Abstract and Keywords
This entry defines sexuality and identifies dominant explanatory models. In doing so, the entry outlines the central debate regarding the relative contributions of biology and social context. In addition, it highlights current key issues in the field of sexuality: the connection between sexuality and social inequality, the growing emphasis on the promotion of sexual health and well-being rather than just the prevention of sexual risk, the salience of sexuality across the life course, and the debate regarding sexuality education policy. Finally, it identifies parallels between these trends and social work, including the relation of sexuality to social work roles and practice.
Definitions of human sexuality have a necessarily wide scope, as reflected in the working definition offered by the World Health Organization (WHO). Empirical evidence also substantiates the need for a broad perspective of the diverse behaviors and relationships through which sexuality is expressed (see the findings of the 2010 National Survey of Sexual Health and Behavior conducted by Indiana University’s Center for Sexual Health Promotion; http://www.nationalsexstudy.indiana.edu/). Many aspects of sexuality are hotly debated, most especially its origin (nature, nurture, or both) and character (risky, normative, or both). These are not simply academic matters; rather, prevailing opinions and theoretical stances have significant implications for sexuality-related policy and practice. Moreover, sexuality is not a neatly cordoned-off domain of life; sexual experiences of all types can have long-term domino effects that shape individuals’ lives and development in dramatic ways [for example, the link between sexual assault and future revictimization (Classen, Palesh, & Aggarwal, 2005)], just as nonsexual life events and conditions play a role in sexual experience [for example, the link between poverty and pregnancy (Harding, 2003; Luker, 1996)].
Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviour, practices, roles and relationships. Sexuality is influenced by the interaction of biological, psychological, social, economic, politics, cultural, ethical, legal, historical, religious and spiritual factors (World Health Organization, 2006, p. 5).
The relative contributions of biology and social context to sexuality are the focus of tremendous debate and divide. This issue underlies discourse surrounding sexual orientation, sexual dysfunction and disorder, and approaches to sexual risk prevention. Given the centrality of this debate to all branches of sexuality theory, research, policy, and practice, this section provides an overview of each of these fundamental positions.
In the WHO definition cited earlier, biological factors appear to be outnumbered by the contextual factors mentioned; however, biology remains the dominant explanatory model for sexuality. There are several biologically based theories of sexuality, some of which are focused on “ultimate” causes, such as long-term evolutionary processes, and others that deal with “proximate” causes, such as hormones (DeLamater & Hyde, 1998). The former, sociobiology, has received significant popular and academic attention. Sociobiology has been used to study various aspects of sexuality, such as jealousy and mate selection, and to argue that observed gender differences in heterosexual relations are the results of natural selection (Buss, 2003). While some evolutionary theories of sexuality treat reproduction as the basis for sexual and romantic behavior, others suggest that although reproduction may coincide with some sexual behaviors (coitus), they are not one and the same. For example, Abramson and Pinkerton (2002) propose that the physical sensation of pleasure is the primary motive for sexual behaviors (of which coitus is only one possibility) and that it is critical to our continuation as a species because it serves to “overcome the disincentives associated with reproduction (for example, the pain and danger of childbirth, menstruation, and so forth)” (p. 111).
Freud proposed that individuals are innately driven by an insatiable and constantly surging libido to seek out erogenous gratification. Drive reduction theories such as Freud’s construe sexual behavior as compelled by an intense and irrational urge that must be restrained by moral and legal codes in order to maintain social order (Abramson & Pinkerton, 2002; Gagnon & Simon, 1973). The enduring influence of this position—and its intersection with notions of an irrepressible male sex drive (Gavey, 2005)—is evident in rhetoric surrounding sexual coercion and assault, in which male sexual aggressors are described as too aroused to stop themselves. A drive reduction perspective also underlies many American policies and debates, such as those regarding sexuality education and sexual health care. In both cases, a persistent concern is that providing information and services too liberally will facilitate licentious sexual behavior. Policy provisions that restrict access (e.g., the exclusion of condom use instruction from sexuality education curricula, the requirement of medical prescription or parental consent for contraception) are seen as a means of curbing an inherent proclivity toward promiscuity.
Proponents of a social constructionist model of sexuality take the position that the biological substrate or physiological mechanics of sexuality are inconsequential on their own; stripped of any surrounding context, arousal (such as, vaginal lubrication or clitoral engorgement), just like sweating or shivering, is simply a physiological state. It is the circumstances and norms surrounding physiological states that imbue them with meaning and significance. Biological models relegate social context to a secondary, mediational role rather than a central and constructive one, whereas social constructionist models theorize the body to be a site or stage on which sexuality is practiced rather than a foundation or source of sexuality (Tiefer, 2004). Sexuality is viewed as a product of norms and discourse practiced by mezzo and macro-level institutions (for example, peers, families, religion, medicine, and media) and as indivisible from intersecting constructs (for example, gender, race, class, sexual orientation, age, and disability).
One of the first and most influential social constructionist theories of sexuality was that of sexual scripts. Gagnon and Simon (1973) argued that individuals’ sexual desires, cognitions, behaviors, and experiences are directed by intrapersonal, interpersonal, and cultural scripts that reflect social norms. Importantly, norms and therefore scripts vary by context; thus one’s behavior during a sexual interaction is a function of immediate circumstance, the individual’s gender, class, race, age, sexual orientation, disability, religion, and so forth, and those of the present partner(s). In critical analyses of how gender norms shape sexuality, scholars have noted that sexual scripts cast women as sexually passive and receptive and men as sexually active and initiating (Gavey, 2005; Morokoff, 2000; Tolman, 2002), thus placing women at a disadvantage in negotiating for their sexual interests with male partners. In addition, social constructionist perspectives cast doubt on medical diagnoses and treatment of disorders such as erectile dysfunction and female sexual dysfunction, which are viewed as commercial inventions of the pharmaceutical and medical industries (Tiefer, 2004; see also http://www.newviewcampaign.org).
The study of sexuality cuts across many academic disciplines and professions. As a result, sexuality theory, research, policy, and practice are highly dynamic as they respond to and build on emerging knowledge and innovations in related fields. While there are too many developments on too many fronts to cover in this briefy entry, the following topics are a subset of key issues that are particularly relevant to social work.
The growing acceptance of the importance of contextual factors in understanding sexuality is evident in the WHO’s working definition. In large part, sexuality has been embraced as a matter of social justice as a result of the struggle against the HIV and AIDS epidemic. In the United States, HIV and AIDS prevention efforts raised awareness regarding the stigmatization of homosexuality and mobilized a new phase of antidiscrimination activism (Andriote, 1999); globally, attempts to stem the catastrophic spread of HIV and AIDS have exposed women’s vulnerability to the virus as a result of gender oppression (World Health Organization, 2006). Leaders in the HIV and AIDS prevention movement vehemently assert that critical steps in the prevention of the virus include increasing women’s direct access to resources such as education, employment, and health care and halting violence against and exploitation of girls and women. While many of the injustices suffered by girls and women have their origin in patriarchal, sexist norms, these also intersect with inequalities based on other social dimensions such as class and race. In the United States, while all girls and women contend with prescriptive gendered sexual scripts as well as the cultural saturation of sexualized depictions of women [what Levy (2005) refers to as “raunch culture”; American Psychological Association, 2007], many also face racist and classist stereotyping and stigmatization as immoral, oversexed, and irresponsible (Reid & Bing, 2000; Stephens & Phillips, 2003). Discrimination also manifests in institutionalized racism, economic injustice, heterosexism, and ableism, which indirectly affect girls and women’s sexual health, relationships, and options insofar as they obstruct girls’ and women’s access to affordable and high-quality sexual health support, information, and services. Furthermore, social inequalities that leave girls and women without viable paths to higher education and gainful employment simultaneously restrict women’s material independence and heighten their subjective investment in relationships, consequently reducing their autonomy and leverage in negotiating with sexual partners.
Since the emergence of sexuality as a focus of scientific study and practice during the late 1800s, it has been approached as a source of treat and pathology (Ingham, 2005).The emergence of HIV and AIDS in the 1980s as public health threats further strengthened the equation of sexuality with risk. Many of the research, policies, and practices that emerged in the wake of HIV and AIDS focused exclusively on the dangers of partnered sexual behaviors (especially those not conforming to standards of heterosexual monogamy among adults; Bay-Cheng, 2003). Gradually, however, this trend is being challenged by those advocating a normative, holistic, strengths-based perspective of sexuality: one that acknowledges the risks associated with sexuality as well as the importance of sexual desire, pleasure, and entitlement. This approach has been embraced by key organizations such as the Guttmacher Institute, Planned Parenthood, and the WHO. Theory, research, policy, and practice that have emerged out of this push for a positive view of sexuality have focused on the importance of sexual empowerment not only in preventing negative sexual experiences and outcomes but also in promoting sexual health and well-being. A vital component of this body of theory, research, policy, and practice is the critical analysis of social inequalities at the root of sex-related risks (Bay-Cheng, 2010; Fine & McClelland, 2006; Santelli & Schalet, 2009; Tolman, 2006).
Sexuality Over the Life Course
Sexuality has been largely overlooked in relation to some stages of the life course, such as in late adulthood, but it has been an almost obsessive focus in relation to others developmental stages, such as adolescence. Child sexuality is an interesting example of both neglect and preoccupation. Kilmer and Shahinfar (2006) indicate that the majority of contemporary research regarding childhood sexuality reflects the prevailing problem-orientation to sexuality insofar as it is commonly framed in the context of sexual abuse and its effects. Some have argued that as a result, we lack perspective on what is “normal” child sexuality. Research regarding children’s sexuality has been stymied by a combination of cultural values (for example, that it is inappropriate to think of children as sexual), logistical difficulties in data collection, and ethical concerns about engaging children as research participants (Kilmer & Shahinfar, 2006). Those studies that do exist are frequently based on parent or teacher observations or on adults’ memories of their childhood experiences; these studies indicate that children engage in a range of sexual behaviors independently and with peers, with the greatest frequency at around age five (Friedrich, Fisher, Broughton, Houston, & Shafran, 1998), and are motivated by pleasure, curiosity, or as “rehearsal” of adult behaviors (Kilmer & Shahinfar, 2006). Another branch of research focuses on the sexual socialization of young children into gendered, heteronormative sexual roles and scripts (for example, Martin, 2009; Martin & Kazyak, 2009).
Adolescence is commonly associated with “raging hormones,” a time when individuals are overrun by sexual impulses that they lack the foresight or fortitude to withstand (Bay-Cheng, 2003). Adolescent sexuality is also useful as an example of how culturally based beliefs about sexuality (such as the drive reduction model) intersect with those about age (such as the necklessness of adolescents) to create a script of hypersexuality and danger (Lesko, 2001; Schalet, 2011). Although adolescence is a time of physiological change and sexual development, it is not necessarily as fraught with danger as is commonly believed. Many common myths regarding adolescent sexuality have been debunked by evidence that youth sexual behavior is not universally risky and ill-advised and that it is not only a normative part of the life course but also critical to developing skills required for healthy adult functioning and relationships (Fortenberry, 2003; Tolman & McClelland, 2011; Welsh, Rostosky, & Kawaguchi, 2000). From this perspective, adult allies, such as researchers, practitioners, teachers, and parents, can best serve the healthy sexuality development of youth not through restriction but through the provision of comprehensive support, information, and services (Bay-Cheng, 2013).
An interesting counterpoint to the characterization of adolescence as hypersexual is the virtual neglect of sexuality in older adulthood. This oversight is gradually being corrected as Americans are living longer and are fitter and more active later in life. Nationally representative studies indicate that significant proportions of older Americans are sexually active, though frequency tends to decrease with age as some sexual difficulties (for example, with arousal and orgasm) increase (Lindau et al., 2007; Schick et al., 2010). Lindau and colleagues found that almost three-quarters of Americans between ages 57 and 65 are sexually active with a partner; over half between ages 65 and 75 are sexually active; and approximately one-quarter between ages 75 and 85 are sexually active. In addition, over half of male respondents and about 25% of female respondents reported masturbating, regardless of whether they had a partner or not. A majority maintained that sexuality was an important part of their lives, thus countering stereotypes of older adults as asexual (Lindau et al., 2007). Barusch's (2008) rich qualitative study of intimacy in older adulthood also attests to the meaning and diversity of sexuality in later life.
Beginning in the 1980s with the Adolescent Family Life Act, federal funds have subsidized abstinence-only until marriage (AOUM) sexuality education in public schools. Under provisions of the Personal Responsibility and Work Reconciliation Act of 1996, federal funding of AOUM sexuality education was significantly increased to an annual allocation of $50 million. To qualify for federal funds, school and community-based programs must adhere to eight points emphasizing the importance of remaining sexually abstinent until marriage in order to safeguard one’s sexual, physical, emotional, and mental health. In addition, these educational programs may not include content regarding condoms or contraception, except to review their rates of failure. Both empirical evidence of the ineffectiveness of abstinence-only education (Kirby, 2008; Trenholm et al., 2007) and critiques of its ideological biases (Elia & Eliason, 2010; Fine & McClelland, 2006; Santelli et al., 2006) have gradually eroded popular, political, and some financial support for AOUM programs, yet federal funding continues. In response, legislation to fund comprehensive sexuality education in public schools has been introduced (most recently in 2013 in the form of the Real Education for Healthy Youth Act) but not yet passed. In addition to these policy efforts to broaden the scope of school-based curricula, several alternative platforms for sexuality education have emerged. For example, community and church organizations have launched programs aimed at providing youth with full information regarding their sexual rights and sexual health, such as the Our Whole Lives Program designed by the Unitarian Universalist Association. There also has been a proliferation of comprehensive sexuality education websites such as http://www.teenwire.com (sponsored by Planned Parenthood), http://www.scarleteen.com (sponsored by Scarleteen), and http://www.sexetc.org (sponsored by Answer at the Rutgers University Center for Applied Psychology). Sexuality education has also become a focus of youth activism through organizations such as Advocates for Youth (http://www.advocatesforyouth.org) and SIECUS (Sexuality Information and Education Council of the United States; http://www.siecus.org). Critiques of sexuality education have also sparked calls for greater inclusivity of diverse youth (not only sexual and gender minority youth but also those with disabilities or trauma histories; Fava & Bay-Cheng, 2012; Lamb & Plocha, 2011), sexuality education that encompasses the ethics of human relationships (Lamb, 2010), and the need for culturally-specific models (Guilamo-Ramos, Bouris, Jaccard, Lesesne, & Ballan, 2009).
Parallels to Social Work
The parallels between these key issues and some of the cardinal features of social work are evident. For instance, the emphasis placed on understanding sexuality in the context of other social dimensions is analogous to social work’s person-in-environment approach. A transactional, systems perspective is also evident in the growing realization that social justice and the remediation of oppression are critical components of sexual health and well-being. Positive views of sexuality are strengths-based and devoted to the cultivation of agency and empowerment. Although much of what we know about sexuality is concentrated on particular stages of life and is often negatively skewed, new research is expanding and balancing our understanding of the variable meaning and role of sexuality across the entire life course. Finally, many of these trends converge in sexuality education policies and practices, including the challenge of risk-focused perspectives of sexuality and the normalization of adolescent sexuality.
Social Work Roles and Practice
Sexuality is not only under the purview of those with “sex” in their professional titles, such as sex therapists, sex educators, or sex researchers. Given the relevance of sexuality to different stages of life and to systems of all sizes, and the placement of social workers in various settings, it stands to reason that sexuality and social work will cross paths in a number of circumstances, including clinical interventions with individuals and families, schools and agencies, community organizing, program and policy development and evaluation. Labor et al. (2004) found that a majority of youth receiving mental health services that were not directly related to sexuality wished that they could talk with a counselor about sexuality. It is important for social workers that are engaged in different settings to be aware of the myriad ways in which sexuality is explicitly and implicitly related to individual, family, and community functioning. Social work practice, in all its diverse forms, that capitalizes on the profession’s holistic understanding of interrelated systems, social justice orientation, strengths-based perspective, and view of the life course will be well-suited to make critical contributions to the field of human sexuality.
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