Introduction

Sexuality is a normal part of the human experience. However, the types of sexual behavior that are considered normal vary greatly within and among different cultures. In fact, it may be impossible to define "normal" sexuality. There are wide variations not only in "normal" sexual behavior but also in the frequency of or need for sexual release. Some people desire sexual activity several times a day, whereas others are satisfied with infrequent activity (for example, a few times a year).

Although younger people are often reluctant to view older people as sexually interested, most older people remain interested in sex and report quite satisfying sex lives well into old age. Problems with sexual function, such as erectile dysfunction in men (see Section 21, Chapter 240) and dyspareunia, vaginismus, or anorgasmia in women (see Section 22, Chapter 250), affect people of all ages, although such problems tend to be more common in older people.

Societal attitudes about sexuality change with time. Examples of such changes can be seen regarding masturbation, homosexuality, and frequent sexual activity with different sex partners.

Masturbation: Masturbation, which was once regarded as a perversion and even a cause of mental disease, is now recognized as a normal sexual activity throughout life. It is estimated that more than 97% of males and 80% of females have masturbated. In general, males masturbate more frequently than females, even if involved in a sexually gratifying relationship. Although masturbation is normal and is often recommended as a "safe sex" option, it may cause guilt and psychologic suffering that stems from the disapproving attitudes of others. This can result in considerable distress and can even affect sexual performance.

Homosexuality: As with masturbation, homosexuality, once considered abnormal by the medical profession, is no longer considered a disorder; it is widely recognized as a sexual orientation that is present from childhood. An estimated 4 to 5% of adults are involved exclusively in homosexual relationships throughout their lives, with an additional 2 to 5% of people periodically engaging in sex with someone of the same sex (bisexuality). Adolescents may experiment with same-sex play, but this does not necessarily indicate an enduring interest in homosexual or bisexual activity as adults (see Section 23, Chapter 270).

Homosexuals discover that they are attracted to people of the same sex, just as heterosexuals discover that they are attracted to people of the opposite sex. The attraction appears to be the end result of biologic and environmental influences and is not a matter of choice. Therefore, the popular term "sexual preference" makes little sense in matters of sexual orientation.

Most homosexuals adjust well to their sexual orientation, although they must overcome widespread societal disapproval and prejudice. This adjustment may take a long time and may be associated with substantial psychologic stress. Many homosexual men and women experience bigotry in social situations and in the workplace, adding to their stress. Discrimination based on sexual orientation (or perceived sexual orientation) remains widespread.

Frequent Sexual Activity With Different Partners: For some heterosexuals and homosexuals, frequent sexual activity with different partners is a common practice throughout life. This behavior may serve as a reason to seek professional counseling, because the transmission of certain diseases (for example, HIV infection, hepatitis, syphilis, gonorrhea, cervical cancer) is linked to having many sex partners and because having many sex partners may signify difficulty in forming meaningful, lasting relationships.