Discovering Human Sexuality , 5th Edition

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 Discovering Human Sexuality, Fifth Edition
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Library of Congress Cataloging-in-Publication Data

Names: LeVay, Simon, author. | Baldwin, Janice I., author. | Baldwin, John D., 1941- author.
Title: Discovering human sexuality / Simon LeVay, West Hollywood, California, Janice Baldwin,
University of California, Santa Barbara, John Baldwin, University of California, Santa Barbara.
Description: Fifth Edition. | New York : Sinauer Associates : Oxford University Press, 2021. | Revised
edition of the authors’ Discovering human sexuality, [2019] | Includes bibliographical references and
index. | Summary: “An evidence-based, accessible introduction to the study of sexuality and the
diverse ways in which it brings joys and challenges to our lives. Now in its fifth edition, Discovering
Human Sexuality has established itself as a popular and widely praised text that respects diversity
both in the sexual world and among the students who read it. The backgrounds of the authors—
in biology, sociology, teaching, and writing—have made possible a text that is multidisciplinary,
authoritative, sex-positive, and a delight to read. The scope of Discovering Human Sexuality ranges
from homosexuality in ancient Greece to the recent Harvey Weinstein sexual harassment scandal
while covering a stunningly diverse array of topics. Questions considered include: How does the
menstrual cycle work? What’s “splitting the bamboo”? Can premature ejaculation be treated? If a
man has undetectable levels of HIV, can he have sex without condoms? Which sex offenders will
repeat their crimes? Is there a gay gene? What’s wrong with polygamy? Is emergency contraception
abortion? This book gives factual answers to important questions and provides material for informed
debate for issues without a single solution”-- Provided by publisher.
Identifiers: LCCN 2020028914 (print) | LCCN 2020028915 (ebook) | ISBN 9780197522578 (paperback) |
ISBN 9780197522608 | ISBN 9780197522585 (epub)
Subjects: LCSH: Sex (Psychology) | Sex (Biology) | Sex--Social aspects. | Sexual disorders.
Classification: LCC BF692 .L47 2021 (print) | LCC BF692 (ebook) | DDC 306.7--dc23
LC record available at https://lccn.loc.gov/2020028914
LC ebook record available at https://lccn.loc.gov/2020028915

9 8 7 6 5 4 3 2 1
Printed in the United States of America
About the Authors
Simon LeVay, PhD is a British born neuroscientist turned science writer
and teacher. He has served on the faculty of Harvard Medical School and the
Salk Institute for Biological Studies, and has taught at Harvard, the University
of California, and Stanford University. He is the author or coauthor of twelve
books, including Gay, Straight, and the Reason Why: The Science of Sexual
Orientation, Second Edition (OUP, 2017).

Janice Baldwin, PhD and John Baldwin, PhD are sociologists at the University
of California, Santa Barbara. They have been collaborators and writers on many
papers and projects in the area of sex, sexuality, and sex education. The Baldwins
co-teach a dynamic undergraduate Human Sexuality course at UCSB that has been
regularly voted the Best Course there, and they have been named Best Professors
multiple times. They also co-created—with their upper division students—a sex
information website: SexInfoOnline.
Brief Contents
CHAPTER 1 Sexuality: Pathways to Understanding 3
CHAPTER 2 Women’s Bodies 23
CHAPTER 3 Men’s Bodies 61
CHAPTER 4 Sex Development and Diversity 91
CHAPTER 5 Attraction, Arousal, and Response 127
CHAPTER 6 Sexual Behavior 157
CHAPTER 7 Sexual Relationships 193
CHAPTER 8 Fertility, Pregnancy, and Childbirth 229
CHAPTER 9 Contraception and Abortion 269
CHAPTER 10 Sexuality across the Lifespan: From Birth to Adolescence 315
CHAPTER 11 Sexuality across the Lifespan: Adulthood 349
CHAPTER 12 Sexual Orientation 379
CHAPTER 13 Atypical Sexuality 415
CHAPTER 14 Sexual Disorders 451
CHAPTER 15 Sexually Transmitted Infections 483
CHAPTER 16 Sexual Assault, Harassment, and Partner Violence 519
CHAPTER 17 Sex Work 555
Contents

1 Sexuality: Pathways to Understanding 3

1.1 Sexuality Is a Broader Concept than Sex 4 1.3 Sexuality Can Be Studied with a Wide
1.2 Sexuality Has Changed over Time 4 Variety of Methods 14
Sexuality has been influenced by evolution 4 Biomedical research focuses on the underlying
mechanisms of sex 14
Box 1.1 Meet My Dads 6
Psychology includes diverse approaches
Society has changed sexuality 6 to sexuality 15
Urbanization has been a curse and a blessing 8 Cultural anthropology focuses on sexual diversity
Marriage has been transformed 8 across cultures 16
Box 1.2 The Media: TV or Not TV? 9 Sociologists focus on the connection between
sex and society 16
Sex researchers followed diverse paths 10
Organizations promote sex research 18
Box 1.3 Freud and Hirschfeld: Contrasting
Theories on Sexual Orientation 11

2 Women’s Bodies 23

2.1 A Woman’s Vulva Includes Her Mons, Labia, Other uterine conditions include fibroids,
Vaginal Opening, and Clitoris 24 endometriosis, abnormal bleeding,
and prolapse 38
Box 2.1 Pubic Hair Removal 26
Box 2.4 Hysteria 39
There is more to the clitoris than meets the eye 27
Should hysterectomy be so common? 40
Box 2.2 Female Genital Cutting 29
The oviducts are the site of fertilization 40
The appearance of the vaginal opening is
variable 30 2.4 The Ovaries Produce Ova and
The vagina is the outermost portion of the
Sex Hormones 41
female reproductive tract 32 Box 2.5 The Feedback Loop That Controls
The vagina undergoes changes during arousal 34 Female Hormone Production 43

The G-spot is a controversial erogenous zone 34 2.5 Menstruation Is a Biological Process with
2.2 The Anus Can Also Be a Sex Organ 35 Cultural and Practical Aspects 44
The menstrual cycle has three phases 44
2.3 The Uterus Serves a Double Duty 35
The cycle is driven by hormonal changes 45
Box 2.3 Genital Self-Examination 36
The menstrual cycle influences women’s
Cancer can affect the cervix or the sexuality 46
endometrium 37
Attitudes toward menstruation vary 47
viii Contents

Women use pads, tampons, or cups during Sex steroids affect more than the reproductive
menstruation 47 tract 51
Menstrual problems are common but treatable 48 2.6 The Breasts Have Both Erotic and
Box 2.6 Where Tampons Aren’t an Option 49 Reproductive Significance 52
Menstrual pain may or may not reflect underlying Breast cancer mortality can be reduced 53
pelvic disease 49 Many factors affect the risk of breast cancer 54
Premenstrual syndrome has physical and Regular mammograms are recommended 55
psychological aspects 50 Treatment depends on the diagnostic findings
Menstruation stops during pregnancy—and for and the woman’s choice 55
other reasons 51

3 Men’s Bodies 61

3.1 The Male External Genitalia Are the Penis 3.3 The Testicles Produce Sperm and
and Scrotum 62 Sex Hormones 73
The penis combines erotic, reproductive, Cancer and other disorders can affect
and urinary functions 62 the testicles 74
Box 3.1 Male Circumcision 66 Box 3.4 Declining Sperm Counts 75
Some disorders affect penile function 67 The testicles secrete sex hormones 76
Box 3.2 How Big Should a Penis Be? 68 The brain and pituitary gland regulate
hormone levels 77
Box 3.3 Diphallia 69
Box 3.5 Steroids and Sports 78
3.2 Penile Erection Involves Nerves, Blood,
and Chemistry 70 3.4 Several Glands Contribute Secretions
Erection is the filling of the penis with blood 70
to Semen 79
What is semen? 81
Muscles are also involved in erection 71
Ejaculation requires coordination of muscles
Erections occur during sleep 71
and glands 82
The scrotum regulates the temperature of the
testicles 72 Box 3.6 The Secret Life of Semen 83
3.5 Nudity Is Culturally Regulated 85

4 Sex Development and Diversity 91

4.1 Genes and Hormones Guide Sex 4.2 Sex Development Is Not Always Binary 98
Development 92 Unusual sets of chromosomes affect growth
Female and male reproductive tracts develop and fertility 98
from different precursors 93 The gonads or genitals may be sexually
Female and male external genitalia develop from ambiguous 99
the same precursors 94 Box 4.1 My Life with Androgen Insensitivity
The gonads descend during development 96 Syndrome 102
Sex hormone levels change over the lifespan 96 Box 4.2 Intersex and Sports 103
The brain also differentiates sexually 97
 Contents ix

4.3 There Are Sex Differences in Many Cognitive developmental models emphasize
Mental Traits 103 thought processes 113
Gender identity does not always match 4.6 Transgender People Challenge Society’s
anatomical sex 104 Deepest Divide 114
Women and men differ in a variety of cognitive Transgender men and women have existed in
and personality traits 104 many cultures 114
There are many differences in sexuality 104 Many transgender people are “beyond the
Many sex differences arise early in life 106 binary” 115
Transexual individuals are of more than
4.4 Biological Factors Contribute to one kind 116
Sex Differences 107
Changing sex is a multistage process 117
Evolutionary forces act differently on females
and males 107 Early treatment of gender-dysphoric children
is controversial 120
Experiments demonstrate a role for sex
hormones 108 Trans people struggle for awareness and
acceptance 120
Box 4.3 Gendered Play in Primates 109
Box 4.4 Rapid-Onset Gender Dysphoria 121
4.5 Life Experiences Mold Gender Roles 110
Girls and boys are socialized differently 110

5 Attraction, Arousal, and Response 127

5.1 Sexual Attraction: It Takes Two 128 5.3 Sexual Arousal Follows a Response
Beauty is not entirely in the eye of the Cycle 143
beholder 128 In the excitement phase, genital responses
Evolution and culture influence the attractiveness begin 144
of bodies 130 In the plateau phase, arousal is maintained 145
Box 5.1 Culture and Body Weight 132 Orgasm is the climax of sexual arousal 146
Attractiveness involves senses besides vision 134 Box 5.3 Female Ejaculation 147
Behavior and personality influence sexual Brain imaging suggests where orgasm may
attractiveness 134 be experienced 148
Familiarity may increase or decrease Box 5.4 Foot Orgasms 149
attraction 136
In the resolution phase, arousal subsides 150
Women’s perceived attractiveness varies around
the menstrual cycle 137 The phases may be linked in different ways 150
Asexual women and men do not experience Men experience a refractory period 151
sexual attraction 138 Pituitary hormones influence the sexual
response cycle 151
5.2 Sexual Arousal Has Multiple Roots 139
The Masters and Johnson cycle may be
Fantasy is a common mode of sexual arousal 139 incomplete 152
Gonadal steroid hormones influence sexual
arousability 141
Box 5.2 Aphrodisiacs and Drugs 142
Conditioning may influence arousal 143
x Contents

6 Sexual Behavior 157

6.1 People Derive Pleasure from Diverse Sexual 6.7 Anal Sex May Be a Part of Either
Behaviors 158 Heterosexual or Male Homosexual
6.2 Masturbation Is a Very Common Form Behavior 173
of Sexual Expression 158 6.8 Men and Women May Have Different
Box 6.1 Sex and Happiness 159 Preferences for Sexual Encounters 175
Negative attitudes toward masturbation are 6.9 Sex Toys Are Used to Enhance Sexual
still prevalent 160 Pleasure 176
Several demographic factors influence Box 6.3 What Is “Great Sex”? 180
masturbation 161
6.10 Sex May Be in Groups 180
Women use more diverse techniques of
masturbation than men 161 6.11 Sexual Behavior and Attitudes Vary
Gay people masturbate more than
across Cultures 181
heterosexuals 163 The Kama Sutra is the classic work on how
to make love 181
6.3 The Kiss Represents True Love—
Sometimes 163 Taoists recommended the avoidance
of ejaculation 183
6.4 Sexual Touching Takes Many Forms 164 Box 6.4 Dry Sex 183
6.5 Oral Sex Is Increasingly Popular 165 The Aka emphasize the importance of
Fellatio is oral stimulation of the penis 165 frequent sex 184
Cunnilingus is oral stimulation of the vulva 167 6.12 Many Disabled People Have Active
6.6 Most Male-Female Sex Includes Coitus 168 Sex Lives 184
Coitus can be performed in many different Many intellectually disabled people are
positions 168 competent to make sexual choices 185
Box 6.2 Progress in Coitus Research 169 Spinal cord injuries present a major challenge
The man-above position is a traditional to sexual expression 186
favorite 170 Arthritis is the number-one disability
The women’s movement and porn have affecting sex 187
encouraged alternative positions 171

7 Sexual Relationships 193

7.1 Sexual Relationships Are Motivated The hookup culture—some like it,
by Many Factors 194 some loathe it 200
7.2 Demographic Factors Affect Sexual Casual sex is more accepted in the gay male
community 202
Attitudes 194
Casual sex can mean more than a hookup 203
Box 7.1 Who May Marry? 196
Negotiating sex involves flirting 203
7.3 Casual Sex Has More Appeal to Men than 7.4 Non-Cohabiting Relationships Are Often
to Women 197
Short-Lived 205
Hooking up—the new norm? 198
Long-distance relationships can be very
Box 7.2 Straight Women, Gay Sex 199 successful 207
 Contents xi

Same-sex relationships follow their Marriage and relationship education teaches

own scripts 207 communication skills 214
Non-cohabiting relationships may How couples deal with conflict affects the stability
evolve rapidly 207 of their relationships 214
7.5 Love Cements Many Sexual In sexual relationships, sex matters 216
Relationships 208 Box 7.3 Lasting Relationships:
There are different kinds of love 208 Gottman’s Seven Principles 217
Liking and reciprocal attraction precede falling 7.8 Love, Jealousy, and Infidelity
in love 210 Are Intertwined 217
Researchers are probing the biological basis Jealousy can have a positive function 218
of love 210
7.9 Unrequited Love Is Painful for
7.6 Life Experiences Mold Our Sexual Both Parties 219
Relationships 211 The rejector may experience guilt 220
Relationship styles are influenced by childhood
attachments 211 7.10 Extra-Pair Relationships Have Many
Styles and Motivations 221
Couples in relationships resemble each other 212
Personal and evolutionary factors influence
7.7 Communication Is a Key Factor in the infidelity 221
Success of Relationships 213
Box 7.4 We Just Clicked 222
Communication may be inhibited by upbringing
or by the gender barrier 213 Extra-pair relationships are uncommon 223

8 Fertility, Pregnancy, and Childbirth 229

8.1 Pregnancy and Childbirth Raise Major Adoption is limited by the supply of
Health Concerns 230 healthy infants 239
8.2 The Fertilization of an Ovum Is Followed Fertility declines with age 240
by Implantation 230 8.5 Many Embryos Do Not Survive 241
Box 8.1 Birth Facts 231 Rh factor incompatibility can threaten
second pregnancies 241
8.3 Pregnancy Is Confirmed by Hormonal Ectopic pregnancy can endanger the
Tests 232 mother’s life 242
8.4 Infertility Can Result from a Problem in the 8.6 Pregnancy Is Conventionally Divided into
Woman or in the Man 233 Three Trimesters 242
A variety of factors can reduce sperm counts 233
8.7 The First Trimester Is a Period of
Box 8.2 The Scent of an Ovum 234 Major Changes 244
Sperm can be donated 235 Prenatal care provides health screening,
In vitro fertilization can circumvent many education, and support 244
sperm problems 235 Adequate nutrition is vital to a successful
Abnormalities of the female reproductive tract pregnancy 245
may reduce fertility 237 Tobacco, alcohol, drugs, and radiation can
Failure to ovulate can be dealt with by drugs harm the fetus 246
or by egg donation 237 8.8 The Second Trimester Is the Easiest 248
Box 8.3 Choosing Children’s Sex 238 Tests can detect fetal abnormalities 248
Surrogate mothers bear children for others 239 Sex during pregnancy is healthy 250
xii Contents

Moderate exercise during pregnancy Premature or delayed birth is hazardous 258

is beneficial 251 Box 8.5 Cesarean Section 259
8.9 The Third Trimester Is a Time 8.11 The Period after Birth Places Many
of Preparation 251 Demands on Parents 260
A hospital is the best location for childbirth Postpartum depression may be accompanied
if complications are foreseen 252 by disordered thinking 260
Childbirth classes prepare parents for birth 252 Childbirth and parenthood affect sexuality 261
The fetus also makes preparations for birth 253
8.12 Breastfeeding Is the Preferred Method of
8.10 Labor Has Three Stages 254 Nourishing the Infant 262
The first stage of labor is marked by uterine Lactation is orchestrated by hormones 262
contractions and cervical dilation 254
The content of breast milk changes over time 262
Box 8.4 Pain-Free Childbirth 256
Infant formula is an alternative to breast milk 263
The second stage is the delivery of the baby 257 Breastfeeding has many advantages and some
The newborn child adapts quickly 257 drawbacks 263
The third stage is the expulsion of the placenta 258

9 Contraception and Abortion 269

9.1 Birth Control Has a Long History 270 9.4 Hormones Can Be Administered by
Feminists led the campaign to legalize Non-Oral Routes 285
contraception 270 Transdermal patches last a week 286
Contraception has not yet solved the problem Vaginal rings last 3 weeks 286
of unintended pregnancy 271 Depo-Provera lasts 3 months 287
Box 9.1 Margaret Sanger and the Birth Implants are extremely reliable 288
Control Movement 272
IUDs require little attention 288
Different users have different contraceptive
needs 273 9.5 The Availability of Hormonal
Contraceptives May Be Limited 290
9.2 Physical Methods Block Sperm
Transport 275 9.6 Behavioral Methods Can Be
Demanding 291
Male condoms are reliable when
properly used 275 In fertility awareness methods, couples avoid
coitus during the fertile window 291
Box 9.2 Male Contraceptives
of the Future? 277 The withdrawal method is simple but
challenging 293
Female condoms are relatively intrusive 278
Noncoital sex can be used as a means of
Diaphragms and cervical caps are inconvenient avoiding pregnancy 294
but have few side effects 278
Combining long-acting methods and condoms
Spermicides are not very reliable when makes sense 294
used alone 279
Box 9.3 Contraceptives and
9.3 Hormone-Based Methods Are Easy the Environment 295
to Use 280
9.7 There Are Contraceptive Options after
Combination pills offer health benefits 281
Unprotected Coitus 296
Continuous use of combination pills eliminates
menstrual periods 283 9.8 Sterilization Is Highly Reliable 297
Progestin-only pills have fewer side effects 284 Vasectomy is a brief outpatient procedure 297
Tubal sterilization is more invasive
and expensive 299
 Contents xiii

9.9 Disabled Persons Have Special Dilation and evacuation is used early in the
Contraceptive Needs 300 second trimester 304
Induced labor and hysterotomy are performed
9.10 Lack of Access to Contraception late in the second trimester 304
Is a Global Problem 301
Medical abortions are two-step procedures 305
9.11 Several Safe Abortion Procedures Are Abortions do not cause long-lasting
Available 302 ill effects 306
Box 9.4 Abortion in the United States:
Key Statistics 303
9.12 Americans Are Divided on Abortion, but
Most Favor Restricted Availability 306
Vacuum aspiration is the standard first-trimester
The availability of abortion is decreasing 308
surgical method 303
Box 9.5 Feticide 309

10 Sexuality across the Lifespan:

From Birth to Adolescence 315
10.1 Some Forms of Childhood Sexual 10.4 Puberty Is a Period of Rapid Maturation 327
Expression Are Common 316 Puberty is marked by visible and invisible
In contemporary Western culture, children are changes 327
insulated from sex 316 Box 10.4 My First Period 330
Box 10.1 Talking with Children about Sex 317 Puberty occurs earlier in girls than boys 330
Some children engage in solitary sexual 10.5 Puberty Is Orchestrated by Hormones 331
activity 318
The body signals its readiness for puberty to
Sex with others can occur during childhood 319 the brain 333
Cultures vary in their attitudes toward childhood Puberty may come too early or too late 333
sexuality 321
10.6 Adolescence Is a Time of Sexual
10.2 Some Children Have Sexual Contacts Exploration 335
with Adults 322
Many cultures have puberty rites 335
Most adult–child contacts involve older children
There are social influences on teen sexual
and are single encounters 322
behavior 336
Some kinds of adult–child sex are more harmful
than others 322 Box 10.5 Sex-ed—What Teens Say 338
Strategies to prevent adult–child sex are quite Social media have risks and benefits 338
effective 323 Males masturbate more than females 339
Box 10.2 Sex and Suggestibility 324 The sexual activity of American teens increased
and then decreased 339
10.3 Preadolescence May Be Marked by
an Increase in Sexual Interest 325 The meaning of “virginity loss” varies 342
Preadolescent children segregate by sex 325 10.7 Teen Sexuality Is Central to Identity
Strict gender norms may traumatize children who
Development 342
become gay or transgender adults 325 Teen relationships are often short-lived 343
Box 10.3 Are Today’s Children Teen pregnancy is declining but is still too
Being Sexualized? 326 common 344
xiv Contents

11 Sexuality across the Lifespan:

Adulthood 349
11.1 In Young Adulthood, Conflicting Demands Several demographic factors increase the
Influence Sexual Expression 350 likelihood of a breakup 365
Most young men and women have only There are more personal reasons for
a few sex partners 350 breakups 365
Dating relationships are short-lived 351 11.6 Marital Disruption Can Have Negative and
Cohabitation is an increasingly prevalent Positive Consequences 366
lifestyle 351 Divorced men and women can suffer
Cohabitation has diverse meanings 352 psychological, physical, and economic
damage 366
Cohabitation does not harm a subsequent
marriage 353 Divorce may be the start of a new life 367
11.2 Marriage Takes Diverse Forms 353 Many divorced people remarry 367
The formalization of sexual unions has social Does marriage have a future? 368
and personal functions 354 11.7 Menopause Marks Women’s Transition
Many societies have permitted polygamy 355 to Infertility 368
Box 11.1 Mormon Polygamy 356 Menopause may be caused by depletion
of ova 369
Polyamory includes a variety of non-monogamous
relationships 357 Women may experience a decline in sexual
function at menopause 370
11.3 The Institution of Marriage Is Evolving 358 Decreased hormone levels affect a woman’s
Companionate marriage makes the availability of physiology 370
divorce a necessity 359
Hormone therapy can reduce menopausal
Marriage is becoming a minority status 360 symptoms 371
Relationship options have diversified 361 11.8 Men’s Fertility Declines Gradually
11.4 Most Long-Term Couples Are Satisfied with with Age 372
Their Sex Lives 361 11.9 Old People Face Challenges to Their
The frequency of sex declines over the course Sex Lives—Often Successfully 373
of long-term relationships 362
Aging is accompanied by physiological changes
Marital satisfaction declines during in the sexual response 373
middle age 363
Medical conditions, drugs, and social factors can
Box 11.2 You Know the Future impair the sexuality of older people 374
of Your Marriage 364
Old age may be a time for romance 375
11.5 A Variety of Factors Bring Relationships Box 11.3 Seniors on Sex 375
to an End 364

12 Sexual Orientation 379

12.1 There Is a Spectrum of Sexual 12.3 Diverse Theories Attempt to Explain

Orientations 380 Sexual Orientation 384
12.2 Sexual Orientation Is Not an Freud proposed psychodynamic models 384
Isolated Trait 381 Sexual orientation has been attributed to
Box 12.1 Boys Will Be Girls 383 socialization 384
 Contents xv

Biological theories focus on prenatal hormones Box 12.4 Beyond Gay and Straight 401
and genes 385 Some gay people are parents 402
Box 12.2 Why Gay Genes? 388 12.9 Changing One’s Sexual Orientation Is
12.4 The Gay Community Has Struggled Difficult or Impossible 403
for Equal Rights 389 12.10 Homophobia Has Multiple Roots 403
The gay rights movement began in Germany 389 Cultural indoctrination transmits homophobia
Box 12.3 Gay Martyrs 390 across generations 404
Gay rights are a global issue 391 Box 12.5 Born That Way? And Does
It Matter? 405
12.5 Growing Up Gay Presents Challenges 393
Coming out is a lifelong process 394 Gay people are seen as rule breakers 406
Lesbians and gay men are well represented in Overcoming homophobia is a communal
certain occupations 396 enterprise 407
12.6 Gay People Who Belong to Minorities Have 12.11 Bisexual People Are Caught between
Special Concerns 397 Two Worlds 408
The prevalence of bisexuality depends on
12.7 Gay Sex Has Its Own Style 398 definitions 408
12.8 There is Diversity among Gay People 399 Bisexual people face prejudice 410
Some same-sex couples differ in gender Lesbian, gay, straight, bi, other—more alike
characteristics 399 than different 411
Gay people aren’t all of a kind 400

13 Atypical Sexuality 415

13.1 Sexual Variety Is the Spice of Life 416 Obscene telephone calling is related to
exhibitionism 430
13.2 Sadomasochism Involves the Infliction or
Receipt of Pain or Degradation 416 Voyeurs are aroused by watching others 431
Frotteurism involves surreptitious
Box 13.1 In the Dungeon 419
physical contact 431
13.3 Most Fetishes Are Related to the Body 420 Box 13.4 Frotteurism: First-Person
Box 13.2 Crush Fetishes 422 Accounts 432
Box 13.3 Rubber Fetishism and the 13.7 Some Adults Are Sexually Attracted
Internet 423 to Children 433
13.4 People Cross-Dress for a Variety Pedophilia and child molestation are not
of Reasons 424 synonymous 433
Transvestism is a sexual drive to cross-dress 425 “Child molestation” is a behavioral and
Some men are aroused by trans women 425 legal term 434
Priests and others may molest children
13.5 There Are Many Uncommon Kinks 426 under their care 435
Adult babies reenact infancy 426 Some organizations support “minor-attracted
Furries wear animal costumes 427 persons” 436
Some men are turned on by their Box 13.5 Child Sex Robots 437
partner’s infidelity 427
13.8 A Variety of Other Paraphilic
13.6 Paraphilic Disorders Cause Distress Disorders Exist 437
or Harm Others 428
Zoophiles are sexually attracted to animals 437
Exhibitionists expose themselves to
nonconsenting persons 430 In necrophilia, nonresistance of the partner
may be arousing 438
xvi Contents

Sexual violence can be paraphilic 439 Conditioning is intended to change

Box 13.6 Autoerotic Asphyxia 440 sexual desires 444
Cognitive therapy is aimed at preventing
13.9 Sex Offenders Do Not Necessarily Repeat repeat offenses 444
Their Offenses 441
The efficacy of psychological treatments
13.10 There Are Numerous Theories of is limited 445
Paraphilic Disorders 441 Drug treatments interact with neurotransmitters
13.11 Theories of Causation Have Suggested or hormones 446
a Variety of Treatments 444 Castration is a treatment of last resort 446
13.12 Few “Kinks” Are Disorders 447

14 Sexual Disorders 451

14.1 Sexual Disorders Are Common 452 14.6 Premature Ejaculation Is Men’s Number
A multidisciplinary approach to treatment One Sex Problem 466
is preferred 452 There are different kinds of premature
Box 14.1 Sensate Focus 453 ejaculation 467
Sex therapy helps some men 467
14.2 Female Sexual Arousal Disorder Involves
Insufficient Genital Response 454 Drug treatment may be effective 468
14.3 There Are Many Reasons for Sexual Pain 14.7 Delayed Ejaculation Is Not Well
in Women 456 Understood 469
Vaginismus may make intercourse 14.8 Erectile Disorder Has Many Causes
impossible 456 and Treatments 470
Box 14.2 Dyspareunia: A Case History 457 Erectile disorder can have physical or
psychological causes 470
14.4 Difficulty in Reaching Orgasm Is Common
Simple measures may alleviate the problem 471
among Women 458
Psychological treatments may be useful 471
Psychotherapy and directed masturbation
may be helpful 459 PDE5 inhibitors have become the leading
treatments 472
Box 14.3 Kegel Exercises 461
Erectile disorder can be treated with devices
Faked orgasms offer a questionable solution 462 and implants 473
14.5 Lack of Interest in Sex Is Not Necessarily 14.9 Men May Have Little Interest in Sex 474
a Problem 462
14.10 Sexual Pain Is Uncommon in Men 475
Estrogen or androgen treatment may improve
sexual desire in women 463 14.11 Too Much Interest in Sex Can
Sex therapy may be helpful for low sexual desire Cause Problems 476
in women 464 Treatment depends on theoretical models 477
Alternative views on women’s response cycles 14.12 LGBT People Have Special Concerns 477
may influence treatment options 464
 Contents xvii

15 Sexually Transmitted Infections 483

15.1 Venereal Diseases Were Once Seen as Box 15.2 Zika—The Virus That Came
Punishment for Sexual License 484 and Went 499

15.2 STIs Are Still a Major Problem in 15.13 Genital Herpes Is a Lifelong Infection 500
the United States 485 Recurrent outbreaks are the rule 501
15.3 Lice and Mites Are More of an Annoyance Drug treatment can shorten or prevent
Than a Danger 488 outbreaks 502
Pubic lice itch, and that’s all they do 488 15.14 Human Papillomaviruses Can Cause
Scabies may be transmitted sexually Genital Warts—and Cancer 502
or nonsexually 488 An HPV vaccine is available 504
15.4 T richomoniasis Is Caused by a Protozoan 489 15.15 Herpatitis Viruses Can Be Sexually
15.5 Bacterial STIs Can Usually Be Treated Transmitted 504
with Antibiotics 490 15.16 AIDS Is Caused by the Human
15.6 Syphilis Is Down but Not Out 490 Immunodeficiency Virus 505
Untreated syphilis progresses through Sexual transmission is chiefly by coitus and
three stages 491 anal sex 507
Syphilis has resisted elimination 491 HIV infection progresses in a characteristic
way 508
Box 15.1 The Tuskegee Syphilis Study 492
Antiretroviral drugs suppress but don’t
15.7 Gonorrhea Can Lead to Infertility 493 eliminate HIV 508
15.8 Chlamydia Causes a Common Infection 15.17 You Can Reduce Your STI Risks 511
with Serious Complications 494 Abstinence prevents STIs 511
15.9 The Status of Bacterial Vaginosis as an STI Sexually active people can reduce their risk
Is Uncertain 496 of STIs 511
15.10 Urethritis Can Be Caused by a Variety Box 15.3 Partner Notification 512
of Organisms 497 Some sexual behaviors are riskier than others
15.11 Viral STIs Can Be Dangerous and Hard for STI transmission 513
to Treat 498 Condoms are the mainstay of STI prevention 513
15.12 Molluscum Contagiosum Is a Self-Limiting 15.18 Not Everything Is an STI 515
Condition 498

16 Sexual Assault, Harassment,

and Partner Violence 519
16.1 What Is Sexual Assault? 520 16.2 Sexual Assaults in College Are Becoming
Young women are the most frequent victims 521 Less Common 523
Most sexual assaults are not reported 521 Many college sexual assaults are committed by
fraternity members and athletes 525
Box 16.1 It Happened to Me 522
Colleges must balance the rights of the accuser
and the accused 526
The number one “date rape drug” is alcohol 527