ABC of Sexual Health

Kevan R. Wylie, Kevan R. Wylie

• Publisher: BMJ Books
• Year: 2015
• ISBN:
  9781118665619
• Edition: 3
• Topic: Medicine
• Subtopic: Sexual Health & Sexuality

ABC of Sexual Health

ABC of Sexual Health provides a comprehensive overview of this important, but difficult subject and includes reading resources as well as information on professional societies, patient groups and online resources.

Fully revised and expanded to cover a range of new content and topics including psychological, urological, gynaecological, endocrinological and psychiatric aspects of sexual health, the effects of medication, sexual dysfunction, sexual orientation, gender identity, paraphilias, forensic sexology, dermatoses, and psychosexual therapy and education.

ABC of Sexual Health is a practical guide for all general practitioners, family physicians, trainees and medical students wanting to improve communicating, examining and managing patients with sexual health problems.

About the ABC series

The new ABC series has been thoroughly updated, offering a fresh look, layout and features throughout, helping you to access information and deliver the best patient care.The newly designed books remain an essential reference tool for GPs, GP registrars, junior doctors and those in primary care, designed to address the concerns of general practitioners and provide effective study aids for doctors in training.

Now offering over 70 titles, this extensive series provides you with a quick and dependable reference on a range of topics in all the major specialities. Each book in the new series now offers links to further information and articles, and a new dedicated website provides you with even more support.

The ABC series is the essential and dependable source of up-to-date information for all practitioners and students in general practice.

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Chapter 1
Psychosexual Development

Brian Daines

University of Sheffield, Sheffield, UK

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Overview

• Psychosexual development is not limited to childhood and adolescence but extends through adult life
• Early psychoanalytic views of the process are still influential but more recent ideas such as consumerist and feminist perspectives offer a more societal emphasis
• It is important to consider the impact of the aspects of law and culture that relate to psychosexual development
• Clinicians need to be aware of the implications of these issues and the various factors impacting on development in their consultations with patients.

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Introduction

Interest in psychosexual development has tended to focus around managing problems, particularly those associated with risks and their management. These areas include sexual abuse in childhood and early adolescence, unwanted pregnancy and sexually transmitted diseases (STDs) in adolescence and early adulthood and functional sexual difficulties in adults. In contrast, the interest, for example of adolescents has been shown to be more in the rite of passage and recreational aspects of sexual activity. There has also been a concentration on childhood and adolescence, with adult psychosexual development being a poor relation and any emphasis for older people being on dysfunctions and disorders rather than the expected course of development. Development through the life cycle involves important areas such as sexual identity, couple relationship issues, fertility and ageing.

Psychoanalytic views

Probably, the most familiar schema of sexual development in childhood and adolescence is that proposed by Freud (Table 1.1). This still has currency in many modern textbooks despite having long been superseded, not only outside of the world of psychoanalysis, but also generally among psychotherapists. A primary criticism is that it pathologizes variations in sexual development, in particular gay and lesbian relationships. With the passage of time, Freud's emphasis on instinct and drive was replaced by highlighting the importance of relating and relationship and then broadened to recognize the importance of learning and culture. Freud's theories assume that children are caught in hidden conflicts between their fears and their desires, whereas the environmental learning view is of identification through observation and imitation. Modern psychoanalytic views include a wide range of innovative ideas such as that the various dynamics in childhood produce a psychosexual core which is unstable, elusive and never felt to be really owned.

Table 1.1 Freud on psychosexual development

Oral stage 0–2 years Desires are focussed on the lips and mouth. The mother becomes the first love-object, a displacement from the earliest object of desire, the breast

Anal stage 2–4 years of age In this stage, the anus is the new auto-erotic object with pleasure being obtained from controlling bladder and bowel movement

Phallic stage 4–7 years of age In this third stage, awareness of and touching the genitals is the primary source of pleasure

Latency period 7–12 years of age During this time, sexual development is more or less suspended and sexual urges are repressed

Genital phase 13 years + (or from puberty on) In this final phase, sexual urges are direct onto opposite sex peers with the primary focus of pleasure of the genitals

Consumerist view

At the other end of the spectrum are ideas that take a societal perspective, such as consumer culture bringing sexuality into the world of commerce. Sex is used to sell products through sexiness and physical attractiveness being closely connected with the goods we buy and are seen to own. This aspect of sex and consumerism is particularly directed towards girls and women. A further development is when sex itself is marketed as pleasure or the idea of sexual self-expression is promoted. The world is sexualized, and there is a seduction into the world of responding to sexual impulse. On the Internet in particular, representations of the body become products to buy. This becomes the world into which children and adolescents are socialized and encouraged to participate. As we grow up, sexuality becomes increasingly focussed on technique and performance with a tendency for it to come to resemble work risking the loss of much of its intimate and caring qualities.

Feminist views

The feminist perspective is that gender shapes our personality and social life and that our sexual desires, feelings and preferences are deeply rooted by our gender status. The identification between mothers and daughters leads girls to become very relationship-orientated. This promotes the connection of sex with intimacy and the valuing of its caring and sharing aspects. It develops as a means of communication and intimacy rather than a source of erotic pleasure. In contrast, boys develop a more detached relationship with their mothers and do not have the same kind of identification with their fathers and this leads them to be more goal-orientated around sexuality. There is more of an emphasis on pleasure and on performance. It is also argued that girls' identification with their mothers makes their heterosexual identification weaker than that of boys.

Definition of childhood and adolescence

The nature of childhood and adolescence has been subject to debate and controversy. Whilst all acknowledge that the nature of both has changed in Western culture over the centuries, there is some dispute about when the idea of childhood as a distinctive phase began, and it has been suggested that the idea we have currently of adolescence did not exist before the beginning of the twentieth century. It has also been argued that the concept of childhood makes children more vulnerable including to sexual exploitation and abuse. The idealization of childhood may also contribute to the sexual attraction of children to certain adults.

The impact of law and culture

Aspects of the definitions of childhood and adolescent become enshrined in law particularly in defining the age of consent for sex and what kinds of sexual practices are legal. It also defines a framework for marriage, and alongside this are cultural issues about the acceptability of sexual relationships outside of this. In different countries, the age of consent varies from 12 to 21 for heterosexual, gay and lesbian relationships, but in many countries same-sex relationships are still illegal. The position is complicated by the fact that these arrangements are often subject to review and potential change.

Although it is clearly interwoven, law is only one of the forces at work here as family, religion, culture and mass media also infl...