Showing papers in "Archives of Sexual Behavior in 2010"

Hypersexual Disorder: A Proposed Diagnosis for DSM-V

Abstract: Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic “excesses” of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.

Agreement of Self-Reported and Genital Measures of Sexual Arousal in Men and Women: A Meta-Analysis

Abstract: The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = 66) showing a greater degree of agreement than women (r = 26) Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response

“Hooking Up” Among College Students: Demographic and Psychosocial Correlates

Abstract: This study investigated 832 college students’ experiences with hooking up, a term that refers to a range of physically intimate behavior (e.g., passionate kissing, oral sex, and intercourse) that occurs outside of a committed relationship. Specifically, we examined how five demographic variables (sex, ethnicity, parental income, parental divorce, and religiosity) and six psychosocial factors (e.g., attachment styles, alcohol use, psychological well-being, attitudes about hooking up, and perceptions of the family environment) related to whether individuals had hooked up in the past year. Results showed that similar proportions of men and women had hooked up but students of color were less likely to hook up than Caucasian students. More alcohol use, more favorable attitudes toward hooking up, and higher parental income were associated with a higher likelihood of having hooked up at least once in the past year. Positive, ambivalent, and negative emotional reactions to the hooking up experience(s) were also examined. Women were less likely to report that hooking up was a positive emotional experience than men. Young adults who reported negative and ambivalent emotional reactions to hooking up also reported lower psychological well-being and less favorable attitudes toward hooking up as compared to students who reported a positive hooking up experience. Based on these findings, suggestions for psychoeducational programming are offered. Additionally, directions for future research are provided.

Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual

Abstract: The American Psychiatric Association (APA) is in the process of revising its Diagnostic and Statistical Manual (DSM), with the DSM-V having an anticipated publication date of 2012. As part of that ongoing process, in May 2008, APA announced its appointment of the Work Group on Sexual and Gender Identity Disorders (WGSGID). The announcement generated a flurry of concerned and anxious responses in the lesbian, gay, bisexual, and transgender (LGBT) community, mostly focused on the status of the diagnostic categories of Gender Identity Disorder (GID) (for both children and adolescents and adults). Activists argued, as in the case of homosexuality in the 1970s, that it is wrong to label expressions of gender variance as symptoms of a mental disorder and that perpetuating DSM-IV-TR’s GID diagnoses in the DSM-V would further stigmatize and cause harm to transgender individuals. Other advocates in the trans community expressed concern that deleting GID would lead to denying medical and surgical care for transgender adults. This review explores how criticisms of the existing GID diagnoses parallel and contrast with earlier historical events that led APA to remove homosexuality from the DSM in 1973. It begins with a brief introduction to binary formulations that lead not only to linkages of sexual orientation and gender identity, but also to scientific and clinical etiological theories that implicitly moralize about matters of sexuality and gender. Next is a review of the history of how homosexuality came to be removed from the DSM-II in 1973 and how, not long thereafter, the GID diagnoses found their way into DSM-III in 1980. Similarities and differences in the relationships of homosexuality and gender identity to psychiatric and medical thinking are elucidated. Following a discussion of these issues, the author recommends changes in the DSM-V and some internal and public actions that the American Psychiatric Association should take.

The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women

Abstract: Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is defined by the monosymptomatic criterion “persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity” that causes “marked distress or interpersonal difficulty.” This article reviews the diagnosis of HSDD in prior and current (DSM-IV-TR) editions of the DSM, critiques the existing criteria, and proposes criteria for consideration in DSM-V. Problems in coming to a clear operational definition of desire, the fact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsive desire, the relative infrequency of unprovoked sexual fantasies in women, and the significant overlap between desire and arousal are reviewed and highlight the need for revised DSM criteria for HSDD that accurately reflect women’s experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.

Predictors and Consequences of Sexual “Hookups” Among College Students: A Short-term Prospective Study

Abstract: “Hookups,” sexual interactions between partners who do not expect a romantic commitment, are believed to be common among adolescents and young adults. Most existing research is cross-sectional and has not investigated the antecedents or consequences of hookups. To our knowledge, this study provides the first prospective investigation of the hypothesized predictors of penetrative sex hookups (i.e., oral, vaginal, and anal sex) and the first exploration of the short-term mental health consequences of hookups. A total of 140 first-semester college students (109 females, 31 males) completed an anonymous survey early in their first semester; the survey assessed 18 potential predictors of hooking up that were identified from theory and past research. At the end of their first semester, students again responded to a survey and provided data on their oral and vaginal sex hookup behavior (occurrence and number of partners), distress, and self-esteem. Baseline and follow-up data were linked using unique codes that protected participants’ anonymity. Pre-college hookup patterns, peak intoxication level, and situational triggers for hookups were consistent predictors of oral and vaginal sex hookup behavior (and number of hookup partners) in the first semester of college. Penetrative sex hookups increased psychological distress for females, but not for males. Implications for education and intervention as well as suggestions for future research are discussed.

The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults

Abstract: Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.

Sexual Dimorphism in the Prenatal Digit Ratio (2D:4D)

Abstract: The second to fourth digit ratio (2D:4D) is smaller in human males than in females and hence this trait is sexually dimorphic. The digit ratio is thought to be established during early prenatal development under the influence of prenatal sex hormones. However, the general assumption of early establishment has hardly been studied. In our study, we analyzed the 2D:4D ratio in 327 deceased human fetuses. We measured digit lengths in 169 male and 158 female fetuses ranging from 14 to 42 weeks old. Our results showed a slight, but significant, sexual dimorphism in the expected direction, i.e., females had, on average, a ratio of 0.924 and males a ratio of 0.916. There was no significant relationship with the presence or absence of minor and major or single and multiple congenital abnormalities. There was a minimal, but significant difference between digit ratios based on digit lengths including and excluding the non-bony fingertip with the values being strongly correlated (r = .98). The prenatal 2D:4D ratio was lower than has thus far been reported for children and adults both for males and females. The extent of the sexual dimorphism in fetuses was similar to that found for children, but lower than for adults. The 2D:4D ratio, thus, seems to increase after birth in both men and women, with the second digit growing faster than the fourth digit (positive allometric growth of digit two) and perhaps more so in women than in men. Therefore, the sexual dimorphism is probably determined by prenatal as well as by postnatal developmental processes.

Sex Differences in Personality Traits and Gender-Related Occupational Preferences across 53 Nations: Testing Evolutionary and Social-Environmental Theories

Abstract: Using data from over 200,000 participants from 53 nations, I examined the cross-cultural consistency of sex differences for four traits: extraversion, agreeableness, neuroticism, and male-versus-female-typical occupational preferences. Across nations, men and women differed significantly on all four traits (mean ds = -.15, -.56, -.41, and 1.40, respectively, with negative values indicating women scoring higher). The strongest evidence for sex differences in SDs was for extraversion (women more variable) and for agreeableness (men more variable). United Nations indices of gender equality and economic development were associated with larger sex differences in agreeableness, but not with sex differences in other traits. Gender equality and economic development were negatively associated with mean national levels of neuroticism, suggesting that economic stress was associated with higher neuroticism. Regression analyses explored the power of sex, gender equality, and their interaction to predict men's and women's 106 national trait means for each of the four traits. Only sex predicted means for all four traits, and sex predicted trait means much more strongly than did gender equality or the interaction between sex and gender equality. These results suggest that biological factors may contribute to sex differences in personality and that culture plays a negligible to small role in moderating sex differences in personality.

Sex Differences in Mental Rotation and Line Angle Judgments Are Positively Associated with Gender Equality and Economic Development Across 53 Nations

Abstract: Mental rotation and line angle judgment performance were assessed in more than 90,000 women and 111,000 men from 53 nations. In all nations, men's mean performance exceeded women's on these two visuospatial tasks. Gender equality (as assessed by United Nations indices) and economic development (as assessed by per capita income and life expectancy) were significantly associated, across nations, with larger sex differences, contrary to the predictions of social role theory. For both men and women, across nations, gender equality and economic development were significantly associated with better performance on the two visuospatial tasks. However, these associations were stronger for the mental rotation task than for the line angle judgment task, and they were stronger for men than for women. Results were discussed in terms of evolutionary, social role, and stereotype threat theories of sex differences.

Ethnic differences in sexual attitudes of U.S. college students: gender, acculturation, and religiosity factors.

Abstract: Although it has been hypothesized that culture and religion play an important role in sexuality, the relative roles of acculturation and religiosity on ethnic differences in sexual attitudes have not been often empirically explored. The present study assessed differences in sexual attitudes in Euro-American, Asian, and Hispanic American populations using measures of acculturation to analyze the relative effects of heritage and mainstream cultures, as well as religiosity, within each ethnic group. A total of 1,415 college students (67% Euro-American, 16% Hispanic, 17% Asian; 32% men, 68% women) completed questionnaires which assessed attitudes towards homosexuality, gender role traditionality, casual sex, and extramarital sex. In concordance with previous studies, Asians reported more conservative sexual attitudes than did their Hispanic and Euro-American peers. Hispanics reported sexual attitudes similar to that of Euro-Americans. For both Hispanic and Asians, higher acculturation predicted sexual attitudes similar to that of Euro-Americans. For Asian, Hispanic, and Euro-American women, there was a significant interaction between intrinsic religiosity and spirituality such that the relationship between conservativism of sexual attitudes and intrinsic religiosity was stronger at higher levels of spirituality. In Euro-Americans and Asians, intrinsic religiosity and religious fundamentalism strongly predicted conservative sexual attitudes; while still significant, these relationships were not as pronounced in the Hispanic sample, implying an ethnic-by-religious effect. Novel to this study, acculturation did not mediate the relationship between religiosity and sexual attitudes, indicating that ethnic differences in religiosity effects were distinct from acculturation.

Pornography, Normalization, and Empowerment

Abstract: Opponents and proponents of erotic representations (referred to hereafter as “pornography”) have described the effects of pornography from their perspective. Little, however, has been done in the way of research to investigate these claims from the consumer’s point of view. This especially has been so regarding the positive impact of such consumption on a person’s sex life. Using a study group of 245 college students, we examined this question in a framework of scripting theory. We wanted to see whether viewing pornography appeared to expand sexual horizons through normalization and facilitate a willingness to explore new sexual behaviors and sexual relationships through empowerment. The data supported this viewpoint and further showed the effects to be mediated by gender and sexual preference identity. They suggested, however, that established scripts were extended rather than abandoned. We conclude with connections between our findings and the widespread viewing of pornography in contemporary society.

Genetic and Environmental Effects on Same-sex Sexual Behavior: A Population Study of Twins in Sweden

Abstract: There is still uncertainty about the relative importance of genes and environments on human sexual orientation. One reason is that previous studies employed self-selected, opportunistic, or small population-based samples. We used data from a truly population-based 2005-2006 survey of all adult twins (20-47 years) in Sweden to conduct the largest twin study of same-sex sexual behavior attempted so far. We performed biometric modeling with data on any and total number of lifetime same-sex sexual partners, respectively. The analyses were conducted separately by sex. Twin resemblance was moderate for the 3,826 studied monozygotic and dizygotic same-sex twin pairs. Biometric modeling revealed that, in men, genetic effects explained .34-.39 of the variance, the shared environment .00, and the individual-specific environment .61-.66 of the variance. Corresponding estimates among women were .18-.19 for genetic factors, .16-.17 for shared environmental, and 64-.66 for unique environmental factors. Although wide confidence intervals suggest cautious interpretation, the results are consistent with moderate, primarily genetic, familial effects, and moderate to large effects of the nonshared environment (social and biological) on same-sex sexual behavior.

Sexual agreements among gay male couples.

Abstract: Many gay male couples make agreements about whether or not to permit sex with outside partners, yet little is known about the development and maintenance of these agreements, their impact on relationships, and whether they are an effective HIV prevention strategy. Using semi-structured, qualitative interviews, 39 gay male couples were asked about their sexual agreements and about other relationship dynamics that might affect their agreements. Analysis revealed a wide range of agreement types, all of which are presented along a continuum rather than as discrete categories. For couples with open agreements, most placed rules or conditions limiting when, where, how often, and with whom outside sex was permitted. Although motivations for having agreements varied, HIV prevention did not rank as a primary factor for any couple. Most couples had congruous agreements; however, a small number reported discrepancies which may increase HIV transmission risk. How couples handled breaks in their agreements also varied, depending on what condition was broken, whether it was disclosed, and the partner’s reaction. Additional results include differences in agreement type and motivations for having an agreement based on couple serostatus. Overall, agreements benefited couples by providing boundaries for the relationship, supporting a non-heteronormative identity, and fulfilling the sexual needs of the couple. Future prevention efforts involving gay couples must address the range of agreement types and the meanings couples ascribe to them, in addition to tempering safety messages with the relationship issues that are important to and faced by gay couples.

Asexuality: a mixed-methods approach.

Abstract: Current definitions of asexuality focus on sexual attraction, sexual behavior, and lack of sexual orientation or sexual excitation; however, the extent to which these definitions are accepted by self-identified asexuals is unknown. The goal of Study 1 was to examine relationship characteristics, frequency of sexual behaviors, sexual difficulties and distress, psychopathology, interpersonal functioning, and alexithymia in 187 asexuals recruited from the Asexuality Visibility and Education Network (AVEN). Asexual men (n = 54) and women (n = 133) completed validated questionnaires online. Sexual response was lower than normative data and was not experienced as distressing, and masturbation frequency in males was similar to available data for sexual men. Social withdrawal was the most elevated personality subscale; however, interpersonal functioning was in the normal range. Alexithymia was elevated in 12%. Social desirability was also in the normal range. Study 2 was designed to expand upon these quantitative findings with 15 asexuals from Study 1 through in-depth telephone interviews. The findings suggest that asexuality is best conceptualized as a lack of sexual attraction; however, asexuals varied greatly in their experience of sexual response and behavior. Asexuals partnered with sexuals acknowledged having to “negotiate” sexual activity. There were not higher rates of psychopathology among asexuals; however, a subset might fit the criteria for Schizoid Personality Disorder. There was also strong opposition to viewing asexuality as an extreme case of sexual desire disorder. Finally, asexuals were very motivated to liaise with sex researchers to further the scientific study of asexuality.

Pornography, Sexual Socialization, and Satisfaction Among Young Men

Abstract: In spite of a growing presence of pornography in contemporary life, little is known about its potential effects on young people's sexual socialization and sexual satisfaction. In this article, we present a theoretical model of the effects of sexually explicit materials (SEM) mediated by sexual scripting and moderated by the type of SEM used. An on-line survey dataset that included 650 young Croatian men aged 18-25 years was used to explore empirically the model. Descriptive findings pointed to significant differences between mainstream and paraphilic SEM users in frequency of SEM use at the age of 14, current SEM use, frequency of masturbation, sexual boredom, acceptance of sex myths, and sexual compulsiveness. In testing the model, a novel instrument was used, the Sexual Scripts Overlap Scale, designed to measure the influence of SEM on sexual socialization. Structural equation analyses suggested that negative effects of early exposure to SEM on young men's sexual satisfaction, albeit small, could be stronger than positive effects. Both positive and negative effects-the latter being expressed through suppression of intimacy-were observed only among users of paraphilic SEM. No effect of early exposure to SEM was found among the mainstream SEM users. To counterbalance moral panic but also glamorization of pornography, sex education programs should incorporate contents that would increase media literacy and assist young people in critical interpretation of pornographic imagery.

Dissecting “Gaydar”: Accuracy and the Role of Masculinity–Femininity

Abstract: “Gaydar” is the ability to distinguish homosexual and heterosexual people using indirect cues. We investigated the accuracy of gaydar and the nature of “gaydar signals” conveying information about sexual orientation. Homosexual people tend to be more sex atypical than heterosexual people in some behaviors, feelings, and interests. We hypothesized that indicators of sex atypicality might function as gaydar signals. In Study 1, raters judged targets’ sexual orientation from pictures, brief videos, and sound recordings. Sexual orientation was assessed with high, though imperfect, accuracy. In Study 2, different raters judged targets’ sex atypicality from the same stimuli. Ratings of sexual orientation from Study 1 corresponded highly with targets’ self-reports of sex atypicality and with observer ratings of sex atypicality from Study 2. Thus, brief samples of sex-atypical behavior may function as effective gaydar signals.

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

Abstract: The categorization of gender identity variants (GIVs) as “mental disorders” in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is highly controversial among professionals as well as among persons with GIV. After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing debate: GIV as psychopathology versus natural variation; definition of “impairment” and “distress” for GID; associated psychopathology and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of “sex reassignment surgery” as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed. Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with other syndromes; narrowing the definition to dysphoria and taking “disorder” out of the label; categorizing GID as a neurological or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases (ICD); and creating a special category for GIV in the DSM. I conclude that—as also evident in other DSM categories—the decision on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.

Infants’ Preferences for Toys, Colors, and Shapes: Sex Differences and Similarities

Abstract: Girls and boys differ in their preferences for toys such as dolls and trucks. These sex differences are present in infants, are seen in non-human primates, and relate, in part, to prenatal androgen exposure. This evidence of inborn influences on sex-typed toy preferences has led to suggestions that object features, such as the color or the shape of toys, may be of intrinsically different interest to males and females. We used a preferential looking task to examine preferences for different toys, colors, and shapes in 120 infants, ages 12, 18, or 24 months. Girls looked at dolls significantly more than boys did and boys looked at cars significantly more than girls did, irrespective of color, particularly when brightness was controlled. These outcomes did not vary with age. There were no significant sex differences in infants’ preferences for different colors or shapes. Instead, both girls and boys preferred reddish colors over blue and rounded over angular shapes. These findings augment prior evidence of sex-typed toy preferences in infants, but suggest that color and shape do not determine these sex differences. In fact, the direction of influence could be the opposite. Girls may learn to prefer pink, for instance, because the toys that they enjoy playing with are often colored pink. Regarding within sex differences, as opposed to differences between boys and girls, both boys and girls preferred dolls to cars at age 12-months. The preference of young boys for dolls over cars suggests that older boys’ avoidance of dolls may be acquired. Similarly, the sex similarities in infants’ preferences for colors and shapes suggest that any subsequent sex differences in these preferences may arise from socialization or cognitive gender development rather than inborn factors.

Biodemographic and physical correlates of sexual orientation in men.

Abstract: To better understand sexual orientation from an evolutionary perspective, we investigated whether, compared to heterosexual men, the fewer direct descendants of homosexual men could be counterbalanced by a larger number of other close biological relatives. We also investigated the extent to which three patterns generally studied separately--handedness, number of biological older brothers, and hair-whorl rotation pattern--correlated with each other, and for evidence of replication of previous findings on how each pattern related to sexual orientation. We surveyed at Gay Pride and general community festivals, analyzing data for 894 heterosexual men and 694 homosexual men, both groups predominantly (~80%) white/non-Hispanic. The Kinsey distribution of sexual orientation for men recruited from the general community festivals approximated previous population-based surveys. Compared to heterosexual men, homosexual men had both more relatives, especially paternal relatives, and more homosexual male relatives. We found that the familiality for male sexual orientation decreased with relatedness, i.e., when moving from first-degree to second-degree relatives. We also replicated the fraternal birth order effect. However, we found no significant correlations among handedness, hair whorl rotation pattern, and sexual orientation, and, contrary to some previous research, no evidence that male sexual orientation is transmitted predominantly through the maternal line.

Dysregulated sexuality and high sexual desire: distinct constructs?

Abstract: The literature on dysregulated sexuality, whether theoretical, clinical or empirical, has failed to differentiate the construct from high sexual desire. In this study, we tested three hypotheses which addressed this issue. A sample of 6458 men and 7938 women, some of whom had sought treatment for sexual compulsivity, addiction or impulsivity, completed an online survey comprised of various sexuality measures. Men and women who reported having sought treatment scored significantly higher on measures of dysregulated sexuality and sexual desire. For men, women, and those who had sought treatment, dysregulated sexuality was associated with increased sexual desire. Confirmatory factor analysis supported a one-factor model, indicating that, in both male and female participants, dysregulated sexuality and sexual desire variables loaded onto a single underlying factor. The results of this study suggest that dysregulated sexuality, as currently conceptualized, labelled, and measured, may simply be a marker of high sexual desire and the distress associated with managing a high degree of sexual thoughts, feelings, and needs.

Loneliness among older lesbian, gay, and bisexual adults: the role of minority stress.

Abstract: Past research has consistently found that aging lesbians, gay men, and bisexuals (LGBs) are more apt to suffer from loneliness than their heterosexual counterparts. Data from the 2002 Gay Autumn survey (N = 122) were used to find out whether minority stress relates to higher levels of loneliness among older LGB adults in the Netherlands. We examined five minority stress factors: external objective stressful events, expectations of those events, internalized homonegativity, hiding and concealment of one’s LGB identity, and ameliorating processes. The results showed that greater insight into loneliness among older LGB adults was obtained when minority stress factors were considered. Older LGB adults who had experienced negative reactions, as well as aging LGBs who expected those reactions, had the highest levels of loneliness. Having an LGB social network buffered against the impact of minority stress. These minority stress processes added to the variance already explained by general factors that influenced levels of loneliness (partner relationships, general social network, physical health, and self-esteem). Interventions aimed at decreasing feelings of loneliness among older LGBs should be focused on decreasing societal homonegativity (to decrease the amount of negative and prejudiced reactions) and on the enhancement of social activities for LGB elderly.

Sexual compulsivity and sexual risk in gay and bisexual men.

Abstract: Much of our understanding of the association between the Sexual Compulsivity Scale (SCS) and sexual risk behavior among men who have sex with men (MSM) has been limited to samples of HIV positive MSM only. Using data from a community-based survey of gay and bisexual men (n = 1214), this analysis sought to further evaluate the association between the SCS and sexual risk behavior. The SCS was significantly associated with a variety of sexual risk behaviors, including having sex under the influence of club drugs, engaging in unprotected anal sex (receptive or insertive) with partners of the same and/or different HIV serostatus, identity as a barebacker, intentions to have bareback sex, number of recent sex partners, and temptation for unsafe sex. The SCS was also significantly associated with having engaged in a variety of specialized sexual behaviors (i.e., fetishes), many of which can increase HIV transmission risks. Finally, in multivariate analyses, the SCS significantly predicted unprotected sex with a non-main partner even when controlling for race, HIV serostatus, age, identity as a barebacker, and club drug use. These data indicate that the SCS may be able to serve as an indicator to detect HIV-associated sexual risk behavior in community-based samples of gay and bisexual men.

The DSM diagnostic criteria for Female Sexual Arousal Disorder

Abstract: This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis—“an inability to attain, or to maintain…an adequate lubrication-swelling response of sexual excitement”—are identified. The significant overlap between “arousal” and “desire” disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.

The DSM diagnostic criteria for vaginismus.

Abstract: Vaginal spasm has been considered the defining diagnostic characteristic of vaginismus for approximately 150 years This remarkable consensus, based primarily on expert clinical opinion, is preserved in the DSM-IV-TR The available empirical research, however, does not support this definition nor does it support the validity of the DSM-IV-TR distinction between vaginismus and dyspareunia The small body of research concerning other possible ways or methods of diagnosing vaginismus is critically reviewed Based on this review, it is proposed that the diagnoses of vaginismus and dyspareunia be collapsed into a single diagnostic entity called “genito-pelvic pain/penetration disorder” This diagnostic category is defined according to the following five dimensions: percentage success of vaginal penetration; pain with vaginal penetration; fear of vaginal penetration or of genito-pelvic pain during vaginal penetration; pelvic floor muscle dysfunction; medical co-morbidity

Common genetic effects of gender atypical behavior in childhood and sexual orientation in adulthood: a study of Finnish twins.

Abstract: The existence of genetic effects on gender atypical behavior in childhood and sexual orientation in adulthood and the overlap between these effects were studied in a population-based sample of 3,261 Finnish twins aged 33-43 years. The participants completed items on recalled childhood behavior and on same-sex sexual interest and behavior, which were combined into a childhood gender atypical behavior and a sexual orientation variable, respectively. The phenotypic association between the two variables was stronger for men than for women. Quantitative genetic analyses showed that variation in both childhood gender atypical behavior and adult sexual orientation was partly due to genetics, with the rest being explained by nonshared environmental effects. Bivariate analyses suggested that substantial common genetic and modest common nonshared environmental correlations underlie the co-occurrence of the two variables. The results were discussed in light of previous research and possible implications for theories of gender role development and sexual orientation.

The DSM diagnostic criteria for gender identity disorder in children.

Abstract: In this article, I review the diagnostic criteria for Gender Identity Disorder (GID) in children as they were formulated in the DSM-III, DSM-III-R, and DSM-IV. The article focuses on the cumulative evidence for diagnostic reliability and validity. It does not address the broader conceptual discussion regarding GID as “disorder,” as this issue is addressed in a companion article by Meyer-Bahlburg (2009). This article addresses criticisms of the GID criteria for children which, in my view, can be addressed by extant empirical data. Based in part on reanalysis of data, I conclude that the persistent desire to be of the other gender should, in contrast to DSM-IV, be a necessary symptom for the diagnosis. If anything, this would result in a tightening of the diagnostic criteria and may result in a better separation of children with GID from children who display marked gender variance, but without the desire to be of the other gender.

Renegotiating sexuality and intimacy in the context of cancer: the experiences of carers.

Abstract: There is a growing body of evidence to show that cancer can result in dramatic changes in sexuality, sexual functioning, and intimate couple relationships, with significant implications for both quality of life and psychological well-being However, the experiences of intimate partners are often neglected in research on sexuality and intimacy in the context of cancer This study used a material-discursive framework and a qualitative methodology to investigate the ways in which intimacy and sexuality are renegotiated in the context of cancer, and what factors are associated with successful or unsuccessful renegotiation, from the perspective of partners caring for a person with cancer Twenty participants were interviewed, across a range of cancer types, stages, and age groups Eleven participants reported that they were unable to negotiate other ways of being sexually intimate when penetrative sexual intercourse was no longer physiologically possible or desirable Nine were able to renegotiate sexual intimacy in the context of cancer to include practices previously positioned as secondary to "real sex," such as mutual masturbation, self masturbation, manual stimulation, oral sex, massage, the use of vibrators, kissing, and hugging Grounded theory analysis identified two themes associated with renegotiation: "Alternative" sexual practices-redefining sexual intimacy, and couple communication and relationship context Difficulties in renegotiation were associated with adherence to the coital imperative, sexual relationship or communication problems which existed prior to cancer, and the positioning of the person with cancer as a child or an asexual sick patient rather than a sexual partner The implications for health professional intervention to ameliorate changes to sexuality in the context of cancer are discussed

Sexual Orientation versus Age of Onset as Bases for Typologies (Subtypes) for Gender Identity Disorder in Adolescents and Adults

Abstract: The most widely used and influential typologies for transsexualism and gender identity disorder (GID) in adolescents and adults employ either sexual orientation or age of onset of GID-related symptoms as bases for categorization. This review compares these two typological approaches, with the goal of determining which one should be employed for the diagnosis of GID in Adolescents or Adults (or its successor diagnosis) in the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Typologies based on sexual orientation and age of onset of GID-related symptoms are roughly comparable in ease and reliability of subtype assignment. Typologies based on sexual orientation, however, employ subtypes that are less ambiguous and better suited to objective confirmation and that offer more concise, comprehensive clinical description. Typologies based on sexual orientation are also superior in their ability to predict treatment-related outcomes and comorbid psychopathology and to facilitate research. Commonly expressed objections to typologies based on sexual orientation are unpersuasive when examined closely. The DSM should continue to employ subtypes based on sexual orientation for the diagnosis of GID in Adolescents or Adults or its successor diagnosis.

Perceived “Out of Control” Sexual Behavior in a Cohort of Young Adults from the Dunedin Multidisciplinary Health and Development Study

Abstract: Out of control sexual behavior, also known as compulsive sexual behavior or sexual addiction, has not been studied in a representative sample of the general population. At age 32 years, 940 (93%) of 1,015 members of the birth cohort of the Dunedin Multidisciplinary Health and Development Study responded to a series of questions about sexual behavior, administered by computer. We enquired about sexual fantasies, urges or behavior that participants regarded as out of control during the previous year, and defined such experiences as out of control sexual experiences (OCSE). Nearly 13% of men and 7% of women reported OCSE in the past year. Women who reported such experiences were more likely than other women to have reported (elsewhere in the interview) having had high numbers of opposite sex partners, concurrent sexual relationships, or sex with a partner met on the internet, as well as a higher likelihood of same-sex attraction or behavior. Among men reporting OCSE, there was an association with having paid for heterosexual sex and with same-sex attraction and behavior. Few believed that OCSE had interfered with their lives (3.8% of all men and 1.7% of all women in the cohort). Only 0.8% of men and 0.6% of women reported that their actual sexual behavior had interfered with their lives. OCSE were also analyzed in relation to certain personality traits and to childhood sexual abuse (CSA). Some evidence of a link with impulsivity (women only) and negative affectivity was found. CSA was associated with OCSE among men. In conclusion, this population-based study has provided the first empirical estimations of the occurrence of OCSE and its relationship to a range of sexual behaviors in a representative sample.