a-Adrenoceptor blockade: Central and peripheral effects on sexual function

K-E Andersson, Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden

In the central nervous system and peripherally, noradrenergic nerves are involved in the regulation of different sexual functions. Released noradrenaline (NA) acts on a-adrenoceptors (ARs), which are of various subtypes, and which are distributed differently in the brain, spinal cord and genital organs. In monkeys and rats, central activation of a1-ARs facilitates, whereas activation of a2-ARs inhibits, copulation. In male rats, a2-AR antagonists like yohimbine facilitate sexual behavior, reducing ejaculation latency and increasing sexual motivation. Experimentally, inhibition of the a2A-AR subtype in the region of locus ceruleus increases sexual activity. The effect of a2-AR antagonists (e.g., yohimbine) for treatment of male erectile dysfunction has not been convincing. In women, the effects of a2-AR antagonists have not been established, but it is known that a2-AR agonists like clonidine, inhibit the early stages of arousal.

Peripherally, a-AR antagonists may have both positive and negative effects on sexual functions. The erectile state of the penis is dependent on the balance between contractant and relaxant factors. During detumscence and flaccidity, contractile factors (mainly noradrenaline) predominate. All a1-AR subtypes (a1A, a1B, a1D, a1L) can be demonstrated in human penile erectile tissues, but It has not been established if one subtype is more important than the others. Non-subtype selective a1-AR antagonists (phentolamine, moxisylyte) are moderately effective in the treatment of erectile dysfunction. Ejaculation has two distinct successive phases: emission and expulsion. Both phases are largely mediated by spinal reflexes activated by pudendal nerve afferents with supraspinal modulation, and may be negatively affected when a1-AR antagonists are used for the treatment of e.g., hypertension or benign prostatic hyperplasia. The cause may be found within the pelvic organs, at the spinal cord level, or within the brain. a1-AR antagonists can decrease seminal emission, which may lead to retarded ejaculation or decreased orgasmic pleasure. a1-AR antagonist relaxes the bladder neck and may give rise to retrograde ejaculation

The effects of different a-AR antagonists may vary, due to the fact that a-AR subtypes are distributed differently in structures involved in sexual functions, but also depending on pharmacokinetic differences. The actions of subtype selective a-AR antagonists (a1 as well as a2) on different sexual functions should be further explored.

The influence of child sexual abuse research on sex research

Hertha Richter-Appelt, Department of Sex Research, Clinic of Psychiatry and Psychotherapy, University of Hamburg, Germany

(hrichter@uke.uni-hamburg.de)

More than two decades of sex research on child sexual abuse (CSA) has not ended up in generally accepted conclusions and implications of the impact of CSA on psychological well-being, mal-adjustment or symptoms in adults. The main aspects of this discussion are the relevance of causality, pervasiveness of harm, intensity of harm and equivalence of male and female CSA experience (see Rind and Tromovitch 1997).

Until the eighties patients were asking for help while suffering from sexual dysfunctions, perversions or gender identity disorders. Since than the group of people is increasing who want help for the disturbances by traumatic sexual experiences with others. These experiences sometimes affect their sexuality, sometimes they suffer from other problems they attribute to their child sexual abusive experience. The reason for asking for help is often not the disturbed sexuality but the disturbance they experience as a consequence of the sexuality of others.

In a study of 276 young German women the relevance of childhood sexual abuse and physically maltreatment for the statistical prediction of sexual problems in adulthood was calculated. Socio-economic and family related factors as well as the partnership of the parents and the parent-child relationship were controlled in the multivariate analysis.

70% of the women with “serious” sexual abuse, 70% of those with “moderate” abuse but only 21% of women with “mild” abuse compared to 15% in the normal control group reported different kinds of sexual problems. The predictors of the multivariate analyses for the prediction of sexual problems in adulthood also will be reported. The aspects of causality, pervasiveness and intensity of harm will be discussed.

A model of sexual traumatization and traumatized sexuality will be presented to point out that many aspects of sexual tramatization have been neglected in research on child sexual abuse and sex research.

Defining hypoactive sexual desire in women using clinical outcome data related to symptoms criteria and subjective self-report

Aubin, S., Trudel, G., Ravart, M., Marchand., A. & Heiman, J.R., Department of Psychology, Université du Québec à Montréal, Canada

(saubin@u.washington.edu)

The current formal diagnostic category for low or absent sexual desire is hypoactive sexual desire (HSD). Since its introduction as a distinct diagnostic entity by Kaplan in 1977, considerable efforts at definition and at diagnostic guidelines for HSD assessment have been offered by clinicians and researchers. Categorization models of HSD symptoms serving to define HSD include the DSM-IV, ICD-10 and more recently, the International Consensus Panel for female sexual dysfunctions (1999). Despite these attempts at clarifying our understanding of HSD, difficulties remain as to the definition and operational diagnostic assessment of HSD. The objective of the paper is to show comparative outcome results using two evaluation methods. First, assessment of changes in HSD symptom criteria by semi-structured couple and individual interviews and second, self-reported questionnaire responses from women and their male partner at post-treatment. Study results are discussed in terms of their implications for specific symptom criteria in defining and assessing HSD in women.

We selected data from a larger controlled treatment study assessing treatment impact on a variety of sexual and relationship variables (Trudel et al, 2001). The sample consisted of a total of 74 couples with HSD diagnosed in the female partner. Couples were randomly assigned to either the experimental/treatment group (N=38) or the control/waiting-list group (N=36). The intervention program was designed to enhance sexual and couple relationships as well as to modify sexually-related cognitive distortions. Weekly homework assignments completed between sessions allowed couples to experiment with a variety of cognitive-behavioral strategies. The treatment application format consisted of twelve 2-hour weekly therapy sessions of 4 to 6 couples per group. Outcome assessment specific to HSD symptom criteria and subject self-report was obtained using two clinical questionnaires created by the authors of the study completed at pre- and post-treatment and at a 3-month follow-up

.

Results showed significant improvements at post-treatment and stability of treatment gains at follow-up on all HSD symptom criteria. The greatest change in HSD symptoms was obtained for the frequency of sexual activities, showing a 51% decrease in the percentage of women meeting the HSD criteria. A non-significant increase to 64% was recorded at the 3-month follow up. In addition to significant changes in HSD symptoms, post-treatment reports of sexual and relationship issues indicated that women and their partners both rated the degree of mutual closeness as the most improved item on the self-report questionnaire (p<.01). Study implications point to the clinical relevance of complementary methods in HSD assessment targeting operationally defined cognitive, affective and behavioral treatment responses and to the importance of assessing both partner’s evaluation of sexual and relationship issues linked to HSD.

Erotic plasticity and female sexuality

Baumeister, R., Department of Psychology, Case Western Reserve University, Cleveland, OH, USA

(rfb2@po.cwru.edu)

Erotic plasticity refers to the degree to which the sex drive is shaped by social, cultural, and situational forces. The core idea is that women have more erotic plasticity than men; in other words, female sexuality is relatively more cultural, whereas male sexuality is more natural. As evidence, individual women exhibit more change across time in their sexual responses; most specific sociocultural variable have larger effects on women than men; and general attitudes are less closely linked to specific behaviors for women than men (indicating greater context-specific responding).

Gendertopia : Development of gender relations in late modernity

Bech, H., Department of Sociology, University of Copenhagen, Denmark

Sexualisation of public life is often considered to be very dangerous, indeed abusive and destructive, particularly in relation to women. Yet perhaps sexualization has no inherent meaning and no fixed effects independently of the broader social and cultural context, including the context of gender relations. And these vary considerably over time, even during the last 50 years and even among the various societies of the "West".

In the lecture, I shall focus on recent trends towards changes in gender relations that, in some social contexts, would seem to combine sexualisation and gender in new, perhaps joyful and beneficial ways.

Sexuality, partnership and Parkinson's Disease: Results of an empirical study in patients and their partners

Beier, K.M., Lüders, M., Boxdorfer, S.A., and Ahlers, C.J., Institure for Sexual medicine and Sex research, Charité, Berlin, Germany

In a retrospective, non randomized cross-section study the influence of Parkinson’s Disease (PD) on sexuality and partnership in 2099 affected members of the German Parkinson Association (dPV) was investigated.

At an average age of 65, 330 women and 1008 men had been living in a partnership for an average of 37 years.

The sexual dysfunctions which occurred both in affected women and men (i.e. patients) as well as in healthy partners included disorder of sexual desire, of sexual arousal, and of orgasm, vaginism, dyspareunie, sexual aversion and premature ejaculation. Apart from these dysfunctions, a reduction of sexual contentment on the whole was also evident. Patients named specific symptoms of PD and medication as the main sources of influence on their sexuality. Impressive was that according to the patients’ attributions one single group of substances was held responsible for increasing sexual functions as well as decreasing them or having no influence at all. Furthermore, it became apparent that the same medication had different effects in men than in women.

The information given by both men and women with respect to their partnership situation shows that since diagnosis communication in general is reduced, especially caressing and showing feelings, whereas a desire for mutual intimacy prevails on the same level as before.

Is written patient information a motivational help in erectile dysfunction?

Berner, M.M., Stodden, V., Porst, H., and Wetterauer, U. Dpt. of Psychiatry and Psychotherapy, University Hospital of the Albert-Ludwigs-University Freiburg, Germany

(Michael_Berner@psyallg.ukl.uni-freiburg.de)

BACKGROUND: Erectile Dysfunction has a high prevalence in the community.The Information Center for Sexuality and Health (ISG e.V.)is a charitable organization that aims to improve the knowledge about sexual dysfunction in the community.The ISG conducts and supports epidemiologic research in the field of sexual dysfunction. METHODS:In a public campaign concerning erectile dysfunction a representative sample of the German reading community was approached by adverts.Interested persons could use an affixed coupon to order information material free of charge. In a sequential 8000 packages we asked to fill in an epidemiologic questionnaire.The response was 1484 questionnaires (18,5 %).RESULTS: 96,22% of the responders were male. The mean age was 59,01 years. 85% suffered from erectile dysfunction with a duration of more than one year in 75,6% of cases.There was marked comorbidity both sexual and medical. 39,4% already had been treated, 15,8% did not have any contacts so far. The quality-rating for the information provided was high. 21,6% of respondents planned a first communication with their partners, 30% intended to ask for treatment.CONCLUSION: Our data reflects the high information needs in the community.The considerable sexual and medical comorbidity requires an integrated view of sexual dysfunction that incorporates biological, psychological as well as sociological facts. It underlines the importance of high quality standards in the education of sexual therapists.

Changing patterns of sexual life of youth in Slovenia

Bernik, I., Faculty of Social Sciences, University of Ljubljana, Slovenia

(ivan.bernik@guest.arnes.si)

My contribution will try to substantiate the hypothesis that the patterns of adolescents sexual life in a post-socialist society is characterised by “delayed modernity”. This hypothesis has been initially proposed by the authors of a comparative survey of youth sexuality in the former West and East Germany, but it can be extended – with some modifications - to all Central European post-socialist societies.

The analysis, based on data from two recent surveys of youth sexuality in Slovenia, will focus on three aspects of sexual life of youth – on the level of their sexual experience, the difference between male and female pattern of sexual life and their reactions to HIV/AIDS related risks. The findings will be compared to an ideal type of modern youth sexuality. The characteristics of the ideal type will be derived from surveys of youth sexuality in some West European societies. The comparison will be guided by the hypotheses that the patterns of sexual life of youth in Slovenia are characterised by higher level of sexual experience and by a more pronounced division between male and female pattern of sexual life than in the societies in which sexual life of youth can be characterised as modern. It will be also hypothesised that Slovenian adolescents are less aware of HIV/AIDS related risks than their counterparts in the Western societies.

The interaction of fraternal birth order and body size on male sexual orientation

Bogaert, A. F., Departments of Community Health Sciences and Psychology, Brock University, St. Catharines, Ontario, Canada

(tbogaert@spartan.ac.brocku.ca)

A late fraternal birth order (i.e., more older brothers) has been demonstrated numerous times in homosexual men. Body size (i.e., height and weight) has been less studied with regard to sexual orientation development and has demonstrated contradictory results. In this research, the relations among fraternal birth order, body size (i.e., height and weight), and sexual orientation were examined in a Canadian sample of homosexual and heterosexual men. An interaction between fraternal birth order and height was observed, with a homosexual orientation most likely to occur in men who had a high number of older brothers and a shorter stature. No significant interactive effects were observed for weight. The results suggest that the mechanism underlying the fraternal birth order phenomenon has an effect on physical development that lasts (and is detectable) into adulthood (i.e., adult stature).

Older brothers and sexual orientation: New test and the attraction/behavior distinction in two national probability samples

Bogaert, A. F., Departments of Community Health Sciences and Psychology, Brock University, St. Catharines, Ontario, Canada

(tbogaert@spartan.ac.brocku.ca)

Previous research indicates that a relatively late birth order (e.g., a high number of older brothers) predicts a homosexual orientation in men but not in women. In the present research, the extent to which birth order (e.g., older brothers) predicts the two main components that researchers have traditionally used to conceptualize sexual orientation—i.e., psychological attraction and sexual behavior—was examined in two recent national probability samples. In both studies, older brothers predicted same-sex attraction in men, with each additional older brother increasing the odds of homosexual attraction by an average of 38%. No sibling characteristics predicted sexual orientation in women. Results also indicated that older brothers only related to homosexual attraction and not homosexual behavior/experience in men. In fact, the older brother relation to homosexual attraction was significant controlling for (and thus independent of) homosexual behavior/experience. Thus, the results indicated that older brothers primarily related to what may be considered the “psychological core” of sexual orientation—sexual attraction—and not to a correlate of and likely outcome of sexual orientation—sexual experience with a partner (or partners) of a particular gender. Results are discussed in relation to recent biological and psychosocial theories of the “older brother” or “fraternal birth order” effect. In particular, these findings indicate that experience-based theories (e.g., early same-sex play) of the older brother effect are unlikely to be correct.

The role of religion and culture in shaping sexuality and gender

Buchanan, C.H., Education, Knowledge, and Religion, The Ford Foundation, New York, NY, USA

(c.buchanan@fordfound.org)

Religious traditions at once reflect basic cultural values regarding gender and sexuality and help shape and legitimize them. The dominant interpretation of what a religion has to say about sex and gender affects all social institutions and all individuals, whether they are believers or not, through religious values that pass into a society’s secular value system. Most of the major and minor religions of the world have been interpreted and led by elite, often celibate men. The religious experience and perspectives of women, in past and present, are only now beginning to be a significant focus of study. Our understanding in the West, therefore, of what biblical religious traditions have to say about sex and gender comes from men and is based on sacred texts written and selected by men. More influential even than what these texts say explicitly about sexuality and gender are the conceptions they have been understood to set forth of the proper God-given social order: of “the way things are and the way they are meant to be.” These have defined “natural” hierarchies of Divine/human, male/female, mind/body, free/enslaved, etc. that reflect and justify a fundamental social dynamic of domination and subordination. Until it is recognized and addressed, this dynamic will remain a potent barrier to women’s control of their own sexuality and to broader social change.

Sexual interest, sexual activity, and sexual satisfaction in the second half of life

Bucher, T., Hornung, R., and Buddeberg, C., Department of Social Psychology II and Department of Psychosocial Medicine, University of Zurich, Switzerland

(tobu@sozpsy.unizh.ch)

The study aimed to 1.) describe sexuality of heterosexual people in the second half of life, and 2.) identify predictors of sexual interest, activity, and satisfaction. The study investigated the influence of psychosocial resources and stressors, sexual-biographical factors, health, and sociodemographic variables.

Methods: Men and women were recruited for the study from the general, German-speaking population of Switzerland via prescreening. 641 men (age: 45-91; M=61.8 years old) and 857 women (age: 45-86; M= 58.2 years old) filled out a questionnaire with items on health, sexuality, and satisfaction with life. Regression analyses were performed to calculate determinants of sexuality in the second half of life.

Results: While sexual interest and sexual activity declined with increasing age, sexual satisfaction remained constant. Less than 3% of the respondents reported having no sexual interest, but 8% of the men and 22% of the women had not been sexually active in the three months prior to the survey. Slightly more than half of the respondents reported having been less sexually active than they desired; women missed tender caresses and petting more than men; the same number of women and men missed sexual intercourse.

The main determinants of sexual interest for both sexes were age, the importance of sexuality in younger years, and active lifestyle; for women, an additional determinant was partner status (having a spouse or steady partner). For sexual activity, partner status, age, active lifestyle, the importance of sexuality in younger years, and social factors accounted for most of the variance. Sexual satisfaction was mainly explained by sexual activity with one's partner, satisfaction with social relationships, and health. Masturbation correlated negatively with sexual satisfaction.

Conclusions: Most people retain sexual interest into old age, particularly with respect to a need for non coital forms of sexuality. Women, due to the absence of suitable partners, can live out their sexuality significantly less frequently than men. Sexuality, as one aspect of an individual's lifestyle, is maintained in the second half of life, if circumstances (availability of partner, health) allow.

Note: Funding for this study was contributed by the Swiss National Science Foundation (Project Nr. 32-52628.97).

Sexual interest, sexual activity, and sexual satisfaction in the second half of life: Influences of the relationship

Bucher, T., Department of Social Psychology II, University of Zurich, Switzerland

(tobu@sozpsy.unizh.ch)

Many studies about sexuality emphasize the importance of the partnerstatus for maintaining sexual activity in middle and old age. But having a spouse or a steady partner per se is no guarantee for a satisfying sex life. The quality of the relationship is a further important factor to be considered. This study aimed to identify 'relationship variables' which explain sexual interest, activity and satisfaction in the second half of life. The influence of age (own and of the partner), duration of the relationship, emotional intimacy (Dyadic Adjustment Scale, Spanier, 1976), physical attractiveness and various aspects of intimate communication (e.g. ability to express own sexual needs) was investigated.

Methods: A sample of 400 men (age: 45-87; M=58.5 years old) and 443 women (age: 45-78; M=54.8 years old) who were either married or had a steady relationship was drawn from the study 'Sexual Interest, Sexual Activity and Satisfaction in the Second Half of Life' (see Bucher, Hornung & Buddeberg, 2002). The effects of the relationship variables on sexual interest, sexual activity and satisfaction were tested simultaneously using structural equation models.

Results: The main determinants of sexual interest for both sexes were age, duration of relationship and perceived physical attractiveness of partner. For women the partner's ability to respond to their sexual needs was an additional significant predictor. No further relationship variables had an effect on sexual interest. Sexual activity was mainly determined by sexual interest; emotional intimacy and intimate communication showed weaker effects and were more important for women than for men. Emotional intimacy and intimate communication explained as much variance of sexual satisfaction as the frequency of sexual interaction.

Conclusions: The quality of the relationship has little effect on sexual interest for women only. It seems that women play a more active part in maintaining sexual activity in long lasting relationships. Emotional factors and the expression of sexual needs explain more variance of sexual activity in women than in men. Sexual satisfaction in the second half of life results from sexual activity as well as from intimate communication and emotional aspects of the relationship. The relationship should be considered more closely in future research about sexuality.

Male sexual arousal is target specific. Female sexual arousal is bisexual.

Chivers, M. L., Rieger, G. Latty, E., & Bailey, J. M. Department of Psychology, Northwestern University, Evanston, IL 60208

(m-chivers@northwestern.edu)

Sexual arousal is target-specific in men. Heterosexual men are more aroused by female than male sexual stimuli and homosexual men show the opposite pattern. It is unknown if

women show target-specific sexual arousal patterns. This presentation addresses the following questions: (1) Is female sexual arousal target specific? (2) Are differences in women’s and men’s sexual arousal patterns due to measurement artifacts? (3) If sex of target is not a determining factor in female genital response, what is it that women are responding to?

Sexual lifestyles in three generations : A comparative study on relationships and sexual behavior of 30-, 45- and 60-years ols men and women in Germany

Dekker, A.M., and Matthiesen, S., Department of Sex Research, Clinic of Psychiatry and Psychotherapy, University of Hamburg, Germany

(dekker@uke.uni-hamburg.de)

The paper presents the design and first results of an ongoing interview study, which is conducted by the Department of Sex Research at Hamburg University in cooperation with the Research Center for Partner- and Sex Research in Leipzig.

Nowadays men and women are getting married less frequently and considerably later, divorces are more common. Also many forms of non-marital steady relationships are coexisting peacefully. More adults are living as “singles” or bringing up their children as a single mother or single father. Due to the separation of families, children less frequently grow up with both of their biological parents. Serial monogamy becomes a new major lifestyle, while many people are still living in life-long relationships and the desire for long-lasting partnerships is still wide-spread.

The extent of the outlined changes, often explained with theoretical concepts of individualization and pluralization in an post-traditional social order, are still not well explored. The consequences for individual satisfaction are widely unknown, as well as the impact on the biographies of children. Our comparative interview study on three generations is designed to describe the changes, to explore how men and women can cope with them and to analyze the expectations, hopes and problems related to them.

The study is currently in the field. Our sample will consist of 800 men and women, in equal parts from the cohorts 1942, 1957 and 1972. The data is currently collected in Hamburg and Leipzig, thus representing German cities both in the former East- and West-Germany. The interviews are both structured and computer assisted. Collected Data is mainly quantitative with some qualitative in-depths analysis. The central issue of the study is the history of partnerships and single periods during the adult life. Also broad data on the current steady relationship or current single period and on sexual behavior, experiences and attitudes is collected.

The paper will present first results concerning the difference between the three generations with regard to their biographies of relationships and sexuality from adolescence until the thirtieth birthday.

Will the real lesbians please stand up? Diversity in sexual-minority women's desires and relationships over time

Diamond, L.M., University of Utah, USA

(lisa.diamond@psych.utah.edu)

Many sexual-minority (i.e., nonheterosexual) women report inconsistencies among their sexual attractions, sexual behaviors, and sexual identities, as well as discontinuities in each of these domains over time. For example, some self-identified lesbians continue to experience sexual attractions for men; others have never had same-sex sexual contact; still others initiate heterosexual relationships after long periods of exclusive same-sex behavior. Such cases complicate efforts to identify prototypical sexual "careers" among lesbian vs. bisexual vs. heterosexual women. In this presentation, I present longitudinal data bearing on this problem and identify areas for future theoretical and empirical study. Specifically, I summarize findings from 2-year and 5-year follow-up interviews with 80 sexual-minority women who were first interviewed in 1995 when they were between 16-23 years of age. Changes in sexual attractions, behaviors, and identities are reviewed, as well as associations among these domains over time. Particular attention is devoted to describing and explaining discrepancies between women's attractions and behaviors, and highlighting individual difference dimensions (such as motives for sexual contact) that help propel women with similar patterns of attraction onto divergent sexual-developmental trajectories. Implications of these findings for folk distinctions between "real" and "fake/bisexual" lesbians, as well as for the hypothesis of female sexual plasticity, are discussed.

The medial amygdala regulates mating-induced dopamine release in the medial preoptic area

Dominguez, J.M., and Hull, E.M. Department of Psychology, University at Buffalo NY, USA

The medial amygdala (MeA) is an integral node in the chemosensory pathway that regulates male rodent sexual behavior. Olfactory input from the main and accessory olfactory bulbs reaches the MeA via the lateral olfactory tract; MeA efferents, in turn, project to several regions of the CNS, including the medial preoptic area (MPOA). Damage to the MeA impairs male sexual behavior, and sexual activity increases Fos-immunoreactivity, indicating increased cellular activity, in the MeA of several species. Furthermore, testosterone implants into the MeA or the MPOA of castrated animals at least partially restores copulation, suggesting that androgen-induced enhancement of male rodent sexual behavior occurs at the level of the MeA and the MPOA.

The neurotransmitter dopamine (DA) facilitates male sexual behavior in most species, including humans. The MPOA is one site where DA may facilitate male sexual behavior. Microinjections of a DA agonist into the MPOA enhance male sexual behavior, whereas DA antagonists impair copulation and sexual motivation. Moreover, levels of extracellular MPOA DA increase during copulation and in the presence of a sexually exciting stimulus.

We now report that one means by which the MeA facilitates copulation is by promoting the mating-induced DA release in the MPOA. Animals with MeA lesions displayed sexual deficits and did not show the mating-induced MPOA DA response. However, microinjections of apomorphine, but not vehicle, into the MPOA of animals with MeA lesions restored copulation, suggesting that the sexual deficits resulted from deficient DA release in the MPOA. Finally, chemical stimulation of the MeA, in anesthetized male rats, enhanced levels of extracellular DA in the MPOA, compared to baseline, again supporting the close relationship between activity in the MeA and DA release in the MPOA, which is essential for male copulatory behavior.

Supported by: NIMH grant#MH40826 to EMH

Opinions, knowledge, behaviour concerning the prevention of HIV/AIDS in a group of Italian high-school students

Efrem, C., Dipartimento di Statistica, Probabilita, Statistiche Applicate, Universita di Roma, Italy

(efrem.colnago@uniroma1.it)

Using a survey of 2000,(the first in Italy,) of the Department of Clinical Sexuology from the Superior Institute of Samnite' we analyzed opinions, knowledge, and behaviours related to HIV prevention of a random group of high schools students (ages 15-20). Measures included some tests of personality (sensation seeking scale), a test of HIV prevention, another about HIV knowledge, and another about risk-consciousness. Students completed tests before and after a course on HIV knowledge. Results will be presented.

The impact of public health policies on women’s sexual behavior and gender

Ehrhardt, A.A., HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, USA

(ehrharda@childpsych.columbia.edu).

Public health policies have a long history of being shaped by political and moral agendas that reflect societal and cultural values. This is particularly true for sexually transmitted diseases such as syphilis in the past (Brandt, 1988) that was often seen as a reflection of a breakdown of social values focused on the domestic roles of women, the sanctity of marital sexuality and other aspects of traditional patterns of heterosexual gender roles. An analysis of public health policy on HIV/AIDS over the last 20 years reflects similar policies that are often assessed against moral and not health standards (Eisenberg, 1989; Ehrhardt, 1992). Specifically, we have been hampered by sexism, racism, and homophobia in the design and implementation of an effective gender-specific agenda for women. Sexism led us to focus entirely on the male condom as the primary method of HIV prevention between heterosexual couples. That focus prevented the development of strategies for women to address the imbalance of power between women and men and prevented them from participating in their own protection by forcing them to depend on a male controlled method. Furthermore, it led to major obstacles in the development and approval of female controlled methods (i.e. the female condom and microbicides). Another example of a skewed focus is that sex workers were universally blamed for spreading the virus rather than a more comprehensive approach that includes their circumstances and their male clients. A public health system that is heavily influenced by societal/religious values is preoccupied with looking to any act it deems immoral as the cause of disease. This explains the preoccupation with sex workers who trade sex for money rather than a more rational approach that would target transmission through “morally acceptable” sexual behaviors, such as the predominant pattern of risk in many parts of the world, i.e. heterosexual behavior within marriage.

Public health policy informed by homophobia ignored the complexities of female homosexuality and consequently grossly neglected prevention and care for women with female sex partners. These policies were not based on the realities of women's lives and failed to consider bisexuality and IV drug use and exclusively focused on the improbability of female-to-female transmission.

Racist attitudes toward young urban women have led to policies in the U.S. targeting abstinence rather than comprehensive sexual education as part of welfare reform. This religiously informed policy with no scientific evidence to support its effectiveness has had far reaching consequences. At the United Nations, in May 2002, the Special Session on Children ground to a halt over U.S. attempts to impose these sex education and abortion policies on the rest of the world and therefore withholding crucial information about sexually transmitted diseases including HIV which is rapidly spreading particularly among the young in developing countries. When conservative morality prevents access to life saving information and the availability of critical health services, people die.

Gender differences in sexual attitudes and behavior among Canadian adults: A national survey

Fischtein, D., and Herold, E. Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada

email: eherold@uoguelph.ca

While gender differences have been a major focus in many sexuality studies, there have been few such studies among Canadian adults especially at a national level. Both evolutionary psychology and social learning theories have been used to account for gender differences. This study analyzed gender differences across age and educational levels using data from a national survey of Canadian adults over the age of 18 (n=1479). The survey was conducted by the Compass survey organization using computer assisted telephone technology.

It was predicted that males would be more permissive than females with regard to casual sex intentions, age of first intercourse, number of intercourse partners and oral sex experience. It was also predicted that males would report thinking about sex more often than females.

The data were analyzed using layered chi-squares and univariate ANOVAs. For each of the variables, males were more sexually permissive than were the females. Those who were younger and who had higher education also tended to be more sexually permissive. Gender differences in age of first intercourse were greatest for the older age groups (with males reporting much younger ages than females) and were minimal for those in their twenties. Also, the intentions to engage in casual sex were lowest for older females and highest for younger males.

The findings show the value of taking into account age and education when analyzing possible gender differences in sexuality.

Adolescent sexual behavior and maltreatment: Reliability and validity of the Adolescent Sexual Behavior Inventory

Friedrich, W.N., Mayo Clinic, USA

The relationship of adolescent sexual behavior to sexual abuse history was examined with a clinical sample of 174 male and female teens, ages 12-18, and their parents. The Adolescent Sexual Behavior Inventory (ASBI), a 45-item measure designed to elicit parent and self-report regarding a range of sexual behaviors was used. The results indicated that the ASBI has adequate internal reliability and measures sexual distress and anxiety, sexual interest, and also intrusive and rule-violating behavior. Parent and self-reports correlate significantly, and a strong relationship between maltreatment, particularly sexual abuse, and sexual behavior in adolescents was noted. However, physical abuse, as well as life stress and impaired family relationships, are also significant correlates of sexual behavior in adolescents.

Sexology as a profession in Europe : Preliminary results of a European survey

Giami, A., de Colomby, P., Fugl-Meyer, K.S., and Wylie, K., Inserm U 569, Paris, France/

Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Sweden/ Porterbrook Clinic, Sheffield , England

(giami@vjf.inserm.fr)

A European survey on sexology as a profession is currently carried out in France, Sweden, England, Finland, Italy, Denmark and Norway. The protocol includes (1) the identification of the professional organizations of sexologists in each country, which accepted to provide the directory of their members; (2) the same questionnaire translated in each language that was sent to all the members of these organizations and to individuals advertising their professional service as "sexologists" in the telephone book (yellow pages), (in France and Sweden only).

The questionnaire included 89 questions related to the socio-demographic characteristics of sexologists, their basic professional and academic training, their training and specialization in sexology, current practice in the field of sexology and attitudes and opinions towards sexuality and the practice of sexology.

The preliminary analysis present the distribution of sexologists in France, England and Sweden by gender, age, highest degree obtained and initial professional training (physicians versus non-medical sexologists).

Preliminary findings point to a major difference between France and other countries. In France about 70 % of sexologists are physicians whereas in England and Sweden only one third or less of the sexologists are physicians. More professions (including nurses, midwives, marital counselors) are involved in the professional practice of sexology in Sweden and England than in France. In France more than half of the sexologists are men whereas about one third of sexologists in England and one fourth in Sweden are men. This finding is likely to relate between differences in the professional distribution of sexologists.

The impact and consequences of the potential medicalization of sexology (higher in France and lower in other European countries) will be discussed. In Sweden and England, it is assumed that medicalization is supported by physicians and non-physicians (nurses, midwives).

Central dopaminergic mechanisms: Experimental pharmacology and clinical applications

Giuliano, F., University of Paris South, Bicetre Hospital, France

The use of the D1/D2 dopamine receptor agonist apomorphine for the treatment of erectile dysfunction provides a strong support in favour of a participation of the dopaminergic system in the control of sexual function. However, the exact involvement of dopamine in the control of sexual motivation and genital arousal in males is unknown. Experimental data in male rats suggested an implication of dopamine in sexual motivation as well as in copulatory performance. Specific tests allowing assessment of sexual motivation showed that the release of dopamine at the level of the nucleus accumbens (innervated by the mesolimbic dopaminergic pathway) and the medial preoptic area of the hypothalamus (innervated by the dopaminergic incertohypothalamic pathway) positively regulated the anticipatory/motivational phase of copulatory behaviour. A permissive role of dopamine released at the level of the median preoptic area of the hypothalamus in the display of copulatory behaviour has been also demonstrated. It is noteworthy that these participations of the dopaminergic system are not specific for sexual behaviour but rather reflect the involvement of dopamine in the regulation of cognitive, integrative and reward processes. Because of its role in the control of locomotor activity, the integrity of the nigrostriatal dopaminergic pathway is also essential for the display of copulatory behaviour. Somehow more specific to sexual function, it is likely that dopamine can trigger penile erection by acting on oxytocinergic neurons located in the paraventricular nucleus of the hypothalamus, and perhaps on the proerectile sacral parasympathetic nucleus within the spinal cord. In conclusion, central dopamine is a key neurotransmitter in the control of sexual function.

A patient-generated, multinational inventory to measure hypoactive sexual desire

Golombok, S.,¹ Rust, J.,² Derogatis, L.,³ Kuznicki, J.,⁴ Rodenberg, C.,⁴ and McHorney, C. ⁵

¹ City University, London, UK, ² Goldsmiths College, London, UK, ³ University of Maryland, Baltimore, USA, ⁴ Procter & Gamble Pharmaceuticals, Cincinnati, USA,

⁵ Indiana University School of Medicine, Indianapolis, USA

Introduction: The Profile of Female Sexual Function (PFSF) is a new, patient-generated, multinational instrument to measure hypoactive sexual desire and associated symptoms in surgically and naturally menopausal women.

Methods: Multinational interviews among 233 menopausal women with low libido were conducted to generate items for a patient-based questionnaire. The items were reviewed in cognitive interviews with patients to develop the preliminary PFSF and confirm content validity. Conceptual translation and harmonization of the items among 5 languages was carried out. The inventory was tested among surgically menopausal women with low libido (N = 325) and age-matched women with normal libido (N = 255) in 8 countries. Data quality, validity, and reliability were assessed and a final PFSF was generated. The final version was validated among independent samples of surgically and naturally menopausal women with low libido.

Results: Over 450 descriptions of symptoms and attitudes were generated and considered as PFSF items. Cognitive interviews revealed ambiguities within languages and altered meanings after translation due to linguistic differences. These difficulties were resolved and an inventory of 65 items (6 domains) was developed. Item reduction yielded a final PFSF of 37 items (7 domains: desire, arousal, orgasm, pleasure, responsiveness, satisfaction, self-image). Results were consistent across the major regions studied. The final PFSF had excellent validity and reliability. All domains discriminated between the low libido and normal groups (p < 0.001).

Conclusions: The complexity of female sexual function requires use of instruments based on patient experience and point of view. Item generation and cognitive interviews done among target patient populations ensure content validity of the PFSF. The PFSF is a multi-national, validated, highly reliable instrument for the measurement of hypoactive sexual desire in menopausal women.

Oral contaceptive androgenicity mediates effects on subjective and genital sexual arousal

Gorzalka, B.B., Seal, B.N., and Brotto, L.A., Department of Psychology, University of British Columbia, Vancouver, Canada

(bgorzalka@cortex.psych.ubc.ca)

It has been demonstrated that subjective sexual arousal is significantly affected by oral contraceptive (OC) use; however, results are conflicting with reports of either an increase, a decrease, or no change following onset of their use. To date, the effects of OC’s on genital sexual arousal have not been investigated. Previous investigations of the effects of OC’s on sexual arousal have focused on the effects of the estrogenic and progestational components of the pill (e.g., Graham et al., 1993; 1995). Recent evidence indicates that progestational components of the pill can alter sex hormone binding globulin levels to varying degrees, and therefore, circulating levels of free testosterone (e.g., Boyd et al., 2001; Collins, 1994; Janaud et al., 1992). Surprisingly, little attention has been paid to the androgenic effects of OC’s on sexual arousal.

The present study was designed to investigate the effects of OC’s on genital and subjective sexual arousal using vaginal photoplethysmography and self-report measures. Sexual arousal to erotic stimuli was assessed before and 5-6 weeks after the onset of oral contraceptive use. Thirty women were to be obtained for this study, and to date a total of eighteen women have completed the study. All women responded with enhanced subjective and genital arousal and with positive mood to the erotic stimulus. Preliminary data showed that there were no overall effects of OC’s on genital measures of sexual arousal. However, a re-examination based on the type of OC used revealed interesting patterns. In women receiving OC progestins producing a larger increase in androgenicity, namely Levenorgestrel, there was a 35% greater increase in genital arousal following the erotic stimulus in session two (post-pill) than in session one (pre-pill). In women receiving OC progestins producing a smaller increase in androgenicity, namely Desogestrel and Norgestimate, the increase in genital arousal following the erotic stimulus was no greater in session two (post-pill) than in session one (pre-pill).

Across all women, there was a trend towards significance for decreased orgasmic frequency. Self-report data also showed that overall, OC’s affected positive and negative affect. An examination of subjective measures of sexual arousal based on pill type found that only OC’s with lower androgenicity resulted in decreased sexual frequency and decreased pleasure from intercourse.

These data are the first to explore the effects of oral contraceptives on both genital and subjective sexual arousal as well as the first to suggest that progestin-induced androgenicity may mediate effects of oral contraceptives on sexual arousal.

Turning on and turning off: Factors related to inhibition and excitation of sexual arousal in women

Graham, C.A. Sanders, S.A., Milhausen, R. and McBride, K.R. The Kinsey Institute for Research in Sex, Gender, and Reproduction, Department of Applied Health Science, Indiana University, Bloomington IN, USA

email: cygraham@indiana.edu

This project investigated factors related to sexual excitation (SE) and sexual inhibition (SI) processes using a woman-centered approach. Focus groups were conducted with 80 women to learn more about how women describe the process of sexual arousal and what factors contribute to SE and SI in women. All transcriptions were analyzed in detail separately by two coders; identified themes were compared and consensus reached on the final coding scheme. Factors that affected SE and SI were classified into the following broad categories: self, partner, general relationship dynamics/interactions; elements of the sexual interaction/activities; setting; sexual or erotic stimuli; hormones, fertility, contraception and STDs; alcohol and drug use; and sexual orientation. The nature of cues to sexual arousal, the relationship between interest and arousal, and the factors affecting SI and SE appear to be different for women than men.

Parental selection of children’s sexual orientation

Greenberg, A. S., Department of Psychology, Northwestern University, Evanston, Illinois , USA

As we learn more about the causes of sexual orientation, the likelihood increases that parents will one day be able to select the orientation of their children. This possibility (at least that of selecting for heterosexuality) has generated a great deal of concern among supporters of homosexual rights, with such selection being widely condemned as harmful and morally repugnant. Notwithstanding this widespread condemnation, and even assuming that homosexuality is entirely acceptable morally, allowing parents, by means morally unproblematic in themselves, to select the sexual orientation of their children would be morally acceptable. This is because allowing parents to select their children’s orientation would further parents’ freedom to raise the sort of children they wish to raise and because selection for heterosexuality may benefit parents and children and is unlikely to cause significant harm.

Premature or rapid ejaculation: Heterosexual couples’ perceptions of men’s ejaculatory behavior

Grenier, G., and Sandra Byers, E., University of New Brunswick, Canada

One hundred fifty-two men and their female partners provided information about the man’s ejaculatory behavior, their perceptions of whether the man had a problem with premature or rapid ejaculation (RE), their sexual and relationship satisfaction, and their sexual concerns. The men’s and women’s reports on the man’s ejaculatory behavior were only moderately correlated. In general, the women saw RE as less of a problem for the men than their male partners reported for themselves. Discriminant function analysis identified three aspects of men’s ejaculatory behavior that were uniquely related to their self-identification of having an ejaculatory problem: a behavioral component, an affective component, and an efficacy component. Only the behavioral component and the affective component were uniquely related to women’s identification of their partner as having an RE problem. For both the men and the women, having more characteristics of RE was related to lower sexual satisfaction, but was unrelated to relationship satisfaction. RE characteristics were also related to the number of non-RE sexual concerns reported by the men, but were unrelated to the number of sexual concerns reported by their female partner. However, men and women who identified the man as having an RE problem rated RE as having only a slightly negative impact on their own or their partners functioning. The results suggest that the timing of ejaculation is important to both men and women and may adversely affect their sexual satisfaction. Thus, it is important to education men and their partners not only about ways to delay ejaculation but also about ways to enhance sexual satisfaction when ejaculation occurs before it is desired.

From fish schools to barstools : A comparative analysis of vertebrate sexuality

Grober, M.S, Department of Biology, Georgia State University and Center for Behavioral Neuroscience, Atlanta GA, USA

(mgrober@gsu.edu)

Humans are a highly social species. From promotions in the workplace to success in relationships, the interactions amongst individuals and groups play a key role in how we make major life decisions. More specifically, social manipulation of sexual and reproductive practices is common in most human cultures. As one might expect, many vertebrate animals, in addition to humans, show dramatic behavioral and physiological responses to changing social interactions. We are studying a group of marine fishes that shows remarkable similarities to humans with regard to the importance of social interactions in regulating major life decisions and the sensitivity of individuals to the behavior of others in the group. By modifying the social group we can induce actively reproducing females to rapidly change into males. Within one week, all aspects of their biology shift from female- to male-typical. Within minutes of removing the male from a group, the dominant female produces aggressive behavior at rates exceeding those produced by males. Male removal also triggers the production of male-typical courtship behavior by the top female. These rapid changes in behavior are followed, at different time points, by changes in a variety of other sex-typical structures. By the completion of sex change, forebrain neuropeptidergic cells change significantly in size and/or activity. The gonad begins to produce sperm and eggs are gradually reabsorbed or discarded. Circulating levels of steroid hormones shift from primarily estrogenic to androgenic. The accessory gonadal structure, a prostate-like gland that is required for successful fertilization is absent in females and rapidly develops in animals that are changing to male phenotype. The external genitalia shift from a blunt papi