CH. 12

androgens

A class of sex hormones—an important one of which is testosterone—that primarily promotes the development of male genitals and secondary sex characteristics.

estrogens

A class of sex hormones─an important one of which is estradiol─that primarily influences the development of female sex characteristics and helps to regulate the menstrual cycle.

Traditional Masculinity and Femininity

A classic study in the early 1970s assessed which traits and behaviors college students believed were characteristic of females and which they believed were characteristic of males (Broverman & others, 1972). The traits associated with males were labeled instrumental: they included characteristics such as being independent, aggressive, and power-oriented. The traits associated with females were labeled expressive: they included characteristics such as being warm and sensitive. Thus, the instrumental traits associated with males suited them for the traditional masculine role of going out into the world as the breadwinner. The expressive traits associated with females paralleled the traditional feminine role of being the sensitive, nurturing caregiver in the home. These roles and traits, however, are not just different; they also are unequal in terms of social status and power. The traditional feminine characteristics are childlike, suitable for someone who is dependent and subordinate to others. The traditional masculine characteristics suit one to deal competently with the wider world and to wield authority.

SEXUAL ORIENTATION

A national study of sexual behavior in the United States among adults 25 to 44 years of age found that 98 percent of the women and 97 percent of the men said that they had ever engaged in vaginal intercourse (Chandra & others, 2011). Also in this study, 89 percent of the women and 90 percent of the men reported that they had ever had oral sex with an opposite-sex partner, and 36 percent of the women and 44 percent of the men stated that they had ever had anal sex with an opposite-sex partner. More extensive information about adult sexual patterns comes from the 1994 Sex in America survey. In this well-designed, comprehensive study of American adults' sexual Page 407patterns, Robert Michael and his colleagues (1994) interviewed more than 3,000 people from 18 to 59 years of age who were randomly selected, a sharp contrast from earlier samples that consisted of unrepresentative groups of volunteers.

romantic script

A perspective in which sex is synonymous with love; belief that if we develop a relationship with someone and fall in love, it is acceptable to have sex with the person whether we are married or not.

Pelvic field defect.

A small number of newborns have a disorder called pelvic field defect, which in boys involves a missing penis. These XY boys have normal amounts of testosterone prenatally but usually are castrated just after being born and raised as females. One study revealed that despite the efforts by parents to rear them as girls, most of the XY children insisted that they were boys (Reiner & Gearhart, 2004). Apparently, normal exposure to androgens prenatally had a stronger influence on their gender identity than being castrated and raised as girls.

gender-typing

Acquisition of a traditional masculine or feminine role.

The Sexual Culture

Adolescence is a bridge between the asexual child and the sexual adult (Diamond, 2019; Savin-Williams, 2019). Every society gives some attention to adolescent sexuality. In some societies, adults clamp down and protect adolescent females from males by chaperoning them. Other societies promote very early marriage. Yet others allow some sexual experimentation. In the United States, children and adolescents learn a great deal about sex from the media (Naezer & Ringrose, 2019; Ward, Moorman, & Grower, 2019). The messages come from TV commercials, which use sex to sell just about everything, as well as from the content of TV shows. A recent study of the prime-time shows that U.S. adolescents and emerging adults watch on television found that sexual violence and abuse, casual sex, lack of contraception use, and no coverage of the consequences of risky sexual behavior were common (Kinsler & others, 2019). In another recent study of television, sexual behavior with casual Page 414acquaintances was shown almost as frequently as sexual behavior in committed relationships (Timmermans & Van den Bulck, 2018). Further, a recent study found that non-Latino White adolescents reported learning more sexual information from parents and less from the media than African American adolescents (Bleakley & others, 2018). One research review concluded that adolescents who viewed more sexual content on TV were likely to initiate sexual intercourse earlier than their peers who viewed less sexual content on TV (Brown & Strasburger, 2007). A special concern is the recent increase in sexting, which involves sending sexually explicit images, videos, or text messages via electronic communication (Bianchi & others, 2019; Englander & McCoy, 2018; Handschuh, La Cross, & Smaldone, 2019). A national study of 13- to 18-year-olds found that 7 percent reported sending or showing someone sexual pictures of themselves (Ybarra & Mitchell, 2014). In this study, sharing sexual photos was linked to a wide range of sexual behaviors including oral sex and vaginal sex. In some schools, sexting occurs more frequently, as indicated in a recent study of 656 high school students at one school in which 15.8 percent of males and 13.6 percent of females reported sending and 40.5 percent of males and 30.6 percent of females reported receiving explicit sexual pictures on cell phones (Strassberg, Cann, & Velarde, 2017). And in another recent study of 13- to 21-year-old Latinos, engaging in sexting was linked to engaging in penetrative (oral, vaginal, and anal) sex (Romo & others, 2017). Further, a recent study of emerging adults found that receiving unwanted sexts and sexting under coercion were linked to higher levels of depression, anxiety, and stress, and lower self-esteem (Klettke & others, 2019). The American Academy of Pediatrics (2010) issued a policy statement on sexuality, contraception, and the media. It pointed out that television, film, music, and the Internet are all becoming increasingly explicit, yet information about abstinence, sexual responsibility, and birth control rarely is transmitted within these media.

Adolescence

Adolescence is a time of sexual exploration and experimentation, of sexual fantasies and realities, and of incorporating sexuality into one's identity. Adolescents have an almost insatiable curiosity about sexuality. They think about whether they are sexually attractive, how to engage in sex, and what the future holds for their sexual lives. The majority of adolescents eventually manage to develop a mature sexual identity, but most experience times of vulnerability and confusion (DeLamater, 2019).

SOCIAL INFLUENCES

Alice Eagly (2010, 2013, 2016, 2018) proposed social role theory, which states that psychological gender differences result from the contrasting roles of women and men. In most cultures around the world, women have less power and status than men do, and they control fewer resources (UNICEF, 2019). Compared with men, women perform more domestic work, spend fewer hours in paid employment, receive lower pay, and are more thinly represented in the highest levels of organizations. In Eagly's view, as women adapted to roles with less power and less status in society, they showed more cooperative, less dominant profiles than men. Thus, the social hierarchy and division of labor are important causes of gender differences in power, assertiveness, and nurture (Eagly, 2016, 2018). The psychoanalytic theory of gender stems from Sigmund Freud's view that the preschool child develops a sexual attraction to the opposite-sex parent. At 5 or 6 years of age, the child renounces this attraction because of anxious feelings. Subsequently, the child identifies with the same-sex parent, unconsciously adopting the same-sex parent's characteristics. However, developmentalists do not hold that gender development proceeds as Freud proposed. Children become gender-typed much earlier than 5 or 6 years of age, and they become masculine or feminine even when the same-sex parent is not present in the family. The social cognitive approach provides an alternative explanation of how children develop gender-typed behavior (see Figure 1). According to the social cognitive theory of gender, children's gender development occurs through observation and imitation, and through the rewards Page 391and punishments children experience for gender-appropriate and gender-inappropriate behavior (Bussey & Bandura, 1999; Leaper & Bigler, 2018).

Sexual Attitudes and Behavior

Although the ability of men and women to function sexually shows little biological decline in middle adulthood, sexual activity usually occurs on a less frequent basis than in early adulthood (Geerkens & others, 2019; Rees & others, 2018). Career interests, family matters, decreased energy levels, and routine may contribute to this decline (Avis & others, 2009). In the Sex in America survey (described earlier in this chapter), the frequency of having sex was greatest for individuals aged 25 to 29 years old (47 percent had sex twice a week or more) and dropped off for individuals in their fifties (23 percent of 50- to 59-year-old males said they had sex twice a week or more, while only 14 percent of the females in this age group reported this frequency) (Michael & others, 1994). Note, though, that the Sex in America survey may underestimate the frequency of sexual activity of middle-aged adults because the data were collected prior to the widespread use of erectile dysfunction drugs such as Viagra. In a recent study, higher frequency of sexual activity in middle-aged and older adults was linked to better overall cognitive functioning, especially in working memory and executive function (Wright, Jenks, & Demeyere, 2019). Living with a spouse or partner makes all the difference in whether people engage in sexual activity, especially for women over 40 years of age. In one study conducted as part of the Midlife in the United States Study (MIDUS), 95 percent of women in their forties with partners said that they had been sexually active in the last six months, compared with only 53 percent of those without partners (Brim, 1999). By their fifties, 88 percent of women living with a partner had been sexually active in the last six months, but only 37 percent of those who were neither married nor living with someone reported having had sex in the last six months. A large-scale study of U.S. adults 40 to 80 years of age found that premature ejaculation (26 percent) and erectile difficulties (22 percent) were the most common sexual problems of older men, whereas lack of sexual interest (33 percent) and lubrication difficulties (21 percent) were the most common sexual problems of older women (Laumann & others, 2009). A person's health in middle age is a key factor in sexual activity during this period (Field & others, 2013). A study of adults 55 years and older revealed that their level of sexual activity was associated with their physical and mental health (Bach & others, 2013). Social and relationship factors also are important in sexual functioning during middle age. For example, in a recent study of healthy middle-aged women, interpersonal aspects such as emotional support and relationship satisfaction, as well the personality traits of optimism and self-esteem, were key predictors of the quality of sexual functioning (Memone, Fiacco, & Ehlert, 2019).

Heterosexual Attitudes and Behavior

Americans tend to fall into three categories: One-third have sex twice a week or more, one-third a few times a month, and one-third a few times a year or not at all. Married (and cohabiting) couples have sex more often than noncohabiting couples (see Figure 4). Most Americans do not engage in kinky sexual acts. When asked about their favorite sexual acts, the vast majority (96 percent) said that vaginal sex was "very" or "somewhat" appealing. Oral sex was in third place, after an activity that many have not labeled a sexual act—watching a partner undress. Adultery is clearly the exception rather than the rule. Nearly 75 percent of the married men and 85 percent of the married women in the survey indicated that they had never been unfaithful. Men think about sex far more often than women do—54 percent of the men said they thought about it every day or several times a day, whereas 67 percent of the women said they thought about it only a few times a week or a few times a month.

Socioemotional Similarities and Differences

Are "men from Mars" and "women from Venus"? Perhaps the gender differences that most fascinate people are those regarding how males and females relate to each other as people. For just about every imaginable socioemotional characteristic, researchers have examined whether there are differences between males and females. Here we examine just two that have been closely studied: (1) aggression and (2) emotion and its regulation. Aggression One of the most consistent gender differences identified is that boys are more physically aggressive than girls (Hyde, 2017). The difference occurs in all cultures and appears very early in children's development (Dayton & Malone, 2017). The difference in physical aggression is especially pronounced when children are provoked. Although boys are consistently more physically aggressive than girls, might girls show as much or more verbal aggression, such as yelling, than boys? When verbal aggression is examined, gender differences typically disappear or aggression is even more pronounced in girls (Eagly & Steffen, 1986). Recently, increased interest has been directed toward relational aggression, which involves harming someone by manipulating a relationship. Relational aggression includes such behaviors as trying to make others dislike a certain individual by spreading malicious rumors about the person (Casper & Card, 2017; Eisman & others, 2018; Padmanabhanunni & Gerhardt, 2019). Relational aggression increases in middle and late childhood Page 398(Dishion & Piehler, 2009). Mixed findings have characterized research on whether girls show more relational aggression than boys, but one consistent finding is that relational aggression comprises a greater percentage of overall aggression for girls than for boys (Putallaz & others, 2007). And a research review revealed that girls engage in more relational aggression than boys in adolescence but not in childhood (Smith, Rose, & Schwartz-Mette, 2010). Further, in a longitudinal study, preschool relational aggression predicted adolescent relational aggression for girls but not for boys (Nelson & others, 2014). Also, in a recent study of adolescents, those who observed relational aggression on television were more likely to engage in relational aggression when they were texting one year later (Coyne & others, 2019). Emotion and Emotion Regulation Gender differences occur in some aspects of emotion (Brody, Hall, & Stokes, 2018; Connolly & others, 2019). Females express emotion more openly than males, are better than males at decoding emotion, smile more, cry more, and are happier (Gross, Frederickson, & Levenson, 1994; LaFrance, Hecht, & Paluck, 2003). Males report experiencing and expressing more anger than females do (Kring, 2000). Girls also are better at reading others' emotions and more likely to show empathy than are boys (Blakemore, Berenbaum, & Liben, 2009). A research meta-analysis found that females are better than males at recognizing nonverbal displays of emotion (Thompson & Voyer, 2014). Another meta-analysis also revealed that overall gender differences in children's emotional expression were small, with girls showing more positive emotion (sympathy, for example) and more internalized emotions (sadness and anxiety, for example) than boys (Chaplin & Aldao, 2013). In this analysis, the gender difference in positive emotions became more pronounced with age as girls more strongly expressed positive emotions than boys in middle and late childhood and in adolescence. Also, a recent study revealed that females are better than males at facial emotion perception across the life span (Olderbak & others, 2019). An important skill is to be able to regulate and control one's emotions and behavior (Cole, Ram, & English, 2019; Denham & Bassett, 2019). Boys usually show less self-regulation than girls (Blakemore, Berenbaum, & Liben, 2009). This low self-control can translate into behavior problems (McClelland, Cameron, & Alonso, 2019). Researchers have found that girls are more "people oriented" and boys are more "things oriented" (Galambos, Berenbaum, & McHale, 2009). In a research review, this conclusion was supported by findings that girls spend more time and energy building relationships, while boys spend more time alone, playing video games, and playing sports; that girls work at part-time jobs that are people-oriented such as waitressing and babysitting, while boys are more likely to take part-time jobs that involve manual labor and using tools; and girls are interested in careers that are more people-oriented, such as teaching and social work, while boys are more likely to be interested in object-oriented careers, such as mechanics and engineering (Perry & Pauletti, 2011). Researchers have found that adolescent girls engage in more self-disclosure (communication of intimate details about themselves) in close relationships, are better at actively listening in a conversation than are boys, and emphasize affiliation or collaboration (Hall, 2011; Leaper, 2013, 2015). Adolescent girls are especially likely to engage in self-disclosure and emotional support in friendship to a greater extent than are boys (Leaper, 2013). By contrast, boys are more likely to value self-assertion and dominance than are girls in their interactions with friends and peers (Leaper, 2013; Rose & Rudolph, 2006).

Emerging Adulthood

At the beginning of emerging adulthood (age 18), surveys indicate that slightly more than 60 percent of individuals have experienced sexual intercourse, but by the end of emerging adulthood (age 25), most individuals have had sexual intercourse (Lefkowitz & Gillen, 2006; Wesche & Lefkowitz, 2020). Also, the U.S. average age for a first marriage has now climbed to 29.5 years for men and 27.4 years for women, higher than at any other point in history (U.S. Census Bureau, 2018). Thus, emerging adulthood is a time frame during which most individuals are both sexually active and unmarried (Waterman & Lefkowitz, 2018). Uncertainty characterizes many emerging adults' sexual relationships (Wesche & Lefkowitz, 2020). Consider a study of emerging adult daters and cohabitors that found nearly half reported a reconciliation (a breakup followed by a reunion) (Halpern-Meekin & others, 2013). Also, emerging adults report that on days when they have vaginal sex they have more positive affect; however, they report higher levels of negative affect or other negative consequences if they have sex with someone they are not dating (Vasilenko & Lefkowitz, 2018). Casual sex is more common in emerging adulthood than it is during the late twenties (Wesche & Lefkowitz, 2020; Waterman & Lefkowitz, 2018; Wesche, Lefkowitz, & Vasilenko, 2018). A recent trend has involved "hooking up" to have non-relationship sex (from kissing to intercourse) (Blayney & others, 2019; Sullivan & others, 2018). One study indicated that 40 percent of 22-year-olds reported having had a recent casual sexual partner (Lyons & others, 2015). Another study also revealed that 20 percent of first-year college women on one large university campus had engaged in at least one hookup over the course of the school year (Fielder & others, 2013). In this study, impulsivity, sensation seeking, and alcohol use were among the predictors of a higher likelihood of hooking up. And in a study of more than 3,900 18- to 25-year-olds, having casual sex was negatively linked to well-being and positively related to psychological distress (Bersamin & others, 2014). Further, research indicates that when emerging adults drink alcohol (especially when they engage in binge drinking or use marijuana), they are more likely to have casual sex and less likely to discuss possible risks (Kuperberg & Padgett, 2017). In addition to hooking up, another type of casual sex that has recently increased among emerging adults is "friends with benefits" (FWB), which involves a relationship formed by the integration of friendship and sexual intimacy without an explicit commitment characteristic of an exclusive romantic relationship (Weger, Cole, & Akbulut, 2019). A recent study found that suicidal ideation was associated with entrance into a friends with benefits relationship as well as continuation of the FWB relationship (Dube & others, 2017). Also, in a study of almost 8,000 emerging adults, males had more permissive sexual attitudes, especially regarding sexual encounters, than did females (Sprecher, Treger, & Sakaluk, 2013).

Androgen-insensitive males.

Because of a genetic error, a small number of XY males don't have androgen cells in their bodies. Their bodies look female, they develop a female gender identity, and they usually are sexually attracted to males.

Other Adults, Media, and Peers

Children also learn about gender from observing other adults in the neighborhood and in the media (Kinsler & others, 2018; Matthes, Prieler, & Adam, 2016). As children get older, peers become increasingly important (Chen, Lee, & Chen, 2018). Peers extensively reward and punish gender behavior (Leaper & Bigler, 2018). For example, when children play in gender-stereotypical ways that are deemed culturally appropriate, they tend to be rewarded by their peers. Those who engage in activities that are considered sex-inappropriate tend to be criticized or abandoned by their peers. It is generally more accepted for girls to act like boys than for boys to act like girls; thus, use of the term tomboy to describe masculine girls is often thought of as less derogatory than the Page 392term sissy to describe feminine boys (Pasterski, Golombok, & Hines, 2011). In a recent study of 9- to 10-year-olds in Great Britain, gender-nonconforming boys were most at risk for peer rejection (Braun & Davidson, 2017). In this study, gender non-conforming girls were preferred more than gender-conforming girls, with children most often citing masculine activities as the reason for this choice. From 4 to about 12 years of age, children spend a large majority of their free play time exclusively with others of their own sex (Maccoby, 2002). What kind of socialization takes place in these same-sex play groups? In one study, researchers observed preschoolers over a period of six months (Martin & Fabes, 2001). The more time boys spent interacting with other boys, the more their activity level, rough-and-tumble play, and gender-typed choice of toys and games increased, and the less time boys spent near adults. By contrast, the more time the preschool girls spent interacting with other girls, the more their activity level and aggression decreased, and the more their girl-type play activities and time spent near adults increased. A study of preschool children (average age: 4 years) found that children selected playmates of the same sex who engaged in similar levels of gender-typed activities (Martin & others, 2013). In selecting a playmate, comparisons of gender of child and activity revealed that gender of the playmate was more important than activity. After watching elementary school children repeatedly play in same-gender groups, two researchers characterized the playground as "gender school" (Luria & Herzog, 1985). From adolescence through late adulthood, friendships also mainly consist of same-sex peers (Mehta & Strough, 2009, 2010).

date or acquaintance rape

Coercive sexual activity directed at someone with whom the victim is at least casually acquainted.

What evidence exists that the classroom setting is biased against boys? Here are some factors to consider

Compliance, following rules, and being neat and orderly are valued and reinforced in many classrooms. These are behaviors that usually characterize girls more than boys. A large majority of teachers are females, especially at the elementary school level. This trend may make it more difficult for boys than for girls to identify with their teachers and model their teachers' behavior. One study revealed that male teachers perceived boys more positively and saw them as more educationally competent than female teachers did (Mullola & others, 2012). Boys are more likely than girls to have a learning disability or ADHD and to drop out of school. Boys are more likely than girls to be criticized by their teachers. School personnel tend to stereotype boys' behavior as problematic.

Gender Controversy

Controversy surrounds the extent of gender differences and what might cause them (Burt, Slawinski, & Klump, 2018; Hyde & others, 2019). As we saw earlier, evolutionary psychologists such as David Buss (2018) argue that gender differences are extensive and caused by the adaptive problems people have faced across their evolutionary history. Alice Eagly (2018) also concludes that gender differences are substantial but reaches a very different conclusion about their cause. She traces gender differences to social conditions that have resulted in women having less power and controlling fewer resources than men do. By contrast, Janet Shibley Hyde (2014, 2017; Hyde & others, 2019) concludes that gender differences have been greatly exaggerated, with these comparisons being especially fueled by popular books such as John Gray's (1992) Men Are from Mars, Women Are from Venus and Deborah Tannen's (1990) You Just Don't Understand. She argues that the research indicates females and males are similar on most psychological factors. In a research review, Hyde (2005) summarized the results of 44 meta-analyses of gender differences and similarities. A meta-analysis is a statistical analysis that combines the results of many different studies. Gender differences in most areas—including math ability and communication—were either nonexistent Page 399or small. Gender differences in physical aggression were moderate. The largest difference occurred on motor skills (favoring males), followed by sexuality (males masturbate more often and are more likely to endorse sex in a casual, uncommitted relationship) and physical aggression (males are more physically aggressive than females are). Hyde's summary of meta-analyses is unlikely to quiet the controversy about gender differences and similarities, but further research should be conducted to provide a basis for more accurate judgments on this topic. Indeed, later in the chapter, after we discuss "Gender Role Classification," we will explore Hyde and her colleagues' (2019) expanded analysis of the breadth of gender similarities.

sexually transmitted infections (STIs)

Diseases that are contracted primarily through sexual contact, including oral-genital contact, anal-genital contact, and vaginal intercourse.

Hormonal Changes in Middle-Aged Men

Do men go through anything like the menopause that women experience? In other words, is there a male menopause? During middle adulthood, most men do not lose their capacity to father children, although there usually is a modest decline in their sexual hormone level and activity (Kaufman & others, 2019). Men experience hormonal changes in their fifties and sixties, but nothing like the dramatic drop in estrogen that women experience. Testosterone production begins to decline about 1 percent a year during middle adulthood, and sperm count usually shows a slow decline, but men do not lose their fertility in middle age. The term male hypogonadism is used to describe a condition in which the body does not produce enough testosterone (Mayo Clinic, 2019). What has been referred to as "male menopause," then, may have less to do with hormonal change than with the psychological adjustment men must make when they are faced with declining physical energy and with family and work pressures. ' The gradual decline in men's testosterone levels in middle age can reduce their sexual drive (Goel & others, 2009). Their erections are less full and less frequent, and men require more stimulation to achieve them. Researchers once attributed these changes to psychological factors, but increasingly they find that as many as 75 percent of the erectile dysfunctions in middle-aged men stem from physiological problems. Smoking, diabetes, hypertension, elevated cholesterol levels, depression, and lack of exercise are responsible for many erectile problems in middle-aged men (Gur & others, 2017; Rakovac Tisdall & others, 2018). Recently, there has been a dramatic surge of interest in testosterone replacement therapy (TRT) (Fode & others, 2019; Larssen, Clausen, & Stahlman, 2019; Moon & Park, 2019). Recent research indicates that TRT can improve sexual functioning, muscle strength, and bone health in men with low testosterone levels (Gray, McHale, & Carré, 2017; Mayo Clinic, 2019; Rastrelli & others, 2019). A recent study indicated that TRT-related benefits in quality of life and sexual function were maintained for 36 months after initial treatment (Rosen & others, 2017). Also, recent research on TRT and cardiovascular disease is inconclusive. Some studies have revealed that testosterone replacement therapy is associated with a lower incidence of heart attack or stroke, as well as a reduction in all-cause mortality (Cheetham & others, 2017; Jones & Kelly, 2018). However, others have not reached these conclusions and some studies have shown increased rates of stroke in men taking testosterone treatments (Fode & others, 2019). Men who have prostate cancer or breast cancer should not take TRT, and men who are at risk for blood clotting (those who have atrial fibrillation, for example) also may need to avoid TRT (Osterberg, Bernie, & Ramasamy, 2014). For many decades, it was thought that TRT increased the risk of prostate cancer, but recent research studies and reviews indicate that this is not the case, at least when TRT lasts one year or less (Debruyne & others, 2017; Yassin & others, 2017). Two studies found Page 423that TRT improved older men's sexual function as well as their moods (Miner & others, 2013; Okada & others, 2014). Another study found that a higher testosterone level was linked to better episodic memory in middle-aged males (Panizzon & others, 2014). However, a research review concluded that the benefit-risk ratio for older adult men is uncertain (Isidori & others, 2014). Erectile dysfunction (ED) is a common condition in aging men, affecting approximately 50 percent of men 40 to 70 years of age (Mola, 2015). Low testosterone can cause erectile dysfunction (Huang & others, 2019). Treatment for men with erectile dysfunction has focused on the drug Viagra and on similar drugs, such as Levitra and Cialis (Bennett, 2018; Gesser-Edelsburg & Hijazi, 2018; Krishnappa & others, 2019). Viagra works by allowing increased blood flow into the penis, which produces an erection. Its success rate is in the 60 to 85 percent range (Claes & others, 2010).

Gender and Aging

Do our gender roles change when we become older adults? Some developmentalists maintain there is decreasing femininity in women and decreasing masculinity in men when they reach late adulthood (Gutmann, 1975). The evidence suggests that older men do become more feminine—nurturant, sensitive, and so on—but it appears that older women do not necessarily become more masculine—assertive, dominant, and so on (Turner, 1982). A longitudinal study revealed that as men entered their sixties, they endorsed more feminine items on a list of personal characteristics, which increased their classification as androgynous (combination of masculine and feminine traits) (Hyde, Krajnik, & Skuldt-Niederberger, 1991). In a more recent cross-sectional study of individuals from 12 to 80 years and older, men in their seventies were more likely than adolescents and younger men to endorse androgynous traits (Strough & others, 2007). Also in this study, women in their eighties and older were less likely than younger and middle-aged women to endorse masculine and androgynous traits. And in an even more recent study, among older adult men, those who were married were more likely to endorse stereotypically masculine traits but also to have higher androgyny scores than unmarried older men (Lemaster, Delaney, & Strough, 2017). The studies of age differences just discussed here were cross-sectional in nature and may reflect cohort effects. Keep in mind that cohort effects are especially important to consider in areas such as gender roles. As sociohistorical changes take place and are assessed more frequently in life-span investigations, what were once perceived to be age effects may turn out to be cohort effects (George & Ferraro, 2016; Schaie, 2016). For example, in the study described above (Strough & others, 2007), the early-adult and middle-aged women were "baby boomers," likely influenced by the women's movement as they were growing up and developing their identity. However, the oldest-old women likely had already established their gender identity when the women's movement began, which might explain why they were less likely than younger women to endorse masculine and androgynous traits. A possible double jeopardy also faces many older women—the burden of both ageism and sexism (Meyer & Parker, 2011). In developing countries, the poverty rate for older adult females is almost double that for older adult males. Not only is it important to be concerned about older women's double jeopardy of ageism and sexism, but special attention also needs to be devoted to female ethnic minority older adults (Angel, Mudrazija, & Benson, 2016). Many, but not all, immigrant ethnic groups traditionally have relegated the woman's role to family maintenance. Many important decisions may be made by a woman's husband or parents, and she is often not expected to seek an independent career or enter the workforce unless the family is in dire financial need. Some ethnic minority groups may define an older woman's role as unimportant, especially if she is unable to contribute financially. However, in some ethnic minority groups, a woman's social status improves in later life. For example, older African American women can express their own needs and have status and power in the community. Despite their positive status in the African American family and the African American culture, however, African American women over the age of 70 are the poorest population group in the United States. Three of five older African American women live alone; most of them are widowed. The low incomes of older African American women translate into less than adequate access to health care. Substantially lower incomes for African American older women are related to the kinds of jobs they have held. Frequently these jobs are not covered by Social Security or, in the case of domestic service, the incomes of these women are not reported even when reporting is legally required. A portrayal of older African American women in cities reveals some of their survival strategies. They highly value the family as a source of mutual support and aid, adhere to the American work ethic, and view religion as a source of strength. In sum, older African American women have faced considerable stress in their lives (Angel, Mudrazija, & Benson, 2016). In dealing with this stress, they have shown remarkable adaptiveness, resilience, responsibility, and coping skills. However, many older African American women would benefit considerably from improved support.

Developmental Changes in Gender Stereotyping

Earlier we described how young children stereotype occupations as being "masculine" or "feminine." When do children begin to engage in gender stereotyping? In one study, gender stereotyping by children was present even in 2-year-olds but increased considerably by 4 years of age (Gelman, Taylor, & Nguyen, 2004). Another study found that 2-year-olds' knowledge of only one or the other gender categories did not predict an increase in gender stereotyping from 2 to 3 years old but their knowledge of both genders did (Zosuls, Ruble, & Tamis-LeMonda, 2014). Gender stereotyping continues to change during middle and late childhood and adolescence (Halim, 2016). Research indicates that while gender stereotyping is often a time of gender rigidity, in middle and late childhood boys and girls become more flexible in their gender-typing (Halim, 2016). In some studies, the increase in gender flexibility characterizes girls more than boys (Halim & others, 2016). For example, a study of 3- to 10-year-old U.S. children revealed that girls and older children used a higher percentage of gender stereotypes (Miller & others, 2009). In this study, appearance stereotypes were more prevalent on the part of girls, whereas activity (sports, for example) and trait (aggressive, for example) stereotyping was more commonly engaged in by boys. During middle and late childhood, children expanded the range and extent of their gender stereotyping in areas such as occupations, sports, and school tasks. In early adolescence, gender stereotyping might increase again, a topic we will address shortly. By late adolescence, gender attitudes become more flexible.

ADOLESCENCE

Early adolescence is another transitional point that seems to be especially important in gender development. Young adolescents have to cope with the enormous changes of puberty. These changes are intensified by their expanding cognitive abilities, which make them acutely aware of how they appear to others. Relations with others change extensively as dating begins and sexuality is experienced. As females and males undergo the physical and social changes of early adolescence, they must come to terms with new definitions of their gender roles (Pascoe, 2017). During early adolescence, individuals develop the adult, physical aspects of their sex. Some theorists and researchers have proposed that, with the onset of puberty, girls and boys experience an intensification of gender-related expectations. Puberty might signal to socializing others—parents, peers, and teachers, for example—that the adolescent is beginning to approach adulthood and therefore should begin to behave in ways that more closely resemble the stereotypical female or male adult. The gender-intensification hypothesis states that psychological and behavioral differences between boys and girls become greater during early adolescence because of increased pressures to conform to traditional masculine and feminine gender roles (Galambos, 2004; Hill & Lynch, 1983). Some researchers have reported evidence of gender intensification in early adolescence (Hill & Lynch, 1983), but others have found no evidence for intensification in masculinity or femininity in young adolescents (Priess, Lindberg, & Hyde, 2009). The jury is still out on the validity of the gender-intensification hypothesis, but research has raised questions about its accuracy (Galambos, Berenbaum, & McHale, 2009). Gender intensification may create special problems for boys. Adopting a strong masculine role in adolescence is increasingly being found to be associated with problem behaviors. Joseph Pleck (1995) argues that definitions of traditional masculinity include behaviors that do not have social approval but nonetheless validate the adolescent boy's masculinity. That is, in the male adolescent culture, male adolescents perceive that they will be thought of as more masculine if they engage in premarital sex, drink alcohol, take drugs, and participate in delinquent activities. One study revealed that both boys and girls who engaged in extreme gender-typed (hyper-gender) behaviors had lower levels of school engagement and school attachment (Ueno & McWilliams, 2010).

The Evolutionary Psychology View

Evolutionary psychology emphasizes that adaptation during the evolution of humans produced psychological differences between males and females (Antfolk, 2019; Buss, 2018; Buss & Schmidt, 2019; Euler, 2019). Evolutionary psychologists argue that primarily because of their differing roles in reproduction, males and females faced different pressures in primeval environments when the human species was Page 390evolving (Ellis & Del Guidice, 2019; Grebe & others, 2019; Solomon & others, 2019). In particular, because having multiple sexual liaisons improves the likelihood that males will pass on their genes, natural selection favored males who adopted short-term mating strategies. These males competed with other males to acquire more resources in order to access females. Therefore, say evolutionary psychologists, males evolved dispositions that favor violence, competition, and risk taking (Buss & Schmitt, 2019). In contrast, according to evolutionary psychologists, females' contributions to the gene pool were improved by securing resources for their offspring, which was promoted by obtaining long-term mates who could support a family. As a consequence, natural selection favored females who devoted effort to parenting and chose mates who could provide their offspring with resources and protection. Females developed preferences for successful, ambitious men who could provide these resources (Buss, 2018; Starr & others, 2019). Critics of evolutionary psychology argue that its hypotheses are backed by speculations about prehistory, not evidence, and that in any event people are not locked into behavior that was adaptive in the evolutionary past. Critics also claim that the evolutionary view pays little attention to cultural and individual variations in gender differences (Best & Puzio, 2019; Hyde & DeLamater, 2017).

Fathers' socialization strategies.

Fathers pay more attention to sons than to daughters, engage in more activities with sons, and put forth more effort to promote sons' intellectual development.

rape

Forcible sexual intercourse, oral sex, or anal sex with a person who does not give consent. Legal definitions of rape differ from state to state.

gender stereotypes

General impressions and beliefs about females and males.

Men's Development Here are some of the areas where men's roles can cause considerable strain (Levant, 2001):

Health. Men die 8 to 10 years earlier than women do. They have higher rates of stress-related disorders, alcoholism, car accidents, and suicide. Men are more likely than women to be the victims of homicide. In sum, the male role is hazardous to men's health. Male-female relationships. Too often, the male role involves expectations that men should be dominant, powerful, and aggressive and should control women. "Real men," according to many traditional definitions of masculinity, look at women in terms of their bodies, not their minds and feelings, have little interest in rapport talk and relationships, and do not consider women equal to men in work or many other aspects of life. Thus, the traditional view of the male role encourages men to disparage women, be violent toward women, and refuse to have equal relationships with women. Male-male relationships. Too many men have had too little interaction with their fathers, especially fathers who are positive role models. Nurturing and being sensitive to others have been considered aspects of the female role, not the male role. And the male role emphasizes competition rather than cooperation. All of these aspects of the male role have left men with inadequate positive, emotional connections with other males.

Early loss of penis and sexual reassignment.

In 1966 in Manitoba, Canada, one of two identical twin boys lost his penis at the age of seven months during a botched circumcision. The twin who lost his penis was surgically reassigned to be a girl and raised as a girl. Bruce (the real name of the boy) became "Brenda." The psychologist overseeing the case reported a positive outcome of the sexual reassignment (Money, 1975), but later it became clear that "Brenda" had not adjusted well to life as a girl (Diamond & Sigmundson, 1997). As a young adult, Brenda became David and lived as a man with a wife and adopted children (Colapinto, 2000). Tragically in 2004, when David was 38 years old, he committed suicide.

GOING BEYOND GENDER AS BINARY

In a number of places in our coverage of gender, we have indicated that the long-existing (for more than a century) concept of gender as having just two categories—male and female—is being challenged. In a recent analysis, leading expert, Janet Shibley Hyde and her colleagues (Hyde & others, 2019) described a number of aspects of gender where this challenge is occurring. These include the following developments: (1) neuroscience research indicates the presence of a gender mosaic rather "his or her" brains that are highly different; (2) endocrinology research reveals more hormonal similarities in males and females than had been previously Page 401envisioned; (3) recent conceptual changes in gender role classification go far beyond characterizing individuals as masculine or feminine and add a number of new gender identity categories such as trans people, transgender, cisgender, and many others; (4) developmental research indicates that the tendency to view gender as a binary category is not due only to biological factors but is also culturally determined and malleable. Further, gender categories are not mutually exclusive because an individual can identify with more than one category. Also, gender categories are fluid because an individual's gender identity can change over time. Each of the ideas described here reflects a substantial change in how gender is conceptualized and reflected in individuals' daily lives, but as we indicated earlier in the chapter there is still controversy about the extent of gender similarities and differences.

What evidence is there that the classroom setting is biased against girls? Consider the views of Myra and David Sadker (2005):

In a typical classroom, girls are more compliant and boys are more rambunctious. Boys demand more attention, and girls are more likely to quietly wait their turn. Teachers are more likely to scold and reprimand boys, as well as send boys to school authorities for disciplinary action. Educators worry that girls' tendency to be compliant and quiet comes at a cost: diminished assertiveness. In many classrooms, teachers spend more time watching and interacting with boys, whereas girls work and play quietly on their own. Most teachers don't intentionally favor boys by spending more time with them, yet somehow the classroom frequently ends up with this type of gendered profile. Boys get more instruction than girls and more help when they have trouble with a question. Teachers often give boys more time to answer a question, more hints at the correct answer, and further tries if they give the wrong answer. Girls and boys enter first grade with roughly equal levels of self-esteem. Yet by the middle school years, girls' self-esteem is lower than boys'.

Mothers' socialization strategies

In many cultures, mothers socialize their daughters to be more obedient and responsible than their sons. They also place more restrictions on daughters' autonomy.

Biological Factors

In our discussion of gender, we identified two main classes of sex hormones: estrogens (which primarily promote the development of female physical sex characteristics) and androgens (which mainly promote the development of male physical sex characteristics). The pituitary gland in the brain monitors hormone levels but is itself regulated by the hypothalamus. The pituitary gland sends out a signal to the testes or ovaries to manufacture a hormone; then the pituitary gland, through interaction with the hypothalamus, detects when the optimal level of the hormone is reached and maintains this level (Iovino & others, 2019). As we move from lower to higher animals, the role of hormones becomes less clear, especially in females. For human males, higher androgen levels are associated with sexual motivation and orgasm frequency (Gray, McHale, & Carré, 2017; King & Regan, 2019). Nonetheless, sexual behavior is so individualized in humans that it is difficult to distinguish the effects of hormones.

Heterosexual Attitudes and Behavior

In sum, one of the most powerful messages in the 1994 survey was that Americans' sexual lives are more conservative than was previously believed. Although 17 percent of the men and 3 percent of the women reported having had sex with at least 21 partners, the overall impression from the survey was that sexual behavior is ruled by marriage and monogamy for most Americans. How extensive are gender differences in sexuality? A meta-analysis revealed that men reported having slightly more sexual experiences and more permissive attitudes than women regarding most aspects of sexuality (Peterson & Hyde, 2010). For the following factors, stronger differences were found: Men said that they engaged more often in masturbation, pornography use, and casual sex, and they expressed more permissive attitudes about casual sex than their female counterparts did. Given all the media and public attention directed toward the negative aspects of sexuality—such as adolescent pregnancy, sexually transmitted infections, rape, and so on—it is important to underscore that research strongly supports the role of sexuality in well-being (Brody, 2010; King, 2017, 2019). For example, in a Swedish study frequency of sexual intercourse was strongly linked to life satisfaction for both women and men (Brody & Costa, 2009). And in a recent study, sexual activity in adults on day 1 was linked to greater well-being the next day (Kashdan & others, 2018). Also in this study, higher reported sexual pleasure and intimacy predicted more positive affect and less negative affect the next day.

Gender in Context

In thinking about gender, it is important to consider the context of behavior (Moreau & others, 2019). Gender behavior often varies across contexts. Consider helping behavior. Males are more likely to help in contexts in which a perceived danger is present and they feel competent to help (Eagly & Crowley, 1986). For example, males are more likely than females to help a person who is stranded by the roadside with a flat tire; automobile problems are an area in which many males feel competent. In contrast, when the context involves volunteering time to help a child with a personal problem, females are more likely to help than males are, because there is little danger present and females feel more competent at nurturing. In many cultures, girls show more caregiving behavior than boys do. Context is also relevant to gender differences in the display of emotions (Shields, 1998). Consider anger. Males are more likely to show anger toward strangers, especially other males, when they think they have been challenged. Males also are more likely than females to turn their anger into aggressive action, especially when their culture endorses such action (Tavris & Wade, 1984). In many cultures around the world, traditional gender roles continue to guide the behavior of males and females (UNICEF, 2019). In China and Iran, for instance, it is still widely accepted for males to engage in dominant behavior and females to behave in subordinate ways. In a recent study of eighth-grade students in 36 countries, in every country girls had more egalitarian attitudes about gender roles than did boys (Dotti Sani & Quaranta, 2017). In this study, girls had more egalitarian gender attitudes in countries with higher levels of societal gender equality. In a recent study of 15- to 19-year-olds in the country of Qatar, males had more negative views of gender equality than did females (Al-Ghanim & Badahdah, 2017). Many Western cultures, such as the United States, have become more flexible about gender behavior and allow for more diversity. For example, although a girl's father might promote traditional femininity, her friends might engage in many traditionally masculine activities and her teachers might encourage her to be assertive. In the United States, the cultural backgrounds of children and adolescents influence how boys and girls will be socialized. In one study, Latino and Latina adolescents were socialized differently as they were growing up (Raffaelli & Ontai, 2004). Latinas experienced far greater restrictions than Latinos in having curfews, interacting with members of the other sex, getting a driver's license, getting a job, and being involved in after-school activities.

gender identity

Involves a sense of one's own gender, including knowledge, understanding, and acceptance of being male or female.

BIOLOGICAL INFLUENCES

It was not until the 1920s that researchers confirmed the existence of human sex chromosomes, the genetic material that determines our sex. Humans normally have 46 chromosomes, arranged in pairs. A 23rd pair with two X-shaped chromosomes produces a female. A 23rd pair with an X chromosome and a Y chromosome produces a male. During the first few weeks of gestation, female and male embryos look alike. Male sex organs start to differ from female sex organs when a gene on the Y chromosome directs a Page 389small piece of tissue in the embryo to turn into testes. Once the tissue has turned into testes, they begin to secrete testosterone. Because in females there is no Y chromosome, the tissue turns into ovaries. To explore biological influences on gender, researchers have studied individuals who are exposed to unusual levels of sex hormones early in development (Hines, 2015; Kung & others, 2018). Here are four examples of the problems that may occur as a result of such exposure (Lippa, 2005, pp. 122-124, 136-137):

What are some good strategies for protecting against HIV and other sexually transmitted infections? They include the following:

Knowing your own and your partner's risk status. Anyone who has had previous sexual activity with another person might have contracted an STI without being aware of it. Spend time getting to know a prospective partner before you have sex. Use this time to inform the other person of your STI status and inquire about your partner's. Remember that many people lie about their STI status. Obtaining medical examinations. Many experts recommend that couples who want to begin a sexual relationship have a medical checkup to rule out STIs before they engage in sex. If cost is an issue, contact your campus health service or a public health clinic. Having protected, not unprotected, sex. When used correctly, latex condoms help to prevent many STIs from being transmitted. Condoms are most effective in preventing gonorrhea, syphilis, chlamydia, and HIV. They are less effective against the spread of herpes. Not having sex with multiple partners. One of the best predictors of getting an STI is having sex with multiple partners. Having more than one sex partner elevates the likelihood that you will encounter an infected partner.

report talk

Language designed to convey information; a communication style preferred by men.

Sexual Risk Factors in Adolescence

Many adolescents are not emotionally prepared to handle sexual experiences, especially in early adolescence (Charlton & others, 2019; Weisman & others, 2019). Early sexual activity is linked with risky behaviors such as drug use, delinquency, and school-related problems (Cai & others, 2018; Donenberg & others, 2018; Rivera & others, 2018). In a recent study of Korean adolescent girls, early menarche was linked to earlier initiation of sexual intercourse (Kim & others, 2019). Another study confirmed that early engagement in sexual intercourse (prior to 14 years of age) is associated with high-risk sexual factors (forced sex, using drugs/alcohol at last sex, not using a condom at last sex, having multiple partners in the previous month, and becoming pregnant or causing a pregnancy), as well as experiencing dating violence (Kaplan & others, 2013). Also, a study of more than 3,000 Swedish adolescents revealed that sexual intercourse before age 14 was linked to risky behaviors such as an increased number of sexual partners, experience of oral and anal sex, negative health behaviors (smoking, drug and alcohol use), and antisocial behavior (being violent, stealing, running away from home) at 18 years of age (Kastbom & others, 2015). Further, a recent South African study found that early sexual debut predicted a lower probability of graduating from high school (Bengesai, Khan, & Dube, 2018). And in an Australian study, sex at age 15 or younger predicted higher rates of emerging adult (average age 21) pregnancy, lifetime sexual partners, and sex without using a condom (Prendergast & others, 2019). In this study, early sex also was associated with higher rates of emerging adult substance use and antisocial behavior. Substance abuse, especially in early adolescence, is linked to sexual risk practices. For example, in a recent study, the likelihood of initiating sexual intercourse before age 13 was higher among individuals who engaged in substance abuse and had mental health problems (Okumu & others, 2019). A number of family factors are associated with sexual risk taking. For example, one study revealed that adolescents who in the eighth grade reported greater parental knowledge of their activities and more family rules about dating were less likely to initiate sex during the eighth through tenth grades (Ethier & others, 2016). In another study, difficulties and disagreements between Latino adolescents and their parents were linked to the adolescents' early sexual initiation (Cordova & others, 2014). Another study revealed that of a number of parenting practices the factor that best predicted a lower level of risky sexual behavior by adolescents was supportive parenting (Simons & others, 2016). Also, having older sexually active siblings or pregnant/parenting teenage sisters placed adolescent girls at increased risk for pregnancy (Miller, Benson, & Galbraith, 2001). Further, in a recent study of urban, predominantly Latino and African American adolescents, talk with extended family members about sexual protection was linked to adolescents having fewer sexual partners, while talk about risks involved in sex was associated with adolescents having more sexual partners (Grossman & others, 2019). Socioeconomic status/poverty, peer, school, and sports contexts provide further information about sexual risk taking in adolescents (Warner, 2018). The percentage of sexually active young adolescents is higher in low-income areas of inner cities (Morrison-Beedy & others, 2013). One study found that associating with more deviant peers in early adolescence was related to having more sexual partners at age 16 (Lansford & others, 2010). Further, a research review found that school connectedness was linked to positive sexuality outcomes (Markham & others, 2010). Further, one study found that adolescent females who skipped school or failed a test were more likely to frequently have sexual intercourse and less likely to use Page 417contraceptives (Hensel & Sorge, 2014). Another study found that adolescent males who play sports engage in a higher level of sexual risk taking while adolescent females who play sports engage in a lower level of sexual risk taking (Lipowski & others, 2016). Weak self-regulation (poor ability to control one's emotions and behavior) is increasingly being implicated in sexual risk taking. For example, a longitudinal study found that weak self-regulation at 8 to 9 years of age and risk proneness (tendency to seek sensation and make poor decisions) at 12 to 13 years of age set the stage for sexual risk taking at 16 to 17 years of age (Crockett, Raffaelli, & Shen, 2006). And another study found that a high level of impulsiveness was linked to early adolescent sexual risk taking (Khurana & others, 2012). Might adolescents' spirituality protect them from negative sexual outcomes? One study found that parents' religiosity was linked to a lower level of risky sexual behavior among adolescents, in part resulting from adolescents hanging out with peers who were less sexually permissive (Landor & others, 2011). And a recent study of African American adolescent girls indicated that those who reported that religion was of low or moderate importance to them had a much earlier sexual debut than their counterparts who said that religion was very or extremely important to them (George Dalmida & others, 2018).

Attitudes and Behavior of Lesbians and Gays

Many gender differences that appear in heterosexual relationships also occur in same-sex relationships (Diamond, 2019; Savin-Williams, 2017, 2019). For example, lesbians have fewer sexual partners than gays, and lesbians have less permissive attitudes about casual sex outside a primary relationship than gays do (Fingerhut & Peplau, 2013). According to psychologist Laura Brown (1989), lesbians and gays experience life as a minority in a dominant, majority culture. For lesbians and gays, developing a bicultural identity creates new ways of defining themselves. Brown believes that lesbians and gays adapt best when they don't define themselves in polarities, such as trying to live in an encapsulated lesbian or gay world completely divorced from the majority culture or completely accepting the dictates and biases of the majority culture. A special concern is discrimination and prejudice toward sexual minority individuals (Schrager, Goldbach, & Mamey, 2018; Shramko, Toomey, & Anhalt, 2018). One study of 15-year-olds found that sexual minority status was linked to depression mainly via peer harassment (Martin-Storey & Crosnoe, 2012).

Developing a Sexual Identity

Mastering emerging sexual feelings and forming a sense of sexual identity is a multifaceted and lengthy process (Diamond, 2019; Savin-Williams, 2019). It involves learning to manage sexual feelings (such as sexual arousal and attraction), developing new forms of intimacy, and learning the skills to regulate sexual behavior to avoid undesirable consequences. An adolescent's sexual identity is influenced by social norms related to sex—the extent to which adolescents perceive that their peers are having sex, using protection, and so on. These social norms have important influences on adolescents' sexual behavior. For example, one study revealed that when adolescents perceived that their peers were sexually permissive, the adolescents had a higher rate of initiating sexual intercourse and engaging in risky sexual practices (Potard, Courtois, & Rusch, 2008). An individual's sexual identity also can be linked to other developing identities, which are discussed in the chapter on "The Self, Identity, and Personality." An adolescent's sexual identity involves activities, interests, styles of behavior, and an indication of sexual orientation (whether an individual has same-sex or other-sex attractions) (Carroll, 2019; Goldberg & Halpern, 2017). For example, some adolescents have a high anxiety level about sex, others a low level. Some adolescents are strongly aroused sexually, others less so. Some adolescents are very active sexually, others not at all. Some adolescents are sexually inactive in response to their strong religious upbringing, while others attend church regularly but their religious training does not inhibit their sexual activity. It is commonly believed that most sexual minority (which can include those who are gay, lesbian, bisexual, or transsexual) individuals quietly struggle with same-sex attractions in childhood, do not engage in heterosexual dating, and gradually recognize that they are gay or lesbian in mid to late adolescence (Savin-Williams, 2017, 2019). Many youth do follow this developmental pathway, but others do not. For example, many youth have no recollection of same-sex attractions in childhood and experience a more abrupt awareness of their same-sex attraction in late adolescence. Researchers also have found that the majority of adolescents with same-sex attractions also experience some degree of other-sex attractions (Diamond, 2019). Even though some adolescents who are attracted to same-sex individuals fall in love with these individuals, others claim that their same-sex attractions are purely physical (Savin-Williams, 2016, 2017, 2019). In the timing and sequence of sexual developmental milestones, there are few individual differences between heterosexual and sexual minority adolescents except that sexual minority adolescents have to cope with their sexual identity in more stressful ways, including disclosing their sexual identity to family members (Savin-Williams, 2019). Page 415 A recent study of more than 4,500 boys and girls examined whether early childhood sex-typed behavior was linked to adolescent sexual orientation (Li, Kung, & Hines, 2017). In this study, gender-typed behavior (for example, rough-and-tumble play was a male sex-typed item and playing house was a female sex-typed item) at 3.5 and 4.75 years (but less so at 2.5 years) predicted sexual orientation at 15 years of age, with the results stronger for boy than for girls. In sum, gay and lesbian youth have diverse patterns of initial attraction, often have bisexual attractions, and may feel physical or emotional attraction to same-sex individuals but do not always fall in love with them (Diamond, 2019; Savin-Williams, 2017, 2019). Further, the majority of sexual minority (gay, lesbian, and bisexual) adolescents have competent and successful paths of development through adolescence and become healthy and productive adults. However, in a recent large-scale study, sexual minority adolescents did engage in a higher prevalence of health-risk behaviors (greater drug use and sexual risk taking, for example) than heterosexual adolescents (Kann & others, 2016). And a recent study found that early sexual debut (first sexual intercourse before age 13) was associated with sexual risk taking, substance use, violent victimization, and suicidal thoughts/attempts in both sexual minority (in this study, gay, lesbian, or bisexual adolescents) and heterosexual youth (Lowry & others, 2017).

Menopause

Menopause is the time in middle age, usually during the late forties or early fifties, when a woman's menstrual periods cease (Mitchell & Woods, 2015). The average age at which U.S. women have their last period is 51 (Wise, 2006). However, there is a large variation in the age at which menopause occurs—from 39 to 59 years of age. Later menopause is linked with increased risk of breast cancer (Mishra & others, 2009). The average age at menarche, a girl's first menstruation, has significantly decreased since the mid-nineteenth century, occurring as much as four years earlier in some countries (Susman & Dorn, 2013). Has there been a similar earlier onset in the occurrence of menopause? No, there hasn't been a corresponding change in menopause, and there is little or no correlation between the onset of menarche and the onset of menopause (Gosden, 2007). However, researchers have found that early-onset menopause is linked to a higher risk of cardiovascular disease and stroke (Kaur, Singh, & Ahula, 2012). Perimenopause is the transitional period from normal menstrual periods to no menstrual periods at all, which often takes up to 10 years (McNamara, Batur, & DeSapri, 2015). Perimenopause occurs most often in the forties but can occur in the thirties (Raglan, Schulkin, & Micks, 2018). One study of 30- to 50-year-old women found that depressed feelings, headaches, moodiness, and heart palpitations were the perimenopausal symptoms that these women most frequently discussed with health-care providers (Lyndaker & Hulton, 2004). Lifestyle factors such as whether women are overweight, smoke, drink heavily, or exercise regularly during perimenopause influence aspects of their future health status such as whether they develop cardiovascular disease or chronic illnesses (Honour, 2018). A recent study found that the more minutes per week that women exercised during the menopausal transition, the lower their perceived stress was (Guerin & others, 2019). In menopause, production of estrogen by the ovaries declines dramatically, and this decline produces uncomfortable symptoms in some women—"hot flashes," nausea, fatigue, and rapid heartbeat, for example (Hachul & Tufik, 2019). Cross-cultural studies also reveal wide variations in the menopause experience (Rathnayake & others, 2018). For example, hot flashes are uncommon in Mayan women (Beyene, 1986). Asian women report fewer hot flashes than women in Western societies (Payer, 1991). In a recent study in China, Mosuo women (Mosuo is a matriarchal tribe in southern China where women have the dominant role in society, don't marry, and can take on as many lovers as they desire) had fewer negative menopausal symptoms, higher self-esteem, and better family support than Han Chinese women (the majority ethnic group in China) (Zhang & others, 2019). It is difficult to determine the extent to which these cross-cultural variations are due to genetic, dietary, reproductive, or cultural factors. Menopause overall is not the negative experience for most women that it was once thought to be (Brown & others, 2018). Most women do not have severe physical or psychological problems related to menopause. For example, a research review concluded that there is no clear evidence that depressive disorders occur more often during menopause than at other times in a woman's reproductive life (Judd, Hickey, & Bryant, 2012). However, the loss of fertility is an important marker for women—it means that they have to make final decisions about having children. Women in their thirties who have never had children sometimes speak about being "up against the biological clock" because they cannot postpone choices about having children much longer. Until recently, hormone replacement therapy was often prescribed as a treatment for unpleasant side effects of menopause. Hormone replacement therapy (HRT) augments the declining levels of reproductive hormone production by the ovaries (Andersson, Borgquist, & Jirstrom, 2018; Lobo, 2017). HRT can consist of various forms of estrogen, usually in combination with a progestin. Page 422 The National Institutes of Health recommends that women who have not had a hysterectomy and who are currently taking hormones consult with their doctor to determine whether they should continue the treatment. If they are taking HRT for short-term relief of menopausal symptoms, the benefits may outweigh the risks. HRT also lowers the risk of bone loss and bone fractures in post-menopausal women (de Villiers & others, 2016). Also, research indicates that if women take HRT within 10 years following menopause, it is associated with reduced risk of coronary heart disease (Langer, 2017). And research has indicated that when women start HRT in their fifties and continue its use for 5 to 30 years, there is an increase of 1.5 quality life years (Hodis & Mack, 2014). However, research indicates that hormone replacement therapy is linked to a slightly higher risk of breast cancer and the longer HRT is taken, the greater the risk of breast cancer (American Cancer Society, 2019; Breastcancer.org, 2019). The current consensus is that HRT increases the risk of breast cancer in women (Breastcancer.org, 2019). Many middle-aged women are seeking alternatives to HRT such as regular exercise, mindfulness training, dietary supplements, herbal remedies, relaxation therapy, acupuncture, hypnosis, and nonsteroidal medications (Asghari & others, 2017; Johnson, Roberts, & Elkins, 2019; Lund & others, 2019). One study revealed that in sedentary women, aerobic training for six months decreased menopausal symptoms, especially night sweats, mood swings, and irritability (Moilanen & others, 2012). Another study found that yoga improved the quality of life of menopausal women (Reed & others, 2014). And in a recent analysis of research, it was concluded that mindfulness training is linked to improved psychological adjustment during the menopause transition (Molefi-Youri, 2019).

CHILDHOOD

Most psychologists doubt Freud's claim that preschool children have a strong sexual attraction to the parent of the other sex. But what are some aspects of sexuality in children? A majority of children engage in some sex play, usually with friends or siblings (Lamb, White, & Plocha, 2019; Moore, 2019). Childhood sex play includes exhibiting or inspecting the genitals. Much of this sex play is likely motivated by curiosity. There does not appear to be any link between such sexual play and sexual adjustment in adolescence or adulthood. As the elementary school years progress, sex play with others usually declines, although romantic interest in peers may be present. Curiosity about sex remains high throughout the elementary school years, and children may ask many questions about reproduction and sexuality. However, the main surge in sexual interest takes place not in childhood but in early adolescence (DeLamater, 2019).

Cognitive Similarities and Differences

No gender differences occur in overall intellectual ability, but in some cognitive areas gender differences do appear (Galambos, Berenbaum, & McHale, 2009; Ganley, Vasilyeva, & Dulaney, 2014; Halpern, 2012). Some gender experts, such as Janet Shibley Hyde (2007, 2014; Hyde & others, 2019), stress that the cognitive differences between females and males have been exaggerated. For example, Hyde points out that there usually is considerable overlap in the distributions of female and male scores on visuospatial tasks (see Figure 3). However, some researchers have found that males have better visuospatial skills than females (Halpern, 2012). Despite equal participation in the Page 397National Geography Bee, in most years all 10 finalists have been boys (Liben, 1995). Also, a research review concluded that boys have better visuospatial skills than girls (Halpern & others, 2007). A research review found that having a stronger masculine gender role was linked to better spatial ability in males and females (Reilly & Neumann, 2013). Are there gender differences in math ability? A very large-scale study of more than 7 million U.S. students in grades 2 through 11 revealed no differences in math scores for boys and girls (Hyde & others, 2008). And a research meta-analysis found no gender differences in math scores for adolescents (Lindberg & others, 2010). Further, in the National Assessment of Educational Progress (2017) there were virtually no gender differences in math scores at the fourth- and eighth-grade levels, with boys scoring only 2 points higher in the fourth grade and 1 point higher in the eighth grade on a 500-point scale. Despite the similarities in math achievement scores for boys and girls, a research review concluded that girls have more negative math attitudes and that parents' and teachers' expectations for children's math competence are often gender-biased in favor of boys (Gunderson & others, 2012). And in one study, 6- to 12-year-olds reported that math is mainly for boys (Cvencek, Meltzoff, & Greenwald, 2011). Are there gender differences in reading and writing skills? There is strong evidence that females outperform males in reading and writing. In the most recent National Assessment of Educational Progress (2017) report, girls had higher reading achievement than boys in both fourth- and eighth-grade assessments, with girls 6 points higher in the fourth grade and 10 points higher in the eighth grade. Girls also have consistently outperformed boys in writing skills in the National Assessment of Educational Progress in fourth-, eighth-, and twelfth-grade assessments. With regard to school achievement, girls earn better grades and complete high school at a higher rate than boys (Halpern, 2012). Males are more likely than females to be assigned to special/remedial education classes. Girls are more likely than boys to be engaged with academic material, be attentive in class, put forth more academic effort, and participate more in class (DeZolt & Hull, 2001). Keep in mind that measures of achievement in school or scores on standardized tests may reflect many factors besides cognitive ability. For example, performance in school may in part reflect attempts to conform to gender roles or differences in motivation, self-regulation, or other socioemotional characteristics (Becker & McElvany, 2018; Cole, Ram, & English, 2019). For example, a recent large-scale study of seventh-graders found that girls' perception that teachers had gendered expectations favoring boys over girls was linked to girls having more negative math beliefs and lower math achievement (McKellar & others, 2019). Also, in this study, when girls perceived that the math curriculum was personally meaningful and relevant for them, they had more positive math beliefs and higher math achievement.

GENDER-ROLE CLASSIFICATION

Not long ago, it was accepted that boys should grow up to be masculine (powerful, assertive, for example) and girls to be feminine (sensitive to others, caring, for example). In the 1970s, however, as both females and males became dissatisfied with the burdens imposed by their stereotypic roles, alternatives to femininity and masculinity were proposed. Instead of describing masculinity and femininity as a continuum in which more of one means less of the other, it was proposed that individuals could have both masculine and feminine traits.

COGNITIVE INFLUENCES

Observation, imitation, rewards, and punishment—these are the mechanisms by which gender develops, according to social cognitive theory. Interactions between the child and the social environment are viewed as the main keys to gender development. Some critics who adopt a cognitive approach argue that social cognitive explanations pay too little attention to the child's own mind and understanding, portraying the child as passively acquiring gender roles (Martin, Ruble, & Szkrybalo, 2002). One influential cognitive theory is gender schema theory, which states that gender-typing emerges as children gradually develop gender schemas of what is gender-appropriate and gender-inappropriate in their culture (Liben & others, 2018; Martin & others, 2017). A schema is a cognitive structure, a network of associations that guide an individual's perceptions. A gender schema organizes the world in terms of female and male. Children are internally motivated to perceive the world and to act in accordance with their developing schemas. Bit by bit, children pick up what is gender-appropriate and gender-inappropriate in their culture, using this information to develop gender schemas that shape how they perceive the world and what they remember (Conry-Murray, Kim, & Turiel, 2012). Children are motivated to act in ways that conform to these gender schemas. Thus, gender schemas fuel gender-typing. How effectively do gender schemas extend to young children's judgments about occupations, for instance? For more information on this topic, see the Connecting with Research interlude.

Just how much does gender matter when it comes to brain structure and activity? Among the differences that have been discovered are the following:

One part of the hypothalamus involved in sexual behavior tends to be larger in men than in women (Swaab & others, 2001). An area of the parietal lobe that functions in visuospatial skills tends to be larger in males than in females (Frederikse & others, 2000). The areas of the brain involved in emotional expression tend to show more metabolic activity in females than in males (Gur & others, 1995). Female brains are approximately 10 percent smaller than male brains (Giedd & others, 2012). However, female brains have more folds; the larger folds (called convolutions) allow more surface brain tissue within the skulls of females than males (Luders & others, 2004).

Parents

Parents, by action and example, influence their children's and adolescents' gender development (Brannon, 2017; Helgeson, 2017). Parents often use rewards and punishments to teach their daughters to be feminine ("Karen, you are being a good girl when you play gently with your doll") and their sons to be masculine ("Keith, a boy as big as you is not supposed to cry"). Mothers and fathers often interact differently with their children and adolescents (Brown & Stone, 2018; Herbrand, 2018; Leaper & Bigler, 2018). Mothers are more involved with their children and adolescents than are fathers, although fathers increase the time they spend in parenting when they have sons, and they are less likely to become divorced when they have sons (Galambos, Berenbaum, & McHale, 2009). Mothers' interactions with their children and adolescents often center on caregiving and teaching activities, whereas fathers' interactions often involve leisure activities (Galambos, Berenbaum, & McHale, 2009). Parents frequently interact differently with sons and daughters, and these gendered interactions that begin in infancy usually continue through childhood and adolescence (Leaper, 2015). In reviewing research on this topic, Phyllis Bronstein (2006) reached these conclusions:

Rape

Rape is forcible sexual intercourse with a person who does not give consent. Legal definitions of rape differ from state to state. For example, in some states, husbands are not prohibited from forcing their wives to have intercourse, although this has been challenged in several of those states. Because victims may be reluctant to suffer the consequences of reporting rape, the actual number of incidents is not easily determined (Walfield, 2016). A meta-analysis found that Page 41160 percent of rape victims do not acknowledge that they have been raped, with the percentage of unacknowledged rapes especially high in college students (Wilson & Miller, 2016). Rape occurs most often in large cities, where it has been reported that 8 of every 10,000 women 12 years and older are raped each year. Nearly 200,000 rapes are reported each year in the United States. Although most victims of rape are women, rape of men does occur (Walfield, 2019). A study of college women who had been raped revealed that only 11.5 percent of them reported the rape to authorities and of those in which the rape involved drugs and/or alcohol, only 2.7 percent of the rapes were reported (Wolitzky-Taylor & others, 2011). Men in prisons are especially vulnerable to rape, usually by heterosexual males who use rape as a means of establishing their dominance and power (Downer & Trestman, 2016). A national study found that 7.4 percent of U.S. ninth- through twelfth-grade students reported that they had been physically forced to have intercourse against their will (Kann & others, 2018). In this study, approximately 11.3 percent of female students and 3.5 of male students reported having been forced to have sexual intercourse. Why does rape of females occur so often in the United States? Among the causes given are that males are socialized to be sexually aggressive, to regard women as inferior beings, and to view their own pleasure as the most important objective in sexual relations (Bevens & Loughnan, 2019; Bock & Burkley, 2019; Vasquez & others, 2018). Researchers have found that male rapists share the following characteristics: aggression enhances their sense of power or masculinity; they are angry at women in general; and they want to hurt and humiliate their victims (Yarber & Sayed, 2019). Rape is more likely to occur when one or both individuals are drinking alcohol (Brown, Horton, & Guillory, 2018). A recent study found that males and heavy drinkers are more likely to adhere to rape myths (such as women being held responsible for preventing the rape) than females or non/light drinkers (Hayes, Abbott, & Cook, 2016). Rape is a traumatic experience for the victims and those close to them (Dworkin & others, 2018). As victims strive to get their lives back to normal, they may experience depression, posttraumatic stress disorder, fear, anxiety, increased substance use, and suicidal thoughts for months or years (Londono, 2017). Sexual dysfunctions, such as reduced sexual desire and an inability to reach orgasm, occur in 50 percent of female rape victims (Sprei & Courtois, 1988). Recovery depends on the victim's coping abilities, psychological adjustments prior to the assault, and social support (Gray, Hassija, & Steinmetz, 2017). Parents, partner, and others close to the victim can provide important support for recovery, as can mental health professionals (Ahrens & Aldana, 2012). Date or acquaintance rape is coercive sexual activity directed at someone with whom the victim is at least casually acquainted (Angelone, Mitchell, & Smith, 2018; Gravelin, Biernat, & Bucher, 2019; Osborn & others, 2019). About two-thirds of college men admit that they fondle women against their will, and half admit to forcing sexual activity. In a recent study of 1,423 four-year universities, those with higher tuition, more liquor violations, and greater numbers of fraternity men and athletes were more likely to report rape on their campuses (Wiersma-Mosley, Jozkowski, & Martinez, 2017). A number of colleges and universities have identified a "red zone"—a period of time early in the first year of college when women are at especially high risk for unwanted sexual experiences (Gray, Hassija, & Steinmetz, 2017). One study revealed that first-year women were at higher risk for unwanted sexual experiences, especially early in the fall term, than second-year women (Kimble & others, 2008). In an effort to reduce unwanted sexual experiences, the program "No Means No Worldwide" (https://nomeansnoworldwide.org) has been effective in reducing the incidence of sexual assault in the African countries of Kenya and Malawi (Baiocchi & others, 2017). The organization's 12-hour curriculum emphasizes interactive verbal skills, role playing, and other techniques to encourage people to speak up, prevent, or intervene in a sexual assault.

Schools and Teachers

there is evidence of gender bias against both males and females in schools. Many school personnel are not aware of their gender-biased attitudes. These attitudes are deeply entrenched in and supported by the general culture. Increasing awareness of gender bias in schools is clearly an important strategy in reducing such bias (Brown & Stone, 2016). Page 393 Might single-sex education be better for children than coeducation? The argument for single-sex education is that it eliminates distraction from the other sex and reduces sexual harassment. Single-sex public education has increased dramatically in recent years. In 2002, only 12 public schools in the United States provided single-sex education; during the 2011-2012 school year, 116 public schools were single-sex and an additional 390 provided such experiences (NASSPE, 2012). The increase in single-sex education has especially been fueled by its inclusion in the No Child Left Behind legislation as a means of improving the educational experiences and academic achievement of low-income students of color. It appears that many of the public schools offering single-sex education have a high percentage of such youth (Klein, 2012). However, recent research reviews concluded that there have been no documented benefits of single-sex education, especially in the highest-quality studies (Goodkind, 2013; Halpern & others, 2011; Hoffnung, 2017; Pahlke, Hyde, & Allison, 2014). One review, titled "The Pseudoscience of Single-Sex Schooling," by Diane Halpern and her colleagues (2011) concluded that single-sex education is highly misguided, misconstrued, and unsupported by any valid scientific evidence. They emphasize that among the many arguments against single-sex education, the strongest is its reduction in the opportunities for boys and girls to work together in a supervised, purposeful environment. There has been a special call for single-sex public education for one group of adolescents—African American boys—because of their historically poor academic achievement and high dropout rate from school (Mitchell & Stewart, 2013). In 2010, Urban Prep Academy for Young Men became the first all-male, all African American public charter school. One hundred percent of its first graduates enrolled in college, despite the school's location in a section of Chicago where poverty, gangs, and crime predominate. And continuing each year since through 2018, 100 percent of Urban Prep's graduates have gone on to college. Because so few public schools focus solely on educating African American boys, it is too early to tell whether this type of single-sex education can be effective across a wide range of participants.

Transgender

Recently, considerable interest has been generated about a category of gender classification known as transgender, a broad term that refers to individuals who adopt a gender identity that differs from the one assigned to them at birth (Budge & Orovecz, 2018; Budge & others, 2018; Hyde & others, 2019; Sinclair-Palm, 2019). For example, an individual may have a female body but identify more strongly with being masculine than being feminine, or have a male body but identify more strongly with being feminine than masculine. A transgender identity of being born male but identifying with being a female is much more common than the reverse (Zucker, Lawrence, & Kreukels, 2016). Transgender persons also may not want to be labeled "he" or "she" but prefer a more neutral label such as "they" or "ze" (Scelfo, 2015). Because of the nuances and complexities involved in such gender categorizations, some experts have recently argued that a better overarching umbrella term might be trans to identify a variety of gender identities and expressions different from the gender identity that was assigned at birth (Galupo & others, 2019; Sinclair-Palm, 2019). The variety of gender identities might include transgender, gender queer (also referred to as gender expansive, this broad gender identity category encompasses individuals who are not exclusively masculine or exclusively feminine), and gender-nonconforming (individuals whose behavior/appearance does not conform to social expectations for what is appropriate for their gender). Another recently generated term, cisgender, can be used to describe individuals whose gender identity and expression conform to the gender identity assigned at birth (Hyde & others, 2019). Transgender individuals can be straight, gay, lesbian, or bisexual. A research review concluded that transgender youth have higher rates of depression, suicide attempts, and eating disorders than their cisgender peers (Connolly & others, 2016). Among the explanations for higher rates of disorders are the distress of living in the wrong body and the discrimination and misunderstanding they encounter as gender-minority individuals (Budge, Chin, & Minero, 2017). Among youth who identify themselves as transgender persons, the majority eventually adopt a gender identity in line with the body into which they were born (Byne & others, 2012; King, 2017, 2019). Some transgender individuals seek transsexual surgery to go from a male body to a female body or vice versa, but most do not. Some choose to receive hormonal treatments, such as biological females who use testosterone to enhance their masculine characteristics, or biological males who use estrogen to increase their feminine characteristics. Yet other transgender individuals opt for another, broader strategy that involves choosing a lifestyle that challenges the traditional view of having a gender identity that fits within one of two opposing categories (King, 2017, 2019).

bisexuality

Sexual attraction to people of both sexes.

Sexual Harassment

Sexual harassment is a manifestation of power by one person over another. It takes many forms—from inappropriate sexual remarks and physical contact (patting, brushing against one's body) to blatant propositions and sexual assaults. Millions of women experience sexual Page 412harassment each year in work and educational settings (Halper & Rios, 2019; Ladika, 2018). Sexual harassment of men by women also occurs but to a far lesser extent than sexual harassment of women by men. In a survey of 2,000 college women, 62 percent reported having experienced sexual harassment while attending college (American Association of University Women, 2006). Most of the college women said that the sexual harassment involved noncontact forms such as crude jokes, remarks, and gestures. However, almost one-third said that the sexual harassment was physical in nature. Sexual harassment can result in serious psychological consequences for the victim. A study of almost 1,500 college women revealed that when they had been sexually harassed they reported increases in psychological distress, physical illness, and disordered eating (Huerta & others, 2006). Eliminating such exploitation requires improvements in work and academic environments (Nielsen & others, 2017). These types of improvements help to provide equal opportunities for people to develop a career and obtain an education in a climate free of sexual harassment (Shakil, Lockwood, & Gradey, 2018; Walsh & Gates, 2018). In 2017, the Me Too Movement spread extensively, with "Me Too" (or "#MeToo") used as a hashtag on social media to show the prevalence of sexual assault and harassment of women, especially in the workplace. As a result, many women felt safe enough to openly discuss their experiences of sexual harassment after having remained silent about these experiences for years or even decades.

Contraceptive Use

Sexual intercourse is a normal activity necessary for procreation, but if appropriate safeguards are not taken it brings the risk of unintended pregnancy and sexually transmitted infections (Carroll, 2019). Both of these risks can be reduced significantly by using certain forms of contraception, especially condoms (Apter, 2018; Fridy & others, 2018; Goldstein & Halpern-Felsher, 2018; Summit & others, 2019; Turner, 2019). In a recent national survey of U.S. high school students, 53.8 percent reported that either they or their partner had used a contraceptive the last time they had sexual intercourse, compared with 46 percent in 1991 and 53.8 percent in 2011 (Kann & others, 2018). However, too many adolescents do not use contraceptives. In the same national survey, 13.8 percent of sexually active adolescents said they had not used any contraceptive method the last time they had sexual intercourse (Kann & others, 2018). Younger adolescents are less likely to take contraceptive precautions than are older adolescents. Researchers also have found that U.S. adolescents are less likely to use condoms than their European counterparts (Jorgensen & others, 2015). Recently, a number of leading medical organizations and experts have recommended that adolescents use long-acting reversible contraception (LARC) (Apter, 2018; Fridy & others, 2018; Summit & others, 2019; Turner, 2019). These organizations include the Society for Adolescent Health and Medicine (2017) and the World Health Organization (2018). LARC consists of the use of intrauterine devices (IUDs) and contraceptive implants, which have a much lower failure rate and greater effectiveness in preventing unwanted pregnancy than the use of birth control pills and condoms (Diedrich, Klein, & Peipert, 2017; Society for Adolescent Health and Medicine, 2017). One study also found that 50 percent of U.S. 15- to 19-year-old girls with unintended pregnancies ending in live births were not using any birth control method when they got pregnant, and 34 percent believed they could not get pregnant at the time (Centers for Disease Control and Prevention, 2012). Another study found that a greater age difference between sexual partners in adolescence is associated with less consistent condom use (Volpe & others, 2013). Sexually Transmitted Infections Earlier, we described sexually transmitted infections. Here we focus on their incidence among adolescents. Nearly half of the 20 million new STI infections in the United States occur in 15- to 24-year-olds (Kann & others, 2018). Individuals 13 to 24 years of age accounted for 21 percent of new HIV diagnoses in the United States, and 81 percent of these young people were gay or bixexual males (Kann & others, 2018). As we discussed earlier, a special concern is the high incidence of AIDS in sub-Saharan Africa (UNICEF, 2019). Adolescent girls in many African countries are vulnerable to being infected with HIV by adult men. Far more adolescent girls than boys have AIDS in these countries, whereas in the United States adolescent males are more likely to have AIDS than their female counterparts (UNAIDS). In Kenya, 25 percent of 15- to 19-year-old girls are HIV-positive compared with 4 percent of boys. Adolescent Pregnancy Unintended pregnancy is another problematic outcome of sexuality in adolescence and requires major efforts to reduce its occurrence (Kahn & Halpern, 2018; Kudesia & Talib, 2019). In cross-cultural comparisons, the United States continues to have one of the highest adolescent pregnancy and childbearing rates in the industrialized world, despite a considerable decline in the 1990s (Cooksey, 2009). The U.S. adolescent Page 418pregnancy rate is four times as high as in the Netherlands (Sedgh & others, 2015). This dramatic difference exists in spite of the fact that U.S. adolescents are no more sexually active than their counterparts in the Netherlands. In the United States, 82 percent of pregnancies to mothers 15 to 19 years of age are unintended (Koh, 2014). A cross-cultural comparison found that among 21 countries, the United States had the highest adolescent pregnancy rate among 15- to 19-year-olds and Switzerland had the lowest rate (Sedgh & others, 2015). Despite the negative comparisons of the United States with many other developed countries, there have been some encouraging trends in U.S. adolescent pregnancy rates. In 2017, the U.S. birth rate for 15- to 19-year-olds was 18.8 births per 1,000 females, the lowest rate ever recorded, which represents a dramatic decrease from the 62 births per 1,000 females for the same age range in 1991 (Centers for Disease Control and Prevention, 2019) (see Figure 7). There also has been a substantial decrease in adolescent pregnancies across ethnic groups in recent years. Reasons for the decline include school/community health classes, increased contraceptive use, and fear of sexually transmitted infections such as AIDS. Ethnic variations characterize adolescent pregnancy. For 15- to 19-year-old U.S. females in 2017, per 1,000 females the birth rate for Latinas was 28.9, for African Americans 27.5, for non-Latina Whites 13.2, and for Asian Americans 3.3 (Centers for Disease Control and Prevention, 2019). These figures represent substantial decreases in adolescent pregnancy rates for Latina and African American teens, especially for Latina (38 per 1,000 in 2014 and African American (35 per 1,000 in 2014) adolescent girls. However, Latina and African American girls are more likely to have a second child during adolescence than are non-Latina adolescent girls (Rosengard, 2009). And daughters of teenage mothers are at higher risk for teenage childbearing, thus perpetuating an intergenerational cycle. A study using data from the National Longitudinal Survey of Youth revealed that daughters of teenage mothers were 66 percent more likely to become teenage mothers themselves (Meade, Kershaw, & Ickovics, 2008). In this study, conditions that increased the likelihood that daughters of the teenage mothers would become pregnant included low parental monitoring and poverty. The consequences of America's high adolescent pregnancy rate are cause for great concern (Devakumar & others, 2019; Tevendale & others, 2017; Mullick, 2019). Adolescent pregnancy creates health and developmental outcome risks for both the baby and the mother (Leftwich & Alves, 2017). Infants born to adolescent mothers are more likely to have low birth weights—a prominent factor in infant mortality—as well as neurological problems and childhood illness (Leftwich & Alves, 2017; Sawyer, Abdul-Razak, & Patton, 2019). One study assessed the reading and math achievement trajectories of children born to adolescent and non-adolescent mothers with different levels of education (Tang & others, 2016). In this study, higher levels of maternal education were linked to higher levels of academic achievement through the eighth grade. Nonetheless, the achievement of children born to adolescent mothers never reached the levels of children born to adult mothers. Adolescent mothers also are more likely to be depressed and drop out of school than their peers (Leftwich & Alves, 2017; Siegel & Brandon, 2014). Although many adolescent mothers resume their education later in life, they generally do not catch up economically with women who bear children in their twenties. A longitudinal study revealed that these characteristics of adolescent mothers were related to their likelihood of having problems as emerging adults: a history of school problems, delinquency, hard substance use, and mental health problems (Oxford & others, 2006). Also, a study of African American urban youth found that at 32 years of age women who had been teenage mothers were more likely to be unemployed, live in poverty, depend on welfare, and not have completed college than women who became mothers during adulthood (Assini-Meytin & Green, 2015). In this study, at 32 years of age, men who had been teenage fathers were less likely to be employed than were men who had fathered children during adulthood. A special concern is repeated adolescent pregnancy. In a recent national study, the percentage of teen births that were repeat births decreased from 21 percent in 2004 to 17 percent in 2015 (Dee & others, 2017). In a recent meta-analysis, use of effective contraception, especially LARC, and education-related factors (higher level of education and school continuation) resulted in a lower incidence of repeated teen pregnancy, while depression and a history of abortion were linked to a higher percentage of repeated teen pregnancy (Maravilla & others, 2017). Researchers have found that adolescent mothers interact less effectively with their infants than do adult mothers. One study revealed that adolescent mothers spent more time in negative interactions and less time in play and positive interactions with their infants than did adult mothers (Riva Crugnola & others, 2014). One intervention, "My Baby and Me," that involved frequent (55), intensive home visitation coaching sessions with adolescent mothers across three years resulted in improved maternal behavior and child outcomes (Guttentag & others, 2014). And a recent study assessed the reading and math achievement trajectories of children born to adolescent and non-adolescent mothers with different levels of education (Tang & others, 2016). In this study, higher levels of maternal education were linked to growth in their children's achievement through the eighth grade. Nonetheless, the achievement of children born to the adolescent mothers never reached the levels of children born to adult mothers. Although the consequences of America's high adolescent pregnancy rate are cause for great concern, it often is not pregnancy alone that leads to negative consequences for an adolescent mother and her offspring (Cavazos-Rehg & others, 2010a, b). Adolescent mothers are more likely to come from low-SES backgrounds (Joyner, 2009). Many adolescent mothers also were not good students before they became pregnant (Malamitsi-Puchner & Boutsikou, 2006). However, not every adolescent female who bears a child lives a life of poverty and low achievement. Thus, although adolescent pregnancy is a high-risk circumstance and adolescents who do not become pregnant generally fare better than those who do, some adolescent mothers do well in school and have positive outcomes (Schaffer & others, 2012). All adolescents can benefit from comprehensive sexuality education, beginning prior to adolescence and continuing through adolescence (Barfield, Warner, & Kappeler, 2017; Tang & others, 2016; Mueller & others, 2017). Family and consumer science educators teach life skills, such as effective decision making, to adolescents. To read about the work of one family and consumer science educator, see the Connecting with Careers profile. And to learn more about ways to reduce adolescent pregnancy, see the Connecting Development to Life interlude.

Cultural Factors

Sexual motivation also is influenced by cultural factors (Carroll, 2019; Crooks & Baur, 2017). The range of sexual values across cultures is substantial (Nimbi & others, 2019). Some cultures consider sexual pleasures "weird" or "abnormal." Consider the people who live on the small island of Inis Beag off the coast of Ireland. They are some of the most sexually repressed people in the world. They know nothing about tongue kissing or hand stimulation of the penis, and they detest nudity. For both females and males, premarital sex is out of the question (Messinger, 1971). In contrast, consider the Mangaian culture in the South Pacific. In Mangaia, young boys are taught about masturbation and are encouraged to engage in it as much as they like. At age 13, the boys undergo a ritual that initiates them into sexual manhood. First, their elders instruct them about sexual strategies, including how to help their female partner have orgasms. Then, two weeks later, the boy has intercourse with an experienced woman who helps him hold back ejaculation until she can achieve orgasm with him. By the end of adolescence, Mangaians have sex virtually every day. As reflected in the behavior of the people in these two different cultures, our sexual motivation is influenced by sexual scripts (Willie & others, 2018). These are stereotyped patterns of expectations for how people should behave sexually (King & Regan, 2019; Singleton & others, 2016). Two well-known sexual scripts are the traditional religious script and the romantic script. In the traditional religious script, sex is acceptable only within marriage. Extramarital sex is taboo, especially for women. Sex involves reproduction and sometimes affection. In the romantic script, sex is synonymous with love. If we develop a relationship with someone and fall in love, it is acceptable to have sex with the person whether or not we are married. You probably are familiar with some sex differences in sexual scripts (Kollah-Cattano & others, 2018). Females tend to link sexual intercourse with love more than males do, and males are more likely to emphasize sexual conquest. Some sexual scripts involve a double standard; for example, it is okay for male adolescents to have sex but not females, and if the female gets pregnant it's viewed as her fault for not using contraception (Tolman & Chmielewski, 2019). One study of young adult men found two main sexual scripts: (1) a traditional male "player" script, and (2) a script that emphasized mutual sexual pleasure (Morrison & others, 2014).

sexual harassment

Sexual persecution that can take many forms—from sexist remarks and physical contact (patting, brushing against someone's body) to blatant propositions and sexual assaults.

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections (STIs) are diseases that are primarily contracted through sex—penile-vaginal intercourse as well as oral-genital and anal-genital sex. STIs affect about one of every six U.S. adults (National Center for Health Statistics, 2019). Among the most prevalent STIs are bacterial infections—such as gonorrhea, syphilis, and chlamydia—and STIs caused by viruses—such as AIDS (acquired immune deficiency syndrome), genital herpes, and genital warts. Figure 5 describes these sexually transmitted infections. A concern in the United States is the recent increase in STIs (Feltman, 2018). Especially concerning are the increased rates of gonorrhea, syphilis, and chlamydia in 2016 and again in 2017 (Centers for Disease Control and Prevention, 2018). Compared with 2013, gonorrhea diagnoses increased 67 percent and syphilis cases increased 76 percent in 2017. It is especially problematic that gonorrhea is increasingly resistant to antibiotic treatments. No single disease has had a greater impact on sexual behavior, or created more public fear in the last several decades, than infection with the human immunodeficiency virus (HIV) (Yarber & Sayed, 2019). HIV is a virus that destroys the body's immune system. Once a person is infected with HIV, the virus breaks down and overpowers the immune system, which leads to AIDS. An individual sick with AIDS has such a weakened immune system that a common cold can be life-threatening. In 2015, 1.1 million people in the United States were living with an HIV infection (National Center for Health Statistics, 201). In 2015, male-male sexual contact continued to be the most frequent AIDS transmission category. Because of education and the development of more effective drug treatments, deaths due to HIV/AIDS have begun to decline in the United States (National Center for Health Statistics, 2018). Globally, the number of AIDS-related deaths is decreasing, with less than 1 million people dying from the disease in 2017 (down from a peak of 1.9 million in 2004) (UNAIDS, 2018). This decrease is due to the increased availability of antiretroviral therapy. The main decrease in AIDS-related deaths is occurring in sub-Saharan Africa.

Congenital adrenal hyperplasia (CAH).

Some girls have this condition, which is caused by a genetic defect that causes increased androgen production beginning prenatally (Deeb & others, 2019; de Jesus, Costa, & Dekemacher, 2019). Their adrenal glands enlarge, resulting in abnormally high levels of androgens. Although CAH girls are XX females, they vary in how much their genitals look like male or female genitals. Their genitals may be surgically altered to look more like those of a typical female (Iovino & others, 2019; Walia & others, 2018). Although CAH girls usually grow up to think of themselves as girls and women, they are less content with being a female and show a stronger interest in being a male than non-CAH girls (Li, Kung, & Hines, 2017). They like sports and enjoy playing with boys and boys' toys. CAH girls usually don't like typical girl activities such as playing with dolls and wearing makeup. In a recent study, CAH girls showed higher levels of aggression than non-CAH girls (Spencer & others, 2017). Also, in another recent study, CAH girls had more conduct problems, a greater likelihood of developing ADHD, and lower engagement in prosocial behavior (Kung & others, 2018).

Gender and Communication

Stereotypes about differences in men's and women's attitudes toward communication and about differences in how they communicate with each other have spawned countless cartoons and jokes. Are the supposed differences real? When Deborah Tannen (1990) analyzed the talk of women and men, she found that many wives complained about their husbands by saying that "He doesn't listen to me anymore" and "He doesn't talk to me anymore." Lack of communication, although high on women's lists of reasons for divorce, is mentioned much less often by men. Page 403 Communication problems between men and women may come in part from differences in their preferred ways of communicating. Tannen distinguishes rapport talk from report talk. Rapport talk is the language of conversation; it is a way of establishing connections and negotiating relationships. Report talk is talk that is designed to give information; this category of communication includes public speaking. According to Tannen, women enjoy rapport talk more than report talk, and men's lack of interest in rapport talk bothers many women. In contrast, men prefer to engage in report talk. Men hold center stage through verbal performances such as telling stories and jokes. They learn to use talk as a way to get and keep attention. How extensive are gender differences in communication? Research has yielded somewhat mixed results, although studies do reveal some gender differences (Anderson, 2006). One study of a sampling of students' e-mails found that people could accurately guess the writer's gender two-thirds of the time (Thompson & Murachver, 2001). Another study revealed that women make 63 percent of phone calls and when talking to another woman stay on the phone longer (7.2 minutes) than men do when talking with other men (4.6 minutes) (Smoreda & Licoppe, 2000). However, meta-analyses suggest that overall gender differences in communication are small in both children and adults (Hyde, 2005, 2014; Leaper & Smith, 2004).

Women's Development

Tannen's analysis of women's preference for rapport talk suggests that women place a high value on relationships and focus on nurturing their connections with others. This view echoes some ideas of Jean Baker Miller (1986), who has been an important voice in stimulating the examination of psychological issues from a female perspective. Miller argues that when researchers examine what women have been doing in life, a large part of it is active participation in the development of others. In Miller's view, women often try to interact with others in ways that will foster the other person's development along many dimensions—emotional, intellectual, and social. Most experts stress that it is important for women not only to maintain their competency in relationships but to be self-motivated, too (Brabek & Brabek, 2006). As Harriet Lerner (1989) concludes in her book The Dance of Intimacy, it is important for women to bring to their relationships nothing less than a strong, assertive, independent, and authentic self. She emphasizes that competent relationships are those in which the separate "I-ness" of both persons can be appreciated and enhanced while the partners remain emotionally connected with each other. In sum, Miller, Tannen, and other gender experts such as Carol Gilligan note that women are more relationship-oriented than men are—and that this relationship orientation should be valued more highly in our culture than it currently is. Critics of this view of gender differences in relationships contend that it is too stereotypical (Hyde & Else-Quest, 2013; Matlin, 2012). They argue that there is greater individual variation in the relationship styles of men and women than this view acknowledges.

CHILDHOOD

The amount, timing, and intensity of gender socialization differs for girls and boys (Beal, 1994). Boys receive earlier and more intense gender socialization than girls do. The social cost of deviating from the expected male role is higher for boys than is the cost for girls of deviating from the expected female role, in terms of peer rejection and parental disapproval. Imagine a girl who is wearing a toy holster, bandanna, and cowboy hat, running around in the backyard pretending to herd cattle. Now imagine a boy who is wearing a flowered hat, ropes of pearls, and lipstick, pretending to cook dinner on a toy stove. Which of these do you have a stronger reaction to—the girl's behavior or the boy's? Probably the boy's. Researchers have found that "effeminate" behavior in boys elicits more negative reactions than does "masculine" behavior in girls (Martin, 1990). Boys might have a more difficult time learning the masculine gender role because male models are less accessible to young children and messages from adults about the male role are not always consistent. For example, most mothers and teachers would like boys to behave in masculine ways, but also to be neat, well mannered, and considerate. However, fathers and peers usually want boys to be independent and to engage in rough-and-tumble play. The mixed messages make it difficult for boys to figure out how to act.Page 402 Although gender roles have become more flexible in recent years, the flexibility applies more for girls than for boys (Beal, 1994). Girls can count on receiving approval if they are ambitious, competitive, and interested in sports, but relatively few adults are equally supportive of boys' being gentle, interested in fashion, and motivated to sign up for ballet classes. Instrumental traits and masculine gender roles may be evolving into a new norm for everyone. Concern about the ways boys are being brought up has been called a "national crisis of boyhood" by William Pollack (1999) in his book Real Boys. Pollack says that little has been done to change what he calls the "boy code." The boy code tells boys they should not show their feelings and should act tough, says Pollack. Boys learn the boy code in many contexts—sandboxes, playgrounds, schoolrooms, camps, hangouts—and are taught the code by parents, peers, coaches, teachers, and other adults. Pollack, as well as many others, argues that boys would benefit from being socialized to express their anxieties and concerns and to better regulate their aggression.

gender

The characteristics of people as females or males.

menopause

The complete cessation of a woman's menstrual cycles, which usually occurs during the late forties or early fifties.

What is the reality behind gender stereotypes? Let's examine some of the differences between the sexes, keeping the following information in mind:

The differences are averages and do not apply to all females or all males. Even when gender differences occur, there often is considerable overlap between males and females. The differences may be due primarily to biological factors, sociocultural factors, or both.

social cognitive theory of gender

The idea that children's gender development occurs through observation and imitation of gender behavior, as well as through the rewards and punishments children experience for behaviors believed to be appropriate or inappropriate for their gender.

rapport talk

The language of conversation; a way to establish connections and negotiate relationships; preferred by women.

climacteric

The midlife transition during which fertility declines.

androgyny

The presence of positive masculine and feminine characteristics in the same individual.

gender schema theory

The theory that gender-typing emerges as children gradually develop gender schemas of what is gender-appropriate and gender-inappropriate in their culture.

The Timing and Frequency of Adolescent Sexual Behaviors

The timing of sexual initiation varies by country as well as by gender and other socioeconomic characteristics. In one cross-cultural study, among females, the proportion having first intercourse by age 17 ranged from 72 percent in Mali to 47 percent in the United States and 45 percent in Tanzania (Singh & others, 2000). The percentage of males who had their first intercourse by age 17 ranged from 76 percent in Jamaica to 64 percent in the United States and 63 percent in Brazil. Within the United States, male, African American, and inner-city adolescents report being the most sexually active, whereas Asian American adolescents have the most restrictive sexual timetable (Feldman, Turner, & Araujo, 1999). What is the current profile of sexual activity of adolescents? In a U.S. national survey conducted in 2017, 57.3 percent of twelfth-graders reported having experienced sexual intercourse, compared with 30 percent of ninth-graders (Kann & others, 2018). By age 20, 77 percent of U.S. youth report having engaged in sexual intercourse (Dworkin & Santelli, 2007). Nationally, in 2017, 44.3 percent of twelfth-graders, 35.3 percent of eleventh-graders, 24.9 percent of tenth-graders, and 12.9 percent of ninth-graders reported that they were currently sexually active (Kann & others, 2018). What trends in adolescent sexual activity have occurred in recent decades? From 1991 to 2017, decreasing percentages of adolescents reported any of the following: ever having had sexual intercourse, currently being sexually active, having had sexual intercourse before the age of 13, and having had sexual intercourse with four or more persons during their lifetime (Kann & others, 2018) (see Figure 6). Sexual initiation varies by ethnic group in the United States (Kann & others, 2018). African Americans are likely to engage in sexual behaviors earlier than other ethnic groups, whereas Asian Americans are likely to engage in them later (Feldman, Turner, & Araujo, 1999). In a 2017 national U.S. survey of ninth- to twelfth-graders, 45.8 percent of African Americans, 37.9 percent of Latinos, and 38.6 percent of non-Latino Whites said they had experienced sexual intercourse (Kann & others, 2018). In this study, 7.5 percent of African Americans (compared with 4 percent of Latinos and 2.1 percent of non-Latino Whites) said they had their first sexual experience before 13 years of age. All of these figures reflect a significant decrease in sexual intercourse since 2011 for African American and Latino adolescents (Kann & others, 2018). Recent research indicates that oral sex is now a common occurrence among U.S. adolescents (Goldstein & Halpern-Felsher, 2018). In a recent national survey of more than 7,000 15- to 24-year-olds, 58.6 percent of the females reported ever having performed oral sex and 60.4 percent said they had ever received oral sex (Holway & Hernandez, 2018). Also, in another national survey, 51 percent of U.S. 15- to 19-year-old boys and 47 percent of girls in the same age group said they had engaged in oral sex (Child Trends, 2015). Thus, more youth engage in oral sex than vaginal sex, likely because they perceive oral sex to be more acceptable and to be associated with fewer health risks. One study also found that among female adolescents who reported having vaginal sex first, 31 percent reported having a teen pregnancy, whereas among those who initiated oral-genital sex first, only 8 percent reported having a teen pregnancy (Reese & others, 2013). Thus, how adolescents initiate their sex lives may have positive or negative consequences for their sexual health.

perimenopause

The transitional period from normal menstrual periods to no menstrual periods at all, which often takes up to 10 years.

Androgyny

The trend toward non-binary thinking about personality traits led to the development of the concept of androgyny, the presence of positive masculine and feminine characteristics in the same person (Bem, 1977; Spence & Helmreich, 1978). The androgynous boy might be assertive (masculine) and nurturing (feminine). The androgynous girl might be powerful (masculine) and sensitive to others' feelings (feminine). Measures have been developed to assess androgyny, such as the Bem Sex Role Inventory (Bem, 1977). Gender experts such as Sandra Bem (1977) argue that androgynous individuals are more flexible, competent, and mentally healthy than their masculine or feminine counterparts. To some degree, though, which gender-role classification is best depends on the context Page 400involved. For example, in close relationships, feminine and androgynous orientations might be more desirable. One study found that girls and individuals high in femininity showed a stronger interest in caring than did boys and individuals high in masculinity (Karniol, Grosz, & Schorr, 2003). And a recent study found that androgynous boys and girls had higher self-esteem and fewer internalizing problems than masculine or feminine individuals (Pauletti & others, 2017). However, masculine and androgynous orientations might be more desirable in traditional academic and work settings because of the achievement demands in these contexts. In a recent analysis, this emphasis on considering contexts in understanding gender identity was described in terms of functional flexibility. In this view, gender identity is positively linked to adjustment and one's competence involves flexibility in adapting to specific situations (Martin & others, 2017).

gender-intensification hypothesis

The view that psychological and behavioral differences between boys and girls become greater during early adolescence because of increased socialization pressures to conform to traditional gender roles.

psychoanalytic theory of gender

Theory that stems from Freud's view that preschool children develop a sexual attraction to the opposite-sex parent, then at 5 or 6 years of age renounce the attraction because of anxious feelings, subsequently identifying with the same-sex parent and unconsciously adopting the same-sex parent's characteristics.

Late Adulthood

Too often it has been assumed that older adults do not have sexual desires (Inelmen & others, 2012). Aging does induce some changes in human sexual performance, more so in men than in women, but many older adults do have sexual desires (Estill & others, 2018; Sinkovic & Towler, 2019; Wright, Jenks, & Demeyere, 2019). Orgasm becomes less frequent in males, occurring in every second to third act of intercourse rather Page 424than every time. More direct stimulation usually is needed to produce an erection. From 65 to 80 years of age, approximately one out of four men has serious problems getting or keeping erections; for those over 80 years of age, the percentage rises to one out of two men (Butler & Lewis, 2002). Even when intercourse is impaired by infirmity, other relationship needs persist, among them closeness, sensuality, and being valued as a man or a woman (Bouman, 2008). An interview study of more than 3,000 adults 57 to 85 years of age revealed that many older adults are sexually active as long as they are healthy (Lindau & others, 2007) (see Figure 8). Sexual activity did decline through the later years of life: 73 percent of 57- to 64-year-olds, 53 percent of 65- to 74-year-olds, and 26 percent of 75- to 85-year-olds reported that they were sexually active. Even in the sexually active oldest group (75 to 85), more than 50 percent said they still had sex at least two to three times a month. Fifty-eight percent of sexually active 65- to 74-year-olds and 31 percent of 75- to 85-year-olds said they engaged in oral sex. As with middle-aged and younger adults, older adults who did not have a partner were far less likely to be sexually active than those who had a partner. For older adults with a partner who reported not having sex, the main reason was poor health, especially the male partner's physical health. However, with recent advances in erectile dysfunction medications such as Viagra, an increasing number of older men, especially the young old, are able to have an erection (Constantinescu & others, 2017; Ozcan & others, 2017). Also, as indicated earlier, there has been a dramatic increase in testosterone replacement therapy in middle-aged adults, but the benefit-risk ratio of testosterone replacement therapy is uncertain for older males (Isidori & others, 2014). As indicated in Figure 8, older women had a lower rate of sexual activity than did men. Indeed, a challenge for a sexually interested older woman is not having a partner. At 70 years of age, only about 35 percent of women have a partner, compared with approximately 70 percent of men of the same age. Many older women's husbands have died, and many older men are with younger women. In other research on sexual behavior in older adults, engaging in sexual activity was linked to great enjoyment of life (Smith & others, 2019). Also, in another study, older adults were asked about their motivation for having sex (Gewirtz-Meydan & Ayalon, 2019). In this study, five main reasons for having sex were (1) to maintain their functioning; (2) to feel young again; (3) to feel attractive and desirable; (4) to go from lust to love; and (5) to change from "getting sex" to "giving sex." At this point, we have discussed many aspects of sexuality, but we have not examined three influential factors that are explored in the chapter on "Moral Development, Values, and Religion."

Sexual Orientation and Its Sources

Until the end of the nineteenth century, it was generally believed that people were either heterosexual or homosexual. Today, sexual orientation is viewed less as an either/or proposition than as a continuum from exclusive male-female relations to exclusive same-sex relations (Savin-Williams, 2019). Some individuals are also bisexual, being sexually attracted to people of both sexes. Others are transsexual, choosing to live full-time as a member of the desired gender and usually seeking sex reassignment surgery that involves altering their sex characteristics to match their gender identity. Let's now further explore more aspects of such categories as bisexuality. People sometimes think that bisexuality is simply a steppingstone to same-sex sexual relationships, while others view it as a sexual orientation itself or as an indicator of sexual fluidity (King, 2019). Evidence supports the notion that bisexuality is a stable orientation that involves attraction to both sexes (King, 2019; Mock & Eibach, 2012). Compared with men, women are more likely to change their sexual patterns and desires (Knight & Morales Hope, 2012). Women are more likely than men to have sexual experiences with same- and opposite-sex partners, even if they identify themselves strongly as being heterosexual or lesbian (King, 2019). Also, women are more likely than men to identify themselves as bisexual (Gates, 2011). Page 408 In the Sex in America survey, 2.7 percent of the men and 1.3 percent of the women reported having had same-sex relations in the past year (Michael & others, 1994). However, in a national survey a higher percentage (3.8 percent) of U.S. adults reported that they were gay, lesbian, bisexual, or transsexual (Gallup, 2015). And the most recent national survey of sexual orientation that included men and women from 18 to 44 years of age, almost three times as many women (17.4 percent) reported having had same-sex contact in their lifetime as men did (6.2 percent) (Copen, Chandra, & Febo-Vazquez, 2016). Feelings of attraction only toward the opposite sex were more frequent for men (92.1 percent) than for women (81 percent). Also in this study, 92.3 percent of the women and 95.1 percent of the men said they were heterosexual or straight. Further, 1.3 percent of women and 1.9 percent of men said they were homosexual, gay, or lesbian, and 5.5 percent of women and 2 percent of men reported that they were bisexual. Why are some individuals lesbian, gay, or bisexual (LGB) and others heterosexual? Speculation about this question has been extensive. All people, regardless of their sexual orientation, have similar physiological responses during sexual arousal and seem to be aroused by the same types of tactile stimulation. Investigators typically find no differences between LGBs and heterosexuals in a wide range of attitudes, behaviors, and adjustments (Fingerhut & Peplau, 2013). Recently, researchers have explored the possible biological basis of same-sex relations. The results of hormone studies have been inconsistent. If gay males are given male sex hormones (androgens), their sexual orientation doesn't change. Their sexual desire merely increases. A very early prenatal critical period might influence sexual orientation (Hines, 2013, 2015; Li, Kung, & Hines, 2017; Mitsui & others, 2019). In the second to fifth months after conception, exposure of the fetus to hormone levels characteristic of females might cause the individual (male or female) to become attracted to males (Ellis & Ames, 1987). If this critical-period hypothesis turns out to be correct, it would explain why clinicians have found that sexual orientation is difficult, if not impossible, to modify. Researchers have also examined genetic influences on sexual orientation by studying twins. A Swedish study of almost 4,000 twins found that only about 35 percent of the variation in homosexual behavior in men and 19 percent in women could be explained by genetic differences (Langstrom & others, 2010). This result suggests that although genes likely play a role in sexual orientation, they are not the only factor (King, 2017, 2019). An individual's sexual orientation is most likely determined by a combination of genetic, hormonal, cognitive, and environmental factors (Hyde & DeLamater, 2017; King, 2017, 2019). Most experts believe that no one factor alone causes sexual orientation and that the relative weight of each factor can vary from one individual to the next. That said, it has become clear that no matter whether a person is heterosexual, gay, lesbian, or bisexual, that individual cannot be talked out of his or her sexual orientation (King, 2017, 2019).

traditional religious script

View that sex is acceptable only within marriage; extramarital sex is taboo, especially for women; and sex means reproduction and sometimes affection.

Physical Similarities and Differences

We could devote pages to describing physical differences between the average man and the average woman. For example, women have about twice the body fat of men, most of it concentrated around breasts and hips. In males, fat is more likely to go to the abdomen. On average, males grow to be 10 percent taller than females. Androgens (the "male" hormones) promote the growth of long bones; estrogens (the "female" hormones) stop such growth at puberty. Many physical differences between men and women are tied to health. From conception onward, females have a longer life expectancy than males, and females are less likely than males to develop physical or mental disorders. Females are more resistant to infection, and their blood vessels are more elastic than males'. Males have higher levels of stress hormones, which cause faster clotting and higher blood pressure. Although some gender differences in brain structure and function have been found, many of these differences are small or research results are inconsistent regarding the differences (Hyde & others, 2019). Recently, because the distributions for males and females on different brain features overlap considerably, Janet Shibley Hyde and her colleagues (2019) have concluded that in most instances it is more accurate to describe these features as a mosaic rather than as male-typical and female-typical brains. Also, when gender differences in the brain have been detected, in many cases they have not been directly linked to psychological differences (Blakemore, Berenbaum, & Liben, 2009). Also, similarities and differences in the brains of males and females may be due to biological or experiential factors (Hyde & others, 2019).