Pornography Use

Pornography Use

Hobby or Habit, Dependence or Addiction?

Clinical psychologist Dr. Gary Brooks has identified five principal symptoms of a "pervasive disorder" linked to consumption of even soft-core pornography like Playboy or Penthouse: (1)

  • Voyeurism - An obsession with visual stimulation trivializes all other mature features of a healthy psychological relationship.
  • Objectification - An attitude where women are rated by size, shape and harmony of body parts.
  • Validation - Men who never come close to sex with their dream woman feel cheated or unmanly.
  • Trophyism - Women become the property of the man as a symbol of accomplishment and worthiness.
  • Fear of true intimacy - Preoccupation with sexuality handicaps the capacity for emotional or non-sexual intimacy.

Not all men are equally vulnerable to habitual porn use. For some men, however, Dr. Victor Cline, a clinical psychologist at the University of Utah, identified four stages of viewing pornography following initial exposure. They are: (2)

  • Addiction - The desire and need to keep coming back for pornographic images.
  • Escalation - The need for more explicit, rougher, and more deviant images for the same sexual effect.
  • Desensitization - Material once viewed as shocking or taboo is seen as acceptable or commonplace.
  • Acting out - The tendency to perform the behaviors viewed, including exhibitionism, sadistic/masochistic sex, group sex, rape, or sex with minor children.

Dr. Cline said that pornography "is the gateway drug to sexual addiction." (3)

  • In a study of 932 sex addicts, by Dr. Patrick Carnes, 90% of the men and 77% of the women indicated that pornography played a significant role in their addiction. (4)

Sources:

1 Brooks, G. R. ( ). The Centerfold Syndrome.

2 Cline, V. (1988). Pornography effects: Empirical and clinical evidence. University of Utah Department of Psychology.

3 Ibid.

4 Carnes, P. (1991). Don't Call It Love: Recovery from Sexual Addictions. New York: Bantam.

APA Reference
Staff, H. (2021, December 27). Pornography Use, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/sexual-addiction/pornography-use

Last Updated: March 26, 2022

Depression and Sex Addiction: The Moment Between the Trapezes

"I choose my behavior; the world chooses my consequences" is a phrase that any recovering sex addict would do well to hold in vivid consciousness. When the awareness of a pattern of sexual addiction starts to become clear, a trail of consequences is likely to follow close behind. Rather than attempt to manage or minimize the consequences, the sex addict is advised to curtail sexual acting out and embrace a quality recovery program taught and modeled by other recovering addicts.

Despite the conviction to move toward the rigorous honesty of recovery, the addict is likely to experience the cold sweat of repercussions of previous behavior. The secret life is unveiled revealing affairs, exhibitionism, voyeurism, or other behaviors comprising a particular sex addict's modus operandi of acting out. Like the trapeze artist in the circus, the addict encounters the moment between letting go of one trapeze and catching the other. Such a crisis will make one exquisitely aware of hopelessness and depression. Hopefully, it will also dawn on the addict that he/she is powerless and that a Higher Power alone can and will be there in that moment.

Six classes of depressive types expressed in sex addicts

The mental health practitioner who treats sex addiction is called upon to diagnoses and treat the depression that is likely to be present before, during, and after the between-trapeze experience. This depression may present in several different forms, which can be summarized in the following classes:

1. Most commonly, a chronic, low grade depression or dysthymia in a shame-based person who has low self esteem and relatively undeveloped social skills. This dysthymic disorder may be punctuated with major depression especially likely at the time of significant relationship losses or at the time of exposure of the pattern of sex addiction. Shame, loneliness, and awareness of lost time spent in active addiction may haunt the addict. When shame rolls in, depression follows the flood. This type tends to have a strong superego and be at risk for self-punitive suicidal thoughts and behavior.

2. A seeming lack of depression in a perfectionistic, shameless-acting high achiever. Despite not having a history of previous clinical depression, this person may experience an overwhelming major depression as perfectionism and narcissism no longer stem the tide of mounting negative consequences of sexual behavior. Since this person may have a lofty professional and occupational position, the sexual acting out may involve level III abuse of a power position with employees, clients, or patients. If professional consequences (e.g. loss of license, termination of employment) lead to a further and more devastating breakdown in personal relationships (e.g. divorce, marital separation), the person's shame can be catastrophic and overwhelming, making suicide a real and pressing danger. This person may even need to be hospitalized against his or her will until adequate defenses can be reestablished and a recovery process begun.

3. The depleted workaholic whose life is without joy, and who has no balance in social or recreational spheres. This sex addict is likely to find someone or a series of subjects at work to groom as he/she presents as a martyr-like victim slaving to support a family yet deserving of a sexual release. When depression finally breaks through clinically, after the pattern of sexual behavior is exposed, it is likely to be massive because this addict has little to fall back on when the merry-go-round of work stops. The workaholic pattern becomes a central treatment issue with both sex addiction and depression seen as outgrowths of the long term lack of self-care. If a workaholic pattern recurs after treatment, relapse into sex addiction is almost certain, whether it be in the behavior or thoughts of the addict. Therefore, a goal in treatment and after for this person is to halt the pattern of self-abandonment expressed previously through workaholism, sex addiction, and martyrdom.

4. Psychotic depression in a person who may be older (45-60 or above) and who has a pre-morbid obsessive-compulsive style and a suspicious temperament. This person may have practiced a type of sex addiction that included perpetrating children or teenagers, but kept it concealed for years. When the addiction progresses and the behavior is discovered, the public outcry and shame may be processed by the addict via psychotic defenses of massive denial and projection. The addict may sink into a stuporous depression with psychotic features including frank paranoid thoughts of feeling acted upon by outside forces and profound social withdrawal. The reality of the perpetrating behavior is alien to the denying lifestyle the person has practiced for years. The recovery from psychosis is gradual and in-depth work on recovery from the addictive sexual cycle must be put off until aggressive pharmacological treatment takes effect.

5.Bipolar depression in a person who may or may not be a true sex addict. Since the manic phase and mixed manic/depressive phases of bipolar disorder are often accompanied by hyper-sexuality with heightened sex drive and increased sexual behaviors of boundary-less type, the clinician, in attempting to make an accurate diagnosis, should be mindful to search for a true pattern of sex addiction behavior which transcends the mood swings of bipolar disorder. A bipolar patient may also be a sex addict, but a significant subset of bipolars show hyper-sexuality during mania that is not part of a pattern of sex addiction. The bipolar group as a whole is at significant risk for suicide (the lifetime suicide rate for untreated bipolars is 15%) and risk can do nothing but rise for the portion who are both bipolar and sex addicts. The dual bipolar/sex addict patient may actually complain of two types of depression; one that is without a particular stimulus (the bipolar depression that comes on suddenly like a black cloud overhead), and another depression which mounts slowly and is accompanied by shame and the emptiness of active addiction much like the dysthymia of Class #1.

6. A sociopath who may feel pain from consequences of addiction or perpetration, but lacks true remorse and may feign a victim stance for secondary gain from significant others and legal authorities. The dramatic victim behavior may mimic depression, but usually lacks the classic vegetative signs (sleep, appetite, energy, and interest disorders) of true major depression. If a person with antisocial personality disorder threatens suicide or acts on suicidal thoughts, it is usually in retaliation toward authority figures, related to substance abuse, or associated with additional accompanying character pathology (e.g. borderline personality).The sociopathic pattern should eventually be evident by the triad of lack of remorse for perpetrator behavior, failure to learn from past mistakes, and projection onto others of blame (lack of accountability). Such a person may have been through multiple previous treatments accompanied by a professed wish to work a strong recovery program yet, in reality, followed by failure to "walk the talk."

The six classes of depressive types show that the entire array of depressive disorders is expressed in sex addicts. As a practical help to the mental health therapist, it might be useful to codify some of the clinical tools to employ in assessing and treating the depressed, suicidal sex addict. First, the practitioner will want to be able to distinguish the type, depth, and severity of the depression. Second, the therapist should as accurately as possible know what to consider in terms of risk of suicide.


Steps for determining the severity of depression

Determining the severity of depression combines a play-it-by-the-book (DSM IV) approach to asking about each possible depressive symptom with an intuitive awareness of what could happen (call it clinical "thinking dirty") as the sex addict in treatment relates to mounting consequences. These steps are suggested:

1. Take no shortcuts in the intake process. Get a broad anthropological/cultural view of the person while conducting a careful search for symptoms and signs of depression and/or suicidal ideation and plans. The cultural context and support system have a telling influence on suicidal potential.

2. Withhold too early conclusions about character pathology. "Hip-shooting" labeling (e.g. borderline, narcissistic, antisocial) only closes off possibilities in the clinician's mind and prevents the therapist from seeing the patient in all his/her potential for resilient recovery or calamities such as suicide.

3. Request psychological testing to back up interview data and clinical observations. Something may surface that was not considered earlier (e.g. schizotypal thinking or a low-grade thought disorder.

4. Search out nooks and crannies in relation to suicidal and homicidal thoughts. For example, if a person denies active suicidal thoughts, he/she may still wish that a semi-truck would meet them head-on. Likewise, even though a patient is a mother of children and says she would never kill herself because her children need her, has she recently bought life insurance or given away belongings?

5. Review any past history of suicidal ideation or attempts. What are the similarities and differences (e.g. strength or lack of strength of support network) to the present situation? Has the person ever faced anything as humiliating as the exposure of sex addict behavior?

6. Consider, "How deep is this person's shame?" Will the person consider suicide to be the only "viable" way out of a lifelong shame-existence bind?

7. Inquire about how the person has taken out anger in the past. Toward self? Toward others? He/she is likely to follow the same pattern again.

8. Determine the dynamic significance of the type of sexual acting out practiced by the patient (e.g. the exhibitionist who could never get his mother's attention). Has that meaning been processed with the patient and the power taken out of the pattern, or does shame still envelop the patient and fuel suicidal/homicidal thoughts?

9. Measure whether the patient's medication for severe depression is at a therapeutic level. Smoldering along with depression that is only partially treated can heighten the patient's hopelessness and could lead to suicide (e.g. Is this as good as it gets?).

10. Assess medication compliance. What has been the response of the depression to medication? Does the patient understand the importance of taking medication as prescribed, and for as long as prescribed? Are any side effects intolerable to the patient (e.g. decreased sex drive, anorgasmia, or impotence)?

11. Examine any progress made in treatment in processing anger, shame, and other overwhelming emotions. Have the circumstances of the person's life changed for the better? For the worse? Remember, if nothing changes, nothing changes.

12. Gauge employment and economic prospects. Has sex-addict behavior led to consequences at work? Will there be further repercussions and consequences?

13. Ask the patient what he or she sees for the future. Hope or hopelessness?

14. Practice appropriate boundary setting with the patient as he/she relates to co-workers and people outside the circle of recovering sex addicts. To whom will the person claim sex addiction, and with whom will anonymity and strict boundaries be maintained? Role play some of these scenarios. Would the person rather die than face so-and-so?

15. Concretize aftercare plans. Who will see the patient for outpatient treatment? Is that therapist knowledgeable about sex addiction treatment and recovery? Will the therapist refer the patient if suicidality becomes prominent again? Is extended care needed? How many and what type of Twelve Step meetings will the person attend? Will the person get a sponsor and work Steps, or will he/she remain a "movie critic" at meetings as in the past? Will the person "put your whole self in" to recovery, as the song says?

16. Bring to light the person's growth or lack thereof of a concept of a Higher Power. Does the person think his/her preciousness is a reality? Would a Higher Power really care? Is there still a false Higher Power operating (e.g. money, power, self, another addiction, or a partner)?

In summary . . .

The sex addict is really hurting. It is the clinician's task to assess where the pain could lead while providing a safe, healing, holding environment.

Depression present at the start of treatment often deepens as shame crashes down upon the addict whose acting out pattern is revealed. Suicidal ideation at the "between trapeze" moment is a likely probability. The educated clinician's index of suspicion will help to anticipate the presence and depth of depression, and the existence of self-destructive thoughts or plans. Caring and professional assessment and treatment will allow the sex addict to survive the shock of discovery and move toward the daily rewards of a healthy and spiritual recovery.

Stephen S. Brockway, M.D., Dr. Brockway has been in private practice since 1979, specializing in in-patient psychiatry and addiction medicine.

APA Reference
Staff, H. (2021, December 27). Depression and Sex Addiction: The Moment Between the Trapezes, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/sexual-addiction/depression-and-sex-addiction-the-moment-between-the-trapezes

Last Updated: March 26, 2022

Sex: When He Has a Headache

The image of men as continual and shameless seekers of sexual gratification has worked its way into society's consciousness. The trouble is, it's badly out of date. Among other problems, it doesn't reflect the new dynamic at work in relationships.

In a touching twist on gender roles, it is increasingly the man, not the woman, who is experiencing anxiety--or alternatively apathy--concerning sex, reports Janet Wolfe, Ph.D. She cites a survey by a major women's magazine showing that nearly 40% of the time, the complaint that one partner has sexually fizzled-out comes from the woman. Wolfe's experience as a psychotherapist bears this figure out.

And so, Wolfe has done what any self-respecting shrink would do. She has written a self-help book, What To Do When He Has a Headache (Hyperion)--not for the ailing men, but for relationship-deprived women.

Wolfe sees several causes of the role reversal:

* As women become more aware of their capacity for sexual fulfillment, they are less inclined to accept a partner who remains oblivious to her needs.

* Men, in turn, feel increased pressure to perform. They may respond by avoiding sex altogether, rather than risk finding themselves failures.

* To make matters worse, men report they are simply too exhausted for sex after a long day's work of 10 to 12 hours. They are in the grip of near-catatonia that barely gives them the stamina to sit and watch TV.

* With the increase in performance anxiety, sex becomes another job... another responsibility...another reason to be afraid.

How to get the guys back?

* Wolfe suggests that emotional honesty does not come easily to most men, but both partners must cultivate it if physical honesty is to have a shot.

* Men need to be reintroduced to nonsexual contact, such as handholding, and made aware of just how pleasing and powerful it can be--and how easy. And it just might act as a non-threatening invitation to more full-bodied contact.

With lots of patience and some care, a little more joy can be returned to the bedroom...and the TV set safely returned to the den.

APA Reference
Staff, H. (2021, December 27). Sex: When He Has a Headache, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/women/sex-when-he-has-a-headache

Last Updated: March 26, 2022

All for Him: Articles About Sex in American Lad Magazines

In May of 2003, Wal-Mart elected to cease the sale of three popular magazines--Maxim, Stuff, and FHM: For Him Magazine. In justifying this decision, they cited customer complaints about the magazines' depictions of scantily clad women on their covers (Carr & Hays, 2003). By banning these three titles, they effectively banned an entire genre of magazines, one that is relatively new to the United States--the lad magazine. Targeted at young men, these magazines are known for being "salacious but not pornographic" and for their "bawdy" humor (Carr, 2003). Given the popularity of the magazines in this new genre, as well as their overtly sexual content, it is possible, even likely, that they may play a role in teaching their young male readers about sex. In the present study, content analysis was used to explore what is being taught.

Current theories of sexuality emphasize that sexual behavior is, to a large extent, learned (Conrad & Milburn, 2001; DeBlasio & Benda, 1990; DeLameter, 1987; Levant, 1997). Although certain aspects of sexuality are physiological, the question of what is considered arousing, what behaviors and which partners are appropriate, when and in what contexts sexual behaviors can be carried out, and what are the emotional, social, and psychological meanings of these various factors are must be learned.

The answers to the questions about sex posed above often differ based on one's gender. Numerous scholars have observed these differences, which seem to emphasize different roles and priorities for men and women in sexual encounters. Men are generally expected to be assertive seekers of sex and to value sexual frequency and variety; women, on the other hand, are expected to be sexual gatekeepers, recipients of men's attention, and to value sex only as part of committed romantic relationships, if then (DeLameter, 1987; Fine, 1988; Holland, Ramanzanoglu, Sharpe, & Thomson, 2000; Levant, 1997; Phillips, 2000). Empirical evidence indicates that these expectations are often realized, as differences between men's and women's sexual behaviors, attitudes, and reactions to sexual stimuli, where observed, tend to be consistent with stereotypical expectations (Andersen, Cyranowski, & Espindle, 1999; Aubrey, Harrison, Kramer, & Yellin, 2003; Baumeister, Catanese, & Vohs, 2001; DeLameter, 1987; Schmitt et al., 2003). Men in general seem to hold more permissive attitudes toward sex, to desire a greater variety of sexual partners and behaviors, and to seek sexual sensations more frequently than women do.

In addition to information about gender roles, values, and so forth, there is a wide array of factual information pertaining to sex that can have important consequences; this includes topics such as possible unwanted consequences of sex, the prevention of such consequences, sexual disorders such as erectile dysfunction or vaginitis, the prevention and treatment of such disorders, and so on. That such information is vital is reflected in the facts that over one-third of adult women in the United States have a limited or incorrect understanding of how STDs can be contracted and that one in five adults in the United States have genital herpes (Kaiser Family Foundation, 2003).

Young people recognize their need to learn about sex. One national survey of a representative sample of young people ages 15-29 found that sexual health was the primary health topic of concern and interest among that population; 77% of the young people in the sample expressed an interest in receiving more information about sexual health (Kaiser Family Foundation, Hoff, Greene, & Davis, 2003). Further, this and other studies have demonstrated that adolescents and young adults are able to name the sexual topics about which they need to be informed--they want to know more about specific sexual health topics, including symptoms, testing, and treatment of STDs, about how to use condoms correctly, about how sex and personal empowerment and happiness fit together, and about how to communicate with partners about sensitive sexual issues (Kaiser Family Foundation et al., 2003; Treise & Gotthoffer, 2002).

READING AS A SOURCE OF INFORMATION ABOUT SEX

Adolescents and young adults receive information about sex from a number of sources; parents, peers, churches, media sources, and schools all make a contribution. When adolescents or young adults are asked to indicate their first or predominant source of information about sex, many cite peers or friends (Andre, Dietsch, & Cheng, 1991; Andre, Frevert, & Schuchmann, 1989; Ballard & Morris, 1998; Kaiser Family Foundation et al., 2003). Other research, drawn from diverse samples and conducted over many years, suggests that for most topics related to sex, however, independent reading is a more important source of information than parents, peers, or schools (Andre et al., 1991; Andre et al., 1989; Bradner, Ku, & Lindberg, 2000; Spanier, 1977). Further, these same studies suggest that this is true for both men and women, and for the sexually experienced as well as the less experienced.

MAGAZINES AS SOURCES OF SEXUAL INFORMATION

Though materials used for independent reading certainly vary, magazines are definitely one such source. Researchers who have employed diverse methods have arrived at the conclusion that adolescents and young adults use magazines to gain information about sexual topics including sexual skills and techniques, reproductive issues, sexual health, and alternative sexualities (Bielay & Herold, 1995; Treise & Gotthoffer, 2002), and that they often prefer magazines over other sources of information (Treise & Gotthoffer, 2002). These findings, coupled with those that document independent reading as an important source of information about sex, suggest that magazines may be very important to the development of knowledge about, beliefs about, and attitudes toward sex, especially for young people.

There are theoretical reasons to believe that reading magazines to obtain sexual information may have effects on attitudes, beliefs, and behaviors, as well as information-type knowledge. Huesmann's (1997, 1998) information processing model suggests that numerous cognitive structures, including attitudes toward and beliefs about social objects, as well as scripts for behavior, can be incrementally learned, reinforced, or altered through essentially the same processes. Cultivation theory has long held that exposure to a consistent set of media messages can lead to altered beliefs about the nature of the real world (Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002).


EFFECTS OF USING INDEPENDENT READING AS A SOURCE OF INFORMATION ABOUT SEX

There is little available research that deals with the issue of what effects, if any, independent reading about sex in general, or reading about sex in magazines in particular, has on readers. What is available is largely correlational in nature. There is an association between receiving more sexual education from independent reading and better performance on a test of knowledge about sex (Andre et al., 1991). There is also some evidence that receiving more information from independent reading as opposed to other sources may be associated with more sexual experience (Andre et al., 1991); given the numerous plausible explanations for such observations, however, it is premature to infer a causal relationship. In addition, in one study, reading sex manuals and reading Playboy were each associated with beliefs about greater frequency of behaviors including sexual intercourse, oral sex, and erotic dreams, and reading Playboy was associated with beliefs that sex without love, the use of stimulants for sex, and the exchange of sex for favors were relatively more common (Buerkel-Rothfuss & Strouse, 1993). Another study found reading women's lifestyle magazines such as Cosmopolitan and Elle to be associated with greater endorsement of sexual stereotypes (Kim & Ward, 2004). Limited experimental evidence also indicates that viewing nonpornographic sexual images from magazines can lead to greater endorsement of rape-supportive attitudes (Lanis & Covell, 1995; MacKay & Covell, 1997).

SEXUAL MESSAGES IN POPULAR MAGAZINES

Given the apparent influence of magazine content and the importance of independent reading in general, and magazines in particular, as sources of sexual information for young people, it is important to understand what messages about sex are contained in the magazines read by young people. Relatively little research is available on this topic, and what is available is largely concerned with magazines targeted at young women. A broad range of sexual topics are apparently available in women's magazines such as Cosmopolitan, including topics as diverse as contraception, sexual technique, and sex addiction, though sexual techniques and pleasuring seem to be most common (Bielay & Herold, 1995); topics of magazines targeted at younger women generally focus on establishing and maintaining romantic relationships and sexual decision-making, though sexual health issues and techniques are also present (Carpenter, 1998; Garner, Sterk, & Adams, 1998). Magazines targeted at adolescent girls, such as Seventeen and YM, have been found to contain conflicting messages about sex; they encourage girls to be sexy, emphasize the importance of romantic relationships, instruct young women on how to please young men, and simultaneously emphasize patience and control (Carpenter, 1998; Durham, 1998; Garner et al., 1998). Studies of magazines targeted at adult audiences, both male and female, such as Cosmopolitan, Self, GQ, and Playboy, have demonstrated that their contents treat women as sex objects, both through use of objectifying images (Krassas, Blauwkamp, & Wesselink, 2001) and the written content of articles about relationships (Duran & Prusank, 1997).

Despite the relatively important role they may play in the development of young people's attitudes toward and beliefs about sex, there is a surprising paucity of research on the nature of sexual content in magazines targeted at young people, especially young men. What little research is available on men's magazines has focused on magazines such as Playboy, Penthouse, and GQ; these magazines are designed for and marketed to adult men in general, and not to adolescent boys and young adult men in particular. Further, magazines such as Playboy, despite their ostensible status as "lifestyle magazines," seem to be in a very different category than lifestyle magazines such as Cosmopolitan that are oriented toward women.

SEX IN LAD MAGAZINES

There is, however, a genre of magazines that is targeted principally at young men and that does parallel, in many ways, women's lifestyle magazines: so-called "lad" magazines such as Maxim, Stuff, and FHM. These magazines, modeled after successful British magazines, are targeted at young men and, although they do feature enough scantily clad models to be banned from some retail stores (Carr & Hays, 2003), they do not contain even frontal nudity. These magazines debuted in the late 1990s in the United States, and they have rapidly established a firm cultural presence. Maxim, the oldest and most successful of the genre, has a readership of over 12 million; according to Maxim's own data, their readership is overwhelmingly male (76%), unmarried (71%), and fairly young (the median age of readers is 26) (Maxim Online, 2003). Other magazines of this genre have smaller followings, but with similar, or even younger, demographic characteristics.

The study described here was undertaken to explore the nature of the messages about sex contained in these magazines. There were several goals in this exploration. First, an attempt was made to discover what specific topics were addressed in articles that were predominantly about sexual subjects. As discussed above, past research suggests that young people want information about sexual health and personal empowerment issues; they want to read about specific STDs, their prevention and treatment, and about how to negotiate condom use with a partner (Kaiser Family Foundation et al., 2003; Treise & Gotthoffer, 2002). At the same time, we know that women's magazines focus more on sexual techniques and pleasuring than on such information, though they do give substantial attention to issues related to women's reproductive health (Bielay & Herold, 1995). Given traditional gender roles that portray women as sexual gatekeepers and men as sexually driven (DeLameter, 1987; Phillips, 2000), we would expect an even greater emphasis on topics related to sexual gratification than those related to sexual health in lad magazines than has been observed in women's magazines. Further, we should observe a clear focus on men's sexuality and sexual outcomes as opposed to women's sexual outcomes.

The second objective of this project was to determine what sexual topics were, though not the primary subject of a given article, embedded in articles about sex. It may be that certain subjects that are underrepresented as foci of entire articles are nonetheless amply represented as elements of other articles. Such is seemingly the case with the presence of messages about condom use on television; although few scenes deal with condom use as a primary subject, relatively more scenes about specific sexual encounters incorporate condom use (Kunkel et al., 2003). To understand the nature of the sexual content in these articles, it is necessary to understand all of the topics, rather than just the predominant subject, that are discussed within them.

The third goal was to assess the nature of the relationships presented as the contexts for sexual activity within these magazines. Given repeated findings that men tend to privilege variety among sexual partners (Baumeister et al., 2001; DeLameter, 1987; Schmitt et al., 2003), it was expected that most articles about sex in magazines targeted at young men would presume fairly low-commitment relationships as the context for sexual activity, such as strangers or casual dating relationships. Alternately, it may be that relatively more committed relationship states are presented as contexts for sexual activity, but that such relationships are portrayed negatively.


METHOD

Sample

Three magazines were identified for inclusion in this study due to their predominance within the genre--Maxim, Stuff, and FHM (For Him Magazine). These magazines are often linked together in the popular press, as well as by Wal-Mart executives, who banned the sale of all three in 2003 (Carr, 2002; Carr & Hays, 2003). They are also the oldest of their genre in the United States (Carr, 2002), and each ranks among the 100 most widely read magazines in the United States (Information Please, 2003).

A systematic random sample of magazines was drawn by selecting 4 months of the year at random (March, May, August, and October) and obtaining an issue of each magazine for each of those 4 months for every year of each magazine's publication through the issue published in May of 2003. This yielded differing sample sizes for each of the three titles because the magazines were founded at different times--Maxim began publishing in the United States in mid-1997, FHM in early 2003, and Stuff in mid-1999. Three specific issues in the sample could not be located; in these cases, the ensuing month's issue of the same magazine was substituted. Initial examination of issues of each title from different years suggests that differences between the magazines' sexual content are minimal.

All articles primarily about a sexual topic in the magazines were included in the sample. The determination of which articles would be included was made primarily by examining the table of contents. An article was defined as a body of editorial content described under a single heading in the table of contents. Articles determined to be about a sexual topic included those for which the primary topic discussed in the article's prose content dealt with sexual behaviors or relationships, their antecedents, or their consequences. Articles that consisted primarily of pictorials of women described in terms of sex appeal were not included. A total of 91 articles from 53 different issues met these criteria, and they constituted the sample of articles about sex.

Coding Scheme and Definitions

Articles were coded first for their primary topic and then for any other topics that received substantial attention in the article. The list of topics included in the coding scheme was adapted from Bielay and Herold's (1995) study of sexual topics in women's magazines by adding topics specific to men's sexual health and pleasure. Coders were provided with a list of topics and asked, after reading the entire article, to select which one, if any, was the primary emphasis of the article. Topics included in this list were improving one's sex life, what women like, improving one's orgasm, improving a woman's orgasm, sexual satisfaction, unorthodox sexual behaviors or positions, unorthodox sexual locations, HIV/AIDS, other STDs, rape, safe sex, pregnancy, condoms, women's sexual health, abortion, vasectomy, other men's sexual health issues, gay men, lesbians, and drugs or alcohol. Although definitions for many of these are self-evident (e.g., HIV/AIDS, pregnancy), others required further development and clarification. A single article could only have one primary topic, but could mention numerous topics. These were coded for separately, but using the same basic definitions (see below).

Improving One's Sex Life

Content that discusses betterment of one's sex life in general, such as suggesting strategies for getting more sex, better sex, or sex more consistent with the reader's desires and interests.

What Women Like

Describes women's preferences, likes, and dislikes relative to sex or sexual relationships. Possible content could include descriptions of sexual techniques women endorse or personality or physical traits women find appealing in potential sex partners.

Sexual Satisfaction

Discusses the nature of sexual satisfaction, or being contented or pleased with one's sexual experiences or sex life, or offers a definition of what constitutes sexual satisfaction. This is distinct from improving sex life in that sexual satisfaction does not presume current dissatisfaction or necessarily recommend change. An article that suggests that the key to sexual satisfaction is to moderate one's expectations, for example, would really not focus on improving one's sex life, but on being satisfied with the sex life one has.

Unorthodox Sexual Behaviors or Positions

Descriptions of sexual behaviors other than precoital behaviors such as kissing and petting, genital intercourse, and oral-genital intercourse, or specific methods of the same that were deemed unusual or extreme. Examples used in coder training included group sex, anal sex, and bondage not described as "playful" or "light." This category also included descriptions of sexual positions that seemed complicated, contorted, or acrobatic in nature.

Unorthodox Sexual Locations

Descriptions of sexual encounters in places other than a place of residence such as a home, apartment, or hotel, or those that, although in a place of residence, occurred in unexpected locations or atop unusual items of furniture. Sex in bed, on a chair or couch, or on the floor was not considered to occur in an unusual location.


Drugs and Alcohol

This category strictly referred to content in which drugs or alcohol was connected in some way to sexual behaviors, gratifications, or outcomes. Articles about beer would not fit this category; articles that discussed bars where alcohol is served as places to recruit sexual partners, however, would.

Relationship States

Each article was also coded for the predominant relationship state, if any, presumed to be the context of sexual activity as discussed within the article. Seven relationship states were coded: strangers, first date, casually dating, seriously dating, engaged, married, and nonromantic acquaintance (definitions can be found in Table I).

In addition, coders were asked to determine the degree to which each article depicted the main relationship state to be positive and negative, either through overt statements or implication. In order to account for possible ambivalence toward a relationship state, positivity and negativity toward relationship state were coded separately. Each article in which a dominant relationship state was observed was therefore coded for relationship positivity, the degree to which a relationship state is implied or stated to be positive, beneficial, or a source of positive outcomes, and relationship negativity, the degree that a relationship is implied or stated to be negative, harmful, limiting, or a source of negative outcomes. Although this was done initially on a five-point scale (where 0 indicated no positivity or negativity, 1 indicated mild, 2 some, 3 moderate, and 4 indicated extremely positive or negative), low intercoder reliability required the collapse of intermediate scores of 2 and 3 into a single score, which resulted in a 4-point scale.

Images

Each article was also coded as to the nature of the photographic images that accompanied it; following the pattern established by Reichert, Lambiase, Morgan, Carstarphen, and Zavoina (1999), cartoons and illustrations were excluded. The presence of members of each sex in such images was coded, as were the explicitness of those images and the nature of the interpersonal contact, if any, that they depicted. In order to maintain a consistent unit of analysis, individual photographs were not analyzed; instead, coders identified whether any photograph that accompanied an article contained each element in the coding scheme. An article with three photographs of women was coded the same as an article with a single photograph of a woman. In the case of explicitness, the photograph with the highest degree of explicitness was used.

Explicitness was measured on a scale based largely on those employed by Kunkel et al. (2003) for their analysis of sexual content on television and Reichert et al. (1999) for their analysis of images in magazine advertisements. Five categories were employed; images were coded as not explicit (0), suggestive (1), begin disrobing (2), discreet nudity (3), and nudity (4). Photographs were coded as suggestive if a model's attire was considered to reflect a strong effort to display one's body in a sexual manner and included bikinis, very short skirts, and sheer tops. Photographs in the "begin disrobing" category depicted an individual apparently in the process of removing clothing, which, if removed, would reveal often sexualized body parts, specifically buttocks, genitals, or a woman's breasts; models who were wearing only very revealing undergarments were included in this category. Discreet nudity indicated portrayals in which nudity was strongly suggested without showing genitals or women's nipples, though the rest of the breast could be visible. Finally, photographs were coded as depicting nudity if genitals, entire buttocks, or a woman's nipple or nipples were visible and unobscured.

Interpersonal contact was measured using a rubric developed by Reichert et al. (1999); images were coded as not having an eligible couple (0), containing at least two people engaging in no physical contact (1); simple contact (2) such as a casual embrace; intimate contact (3) such as kissing, embracing suggestively, or caressing; or very intimate contact (4) such as sexual intercourse or other direct sexual stimulation. The gender of each pair was also coded.

Coder Training and Reliability

Two paid coders, both male students enrolled at a large midwestern university, conducted all coding activities for this project. They received 8 hours of training in which they learned the definitions, were presented with examples of content that represented each type, and practiced coding articles from issues of lad magazines not included in the sample. Through repeated practice and discussion about coding decisions, coders demonstrated an understanding of relevant constructs and decisions.

Intercoder reliability was assessed using Cohen's kappa as described by Neuendorf (2002), calculated for each topic, relationship state, and explicitness rating. A total of 20 articles from the sample, chosen at random, were coded by both coders. All kappas were above. 70, which, given the exploratory nature of this study, the conservative nature of Cohen's kappa as a tool for assessing intercoder reliability, and the relatively small sample size (due, in part, to the relative newness of the genre being studied), was considered to be a good indicator of reliability (for a detailed discussion of acceptable levels of intercoder reliability, see Neuendorf, 2002). The two exceptions to this were relationship positivity and negativity, which, as discussed above, did not reach acceptable levels of reliability (.51 and .39, respectively); for each, the categories of "some" and "moderate" were collapsed into a single category, improving the kappas to acceptable levels (above .70).


RESULTS

Main Topics of Articles About Sex

Only a handful of the topics coded were represented as main topics of articles in the sample. The most common topic was what women like (37 articles or 41%); this was followed by unorthodox sexual behaviors or positions (18 articles or 20%) and improving sex life (17 articles or 19%). Articles focused on unorthodox locations for sex (6 articles or 7%), improving women's orgasms (3 articles or 3%), men's sexual health issues, and sexual satisfaction (1 article or 1% each) were also identified. Eight articles did not have an identifiable main topic that fit the coding scheme.

Perhaps as relevant as what is present is what is missing; there were no articles focused on alternative sexualities (gay men, lesbians) whatsoever. There was also an absence of any articles focused on risks associated with pregnancy (pregnancy, abortion, STDs, HIV/AIDS) or the prevention of those risks (safe sex, vasectomy, condoms). The sole article focused on sexual health consisted entirely of trivia that pertained to sexual functioning and health, such as the effect of zinc on sperm motility and reasons used to justify circumcision.

Secondary Topics

In addition to coding for a single, dominant topic for each article, coders also indicated all topics that received substantial mention within each article. A substantial mention was one that was considered to be clear and relatively unambiguous. For example, in an article whose main topic is what women like, an explicit statement about group sex would be coded as a substantial mention of unorthodox sexual behaviors; a veiled reference to the same behavior such as a reference to "heading down the hall together" would not be coded.

The most common secondary topic was improving sex life, present in 47 of 91 articles (52%). This was followed closely by unorthodox sexual behaviors (39 articles or 43%), unorthodox sexual locations (35 articles or 38%), drugs or alcohol (34 articles or 37%), and what women like (33 articles or 36%) (for all frequencies, see Table II). Of these, only drugs and alcohol were not among the most frequent main topics as well. Clearly, a few topics overwhelmingly dominate articles about sex in American lad magazines. If young men are using these magazines as sources of sex education, they are learning about a very limited range of topics.

Intersections Between Topics

Several intersections exist between the more common main and secondary topics that may shed additional light onto the content of articles about sex in these magazines. For example, articles that are principally focused on what women like are also very likely to contain messages about improving men's sex life (25 of 37); in fact, chi-square analysis suggests that they were significantly more likely to contain such messages than expected by chance, even given the overall frequency of such messages in articles on all topics, [chi square] = 18.64, p < .001. Articles principally focused on what women want were also more likely to contain mention of unorthodox sexual practices than would be expected by chance, [chi square] = 16.62, p = .002, but no more likely to mention unorthodox sexual locations, [chi square] = 4.50, n.s.

There were insufficient mentions of sexual health topics to conduct any sort of statistical analysis, but it is interesting to note where these mentions did occur. Three of the five mentions of safe sex occurred in articles focused on unorthodox sexual behaviors; the other two were in articles with no identifiable main topic. There were no mentions of safe sex in articles primarily about what women want, and only two such articles mentioned condoms. On the other hand, nearly one-half of all articles that mentioned condoms were primarily about unorthodox sexual behaviors or locations; specific examples of such articles concern the convenience of having sex in public places where condom machines are located and deride the masculinity of a man who opens a box of condoms in front of a new sexual partner. Articles that included mentions of other men's sexual health topics were predominantly focused on improving readers' sex lives or on unorthodox sexual practices, and they often took the form of unusual trivia, such as the percentage of sperm that are fertile in the average man.

Relationship States

Of 91 articles about sex, 73 were coded as stating or clearly implying a single dominant relationship state presumed to be the context for sexual activity. The most common relationship state was serious dating (44 articles). These articles often made explicit references to committed relationship roles by referring to "your girlfriend" or "your girl." Others implied such a relationship with a combination of mentions of longer relationships and expectations of sexual exclusivity. The next most common relationship state was strangers (17 articles). The first date (3 articles), a casual dating relationship (3 articles), and nonromantic acquaintances (4 articles) also received some attention. Only one article presumed engagement or marriage as a context for sex.

Most articles that depicted serious dating as the context for sexual activity portrayed it ambivalently. Only 15 articles in this group were coded as strictly positive or negative toward the serious dating relationship; the rest conveyed a combination of both. Most of the articles (27 of 44 or 61%) were moderately positive about serious dating relationships; of these, 10 were also moderately negative, and 8 were mildly negative. Only two articles were rated as highly positive toward serious dating relationships, and only two were rated as highly negative. Relationship positivity overall was mild to moderate (M = 1.52, SD = .73); relationship negativity was just slightly lower (M = 1.27, SD = .84).

Similar patterns emerged for articles that depicted strangers as the relationship context for sex. None of these articles portrayed this context as extremely positive or negative, and most articles were ambivalent (11 of 17, or 65%). Scores for positivity seem to be slightly higher than scores for negativity (M = 1.53, SD = .80 and M = 1.00, SD = .70, respectively).

The one article that featured married sex was also ambivalent. The article discussed the practice of married couples inviting another individual to join them in group sex as both an enlightened practice for the most sincerely committed and as an attempt to breathe life into the impractical, unrealistic sexual world that is marriage.


Images

All articles in the sample were accompanied by at least one photograph, and so all were included in the following analysis. Of the 91 articles in the sample, 89 were accompanied by a picture of a woman; the median explicitness was 2, or "begin disrobing." This was also the modal category (43 articles), followed by discreet nudity (21 articles), and suggestive appearance (17 articles). Only one article was accompanied by an image that met the description of nudity. Nearly one-half of the articles in the sample (45) included a picture of a man, although the median explicitness was much lower than that for women (Md = .40). Most images (25) were not explicit; nine articles included an image of a man suggestively attired, 10 were partially disrobed, and one exhibited discreet male nudity.

Thirty-seven articles included photographs of men and women together; of these, 17 included a depiction of intimate contact, and five included a depiction of very intimate contact. Simple contact occurred in nine articles, and no contact in six.

Articles accompanied by images of multiple women were also fairly common (33 articles). Most of these depicted no contact (9) or simple contact (14) between or among the women in the photograph; a few (9) depicted intimate contact, and one depicted very intimate contact between two women. Only nine articles in the sample included more than one man; of these, seven depicted no contact between the men, and the other two depicted simple contact.

DISCUSSION

The most common topics of articles about sex in American lad magazines are what women want, how to improve one's sex life, and unorthodox sexual positions and locations. The last three of this group were expected and consistent with cultural norms that describe sex in generally androcentric terms and male sexuality as oriented toward maximizing variety. The fact that the most common topic, what women want, seems, at first glance, to be inconsistent with this pattern will be taken up later.

The finding that improving the male reader's sex life was a prominent topic is hardly surprising, yet is nonetheless important. After all, if lad magazines are being used as sources of sex education, what are readers learning? First, as they read repeatedly about how to improve their sex life, they are likely to learn that their sex life is presently inadequate. Otherwise, it would not need improving. Second, readers may learn that they can improve it along fairly narrowly defined lines--lines suggested, for example, by the next most common topics, specifically unorthodox sexual locations and positions, and by other topics frequently mentioned in these articles, such as use of alcohol. Ultimately, these articles seem very clearly to emphasize an androcentric sexuality that emphasizes sexual variety.

To understand the exception to this pattern, specifically the phenomenon that the most common topic of articles about sex in the sample was what women want, we must look beyond the primary topic of those articles and explore their contents further. After all, most of those articles also contained discussion of improving the presumably male readers' sex life. It is possible that such mentions alter the fundamental meaning of the articles in which they occur. Examination of examples of such articles makes this clear. One article in Maxim titled "More Sex Now!" suggested a number of strategies for pleasing a woman and helping her to enjoy sex more. These included talking dirty, giving her surprise gifts, and extending foreplay. The initial paragraphs of the article, however, as well as the title, signal that the male reader should engage in such behaviors in order to increase the frequency and enthusiasm of sexual intercourse. This is echoed throughout the article, as the author promised that the specific behaviors presented as what women desire will result in sexual rewards for men, as when she stated that "we'll go out of our way to express our gratitude (read: blow job), and presto: Your sex life's back." Another article features a discussion among six women about what makes a potential male partner appealing and a present sex partner worth keeping; the article, written entirely from a woman's perspective, emphasized women's wants, yet the opening paragraph encouraged the male reader to use the article as a "guided tour through a first encounter and beyond" in order to "make sure" they get what they want sexually.

Thus, articles about what women want are essentially framed in terms of improving men's sexual experiences. The message is that if you give women what they want, then your sex life will improve. Essentially, then, any such article is consistent with the expectation that articles about sex in lad magazines will reinforce traditional masculine gender norms about sex, as women's sexual experience serves as a pathway to the fulfillment of men's sexual goals.

This is further reinforced by the frequent occurrence of mentions of unorthodox sexual behaviors in articles about what women want. The message of such articles is that women want to engage in unusual sexual behaviors as much as men do, that women are driven by sexual variety just as men are. This is exemplified by articles in which women are quoted as they enthuse over bondage, sex in public, group sex, and the use and imitation of pornography during sex. The implicit message is that women's and men's sexual desires are essentially similar (for discussions of the similarities and differences between men's and women's sexuality, see Baumeister et al., 2001; Oliver & Hyde, 1993; Schmitt et al., 2003).

The finding that 17 articles mentioned lesbianism also, at first glance, seems inconsistent with expectations about androcentric messages about sex. Closer examination, however, indicates that most such references are actually about women engaging in sex with other women while men watch or participate. A few others consist of descriptions of sexual encounters with women by women who claim to be bisexual which, at least in their description in print, could be seen as essentially serving to further men's sexual satisfaction. In short, these references are also essentially oriented toward men's sexual outcomes.


The fact that most of the articles about sex in these magazines are accompanied by images of women depicted suggestively or only partially clothed may reinforce this notion. Regardless of the subject matter of an article, it is accompanied by a sexualized image of at least one woman. This may serve to influence the meaning readers ascribe to any content. The images themselves may function to activate stereotypes about women as sex objects; these stereotypes would then be expected to influence how readers understand what they read. Articles about what women want sexually, for example, may be understood even more in terms of men's pleasure than would otherwise be the case.

Another unexpected outcome is more difficult to explain. Although it was expected that information about the positivity and negativity of various relationship states depicted as the contexts for sex would ultimately privilege relatively uncommitted relationships, it was found that both committed (steady or serious dating) and uncommitted (strangers) relationships were portrayed ambivalently. This may have important consequences for readers, though those consequences are unlikely to be simple. Readers may learn that no relationship state is a perfect context for sex and that there are benefits drawbacks both to having sex with strangers and to having sex with a committed romantic partner. They may also learn what those respective drawbacks and benefits are, which may shape their own sexual decisions.

Ultimately, it seems that these magazines offer little in the way of sexual information that is different from the broad, stereotypical perceptions of sex as androcentric and men's sexuality as focused on variety. Even articles that seem to contradict such notions ultimately seem to reinforce them. Of course, whether or not this reinforcement occurs, and whether magazine articles such as those included in the present study reinforce or change the attitudes of readers are ultimately questions for experimental studies.

Table I. Definitions of Relationship States

Strangers Individuals who are not romantically involved, have not dated
First date On or immediately after a first date that is stated to be such
Casually dating Nonexclusive dating, dating that is relatively low on commitment
Seriously dating Relatively exclusive dating, moderate to high level of commitment; signaled by terms like "girlfriend," indications of possession, etc.
Engaged Engaged, formally intending to marry
Married Married to each other
Nonromantic acquantance Not dating nor romantically involved, but also not strangers. Would include ex-girlfriends, friends, well-known co-workers

 

Table II. Frequencies of Articles Principally About and Containing Mention of Sexual Topics

Topic Number of articles with topic as primary focus Number of articles with substantial mention of topic Total number of articles mentioning topic
Improving sex life 17 47 64
What women like 37 33 70
Improving orgasm 0 3 3
Improving a woman's orgasm 3 8 11
Sexual satisfaction 1 15 16
Unorthodox sexual behaviors or positions 18 39 57
Unorthodox sexual locations 6 35 41
HIV/AIDS 0 2 2
STDs 0 5 5
Rape 0 0 0
Safe Sex 0 5 5
Pregnancy 0 4 4
Condoms 0 11 11
Women's sexual health 0 6 6
Abortion 0 0 0
Vasectomy 0 0 0
Other men's sexual health issues 1 7 8
Gay men 0 3 3
Lesbians 0 17 17
Drugs or Alcohol 0 34 34

next: Penis Questions


ACKNOWLEDGMENTS

The author wishes to thank Trek Glowacki for his work as primary coder on this project and Monique Ward for guidance in its early stages.

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Laramie D. Taylor (1)

(1) To whom correspondence should be addressed at Department of Communication Studies, 2020 Frieze Building, University of Michigan, Ann Arbor, Michigan 48109; e-mail: ldt@umich.edu.

Source of article:Sex Roles: A Journal of Research

APA Reference
Staff, H. (2021, December 27). All for Him: Articles About Sex in American Lad Magazines, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/teen-sex/articles-about-sex-in-american-lad-magazines

Last Updated: March 26, 2022

Sexually Transmitted Diseases: What's Your Risk?

Summary & Participants

Among STDs, AIDS has occupied the spotlight for many years now, and for good reason. But other STDs -- like herpes, gonorrhea, and syphilis -- are still prevalent, and not to be taken lightly. What do you know about these diseases? How are they spread? What are the symptoms? And how do you keep yourself out of risk? Our panel of experts will answer these questions and more as they discuss the ever-present threat of STDs.

Host: David Folk Thomas
Fox News Channel
Participants:
Brian A. Boyle, MD
Assistant Professor of Medicine, Weill Medical College of Cornell University
Adam Stracher, MD:
Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital

Webcast Transcript

DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. It's the downside of sex: sexually transmitted diseases, or STDs -- chlamydia, herpes, gonorrhea. If you're sexually active, you're at risk. It's important to know how to prevent getting infected with an STD and what to do if you should be infected by an STD. Joining us to discuss this topic are two experts. I'm joined by Dr. Adam Stracher -- he's sitting on my left -- and sitting next to Dr. Stracher is Dr. Brian Boyle. They are both attending physicians at New York Presbyterian Hospital, Cornell University Medical Center, and they are both assistant professors in the department of international medicine and infectious diseases at Cornell University Medical College. I need a drink of water. That's a mouthful. Gentlemen, doctors, thanks for joining us today.
We're talking about STDs. Let's just start with a general overview. Dr. Stracher, what is a sexually transmitted disease?

ADAM STRACHER, MD: Sexually transmitted diseases are basically exactly what they sound like.

DAVID FOLK THOMAS: I guess that's why they're called STDs.

ADAM STRACHER, MD: They're diseases that can be transmitted sexually, and they include bacterial and viral and fungal infections that can be transmitted in multiple different ways... from one partner who is infected to a partner who isn't infected.

DAVID FOLK THOMAS: Dr. Boyle, I mentioned a few of them, but if you could just tick off the more common ones. Of course, we know AIDS is the top most devastating one, but what are the other sexually transmitted diseases?

BRIAN BOYLE, MD: I think as you point out, AIDS is probably the most important sexually transmitted disease that we deal with today, and it's probably the most devastating, but there are many other sexually transmitted diseases: gonorrhea, chlamydia, syphilis. All, of course, are bacterial diseases that are spread from person to person. There are numerous fungal infections that can also be spread, and there are viral infections, some of which have lifelong consequences associated with them: herpes -- which, once you're infected with, you're infected for life, as is true of most of the viral infections. Other viral infections also occur, CMV -- cytomegalovirus -- is also a sexually transmitted disease. Epstein-Barr virus can be a sexually transmitted disease. While most of us associate hepatitis B virus or hepatitis C virus with the liver, it also can be effectively transmitted sexually and, in fact, the main way that hepatitis B is spread is sexually.

DAVID FOLK THOMAS: In layman's terms, bacterial or viral, what's the difference?

ADAM STRACHER, MD: I think that an important distinction is that, for the most part, viral -- AIDS is a viral infection -- those are much more difficult to treat. They tend to be lifelong infections in many situations. They tend to have no cures, their treatment tends to be less effective, whereas with bacterial infections like chlamydia and gonorrhea and syphilis, while they can be just as devastating, if they're caught in time they can be treated effectively with antibiotics.

DAVID FOLK THOMAS: AIDS, again -- everybody's been inundated with this, affected by it -- maybe personally, through friends. You read about it every day. Devastating. Has the fact that AIDS has just emerged in the past 20 years or so as such a devastating killer, has that had an effect on having people not take these other STDs seriously, Dr. Boyle?

BRIAN BOYLE, MD: Exactly the opposite, really. Not that they didn't take them seriously, but that they, as a result of the threat of AIDS and contracting HIV -- which is the virus that causes AIDS -- they have taken sexually transmitted diseases much more seriously. If you are at risk of getting HIV, you may be much more cautious about having unprotected sex than if you're not. The disease of the '80s, herpes simplex -- HSV, which is also a viral infection and also lifelong -- was really nothing compared to the consequences and the devastation caused by HIV. But what we saw initially was that we saw the numbers of STDs -- gonorrhea, syphilis, chlamydia -- decline as people were alerted by HIV and frightened by HIV into using safer sex and using condoms. But as we've seen recently, the numbers are starting to go back up. Many centers track syphilis, and the syphilis numbers and gonorrhea numbers tend to be going back up, which makes many of us worry that perhaps people are not taking the appropriate precautions, they're not taking these diseases seriously enough now.

DAVID FOLK THOMAS: Dr. Stracher, is there any rating system, can we put AIDS at the top, as far as the seriousness of the other STDs, whether it be gonorrhea, chlamydia, herpes. They're obviously all bad, but would you say this one's worse than that, et cetera?

ADAM STRACHER, MD: I think, as Brian pointed out, HIV, clearly, because of it is such a serious illness and so frequently results in death. Perhaps until recently, it is the number one most concerning and most serious. But I think that I would not rate the others. I think they all are serious infections. I think they all can cause serious disease -- life-threatening disease in some situations -- or have devastating consequences in some situations, so I don't think that I would rate them except to say that they're all serious and important to avoid.

DAVID FOLK THOMAS: How can they be prevented from spreading? Obviously, it's sexual contact. What different types of ways are they spread? Then we'll talk about prevention.


It only takes on time of unprotected sex and you can have a sexually transmitted disease like AIDS or herpes for life. How are STDs spread?

BRIAN BOYLE, MD: They can be spread through genital-to-genital contact, genital-anal contact or genital-oral contact. Any of those can spread disease and spread it very effectively, especially if there are other STDs or sores or problems present. So any of the ways that people commonly have sex can spread these diseases, which means, basically, that you have to use a condom or a dental dam or something else to protect yourself from having a mucous membrane contact -- your mouth or your genitals -- contacting someone else's genitals or mucous membranes.

DAVID FOLK THOMAS: Can you spread sexually transmitted diseases such as gonorrhea through kissing?

ADAM STRACHER, MD: Some of those infections can be spread from oral-genital infection for sure, and some can be spread from one person's mouth to another person's mouth -- certainly herpes can, certainly gonorrhea can -- and in rare situations they can be spread from one skin site to another skin site that is not a genital or an oral area.

DAVID FOLK THOMAS: What about sitting on a toilet seat?

BRIAN BOYLE, MD: Those are the stories that people hear about or that some people would like to be able to tell their partners, but that's generally not true and really doesn't occur.

DAVID FOLK THOMAS: As far as the different contacts -- you said genital-to-genital, oral, et cetera -- is there any one scenario that's more risky than the other?

ADAM STRACHER, MD: They're all risky and, again, it's very difficult to rank them. Genital-anal contact, anal intercourse, is particularly risky because of the conditions under which that occurs. Normal vaginal intercourse is a little less risky.

DAVID FOLK THOMAS: Can you go back? What conditions, because it's more likely to be unprotected?

ADAM STRACHER, MD: In particular, speaking of HIV, again, because that can lead to mucous membrane rupture that can make infection with HIV much more likely. So anal intercourse can make HIV spread much more likely because of the nature of it. Usual vaginal intercourse is a little less likely to spread disease, although it has spread HIV, although, as far as the other pathogens are concerned, it's equally likely.

BRIAN BOYLE, MD: And oral-genital, again, a little less likely to spread disease than the others, but still possible, and recent studies have shown that even HIV -- although many HIV specialists thought that oral sex was relatively safe -- recent studies are showing that, in fact, a significant number of infections of HIV have occurred through unprotected oral sex.

DAVID FOLK THOMAS: Dr. Stracher, do you have something to add?

ADAM STRACHER, MD: I don't have much to add. I think Brian covered it all. I think that in homosexual men, the risk of anal intercourse does increase the risk of infection, both because of the increased rate of infection and also because of occasional bleeding and that sort of thing that may increase the risk of developing infection or of spreading infection and, as Dr. Boyle pointed, that's true for HIV infection, but all of those intercourse methods may spread other infections equally.

DAVID FOLK THOMAS: Is there any way to tell -- say you have one partner who is infected, whether it be with HIV, herpes, gonorrhea, what have you -- they have unprotected sex with the other partner, who has a clean bill of health. Is there any way to determine the likelihood that they will pass the disease?

ADAM STRACHER, MD: We do have some estimates of what the rate is with each episode of intercourse or another contact for many types of illnesses. The rate varies. It depends on many factors, as Dr. Boyle mentioned, whether there are other sexually transmitted diseases and sores and the stage of infection that people have and whether they're symptomatic or asymptomatic infection, so there are estimates, and the range is from very common to very uncommon. I think that's probably enough.

BRIAN BOYLE, MD: It's sort of a crapshoot. It's Russian roulette. You may be infected, you may escape. It's not guaranteed.

ADAM STRACHER, MD: The risk may be 1 in 300 for episode, for instance. That means that you may just have sex once and spread the infection and develop the infection, so I think it's not fair to look at it and say, "I have a very low chance. I can do it and be risky and I'm probably not going to get infected," because it really only takes one episode.

BRIAN BOYLE, MD: We've had several patients who have come in with HIV who have been monogamous with one person who is not HIV infected and reported that years and years ago they had a single encounter -- perhaps when they were in college or in some other circumstance -- and yet they're infected with HIV. As Adam just pointed out -- and as you pointed out -- it's a crap shoot. You may get lucky and the odds may be 1 in 300. You may be that unlucky one where one encounter leads to your getting infected.

DAVID FOLK THOMAS: In a little bit I want to go back to the issue of being monogamous. But symptoms, we have some pictures next to you, I believe. What are these? Syphilis? To show sometimes you have no symptoms, but a lot of times you do. What have you got over there?


A person may not show physical symptoms of having an STD, but they can still spread it

ADAM STRACHER, MD: Sometimes you have absolutely no symptoms. I think that's an important thing for people to understand. These are some of the common infections that we tend to see. These, at the top, are some common presentations of herpes simplex. You can see the ulcerative nature of these lesions, which start as blisters, a blistering type condition, as reflected in these drawings, and then may progress to a frankly ulcerative disease, where you actually have a complete loss of the skin, which can be quite, quite painful. In the lower frame, here, you have lesions which are commonly associated with syphilis. This is a chancre. It generally has rolled edges. I'm not sure that's going to come across well on the camera.

DAVID FOLK THOMAS: Is that a medical term, chancre, or is that just a slang term?

ADAM STRACHER, MD: No, that's the medical term. It's actually called a chancre. It has rolled edges, which kind of define it. It generally is painless, though, so this occurs -- Unlike the herpes lesions that we saw at the top, this lesion tends to be painless and if left alone, it very frequently will heal on its own. That doesn't mean that the Syphilis is cured or gone. It simply means that they may progress to subsequent diseases, and these are some illustrations of secondary syphilis, where you end up with these lesions all over your body and perhaps on the palms of your hands and disseminated throughout your body. Then, again, many patients who have secondary syphilis may tend to get better from that condition despite the fact that the syphilis persists in their body. Then they may go on to have what's called tertiary syphilis, which has very serious neurologic conditions associated with it.

DAVID FOLK THOMAS: So syphilis can, untreated, go away on its own?

BRIAN BOYLE, MD: Absolutely, and it very frequently -- Again, I think this goes back to the concept of when you have a problem you need to go see your doctor and have him or her treat you, diagnose and treat the problem because these diseases may tend to go away on their own. That doesn't mean they've been cured. It doesn't mean you're better. It may mean that you're then at risk for passing it to other people and that you're at risk for very serious long-term complications.

DAVID FOLK THOMAS: Dr. Stracher, we were talking about being monogamous. You can be in what you feel is a monogamous relationship and you never necessarily have a guarantee that your partner's keeping their end of the bargain. What's your advice on that scenario?

ADAM STRACHER, MD: I could be a marriage counselor if I could give that sort of advice, but I think it's important that if you have any doubts at all that you use protection, that you wear condoms, that you are as faithful to your partner as you would want them to be to you, and that you take whatever precautions are necessary to protect yourself and to protect your partner. I think it's also important to point out that condoms, while they're helpful, are not always 100 percent. I have a patient who I saw today who is married and had one exposure to a prostitute, wore a condom, oral contact, and developed herpes. It can develop if a condom breaks. It can develop underneath or behind or below a condom, so I think it's important, while protective measures are helpful, monogamy or abstinence is clearly the best way to prevent or protect yourself.

DAVID FOLK THOMAS: Go ahead, Dr. Boyle.

BRIAN BOYLE, MD: I think that's one of the tragedies of people who treat HIV, as I do, on a frequent basis. Many of my patients are women who were infected by their husbands, who they thought were monogamous and were not, and did not disclose to them their HIV status. So, as you point out, your partner is not necessarily 100 percent reliable.

DAVID FOLK THOMAS: You mentioned before, a lot of these STDs, you do not have symptoms. How is that possible, and in that case, how do you know to get treatment?

ADAM STRACHER, MD: Again, it goes back to the importance of seeing your doctor on a frequent basis, especially if you're having unprotected sex, which is really a foolish thing to be doing in this day and age. It goes back to seeing your doctor and discussing that and getting advice from him or her about how to avoid that, as well as being screened. Women should follow up with their internist or, if they're sexually active, they should see a gynecologist every six months to a year to be evaluated by the gynecologist, and the gynecologist, as a part of his or her routine screening, will do the necessary testing to see if the person has been infected. The same thing is also true with a sexually active male. In addition, there are some things that you should do if you're sexually active, and as a standard part of vaccination of children now, children are given hepatitis B vaccine. Now, many of us were born in a time when that vaccine was not available and was not given. If you're sexually active, you ought to go get vaccinated for hepatitis B, because that is a lifelong infection that can lead to liver failure and disease and it is commonly spread sexually. You should go and get the vaccine and protect yourself from at least one viral pathogen that some protection is available for.

BRIAN BOYLE, MD: I think that's an important point, talking about the asymptomatic infection, that individuals may be asymptomatic with these infections, either for weeks or for many, many years. In the case of HIV infection or hepatitis B, individuals may be infected but be asymptomatic for 20 years and be able to spread to their partners.

DAVID FOLK THOMAS: Gentlemen, thank you very much. I say "gentlemen," I think should be saying "doctors," correct? We've been joined by Dr. Brian Boyle and Dr. Adam Stracher. We hope you've learned a lot about sexually transmitted diseases, STDs. You can never have enough information on this topic. Thanks for joining us on this webcast. I'm David Folk Thomas.

APA Reference
Staff, H. (2021, December 27). Sexually Transmitted Diseases: What's Your Risk?, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/diseases/sexually-transmitted-diseases-whats-your-risk

Last Updated: March 26, 2022

AIDS Phobia

AN EPIDEMIC OF FEAR

Despite the attention devoted to AIDS, a related epidemic has gone unnoticed, variously termed by doctors as AIDS phobia, AIDS panic, pseudo AIDS, AIDS stress, AIDS hysteria or AIDS anxiety. It consists of unfounded fears of having contracted AIDS, incorrect beliefs as to how HIV is transmitted, producing bizarre attempts to avoid the illness. American Psychiatrists have even suggested the acronym FRAIDS or fear of AIDS.

Some recent examples in Britain include: - a man who regularly immersed his penis and feet in undiluted bleach after entering public toilets; a young girl who gave up her piano lessons because she was convinced there was infected blood on the key board since her tutor's wife worked in the blood transfusion service, the AIDS phobic's lips were raw from continually being wiped, in case she had got someone else's spit on them; a woman who bathed only in darkness to avoid finding AIDS lesions on her skin; a man who operated all household gadgets with a sterile wooden stick to avoid catching AIDS from any surfaces; yet another man stopped eating and drinking altogether for fear of ingesting the HIV virus.

Meanwhile in the USA: - a New York postman refused to deliver mail to an AIDS public health office as he feared catching the disease from their letters; hairdressers have refused to cut the hair of AIDS victims and clergy asked AIDS sufferers to stay away from church for fear of infecting the congregation.

Since all these people are physically completely healthy they are the 'worried well'. Research among university students found 24% thought AIDS could be picked up from toilet seats, 14% were convinced it could be caught from trying clothes on in a store, while 10% believed money touched by AIDS victims was contagious.


 


The term pseudo AIDS is used because these worries produce anxiety and depression, which are associated with physical responses similar to AIDS symptoms, like weight loss, night sweats, malaise, lethargy, loss of appetite and headaches! These features reinforce the erroneous belief of AIDS infection.

It could even be argued that stringent guidelines set out by the Department of Health last week, where health authorities must now inform patients who received treatment from HIV infected medical staff, is just such an example of AIDS phobia.

8000 people directly linked with the three recent cases of doctors suffering from HIV infection have been tested - but none of them has yet been found to be infected with the virus. National AIDS phobia may explain the vast sums we spend on AIDS to the neglect of other serious medical problems. Emeritus Professor of Public Health at Glasgow University, Gordon Stewart, complained recently in the press that the 700 million the UK has spent during the past decade on AIDS research, was ten times that spent on cancer. In 1988, AIDS hysteria produced dire predictions of the future - Government committees forecast that by now there would be up to 40,000 AIDS sufferers, instead the total is actually 7,000 cases in Britain to date.

However, to be diagnosed genuinely AIDS phobic, the required symptom is irrational avoidance of AIDS - yet this seems an implicit paradox - can it ever be illogical to go to extremes to elude deadly diseases?

AIDS fear produces hyper-vigilance - a characteristic response to any fearful situation. This leads to a 'better safe than sorry' - 'you can't be too careful' approach which has served our species well historically, otherwise we would not have survived to write articles complaining about AIDS phobias. In fact fear is a vital evolutionary legacy that leads to threat avoidance; without fear, few would survive long under natural conditions.

However there is an optimal amount of fear - too little produces carelessness, too much and we are so paralyzed that performance deteriorates. Hence the dilemma for public health programs and concerned AIDS doctors, who are partly responsible for generating AIDS hysteria; will AIDS phobia save us, or cause more distress than AIDS itself? As a nation will we divert so much resource to AIDS because of AIDS fear, that other more prevalent diseases will be left unfettered to kill many others?

This is not a new predicament, in the words of Sir Philip Sidney (1554-1586) favorite poet of Queen Elizabeth I, 'Fear is more pain than the pain it fears'.

While professionals' views are based on actual or expected mortality figures, research has shown the public's assessment of risk is determined more by feelings of dread for the unknown and the unobservable, particularly events which they are exposed to involuntarily. For example skiers will accept risks involved in sport roughly 1000 times as great as they would tolerate from involuntary hazards such as food preservatives.

Today we are likely to feel the world is a riskier place than ever before, although this runs against the views of professional risk assessors. This produces the paradoxical situation where in the West the wealthiest, best protected and most educated civilization, is on its way to being the most frightened.

Yet in fact it may be precisely our anxieties and fears which have reduced our risks. Research has suggested that AIDS fear is heightened among less promiscuous homosexuals who are actually at smaller risk. It may be that it is precisely their greater fear which results in less promiscuity, so reducing their risk.

AIDS phobia has undoubtedly contributed to the remarkable changes in Gay risk behaviours over the last few years, the most dramatic voluntary changes in health-related behaviours in history. As a direct result of these AIDS prevention strategies, other diseases transmitted in the same way, like syphilis and gonorrhea, have declined dramatically in incidence since 1985.

Contrast this situation with cigarette smoking, which has been the most preventable cause of death and disease in the UK for some time, yet has actually increased among women over the last few decades.

But generating FRAIDS does not just simply save lives - extreme fears of death, can also kill. The billionaire, Howard Hughes developed an obsessional disorder and illness phobia leading him to become a recluse, refusing to see doctors. When he became seriously physically ill, a doctor could only be brought to him when he was unconscious and on the point of death. By then it was too late, yet elementary medical attention much earlier could have saved him. It was his fear of death which killed him.

next: Introduction to HIV

APA Reference
Staff, H. (2021, December 27). AIDS Phobia, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/diseases/aids-phobia

Last Updated: March 26, 2022

What Does It Take to Make New Friends?

For some, making friends can be challenging, even downright difficult. Here's a step-by-step guide to making new friends and deep friendships.

Making friends

Going to a new job or school, especially if it is in a new city, brings many opportunities to learn and try new things, to see new places and make new friends from a variety of backgrounds and cultures. This can be an exciting time of personal growth. However, making new friends can be scary, especially if none of your old friends are with you. It can also be a lonely time before your social network is established.

Why We Want Friends

Loneliness means having no-one to confide in, no-one who will listen when you're low during the rough times. Without friends, it's easier to feel bad about yourself and to feel as if your problems are insurmountable. Added to that is the fear that "there is something wrong with me if I don't have friends." Friends provide status, support, fun, ideas and much more - no wonder people want friends! They are often our first source of practical help, advice and information. Having more than one friend shares the load so that you don't feel you're bothering someone with all your problems. Also, they may not be available when you need them most.

How we make things worse

It is easy to assume everyone else has friends, especially if you see them surrounded by people at social gatherings.

Starting new friendships involves taking a risk, risking rejection. If someone isn't interested in making friends with you beyond an acquaintance level, it's not necessarily a judgment about you. They may already have some friends and not feel the need or have the time to develop new friends. We also get along with people similar to ourselves. You may not be their type or they may not be your's. It is easy to fall prey to negative self-talk, such as "there's something wrong with me," or "I'm the only one who feels like this."

It may feel a little awkward at first to make the step from greeting someone in your office to inviting them for a coffee or to meet for lunch, but if you take the risk you may be rewarded by friendship. Turning a chance encounter into a friendship takes time, and can't be rushed. Take courage in the friends you had before. If you've done it before, you can do it again. Be patient and don't jump to critical conclusions about yourself.

Making new friends - first steps

  • This requires a few key social skills that can be learned - assertiveness is helpful.
  • Remind yourself that anyone in a new environment goes through an adjustment phase and in time you will make friends.
  • Resist the urge to withdraw from people, don't isolate.
  • Practice your social skills by making a daily effort to always sit beside someone in lectures and say hello to them, get involved in class discussions.
  • See your early attempts to talk to people as just a "practice session." This will make their response less of an issue. You'll be less anxious and more your natural self.
  • It may sound a bit sappy, but it works: Make a commitment to be a friend to yourself first and foremost, and see this as something you are doing to meet your needs and take care of yourself. Relax alone, and become comfortable with yourself. Find your balance between solitude and socializing. This will help you be your natural self rather than coming across as needy or desperate.
  • Get involved in a sport, music, art, religion or clubs in your area - these are great places to meet people. The sport or activity provides a natural icebreaker to overcome any initial awkwardness.

Deeper friendships - next steps

Understanding yourself a little can help. For example, if you are naturally an introvert or a shy person, you may do things very differently than the extrovert. They always seem to be surrounded by others who seem to be laughing and joking. You may find it easier to get to know people slowly one-on-one. If you think about it, you may actually prefer to have a few quiet, serious friends, rather than a lot of talkative ones. Introverted people can find it isolating if they do not fit into the drinking and loud partying culture which can be dominated by extroverts. Finding other people to have a meaningful conversation with can be a struggle.

Try listening first and talking later. Most people are happy to talk about films they have seen, books they have read, sports or even the weather. These topics provide important bridges to more important interesting stuff.

Talk about your feelings and experiences a little too, so that others start to get a sense of who you are. Be positive, enthusiastic, thoughtful and encouraging in your support and acceptance of them. Ask open questions such as "how was that for you" ... rather than questions requiring only a yes or no answer. Remember that building friendships takes time.

Try and make friends of both genders and be clear about the nature of you friendships while recognizing the boundaries that distinguish friendship from an intimate relationship. You do not have to be in an intimate or romantic relationship to meet your needs for friendship and belonging.

Friends are great in themselves and they form a vital part of your personal support network. They can throw you a lifeline when you feel like you are drowning in a crisis. Taking the time to make friends is part of taking care of yourself, and it gives you the opportunity to be a support to others when they are in need (and that can feel pretty good too!). Be aware of your good points - find them so that you can encourage others to do the same. Friendship, it's up to you to take the first step, take a deep breath and go for it!

Where do I go from here?

You can find out more about developing friendships by reading one of the all-time classics on the subject: "How to Make Friends and Influence People" by Dale Carnegie.

If you have persistent difficulties developing and maintaining friendships, then speaking with a counselor can also be helpful.

APA Reference
Staff, H. (2021, December 27). What Does It Take to Make New Friends?, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/relationships/building-friendships/what-does-it-take-to-make-new-friends

Last Updated: February 2, 2022

Doctor/Patient Communication About Sexuality Issues

Patient sexuality issues can be difficult and daunting for a doctor to explore, but accurate diagnosis and effective treatment hinge on good communication between doctor and patient, as well as between the patient and her sexual partner. Given the increasing emphasis on sexuality in our society, the continuing sexual activity of midlife and older women and their partners, the aging of Americans, and the growing awareness of sexual disorders, the chances are good that most doctors will encounter patients who inquire about their sexuality.

Many doctors say they don't broach sexuality issues because they lack training and skills to deal with human sexuality concerns, feel personal discomfort with the subject, fear offending the patient, have no treatments to offer, or believe that sexual interest and activity naturally decline with age. (1,2) They also may avoid the topic because of concerns about time constraints, (2) although initial general assessments need not take an inordinate amount of time. Follow-up appointments or referrals can be made to perform more complete assessments. Sometimes, a brief discussion about sexual issues can reveal that education is needed more than treatment. For instance, many patients may not know about the ways in which aging can affect their and their partner's sexual function.

Many patients are unaware that it is appropriate to discuss sexual issues with their doctors or are concerned about embarrassing those doctors. According to Marwick, 68 percent of patients surveyed cited fear of embarrassing a doctor as a reason for not broaching sexuality issues.3 In the same survey, 71 percent of the respondents believed their doctors would simply dismiss their sexual concerns. And in a survey conducted by the American Association of Retired Persons of 1,384 Americans aged 45 or older, only 14 percent of women had ever visited a doctor for problems related to sexual function.4 In a Web-based survey of 3,807 women, 40 percent of women said they did not seek help from a doctor for sexual function problems they experienced, but 54 percent said they wanted to see a doctor. (1) Those who did seek help did not rank the attitude or services provided by their doctors highly.

In contrast, a recent survey revealed that only 14 percent of Americans age 40 or older have been asked by their doctors over the past 3 years whether they're having sexual difficulties.(5)

Because of the many interpersonal variables that come into play in creating sexual problems, it is important for the doctor to approach a sexual disorder as a couple's problem rather than just one female partner's problem. Doctors also should be open and non-judgmental about the types of sexual activities patients are engaging in (including masturbation and same-sex partnerships) and should not make assumptions that all patients are involved in heterosexual relationships. Finally, they should be aware that midlife patients may not all be in long-standing relationships.

Table 8 lists skills that all doctors can develop to communicate with patients about sexuality issues.

TABLE 8. Communicating with Patients About Sexuality
  • Be a sympathetic listener
  • Reassure the patient
  • Educate the patient
  • Address sexual problems as a couples issue
  • Provide literature
  • Schedule a follow-up visit to focus on sexuality issues
  • Make a referral as necessary

Concomitant medical and psychological approaches to sexual problems are often warranted. In fact, Sheryl Kingsberg, PhD, a clinical psychologist specializing in sexuality at Case Western Reserve University, suggests that if a doctor ignores psychosocial issues related to sexual disorders, medical interventions can be sabotaged and destined to fail.(6)

As a doctor, you may not feel comfortable or prepared to offer extensive counseling to patients with sexual problems. Partnering with a psychologist, psychiatrist, sex therapist, or other professionals with expertise in this area who offers couples therapy, sex therapy, training in communication techniques, anxiety reduction, or cognitive-behavior approaches is often beneficial to the patient so that both medical and psychological etiologies are managed.(2)

The Impact of Male Sexual Functioning on Midlife Women

For many midlife women, sexual activity is dependent on the health of their male partner. The Duke Longitudinal Study of men and women aged 46 to 71 found that sexual activity for women often declined as they aged because of the death or illness of a male spouse (36 percent and 20 percent, respectively) or because the spouse was unable to perform (18 percent).7-9

In the National Health and Social Life Survey, 31 percent of men between the ages of 18 and 59 years suffer from a sexual dysfunction, most notably erectile dysfunction (ED), premature ejaculation, and lack of desire for sex (which is often related to performance issues).10 A more recent international survey of 27,500 men and women 40 to 80 years of age found that 14 percent of male respondents suffer from early ejaculation, and 10 percent suffer from ED.11 ED tends to increase with age and become more severe: The Massachusetts Male Aging Study found that 40 percent of men age 40 suffer from some degree of ED, a figure that jumps to 70 percent by age 70.12

According to Whipple, some women feel that ED is their fault, suggesting they are no longer attractive to their partner or that he is having an affair. Some welcome the cessation of sexual activity and feel that it is better to avoid sexual encounters that can't be taken to completion of sexual intercourse so as not to embarrass their partner.13,14 Others may find that sex becomes mechanical and boring, or focused on maintaining or prolonging a man's erection, rather than on mutual pleasure.14

The advent of phosphodiesterase type 5 (PDE-5) inhibitor treatment of ED has changed sex in America for midlife couples. Many couples that were not engaging in sexual activities are now attempting to have intercourse and encountering female sexual problems caused by the previous cessation of intercourse and the effects of aging on the vagina. Common complaints of midlife women resuming sexual intercourse after abstinence due to their partner's ED include vaginal dryness, dyspareunia, vaginismus, urinary tract infections, and lack of desire.

Three oral PDE-5 inhibitors are currently available.15,16 The three represent the current standard of care for ED and have different durations of action.15,16 As a group, the PDE-5 inhibitors have similar efficacy rates15,16 - although 30 to 40 percent of men with ED are resistant to the drugs.17 According to Sheryl Kingsberg, the 36-hour duration of tadalafil may offer some psychological advantages to couples.14 For men, it decreases the pressure to perform immediately after pill-taking and allows for more sexual spontaneity. For women, it decreases the perception of "sex on demand."

Sharing this type of information with couples can be the first step to putting them back on the path to a mutually satisfying sex life. These women and their partners need education and counseling about the changes their bodies have undergone since they last were having sexual intercourse on a regular basis, and possibly psychological counseling and other medical treatment as well.14


References:

  1. Berman L, Berman J, Felder S, et al. Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience. Fertil Steril 2003;79:572-576.
  2. Kingsberg S. Just ask! Talking to patients about sexual function. Sexuality, Reproduction & Menopause 2004;2(4):199-203.
  3. Marwick C. Survey says patients expect little physician help on sex. JAMA 1999;281:2173-2174.
  4. American Association of Retired Persons. AARP/Modern Maturity Sexuality Study. Washington, DC: AARP; 1999.
  5. The Pfizer Global Study of Sexual Attitudes and Behaviors. Available at www.pfizerglobalstudy.com. Accessed 3/21/05.
  6. Kingsberg SA. Optimizing the management of erectile dysfunction: enhancing patient communication. Slide presentation, 2004.
  7. Pfeiffer E, Verwoerdt A, Davis GC. Sexual behavior in middle life. Am J Psychiatry 1972;128:1262-1267.
  8. Pfeiffer E, Davis GC. Determinants of sexual behavior in middle and old age. J Am Geriatr Soc 1972;20:151-158.
  9. Avis NE. Sexual function and aging in men and women: community and population-based studies. J Gend Specif Med 2000;37(2):37-41.
  10. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537-544.
  11. Nicolosi A, Laumann EO, Glasser DB, et al. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 2004;64:991-997.
  12. Feldman HA, Goldstein I, Hatzichritous DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61.
  13. Whipple B. The role of the female partner in assessment and treatment of ED. Slide presentation, 2004.
  14. Kingsberg SA. Optimizing the management of erectile dysfunction: enhancing patient communication. Slide presentation, 2004.
  15. Gresser U, Gleiter H. Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil, and tadalafil. Review of the literature. Eur J Med Res 2002;7:435-446.
  16. Briganti A, Salonia A, Gallina A, et al. Emerging oral drugs for erectile dysfunction. Expert Opin Emerg Drugs 2004;9:179-189.
  17. de Tejada IS. Therapeutic strategies for optimizing PDE-5 inhibitor therapy in patients with erectile dysfunction considered difficult or challenging to treat. Int J Impot Res 2004;suppl 1:S40-S42.

APA Reference
Staff, H. (2021, December 27). Doctor/Patient Communication About Sexuality Issues, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/female-sexual-dysfunction/doctorpatient-communication-about-sexuality-issues

Last Updated: March 26, 2022

Normal Marriage After Child Abuse

Question:

I was sexually abused as a child. To this day I hate to let anyone get too close. This is causing real problems with my husband and me. I don't dress like normal women; I wear baggy clothes. My moods change very drastically -- I actually scare myself. I have tried medicines. Nothing seems to help. I just want to be able to have a real husband-and-wife relationship. How can this happen before it's too late?

Answered by Peggy Elam, PhD:

The behaviors you describe -- including the mood swings -- are often found in people who were sexually abused as children. And it IS possible to get relief. You mention that you've taken medicines, but they don't seem to help. That may be because therapy is the best treatment for emotional and behavioral problems related to child abuse or other trauma. Medication can sometimes be a helpful adjunct to therapy, but it won't address the underlying issues related to trauma-based mood changes, fears and intimacy difficulties.

You might benefit from seeing a psychologist or other therapist who is experienced in working with individuals who have been sexually abused. Your therapist might also be able to meet with you and your husband together to help the two of you address problems, and perhaps assist your husband (and you) in understanding what you've been going through and what might help.

Working through the fears and issues related to your abuse, and becoming more aware of the differences between your husband and your abuser, might help you feel safer. Feeling safer, in turn, might enable you to relax and allow more emotional and physical intimacy to enter your marriage. Of course, it's a different story if your husband actually ISN'T very different from your abuser. If he's physically or emotionally abusive, your relationship may not be safe -- or healthy -- regardless of how much work you do on yourself.

In short, it IS possible for survivors of childhood sexual abuse to have close, supportive marriages, if both spouses respect each other and work on any necessary changes. I hope you'll try seeing a therapist -- or more than one, if the first doesn't seem a good match for you. Good luck.

Peggy Elam provides psychotherapy, psychological consultation and personal coaching to help people overcome personal difficulties and achieve emotional well-being. She has a private practice in Nashville, TN and is licensed as a psychologist/health service provider in Tennessee. Dr. Elam helps people resolve a range of problems, including eating disorders, traumatic stress, dissociative disorders, depression, stress, relationship problems and life transitions.

APA Reference
Staff, H. (2021, December 27). Normal Marriage After Child Abuse, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/abuse/normal-marriage-after-child-abuse

Last Updated: March 26, 2022

Maintaining a Physical Relationship While Helping Your Loved One to Heal From Sexual Abuse

Discover how to maintain a physical relationship while helping your loved one heal from sexual abuse.

Let me begin by saying I am not a specialist in any way except one- I've had to deal with a lot of what your loved one is feeling and expressing, and I think that makes me a specialist in the sense that I can relate to what is going around in their head at certain times. On the other hand, each person's case is different. The best judge of what anyone feels or thinks or wants is that person. So if you and your partner are up to discussion, ask him or her first. In all honesty, if you can't yet discuss it, you probably shouldn't even try to resume a physical relationship at this point.

Deciding to Touch

I can tell you that many, many people are simply not prepared to manage in an intimate physical or sexual relationship environment after they have been raped or assaulted. Some will go to extreme measures to "prove" that the incident didn't affect them too much- and as a result will go to exceptional lengths to assert a promiscuous attitude. Others will simply back away from contact, emotionally or physically- sort of a "grin and bear it" or "run and hide" approach. Many studies have shown that the hardest relationships to maintain after abuse or assault are the most intimate ones. The victim has a great deal to handle in learning to trust others and feel safe again. They may feel betrayed, worthless, frightened to open up to friends and family, self-judgmental or self-critical, even suicidal.

The best way to determine whether or not your mate is "touch-ready" is to ask. Always ask before touching your mate. At a certain point in their healing process, they are trying to determine how they feel about many things that they didn't have the chance to discover or control before. What used to be acceptable to them may have changed in their view. Healing is an ongoing process; it changes constantly. Never assume that anything that was okay for them before is still okay.

The Body Recall

Even if your mate has problems with memory gaps filtering out their traumatic experiences, that person's body will remember. The body's memory is a very effective trigger. Some common reactions you may find your mate displaying while trying to sort out their physical and emotional boundaries are:

  • Fear, especially fear of pain, darkness, or suffocation
  • Need to stop foreplay or intercourse for no "apparent" reason
  • Nausea or vomiting before, during, or after sexual activity
  • Cramping or other unexplained pain
  • Being triggered- often displayed by hand gestures, sudden silence, frightened facial expressions, or refusal to look at you
  • Overzealous attitude or display of arousal that often appears unreal
  • Crying or other emotional outbursts before, during, or after sexual activity
  • Inability to tolerate sensation of any kind
  • Dissociating, going out of the body or away from the present time's activities
  • Questioning their sanity, senses, feelings, instincts, or emotions
  • May want to shower or bathe often, especially after sexual activity
  • Feeling trapped or bound for no obvious reason
  • Panic attacks at sudden triggers may occur
  • Nightmares, unexplained waking in the night
  • Being startled easily by the sudden sound or appearance of another
  • Suddenly recurring behavior you suspect is associated with the trauma
  • Inability to determine the difference between sexual and non-sexual touching
  • Inability to be comfortable with their body as a part of their humanity
  • Inability to handle certain positions or postures without panicking
  • Being unable to or refusing to take joy or pleasure in the experience
  • Being ashamed or feeling indecent or dirty for participating
  • Being confused about what is pleasant and what is painful

This list is by no means complete. It is simply an example of some of the possible reactions one might expect from a victim of sexual abuse. Often there are so many reactions at the same time, your mate may have trouble registering how they feel. Any reactions your mate displays are considered "normal" under the circumstances.

If your mate is displaying any of the previous attitudes or behaviors, they are probably not quite ready to resume any sort of sexual activity-- even though they may not realize it yet. When your mate will begin to feel ready to resume any sexual activity is entirely up to them. There may be intermittent progress where the victim will be fine with some activities one day, and the next day may not be emotionally prepared for even a simple hug or kiss.


Impact on You and Your Feelings

It is important to realize that your mate is already feeling "different" enough. Judging their behavior is not helping them to recover. You can distance yourself from your mate's behavioral pattern by accepting it for what it is- a reaction to past or present internal or external stimulation. It is not directed toward you. I admit it is incredibly hard to do this, but may save your sanity and sense of humor in the long run.

It is fairly common for a victim to seem interested in sexual activity until a certain point, then suddenly seem as though they have disappeared into space. This is likely to register as a rejection to you. Try to understand that this behavior is simply a defense mechanism rearing its ugly head. Patience and understanding and a willingness to stop until your mate is more aware or less distant can be immensely helpful in reducing the stress related to these situations.

Asking if they would like to stop, or asking what they are thinking or feeling can help identify what is triggering that behavior. Allowing your mate to determine which boundaries are comfortable and which feelings and expressions are acceptable is essential. Always remember the body and person you are loving belongs to someone else- and they have the right to determine how it is treated, if at all.

Finding Other Methods of Helping

There are actually several resources available to singles and couples who wish to resume sexual activity after trauma. One is obvious- a good therapist or counselor can often treat couples as well as single people for trauma-related difficulties. There are numerous self-help books available also. One I often find myself recommending is A Woman's Guide to Overcoming Sexual Fear and Pain. This book contains numerous exercises used by many therapists around the U.S. and abroad. It is based loosely on the Masters and Johnson model.

There are also other philosophies to look into. Tantric or Karezzan practices can help to reduce the anxiety often accompanied by sexual activity after trauma. There are two exercises in particular that, if done properly and with respect for the person, have assisted many people to begin to feel more comfortable with their bodies after trauma.

Having your mate meditate or relax alone for a time before attempting any kind of activity may be of some assistance. Beginning with something non-sexual such as a massage, or allowing your mate to decide what and how and when any activity is begun is almost always helpful. Asking frequently how they are doing is an excellent way of keeping track of their emotional base. It is usually a good idea to avoid the use of alcohol or drugs, as these are common factors found during rape and assault and can be triggers for your mate. Some people find that keeping the lights on or having sunlight is helpful.

Being Observant and Cautious

If at any time you feel your mate is not responding in a manner that seems realistic or you suspect they are in emotional or physical distress- by all means, please be kind enough to ask how they are feeling. If at any point you are asked to stop, believe it is necessary for your mate's well-being that you do so. It absolutely is. Any time you allow them to be in control, it increases the chances that your mate will recover more quickly and fully.

An inconsiderate partner can re-route all the previously-done healing back to square one. Encourage your mate to be guiding and vocal about what they feel comfortable with. You should probably not attempt to experiment unless you are very familiar with your mate's triggers.

You can find out what your mate wishes you to do when he or she is having a panic attack or in the grip of some memory by being prepared for that to happen. Beforehand, asking them questions like "What would you like me to do when ______ happens?" may be helpful. Expect them not to know what will help. Offer to hold them in a non-threatening posture, or provide a comforting object for them to hold. Allow them to move freely to a position that feels more emotionally and physically comfortable for them. Try not to feel rejected if they choose to move away from you. Being suddenly and powerfully overwhelmed with emotions in a frightening way can force some victims to take a step backward in their healing. This is not necessarily a reflection on you; many times it is simply a way for the victim to re-integrate that emotion into their lives on a less threatening basis.

Expect them to cry or have other emotional outbursts at the drop of a hat, and not to understand why or how they came to feel that way. It is rare for someone newly on the healing path to be able to distinguish how or why they feel something in a particular way at any given moment. Often there is some remaining sense of not feeling in control or sense of shame that can linger, even after they are feeling well for a long time.

APA Reference
Staff, H. (2021, December 27). Maintaining a Physical Relationship While Helping Your Loved One to Heal From Sexual Abuse, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/abuse/maintaining-a-physical-relationship-while-helping-your-loved-one-to-heal-from-sexual-abuse

Last Updated: March 26, 2022