HLP 7 VR Lesson TemplateAppendix D Lesson Plan TemplateInstru

HLP 7 VR Lesson Template
Appendix D: Lesson Plan Template
Instructions: Complete tables with your own information by
deleting & replacing light gray example text. Consider either (a)
developing separate plans for in-person & remote instruction or
(b) including examples across contexts
Creating Effective Classroom Environments Social Skills
Lesson Plan Template
Educator Name:
Add
Grade Level/Period:
Add
Date: Add
Lesson Focus:
Demonstrating _________________ (expectation) in the
_________________ (setting/routine).
Teaching Objective:
Following instruction, students will demonstrate
_________________ (expectation) in the _________________
(setting/routine)
by_________________________________(describe behaviors)
across __ out of __ sampled opportuni ties (criteria).
Teaching Examples:
Positive Examples
(Looks, sounds, & feels like…)
Negative Examples
(Does NOT look, sound, & feel like…)
·
·
·
·

·
·
Lesson Materials:
Lesson Activities:
Model (I do):
Lead (We do):
Test (You do):
Follow-up Activities:
Strategies to prompt:
Procedures to reinforce context-appropriate behavior:
Procedures to correct errors (e.g., context-inappropriate
behavior):
Procedures to monitor/supervise:
Procedures to collect and evaluate student data:
Lesson plan template adapted from: Simonsen, B., Myers, D.,
Everett, S., Sugai, G. Spencer, R., & LaBreck, C. (2012).
Explicitly teaching social skills school-wide: Using a matrix to
guide instruction. Intervention in School and Clinic, 47, 259-
266. https://doi.org/10.1177/1053451211430121
265

The Psychology of Human Sexuality, Second Edition. Justin J.
Lehmiller.
© 2018 John Wiley & Sons, Ltd. Published 2018 by John Wiley
& Sons, Ltd.
Companion Website: www.wiley.comgolehmiller2e
10
CHAPTER OUTLINE
Introduction, 265
Sexual Development From Infancy Through Adolescence, 267
Infancy and Childhood, 267
Puberty, 268
Adolescence, 270
Biopsychosocial Influences on Teenage Sexual Activity, 273
Implications of Early or Late Sexual Development, 274
Sexuality and Aging, 277
Biopsychosocial Influences on the Sexual Activities of Older
Adults, 281
Lifespan Sexual Development
Introduction
Take a moment and think back to your very first sexual
experience (if you have not had one yet,
envision what that experience might be like). Next, imagine
what your sex life will look like ten
years from now—what kinds of things do you think you will
desire, and which activities might
©JohnnyGreig/Getty Images

Lehmiller, J. J. (2017). The psychology of human sexuality.
John Wiley & Sons, Incorporated.
Created from umuc on 2021-11-19 16:32:16.
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http://www.wiley.comgolehmiller2e
10 Lifespan Sexual Development266
you engage in? Finally, think about what your sex life will be
like in the distant future, when you
are much older and in your retirement years.

If you’re like most people, you have probably never stopped to
seriously reflect on how your
sex life has evolved over time, or how it is likely to change in
the future. However, if you took the
exercise in the opening paragraph seriously, chances are that
you discovered just how dynamic
human sexuality can be across the lifespan. It is precisely this
insight that has led psychologists
to begin looking at human sexuality as a developmental process.
Psychology has long since
abandoned the Freudian view that virtually all of our sexual
development occurs in childhood
as we advance through a series of psychosexual stages (perhaps
getting “fixated” in one of them
along the way). Instead, psychologists now view sexuality as
something that continually evolves
over the lifespan in response to biopsychosocial influences.
In this chapter, we are going to look at sexuality at various
stages of the life cycle. Specifically,
we will address the development of sexuality in childhood and
adolescence, as well as the ways
in which it changes in older age. This chapter will devote
particular attention to biopsychoso-
cial factors that trigger changes in sexual development at these
different life stages. We will also
consider the implications of becoming sexually active much
earlier or later than one’s peers.
Before we begin, it is worth pointing out that we do not have as
many data and as much
information on lifespan sexual development as we would like.
Most sex research has focused
on young adults (as described in previous chapters), with
children and seniors being largely

neglected. There are a few reasons for this. Conducting research
on sexuality in childhood
is politically challenging. For example, in the United States, sex
researchers cannot survey
persons under age 18 about their sexual attitudes and behaviors
unless they receive parental
consent. Many parents are reluctant to provide their consent,
either because they do not see
their children as sexual beings or because they feel that it would
be inappropriate or immoral
for their kids to participate in sex research. As some evidence
of this, recall from chapter 2
that when the initial wave of the National Survey of Sexual
Health and Behavior (NSSHB) was
undertaken, about 4 in 10 of the parents who were contacted
refused to let their children aged
14–17 take part in the study (Herbenick et al., 2010). Due to
such resistance, much of our data
on sexuality in childhood and adolescence comes from
retrospective self-reports of adults who
try to recall what they can from the past, or from self-reports of
parents who provide infor-
mation about behaviors they have observed among their
children. However, these are both
imperfect methods that raise some concerns about the validity
of the data, with the former
being subject to memory distortions and the latter consisting of
secondhand information from
untrained observers (recall from chapter 2 that two people
watching the same activity could
categorize it very differently).
Our lack of information on the sex lives of older adults has been
hampered by the fact that
most sex research takes place on college and university
campuses. The increasing move-

ment toward online research has enhanced older adults’
representation in sex studies to some
degree; however, there are limits to what online research can
accomplish, given that seniors
are less likely than the rest of the adult population to go
online—indeed, 41% of US seniors age
65+ say they do not use the internet at all, a figure that is about
three times higher than that of
the overall adult population (Smith, 2014). In light of this,
achieving representative samples of
seniors tends to be quite labor intensive and expensive. Another
reason older adults have been
overlooked in most sex research probably stems from mistaken
assumptions and stereotypes
about sexuality and aging and, perhaps, discomfort with the
topic. Just as many parents refuse
to recognize their children as sexual beings, many people refuse
to recognize seniors as sexual
beings, too.
Thus, as we explore sexuality across the lifespan in this chapter,
keep in mind that this is an
area in which our empirical knowledge is limited in several
ways.
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Sexual Development Fom nfanncy TFouuT Aolesnenne 267
Sexual Development From Infancy Through Adolescence
Let us begin by taking a look at how sexuality develops and
changes during childhood and
adolescence, as well as some of the most significant biological,
psychological, and social factors
that contribute to early sexual development.
Infancy and Childhood
Sex researchers dating back to Alfred Kinsey have noted that
sexuality has its roots in infancy.
Indeed, both male and female infants are capable of sexual
response from the moment of
birth, if not before. For example, not only have erections been
observed among male infants

in the first hours of life, but ultrasound studies indicate that
male fetuses experience erec-
tions in the womb, too (Hitchcock, Sutphen, & Scholly, 1980).
In addition to showing signs of
physiological sexual response, infant self-stimulation has been
documented; however, there is
some debate about whether a behavior such as this that occurs
so early in life is purposeful.
Kinsey’s writings include references to both male and female
infants engaging in various forms
of self- stimulation, such as rubbing or thrusting their genitals
against an object, followed by
what appears to be orgasm (Kinsey, Pomeroy, & Martin, 1948;
Kinsey, Pomeroy, Martin, &
Gebhard, 1953). The orgasms of male infants are different from
those of adult men, though, in
that they are dry orgasms, meaning no ejaculation occurs. What
the psychological experience
of these behaviors is like for infants, we do not know, although
it does appear that they find
these activities to be gratifying.
As motor development progresses, children begin to engage in
genital manipulation that
more closely resembles adult masturbation, something that may
occur as early as two-and-
a-half years of age (Martinson, 1994). Many children—both
male and female—experiment
with masturbation at this time and in the years leading up to
puberty. In fact, retrospective
self-report data indicates that approximately 4 in 10 adult men
and women recall prepubertal
Figure 10.1 Ultrasound studies reveal that the human body’s
capacity for sexual response begins in the womb.
©GagliardiImages 2016. Used under license from

Shutterstock.com.
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masturbation and, further, about 1 in 8 recall having their first
orgasm before puberty (Bancroft,
Herbenick, & Reynolds, 2003). Parents who observe their

children masturbating have a range of
reactions. Some discourage them from engaging in self-
stimulation completely, others encour-
age them to do so only in private, and yet others ignore it, laugh
at it, or punish the behavior.
The messages that parents send about masturbation at this very
early age can have a significant
impact on how masturbation is viewed throughout one’s life.
As children grow older, sexuality is something that often
expands from self-stimulation to
sexual experience with peers. For many, this includes “playing
doctor,” a game in which chil-
dren inspect one another’s genitals. Which specific sexual
behaviors are most common at this
age? In a study that involved parental reports of their children’s
sexual behaviors (ages 2–12)
during the past six months, 34% were observed kissing other
nonrelated children, 8% showed
their genitals to other children, 7% rubbed their bodies against
others, and 6% touched others’
genitals (Friedrich et al., 1992). Keep in mind that these
numbers are probably underestimates,
given that parents do not necessarily monitor their children’s
activities at all times. Adults’ ret-
rospective self-reports of their own childhood sexual behaviors
suggest participation rates that
are even higher than those obtained from studies that rely on
parental reports. For instance,
Kinsey found that almost half of the adult women and a
majority of the adult men he sur-
veyed remembered having a sexual experience by the age of 12
(Kinsey et al., 1948; Kinsey
et al., 1953). Experiences of this nature can occur with peers of
the same sex or the other
sex; however, given the prevalence of sex-segregated play at

this stage of life (i.e., boys playing
primarily with boys and girls playing primarily with girls),
same-sex experiences may actually
be most common (Martinson, 1994). Keep in mind, though, that
childhood same-sex experi-
ences are not necessarily indicative of adult sexual orientation
and, sometimes, simply reflect
transitory behaviors.
All of the behaviors we have discussed here stem, in part, from
an inherent curiosity children
appear to have about sex and the human body. This curiosity,
which only increases as children
get older, is further reflected in the fact that it is not uncommo n
for parents to notice their
children watching others undress or looking at nude photos
(Friedrich et al., 1992). Many par-
ents are reluctant to indulge their children’s curiosity by talking
to them about sex or anatomy,
which may lead children to seek out alternative sources of
information, such as their peers or
the Internet. This is particularly true in the United States, but
less so in other countries such
as the Netherlands, where sex is normalized, parents tend to
have a more open dialogue with
their children, and school-based sex education begins at a
younger age (see chapter 11 for more
on this).
It is important to note that, in the modern world, expressing
curiosity about sex, masturbat-
ing, and/or engaging in sexual activities with one’s peers are all
generally regarded as normal
and perfectly harmless by the medical and psychological
communities. This is quite a depar-
ture from the late 1800s and early 1900s, when childhood

masturbation in particular was
considered unhealthy and physicians developed a number of
cruel and unusual methods to
curb this behavior, as discussed in chapter 8.
Puberty
As the data reviewed in the previous section clearly reveal,
sexual curiosity and behavior
set in well before puberty begins; however, they tend to
increase significantly afterwards.
Puberty, of course, refers to a period of rapid physical changes
that ultimately leads to sexual
maturity. Puberty typically begins between ages 10 and 12 and
lasts for several years. Girls
tend to start puberty a little earlier than boys; however, there is
significant variability in onset
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of puberty, with some beginning as early as ages 7 or 8 (known
as precocious puberty) and
others as late as 15 or 16 (known as delayed puberty). In
addition to this gender difference
in age of puberty onset, there are also racial and cultural
differences. For instance, in the
United States, 10% of White girls show signs of breast
development by age 7, compared to
23% of African American girls (Biro et al., 2010), a finding that
may reflect differences in diet
and obesity rates (obesity is linked to earlier onset of puberty,
and rates of obesity are higher
among African American girls). This link between puberty and
obesity also helps to explain
why puberty tends to begin later in developing and
underprivileged countries—where many
children are starving or malnourished —than it does in the
United States and other developed
nations (Parent et al., 2011).
During puberty, the body experiences a surge of sex hormones
that leads to the develop-
ment of secondary sex characteristics, or physical features that

indicate sexual maturity, such
as growth of pubic hair. Many secondary sex characteristics are
sexually dimorphic—meaning
they are different across the sexes. This includes the
development of breasts in girls, as well as
the deepening of the voice and growth of facial hair that occurs
in boys. These hormones also
stimulate further development of the internal and external
genital structures, ultimately leading
to menarche, a girl’s first menstruation, and spermarche, when
sperm production in the testes
begins in boys. Thus, for both boys and girls, fertility is
typically present by the end of puberty.
Figure 10.2 It is not uncommon for parents to observe their
children engaging in behaviors of an intimate or
sexual nature with their peers, such as kissing. Such behaviors
are generally regarded as normal and harmless.
©bikeriderlondon 2016. Used under license from
Shutterstock.com.
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Adolescence
Generally speaking, adolescence is the period of life between
ages 10 and 19. Puberty usually
begins and ends during adolescence, but (as noted in the
preceding section) it sometimes
begins in late childhood. Adolescence is a significant life stage
because not only is it when most
people develop feelings of sexual attraction for the first time, it
is also when most people have
their first experience with sexual intercourse and their first
romantic relationship.
Sexual Attraction and Sexual Identity Development
Research suggests that, regardless of sexual orientation, 10 is
the average age at which both
men and women recall their earliest feelings of sexual attraction
(McClintock & Herdt, 1996).
Thus, sexual attraction develops very early in life, and usually
long before the gonads have fully

matured. Those whose initial attractions are to persons of the
same sex do not necessarily come
to an immediate realization that they are gay or bisexual—in
fact, there may be a period of years
in between someone’s first same-sex attraction and when that
person begins to question and,
eventually, label their sexuality (Diamond, 1998).
The processes by which gay, lesbian, and bisexual individuals
come to adopt sexual identity
labels is itself another developmental process. This is something
that often begins in ado-
lescence and may extend well into adulthood for some.
Numerous models of sexual identity
development have been proposed, most of which are stage
models, which argue that sexual
identity develops according to a very distinct, orderly pattern.
One example of this would be
the Cass Model (Cass, 1979), which theorizes that a gay or
lesbian identity develops after one
passes through a series of six stages. Briefly, they are:
confusion (initial awareness of same-sex
attraction), comparison (consideration of the implications of
being gay or lesbian), tolerance
(recognizing that you are not the only one), acceptance (seeing
one’s sexuality in a positive
light), pride (coming out), and synthesis (integrating a gay
identity with other aspects of the
self ). Although popular, these models are limited in that they
fail to capture the vast diversity
that exists in the processes by which people come to form and
integrate their sexual identities—
not everyone develops their identity according to such a
predictable, linear pattern (Rosario,
Schrimshaw, & Hunter, 2011).

Sexual Exploration
After the onset of sexual attraction, it is common for
adolescents to further explore sexual
behavior with their peers. Interestingly, those who start
masturbating early seem to progress to
peer sexual behaviors more quickly. As some evidence of this,
in a study comparing adults who
reported masturbating prepubertally to those who started
masturbating after puberty, early
masturbation was linked to engaging in partnered sexual
behaviors at a younger age (Bancroft
et al., 2003). This suggests that masturbation may be a marker
for sexual development.
With respect to partnered sexual behaviors, there is usually a
progression of sexual activities
that takes place over three to four years, with the activities
gradually leading up to intercourse.
At least among American adolescents, kissing typically begins
between ages 12 and 14,
followed by petting and genital fondling between ages 15 and
16, and first intercourse between
ages 16 and 18 (Reynolds, Herbenick, & Bancroft, 2003). Of
course, as always, there is wide
individual variation, not to mention substantial variation across
race and culture. For instance,
as discussed in chapter 9, African American adolescents tend to
have their first kiss and first
intercourse experiences at younger ages than Asian Americans
(Regan, Durvasula, Howell,
Ureno, & Rea, 2004). Despite this variability, what the
available data suggest is that adolescent
sexual behavior tends to follow a given culture’s sexual script
for the order in which intimacy
tends to be expressed in a dating relationship. For further
information on the sexual activities

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practiced among adolescents and how they vary across age and
sex, check out Table 10.1.
This table focuses on data from the 14–17-year-old participants
who took part in the NSSHB.

As you can see in this table, reports of both masturbation and
partnered behaviors appear
to increase throughout adolescence, regardless of gender.
However, the overall number who
have engaged in partnered activities is lower than you might
expect based on the popular
media narrative that teenagers today are hypersexual and having
sex of all kinds at younger
and younger ages. To the contrary, these data indicate that a
majority of American adolescents
aged 14–17 have not engaged in any partnered sexual behaviors
in the past year. When you
combine this with other research showing that the percentage of
teens who report having ever
had penile–vaginal intercourse has actually decreased since the
1980s (see Figure 10.3), we
begin to see that the reality of adolescents’ sex lives is very
different from the media spin.
On a side note, partnered sexual behavior in adolescence is
often referred to in the media
and on sex surveys as “premarital sex.” However, this is a
problematic term because it implies
that marriage is normative and something that everyone aspires
to. It is also usually defined
very narrowly as penile–vaginal intercourse. As such, I have
avoided usage of that term in this
section and throughout the rest of the book.
Romantic Relationship Initiation
Coinciding with a rise in sexual attraction and behavior is the
pursuit of romantic relation-
ships. Contrary to popular belief, most adolescent sexual
behaviors take place in the context of
relationships, not sexual hookups. Indeed, NSSHB data reveal

that the majority of adolescent
boys and girls who engaged in partnered sexual behaviors in the
last year did so with someone
they considered a boyfriend or girlfriend (Fortenberry et al.,
2010). Certainly, many adoles-
cents do engage in casual sex (e.g., one-night stands, friends
with benefits)—it is just that most
adolescent sex occurs with a romantic partner.
Adolescent romantic relationships serve multiple purposes and
represent far more than
simply a potential avenue to express and explore one’s
newfound feelings of sexual attraction.
For example, just as adults’ romantic relationships help to
fulfill needs for belongingness and
self-expansion (see chapter 8), adolescents’ relationships do
just the same. Moreover, given that
Table 10.1 Male and female sexual behaviors among adolescents
aged 14–17.
Age
14 15 16 17
Behavior M F M F M F M F
Solo masturbation 53% 42% 71% 38% 75% 42% 73% 48%
Partnered masturbation 2% 10% 8% 5% 15% 15% 17% 24%
Gave oral sex 4% 8% 11% 17% 9% 22% 28% 26%
Received oral sex 4% 11% 18% 9% 27% 21% 36% 26%
Vaginal intercourse 2% 12% 16% 9% 20% 28% 40% 31%
Anal intercourse 1% 7% 5% 1% 6% 5% 5% 4%
Any partnered sexual behavior 5% 16% 20% 21% 33% 35%
48% 39%

Note: M = male, F = female. Numbers represent the percentage
of adolescents reporting each behavior in the past
year. Adapted from the National Survey of Sexual Health and
Behavior. Source: Fortenberry et al., 2010.
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adolescence is often a very tumultuous period of major life
transitions, romantic relationships
may offer some much-needed stability and emotional support.
On another note, it is worth
mentioning that the dynamics of adolescent relationships are
strikingly similar to those of adult
relationships in terms of the factors that promote love and
commitment (Levesque, 1993).
Figure 10.4 Most people report their first feelings of sexual
attraction in early adolescence. Subsequently,
many begin pursuing sexual and/or romantic relationships.
©Dragon Images 2016. Used under license from
Shutterstock.com.
0
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30
40
50
60
70
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Year of data collection
19
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19
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Women
Men
Figure 10.3 Note: This figure presents the percentage of never -
married male and female teens aged 15–19 who
report having engaged in penile–vaginal intercourse at least
once. Data obtained from Martinez and Amba (2015).
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Biopsychosocial Influences on Teenage Sexual Activity
It should be clear by now that not all adolescents are sexually
active and, further, among those
who are, some become active much sooner than others. The
reasons for this variability in sex-
ual behavior are biopsychosocial in nature. In this section, we
will consider some of the myriad
factors that have been linked to timing of sexual debut (i.e.,
first sexual intercourse), number
of partners, and risky sexual practices among adolescents.
With respect to biological factors, precocious puberty (i.e.,
going through puberty early) is
linked to having sex prior to age 16 as well as a greater
likelihood of having unprotected sex
(Downing & Bellis, 2009). The link between early puberty and
early sex might be explained
by psychosocial factors, though, given that early puberty is
confounded with lower parental
socioeconomic status (SES). To the extent that lower SES
translates to less adult supervision
(e.g., by affecting parents’ ability to afford childcare), this
could potentially account for the
association. Beyond puberty, physical disabilities represent
another biological factor that has
the potential to impact age of sexual debut; however, different
disabilities may have different
effects. For instance, adolescents with physical disabilities that
permanently affect function
of their arms and/or legs have a sexual development trajectory
that is quite similar to that of

their able-bodied counterparts, although those with minimal
disabilities are more likely to be
sexually active than those with severe disabilities (Cheng &
Udry, 2002). By contrast, persons
with visual impairments tend to have a later age of sexual debut
compared to sighted persons
(Welbourne, Lifschitz, Selvin, & Green, 1983). One potential
explanation for the differences
between these studies is that, compared to disabilities affecting
the limbs, visual impairments
may make it more difficult to meet partners and/or to recognize
many of the common social
cues relevant to sex and dating. Differences in others’ attitudes
toward specific disabilities
could play a role as well.
Figure 10.5 Research suggests that the sexual development
trajectory of adolescents with physical disabilities
is not necessarily different from that of able-bodied
adolescents; however, sexual development patterns may
vary across different types of disabilities.
©iStockphoto.com/nullplus.
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Next, in terms of psychological factors linked to adolescent
sexual activity, having an anxious
attachment style is associated with having sex more often at a
young age (Tracy, Shaver, Albino, &
Cooper, 2003). Why? Perhaps because fear of abandonment and
rejection makes anxiously
attached teens more likely to agree to sex in the hope that their
partner will stick around.
In other words, adolescents’ feelings of relationship
security/insecurity may influence whether
and how often they have sex. In addition, adolescents with
sensation-seeking personalities tend
to have more partners, more casual sex, and more unprotected
sex (Arnett, 1996). Regardless
of where we are in the lifespan, sensation seekers tend to be
more sexually active and engage in
riskier activities. Furthermore, adolescents who hold positive
beliefs and attitudes toward sex

are more likely to have sex at an early age and to say they have
had sex in the past year, whereas
those with positive attitudes toward abstinence are more likely
to delay sexual activity (Buhi &
Goodson, 2007).
Finally, let us consider some of the many social and
environmental factors that have been
linked to adolescent sex. Parent–child relationships are
particularly notable. Several studies
have found that having a closer relationship with one’s parents,
receiving more parental support,
and having more parental supervision/monitoring are linked to
delayed sexual activity (Buhi &
Goodson, 2007). I should mention that several studies have
found no association between
parent–child relationship quality and adolescent sexual
behavior; however, this may be a func-
tion of the fact that researchers have not operationalized and
measured relationship quality in
a consistent manner across studies. In addition to relationships
with parents, peer relationships
also play an important role. Specifically, several studies have
found that adolescents who believe
that most of their peers are having sex and/or who bel ieve that
their peers have positive attitudes
toward sex tend to have an earlier sexual debut (Buhi &
Goodson, 2007).
The popular media and modern technology have also been
identified as potential influences
on adolescent sexual behavior. Longitudinal research has found
that exposure to sexual content
in movies is linked to having sex at a younger age, having more
partners, and engaging in riskier
sexual practices (O’Hara, Gibbons, Gerrard, Li, &

Sargent, 2012). Although these data are often
interpreted as evidence that kids simply imitate what they see
on screen (“monkey see, mon-
key do”), caution is warranted in drawing conclusions about
cause-and-effect here because
alternative explanations are possible. For instance, perhaps
exposure to sexualized media is
confounded with lower parental supervision. In addition to
media influences, researchers have
increasingly been exploring the role of the Internet in
adolescent sexual behavior. In particular,
much concern has been directed toward the issue of sexting, or
the electronic transmission
of sexual images or text messages, with some arguing that this
is a “gateway” behavior that
increases the odds of early and risky sex. For a closer look at
what research on sexting has
revealed, check out the Digging Deeper 10.1 box.
School-based sex education courses represent another social
factor with the potential to
shape the sexual behaviors of adolescents; however, we will
consider this topic in more detail
in the next chapter.
Implications of Early or Late Sexual Development
Clearly, there are numerous factors that can influence when and
why adolescents decide to
become sexually active. Ultimately, however, research suggests
that most adolescents start
having sex within a relatively narrow period of just a few years.
For instance, in a national
study of over 6,000 US men and women who were asked to
report the age at which they first
had sex (defined specifically in this study as penile–vaginal

intercourse), the vast majority
(60% of women and 56% of men) reported having done so
between their 15th and 20th birth-
days (Finer & Philbin, 2013). Of course, a sizeable minority fell
outside of this window due to
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Digging Deeper 10.1 Teen Sexting is Linked to Having Sex, But
Not to Having Risky Sex.
Many scientific studies have reported a link between sexting
and sexual behavior among teenagers.
However, this body of research is inherently limited because
most studies on this topic have simply
surveyed teens at one point in time and asked them about both
sexting and sexual behavior, cre-
ating the classic “chicken and egg” problem that exists in all
correlational studies: which came first?
Does sexting increase the odds of future sexual activity, or
might being sexually active predispose
teens to sexting? A longitudinal study by Temple and Choi
(2014) offers some insight.
Temple and Choi studied 964 racially diverse adolescents
(approximately one-third White,
one-third Black, and one-third Hispanic) who were age 16 on
average. Participants completed two
surveys about one year apart in which they were asked whether
they had ever sent or received a
sext (defined as sending “naked pictures of yourself to another
through text or e-mail”). They were
also asked whether they had ever engaged in sexual intercourse
(defined broadly so as to encom-
pass both vaginal and anal intercourse with partners of any sex),
whether they use condoms, how
often they use alcohol or drugs before sexual activity, and how
many partners they have had.
Results revealed that sexting was common. In the first survey,
60% said they had been asked
for a sext, 31% had asked someone else for a sext, and 28% had
actually sent a sext. In addition,

most teens were sexually active: 53% reported having had
intercourse on the first survey, while
64% reported it on the second survey.
So how was sexting at Time 1 related to sexual behavior one
year later? Neither being asked for
a sext nor asking someone else for a sext were linked to having
intercourse at Time 2; however,
sending a sext was. Specifically, compared to those who did not
send sexts at Time 1, the odds of
engaging in intercourse at Time 2 were 1.3 times greater for
those who sent sexts.
Figure 10.6 Sexting, or the electronic transmission of sexual
images or text messages, has become
an increasingly common sexual behavior among adolescents.
©nito 2016. Used under license from
Shutterstock.com.
(ContinueA)
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the biopsychosocial variables we considered in the preceding
section (not to mention the fact
that some adolescents are attracted to the same sex and others
are asexual). This raises the
interesting question of whether there are any implications of
becoming sexually active much
sooner or later than one’s peers. We will consider this in the
paragraphs that follow; however,
please bear in mind that research on age of sexual debut has
primarily focused on age of first
penile–vaginal intercourse. As a result, we do not know as much
about the implications of age
of debut for other sexual activities or for persons who are
nonheterosexual.
With respect to early sexual debut, research suggests that this
has implications for sexual
health, given that the earlier adolescents begin having penile–
vaginal intercourse, the less
likely they are use contraception and the longer it takes them to

start using birth control (Finer &
Philbin, 2013). In light of this finding, it should not be
surprising to learn that early sexual
debut is linked to increased risk of contracting sexually
transmitted infections (Epstein
et al., 2014) and teenage pregnancy (Baumgartner, Geary,
Tucker, & Wedderburn, 2009).
Beyond this, some researchers have suggested that early sexual
debut has implications for
subsequent nonsexual behaviors. Specifically, longitudinal
research has found that adoles-
cents who begin having intercourse early are more likely to
engage in delinquent behavior
one year later, such as committing minor theft or property
damage (Armour & Haynie, 2007).
One interpretation of this finding is that, because early sex is
widely considered a taboo activ-
ity, perhaps this opens the door to violating other taboos.
However, an alternative explana-
tion is that perhaps this association is explained by a third
variable, such as sensation-seeking
tendencies. Lastly, having sex at a younger age has long been
argued to have psychological
implications, such that it increases risk of depression and poor
mental health—not just in ado-
lescence, but carrying over into adulthood. In fact, this is one of
the main arguments advanced
by those who favor abstinence-only sex education. However,
this claim appears to have been
vastly over-stated. While a nationally representative
longitudinal study of over 5,000 US ado-
lescents revealed that early experiences with vaginal intercourse
were linked to experiencing
depressive symptoms, this was only true for girls and only those
under age 16; beyond 16, age
of first intercourse was unrelated to symptom reports (Spriggs

& Halpern, 2008). Thus, early
sexual debut may have some mental health implications, but
they appear specific to one sex
and seem to be quickly overcome.
Regarding delayed sexual debut, research has found that persons
who do not begin having
intercourse in adolescence and, instead, wait until early
adulthood tend to report experiencing
However, while sending sexts predicted future intercourse
experience, it did not predict risky
sexual behavior, such as having sex without condoms, reporting
multiple sexual partners, or
combining alcohol/drugs with sex.
These results reveal that sexting does indeed predict subsequent
experience with sexual inter-
course among teenagers; however, the association is relatively
small. At most, this means that
sexting is just one of many potential factors that might shape
adolescents’ sexual behavior. In
other words, while sexting could potentially be a “gateway” to
sex for some, it isn’t for everyone.
There are some important limitations of this research. For
instance, it only considered experi-
ences with intercourse, and not with other behaviors such as
oral sex. In addition, the researchers
did not consider whether the link between sexting and sexual
behavior might vary across differ-
ent groups of adolescents. That said, this study suggests that
while sexting has a small link with
initiation of sexual activity, it is not necessarily a sign of future
sexual risk-taking.

Note: Reprinted with permission from Sex anA PscynToloucy
(www.lehmiller.com).
Digging Deeper 10.1 (Continued)
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http://www.lehmiller.com
Sexualitcy anA uinu 277

more sexual problems. This is particularly true for men, with
later sexual debut being linked
to issues becoming—and staying—aroused and reaching orgasm
(Sandfort, Orr, Hirsch, &
Santelli, 2008). One interpretation of these findings is that
perhaps not having sex in adoles-
cence negatively affects the development of emotional and
interpersonal skills, which impairs
later sexual functioning. However, an alternative explanation is
that those who did not have sex
in adolescence had sexual difficulties to begin with, or perhaps
had more anxiety or other issues
that can interfere with sexual function. In addition to increased
reports of sexual difficulties,
those who delay sexual activity into adulthood tend to be
socially stigmatized, at least in the
Western world. In many parts of Africa and the Middle East,
virginity—especially female
virginity—is a highly desired trait in a romantic partner.
However, in the United States and other
Western countries, virginity has largely gone from a coveted
trait to a social liability. As some
evidence of this, when researchers surveyed 5,000 heterosexual
American adults about how
likely they would be to begin a committed relationship with
someone who was a virgin, most
said that the odds were low (Gesselman, Webster, &
Garcia, 2016). Moreover, men said they
were less willing to date a virgin than were women, which
suggests that female virginity is actu-
ally more stigmatized than male virginity among US adults. It
appears that there is an optimal
amount of sexual experience that Westerners now desire, such
that small numbers of partners
boost one’s attractiveness relative to both being a virgin as well

as having an extensive sexual
history (Stewart-Williams, Butler, & Thomas, 2016).
Before we move on, it is important to note that there is wide
individual variability with
respect to all of the implications of early and late sexual debut
considered above. For instance,
whereas adult virgins may be stigmatized at a societal level, this
stigma does not exist within all
communities (e.g., among followers of religions that strongly
disapprove of sex outside of mar-
riage). Likewise, early sexual debut does not necessarily always
precipitate delinquent behavior
or have negative health implications—in fact, more often than
not, it is likely that neither one
of these things occurs. Keep in mind that how early or late
sexual debut will affect a specific
individual is the product of a unique interaction between that
person and their environment.
Sexuality and Aging
Researchers and journalists alike who write about the topic of
sexuality and aging have a ten-
dency to focus on just one thing: sexual difficulties. Their
articles paint a bleak portrait of the
future, suggesting that the sex lives of older adults are either
fraught with problems or nonex-
istent. While it is certainly true that we tend to encounter more
sexual difficulties as we age
(more on this in chapter 13), sex can still be a very important
and positive aspect of seniors’
lives. Sadly, few recognize this, and the repercussions for older
adults’ health and happiness are
immense.

For one thing, doctors tend to neglect the topic of sex entirely
when dealing with elderly
patients. For some physicians, this neglect stems from the fact
that they stereotype seniors
as being asexual or “post-sexual,” whereas for others, it stems
from feeling under-trained in
the area, concern about potentially offending older patients by
talking about sex, or simply
not being comfortable with the subject (Taylor &
Gosney, 2011). Regardless of the reason,
the end result is that seniors’ sexual health needs (e.g.,
treatment for sexual dysfunctions,
getting tested for STIs) go unaddressed all too often. In
addition, many seniors end up mov-
ing to nursing homes or assisted living facilities, the vast
majority of which discourage sen-
iors from having sex lives. This is partially because these
facilities tend to afford residents
relatively little privacy, but it is also because many staff
members and managers simply lack
awareness of older adults’ sexual needs, they consider sex
among residents to be taboo, or
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they worry that residents having sex might create liability
issues (For example, can patients
with diminished cognitive capacity consent to sex? We will
explore this issue in more detail
in just a moment.). No matter the reason, when seniors are
denied the ability to meet their
sexual needs, it has the potential to negatively impact their
physical and psychological health
and wellbeing.
In order to change this state of affairs, we must begin by
recognizing and acknowledging that
one’s sexuality does not suddenly shut off upon hitting
retirement age. Indeed, research reveals
that most men and women in their 60s are sexually active and,
further, that many in their 70s
and beyond are having sex as well. For a closer look at the
numbers, check out Table 10.2,

which reports findings from a nationally representative US
study of more than 3,000 adults
aged 57–85 (Lindau et al., 2007).
As you can see in this table, many older adults continue to
masturbate and engage in part-
nered sex, and some do so quite frequently. In fact, across all
age groups included in this study,
the majority of seniors who indicated having had partnered sex
in the past year did so at least
2–3 times per month, with vaginal intercourse being the most
common sexual activity. Many
seniors also engage in oral sex, although that appeared to
decline in frequency with advancing
age more so than did vaginal intercourse. Other research on the
sexual practices of older adults
is consistent these trends (Schick et al., 2010).
It is important to note that the results reported in Table 10.2
come from a study in which
less than one-half of one percent of participants in relationships
had a same-sex partner. Thus,
these findings do not necessarily reflect the sexual acti vity
patterns of sexual minority seniors.
Very little research has addressed the sex lives of gay, lesbian,
and bisexual seniors; however,
the few studies that do exist indicate that many of them
continue to be sexually active, too
(Orel, 2004). Such research also reveals that, just like their
heterosexual counterparts, sexual
minority seniors report that their physicians typically neglect to
discuss sexual activity; how-
ever, on the rare occasions it is addressed, they often encounter
heterosexism, with their phy-
sicians making presumptions of heterosexuality. Thus, while the
sexuality of older adults in

general tends to be invisible to the outside world, this issue is
even more pronounced for gay,
lesbian, and bisexual seniors.
Table 10.2 Male and female sexual behaviors among older
adults aged 57–85.
Age
57–64 65–74 75–85
Behavior M F M F M F
Solo masturbation 63% 32% 53% 22% 28% 16%
Any partnered sexual behavior 84% 62% 67% 40% 39% 17%
Of those who had partnered sex in the last year,
number who did so at least 2–3 times per month
68% 63% 65% 65% 54% 54%
number who engaged in oral sex
62% 53% 48% 47% 28% 35%
number who engaged in vaginal intercourse
91% 87% 79% 85% 83% 74%
Note: M = male, F = female. Numbers represent the percentage
of older adults reporting each behavior in the past
year. Adapted from Lindau et al. 2007.

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Regardless of sexual orientation, the single biggest factor that
affects whether older adults
maintain active sex lives is their health—and the health of their
partners. A big part of the
reason for this is because some of the most common chronic
health conditions experienced
by seniors (e.g., cardiovascular disease, arthritis, diabetes) have

a deleterious impact on sexual
functioning (see chapter 13). As a result, it should not be
surprising to learn that seniors who
rate their overall health status as fair or poor are only about half
as likely to engage in partnered
sex as seniors who indicate that their health is excellent (Lindau
et al., 2007).
Seniors who remain in good physical health obviously have an
easier time maintaining an
active sex life. However, research suggests that maintaining an
active sex life in older adulthood
may also be good for seniors’ physical health and mental
abilities. In other words, the associa-
tion between sex and health is bidirectional. As some evidence
of this, recall from chapter 9
that research has found frequent orgasms to be linked to
enhanced immune system function
(Haake et al., 2004) and a longer lifespan (Davey Smith,
Frankel, & Yarnell, 1997). In addition,
research on middle-aged and older adults (ages 50–89) has
found that having more frequent
sex is linked to higher levels of cognitive functioning (Wright
& Jenks, 2016)—a finding that
is theorized to stem from sexual activity stimulating neuron
growth, something that has been
shown to occur in rat studies (Leuner, Glasper, & Gould, 2010).
Maintaining an active sex life may also benefit seniors’
romantic relationships. Research
reveals that the more frequently older adults engage in
physically intimate behaviors such as
kissing, cuddling, and sexual caressing, the happier they are
with their relationships (Heiman
et al., 2011). Enhanced relationship happiness, in turn, has the
potential to offer additional

health benefits, given that being in a happy, high quality
relationship has been linked to better
health and longer life (Kiecolt-Glaser & Newton, 2001).
Before we round out this chapter by considering
biopsychosocial influences on the sex lives
of seniors, let us consider the topic of sexual satisfaction among
older adults. How sexually
satisfied are seniors, and what makes for satisfying sex later in
life? For a look at what the
research has found, check out the Digging Deeper 10.2 box.
Figure 10.7 Many older adults maintain active sex lives,
including those who are gay, lesbian, or bisexual.
However, research on the sex lives of older sexual minorities
has received scant research attention.
©iStockphoto.com/DavidsAdventures.
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Digging Deeper 10.2 How Does Sexual Satisfaction Change in
Older Age?
It’s a simple biological fact that, as we age, the odds of
developing one or more sexual problems
increases. But what exactly does this mean for the sexual
satisfaction of older adults? Are they
necessarily discontent with their sex lives? Study after study
has found that there is a negative
correlation between age and sexual satisfaction, such that the
older people get, the less satisfied
they tend to be (e.g., Forbes, Eaton, & Kruger, 2016; Laumann
et al., 2006). However, if you dig a lit-
tle deeper into the research, you will see that it would be a
mistake to conclude that older adults
are inherently unhappy in the bedroom.
For one thing, studies of middle-aged and older adults reveal
that a majority of them actually
report being sexually satisfied. For example, in a nationally
representative US sample of 1,384
older adults (mean age of 60 for men and 61 for women),
average sexual satisfaction scores

ranged from 3.6–3.8 on a five-point scale (DeLamater &
Moorman, 2007). Given that the aver-
age was above the scale mid-point, this tells us that most
participants were satisfied with their
sex lives on balance. Similar results were obtained in a study of
1,009 heterosexual couples from
five countries: Brazil, Germany, Japan, Spain, and the United
States (Heiman et al., 2011). Overall,
64% of male participants (median age of 55) and 69% of female
participants (median age of 52)
reported being sexually satisfied.
More importantly, while studies find that average levels of
sexual satisfaction tend to decrease
as people get older, it appears that this is largely accounted for
by the fact that what makes sex
satisfying changes considerably as we age. Specifically, when
we are younger, our sexual sat-
isfaction depends more on how often we are having sex (i.e.,
more sex = better sex); however,
when we get older, quantitcy matters less and qualitcy begins to
matter more (Forbes et al., 2016).
Put another way, older adults care more about the thought and
effort that goes into sex than
Figure 10.8 What makes for a satisfying sex life in older
adulthood has more to do with quality than it
does with quantity. ©iStockphoto.com/KatarzynaBialasiewicz.
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Biopsychosocial Influences on the Sexual Activities of Older
Adults
Just as the sexual activities of adolescents are subject to
biopsychosocial influences, so are those
of older adults. Regarding biological factors, health status is
undoubtedly the most important,
as previously mentioned. In chapter 13, we will go into much
greater detail about the most
common health issues experienced by seniors and consider how
they affect sexual function-
ing, as well as how they can be treated. Beyond changes in

health and ability status, there are
also hormonal changes associated with aging that can impact
sexual functioning. Most signifi-
cantly, when women go through menopause, their menstruation
permanently ceases and there
is a dramatic drop in the production of sex hormones by the
ovaries. As mentioned in chap-
ter 3, menopause occurs on average between ages 50 and 52, but
some women experience it in
their 30s and others in their 60s. Longitudinal research has
found that the hormonal changes
that occur during menopause can have several effects on
women’s sexual functioning includ-
ing low sexual desire, vaginal dryness, and difficulties with
arousal and orgasm (Dennerstein,
Dudley, & Burger, 2001). This same research also reveals that
menopause is related to a decline
in sexual frequency. As we will discuss in chapter 13, hormone
replacement therapy is one
potential treatment for these effects. On a side note, there is no
true equivalent of menopause
in men; instead, men experience a steady, gradual decline in the
production of sex hormones
as they age. Hormone replacement therapy is sometimes
prescribed to aging men, too, as a
treatment for sexual difficulties that stem from hormonal
issues.
With respect to psychological factors, some older adults
develop diminished cognitive capac-
ity as a result of Alzheimer’s disease and other forms of
dementia. This can have implications for
seniors’ sex lives because many argue that diminished capacity
impairs one’s ability to provide
sexual consent. To learn more about this complex and
controversial issue, check out the Your

Sexuality 10.1 box. Another psychological factor that may
affect seniors’ sex lives is the fact
that, after menopause, pregnancy is no longer possible, which
may create an illusion of safety.
This, combined with research suggesting that most seniors do
not perceive themselves to be
at risk of contracting sexually transmitted infections (Syme,
Cohn, & Barnack-Tavlaris, 2016),
contributes to extremely low rates of condom use among
seniors. In fact, according to the
NSSHB, just 6% of men and women over age 60 reported using
a condom the most recent time
they had sexual intercourse (Schick et al., 2010)! This finding
suggests that there is great need
for sexual health education among older adults, just as there is
among adolescents.
Finally, with respect to social and environmental influences on
older adults’ sex lives, per-
haps the most notable is relationship status. Indeed, beyond
health, relationship status is the
other major predictor of whether older adults remain sexually
active, with partnered individu-
als being more likely than singles to continue having sex
(Schick et al., 2010). A big part of the
reason for this is because many seniors who were married or in
long-term relationships have
they do about how often they’re doing it. When researchers
statistically account for this different
emphasis placed on quantity vs. quality of sex, they see that the
negative correlation between
age and sexual satisfaction dissipates.
In short, these results suggest that it may be misguided to
attempt simple, direct comparisons

of sexual satisfaction scores for persons at different stages of
the lifespan. Getting older doesn’t
necessarily mean that your sex life is going to get worse.
Instead, the more likely outcome is that
your sexual priorities and preferences are likely to change.
Note: Reprinted with permission from Sex anA PscynToloucy
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.
lost their partners to death. When the death of a spouse occurs,
one enters a post-relationship
state known as widowhood. Although some widowed persons
remarry or begin new relation-
ships, many do not, perhaps because they find the prospect of
starting over to be daunting,
they do not want to diminish the memory of their former spouse,
or they find themselves
Your Sexuality 10.1 Can Older Adults with Diminished
Capacity Consent to Sex?
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Donna Lou Younu anA HenFcy V. RacyTons
in Dunnan, owa on Den. 15, 2007. amilcy anA fFienAs ate
poFk Foast anA AanneA polkas to nelebFate
tTe union of a wiAow anA a wiAoweF, botT in tTeiF 70s, wTo
TaA founA unexpenteA love afteF tTe
AeatTs of tTeiF lonu-time spouses. oF tTe next six-anA-a-Talf
cyeaFs, HenFcy anA Donna RacyTons weFe
insepaFable. . . oAacy, Te’s awaitinu tFial on a feloncy nTaFue
tTat Te FapeA Donna at a nuFsinu Tome
wTeFe sTe was livinu. Te owa ttoFnecy GeneFal’s offine
sacys RacyTons TaA inteFnouFse witT Tis wife
wTen sTe lankeA tTe mental napanitcy to nonsent benause sTe
TaA lzTeimeF’s. STe AieA on uu. 8, fouF
Aacys sToFt of TeF 79tT biFtTAacy, of nomplinations fFom tTe
Aisease. One week lateF, RacyTons, 78, was
aFFesteA. He pleaAeA not uuiltcy. . .Bcy mancy announts,

HenFcy anA Donna RacyTons weFe Aeeplcy in love.
BotT tTeiF families embFaneA tTeiF maFFiaue. Te nase Tas
pFoAuneA no eviAenne tTus faF tTat tTe nou-
ple’s love faAeA, tTat Donna faileA to Fenounize TeF TusbanA
oF tTat sTe askeA tTat Te not tounT TeF. . .
BaseA on eviAenne ueneFateA so faF, state pFosenutoFs aFe
likelcy to poFtFacy RacyTons as a sex-TunuFcy
man wTo took aAvantaue of a sweet, nonfuseA woman wTo
AiAn’t know wTat montT it was, foFuot
Tow to eat a TambuFueF anA lost tFank of TeF Foom (GFulecy,
2014).”
The above excerpt comes from a news story about the 2014
sexual assault case against Henry
Rayhons, who was charged with felony rape after having sex
with his wife, Donna, a nursing
home patient with Alzheimer’s disease. Donna’s roommate
alerted nursing home staff that she
heard noises coming from the other side of the privacy curtain
in their room while Henry was vis-
iting one evening. The staff informed Donna’s daughters, who
asked that the police be called. The
ensuing case made national news in the United States and
spurred multiple discussions about
the issue of sexual consent among older adults with diminished
cognitive capacity. While Henry
was later cleared of the charge in 2015 after a jury returned a
not guilty verdict, the broader
debate over this issue continues.
Take a few moments to consider your perspective by answering
the following questions:
● When older adults develop dementia or Alzheimer’s disease,
do they lose their ability to con-
sent to sex? If so, at what point does that occur? As soon as the

condition is diagnosed, or only
when the condition becomes severe? If consent is lost only
when the condition is severe, who
determines when it becomes “severe?”
● Should nursing homes and assisted living facilities have
blanket policies in place that prohibit
patients with diminished cognitive capacity from having sexual
contact with anyone, includ-
ing their spouses?
● Suppose two nursing home patients with diminished capacity
enter into a sexual relationship.
Should staff intervene? What if one or both patients are married
to someone who does not live
at the facility?
● If a nursing home patient with diminished capacity engages
in sexual activity and the patient’s
family believes that it was coercive, should management be
liable for damages?
● We have focused here on cognitive capacity and sexual
consent in the context of chronic men-
tal conditions like Alzheimer’s disease and dementia—but what
about when people tempo-
rarily experience reduced cognitive capacity due to the
consumption of alcohol, marijuana,
or other drugs? Do people lose the ability to consent to sex
when they consume substances?
How are these issues similar or different?

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RefeFennes 283
under pressure from their children not to remarry. Regardless of
the reason, the end result is
that many seniors who would otherwise be sexually active are
not because their partner has
passed away. As previously mentioned, one other environmental
factor that may affect seniors’
sex lives is their living arrangement. Specifically, those who
reside in nursing homes or assisted
living facilities may have limits that are implicit (e.g., lack of

privacy) or explicit (e.g., formal
rules and regulations) placed on their sexuality, which may
affect whether and how often they
are able to have sex.
Key Terms
puberty
secondary sex
characteristics
menarche
spermarche
sexual debut
sexting
menopause
widowhood
Discussion Questions: What is Your Perspective on Sex?
● If a friend of yours asked for advice on how to respond after
walking in on their 7-year-old
child “playing doctor” with one of the neighbor’s kids, what
action(s) would you advise, if
any?
● When it comes to what Western adults want in a romantic
partner, virginity has gone from
a once-coveted trait to a stigmatized social status in the span of
just a few decades. What
cultural or other factors do you think account for this change in
attitudes?
● Physicians report a number of barriers to speaking with

elderly patients about sex during
office visits (e.g., fear of offending the patient, discomfort with
the subject). If you were asked
to contribute to a medical school curriculum designed to
enhance doctors’ sexual communi-
cation skills with older patients, what recommendations would
you offer?
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235
The Psychology of Human Sexuality, Second Edition. Justin J.
Lehmiller.
© 2018 John Wiley & Sons, Ltd. Published 2018 by John Wiley
& Sons, Ltd.
Companion Website: www.wiley.comgolehmiller2e
9
CHAPTER OUTLINE
Introduction, 236
Solitary Sexual Behaviors, 236
Asexuality and Celibacy, 236
Sexual Fantasy, 238
Masturbation, 241
Partnered Sexual Behaviors, 246
Kissing, 246
Touching, 248
Oral Sex, 248
Vaginal Intercourse, 249
Anal Sex, 250

Same-Sex Behaviors, 251
Sex With Three, or Four, or More, 252
Frequency and Benefits of Sex and Orgasm, 255
Sexual Behavior in Psychological Perspective, 257
Self-Regulation, 257
Attachment Style, 259
Mortality Salience, 259
Sexual Behaviors
©ginasanders/123RF.COM.
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http://www.wiley.comgolehmiller2e
9 Sexual Behaviors236
Introduction
What does it mean to be “sexually active?” It is difficult to say
because everyone has different
ideas about what “counts” as sex and how frequently you need
to do it in order to be con-
sidered “active.” Consider this: in a study in which college
undergraduates were given a long
list of sexual behaviors (e.g., kissing, nipple stimulation,
vaginal intercourse) and asked to rate
whether each one counted as “having sex,” researchers found
that there was not a single act that
everyone agreed was “definitely sex” or “definitely not sex”
(Sewell & Strassberg, 2015)!
Rather than getting bogged down in a debate about what sex is
and is not, this chapter
will instead focus on the incredible diversity that exists in
human sexual practices. As some
evidence of just how much variability there is when it comes to
sexual behavior, the National
Survey of Sexual Health and Behavior (NSSHB) revealed that
Americans reported 41 different
combinations of sex acts during their most recent sexual
encounter (Herbenick et al., 2010a).
The NSSHB also revealed that the prevalence of specific sexual

acts varied considerably across
sex, age, relationship status, and numerous other demographic
variables. For a sampling of just
a few of the ways that sexual activities differ across
individuals, check out Table 9.1. Please pay
particular attention to the finding that sexual activity persists
across the lifespan. At least some
participants in each age group reported practicing each activity,
which tells us that there is no
definitive end point to our sex lives. Although it is true that the
frequency of sexual activity
often decreases as we age (more on this in chapter 10), the
stereotype that older adults do not
desire or engage in sexual activity is patently false.
This chapter will shed light on some of the most common forms
of sexual expression. We will
consider both the prevalence of each behavior and the different
forms each can take. Before we
delve into the details, please recall that sexual behavior is a
biopsychosocial event: as discussed
in chapter 1, everything from hormones, to evolved traits, to
cultural standards, to our current
mood state affect both our general level of interest in sex and
our specific sexual practices. That
said, our psychology has a particularly profound influence on
sexual behavior, affecting when
and how it is expressed. As a result, we will explore the role of
psychology in greater depth
toward the end of this chapter.
Solitary Sexual Behaviors
We will begin our discussion of sexual practices by focusing on
sexual thoughts and behaviors
at the individual level.

Asexuality and Celibacy
Some individuals are not sexually active for a part of their life
or for their entire life for reasons
that vary widely. For instance, as discussed in previous
chapters, some people are asexual,
meaning they have a general lack of desire for partnered sexual
activity. Asexual persons may
still masturbate and have sexual fantasies, but some do not
engage in any type of sexual behav-
ior whatsoever (Bogaert, 2013). Contrary to popular belief,
many asexual individuals still desire
relationships and intimacy (e.g., cuddling), and some even go
on to enjoy sexless marriages
(Travis, 2010). In contrast to asexuality, individuals who have
sexual desire but intentionally
refrain from acting on it are practicing celibacy. There are two
variations of celibacy. Complete
celibacy refers to abstention from any kind of solitary or
partnered sexual activity, whereas
partial celibacy refers only to abstention from partnered acts,
while still engaging in masturba-
tion. Whereas asexuality is increasingly being viewed as a
sexual orientation, in the sense that
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12
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it can be seen as an enduring characteristic of a person, celibacy
is instead regarded as a form
of sexual expression because it reflects a voluntary decision to
forego certain types of sexual
behavior for a period of time ranging from months to years.
Celibacy is practiced for various reasons, but it is perhaps most
frequently associated with reli-
gion. For example, nuns and priests are usually required to take
vows of celibacy, and many ado-
lescents and adults abstain from sex before marriage because
they believe it is the moral thing to
do. However, there are a number of other reasons one might
choose to become celibate, includ-
ing a desire to focus on personal growth, physical and
psychological health concerns, and having

endured some bad sexual experiences (Siegel &
Schrimshaw, 2003). Regardless of the reason, some
people find that they benefit from the experience, while others
find it challenging and lonely.
Of course, not everyone becomes celibate by choice.
Involuntary celibacy is a reality for some
individuals when they lack access to a desired partner due to
separation (e.g., military deploy-
ment), institutional restrictions (e.g., nursing homes may have
rules that restrict sexual activity
among patients), and other constraints (e.g., persons with
physical and psychological disabili-
ties may have caregivers who discourage or do not allow sex).
Involuntary celibacy can also
arise when a long-term relationship becomes sexually inactive
(e.g., one partner loses interest
in or desire for sex), or when a single individual desires a
sexual relationship but encounters
barriers to establishing one. Barriers to establishing a sexual
relationship can include shyness,
issues with body image, as well as unfavorable living and
workplace arrangements (e.g., living
at home with one’s parents, working in an environment that is
segregated by sex) (Donnelly
et al., 2001). By and large, involuntary celibacy tends to be
experienced negatively.
Sexual Fantasy
One of the most common forms of sexual expression occurs
entirely within the brain: fantasiz-
ing. Sexual fantasies have been defined as “any mental imagery
that is sexually arousing or erotic
to the individual. A sexual fantasy can be an elaborate story, or
it can be a fleeting thought of

some romantic or sexual activity. It can involve bizarre
imagery, or it can be quite realistic. It can
involve memories of past events, or it can be a completely
imaginary experience” (Leitenberg &
Henning, 1995, p. 470). Sexual fantasies are thus very diverse
in nature, ranging from mild to wild.
The vast majority of people fantasize. In fact, studies have
revealed that more than 95% of
men and women have fantasized at least once in their lives
(Davidson, 1985; Pelletier & Her-
old, 1988). That said, men tend to fantasize more frequently
than women, and the sexes have
different fantasy content. For a discussion of some of the ways
that male and female fantasies
differ and how sexual orientation factors into this, see the
Digging Deeper 9.1 box.
Sexual fantasies serve a number of functions, including
enhancement of sexual arousal, compen-
sation for a less than ideal sexual situation, and reduced sexual
anxiety (McCauley & Swann, 1980).
Others may fantasize in order to express hidden desires (e.g.,
for culturally taboo activities) or to
break free of traditional gender role expectations. Our fantasies
may also serve a self-protective
function. For example, consider a study in which participants
were primed to feel either attach-
ment security or anxiety by subliminally exposing them to
photos of either (1) a mother looking
at and caressing her child (security prime) or (2) a mother who
had turned her back on a crying
child (insecurity prime) (Birnbaum, Simpson, Weisberg, Barnea,
& Assulin-Simhon, 2012). After-
ward, participants wrote down one of their sexual fantasies.
Participants who were primed to feel

insecure and anxious reported more fantasy content that
involved distancing the self from one’s
partner (i.e., emotionless sex) than participants who received
the security prime. This suggests
that among persons who are feeling situational anxiety or are
chronically insecure, the nature of
their fantasies may shift so as to protect the self from further
feelings of rejection. In other words,
when we are feeling anxious, our fantasies may contain less
content that could potentially result in
further harm to our self-esteem (e.g., feelings of dependence on
one’s partner).
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Soliiarry Sexual Behaviors 239
Figure 9.1 Sexual fantasies are very common in both men and
women and serve a number of different
purposes. ©gpointstudio/123RF.COM.
Digging Deeper 9.1 How Do Men’s and Women’s Sexual
Fantasies Differ?
“Hoi iub filled wiih whipped cream, pudding, and muliiple
blondes”
“We’re oui for a drive in ihe counirry and ii siaris io rain. We
pull inio ihe drivewary ai home and
mry pariner pulls me inio ihe barn, where we make love on a
bale of hary as ihe rain coniinues
ouiside.”
Can you guess which of the above fantasies was written by a
man and which was written by a
woman? If you guessed a man wrote about the hot tub and a
woman wrote the romantic farm
story, you would be right. When it comes to sexual fantasies, is
it usually this easy to categorize
which fantasies belong to which sex? Are men’s and women’s
fantasies really that different?
Research has found that fantasy content differs in several ways
between the sexes, and those
differences frequently align with modern stereotypes
(Zurbriggen & Yost, 2004). First, men’s sex-

ual faniasies are more sexuallry explicii ihan women’s on
average. That is, not only are men’s fanta-
sies more focused on the sexual act itself, but they frequently
include mention of specific body
parts (including pieces of their own and their partner’s
anatomy). Second, women’s faniasies irypi-
callry coniain more in ihe wary of emoiional and romaniic
conieni ihan do men’s. Women frequently
describe the setting of their sexual encounter in detail (e.g., on
the beach or under the stars), as
well as the “prelude” or build-up to sex (e.g., drinking
champagne at a candlelight dinner before
adjourning to the bedroom).
(Coniinued)
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Figure 9.2 The content of men’s and
women’s sexual fantasies differs, and often
in a way that is consistent with gender role
stereotypes. ©altafulla, 2013. Used under
license from Shutterstock.com.
Figure 9.3 ©zhu difeng, 2013. Used under license from
Shutterstock.com.
Third, men are more likely than women to fantasize about
having several sexual partners at
the same time (e.g., threesomes, “fourgys,” gangbangs, and
more). Finally, the sexes also differ
when it comes to fantasizing about dominance and submission.
While men are equallry likelry io
faniasize aboui being dominani and submissive, women iend io
faniasize more aboui being submis-
sive ihan dominani.
How does sexual orientation play into all of this? Do gays and
lesbians have different fantasy
content than their heterosexual counterparts? Most research on
this topic suggests that the only

reliable difference between the fantasies of gay and
heterosexual men and between lesbian and
heterosexual women is the sex of the person(s) they are
fantasizing about (Leitenberg & Hen-
ning, 1995). Thus, the same sex differences in fantasy content
observed among heterosexuals
also emerge when you compare gay men to lesbians.
In short, the fantasy worlds that occupy men’s and women’s
minds are quite distinct and, while
there is always a vast amount of individual variability (e.g.,
there are many men who fantasize
about romance, just as there are many women who fantasize
about group sex), there appears to
be at least a hint of truth to some of the gender stereotypes that
exist regarding fantasy content.
Note: Reprinted with permission from Sex and Psrychologry
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Sexual fantasies used to be viewed as problematic and revealing
of psychological troubles.
Indeed, Sigmund Freud once argued that “a happy person never
fantasizes, only an unsatisfied
one.” In the modern world, however, sexual fantasies are
generally regarded as a healthy aspect
of human sexuality. Indeed, people who fantasize more often
tend to report being more sexu-
ally satisfied (Leitenberg & Henning, 1995). That said, people
are sometimes concerned about
the content of their fantasies. In particular, students have
frequently asked me whether it is
normal to fantasize about (1) being “forced” to have sex, and
(2) having sex with someone other
than one’s current partner. As it turns out, both of these are
very common fantasies and they
do not signify anything pathological about the individual or the
relationship. With respect to
forced sex (i.e., “rape”) fantasies, studies indicate that 31 to
57% of women report having them

(Critelli & Bivona, 2008); however, this should not be taken to
mean that 31 to 57% of women
want to be sexually assaulted. This research simply tells us that
many women find the thought
(not the reality) of some type of forced sex to be arousing, and
it is important to emphasize
that the amount and type of force desired varies, as does the
nature of the resistance (for many
women, arousal comes from providing token resistance). Thus,
“rape fantasies” generally do
not resemble a rape, if for no other reason than that the woman
remains in control—a feature
that is absent in actual rape. Although it was once thought that
only victims of sexual assault
fantasized about forced sex, research has found that this is not
the case (Gold, Balzano, &
Stamey, 1991). Where do these fantasies come from? It appears
that forced sex fantasies are
most likely a product of greater openness to sexual experience
(Bivona, Critelli, & Clark, 2012).
The idea is that women with more positive feelings about sex
have more fantasies, and that as
the frequency of fantasizing increases, so does the range of
fantasy content. Thus, forced sex
fantasies are not a reflection of past experience or a product of
unhealthy attitudes toward
sex. With respect to fantasies about cheating and infidelity,
research indicates that 98% of men
and 80% of women in relationships have fantasized about
someone other than their current
romantic partner, and these fantasies become more common the
longer a relationship goes on
(Leitenberg & Hicks, 2001). Thus, cheating fantasies appear to
be normative and do not mean
that someone actually wants to cheat or has plans to do so. If
such fantasies signified trouble, it

would be extremely rare for a monogamous relationship to last.
Of course, this is not to say that all sexual fantasies are
inherently good. There are certainly
some cases where the desire for a specific sexual activity could
be dangerous. For more on the
darker aspects of sexual fantasy, check out the Your Sexuality
9.1 box.
Masturbation
Sexual fantasies go hand-in-hand with a variety of sexual
behaviors, especially masturbation.
Masturbation refers to all solo forms of self-stimulation
focusing on the genitals. Mastur-
bation practices vary widely depending upon the individual’s
body and personal preferences.
For instance, masturbation among women may involve
manipulation of the clitoris and labia,
stimulation of the breasts, or vaginal penetration with a sex toy.
To learn more about sex toys
and how they came to be so popular among women, check out
the Digging Deeper 9.2 box.
Among men, masturbation most frequently involves using one
or both hands to stimulate the
penis. Of course, men sometimes utilize sex toys too (e.g.,
masturbation sleeves, butt-plugs,
etc.). Across individuals of all sexes, masturbation habits vary
in terms of the motion, speed,
and amount of pressure applied, as well as whether they
incorporate pornography (e.g., erotic
images, videos, or stories).

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Your Sexuality 9.1 The Dark Side of Sexual Fantasy.
Having sexual fantasies is generally considered a sign of a
healthy sex life (Leitenberg & Henning,
1995). However, there is wide variability in terms of what
people fantasize about. Although most
fantasies are relatively harmless, some are potentially
problematic and even dangerous to others.

For instance, if a man develops an obsession with a very
idiosyncratic fantasy that is incompat-
ible with his partner’s desires, it could negatively impact the
relationship. In addition, to the
extent that someone fantasizes about an activity that is harmful
to another person (e.g., sexually
assaulting children or adults), there is a risk of other people
getting hurt should this person act
on their fantasy.
Unfortunately, however, determining which fantasies are
acceptable and which are unaccep-
table is not as clear-cut as it sounds. For instance, the fantasy
most common among people who
identify as feeders is that their partner will gain an excessive
amount of weight, sometimes to the
point where that person becomes physically immobile and
requires a caretaker. Such individuals
often find complete dependency on someone else to be sexually
arousing. Is this a healthy or an
unhealthy fantasy? What about a heterosexual man who only
fantasizes about having sex with mar-
ried women who are secretly cheating on their husbands? In
these scenarios, the subject of the
fantasy is consensual sex, but somebody ends up getting hurt.
The question therefore becomes
this: at what point does a sexual fantasy cross the line? And
who should be the one to draw this line?
Are there certain fantasies that you think are potentially
problematic? What should someone
do if they have a sexual fantasy that is potentially harmful?
Digging Deeper 9.2 The History of Motorized Sex Toys.
Believe it or not, human beings have been making sex toys since

the Stone Age. Dildos, Ben Wa
balls, and various other devices to aid in sexual pleasure have a
surprisingly long (and quite inter-
esting) history. However, out of all of the different sex toys
ever created, one in particular stands
out for having a most unique and “hysterical” backstory: the
vibrator.
In the modern world, vibrators are a sex and masturbation aide
utilized by men and women
alike. In fact, approximately half of US men (44.5%) and
women (52.5%) today say that they have
used a vibrator before (Herbenick et al., 2009; Reece et
al., 2009). However, the world’s first vibra-
tor was designed as a therapeutic device for doctors to use on
their female patients who were
diagnosed with hysteria. At one point in time, hysteria was
among the most common medical
disorders diagnosed in women, and included a wide range of
symptoms from nervousness and
insomnia to loss of appetite for sex with one’s husband, to a
“tendency to cause trouble for oth-
ers” (Maines, 1998). The symptoms were so broad that almost
any woman with any medical com-
plaint could be diagnosed as hysterical. Although hysteria was
originally thought to be the result
of a woman’s uterus “wandering” throughout her body and
causing problems, later physicians
viewed the disorder as a consequence of inadequate or
insufficient sex.
For centuries, the primary treatment for hysteria was a “pelvic
massage” culminating in “hys-
terical paroxysm” (i.e., orgasm) (Maines, 1998). Massages of
this nature were usually performed
by doctors, who made a hefty profit practicing this “therapy,”

given that hysteria was so prevalent
and required multiple treatments. In reality, all these doctors
were doing was helping women
have the orgasms they weren’t having with their husbands and
taking the husbands’ money for
the privilege of doing so! The only problem was that these
treatments were very time consuming
(even with effective stimulation, an average woman may take up
to 20 minutes to reach orgasm)
and the doctors were doing it by hand. The first vibrator was
thus invented to cut down on the
length of office visits, thereby allowing doctors to “treat” more
patients.
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Figure 9.4 Sizes, and shapes, and colors, oh my! ©IVL, 2013.
Used under license from Shutterstock.com.
As electricity started making its way into people’s homes, the
consumer market for vibrators
grew rapidly. Not only could a personal vibrator save money on
trips to the doctor’s office, but it
could also be utilized within the privacy of one’s own home day
or night. The demand for vibra-
tors was so strong that motorized sex toys became just the fifth
electric device approved for
home use after the sewing machine, fan, teakettle, and toaster
(Maines, 1998). Vibrators thus
made their way into homes long before vacuum cleaners,
electric irons, and television sets.
Modern vibrators are battery operated (or solar powered, for the
environmentally conscious),
many are waterproof, and hundreds of variations exist to serve
many different sexual purposes.
Certain vibrators are optimized for clitoral stimulation, others
for the G-spot, and yet others for
the anus. Some vibrators are lifelike, others are pointy and
ribbed, and some look like probes
taken from an alien spaceship. And, of course, vibrators come in

all different sizes, shapes, and
colors and are made for people of all genders and sexualities.
However, please keep in mind that
if you incorporate vibrators or other sex toys into partnered sex,
those toys need to be properly
cleaned before sharing to reduce the risk of transmitting sexual
and other infections. Using con-
doms with shared sex toys is also an advisable practice, given
research demonstrating that, even
after cleaning, infectious agents are sometimes still detected on
vibrators (Anderson et al., 2014).
As you can see, the history and evolution of vibrators is a
fascinating subject. If you want to
know more, check out The Technologry of Orgasm by Rachael
Maines (1998).
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Most people masturbate. For instance, as seen in Table 9.1, the
NSSHB revealed that a major-
ity of men and women across all age groups reported
masturbating before. The percentage of
masturbators is higher today than it was in the original Kinsey
reports as well as the NHSLS;
however, it is not clear whether this reflects a true increase in
masturbation, or simply an
increase in comfort admitting to this behavior. Although
masturbation is something that
most people have done, there are some important sex
differences in this practice. Specifically,
research indicates that men are more likely to masturbate than
women, and also that men do
it with greater frequency (see Table 9.2). Despite these
differences, the NHSLS found that men
and women masturbate for similar reasons, including tension
relief, pleasure, relaxation, and
the unavailability of a sexual partner. Research in the United
States finds that masturbation

practices also vary according to age, education level, and race
(Laumann, Gagnon, Michael, &
Michaels, 1994). Specifically, being younger (i.e., under age
49), having a higher level of educa-
tion, and being White are associated with a greater likelihood of
masturbating compared to
being older (i.e., over age 50), having less education, and being
African American.
Concerns About Masturbation
Masturbation has been a source of moral and medical concern
for centuries. Historically,
penis-in-vagina intercourse within the context of a heterosexual
marriage was seen as the only
“valid” form of sex by many world religions. Because
masturbation provides pleasure with-
out the possibility of procreation, it was long condemned as a
sinful activity. However, this
view of masturbation began to change in the eighteenth century
with a movement that is best
described as the medicalization of sex. During this time period,
masturbation, homosexual-
ity, and other sexual activities that had traditionally been seen
as immoral came to be viewed
largely as health problems and diseases.
For instance, in the 1700s, Swiss physician Samuel Auguste
Tissot wrote extensively about
the physical and psychological health damage that accompanies
masturbation. In Tissot’s view,
semen was an “essential oil” that the body cannot function
properly without. He argued that
excessive masturbation could therefore lead to everything from
blindness to insanity. These
beliefs about the dire consequences of masturbation persisted
for centuries after and led to many

inventive attempts to “cure” the masturbation pandemic. One
supposed cure was dietary modi-
fication. It was thought that being a vegetarian, eating bland
foods, and getting frequent exercise
would curb the desire to masturbate. To that end, the Reverend
Sylvester Graham invented the
original graham cracker and Dr. John Harvey Kellogg invented
to original cornflake. Yes, you read
that right—cornflakes and graham crackers were originally
designed for the purpose of stop-
ping chronic masturbators. I bet you will never look at the
cereal aisle in the grocery store the
same way again! Of course, keep in mind that the original
formulations of graham crackers and
Table 9.2 Frequency of masturbation by age and gender groups.
Age
18–19 20–24 25–29 30–39 40–49 50–59 60–69 70+
Men
In the last month 61.1% 62.8% 68.6% 66.4% 60.1% 55.7%
42.3% 27.9%
Lifetime 86.1% 91.8% 94.3% 93.4% 92% 89.2% 90.2% 80.4%
Women
In the last month 26% 43.7% 51.7% 38.6% 38.5% 28.3% 21.5%
11.5%
Lifetime 66% 76.8% 84.6% 80.3% 78% 77.2% 72% 58.3%
Note: Adapted from the National Survey of Sexual Health and
Behavior (Herbenick et al., 2010a).

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cornflakes were very bland, and barely resemble the sweetened
versions you see on supermarket
shelves today, which do not claim to have any anti-masturbatory
properties. At any rate, Kellogg
and Graham were both strong believers that masturbation was a
source of both physical and
psychological ailments ranging from acne to epilepsy to
insanity and, therefore, required a cure.

When the nutritional solution did not work, the means for
stopping masturbation became more
extreme. For instance, in his book Plain Facts for Old and
Young, Kellogg (1881) recommended
that young boys be circumcised without anesthetic, because the
pain of the procedure would serve
as a deterrent to future masturbation. Another procedure he
recommended for boys was to pull
the foreskin over the glans and suture it together so as to
prevent erections. For girls, Kellogg rec-
ommended applying carbolic acid to the clitoris in order to
reduce “abnormal excitement.”
As if that were not enough, a number of devices were invented
that were designed to not only
discourage boys from masturbating, but also to prevent them
from having nocturnal emis-
sions. In fact, between 1856 and 1919, fourteen patents were
granted in the United States for
devices of this nature (Mountjoy, 1974). Among them were
genital cages (a sort of chastity belt
that could only be removed by the person who held the key),
spermatorrhoea rings (which
sort of looked like modern “cock rings,” but with an extra, inner
layer of sharp metal teeth that
would dig into the penis should the wearer get an erection), as
well as the spermatic truss (a
device that involved stretching the penis out and strapping it to
a short pole in order to make
an erection impossible). However, my personal favorite is what
I call “the bell-ringer,” a device
patented in 1899 that would ring a bell any time the wearer’s
penis started to swell, effectively
alerting everyone in town that an erection was nearby. Rather
than try to physically prevent

erections, this device was designed to curb them through shame
and embarrassment.
As it turns out, all of the longstanding health concerns about
masturbation have been com-
pletely unsubstantiated by modern research, which means that
all of these radical attempts to
stop people from pleasuring themselves have been for naught. In
fact, research suggests that, if
anything, masturbation is associated with enhanced physical and
psychological health. As just a
Figure 9.5 Among the more popular anti-masturbation devices
of the late 19th and early 20th centuries were
genital cages. ©Science & Society Picture Library/Getty
Images.
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few examples, masturbating frequently is linked to higher self-
esteem among women (Hurlbert &
Whittaker, 1991) and a lower risk of prostate cancer among men
(Giles et al., 2003). There is
simply no truth to the idea that masturbation will make you go
blind, crazy, or grow hair on
your palms. On a side note, there is also no evidence that
masturbation is harmful to people’s
romantic and sexual relationships, which has also been a major
concern about self-pleasure.
For instance, some research has found that people in
relationships masturbate more than sin-
gles (Laumann et al., 1994), suggesting that masturbation may
complement an active sex life
rather than supplant partnered sex. As a result of these and
other findings, most modern medi-
cal and psychological associations around the world have
adopted the view that masturbation
is a normal part of sexual experience and is not something that
requires treatment.
Partnered Sexual Behaviors
At this point, we will shift our focus to some of the most

common partnered sexual activities,
including kissing, sexual touching, oral sex, anal sex, and
vaginal intercourse. This is not meant
to be an exhaustive list of all possible sexual behaviors, just
those that are most frequently
observed. I should also clarify that “partnered” does not
necessarily mean just two people,
because some individuals enjoy these activities in the context of
groups. We will also consider
the nature of same-sex behavior and correct some of the most
common misconceptions about
the sex lives of gay men and lesbians. Sexual behavior
variations (i.e., uncommon forms of
sexual expression) will be addressed separately in this book in
chapter 14.
Most adults have engaged in partnered sexual activity. For
instance, national US surveys have
found that by the time people reach their mid-twenties to early
thirties, 97% have had oral, vaginal,
or anal sex previously, while 3% have had no sexual experience
at all (Haydon et al., 2014). When do
people typically start engaging in partnered sexual activities?
That depends upon the specific activi-
ties and cultural backgrounds in question. For example, one
study of US college students found
that, on average, men and women reported having their first kiss
around age 15 and their first act of
sexual intercourse around age 17 (Regan, Durvasula, Howell,
Ureno, & Rea, 2004). Other research
is consistent with these numbers, although men usually become
sexually active at a slightly younger
age. How does cultural background factor into the equation?
Regan and colleagues found that White
and African American participants tended to have their first kiss
and first sex at a younger age than

those who were Latino(a) or Asian American. The largest
difference was seen between African and
Asian Americans. Specifically, African Americans reported
their first kiss at age 14.8 and first sex at
age 16.3, whereas Asian Americans had their first kiss at age
17.6 and first sex at 18.85.
As noted at the beginning of this chapter, once partnered sexual
activity begins, it often con-
tinues through the rest of our lives. In fact, it is not uncommon
for men and women to stay sexu-
ally active into their 70s and 80s. However, a number of factors
are related to continued sexual
activity, including good health (both physical and
psychological), having a positive view of sex
and one’s own sexuality, not to mention access to a partner
(DeLamater, 2012). It is also worth
noting that even in cases where older adults’ health has declined
or they have acquired physical
disabilities or chronic illnesses, sex often continues to be an
important part of their lives.
Kissing
Kissing is an activity that people frequently associate with sex,
and this makes sense in a lot
of ways. The mouth is an erogenous zone endowed with many
nerve endings, which means
kissing can be very pleasurable. In Western society, kissing is
one of the most common and
socially accepted sexual behaviors; however, in other cultures,
kissing is considered a dis-
gusting act (Gregersen, 1996). Thus, kissing is by no means
universally practiced throughout

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Parinered Sexual Behaviors 247
the world. As some evidence of this, consider the results of a
study that analyzed the pres-
ence of kissing (defined as “lip-to-lip contact lasting long
enough for the exchange of saliva”)
using anthropological data obtained from 168 different cultures
(Jankowiak, Volsche, & Gar-

cia, 2015). These researchers found that kissing was present in
less than half (45.8%) of the
cultures studied! Kissing was least likely to be observed among
cultures in Africa, Central
and South America, and Oceania, but more frequently observed
in North America, Asia,
Europe, and the Middle East.
In places where kissing is deemed acceptable, it often becomes
an individual’s first and, for
some, most memorable sexual experience. Although most people
only distinguish between
two types of kissing, the closed-mouth kiss of affection and the
open-mouthed kiss of passion,
kissing can take many different forms. In fact, the Kama Sutra
denotes 17 different types of
kisses that vary in terms of whether they permit tongue action,
the amount of pressure and
force applied, and so on. Because there are so many different
manners of kissing and people
have their own preferences when it comes to what feels good, it
is inevitable that some people
will be thought of as “bad kissers” and others as “good kissers.”
Beyond simply feeling good, scientists believe kissing may
serve other purposes. In fact,
some have suggested that kissing might be an evolutionarily
adaptive behavior. For instance,
perhaps kissing emerged as a way of “sizing up” potential
partners (Wlodarski & Dunbar, 2013).
Specifically, the act of putting our noses and mouths so close
together could assist in the
detection of pheromones, thereby helping people to
subconsciously identify partners who
are healthy and fertile. Alternatively, other scientists believe
that kissing evolved in order to

promote the exchange of bacteria and microorganisms that
promote good health (Hendrie &
Brewer, 2010).
Figure 9.6 For some individuals, kissing is one of the most
pleasurable sexual activities there is.
©Alexandru Chiriac, 2013. Used under license from
Shutterstock.com.
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Touching
As discussed in chapter 4, touch is the predominant sexual sense
in most people. As a result,
it should not be a surprise to learn that touching is often an
integral part of sexual activity. In
fact, the role of touch in sexual arousal and pleasure was
considered so vital by Masters and
Johnson that they recommended it as part of almost every sex
therapy routine (we will return
to this idea in chapter 13). Sexual touching usually focuses on
primary and secondary erog-
enous zones; however, almost any part of the body can be
involved, because nerve endings are
present throughout our skin. It is important to note that sexual
pleasure can be derived from
touch even if the genitals are not directly stimulated. What
matters most is the individual’s
personal preferences and how the touch is interpreted, which
means that it is important to
communicate with your partner about what does and does not
feel good.
One of the most common forms of sexual touching is tribadism,
which refers to the act of
rubbing one’s genitals on the body of a sexual partner. This
could mean rubbing the genitals
together, or rubbing them against other parts of the body.
Tribadism is most commonly used
to describe vulva-to-vulva contact between two women (known
colloquially as “scissoring,”
because it involves interlocking the legs of the partners like two

pairs of scissors; Hite, 2003).
Oral Sex
Stimulation of the genitals with the mouth has become
extremely common over the past cen-
tury. As evidence of the current prevalence of this behavior,
both the NSSHB and the NHSLS
have reported that approximately three-quarters of all adults
have engaged in oral sex within
the past year (Herbenick et al., 2010a; Laumann et al., 1994).
As you can see in Table 9.1, oral
Figure 9.7 Touch can be a sensual experience even if it is not
focused on the genitals. ©Dewayne Flowers,
2013. Used under license from Shutterstock.com.
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sex practices vary with age, with younger folks being the most
likely to do it; however, even
among older adults, oral sex still occurs with some frequency.
There are also educational and
racial differences in the practice of oral sex. Being college-
educated and White are linked to a
greater likelihood of having ever practiced oral sex compared to
having a high school education
(or less) and being African American or Hispanic (Laumann et
al., 1994). It is also important to
note that within some religions and some parts of the world
(e.g., Sub-Saharan Africa), oral sex
is seen as an unnatural and unclean activity and is not practiced
widely.
The general term used to describe stimulation of the vulva by a
partner’s mouth is cunnilin-
gus, while the term used to describe oral stimulation of the
penis is fellatio. Oral sex is a behav-
ior practiced by people of all genders and sexualities, and it can
take many forms. For instance,
oral sex varies in terms of whether it is performed individually
vs. simultaneously in the so-
called sixty-nine position. In addition, the area of focus may

differ (e.g., fellatio sometimes
includes oral stimulation of the scrotum), as does movement,
speed, pressure, and use of the
hands (e.g., a finger or two may be used for vaginal insertion
during cunnilingus). If applicable,
couples also vary in terms of how they prefer to deal with male
and/or female ejaculate. Some
find ejaculation inside the mouth to be exciting, while others
dislike it. As always, it is best to
communicate with your partner about your preferences and it is
important to recognize that
when your partner reveals personal likes and dislikes, it should
not be construed as an attack
on you. Everyone’s bodies and brains are different, which
means that the sexual techniques that
brought you compliments in a previous relationship may not
necessarily draw praise from all
future sexual partners. Thus, it is wise not to assume you know
what your partner will enjoy or
that your partner will automatically know what you want. When
it comes to sex, communicate
early and often.
Not surprisingly, many men and women find that oral
stimulation alone is enough to bring
them to orgasm. In fact, about one in ten men and one in five
women report that oral sex is
their preferred route to climax (Janus & Janus, 1993). Despite
the large number of people who
practice and enjoy oral sex, there is a lot of misinformation out
there about this activity. Per-
haps the biggest misconception is that oral sex is a “safe”
activity with little to no risk of disease
transmission. However, as we will discuss in chapter 12, there
are multiple infections that can
be spread through this activity, which means it is important to

take appropriate precautions no
matter what kind of sex you are having.
Vaginal Intercourse
Among heterosexual adults, vaginal intercourse (also known as
coitus) is the most common
form of partnered sexual activity (see Table 9.1) and it is most
frequently practiced among
those who are younger, married, and more highly educated
(Laumann et al., 1994). As with all
of the other behaviors we have discussed up until this point,
vaginal intercourse is an activ-
ity that can take many forms. For one thing, a multitude of
sexual positions are possible. The
four most basic positions are man-on-top (i.e., “missionary”),
woman-on-top, side-by-side, and
rear-entry (i.e., “doggy style”). People obviously vary in their
position preferences, and those
preferences can change over time (e.g., during pregnancy,
certain positions can become impos-
sible or uncomfortable). In general, research shows that men
tend to prefer woman-on-top,
while women tend to prefer man-on-top (Elliot &
Brantley, 1997). We do not know why that is,
but some might view it as evidence that most people are lazy in
bed. By contrast, others might
see it as a sign that a lot of us just like to give up control.
One of the most common things students ask about in my human
sexuality course is the
“best” position for vaginal intercourse, usually meaning the
position that provides the great-
est likelihood of female orgasm. Research has found that the
coital alignment technique
(CAT) significantly increases the odds of both female orgasm

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during heterosexual intercourse (Pierce, 2000). The CAT is a
modified “missionary” position
in which the male partner leans further forward to the point

where the base of his penis comes
into contact with his partner’s clitoris. Instead of thrusting in
and out, the partners “grind”
back and forth to maintain the penile–clitoral connection. This
is a very coordinated set of
body movements that takes some practice to master, but many
people find that the results are
worth the effort.
Beyond position selection, partners also vary in terms of what
they do with their hands (e.g.,
providing breast and/or clitoral stimulation), whether they keep
their eyes open or closed,
whether they require an artificial lubricant, and so on. There are
also cross-cultural differ-
ences in the practice of vaginal intercourse, such as the common
preference for dry sex in Sub-
Saharan Africa. Dry sex (not to be confused with “dry
humping,” or non-penetrative sex) is a
form of intercourse accompanied by removal of a woman’s
natural vaginal lubrication (Sandala
et al., 1995). Lubrication is removed or minimized by wiping
the vagina out or by placing leaves
or chemicals inside the vagina. The goal is to increase friction
during sex, which is thought to
provide more pleasure to the male partner; however, this
behavior may also stem from a cul-
tural view that female wetness is a sign of promiscuity.
Regardless of the reason, the practice
is painful for women and may increase the risk of contracting
infections by causing trauma to
the vaginal lining.
Anal Sex
Although anal sex tends to be among the least commonly

reported partnered sexual behaviors
(see Table 9.1), it is certainly not rare and, like oral sex, has
been increasing in recent years.
For instance, according to the NSSHB, as many as one in four
or one in five US adults in their
20s and 30s report having practiced this behavior in the past
year (Herbenick et al., 2010a).
Lifetime prevalence estimates are even higher. For instance, the
2006–2008 National Survey
of Family Growth found that about one-third of women and
almost half of all men surveyed
had attempted anal sex at least once before (Chandra, Mosher,
& Copen, 2011). However, there
are age, education, and racial differences in this practice
(Laumann et al., 1994). Similar to
masturbation and oral sex, anal sex is more common among
those who are younger and more
highly educated. With respect to race, White and African
American men are equally likely to
reported having ever tried it; however, African American
women are about half as likely as
White women to report having had anal sex in their lifetime.
Anal sex is an activity that produces divided opinions. Some
people find it repulsive, while
others find it thoroughly arousing. Although anal sex is most
commonly associated with gay
men, it is also practiced frequently among heterosexuals. Given
the prevalence of anal sex
observed in survey studies and the fact that heterosexuals vastly
outnumber gay men, the real-
ity is that most of the people who practice anal sex in this world
are male-female couples, a fact
that many people find surprising.
When most people hear the term “anal sex,” they tend to think

about penile–anal penetration.
However, this is not the only way that the anus can be involved
in sexual activity. Some people
may insert a finger or sex toy into the anus during masturbation
or partnered sex. Others orally
stimulate the anus, a practice known as anilingus (colloquially
referred to as “rimming”).
There are a few special health concerns that merit mention in
our discussion of anal stimu-
lation. First, the rectum is a rather delicate structure and does
not produce its own lubrica-
tion, unlike the vagina. As a result, a generous amount of a safe,
non-irritating lubricant
should be used, in addition to gentle, slow penetration. This
applies regardless of whether a
penis or a sex toy is being inserted. If inserting a sex toy, please
ensure that the base is sig-
nificantly larger than the top so that it does not accidentally
enter all of the way and become
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stuck. I have heard many a story from my friends in medicine
who have encountered emer-
gency room patients with devices lodged in their rectums.
Perhaps the most interesting case
I ever heard about was a man who had set his cellular phone to
vibrate, wrapped it inside
a condom, and inserted it into his anus before proceeding to call
himself repeatedly from
another phone (this gives new meaning to the terms
“buttdialing” and “booty call,” right?).
Unfortunately for him, however, his phone made for a poor sex
toy. It became irretrievable
after going in too far and had to be removed in the middle of the
night by a very talented and
slightly amused surgeon.
In addition, it is important to note that anal sex carries the
highest risk of disease transmis-
sion out of all of the sexual activities we have discussed above
(for more on this, see chap-

ter 12). To reduce risk, condoms should be worn during penile–
anal penetration and, during
anilingus, dental dams should be used to limit transmission of
intestinal infections. On a side
note, a practice often referred to as ATM (“ass-to-mouth”) is
becoming increasingly common
in pornography and involves taking the penis directly from a
person’s anus and putting it in
someone’s mouth without cleansing the penis in between. This
is an extremely risky activity
and is not recommended because of the very high risk of
transmitting infections.
Same-Sex Behaviors
The sex lives of gays and lesbians are strikingly similar to those
of heterosexuals in most regards.
The one exception, of course, is the lack of penile–vaginal
intercourse. Nonetheless, there are
numerous stereotypes about what non-heterosexual individuals
do when it comes to sex. For
instance, perhaps the most prevalent sex stereotype targeting
lesbians is the notion of “lesbian
bed death,” or the idea that sexual activity drops off
dramatically in long-term female couples,
a result some have argued stems from the fact that there is no
man around to initiate sex (see
Schwartz & Blumstein, 1983). Although the sex lives of some
lesbian couples eventually slow
down, the idea that this is somehow a universal phenomenon is
a myth and many psychologists
have been critical of the data used to support the notion of
“lesbian bed death” (Jasenza, 2000).
The reality is that many lesbian couples maintain long-term,
sexually satisfying relationships.
It is also important to note that, while studies have shown that

lesbian couples tend to have sex
less often than other types of couples (e.g., gay male and
heterosexual couples), lesbians’ sexual
events typically last much longer (Blair & Pukall, 2014). For
more on myth versus reality when
it comes to lesbian sex, check out the Digging Deeper 9.3 box.
What about gay men? There is a widespread belief that anal
intercourse is the primary sexual
behavior practiced by gay men. However, this could not be
further from the truth. As it turns
out, oral sex and mutual masturbation are far more common. See
the Digging Deeper 9.4 box
for more on what the sex lives of gay men are actually like.
There is less research into the sexual behaviors of bisexually
identified individuals, but exist-
ing work suggests that, like persons of other sexual
orientations, they also have a wide sexual
repertoire. For example, in a study of bisexual men in the
Midwestern United States, research-
ers found that the vast majority (>75%) reported having
practiced vaginal intercourse, given
and received oral sex with male and female partners, engaged in
mutual masturbation with
male and female partners, and practiced some form of anal sex
(Dodge et al., 2013). Notably,
bisexual men were much more likely to have anal sex with male
partners compared to female
partners, and they were far more likely to be the insertive
partner rather than the receptive
partner during such activities; however, a small number of
bisexual men reported that their
only experience being the receptive partner during anal
intercourse occurred with women
(e.g., being penetrated with a strap-on dildo, known colloquially

as “pegging”). Thus, the sexual
practices of bisexuals are incredibly diverse.
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Sex With Three, or Four, or More

Up until this point, our discussion of partnered sexual behaviors
has primarily focused on sex
that occurs between two people; however, as mentioned earlier
in this chapter, it is not uncom-
mon for people—especially men—to fantasize about sex acts
that involve more than two part-
ners, such as threesomes, orgies, and gangbangs. In other
words, a lot of us are turned on by the
idea of having sex in a group. Despite the fact that group sex is
a common sexual fantasy, little
is known about how many people have actually practiced it or
what the most common group
sex activities are because this is not something that is routinely
inquired about on national sex
surveys.
Digging Deeper 9.3 Are Media Portrayals of Lesbian Sex
Accurate?
When it comes to lesbian sex, there are a lot of myths and
misconceptions, many of which are
fueled by inaccurate representations in pornography and in the
popular media. In light of this,
let’s take a moment to separate fact from fiction.
First, the activities depicted in most woman-on-woman internet
porn hardly reflect the reality
of most lesbians’ sex lives. Most such porn is produced by men,
for men—and this kind of porn
is blatantly obvious because it focuses on imagery and activities
that appeal primarily to hetero-
sexual men’s fantasies. For example, these videos typically
feature highly feminine women who
have bodies that conform to straight men’s ideals (i.e., young,
skinny, shaved, with large breasts)
and who engage in sexual activities that revolve around vaginal

and oral penetration with dildos
and strap-ons (Morrison & Tallack, 2005). In reality, lesbians’
bodies come in many shapes and
sizes and their bodily ideals are not necessarily the same as
those of heterosexual men (e.g., many
lesbians prefer women who are “butch”). Likewise, lesbians’
sexual repertoires involve more than
just dildos. In fact, one study found that vaginal penetration
with sex toys is something that just
16% of lesbian and bisexual women say that they do often
(Bailey et al., 2003). Despite what
you might see in porn, lesbians do not necessarily enjoy
performing oral sex on dildos either.
Consider this comment from a qualitative study by Morrison
and Tallack (2005) in which lesbians
were exposed to pseudo-lesbian porn:
“The sirap-on dildo. . .boihers me. Because ii doesn’i alwarys
happen and whry would a
lesbian. . .suck a sirap-on? How is ihai visuallry or even
sexuallry appealing? If ryou’re a lesbian,
ryou are a lesbian for a reason. Yes, use iorys. I’m noi sarying
don’i use iorys. Bui I don’i suck on
ihem afier.”
Second, another popular stereotype about lesbian sex is that it
focuses primarily on “scissor-
ing” (i.e., tribadism), an idea popularized by the television
show Souih Park, which aired an infa-
mous episode about lesbian sex in 2007. In stark contrast to this
stereotype, a survey of over
1,200 lesbian and bisexual women who were asked about their
sexual practices revealed that
genital-genital touching was something that just 50% of the
sample said that they did often
(Bailey et al., 2003). Even larger percentages said that they

often practiced oral sex (72%), vaginal
penetration with fingers (84%), and mutual masturbation (71%).
Thus, while tribadism/scissoring
is certainly a sexual behavior that many lesbians practice, it is
far from the only behavior, and by
no means is it the most common.
In short, lesbians have very diverse sex lives, and the reality of
them is not well represented in
porn or in the media.
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Figure 9.8 Despite the widespread stereotype of “lesbian bed
death,” many female same-sex couples lead very
active and satisfying sex lives. ©Rawpixel.com/Shutterstock.
Digging Deeper 9.4 Do Gay Men’s Sex Lives Match Up With
the Stereotypes?
There are several common stereotypes about the sex lives of gay
men. One of the most prevalent
is that anal sex is the primary (if not only) sexual activity that
gay men practice. Another is that sex
in public places (e.g., in parks or public bathrooms) is a
common occurrence. And yet one more is
that gay men mostly have sex with anonymous partners. Is there
any truth to these widespread
stereotypes? According to research, the answer is no.
Rosenberger and colleagues (2011) examined the sexual
behaviors of a national US online
sample of nearly 25,000 men who have sex with men (86% of
whom identified as gay). Par-
ticipants were asked to describe the details of their most recent
sexual event with a male part-
ner. Results indicated that these men have a diverse sexual
repertoire, with over 1,300 unique
combinations of sexual behavior reported. Most participants

(63.2%) reported engaging in
somewhere between five and nine different sexual activities
during their most recent sexual
encounter.
The single most commonly reported behavior was kissing on the
mouth (74.5%), followed
closely by oral sex (72.7%) and mutual masturbation (68.4%).
Contrary to popular belief, only
about one-third of men in the sample reported engaging in anal
sex (37.2%). This tells us that the
common assumption that “gay sex” is necessarily anal sex is
inaccurate.
In terms of the context of sexual behavior, only a very small
minority of participants reported
that their sexual activity took place in what would be
considered a public setting (3.1%)—the
vast majority had sex in their own home or in their partner’s
home (77.7%). In addition, 37%
reported that sex occurred with a boyfriend or dating partner,
and 17% indicated a friend. Thus,
for the majority of the men in this study, their most recent
partner was well known to them and
was not anonymous.
(Coniinued)
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Just a few studies have addressed this topic, and they have
largely been limited to hetero-
sexual college students and their experiences with threesomes.
This is unfortunate because it
is likely that interest in and experience with threesomes—and
group sex more broadly—varies
with age. For younger persons, sex with just one partner is still
very much a novelty. As a result,
group sex might not even be on their radar. However, for older
adults, especially those who are
in long-term monogamous relationships, that novelty is more
likely to have worn away. Group
sex might therefore be more appealing to older adults because

they see it as a way of augment-
ing sex with a romantic partner.
With that said, one study of heterosexual Canadian college
students found that 13% of them
reported having taken part in a threesome before; however, men
(24%) were actually three times
more likely to say they had been in a threesome than women
(8%; Thompson & Byers, 2017).
For both male and female participants in this study, the most
common type of threesome they
had experience with involved two women and one man. Some
research has examined group
sex practices among non-heterosexuals, with the results
revealing that interest in multi-partner
Figure 9.9 Contrary to popular belief, kissing on the mouth is
the most frequently reported sexual
behavior among men who have sex with men.
©mavo/123RF.COM.
While it is certainly true that some gay men have anonymous
anal sex in public places, this
is not necessarily what all or even most gay men do. The results
of this research thus seem to
counteract many common stereotypes about the sex lives of gay
men. In addition, these findings
suggest that doctors and public health professionals should not
make too many assumptions
about the sexual behaviors of men who have sex with men;
rather, we need to take into account
the wide individual variability that exists.

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-requencry and Benefiis of Sex and Orgasm 255
sex transcends sexual orientation. For example, in a study of
mostly younger men who have

sex with men from New York City, approximately 18% reported
having had group sex before
(Jenness et al., 2010). However, “group sex” was not defined
in this study, so it is not clear
whether these experiences represented threesomes, orgies, sex
parties, or something else.
Obviously, group sex can mean a lot of different things. As a
result, the relative risk associ-
ated with this activity can vary tremendously. For instance, a
couple who brings a third person
into their relationship for an evening but uses condoms would
be taking on far lower risk than,
say, someone who is participating in an orgy or gangbang and
has successive sexual contact
with ten or twenty people. That said, research has found an
association between group sex and
STI acquisition (Rothman et al., 2012), which highlights the
importance of employing safer-sex
practices when engaged in any form of multi-partner sex.
Frequency and Benefits of Sex and Orgasm
One of the most common concerns people have about their own
sex lives is whether they
are having “enough” sex. As a result, students taking this course
often ask what a “normal”
frequency of sexual activity is. As discussed in chapter 2,
however, we cannot look to a single
number to represent normalcy; rather, we need to consider a
range of responses. The reason
for this is because people have preferences for different
amounts and types of sexual activity.
For instance, some older married couples may be content having
sex just one per year on their
anniversary, whereas some younger couples may not be content

unless they are having sex
most days of the week. Thus, the “correct” amount of sex is the
amount that makes you and
your partner(s) happy.
Although there is a lot of variability when it comes to desired
amounts of sex, several studies
have found that, overall, the more frequently people have sex,
the more satisfied they tend to
be. However, a closer examination of this data reveals that
there’s a leveling-off point. What
this means is that once you reach a certain level of sexual
activity, having more sex doesn’t
seem to enhance sexual satisfaction any further. Specifically,
once per week seems to be the
leveling-off point—having more sex than that offers
diminishing returns (Muise, Schimmack, &
Impett, 2016). In other words, people who are having sex once
per week are happier than
people who are doing it less often; however, people who are
having sex every day or multi-
ple times per day aren’t necessarily any happier than people
who are doing it once per week.
Experimental research supports this idea. In a study in which
people who were already having
weekly sex were asked to either double their sexual frequency
or not, those who tried to dou-
ble the amount of sex they were having weren’t any happier
after three months (Loewenstein
et al., 2015). In fact, those who forced themselves to have more
sex found the experience to be
negative for the most part. Thus, although people tend to think
that more is always better when
it comes to sex, this does not necessarily seem to be the case in
reality. As a result, it is usually
not productive to worry about whether you “should” be doing it

more.
With that in mind, to give you some sense of sexual frequency,
Table 9.3 presents results from
the NSSHB looking at how often heterosexual married adults
report having penile–vaginal
intercourse in the United States. Of course, keep in mind that
while vaginal intercourse is one
of the most common sexual behaviors, it is far from the only
behavior people might engage in.
Unfortunately, we currently lack nationally representative data
on how often people engage
in other sexual activities, as well as how sexual frequency
differs across other demographic
groups. If other sexual behaviors were assessed and more
diverse groups were considered,
the conclusions might be quite different. With these limitations
in mind, what you will see
is that a few times per week was the most common response.
However, you will also see that
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frequency of vaginal intercourse depends upon both age and
sex, with adults under age 50 and
men reporting it most frequently.
Research suggests that there may be some physical and
psychological health benefits of being
sexually active on at least a semi-regular basis. For instance, a
study of male rats that were ran-
domly assigned to sex deprivation (i.e., just one act of sex over
the course of the study) or daily
sex for two weeks revealed that the more sexually active rats
exhibited greater neuron growth (a
key factor in mental agility) and lower circulating levels of
stress hormones (Leuner, Glasper, &
Gould, 2010). In addition, research on humans has found that
people who have recently fallen
in love have higher levels of nerve growth factor in their blood
(Emanuele et al., 2005). Like-
wise, research on young heterosexual women has found that
more frequent vaginal intercourse

is linked to enhanced memory on word recognition tasks
(Maunder, Schoemaker, Pruessner,
2016). Together, these results suggest the intriguing possibility
that sex may help maintain and
possibly enhance cognitive functioning.
In addition, sex may promote better physical health and
longevity. As some evidence of this,
an experimental study in which men’s blood was tested
immediately after masturbating to
orgasm or after refraining from sexual activity revealed that
orgasm was linked to enhanced
immune system functioning, including an increase in natural
killer cells (Haake et al., 2004).
Could frequent immune boosts following orgasm potentially
help you to live longer? A study
of men from the United Kingdom found that participants with
the highest orgasmic frequency
had a 50% lower risk of death than those men who had did not
have as many orgasms (Davey
Smith, Frankel, & Yarnell, 1997).
Table 9.3 Frequency of Penile–vaginal intercourse in the past
year among married American adults stratified
by age and sex.
Women
Not in the
past year
A few times per year to
monthly
A few times each month to
weekly

2–3 times per
week
4+ times per
week
18–24 11.8% 14.7% 14.7% 35.3% 23.5%
25–29 3.5% 11.6% 47.7% 35.2% 2.0%
30–39 6.5% 16.3% 50.2% 21.9% 5.1%
40–49 8.1% 21.7% 46.6% 20.8% 2.7%
50–59 22.0% 23.7% 36.2% 16.9% 1.1%
60–69 37.9% 20.0% 35.9% 6.2% 0.0%
70+ 53.5% 25.4% 18.3% 1.4% 1.4%
Men
Not in the
past year
A few times per year to
monthly
A few times each month to
weekly
2–3 times per
week
4+ times per
week
18–24 4.2% 12.5% 16.7% 45.8% 20.8%
25–29 1.6% 9.3% 46.3% 37.1% 5.9%
30–39 4.5% 15.6% 47.3% 26.8% 5.8%
40–49 9.1% 16.2% 51.0% 19.9% 3.7%
50–59 20.6% 25.0% 38.3% 15.0% 1.1%
60–69 33.9% 21.2% 35.4% 9.5% 0.0%

70+ 54.2% 24.2% 15.0% 5.8% 0.8%
Note: Adapted from Herbenick et al. (2010b) and Reece et al.,
(2010).
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Sexual Behavior in Psrychological Perspeciive 257

Sexual Behavior in Psychological Perspective
As we close out this chapter, we will further explore the role
that psychology plays in sexual
behavior so that you can better understand when and why people
might be inclined to engage
in or avoid the behaviors discussed above. In chapter 1, we
mentioned a few psychological
influences in detail, including personality traits (e.g.,
erotophilia, sociosexuality, and sensation
seeking), classical and operant conditioning, observational
learning, and evolved tendencies.
However, beyond these factors, there are a number of other
variables psychologists have identi-
fied that can affect how and when we express our sexuality. In
this section, we will consider the
roles of self-regulation (i.e., self-control), attachment style, and
mortality salience.
Self-Regulation
According to the Strength Model of Self-Control (Baumeister,
Vohs, & Tice, 2007), our will-
power is a limited resource. In other words, our ability to exert
self-control is finite. You can
think of self-control as being akin to a muscle in the sense that
drawing upon your willpower
repeatedly in a short period of time will deplete your strength,
thereby making it harder to
exert self-control again in the near future. Psychologists have
documented evidence of this
time and again in a variety of settings (although, to be fair,
some self-control effects have
failed to replicate and there is an ongoing debate in the field
about the precise mechanism that
underlies this phenomenon, as well as the length of time it takes

for depletion effects to set
in; Hagger & Chatzisarntis, 2016). Among other things, studies
have found that when people’s
self-control abilities have been weakened, they have less ability
to resist the temptation to
consume alcohol, eat sugary foods, and spend money
impulsively (see Baumeister et al., 2007).
Does self-regulatory failure also have implications for our sex
lives? It would appear so.
Figure 9.10 Frequent sex increases the growth rate of neurons in
rats. Are creatures that have more frequent
sex smarter? ©Cathy Keifer/123RF.COM.
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Before we get into the findings, it is worth pointing out that
there is a difference in trait vs.
state self-control. Trait self-control refers to your overall,
chronic level of self-control. It is
a simple fact of life that some people just have bigger self-
control reserves than others. For
instance, you probably know some people who are very good at
sticking to diets, and others
who constantly fail at them. Part of the reason for this is
because self-control is, to some extent,
a psychological trait that we can possess in larger or smaller
quantities. State self-control
refers to your self-control abilities at a specific moment, taking
into account situational factors.
State self-control therefore fluctuates moment to moment and
can go up or down depending
upon how much willpower you have exerted recently.
With regard to trait self-control, research on adolescents has
found that lower overall levels
of self-control longitudinally predict pursuit of riskier sexual
behaviors (e.g., Raffaelli & Crock-
ett, 2003). Thus, being chronically low on self-control may
predispose individuals to forego con-
doms, have larger numbers of partners, and engage in other
behaviors that increase their risk of
infection transmission. Likewise, research has demonstrated

that lower levels of trait self-control
are associated with more temptation to cheat on one’s current
romantic partner. For instance, a
study of romantically involved, heterosexual male participants
seated in a waiting room with an
attractive female confederate revealed that the men with lower
levels of trait self-control engaged
in more flirting with the confederate than men who possessed
greater willpower (Pronk, Kar-
remans, & Wigboldus, 2011). With regard to state self-control,
we discussed a study by Gailliot
and Baumeister (2007) in chapter 2 in which they found that
when participants’ self-regulatory
abilities were temporarily weakened, participants subsequently
engaged in more extensive sexual
activities with their current romantic partner. In two other
studies, Gailliot and Baumeister found
that when participants’ self-control abilities were temporarily
depleted, they reported a greater
likelihood of cheating on their partner and had a stronger
tendency to unscramble letter sets (e.g.,
Figure 9.11 When our self-control resources are low, we may
become more susceptible to cheating on a
romantic partner. ©Kzenon, 2013. Used under license from
Shutterstock.com.
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Sexual Behavior in Psrychological Perspeciive 259
N I S E P) as sex words (PENIS) instead of non-sex words
(SPINE). Thus, both our trait and state
levels of self-control appear to influence our sexual thoughts
and behaviors.
Attachment Style
As described in chapter 8, each of us has our own attachment
style, which can be thought
of as one’s general approach to developing and maintaining
relationships with other people
(Hazan & Shaver, 1987). To refresh your memory, people can
be securely attached (i.e., they
have an easy time getting close to others), anxiously attached

(i.e., they fear that their partners
may leave), or avoidantly attached (i.e., they are uncomfortable
with intimacy). Research has
found that these attachment styles are associated with different
sexual behaviors, as well as dif-
ferent overall levels of sexual functioning.
Specifically, a review of 15 studies in this area by Stefanou and
McCabe (2012) revealed that
higher levels of anxious attachment were associated with a
greater frequency of sex and the
pursuit of sex as a means of getting closer to one’s partner.
Additionally, higher levels of avoid-
ant attachment were linked to a lower frequency of sexual
activity and pursuing sex for nonro-
mantic reasons (e.g., to enhance one’s own status or to
manipulate a partner). Moreover, both
anxious and avoidant attachment were linked to lower levels of
sexual satisfaction and a higher
number of sexual problems (e.g., difficulty reaching orgasm).
Other research has found that
patterns of attachment also predict safe-sex practices. For
example, high levels of attachment
anxiety are associated with lower levels of condom use
(Strachman & Impett, 2009), perhaps
because anxious individuals feel as though they have less power
to negotiate condom use out of
fear that their partner will leave. Thus, our attachment style
may lead us to view sex very differ-
ently, which may ultimately influence the frequency with which
we engage in certain behaviors
as well as the quality and safety of the sex that we have.
Mortality Salience
One additional psychological factor that can affect sexual

behavior is mortality salience, which
refers to human beings’ conscious or unconscious recognition
that we will eventually die. Accord-
ing to Terror Management Theory (Solomon, Greenberg, &
Pyszczynski, 1991), when we are
reminded of our own mortality, we subconsciously alter our
attitudes and behaviors in order to help
us cope with the “terrifying” prospect of our eventual death. If
you have ever taken a social psychol-
ogy course, you have probably learned that these coping
mechanisms focus on embracing cultural
worldviews and enhancing self-esteem; however, what you may
not have learned is that changes in
sexual attitudes and behavior may be an important part of
coping efforts for some people.
Consider a series of studies conducted by Landau and
colleagues (2006) in which participants
were primed with mortality salience (i.e., the prospect of death
was brought to mind by asking
participants to write a brief essay about what will happen to
their body when they physically
die). Their research consistently found that mortality salience
primes reduced heterosexual men’s
interest in sexy and alluring women; however, mortality
salience did not diminish their interest in
women who appeared more “wholesome” (i.e., women who were
dressed more conservatively).
Landau and colleagues argue that, for some men, “the
experience of raw sexual attraction. . . trans-
forms the individual from something unique and special to an
impulsive, animalistic, material,
and finite piece of biological protoplasm” (p. 132). In other
words, sexy women may remind men
of their creaturely instincts and impulses. As a result, when a
man is already feeling threatened

(e.g., as a result of a mortality salience prime), he may seek to
distance himself from and perhaps
even derogate sexy women as a way of helping him feel better
about himself.
However, mortality salience does not lead everyone to distance
themselves from sex. In fact,
for some people, the opposite effect emerges. For example,
interest in sex increases after a
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Discussion Questions: What is Your Perspective on Sex?
● What (if anything) were you told about masturbation while
you were growing up? What does
the information you received (or failed to receive) suggest about
modern society’s attitudes
toward self-pleasure?
● Several studies have suggested that people who have sex and
reach orgasm more frequently
tend to be healthier. Do you think this is primarily because sex
is good for you, or because
healthy people are just more capable of sex and tend to “do it”
more often?
● Out of all of the different psychological influences on sexual
behavior we have considered
thus far, which ones do you think best explain your own sexual
attitudes and behaviors?
References
Anderson, T.A., Schick, V., Herbenick, D., Dodge, B., &
Fortenberry, J.D. (2014). A study of human
papillomavirus on vaginally inserted sex toys, before and after
cleaning, among women who
have sex with women and men. Sexually Transmitted Infections,
90(7), 529–31. doi:10.1136/
sextrans-2014-051558
Bailey, J.V., Farquhar, C., Owen, C., & Whittaker, D. (2003).

Sexual behaviour of lesbians and
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doi:10.1136/sti.79.2.147
Baumeister, R.F., Vohs, K.D., & Tice, D.M. (2007). The
strength model of self-control. Current
Directions in Psychological Science, 16, 351–355.
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Birnbaum, G. E., Simpson, J. A., Weisberg, Y. J., Barnea, E., &
Assulin-Simhon, Z. (2012). Is it my
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1131–1152. doi:10.1177/0265407512452978
mortality salience prime among people who have positive body
image (Goldenberg et al., 2000).
What this suggests is that for people who are more comfortable
with their physical appear-
ance, the body itself and bodily activities like sex come to
represent an important source of
self-esteem. For such individuals, sex may be an appropriate
way of dealing with the prospect
of one’s own mortality by reducing feelings of anxiety.
Research has also found that mortality
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Ari, 2004). Again, this suggests
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intimacy, reminders of death may spur
sexual behavior. Thus, the specific effects of mortality salience
fundamentally depend upon
how we feel about ourselves and about sex in general.

As you can see, a variety of dispositional (e.g., trait self-
control, attachment style) and situ-
ational factors (e.g., state self-control, mortality salience) may
affect the likelihood that an indi-
vidual will engage in sexual behavior. Because there are so
many factors that can promote or
inhibit sexuality, it makes understanding both the causes and
treatments of sexual problems
incredibly complex, an issue we will return to in chapter 13.
Key Terms
celibacy
sexual fantasies
masturbation
hysteria
tribadism
cunnilingus
fellatio
coitus
coital alignment technique
(CAT)
dry sex
anilingus
trait self-control
state self-control
mortality salience
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