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Three decades of sex: reflections on sexuality and sexology.

This commentary provides selected observations drawn from 30 years of experience teaching university sexology courses and as a sex therapist. Over the past three decades, there have been social changes in our perceptions of sexuality, even if on the personal level, little has shifted. The changes include the dramatic impact of the Internet in shaping sexual knowledge and defining restrictive norms as well as the increasing use of drugs that affect sexuality. Evolving attitudes towards sexual assault and LGBTQ issues are among the most significant of these changes. It is noteworthy that the field of sexology is thriving in Canada.

KEY WORDS: Information technology; cohort differences; sexual side-effects/ADRs; university sexual norms; sexual assault; LGBTQ attitudes

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I have been teaching university sexology courses for 30 years. For almost as long, I have been teaching advanced courses in sexual dysfunctions and sex therapy while my day job has consisted of the practice of sex therapy. This commentary consists of some select observations from my vantage point as an educator and therapist. The focus is on how aspects of human sexuality, and our perceptions of them, have changed since 1983 and, in some instances, have failed to change despite some major social and academic upheaval over these years. (For a comprehensive analysis of the current state of sex therapy and sexology see Kleinplatz, 2012.)

"That's how it goes/Everybody knows"

--Leonard Cohen

In the three decades since I developed the first sexology course at the University of Ottawa, course enrollment has increased dramatically and has far outpaced overall university enrollment. Interestingly, the desire to study and learn about sexuality has grown unabated, even though each new cohort of students assures me that "everybody knows" so much more about sex today than people used to a generation or two ago. "We are so much more open about sexuality as a society than we used to be." So they said in 1983 and so they say in 2013. "We are having more sex, with more partners. And so much more than our parents, we know about sex ... Everybody knows..." The reality that dyadic sex now begins no earlier than it did in the 1980s or 1990s and with fewer partners (Boyce et al., 2006; Eaton et al., 2011) is beyond their comprehension. Students who believe that their generation invented the "hook up" are advised to see the 1977 blockbuster, Looking for Mr. Goodbar. I tell them that one-third of the women getting married in 1945 were already pregnant. "Not my grandmother [or great-grandmother] ..." they say.

Every generation believes it has in some sense invented or perfected sex, and that its own cohort is infinitely more knowledgeable and more open-minded than its predecessors even if there is little, if any, empirical evidence to confirm such self-affirmations. This is unchanged. However, what has changed is that in 1983, my students were more interested in exploring possibilities for their own sexuality, broadening sexual repertoires and options, and discovering new ways of being sexual. In 2013, it appears that, in comparison, students are more likely to be looking for answers to questions related to proper sexual conduct and technique. Their queries are increasingly founded on myths and beliefs rooted in sexual imperatives. In my courses, there has always been an opportunity for students to participate via anonymous questions. Over a 30-year period, tens of thousands of questions have been submitted. Throughout the years, questions about oral sex have been among the most common. However, whereas the wording and tone of such questions used to be, "Is it OK to..." or "What are different ways to experiment with oral sex?" the current tone is about getting it right, being competent performers: "What is the correct way to give a blowjob?" Similarly, monolithic thinking or the assumption of one-true-way to sexual skill comes through in questions such as, "What is the best position for intercourse?" or "Why doesn't my girlfriend squirt?" Of course, there is wide variation among individuals but it often seems that students are currently more likely to approach their developing sexuality as some kind of test to be passed.

Ironically, the language used to talk about sexuality seems to be curiously sanitized and neutered of "sex". Clients/ patients referred to me for sex therapy, in contrast to 10 or 20 years ago, now state that they are seeking treatment for "problems in intimacy". Students refer to the "gender" of their partners (typically worded as the "opposite gender") rather than whether their partners are men or women. Rather than being progressive, both students and clients explain that it is impolite to say "sex"--"gender" is less offensive.

THE IMPACT OF INFORMATION TECHNOLOGY

Over these years, especially since the early 1990s, the most conspicuous and fundamental change in the way people learn about and explore sexuality has been via the revolution in information technology (IT). The Internet has led to vastly increased public access to sexual information and entertainment. This access to information has provided hope to sexuality educators and therapists who believe that widespread dissemination of sex information can be a boon for the prevention and amelioration of sexual difficulties. (We hope, of course that the particular website a person stumbles upon offers credible educational material about sex: Many offer nothing more than cliches, half-truths, distortions, and ideological bias.) Equally important, the Internet has been of great benefit to various sexual minority members, assisting them in finding and communicating with one another and establishing a sense of community. It has provided an opportunity for those feeling alone and alienated to reach out to others across cyberspace to forge connections more readily.

As a consequence of the IT revolution, students are positioned increasingly, and come to regard themselves correspondingly, as seekers of data rather than knowledge, let alone wisdom. Their overall levels of general, (what used to be called) "background" knowledge has deteriorated--(try asking current students about ancient Greek art or the medieval persecution of witches or the social changes wrought by the Industrial Revolution, each of which is important for understanding the history of sexuality)--and what they have often acquired instead is de-contextualized, randomly organized bits of information.

In recent years, students (in my third and fourth year sexology courses) have shown increasing alarm and delight over my essay assignments, saying that they have not been asked to write an essay since high school, if that. Despite their eagerness to be engaged intellectually, they report that they have not typically been expected to think, have original ideas, study different theoretical or philosophical perspectives or to question what is written in their textbooks. Whereas educators across most academic disciplines might articulate the same laments, these problems are particularly worrisome for the field of sexotogy where it is crucial that our emerging scholars and practitioners learn to think critically. Clearly, the concern here is partially the result of a discernible shift in the way post-secondary institutions "deliver" education. As a result, it is more essential than ever that university sexology and sex therapy courses focus on developing the skills for theoretical and critical analysis.

The explosion of access to information through IT has been mostly heralded for its advantages but the downside of the "new normal" has sometimes been glossed over. The Web has been central in defining sexual options, norms and ideals. The same technology that has provided breadth and diversity at the margins has narrowed and flattened norms, creating the perception of homogeneity at the center. Although there is variation for those with the inclination to seek it out, much of the Internet's display of sexuality routes us toward an idealized uniformity.

Aided by the Internet, the popular culture discourse has increased sexual performance expectations while narrowing the definition of "sex" itself. The notion is that lovers should be ever ready for sex, "sex" should be effortless, requiring only paralanguage rather than verbal communication, everyone ought to have great sex, and those who do not attain it are somehow defective. Internet pornography aimed at mainstream, heterosexual audiences has increasingly conveyed to viewers that sex equals intercourse, as well the expectation that women should reach orgasm as a result of intercourse alone to a degree that no one imagined possible in the afterglow of the sexual revolution. Prevailing images of "sex" are now more focused on performance than in the 1980s; correspondingly, there is less focus on pleasure, desire, arousal, communication or authentic intimacy than ever (Kleinplatz, 2011). It is no surprise then that so many male and female university students are faking orgasm (Muelenhard & Shippee, 2010).

Thus, the tragedy at present is in the contrast between the public discourse, in which "everybody knows" that talk of sex surrounds us openly--or at least visibly--everywhere and the hidden reality in which people are no better able to share their deepest sexual hopes, wishes and fears with their sexual partners than they were generations ago. The discrepancy between the public perception and the private experience exacerbates sexual problems; it makes individuals feel all the more alone with their sexual difficulties, adding to their pain with the shame of seemingly being the last ones on earth with sexual inhibitions. Restrictive but ever-present sexual norms, most especially the belief that sexual discomfort is obsolete, only engender more sexual problems and compound sexual suffering with heightened alienation.

SEX AND DRUGS

A major change that has affected my patients and students (and thus my pedagogical and clinical practice) has been the increasing proliferation of medications in Canadian society which affect sexuality (Moynihan & Cassels, 2006; Moynihan & Mintzes, 2010). Over the last 30 years, there has been a huge increase in the proportion of my students and patients using drugs that might affect their sexual functioning or desire. In the 1980s, most of the patients I encountered who were on medications that might affect their sexuality were being treated for cardiovascular disease or cancer. Their chemotherapy and antihypertensive treatments were widely known to have an adverse impact on sexuality. Many of my older male patients who had diabetes or a history of heart disease were pronounced to be suffering from "leaky veins" and had been prescribed intracavernosal injections to treat their resulting erectile dysfunction. Intracavernosal injections mostly went the way of the dodo bird with the introduction of the PDE5 inhibitors, first approved by Health Canada in 1999. With the introduction of Viagra most of the public discourse over the last 15 years has focused on the search for new magic pills that would magically enable "natural" and effortless sexual desire and response.

Paradoxically, over the course of these same years, more and more of my clients and students across the age spectrum are suffering the adverse sexual effects of polypharmacy, without informed consent as it pertains to these sexual side effects. I got into this line of work to do psychotherapy, specifically sex therapy. I am spending more and more of my clinical time explaining to new patients that the same physician who referred them to me has put them on two or more medications which will actively prevent sexual relations. No amount of sex therapy can undo the impact of the cocktail of medications prescribed for elevated cholesterol, diabetes (Type II), acid reflux, plus a little something thrown in at bedtime for a good night's sleep. I have seen female patients and students on SSRIs/SNRIs, increasingly in combination with second-generation antipsychotics to top it off plus a third-generation oral contraceptive pill. Some who are not on "birth control" may be taking highly anti-androgenic medications such as Diane-35 (Collier, 2013; Mintzes, 2004) or Depo-Provera, both of which contain agents that are used for chemical castration (albeit, at higher dosages) although few female recipients are informed of this. I have no magic wand. Admittedly, underlying conditions such as heart disease, diabetes, and depression, which lead to many of these prescriptions can themselves, cause sexual difficulties. My concern is that many of my patients and students have little, if any inkling of the sexual consequences of these pharmaceutical interventions. Thus, they are less likely to have considered alternate health care options including weight loss, exercise, quitting smoking, reducing salt intake, psychotherapy, IUDs and condoms.

Meanwhile, most of my students in the 1980s did not typically seem to be heavy users of any drugs, whether prescription or recreational. They also used a wider array of contraceptive and prophylactic measures, including condoms (to prevent pregnancy and the perceived scourge of Herpes), the sponge, the diaphragm, spermicides and second-generation oral contraceptive pills. "Birth control" had not yet come to be synonymous with hormonal contraceptive methods, and neither Depo-Provera nor the current crop of anti-androgenic oral contraceptive pills was available. The students and young patients I encountered in the 1980s generally favored marijuana as their drug of choice alongside a pitcher of beer or bottle of wine over the course of an evening. However, over the years, binge drinking has become an increasingly normative behaviour on Canadian campuses (Balodis, Potenza, & Olmstead, 2009; Tamburri, 2012). This has resulted in a steady stream of young patients in my office who complain of erectile dysfunction, difficulties with orgasm and desire who have never considered the possibility that their levels of alcohol use are causing their sexual difficulties. They have all sniggered at jokes about "whiskey dick" but were sure that because they are not alcoholics, "It couldn't happen to me ..."

SEXUAL ASSAULT

When I began teaching, the latest national data (e.g., the Badgley Report) indicated that one in three Canadian women would be sexually assaulted, (as defined in Canadian law), at some point in their lives. I found this hard to believe, asking (just as my students would) what sampling techniques were used, whether the findings were truly representative of the Canadian population, whether researchers had used self-report or some other manner of data collection, what exactly was meant by "sexual assault", etc. I later realized that students rarely ask about the specifics of research methods unless they, too, are incredulous at a particular set of research findings. However, the first time I covered sexual assault, about one-third of the women in the class approached me privately to disclose that they had been sexually assaulted, half of them more than once. That rate has remained relatively stable for 30 years among my students, just as national victimization statistics currently suggest (Brennan, & Taylor-Butts, 2008), although my impression is that students who have been victims of sexual assault seem to acknowledge it with less shame and self-blame. Perhaps attitudes, if not yet behaviours, really have begun to change as a result of a broader social conversation about consent in sexual relationships.

LGBTQ ISSUES

One of the few areas where seismic changes in sexual attitudes, values and civil rights have occurred is in relation to LGBTQ issues. The scales of homophobia used in early 1980s research seem almost archaic today. Canada was the second country, not long after South Africa, to enshrine the right of our citizens to be free of discrimination based on sexual orientation. Although heterosexism certainly lingers on many levels, students are more likely to be comfortable enough with their LGBTQ sexuality to discuss it openly in class. It is now uncommon for the LGB clients I see in therapy to consult me for matters related to their sexual orientation but rather for the same problems and concerns that confront heterosexual patients. Relationship issues are apparently similar across the spectrum of constituents.

More recently, the increased attention to and visibility of transgender issues means there has been an influx of much younger trans clients eager to explore options that transcend the gender binary. Although some are hoping for "traditional" sex reassignment, others are open to living as a member of the other sex, with or without medical intervention and whether continuously, (i.e., permanently), or with room to shift back and forth over time and setting.

CANADIAN SEXOLOGY: SOMETHING TO CELEBRATE

One noteworthy change in sexology over the last 30 years has been the impressive expansion of the field in Canada. There are more sexology courses in more Canadian universities than could have been anticipated. By contrast with American sexology, which has suffered due to political conservatism and corresponding funding cutbacks, we are flourishing. As noted by Farmer and Binik (2005), "Based on the current membership for the International Academy of Sex Research, the ratio of Canadian sexologists to American sexologists is twice the population ratio between the two countries" (p. 51). Indeed from the Maritimes to British Columbia, sex research and therapy are thriving. When I first began attending the annual meetings of the Canadian Sex Research Forum (CSRF), there were generally about 20 participants. Our 2012 meeting in Ottawa was the largest in CSRF history with over 100 participants, most of them students, which is encouraging news for the future of sexology in Canada. The annual Guelph Sexuality Conference has been held every June at the University of Guelph since 1979 and continues to excel. The Board of Examiners in Sex Therapy and Counseling of Ontario has more than doubled its registration over the last 25 years. The Canadian Journal of Human Sexuality, founded in 1992 and published by the Sex Information and Education Council of Canada (SIECCAN), has recently taken a major step forward by partnering with the University of Toronto Press. The fact that Canada's academic sexology journal has a bright future is, per se, cause for celebration.

It has been an unending privilege to spend my days in Canadian sexology since 1983. I look forward to reminiscing with you, again, in another 30 years.

doi: 10.3138/cjhs.937

REFERENCES

Balodis, I.M., Potenza, M.N., & Olmstead, M.C. (2009). Binge drinking in undergraduates: relationships with sex, drinking behaviors, impulsivity, and the perceived effects of alcohol. Behavioural Pharmacology, 20(5-6), 518-526. http://dx.doi.org/10.1097/ FBP.0b013e328330c779. Medline:19730367

Boyce, W., Doherty-Poirier, M., MacKinnon, D., Fortin, C., Saab, H., King, M., & Gallupe, O. (2006), Sexual health of Canadian youth: Findings from the Canadian Youth, Sexual Health and HIV/ ADS Study. Canadian Journal of Human Sexuality, 15(2), 59-68.

Brennan, S., & Taylor-Butts, A. (2008). Sexual Assault in Canada 2004 and 2007. Ottawa, Ontario: Canadian Centre for Justice Statistics, Statistics Canada.

Collier, R. (2013). Scrutiny of Diane-35 due to potential dangers of off-label prescribing. Canadian Medical Association Journal, 185(5), E217-E218. http://dx.doi.org/10.1503/cmaj.109-4414. Medline:23439622

Eaton, D.K., Lowry, R., Brener, N.D., Kann, L., Romero, L., & Wechsler, H. (2011). Trends in human immunodeficiency virus- and sexually transmitted disease-related risk behaviors among U.S. high school students, 1991-2009. American Journal of Preventive Medicine, 40(4), 427-433. http://dx.doi.org/10.1016/ j.amepre.2010.12.010. Medline:21406276

Farmer, M.A., & Binik, Y.M. (2005). Psychology is from Mars, sexology is From Venus: Can they meet on Earth? Canadian Psychology, 46(1), 46-51. http://dx.doi.org/10.1037/h0085824

Kleinplatz, P.J. (2011). Arousal and desire problems: Conceptual, research and clinical considerations or the more things change the more they stay the same. Sexual and Relationship Therapy, 26(1), 3-15. http://dx.doi.org/10.1080/14681994.2010.521493

Kleinplatz, P.J. (2012). Advancing sex therapy or is that the best you can do? In P.J. Kleinplatz (Ed.), New directions in sex therapy: Innovations and alternatives (2nd ed., pp. xix-xxxvi). New York, NY: Routledge.

Mintzes, B. (2004). Drug regulatory failure in Canada: The case of Diane-35. Women and Health Protection. Retrieved on April 5, 2013 from http://www.whp-apsf.ca/en/documents/diane35.html.

Moynihan, R., & Cassels, A. (2006). Selling sickness: How the world's biggest pharmaceutical companies are turning us all into patients. Vancouver: Greystone.

Moynihan, R., & Mintzes, B. (2010). Sex lies and pharmaceuticals: How drug companies plan to profit from female sexual dysfunction. Vancouver: Greystone.

Muelenhard, C., & Shippee, S. (2010). Men's and women's reports of pretending orgasm. Journal of Sex Research, 46, 1-16.

Tamburri, R. (2012). Heavy drinking a problem at most Canadian campuses. University Affairs, August 29, 2012. Retrived on April 5, 2013 from http://www.universityaffairs.ca/heavy-drinking-a-problem-at-most-canadian-campuses-report.aspx.

Peggy J. Kleinplatz (1)

(1) Faculty of Medicine and School of Psychology, University of Ottawa, Ottawa, ON

Correspondence: Concerning this article should be addressed to Peggy J. Kleinplatz, Ph.D., 161 Frank Street, Ottawa, ON K2P 0X4. E-mail: kleinpla@ottawa.ca

Peggy J. Kleinplatz, Ph.D. is Professor in the Faculty of Medicine and Clinical Professor of Psychology at the University of Ottawa. She is a clinical psychologist, certified in Sex Therapy, Sex Education and as a Diplomate in and Supervisor of Sex Therapy. She is currently Chair of Ethics and former Chair of Certifications for the American Association of Sexuality Educators, Counselors and Therapists. She has edited three books, most recently, New Directions in Sex Therapy: Innovations and Alternatives (Routledge, 2012) winner of the 2013 AASECT Book Award. Her clinical work emphasises eroticism and transformation. Her current research focuses on optimal sexual experience, with a particular interest in sexual health in the elderly, disabled and marginalized populations.
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Title Annotation:COMMENTARY
Author:Kleinplatz, Peggy J.
Publication:The Canadian Journal of Human Sexuality
Article Type:Essay
Geographic Code:1CANA
Date:Mar 22, 2013
Words:3493
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