Human sexuality has intricate meaning for both individuals and societies. It is a complex mixture of biological response, psychological meaning and societal/cultural overlays. It is only in recent years that sexuality has been studied in a scientific way by sociologists who seek to report and analyze current sexual behaviour.
Basically, sexuality refers to erotic stimulation. Erotic stimulation refers to what a particular society teaches are the pathways, directly or indirectly, to genital response. The learned aspect of erotic stimulation is obvious. For example we are told that a gynaecological examination is not supposed to be erotic to either the client or the gynaecologist and that husbands and partners therefore should not feel jealous concerning such examinations. If erotic arousal does occur in such a situation, a feeling of guilt or qualms will probably arise because there is no cultural support for such a reaction.
Another illustration of our learned eroticism is that many male-dominated cultures assert that for a male to reach orgasm quickly and easily, in a matter of seconds, is something to be proud of. On the other hand, western society today, contends that such a male is a premature ejaculator and needs therapy to learn to delay orgasm. So each culture defines the proper way to behave and to think about erotic stimulation. There are cultures where female breasts are not part of the erotic imagery, and there are cultures where obese or very thin individuals are thought to be sexually attractive. Some cultures stress only heterosexual preferences, and others permit homosexual eroticism as well.
So, it is clear that the specific ways in which we think, feel, and behave concerning erotic stimulation are socially learned. It is true that without the ability to reach orgasm and without nerve endings to yield pleasure none of these sexual customs would exist. But it is also apparent that the specific way we become erotically stimulated is learned, because the biological factors are the same in virtually all societies but the customs still vary considerably.
Despite the tremendous diversity in sexual customs, in all societies there is an awareness of two major consequences of erotic beliefs and practices. These two consequences are (1) physical pleasure and (2) psychological intimacy.
Physical pleasure as a motivation for sexuality and as a consequence of sexual behaviour is often left unmentioned. The reason for this would seem to be that our culture has strived to restrict sexual behaviour and thus has tended to avoid mention of such pleasurable outcomes for fear of encouraging sexual behaviour. Our cultural traditions have tended to stress negative consequences such as unwanted pregnancy, venereal disease, guilt, and social condemnation much more than any positive consequences of sexuality. Despite these social attitudes, it is clear that the pleasure component of sexuality is the major reinforcement for the learning of sexual attitudes and behaviours. Of course, we do not refer to orgasm as the only sexual pleasure, we include all forms of subjectively felt pleasure related to a sexual activity. Defined in this way, pleasure is indeed a part of the vast majority of sexual acts and thoughts. However, non-pleasurable responses may also occur. The sexual action may be uninvited and the response may be negative and painful. There may be guilt in addition to pleasure. In general however, pleasure tends to be the most common consequence of sexuality.
A second very common consequence of human sexual relationships is the development of psychological feelings of intimacy. Although sexual relationships without intimacy do occur – for example prostitution and casual sexual relationships.
Types of Sexual Behaviour
There are many different types of sexual behaviour (see discussion below). Defining “normal” sexual behaviour can be very difficult and will often reflect an individuals own sexuality and prejudices. In general, normal sexual behaviour is not associated with undesirable sequelae either to the individual or to society.
Normal sexual behaviour generally has three purposes. Firstly for reproduction, secondly for pleasure and lastly to promote or strengthen interpersonal relationships—the psychological intimacy previously mentioned.
Sexual abstinence means refraining from any sexual stimulation. (Technically this includes refraining from masturbation as well as sexual involvement with another partner). Abstinence protects individuals from acquisition of STDs, but in general abstinence is usually advocated for moralistic rather than health reasons.
Some cultures and individuals believe that abstinence can in fact be harmful, due to the accumulation of sexual fluids. When counselling clients with STDs and advising abstinence (e.g. until test of cure has been done) it is worthwhile getting some idea about the client’s attitude towards abstinence.
Masturbation should be discussed as a sexual outlet and “permission” given that masturbation is an acceptable practice whilst being treated.
Masturbation refers to self-stimulation or manipulation of one’s own genitals for sexual pleasure. Mutual masturbation is where two people will manipulate their own and each other’s genitals for sexual gratification. Mutual masturbation is a common homosexual behaviour and is now promoted widely as a safe sex behaviour.
There are many masturbation techniques. They may involve stimulation of the genitals, stimulation of extra-genital sites, the use of various parts of the body to provide the stimulus and an assortment of inanimate objects or “toys” which may increase sexual pleasure. However, most masturbatory behaviour involves manual stimulation of the genitals or adjacent areas, with or without associated fantasy. Almost all men and women masturbate at some time in their lives however, strong taboos make open discussion and data collection difficult.
In general the practice is most common in young males, however, masturbation has greater acceptance amongst those with higher (tertiary) education than those who left school at an early age.
In general vaginal intercourse is firmly established as the most desirable or usual sexual behaviour. Extravaginal coitus is considered unhealthy, abnormal or perverse by some sections of society. It should be clearly recognised that extravaginal intercourse (e.g. anal intercourse) is a common sexual behaviour and is not limited to homosexual men. Again it is virtually impossible to get reliable statistics but anal intercourse (if enquired about) is a frequent sexual behaviour reported by women. Many older women, before the advent of modern contraception, relied on anal intercourse as a method of avoiding pregnancy. Vaginal intercourse can occur in several different positions, however, in western society the so called “missionary position” (face to face with the male on top) tends to predominate. This position would seem to be the optimum one for achieving pregnancy. In many other cultures (and possibly increasingly in western societies) the female superior position is more popular.
There are many other variations of vaginal intercourse which are practised by individuals at various times (see references).
It should be noted that although there tend to be some taboos against coitus during menstruation, many individuals continue sexual behaviour during menstruation. Safer sex advice should point out that menstrual blood if infected is an unsafe body fluid.
Anal intercourse is a common component of homosexual behaviour but as already mentioned is also a significant heterosexual behaviour. The anus is an erotically sensitive area closely related to the genitalia in both innervation and muscular response. The rectum is usually empty except during defaecation. Enemas can be used to empty the rectum before anal intercourse occurs, however, faecal soiling to some degree is often a problem and contributes to the higher incidence of STDs with this practice. Anal intercourse without a condom is considered totally unsafe in the current climate of concern about HIV infection. The anus can be easily torn during coitus and thus can allow entry to infected semen very easily. When discussing with clients their sexual behaviour it should be pointed out that unprotected anal intercourse particularly for the passive partner (or recipient) is the most dangerous sexual behaviour.
Counselling should focus around essential use of condoms and discussion of other sexual behaviours e.g. mutual masturbation. It is erroneously thought by many, that anal intercourse is the sole homosexual behaviour usually practised. This is not so, and much homosexual behaviour relies on non-penetrative activity. Different men will behave in different ways and it is essential to ask about sexual behaviour patterns rather than assume a particular practice simply because of sexual partner preference.
Women who have anal intercourse should be counselled that if vaginal intercourse occurs at the same time, vaginal coitus should occur first to prevent vaginal contamination with faecal flora. If anal intercourse occurs first, a condom should be used and then discarded. A new condom should be used before vaginal entry.
Fellatio refers to mouth contact with the penis.
Cunnilingus refers to mouth contact with the female genitalia.
These practices may occur singly, alternately or concurrently either as a prelude to coitus or as a discrete act to lead to orgasm. In general orogenital contact is designed more to stimulate the receiving partner, however it also produces erotic arousal in the stimulating partner.
It should be noted that teeth can produce genital trauma and that human bites can easily become infected. Advice about how “safe” orogenital contact is difficult. Certainly ejaculation into the mouth should be avoided. Condoms use on the male partner increases safety. There is a new latex “female condom” which has been developed, however, it is difficult to know how practical the device will be. Prostitutes should be advised to use condoms for orogenital contact. (In South Australia anecdotal evidence suggests that the majority of sex workers—certainly of those seen in Clinic 275—use condoms for oral sex).
A prostitute or sex worker provides a client with the use of his or her body in return for material gain. Working as a prostitute rarely contributes to that individual’s sexual gratification. There is a distinct separation between “work” and the partner at home.
We know mostly about women who work in the sex industry because they are more common, but male prostitution (both homosexual and heterosexual) is either becoming more common or certainly is being discussed more. In South Australia prostitution remains illegal and it is important to remember that clients may be sensitive and secretive about their occupation until trust and confidence has been gained. Sex workers should be encouraged to have regular checkups in an STD clinic or equivalent.
The role of prostitution in the spread of STDs has varied through the ages, and varies from one country to another. Today its importance depends largely on the extent to which it provides the casual outlet and on the extent to which prostitutes are infected. Prostitution is the major casual outlet in eastern and developing countries, and the prostitutes are heavily infected. In western countries, the “amateur” contact (“casual sex for pleasure”) has become the major source of infection. Prostitution is still very common in western society, and some groups particularly those catering to poorer populations, have a considerable amount of STD. However, an increasing proportion of prostitutes pass on relatively little disease. They are frequently careful in their choice of clients, many of whom have only occasional casual contacts. They often examine their partners’ genitals or undertake other precautions, and they tend to have regular medical examinations to detect and treat STD. Also, large numbers of prostitutes provide mainly hand or oral stimulation (in massage parlours and brothels), and these have a lower risk of STD transmission than does sexual contact between penis and vagina.
Sex workers have been found to practise high levels of safe sex in the course of their work. A survey in New South Wales and the Australian Capital Territory in 1989 found that, of 153 women sex workers, 97% used condoms at work (only 47% used them in private). Another survey in 1990 found that, of 280 sex workers, 97.5% used condoms, 95.4% always. This study compared responses from a Cleo magazine questionnaire which showed that sex workers had a narrower variety and frequency of sexual activities than did other people, but used condoms more often, including with casual partners. The sex workers also had fewer STDs and had more HIV tests than were reported in a similar study in 1985-86. They also contracted more STDs privately than they did at work (Inter-Governmental Committee on AIDS Legal Working Party, 1991).
When prostitution is a criminal offence, sex workers are reluctant to seek medical treatment for fear that the information they provide will not remain confidential. Those who do seek treatment may hide their involvement in the industry. Because of the stigmatisation of prostitution, people who sell sex casually often do not identify themselves as prostitutes. Over-policing can lead to a large subculture of people in this category. Despite these barriers, anecdotal evidence suggests that medical check-ups are occurring regularly in the sex industry and there are high levels of condom use.
Advocates for the maintenance of laws punishing prostitution suggest that this may deter people from becoming involved in prostitution and spreading STDs. There is no evidence to support this. Similarly, compulsory testing for STDs, including HIV, constitutes a personal rights issue, as well as the potential cause of many other problems. It can result in a false sense of security for both sex workers and clients; the “window period” for HIV can mask infection, and tests are accurate only until the next risky exposure. In short:
The treatment of prostitute(s) . . . as wilful children, who cannot be expected to look after their own health, is less effective than providing them with accurate health education and ensuring that they have the power to use it.
(Inter-Governmental Committee on AIDS Legal Working Party, 1991)
Transvestism refers to the use of clothing of the opposite sex for sexual gratification. It may involve single items of clothing or an entire outfit; may be conducted in secrecy or openly displayed to others. This behaviour will often begin before puberty or in adolescence. Usually transvestites have clear cut heterosexual identification and sexual behaviour.
Transsexualism is primarily a disorder of gender identity in which the individual wishes to be or feels that he/she is a member of the opposite sex. It occurs in both sexes but is more common in men. It can often cause great confusion because of the misunderstanding associated with transvestism and homosexuality.
Surgery for transsexuals is available in Australia but must be preceded and accompanied by expert medical management and counselling.
Sexual Partner Preferences – Homosexual and Heterosexual
Each culture spells out the circumstances under which sexual acts are to occur, and one very important circumstance is the gender of the sexual partner. Since the Romans, the western world has been strongly anti-homosexual, and sexual partners are supposed to be of the opposite gender. This is so, despite the fact that all major civilizations report homosexual behaviour.
There are some characteristics peculiar to humans in terms of sexual partner preferences. For example, a preference for a same-gender partner is almost never reported for nonhuman primates. It is a chance and occasional event and not a preference of particular individuals. There are human cultures wherein homosexuality is also a chance occurrence and not a strong preference expressed by a minority; e.g. Marshall and Suggs report that in Mangaia (Polynesia) homosexual behaviour does occur but it is not labelled negatively and does not lead to preferred homosexuality.
Homosexuality is the preference for the same gender in one’s erotic imagery and partners. Note that homosexual behaviour is not included as a necessary part of this definition. Clearly, a person can be a heterosexual and never have heterosexual intercourse, and also a person can be a homosexual and never have a homosexual relationship. In this definition it is the erotic imagery and partners preference that are the heart of the concept of both homosexuality and heterosexuality.
Both homosexual and non-homosexuals may engage in overt homosexual behaviour but the significance of the behaviour is different in the two groups. Among homosexuals, behaviour is quite varied with neither partner necessarily being exclusively “active” or “passive”. Emotional involvement and intimacy is present.
Homosexual behaviour in prisons and in the services generally, tends to be more stereotypic and designed for physical gratification. Certain men will be assigned submissive roles and rape commonly occurs.
Homosexual behaviour in women is often thought to be totally safe however, this is not so. Lesbians should be asked about their sexual practices, the use of sex toys, and the number of partners. Again, women should be warned about the risks associated with menstrual blood.
Homosexual behaviour is a common experience. Although Kinsey et al. reported that only about 1 or 2 percent of the females and 4 or 5 percent of the males in his sample were “exclusively homosexual,” he noted that 13 percent of the females and 37 percent of the males had engaged in at least one homosexual act to orgasm. Such acts often occurred in adolescence and did not develop into habitual patterns. There are no good trend data to indicate whether an increase or decrease has occurred in homosexuality in recent decades, and Kinsey reports no trends in his older data.