March 25th, 2009 admin
Europe was dominated by a single religion for more than 1,000 years. During the Middle Ages, formal sexual values were dictated by the sacred laws of the Roman Catholic church. Religious law was the highest law in the land. It was based on the belief that all sensual pleasure was sinful. It determined who could marry, what kind of sex was allowed, where it was allowed, when it was allowed, and why women had to always submit to their husbands. People could be ruthlessly punished if they disobeyed. Punishment ranged from meditation, fasting, and prayerful penance to imprisonment, torture, excommunication, and execution.
Some countries worldwide are still dominated by sacred law, but over the centuries, sacred law has given way to secular law. Today, few people rely exclusively on religion to decide their sexual behavior. In the United States, federal, state, and local governments make laws that regulate sexual behavior. These laws are often designed to protect people against sexual abuse. Often, however, laws regulate sexual conduct between consenting adults.
Some laws, such as those that prohibit rape and prostitution, are criminal laws with criminal penalties. Other laws, such as those that prohibit discrimination and sexual harassment, are civil and give individuals the right to sue for damages. Criminal and civil laws are enforced by the federal, state, and local courts.
Increasingly, scientific and medical knowledge has an impact on sexual law. Lawmakers and enforcers are more likely to try to understand unusual sex practices by looking for medical or psychological explanations rather than devils or demons. People with socially unacceptable sex problems are more likely to be treated with drugs or therapy than with whips and red-hot pokers.
But the sexual values established by religious sacred laws continue to have a powerful impact on our current secular laws. They, too, have become a part of our cultural traditions. For example, religious law in the Middle Ages taught that oral and anal sex were much worse crimes than rape. Religious leaders believed that rape was a more moral behavior because it could cause pregnancy, and they believed that pregnancy was the only moral reason for having sex. Because oral and anal sex couldn’t cause pregnancy, they were considered very great crimes. People were publicly executed for such behavior.
These medieval punishments left a powerful impression in cultural traditions and beliefs that lasted thousands of years. Some religious teachers still teach young people that many sexual behaviors are immoral and sinful because they don’t cause pregnancy. And nearly 20 states still have laws against these sexual behaviors.
These sexual values were handed down to us from generation to generation, from the earliest church fathers, such as Augustine and Thomas Aquinas, to the Victorians of 100 years ago and televangelists of today. To a great degree, they are responsible for the confused attitudes toward sexuality that still have a deep hold on our society. They have taught us that sex is a dangerous, uncontrollable part of our lives, instead of a wholesome birthright that we can celebrate without fear.
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March 25th, 2009 admin
Recovering from Child Sexual Abuse
Child sexual abuse is sometimes recalled only when the survivors reach adolescence or adulthood. Children may not have understood what was happening to them. They may have felt that something was “wrong,” and they may have been very uncomfortable with the activity at the time, but they have tried to forget it.
Recovery from the effects of child sexual abuse can be a long process. Not every survivor of sexual abuse will react in the same way. Although the psychological responses may affect daily life, they may be difficult to identify. Adult survivors may go through many traumatic events as they learn how to deal with the facts and effects of the past abuse.
Recovery from child sexual abuse may include professional help. It is also important to talk with loved ones in order to deal with all the feelings that arise from child sexual abuse. They can provide the essential support system that is needed. Having someone listen, believe, and care is essential for a survivor to begin to feel safe and worthwhile during recovery.
Helping children who say they’ve been abused
• Believe the child. Children rarely lie about sexual abuse.
• Praise the child for telling you about the experience.
• Don’t let the child take the blame. Children fear being at fault and responsible for what’s happened.
• Be as calm as you can and don’t let your response increase the child’s sense of shame, confusion, and guilt. If you can avoid describing the event as being “bad,” you may help the child recover more quickly.
• Find a specialized agency that evaluates sexual abuse victims—a hospital, child welfare agency, or community mental health therapy group. If a medical examination is necessary, ask for a referral to a health care provide who has experience and training in recognizing and treating sexual abuse.
• If other children in the community may be harmed, talk with other parent so they can talk with their children and be on the lookout for unusual behavior or physical symptoms in their children.
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March 25th, 2009 admin
In the case of idiopathic delayed puberty, mainly timing is in error. The hypothalamic-pituitary-gonadal system matures late but appears to function largely normally thereafter. In other cases, the gonads, the pituitary, or the hypothalamus, are defective so that puberty will never occur spontaneously. For those patients, it becomes of utmost importance for their psychological growth and development that puberty is induced by a sex-appropriate hormone regimen. Our clinical experience has been that there are no dramatic, uncontrollable psychosexual effects of sex hormone treatment. Usually, for both boys and girls, sex hormone treatment constitutes a boost to morale, especially when the body begins changing visibly. Often there is an upswing in mood and assertiveness and later also in sexual feelings, sexual fantasies, and interests.
Hypopituitary or hypogonadal patients usually do not show full psychosexual development without hormone treatment. Particularly important is the timing of the induction of puberty. If the appropriate sex hormone treatment can be started when the patient’s peers go into puberty, both psychosocial and psychosexual development may be mostly normal. The longer treatment is delayed, the greater is the chance of maldevelopment. The evidence for this comes from studies of Turner’s syndrome in females, hypogonadism in males. Induction of puberty after age twenty often does not lead to normal psychosexual development. A number of older (hypopituitary) patients have even refused to start sex hormone treatment or have ceased taking it later. It is unclear if this negative reaction toward treatment is due to a generally poorer physiological response to exogenous sex hormones (Zachman and Prader) or to a psychological rigidity and contentment with the patient’s particular status at that age. Generally, the patient groups described showed low sexual arousability, motivation, and activities, as well as deficiencies in sexual pair-bonding, the latter possibly related to decreased socializing with peers. In part, this must be because many of the patients started adequate endocrine treatment later than desirable and/or showed very slow or incomplete somatic maturation. Moreover, it is likely that current treatment regimens do not create an internal hormonal milieu comparable to the one of normal adolescents which may have behavioral consequences of its own. In addition, several syndromes involve hypogonado-tropinism of hypothalamic origin; here, behavioral deficiencies may be linked to the deficiency of LH-RH or to additional undiagnosed hypothalamic dysfunctions.
Methodologically, the clinical studies of pubertal disorders available can be considered only preliminary. No control groups have been employed, hormone measures at the time of psychosexual assessment are usually missing, and the effects of the timing and dosage of hormonal treatment regimens on behavioral changes have not been analyzed. The assessment of social influences also is usually incomplete. Nevertheless, the data suggest an interactive view in the theory of psychosexual development: physical and hormonal changes are necessary for normal psychosocial and psychosexual development in adolescence, but even if they are present, normal psychosexual development is dependent on the social integration of the individual in society and especially in his or her peer group. More detailed theoretical formulation would require much methodologically refined investigation.
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March 25th, 2009 admin
Infant encounters with children (three to seven years old) do occur, but they have not been systematically observed or if observed they have not been recorded. Kinsey observed in some of his unpublished interviews that embracing and kissing among young siblings is much in evidence. It is reasonable to speculate that such behavior is not uncommon in unsupervised intimate play of siblings within the family.
Survey data on the infant’s sexual encounters with preadolescents and adolescents is also sparse, though isolated cases are frequently reported in the psychoanalytic literature. This should not be understood as implying that such encounters do not occur among infants and children not referred for treatment. For example, in a recent survey of a large, self-selected United States sample of adults, approximately three hundred (one percent of the females and two percent of the males) reported that they had had their first sexual intercourse with a relative. If this is true of coitus, intimacy among young siblings, short of incest, can be assumed to be much more prevalent. No researcher has systematically studied such encounters, however, and in a sexually repressive society adolescents and preadolescents are careful not to be caught in such play.
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March 25th, 2009 admin
In human beings, not only do XX fetuses become androgenized, but also XY fetuses become deandrogenized. The term for the latter type of hermaphroditism is the androgen-insen-sitivity syndrome. The primary pathognomonic feature of the androgen-insensitivity syndrome is the genetically transmitted insensitivity of the target tissues of the body to androgen.
The effect of androgen insensitivity in fetal life is that the external genital structures differentiate as female. There is a lack of development of the wolffian ducts and failure of masculinization of the external genitalia. When androgen insensitivity is total, the external appearance of affected individuals is indistinguishable from the external appearance of normal females. Internally, the fallopian tubes, uterus, and upper vagina fail to differentiate and develop, since responsiveness to mullerian inhibiting substance (MIS), in contrast to androgen, is unaffected. When androgen insensitivity is partial, as sometimes happens, the affected individuals are born with ambiguous-looking sex organs. Some such babies have been assigned and reared as females and some as males.
Since totally androgen-insensitive individuals at birth look like normal females, they are invariably assigned and reared as females. Although such females are occasionally detected in infancy or childhood because of the presence of inguinal hernias or labial masses which are the gonads (defective testes), the majority are not recognized until puberty. At puberty the patients consult physicians because of primary amenorrhea, secondary to absence of the uterus.
With the exception of amenorrhea, girls with the androgen-insensitivity syndrome have a feminizing puberty. Feminization is the result of estrogen secreted noncyclically by the gonads (testes) and unopposed by androgen.
Once puberty is complete, physicians usually advise gonadectomy because it is a widely held, though poorly documented doctrine, that there is an increased risk in adulthood of potentially malignant gonadal tumors. Having had a gonadectomy, androgen-insensitive girls require replacement estrogen, preferably combined with progestin, to maintain hormonal femininity.
Since the upper one-third of the vagina fails to differentiate, the vagina usually requires lengthening. This lengthening may be achieved by a self-dilatation technique or by surgery (vaginoplasty).
Psychosexually, individuals diagnosed as androgen insensitive who are assigned and reared as girls, differentiate and develop an unequivocal feminine gender identity/role.
Viola G. Lewis (unpublished M.A. thesis) recently compared a group of androgen-insensitive women with a group of women diagnosed as having Rokitansky’s syndrome. Women with Rokitansky’s syndrome resemble women with the androgen-insensitivity syndrome anatomically and physiologically, but have XX instead of XY chromosomes, ovaries instead of testes, and are hormonally cyclic instead of acyclic. Results of the comparison indicate no statistical differences between the findings on the two groups of women on the following variables: psychosexual orientation, acceptance of sexual status, self-rating of sexual frequency and interest, masturbation, orgasm, attitude toward infant care, and attitude toward marriage. All of the women had differentiated an unequivocal female gender identity/role.
In partial androgen insensitivity, also known as Reifenstein’s syndrome, there is partial masculinization of the external genitalia in fetal life. Consequently, the baby is born with ambiguous-looking, hermaphroditic external genitalia and may be assigned and reared as either a male or female. Money and Ogunro (1974) compared partially androgen-insensitive hermaphrodites discordant for sex assignment and rearing.
Behaviorally, the individuals reared as boys tried to compensate for their relative inferiority in competitive sports. Because of their unvirilized, beardless appearance, and extremely small, surgically repaired genitalia, they had great difficulty in establishing a sex life, even though they had differentiated a male gender identity/ role.
Individuals reared as females differentiated a female gender identity/role, and for them an adequate sex life was feasible.
In partial androgen insensitivity, as in the adrenogenital syndrome, it is possible to match patients in pairs concordant for diagnosis and prenatal history but discordant for assigned sex and postnatal history. This matched-pair method demonstrates the relative importance of postnatal history in differentiating gender identity/ role. The method is applicable also to the syndrome of micropenis.
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