Medicalizations and demedicalizations of sexuality therapies

This article complicates recent discussions about the expanding zones and influences of medicalization and biomedicalization on sexuality and sex therapy by contextualizing them with competing nonmedicalizing trends. These latter developments include an escalating nonexpert commercial sexuality sector on the Internet, as well as a long history of anarchic and democratizing social politics, such as "the counterculture" and "free love movements." What these nonmedicalizing trends have in common is the view of sexual problems and solutions as far broader than sexual dysfunctions and sex therapies, a belief in the social determinants of individuals' sexual experiences, and a deep concern regarding the socially harmful consequences of medicalization. With the quantity of sexuality information and advice available to the public through the Internet only likely to expand, a long era of clashing claims about relations between sexuality and health and about the role of expertise in sexual life can be foreseen.     

The medicalization of women's sexual pain

The medicalization of women's sexual problems under the overall rubric of female sexual dysfunction (FSD) has been thoroughly critiqued by feminist scholars, health practitioners, and sex therapists. However, there has been much less commentary on the medicalization of women's sexual pain-currently, a subset of an official FSD diagnosis. This article critically examines interdisciplinary understandings and ways of addressing sexual pain. It analyzes these frameworks in relation to feminist theories on medicalization, heteronormativity, and the reciprocal relationship between these two processes. We argue that many women who experience sexual pain have been eager for medicalization as a path to minimizing pain during sexual activity and reinstating normative heterosexual practices and identities. These goals have been lobbied for by patient advocacy groups and noted by professionals in the field. Although there are some clear benefits to this case for medicalization, there are also theoretical, personal, and political costs. Guided by a growing body of feminist theoretical and qualitative, empirical research on this topic, as well as the first author's personal experience of sexual pain, this article highlights some alternatives to medicalization and makes suggestions for change.     

The Quest for the Elusive Female Orgasm

Public health information and educational interventions regarding human papillomavirus (HPV) have focused on the link between vaginal sex and cervical cancer among women. Many people are unaware that HPV can be transmitted through oral sex or that HPV causes oral cancers. Given that HPV infections and unprotected oral sex are increasing, research on oral sex-related HPV risk is important. This study examined the effect of a brief informational intervention regarding HPV and oral sex on the sexual risk cognitions of young adults. College students (N = 238) read information on HPV, oral sex, and oral cancer or no information. Participants then completed measures of oral sex and HPV knowledge, oral sex willingness, HPV vaccination likelihood, and risk perceptions. Participants who read the information on HPV and oral sex and cancer (compared to those who did not) reported greater knowledge, perceived risk and concern, and lower willingness to engage in oral sex. These effects were only significant among women. However, men reported a higher likelihood of future HPV vaccination compared to women who had not yet received the vaccine. Focusing on oral sex and cancer, this study adds to research investigating ways to reduce HPV infections.     

How Did Erectile Dysfunction Become “Natural”? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as “dysfunction” and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men’s sexual function as medical pathology. However, comparative qualitative data on men’s and their sexual partners’ experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men’s sexual dysfunction. The diversity in people’s sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.     

From Sin to Sick: Digital Judaism and Pornography

This article explores how a Jewish religious website dedicated to solving pornography addiction negotiates religion/tradition and science/technological modernity. Further, the article discusses how medicalization of sexuality is used to resolve inherent tensions in the practice of digital usage. Medicalization language transforms the GuardYourEyes.com website from a forbidden medium for ultra-Orthodox members into a clinical space, a tool for healing. Furthermore, medicalization language allows religious digital prosumers to speak freely about sexuality. By framing sexuality as a “problem of truth” (Foucault, 1998), the ultra-Orthodox authors of GuardYourEyes.com can speak about sex, without being guilty of breaking the admonition that forbids speaking about sex. However, this open discussion serves as a tool to discipline and regulate sexual behavior, thus maintaining the accepted community norms, albeit in a way that is revolutionary for this community. Furthermore, by supporting religious language with medical language, religion and science blur in a way that could potentially undermine both.     

Responsible mothers and normal children: eugenics, nationalism, and welfare in post-revolutionary Mexico, 1920-1940

This article examines the emergence of the eugenics movement in Mexico during the 1920s and 1930s and explores the ways in which eugenicists and physicians participated in the creation of a new paternal order focused on motherhood, sexuality, and child welfare. I analyze this transformation as part of a broader process of medicalization and state expansion that recast understandings of reproduction, heredity, childhood, and the female body during the post-revolutionary period. I argue that eugenics, and the related puericulture movement, played a critical role in the emergence of novel forms of governmentality, the nationalization of women, and the neutralization of anterior forms of patriarchy in modern Mexico. The article contributes to a growing body of scholarship on the meaning of motherhood, the standardization of elementary school education, and the formation of welfare states in Latin America.     

Transformations in the medicalization of sex: HIV prevention between discipline and biopolitics

This article examines transformations in HIV prevention strategies from the 1980s to the present. Drawing on the concepts of medicalization (Conrad, 2007 ), discipline and biopolitics (Foucault, 1976/ 1988 ), and biomedicalization (Clarke, Fishman, Fosket, Mamo, & Shim, 2003 ), it explores the shift from behavioral to biomedical and surgical prevention techniques-a shift symbolic of a more general trend toward the biomedicalization of sexuality. It argues that, although biomedical and surgical approaches (chemoprevention and male circumcision) have certain benefits, their efficacy is limited and uncertain. They do not guarantee individual protection. The aim is no longer the modification of sexual behavior through disciplinary strategies aimed at the development of subjective and sexual awareness, but the modification of health behavior as a positive response to biomedical recommendations. Through the use of preventative or curative drugs, the same type of sexual awareness is seen as no longer required.     

Knowledge,Attitudes, and Informational Behaviors of College Students in Regard to the Human Papillomavirus

Abstract

Objective: To assess students’ human papillomavirus (HPV) knowledge, attitudes, and behaviors. Participants/ Methods: Students (N = 1,282) at a large, public university in the Northeast United States completed a questionnaire during February 2008 assessing HPV knowledge, prevalence, transmission, cervical cancer risk and stigma; sexual behavior, vaccination status, as well as past and preferred sources of information about HPV and sexual health. Results: A majority of respondents know of HPV. However, understanding was insufficient in several important areas. Overwhelmingly, respondents heard about HPV via television commercials yet preferred to obtain sexual health information from physicians. Hearing about HPV on a TV commercial was associated with increased knowledge. More knowledge of HPV was associated with less stigma. Men exhibit a higher level of stigma and less knowledge than women. Conclusions: Publicly funded health campaigns aimed at increasing knowledge about HPV are overdue and necessary. This is especially true for efforts targeting young adults about this extremely common sexually transmitted infection (STI).     

The Effects of a Web-Based Intervention on College Students' Knowledge of Human Papillomavirus and Attitudes toward Vaccination

ABSTRACT

Research suggests that college students know relatively little about human papillomavirus (HPV), and that educational interventions increase knowledge of HPV. However, to date, there are no published studies testing the effects of computer-based education on attitudes toward being vaccinated in this population. The present study of 119 college students explored the effect of a web-based intervention on participants' knowledge of HPV and attitudes toward HPV vaccination. Participants were randomized to a web-based, self-administered HPV educational intervention or to a control group. Knowledge and attitudes were assessed at baseline, after the completion of the intervention, and at one-month follow-up. At baseline, women knew more than men about risks and symptoms of HPV. At immediate and long-term follow-up, the intervention group had better knowledge of HPV and more positive attitudes toward HPV vaccination than the control group. There were some gender differences in response to the intervention; increases in knowledge of HPV were greater in men, while changes in attitudes toward vaccination were larger in women.     

Social Ecological Factors of Sexual Subjectivity and Contraceptive Use and Access Among Young Women in the Northwest Territories,Canada

Adolescent women in the Northwest Territories (NWT), Canada, experience many sexual health challenges that are linked to a history of colonization and intergenerational effects of trauma. This study was informed by social ecological theory and explored how young women in the NWT develop sexual subjectivity within the context of contraception use and access during this time of decolonization. A total of 41 participants (aged 13 to 17 years) attended the Fostering Open eXpression among Youth (FOXY) body-mapping intervention in six NWT communities and then completed semistructured interviews. Framework analysis identified barriers to the development of sexual subjectivity that included a culture of stigma and shame surrounding sexuality; pervasive alcohol use in communities; predatory behaviors by older men; poor quality sexual health education offered in schools; and issues with accessing health services. In addition, analysis identified the following facilitators: comprehensive sexual health education; widespread access to free condoms; and positive health support networks with female relatives, peers, and some teachers. Our findings suggest the need for multiple intervention strategies within a complex social ecological framework, including arts-based interventions that focus on developing self-esteem and self-efficacy of youth, combined with interpersonal interventions that strengthen communication skills among supportive adults, and community-level campaigns that target stigma reduction and shift cultural norms.     

Effects of a peer-led AIDS intervention with university students

Acquired immune deficiency syndrome (AIDS) has become a major health threat to university students. This study evaluated a peer-led AIDS intervention program with university students (1) increase knowledge of human immunodeficiency virus (HIV) transmission and infection; (2) change attitudes to reflect scientific information on AIDS-related facts; and (3) change behavioral intentions to correspond with safer sexual practices. Subjects were students (N = 142) from four undergraduate classes and were predominantly female (65%), white (82%), and sexually active (86%). A non-equivalent control group design was used, with two classes receiving the intervention and two classes receiving no information. For the intervention, peer educators presented AIDS-related information, modeled ways to use condoms safely and ways to discuss condom use with sexual partners, and led discussions on HIV infection and use with sexual partners, and led discussions on HIV infection and AIDS, relationships, sexuality, and condom use. A questionnaire was administered to assess differential changes in AIDS-related knowledge, attitudes, and behavioral intentions between the intervention and control groups. The results showed significant improvements among intervention subjects on the knowledge, attitudes, and behavioral intentions scales compared with the control group.     

Sex With Chinese Characteristics: Sexuality Research in/on 21st-Century China

This article examines the changing contours of Chinese sexuality studies by locating recent research in historical context. Our aim is to use the literature we review to construct a picture of the sexual landscape in China and the sociocultural and political conditions that have shaped it, enabling readers unfamiliar with China to understand its sexual culture and practices. In particular, we focus on the consequences of recent changes under the Xi regime for individuals’ sexual lives and for research into sexuality. While discussing the social and political regulation of sexuality, we also attend to the emergence of new forms of gendered and sexual subjectivity in postsocialist China. We argue throughout that sexuality in China is interwoven with the political system in a variety of ways, in particular through the tension between neoliberal and authoritarian styles of governance. We explore normative and dissident sexualities as well as forms of sexual conduct that are officially “deviant” but nonetheless tolerated or even tacitly enabled by the party-state. In particular, we highlight the dilemmas and contradictions faced by China’s citizens as they negotiate their sexual lives under “socialism with Chinese characteristics.”     

‘I myself had a sweetie …’: re‐thinking female same‐sex intimacy beyond the institution of marriage and identity politics

This article is understood as an intervention into current debates around the question of rights in relation to sexuality and in particular to issues of same‐sex marriages and alternative family structures. As the interpretation of rights in relation to sexuality generally focuses on gay identities, this article reflects on the effects of these discourses on non‐normative modes of sexuality and intimacy. More specifically the article focuses on interviews conducted in Johannesburg on ‘mummy–baby’ relationships. By contextualising these relationships in the historical and cultural framework of sexual cultures and cultures of intimacy, this article argues that the South African history and cultures provided and provide a space which accommodates forms of female same‐sex intimacy that are not necessarily linked to metropolitan sexual cultures. The article discusses the tensions between non‐lesbian same‐sex intimacy and metropolitan lesbianism by focusing on homosociality as a gender theory. The article questions the regulatory functions of identity and problematises the practice of ‘coming out’ as always being a liberating moment.     

Why medicalization? Introduction to the special issue on the medicalization of sex

This special issue grows out of the need to bring into focus the historical and sociocultural contextualization of sex to the sexological community. The specific focus is on analyzing how medicalization is affecting many areas of sexual life and discourse, but the larger goal is to help situate sexuality studies in its broadest perspective. Articles will be of general interest to those interested in interdisciplinary scholarship; the specific articles address HIV politics, sex therapy, women's sexual health, sex and aging, the popularization of weak science, and the media's view that sexual exuberance is a central marker of recovery from cancer. Medicalization is a current trend that illuminates the importance of a broader view of sexology.     

Effects of sexually transmitted infection status, relationship status, and disclosure status on sexual self-concept

Research has indicated that having a sexually transmitted infection (STI) such as genital herpes and genital human papilloma virus (HPV) can have a negative impact on an individual's sexuality. The current study was designed to evaluate the effect of STI status, relationship status, and disclosure status on various dimensions of sexual self-concept. A questionnaire that evaluated the above variables was completed by 117 individuals with genital herpes, 82 individuals with HPV, and 75 individuals with no STI. The results demonstrated that having herpes or HPV had a significant negative impact on aspects of sexual self-concept. It does not appear that an individual's relationship status is a factor associated with the impact of having an STI on the sexual self-concept. Respondents who had disclosed their STI to their partners, however, had significantly more positive feelings about aspects of their sexual self-concept than those who had not disclosed their STI to their partners. The implications of these research findings for health practitioners are discussed.     

Parenting in 2 Worlds: Testing improved parent–adolescent communication about sexuality in Urban American Indian families

Urban American Indian (AI) adolescents are more likely than non-Natives to have early sexual debut, teen pregnancies, sexually transmitted infections, and inadequate sexual health information. A RCT in three Arizona cities, with 585 parents of urban AI adolescents, tested whether a culturally tailored parenting intervention for urban AI families, Parenting in 2 Worlds (P2W), increased parent–adolescent communication about sexuality, compared to an informational family health intervention that was not culturally tailored. P2W produced significantly larger increases on two measures: communication about general sexual health and about sexual decision-making. The desired effects of P2W on the first measure were stronger short-term for cross-gender dyads, while for the second measure, they were stronger long-term for both mothers and fathers of adolescent sons.     

The sexualization of the medical

The medicalization of sex is part of an already-in-place discursive problem that can be illuminated by looking at efforts to sexualize the medical. "Erectile dysfunction," "female sexual dysfunction," and their real and imagined pharmacopia, do not constitute the medicalization of sex; they are effects of sex already having been-to borrow a term from Peter Conrad ( 1992 )-healthicized. The equation of sex and health, as cultural common sense, has made health seem like the natural discourse for thinking about sex in the first place. Reversing the terms of this special issue, and using the methodology of rhetorical analysis, this article looks at the person with cancer as a sexualized subject-someone whose health is represented as intimately tied to his or her sex life. It suggests that, in public discourse-and notably in movies and on television-sex is the comic ending of the illness narrative. In light of this narrative move, the ability to have good sex joins the ability to be positive and cheerful as a (Western) cultural imperative of illness experience, in general, and cancer experience, in particular. Public representations of illness virtues often fail, then, to answer realistically the compelling question, "How shall I be ill?"     

Effects of Sexually Transmitted Infection Status,Relationship Status,and Disclosure Status on Sexual Self-Concept

Research has indicated that having a sexually transmitted infection (STI) such as genital herpes and genital human papilloma virus (HPV) can have a negative impact on an individual's sexuality. The current study was designed to evaluate the effect of STI status, relationship status, and disclosure status on various dimensions of sexual self-concept. A questionnaire that evaluated the above variables was completed by 117 individuals with genital herpes, 82 individuals with HPV, and 75 individuals with no STI. The results demonstrated that having herpes or HPV had a significant negative impact on aspects of sexual self-concept. It does not appear that an individual's relationship status is a factor associated with the impact of having an STI on the sexual self-concept. Respondents who had disclosed their STI to their partners, however, had significantly more positive feelings about aspects of their sexual self-concept than those who had not disclosed their STI to their partners. The implications of these research findings for health practitioners are discussed.