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Hand Preference, Sexual Preference, and Transsexualism Richard Green, MD, JD,1,2,4 and Robert Young, BSc (Hons) PgD3
Atypical handedness patterns, i.e., persons being less exclusively right-handed, have been found previously in large samples of male and female homosexuals and in small samples of male and female transsexuals compared to controls. The posited role of prenatal androgen influencing both cerebral hemispheric dominance and psychosexual development warrants further study with large samples of transsexuals. 443 male-to-female transsexuals and 93 female-to-male transsexuals were studied for their use of the right or left hand in six common one-handed tasks. Both male and female transsexuals were more often nonright-handed than male and female controls were. Results suggest an altered pattern of cerebral hemispheric organisation in male and female transsexuals. KEY WORDS: handedness; cerebral dominance; transsexualism; homosexuality.
Handedness or hand use preference has been observed as early as Week 15 of gestation (Hepper et al., 1991). It may be influenced by prenatal androgen levels. One suggestion is that elevated levels of testosterone, perhaps during the second trimester of pregnancy, affect foetal brain development and increase asymmetry via accelerating the growth of the right hemisphere resulting in nonrighthandedness (Galaburda et al., 1987; Geschwind and Galabruda, 1985a,b). In partial support, persons with known atypical prenatal sex hormone levels show alterations in handedness. Females with congenital adrenal hyperplasia, with elevated prenatal androgen, show increased nonright-handedness (Nass et al., 1987), as do females 1 Department
of Psychiatry, Imperial College School of Medicine at Charing Cross, Gender Identity Clinic, Charing Cross Hospital, London, United Kingdom. 2 University of Califonia, Los Angeles, California. 3 MRC, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom. Study conducted while at Charing Cross Hospital. 4 To whom correspondence should be addressed at Department of Psychiatry, Gender Identity Clinic, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom; e-mail:
[email protected]. 565 C 2001 Plenum Publishing Corporation 0004-0002/01/1200-0565$19.50/0 °
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with intrauterine exposure to diethylstilbestrol (DES), a masculinising synthetic oestrogen (Schacter, 1994). However, Klinefelter syndrome (karyotype XXY) males show a high proportion of left-handers (Netley and Rovet, 1982) but have a postnatal, and perhaps prenatal, deficiency of androgen. Alternative mechanisms accounting for handedness include genetic models and range from single to multiple gene models (Annett, 1985; Jones and Martin, 2000). Another proposes two mechanisms by which individuals may become lefthanded; natural or genetic left-handedness and pathological left-handedness, a consequence of diffuse neurodevelopmental difficulty. Elevated rates of birth stressors such as Rh incompatibility, higher rates of caesarean sections at birth and multiple births are associated with left-handedness (Coren, 1995). Left-handedness is associated with indicators of reduced Darwinian fitness such as a smaller number of offspring, lower birth weight and shorter life span (Yeo et al., 1993) and is found more commonly in persons with mental retardation, autism, schizophrenia, cerebral palsy, and epilepsy (Coren, 1993a). It is found more commonly in association with indicators of developmental instability such as fluctuating asymmetry of bilateral body features expected to be symmetrical, e.g. finger length (Yeo and Gangestad, 1998). Fluctuating asymmetry can result from disruptive events in pregnancy (Wilber et al., 1933; Kieser et al., 1997) and is associated with neurodevelopmental dysfunctions (Naugler and Ludman, 1996). Homosexual orientation in the male has been posited to result from atypical levels of prenatal androgen. Usually the alteration is proposed as a deficiency (Dorner, 1988). However, rodent research suggests that an increase in intrauterine testosterone at one period of human foetal development could result in a decrease in hormone at subsequent periods (Ward and Weisz, 1980). Taken together with theories on the development of cerebral asymmetry, these fluctuations could direct the developing individual to both nonright-handedness and homosexuality. The relation between sexual orientation and hand use preference has received considerable recent attention. Although not all studies have found a difference between homosexual and heterosexual subjects, a meta-analysis of 20 studies comparing 6,182 homosexual men and 805 homosexual women with 16,808 heterosexual men and 1,615 heterosexual women found a 39% greater odds of homosexual persons being nonright-handed (Lalumiere et al., 2000). Transsexualism and handedness has also received attention. A higher incidence of nonright-handedness was clear among a sample of 85 female-to-male transsexuals with a trend in that direction for 15 male-to-female transsexuals (Herman-Jeglinska et al., 1997). Another study of 44 female-to-male transsexuals found more nonright-handedness (Orlebeke et al., 1992) and two studies of male-to-female transsexuals, with 45 and 93 subjects, also found elevated rates of nonright-handedness (Orlebeke et al., 1992; Watson and Coren, 1992). The etiology of transsexualism remains enigmatic although there is increasing speculation among researchers for an inborn basis rather than its being the
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result of early life experiences (Zhou et al., 1995). Favored theories, as with origins of homosexual orientation, are those of an alteration in prenatal sex steroid levels. Thus the association between atypical prenatal sex hormone levels and cerebral dominance suggests value in studying transsexuals for cerebral laterality differences as reflected in hand use preference.
METHOD Participants Participants were patients attending the Gender Identity Clinic at Charing Cross Hospital, London. The Clinic is essentially the sole National Health Service facility for gender dysphoric patients in the United Kingdom seeking hormonal and surgical sex change. Those recruited included 443 male-to-female transsexuals and 93 female-to-male transsexuals. All met the Diagnostic and Statistical Manual-IV (DSM-IV ) diagnostic criteria of gender identity disorder (American Psychiatric Association, 1994). Average age of the male-to-female transsexuals was 38.6 years, average age of the female-to-male transsexuals was 30.9 years. Nearly all were Caucasian. They signed an informed consent to participate in the research with the understanding that participation or refusal would not influence treatment. A total of 284 nonpatient volunteers, undergraduate and graduate students, unselected for sexual orientation, comprised the control groups.
Measures Sexual Orientation Sexual orientation of patients was determined by responses to questionnaire items on sexual fantasy and sexual behavior during blocks of time from the present back to early adolescence. This was categorized as heterosexual (sexual attractions and sexual behaviors exclusively or nearly exclusively with persons of the opposite birth sex), homosexual (sexual attractions and sexual behaviors exclusively or nearly exclusively with persons of the same birth sex), bisexual (a substantial mix of same and opposite sex attractions/partners), and asexual (a dearth of sexual attractions or behaviors). Two raters independently judged sexual orientation using this method. Nonconcordant judgments were settled by agreement between raters without access to handedness information. Inquiry concerning sexual preference was not conducted with the control groups. Based on samples recruited from the general population over 95% of the control sample would be expected to be heterosexual (Diamond, 1993).
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Handedness Handedness was determined by a six-item questionnaire that asked respondents to indicate for each task whether the task was performed exclusively with the right hand, exclusively with the left hand, or with either or both hands. The tasks were: cutting, throwing, writing, holding a toothbrush, holding a glass, combing hair. These items were selected because they are similar to those used in previous studies investigating handedness and its association with either transsexualism or sexual orientation (Becker et al., 1992; Holtzen, 1994; Oldfield, 1971; Orlebeke et al., 1992; Satz et al., 1991; Watson and Coren, 1992). Research has shown that short and extended hand measures show high correlation with each other (Coren, 1993a). Measures composed of 4 and 12 items show a correlation of r = 0.948 with a 98.8% concordance in dichotomous categorization of handedness. Even a single item showed a correlation of r = 0.886 with the extended measure. RESULTS Table I shows male and female transsexuals by sexual orientation subgroup vs. male and female control groups. Handedness is categorized as all six tasks right-handed, one task not right-handed and two tasks not right-handed. Male and female controls do not differ from each other. All male transsexuals combined differ from control males, χ 2 (2, N = 587) = 23.205, p < 0.001, and control females, χ 2 (2, N = 583) = 15.785, p < 0.001. Transsexuals are more often nonright-handed. Extending analysis by subgroups demonstrated that asexual male transsexuals, heterosexual male transsexuals, homosexual male transsexuals, and bisexual male transsexuals all differ from both male and female controls, p < 0.02. Substituting female for male controls gave similar results, p < 0.02, with the exception of the homosexual subgroup, which showed a trend in this direction, p < 0.091. Thus male transsexuals, whatever their sexual orientation, are more often nonrighthanded. Female-to-male transsexual subgroups are small as nearly all are homosexual and tests of significance are inappropriate. All female transsexuals combined differ from both female and male controls separately, p < 0.041, female controls, p < 0.007, male controls. A further measure of handedness, a handedness score, was computed and scored in a manner similar to that by Coren (1992). Thus for each of the six items a score of 1 is given if the respondent uses the left hand predominantly for that particular task, a score of two is given if the respondent has no hand preference for that task and a score of three is given if the respondent uses the right hand predominantly. The sum for the six tasks was used as a measure of handedness, and was considered an interval level variable for the purposes of data analysis. This summed
13 (28.9%) 66 (48.2%) 43 (40.2%) 48 (31.2%) 170 (38.4%) 1 (20.0%) 2 (40.0%) 31 (44.3%) 7 (53.8%) 41 (44.1%) 70 (48.6%) 66 (47.1%) 136 (47.9%)
45 137 107 154 443 5 5 70 13 93 144 140 284
All tasks right-handed
34 (23.6%) 38 (27.1%) 72 (25.4%)
4 (80.0%) 3 (60.0%) 25 (35.7%) 6 (46.2%) 38 (40.9%)
22 (48.9%) 57 (41.6%) 43 (40.2%) 79 (51.3%) 201 (45.4%)
Two tasks not right-handed
0.49 ns — —
— — — — 6.30∗
10.83∗∗ 18.29∗∗∗ 8.14∗ 24.24∗∗∗ 23.21∗∗∗
Control males
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a Male asexual transsexuals significantly different from male heterosexual transsexuals, χ 2 = 7.02, p < 0.03. b Male heterosexual transsexuals significantly different from male bisexual transsexuals, χ 2 = 9.56, p < 0.008. † p < 0.1; ∗ p < 0.05; ∗∗ p < 0.01; ∗∗∗ p < 0.001.
— — —
— — — — 9.80∗∗
7.79∗ 13.45∗∗∗ 4.79† 17.87∗∗∗ 15.79∗∗∗
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40 (27.8%) 36 (25.7%) 76 (26.7%)
— — 14 (20.0%) — 14 (15.0%)
10 (22.2%) 14 (10.2%) 21 (19.6%) 27 (17.5%) 72 (16.2%)
One task not right-handed
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Note. The percentages of cases in each handedness category by group are shown in parenthesis. For all statistics, (2 × 3), χ 2 , df = 2, two-tail.
Male transsexuals Asexuala Heterosexualb Homosexual Bisexual All male transsexuals Female transsexuals Asexual Heterosexual Homosexual Bisexual All female transsexuals Controls Control male Control female All controls
n
Comparisons vs. control group (χ 2 )
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Table I. Handedness by Transsexual Group and Controls
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Green and Young Table II. Handedness Score by Transsexual Group and Controls Group Male transsexuals Asexual Heterosexual Homosexual Bisexual All male transsexuals Female transsexuals All female transsexuals Controls Control male Control female
n
M
SD
45 137 107 154 443
15.44 15.77 15.74 15.34 15.58
2.94 3.27 3.17 3.27 3.21
93
15.72
3.49
144 140
16.53 16.54
2.49 2.17
method of constructing handedness measures has received some support over the quotient method. Bishop et al. (1996) demonstrated that the different methods of calculation, summed vs. quotient, categorized individuals who are weakly one handed or mixed handed in a different manner. Using evidence from behavioral midline crossing tasks they concluded that the summed method is to be favored. Table II shows the mean handedness scores. A series of ANOVA analyses were conducted to investigate the relationship between sexual orientation and handedness score. We excluded from further analysis male asexual transsexuals because of the relatively low frequency of this group. Additionally, all female transsexual groups were collapsed, because of the very low frequency of the nonhomosexual groups. A one-way ANOVA using the three remaining male transsexual subgroups and male and female controls showed a statistical difference between the groups, F(4, 677) = 5.37, p < 0.001. Post hoc LSD test revealed that all male transsexual subgroups differed from both male and female controls, p < 0.05, with all transsexual subgroups less right-handed. A one-way ANOVA using the collapsed female transsexual subgroups and male and female controls showed a statistical difference between the groups, F(2, 374) = 3.76, p < 0.024. Post hoc LSD test revealed that all female transsexual subgroups differed from both male and female controls, p < 0.022, with transsexuals less right-handed. Age can be a confounding factor when comparing different groups on measures of handedness with fewer older subjects being nonright handed (Coren and Halpern, 1991; Davis and Annett, 1994). This could affect the relation between sexual orientation and handedness within transsexual subgroups because of the common finding that male homosexual transsexuals show an earlier age of clinical presentation (Green and Blanchard, 2000). As expected, in our sample, age showed the typical gradient for male transsexual subjects (Homosexual mean age: M = 33.25, SD = 8.81, years, n = 107: Bisexual mean age: M = 38.70, SD = 9.20, years, n = 153: Heterosexual mean age: M = 43.22, SD = 9.95, years,
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n = 137). There was a significant overall difference between groups in age, oneway ANOVA F(2, 394) = 34.10, p < 0.001. A Scheffe test showed no homogeneous subsets and all groups differed from each other, p < 0.001. Using ANCOVA, with age as a covariant, we tested whether age differences between male transsexual subgroups could be masking any differences in handedness scores. Even after adjusting for age differences in the subsamples, no male transsexual subgroup differed from each other on handedness scores, one-way ANCOVA, F(2, 393) = 1.07, ns. The age of the control group was not recorded, however they were undergraduate and postgraduate students. Given the typically low age of this group and the negative relation between handedness and age, it is likely that we would inflate our type II rather than type I error rate and underestimate differences between the control and transsexual groups. DISCUSSION That all transsexual subgroups, not just the homosexual subgroup, were more often nonright handed suggests that some pattern of atypical central nervous system laterality organization is associated with both transsexualism and homosexuality. Handedness differences between transsexuals and controls did not appear due to familial handedness patterns (Chamberlain, 1928). The incidence of lefthandedness in the general population is about 10% (Springer and Deutch, 1989) and based on nonassortive mating of left- and right-handed parents, approximately 80% of the general population should have both parents right-handed. With our transsexual patients, 19% reported at least one nonright-handed parent. When only transsexual subjects who did not have a family history of nonright handedness were analysed, transsexual subjects and controls continued to differ significantly. Differences between male transsexuals and male nontranssexuals are not consistent with an explanation that transsexuals’ hand preference reflects a female pattern. This is because typical males are more often reported as less exclusively right-handed, although some studies, including this study, find no sex difference. However, the difference between female transsexuals and female nontranssexuals is in the more common male pattern. The parsimonious explanation for both sets of findings and the reports of handedness patterns in the clinical samples reviewed above invokes explanations positing a disruption in typical cerebral organization. The association of atypical prenatal sex hormone levels and alterations in cerebral dominance reflected in handedness patterns is consistent with the theory of an altered prenatal sex hormone origin for transsexualism. It is consistent with evidence found in other clinical conditions most likely to exhibit androgen effects on the brain, such as females exposed prenatally to diethylstilbestrol (DES), females with virilizing congenital adrenal hyperplasia and possibly males with Klinefelter syndrome. Congenital adrenal hyperplasia and prenatal DES exposure in females is also associated with elevated rates of homosexual or bisexual
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experience (Ehrhardt et al., 1985; Money et al., 1984). Klinefelter syndrome males may have elevated rates of transsexualism (Money and Pollitt, 1964). Alternatively, modification of cerebral laterality, gender identity, and sexual orientation could all reflect developmental instability, not necessarily resulting from atypical levels of prenatal sex steroid, but from a range of stressors found in association with instability. Fluctuating asymmetry, associated with nonright handedness and reflecting developmental instability, may also be related to birth order. Higher scores of fluctuating asymmetry have been found in association with more older brothers (Lalumiere et al., 1999). Homosexual males have been found to have more older brothers (Blanchard, 1997) as do homosexual male transsexuals (Green, 2000). The developmental perturbation hypothesized to account for the older brother phenomenon in atypical male sexuality is the maternal response to the “foreign” HY antigen of the male foetus, with an increasing response to successive male pregnancies (Blanchard, 1997). Though the evidence for a progressive immunological reaction is not consistent (Green, 2000), at this time the developmental instability hypothesis merits as much research attention as does the prenatal hormonal hypothesis. ACKNOWLEDGMENT Research supported by the Wellcome Trust. REFERENCES American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., American Psychiatric Association, Washington, DC. Annett, M. (1985). Left, Right, Hand and Brain: The Right Shift Theory, Erlbaum, Hillsdale, NJ. Becker, J., Bass, S., Dew, M., Kingsley, L., Selnes, O., and Sheridan, K. (1992). Hand preference, immune system disorder and cognitive function among gay/bisexual men: Multicenter AIDS cohort study. Neuropsychologia 30: 229–235. Bishop, D. V. M., Ross, V. A., Daniels, M. S., and Bright, P. (1996). The measurement of hand preference: A validation study comparing three groups of right-handers. Br. J. Psychol. 87: 269– 285. Blanchard, R. (1997). Birth order and sibling sex ratio in homosexual versus heterosexual males and females. Ann. Rev. Sex Res. 8: 27–67. Chamberlain, H. (1928). The inheritance of left handedness. J. Hered. 19: 557. Coren, S. (1992). Left-handedness in male-to-female transsexuals. JAMA 267: 1342. Coren, S. (1993a). The Left-Hander Syndrome, Vintage, New York; John Murray, London. Coren, S. (1993b). Measurement of handedness via self-report: The relationship between brief and extended inventories. Percept. Mot. Skills 76: 1035–1042. Coren, S. (1995). Family patterns in handedness: Evidence for indirect inheritance mediated by birth stress. Behav. Genet. 25: 517–524. Coren, S., and Halpern, D. (1991). Left-handedness: A marker for decreased survival fitness. Psychol. Bull. 109: 90–106. Davis. A., and Annett, M. (1994). Handedness as a function of twinning, age and sex. Cortex 30: 105–111.
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Diamond, M. (1993). Homosexuality and bisexuality in different populations. Arch. Sex. Behav. 22: 291–310. Dorner. G. (1988). Neuroendocrine response to estrogen and brain differentiation in heterosexuals, homosexuals and transsexuals. Arch. Sex. Behav. 17: 57–75. Ehrhardt, A., Meyer-Bahlburg, H., Rosen, L., Feldman, J., Veridiano, N., Zimmerman, I., and McEwen, B. (1985). Sexual orientation after prenatal exposure to exogenous estrogen. Arch. Sex. Behav. 14: 57–75. Galaburda, A., Corsiglia, J., Rosen, G., and Sherman, G. (1987). Planum temporale asymmetry. Reappraisal since Geschwind and Levitsky. Neuropsychologia 25: 853–868. Geschwind, N., and Galaburda, A. (1985a). Cerebral lateralization I: A hypothesis and a program for research. Arch. Neurol. 42: 428–459. Geschwind, N., and Galaburda, A. (1985b). Cerebral lateralization II: A hypothesis and a program for research. Arch. Neurol. 42: 521–552. Green, R. (2000). Birth order and ratio of brothers to sisters in transsexuals. Psychol. Med. 30: 789– 795. Grimshaw, G., Bryden, M., and Finegan, J. (1995). Relations between prenatal testosterone and cerebral lateralization in children. Neuropsychology 9: 68–79. Hepper, P., Shabidullah, S., and White, R. (1991). Handedness in the human fetus. Neuropsychologia 29: 1107–1111. Herman-Jeglinska, A., Duklo, S., and Grabowska, A. (1997). Transsexuality and adextrality. In Ellis, L., and Ebertz, L. (eds.), Sexual Orientation, Praeger, Westport, pp. 163–180. Holtzen, D. (1994). Handedness and sexual orientation. J. Clin. Exp. Neuropsychol. 16: 702–712. Jones, G., and Martin, M. (2000). A note on Corballis (1997) and the genetics and evolution of handedness: Developing a unified distributional model from the sex-chromosomes gene hypothesis. Psychol. Rev. 107: 213–218. Kieser, J., Groeneveld, H., and Da Silva, P. (1997). Dental asymmetry, maternal obesity, and smoking. Am. J. Phys. Anthropol. 102: 133–139. Lalumiere, M., Blanchard, R., and Zucker, K. (2000). Sexual orientation and handedness in men and women: A meta-analysis. Psychol. Bull. 126: 575–592. Lalumiere, M., Harris, G., and Rice, M. (1999). Birth order and fluctuating asymmetry: A first look. Proc. R. Soc. London B. 266: 2351–2354. Money, J., and Pollitt, E. (1964). Cytogenetic and psychosexual ambiguities, Klinefelter’s syndrome and transvestism compared. Arch. Gen. Psychiatry 11: 589–595. Money, J., Schwartz, M., and Lewis V. (1984). Adult erotosexual status and fetal hormonal masculinization and demasculinization. Psychoneuroendocrinology 9: 405–414. Nass, R., Baker, S., Virdis, R., Balsamo, A., Cacciaro, E., Loche, A., Dumic, M., and New, M. (1987). Hormones and handedness: Left hand bias in female congenital adrenal hyperplasia patients. Neurology 37: 711–715. Naugler, C., and Ludman, M. (1996). Fluctuating asymmetry and disorders of developmental origins. Am. J. Med. Genet. 66: 15–20. Netley, C., and Rovet, J. (1982). Handedness in 47 XXY males. Lancet 1: 267. Oldfield, R. (1971). The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia 9: 97–113. Orlebeke, J., Boomsma, D., Gooren, L., Verschoor, A., and Vanden Bree, M. (1992). Elevated sinistrality in transsexuals. Neuropsychology 6: 351–355. Satz, R., Miller, E., Selnes, O., Van Gosp, W., D’Elia, L., and Vischer, B. (1991). Hand preference in homosexual men. Cortex 27: 295–306. Schacter, S. (1994). Handedness in women with intrauterine exposure to diethylstilbestrol. Neuropsychologia 32: 619–623. Springer, P., and Deutch, G. (1989). Left Brain Right Brain, 3rd edn., Freeman, New York, p. 141. Ward, I., and Weisz, J. (1980). Maternal stress alters plasma testosterone in fetal males. Science 207: 328–329. Watson, D., and Coren, S. (1992). Left-handedness in male-to-female transsexuals. JAMA 267: 1342. Wilber, E., Newell-Morris, L., and Streissguth, A. (1933). Dermatoglyphic asymmetry in fetal alcohol syndrome. Biol. Neonate. 64: 1–6.
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Yeo, R., and Gangestad, S. (1998). Developmental instability and phenotypic variation in neural organization. In Raz, N. (ed.), The Other Side of the Error Term. Elsevier, Amsterdam, pp. 1–51. Yeo, R., Gangestad, S., and Daniel, W. (1993). Hand preference and developmental instability. Psychobiology 21: 161–168. Zhou, J.-N., Hofman, M. A., Gooren, L. J., and Swaab, D. F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature 378: 68–70.
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Differences in Sexual Risk Behaviors Between College Students with Same-Sex and Opposite-Sex Experience: Results From a National Survey Marla Eisenberg, MPH, ScD1,2
The goal of this study was to identify differences in the sexual health behaviors (condom use and number of sexual partners) between college students with samesex sexual experiences and those with only opposite-sex partners. Data from a random sample of American university students were gathered as part of the 1997 College Alcohol Study. Odds ratios were estimated for consistent condom use and multiple sex partners for students with same-sex or both-sex sexual partners compared to those with exclusively heterosexual contacts. Five percent of respondents reported ever having a same-sex partner. Significant differences in safer-sex practices were found between groups. Females with both-sex experience and males with both-sex or only same-sex experiences were more likely to report multiple recent sexual partners than their peers with only opposite-sex partners. Odds ratios of consistent condom use were lower for men with only same-sex experience than among those with only opposite-sex partners. Findings have implications for sexual health education on the college campus. Consistent condom use remains low among college students. Education programs should emphasize the importance of limiting the number of lifetime sex partners, especially among students with same-sex experiences. KEY WORDS: sex behavior; sexual partners; condoms; homosexuality.
INTRODUCTION For many students at American universities, college is a time of sexual activity. Today, many young people’s first experience of sexual intercourse occurs during the 1 Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts. 2 To
whom correspondence should be addressed at The National Teen Pregnancy Prevention Research Center, University Gateway Building, Division of General Pediatrics and Adolescent Health, 200 Oak Street SE, Suite 260, Minneapolis, Minnesota; e-mail:
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middle teen years, typically at 16 for males and 17 for females (Alan Guttmacher Institute, 1994). Recent research has shown that the sexual activity of college students puts them at risk for sexually transmitted infections (STIs) including HIV. Eighty to 90% of college students report being sexually experienced (Bishop and Lipsitz, 1991; DeBuono et al., 1990; DiClemente et al., 1990; Douglas et al., 1997; Leik et al., 1995; Lewis, 1995; Lewis et al., 1997; MacDonald et al., 1990; Mahoney et al., 1995; O’Leary et al., 1992). Approximately one-third of sexually active students report consistent condom use, and a similar percentage reported using a condom at their last act of intercourse (Douglas et al., 1997). A majority of sexually active students report having multiple sexual partners; approximately one-third of respondents to the National College Health Risk Behavior Survey report having six or more lifetime partners (Douglas et al., 1997). These behaviors are reflected in high rates of STIs. Eighty-two percent of all cases of chlamydia and gonorrhea in the United States occur in those aged 15–29 years (Centers for Disease Control and Prevention, 1998a). In addition, approximately 35% of people living with HIV infection were between 20 and 29 years of age at the time of diagnosis, and approximately 18% of AIDS cases were diagnosed in this age group (Centers for Disease Control and Prevention, 1998b). Given the invisibility of infection and the long latency period before diagnosis with AIDS, many of these cases undoubtedly originated in sexual behavior of adolescence and young adulthood. Most of the research investigating the sexual behaviors of college students does not address specific sexual practices such as same-sex sexual contact. The bulk of the literature on college students’ sexual behaviors employs samples of several hundred students which would be unlikely to include sufficient numbers of students reporting same-sex sexual contact to conduct appropriate analyses (if such behaviors were even assessed). Studies using large representative samples have not included these measures. Likewise, research into the sexual practices of adults identifying as gay, lesbian, or bisexual typically utilizes samples of people affiliated with gay and lesbian support organizations or educational programs. This type of sampling is limited to individuals who self-identify as gay, lesbian, or bisexual. Because this is a much-stigmatized label, a large proportion of people with same-sex behavioral experiences is likely to avoid this categorization. Any research overtly focused on gay, lesbian, and bisexual people misses the substantial group that has had same-sex experience but does not consider themselves gay, lesbian, or bisexual. Very little information is available, therefore, regarding the sexual risk behaviors of college students who have had same-sex sexual contact. College campuses are conducive to a variety of interventions encouraging safer sexual practices. However, programs developed and presented with a general (i.e., heterosexual) audience in mind may be awkward, inappropriate, or even harmful for students engaging exclusively or occasionally in same-sex sexual
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practices. Gathering information on differences in risk behavior associated with same-sex sexual contact could indicate whether particular subgroups of students might benefit from health-behavior interventions tailored to their needs. This research uses a large, nationally representative sample of college students to compare the sexual health behaviors (i.e., consistent condom use and limiting one’s number of sex partners) of students who have had same-sex sexual experiences and those who have had exclusively heterosexual experiences. The goals of this project are to determine if either group is at higher risk and provide information to sexual health educators on appropriate priorities for educational programs tailored according to sex-partner group.
METHODS Data Collection and Measurement Data were gathered as part of the 1997 College Alcohol Study, which surveyed a random sample of students at American colleges and universities. Of the original 195 institutions selected, 130 (67%) participated. The main reason for colleges’ nonparticipation was administrators’ inability to provide student contact information within the time parameters of the study. Fourteen participating colleges had response rates of less than 45% of eligible students in the combined 1993 and 1997 dataset; these were not included in analysis, leaving a final sample of 116 colleges. These 116 colleges are representative of US institutions of higher learning. They are located in 39 states, with 22% in the Northeast, 29% in the South, 29% in the North Central region, and 19% in the West. More than two-thirds are public institutions and the remainder are private. Forty-seven percent of colleges sampled enrolled more than 10,000 students; 21% enrolled 5,001 to 10,000 students, and 32% enrolled 5,000 or fewer students. Approximately two-thirds are in an urban or suburban location and one-third are in a rural or small town setting. Sixteen percent have a religious affiliation, and 5% enroll only women. A random sample of 230 full-time undergraduate students was provided by administrators at each college. Self-administered 20-page questionnaires were mailed to 24,140 students in February, 1997. Responses were voluntary and anonymous, and participation was encouraged by a cash incentive. A total of 14,521 students (60%) responded, and response rates varied among the 130 participating colleges (26–88%). Further details of the study design have been published elsewhere (Wechsler et al., 1995, 1998a,b). Four items regarding sexual behavior were included in the College Alcohol Study and in these analyses. These were (1) “Have you ever had sexual intercourse (with opposite or same sex partner),” (2) “If you have ever been sexually active, has it been with . . . (a) opposite sex partner(s), (b) same sex partner(s),
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or (c) both opposite and same sex partners,” (3) “How many people have you had sexual intercourse with in the past 30 days,” and (4) “When you have sexual intercourse, how often do you or your partner use a condom.” No particular instructions or definitions of these sexual behaviors were given, and specific items were selected to meet the needs of the College Alcohol Study. Additional demographic variables relevant to college students’ high risk behaviors were measured, including sex, age, racial identity, Hispanic origin, marital status, and on/off campus residence. Data Analysis Over 10,000 students who responded to the survey’s sexual behavior questions were included in this study. Analyses were conducted separately for males and females. Married students (9% of females and 7% of males) were excluded from these analyses, as their sexual behavior is assumed to be monogamous, and condom use for disease prevention less of a concern than among unmarried college students. In addition, women reporting sexual contact exclusively with other women were excluded from condom-use analyses. After these exclusions, 3,520 males and 5,138 females remained for the analyses (with 5,046 women for condom-use analysis). The current version of SAS was used for statistical analyses (SAS Institute, 1990). Differences in the prevalence of sexual behaviors were indicated by percentages, and tests of the significance of the differences of proportion were carried out using chi-square analysis. Logistic regression was used to estimate the odds of consistent condom-use or nonuse and multiple sex partners for students reporting same-sex only or both-sex partners versus those with exclusively heterosexual contacts. Odds ratios are reported with a 95% confidence interval, adjusted for several control variables. The generalized estimating equation approach was used to fit the final logistic regression models in order to make more robust inference using the clustered sampling design (Liang and Zeger, 1992; Zeger et al., 1988). The point estimates and confidence intervals were almost identical to those obtained using ordinary logistic regression; these results are not reported here.
RESULTS Characteristics of the Sample Characteristics of the students responding to the survey are presented in Table I. The sample includes more female students than male students, due in part to the inclusion of 6 institutions for women only. Over 80% of respondents were in the traditional college age group of 18–22 years old. A majority were White, non-Hispanic, and half lived off-campus.
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Characteristic Sex Age group ≤17 18–19 20–22 23+ Racial identification White Black Asian/Pacific Islander Native American Indian/Native Alaskan Other Hispanic origin Yes No Housing On campus Off campus Other housing a Sexually active Yes No Sex partnersb Opposite sex only Both opposite and same sex Same sex only Condom useb Never Rarely Sometimes Always Number of partners (in past 30 days)b 0 1 2 3 or more
Males
Total
n
%
n
%
n
%
7,905
40
5,351
60
13,256
100
26 2,831 3,863 1,183
<1 36 49 15
10 1,542 2,702 1,094
<1 29 51 20
36 4,373 6,565 2,277
<1 33 50 17
6,154 444 559 40 595
79 6 7 1 8
4,116 198 478 31 434
78 4 9 1 8
10,270 642 1,037 71 1,029
79 5 8 1 8
626 7,228
8 92
416 4,899
8 92
1,042 12,127
8 92
3,723 3,840 293
47 49 4
2,371 2,782 157
45 52 3
6,094 6,622 450
47 50 3
5,519 2,303
71 29
3,754 1,541
71 29
9,273 3,844
71 29
4,859 184 92
95 4 2
3,339 82 93
95 2 3
8,198 266 185
95 3 2
1,425 619 1,002 2,092
28 12 19 41
673 394 779 1,674
19 11 22 48
2,098 1,013 1,781 3,766
24 12 20 43
1,350 3,515 186 80
26 69 4 2
1,229 1,972 186 132
35 56 5 4
2,579 5,487 372 212
30 64 4 2
Note. Totals may not sum to 100% due to rounding. a Students living in “other housing” were deleted from further analyses. b Percentages given are of students who report ever having sexual intercourse.
Student Sexual Behavior Almost three-quarters (71%) of college students report being sexually experienced; this figure is slightly lower than those reported in other college samples (DeBuono et al., 1990; Douglas et al., 1997). Ninety-five percent of students report that their sexual experiences have been exclusively with opposite-sex partners, and 5% report sexual experiences with members of their own sex (including
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Table II. Characteristics of Students Reporting Sexual Behaviors: Percent in Each Demographic Category (Sex Partner Groups) Opposite-sex only Male
Age <23 23+ Race White Non-White Ethnicity Hispanic Non-Hispanic Housing On-campus Off-campus
Both opposite- and same-sex
Female
Male
Female
Same-sex only Male
Female
n
%
n
%
n
%
n
%
n
%
n
%
2,553 786
76 24
4,065 794
84 16
50 32
61 39
122 62
66 34
60 33
65 35
67 25
73 27
2,654 81 638 19
3,881 923
81 19
63 17
79 21
141 40
78 22
68 25
73 27
69 22
76 24
272 8 3,049 92
366 4,468
8 92
9 73
11 89
17 165
9 91
14 78
15 85
9 83
10 90
1,424 1,892
2,169 2,659
45 55
35 46
43 58
70 112
38 62
33 59
36 64
38 53
42 58
43 57
Note. Totals may not sum to 100% due to rounding.
approximately 3% reporting both-sex partners and 2% reporting only same-sex partners). Only 0.5% of sexually active respondents failed to indicate the sex of their partner(s). Students reporting same-sex behavior were more likely to be older than those with only opposite-sex partners. Among men, 39% and 35% of those reporting both-sex and same-sex partners, respectively, were 23 years of age or older, compared to 24% of men with only opposite-sex experience. Similarly among women, 34% and 27% of those with both-sex and same-sex partners were 23 or older, versus 16%. Students reporting exclusively same-sex behavior were also more likely to be non-White than those with opposite-sex or both-sex partners, especially among men. Characteristics of students by sex partner group are shown in Table II. Less than half of all students (43%) report always using condoms during sexual intercourse, and 24% report never using condoms. Students who reported always using condoms were more likely to be under 23 years old (81% of men and 87% of women) than those that do not use condoms consistently (71% of men and 80% of women). Consistent condom users were also more likely to live on-campus (48% of men and 51% of women) than those that do not always use condoms (38% and 40%, respectively). These characteristics are shown in Table III. A majority of respondents (64%) report a single sexual partner in the past 30 days and an additional 30% report no sexual partners in that period. Students with two or more recent partners were more likely to be non-White than those with fewer than two recent partners, with 29% of men and 25% of women with two or more partners being non-White, compared to 19% of students with fewer than two partners being non-White (Table IV).
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Table III. Characteristics of Students Reporting Sexual Behaviors: Percent in Each Demographic Category (Consistency of Condom Use) Always use condoms Male
Age <23 23+ Race White Non-White Ethnicity Hispanic Non-Hispanic Housing On-campus Off-campus
Don’t always use condoms
Female
Male
Female
n
%
n
%
n
%
n
%
1,350 324
81 19
1,827 265
87 13
1,317 529
71 29
2,429 617
80 20
1,312 334
80 20
1,680 385
81 19
1,477 347
81 19
2,414 600
80 20
147 1,516
9 91
155 1,927
7 93
148 1,689
8 92
238 2,791
8 92
801 863
48 52
1,064 1,014
51 49
693 1,138
38 62
1,215 1,811
40 60
Note. Totals may not sum to 100% due to rounding.
Significant differences exist in sexual health practices between students with only heterosexual experience and those reporting same-sex sexual experience. Percentages and chi-square values are shown in Table V. Among males, those with same-sex experiences were significantly more likely to have two or more sexual partners in the 30 days preceding the survey than males with only oppositesex experience, with 20.4% of men with only same-sex experience and 15.9% of men with both-sex experience reporting two or more recent partners, compared Table IV. Characteristics of Students Reporting Sexual Behaviors: Percent in Each Demographic Category (Number of Sexual Partners in the Past 30 days) <2 Partners Male
Age <23 23+ Race White Non-White Ethnicity Hispanic Non-Hispanic Housing On-campus Off-campus
2+ Partners
Female
Male
Female
n
%
n
%
n
%
n
%
2,448 753
76 24
4,022 843
83 17
219 99
69 31
228 38
86 14
2,564 590
81 19
3,891 917
81 19
224 91
71 29
197 67
75 25
266 2,917
8 92
372 4,466
8 92
29 287
9 91
19 247
7 93
1,367 1,810
43 57
2,145 2,688
44 56
127 190
40 60
130 134
49 51
Note. Totals may not sum to 100% due to rounding.
52.1 47.9 91.4 8.6
3,053 286
%
1,741 1,598
n
69 13
43 39
n
84.2 15.9
52.4 47.6
%
74 19
60 33
n
79.6 20.4
64.5 35.5
%
Same-sex partner(s)
20.2∗∗∗
5.6†
χ2
4,615 240
2,863 1,996
n
95.1 4.9
58.9 41.1
%
Opposite sex partner(s)
161 20
107 77
n
89.0 11.1
58.2 41.9
%
Both-sex partners
Females
87 5
— —
n
94.6 5.4
— —
%
Same-sex partner(s)
13.3∗∗
0.04
χ2
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Note. Totals may not sum to 100% due to rounding. Nine respondents were missing on one of the above variables and excluded from analysis. † p < 0.10; ∗ p < 0.05; ∗∗ p < 0.01; ∗∗∗ p < 0.001.
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Characteristic
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to 8.6% of men with only opposite-sex partners (χ 2 = 20.2, p < 0.001). This relationship among females was slightly different: 11.1% of women with bothsex partners reported two or more recent partners, while only 4.9% of oppositesex and 5.4% of same-sex partnered women reported this (χ 2 = 13.3, p < 0.01). The relationship between sex-partner group and condom-use group was not as pronounced. The difference in the proportion of men in the three sex-partner groups reporting consistent condom use did not achieve significance at the 0.05 level (47.9%, 47.6%, 35.53%; χ 2 = 5.6, p < 0.10). Among women, the proportion with opposite-sex and both-sex partners reporting consistent condom use was virtually identical (41.1%, 41.9%). Logistic regression was used to estimate the odds of engaging in high-risk sexual behaviors, controlling for several other factors. Variables were dichotomized to enable comparisons of students with both-sex or same-sex partners versus opposite-sex partners only, those age less than 23 versus 23 and older, white versus non-White students, those with Hispanic versus non-Hispanic heritage, and off-campus versus campus residents. In addition, each outcome variable (condom use and number of partners) was tested for significance as a predictor variable for the other behavior. Results of these analyses are shown in Tables VI and VII. The odds of women who have had both-sex partners reporting two or more sexual partners in the past 30 days are more than twice the odds of women with only male partners reporting this behavior (OR = 2.43), controlling for age, race, Hispanic heritage, housing, and condom use. Women reporting only same-sex partners were not significantly more likely to have multiple sex partners than women with only male partners. Among men, those with both-sex and same-sex partners also had odds of multiple recent sexual partners approximately twice as Table VI. Logistic Regression Results for Correlates of Having Two or More Recent Sexual Partners Among College Students Females
Sex group Age group Race Hispanic Housing Condom use
Description
OR
Only opposite-sex partners Both-sex partners Same-sex partners <23 years old 23+ years old White Non-White Non-Hispanic Hispanic On-campus Off-campus Not always Always
1.00 2.43 1.12 1.00 0.78 1.00 1.56 1.00 0.78 1.00 0.86 1.00 0.91
95% CI 1.48–4.00 0.45–2.78 0.53–1.14 1.15–2.12 0.45–1.28 0.66–1.12 0.70–1.17
Note. ORs which are significant at the 0.05 level are shown in boldface.
Males OR 1.00 1.99 2.60 1.00 1.35 1.00 1.87 1.00 0.74 1.00 0.97 1.00 0.70
95% CI 1.08–3.67 1.53–4.39 1.03–1.77 1.41–2.48 0.47–1.15 0.75–1.25 0.55–0.89
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Sex group Age group Race Hispanic Housing Multiple partners
Description
OR
Only opposite-sex partners Both-sex partners Same-sex partners <23 years old 23+ years old White Non-White Non-Hispanic Hispanic On-campus Off-campus <2 recent partners 2+ recent partners
1.00 1.20 — 1.00 0.66 1.00 0.95 1.00 1.00 1.00 0.70 1.00 0.92
95% CI 0.88–1.63 — 0.55–0.78 0.81–1.11 0.78–1.27 0.62–0.79 0.71–1.19
Males OR 1.00 0.99 0.61 1.00 0.67 1.00 1.17 1.00 1.01 1.00 0.73 1.00 0.70
95% CI 0.63–1.57 0.39–0.96 0.56–0.79 0.97–1.41 0.77–1.33 0.63–0.84 0.55–0.89
Note. ORs which are significant at the 0.05 level are shown in boldface.
high as the odds for men with opposite-sex partners (OR = 1.99 for both-sex; OR = 2.60 for same-sex), with the same controls. For both sexes, reported odds ratios were significant at the 0.05 level. Race was also a significant predictor of multiple recent partners, controlling for all other variables listed. For both sexes, non-White students were more likely to report multiple recent partners than White students (OR = 1.56 for women; 1.87 for men). Among men, those 23 and older were also more likely to report multiple partners than younger men (OR = 1.35). Men with exclusively same-sex partners were less likely to report consistent condom use than those with only opposite-sex partners, controlling for all other variables (OR = 0.61). Women with both-sex partners did not have significantly different odds of consistent condom use than women with only opposite-sex partners after controlling for other factors. Two demographic variables were significant predictors of female and male students’ reporting always using condoms. Being of traditional college age (i.e., under 23 years) was associated with consistent condom use: students 23 years of age and older had lower odds of consistent condom use, 0.66 and 0.67 (female and male, respectively) that of younger students. Living on-campus was similarly protective. Off-campus residents had lower odds of consistent condom use, 0.70 and 0.73 (female and male, respectively) than students living on-campus. Finally, each sexual behavior was related to the other male respondents. Those that reported two or more recent sexual partners were also less likely to report always using condoms than men who did not have multiple recent partners (OR = 0.70).
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DISCUSSION The purpose of this analysis was to identify differences in sexual health practices between college students with same- versus opposite-sex partners. The 5% of respondents reporting same-sex behavior is similar to other findings on samesex experiences in the general adult population (Diamond, 1993; Laumann et al., 1994). Significant differences did emerge for some groups and some behaviors; female students reporting both-sex partners and males with both-sex and only same-sex partners were more likely to report multiple sexual partners than students with only opposite-sex experiences. This finding supports previous research comparing sexual risk-taking behaviors according to sexual orientation among high school students, which also found that number of sexual partners was associated with a gay, lesbian, or bisexual orientation (Garofalo et al., 1998). Though specific behaviors were assessed differently, both studies used large random samples of students to make comparisons between groups, and their consistent results indicate that sexual identity and/or sex-partner experience appear to be a risk factor for having multiple sexual partners. Sex-partner group was also related to consistent condom use among men in this sample. This finding may reflect changes in the perceived threat of HIV and AIDS within the gay male community, such that acquisition of the virus is no longer viewed as the death sentence it was several years ago (Bouldrey, 1999), or it may reflect a shortcoming in safer-sex promotion for college students. Differences in sexual health behaviors were also evident between other subgroups of college students. Non-White students and older male students tended to report more sexual partners within the last 30 days, and younger students and those who lived on-campus were more likely to report consistent condom use. The two behaviors appeared to work in tandem for men: those with more partners tended to report less consistent condom use—a combination putting them and their partners at substantial risk for sexually transmitted infections. Rates of consistent condom use found in this sample are somewhat higher than those found previously in large studies of U.S. college students (Centers for Disease Control and Prevention, 1997; Douglas et al., 1997; Lewis et al., 1997). This difference could be due to a genuine increase in the rates of condom use during the few years between this and prior studies; it could also be due in part to the exclusion of married students from this analysis, as this group is less likely to use condoms than their unmarried peers. In any case, less than half of sexually active college students consistently use condoms to protect themselves from STIs. Though only 6% of students here reported having multiple sexual partners in the past 30 days, this is likely to be comparable to the lifetime measures of sexual partners reported elsewhere (Centers for Disease Control and Prevention, 1997; Douglas et al., 1997), and suggests that having multiple sexual partners is a relatively common practice among sexually active young people.
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Limitations Several limitations are associated with the use of survey data. First, the sensitive subject matter of this investigation is a potential limitation. Because same-sex contact is a very personal and much-maligned behavior, the possibility exists that social desirability may influence responses. Misclassification of sex-partner group or failure to report same-sex behavior would bias the results of these analyses. This concern is tempered, however, by the awareness that the percentage of respondents reporting same-sex behavior coincides with previous studies, and the proportion of sexually active students who did not indicate their sex-partner group was extremely small. Second, there is the possibility that the behavior of nonrespondents is substantively different from respondents’. In related studies using this dataset, the prevalence of high-risk substance use was found to be uncorrelated with college response rates; furthermore, the behaviors of a subsample of nonrespondents were assessed and no significant differences were found between respondents and nonrespondents (Wechsler et al., 1995, 1998a,b). Finally, the anonymity of student responses was made clear during data collection, which is recommended to minimize under-reporting and misreporting of information (Aday, 1996). Given that the measure of sex-partner group includes only lifetime experience, the “both-sex” group is likely to include both respondents who have had a onetime same-sex experience as well as those for whom this is a primary sexual behavior; this may limit our ability to draw inferences from this data as to highrisk sex behaviors associated with sex-partner groupings. Members of this group who have only minimal same-sex experience may not have the same risk profile as those with primarily same-sex partners. This potential blurring of students’ sexual experiences and risk profiles may make it more difficult to detect differences among the groups, and may bias results toward the null. In addition, sexual orientation items do not include a measure of “outness”; this characteristic is likely to be important, especially as it might relate to the support garnered from an individual’s social network. Unfortunately, this information was not included in the original data. Future studies will need to assess same-sex experiences and sexual identity in greater detail in order to build on the findings described here. Prior research has demonstrated that college students hold divergent opinions about what behaviors constitute “having sex” (Sanders and Reinisch, 1999), thus the measure of “sexual activity” used without definition in this survey may raise concerns about misinterpretation and possible misclassification. Sex-partner group was not defined by experience with sexual intercourse or any other particular sexual act, but on the respondents’ own understanding of their past sexual activity with same- or opposite-sex partners. To minimize concerns about misinterpretation, women with only other female partners were dropped from this analysis, as condom use is widely recommended only for sexual activity involving a male. Use of other forms of latex barrier protection recommended to prevent STI transmission between women was not assessed in the College Alcohol Study.
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A final issue which may limit interpretation of these findings is that this study does not assess other factors of sexual behavior, such as the use of other contraceptive methods or monogamous partnerships; this may make some sexual interactions appear high risk when they are in fact relatively safe. On a practical level, these analyses may overestimate the scope of the problem of high-risk sexual behaviors. Further research on high-risk sexual behaviors of college students is needed to establish a greater understanding of the context in which these behaviors take place. Information about the extent of same-sex experience, age of initiation of sexual experiences, use of other birth control methods, lifetime number of sexual partners, and the relationship of alcohol and drug use to sexual behavior could have profound implications for sexual health education, promotion and interventions in the college environment.
Implications In spite of the above limitations, these findings have several implications for the practice of sexual health education on the college campus. First, messages about the importance of condom use and condom promotion and distribution may need to be renewed for all students, and in particular for males with same-sex partners. Second, sexual health education programs need to emphasize the importance of minimizing one’s number of sexual partners as a risk prevention strategy. This is particularly important in any programs developed for or delivered to male students who have ever had same-sex experiences and female students with both male and female partners, as these groups tend to have a larger number of recent sexual partners. A focus on lifetime partner minimization is also critical given the fact that most college students are not reliable condom users. This is especially important in light of the finding that males who are less consistent condom users tend to have more partners, thus elevating their risk of infection. In addition, this paper makes an important contribution to the literature on the sexual health behaviors of students with same-sex experiences. First, this research extends previous research with adolescents to college students, using a large, nationally representative sample of students in a study unrelated to sexuality. This study is the first to make comparisons between students with same-sex versus opposite-sex experience in a sample of this nature. Second, these findings are also useful in that the assessment of sexual orientation used here is based on experience rather than self-identification as gay, lesbian, or bisexual. Because much of the HIV/AIDS prevention intervention work in the United States now specifically targets audiences defined by behaviors (e.g., “men who have sex with men”), accurate information about high-risk behaviors based on such categories is essential. Further research is warranted to obtain additional information on psychological and social correlates of high risk behaviors by sex-partner
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group in order to inform the development of prevention programs, and ultimately reduce the spread of HIV and other sexually transmitted infections. ACKNOWLEDGMENTS The project was supported by the Robert Wood Johnson Foundation, Princeton, New Jersey. All human subjects consented to participation, and the Harvard School of Public Health Institutional Review Board exempted this study (due to anonymous data collection) on November 22, 1996. The author thanks Dr. Henry Wechsler for use of the College Alcohol Study data and generous assistance with analysis, and Dr. Valerie Ulstad and Dr. Hang Lee for reviews of this manuscript. REFERENCES Aday, L. A. (1996). Designing and Conducting Health Surveys: A Comprehensive Guide, 2nd edn., Jossey-Bass, San Francisco, p. 110. Alan Guttmacher Institute (1994). Sex and America’s Teenagers, Alan Guttmacher Institute, New York and Washington. Bishop, P., and Lipsitz, A. (1991). Sexual behavior among college students in the AIDS era: A comparative study. J. Psychol. Hum. Sex. 4: 135–148. Bouldrey, B. (1999). Brave new world: We have money, we have Web. Do we have community? Do we need it? San Francisco Bay Guardian, June 23. Centers for Disease Control and Prevention (1997). Youth risk behavior surveillance: National college health risk behavior survey—United States, 1995. MMWR CDC Surveill. Summ. 46(6): 1–57. Centers for Disease Control and Prevention (1998a). Sexually Transmitted Disease Surveillance, 1997, United States Department of Health and Human Services, Public Health Service, Atlanta, GA. Centers for Disease Control and Prevention (1998b). HIV/AIDS Surveill. Rep. 10(1): 14–15. DeBuono, B. A., Zinner, S. H., Daamen, M., and McCormack, W. M. (1990). Sexual behavior of college women in 1975, 1986 and 1989. N. Engl. J. Med. 322(12): 821–825. Diamond, M. (1993). Homosexuality and bisexuality in different populations. Arch. Sex. Behav. 22(4): 291–310. DiClemente, R., Forrest, K., and Mickler, S. (1990). College students’ knowledge and attitudes about AIDS and changes in HIV-preventive behaviors. AIDS Educ. Prev. 2: 201–212. Douglas, K. A., Collins, J. L., Warren, C., Kann, L., Gold, R., Clayton, S., Ross, J. G., and Kolbe, L. J. (1997). Results from the 1995 National College Health Risk Behavior Survey. J. Am. Coll. Health 46: 55–66. Garofalo, R., Wolf, R. C., Kessel, S., Palfrey, J., and DuRant, R. H. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 101(5): 895–902. Laumann, E. O., Gagnon, J. H., Michael, R. T., and Michaels, S. (1994). The Social Organization of Sexuality: Sexual Practices in the United States, University of Chicago Press, Chicago. Leik, M., Malow, R. M., Ireland, S. J., Porter, L., and Lewis, J. E. (1995). HIV risk and drug use among college women. NIDA Res. Monogr. 151: 54. Lewis, J. E. (1995). Psychosocial Correlates of HIV Risk Behavior Among College Students: A Test of the AIDS Risk Reduction Model, Dissertation, University of Miami. Lewis, J. E., Malow, R. M., and Ireland, S. J. (1997). HIV/AIDS risk in heterosexual college students: A review of a decade of literature. J. Coll. Health 45: 147–158. Liang, K. Y., and Zeger, S. L. (1992). Longitudinal data analysis using generalized linear models. Biometrica 73: 12–22.
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MacDonald, N. E., Wells, G. A., Fisher, W. A., Warren, W. K., King, M. A., Doherty, J. A., and Bowie W. R. (1990). High-risk STD/HIV behavior among college students. JAMA 263: 3155–3191. Mahoney, C. A., Thombs, D. L., and Ford, O. J. (1995). Health belief and self-efficacy models: Their utility in explaining college student condom use. AIDS Educ. Prev. 7: 32–49. O’Leary, A., Goodhart, F., and Jemmott, L. S. (1992). Predictors of safer sex on the college campuses: A social cognitive theory analysis. J. Am. Coll. Health 40: 254–263. Sanders, S. A., and Reinisch, J. M. (1999). Would you say you “Had Sex” if . . .? JAMA 281: 275–277. SAS Institute. (1990). SAS/STAT User’s Guide, Version 6, 4th edn. Vol. 1, SAS Institute, Cary, NC. Wechsler, H., Dowdall, G. W., Davenport, A., and Castillo, S. (1995). Correlates of college student binge drinking. Am. J. Public Health 85(7): 921–926. Wechsler, H., Dowdall, G. W., Meanner, G., Gledhill-Hoyt, J., and Lee, H. (1998a). Changes in binge drinking and related problems among American college students between 1993 and 1997: Results of the Harvard School of Public Health College alcohol study. J. Am. Coll. Health 47: 57–68. Wechsler, H., Rigotti, N. A., Gledhill-Hoyt, J., and Lee, H. (1998b). Increased levels of cigarette use among college students: A cause for national concern. JAMA 280(19): 1673–1678. Zeger, S. L., Liang, K. Y., and Albert, P. S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics 44(4): 1049–1060.
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c 2001) Archives of Sexual Behavior, Vol. 30, No. 6, December 2001 (°
Spinal Cord Injury and Sexuality in Married or Partnered Men: Activities, Function, Needs, and Predictors of Sexual Adjustment Jerry Phelps, PhD,1,2,3,5 Michael Albo, MD,3,4 Kathleen Dunn, MS, RN, CRRN-A,3 and Angela Joseph, RN3
The sexual behaviors, functioning, needs, and sexual satisfaction levels of men with spinal cord injuries (SCI) were studied. A sample of 50 men with SCI (median age = 50; median age at injury = 25.0), either married or in a committed relationship, responded to an anonymous survey of a large southern California regional spinal injury rehabilitation center. Multiple regression analyses indicated that perceived partner satisfaction, relationship quality, and sexual desire were significant predictors of sexual satisfaction and behavior. Erectile function, level of genital sensation, and orgasmic capacity all varied widely in the sample, as well. However, none of these variables were significantly related to sexual satisfaction. A varied sexual repertoire was independently related to sexual satisfaction and behavior, but did not offer additional predictive power. Results suggest that for married or partnered men with SCI, relationship factors including partner satisfaction and relationship quality are significantly and positively related to sexual satisfaction. Married or partnered men with SCI who report low relationship satisfaction, have difficulty satisfying their partner, and/or report low sexual desire may benefit from assessments and interventions that address these issues. KEY WORDS: disability; erectile dysfunction; marital satisfaction; spinal cord injury; sexual satisfaction.
1 Psychological 2 Department
and Counseling Services, University of California, San Diego, La Jolla, California. of Psychiatry, School of Medicine, University of California, San Diego, La Jolla,
California. Affairs San Diego Healthcare System, La Jolla, California. 4 Department of Surgery, Division of Urology, University of California, San Diego, School of Medicine, San Diego, California. 5 To whom correspondence should be addressed at Psychological and Counseling Services, University of California, San Diego, CB 0304, La Jolla, California 92093-0304; e-mail: jsphelps@ uscd.edu. 3 Veterans
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INTRODUCTION Persons with spinal cord injuries (SCI), an increasing segment of the American population (Lasfaugues et al., 1995), experience a host of acute and long-term physical and psychosocial consequences that can negatively impact the quality of their lives and the lives of their family. In the majority of cases, persons with SCI undergo significant alterations in sexual functioning, which affect multiple areas of sexuality, including desire, arousal, erectile function, orgasm, ejaculation, and fertility (Alexander et al., 1993; White et al., 1992; Wilmuth, 1987). Also, an SCI has an impact on the marital relationship, as the divorce rate for persons married prior to injury is higher than the national average (National Spinal Cord Injury Statistical Center, 2000). In addition, there is increasing evidence demonstrating the importance of relationship factors in sexual satisfaction in general, not only among men with SCI (Kreuter et al., 1996; Urey and Henggeler, 1987), but for men without a disability as well (Janus and Janus, 1993; Michael et al., 1994). While men with SCI are one of the best-understood and studied disability groups in the area of sexuality (Dunn, 1999), few studies have specifically addressed the sexuality-related issues of married or otherwise partnered men with SCI (Kreuter et al., 1996; Urey and Henggeler, 1987). Previous studies show that relationship factors play an important role in the sexuality of men with SCI; however, generalizations from these studies are limited by their use of relatively young, recently injured samples, and the use of a mix of partnered and single men. Therefore, to clarify the significance of partner status in men with SCI and to further investigate the importance of relationship factors on sexuality, the following study was conducted. The main purpose of this study was to investigate predictors of sexual satisfaction in married or partnered men with SCI, using a sample that was representative of the population served by a healthcare system that provides both acute rehabilitation and primary care services. A second goal was to explore the sexual functioning, activities, and needs of this group. METHOD Subjects A population of 482 male veterans with SCI currently served by a Department of Veterans Affairs SCI center was sent anonymous questionnaires. Females were excluded from this study owing to the difficulty in maintaining anonymity because of their small number (9) in the population sampled. Subjects were asked to return their completed questionnaires in a postage-paid, pre-addressed envelope. One hundred fifteen persons (24%) returned valid questionnaires. Of those,
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Table I. Demographic Characteristics of Married or Partnered Men With SCI (n = 50) Age (Median) Age at SCI (Median) Education (Median) Ethicity White Hispanic African American Asian American Other Level of injury Cervical Thoracic Lumbar Sacral Etiology of injury Vehicular Act of violence Falls Sports activity Other Marital status Married Non-marital, committed relationship Employment Retired Employed Volunteer Unemployed Student
50 years (range 20–83) 25 years (range 18–64) 14 years (range 12–22) 83% 4% 4% 2% 6% 35% 35% 27% 4% 28% 18% 14% 10% 30% 78% 22% 43% 27% 14% 12% 4%
50 (44%) identified themselves as married or in a committed relationship. These 50 comprised the sample studied. Age, ethnicity, etiology, and level of injury of the sample were compared to the larger population surveyed. There were no significant differences between the 50 subjects in the sample and the 482 patients who were asked to participate, indicating that this sample is representative of the population surveyed. Table I describes the demographics of the sample.
Measurement Instrument An 80-item multiple-choice questionnaire, similar to surveys used in prior studies (Alexander et al., 1993; Kreuter et al., 1996; White et al., 1992), was developed by the authors and pilot tested with a small (n = 5) sample. This questionnaire was developed to assess sexual behavior, functioning, satisfaction, and needs for services, as well as relationship issues.
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Sexual Behavior Subjects were asked whether or not they were sexually active, types of sexual activity in which they engaged (kissing, intimate touching, masturbation of self, masturbation of partner, oral sex, and intercourse), and their frequency of sexual activity (never, less than once a month, once or twice a month, every week, or every other day or more).
Sexual Functioning Subjects rated their level of genital sensation (none to low, moderate, or high); level of sexual desire (none to low, moderate, or high), erectile function (none, partial, or full); and orgasmic capacity (none, different than pre-SCI, or same as pre-SCI).
Relationship Issues Subjects estimated their partner’s level of sexual desire (low, moderate, or high) and their partner’s satisfaction with the sexual relationship (very dissatisfied, dissatisfied, indifferent, satisfied, or very satisfied). Overall relationship satisfaction was measured using the first question from the Marital Adjustment Test (MAT; Locke and Wallace, 1959) (see Appendix A, for question). Item analysis of the MAT has previously found that this question is highly correlated with the total score on the MAT, r = 0.81, and correctly classifies 85% of high- and low-scoring couples on the MAT (Cross and Sharpley, 1981), indicating that this question is a reliable and valid measure of relationship satisfaction.
Informational Interests Subjects were given a checklist and asked to rate their level of interest (none, moderate, or high) in receiving information on sexuality-related topics: fertility, birth control, coping with sexual limitations, methods to achieve sexual satisfaction, methods to produce sexual satisfaction in a partner, helping partner cope with sexual limitations, erectile therapy, finding a partner, and safer sex.
Sexual Adjustment A combination of three items from the questionnaire covering frequency of sexual behavior, enjoyment of sex, and satisfaction with the sexual relationship
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was used to measure sexual adjustment. These items were summed and treated as one composite variable, the Sexual Behavior, Enjoyment, and Satisfaction (SBES) scale (Appendix B). This scale is a modified version of the Sexual Activity and Satisfaction (SAS) scale used by Kreuter et al. (1996) in their study of sexual adjustment in SCI. Internal consistency, as determined by Cronbach’s alpha (Cronbach, 1951) was 0.82, and a principal components analysis confirmed the unidimensionality of the SBES scale. Factor loadings on the principal factor ranged from 0.78 to 0.91. The SBES scale was used as the dependent variable in the analysis of sexual adjustment. Statistical Analysis Seven possible predictors of sexual adjustment were tested: sexual desire, erectile function, orgasmic capacity, genital sensation, relationship satisfaction, sexual repertoire, and perceived partner sexual satisfaction. These were a priori hypotheses, derived from previous research and limited in number to reduce Type I error. Two separate analyses were completed to assess predictors of the SBES scale. First, Pearson correlations were performed for each variable to assess individual relationships with sexual adjustment. Second, the predictor variables were entered simultaneously into a multiple regression equation to test the unique contributions of each to the SBES scale. RESULTS Sexual Behavior Almost all (96%) of the sample reported being currently sexually active. Subjects reported that they engaged in particular types of sexual activities in the following percentages: kissing – 94%; intimate touching – 84%; oral sex – 72%; intercourse – 62%; masturbation of partner – 52%; and masturbation of self – 30%. Frequency of sexual activity was reported as never – 2%, less than once a month – 12.5%, once or twice a month – 37.5%, every week – 44%, and every other day or more – 4%. Sexual Functioning Subjects reported their levels of genital sensation, sexual desire, orgasmic capacity, and erectile function. Regarding genital sensation, 32% reported none, 52% reported partial, and 18% reported full genital sensation. In regards to sexual desire, 20% reported none to low, 38% reported moderate, and 42%
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reported high levels of sexual desire. In estimating their partner’s level of sexual desire, 12% estimated none to low, 54% estimated moderate, and 34% estimated high levels of sexual desire. Concerning orgasmic capacity, 32% reported none, 60% reported that it was different than pre-SCI orgasmic capacity, while 8% stated that their orgasmic capacity was the same as pre-SCI. Finally, in reference to erectile function, 28% reported no erectile function, 52% reported partial erectile function, and 20% stated that they had full erectile function.
Relationship Factors Relationship satisfaction, enjoyment of sex, and satisfaction with sex were also surveyed. Eighteen percent of subjects reported that their relationships were unhappy, 38% said they were happy, and 44% stated that their relationship was very happy to perfect. Only 6% of subjects reported that did not enjoy the sexual part of their relationship, with 12% saying that they sometimes enjoyed it and 76% stating that they usually enjoyed or very much enjoyed it. When asked whether they were satisfied with their sexual relationship, 22% replied that they were very dissatisfied or dissatisfied, with 22% endorsing indifference and 56% saying they were either satisfied or very satisfied. Regarding partner satisfaction with sexual part of relationship, 10% said their partner was very dissatisfied or dissatisfied, with 16% endorsing indifference and 74% responding that they were either satisfied or very satisfied.
Informational Interests Subjects indicated their interests in receiving information on sexuality-related topics. Table II lists the subjects’ interests in descending order.
Table II. Degree of Interest in Sexuality Related Information in Married or Partnered Men with SCIa
Treatment for erectile problems Methods to achieve sexual satisfaction Methods to produce sexual satisfaction in a partner Helping partner cope with sexual limitations Emotional coping Fertility Safer sex Birth control a Percentiles.
None
Some
Great interest
20 21 31 33 51 83 70 93
18 33 25 43 42 4 22 7
54 46 44 24 7 13 2 0
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Table III. Intercorrelations (r ) or Predictors of Sexual Adjustment in Married or Partnered Men with SCI SBES SBES Partsat RQual Desire SxRep Orgsm Erec Sens
— 0.71∗∗∗∗ 0.54∗∗∗∗ 0.47∗∗∗∗ 0.44∗∗∗ 0.22 0.16 0.16
Partsat
RQual
Desire
0.71∗∗∗∗ 0.54∗∗∗∗ 0.47∗∗∗∗ — 0.38∗∗ 0.31∗ 0.38∗∗ — 0.14 0.31∗ 0.14 — 0.53∗∗∗∗ 0.02 0.20 0.12 −0.03 −0.03 0.01 −0.12 0.11 0.03 −0.14 0.21
SxRep
Orgsm
Erec
Sens
0.44∗∗∗ 0.22 0.16 0.16 0.53∗∗∗∗ 0.12 0.01 0.03 0.02 −0.03 −0.12 −0.14 0.20 −0.03 0.11 0.21 — 0.26 0.24 0.22 0.26 — 0.23 0.58∗∗∗∗ 0.24 0.23 — 0.15 0.22 0.58∗∗∗∗ 0.15 —
Note. r – Pearson’s correlation coeffecient; SBES – Sexual Behavior and Satisfaction Scale (SBES); Partsat – Perceived partner satisfaction with the sexual relationship; RQual – Relationship quality; Desire – Level of sexual desire; SxRep – Sexual repertoire; Orgsm – Orgasm type; Erec – Type of erection; Sens – Level of genital sensation. ∗ p < 0.05; ∗∗ p < 0.01; ∗∗∗ p < 0.005; ∗∗∗∗ p < 0.001 (all significance tests are two-tailed).
Predictors of Sexual Adjustment Pearson correlations between the seven predictor variables and the SBES scale are listed in Table III. Intercorrelations between all variables are listed as well (though these will not be discussed to reduce the probability of Type 1 error). Strikingly, erectile function, orgasmic capacity, and genital sensation were not related to sexual behavior, enjoyment, and satisfaction. Perceived partner satisfaction, sexual desire, relationship satisfaction, and sexual repertoire were all significantly correlated with the SBES scale. Results of the multiple regression analysis are reported in Table IV. Three variables were found to significantly predict the SBES scale. Results indicate that perceived partner satisfaction with the sexual relationship was the strongest predictor of the SBES scale, with relationship satisfaction and sexual desire also contributing significant predictive power. Notably, while sexual repertoire was independently correlated with the SBES scale, it did not offer additional predictive power when entered into the regression equation. Table IV. Multiple Linear Regression Predicting Sexual Adjustment in Married or Partnered Men with SCI Dependent variable
Independent variable
β
t
p
1R 2
Sexual adjustment (SBES)
Partner satisfaction Relationship quality Sexual desire
0.51 0.31 0.27
5.20 3.23 3.00
0.001 0.002 0.005
0.502 0.085 0.066
Model R 2 = 0.65 Adjusted Model R 2 = 0.63 Note. β values represent standardized regression coefficients.
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DISCUSSION A sexually active group, married or significantly partnered SCI men engage in a variety of sexual behaviors and usually enjoy the sexual parts of their lives. The majority of these men report having satisfying relationships, which strongly influence their sexual satisfaction. Sexual behaviors, function, and satisfaction levels vary widely in this group, with a significant proportion indicating sexual function problems, low sexual adjustment, and relationship dissatisfaction. Overall, the majority of men in this sample are satisfied with their sexual lives. Relationship factors strongly affect the sexual lives of married or partnered men with SCI. Sexual behavior, enjoyment, and satisfaction of these men were all significantly related to partner satisfaction with the sexual relationship, relationship satisfaction, level of sexual desire and, to some extent, repertoire of sexual behaviors. In fact, the strongest predictor of sexual adjustment in partnered men with SCI was perceived partner satisfaction with the sexual relationship. On the other hand, men in our sample who perceived that their partners were not sexually satisfied reported low sexual satisfaction and less sexual activity. Likewise, men stating that the overall quality of their relationship was “poor” also reported reduced sexual satisfaction and less sexual activity. Furthermore, almost half of the men expressed “a great interest” in learning more about methods to produce sexual satisfaction in a partner. These results suggest that not only are the partner relationship and the partner’s sexual satisfaction important for men’s sexual satisfaction, but also that men are interested in learning how to please their partner. The correlation between relationship satisfaction and sexual adjustment is not surprising given the research in nondisabled, married adults. Two major sexual surveys found that married/cohabiting adults have qualitatively and quantitatively different sex, including more frequent and more satisfying sexual experiences, than single adults (Janus and Janus, 1993; Michael et al., 1994). Young et al. (1998) also showed that marital satisfaction, satisfaction with nonsexual aspects of the relationship, and frequency of spouse/partner orgasm are strongly correlated with overall sexual satisfaction. In addition, Schiavi et al. (1994) found that marital adjustment and level of sexual information were significantly related to sexual satisfaction. Also, marital satisfaction in long-term relationships has been correlated with sexual satisfaction, above and beyond other factors (Lawrence and Byers, 1995). Yet there is scant research on partner variables and sexuality in men with SCI. Some authors have noted anecdotally that the ability to please and satisfy a partner, in addition to “feelings of closeness,” contribute to the sexual satisfaction of men with SCI (Cole, 1975; Comarr and Vigue, 1978; Ray and West, 1984). White et al. (1994) also found that men with SCI rated “not satisfying a partner” as the most important of 17 possible concerns about sexual activity following their injury. Also, in a study of partners of persons with SCI, not only did the
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majority report satisfying relationships, but also their sexual fulfillment was more influenced by emotional closeness, mutual concern, and a varied sexual repertoire than by physiological factors, such as erectile or orgasmic function (Kreuter et al., 1994). In addition, the sexual adjustment of persons with SCI who have stable partners is correlated with relationship factors such as emotional quality and perceived partner satisfaction (Kreuter et al., 1996). Not surprisingly, a sample of single and partnered recently injured men with SCI report greater sexual satisfaction with increased partner availability and partner sexual desire (Alexander et al., 1993). Similarly, sexual desire influenced sexual satisfaction and behavior for married partnered men with SCI. In addition, 20% of the present sample reported none to low sexual desire, which is consistent with studies of able-bodied men, where sexual desire problems affect approximately 15% of the population (Rosen and Leiblum, 1995). Also, almost half of able-bodied men with diagnosed hypoactive sexual desire have a comorbid sexual dysfunction (Seagraves and Seagraves, 1991). Thus, low sexual desire or desire discrepancies between partners deserve consideration when married or partnered men with SCI report sexual problems to medical providers. Despite considerable variation in levels of genital sensation, orgasmic capacity, and erectile function among men with SCI, none of these variables predicted sexual behavior, enjoyment, or satisfaction. The absence of any association does not imply that these issues are unimportant or unrelated to sexual satisfaction. Post hoc correlations revealed a significant association between genital sensation and orgasmic capacity. And, previous research on men with SCI found a significant correlation between erectile function and sexual satisfaction (Alexander et al., 1993). Also, treating erectile dysfunction with sildenafil (Viagra) in men with SCI improves sexual satisfaction (Derry et al., 1998). However, these observations were based on a mixed population of partnered and single men. The present study found that for men with SCI who are in long-term relationships, sexual satisfaction might not be so dependent on physiological factors. Alternately, sexual satisfaction in new or dating relationships may be more strongly influenced by erectile functioning, orgasmic capacity, and genital sensation, than by relationship satisfaction, partner satisfaction, and sexual desire. However, because we used a cross-sectional design, it is impossible to known for certain the direction of the relationship between the variables. This study’s population differed from other studies on sexuality in men with SCI. Demographically, the population responding to the questionnaire is a middle aged, educated, and mainly Caucasian sample. Recent sexuality surveys of men with SCI tend to have a younger, less educated, and somewhat more ethnically diverse sample (Alexander et al., 1993; Kreuter et al., 1996; Urey and Henggeler, 1987). Since aging is associated with changes in sexual behaviors and function, and is correlated with the development of certain sexual problems, this factor should
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be considered when comparing the results to other studies. Also, the average length of time since injury in the present sample was 25 years. Since most studies on sexuality in SCI used relatively recently injured samples, the results of the present study suggest that length of time since injury may be an important factor in sexual adjustment. Generalizations from these results are limited by sample characteristics, i.e. male veterans served by one rehabilitation and primary care center. In addition, because of a relatively low response rate (24%), the sample may not be representative. However, this sample encompassed a wide range of ages and length of time since injury, and did not significantly differ demographically from the population from which it was drawn. Possible directions for future research include investigating longitudinally how the relationship and/or partner affects sexual satisfaction; assessing the impact of sex education, sex therapy, and/or marriage/relationship counseling on sexual satisfaction; looking at the differential impact of SCI on sexuality in men and women; examining the effects of length of time postinjury on relationships and sexuality; and exploring the nature of sexuality in older men with SCI. Our results also have implications for those who evaluate and treat men with SCI for sexual problems. In the clinical experience of the authors, men with SCI and their medical providers often focus on erectile dysfunction without adequately assessing and treating relationship issues that may impact sexuality. The results of the present study strongly suggest that assessment of sexual desire, perceived partner satisfaction, ability to please a partner, and knowledge of nonintercourse forms of sexual expression should be a routine part of clinical practice when assessing and treating sexual difficulties. Providing education on methods to produce sexual satisfaction in a partner will likely be well received by most partnered men with SCI and may improve their sexual satisfaction. Men with SCI who report sexual problems may also benefit from an evaluation of marital/relationship dysfunction. Those men who report marital/relationship dissatisfaction should be referred for relationship counseling, not only to evaluate and treat relationship problems, but to improve their sexual satisfaction as well. In married or partnered men with SCI, sexual satisfaction, behavior, and enjoyment is not only related to physiological parameters, but is strongly associated with the quality of the relationship and the partner’s sexual satisfaction. These associations deserve our continued attention in research as well as in clinical practice. APPENDIX A Locke–Wallace Marital Adjustment Test (MAT): Question 1 The dots on the following line represent different degrees of happiness in your relationship. The middle point, “happy,” represents the degree of happiness of most relationships. Please circle the dot which best describes the degree of
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happiness, all things considered, of your relationship. •
•
Extremely Fairly Unhappy Unhappy
•
•
•
•
•
A little Unhappy
Happy
Very Happy
Extremely Happy
Perfect
APPENDIX B The Sexual Behavior, Enjoyment and Satisfaction (SBES) Scale Area Sexual behavior Sexual enjoyment Sexual satisfaction
Question
Scale
How often do you and your partner engage in From every other day sexual activity, with or without intercourse? or more to never Do you generally enjoy the sexual part of your From very much to not relationship? at all How satisfied are you with the quality of your From very satisfied to sexual relationship? very dissatisfied
Score 1–6 1–4 1–5
ACKNOWLEDGEMENT This research was supported in part by a grant from the Cal-Diego Chapter of the Paralyzed Veterans of America (Cal-Diego PVA). REFERENCES Alexander, C. J., Sipski, M. L., and Findley, T. W. (1993). Sexual activities, desire, and satisfaction in males pre- and post-spinal cord injury. Arch. Sex. Behav. 22: 217–228. Cole, T. M. (1975). Sexuality and physical disabilities. Arch. Sex. Behav. 4: 389–403. Comarr, A. E., and Vigue, M. (1978). Sexual counseling among male and female patients with spinal cord and/or cauda equina injury: Part I. Am. J. Phys. Med. Rehabil. 57: 107–122. Cronbach, L. J. (1956). Coefficient alpha and the internal structure of tests. Psychometrica 16: 297–334. Cross, D. G., and Sharpley, C. F. (1981). The Locke-Wallace Marital Adjustment Test reconsidered: Some psychometric findings as regards its reliability and factorial validity. Educ. Psychol. Measure. 41: 1303–1306. Derry, F. A., Dinsmore, W. W., Fraser, M., Gardner, B. P., Glass, C. A., Maytom, M. C., and Smith, M. D. (1998). Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury. Neurology 51: 1629–1633. Dunn, K. (1997). Sexuality education and the team education approach. In Spiski, M. L., and Alexander, C. J., (eds.), Sexual Function in People With Disability and Chronic Illness, Aspen, Gaithersburg, MD. Janus, S. S., and Janus, C. L. (1993). The Janus Report on Sexual Behavior, Wiley, New York. Kreuter, M., Sullivan, M., and Siosteen, A. (1994). Sexual adjustment after spinal cord injury focusing on partner experiences. Paraplegia 32: 225–235. Kreuter, M., Sullivan, M., and Siosteen, A. (1996). Sexual adjustment and quality of relationships in spinal cord paraplegia: A controlled study. Arch. Phys. Med. Rehabil. 77: 541–548.
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Lasfargues, J. E., Custis, D., Morrone, F., Carswell, J., and Nguyen, T. (1995). A model for estimating spinal cord injury prevalence in the United States. Paraplegia 33: 62–68. Lawrance, K., and Byers, S. E. (1995). Sexual satisfaction in long-term heterosexual relationships: The interpersonal exchange model of sexual satisfaction. Pers. Relation. 2: 267–285. Locke, H., and Wallace, K. (1959). Short marital adjustment and prediction tests: Their reliability and validity. Marr. Fam. Living 21: 251–255. Michael, R. T., Gagnon, J. H., Lauman, E. O., and Kolata, G. (1994). Sex in America: A Definitive Survey, Little, Brown and Company, New York. Ray, C., and West, J. (1984). Social, sexual, and personal implications of paraplegia. Paraplegia 22: 75–86. Rosen, R. C., and Leiblum, S. R. (1995). Hypoactive sexual desire. Psychiatr. Clin. North Am. 18: 10–121. Schiavi, R. C., Mandeli, J., and Schreiner-Engel, P. (1994). Sexual satisfaction in healthy, aging men. J. Sex Marital Ther. 20: 3–13. Seagraves, K. B., and Seagraves, R. T. (1991). Hypoactive sexual desire disorder: Prevalence and comorbidity in 906 subjects. J. Sex Marital Ther. 17: 55–58. Urey, J. R., and Henggeler, S. W. (1997). Marital adjustment following spinal cord injury. Arch. Phys. Med. Rehabil. 68: 69–74. Young, J. S., Burns, P. E., Bowen, A. M., and McCutchen. (1982). Spinal Cord Injury Statistics: Experience of the Regional Spinal Cord Injury Systems (WE 725 Spina 82), Good Samaritan Medical Center, Phoenix, AZ. Young, M., Denny, G., Luquis, R., and Young, T. (1998). Correlates of sexual satisfaction in marriage. Can. J. Human Sexuality 7: 115–127. White, M. J., Rintala, D., Hart, K., Young, M. E., and Fuhrer, H. J. (1992). Sexual activities, concerns and interests of men with spinal cord injury. Am. J. Phys. Med. Rehabil. 71: 225–231. Wilmuth, M. E. (1987). Sexuality after spinal cord injury: A critical review. Clin. Psychol. Rev. 7: 389–412.
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Gender-Related Traits in Transsexuals and Nontranssexuals Richard A. Lippa, PhD1
Thirty-eight male-to-female (M-to-F) transsexuals, 7 female-to-male (F-to-M) transsexuals, 135 nontranssexual men, and 225 nontranssexual women were assessed on the following: gender diagnosticity (GD) measures, which assessed male- vs. female-typical occupational and hobby preferences; instrumentality; expressiveness; self-ascribed masculinity; and self-ascribed femininity. M-to-F transsexuals differed strongly and significantly from nontranssexual men on GD and self-ascribed femininity (effect sizes from 1.84 to 3.40) and more weakly on instrumentality, expressiveness, and self-ascribed masculinity (effect sizes from 0.40 to 0.56). F-to-M transsexuals differed strongly and significantly from nontranssexual women on GD and on self-ascribed masculinity and femininity (effect sizes from 2.45 to 3.97), but not on instrumentality or expressiveness (effect sizes of 0.07 and 0.39). The degree to which the six assessed gender-related traits distinguished transsexual from nontranssexuals was strongly correlated with the degree to which these same traits distinguished nontranssexual men from nontranssexual women. Using comparison data from past research, M-to-F transsexuals were quite similar to gay men on all gender-related traits except selfascribed femininity, but F-to-M transsexuals were considerably more masculine than lesbian women on all gender-related traits except for instrumentality and expressiveness. KEY WORDS: transsexuals; gender-related traits; masculinity; femininity; gender differences.
INTRODUCTION Many studies have contrasted the personalities of transsexual and nontranssexual individuals, often with the goal of diagnosing transsexualism and understanding its origins (Blanchard and Freund, 1983; Bodlund and Armelius, 1995; 1 Psychology
Department, California State University, Fullerton, California 92834. 603 C 2001 Plenum Publishing Corporation 0004-0002/01/1200-0603$19.50/0 °
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Freund et al., 1977; Johnson and Hunt, 1990; Leavitt and Berger, 1990; Lothstein, 1984; Midence and Hargreaves, 1997). The current research extends this work by focusing specifically on whether transsexual and nontranssexual individuals differ on gender-related interests, on instrumentality and expressiveness, and on selfascribed masculinity and femininity. Studying the relationship between genderrelated traits and individuals’ status as transsexual or nontranssexual not only has the potential to yield information about the nature of transsexualism, but it may also provide new information about the nature of gender-related traits. For just as men and women differ more strongly on some gender-related traits than others (Lippa, 2001), transsexuals may similarly differ from nontranssexuals more strongly on some gender-related traits than others.
The Measurement of Gender-Related Traits In seminal work, Terman and Miles (1936) developed a bipolar masculinity– femininity (M–F) scale, which included diverse items showing large gender differences in normative populations. A number of other M–F scales were developed in this tradition, including the M–F scale of the Strong Vocational Interest Blank (Strong, 1943), the Fe scale of the California Psychological Inventory (Gough, 1987), and the Mf scale of the MMPI (Hathaway, 1980). These scales typically included a variety of items that assessed gender-related interests, occupational preferences, personality traits, emotional styles, and sexual preferences (see Constantinople, 1973; Lippa, 2001). In the early 1970s a two-dimensional conception of masculinity and femininity supplanted the earlier bipolar approach to M–F. This newer approach held that masculinity and femininity are separate dimensions, with masculinity defined in terms of instrumental personality traits (e.g., dominance, independence) and femininity defined in terms of expressive traits (warmth, compassion). A number of self-report inventories were developed to assess instrumentality and expressiveness, including the Bem Sex-Role Inventory (BSRI; Bem, 1974, 1981) and the Personal Attributes Questionnaire (PAQ; Spence et al., 1974; Spence and Helmreich, 1978). Although instrumentality and expressiveness scales continue to be widely used in gender research, considerable evidence suggests that these scales do not measure masculinity and femininity per se, but rather dominance and nurturance (Lubinski et al., 1983; Paulhus, 1987; Spence and Buckner, 1995; Spence and Helmreich, 1980). Recent research shows further that instrumentality and expressiveness overlap substantially with the Big Five traits (Lippa, 1991, 1995b, 2001). The gender diagnosticity approach was developed to address some of the limitations of instrumentality and expressiveness scales (see Lippa, 1991, 1995a,b, in press; Lippa and Connelly, 1990). Gender diagnosticity (GD) refers to the Bayesian probability that an individual is predicted to be male or female based on
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gender-related interests. GD is formally computed through the application of discriminant analyses (see Lippa, 1991, 1995b; Lippa and Connelly, 1990; this process will be described more fully later in this paper). Discriminant analysis identifies the linear combination of predictor variables—the discriminant function— that optimally predicts group membership (in this case, being male or female). Bayes’ theorem is then applied to individuals’ discriminant function scores to compute the probability that an individual is male or female. A number of studies have demonstrated that GD can be measured reliably, both within and across the sexes, from self-report data such as occupational preference ratings. Furthermore, GD measures assessed from interests prove to be distinct from instrumentality and expressiveness (Lippa, 1991, 1995b; Lippa and Connelly, 1990). Interest-based GD measures also prove to be independent of the Big Five personality traits (Lippa, 1991, 1995b), and they often predict varied gender-related behaviors and attitudes better than instrumentality and expressiveness do (Lippa, 2001). Lippa and Arad (1997) found that GD was more strongly associated with men’s sexual orientation than were instrumentality or expressiveness. In three additional studies Lippa (2000) found that men’s and women’s sexual orientations were much more strongly related to GD measures than to measures of instrumentality and expressiveness. Differences between homosexual and heterosexual individuals on GD measures showed effect sizes ranging from 0.96 to 2.70, with gay men more female-typical than heterosexual men and lesbian women more male-typical than heterosexual women in their occupational and hobby preferences. GD, instrumentality, and expressiveness can be conceptualized in terms of broader structural models of individual differences (Lippa, 2001). For example, instrumentality and expressiveness are, in essence, gender-linked Big Five traits. GD assesses M–F in terms of gender-linked vocational preferences and interests, and it can be conceptualized as a trait that overlaps substantially with the People– Things dimension of vocational interests (see, Holland, 1992, 1996; Lippa, 1998c; Prediger, 1982). On average, women and female-typical individuals are more interested in occupations that are people-oriented (e.g., teacher, counselor, manager), whereas men and male-typical individuals are more interested in occupations that are thing-oriented (e.g., engineer, mechanic, farmer). Masculinity and femininity can be directly assessed in terms of individuals’ conscious self-concepts. For example, Storms (1979) developed a six-item scale that asked respondents to rate their degree of agreement with the following questions: “How masculine (feminine) is your personality?” “How masculine (feminine) do you act, appear, and come across to others?” “In general, how masculine (feminine) do you think you are?” Previous research on gender-related traits in transsexuals and nontranssexuals has often inadvertently combined the various approaches to masculinity and femininity just described. For example, studies have used multifaceted “gender
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identity scales” (e.g., Blanchard and Freund, 1983; Freund et al., 1977; see Bailey, 1996, for a broad discussion of gender identity) and the Mf scale of the MMPI (see Lothstein, 1984). However, because these scales contain multidimensional content, research has not identified which kinds of content (e.g., Big Five items, occupational preferences and interests, self-ascribed masculinity and femininity) best distinguish transsexuals from nontranssexuals. By employing relatively pure measures of gender-related traits, the current research sought to clarify which gender-related traits best distinguish transsexual from nontranssexual individuals. METHOD Participants Transsexual participants were volunteers recruited from two support groups for transsexuals in Orange County and Los Angeles, California.2 Participants received questionnaires, which they completed privately and mailed back anonymously in stamped addressed envelopes attached to questionnaires. Thirty-eight M-to-F transsexuals participated, ranging in age from 22 to 57 (median age = 37). Seven F-to-M transsexuals participated, ranging in age from 24 to 42 (median age = 34). Heterosexual, nontranssexual participants were volunteers recruited from several human sexuality classes at California State University, Fullerton. One hundred and thirty-six men participated, ranging in age from 22 to 57 (median age = 23), and 225 women participated, ranging in age from 18 to 49 (median age = 22). Although transsexual participants were older than nontranssexual participants on average, none of the results that follow were much changed when older (>30 years old) transsexuals were excluded from analyses or when older heterosexuals (groups with mean ages similar to those of transsexual groups) were used as comparisons. Accordingly, the results that follow make use of the full samples of transsexual and nontranssexual participants. Measures Questionnaires completed by transsexual and nontranssexual participants included a cover sheet that asked for demographic information as well as a series of personality and attitude scales. The scales most relevant to the current study were several scales assessing gender-related traits. These included the PAQ instrumentality and expressiveness scales (as presented in Spence and Helmreich, 1978) and questionnaires that asked participants to rate their degree of preference for 74 occupations and for 60 hobbies. Occupational and hobby preference ratings 2I
express great appreciation to members of “LOTS” (Loved Ones of Transsexuals) and “Under Construction” for welcoming me to their meetings and for participating in the current research.
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were made on a 5-point scale ranging from 1 – strongly dislike to 5 – strongly like and were used to compute GD measures. The questionnaire packet also included Storms’ (1979) 6-item scale of self-ascribed masculinity (3 items) and self-ascribed femininity (3 items). Participants were also asked to rate their degree of sexual attraction to men and to women on a 7-point scale. Participants reported which of the following labels they used to describe themselves: Heterosexual (“straight”), Gay, Lesbian, Bisexual, or Transsexual or Transgender. They did so by checking “True” or “False” to the question, “I currently use this label to describe myself.” Participants also reported their gender (“male” or “female”). All individuals categorized as nontranssexuals in subsequent analyses were heterosexual in self-reported sexual orientation and did not label themselves as transsexual or trangendered. All M-to-F and F-to-M transsexuals were individuals who labeled themselves as such. RESULTS Computation and Reliability of Gender-Related Trait Measures Gender diagnostic probabilities were computed by applying seven discriminant analyses to seven nonoverlapping subsets of participants’ 74 occupational preference ratings and similarly, by applying six discriminant analyses to six nonoverlapping subsets of participants’ 60 hobby preference ratings (see Lippa, 1995b; Lippa and Connelly, 1990, for a more complete discussion of computation methods). Biological sex of participant was the grouping variable in these analyses. Thus, heterosexual nontranssexual men and M-to-F transsexuals were treated as biological males, and heterosexual nontranssexual women and F-to-M transsexuals were treated as biological females. Each discriminant analysis yielded the probability that a given participant was classified as “biological male” or “biological female,” based on his or her preference ratings. An individual’s overall GD score based on occupational preferences was simply the mean of the seven probabilities computed by discriminant analyses conducted on occupational preference item packets. Similarly, an individual’s overall GD score based on hobby preferences was the mean of the six probabilities computed by the discriminant analyses conducted on hobby preference item packets. In essence, GD measures give the probability that an individual is predicted to be male or female based on his or her pattern of occupational (or hobby) preference ratings. The multiple discriminant analyses conducted on item packets permitted assessment of the reliability of gender diagnostic probabilities. These reliabilities were acceptably high. For GD based on occupation preferences, reliabilities (alpha coefficient) were 0.90 for all participants, 0.84 for biological males, and 0.81 for biological females. For GD based on hobby preferences, reliabilities were 0.88 for all participants, 0.78 for biological males, and 0.72 for biological females.
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Table I. Means of M-to-F Transsexuals, F-to-M Transsexuals, Nontranssexual Men, and Nontranssexual Women on Six Gender-Related Traits Assessed groups
Gender-related traits GD – occupations GD – hobbies Self-ascribed masculinity Self-ascribed femininity PAQ instrumentality PAQ expressiveness
M-to-F transsexuals (N = 37–38)
F-to-M transsexuals (N = 7 )
Nontranssexual men (N = 133–136 )
Nontranssexual women (N = 221–225 )
0.45 (0.14) 0.46 (0.14) 3.05 (0.93)
0.68 (0.14) 0.69 (0.15) 4.43 (0.60)
0.68 (0.12) 0.71 (0.13) 3.48 (1.11)
0.35 (0.13) 0.32 (0.14) 1.78 (0.67)
3.96 (0.57)
2.00 (0.77)
1.66 (0.71)
4.13 (0.72)
3.54 (0.60) 4.08 (0.41)
3.64 (0.81) 4.00 (0.40)
3.82 (0.49) 3.80 (0.55)
3.60 (0.55) 4.17 (0.46)
Note. Numbers in parentheses are standard deviations.
PAQ instrumentality and expressiveness scales were scored in standard ways (however, items were averaged rather than summed), and their reliabilities were respectively 0.73 and 0.77. The three items assessing self-ascribed masculinity from Storms’s scale were averaged (Storm, 1979), as were the three items assessing self-ascribed femininity. The reliability of self-ascribed masculinity was 0.88 for all participants, 0.77 for males, and 0.83 for females. The reliability of self-ascribed femininity was 0.96 for all participants, 0.94 for males, and 0.87 for females.3 Contrasting Gender-Related Traits in Transsexuals and Nontranssexuals Table I presents mean scores on the six assessed gender-related traits for four groups: M-to-F transsexuals, F-to-M transsexuals, heterosexual nontranssex3 Both
transsexuals and nontranssexuals were included in the discriminant analyses used to compute GD scores as this permitted computation of GD scores for transsexuals as well as for nontranssexuals. Because the number of nontranssexual individuals (n = 360) was so much larger than the number of transsexual individuals (n = 45), gender differences in item responses were overwhelmingly determined by nontranssexual participants. In previous studies (e.g., Lippa, 2000; Lippa and Tan, 2001), when very large samples of gay and lesbian individuals were compared with roughly equivalently sized samples of heterosexual men and women, the heterosexual samples were multiplied in size before computing GD measures. Otherwise, as the number of gay and lesbian participants increased, “gender diagnosticity” scores would increasingly become “gay male–lesbian woman” diagnosticity scores. In the current study, multiplying the nontranssexual sample was unnecessary, because it was large to start with. If anything, the inclusion of small numbers of transsexual participants in the current discriminant analyses would tend to dilute (albeit very slightly) gender differences in item responses and GD scores, and it would also serve to reduce transsexual versus nontranssexual differences on GD. The strong differences observed between transsexuals’ and nontranssexuals’ GD scores are thus all the more impressive. GD scores of nontranssexual men and women in the current study were quite similar to mean GD scores for samples of men and women assessed in previous GD studies. This suggests that including small numbers of transsexuals did not have much effect on the computed GD scores of nontranssexuals.
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Table II. Effect Sizes for Three Group Contrasts on Gender-Related Traits Contrasted groups M-to-F F-to-M Nontranssexual transsexuals vs. transsexuals vs. men vs. nontranssexual men nontranssexual women nontranssexual women Gender-related traits GD – occupations GD – hobbies Self-ascribed masculinity Self-ascribed famininity PAQ instrumentality PAQ expressiveness
−1.84∗∗∗ −1.93∗∗∗ −0.40∗
2.45∗∗∗ 2.71∗∗∗ 3.97∗∗∗
2.53∗∗∗ 2.91∗∗∗ 2.04∗∗∗
3.40∗∗∗ −0.56∗∗ 0.53∗∗
−2.97∗∗∗ 0.07 −0.39
−3.46∗∗∗ 0.42∗∗∗ −0.75∗∗∗
Note. Positive effect sizes indicate that the first-listed group is higher on trait than the second-listed group; negative effect sizes indicate that second-listed group is higher on trait than first-listed group. ∗ p < 0.05, two-tailed; ∗∗ p < 0.01, two-tailed; ∗∗∗ p < 0.001, two-tailed.
ual men, and heterosexual nontranssexual women. Table II presents effect sizes for three group contrasts: (1) differences between M-to-F transsexuals and nontranssexual men, (2) differences between F-to-M transsexuals and nontranssexual women, and (3) differences between nontranssexual men and nontranssexual women. Table II also indicates differences that were statistically significant, based on t-tests between contrasted groups. As Tables I and II show, differences between M-to-F transsexuals and nontranssexual men were significant for all gender-related traits. Effect sizes were very large for GD based on occupational preferences, GD based on hobby preferences, and self-ascribed femininity, but were moderate for instrumentality, expressiveness, and self-ascribed masculinity. Despite the small sample of F-to-M transsexuals (N = 7), four gender-related traits showed significant differences between F-to-M transsexuals and nontranssexual women: GD based on occupational preferences, GD based on hobby preferences, self-ascribed masculinity, and selfascribed femininity. In contrast, instrumentality and expressiveness did not show significant differences. Differences between F-to-M transsexuals and nontranssexual women were very large for GD based on occupational preferences, GD based on hobby preferences, self-ascribed masculinity, and self-ascribed femininity, but were much smaller for instrumentality and expressiveness. Nontranssexual men and nontranssexual women differed significantly on all six gender-related traits. However, effect sizes again varied substantially across traits. Male–female differences were very large for GD measures and for selfascribed masculinity and femininity, but were more modest for instrumentality and expressiveness. To determine how well transsexual versus nontranssexual differences mirrored male versus female differences on gender-related traits, the first two effect-size column vectors in Table II were correlated with the last column. The two resulting correlations were −0.96 and 0.95 (two-tailed p’s < 0.01), indicating
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Table III. Means of M-to-F Transsexuals, Gay Men, F-to-M Transsexual Men, and Lesbian Women on Six Gender-Related Traits Assessed groups M-to-F transsexuals F-to-M transsexuals Gay men Lesbian women (N = 37–38) (N = 7) (N = 183–189) (N = 127–132) Gender-related traits GD – occupations GD – hobbies Self-ascribed masculinity Self-ascribed femininity PAQ instrumentality PAQ expressiveness
0.45 (0.14) 0.46 (0.14) 3.05 (0.93)
0.68 (0.14) 0.69 (0.15) 4.43 (0.60)
0.45 (0.17) 0.45 (0.16) 3.33 (0.75)
0.58 (0.21) 0.55 (0.14) 2.78 (0.91)
3.96 (0.57)
2.00 (0.77)
2.26 (0.78)
2.93 (0.96)
3.54 (0.60) 4.08 (0.41)
3.64 (0.81) 4.00 (0.40)
3.55 (0.60) 4.02 (0.51)
3.75 (0.63) 3.86 (0.74)
Note. Numbers in parentheses are standard deviations.
that gender-related traits that strongly distinguished transsexuals from nontranssexuals (e.g., GD measures, self-ascribed femininity) also strongly distinguished nontranssexual men from nontranssexual women, whereas traits that more modestly distinguished transsexuals from nontranssexuals (e.g., instrumentality and expressiveness) also modestly distinguished nontranssexual men from nontranssexual women. As noted before, Lippa (2000) assessed gender-related traits in large samples of gay men and lesbian women. In Table III, the pooled data for gay men (N = 189) and for lesbian women (N = 132) are contrasted with the current results for M-to-F and F-to-M transsexuals. Table IV presents effect sizes and significance tests for two group contrasts: (1) M-to-F transsexuals vs. gay men and (2) F-to-M transsexuals vs. lesbian women. In general, these contrasts show that M-to-F transsexuals Table IV. Effect Sizes for Two Group Contrasts on Gender-Related Traits: M-to-F Transsexuals vs. Gay Men and F-to-M Transsexuals vs. Lesbian Women Contrasted groups M-to-F transsexuals vs. gay men Gender-related traits GD – occupations GD – hobbies Self-ascribed masculinity Self-ascribed femininity PAQ instrumentality PAQ expressiveness
0.03 0.10 −0.39∗∗ 2.28∗∗∗ −0.01 0.12
F-to-M transsexuals vs. lesbian women 0.43∗ 1.00∗∗∗ 1.84∗∗∗ −0.98∗∗∗ −0.17 0.19
Note. Positive effect sizes indicate that the first-listed group is higher on trait than the second-listed group; negative effect sizes indicate that second-listed group is higher on trait than first-listed group. ∗ p < 0.05, two-tailed; ∗∗ p < 0.01, two-tailed; ∗∗∗ p < 0.001, two-tailed.
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scored similarly to gay men on all measures except for self-ascribed femininity, which was considerably higher for transsexuals. In contrast, F-to-M transsexuals were significantly more masculine than lesbian women on all measures except for instrumentality and expressiveness. DISCUSSION The current findings add to existing evidence that GD measures and scales of self-ascribed masculinity and femininity more validly assess masculinity and femininity than do instrumentality and expressiveness scales. Certainly, if any groups (other than men and women) might be expected, a priori, to differ strongly on measures of masculinity and femininity, it would be transsexuals and nontranssexuals. In the current study, instrumentality and expressiveness scales did not strongly distinguish transsexuals from nontranssexuals nor did they most strongly distinguish men from women. In contrast, GD measures and self-ascribed masculinity and femininity scales strongly distinguished transsexuals from nontranssexuals, and they also strongly distinguished men from women. Stated in terms of the broader structural models described at the start of this paper, Big Five measures of masculinity and femininity (instrumentality and expressiveness scales) did not strongly differentiate transsexuals from nontranssexuals. However, GD measures (which are linked to the vocational/interest circumplex) and measures of selfascribed masculinity and femininity did strongly differentiate transsexuals from nontranssexuals. Although the current study documented large mean GD differences between transsexual and nontranssexual individuals, transsexuals were by no means homogeneous on GD measures. In fact, the GD scores of M-to-F transsexuals varied widely, showing a range of 0.18–0.80 for GD based on occupational preferences and a range of 0.17–0.76 for GD based on hobby preferences. The mean GD scores of M-to-F transsexuals were 0.45 for GD based on occupational preferences and 0.46 for GD measures based on hobby preferences. Thus these individuals were, on average, slightly more female-typical than male-typical in their occupational and hobby preferences. However, the mean GD scores of M-to-F transsexuals were not as low as those of nontranssexual women (whose mean GD score were respectively 0.35 and 0.32). Thus the mean GD scores of M-to-F transsexuals were intermediate between the corresponding mean scores for nontranssexual men and women, but closer to women’s than to men’s mean scores. In comparison, the mean GD scores of F-to-M transsexuals were 0.68 for GD based on occupational preferences and 0.69 for measures based on hobby preferences. Thus F-to-M transsexuals displayed extremely male-typical patterns of occupational and hobby preferences. Indeed, F-to-M transsexuals’ GD means were very close to the GD means of nontranssexual men (which were respectively 0.68 and 0.71) and very dissimilar from the GD means of nontranssexual women.
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Despite the small sample of F-to-M, their GD scores also showed substantial variation, ranging from 0.51 to 0.86 for GD based on occupational preferences and from 0.41 to 0.90 for GD based on hobby preferences. M-to-F transsexuals proved to be relatively similar to gay men, except for their higher level of self-ascribed femininity. Storms’ scale of self-ascribed femininity includes the item, “How feminine do you act, appear, and come across to others?” Because M-to-F transsexuals more often attempt to appear physically female than do gay men, this one item may help explain why M-to-F transsexuals scored substantially higher than gay men on self-ascribed femininity. Despite the difference between M-to-F transsexuals and gay men on self-ascribed femininity, the current findings indicate that on other gender-related traits, there was substantial similarity between M-to-F transsexuals and gay men. This finding provides at least circumstantial evidence that some varieties of M-to-F transsexualism may share psychological similarities with male homosexuality. In contrast, F-to-M transsexuals were more masculine than lesbian women on GD measures and on self-ascribed masculinity and femininity. Given the small sample of F-to-M transsexuals in the current study, these findings must be regarded as tentative. However, if replicated, the current findings suggest that F-to-M transsexualism and lesbianism may have less in common—in terms of psychological profile—than do M-to-F transsexualism and male homosexuality. One possible explanation for the differing results for men and women may be that the social construction of lesbianism is more complex and multifaceted than that of male homosexuality (see Baumeister, 2000; Bohan, 1996; Brown, 1995; Golden, 1996). The current findings are potentially relevant to counseling and screening of transsexual individuals, for they suggest that GD measures and scales of selfascribed masculinity and femininity are much more valid as indicators of transsexual and nontranssexual status than are instrumentality and expressiveness scales. Just as some gender-related traits are better than others at distinguishing transsexuals from nontranssexuals, it may similarly be true that some gender-related traits are better than others at distinguishing among subtypes of transsexuals. Blanchard (1985, 1988, 1989a,b, 1990) has described two subtypes of M-to-F transsexuals: (1) the “homosexual” M-to-F transsexual, who is characterized by early effeminate behavior, early transsexual identity, and erotic attraction to men, and (2) the autogynephilic M-to-F transsexual, who is characterized by more masculine childhood behavior, later realization of transsexual identity, and more variable sexual orientation, which often includes sexual arousal to the fantasy of one’s self as female. Because of the relatively small numbers of transsexuals assessed in the current research, it was not possible to compare with adequate statistical power whether various gender-related traits distinguish these proposed subtypes.4 However, given the strength of the current results, this would be an intriguing topic for further research. 4 Correlations
were computed between self-reported degree of sexual attraction to men and to women and gender-related traits in M-to-F transsexuals. None of these correlations was significant.
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Lippa, R. (1998a). The nonverbal judgment and display of extraversion, masculinity, femininity, and gender diagnosticity: A lens model analysis. J. Res. Pers. 32: 80–107. Lippa, R. (1998b). Gender-related individual differences and National Merit Test performance: Girls who are “masculine” and boys who are “feminine” tend to do better. In Ellis, L., and Ebertz, L. (eds.), Males, Females, and Behavior: Toward Biological Understanding, Praeger, Westport, CN. Lippa, R. A. (1998c). Gender-related individual differences and the structure of vocational interests: The importance of the “People–Things” dimension. J. Pers. Soc. Psychol. 74: 996–1009. Lippa, R. A. (2000). Gender-related traits in gay men, lesbian women, and heterosexual men and women: The virtual identity of homosexual–heterosexual diagnosticity and gender diagnosticity. J. Pers. Lippa, R. A. (2001). On deconstructing and reconstructing masculinity–femininity. J. Res. Pers. 35: 168–207. Lippa, R., and Arad, S. (1997). The structure of sexual orientation and its relation to masculinity, femininity, and gender diagnosticity: Different for men and women. Sex Roles 37: 187–208. Lippa, R., and Connelly, S. C. (1990). Gender diagnosticity: A new Bayesian approach to gender-related individual differences. J. Pers. Soc. Psychol. 59: 1051–1065. Lippa, R. A., and Tan, F. D. (2001). Does culture moderate the relationship between sexual orientation and gender-related personality traits? Cross-Cul. Res. 35: 65–87. Lothstein, L. M. (1984). Psychological testing with transsexuals: A 30-year review. J. Pers. Assess. 48: 500–507. Lubinski, D., Tellegen, A., and Butcher, J. N. (1983). Masculinity, femininity, and androgyny viewed and assessed as distinct concepts. J. Pers. Soc. Psychol. 44: 428– 439. Midence, K., and Hargreaves, I. (1997). Psychosocial adjustment in male-to-female transsexuals: An overview of the research evidence. J. Psychol. 131: 602–614. Paulhus, D. L. (1987). Effects of group selection on correlations and factor patterns in sex role research. J. Pers. Soc. Psychol. 53: 314–317. Prediger, D. J. (1982). Dimensions underlying Holland’s hexagon: Missing link between interests and occupations? J. Vocation. Behav. 21: 259–287. Spence, J. T., and Buckner, C. (1995). Masculinity and femininity: Defining the undefinable. In Kalbfleisch, P. J., and Cody, M. J. (eds.), Gender, Power, and Communication in Human Relationships, Erlbaum, Hillsdale, NJ, pp. 105–138. Spence, J. T., and Helmreich, R. L. (1978). Masculinity and Femininity: Their Psychological Dimensions, Correlates, and Antecedents, University of Texas Press, Austin, TX. Spence, J. T., and Helmreich, R. L. (1980). Masculine instrumentality and feminine expressiveness: Their relationships with sex role attitudes and behaviors. Psychol. Women Q. 5: 147–163. Spence, J. T., Helmreich, R. L., and Stapp, J. (1974). The Personal Attributes Questionnaire: A measure of sex role stereotypes and masculinity–femininity. JSAS (Catalog of Selected Documents in Psychology), 4: 43– 44 (MS. No. 617). Storms, M. D. (1979). Sex role identity and its relationship to sex role attributions and sex role stereotypes. J. Pers. Soc. Psychol. 37: 1779–1789. Strong, E. K., Jr. (1943). Vocational Interests of Men and Women, Consulting Psychologists Press, Stanford, CA. Terman, L. M., and Miles, C. C. (1936). Sex and Personality: Studies in Masculinity and Femininity, Russell and Russell, New York.
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c 2001) Archives of Sexual Behavior, Vol. 30, No. 6, December 2001 (°
Implicit and Explicit Memory of Neutral, Negative Emotional, and Sexual Information Stephanie I. Bush, PhD,1,3 and James H. Geer, PhD2
Implicit and explicit memory for sexual, negative emotional, and neutral words using Jacoby’s process dissociation framework was investigated. This framework provides estimates of conscious (explicit) and automatic (implicit) influences on memory. We found that explicit memory was greater for the sexual words when compared to negative emotional and neutral words and suggest that these results are due to increased saliency of sexual stimuli. Dividing attention did not decrease explicit memory for sexual words, although it did significantly decrease explicit memory for the negative emotional and neutral words. Finally, females used more previously presented emotional words to complete word stems. The genders did not differ in their recall of previously presented sexual and neutral words. A discussion of possible explanations for the various findings is presented. KEY WORDS: memory; sexual words; implicit; explicit.
INTRODUCTION Sexuality has been a focus of cognitive research for many years (Geer and Fuhr, 1976; Kirsch-Rosenkrantz and Geer, 1991; Przybyla and Byrne, 1984). However, studying memory for sexual stimuli has been a research interest only within the last several years. Lewis et al. (1986) found that regardless of gender and level of sex guilt, participants recalled more of the sexual information than nonsexual information. Kirsch-Rosenkrantz and Geer (1991) reported that both men and women exhibited more sexual intrusions than romantic intrusions when recalling a 1 Department
of Psychology, St. Bonaventure University, St. Bonaventure, New York. State University, Baton Rouge, Louisiana. 3 To whom correspondence should be addressed at Department of Psychology, St. Bonaventure University, St. Bonaventure, New York 14778; e-mail:
[email protected]. 2 Louisiana
615 C 2001 Plenum Publishing Corporation 0004-0002/01/1200-0615$19.50/0 °
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story and that both genders endorsed more sexual distractors than romantic distractors when recalling a sexual story. In addition, Nielsen and Sarason (1981) found that participants engaged in a dichotic listening task exhibited more shadowing errors when sexually explicit words were heard in their unattended channel than when other word types were heard. It appears that sexual information tends to be more salient and more easily recalled than neutral material. The definition of saliency used in this study is “prominent, conspicuous, striking, and noticeable” (Mish, 1989). The idea of saliency within the framework of cognitive research has generally been defined as a stimulus that is more easily detected when embedded in a series of less noticeable stimuli. Therefore, the issue of saliency in this type of research is primarily one of perceptual saliency. The current study examined the issue of saliency with regard to semantic, rather than perceptual, meaning. In other words, this research was concerned with whether the semantic saliency of a stimulus would cause the stimulus to be more noticeable and therefore more likely to be processed and remembered, when compared to other stimuli. Memory has been broken down into two categories, explicit and implicit. Explicit memory is the ability to consciously recall some experience or thought. Implicit memory is an experience that you may not be able to consciously recall yet can be shown to be present. Direct tests of memory, such as recognition and recall tasks, are often used to measure explicit memory. On the other hand, indirect tests of memory, such as word stem and fragment completion, are used to measure implicit memory (Schacter, 1987). In indirect tests, participants are not required to have conscious recollection of the past event. The dissociation of implicit and explicit memory has been described as resulting from two distinct anatomical memory systems (Squire, 1986; Tulving, 1985; Weiskrantz, 1989). This suggestion is derived from findings that an amnesic’s implicit memory can be nearly normal while his/her explicit memory is severely impaired (Graf et al., 1984; Warrington and Weiskrantz, 1974). Consistent with that finding, Squire (1986) reports data suggesting the existence of different neural structures underlying the two memory types. A second theory that has been proposed to explain implicit and explicit memory is the “transfer-appropriate procedures approach” (Morris et al., 1977; Roediger et al., 1989). This theory states that different processes involved in learning and task result in the findings that resulted in the concepts of implicit and explicit memory. Explicit tests are seen as conceptually driven tasks (Jacoby, 1983) that reflect meaning. Implicit tests are data-driven tasks and reflect perceptual processing. According to this view, performance on a test will increase if the test is similar in operation to the operation used in learning. Since different operations are used in implicit and explicit tests, different types of information are retrieved. While of importance to conceptual issues, our research will not be testing the adequacy of this theory.
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Another important concept in information processing and memory in the domain of sexuality is attentional allocation. Research (Abrahamson et al., 1985a,b; Beck et al., 1983; Geer and Fuhr, 1976) has found that attentional focus on erotic stimuli was important in responding that included genital changes. Using erotic films and audiotapes, these investigators found that distraction from erotic focus appeared to differentially influence penile response in dysfunctional and normal participants. Nielson and Sarason (1981) employed a dichotic listening task that is used to study attentional processes. They used four types of emotional targets and concluded that sexual information tended to be very salient. They reported higher rates of shadowing errors for participants who were presented with sexually explicit words in their unattended channel than those participants who were presented with other emotional words in their unattended channel. The current research extends investigations of the perception and retrieval of sexual stimuli using the process dissociation framework (Jacoby, 1991) to investigate automatic versus conscious memory. The process dissociation framework (Jacoby and Kelley, 1992) was designed to separate the effects of automatic and conscious influences on direct tests of memory. To effectively use the procedure, it must be strongly assumed that conscious and automatic influences are independent. Jacoby and Kelley (1992) found that the likelihood of a word being used to complete a word stem (indirect test) is increased by prior presentation of the word. This effect is consistent even though a direct test shows no memory for the prior presentation. Jacoby and Kelley (1992) argue that these automatic influences may increase the likelihood of correct guessing on cued recall tests that are usually, and from their perspective, incorrectly viewed as reflecting only conscious processes. The first step in Jacoby and Kelley’s procedure (Jacoby and Kelley, 1992) is to place the consciously controlled (recollection) and automatic processes in opposition to each other. They accomplish this by using an exclusion task condition. Participants are presented with words on a computer screen and are told to read them out loud and try to remember them. The participants are later given a list of word stems and are instructed to complete some of them with words that were presented earlier and some with words they were not presented with. These two tasks are labeled the inclusion and exclusion tests respectively. In the exclusion test, the automatic influences on memory are assumed to create a response bias in favor of the previously presented words, since the previously presented words are more likely to be used to complete word stems. However, conscious recollection (remembering the previously presented words) would serve to exclude previously presented words. In effect, recollection opposes automatic influences in the exclusion condition because recollection would serve to exclude the previously presented words while at the same time automatic influences would cause the subject to be more likely to use the previously presented words to complete the word stems.
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The second step of the process dissociation procedure (Jacoby et al., 1993) is to use a simple mathematical transformation to estimate the separate contributions of conscious recollection and automatic influences (see Appendix for these equations). These transformations result in estimates of recollection (conscious memory) and automatic influences (implicit/nonconscious memory). Baseline is also important in the mathematical transformations. Baseline is defined as “the probability of using a particular word as a completion for a stem when that word was not presented for study” (Jacoby et al., 1993). Baseline is used to assess the effects of all experience prior to presentation of words. In other words, baseline is what would happen if we simply gave individuals a list of word stems to complete without ever presenting any words to them in a formal setting such as an experiment. Jacoby et al. (1993) has identified variables that will produce dissociations between recollection and automatic processes. One of those variables is attention allocated to stimuli at study. Jacoby (1991) manipulated participants’ ability to attend to the experimental stimuli by dividing their attention. Participants in Jacoby’s divided-attention condition were visually presented with a word list and at the same time, they listened to a string of digits. They were instructed to identify the target sequence of digits—any three odd numbered digits in a row. The participants in this condition had only limited attentional resources available to study the word list, in comparison to a full-attention condition. The memory test for both conditions was a stem-completion task. Jacoby (1991) found that manipulating attention allocation at presentation dramatically influenced recollection estimates. Participants in the divided-attention condition had recollection estimates that were virtually zero, but automatic influences were unaffected. Results of Jacoby’s study (Jacoby, 1991) indicated that the probability of conscious recollection was reduced from 0.25 to 0.00 under the divided-attention condition. On the other hand, automatic influences remained constant (0.47–0.46). These results argue that the probability of recollection in the divided-attention condition was truly zero. The current study proposed that the saliency of sexual stimuli used in the present study would primarily affect explicit memory, in that participants would recall sexual words better than other word types (negative emotional and neutral). In theory, this occurs because sexual words tend to “grab” the attention of the participants. When this occurs, they are more likely to have a conscious memory of the word and would therefore affect explicit memory more than implicit memory. In order to manipulate conscious influences on the memory of sexual words, we employed the divided-attention task. We wanted to determine if the divided-attention task would affect the conscious influences on sexual stimuli as dramatically as it affected conscious influences on neutral stimuli in Jacoby’s research (Jacoby, 1991, 1993). Knowledge of this type might further our understanding of sexuality and the cognitive operations involved in the processing of sexual and other types of stimuli.
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Geer et al. (in press) used the process-dissociation framework to study negative, but nonsexual, emotional words versus neutral words. They found that estimates of conscious and automatic influences on memory did not differ significantly for the two word types. It had been predicted that conscious influences would have a greater impact on the recall of emotional words than neutral words, but that hypothesis was not supported. The authors suggested several possible explanations for their results. First, the process-dissociation procedure may not be sensitive enough to analyze emotional words. The concepts of conscious and nonconscious processes outlined by the process-dissociation framework may be different than those same-named concepts in emotion theory and thus not relevant to a theory that considers the interaction of emotional and conscious processes important. Second, the theories that suggest a differential effect of emotional material upon conscious and nonconscious memory may be incorrect. It may be that, in the area of conscious and nonconscious memory, emotion is not a relevant variable. The current study used a 2 × 3 × 2 experimental design to investigate implicit versus explicit memory for sexual words. The independent variables were Gender (male versus female), Word Type (sexual, negative emotional, and neutral), and Attention (divided and nondivided). We predicted that participants, because of increased saliency of the words, would complete word stems with more previously presented sexual words than other word types. We also predicted that male participants would complete word stems with more previously presented sexual words than would female participants. This hypothesis is based on previous research (Geer and McGlone, 1990; Kirsch-Rosenkrantz and Geer, 1991; Lewis et al., 1986) that has found that males tend to recall more sexual material than females do. Concerning the dependent variable of recollection estimates, we proposed that participants would have more conscious recollection for sexual words than for negative emotional and neutral words and again, that males will have higher recollection estimates (explicit memory) for sexual words than would females. We did not predict significant effects for gender regarding automatic estimates (implicit memory) because it is assumed that the saliency of the sexual words would increase the amount of attention paid to them causing the words to remain in conscious memory longer and have a greater chance of being processed and encoded. This would result in conscious (explicit) processes being used to such an extent that automatic (implicit) processes would be “overshadowed.”
METHOD Participants Participants included 34 male and 40 female undergraduates at Louisiana State University. Participants were randomly assigned to the full and
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divided-attention conditions so that there were 20 females in each condition and 17 males in each condition. There were a total of 74 participants in the study. Participants received extra credit in psychology classes. All participants read and signed an informed consent statement prior to participation. All experimental procedures were approved by the University’s Institutional Review Board on the use of human subjects. Materials Word List A list of 24 neutral (kettle, saloon), 24 negative emotional (fight, injure), and 22 sexual (fellatio, cum) words were selected from both a list compiled by Jackson (personal communication) and pilot research. Categories of words were equated on length. Word familiarity was assessed using a 7-point Likert scale. Word familiarity differed between the three Word Types. Sexual words (M = 4.11) and neutral words (M = 3.66) were rated as more familiar than negative emotional words [M = 3.08; (t(1, 21) = −6.99, p = 0.0001 and t(1, 23) = −2.33, p = 0.029)]. Neutral words and sexual words did not differ in familiarity. Analyses were performed to examine if there was any effect of this difference in familiarity. Four lists of 36 words each (12 neutral, 12 negative emotional, and 12 sexual words) were randomly generated without replacement from the original list of 70 words. These four lists were rotated and used among participants as both presented words and nonpresented words. Each of these lists was further divided into two sets of 18 words each, two sets of neutral words, two sets of negative emotional, and two sets of sexual words. For each participant one set of each word type (neutral, negative emotional, and sexual) was tested in the inclusion task and the other set was tested in the exclusion task. In order to reduce primacy and recency effects, five neutral buffer items were presented at the beginning and end of the lists. These buffer items were kept constant across lists. Memory Test List Memory test lists consisted of 70 word stems. The word stems were derived from the list of 36 words presented to the subject (12 neutral, 12 negative emotional, and 12 sexual) and the 34 (12 neutral, 12 negative emotional, 10 sexual) words not presented to the subject. Thus, the memory test list contained three-letter word stems that were derived from the presented words as well as the nonpresented words. Each word stem could be completed with more than one English word. Two randomly selected lists of 36 word stems each (6 neutral words, 6 negative emotional words, 5 or 6 sexual words, 6 nonpresented neutral words,
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6 nonpresented negative emotional words, and 5 or 6 nonpresented sexual words) was derived from the test list. One of these lists was designated as the inclusion test and the other as the exclusion test. Designation of the lists as inclusion and exclusion were systematically varied across participants. Baseline was computed using the number of nonpresented target words used to complete word stems. Participants were given word stems that corresponded to target words used in the research but the words had not been presented to that particular participant. The number of word stems that were filled in with nonpresented target words were then counted and divided by the total number of word stems for target, nonpresented words. This gave an estimate of a participant completing word stems with one of the target words without being presented with them prior to test. The process dissociation model suggests that if recollection and automatic estimates for previously presented words are higher than baseline, then the researcher is able to examine the effects of independent variables upon explicit (conscious) and implicit (nonconscious) memory. Listening Task The divided-attention condition employed a listening task. This task was composed of a tape-recorded list of digits that participants were instructed to listen to and identify target sequences (three odd digits in a row). Digits were presented in random order with a minimum of one and a maximum of five digits presented between target sequences. Numbers were recorded at a 1.5 s rate. This attention capturing procedure was adapted from Craik (1982). Procedure Words were presented in lower case letters on a computer. They were presented in the middle of the screen for 1.5 s followed by 0.5 s of blank screen. In the first phase of the experiment, the participants in the full-attention condition saw a list of 46 words. Recall that the list consisted of five buffer words at the beginning and end of each of the lists. Then 12 sexual, 12 negative emotional, and 12 neutral words were presented randomly. The participants were told to read the words aloud and try to remember them. Participants in the divided-attention condition were also presented with 46 words on the computer screen and asked to read them aloud, but were not told to try to remember them. In addition, participants in the divided attention condition listened to a tape recording of digits read at a 1.5 s rate and were asked to detect target sequences of any three odd digits. When a target sequence was detected, participants were instructed to place an “x” on a “Target Sequence” answer sheet. After completing the computer task, participants were given two different lists of word stems. Participants were asked to complete the stems with previously
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presented words in the inclusion test and nonpresented words in the exclusion test. Participants were directed not to use proper names or plural words when completing stems. One half of the participants received the inclusion word stems first and the other half received the exclusion stems first. RESULTS Baseline Comparisons More previously presented target words (regardless of word type) were used to complete word stems than nonpresented words (t(1, 73) = 21.47, p = 0.0001). Target sexual words were used more often to complete word stems when they had been previously presented as compared to participants filling in word stems with target sexual words by chance (t(1, 73) = −10.04, p = 0.0001). The same result was found with the other word types. Presented target negative emotional words were used more often to complete word stems than nonpresented target words (t(1, 73) = −7.97, p = 0.0001), as were presented target neutral words (t(1, 73) = −5.94, p = 0.0001). These data make it clear that the use of our target words to fill in word stems, when the words had not been presented, was well below levels found following presentation. Means and standard deviations for the three word types by condition are presented in Table I. Interestingly, mean baseline estimates for the sexual and neutral words differed between the inclusion and exclusion tasks. For both word types, participants had higher estimates of baseline in the inclusion than in the exclusion task. There was not a task difference for baseline estimates of negative emotional words, although it approached significance ( p = 0.092). This indicates that there may have been a difference in criterion for responding in each condition, which is difficult to interpret. T-test analyses for differences between conditions are also presented in Table I. Table I. Means and Standard Deviations of Word Stem Completion for the Three Word Types and Each Taska Word type Baseline sexual estimates Baseline emotional estimates Baseline neutral estimates Presented sexual Presented emotional Presented neutral a t-Test
Inclusion
Exclusion
t-test analyses
0.441 (0.246)
0.085 (0.115)
t(1, 73) = 11.76, p = 0.0001
0.092 (0.132)
0.133 (0.138)
t(1, 73) = −1.71, p = 0.092
0.206 (0.160) 0.808 (0.160) 0.360 (0.218) 0.403 (0.228)
0.130 (0.132) 0.064 (0.121) 0.132 (0.153) 0.194 (0.191)
t(1, 73) = 3.15, p = 0.002 t(1, 73) = 31.69, p = 0.0001 t(1, 73) = 7.23, p = 0.0001 t(1, 73) = 5.75, p = 0.0001
analyses for differences between tasks are also presented.
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Overall, the word types also differed in their baseline usage. Once again, sexual words were used more often to complete word stems in the baseline condition than either emotional words (t(1, 73) = 7.31, p = 0.0001) or neutral words (t(1, 73) = 3.91, p = 0.0001). In addition, emotional words were used more often than neutral words (t(1, 73) = −3.41, p = 0.001). Possible reasons for this are included in the Discussion section.
Analyses of Previously Presented Words The first dependent variable examined was the overall probability of using previously presented words to complete word stems. A repeated measures 3 × 2 × 2 ANOVA was performed on these data. The independent variables were Word Type, Gender, and Attention condition. The ANOVA revealed a significant main effect for Word Type (F(2, 72) = 68.43, p < 0.0001). This indicates that there were differences between each of the Word Types in the participants’ use of them to complete word stems. Sexual words (M = 0.444) were used significantly more often than negative emotional (M = 0.245; t(1, 71) = −7.21, p = 0.0001) and neutral (M = 0.299; t(1, 71) = −11.05, p = 0.0001) words to complete word stems. Neutral words were used significantly more often than negative emotional words (t(1, 71) = −2.95, p = 0.004). Analyses of the overall data from the word stem completion task did not reveal a significant main effect for Attention (F(1, 71) = 1.68, p < 0.199). That is, participants in the full-attention condition did not use more previously presented words to complete word stems than participants in the divided-attention condition. This result was unexpected. The main effects were qualified by a significant Gender × Word Type interaction (F(2, 72) = 4.819, p < 0.011). We had predicted that males would use more previously presented sexual words to complete word stems than would females. We did not find this expected interaction. Rather, we found that the genders differed on their use of negative emotional words to complete words stems. Post hoc analyses (Tukey HSD) indicate that females used negative emotional words to complete word stems significantly more than males (F(1, 73) = 4.958, p < 0.029). The female mean and standard deviation for emotional words was M = 0.275, SD = 0.110. The male mean and standard deviation for emotional words was M = 0.210, SD = 0.142. (See Table II for means and standard deviations regarding these results.)
Analyses of Recollection Estimates A repeated measures ANOVA (3 × 2 × 2) was performed using recollection estimates as the dependent variable. Recall that recollection is the estimate of
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Bush and Geer Table II. Means and Standard Deviations by Gender and Condition of the Probability of Using Previously Presented Words to Complete Word Stems
Male Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral Female Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral
Mean
Standard deviation
0.436 0.266 0.295
0.085 0.128 0.108
0.434 0.285 0.285
0.123 0.091 0.149
0.449 0.238 0.360
0.08 0.122 0.166
0.459 0.182 0.259
0.118 0.159 0.139
conscious or explicit processes. The actual dependent variable is the probability of a participant completing word stems with a previously presented word in the inclusion condition minus the probability of responding with a previously presented word in the exclusion condition. Again, the independent variables were Word Type, Gender, and Attention conditions. Analyses of recollection estimates revealed a significant main effect for Word Type (F(2, 72) = 157.287, p < 0.0001). Means analysis indicate that participants had significantly higher estimates of recollection for sexual words than for negative emotional words (t(1, 73) = −13.93, p = 0.0001) and for neutral words (t(1, 73) = −14.30, p = 0.0001). Estimates of recollection between neutral and negative emotional words did not differ (t(1, 73) = 0.66, p = 0.508). Means and standard deviations of recollection estimates for the Word Types, Gender, and Attention conditions are presented in Table III. In these data, a significant main effect of Attention upon recollection estimates was found (F(1, 73) = 10.30, p < 0.002). Participants in the full attention condition (M = 0.457) had higher estimates of recollection than participants in the divided attention condition (M = 0.325). Again, the main effects were qualified by a significant interaction between Attention and Word Type (F(2, 72) = 3.69, p < 0.03). Post hoc analyses indicate that when attention was divided, recollection estimates for negative emotional (F(1, 73) = 9.167, p < 0.0034) and neutral words (F(1, 73) = 7.357, p < 0.0083) were reduced significantly, but estimates for sexual words did not differ between Attention conditions (F(1, 73) = 0.2543, p < 0.6156).
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Table III. Estimates of Recollection Means and Standard Deviations for the Three Word Types by Condition
Male Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral Female Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral
Mean
Standard deviation
0.782 0.385 0.306
0.149 0.279 0.294
0.698 0.130 0.039
0.177 0.293 0.296
0.723 0.243 0.284
0.260 0.223 0.335
0.771 0.147 0.179
0.221 0.212 0.299
Analyses of Automatic Estimates A repeated-measures ANOVA (3 × 2 × 2) was performed using automatic estimates as the dependent variable. No significant effects were found for Automatic estimates (F(2, 69) = 0.41, p < 0.666). Note that we did not predict any significant effects for this dependent variable. (See Table IV for the means and standard deviations regarding this dependent variable.) Correlational Analyses To examine whether the different levels of word familiarity influenced our findings, familiarity ratings for each word within each Word Type were correlated with the corresponding sum of word usage in the inclusion condition. No significant correlations were found. This suggests that word familiarity did not play a role in participants’ use of target words to complete word stems in the inclusion condition. DISCUSSION This study investigated the conscious and nonconscious influences on the memory of sexual, negative emotional, and neutral words using and Jacoby’s process-dissociation framework (Jacoby, 1991). Our study found that participants
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Bush and Geer Table IV. Estimates of Automatic Means and Standard Deviations for the Three Word Types by Condition and Gender
Male Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral Female Full attention Sexual Negative emotional Neutral Divided attention Sexual Negative emotional Neutral
Mean
Standard deviation
0.076 0.064 0.078
0.183 0.115 0.096
0.155 0.131 0.111
0.275 0.120 0.137
0.060 0.087 0.130
0.113 0.100 0.182
0.120 0.077 0.086
0.247 0.140 0.131
used more previously presented sexual words to complete word stems than negative emotional and neutral words. This finding supports previous research concerned with the saliency of sexual information (Geer and McGlone, 1990; KirschRosenkrantz and Geer, 1991; Nielson and Sarason, 1981). We have suggested that sexual information is more salient than nonsexual information and is therefore easier to recall. Interestingly, neutral words were used significantly more than negative emotional words to complete word stems. This finding makes it clear that some factor other than emotionality produces our findings of better memory for sexual words. We argue it is the saliency of the sexual words. Participants differed in their baseline usage for target sexual and neutral words across the tasks (inclusion and exclusion). In general, participants used more target sexual and neutral words to complete word stems on the inclusion test as compared to the exclusion task. It is possible that participants were more accurate in including sexual words in the inclusion task and excluding sexual words in the exclusion task because they were aware that they had seen some sexual words (although none of the baseline words had been seen by the participant prior to the word stem completion task). The number of sexual words is relatively finite and therefore the word stems associated with those words are also finite, making it easier to complete a sexual word stem with a sexual word regardless of whether the person had seen it before. However, this explanation does not hold for the neutral words as there are many more neutral words that could have been used to complete the neutral word stems. Why the participants were so adept at choosing the target neutral words (which were not seen by them) is unclear.
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The current study also found a significant interaction between Gender and Word Type, although it was not the interaction we had predicted. We had predicted that male participants would use more previously presented sexual words to complete word stems than would females. This hypothesis was based on previous research (Geer and McGlone, 1990; Kirsch-Rosenkrantz and Geer, 1991; Lewis et al., 1986) that found that males recall, or report, more sexual information than females do. The current study found that males and females did not differ in regard to memory for sexual words, but they did differ in usage of negative emotional words to complete word stems. Females used negative emotional words significantly more often than males. There are several possible reasons for this lack of results regarding sexual words. The first reason may involve the type of stimuli used. It is possible that simple sexual words are not as socially unacceptable as perhaps a sexually oriented paragraph or sentences. Therefore females would not be as hesitant to report recalling the sexual words. Second, it may be that as our culture changes and evolves, females are becoming socialized to believe that it is not necessary to hide interest in sexual stimuli. If this is the case, as data continue to be collected, identified gender differences will lessen. Only further research will clarify these findings. This study found that participants had significantly higher estimates of recollection for the sexual words (0.74) than for negative emotional (0.23) and neutral (0.20) words. This is consistent with previous research (Geer and McGlone, 1990; Kirsch-Rosenkrantz and Geer, 1991; Neilson and Sarason, 1981) that found sexual stimuli are better recalled than nonsexual stimuli. Given the robustness of our data, we argue that there is clearly something different about sexual words that result in their being better remembered than other word types. As already stated, we suggest that it might be the increased saliency of sexual words that result in their being more noticeable and more elaborately processed and therefore more easily recalled than other word types. This may occur because there is more attention allocated to sexual words, which could result in a higher level of conscious processing at the time of study. It would then follow that conscious influences will have a larger effect on recall at the time of test, as our result supports. We do not think that these results are the result of novelty of the sexual words. As presented in the Methods section, the sexual and neutral words were statistically more familiar than the negative emotional words. Since novelty suggests that something is new or unusual, if the sexual words were in fact novel, then they would not have been rated as familiar as they were. Therefore, novelty of the sexual words cannot explain why they would have produced such robust recollection estimates. It was found that when attention was divided, recollection estimates for negative emotional and neutral words were reduced significantly, but estimates for sexual words did not differ between attention conditions. Again, it appears that sexual words are so salient and attention-grabbing that even dividing the attention of the participants did not significantly lower their ability to recall the sexual
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words. However, dividing the attention of the participants did affect their ability to recall negative emotional and neutral words. This argues that the saliency of sexual stimuli overcomes attempts to distract the participant from the presentation of the words. They stand out so much to the participant that he/she is able to remember the sexual words even though their recall of the other word types is reduced. As stated previously, there were differences in familiarity between sexual and negative emotional words and between negative emotional words and neutral words. In both cases, negative emotional words were less familiar than the other word types. To examine possible effects of this finding, we conducted several analyses. In these analyses, we compared word familiarity for each word in a given word category with the actual word usage for each word in the inclusion condition. We found no significant correlations, which indicates that familiarity was not playing a major role in participants’ usage of the words to complete word stems. We failed to find significant nonconscious effects in our data. It may have been that the presence of salient sexual words increased the conscious processing of all the word types to the point that measurable automatic influences were eradicated. This type of result was also found in the study by Geer et al. (in press) in which the researchers used emotional and neutral words. Their study also did not produce statistically significant automatic effects. Even though there were no statistically significant results concerning automatic influences, it is interesting to note that the estimates of nonconscious effects from this study are decidedly less than those found in previous studies done by Jacoby and colleagues (1992, 1993, 1994). In the previous studies, automatic effects have ranged from 0.16 to 0.73 and are, in general, fairly robust influences on memory. The current study found automatic estimates that were much lower (0.07–0.14) than previous research. The reasons for this are unknown. It may be because baseline usage of target words was higher in the current study than in previous studies, which would impact automatic estimates. It may also be that the presence of emotional or sexual stimuli somehow affect implicit and explicit memory. This possibility raises questions that only further research will answer. The current study did have weaknesses that could be addressed in future undertakings. The use of only negatively valenced emotional words may have had an effect on the dependent variables. Perhaps positive words are more familiar than the negative words and would produce different results. It would be interesting to see if positive emotional words produce defferent results. Demand characteristics may have played a role in the results pertaining to sexual words. It was quite clear that sexuality was being studied and this may have impacted participants in some way not foreseen. Finally, the very nature of using sexual words presents a problem when dealing with word stem research. There are relatively few sexual words and the word stems related to those sexual words can be completed with relatively few words other than the target sexual words. This may impact any research using this type of methodology but a solution has not yet been presented.
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In general, we supported the idea that sexual words appear to be quite attention-grabbing, as has been found in previous research (Geer and McGlone, 1990; Kirsch-Rosenkrantz and Geer, 1991; Nielson and Sarason, 1981). When considering the dependent variable of recollection, we found that dividing attention at study significantly reduced estimates of explicit memory for neutral and negative emotional words, but did not affect explicit memory for sexual words. It appears that the sexual words were so salient that they had higher estimates of recollection regardless of attention at study. These data argue that words with sexual meaning may be processed differently than the other words. These findings warrant further study to identify the mechanisms involved. Studies that focus on other cognitive processes, such as encoding and attention allocation, would provide further information about the differing ways in which we use and process sexual versus other types of stimuli. APPENDIX The mathematical computation of recollection and automatic estimates are described in this Appendix. First, consider the inclusion test condition in which the probability of responding with a previously studied word is the probability of recollection (R) plus the probability of the word automatically coming to mind (A) when there is a failure in recollection. In the computational formula, A is taken times 1 − R, where 1 is the total probability of recalling a presented word. In that formula, 1 − R is the probability of remembering if total conscious recollection is not there. To yield the actual number of words that result from automatic processes, A is multiplied by 1 − R, which represents what is left of the inclusion data once recollection is subtracted. This results in the following formula to describe the data from the inclusion condition: Inclusion = R + A(1 − R)
(1)
In the exclusion test condition, a previously studied word will be generated only if it comes to mind automatically and there is a failure to recollect that it was presented earlier: Exclusion = A(1 − R)
(2)
The probability of recollection can be estimated as the probability of generating a previously studied word in the inclusion condition minus the probability of responding with a previously studied word in the exclusion condition: R = Inclusion − Exclusion
(3)
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Using simple algebra, unconscious or automatic influences can be estimated: A = Exclusion/(1 − R)
(4)
By using equation (4), an estimate of the probability of a previously presented word being generated from an automatic basis of responding results in an estimate that incorporates both automatic influences of memory (M) and the baseline probability of using a certain word to complete a stem (B). Baseline is obtained by giving participants stems that can only be completed with words that were not presented before. It is assumed that those two effects are additive: A=M+B
(5)
Automatic influences can then be estimated by subtracting baseline from the “ A” estimate resulting from equation (4).
REFERENCES Abrahamson, D. J., Barlow, D. H., Sakheim, D. K., Beck, J. G., and Athansiou, R. (1985a). Effects of distraction on sexual responding in functional and dysfunctional men. Behav. Ther. 16: 503–515. Abrahamson, D. J., Barlow, D. H., Beck, J. G., Sakheim, D. K., and Kelly, J. P. (1985b). Effects of attentional focus and partner responsiveness on sexual responding: Replication and extension. Arch. Sex. Behav. 14: 361–371. Beck, J. G., Barlow, D. H., and Sakheim, D. K. (1983). The effects of attentional focus and partner arousal on sexual responding in functional and dysfunctional men. Behav. Res. Ther. 21: 1–8. Craik, F. I. (1982). Selective changes in encoding as a function of reduced processing capacity. In Klix, F., Hoffman, J., and Meer, E. van der (eds.), Cognitive Research in Psychology, Deutscher Verlag der Wissenschaffen, Berlin. Geer, J. H., and Fuhr, R. (1976). Cognitive factors in sexual arousal: The role of distraction. J. Cons. Clin. Psychol. 44: 238–243. Geer, J. H., and McGlone, M. (1990). Sex differences in memory for erotica. Cogn. Emo. 4: 71–78. Geer, J. H., Bush, S. I., Francingues, N. A., Manguno-Mire, G., and Jackson, S. R. (in press). Using the process-dissociation procedure to separate implicit and explicit influences on the memory of emotional stimuli. Graf, P., Squire, L., and Mandler, G. (1984). The information that amnestic patients do not forget. J. Exp. Psychol. Learn. Mem. Cogn. 10: 164–178. Jacoby, L. L. (1983). Remembering the data: Analyzing interactive processes in reading. J. Verb. Learn. Verb. Behav. 22: 485–508. Jacoby, L. L. (1991). A process dissociation framework: Separating automatic from intentional uses of memory. J. Mem. Lang. 30: 513–541. Jacoby, L. L., and Kelley, C. M. (1992). A process dissociation framework for investigating unconscious influences: Freudian slips, projective tests, subliminal perception, and signal detection theory. Cur. Dir. Psychol. Sci. 1: 174–178. Jacoby, L. L., Toth, J. P., and Yonelinas, A. P. (1993). Separating conscious and unconscious influences of memory: Measuring recollection. J. Exp. Psychol. Gen. 122: 139–154. Jacoby, L. L. (1994). In Umilta, C., and Moscovitch, M. (eds.), Attention and Performance XV, Bradford, Cambridge, MA. Kirsch-Rosenkrantz, J., and Geer, J. H. (1991). Gender differences in memory for a sexual story. Arch. Sex. Behav. 20: 295–305.
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Lewis, R. J., Gibbons, F. X., and Gerrard, M. (1986). Sexual experience and recall of sexual vs. nonsexual information. J. Pers. 54: 676–693. Mish, F. C. (ed.) (1989). The New Mirriam-Webster Dictionary, Mirriam-Webster, Springfield, MA. Morris, C. D., Bransford, J. D., and Franks, J. J. (1977). Levels of processing versus transfer appropriate processing. J. Verb. Learn.Verb. Beh. 16: 519–533. Nielson, S. L., and Sarason, I. G. (1981). Emotion, personality, and selective attention. J. Pers. Soc. Psychol. 41: 945–960. Przybyla, D., and Byrne, D. (1984). The mediating role of cognitive processes in self-reported sexual arousal. J. Res. Psychol. 18: 54–63. Roediger, H. L., Weldon, M. S., and Challis, B. H. (1989). Explaining dissociations between implicit and explicit measures of retention: A processing account. In Roedinger, H. L., and Craik F. I. (eds.), Varieties of Memory and Consciousness: Essays in Honor of Endel Tulving, Earlbaum, Hillsdale, NJ. Schacter, D. L. (1987). Implicit memory: History and current status. J. Exp. Psychol. 13: 501–518. Squire, L. R. (1986). Mechanisms of memory. Science 232: 1612–1619. Tulving, E. (1985). How many memory systems are there? Am. Psychologist 40: 375–398. Warrington, E. K., and Weiskrantz, L. (1974). The effect of prior learning on subsequent retention in amnesic patients. Neuropsychologia 12: 419–428. Weiskrantz, L. (1989). Remembering dissociation. In Roediger, H. L., and Craik, F. I. (eds.), Varieties of Memory and Consciousness: Essays in Honor of Endel Tulving, Earlbaum, Hillsdale, NJ.
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c 2001) Archives of Sexual Behavior, Vol. 30, No. 6, December 2001 (°
A 30 Years’ Thank You Richard Green, MD, JD
Sixteen thousand and eight hundred pages ago, I wrote:
A Statement of Purpose The Archives of Sexual Behavior: An Interdisciplinary Research Journal will attempt to bring together findings from the several academic disciplines investigating human sexuality. Research data on sexual behavior are emerging at an accelerating rate. Inspection of the past year’s Index Medicus and Psychological Abstracts reveals hundreds of noteworthy papers published throughout the world addressed directly to this subject. They were from psychologists, psychiatrists, neuroendocrinologists, ethologists, psychoanalysts, geneticists, and social scientists. Unfortunately for the student of sexual behavior, these papers were published in literally dozens of journals, rendering it a practical impossibility to maintain a scholarly awareness of that material. An additional deficiency in effective communication among these investigators derives from man’s inefficient system of language. Of the scores of innovative papers published last year, one-third were in a variety of languages other than English. The Archives of Sexual Behavior hopes to be the first journal to collate effectively research contributions of consistently high caliber from scholars throughout the world. It hopes to incorporate, among others, the research strategies of the clinician, including the psychoanalyst and behavior therapist, with the perspective of the social scientist and the findings of the laboratory investigator. Associate Editors and members of the Editorial Board have been selected to maximize this potential. The Archives of Sexual Behavior will also translate selected non-English-language research papers and make them available in summary form to an English-language readership. How did I become Founding Editor in 1971? I was chosen because of the fatherly confidence of Robert Stoller and the confidence that Seymour Weingarten had in Bob. Seymour had been Bob’s editor at Science House when Sex and 633 C 2001 Plenum Publishing Corporation 0004-0002/01/1200-0633$19.50/0 °
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Gender was written in the mid-60s. After moving to Plenum, Seymour identified the void in scholarly journals in sexology and asked Bob to edit one. Bob, knowing a problematic offer when he heard one, declined and suggested me. Plenum, then as now, spared no expense in moving forward. Seymour and I sealed the deal at a local saloon where cockroaches carry the nuts, not waiters. My only regret in signing on was accepting a modest annual stipend, rather than Plenum stock options. From 1971 Plenum stock has increased a few thousand percent. Seymour had options and founded The Guildford Press. Our contract was a well-kept secret. After I told my father in 1970 that I had just contracted to edit a new journal, he subwayed downtown to the Plenum office to enrol as the first subscriber. When he marched in no one had a clue what he was talking about. When he refused to leave someone was finally located who’d heard of it. Leo Green kickstarted what was to become our mammoth subscription list. The introduction of Archives of Sexual Behavior was treated cautiously. As a frequent expert court witness defending pornographic publications, I was bemused to find that when Archives was first published, the UCLA medical library refused to put it on their shelving with other journals. It had to be specially requisitioned at the reference desk by a duly qualified reader. This is still the case. They may have heard the rumours of my plan to increase subscriptions with a monthly nude centrefold featuring a member of the Editorial Board. The idea was to go in alphabetical order. But Gene Abel refused. Archives of Sexual Behavior established itself as the preeminent international multidisciplinary research journal in human sexuality. A content analysis of Archives articles demonstrates its uniquely international scope. We have published over 350 articles by non-US authors, about one-third of all our papers. Editorial Board members have been scholars in Colombia, India, China, Russia, Switzerland, Czechoslovakia, Germany, the Netherlands, Denmark, Sweden, Australia, the United Kingdom, South Africa, Hungary, Israel, Canada, Japan, and the United States. Two early years’ features of Archives were discontinued. For the first four volumes we had Associate Editors as well as general members of the Editorial Board. Associates represented their academic subdisciplines and were asked to solicit work from their colleagues. They were Robert Goy (primate behavior), John Money (medical psychology), Isaac Marks (behavioral psychiatry), Robert Stoller (psychoanalysis), Ira Reiss (sociology), and Gunter Schmidt (European sexual science). Later, with such representation in Archives secured, we moved to a one-tier Editorial Board. The ambitious plan to translate non-English language publications proved to be expensive and time-consuming. And I stopped dating the UCLA librarian who was helping me. From Volume 14, November 4, the Archives masthead has identified the journal as the “The Official Publication of the International Academy of Sex Research.” The strong link between Archives and the Academy has been forged via the
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Editorial Board. Over the 30 years most Board members have been Academy members. Currently this is true for 43 of the 50 Editors. This has been a working Editorial Board. Invitation letters to prospective editors required a commitment to a review within 4 weeks on 5–7 articles a year. Submissions were sent to three reviewers for majority vote, as “occasionally” there was disagreement (see below). Over the years, communicating editorial reviews to the Editor has kept pace with emergent technology. The evolution progressed from Pony Express to snail mail to fax to electronic mail. Some Editorial Board members have been with me for 30 years: Joe Herbert, Judd Marmor, Gunter Schmidt, and Richard Whalen. Kurt Freund, Bob Goy, and Bill Simon would have been. I am in awe over the subjectivity of the editorial process. Repeatedly, two reviewers have reached polarized conclusions over the value of a manuscript. Years ago I stopped counting the papers where one reviewer recommended speedy publication for a major innovative piece of work as another condemned it as worthless, unpublishable crap. Over the 30 years ten Managing Editors (n´ee Editorial Correspondent, then Special Assistant to the Editor), rescued me from the day-to-day tedium of the editorial process. They hounded reviewing editors missing in inaction. They checked pageproofs to double-check authors. In 1978 we learned that we also had to proofread the Table of Contents printed by Plenum on the back cover of each issue. Psychiatrist Norman Fisk published his paper under the (inadvertent) nom de plume Normal Fish. The ten women who made me look good were Thelma Guffan, Mary McAllister, Tina Wheeler, Patricia Donahue, Katherine Williams, Virginia Bentley, Elizabeth Houck, Laurel Mallett, Carmel Rosal, and Claire Morris. I was never able to find a qualified male with a helping hand (for editing). But one Editor’s task to which I was enslaved was copyediting—16,800 pages. How many bottles of wine have rendered this mindless task more salubrious. A gene for scholarly research is often incompatible with one for spelling, syntax, or punctuation. When I was accepted by Yale Law School in 1984, 13 years of reading for commas; not content, so addled my brain that I was initially unable to comprehend textbook legal cases. I would circle printing errors, but not remember the law. The new Editor in 2002 faces a starkly different challenge than I met in 1971. Then there was one English language sex journal—The Journal of Sex Research. Now there are 28 English language journals on sexual behavior, many more on gender behavior, and still others in a language other than English. Coupled with the explosion of sex journals has been the implosion in research funding. When I served on the NIMH study section funding research in the 70s, we powered study after study on sexual behaviors: normal, abnormal, functional, and dysfunctional. Today, except for some colleagues in HIV-related fields, those halcyon days are gone. Consequently, more journals compete for less research.
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Another rub is Criterion D of the DSM-IV diagnosis of Obsessive–Compulsive Disorder. This describes the repetitive recording of each time every article published in a given journal is cited in any other journal. Upon completion of the ritual, at year’s end, it recommences. Academic Darwinism requires for survival that one’s papers be published in journals with towering impact factors. Archives has, at most recent compilation, the highest among sexological journals with the exception of the Viagra-fuelled International Journal of Impotence Studies. That stands, erect, above the crowd. The problem for an Editor is that academics with a mortgage to pay will often opt, with their good papers, for a wider readership, higher impact factor, nonsex journal. And a major breakthrough in sexology, as occurs regularly every twelve years, is shunted to Nature or Science. A continuing challenge for the new Editor will be publication lag. We eventually conquered ours. At the memorial for Kurt Freund at the 1997 Academy meeting, someone noted that Kurt had set a record by publishing a paper (posthumously) in Archives at age 84. I pointed out that the fact was true, but he had actually submitted the paper when he was 53. It wasn’t really quite that bad. The worst was two years from submission. We have cut that by more than half. But we had no way of cutting much more as we are a bimonthly and accepted, copyedited manuscripts are processed in New York for 6 months by the Publisher. Two other variables account for publication lag: turnaround time by Editorial Board members and turnaround time by authors to revise a provisionally accepted paper in line with Board requirements. As of this writing, there is no queue of accepted papers. Plenum has been happy with Archives. Although it has had no paid adverts and has close to the same number of subscribers as in 1971, it makes money. Further, we have never been late in supplying the next issue’s contents to the publisher. Our reliability was rewarded when, in 1998, we were one of 15 of over 150 Plenum journals selected for their electronic journal launch. It has been a peripatetic editorship: 1971–74 University of California, Los Angeles, 1974–86 State University of New York at Stony Brook, 1986–94 (again) University of California, Los Angeles, 1994–2001, University of Cambridge. The time for my retirement as Editor was determined in 1994 when I moved Archives to Cambridge. My appointment as Senior Research Fellow at the Institute of Criminology and Affiliated Lecturer, Faculty of Law, runs through 2001. The Institute has housed Archives for 7 years. That accommodation expires at the end of 2001. This coincides with completion of data collection by my last Cambridge doctoral student who partly supports herself as Managing Editor. In this final editorial chapter I have attempted to share the editorial role and provide more writing opportunity for Board members. Invitations were sent to the Board inviting guest essays and guest-edited entire issues. Three essays were received and published: Volkmar Sigusch on The Neosexual Revolution, Nathaniel
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McConaghy on Unresolved Issues in Scientific Sexology, and Donald West on Boys and Sexual Abuse. Two guest-edited issues have been published: one by Ken Zucker devoted entirely to book reviews and one by Gil Herdt on sexual attraction. A third is nearing completion on female sexual dysfunction and is co-edited by Ray Rosen. The new Editor has many options for expanding Archives. Among others: reintroducing Associate Editors from subdisciplines, inviting guest essays on controversial topics, not only by Board members but by other Academy members, state-of-the-art reviews, clinical case reports that bear on research questions, more Academy presidential addresses, and debates by sexperts, in a series, perhaps entitled “Masterdebates.” Will I miss Archives ? Since I entered first grade at Public School 241 in Brooklyn in 1941 one-half of my years have been spent as Editor. Thank you for the privilege. Richard Green Editor, 1971–2001
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BOOK REVIEWS Annual Review of Sex Research (Vol. VIII). Edited by Raymond C. Rosen. Society for the Scientific Study of Sexuality, Mt. Vernon, Iowa, 1997, 253 pp., $53.00. Reviewed by Erick Janssen, PhD1
Volume VIII of the Annual Review of Sex Research starts off with a chapter by Murray, a historian, on seminal emissions and sexual anxiety in the Middle Ages. In the Introduction, she notes that medieval Christians “perceived the male body as dichotomous and conflicted; made in the image of God, it was also a constant reminder of humanity’s fall from grace” (pp. 1–2). An historical examination of seminal emissions and other “movements of the flesh” might, in Murray’s opinion, reveal something of the anxiety that accompanied “men’s experience of their own embodiment,” an anxiety that, according to her, influenced, if not guided, the medieval construction of human sexuality. What follows is a meticulous and at times rather entertaining review of the struggle of medieval moralists to give meaning to (e.g., nocturnal) seminal emissions. Are they sinful, immoral, or the innocuous result of humoral build-up? Can they be willfully induced or do they result from carnal thoughts? We are introduced to the theories of Augustine, Pope Gregory, and Aquinas, among others, and we are presented with persuasive examples of how the discussion of emissions (and related sins of gluttony) shifted from celibate men to all men, and, finally, to all people. Although the chapter is interesting and well-written, it is somewhat repetitious. Also, the author’s claim that anxiety was both a basis for and an outcome of discussions regarding emissions is unfortunately not examined with the same rigor as her exploration of the discourse on seminal emissions per se. Blanchard, in his chapter on birth order and sibling sex ratio in homosexual males and females, observes that researchers began asking at least 60 years ago whether the mean birth order of homosexual persons is unusually early or late. After reviewing previous research, Blanchard presents the findings of an impressive and ingenious series of studies involving thousands of participants, which 1 The Kinsey Institute for Research in Sex, Gender, and Reproduction, Morrison Hall, 3rd Floor, Indiana
University, Bloomington, Indiana 47405. 639 C 2001 Plenum Publishing Corporation 0004-0002/01/1200-0639$19.50/0 °
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he conducted with his colleagues at Toronto’s Clarke Institute of Psychiatry. Blanchard concludes that a late birth order in homosexual men “is one of the most reliable epidemiological variables ever identified in the study of sexual orientation” (p. 33). From sibling sex ratio studies, a more intricate picture emerges, suggesting that in particular extremely feminine homosexual men tend to have a greater number of older brothers, not sisters. The data for women, no matter how they are analyzed, reveal no consistent tendencies, and do not allow for any conclusion regarding birth order or sibling sex ratios. Blanchard devotes a good third of his chapter to possible explanations for these findings. He is critical of most, including ones he offered and tested himself, but seems to lean toward biological interpretations of the birth order effect, the most interesting one involving maternal immune reactions. As for sibling sex ratio, Blanchard does not exclude psychosocial causes (e.g., gender conformity pressures), but offers as a possible alternative that different degrees of maternal immune reactions may lead to different degrees of brain feminization. Paredes and Baum discuss the role of the medial preoptic area/anterior hypothalamus (MPOA/AH), a steroid-hormone sensitive area located at the border of the diencephalon and telencephalon, in the control of masculine sexual behavior. Lesions in this brain area disrupt masculine sexual behavior in many (vertebrate) species, although responses such as (“noncontact”) erections and ejaculation may or may not be affected. The MPOA/AH contains sexually dimorphic cell groups that are larger in the male than in the female and that are believed to play a role in male sexual behavior and in protecting males from the influence of “female” hormone exposure on sexual behavior. Although the MPOA/AH is believed to be important in the control of sexual behavior, the mechanisms involved are not well understood. There is evidence of lesions affecting consummatory aspects (e.g., motoric responses) but not motivational or appetitive aspects of behavior, evidence for lesions affecting motivational aspects—a number of studies, including some conducted by the authors, show that MPOA/AH lesions can affect partner preferences—and evidence for lesions affecting both. Single cell recordings in monkeys have led to the suggestion that MPOA/AH neurons integrate visual and/or olfactory cues, leading to sexual arousal and behavior. Paredes and Baum refer briefly to research on homologous structures in humans and conclude that research in ferrets and rats supports “the possibility that neurons in this part of the human diencephalon play some role in the male-typical profile of preference for a heterosexual partner” (p. 92). Neurobiological papers can be hard to digest (especially for nonbiologists) but, with the exception of a few concepts that perhaps could have been explained better, Paredes and Baum managed to write a very comprehensive and comprehensible review. Doll, Myers, Kennedy, and Allman examine the relation between bisexual behavior and HIV risk, comparing data from Canada and the United States. In their Introduction, Doll et al. state that sexual identity development involves an
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ongoing and dynamic process, a notion that challenges theories of “linear identity acquisition and sexual identity group homogeneity” (p. 103). HIV prevention in bisexuals is, possibly more than in any other group, complicated by this heterogeneity. Bisexual behavior may be based on sexual identity but it may also occur for economic reasons (e.g., male sex workers), secretly (e.g., in Latino and African American cultures), or as part of sexual experimentation (e.g., sexual identity exploration during adolescence)—exactly the type of contexts that seem associated with higher HIV risk (in addition to drug use). Further complicating prevention, bisexual communities are less visible than gay and lesbian ones. A substantial part of the chapter is devoted to a review of surveys conducted in the United States and Canada on the prevalence of bisexual behavior and the prevalence and determinants of HIV risk behaviors. Among their conclusions is that little is known about bisexual women in the United States or Canada. With regard to men, although bisexual men seem to engage in less unsafe sexual behavior than exclusively homosexual men do, some (see the groups mentioned above) are at particularly high risk for HIV. Also, bisexual men use condoms less often with female than with male partners. All in all, this is a very informative chapter on a topic that has, to date, not received much attention. Heiman and Meston present a review of treatments for sexual dysfunction. Using criteria proposed by the American Psychological Association, they evaluate empirically validated treatments that are either “well established” or “probably efficacious.” Following a very thorough and comprehensive literature review, they conclude that validated psychological treatments do exist. These are “wellestablished” in the case of primary anorgasmia in women (directed masturbation) and erectile failure in men (systematic desensitization), and “probably efficacious” for secondary anorgasmia and, perhaps, vaginismus in women, and premature ejaculation in men. Regarding medical treatments, the review was written before the rise of Viagra, but the authors discuss the role of yohimbine and prostaglandin-E1 in the treatment of erectile problems, and of SSRIs in the treatment of premature ejaculation. The treatment of sexual desire problems and dyspareunia in men and women and of delayed orgasm in men are not reviewed because “[t]here are inadequate data on these topics to claim efficacious treatments” (p. 185). Heiman and Meston conclude that we need more research comparing couple and individual interventions, short- and long-term effects, and psychological, pharmacological, and combined treatments. Although Heiman and Meston’s chapter will, I am convinced, prove to be a “classic,” I missed a more in-depth discussion of the relevance of prognostic indicators (what predicts treatment efficacy?) and, more than that, of the theories behind the therapies. The authors focus on efficacy but I believe the chapter would have benefitted from a discussion of the importance of research that would aim to improve our understanding of both the “dysfunctions” themselves—and how best to define, classify, and diagnose them—and the mechanisms underlying (effective) treatments.
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Wallen and Parsons ask in the title of their chapter whether same-sex sexual behavior in nonhuman primates is relevant to understanding human homosexuality. They are careful to acknowledge that the existence of common motor patterns “does not mean the behavior represents or serves similar psychological functions” (p. 196) but same-sex sexual behavior clearly is “a relatively common part of the behavioral repertoire of nonhuman primates” (p. 204). It does not appear to be influenced by early rearing conditions, is often sexually motivated, and generally reflects limited heterosexual mating opportunities. Although dominance may not be important, “it is evident that unstable social relations or periods of high excitement increase same-sex sexual behavior” (p. 212). This made me wonder whether “excitation transfer” might be involved in such situations. Also, same-sex sex plays a role in the formation and maintenance of alliances and social bonds. Particularly interesting, same-sex sexual interactions tend to be more prevalent in younger than in older males, whereas the opposite seems to be true for females. This suggests “that same-sex sexual behavior serves markedly different functions in male and female non-human primates and may not result from a mechanism common to both sexes” (p. 218). As for the answer to the question raised in the title, the conclusion must be that the relevance is limited, because “nothing behaviorally akin to human homosexual behavior, characterized by almost exclusive same-sex sexual interactions, has been observed in nonhuman primates” (p. 219). What we can learn from nonhuman primates may not as much concern “the origins of homosexuality” but society’s reactions to it; in no study of nonhuman primates “has any negative social reaction to same-sex sexual behavior been reported” (p. 219). The last chapter, by Rowland and Slob, focuses on premature ejaculation (PE). Underscoring the complexity of such a seemingly simple “movement of the flesh”—by the way, existing models would have difficulty explaining the seminal emissions discussed by Murray—Rowland and Slob state that variations in ejaculatory latency can arise from many “known or unknown” processes. Recently, some progress has been made, in part by Rowland and Slob themselves. For example, it seems that subtypes exist, as demonstrated by different (e.g., affective) responses in men with PE-only and men with PE and erectile dysfunction (ED). According to Rowland and Slob, however, the key issue lies in “the ability (or lack thereof) to exert control over the timing of ejaculation” (p. 230). Future research might help develop “cognitive/affective strategies that enable control” (p. 230). Although wary of dualistic approaches, the authors seem to imply that ejaculation latency might be modified through psychological means. Unfortunately, no studies seem to exist that directly tested the assumption that men, with or without PE, are able to voluntarily decrease or increase their ejaculation latency. As Rowland and Slob admit, psychophysiological analysis has only begun to delve into the many issues surrounding PE. Their own work, as well as other recent studies, does allow for a preliminary analysis and “lends support to waning theoretical perspectives (e.g.,
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higher anxiety or negative emotional response in PE men); it corroborates existing suppositions and findings about the response in PE men (e.g., importance of penile stimulation), yet questions a number of previously offered explanations (e.g., PE men with ED ejaculate quickly out of fear of losing their erections)” (p. 243). Ten years ago, Bancroft (1990), the first Editor of the Annual Review of Sex Research, wrote that with this publication, the Society for the Scientific Study of Sex aims to “bring together authoritative and scholarly reviews” from the wide field of sex research into one annual volume. Indeed, this series has become a forum where disciplines meet. As Bancroft pointed out, the emphasis is on research, but it would be good to see more theoretical or philosophical papers in future volumes. Also, it might be worth considering including commentaries (cf. Behavioral and Brain Sciences). Whatever the future may bring, this volume, artfully compiled and edited, confirms that the Annual Review of Sex Research cherishes quality, bears provocation, and values creative and innovative scientific and scholarly work. REFERENCE Bancroft, J. (1990). Editorial. Ann. Rev. Sex Res. 1: i.
Annual Review of Sex Research (Vol. IX). Edited by Raymond C. Rosen. Society for the Scientific Study of Sexuality, Mt. Vernon, Iowa, 1998, 241 pp., $53.00. Reviewed by Cynthia Graham, PhD2
The Annual Review of Sex Research was first published in 1990, with the aim being to fill a gap in the literature by publishing reviews on a broad range of topics and disciplinary approaches in the area of sex research. Other stated goals were “to foster an interdisciplinary perspective, to provide a critical appraisal of theories and dogma in sexuality, and to set the agenda for future research” (Rosen, 1995). Volume IX certainly covers a very diverse range of topics and disciplines, including anthropological and cross-cultural research, sex differences in the rat brain, theories of sexual and reproductive behavior, sexual behavior in the Japanese quail, menstrual synchrony, and sexual revictimization. I will give a brief overview of each of the seven contributions. Parker and Easton’s chapter, “Sexuality, Culture, and Political Economy: Recent Developments in Anthropological and Cross-Cultural Research,” presents an overview of the development of anthropological research on sexuality over 2 Department
of Psychology, Indiana University, Bloomington, Indiana 47405.
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the last two decades. This essay provides an interesting account of how the social constructionist approach has developed and been applied in anthropological research. The authors identify key issues that the constructionist framework has highlighted, such as the complex relation between sexual behavior and sexual identity. They also discuss how the investigation of sexual cultures has increasingly been linked to the analysis of political and economic systems and trace the roots of this development. I found Juraska’s chapter, “Neural Plasticity and the Development of Sex Differences,” one of the most informative and well-written in this volume. Juraska provides an up-to-date and concise review of research on sex differences in the major cognitive areas of the rat brain—the cortex and hippocampus—and concludes with a short section on the relevance to human sex differences. The goals of the chapter are to show that “cellular sex differences are multifaceted and quite complicated” (p. 20) and “to illustrate that the plasticity of the brain interacts with sex” (p. 20). There are fascinating examples provided of how environmental events can alter neural sex differences, and of how neural changes may differ depending on the phase of the estrous cycle, all written in a way that is accessible for the nonspecialist. Juraska’s conclusion is that, even with the rat, there is no simple generalization about sex differences, but that “research in nonhuman species can help us understand the dynamic influences on, and the cellular basis for, sex differences in the human brain” (p. 35). Fisher and Fisher’s chapter, “Understanding and Promoting Sexual and Reproductive Health Behavior: Theory and Method,” is primarily devoted to a description of the Information–Motivation–Behavioral Skills Approach model developed by the authors. The model originated as an account of the determinants of HIV preventive behavior, but has been used in the area of adolescent contraceptive behavior. The basic tenets of the model are that information, motivation, and behavioral skills are “fundamental determinants of the initiation and maintenance of sexual and reproductive health behaviors” (p. 43). This somewhat unsurprising conclusion is supported by an exhaustive review of the relevant empirical research, resulting in a dense presentation that I found difficult to read. McClintock’s chapter, “Whither Menstrual Synchrony?,” provides a summary of the research carried out on the phenomenon of menstrual synchrony—the convergence of menstrual onset dates—since her original study was published in 1971. The review is organized around countering a number of “myths” that have arisen about menstrual synchrony. McClintock does an excellent job of revealing how, as she puts it, “well-founded observations have become interwoven not only with naive interpretation, but naive biology and naive statistics” (p. 78). For example, although critics have pointed to studies that have not detected synchrony as a “failure to replicate” her original findings, McClintock makes the valid point that one should not expect that menstrual synchrony should occur among all groups of women. Similarly, she argues that instead of asking whether menstrual synchrony exists or not, it is more appropriate to ask what variables affect menstrual
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synchrony and identify the characteristics of those groups who fail to synchronize, questions that have been addressed by researchers over the last three decades (e.g., Weller and Weller, 1993). She gives compelling evidence for the fact that menstrual synchrony is but one example of the social regulation of the ovarian cycle: “Other significant forms include asynchrony as well as stasis, the steady maintenance of initial phase relationships and cycle regularity” (p. 87). Although this volume does cover a good range of topics, it is worth noting that one-third of the volume is taken up by Balthazart and Ball’s chapter, “The Japanese Quail as a Model System for the Investigation of Steroid–Catecholamine Interactions Mediating Appetitive and Consummatory Aspects of Male Sexual Behavior.” The authors begin by explaining why the Japanese quail has become an alternative animal model to the laboratory rat. Although there is some discussion of behavioral sex differences in quail, the bulk of the chapter focuses on the neuroendocrine control of male sexual behavior. The authors describe their extensive research in this area, in particular their studies on the interaction between testosterone and dopamine in the regulation of sexual behavior, and research into the hormonal control of appetitive behaviors in male quail. Early on, the authors state that “if quail are also going to be considered an animal model one needs to address the question of what these studies might tell us about human sexual behavior” (p. 112). I was disappointed to find that this question was not addressed, except in a sentence or two. A briefer and more concise paper would have made this undoubtedly important work much more accessible to a wider audience. The chapter by Muehlenhard, Highby, Lee, Bryan, and Dodrill, “The Sexual Revictimization of Women and Men Sexually Abused as Children: A Review of the Literature,” is a comprehensive summary of the research investigating whether individuals who have experienced child sexual abuse (CSA) are at increased risk for adolescent or adult sexual victimization (AASV). The authors do a good job of highlighting the myriad of definitional and methodological issues in this area that, they argue, while similar to those in research on CSA generally, may have even greater implications for studies on sexual revictimization. In the second half of the chapter, the different theories that have been put forward to account for the relation between CSA and subsequent revictimization are discussed, including those that postulate that a history of CSA might be correlated with AASV because of a third variable or set of variables (e.g., family environment). One of the refreshing aspects of this chapter is that research findings in areas of tremendous controversy (e.g., the role of memory) are presented in a balanced and thoughtful manner. The authors conclude that the experience of CSA is associated with a higher risk of experiencing AASV and, regarding possible reasons for sexual revictimization, they state that “it is likely that different pathways between CSA and AASV operate for different individuals, and that multiple pathways sometimes operate within the same individual” (p. 218). The final chapter by Schmidt, “Sexuality and Late Modernity,” is an entertaining and thought-provoking piece that highlights the process of social and
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cultural transformation of sexuality in Western culture over the last two decades. Schmidt begins by arguing that traditional sexual morals, which focus on the morality of individual sexual acts, are being replaced by a “new moral code that prescribes negotiations between partners” (p. 225). Schmidt also discusses the evolution of a new form of relationship that Giddens has described as “pure”: “A pure relationship . . . is not based on institutions. . . . It exists in its own right, and lasts only as long as both partners are happy and satisfied with the ‘personal bonus’ it provides” (p. 227). He acknowledges that this type of relationship is mainly found only where traditional gender differences in society are minimized (e.g., in student couples without children). Another development he touches upon is an increasing use of “sexual escape routes”; for example, today’s young people are more likely than earlier generations to masturbate when living with a steady partner, apparently to escape from obligations, negotiations, and sexual propriety. There are a number of other trends that are discussed, including the impact of the Internet and the media, as well as a digression into the issue of social class, about which Schmidt writes that “it seems inevitable that this division into haves and have nots will drastically aggravate class differences in the realm of sex” (p. 235). Although he acknowledges that differences in sexual behavior related to social class have been negligible in recent years, he predicts that in future there will be an increased impact of social class on sexuality and intimate relationships. In summary, this volume of the Annual Review of Sex Research brings together up-to-date reviews on a diverse range of topics and covers different theoretical and methodological approaches; however, some of the chapters are more accessible to a cross-disciplinary audience than others. REFERENCES Rosen, R. C. (1995). Editorial. Ann. Rev. Sex Res. 6: i–ii. Weller, L., and Weller, A. (1993). Human menstrual synchrony: A critical assessment. Neurosci. Behav. Rev. 17: 427–439.
The Two Sexes: Growing Up Apart, Coming Together. By Eleanor E. Maccoby. The Belknap Press of Harvard University Press, Cambridge, Massachusetts, 1998, 376 pp., $39.95. Reviewed by Richard C. Friedman, MD3
During the past four decades, Maccoby has made important contributions to the field of sex differences in behavior. The developmental biopsychosocial 3 225
Central Park West, #103, New York, New York 10024.
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interactionist approach that has consistently informed her work remains timely. It provides a sound alternative to the reductionistic view of essentialists, who argue that behavior is biologically determined, and those social constructionists, who dismiss altogether the importance of biological influences on behavior: If there are any biological predispositions underlying development of the male and female patterns of social behavior . . . they never act alone. In humans and other species, the form that instinctive behaviors take depends on the environmental inputs that activate them. . . . To ask whether nature or nurture is more important in these developmental events is not a meaningful question. . . . Nature and nurture are jointly involved in everything human beings do. (p. 89)
The first two chapters of this volume discuss empirical research on the genderrelated behavior of children. Chapter 1, “Gender Segregation in Childhood,” reviews studies of sex-segregated childhood play. A preference among girls for playing with other girls is present by about age 3. Boys tend to follow suit the following year and by age 5 they prefer same-sex playmates more insistently and persistently than girls do. In both girls and boys, preference for same-sex playmates becomes more pronounced over time, peaking between the ages of 8 and 11. This behavioral tendency is initiated by children and not learned from adults. Research on the free play of children has been carried out among children of different nationalities, ethnicities, and socioeconomic status, and the evidence for the universality of sex-segregated play in mid and late childhood is robust. For example, 100 children in the San Francisco Bay area were observed at ages 4-1/2 and 6-1/2. At 4-1/2 years, children played three times more frequently with same-sex than oppositesex peers. Two years later, the ratio had changed to 11 to 1 (Maccoby and Jacklin, 1987). In a different study, investigators observed that between the ages of 8 and 11 the median percent time of boy–girl free play was zero (Gray and Feldman, 1997). Chapter 2, “The Two Cultures of Childhood,” reviews evidence indicating that juvenile girls and boys form peer cultures that are quite different from each other. The meaning of much behavior in children of this age must be understood in the context of the peer group in which it occurs. Sex differences in the behavior of girls and boys in groups tend to be greater than the sum of specifically defined behaviors of individual group members. The group is an entity greater than the sum of its parts. Maccoby observes that childhood play is a psychobiologically determined phenomenon. In fact, in humans and other mammals, it is one of the most important psychobiological influences on later development. The many functions of play include rehearsal for adult roles, fostering behavioral flexibility, facilitation of many types of social behavior, and fostering the capacity to express fantasy in art, music, and dance (Meaney et al., 1985). Maccoby describes developmental lines different for boys and girls beginning with sex differences in play and culminating in asymmetrical peer cultures of late childhood. Boys are drawn to participate in rough-and-tumble play and play fighting. These activities are rarely harmful, often a source of pleasure, and may facilitate bonding between peers. Within groups,
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boys compete with each other and establish dominance hierarchies. Groups of boys are also prone to compete with other such groups. Boys’ groups tend to be larger than those of girls and more walled off and bounded from the influence of girls and adults. Maccoby is quick to point out that although girls tend to be more affiliative, amenable to reason and compromise, and less physically aggressive than boys, girls’ groups are by no means immune from conflict. Girls tend to express what Maccoby (and others) term “relational aggression” more frequently than boys. For example, threats of alienation or even ostracism occur in situations where boys might be threatening in a more directly physical way. Maccoby’s observation that neither sex has a monopoly on virtue or vice is sagacious. The emphasis in this chapter and the book as a whole is on difference, not on whether such difference endows one sex or the other with moral superiority. Another important topic in the second chapter concerns the expression of fantasy during childhood. Boys imagine themselves to be heroes. They create scenarios in which they overcome dangerous obstacles or courageously triumph in combat over powerful adversaries. Although Maccoby does not comment on adult fiction, one notes that these scripts provide the basic building blocks for dramatic pieces by men and largely about males. This includes literature such as The Iliad, Moby Dick, and Deliverance, and stories aimed at younger audiences such as Tarzan, Batman, and Superman. Films such as Rocky, Rambo, The Seven Samuari, and Teenage Mutant Ninja Turtles, to name just a few, also express themes of masculine heroism. Stories expressing the fantasies of girls usually involve family life. Girls’ fantasy play frequently involves enacting family roles. Girls seem comfortable in assuming the role of father as well as mother, though the mother role is more central. (It is worth noting that boys seldom take on the pretend roles of either mother or father when playing with each other.) When girls enact family-based pretend scenarios, the preparation and serving of food looms large, as do other aspects of domestic life: managing households, entertaining guests, caring for children. When one girl takes the role of mother and another girl takes the role of child or baby, the “mother” enacts a number of nurturant activities: feeding the “baby,” putting on a Band-Aid, engaging in soothing talk when the “child” is hurt, and rocking a “child” to sleep. (p. 42)
Thus, girls everywhere organize fantasies around the theme of home life. In their pretend play, they sometimes take the roles of males. Juvenile-aged boys, however, with extremely rare exceptions (which I discuss later), do not imagine themselves in female roles. In Chapter 3, “Cross-Sex Encounters,” Maccoby observes that girls are often wary of boys, and likely to seek adult company when groups of boys are about. She argues that because of innate temperamental styles, boys tend to be rough, intrusive, and domineering and girls avoid them for their own protection. As children approach puberty, cross-sexed encounters tend to be tinged with romance and/or sexuality.
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The next section consists of three thoughtful chapters in which Maccoby discusses the meaning of sex differences in childhood from biological, social, and cognitive points of view. She observes that human sex differences are similar to those of nonhuman primates and make sense from an evolutionary perspective. The evidence that childhood rough-and-tumble play behavior is influenced by prenatal sex steroid hormones in humans, and many other mammals, is incontrovertible. The inference that the greater interest of human females in neonates and maternal doll play is also a result of the prenatal hormonal influences rests on a less substantial data base, but is plausible and at least in this reviewer’s opinion, likely. Maccoby notes that the interest of girls in neonates and maternal doll play and their preoccupation with themes of domesticity is in keeping with their subsequent capacity to be mothers. This is not to say that all women must be mothers of course or that motherhood is somehow intrinsic to the idea of femininity or that men cannot adequately care for children. Maccoby’s basic argument rests on evolutionary biopsychology. Temperamental relational tendencies to be maternal exist among women more than in men. Resulting in part from prenatal hormonal effects on the embryonic brain, and following birth, from diverse behavioral cascades, these influence the behavior of women independently of their actual reproductive status. It should be noted that although sociocultural diversity with regard to neonatal interest and care certainly exists, this reviewer is unaware of any research indicating that human males express more interest in and care for small children and neonates than females do in any society. Maccoby is more puzzled by the functional significance of juvenile roughand-tumble play in boys than maternal doll play and interest in girls. For instance, she writes Why should a young male who will later seek to father many children avoid girls and engage in male–male rough play during his childhood years? To ask this question makes us aware how little we know about the adaptive functions of play in childhood for later successful functioning. (p. 93)
One way of looking at juvenile male peer group behavior that Maccoby does not discuss is as a precursor to later life military organization. A qualification is necessary here. Competition is certainly not to be equated with destructive aggression, a point that Maccoby does stress. Be that as it may, throughout history, groups of men have organized themselves to make war and their armies have operated according to rules which, if not exactly the same as juvenile male peer groups, certainly can easily be seen as evolving from them. Many sports, both individual and team, also appear to have their origins in juvenile male peer organization. Moreover, concepts of masculinity across cultures tend to be heavily influenced by ideas that seem to have their roots in the culture of juvenile males (Gilmore, 1991). This is not to suggest that all societies have prescriptions about the meaning of masculinity that are sex-role stereotypic nor does it set the standard optimal moral behavior for one’s own society (whatever that happens to be). A
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widespread tendency seems to exist, however, despite the existence of sociocultural diversity. Maccoby extensively discusses the possible roles of social and cultural influences on sex-segregated play and the two cultures of childhood. Because of the limitations of space, the important topics she reviews will not be considered here. She does not discount social influences on gender role behavior, but argues that available evidence suggests that the role of parents in influencing this behavior is more limited than commonly believed. As Kohlberg (1966) originally observed, cognitive influences on gender identity differentiation, and gender role behavior, are substantial. These influences of cognitive development on gender categorization and sex-role script construction are thoughtfully and extensively considered. The latter part of the book discusses aspects of sex differences during adulthood in light of the two cultures of childhood. The major topics reviewed include heterosexual relationships, the two sexes in the workplace, and parenting. Once again, there are far too many interesting observations made than can be summarized here. For example, she joins the many others who have commented on the difference between the sexes with regard to sexual motivation. Women are more relational than men, who emphasize direct pleasure as a goal more frequently. A point not often made by others, however, is that the values of the sexes differ. Women primarily value the relationship and emphasize romance and commitment. Men (particularly young men) more frequently place loyalty to their peer group above loyalty to a particular romantic partner in a hierarchy of values. Another important point concerns parenting. Men may be thoughtful, loving, and devoted parents, but Maccoby points that “In all known societies, women, whether they are working outside the home or not, assume most of the day-to-day responsibility for child care” (p. 256). Although this volume is based on substantial empirical research, it is really about the development of boys and girls, men and women, who take conventional pathways toward male–female roles within their societies. For example, not discussed (or mentioned only in passing) are the developmental pathways of gay and lesbian, intersex, or transgendered people. Even so, important insights about these groups derive from observations about the conventional majority. For example, the tendency of boys to sex-segregate and to devalue feminine behavior suggests that the origins of homophobia among men might well be in late childhood. It sheds light on the often painful development of children whose juvenile peer preferences are for the opposite sex, who have sex-role atypical interests, and/or who imagine themselves in female roles. The Two Sexes is a major contribution to scholarship by an important and productive scholar. It is written clearly, without jargon, and is carefully and diligently referenced. It should be read and studied not only be developmental psychologists, and all students of sex differences in behavior, but by psychotherapists and couple therapists as well.
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REFERENCES Gilmore, D. D. (1991). Manhood in the Making: Cultural Concepts of Masculinity, Yale University Press, New Haven, CT. Gray, P., and Feldman, J. (1997). Patterns of age mixing and gender mixing among children and adolescents at an ungraded school. Merrill-Palmer Q. 42: 67–80. Kohlberg, L. A. (1966). A cognitive developmental analysis of children’s sex role concepts and attitudes. In Maccoby, E. E. (ed.), The Development of Sex Differences, Stanford University Press, Stanford, California, pp. 82–172. Maccoby, E. E., and Jacklin, C. N. (1987). Gender segregation in childhood. Adv. Child Dev. Behav. 20: 239–287. Meaney, M. J., Stewart, J., and Beatty, W. W. (1985). Sex differences in social play: The socialization of sex roles. Adv. Study Behav. 15: 1–58.