Sexuality is the way in which people experience and express the instincts and feelings that make up sexual attraction for others. It is a normal part of human experience and is determined by several different factors, including genetic makeup, childhood upbringing, influences of those around us, and societal attitudes. Accepted norms of sexual behavior and attitudes vary greatly within and among different cultures.
Generally, what is "normal" and "abnormal" cannot be defined medically. However, when sexual behavior or difficulties cause significant distress for a person or the person’s partner, or cause harm, treatment is warranted.
There are wide variations in people’s sexual behavior, including interest in sex and the frequency of or need for sexual release throughout life. Some people desire sexual activity several times a day, but 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 satisfying sex lives well into old age.
(See also Sexual Function and Dysfunction in Men and Sexual Function and Dysfunction in Women.)
Concepts of Sex and Sexual Identity
Various terms are used to talk about sex and gender. Sex and gender are not the same thing.
Sex refers to a person's anatomy and is often captured in the phrase "assigned at birth." A person may be considered to be male (AMAB, meaning "assigned male at birth"), female (AFAB, meaning "assigned female at birth"), or not clearly male or female (may be described as having ambiguous genitals or being intersex).
Sexual identity/sexual orientation is the pattern of emotional, romantic, and/or sexual attractions that people have toward others. It also refers to a person's sense of personal and social identity based on those attractions, related behaviors, and membership in a community of others with similar attractions and behaviors. There are many different sexual identities, such as heterosexual (attraction to the opposite sex), homosexual (attraction to the same sex), bisexual (attraction to both sexes), and asexual (attraction to neither sex).
Gender identity is different from sexual identity. Gender identity is an internal sense of being male, female, or something else, which may or may not correspond to an individual's sex assigned at birth or sex characteristics (see Gender Incongruence and Gender Dysphoria).
Developmental Aspects of Sexuality
(See also Development of Sexuality and Gender in Adolescents.)
Helping adolescents put sexuality and sexual identity into a healthy context is extremely important. Some adolescents struggle with their sexual identity and may be afraid to reveal their sexual identity to friends or family members, particularly if they have a non-heterosexual identity. Adolescents with a non-heterosexual identity are 2 to 3 times more likely to have suicidal and self-harming behaviors than their heterosexual peers. Adolescents and their parents should be encouraged to speak openly regarding their attitudes toward sex and sexuality.
Parents can damage their children’s ability to develop sexual and emotional intimacy by doing things such as the following:
Being emotionally distant
Punishing children too severely
Being overtly seductive and exploiting children sexually
Being verbally and physically hostile
Rejecting children
Being cruel
Parents' opinions remain an important determinant of adolescent behavior in spite of the influences of social media and internet sources of information. Social media may form the basis for most information and misinformation on sexuality obtained by adolescents.
Changing Attitudes about Sex and Sexuality
Societal attitudes about sexuality and gender and what is acceptable vary greatly among cultures and have undergone radical change in some societies. Many people have become more comfortable with their own gender identity (how they present themselves to the world) and with engaging in sexual activities that might have been considered unacceptable in the past. As a result, social norms have been redefined, as illustrated by the following examples of attitude changes in Western culture over recent years.
Masturbation
Doctors have long recognized that masturbation is a normal sexual activity throughout life. Masturbation is the most common of all human sexual behaviors. About 97% of males and 80% of females have masturbated.
Masturbation is considered unhealthy only when it inhibits partner-oriented behavior, is done in public, or is compulsive enough to cause distress or dysfunction in work, social, or other settings. Although a normal sexual activity, masturbation may cause guilt and psychologic suffering that stems from the disapproving attitudes still held by some people. These feelings can result in considerable distress and can even affect sexual performance.
Masturbation often continues at some level even in a sexually healthy relationship. People who masturbate may have a better sense of well-being, better fertility, and achieve sexual satisfaction without risk of sexually transmitted infections.
Homosexuality
Homosexuality is sexual attraction to people of the same sex. Like heterosexuality, homosexuality results from complex biologic factors and a person's experiences, leading to an ability to become sexually aroused by people of the same sex. And like heterosexuality, homosexuality is not a matter of choice. Homosexuality is widely recognized as a sexual orientation that is present from childhood. Adolescents may experiment with same-sex play, but this experimentation does not necessarily indicate an enduring interest in homosexual or bisexual activity as adults (see Development of Sexuality and Gender in Adolescents).
A 2022 Gallup poll of Americans found that the proportion of adults who identify as gay, lesbian, bisexual, or transgender has doubled since 2012 to a total of 7.1%. The proportions vary substantially by age group. Among adults who identify as gay, lesbian, bisexual, or transgender, 91% of those born between 1946 and 1964 ("Baby Boomers") self-identify as "straight/heterosexual" versus 76% of those born between 1997 and 2003 ("Generation Z"). See Gallup: LGBT Identification in U.S. Ticks Up to 7.1%.
Frequent sexual activity with different partners
For some heterosexuals and homosexuals, frequent sexual activity with different partners is a common practice throughout life. In Western cultures, this behavior has become more acceptable. However, having many sex partners is linked to the transmission of certain diseases (such as HIV infection, herpes simplex, hepatitis, syphilis, gonorrhea, and human papillomavirus, which causes cervical cancer) and may also signify difficulty in forming meaningful, lasting intimate relationships.
Extramarital sex
In the United States, most people engage in sexual activity before they are married or while they are not married. This behavior is part of the trend toward more sexual freedom in industrialized countries. However, most cultures discourage married people from engaging in sex with someone other than their spouse. This behavior occurs frequently despite social disapproval. One objective problem that results is the possible spread of sexually transmitted infections to unsuspecting spouses or sex partners.
Sexual Problems
When sexual feelings, behavior, or dysfunction cause significant distress for a person or the person's partner or harms another person, the person may need to be evaluated by a health care professional and treated. For example, people who have frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children, or nonconsenting adults or that involve suffering or humiliation of oneself or the partner (paraphilias) may feel distressed by the paraphilia and seek or be referred for treatment.
Sexual problems may have physical causes, psychologic causes, or both. Problems with sexual function can affect both men and women. Men may experience decreased libido, erectile dysfunction, the inability to ejaculate, or premature ejaculation. Women may experience low sexual interest or a sexual arousal disorder, pain during sexual intercourse (genito-pelvic pain/penetration disorder), or problems with orgasm (female orgasmic disorder). Sexual problems tend to be more common among older people. Many of these problems can be effectively treated.
