IASR 2000 Conference Abstracts

In the first part of my talk, I present interview/questionnaire data comparing heterosexual men, gay men, drag queens (who are intermediate between gay men and homosexual transsexuals), and homosexual transsexuals. The common notion that transsexuals are "women trapped in men's bodies" is partly true and partly false. In the second part of my talk I summarize less systematically investigated clinical impressions that should be studied further.

CONTRACEPTION AS A SEXUAL PRACTICE

Bajos, N., Ferrand, M., and GINE Group, INSERM-U292, Hpital de Bictre, 82, rue du General Leclerc, 94276 Le Kremlin-Bicetre Cedex, France (email: bajos@vjf.inserm.fr)

The availability of medical methods of contraception in the 1970s in France has led to the so‑called "second contraceptive revolution." Since that time, contraception has been seen as the exclusive responsibility of women. If medical methods of contraception do permit a separation of intercourse act and pregnancy, this does not mean that contraception and sexuality are disconnected. Contraceptive practice has to be understood within the context of a given sexual relationship. Social research on AIDS has shown how risky sexual behavior is relationally based. In particular, gender relations are essential to understand how risk occurs in specific situations. Surveys on sexual behavior in France have shown that, partly thanks to medical contraception, women's attitudes and sexual practices have changed in the recent decades in that women today are more active and more sexually satisfied. Nevertheless, gender differences in sexual attitudes and practices are still important. Following French sociologists, we argue that women's control of contraception has not led to the disappearance of male domination in the sexual arena but that this domination takes new forms. Based on the results of a qualitative survey conducted in 1999 of 50 women who had an unwanted pregnancy in the last three years, we examine how contraceptive practice is negotiated between partners in those sexual events where women knew they were exposed to an unwanted pregnancy. The analysis of the in‑depth interviews lead us to distinguish two types of situations. In the first, risk taking is relational in the sense that women, while not specifically wishing to get pregnant, were ambivalent. The unprotected sexual intercourse happened because the men were not at all concerned with contraception and were motivated by their interest in sexual pleasure. In the second type of situation, women clearly did not want to get pregnant, and told their partners that they were not using contraception, and asked them to use a condom, to postpone the sexual intercourse, or to use withdrawal. Due to the fact that both women and men accepted the preeminence of male sexual pleasure and that women were not in a position, socially speaking, to negotiate contraceptive use, sexual intercourse without any protection occurred. These results show that contraceptive practice becomes comprehensible within a given relational context and that sexual issues play an important role in producing unprotected sexual intercourse.

TESTOSTERONE, THE PREOPTIC AREA, AND THE ACTIVATION OF MALE SEXUAL BEHAVIORS

Ball, G. F., Riters, L., and Balthazart, J., Department of Psychology, 3400 N. Charles St., Johns Hopkins University, Baltimore, Maryland 21218-2686; Department of Psychology, University of Nebraska, Omaha, Nebraska; Laboratory of Biochemistry, University of Liege, Liege, Belgium (email: gball@jhu.edu)

Male sexual behavior in non‑human animal species consists of courtship (sometimes referred to as appetitive sexual behaviors) followed by copulation (referred to as consummatory sexual behavior). For example, in avian species, male courtship often includes species‑typical vocal behaviors that females find attractive and that facilitate the onset of copulation. Both components of male sexual behavior are dependent on high concentrations of circulating testosterone in the plasma. Testosterone is usually metabolized to estrogenic or androgenic metabolites in the brain which, in turn, bind to estrogen or androgen receptors to promote behavioral activation. The conversion of testosterone into an estrogen, such as estradiol, appears to be critical for the activation of both components of sexual behavior. It is now clear, based on lesion studies carried out on a large number of vertebrate species, that the preoptic area (POA) is essential for the activation of male‑typical copulatory behavior. It is also apparent that this brain area is the critical site where testosterone is metabolized and binds to steroid receptors to exert its effects of male copulatory behavior. It has been argued that the POA plays a role specifically in copulatory behavior per se and not in other aspects of male‑typical sexual behaviors. However, recent animal studies question this claim. For example, studies in Japanese quail have revealed that this region also regulates the occurrence of appetitive male sexual behaviors that anticipate copulation. In male European starlings, POA lesions blocked the performance of male song that attracts females. There is some evidence that sub‑regions of the POA are differentially involved in different aspects of male sexual behavior. However, these recent findings do indicate that the preoptic region plays a general role in the regulation of a variety of aspects of male sexual behavior. Future studies need to focus on the connectivity and neurochemistry of this region in relation to specific measures of male sexual behavior. The fact that this brain area is critical for many aspects of male sexual behavior will make it a challenge to identify compounds that selectively enhance or block anticipatory aspects of male sexual behavior as compared to copulation per se.

SEXOLOGY AND EUGENIC STERILIZATION IN EARLY 20^TH CENTURY FRANCE

Bjin, A., Centre National de la Recherche Scientifique, 9, rue de Guise, 02140 Vervins, France (email: nbejin@aol.com)

No legislative measure allowing for voluntary or forced eugenic sterilization was adopted in France in the first half of the 20th century. This is in contrast to neighboring countries such as Switzerland (Canton of Vaud, 1928), a number of American states (beginning with Indiana in 1907), the Scandinavian countries (Denmark 1929, 1934, and 1935; Norway 1934; Sweden 1935 and 1941; Finland 1935), and, finally, Nazi Germany (1933). However, recourse to eugenic sterilization had been advocated in France since, at least, 1890. It was supported by important French authors, such as the eugenicist Georges Vacher de Lapouge, the libertarian neo-Malthusian Paul Robin (who influenced Margaret Sanger), the Nobel prize winner in Medicine, Charles Richet, and the biologist and writer Jean Rostand (elected to the Acadmie franaise in 1959). French sexologists, Dr. Edouard Toulouse (founder in 1931 of the Association dtudes sexologiques (Association for Sexological Studies) and Ren Guyon (in 1936), better known outside of France than in his own country, favored eugenic sterilization for "medical reasons." Their proposals were hardly unique among sexologists. They were similar to those of Havelock Ellis (in 1917) and were milder than those of the Swiss sexologist Auguste Forel, or even those of Kinsey (in 1935). In my lecture, I will analyze the debates on eugenic sterilization in France from 1890 to 1950 and I will explore the principal reasons for the lack of legislation on this question during this period in the context of favorable arguments by Neo-Malthusians, eugenicists, and natalists.

THE PREVALENCE OF SEXUAL PROBLEMS IN GERMAN GENERAL PRACTICE: IS IT A TOPIC?

Berner, M. M., and Berger, M., Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University, Hauptstr. 5, 79104 Freiburg im Breisgau, Germany (email: michael_berner@ psyallg.ukl.uni-freiburg.de)

Although the general prevalence of sexual problems in Germany seems remarkably high, there appears to be little reflection of that in general practice. To examine the prevalence in general practice, we conducted a small survey by questionnaire.

151 general practitioners (76% male, 24% female; M age, 48 8 years) were asked to rate the prevalence of sexual problems as part of their daily practice. They were also given a list to create a hierarchy of the most common problems. In addition to questions on the importance of sexology teaching, prescription patterns of sildenafil and affiliation to a sexual psychologist were asked.

Estimation of the prevalence in daily practice was generally low (4.05 3 % of daily routine; 29% and 54% answered "rarely" and "sometimes," respectively). The three most common problems were erectile dysfunction, sexual problems connected with physical illness, and those of the aging male and female. 41% and 42% rated teaching sexology as medium and quite important. Whereas 87 % of the physicians already had prescribed sildenafil (median quantity, 10 times), 78% of those did so without prior consultation of a specialist. Only 25% knew the address of a sexual psychologist.

Sexual problems are not seen as common by the German general practitioners in their daily practice. This might be due to reluctance either of patient or therapist to address those problems. It has to be clarified if in a larger proportion of patients if there is suffering from sexual problems despite not talking to their practitioners about it. We conclude that there is a clear tendency towards solving sexual problems in a medical way than to consider non-medical strategies.

COUNSELLING BY PHONE AS A PSYCHOEDUCATIVE AND MOTIVATIONAL AID IN SEXUAL DYSFUNCTION: IS IT WORTH THE DOING?

Berner, M. M., Popken, G., Popken, K., and Wetterauer, U., Department of Psychiatry and Psychotherapy, Albert Ludwigs University, Hauptstr. 5, 79104 Freiburg im Breisgau, Germany; Department of Urology, Albert Ludwigs University, Freiburg im Breisgau, Germany (email: michael_berner@ psyallg.ukl.uni-freiburg.de)

In the light of the huge advances in the medical treatment of erectile dysfunction, little attention has recently been paid to psychotherapeutic interventions. Considering the dysfunction as psychophysiological, the importance of psychological factors is nevertheless evident. Despite high prevalence of sexual dysfunction, only a small proportion of patients seek treatment. This might be to either lack of time in doctor-patient contact, a high anxiety to address the problem in direct contact, or lack of knowledge about the dysfunction and treatment options.

To give patients the opportunity to talk anonymously about their sexual problems and to gather information, we founded the "Informationszentrum Sexualitt und Gesundheit e.V" (Information Center for Sexuality and Health [ISG])) as a charitable organization in Freiburg. The ISG offers patients a scientifically supervised telephone "helpline" for callers from the whole of Germany which is open 35 hrs per week. According to the first two steps of the PLISSIT-concept, the aim is to show acceptance and empathy for patients' problems as well as to inform, educate, and motivate the patient to seek professional advice if necessary. No diagnosis is made.

In the first 100 days, the ISG received 1787 calls (M, 18 per day). The mean duration of the call was 6 min 40 sec. The maximum duration was 60 min. 86.1% of the callers were male. 58.6% of the callers asked to receive written information as well. More than two-thirds of the calls were concerning erectile dysfunction and their treatment options. There were only very little faked or abusive calls. 21.4% of the callers were suggested to contact a urologist first, 7.2% a psychosexual therapist.

The counseling by phone established itself in a very short period and was well accepted by the community. The main aims of the callers were to be listened to and to receive information free of commercial interests. The next step is now to establish a quality management instrument to investigate if patients found the call to be useful and helpful, as well as to conduct a three- month follow-up about the effectiveness and the result of the psychoeducation and motivation offered.

AUTOGYNEPHILIA AND THE TAXONOMY OF GENDER IDENTITY DISORDERS IN BIOLOGICAL MALES

Blanchard, R., Law and Mental Health Program, Centre for Addiction and Mental Health--Clarke Division, 250 College St., Toronto, Ontario M5T 1R8 Canada (email: Ray_Blanchard@ camh.net)

By 1980, the clinical literature included a confusing array of classification schemes for gender identity disorders in biological males. One thing that most authorities did agree on is that gender identity disorders are phenomenologically and probably etiologically heterogeneous. The taxonomic question, therefore, was not whether there is more than one type of transsexualism in males, but rather, how many more than one type, and how these should be characterized. The research strategy that I used for this question was to start by distinguishing a larger number of groups and then reduce this to a smaller number by combining groups that seem to be merely superficially different variants. I started this research program by returning to the first taxonomic scheme ever proposed, namely, that advanced by Magnus Hirschfeld. He distinguished four main types of transvestites: heterosexual, asexual, bisexual, and homosexual. I therefore began my research by defining and labeling groups in the manner introduced by Hirschfeld, that is, according to their erotic interest in men, women, both, or neither. My empirical research showed that bisexual, asexual, and heterosexual transsexuals are similar to each other, and dissimilar to homosexual transsexuals, with regard to a history of transvestic fetishism, degree of recalled childhood femininity, age at clinical presentation, extent of interpersonal heterosexual experience, and a history of erotic arousal in association with the thought of being a woman. These findings indicate that there are only two fundamentally different types of transsexualism in males: homosexual and nonhomosexual. This points to the next question: What do the three nonhomosexual types have in common? I have suggested that the common characteristic is their paraphilic tendency to be sexually aroused by the thought or image of themselves as women--an erotic orientation that I have labeled autogynephilia. The concept of autogynephilia is obviously related to the concept of (fetishistic) transvestism. Autogynephilia is much broader, however, in that it encompasses transvestism as well as erotic fantasies and behaviors in which the wearing of womens apparel is secondary or absent altogether. For example, the favorite masturbatory fantasy of some autogynephiles is simply the mental image of themselves with a nude female body--not doing anything in particular or having sex with another person, but simply existing. Thus, the concept of autogynephilia is useful, not only for explaining why heterosexual, asexual, and bisexual transsexuals are more similar to each other than any of them is to the homosexual type, but also for understanding the essential similarity of transvestism and the many other forms of sexual behavior in which paraphilic men enact their erotic fantasies of being women with symbols other than womens attire.

BIRTH ORDER AND SEXUAL ORIENTATION IN A NATIONAL PROBABILITY SAMPLE

Bogaert, A. F., Department of Community Health Sciences and Psychology, Brock University, St. Catharines, Ontario L2S 3A1 Canada (email: tbogaert@spartan.ac.brocku.ca)

The relation between birth order and sexual orientation in both men and women was examined in a national probability sample from the United States (Laumann, Gagnon, Michael, & Michaels, 1994). In addition, a possible mechanism that may underlie a birth order-sexual orientation relationship‑‑sibling sexual activity/influence‑‑was examined in these data. As in previous studies, men with same‑sex attraction were later born relative to men with opposite‑sex attraction and there was no birth effect in women. In addition, no evidence was found that sibling sexual activity/influence (e.g., mutual sexual play/activity among brothers) underlies the birth order effect in men. These results suggest that existing birth order-sexual orientation findings are reliable, despite recent sampling problems in other research areas on sexual orientation development, and that future research needs to concentrate on other theories of the birth order effect, particularly on gender‑specific (i.e., male only) developmental mechanisms.

MEN AND WOMEN'S SEXUAL BEHAVIOR IN RESPONSE TO LABORATORY INDUCED SEXUAL AROUSAL

Both, S., Spiering, M., Everaerd, W., and Laan, E., Department of Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands (email: kp_both@ macmail.psy.uva.nl)

Emotions can be considered as changes in action readiness. Since emotions serve to satisfy concerns, they result in motivational states. When applied to sexual emotions, this means that sexual arousal should result in sexual action. The purpose of this study was to perform a test of the prediction that sexual arousal motivates sexual behavior.

The relation between sexual arousal and sexual behavior was investigated by comparing sexual behavior following neutral and sexual film excerpts. 22 male and 25 female subjects participated and were randomly assigned to a neutral or sex film condition. Genital and subjective sexual responses to the film were measured. Sexual behavior was measured by a questionnaire assessing the frequency and latency of sexual activity (alone or with a partner) after exposure to film. Subjects completed the sexual behavior questionnaire 24 hours after finishing the experimental session.

The sexual film evoked significantly higher levels of genital and subjective arousal. In agreement with our expectations, men and women showed more sexual behavior after exposure to the sex film compared to the neutral film. For the sex film group, correlations between behavior and genital and subjective arousal were calculated. In women, sexual behavior was positively correlated with subjective and genital arousal, although most correlations were

nonsignificant. In men, a mixed pattern of correlations was found. The results show that sexual arousal in response to a sexual stimulus facilitates sexual behavior. Regarding the correlations between sexual behavior and subjective genital arousal, the mixed results may be due to the small number of observations.

The results confirm the view of sexual emotions as preparations of sexual action and support the external validity of laboratory experiments of sexual responses.

LOVE, SEX, AND THE DYNAMICS OF COUPLE LIFE

Bozon, M., Institut National dEtudes Dmographiques, 133 Bd Davout, 75980 Paris Cedex 20, France (email: booz@ined.fr)

This paper deals with the dynamics of sex life among French couples. The data are taken from a quantitative survey on sexual behaviour in the general population (N = 4800), carried out in 1992, in which transversal information on lasting couples under 45 was used in a longitudinal perspective. Sex life in lasting couples follows a rather predictable course, with a stable link to the duration of couple. This finding is not quite new but former interpretations were diverging and sometimes trivial. Some authors think that after the sexual honeymoon of the early period, conjugal sex life follows a course of steady decline, resulting in a drop in frequency of and satisfaction with intercourse. For other authors on the contrary, as spouses need time to adapt to each other, it is only when they have gathered enough experience that mutual sex becomes satisfactory, and contributes in stabilizing the relationship. Neither of the two theories is fully supported by the data. Sex in the early couple is characterized by a high frequency of intercourse, but also by a high rate of sexual dysfunctions, by strong love feelings, and strict expectations about partners fidelity. In the stabilized couple, after some years, the intensity of feelings goes down, the frequency of sex drops as well as the prevalence of dysfunctions, and both spouses become more flexible on fidelity. In the transition from early couple to stabilized couple, child birth is often central. It tends to accelerate the drop in the frequency of intercourse; it plays also a specific role in the weakening in womens sexual initiative and desire, compared to mens. Gender relations and the fact that women and men play different roles in sex and as a couple are actually one of the main factors behind the dynamics of marital sex. A marked contrast between women and men is observed, in the form of a potential tension between an individual interpretation of sex, dominant among males (in which sexuality and desire are about self-making and self-identity), and a conjugal interpretation, prevailing among females (in which sex is firstly in the service of a relationship). Whereas this tension is easily overcome in the early period, it re-emerges forcibly in the stabilized couple.

AN EVALUATION OF A MIXED‑GENDER SEXUAL ASSAULT PREVENTION PROGRAM

Bradley, A., Yeater, E., and O'Donohue, W., Department of Psychology, University of Nevada‑ Reno, Mail Stop 298, Reno, Nevada 89557 (email: abradley@scs.unr.edu)

Sexual assault on college campuses in the United States is a serious problem. Studies suggest that the rates of sexual assault among college women are substantially higher than women in the general population (Koss, Gidycz, & Wisniewski, 1987). Furthermore, sexual assault experiences often result in psychological and emotional difficulties, such as substance abuse, depression, sexual dysfunction, anxiety, and relationship problems (Polusney & Follette, 1995). Due to the difficulties created by sexual assault and the relatively high rates among college age women, sexual assault prevention programs are needed to reduce the rates of sexual assault on college campuses.

This study evaluates the effectiveness of a mixed‑gender sexual assault prevention program on a college campus. The program was designed to be administered during one class meeting to both male and female undergraduate students. The goals of the prevention program are to: (1) decrease adherence to rape myths; (2) increase awareness of sexual assault; (3) increase empathy for victims of sexual assault; (4) increase clear communication about sex in social or dating situations; (5) emphasize the consequences of engaging in assaultive behavior; and (6) decrease the use of risky behaviors in dating situations.

Subjects include 200 college undergraduates, half of which received the prevention program during a class. Male participants were given the Victim Empathy Scale, Probability Questionnaire, and Rape Myth Acceptance, Acceptance of Interpersonal Violence, and Adversarial Sexual Belief Scales. These scales are designed to assess empathy of victims of sexual assault, adherence to rape myths, and identification of the negative consequences for engaging in assaultive behavior. Female participants were given the Sexual Assault Awareness Survey, Dating Behavior Survey, and Sexual Communication Survey. These measures are designed to assess women's beliefs about sexual assault, risky behaviors in which women engage, and communication in dating situations. Responses to questionnaires are compared with responses from students who did not receive the prevention program. The development of the prevention program as well as its effectiveness with a college population are discussed. Implications for future prevention programs and methodological issues in prevention research are also discussed.

ADAPTATION OF THE TIMELINE FOLLOWBACK TO THE ASSESSMENT OF SEXUAL BEHAVIOR

Carey, K. B., Carey, M. P., Maisto, S. A., and Gordon, C. M., Center for Health and Behavior, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, New York 13244‑2340 (email: kbcarey@syr.edu)

Detailed assessment of sexual behavior poses challenges to researchers who work with populations characterized by low literacy or cognitive limitations. The purpose of our research was to adapt the Timeline Followback (TLFB) interview to facilitate the assessment of sexual behavior as well as substance use, to assess its feasibility for use with psychiatric outpatients, and to obtain evidence of its reliability and validity. Our research involved four steps. First, we adapted the TLFB interview to assess sexual behavior as well as alcohol and drug use; experience with over 100 participants with severe and persistent mental illness revealed that the TLFB methodology was feasible and engaging. Second, we evaluated the inter‑rater reliability of the coding scheme developed for sexual behaviors. Intraclass correlations (ICCs) ranged from .80‑1.00, with a mean of .98. Third, we evaluated the test‑retest stability over a period of one week. Significant ICCs indicated that the frequency of both sexual behaviors and substance use were reported consistently. Fourth, we compared the TLFB data with standard survey items to obtain evidence of validity for the sexual behavior items. Both methods produced high levels of agreement. We conclude that the TLFB interview provides reliable reports of sexual behavior and substance use, and also yields event‑level data that are extremely valuable for sexual behavior and HIV‑prevention research.

PREVALENCE AND CORRELATES OF HIV RISK BEHAVIOR AMONG PSYCHIATRIC OUTPATIENTS

Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., and Vanable, P. A., Center for Health and Behavior, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, New York 13244‑2340 (email: mpcarey@syr.edu)

This study estimates the prevalence and identifies the correlates of HIV‑related risk behavior among adults living with a mental illness. Medical records from two outpatient psychiatric clinics in a mid‑sized U.S. city were reviewed to obtain data on demographic and psychiatric characteristics, sexual behavior, and substance use. Data from 1,630 outpatients indicated that 68% were sexually active and 22% were at elevated risk for HIV infection during the past year. The most common risk behavior involved having multiple sexual partners (19.5%), with injection use being less frequent (5%). During the past year, 3% of patients reported a diagnosis of an STD, 3% had traded sex, and fewer than 1% had shared injection equipment. Being sexually active and being at elevated risk for HIV infection were both associated with alcohol and drug use, psychiatric diagnosis, marital status, race, and age. We conclude that routine screening for HIV risk in psychiatric settings can identify patients who may benefit from risk reduction programs.

GENITAL AND SUBJECTIVE SEXUAL AROUSAL IN HETEROSEXUAL, BISEXUAL, AND LESBIAN WOMEN

Chivers, M. L., and Bailey, J. M., Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, Illinois 60208‑2710 (email: m‑chivers@nwu.edu)

This study examined whether heterosexual, bisexual, and lesbian women's subjective and genital sexual arousal is higher to sexual stimuli depicting their preferred sexual partners. That is, do women exhibit a target‑specific pattern of sexual arousal? Thirty‑nine women (12 lesbian, 15 bisexual, 12 heterosexual) were exposed to sexual stimuli (film excerpts) depicting lesbian, heterosexual, and gay sex. Photoplethysmographic vaginal pulse amplitude and self‑reported ratings of sexual arousal were recorded continuously. Subjective arousal responses showed a pattern of target‑specificity while genital responses did not. The lack of target‑specific genital

arousal in women may be an important factor in broadening our understanding of female sexual orientation and female sexuality in general.

INTERNALIZING DISORDERS IN PREPUBERTAL CHILDREN WITH GENDER IDENTITY DISORDER

Cohen-Kettenis, P. T., van Goozen, S. H. M., and Snoek, H., Department of Child & Adolescent Psychiatry (B01.324), Rudolph Magnus Institute for Neurosciences, Utrecht University Hospital, POB 85500, 3508 GA Utrecht, The Netherlands (email: p.t.cohenkettenis@ psych.azu.nl)

In various studies, high percentages (up to 84%) of prepubertal children with gender identity disorder (GID) have been found to show behavioral and emotional problems (Coates & Person, 1985; Zucker & Bradley, 1995; Zucker et al., 1996). The reported problem behaviors primarily belong to the so-called internalizing domain, such as fearfulness, inhibition, separation anxiety, social incompetence, and feelings of inadequacy and depression. It has been suggested that anxiety in particular contributes to or even determines the development of GID. Other types of internalizing psychopathology, such as depression and social withdrawal, are supposed to be the result of social ostracism. So far, the studies included only parent and child interviews and questionnaires, but no psychophysiological or hormonal measures that are indicative of high levels of anxiousness.

We investigated whether GID children are more anxious than normal controls (NC) as measured by a parent questionnaire, saliva cortisol levels, skin conductance and heart rate before and during interpersonal stress. Subjects were 25 GID children (21 boys and 4 girls) and 26 controls (20 boys and 6 girls). Interpersonal stress was induced, using a previous developed method (Van Goozen et al., 1998), for 75 minutes and involved frustration, provocation, and aggression in a general setting of competition between the real subject and a videotaped opponent of similar age and sex, who competed for best performance over the session. Provocation was standardized by using a pre-recorded videotape of the competitor. This competitor criticized the performance of the subject in a derogatory way.

The parent questionnaire scores showed that GID children do not show the high levels of general psychopathology as reported in the literature. Though neither the internalizing nor the anxiety scores are in the clinical or borderline range, GID children were reported to show more internalizing than externalizing behaviors. With the exception of their skin conductance levels, GID children did not react in any other way differently from the normal controls, as measured by means of heart rate and cortisol, when they were exposed to interpersonal stress.

Our data offer little support to the idea that anxiety plays an important role in the etiology or maintenance of gender identity disorder in prepubertal children.

SEXUAL RESPONSE IN WOMEN

Cutler, W. B., McCoy, N. L., Zacher, M. G., Genovese, E., and Friedmann, E., Athena Institute for Womens Wellness Research, 1211 Braefield Rd., Chester Springs, Pennsylvania 19425; Department of Psychology, San Francisco State University, San Francisco, California; Division of Reproductive Endocrinology, Albert Einstein Medical Center, Bronx, New York; IMX, Bala Cynwyd, Pennsylvania; Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York (email: Cutler@ AthenaInstitute.com)

This research examined the sexual activity, frequency, and orgasmic experience in: (1) 132 women with an intact uterus undergoing assessment in the Athena Institute's Women's Wellness Program; (2) 37 other patients with uterine fibroid tumors; and (3) 23 women from the Wellness Program who had had a hysterectomy. We compared these data to recently published data on sexuality for women before hysterectomy and for women from the Wellness Program who had had a hysterectomy.

Consecutive patients undergoing comprehensive executive physical exams were offered perineometry tests of pubococcygeal muscle strength and endurance and asked to complete extensive questionnaires on genitourinary experience of incontinence and sexual response including coital and orgasmic frequency. Women using either oral contraceptives or Prozac were excluded from our final data analysis because of recent studies showing sexual response deficiencies in these groups. Informed consent was obtained to use their data. An unaffiliated gynecologist provided the same questionnaires to the 37 patients with fibroid tumors who mailed them to the Athena Institute.

Confirming prior reports, clitoral and vaginal sites were commonly recognized as sites contributing to orgasm. A third site--the cervix---was reported by a substantial minority of women. Both study groups showed similar responses. Cervical stimulation was recognized as making a contribution to orgasm by 46% of the wellness program women and 70% of the fibroid patients. Vaginal stimulation was recognized in 86% and 91% respectively. Clitoral stimulation was reported in 98% and 97%. Although pelvic muscle strength and endurance had previously been shown to be inversely related to incontinence neither was related to these sexual findings. Parity also was an independent factor; multiparous women were more sexually responsive than primiparas or nulliparas. Women who were scheduled for hysterectomy showed both a statistically and clinically significant reduction in sexual activity and orgasm compared to other women.

Most women reported that clitoral stimulation evoked their orgasms; many women also recognized that vaginal stimulation would; fewer also perceived that cervical stimulation could contribute to their orgasm. More women with fibroid tumors reported being sexually responsive than intact well women at the vaginal and cervical sites. Probably, hysterectomy negatively impacts sexuality. We found intact well women more sexually active and orgasmic than women scheduled for surgical removal of the uterus. Recent studies using the pre-op period as a baseline have employed a distorted, i.e., suppressed prehysterectomy measure of sexuality; those studies incorrectly compared posthysterectomy sexuality at 2 years to support an invalid conclusion that hysterectomy "improves" a woman's sexuality. Multiple child bearing appeared to improve perceived sexual responsiveness at vaginal and cervical sites.

SOCIOSEXUAL RELATIONS OF INSTITUTIONALIZED DISABLED INDIVIDUALS:

A SECONDARY ANALYSIS OF THE HID SURVEY

de Colomby, P., and Giami, A., Inserm U 292, Hpital de Bictre, 94276 Le Kremlin Bictre, Cedex, France (email: colomby@vjf.inserm.fr)

The sociosexual relationships among disabled people have been rarely studied until now. This may be due to the difficulties in communicating with these persons, but also by difficulties in contacting them. In 1999, a large quantitative survey about "Handicap, Disabilities and Institutions" (HID) was conducted in France among 15,000 persons of every age living in specialized institutions. Despite the fact that the main purpose of the HID survey was to estimate the number of disabled men and women living in institutions, to evaluate the degree of handicap or disablement, to estimate the discriminations faced in education, employment, transports, and so on, a few questions were asked concerning matrimonial status, whether they consider they live (or not) in a coupled relationship, and if they actually have a sexual partner, which allowed us to analyze and estimate the possibility for these persons to have such a relation. Two more questions were asked about the frequency of encounters and the possibility of privacy with the partner in the institution itself.

Our analysis is based on the 6628 persons aged 16-69 yrs who answered the questionnaire. The main hypothesis is, following Goffman, that sociosexual life is dependent on suffering from a handicap or from disabilities and on living in an institution. These analyses were mainly performed using statistical methods such as factor analysis and logistic regression. We also controlled for whether the responses were given by the respondent himself (30%), with somebody's help (35 %), or by a third party (35%). In these two last cases, the respondent (or the co-respondent) was mostly a member of the establishment staff.

One of the most dramatic results is that only 23% of the HID respondents aged 16-69 declared that they live in a coupled relationship or have a current sexual partner vs. 75% of the French "general population." However, those who are physically or mentally independent, less than 50 years old, those who live in an institution for adults, psychiatric establishment or hospital and those who are in a "middle size" institutions (between 50 and 100 residents) for less than 5 years are more likely to have a current sexual partner. This is also the case for those who responded by themselves, which can be explained either by the fact that they are the less dependent but also less exposed to the constraints of the institution. In addition, women are more likely than men to declare having a sexual partner, something never found in the general population. The greater number of men than women between 16 and 69 living in institutions may be a possible explanation, but it is also possible that women are more vulnerable to sexual advances than men in specialized institutions.

THE SEX LIVES OF THE OVER 50s

Delbs, C., and Gaymu, J., Institut National dEtudes Dmographiques, 133 boulevard Davout, 75020 Paris, France (email: fng@club-internet.fr)

Society has always considered old age to be a sexless time of life. However, the study of sexual behavior shows that certain elderly and even very elderly people continue to have an active and satisfactory sex life. Older people differ of course from younger people in several respects: they are less likely to have a partner, they have sex less often, their ways of loving are less varied and they are less satisfied. The comparison of the Simon (1970) and ACSF (1992) surveys has shown that this is not entirely an effect of advancing age (associated with ill health and in particular sexual dysfunction) or of life cycle (loss of partner, erosion in a couple, etc.). Elderly people in 1992 had a better sex life than in 1970, which means that there was, and perhaps still is, a generation effect. Observation of the 1921-1940 cohorts, who have benefitted from the sexual revolution shows that, contrary to what is seen in cross-sectional observation, there was no contraction of the sexual repertoire. Reaching orgasm by manual or oral caresses became more frequent and levels of post-coital well-being and sexual satisfaction were higher. The differences observed in 1992 between younger and older people are thus due partly to the fact that the latter have lived all or part of their sex lives at a time when sexual expression was more controlled.

FACTORS AFFECTING SEXUAL FUNCTIONING DURING THE MENOPAUSAL TRANSITION

Dennerstein, L., Lehert, P., Burger, H., and Dudley, E., Office for Gender and Health,

Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Charles Connibere Bldg., 6^th Fl., Victoria 3050, Australia (email: l.dennerstein@medicine. unimelb.edu.au)

The purpose of the present study was to determine whether women's sexual functioning is affected by the natural menopausal transition and the relative roles of hormonal and psychosocial factors.

This was a prospective, observational study of a community based sample of Australian born women aged 45-55 at baseline. Baseline telephone interview of 2001 women, then 8 annual assessments in womens own homes, including self-report questionnaire based on the McCoy Female Sexuality Questionnaire and blood sampling for hormone levels.

Retention rate at year 8 was 88%. Using a difference score in which values prior to the late perimenopause were meaned and compared with those from later phases, we found a significant decline in sexual functioning and a negative correlation with FSH. There were no significant correlations between sexual functioning and the androgens or with estradiol. Using structural equation modeling on 6 years of follow-up data, we found a significant direct effect of menopausal status on vaginal dryness/dyspareunia and an indirect effect on sexual responsivity via a direct effect of menopause on symptoms. Feelings for partner and partner's sexual problems directly affect the different aspects of sexual functioning. Other social variables, such as paid work, interpersonal stress, daily hassles, and educational level affect sexual functioning via effects on symptoms and well-being.

Both hormonal and psychosocial factors affect women's sexual functioning during the midlife years, with particularly powerful effects of feelings for partner.

THE EVOLUTION OF SEXUAL BEHAVIOR IN MONKEYS, APES, AND MAN

Dixson, A. F., Center for Reproduction of Endangered Species, Zoological Society of San Diego,

POB 120551, San Diego, California 92112-0551 (email: adixson@sandiegozoo.org)

The evolution of human sexuality may be studied by a number of methods. Fossils can tell us something about the degree of sexual dimorphism in body size and dentition, for example, but they reveal little about the sexual behavior of ancestral forms. Then there is the rich field of cultural anthropology, with its comparative perspectives on human mating systems and patterns of sexual behavior. Experimental studies, which examine the physiological and psychological basis of human sexuality, supply much useful information. However, a fourth area concerns comparative research on the non-human primates, some 250 species of which still exist in South America, Africa, and Asia. The patterns of copulatory behavior, mating systems, and reproductive anatomies of these primates have a great deal to tell us about the human condition. Indeed, since sexual behavior does not leave a fossil record, comparative studies of the extant primates offer the most effective way to understand how sexual behavior and the anatomy of the genitalia might have evolved in human beings.

This lecture will summarize evidence relating to several questions. First, how did human copulatory postures evolve? Second, what factors have influenced the evolution of copulatory durations and frequencies in the human species? Third, has sperm competition played any significant role in the evolution of the human reproductive organs, mating systems, and mating tactics? Many gaps remain in our knowledge of the non-human primates; sadly, many of them are endangered species so that opportunities for study decrease with each year that passes. Nonetheless, I hope that after listening to this lecture you will agree that comparative studies of primate sexuality have as much to us about human evolution as comparative research on primate skeletal anatomy, dentition, or neuroanatomy and physiology.

BDSM INTERNET WEB MASTERS: GENDER AND SEXUAL ORIENTATION EFFECTS ON THE INTERNET SEX SURVEY RESPONSES OF SELF-PROCLAIMED SADOMASOCHISTS

Fedoroff, J. P., and Jacques, T., Law and Mental Health Program, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8 Canada (email: Paul_ Fedoroff@camh.net)

Internet survey responses by 1,044 people (483 men and 561 women) with a sexual interest in some aspect of "bondage, discipline, submission, sadism and/or masochism" (BDSM) were analyzed to examine the effects of gender and sexual orientation upon self-reported sadomasochistic interest and behavior.

Using the Kinsey scale of sexual orientation, 29% of the male respondents and 14% of the female respondents were sexually attracted mostly or only to the same sex (Kinsey 5 or 6). As predicted, there were several statistically significant differences between men and women in terms of self reported sexual characteristics. Compared to men, female respondents had fewer life-time sexual partners (p < .0001) and were more likely to have been sexually abused in childhood (p < .0001). Homosexual (Kinsey 5-6) men and women were significantly older than heterosexual men and women (Kinsey 0-4) when they became aware of their sexual orientation (p = .002). However, there were no significant differences between men and women of either sexual orientation at the time of first masturbation or awareness of an interest in BDSM activities. For both groups, age of first interest in BDSM was significantly later than age of awareness of sexual orientation (p = .005). Surprisingly, most respondents reported engaging in BDSM activities without accompanying sexual activities. Compared to their heterosexual counterparts, lesbian women were significantly less likely to separate sex from BDSM activities (73% vs. 84% respectively, p < .01). Finally, heterosexual men were more likely to engage in exclusively sadistic sexual activities than were gay men or (straight or lesbian) women (p < .05).

Taken together, the results of this study lend support to the view that the development of sexual orientation is independent of the development of specific sexual behavioral interests such as interest in BDSM. The finding that the majority of self-proclaimed sadists and masochists separate their BDSM interests from sexual activities challenges the view that all people with BDSM interests are paraphilic.

MOTIVATIONS FOR FATHERHOOD AMONG HOMOSEXUAL AND HETEROSEXUAL MEN

Friedlander, D., and Safir, M. P., Department of Psychology, University of Haifa, Haifa 31905, Israel (msafir@psy.haifa.ac.il)

There is a growing recognition of the fathers involvement in the processes of pregnancy, birth, and parenthood. Motivation for fatherhood may be studied by employing a decision making approach. Jacobs (1995) expectancy-value model describes the stages in decision making related to parenthood. The first phase is called desire. At this phase, the advantages and disadvantages are juxtaposed, and both are equally weighted. The next phase is intention. In this phase, the advantages are still highly valued, but the importance of the disadvantages has diminished. The third and last phase is characterized by instrumental behavior. The evaluation of desire and intention for fatherhood is based on the relation between positive and negative motivations. In this study, the concept of motivation was separated into two distinct constructs: desire and intention to become a father. This is the first time that this distinction was empirically tested.

The present research examined the motivation for fatherhood among homosexual and heterosexual men. Research on motivation for fatherhood among homosexual men is almost non-existent. In the current study, homosexual men were asked whether they were in a relationship, living with a partner, and the rate of self-disclosure of sexual identity (being out) to determine if these variables might act as mediators in desire and intention to have children. Gender-role was also examined in this study. Earlier studies indicated that motivation for parenthood was gender-related. The literature indicates that there are no differences in the distribution of masculinity and femininity among homosexual and heterosexual men. Therefore, our assumption was that a mans masculinity or femininity would be the variable influencing his own wish to become a father, rather than his sexual orientation.

Participants were 103 Jewish men (53 homosexual, 50 heterosexual), non-parents between the ages of 22-37. In contrast with our prediction, a difference was found in the desire for fatherhood according to sexual orientation. Heterosexual men were found to have a greater desire to become fathers. The differences in positive and negative motivations for fatherhood indicate that, among the homosexual men, fatherhood is perceived as a personal-individualistic experience, less dependant on partnership or social norms. This finding might explain why neither partnership nor living with a partner was related to motivation for fatherhood among the homosexual men. Among the heterosexual men, fatherhood seems to be perceived as a normative experience, in context of partnership with a woman who might be at risk during pregnancy or child delivery. Among this group, risk was perceived as a major disadvantage in the negative motivations for fatherhood. It seems likely that in the desire phase of the decision, among the homosexual men the disadvantages tend to be more crucial (personal, social and normative considerations). Thus the initial motivation, desire, was found to be lower among them in comparison to the heterosexual men. In contrast with the difference found in the desire for fatherhood, no difference in intention for fatherhood was found between the homosexual and the heterosexual men. It appears that a major finding in this study is that there are no differences in positive motivations for fatherhood between homosexuals and heterosexuals. The crucial difference between the two groups is revealed by homosexuals higher negative motivations for fatherhood.

The hypotheses predicting a relationship between gender-role and the motivation for fatherhood were supported. Differences were found both in desire and in intention, in relation to the strength of the gender-role (androgynous vs. undifferentiated). An additional finding concerning gender role is that both masculine and feminine roles were related to stronger motivations for fatherhood among men, regardless of sexual orientation. It seems likely that femininity and masculinity are both contributors to the positive motivation for fatherhood. Femininity strengthens the need for forming a significant relationship, whereas masculinity strengthens the need for influencing and achieving. Both components have an influence on the wish to father a child and might also have an interaction effect between them.

CORRELATES OF SEXUAL BEHAVIOR IN CHILDREN

Friedrich, W. N., Department of Psychology and Psychiatry, Mayo Clinic, 5463 St. Mary's Dr., NW, Rochester, Minnesota 55905 (email: friedrich.william@mayo.edu)

Nine face‑valid domains of sexual behavior were derived from the 38‑item Child Sexual Behavior Inventory (CSBI). The CSBI had been completed by the mothers of 1650 children. These subjects were from a mixed sample of normative, sexually abused, and psychiatric outpatients aged 2‑12 yrs. The domains included boundary problems, gender role, sexual intrusiveness, sexual knowledge, self‑stimulation, sexual anxiety, sexual interest, voyeurism, and exhibitionism. Each domain was then correlated with the following variables: age, gender, maternal education, family income, life stress, family sexuality, hours/week in day care, social relational quality, sexual abuse status, and Internalizing and Externalizing T scores from the

Child Behavior Checklist. Sexual abuse status was the last variable entered in the multiple regression analysis, and always accounted for unique and significant variance. However, there was significant variability across domains in the relationship with age and gender, as well as with

externalizing and internalizing behavior. For example, sexual intrusiveness was associated with younger age, externalizing and internalizing behavior, family sexuality, and family stress, as well as a sexual abuse history. In addition, family sexuality was a significant contributor in the solution for all domains with the exception of sexual anxiety and exhibitionism. The results clearly indicate that sexual behavior in children is multidetermined, and has developmental and social elements as well as more pathological correlates.

DEPRESSION AND SEXUAL FUNCTIONING

Frohlich, P. F., and Meston, C. M., Department of Psychology, Mezes Hall 330, University of Texas at Austin, Austin, Texas 78712 (email: pfrohlich@mail.utexas.edu)

It has long been assumed that depression impairs sexual functioning (e.g., Graziottin, 1998). In fact, frequently used questionnaires assessing depression, such as the Hamilton Depression Inventory (Reynolds & Kobak, 1995) and the Beck Depression Inventory (BDI; Beck & Beamesderfer, 1974), include a decrease in sexual interest as a hallmark of depression. Few controlled studies, however, have examined the effect of depression on sexual functioning and those studies that have been published in this area have focused on more global aspects of sexual functioning. For example, previous studies have not examined the full spectrum of sexual functioning (e.g., desire, arousal, orgasm, pain, and satisfaction) or have pooled male and female data, making it difficult to determine whether depression may differentially affect males versus females (e.g., Mathew & Weiman, 1982). Furthermore, most studies are confounded by pharmacological treatment for depression; subjects taking antidepressant medication are often not excluded, making it difficult to distinguish between depression induced and antidepressant medication induced sexual dysfunction (e.g., Meston & Gorzalka, 1992). The purpose of the present study was to examine the effect of depressive symptoms on specific aspects of sexual functioning in individuals not receiving antidepressant treatment.

Participants were 78 undergraduate females who reported depressive symptoms (BDI > 15) and 77 undergraduate females who reported lack of depressive symptoms (BDI = 0). Subjects were included if they reported being in a sexually active relationship and were excluded if they reported use of any antidepressant medication within the past six months. The depression group and the control group did not differ in average age (mean, 20 and 19 yrs, respectively). Groups were compared on seven dimensions: desire for sexual activity alone (e.g., desire to engage in masturbation), desire for sexual activity with a partner (e.g., frequency of thoughts about kissing, foreplay, and vaginal penetration), arousal difficulties (e.g., lack of vaginal lubrication), orgasm problems (e.g., difficulty reaching orgasm), pain (e.g., painful penetration), satisfaction (e.g., how satisfied have you been with your sexual relationship with your partner?), and pleasure (e.g., have you felt pleasure from any forms of sexual experience?).

Depressed and non-depressed subjects did not differ on reported desire for sexual activity with a partner but the depressed subjects reported greater desire for sexual activity without a partner (t(152) = 2.29, p = .023). Depressed subjects were also more likely than non-depressed subjects to report sexual arousal difficulties (t(153) = 3.44, p = .001), orgasm difficulties (t(153) = 3.08, p = .002), and sexual pain (t(152) = 3.69, p = .0003). Depressed subjects were less likely than non-depressed subjects to report being sexually satisfied (t(155) = 4.50, p = .00001) but depressed and non-depressed subjects did not significantly differ in pleasure experienced during sexual activity.

Consistent with previous findings, depressed women are more likely than non-depressed women to experience arousal and orgasm problems, and to feel less sexually satisfied. Contrary to what has previously been reported, however, depressed women may engage in more masturbatory behavior than non-depressed women. Further research is needed before this finding can be adequately explained. It is possible, however, that depressed women may seek activities that have a greater likelihood of providing pleasure. Depression is associated with a loss of interest in previously enjoyed activities; it is possible that secondary reinforcers (e.g., work and hobbies) may provide depressed women little to no pleasure while primary reinforcers (e.g., food and sex) may continue to provide some pleasure.

PERIPHERAL SEROTONIN AND FEMALE SEXUAL FUNCTIONING

Frohlich, P. F., and Meston, C. M., Department of Psychology, Mezes Hall 330, University of Texas at Austin, Austin, Texas 78712 (email: pfrohlich@mail.utexas.edu)

Research examining the relation between serotonin and sexual functioning has focused primarily on central nervous system (CNS) activity. In animals, the goal has been to map relations between sexual activity and specific serotonin receptor activity and/or specific serotonin-rich brain regions (e.g., Uphouse & Caldarola-Patuszka, 1993). In humans, indirect research on the link between serotonin and sexual behavior has also focused primarily on centrally mediated events. For example, sexual side effects subsequent to antidepressant, anti-psychotic, or other serotonergic drugs have been discussed almost exclusively in terms of serotonin receptor subtype activation or inhibition in the central nervous system (e.g., Meston & Gorzalka, 1992). Clearly, serotonin may mediate some aspects of sexual functioning almost entirely within the central nervous system. Given, however, that the vast majority of serotonin receptors are located in the periphery of the body, with only 5% located in the CNS (Prichard & Smith, 1990), it is feasible that some aspects of sexual behavior are affected, at least in part, by activation of these peripheral receptors. This would be consistent with research on eating and drinking behaviors, which are also affected by serotonin, and which have been shown to be differently affected by central versus peripheral manipulation (e.g., Bateman, Lichtman, & Cramer, 1990). Moreover, a vast literature indicates that serotonin is involved in a wide variety of peripheral processes, including vascular and non-vascular smooth muscle contraction, autonomic and sensory neurotransmission, and endocrine and exocrine secretion.

A review of the literature indicates that serotonin is active in several peripheral mechanisms that are likely to affect female sexual functioning. Serotonin has been found in several regions of the female genital tract in both animals and humans. In the CNS, serotonin acts primarily as a neurotransmitter, but in the periphery serotonin acts primarily as a vasoconstrictor and vasodilator. Since the principal component of sexual arousal is vasocongestion of the genital tissue, it is likely that serotonin participates in producing normal sexual arousal. In addition, serotonin administration produces contraction of the smooth muscles of the genito-urinary system and is found in the spinal cord and in nerves innervating the sexual organs. Taken together, this evidence suggests that peripheral serotonergic activity may be involved in the normal sexual response cycle. In addition, exogenous substances that alter serotonin activity, such SSRIs and the atypical anti-psychotics, can produce sexual dysfunction. It is possible that sexual side effects seen with these drugs may result, at least in part, from their action on peripheral mechanisms.

FEMALE MATE PREFERENCES, SHIFTS ACROSS THE MENSTRUAL CYCLE, AND ADAPTIVE DESIGN

Gangestad, S. W., Department of Psychology, University of New Mexico, Albuquerque, New Mexico (email: sgangest@unm.edu)

Evidence indicates that womens sexual desire changes across the menstrual cycle, with many women experiencing a peak during the period of highest conception risk. Recent evidence indicates that womens mate preferences change as well. Four studies have shown that women prefer the scent of men who evidence developmental health, as revealed by bodily symmetry, but only during the period of conception risk. Several additional studies have indicated that womens find masculinized faces more attractive prior to ovulation than during the luteal phase, and evidence indicates that the preference shift is particular to evaluating men as short-term mates. As symmetrical men tend to possess masculine facial features, these preferences shifts favor correlated sets of men. An evolutionary framework asks whether these preference shifts are special design features forged by natural selection to solve particular adaptive problems in ancestral conditions. One possibility is that the shifts increase the likelihood that a woman will obtain genetic benefits from a partner, even if from an extrapair mate, selectively during peak conception risk because of the costs associated with doing so. This notion and alternatives will be discussed.

SEXOLOGY AS A FIELD AND A PROFESSION IN FRANCE

Giami, A. J., INSERM-U292, Hpital de Bictre, 82, rue du General Leclerc, 94276 Le Kremlin-Bicetre Cedex, France (email: giami@vjf.inserm.fr)

In France, it is taken for granted that professional sexologists are clinicians (sex therapists). Until recently, there were no accepted professional standards of qualification or licensing. The five most important professional associations organize training and define the

ethical rules of professional practice. Since 1983, medical schools deliver a national 3-year diploma for medical sexologists. Sexology as a profession is currently under structural change. In 1997, the National Order of Medical Doctors began a process of official assessment for medical sexologists. The problem of the professional assessment of non‑medical clinical sexologists soon will become an issue.

In 1999, an independent national survey of sexology as a profession was performed by INSERM. Sexologists were identified through the mailing lists of the professional organizations and the telephone book (yellow pages). Around 1,000 sexologists were identified as sexologists.

A self‑administered questionnaire was sent by post. Final response rate was over 60%. Results indicate that two-thirds are physicians. Among the MDs, 60% are General Practitioners and two-thirds are men, while the majority of non‑medical sexologists are women. Overall, 90% of self-identified sexologists have received a training in sexology and over 70% in psychotherapy. Psychotherapy and counseling are the principal mode of intervention, while 40% of MDs mix psychological and pharmacological treatments for sexual dysfunction.

The discussion will raise the issue of the consequences of the medicalization (predominance of medical sexologists and clinicians) in the field of French sexology.

EFFECTS OF SILDENAFIL ON SLEEP-RELATED ERECTIONS IN MEN NOT SUFFERING FROM ERECTILE DYSFUNCTION

Granata, A. R. M., Pizzini, A., Cappi, C., Fabbi, M., Balestrieri, A., and Carani, C., Department of Internal Medicine, University of Modena, Policlinico, Via del Pozzo 71, 41100 Modena, Italy (andrologia@unimo.it)

Sildenafil is an oral drug whose efficacy has been shown for psychogenic and mild to moderate organic penile erectile dysfunction (ED). The aim of this study is to evaluate the effects of sildenafil on sleep-related erections in men not affected by ED.

13 healthy men not affected by ED underwent nocturnal penile tumescence and rigidity monitoring (NPTRM) on 3 consecutive nights where the first night was regarded as an adaptation night. Three men were dropped from the study because the second and/or the third NPTRM lasted less than 8 hours. Only the data from the other 10 men (mean age, 40.7 + 13.6 yrs) were analyzed. Four subjects were administrated a 50 mg Viagra tablet 1 hour before starting the second night monitoring; the other 6 subjects were administrated the drug 1 hour before starting the third night monitoring. The following parameters were analyzed during the first 8 hours monitoring and during the 1st-4th and 5th-8th hour interval monitoring: number of valid erections, total number of valid and not valid erections, maximum rigidity, mean of the maximum rigidity, maximum increase of tumescence, mean of the maximum increase of tumescence, duration of increase of tumescence > 30 mm, and duration of rigidity > 70 % during Viagra test. Student's t-test for paired data was performed to compare the full test with vs. without Viagra, the first vs. the second 4 hours without Viagra, the first vs. the second 4 hours with Viagra, the first 4 hours with vs. without Viagra, the second 4 hours with vs. without Viagra.

Full test with vs. without Viagra and the second four hours with vs. without Viagra showed significantly higher values for valid erections, maximum rigidity, mean of the maximum rigidity, duration of increase of tumescence > 30 mm, and duration of rigidity > 70 %. The 1st vs. the 2nd 4 hours with Viagra showed significantly higher values for mean of the maximum rigidity, duration of increase of tumescence > 30 mm, and duration of rigidity > 70 % during the 2nd 4 hours.

These data suggest that Viagra is effective on the sleep-related erections of men not suffering from ED. Furthermore, the effect of Viagra seems greater after more than 5 hours from administration than after a few hours. The latter data could be due to a better sleep during the second 4 hours but this is not confirmed by the comparison of the first 4 hours without Viagra vs. the second four hours without Viagra. In conclusion, if these data will be confirmed on a larger number of subjects and on awake subjects during sexual stimulation, Viagra could be regarded as a drug which can improve the sexual performance even in subjects without any sexual problem.

(SERIOUS) SADO-MASOCHISM: A PROTECTED RIGHT OF PRIVACY?

Green, R., Gender Identity Clinic, Department of Psychiatry, Imperial College School of Medicine at Charing Cross Hospital, Fulham Palace Road, London W6 8RF England; Institute of Criminology, University of Cambridge, Cambridge, England (email: richard. green@ic.ac.uk)

English police discovered videos of male-male sado-masochistic acts consisting of maltreatment of the genitalia with hot wax, sandpaper, fish hooks, needles, scalpels, and nails. Activities were consensual. Legal proceeding became known as the "Spanner Case" because one detective remarked after watching a video that he felt as though "someone had tightened a spanner around his nuts." Participants were convicted under an 1861 law, "Offences Against the Person Act." The men appealed their conviction to the highest UK Court and then on to the European Court of Human Rights. They argued an unjustified interference with their private life. They pointed to the exceptions to prosecution under the 1861 Act such as organized sport, notably boxing. Is there a principled argument for criminalizing these men's sexual behavior? Is sex sport?

THE "HAMBURG MODEL" OF COUPLE THERAPY: NEW EMPIRICAL DATA ON THERAPY OUTCOME

Hauch, M., Department of Sex Research, Hamburg University Clinic, Martinistr. 52, 20246 Hamburg, Germany (e-mail: hauch@uke.uni-hamburg.de)

At the Department of Sex Research at the Hamburg University Clinic, we have developed a therapeutic approach for treating heterosexual couples with sexual problems that integrates behavioral, psychodynamic, and systemic elements. Although originally designed for treating couples suffering from classical sexual dysfunctions, this differentiated approach also enables us to work with couples with lack of desire problems and even include those couples where one of the partners has been traumatized in the past. The results are promising.