report thinking about sex only “a few times a week or a few times a month” (Laumann et al., 1994). One other notable gender difference is that men consistently report a higher frequency of masturbation (Peplau, 2003), a finding that has been replicated with a British sample (Gerressu, Mercer, Graham, Wellings, & Johnson, 2008). Men in the United States tend to be more tolerant than women when it comes to casual sex before marriage, as well as more permissive in their attitudes about extramarital sex (Laumann et al., 1994). But these attitude differences are not apparent in heterosexual teenagers and young adults, as young men and women more commonly engage in hookups, or “brief uncommitted sexual encounters among individuals who are not romantic partners or dating each other” (Garcia, Reiber, Massey, & Merriwether, 2012, p. 161). For these young people, attitudes about casual sex are apparent in their “hookup” behavior (TABLE 10.3).

What sexual encounters do people commonly have? Herbenick and colleagues (2010) used a cross-sectional survey study to provide a snapshot of the types and rates of sexual behaviors across a wide range of ages in the United States. They found that masturbation is more common than partnered sexual activities among adolescents and people over the age of 70. They also discovered that more than half of the participants aged 18 to 49 had engaged in oral sex in the past year, with a lower proportion of the younger and older age groups engaging in this activity. Penetrative sex (vaginal and anal) was most common among adults ages 20 to 49. In another study of around 3,000 adults (57 to 85 years old), researchers reported that aging did not seem to adversely affect interest in sexual activity; many of the respondents in their sixties, seventies, and eighties were still sexually active. In fact, through the age of 74, the frequency of sexual activity remained steady, even with a high proportion of “bothersome sexual problems.” Physical health problems can affect sexual activity at any age (Lindau et al., 2007).

across the WORLD

What They Are Doing in Bed…or Elsewhere

How often do people in New Zealand have sex? How many lovers has the average Israeli had? And are Chileans happy with the amount of love-making they do? These are just a few of the questions answered by the Global Sex Survey (2005), which, we dare to say, is one of the sexiest scientific studies out there (and which was sponsored by Durex, a condom manufacturer). We cannot report all the survey results, but here is a roundup of those we found most interesting:

PEOPLE IN GREECE ARE HAVING THE MOST SEX.

• People in Greece have the most sex—an average of 138 times per year, or 2 to 3 times per week.
• People in Japan have the least amount of sex—an average of 45 times per year, or a little less than once per week.

Happy Between the Sheets Nearly half (44%) of adults participating in the Global Sex Survey said they were happy with their sex lives. Men were more likely than women to say they wanted to have sex more often (Global Sex Survey, 2005).

© John Lund/Blend Images/Corbis

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• The average age for losing one’s virginity is lowest among Icelanders (between 15 and 16) and highest for those from India (between 19 and 20).
• Across nations, the average number of sexual partners is 9. If gender is taken into account, that number is a little higher for men (11) and lower for women (7).
• Of respondents, 50% reported having sex in cars, 39% in bathrooms, and 2% in airplanes.
• Across the world, many people use sexual aids such as pornography (41%), massage oils and creams (31%), lubricants (30%), and vibrators (22%).
• Approximately 13% of adults say they have had a sexually transmitted infection.
• Nearly half the people around the world are happy with their sex lives.

As you reflect on these results, remember that surveys have limitations. People are not always honest when it comes to answering questions about personal issues (like sex), and the wording of questions can influence people’s responses. Even if responses are accurate, we can only speculate about the beliefs and attitudes under-lying them.

Contemporary Trends in Sexual Behavior

As noted earlier, we can define sex as an activity (for example, she had sex), but how we define what constitutes sex is not always consistent (Schwarz, Hassebrauck, & Dörfler, 2010). If you ask one teenager whether she has had “sex,” she might say no, even if she has had oral sex, whereas another teen might say yes, thinking that oral sex does count as sex. Such variability may explain why teenagers are more likely to participate in oral sex than intercourse, and to have more oral sex partners because they are not defining it as sex (Prinstein, Meade, & Cohen, 2003).

If oral sex doesn’t qualify as “sex,” as some teenagers believe, then it doesn’t pose a health risk…right? Wrong. Many diseases can be transmitted through oral sex, among them HIV, herpes, syphilis, genital warts, and hepatitis (Saini, Saini, & Sharma, 2010). Needless to say, it is crucial for teen-targeted sex education programs to spread the word about the risks associated with oral sex (Brewster & Tillman, 2008).

THINK again

Sext You Later

Sext Offender Sending sexually explicit text messages, or “sexting,” has become increasingly popular among young people. Although it may seem casual and fun, sexting can have serious repercussions. When 18-year-old Phillip Alpert texted a naked photo of his 16-year-old girlfriend, police arrested him for distributing child pornography. He was then assigned 5 years of probation and required to register as a sex offender (Feyerick & Steffen, 2009, April 8).

Ricardo Ramirez Buxeda/Orlando Sentinel/MCT/Getty Images

What kinds of environmental factors do you think encourage casual attitudes about sex among teens? Most adolescents have cell phones these days (77%, according to one survey; Lenhart, 2012) and a large number of those young people are using their phones to exchange text messages with sexually explicit words or images. In other words, today’s teenagers are doing a lot of sexting. One study found that 20% of high school students have used their cell phones to share sexual pictures of themselves, and twice as many have received such images from others (Strassberg, McKinnon, Sustaíta, & Rullo, 2013). Teens who sext are more likely to have sex and take sexual risks, such as having unprotected sex (Rice et al., 2012).

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Sexting carries another set of risks for those who are married or in committed relationships. As many people see it, sexting outside a relationship is a genuine form of cheating. And because text messages can be saved and forwarded, it becomes an easy and effective way to damage the reputations of people, sometimes famous ones. Perhaps you have read about the sexting scandals associated with golfer Tiger Woods, ex-footballer Brett Favre, and former U.S. Congressman Anthony Weiner?

ARE TEENS WHO SEXT MORE LIKELY TO HAVE SEX?

Now that’s a lot of bad news about sexting. But can it also occur in the absence of negative behaviors and outcomes? When sexting is between two consenting, or shall we say “consexting,” adults, it may be completely harmless (provided no infidelity is involved). According to one survey of young adults, sexting was not linked to unsafe sex or psychological problems such as depression and low self-esteem (Gordon-Messer, Bauermeister, Grodzinski, & Zimmerman, 2013). For some, sexting is just a new variation on flirting; for others, it may fulfill a deeper need, like helping them feel more secure in their romantic attachments (Weisskirch & Delevi, 2011).

One way to learn about this relatively new phenomenon of sexting—or any sexual topic, for that matter—is through sex education in the classroom. School is the primary place where American children get information about sex (Byers, 2011), yet it is somewhat controversial. Many parents are afraid that some types of sex education essentially condone sexual activity among young people. Until 2010, Title V federal funding was limited to states that taught abstinence only (Chin et al., 2012). Yet, research suggests that programs promoting abstinence are associated with more teenage pregnancies: States with a greater emphasis on abstinence (as reflected in state laws and policies) have higher teenage pregnancy and birth rates (Stanger-Hall & Hall, 2011).

Teenagers who are provided a thorough education on sexual activity, including information on how to prevent pregnancy, are less likely to become pregnant (or get someone pregnant). Research shows that formal sex education increases safe-sex practices, reducing the likelihood of disease transmission (Kohler, Manhart, & Lafferty, 2008; Stanger-Hall & Hall, 2011). Sex education clearly impacts the behaviors of teenagers and young adults. In some European nations, “openness” and “comfort” about sex lead to an understanding that sexuality is “a lifelong process.” Sex education programs in these countries aim “to create self-determined and responsible attitudes and behavior with regard to sexuality, contraception, relationships and life strategies and planning” (Advocates for Youth, 2009; Stanger-Hall & Hall, 2011, p. 9).