Editor's Note: The late Dr. Haroian was a Professor at the Institute for Advanced Study of Human Sexuality for many years. This monograph was prepared for student use in the mid-1980's, and has been a part of the education of many sexologists. It is time it was made available to the general public, and the many teachers of sexuality education to our young people. The references to DSM-III are a bit outdated, but the information is still useful.
David Hall, Ph.D. Editor
Sexual health is more than the absence of sexual pathology. The anatomy, gender and function of the human body is the foundation of identity. The awareness of the sexual self as an integrated aspect of identity begins in infancy with the attitudes about the physical body communicated by the caretakers.
The sexual response cycle as described by William Masters, M.D. and Virginia Johnson, M.A., is present at birth, and there is evidence that the neurological maturation necessary to produce penile erections occurs in utero. The development and expression of the erotic response throughout the human lifespan is not a well studied phenomenon, and normative data have not been compiled for sexual behaviors of childhood and adolescence. As we know it, the erotic response consists of a complex interplay of physiological and psychological factors that are highly susceptible to familial, religious and cultural folkways, mores and attitudes. The styles of acceptable sexual attitude and expression fluctuate historically and culturally between generally positive and generally negative polarities. At this time, our own restrictive culture time is still preoccupied with imposing sexual constraints rather than promoting sexual competencies as a basic value system. We are certainly less zealous in this pursuit than the repressive Victorians, but fears of sexual excess and pleasure leading to a fall from grace are deeply imbedded in the Judeo-Christian ethic. The impacts of this often unconscious attitude on child rearing are the overt and/or covert discouragement of sexual interest, curiosity, expression and sexual behavior of children in the presence of adults and the continual obfuscation of the scientific answer to the question "What is normal?"
Sexually permissive cultures not only allow a less fettered expression of adult sexuality, but may give little attention to the sexual behaviors of children as long as they are not blatantly displayed. Sexually supportive cultures, believing that sex is indispensable to human happiness, encourage early sexual expression as a means of developing adult sexual competency and positive sexual attitudes. The children in sexually permissive and sexually supportive societies display a similar developmental pattern that is not apparent in sexually restrictive and sexually repressive societies:
In infancy, there is usually manual and oral genital stimulation of children of both sexes by parents as a means of comforting and pacifying them (most frequently between mothers and sons).
In early childhood, masturbation alone and in groups, leads to exploration and experimentation among children of same and opposite gender.
Late childhood (prepubescent) is characterized by heterosexual role modeling and attempted intercourse (girls may begin having regular coitus with older boys).
In pubescence, girls rapidly accelerate into a phase of intense sexual experience, culminating in the acquisition of basic sexual techniques at the adult level. Boys follow a similar pattern, but their learning process is not as rapid or complete because they are usually experimenting with younger girls. Heterosexual patterns replace masturbation and homosexual activities for the majority of both boys and girls.
In adolescence, there is increased sexual activity with peers and adults for both boys and girls; and it is believed that birth control is facilitated by the practice of multiple partners. Marriage is common for late adolescent girls, but boys may delay marriage for economic considerations and continue their adolescent sex patterns for longer periods (Ford and Beach, 1951)
It would appear that human sexual expression follows a logical, orderly and self regulating developmental pattern in much the same way as other aspects of human behavior and that psychosexual disorders may be the result of the interruptions of that sequential growth process. It is well to remember that prior to the Victorian idealization of childhood innocence, children were commonly used and abused physically and psychologically. Eighteenth century aristocratic tradition imposed a barrier between parent and child. It was the height of bad taste to love one's spouse and children, as parenthood was thought to render both men and women less fit for amorous adventure. Infants were removed from their parents and suckled by wet nurses; mortality was high, even for children who were well cared for. Infanticide was the major method of population control, and infants were abandoned, neglected and intentionally killed by drowning, burning, scalding, potting and overlaying. Those who survived were often maimed or crippled to make them more poignant beggars and were at the mercy of unscrupulous and exploitive adults. Sexual exploitation of children was freely indulged in until the latter half of the 18th century, at which time it was fully repudiated. This was a decisive turning point in parent child relationships in that parents began to punish children for their sexual curiosity and activity (DeMause, 1974).
The Victorian era was a period of sexual schizophrenia for children. The cultural dictum that childhood was free of, and was to remain free from, sexual knowledge, interest and behavior, was contradicted by a constant and continual adult preoccupation with, and surveillance of, children's sexual potential. Freud's attempt to bring some sanity into this schizophenogenic bind was theoretically helpful; however, the sadistic trend in anti-masturbatory therapy accelerated when people became aware of infant sexuality (Spitz, 1952).
The repression of sexuality made any expectation of sexual health improbable, if not impossible, to achieve. It produced a pervasive negative preoccupation with the sexuality of others and a category of emotional disorders labeled "psychosexual." In keeping with the contradictions of the time, the sexual referent to all nonsexual symptomatology was diligently searched for or speculated about; and direct treatment of sexual symptoms was bypassed in favor of analyzing the "psychosexual" stages of childhood development. Although the expectation of both therapist and patient was that healthy sexual function would be restored by the exploration of the parent-child bonding relationship, this was rarely, if ever, the result of psychoanalysis.
The mental health community continues to have a poorly defined concept of sexual health and is in fact only called upon to attend those who have experienced sexual trauma, dysfunction and/or sexual pathology. Although sexuality (i.e. sexual interest, sex drive) is considered by many to be the life force, sexology (sexual science) is less than 100 years old. Clinical sexology (the diagnosis and treatment of sexual concerns and dysfunctions) as a specialty is newer still. Sex therapy has been a viable and identifiable health specialty since the 1960s, and the clinical sexologist is a phenomena of the late 1970s. However, the clinical child sexologist is a professional category of the future. Even so, pediatric professionals in both medicine and mental health are consulted by parents, caretakers, authorities and occasionally, youth themselves about sexual matters. It is no longer questionable to consider sexual health as the absence of sexual pathology, because sexual pathology is often a religious-cultural definition which fails to consider the broad range of human sexual activity and its developmental aspects and measurable frequencies, as well as its impact on the quality of human life.
Sexual Rights of Children
In the western culture, great controversy has been perpetuated over what adult (parent and professional) attitudes about children's sexual expression should be. Many child rights advocates believe that children are a disenfranchised minority in the age/class system and state that the privilege and responsibility of sexual behavior is one of the many human rights denied them. They suggest that the proper adult stance is one of permissiveness to encouragement (Farson, 1974; Yates, 1978). This argument is more than vaguely akin to the rhetoric of the pedophile groups who have a vested interest in the relaxation or abolishment of child protective (albeit restrictive) laws. Many child experts more conversant with the vulnerabilities of children in a complex pluralistic society opt for laws and social custom that, although somewhat limiting, provide protection from unscrupulous adults. Children, by definition, are not consenting adults in sexual matters and may need protection from the liability of sexual contracts in the same manner that they are not held accountable for business or labor contracts.
This position does not suggest that there is inherent harm in sexual expression in childhood; in fact, we have considerable evidence to the contrary. Sexologically, it is based on the knowledge that the benefits of free sexual expression of children can only occur in a sexually supportive society: a society in which all people have sex for sexual reasons, one in which sexual knowledge, skill and pleasure are valued for both males and females. A society that encourages sexual competency rather than constraint and in which every man, woman and child can say "yes" or "no" to sex without prejudice or coercion. To encourage children to be sexual in a sexually repressive or permissive/ambivalent culture is to exploit their healthy sexual interest, as they will be left alone to deal with a double...