Gender matters: constructing a model of adolescent sexual health.

For better or worse, adolescence is an inescapable part of the life cycle. Although many parents, teachers, politicians, and adolescents themselves might prefer that sexuality were not involved in the process of moving from childhood to adulthood, it is. On a societal level, there is an obligation to provide safe passage for this transition. How this happens depends, in part, on how adolescent sexual health is conceptualized. Conceptual models affect both the questions researchers ask and what society knows about adolescent sexuality.

In this paper, we examine the role of gender in sexual health models for adolescents. Our purpose is threefold: (a) We review current comprehensive models of adolescent sexual health, noting that gender is absent in these models; (b) we provide theoretical and empirical evidence for the importance of including gender in an explicit way; and (c) we describe how we developed a new model of adolescent sexual health in which gender matters.

CURRENT MODELS OF ADOLESCENT SEXUAL HEALTH

In 1995, The National Commission on Adolescent Sexual Health released a consensus statement on adolescent sexual health, which was endorsed by 50 national organizations and over 35 professional organizations, including the American Psychological Association, the Society for the Scientific Study of Sex, and the Society for Adolescent Medicine (Hafner, 1998). In contrast to most approaches to sexual health, which are narrowly focused on avoiding unwanted pregnancy and disease, the Commission's statement articulated one of the most comprehensive approaches to adolescent sexual health to date. According to the statement, sexual health includes the abilities (a) to develop and maintain meaningful interpersonal relationships; (b) to appreciate one's own body; (c) to interact with both genders in respectful and appropriate ways; and (d) to express affection, love, and intimacy in ways consistent with one's own values. Achieving sexual health requires the integration of psychological, physical, societal, cultural, educational, economic, and spiritual factors. This model identified the interplay between developmental processes of adolescence and sexual health, construing sexual health as a normative aspect of adolescent development.

The recent U.S. Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior (Satcher, 2001) signaled recognition of broader contexts of relationship and community as part of sexual health. This call to action was the result of an interdisciplinary collaborative effort to advance scientific rigor in studying sexual health, HIV and AIDS, and STD prevention. One outcome of the collaboration was the following definition of sexual health:

   Sexual health is not limited to the absence of disease or
   dysfunction, nor is its importance confined to just the
   reproductive years. It includes the ability to understand and
   weigh the risks, responsibilities, outcomes and impacts of
   sexual actions and to practice abstinence when appropriate. It
   includes freedom from sexual abuse and discrimination and the
   ability of individuals to integrate their sexuality into their
   lives, derive pleasure from it, and to reproduce if they so
   choose. (Satcher, 2001, p. 1)

For adolescents in particular, the report asserted the universal right to sexual health and the need for education and for skills training that goes beyond learning to say no to sexual intercourse. Advancing sexual health among adolescents requires understanding the relationships between relevant aspects of the developing self (e.g., self-esteem and sexual expectations) and the multiple contexts in which such development occurs (e.g., interpersonal experiences).

GENDER MATTERS

Sexual health models such as the ones cited above have moved us beyond an exclusive focus on risky sexual behavior. Yet despite this inclusive scope, the construct of gender does not appear in a substantive way. We contend that gender is a fundamental part of adolescent sexual health and thus needs to be included. To support this perspective, we review here theoretical and empirical evidence illuminating how gender matters.

Although there is a consensus that gender is a key aspect of sexuality, how gender influences sexual health is understudied. In our view, the meaning of gender is organized by patriarchy and, more specifically, by institutionalized heterosexuality. Forming a sense of one's gender, often referred to as gender identity development, is a process that begins early in life and heightens during early adolescence (Galambos, Almeida, & Petersen, 1990). As young people's bodies begin to mature, new questions of identity and new types of relationships enter the lives of adolescents in compelling ways. For example, feminist-based research has found that girls' psychosocial development is negatively impacted by gender expectations. For instance, norms of femininity push girls to avoid conflict and attend to others' needs more than their own. Capitulation to such norms has been shown to make authentic relationships with others difficult and to lead some girls to dissociate from their bodily feelings of hunger and desire (Brown, 1999; Brown & Gilligan, 1992; Tolman, 2002; Tolman & Debold, 1993). It is also at this time in the life cycle that gender becomes explicitly linked to emerging adult forms of sexuality (Gagnon & Simon, 1973). For instance, developmental psychologists have identified gender as playing a crucial role in adolescents' sexual identity development, a key element of which is determining to whom one is physically and emotionally attracted (Deaux & LaFrance, 1998; Diamond & Savin-Williams, 2000).

HOW GENDER MATTERS

Frequently a category of interest, gender is defined as male and female or boy and girl (Buysse & Van Oost, 1997). Evaluating gender differences in sexual and reproductive behavior is one of the most common ways that gender has entered the study of adolescent sexuality. Gender differences have been found in the types and consistency of contraceptive use (Ford, Sohn, & Lepkowski, 2001) and in partner characteristics (Darroch, Landry, & Oslak, 1999). Such studies do not offer a theoretical justification for this approach to the study of gender. This gender-differences approach is based on the assumption that gender can be measured as a binary variable and demonstrates how a theory of gender (premised on and forefronting differences) is implicit. Based on the literature, there appears to be an unstated consensus that gender is a meaningful category by which adolescent sexual behaviors can and should be distinguished.

It is important to recognize, however, that the concept of gender is frequently contested among sexuality theorists and researchers. Possible definitions of gender emerge from a wealth of theoretical perspectives. These include evolutionary theory, in which gender is grounded in biological or physical characteristics that have historically separated male and female behavior (Buss, 1996; Thornhill & Palmer, 2000); social role theory, in which gender is understood in terms of norms that differentiate masculine and feminine qualities and behavior (Pleck, 1987; Spence, 1993); and social construction theory, in which gender is understood as a set of practices and performances constituted through language or discourses (Butler, 1993; Gergen, 1985) and as features of a political system (Bartky, 1990; Connell, 1995).

Although the jury is still out on whether these contradictory epistemological stances can be resolved (DeLamater & Hyde, 1998; M. Diamond, 2000; Tolman & Diamond, 2002), atheoretical assumptions about what gender means both to researchers and to adolescents can obscure how gender plays out in the realm of sexuality (Parker, Barbosa, & Aggleton, 2000). Gender differences in adolescent sexual behavior and attitudes and in factors related to risky choices are certainly relevant. However, given the range of possible meanings of gender, moving beyond the question of difference is necessary. An in-depth examination is needed to decipher how gender is promoting and undermining adolescent sexual health (Brooks-Gunn & Paikoff, 1997).

In the study of sexuality, a growing body of literature uses a social constructionist perspective on gender. The relationships among meaning, power, and gender are revealed to be mediated by language and "deployed" through codified and condoned discourses or ideologies. As Parker and Gagnon (1995) noted, much of the movement in this direction has been provoked by feminist and queer theories, which identify sexuality as a system that cannot be understood either as gender neutral or as simply the actions of male and female (heterosexual) bodies (G. Rubin, 1984). Revealing how such discourses are reproduced through systematic sources of power (e.g., through institutions like the medical profession or the educational system), social constructionists expose how gendered meanings are one vehicle through which sexuality is constituted (Hollway, 1984a, 1984b; Kimball, 2001; Tiefer, 1995). Feminist researchers have argued that the meanings and realities associated with male and female sexuality are socially constructed to serve political systems that generate and sustain White, heterosexual, middle- and upper-class male privilege (Kitzinger & Wilkinson, 1993; Rich, 1983; G. Rubin, 1984).

A social constructionist approach to gender has yielded insight into the processes by which gender operates to shape various dimensions of adolescent sexuality. This approach to gender involves a move away from questions of difference and toward what has been called the "politics of female sexuality" (Snitow, Stansell, & Thompson, 1983). This paradigm shift has inspired different research questions about sexuality for adolescent girls and the use of different methodologies. Social constructionist research is typified by investigations of the cultural and personal meanings of girls' race and ethnicity, socioeconomic status, and sexual orientation in understanding their sexuality. This research asks questions like the following: What are the discourses available to adolescent girls for making meaning out of their experiences with their bodies, their relationships, and their sexual choices; and in what ways do gendered constructions of female and male adolescent sexuality enable and undermine adolescent girls' sexual health? Relying primarily on intensive interviews, this work has shed light on the importance of gender for girls' sexual experiences and the meaning of their sexual behaviors.

The Women, Risk and AIDS Project (WRAP), a collective of feminist sociologists, has conducted discourse analyses of young women's narratives about their sexual encounters and relationships with young men. Specifically, the analyses assess "the power relations within which sexual identities, beliefs and practices are embedded" (Holland, Ramazanoglu, Scott, & Thomson, 1990). The findings reveal how dominant cultural conceptions of female sexuality as passive, devoid of desire, and subordinate to male needs and desires make it difficult for women to negotiate safe sex (Holland, Ramazanoglu, Scott, Sharpe, & Thomson, 1992; Thomson & Holland, 1994). Holland, Ramazanoglu, Scott, Sharpe, and Thompson (1994) juxtapose these findings with public health campaigns, which advocate for gifts and women to be more assertive in making safer sexual "choices." These findings illuminate how failing to attend to the realities of gender relations renders such preventive efforts at best ineffective and at worst potentially dangerous for young women. The authors also reported young women's descriptions of managing their embodied sexuality in the face of a discourse of "normal" female sexuality as disembodied, a discourse that is central in reproducing gender relations. The researchers noted that disrupting the discourse of disembodiment "can offer some space for women's resistance to men's sexual power" (Holland, Ramazanoglu, Scott, et al., 1994, p. 23).

Fine's (1988) research identified a missing discourse about sexual desire in how adults in an urban school talked about female adolescent sexuality. She heard discourses of victimization, morality, and disease, especially in sexuality education. She reported that this silence about girls' sexual feelings was "interrupted" by the girls themselves, who did discuss sexual desire. In contrast, J. Kitzinger (1995) has shown how alternative discourses of girls' sexuality (e.g., "I'm sexually attractive, but I'm powerful") require overt and ongoing resistance to negative constructions. Even though alternative ways of being sexual are available, such as those embodied in superstars like Madonna, many gifts do not feel they themselves have access to these constructions of female sexuality. Rather, their narratives suggest that they believe female role models who exhibit sexual agency have a status that protects them from being labeled as promiscuous. These girls continue to fear invoking a punitive response from other girls and boys, who enforce more conventional constructions of female sexuality.

Griffin (2000) conducted research on the erotic and sexual dimensions of female friendships in relation to available constructions of "normal" female sexualities. She demonstrated how "adolescence is a crucial moment in which young women (and men) must be `won' for the (heterosexual) patriarchal system" (p. 227). In interviews with 400 White, working-class girls, Thompson (1990, 1995) found that most of them reported experiences of first heterosexual intercourse that were unpleasant, disappointing, and painful. However, a small group of "pleasure narrators" described positive experiences, in which they felt entitled to enjoy initial experiences with sexual intercourse. These girls relayed how their mothers had encouraged expectations that challenged the status quo. In another analysis, Thompson (1992) found that lesbian adolescents conveyed having more pleasurable initial sexual experiences than did heterosexual girls. She suggested that this pattern resulted from the silence surrounding lesbian sexuality, so that lesbian girls heard nothing at all about what their experiences might be like, in contrast with the negative ways that heterosexual sex is portrayed for gifts (Thompson, 1992).

L. Diamond (1998, 2000) has shown how some girls challenge conventional categories of sexual orientation--heterosexual, homosexual, and bisexual, which are premised on gender--by refusing to choose among these options, which do not fully describe their feelings. Other research has also identified the function of femininity ideologies in girls' experiences and constructions of their own sexuality using both narrative and correlational methods. For instance, Tolman's (1994, 2002) empirical work on girls' experiences of sexual desire illuminated the central role that social constructions of normal, appropriate female adolescent sexuality played in girls' experiences of balancing pleasure and danger while negotiating their sexuality (Tolman & Szalacha, 1999).

A comparable body of research is emerging on young men's sexuality. Some of this work grows out of queer theory, which focuses on how young gay men engage with heteronormative discourses. These inquiries illuminate how masculinity is premised on and produced through the performance and policing of specific forms of heterosexual behavior and also through punitive responses to homosexual feelings, behaviors, and relationships (Cohen & Savin-Williams, 1996; Dowsett, 1998; Ross & Rosser, 1995). For instance, Pleck, Sonenstein, and Ku (1994) have found that heterosexual boys' masculinity ideology predicts their use of condoms and other aspects of their sexual decision making. This research suggests that the more boys accept conventional masculinity, the more likely they are to take sexual risks (Pleck, Sonenstein, & Ku, 1993a, 1993b). Boys' behavior in heterosexual relationships becomes a primary site for demonstrating the "menacing, predatory, possessive and possibly punitive" sexuality that proves one's manhood, especially to male peers (Kimmel, 1996, p. 121). This behavior is undergirded by the social imperative not only to demonstrate successful heterosexuality, but also to deny any possibility of homosexuality and to reject thoughts, feelings, or behaviors that hint at femininity (Holland, Ramazanoglu, Sharpe, & Thomson, 1994; Kimmel, 1996; Martino, 2000).

Interestingly, research on adolescent sexuality tends to focus on either girls or boys exclusively (Martin, 1996; L. Rubin, 1990). This approach reinforces the assumption of gender dichotomies and neglects the possible interplay between girls' and boys' perceptions and expectations about femininity, masculinity, and male and female sexuality.

GENDER MATTERS FOR ADOLESCENT SEXUAL HEALTH

Both theory and research suggest that social constructions of gender and sexuality are central aspects of adolescent sexual health. In the consensus statement from the Sexuality Information and Education Council of the United States (SIECUS; 1995), gender is explicitly mentioned in one context: The statement construes sexual health as including the ability "to interact with both genders in respectful and appropriate ways" (p. 4). This single mention is a poignant example of why gender matters. How we conceptualize gender and sexual health influences research, education, and services for adolescents. Gendered conceptions of sexuality challenge the basic premise of equal access to the psychological, social, and material resources required to interact "with both genders in respectful and appropriate ways." By not acknowledging unequal access, the model overlooks crucial barriers to this aspect of sexual health. The theoretical lens of feminist social construction theory reveals that what is taken to be normal, appropriate, and natural about girls and boys and their respective sexualities does not easily enable "respectful and appropriate" interaction. What is "appropriate" for girls' interaction regarding their sexuality from this epistemological perspective?

When gender is understood as mattering, questions emerge about power, privilege, and access; such questions are central to understanding many aspects of sexual health, such as nonexploitative and pleasurable intimate relationships (Amaro, Raj, & Reed, 2001; Wingood & DiClemente, 2002). One feature of these progressive models of sexual health is the inclusion of the context in which adolescents experience aspects of sexual health. If gender is understood as a social and political institution suffusing individual experiences and sexual contexts, then the absence of gender in sexual health models may actually mask significant threats to adolescent sexual health. It is therefore critical to incorporate gender into a model of adolescent sexual health. Emerging from this perspective, our aim in the Gender and Sexuality Project is to produce a sexual health model that illustrates ways in which gender matters for research, practice, policy, and education.

ONE STORY OF MODELING ADOLESCENT SEXUAL HEALTH

Step One: A Web of Theories

We use the image of a web to describe how we have constructed a multidimensional theoretical framework to guide model development. Consider how a web results from the connection of discrete strands, each relying on the flexibility and strengths of the others; in the case of a web of theories, these strands hold some epistemological tensions to create a fragile yet workable whole. In our web of theories, sexuality and gender are woven together in a variety of ways. The overarching or "weight-beating" strands we use are (a) feminist theory, in particular the theory of compulsory heterosexuality (Rich, 1983) and gender as a matter of social justice (Weis & Carbonell-Medina, 2000); (b) a "rapprochement" between social construction theory and phenomenology (Cosgrove, 2000); and (c) a relational theory of (female) adolescent development (Brown & Gilligan, 1992; Jordan, Kaplan, Miller, Stiver, & Surrey, 1991).

Step Two: Model Building

An initial mission of our research program on adolescent sexuality was to develop a model of female adolescent sexual health. At that time our aim was to be grounded in and reflective of girls' sexuality using a model that went beyond pregnancy and AIDS prevention. Although this model was meant for educators, service providers, counselors, and others working with young women, our primary intended use was to guide our research in innovative directions. Using the principles held in our web of theories, the model was first constructed based on findings from feminist narrative research on girls' sexuality. These findings consistently revealed that (a) girls' lived experience of themselves as sexual beings--most often manifested as a view of themselves as normal, acceptable girls--was profoundly informed by their gender ideologies, especially their femininity ideologies; (b) sexual behaviors had layered meanings that were highly dependent on multiple contexts; (c) gendered contours of romantic and other social relationships (with family, male and female peers, and other adults) affected girls' ability to make decisions in terms of their own needs and their ability to develop a multidimensional understanding of their experiences; and (d) the larger social, cultural, political, and material terrain of girls' lives, which are always highly gendered, impinged upon and shaped their experiences of sexuality.

Ecological developmental theory (Bronfenbrenner, 1979) provided a compelling template for the model as we envisioned it. By placing the individual within concentric circles of widening social contexts, an ecological approach provides a kind of Russian nested doll portrayal from the more proximate out to the broadest contexts, in which the dynamic interplay between these contexts is acknowledged. What makes this model of sexual health distinctive is that we have integrated specific social constructions of female adolescent sexuality that involve resistance to beliefs and practices flowing from patriarchal ideologies that serve to regulate and police girls' sexuality. (1) The model represents the complex nature of sexuality as defined in the sexual health models reviewed previously (Satcher, 2001). Specifically, the model moves beyond measuring limited "subject positions" for adolescent girls and considers how to articulate healthy versions of sexuality explicitly for girls in the context of a patriarchal (i.e., sexist, racist, homophobic, elitist) society.

In the center of the first version of the model (see Figure 1) are aspects of sexual health associated with an individual girl, including knowledge, attitudes, and values. However, most of the individual qualities or processes in this model are not typically seen in models of adolescent sexual health because they are derived from an understanding of gendered experiences. For instance, we included being able to feel one's own sexual feelings, resisting objectifying sex and oneself, and feeling entitled to sexual experiences and pleasure, including self-pleasure, without guilt. Throughout the model, we include aspects of sexual identity to reflect how understanding one's sexual identity is more than just sexual orientation. For example, all girls should feel free to explore their sense of sexual desire. This framing acknowledges that these features of sexual health are not easily accessible to girls; rather, they require girls to resist social forces that often undermine their efforts to live sexually healthy lives.

[FIGURE 1 OMITTED]

We identified dating and romantic relationships as the most immediate interpersonal context in which girls are experiencing and playing out their sexuality and within which concerns about their sexual health arise. Applying the same principles that we used in the individual context, we included the qualities consistently found in other sexual health models, such as preventing unwanted conception and STDs. We also included recognizing and employing a range of appropriate ways to express love, affection, intimacy, and sexual desire with another person. Developing a critical perspective on romantic conventions regulating heterosexual relationships and feeling entitled and able to make active choices in romantic contexts constitute aspects of sexual health that have not been articulated before. In this interpersonal context, another aspect of sexual health that requires resistance to social conventions is being aware of and feeling entitled to one's own needs and feelings in relationships, balanced by sensitivity and respect for the needs and feelings of one's partner.

The next context we identified was social relationships, which can support or undermine a girl's efforts to pursue sexual health. We incorporated key elements of the other sexual health models, such as getting factual information about sexuality (e.g., information about contraception and protection) and having an understanding of the influence of one's culture on sexual and relationship values. Unique to our model is a focus on the relational dimensions of these processes. This approach incorporates how adolescents use social support in evaluating the quality of relationships, identifying and leaving abusive relationships, and working through conflict and questions about sexuality and relationships.

The outermost ring in the model, which is the most distal but also the most pervasive, is the sociocultural-sociopolitical context. This context is comprised of a broad layer of social arrangements and material conditions that are critical in forming and informing relationships and individual experiences. We chose to articulate this domain in terms of access. Other models of adolescent sexual health include some of these concerns in broad terms but imply that it is individuals' responsibility to be successful in using these resources to ensure their own sexual health. Our model is meant to incorporate the institutional, cultural, and political conditions that can make resources (like access to information about sexuality) inaccessible to individuals but that can also be challenged or disrupted by individuals. Our model included having access to material resources (such as contraception), to alternative discourses (such as images of girls' sexuality as normal), and to information (such as information about modes of sexual expression other than sexual intercourse).

A combination of qualitative and quantitative methods has been used to examine adolescent sexuality in the directions that the model suggests (Tolman, 1999). We are particularly interested in identifying some of the tensions adolescents experience while trying to make sense of their evolving sexuality. Our primary method is to elicit (or co-construct) and analyze young women's narratives about experiences with sexuality and relationships over the course of adolescence. We use a narrative analysis approach, called the Listening Guide, which incorporates elements of social construction and phenomenological approaches (Brown, 1999, 2001; Brown & Gilligan, 1992; Tolman, 2000, 2002; Tolman & Szalacha, 1999; Way, 1998). This method constitutes a feminist, psychodynamic approach, examining each girl's experience as she describes it, and identifying similarities and differences among girls' experiences within and among theoretically relevant groupings of girls. We use this method to understand individual girls' narrations of their lived experiences as interpreted through the feminist lens of compulsory heterosexuality, and to understand how girls' experiences cluster around specific emergent themes (for a detailed description of this method, see Tolman, 2002).

These analyses have yielded insights into how these aspects of sexual health operate in tandem. For example, we have investigated how girls' conceptions of romance disable them from being agentic and authentic regarding their bodies and sexual relationships (Tolman, 1999). We have also tracked how their refusal to be sexually objectified enables them to have access to their embodied feelings (i.e., sexual desire or its absence) and a sense of entitlement to their own sexual concerns (Tolman, 1999; Tolman, Spencer, Rosen-Reynoso, & Porche, 2002). Using this methodological approach, we developed a measure of girls' investment in conventional adolescent femininity ideologies (Tolman & Porche, 2000), which has enabled us to examine some aspects of gender ideology quantitatively. For example, we have found that, compared with other early adolescent girls, those with more conventional femininity ideologies are more likely to embrace romance conventions that disable girls in relationships (Tolman, 1999).

Step Three: Not for Girls Only

The work of the Gender and Sexuality Project grows out of a tradition of studying girls as a response to their absence in developmental psychology, in which the adolescent really meant the male adolescent (Gilligan, 1982). This focus was interrupted when school personnel at our research site questioned us about gathering data from girls only. Their challenge had both practical and ethical contours. The practical issue was what to do with the boys while the girls answered questions; the ethical issue was how to explain the apparent lack of equity if we talked with girls but not with boys. In addition, from their perspective, information about both girls' and boys' relationships and experiences would be useful. In the context of working collaboratively with the schools and based on our web of theories, we saw how including boys made sense. It seemed logical to develop a companion model of adolescent boys' sexual health.

As we began to work on this second model, we were analyzing early adolescent boys' narratives about their peer and romantic relationships and their descriptions of their experiences with sexuality. We had the experience of listening to boys talk about a part of their development about which very little is known. We began to fill out the same nested domains of sexual health as in the girls' model: individual, dating and romantic relationships, social relationships, and sociocultural-sociopolitical contexts. As we started mapping out the model, we began noticing similarities between how boys and girls described different aspects of sexual health. For example, boys described wanting emotional connection, so it made sense to include this and other features we had identified as aspects of adolescent girls' sexual health. Acknowledging the specifics of the social construction of male adolescent sexuality, we also sought to identify what was distinctive for boys. In the sociopolitical-sociocultural context, the public discourse about male adolescent sexuality positioned boys as being driven by sexual desire and as sexual predators with no interest in emotions or relationships. This is an example of a tension boys may experience between a personal desire for genuine emotional connection and a sociocultural expectation that they should have a sense of entitlement to sexual feelings, needs, and desires.

As we went through each ring of sexual health for boys, this pattern emerged repeatedly. We found ourselves tweaking features of the girls' model to create a model that was applicable to boys. For example, in the girls' model, the need to "be aware of and entitled to own needs and feelings in relationships, balanced by sensitivity to and respect for needs and feelings of partner" was adjusted for boys as the need to "be sensitive to and have respect for the needs and feelings of partner, balanced with awareness of own needs and feelings." The less proximate the arena of sexual health, the more overlap we found, in some cases simply substituting boys for girls. In the end, these gendered models of male and female adolescent sexual health overlapped at least as much as they differed. We were curious why these specifically gendered models were not telling two entirely different stories about adolescent sexual health. With 20/20 hindsight, we realized that we had made a defining decision about how gender matters implicitly in developing a model of adolescent girls' sexual health. This project had a potent unintended consequence: It pushed us to acknowledge the ways gender had been implicit in our own work. Because of our focus on gender differences, we were surprised by our finding of both similarities and differences associated with gender.

Step Four: Coming to Gender Complementarity

While this admittedly confusing work on a model of adolescent boys' sexual health was unfolding, we were also analyzing interview transcripts in which early adolescent girls provided descriptions about their experiences with heterosexual relationships and sexual experiences. Although our questions did not specify the gender of the partner, virtually all offered heterosexual stories. To adapt the Listening Guide for our research questions, we scanned girls' transcripts for anything that sounded like aspects of our sexual health model. In so doing, we were drawn repeatedly to the adherence to, or conversely, the overt rejection of what we had started calling "the heterosexual script," which dominated their stories. That is, we heard these girls describe interactions that loosely followed a hegemonic and conventional script between them and their boyfriends. These interactions were dependent upon and constituent of patriarchal constructions of the intersections between femininity, masculinity, sexuality, and romantic relationships. We further drew from Rich's (1983) theory of compulsory heterosexuality to better understand girls' complex experiences in the context in which they were described.

Although Rich's (1983) theory of compulsory heterosexuality was written to draw attention to lesbian existence and to articulate a continuum of women's relationships with one another, the work we were doing on boys' sexual health resonated with this theory. In particular, this work began to suggest the importance of including aspects of heterosexuality as an institution that control boys and men, often at the expense of girls and women. Consistent with recent work on boys (Connell, 1995; Kimmel, 1996), we articulated the constant pressure to deflect evidence of homosexuality and to display signs of conventional masculinity as central tenets of compulsory heterosexuality as it applies to men (Tolman, Spencer, Rosen-Reynoso, Harmon, & Striepe, in press). This work suggests that men and boys encounter discourses and pressures to behave as acceptable heterosexual males that are comparable and complementary to the discourses and pressures encountered by women and girls. The emerging overlaps and differences between our models of female and male adolescent sexual health reflected the importance of how the mandates for males and females fit together within our theoretical framework. That is, rather than parallel versions of compulsory heterosexuality for boys and girls, we began to see how these highly gendered processes and subsequent experiences are fundamentally integrated.

Our work on the boys' model in conjunction with listening to early adolescent boys' experiences with heterosexual relationships motivated us to incorporate hegemonic masculinity and the central role of homophobia into Rich's theory of compulsory heterosexuality and our model (Tolman et al., 2002). For instance, in boys' narratives, we began to see how homophobia is at the heart of their felt need to act in coercive ways towards girls to prove their masculinity to other boys. In turn, boys' heterosexual coercion produces the threat of violence against girls. We then identified in girls' narratives how this behavior on the part of boys, and girls' fear of it, makes it hard for girls to become embodied sexual beings.

Our work in developing female and male adolescent models, in tandem and as an interactive process with theoretical and empirical work, provided an approach to understanding gender's formative force. We have termed this formative force gender complementarity. Gender complementarity is meant as a meaningful alternative to arguments about gender difference versus sameness. It means that ideologies of masculinity and femininity, which infuse constructions of adolescent male and female sexuality, fit together to reproduce particular and limited forms of sexuality that are deemed to be "normal," all in the service of reproducing and sustaining compulsory heterosexuality. For instance, the notion that adolescent boys are sexual predators fits together with the notion that adolescent girls are supposed to be sexually passive. Both notions represent and reproduce compulsory heterosexuality. Conventional and condoned masculinity ideologies about boys are relevant to both boys and girls, and, concomitantly, femininity ideologies about girls are relevant to both girls and boys.

Our construct of gender complementarity informs theory by noting how specific pressures on boys and girls undermine essential aspects of sexual health. Thus, resistance to these specific pressures and subsequent sexual practices emerges as a formative principle for constructing one integrated model of adolescent sexual health. Thinking about gender complementarity as a social construction highlights how the barriers to sexual health that girls and boys face are profoundly different. Gender complementarity illuminates the need to keep gender central in conceptualizing adolescent sexual health. For instance, for girls this means being able to acknowledge their sexual desire, feeling sexually empowered, and having access to contraception and condoms, all of which are "punishable offenses" under compulsory heterosexuality. For boys, this means being able to experience and acknowledge the emotional feelings associated with sexuality, being able to resist peer pressure to objectify girls and sex, and having access to images of male sexuality that do not extol sexual predation.

CONCLUDING THOUGHTS

Based on the theory and findings discussed, our initial sexual health model appears incomplete (see Figure 1). We are moving in the direction of building one integrated model of adolescent sexual health that has gender at its center. Although it may seem extraneous to have included some of the details of our process, we did so to make a point. We believe in the importance of a specific theoretical framework in sexuality research, and we are confident that our web of theory has served us well. Yet it is also useful to note how theory, be it implicit or explicit, is a double-edged sword and should be revisited and perhaps revised regularly. The serendipitous inclusion of boys in a study that had been focused on understanding female adolescent sexuality had a tremendous impact on examining and expanding the ways that we consider how gender matters for sexual health. For example, including boys revealed how our confinement of the study to girls produced an incomplete and impoverished understanding of their sexual health. By attending to the other half of the synergistic system that produces social constructions of gendered adolescent sexuality and normalcy for girls, we discovered our contextualized approach was lacking the full context. We are now positioned to investigate how masculinity and femininity are constructed and deployed in ways that appear to diminish boys' and girls' humanity and potential for healthy romantic and sexual relationships.

We want to conclude by arguing for the importance of articulating adolescent sexual health models. It is difficult, perhaps impossible, to offer models of human behavior that can account for the innumerable structural variations in people's lives (gender being an excellent example) or for the intersection of such structures (Crenshaw, 1991). Yet this concern must be balanced with recognition that, much like theory, models influence how we approach sexuality research, practice, theory, education, and policy (Foucault, 1980; Weeks, 1991). By continuing to critically examine our web of theories in a dynamic and collaborative way, we plan to continue to build and revise a sexual health model that will be useful for researchers, as well as for other sexuality professionals.

This work was supported by a grant from the Ford Foundation. The authors wish to express their gratitude to the anonymous reviewers and to our colleagues at the Gender and Sexuality Project, and especially to Katherine Collins. [Editor's note: One of the anonymous reviewers, Zoe D. Peterson, subsequently agreed to be identified in the author note.]

(1) The initial work on developing this model included the contributions of project members Michelle Porche, Judy Chu, Renee Spencer, and Myra Rosen-Reynoso.

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Mamuscript accepted December 16, 2002

Address correspondence to Dr. Deborah L. Tolman, Center for Research on Women, Wellesley College, 106 Central Street, Wellesley, MA 02481; e-mail: [e-mail].