Why are health psychologists interested in human sexual behaviour and how have they attempted to study it?
SS3.27 Psychology of Education & Health Lecturer: Carla Willig
Why are health psychologists interested in human sexual behaviour and how have they attempted to study it?
In order to thoroughly answer the question posed various factors need to be scrutinized. Firstly the main reasons for health psychologists' interest in human sexual behaviour shall be explored and secondly the main methods used will be described. The foremost techniques shall be argued to be sex surveys, laboratory studies, studies of social cognitions, sexual experience within close relationships, and the study of sexual meanings. These five contemporary approaches are behavioural, physiological, cognitive, relationship and meaning orientated respectively and an example of each shall be presented. All these features will be evaluated in detail before summarising the main points and offering a conclusion as to which direction future research into human sexual behaviour should take.
From a health psychologists viewpoint it is unproblematic to see why they choose to study human sexual behaviour. The three main reasons resolve around the idea of mind-body interdependence, physical/emotional consequences and social interaction. The first motive is pretty straightforward as sexual activity incorporates the body as well as the mind. Yet the second one is slightly more complex. The outcomes of sexual behaviour could include pregnancy (wanted or unwanted), sexually transmitted diseases or major emotional problems such as guilt or humiliation. Both bodily and emotional consequences can have a serious effect on an individual's psychological well-being. Indeed history has been punctuated by a series of panics around sexuality over "childhood sexuality, prostitution, homosexuality, public decency, STD's and pornography", (Weeks, 1985). The final imperative reason for health psychologists' interest in sex is due to the social interaction that takes place during a sexual encounter. Sex is very much a social activity and therefore affords health psychologists attention (as originally derived from social psychology).
Historically (preceding 19th century) a wholly moral approach to sexual behaviour prevailed. Sexologists (not unified discipline) classed sex into two genres, reproductive and non-reproductive. The former was considered the only moral rationalization for sexual pleasure and the latter was classed as 'sodomy' i.e. a temporary aberration. Through the 19th century however a more medico-scientific approach to sex influenced which assumed a continuum between normal (healthy) and abnormal (unhealthy) sexual activity. This centred on the idea that sexual behaviour is actually an inherent trait rather than the aberrant behaviour suggestion that preceded the 19th century. Moreover, this new approach produced sexual types, such as 'homosexual' 'sadist' 'transvestite' 'masochist' and so on. Sexologists ("the scientists of sex, the arbiters of desire" Weeks, 1985) were studying people who did not conform to sexual norms rather than those 'ordinary' people who did. Marquis de Sade detailed the "thousand sins (and pleasures) of Sodom...discourse of sexology was to measure the range of the perverse" Weeks, 1985. Yet, in the middle 20th century sexologists began to describe typical human sexual behaviour. The lack of knowledge surrounding normal sexuality was acknowledged and measures made to alter this, which led to modern sexology. Kinsey et al (1953) argued the "scientific understanding of human sexual behaviour was more poorly established than the understanding of almost any other function of the human body." This became the rationale for his later survey. However, Weeks (1985) believes that sexologists' work to give sex a scientific basis and concern has been disastrous and that there is a need to back away to the old structures of meaning (see Willig, 1998).
There are currently three principal approaches to the study of sexual behaviour and experience. Namely, these are sex surveys, laboratory studies, and social constructionist studies. Although additional alternative approaches have also been implemented to aid the understanding of human sexual behaviour, these are: the study of sexual experience in the context of close relationships and the study of sexual meanings.
Sex surveys have a behavioural focus and are usually implemented through the use of questionnaires. The questions asked usually relate to particular themes such as; age at first intercourse, number of sexual partners, sexual orientation, frequency ...
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There are currently three principal approaches to the study of sexual behaviour and experience. Namely, these are sex surveys, laboratory studies, and social constructionist studies. Although additional alternative approaches have also been implemented to aid the understanding of human sexual behaviour, these are: the study of sexual experience in the context of close relationships and the study of sexual meanings.
Sex surveys have a behavioural focus and are usually implemented through the use of questionnaires. The questions asked usually relate to particular themes such as; age at first intercourse, number of sexual partners, sexual orientation, frequency of intercourse, use of contraception amongst others.
The two core characteristics of sex surveys are that: 1) they have a propensity to receive great opposition from influential institutions and individuals who feel that the questions are socially and/or morally unsuitable 2) They habitually reveal a much larger diversity of sexual practices than one would have thought within that particular culture. For instance, the former attribute was made apparent quite recently when Margaret Thatcher chose to delay a national sex survey aimed at reducing the spread of HIV because she felt it was a bit precarious and that certain individuals may be offended. Furthermore Kinsey et al were told to only publish their findings with a medical publisher.
The Kinsey reports (Kinsey et al, 1948; 1953) were the earliest mass sex surveys and interviews of this sort are typically approved in order to answer certain social/medical questions. In this particular survey data was obtained and consequently analysed from 5,300 males and 5,940 females. The interview itself was extremely intensive and covered 300-500 questions that took on average two hours to complete. To thoroughly study human sexual behaviour Kinsey et al asked about an extensive range of features of sexual experience. The major findings that resulted from this survey were that there were high incidences and considerable frequencies of particular sexual behaviours that had been considered rare and even abnormal prior to this. Examples of these findings include: 25% of teenage males had experienced homosexual activity to the point of orgasm and by age 40, 50% of men and 26% of women had indulged in extramarital sex. While criticisms of Kinsey's survey include the fact that all the interviewers were male whilst 50% of the respondents were female. This could have caused problems as far as full honesty is concerned and studies have argued that both sexes tend to find it less difficult to be interviewed by a woman (Johnson et al., 1994). In terms of representiveness a great deal of the interviews took place in same sex institutions such as education and penal establishments, this could lead to over reporting of homosexual experiences compared to the general public.
Another mass survey was the National Survey of Sexual Attitudes and Lifestyles (NSSAL) by Johnson et al., 1994. The objectives of this study were two fold: 1) To make accessible data which would enhance understanding of transmission patterns of HIV and other STD's. 2) To attain information which would be helpful in designing valuable HIV/AIDS education interventions. This is crucially vital as "disease sanctions govern and encode many of our responses to sex. It is this which makes the moral panic around AIDS...so important" (Weeks, 1985). These aims were achieved by administering a questionnaire through personal interview and the inclusion of self-completions booklets for the most sensitive questions. Some findings from NSSAL include: non-use of contraception at first intercourse has declined steadily; condoms are the most popular form of contraception at first intercourse and 17.6% of sexually active men and 21.1% of sexually active women reported no use of contraception in the past year, see Figure 1. The central criticism of this survey is that the age of respondents was 16-59; non-inclusion of anyone older than 59 could be problematic as it is unlikely that sexual relations suddenly stop at this age and therefore the sample is not truly representive.
Figure 1 Johnson et al., 1994. Contraceptive method used in the last year by single respondents
Consequently sex surveys are not without fault, as made apparent earlier there is a clear systematic bias in terms of their representiveness. Additionally many problems present themselves in terms of the validity of this method, these include social desirability bias, interviewer effect (gay participant may not tell a heterosexual interviewer what they might say to another homosexual), use of clinical language (creates a medical frame which may limit what participants say), and furthermore they have an observably restrictive design.
Alternatively laboratory studies have a physiological focus i.e. Masters & Johnson, 1966.Virginia Johnson was a student of master's and the experimental questions they set out to answer were: 1) what happens to the human male and female as they respond to effective sexual stimulation 2) why do men and women behave as they do to effective sexual stimulation. They recruited male and female participants aged 21-40 years old and asked them to either have sexual intercourse or to masturbate in a room containing a two way mirror (observation took place in the adjacent room). The participants had electrodes attached to their bodies and in more current investigations the researches inserted micro cameras into the body to monitor internal processes. Masters & Johnson's whole study took 11 years and the investigators observed over 10,000 sexual response cycles. They ultimately 'found' that male and female responses follow the same pattern (See Table 1.).
4 PHASES OF SEXUAL RESPONSE:
(1) EXCITEMENT
(2) PLATEAU
(3) ORGASM
(4) RESOLUTION
Table 1. Masters & Johnson's sexual response cycle
Supplementary findings demonstrated verification of sexual arousal throughout the entire body such as vasocongestion and myotonia, increase blood flow and muscle tension respectively. Additionally it was realised that more intense orgasms (physiologically) were achieved through masturbation and this was apparent in both sexes. Lastly orgasms were found to be more reliably produced through masturbation for women. These findings from the study can and have been incorporated into sex therapy as steps can be taken to help people achieve the sexual response cycle; initial evaluation of this type of treatment has shown that it can be effective.
Criticisms include the very significant fact that Masters & Johnson were only interested in the sexual response cycle and they subsequently recruited people who stated that they functioned 'normally'. They were therefore ultimately recruiting people who already fitted the bill and excluding any individuals who would have disconfirmed their expectation about what would come to pass. The core problems with laboratory studies such as these are that they lack ecological validity, lack representiveness (participants clearly interested in sex and have minimal inhibitions about been involved), and medicalisation of sexuality as a laboratory setting is not a very natural place for sexual activity. Additionally 70's feminists had extremely negative things to say about the apparent pressure for women to go through the 'normal' sexual response cycle.
The next central method of studying human sexual relations is through social constructionist studies, this approach has a meaning-centred focal point and is implemented through the use of questionnaires. It analyses the consequences of dissimilar meanings attributed to sex, for instance HIV and AIDS. Examples of these include Holland et al (1991; 1998) and Willig (1995; 1997). An interesting example is of a homosexual male who takes a big risk by not using a condom during anal intercourse because of the meaning behind it (Willig, lecture 2001). Studies of this kind aim to predict sexual behaviour through analysing behavioural intentions. Researchers who implement social cognition models believe that "people's sexual behaviour is mediated by attitudes rather than knowledge" (Marks et al, 2000). Various theories such as the health belief model, protection motivation theory, theory of reasoned action and more recently the Cognitive-Environmental model have educated health psychologists' study of sexual behaviour. Rosario et al (1999) attempted to understand the sexual behaviour of homosexual and bisexual youths using the Cognitive-Environmental model (CEM) created by Fishbein et al (1991). The researchers in this study argued that three factors are generally necessary and sufficient to predict behaviour according to the CEM. They proposed that behaviour
is influenced by: 1) skills or abilities to engage in the behaviour 2) intentions or commitments to perform the behaviour 3) absence of environmental constraints that prevent the behaviour. One of the major findings of this study was that of a significant relation between social desirability and unprotected anal and oral sex, this discovery obviously has serious implications for HIV research.
An additional first-rate example of this cognitive method for studying sexual behaviour comes from research conducted by Rise (1992) using the Theory of Reasoned Action (TRA). Rise established that the decision whether or not to use a condom was under normative control, and immediate consequences were more important than long-term consequences. Thus persuasive communications should pay increased attention to social pressure and also psychological costs as individuals will consistently choose the alternative "which maximises benefits and minimizes costs" (Luker, 1975).
However there are criticisms of the social cognitions approach. One of which is the reliance on questionnaires. This is clearly problematic as cognitions are not necessarily stable (See MacDonald et al, 1999). It's ability to predict behaviour is therefore undermined, especially as two or people are involved in sexual activity and as a result you have more than one person's cognitions to interpret and predict. Additionally reliance on self-reports (as with previous techniques) on past sexual behaviour can pose a problem due to memory problems and associated mistakes in accuracy. Lastly individuals who have tended to be the focus of these types of studies have usually been those most perceived as been at risk from HIV infection, i.e. homosexual men and young sexually active people. Clearly this is not necessarily true (see Johnson et al, 1994) and additional studies need to take place with older people as the focus.
Research into sexual experience within close relationships is a fairly new method of studying sexual behaviour and it tends to centre greatly on the measurement of sexual satisfaction, usually through the use of questionnaires, interviews, diaries and observation. However this does not give the researcher must information, for instance health psychologists are unable to gain knowledge of which aspects of the sexual relationship are particularly satisfying. moreover the majority of respondents tend to position themselves at the higher end of the response scale (little variation in the responses), yet it is unlikely that all participants are equally satisfied with their sexual relationship. Methodological issues that arise with this method of studying human sexual behaviour include self-report biases (under-or over reporting), memory problems and artificiality. Another major problem is that "quantitative averaging of...varied experiences does not capture the diverse range of experience of an individual's sex life" Marks et al, 2000.
The study of sexual meanings is a further technique for studying sexual behaviour and it originates from a social constructionist standpoint; discourse analysis especially is frequently implemented in order to comprehend how people make sense of events. The aim is to understand sexual activity by analysing the meanings people attribute to their actions. Discourse analytic theory is used frequently and is primarily concerned with discursive constructions of sexual activity and their implications for sexual practice. A study by Willig (1995) looked at heterosexual adults' accounts of condom use, she was concerned about the preoccupation with 'risk groups' (gay men, injecting drug users etc) as this could create a false sense of security among heterosexual non-drug using adults. The results were extremely interesting and it appears that condom use is associated with casual sex. Therefore discontinuing condom use signifies the establishment of trust within a relationship as condoms carry symbolic meaning. Clearly trust to these individual carries such a meaning that they call upon it to justify not using condoms; this is quite a different perspective on trust than sex education professionals promote. Willig (1998) also carried out interviews with male and female participants and discovered constructions of sex as a male preserve, these prevent women adopting sexual agency and hinder their ability to prevent HIV infection (See Knox, 2001). Consequently Willig proposed that "sex education within the context of HIV/AIDS must challenge these constructions if it is to be effective" The problems that arise from studying sexual meanings are such as how time-consuming the technique is and how small the samples tend to be. It takes an enormous amount of time to transcribe an interview. Moreover, Segal (1994) argues that this approach "fails to address questions about bodily and psychic processes".
To conclude, "In modern civilised life sex enters probably even more into consciousness than hunger". Edward Carpenter, Love's coming of age. In essence this quote sums up the reason why health psychologists are accordingly interested in sexual behaviour, and why Kinsey was so shocked that it hadn't previously been studied further. However the contemporary reasons health psychologists study human sexual behaviour/experience are because of the mind-body interdependence, the consequences (both emotional and physical) and lastly because of the social interaction involved. The five main approaches to the study of sexual behaviour/experience have been cited with praises and criticisms explored. It is clear that health psychologists need to further develop alternative research strategies in order to gain access to differing types of data and to advance and improve the reliability and validity of contemporary research results. In order to do this the problems mentioned with the techniques need to be minimalised if possible and a more eclectic approach could prove beneficial as currently contrasting approaches are measuring incompatible aspects of human sexual behaviour.
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Rachel MacDonald Why interested in human sexual behaviour and how attempted to study it?
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